Simone Weyers

Low socio-economic position is associated with poor social networks and social support: results from the Heinz Nixdorf Recall Study

BackgroundSocial networks and social support are supposed to contribute to the development of unequal health within populations. However, little is known about their socio-economic distribution. In this study, we explore this distribution.MethodsThis study analyses the association of two indicators of socio-economic position, education and income, with different measures of social networks and support. Cross-sectional data have been derived from the baseline examination of an epidemiological cohort study of 4.814 middle aged urban inhabitants in Germany (Heinz Nixdorf Recall Study). Bivariate and multivariate logistic regression analysis were carried out to estimate the risk of having poor social networks and support across socio-economic groups.ResultsSocially disadvantaged persons more often report poor social networks and social support. In multivariate analyses, based on education, odds ratios range from 1.0 (highest education) to 4.9 (lowest education) in a graded way. Findings based on income show similar effects, ranging from 1.0 to 2.5. There is one exception: no association of SEP with close ties living nearby and regularly seen was observed.ConclusionPoor social networks and low social support are more frequent among socio-economically disadvantaged people. To some extent, this finding varies according to the indicator chosen to measure these social constructs.

How does socio economic position link to health behaviour? Sociological pathways and perspectives for health promotion

Socio economic inequalities in adult health behaviour are consistently observed. Despite a well-documented pattern, social determinants of variations in health behaviour have not been sufficiently clarified. This article therefore presents sociological pathways to explain the existing inequalities in health behaviour. At a micro level, control beliefs have been part of several behavioural theories. We suggest that these beliefs might bridge the gap between sociology and psychology by emphasising their roots in fundamental socio-economic environments. At a meso level, social networks and support have not been explicitly considered as behavioural determinants. This contribution states that these social factors influence health behaviour while being unequally distributed across society. At a macro level, characteristics of the neighbourhood environment influence health behaviour of its residents above and beyond their individual background. Providing further opportunity for policy makers, it is shown that peer and school context equalise inequalities in risky behaviour in adolescence. As a conclusion, factors such as control expectations, social networks, neighbourhood characteristics, and school context should be included as strategies to improve health behaviour in socially disadvantaged people.

Does socioeconomic status affect the association of social relationships and health? A moderator analysis

BackgroundSocial relations have repeatedly been found to be an important determinant of health. However, it is unclear whether the association between social relations and health is consistent throughout different status groups. It is likely that health effects of social relations vary in different status groups, as stated in the hypothesis of differential vulnerability. In this analysis we explore whether socioeconomic status (SES) moderates the association between social relations and health.MethodsIn the baseline examination of the Heinz Nixdorf Recall study, conducted in a dense populated Western German region (N = 4,814, response rate 56%), SES was measured by income and education. Social relations were classified by using both structural as well as functional measures. The Social Integration Index was used as a structural measure, whilst functional aspects were assessed by emotional and instrumental support. Health was indicated by self-rated health (1 item) and a short version of the CES-D scale measuring the frequency of depressive symptoms. Based on logistic regression models we calculated the relative excess risk due to interaction (RERI) which indicates existing moderator effects.ResultsOur findings show highest odds ratios (ORs) for both poor self-rated health and more frequent depressive symptoms when respondents have a low SES as well as inappropriate social relations. For example, respondents with low income and a low level of social integration have an OR for a high depression score of 2.85 (95% CI 2.32-4.49), compared to an OR of 1.44 (95% CI 1.12-1.86) amongst those with a low income but a high level of social integration and an OR of 1.72 (95% CI 1.45-2.03) amongst respondents with high income but a low level of social integration. As reference group those reporting high income and a high level of social integration were used.ConclusionsThe analyses indicate that the association of social relations and subjective health differs across SES groups as we find moderating effects of SES. However, results are inconsistent as nearly all RERI scores are positive but do not reach a significant level. Also moderating effects vary between women and men and depending on the indicators of SES and social relations used. Thus, the hypothesis of differential vulnerability can only partially be supported. In terms of practical implications, psychosocial and health interventions aiming towards the enhancement of social relations should especially consider the situation of the socially deprived.

Poor social relations and adverse health behaviour: stronger associations in low socioeconomic groups?

