Search

Preference weights are widely used to score generic health states into utility indexes for estimation of quality adjusted life years (QALYs) and to aid health care funding decisions. To date, health state utilities are predominantly derived using stated preference methods based on decision utility. This paper tests an alternative and generates preference weights using experienced utility for children based on the Child Health Utility 9D (CHU9D) descriptive system. We estimate the relative values of the CHU9D health states with regard to experienced utility, where experienced utility is approximated by self-reported happiness. A nationally-representative longitudinal survey was used including 6090 Australian children aged 12–17 years surveyed over 2014–2018. The derived weights were then applied to calculate the utility decrements for a few common child health conditions. We found that the estimated utility decrements are largely similar to those estimated using the published CHU9D Australian adolescent weights based on decision utility, except for pain and depression. A smaller utility decrement for pain and a larger utility decrement for depression were indicated by experienced utility. We contribute to the literature by showing that using experienced utility methods to generate preference weights for health states is possible, and we discuss some important methodological challenges for future studies such as the impracticability of anchoring to 'dead' when utilizing experienced utility. • Established methods of valuing health states rely on decision utility. • We use experienced utility to generate preference weights for children. • The estimated decrements for health conditions are similar to published weights. • We see smaller impact for pain, larger for depression compared to published weights. • Feasibility is demonstrated using child experienced utility for preference weights. [ABSTRACT FROM AUTHOR]

Obesity remains a significant public health concern globally with over one billion adults projected to be obese by 2025. To better understand the drivers of obesity and to inform policy, it is important to explore the factors that influence obesity. The objective of this paper to examine if the crime rates in the neighbourhood or local area in which a person lives influences their likelihood of being obese. Thus, we seek to contribute to the literature on the determinants of obesity by asking the question: what is the effect of neighbourhood (i.e., postcode) crime on obesity? We also examine the pathways through which neighbourhood crime influences obesity with a focus on the role of social capital, physical activity and sleep quality. Using 14 waves of longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey merged with official police statistics on crime rates at the postcode level, we apply identification strategies that address endogeneity arising from endogenous sorting and omitted variable bias. We find that an increase in neighbourhood crime rates is associated with an increase in body mass index (BMI) and the likelihood of being obese. Exploring the pathways through which neighbourhood crime influences obesity, we find that social capital and physical activity are important channels, while sleep quality is not. The evidence also suggests that the effects of violent crime are more pronounced compared to property crime. Our findings suggest that targeting crime, and in particular violent crime, which seems to be driving the findings, is a core mechanism for reducing BMI and maintaining healthy body weight. The mediating role of physical activity and social capital also suggest that public policy can specifically target these areas by providing interventions that promote social capital and physical activity even amidst high crime rates. • We examine the impact of neighbourhood crime on obesity. • We use 14 waves of longitudinal data from Australia. • Neighbourhood crime increases obesity. • Social capital and physical activity are important channels. • Effects are stronger for females than males. [ABSTRACT FROM AUTHOR]

Abstract This paper describes who is most likely to experience household employment insecurity and housing affordability stress – double precarity – and estimates the degree to which housing affordability mediates the effect of employment insecurity on mental health. We use a cohort of 24,201 participants in 2016 Household, Income and Labour Dynamics in Australia survey (6.2 repeated measures on average). We estimate the likelihood of onset of household employment insecurity, housing affordability stress and change in housing costs using longitudinal regression analyses for socio-demographic groups. We assess mediation by estimating how much exposure variable coefficients attenuate with inclusion of a mediator in fixed effects regression models. We also apply causal mediation methods to fixed-effects regression models to better account for exposure-mediator interaction and meet strict model assumptions. If people's households become insecurely employed, there are five times greater odds of them also experiencing housing affordability stress (OR 4.99 95%CI 4.21–5.90). Key cohorts within the population are shown to be especially vulnerable to double precarity – notably single parents (OR 2.91, 95%CI 1.94–4.35) and people who live alone (OR 4.42, 95% CI 3.03–6.45) (compared to couples), and people who are recently separated or divorced (OR 2.59, 95%CI 1.81–3.70). Mediation analysis confirms that household employment insecurity has a small, negative effect on mental health (Beta −0.24, 95%CI -0.38-0.11 on a 1 to 100-point scale with 10-point standard deviation). Estimates from casual mediation analyses suggest housing affordability accounts for 20% of the total effect; likely concentrated in the lowest and highest strata of income. Employment and housing insecurity represent a form of double precarity for people in households with a single income. When we consider the impact on mental health, we find evidence of a causal relationship between insecure employment onset and mental health, around one fifth of which is mediated by changing housing cost and onset of affordability stress. Highlights • Insecurely employed households are five times as likely to have unaffordable housing. • Lone person and lone parent households are more susceptible to double precarity. • Housing costs mediate the impact of insecure employment on mental health. [ABSTRACT FROM AUTHOR]

