Educational attainment, deprivation-affluence and self reported health in Britain: a cross sectional study

Does higher education matter for health in the UK?

Using six sweeps of data from the 1958 British National Child Development Study (NCDS), we employ a quasi-parametric approach of propensity score matching to estimate the impacts of higher education attainment on a wide range of health-related outcomes for cohorts at ages 33, 42, and 50. The non-pecuniary benefits of higher education on health are substantial. Cohorts with higher levels of education are more likely to report better health, maintain a healthy weight, refrain from smoking, exhibit a lower frequency of alcohol consumption, and are less likely to be obese. The effects on self-reported health, body mass index (BMI), drinking alcohol increase with age, but continuously decrease with smoking frequency. When considering gender heterogeneity, higher education has a more significant effect on BMI and the likelihood of obesity for males, while it has a greater impact on self-reported health, drinking alcohol, and smoking frequencies for females. Furthermore, we find no significant evidence that higher education reduces the likelihood of depression. The results of the Rosenbaum bounds sensitivity analysis suggest that, although our overall results demonstrate robustness, there may still be unobserved hidden bias in the relationship between higher education and self-reported health.

Back to school - The teachers' worries and needs having a childhood cancer patient or survivor in their class

BACKGROUND

A cancer diagnosis during childhood or adolescence causes nursery and school absences to various degrees. Attending school and meeting classmates gives many children and adolescents some normality back. Nevertheless, it can cause fears and concerns among the teachers. We are currently lacking information about the fears and needs of teachers having a child or adolescent diagnosed with cancer or with a cancer history in their classes. With this study, we aim to close this knowledge gap and assess the teachers' fears, worries and information needs having a child or adolescent diagnosed with cancer in the class to develop a suitable information tool (flyer).

METHODS

We performed an online survey including teachers covering all grades from nursery to vocational school within the catchment area of our hospital. The survey included separate questions for experience with students still receiving active treatment and those in follow-up care. Answer options included tick boxes and open-ended questions, which we grouped thematically. We used descriptive analysis to describe the survey findings, resulting in a newly developed flyer.

RESULTS

In total 358 teachers participated in the survey, 80% were female, 63% worked in nursery or primary school. One quarter (26%) had experience with a student diagnosed with cancer. Most teachers with (81%) and without (85%) experience reported at least one concern. The top three concerns reported were: (1) how to inform the class, (2) the resilience of the student and (3) how to deal with the student and his or her family. The teachers preferred oral information by physicians or parents and written information equally. Information on resilience, guidelines with an emergency situation, and the need for cancer-specific information were considered important by about 75-94% of the teachers.

CONCLUSION

Most teachers reported concerns, which we cover in a newly developed information flyer. However, such a flyer cannot replace individual communication between health care professionals and teachers. The identified concerns are likely to be transferable to other school systems and countries.

Socioeconomic inequalities in metabolic syndrome in the French West Indies

BACKGROUND

Obesity and metabolic diseases represent a major health burden in the Caribbean, particularly since a large part of the population is disadvantaged. However, socioeconomic inequalities in chronic diseases are poorly explored in this region. We investigated the association between socioeconomic position and metabolic syndrome (MetS) prevalence and explored the contribution of diet quality to explain this association, among adults in the French West Indies.

METHODS

This cross-sectional analysis included 1144 subjects (≥16 y) from a multistage sampling survey conducted in 2013-2014 on a representative sample of the Guadeloupean and Martinican population. MetS prevalence was assessed using the Joint Interim Statement. Dietary intakes were estimated from 24 h-dietary recalls, and diet quality was assessed through the Diet Quality Index-International (DQI-I). Associations between socioeconomic indicators (education, employment, social assistance benefits) and MetS prevalence, and the potential contribution of diet quality in this association were assessed using multivariable logistic regression models, adjusted for sociodemographic characteristics.

RESULTS

MetS prevalence adjusted for age and sex was 21 and 30% among Guadeloupean and Martinican, respectively. Compared to high-educated participants, low-educated subjects were more likely to be at risk of MetS (OR = 2.4; 95%CI = [1.3-4.4], respectively), as were recipients of social assistance benefits compared to non-recipients (OR = 2.0; 95%CI = [1.0-4.0]). The DQI-I explained 10.5% of the overall variation in MetS due to education.

