Long-standing Illness Research Articles

Associations between measures of child poverty, health-care use, and health outcomes: observational study of nationally representative English data

BackgroundThe UK Government has recently proposed the abolition of income-based measures of child poverty in favour of environmental, educational, and employment measures of deprivation. We aimed to study how strongly these proposed measures are associated with health outcomes among children and young people compared with a relative income measure. MethodsWith data from Hospital Episode Statistics for 2013–14 (n=16·4 million), we compared inequalities in inpatient admissions of children and young people aged 0–24 years per thousand (total and chronic conditions) using five deprivation measures (deciles of area-based measures: index of multiple deprivation [IMD], income, index of income deprivation affecting children [IDACI], education, living environment). With data from Health Survey for England for 2014 (n=3085), we compared inequalities in general health and long-standing illness reported by an individual, parent, or carer using equivalised household income quintiles, IMD quintiles, and whether the household reference person was employed (n=2417, 78·3%); not working (397, 12·9%); or retired, long-term sick, or other (274, 8·9%). The ratios of hospital admission rates and weighted prevalence of poor self-reported health were compared between the most and least deprived groups within each measure. FindingsTotal admission rates were higher among the most versus least deprived IMD deciles (ratio 1·60, 95% CI 1·59–1·61). The ratio was greater when income deciles were compared (1·69, 1·68–1·71) and smaller when analysis was by education (1·59, 1·58–1·60), IDACI (1·52, 1·51–1·53), and living environment (1·01, 1·00–1·02). The ratio was lower for admissions for chronic conditions (IMD 1·18, 1·16–1·20). Inequalities were largest when analysis was by income decile (1·25, 1·22–1·27). In the household-level analyses, inequalities in fair or poor, self or parent-reported health were seen when comparing lowest versus highest income quintiles (12·2% vs 3·9; ratio 3·12, 1·99–5·87), not working versus being employed (14·1 vs 6·1; 2·30, 1·68–3·03), and most versus least deprived IMD quintiles (9·8 vs 6·5; 1·49, 1·05–2·21). For long-standing illness, the equivalent data were: income (22·0 vs 11·0; 1·99, 1·50–2·77), employment (23·6 vs 15·8; 1·50, 1·21–1·81), and IMD (18·9 vs 17·2; 1·10, 0·88–1·39). InterpretationAlthough some important aspects of health such as use of primary care and community services are not included, this study shows that child poverty measures differ significantly in their association with key indicators of population health and health-care use. Of the deprivation measures studied here, hospital admissions were most strongly associated with income inequality. Self-reported health outcomes were also more strongly linked to household income than area-level IMD. FundingNone.

Understanding social inequalities in childhood hospital admissions: longitudinal analysis of the UK Millennium Cohort Study

BackgroundChildhood hospital admission rates are increasing annually and are socially patterned. To inform policies to reduce hospital admissions in children, we aimed to assess risk factors for hospital admissions and the extent to which any socioeconomic inequality in admissions could be attenuated after accounting for risk factors. MethodsThis analysis used a sample of 11 085 children, across five sweeps from ages 9 months to 11 years, from the UK Millennium Cohort Study. The Millennium Cohort Study oversamples children living in disadvantaged areas and ethnic minority groups by means of a stratified clustered sampling design, and includes sampling weights to address attrition. The primary outcome for the present analysis was parental report of a child “ever being admitted to a hospital ward” (ever admitted) by age 11 years. Parents' educational attainment at the child's birth was the main exposure. Primary outcome data were analysed with Poisson regression, according to parental education, adjusted for covariates including perinatal risk factors, maternal and child health status, and environmental risk factors. Findings4615 parents (45·6%) reported that their child had been admitted to hospital by age 11 years. Children of parents with no educational qualifications were more likely than those of parents with degree level or higher qualifications to have been admitted (risk ratio 1·49, 95% CI 1·20–1·85), and there was evidence of a dose-response association. Controlling for risk factors attenuated the increased risk of admissions in children from households with the lowest educational attainment (adjusted risk ratio 1·09, 95% CI 0·93–1·29). In the fully adjusted analysis, low birthweight (1·24, 1·06–1·45) and longstanding illnesses (1·21, 1·18–1·24) were associated with an increased risk of being ever admitted, and female sex was protective (0·81, 0·75–0·88). Repeating the analysis with the main exposure as income produced similar results. InterpretationIn a contemporary representative sample of children in the UK, nearly half were admitted to hospital by age 11 years. Children of parents with no qualifications had around 50% greater risk of admission, largely explained by differences in childhood longstanding illness and low birthweight. Policies to reduce inequalities in these factors might also reduce inequalities in hospital admissions. Study limitations include the potential for differential self-reporting of hospital admission from households with different educational attainment, and not being able to explore service model differences. FundingNone.

