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PubMed1991

Determinants of late stage diagnosis of breast and cervical cancer: the impact of age, race, social class, and hospital type.

Previous studies of the relationship between cancer stage, age, and race have not controlled for social class and health care setting. Logistic regression analyses, using information from the New York State Tumor Registry and area-level social class indicators, demonstrated that, in New York City, older Black, lower class women in public hospitals were 3.75 and 2.54 times more likely to have late stage breast or cervical cancer, respectively, than were younger White, high social class women in non-public hospitals.

Adult↗
PubMed2003

Continuing inequality: gender and social class influences on self perceived health after a heart attack.

STUDY OBJECTIVE: To investigate the effect of social class and gender on self perceived health status for those recovering from an acute myocardial infarction. DESIGN: A longitudinal survey design was used, collecting both qualitative and quantitative data. Quantitative data are reported in this article, obtained by questionnaire over the first year after the event. SF-36 and EQ-5D (EuroQol) were used to measure self perceived health status. SETTING: Community based study in a city in the north of England. PARTICIPANTS: A consecutive sample of 229 people discharged from hospital after acute myocardial infarction. MAIN RESULTS: Overall gain in health status was found to be statistically significant over the year. Improvements were greatest in domains relating to role fulfillment and pursuit of normal and social activities. When analysed by gender, women showed poorer improvement than men, particularly in the domains relating to physical and social functioning. Analysed by social class, those without educational qualifications showed poorer improvement in pain experience and vitality. Access to a car was significant in avoiding physical limitations and promoting general health. CONCLUSIONS: Existing gradients between the health of women and men, and between the social classes, are maintained and probably exacerbated by the experience of acute illness, and health professionals need to be made aware of social groups who are at risk of poor rehabilitation.

Adult↗
PubMed1980

Social class and suitability for psychodynamic psychotherapy A causal Model.

A causal model is postulated to mediate the connection between patients' social class and therapists' evaluations of patients' suitability for psychodynamic psychotherapy. The model postulates that patients' social class gives rise to the learning of intellectual skills cognitive styles, which lead to ways of interacting verbally with others, which in turn result in therapists' evaluations of patients suitability. Thirty psychiatric outpatients were assessed therapists during the first therapy session. One mediational pathway was discovered as postulated by the model. This pathway was found to mediate the connection between patients' social class and their subsequent attendance in psychotherapy as well. Two unexpected pathways were found to mediate therapists' judgments of suitability, one of which also mediated patients' attendance in psychotherapy. These unexpected pathways are of particular interest for the clues they offer to the ways in which psychodynamic psychotherapy may be possible and rewarding with lower-class patients.

Adult↗
PubMed1975

The effect of social class on psychiatric psychological evaluations in patients with pulmonary tuberculosis.

The present study is a methodological examination in which the social and psychic background factors of 100 tuberculous patients, aged 20 to 45 years, were explored using psychiatric interview and psychological tests (MMPI, Rorschach, and Wartegg). The purpose of the study was to analyse the effect of social background factors on the psychiatric and psychological examination. With the help of correlation coefficients and three-factor factor analysis, the variable indicating the social class of the subject could be proved to correlate significantly to the projective test variables (Rorschach, Wartegg). No such correlation between the social group variable and those obtained in the psychiatric interview or the MMPI test could be demonstrated. On the basis of the projective tests, subjects in the lower social classes were considered more disturbed. It can be supposed that the background factors characteristic of lower social classes would contribute to the unfamiliar test situation, causing reactions disturbing the test performance. This suggests that the mentioned tests should be used with caution in the evaluation of personality disturbances.

Adult↗
PubMed1980

Childhood autism and social class: a question of selection?

Children with typical autism, other early childhood psychoses and severe mental retardation without autistic behaviour were identified in an epidemiological study in an area of South East London. The social class distribution of their fathers was examined and no significant differences were found between the groups, nor in a comparison with the general population of the area. Fathers of children with autism and related conditions referred to an out-patient clinic with a special interest in autism, mostly at their own request, and fathers joining the National Society for Autistic Children, were of higher social class than both the average for England and Wales and the fathers of the study children. Joining the NSAC during its early years, and keeping up membership were also linked with higher social class. The findings supported the view that reports of a social class bias in autism may be explained by factors affecting referral and diagnosis.

