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PubMed2002

Sociodemographic inequalities in the diet of young children in the 1946 British birth cohort.

OBJECTIVE: To evaluate whether there was food and nutrient equality across occupational social classes and geographical region for members of the 1946 British birth cohort at age 4 years. DESIGN: Cross-sectional analysis of selected food groups, energy and nutrients from one-day recall diet records. SETTING: England, Scotland and Wales in 1950. SUBJECTS: Nationally representative sample of 4419 children aged 4 years in 1950 from the MRC National Survey of Health and Development (NSHD) (1946 Birth Cohort). RESULTS: Significant food and nutrient inequalities occurred by region and occupational social class of the father. Disparity in fruit and vegetable consumption primarily led to the nutrient differences, especially with respect to lower vitamin C and carotene intakes in children from Scotland and from a manual social class background. Lower energy intake in Scottish children was attributable to inequality in the consumption of foods providing fat, and also to the retention of the traditional Scottish diet that included porridge and soups. Consumption of some rationed foods -- bacon, orange juice and tea -- was inequitably distributed by father's social class, but others, in particular meat and spreading fats, were consumed more uniformly. In contrast to fruits and vegetables, which showed marked sociodemographic disparities, other non-rationed foods such as bread and potatoes were consumed universally. CONCLUSION: Local cultural norms may have played as strong a part in sociodemographic differences in the diet of children in the early 1950s as did the strict, post-war food rationing that prevailed. In consequence, nutritional equality was not achieved, and the relatively low intake of antioxidant vitamins during early childhood in certain population groups may have compromised health in the long term.

Child Nutritional Physiological Phenomena↗
PubMedDate not supplied

[Effect of socioeconomic factors on twin pregnancy].

A material of 336 mothers of twins was divided into four groups on the basis of socioeconomic background. On average, mothers belonging to the first social class delivered at 38.2 +/- 1.6 week of pregnancy and their newborn weighed more than those in other social classes. Careful follow-up at outpatient maternity clinics is warranted in the case of expectant mothers of twins belonging to the third or fourth social class.

Adolescent↗
PubMed2001

Risk factors for coronary heart disease in different socioeconomic groups of Lithuania and Sweden--the LiVicordia Study.

AIMS: Lithuanian middle-aged men have a fourfold higher risk for coronary heart disease (CHD) mortality compared with Swedish men. In Sweden, CHD mortality is twice as high in blue- compared with white-collar workers. Whether the same risk factors that characterized Lithuanian men, compared with Swedish men, could be found in low socioeconomic groups within the cities was investigated. METHODS: The LiVicordia study compared both traditional and new possible risk factors for CHD among 150 50-year-old men in Linköping, Sweden and Vilnius, Lithuania. A comparison was made of the prevalence of these risk factors in high and low socioeconomic groups within the cities and, after controlling for the city, variations across socioeconomic groups in the total sample. RESULTS: Small differences were found in traditional risk factors between cities. However, Vilnius men were shorter, had lower serum levels of antioxidant vitamins, more psychosocial strain, and lower cortisol response to a standardized laboratory stress test. These characteristics were also found among men in low social classes in both cities. In linear regression models, short stature, low serum beta-carotene, low social integration, coping and self-esteem, high vital exhaustion, high baseline and low cortisol response to stress were related to low social class. CONCLUSIONS: The same set of risk factors, mainly relating to oxidative and psychosocial stress, that characterized Vilnius men was also found in men in low social classes within the cities. The results suggest that a common set of risk factors may help to explain health differences both between and within countries.

Antioxidants↗
PubMedDate not supplied

Plasma fibrinogen and ischemic heart disease risk factors.

The association between risk factors for ischemic heart disease and plasma fibrinogen level was analyzed in a cross-sectional population study. All 51-year-old men living in a certain area within the county of Copenhagen were invited; 439 of 542 (81%) participated in the study. Data were collected via questionnaire and at health examinations. The following independent variables were analyzed: social variables, which included social class, marital status, and job strain; psychological and psychosomatic variables, which included abdominal pain, personal and economic problems, self-assessed state of health, and degree of loneliness; behavioral variables, which included smoking, drug consumption, physical activity, use of sugar, and alcohol consumption; and physiological variables, which included high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, physical fitness, fasting glucose level, waist-to-hip ratio, and systolic blood pressure. In the multivariate analyses, the following variables showed an independent positive association with plasma fibrinogen level: one social variable (low social class); two psychological variables (abdominal pain index and personal/economic problems); two behavioral variables (smoking and physical inactivity during leisure time); and three physiological variables (low HDL cholesterol, low physical fitness, and high LDL cholesterol). The strongest independent associations with plasma fibrinogen level were found for smoking, social class, LDL cholesterol, and HDL cholesterol. These analyses suggest that smoking is a major risk factor for an elevated plasma fibrinogen level, but that other factors such as social class, cholesterol level, physical inactivity/physical fitness, and psychological problems also influence plasma fibrinogen level.

