Report Poor Health Research Articles

Experience and Management of Chronic Pain Among Patients With Other Complex Chronic Conditions

Managing multiple chronic health conditions is a significant challenge. The purpose of this study was to examine the experience and management of chronic pain among adult patients with other complex chronic conditions, specifically diabetes and heart failure (HF). We surveyed 624 US Department of Veterans Affairs primary care patients in 3 study groups: 184 with HF, 221 with diabetes, and 219 general primary care users. We compared health status and function between those with and without chronic pain within the 3 study groups. Among those with chronic pain, we compared pain location, severity, and treatment across groups. More than 60% in each group reported chronic pain, with the majority reporting pain in the back, hip, or knee. In all groups, patients with chronic pain were more likely to report fair or poor health than those without pain (P<0.05). In the HF and diabetes groups, a higher percentage of patients with pain were not working because of health reasons. Of those with pain, more than 70% in each group took medications for pain; more than one-half managed pain with rest or sedentary activities; and less than 50% used exercise for managing their pain. Chronic pain is a prevalent problem that is associated with poor functioning among multimorbid patients. Better management of chronic pain among complex patients could lead to significant improvements in health status, functioning, and quality of life and possibly also improve the management of their other major chronic health conditions.

Self‐rated health, psychosocial functioning, and health‐related behavior among Thai adolescents

Despite the popularity of self-rated health (SRH) in Western countries as a useful public health tool, it has only rarely been used in Asian countries. The purpose of the current study was to determine whether measures of psychosocial functioning and health-related factors differ according to SRH in a school-based sample of Thai adolescents. The survey was given to 2519 adolescents attending 10 coeducational secondary high schools in Chiang Mai Province, Thailand and included measures of psychosocial functioning (loneliness, hopelessness, shyness, perceptions of social status, self-rated happiness, and perception of physical attractiveness) and certain health-related factors (height/weight, physical activity, eating breakfast, sleep). The proportion of boys (5.1%) reporting that they were not healthy was similar to the proportion of girls (4.6%) making the same rating. These adolescents showed a pattern of overall poor health risk. Compared to adolescent peers who rated their health as healthy or very healthy, they were less physically active, got less sleep, were more likely to be overweight, and scored lower on loneliness, shyness, hopelessness, and self-rated happiness. The present pattern of poor health risk warrants attention and supports the merit of using SRH in adolescent health assessment. SRH is easy to obtain and simple to assess and single-item assessments of SRH appear to be valid measures of health status in adults and adolescent. Interventions, such as health counseling, mental health counseling, and health education, can target adolescents who rate themselves as 'not healthy' or report poor health status.

Effects of a nurse-managed program on hepatitis A and B vaccine completion among homeless adults.

Hepatitis B virus (HBV) infection constitutes a major health problem for homeless persons. Ability to complete an HBV vaccination series is complicated by the need to prioritize competing needs, such as addiction issues, safe places to sleep, and food, over health concerns. The objectives of this study were to evaluate the effectiveness of a nurse-case-managed intervention compared with that of two standard programs on completion of the combined hepatitis A virus (HAV) and HBV vaccine series among homeless adults and to assess sociodemographic factors and risk behaviors related to the vaccine completion. A randomized, three-group, prospective, quasi-experimental design was conducted with 865 homeless adults residing in homeless shelters, drug rehabilitation sites, and outdoor areas in the Skid Row area of Los Angeles. The programs included (a) nurse-case-managed sessions plus targeted hepatitis education, incentives, and tracking (NCMIT); (b) standard targeted hepatitis education plus incentives and tracking (SIT); and (c) standard targeted hepatitis education and incentives only (SI). Sixty-eight percent of the NCMIT participants completed the three-series vaccine at 6 months, compared with 61% of SIT participants and 54% of SI participants. NCMIT participants had almost 2 times greater odds of completing vaccination than those of participants in the SI program. Completers were more likely to be older, to be female, to report fair or poor health, and not to have participated in a self-help drug treatment program. Newly homeless White adults were significantly less likely than were African Americans to complete the vaccine series. The use of vaccination programs incorporating nurse case management and tracking is critical in supporting adherence to completion of a 6-month HAV/HBV vaccine. The finding that White homeless persons were the least likely to complete the vaccine series suggests that programs tailored to address their unique cultural issues are needed.

