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Numerous factors in the social environment may affect the incidence and mortality from cancer in women. Women's work roles, possible exposure to workplace hazards, social class, social roles, social stress, access to health care, and health behaviors are among the factors that act together to help determine a woman's health and well-being.
This study relates certain family network variables (martial status and number of children) to chances of survival. Through multivariate analysis, survival is also related to social class, social mobility, migration and local environment, and legitimacy of birth. All persons in a local birth cohort born in the years 1902 and 1903 were followed in population records from birth until eighty years of age. The group comprised 487 individuals with a dropout rate of 4 percent. Univariate survival analysis between twenty to eighty years of age showed widows and also divorced women to have a significantly higher survival than those still married and never married. Never married men and women had the lowest survival rates. The number of children was not associated with survival for neither men nor women when controlled for marital status. Multiple regression survival analysis showed different patterns for males and females. The risk of not surviving to eighty years of age for men resulted from a combination of being single, downward social mobility, a father in the manual working class group and few children, with being single as the strongest predictor. For women the strongest predictor for death before eighty was the category single and/or married (as opposed to earlier married). The combination of being single/married, high migration, earlier life mainly in rural areas, and having few children were predictors in the model of death before eighty. Thus, for both men and women marital status was the strongest predictor for survival but in different ways.
In the Gothenburg primary prevention study 7083 middle aged men were classified into five categories by occupational state. A retrospective analysis of the data showed that low occupational class was associated with slight increases in smoking rates, systolic blood pressure, serum cholesterol concentration, body mass index, and heart rate. Alcohol abuse was strongly associated with low occupational class. After a mean of 11.8 years' follow up the incidence of coronary heart disease was found to be strongly and inversely related to occupational class. For death from coronary heart disease this association fell just below significance when other risk factors were taken into account, but the inverse association between non-fatal myocardial infarction and occupational class persisted even in multivariate analysis. A weak but independent inverse relation was found between occupational class and fatal cancer. Mortality from all causes in the lowest occupational class was 12% compared with 6% in the highest class, and this difference could only partly be explained by other factors. After 10 years a sub-sample of the men were examined again. Risk factors had decreased in all occupational classes, but the changes in risk were not associated with occupational class. Social class, defined by occupation, in Sweden is clearly related to the incidence of coronary heart disease.
To assess the relationship of psychosocial variables to risk factors for hypertension in children, we administered instruments designed to measure aspects of children's personality, behavior, family environment and family social status to 1505 school children aged 7-10 years. Children's blood pressure was significantly related only to mother's occupation, the children of unskilled employees having higher blood pressure than children of higher status workers. Children's body mass index was directly related to scores on the conformity scale of the personality inventory and inversely related to scores on the intellectual-cultural orientation scale of the family environment instrument and to social class. Social status but not measured dimensions of children's personality, behavior and family environment may influence the risk of hypertension in children.
AIMS: To compare different socio-demographic predictors of quitting smoking in a cohort representative of adult smokers in the British population using appropriate models that take into account the clustering of smoking behaviours at the household and area levels. DESIGN: A longitudinal, population representative survey of British adults (the British Household Panel Survey, BHPS) from 1991 to 2000. SETTING AND PARTICIPANTS: At wave 1 of the BHPS, 10264 adults living in 5511 households were interviewed. Around 30% of the wave 1 respondents reported smoking cigarettes. Of these, 21% had quit smoking over a 10-year period. MEASUREMENTS: 'Quitters' (quitting smoking) were defined as smokers who had subsequently described themselves as non-smokers for at least 2 consecutive waves (years) of the BHPS. Degree of dependence was indexed using the number of cigarettes currently smoked per day. FINDINGS: Degree of dependence was the strongest predictor of quitting smoking, followed by occupational social class, social support, marital status and the proportion of smokers in the household. There was some evidence of clustering of quitting smoking behaviour within households-members of the same household had similar quitting smoking behaviours. This clustering at the household level appeared to be explained by mechanisms related to the household level. However, there was little evidence for clustering of smoking behaviour within areas. CONCLUSIONS: In addition to reducing addiction to cigarettes, policies designed to encourage smokers to quit may need to take into account factors related to household support and employment relations, in order to encourage smokers from all socio-demographic groups to quit