ObjectivePoor social relations are supposed to contribute to adverse health behaviour. We examined this association and the role of low socio-economic position.MethodsWe regressed health behaviour on composite variables of the two exposures of social relations and socio-economic position (SEP). Social relations included networks and support; health behaviour was analysed in terms of smoking, poor nutrition and physical inactivity; socio-economic position comprised of income and education. Cross sectional data from a population based epidemiological study in German (4,814 men and women aged 45–75) was analysed.ResultsAmong the indicators for social relations, social isolation was consistently associated with adverse health behaviour; social support showed modest effect. A combination of poor social relations and low SEP displayed stronger (additive) associations with adverse health behaviour than each factor alone. However, superadditivity was excluded.ConclusionGiven the important role of health adverse behaviour in chronic disease development, results underline the relevance of social environment and socio-economic structure in Public Health interventions.

Insomnia and urban neighbourhood contexts – are associations modified by individual social characteristics and change of residence? Results from a population-based study using residential histories

BackgroundUntil now, insomnia has not been much of interest in epidemiological neighbourhood studies, although literature provides evidence enough for insomnia-related mechanisms being potentially dependent on neighbourhood contexts. Besides, studies have shown differences in sleep along individual social characteristics that might render residents more vulnerable to neighbourhood contextual exposures. Given the role of exposure duration and changes in the relationship between neighbourhoods and health, we studied associations of neighbourhood unemployment and months under residential turnover with insomnia by covering ten years of residential history of nearly 3,000 urban residents in the Ruhr Area, Germany.MethodsIndividual data were retrieved from the Heinz Nixdorf Recall Study, a population-based study of randomly chosen participants from adjacent cities, which contains self-rated insomnia symptoms and individual social characteristics. Participants’ residential addresses were retrospectively assessed using public registries. We built individually derived exposure measures informing about mean neighbourhood unemployment rates and months under high residential turnover. These measures were major predictors in multivariate logistic regressions modelling the association between social neighbourhood characteristics and insomnia in the whole sample and subgroups defined by low income, low education, social isolation, and change of residence. Traffic-related noise, age, gender, economic activity, and education were considered as covariates.ResultsNearly 12 per cent of the participants complained about insomnia. Associations of neighbourhood unemployment with insomnia were more consistent than those of residential turnover in the whole sample (adjusted OR 1.42, 95% CI 1.00-2.03 for neighbourhood unemployment and OR 1.33, 95% CI 0.78-2.25 for residential turnover in the highest exposure categories). In low-income and socially isolated participants, neighbourhood unemployment odds of reporting insomnia were particularly elevated (adjusted OR 2.90, 95% CI 1.39-6.02 and OR 3.32, 95% CI 1.11-9.96, respectively). Less educated participants displayed relatively high odds of reporting insomnia throughout all upper neighbourhood unemployment exposure categories. Change of residence weakened associations, whereas undisrupted exposure sharpened them by trend.ConclusionsOur findings hint at multiple stressors being effective in both the neighbourhood context and individual resident, possibly reflecting precarious life situations undermining residents’ sleep and health chances. Moreover, our results suggest a temporal dependency in the association between neighbourhood and insomnia.

“I just realized that something happened to me today” — An innovative educational approach to support students in dealing with the dissection course, death and dying ☆

BACKGROUND AND AIM The dissection course is an essential part of preclinical medical education. At the Medical Faculty of Duesseldorf, a required elective course has been developed over three semesters with the aim of encouraging students to reflect on their experiences in the dissection course and offering them support in dealing with aspects of death and dying. The aim of this paper is to present this educational approach and the student evaluations. METHODS AND RESULTS The educational concept follows a peer group approach and is comprised of several components spanning three semesters: introductory lectures, tours of the dissection hall and clinical wards, an online diary, and reflection groups. Quantitative and qualitative evaluation has shown that students rate the course positively as to its benefits and workload. While all of the components should be retained, students do wish more time to visit sites and engage with professionals in connection with death and dying. DISCUSSION This strategy could serve as a cornerstone for longitudinal training to promote adequate coverage of topics such as death and dying. The course has a reasonable cost-benefit ratio. When transferring it to another setting, a gratification system should be considered.

