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PubMed1999

[The perceptions of the adult Spanish population of the factors determinative of health].

OBJECTIVE: To assess which are the most important perceived influential factors on health among the Spanish adult population. This may provide sufficient information to promote primary health care campaigns directed specifically to those that acknowledge that lifestyles are important in spite of not living healthy lifestyles themselves. DESIGN: Observational cross-sectional study. SETTING: Spain (Canary Islands not included). PARTICIPANTS: A representative sample of 1000 Spanish participants over 15 years old selected by a multistage procedure. INTERVENTION: Survey to evaluate the population choosing one of nine known health-related factors (smoking, food, alcohol intake, stress, physical activity, environment, body weight, support from family, genetics) as being one of the two most important factors influencing health through a validated questionnaire. MEASUREMENTS AND RESULTS: The chi-square test for linear trend was used to assess the influence of factors coded on an ordinal scale. The Pearson chi-square test was applied for categorical factors. Smoking was considered the most influential health-related factor by most participants (47.8%). Males, those from lower socioeconomic and educational levels; people living in the south of Spain, and rural regions; those married and individuals who had 3 or more children below 15 years, perceived smoking more often as one of the most important determinants of health. CONCLUSIONS: These data suggest that a large percentage of the Spanish adult population recognizes that life-styles are important determinants of health.

Adolescent↗
PubMed2000

Determinants of health status in fibromyalgia: a comparative study with systemic lupus erythematosus.

OBJECTIVE: To compare perceived health status in women with fibromyalgia (FM) and systemic lupus erythematosus (SLE) using the Medical Outcomes Study (MOS) Short Form Health Survey (SF-36); and to identify determinants of physical and mental health in each patient group. METHODS: A cross sectional study of 46 women with FM (mean age 48.13 yrs, SD 9.40) and 59 women with SLE (mean age 42.36 yrs, SD 11.31). Patients with FM were recruited from a rheumatology clinic and a rheumatology practice, while patients with SLE were recruited from 4 rheumatology clinics. Clinical examination determined disease activity (by Systemic Lupus Activity Measure) in SLE and a tender point count was used for FM. Patients completed questionnaires assessing health status (SF-36), stress (Hassles), social support (Social Support Questionnaire 6), and coping (Coping Inventory for Stressful Situations). RESULTS: Patients with FM reported more impairment on the following SF-36 subscales: physical function (p < 0.001), role physical (p < 0.001), bodily pain (p < 0.001), and vitality (p < 0.001). Physical component summary scores were also significantly lower (p < 0.001) for the FM group. Four hierarchical regression analyses were computed to determine factors related to physical and mental health in each patient group, with the following variables in the equation: age, income, disease activity (Step 1), hassles (Step 2), emotional and task coping, and social support (Step 3). Better physical health in FM was related to higher income (R2 = 0.17, p < 0.05). In the SLE group, better physical health was associated with younger age, less disease activity, and lower hassles (R2 = 0.37, p < 0.0001). Worse mental health among women with FM was associated with more hassles, more emotional coping, and less satisfaction with social support (R2 = 0.64, p < 0.0001), while lower income, higher hassles, and more emotional coping were linked to worse mental health in SLE (R2 = 0.46, p < 0.0001). CONCLUSION: Health related quality of life (HRQL) is impaired among women with FM and SLE, with FM patients reporting greater impairment along several dimensions. Enhancing the HRQL of patients with FM and SLE requires targeting specific modifiable psychosocial factors.

Adult↗
PubMed2003

Understandings of health and its determinants among clients and providers at an urban community health center.

The authors' aim was to explore clients' and health care providers' perceptions of health and its determinants in preparation for the development of a screening tool to assess client health determinants at a community health center through template and editing analyses of interviews with 6 health care providers and 7 clients. Participants defined health as a multidimensional state, with common themes including the ability to cope and to function according to expectations. They identified multiple interrelated factors that affect health. The findings support existing health determinant frameworks but provide greater detail about specific determinants within broad categories presented in these frameworks. The results create a foundation for the development of a screening tool to assess client health determinants.

Adult↗
PubMed1993

Determinants of health care utilization--visits and referrals.

This study explores determinants of I) general practitioner (GP) visits and II) referrals (outpatient and hospitalization). The analyses were performed with regression models on a set of data from a comprehensive population study of 3533 men and 3578 women aged 40-42 in a county in Northern Norway. Among the various health status dimensions included, self-rated health was found to be the most important determinant, regardless of type of service. Factors, other than health status aspects affecting GP visits, were preoccupation with health and help seeking attitude. Volume of resources (GP per population), socio-demographic characteristics and social networks did not appear as important. Several inequitable effects were revealed on referrals: First, higher rate of referral of patients with higher educational achievement indicates a bias towards higher social status groups. Second, high GP/population ratio and residence in municipalities with referral care facilities were both found to be associated with higher probability of referral.

