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PubMed1977

Differences between dental health data obtained by interviews and questionnaires.

Two hundred and eighty-six persons out of a population of 358 were interviewed about dental health. Approximately 9 months later the same group was posed identical questions in a self-administered questionnaire. An open-ended question about reasons for loss of teeth showed nearly 50% more answers on the questionnaire than in the interview. The number of answers in the questionnaire fell with increasing age and decreasing income and/or lower social class, while sex, age, income, and social class seemed to have only a minor effect on the number of answers in the interview. The number of two-reply categories varied between the interview and the questionnaire. To questions about water fluoridation and covering of dental expenses by Social Security, married couples gave more often identical replies on the questionnaire than in the interview. The findings imply that the method itself, i.e. the choice between the interview and questionnaire methods, is of importance for the results as such.

Adult↗

PubMed1980

Cot deaths in Edinburgh: infant feeding and socioeconomic factors.

One hundred and twenty-six consecutive cases of sudden infant death syndrome (SIDS) in the Edinburgh area have been studied with particular reference to the interrelationship of feeding, associated biochemical changes, and social status. There was an excess of cases born to parents in Social Classes IV and V: the effect was maximal in children who dies beyond 12 weeks of age. A low-grade uraemia was discovered in approximately one-fifth of the cases; analysis showed this to be related most strongly to bottle-feeding. Feeding habits were found to be associated with social class and this accounted for the relationship between bottle-feeding and the youth of mothers and also for an apparent relationship between uraemia in the infant and social class of the mother. Mothers of SIDS children were younger than expected and SIDS was found to be electrolyte imbalance is common in SIDS cases, nor did the findings support the suggestion that cross-infection due to overcrowding is an important aetiological factor. The significant factors of young motherhood, low social status, bottle-feeding, and mild uraemia in the babies are interrelated and seem to focus attention on unwitting 'mothering problems'. It is, however, not easy to see how this, or any other hypothesis, can account for all cases of SIDS.

Age Factors↗

PubMed1995

Hormone replacement therapy: characteristics of users and non-users in a British general practice cohort identified through computerised prescribing records.

STUDY OBJECTIVE: To assess the feasibility of recruiting a cohort of women, including long term users of postmenopausal hormone replacement therapy (HRT), through computerised general practice prescribing records, and to compare clinical and demographic characteristics of users and non-user controls. DESIGN: Cross sectional analysis of questionnaire data. SETTING: Subjects were recruited through 17 general practices in the Oxfordshire, south west Thames, and north west Thames regions that contributed to the VAMP Research Database. PARTICIPANTS: A total of 2964 women aged 45-64 years were identified. Altogether 1482 were long term (> 1 year) users of HRT and 1482 were non-user controls: 1037 (70%) of the users and 819 (55.3%) of the controls agreed to participate and provided questionnaire data. MAIN RESULTS: Users of HRT were more likely to have undergone hysterectomy than controls. Most women with a history of hysterectomy used unopposed oestrogen, while those with intact uteri generally used a combination of oestrogen and a progestagen. Among women who had undergone hysterectomy, HRT users did not differ significantly from controls over a range of demographic and clinical characteristics but they were more likely to be past users of oral contraceptives. Among women with intact uteri, users were similar to controls in terms of reported clinical characteristics, but were of higher social class and were more likely to be past users of oral contraceptives and to have had a mammogram after the age of 50. Compared with the general population, all categories of women recruited to the study were of higher social class and exhibited more health conscious behaviours. CONCLUSIONS: Electronic general practice prescribing records provide a feasible and efficient method for recruiting women to a cohort of HRT. Women who agreed to participate in this study were not representative of the general population, emphasising the importance of internal controls in such a study. Among participants, HRT users who had not undergone hysterectomy showed evidence of better health than non-users on some dimensions. In the whole sample, however, there were no appreciable differences in social class and self reported health indicators between users and controls.

Cohort Studies↗

PubMed2000

Understanding income inequalities in health among men and women in Britain and Finland.

