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Whitley E, McCartney G, Bartley M, Benzeval M. Examining the impact of different social class mechanisms on health inequalities: A cross-sectional analysis of an all-age UK household panel study. Soc Sci Med 2022; 312:115383. [PMID: 36155357 DOI: 10.1016/j.socscimed.2022.115383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/24/2022] [Accepted: 09/16/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Socioeconomic inequalities are well established across health, morbidity and mortality measures. Social class theory describes how social groups relate, interact and accrue advantages/disadvantages relative to one another, with different theorists emphasising different dimensions. In the context of health inequalities, different social class measures are used interchangeably to rank population groups in terms of health rather than directly exploring the role of social class in creating inequalities. We aim to better understand how four distinct social class mechanisms explain differences in a range of self-reported and biological health outcomes. METHODS We use data from the UK Household Longitudinal Study, a representative population survey of UK adults, to identify measures pertaining to Early years, Bourdieusian, Marxist, and Weberian social class mechanisms. Using logistic and least-squares regression we consider the relative extent to which these mechanisms explain differences in health (Self-reported health, SF12 Physical (PCS) and Mental (MCS) Component Scores, General Health Questionnaire; N = 21,446) and allostatic load, a biomarker-based measure of cumulative stress (N = 5003). RESULTS Respondents with higher social position according to all social class measures had better self-rated, physical and mental health, and lower allostatic load. Associations with Marxist social class were among the strongest (e.g. Relative Index of Inequality for very good/excellent self-rated health comparing highest versus lowest Marxist social class: 4.96 (4.45, 5.52), with the Weberian measure also strongly associated with self-rated (4.35 (3.90, 4.85)) and physical health (Slope Index of Inequality for SF12-PCS: 7.94 (7.39, 8.48)). Health outcome associations with Bourdieusian and Marxist measures were generally stronger for women and older respondents, and physical health associations with all measures were stronger among those aged 50+ years. CONCLUSIONS The impact of social class on health is multi-faceted. Policies to reduce health inequalities should focus more on unequal capital ownership, economic democracy and educational inequalities, reflecting Marxist and Weberian mechanisms.
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Affiliation(s)
- Elise Whitley
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G3 7HR, UK.
| | - Gerard McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, G12 8RT, UK
| | - Mel Bartley
- Institute of Epidemiology & Health, University College London, London, WC1E 7HB, UK
| | - Michaela Benzeval
- Institute for Social and Economic Research, University of Essex, Colchester, CO4 3SQ, UK; Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
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Nieman CL, Suen JJ, Dean LT, Chandran A. Foundational Approaches to Advancing Hearing Health Equity: A Primer in Social Epidemiology. Ear Hear 2022; 43:5S-14S. [PMID: 35724250 PMCID: PMC9219014 DOI: 10.1097/aud.0000000000001149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hearing health is inextricably linked to factors beyond biology. Social, demographic, environmental, geographic, and historical influences affect hearing health, but these factors are often unmeasured within traditional biological, clinical, and epidemiological studies of hearing health. With increasing recognition of hearing health over the life course as a public health priority, there is also a growing understanding of existing hearing health inequities at the individual, community, national, and global levels. To make progress in addressing these inequities, public health disciplines, such as social epidemiology, can provide valuable frameworks. With a focus on integrating the biological and functional with social and structural factors influencing health, social epidemiology provides key concepts and approaches for filling existing research and practice gaps. In this review, we introduce the discipline of social epidemiology and its associated concepts to inspire greater cross-disciplinary collaboration for the ultimate goal of advancing hearing health equity.
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Affiliation(s)
- Carrie L Nieman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jonathan J Suen
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Kim E, Cho SI. Trajectories of health-related quality of life by change pattern of objective and subjective social status. SSM Popul Health 2022; 17:101061. [PMID: 35295744 PMCID: PMC8919292 DOI: 10.1016/j.ssmph.2022.101061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/19/2022] [Accepted: 03/01/2022] [Indexed: 12/05/2022] Open
Abstract
Long-term and cumulative social experiences influence an individual's objective and subjective social status. Social determinants of health are more effectively investigated by longitudinal rather than cross-sectional studies. The primary focus of this study was the prospective effect of socioeconomic transition on health-related quality of life trajectories. The study population were adults over 18 years of age who responded in all nine waves of the Korea Health Panel (2009–2017). Data were analyzed by group-based trajectory modeling to identify health trajectories, and group-based multi-trajectory modeling to investigate combined change patterns of objective and subjective social status (i.e., multi-SES trajectories). To predict the effects of underlying socioeconomic measures on health trajectory group membership, we included these time-stable covariates in trajectory modeling and estimated the risk of belonging to each trajectory based on the measures. The health-related quality of life trajectories showed three patterns during the period 2013 to 2017; 13.7% of individuals had a low and declining health trajectory and the others had a higher stable health trajectory. Four types of multi-SES trajectory were derived during the period 2009 to 2013; the richer had a steeper income slope while there were slight changes in subjective social status among all groups. These combined longitudinal SES patterns in 2009–2013 were strong predictors of subsequent health trajectory group membership in 2013–2017. These findings indicate that rich countries, such as South Korea, may encounter growing income inequality, where individuals become entrenched in income disparity that pins down their perceptions of social position. Over time this rigid social structure will widen the gap in health-related quality of life. Changes in health are strongly influenced by changes in the combined patterns of objective and subjective social status. Objective and subjective social status interact, forming distinct trajectories in the life-course. Benefits from society are concentrated on the privileged, exacerbating income inequality and health disparities over time.
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Wami W, McCartney G, Bartley M, Buchanan D, Dundas R, Katikireddi SV, Mitchell R, Walsh D. Theory driven analysis of social class and health outcomes using UK nationally representative longitudinal data. Int J Equity Health 2020; 19:193. [PMID: 33115485 PMCID: PMC7594287 DOI: 10.1186/s12939-020-01302-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/14/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Social class is frequently used as a means of ranking the population to expose inequalities in health, but less often as a means of understanding the social processes of causation. We explored how effectively different social class mechanisms could be measured by longitudinal cohort data and whether those measures were able to explain health outcomes. METHODS Using a theoretically informed approach, we sought to map variables within the National Child Development Study (NCDS) to five different social class mechanisms: social background and early life circumstances; habitus and distinction; exploitation and domination; location within market relations; and power relations. Associations between the SF-36 physical, emotional and general health outcomes at age 50 years and the social class measures within NCDS were then assessed through separate multiple linear regression models. R2 values were used to quantify the proportion of variance in outcomes explained by the independent variables. RESULTS We were able to map the NCDS variables to the each of the social class mechanisms except 'Power relations'. However, the success of the mapping varied across mechanisms. Furthermore, although relevant associations between exposures and outcomes were observed, the mapped NCDS variables explained little of the variation in health outcomes: for example, for physical functioning, the R2 values ranged from 0.04 to 0.10 across the four mechanisms we could map. CONCLUSIONS This study has demonstrated both the potential and the limitations of available cohort studies in measuring aspects of social class theory. The relatively small amount of variation explained in the outcome variables in this study suggests that these are imperfect measures of the different social class mechanisms. However, the study lays an important foundation for further research to understand the complex interactions, at various life stages, between different aspects of social class and subsequent health outcomes.
