Suchergebnisse

BACKGROUND: Global climate change impacts on human and natural systems are predicted to be severe, far reaching, and to affect the most physically and economically vulnerable disproportionately. Society can respond to these threats through two strategies: mitigation and adaptation. Industry, commerce, and government play indispensable roles in these actions but so do individuals, if they are receptive to behavior change. We explored whether the health frame can be used as a context to motivate behavioral reductions of greenhouse gas emissions and adaptation measures. METHODS: In 2008, we conducted a cross-sectional survey in the United States using random digit dialing. Personal relevance of climate change from health threats was explored with the Health Belief Model (HBM) as a conceptual frame and analyzed through logistic regressions and path analysis. RESULTS: Of 771 individuals surveyed, 81% (n = 622) acknowledged that climate change was occurring, and were aware of the associated ecologic and human health risks. Respondents reported reduced energy consumption if they believed climate change could affect their way of life (perceived susceptibility), Odds Ratio (OR) = 2.4 (95% Confidence Interval (CI): 1.4-4.0), endanger their life (perceived severity), OR = 1.9 (95% CI: 1.1-3.1), or saw serious barriers to protecting themselves from climate change, OR = 2.1 (95% CI: 1.2-3.5). Perceived susceptibility had the strongest effect on reduced energy consumption, either directly or indirectly via perceived severity. Those that reported having the necessary information to prepare for climate change impacts were more likely to have an emergency kit OR = 2.1 (95% CI: 1.4-3.1) or plan, OR = 2.2 (95% CI: 1.5-3.2) for their household, but also saw serious barriers to protecting themselves from climate change or climate variability, either by having an emergency kit OR = 1.6 (95% CI: 1.1-2.4) or an emergency plan OR = 1.5 (95%CI: 1.0-2.2). CONCLUSIONS: Motivation for voluntary mitigation is mostly dependent on perceived susceptibility to threats and severity of climate change or climate variability impacts, whereas adaptation is largely dependent on the availability of information relevant to climate change. Thus, the climate change discourse could be framed from a health perspective to motivate behaviour change.

AbstractOnly children's uniqueness has intrigued researchers for decades, but many gaps in knowledge remain as to whether only children differ from children who have siblings. We use data from four British birth cohorts (born in 1946, 1958, 1970, 2000–2002) to investigate cross‐cohort differences in the composition of only child families and whether the association between being an only child and cognitive ability in childhood has changed over time. Only children show similar scores to children from two child families and higher scores than children with two or more siblings across each of the cohorts analyzed. However, the results also show that—consistent with the finding that, across cohorts, the composition of the only child group has become more associated with social disadvantage—the "only child advantage" has weakened when comparing the most recent birth cohort to the older ones. Adjustment by family sociodemographic characteristics attenuates within and cross‐cohort differences. Moreover, the results show that the cognitive advantages associated with being an only child vary considerably by whether the cohort member has been exposed to parental separation or is growing up in a family with lower socioeconomic status. The results highlight diversity in being an only child whose characteristics are conditional on changes throughout time and society.

Equity in healthcare has been a long-term guiding principle of health policy in India. We estimate the change in horizontal inequities in healthcare use over two decades comparing the older population (60 years or more) with the younger population (under 60 years). We used data from the nationwide healthcare surveys conducted in India by the National Sample Survey Organization in 1995-96 and 2014 with sample sizes 633 405 and 335 499, respectively. Bivariate and multivariate logit regression analyses were used to study the socioeconomic differentials in self-reported morbidity (SRM), outpatient care and untreated morbidity. Deviations in the degree to which healthcare was distributed according to need were measured by horizontal inequity index (HI). In each consumption quintile the older population had four times higher SRM and outpatient care rate than the younger population in 2014. In 1995-96, the pro-rich inequity in outpatient care was higher for the older (HI: 0.085; 95% CI: 0.066, 0.103) than the younger population (0.039; 0.034, 0.043), but by 2014 this inequity became similar. Untreated morbidity was concentrated among the poor; more so for the older (-0.320; -0.391, -0.249) than the younger (-0.176; -0.211, -0.141) population in 2014. The use of public facilities increased most in the poorest and poor quintiles; the increase was higher for the older than the younger population in the poorest (1.19 times) and poor (1.71 times) quintiles. The use of public facilities was disproportionately higher for the poor in 2014 than in 1995-96 for the older (-0.189; -0.234, -0.145 vs - 0.065; -0.129, -0.001) and the younger (-0.145; -0.175, -0.115 vs - 0.056; -0.086, -0.026) population. The older population has much higher morbidity and is often more disadvantaged in obtaining treatment. Health policy in India should pay special attention to equity in access to healthcare for the older population.

