Importance Of Social Determinants Research Articles

Association between living arrangements and health risk behaviors among the Hakka older adults in Fujian, China

BackgroundBehavioral lifestyles are important social determinants of health. The impact of changes in living arrangements on behavioral lifestyles is currently under-explored. This study aims to examine the association between living arrangements and health risk behaviors among the Hakka older adults.MethodsData were extracted from China’s Health-Related Quality of Life Survey for Older Adults 2018. Living arrangements were divided into five categories: living alone, living with spouse only, living with child, mixed habitation, and others. Five health risk behaviors, including unhealthy dietary patterns, drinking, smoking, irregular sleep practices, and physical inactivity were measured. Logistic regression analysis was used to assess the association between living arrangements and specific health risk behaviors, and generalized linear models were established to test the association between living arrangements and the number of health risk behaviors.ResultsA total of 1,262 Hakka older adults were included in this study. Compared to those living alone, those living with spouse only were less likely to have unhealthy dietary patterns (OR = 0.45, P < 0.05) and drinking (OR = 0.50, P < 0.05), those living with the child were less likely to experience unhealthy dietary patterns (OR = 0.35, P < 0.001), drinking (OR = 0.32, P < 0.001), smoking (OR = 0.49, P < 0.05), and physical inactivity (OR = 0.13, P < 0.01). Moreover, those who were living with child (β = -0.78, P < 0.001) or mixed habitation (β = -0.33, P < 0.05) tended to engage in fewer health risk behaviors than those living alone.ConclusionsThis study suggests significant differences in health risk behaviors among the Hakka older adults with different living arrangements. Living with the child could reduce the occurrence of health risk behaviors in the Hakka older adults and thus maintain their health status.

Health-Related Stigma and Challenges Faced by Men Living with Celiac Disease: A Qualitative Analysis

BackgroundCeliac disease (CD) is an autoimmune condition managed by strict adherence to a gluten-free diet. Dietary choice has gendered connotations, and men with CD may face judgment from others when following a gluten-free diet. However, little is known about health-related stigma in men with CD. ObjectivesThe study aim was to explore the health-related stigma and challenges faced by men with CD, and the influence of CD on their lives. MethodsQualitative semistructured online interviews were conducted with men living with CD. ParticipantsTwenty adults (aged 18 years or older) identifying as men living in the United Kingdom, with self-reported CD, were recruited using social media and opportunistic sampling. Statistical analysesParticipants provided rich, detailed discussions about aspects of their experience of living with CD. Reflexive thematic analysis was used, with a critical-realist lens that enabled researchers to connect men’s experiences within wider sociocultural constructs such as masculinity and social identity. ResultsThree themes were identified: CD threatens social inclusion; others’ assumptions about CD and microaggressions have a psychological influence, and masculine norms, health-related stigma, and power dynamics influence men’s health behaviors and everyday experience. Health-related stigma was found to be interconnected with these men’s gendered social environment, suggesting thatmay be an important social and structural determinant of dietary, health-related, and health support-seeking behaviors in men diagnosed with CD. ConclusionsContrary to prior assumptions, health-related stigma influences men with CD of all ages, particularly in social settings. The study unveils the complex interplay of individual beliefs, social norms, and power dynamics, in particular with other men, that influence individual beliefs and emphasize the performative aspect of food consumption. Internalized stigma and microaggressions influence men’s well-being. To better support men with CD, health providers, charitable organizations, and the food industry should address the social influence of adherence to a gluten-free diet, in particular perceived threats to social status and inclusion, which may cause concern, influence food choice, and influence dietary adherence.

Disparities in Prevalence of COVID-19, Long COVID, Disease Severity, and Mental Health Outcomes among US Adults by Industrial Sector of Employment, September-November 2022

