Long term unemployment, income, poverty, and social public expenditure, and their relationship with self-perceived health in Spain (2007-2011)

Extending the PROMIS item bank "ability to participate in social roles and activities": a psychometric evaluation using IRT

OBJECTIVE

Our objective was to explore whether the extension of the PROMIS item bank Ability to Participate in Social Roles and Activities (APSRA) with new items would result in more effective targeting (i.e., selecting items that are appropriate for each individual's trait level), and more reliable measurements across all latent trait levels.

METHODS

A sample of 1,022 Dutch adults completed all 35 items of the original item bank plus 17 new items (in Dutch). The new items presented in this publication have been translated provisionally from Dutch into English for presentation purposes. We evaluated the basic IRT assumptions unidimensionality, local independence, and monotonicity. Furthermore, we examined the item parameters, and assessed differential item functioning (DIF) for sex, education, region, age, and ethnicity. In addition, we compared the test information functions, item parameters, and θ scores, for the original and extended item bank in order to assess whether the measurement range had improved.

RESULTS

We found that the extended item bank was compatible with the basic IRT assumptions and showed good reliability. Moreover, the extended item bank improved the measurement in the lower trait range, which is important for reliably assessing functioning in clinical populations (i.e., persons reporting lower levels of participation).

CONCLUSION

We extended the PROMIS-APSRA item bank and improved its psychometric quality. Our study contributes to PROMIS measurement innovation, which allows for the addition of new items to existing item banks, without changing the interpretation of the scores and while maintaining the comparability of the scores with other PROMIS instruments.

Values, Health and Well-Being of Young Europeans Not in Employment, Education or Training (NEET)

Youth unemployment is a problem that undermines young people's health and well-being and is also a concern for their immediate communities and society. Human values predict health-related behaviour; however, this relation is very little studied and not examined earlier among NEET (not in employment, education or training) young people. This study aimed to explore the association between four higher-order human values (conservation, openness to change, self-enhancement, self-transcendence), self-rated health (SRH) and subjective well-being (SW) among NEET young men and women (n = 3842) across European regions. Pooled European Social Survey data from 2010-2018 were used. First, we run linear regression analysis stratified by European socio-cultural regions and gender. Then, multilevel analyses by gender with interactions were performed. The results show expected variation in value profiles across genders and regions and corresponding differences in SRH and SW. Significant associations between values and SRH and SW were found among both genders and across the regions; however, the results did not entirely confirm the expectations about the "healthiness" of specific values. More likely, prevailing values in societies, such as the social norm to work, might shape these associations. This study contributes to a deeper understanding of the factors affecting NEETs' health and well-being.

Effects of Housing Deprivation on Health: Empirical Evidence from Spain

Severe housing deprivation rates in Spain have tripled in just four years, affecting 3.4% of the population in 2020, with a higher incidence among the low-income population (9.2%). Despite the social aspect of the problem, minimal research has been carried out in Spain on the effects that the various forms of housing deprivation have on health. This study analyzes the impact of housing deprivation on health outcomes, with the objective of achieving results that facilitate the creation of improved public policies. Microdata are used from the Living Conditions Survey carried out by the National Institute of Statistics for the period 2009-2019, and several multilevel logistic regression models are presented to control for possible regional differences. The results show that the elements with the greatest effect on objective health are noise, leaks and harmful temperatures in housing. In addition, environmental factors, such as pollution, neighborhood crime and the number of units in a given apartment building, can be added to the list. As a result, we conclude that there are certain structural and environmental elements in housing and the environment in which is located that have a more intense impact on objective health and on the subjective perception of a person's state of health.

Feasibility of Work-Related Interviewing and Conversational Skills Trainings for Individuals With Psychiatric Disabilities

This study examined the feasibility of group interventions using the Direct Skills Teaching (DST) approach to teach interview preparedness skills (“Presenting Qualifications”) and basic work-related conversational skills (“Conversing with Others”) to individuals with psychiatric disabilities. This quasi-experimental pilot study included 87 participants in Study 1 and 55 participants in Study 2, all with various psychiatric diagnoses. Each group intervention consisted of four sessions delivered by graduate counseling students. Participants reported increased confidence in presenting qualifications at interviews in Study 1, and in conversational skills at work in Study 2. Participants in both studies reported high levels of satisfaction with the respective group intervention. The results of the study supported the feasibility of DST group interventions designed to teach work-related skills to individuals with psychiatric disabilities.

Snus and Alcohol: Mutually Rewarding Effects in the Brain? A Matched Controlled Population Study

Background:

The use of moist smokeless tobacco (snus) is increasing in the U.S. and other Western countries, and especially among young people. Snus is associated with several health problems, but the relationship between use of snus and alcohol is scarcely explored. Neuro-cognitive and psychological research suggest an association due to possible mutually rewarding effects in the limbic brain. We investigated this issue in a matched controlled population study.