OBJECTIVES: We report hospitalisation trends for different age groups across the states of India and for various disease groups, compare the hospitalisation trends among the older (aged 60 years or more) and the younger (aged under 60 years) population and quantify the factors that contribute to the change in hospitalisation rates of the older population over two decades. DESIGN: Serial cross-sectional study. SETTING: Nationally representative sample, India. DATA SOURCES: Three consecutive National Sample Surveys (NSS) on healthcare utilisation in 1995-1996, 2004 and 2014. PARTICIPANTS: Six hundred and thirty-three thousand four hundred and five individuals in NSS 1995-1996, 385 055 in NSS 2004 and 335 499 in NSS 2014. METHODS: Descriptive statistics, multivariable analyses and a regression decomposition technique were used to attain the study objectives. RESULT: The annual hospitalisation rate per 1000 increased from 16.6 to 37.0 in India from 1995-1996 to 2014. The hospitalisation rate was about half in the less developed than the more developed states in 2014 (26.1 vs 48.6 per 1000). Poor people used more public than private hospitals; this differential was higher in the more developed (40.7% vs 22.9%) than the less developed (54.3% vs 40.1%) states in 2014. When compared with the younger population, the older population had a 3.6 times higher hospitalisation rate (109.9 vs 30.7) and a greater proportion of hospitalisation for non-communicable diseases (80.5% vs 56.7%) in 2014. Among the older population, hospitalisation rates were comparatively lower for females, poor and rural residents. Propensity change contributed to 86.5% of the increase in hospitalisation among the older population and compositional change contributed 9.3%. CONCLUSION: The older population in India has a much higher hospitalisation rate and has continuing greater socioeconomic differentials in hospitalisation rates. Specific policy focus on the requirements of the older population for hospital care in India is needed in light of the anticipated increase in their proportion in the population.

Background:Life course trajectories of affective symptoms (depression and anxiety) are heterogenous. However, few studies have investigated the role of early life risk factors in the development of these trajectories. The present study aimed to: (1) derive latent trajectories of affective symptoms over a period of more than 50 years (ages 13–69), and (2) examine early life risk factors for associations with specific life course trajectories of affective symptoms.
Method:Participants are from the MRC National Survey of Health and Development (NSHD) (n = 5,362). Affective symptoms were measured prospectively at ages 13, 15, 36, 43, 53, 60–64 and 69. A latent variable modelling framework was implemented to model longitudinal profiles of affective symptoms. Twenty-four prospectively measured early life predictors were tested for associations with different symptom profiles using multinomial logistic regression.
Results:Four life course profiles of affective symptoms were identified: (1) absence of symptoms (66.6% of the sample); (2) adolescent symptoms with good adult outcome (15.2%); (3) adult symptoms only (with no symptoms in adolescence and late life) (12.9%); (4) symptoms in adolescence and mid adulthood (5.2%). Of the 24 early life predictors observed, only four were associated with life course trajectories, with small effect sizes observed.
Conclusions:People differ in their life course trajectories of anxiety and depression symptoms and that these differences are not largely influenced by early life factors tested in this study.

