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PubMed1981

Mortality from coronary heart disease in the British army compared with the civil population.

A study was carried out in which mortality from coronary heart disease during 1973-7 in men aged under 55 years in the British army was compared with that in men in the civilian population. An inverse relation was found between mortality from coronary heart disease and rank in the army similar to that seen among the civilian social classes, but soldiers aged under 40 years had a significantly higher mortality than their civilian counterparts irrespective of the civilians' social class. Correspondingly, officers had a significantly lower mortality, which suggests that strenuous exercise and other exigencies of military life per se, with the possible exception of cigarette consumption, are not to blame. Possibly the extremes of risk in the army are due mainly to factors associated with the identification of subgroups of high and low risk within the social classes and to the higher prevalence of cigarette smoking among soldiers.

Adolescent↗
PubMed2005

Widening social inequalities in risk for sudden infant death syndrome.

OBJECTIVES: In 1994, the US Public Health Service launched the "Back to Sleep" campaign, promoting the supine sleep position to prevent sudden infant death syndrome (SIDS). Studies of SIDS in the United States have generally found socioeconomic and race disparities. Our objective was to see whether the "Back to Sleep" campaign, which involves an effective, easy, and free intervention, has reduced social class inequalities in SIDS. METHODS: We conducted a population-based case-cohort study during 2 periods, 1989 to 1991 and 1996 to 1998, using the US Linked Birth/Infant Death Data Sets. Case group was infants who died of SIDS in infancy (N = 21 126); control group was a 10% random sample of infants who lived through the first year and all infants who died of other causes (N=2241218). Social class was measured by mother's education level. RESULTS: There was no evidence that inequalities in SIDS were reduced after the Back to Sleep campaign. In fact, odds ratios for SIDS associated with lower social class increased between 1989-1991 and 1996-1998. The race disparity in SIDS increased after the Back to Sleep campaign. CONCLUSIONS: The introduction of an inexpensive, easy, public health intervention has not reduced social inequalities in SIDS; in fact, the gap has widened. Although the risk of SIDS has been reduced for all social class groups, women who are more educated have experienced the greatest decline.

Adult↗
PubMed1996

Risk factors for Neisseria meningitidis carriage in a school during a community outbreak of meningococcal infection.

As part of the management of an outbreak of meningococcal infection, 119 school contacts of an index case were swabbed for nasopharyngeal carriage. In a cohort study, risk factors for Neisseria meningitidis carriage were ascertained by means of a questionnaire, completed by 114 (96%) of those swabbed. Twenty five (21%) cultures were identified as "neisseria positive'; of which there were 18 (15%) Neisseria meningitidis isolates, 2 (2%) Neisseria lactamica isolates and 5 (4%) showed contaminants only. Two (2%) carriers were identified as harbouring the implicated outbreak strain. Single variable analysis identified six statistically significant risk factors for meningococcal carriage; increasing age, female sex, manual social class, personal smoking, regular attendance at a discotheque and rhinorrhoea. Multivariate analysis, using logistic regression modelling, found that of these six variables only age, sex and social class remained statistically significant when the other factors were controlled for. Nevertheless the role of smoking, social events and respiratory/viral infections in nasopharyngeal carriage, and other plausible mechanisms whereby age, sex and social class might exert their effect, could usefully be investigated further.

Adolescent↗
PubMed2002

Differential effect of environmental adversity by gender: Rutter's index of adversity in a group of boys and girls with and without ADHD.

