Risk factors for not completing health interventions and the potential impact on health inequalities between educational groups - a mixed method study from Denmark.

BACKGROUND: Individual-based interventions aim to improve patient self-management of chronic disease and to improve lifestyle among people at high risk, to reduce the prevalence of diseases contributing to health inequality. The present study investigates risk factors for uncompleted health interventions, via a combination of quantitative and qualitative methods. METHODS: From a health centre in Copenhagen, questionnaire data on educational level, gender, age, and cohabitation status from 104 participants in health interventions were used to examine risks for dropout. Qualitative telephone interviews further investigated risk factors among 17 participants who were registered as uncompleted. RESULTS: Our findings show that there is a significantly higher prevalence of uncompleted courses among participants below age 60 (OR 3.38, 95 % CI 1.08; 10.55) and an insignificantly higher prevalence among people with low education (OR 1.82, 95 % CI 0.66; 5.03). Qualitative elaboration of these findings points to low self-control in jobs and a higher degree of comorbidity and treatment of diseases among the lower educated as determinants for not completing, but not lower motivation or less positive attitude toward the intervention itself. CONCLUSIONS: This study indicates a social difference in dropout, and if dropout is to be prevented, there is a need to acknowledge factors such as organization of the intervention, lack of job flexibility, and comorbidity. If these factors are not addressed, people with low socioeconomic status will most likely have reduced opportunities for making healthy choices, in this case, completing the intervention, and this may increase health inequality.

Equating the HBSC Family Affluence Scale across survey years: a method to account for item parameter drift using the Rasch model.

PURPOSE: To investigate the measurement invariance (MI) of the Family Affluence Scale (FAS) measured in the Health Behavior in School-aged Children (HBSC) survey, and to describe a method for equating the scale when MI is violated across survey years. METHODS: This study used a sample of 14,076 Norwegian and 17,365 Scottish adolescents from the 2002, 2006 and 2010 HBSC surveys to investigate the MI of the FAS across survey years. Violations of MI in the form of differential item functioning (DIF) due to item parameter drift (IPD) were modeled within the Rasch framework to ensure that the FAS scores from different survey years remain comparable. RESULTS: The results indicate that the FAS is upwardly biased due to IPD in the computer item across survey years in the Norwegian and Scottish samples. Ignoring IPD across survey years resulted in the conclusion that family affluence is increasing quite consistently in Norway and Scotland. However, the results show that a large part of the increase in the FAS scores can be attributed to bias in the FAS because of IPD across time. The increase in the FAS was more modest in Scotland and slightly negative in Norway once the DIF in the computer item was accounted for in this study. CONCLUSIONS: When the comparison of family affluence is necessary over different HBSC survey years or when the longitudinal implications of family affluence are of interest, it is necessary to account for IPD in interpretation of changes in family affluence across time.

Socioeconomic inequalities in the impact of tobacco control policies on adolescent smoking. A multilevel study in 29 European countries.

INTRODUCTION: There are concerns that tobacco control policies may be less effective in reducing smoking among disadvantaged socioeconomic groups and thus may contribute to inequalities in adolescent smoking. This study examines how the association between tobacco control policies and smoking of 15-year-old boys and girls among 29 European countries varies according to socioeconomic group. METHODS: Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 comprising 50,338 adolescents aged 15 years from 29 European countries. Multilevel logistic regression analyses were conducted to assess the association of weekly smoking with components of the Tobacco Control Scale (TCS), and to assess whether this association varied according to family affluence (FAS). Analyses were carried out per gender and adjusted for national wealth and general smoking rate. RESULTS: For boys, tobacco price was negatively associated with weekly smoking rates. This association did not significantly differ between low and high FAS. Levels of tobacco-dependence treatment were significantly associated with weekly smoking. This association varied between low and high FAS, with higher treatment levels associated with higher probability of smoking only for low FAS boys. For girls, no tobacco policy was significantly associated with weekly smoking, irrespective of the FAS. CONCLUSIONS: Results indicated that most tobacco control policies are not clearly related to adolescent weekly smoking across European countries. Only tobacco price seemed to be adequate decreasing smoking prevalence among boys, irrespective of their socioeconomic status.

[The gastrointestinal system's association with autism]. / Mave-tarm-systemets mulige relation til autisme.

Autism was first described by Leo Kanner in 1943. He described common features in 11 children, who were, among others, characterised by limited social interaction and lack of communicative skills. However, Kanner also described characteristics related to the gastrointestinal system. Subsequently, studies have related autism to chronic inflammation in the intestinal lining and to food allergies. If the severity of autism is affected, e.g. by a pathological gastrointestinal condition, there is a possibility that treatment of the secondary condition will lead to improvement in the primary ailment followed by increased well-being.