OBJECTIVE: To identify factors in childhood which might influence the development of obesity in adulthood. BACKGROUND: The prevalence of obesity is increasing in the UK and other developed countries, in adults and children. The adverse health consequences of adult obesity are well documented, but are less certain for childhood obesity. An association between fatness in adolescence and undesirable socio-economic consequences, such as lower educational attainment and income, has been observed, particularly for women. Childhood factors implicated in the development of adult obesity therefore have far-reaching implications for costs to the health-services and economy. SEARCH STRATEGY: In order to identify relevant studies, electronic databases--Medline, Embase, CAB abstracts, Psyclit and Sport Discus-were searched from the start date of the database to Spring 1998. The general search structure for electronic databases was (childhood or synonyms) AND (fatness or synonyms) AND (longitudinal or synonyms). Further studies were identified by citations in retrieved papers and by consultation with experts. INCLUSION CRITERIA: Longitudinal observational studies of healthy children which included measurement of a risk factor in childhood (<18 y), and outcome measure at least 1 y later. Any measure of fatness, leanness or change in fatness or leanness was accepted. Measures of fat distribution were not included. Only studies with participants from an industrialized country were considered, and those concerning minority or special groups, e.g. Pima Indians or children born preterm, were excluded. FINDINGS: Risk factors for obesity included parental fatness, social factors, birth weight, timing or rate of maturation, physical activity, dietary factors and other behavioural or psychological factors. Offspring of obese parent(s) were consistently seen to be at increased risk of fatness, although few studies have looked at this relationship over longer periods of childhood and into adulthood. The relative contributions of genes and inherited lifestyle factors to the parent-child fatness association remain largely unknown. No clear relationship is reported between socio-economic status (SES) in early life and childhood fatness. However, a strong consistent relationship is observed between low SES in early life and increased fatness in adulthood. Studies investigating SES were generally large but very few considered confounding by parental fatness. Women who change social class (social mobility) show the prevalence of obesity of the class they join, an association which is not present in men. The influence of other social factors such as family size, number of parents at home and childcare have been little researched. There is good evidence from large and reasonably long-term studies for an apparently clear relationship for increased fatness with higher birth weight, but in studies which attempted to address potential confounding by gestational age, parental fatness, or social group, the relationship was less consistent. The relationship between earlier maturation and greater subsequent fatness was investigated in predominantly smaller, but also a few large studies. Again, this relationship appeared to be consistent, but in general, the studies had not investigated whether there was confounding by other factors, including parental fatness, SES, earlier fatness in childhood, or dietary or activity behaviours. Studies investigating the role of diet or activity were generally small, and included diverse methods of risk factor measurement. There was almost no evidence for an influence of activity in infancy on later fatness, and inconsistent but suggestive evidence for a protective effect of activity in childhood on later fatness. No clear evidence for an effect of infant feeding on later fatness emerged, but follow-up to adulthood was rare, with only one study measuring fatness after 7y. Studies investigating diet in childhood were limited and inconc
The identification and measurement of the population health needs should be the first step in health planning. In order to guarantee equity criteria, to know the situation of the whole population, and therefore also that of women, is a key issue. Health interview surveys are a good tool for pinpointing the needs of the population, but mainly they are usually focused on health risk factors that explain men's health status such as health behaviours and paid job. These factors often fail to capture aspects that are relevant for women's health, such as household work. The main objective of this paper is to emphasise the importance of a gender perspective in the design and analysis of health interview surveys, and to propose variables that should be included in health surveys in order to better know gender health inequalities. Likewise, this article deals with the gender concept and its importance as a health inequality factor. Gender is an analytical construct based on the social organisation of the sexes that can be used to better understand the conditions and factors influencing women's and men's health beginning by the social roles that each culture and society assigns to people based on their sex. Health is a complex process determined by a wide range of factors: biological, social, environmental and health services related factors. Gender, because of its close relation to all of them, plays a key role. The gender approach is characterised by the analysis of the social relation between men and women, taking into account that sex is a determinant of social inequalities. This paper presents the variables that health interview surveys should include from a gender approach point of view: reproductive work, productive work, social class, social support, self-perceived health status, quality of life, mental health and chronic conditions. In addition, issues related to the wording of questions, data collection and analysis are discussed.
AIMS: To test the relationship between job strain and the incidence of ischaemic heart disease (IHD) prospectively in the Danish working population. METHODS AND RESULTS: In 1986, a clinical examination was undertaken of 659 men, all employed and without known IHD, together with a questionnaire-based evaluation of living conditions and psychosocial factors at work, including items identified in the job strain model. This study was part of the World Health Organization-initiated MONICA II study. In the job strain model, job strain is defined as the combination of high psychological demands and a low degree of control in the work situation. An objective classification of the components in the job strain model was made by imputation by utilizing the participants' job title and the principles guiding the payment of their salaries/wages. In addition, a questionnaire-based subjective classification was undertaken. All participants were followed until the end of 1999 with regard to hospitalization and death as a result of IHD. Stepwise analyses were made, adjusting for age, social class, social network and established behavioural and physiological coronary risk factors. Self-reported job strain was significantly associated with IHD independently of standard coronary risk factors. Of the two components in the job strain model only high demands contributed significantly to this result. The study did not support the job strain hypothesis when an imputed, objective classification of the components in the job strain model was applied. This is in accordance with the majority of other studies in this area. An unexpected finding was that the incidence of IHD was highest among employers and managers. CONCLUSION: High psychological demands at work are a risk factor for IHD, a fact that should affect the primary and secondary prevention of IHD.
