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Background: Within the European Union (EU), substantial efforts are being made to achieve economic and social cohesion, and the reduction of health inequalities between EU regions is integral to this process. This paper is the first to examine how self-reported conditions and non-communicable diseases (NCDs) vary spatially between and within countries. Methods: Using 2014 European Social Survey (ESS) data from 20 countries, this paper examines how regional inequalities in self-reported conditions and NCDs vary for men and women in 174 regions (levels 1 and 2 Nomenclature of Statistical Territorial Units, 'NUTS'). We document absolute and relative inequalities across Europe in the prevalence of eight conditions: general health, overweight/obesity, mental health, heart or circulation problems, high blood pressure, back, neck, muscular or joint pain, diabetes and cancer. Results: There is considerable inequality in self-reported conditions and NCDs between the regions of Europe, with rates highest in the regions of continental Europe, some Scandinavian regions and parts of the UK and lowest around regions bordering the Alps, in Ireland and France. However, for mental health and cancer, rates are highest in regions of Eastern European and lowest in some Nordic regions, Ireland and isolated regions in continental Europe. There are also widespread and consistent absolute and relative regional inequalities in all conditions within countries. These are largest in France, Germany and the UK, and smallest in Denmark, Sweden and Norway. There were higher inequalities amongst women. Conclusion: Using newly available harmonized morbidity data from across Europe, this paper shows that there are considerable regional inequalities within and between European countries in the distribution of self-reported conditions and NCDs. [ABSTRACT FROM AUTHOR]

Context/problem: Comparative analysis of relative and absolute mortality differentials between socioeconomic groups are now available. These show consistently increasing relative increases in mortality differentials but complex trends in absolute mortality differentials. Objective: This paper provides an analysis of relative and absolute trends in mortality by cause of death and socioeconomic group (SEG) from 1984 to 2008 among men and active women aged 30-64 years in Ireland and compares these results with recent European and US studies to give an overview of trends. Methods: This paper uses mortality data from the Irish Central Statistics Office from 1984 to 2008 to calculate standardized death rates by age, sex, socioeconomic status and cause of death showing trends in SEG inequalities in mortality in Ireland. These show which specific causes of death are driving all-cause mortality trends. Results: SEG differentials in all-cause mortality among men and women have been increasing since the 1980s. Some of this increase reflects larger falls in cardiovascular causes among advantaged groups, but the trend is largely accounted for by increasing inequalities in mortality in digestive, neoplasm and external causes of deaths. Conclusions: These findings are in line with international findings that show that socioeconomic differentials in digestive, neoplasm and external cause deaths are driving general socioeconomic differentials in all-cause mortality. External cause deaths may have been influenced by levels of economic activity, particularly in construction, during the economic boom among manual workers. Furthermore, deaths from digestive diseases during the 1990s and 2000s may well be the result of increases in liver disease associated with excessive alcohol consumption. [ABSTRACT FROM AUTHOR]

Background The aim of this paper was to compare the effects of demography (population aging and the increasing fraction of tertiary educated) and behaviour (intra-cohort ageing and inter-cohort change) on long-term change in the fraction of daily smokers (FrS), using a counterfactual framework. Methods Using aggregated data on smoking prevalence, education and population size from Norway 1978 to 2017, the probabilities of smoking for men and women were calculated using a pseudo-panel approach. From these estimates, four counterfactual scenarios of FrS were constructed by holding the age effect, the cohort effect and the distribution of age and education constant over time. Results FrS decreased from 45 to 14% among men, and from 33 to 14% among women over the study period. Holding the age distribution constant did not have any substantial effect on FrS. Holding the distribution of education constant led to a five percentage points increase in FrS among women, but not among men. In the case of no intra-cohort ageing, FrS would have been 11/12 percentage points higher among women/men. The corresponding figures for no inter-cohort change were 13 points for women and 27 points for men. Conclusions If the age distribution had remained stable over time, FrS would have been almost identical to the current level. In contrast, if smoking behaviour had remained stable over the life course or between birth cohorts, FrS would have been substantially higher than it is today. These results highlight the large cumulative effect of reducing smoking uptake in successive cohorts. [ABSTRACT FROM AUTHOR]

