Local Inequalities in Health Behaviours: Longitudinal Findings from the Stockton-On-Tees Cohort Study.

Nasima Akhter,Ross Stewart Fairbairn,Jon Warren,Mark Pearce,Adetayo Kasim,Clare Bambra

doi:10.3390/ijerph182111018

Abstract

This paper provides a longitudinal examination of local inequalities in health behaviours during a period of austerity, exploring the role of ‘place’ in explaining these inequalities. Data from the Stockton-on-Tees prospective cohort study of 836 individuals were analysed and followed over 18 months (37% follow-up). Generalised estimating equation models estimated the deprivation gap in health behaviours (smoking status, alcohol use, fruit and vegetable consumption and physical activity practices) between the 20% most- and least-deprived neighborhoods (LSOAs), explored any temporal changes during austerity, and examined the underpinning role of compositional and contextual determinants. All health behaviours, except for frequent physical activity, varied significantly by deprivation (p ≤ 0.001). Smoking was lower in the least-deprived areas (OR 0.21, CI 0.14 to 0.30), while alcohol use (OR 2.75, CI 1.98 to 3.82) and fruit and vegetable consumption (OR 2.55, CI 1.80 to 3.62) were higher in the least-deprived areas. The inequalities were relatively stable throughout the study period. Material factors (such as employment, education and housing tenure) were the most-important and environmental factors the least-important explanatory factors. This study suggests that material factors are the most important ‘place’ determinants of health behaviours. Health promotion activities should better reflect these drivers.

Highlights

Geographical inequalities in health behaviours are present at all spatial scales—between neighbourhoods, local authorities, regions and countries [1]
The socio-spatial distribution of alcohol consumption is less clear; whilst some studies have reported that it is associated with area-level deprivation [5], other literature reports an absence of association [6]
This paper assessed inequalities in health behaviours, factors associated with health behaviours at baseline, and changes in inequality gap over the study period using data from a prospective 18-month household cohort survey of health and the social and behavioural determinants of health

Summary

Introduction

Geographical inequalities in health behaviours (smoking status, alcohol use, fruit and vegetable consumption and physical activity levels) are present at all spatial scales—between neighbourhoods, local authorities, regions and countries [1]. Geographical inequalities in health behaviours (smoking status, alcohol use, fruit and vegetable consumption and physical activity levels) are present at all spatial scales—. A number of studies have found that there are inequalities in smoking prevalence, with higher rates in places with higher levels of deprivation [2,3,4]. The socio-spatial distribution of alcohol consumption is less clear; whilst some studies have reported that it is associated with area-level deprivation [5], other literature reports an absence of association [6]. A more clear finding is that the most severe levels of alcohol use–and alcohol-related harm—are more prevalent in more-deprived areas. In terms of physical activity, a number of studies have found an inverse association with deprivation [2,5]—people living in more deprived areas have lower levels of physical activity. In terms of diet it is generally recognised that those in more deprived areas consume less fruit and vegetables [6]

Methods

Results

Conclusion