Are housing tenure and car access still associated with health? A repeat cross-sectional study of UK adults over a 13-year period.

BACKGROUND: It is usually assumed that housing tenure and car access are associated with health simply because they are acting as markers for social class or income and wealth. However, previous studies conducted in the late 1990s found that these household assets were associated with health independently of social class and income. Here, we set out to examine if this is still the case. METHODS: We use data from our 2010 postal survey of a random sample of adults (n=2092) in 8 local authority areas in the West of Scotland. Self-reported health measures included limiting longstanding illness (LLSI), general health over the last year and the Hospital Anxiety and Depression Scale. RESULTS: We found a statistically significant relationship between housing tenure and all 4 health measures, regardless of the inclusion of social class or income as controls. Compared with owner occupiers, social renters were more likely to report ill-health (controlling for social class-LLSI OR: 3.24, general health OR: 2.82, anxiety η2: 0.031, depression η2: 0.048, controlling for income-LLSI OR: 3.28, general health OR: 2.82, anxiety η2: 0.033, depression η2: 0.057) (p<0.001 for all models). Car ownership was independently associated with depression and anxiety, with non-owners at higher risk of both (controlling for income-anxiety η2: 0.010, depression η2: 0.023, controlling for social class-anxiety η2: 0.013, depression η2: 0.033) (p<0.001 for all models). CONCLUSIONS: Our results show that housing tenure and car ownership are still associated with health, after taking known correlates (age, sex, social class, income) into account. Further research is required to unpack some of the features of these household assets such as the quality of the dwelling and access to and use of different forms of transport to determine what health benefits or disbenefits they may be associated with in different contexts.

Mapping area variability in social and behavioural difficulties among Glasgow pre-schoolers: linkage of a survey of pre-school staff with routine monitoring data.

BACKGROUND: Social, emotional and behavioural development in early to middle childhood impact upon many outcomes in future life and are influenced by home, neighbourhood and school environments. We used linked data to investigate differences between areas in Glasgow City in level of difficulties in pre-school age children, after consideration of demographics, including area-level deprivation. METHODS: Pre-school education staff completed Strengths and Difficulties Questionnaires (SDQ) on all children progressing to school from a local authority or partnership (local authority-funded private) pre-school in Glasgow City between 2010 and 2012. These data were linked to individual (age, gender) and area-level (deprivation) demographics from the City Council Education Services Department. Statistical models were fitted to the SDQ scores, adjusting for age, gender, area deprivation, year of school entry, pre-school establishment attended and electoral ward of residence. Correlation between neighbouring wards was incorporated to allow for clustering of scores. RESULTS: Boys and those living in more deprived areas had higher levels of difficulties. Children aged 5.0-5.5 years had fewest difficulties, while the oldest and youngest children had similar levels of difficulties. There were no significant secular trends by year of school entry. There remained differences among areas after adjusting for these variables, with children living in some areas having fewer difficulties than would be expected based on their socio-demographic characteristics. CONCLUSIONS: There remained differences in children's levels of difficulties between areas after adjusting for age, gender, area deprivation and year of school entry. Children in some very deprived areas had fewer difficulties than might be expected, while those in relatively affluent areas had more difficulties than expected based on their deprivation level. There may be other, unmeasured, individual- and area-level reasons for children's level of difficulties, and these require further exploration.

Associations between health and different types of environmental incivility: a Scotland-wide study.

OBJECTIVES: Concern about the impact of the environment on health and well-being has tended to focus on the physical effects of exposure to toxic and infectious substances, and on the impact of large-scale infrastructures. Less attention has been paid to the possible psychosocial consequences of people's subjective perceptions of their everyday, street-level environment, such as the incidence of litter and graffiti. As little is known about the potential relative importance for health of perceptions of different types of environmental incivility, a module was developed for inclusion in the 2004 Scottish Social Attitudes survey in order to investigate this relationship. STUDY DESIGN: A random sample of 1637 adults living across a range of neighbourhoods throughout Scotland was interviewed. METHODS: Respondents were asked to rate their local area on a range of possible environmental incivilities. These incivilities were subsequently grouped into three domains: (i) street-level incivilities (e.g. litter, graffiti); (ii) large-scale infrastructural incivilities (e.g. telephone masts); and (iii) the absence of environmental goods (e.g. safe play areas for children). For each of the three domains, the authors examined the degree to which they were thought to pose a problem locally, and how far these perceptions varied between those living in deprived areas and those living in less-deprived areas. Subsequently, the relationships between these perceptions and self-assessed health and health behaviours were explored, after controlling for gender, age and social class. RESULTS: Respondents with the highest levels of perceived street-level incivilities were almost twice as likely as those who perceived the lowest levels of street-level incivilities to report frequent feelings of anxiety and depression. Perceived absence of environmental goods was associated with increased anxiety (2.5 times more likely) and depression (90% more likely), and a 50% increased likelihood of being a smoker. Few associations with health were observed for perceptions of large-scale infrastructural incivilities. CONCLUSIONS: Environmental policy needs to give more priority to reducing the incidence of street-level incivilities and the absence of environmental goods, both of which appear to be more important for health than perceptions of large-scale infrastructural incivilities.

