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We examined like and unlike sex twinning rates in Great Britain by social class over the period 1974-85. Although twinning rates are believed to have changed over that period, we found no evidence of differential change by social class, suggesting that any factors affecting twinning are widespread in the population.
OBJECTIVES: To assess breast-feeding initiation and rates of exclusive breast-feeding for the first 6 months after birth, and to examine social class differences in breast-feeding rates. DESIGN: First sweep of a longitudinal population-based survey, the Millennium Cohort Study. SETTING: Four countries of the UK. SUBJECTS: Subjects were 18 125 singletons born over a 12-month period spanning 2000-01. Data were collected by parental interview on the initiation of breast-feeding and exclusivity at 1, 4 and 6 months after birth. RESULTS: Overall breast-feeding was initiated for 71% of babies, and by 1, 4 and 6 months of age the proportions being exclusively breast-fed were 34%, 3% and 0.3%, respectively. There were clear social class differences and mothers with routine jobs with the least favourable working conditions were more than four times less likely (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.18-0.29) to initiate breast-feeding compared with women in higher managerial and professional occupations. Women in routine jobs were less likely to exclusively breast-feed their infants at 1 month (OR 0.42, 95% CI 0.36-0.50) and 4 months (OR 0.5, 95% CI 0.31-0.77) compared with women in higher managerial and professional occupations. CONCLUSIONS: Clear social class differences in breast-feeding initiation and exclusivity for the first 4 months were apparent in this large UK sample. By 6 months, less than 1% of babies were being exclusively breast-fed. A co-ordinated multi-faceted strategy is required to promote breast-feeding, particularly among lower-income women.
The caries prevalence of 1273-, 4- and 5-y-old white children was determined with mirror and probe under natural light at mother and child clinics. The social class of the family, the educational level of the mother and that of the father were determined from a questionnaire filled in by the accompanying adult at the time of examination. Both social class and parent's education had a statistically significant influence on the caries prevalence: those in the lower social classes and with parents without tertiary education had a much higher prevalence of caries.
Two studies were carried out to examine socio-economic factors in breast cancer: a random sample of all new cases in Edinburgh in 1979 was reviewed, and the control population of the Edinburgh randomized trial of breast screening was used to determine stage and survival in relation to social class. Small area statistics from census data were used as measures of social class, the method being now well accepted. More than one-third of women still present with obviously advanced or metastatic breast cancer, but both studies showed this has no association with socio-economic status. Late stage at presentation is a serious problem, and although mass screening is likely to cause an improvement in those who are screened, it cannot in those who do not attend for screening. As attendance is related to social class, less affluent women are less likely to benefit and will continue to be diagnosed with advanced disease.
A cross-sectional assessment of differences in social class and other sociodemographic variables at hospital admission for patients with psychotic disorders was carried out through a systematic survey of psychotic patients admitted to greater Baltimore psychiatric facilities between 1983 and 1989. Female patients, first-admission patients, and patients with bipolar disorder or other, nonschizophrenic psychosis were more likely to have been admitted to community, university, and private hospitals than to state hospitals. Patients in medium and higher social class categories were 1.29 to 2.57 times more likely to be admitted to community, university, and private hospitals than to state hospitals.
This article examines trends in inequalities in infant mortality in England and Wales between 1976 and 2000. It describes variations in neonatal, postneonatal and infant mortality by mother's age, registration status, father's social class, multiplicity and birthweight. Throughout the period, social class differences in mortality were wider in the postneonatal period than the neonatal period and there was considerable variation in infant mortality by age of mother, birthweight and multiplicity within both manual and non-manual groups.
The pattern of sugar consumption in a sample of 350 11-12-year-old adolescents was examined. Their knowledge of the sugar content of a range of common foodstuffs was also investigated. There were only small differences between the social class groups in mealtime sugar consumption. The frequency of total food and drink was significantly higher in the low social class groups and this was mainly explained by significantly higher between meal consumption of solid food which contained sugar. The level of knowledge of the sugar content of foods was significantly higher in the higher social class groups. Fifty-two per cent of the questions were answered correctly, with a range of 9-91 per cent for individual foodstuffs.
