Social participation, social capital and socioeconomic differences in health-related behaviours. An epidemiological study

Abstract: Abstract OBJECTIVES: The aim of this study was to investigate whether psychosocial resources explain socioeconomic differences in smoking cessation and its maintenance. METHODS: A subpopulation of 11,837 individuals from the Malmö Diet and Cancer Study interviewed in 1992-94, age range 45-64 years, was investigated in this cross-sectional study. A multivariate logistic regression model was used to assess relative risks of having stopped smoking, adjusting for age, country of origin, previous/current diseases, and marital status. RESULTS: An odds ratio of 1.9 (1.4-2.5; 95% CI) for men and 2.0 (1.4-2.7; 95% CI) for women of having stopped smoking was found for higher non-manual employees when compared with unskilled manual workers. A decrease in these odds ratios was found when social participation was introduced into the model. The other three social network and social support variables were non-significant. CONCLUSION: High social participation is a predictor of maintenance of smoking cessation. It seems possible to interpret parts of the socioeconomic differences in smoking cessation and its maintenance as a consequence of differing social network resources and social capital between socioeconomic groups. Several studies have shown socioeconomic differences in leisure-time physical activity. One explanation may be socioeconomic differences in relevant psychosocial conditions. The Malmö Diet and Cancer Study is a prospective cohort study including inhabitants in Malmö, Sweden. The baseline questionnaire used in this cross-sectional study was completed by the 11,837 participants born 1926-1945 in 1992-1994. Leisure-time physical activity was measured by an item presenting a variety of activities. These activities were aggregated into a summary measure of leisure-time physical activity that takes both the intensity and duration of each specific activity into consideration. The effects of the psychosocial variables on the socioeconomic differences in leisure-time physical activity were calculated in a multivariate logistic regression analysis. The quartile with the lowest degree of leisure-time physical activity was not evenly distributed between the socioeconomic groups. Socioeconomic differences were seen as odds ratios 1.5 for skilled and 1.5 for unskilled male manual workers, compared to the high level non-manual employees. An OR 1.6 was observed for female unskilled manual workers. Self-employed men and female pensioners also had a significantly increased risk of low leisure-time physical activity. Adjustment for age, country of origin and previous/current diseases had no effect on these SES differences. Finally, adjusting for social participation almost completely erased the SES differences. Among the psychosocial variables, social participation was the strongest predictor of low physical activity, and a strong predictor for socioeconomic differences in low leisure-time physical activity. Social participation measures the individual's social activities in, for example political parties and organisations. It therefore seems possible that some of the socioeconomic differences in leisure-time physical activity are due to differing social capital between socioeconomic groups. BACKGROUND: The aim was to investigate whether social network and social support factors can explain socioeconomic differences in the risk of consuming low amounts of vegetables, fruit and fruit juices. METHODS: The Malmö Diet and Cancer Study was a prospective cohort study. The present cross-sectional study examined data from a subpopulation of 11,837 individuals that completed baseline examinations in 1992-1994. Dietary habits were assessed using a modified diet history method, and socioeconomic and social network factors were measured with a structured questionnaire. Low consumption was defined as the lowest consumption quartile for vegetables and fruit, while fruit juice consumption was dichotomized to separate users from non-users. RESULTS: Socioeconomic differences were most pronounced regarding the consumption of vegetables and fruit juices. For both sexes, unskilled manual workers had a twice as high risk of low vegetable and fruit juice consumption as higher non-manual employees. No socioeconomic differences in fruit consumption were observed for men, and only moderate differences for women with a higher consumption in higher socioeconomic groups. When the psychosocial variables were introduced in the multivariate model, social participation moderately reduced the socioeconomic differences in vegetable consumption, and the female socioeconomic differences in fruit consumption, but had no effect on the socioeconomic differences in fruit juice consumption. The other psychosocial variables had no effect on the socioeconomic differences. CONCLUSION: Considerable socioeconomic