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PubMed2005

Social class, gender and psychosocial predictors for early sexual debut among 16 year olds in Oslo.

BACKGROUND: Variations in early sexual debut among 16 year olds were investigated by social level variables, parental occupation, gender, ethnicity, family structure, family functioning, and individual level variables, future aspirations, academic and social self-perception, and depressed moods. METHODS: The variations in sexual debut were investigated by examining proportions of 16 year olds reporting their first intercourse before age 16. The data were collected by self-reporting questionnaires administered to in-school-youth, in Oslo. Multivariate logistic regression analyses were used to test for associations. Gender interactions with all variables were tested. RESULTS: Overall, 25% reported early debut. Independent effect of social class on differences in proportions in early sexual debut were found. Gender interaction with social class, ethnicity and academic self-perception as they associate to proportions having had early sexual debut, were found. For girls the pattern of social class differences was linear and the highest proportions were found among working classes. For boys the pattern was U-shaped and upper managerial and manual working class youth had similar, higher proportions of early debutants. High scores of parental monitoring, future aspirations and academic self-concept and low scores of depressed moods, are protective factors. While high social self-perception is positively associated with early debut for both genders. CONCLUSION: Early sexual debut varies according to social class, following gender-specific patterns, among 16 year olds in Oslo. The negative association between early debut and academic self-perception are for boys less influenced by other social and individual level factors, than for girls.

Adolescent↗
PubMed2001

Vision-related quality of life impairment in an elderly UK population: associations with age, sex, social class and material deprivation.

PURPOSE: To describe the prevalence of vision-related quality of life (VR-QOL) impairment in an elderly UK population sample. METHOD: The survey, using the VCM1 questionnaire, was based on an age- and sex-stratified random population sample of 2783 individuals aged 55 years or over. RESULTS: One thousand eight hundred and forty-six (69.7%) of 2647 eligible subjects responded. One thousand six hundred and eighty-three individuals completed all 10 VCM1 items. Overall the prevalence of a VCM1 score >2.0 ('more than a little' concern about vision) was 4.6% (95% CI = 3.7% to 5.7%), leading to an estimate of more than 550,000 individuals in England with substantial VR-QOL impairment. The prevalence increased with age from 2.1% in the 55-64 year age group to 17.9% in the group aged 85 years and older. The prevalence also increased as social class became lower, from 0 in social class I to 10.2% in social class V, and increased with increasing material deprivation, from 1.2% in the most affluent quintile to 6.8% in the most deprived quintile. Multivariable logistic regression analysis showed that age (p = 0.0001), decreasing social class (p = 0.03) and increasing material deprivation (p = 0.008) were independently associated with VR-QOL impairment (VCM1 score >2.0), whilst gender and means of questionnaire administration were not associated with VR-QOL impairment at the 5% level. CONCLUSIONS: The findings suggest a substantial national prevalence of VR-QOL impairment, and are consistent with earlier studies linking ocular disease with social deprivation. Consideration should be given to directing resources more carefully towards groups at higher risk of VR-QOL impairment, in particular the very elderly and socially deprived.

Age Factors↗
PubMed1981

Social class and perceived improvement in therapy: the effects of therapist discipline and therapy type.

The present study approached the question of differential perception of improvement across social classes by various disciplines and therapeutic orientations. Records of 4,257 psychiatric patients were examined for type of therapy, discipline of therapist, rated improvement, and social class. For variables "type of therapy" and "discipline of therapist," the interaction term of analysis of variance was significant, indicating that some therapists (i.e., with a given therapeutic orientation) show greater differential among the social classes with regard to perceived improvement than others. Psychiatrists were found more reluctant to rate patients as improved, and responded less differentially among the classes than social workers and psychologists. With regard to therapeutic orientation used, therapists using family therapy or medication rated a higher percentage of patients improved in Class IV than in Class III. The results suggest that therapists with differential training backgrounds (either discipline or therapeutic orientation) have different perceptions of change in psychiatric patients, which may be due to their differential training.

