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Subjective socioeconomic status (SES) has previously been shown to be correlated with a large number of health measures. In this study, the subjective SES measure is modified and translated to measure childhood SES. The subjective SES scale is examined in a participant's hometown, community, and nation. Both an immigrant Hispanic and a Caucasian sample were studied (31 Hispanic males; 42 Hispanic females; 38 Caucasian males, 40 Caucasians females). Childhood SES was the most significant predictor of self-reported health in both sample groups.

My doctoral thesis examines the broad question of the effect of some recent health policies on health and also tries to measure socioeconomic inequalities. The first essay investigates the effect of public health insurance on people with vulnerable health. The second chapter analyses the effect of the legalization of marijuana on health, while the third chapter measures socioeconomic inequalities in health. In chapter 1, I study the evolution of access to health care for individuals in vulnerable health before and after the Affordable Care Act. I define leakage of health care as the aggregation of accessibility hurdles for individuals in vulnerable health. However, "being in vulnerable health" is a linguistic concept that does not have a sharp mathematical definition. I draw on the fuzzy sets theory and assume a non-dichotomous membership function to capture the linguistic imprecision. However, the task of choosing the "right" membership function remains an issue. To circumscribe this additional issue, I use a stochastic dominance approach to test for changes in leakage. In order to establish causality, I exploit two quasi-experimental settings offered by the dependent coverage and the states in which medicaid expansion took place. In order to use these quasi-experiments in a stochastic dominance framework, I extend Athey and Imbens (2006) changes in changes approach to a bivariate setting. Using data from the National Health Interview Survey, the results from a before and after analysis show that leakages are much lower in 2015 compared to 2009 in the US. These before and after results hold irrespective of a person's sex or socio-economic status. The causal analysis shows that leakages in not having insurance and access are reduced in medicaid expansion states after the ACA. Chapter 2 analyzes the implications of these recreational marijuana legalization (RML) on Body Mass Index (BMI) and some healthy behaviours. I exploit the quasi experimental nature of marijuana legalization policy in states using changes in changes and difference in difference approaches to identify the effect of these recreational marijuana policies. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), the results show that recreational marijuana legalization reduces BMI for the entire population. The effect is mainly in the mid and top part of the BMI distribution. Subgroup analysis shows that the reduced BMI resulting from RML is significant among women but not among men. For females, the effect is found both at the lower tail (being underweight) and at the upper tail (morbid obesity). While we found evidence of a reduction in being overweight for both whites and non-whites due to RML, the reduction in obesity and morbid obesity was only found for non-whites. In addition, RML reduces obesity for those below 45 years. I also found evidence that RML increases alcohol consumption, has no effect on smoking of tobacco and binge drinking but reduces the probability of doing any physical activity. The final chapter explores the measurement of socioeconomic inequality using ordinal variables. Most measures of socioeconomic inequality are developed for ratio scale variables. These measures use the mean as a reference point which is non-robust in the presence of categorical variables. This chapter extends Allison and Foster (2004) median based approach to measuring inequalities to a bivariate case and provides conditions to robustly rank any two distributions of socioeconomic inequalities in well-being or mental health. Using the Canadian Community Health Survey (CCHS), I provide robust ordering for socioeconomic inequalities in well-being and mental health for different sub-populations in 2015. The results show that there is less socioeconomic inequality in life satisfaction, happiness, mental health, and general health status among employed males and females compared to their respective unemployed groups in 2015.

To get closer to an answer to the questions of how the pandemic affected one's mental health after the pandemic, but also how it affected one's church involvement and one's own faith in God, interviews were conducted with five young women, aged 19–25 years. I used a mixed method, namely three short questionnaires where the informants had to assess their mental, existential, physical, and social health, as well as describe their church involvement, before, during and after the pandemic. These questionnaires were then the basis for the interviews, where they had to nuance their answers even more. In this way, the study's material and empirical data were collected. This was then analyzed based on selected theories dealing with coping, religious coping, meaning-based coping, and spirituality processes. The results of the study show that the pandemic affected the informants in different ways and to different extents. What one brought into the pandemic when it comes to one's mental, existential, physical, and social health tends to influence how one coped with it and what consequences the pandemic created for one's well-being. On the other hand, most of the informants expressed that they take with them new perspectives and lessons learned from the pandemic that they did not have in the same way before. Much of what they mention is that you learned how the body works and that your well-being is better from physical activity, or that now, after the pandemic, you can choose in a different way what you want to be involved in when it comes to the social aspect, but also concrete social interactions and relationships. They prioritize their well-being and well-being in a different way.