Background Tobacco use is a leading but preventable cause of non-communicable diseases and premature death. The legislature has a key role in setting tobacco control policies. Smoking trends are decreasing thanks to the introduction of effective tobacco control policies in Turkey and these policies may have been shaped by how politicians' interpreted social problems that were prominent during the development and implementation of tobacco regulations. Aim This paper explores the long-term national relationship between tobacco consumption, tobacco control policies and the associated political discourse in Turkey, considering the varying influences through national leadership on this important public health agenda. This relationship is studied by comparing a time series analysis of tobacco consumption trends with a policy analysis of the minutes of deliberations at the Grand National Assembly of Turkey (GNAT). Methods This study uses Bayesian time series analysis in order investigate whether the tobacco control policies and related activities influenced the annual per adult cigarette consumption in Turkey. We used a novel method to identify change points in tobacco trends and whether they correspond with key policy changes intended to alter usage after adjusting for the effect of other non-policy related covariates, such as the purchasing power. The policy analysis included an examination of the minutes of deliberations at the GNAT—which is the Turkish parliament and unicameral Turkish legislature—1 year before and 1 year after the break years associated with an increase or decrease in tobacco consumption. Results and recommendations Tobacco consumption increased with the encouragement of tobacco production and the entrance of multinational companies in the country in 1976 and 1993, respectively. The National Tobacco Law of 1996 and comprehensive amendments in 2008, including smoke-free public places and tax increases, appear to have helped reduce tobacco consumption in Turkey. The focus of Parliamentary discussions throughout this period changed, becoming less supportive of tobacco over time. However, throughout the period there remained discussions focussing on concerns around the implications for the economy and the privatization agenda, national agriculture and the welfare of farmers. Effective control appears to require certain political ingredients to be implemented: politicians who are well informed on tobacco control measures and understand the range of issues surrounding the policies (not only those directly health-related); and supportive public health information in the community. Evidence-based public health policy should be introduced to the politicians. [ABSTRACT FROM AUTHOR]

Background: Financial difficulties in childhood may be associated with immediate and long-term consequences for mental health. The aim of the current paper is to investigate the association between childhood financial difficulties and adult depression, and assess the relative contribution of financial difficulties in childhood to symptoms of adult depression across different age groups. Methods: Using three age cohorts (25-40, 41-59, 60-75) from 19 countries in the European Social Survey Round 7 (N=18 401), multi-level and country-wise OLS regression analyses were used to investigate the association between financial difficulties in childhood and adult depression, while adjusting for age, education, gender, highest education in family, level of family conflict, number of social meetings and marital status. Results: Financial difficulties in childhood was found to be influential predictors of depression scores for 25-40 year olds in 10 out of 19 countries in fully adjusted models. In older participants, depression scores were mostly influenced by frequency of social meetings and marital status. There was great variation in the pattern of influential risk factors across countries, and the predicted effect childhood financial difficulties had on adult depression scores. Conclusion: Childhood financial difficulties as predictors of depression appear to, by themselves, exert the strongest influence in younger adults. There was, however, large variation between countries in the magnitude of associated risk, and in the pattern of risk factors contributing to adult depression, which underscores the need to account for country-level factors when aiming to gain knowledge about mental health. [ABSTRACT FROM AUTHOR]

Background: Health inequalities persist between and within European countries. Such inequalities are usually explained by health behaviours and according to the conditions in which people work and live. However, little is known about the relative contribution of these factors to health inequalities in European countries. This paper aims to investigate the independent and joint contribution of a comprehensive set of behavioural, occupational and living conditions factors in explaining social inequalities in self-rated health (SRH). Method: Data from 21 countries was obtained from the 2014 European Social Survey and examined for respondents aged 25-75. Adjusted rate differences (ARD) and adjusted rate risks (ARR), generated from binary logistic regression models, were used to measure health inequalities in SRH and the contribution of behavioural, occupational and living conditions factors. Result: Absolute and relative inequalities in SRH were found in all countries and the magnitude of socio-economic inequalities varied considerably between countries. While factors were found to differentially contribute to the explanation of educational inequalities in different European countries, occupational and living conditions factors emerged as the leading causes of inequalities across most of the countries, contributing both independently and jointly with behavioural factors. Conclusion: The observed shared effects of different factors to health inequalities points to the interdependent nature of occupational, behavioural and living conditions factors. Tackling health inequalities should be a concentred effort that goes beyond interventions focused on single factors. [ABSTRACT FROM AUTHOR]

