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      Lifestyle-related factors that explain disaster-induced changes in socioeconomic status and poor subjective health: a cross-sectional study from the Fukushima health management survey

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          Abstract

          Background

          Socioeconomic status (SES) and lifestyle-related factors are determinants of subjective health. However, changes in SES are inevitable in times of natural disaster, while lifestyle-related factors remain modifiable. The aim of this study was to use a cross-sectional approach to examine lifestyle-related factors that may attenuate the negative impact of disaster-induced changes in SES on poor subjective health.

          Methods

          We analyzed 33,350 men and women aged 20–64 years who were living in evacuation zones due to the radiation accident in Fukushima, Japan. Disaster-induced changes in SES were defined by living arrangements and working conditions. Using Poisson regression analysis adjusted for confounders (model 1) and lifestyle-related factors as intermediate variables (model 2), we compared the prevalence ratios (PRs) of poor subjective health of participants who did not undergo disaster-induced changes in SES (did not become unemployed, income did not decrease, and living in relative’s home/own home) with that of participants who did undergo disaster-induced changes in SES (became unemployed, decreased income, or lived in an evacuation shelter, temporary housing, or rental housing/apartment). We calculated the percentage of excess risks explained by lifestyle-related factors as follows: ((PR model 1 − PR model 2)/(PR model 1–1)) × 100.

          Results

          Disaster-induced changes in SES were significantly associated with poor subjective health. The PRs (95% CIs) among participants who underwent disaster-induced changes in SES were 2.02 (1.81–2.24) for men and 1.80 (1.65–1.97) for women. After adjusting for lifestyle-related factors, we found that the PRs in men and women were remarkably attenuated, decreasing to 1.56 (1.40–1.73) and 1.43 (1.31–1.55), respectively. Controlling for lifestyle-related factors resulted in PR attenuation by 45.1% (men) and 46.3% (women). Satisfaction of sleep and participation in recreation and community activity particularly contributed to this attenuation.

          Conclusions

          While disaster-induced changes in SES are unavoidable, lifestyle-related factors have the potential to attenuate the impact of these changes on poor subjective health.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12889-017-4247-2) contains supplementary material, which is available to authorized users.

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          Most cited references28

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          Socioeconomic conditions, lifestyle factors, and self-rated health among men and women in Sweden.

          Socioeconomic conditions and lifestyle factors have been found to be related to self-rated health, which is an established predictor of morbidity and mortality. Few studies, however, have investigated the independent effect of material and psychosocial conditions as well as lifestyle factors on self-rated health. The association between socioeconomic conditions, lifestyle factors, and self-rated health was investigated using a postal survey questionnaire sent to a random population sample of men and women aged 18-79 years during March-May 2000. The overall response rate was 65%. The area investigated covers 58 municipalities in the central part of Sweden. Multivariate odds ratios for poor self-rated health were calculated for a range of variables. A total of 36 048 subjects with full data were included in the analysis. Similar analyses of the influence of working conditions were conducted among those employed aged 18-64 years (17 820 subjects). The overall prevalence of poor self-rated health was 7% among men and 9% among women. Poor self-rated health was most common among persons who had been belittled, who had experienced economic hardship, who lacked social support, or who had retired early. A low educational level was independently associated with poor self-rated health among men, but not among women. Physically inactive as well as underweight and obese subjects were more likely to have poor self-rated health than other subjects. Working conditions associated with poor self-rated health were dissatisfaction with work, low job control and worry about losing one's job. While a cross-sectional study does not allow definite conclusions as to which factors are determinants and which are consequences of poor self-rated, the present findings support the notion that both psychosocial and material conditions as well as lifestyle factors are independently related with poor self-rated health.
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            Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis.

            To determine the effect of inequalities in income within a state on self rated health status while controlling for individual characteristics such as socioeconomic status. Cross sectional multilevel study. Data were collected on income distribution in each of the 50 states in the United States. The Gini coefficient was used to measure statewide inequalities in income. Random probability samples of individuals in each state were collected by the 1993 and 1994 behavioural risk factor surveillance system, a random digit telephone survey. The survey collects information on an individual's income, education, self rated health and other health risk factors. All 50 states. Civilian, non-institutionalised (that is, non-incarcerated and non-hospitalised) US residents aged 18 years or older. Self rated health status. When personal characteristics and household income were controlled for, individuals living in states with the greatest inequalities in income were 30% more likely to report their health as fair or poor than individuals living in states with the smallest inequalities in income. Inequality in the distribution of income was associated with an adverse impact on health independent of the effect of household income.
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              Does social participation improve self-rated health in the older population? A quasi-experimental intervention study.

              Social participation has been linked to healthy aging and the maintenance of functional independence in older individuals. However, causality remains tenuous because of the strong possibility of reverse causation (healthy individuals selectively participate in social activities). We describe a quasi-experimental intervention in one municipality of Japan designed to boost social participation as a way of preventing long-term disability in senior citizens through the creation of 'salons' (or community centers). In this quasi-experimental intervention study, we compared 158 participants with 1391 non-participants in salon programs, and examined the effect of participation in the salon programs on self-rated health. We conducted surveys of community residents both before (in 2006) and after (in 2008) the opening of the salons. Even with a pre/post survey design, our study could be subject to reverse causation and confounding bias. We therefore utilized an instrumental variable estimation strategy, using the inverse of the distance between each resident's dwelling and the nearest salon as the instrument. After controlling for self-rated health, age, sex, equivalized income in 2006, and reverse causation, we observed significant correlations between participation in the salon programs and self-rated health in 2008. Our analyses suggest that participation in the newly-opened community salon was associated with a significant improvement in self-rated health over time. The odds ratio of participation in the salon programs for reporting excellent or good self-rated health in 2008 was 2.52 (95% CI 2.27-2.79). Our study provides novel empirical support for the notion that investing in community infrastructure to boost the social participation of communities may help promote healthy aging. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                +81-22-717-8104 , m-nagai@med.tohoku.ac.jp
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                20 April 2017
                20 April 2017
                2017
                : 17
                : 340
                Affiliations
                [1 ]ISNI 0000 0001 1017 9540, GRID grid.411582.b, Radiation Medical Science Center for the Fukushima Health Management Survey, , Fukushima Medical University, ; Fukushima, Japan
                [2 ]ISNI 0000 0001 1017 9540, GRID grid.411582.b, Department of Epidemiology, , Fukushima Medical University School of Medicine, ; Fukushima, Japan
                [3 ]ISNI 0000 0001 1017 9540, GRID grid.411582.b, Department of Disaster Psychiatry, , Fukushima Medical University School of Medicine, ; Fukushima, Japan
                [4 ]ISNI 0000 0001 1017 9540, GRID grid.411582.b, Department of Public Health, , Fukushima Medical University School of Medicine, ; Fukushima, Japan
                Author information
                http://orcid.org/0000-0003-0818-3158
                Article
                4247
                10.1186/s12889-017-4247-2
                5397819
                28427361
                d0d26e95-3956-440c-9a69-5217fdab3ab7
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 December 2015
                : 8 April 2017
                Funding
                Funded by: The National Health Fund for Children and Adults Affected by the Nuclear Incident
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Public health
                socioeconomic status,subjective health,disaster,lifestyle
                Public health
                socioeconomic status, subjective health, disaster, lifestyle

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