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PubMed2001

I am woman: the impact of social identities on African American women's mental health.

We examine the psychological impact of a range of social identities among a sample of African American women. Using data from the National Survey of Black Americans (NSBA), we find that measures of body image, role performance, discrimination, and social class position are related to mental health status. Women of lower social class standing are especially at risk for poor mental health outcomes. Having low educational attainment, low personal incomes, and less prestigious occupations is associated with a poor self-concept (self-esteem and self-efficacy). Women with low self-concepts, in turn, report poorer mental health. We argue that African American women face multilayered realities that may compromise their abilities to handle the stresses of everyday life.

Adaptation, Psychological↗
PubMed2005

Standard of living in the retirement survey: a predictor of six-year functional limitation onset and mortality in women, but not in men from ages 55 - 69 years.

PURPOSE: To investigate the predictive validity for health decline of a standard of living, a measure that combines basic necessities and consumer durables. METHOD: A nationally representative sample of those aged 55-69 years was interviewed at home in the Great Britain Retirement and Retirement Plans Survey, (1988; n=3,541). In 1994, 2,247 were re-interviewed, response rate being 70% of survivors. Relationships between socioeconomic status and health decline were investigated using polytomous logistic regression modelling. The outcomes were onset of functional limitation and mortality. RESULTS: Standard of living was an independent predictor of 6-year functional limitation onset (Odds Ratio compared to good standard of living 2.2; 95% Confidence Interval 1.3-3.8) and mortality (OR=4.6; 95% CI 2.3-8.9) in women, with age, household type, educational qualifications and social class taken into account. However, in men, weaker associations were largely accounted for by differences in education and social class (adjusted OR for functional limitation onset 1.0; 95% CI 0.5-1.9; adjusted OR for mortality 1.4; 95% CI 0.6-2.9). A combined indicator of housing tenure and property value was also an independent predictor of functional limitation onset in women. CONCLUSIONS: Poor standard of living identifies women but not men at risk of health decline who are missed by social class and educational level. Measures of current home-based material resources are a useful addition to minimum datasets for monitoring health inequalities.

Activities of Daily Living↗
PubMed1978

Effect of smoking during pregnancy upon the haematological values of cord blood.

Haematological indices in cord blood, measured by a Coulter Counter, in 50 mothers who smoked 10 or more cigarettes a day were compared with those in 75 control mothers who were non-smokers, but of similar age and parity. Smoking during pregnancy was associated with higher levels, of haemoglobin, and the haematocrit, as well as with higher red cell counts and a higher mean corpuscular haemoglobin. The percentage of fetal haemoglobin in cord blood was not affected by smoking. There was no correlation between social class and cord blood haemoglobin; but within social class groups, higher cord blood haemoglobin levels were associated with smoking. It is suggested that smoking during pregnancy stimulates fetal erythropoeisis.

Bilirubin↗
PubMed1999

When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood.

STUDY OBJECTIVES: To compare associations of childhood and adult socioeconomic position with cardiovascular risk factors measured in adulthood. To estimate the effects of adult socioeconomic position after adjustment for childhood circumstances. DESIGN: Cross sectional survey, using the relative index of inequality method to compare socioeconomic differences at different life stages. SETTING: The Whitehall II longitudinal study of men and women employed in London offices of the Civil Service at study baseline in 1985-88. PARTICIPANTS: 4774 men and 2206 women born in the period 1930-53 who were administered questions on early socioeconomic circumstances. MAIN RESULTS: Adult occupational position (employment grade) was inversely associated (high status-low risk) with current smoking and leisure time physical inactivity, with waist/height, and with metabolic risk factors HDL cholesterol, triglycerides, post-load glucose and fibrinogen. Associations of these variables with childhood socioeconomic position (father's Registrar General Social Class) were weaker or absent, with the exception of smoking in women. Childhood social position was associated with adult weight in both sexes and with current smoking, waist/height, HDL cholesterol and fibrinogen in women. Height, a measure of health capital or constitution, was weakly linked with father's social class and more strongly linked with own employment grade. The combination of childhood disadvantage (low father's class) together with a low status clerical occupation in men was particularly associated with higher body mass index as an adult (interaction test p < 0.001). Adjustment for earlier socioeconomic position--using father's class and own education level simultaneously--did not weaken the effects of adult socioeconomic position, except in the case of smoking in women, when the grade effect was reduced by 59 per cent. CONCLUSIONS: Cardiovascular risk factors in adulthood were in general more strongly related to adult than to childhood socioeconomic position. Among women but not men there was a strong but unexplained link between father's class and adult smoking habit. In both sexes degree of obesity was associated with both childhood and adulthood social position. These findings suggest that the socially patterned accumulation of health capital and cardiovascular risk begins in childhood and continues, according to socioeconomic position, during adulthood.

