The interplay of contextual layers: A multilevel analysis of income distribution, neighborhood infrastructure, socioeconomic position and self-rated health in Brazil

Vincens, Natalia; Emmelin, Maria; Stafström, Martin

doi:10.1016/j.healthplace.2018.05.012

Cited by 13 publications

(10 citation statements)

References 61 publications

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“…This study revealed that QOL of empty nesters were significantly influenced by gender, age, education, monthly income, drinking status, exercise frequency, physical examination frequency, attention to daily nutritional health, relationship with children, relationship with spouse. Generally, empty nesters who were the older adults [ 38 ], low education level [ 9 ] and low-income individuals [ 39 ] might have less awareness and ability to maintain health, which means they could not be of better QOL. In addition, we explore the association between socio-economic status, behavioral lifestyle, family relationship and QOL among the empty nesters, and verified the relationship among them.…”

Section: Discussionmentioning

confidence: 99%

Exploring the influencing factors of quality of life among the empty nesters in Shanxi, China: a structural equation model

Zhang

Cai

Xue

et al. 2021

Health Qual Life Outcomes

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Background As China’s aging trend intensifies and the proportion of empty nests increases, the health-related quality of life of the elderly is the focus of social attention. Previous studies focused on the quality of life of the elderly, rather than empty nesters, and lacked the discussion of the mechanism of influencing factors. Thus, this study aimed to explore the influencing factors of the quality of life (QOL) and interaction mechanisms among empty nesters in Shanxi Province, China, so as to provide practical reference for improving the QOL of empty nesters. Methods A total of 4901 empty nesters in Shanxi Province, China, were selected using multi-stage random cluster sampling method in this cross-sectional study. The quality of life was assessed with the Short Form 36 Health Survey (SF-36). Multiple linear regression analysis (stepwise) was performed to examine the factor associated with QOL. Structural equation model (SEM) approach was conducted to test the direct and indirect association between QOL influencing factors with QOL. Results The average QOL score of empty nesters was 63.34 (SD = 17.23). The multiple linear regression revealed that gender, age, education, monthly income, drinking status, exercise frequency, physical examination frequency, attention to daily nutritional health, relationship with a spouse and relationship with children were significant predictors of the empty nester’s QOL (P < 0.05) (R2 = 0.128). SEM showed that behavioral lifestyle had a direct effect on QOL (β = 0.446, P < 0.001). Socio-economic status had an indirect effect (β = 0.288, P < 0.001) on QOL through behavioral lifestyle. The family relationship had an indirect effect (β = 0.115, P < 0.001) on QOL. Conclusion Behavioral lifestyle was the strongest influencing factor in the quality of life among empty nesters, followed by socio-economic status and family relationships. Thus, maintaining a healthy behavioral lifestyle was important to improve the QOL of the empty nesters. Our findings provide a concrete and strong reference for the formulation of targeted intervention strategies.

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Section: Discussionmentioning

confidence: 99%

Exploring the influencing factors of quality of life among the empty nesters in Shanxi, China: a structural equation model

Zhang

Cai

Xue

et al. 2021

Health Qual Life Outcomes

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“…Yet, our findings focused on the role of these strategies in the construction of social identity and on the positive and negative consequences of these strategies for the social comparisons, the erosion of social capital and the developments of pride and shame, which in turn influences social stress and generates or reduces health inequalities. We find this cascade of events helpful to further explain the previously demonstrated association between income inequality, neighborhood basic infrastructure and indicators of social economic positionand its interactions-with health in Brazil [3,18,21,23].…”

Section: Discussionmentioning

confidence: 52%

“…In a previous study, investigating the association between the target contextual factors and health in Brazil, we demonstrated a synergism between income distribution and neighborhood basic infrastructure on self-rated health in Brazil [23]. Neighborhood basic infrastructurei.e., access to water, sewage, electricity and garbage collection-amplified the effects of state-level income distribution on self-rated health.…”