Abdominal Pain↗
PubMed1996

Health state valuations from the general public using the visual analogue scale.

In the clinical and economic evaluation of health care, the value of benefit gained should be determined from a public perspective. The objective of this study was to establish relative valuations attached to different health states to form the basis for a 'social tariff' for use in quantifying patient benefit from health care. Three thousand three hundred and ninety-five interviews were conducted with a representative sample of the adult British population. Using the EuroQol health state classification and a visual analogue scale (VAS), each respondent valued 15 health states producing, in total, direct valuations for 45 states. Two hundred and twenty-one re-interviews were conducted approximately 10 weeks later. A near complete, and logically consistent, VAS data set was generated with good test-retest reliability (mean ICC = 0.78). Both social class and education had a significant effect, where higher median valuations were given by respondents in social classes III-V and by those with intermediate or no educational qualifications. These effects were particularly noticeable for more severe states. The use of such valuations in a social tariff raises important issues regarding the use of the VAS method itself to elicit valuations for hypothetical health states, the production of separate tariffs according to social class and/or education and the appropriate measure of central tendency.

Activities of Daily Living↗
PubMed2002

Economic inequality, working-class power, social capital, and cause-specific mortality in wealthy countries.

This study tests two propositions from Navarro's critique of the social capital literature: that social capital's importance has been exaggerated and that class-related political factors, absent from social epidemiology and public health, might be key determinants of population health. The authors estimate cross-sectional associations between economic inequality, working-class power, and social capital and life expectancy, self-rated health, low birth weight, and age- and cause-specific mortality in 16 wealthy countries. Of all the health outcomes, the five variables related to birth and infant survival and nonintentional injuries had the most consistent association with economic inequality and working-class power (in particular with strength of the welfare state) and, less so, with social capital indicators. Rates of low birth weight and infant deaths from all causes were lower in countries with more "left" (e.g., socialist, social democratic, labor) votes, more left members of parliament, more years of social democratic government, more women in government, and various indicators of strength of the welfare state, as well as low economic inequality, as measured in a variety of ways. Similar associations were observed for injury mortality, underscoring the crucial role of unions and labor parties in promoting workplace safety. Overall, social capital shows weaker associations with population health indicators than do economic inequality and working-class power. The popularity of social capital and exclusion of class-related political and welfare state indicators does not seem to be justified on empirical grounds.

Adolescent↗
PubMed1992

Social effects of wheeze in childhood: a 25 year follow up.

OBJECTIVES: To determine the outcome of childhood wheeze in terms of education, employment, housing, and social class. DESIGN: 25 year follow up study. SETTING: Community study based at the department of thoracic medicine, Aberdeen Royal Infirmary. PARTICIPANTS: Three groups of subjects who had been identified in a random community survey in 1964: those who had had asthma in childhood (n = 97), those who had wheezed only in the presence of upper respiratory tract infections (n = 132), and a comparison group who had had no respiratory symptoms as children (n = 131). Subjects were aged 34 to 40 years at the time of the current study. MAIN OUTCOME MEASURES: Interview and questionnaire data on education, employment, housing and social class, ventilatory function, and peak flow rate. RESULTS: Pulmonary function testing showed that only the "asthmatic" group had airways obstruction; this group showed greater peak flow variation than the "wheezy" group, which did not differ from the comparison group. The asthmatic subjects were more likely to have experienced respiratory problems during their school years and associated with their work. Despite these problems, educational attainment, employment, housing, and eventual social class were similar for all three groups. CONCLUSION: Childhood wheeze did not adversely affect education, employment, housing, or social class in this population.

Asthma↗
PubMed1982

Increasing participation and improving the quality of discussions in seventh-grade social studies classes.

An experiment was conducted to evaluate procedures to improve classroom discussions in seventh-grade social studies classes. An increased number of students participated in discussions when rules were stated for discussions, students were praised for their contributions, the teacher restated or paraphrased students' contributions aloud or on the blackboard, the teacher planned an outline of discussion questions, student contributions to discussions were recorded and were used to determine part of the students' grades for the class, and discussion grades were publicly posted.The second part of the study focused on procedures designed to improve quality of classroom discussions. Students were taught to participate in discussions by providing reasons for their statements, comparisons between different points, or examples supporting their statements. As each type of contribution was taught, recorded, and counted toward part of the students' classroom grades, each type of contribution increased. Ratings of discussions by outside judges consisting of junior high school teachers, junior high school students, and persons experienced in conducting discussions, indicated that the training increased the overall quality of the discussions. Use of the quality training procedures, however, resulted in decreased levels of overall participation in discussion, a decrease that was reversed by the use of a group contingency for participation. Finally, the discussions after training seemed to be preferred by both the teacher and the students.