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Affiliation(s)
- Welcome Wami
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX UK
- Present Address: Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
| | - Gerry McCartney
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE UK
| | - Mel Bartley
- Institute of Epidemiology & Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Duncan Buchanan
- Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX UK
| | | | - Rich Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX UK
| | - David Walsh
- Glasgow Centre for Population Health, Olympia Building, Bridgeton Cross, Glasgow, G40 2QH UK
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5
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Sociodemographic differences affecting insufficient fruit and vegetable intake: a population-based household survey of Thai people. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-07-2019-0150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThe sociodemographic determinants of insufficient fruit and vegetable (FV) consumption in the general population in Thailand remain understudied. The purpose of this study was to investigate the association between sociodemographic characteristics and insufficient FV consumption in Thailand.Design/methodology/approachThis nationally representative survey employed a cross-sectional multi-stage sampling design. A total of 6,991 individuals aged 15 years or older participated in the study. Information on participants' FV consumption and sociodemographic characteristics were collected via questionnaire. The data were analyzed using binary logistic regression.FindingsThe overall prevalence of insufficient FV consumption in the study sample was 65.6%. Age of the participants, sex, marital status, place of residence, occupation, income and education were found to be significantly associated with insufficient FV consumption among this sample of the Thai population.Originality/valueFindings suggest the need for promotion of FV consumption and intervention policies aimed at increasing FV intake by taking into account sociodemographic characteristics of the population.
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Lahelma E, Rahkonen O. Class and health in changing societies: the need for novel approaches. J Epidemiol Community Health 2019; 74:1-2. [PMID: 31615891 DOI: 10.1136/jech-2019-213325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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McCartney G, Bartley M, Dundas R, Katikireddi SV, Mitchell R, Popham F, Walsh D, Wami W. Theorising social class and its application to the study of health inequalities. SSM Popul Health 2019; 7:015-15. [PMID: 31297431 PMCID: PMC6598164 DOI: 10.1016/j.ssmph.2018.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 01/24/2023] Open
Abstract
The literature on health inequalities often uses measures of socio-economic position pragmatically to rank the population to describe inequalities in health rather than to understand social and economic relationships between groups. Theoretical considerations about the meaning of different measures, the social processes they describe, and how these might link to health are often limited. This paper builds upon Wright's synthesis of social class theories to propose a new integrated model for understanding social class as applied to health. This model incorporates several social class mechanisms: social background and early years' circumstances; Bourdieu's habitus and distinction; social closure and opportunity hoarding; Marxist conflict over production (domination and exploitation); and Weberian conflict over distribution. The importance of discrimination and prejudice in determining the opportunities for groups is also explicitly recognised, as is the relationship with health behaviours. In linking the different social class processes we have created an integrated theory of how and why social class causes inequalities in health. Further work is required to test this approach, to promote greater understanding of researchers of the social processes underlying different measures, and to understand how better and more comprehensive data on the range of social class processes these might be collected in the future.
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Affiliation(s)
- Gerry McCartney
- NHS Health Scotland, 5th Floor, Meridian Court, 5 Cadogan Street, Glasgow, Scotland, UK
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Niessen LW, Mohan D, Akuoku JK, Mirelman AJ, Ahmed S, Koehlmoos TP, Trujillo A, Khan J, Peters DH. Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda. Lancet 2018; 391:2036-2046. [PMID: 29627160 DOI: 10.1016/s0140-6736(18)30482-3] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 07/24/2017] [Accepted: 01/17/2018] [Indexed: 12/01/2022]
Abstract
Five Sustainable Development Goals (SDGs) set targets that relate to the reduction of health inequalities nationally and worldwide. These targets are poverty reduction, health and wellbeing for all, equitable education, gender equality, and reduction of inequalities within and between countries. The interaction between inequalities and health is complex: better economic and educational outcomes for households enhance health, low socioeconomic status leads to chronic ill health, and non-communicable diseases (NCDs) reduce income status of households. NCDs account for most causes of early death and disability worldwide, so it is alarming that strong scientific evidence suggests an increase in the clustering of non-communicable conditions with low socioeconomic status in low-income and middle-income countries since 2000, as previously seen in high-income settings. These conditions include tobacco use, obesity, hypertension, cancer, and diabetes. Strong evidence from 283 studies overwhelmingly supports a positive association between low-income, low socioeconomic status, or low educational status and NCDs. The associations have been differentiated by sex in only four studies. Health is a key driver in the SDGs, and reduction of health inequalities and NCDs should become key in the promotion of the overall SDG agenda. A sustained reduction of general inequalities in income status, education, and gender within and between countries would enhance worldwide equality in health. To end poverty through elimination of its causes, NCD programmes should be included in the development agenda. National programmes should mitigate social and health shocks to protect the poor from events that worsen their frail socioeconomic condition and health status. Programmes related to universal health coverage of NCDs should specifically target susceptible populations, such as elderly people, who are most at risk. Growing inequalities in access to resources for prevention and treatment need to be addressed through improved international regulations across jurisdictions that eliminate the legal and practical barriers in the implementation of non-communicable disease control.
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Affiliation(s)
- Louis W Niessen
- Department of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan K Akuoku
- Department of Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | | | - Sayem Ahmed
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh; Health Economics and Policy Research Group, Department of Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Tracey P Koehlmoos
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Antonio Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jahangir Khan
- Department of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Health Economics and Policy Research Group, Department of Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dragano N, Verde PE, Moebus S, Stang A, Schmermund A, Roggenbuck U, Möhlenkamp S, Peter R, Jöckel KH, Erbel R, Siegrist J. Subclinical coronary atherosclerosis is more pronounced in men and women with lower socio-economic status: associations in a population-based study Coronary atherosclerosis and social status. ACTA ACUST UNITED AC 2016; 14:568-74. [PMID: 17667649 DOI: 10.1097/hjr.0b013e32804955c4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Social inequalities of manifest coronary heart diseases are well documented in modern societies. Less evidence is available on subclinical atherosclerotic disease despite the opportunity to investigate processes underlying this association. Therefore, we examined the relationship between coronary artery calcification as a sign of subclinical coronary atherosclerosis, socio-economic status and established cardiovascular risk factors in a healthy population. Design Cross-sectional. Methods In a population-based sample of 4487 men and women coronary artery calcification was assessed by electron beam computed tomography quantified by the Agatston score. Socio-economic status was assessed by two indicators, education and income. First, we investigated associations between the social measures and calcification. Second, we assessed the influence of cardiovascular risk factors on this association. Results After adjustment for age, men with 10 and less years of formal education had a 70% increase in calcification score compared with men with high education. The respective increase for women was 80%. For income the association was weaker (among men 20% higher for the lowest compared with the highest quartile; and among women 50% higher, respectively). Consecutive adjustment for cardiovascular risk factors significantly attenuated the observed association of socio-economic status with calcification. Conclusions Social inequalities in coronary heart diseases seem to influence signs of subclinical coronary atherosclerosis as measured by coronary artery calcification. Importantly, cumulation of major cardiovascular risk factors in lower socio-economic groups accounted for a substantial part of this association.
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Affiliation(s)
- Nico Dragano
- Department of Medical Sociology, University Clinic Düsseldorf, West-German Heart Center Essen, University Duisburg-Essen, Germany.
