Assessing the Use of the Family Affluence Scale as Socioeconomic Indicators for Researching Health Inequalities in Taiwan Adolescents

This study examined the reliability and validity of the Family Affluence Scale (FAS) and explored the relationship between FAS and health in a general adolescent population of Taiwan. Our data was obtained from a 2009 school-based survey. In total, 3,368 students (1,741 boys, 1,627 girls) in grades 6–10 in Kinmen County, Taiwan completed a modified WHO Health Behaviour in School-Aged Children (HBSC) questionnaire. Indicators of the family’s social position were their parents’ occupation and education. Indicators of material affluence were number of cars, number of holiday travel, whether the participant had his or her own room and number of computers (FAS items). A higher proportion of the participants completed the four family affluence items than their parents’ occupation and education items (≧98% vs. 90% and 88%; respectively). Analysis of the FAS showed a moderate internal reliability (Cronbach’s alpha = 0.35). The associations between the FAS scores and parental occupation and education were moderate (P < .001). Consistent gradients were found for the association between FAS and positive health and health promoting behaviours. In conclusion, the Taiwan version of the FAS had a high completion rate and moderate internal reliability and external validity. The clear associations between the FAS and health indicators confirm the findings of previous studies and suggest that the FAS can be used as an additional measure of socioeconomic status among Taiwan adolescents.     

Socio-economic Indexes in Surveys for Comparisons between Countries

The study of socio-economic inequalities from across-national perspective has been hampered by the lack of adequate common indices of socio-economic status that can be used in a self-report survey instrument. This paper examines the construction and the properties of global social indexes in general, and of the Family Affluence Scale (henceforth FAS) in particular. The paper proposes a new strategy for making comparisons of the global index with stratified data, building a revised FAS based on Adapted Canonical Variate Analysis (henceforth ACVA). This alternative strategy for constructing a global index is available in standard software, and the new proposal for stratified data only requires a simple program, which is justified, explained and provided in the text. Data come from the 1998 Health Behaviour in School-Aged Children (HBSC), a WHO Cross-National Study using cluster sampling of schoolchildren from five countries: Denmark, Latvia, Portugal, Scotland and the USA. The results reveal that in every country we would have had a completely different evaluation of the three indicators of Family Affluence if we had used either linear or nonlinear approaches to compute the global indexes. Moreover, Family Affluence comparisons among countries shows that the relative contribution of the three indicators to the overall FAS, changes from country to country. We conclude that separate indicators of Family Affluence are not equally relevant in each country and, as a consequence, do not contribute equally to the global index. For cross-cultural studies, the strategy for constructing an index should be country specific. The methodological developments presented in the paper open up opportunities to study socio-economic patterning of health among young people in the developed world, since self completed surveys can now employ a common measure of family material wealth. The findings show that the RFAS (Revised FAS) is a useful index of socio-economic status for use in national and cross-national surveys of adolescent health and health behaviour. The new strategy for weighting observed indicators in the index gives it enhanced power to detect in equalities.     

Differential Item Functioning of a Family Affluence Scale: Validation Study on Data from HBSC 2001/02

Methodology for making cross-national comparisons is an area of increasing interest in social and public health related research. When studying socio-economic differences in health outcomes cross-nationally, there are several methodological issues of concern, especially when data is derived from self-reported questionnaires. Health Behaviour in School-aged Children (Currie et al. 1998) is a WHO cross-national study using school samples. HBSC provides comparable data, and thereby a unique opportunity to study associations between social indicators and health outcomes within an international perspective. In 2001/02 data was collected from a total of 162,323 children in 32 countries (Austria, Belgium, Canada, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Greenland, Hungary, Ireland, Israel, Italy, Latvia, Lithuania, Macedonia, Malta, Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, Ukraine, United Kingdom, USA.). Studies of social inequalities requires that a comparable measure of socio-economic position (SEP) is in use. HBSC has developed a proxy for social position measuring material wealth, the Family Affluence Scale (FAS). This paper studies FAS and whether it is comparable across population subgroups defined by country, age and gender. Initial analysis revealed that an item measuring perceived family wealth was a valid FAS item. Including this item in the FAS score will improve the reliability of FAS. Graphical log-linear Rasch models (GLLRM) showed that FAS contain differential item functioning (DIF) with respect to country, age, and gender as well as local dependency (LD) between items. During the analysis, test equating techniques where used to adjust for the test bias generated by DIF. We recommend that the equated scores are used whenever FAS is included as a variable. This study suggests that HBSC-FAS should contain five items (additional item: perceived family wealth) when analysing data from HBSC 2001/02, and furthermore that each country should adjust for the DIF or make use of the converted FAS scores provided. If using FAS as a proxy for social position at an international level, it is not advised to compare the absolute levels of FAS, but weigh the scale by ridit transformation.

