To obtain reliable measures researchers prefer multiple-item questionnaires rather than single-item tests. Multiple-item questionnaires may be costly however and time-consuming for participants to complete. They therefore frequently administer two-item measures, the reliability of which is commonly assessed by computing a reliability coefcient. There is some disagreement, however, what the most appropriate indicator of scale reliability is when a measure is composed of two items.
To summarize evidence about (1) the costs of limited health literacy (HL) and (2) the cost-effectiveness of interventions to improve limited HL. We performed a systematic review searching electronic databases and additional information resources. We included observational studies and interventional studies with HL-outcomes. We included populations at high risk for low HL and patients with (1) diabetes mellitus or (2) hyperlipidemia. We retrieved 2,340 papers and included 10 studies for analysis. The prevalence of limited HL is considerable (range 34-59%). On the health system level, the additional costs of limited HL range from 3 to 5% of the total health care cost per year. On the patient level, the additional expenditures per year per person with limited HL compared to persons with adequate HL range from US $143 to 7,798. Data on the cost-effectiveness of interventions to improve limited HL are scarce. The costs of limited HL may be substantial, but few studies were retrieved and the results are heterogeneous.
Systematic reviews on prevalence estimates of child sexual abuse (CSA) worldwide included studies with adult participants referring on a period of abuse of about 50 years. Therefore we aimed to describe the current prevalence of CSA, taking into account geographical region, type of abuse, level of country development and research methods.We included studies published between 2002 and 2009 that reported CSA in children below 18 years. We performed a random effects meta-analysis and analyzed moderator variables by meta-regression.Fifty-five studies from 24 countries were included. According to four predefined types of sexual abuse, prevalence estimates ranged from 8 to 31 % for girls and 3 to 17 % for boys. Nine girls and 3 boys out of 100 are victims of forced intercourse. Heterogeneity between primary studies was high in all analyses.Our results based on most recent data confirm results from previous reviews with adults. Surveys in children offer most recent estimates of CSA. Reducing heterogeneity between studies might be possible by standardized measures to make data more meaningful in international comparisons.
Place of death, specifically the percentage who die in hospital or residential aged care, is largely unreported. This paper presents a cross-national comparison of location of death information from published reports and available data.Reports of deaths occurring in hospitals, residential aged care facilities, and other locations for periods since 2001 were compiled.Over 16 million deaths are reported in 45 populations. Half reported 54 % or more of all deaths occurred in hospitals, ranging from Japan (78 %) to China (20 %). Of 21 populations reporting deaths of older people, a median of 18 % died in residential aged care, with percentages doubling with each 10-year increase in age, and 40 % higher among women.This place of death study includes more populations than any other known. In many populations, residential aged care was an important site of death for older people, indicating the need to optimise models of end-of-life care in this setting. For many countries, more standardised reporting of place of death would inform policies and planning of services to support end-of-life care.
Objectives: (1) To compare the prevalence of bullying and victimization among boys and girls and by age in 40 countries. (2) In 6 countries, to compare rates of direct physical, direct verbal, and indirect bullying by gender, age, and country. Methods: Cross-sectional self-report surveys including items on bullying and being bullied were obtained from nationally representative samples of 11, 13 and 15 year old school children in 40 countries, N = 202,056. Six countries (N = 29,127 students) included questions about specific types of bullying (e. g., direct physical, direct verbal, indirect). Results: Exposure to bullying varied across countries, with estimates ranging from 8.6% to 45.2% among boys, and from 4.8% to 35.8% among girls. Adolescents in Baltic countries reported higher rates of bullying and victimization, whereas northern European countries reported the lowest prevalence. Boys reported higher rates of bullying in all countries. Rates of victimization were higher for girls in 29 of 40 countries. Rates of victimization decreased by age in 30 of 40 (boys) and 25 of 39 (girls) countries. Conclusion: There are lessons to be learned from the current research conducted in countries where the prevalence is low that could be adapted for use in countries with higher prevalence.
To determine whether depression and anxiety in adulthood are associated with abuse exposure in childhood.A search of PUBMED, EMBASE and PSYCHINFO databases (2002–2012) was supplemented by hand searches of bibliographies of articles and reviews. We included studies contrasting abuse exposure vs. no-abuse exposure before age 16 years to depression and anxiety after age 16 years. Data on sample and exposure and outcome instruments, covariates and odds ratios (ORs) with the respective 95 % confidence intervals (CI) were extracted. Combined ORs and 95 % CI were calculated using random effects models. Heterogeneity was quantified using the I 2 test.Inclusion criteria were met by 19 studies with 115,579 study participants, for assessing depression (n = 14) and anxiety (n = 13). The combined ORs for depression were 2.04 (95 % CI: 1.65–2.53) for sexual abuse and 1.49 (95 % CI: 1.29–1.72) for physical abuse. The combined ORs for anxiety were 2.52 (95 % CI: 2.12–2.98) for sexual abuse and 1.70 (95 % CI: 1.33–2.18) for physical abuse.High levels of depression, anxiety and distress are reported in adults exposed to childhood sexual and physical abuse. These findings require increased awareness for the potential needs of adults exposed to child abuse and public health interventions to prevent child abuse.