Adult↗
PubMed1979

The influence of availability of free school milk on the height of children in England and Scotland.

The effect is investigated of availability of free school milk on height gain in one year of six- and seven-year-old primary schoolchildren in England and Scotland, using data collected annually from 1972 to 1976. The height gain of children for whom milk was available for the whole year of observation was compared with that of children who had no milk. Out of 16 sex-country-year-specific analyses for children from manual social classes only, 13 showed no significant evidence of greater height gain in children who had milk. Comparison of children from Social Classes IV and V (semi-skilled and unskilled) showed no greater increase in height for those who had milk, nor was there a difference in height gain between manual social class children according to the number of glasses of milk they drank a day at home or at school. We concluded that, given the standard of living at the time of the survey, the drinking of free school milk did not increase the growth rate of six- and seven-year-old children.

Animals↗
PubMed2000

Longest held occupation in a lifetime and risk of disability in activities of daily living.

OBJECTIVES: To examine the association between the longest held occupation in a lifetime and risk of disability in activities of daily living (ADL) among elderly people (65 years and older) in northern Taiwan. METHODS: A case-control design was used nested within two cohorts of a total of 2198 elderly people who had been followed up either between 1993 and 1997 or between 1996 and 1997. Cases were 360 elderly people with ADL disability within the study period. For each case, two sex matched controls were randomly sampled from the pool of elderly people free from ADL disability. Occupational data were collected through interviews conducted in 1997. Performed job contents were classified into occupational categories and occupation based social classes. Unconditional logistic regression techniques were used to estimate relative risk and 95% confidence intervals (95% CIs) of ADL disability. RESULTS: Compared with people who were former legislators, government administrators, or business executives and managers, workers in agriculture, animal husbandry, forestry, or fishing (odds ratio (OR) 1.9, 95% CI 1.1 to 3.5) and workers in craft and related trades (OR 1.9, 95% CI 1.1 to 3.4) had significantly increased risks of subsequent ADL disability. Differential risks of ADL disability were found across social classes, with a significant dose-response trend in which unskilled blue collar workers had an 1.8 times higher risk of ADL disability than higher social classes of white collar workers. CONCLUSIONS: After adjustment for education, there was still an inverse relation between risk of ADL disability and social class. Although total control for all the known risk factors for ADL disability among elderly people was impossible, the results tend to suggest a potential for an effect of longest held occupation in a lifetime on risk of ADL disability.

Activities of Daily Living↗
PubMed1974

Factors affecting work load in general practice. II.

The second part of a survey studying factors that affect a general practitioner's work load considers the effects of age, sex, social class and time on list. Women, the old, and the young created the most work for the doctor and his paramedical team. Patients in the lower social classes also generated more work, even though a larger proportion of the higher social classes used the resources of the general practice-and more fully. Newly-registered patients generated slightly more work than the more permanent residents. Not only the size of a doctor's list, therefore, but also the demographic features of the community should be taken into account in determining the size and structure of the general-practice team needed for an area.

Adolescent↗
PubMed1979

A study of infant growth in relation to the type of feeding.

A total of 133 breast fed newborn babies, and 106 bottle fed babies, were selected and studied prospectively. Details taken of feeding practices have shown that by 5--7 wk of age bottle feeds had been introduced in about 50% of breast fed babies. Entirely breast fed babies received their first solid food later than breast-and-bottle fed or entirely bottle fed babies when such babies were in social class I, II or III, but in social class IV and V entirely breast fed babies were weaned at a similar age to those in the other two groups of babies. In the first 5--7 wk of life there was a significant negative correlation between the increase in skinfold thickness and the skinfold thickness at birth. The study has also shown that the present practice of feeding babies modified milks retards weight gain and the increase in subcutaneous fat in male babies.