Journal Article↗
PubMed1999

Social determinants of birthweight, ponderal index and gestational age in Sweden in the 1920s and the 1980s.

This study compared the effect of social class and marital status on birth outcomes in Sweden, using (i) data on all births at the Akademiska Hospital in Uppsala from 1920 to 1924 with socioeconomic information from records at birth; and (ii) a linkage of the Medical Births Registry for all births in Sweden in November/December 1985 to the 1985 Census. Preterm births (<37 weeks) have become less common during the 20th century. Between 1920-24 and 1985, mean and median birthweight increased, as did mean ponderal index, indicating a shift to the right of the birthweight and ponderal index distributions. In 1920-24, birthweight and ponderal index were associated with the social class of the household and with the marital status of the mother. Babies of single mothers were lighter and thinner, and had a much greater probability of being born preterm. In contrast, in 1985, maternal marital status (and cohabitation status) had a weaker effect on birthweight and ponderal index. The importance of household social class for ponderal index and preterm birth changed similarly, but its importance for birthweight remained. The mediating mechanism may have changed. Mothers from farming households now gave birth to the heaviest babies (nearly 200 g heavier than those of unskilled workers). Adjustment for a number of factors, including smoking, had a limited effect on these social class differences. In conclusion, biological processes during the foetal period are systematically linked to the social circumstances of the mother, but in a different way in the 1920s and in 1985.

Adult↗
PubMed2004

Involving South Asian patients in clinical trials.

OBJECTIVES: To investigate how South Asian patients conceptualise the notion of clinical trials and to identify key processes that impact on trial participation and the extent to which communication difficulties, perceptions of risk and attitudes to authority influence these decisions. Also to identify whether 'South Asian' patients are homogeneous in these issues, and which factors differ between different South Asian subgroups and finally how professionals regard the involvement of South Asian patients and their views on strategies to increase participation. DATA SOURCES: A review of the literature on minority ethnic participation in clinical trials was followed by three qualitative interview studies. Interviews were taped and transcribed (and translated if required) and subjected to framework analysis. Face-to-face interviews were conducted with 25 health professionals; 60 South Asian lay people who had not taken part in a trial and 15 South Asian trial participants. RESULTS: Motivations for trial participation were identified as follows: to help society, to improve own health or that of family and friends, out of obligation to the doctor and to increase scientific knowledge. Deterrents were concerns about drug side-effects, busy lifestyles, language, previous bad experiences, mistrust and feelings of not belonging to British society. There was no evidence of antipathy amongst South Asians to the concept of clinical trials and, overall, the younger respondents were more knowledgeable than the older ones. Problems are more likely to be associated with service delivery. Lack of being approached was a common response. Lay-reported factors that might affect South Asian participation in clinical trials include age, language, social class, feeling of not belonging/mistrust, culture and religion. Awareness of clinical trials varied between each group. There are more similarities than differences in attitudes towards clinical trial participation between the South Asian and the general population. Important decisions, such as participation in clinical trials, are likely to be made by those family members who are fluent in English and younger. Social class appears to be more important than ethnicity, and older South Asian people and those from working class backgrounds appear to be more mistrustful. Approachable patients (of the same gender, social class and fluent in English) tend to be 'cherry picked' to clinical trials. This practice was justified because of a lack of time and resources and inadequate support. South Asian patients might be systematically excluded from trials owing to the increased cost and time associated with their inclusion, particularly in relation to the language barrier. Under-representation might also be due to passive exclusion associated with cultural stereotypes. Other characteristics such as gender, age, educational level and social class can also affect trial inclusion. CONCLUSIONS: Effective strategies for South Asian recruitment to clinical trials include: using multi-recruitment strategies; defining the demographic and social profiles of the population to be included; using focus groups to identify any potential barriers; consulting representative community members to provide assistance in the study; ensuring eligibility criteria are set as wide as possible; developing educational and recruitment approaches to attract ethnic minority health professionals; ensuring health professionals are adequately trained in culturally and ethnically orientated service provision; determining the most effective mass media to use in study promotion and recruitment; and targeting inner-city, single-handed practices likely to have high ethnic minority populations. Future research should consider: responses when invited to participate; the role of methodological and organisational barriers to recruitment; the complexities of recruitment from a health professional perspective; developing culturally sensitive research methods; the magnitude of the problem of under-recruitment; strategies to encourage inner-city, single-handed GP participation; and other factors affecting trial inclusion, such as age, gender, educational level and socio-cultural background.

