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Patients referred to the Orthodontic Department of Glasgow Dental Hospital over a 5-year period were divided into social class. The analysis of some dental features revealed that the upper social classes presented with proportionally more minor malocclusions than the lower social classes.
In the study, the first results of which are reported here, salivary nitrate and nitrite levels were examined in populations drawn from regions of the UK which differ in mortality rates for gastric cancer. The aims were to see, firstly, whether there was an equivalent geographic variation for nitrate and nitrite levels and, secondly, whether within each region any socio-economic or dietary characteristics correlated with the salivary levels. The results show that the nitrate and nitrite levels are significantly higher in residents from the Oxford region (low gastric cancer incidence area) than in residents from the north-east of England and north Wales (high-incidence areas). Further, within each area there is a noticeable relationship between nitrate and nitrite levels and age and social class. The social class trend is, as with the geographic trend, the inverse of that for stomach cancer risk. It is felt that the explanation of these results is probably a greater consumption of fresh, nitrate-containing vegetables by people in the Oxford region and by those in higher socio-economic groups. The implications that these results have for the nitrate hypothesis in relation to gastric cancer is discussed.
Socioeconomic status explains many ethnic disparities in health; however, mechanisms are hard to identify. Fatigue-a frequent complaint in patients and normals-is associated with poorer quality of life. We wondered if ethnicity and social class interact to explain fatigue. A total of 40 African Americans (AAs) and 64 Caucasian Americans (CAs) completed short forms of the Profile of Mood States (POMS-SF) and Multidimensional Fatigue Symptom Inventory (MFSI-SF). Participants were divided into high-middle and low social class groups (as per Hollingshead, 1958a). After controlling for gender, body mass index, depressive symptoms, and response bias, ethnicity and social class interacted for POMS-SF fatigue. AAs in the high-middle classes reported more fatigue than AAs in the low classes and CAs in the high-middle classes. Fatigue did not differ by class for CAs nor by ethnicity in the lower classes. Similar findings emerged for MFSI-SF general fatigue. Social class is important for understanding fatigue in AAs but not CAs.
This article addresses methodological problems in conducting cross-cultural comparisons of health findings analysed by social class. It then illustrates these problems by describing the difficulties faced and the methods adopted to conduct a cross-cultural comparison between Australia and Britain for infant mortality data analysed by social class. The specific findings on social class and infant mortality are reported, and the wider implications for cross-cultural research discussed.
The purpose of this paper was to analyse the role of social class concerning changes in alcohol consumption and severe alcohol-related problems from the end of the 1960s to the 1990s in Stockholm County, and in the whole of Sweden for consumption. Survey data showed that the prevalence of moderate and/or high alcohol consumption in adults of both sexes was highest among non-manual employees at medium and high level, in 1967 as well as in 1980 in the whole of Sweden. After 1980, an equalization occurred. A similar change in the social class pattern of alcohol consumption was noted in young people. We analysed all 36,404 male and 10,648 female hospitalizations and all the 3175 male and 713 female deaths with a diagnosis of alcoholism, alcohol psychosis or alcohol intoxication in Stockholm County during 1970-86 (1970-84 for mortality) linked to individual census data. There was a greater increase in rates among women than among men, especially among women outside the labour market. We found pronounced social class differences between manual and non-manual employees, which widened up to 1986 (1984 for mortality)-a period with an initial increase and a subsequent decrease in alcohol consumption. Thus, the changes in consumption and alcohol-related problems developed differently in principal social classes over time, suggesting that an expanded theory on alcohol consumption in the population should take socio-economic factors into account.
STUDY OBJECTIVE: To test the hypothesis that poor material standard of living is independently associated with the prevalence of the common mental disorders after adjusting for occupational social class, and to estimate the population impact of poor material standard of living on the prevalence of these disorders. DESIGN: Cross sectional survey. Prevalence of the common mental disorders was assessed using the General Health Questionnaire, a self administered measure of psychiatric morbidity. PARTICIPANTS: 9064 adults aged 16-75 living in private households in England, Wales, and Scotland. MAIN RESULTS: The common mental disorders were significantly associated with poor material standard of living, including low household income (OR 1.24, 95% CI 1.00, 1.54) and not saving from income (OR 1.29, 95% CI 1.15, 1.45), after adjusting for occupational social class and other potential confounders. An independent association was also found with occupational social class of the head of household among women, but not men, after adjusting for material standard of living. The adjusted population attributable fraction for poor material standard of living (using a five item index) was 24.0%. CONCLUSIONS: Like mortality and physical morbidity, common mental disorders are associated with a poor material standard of living, independent of occupational social class. These findings support the view that recent widening of inequalities in material standards of living in the United Kingdom pose a substantial threat to health.