Body Weight↗
PubMed1984

Doctor-patient communication. Clinical implications of social scientific research.

Research in the social sciences has clarified the nature and problems of doctor-patient communication. The development of adequate communication skills is now a goal of training programs in the primary-care specialties. Social structural barriers impede effective communication, however, and information giving remains problematic. Doctors tend to underestimate patients' desire for information and to misperceive the process of information giving. The transmission of information is related to characteristics of patients (sex, education, social class, and prognosis), doctors (social-class background, income, and perception of patients' desire for information), and the clinical situation (number of patients seen). Doctors' nonverbal communication abilities are associated with outcomes of medical care such as satisfaction and compliance. Regarding the sociolinguistic structure of communication, doctors often maintain a style of high control, which involves many doctor-initiated questions, interruptions, and neglect of patients' "life world." Training programs and standards of clinical practice should emphasize that improved doctor-patient communication is both desirable and possible.

Attitude of Health Personnel↗
PubMed1999

[Arguments and basic principles for continuous monitoring of social differences in the health of Swiss children].

On the basis of the thesis that social inequality has increased during the nineties in all western societies, and that this development is a reason for considerable concern with respect to public health, the authors propose the establishment of a long term monitoring system within the Swiss school health services. A re-analysis of the data obtained in a Swiss epidemiological study of seven-year-olds in the eighties demonstrates that social class was an important determinant of health and development of these children also during a period of economic boom. For various health and developmental problems odds-ratios (lower class vs. upper class) between 1.7 and 6.4 were found. Social class of the parents is considered as a reliable indicator of the socio-economic situation of children also for future long term observations. The number of significant somatic health problems as well as disorders of motor and speech development of six- or seven-year-olds are proposed as indicators of health status which can be assessed repeatedly at reasonable cost and with standardised methodology. This project could be started rather easily within the newly established Swiss "Health Observatory".

Child↗
PubMed1994

A descriptive epidemiology of physical activity from a Northern Ireland perspective.

The benefits of physical activity are well documented and exercise is included in most health promotion recommendations but, before adopting a population strategy, it is important to establish baseline patterns of physical activity so as to make regional and international comparisons and measure behaviour change. This review examines adult physical activity participation in a national and international context and highlights how difficult it is to draw meaningful conclusions and detect trends from studies that measure physical activity using different measuring instruments. Overall, about 4 in 5 people are active at least occasionally but the more rigorous the definition of habitual physical activity the lower the participation rates so that less than 1 in 5 people perform regular vigorous physical activity. Males are more active than females with a decrease in physical activity with increasing age. There is a social class gradient with those in social classes 1 and 2 being more active.

Adolescent↗
PubMedDate not supplied

[Socioeconomic inequalities in the provision and uptake of prenatal care].

OBJECTIVE: To describe socioeconomic inequalities in the provision and uptake of prenatal care among women in Barcelona (Spain) between 1994 and 2003. METHODS: Cross-sectional study of women in Barcelona who delivered a child without birth defects. Information was obtained from hospital medical records and a personal interview with women included in the Barcelona Birth Defects Registry, containing a random sample of 2% of all pregnant women in the city (n = 2299). DEPENDENT VARIABLES: number of obstetric visits, the trimester of the first visit, the number of obstetric ultrasound scans, the fifth-month diagnostic ultrasound scan, invasive procedures, prenatal folic acid intake, pregnancy planning, smoking and smoking cessation. The independent variables were maternal age and social class. Logistic regression models were filted for each dependent variable. RESULTS: In social classes with manual occupations, there was a higher proportion of pregnant women who attended less than six obstetric visits and who attended the first obstetric visit after the first trimester. Moreover, these women were less likely to have undergone an invasive procedure, to have taken folic acid supplements, to have planned the pregnancy, to be non-smokers and to stop smoking. In the more privileged classes, there was a higher proportion of women who attended more than 12 obstetric visits and who underwent more than three ultrasound scans. CONCLUSIONS: Socioeconomic inequalities were found in the provision and uptake of prenatal care in Barcelona. Uptake was greater in the more advantaged social classes but excessive medicalization was found in all classes. Rationalizing the use of healthcare resources and reducing excessive medicalization would reduce inequalities in prenatal care in Barcelona.