The aims of this study were to investigate whether the relationship between income and self-perceived health is similar for men and women in two contrasting welfare states, Britain and Finland; whether the relationship between income and health is accounted for by employment status, education, and occupational social class; and whether the association differs when using alternative ways of measuring income: gross individual and net household equivalent income. Among British and Finnish men, low household and low individual income were related to poor health, even after adjusting for employment status, education, and social class. The adjusted relationship between individual income and health was stronger for British than Finnish men. Among British and Finnish women, net household equivalent income was strongly related to health, but after adjusting for employment status, education, and social class this relationship became weaker for British women and practically disappeared for Finnish women. For British women the association between income and health differed strongly depending on the income measure used; gross individual income had almost no effect on health. These results indicate that the association between health and income has no threshold in the sense that only people in poverty have poorer health than others. In further studies of income and health, household equivalent income should be used as the principal measure of income with adjustments for employment status, and men and women should be studied separately.

Cross-Sectional Studies↗

PubMed1996

Quality of life after stroke.

BACKGROUND AND PURPOSE: The purposes of this study were to examine overall and domain-specific quality of life in long-term stroke survivors and to identify variables that predict quality of life after stroke. METHODS: The study used a cross-sectional, descriptive correlational design. Subjects were 86 stroke survivors who were interviewed 1 to 3 years after stroke. Quality of life was measured with the use of an instrument that assesses satisfaction and importance for four domains (health and functioning, socioeconomic, family, and psychological-spiritual). Independent variables were age, social class, aphasia, functional status, motor impairment, depression, comorbidity, and perceived social support. Multiple regression analysis was used to predict quality of life. RESULTS: Thirty percent of subjects scored in the depressed range. The mean overall quality of life score was relatively high and was comparable to that of a normative population. Quality of life was highest for the family domain and lowest for health and functioning. Depression, perceived social support, and functional status predicted quality of life (adjusted R2 = .38) and contributed to prediction of domain quality of life. Social support and three additional variables, social class, age, and cardiovascular disease, predicted socioeconomic quality of life. CONCLUSIONS: The identification of depression, social support, and functional status as predictors of quality of life suggests the need to assist stroke survivors in coping and in maintaining and strengthening their support systems.

Adaptation, Psychological↗

PubMed2002

Psychosocial correlates of low-back pain in adolescents.

Knowledge is sparse concerning associations between juvenile low-back pain (LBP) and psychosocial factors. A cross-sectional study was performed to study whether juvenile LBP may be associated with self-reported headache and wellbeing, and with social class and parental LBP reported by the parents. The material comprised all adolescents (n=105), aged 14.1-16.1 years, in a rural municipality and in a nearby urban area in inland Norway. The response rate was 84% (n=88). Data were supplied from questionnaires filled out by the adolescents and their parents. Associations were calculated by bivariate and multivariate methods. The level of significance was set at P< or =0.05. In multivariate analyses, associations were found between LBP and both female gender and poor wellbeing, in particular poor self-perceived fitness. There was a tendency towards an association between weekly headache and LBP. No associations were found between social class, parental LBP and juvenile LBP. The results do not confirm hypotheses that social class and parental LBP are related to juvenile LBP. The findings indicate that poor wellbeing, in particular poor self-perceived fitness, is associated with LBP among adolescents.

Adolescent↗

PubMed1994

Understanding differences between high and low childhood accident rate areas: the importance of qualitative data.

BACKGROUND: The research discussed in the paper was undertaken for a District Health Authority to aid the development of appropriate policies to achieve the Health of the nation strategic target for reducing the death rate from accidents amongst children under 15. There has been a great deal of quantitative and epidemiological research into childhood accidents which has demonstrated a clear social class gradient in childhood accidents, fatalities and injuries. Less research has been undertaken into the possible reasons for the 'social patterning' of accidents and other aspects of health. Recent sociological research on childhood accidents has adopted a more qualitative approach and studied childhood safety within a family and community context. This approach has been used in the Huddersfield study on parental perspectives on childhood safety. METHODS: In-depth interviews were held with a sample of parents from a high and a low childhood accident rate area. RESULTS: The two focus areas reveal contrasting social profiles. There were significant differences on a number of aspects of parental perceptions on safety and beliefs about accidents, in the two areas. Analysis of accident events revealed that all the families in the high childhood accident rate area sample had children who had had an accident in the past which required hospital treatment. A high proportion of their children had experienced 'near misses'. In contrast, half the families in the low childhood accident rate area had children who had experienced an accident in the past and a much smaller proportion had experienced 'near misses'. All the parents in the sample from both areas developed rules, routines and practices to keep their children safe. The study suggests that there are social class differences in the effective use of these safety rules. CONCLUSION: Qualitatively orientated sociological research into parental perspectives on childhood safety contributes to an understanding of the reasons for the social patterning of childhood accidents. Such information should be of help to professionals in their prevention and safety promotion work.