An Agricultural Wealth Index for Multidimensional Wealth Assessments

Social scientists have increasingly used asset‐based wealth scores, like the Demographic and Health Survey (DHS) wealth index, to assess economic disparities. However, current indices primarily capture wealth in globalized market economies, thus ignoring other forms of prosperity, such as success in agricultural activities. Using a simple extension to the standard estimation of the DHS wealth index, we describe procedures for estimating an agricultural wealth index (AWI) that complements market‐based wealth indices by capturing household success in agricultural activities. We apply this procedure to household data from 129 DHS surveys from over 40 countries with sufficient land and livestock data to estimate a reliable and consistent AWI. We assess the construct validity of the AWI using benchmarks of growth in both adults and children. This alternative measure of wealth provides new opportunities for understanding the causes and consequences of wealth inequality, and how success along different dimensions of wealth creates different social opportunities and constraints for health and well‐being.     

A DEA Approach to Measure the Quality-of-Life in the Municipalities of the Canary Islands

The notion of the quality of life has always intrigued economists, sociologists and other researchers in the area of social science. Since the genesis of the definition of Gross Domestic Product (GDP) as a truthful measure of well-being and economic development, other sophisticated methodologies have been proposed in the literature to measure the quality-of-life (QOL) that extend in a multidimensional way this complex concept. Measuring QOL in municipalities consists in finding a set of comparable attributes that can be weighted by some metric in order to construct a synthetic index. Thus, the narrow vision obtained by a single measure as the GDP, in which differences in the QOL cannot be fully analyzed, is overcome. Based upon a refinement of data envelopment analysis (DEA)—the cross-efficiency method, the current paper develops a synthetic QOL index that is based in 19 partial indicators which present the tradeoffs of different dimension for the 87 municipalities of the Canary Islands in Spain. Marginal rates of substitution are calculated to evaluate the tradeoffs on QOL dimensions. A method is also proposed to determine the scores chart of each municipality which can be used as a tool to policy makers in order to establish a program of improving the ranking position of the municipality identifying the critical QOL factors.     

Country-Level Investment in Cultural Opportunity Structures. A Potential Source of Health Differences Between 21 European Countries

Individual’s participation in cultural activities may positively affect health through a pathway mediated by social capital. We examine whether country-level investment in cultural opportunity structures was associated with between-country differences in self-rated health and, if so, whether these associations were mediated by citizens’ confidence in societal institutions, i.e., by institutional trust, regarded as a dimension of social capital. For 24,887 respondents in the European Social Survey, 2006, data on self-rated health, institutional trust (individual-level and country-level), and sociodemographic variables were linked with statistics-based country-level data on 10 indicators of cultural opportunity structures and mediator variables (gross domestic product (GDP), Gini index, and welfare state regime). Over and above the sociodemographics, six cultural indicators contributed to between-country health differences in logistic multilevel regression analysis: the percentage of arts students, the RC index, the percentage of writers and creative artists of total employment, exports of cultural goods, imports of cultural goods, and the number of feature films produced per capita. Controlling, furthermore, for trust, and country-level mediators, only imports of cultural goods contributed to between-country differences in health. No associations with other cultural indicators remained after controlling for GDP or welfare state regime. Institutional trust may partially mediate the significance of cultural investments for self-rated health. However, both cultural investment and trust may be concomitants of general prosperity and welfare policies. Future studies should investigate whether the countries’ welfare policies influence the transformation of cultural investment into institutional trust and which types of indicators best depict associations between investments and health.     