Adult↗
PubMed1990

[Socioeconomic status and survival in multiple myeloma].

In order to investigate the relationship between socioeconomic status and survival in multiple myeloma, a group of 121 patients, followed from first diagnosis to their demise, was subdivided into three social classes: high, medium, and low. Social class subdivision was performed taking into account the degree of education, occupation, and income. Significant differences (p less than 0.05) exist regarding mean survivals, survival curves, clinical stages, and responses to therapy between the three considered classes. A low socioeconomic status is associated with shorter survival, higher frequence in poor clinical stage, and less percentage of positive responses to chemotherapy. In conclusion, the socioeconomic status is an important prognostic factor in patients with multiple myeloma, to be considered with other clinical and laboratory data.

Adult↗
PubMed1986

Dietary sources of energy, protein, fat and fibre in 375 English adolescents.

The aim of this report of the dietary sources of energy, protein, fat and fibre in 375 English adolescents aged 11-14 years is to contribute to the development of health education. Each child recorded their dietary intake five times over a 2-year period using a 3-day diary with interview. Food tables (Paul & Southgate, 1978) were used to calculate nutrient intake. The results are the mean of all 15 days intake. Potatoes (chips and crisps) were the largest single source of energy but 'meat' was the main source of protein and fat, other important sources of fat were the spreading fats, milk, chips and crisps. Chips were the main source of fibre but white bread, crisps and baked beans also contributed similar proportions of fibre. Some differences between the sexes and social classes were observed; the lower social class children appeared to have more undesirable eating habits.

Adolescent↗
PubMed1979

The content of physician/patient communication in family practice.

Observation of a series of office visits by patients to family physicians provide information on physician-patient communication. During interaction on medical matters, the physicians instigated 80 percent of the interview. By way of contrast, when discussion of matters beyond the strictly medical situation occurred, 70 percent of the conversation was initiated by the patients. Irrespective of diagnoses, there were significant differences in the overall content of communications for patients from different socioeconomic groups, with more verbal exchange occurring with upper social class patients than with lower social class patients. Other patient factors which led to an increase in verbal interaction were chronic illness, emotional disorders, and ill-defined conditions. The analysis of categories of verbal interaction between physicians and patients proved to be a practical method of studying the physician-patient relationship, and provided guidelines for those seeking to make objective measurements of communication in family practice.

Adolescent↗
PubMed2002

Selenium status and associated factors in a British National Diet and Nutrition Survey: young people aged 4-18 y.

OBJECTIVE: Assessment of selenium status to provide normative reference values, and investigation of associated socio-demographic factors, in a national sample of British young people aged 4-18 y. SETTING: National Diet and Nutrition Survey-a nationwide cross-sectional sample of young people aged 4-18 y living in mainland Britain in 1997. METHODS: Selenium status was measured, mainly in fasting blood samples, by plasma selenium concentration in 1127 participants, by red blood cell (RBC) selenium concentration in 1112, and by whole-blood glutathione peroxidase (GPx) activity in 658. RESULTS: No evidence of severe selenium deficiency or toxicity was observed. Plasma selenium concentration was directly correlated with RBC selenium concentration, and both were associated directly, although less strongly, with GPx activity. Plasma and RBC selenium concentrations increased significantly with age, with RBC concentrations significantly higher in older girls than boys. Region of domicile exhibited a significant relationship. Associations also occurred with parental occupational social class, selenium concentrations being higher in more socially advantaged children. Black and Indian children had considerably higher concentrations than Caucasian children. Concentrations, especially of plasma selenium, were significantly lower in children either (or both) of whose parents were smokers, although, unexpectedly, there was no evidence that children who themselves smoked had lower levels. CONCLUSIONS: The observed associations between selenium status indices and age, gender, social class, parental smoking and ethnic group indicate a complex network of biological factors which determine selenium concentrations in blood components, and which thus need to be controlled for when using these indices to assess selenium status in young people. SPONSORSHIP: The survey was commissioned jointly by the Department of Health and the Ministry of Agriculture, Fisheries and Food, whose responsibility has since been transferred to the Food Standards Agency. Support for the further analysis presented in this paper was provided by the Department of Health.

