Mahnaz Moghaddassi

Social capital and leisure time physical activity: a population based multilevel analysis in Malmö, Sweden

Objective: To investigate the influence of social capital and individual factors on the level of leisure time physical inactivity in the neighbourhoods. Methods: The public health survey in Malmö 1994 is a cross sectional study. A total of 5600 people aged 20–80 years were invited to answer a postal questionnaire. The participation rate was 71%. A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second, was performed. The effect (intra-area correlation, cross level modification, and odds ratios) was analysed of individual and neighbourhood (the 1993 migration out of an area as a proxy for social capital) factors on leisure time physical inactivity after adjustment for individual factors. Results: Neighbourhood factors accounted for 5.0% of the crude total variance in physical inactivity. This effect was significantly reduced when the individual factors, especially country of origin, education, and social participation, were included in the model. In contrast, it was not reduced by the introduction of the contextual social capital variable. Conclusion: This study suggests that in the neighbourhoods of Malmö leisure time physical inactivity is mainly affected by individual factors.

Social participation, social capital and daily tobacco smoking: a population-based multilevel analysis in Malmö, Sweden.

Aims: The aim of this study was to investigate the influence of contextual and individual factors on daily tobacco smoking. Methods: The public-health survey in Malmö 1994 is a cross-sectional study. A total of 5,600 individuals aged 20 - 80 years were invited to answer a postal questionnaire. The participation rate was 71%. A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second, was performed. We analysed the effect (intra-area correlation, cross-level modification and odds ratios) of individual and neighbourhood factors on smoking after adjustment for individual factors. Results: Neighbourhood factors accounted for 2.5% of the crude total variance in daily tobacco smoking. This effect was significantly reduced when the individual factors such as education were included in the model. However, individual social capital, measured by social participation, only marginally affected the total neighbourhood variance in daily tobacco smoking. In fact, no significant variance in daily tobacco smoking remained after the introduction of the individual factors other than individual social capital in the model. Conclusion: In Malmö, the neighbourhood variance in daily tobacco smoking is mainly affected by individual factors other than individual social capital, especially socioeconomic status measured as level of education.

Social predictors of non-attendance in an urban mammographic screening programme: A multilevel analysis

Objective: Rate of non-attendance following invitation for breast cancer screening is related to several socioeconomic conditions. To what extent this reflects differences with regard to individual and environmental circumstances, respectively, has received little attention. The purpose of this study was to investigate the effect of individual socioeconomic and area-level determinants on variations in non-attendance among geographic areas in an urban mammographic service screening programme. Methods: The study population consisted of 32,119 women invited for mammographic screening in 1990—93, residing in 97 neighbourhoods in the city of Malmö in Sweden. The influence of the individual factors age, marital status, education, housing accommodation, household income, and area-level circumstances, e.g. rate of migration and rate of being gainfully employed, on the rate of non-attendance was assessed by multilevel analysis. Results: Area rates of non-attendance ranged from 18% to 63%. Of the total variability in non-attendance, 4.3% was between neighbourhoods. This effect was significantly reduced when adjusting for the individual factors. The area-level factors, migration, and rate of being gainfully employed reduced and almost erased the neighbourhood variance in non-attendance. Conclusion: In addition to individual socioeconomic factors, area-level factors seem to be important determinants of neighbourhood rates of non-attendance in an urban mammographic screening programme. In a public health perspective neighbourhoods may be targeted in order to affect the problem of non-attendance in mammographic screening.

A multilevel analysis of condom use among adolescents in the European Union.

OBJECTIVES This study examined which individual and national factors affect condom use among adolescents. STUDY DESIGN Multilevel analysis. METHODS This study reviewed the data on bullying, alcohol use and condom use provided by 18 European countries and subnational entities in the Health Behaviour in School-Aged Children survey. Another eight contextual variables were also analysed. Three multilevel logistic regression models were applied consecutively (analysing for crude geographical and school variance in condom use, adjusting for gender and adjusting all variables for one another). RESULTS Among the 15-year-olds studied, 7.0% of the total variance in condom use was explained by school-related factors (intraschool-level correlation) and 5.8% by national/subnational factors. In the empty model, condom use was significantly associated with gender, alcohol consumption, predominant national religion and national prevalence of human immunodeficiency virus (HIV). In the full model, there was also a significant association with the Human Development Index ranking, gross domestic product, Gini coefficient and the Gender-related Development Index. CONCLUSIONS This study suggests that while alcohol, gender, human development level, income, religion and HIV prevalence affect condom use in young Europeans, these factors do not explain all or even most of the variation. Nonetheless, since some of these factors are not traditionally associated with young peoples sexual and reproductive health, these findings should enable more nuanced health policy programming.

Health information for migrants: The role of educational level in prevention of overweight.

