Individual Socioeconomic Factors Research Articles

Work participation in spondyloarthritis across countries: analysis from the ASAS-COMOSPA study

ObjectivesTo explore the role of individual and country level socioeconomic (SE) factors on employment, absenteeism and presenteeism in patients with spondyloarthritis (SpA) across 22 countries worldwide.MethodsPatients with a clinical diagnosis...

Is familial risk for depression confounded by individual and familial socioeconomic factors and neighborhood environmental factors? A 7-year follow-up study in Sweden

Family history of depression is an important risk factor for depression. The aim of this study was to examine whether the effect of family history of depression is confounded by individual and familial socioeconomic factors (i.e., country of origin, educational attainment, family income and mobility) and neighborhood environmental factors (i.e., neighborhood deprivation and neighborhood social capital). The study population comprised 188,907 individuals aged 20–44 years from a nationwide sample of primary care centers in Sweden. Among these individuals, 22,014 with a first event of depression (6,486 men and 15,528 women) were identified during the 7-year follow-up period. Family history of depression was defined as depression in at least one parent. Cross-classified multilevel logistic regression models were used to calculate odds ratios with 95% credible intervals. Increased familial odds were observed after adjustment for individual and familial socioeconomic factors and neighborhood environmental factors for both men and women. Our results suggest that family history of depression is an independent risk factor for depression. Offspring of parents with depression are important targets for disease prevention, regardless of individual and familial socioeconomic factors and neighborhood environmental factors.

Individual and Area-Based Socioeconomic Factors Associated With Dementia Incidence in England

Lower educational attainment is associated with a higher risk of dementia. However, less clear is the extent to which other socioeconomic markers contribute to dementia risk. To examine the relationship of education, wealth, and area-based deprivation with the incidence of dementia over the last decade in England and investigate differences between people born in different periods. Data from the English Longitudinal Study of Ageing, a prospective cohort study that is representative of the English population, were used to investigate the associations between markers of socioeconomic status (wealth quintiles and the index of multiple deprivation) and dementia incidence. To investigate outcomes associated with age cohorts, 2 independent groups were derived using a median split (born between 1902-1925 and 1926-1943). Dementia as determined by physician diagnosis and the Informant Questionnaire on Cognitive Decline in the Elderly. A total of 6220 individuals aged 65 years and older enrolled in the study (median [interquartile range] age at baseline, 73.2 [68.1-78.3] years; 3410 [54.8%] female). Of these, 463 individuals (7.4%) had new cases of dementia ascertained in the 12 years between 2002-2003 and 2014-2015. In the cohort born between 1926 and 1943, the hazard of developing dementia was 1.68 times higher (hazard ratio [HR] = 1.68 [95% CI, 1.05-2.86]) for those in the lowest wealth quintile compared with those in the highest quintile, independent of education, index of multiple deprivation, and health indicators. Higher hazards were also observed for those in the second-highest quintile of index of multiple deprivation (HR = 1.62 [95% CI, 1.06-2.46]) compared with those in the lowest (least deprived) quintile. In an English nationally representative sample, the incidence of dementia appeared to be socioeconomically patterned primarily by the level of wealth. This association was somewhat stronger for participants born in later years.

Correlates of frequent alcohol consumption among middle-aged and older men and women in Russia: A multilevel analysis of the PrivMort retrospective cohort study

BackgroundA large proportion of premature deaths in Russia since the early 1990s, following the transition from communism, have been attributed to hazardous drinking. Little is known about the correlates of alcohol consumption. We present new data on the consumption of alcoholic beverages among middle-aged and older Russians and identify socio-demographic, socio-economic, and life-course correlates of frequent drinking. MethodsWithin the framework of the PrivMort project, conducted in 30 industrial towns in the European part of Russia, we acquired information on the frequency of drinking among 22,796 respondents and 57,907 of their surviving and deceased relatives. We fit three-level mixed-effects logistic regression models of frequent drinking in which respondents’ relatives, aged 40 and over, are nested in their families and towns. ResultsDeceased male relatives consumed alcohol significantly more often, while deceased female relatives consumed alcohol significantly less often than the respondents of corresponding gender. In a multivariable analysis, we found that individuals’ education, communication with family members, labour market status, history of unemployment, and occupational attainment are all significant correlates of frequent drinking in Russia. These associations are stronger among men rather than among women. ConclusionThere are significant differences between frequency of drinking among surviving and deceased individuals and frequent drinking is associated with a wide array of individual socio-demographic, socio-economic, and life course factors that can partially explain high alcohol consumption in post-communist Russia.