Serious psychological distress and health outcomes for persons with epilepsy in poverty

Epidemiology literature demonstrates socioeconomic status as an important variable for outcomes in persons with epilepsy. However, no previous studies have analyzed the association between poverty and epilepsy in the United States. Forty-one percent (246/604) of persons with a history of epilepsy (PWHE) in the 2005 California Health Interview Survey ( n = 43,020) had an annual income <200% Federal Poverty Level (FPL), adjusted lifetime prevalence rate 0.5% [98.33% CI 0.4–0.7]. Four groups are presented in the analyses: (1) those with a history of epilepsy <200% FPL, (2) those with a history of epilepsy ≥200% FPL, (3) those not reporting a history of epilepsy <200% FPL and (4) those not reporting a history of epilepsy ≥200% FPL. PWHE in poverty reported significantly higher amounts of serious psychological distress, based on the validated Kessler 6 (K6) scale, than both non-epilepsy populations. After adjusting for demographics and other comorbid conditions, logistic regression analyses show PWHE in poverty are significantly more likely to report fair or poor self-rated health status when compared to the PWHE not in poverty and both non-epilepsy populations. PWHE in poverty are also more likely to report ≥14 generally unhealthy days and ≥14 physically unhealthy days in the past 30 days compared to the PWHE not in poverty and both non-epilepsy populations. Psychological well-being needs to be incorporated into any comprehensive treatment strategy for managing epilepsy.

Racial/Ethnic Disparities in Self-Rated Health Status Among Adults With and Without Disabilities—United States, 2004—2006

Self-rated health status has been found to be an independent predictor of morbidity and mortality, and racial/ethnic disparities in self-rated health status persist among the U.S. adult population. Black and Hispanic adults are more likely to report their general health status as fair or poor compared with white adults. In addition, the prevalence of disability has been shown to be higher among blacks and American Indians/Alaska Natives (AI/ANs) (3). To estimate differences in self-rated health status by race/ethnicity and disability, CDC analyzed data from the 2004-2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys. This report summarizes the results of that analysis, which indicated that the prevalence of disability among U.S. adults ranged from 11.6% among Asians to 29.9% among AI/ANs. Within each racial/ethnic population, adults with a disability were more likely to report fair or poor health than adults without a disability, with differences ranging from 16.8 percentage points among Asians to 37.9 percentage points among AI/ANs. Efforts to reduce racial/ethnic health disparities should explicitly include strategies to improve the health and well being of persons with disabilities within each racial/ethnic population.

Dietary Patterns Derived by Hybrid Clustering Method in Older People: Association with Cognition, Mood, and Self-Rated Health

Background Several nutritional factors, including dietary fatty acids, antioxidants, and folates, have been related to pathological brain aging. Dietary patterns that represent a combination of foods may better predict disease risk than single foods or nutrients. Objective To identify dietary patterns by a mixed clustering method and to analyze their relationship with cognitive function, depressive symptoms, and self-rated health in older people. Design Cross-sectional population-based study. Subjects/setting Subjects included 1,724 elderly community dwellers living in Bordeaux, France from 2001 to 2002. Statistical analysis Cluster analysis, combining hybrid clustering, and research for stable groups during the k-means step on mean number of weekly servings of 20 predetermined food groups, separately in men and women. Results Five dietary clusters were identified in each sex. A “healthy” cluster characterized by higher consumption of fish in men (n=157; 24.3%) and fruits and vegetables in women (n=267; 24.8%) had significantly lower mean number of errors to Mini Mental State score after adjustment for socio-demographic variables (β=−0.11; 95% confidence interval [CI], −0.22 to −0.004 in men; β=−0.13; 95% CI, −0.22 to −0.04 in women). The same cluster was associated with borderline significance with lower depressive symptoms in women (β=−0.16; 95% CI, −0.33 to 0.007). Men in the “pasta eaters” cluster (n=136; 21%) had higher depressive symptoms (β=0.26; 95% CI, 0.06 to 0.46) and higher risk to report poor health (polytomous regression, odds ratio [OR]=1.91; 95% CI, 1.21 to 3.01) than the “healthy” cluster. Women in the “biscuits and snacking” cluster (n=162; 15%) had greater risk of poor perceived health (OR=1.69; 95% CI, 1.15 to 2.48) compared to “healthy” eaters. Additional adjustment for body mass index and medication use strengthened these associations. Conclusions Sex-specific dietary patterns derived by hybrid clustering method are associated with fewer cognitive and depressive symptoms and better perceived health in older people.