Background: During the global pandemic of A/H1N1/California/07/2009 (A/H1N1/Cal) influenza, many governments signed contracts with vaccine producers for a universal influenza immunization program and bought hundreds of millions of vaccines doses. We argue that, as Health Ministers assumed the occurrence of the worst possible scenario (generalized pandemic influenza) and followed the strong version of the Precautionary Principle, they undervalued the possibility of mild or weak pandemic wave. Methodology: An alternative decision rule, based on the non-extensive entropy principle, is introduced, and a different Precautionary Principle characterization is applied. This approach values extreme negative results (catastrophic events) in a different way and predicts more plausible and mild events. It introduces less pessimistic forecasts in the case of uncertain influenza pandemic outbreaks. A simplified application is presented using seasonal data of morbidity and severity among Italian children influenza-like illness for the period 2003–10. Principal Findings: Established literature results predict an average attack rate of not less than 15% for the next pandemic influenza [Meltzer M, Cox N, Fukuda K. The economic impact of pandemic influenza in the United States: implications for setting priorities for interventions. Emerg Infect Dis 1999;5:659–71; Meltzer M, Cox N, Fukuda K. Modeling the Economic Impact of Pandemic Influenza in the United States: Implications for Setting Priorities for Intervention. Background paper. Atlanta, GA: CDC, 1999. Available at: http://www.cdc.gov/ncidod/eid/vol5no5/melt_back.htm (7 January 2011, date last accessed))]. The strong version of the Precautionary Principle would suggest using this prediction for vaccination campaigns. On the contrary, the non-extensive maximum entropy principle predicts a lower attack rate, which induces a 20% saving in public funding for vaccines doses. Conclusions: The need for an effective influenza pandemic prevention program, coupled with an efficient use of public funding, calls for a rethinking of the Precautionary Principle. The non-extensive maximum entropy principle, which incorporates vague and incomplete information available to decision makers, produces a more coherent forecast of possible influenza pandemic and a conservative spending in public funding. [ABSTRACT FROM PUBLISHER]

To design effective and commonly accepted public health policies against performance-enhancing drugs (PED), it is important to understand general population attitudes. This article elicits PED attitudes in the Berlin population and compares response rates of former athletes (N = 496) with those of non-athletes (N = 1686). In addition, exploiting the natural experiment of the division of Germany, by comparing East (N = 687) to West Berliners (N = 1315), the article studies the long-term impact of state socialisation on PED attitudes. Former West German amateur athletes are a statistically significant 6ppt more likely to believe that athletes can be successful without doping. Former GDR amateur athletes are 8ppt more likely to believe that doping is inevitable in professional sports. [ABSTRACT FROM AUTHOR]

Background Health status is a principal determinant of labour market participation. In this study, we examined whether excess weight is associated with withdrawal from the labour market owing to premature retirement. Methods The analyses were based on nationally representative data from Finland over the period 2001–15 (N ∼ 2500). The longitudinal data included objective measures of body weight (i.e. body mass index and waist circumference) linked to register-based information on actual retirement age. The association between the body weight measures and premature retirement was modelled using cubic b-splines via logistic regression. The models accounted for other possible risk factors and potential confounders, such as smoking and education. Results Excess weight was associated with an increased risk of premature retirement for both men and women. A closer examination revealed that the probability of retirement varied across the weight distribution and the results differed between sexes and weight measures. Conclusion Body weight outside a recommended range elevates the risk of premature retirement. [ABSTRACT FROM AUTHOR]