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Hiyoshi A, Fukuda Y, Shipley MJ, Bartley M, Brunner EJ. A new theory-based social classification in Japan and its validation using historically collected information. Soc Sci Med 2013; 87:84-92. [PMID: 23631782 DOI: 10.1016/j.socscimed.2013.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 03/09/2013] [Accepted: 03/13/2013] [Indexed: 11/22/2022]
Abstract
Studies of health inequalities in Japan have increased since the millennium. However, there remains a lack of an accepted theory-based classification to measure occupation-related social position for Japan. This study attempts to derive such a classification based on the National Statistics Socio-economic Classification in the UK. Using routinely collected data from the nationally representative Comprehensive Survey of the Living Conditions of People on Health and Welfare, the Japanese Socioeconomic Classification was derived using two variables - occupational group and employment status. Validation analyses were conducted using household income, home ownership, self-rated good or poor health, and Kessler 6 psychological distress (n ≈ 36,000). After adjustment for age, marital status, and area (prefecture), one step lower social class was associated with mean 16% (p < 0.001) lower income, and a risk ratio of 0.93 (p < 0.001) for home ownership. The probability of good health showed a trend in men and women (risk ratio 0.94 and 0.93, respectively, for one step lower social class, p < 0.001). The trend for poor health was significant in women (odds ratio 1.12, p < 0.001) but not in men. Kessler 6 psychological distress showed significant trends in men (risk ratio 1.03, p = 0.044) and in women (1.05, p = 0.004). We propose the Japanese Socioeconomic Classification, derived from basic occupational and employment status information, as a meaningful, theory-based and standard classification system suitable for monitoring occupation-related health inequalities in Japan.
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Affiliation(s)
- Ayako Hiyoshi
- Research Department of Epidemiology and Public Health, University College London, United Kingdom.
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Demiral Y, Arik H, Toğrul BU. The Association Between Employment Status and Metabolic Syndrome in Women: Modifying Effect of Education. Women Health 2012; 52:755-70. [DOI: 10.1080/03630242.2012.725240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Christ SL, Fleming LE, Lee DJ, Muntaner C, Muennig PA, Caban-Martinez AJ. The effects of a psychosocial dimension of socioeconomic position on survival: occupational prestige and mortality among US working adults. SOCIOLOGY OF HEALTH & ILLNESS 2012; 34:1103-17. [PMID: 22443309 PMCID: PMC4991360 DOI: 10.1111/j.1467-9566.2012.01456.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The association between education or income and mortality has been explored in great detail. These measures capture both the effects of material disadvantage on health and the psychosocial impacts of a low socioeconomic position on health. When explored independently of educational attainment and income, occupational prestige - a purely perceptual measure - serves as a measure of the impact of a psychosocial phenomenon on health. For instance, a fire-fighter, academician or schoolteacher may carry the social benefits of a higher social status without actually having the income (in all cases) or the educational credentials (in the case of the fire-fighter) to match. We explored the independent influence of occupational prestige on mortality. We applied Cox proportional hazards models to a nationally representative sample of over 380,000 US workers who had worked at any time between 1986 and 1994 with mortality follow up through 2002. We found that occupational prestige is associated with a decrease in the risk of all-cause, cancer, cardiovascular and respiratory-related mortality after controlling for household income and educational attainment. We further investigated the question of whether the effects of prestige are moderated by sex and broader occupational groupings. Prestige effects operate in white-collar occupations for men only and within service occupations for all workers.
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Affiliation(s)
- Sharon L Christ
- Department of Human Development and Family Studies and the Department of Statistics, Purdue University, West Lafayette, IN 47906, USA.
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Santos JAF. Class divisions and health chances in Brazil. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2011; 41:691-709. [PMID: 22053529 DOI: 10.2190/hs.41.4.e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article analyzes the association between class divisions and health chances in the Brazilian population. It uses data from the health supplement of the 2008 National Household Survey. Multiple logistic regression models are estimated to determine the relation between social class and self-rated health status. This empirical investigation of health inequalities combines two modalities for social class comparison, thus benefiting from the potential utility of each. On the one hand, socioeconomic inequalities in health are analyzed with reference to the combination of two main assets, capital and expert knowledge, which generate material and health advantages in Brazil. The results demonstrate that social class measurements for Brazil capture a source of variation in health chances among social groups that is independent of education and family income. On the other hand, the use of theoretically univocal categories for exploring diversified class contrasts offers some explanatory starting points for health inequalities in the Brazilian population.
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Affiliation(s)
- José Alcides Figueiredo Santos
- Universidade Federal de Juiz de Fora, Instituto de Ciências Humanas, Departamento de Ciências Sociais, Juiz de Fora, Brazil.
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Boylan S, Lallukka T, Lahelma E, Pikhart H, Malyutina S, Pajak A, Kubinova R, Bragina O, Stepaniak U, Gillis-Januszewska A, Simonova G, Peasey A, Bobak M. Socio-economic circumstances and food habits in Eastern, Central and Western European populations. Public Health Nutr 2011; 14:678-87. [PMID: 20843403 PMCID: PMC3951866 DOI: 10.1017/s1368980010002570] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the relationship between several socio-economic indicators and frequency of consumption of seven predefined healthy foods (consumption of fruit, vegetables, wholegrain bread, vegetable-fat spread, vegetable cooking fat, low-fat milk and low-fat cheese) in populations from Eastern, Central and Western Europe. DESIGN Analysis of baseline data collected in two cross-sectional cohort studies between 2000 and 2005: the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study and the Finnish Helsinki Health Study (HHS). SETTING Urban populations in the Czech Republic, Russia, Poland and Finland. SUBJECTS In the HAPIEE study, random samples of men and women aged 45-69 years were drawn from population registers and electoral lists of selected cities. In the HHS, men and women aged 40-60 years employed by the City of Helsinki were recruited. Data on 21,326 working subjects from both cohorts were analysed. RESULTS Healthy food habits were, in general, positively associated with higher education, occupational position and fewer economic difficulties, but there were differences in the strength of the gradient by food and country. Fruit consumption showed the most consistent gradients, especially in relation to socio-economic status among men (country-specific relative index of inequality (RII)=2.02-5.17) and women (RII=2.09-3.57). CONCLUSIONS The associations between socio-economic indicators and healthy food habits showed heterogeneity between countries. Future studies of dietary behaviours should consider multiple measures of socio-economic position.
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Affiliation(s)
- Sinéad Boylan
- Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
| | - Sofia Malyutina
- Institute of Internal Medicine, Russian Academy of Medical Sciences, Novosibirsk, Russia
| | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | | | - Oksana Bragina
- Institute of Internal Medicine, Russian Academy of Medical Sciences, Novosibirsk, Russia
| | - Urszula Stepaniak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | | | - Galina Simonova
- Institute of Internal Medicine, Russian Academy of Medical Sciences, Novosibirsk, Russia
| | - Anne Peasey
- Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
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15
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Employment relations, social class and health: A review and analysis of conceptual and measurement alternatives. Soc Sci Med 2010; 71:2130-40. [DOI: 10.1016/j.socscimed.2010.09.038] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 08/12/2010] [Accepted: 09/29/2010] [Indexed: 11/17/2022]
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Complaints of insomnia among midlife employed people: The contribution of childhood and present socioeconomic circumstances. Sleep Med 2010; 11:828-36. [DOI: 10.1016/j.sleep.2010.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 03/16/2010] [Accepted: 04/16/2010] [Indexed: 01/27/2023]
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Huisman M, Araya R, Lawlor DA, Ormel J, Verhulst FC, Oldehinkel AJ. Cognitive ability, parental socioeconomic position and internalising and externalising problems in adolescence: findings from two European cohort studies. Eur J Epidemiol 2010; 25:569-80. [PMID: 20535529 PMCID: PMC2921071 DOI: 10.1007/s10654-010-9473-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 05/27/2010] [Indexed: 11/28/2022]
Abstract
We investigated whether cognitive ability (CA) may be a moderator of the relationship of parental socioeconomic position (SEP) with internalising and externalising problems in adolescents. We used data from two longitudinal cohort studies; the Avon Longitudinal Study of Parents and Children (ALSPAC) and the Tracking Adolescents' Individual Lives Survey (TRAILS). Indicators of SEP were mother's education and household income. CA was estimated with IQ scores, derived from the Wechsler Intelligence Scale for Children. Internalising and externalising problems were measured with the Strengths and Difficulties Questionnaire in ALSPAC and with the Child Behavior Checklist in TRAILS. Logistic regression analyses were used to estimate the relative index of inequality (RII) for each outcome; the RII provides the odds ratio comparing the most to least deprived for each measure of SEP. In fully adjusted models an association of mother's education with externalising problems was observed [ALSPAC RII 1.42 (95%CI: 1.01-1.99); TRAILS RII 2.21 (95%CI: 1.37-3.54)], and of household income with internalising and externalising problems [pooled ALSPAC & TRAILS internalising RII 1.30 (95%CI: 0.99-1.71); pooled ALSPAC & TRAILS externalising RII 1.38 (95%CI: 1.03-1.84)]. No consistent associations were observed between mother's education and internalising problems. Results of stratified analyses and interaction-terms showed no evidence that CA moderated the association of SEP with internalising or externalising problems.
