rubrica

Disuguaglianze

  • Chiara Marinacci1

  1. S.C. a D.U. Scuola di Sanità Pubblica, ASL TO3
Chiara Marinacci -

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Ricerca del 23 ottobre 2010

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Database: Ovid MEDLINE(R) <1996 to October Week 2 2010>
Search Strategy:
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1 Socioeconomic Factors/ (48133)
2 Social Class/ (13365)
3 Educational Status/ (19217)
4 Italy/ (29225)
5 italy.in. (235465)
6 4 or 5 (246618)
7 1 or 2 or 3 (73229)
8 6 and 7 (1113)
9 limit 8 to yr="2010 -Current" (47)
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Database: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations <October 22, 2010>
Search Strategy:
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1 inequalities.ab,ti. (558)
2 inequities.ab,ti. (131)
3 italy.in. (19924)
4 socioeconomic.ab,ti. (1488)
5 1 or 2 or 4 (2051)
6 3 and 5 (31)
7 limit 6 to yr="2010 -Current" (19)
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Sono esclusi commenti, editoriali ed articoli pubblicati su riviste italiane.

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

1. The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: a review. Spadea T.  Bellini S.  Kunst A.  Stirbu I.  Costa G. Preventive Medicine 2010;  50(4): 159-64. [Journal Article.  Research Support, Non-U.S. Gov't] UI: 20093138
Abstract
OBJECTIVE
: To review the scientific evidence on the effectiveness of interventions to promote attendance to breast and cervical cancer screening among lower socioeconomic groups.

METHODS: We performed a computerized literature search looking for relevant papers published between 1997 and 2006. Papers were classified into three groups based on the type of intervention evaluated: (1) implementation of organized population screening programs; (2) different strategies of enhancing attendance within an organized program; (3) local interventions in disadvantaged populations.

RESULTS: The available evidence supports the hypothesis that while organized population screening programs are successful in increasing overall participation rates, they may not per se substantially reduce social inequalities. Some strategies were consistently found to enhance access to screening among lower socioeconomic groups, including cost-reducing interventions (e.g. offering free tests and eliminating geographical barriers), a greater involvement of primary-care physicians and individually tailored pro-active communication that addresses barriers to screening.

CONCLUSIONS: Evidence from studies suggests that the attendance of deprived women to cancer screening can be improved with organized screening programs tailored to their needs. The same may apply to the prevention of adverse outcomes of other health conditions, such as hypertension, hypercholesterolemia, and diabetes. Copyright 2010 Elsevier Inc. All rights reserved.

Status In-Process

Breve commento a cura di Lidia Fubini:
La revisione prende in esame le prove di efficacia degli interventi per promuovere la partecipazione agli screening contro i tumori della mammella e del collo dell’utero fra gruppi di popolazione di basso livello socioeconomico, pubblicati dal 1997 al 2006. L’analisi della letteratura sembra suggerire che la partecipazione delle donne deprivate agli screening possa  essere migliorata mediante programmi che siano adattati a particolari bisogni, ed in particolare assicurando la gratuità del test, diminuendo gli ostacoli geografici, coinvolgendo maggiormente la medicina di base e utilizzando messaggi comunicativi di immediata comprensione.

2. Cancer risk in relationship to different indicators of adult socioeconomic position in Turin, Italy. Spadea T.  Zengarini N.  Kunst A.  Zanetti R.  Rosso S.  Costa G. Cancer Causes & Control  21(7): 1117-30, 2010 Jul. [Journal Article.  Research Support, Non-U.S. Gov't] UI: 20349125
Abstract

