Eunice Rodriguez

Marginal employment and health in Britain and Germany: does unstable employment predict health?

This study examines the possible health impact of marginal employment, including both temporary and part-time employment schemes. It addresses three research questions: (1) Are employed people with a fixed-term contract or no contract more likely to report poor health than those who hold jobs with permanent contracts? (2) Are part-time employed respondents (even when they hold jobs with permanent contracts) more likely to report poor health than full-time workers? (3) Does change in employment stability (i.e., from employment with permanent contract to fixed-term or no contract employment and vice-versa) have an impact on health status? Logistic regression models were used to analyze panel data from Britain and Germany (1991-1993), available in the Household Panel Comparability Project data base. We included 10,104 respondents from Germany and 7988 from Britain. A single measure of perceived health status was used as the dependent variable. Controlling for background characteristics, the health status of part-time workers with permanent contracts is not significantly different from those who are employed full-time. In contrast, fulltime employed people with fixed-term contracts in Germany are about 42 per cent more likely to report poor health than those who have permanent work contracts. In Britain, only part-time work with no contract is associated with poor health, but the difference is not statistically significant. We conclude that monitoring the possible health effects of the increasing number of marginal employment arrangements should be given priority on the social welfare research agenda.

Keeping the unemployed healthy: The effect of means-tested and entitlement benefits in Britain, Germany, and the United States

OBJECTIVES Although considerable evidence about the health effects of unemployment exists, little is known about the possible protective effects of various social interventions. This study examined the role that means-tested and entitlement programs could have in ameliorating the health impact of unemployment in Britain, Germany, and the United States. METHODS Logistic regression models were used to analyze panel data from Britain (1991-1993), Germany (1991-1993), and the United States (1985-1987) available in the Household Panel Comparability Project database. The analysis included 8,726 respondents from Britain, 11,086 from Germany, and 11,668 from the United States. The health-dependent variable used was a single measure of perceived health status. RESULTS Evidence was found of differences in perceived health status between groups of unemployed people characterized by the types of benefits they receive. When socioeconomic characteristics and previous health and employment status are controlled for, means-tested benefits do not seem sufficient to reduce the impact of unemployment on health. CONCLUSIONS Monitoring the possible health effects of changes in public assistance benefits should be given priority in the research and political agenda.

Unemployment, depression, and health: a look at the African-American community.

OBJECTIVES: While the unemployment rate of African-American people is more than twice that of the white population, the research on the impact of unemployment on the health of this population is scarce. This study analysed the impact of unemployment on depression and well being among African-American people, and the factors associated with well being. METHODS: Logistic and multiple regression models were used to analyse panel data collected in the National Survey of Families and Households 1987-1992. African-American (1369) and white (6660) respondents were analysed separately. Outcome variables included an index of depression and self reported health status. MAIN FINDINGS: Differences between employment and unemployment groups were less significant for African-Americans than for the white population in predicting depression and well being. Health enhancing factors such as education and wealth were significantly associated with better health and lower depression indices among the white population but not consistently so among African-Americans. Satisfaction with personal relationships was the strongest predictor of well being for both groups. CONCLUSION: Research should focus on the special needs and circumstances of African-Americans, because protective factors may not have the same impact in different groups of the population.

Provincial income inequality and self-reported health status in China during 1991-7.

Background: The relationship between income inequality and health has been widely explored. Today there is some evidence suggesting that good health is inversely related to income inequality. After the economic reforms initiated in the early 1980s, China experienced one of the fastest-growing income inequalities in the world. The state of China in the 1990s is focussed on and possible effects of provincial income inequality on individual health status are explored. Methods: A multilevel regression model is used to analyse the data collected in 1991, 1993 and 1997 from nine provinces included in the China Health and Nutrition Survey. The effects of provincial Gini coefficients on self-rated health in each year are evaluated by two logistic regressions estimating the odds ratios of reporting poor or fair health. The patterns of this effect are compared among the survey years and also among different demographic groups. Results: The analyses show an independent effect of income inequality on self-reported health after adjusting for individual and household variables. Furthermore, the effect of income distribution is not attenuated when household income and provincial gross domestic product per capita are included in the model. The results show that there is an increased risk of about 10–15% on average for fair or poor health for people living in provinces with greater income inequalities compared with provinces with modest income inequalities. Conclusions: In China, societal income inequality appears to be an important determinant of population health during 1991–7.

Smoking, drinking and body weight after re-employment: does unemployment experience and compensation make a difference?