Objectives: To describe the methodological development of the HBSC survey since its inception and explore methodological tensions that need to be addressed in the ongoing work on this and other large-scale cross-national surveys. Methods: Using archival data and conversations with members of the network, we collaboratively analysed our joint understandings of the survey's methodology. Results: We identified four tensions that are likely to be present in upcoming survey cycles: (1) maintaining quality standards against a background of rapid growth, (2) continuous improvement with limited financial resources, (3) accommodating analysis of trends with the need to improve and adapt questionnaire content, and (4) meeting the differing requirements of scientific and policy audiences. Conclusions: While these challenges are not trivial, the structure of the HBSC network and its long-term experience in working through such challenges renders it likely that HBSC can provide a model of other similar studies facing these tensions.
Outpatient antibiotic consumption widely varies across Europe. The investigation of the causes of such variation may help to identify interventions that would improve the efficient use of antibiotics. The aim of this study was to assess the impact of socioeconomic determinants and the role played by information about bacterial resistance.Comparable data on systemically administered antibiotics and socioeconomic determinants in 17 European countries were available between 2000 and 2005. We estimated an ad hoc econometric model by means of a hybrid log–log functional form and random effects generalised least squares regressions. Lagged values and the instrumental variable method were applied to address endogeneity of bacterial resistance and infections. Bacterial resistance was measured by the rate of penicillin non-susceptible Streptococcus pneumoniae isolates (PNSP) and methicillin-resistant Staphylococcus aureus (MRSA).The population income, demographic structure, density of general practitioners and their remuneration method appeared to be significant determinants of antibiotic consumption. Although countries with higher levels of bacterial resistance exhibited significantly higher levels of per capita antibiotic use, ceteris paribus, the responsiveness of antibiotic use to changes in bacterial resistance was relatively low (0.09–0.18).The study confirms that socioeconomic factors should be taken into account while explaining differences in outpatient antibiotic use across countries. The impact of supply-side factors and incentives attached to payment schemes for physicians need to be considered in government interventions to reduce inequalities and improve effectiveness in antibiotic utilisation.
Climate change will bring more frequent, long lasting and severe adverse weather events and these changes will affect mental health. We propose an explanatory framework to enhance consideration of how these effects may operate and to encourage debate about this important aspect of the health impacts of climate change. Literature review. Climate change may affect mental health directly by exposing people to trauma. It may also affect mental health indirectly, by affecting (1) physical health (for example, extreme heat exposure causes heat exhaustion in vulnerable people, and associated mental health consequences) and (2) community wellbeing. Within community, wellbeing is a sub-process in which climate change erodes physical environments which, in turn, damage social environments. Vulnerable people and places, especially in low-income countries, will be particularly badly affected. Different aspects of climate change may affect mental health through direct and indirect pathways, leading to serious mental health problems, possibly including increased suicide mortality. We propose that it is helpful to integrate these pathways in an explanatory framework, which may assist in developing public health policy, practice and research.
This paper traces the history of the HBSC study from its origins in the early 1980's to the present day describing how it was first conceptualised scientifically and how this influenced issues of study design. The challenges of managing a cross-national study are explained as are changes and adaptations over time with growth of the study from 3 to over forty country members. The key partnership with the World Health Organisation and its benefits are presented. With developments in scientific management and theoretical perspectives, HBSC has made a substantial contribution to the area of youth health. The last decade has seen increased dissemination to policy makers and evidence that scientific information arising from the study has influenced strategic policy development and practical health improvement programmes. This paper considers some of the key success factors and challenges for the study as it attempts to maximise its scientific output and channels the research findings into health improvement for young people. Future challenges for the study are also considered.