OBJECTIVE: To determine the magnitude of social inequalities in cancer incidence according to different socioeconomic indicators and to assess the independent role of each indicator.
METHODS: Data from the Turin Longitudinal Study and the Piedmont Cancer Registry (1985-1999) were used to analyse the relationship of cancer incidence with three dimensions of individual socioeconomic position (education, occupation, and material living conditions) and with an area-based deprivation index. Multivariate Poisson regression models were used to estimate both relative risks and relative indexes of inequality (RIIs).
RESULTS: Results showed an independent role of all the socioeconomic indicators. The overall gradients of inequalities, expressed by the RIIs for total cancer incidence, varied from 9 to 26% among men; among women, we estimated a 22% protection at the bottom of the educational hierarchy, and a 12% gradient for decreasing ease of living conditions. For most cancer sites, socioeconomic position in early adult life was as important as later socioeconomic position, while the area-based deprivation index played only an additional role.
CONCLUSIONS: Different socioeconomic indicators pinpoint to a series of specific risk factors that are related to specific phases of the life course. Individual level data, rather than ecological data, is preferred to accurately monitor social inequalities in cancer risk.

3. Inequalities, inequities, environmental justice in waste management and health. Martuzzi M.  Mitis F.  Forastiere F. European Journal of Public Health 2010;  20(1): 21-26. [Journal Article.  Research Support, Non-U.S. Gov't] UI: 20061348
Abstract
BACKGROUND
: The scientific evidence on the health effects of waste-related exposure is not conclusive. Differential exposure to waste by socio-economic status (SES) is often documented, but the interplay between environmental and social factors, crucial for policy making, is not well known. This review aims at investigating the role of health inequalities and inequities in waste management.

METHODS: Grey and peer-reviewed literature, published after 1983, was reviewed from Europe and the USA.

RESULTS: Available data provide consistent indications that waste facilities are often disproportionally more located in areas with more deprived residents, or from ethnical minorities. This applies to waste incinerators, landfills, hazardous waste sites, legal and illegal. In studies considering health effects (mainly from Europe), risks are estimated with standardization for SES. Such standardization almost always decreases risk estimates for several cancers and reproductive outcomes. However, effect modification is not investigated in these studies.

CONCLUSIONS: The patterns of association between waste-related environmental pressures and SES suggest that some of the observed inequalities in exposure and health represent a case of environmental injustice as they are the result of social processes and may be prevented, at least partly. Disentangling the possible health effects remains difficult, due to limitations in the methodology. It seems important to investigate if disadvantaged people are more vulnerable, i.e. risks differ in different social groups living in the same area. Notwithstanding these open questions, public health officers and decision makers should identify waste management policies to minimize their potential health impacts and their unequal distribution.

Status In-Process

Breve commento a cura di Chiara Marinacci:
Siti legati alla gestione e allo smaltimento dei rifiuti sono dislocati più frequentemente nelle aree socio economicamente più deprivate. Oltre ai principali risultati riportati, la rassegna si ricollega implicitamente ai potenziali meccanismi che legano la salute alla deprivazione socioeconomica di un’area, soprattutto quando questa si associa ad un incremento del rischio di specifiche cause di morte, indipendentemente dagli effetti sulla salute prodotti dalle singole circostanze socioeconomiche delle persone che ci vivono. .

4. Particulate matter and out-of-hospital coronary deaths in eight Italian cities. Serinelli M.  Vigotti MA.  Stafoggia M.  Berti G.  Bisanti L.  Mallone S.  Pacelli B.  Tessari R.  Forastiere F. Occupational & Environmental Medicine  67(5):301-6, 2010 May. [Journal Article.  Multicenter Study.  Research Support, Non-U.S. Gov't] UI: 19819851
Abstract

