Health inequalities between Roma and non-Roma populations in Europe: A study of 118,834 individuals combining the UNDP Roma and the EU-SILC surveys.

AIMS: This study aimed to compare the self-rated health status of the Roma and of the general population by gender and educational level in six Central and Eastern European countries. METHODS: We analysed the United Nations Development Program Regional Roma Survey and EUROSTAT's European Union Statistics on Income and Living Conditions surveys from 2011 for Bulgaria, Croatia, Czechia, Hungary, Romania and Slovakia. Using logistic regression, predicted probabilities of good or very good self-rated health were estimated for the Roma (n=11,401), Roma neighbours (n=5857) and the general population (n=101,579) stratified by gender, and adjusted by age, country and educational level. RESULTS: There was a distinctive social gradient in self-rated health between the groups among both men and women, and a gap between primary versus secondary or tertiary education among all three groups, but Roma (men) and their neighbours with secondary or higher education had significantly worse predicted self-rated health compared to the general population with similar qualifications. CONCLUSIONS: These results strongly suggest that ethnicity and gender should be considered as fundamental causes that explain structural health inequalities. Consequently, future research and policy initiatives to reduce health inequities should acknowledge the impact of ethnic minorities and how these fundamental causes extend the general population's social gradient in health. Study designs enabling direct comparisons between ethnic groups and the general population should be applied. More and better data about ethnic minorities are needed to document and monitor existing health inequalities.

Gender, class, employment status and social mobility following spinal cord injury in Denmark, the Netherlands, Norway and Switzerland.

STUDY DESIGN: Cross sectional survey of 1055 persons with spinal cord injury (SCI) in Denmark, the Netherlands, Norway and Switzerland. OBJECTIVES: (1) To analyse the employment levels of people of working age with SCI, including possible gender differences. (2) To study the relevance of occupational class before SCI and its impact on employment and occupational class after SCI. SETTING: Members of national SCI consumer associations. METHODS: Employment status and social mobility after SCI was regressed on occupational class before SCI, using multinomial and binary logistic regression analysis of employment, while controlling for other explanatory variables to employment after SCI and demographic characteristics. RESULTS: Employment levels after injury were similar for men and women in each of the four nations, but Dutch women had significantly lower scores on predicted employment than Dutch men. Employment and social mobility trajectories were heavily in favour of middle-class occupations. Gender differences in employment status at the time of study primarily occurred among those in working-class occupations before SCI, with men less likely than women of being non-employed. Working-class men were significantly more likely than working-class women to retain a working-class occupation at the time of study, and although non-significant, to attain a middle-class occupation after SCI. CONCLUSION: There was little variation in employment by gender within and across countries but significant differences between working-class and middle-class occupations before and after injury. The results suggest that targeted employment measures should be particularly invested in the rehabilitation of women in working-class occupations.

Improving outgroup attitudes in schools: First steps toward a teacher-led vicarious contact intervention.

Despite the urgent need for promoting positive intergroup relations in schools, research on intergroup relations is not systematically translated into prejudice-reduction interventions. Although prejudice-reduction interventions in schools based on indirect contact have been conducted for decades, they have all been carried out by researchers themselves. In a field experiment in Finland in autumn 2015, we tested for the first time a vicarious contact prejudice-reduction intervention for its effectiveness among adolescents (N = 639) when implemented independently by school teachers instead of researchers. In addition, we tested the extent to which the intervention's effect depends on initial outgroup attitudes, previous direct outgroup contact experiences, and gender, hypothesizing that the intervention improves outgroup attitudes particularly among adolescents with more negative prior attitudes and less positive prior direct contact, and more among girls than among boys. We found an unanticipated overall deterioration in the outgroup attitudes during intervention in both the experimental and control groups. However, attitudes seemed to deteriorate somewhat less in the experimental than in the control group, and the intervention had a significant positive effect on outgroup attitudes in one experimental subgroup that needed it most: girls who had negative rather than positive outgroup attitudes at the outset. We discuss our results in light of previous research and contextual particularities.

Self-rated health and wellbeing among the working-age immigrant population in Western Europe: findings from the European social survey (2014) special module on the social determinants of health.