Adolescent↗
PubMed1990

Effect of social class of subjects on normative responses to TAT cards.

The present study investigated whether there are significant differences in the responses of individuals of varied social class background to selected TAT cards. White, female college students (N = 70) were classified as "working class" or "middle class" according to the characteristics of their families of origin and were asked to write stories in response to five TAT cards. Significant differences between the TAT stories written by the two social class groups were found for pattern of dependency and locus of control. No significant differences were found in number of drive expressions, intensity of drive expressions, or level of defenses used. Implications of these results for testing, as well as the difficulties in studying psychological phenomena across social class, are discussed.

Achievement↗
PubMed1990

ABO blood group and social class: a prospective study in a regional blood bank.

STUDY OBJECTIVE: The aim of the study was to investigate an association previously reported in a retrospective study between the A phenotype and social classes I and II. DESIGN: The study was a prospective survey using a cohort of blood donors. SETTING: Participants were donors at a regional blood bank in southern Ireland servicing a population of approximately 380,000. PARTICIPANTS: Of 2442 donors considered for inclusion in the study, 21 refused to participate, 33 provided insufficient information, and 184 were excluded because they were not wholly of Irish extraction, leaving a total of 2204 subjects, 64% of whom were male. MEASUREMENT AND RESULTS: Occupation, age and birth place were obtained from a short questionnaire given to all potential donors during the study period. Social class was defined according to the United Kingdom Registrar General's criteria. No association between the ABO phenotype and social class could be found, either on the whole sample, or on currently employed persons, or on separate analysis of the sexes. CONCLUSIONS: The balance of current evidence is against a variation in ABO distribution by social class designation.

ABO Blood-Group System↗
PubMed2002

The influence of ethnicity, social class, and context on judgments about U.S. women.

In 2 studies, the authors investigated impression formation as influenced by category-based stereotypes associated with ethnicity and social class. The participants in Study I made judgments about 1 target woman, described as interested in running for office in the Parent Teacher Organization (PTO) of her children's school. The hypothetical woman was presented to the respondents along with her photograph and information about her ethnic background (Anglo-Saxon, Latina, or Jewish) and occupation (middle class or working class). In Study 2, the authors changed the context and presented a younger target woman (also varied by ethnicity and social class) to the respondents as the new girlfriend of their older brother or cousin. In both studies, judgments were assessed by the participants' responses to 45 bipolar adjectives that, in each case, yielded 8 component factors. In both hypothetical contexts, social class was a powerful trigger for a variety of negative expectations: With respect to ethnicity, the Latina women were judged to be more unsuitable for the job of PTO vice president than were the Anglo-Saxon or Jewish women. The authors discussed potential psychological and social consequences of such category-based judgments.

Adult↗
PubMed1988

A possible artefactual component in specific cause mortality gradients. Social class variations in the clinical accuracy of death certificates.

This paper investigates one possible avenue of artefactual influence on the production and/or concealment of social class gradients in specific cause mortality rates, namely, the possibility of social class biases in the accuracy of diagnosis of cause of death and the systematic misallocation of certain social groups to particular diagnoses. Information on this topic was obtained by matching occupational data gathered at death registration with data on the accuracy of diagnosis of cause of death (measured by diagnostic agreement between clinician and pathologist) collected in a prospective study of 1152 hospital necropsies. Extrapolation from these data to national mortality rates should be cautious, but it appears that in the majority of the most common causes of death grouped by ICD chapter (neoplasms, cerebrovascular and digestive) social class gradients would be steeper if mortality data were based on pathologists' rather than clinicians' diagnoses. Only in the respiratory chapter would the gradient be reduced, with the gradient in cardiovascular deaths unaffected.

Age Factors↗
PubMed1997

Social class background, sexual attitudes, and sexual behavior in a heterosexual undergraduate sample.

