A life-course approach to measuring socioeconomic position in population health surveillance systems.

Measuring socioeconomic position (SEP) in population chronic disease and risk factor surveillance systems is essential for monitoring socioeconomic inequalities in health over time. Life-course measures are an innovative way to supplement other SEP indicators in surveillance systems. A literature review examined the indicators of early-life SEP that could potentially be used in population health surveillance systems. The criteria of validity, relevance, reliability and deconstruction were used to determine the value of potential indicators. Early-life SEP indicators used in cross-sectional and longitudinal studies included education level, income, occupation, living conditions, family structure and residential mobility. Indicators of early-life SEP should be used in routine population health surveillance to monitor trends in the health and SEP of populations over time, and to analyse long-term effects of policies on the changing health of populations. However, these indicators need to be feasible to measure retrospectively, and relevant to the historical, geographical and sociocultural context in which the surveillance system is operating.

Involvement in civil society groups: Is it good for your health?

STUDY OBJECTIVE: To determine the involvement in civil society groups (CSGs) and the impact of this on health. DESIGN: Case study, cross sectional, self completion questionnaire, and semi-structured interviews. SETTING: Residents in two suburbs in Adelaide, South Australia. PARTICIPANTS: Every household (1038) received a questionnaire asking the adult with the next birthday to complete it. A total of 530 questionnaires were returned. Sixteen questionnaire respondents were also interviewed. MAIN RESULTS: 279 (53%) questionnaire respondents had been involved in a CSG in the past 12 months, 190 (36%) in locally based CSGs, and 188 (35%) in CSGs outside the area. Eleven of the 16 interviewees had been involved in a CSG. A path analysis examined the relation between demographic variables, CSG involvement, and mental and physical health, as measured by the SF-12. Physical health was negatively associated with CSG involvement and older age, and positively associated with working full time or part time and higher education level. Mental health was positively associated with older age, working full time or part time, and higher income but negatively associated with having a child under 18, speaking a language other than English and higher education level. Very few interviewees made a direct link between CSGs and positive individual health outcomes, though some positive community level outcomes were noted. More consistent were reports of the detrimental effects of CSG involvement on mental and physical health. CONCLUSIONS: Involvement in CSGs was significant but not always positive for health. It is possible that CSG involvement is good for a community but not necessarily for the individual.

Social capital.

This glossary aims to provide readers with some of the key terms that are relevant to a consideration of the relevance of social capital for health, and to introduce some of the debates on the concepts.

Epidemiology of participation: an Australian community study.

STUDY OBJECTIVE: To determine the levels of participation in social and civic community life in a metropolitan region, and to assess differential levels of participation according to demographic, socioeconomic and health status. To contribute to policy debates on community participation, social capital and health using these empirical data. DESIGN: Cross sectional, postal, self completed survey on health and participation. SETTING: Random sample of the population from the western suburbs of Adelaide, the capital city of South Australia, a population of approximately 210 000. PARTICIPANTS: 2542 respondents from a sample of 4000 people aged 18 years and over who were registered on the electoral roll. MAIN RESULTS: The response rate to the survey was 63.6% (n=2542). Six indices of participation, on range of social and civic activities, with a number of items in each, were created. Levels of participation were highest in the informal social activities index (46.7-83.7% for individual items), and lowest in the index of civic activities of a collective nature (2.4-5.9% for individual items). Low levels of involvement in social and civic activities were reported more frequently by people of low income and low education levels. CONCLUSIONS: Levels of participation in social and civic community life in an urban setting are significantly influenced by individual socioeconomic status, health and other demographic characteristics. An understanding of the pattern of participation is important to inform social and health policy making. Increasing levels of participation will reduce social exclusion and is likely to improve the overall quality of community life.

Sleep difficulties, pain and other correlates.

A multiple regression analysis was used with variables relevant to sleeping problems from a large community health survey in South Australia. The variables that were found to be most strongly correlated with sleep problems were, in order of importance, pain, anxiety, age, somatic health and annual household income, all of which accounted for 22% of the variance. Weight problems, depression and sex of the respondent were not so important in this analysis. Arthritis, which often increases with age, appeared to be most strongly associated with pain, explaining in part why sleeping problems increase with age. Anxiety, pain and poor somatic health were most strongly associated with lying awake at night or sleeping badly, and anxiety and pain were most strongly correlated with taking longer to get to sleep. Poor somatic health and anxiety were most strongly associated with waking early, and age and pain were the most important variables in taking tablets to aid sleep.

Community-health needs assessment: use of the Nottingham health profile in an Australian study.

This article reports on the use of the Nottingham health profile (which was developed in the United Kingdom as a valid and reliable indicator of perceived health status) in a community-health survey in Noarlunga, an outer suburban area of Adelaide. The instrument appears valid for use with an Australian population. It was used in Noarlunga to demonstrate a correlation between health status and a range of social and economic variables. The uses of the Nottingham health profile in health-services planning are discussed.

Orientations towards voluntary childlessness.

PIP: This paper reports on a study of decision making among voluntarily childless couples that was conducted in Britain. The discussion is based on evidence from an intensive interview survey with 38 childless husbands and wives. 4 main orientations towards childlessness have been delineated: hedonistic, idealistic, emotional and practical. These are based on the decision making processes childless couples go through. Each orientation is described, showing that childless individuals can differ markedly in their attitude towards not having children and in their values and ideas about life in general. It is maintained that these differences are important in understanding the complexities of voluntary childlessness and can have practical value in studying aspects of the phenomenon, such as forecasting changes in the pattern of childlessness. The author predicts that voluntary childlessness may increase: 1) as a conjunction of recent trends towards egalitarianism in marriage and emphasis on individual freedom as opposed to concentration on familial values; 2) as a reflection of the economic recession to maintain living standards; 3) as a growing reflection of disillusionment with social, political and environmental problems at the national and global level; 4) and as an outgrowth of increased public support and discussion on voluntary childlessness. The trend may reverse if those who feel they are too old are reassured, if daycare becomes more prevalent for working mothers, and if employment opportunities shrink for women, making motherhood an increasingly attractive option.^ieng