Developing a Measure of Internet Well-Being: Nomological (Predictive) Validation

This paper reports on an effort to develop an Internet well-being measure for possible use by government agencies and industry associations that are directly involved with the promulgation of the Internet. Such measures can help officials gauge the social health of those Internet-related industries and institutional sectors, which in turn can guide the development of policies to enhance the quality-of-life impact of the Internet. The Internet well-being measure is based on the theoretical notion that the perception of the overall impact of the Internet on users of the Internet is determined by their perceptions of the impact of the Internet in their life domains such as consumer life, work life, leisure life, social life, community life, sensual life, among others. In turn, the perception of impact of the Internet in a given life domain (e.g., consumer life, work life) is determined by perceptions of benefits and costs of the Internet within that domain. We conducted a focus group to identify all the perceived benefits and costs within salient life domains of college students. We also conducted a thorough literature search to identify studies that examined the quality-of-life impact of the Internet in a variety of life domains. We then tested the nomological validity of the measure through two surveys at two major universities (one in the USA and the other in Korea). The statistical analysis allowed us to identify those measurement items that are most predictive, and therefore considered as nomologically valid. Policy implications of the study are discussed along with future research avenues.     

A New Measure of Quality of Work Life (QWL) Based on Need Satisfaction and Spillover Theories

A new measure of QWL was developed based on need satisfaction and spillover theories. The measure was designed to capture the extent to which the work environment, job requirements, supervisory behavior, and ancillary programs in an organization are perceived to meet the needs of an employee. We identified seven major needs, each having several dimensions. These are: (a) health and safety needs (protection from ill health and injury at work and outside of work, and enhancement of good health), (b) economic and family needs (pay, job security, and other family needs), (c) social needs (collegiality at work and leisure time off work), (d) esteem needs (recognition and appreciation of work within the organization and outside the organization), (e) actualization needs (realization of one's potential within the organization and as a professional), (f) knowledge needs (learning to enhance job and professional skills), and (g) aesthetic needs (creativity at work as well as personal creativity and general aesthetics). The measure's convergent and discriminant validities were tested and the data provided support to the construct validity of the QWL measure. Furthermore, the measure's nomological (predictive) validity was tested through hypotheses deduced from spillover theory. Three studies were conducted – two studies using university employees and the third using accounting firms. The results from the pooled sample provided support for the hypotheses and thus lent some support to the nomological validity to the new measure.     

Economic inequality and child stunting in Bangladesh and Kenya: an investigation of six hypotheses

Consistent with the increasing focus on issues of equity in developing countries, I extend the literature analyzing the relationship between economic inequality and individual health to the developing world. Using survey data from Bangladesh and Kenya with economic status measured by a wealth index and with three different geographic definitions of community, I analyze six competing hypotheses for how economic inequality may be related to stunting among children younger than 5 years old. I find little support for the predominant hypothesis that economic inequality as measured by a Gini index is an important predictor of individual health. Instead, I find that the difference between a household's wealth and the mean household wealth in the community is the measure of economic inequality that is most closely related to stunting in these countries. In particular, a 1 standard deviation increase in household wealth relative to the community mean is associated with a 30–32 percent decrease in the odds of stunting in Bangladesh and a 16–21 percent decrease in the odds of stunting in Kenya.     

Discomfort With Homosexuality: A New Measure Captures Differences in Attitudes Toward Gay Men and Lesbians

This study describes a creative and psychometrically sound method that allows researchers to measure homonegativity at a lower threshold than existing measures and to differentiate between homonegativity toward gay men and lesbians. Four hundred and thirty-one undergraduate students at a Western comprehensive university were asked to respond to a series of vignettes describing situations in which heterosexuals sometimes experience discomfort in the presence of homosexuals, indicating the degree to which they would feel comfortable or uncomfortable. The 12-item Homonegativity as Discomfort Scale (HADS) has adequate alpha reliability (.92) as well as good criterion and construct validity. Suggestions are made as to how the measure could be employed in research. Testing on this sample shows greater discomfort with gay men than with lesbians and greater discomfort among men than among women.     