Background: The coronavirus disease (COVID-19) pandemic has had a major adverse impact on people’s health and well-being in the United States (US) and globally. Although inequalities in COVID-19 prevalence and to a lesser extent in Long COVID and related mental health impact among US adults have been documented, disparities in COVID-related outcomes by industrial sector of employment, an important social determinant, have not been studied. Using the latest nationally representative data, we examine disparities in COVID-19, Long COVID, and associated mental health impact among US adults aged ≥18 years by industrial sector. Methods: Using three consecutive rounds of the US Census Bureau’s Household Pulse Survey from September 14 to November 14, 2022 (N=148,813), disparities in COVID-related outcomes by industrial sector were modeled by multivariable logistic regression after controlling for race/ethnicity, socioeconomic status, health insurance, and other demographic characteristics. Results: During September–November 2022, an estimated 117 million or 48.7% of US adults reported having been diagnosed with COVID-19; 34.3 million or 29.4% of COVID patients reported developing Long COVID; 14.7 million or 12.6% of COVID patients reported experiencing severe COVID symptoms; 10.7% of COVID patients reported serious depression, and 17.8% reported serious anxiety. Adjusted for covariates, workers in wholesale trade, finance and insurance, educational services, healthcare, social assistance, and accommodation and food services had 30-39% higher odds of being diagnosed with COVID-19 than workers in the agricultural sector. Workers in social assistance, real estate, utilities, construction, and healthcare sectors had 48-102% higher adjusted odds of developing Long COVID than workers in wholesale trade. Conclusion and Implications for Translation: Marked disparities in COVID-related outcomes existed, with workers in employment industries such as healthcare, social assistance, real estate, arts and entertainment, and accommodation and food services being at increased risk of COVID-19 diagnosis, Long COVID, severe COVID symptoms, serious depression, and anxiety. Equitable access to social services and healthcare, including mental and behavioral health services, among workers afflicted with these conditions is critical to reducing inequities in COVID-related health outcomes. Copyright © 2023 Singh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Work stressors, work-family conflict, parents’ depressive symptoms and perceived parental concern for their children’s mental health during COVID-19 in Canada: a cross-sectional analysis

BackgroundWork-related stressors and work-family conflict are important social determinants of mental health. While the impact of these stressors on parents’ mental health is well documented, we know comparatively less about their impact on children’s mental health. Furthermore, though the COVID-19 pandemic has significantly altered these stressors, particularly with the increase in teleworking, major knowledge gaps persist regarding the association between parents’ stressors and perceived parental concern for their children’s mental health during the COVID-19 pandemic. Based on the stress contagion perspective, this study tests (1) the mediating role of parents’ depressive symptoms with parental concern for their children’s mental health, and (2) whether these associations vary depending on whether parents had the opportunity to engage in telework.MethodsA path analysis was performed from a cross-sectional analytic sample of 780 employed parents in the province of Quebec (Canada). The same model was then stratified by teleworking opportunity. The model’s indirect associations were obtained by the bootstrap bias-corrected method with 1,000 replications.ResultsThe results show that the stressors of work-to-family conflict, increased difficulties in work-family balance since the COVID-19 pandemic, irregular schedules, low esteem derived from work, and job insecurity were all indirectly associated with an increase in parental concern for their children’s mental health through increased parents’ depressive symptoms. However, some associations differ depending on teleworking status. The indirect associations involving increased difficulties in work-family balance since the COVID-19 pandemic as well as irregular work schedules were observed only in the teleworking group.ConclusionsThis study fills a gap in research on the association between the work-family interface and parental concern for their children’s mental health during the COVID-19 pandemic. It highlights the importance of concerted and cohesive action between child health policies and those regarding work and work-family balance to prevent work-related psychosocial risks, particularly considering the post pandemic expanded and persistent reliance on teleworking.

Introducing the SEER-Medicare-Housing and Urban Development data linkage: A novel resource for examining the association of housing assistance and cancer care and outcomes.