Going Beyond Zip Code: Can a Person's Address Help Us Improve Their Acute Care?

Going Beyond Zip Code: Can a Person's Address Help Us Improve Their Acute Care?

Abstract P308: Independent Effects of Individual and Neighborhood Socioeconomic Characteristics on Cardiovascular Health Response to an Exercise Trial

Introduction: Both individual-level socioeconomic position (SEP) and the socioeconomic context of neighborhood of residence are important social determinants of cardiovascular health. However, few studies have considered how both individual and neighborhood socioeconomic factors simultaneously impact the effect of an intervention on cardiovascular health. Hypothesis: We assessed the hypothesis that higher individual SEP and lower neighborhood poverty and would each be independently associated with better cardiovascular health in response to the Examination of Mechanisms (E-Mechanic) of Exercise-Induced Weight Compensation randomized control trial. Methods: Cardiovascular health (CVH) was measured via a composite score that included 4 factors (1) BMI, 2) cholesterol, 3) glucose, and 4) systolic blood pressure), each categorized as ideal (2 points), intermediate (1 point), and poor (0 points) health for a possible range of 0 points (worst CVH) to 8 points (best CVH). CVH scores were calculated at baseline and follow-up. Individual SEP was created using principal components analysis with income and educational attainment, controlling for race, to produce a single socioeconomic factor that was dichotomized to indicate high (=1) or low (=0) SEP. Neighborhood socioeconomic context was measured at the census block group using percent (%) poverty derived from the U.S. Census Bureau’s American Community Survey. We estimated a multilevel repeated-measures regression model of CVH against individual SEP and neighborhood poverty that included covariates for age, sex, race, and marital status. Results: The final analytic sample included 114 participants (mean age = 48.3 years, SD age = 11.5 years; 72% female; 30% African American; 72% married) residing in 88 neighborhoods (mean poverty = 14.5%, SD=13.3%) who received the E-Mechanic exercise intervention and who had no missing data for all variables. On average, the E-Mechanic trial improved cardiovascular health among all exercise intervention participants by 0.3 points (95% CI 0.2 to 0.5). Results from the regression model demonstrated that participant SEP only approached marginal significance (p=0.12), while neighborhood poverty was not significant (p=0.32). Conclusions: The current study found that individual and neighborhood socioeconomic characteristics were not independently associated with response in cardiovascular health to the E-Mechanic exercise intervention. While findings from the analysis do not implicate either personal or contextual socioeconomic influences in intervention response for the E-Mechanic trial, this study does address the need to assess potential disparities in randomized control trials by examining differential response in health outcomes among participants by multiple social determinants of health.

Factors Influencing Various Aspects of Patients' Knowledge of Oral Anticoagulation.

To identify and examine individual characteristics and socioeconomic factors that contribute to the knowledge of patients who receive warfarin anticoagulation. All patients treated using warfarin for anticoagulation were enrolled during a 6-month period at a university-affiliated cardiac clinic. All relevant demographic and clinical information were collected and the Anticoagulation Knowledge Assessment (AKA) questionnaire consisting of 29 questions was administered. After completion, the questionnaires were scored and the percent correct answers were analyzed for overall scores, as well as the following categories: drug/food interactions, pharmacological knowledge, recognition of complications, and patient compliance. Multiple linear regression analysis was used to identify the contributing factors to the knowledge level of the patients in each category. One hundred fifty patients (79 men and 71 women) with a median age of 61.5 years completed the AKA questionnaire. The average overall score was 29.3%. Living alone (P = 0.008), higher levels of education (P = 0.001), and durations of ≥3 years of warfarin therapy (P = 0.018) positively impacted overall AKA scores. Socioeconomic factors and level of general education remain the most important elements determining the patient awareness of therapeutic goals, possible drug/food interaction, recognition of adverse effects, and compliance of warfarin treatment.

Gender differences in European volunteer rates

The main goal of this research is to identify the reasons for gender differences in European volunteer rates in different types of voluntary organisations. To that end, we focus in volunteer rates at individual and national levels. We have drawn our data from the European Values Survey (EVS, 1999 and 2008). We have employed Logit models carrying out independent estimations for the individual likelihood of working as a volunteer for four categories: social awareness, professional, education and social justice. We have carried out independent estimations and we have also repeated estimations by gender subsamples. Our main result is that social factors might be even more relevant for decisions to volunteer than individual socio-economic factors. Specifying the peer group as much as possible allows better control of social variables. For example, studying the female volunteer rate is more relevant to control for the female national NGO membership rate than the total national rate. We also highlight important gender differences. For example, education is positively correlated with decisions to volunteer for both genders in all categories, but the educational effect is stronger for men in relation to professional activities and stronger for women in relation to social awareness and social justice activities.