Humans↗
PubMed1978

Population structure in the Western Pyrenees: social class, migration and the frequency of consanguineous marriage, 1850 to 1910.

The effects of social class on migration distances and on the frequency of consanguineous marriages in Errazu, a Pyrenean village in Navarre, Spain, have been studied using data from parish records of baptisms and marriages, 1850-1910, and the census data for the year 1897. Migration distances are greater for tenants than for land-owners. Mean marital distances are not significantly different for the two social classes, but the movement of tenant families during married life results in significantly different parent-offspring distances for the two classes, at the 0.001 level for fathers and at the 0.002 level for mothers, by a t-test. Consanguineous marriages, up to and including third cousin marriages, are more frequent among land-owners (16.3 per cent) than among tenants (3.7 per cent). These frequencies are consistent with estimates based on the demographic characteristics of the population. Some implications of these results are discussed with reference to the findings of communities elsewhere in Europe and studies of communities in Japan. The implications of variation in the social class composition of populations with population density, for pedigree inbreeding values, are also considered.

Consanguinity↗
PubMed1992

Lung cancer risk and social class. The Copenhagen Male Study--17-year follow up.

The Copenhagen Male Study is a prospective cohort study initiated in 1970/71 comprising 5249 employed men between the ages of 40 and 59 years. Included in a registry follow up of lung cancer were 4931 men who responded sufficiently to a number of questions on tobacco habits and who could be classified into social classes. During the 17 years of follow up, lung cancer was diagnosed in 144 men. By the end of the follow up period, 135 had died. Substantial social inequalities in the risk of lung cancer were found with a gradually increased risk with low social class, Kendall's tau B = 0.07, p less than 0.001. In multivariate analysis, compared with the highest social class (highly educated, administrators), the lowest social class (unskilled workers), had a highly increased risk, relative risk (with 95% confidence limits), RR = 3.7 (1.9-7.3). If in the analysis, adjustments were made for form of smoking, amount smoked, whether inhalation took place, number of pack-years and age, the increased risk dropped to RR = 2.9 (1.5-5.9). We conclude that the substantial social inequalities in lung cancer risk are only to a minor degree explained by social class differences in tobacco smoking habits.

Adult↗
PubMed1998

Body mass and social class: a comparison of Finland and Sweden in the 1990s.

High physical weight affects public health as well as people's social relations. This study seeks to examine the distribution of physical weight across the social structure in Finland and Sweden in the early 1990s. We compare physical weight, classified by overweight and obesity, 1) between men and women, 2) between different age groups, and 3) between social classes in these two countries. Comparable interview surveys were conducted in Finland 1994 (N = 8,650, response rate 73%) and in Sweden 1991 (N = 5,306, response rate 79%). Physical weight, overweight and obesity of populations are described in terms of body mass index (BMI = weight (kg)/height (m2)). The average BMI is higher in Finnish men (25.6) and women (24.6) than in their Swedish counterparts (24.6 and 23.2, respectively). In both countries, the average BMI is higher in men than in women below the age of about 55-64 years. In both countries and in both genders the average BMI is higher, the higher the age. The level of overweight as well as obesity is lower in Sweden than in Finland. Social class differences can be found in both countries. The odds ratio for overweight is higher in Finnish male and female farmers (OR = 1.57 and 1.94, respectively) as compared to upper white collars (OR = 1.0). In Sweden, high odds ratio for overweight can be found among male entrepreneurs (OR = 1.80) and female unskilled manuals (OR = 2.65). Obesity varies by social class in Swedish men and women as well as in Finnish women, but not in Finnish men. The results show that Finnish men and women are more often overweight and obese than their Swedish counterparts, but social class differences in overweight and obesity are larger in Sweden than in Finland.

Adult↗
PubMed1991

Social class, skin color, and arterial blood pressure in two societies.