Mental Health Patterns and Consequences: Results from Survey Data in Five Developing Countries

The social and economic consequences of poor mental health in the developing world are presumed to be significant, yet are largely under-researched. The authors argue that mental health modules can be meaningfully added to multi-purpose household surveys in developing countries, and used to investigate this relationship. Data from nationally representative surveys in Bosnia and Herzegovina, Indonesia, and Mexico, along with special surveys from India and Tonga, show similar patterns of association between mental health and socioeconomic characteristics across countries. Individuals who are older, female, widowed, and report poor physical health are more likely to report worse mental health outcomes. Individuals living with others with poor mental health are also significantly more likely to report worse mental health themselves. In contrast, there is little observed relationship between mental health and poverty or education, common measures of socio-economic status. The results instead suggest that economic and multi-dimensional shocks such as illness or crisis can have a greater impact on mental health than overall levels of poverty. This may have important implications for social protection policy. The authors also find significant associations between poor mental health and lowered labor force participation (especially for women) and higher frequency visits to health centers, suggesting that poor mental health can have significant economic consequences for households and the health system. Finally, the paper discusses how measures of mental health are distinct from general subjective welfare measures such as happiness and indicate useful directions of future research.

Lifestyle characteristics and 3-year total mortality of Japanese with self-reported diabetes

Despite the significant adverse health consequences of diabetes, data on lifestyle characteristics and mortality among the Japanese with diabetes are limited. Our objective was to investigate the lifestyles of Japanese community residents with self-reported diabetes and their 3-year total mortality. Our cohort was 7178 randomly selected residents aged 30-79 years in Nihonmatsu City, Fukushima Prefecture, Japan; 5187 responded to the survey (72% response rate) and were followed for 3 years. Baseline data were collected using questionnaires in December 2002, and deaths were monitored monthly. Only 19% of women and 4% of men followed six to seven of Breslow's seven health practices. The percentage of people with self-reported diabetes was 4.2%[95% confidence interval (CI), 3.4-5.1%] for women and 7.9% (95% CI, 6.8-9.1%) for men, and the 3-year total mortality was 1.4% (95% CI, 1.0-1.9%) for women and 3.1% (95% CI, 2.4-3.8%) for men. Factors associated with 3-year mortality were fair or poor subjective health [odds ratio (OR) = 3.1, 95% CI 1.7-5.5] and self-reported diabetes (OR = 2.3, 95% CI 1.1-4.9) in a logistic regression controlling for age and gender. In stratified analyses, 3-year mortality of those with diabetes was significantly higher than those without the disease among men and those aged under 65. Those with diabetes were more likely to have self-reported comorbidities, high blood pressure and report poor subjective health regardless of age and gender, and healthier lifestyles among the women and those aged under 65. Our results support the need for community-based primary prevention measures to improve the lifestyles of residents, along with secondary prevention approaches to monitor those with diabetes for complications and to give them lifestyle instructions.

Health-related quality of life and hypertension status, awareness, treatment, and control: National Health and Nutrition Examination Survey, 2001--2004.