To further the understanding of the relationship between social class and sexual attitudes and behavior, we present data from a study of undergraduate students. We look at the education of students' fathers and how it relates to students' sexual profiles. Among the men, some traditional social class differences are found, indicating that class differences persist among some upwardly mobile men. For the women, fewer social class differences appear. Further, we compare our 1992 sample of 554 college students, 19-22 years old, with a university sample of 904 similar age students from 1967, and find our sample more coitally experienced. College students today are following norms that in the past were associated with a lower educational level. Implications of our findings for class convergence theory are addressed. Reliable birth control, gains in equality by women, and the sexual images of television and other media are discussed as major factors contributing to the increased sexual permissiveness among university students of the 1990s.

Adult↗
PubMed1978

Are there social class differences in patients' treatment conceptions?

Traditionally, lower-class individuals who have sought psychiatric help have been hampered in their efforts by classrelated inequities in the delivery of psychiatric services. A common explanation for this phenomenon has been that the treatment conceptions of lower-class individuals are "inappropriate." This report presents theoretical and research evidence challenging this notion. A review of the literature from 1954 through 1974 yielded no good evidence that lower-class patients need, expect, or want treatments incongruent with those of upper-middle-class therapists. An experimental study of the requests for help made by 278 walk-in clinic patients confirmed this observation. Patient requests, as measured by an 84-item, self-rated questionnaire, were largely independent of social class. It was concluded that social class differences in treatment disposition and outcome cannot be attributed to social class differences in patients' treatment conceptions. The possibility that methodological and sociological factors can account for the discrepancies between the findings of this study and past studies is discussed. Strategies for minimizing treatment biases against lower-class patients and for maximizing treatment effectiveness with higher-class patients are also suggested.

Adolescent↗
PubMed1996

Total and occupationally active life expectancies in relation to social class and marital status in men classified as healthy at 20 in Finland.

STUDY OBJECTIVE: To study differences in total life expectancy and in occupationally active life expectancy in relation to social class and marital status in men classified as healthy as young adults. DESIGN: Historical cohort study. SETTING: Finland. PARTICIPANTS: Altogether 1662 men classified as completely healthy at the time of induction to military service (mean birth year 1923), who had been selected as referents for a study of former athletes. Mean follow up time was 46 years. MEASUREMENTS: Vital status was determined by follow up through local parish data up to 1990. Mortality data were obtained from the Cause of Death bureau of the Central Statistical Office of Finland. Occurrence of work disability was assessed from nationwide disability pension register data. Mean total life expectancy and mean occupationally active life expectancy (end points disability pension or death before age 65 years) were estimated. Social class was based on the major lifetime occupation, while marital status was classified as "never married" or "ever married" at the end of follow up. MAIN RESULTS: Mean total life expectancy was highest among executives and managers (73.2 (95% confidence interval (CI): 70.3, 76.1) years), next highest in clerical (white collar) workers (72.0 (70.0, 74.1) years), and lowest in unskilled blue collar workers (63.65 (61.1, 66.2) years). Skilled workers and farmers were intermediate. For the occupationally active life expectancy estimates, a similar gradient was observed: highest for executives (61.9 (60.7, 63.1) years) and lowest for the unskilled (52.2 (50.2, 54.2) years). The ratio of occupationally active life expectancy to total life expectancy was highest for executives (85%) and lowest for farmers (81%) and unskilled workers (82%). CONCLUSIONS: The social class gradient known to exist for mortality is also present for occupational disability. Social class and marital status differences in mortality are already evident in early adulthood and continue into old age. Those with the highest life expectancy also have the largest proportion of their life span free of occupationally incapacitating disability.

Adult↗
PubMed1978

Changing social-class distribution of heart disease.

Analysis of mortality trends over 40 years in England and Wales showed that mortality from coronary heart disease had become progressively more common in working-class men and women than in those from the middle and upper classes. The change was most noticeable for men. Whereas in 1931 and 1951 heart disease was more common in men of social classes I and II, by 1961 it was more common in men of classes IV and V. This change in social-class distribution can only partly be explained by changes in diagnostic methods. The worsening mortality of classes IV and V correlated with relatively more smoking, a higher consumption of sugar, and a lower consumption of wholemeal bread in these classes. There was no correlation between change in heart disease and change in the social-class pattern of fat consumption.

Adult↗
PubMed1985

Social class, ethnic group, and male mortality in New Zealand, 1974-8.