Background In Denmark, a tax-based universal healthcare setting, drug reimbursement for terminal illness (DRTI) should be equally accessible for all terminally ill patients. Examining DRTI status by regions provides new knowledge on inequality in palliative care provision and associated factors. This study aims to investigate geographical variation in DRTI among terminally ill cancer patients. Methods We linked socioeconomic and medical data from 135 819 Danish cancer decedents in the period 2007–15 to regional healthcare characteristics. We analyzed associations between region of residence and DRTI. Prevalence ratios (PR) for DRTI were estimated using generalized linear models adjusted for patient factors (age, gender, comorbidity and socioeconomic profile) and multilevel models adjusted for both patient factors and regional healthcare capacity (patients per general practitioner, numbers of hospital and hospice beds). Results DRTI allocation differed substantially across Danish regions. Healthcare capacity was associated with DRTI with a higher probability of DRTI among patients living in regions with high compared with low hospice bed supply (PR 1.13, 95% CI 1.10–1.17). Also, the fully adjusted PR of DRTI was 0.94 (95% CI 0.91–0.96) when comparing high with low number of hospital beds. When controlled for both patient and regional healthcare characteristics, the PR for DRTI was 1.17 (95% CI 1.14–1.21) for patients living in the Central Denmark Region compared with the Capital Region. Conclusion DRTI status varied across regions in Denmark. The variation was associated with the distribution of healthcare resources. These findings highlight difficulties in ensuring equal access to palliative care even in a universal healthcare system. [ABSTRACT FROM AUTHOR]

Background: In Spain, migrants are disproportionately affected by HIV and experience high rates of late diagnosis. We investigated barriers to health care access among migrants living with HIV (MLWH) in Spain. Methods: Cross sectional electronic survey of 765 adult HIV-positive migrants recruited within 18 health care settings between July 2013 and July 2015. We collected epidemiological, demographic, behavioral and clinical data. We estimated the prevalence and risk factors of self-reported barriers to health care using multivariable logistic regression. Results: Of those surveyed, 672 (88%) had information on health care access barriers: 23% were women, 63% from Latin America and Caribbean, 14% from Sub-Saharan Africa and 15% had an irregular immigration status. Men were more likely to report barriers than women (24% vs. 14%, P = 0.009). The main barriers were: lengthy waiting times for an appointment (9%) or in the clinic (7%) and lack of a health card (7%). Having an irregular immigration status was a risk factor for experiencing barriers for both men (OR: (4.0 [95%CI: 2.2-7.2]) and women (OR: 10.5 [95%CI: 3.1-34.8]). Men who experienced racial stigma (OR: 3.1 [95%CI: 1.9-5.1]) or food insecurity (OR: 2.1 [95%CI: 1.2-3.4]) were more likely to report barriers. Women who delayed treatment due to medication costs (6.3 [95%CI: 1.3-30.8]) or had a university degree (OR: 5.8 [95%CI: 1.3-25.1]) were more likely to report barriers. Conclusion: Health care barriers were present in one in five5 MLWH, were more common in men and were associated to legal entitlement to access care, perceived stigma and financial constraints. [ABSTRACT FROM AUTHOR]

Background: At-risk alcohol use is associated bi-directionally to unemployment, and decreases chances of reemployment. Brief alcohol interventions (BAI) can reduce at-risk alcohol use. This study aimed to investigate 15-month effects of BAI on unemployment among persons with at-risk alcohol use. Methods: As part of the randomized controlled 'Trial on proactive alcohol interventions among job-seekers, TOPAS', 1243 18- to 64-yearold job-seekers with at-risk alcohol use were systematically recruited at three job agencies in Germany (2008/09), and randomized to (i) a stage tailored intervention based on the trans-theoretical model of intentional behavior change (ST), (ii) a non-stage tailored intervention based on the theory of planned behavior (NST) and (iii) assessment only (AO). To test the effects of ST and NST on employment status 15 months after baseline, latent growth models were calculated among those initially unemployed (n = 586). Results: In all three groups, unemployment significantly decreased over 15months (ST: odds ratio, OR= 0.06; 95% confidence interval, CI: 0.01-0.27; NST: OR= 0.04; 95% CI: 0.01-0.18; AO: OR = 0.05; 95% CI: 0.01-0.21). No intervention effects were found on unemployment. Age (P = 0.002), school education (P = 0.001), self-rated health (P = 0.04), the Alcohol Use Disorder Identification Test-Consumption score (P = 0.02) and motivation to change (P = 0.04) significantly affected the development of unemployment over time. Conclusion: After 15 months, no BAI effect on unemployment was found. The mediated effect of BAIs on unemployment could be a longsome process needing longer follow-ups to be detected. [ABSTRACT FROM AUTHOR]