We examined health-related quality of life measures by hypertension status, awareness, treatment, and control. Five unfavorable health-related quality of life measures were analyzed among 8303 adults aged 20 years or older who participated in the 2001--2004 National Health and Nutrition Examination Survey. Multivariable logistic regression analyses examined differences in health-related quality of life with adjustment for age, race, sex, healthcare coverage, and other medical conditions. The 30% of respondents with hypertension were more likely to report fair or poor health status (adjusted odds ratio 1.72, 95% confidence interval 1.44-2.05), 14 or more unhealthy days in the past 30 days (1.23, 1.06-1.43), 14 or more physically unhealthy days (1.39, 1.15-1.67), and 14 or more activity-limited days (1.55, 1.17-2.04) than those without hypertension. Among adults with hypertension, the 73.2% who were aware of their condition were more likely to report fair or poor health status (2.19, 1.54-3.12), 14 or more unhealthy days (1.53, 1.12-2.09), 14 or more physically unhealthy days (1.49, 1.10-2.03), 14 or more mentally unhealthy days (1.70, 1.05-2.75), and 14 or more activity-limited days (2.38, 1.39-4.05) than those who were unaware. Among those aware they had hypertension, 14 or more physically unhealthy days (0.50, 0.28-0.90) was associated with current treatment. Health-related quality of life measures did not differ by blood pressure control status. Having hypertension and being aware of it was related to lower health-related quality of life. Antihypertensive medication was associated with more physically unhealthy days, while there were no differences in health-related quality of life by control status. Further study is needed to examine these differences including: disease severity, sex and racial/ethnic differences, comorbidities not examined, and impact of health-related quality of life and its changes on outcomes.

Lifestyle behaviors, obesity, and perceived health among men with and without a diagnosis of prostate cancer: A population-based, cross-sectional study

BackgroundA better understanding of how prostate cancer survivors differ from men without prostate cancer and whether these potential differences vary across demographic subgroups will help to focus and prioritize future public health interventions for improving the health and well-being of prostate cancer survivors. Therefore, our study aims were to compare lifestyle behaviors, body mass index (BMI), and perceived health in men with and without a diagnosis of prostate cancer in a national, population-based sample and to explore whether these comparisons differ for demographic subgroups.MethodsIn a cross-sectional study, men aged ≥ 40 were identified from the Behavioral Risk Factor Surveillance System (BRFSS) 2002 data (n = 63,662). Respondents reporting history of prostate cancer (n = 2,524) were compared with non prostate cancer controls (n = 61,138) with regard to daily fruit and vegetable servings (FVPD), smoking, alcohol, sedentary behavior, BMI, and perceived health. Multivariable logistic regression calculated adjusted odds ratios (OR) and 95% confidence intervals (CI) for the entire sample and for age, race, education, and urbanicity subgroups.ResultsMen with prostate cancer did not differ from men without prostate cancer with regard to smoking, alcohol, sedentary behavior, and obesity but were more likely to consume ≥ 5 FVPD (OR, 95% CI: 1.30, 1.09–1.56) and report poor or fair health (OR, 95% CI: 1.62, 1.33–1.97). Subgroup analyses demonstrated attenuation of the higher likelihood of ≥ 5 FVPD among prostate cancer survivors in rural respondents (OR, 95% CI: 0.98, 0.72–1.33). Poorer perceived health was greatest if ≤ 65 years of age (OR, 95% CI: 2.54, 1.79–3.60) and nonsignificant if black (OR, 95% CI: 1.41, 0.70–2.82). Smoking and alcohol which were not significant for the sample as a whole, demonstrated significant associations in certain subgroups.ConclusionAlthough efforts to enhance perceived health and healthy lifestyle behaviors among prostate cancer survivors are warranted, demographic subgroups such as prostate cancer survivors ≤ 65 and rural populations may require more aggressive interventions.