Residential green space and birth outcomes in a coastal setting

BackgroundResidential green space may improve birth outcomes, with prior studies reporting higher birthweight among infants of women living in greener areas. However, results from studies evaluating associations between green space and preterm birth have been mixed. Further, the potential influence of residential proximity to water, or ‘blue space’, on health has not previously been evaluated. ObjectivesTo evaluate associations between green and blue space and birth outcomes in a coastal area of the northeastern United States. MethodsUsing residential surrounding greenness (measured by Normalized Difference Vegetation Index [NDVI]) and proximity to recreational facilities, coastline, and freshwater as measures of green and blue space, we examined associations with preterm birth (PTB), term birthweight, and term small for gestational age (SGA) among 61,640 births in Rhode Island. We evaluated incremental adjustment for socioeconomic and environmental metrics. ResultsIn models adjusted for individual – and neighborhood-level markers of socioeconomic status (SES), an interquartile range (IQR) increase in NDVI was associated with a 12% higher (95% CI: 4, 20%) odds of PTB and, conversely, living within 500 m of a recreational facility was associated with a 7% lower (95% CI: 1, 13%) odds of PTB. These associations were eliminated after further adjustment for town of residence. NDVI was associated with higher birthweight (7.4 g, 95% CI: 0.4–14.4 g) and lower odds of SGA (OR = 0.92, 95% CI: 0.87–0.98) when adjusted for individual-level markers of SES, but not when further adjusted for neighborhood SES or town. Living within 500 m of a freshwater body was associated with a higher birthweight of 10.1 g (95% CI: 2.0, 18.2) in fully adjusted models. ConclusionsFindings from this study do not support the hypothesis that residential green space is associated with reduced risk of preterm birth or higher birthweight after adjustment for individual and contextual socioeconomic factors, but variation in results with incremental adjustment raises questions about the optimal degree of control for confounding by markers of SES. We found that living near a freshwater body was associated with higher birthweight. This result is novel and bears further investigation in other settings and populations.

Neighbourhood disadvantage, geographic remoteness and body mass index among immigrants to Australia: A national cohort study 2006-2014.

Obesity is socioeconomically, geographically and ethnically patterned. Understanding these elements of disadvantage is vital in understanding population obesity trends and the development of effective and equitable interventions. This study examined the relationship between neighbourhood socioeconomic disadvantage and geographic remoteness with prospective trends in mean body mass index (BMI) among immigrants to Australia. Longitudinal data (2006–2014) from a national panel survey of Australian adults was divided into an immigrant-only sample (n = 4,293, 52.6% women and 19,404 person-year observations). The data were analysed using multi-level random effects linear regression modelling that controlled for individual socioeconomic and demographic factors. Male immigrants living in the most disadvantaged neighbourhoods had significantly higher mean BMI compared with those living in the least disadvantaged. Over time, mean BMI increased for all groups except for men living in the least disadvantaged neighbourhoods, for whom mean BMI remained almost static (0.1 kg/m2 increase from 2006 to 2014), effectively widening neighbourhood inequalities. Among women, mean BMI was also significantly higher in the most compared with the least, disadvantaged neighbourhoods (β = 2.08 kg/m2; 95%CI: 1.48, 2.68). Neighbourhood inequalities were maintained over time as mean BMI increased for all groups at a similar rate. Male and female immigrants residing in outer regional areas had significantly higher mean BMI compared with those living in major cities; however, differences were attenuated and no longer significant following adjustment for ethnicity, individual socioeconomic position and neighbourhood disadvantage. Over time, mean BMI increased in all male and female groups with no differences based on geographic remoteness. Obesity prevention policy targeted at immigrant cohorts needs to include area-level interventions that address inequalities in BMI arising from neighbourhood disadvantage, and be inclusive of immigrants living outside Australia’s major cities.

Ethnic inequalities in health between Arabs and Jews in Israel: the relative contribution of individual-level factors and the living environment.