Background People with disabilities have difficulties in obtaining work. However, evidence suggests that those with disabilities derive substantial mental health benefits from employment. This paper assesses how the relationship between work and mental health is influenced by psychosocial job quality for people working with a disability. Methods The study design was a longitudinal cohort with 13 annual waves of data collection, yielding a sample of 122,883 observations from 21,848 people. Fixed-effects within-person regression was used to control for time invariant confounding. The Mental Component Summary (MCS) of the Short Form 36 (SF-36) measure was used as the primary outcome measure. The main exposure was a six-category measure of psychosocial job quality and employment status (including ‘not in the labour force’ [NILF] and unemployment). Disability status (‘no waves of disability reported’ and ‘all contributed waves with reported disability’) was assessed as an effect modifier. We also conducted a secondary analysis on respondents contributing both disability and non-disability waves. Results For those with no disability, the greatest difference in mental health (compared to optimal employment) occurs when people have the poorest quality jobs (−2.12, 95% CI −2.48, −1.75, p < 0.001). The relative difference in mental health was less in relation to NILF and unemployment (−0.39 and −0.66 respectively). For those with consistent disability, the difference in mental health when employed in an optimal job was similar between the poorest quality jobs (−2.25, 95% CI −3.84, −0.65, p = 0.006), NILF (−2.84, 95% CI −4.49, −1.20, p = 0.001) or unemployment (−2.56, 95% CI −4.32, −0.80, p = 0.004). These results were confirmed by the secondary analysis. Conclusions Efforts to improve psychosocial job quality may have significant mental health benefits for people with disabilities. This will contribute to the economic viability of disability employment insurance schemes in Australia and other high-income countries. [ABSTRACT FROM AUTHOR]

There is growing evidence that providing increased voice to vulnerable or disenfranchised populations is important to improving health equity. In this paper we will examine the engagement of Aboriginal community members and community controlled organisations in local governance reforms associated with the Aboriginal Health National Partnership Agreements (AHNPA) in Australia and its impact on the uptake of health assessments. The sample included qualitative and quantitative responses from 188 people involved in regional governance in Aboriginal health. The study included data on the uptake of Aboriginal health assessments from July 2008 to December 2012. The study population was 83190 in 2008/9, 856986 in 2009/10, 88256 in 2010/11 and 90903 in 2011/12. Logistic regression was used to examine the relationships between organisations within forums and the regional uptake of Aboriginal health assessments. The independent variables included before and after the AHNPA, state, remoteness, level of representation from Aboriginal organisations and links between Aboriginal and mainstream organisations. The introduction of the AHNPA was associated with a shift in power from central government to regional forums. This shift has enabled Aboriginal people a much greater voice in governance. The results of the analyses show that improvements in the uptake of health assessments were associated with stronger links between Aboriginal organisations and between mainstream organisations working with Aboriginal organisations. Higher levels of community representation were also associated with improved uptake of health assessments in the AHNPA. The findings suggest that the incorporation of Aboriginal community and community controlled organisations in regional planning plays an important role in improving health equity. This study makes an important contribution to understanding the processes through which the incorporation of disadvantaged groups into governance might contribute to health equity. [ABSTRACT FROM AUTHOR]