Are housing tenure and car access still associated with health? A repeat cross-sectional study of UK adults over a 13-year period

BackgroundIt is usually assumed that housing tenure and car access are associated with health simply because they are acting as markers for social class or income and wealth. However, previous...

Multiple health behaviours among mothers and partners in England: Clustering, social patterning and intra-couple concordance

Research on multiple health behaviours is increasing but little is known about parental behaviours and how they covary. Our study investigates cigarette smoking, alcohol intake, fruit and vegetable (F&V) consumption and physical activity among mothers and co-resident partners in England. Using the UK Household Longitudinal Study, we examined (i) clustering of health behaviours using observed-expected ratios and latent class analysis (ii) socio-demographic correlates of the derived latent classes and (iii) intra-couple concordance of individual health behaviours and their latent classes. We identified five latent classes for mothers and partners: Never smoked drinkers (28% of mothers; 29% of partners), Abstainers (25%; 17%), Drinkers and ex-smokers (19%; 26%), Unhealthy low frequency drinkers (18%; 16%) and Unhealthiest behaviour group (11%; 12%). These had distinctive social profiles. Never smoked drinkers were more likely than those in other groups to be white and socially advantaged: married, older, and with higher educational qualifications and incomes. Abstainers were non-smokers who never or occasionally drank, and were disproportionately drawn from ethnic minority groups and middle/lower income families. Drinkers and ex-smokers were the most physically active group and were more likely to be socially advantaged. Unhealthy low frequency drinkers were more likely to be disadvantaged and have a limiting long-standing illness. The Unhealthiest behaviour group had the highest proportion of smokers, heavy smokers and binge drinkers and the lowest F&V intake and physical activity levels. They were largely white and socially disadvantaged: younger, non-married and with lower educational levels. Mothers and their partners typically shared the same risk behaviours, and 44 per cent of partners and mothers belonged to the same latent class. Our findings point to the potential for a broadening of research and policy perspectives, from separate behaviours to combinations of behaviours, and from individuals to the domestic units and communities of which they are part.

„NASZ DOM JUŻ NIE JEST TAKI SAM” – POCZUCIE OSAMOTNIENIA W RODZINIE OSIEROCONEJ

Przedmiotem podjętych badań było osamotnienie w rodzinie spowodowane śmiercią rodzica/małżonka wskutek długotrwałej choroby. Badaniami jakościowymi objęto 10 rodzin (6 matek, 4 ojców, 15 dzieci) za- mieszkujących w mieście Białystok, będących w okresie żałoby od dwóch lat. Wykorzystano metodę indywidualnego przypadku oraz techniki badawcze: wywiad skategoryzowany i wywiad narracyjny.

The relationship between physical activity, sleep duration and depressive symptoms in older adults: The English Longitudinal Study of Ageing (ELSA).

Research to date suggests that physical activity (PA) is associated with distinct aspects of sleep, but studies have predominantly focused on sleep quality, been carried out in younger adults, and have not accounted for many covariates. Of particular interest is also the reported relationship between physical activity and depression in older adults and as such, their associations with sleep duration. Here we examine the cross-sectional relation between physical activity and sleep duration in a community-dwelling sample of 5265 older adults from the English Longitudinal Study of Ageing. We analysed the data using multiple regression, with physical activity as a categorical exposure and sleep duration a continuous outcome, as well as testing the interaction between physical activity and depressive symptoms, which was significant (p < 0.001). We therefore stratified our analyses by depressive symptomatology. Our main finding was that, in the group with elevated depressive symptoms only, physical activity was positively associated with sleep duration in models adjusted for all covariates (age, sex, wealth, ethnicity, smoking, alcohol consumption, BMI, long-standing illness) across low [B (mean difference in sleep duration) = 25.22 min, 95% CI = (3.72; 46.72)], moderate [B = 27.92 min, 95% CI = (6.59; 49.26)] and high [B = 31.65 min, 95% CI = (7.36; 55.94)] PA groups, in comparison to the sedentary group. However, we observed no relation between physical activity and sleep duration in respondents who reported no depressive symptoms, irrespective of physical activity level (p > 0.05). Our findings suggest that a potentially effective way of improving sleep in older adults with depressive symptoms is via physical activity interventions.