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Affiliation(s)
- Martijn Huisman
- Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, Groningen, The Netherlands.
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18
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The association of income with fresh fruit and vegetable consumption at different levels of education. Eur J Clin Nutr 2010; 64:324-7. [DOI: 10.1038/ejcn.2009.155] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Adult education and child mortality in India: the influence of caste, household wealth, and urbanization. Epidemiology 2008; 19:294-301. [PMID: 18300716 DOI: 10.1097/ede.0b013e3181632c75] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although socioeconomic position is generally found to be related to health, the associations can be different for different measures of socioeconomic position. We examined the association between adult education and child mortality, and the influence of other socioeconomic markers (caste, household wealth, and urbanization) on this association. METHODS Data were drawn from the 1998-1999 Indian National Family Health Survey, conducted in 26 states and comprising 66,367 children age 5 years or under. Adult education, for the head of household and spouse, was categorized into 0, 1-8, and 9 or more years of schooling. We used logistic regression to estimate associations between education and child mortality in analysis adjusted for other socioeconomic markers. Effect modification by caste, household wealth, and urbanization was assessed by fitting an interaction term with education. RESULTS Compared with those who had no education, 9 or more years of education for the head of household and for the spouse were associated with lower child mortality (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.48-0.62 and OR = 0.44; 95% CI = 0.36-0.54, respectively) in analyses adjusted for age, sex, and state of residence. Further adjustments for caste and urbanization attenuated these associations slightly; when adjustments were made for household wealth the associations were attenuated more substantially. Nevertheless, in fully adjusted models, 9 or more years of education for the head of household (OR = 0.81; 95% CI = 0.70-0.93) and the spouse (OR = 0.75; 95% CI = 0.60-0.94) remained associated with lower child mortality. There was no effect modification of this association by caste, household wealth, and urbanization. CONCLUSION Adult education has a protective association with child mortality in India. Caste, household wealth, and urbanization do not modify or completely attenuate this association.
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Schooling CM, Sun W, Wenjie S, Ho SY, Chan WM, Tham MK, Ho KS, Leung GM, Lam TH. Moderate alcohol use and mortality from ischaemic heart disease: a prospective study in older Chinese people. PLoS One 2008; 3:e2370. [PMID: 18523644 PMCID: PMC2396290 DOI: 10.1371/journal.pone.0002370] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 05/01/2008] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Moderate alcohol use is generally associated with lower ischaemic heart disease (IHD) mortality but it is difficult to ascertain whether this is due to attributes of moderate alcohol users or the properties of alcohol itself. Evidence from populations with different patterns of alcohol use and IHD can provide crucial evidence. We assessed the association of moderate alcohol use with IHD mortality in older Chinese people from Hong Kong. METHODOLOGY We used Cox regression to determine whether moderate alcohol use was associated with IHD mortality in a prospective, population-based cohort study of all 56,167 attendees, aged 65 years or over, from July 1998 to December 2000 at all 18 Elderly Health Centers operated by the Department of Health in Hong Kong. PRINCIPAL FINDINGS After a median follow-up of 4.2 years, there were 406 (188 in men, 218 in women) deaths from IHD in 54,090 subjects (96.3% successful follow-up). Moderate alcohol use in men was not associated with IHD mortality adjusted only for age [Hazard Ratio, HR 1.01 (95% CI 0.55 to 1.84) compared with never drinkers] or additionally adjusted for socio-economic status and lifestyle. Almost all women were occasional drinkers and their current alcohol use was not significantly associated with IHD mortality [HR 0.88, (95% CI 0.51 to 1.53)]. CONCLUSIONS Moderate alcohol use had no effect on IHD mortality in older Chinese men. Lack of replication of the usual protective effect of moderate alcohol use in a setting with a different pattern of alcohol use and IHD could be due to chance or could suggest that the protective effect of alcohol on IHD does not extend to all populations.
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Affiliation(s)
- C Mary Schooling
- Department of Community Medicine and School of Public Health, The University of Hong Kong, Hong Kong SAR, China
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Abegunde DO, Stanciole AE. The economic impact of chronic diseases: How do households respond to shocks? Evidence from Russia. Soc Sci Med 2008; 66:2296-307. [DOI: 10.1016/j.socscimed.2008.01.041] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Indexed: 11/16/2022]
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22
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Martikainen P, Nihtilä E, Moustgaard H. The Effects of Socioeconomic Status and Health on Transitions in Living Arrangements and Mortality: A Longitudinal Analysis of Elderly Finnish Men and Women From 1997 to 2002. ACTA ACUST UNITED AC 2008; 63:S99-109. [PMID: 18441275 DOI: 10.1093/geronb/63.2.s99] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Pekka Martikainen
- Helsinki Collegium for Advanced Studies & Population Research Unit, Department of Sociology, University of Helsinki, Helsinki, Finland.
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Regidor E. Social determinants of health: a veil that hides socioeconomic position and its relation with health. J Epidemiol Community Health 2007; 60:896-901. [PMID: 16973539 PMCID: PMC2566061 DOI: 10.1136/jech.2005.044859] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The emergence of theoretical models of social determinants of health has added conceptual ambiguity to the understanding of social inequalities in health, as it is often not possible to clearly distinguish between socioeconomic position and these determinants. Whether the existence of social inequalities in health is based on differences in health or on differences in social determinants of health that are systematically associated with socioeconomic position, policymakers should be clearly informed of the importance of socioeconomic position for health. Thus, the following three basic requirements are proposed: to reach a consensus about the dimensions that reflect socioeconomic position; to agree about what are to be considered the social determinants of health and whether or not these determinants are a construct that can be distinguished from socioeconomic position; and finally, to establish which dimensions and measures of socioeconomic position are most appropriate for the evaluation of interventions that aim to reduce these inequalities.
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Affiliation(s)
- Enrique Regidor
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040 Madrid, Spain.