OBJECTIVES: We evaluated the association between PM(10) concentration and out-of-hospital coronary deaths in eight Italian cities during 1997-2004.
METHODS: 16 989 subjects aged >35 years who died out-of-hospital from coronary causes were studied and hospital admissions in the previous 2 years identified. We studied the effect of the mean of current and previous day PM(10) values (lag 0-1). A city-specific case-crossover analysis was applied using a time-stratified approach considering as confounders weather, holidays, influenza epidemics, and summer decrease in population. The pooled percentage increase (95% CI) in mortality per 10 microg/m(3) increase in PM(10) was estimated.
RESULTS: A statistically significant increase in out-of-hospital coronary deaths was related to a 10 microg/m(3) increase in PM(10): 1.46% (95% CI 0.50 to 2.43). Although no statistically significant effect modification by age was found, the effect was stronger among subjects aged >65 years (1.60%, 0.59 to 2.63), particularly those aged 65-74 (3.01%, 0.74 to 5.34). People in the lowest socio-economic category (3.34%, 1.28 to 5.45) had a stronger effect than those in the highest category. No clear effect modification was seen for gender, season or any specific comorbidity. An indication of negative effect modification was seen for previous admission for cardiac dysrhythmias. Subjects without hospital admissions in the previous 2 years were slightly more affected by PM(10) effects (1.91%, 0.28 to 3.47) than those with at least one previous hospital admission (1.44%, 0.09 to 2.82).
CONCLUSIONS: Our results show that short term exposure to PM(10) is associated with coronary mortality especially among the elderly and socio-economically disadvantaged. No clear effect modification by previous hospitalisations was detected except for cardiac dysrhythmias, possibly due to protective treatment.

5. Self-reported history of Pap-smear in HIV-positive women in Northern Italy: a cross-sectional study. Dal Maso L.  Franceschi S.  Lise M.  De' Bianchi PS.  Polesel J.  Ghinelli F.  Falcini F.  Finarelli AC.  Screening of HIV-positive women in Emilia-Romagna (SHER) Study. BMC Cancer  10: 310, 2010. [Journal Article.  Research Support, Non-U.S. Gov't] UI: 20565935
Abstract

BACKGROUND: The incidence of invasive cervical cancer in HIV-positive women is higher than in the general population. There is evidence that HIV-positive women do not participate sufficiently in cervical cancer screening in Italy, where cervical cancer is more than 10-fold higher in women with AIDS than in the general population. The aim of the present study was to evaluate the history of Pap-smear in HIV-positive women in Italy in recent years. We also examined the sociodemographic, clinical, and organizational factors associated with adherence to cervical cancer screening.

METHODS: A cross-sectional study was conducted between July 2006 and June 2007 in Emilia-Romagna region (Northern Italy). All HIV-positive women who received a follow-up visit in one of the 10 regional infectivology units were invited to participate. History of Pap-smear, including abnormal smears and subsequent treatment, was investigated through a self-administered anonymous questionnaire. The association between lack of Pap-smear in the year preceding the interview and selected characteristics was assessed by means of odds ratios (OR) and 95% confidence intervals adjusted for study centre and age.

RESULTS: A total of 1,002 HIV-positive women were interviewed. Nine percent reported no history of Pap-smear, and 39% had no Pap-smear in the year prior to the date of questionnaire (last year). The lack of Pap-smear in the last year was significantly associated with age <35 years (OR = 1.4, compared to age > or =45 years), lower education level (OR = 1.3), first HIV-positive test in the last 2 years (OR = 1.4), and CD4 count <200 cells/microl (OR = 1.6). Conversely, when women were advised by a gynecologist rather than other health workers to undergo screening, it significantly increased adherence. Non-significantly higher proportions of lack of Pap-smear in the last year were found in women born in Central-Eastern Europe (OR = 1.8) and Africa (OR = 1.3). No difference in history of Pap-smear emerged by mode of HIV-acquisition or AIDS status.Three hundred five (34%) women reported a previous abnormal Pap-smear, and of the 178 (58%) referred for treatment, 97% complied.

CONCLUSIONS: In recent years the self-reported history of Pap-smear in HIV-positive women, in some public clinics in Italy, is higher than previously reported, but further efforts are required to make sure cervical cancer screening is accessible to all HIV-positive women.