Aims: Modifiable risk factors for cardiovascular disease include overweight, which is prevented by healthy diet and physical activity. Recently settled migrants may have varying levels of exposure to health information. Therefore, the objectives of this study were to explore the associations between self-reported information on healthy diet and on physical activity and overweight and the possible modification of this association by educational level among recently settled Iraqi migrants in Sweden. Methods: Cross-sectional data were collected through a postal questionnaire in Arabic and analysed by means of logistic regression. Dummy variables were created in order to assess the possible modification by educational level on the association between health information and overweight. Results: After adjustments for potential confounders, associations were found between overweight and not having received information on healthy diet (OR 1.56, 95% CI 1.07—2.27) and physical exercise (OR 1.58, 95% CI 1.07—2.32). Educational level modified these associations, so that the impact on overweight by information was much more evident among those with a high level of education. Conclusions: The findings showed that overweight was associated to perceived lack of health information among recently settled Iraqi migrants. It may be easier for migrants with high education to seek, receive, and understand health-related information. Migrants with low education may be more traditional in, for example, their diet and therefore less likely to be overweight. Culturally adapted information may therefore not be relevant for them. The broader context of the social determinants of health needs to be considered when planning interventions for migrants.

Prior psychiatric inpatient care and risk of cesarean sections: a registry study

This study of 17,443 childbearing women, investigated the relationship between hospital admissions 5 years prior to index birth, type of mental disorders and risk factors for mode of delivery. Hospital based electronic perinatal medical records between 2001 and 2006, were linked with the Swedish National Inpatient Care Registry 1996–2006. Of all the women, 39.3% had had inpatient care prior to index birth (27.3% had had obstetric, 10.1% somatic, and 1.9% psychiatric inpatient care). Diagnoses of mental disorders at psychiatric admission (n = 333) were categorized into five groups: personality/behavioral/unspecified disorder (30.9%), affective disorders and ‘suicide attempt’ (28.9%), neurotic/somatoform disorders (18.9%), substance use (17.1%) and schizophrenia (4.2%). Women with history of psychiatric care were more often smokers, below age 24 and single (p < 0.001, respectively), had more markers of mental ill-health in pregnancy records (p ≤ 0.001), compared to women without such previous care, and fewer were nulliparous (p < 0.001). The results show that women with prior psychiatric inpatient care and those with identified mental ill-health in pregnancy records, were associated with increased adjusted risks of cesarean sections. Identifying a woman’s mental health status in pregnancy may predict and prevent emergency cesarean section.

Individual and contextual determinants of self-reported poor psychological health: A population-based multilevel analysis in southern Sweden

Objective: To investigate the influence of contextual and individual factors on self-reported psychological health. Design/ setting/participants/measurements: The 2000 public health survey in Scania is a cross-sectional postal questionnaire study with a 59% participation rate. A total of 13,715 persons aged 18—80 answered the questionnaire. A multilevel logistic regression model, with individuals at the first level and municipalities/city quarters at the second, was performed. The effect (intra-class correlation, cross-level modification, and odds ratios) of individual and municipality/city quarter factors on self-reported psychological health was analysed. Results: The crude variance between municipalities/city quarters was small but significant. It was particularly affected and lowered by individual civil status, country of origin, economic stress, and social participation. The inclusion of all individual factors age, sex, civil status, country of origin, education, economic stress, and social participation lowered the between municipality variance to not-significant levels, which is the reason why no contextual variables were included in the calculations. Conclusions: The results of this study suggest that poor self-reported psychological health is affected mainly by individual characteristics of the population and not by contextual factors at the municipality/city quarter level.

The negative effects on mental health of being in a non-desired occupation in an increasingly precarious labour market

Precarious employment has been associated with poor mental health. Moreover, increasing labour market precariousness may cause individuals to feel ‘locked-in’, in non-desired workplaces or occupations, out of fear of not finding a new employment. This could be experienced as a ‘loss of control’, with similar negative health consequences. It is plausible that the extent to which being in a non-desired occupation (NDO) or being in precarious employment (PE) has a negative impact on mental health differs according to age group. We tested this hypothesis using data from 2331 persons, 18–34, 35–44, and 45–54 years old, who answered questionnaires in 1999/2000, 2005, and 2010. Incidence rate ratios (IRR) were calculated for poor mental health (GHQ-12) in 2010, after exposure to NDO and PE in 1999/2000 or 2005. NDO and PE were more common in the youngest age group, and they were both associated with poor mental health. In the middle age group the impact of NDO was null, while in contrast the IRR for PE was 1.7 (95% CI: 1.3–2.3) after full adjustment. The pattern was completely the opposite in the oldest age group (adjusted IRR for NDO 1.6 (1.1–2.4) and for PE 0.9 (0.6–1.4)). The population attributable fraction of poor mental health was 14.2% and 11.6%, respectively, for NDO in the youngest and oldest age group, and 17.2% for PE in the middle age group. While the consequences of PE have been widely discussed, those of NDO have not received attention. Interventions aimed at adapting work situations for older individuals and facilitating conditions of job change in such a way as to avoid risking unemployment or precarious employment situations may lead to improved mental health in this age group.