AIM: To explore whether the association between social class and smoking among teenagers varies according to the definition of smoking adopted. Design, setting and participants. A survey of 2196 15-year-olds in 43 secondary schools in the West of Scotland. MEASURES: Current smoking status and number of cigarettes smoked, and social class based on the occupation of the head of the household. FINDINGS: 'Current smoker' was the only category not significantly differentiated by class; the ratio of smokers from unskilled compared with professional backgrounds rose with increasingly stringent definitions of smoking. CONCLUSION: The extent to which teenage smoking is patterned by social class depends on the definition of smoking adopted.
This research derives and tests hypotheses from two alternative conceptual models: the modified extended family model, and the changing family constraints model, which takes into account recent changes in work and family life. The hypotheses address social class differences in geographic distance and contact frequency between middle-aged children and their parents over time. Simultaneous probit models are used to analyze distance and contact as jointly determined outcomes with data from the USC Longitudinal Study of Generations and Mental Health. Results from these analyses indicate that children's 1971 educational aspirations and social class positions predict 1991 distance and contact between generations. Parents who have lower 1991 incomes, however, live farther from children and talk with them on the telephone less frequently than higher-income parents. Thus, the effects of early social class position support the modified extended family model, whereas the effects of current social class position support the changing family constraints model.
The paper examines class based differences in smoking behaviour in middle and later adolescence. The analyses are based on questionnaire survey data drawn from a longitudinal study of adolescent socialisation, leisure and lifestyles in Scotland. Perhaps surprisingly, the social class of the family is found to have little relationship to smoking in middle and later adolescence. By contrast, marked variations in smoking are evident with respect to the current socio-economic position occupied by young people themselves in middle and later adolescence. The connections between smoking, social class background, and current social class position are examined through a consideration of inter-generational occupational mobility, and once more a clear pattern of differences is found. Thus, we conclude that there is an emergent pattern of class based differences in adolescent smoking behaviour, as young people make the transition towards adulthood. We consider the possible role that factors from the family, the peer group, and the school contexts may play in the production of these differences in smoking behaviour. We also highlight the importance that our findings may have for the health inequalities debate, and particularly for explanations which link the production of class based differences in health to processes of inter-generational mobility.
An examination is made of various hypotheses which have been developed to account for the frequently observed inverse relationship between social class and psychological disturbance. Two of these explanations--the social selection and social causation hypotheses--are tested in a study designed to enable an assessment of their relative power to be made. Quasi-random samples of 200 Indian-born, 200 Pakistani-born and 240 native-born residents of England were interviewed and measures of social class, psychological symptoms and other relevant variables made. The results failed to support either of the two hypotheses as the expected social class gradient in psychological disorder only emerged in the native group. Indian immigrants in fact showed a reversal with higher status individuals, especially women, having higher symptom levels. Overall Indian immigrants had significantly fewer symptoms than either of the other groups. The findings are discussed in terms of differential selection for migration and the varying experiences of immigrants after arrival in Britain.
A total of 334 nonreferred grade-school boys were examined for measures of physical growth, I.Q., and reading proficiency. SES was determined by the Hollingshead-Redlich index. Results of the study indicate: (1) for the total sample all physical measures significantly correlated with at least two of the three psychometric test scores; (2) SES alone accounted for 29 to 38% variance in psychometric scores; (3) mean scores of all psychometric and some physical variables significantly separated social classes: the higher the social class the greater the psychometric test scores (I.Q. and reading), HC, and height of the child; (4) holding constant SES decreased all correlations between intellectual performance and somatic growth; but (5) significant correlations remained between all physical measures and one or more psychometric scores; and (6) within individual social classes HC was the best physical predictor of WISC I.Q. and was significantly correlated with it in Classes I through IV.
We examine the causes and consequences of fatalism in a cross-cultural setting, focusing on the ways in which a fatalistic world view may mediate the effects of social class and Mexican ethnic identity on psychological distress. We find that persons in the lower social classes and Mexicans tend to be more fatalistic than persons in the upper classes and Anglos, and that fatalism, in turn, increases psychological distress. We attempt to integrate research on the social and cultural determinants of cognitive orientations with studies of the effects of social class and Mexican culture on distress.
The joint associations of maternal cigarette smoking and social class on perinatal outcome were studied in the 1970 British birth cohort (British Births). Whereas smoking was much more frequent among women in social classes III, IV, and V, there was little difference in the birthweight decrement associated with smoking across class. Perinatal mortality, however, was increased only among smokers in the manual social classes. Thus whereas the offspring of more privileged smokers were not protected from intrauterine growth retardation, they did not suffer from increased perinatal mortality. Observations of other populations suggest a possible nutritional mediation of this protective effect.