Do flexicurity policies protect workers from the adverse health consequences of temporary employment? A cross-national comparative analysis

Flexicurity policies comprise a relatively novel approach to the regulation of work and welfare that aims to combine labour market flexibility with social security. Advocates of this approach argue that, by striking the right balance between flexibility and security, flexicurity policies allow firms to take advantage of loose contractual arrangements in an increasingly competitive economic environment while simultaneously protecting workers from the adverse health and social consequences of flexible forms of employment. In this study, we use multilevel Poisson regression models to test the theoretical claim of the flexicurity approach using data for 23 countries across three waves of the European Social Survey. We construct an institutional typology of labour market regulation and social security to evaluate whether inequalities in self-reported health and limiting longstanding illness between temporary workers and their permanent counterparts are smaller in countries that most closely approximate the ideal type described by advocates of the flexicurity approach. Our results indicate that, while the association between temporary employment and health varies across countries, institutional configurations of labour market regulation and social security do not provide a meaningful explanation for this cross-national variation. Contrary to the expectations of the flexicurity hypothesis, our data do not indicate that employment-related inequalities are smaller in countries that approximate the flexicurity approach. We discuss potential explanations for these findings and conclude that there remains a relative lack of evidence in support of the theoretical claims of the flexicurity approach.

Changes in leisure time physical activity and subsequent disability retirement: A register-linked cohort study

BackgroundDisability retirement is an economic, public health and work life issue causing costs for employees, workplaces and society. Adopting physical activity at middle-age has been associated with reduced risk of sickness absence and mortality. The aim of this study was to examine how changes over time in leisure time physical activity are associated with subsequent disability retirement among midlife employees.MethodsThe Helsinki Health Study cohort baseline (phase 1) mail questionnaire survey data were collected in 2000, 2001 and 2002 among 40–60-year-old employees of the City of Helsinki, Finland. A phase 2 survey was conducted in 2007 (N = 3943). Respondents were classified into three groups: 1. low-active (<14 MET-hours/week), 2. moderately active (> = 14 MET-hours/week in moderate-intensity physical activity) and 3. vigorously active (> = 14 MET-hours/week including vigorous physical activity) at both phases. This yielded nine groups for describing stability and change of leisure time physical activity. Disability retirement data were derived from the registry of the Finnish Centre for Pensions until the end of 2013. A Cox regression analysis was used to calculate hazard ratios (HR) and their 95 % confidence intervals (CI) adjusting for covariates.ResultsDuring the follow-up, 264 (6.7 %) participants retired due to disability. Compared with those who were persistently low-active, those who increased their physical activity from low to vigorous had a lower risk of subsequent disability retirement (HR = 0.38, 95 % CI = 0.15–0.97) when adjusting for age, gender, occupational social class, strenuousness of work, smoking and binge drinking. Similarly, compared with those who were persistently moderately active, those increasing from moderate to vigorous (HR = 0.50, 95 % CI = 0.28–0.86) had a reduced risk. In contrast, those decreasing their physical activity from vigorous to low (HR = 2.42, 95 % CI = 1.32–4.41) or moderate (HR = 1.70, 95 % CI = 1.03–2.82) had an increased risk, compared with those who were persistently vigorously active. Adjusting for BMI, limiting longstanding illness and prior sickness absence somewhat attenuated the associations.ConclusionsAdopting vigorous physical activity was associated with a reduced risk of disability retirement. Promoting vigorous physical activity among midlife employees may help prevent disability retirement.

Anxiety in teenage girls rises sharply in past decade, finds study.

The mental wellbeing of teenage girls in England seems to have worsened over the past 10 years, a survey by the Department for Education has found.1 The study included a representative sample of 13 100 people aged 14 who were surveyed in 2014 about their attitudes, health, and wellbeing, and it compared the findings with a previous cohort interviewed in 2005. Young people’s general wellbeing was slightly worse in 2014 than in 2005 in terms of self reported health and psychological distress. This was observed particularly in girls, young people living in single parent or step families, and respondents with a longstanding illness or disability that affected their schooling. These groups also displayed less confidence in their ability to control the events …

Associations between access to recreational physical activity facilities and body mass index in Scottish adults.