6. Update on age at menarche in Italy: toward the leveling off of the secular trend. Rigon F.  Bianchin L.  Bernasconi S.  Bona G.  Bozzola M.  Buzi F.  Cicognani A.  De Sanctis C.  De Sanctis V.  Radetti G.  Tato L.  Tonini G.  Perissinotto E. Journal of Adolescent Health  2010; 46(3):238-44. [Journal Article.  Multicenter Study] UI: 20159500
Abstract

PURPOSE: To update the information on age at menarche in the Italian population and to verify the influence of genetic, nutritional, and socioeconomic factors on menarcheal age. Recent studies suggest that the magnitude of the secular trend toward an earlier age at menarche is slackening in industrialized countries.

METHODS: This multicenter study was conducted on a large, population-based sample of Italian high school girls (n = 3,783), using a self-administered questionnaire. The questionnaire was used to gather information on the girls, including demography, anthropometry, menarcheal date, regularity of menses, behavioral habits, and physical activity. The questionnaire was also used to gather information on parents, including demography and mothers' and sisters' menarcheal ages. The median age at menarche and its 95% confidence interval were estimated by means of Kaplan-Meier survival analysis. To identify the independent predictive factors of age at menarche, multivariate mixed-effects models were applied.

RESULTS: The median age at menarche of the subjects was 12.4 years (95% confidence interval: 12.34-12.46). The girls had their first menses approximately one-quarter of a year (median-0.13) earlier than did their mothers (p < .0001). Among all variables, parents' birth area, body mass index, family size, and the mother's menarcheal age were significantly and independently associated with age at menarche.

CONCLUSIONS: This study confirmed the reduction in the trend toward earlier menarche in Italy. The results also confirmed that genetic and nutritional factors are strong markers for early menarche. Currently, socioeconomic factors do not seem to play as significant a role as in the past.

7. An analysis of the regional differences in health care utilization in Italy. Mangano A. Health & Place  16(2):301-8, 2010 Mar. [Journal Article] UI: 19914120
Abstract

This paper focuses on the differences in regional expenditure on health care in the attempt to verify how equitable is the pattern of health care supply across the Italian regions and whether disparities are related to the existing socioeconomic imbalances, especially in terms of the North-South divide. The analysis has been carried out according to an egalitarian view of equity. For several categories of health services simple concentration measures and an horizontal inequity index have been derived to quantify the degree of inequity due to the discrepancy between the actual regional expenditure and a "just" amount implied by need indicators. Findings are that richer areas spend more than the "fair" amount on hospital and residential care as well as on the overall health care system, whereas inequity favouring poorer areas occurs in the delivery of pharmacological and secondary care.

8. Toward a needs based mechanism for capitation purposes in Italy: the role of socioeconomic level in explaining differences in the use of health services. Petrelli A.  Picariello R.  Costa G. International Journal of Health Care Finance & Economics  10(1):29-42, 2010 Mar. [Journal Article] UI: 19526379
Abstract

The paper investigated differences in the use of hospital care, out-patient care and pharmaceutical care in Piemonte, a region of northern Italy with 4,000,000 inhabitants, taking into account factors of need and supply, for capitation purposes. The study used a geographical design, with the municipalities as statistical units, and was based on integrated data from health and health service information systems, the population census and on the geographical distances among municipalities. Hierarchical regression models were fitted with the utilisation of services as the outcome variable and a set of direct and indirect factors of need and supply indicators as covariates. Higher health service consumption rates were observed for the most disadvantaged employment categories, in addition to the elderly. Distance from hospital was inversely correlated with the hospitalisation rate. A formula for determining capitation can be developed using age and indirect factors of need as weights.

