Health and well-being of movers in rural and urban areas--a grid-based analysis of northern Finland birth cohort 1966

Associations between neighbourhood characteristics, physical activity and depressive symptoms: the Northern Finland Birth Cohort 1966 Study

BACKGROUND

Due to rapid urbanization, there is a need to better understand the relative roles of residential environment and physical activity in depression. We aimed to investigate whether neighbourhood characteristics are related to the presence of depressive symptoms and whether the association is modified by physical activity.

METHODS

This cross-sectional study used the 46-year-old follow-up data (n = 5489) from the Northern Finland Birth Cohort 1966. Data on depressive symptoms, measured by Beck Depression Inventory-II, and self-reported and accelerometer-measured physical activity were included. Neighbourhood characteristics, population density, distance to the closest grocery store, bus stops and cycle/pedestrian paths, distance to the nearest parks and forests, residential greenness and level of urbanicity were calculated using Geographic Information System methods based on participants' home coordinates.

RESULTS

According to ordinal logistic regression analyses adjusted for physical activity at different intensities and individual covariates, living in a neighbourhood with higher population density and urbanicity level were associated with a higher risk of experiencing more severe depressive symptoms. Higher residential greenness was associated with a lower risk of experiencing more severe depressive symptoms after adjustment for self-reported light and moderate-to-vigorous physical activity, accelerometer-measured moderate-to-vigorous physical activity and individual covariates. Both higher self-reported and accelerometer-measured physical activity were independently associated with a lower risk of more severe depressive symptoms.

CONCLUSIONS

Both residential environment and physical activity behaviour play an important role in depressive symptoms; however, further research among populations of different ages is required. Our findings can be utilized when designing interventions for the prevention of depression.

Association of travel time with mental health service use in primary health care according to contact type - a register-based study in Kainuu, Finland

BACKGROUND

The study aim was to analyse how mental health services are used in different parts of the Kainuu region in Finland and whether travel time to primary health care services is associated with the use of different contact types (in-person visits, remote contacts, home visits).

METHODS

The study population included adults who had used mental health services under primary health care (N = 7643) between 2015 and 2019. The travel times to the nearest health centre in a municipality were estimated as the population-weighted average drive time in postal code areas. The Kruskal-Wallis test and pairwise comparisons with Dunn-Bonferroni post hoc tests were used to assess the differences in mental health service use between health centre areas. A negative binomial regression was performed for the travel time categories using different contact types of mental health service use as outcomes. Models were adjusted for gender, age, number of mental health diseases and the nearest health centre in the municipality.

RESULTS

Distance was negatively associated with mental health service use in health centre in-person visits and in home visits. In the adjusted models, there were 36% fewer in-person visits and 83% fewer home visits in distances further than 30 min, and 67% fewer home visits in a travel time distance of 15-30 min compared with 15 min travel time distance from a health centre. In the adjusted model, in remote contacts, the incidence rate ratios increased with distance, but the association was not statistically significant.

CONCLUSIONS

The present study revealed significant differences in mental health service use in relation to travel time and contact type, indicating possible problems in providing services to distant areas. Long travel times can pose a barrier, especially for home care and in-person visits. Remote contacts may partly compensate for the barrier effects of long travel times in mental health services. Especially with conditions that call for the continuation and regularity of care, enabling factors, such as travel time, may be important.

Gender differences in association of urbanization with psychological stress in Chinese adults: A population-based study

Objective

To investigate the gender-specific associations between exposure to urbanization and psychological stress in China experiencing rapid urbanization.

Methods

Data were obtained from the 2015 China Health and Nutrition Survey. A total of 4,388 men and 5,098 women aged at least 18 years were obtained from 288 communities across 12 provinces and municipalities. Tertiles of the urbanization index, summarizing 12 urbanization dimensions at the community level, were used to define low, medium, and high levels of urbanization. The psychological stress was measured based on the 10-item Perceived Stress Scale. The gender-stratified multilevel analysis (Level-1: Individuals, Level-2: Communities, and Level-3: provinces/municipalities) was used to estimate the association between exposure to urbanization and psychological stress.

Results

After controlling for age, education status, marital status, work status, household income per capita, current smoking, alcohol drinking, sleep duration, BMI, and chronic conditions, the urbanization index was negatively associated with psychological stress in women (P _trend = 0.017) but not men (P _trend = 0.476). More specifically, a one-standard deviation increase in the score of community population density (β = -0.329, P = 0.329), modern markets (β = -0.247, P = 0.044), education (β = -0.448, P = 0.002), and housing (β = -0.380, P = 0.005) was negatively associated with psychological stress only in women, separately.

Conclusion

Our data revealed that living in the most urbanized communities is associated with lower levels of psychological stress for women but not men. Thus, this study can help empower decision-makers to accurately target vulnerable communities and plan effective strategies to address psychological outcomes.