Black people have higher blood pressure relative to whites; darker-skinned black people have higher blood pressure relative to lighter-skinned black people in some studies. These findings have been attributed either to racial-genetic factors or to sociocultural factors associated with social class. It is argued here that conventional social class theory is inadequate for the development of testable research hypotheses regarding skin color and blood pressure. New developments in social class theory are used to generate an alternate hypothesis. It is suggested that darker skin color is related to higher blood pressure in combination with the struggle to establish and maintain a middle-class life-style. Darker-skinned persons' claims to this social status are rejected in social interaction because of the use of skin color as a criterion of low social class in color-conscious societies. This hypothesis accounts for black-white differences in blood pressure in Brazil and for the association of darker skin color and blood pressure in a black American community in the United States. These results are consistent with a model in which skin color and blood pressure are associated solely through sociocultural processes.

Adult↗
PubMed1987

Loss of parent in childhood and adult psychiatric disorder: the role of social class position and premarital pregnancy.

This paper addresses the critique which maintains that loss of parent in a sample of female adults plays no role in determining current depression over and above that of low social class position with which such loss is associated. It examines a series of variables which combine to determine current social class position and which seem to stem from lack of adequate replacement care following loss of mother. The experience of a premarital pregnancy and the way in which women cope with it emerge as critical in this process. The relationship of low social class to the onset of depression is discussed in the light of better-known vulnerability factors such as low confiding in, and undependability of, marital partner, employment outside the home and number of children. It is concluded that a current low social class position, far from explaining away the association between loss of mother and current depression, may itself be brought about by a chain of circumstances stemming from the loss. Once again, the quality of replacement care is shown to play a critical role.

Adaptation, Psychological↗
PubMed1998

Social class differences in health and functional disability among older men and women.

The aims of the study were to describe the health of older men and women and to investigate the social patterning of health and functional disability among older men and women, with special reference to social class differences. The data were derived from the 1994 nationwide Finnish Survey on Living Conditions (N = 1,448). Functional disability, limiting long-standing illness, and self-assessed health were used as health measures. Sociodemographic measures were social class, marital status, and urbanization. The age-adjusted social class differences were clear. Farmers and workers reported more functional disability and poorer health than did the white-collar class. Differences were somewhat smaller among women than among men. Social class was a stronger determinant than urbanization and marital status of functional disability and health.

Aged↗
PubMed1999

Implications of social class and race for urban public health policy making: a case study of HIV/AIDS and TB policy in Washington, DC.

This paper explores how social class and race affect the public health policy-making process in an urban area. Ethnographic methods were used to collect and analyze information about HIV/AIDS and tuberculosis policy-making by the Washington, DC Commission of Public Health, Kingdon's conceptual model of policy making was used to analyze and understand the process. The problems of HIV/AIDS and tuberculosis in the district have important social class dimensions that were not always made explicit, but were instead defined in terms of 'race' and 'place'. Social class considerations and racial politics shaped what policies were developed or not developed and implemented successfully or failed. This study, which has national and international implications, concludes that there is a need to improve our understanding of the complex social dimensions of public health problems; there needs to be more consideration of the politics of strategy formulation and how issues of social class and race affect this process; and public health needs to strengthen its constituency in order to build support for the successful development and implementation of policy.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 1988-1994.

BACKGROUND: Physical inactivity is more prevalent among racial and ethnic minorities than among Caucasians. It is not known if differences in participation in leisure time physical activity are due to differences in social class. Thus, this paper provides estimates of the prevalence of physical inactivity during leisure time and its relationship to race/ethnicity and social class. METHODS: This was a national representative cross-sectional survey with an in-person interview and medical examination. Between 1988 and 1994, 18,885 adults aged 20 or older responded to the household adult and family questionnaires as part of the Third National Health and Nutrition Examination Survey . Mexican-Americans and African-Americans were over-sampled to produce reliable estimates for these groups. Multiple assessment of social class included education, family income, occupation, poverty status, employment status, and marital status. RESULTS: The age-adjusted prevalence (per 100) of adults reporting leisure time inactivity is lower among Caucasians (18%) than among African-Americans (35%) and Mexican-Americans (40%). African-American and Mexican-American men and women reported higher prevalence of leisure time inactivity than their Caucasian counterparts across almost every variable, including education, family income, occupation, employment, poverty and marital status. CONCLUSIONS: Current indicators of social class do not seem to explain the higher prevalence of physical inactivity during leisure time among African-American and Mexican-American. More research is needed to examine the effect of other constructs of social class such as acculturation, safety, social support and environmental barriers in promoting successful interventions to increase physical activity in these populations.