Soziale Ungleichheit im Ernährungsverhalten

Malnutrition is unhealthy: obesity, type 2 diabetes, cardiovascular diseases, some cancers, and premature mortality are reliably associated with poor nutrition. However, literature reveals that some population groups are at higher risk of poor nutrition than others. More specifically, evidence shows that people with low social status are more likely to have poor nutrition than those with higher status, what may contribute to health inequalities. In this article, selected reviews and meta-analyses on social inequalities in nutrition are presented. By showing current data from the Second National Food Consumption Study, the situation in Germany is highlighted. Further, potential causes of social inequalities in nutrition are discussed, drawing on the results of current research. More specifically, socioeconomic and structural deprivation (e.g., poverty, living in deprived neighborhoods) in addition to unfavorable psychosocial (e.g., poor knowledge of nutrition, low levels of social support) and sociocultural factors (e.g., unfavorable nutritional traditions) might be associated with poor nutrition in people with low social status. Interventions promoting nutritional quality in disadvantaged groups should take into account the various influences on nutrition and meet good practice criteria for health promotion. Using three examples of interventions, conceivable concrete measures that can reduce social inequalities in nutrition are presented.

Psychosocial aspects of donation and the dissection course: An extra-curricular program with the objective of assisting students confront issues surrounding gross anatomy lab.

Background and aim: The dissection course is an essential part of preclinical medical education. At the Medical Faculty of Duesseldorf, an education concept has been developed with the aim, to reflect with students their experiences and to support them in dealing with the donor and preparation. The aim of this paper is to present the concept. Method: The education concept had a peer group approach. It comprised a lecture, a small group seminar and an online diary as core element. Finally, the concept was evaluated. Results: Approximately one sixth of students made use of the online diary. Selected entries are presented here. Also, one sixth of students took part in the evaluation. They rated the activity as helpful to prepare for the dissection course. Discussion: The education concept could be a corner stone of a longitudinal training to promote the adequate encounter with topics such as dying and death.

Erratum zu: Bildung, ausgewählte Ernährungseinstellungen und Ernährungsverhalten. Ergebnisse der Heinz Nixdorf Recall-Studie

Geschlecht (0) 2054 49,4 2103 50,6 4157 100 Alter (0) [59,2] [7,5] [59,2] [7,7] [59,2] [7,6] Bildung (5) ≤10 Jahre 86 4,2 335 15,9 421 10,1 11–13 Jahre 965 47,1 1353 64,4 2318 55,8 14–17 Jahre 700 34,1 240 11,4 940 22,6 ≥18 Jahre 299 14,6 174 8,3 473 11,4 Ernährungsumstellung schützt (176) Nein 697 35,2 625 31,2 1322 31,8 Ja 1283 64,8 1376 68,8 2659 64,0 Ernährungsumstellung zu aufwändig (213) Nein 1076 54,7 1140 57,7 2216 53,3 Ja 892 45,3 836 42,3 1728 41,6 Verzehr von frischem Gemüse (48) Mittel bis günstig 560 27,6 859 41,3 1419 34,5 Ungünstig 1470 72,6 1220 58,8 2690 65,5 Verzehr vonMüsli (43) Mittel bis günstig 772 38,0 911 43,8 1683 40,9 Ungünstig 1262 32,

Soziale Ungleichheit im Ernährungsverhalten@@@Social inequalities in nutrition: Befundlage, Ursachen und Interventionen@@@Evidence, causes and interventions

Malnutrition is unhealthy: obesity, type 2 diabetes, cardiovascular diseases, some cancers, and premature mortality are reliably associated with poor nutrition. However, literature reveals that some population groups are at higher risk of poor nutrition than others. More specifically, evidence shows that people with low social status are more likely to have poor nutrition than those with higher status, what may contribute to health inequalities. In this article, selected reviews and meta-analyses on social inequalities in nutrition are presented. By showing current data from the Second National Food Consumption Study, the situation in Germany is highlighted. Further, potential causes of social inequalities in nutrition are discussed, drawing on the results of current research. More specifically, socioeconomic and structural deprivation (e.g., poverty, living in deprived neighborhoods) in addition to unfavorable psychosocial (e.g., poor knowledge of nutrition, low levels of social support) and sociocultural factors (e.g., unfavorable nutritional traditions) might be associated with poor nutrition in people with low social status. Interventions promoting nutritional quality in disadvantaged groups should take into account the various influences on nutrition and meet good practice criteria for health promotion. Using three examples of interventions, conceivable concrete measures that can reduce social inequalities in nutrition are presented.