Health status and behavioral risk factors among persons with epilepsy in Ohio based on the 2006 Behavioral Risk Factor Surveillance System

In 2006, Ohio added questions to the Centers for Disease Control and Prevention’s yearly Behavioral Risk Factor Surveillance System (BRFSS) survey to assess epilepsy prevalence. Ninety-seven of 5506 respondents reported a history of epilepsy, yielding a weight-adjusted prevalence rate of 1.48% (95% CI = 0.9–2.1), which is supportive of previous state-based epidemiology estimates. Persons with a history of epilepsy report double the rate of cigarette smoking than the population without epilepsy. Persons with both active epilepsy and a history of epilepsy report poor physical and mental health. Health screening behaviors were comparable to or higher than those of the population without epilepsy. Data from previous BRFSS surveys are used to identify major risk factor trends, as well as to explore the health promotion implications for people with epilepsy. Assessments reveal a need for smoking cessation and increased physical activity for persons with a history of epilepsy in Ohio.

Health care disparities and language use at home among latino, asian american, and american indian adolescents: Findings from the california health interview survey

AbstractUsing the 2001 California Health Interview Survey, this study compared health status, medical insurance, and having a usual source of care for 2,230 ethnic minority adolescents based on language use at home: Group 1, English only; Group 2, both English and another language; and Group 3, exclusively another language. Adjusting for demographic variables, adolescents in Group 3 were more likely to report fair or poor health (OR=2.37, p=.012) and to not have medical insurance (OR=4.61, p&lt;.001) compared to adolescents in Group 1. Young adolescents in Group 3 were more likely to have no usual source of care (OR=4.07, p=.029). Interventions need to consider language barriers in the context of an adolescent's age. © 2007 Wiley Periodicals, Inc.

Religiosity and Self-Rated Health among Latin American and Caribbean Elders

To describe religious affiliation, importance of religion, and the relationship between religion and self-rated health in persons aged 60 or older living in Latin America or the Caribbean. We used data from seven cities (n = 10,587). Multivariate models were used to analyze the associations between religious affiliation and importance of religion with sociodemographic or health factors and self-rated health. Overall, 92% of the total study population had a religious affiliation; among those who are religious, 80% considered religion to be important in their lives. Half of the population (51%) reported fair or poor health. In multivariate models, older age increased odds of having a religious affiliation and religion being important. Women were about four times more likely to have a religious affiliation and over twice as likely as men to indicate that religion was important. Although religious affiliation was associated with poor health, this association was no longer significant after controlling for functional status. Older adults who considered religion as very important were less likely to report fair or poor health compared to those who were less religious (somewhat important, not very important). These older adults have a high prevalence of religious affiliation and most of them consider religion to be important. Better self-rated health was associated with higher self-rated religiosity.

Use of a Population-Based Survey to Describe the Health of Boston Public Housing Residents

We compared the health of public housing residents with other Boston residents through a random-digit-dial survey. We used data from the Boston Behavioral Risk Factor Surveillance System collected in 2001 and 2003 to make crude and demographically adjusted comparisons between public housing residents and other city residents on measures of health status, access and utilization, and health behaviors. Public housing residents were more likely to report fair or poor overall health status, ever-diagnosed hypertension, current asthma, ever-diagnosed diabetes, obesity, disability, loss of 6 or more teeth, and feelings of depression for 15 days or more in the past month. Public housing residents were slightly more likely than others to be without health insurance or report financial barriers to medical care. Public housing residents reported more smoking and physical inactivity, less past-month binge drinking and past-year marijuana use, and similar levels of lifetime drug use. Public housing residents reported substantially poorer health than did other city residents across a variety of conditions but similar levels of access to and utilization of health care. Public health departments may be able to use established surveys to measure health among public housing residents.

Determinants of Health-related Quality of Life in Adults with Congenital Heart Disease

