Differences in chronic conditions and lifestyle behaviour between people with a history of cancer and matched controls.

OBJECTIVE: To determine whether people with a history of cancer have a higher prevalence of chronic conditions or different lifestyle behaviour compared with controls. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional, self-reported data from a telephone survey conducted between 1 January 2010 and 31 March 2012 of adult residents of South Australia who self-reported a previous cancer diagnosis (cases) and randomly selected age- and sex-matched residents with no cancer diagnosis (controls). MAIN OUTCOME MEASURES: Self-reported medically diagnosed cardiovascular disease, hypertension, hyperlipidaemia, diabetes and osteoporosis; lifestyle behaviour (smoking, physical activity and diet); body mass index (BMI); psychological distress and self-reported health. RESULTS: A total of 2103 cases and 4185 controls were included in the analyses. For men, after adjusting for age, cancer survivors were more likely than controls to have ever had cardiovascular disease (P<0.001), high blood pressure (P=0.001), high cholesterol (P<0.001) and diabetes (P=0.04). These associations remained significant after controlling for socioeconomic status (SES), with the exception of high blood pressure (P=0.09). For women, there was an increased prevalence of high cholesterol (P=0.005), diabetes (P=0.02) and osteoporosis (P=0.005) in cancer cases, but after adjusting for SES, these associations were no longer significant. Women with a previous cancer diagnosis were more likely than controls to have ever smoked, after adjusting for SES (P=0.001). There were no other differences in lifestyle behaviour or BMI between cases and controls for men or women. CONCLUSION: Despite similar lifestyle habits and BMI, the prevalence of chronic conditions was significantly higher among people with a history of cancer than among controls without cancer. This supports the importance of chronic disease management as part of health care after a diagnosis of cancer.

A qualitative study of the interactions among the psychosocial work environment and family, community and services for workers with low mental health.

BACKGROUND: The psychosocial work environment can benefit and harm mental health. Poor psychosocial work environments and high level work-family conflict are both associated with poor mental health, yet little is known about how people with poor mental health manage the interactions among multiple life domains. This study explores the interfaces among paid work, family, community and support services and their combined effects on mental health. METHODS: We conducted 21 in-depth semi-structured interviews with people identified as having poor mental health to examine their experiences of paid employment and mental health and wellbeing in the context of their daily lives. RESULTS: The employment-related psychosocial work environment, particularly workplace relationships, employment security and degree of control over hours, strongly affected participants' mental health. The interfaces among the life domains of family, community and access to support services suggest that effects on mental health differ according to: time spent in each domain, the social, psychological and physical spaces where domain activities take place, life stage and the power available to participants in their multiple domains. This paper is based on a framework analysis of all the interviews, and vignettes of four cases. Cases were selected to represent different types of relationships among the domains and how interactions among them either mitigated and/or exacerbated mental health effects of psychosocial work environments. CONCLUSIONS: Examining domain interactions provides greater explanatory capacity for understanding how people with low mental health manage their lives than restricting the research to the separate impacts of the psychosocial work environment or work-family conflict. The extent to which people can change the conditions under which they engage in paid work and participate in family and social life is significantly affected by the extent to which their employment position affords them latitude. Policies that provide psychosocial protections to workers that enable them to make changes or complaints without detrimental repercussions (such as vilification or job loss) and increase access to welfare benefits and support services could improve mental health among people with paid work. These policies would have particularly important effects for those in lower socioeconomic status positions.

Deliberately casual? Workers' agency, health, and nonstandard employment relations in Australia.

OBJECTIVE: We explored Australian workers' experiences of nonstandard employment, how it related to health and well-being, and the role that Bourdieu's forms of capital (cultural, economic, and social resources) played in underpinning workers' agency. METHODS: Qualitative data from semistructured interviews with 32 causal workers were analyzed on the basis of framework analysis. RESULTS: Most participants were "deliberate casuals" who had chosen casual over permanent employment, with half of that group naming improved health and well-being as motivation. Those with greater access to capital felt more able to exercise choice, whereas those with fewer capital resources felt constrained to be casual. Gendered structures and labor market dynamics were also significant in shaping agency. CONCLUSIONS: Access to capital and a buoyant labor market underpinned workers' agency in Australia, enabling some to gain health and well-being benefits from nonstandard employment.