Accident Prevention↗

PubMed1996

The development and prevention of cardiovascular disease risk factors: socioenvironmental influences.

In Third World countries, coronary heart disease is more frequent in the upper classes. In industrial countries such as the United States, Canada and the United Kingdom, there has been a widening social class difference in the opposite direction. Yet the social class differences have been largely ignored in the development of public health programs to prevent cardiovascular disease. This paper presents specific recommendations to correct this glaring defect, including giving priority to the reduction of risk factor prevalence among low-income blue collar and white collar workers; strengthening regulatory, taxation and other measures that directly impact all classes of the population; reversing the declining living standards of large segments of the U.S. population which result from current economic and political policy; and greatly expanding the resources available for public health programs from their grossly inadequate level.

Aged↗

PubMed1989

Deprivation: explaining differences in mortality between Scotland and England and Wales.

To detect reasons for the difference in mortality between Scotland and England and Wales a measure of deprivation was studied, comprising overcrowding, unemployment of men, low social class, and not having a car. Data for Scotland for 1980-2 showed this measure to be strongly associated with mortality, with gradients being particularly steep in young adults. Deprivation was much severe in Scotland than in England and Wales. These findings suggest that much excess mortality may be ascribed to more adverse conditions. Standardising the mortality ratios to take account of the relative affluence and deprivation of the two populations led to the differentials observed being radically adjusted, while standardising for social class had little effect. Deprivation measures based on areas overcome many of the limitations associated with social class analysis and also show much greater discrimination between populations. Measures of deprivation apparently provide a powerful basis for explanation of health differences. Such measures should therefore form part of the 1991 census output to facilitate their use on a consistent basis.

Automobiles↗

PubMed1982

Severe sunburn and subsequent risk of primary cutaneous malignant melanoma in scotland.

A case-control study of occupational and recreational sun exposure, Mediterranean and other sun-exposed holidays, tanning history and history of isolated episodes of severe sunburn has been carried out on 113 patients with cutaneous malignant melanoma and 113 age- and sex-matched controls. Social class and skin type were also considered in the analysis of the data which involved the use of conditional multiple logistic regression. A highly significant increase in the history of severe sunburn was recorded in melanoma patients of both sexes in the 5-year period preceding presentation with their tumour. Higher social class and negative history of recreational sun exposure were also significantly increased in patients by comparison with controls. In the male group severe sunburn, lack of occupational sun exposure and higher social class were significant factors while in the female group only severe sunburn was significantly increased in the melanoma patients. This study thus provides evidence to suggest that short intense episodes of UV exposure resulting in burning may be one of the aetiological factors involved in subsequent development of melanoma.

Adolescent↗

PubMed2003

The importance of composite foods for estimates of vegetable and fruit intakes.

OBJECTIVE: To evaluate the contribution of composite foods to vegetable and fruit intakes in Irish adults and to compliance with dietary guidelines for vegetable and fruit intake. DESIGN: Data were analysed from the North/South Ireland Food Consumption Survey of 18-64-year-old adults (n=1379; 662 men, 717 women), which used a 7-day food diary to estimate food intake. RESULTS: The mean intake of vegetables (excluding potatoes) was 140 g day(-1) (men 149 g day(-1); women 132 g day(-1)), of fruit was 136 g day(-1) (men 133 g day(-1); women 140 g day(-1)) and of potatoes was 227 g day(-1) (men 296 g day(-1); women 163 g day(-1)). The mean daily intakes of vegetables, fruit and potatoes from composite foods were 37 g (26%), 6 g (5%) and 17 g (7%), respectively. The mean intake of vegetables from composite foods was unrelated to age or gender, but increased with increasing social class and level of education attained. The proportions of men and women meeting the recommendation for >or=400 g day(-1) (5 servings of 80 g per day) of vegetables and fruit were 21% (15% excluding composite foods) and 19% (12% excluding composite foods), respectively. Compliance with the dietary recommendation decreased with decreasing levels of educational attainment and social class. CONCLUSION: Intakes of vegetables and fruit are low compared with current dietary recommendations, particularly in those of lower levels of educational attainment and social class. Composite foods are an important source of vegetables (less importantly of fruit) and should be included when estimating vegetable intakes. Failure to do so may result in bias in estimates of intake and of compliance with dietary guidelines for population groups, as well as misclassification of individuals by level of intake.