Attitude of Health Personnel↗
PubMed2005

Incidence of retained deciduous teeth in a Nigerian population: an indication of poor dental awareness/attitude.

This pilot study aimed at assessing the incidence of retained deciduous teeth in a Nigerian orthodontic population, which could be helpful in teaching, as well as motivation of the community. A total of 361 patients were seen between January 2001 and May 2003 at the orthodontic clinic of University College Hospital, Ibadan, Nigeria, and 60 (16.6%) of them comprising 31 (51.7%) males and 29 (48.3%) females with age range of 7-23 years (mean age, 12.3 + 4.8 SD) presented with retained deciduous teeth. The social classification of the patients was according to the Registrar General's Social Class with no significant differences between the social classes (p > 0.05). Generally, more males had this occlusal anomaly than females. Angle's class I occlusion was found most in the subjects with the anomaly. Bilateral presentation of the anomaly was more than unilateral cases. The incidence was considered high and suggests a need for intensified dental education for the community for earlier preventive/interceptive measures.

Adolescent↗
PubMed2005

Biosocial correlates of stature in a British national cohort.

Analyses of height variation using the 1970 UK national cohort study (12,508 children at age 10 and 5470 at age 16) found clear evidence that children of higher socioeconomic status (as measured by social class, crowding, tenure, type of accommodation, income and receipt of government financial assistance) were on average taller than children of lower socioeconomic status but there was little or no difference in average stature between children living in urban or rural areas. Significant differences in height remained for most of the variables after removing the effects of father's social class suggesting that reliance on social class per se to explain height variation is inadvisable.

Adolescent↗
PubMed2003

Life course influences on insulin resistance: findings from the British Women's Heart and Health Study.

OBJECTIVE: To assess the independent associations of a broad range of early life risk factors and adult obesity with adult insulin resistance. RESEARCH DESIGN AND METHODS: This was a cross-sectional study of 1,394 women, aged 60-79 years, from 23 British towns. RESULTS: There was a strong (independent of confounding factors, other early life factors, and adult waist-to-hip ratio) inverse association between birth weight and insulin resistance in women in the highest third of BMI (>28.77 kg/m2): -0.12 (95% CI -0.19 to -0.04) log homeostasis model assessment (HOMA) score per 1 SD birth weight, but no association between birth weight and insulin resistance in women in the two lowest thirds of BMI (P for interaction = 0.04). Offspring birth weight, own leg length, and childhood manual social class did not interact with adult obesity and were all independently inversely associated with insulin resistance: -0.05 (-0.09 to -0.01) log HOMA score per 1 SD offspring birth weight, -0.09 (-0.12 to -0.06) log HOMA score per 1 SD leg length, and a -0.07 (-0.14 to 0.00) difference in log HOMA score between manual and nonmanual childhood social class. Childhood manual social class and shorter leg length were both independently associated with adverse lipid profiles. BMI and waist-to-hip ratio were independently positively associated with insulin resistance and with all other components of the insulin resistance syndrome. CONCLUSIONS: Insulin resistance is an important risk factor for type 2 diabetes and coronary heart disease. Our results suggest that genetic factors, intrauterine environment, early childhood, and adult environmental factors are all relevant in determining adult insulin resistance.

Aged↗
PubMed2000

The influence of gender, social circumstances and smoking on survival: the Renfrew and Paisley study.

The present study aimed to compare survival to age 75 between men and women, by social circumstances and smoking behaviour. A 20 year follow up was carried out of a large representative cohort of Scottish men and women in the Renfrew and Paisley study, and was combined with Scottish mortality statistics. 6831 men and 7993 women aged 45-64 y at time of examination (between 1972 and 1976) were considered. Combining the estimates from the Renfrew and Paisley study with those from Scottish mortality statistics for men and women younger than 45 y of age, it was calculated that 28% of the male smokers and 44% of the male never smokers in disadvantaged social circumstances will have survived to age 75 y, compared with 46% and 56% of the female smokers and never smokers respectively. In more privileged social circumstances, 41% of the male smokers and 62% of the male never smokers will have survived to age 75 y, compared with 56% and 70% of the female smokers and never smokers respectively. The difference between male smokers in low social classes and female never smokers in high social classes is 42% in absolute terms (28% vs 70%), which gives an indication of the combined influence of gender, social circumstances and smoking on survival. These results show that gender, social circumstances and smoking are important determinants of mortality which have led to substantial differences in survival. The influence of additional factors related to mortality could usefully be compared to these to put their effects into perspective.