CONCLUSIONS

Socioeconomic inequalities in MetS prevalence, reflected by education and social assistance benefits, were found. However, diet quality contributed only to socioeconomic inequalities due to education underlining that education may impact health through the ability to generate overall dietary behavior, long-term beneficial. Our work identified subgroups with higher risk of MetS, which is needed when implementing public health measures, particularly in this Caribbean population with of high poverty rates. Further prospective studies are needed to improve our understanding of the mechanisms of social inequalities in MetS in a high poverty rates context.

Using DNA to predict educational trajectories in early adulthood

At the end of compulsory schooling, young adults decide on educational and occupational trajectories that impact their subsequent employability, health and even life expectancy. To understand the antecedents to these decisions, we follow a new approach that considers genetic contributions, which have largely been ignored before. Using genomewide polygenic scores (EA3) from the most recent genomewide association study of years of education in 1.1 million individuals, we tested for genetic influence on early adult decisions in a United Kingdom-representative sample of 5,839 at 18 years of age. EA3 significantly predicted educational trajectories in early adulthood (Nagelkerke R2 = 10%), χ2(4) = 571.77, p < .001, indicating that young adults partly adapt their aspirations to their genetic propensities-a concept known as gene-environment correlation. Compared to attending university, a 1 standard deviation increase in EA3 was associated on average with a 51% reduction in the odds of pursuing full-time employment (OR = .47; 95% CI [.43, .51]); an apprenticeship (OR = .49; 95% CI [.45, .54]); or not going in education, employment, or training (OR = .50; 95% CI [.41, .60]). EA3 associations were attenuated when controlling for previous academic achievement and family socioeconomic status. Overall this research illustrates how DNA-based predictions offer novel opportunities for studying the sociodevelopmental structures of life outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neuropsychological and resting-state electroencephalographic markers of older adult neurocognitive adaptability

OBJECTIVE

This study was undertaken to explore multimethod neurocognitive screening tools to aid in detection of older adults who may be at heightened risk of pathological cognitive decline (preclinical dementia). In so doing, this study advances the theoretical conceptualization of neurocognitive adaptability in the context of aging and dementia.

METHOD

This article reports original data from the baseline measurement occasion of a longitudinal study of healthy, community-dwelling older adults from the Victoria, British Columbia region. Participants were diagnosed as normal, subtle decline, or mild cognitive impairment according to actuarial neuropsychological criteria (adjusted for age only or adjusted for age and premorbid IQ). Diagnostic classification was employed to illustrate group differences in a novel metric of multi-timescale neural adaptability derived from 4-min of resting-state electroencephalographic data collected from each participant (immediately following their neuropsychological evaluation).

RESULTS

Prior findings were replicated; adjusting raw neuropsychological test scores for individual differences in estimated premorbid IQ appeared to increase the sensitivity of standardized clinical tasks to subtle cognitive impairment. Moreover, and consistent with prior neuroscientific research, timescale-specific (i.e. at ∼12-20 ms timescales) differences in resting-state neural adaptability appeared to characterize groups who differed in terms of neuropsycholgoical diagnostic classification.

CONCLUSIONS

Recently proposed actuarial neuropsychological criteria for subtle cognitive decline identify older adults who show timescale-specific changes in resting brain function that may signal the onset of preclinical dementia. The subtle decline stage may represent a critical inflection point-partial loss of neurocognitive adaptability-on a pathological aging trajectory. These findings illustrate areas of potential future development in neurocognitive health care.