The results presented here show that there is no single variable nor a particular set of variables which are ideal to stratify the Mexican population in socioeconomic terms. This means that it is necessary to select indicators appropriate to each case, taking into consideration their specificity of meaning, their meaning with regard to the study problem and, naturally, also the objective and conceptual framework of the research, in the present case, public health research. The selection of indicators needs to be based on practical/methodological and theoretical considerations. Some of these are discussed in the present paper. Regaining the conceptual meaning of the indicators is fundamental and this is why a discussion of the concepts of social class, social strata, social inequality and poverty was undertaken. The practical/methodological criteria which were examined, include such elements as the type of variable used (dichotomic, categorical, continuous, etc.). To this end, socioeconomic variables of the National Fertility and Health Survey were analyzed, as well as the variable "poverty", which was constructed with data from the National Household Income and Expenditures Survey. As a result, outlines were drawn for a better understanding, utilization and measurement of socioeconomic indicators in public health research in Mexico.
The homeless population in Germany is continually increasing. Featuring prominently among those on the increase are women, young persons and homeless people from East Germany. Studies of the health of homeless individuals in recent years show that indices of illness are far higher for many disorders than for comparable groups who are housed. One result from a recent study by the University of Mainz (1994) was that more than 90% of homeless people urgently need medical treatment. According this research, the main health problems of the homeless are: cardiac disease (hypertension, CAD) (52.5%), skin disease (scabies, lice, leg ulcers, abscesses, pyodermias) and acute infections (50%), lower respiratory tract (COAD) (47.5%) and trauma victims (50%), followed by liver (30%), kidney (25%) and gastrointestinal diseases (GU) (20%). The problems of alcoholism and mental disorders of various sorts are added to this picture. Violence to homeless people is increasing. A lot of homeless people are multi-morbid. The relationship between the time of homelessness and the state of illness was not linear. It was found that in the beginning of homelessness most of the homeless people were in a poor physical condition. The poor physical condition of homeless people does not stem from only one cause, but results from a combination of different factors: individual social conditions (social class; social relations; sedentary lifestyle), personal or family life crisis (life events and coping behaviour), the individual risk behaviour (for instance the bizarre sleeping accommodations, alcohol and cigarette consumption unemployment in a depressed economy, structure of the society (cutbacks in government welfare and social service programmes). As a result of bad experiences with existing medical institutions, homeless persons do not consult the doctor or too late. Many are afraid of large institutions; most are not members of a health insurance scheme (uninsured); and many are perceived in some sense to be "undesirable" as patients. Medical care offers for homeless people must be re-examined and changed appropriately in accordance with the requirements of the patients and the acceptability of the measures. Health care for the homeless is sorely needed. It is an urgent necessity to create special low-level acceptance medical care institutions. This health care service should be made available to homeless persons at the places where they gather (to set up a mobile medical service, medical streetwork, medical care ambulances). The interdisciplinary theme approach, which integrates the skills of physicians, nurses and social workers, is an invaluable strategy for establishing though and continuous care. Without good health, homeless people cannot resolve their other basic problems; and people simply cannot be healthy if they do not have a stable place to live.
Low social class is associated with higher mortality from cancer at several sites and in patients with cancer low social class is known to be associated with a poorer chance of survival. Social differences in cancer incidence are less consistent. The present study was undertaken to assess the relation between occupational class and cancer incidence, mortality and survival from cancer in a large population of 7001 men aged 51-59, free of diagnosed cancer at baseline in 1970--1972. The main outcome measures were cancer incidence and cancer mortality until 1992 according to the Swedish national cancer and cause-specific death registries. Cancer survival was analysed in a subgroup of 904 men diagnosed with cancer before 1990. There were 1329 incident cases of cancer including 620 deaths from cancer. Overall cancer incidence during follow-up did not vary significantly by occupational class, but respiratory cancers were significantly more common among men with manual occupations; p = 0.0004. This was not be explained by differences in tobacco smoking, which were minor at the start of the study and did not increase much during follow-up. Overall mortality from cancer was significantly higher among men with manual occupations. Among professionals and higher officials 336 per 100,000 observation years died from cancer, compared to 391 among intermediate officials, 509 among lower officials, 474 among skilled and 548 among non-skilled workers; p for trend = 0.0003. This difference was mainly due to mortality from respiratory cancer, with a threefold difference between manual workers and professionals; this did not change after adjustment for smoking. Among the 904 men diagnosed before 1990 with cancer at any site (except non-melanoma skin cancer) the adjusted relative risk of dying from cancer was 1.75 (95% confidence interval 1.22-2.50) in unskilled workers compared to higher officials (p for trend 0.015).