9. Occupational exposures contribute to educational inequalities in lung cancer incidence among men: Evidence from the EPIC prospective cohort study.  Menvielle G.  Boshuizen H.  Kunst AE.  Vineis P.  Dalton SO.  Bergmann MM.  Hermann S.  Veglia F.  Ferrari P.  Overvad K.  Raaschou-Nielsen O.  Tjonneland A.  Kaaks R.  Linseisen J.  Palli D.  Krogh V.  Tumino R.  Rodriguez L.  Agudo A.  Sanchez MJ.  Arozena JM.  Cirera L.  Ardanaz E.  Bingham S.  Khaw KT.  Boffetta P.  Duell E.  Slimani N.  Gallo V.  Riboli E.  Bueno-de-Mesquita HB. International Journal of Cancer 126(8):1928-35, 2010.
Abstract

The aim of this study is to investigate to what extent occupational exposures may explain socioeconomic inequalities in lung cancer incidence after adjusting for smoking and dietary factors. Analyses were based on a subsample of the European Prospective Investigation into Cancer and Nutrition (EPIC study), a prospective cohort. The analyses included 703 incident lung cancer cases among men in Denmark, the United Kingdom, Germany, Italy, Spain and Greece. The socioeconomic position was measured using the highest level of education. The estimates of relative indices of inequality (RII) were computed with Cox regression models. We first adjusted for smoking (with detailed information on duration and quantity) and dietary factors (fruits and vegetables consumption) and then for occupational exposures. The exposure to three carcinogens [asbestos, heavy metals and polycyclic aromatic hydrocarbons (PAH)] was analyzed. The occupational exposures explained 14% of the socioeconomic inequalities remaining after adjustment for smoking and fruits and vegetables consumption. The inequalities remained nevertheless statistically significant. The RII decreased from 1.87 (95% CI: 1.36-2.56) to 1.75 (1.27-2.41). The decrease was more pronounced when adjusting for asbestos than for heavy metals or PAH. Analyses by birth cohort suggested an effect of occupational exposures among older men, while due to small number of endpoints, no conclusion could be drawn about the role of occupational exposures in educational inequalities among younger men. Our study revealed that the impact of occupational exposures on socioeconomic inequalities in cancer incidence, rarely studied until now, exists while of modest magnitude.

10. Health inequalities between lone and couple mothers and policy under different welfare regimes - the example of Italy, Sweden and Britain. Burstrom B.  Whitehead M.  Clayton S.  Fritzell S.  Vannoni F.  Costa G. Social Science & Medicine  70(6):912-20, 2010 Mar. [Journal Article] UI: 20060633
Abstract
This study examines the welfare state arrangements and social policy, living conditions and health among lone and couple mothers in three contrasting policy environments: Italy, Sweden and Britain. These countries fall into distinctive family policy categories. Data were drawn from representative national household interview surveys. The findings highlight both similarities and differences. Lone mothers had significantly worse health than couple mothers in all three countries, were more likely to suffer material disadvantage and were much more likely to be smokers. They could be considered a disadvantaged group in particular need in all three countries, irrespective of the policy regime. It is the differences between countries, however, in the experiences of lone and couple mothers that indicate that the prevailing policy regime really does matter. There were telling differences in the prevalence of lone motherhood, their composition, rates of joblessness, poverty and health status of lone mothers in relation to couple mothers in each country. These may be traced back to the main policy regimes of each country, but also partly reflect culture and traditions. The study illustrates an emerging approach to investigating the health inequalities impact of complex social policy contexts. The experiences of lone mothers as a group may serve as a 'litmus' test of how each family policy system is operating and offer an early warning of adverse impacts when policies change. Copyright 2009 Elsevier Ltd. All rights reserved.
11. Does social capital determine health? Evidence from eight transition countries. d'Hombres B.  Rocco L.  Suhrcke M.  McKee M. Health Economics.  19(1):56-74, 2010 Jan. [Journal Article.  Research Support, Non-U.S. Gov't] UI: 19301350
Abstract
There is growing interest in the role of social relationships in explaining patterns of health. We contribute to this debate by investigating the impact of social capital on self-reported health for eight countries from the Commonwealth of Independent States. We rely on three indicators of social capital at the individual level (trust, participation in local organisations, social isolation) and employ alternative procedures to estimate consistently the impact of social capital on health. The three social capital indicators are choice variables and are hence, by definition, endogenously determined. We attempt to circumvent the endogeneity problems by using instrumental variable estimates. Our results show that the individual degree of trust is positively and significantly correlated with health, this being true with least squares estimators as well as when relying on instrumental variable estimators with (and without) community fixed effects. Similarly, social isolation is negatively and significantly associated with health, irrespective of the procedure of estimation. On the other hand, the effect of being a member of a Putnamesque organisation is more ambiguous and usually not significantly related to health.
12. Socioeconomic risk factors and depressive symptoms in alcohol use disorders among male suicides in South Tirol, Italy. Giupponi G.  Bizzarri J.  Pycha R.  Innamorati M.  Lester D.  Conca A.  Girardi P.  Tatarelli R.  Pompili M. Journal of Addictive Diseases 2010; 29(4):466-74. [Journal Article] UI: 20924883
Abstract
The aim of the current study was to evaluate whether socioeconomics risk factors and depressive symptoms are associated with suicide in men with alcohol use disorders in South Tirol, Italy. The authors hypothesize that socioeconomics inequalities interact with greater psychopathology in men with alcohol use disorders who committed suicide. The authors found a positive association between unstable work positions and low educational attainment and alcohol use disorders in individuals who committed suicide. The results point to the need for careful assessment of subsyndromal depression in individuals with alcohol use disorders, especially when abuse is associated with socioeconomic risk factors such as lower educational attainment and unemployment or employment instability.