DO BIOMARKERS VARY BY SOCIAL CLASS, EDUCATION AND REGION AND IS MIGRATION IMPORTANT? EVIDENCE FROM A COHORT OF BRITISH ADULTS

The aim of this study was to test whether Body Mass Index (BMI), waist circumference, systolic and diastolic blood pressure, Forced Expiratory Volume (FEV1) and Peak Expiratory Flow (PEF) vary in relation to social class at birth and adulthood, educational level and region of residence, and also with inter-generational social, educational and regional mobility/migration. The study used 5702 adults (2894 males and 2718 females) from the longitudinal British National Child Development Study (all children born in England, Scotland and Wales during the first week in March 1958 with follow-up throughout childhood and adulthood, most recently at 55 years of age). In both sexes BMI and waist circumference tended to increase from social classes I+II to IV+V and higher social class was associated with higher mean FEV1 and PEF. Better-educated adults tended to have lower BMI and waist circumference, and higher mean FEV1 and PEF. Women from Wales had the highest mean BMI and waist circumference but the lowest mean PEF, while women in Scotland had the highest mean systolic blood pressure and the lowest mean FEV1. For men only, FEV1 and PEF showed regional variation and the lowest mean FEV1 was in Wales and the lowest PEF in Yorkshire & Humberside. Inter-generational social mobility was not found to be associated with any of the biomarkers, while educational mobility was related only to FEV1 and PEF. In both sexes, in unadjusted regression analysis regional migrant cohort members tended to have a lower mean BMI than sedentes. Regional male migrants also tended to have a lower waist circumference and a higher FEV1 and PEF than sedentes.

Socioeconomic health inequalities in Latvia: a cross-sectional study

Aims: Socioeconomic health differences have been studied elaborately for many Western societies. Relatively little is know about the social variations in health in the former communist states of Eastern Europe. This study investigated socioeconomic health inequalities in Latvia. Methods: Cross-sectional analysis was undertaken of the 1999 Norbalt-II Living Conditions Survey, a random population-based sample in Latvia, and included males and females aged 25 to 70. Results: Lower educated subjects had higher rates of self-assessed poor health than those with tertiary education (men OR 2.21; 1.31 - 3.71 95% CI, and women OR 2.48; 1.74 - 3.54 95% CI). After adjusting for income, educational differences were significant only for women. Income differences were larger than educational differences in self-assessed poor health for both genders (OR of highest vs. lowest quintile for men: 5.10; 2.26 - 11.5 95% CI, women: OR 3.26; 1.92 - 5.51 95% CI). For longstanding health problems socioeconomic differences were smaller. After adjusting for income no educational differences were found, but income differences were significant (men: OR 2.06; 1.15 - 3.69 95% CI, women: OR 1.42; 1.12 - 2.63 95% CI). The economically non-active were in worse health than the (self-)employed subjects (men: OR 6.12; 3.65 - 10.3 95% CI, women: OR 2.79; 1.66 - 3.39 95% CI). Conclusions: Substantial social inequalities in self-assessed poor health and longstanding health problems exist in Latvia for both sexes. Inequalities by material circumstances, as measured by income, appear to be larger than educational differences. Economic activity was also strongly associated with health. There were no inequalities with regard to urbanization and ethnic differences were found only for long-standing health problems among women.

Genetic link between family socioeconomic status and children's educational achievement estimated from genome-wide SNPs

One of the best predictors of children's educational achievement is their family's socioeconomic status (SES), but the degree to which this association is genetically mediated remains unclear. For 3000 UK-representative unrelated children we found that genome-wide single-nucleotide polymorphisms could explain a third of the variance of scores on an age-16 UK national examination of educational achievement and half of the correlation between their scores and family SES. Moreover, genome-wide polygenic scores based on a previously published genome-wide association meta-analysis of total number of years in education accounted for ~3.0% variance in educational achievement and ~2.5% in family SES. This study provides the first molecular evidence for substantial genetic influence on differences in children's educational achievement and its association with family SES.

Healthy life expectancy and the correlates of self-rated health in Bangladesh in 1996 and 2002

Background

Life expectancy (LE) at birth has increased steadily in Bangladesh since its independence. When people live longer, quality of life becomes a central issue. This study examines whether healthy life expectancy (HLE) at ages 15, 25, 35, and 45 is keeping pace with LE at those ages between 1996 and 2002. It also seeks to investigate the correlates of self-rated health (SRH) in 1996 and 2002.