No description available.

Les expositions psychosociales au travail restent un problème de santé publique important en Europe. Il est nécessaire d'étudier le rôle de ces expositions dans l'association avec la santé en explorant les différences selon le genre, la position sociale et le pays. Le rôle de ces expositions dans l'explication des inégalités sociales du bien-être est presque inexploré. À ce jour, les concepts émergents d'expositions psychosociales au travail ont été souvent négligés.À l’aide des enquêtes européennes sur la qualité de vie 2007 (17 005 travailleurs) et sur les conditions de travail 2010 (33 443 salariés), les résultats ont montré que les inégalités sociales de santé perçue et du bien-être persistent en Europe. L'ampleur de ces inégalités diffère selon le genre et est plus élevé dans les pays qui ne sont pas dans l'Union européenne. Une forte demande psychologique, des faibles récompenses et une mauvaise conciliation travail-famille sont des facteurs de risque pour la santé perçue dans le modèle ajusté complet. Un certain nombre des facteurs psychosociaux au travail ont montré des associations significatives avec un faible bien-être. Presque aucune différence selon le genre, la profession et le pays n’a été trouvée dans ces associations pour les deux marqueurs de la santé. Les facteurs psychosociaux au travail contribuent à réduire les inégalités sociales de bien-être de 97% et plus selon le genre et la profession. Parmi eux, les facteurs liés à l’influence et au développement des compétences jouent un rôle important.Le genre, la position sociale et une grande variété de facteurs psychosociaux au travail doivent être considérés de manière plus complète dans les futures recherches et politiques de prévention. Les résultats de cette thèse pourraient être utilisés comme un élément fondamental pour mettre en œuvre des politiques de prévention au niveau européen. / Psychosocial work exposures remain a public health issue in Europe. There is a need of studying the role of these exposures in the association with health outcomes exploring differences according to gender, social position and country at the same time. The role of these exposures in the explanation of social inequalities in well-being is almost unexplored. To date emergent concepts of psychosocial work exposures have been often neglected. Using European data coming from the European Quality of Life Survey 2007 (17005 workers) and the European Working Conditions Survey 2010 (33443 employees), the results showed that social inequalities in self-reported health (SRH) and well-being remain in Europe. The magnitude of these inequalities differed according to gender and was higher in countries that are not in the European Union. High psychological demands, low reward and work-life imbalance were risk factors for poor SRH in the full-adjusted model. A number and variety of psychosocial work factors showed significant associations with poor well-being. Almost no differences according to gender, occupation and country were found in the associations with both health outcomes. Psychosocial work factors reduced social inequalities in well-being by 97% and more according to gender and occupation studied. Factors related to influence and development at work played a substantial role.Gender, social position and a variety of psychosocial work factors should be considered more comprehensively in future research and policies. Findings of this thesis could be used as a fundamental element in implementing health prevention policies at a European level.

