Carsten Kronborg Bak

The association between social position and self-rated health in 10 deprived neighbourhoods

BackgroundA number of studies have shown that poor self-rated health is more prevalent among people in poor, socially disadvantaged positions. The aim of the present study was to investigate the association between self-rated health and social position in 10 deprived neighbourhoods.MethodsA stratified random sample of 7,934 households was selected. Of these, 641 were excluded from the study because the residents had moved, died, or were otherwise unavailable. Of the net sample of 7,293 individuals, 1,464 refused to participate, 885 were not at home, and 373 did not participate for other reasons, resulting in an average response rate of 62.7%. Multiple logistic regression models were used to estimate the associations between the number of life resources and the odds of self-rated health and also between the type of neighbourhood and the odds of self-rated health.ResultsThe analysis shows that the number of life resources is significantly associated with having poor/very poor self-rated health for both genders. The results clearly suggest that the more life resources that an individual has, the lower the risk is of that individual reporting poor/very poor health.ConclusionsThe results show a strong association between residents’ number of life resources and their self-rated health. In particular, residents in deprived rural neighbourhoods have much better self-rated health than do residents in deprived urban neighbourhoods, but further studies are needed to explain these urban/rural differences and to determine how they influence health.

The association between socio-demographic characteristics and perceived stress among residents in a deprived neighbourhood in Denmark

BACKGROUND It is known that stress is associated with various negative health outcomes, and higher levels are found among people with low socio-economic status (SES) compared with those better-off. Evidence of the characteristics of deprived neighbourhoods with negative impact on health and stress is accumulating while little is known about the stress variation by the socio-demographic characteristics of the dwellers. The present study aimed to investigate how stress varies by socio-demographic characteristics of the residents in a deprived neighbourhood. METHODS The data used in this article were collected in the spring 2009. The 1160 participants, aged 16-104 years were randomly selected among the residents in a deprived neighbourhood in Esbjerg, Denmark. The survey was conducted through telephone and face to face interviews. Multiple linear regression analyses were carried on to examine the association of perceived stress with age, gender, ethnicity, education, civil status, economy, unemployment, sick leave, social deprivation and loneliness. RESULTS The results show higher levels of stress among women, immigrants, poor and lonely compared with their counterparts. Stress decreases as the economy situation improves and people get old. Education, civil status and unemployment, initially significant, lost power in association with stress when income and economic deprivation were taken into account. CONCLUSION The results of this study suggest that variation in the stress levels across socio-demographic characteristics may have specific features among people in the low SES hierarchy, dwellers of a deprived neighbourhood.

Social exclusion or poverty individualisation? An empirical test of two recent and competing poverty theories

In recent years, two new theoretical perspectives on poverty in modern welfare societies have emerged: the perspective of ‘cumulative disadvantage’ and poverty individualisation. Both perspectives challenge traditional class-based poverty definitions. This article notes certain limitations that pertain to the relatively few empirical tests that have been performed to support these theories. The purpose of the article is to demonstrate that the results obtained depend largely on the type of poverty definition applied (income or deprivation), the actual data used (national or comparative) and the extent to which these data represent an observation period that is long enough to provide a reliable basis for testing the theories in question. The article concludes that because only few Danes experience long-term poverty and social exclusion, the combination of class and individual biography is important. In other words, structural conditions and, to a lesser degree, group risks drive individuals to the social margin.

Experiences with Recruitment of Marginalized Groups in a Danish Health Promotion Program: A Document Evaluation Study

Background Studies have found that marginalized groups living in deprived neighborhoods are less likely to participate in health programs compared to the majority of society. This study evaluates recruitment approaches conducted during a national government-funded project in 12 deprived neighborhoods across Denmark between 2010 and 2014. The aim of this study was to understand how recruitment approaches could promote participation in health programs within deprived neighborhoods to reach marginalized groups. Method Documents from all 12 of the included municipalities were collected to conduct a document evaluation. The collected documents consisted of 1,500 pages of written material with 12 project descriptions, three midterm and 10 final evaluations. The collected data were analyzed through a qualitative content analysis. Results The results are based on the fact that only 10 municipalities have developed evaluations related to recruitment, and only three evaluations provided a description of which marginalized groups were recruited. Challenges related to recruitment consist of difficulties involving the target group, including general distrust, language barriers and a lack of ability to cope with new situations and strangers. Additional geographical challenges emerged, especially in rural areas. Positive experiences with recruitment approaches were mainly related to relationship building and trust building, especially through face-to-face contact and the project employees’ presence in the neighborhood. Additionally, adjusting some of the interventions and the recruitment strategy increased participation. Conclusion This study found that relation and trust between the residents and the project employees is an important factor in the recruitment of marginalized groups in deprived neighborhoods as well as adjusting the health interventions or recruitment strategy to the target groups. In future research, it is necessary to examine which recruitment approaches are effective under which circumstances to increase participation among marginalized groups.