The importance of home: Satisfaction with accommodation, neighborhood, and life in adults with autism

Although good quality housing and a socially cohesive neighborhood are associated with a higher well‐being in the general population, housing is a rarely studied topic in autism research. In the present study, we describe the housing situation of a large sample of adults with autism and mostly (above) average intellectual abilities (n = 1429; 17 to 84 years), and examine predictors of independent living, accommodation satisfaction, neighborhood satisfaction, and satisfaction with life based on an online survey. The outcomes of independently living adults were compared with those from a Dutch community sample (n = 929). Nearly 80% of the autistic adults lived independently. Older participants, women, and those with higher self‐reported IQ's were more likely to live independently. Autistic adults living independently were equally satisfied with their accommodation and neighborhood as the comparison group, but were less satisfied with their life in general. In both groups, higher satisfaction with accommodation and neighborhood was associated with higher life satisfaction. We advocate further research to better understand and anticipate the housing needs of the growing group of adults with autism.

Physical, emotional, and practical concerns, help-seeking and unmet needs of rural and urban dwelling adult cancer survivors

PURPOSE

This study explores the influence of residency location on the experiences of cancer survivors. The influence of where individuals live during cancer screening, diagnosis, and treatment has been described in various countries. However, understanding the context of residency on experiences during survivorship has received less attention.

METHODS

A survey was designed to assess experiences of cancer survivors transitioning to follow-up care. Descriptive statistics were used to contrast physical, emotional, and practical concerns, help-seeking, and unmet needs of rural and urban dwelling respondents. Difference in proportions of greater than 5% were considered clinically meaningful.

RESULTS

In total, 13,319 respondents completed the survey of which 4646 met the criteria for rural dwelling (e.g., living in villages or towns with 10,000 or less residents or on an acreage, ranch, or farm). Proportions of respondents in rural and urban groups were similar in terms of level of concerns. Differences were observed for help seeking regarding return to work and for difficulty in obtaining help regarding taking care of children and other family members, changes in relationships with family, friends and co-workers, and getting to and from appointments. Unmet needs existed across all domains and were similar in both groups. A larger proportion of rural dwelling respondents experienced unmet needs regarding return to work.

CONCLUSIONS

[implications]: High proportions of cancer survivors experienced concerns following cancer treatment. However, rural dwelling survivors were more challenged in obtaining help for selected concerns. Implications exist for development of community-based support services in rural settings.

Are the Sick Left Behind at the Peripheries? Health Selection in Migration to Growing Urban Centres in Finland

We study health selection in rural–urban migration in Finland using register data. Specifically, we ask whether ‘movers’ differ from ‘stayers’ in their use of special health care services prior to moving. We focus on migration to twelve growing urban centres in different sub-groups of the population as well as in different regions, using multinomial logistic regression and multilevel modelling and by distinguishing between short- and long-distance moves. The results show that urban centres attract healthier individuals, while people with health problems are also prone to move, but not to urban centres. The results were similar when looking only at psychiatric diagnoses. The findings suggest that it is important to distinguish between different types of moves when studying health-selective migration. Studying the patterns of migration according to health enables us to understand drivers of regional health differences. Moreover, such evidence will help in projecting future demand for healthcare across the country.

What is known about the role of rural-urban residency in relation to self-management in people affected by cancer who have completed primary treatment? A scoping review

Purpose

Despite wide acknowledgement of differences in levels of support and health outcomes between urban and rural areas, there is a lack of research that explicitly examines these differences in relation to self-management in people affected by cancer following treatment. This scoping review aimed to map the existing literature that examines self-management in people affected by cancer who were post-treatment from rural and urban areas.

Methods

Arksey and O’Malley’s framework for conducting a scoping review was utilised. Keyword searches were performed in the following: Academic Search Complete, CINAHL, MEDLINE, PsycINFO, Scopus and Web of Science. Supplementary searching activities were also conducted.

Results

A total of 438 articles were initially retrieved and 249 duplicates removed leaving 192 articles that were screened by title, abstract and full text. Nine met the eligibility criteria and were included in the review. They were published from 2011 to 2018 and conducted in the USA (n = 6), Australia (n = 2) and Canada (n = 1). None of the studies offered insight into self-managing cancer within a rural-urban context in the UK. Studies used qualitative (n = 4), mixed methods (n = 4) and quantitative designs (n = 1).

Conclusion

If rural and urban populations define their health in different ways as some of the extant literature suggests, then efforts to support self-management in both populations will need to be better informed by robust evidence given the increasing focus on patient-centred care. It is important to consider if residency can be a predictor of as well as a barrier or facilitator to self-management.

Is geographical distance a barrier in the use of public primary health services among rural and urban young adults? Experience from Northern Finland

OBJECTIVES

To study the role of distance in public primary health service use in rural and urban local residential areas (1 km² grids) among the young adults of the Northern Finland Birth Cohort 1966 (N = 4503).

STUDY DESIGN

Cross-sectional study of a cohort born in Northern Finland in 1966.

METHODS

Use of local health centres was surveyed by postal questionnaire in 1997, and distance from study subjects' home to health centre was calculated along road network. The crude and adjusted incidence rate ratios (IRR) and their 95% confidence intervals were calculated for distance, predisposing and illness-level variables. Distance-related health inequity indices were calculated.