Amalgam has been used as a dental restorative material for centuries, but its potential health effects and biopersistance has lead to a decreased use especially in the Nordic countries. New materials have been introduced, partly to replace the mercury containing amalgam and partly because of esthetical reasons. The possible health effects of amalgam have been studied extensively and the material has been replaced with other less well-examined materials during the last few decades. The prevalence of side effects of dental materials is considered to be low in relation to the vast number of dental treatments undertaken. With the introduction of new and more complex materials, side effects related to dental treatment may increase. Epidemiological data suggest that the side effects of dental resins that have almost completely replaced amalgam fillings in Scandinavia, possess a risk for adverse reactions; however, the causal relation has not been fully established. Therefore, the type and extent of side effects caused by resin-based materials are of great interest. The aims of the study were: - to describe the change in health over time for patients with problems related to their dental materials. The hypothesis was that the patients could be divided into subgroups based on their symptoms and that the ability to recover differs between these groups [Paper I]. Furthermore, to determine whether factors such as the replacement of dental restorative materials and follow-up time had any impact on the perceived health. - to assess the long-term development of symptoms and their social consequences among patients referred for diagnosis and treatment of symptoms related to dental materials [Paper II] - to investigate the possible risks with dental restorative materials other than amalgam [Paper III]. - to describe side effects assessed to be caused by resin-based materials that occurred in a group of patients as well as treatment and long-term consequences of the reactions [Paper IV]. A questionnaire was sent to 614 patients [Paper I and II] that had been referred to the School of Dentistry, Umeå, Sweden, with symptoms allegedly caused by dental materials. The questionnaire contained questions on, among others; civil status, present health, medical and dental treatment and other measures and precautions taken because of psychosocial problems related to current employment situation, feelings, self-image and coping behavior. Moreover, information was collected [Paper III] from the Swedish Dental Materials Register 2003 (DentMr), a compilation of MSDS for 487 materials, and information from the user guide of the materials. The Material Safety Data Sheets (MSDS) included in the DentMR were examined regarding the given composition of the products, the occurrence of CAS-numbers and the risk- and safety phrases of the substances. Information was collected [Paper IV] on 36 patients with reactions to resin-based restorative materials from the Swedish National Register of Side-Effects of Dental Materials. Patients with complex symptoms had a more unfavorable long-term prognosis concerning persistent complaints than those with local symptoms only. Furthermore, the results indicate that the patients might experience health improvements after removal of their dental restorative materials. However, the reason for this improvement was unclear. Replacement of dental restorative materials had no significant impact on the ability to recover completely. Our results also indicate a relationship between patients’ self-related health and social consequences in daily life. Those with remaining complex symptoms had more often stopped working or had decreased their work hours because of their symptoms The information about hazards with dental materials seems insufficiently described in MSDS and there might be materials with side effects unknown to both patients and dental professionals. A literature search indicated that some of the listed substances had possible hazards, e.g. substances with embryotoxic and neurotoxic potential. The patients were very heterogeneous; a few with only local symptom free reactions while other had more complex symptoms. The latter group would gain from a multidisciplinary approach, i.e. dental, medical, as well as social and psychological factors have to be considered when developing care management programs for this group of patients. Furthermore, there is a need for stronger regulations of dental materials, such as those applied to pharmaceutical drugs. Finally, it was found that the majority of symptoms suspected to be caused by resin-based materials were local or a combination of local and extra-oral symptoms that appeared within the first 24 hours after treatment. The most frequent adverse effect reported was skin problems/dermatitis. It appears as though immediate reactions to resin based materials are not uncommon and more prevalent than allergic reactions. Still, we have had, difficulties in verifying associations between the dental restorative materials and adverse reactions and also to identify the offending component.

This thesis consists of a quantitative and a qualitative study. The quantitative study (articles I-III) aimed to examine how self-reported health in adolescence is associated with behavioral, parental, and school factors. Through a survey directed at all adolescents in grades 7-9, data were collected in 2005 in a region in northern Sweden (n=5060). Statistical methods were used to analyze the survey data: chi2tests, multivariate logistic regressions and multilevel logistic regressions. Results showed that even though most adolescents reported good health, there were also rather large proportions of adolescents who reported headaches, stomach aches and feelings of stress. Girls reported poor health to a higher extent than boys, a difference that was larger in grade 9 than in grade 7. The results also showed that being norm compliant was associated with good self-reported health. Furthermore, perceiving relations and communication with parents as poor was associated with poor self-reported health; however, this relationship could not explain