Consumption of tobacco products, both by smoking and by other means, has long been causally connected with cancers of the lung, larynx, mouth and pharynx, oesophagus, bladder, and many other sites. Tobacco is the main specific contributor to total mortality in many developed countries and has become a major contributor in the developing countries as well. In most industrialized countries, prevalence of cigarette smoking is currently higher in low than in high social classes, although in some industrialized countries smoking was more frequent in high social classes during the first half of this century. The latter pattern of tobacco consumption is more likely to apply to developing countries. To formulate and carry out effective tobacco control activities it is essential to assess the relative incidence of tobacco-related cancers in different social strata and the prevalence of tobacco use across strata. Despite many years of data gathering the information base is far from complete, especially in developing countries where tobacco use is increasing rapidly, and where aggressive marketing by the transnational tobacco industry is occurring. A critical question is the extent to which tobacco usage can 'explain' the observed social class differences in cancer risk. Class differences in lung cancer are likely to be mostly related to the unequal distribution of tobacco smoking between social classes, and in some fairly simple situations this has been satisfactorily demonstrated. Nevertheless, there are many unresolved issues, especially with regard to the role of collateral exposures, such as hazardous occupations, poor diet, and limited access to health care. The question of whether tobacco use 'explains' socioeconomic differences in one or more of the cancers that it causes has rarely been directly addressed in epidemiological studies.
BACKGROUND: The new UK National Statistics Socio-Economic Classification (NS-SEC) is theoretically based on differences in employment relations and conditions. Differences in employment relations could account for some of the often observed social class differences in health in the United Kingdom. This study investigates the associations of the NS-SEC with a well-validated health outcome measure--the Short Form health survey (SF-36). METHODS: Data from the Oxford Healthy Lifestyles Survey III (OHLS III, n = 6,454), a cross-sectional survey of adult men and women aged 18-64 randomly selected from the counties of Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire, were analysed. The associations of the NS-SEC with the SF-36 physical and mental summary scores are investigated in a series of regression models controlling for age, lifestyle factors, housing and neighbourhood conditions. RESULTS: There are significant social class differences in the SF-36 physical and mental summary scores after controlling for age. When lifestyle, housing and neighbourhood conditions are controlled for, these differences reduce to non-significance. CONCLUSION: The NS-SEC shows significant social class differences in health, further evidence for its construct validity. Social class differences in housing, neighbourhood and lifestyle factors appear to have a large role in understanding class differences in health. As it is grounded in theory, the NS-SEC is likely to prove a valuable tool for explanations of inequalities in health.
STUDY OBJECTIVE: The aim was to compare four different measures of women's social class (interview and census based) as predictors of well known social gradients in reproductive outcomes. The intent was to address two obstacles that confront research in the United States regarding social gradients in women's health: how women's social class should be measured, and the absence of socioeconomic data in most health records. STUDY DESIGN: The study was a retrospective cohort analysis, using a community based random sample. Setting--Alameda County, California, 1987. SUBJECTS: 51 black and 50 white women, ages 20 to 80 years, identified by random digit dialling, were interviewed by telephone. MEASUREMENTS AND MAIN RESULTS: Census data were linked to individual records via the respondents' addresses. Using number of full term pregnancies as an example, multiple linear regression analyses demonstrated that individual class was not significantly associated with this outcome, whereas household class was: women from non-working-class households had 0.8 fewer such pregnancies than women from working class households (95% confidence interval [CI] = -1.4, -0.1). The block group measure functioned most like the household class measure (beta = -0.7, 95% CI = -1.4, 0.1), while the census tract measure was non-significant (beta = -0.4, 95% CI = -1.2, 0.4). Similar results were obtained for the outcomes: age at first full term pregnancy, percent of early terminated pregnancies, and yearly income. CONCLUSIONS: These results suggest block group data may offer a uniform source of social class information that can be appended to individual health records, and that this strategy is not invalidated by concerns regarding ecological fallacy.
Social class differences were investigated among patients admitted to public and private psychiatric hospitals. Participants included first admission White psychotic men admitted to Baltimore metropolitan area hospitals between 1983 and 1989. After adjusting for age and diagnosis, patients with low levels of skills/credentials were found to be more likely than patients with higher levels to be admitted to state psychiatric hospitals. These findings underscore the persistence of social class as a determinant of differences in the use of psychiatric care.
STUDY OBJECTIVES: To assess the relative contribution of age and social class to variations in the prevalence of a selection of self reported health problems. To examine the implications of observed variations for research on health inequalities. DESIGN: Secondary analysis of the Health Survey for England (1991-1997) using morbidities that are particularly prone to class effects. A statistical measure of the "relative class effect" is introduced to compare the effects of adjusting for social class and age. MAIN RESULTS: There is substantial variation in the relative importance of the age and class distributions of different diseases. Age effects often overshadow those of class even for conditions where an apparently strong social gradient exists. Only for self reported mental health among women does the social gradient exceed the age gradient. Within the context of a dominating age gradient, social gradients are relatively high for mental health and general health for both sexes. Variation in the relative strengths of the social gradients between the sexes are observed for angina symptoms. CONCLUSIONS: Given variations in the "relative class effect", analysis recognising the distinct contributions of age, sex, and social class to specific morbidities is advocated as a transparent and robust approach to the assessment of morbidity based inequality.