The research leading to these results has received funding from the European Research Council under the European Union's Seventh Framework Programme (FP7/2007-2013)/ ERC grant agreement n° 324055. ; Background: Marital and partnership history is strongly associated with health in midlife and later life. However, the role of health behaviours as an explanatory mechanism remains unclear. The aim of this study was to investigate prospective associations between life-course partnership trajectories (taking into account timing, non-marital cohabitation, remarriage and marital transitions) and health behaviours measured in midlife. Methods: We analysed data from the British National Child Development Study, a prospective cohort study that includes all people born in 1 week of March 1958 (N=10 226). This study included men and women with prospective data on partnership history from age 23 to 42–44 and health behaviours collected at ages 42–46 (2000–2004). Latent class analysis was used to derive longitudinal trajectories of partnership history. We used multivariable regression models to estimate the association between midlife health behaviours and partnership trajectory, adjusting for various early and young adult characteristics. Results: After adjustment for a range of potential selection factors in childhood and early adulthood, we found that problem drinking, heavy drinking and smoking were more common in men and women who experienced divorce or who had never married or cohabited. Women who married later had a lower prevalence of smoking and were less likely to be overweight than those who married earlier. Overall marriage was associated with a higher body mass index. Individuals who never married or cohabited spent less time exercising. Conclusions: Some aspects of partnership history such as remaining unpartnered and experiencing divorce are associated with more smoking and drinking in midlife, whereas marriage is associated with midlife weight gain. Despite these offsetting influences, differences in health behaviours probably account for much of the association between partnership trajectories and health found in previous studies. ; Publisher PDF ; Peer reviewed

This article addresses the question of whether attending a private school affects voting behaviour and political attitudes in adulthood in Britain. The analysis is based upon the British Cohort Study, a nationally representative cohort of children born in one week in April 1970. The 'effect' of attending a private school on the tendency to vote Conservative in four consecutive General Elections, and on the expression of conservative attitudes in mid-life is assessed using path analysis. The model includes multiple indicators for a range of antecedents: social origins at birth, cultural and material capital, academic achievements and early social class destination. Once these antecedents are included in the model, for both men and women a direct positive relationship remains between attending private school and voting Conservative and holding right-leaning attitudes. The main significance of these findings follows from the high proportion of private school alumni in influential positions in public life.

Non-response is common in longitudinal surveys, reducing efficiency and introducing the potential for bias. Principled methods, such as multiple imputation, are generally required to obtain unbiased estimates in surveys subject to missingness which is not completely at random. The inclusion of predictors of non-response in such methods, for example as auxiliary variables in multiple imputation, can help improve the plausibility of the missing at random assumption underlying these methods and hence reduce bias. We present a systematic data-driven approach used to identify predictors of non-response at Wave 8 (age 25–26) of Next Steps, a UK national cohort study that follows a sample of 15,770 young people from age 13–14 years. The identified predictors of non-response were across a number of broad categories, including personal characteristics, schooling and behaviour in school, activities and behaviour outside of school, mental health and well-being, socio-economic status, and practicalities around contact and survey completion. We found that including these predictors of non-response as auxiliary variables in multiple imputation analyses allowed us to restore sample representativeness in several different settings, though we acknowledge that this is unlikely to universally be the case. We propose that these variables are considered for inclusion in future analyses using principled methods to explore and attempt to reduce bias due to non-response in Next Steps. Our data-driven approach to this issue could also be used as a model for investigations in other longitudinal studies.

Mediation Analysis for Life Course Studies: Bianca De Stavola & Rhian Daniel -- Lifelong socio-economic position and later life health related behaviour: A formal mediation approach: George B. Ploubidis, Lenka Benova, Bianca DeStavola & Emily Grundy -- Physical activity: a moderator or mediator in the association between fertility history and later life health?: Sanna Read & Emily Grundy -- Self-rated health over the life course: Evidence from the 1958 and 1970 British birth cohorts:George B. Ploubidis & Benedetta Pongiglione

The impact of integrated reproductive health and HIV services on HIV testing and counseling (HTC) uptake was assessed among 882 Kenyan family planning clients using a nonrandomized cohort design within six intervention and six "comparison" facilities. The effect of integration on HTC goals (two tests over two years) was assessed using conditional logistic regression to test four "integration" exposures: a training and reorganization intervention; receipt of reproductive health and HIV services at recruitment; a functional measure of facility integration at recruitment; and a woman's cumulative exposure to functionally integrated care across different facilities over time. While recent receipt of HTC increased rapidly at intervention facilities, achievement of HTC goals was higher at comparison facilities. Only high cumulative exposure to integrated care over two years had a significant effect on HTC goals after adjustment (aOR 2.94, 95%CI 1.73‐4.98), and programs should therefore make efforts to roll out integrated services to ensure repeated contact over time.