A Comparative Analysis of the Validity of US State- and County-Level Social Capital Measures and Their Associations with Population Health

The goals of this study were to validate a number of available collective social capital measures at the US state and county levels, and to examine the relative extent to which these social capital measures are associated with population health outcomes. Measures of social capital at the US state level included aggregate indices based on the Annenberg National Health Communication Survey and the Behavioral Risk Factor Surveillance System (BRFSS), Petris Social Capital Index (PSCI), Putnam’s index, and Kim et al.’s scales. County-level measures consisted of PSCI, Rupasingha et al.’s social capital index, and a BRFSS-derived measure. These measures, except for the PSCI, showed evidence of acceptable validity. Moreover, we observed differences across the social capital measures in their associations with population health outcomes. The implications of the findings for future research in this area were discussed.     

Does National Income Inequality Affect Individuals’ Quality of Life in Europe? Inequality,Happiness, Finances,and Health

This paper analyses the effect of income inequality on Europeans’ quality of life, specifically on their overall well-being (happiness, life satisfaction), on their financial quality of life (satisfaction with standard of living, affordability of goods and services, subjective poverty), and on their health (self-rated health, satisfaction with health). The simple bivariate correlations of inequality with overall well-being, financial quality of life, and health are negative. But this is misleading because of the confounding effect of a key omitted variable, national economic development (GDP per capita): Unequal societies are on average much poorer (r = 0.46) and so disadvantaged because of that. We analyse the multi-level European Quality of Life survey conducted in 2003 including national-level data on inequality (Gini coefficient) and economic development (GDP) and individual-level data on overall well-being, financial quality of life, and health. The individual cases are from representative samples of 28 European countries. Our variance-components multi-level models controlling for known individual-level predictors show that national per capita GDP increases subjective well-being, financial quality of life, and health. Net of that, the national level of inequality, as measured by the Gini coefficient, has no statistically significant effect, suggesting that income inequality does not reduce well-being, financial quality of life, or health in advanced societies. These result all imply that directing policies and resources towards inequality reduction is unlikely to benefit the general public in advanced societies.     

The Relationship between Economic Development and Social Welfare: A New Adjusted GDP Measure of Welfare

Existing literature focuses on the issue ofpreparation of social welfare measurements onthe basis of an unadjusted Gross DomesticProduct (GDP). This paper extends this methodto incorporate cost-benefit analysis ofeconomic growth in a growing economy incalculating the adjusted GDP, termed as thecost-benefit (CB)-adjusted GDP. This approachis empirically applied to Thailand. There arestark differences between GDP per capita and CBadjusted GDP per capita rates for this period.This paper concludes that GDP can be used as anindicator of social welfare if the GDPestimates are undertaken within a cost-benefitanalysis framework.     

An examination of the validity of the Family Affluence Scale II (FAS II) in a general adolescent population of Canada

This study examined the performance of the FAS II in a general population of 17,545 students in grades 7, 9, 10 and 12 in the Atlantic provinces of Canada. The FAS II was assessed against two other measures of socioeconomic status: mother’s highest level of education and family structure. Our study found that the FAS II reduces the likelihood of nonresponse which is a common threat to the validity of items inquiring about parental income, education or occupation. Ordinal regression analysis revealed that mother’s education and family structure were independent risk factors of lesser affluence. Participants whose mother had less than a post secondary degree were 2 to 3 times more likely to report lesser affluence and those who reported living in other than 2 parent families were 1.5 to 3 times more likely to report lesser affluence. The authors conclude that the FAS II is a useful measure of socioeconomic status for this population.     

Dimensions Of Well-Being In Eu Regions: Do GDP And Unemployment Tell us All We Need To Know?

Unemployment and GDP are widely used as proxies for a broader concept of well-being in the European Union, especially at regional level. This paper asks whether such an approach is reasonable. Using data from a range of sources, it examines the association between unemployment, GDP and a number of alternative well-being indicators in five domains – material welfare, education, health, productive activity and social participation. It finds that GDP per capita is not a good proxy for wider regional well-being within a country, but that the regional unemployment rate performs reasonably well. Pooling fifteen member states together, however, regional GDP is a better predictor of a region’s well-being than unemployment. This is because national GDP tells us more about how a country is doing overall than the national unemployment rate. These findings have implications for the European Council’s decision to treat variation in the regional unemployment rates as the sole indicator of regional inequality within Member States, and for the allocation of the Structural Funds.     