The Vietnamese government is committed to universal health care largely through social health insurance. The near-poor population is entitled to subsidized but not free insurance under this scheme, but remains under-represented compared to other groups. The aims of this research were to estimate the health insurance coverage of the near-poor in rural Vietnam and identify the individual and household factors associated with health insurance status.Rates of health insurance coverage were estimated from district-level administrative data. A cross-sectional survey was conducted in a representative sample of 2000 near-poor in Cao Lanh district, Dong Thap province, Vietnam. Face-to-face interviews were conducted with a standardized questionnaire. Multiple logistic regression was applied to identify the factors associated with insurance status.The insurance coverage of the near-poor in the selected communities was 20.3%. Enrollment in the health insurance scheme was significantly associated with poor health status (OR = 4.8, 95% CI = 2.4–9.8), good knowledge of health insurance (OR = 4.6, 95% CI = 3.4–6.2), interest in health insurance (OR = 30.1, 95% CI = 11.6–78.0), and the perceived cost of the insurance premium (OR = 2.4, 95% CI = 1.7–3.6).The cost of insurance premiums is a barrier to enrollment. Information, education and communication campaigns together with modified insurance scheme for the near-poor are necessary to enhance insurance coverage in Vietnam.
To compare e-cigarette flavors preferred and reasons for use and discontinued use across never, current, and former e-cigarette users and cigarette smokers.We recruited 1567 participants aged 18–34 years through Facebook ads targeting tobacco users and nonusers in August 2014 to complete an online survey. We assessed tobacco use, preferred flavors, and reasons for e-cigarette use and discontinued use.Our sample was 49 % male, 87 % White; 56 % current cigarette smokers; and 53 % e-cigarette users. Current e-cigarette users used an average of 20.9 days in the past 30 (SD = 11.7) and 55.2 puffs/day (SD = 37.3). Compared to never and current smokers, former smokers used e-cigarettes more frequently (p’s <0.001). Among users and nonusers, the most preferred was fruit flavors, and the most commonly reported reason for e-cigarette use was “they might be less harmful than cigarettes”. The most endorsed reason for discontinued e-cigarette use was “using other tobacco products instead”. Never, current, and former smokers had distinct reasons for e-cigarette use and discontinued use and differed in flavor preferences.Regulating marketing and flavors may impact e-cigarette uptake by young adults.
This review assessed the confounding effect of one traffic-related exposure (noise or air pollutants) on the association between the other exposure and cardiovascular outcomes.A systematic review was conducted with the databases Medline and Embase. The confounding effects in studies were assessed by using change in the estimate with a 10 % cutoff point. The influence on the change in the estimate of the quality of the studies, the exposure assessment methods and the correlation between road noise and air pollutions were also assessed.Nine publications were identified. For most studies, the specified confounders produced changes in estimates <10 %. The correlation between noise and pollutants, the quality of the study and of the exposure assessment do not seem to influence the confounding effects.Results from this review suggest that confounding of cardiovascular effects by noise or air pollutants is low, though with further improvements in exposure assessment, the situation may change. More studies using pollution indicators specific to road traffic are needed to properly assess if noise and air pollution are subjected to confounding.
This study assessed the awareness and use of traditional and novel tobacco products and dual use of cigarettes with electronic nicotine delivery systems (ENDS) among USA adults.Data were obtained from the 2014 Tobacco Products and Risk Perceptions Survey of a probability sample of 5717 USA adults conducted June–November, 2014.Use of ENDS varied by demography and by cigarette and other tobacco use. Adults aged 25–34, non-heterosexual adults, and those reporting poorer health reported higher rates of current ENDS use. Current cigarette smokers had much greater odds of ENDS ever use than never smokers, with one-half of all cigarette smokers having used ENDS and 20.7 % currently using them. However, 22.0 % of current ENDS users were former cigarette smokers, and 10.0 % were never cigarette smokers.Patterns of ENDS use are evolving rapidly and merit continued surveillance. Nearly 10 % of adult ENDS usage is among never smokers. The public health challenge is how to enhance the potential that ENDS can replace combusted tobacco products without expanding nicotine use among youth, long-term ex-smokers, and other vulnerable populations.
OBJECTIVE: Quantitative estimates of air pollution health impacts have become an increasingly critical input to policy decisions. The WHO project "Health risks of air pollution in Europe-HRAPIE" was implemented to provide the evidence-based concentration-response functions for quantifying air pollution health impacts to support the 2013 revision of the air quality policy for the European Union (EU). METHODS: A group of experts convened by WHO Regional Office for Europe reviewed the accumulated primary research evidence together with some commissioned reviews and recommended concentration-response functions for air pollutant-health outcome pairs for which there was sufficient evidence for a causal association. RESULTS: The concentration-response functions link several indicators of mortality and morbidity with short- and long-term exposure to particulate matter, ozone and nitrogen dioxide. The project also provides guidance on the use of these functions and associated baseline health information in the cost-benefit analysis. CONCLUSIONS: The project results provide the scientific basis for formulating policy actions to improve air quality and thereby reduce the burden of disease associated with air pollution in Europe.