To examine health-related quality of life (HR-QoL) of adults with congenital heart disease (CHD). The HR-QoL of a large consecutive series of adults with CHD was prospectively studied using the Medical Outcome Study-Short Form 36. Except for very young men who report normal health, young adults describe poor health and exercise limitations relative to their peers in the community. In addition, middle-aged men report fatigue, psychological distress, impaired social functioning, and disability because of emotional difficulties. Among structurally defined subgroups, palliated and repaired cyanotic groups describe poor health. Patients with unoperated and palliated cyanotic lesions and men with repaired cyanotic defects or unoperated shunts also report exercise intolerance. Current cyanosis emerged as an important influence on HR-QoL. Patients with acquired cyanosis report poor health, exercise intolerance, fatigue, psychological difficulties, and social impairment. Chronic cyanosis was associated with only patient reports of poor health, exercise limitations, exercise-related disability, and social difficulties. Although adults with repaired cyanotic defects report poor health, no other HR-QoL deficits were reported by acyanotic patient groups. Pulmonary hypertension and rhythm disorders also influenced specific HR-QoL domains. Although gross structural and pathophysiologic factors influenced perceived health and exercise ratings, these variables were relatively poor predictors of self-reported health status and exercise capacity. Many adults with CHD do not meet normative expectations for perceived health status and exercise tolerance. The principal determinants of self-reported health status and perceived exercise tolerance in adults with CHD are not known. Gender differences in outcome require further investigation.

Implications of Medicaid coverage in a program for Latino substance users

Background This cross-sectional study explored baseline differences between Medicaid covered and uninsured clients ( n=368) in the Project La Voz, a community outreach program targeting Latino substance users. Methods Independent variables included client demographics, health status and health service use; the dependent variable was Medicaid coverage vs. uninsured. Bi-variate analyses and three binomial logistic regression models were conducted. Results The first logistic regression model examining client characteristics indicated that La Voz enrollees with Medicaid coverage were more likely to be women, reside in stable housing, and report poor health status. Employment and educational status were not significantly associated with having Medicaid. A second model, examining the association between health care utilization in the past 30 days and Medicaid coverage, indicated that LaVoz enrollees with Medicaid were significantly more likely to have entered substance use treatment. In the third model, client characteristics and health care use were examined in one model; all variables remained significant except for gender. Implications for program planning Massachusetts recent health care reform efforts include substance abuse treatment benefits through Medicaid. Specific strategies are needed to ensure that Latinos substance abusers, particularly those who are homeless, gain Medicaid coverage and then have access to needed services.

Why do Hispanics in the USA report poor health?

Despite the health and survival advantages of Hispanics relative to non-Hispanic whites in the USA, Hispanics report themselves to be in worse health than whites. Prior research indicates that these ethnic differences in self-rated health (SRH), measured by a simple question asking individuals to assess their overall health status, persist in the presence of an extensive set of explanatory variables. In this paper we use data from the first wave of the Los Angeles Family and Neighborhood Survey (L.A.FANS-1) to test three hypotheses regarding Hispanic–white differences in SRH. We evaluate whether poorer health reports among Hispanics result from: (1) acculturation and language-related differences in reports; (2) measures of socioeconomic status (SES) that are often omitted in other studies; and (3) somatization of emotional distress by Hispanics. Our results provide new insights into the validity of these explanations and suggest avenues for future research. First, they underscore the importance of language of interview over other measures of acculturation, suggesting that translation issues between the Spanish and English versions of the SRH question may give rise to some of the differences. Second, adjustment for SES—especially years of schooling—narrows, but does not eliminate, the gap between whites’ and Hispanics’ SRH. Finally, although respondents who are depressed are more likely to report poor SRH, this study provides little evidence to support the somatization hypothesis. The second wave of L.A.FANS incorporates new questions that are likely to permit more in-depth assessments of these hypotheses in future analyses.