Background: We aimed to describe gender and region differences in the prevalence of binge drinking and in the association between binge drinking and well-being, among older adult Europeans. Methods: This is a cross-sectional study using the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 4, conducted between 2011 and 2012, including 58 489 individuals aged 50 years or older. Sixteen European countries were grouped in four drinking culture regions: South, Central, North and East. We categorized drinking patterns as: never, former, no-binge and binge drinkers. We used the CASP-12 questionnaire to measure well-being. To assess the association between binge drinking and well-being, we fitted two-level mixed effects linear models. Results: The highest percentage of binge drinkers was found in Central Europe (17.25% in men and 5.05% in women) and the lowest in Southern Europe (9.74% in men and 2.34% in women). Former, never and binge drinkers had a significant negative association with well-being as compared with no-binge drinkers. There was a significant interaction in this association by gender and region. Overall, associations were generally stronger in women and in Southern and Eastern Europe. The negative association of binge drinking with well-being was especially strong in Southern European women (β = -3.80, 95%CI: -5.16 to -2.44, P value <0.001). Conclusion: In Southern and Eastern European countries the association between binge drinking and well-being is stronger, especially in women, compared with Northern and Central Europe. Cultural factors (such as tolerance to drunkenness) should be further explored. [ABSTRACT FROM AUTHOR]

Background: HIV testing is generally accepted as being the lynchpin of a prevention strategy to tackle the HIV epidemic among MSM. However, few studies have analysed in detail the factors that influence HIV test seeking behaviour. Methods: The objective of this article is to analyse the relationship between HIV test seeking behaviour and individual, social and demographic factors in a sample of MSM recruited though a multi-centre bio- behavioural cross-sectional study. A multi-level analysis was conducted to identify factors associated with HIV test seeking behaviour. Results: A total of 2400 men were included in the sample. Age, self-reported sexual orientation, residence, household composition, educational status and perceived homonegativity all seem to impact on test seeking behaviour. Conclusions: The results suggest the need for more targeted testing promotion strategies among MSM that take structural and environmental factors into consideration, as part of a comprehensive public health strategy to address the HIV epidemic. [ABSTRACT FROM AUTHOR]

Background: Maximising the happiness and life satisfaction [i.e. subjective well-being (SWB)] of citizens is a fundamental goal of international governmental organizations' policies. In order to decide what policies should be pursued in order to improve SWB there is a need to identify what the key drivers of SWB are. However, to date most studies have been conducted in unrepresentative samples of largely 'developed' nations. Methods: Data from the latest World Value Survey (2010-14) and gathered 85 070 respondents from 59 countries (Age 1-99 years, Mean = 42, SD = 16.54; 52.29% females) were pooled for the analysis. A cross-sectional multilevel random effects model was performed where respondents were nested by country. Results: The average levels of SWB varied across countries and geographical regions. Among the lowest 10 SWB countries are nations from: Eastern Europe and Former Soviet Union and Middle East and North Africa. Factors driving SWB include state of health, financial satisfaction, freedom of choice, GDP per capita, income scale, importance of friends, leisure, being females, weekly religious attendance, unemployment and income inequality. Nevertheless, according to Cohen's rules of thumb, most of these factors have 'small' effect sizes. Thus, the main factors that possibly will improve the SWB of people across the globe are: state of health, household's financial satisfaction and freedom of choice. Conclusions: To maximize the well-being of the population, policy makers may focus on health status, household's financial satisfaction and emancipative values. The levels of prosperity and political stability appear to positively improve the SWB of people. [ABSTRACT FROM AUTHOR]

Background: Injury morbidity data are collected through hospital-based surveillance in many countries. We assessed the extent of non-fatal injures treated outside a hospital. Methods: Data from the first provincial health household interview survey of Hunan, China, conducted in 2013, were used. Injury events were identified and included as medically significant when any of the following circumstances occurred in the prior 14 days: (i) receiving medical treatment from a doctor at a hospital following an injury; (ii) receiving medical treatment by self or others outside a hospital following an injury (e.g. taking medications, or receiving massage or hot compress); and/or (iii) being off work or school, or in bed for more than 1 day, following an injury. The 2-week prevalence of non-fatal injuries and 95% confidence intervals were calculated. We calculated the proportion of injury events treated outside a hospital and the reasons for not visiting a hospital for injury events occurring during the previous 2 weeks. Results: We captured 56 injury events during the previous 2 weeks. The weighted injury prevalence was 4.9 per 1000 persons during the last 2 weeks (95% confidence interval: 2.9-6.9 per 1000 persons). Of the 56 events, 14 (weighted proportion 41.2%) were treated outside a hospital. Primary explanations for skipping hospital visits included perceiving injuries were too minor and economic limitations to travel to hospitals or seek treatment. Conclusion: Results imply the burden of non-fatal injury may be underestimated by hospital-based surveillance systems such as that used in China. [ABSTRACT FROM AUTHOR]