BackgroundThe aim of this country-wide study was to link individual health and behavioural data with area-level spatial data to examine whether the body mass index (BMI) of adults was associated with access to recreational physical activity (PA) facilities by different modes of transport (bus, car, walking, cycling) and the extent to which any associations were mediated by PA participation.MethodsData on individual objectively-measured BMI, PA (number of days of (a) ≥20 min of moderate-to-vigorous PA, and (b) ≥15 min of sport or exercise, in previous 4 weeks), and socio-demographic characteristics were obtained from a nationally representative sample of 6365 adults. The number of accessible PA facilities per 1,000 individuals in each small area (data zones) was obtained by mapping a representative list of all fixed PA facilities throughout mainland Scotland. A novel transport network was developed for the whole country, and routes on foot, by bike, by car and by bus from the weighted population centroid of each data zone to each facility were calculated. Separate multilevel models were fitted to examine associations between BMI and each of the 24 measures of accessibility of PA facilities and BMI, adjusting for age, gender, longstanding illness, car availability, social class, dietary quality and urban/rural classification.ResultsWe found associations (p < 0.05) between BMI and 7 of the 24 accessibility measures, with mean BMI decreasing with increasing accessibility of facilities—for example, an estimated decrease of 0.015 BMI units per additional facility within a 20-min walk (p = 0.02). None of these accessibility measures were found to be associated with PA participation.ConclusionsOur national study has shown that some measures of the accessibility of PA facilities by different modes of transport (particularly by walking and cycling) were associated with BMI; but PA participation, as measured here, did not appear to play a part in this relationship. Understanding the multi-factorial environmental influences upon obesity is key to developing effective interventions to reduce it.

Material deprivation and health: a longitudinal study.

BackgroundDoes material deprivation affect the consequences of ill health? Answering this question requires that we move beyond the effects of income. Longitudinal data on material deprivation, longstanding illness and limiting longstanding illness enables investigations of the effects of material deprivation on risk of limiting longstanding illness. This study investigates whether a shift from affording to not affording a car predicts the probability of limiting longstanding ill (LLSI).MethodsThe 2008–2011 longitudinal panel of Statistics on Income, Social Inclusion and Living Conditions (EU-SILC) is utilised. Longitudinal fixed effects logit models are applied, using LLSI as dependent variable. Transition from affording a car to not affording a car is used as a proxy for material deprivation. All models are controlled for whether the person becomes longstanding ill (LSI) as well as other time-variant covariates that could affect the results.ResultsThe analysis shows a statistically significant increased odds ratio of LLSI when individuals no longer can afford a car, after controlling for confounders and LSI in the previous year (1.129, CI = 1.022–1.248). However, when restricting the sample to observations where respondents report longstanding illness the results are no longer significant (1.032, CI = 0.910–1.171).ConclusionThe results indicate an individual level effect of material deprivation on LLSI, suggesting that material resources can affect the consequences of ill health.

Domains and levels of physical activity are linked to adult mental health and wellbeing in deprived neighbourhoods: A cross-sectional study

Although relationships between participating in physical activity (PA) and positive mental health and wellbeing are well established, little is known about the relative contributions of the different domains of PA —household, occupational, active travel, leisure and sport, family activities— to total PA and, in turn, to mental health and wellbeing. This is particularly important for deprived communities where PA is low and mental health and wellbeing poor.Using multivariate multilevel regression of cross-sectional survey data collected in 2011, we examined self-reported PA levels and the domains and diversity of sources of PA among 2654 residents of 32 deprived neighbourhoods in Glasgow, UK, and their associations with measures of mental health, positive mental wellbeing, and physical and general health.Household chores and active travel were the most commonly cited PAs. People achieving PA from family activities, and those doing more diverse PAs, had better mental wellbeing. Active travel was associated with better mental wellbeing and mental health among the highly and moderately physically active, respectively. Highly active people who engaged in leisure-based PA had better mental health. Long-standing illness was associated with worse health scores, although mental wellbeing was ameliorated amongst those who did domestic or occupational PA.It is important to encourage greater diversity of PA in disadvantaged areas, including leisure and family activities and active travel for those out of work with low PA. Nevertheless, interventions aimed at managing long-term health conditions and providing employment may be of even greater importance.

Lifetime rates and correlates of crime victimisation in young people with mental ill-health.