OBJECTIVE: This study examined the effect of gender in mediating the association between environmental adversity and the risk of attention deficit hyperactivity disorder (ADHD) and associated impairments. METHOD: The authors studied 280 ADHD and 242 healthy comparison probands of both genders who were between the ages of 6 and 17 years. They tested the association between Rutter's indicators of adversity (including family conflict, social class, family size, maternal psychopathology, and paternal criminality) and ADHD, comorbidity, and functioning. RESULTS: Greater levels of environmental adversity were associated with a greater risk for ADHD and other comorbidity in both genders in a dose-dependent fashion. However, learning disability and global functioning were modified by gender, with more detrimental effects observed in boys than in girls. Low social class, maternal psychopathology, and family conflict were significantly associated with psychopathology and functional impairment in the probands, with control for gender, parental ADHD, proband ADHD status, and maternal smoking during pregnancy. CONCLUSIONS: Psychosocial adversity in general and low social class, maternal psychopathology, and family conflict in particular increased the risk for ADHD and associated morbidity independently of gender and other risk factors, but gender modified the risk for adverse cognitive and interpersonal outcomes; boys were more vulnerable to the disorder than girls. Because of the difficulties in separating the effects of genetics from environment, these results must be interpreted as provisional until confirmation from twin and adoption studies.

Adolescent↗
PubMed1994

Women who have abortions--are they different?

BACKGROUND: The aim of the study is to test the hypothesis that there is no difference between women who are currently undergoing an abortion and those who are not in an inner London health district. METHODS: One hundred and thirty-one consecutive attenders at an inner city day-care abortion service were compared, using a self-administered questionnaire, with two other groups: a random sample of 142 women aged between 18 and 45 taken from the local Family Health Services Authority age-sex register, and 149 consecutive attenders at the district's antenatal clinic. RESULTS: Women in the abortion group were found to be very similar to those in the antenatal sample in terms of social class, obstetric history, ethnic origin and knowledge of contraception. Women in the population survey, however, were found to be older, of higher social class, more likely to be white and of UK origin, and to have higher contraceptive knowledge scores. However, when the results were adjusted for age, the differences in social class and several other variables disappeared, although differences in ethnic origin remained. CONCLUSION: It was concluded that apart from age and ethnic origin, there were no differences between women who were having abortions and those who were not. The evidence points to abortion rates being a function of fertility rate, which is in turn a function of culture, rather than the results of the activities of individual or sub-groups of women at particular risk.

Abortion Applicants↗
PubMed2000

Parental recall of birthweight: a good proxy for recorded birthweight?

Recent evidence suggests potential associations between birthweight and disease in later life. For resource or other reasons recorded birthweight may be unavailable to researchers who have access to uniquely relevant outcome data. The present study examined the validity of parental recall of birthweight. Parents of 1015 males and females aged 12 and 15 years participating in the Young Hearts Study (a cluster random sample of 1015 males and females aged 12 and 15 years from post-primary schools in Northern Ireland) completed a questionnaire which included a question about their child's birthweight. The answer provided was compared with recorded birthweight obtained from archived computerised child health records with a cut-off point for inaccurate reporting set at +/- 227 g (1/2 lb). The influence of social class and weight at birth on accuracy of recall was also determined. A total of 84.8% of parents accurately recalled their child's birthweight to within 227 g. Parents from non-manual occupation social classes recalled birthweight more accurately than those from manual occupation social classes (88.0 vs. 82.6% accurate: chi2 = 4.81, p = 0.03). Parents of low birthweight infants tended to recall their birthweight less accurately than parents of normal weight infants: 76.1% accurate compared to 86.1% accurate: chi2 = 3.54, p = 0.06. Parents of high birthweight infants recalled their birthweight less accurately than parents of normal weight infants: 78.5% accurate: chi2 = 3.94, p = 0.05. In conclusion, parentally recalled birthweight may be a suitable proxy for recorded birthweight for population based research into disease in childhood and adolescence.

Adolescent↗
PubMed1997

[Research on social support in health: current status and new challenges].