gender differences in self-reported health. Continuing on, analyses showed that there exist greater variations in self-reported health between students (within a school) than between different schools. On an individual level, poor relations to teachers, bullying and truancy were associated with poor general health. The qualitative study  (article IV) sought to examine barriers to and facilitators of utilization of local school survey results within a school setting. In 2011, 21 school district managers and principals within a Swedish municipality were interviewed. Analyses were performed using a qualitative content analysis. The results from the qualitative study showed that the dissemination and utilization of school survey results appeared as two interrelated phases in one process. Barriers and facilitators differed qualitatively depending on the phase, dissemination or utilization. In conclusion, professionals as well as researchers need to consider the complexity of adolescent health and its social determinants. Adolescent health is a concern for multiple sectors in society, which highlights the need for further development of collaborations between professionals in relevant fields, such as health care, school and social services. / Den här avhandlingen består av en kvantitativ och en kvalitativ studie. Syftet med den kvantitativa studien (artikel I-III) var att undersöka sambandet mellan ungdomars självrapporterade hälsa och deras normrelaterade beteende samt föräldra- och skolfaktorer. Data samlades in under 2005, genom en enkät som riktade sig till alla ungdomar i årskurs 7-9 i en region i norra Sverige (n=5060). De statistiska metoder som användes i den kvantitativa studien var bland annat chi2- test, logistisk regression samt flernivåanalys. Resultaten visade att även om de flesta ungdomar rapporterade en god allmän hälsa, så var det också en relativt stor andel som rapporterade huvudvärk, magont samt upplevelser av stress. Flickor rapporterade sämre hälsa än pojkar, en skillnad som var större i åk 9 jämfört med åk 7. Resultaten visade också att normföljsamhet hade ett signifikant samband med god självrapporterad hälsa. De ungdomar som upplevde relationen och kommunikationen med sina föräldrar som dålig, rapporterade också dålig hälsa i högre utsträckning än övriga. Sambandet mellan självrapporterad hälsa och föräldrarelationer kunde inte förklara skillnaderna i ohälsa mellan pojkar och flickor. Vidare, analyser visade att det fanns större variationer i självrapporterad hälsa mellan ungdomar (inom en skola) än mellan olika skolor. Dåliga relationer med lärare, skolk, samt att bli utsatt för mobbning hade ett signifikant samband med dålig självrapporterad hälsa, på en individuell nivå. Syftet med den kvalitativa studien (artikel IV) var att undersöka vilka faktorer inom skolan som möjliggör och som utgör barriärer för användningen av enkätresultaten från en lokal skolenkät. 2011 genomfördes 21 intervjuer med skolområdeschefer och rektorer inom en kommun i Sverige. Analyser av intervjumaterialet genomfördes med hjälp av kvalitativ innehållsanalys. Resultaten från denna studie visade att spridningen och användningen av resultaten från skolenkäten kan beskrivas som två relaterade faser i en process. De faktorer som underlättade samt utgjorde barriärer för spridningen och användningen av enkätresultaten var kvalitativt olika varandra beroende på vilken fas i processen respondenterna hänvisade till. Dessa resultat illustrerar den mångfacetterade komplexitet som inryms i ungdomars hälsa och dess sociala determinanter, en komplexitet som både forskare och professionella behöver ta hänsyn till. Ungdomars hälsa angår ett flertal samhällssektorer, vilket visar på betydelsen av en fortsatt utveckling av samverkan mellan professionella inom exempelvis hälso- och sjukvården, skolan och socialtjänsten.

Work stress has a substantial impact on employees, organisations and economies; especially in the fragile economic environment since the ‘Great Recession’ of 2008; which has seen employment levels drop and employees willing to endure more stress at work to avoid retrenchment. These impacts include serious health and financial consequences. Attempts should therefore be made to effectively manage and address work stress to lessen these dire consequences. Many models have been developed and theorised to assist in explaining work stress, the pinnacle of these being the job demands-resources (JD-R) model. In JD-R theory, the dual process explains that work-related well-being follows the following processes: An energetic, also called the health impairment process, in which job demands leads to ill health outcomes through burnout; and then a motivational process which presents that job resources leads to positive organisational outcomes, e.g. organisational commitment, through engagement. The main objectives of this research were 1) to investigate a JD-R model in a large South African sample with a categorical estimator; 2) to investigate the reversed causal hypotheses of burnout and engagement in job demands-resources theory over time; 3) to investigate the likelihood of reporting treatment for health conditions based on burnout and engagement, and 4) to investigate the link between burnout and objective financial outcomes, i.e. by medical aid provider expenditure. To achieve the first objective a cross-sectional design was used (n = 15 633) covering numerous sectors in South Africa. A dual process model was specified with job demands (work overload) leading to ill health through burnout, and job resources (colleague and supervisor support, communication, growth opportunities and role clarity) leading to organisational commitment through engagement. Results of structural equation modelling indicated that the proposed JD-R model was a good fit to the sample. Furthermore, burnout was found to mediate the relationship between job demands and ill health with a medium effect. Engagement was found to mediate the relationship between job resources and organisational commitment with a large effect. The second objective, concerning reversed causality, was achieved with a longitudinal