Research on crime victimisation in the mentally ill has focused on middle aged cohorts with long-standing illness and functional disability. The rates and correlates of victimisation in young cohorts is largely unknown. Participants ( n=776) were aged 12-25 years attending headspace centres in Australia, who consented to a clinical interview and provided self-reported data regarding lifetime victimisation. A quarter of the sample (24.5%) reported crime victimisation, including 18.5% who experienced violent victimisation (mainly physical or sexual assault) and 14.1% non-violent crime. Both forms of victimisation were associated with illicit substance use, sexual orientation, and young adult age, while male gender was specifically associated with non-violent victimisation. Participants who reported violent victimisation were significantly more impaired both functionally and clinically than those reporting non-violent victimisation or no victimisation. Young people with mental ill-health are vulnerable to criminal victimisation, particularly violent assaults, although the lifetime rates of victimisation are substantially lower than those observed in older cohorts with serious mental illness. Effective, early intervention to address modifiable factors may reduce the risk of further victimisation.

Extent and orientation of coping in chemical intolerance.

Chemical intolerance is a long-standing illness with minimal guidelines regarding treatment. Hence, individual attempts to cope with the illness gain importance in dealing with its consequences. This study used data from 164 persons with self-reported chemical intolerance to understand the nature of coping with the illness. Coping was studied along two dimensions, the extent and predominant orientation of coping. The association of these coping dimensions with mental health variables of stress, depression, anxiety, burnout, and non-restorative sleep was examined as well. Results revealed that the persons with chemical intolerance used a moderate amount of coping strategies which were slightly more emotion-focused than problem-focused in orientation. Users of both problem-focused and emotion-focused orientations report scores in the normal range on all mental health indices. However, significantly higher level of anxiety was found to be associated with predominantly emotion-focused coping, whereas coping orientation did not differ with respect to the four other mental health indices. The above findings are discussed in relation to existing literature on coping with long-term illness.

Co-Occurrence of Health Conditions during Childhood: Longitudinal Findings from the UK Millennium Cohort Study (MCS).

AimsTo identify patterns of stability and change in co-occurrence in children between 5–11 years, and to assess if they vary by socio-demographic factors.MethodsData from 9548 singleton children from the UK Millennium Cohort Study (MCS) were assessed for co-occurrence of five common adverse conditions: wheeze; longstanding illness; unfavorable weight; injury; and socio-emotional difficulties. We summed adverse conditions (0–5) for each child at ages 5, 7, and 11 and identified co-occurrence (≥2 conditions). Using multinomial regression, we explored associations between co-occurrence trajectories and child’s sex and ethnicity, maternal education, and income quintile.Results45.6% of children experienced co-occurrence between 5–11 years (7% experienced constant co-occurrence). More children moved into co-occurrence than moved out (16.9 vs. 11.9%). Mutually-adjusted relative risk ratios (aRRR) showed a gradient by maternal education: compared to children with no co-occurrence whose mothers had a higher/degree, children whose mothers had no qualifications were more likely to move into (aRRR = 1.32(95%CI:1.02,1.70)), out of (1.74(1.34,2.26)), have fluctuating (1.52(1.09,2.10)) or constant co-occurrence (2.58(1.76,3.80)). The same gradient (high vs. low) was evident for income quintiles. Girls were less likely to experience co-occurrence.ConclusionsCo-occurrence of adverse conditions is common during childhood, and trajectories are socially patterned. Child-focused care for lower-income children and boys early in life may prevent and reduce co-occurrence in later childhood.

Migrant integration policies and health inequalities in Europe.

BackgroundResearch on socio-economic determinants of migrant health inequalities has produced a large body of evidence. There is lack of evidence on the influence of structural factors on lives of fragile groups, frequently exposed to health inequalities. The role of poor socio-economic status and country level structural factors, such as migrant integration policies, in explaining migrant health inequalities is unclear. The objective of this paper is to examine the role of migrant socio-economic status and the impact of migrant integration policies on health inequalities during the recent economic crisis in Europe.MethodsUsing the 2012 wave of Eurostat EU-SILC data for a set of 23 European countries, we estimate multilevel mixed-effects ordered logit models for self-assessed poor health (SAH) and self-reported limiting long-standing illnesses (LLS), and multilevel mixed-effects logit models for self-reported chronic illness (SC). We estimate two-level models with individuals nested within countries, allowing for both individual socio-economic determinants of health and country-level characteristics (healthy life years expectancy, proportion of health care expenditure over the GDP, and problems in migrant integration policies, derived from the Migrant Integration Policy Index (MIPEX).ResultsBeing a non-European citizen or born outside Europe does not increase the odds of reporting poor health conditions, in accordance with the “healthy migrant effect”. However, the country context in terms of problems in migrant integration policies influences negatively all of the three measures of health (self-reported health status, limiting long-standing illnesses, and self-reported chronic illness) in foreign people living in European countries, and partially offsets the “healthy migrant effect”.ConclusionsPolicies for migrant integration can reduce migrant health disparities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3095-9) contains supplementary material, which is available to authorized users.

