Inez M.A. Joung

A LONGITUDINAL STUDY OF HEALTH SELECTION IN MARITAL TRANSITIONS

We examined whether differences in health were associated with different probabilities of marital transitions in a longitudinal study, using Cox proportional hazard analysis. Data on approximately 10,000 Dutch persons of the GLOBE study, aged 15-74 years, were used for this purpose. The study started in 1991 and study subjects have been followed for 4.5 years. Of the four marital transitions studied (marriage among never married and divorced persons, and divorce and bereavement among married persons), only divorce among married persons was associated with health status: married persons who reported four or more subjective health complaints or two or more chronic conditions were, respectively, 1.5 and two times more likely to become divorced during follow-up than persons without these health problems. Since hardly any other studies have examined the role of health selection in marital transition with longitudinal data, more research is required before firm conclusions can be drawn. It can be concluded, however, that the frequently made assumption that health selection contributes only little to the explanation of health differences between marital status groups, seems, at least for the divorced, not justified.

Health behaviours explain part of the differences in self reported health associated with partner/marital status in The Netherlands.

STUDY OBJECTIVE--To describe the differences in health behaviours in disparate marital status groups and to estimate the extent to which these can explain differences in health associated with marital status. DESIGN--Baseline data of a prospective cohort study were used. Directly age standardised percentages of each marital group that engaged in each of the following behaviours--smoking, alcohol consumption, coffee consumption, breakfast, leisure exercise, and body mass index--were computed. Multiple logistic regression models were fitted to estimate the health differences associated with marital status with and without control for differences in health behaviours. SETTING--The population of the city of Eindhoven and surrounding municipalities (mixed urban-rural area) in The Netherlands in March 1991. PARTICIPANTS--There were 16,311 men and women, aged 25-74 years, and of Dutch nationality. MAIN RESULTS--There were differences in relation to marital status for each health behaviour. Married people were more likely to practise positive health behaviours (such as exercise and eating breakfast) and less likely to engage in negative ones (such as smoking or drinking heavily) than the other groups. Control for all six health behaviours could explain an average of 20-36% of the differences in perceived and general health and subjective health complaints. CONCLUSIONS--Differences in health behaviours explained a considerable amount, but not all, of the health differences related to marital status. Longitudinal data are necessary to confirm these findings; to determine whether the differences in health behaviours related to marital status are caused by selection effects or social causation effects; and to learn how social control, social support, and stress inter-relate to reinforce negative or to maintain positive health behaviours.

The contribution of intermediary factors to marital status differences in self-reported health

The aim of this study is to estimate the relative contributions of psychosocial conditions, material circumstances, and health behaviors to differences in physical and mental health by marital status. Data on 3,510 Dutch persons who were part of the GLOBE study, aged 25-74 years, are used. Multiple logistic regression models show that never-married, divorced, and widowed men have higher morbidity rates than married men. For women, the health differences are almost solely due to excess morbidity among divorced women. We found that psychosocial conditions contributed most to the explanation of morbidity differences among men (25%-50%), but material circumstances contributed most among women (50%-100%)

Predictors of self-reported problem behaviours in Turkish immigrant and Dutch adolescents in the Netherlands

BACKGROUND Although many studies have compared psychopathology in different cultures, not much is known about factors that contribute to the observed differences. METHODS We compared self-reported emotional and behavioural problems in 363 Turkish immigrant and 1098 Dutch adolescents in the Netherlands and we evaluated the contribution of adolescent, parent, family and stress-related factors to the observed ethnic differences. Data were drawn from the Dutch version of the Youth Self-Report (YSR), as well as from Dutch and Turkish parental questionnaires. RESULTS Turkish girls scored higher on four of the eight YSR syndrome-scales, on the Internalising broadband scale and on total problems than Dutch girls. Turkish boys scored higher on three syndrome scales and on the Internalising scale, but scored less on Delinquent Behaviour than their Dutch peers. Ethnic differences for both sexes were most pronounced on the Withdrawn and Anxious/Depressed scales. Socio-economic measures, in particular education of the parents, contributed most to the explanation of ethnic differences on the Somatic Complaints scale for girls and Social Problem and Internalising scales for boys. On most scales, however, ethnic differences could not be explained by other factors. The distribution of some factors appeared to be more favourable (i.e., less frequent) for Turkish than for Dutch youths, such as referral of family members to mental health services. CONCLUSIONS Low educational levels of the parents play an important, yet not an exclusive role in explaining cross-cultural differences in emotional and behavioural problems in adolescents. In particular, differences in Withdrawn and Anxious/Depressed behaviour could not be explained by non-cultural factors. This study offers starting-points for future research on cultural-specific predictors of psychopathology in immigrants.

Material and behavioral factors in the explanation of educational differences in incidence of acute myocardial infarction: The globe study

PURPOSE To quantify the contribution of material and behavioral factors to educational differences in the incidence of acute myocardial infarction (AMI), taking into account their interrelationship. METHODS Self-reported information about educational level, behavioral factors (alcohol, smoking, physical inactivity, and obesity), and material factors (housing conditions, crowding, employment status, financial problems, and an income proxy) was obtained from 45 to 74 year old responders to the baseline measurement of the Dutch prospective GLOBE-study in 1991 (n = 9872). Incidence of AMI in study participants was determined by hospital admissions due to AMI between 1991 and 1998. RESULTS The increased hazard ratio of AMI in the lowest compared to the highest educational group [hazard ratio (HR) = 1.85, 95% confidence interval (CI): 1.19; 2.88] decreased by 60% after adjustment for all four behavioral factors. Similarly, adjustment for housing conditions, employment status and the income proxy reduced the hazard ratio by 76%. Thirty-six percent of the contribution of behavioral factors to educational differences in AMI in the lowest compared to the highest educational group was the result of more often living in worse material circumstances in the first group. CONCLUSIONS Material factors contribute more to educational differences in incidence of AMI than behavioral factors. Improving material circumstances in lower educational groups may form an important strategy in the reduction of inequalities in AMI, partly because of its influence on unhealthy behavior.