200 Background: Lack of stable and affordable housing is an important social determinant of health. Federal housing assistance—through housing choice vouchers, public housing, and other programs—may buffer against housing vulnerabilities among low-income households, but research examining the association of housing assistance and cancer care has been limited. We introduce a new linkage of SEER-Medicare and Housing and Urban Development (HUD) administrative data that can be used to examine housing assistance and cancer care and patient outcomes to inform efforts to reduce inequities. Methods: Individuals enrolled in HUD programs 2006-2021 were linked with cancer diagnoses 2006-2019 identified in the SEER-Medicare data from 16 states using Match*Pro probabilistic linkage software. HUD administrative data include timing and type of housing assistance and verified household income. Medicare administrative data are available through 2020. We describe the cohort aged ≥66 years with continuous Medicare fee-for-service Parts A/B coverage surrounding diagnosis who had episodes of housing assistance: 1) at diagnosis or 2) starting within 3 years after diagnosis. Because supply of housing assistance is limited, eligible, low-income families are frequently wait-listed; individuals who receive housing assistance after diagnosis can serve as controls for individuals with housing assistance at diagnosis. Results: Among 42,197 individuals aged ≥66 years diagnosed with cancer and with housing assistance, the most common diagnoses were female breast (n=8,108), lung (n=5,400), colorectal (n=5,197), and prostate (4,548) cancers. Sociodemographic characteristics were similar among the 35,873 individuals with HUD assistance at diagnosis and 6,334 who received it later (Table). Both groups were majority female and non-Hispanic white and with median household income &lt;$14,000. Private multifamily housing programs were the most common form of assistance, followed by housing choice vouchers, and public housing. Conclusions: This novel data linkage will be available through the National Cancer Institute and can be used to explore the ways in which housing assistance is associated with cancer diagnosis and outcomes, including the role of housing assistance in potentially reducing or contributing to inequities across racialized and ethnic groups.[Table: see text]

Supporting Solidarity

Supporting Solidarity

1.Q. Workshop: Work, health, and migration: understanding the health impacts of precarious and exploitative work

Abstract The ILO estimates that of the 169 international migrant workers globally, the largest share resides in Europe, where increasing numbers are at substantial risk of precarious, exploitative, and hazardous work conditions. While the right to health and decent work of migrants is recognised by European member states, COVID-19 has exposed how some low-wage migrant workers are compelled to accept exploitative and precarious employment terms and conditions, with implications for their health. The vulnerability of migrants to labour exploitation is influenced by both personal factors (such as age and gender) as well as situational factors (such as risk environments across the migration journey and national legislation). Hazardous, precarious, and exploitative work is an entrenched driver of poor health. Data show that low-wage migrant workers have higher injury and mortality rates compared to host workers and face barriers to occupational and mainstream health and vaccination systems. In this workshop, we will discuss the patterns of precarious work and labour exploitation in migrants residing in Europe, physical and mental health effects of labour exploitation, research and policy gaps, and models of good practice to ensure that the health and rights of migrant workers are protected. Workshop plan The workshop will start with 10-minute presentations by each of the 4 speakers (including a short Q&amp;A after each talk). This will then move into a 20-minute audience discussion centred around exploring how to foster intersectoral collaboration across the work, migration, and health research communities to begin addressing some of the evidence and policy gaps in the European region. Key messages • Migrant workers have worse health outcomes than native workers, including higher rates of occupational injury and deaths. • Labour exploitation is an important social determinant of health among migrants which requires greater recognition in research and practice.

How work impacts health and smoking practices among sexuality and gender minority young adults

ABSTRACT While work has been established as an important social determinant of health, it remains understudied in health inequities research. Although work has the potential to both promote and harm health, this analysis focuses on the health-compromising elements of work in a sample of sexuality and gender minority (SGM) young adults in the San Francisco Bay Area who participated in a study investigating nicotine and tobacco (NT) use practices. Survey and interview data were collected from 100 participants ages 18–25 who reported current or former NT use. In-depth qualitative interviews explored their experiences of daily life, social identities and beliefs about structural oppression, practices of NT use, and perceptions of health and wellbeing. A thematic analysis of the narratives highlighted the centrality of work to daily life. Participants described how work structured time and became a site of daily exploitation. They also identified the structural barriers that shape employment opportunities for SGM young adults, compromising health, and shaping NT use. Results elucidate the harmful practices embedded in daily work and the inequities within the structure of work itself, underscoring the need to shift focus away from individual behaviors like NT use and towards the structural factors that perpetuate health inequities.