On the borderline between sociology and psychology, the concept of social support has made it possible to develop a whole research tradition aimed at explaining some of the differences existing in the distribution of mental and physical disease. The concept of social support itself, however, still presents some ambiguities which must be clarified. These problems are discussed and it is showed and shows that the topic can be enriched with the contribution of the social sciences. Different definitions of the concept itself, are briefly analysed and the complexity and multidimensional character of social support are highlighted. The association between social support and health is discussed. The differences and implications of the direct effect model and the buffering effect model are addressed, and the relevance of the construct of social support is enhanced. The need to study social support not only as a likely determinant of some forms of disease, but also as a dependent variable, is brought out. Some recent developments in the study of factors associated with the availability of social support are discussed. It is shown that social support is a product of certain social factors which can be clearly identified by sociological analysis. In order to illustrate this point, the structural determinants of a specific dimension of social support-attention-are discussed. The importance of structural variables like social class and gender in attempting to explain the differential distribution of certain forms of social support is emphasized. It is proposed, on the theoretical level, that the intersection between two related autonomous constructs-social class and social support-may better explain those aspects of these concepts that are of importance to observed heterogeneity in the distribution of mental and physical health. Different theoretical and methodological approaches to the understanding of the determinants of social support and its effect on health are suggested.

Humans↗
PubMed1992

Application of Fishbein and Ajzen's expectancy-value model to understanding fat intake.

A questionnaire on attitudes towards the consumption of food types (specified by verbal labels) which contribute highly to fat in the diet was completed by 240 subjects who were quota sampled for sex, age and social class. The person's attitude toward consumption was found to be a good predictor of reported consumption. Differences in responses were found between groups of subjects who were classified by sex, age and social class. In general, females, the lower age groups and the higher social class subjects were found to have lower consumption and more negative attitudes towards the food types included. Individual belief-evaluation products on taste and healthiness of the foods were more closely related to attitudes towards consumption than were other beliefs (e.g. on convenience and price).

Adolescent↗
PubMed1991

Why patients consult and what happens when they do.

OBJECTIVE: To study patients' perceptions of why they consulted the doctor, how ill they thought they were, and what happened in the consultation. To compare patients' perceptions before and after the consultation and to compare these perceptions with those of the doctor. DESIGN: Patients filled in a questionnaire before and after the consultation. The doctor filled a questionnaire in after the consultation. SETTING: Three general practices in Bedfordshire and one in Hertfordshire. PATIENTS: 500 consecutive patients consulting in each practice. MAIN OUTCOME MEASURES: Changes in patients' perceptions and differences between the perceptions of patients and doctors. RESULTS: Doctors perceived patients to be less ill than the patients themselves did. Patients from social classes IV and V and children perceived themselves to be more ill than the average. Patients perceived themselves to be less ill after the consultation. A third of patients attended because doctors had told them to, and a quarter of patients had already tried to treat their problem themselves when they attended the consultation. Doctors' perceptions of the consultation emphasised listening, supporting, and giving advice. Patients' perceptions emphasised prescribing, reassuring, and referring to a consultant. Doctors perceived that they listened, examined, and gave advice less to social classes IV and V than to social classes I, II, and III and gave explanations more often to men than to women. Patients perceived external factors rather than lifestyle factors as being more important in causing their problems. CONCLUSION: Doctors' perceptions of patients' problems differed from those of patients expressed both before and after their consultation. Doctors' and patients' perceptions also differed about the consultation itself. The consultation reassured some patients.

Attitude to Health↗
PubMed1995

Childhood leukaemia and non-Hodgkin's lymphoma near large rural construction sites, with a comparison with Sellafield nuclear site.

OBJECTIVE: To determine whether population mixing produced by large, non-nuclear construction projects in rural areas is associated with an increase in childhood leukaemia and non-Hodgkin's lymphoma. DESIGN: A study of the incidence of leukaemia and non-Hodgkin's lymphoma among children living near large construction projects in Britain since 1945, situated more than 20 km from a population centre, involving a workforce of more than 1000, and built over three or more calendar years. For periods before 1962 mortality was studied. SETTING: Areas within 10 km of relevant sites, and the highland counties of Scotland with many hydroelectric schemes. SUBJECTS: Children aged under 15. RESULTS: A 37% excess of leukaemia and non-Hodgkin's lymphoma at 0-14 years of age was recorded during construction and the following calendar year. The excesses were greater at times when construction workers and operating staff overlapped (72%), particularly in areas of relatively high social class. For several sites the excesses were similar to or greater than that near the nuclear site of Sellafield (67%), which is distinctive in its large workforce with many construction workers. Seascale, near Sellafield, with a ninefold increase had an unusually high proportion of residents in social class I. The only study parish of comparable social class also showed a significant excess, with a confidence interval that included the Seascale excess. CONCLUSION: The findings support the infection hypothesis and reinforce the view that the excess of childhood leukaemia and non-Hodgkin's lymphoma near Sellafield has a similar explanation.