design (n = 593). The hypothesized model included burnout and engagement at time one, and at time two work overload as indicator of job demands, and colleague and supervisor support, communication, growth opportunities and role clarity as indicators of job resources. Results indicated that burnout had a significant negative reversed causal effect to supervisor support and colleague support. Engagement showed only one significant result, i.e. a small negative reversed causal relationship with supervisor support. To achieve the third objective, a cross-sectional design was used (n = 7 895). Results for logistic regression analyses showed that an increase in burnout was associated with a significant increase in the estimated odds for reporting an affirmative answer for receiving treatment for any of the health conditions, i.e. cardiovascular conditions, cholesterol, depression, diabetes, hypertension and irritable bowel syndrome. In contrast, an increase in engagement was associated with a decrease in affirmative reporting for cardiovascular conditions, cholesterol and depression; but not for diabetes, hypertension or irritable bowel syndrome. Addressing the link between burnout and financial outcomes was the fourth objective; and met with a cross-sectional design (n = 3 182). Participants were divided into a high and low burnout group based on the comorbidity of exhaustion and cynicism Analysis of covariance (ANCOVA) was implemented, controlling for age and gender, to investigate the difference in medical aid provider expenditure of the two groups. Results revealed that expenditure in the high burnout group was consistently more in all cases, compared to the low burnout group. By way of conclusion, the implications of the research were discussed and recommendations for managers and for future research were made. / Thesis (PhD (Industrial Psychology))--North-West University, Potchefstroom Campus, 2013

Work stress has a substantial impact on employees, organisations and economies; especially in the fragile economic environment since the ‘Great Recession’ of 2008; which has seen employment levels drop and employees willing to endure more stress at work to avoid retrenchment. These impacts include serious health and financial consequences. Attempts should therefore be made to effectively manage and address work stress to lessen these dire consequences. Many models have been developed and theorised to assist in explaining work stress, the pinnacle of these being the job demands-resources (JD-R) model. In JD-R theory, the dual process explains that work-related well-being follows the following processes: An energetic, also called the health impairment process, in which job demands leads to ill health outcomes through burnout; and then a motivational process which presents that job resources leads to positive organisational outcomes, e.g. organisational commitment, through engagement. The main objectives of this research were 1) to investigate a JD-R model in a large South African sample with a categorical estimator; 2) to investigate the reversed causal hypotheses of burnout and engagement in job demands-resources theory over time; 3) to investigate the likelihood of reporting treatment for health conditions based on burnout and engagement, and 4) to investigate the link between burnout and objective financial outcomes, i.e. by medical aid provider expenditure. To achieve the first objective a cross-sectional design was used (n = 15 633) covering numerous sectors in South Africa. A dual process model was specified with job demands (work overload) leading to ill health through burnout, and job resources (colleague and supervisor support, communication, growth opportunities and role clarity) leading to organisational commitment through engagement. Results of structural equation modelling indicated that the proposed JD-R model was a good fit to the sample. Furthermore, burnout was found to mediate the relationship between job demands and ill health with a medium effect. Engagement was found to mediate the relationship between job resources and organisational commitment with a large effect. The second objective, concerning reversed causality, was achieved with a longitudinal design (n = 593). The hypothesized model included burnout and engagement at time one, and at time two work overload as indicator of job demands, and colleague and supervisor support, communication, growth opportunities and role clarity as indicators of job resources. Results indicated that burnout had a significant negative reversed causal effect to supervisor support and colleague support. Engagement showed only one significant result, i.e. a small negative reversed causal relationship with supervisor support. To achieve the third objective, a cross-sectional design was used (n = 7 895). Results for logistic regression analyses showed that an increase in burnout was associated with a significant increase in the estimated odds for reporting an affirmative answer for receiving treatment for any of the health conditions, i.e. cardiovascular conditions, cholesterol, depression, diabetes, hypertension and irritable bowel syndrome. In contrast, an increase in engagement was associated with a decrease in affirmative reporting for cardiovascular conditions, cholesterol and depression; but not for diabetes, hypertension or irritable bowel syndrome. Addressing the link between burnout and financial outcomes was the fourth objective; and met with a cross-sectional design (n = 3 182). Participants were divided into a high and low burnout group based on the comorbidity of exhaustion and cynicism Analysis of covariance (ANCOVA) was implemented, controlling for age and gender, to investigate the difference in medical aid provider expenditure of the two groups. Results revealed that expenditure in the high burnout group was consistently more in all cases, compared to the low burnout group. By way of conclusion, the implications of the research were discussed and recommendations for managers and for future research were made. / Thesis (PhD (Industrial Psychology))--North-West University, Potchefstroom Campus, 2013