Adult↗
PubMed2000

The determinants of health care seeking behaviour of adolescents attending STD clinics in South Africa.

The study investigated the determinants of delay behaviour in health care seeking in a sample of 292 adolescent patients (20 years and younger) with STD symptoms. Fifty six percent (56%) of the adolescents sought health care within the first 6 days of noticing symptoms, 23% waited between 7 to 10 days and 21% waited longer than 10 days before seeking health care. Early health care seeking was determined by perceived seriousness of STDs, an absence of self treatment prior to seeking care and positive attitudes regarding personal autonomy in condom use behaviour. Facilitation of early health care seeking remain critical in curbing the threat of AIDS among the South African youth.

Adolescent↗
PubMed2006

Social determinants of health and health inequalities: what role for general practice?

This paper argues that general practice is potentially an important social determinant of health and health inequalities. The way it is influential is consistent with models of causal pathways in the way social and societal factors influence health. General practice clinical care can be thought of as a material resource. Evidence exists at many levels that this resource is inequitably distributed. But encounters in general practice are profoundly social processes, embedded in wider society. Debating and reflecting on the values underpinning relations between GP and patient may help challenge and illuminate wider inequitable processes in society that sustain inequalities in health.

Australia↗
PubMed1992

Perceived morbidity as a determinant of health behavior.

It is hypothesized that perceived morbidity, a concept closely related to perceived vulnerability, is an important determinant of health behaviors. In this cross-sectional study (N = 2740), perceived morbidity was conceptualized as a categorical variable defining six distinct morbidity groups: the hypertension, high cholesterol, angina pectoris, heart attack, stroke and 'morbidity-free' groups. We used analyses of covariance to identify differences in health behaviors between the six groups; the analyses were done separately for middle-aged (40-60 years old) and older ( greater than 60 years old) respondents. Results show that perceived morbidity had a significant effect on fat consumption (P less than 0.001) and on physical activity (P < 0.01). In both age ranges, the morbidity-free group had the highest fat consumption; among the middle-aged respondents, the level of physical activity was significantly lower in the morbidity-free group than in the heart attack group. Furthermore, respondents in the high cholesterol group showed consistently a 'better' health behavior than people in the hypertension group. Overall, these results suggest that the concept of perceived morbidity may be useful in explaining inter-individual differences in health behaviors.

Adolescent↗
PubMed2005

Defining and measuring gender: a social determinant of health whose time has come.

This paper contributes to a nascent scholarly discussion of sex and gender as determinants of health. Health is a composite of biological makeup and socioeconomic circumstances. Differences in health and illness patterns of men and women are attributable both to sex, or biology, and to gender, that is, social factors such as powerlessness, access to resources, and constrained roles. Using examples such as the greater life expectancy of women in most of the world, despite their relative social disadvantage, and the disproportionate risk of myocardial infarction amongst men, but death from MI amongst women, the independent and combined associations of sex and gender on health are explored. A model for incorporating gender into epidemiologic analyses is proposed.

Journal Article↗
PubMedDate not supplied

[From disease to health: the individual, society, environment and culture].

With the onset of science-based medicine in the mid-19th century, environmental factors were almost totally discarded as health determinants. This was a complete rupture with the medical thinking which had prevailed since the time of Hippocrates. Yet, for the vast majority of mankind, harmony with environmental reality remains the most important determinant of good or ill health. This scission explains to a great extent the differences between traditional and Western medicine, which are based on entirely different concepts and on distinct paradigms. Environment as a health determinant--in its broadest definition to include both physical and social environments--is again being considered of importance as a result of better understanding of causality factors, and because of the influence of disciplines such as ecology and epidemiology. Here we show that human societies can develop different methods of adjusting to their environments, some of which would increase the risks of disease and others which can be considered as resistance factors of a social nature. Societies and individuals alike are not equal in relation to health risks.

Cultural Characteristics↗
PubMed2004

Morbidity and determinants of health on youth expeditions.