RESULTS

The IRRs indicated 1.5-fold higher rate of health centre visits among subjects living farther than 10 km compared to subjects living within 2 km from health centre in urban areas. In rural areas, IRRs indicated no significant association with distance and health centre use. No distance-related inequity in the use of health centre services was found.

CONCLUSIONS

Distance does not seem to be major barrier in health service use among these 31-year old adults. However, closer study of some groups, such as the rural unemployed, might be valuable.

Does conurbation affect the risk of poor mental health? A population based record linkage study

To determine if urban residence is associated with an increased risk of anxiety/depression independent of psychosocial stressors, concentrated disadvantage or selective migration between urban and rural areas, this population wide record-linkage study utilised data on receipt of prescription medication linked to area level indicators of conurbation and disadvantage. An urban/rural gradient in anxiolytic and antidepressant use was evident that was independent of variation in population composition. This gradient was most pronounced amongst disadvantaged areas. Migration into increasingly urban areas increased the likelihood of medication. These results suggest increasing conurbation is deleterious to mental health, especially amongst residents of deprived areas.

Residential mobility and the association between physical environment disadvantage and general and mental health

BACKGROUND

Selective migration may influence the association between physical environments and health. This analysis assessed whether residential mobility concentrates people with poor health in neighbourhoods of the UK with disadvantaged physical environments.

METHODS

Data were from the British Household Panel Survey. Moves were over 1 year between adjacent survey waves, pooled over 10 pairs of waves, 1996-2006. Health outcomes were self-reported poor general health and mental health problems. Neighbourhood physical environment was defined using the Multiple Environmental Deprivation Index (MEDIx) for wards. Logistic regression analysis compared risk of poor health in MEDIx categories before and after moves. Analyses were stratified by age groups 18-29, 30-44, 45-59 and 60+ years and adjusted for age, sex, marital status, household type, housing tenure, education and social class.

RESULTS

The pooled data contained 122 570 observations. 8.5% moved between survey waves but just 3.0% changed their MEDIx category. In all age groups odds ratios for poor general and mental health were not significantly increased in the most environmentally deprived neighbourhoods following moves.

CONCLUSIONS

Over a 1-year time period residential moves between environments with different levels of multiple physical deprivation were rare and did not significantly raise rates of poor health in the most deprived areas.

A break in the obesity epidemic? Explained by biases or misinterpretation of the data?

Recent epidemiologic papers are presenting prevalence data suggesting breaks and decreases in obesity rates. However, before concluding that the obesity epidemic is not increasing anymore, the validity of the presented data should be discussed more thoroughly. We had a closer look into the literature presented in recent reviews to address the major potential biases and distortions, and to develop insights about how to interpret the presented suggestions for a potential break in the obesity epidemic. Decreasing participation rates, the use of reported rather than measured data and small sample sizes, or lack of representativeness, did not seem to explain presented breaks in the obesity epidemic. Further, available evidence does not suggest that stabilization of obesity rates is seen in higher socioeconomic groups only, or that urbanization could explain a potential break in the obesity epidemic. However, follow-ups of short duration may, in part, explain the apparent break or decrease in the obesity epidemic. On the other hand, a single focus on body mass index (BMI) ⩾25 or ⩾30 kg m(-)(2) is likely to mask a real increase in the obesity epidemic. And, in both children and adults, trends in waist circumferences were generally suggesting an increase, and were stronger than those reported for trends in BMI. Studies concluding that there is a recent break in the obesity epidemic need to be interpreted with caution. Reported studies presenting a break were mostly of short duration. Further, focusing on trends in waist circumference rather than BMI leads to a less optimistic conclusion: the public health problem of obesity is still increasing.

Quality of life in urban and rural settings: a study of head and neck cancer survivors

OBJECTIVE

Urban-rural variation in cancer incidence, treatment, and clinical outcomes has been well researched. With the growing numbers and longer lifespan of cancer survivors, quality of life (QOL) is now a critical issue. The present study investigates the QOL of head and neck cancer (HNC) survivors in Ireland, paying special attention to urban and rural variation.

METHODS

From the population-based National Cancer Registry Ireland, we identified 991 survivors of HNC (ICD10 C00-C14, C32), who were at least eight months post-diagnosis, and invited them to complete a postal survey. We used self-reported data and information from the Registry to create a composite variable classifying respondents' current area of residence as "urban" or "rural." Respondents self-reported QOL using the Functional Assessment for Cancer Therapy with Head and Neck module (FACT-HN). We used bootstrap linear regression to control for confounding variables, while estimating the association of urban and rural residence to FACT-HN domain scores.

RESULTS

We obtained survey and Registry data from 583 HNC survivors. Controlling for demographic and clinical variables, rural survivors reported higher physical (coefficient 1.27, bias-corrected and accelerated 95% confidence interval 0.54, 2.43), emotional (coef. 0.99, 95% CI 0.21, 2.02), and HNC-specific (coef. 1.55, 95% CI 0.32, 3.54) QOL than their urban counterparts. Social and functional QOL did not differ significantly.

CONCLUSIONS

These findings add to growing evidence of important differences in life experiences of cancers survivors in urban and rural settings. Results such as these will allow health professionals, policy makers and service providers to better serve these populations.