AIM: To determine risk factors for child maltreatment within the socio-economic environment of a contemporary UK child population. METHODS: The research is based on a large cohort study, the Avon Longitudinal Study of Parents and Children. Out of 14256 children participating in the study, 115 have been identified as having been placed on local child protection registers prior to their 6th birthday. Data on the socio-economic environment of the families have been obtained from a series of questionnaires administered during pregnancy and the first 3 years of life. Risk factors have been analyzed using logistic regression analysis. RESULTS: Four indicators of deprivation all showed significant relationships with registration. Adjusted odds ratios were 2.33 for paternal unemployment; 7.65 for council housing; 2.16 for overcrowding; and 2.33 for car ownership. There was a strong relationship between the number of indicators of deprivation and the risk of maltreatment. In a second model, maternal unemployment, high mobility (> 3 house moves in the previous 5 years) and a poor social network were also significant with odds ratios of 2.82, 2.81, and 3.09, respectively. CONCLUSIONS: This study confirms the importance of social factors in the etiology of child maltreatment. Social deprivation is an important determinant of child maltreatment, and encompasses a number of different aspects, including financial security, housing situation and material benefits; in addition, the job situation of the parents and the stability and richness of their social networks all have a significant impact on risk of maltreatment. Interventions at both an individual and a community level are important to support families and reduce the risk of maltreatment.
Cervical cancer accounted for 57 deaths to women in Nottingham District in 1986 and 1987. 28% were women aged under 50 years of age. Using age specific death rates, the greatest risk was among women aged 60-69 years. However, when expressed as a proportion of all deaths, cervical cancer represents 8.5% of deaths in women aged 25-45, but only 0.6% of deaths to women over 46. There was no significant difference in relative risk between the five social classes, even when social class V was compared to aggregated data for social classes I-IV. This supports other evidence that the social class gradient in cervical cancer mortality is lessening. There was no excess risk shown to women resident in the inner city or in areas of social deprivation. This finding is in contrast to the work of others who have shown an increased incidence in areas of social deprivation. The evidence from this study would support those who suggested over 20 years ago that it is not social deprivation or occupation that constitute an increased risk to women, but sexual behaviour and other habits such as smoking.
A measure of deprivation has been devised using data from the 1981 Census about area characteristics which may be considered to reflect material deprivation, and a score is calculated for each postcode sector in Scotland. The routine data sources provide information for a range of health measures which are shown to be strongly linked to levels of deprivation, with specific causes--respiratory conditions, cancer of the lung and cancer of the cervix--exhibiting very considerable differentials in respect of both mortality and cancer morbidity. Nevertheless not all causes exhibit this positive association. This area-based measure provides a valuable tool for the analysis of health data in relation to socio-economic circumstances which overcomes many of the limitations which arise in the use of the more traditional measure of social class. Like social class however it depends on data from the census which are available only at ten-yearly intervals. Other existing data sources are suggested which could possibly provide relevant information on area characteristics and populations for inter-censal years.