Methods

We used data from the World Values Survey conducted in 1996 and 2002 among individuals 15 years and older. The Sullivan method was used to compute HLE. Socio-demographic differences and their association with different states of health were examined by chi-square and Pearson’s correlation tests. Multiple linear regression models were fitted to examine the correlates of SRH.

Results

The results show that perceived health improved between 1996 and 2002. For males, statistically significant increases in the expected number of years lived in good SRH were found. Proportionally, in 2002, both males and females at ages 15, 25, 35 and 45 expected more life years in good health and fewer life years in fair and poor health than did their counterparts in 1996. Comparatively, males expected fewer life years spent in good health but a much larger proportion of expected life in good health than did females. Finally, in multivariate analyses, life satisfaction was the only factor found to be significantly and positively associated with SRH for males and females in both years, although in both years the association was much more pronounced for females than for males.

Conclusion

This study documented changes in HLE during 1996-2002. Women outlive men, but they have a lower quality of life and are more likely to live a greater part of their remaining life in poor SRH. Life satisfaction as well as other significant factors associated with SRH should be promoted, with special attention given to women, to improve healthy life expectancy and the quality of life of the Bangladeshi people.

Material, psychosocial and behavioural factors associated with self-reported health in the Republic of Ireland: cross-sectional results from the SLAN survey

OBJECTIVES

To explore the associations between various material, psychosocial and behavioural factors and self-reported health (SRH), and to determine whether these associations varied according to educational level.

DESIGN

Representative national cross-sectional survey.

SETTING

Republic of Ireland.

PARTICIPANTS

4369 men and 5995 women aged 18 or more (Survey of Lifestyle, Attitudes and Nutrition (SLÁN) 2007).

METHODS

SRH was measured using one single item. Three groups of factors were studied: material, psychosocial and behavioural factors. Statistical analyses were performed using logistic regression analysis and interaction testing, the sample design being taken into account. All results were adjusted for age and educational level and stratified on gender.

RESULTS

When each group of factors was studied separately, non-working status, no private health insurance, inability to afford enough food, no car, being non-married, low social participation, serious neighbourhood problems, low social support, smoking, no alcohol consumption, illicit drug use, low physical activity and obesity were associated with poor SRH. When studied together, some material and psychosocial factors were no longer significant. Four significant interaction terms were found, suggesting that some factors might have a stronger association with SRH among low-educated people.

CONCLUSIONS

Various types of factors were found to be associated with SRH, and most of these associations were similar according to educational level. Behavioural factors might be intermediate factors in the causal pathways from material and psychosocial factors to SRH. Prevention policies should integrate a large number of factors comprehensively to improve SRH.

Money is not enough: exploring the impact of social and cultural resources on youth health

BACKGROUND

Findings on socioeconomic health differentials in youth remain fragmented with the role of cumulative and interaction effects of different forms of health resources not well understood.

METHODS

European KIDSCREEN data were analysed to explore effects of material and non-material resources on subjective health in The Netherlands, Hungary, and the UK.

RESULTS

Regression analysis revealed significant main effects of economic, social, and cultural resources on youth health. In the UK an interaction effect between economic and cultural resources indicated a conditional relationship between material and non-material health resources.

CONCLUSIONS

Exploring the combined impact of economic, social, and cultural resources may contribute to our understanding of health differentials.

Joining the dots: The links between education and health and implications for indigenous children

This paper provides a general overview of the literature investigating the nexus between education and health; discussing the relationship between these domains at individual, family and community levels. We then briefly examine the programme and research implications of such a framework for interventions aimed at improving education and health, with specific reference to young Indigenous Australians. We find that while education and health are inextricably linked, throughout the life course and at different levels of influence, there is less empirical work exploring this relationship in an Indigenous context. Given the gravity of literacy and numeracy failure rates in school-based education and its potential impact on Indigenous health, we assert an urgent case for rigorous research into interventions that address the barriers to effectiveness in implementing quality educational experiences and opportunities for Indigenous children.

Factors associated with cigarette smoking among young military conscripts in taiwan

BACKGROUND

The purpose of this study was to identify the most important risk factors that influence cigarette smoking among young adult military conscripts in Taiwan.