OBJECTIVE: To document the prevalence of illness and injury on youth expeditions and analyze specific determinants of health. METHODS: Two thousand nine hundred fifteen people, aged 15 to 18 years, traveled with a commercial company, World Challenge Expeditions Ltd, between June and September 2001. Adult team leaders were required to keep medical cards for each person. This study is a retrospective analysis of these medical cards. RESULTS: Completed medical cards were available for 2402 people (82%). There were no medical problems in 36% of people. Illness or injury was reported by 64% (mean, 2.0 medical problems per person). Of the medical problems, 6% were defined as serious, and 1% were admitted to the hospital. One fatality occurred. The five most prevalent medical problems were diarrhea (22%), nausea and vomiting (20%), cold or sore throat (11%), headache (11%), and trauma (10%). Girls reported 19% more medical problems than the boys reported. Gastrointestinal illness was significantly increased at high altitude. Illness and injury were most prevalent in South America and least prevalent in Australasia. CONCLUSIONS: Our results demonstrate that in young people traveling to remote parts of the world, illness and injury are common. Serious incidents are rare; however, the death of one person does highlight the dangers present. This study may help risk assessment for young people considering taking part in an expedition.

Adolescent↗
PubMed2005

Socioeconomic status overrides age and gender in determining health-seeking behaviour in rural Bangladesh.

OBJECTIVE: To study the health-seeking behaviour of elderly members (aged > 60 years) of households in rural Bangladesh, to ascertain how their behaviour differs from that of younger people (aged 20-59 years) living in the same household and to explore the determinants of health-seeking behaviour. METHODS: Structured interviews were conducted to elicit information on the health-seeking behaviour of household members aged > 20 years. Respondents were asked about major illnesses occurring within 15 days prior to the interview. The sample consisted of 966 households that had at least one resident who was aged > 60 (32% of 3031 households). FINDINGS: We found no major differences in health-seeking behaviour between elderly people and younger adults. On average about 35% (405/1169) of those who reported having been ill during the previous 15 days in both age groups chose self-care/self-treatment; for both age groups the most commonly consulted type of provider was a paraprofessional such as a village doctor, a medical assistant or a community health worker. A household's poverty status emerged as a major determinant of health-seeking behaviour. The odds ratio (OR) that individuals from poor households would seek treatment from unqualified allopathic practitioners was 0.6 (95% confidence interval (CI) = 0.40-0.78); the odds ratio that individuals from poor households would seek treatment from qualified allopathic practitioners was 0.7 (95% CI = 0.60-0.95). For self-care or self-treatment it was 1.8 (95% CI = 1.43-2.36). Patients' level of education affected whether they avoided self-care/self-treatment and drugstore salespeople (who are usually unlicensed and untrained but who diagnose illnesses and sell medicine) and instead chose a formal allopathic practitioner (OR = 1.5; 95% CI = 1.15-1.96). When a household's poverty status was controlled for, there were no differences in age or gender in terms of health-care expenditure. CONCLUSION: We found that socioeconomic indicators were the single most pervasive determinant of health-seeking behaviour among the study population, overriding age and sex, and in case of health-care expenditure, types of illness as well.

Adult↗
PubMed2006

Asthma-related health status determinants of environmental control practices for inner-city preschool children.

BACKGROUND: Asthma guidelines recommend environmental control practices (ECPs) to improve asthma health. In the inner city, where asthma morbidity is high, it is not known whether children's health status affects the use of ECPs. OBJECTIVE: To investigate health status determinants of ECPs in the homes of children with asthma. METHODS: Caregivers of children aged 2 to 6 years with (n = 150) and without (n = 150) asthma completed a survey about ECPs. Atopic status was determined by means of skin prick testing. RESULTS: Most ECPs were similarly practiced, regardless of whether the child had asthma. Only pet avoidance was more common in children with asthma (30% vs 19%). Asthma severity and recent acute health care visits for asthma were not associated with ECP use. Most ECPs were not linked to allergen sensitization (eg, mite and mouse), although cockroach-sensitized children were more likely to have cockroach control than nonsensitized individuals (65% vs 45%). Caregivers of asthmatic children with rhinitis were more likely than those without rhinitis to report ECPs, including pet avoidance (44% vs 15%), smoking avoidance (78% vs 53%), cockroach control (65% vs 42%), mouse control (78% vs 42%), air-conditioning (45% vs 24%), and allergyproof covers (7% vs 0%). CONCLUSIONS: The presence of asthma, asthma severity, and allergen sensitization seem to have little relationship to ECP use in the homes of inner-city children. Rhinitis was consistently linked to ECPs, which suggests that caregivers may make changes in the home environment for upper airway but not lower airway symptoms.

Air Pollution, Indoor↗
PubMed2000

Making a difference to the socioeconomic determinants of health: policy responses and intervention options.