This study focuses on social class variation in the intake of fat and fibre in Maastricht, Liège and Aachen, based on food frequency questionnaires of 849 women from nuclear families with schoolgoing children. In Maastricht and Liège higher-middle class women consumed less fat than working class women, while in Aachen no class difference was apparent. The intake of fibre was highest among the higher-middle class women, although this tendency was not significant in Aachen. Analysis of food groups that contribute to the intake of fat and fibre revealed that not all food groups showed this pattern. Higher-middle class women consumed less bread, less potatoes and more cheese than working class women. Moreover, they chose more often high-fat cheese and fats. Yet, working class women consumed more meat, milk and fats, and less grain, fruit and vegetables. In general, social class variations in fat and fibre intake were uniform across the cities, although in Aachen class differences were small or absent. In conclusion, these results suggest that the diet of higher-middle class women is more in accordance with the dietary recommendations regarding fat and fibre than the diet of working class women.
This paper describes the first author's attempt to collect data in a homeless shelter without attending to her role in the social class hierarchy of the organization. The author's egalitarian approach towards the homeless clients, and her lack of involvement in "staff-only" activities, transgress the social class norms within the organizational structure. While the author is successful in gaining the trust of the homeless clients, her approach alienates shelter staff, especially those in the higher echelons of the social hierarchy. The concepts of classism, world views, and Social Identity Theory, are utilized to discuss the dilemma faced by researchers who want to challenge, or work outside, a setting's status quo.
Much of the epidemiologic research in the United States has been based only on the categories of age, sex and race; thus, race has often been used in health statistics as a surrogate for social and economic disadvantage. Few multivariate analyses distinguish effects of components of social class (such as economic level) from the relative, joint, and independent effects of sociocultural identifiers such as race or ethnicity. This paper reviews studies of social class and minority status differentials in health, with a particular emphasis on health status outcomes which are known or suspected to be related to environmental quality and conditions which increase susceptibility to environmental pollutants. Sociodemographic data are presented for the U.S. population, including blacks, Asian American/Pacific Islanders, American Indian/Alaska Natives, and Hispanics. Four areas of health status data are addressed: mortality, health of women of reproductive age, infant and child health, and adult morbidity. Conceptual and methodological issues surrounding various measures of position in the system of social strata are discussed, including the multidimensionality of social class, in the context of the importance of these issues to public health research. Whenever possible, multivariate studies that consider the role of socioeconomic status in explaining racial/ethnic disparities are discussed.
OBJECTIVE: To study patterns of alcohol consumption and prevalence of high-risk drinking. METHODS: A household survey was carried out in a sample of 2,302 adults in Salvador, Brazil. Cases of High-Risk Drinking (HRD) were defined as those subjects who referred daily or weekly binge drinking plus episodes of drunkenness and those who reported any use of alcoholic beverages but with frequent drunkenness (at least once a week). RESULTS: Fifty-six per cent of the sample acknowledged drinking alcoholic beverages. Overall consumption was significantly related with gender (male), marital status (single), migration (non-migrant), better educated (college level), and social class (upper). No significant differences were found regarding ethnicity, except for cachaça (Brazilian sugarcane liquor) and other distilled beverages. Overall 12-month prevalence of high-risk drinking was 7%, six times more prevalent among males than females (almost 13% compared to 2.4%). A positive association of HRD prevalence with education and social class was found. No overall relationship was found between ethnicity and HRD. Male gender and higher socioeconomic status were associated with increased odds of HRD. Two-way stratified analyses yielded consistent gender effects throughout all strata of independent variables. CONCLUSIONS: The findings suggest that social and cultural elements determine local patterns of alcohol-drinking behavior. Additional research on long-term and differential effects of gender, ethnicity, and social class on alcohol use and misuse is needed in order to explain their role as sources of social health inequities.
OBJECTIVE: To describe the relationship between socio-demographic factors, heart disease risk factors, psychological symptoms and the use of hormone replacement therapy by English women. DESIGN: Cross-sectional analysis of a population-based survey. SETTING: England. POPULATION: 13,214 women aged 40-69 years who participated in the nurse-administered schedule of the Health Survey for England between 1993 and 1996. OUTCOME: Current hormone replacement therapy use. RESULTS: Women from social classes II and I and women who live in the south of England were more likely to use hormone replacement therapy independently of a range of socio-demographic factors including education. The adjusted odds ratio for social classes II and I compared with social classes IV and V was 1.51 (95% CI 1.20 to 1.91) and for women in the South of England was 1.38 (95% CI 1.18 to 1.62). Women with a history of heart disease and those with high cholesterol levels were less likely to use hormone replacement therapy. Women with psychological symptoms were more likely to be prescribed hormone replacement therapy, as were those who had recently seen a doctor. CONCLUSION: There is marked socio-demographic inequity in use of hormone replacement therapy. This may accentuate existing inequalities in health and reduce any potential benefits of Hormone Replacement Therapy for public health. The relationship between psychological symptoms, use of medical services and use of hormone replacement therapy suggests that hormone replacement therapy is prescribed for the management of psychological symptoms.