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Laaksonen M, Silventoinen K, Martikainen P, Rahkonen O, Pitkäniemi J, Lahelma E. The Effects of Childhood Circumstances, Adult Socioeconomic Status, and Material Circumstances on Physical and Mental Functioning: A Structural Equation Modelling Approach. Ann Epidemiol 2007; 17:431-9. [PMID: 17395480 DOI: 10.1016/j.annepidem.2006.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 10/06/2006] [Accepted: 11/01/2006] [Indexed: 11/27/2022]
Abstract
PURPOSE We sought to examine the importance of childhood circumstances, adult socioeconomic status, and material circumstances to physical and mental functioning among middle-aged women and men. METHODS The data were collected among the employees of the City of Helsinki by mailed questionnaires from 2000 to 2002 (7148 women and 1799 men, response rate 67%). Three latent variables covering childhood circumstances, adult socioeconomic status, and material circumstances were constructed from 10 observed socioeconomic indicators. Direct and indirect effects of the latent variables on physical and mental functioning, measured by the SF-36 component summaries, were examined using structural equation modelling. RESULTS Childhood circumstances were not directly associated with either physical or mental functioning but had some effect through socioeconomic status. Low socioeconomic status was associated with poor physical functioning, but mental functioning was poorer among those in higher positions. Material circumstances were associated with physical and especially with mental functioning. CONCLUSIONS Low socioeconomic status and material circumstances are both important for physical functioning. However, mental functioning does not necessarily follow a similar socioeconomic pattern and the results are heavily influenced by how socioeconomic position is measured.
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Affiliation(s)
- Mikko Laaksonen
- Department of Public Health, University of Helsinki, Helsinki, Finland.
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25
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Adamson J. Commentary: Disability and education--the Madonna factor? Int J Epidemiol 2007; 36:365-7. [PMID: 17470487 DOI: 10.1093/ije/dym028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joy Adamson
- Department of Health Sciences, University of York, Heslington, York, UK.
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van Jaarsveld CHM, Miles A, Wardle J. Pathways from deprivation to health differed between individual and neighborhood-based indices. J Clin Epidemiol 2007; 60:712-9. [PMID: 17573987 DOI: 10.1016/j.jclinepi.2006.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Revised: 09/12/2006] [Accepted: 10/03/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the role of behavioral and psychosocial factors in explaining the social gradient in self-rated health as defined either by an individual or a neighborhood deprivation index. STUDY DESIGN AND SETTING Data were from the baseline survey of the UK Flexible Sigmoidoscopy trial. Recruitment through general practices was stratified to generate a socioeconomically diverse sample (N=5,253, aged 55-64). Assessments included an individual and neighborhood deprivation index, each of which were categorized in four levels; three behavioral and three psychosocial factors; and self-rated health. RESULTS Neighborhood deprivation was more strongly related to behavioral than to psychosocial factors, whereas individual deprivation was strongly related to both. The social gradient in poor self-rated health (odds in most compared to least deprived group) was 6.5 for individual and 4.2 for the neighborhood deprivation index. Behavioral and psychosocial variables explained, respectively, 7% and 11% of the individual deprivation gradient and 11% and 4% of the neighborhood gradient. The psychosocial pathway did not significantly mediate the neighborhood deprivation effect on self-rated health. CONCLUSION Intermediary pathways of the social gradient in self-rated health differed between individual and neighborhood-based deprivation indices, suggesting at least partly independent influences on poor health of individual and neighborhood-level deprivation.
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Affiliation(s)
- Cornelia H M van Jaarsveld
- Cancer UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
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Lallukka T, Laaksonen M, Rahkonen O, Roos E, Lahelma E. Multiple socio-economic circumstances and healthy food habits. Eur J Clin Nutr 2006; 61:701-10. [PMID: 17180154 DOI: 10.1038/sj.ejcn.1602583] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine associations between seven indicators of socio-economic circumstances and healthy food habits, while taking into account assumed temporal order between these socio-economic indicators. DESIGN AND SETTING Data were derived from cross-sectional postal questionnaires in 2000-2002. Socio-economic circumstances were assessed by parental education, childhood economic difficulties, own education, occupational class, household income, home ownership and current economic difficulties. Healthy food habits were measured by an index consisting of consumption of fresh vegetables, fruit or berries, rye bread, fish and choosing vegetable fats on bread and oil in cooking. Sequential logistic regression models were used, adjusting for age and marital status. PARTICIPANTS Employees of the City of Helsinki, Finland (n=8960, aged 40-60 years). RESULTS Healthy food habits were reported by 28% of women and by 17% of men. Own education, occupational class, household income, home ownership and current economic difficulties were associated with healthy food habits. These associations were attenuated but mainly remained after mutual adjustments for the socio-economic indicators. Among women, a pathway was found suggesting that part of the effects of education on food habits were mediated through occupational class. CONCLUSIONS Employees in higher and lower socio-economic positions differ in their food habits, and those in lower positions and economically disadvantaged are less likely to report healthy food habits. Health promotion programmes and food policies should encourage healthier food choices among those in lower socio-economic positions and among those with economic difficulties in particular.
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Affiliation(s)
- T Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland.
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28
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Lahelma E, Laaksonen M, Martikainen P, Rahkonen O, Sarlio-Lähteenkorva S. Multiple measures of socioeconomic circumstances and common mental disorders. Soc Sci Med 2006; 63:1383-99. [PMID: 16690186 DOI: 10.1016/j.socscimed.2006.03.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Indexed: 10/24/2022]
Abstract
While serious mental disorders typically show socioeconomic differences similar to physical illness-that is, that lower positions imply poorer health-differences for common mental disorders have been inconsistent. We aim to clarify the associations and pathways between measures of socioeconomic circumstances and common mental disorders by simultaneously analysing several past and present socioeconomic measures. The data were derived from middle-aged women and men employed by the City of Helsinki. Cross-sectional surveys were conducted in 2000-2002 among employees who, during each year, reached 40, 45, 50, 55 or 60 years of age. The pooled data include 8970 respondents (80% women; response rate 67%). Common mental disorders were measured by GHQ-12 and the SF-36 mental component summary. Seven socioeconomic measures were included: parental education, childhood economic difficulties, own education, occupational class, household income, home ownership, and current economic difficulties. Logistic regression analysis was used to examine associations between the socioeconomic circumstances and common mental disorders. Past and present economic difficulties were strongly associated with common mental disorders, whereas conventional past and present socioeconomic status measures showed weak or slightly reverse associations. Adjusting for age and gradually for each socioeconomic measure did not affect the main findings, which were very similar for women and men, as well as for both measures of common mental disorders. While the associations of conventional socioeconomic status measures with common mental disorders were weak and inconsistent, our results highlight the importance of past and present economic difficulties to these disorders.
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Affiliation(s)
- Eero Lahelma
- Department of Public Health, University of Helsinki, Finland.
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Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G. Indicators of socioeconomic position (part 1). J Epidemiol Community Health 2006; 60:7-12. [PMID: 16361448 PMCID: PMC2465546 DOI: 10.1136/jech.2004.023531] [Citation(s) in RCA: 1601] [Impact Index Per Article: 88.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2004] [Indexed: 11/03/2022]
Abstract
This glossary presents a comprehensive list of indicators of socioeconomic position used in health research. A description of what they intend to measure is given together with how data are elicited and the advantages and limitation of the indicators. The glossary is divided into two parts for journal publication but the intention is that it should be used as one piece. The second part highlights a life course approach and will be published in the next issue of the journal.
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Affiliation(s)
- Bruna Galobardes
- Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK.