Ethnic inequalities in health (EIH) are unjust public health problem that emerge across societies. In Israel, despite uniform healthcare coverage, marked EIH persist between Arabs and Jews. We draw on the ecosocial approach to examine the relative contributions of individual socioeconomic status (SES), psychosocial and health behavioral factors, and the living environment (neighborhood problems, social capital, and social participation) to explaining ethnic differences in self-rated health (SRH). Data were derived from two nationwide studies conducted in 2004-2005 of stratified samples of Arabs (N=902) and Jews (N=1087). Poor SRH was significantly higher among Arabs after adjustment for age and gender [odds ratio and 95% confidence interval (CI)=1.94 (1.57-2.40)]. This association was reversed following adjustment for all possible mediators: OR (95% CI)=0.70(0.53-0.92). The relative contribution of SES and the living environment was sizable, each attenuating the EIH by 40%, psychosocial factors by 25%, and health behaviors by 16%. Arabs in Israel have poorer SRH than Jews. Polices to reduce this inequality should mainly focus on improving the SES and the living conditions of the Arabs, which might enhance health behaviors and well-being.

Socioeconomic inequalities of outpatient and inpatient service utilization in China: personal and regional perspectives

BackgroundChina’s health system has shown remarkable progress in health provision and health outcomes in recent decades, however inequality in health care utilization persists and poses a serious social problem. While government pro-poor health policies addressed affordability as the major obstacle to equality in health care access, this policy direction deserves further examination. Our study examines the issue of health care inequalities in China, analyzing both regional and individual socioeconomic factors associated with the inequality, and provides evidence to improve governmental health policies.MethodsThe China Health and Nutrition Survey (CHNS) 1991–2011 data were used to analyze the inequality of health care utilization. The random effects logistic regression technique was used to model health care utilization as the dependent variable, and income and regional location as the independent variables, controlling for individuals’ age, gender, marital status, education, health insurance, body mass index (BMI), and period variations. The dynamic trend of 1991–2011 regional disparities was estimated using an interaction term between the regional group dummy and the wave dummy.ResultsThe probability of using outpatient service and inpatient services during the previous 4 weeks was 8.6 and 1.1% respectively. Compared to urban residents, suburban (OR: 0.802, 95% CI: 0.720–0.893), town (OR: 0.722, 95% CI: 0.648–0.804), rich (OR: 0.728, 95% CI: 0.656–0.807) and poor village (OR: 0.778, 95% CI: 0.698–0.868) residents were less likely to use outpatient service; and rich (OR: 0.609, 95% CI: 0.472–0.785) and poor village (OR: 0.752, 95% CI: 0. 576–0.983) residents were less likely to use inpatient health care. But the differences between income groups were not significant, except the differences between top and bottom income group in outpatient service use.ConclusionRegional location was a more important factor than individual characteristics in determining access to health care. Besides demand-side subsidies, Chinese policy makers should pay enhanced attention to health care resource allocation to address inequity in health care access.

Socio-economic factors associated with an increase in fruit and vegetable consumption: a 12-year study in women from the E3N-EPIC study.

To identify individual and contextual socio-economic factors associated with an increase in fruit and vegetable (F&V) consumption over a 12-year period and evaluate if some socio-economic factors were differentially associated with the change in consumption of some types of F&V. Associations between increased F&V consumption and socio-economic factors were studied with multivariate logistic regression. E3N, a French prospective cohort study of 98 995 women. E3N participants (n 58 193) with information on diet in 1993 and 2005, and numerous individual and contextual socio-economic factors available. Associations between some individual socio-economic factors and changes in F&V consumption were observed. For instance, women who lived in a large household (>3 children v. no child) had higher probability of increasing their vegetable consumption (OR=1·33; 95 % CI 1·24, 1·42). This association was driven by higher consumption of courgette and raw cucumber. Living with a partner was associated with higher odds of increasing consumption of fruits (OR=1·07; 95 % CI 1·02, 1·13) such as pear, peach and grape. Certain individual socio-economic factors, but none of the contextual socio-economic factors examined, were associated with an increase in F&V consumption. Factors associated with an increase in total F&V consumption were not necessarily associated with an increase in fruit or vegetable consumption separately, or with an increase in each subtype of fruit or vegetable. Magnitudes of the different associations observed also differed when F&V were considered together, separately or by subtype. Increases in F&V consumption were mostly observed in women with high socio-economic position. To develop effective nutritional interventions and policies that take the socio-economic environment of individuals into account, we recommend future research to further focus on (i) pathways through which population characteristics might influence changes in F&V consumption and (ii) existing interactions between individual and contextual socio-economic factors.