Adolescent↗
PubMed2001

Socio-occupational differences in acute myocardial infarction case-fatality and coronary care in a northern Italian population.

AIMS: To appraise 28-day case-fatality of myocardial infarction (MI) among socio-occupational classes; to assess the consistency of the results for different degrees of MI severity; to explore if such differences are related to differences in management and treatment of the acute attack. METHODS: All coronary events (n = 1077), registered in 1993-1994 among the 35-64 year old male residents in MONICA Area Brianza were investigated and classified into diagnostic categories according to MONICA criteria. For all cases standardized information on acute coronary care and interventions before and during hospitalization was collected. Classification of social classes was derived from the Erikson-Goldthorpe-Portocarero social class scheme, based on information on occupational characteristics widely available in European countries. RESULTS: An increasing rate of case-fatality for decreasing levels of socio-occupational class was found. The social gradient resulted mainly from the higher incidence of out-of-hospital cardiac arrests. Treatment before and during the acute attack cannot explain the observed differences. CONCLUSION: Combining these results with those obtained in other MONICA centres, it appears that further decreases in coronary mortality might be achieved through specific programmes addressed in particular to the reduction of out-of-hospital case-fatality in lower social classes.

Adult↗
PubMed2004

The role of manual occupation in the aetiology of Dupuytren's disease in men in England and Wales.

We compared the incidence of significant Dupuytren's disease in men across occupational social classes in England and Wales, using data from the National Morbidity Survey. We found that manual occupational social class was not associated with an increased incidence of Dupuytren's disease. In fact, the incidence rates of Dupuytren's disease in the elderly were higher in non-manual than in manual social classes.

Adult↗
PubMed1998

Trends in intentional injury deaths in children and teenagers (1980-1995).

BACKGROUND: The aim of the study was to describe patterns and trends in intentional injury death rates in children and teenagers. METHODS: Analyses were carried out on data from the Office of National Statistics on all intentional injury deaths in people aged 0 to 19 years, in England and Wales, from 1980 to 1995. Trends in death rates were examined using Poisson regression modelling, and class-specific death rates were estimated using the Registrar General's Standard Classification of Occupations. RESULTS: Between 1980 and 1995, there has been a substantial fall in the unintentional injury death rate, but no reduction in the intentional injury death rate. Intentional injuries made up 13 per cent of injury and poisoning deaths in 1980, and 25 per cent of such deaths in 1995. Each year in England and Wales an average of 335 children and teenagers die as a result of homicide, suicide and injuries of undetermined intent. Older teenagers (15-19 years) account for 70 per cent of intentional injury deaths, children 0-4 years account for 18 per cent, and children 5-15 years account for 12 per cent. Of the 5361 intentional injury deaths, 45 per cent were classified as injury undetermined whether accidentally or purposely inflicted, 35 per cent were classified as suicide, and 20 per cent were classified as homicide. With the exception of suicide, there are steep social class gradients for each category of intentional injury. The homicide rate for children in social class V is 17 times that for children in social class I. For all intentional injury, homicide, suicide and injuries of undetermined intent, the relative risk of death for manual vs. non-manual was higher for the four year period 1992-1995 than in the four year period 1980-1983. CONCLUSIONS: Intentional injury is responsible for an average of 335 deaths of children and teenagers each year in England and Wales. Unlike for unintentional injury, there has been no reduction in death rates from intentional injury, which now accounts for 25 per cent of all injury deaths. There is a steep social class gradient in intentional injury death rates, which has widened over the period 1980-1995.

Adolescent↗
PubMed2003

Social capital and social exclusion in England and Wales (1972-1999).

Recent research on social capital has explored trends in membership in voluntary organizations. However, there is currently little robust evidence on such trends in the UK since the 1970s, nor is there any analysis of whether participation bridges social divisions or accentuates them. This paper explores trends in participation in England and Wales since 1972 using data from the Social Mobility Inquiry of 1972 and the British Household Panel Survey of 1992 and 1999. We are concerned with social exclusion mechanisms in social capital generation in Britain over the three decades. Using binomial and multinomial models to 'unpack' the effects of socio-cultural factors on civic participation and on different types of associational membership, we test the thesis of across-the-board decline in social capital by Putnam (2000) and that of rising levels of middle-class social capital versus consistent low levels of working-class social capital by Hall (1999). The results show significant socio-cultural-gender differences, a relative stability of middle-class participation, and a rapid decline in the working-class access to social capital. We challenge the established accounts of both theses.

England↗