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Arber S, McKinlay J, Adams A, Marceau L, Link C, O'Donnell A. Patient characteristics and inequalities in doctors’ diagnostic and management strategies relating to CHD: A video-simulation experiment. Soc Sci Med 2006; 62:103-15. [PMID: 16002197 DOI: 10.1016/j.socscimed.2005.05.028] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2003] [Accepted: 05/11/2005] [Indexed: 10/25/2022]
Abstract
Numerous studies examine inequalities in health by gender, age, class and race, but few address the actions of primary care doctors. This factorial experiment examined how four patient characteristics impact on primary care doctors' decisions regarding coronary heart disease (CHD). Primary care doctors viewed a video-vignette of a scripted consultation where the patient presented with standardised symptoms of CHD. Videotapes were identical apart from varying patients' gender, age (55 versus 75), class and race, thereby removing any confounding factors from the social context of the consultation or other aspects of patients' symptomatology or behaviour. A probability sample of 256 primary care doctors in the UK and US viewed these video-vignettes in a randomised experimental design. Gender of patient significantly influenced doctors' diagnostic and management activities. However, there was no influence of social class or race, and no evidence of ageism in doctors' behaviour. Women were asked fewer questions, received fewer examinations and had fewer diagnostic tests ordered for CHD. 'Gendered ageism' was suggested, since midlife women were asked fewest questions and prescribed least medication appropriate for CHD. Primary care doctors' behaviour differed significantly by patients' gender, suggesting doctors' actions may contribute to gender inequalities in health.
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Affiliation(s)
- Sara Arber
- Department of Sociology, Centre for Research on Ageing and Gender, University of Surrey, Guildford, Surrey GU2 7XH, UK.
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31
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Blane D. Commentary: The place in life course research of validated measures of socioeconomic position. Int J Epidemiol 2005; 35:139-40. [PMID: 16284403 DOI: 10.1093/ije/dyi217] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Blane
- Imperial College London, Charing Cross, St Dunstan's Road, London W6 8RP, UK.
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Singh-Manoux A, Marmot MG, Adler NE. Does subjective social status predict health and change in health status better than objective status? Psychosom Med 2005; 67:855-61. [PMID: 16314589 DOI: 10.1097/01.psy.0000188434.52941.a0] [Citation(s) in RCA: 523] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine, among middle-aged individuals, if subjective socioeconomic status (SES) predicts health status and change in health status over time better than objective SES. METHODS Data are from the Whitehall II study, a prospective study of British civil servants. SES data are drawn from Phase 5 (1997-1999) of the study and health data from Phases 5 and 6 (2000-2001). Physical and mental component scores from the Short Form 36, the General Health Questionnaire, and self-rated health were used to assess health status. Multiple linear regressions were used to examine the relationship between SES and health and change in health status. RESULTS Complete data were available on 5486 people. Results show both measures of SES to be global measures of SES. Both measures of SES were significantly associated with health outcomes and with decline in health status over time. However, when both objective and subjective measures of SES are entered simultaneously in the model to predict change in health status, it was only the latter that continues to be significantly associated with health and changes in health. CONCLUSIONS Subjective SES is a better predictor of health status and decline in health status over time in middle-aged adults. These results are discussed in terms of three possible explanations: subjective SES is a more precise measure of social position, the results provide support for the hierarchy-health hypothesis, and the results could be an artifact of common method variance.
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Affiliation(s)
- Archana Singh-Manoux
- INSERM, U687, National Institute of Health and Medical Research, HNSM, Saint-Maurice Cedex, France.
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Laaksonen M, Rahkonen O, Martikainen P, Lahelma E. Socioeconomic position and self-rated health: the contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources. Am J Public Health 2005; 95:1403-9. [PMID: 16006419 PMCID: PMC1449373 DOI: 10.2105/ajph.2004.047969] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined socioeconomic inequalities in self-rated health by analyzing indicators of childhood socioeconomic circumstances, adult socioeconomic position, and current material resources. METHODS We collected data on middle-aged adults employed by the City of Helsinki (n=8970; 67% response rate). Associations between 7 socioeconomic indicators and health self-ratings of less than "good" were examined with sequential logistic regression models. RESULTS After adjustment for age, each socioeconomic indicator was inversely associated with self-rated health. Childhood economic difficulties, but not parental education, were associated with health independently of all other socioeconomic indicators. The associations of respondents' own education and occupational class with health remained when adjusted for other socioeconomic indicators. Home ownership and economic difficulties, but not household income, were the material indicators associated with health after full adjustment. CONCLUSIONS Own education and occupational class showed consistent associations with health, but the association with income disappeared after adjustment for other socioeconomic indicators. The effect of parental education on health was mediated by the respondent's own education. Both childhood and adulthood economic difficulties showed clear associations with health and with conventional socioeconomic indicators.
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Affiliation(s)
- Mikko Laaksonen
- Department of Public Health, P.O. Box 41, 00014, University of Helsinki, Finland.
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Singh-Manoux A, Ferrie JE, Lynch JW, Marmot M. The role of cognitive ability (intelligence) in explaining the association between socioeconomic position and health: evidence from the Whitehall II prospective cohort study. Am J Epidemiol 2005; 161:831-9. [PMID: 15840615 DOI: 10.1093/aje/kwi109] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Associations among cognitive ability, socioeconomic position, and health have been interpreted to imply that cognitive ability could explain social inequalities in health. The authors test this hypothesis by examining three questions: Is cognitive ability related to health? To what extent does it explain social inequalities in health? Do measures of socioeconomic position and cognitive ability have independent associations with health? Relative indices of inequality were used to estimate associations, using data from the Whitehall II study (baseline, 1985-1988), a British prospective cohort study (4,158 men and 1,680 women). Cognitive ability was significantly related to coronary heart disease, physical functioning, and self-rated health in both sexes and additionally to mental functioning in men. It explained some of the relation between socioeconomic position and health: 17% for coronary heart disease, 33% for physical functioning, 12% for mental functioning, and 39% for self-rated health. In analysis simultaneously adjusted for all measures of socioeconomic position, cognitive ability retained an independent association only with physical functioning in women. These results suggest that, although cognitive ability is related to health, it does not explain social inequalities in health.
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35
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Ferrie JE, Martikainen P, Shipley MJ, Marmot MG. Self-reported economic difficulties and coronary events in men: evidence from the Whitehall II study. Int J Epidemiol 2005; 34:640-8. [PMID: 15831564 DOI: 10.1093/ije/dyi063] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Numerous studies have demonstrated social inequalities in coronary heart disease using a variety of measures of social position. In this study we examine associations between persistent economic difficulties and serious coronary events. Our aim is to assess whether these associations are (i) explained by other measures of socioeconomic status, and (ii) mediated by psychosocial, behavioural and biological factors. METHODS The data come from 5021 middle-aged, white-collar men in the Whitehall II study. Self-reported household financial problems, measured at baseline (1985-88) and Phase 3 (1991-93), were used to construct a five-category score of persistent economic difficulties. Associations between economic difficulties and incident coronary events were determined over an average follow-up of 7 years. Other socioeconomic, psychosocial, behavioural and biological explanatory variables were obtained from the Phase 3 questionnaire and clinical examination. RESULTS Age-adjusted Cox regression analyses demonstrated steep gradients in the incidence of coronary events with economic difficulties. The relative hazard between the bottom and the top of the difficulties hierarchy was 2.5 (95% confidence intervals (CI) 1.2-5.2) for fatal and non-fatal myocardial infarction (MI), 2.1 (1.3-3.6) for MI plus definite angina and 2.8 (1.9-4.2) for total coronary events. Adjustment for other markers of socioeconomic position, early life factors, psychosocial work environment characteristics and health-related behaviours had little effect, while adjustment for the biological factors reduced the association between difficulties and coronary events by 16-24%. CONCLUSION We have demonstrated an economic difficulties gradient in coronary events in men that is independent of other markers of socioeconomic position and appears to be only partially mediated by well-known risk factors in mid-life.