METHODS

A cross-sectional survey was conducted among young conscripts (19-25 years old) in Taiwan from August to December 2001. A total of 3,569 conscripts who had served more than 1 month in the military were chosen. Information regarding cigarette smoking and other factors was collected using a standard structured questionnaire.

RESULTS

Subjects whose lifestyles included betel-nut chewing (OR, 16.81; 95% CI, 11.35-25.91) and alcohol drinking (OR, 2.11; 95% CI, 1.54-2.90) were more likely to smoke compared to subjects without these adverse behaviors. Subjects whose education stopped at junior high school or before were more likely to smoke compared to those with a university degree (OR, 5.36; 95% CI, 3.77-7.69). Subjects who had a higher proportion of peers who smoked were more likely to smoke compared to those with no peers who smoked (OR, 3.16; 95% CI, 2.42-4.15). Subjects whose parents and peers approved of smoking were also at a higher risk for smoking compared with those whose parents and peers disapproved (father's approval---OR, 3.28 and 95% CI, 2.02-5.43; mother's approval---OR, 3.11 and 95% CI, 1.47-7.12; peer approval---OR, 2.27 and 95% CI, 1.60-3.22).

CONCLUSION

From this study, we found that education level, betel-nut chewing, alcohol intake, smoking behavior of peers, and the attitudes of parents and peers toward smoking are all associated with the risk of a young adult conscripts becoming a habitual cigarette smoker. These results provide insight for targeting critical risk factors in helping these individuals control or cease their cigarette smoking habit in the future.

Area deprivation and its association with health in a cross-sectional study: are the results biased by recent migration?

BACKGROUND

The association between area deprivation and health has mostly been examined in cross-sectional studies or prospective studies with short follow-up. These studies have rarely taken migration into account. This is a possible source of misclassification of exposure, i.e. an unknown number of study participants are attributed an exposure of area deprivation that they may have experienced too short for it to have any influence. The aim of this article was to examine to what extent associations between area deprivation and health outcomes were biased by recent migration.

METHODS

Based on data from the Oslo Health Study, a cross-sectional study conducted in 2000 in Oslo, Norway, we used six health outcomes (self rated health, mental health, coronary heart disease, chronic obstructive pulmonary disease, smoking and exercise) and considered migration nine years prior to the study conduct. Migration into Oslo, between the areas of Oslo, and the changes in area deprivation during the period were taken into account. Associations were investigated by multilevel logistic regression analyses.

RESULTS

After adjustment for individual socio-demographic variables we found significant associations between area deprivation and all health outcomes. Accounting for migration into Oslo and between areas of Oslo did not change these associations much. However, the people who migrated into Oslo were younger and had lower prevalences of unfavourable health outcomes than those who were already living in Oslo. But since they were evenly distributed across the area deprivation quintiles, they had little influence on the associations between area deprivation and health. Evidence of selective migration within Oslo was weak, as both moving up and down in the deprivation hierarchy was associated with significantly worse health than not moving.

CONCLUSION

We have documented significant associations between area deprivation and health outcomes in Oslo after adjustment for socio-demographic variables in a cross-sectional study. These associations were weakly biased by recent migration. From our results it still appears that migration prior to study conduct may be relevant to investigate even within a relatively short period of time, whereas changes in area deprivation during such a period is of limited interest.

Community-level socio-economic status and cognitive and functional impairment in the older population

BACKGROUND

This study aimed to determine if people living in communities with higher socio-economic deprivation are at an increased risk of cognitive and functional impairment even after controlling for the effects of individual socio-economic status.

METHODS

We analysed cross-sectional data from the Medical Research Council Cognitive Function and Ageing Study which consists of a community-based sample of Cambridgeshire, Gwynedd, Newcastle, Nottingham and Oxford. The study included 13 004 men and women aged 65 years and over who were randomly selected from Family Health Services Authority computerized records after being stratified to ensure equal numbers of those aged 75 years and over and those under 75 years. The outcome measures were cognitive impairment (Mini-Mental State Exam 0-21) and functional impairment (Instrumental Activities of Daily Living and/or Activities of Daily Living disability).