Gender and health inequalities among adolescents and adults in Brazil, 1998

To assess the extent of gender inequalities in health status and health services utilization among adolescents and adults in Brazil. A representative sample of 217,248 individuals from 15 to 64 years of age was obtained from the National Household Sample Survey (Pesquisa Nacional de Amostras por Domicílios, PNAD) conducted in 1998 by the Brazilian Institute of Geography and Statistics and funded by the Ministry of Health. The study focused on three outcome variables (self-assessed health status, medical visits, and hospitalizations (except childbirth)) and five exposure variables (age, gender, ethnicity, income, and education). Unconditional logistic regression and Mantel-Haenszel stratified analysis was employed. Prevalence rate ratios were calculated for each stratum. Confidence intervals were calculated using the Taylor series, with a 95% confidence interval (95% CI). Women were more likely to report fair or poor health than men (odds ratio (OR) = 1.33; 95% CI: 1.31-1.35). Gender disparities were significant for all ages, household income brackets, and education levels, and were always unfavorable to women (1.17 < or = OR < or = 1.44). Gender disparities for medical visits were higher for those in good health; tended to fall as age, income, and education increased; and were always favorable for women (1.12 < or = OR < or = 2.06). Gender disparities in hospitalization rates decreased with age, varied according to income and education level in each age group, and were always favorable for women (1.16 < or = OR < or = 1.66). The difference in self-reported health status for men and women became even greater after adjusting for socioeconomic variables, suggesting that poorer women have more pronounced, relative differences than men do. The impact of structural determinants, such as education and income, is considerably smaller than the social construct of gender, although the former are more important predictors. Women use health services more often than men do, which is consistent with their health needs. However, medical visit rates show an inverse relationship to health care needs, suggesting an inequitable access to outpatient care, mainly preventive care.

Partners in health? Exploring resemblance in health between partners in married and cohabiting couples

Sociological theories on family formation and families and health suggest that married and cohabiting partners will resemble each other in health status, positively or negatively. The family is often seen as a health-enhancing agent for individuals. However, there are large health differences among families. This study aims to answer the question whether it is the case that the healthy live with the healthy and individuals with poor health have partners who are also in poor health. Moreover, it examines whether resemblance in health is a consequence of partner choice--educational homogamy in particular--behaviour or shared circumstances. Younger and older couples are compared to investigate whether health resemblance increases over the lifecourse. Analyses of a nationally representative sample of almost 12,000 Dutch couples show that partners are indeed significantly alike with regard to several health indicators. Respondents whose partner reports poor health are almost three times more likely to report poor health than respondents whose partner is in good health. There is a strong accumulation of health problems within households. Partner selection with regard to education causes part of the partner resemblance in health. Less support is found for the hypotheses that risk behaviour, mutual influence or the effects of shared circumstances cause similarity between partners' health status. Surprisingly, partners in older couples, who have been together for a longer time, do not resemble each other significantly more than partners in younger couples. The implications of these findings for sociological theory and social inequalities in health are discussed.

Health Inequity among Waged Workers by Employment Status

The purpose of this study was to examine the relationship between the differences in employment status and self assessed health in Korea. We analyzed 4 year follow-up data generated by the Korean Labor and Income Panel Study(KLIPS), which was conducted on 1,207 men and 582 women who had undergone a change in employment status. The study subjects were placed into 1 of the following 4 groups based on their employment history; Non-precarious workers, Precarious to non-precarious workers, Non-precarious to precarious workers and Precarious workers. Logistic regression was then used to examine the relationship between the changes in employment status and self assessed health. When males were considered, self assessed health was better among the precarious to non-precarious workers (OR 1.58, 95% CI=1.57-1.60) and the precarious workers (OR 1.29, 95% CI=1.28-1.30) than in the non-precarious workers, after adjusting for age, socioeconomic status (education level, occupational class, marital status, average equivalent household income and average number of hours worked per week), health behavior (smoking, drinking and exercise) and medical service access (regular medical examination, have chronic disease or hospitalized within 1 year). When female workers were considered, the precarious to non-precarious workers (OR 1.89, 95% CI=1.86-1.92), non-precarious to precarious workers(OR 1.24, 95% CI=1.23-1.26) and precarious workers (OR 1.27, 95% CI=1.25-1.28) all reported poorer health than the non-precarious workers after adjusting for the aforementioned factors. This study showed that changes in employment status were associated with differences in self assessed health among men and women. Specifically, the results of this study showed that a corresponding positive outcome based on self assessed health was greater for employees that changed from precarious to non-precarious jobs and for male employees with precarious jobs, whereas female employees with non-precarious jobs had higher self assessed health. However, additional longitudinal studies on the health effects of employment status should be conducted.