Methods:

Matched control group design where drinking habits and alcohol consumption in a group of users of snus (n = 1043, mean age = 35.20; n men = 749, n women = 294) were compared to a control group of non-users matched on age and gender (n = 1043, mean age = 35.65; n men = 749, n women = 294). In addition, we registered background variables such as level of education, income, self-perceived general, dental health, mental health, current depressive symptoms, and BMI. In estimation of alcohol consumption, the background variables were used as covariates in factorial analyses of variance (ANCOVA).

Results:

Users of snus had lower level of education, lower income, poorer general, dental, and mental health status than non-users, but there were no differences in BMI. Differences in mental health status were related to drinking habits. Users of snus had a higher frequency of drinking, higher frequency of intoxication, and showed more excess drinking. Controlled for background variables users of snus had a 25.2% higher estimated yearly consumption of alcohol in terms of standard units of alcohol on the weekdays, 26.4% higher on weekends and a 60.2% higher yearly excess consumption.

Conclusion:

Users of snus had an elevated alcohol consumption and another drinking style than non-users. The findings are discussed according to neuro-cognitive and psychopharmacological mechanisms, reward learning and conditioning. The results have implications for prevention, treatment and rehabilitation of alcohol and nicotine dependence.

Comparison of inequity in health-related quality of life among unemployed and employed individuals in China

BACKGROUND

In China, achieving health equity has been regarded as a key issue for health reform and development in the current context. It is well known that unemployment has a negative effect on health. However, few studies have addressed the association between unemployment and inequity in health-related quality of life (HRQOL). This study aims to compare the inequality and inequity in HRQOL between the unemployed and employed in China.

METHODS

The material regarding this study was derived from the Chinese National Health Services Survey of Shaanxi Province for 2013. We controlled for confounding factors by utilizing the coarsened exact matching method. Finally, 7524 employed individuals and 283 unemployed individuals who were 15 to 64 years old in urban areas were included in this study. We used HRQOL as the outcome variable, which was evaluated by using the Chinese version of EQ-5D-3L. The health concentration index, decomposition analysis based on the Tobit model, and the horizontal inequity index were employed to compute the socioeconomic-related equity between the unemployed and employed and the contribution of various factors.

RESULTS

After matching, unemployed people tended to have poorer EQ-5D utility scores than employed people. There were statistically pro-rich inequalities in HRQOL among both employed and unemployed people, and the pro-rich health inequity of unemployed people was substantially higher than that of employed people. Economic status, age, education, smoking and health insurance were the factors influencing inequality in HRQOL between employed and unemployed individuals. Education status and basic health insurance have reduced the pro-rich inequity in HRQOL for unemployed people.

CONCLUSION

It is suggested that unemployment intensifies inequality and inequity in HRQOL. According to policymakers, basic health insurance is still a critical health policy for improving health equity for the unemployed. Intervention initiatives aiming to tackle long-term unemployment through active labour market programmes, narrow economic gaps, improve educational equity and promote the health status of the unemployed should be considered by the government to achieve health equity.

Unemployment and Psychological Distress among Young People during the COVID-19 Pandemic: Psychological Resources and Risk Factors

In the wake of COVID-19, unemployment and its potential deleterious consequences have attracted renewed interest. We examined (1) the association between unemployment, occurring upon the coronavirus outbreak, and psychological distress among Israeli young people (20–35-years-old); (2) the associations between various psychological resources/risk factors and psychological distress; and (3) whether these resources and risk factors were moderators in the unemployment-psychological distress link. A real-time survey based on snowball sampling was conducted during the month of April 2020 (N = 390). We employed hierarchical linear models to explore associations between unemployment, psychological resources, risk factors, and psychological distress. Unemployment was independently associated with greater psychological distress. Perceived trust, optimism, and sense of mastery decreased psychological distress, whereas financial strain and loneliness during the crisis increased this distress. The effect of unemployment on psychological distress did not depend on participants’ resource and risk factor levels. Policymakers must develop and extend health initiatives aimed at alleviating the mental health consequences of COVID-19-related unemployment and promote labor market interventions to help young job seekers integrate into employment. These measures, which are in line with the UN sustainable development goals, should be seen as an important route to promote public health.