Area-level mortality and morbidity predict ‘abortion proportion’ in England and Wales

Life history theory predicts that where mortality/morbidity is high, earlier reproduction will be favoured. A key component of reproductive decision-making in high income contexts is induced abortion. Accordingly, relationships between mortality/morbidity and ‘abortion proportion’ (proportion of conceptions ending in abortion) are explored at small-area (‘ward’) level in England and Wales. It is predicted that where mortality/morbidity is high, there will be a lower ‘abortion proportion’ in younger women (<25years), adjusting for education, unemployment, income, housing tenure and population density. Results show that this prediction is supported: wards with both shorter life expectancy and a higher proportion of people with a limiting long-standing illness have lower abortion proportions in under 25s. In older age bands, in contrast, elevated mortality and morbidity are mostly associated with a higher ‘abortion proportion’. Further, morbidity appears to have a larger effect than mortality on ‘abortion proportion’ in the under-25 age band, perhaps because a) morbidity is be more salient than mortality in high-income contexts, and/or b) young women are influenced by health of potential female alloparents when scheduling fertility.

Non-prescription medicine misuse, abuse and dependence: a cross-sectional survey of the UK general population.

Background Non-prescription medicines (NPMs) can be misused, abused or lead to dependence, but the prevalence of these problems within the UK general population was unknown. The aim of this study was to estimate the prevalence of self-reported misuse, abuse and dependence to NPMs. Methods A cross-sectional postal survey was sent to 1000 individuals aged � 18 randomly drawn from the UK Edited Electoral Register. Results A response rate of 43.4% was achieved. The lifetime prevalence of NPM misuse was 19.3%. Lifetime prevalence of abuse was 4.1%. Younger age, having a long-standing illness requiring regular NPM use and ever having used illicit drugs or legal highs were predictive of misuse/ abuse of NPMs. In terms of dependence, lifetime prevalence was 2% with 0.8% currently dependent and 1.3% dependent in the past. Dependence was reported with analgesics (with and without codeine), sleep aids and nicotine products. Conclusion Given the increasing emphasis on self-care and empowering the public to manage their health with NPMs, the findings highlight the need for improved pharmacovigilance of these medicines to maximize benefits with minimal risk. Healthcare providers need to be aware of the potential for misuse, abuse and dependence, particularly in patients with long-term illness.

Predictors of influenza vaccine uptake during the 2009/10 influenza A H1N1v (‘swine flu’) pandemic: Results from five national surveys in the United Kingdom

ObjectivesTo investigate reasons underlying the low uptake of the influenza A H1N1v vaccination in the UK during the 2009/10 pandemic. MethodsWe analysed data from five national telephone surveys conducted in the UK during the latter stages of the pandemic to identify predictors of uptake amongst members of the public offered the vaccine by their primary care physician (n=1320). In addition to demographic variables, participants reported: reasons for declining the vaccination, levels of worry about the risk of catching swine flu, whether too much fuss was being made about the pandemic, whether they or a close friend or relative had had swine flu, how effective they felt the vaccine was, whether they had previously had a seasonal flu vaccination, how well prepared they felt the government was for a pandemic and how satisfied they were with information available about the pandemic. Most participants (n=734, 55.6%) reported being vaccinated against swine flu, compared to 396 who had not been vaccinated and were unlikely to be vaccinated in the future. ResultsThe main reasons given for declining vaccination were concerns over the vaccine's safety, and being generally healthy. Controlling for demographic variables, risk factors for not being vaccinated were: being female, not having a long-standing infirmity or illness, not having been vaccinated against seasonal flu in previous years, feeling that too much fuss had been made about the pandemic and believing that the vaccine was ineffective. ConclusionsInterventions that target these factors may be effective in improving uptake in a future pandemic.

Fit-for-work or fit-for-unemployment? Does the reassessment of disability benefit claimants using a tougher work capability assessment help people into work?

BackgroundMany governments have introduced tougher eligibility assessments for out-of-work disability benefits, to reduce rising benefit caseloads. The UK government initiated a programme in 2010 to reassess all existing disability benefit...