To analyze the relationship between alcohol consumption and incident HIV infection.Articles were identified via electronic and hand searches. Inclusion criteria were: incident HIV infection, preceding alcohol consumption, and association relating the two. The DerSimonian and Laird random effects model was used. For studies with more than one estimate of a given type, estimates were combined using the inverse variance weighted method. Publication bias was assessed using Begg’s and Egger’s tests. Heterogeneity was assessed using Q and I 2 statistics.Ten studies were included. Overall alcohol consumption (any of the three types identified) increased the risk of HIV (RR 1.98, 95% CI 1.59–2.47). Alcohol consumers were at 77% higher risk (RR 1.77, 95% CI 1.43–2.19). Those consuming alcohol prior to, or at the time of, sexual relations were at an 87% increased risk (RR 1.87, 95% CI 1.39–2.50). For binge drinkers, the risk was double that of non-binge drinkers (RR 2.20, 95% CI 1.29–3.74).Alcohol consumption is associated with an increased risk of incident HIV infection. Additional research is required to further investigate a possible causal role.
The aim of this study was to determine estimates of the prevalence and social correlates of physical inactivity among university students in 23 low-, middle- and high-income countries.The International Physical Activity Questionnaire was used to collect data from 17,928 undergraduate university students (mean age 20.8, SD = 2.8) from 24 universities in 23 countries.The prevalence of physical inactivity was 41.4 %, ranging from 21.9 % in Kyrgyzstan to 80.6 % in Pakistan. In multivariate logistic regression, older age (22–30 years), studying in a low- or lower middle-income country, skipping breakfast and lack of social support were associated with physical inactivity. In men, being underweight, being overweight or obese, not avoiding fat and cholesterol, not having severe depression symptoms, low beliefs in the health benefits of physical activity, low personal control and knowledge of exercise-heart link, and in women, not trying to eat fibre, low personal mastery and medium personal control were additionally associated with physical inactivity.Four in each ten students are physically inactive, calling for strategic interventions by relevant professionals in higher educational institutions.
The purpose of the present study was to describe health literacy and its association with substance use among young men.The present study was part of the Cohort Study on Substance Use Risk Factors that included 11,930 Swiss males participating in initial screening from August 2010 to July 2011. Self-completed questionnaires covered use of three substances and three components of health literacy.Roughly 22 % reported having searched the Internet for health information and 16 % for information on substances over the past 12 months. At-risk and not at-risk users of alcohol (adjusted odds ratio (AOR) = 2.50 and 1.46), tobacco (AOR = 2.51 and 1.79) and cannabis (AOR = 4.86 and 3.53) searched for information about substances significantly more often via the Internet than abstainers. Furthermore, at-risk users reported better knowledge of risks associated with substance use and a marginally better ability to understand health information than abstainers.Substance users appear to be more informed and knowledgeable about the risks of substance use than non-users. Consequently, interventions that focus only on information provision may be of limited benefit for preventing substance use.
Knowledge about self-perceived health can help us understand the health status and needs among migrants and ethnic minorities in the European Union (EU) which is essential to improve equity and integration. The objective was to examine and compare self-perceived health among migrant and ethnic minority groups in the EU countries.Publications were ascertained by a systematic search of PUBMED and EMBASE. Eligibility of studies was based on the abstracts and the full texts. Additional articles were identified via the references. The final number of studies included was 17.Publications were identified in 5 out of the 27 EU countries. In regard to self-perceived health, most migrants and ethnic minority groups appeared to be disadvantaged as compared to the majority population even after controlling for age, gender, and socioeconomic factors. Only limited cross-country comparisons could be carried out, still they revealed a parallel pattern of self-perceived health among similar migrant/ethnic minority groups.Policies to improve social and health status, contextual factors, and access to healthcare among migrants and ethnic minorities are essential to reduce ethnic inequalities in health.
The aim of this study was to investigate which GIS-based measures of walkability (density, land-use mix, connectivity and walkability indexes) in urban and suburban neighbourhoods are used in research and which of them are consistently associated with walking and cycling for transport, overall active transportation and weight-related measures in adults.A systematic review of English publications using PubMed, Science Direct, Active Living Research Literature Database, the Transportation Research Information Service and reference lists was conducted. The search terms utilised were synonyms for GIS in combination with synonyms for the outcomes.Thirty-four publications based on 19 different studies were eligible. Walkability measures such as gross population density, intersection density and walkability indexes most consistently correlated with measures of physical activity for transport. Results on weight-related measures were inconsistent.More research is needed to determine whether walkability is an appropriate measure for predicting weight-related measures and overall active transportation. As most of the consistent correlates, gross population density, intersection density and the walkability indexes have the potential to be used in planning and monitoring.