Local inequalities in health behaviours: longitudinal findings from the Stockton-on-Tees cohort study

Abstract

This paper provides a longitudinal examination of local inequalities in health behaviours during a period of austerity, exploring the role of ‘place’ in explaining these inequalities. Data from the Stockton-on-Tees prospective cohort study of 836 individuals were analysed and followed over 18-months (37% follow up). Generalised Estimating Equation models estimated the deprivation gap in health behaviours (smoking status, alcohol use, fruit and vegetable consumption and physical activity practices) between the 20% most and least deprived neighborhoods (LSOAs), explored any temporal changes – during austerity, and examined the underpinning role of compositional and contextual determinants. All health behaviours, except for frequent physical activity varied significantly by deprivation (p=<0.001). Smoking was lower in the least deprived areas (OR 0.21, CI 0.14 to 0.30), while alcohol use (OR 2.75, CI 1.98-3.82) and fruit and vegetable consumption (OR 2.55, CI 1.80 to 3.62) were higher in the least deprived areas. The inequalities were relatively stable throughout the study period. Material factors (such as employment, education, housing tenure) were the most - and environmental factors the least - important explanatory factors. This study suggests that material factors are the most important ‘place’ determinants of health behaviours. Health promotion activities should better reflect these drivers.