Reasons for women’s non-participation in follow-up screening after gestational diabetes

BACKGROUND Due to the increased risk of type 2 diabetes, follow-up screening after birth is recommended to women with previous gestational diabetes. Low participation in such screening has been shown to delay detection of diabetes with potentially serious consequences for the womens future health. The womens experiences of treatment and care during their pregnancies may affect participation. AIM This study aimed at understanding the womens experiences with treatment and care during pregnancy and to understand how these experiences influence participation in follow-up screening. METHODS A qualitative study was undertaken drawing on a phenomenological methodology. Seven women treated for gestational diabetes at a university hospital in the North Denmark Region participated in interviews. FINDINGS The women experienced lack of continuity in care between hospital departments and health sectors. We identified the following causes for low participation in follow-up screening: poor coordination, little elaboration of information, a lack of clear coordination of responsibility for follow-up screening among health care professionals and absence of focus and inclusion of their individual needs and preferences. CONCLUSION The women wished to be reminded of screening to increase their sense of safety. The womens experiences seem to reflect a lack of patient-centeredness during the pregnancy, which may be remedied by increasing the focus on the womens need for improved continuity in treatment and care. Participation in follow-up screening after gestational diabetes may be increased by sending reminders to the women. Raised awareness of the womens individual needs and preferences for treatment and care offers potential for improvement.

Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study

BackgroundPrevious studies have found that residents of deprived neighbourhoods have an increased risk of perceived stress compared to residents with similar sociodemographic and socioeconomic characteristics in non-deprived neighbourhoods. While stress may provide an explanatory pathway linking neighbourhood deprivation to health-risk behaviour, only limited research has been undertaken on whether perceived stress influences health-risk behaviour in deprived neighbourhoods. Moreover, it is uncertain whether perceived stress has a negative effect on the associations between socioeconomic status and health-risk behaviours in deprived neighbourhoods. The overall aim of this study was to compare perceived stress in deprived neighbourhood with that in the general population, and to examine whether perceived stress was associated with health-risk behaviours (including their co-occurrence) in deprived neighbourhoods. A further aim was to examine whether perceived stress modified the associations between socioeconomic status and health-risk behaviours.MethodsFour questions from the Perceived Stress Scale were used as indicators of perceived stress. Multiple logistic regression analyses were applied to cross-sectional data from 5113 adults living in 12 deprived neighbourhoods in Denmark. Data from 14,868 individuals from the nationally representative Danish Health and Morbidity Survey 2010 were used as a comparison group with regard to perceived stress.ResultsResidents of deprived neighbourhoods had higher odds of perceived stress than the general population. Associations between disposable income, economic deprivation, strain, and perceived stress were found in deprived neighbourhoods. Perceived stress was significantly associated with higher odds of health-risk behaviour, including a low intake of fruit or vegetables, daily smoking, physical inactivity, and the co-occurrence of health-risk behaviours, even after adjustment for demographic and socioeconomic characteristics. Perceived stress was more strongly associated with physical inactivity and having two or more health-risk behaviours among residents with medium/high socioeconomic status compared to residents with low socioeconomic status.ConclusionsOverall, the study showed a clear association between perceived stress and health-risk behaviour in deprived neighbourhoods. Future health promotion interventions targeting deprived neighbourhoods may benefit from incorporating stress reduction strategies to reduce health-risk behaviour. Further research is needed to fully understand the mechanism underlying the association between perceived stress and health-risk behaviour in deprived neighbourhoods.