Long-term trends in marital status mortality differences in The Netherlands 1850-1970.

This article describes the long-term trends in marital status mortality differences in the Netherlands using a unique dataset relating to the period 1850-1970. Poisson regression analysis was applied to calculate relative mortality risks by marital status. For two periods, cause-of-death by marital status could be used. Clear differences in mortality by marital status were observed, with strongly increasing advantages for married men and women and a relative increase in the mortality of widowed compared with non-married people. Excess mortality among single and formerly married men and women was visible in many cause-of-death categories, and this became more widespread during the last decades of the nineteenth century. Hypotheses are formulated that might explain why married men and women underwent a stronger decrease in mortality up until the end of World War II.

Determinants of self-reported emotional and behavioral problems in Turkish immigrant adolescents aged 11–18

Abstract.Objective:The aim of this study was to determine how adolescent, parent, family and stress factors and parental psychopathology are associated with self-reported emotional and behavioral problems in Turkish immigrant adolescents.Methods:Multiple logistic models were fitted to determine the associations between problems, assessed by the Youth Self-Report (n = 363), and determinants, derived from the Turkish Immigrant Assessment Questionnaire and the General Health Questionnaire-28 filled in by parents.Results:Repeating a grade,not living with both parents, remarriage and death or serious health problems in the family were associated with higher YSR scores. Support from the mother’s family was of major importance. The strongest predictive power was found for family-related factors in boys and for parent-related factors in girls.Conclusions:Cultural aspects and post-immigration issues play an important underlying role in explaining problem behavior in Turkish immigrant adolescents. Future research should include additional immigrant-specific factors, e. g., acculturation-related issues, preferably in a longitudinal study design to gain more insight into the complex relationship between immigrant status and psychopathology.

Determinants of daily smoking in Turkish young adults in the Netherlands.

BackgroundAs little is known about the determinants of smoking in large ethnic minorities in the Netherlands and other Western European countries, we studied the determinants of smoking young adult offspring of Turkish migrants to the Netherlands.MethodsCross-sectional survey of 439 Turkish adults (18–28 y) in 2003. Smokers were compared with never smokers for five groups of determinants: demographic and socioeconomic factors, behavioral and emotional problems, psychosocial factors, and cultural factors. Associations were measured by prevalence rate ratios.ResultsPrevalences for men were 51% for daily smoking, 12% for former smoking, and 38% for never smoking. For women they were 44%, 11%, and 47%, respectively. Without adjustment for other determinants, higher prevalence was associated with: emotional problems, boredom, life events, and being male; and, specifically among women, with low self-esteem and having children. The strongest determinants of daily smoking In multivariate models were alcohol use and demographic and socio-economic factors. Of the cultural factors only strong Muslim identification was associated with lower smoking prevalence.ConclusionThe high prevalence of smoking warrants action. Many of the well-known determinants of smoking in Western countries were also important among young adults from ethnic minorities. Women with children and people of a low educational level deserve special attention.

Ethnic Disparities in Mental Health and Educational Attainment: Comparing Migrant and Native Children

Study background and aims: Ethnic disparities in mental health in adolescence may play a role in the development of ethnic disparities in educational attainment. The aim of this study was to assess the contribution of ethnic disparities in mental health problems in adolescence to ethnic disparities in educational attainment in adulthood. Methods: We followed two community samples of respectively 486 Dutch native and 168 Turkish migrant adolescents (11—15 years old) into adulthood (21—25 years old). Mental health was measured in adolescence, and educational attainment was assessed in adulthood. The contribution of mental health disparities to educational disparities was estimated by the degree of attenuation of the odds ratio (OR) for low education after adjustment for mental health problems. Results: Adult Turkish men more often had attained lower education than Dutch men (OR 1.81 (1.01—3.25)). Additional adjustment for mental health problems during adolescence did not change the OR. In Turkish women, however, the OR was 1.94 (1.04—3.62), and adjustment for mental health problems lowered it by 96% to 1.04 (0.51—2.14). The contribution was mostly due to ethnic disparities in internalizing problems. Conclusion: In women, but not in men, ethnic disparities in mental health, especially internalizing problems, were a strong predictor for the development of ethnic disparities in educational attainment. Prevention or treatment of internalizing problems among Turkish girls will probably contribute to the prevention of educational disparities.

Internalising and externalising behaviours in young adults: Dutch natives and Turkish migrants in the Netherlands.

Objective . To compare the prevalence of internalising and externalising behaviour of Dutch and Turkish migrant young adults in the Netherlands. We will also assess associations with socio-economic position. Method . Dutch natives (1,236) and Turkish migrants (438), age 18–28, completed the Young Adult Self-Report. Scores above the 90th percentile of the distribution of the Dutch sample were defined as deviant. Results . Turkish migrants more often reported deviant scores than natives for internalising problems, especially for the Anxious/Depressed syndrome. For externalising problems, Turkish migrants less often had deviant scores for Intrusive Behaviour, whereas Turkish women more often had deviant scores for Aggressive and Delinquent Behaviour. Similar results were found for comparison between mean scores. After adjustment for socio-economic position, the disparities in men remained, whereas disparities in women largely disappeared. Conclusion . Compared with Dutch young adults, Turkish migrant young adults reported more problems. Ethnic disparities were strongly associated with socio-economic disparities among women, but not among men.