INTRODUCTION: Several studies indicated that prevalence of ischaemic heart disease (IHD) rose with increasing wealth of the population and previously higher IHD prevalence was observed in the higher social strata. Later, the IHD prevalence was higher in lower social class because the higher social class faster followed the recommendation connected with IHD prevention. Currently, in majority of wealthy countries the higher IHD prevalence is connected with lower social class. To assess the relationship between analyzed social factors (social background, education of father and subject himself and character of activity at work), marital status and self evaluation of the health status on the one hand and on the other hand classical IHD risk factors and death both total and cardiovascular. The basis of analyses constituted the results of examined in 1984, 1988 and 1993 independent 3 random samples of Warsaw population aged 35-64 years, the study conducted within the framework of the Pol-MONICA Warsaw Project. The screened population was followed up to 1998 from the death and its cause point of view. To the lower social class were included persons with peasant or blue collar worker social background, subjects, whose father's or himself had not finished the elementary education, and whose employment required very heavy physical work. Separately the analysis dealt with marital status and self assessment of health status. The lower social class was characterized by higher BMI and higher prevalence of obesity, higher heart frequency, higher level of systolic, diastolic and pulse pressure as well as prevalence of hypertension and higher HDL-C level. Higher social class was characterized by higher height and higher prevalence of cigarettes smoking. Married persons were characterized by higher weight and height as well as BMI. Persons who evaluated health status as bad or poor had lower height but higher systolic, diastolic and pulse pressure as well as prevalence of hypertension than the reference characteristics. Regardless that 18 characteristics (social factors and classical risk factors) were introduced previously into the regression model to evaluate the risk of death, in female population only lack of employment and poor assessments of health status out of social factors increased the overall risk of death; the risk of cardiovascular death increased with higher level of education, employment required heavy physical activity, not--maried status and poor or bad evaluation of health status, while compared with risk of reference characteristics. Among men the overall risk of death was connected with blue collar type of work, widow or divorced status, employment required heavy physical activity and poor or bad evaluation of health status. The risk of IHD death was connected with widow or not--married status, education at least college and poor or bad assessment of health status. One should conclude that currently in Poland the higher risk of death began to be transferred to lower social class.
The classification of the medical and social characteristics of a random sample of 360 children requiring admission to a paediatric unit in a Northern town revealed a marked social class gradient, rising from social class I to social class V, when compared with the social class distribution of children in the hospital catchment area wards. This was most evident in children suffering from respiratory diseases. Infants were particularly susceptible to respiratory diseases when compared with the age distribution of children in the selected wards. Two electoral wards had a higher than expected number of ill children. One the crisis of a sick child developed, the families of these children were disadvantaged in their access to medical care by their lack of private transport and private telephones. The reported delay experienced by these families from approach to, and contact with, GPs was particularly acute in the mornings and it must be concluded that some children may be at risk at this time of day. Out-of-hours calls were promptly attended by both GPs and deputising service doctors.
This study explored pregnant women's assessment of the health risks associated with maternal smoking. The aim was to determine if stage of change relating to smoking is associated with risk assessment. A cross-sectional survey (employing a self-completion questionnaire) was conducted of all women who attended antenatal clinics at Leicester Royal Infirmary, National Health Service Trust, UK over a 2 week period. Questionnaires were completed by 254 respondents. Twenty seven percent of non-smokers agreed with more than 75% of a series of statements about the dangers of maternal smoking compared to 5% of smokers and 44% of women in social class I (highest social class) agreed with more than 75% of the statements compared with only 10% of women in social classes IV and V (lower social class groups). Married women were twice as likely to concur with more than 75% of the health risks compared to single or cohabiting women and 29% of women intending to breastfeed agreed with more than 75% of the statements compared with only 8.7% of women not intending to breastfeed. There was no significant effect of age, whether the pregnancy was planned, previous obstetric complications or whether the woman had a child with asthma or respiratory infections. A multiple regression analysis indicated that smokers were much less likely to agree with the health risks than their non-smoking counterparts (p = 0.034). Stage of change was related to both the number of health risks agreed with and the level of conviction. A woman's stage of change could be assessed at the start of antenatal care so that appropriate smoking cessation advice can be offered.
We decided to examine the services provided by doctors in an inner London practice for domiciliary care. It was expected that the study would highlight the most relevant questions and variables related to access and uptake of this service; it would thus contribute to the design of an accurate procedure for auditing the pattern of delivery of home care to be conducted in the practice in the future. During the study period, 1976-81, there were 90 500 doctor-patient contacts. For patients up to the age of 10 years the proportion of home visits was 9.2%, falling to 2.2% in the age group 20 to 29; then there is a quasi plateau till the age of 60. After 60 the proportion of home visits doubles in each of the following 10 year age groups, reaching 54% in the over 80s. The proportion of home visits (standardised by age) rises from social class II (8.0%) to social class V (10.0%), but is higher in social class I (11.7%). The proportion of home visits according to distance from the practice rises from 8.2% near the health centre to 9.6% at a distance of 0.25 to 0.50 mile, and drops to 8.8% beyond 0.75 mile. The distance effect is not consistent when the social class dimension is added: social classes I and II have higher proportions of home visits in certain age and distance groups. Single people have the lowest proportion of home visits (6.8%); there are large differences between men and women among widowed (14.1% and 8.6% respectively) and divorced or separated (7.0% and 10.7% respectively) patients. There are important variations in the proportions of home visits made by the doctors in the practice, the trainees carrying out proportionally many more home visits. Data collected in the practice can be used to define specific issues for future audit exercises. Furthermore, sociodemographic characteristics of patients have been shown to be associated with use and access to medical services.