Rebecca Bentley

Does gender modify associations between self rated health and the social and economic characteristics of local environments

Objectives: To examine whether area level socioeconomic disadvantage and social capital have different relations with women’s and men’s self rated health. Methods: The study used data from 15 112 respondents to the 1998 Tasmanian (Australia) healthy communities study (60% response rate) nested within 41 statistical local areas. Gender stratified analyses were conducted of the associations between the index of relative socioeconomic disadvantage (IRSD) and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, political participation, social trust, trust in institutions) and individual level self rated health using multilevel logistic regression analysis before (age only) and after adjustment for individual level confounders (marital status, indigenous status, income, education, occupation, smoking). The study also tested for interactions between gender and area level variables. Results: IRSD was associated with poor self rated health for women (age adjusted p<0.001) and men (age adjusted p<0.001), however, the estimates attenuated when adjusted for individual level variables. Political participation and neighbourhood safety were protective for women’s self rated health but not for men’s. Interactions between gender and political participation (p = 0.010) and neighbourhood safety (p = 0.023) were significant. Conclusions: These finding suggest that women may benefit more than men from higher levels of area social capital.

Social capital and health in rural and urban communities in South Australia.

Objective : This paper seeks to compare the relationships between social capital and health for rural and urban residents of South Australia.

Fast food purchasing and access to fast food restaurants: a multilevel analysis of VicLANES

BackgroundWhile previous research on fast food access and purchasing has not found evidence of an association, these studies have had methodological problems including aggregation error, lack of specificity between the exposures and outcomes, and lack of adjustment for potential confounding. In this paper we attempt to address these methodological problems using data from the Victorian Lifestyle and Neighbourhood Environments Study (VicLANES) – a cross-sectional multilevel study conducted within metropolitan Melbourne, Australia in 2003.MethodsThe VicLANES data used in this analysis included 2547 participants from 49 census collector districts in metropolitan Melbourne, Australia. The outcome of interest was the total frequency of fast food purchased for consumption at home within the previous month (never, monthly and weekly) from five major fast food chains (Red Rooster, McDonalds, Kentucky Fried Chicken, Hungry Jacks and Pizza Hut). Three measures of fast food access were created: density and variety, defined as the number of fast food restaurants and the number of different fast food chains within 3 kilometres of road network distance respectively, and proximity defined as the road network distance to the closest fast food restaurant.Multilevel multinomial models were used to estimate the associations between fast food restaurant access and purchasing with never purchased as the reference category. Models were adjusted for confounders including determinants of demand (attitudes and tastes that influence food purchasing decisions) as well as individual and area socio-economic characteristics.ResultsPurchasing fast food on a monthly basis was related to the variety of fast food restaurants (odds ratio 1.13; 95% confidence interval 1.02 – 1.25) after adjusting for individual and area characteristics. Density and proximity were not found to be significant predictors of fast food purchasing after adjustment for individual socio-economic predictors.ConclusionAlthough we found an independent association between fast food purchasing and access to a wider variety of fast food restaurant, density and proximity were not significant predictors. The methods used in our study are an advance on previous analyses.

Association Between Housing Affordability and Mental Health: A Longitudinal Analysis of a Nationally Representative Household Survey in Australia

Evidence about the mental health consequences of unaffordable housing is limited. The authors investigated whether people whose housing costs were more than 30% of their household income experienced a deterioration in their mental health (using the Short Form 36 Mental Component Summary), over and above other forms of financial stress. They hypothesized that associations would be limited to lower income households as high housing costs would reduce their capacity to purchase other essential nonhousing needs (e.g., food). Using fixed-effects longitudinal regression, the authors analyzed 38,610 responses of 10,047 individuals aged 25-64 years who participated in the Household, Income, and Labour Dynamics in Australia (HILDA) Survey (2001-2007). Respondents included those who remained in affordable housing over 2 consecutive waves (reference group) or had moved from affordable to unaffordable housing over 2 waves (comparison group). For individuals living in low-to-moderate income households, entering unaffordable housing was associated with a small decrease in their mental health score independent of changes in equivalized household income or having moved house (mean change = -1.19, 95% confidence interval: -1.97, -0.41). The authors did not find evidence to support an association for higher income households. They found that entering unaffordable housing is detrimental to the mental health of individuals residing in low-to-moderate income households.

Individual and area-level socioeconomic associations with fast food purchasing

Background It has been suggested that those with lower socioeconomic characteristics would be more likely to seek energy-dense food options such as fast food because of cheaper prices; however, to date the evidence has been inconsistent. This study examines both individual- and area-level socioeconomic characteristics and their independent associations with chain-brand fast food purchasing. Methods Data from the 2003 Victorian Lifestyle and Neighbourhood Environments Study (VicLANES); a multilevel study of 2547 adults from 49 small-areas in Melbourne, Australia, were used. Multilevel multinomial models adjusted for confounders were used to assess associations between individual socioeconomic position (education, occupation and income) and area socioeconomic characteristics in relation to fast food purchasing from five major fast food chains with outcome categories: never, at least monthly and at least weekly. The study finally assessed whether any potential area-level associations were mediated by fast food access. Results Increased fast food purchasing was independently associated with lower education, being a blue-collar employee and decreased household income. Results for area-level disadvantage were marginally insignificant after adjustment for individual-level characteristics, although they were suggestive that living in an area with greater levels of disadvantage increased an individuals odds of more frequent fast food purchasing. This effect was further attenuated when measures of fast food restaurant access were included in the models. Conclusion Independent effects of lower individual-level socioeconomic characteristics and more frequent fast food purchasing for home consumption are demonstrated. Although evidence was suggestive of an independent association with area-level disadvantage this did not reach statistical significance.