Adolescent↗
PubMedDate not supplied

[Socioeconomic inequalities in health in the Tuscany Longitudinal Study (SLTO): persistence and changes over time in overall mortality and selected causes (lung cancer, liver cirrhosis, AIDS and overdose)].

We evaluate the persistence of social inequalities in overall mortality or mortality by causes (lung cancer, liver cirrhosis; AIDS and overdose) in the Tuscany Longitudinal Study (SLTo), a record linkage-study on the census population identified at the 1981 and 1991 censuses in Leghorn (1981: 175,741 subjects; 1991: 167,512 subjects), and 1991 in Florence (403,294 subjects), Central Italy. The census data allow an evaluation of socio-economic status of each subject, using variables such as education or occupation, or constructing indexes inclusive of deprivation indexes. Follow-up is from the census up to 1995 and for specific causes of death from 1987 (Leghorn) or 1991 (Florence). Estimates of risk are computed comparing rates of mortality among socio-economic groups, by means of poisson regression models, or by means of Standardized Mortality Ratios using the indirect method. The causes of deaths have been selected mainly because explained by known and strong determinants. As far as overall mortality, the results suggest the persistence of gradients by social class, more often negative among males. Mortality from lung cancer has a strong negative social class gradient among males, and a divergent gradient among women in the two towns, which is interpreted as the effect of a different prevalence of smoking by period, social class and sex. High RRs among lower socio-economic groups have been detected for liver cirrhosis mortality. Excess mortality of AIDS and overdose, an expression of the recent drug crisis, concentrates on the lower social strata and in young adults. Whereas mortality from AIDS has been detected among both sexes, deaths from overdose are occurring among males only. Being AIDS and overdose recent diseases, they stress the persistence of social inequalities over time.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Association between mortality among women and socioeconomic factors in general practices in Edinburgh: an application of small area statistics.

Women aged 45-64 in 78 general practices in the city of Edinburgh were followed up for five to seven years and all cause mortality noted. Standardised mortality ratios were calculated for the individual practices. Postcodes were available for a 20% sample of these women and were used to retrieve relevant measures of social class and deprivation from the 1981 census for the smallest division, the enumeration district. Weighted averages gave socioeconomic variables at the level of the general practice. High positive correlations were found between standardised mortality ratios and the socioeconomic variables, with the highest being for percentage overcrowding. This study established that the relation between deprivation and excess mortality can be shown in general practices in one large city and gave a direct relation for women without reference to their husbands' occupations, thus obviating problems of assigning social class. The data also partially refute the "social drift" hypothesis as an explanation of the association between mortality and social class.

Female↗
PubMed1995

Male and female health problems in general practice: the differential impact of social position and social roles.

Sex, social position and social roles have been identified as important health predictors. Moreover, various social variables have been found to bear differently upon female as compared to male health. This study analyses data from a large-scale registration project in general practice (the Continuous Morbidity Registration), pertaining to the medical diagnoses of nearly 10,000 patients over a five year period. The effects of sex, social class, marital and parental status on a number of distinct categories of health problems were established, and a possible differential impact of social position and social roles on male and female health was explored. Categories of health problems studied were 'overall health problems', 'sex specific conditions', 'symptoms without disease', 'prevention and diagnostics' and 'trauma'. Sex and, above all, social class were identified as important predictors of most categories of health problems, especially during the reproductive period of life. Marital status and parental status did not contribute substantially to most types of health problems. Rates of prevention and diagnostics, sex specific conditions and total number of health problems could to a certain extent be predicted by the four sociodemographic variables, as opposed to trauma rates and symptoms without disease rates. Social class appeared the only variable with a substantially different effect on male vs female rates of sex specific conditions, prevention and diagnostics and trauma, but not so for overall health problems and symptoms without disease. Marital status and parental status did not differ significantly in their effect on male vs female health. Results illustrate that differentiation of the health variable into categories of health problems elucidates the relationship between sex, social variables and health.

