Rosemary Hiscock

Socioeconomic status and smoking: A review

Smoking prevalence is higher among disadvantaged groups, and disadvantaged smokers may face higher exposure to tobaccos harms. Uptake may also be higher among those with low socioeconomic status (SES), and quit attempts are less likely to be successful. Studies have suggested that this may be the result of reduced social support for quitting, low motivation to quit, stronger addiction to tobacco, increased likelihood of not completing courses of pharmacotherapy or behavioral support sessions, psychological differences such as lack of self‐efficacy, and tobacco industry marketing. Evidence of interventions that work among lower socioeconomic groups is sparse. Raising the price of tobacco products appears to be the tobacco control intervention with the most potential to reduce health inequalities from tobacco. Targeted cessation programs and mass media interventions can also contribute to reducing inequalities. To tackle the high prevalence of smoking among disadvantaged groups, a combination of tobacco control measures is required, and these should be delivered in conjunction with wider attempts to address inequalities in health.

In the driving seat: psychosocial benefits from private motor vehicle transport compared to public transport

The aim of current transport policy in the UK and many other developed countries is to reduce reliance on private motor vehicle transport in order to promote public health and reduce environmental degradation. Despite the emphasis in these policies on the unhealthiness of private motor car use, epidemiological studies have consistently shown that car access is associated with longevity and better health. We examine this paradox using a postal survey of adults in the West of Scotland (n=2043, m=896, f=1147) to investigate the psychosocial benefits associated with private and public motor vehicle transport. Those with access to a car appear to gain more psychosocial benefits (mastery, self esteem, and feelings of autonomy, protection, and prestige) than public transport users from their habitual mode of transport. Being a car driver conferred more benefits than being a passenger, except for self esteem which was only associated with driving among men. Self-esteem was also associated with type of car among men but not women. This study suggests that if people are to be encouraged to reduce private motor vehicle use, policies need to take into account some of the psychosocial benefits people might derive from such use.

The contextual effects of neighbourhood access to supermarkets and convenience stores on individual fruit and vegetable consumption

Background: It is often suggested that neighbourhood access to food retailers affects the dietary patterns of local residents, but this hypothesis has not been adequately researched. We examine the association between neighbourhood accessibility to supermarkets and convenience stores and individuals’ consumption of fruit and vegetables in New Zealand. Methods: Using geographical information systems, travel times from the population-weighted centroid of each neighbourhood to the closest supermarket and convenience store were calculated for 38 350 neighbourhoods. These neighbourhood measures of accessibility were appended to the 2002–3 New Zealand Health Survey of 12 529 adults. Results: The consumption of the recommended daily intake of fruit was not associated with living in a neighbourhood with better access to supermarkets or convenience stores. Similarly, access to supermarkets was not related to vegetable intake. However, individuals in the quartile of neighbourhoods with the best access to convenience stores had 25% (OR 0.75, 95% CI 0.60% to 0.93%) lower odds of eating the recommended vegetable intake compared to individuals in the base category (worst access). Conclusion: This study found little evidence that poor locational access to food retail provision is associated with lower fruit and vegetable consumption. However, before rejecting the commonsense notion that neighbourhood access to fruit and vegetables affects personal consumption, research that measures fruit and vegetable access more precisely and directly is required.

Beyond four walls - the psycho-social benefits of home: evidence from West Central Scotland

This paper reviews the literatures on housing and ontological security and the meaning of the home in order to derive specific examples of the psycho-social benefits of the home which can be assessed through empirical research. A postal survey measuring these psycho-social benefits was distributed to a random sample of adults in eight local authority districts in West Central Scotland. From the responses to the survey, three factors were constructed relating to the home as a haven, as a locus of autonomy and as a source of status for the occupants. Multivariate analysis showed that housing tenure is less important as an influence upon the attainment of psycho-social benefits from the home than the neighbourhood context and the incidence of problems with the home. Further, those factors negatively associated with psycho-social benefits appear to be more important than those factors positively associated with such benefits. This suggests that future research should focus on the fact that what detracts from psycho-social benefits may be more important than what contributes to them. A further important finding is that, after controlling for other influences, people living alone derive more benefits from the home as a haven and as a locus of autonomy than people in multi-person households.

What features of the home and the area might help to explain observed relationships between housing tenure and health? Evidence from the west of Scotland.

This study aimed to explore the role of dwelling conditions and neighbourhood characteristics in explaining the frequently observed association between housing tenure and health. A postal questionnaire, focusing on a number of specific aspects of the home and the area, was sent to a random sample of adults in the west of Scotland (achieved sample size 2867, response rate 50%). The health measures were limiting long-standing illness, self-assessed health, recent symptoms, and anxiety and depression. Having controlled for age, sex, and marital status, housing tenure explained, respectively, 2.7%, 5.4%, 3.9%, 2.4% and 5.4% of the variance in these variables. These percentages were reduced by between 93% (for anxiety) and 73% (for self-assessed health) when housing problems, housing fixtures, overcrowding, dwelling type, access to garden, area type and area amenities were introduced into the model. This suggests that features of the dwelling and its surroundings help to explain observed associations between tenure and health in the UK, and that housing and area problems may be particularly important. Housing improvements and urban regeneration may help to reduce the health gap between housing tenures, and more generally to reduce inequalities in health.