Background: The aim is to study the difference in self-rated health and wellbeing between native non-migrants and different immigrant groups: new (defined as having lived in the host country for 10 years or less), old (living in the host country for more than 10 years) and second-generation immigrants living in Western European countries. Methods: We use the European Social Survey Round 7, collected in 2014/15, to study the working-age population aged 20­64. We separate between first (new and old) and second-generation immigrants. Self-rated health was dichotomised as very good and good versus less than good health. Wellbeing was measured by constructing a continuous scale from eight 4-point Likert scale items (CES-D8). Data for 14 Western European countries were pooled together (N = 18 577). Men and women were analyzed separately using binary logistic and OLS regression. Results: For self-rated health, we found support among both men and women for the healthy migrant hypothesis. Among men only, second-generation immigrants had more deteriorating self-rated health by age, and old immigrants were similar to the natives. The four groups differed in wellbeing only among those with primary education, and more so among men than among women. Second-generation immigrants were worse and new immigrants better than natives and old immigrants. Conclusion: This study supports the healthy migrant hypothesis among both men and women. Among men, old and second-generation immigrants' predicted health falls more steeply by age. There was some variation between migrant groups in wellbeing among those with low education.

Financial difficulties in childhood and adult depression in Europe.

Background: Financial difficulties in childhood may be associated with immediate and long-term consequences for mental health. The aim of the current paper is to investigate the association between childhood financial difficulties and adult depression, and assess the relative contribution of financial difficulties in childhood to symptoms of adult depression across different age groups. Methods: Using three age cohorts (25­40, 41­59, 60­75) from 19 countries in the European Social Survey Round 7 (N =18 401), multi-level and country-wise OLS regression analyses were used to investigate the association between financial difficulties in childhood and adult depression, while adjusting for age, education, gender, highest education in family, level of family conflict, number of social meetings and marital status. Results: Financial difficulties in childhood was found to be influential predictors of depression scores for 25­40 year olds in 10 out of 19 countries in fully adjusted models. In older participants, depression scores were mostly influenced by frequency of social meetings and marital status. There was great variation in the pattern of influential risk factors across countries, and the predicted effect childhood financial difficulties had on adult depression scores. Conclusion: Childhood financial difficulties as predictors of depression appear to, by themselves, exert the strongest influence in younger adults. There was, however, large variation between countries in the magnitude of associated risk, and in the pattern of risk factors contributing to adult depression, which underscores the need to account for country-level factors when aiming to gain knowledge about mental health.

The socioeconomic distribution of non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health.

Background: A range of non-communicable diseases (NCDs) has been found to follow a social pattern whereby socioeconomic status predicts either a higher or lower risk of disease. Comprehensive evidence on the socioeconomic distribution of NCDs across Europe, however, has been limited. Methods: Using cross-sectional 2014 European Social Survey data from 20 countries, this paper examines socioeconomic inequalities in 14 self-reported NCDs separately for women and men: heart/circulatory problems, high blood pressure, back pain, arm/hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. Using education to measure socioeconomic status, age-controlled adjusted risk ratios were calculated and separately compared a lower and medium education group with a high education group. Results: At the pooled European level, a social gradient in health was observed for 10 NCDs: depression, diabetes, obesity, heart/circulation problems, hand/arm pain, high blood pressure, breathing problems, severe headaches, foot/leg pain and cancer. An inverse social gradient was observed for allergies. Social gradients were observed among both genders, but a greater number of inequalities were observed among women. Country-specific analyses show that inequalities in NCDs are present everywhere across Europe and that inequalities exist to different extents for each of the conditions. Conclusion: This study provides the most up-to-date overview of socioeconomic inequalities for a large number of NCDs across 20 European countries for both women and men. Future investigations should further consider the diseases, and their associated determinants, for which socioeconomic differences are the greatest.

Educational inequalities in high- vs. low-preventable health conditions: Exploring the fundamental cause theory.

AIM: To explore variations in educational gradients or gaps between high- and low-preventable health conditions. BACKGROUND: This is one of the first European studies to test whether the association between socioeconomic status and morbidity is stronger for 10 high- than three low-preventable health conditions, by gender across 20 countries. DATA AND METHODS: The 2014 European Social Survey included questions on 11 health conditions experienced over the last 12 months, cancer at any age, and symptoms of depression during the last week. We include respondents from 20 countries (Nmen = 12,073; Nwomen = 13,488) aged 25 to 69. We estimated age-adjusted educational gradients on 13 conditions using logistic or OLS-regression stratified by country and gender, and high- and low-preventable pooled conditions variables on pooled country samples. RESULTS: Both among men and women the proportion of educational gaps were larger for the high-preventable than the low-preventable conditions in most countries, supporting the Fundamental Cause Theory (FCT) hypothesis. However, there was large variations in the number of significant associations across countries and between genders. In the pooled conditions and countries analysis, no associations were significant among the low-preventable conditions. For the high-preventable conditions there was a weak significant educational gap among men, and a weak but nevertheless more distinctive and complete sigificant educational gradient among women. CONCLUSION: In a first explorative comparative European analysis we found support for the FCT hypothesis. Thus, the FCT can be used on morbidity data classified as low- versus high-preventable. We recommend extending this framework with institutional theories to explain within- and between-country health inequalities.