Background: Low socioeconomic position (SEP) tends to be linked to higher use of general practitioners (GPs), while the use of health care specialists is more common in higher SEPs. Despite extensive literature in this area, previous studies have, however, only studied health care use by income or education. The aim of this study is, therefore, to examine inequalities in GP and health care specialist use by four social markers that may be linked to health care utilization (educational level, occupational status, level of financial strain and size and frequency of social networks) across 20 European countries and Israel. Methods: Logistic regression models were employed using data from the seventh round of the European Social Survey; this study focused upon people aged 25-75 years, across 21 countries. Health care utilization was measured according to self-reported use of GP or specialist care within 12 months. Analyses tested four social markers: income (financial strain), occupational status, education and social networks. Results: We observed a cross-national tendency that countries with higher or equal probability of GP utilization by lower SEP groups had a more consistent probability of specialist use among high SEP groups. Moreover, countries with inequalities in GP use in favour of high SEP groups had comparable levels of inequalities in specialist care utilization. This was the case for three social markers (education, occupational class and social networks), while the pattern was less pronounced for income (financial strain). Conclusion: There are significant inequalities associated with GP and specialist health care use across Europe--with higher SEP groups more likely to use health care specialists, compared with lower SEP groups. In the context of health care specialist use, education and occupation appear to be particularly important factors. [ABSTRACT FROM AUTHOR]

Background: Despite increasing overall life expectancy, substantial differences in health between socioeconomic groups persist. Research on inequalities in health often draws on data from different, single surveys. An important question that arises is whether these surveys reflect health and inequalities in the same way. When occupational class is utilized, data are often not analysed for women. The aim of this study therefore is to investigate whether patterns of occupational class inequalities in self-reported health differ across sex and country, between four major European surveys. Methods: Data on self-reported health and occupational class are taken from the European Social Survey (ESS), the EU Statistics on Income and Living Conditions (EU-SILC), the European Working Conditions Survey (EWCS) and the International Social Survey Programme (ISSP). Data from 35 countries for men and women aged 25-65 years are analysed. Occupational class is measured according to manual and non-manual workers. Age-standardized prevalence rates, and prevalence ratios (PR) between non-manual and manual workers and likelihood ratio (LR) tests are estimated to determine occupational class inequalities in self-rated health in Europe. Results: Results show that prevalence rates of less than good health differ noticeably between countries and surveys. Furthermore, occupational class inequalities in health differ between countries. In some countries inequalities are larger for women than for men. This is especially true in Eastern, Central and Baltic European countries. Besides that no regional patterns, consistent over all surveys, in inequalities could be detected. Inequalities differed significantly between surveys. Conclusion: The magnitude of inequalities in all countries depend on the survey used in the analysis. When undertaking a comparative analysis of inequalities in health, or other determinants, these differences have to be taken into account, as results might differ according to the data source used. [ABSTRACT FROM AUTHOR]

Background: Economic crises constitute a shock to societies with potentially harmful effects to the mental health status of the population, including depressive symptoms, and existing health inequalities. Methods: With recent data from the European Social Survey (2006-14), this study investigates how the economic recession in Europe starting in 2007 has affected health inequalities in 21 European nations. Depressive feelings were measured with the CES-D eight-item depression scale. We tested for measurement invariance across different socio-economic groups. Results: Overall, depressive feelings have decreased between 2006 and 2014 except for Cyprus and Spain. Inequalities between persons whose household income depends mainly on public benefits and those who do not have decreased, while the development of depressive feelings was less favorable among the precariously employed and the inactive than among the persons employed with an unlimited work contract. There are no robust effects of the crisis measure on health inequalities. Conclusion: Negative implications for mental health (in terms of depressive feelings) have been limited to some of the most strongly affected countries, while in the majority of Europe persons have felt less depressed over the course of the recession. Health inequalities have persisted in most countries during this time with little influence of the recession. Particular attention should be paid to the mental health of the inactive and the precariously employed. [ABSTRACT FROM AUTHOR]