Racial disparity in infant mortality

In the United States, African-American infants have significantly higher mortality than white infants. Previous work has identified associations between individual socioeconomic factors and select community-level factors. In this review, the authors look beyond traditional risk factors for infant mortality and examine the social context of race in this country, in an effort to understand African-American women’s long-standing birth outcome disadvantage. In the process, recent insights are highlighted concerning neighborhood-level factors such as crime, segregation, built environment, and institutional racism, other likely causes for the poor outcomes of African-American infants in this country compared with infants in most other industrialized nations.

Neighborhood characteristics influence DNA methylation of genes involved in stress response and inflammation: The Multi-Ethnic Study of Atherosclerosis

ABSTRACTLiving in a disadvantaged neighborhood is associated with poor health outcomes even after accounting for individual-level socioeconomic factors. The chronic stress of unfavorable neighborhood conditions may lead to dysregulation of the stress reactivity and inflammatory pathways, potentially mediated through epigenetic mechanisms such as DNA methylation. We used multi-level models to examine the relationship between 2 neighborhood conditions and methylation levels of 18 genes related to stress reactivity and inflammation in purified monocytes from 1,226 participants of the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based sample of US adults. Neighborhood socioeconomic disadvantage, a summary of 16 census-based metrics, was associated with DNA methylation [False discovery rate (FDR) q-value ≤ 0.1] in 2 out of 7 stress-related genes evaluated (CRF, SLC6A4) and 2 out of 11 inflammation-related genes (F8, TLR1). Neighborhood social environment, a summary measure of aesthetic quality, safety, and social cohesion, was associated with methylation in 4 of the 7 stress-related genes (AVP, BDNF, FKBP5, SLC6A4) and 7 of the 11 inflammation-related genes (CCL1, CD1D, F8, KLRG1, NLRP12, SLAMF7, TLR1). High socioeconomic disadvantage and worse social environment were primarily associated with increased methylation. In 5 genes with significant associations between neighborhood and methylation (FKBP5, CD1D, F8, KLRG1, NLRP12), methylation was associated with gene expression of at least one transcript. These results demonstrate that multiple dimensions of neighborhood context may influence methylation levels and subsequent gene expression of stress- and inflammation-related genes, even after accounting for individual socioeconomic factors. Further elucidating the molecular mechanisms underlying these relationships will be important for understanding the etiology of health disparities.

Environmental stressors, socioeconomic factors, and alcohol-related problems among Argentinian college students

Introduction. The relationship between alcohol consumption, individual characteristics, and alcohol-related problems may vary according to environmental characteristics in certain populations. Objective. To explore the existence of a hierarchical structure in the links between environmental stressors, individual socioeconomic factors, regular alcohol consumption, use of other substances, and alcohol-related problems in Argentinian university students. Method. With a correlational design and data from a random sample of students from a public university (N = 1578, 58% female), we used a multilevel modeling strategy as follows: alcohol-related problems; regular alcohol consumption (quantity/frequency) as fixed effect, use of other psychoactive substances, sociodemographic factors (individual socioeconomic status, age, and gender); and environmental stressors as random effects (index of overcrowding as an indicator of poverty and reported crime as an indicator of violence in the neighborhood). Results. The rate of overcrowding proved to be the best Level 2 predictor for the alcohol-related problems model. Socioeconomic status, quantity and frequency of consumption, use of other substances, and age directly predicted alcohol-related problems (Level 1). Gender was neither a direct predictor nor a moderator of the links. Discussion and conclusion. At least one environmental stressor (neighborhood poverty) partly explains the variability observed in alcohol-related problems. The quantity and frequency of alcohol consumption and the use of other psychoactive substances were the strongest predictors of alcohol-related problems.

PM2.5 AIR POLLUTION, EDUCATIONAL ATTAINMENT, AND COGNITIVE FUNCTION AMONG OLDER U.S. ADULTS

AbstractThis study examines whether the association between air pollution and cognitive function among older adults differs by educational attainment. Data on 13,389 adults over age 50 are from the 2004 Health and Retirement Study and were linked to 2004 annual average concentrations of ambient fine particulate matter air pollution (PM). Multilevel linear regression models were used to examine the association of PM concentrations and individual-level education on cognitive function. Higher concentrations of PM were associated with lower scores on cognitive function, but the association was stronger among individuals with lower educational attainment. These findings were robust to the inclusion of a variety of individual demographic, socioeconomic, and health factors as well as neighborhood-level education and income. The findings suggest the cognitive harms of pollution exposure may be offset by educational attainment, and that older adults with low educational attainment may be particularly vulnerable to air pollution.