Educational Attainment and Cardiovascular Risk Among Patients in Cardiac Rehabilitation

We explored whether patient educational attainment impacted changes in cardiovascular risk factors during cardiac rehabilitation (CR). An observational study was conducted using participant data who completed phase 2 of CR from January 2011 to February 2020 at an academic medical center. The patient cohort was referred to CR after a major cardiac event or to outpatients with stable angina. Patients were excluded if they had no recorded food frequency assessment (FFA) score at CR orientation and graduation. The eligible sample of 1,307 patients were further divided: (1) low educational attainment group (<16 years formal education: high school, high school/general educational development, trade school, and associate's degree) and (2) high educational attainment group (>16 years formal education: bachelor's degree, some postgraduate, master's degree, PhD, and MD). The outcomes included measurements of the FFA, body composition, biophysical health, and psychologic distress. Most patients were male (71.2%), non-Hispanic White (82.2%), and married (73.0%). There were more patients with a high educational attainment (56.8%) than patients with a low educational attainment (43.2%). All measured cardiovascular markers improved after CR for both education level groups. The change in mean FFA score (0.163, p=0.11) and Brief Symptom Inventory-53 global severity index score (0.422, p=0.34) did not differ significantly. We observed an improvement in cardiovascular risk measures upon CR participation. These improvements were not limited to high educational attainment patients because we found few differences in the change of risk between the 2 groups. Future studies should continue investigating the impact of education on cardiovascular outcomes as an important social determinant of health.

Educational Attainment and Cancer Incidence in a Large Nationwide Prospective Cohort.

Educational attainment is a social determinant of health and frequently used as an indicator of socioeconomic status. Educational attainment is a predictor of cancer mortality, but associations with site-specific cancer incidence are variable. The aim of this study was to evaluate the association of educational attainment and site-specific cancer incidence adjusting for known risk factors in a large prospective cohort. Men and women enrolled in the American Cancer Society's Cancer Prevention Study-II Nutrition Cohort who were cancer free at baseline were included in this study (n = 148,965). Between 1992 and 2017, 22,810 men and 17,556 women were diagnosed with incident cancer. Cox proportional hazards regression models were used to estimate age- and multivariable-adjusted risk and 95% confidence intervals of total and site-specific cancer incidence in persons with lower versus higher educational attainment. Educational attainment was inversely associated with age-adjusted cancer incidence among men but not women. For specific cancer sites, the multivariable-adjusted risk of cancer in the least versus most educated individuals remained significant for colon, rectum, and lung cancer among men and lung and breast cancer among women. Educational attainment is associated with overall and site-specific cancer risk though adjusting for cancer risk factors attenuates the association for most cancer sites. This study provides further evidence that educational attainment is an important social determinant of cancer but that its effects are driven by associated behavioral risk factors suggesting that targeting interventions toward those with lower educational attainment is an important policy consideration.

Informal Employment Under the Skin: Informality and Health Inequalities Among Chilean Workers.

Informal employment has been identified as an important social determinant of health. This article addresses the processes through which informal employment affects workers' health in Chile. The study's methodological approach was based on qualitative interviews with 34 formal and informal workers. The findings show how workers perceive informal employment as negatively affecting their mental and physical health through different dimensions of their living and working conditions. Incorporating a gender perspective proves to be integral to the analysis of these processes. The article concludes by discussing how neoliberalism underlies such vulnerability processes and negatively impacts on the population's health.

Urban residence and elevated blood pressure among migrant women in South Africa.

This paper demonstrates that internal migration may be contributing to rising non-communicable disease risk in low- and middle-income countries in gendered and geographically differentiated ways. With 2018 baseline data from the Migrant Health Follow-Up Study, we investigate the relationship between internal migration and elevated blood pressure (BP) among 2163 rural-origin men and women in South Africa, testing for sex differences. To examine the influence of place, we test whether the migration-BP relationship differs by migrants' destination locations, controlling for household composition, social support, prior migration, and housing quality. We find that migration is associated with elevated BP only among women, and that this association is greatest for migrants living in Tembisa township. Our research underscores that gender and migration are important social determinants of noncommunicable disease risk in low-resource, rapidly-urbanizing settings.

The Michigan Farmworker Project: A Community-Based Participatory Approach to Research on Precarious Employment and Labor Exploitation of Farmworkers

Precarious employment is an important social determinant of health inequities. Through in-depth qualitative interviews ( n = 35), we examine precarious employment and labor exploitation, their potential impact on the working environment, and, ultimately, the health of farmworkers. We present results from the community-based participatory Michigan Farmworker Project. Our analysis identified dimensions of precarious employment and labor exploitation that involved lacking access to fundamental labor and social rights—including dehumanization—discriminatory occupational practices, and insufficient access to health care and social benefits. Policy reform is needed to address precarious employment and labor exploitation among farmworkers due to their potential long-lasting health effects.