Adolescent↗
PubMed2005

Sociodemographic factors and delays in the diagnosis of six cancers: analysis of data from the "National Survey of NHS Patients: Cancer".

This paper aims to explore the relationship between sociodemographic factors and the components of diagnostic delay (total, patient and primary care, referral, secondary care) for these six cancers (breast, colorectal, lung, ovarian, prostate, or non-Hodgkin's lymphoma). Secondary analysis of patient-reported data from the 'National Survey of NHS patients: Cancer' was undertaken (65 192 patients). Data were analysed using univariate analysis and Generalised Linear Modelling. With regard to total delay, the findings from the GLM showed that for colorectal cancer, the significant factors were marital status and age, for lung and ovarian cancer none of the factors were significant, for prostate cancer the only significant factor was social class, for non-Hodgkin's lymphoma the only significant factor was age, and for breast cancer the significant factors were marital status and ethnic group. Where associations between any of the component delays were found, the direction of the association was always in the same direction (female subjects had longer delays than male subjects, younger people had longer delays than older people, single and separated/divorced people had longer delays than married people, lower social class groups had longer delays than higher social class groups, and Black and south Asian people had longer delays than white people). These findings should influence the design of interventions aimed at reducing diagnostic delays with the aim of improving morbidity, mortality, and psychological outcomes through earlier stage diagnosis.

Adult↗
PubMed2004

Social position and minor psychiatric morbidity over time in the British Household Panel Survey 1991-1998.

STUDY OBJECTIVE: To examine social inequalities in minor psychiatric morbidity as measured by the GHQ-12 using lagged models of psychiatric morbidity and changing job status. DESIGN: GHQ scores were modelled using two level hierarchical regression models with measurement occasions nested within individuals. The paper compares and contrasts three different ways of describing social position: income, social advantage and lifestyle (the Cambridge scale), and social class (the new National Statistics Socio-Economic Classification), and adjusts for attrition. SETTING: Survey interviews for a nationally representative sample of adults of working age living in Britain. PARTICIPANTS: 8091 original adult respondents in 1991 who remain of working age during 1991-1998 from the British Household Panel Survey (BHPS). MAIN RESULTS: There was a relation of GHQ-12 to social position when social position was combined with employment status. This relation itself varied according to a person's psychological health in the previous year. CONCLUSIONS: The relation between social position and minor psychiatric morbidity depended on whether or not a person was employed, unemployed, or economically inactive. It was stronger in those with previously less good psychological health. Among employed men and women in good health, GHQ-12 varied little according to social class, status, or income. There was a "classic" social gradient in psychiatric morbidity, with worse health in less advantaged groups, among the economically inactive. Among the unemployed, a "reverse" gradient was found: the impact of unemployment on minor psychiatric morbidity was higher for those who were previously in a more advantaged social class position.

Adult↗
PubMed2006

Birth characteristics and the risk of childhood leukaemias and lymphomas in New Zealand: a case-control study.