Status In-Process

13. Trends in adherence to the Mediterranean diet in an Italian population between 1991 and 2006. Pelucchi C.  Galeone C.  Negri E.  La Vecchia C. European Journal of Clinical Nutrition 2010  64(10): 1052-56. [Journal Article.  Research Support, Non-U.S. Gov't] UI: 20717133
Abstract
BACKGROUND/OBJECTIVES
: The aim of this study is to investigate whether adherence to the Mediterranean diet changed during the period 1991-2006 in an Italian population. SUBJECTS/METHODS: We derived data from the comparison groups of a network of case-control studies on cancer and acute myocardial infarction conducted in the greater Milan area between 1991 and 2006. Subjects were 3247 adults (1969 women, 1278 men; median age 59 years) admitted to major teaching and general hospitals for a wide spectrum of acute conditions unrelated to long-term modifications of diet. Trained interviewers collected data on selected socioeconomic and demographic characteristics, lifestyle habits and other personal and familial factors. Information on diet was collected through an interviewer-administered, reproducible and validated food-frequency questionnaire. We computed a Mediterranean diet score (MDS) on the basis of nine a priori defined peculiar characteristics of the Mediterranean dietary pattern.

RESULTS: In multiple linear regression models, adjusted for age, education, place of birth and residence, and total energy intake, there was no significant association between the period of interview and MDS in both sexes. Subjects aged 55-64 years, those with high education, and those born in central and southern Italy showed the highest adherence to the Mediterranean diet in both sexes.

CONCLUSIONS: In this population, adherence to the Mediterranean diet showed no significant change over the last 15 years.

Status In-Process

14. Socioeconomic determinants of outpatient antibiotic use in Europe. Masiero G.  Filippini M.  Ferech M.  Goossens H. International Journal of Public Health 2010; 55(5): 469-78. [Journal Article] UI: 20603713
Abstract
OBJECTIVES
: Outpatient antibiotic consumption widely varies across Europe. The investigation of the causes of such variation may help to identify interventions that would improve the efficient use of antibiotics. The aim of this study was to assess the impact of socioeconomic determinants and the role played by information about bacterial resistance.

METHODS: Comparable data on systemically administered antibiotics and socioeconomic determinants in 17 European countries were available between 2000 and 2005. We estimated an ad hoc econometric model by means of a hybrid log-log functional form and random effects generalised least squares regressions. Lagged values and the instrumental variable method were applied to address endogeneity of bacterial resistance and infections. Bacterial resistance was measured by the rate of penicillin non-susceptible Streptococcus pneumoniae isolates (PNSP) and methicillin-resistant Staphylococcus aureus (MRSA).