Development and maturation of the occupational health services research field in the United States over the past 25 years: Challenges and opportunities for the future.

Work is an important social determinant of health; unfortunately, work-related injuries remain prevalent, can have devastating impact on worker health, and can impose heavy economic burdens on workers and society. Occupational health services research (OHSR) underpins occupational health services policy and practice, focusing on health determinants, health services, healthcare delivery, and health systems affecting workers. The field of OHSR has undergone tremendous expansion in both definition and scope over the past 25 years. In this commentary, focusing on the US, we document the historical development and evolution of OHSR as a research field, describe current doctoral-level OHSR training, and discuss challenges and opportunities for the OHSR field. We also propose an updated definition for the OHSR field: Research and evaluation related to the determinants of worker health and well-being; to occupational injury and illness prevention and surveillance; to healthcare, health programs, and health policy affecting workers; and to the organization, access, quality, outcomes, and costs of occupational health services and related health systems. Researchers trained in OHSR are essential contributors to improvements in healthcare, health systems, and policy and programs to improve worker health and productivity, as well as equity and justice in job and employment conditions. We look forward to the continued growth of OHSR as a field and to the expansion of OHSR academic training opportunities.

Validation of the Adolescent Social Identity Measure: Adolescents’ Perception of Themselves in a Social Context

&lt;p style="text-align:justify"&gt;Social identity is an important social determinant of student outcomes such as mental health and well-being. Currently, no validated social identity measures exist for adolescents in secondary school settings. A new ‘Adolescent Social Identity’ measure was developed by adapting two social identity dimensions from a validated reputation enhancement scale. The Social Identity Measure comprises two scales of 10 items each to measure how adolescents think their peers view them (e.g., reputational status) in terms of their conforming and nonconforming behaviour (Self-perception of Public Self) and how adolescents would ideally like to be viewed (Ideal Public Self) by peers. Exploratory and confirmatory factor analyses were conducted along with assessments of reliability, validity, and measurement invariance. Conforming and Nonconforming subscales for both scales were shown to be reliable, valid, and invariant across age and gender groupings. There were significant but small differences in the latent means for gender.&lt;/p&gt;

Validation ofthe eHEALTH Literacy Scale (Eheals) With Military Service Members.

Medical readiness of individual service members (SMs) is an integral component of operational readiness. Electronic Health (eHealth) literacy, here defined as the ability to seek out, find, evaluate, and appraise, integrate, and apply what is gained in electronic environments toward solving a health problem, is a key skill to enhance individual medical readiness. The World Health Organization (WHO) has identified health literacy as an important social determinant of health. The Internet enables individuals to access information virtually anywhere, at any place, any time, which is especially beneficial for SMs who serve around the globe, often isolated from modern health care facilities. This study examined the utility of the eHealth literacy scale (eHeals) as a potentially valuable tool to assist commanders and medical teams for assessing the health literacy of SMs. The main objective of our study was to examine the validity of the three-factor eHEALS measure for an active duty sample, using confirmatory factorial analysis. Our findings support the validity of the eHEALS measure of electronic health literacy among military SMs, potentially identifying a means of measuring SMs' health literacy, and a target for intervention to increase medical readiness, well-being, and overall quality of life for individual SMs. The study highlights a brief 6-item assessment tool that can quickly and efficiently be added to the current validated health and well-being measures for military personnel. This brief assessment can provide a measure of knowledge, skills, and confidence regarding ehealth information leading to better-informed health care decisions in the military context. These findings are especially relevant given the military's current emphasis on modernization and the need to put people first in order to build the overall team and improve unit effectiveness.

Late life depression and concepts of aging: an emerging paradigm.