BACKGROUND: Some studies have found that lower parity and higher or lower social class (depending on the study) are associated with increased risks of childhood acute lymphoblastic leukaemia (ALL). Such findings have led to suggestions that infection could play a role in the causation of this disease. An earlier New Zealand study found a protective effect of parental marriage on the risk of childhood ALL, and studies elsewhere have reported increased risks in relation to older parental ages. This study aimed to assess whether lower parity, lower social class, unmarried status and older parental ages increase the risk of childhood ALL (primarily). These variables were also assessed in relation to the risks of childhood acute non-lymphoblastic leukaemia, non-Hodgkin's lymphomas and Hodgkin's disease. METHODS: A case control study was conducted. The cases were 585 children diagnosed with leukaemias or lymphomas throughout New Zealand over a 12 year period. The 585 age and sex matched controls were selected at random from birth records. Birth records from cases (via cancer registration record linkage) and from controls provided accurate data on maternal parity, social class derived from paternal occupation, maternal marital status, ages of both parents, and urban status based on the address on the birth certificate. Analysis was by conditional logistic regression. RESULTS: There were no statistically significant associations overall between childhood ALL and parity of the mother, social class, unmarried maternal status, increasing parental ages (continuous analysis), or urban status. We also found no statistically significant associations between the risks of childhood acute non-lymphoblastic leukaemia, non-Hodgkin lymphomas, or Hodgkin's disease and the variables studied. CONCLUSION: This study showed no positive results though of reasonable size, and its record linkage design minimised bias. Descriptive studies (eg of time trends of ALL) show that environmental factors must be important for some diagnoses. Work has been done on the risk of ALL in relation to chemicals (eg pesticides) and drugs, dietary factors (eg vitamins), electromagnetic fields and infectious hypotheses (to name some); but whether these or other unknown factors are truly important remains to be seen.

Journal Article↗
PubMed1988

Age-related hearing difficulties. II. Psychological and sociological consequences of hearing problems--a controlled study.

71 individuals aged 70-75 years, whose audiological profile has been described in part I' of the study, were subjected to an extensive psychological questionnaire to evaluate the influence of hearing impairment on the psychological and sociological profile and general behaviour. The subjects consisted of three groups: first-time applicants for hearing-aids, re-applicants, and a control group not complaining of hearing problems. Neither hearing deterioration in general, as measured by hearing handicap and communication handicap, nor noise-induced hearing impairment was correlated to social class. The general activity level and the intellectual capacity were independent of hearing level, but a significant correlation was found between activity level and intellectual capacity. Also social class was correlated to activity level and intellectual level. Thus, a highly active life was correlated to preserved intellect and higher social class. Most of the elderly regarded themselves as being active, but this did not correlate with the objective activity score. Decreased activity was not correlated to hearing problems, but rather to physical limitations, decreased number of interests, tiredness. Self-perception was not influenced by the degree of hearing handicap and a stable mood and an optimistic attitude predominated. Only 14% experienced a depressed mood, and this state seemed to be linked to deteriorated hearing.

Aged↗
PubMed1986

The nutrient intakes of pregnant and lactating mothers of good socio-economic status in Cambridge, UK: some implications for recommended daily allowances of minor nutrients.

1. Forty-two mothers from social classes I, II and III non-manual and twenty-one from social classes III manual M), IV and V were studied longitudinally. The mean daily nutrient intakes in months 4-9 of pregnancy, months 2-4 of lactation and 3 and 6 months post-lactation are presented and are compared with the UK and the US recommended daily allowances (RDA). 2. The quality of the diets (nutrients per 4184 kJ (1000 kcal] was found to be better than that of other adult female populations studied in the UK, except for a group of dietitians. 3. The mean daily intakes of nutrients for which there are UK RDA were almost all greater than 100% of the RDA. The exceptions were iron, which in the manual group (social classes IIIM, IV and V) was 85% of the RDA in pregnancy and 75% post-lactation, and vitamin D. 4. Among the nutrients for which there are US, but not UK RDA, only phosphorus and vitamin B12 intakes were greater than 100% of the RDA in both groups at all stages of the study. Intakes of other nutrients were below the RDA: pantothenate 70-91, vitamin B6, zinc, vitamin E and copper 40-72, folate 21-44, and biotin less than 20% of the RDA. 5. The bases of the RDA for adult women were examined; for most nutrients the information is limited. It was concluded that the RDA for magnesium, vitamin E and pantothenate are probably higher than necessary and that deficiency is unlikely; that zinc, copper, vitamin B6 and folate are probably 'marginal' nutrients for 'at risk' groups; and that information on biotin is insufficient even roughly to assess the dietary requirement.

Adult↗