Adolescent↗

PubMed1992

Biosocial factors affecting menarche in a mixed Nigerian population.

A prospective study of school girls in a mixed Nigerian population revealed that the mean menarcheal age was 13.98 +/- 1.30 years. The mean menarcheal age was influenced by the social class of the parents, being higher in the lower social class, there were considerable variations in the biologic measurements (height, weight and body mass index) among girls who attained menarche.

Adolescent↗

PubMed2005

[Use of the Information, Memory and Concentration (IMC) Test in the epidemiological study of senile dementia in Fortaleza,Ceará (Brazil)].

The objective of the present paper was to verify the occurrence of senile dementia in the city of Fortaleza, Brazil. A screening test, the Information, Memory and Concentration Test (IMC), was applied to 865 persons (65 years old and older). The Test includes questions on personal identification, recent and remote memory and concentration. Dementia was determined as a function of the total score obtained by the person in the test previously examined as far as sensitivity and specificity are concerned. The results were analysed according to age, sex and social strata. It was demonstrated a prevalence of dementia of 8.4% in the sample studied with no significant difference in the proportions of cases among people 75 years old or older (9.3%) as compared to the group younger, 65 to 74 years old, (7.5%). The percentage of dementia was similar between men (8.7%) and women (8.3%). It was verified a progressive increase in the frequency of dementia ranging from 5.2% for the higher social classes (A/B) to 6.9% and 10.3% for medium (C) and lower (D/E) ones respectively, with a significant difference between the social classes A/B and D/E. These results, however, should be seen with caution because of the percentage of refuse especially in the higher, A/B (19.3%) and lower D/E (9.3%) social classes.

English Abstract↗

PubMed2002

Oral cleanliness, gingivitis, dental caries and oral health behaviours in Jordanian children.

The aims of the study were to investigate the association between oral cleanliness, gingivitis and sociodemographic factors, dental caries and oral health behaviours amongst 4-5-year-old Jordanian children. A two stage random sampling procedure was used to select children enrolled in kindergartens in Amman. Clinical examinations were carried out by one examiner. Mothers completed questionnaires relating to sociodemographic factors and oral health behaviours. Presence of gingivitis and of four or more sites with dental plaque were seen in 66% and 83% of the children, respectively. No differences in these outcomes were seen between ages and genders. Social class and oral hygiene behaviours were important risk indicators for the level of oral cleanliness and presence of gingivitis. Higher percentages of children with four or more sites with plaque and with gingivitis had a dmft score equal or greater than four. Due to the high level of dental plaque accumulation, presence of gingivitis and their association with social class, dental caries and oral hygiene behaviours, attention should be given to the oral health of these children. In particular to the oral health of children attending kindergartens in areas of lower social class in Amman.

Child, Preschool↗

PubMed1997

Behavioural adjustment in school of very low birthweight children.

The school-based behavioural adjustment at 7-8 years of a cohort of 243 prematurely born, very low birthweight (< 1501 g) children and their normal birthweight controls is reported. The findings indicate that the children born preterm (both male and female) were rated by their teachers as expressing more behaviour problems than their controls, and were less well adjusted to the school environment. The deficits noted in the preterms applied across the social classes, with no amelioration noted in preterms of higher social class. It is speculated that the problem behaviours reflect a failure in self-regulatory functions.