Overeducation,Skills and Wage Penalty: Evidence for Spain Using PIAAC Data

Despite well documented high levels of socioeconomic inequalities, health gradients by socioeconomic status (SES) in contemporary China have been reported to be limited. Using data from the 2010–2012 China Family Panel Studies, we reexamine associations between three sets of SES—human capital, material conditions, and political capital—and self-rated health among Chinese adults 18–70 years old, capitalizing on anchoring vignette data to adjust for reporting heterogeneity. We find strong evidence of substantial variations in reporting behaviors by education, cognition, and family wealth but not by family income or political capital. Failing to correct for reporting heterogeneity can bias the estimates of SES gradients in self-rated health as much as nearly 40 %. After vignette adjustment, we find significantly positive associations of education, family income, wealth, and political capital with self-rated health. Individuals’ cognitive capacity, however, does not predict self-rated health.     

Validation of the 12 Item Short form Health Survey in a Sample from Region Central Jutland

In 2010 the Danish regions started a new program of public health surveillance in collaboration with the national and local health authorities using the short form health survey (SF-12) for measuring and reporting on health related quality of life among the Danish adult population. The instrument has not, however, been validated in a Danish setting. The aim of this study was to assess the reliability and validity of the physical component summary (PCS) and the mental component summary (MCS) score of the 12-item short form health survey (SF-12) in a sample from Central Denmark Region. A total of 26,397 persons above the age of 25 were included in the analyses. Reliability was assessed by Cronbach’s α. The validity was assessed using known-groups comparisons and convergent validity. The factor structure was investigated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach’s α showed high reliability with a score of 0.90 and 0.85 for PCS and MCS respectively. The SF-12 discriminated well with respect to gender, age, educational status and long term illness. Individual items correlated higher with own hypothesized scales than with other scales and summary measures corroborating the convergent validity. The EFA gave a two-factor structure. Irrespective of the chosen rotation method (varimax and oblimin) the items related to PCS loaded on one factor and the items related to MCS loaded on another factor. The factor structure was validated with acceptable model-fit values in CFA. The SF-12 instrument is a reliable and valid measure of health related quality of life among the population of Central Denmark Region.     

The validity of an index of leisure-time physical activity

An index of leisure-time physical activity is presented for use in health promotion research. Based on the values of metabolic equivalents (METs), this index is found to have a high degree of concurrent, construct and predictive validity when it is related to a measure of perceived health status. It is useful in investigations of the impact of exercise and other types of leisure-time physical activity on health.     

Development and Validation of a Measure of Living Standards for Older People

Living standards are an effective way to assess socioeconomic status in relation to health but controversy remains about their assessment, particularly for older people. Sen’s capability framework shifts attention from material conditions to opportunities for choice enabled by material resources. To develop this promising approach, this paper reports on the development of a measure of living standards for older people based on Sen’s capability framework. Six living standards domains were established from thematic analysis of 143 interviews with people aged over 65 years in New Zealand. Questionnaire items were developed and tested to assess the extent to which older people had the freedom to pursue these domains. The 73 items were tested for face validity in interviews. Following this, a revised version was posted to 2,000 people aged over 65 years randomly selected from the New Zealand electoral roll and 1,064 completed questionnaires were returned. Item screening for response rates and spread reduced the items to 34. Confirmatory factor analysis of these 34 items suggested that the six theoretical domains were supported. Following model development, 25 items assessing the six domains were selected. Results to date show that this measure of living standards (LS-Cap) is a promising instrument to assess living standards as the freedom to access valued needs.     

A Need-Based Measure of Consumer Well Being (CWB) in Relation to Personal Transportation: Nomological Validation

This paper reports the results of three studies designed to test the nomological validity of a consumer well-being (CWB) measure in relation to personal transportation. The CWB measure was developed guided by the theoretical notion that the CWB in relation to personal transportation vehicles is significantly enhanced when the consumption of the vehicle meets the full spectrum of human developmental needs (i.e., safety, economic, family, social, esteem, actualization, knowledge, and aesthetics needs). The nomological validity of the CWB measure was tested by exploring the various antecedents and consequences of the construct. This was done in three separate studies in which the results of one study prompted further conceptual development and additional testing. The overall findings of the three studies provided support for the nomological validity of the CWB measure.