Section: Introductionmentioning

confidence: 85%

“…Within that social space social classes are thus distinguished and defined in relation to others, based on the shared circumstances of a given position and the distance between positions. Physical and social aspects of the neighborhood have been associated with health inequality [20][21][22][23]. These aspects constitute the local "opportunity structure", i.e., "socially constructed and socially patterned features of the physical and social environment which may promote or damage health either directly or indirectly through the possibilities they provide for people to live healthy lives" [14].…”

Section: Introductionmentioning

confidence: 99%

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Constructing social identity through multiple “us and them”: a grounded theory study of how contextual factors are manifested in the lives of residents of a vulnerable district in Brazil

Vincens

Stafström

Ferreira

et al. 2020

Int J Equity Health

Self Cite

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The association between contextual factors and health inequalities is well documented, also in Brazil. However, questions about how contextual factors actually affect health and well-being persist. The aim of this qualitative study was to explore how contextual factors-i.e., social stratification and neighborhood opportunity structuresare manifested in the lives of the residents of a vulnerable district in Brazil. We used a Constructivist Grounded Theory approach based on 12 in-depth interviews. The core category constructing social identity through multiple "us and them" is supported by eight main categories that characterize different pairs of "us and them", based on internal and external aspects of the social processes involved. Our findings strengthen and support the links between contextual factors and health inequalities, highlighting the relevance of downward social comparison, territorial segregation and stigmatization and erosion of social capital in the construction of social identities and the manifestation of social hierarchies and neighborhood structures in the Brazilian context. Ultimately, these create shame and stress but also pride and empowerment, which are recognized determinants of health inequities.

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“…Association observed for social disorder in the unadjusted model disappeared when individual-level covariates were adjusted for. Other studies have found that quality of services, mobility, public facilities, safety from traffic, violence, presence of parks, street noise, income, overcrowding, and the water, sewage network, electricity, and garbage collection services were related to health status [12,15,31,[41][42][43]. It is possible that many of these elements are better captured in the physical disorder scale that we used.…”

Section: Discussionmentioning

confidence: 99%

Physical Disorders and Poor Self-Rated Health in Adults Living in Four Latin American Cities: A Multilevel Approach

Vaz

Andrade

Silva³

et al. 2020

IJERPH

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Considering that urban environments may affect self-rated health through behavioral and psychosocial mechanisms, the aim of this study was to investigate the association between self-rated health and perceived urban environment characteristics among adults living in four Latin American cities. Data is from a population-based survey by Development Bank of Latin America, encompassing adults between 20 and 60 years old in Buenos Aires, Lima, Mexico City, and Panama City. Self-rated health was measured using a single question and the response options were categorized as poor and good. The explanatory variables were empirical Bayes estimates of self-reported area physical disorder, social disorder, access to services, and access to leisure spaces derived from the survey. The covariates were: individual age, sex, education, wealth index, and length of residency in the neighborhood; and an area social environment index. Multilevel logistic regressions with two levels (individual and sub-city areas) were fitted. Poor self-rated health was reported by 34.73% (95% CI: 33.17 to 36.29) of the participants and was associated with physical disorder (OR = 1.16 per SD; 95% CI: 1.02 to 1.32). Our findings suggest that public policies to promote population health should consider area urban environment factors, especially those associated with disorder.

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The interplay of contextual layers: A multilevel analysis of income distribution, neighborhood infrastructure, socioeconomic position and self-rated health in Brazil

Cited by 13 publications

References 61 publications

Exploring the influencing factors of quality of life among the empty nesters in Shanxi, China: a structural equation model

Exploring the influencing factors of quality of life among the empty nesters in Shanxi, China: a structural equation model

Constructing social identity through multiple “us and them”: a grounded theory study of how contextual factors are manifested in the lives of residents of a vulnerable district in Brazil

Physical Disorders and Poor Self-Rated Health in Adults Living in Four Latin American Cities: A Multilevel Approach

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