Attention Deficit Disorder with Hyperactivity↗

PubMed2001

Use of alternative medicines in a multi-ethnic population.

BACKGROUND: The prevalence and cost of regular use of non-prescribed alternative medicines are rising around the world, yet, little evidence is available that demonstrates the safety, efficacy, or effectiveness of specific alternative medicine interventions. It is of interest to understand how and why these practices have become so popular in different societies with different health care organizations and provisions, and which factors predict the regular use of alternative medicines. METHODS: We assessed the prevalence and the predictors of regular use of non-prescribed vitamin supplements, cod liver oil, primrose oil, and garlic in a cross-sectional population-based study in South London of 1,577 men and women, aged 40-59 years (883 women, 523 White, 549 of African origin and 505 of South Asian origin), when allowing for potential confounders. RESULTS: The prevalence of regular users of alternative medicines was 10.4% (164/1,577); 7.4% (116) made regular use of non-prescribed vitamin supplements, whereas 5.3% (84) used either cod liver oil, primrose oil, or garlic preparations. When adjusted for age, ethnicity and social class, women were more likely than men to use at least one alternative medicine (OR 2.09 [95% CI 1.45-3.00]). This was true both for vitamin supplements (1.98 [1.29-3.03]) and for oil or garlic supplements (1.91 [1.17-3.14]). The use of oil or garlic (P<.005) but not vitamin supplements (P=.32) varied by ethnic group. In particular, Black people of African origin were more likely to use alternative medicines than either Whites (1.78 [1.07-2.94]) or South Asians (1.66 [1.07-2.59]), the least common users. People in social classes IV and V were less likely to use alternative medicines (0.53 [0.31-0.90]) than those in social classes I and II, though this was due more to lesser use of non-prescribed vitamin supplements than of cod liver oil, primrose oil or garlic. These associations were not attenuated by further adjustment for body mass index, smoking, marital status and age at leaving full-time education. CONCLUSIONS: The regular users of alternative medicines in London are more likely to be women, of African origin, and of higher socioeconomic status. Given the lack of evidence of efficacy and safety of these alternative medicines, it is important to understand the cultural differences in values and beliefs about traditional medicine that may underlie these findings.

Adult↗

PubMed1990

Using a "lifestyle" perspective to understand toothbrushing behaviour in Scottish schoolchildren.

Using data from a wider survey of health related behaviour in 4,935 Lothian schoolchildren, 11, 13, and 15 yr old, this paper analysed toothbrushing frequency and its relation to "lifestyle" factors. Analysis of the results showed that girls brush more frequently than boys and that children with higher social class background brushed more frequently than children with low social class background. Further toothbrushing frequency was significantly related to the subjects' health perception, smoking and drinking habits, eating habits, bedtimes, and video-watching. Moreover, all these lifestyle factors were inter-related. The paper reinforced the concept of lifestyle as a meaningful descriptive term. The results demonstrated that the bivariate associations are pieces in a more complex mosaic. Toothbrushing thus seems to be an integrated part of a child's lifestyle and should be regarded as such in future health promotion efforts.

Adolescent↗

PubMed1990

Occupational and socioeconomic factors associated with peptic ulcer and with cancers following consequent gastric surgery.

Over 3000 patients, treated surgically for peptic ulcers, were assigned to a Social Class and Occupation Group using information obtained either from their death certificates or from their hospital notes. An analysis of the relationship of socioeconomic status and occupation with the site of original ulcer and the risk of cancer is reported. The major observations were: (a) an association of gastric ulcer with manual and of duodenal ulcer with non-manual Social Class; (b) an association of gastric cancer with dusty occupation and colorectal cancer with professional and managerial workers; and (c) no association between post-surgery gastric cancer risk and social class. This implies that the early stages of gastric carcinogenesis are related to poor socioeconomic conditions but the progression from the precursor lesion (in this case gastric ulcer) to gastric cancer is not, and is consistent with the multistage hypothesis of gastric carcinogenesis proposed by Correa [Diet and Human Carcinogenesis (Edited by Joosens, J. V., Hill, M. J. and Geboers, J.), pp. 109-115. Excerpta Medica, Amsterdam (1985)].

Colorectal Neoplasms↗