RESULTS

Individuals living in more deprived areas, as measured by the Townsend deprivation score, were found to have a higher prevalence of cognitive impairment [odds ratio (OR) (most deprived versus least deprived quintile) = 2.3; 95% confidence interval (CI)1.8-3.0; P < 0.001] and functional impairment [OR (most deprived versus least) = 1.6; 95% CI 1.4-1.9; P < 0.001] after controlling for age, sex, centre effects, education and social class.

CONCLUSIONS

There is a significantly higher prevalence of cognitive impairment and functional impairment in elderly individuals living in socio-economically deprived areas regardless of their own socio-economic status. This evidence is of relevance for informing public health policy and those allocating resources for the long-term care of the elderly.

Self-reported health in high and very high incomes

The objective of the present study was to investigate whether self-reported health (SRH), an overall health indicator, continues to improve as individual income increases to very high levels or whether there is a threshold above which this relationship changes direction. We used data from the 2003 US Current Population Survey, focusing on the upper income decile. We modelled the relationship between income and SRH before and after adjustment for other socio-demographic parameters that are known to influence SRH. In the unadjusted model, SRH increased with increasing income up to the threshold of $326,000, above which SRH declined. After adjustment for all major socio-demographic parameters (age, gender, race, education, and marital status), the adjusted curve showed monotonically increasing SRH with increasing income. Adjustment for each of these parameters separately revealed that the threshold effect was lost only after adjusting for education. There were more people with low levels of educational attainment among those receiving more than $500,000 per year, compared to other people in the upper income decile. Increasing income does not always improve SRH. People in the very high income bracket tend to report slightly worse health, which may be explained by their lower education.

Maternal education, lone parenthood, material hardship, maternal smoking, and longstanding respiratory problems in childhood: testing a hierarchical conceptual framework

BACKGROUND

Maternal smoking and low socioeconomic status are known to be associated with each other and with longstanding respiratory problems in childhood but their interrelation has received little attention. In this paper, the interrelations is studied using a conceptual hierarchical framework among children aged 0-11 years in a representative sample of British households with children.

METHOD

With data from the family and children study, this paper tested a conceptual hierarchical framework, in which maternal education acting through lone parenthood would influence material hardship and all three would have effects on maternal smoking increasing the risk of children's longstanding respiratory problems.

RESULTS

Among children 0-2, maternal education and material hardship had indirect effects on respiratory problems mediated through more proximal variables. After adjustment for maternal education, the effect of lone parenthood was partially mediated through material hardship and maternal smoking. Adjustment for socioeconomic status variables attentuated but did not eliminate the effect of maternal smoking (odds ratio=2.04, 95% confidence interval=1.30, 3.20). Among children 3-11, the effect of maternal education was partially mediated through proximal variables. Lone parenthood and material hardship had indirect effects only. Adjustment for confounding eliminated the effect of maternal smoking (odds ratio=1.06, 95% confidence interval=0.88, 1.26).

CONCLUSIONS

Reducing childhood longstanding respiratory problems will require attention to background socioeconomic status factors in addition to maternal smoking.

Is the disease risk associated with good self-reported health constant across the socio-economic spectrum?

BACKGROUND

Self-reported health is likely to be dependent on two key assessments: that of one's own health and that of the best health that could be expected. As many health outcomes are known to vary according to socio-economic position (SEP), it is possible that assessments of the best health that could be expected will vary with SEP. It is, therefore, possible that the disease risk associated with different levels of self-reported health varies according to SEP. We investigated this using data from the 1998 Health Survey for England.

METHODS

Disease risk was measured as systolic blood pressure and body mass index (BMI), and SEP was measured as occupational social class. Associations between social class and the markers of disease risk were investigated in those reporting different levels of self-reported health using linear regression in order to control for age.

RESULTS

There were statistically significant socio-economic variations in systolic blood pressure and BMI (in women only) in those who reported their health as good or very good. No such socio-economic variations in disease risk were seen amongst those reporting their health as less than good.

CONCLUSIONS

The meaning of self-reported health, in terms of disease risk, may not be comparable across the socio-economic spectrum.

Indicators of socioeconomic position (part 1)

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.