APACPH has previously highlighted the profound effect of global economic change on increasing health disparities in most countries in the Asian Pacific Region of the world, with those citizens who are most disadvantaged and vulnerable, suffering most. This presentation identifies two key issues that should underpin efforts to reduce socioeconomic health disparities: (1) the current evidence base on policies and interventions successful in reducing inequalities; and, (2) how to implement such strategies. Actions to reduce such disparities should ideally include: (1) changes in macro-level social and economic policies, (2) improving living and working conditions, (3) strengthening communities for health, (4) influencing behavioural risk factors, (5) strengthening individuals and their social networks, and (5) an improved response from the health care system and associated services. Other than a few notable exceptions, few countries have developed a coordinated and integrated approach to addressing health inequalities. However, previously successful public health interventions represent a good starting point. Health professionals have an important role to play in not only recognising that the determinants of health are rooted in the economic, social and cultural fabric of our society, but in supporting and advocating strategies and approaches that lie upstream from the health care system.

Australia↗
PubMed1998

Determinants of health and service use patterns in homeless and low-income housed children.

OBJECTIVE: Previous studies of homeless children have described more health problems and service use than in housed children, but failed to control for potential confounding factors that may differ between these children. This observational study examines the relationship of homelessness and other determinants to health status and service use patterns in 627 homeless and low-income housed children. METHODS: Case-control study of 293 homeless and 334 low-income housed children aged 3 months to 17 years and their mothers conducted in Worcester, Massachusetts. Information was collected about mothers' housing history, income, education, emotional distress, and victimization history. Standardized instruments were administered to assess children's health. Health service use questions were adapted from national surveys. Main outcome measures included health status, acute illness morbidity, emergency department and outpatient medical visits. Multivariable regression analyses were used to examine the association of family and environmental determinants, including homelessness, with health status and service use outcomes. RESULTS: Mothers of homeless children were more likely to report their children as being in fair or poor health compared with their housed counterparts. Homeless children were reported to experience a higher number of acute illness symptoms, including fever, ear infection, diarrhea, and asthma. Emergency department and outpatient medical visits were higher among the homeless group. After controlling for potential explanatory factors, homeless children remained more likely to experience fair or poor health status (adjusted odds ratio [OR] = 2.83; 95% confidence interval [CI], 1.16, 4.87), and a higher frequency of outpatient (OR = 1.71; 95% CI, 1.18, 2.48) and emergency department visits (OR = 1.21; 95% CI, 0.83, 1.74). Mothers' emotional distress was independently associated with acute illness symptoms and frequent use of outpatient and emergency department settings. CONCLUSIONS: Homelessness is an independent predictor of poor health status and high service use among children. The present findings highlight the importance of preventive interventions and efforts to increase access to primary care among homeless children.

Adolescent↗
PubMed2001

Determinants of health and nutritional status of rural Nigerian women.

This study was undertaken to determine the effects of socioeconomic and cultural factors on the health and nutritional status of 300 women of childbearing age in two rural farming communities in Enugu State, Nigeria. The women were engaged in farming, trading, and teaching. A cross-sectional survey was conducted using both qualitative and quantitative data-collection methods. The study involved focus-group discussions (FGDs), interviews using a questionnaire, measurement of food/nutrient intake, assessment of activity patterns, anthropometry, and observations of clinical signs of malnutrition. The better-educated women had higher incomes than those with little or no education. Poor education was mainly attributed to lack of monetary support by parents (34%), marriage while in school (27%), and sex discrimination (21%). The teachers had significantly (p < 0.05) better health status, health and nutrition knowledge, food habits, nutrient intake, and self-concept, and adhered less to detrimental cultural practices. However, none of the women met their iron, riboflavin and niacin requirements. More cases of chronic energy deficiency were observed among the farmers (16%) and traders (13%) than among the teachers (5%). Generally, the women worked long hours with reported working hours (6-7 hours) being lower than the observed working hours (11 hours) for the traders and teachers. Income had a significant (p < 0.05) positive correlation with all nutritional variables, except vitamin C, age-at-marriage (r = 0.719), and nutrition knowledge (r = 0.601). Age-at-marriage had a positive correlation with body mass index (BMI) and all nutritional variables but was significant (p < 0.05) for protein (r = 0.362), calcium (r = 0.358), iron (r = 0.362), riboflavin (r = 0.364), and vitamin C (r = 0.476). Workload was negatively correlated with protein intake (r = 0.346; p < 0.05). Meal frequencies for more than 70% of the farmers and petty traders and 42% of the teachers were dependent on the availability of food in the household. Food taboos had no effect on their nutrient intake, since only 5-11% of women adhered to taboos. Although most women gave their children and husbands preference in food distribution, not much difference was found in the amount of food consumed by these women. The ratio of wife's portion to husband's was 1:1.4 for the farmers, 1:1.3 for the traders, and 1:1.2 for the teachers. FGDs revealed that sex discrimination in education prevailed where resources were limited. The results of the study suggest that the basic determinants of health and nutritional status of women are socioeconomic and cultural, education having a mediating or modifying influence on cultural practices.

Adolescent↗