Adult↗
PubMed1991

Association of age and social class with suicide among men in Great Britain.

STUDY OBJECTIVE: The aim was to investigate suicide and "undetermined" deaths by age, economic activity status, and social class in Great Britain among males of working age. DESIGN: The study was a cross sectional analysis of Registrar General's data for England and Wales around 1981, repeated for around 1971, and for Scotland around 1971 and 1981. MEASUREMENTS AND MAIN RESULTS: For England and Wales around 1971, suicide and undetermined death rates showed a progressive increase with age and a markedly higher rate in the lower social classes. A significant interaction effect was identified in the central age groups of the lower occupational categories. This interaction was confirmed in the remaining three data sets, notwithstanding some differences in the profile of age specific mortality. Other findings included a higher standardised mortality ratio for the economically inactive, who also showed an earlier peak in age specific mortality, and a relative concentration of undetermined as compared to suicide deaths in the lower social classes, but not all these further results were fully replicated. CONCLUSIONS: There is a concentration of suicide and undetermined deaths in the middle age groups of the lower social classes. Plausible explanations include both the social drift and the social genesis hypotheses, the latter including the effects of long term unemployment.

Adolescent↗
PubMed1998

Family practitioners' remuneration and patterns of care--does social class matter?

The objective of the study is to examine whether medical care patterns and/or outcomes for patients under a prepaid system differ from those under fee-for-service according to social class. An effect of this kind was suggested by the investigators reporting on the RAND Health Insurance Experiment (RAND HIE). We performed a cross-sectional study in family practice in Germany (fee-for-service) and the UK (predominantly capitation i.e. prospective payment). 778 attending patients aged 18 and above were included. Indicators of care, relating mainly to cardiovascular prevention, were collected by patient interview and questionnaire, doctor's questionnaire, analysis of records, and blood pressure (BP) measurement. Multiple linear and logistic regression models with these indicators as dependent variables were calculated to examine possible interactions between social class and system of payment. Social class as a main effect was related to diastolic BP, BP measurement frequency, and the number of non-pharmacological interventions to lower BP. The data on the process and the outcome of primary care from British and German family practice do not show any significant interaction between system of family practitioners' remuneration and patients' social class. We were unable to reproduce the effect postulated by the RAND HIE investigators.

Adolescent↗
PubMed2000

[Social class, life satisfaction and health assessment. Results of a representative study of the German population].

The supposition that a higher risk of morbidity and mortality is connected with the belonging to a particular social class has been confirmed by numerous national and international researches. But still unsolved is the question of how objective social situations do lead to individual processes of disease. In order to solve this question in a representative assessment of the german population, data of 2948 individuals, referring to aspects of life-satisfaction, personality, subjective complaints and attitudes to current state of health, has been ascertained. In nearly all scales of the chosen instruments significant gradients connected to social class have been found. Persons belonging to a lower social class show a minor life satisfaction, significant differences in personality, higher subjective complaints and a poor state of health. This persons also seem to be convinced that they could do less to care for their health. This self-assessment indicates processes, that stand before the state of manifestation of disease. They can be seen as an expression of persons mental reflection of their social situation. Within the context of this analysis of social inequality and disease we argue to include psychological theories and stress theory in sociological theories. They achieve an important contribution to the clarification of the interface between social class, respectively life circumstances, experiences of distress, available resources of coping with the situation and the individual process of development of disease.

Adolescent↗
PubMed2006

The influence of maternal childhood and adulthood social class on the health of the infant.