Neighbourhood access to open spaces and the physical activity of residents: A national study

OBJECTIVE Increasing population levels of physical activity is high on the health agenda in many countries. There is some evidence that neighbourhood access to public open space can increase physical activity by providing easier and more direct access to opportunities for exercise. This national study examines the relationship between travel time access to parks and beaches, BMI and physical activity in New Zealand neighbourhoods. METHODS Access to parks and beaches, measured in minutes taken by a car, was calculated for 38,350 neighbourhoods nationally using Geographic Information Systems. Multilevel regression analyses were used to establish the significance of access to these recreational amenities as a predictor of BMI, and levels of physical activity and sedentary behaviour in the 12,529 participants, living in 1178 neighbourhoods, of the New Zealand Health Survey 2002/3. RESULTS Neighbourhood access to parks was not associated with BMI, sedentary behaviour or physical activity, after controlling for individual-level socio-economic variables, and neighbourhood-level deprivation and urban/rural status. There was some evidence of a relationship between beach access and BMI and physical activity in the expected direction. CONCLUSIONS This study found little evidence of an association between locational access to open spaces and physical activity.

A national study of the association between neighbourhood access to fast-food outlets and the diet and weight of local residents

Differential locational access to fast-food retailing between neighbourhoods of varying socioeconomic status has been suggested as a contextual explanation for the social distribution of diet-related mortality and morbidity. This New Zealand study examines whether neighbourhood access to fast-food outlets is associated with individual diet-related health outcomes. Travel distances to the closest fast-food outlet (multinational and locally operated) were calculated for all neighbourhoods and appended to a national health survey. Residents in neighbourhoods with the furthest access to a multinational fast-food outlet were more likely to eat the recommended intake of vegetables but also be overweight. There was no association with fruit consumption. Access to locally operated fast-food outlets was not associated with the consumption of the recommended fruit and vegetables or being overweight. Better neighbourhood access to fast-food retailing is unlikely to be a key contextual driver for inequalities in diet-related health outcomes in New Zealand.

A national study of neighbourhood access to gambling opportunities and individual gambling behaviour

Objective: To investigate associations between neighbourhood accessibility to gambling outlets (non-casino gaming machine locations, sports betting venues and casinos) and individual gambling behaviour in New Zealand. Design: A Geographical Information Systems (GIS) measure of neighbourhood access to gambling venues. Two-level logistic regression models were fitted to examine the effects of neighbourhood access on individual gambling behaviour after controlling for potential individual- and neighbourhood-level confounding factors. Setting: 38 350 neighbourhoods across New Zealand. Participants: 12 529 respondents of the 2002/03 New Zealand Health Survey. Results: Compared with those living in the quartile of neighbourhoods with the furthest access to a gambling venue, residents living in the quartile of neighbourhoods with the closest access were more likely (adjusted for age, sex, socio-economic status at the individual-level and deprivation, urban/rural status at the neighbourhood-level) to be a gambler (OR 1.60, 95% CI 1.20 to 2.15) or problem gambler (OR 2.70, 95% CI 1.03 to 7.05). When examined independently, neighbourhood access to venues with non-casino gaming machines (gambling: OR 1.67, 95% CI 1.28 to 2.18; problem gambling: OR 2.71, 95% CI 1.45 to 5.07) and sports betting venues (gambling: OR 1.67, 95% CI 1.28 to 2.18; problem gambling: OR 2.71, 95% CI 1.45 to 5.07) were similarly related. Conclusions: Neighbourhood access to opportunities for gambling is related to gambling and problem gambling behaviour, and contributes substantially to neighbourhood inequalities in gambling over and above-individual level characteristics.

Social inequalities in quitting smoking: what factors mediate the relationship between socioeconomic position and smoking cessation?

BACKGROUND Smokers from lower socio-economic groups are less likely to be successful in a quit attempt than more affluent smokers, even when they access smoking cessation services. METHODS Data were collected from smoking cessation service users from three contrasting areas of Great Britain-Glasgow, North Cumbria and Nottingham. Routine monitoring data were supplemented with CO-validated smoking status at 52-week follow-up and survey data on socio-economic circumstances and smoking-related behaviour. Analysis was restricted to the 2397 clients aged between 25 and 59. RESULTS At 52-week follow-up, 14.3% of the most affluent smokers remained quit compared with only 5.3% of the most disadvantaged. After adjustment for demographic factors, the most advantaged clients at the English sites and the Glasgow one-to-one programme were significantly more likely to have remained abstinent than those who were most disadvantaged [odds ratio: 2.5, confidence interval (CI): 1.4-4.7 and 7.5 CI: 1.4-40.3, respectively). Mechanisms producing the inequalities appeared to include treatment compliance, household smokers and referral source. CONCLUSIONS Rather than quitting smoking, disadvantaged smokers quit treatment. More should be done to encourage them to persevere through the first few weeks. Other causes of inequalities in quitting varied with the service provided.

Housing tenure and car access: further exploration of the nature of their relations with health in a UK setting

Housing tenure and car access predict longevity and health in many European countries. It is usually assumed that they do so only because they are markers of other material determinants of health. However, in a previous paper we showed that both variables were still significantly associated with several health outcomes after controls for age, sex, and income.1 Here we replicate and extend that analysis in another sample, examining whether observed relations between tenure or car access and health remain after controlling for alternative measures of material assets (social class and income), and, following suggestions that socioeconomic gradients in health may differ between men and women,2 whether there are interactions with gender. A postal questionnaire, with three follow ups, achieved a response rate of 50% (42% male, 58% female), from a random sample of 6500 adults from the electoral roll in eight local authority areas in the west of Scotland in 1997. We examined four domains of self assessed health: chronic, recent and mental …