AIMS: This study investigates whether conditions present or established in youth and adolescence among young men contribute to the differences in the risk of an early disability pension (DP) among social classes. METHODS: The study is based on data from a nationwide survey of the 49,285 Swedish males born between 1949 and 1951 who were conscripted into military service between 1969 and 1970. Data on socioeconomic groups were based on information of occupation and educational level reported in the census of 1975 held by Statistics Sweden. Potential psychosocial and behavioural risk factors were linked to records from the Swedish Social Insurance Board up until 1993. The analyses were based upon those 33,609 conscripts with information on all background variables who reported an occupation and who were not granted a DP in 1975. RESULTS: The strongest social class difference in the distribution of risk indicators was found for low ranking on the psychometric tests and for having been in a remedial class. In the univariate analyses, the highest odds ratios were noted for unskilled manual workers. In the multivariate model, with all the background variables included, the increased risk ratios for lower socioeconomic groups decreased considerably for a DP irrespective of diagnosis, and diminished for a DP with an alcohol-related diagnosis. CONCLUSION: It is concluded that conditions present or established in youth and adolescence are of major importance to understand the strong social class gradient in disability pensions among young men. It is suggested that the increased risks for skilled and unskilled manual workers compared with non-manual employees might be interpreted according to the concept of unfavourable life careers.
The association of cigarette smoking habits and social class with nutrient intake was investigated in 162 men aged 45-54 using a 7-d weighed dietary record. Cigarette smokers had a significantly lower intake of fibre and polyunsaturated fatty acids and a lower P:S ratio than non-smokers. Fibre intake was lower in men in the manual compared to the non-manual group but smoking was a more powerful influence than social class. The differences in nutrient intake were accompanied by differences in the consumption of polyunsaturated margarines and cereal-containing foods. These results should be considered in the explanation of the increased incidence of coronary heart disease in smokers.
A study has been made of the relationship between socio-economic factors and the incidence of acute lymphoblastic leukaemia (ALL) of childhood. It was found that the incidence of childhood ALL in 12 areas of Queensland. Australia, correlated well with some indicators of above-average socio-economic status for these areas. A similar result was found when Brisbane City was studied separately. Social class was determined from the fathers' occupations at the time of diagnosis. There was found to be a higher than expected number of ALL cases in each of the upper 5 social classes and a lower than expected number in the remaining 2 lower classes. Factors associated with differences in lifestyle amongst the various social classes may increase or decrease the risk of development of ALL.
Shift work has been reported as a risk factor for ischaemic heart disease. Most studies have only partly controlled for social class differences, a recognized risk factor for ischaemic heart disease (IHD), and the relative risk of 1.4 could be a result of confounding. The Copenhagen Male Study was established in 1971 as a prospective cohort study of 5,249 men, and included questions on working time, social class and other potential confounders. The cohort was followed through registers for 22 years. Risk of IHD and all cause mortality did not differ between shift and day workers, the adjusted relative risk for IHD being 0.9 (0.7-1.1). Restriction to social class III led to lower risk estimates, with an adjusted relative risk of 0.7 (0.5-1.0). The study gave no support to the hypothesis that shift work is an independent risk factor for IHD. The role of shift work as an independent risk factor for IHD is still controversial.
The standardized proportionate mortality ratio (SPMR) method uses all deaths in all occupations and, therefore, all social classes to compute expected deaths in a single occupational group. By performing SPMR analysis within groups of occupations which are stratified by social class, the occupational contribution to the SPMR can be better identified. Mortality data from Washington state were used as illustrations.
Caries experience in 1374 children aged 15-16 years from three towns in the north east of England with varying concentrations of fluoride in drinking water, was determined. The mean DMFT values for 15-year-old continuous residents was 1.7 in Hartlepool (natural F 1.0-1.3 ppm), 2.5 in Newcastle (F adjusted to 1.0 ppm) and 3.3 in Middlesbrough (F = 0.2 ppm). Forty per cent of Hartlepool 15-year-olds were caries free, compared with 30% in Newcastle and 24% in Middlesbrough. Caries prevalence for both Hartlepool and Newcastle 'continuous residents' was lower than for non-continuous residents, whereas in Middlesbrough, the low fluoride area, non-continuous residents had a lower DMF value than those who had lived in Middlesbrough all their lives. There was a slight trend in both Newcastle and Middlesbrough for DMFT values to increase from social class I to social class V, but no discernable trend was observed in Hartlepool. The results for Hartlepool 15-year-olds were very similar to those reported by Weaver in 1949.