Are perceived neighbourhood problems associated with the likelihood of smoking?

OBJECTIVE: To explore associations between residents' perceptions of the local residential environment and the likelihood of their smoking. DESIGN: Using data (n = 2615) from the West of Scotland Twenty-07 Study, separately by gender, cross-sectional associations between respondents' perceptions of neighbourhood (perceived absence of goods, incivilities and physical environmental problems) and the likelihood of being a current smoker and the amount smoked were examined. RESULTS: Perceived neighbourhood problems are associated with the likelihood of smoking but mainly among those with the most negative view of the local neighbourhood. Perceptions of the provision of neighbourhood amenities seems to be more strongly associated with women's than men's smoking status, whereas the perceived quality of the local neighbourhood appears to be a better predictor of men's smoking. CONCLUSIONS: Efforts to reduce smoking levels among more deprived groups may need to pay more attention to the role of local environmental conditions in influencing smoking behaviour.

Gender differences in the associations between health and neighbourhood environment.

Multiple deprivation indicators are frequently used to capture the characteristics of an area. This is a useful approach for identifying the most deprived areas, and summary indices are good predictors of mortality and morbidity, but it remains unclear which aspects of the residential environment are most salient for health. A further question is whether the most important aspects vary for different types of residents. This paper focuses on whether associations with neighbourhood characteristics are different for men and women. The sociopolitical and physical environment, amenities, and indicators of economic deprivation and affluence were measured in neighbourhoods in the UK, and their relationship with self-rated health was investigated using multilevel regression models. Each of these contextual domains was associated with self-rated health over and above individual socioeconomic characteristics. The magnitude of the association was larger for women in each case. Statistically significant interactions between gender and residential environment were found for trust, integration into wider society, left-wing political climate, physical quality of the residential environment, and unemployment rate. These findings add to the literature indicating greater effects of non-work-based stressors for women and highlight the influence of the residential environment on women's health.

Neighbourhood cohesion and health in socially contrasting neighbourhoods: implications for the social exclusion and public health agendas.

OBJECTIVE: To report on perceived neighbourhood cohesion and describe its social distribution. DESIGN: Analysis of data from third wave of data collection from Localities component of West of Scotland Twenty-07 Study, collected in 1997 by postal survey. SETTING: Socially contrasting neighbourhoods in Glasgow City in the West of Scotland. SUBJECTS: Five hundred and ninety seven people (262 males, 336 females), participants in a longitudinal study. RESULTS: Respondents who are older, live in owner-occupied houses in more affluent areas and who are not working outside the home report significantly more positive assessments of perceived neighbourhood cohesion. Sex, social class and family circumstances did not predict perceived neighbourhood cohesion. There were significant associations between neighbourhood cohesion and self assessed health in the last year; mental health using the GHQ12 measure; total number of symptoms reported in the last month; and reported number of 'malaise' or 'physical' symptoms after taking socio-demographic factors into account. CONCLUSION: Lack of social cohesion may be more common in deprived areas in Scotland and may produce poorer mental health. Living in an area with low levels of social cohesion may be part of the pathway between life circumstances and death.

Mums on Prozac, kids on inhalers: the need for research on the potential for improving health through housing interventions.

In a short term qualitative study exploring the impact that improvements to housing might have upon the health of household members, respondents perceived significant benefits of housing improvements for physical and mental health, and for both children and adults. There is a need for prospective research which monitors health and wellbeing before, during, and after housing improvement and which uses independent measures of health.

Someone to talk to? The role of loneliness as a factor in the frequency of GP consultations.

BACKGROUND: There are many reasons why people frequently consult their general practitioner (GP). Although loneliness is increasingly recognized as a problem affecting well-being for elderly people, it has rarely been addressed as a predictor of frequency of consultation. AIM: To examine whether loneliness is associated with rates of GP consultations (home and surgery visits). METHOD: Analysis of data collected in face-to-face interviews at the second wave of a longitudinal health survey of two adult age cohorts living in four socially contrasting urban localities in Glasgow City. There were a total of 691 subjects: 142 males and 176 females aged 40 years at interview; and 167 males and 206 females aged 60 years at interview. Frequency of reported GP consultations in the past 12 months at home or in the surgery was examined. RESULTS: After controlling for sociodemographic and socioeconomic variables and health, loneliness was significantly associated with frequency of consultation at the surgery but not with the frequency of home visits. CONCLUSION: Loneliness may still be underestimated as a factor related independently to frequency of consultations with a GP at the surgery.