Elderly’s Travel Patterns and Trends: The Empirical Analysis of Beijing

Travel by the elderly is generally characterized by relatively short distances and low frequencies. However, with social development, the travel patterns of the elderly are lacking in sustainability. In some European countries, the elderly are increasingly dependent on cars while traveling. In addition, the influencing factors of the elderly’s travel behavior are also changing. At present, most foreign and domestic studies focus on the impact of individual and household socioeconomic attributes, travel attributes, and policy factors on the travel frequency, travel mode choice, and travel demand of the elderly, but they lack an analysis of the regional differences of the elderly’s travel behavior characteristics and related countermeasures. The studies excessively focus on the influencing factors but overlook the difference between the elderly’s travel characteristics and young people’s travel characteristics, as well as the interactions at the household level. Based on data from the Fifth Travel Survey of Residents in Beijing 2014, this paper uses variance analysis, Spearman’s correlation analysis, and descriptive and comparative analysis to study the difference in travel frequency over 24 hours between the elderly and middle-aged/young people in Beijing, the impact of household, individual, and travel attributes on the travel frequency difference, and the regional difference in the elderly’s travel behavior characteristics. The results show that there is a significant difference in travel frequency between the elderly group and the middle-aged/young group in Beijing; the main reason is the individual difference between travelers. Travelers’ attributes all exert an influence on the travel frequency of both groups, but the degree and direction of the influence are different. At the household level, middle-aged/young people with a higher household income travel less frequently, whereas the case is completely the opposite for the elderly. In terms of personal attributes, gender has a significant negative effect on the elderly’s travel frequency; that is, women travel less than men, whereas there is no difference between men and women in middle-aged/young people. Regarding travel attributes, travel distance and travel duration have a significant negative effect on the two groups’ travel frequencies. The elderly in some European countries are more dependent on cars, whereas a large proportion of elderly people in Beijing walk on foot, but the degree of dependence on cars of the “new generation” of the elderly in Beijing will increase rapidly, which will bring the lack of sustainability of travel patterns, further bringing new challenges to policymakers and transport planning departments.

The role of healthcare and education systems in co-occurrence of health risk behaviours in 27 European countries.

Contextual factors play an important role in health and related behaviours. This study aims to examine the association of co-occurrence of five health-risk behaviours with healthcare and education contextual factors using nationally representative samples from 27 European countries. Data were from Eurobarometer 72.3, 2009. The outcome was a count variable ranging from 0 to 5 indicating co-occurrence of five health-risk behaviours, namely smoking, excessive alcohol consumption, non-frequent fresh fruit consumption, physical inactivity and non-dental check-ups. Public expenditures on healthcare and education as a percentage of GDP and quality of healthcare and education at a country-level were used as contextual factors. A set of multilevel Poisson regression models were conducted to examine the associations between co-occurrence of health-risk behaviours and each of the contextual factors considering age, gender, marital status, urbanisation, individual socioeconomic positions (education, subjective social status or difficulty in paying bills) and GDP per capita. The total population was 23 842. Greater expenditures on healthcare and education, and better quality of healthcare systems had negative associations with co-occurrence of health-risk behaviours in the model adjusted for all individual demographic indicators. However, statistical significance disappeared after adjusting for socioeconomic indicators and GDP per capita. While the study highlights the importance of developing high-quality healthcare and education systems generously supported by public fund in relation to co-occurrence of health-risk behaviours, the influence of contextual factors in adopting health-related behaviours is probably attenuated by individual socioeconomic factors.

Local Labor Market Condition and Influenza Vaccination

Influenza vaccination is a cost-effective preventive service, but its utilization rate is below the recommended level. Many studies have explored possible predictors and causes for low vaccination rates. Despite a large volume of studies in this area, there is limited research on how local economic conditions can affect individual influenza vaccination. This study explores this topic by merging the 2008–2012 individual-level data from the Behavioral Risk Factor Surveillance System (BRFSS) with the Area Health Resources Files (AHRF), and the Bureau of Labor Statistics Local Area Unemployment Statistics (LAUS). Using county-level unemployment rates as a measurement of local economic conditions, we used multivariate probit models to examine its relationship with individual flu vaccination while controlling for individual socioeconomic and demographic factors and contextual characteristics. We found that county-level unemployment rates were significantly and negatively associated with individual influenza vaccination, especially for people who were employed or living in metropolitan counties. Our results support public health interventions to improve flu vaccination during economic recessions.