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Affiliation(s)
- J E Ferrie
- International Centre for Health and Society, Department of Epidemiology and Public Health, UCL Medical School, London, UK.
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Abstract
TOPIC Concept analysis of risk. PURPOSE To analyze the concept risk and provide a new definition of risk. SOURCES Published literature. CONCLUSIONS A new definition of risk that emerged from this concept analysis can provide clarity and direction for future research. Nurse researchers can look to this definition to expand what is known about health-seeking behaviors as opposed to "risk" behaviors and seek to further our understanding of the cognitive and experiential process of risk identification.
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Affiliation(s)
- Mona Shattell
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA.
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37
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Affiliation(s)
- M Bartley
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Andersen I, Osler M, Petersen L, Grønbaek M, Prescott E. Income and risk of ischaemic heart disease in men and women in a Nordic welfare country. Int J Epidemiol 2003; 32:367-74. [PMID: 12777421 DOI: 10.1093/ije/dyg073] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The inverse relation between ischaemic heart disease (IHD) and income is well known among men, but it remains to be clarified whether the relationship between social gradient and IHD is similar for men and women. The present study explores the associations between income and IHD in men and women in a Nordic country. METHODS We used data from two prospective population studies conducted in Copenhagen. A total of 22 782 subjects, 54% women, with initial examination between 1964 and 1992 were followed until 1996 for hospital admission or death from IHD. We performed survival analyses, taking traditional cardiovascular risk factors into account, and estimated IHD-free life expectancy by household income in men and women. RESULTS During follow-up, 1803 men and 1258 women experienced an event of IHD (21% fatal). The hazards by deciles of income showed a non-linear graded inverse effect of income, with a large group of middle-income in which income was not associated with risk of IHD. The hazard ratio for highest versus lowest deciles was 0.53 (95% CI: 0.44-0.65). The association was attenuated by adjustment for risk factors, but remained statistically significant. The associations were similar for both sexes. Median IHD-free life expectancy for low-income versus high-income groups was reduced by 9.4 and 7.0 years in men and women, respectively. CONCLUSIONS The effect of household income on risk of IHD was graded and similar for men and women. The difference between high and low income, regarding IHD-free life expectancy, was considerable.
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Affiliation(s)
- Ingelise Andersen
- Copenhagen Centre for Prospective Population Studies, Danish Epidemiology Science Centre at the Institute of Preventive Medicine, H:S Kommunehospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Bottero W, Prandy K. Social interaction distance and stratification. THE BRITISH JOURNAL OF SOCIOLOGY 2003; 54:177-197. [PMID: 12945866 DOI: 10.1080/0007131032000080195] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
There have been calls from several sources recently for a renewal of class analysis that would encompass social and cultural, as well as economic elements. This paper explores a tradition in stratification that is founded on this idea: relational or social distance approaches to mapping hierarchy and inequality which theorize stratification as a social space. The idea of 'social space' is not treated as a metaphor of hierarchy nor is the nature of the structure determined a priori. Rather, the space is identified by mapping social interactions. Exploring the nature of social space involves mapping the network of social interaction--patterns of friendship, partnership and cultural similarity--which gives rise to relations of social closeness and distance. Differential association has long been seen as the basis of hierarchy, but the usual approach is first to define a structure composed of a set of groups and then to investigate social interaction between them. Social distance approaches reverse this, using patterns of interaction to determine the nature of the structure. Differential association can be seen as a way of defining proximity within a social space, from the distances between social groups, or between social groups and social objects (such as lifestyle items). The paper demonstrates how the very different starting point of social distance approaches also leads to strikingly different theoretical conclusions about the nature of stratification and inequality.
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Affiliation(s)
- Wendy Bottero
- Department of Sociology and Social Policy, University of Southampton
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Singh-Manoux A, Adler NE, Marmot MG. Subjective social status: its determinants and its association with measures of ill-health in the Whitehall II study. Soc Sci Med 2003; 56:1321-33. [PMID: 12600368 DOI: 10.1016/s0277-9536(02)00131-4] [Citation(s) in RCA: 547] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The purpose of this study was twofold-(1) investigate the role of subjective social status as a predictor of ill-health, with a further exploration of the extent to which this relationship could be accounted for by conventional measures of socioeconomic position; (2) examine the determinants of a relatively new measure of subjective social status used in this study. A 10 rung self-anchoring scale was used to measure subjective social status in the Whitehall II study, a prospective cohort study of London-based civil service employees. Results indicate that subjective status is a strong predictor of ill-health, and that education, occupation and income do not explain this relationship fully for all the health measures examined. The results provide further support for the multidimensional nature of both social inequality and health. Multiple regression shows subjective status to be determined by occupational position, education, household income, satisfaction with standard of living, and feeling of financial security regarding the future. The results suggest that subjective social status reflects the cognitive averaging of standard markers of socioeconomic situation and is free of psychological biases.
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Affiliation(s)
- Archana Singh-Manoux
- International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Singh-Manoux A, Clarke P, Marmot M. Multiple measures of socio-economic position and psychosocial health: proximal and distal measures. Int J Epidemiol 2002; 31:1192-9; discussion 1199-200. [PMID: 12540721 DOI: 10.1093/ije/31.6.1192] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this paper is to compare three models for exploring the links between different measures of adult socioeconomic position (SEP)-education, occupation, income-and psychosocial health. Model I is a basic univariate regression model with psychosocial health as the outcome and a measure of SEP as the predictor. Model II is a multiple regression model with psychosocial health as the outcome with all three measures of SEP allocated the same temporal position as predictors. Model III treats education, a distal measure of SEP, as antecedent to the proximal measures of SEP in the prediction equations linking SEP to health. METHODS Participants were drawn from the Whitehall II study, a prospective cohort study of British civil servants. Data analysed here are from Phase 5 (1997-1999) of data collection, 7830 individuals in all. The measures of SEP and psychosocial health were assessed via a self-administered questionnaire. RESULTS The three models can lead to completely different conclusions. Model III, our preferred model, shows education to have a stronger indirect effect on psychosocial health when compared to its direct effect. The indirect effect is due to the effect of education on proximal measures of social position, occupation, and income in this case. CONCLUSIONS Results reported here support the hypothesis that a comparison of the relative importance of the different measures of social position in predicting health is meaningless if the causal relationships among these measures are not accounted for.
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Affiliation(s)
- Archana Singh-Manoux
- International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Abstract
BACKGROUND In the United Kingdom (UK), concern about inequalities in health and health care has led to interest in gender sensitivity in health policy and practice. AIM To develop an understanding of possibilities for gender sensitive care through exploring the concepts of gender and gender sensitivity and through reviewing relevant knowledge about gender and health. METHODS The dimensions of the concept of gender and theories explaining gender relations are explored through a review of key social science texts. A discussion of gender sensitivity draws on Bowden's analysis of gender sensitive ethics. A literature review of evidence about gender and health identifies relevant knowledge for gender sensitive care. FINDINGS Seven features of the concept of gender are identified. Gender sensitivity involves an understanding of the socio-political context of experience and relationships. The social context also affects health. Differences in male and female mortality and morbidity rates are likely to be related to differences in economic resources, differences in men and women's position in public and private worlds, to power in social relations and to sexuality and body image. Possibilities for gender sensitive care may be supported through feminist approaches and through a postmodernist understanding of the manner in which discourses shape our understanding of gender and gender relations. Valuing care is a feature of gender sensitivity. CONCLUSION Gender sensitive care involves recognizing the significance of research related to social influences on health and understanding nursing in its socio-political context, and care in the context of gender relations. Experiential learning can synthesize learning across varied learning modes, bridging learning through experience and formal analysis. Exploring concepts, evidence about gender and health and personal experience will all be important in the development of gender sensitive care.