Late life depression (LLD) is an emerging challenge, and recognized as a significant barrier to long-term healthy aging. Viewed within the context of the medical/biological model, advances in brain sciences over the last several decades have led to a deeper understanding of the biology of LLD. These advances in current knowledge include the description of aging brain pathophysiology; the biology and biochemistry of neurotransmitters; the correspondence between changes in neurological structure, function, and neural network; the description of neural, hormonal and inflammatory biomarkers; and identification of typical phenotypic subtypes of LLD. Despite these advances, current treatment of LLD, which remains largely pharmacological with accompanying cognitive and behavioral interventions, has poor success rate for long-term remission among older people. A wider perspective, in keeping with several emerging aging concepts, is suggested as an alternative framework within which to view LLD. A growing body of research supports the important role in LLD of frailty, resilience, intrinsic capacity, and functional integrity. Similarly, important social determinants need to be addressed in the etiology of LLD, rooted largely in negative stereotypes of aging, with consequent repercussions of reduced participation and inclusion, growing social isolation, with loss of identity, meaning and hope. This perspective suggests the importance of a wider integrative conceptualization of depression, set against a background of emerging aging concepts.

Employment interventions to assist people who experience borderline personality disorder: A scoping review.

Employment is an important social determinant of health and is associated with positive health outcomes. However, individuals who have been diagnosed with borderline personality disorder (BPD) are significantly underrepresented in the workforce. Whilst there is an array of evidence based therapeutic interventions, there remains a gap in knowledge regarding the most effective ways to enhance employment outcomes for people with a diagnosis of BPD. To explore employment interventions for people with BPD, map the available evidence and identify key concepts and knowledge gaps. A scoping review was conducted to identify and map the relevant literature. Findings were summarised using a narrative approach. Consultation was provided by a reference group including peer support workers with lived experience of BPD and mental health clinicians. Seven articles met the inclusion criteria, including non-randomised and case study/series designs and a randomised controlled trial protocol, with participant numbers generally low. All programmes combined a psychotherapeutic component with work related goals; however, there were notable differences in relation to the conceptual/theoretical approach of the psychotherapeutic component and delivery of the work-related components. Barriers and enablers to programme participation and success are explored. This review provides important insights into the characteristics of vocational rehabilitation interventions for people diagnosed with BPD. The findings will inform the co-production of approaches to support people with BPD to engage in employment.

Oral health of adolescents in West Africa: prioritizing its social determinants

Oral health is a major public health issue in West Africa, yet it has gotten little attention. Individual and group disparities in health status are influenced by social determinants of health (SDH), which also affect oral health. Adolescence is a significant transition into adulthood, a time when the SDH can contribute to lifelong health status. This article explored the SDH associated with oral health behaviour, perception, and oral health development amongst adolescents in West Africa. This article engaged articles published in peer-reviewed journals relating to adolescents' oral health and West Africa. The authors undertook this desk review to determine the social determinants of adolescents' oral health in West Africa. The literacy levels and oral health awareness of adolescents, family and social circle influences, socioeconomic status, nutritional levels, and cultural and environmental factors have been identified as important social determinants. Adequate policy implementation with the integration of oral health in schools' curriculum, health systems reorientation with the adoption of oral health delivery in primary health care and expansion in oral health research with the assessment of cultural influences on oral health development have been recommended as interventions to reduce oral health inequalities in West Africa.

Social determinants of health in non-communicable diseases prevention policies in South Africa.

The South African government has developed many policies for the prevention and control of non-communicable diseases. However, non-communicable diseases remain among the major causes of morbidity and mortality in South Africa. Although these diseases are linked to interaction of multiple risk factors, many of which are modifiable, they continue to cause much suffering particularly among the marginalised and people from the lower socio-economic status. The objective of this research was to explore and present the inclusion of social determinants of health in the policies meant for the prevention and control of non-communicable diseases in South Africa. The qualitative document analysis approach was used to conduct policy analysis of purposefully selected policies for prevention and control of cancers, obesity and mental and behavioural disorders in South Africa. The analysis revealed that policies for prevention and control of cancers, obesity and mental and behavioural disorders included policy intervention activities that focused on five social determinants of health: (1) governance, (2) social policies, (3) public policies, (4) material circumstances and (5) health system. Excluding most of the important social determinants of health in the policies for prevention and control of non-communicable diseases means that these policies would continue to fail in preventing these diseases from the root causes.Contribution:This article points out weaknesses in the policies meant for prevention and control of obesity, cancers and mental and behavioural disorders. This article further suggests policy improvement strategies that may be considered to effectively address these diseases.