Background: In many developed countries, associations have been documented between higher levels of area unemployment and workforce exit, mainly for disability pension receipt. Health of individuals is assumed to be the primary driver of this relationship, but no study has examined whether health explains or modifies this relationship. Methods: We used data from 98 756 Office for National Statistics Longitudinal Study members who were aged 40-69 and working in 2001, to assess whether their odds of identifying as sick/disabled or retired in 2011 differed by local authority area unemployment in 2001, change in local area unemployment from 2001 to 2011 and individual reported health in 2001 (self-rated and limiting long-term illness). Results: Higher local area unemployment and worse self-rated health measures in 2001 were independently related to likelihood of identifying as sick-disabled or retired, compared to being in work, 10 years later, after adjusting for socio-demographic covariates. Associations for local area unemployment were stronger for likelihood of identification as sick/disabled compared to retired in 2011. Associations for changes in local area unemployment from 2001 to 2011 were only apparent for likelihood of identifying as retired. For respondents that identified as sick/ disabled in 2011, effects of local area unemployment in 2001 were stronger for respondents who had better self-rated health in 2001. Conclusions: Strategies to retain older workers may be most effective if targeted toward areas of high unemployment. For persons in ill health, local area unemployment interventions alone will not be as efficient in reducing their exit from the workforce. [ABSTRACT FROM AUTHOR]

Objective: Fall-related injuries among the elderly, specifically hip fractures, cause significant morbidity and mortality as well as imposing a substantial financial cost on the health care system. Impact-absorbing flooring has been advocated as an effective method for preventing hip fractures resulting from falls. This study identifies the cost-effectiveness of impact-absorbing flooring compared to standard flooring in residential care facilities for the elderly in a Swedish setting. Method: An incremental cost-effectiveness analysis was performed comparing impact-absorbing flooring to standard flooring using a Markov decision model. A societal perspective was adopted and incremental costs were compared to incremental gains in quality-adjusted life years (QALYs). Data on costs, probability transitions and health-related quality of life measures were retrieved from the published literature and from Swedish register data. Probabilistic sensitivity analysis was performed through a Monte Carlo simulation. Results: The base-case analysis indicates that the impact-absorbing flooring reduces costs and increases QALYs. When allowing for uncertainty we find that 60% of the simulations indicate that impact-absorbing flooring is cost-saving compared to standard flooring and an additional 20% that it has a cost per QALY below a commonly used threshold value Conclusions: Using a modelling approach, we find that impact-absorbing flooring is a dominant strategy at the societal level considering that it can save resources and improve health in a vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Sexual activity is often initiated during the adolescent period, and previous research suggests that the age of first sexual intercourse and condom use are crucial determinants of later sexual health. This study examined trends in adolescent sexual behaviours from 2002 to 2010 in 20 countries across four geographical regions of Europe. Methods: Data were collected by self-report questionnaires from 15-year-olds in classrooms during 2002, 2006 and 2010. Linear time trends were determined through logistic regression models, stratified for gender. Results: No linear trend over time was documented for most countries for sexual intercourse at the age of 13 or younger. Increased initiation among girls in Eastern Europe and decreased very early initiation among girls in Northern Europe emerged, along with a general increase in condom use in boys and most notably in girls. Conclusion: Overall prevalence of early and very early sexual intercourse initiation was quite stable in Europe between 2002 and 2010, while condom use increased. More detailed research and policy attention to the antecedents of non-condom use among young people is warranted; and further study of the relationships between age of sexual initiation and condom or pill use would be particularly valuable. [ABSTRACT FROM AUTHOR]

Background: Bullying among children and adolescents is a public health concern; victimization is associated with psychological and physical health problems. The purpose of this study is to examine temporal trends in bullying victimization among school-aged children in Europe and North America. Methods: Data were obtained from crosssectional self-report surveys collected as part of the Health Behaviour in School-aged Children (HBSC) study from nationally representative samples of 11-, 13- and 15-year-olds, from 33 countries and regions which participated in the 2001-02, 2005-06 and 2009-10 surveys. Responses from 581 838 children were included in the analyses. Binary logistic regression was used for the data analyses. Results: The binary logistic regression models showed significant decreasing trends in occasional and chronic victimization between 2001-02 and 2009-10 across both genders in a third of participating countries. One country reported significant increasing trends for both occasional and chronic victimization. Gender differences in trends were evident across many countries. Conclusion: Overall, while still common in many countries, bullying victimization is decreasing. The differences between countries highlight the need to further investigate measures undertaken in countries demonstrating a downward trend. [ABSTRACT FROM AUTHOR]