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Affiliation(s)
- Margaret Miers
- Faculty of Health and Social Care, University of the West of England, Bristol, UK.
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Pevalin D, ROSE D. The national statistics socio-economic classification : unifying official and sociological approaches to the conceptualisation and measurement of social class in the united kingdom. ACTA ACUST UNITED AC 2002. [DOI: 10.3917/soco.045.0075] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Grundy E, Holt G. The socioeconomic status of older adults: how should we measure it in studies of health inequalities? J Epidemiol Community Health 2001; 55:895-904. [PMID: 11707484 PMCID: PMC1731799 DOI: 10.1136/jech.55.12.895] [Citation(s) in RCA: 287] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE To identify which of seven indicators of socioeconomic status used singly or combined with one other would be most useful in studies of health inequalities in the older population. DESIGN Secondary analysis of socioeconomic and health data in a two wave survey. SETTING Great Britain. Participants were interviewed at home by a trained interviewer. PARTICIPANTS Nationally representative sample of 3543 adults aged 55-69 interviewed in 1988/9, 2243 of whom were interviewed again in 1994. METHODS Desirable features of socioeconomic measurement systems for identifying health inequalities in older populations were identified with reference to the literature. Logistic regression was used to examine variations in self reported health by seven indicators of socioeconomic status. The pair of indicators with the greatest explanatory power was identified. MAIN RESULTS All indicators were significantly associated with differences in self reported health. The best pair of variables, according to criteria used, was educational qualification or social class paired with a deprivation indicator. DISCUSSION For a range of reasons the measurement of socioeconomic status is particularly challenging in older age groups. Extending our knowledge of which indicators work well in analyses and are relatively easy to collect should help both further study of health inequalities in the older population and appropriate planning.
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Affiliation(s)
- E Grundy
- Centre for Population Studies, London School of Hygiene and Tropical Medicine, London, UK.
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La Parra D. [Contribution of women and low-income households to the provision of informal home healthcare]. GACETA SANITARIA 2001; 15:498-505. [PMID: 11858784 DOI: 10.1016/s0213-9111(01)71612-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine gender and socioeconomic inequalities in the production of informal home health care. METHODS Cross-sectional survey. The study population was formed by 17.907 individuals interviewed in 1994 in the Spanish sample of 1994 the European Community Household Panel. The number of caregivers in the sample is 1.305 individuals (7.3% of the total). Two outcome measures were analysed: the risk of being an informal caregiver and the risk of caring more than 28 h weekly. The independent variables were the household income level, occupation, gender, age and self-perceived health status. The odds ratio are obtained from logistic regression models. RESULTS Women are more likely than men to provide care for someone (74.4%). Low-income individual without occupation bear the greatest probability of providing care more than 28 h weekly OR = 2.24 (1.45-3.47). Bad self-perceived health status in people with occupation is associated with being a full-time caregiver OR = 4.51 (1.48-13.68). Age increase the probability both of being an informal caregiver and to care more than 28 hours a week. CONCLUSION Women, low-income social classes and aged people bear the greatest burden of giving care.
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Affiliation(s)
- D La Parra
- Departamento de Salud Pública, Universidad de Alicante, Spain.
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Affiliation(s)
- D Blane
- Department of Social Science and Medicine, Imperial College of Science, Technology and Medicine: Charing Cross, St Dunstan's Road, London W6 8RP, UK.
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Abstract
Fetal growth is an indicator of social inequalities in health that may have a long-term impact persisting into later life. Little is known about the social patterns of birth weight in Hong Kong. This is a study of live-born singletons from 1984 to 1997 in a Hong Kong birth registry. Ordinary least-squares regression and logistic regression are used to analyse birth weight and low birth weight (< 2500 g), respectively. A gradient of birth weight and prevalence of low birth weight is demonstrated according to mothers' educational attainment. In relation to babies of the most educated mothers, babies of the least educated mothers had a mean deficit of 46g in birth weight and an odds ratio of 1.56 of low birth weight (each P<0.05). This social gradient was hidden unless parity was adjusted for. Unexpectedly, migrants from mainland China delivered heavier rather than lighter babies (each P<0.05). Type of living quarters and parental relation were also related to birth weight and low birth weight (each P<0.05). Continuous monitoring of the social patterns of birth weight is recommended.
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Affiliation(s)
- Y B Cheung
- Clinical Trials Centre, Faculty of Médicine, University of Hong Kong, Pokfulam
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Chandola T. Ethnic and class differences in health in relation to British South Asians: using the new National Statistics Socio-Economic Classification. Soc Sci Med 2001; 52:1285-96. [PMID: 11281410 DOI: 10.1016/s0277-9536(00)00231-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The paper examines the use of the new measure of social class in the UK, the National Statistics Socio-Economic Classification (NS-SEC) and other socio-economic variables in explaining differences in health between British South Asians and the majority White population. There are a number of hypotheses which try to explain ethnic differences in health and yet there have been relatively few empirical studies which test the explanatory value of these hypotheses. Cross sectional data from the fourth National Survey of Ethnic Minorities (1993-1994) with 2860 white, 1268 Indian and 1771 Pakistani and Bangladeshi adult respondents are analysed. The associations of self-rated health with ethnicity, social class, local area deprivation and standard of living are analysed. Pakistani and Bangladeshi respondents have the poorest self-rated health, followed by Indians. Differences in self-rated health between ethnic groups reduce to non-significance after adjusting for social class, local area deprivation and standard of living. There is some evidence of social class differences in the health of Indians and not much evidence for Pakistanis and Bangladeshis. The NS-SEC is useful in explaining ethnic differences in health. The poorer health of Indians, Pakistanis and Bangladeshis compared to Whites may be largely understood in terms of factors related to occupational social class, material living conditions and local area deprivation.
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Sacker A, Bartley M, Firth D, Fitzpatrick R. Dimensions of social inequality in the health of women in England: occupational, material and behavioural pathways. Soc Sci Med 2001; 52:763-81. [PMID: 11218179 DOI: 10.1016/s0277-9536(00)00176-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper examines the role of behavioural and psychosocial risk and protective factors in explaining social inequalities in the general self-assessed health of women. Using path analysis, data from the Health Survey for England (1993) are used to demonstrate how different dimensions of social position (working conditions, general social advantage and material deprivation) have distinct pathways to ill-health. Smoking, diet, alcohol consumption, exercise, social support and job strain were all related to poorer health, but not always in the predicted direction. The effects of social position on health were not fully mediated through these risk and protective factors. Each dimension of social position had unique pathways to ill-health via other unidentified mechanisms. Furthermore, the salience of the three dimensions of social position differed according to the level of labour market attachment. Different path models are required to fit the data for women at home or in full-time or part-time work.
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Affiliation(s)
- A Sacker
- Department of Epidemiology and Public Health, University College London Medical School, UK.
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Marmot M, Bobak M. International comparators and poverty and health in Europe. BMJ (CLINICAL RESEARCH ED.) 2000; 321:1124-8. [PMID: 11061736 PMCID: PMC1118901 DOI: 10.1136/bmj.321.7269.1124] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M Marmot
- International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, London WC1E 6BT.
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