Health-risk behaviour among residents in deprived neighbourhoods compared with those of the general population in Denmark: A cross-sectional study

Abstract This study compares health‐risk behaviours (including the co‐occurrence of health‐risk behaviours) of residents in the deprived neighbourhoods with those of the general population of Denmark. It also examines associations between sociodemographic and socioeconomic characteristics and health‐risk behaviours in deprived neighbourhoods in Denmark. Even after adjustment for socioeconomic characteristics there were large differences in health‐risk behaviours between residents in deprived neighbourhoods and the general population. In the deprived neighbourhoods large sociodemographic and socioeconomic differences in health‐risk behaviours were found among the residents. Our findings highlight the need for health promotion programmes targeting residents in deprived neighbourhoods. HighlightsHealth‐risk behaviour was higher in deprived neighbourhoods than general population.Co‐occurrence of health‐risk behaviour was higher in deprived neighbourhoods.Health‐risk behaviour varies by personal characteristics in deprived neighbourhoods.Health promotion programmes targeting deprived neighbourhoods are needed.

Social network resources and self-rated health in a deprived Danish neighborhood.

Research has demonstrated that living in a deprived neighborhood contributes to the occurrence and development of poor health. Furthermore evidence shows that social networks are fundamental resources in preventing poor mental health. Neighborhood relationships and networks are vital for sustaining and improving quality of life. However, to determine potentials for public health action, the health impact of various types of network resources need to be explored and the association between socioeconomic position and self-rated health needs to be analysed to determine whether it is partially explained by social network resources. This is the main aim of this article. Cross-sectional data from one deprived neighborhood located in Denmark were collected in 2008 and 2013 using a postal health survey. The target group was defined as adults older than 16 years. In 2008, 408 residents participated in the survey, and 405 residents participated in 2013. Our main explanatory variables were indicators of socioeconomic positions and social network resources. The analyses were conducted using univariate and bivariate analyses and multiple logistic regressions. The results showed that there was a significant decrease in respondents being involuntarily alone during the period from 2008 to 2013. An impact of the association between disposable income and self-rated health was found, showing that low income residents with a better social network also have slightly higher odds of having good self-rated health compared with residents with higher income. This investigation is the first Danish study that repeats a health survey in the same neighborhood to measure possible improvement in health among residents. More longitudinal research is needed in the future to explore the complex relationship between social network resources, social capital and health in neighborhoods.

An ethnographic field study of the influence of social interactions during the school day for children diagnosed with ADHD

Abstract The aim of this ethnographic field study was to investigate the influence of school-day social interactions on the well-being and social inclusion of children diagnosed with ADHD. The empirical data consisted of participant observations and informal interviews over a three-month period at a Danish primary school. Two ADHD-diagnosed 11-year-old boys in the fourth and fifth grades were followed on an alternating basis. The field notes were analysed using a qualitative content analysis that incorporated Etienne Wenger’s concepts of social identity and participation. The results revealed that the effects of school-day social interactions are complex and situation dependent. Medication, friendships and relationships with teachers and other adults strongly influence how children diagnosed with ADHD participate in social interactions and, consequently, how they thrive. We argue that it is important to emphasise the mediation of these children’s participation in the classroom community throughout an entire school day to ensure their social inclusion and well-being.

Unemployment and Causes of Hospital Admission Considering Different Analytical Approaches

The association between unemployment and hospital admission is known, but the causal relationship is still under discussion. The aim of the present analysis is to compare results of a cross-sectional and a cohort approach considering overall hospital admission and hospital admission due to cancer and circulatory disease. Register-based data were analysed for the period of 2006–2009. In the cross-sectional analysis, a multiple logistic regression model was conducted based on the year 2006, and cohort information from the same year onward up to 2009 was available for a Cox regression model. Social welfare compensated unemployment and both types of disease-specific hospital admission were associated to be statistically significant in the cross-sectional analysis. With regard to circulatory disease, the cohort approach suggests that social welfare compensated unemployment might lead to hospital admission due to the disease. Given the significant results in the cross-sectional analysis for hospital admission due to cancer, the unfound cohort effect might indicate a reverse causation suggesting that the disease caused joblessness, and finally social welfare compensated unemployment and not vice versa. Comparing different study designs allows for a better causal interpretation, which should be recommended in future quantitative social welfare analysis.