The aim of this study is to investigate how maternal childhood and adulthood social class contribute to social inequalities in low birth weight, neonatal mortality and postneonatal mortality. In particular I consider the combined influence of childhood and adult class, and compare outcomes with regard to the time distance from birth. Analyses were performed on a large sample of Swedish births from 1973 to 1990, restricted to infants of women with both childhood and adult class, classified as manual or non-manual. Logistic regression is used to compare odds ratios for social classes. The results indicate that manual maternal childhood class is consistently associated with higher risks for low birth weight and neonatal mortality, even when adult class was adjusted for. The influence of adult class was greater than that of childhood class for all health outcomes. Compared to higher/middle non-manual workers, unskilled workers in the service sector and workers in the manufacturing sector displayed the highest odds ratios for all adverse health outcomes. When both childhood and adult class were taken into account, social differences were greater for low birth weight and neonatal mortality than for postneonatal mortality. Maternal childhood class had more influence on low birth weight and neonatal mortality than on postneonatal mortality. I conclude that maternal childhood and adulthood social class are both independently associated with inequalities in health-related birth outcomes, and that social differences are greater for health outcomes closer to birth.

Adult↗
PubMed1984

Diet, smoking, social class, and body mass index in the Caerphilly Heart Disease Study.

Associations between smoking habit, social class, body mass index, and diet were examined in 493 men aged 45 to 59 yr, selected from the general population and who had completed a 7-day weighed dietary record. Smokers were lighter than nonsmokers and had a lower body mass index. There was no difference in energy intake, but in general, smokers had lower intakes of vitamins, minerals, and dietary fiber. Exsmokers had similar intakes to nonsmokers. Manual workers tended to be shorter, had a higher body mass index, higher intakes of energy and carbohydrates, and lower intakes of vitamins and minerals than nonmanual workers. Social class had a greater effect than smoking habit on intakes of energy and carbohydrates, whereas smoking habit had the greater effect on intakes of minerals and vitamins. Body mass index was associated negatively with sucrose intake and positively with protein intake, smoking habit, and social class being less important determinants.

Alcohol Drinking↗
PubMed1988

Inequalities? Social class differentials in health in British youth.

In the British context, there is a widespread assumption that inequalities in health between social classes are a persistent feature of the life-course, an assumption appearing most plausible by reference to the more accessible published statistics on the issue. However, the age-bands typically employed are in fact so broad as to obscure important life-stages altogether. One such stage is youth which on the evidence of the major indicators of mortality, chronic illness and self-rated health is characterised more by the absence than presence of class gradients. That social class differentials re-emerge quite dramatically after this relative equalisation in youth has implications for the broader debate about the explanation of inequalities in health.

Adolescent↗
PubMed1994

The association of maternal social class with maternal diet and the dimensions of babies in a population of London women.

Records of the diets of 513 London mothers towards the end of the first trimester of pregnancy have been reported previously to show the maternal nutritional intakes associated with birthweight in the optimum range, which may be assumed to approximate to basic maternal needs for reproduction. The diets associated with low birthweight and small head size were also recorded and were found to be inferior. The present paper shows social class gradients for baby size and 35 essential dietary components, providing an indication of which basic maternal nutritional needs were not always met. There was no social class gradient for intake of total energy, or the energy carriers carbohydrate and fat. There were, however, statistically highly significant social class gradients for intake of protein, seven minerals and six B-vitamins, all of which were also highly significantly correlated with birthweight. Maternal intake of these 14 components of diet fell progressively as birthweight fell, but only for the mothers of smaller babies below 3270g, the median for the study. Further increase of maternal intakes of any nutrient by mothers whose babies were above median did not apparently further increase birthweight. The social and medical problem presented by maternal nutrition is that of a minority of women who enter pregnancy with qualitatively inadequate nutritional status. This minority is found in all social classes but increases from social class I to V, and further still among single mothers. The women comprising this minority eat foods not meeting basic maternal needs for a range of nutrients characteristic of whole grains, vegetables and fruit and dairy produce, which may partly be explained by their high cost.

Alcohol Drinking↗