differences in vegetable, fruit and fruit juice consumption were observed. Social participation seemed to be a strong determinant for these food choices. However, this effect was largely independent of the socioeconomic differences. The aim of this study was to analyse the impact of neighbourhood on individual social capital (measured as social participation). The study population consisted of 14,390 individuals aged 45-73 that participated in the Malmö diet and cancer study in 1992-1994, residing in 90 neighbourhoods of Malmö, Sweden (population 250,000). A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second level, was performed. The study analysed the effect (intra-area correlation and cross-level modification) of the neighbourhood on individual social capital after adjustment for compositional factors (e.g. age, sex, educational level, occupational status, disability pension, living alone, sick leave, unemployment) and, finally, one contextual migration factor. The prevalence of low social participation varied from 23.0% to 39.7% in the first and third neighbourhood quartiles, respectively. Neighbourhood factors accounted for 6.3% of the total variance in social participation, and this effect was reduced but not eliminated when adjusting for all studied variables (-73%), especially the occupational composition of the neighbourhoods (-58%). The contextual migration variable further reduced the variance in social participation at the neighbourhood level to some extent. Our study supports Putnam's notion that social capital, which is suggested to be an important factor for population health and possibly for health equity, is an aspect that is partly contextual in its nature. OBJECTIVE: To investigate socioeconomic differences in intermittent and daily smoking, and to assess the association between social participation and these two smoking behaviours. DESIGN/SETTING/PARTICIPANTS/MEASUREMENTS: A population of 11 837 individuals interviewed in 1992-94, aged 45-64 years, was investigated in this cross sectional study. A multivariate logistic regression model was used to assess socioeconomic differences in daily and intermittent smoking, adjusting for age, country of origin, previous/current diseases, and marital status. Finally, social participation as a measure of social capital was introduced in the multivariate model. RESULTS: When unskilled manual workers were compared to high level non-manual employees, odds ratios of 2.3 (95% confidence interval (CI) 1.7 to 3.0) for men and 1.9 (95% CI 1.4 to 2.5) for women were found in regard to daily smoking, but odd ratios of only 0.7 (95% CI 0.4 to 1.2) for men and 1.3 (95% CI 0.7 to 2.4) for women were found in regard to intermittent smoking. A decrease in the daily smoking odds ratios was found when social participation was introduced in the model, while the odds ratios regarding intermittent smoking were unaffected. CONCLUSIONS: There were no socioeconomic differences in intermittent smoking and no association with social participation, a result that contrasts sharply with the patterns of daily smoking. These findings have important implications for the discussion concerning social capital and preventive measures. BACKGROUND: The objective was to investigate whether socioeconomic differences in fat intake may explain socioeconomic differences in cardiovascular diseases. METHODS: The Malmö Diet and Cancer Study is a prospective cohort study. The baseline examinations used in the present cross-sectional study were undertaken in 1992-1994. Dietary habits were assessed using a modified diet history method consisting of a 7-day menu book and a 168-item questionnaire. A subpopulation of 11 837 individuals born 1926-1945 was investigated. This study examined high fat intake, defined as >35.9% among men and >34.8% among women (25% quartile limit) of the proportion of the non-alcohol energy intake contributed by fat. The subfractions saturated, mono-unsaturated and poly-unsaturated fatty acids and the P:S ratio (polyunsaturated/saturated fatty acids) were analysed in the same way. The uppermost quartile (75%) of total and subgroup fat intake was also studied. Socioeconomic differences before and after adjustment for low energy reporting (LER), defined as energy intake below 1.2 x Basal Metabolic Rate, were examined. RESULTS: No socioeconomic differences in fat intake were seen between the SES groups, except for self-employed men, and male and female pensioners. Approximately 20% in most SES groups were LER. The LER and body mass index were strongly related. The SES pattern of fat intake remained unchanged after adjustment for age, country of origin and LER in a logistic regression model. The results for the subfractions of fat and the P:S ratio did not principally differ from the total fat results. CONCLUSIONS: This study provides no evidence that fat intake contributes to the inverse socioeconomic differences in cardiovascular diseases.