A multilevel study of area socio-economic status and food purchasing behaviour.

OBJECTIVE The present study examined the association between area socio-economic status (SES) and food purchasing behaviour. DESIGN Data were collected by mail survey (64.2 % response rate). Area SES was indicated by the proportion of households in each area earning less than

Housing affordability and mental health: does the relationship differ for renters and home purchasers?

AUS 400 per week, and individual-level socio-economic position was measured using education, occupation and household income. Food purchasing was measured on the basis of compliance with dietary guideline recommendations (for grocery foods) and variety of fruit and vegetable purchase. Multilevel regression analysis examined the association between area SES and food purchase after adjustment for individual-level demographic (age, sex, household composition) and socio-economic factors. SETTING Melbourne city, Australia, 2003. SUBJECTS Residents of 2564 households located in fifty small areas. RESULTS Residents of low-SES areas were significantly less likely than their counterparts in advantaged areas to purchase grocery foods that were high in fibre and low in fat, salt and sugar; and they purchased a smaller variety of fruits. There was no evidence of an association between area SES and vegetable variety. CONCLUSIONS In Melbourne, area SES was associated with some food purchasing behaviours independent of individual-level factors, suggesting that areas in this city may be differentiated on the basis of food availability, accessibility and affordability, making the purchase of some types of foods more difficult in disadvantaged areas.

Fruit and vegetable purchasing and the relative density of healthy and unhealthy food stores: evidence from an Australian multilevel study

There is increasing evidence of a direct association between unaffordable housing and poor mental health, over and above the effects of general financial hardship. Type of housing tenure may be an important factor in determining how individuals experience and respond to housing affordability problems. This study investigated whether a relationship exists between unaffordable housing and mental health that differs for home purchasers and private renters among low-income households. Data from 2001 to 2010 of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) survey were analysed using fixed-effects linear regression to examine change in the SF-36 Mental Component Summary (MCS) score of individuals aged 25-64 years, associated with changes in housing affordability, testing for an interaction with housing tenure type. After adjusting for age, survey year and household income, among individuals living in households in the lower 40% of the national income distribution, private renters in unaffordable housing experienced somewhat poorer in mental health than when their housing was affordable (difference in MCS = -1.18 or about 20% of one S.D. of the MCS score; 95% CI: -1.95,-0.41; p = 0.003) while home purchasers experienced no difference on average. The statistical evidence for housing tenure modifying the association between unaffordable housing and mental health was moderate (p = 0.058). When alternatives to 40% were considered as income cut-offs for inclusion in the sample, evidence of a difference between renters and home purchasers was stronger amongst households in the lowest 50% of the income distribution (p = 0.020), and between the 30th and 50th percentile (p = 0.045), with renters consistently experiencing a decline in mental health while mean MCS scores of home purchasers did not change. In this study, private renters appeared to be more vulnerable than home purchasers to mental health effects of unaffordable housing. Such a modified effect suggests that tenure-differentiated policy responses to poor housing affordability may be appropriate.

Reduced food access due to a lack of money, inability to lift and lack of access to a car for food shopping: a multilevel study in Melbourne, Victoria

Background Evidence of a relationship between residential retail food environments and diet-related outcomes is inconsistent. One reason for this may be that food environments are typically defined in terms of the absolute number of particular store types in an area, whereas a measure of the relative number of healthy and unhealthy stores may be more appropriate. Methods Using cross-sectional data from the VicLANES study conducted in Melbourne, Australia, multilevel logistic regression analysis was used to estimate the independent associations between absolute measures (numbers of healthy and unhealthy stores) and a relative measure (relative density of healthy stores) of the food environment, and self-reported variety of fruit and vegetable purchasing in local households. Purchasing behaviour was measured as the odds of purchasing above the median level of fruit and vegetables. Results Compared to households in areas where healthy food stores made up no more than 10% of all healthy and unhealthy stores, households in areas with 10.1–15.0% healthy food stores and >15% healthy stores had increased odds of healthier purchasing (OR=1.48 (95% CI 1.12 to 1.96) and OR=1.45 (95% CI 1.09 to 1.91), respectively). There was less evidence of an association between absolute numbers of healthy or unhealthy stores and fruit and vegetable purchasing. Conclusions We found strong evidence of healthier fruit and vegetable purchasing in households located in areas where the proportion of food stores that were healthy was greater. Policies aimed at improving the balance between healthy and unhealthy stores within areas may therefore be effective in promoting greater consumption of fruit and vegetables.

Individual and household‐level socioeconomic position is associated with harmful alcohol consumption behaviours among adults

OBJECTIVE To describe associations between demographic and individual and area-level socio-economic variables and restricted household food access due to lack of money, inability to lift groceries and lack of access to a car to do food shopping. DESIGN Multilevel study of three measures of restricted food access, i.e. running out of money to buy food, inability to lift groceries and lack of access to a car for food shopping. Multilevel logistic regression was conducted to examine the risk of each of these outcomes according to demographic and socio-economic variables. SETTING Random selection of households from fifty small areas in Melbourne, Australia, in 2003. SUBJECTS The main food shoppers in each household (n 2564). RESULTS A lack of money was significantly more likely among the young and in households with single adults. Difficulty lifting was more likely among the elderly and those born overseas. The youngest and highest age groups both reported reduced car access, as did those born overseas and single-adult households. All three factors were most likely among those with a lower individual or household socio-economic position. Increased levels of area disadvantage were independently associated with difficulty lifting and reduced car access. CONCLUSIONS In Melbourne, households with lower individual socio-economic position and area disadvantage have restricted access to food because of a lack of money and/or having physical limitations due difficulty lifting or lack of access to a car for food shopping. Further research is required to explore the relationship between physical restrictions and food access.