Social science & medicine
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Social science & medicine · Jun 2012
Comparative StudyComparing the socioeconomic status--health gradient among adults 50 and older across rural and urban areas of Thailand in 1994 and 2007.
This paper examines associations between three indicators of socioeconomic status, education, income and bank savings, as well as one composite of these three measures, and self-assessed health for adults aged 50+ across rural and urban Thailand, comparing 1994 and 2007. Between 1994 and 2007 Thailand experienced rapid social changes that could impact on health overall and across groups, including population aging, socioeconomic development and changes in health policy. This led us to test whether overall health has improved as a result and whether the SES health gradient has changed. ⋯ The three-way interactions allow for testing and of whether changes over time are due to complex intertwined effects. Results indicate that a) there has been improvement in health among the population aged 50 years and older in Thailand; b) there has been a flattening in the SES - health gradient in rural areas, and c) there has been little change in the gradient in urban areas, and if anything, there has been a widening of the relationship between income and health in urban Thailand. Divergence in the way the gradient has changed across rural and urban Thailand may point to the impact of social policy that has been aimed at poorer rural residents.
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Social science & medicine · May 2012
Randomized Controlled TrialIndividual- and area-level unemployment influence smoking cessation among African Americans participating in a randomized clinical trial.
African Americans suffer disproportionately from the adverse health consequences of smoking, and also report substantially lower socioeconomic status than Whites and other racial/ethnic groups in the U. S. Although socioeconomic disadvantage is known to have a negative influence on smoking cessation rates and overall health, little is known about the influence of socioeconomic status on smoking cessation specifically among African Americans. ⋯ However, only neighborhood unemployment remained significantly associated with abstinence status when individual-level income and unemployment were included in the model. Overall, findings suggest that individual- and area-level unemployment have a negative impact on smoking cessation among African Americans. Addressing unemployment through public policy and within smoking cessation interventions, and providing smoking cessation treatment for the unemployed may have a beneficial impact on tobacco-related health disparities.
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Waiting times for elective surgery, like hip replacement, are often referred to as an equitable rationing mechanism in publicly-funded healthcare systems because access to care is not based on socioeconomic status. Previous work has established that that this may not be the case and there is evidence of inequality in NHS waiting times favouring patients living in the least deprived neighbourhoods in England. We advance the literature by explaining variations of inequalities in waiting times in England in four different ways. ⋯ Moreover we find that the education gradient becomes smaller for very long waiting. Fourth, we investigate whether the gradient may reflect the fact that patients with higher socioeconomic status have a different severity as proxied through a range of types and the number of diagnoses (in addition to age and gender) compared to those with lower socioeconomic status. We find no evidence that differences in severity explain the social gradient in waiting times.
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Social science & medicine · May 2012
OxyContin® as currency: OxyContin® use and increased social capital among rural Appalachian drug users.
Studies have shown that position within networks of social relations can have direct implications on the health behaviors of individuals. The present study examines connections between drug use and individual social capital within social networks of drug users (n = 503) from rural Appalachian Kentucky, U. S. ⋯ Adjusting for gender, income, and education, daily OxyContin(®) use was found to be significantly associated with greater social capital, and daily marijuana use was associated with less social capital. These results suggest that in regions with marked economic disparities such as rural Appalachia, OxyContin(®) may serve as a form of currency that is associated with increased social capital among drug users. Interventions focusing on increasing alternate pathways to acquiring social capital may be one way in which to alleviate the burden of drug use in this high-risk population.