Social class mortality differences in New Zealand males aged 15 to 64 were investigated for the period 1974-8 using the Registrar-General's classification. The mortality gradient was similar to that previously found in England and Wales, but the New Zealand pattern was non-linear with particularly high mortality in class V. Smoking patterns accounted for much of the increased risk for classes III and IV but did not appear to explain the high mortality in class V. The patterns for the major disease groupings also paralleled those previously found in England and Wales, coronary heart disease and neoplasms displaying weaker gradients than accidents, respiratory diseases, digestive diseases, and infectious diseases. Maori and non-Maori males had comparable social class mortality gradients, but the Maori mortality rates were approximately 50% higher than the non-Maori rates in each class.

Adolescent↗
PubMed1998

Social class, assets, organizational control and the prevalence of common groups of psychiatric disorders.

This study provides an update on the association between social class and common types of psychiatric disorder in the US. In addition to usual measures of social class, we provide hypotheses for the expectation that assets and organizational control are associated with specific varieties of psychiatric disorders (mood, anxiety, alcohol and drug use disorders). We analyzed two surveys. The National Comorbidity Survey conducted in 1990-1992 yielded 12-month prevalence rates in a probability sample of 8098 respondents in the 48 contiguous states. The Epidemiologic Catchment Area Follow-up conducted in 1993-1996 provided similar rates among 1920 East Baltimore residents. Analyses of the National Comorbidity Survey showed an inverse association between financial and physical assets and mood, anxiety, alcohol, and drug disorders. The Epidemiologic Catchment Area Followup provided additional evidence for the inverse association between financial and physical assets and anxiety, alcohol and drug disorders. Also in the Epidemiologic Catchment Area, lower level supervisors presented higher rates of depression and anxiety disorders than higher level managers. Inequalities in assets and organizational control, as well as typical measures of social class, are associated with specific psychiatric disorders. These constructs can provide additional explanations for why social inequalities in psychiatric disorders occur.

Adolescent↗
PubMedDate not supplied

Social class and political involvement in age graded and non-age graded associations.

This paper examines the relationship between social class and political involvement after retirement and seeks to determine whether this relationship is differentially mediated by participation in non-age graded and age graded associational contexts. Controlling for the age structure of association memberships, the relationships between social class and political activity and several measures of political interest are examined for 304 retired people. Strong and moderate relationships were found for individuals without memberships and those with non-age graded memberships exclusively. No relationships were found for members of age graded associations only. The absence of a relationship between social class and political involvement for those individuals who confine their formal associational activity to age peers is explained by positing the existence of a generational community which insulates lower class older people from class related cross-pressures and invidious distinctions which depress political involvement in other contexts.

Age Factors↗
PubMed1984

Social class and ischaemic heart disease: use of the male:female ratio to identify possible occupational hazards.

In England and Wales there has been an increasing excess of ischaemic heart disease death rates among men and women of social classes IV and V compared with those in classes I and II and this excess is greater in young than in old adults. The male excess over women in IHD death rates is much greater in social classes I and II than in classes IV and V. Although men in professional occupations are at low risk for IHD compared with men in other occupations, women married to professional men are at an even lower risk compared with other women. Also, women married to men in unskilled occupations have relatively higher IHD rates than their husbands. These patterns are not seen for "all causes," cerebrovascular disease, chronic bronchitis, or stomach cancer, where the social class mortality gradients are similar in men and women. There may thus be factors associated with professional occupations that increase the risk of IHD despite the relatively low death rates of men engaged in them. In addition there may be factors operating in women in social classes IV and V that put them at a particularly high risk for the development of IHD.

Adult↗
PubMed1976

The interaction of social class and other factors in the etiology of schizophrenia.

Epidemiological evidence clearly indicates an especially high rate of schizophrenia at the lowest social class levels of urban populations. The author suggests that this relationship between class and schizophrenia exists because the conditions of life experienced by people of lower social class position foster conceptions of social reality that are so limited and rigid as to impair their ability to deal resourcefully with the problematic and the stressful. Such impairment does not in itself result in schizophrenia; however, in conjunction with genetic vulnerability and great stress, it could be disabling.

Humans↗