Studying the impact of the Eurozone's Great Recession on health: Methodological choices and challenges

Europe's Great Recession provides an opportunity to study the impact of increased financial insecurity on health. A number of studies explored the impact of the Recession on health, but they often reached different conclusions. To understand the root of this debate, we undertook a systematic literature review. Articles were analysed thematically based on: geography, data type, operationalisations of wealth and health, and study design. A critical appraisal was also undertaken. Forty-two studies, published from January 2010 to October 2018, were included in our review. Twenty-six of the forty-two studies found that the Great Recession worsened physical health indicators in the Eurozone. In terms of geography, a large concentration of studies focussed on Spain and Greece, indicating that there may be a gap in understanding the health consequences for EU countries with less severe experiences of the Recession. Regarding data type, nearly all studies used secondary datasets, possibly meaning that studies were constrained by the data available. In terms of operationalisations of wealth and health, a majority of studies used single/simple measures of both, so that these multi-faceted concepts were not fully reflected. Further, fewer than half included studies used panel data, with the remaining studies unable to undertake more causal analyses. The results of the critical appraisal showed that lower-quality studies tended to not find a negative impact of the Recession on health, whereas higher quality studies generally did. In future, we recommend conducting cross-country comparisons, using (inter)nationally-representative panel data conducted over a minimum of a ten-year time horizon, and employing multi-faceted operationalisations of wealth and health. This could provide more common ground across studies, and a clearer indication of whether the Recession impacted health.

[How does the employment status influence the effects of residential insecurity on health?]

OBJECTIVE

This study aims to analyze the effects of housing insecurity on health and if those are modified by employment status of people belonging to "Treball als Barris" program in Barcelona between 2015 and 2016.

METHODS

We conducted a longitudinal study using a survey which included sociodemographic, employment and housing status information. This was administered to 469 individuals attended by "Treball als Barris" at baseline and after one year of follow-up. Then, we carried out a descriptive analysis and fitted regression models to estimate the effects of housing insecurity and employment status on health, and the interaction between them.

RESULTS

Among women, we found negative effects of housing insecurity on health (PR of poor self-reported health among women who stayed under housing insecurity was 2.29 [IC95%: 1.36-3.84] compared to those who stayed secured), while, among men, main effects on health were due to employment status (PR of poor self-reported health among men who were unemployed without subsidy was 3.16 [IC95%: 1.02-6.15] compared to those who were employed after follow-up). In addition, results suggest an interaction between housing and employment status on mental health among.

DISCUSSION

Housing insecurity rates have increased in last years. It produces negatives effects on health and can interact with other social determinants such as employment, mainly on men's mental health.

Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review

BACKGROUND

Our main objective was to evaluate the fundamental biases detected in studies assessing the effects the Great Recession had on health for the case of Spain. As secondary objectives we presented methods to control these biases and to discuss the results of the studies in question if they had controlled for them.

METHODS

We carried out a systematic review of the literature published up to June 2018. We evaluated the biases that could have happened in all the eligible studies.

RESULTS

From the review, we finally selected 53 studies. Of the studies we reviewed, 60.38% or 32 out of 53, were evaluated as having a high risk of bias. The main biases our review revealed were problems with evaluation, time bias, lack of control of unobserved confounding, and non-exogeneity when defining the onset of the Great Recession.

CONCLUSIONS

The results from the studies that controlled the biases were quite consistent. Summing up, the studies reviewed found that the Great Recession increased the risk of declaring poor self-rated health and the deterioration of mental health. Both the mortality rate and the suicide rate may well have increased after the Great Recession, probably after a three- to four-year delay.

Dose-response relation of self-reported and accelerometer-measured physical activity to perceived health in middle age-the Northern Finland Birth Cohort 1966 Study

Background

Regular physical activity (PA) promotes health and decreases mortality. The positive relationship between PA and perceived health (PH) is well known. However, previous research in the field has often used self-reported PA measures. The aim of this population-based NFBC1966 birth cohort study was to assess the relationship between both self-reported and objectively measured PA and PH in midlife.

Methods

A sample group of 6384 participants (2878 men, 3506 women, response rate 62%) aged 46 completed a questionnaire on PH and health behaviors, including items on weekly leisure time physical activity (LTPA) and daily sitting time (ST). PH was dichotomized as good (very good or good) and other (fair, poor, or very poor). PA was measured with a wrist-worn Polar Active (Polar Electro, Finland) accelerometer for 14 days (n = 5481, 98%) and expressed as daily average time spent in moderate to vigorous intensity PA (MVPA). Odds ratios (OR) and 95% confidence intervals for good PH were calculated using binary logistic regression and adjusted for relevant demographic, socioeconomic, and health characteristics, and ST.

Results

The level of PA was positively associated with PH after adjustments with covariates and ST. There was a dose-response relationship across the PA quartiles according to the adjusted multivariable models. Self-reported LTPA was more strongly associated with good PH (OR from 1.72 to 4.33 compared to lowest PA quartile) than objectively measured PA (OR from 1.37 to 1.66 compared to lowest PA quartile).

Conclusions

In this large population-based birth cohort study, we for the first time show a positive dose-response relationship of both self-reported and objectively measured PA to PH, the relationship being stronger for self-reported LTPA. Despite the cross-sectional design of this study, the results from this large sample suggest that both self-reported and objectively measured physical activity are strongly associated with PH, which is a predictor of morbidity and mortality, and regular PA should be encouraged in midlife.