Adolescent↗
PubMed2003

Squamous cell carcinoma of the oral cavity in patients aged 45 years and under: a descriptive analysis of 116 cases diagnosed in the South East of England from 1990 to 1997.

BACKGROUND: there is, currently, much anecdotal and some epidemiological evidence for a rise in oral cancer rates amongst younger individuals, many of whom have had no exposure to traditional risk factors such as tobacco and heavy alcohol use, or at least not the exposure over decades usually associated with this disease. The probity of this assertion and the presence or absence of traditional risk factors needs further evidence. OBJECTIVES: this paper describes the demography and the exposure to potential risk factors amongst a cohort aged 45 years and younger, diagnosed with squamous cell carcinoma of the oral cavity between 1990 and 1997 from the South East of England. MATERIALS AND METHODS: eligible patients registered with a cancer registry were included in this retrospective study. Information was accessed from the database and by a postal questionnaire survey. The self-completed questionnaire contained items about exposure to the following risk factors: tobacco; alcohol; diet; frequency of dental visits and familial cancer. RESULTS AND CONCLUSIONS: this is the largest UK epidemiological study so far to be undertaken on young subjects diagnosed with oral cancer. One-hundred and sixteen cases were recruited representing a response rate of 59%. Slightly over 90% of this cohort were classified as white European. A large proportion of cases (40%) were from social classes I & II suggesting either a true social class difference in young cases versus older oral cancer cases or a possible bias in responders or survivors. Risk factors of tobacco use and excessive alcohol consumption were present in the majority (75%) of patients. Significant differences in the pattern of alcohol consumption were found in female subjects, who were less likely to consume over the recommended amounts of alcohol compared with male subjects. Daily regular fresh fruit and vegetable consumption during the ten year period before cancer diagnosis was recorded to be low. There was a distinct subgroup of cases, 26% of the group, that showed little, if any, exposure to any major risk factors.

Adult↗
PubMed1996

Sociodemography of borderline personality disorder (PD): a comparison with Axis II PDs and psychiatric symptom disorders convergent validation.

A theoretical objective of the present meta-analysis based upon data derived from a previously reported review (Taub, 1995), was to test two inductive hypotheses empirically regarding educational background and social class across different criteria for the DSM-III diagnosis of borderline personality disorder (PD). A secondary purpose was to determine whether comorbidity of borderline PD with other Axis II PDs would significantly delineate socioeducational variables. Across 7/8 pairwise contrasts which represented five studies, distribution of Hollingshead Redlich (H-R) social classes II-IV borderline PD (N = 326) significantly exceeded that in 457 diagnostic controls with Axis II PDs and psychiatric symptom disorders. Although average differences, as well as, interactions reflected by values of the H-R two-factor scale attained statistical significance these were were less consistent in magnitude and direction versus outcomes yielded by distribution of social classes. For the borderline PD diagnosis, the inductive hypotheses were substantiated by findings of significantly advanced scholastic achievement, as well as the younger age of most cohorts versus diagnostic controls with Axis II PDs and psychiatric symptom disorders; and in pairwise contrasts of outpatients with hospitalized cohorts. Comorbidity of the borderline PD diagnosis was associated with significantly lower social class, scholastic achievement and to a lesser extent, more severe psychopathology. Evidence for predominantly convergent validation relative to the socioeducational variables was substantiated by comparisons with (a) cohorts selected by criteria of the DSM-III-R, Gunderson's DIB and Borderline Personality Scale: (b) Norwegian females admitted to Gaustad Hospital and (c) patients with the DSM-III diagnosis of borderline PD attending an outpatient clinic in Norway.

Adult↗