Background: Pressure within school can be a critical component in understanding how the school experience influences young people's intellectual development, physical and mental health and future educational decisions. Methods: Data from five survey rounds (1993/1994, 1997/1998, 2001/2002, 2005/2006 and 2009/2010) were used to examine time-, age- and gender-related trends in the amounts of reported school pressure among 11-, 13- and 15-year-olds, in five different regions (North America, Great Britain, Eastern Europe, Nordic and Germanic countries). Results: Across the regions the reported perceptions of school pressure did not change between 1994 and 2010, despite a temporary increase in 2002 and 2006. With the exception of children at 11 years of age, girls reported higher levels of school pressure than boys (Cohen's d from 0.12 to 0.58) and school pressure was higher in older age groups. These findings were consistent across countries. Regionally, children in North America reported the highest levels of school pressure, and students in the Germanic countries the lowest. Conclusion: Factors associated with child development and differences in societal expectations and structures, along with the possible, albeit, differential impact of the Programme for International Student Assessment (PISA), may partially explain the differences and trends found in school pressure. School pressure increases alongside the onset of adolescence and the shift from elementary school to the higher demanding expectations of secondary education. Time-related increases in school pressure occurred in the years following the release of the PISA results, and were larger in those regions in which results were less positive. [ABSTRACT FROM AUTHOR]

Background: Little is known about the differential impact of comprehensive and partial smoke-free legislation on smoking cessation. This study aimed to examine the impact of comprehensive smoke-free workplace legislation in Ireland and England, and partial hospitality industry legislation in the Netherlands on quit attempts and quit success. Methods: Nationally representative samples of 2,219 adult smokers were interviewed in three countries as part of the International Tobacco Control (ITC) Europe Surveys. Quit attempts and quit success were compared between period 1 (in which smoke-free legislation was implemented in Ireland and the Netherlands) and period 2 (in which smoke-free legislation was implemented in England). Results: In Ireland, significantly more smokers attempted to quit smoking in period 1 (50.5%) than in period 2 (36.4%) (p < 0.001). Percentages of quit attempts and quit success did not change significantly between periods in the Netherlands. English smokers were significantly more often successful in their quit attempt in period 2 (47.3%) than in period 1 (26.4%) (p = 0.011). In the first period there were more quit attempts in Ireland than in England and fewer in the Netherlands than in Ireland. Fewer smokers quitted successfully in the second period in both Ireland and the Netherlands than in England. Conclusion: The comprehensive smoke-free legislation in Ireland and England may have had positive effects on quit attempts and quit success respectively. The partial smoke-free legislation in the Netherlands probably had no effect on quit attempts or quit success. Therefore, it is recommended that countries implement comprehensive smoke-free legislation. [ABSTRACT FROM AUTHOR]

The aim of this short report was to describe the output and citation rates of public health. Data-based publications and literature reviews from the year 2008, and their 5-year citation rates were extracted from 10 randomly selected public health journals. In total, 86.2% of publications were descriptive/epidemiological studies, 56.8% used cross-sectional (56.8%) designs and 77.8% were classified as research translation stage 2. Reviews and publications describing randomized controlled trials were the most highly cited, but were infrequently published. Strategies to address the discordance between public health research output and research citation may improve the impact of public health research. [ABSTRACT FROM AUTHOR]

We experimentally evaluate inexpensive interventions to increase response fractions in two alcohol surveys. Residents on the New Zealand General and Maori electoral rolls were randomized to receive a survey pack with or without an offer of entry to a $500 prize draw. Subsequent randomization of sample members who did not initially respond allowed estimation of effects of offering a $5 donation to charity as an incentive to respond. Offering prize draw entry did not significantly increase responses in either population. Contrary to expectation, promising a $5 donation to non-respondents reduced subsequent responding in the group previously offered the prize draw incentive. [ABSTRACT FROM AUTHOR]