Associations of psychosocial working conditions with self-rated general health and mental health among municipal employees

OBJECTIVES

To examine associations of job demands and job control, procedural and relational organizational fairness, and physical work load with self-rated general health and mental health. In addition, the effect of occupational class on these associations is examined.

METHODS

The data were derived from the Helsinki Health Study baseline surveys in 2001-2002. Respondents to cross-sectional postal surveys were middle-aged employees of the City of Helsinki (n=5.829, response rate 67%). Associations of job demands and job control, organizational fairness and physical work load with less than good self-rated health and poor GHQ-12 mental health were examined.

RESULTS

Those with the poorest working conditions two to three times more, often reported poor general and mental health than those with the best working conditions. Adjustment for occupational class weakened the associations of low job control and physical work load with general health by one fifth, but even more strengthened that of high job demands. Adjustment for occupational class clearly strengthened the associations of job control and physical work load with mental health in men. Mutual adjustment for all working conditions notably weakened their associations with both health measures, except those of job control in men. All working conditions except relational organizational fairness remained independently associated with general and mental health.

CONCLUSIONS

All studied working conditions were strongly associated with both general and mental health but the associations weakened after mutual adjustments. Of the two organizational fairness measures, procedural fairness remained independently associated with both health outcomes. Adjustment for occupational class had essentially different effects on the associations of different working conditions and different health outcomes.

Pathways between socioeconomic determinants of health

STUDY OBJECTIVE

Many previous studies on socioeconomic inequalities in health have neglected the causal interdependencies between different socioeconomic indicators. This study examines the pathways between three socioeconomic determinants of ill health.

DESIGN, SETTING, AND PARTICIPANTS

Cross sectional survey data from the Helsinki health study in 2000 and 2001 were used. Each year employees of the City of Helsinki, reaching 40, 45, 50, 55, and 60 years received a mailed questionnaire. Altogether 6243 employees responded (80% women, response rate 68%). Socioeconomic indicators were education, occupational class, and household income. Health indicators were limiting longstanding illness and self rated health. Inequality indices were calculated based on logistic regression analysis.

MAIN RESULTS

Each socioeconomic indicator showed a clear gradient with health. Among women half of inequalities in limiting longstanding illness by education were mediated through occupational class and household income. Inequalities by occupational class were largely explained by education. A small part of inequalities for income were explained by education and occupational class. For self rated health the pathways were broadly similar. Among men most of the inequalities in limiting longstanding illness by education were mediated through occupational class and income. Part of occupational class inequalities were explained by education. Two thirds of inequalities by income were explained by education and occupational class.

CONCLUSIONS

Parts of the effects of each socioeconomic indicator on health are either explained by or mediated through other socioeconomic indicators. Analyses of the predictive power of socioeconomic indicators on health run the risk of being fruitless, if interrelations between various indicators are neglected.

Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross sectional study in the Norfolk cohort of the European Investigation into Cancer (EPIC-Norfolk)

OBJECTIVES

To investigate the independent association between individual and area based measures of socioeconomic status and cigarette smoking habit.

DESIGN AND SETTING

Cross sectional, population based study.

PARTICIPANTS AND METHODS

12 579 men and 15 132 women aged 39-79 years living in the general community participating in the EPIC-Norfolk Study in 1993-1997. The association between social class, educational status, Townsend residential deprivation level, and cigarette smoking status was examined.

MAIN OUTCOME MEASURES

Cigarette smoking status at baseline survey.

RESULTS

Social class, educational level, and residential deprivation level independently related to cigarette smoking habit in both men and women. Multivariate age adjusted odds ratios for current smoking in men were 1.62 (95% CI 1.45 to 1.81) for manual compared with non-manual social class, 1.32 (95% CI 1.17 to 1.48) for those with educational level less than O level compared with those with O level qualifications or higher and 1.84 (95% CI 1.62 to 2.08) for high versus low area deprivation level. For women, the odds ratios for current smoking for manual social class were 1.14 (95% CI 1.03 to 1.27); 1.31 (95% CI 1.18 to 1.46) for low educational level and 1.68 (95% CI 1.49 to 1.90) for high residential deprivation respectively.