RESULTS: The population income, demographic structure, density of general practitioners and their remuneration method appeared to be significant determinants of antibiotic consumption. Although countries with higher levels of bacterial resistance exhibited significantly higher levels of per capita antibiotic use, ceteris paribus, the responsiveness of antibiotic use to changes in bacterial resistance was relatively low (0.09-0.18).

CONCLUSIONS: The study confirms that socioeconomic factors should be taken into account while explaining differences in outpatient antibiotic use across countries. The impact of supply-side factors and incentives attached to payment schemes for physicians need to be considered in government interventions to reduce inequalities and improve effectiveness in antibiotic utilisation.

Status In-Process

15. Socioeconomic position and health status of people who live near busy roads: the Rome Longitudinal Study (RoLS). Cesaroni G.  Badaloni C.  Romano V.  Donato E.  Perucci CA.  Forastiere F. Environmental Health: A Global Access Science Source 2010; 9: 41. [Journal Article] UI: 20663144
Abstract
BACKGROUND
: Subjects living close to high traffic roads (HTR) are more likely to suffer from air-pollution related morbidity and mortality. The issue has large public health consequences but few studies have described the main socio-demographic characteristics of people exposed to traffic. OBJECTIVES: To characterise a large cohort of residents in Rome according to different measures of traffic exposure, socioeconomic position (SEP), and baseline health status.

METHODS: Residents of Rome in October 2001 were selected. Individual and area-based SEP indices were available. GIS was used to obtain traffic indicators at residential addresses: distance from HTR (> = 10,000 vehicles/day), length of HTR, average daily traffic count, and traffic density within 150 meters of home. Hospitalisations in the 5-year period before enrolment were used to characterise health status. Logistic and linear regression analyses estimated the association between traffic exposure and socio-demographic characteristics.

RESULTS: We selected 1,898,898 subjects with complete SEP information and GIS traffic indicators. A total of 320,913 individuals (17%) lived within 50 meters of an HTR, and 14% lived between 50 and 100 meters. These proportions were higher among 75+ year-old subjects. Overall, all traffic indicators were directly associated with SEP, with people living in high or medium SEP areas or with a university degree more likely to be exposed to traffic than people living in low SEP areas or with a low level of education. However, an effect modification by area of residence within the city was seen and the association between traffic and SEP was reversed in the city centre.

CONCLUSIONS: A large section of the population is exposed to traffic in Rome. Elderly people and those living in areas of high and medium SEP tend to be more exposed. These findings are related to the historical stratification of the population within the city according to age and socioeconomic status.

Status

In-Process

16. The contribution of club participation to adolescent health: evidence from six countries. Zambon A.  Morgan A.  Vereecken C.  Colombini S.  Boyce W.  Mazur J.  Lemma P.  Cavallo F. Journal of Epidemiology & Community Health 2010; 64(1): 89-95. [Journal Article.  Research Support, Non-U.S. Gov't] UI: 20007634
Abstract
BACKGROUND
: Social networks have been recognised as an important factor for enhancing the health of people and communities. Bridging social capital, characterised by numerous and varied weak ties, exemplifies a particular type of network that can help people reach their goals and improve their health. This study seeks to contribute to the evidence base on the use of positive social networks for young people's health by exploring the importance of club participation in predicting the health and health-related behaviours of 15-year-old girls and boys across Europe and North America.

METHODS: Data are derived from a 2005-6 World Health Organization collaborative study, to establish the relationships between different types of club and a range of health outcomes (self-perceived health, wellbeing and symptoms) and health-related behaviours (smoking, drinking). Multi-level logistic regression was used to assess the independent effects of club participation by controlling for gender and socioeconomic position. Data were compared across six countries.

RESULTS: All the considered outcomes, both in terms of perceived health and wellbeing and health behaviours were associated with participation in formal associations. The associations are in the expected direction (participation corresponding to better health) except for some particular association types.

CONCLUSIONS: Participation in formal associations seems supportive for good health and health behaviours in adolescence, and should be promoted in this age group.

Status In-Process