BackgroundThe impact of unemployment on behaviours such as smoking, drinking and body weight has been extensively researched. However, little is known about the possible protective effects of social assistance programs on these behavioural changes. This study examines the impact of unemployment periods on smoking, drinking and body weight changes among re-employed individuals and investigates whether the receipt of unemployment benefits influences these behaviours.MethodsThis study used panel data provided by the Panel Study of Income Dynamics. Logistic regression models were used to analyze whether a period of unemployment in 2000 resulted in an increase in smoking and drinking or fluctuations in body weight among 2001 re-employed individuals in comparison with 1999 baseline levels. A total of 3,451 respondents who had been initially healthy and who had been continuously employed between 1998 and 1999 were included in the analysis.ResultsCompared to stably employed respondents, those who had experienced periods of unemployment in 2000 and did not receive unemployment benefits were more likely than continuously employed individuals to report an increase in alcohol consumption (OR 1.8, 95% CI 1.0–3.1) and a decrease in body weight (OR 1.7, 95% CI 1.1–2.8) when they were already re-employed in 2001.ConclusionOur findings suggest that the receipt of unemployment benefits confers a protective effect on health behavioural changes following periods of unemployment. These findings underscore the need to monitor the impact of unemployment assistance programs on health, particularly in light of the rapidly changing structure of employment and unemployment benefits.

The Potential Role of Unemployment Benefits in Shaping the Mental Health Impact of Unemployment

This study looks at the association between formal systems of support (unemployment compensation or welfare) and mental health outcomes during periods of unemployment. It assesses whether unemployed persons not receiving unemployment benefits are at greater risk of reporting depression and suffering ill-health than those receiving some kind of unemployment compensation, independent of total household income. The authors performed a secondary analysis of data collected in the National Survey of Families and Households, 1987–1988. Outcome measures included an index of depression and perception of health status. Multiple regression analyses were used. The unemployed receiving unemployment compensation or benefits from other entitlement programs did not report significantly higher depression relative to the employed. Rather, the study found a significantly higher index of depression among unemployed persons receiving welfare benefits or no benefits, even after controlling for total household income and previous employment/unemployment history. Thus unemployment compensation may play an important role in ameliorating the impact of unemployment on depression. By contrast, means-tested benefits may not be sufficient to reduce the risk for reporting depression and suffering ill-health in comparison with the full-time employed. The implications of the findings are discussed in terms of social policy development.

Does breastfeeding duration decrease child obesity? An instrumental variables analysis.

Many studies have documented that breastfeeding is associated with a significant reduction in child obesity risk. However, a persistent problem in this literature is that unobservable confounders may drive the correlations between breastfeeding behaviors and child weight outcomes.

Alcohol, Employment Status, and Social Benefits: One More Piece of the Puzzle

Objectives: To examine the role of employment status and the receipt of social benefits in the prediction of alcohol use. Methods: Logistic regression models were used to analyze panel data from the National Survey of Families and Households (NSFH) 1987–88 and 1991–92. A total of 7,599 respondents who were older than 16 years of age in 1987 and did not have a physical or mental condition were included in the analysis. The alcohol measures were (a) total number of drinks in the past 30 days; and (b) having 5 or more drinks in a day, 4 or more days in the past 30 days. Results: Employed welfare recipient women have a greater likelihood of heavy drinking than other full-time employed. We do not find evidence of an association between not being employed (with or without benefits) and greater likelihood of engaging in heavy drinking behaviors. Alcohol drinking among other employment groups is not significantly different, with the exception of retired men who drink less. Conclusion: It is important to focus attention on women working while receiving welfare, and who may need help maintaining their jobs.

New Developments and Challenges of Health Status Measurement for Outcomes Evaluation

Increasing interest is now being directed towards the assessment of patient outcomes, both in evaluating medical interventions and in endeavors to increase the quality of care patients receive. While it is argued that outcomes measurement has the potential to positively influence medical care, when carried out without due consideration of its limitations and weaknesses it could lead to data that are misleading. In light of health outcomes data being viewed as central to monitoring and evaluation, we believe that evaluators have the potential to bring expertise and valuable experience into this rapidly evolving field of inquiry. The following article will discuss recent developments in the field of health status measurement for outcomes evaluation and analyse some of the most important challenges in the field.

Teachers’ Perceptions of Full- and Part-Time Nurses at School

Teachers and school nurses partner together to help ensure students stay healthy and engaged in school. The purpose of this study is to generate a deeper understanding of teachers’ perceptions on the benefits and challenges of working with full- or part-time school nurses. We conducted a qualitative analysis of open-ended survey responses from 129 teachers in nine low-income, ethnically diverse urban schools. These schools were part of a multiyear project that placed full-time nurses in four schools, while five schools with part-time nurses were used as a comparison group. Findings indicate that teachers had strong appreciation for the wide range of responsibilities undertaken by the school nurse. Teachers’ level of satisfaction was linked to the number of hours the nurse is on-site, where teachers reported greater satisfaction with nurses who worked on campus full time. Results point to factors that may improve working relations between teachers and nurses.