CONCLUSIONS

Residential deprivation level using the Townsend score, individual social class, and educational level all independently predict smoking habit in both men and women. Efforts to reduce cigarette smoking need to tackle not just individual but also area based factors. Understanding the specific factors in deprived areas that influence smoking habit may help inform preventive efforts.

Health inequalities in the older population: the role of personal capital, social resources and socio-economic circumstances

Older people now constitute the majority of those with health problems in developed countries so an understanding of health variations in later life is increasingly important. In this paper, we use data from three rounds of the Health Survey for England, a large nationally representative sample, to analyse variations in the health of adults aged 65-84 by indicators of attributes acquired in childhood and young adulthood, termed personal capital; and by current social resources and current socio-economic circumstances, while controlling for smoking behaviour and age. We used six indicators of health status in the analysis, four based on self-reports and two based on nurse collected data, which we hypothesised would identify different dimensions of health. Results showed that socio-economic indicators, particularly receipt of income support (a marker of poverty) were most consistently associated with raised odds of poor health outcomes. Associations between marital status and health were in some cases not in the expected direction. This may reflect bias arising from exclusion of the institutional population (although among those under 85 the proportion in institutions is very low) but merits further investigation, especially as the marital status composition of the older population is changing. Analysis of deviance showed that social resources (marital status and social support) had the greatest effect on the indicator of psychological health (GHQ) and also contributed significantly to variation in self-rated health, but among women not to variation in taking three or more medicines and among men not to self-reported long-standing illnesses. Smoking, in contrast, was much more strongly associated with these indicators than with self-rated health. These results are consistent with the view that self-rated health may provide a holistic indicator of health in the sense of well-being, whereas measures such as taking prescribed medications may be more indicative of specific morbidities. The results emphasise again the need to consider both socio-economic and socio-psychological influences on later life health.

Back pain reporting in children and adolescents: the impact of parents' educational level

BACKGROUND

Social class, including educational level, is a strong predictor for health-related perceptions and behavior and for health outcomes in general. It is not known whether parental education has an effect on back pain in their offspring.

OBJECTIVES

To establish whether parents' educational level is associated with back pain reporting and consequences of back pain in their children.

DESIGN

A cross-sectional survey.

DATA COLLECTION

Information on parental education was obtained through questionnaires to parents and back pain information through standardized interviews with the children.

PARTICIPANTS

Children aged 8 to 10 years (n = 481) and adolescents aged 14 to 16 years (n = 325) obtained through a proportional 2-stage cluster sample.

SETTING

Local schools in Odense, Denmark.

MAIN OUTCOME MEASURES

The strength of association and dose-response connection were studied between parental educational level (high/medium/low) and the outcome variables (back pain in the preceding month, and consequences of back pain) in their children.

RESULTS

There was a significant modest negative association between the level of parental education and back pain in children but not in adolescents. There was no significant association between parental educational level and back pain consequences.

CONCLUSIONS

Further research in this area requires a more ingenious approach such as use of more socially heterogeneous study populations than those usually found in Denmark.

The Innsbruck Women's Health Study 1999: health status and behaviour

OBJECTIVES

The aim of this study is to report descriptive results of a recent survey on women's health and to analyse associations between perceived health status and health behaviour.

METHODS

A cross-sectional survey on 609 women aged 20 to 95 years was performed in Innsbruck (Austria) in 1999.

RESULTS

Self-reported poor health status was 6% in the 20-39 age group, 10% in the 40-59 age group and 20% in the 60 and older age group. Age and physical activity were significant predictors for health status. Women who performed physical activities on a regular basis had a more than 70% reduced risk of poor health status. Concerning the prevalence of self-reported morbidity, urogenital disorders (35%), allergies (32%), and headache (42%) were most frequent in younger women whereas skeletal disorders such as rheumatic diseases (41%), osteoporosis (39%), and invertebral disc damage (39%) in older women. Important health behaviour-related problems to be found were 40% smoking among women under 40, and 42% overweight or obesity among women over 60. Stress affected 37% of women under 60 years of age.

CONCLUSIONS

Physical activity, smoking, overweight and stress revealed to be key-indicators for improving women's health.