Do housing tenure and car access predict health because they are simply markers of income or self esteem? A Scottish study.

OBJECTIVE: To investigate relations between health (using a range of measures) and housing tenure or car access; and to test the hypothesis that observed relations between these asset based measures and health are simply because they are markers for income or self esteem. DESIGN: Analysis of data from second wave of data collection of West of Scotland Twenty-07 study, collected in 1991 by face to face interviews conducted by nurse interviewers. SETTING: The Central Clydeside Conurbation, in the West of Scotland. SUBJECTS: 785 people (354 men, 431 women) in their late 30s, and 718 people (358 men, 359 women) in their late 50s, participants in a longitudinal study. MEASURES: General Health Questionnaire scores, respiratory function, waist/hip ratio, number of longstanding illnesses, number of symptoms in the last month, and systolic blood pressure; household income adjusted for household size and composition; Rosenberg self esteem score; housing tenure and care access. RESULTS: On bivariate analysis, all the health measures were significantly associated with housing tenure, and all except waist/hip ratio with car access; all except waist/hip ratio were related to income, and all except systolic blood pressure were related to self esteem. In models controlling for age, sex, and their interaction, neither waist/hip ratio nor systolic blood pressure remained significantly associated with tenure or care access. Significant relations with all the remaining health measures persisted after further controlling for income or self esteem. CONCLUSIONS: Housing tenure and car access may not only be related to health because they are markers for income or psychological traits; they may also have some directly health promoting or damaging effects. More research is needed to establish mechanisms by which they may influence health, and to determine the policy implications of their association with health.

Does housing tenure predict health in the UK because it exposes people to different levels of housing related hazards in the home or its surroundings?

In the UK housing tenure (whether the dwelling is owner occupied or rented) has consistently been found to be associated with longevity and with a number of measures of health. It has been argued that it is a good measure of material circumstances, and it is often incorporated into area based measures of social or material deprivation. However there is little published research on whether housing tenure predicts mortality and morbidity simply because it is an indicator of material well being, or whether, in addition, different categories of housing tenure expose people to different levels of health hazards in the dwelling itself or in the immediate environment. In this paper we examine, using data on adults aged 40 and 60 from socially contrasting neighbourhoods in Glasgow, Scotland, whether housing tenure is associated with housing stressors (e.g. overcrowding, dampness, hazards, difficulty with heating the home) and with assessment of the local environment (e.g. amenities, problems, crime, neighbourliness, area reputation and satisfaction), and whether this might help to explain tenure differences in long-standing illness, limiting long-standing illness, anxiety and depression. Controlling for income, age and sex, housing stressors independently predicted limiting long-standing illness; assessment of the area and housing type independently contributed to anxiety; and housing stressors, housing type and assessment of the area independently contributed to depression. This suggests that housing tenure may expose people to different levels of health hazards, and has implications for urban housing policies.

Does area of residence affect body size and shape?

OBJECTIVE: To examine whether neighbourhood or residence is associated with body size and shape (height, weight, BMI, waist circumference and waist-hip ratio). DESIGN: Analysis of data collected in fact to face interviews at the second wave of longitudinal health survey of two adult age cohorts in the West of Scotland. SETTING: Four socially contrasting urban neighbourhoods in Glasgow City, Scotland. SUBJECTS: A total of 691 subjects: 142 males and 176 females aged 40 at interview; and 167 males and 206 females aged 60 at interview. All had been resident in their current neighbourhood for at least four years. MEASUREMENTS: height, weight, BMI, waist circumference and waist-hip ratio. RESULTS: Neighbourhood of residence was significantly associated with height, BMI, waist circumference and waist-hip ratio after controlling for individual characteristics such as gender, age, social class, smoking behaviour and material deprivation (an index comprising income, housing tenure and car ownership). Individuals living in the most deprived neighbourhood were significantly shorter, and had bigger waist circumferences, waist-hip ratios and BMIs. CONCLUSIONS: If Health of the Nation targets on reducing the proportion of overweight individuals in the population are to be met, public health policy should focus on places as well as people.

Are single indicators of deprivation as useful as composite indicators in predicting morbidity and mortality: results from the Central Clydeside Conurbation.

Analysis of 1991 Census data for the Central Clydeside Conurbation suggests that male unemployment and car ownership provide useful alternatives to composite deprivation indices in predicting health.

Does where you live predict health related behaviours?: a case study in Glasgow.

In a study of four socially contrasting neighbourhoods in Glasgow, three health related behaviours (diet, smoking and participation in sport) were independently associated with neighbourhood of residence among adults after controlling for gender, age, social class and income. Policies aiming to improve the health of the population should take into account local neighbourhoods as well as individuals living within them.