Using an interactive framework of society and lifecourse to explain self-rated health in early adulthood

The Long-Term Consequences of Childbearing: Physical and Psychological Well-Being of Mothers in Later Life

Growing evidence points to relationships between patterns of childbearing and health outcomes for mothers; yet a need remains to clarify these relationships over the long-term and to understand the underlying mechanisms. Using data from the National Longitudinal Survey of Mature Women (N=1,608), I find that the long-term consequences of childbearing vary by health outcome. Early childbearing is associated with higher risk of ADL limitations at ages 65-83, though effects appear stronger among white than black mothers until SES is controlled. Early childbearing is also associated with greater levels of depressive symptomatology, though this association is mediated by SES and health. Late childbearing is associated with more depressive symptoms net of early life and current SES, child proximity and support, and physical health. Finally, I find no significant effects of high parity. These findings emphasize the need to better understand the mechanisms linking childbearing histories to later physical and psychological well-being.

Early-life and adult socioeconomic status and inflammatory risk markers in adulthood

BACKGROUND

Associations between childhood and adult socioeconomic status (SES) and adult levels of inflammatory markers (C-reactive protein [CRP], fibrinogen, white blood cell count [WBC], and von Willebrand factor [vWF]) were examined in the Atherosclerosis Risk in Communities (ARIC) Study cohort.

METHODS

A total of 12,681 white and African-American participants provided information on SES (via education and social class) and place of residence in childhood and adulthood. Residences were linked to census data for neighborhood SES information. Multiple imputation was used to impute missing data. Hierarchical and linear regression were used to estimate the effects of SES and possible mediation by adult cardiovascular disease (CVD) risk factors.

FINDINGS

Low childhood social class and education were associated with elevated levels of CRP, fibrinogen, WBC, and vWF (increments of 17%, 2%, 4% and 3% for lowest versus highest education in childhood, respectively) among whites. Findings were less consistent among African-Americans. Adult SES was more strongly associated with inflammation than childhood SES. Individual-level SES measures were more consistently associated with inflammation than neighborhood-level measures. Fibrinogen and WBC showed the most consistent associations with SES; the largest changes in inflammation by SES were observed for CRP. Covariate adjustment strongly attenuated these associations. Mediation of the SES-inflammation associations by BMI, smoking and HDL cholesterol (HDL-C) are suggested by these data.

CONCLUSION

Low individual- and neighborhood-level SES in childhood and adulthood are associated with modest increments in adult inflammatory burden. These associations may operate through the influence of low SES on traditional CVD risk factors, especially BMI, smoking and HDL-C.

A life-course approach to measuring socioeconomic position in population health surveillance systems

Measuring socioeconomic position (SEP) in population chronic disease and risk factor surveillance systems is essential for monitoring socioeconomic inequalities in health over time. Life-course measures are an innovative way to supplement other SEP indicators in surveillance systems. A literature review examined the indicators of early-life SEP that could potentially be used in population health surveillance systems. The criteria of validity, relevance, reliability and deconstruction were used to determine the value of potential indicators. Early-life SEP indicators used in cross-sectional and longitudinal studies included education level, income, occupation, living conditions, family structure and residential mobility. Indicators of early-life SEP should be used in routine population health surveillance to monitor trends in the health and SEP of populations over time, and to analyse long-term effects of policies on the changing health of populations. However, these indicators need to be feasible to measure retrospectively, and relevant to the historical, geographical and sociocultural context in which the surveillance system is operating.

The “Americanisation” of migrants: Evidence for the contribution of ethnicity, social deprivation, lifestyle and life-course processes to the mid-20th century Coronary Heart Disease epidemic in the US

We investigated the contribution of the large-scale immigration of White Europeans into the US between 1850 and 1930 to the timing and extent of the epidemic pattern of heart disease between 1900 and 1980. The analyses are based on data collected through the United States Federal Census from 1850 to the present. The hardcopy historical record confirms that census reports themselves and related monographs were concerned from 1850 with excessive mortality from heart disease of immigrants, particularly of Northern European origin and initially at least, their first-generation native-born children. Our analysis of the electronic database indicates a strong relationship between the percentage of US population foreign born and native born of foreign parentage and age adjusted mortality from heart disease. We identified a lag of 50 years giving the maximum linear correlation coefficient for men (r(2) = 0.92), and for women a shorter lag of 38 years and an earlier decline in Coronary Heart Disease (CHD) rates (r(2) = 0.96). Both the rise and fall of the CHD epidemic over an 80-year period correspond closely to the rise and fall of the foreign population in previous years. For the foreign born only, age adjusted negative binomial general estimated equation (GEE) models calculate the relative risk of dying of heart disease per 10% increase in proportion foreign born. There is an independent influence for men until 1930 and for women throughout the period from 1910 onwards. We conclude there is an impact of immigration on the pattern of the epidemic, mediated through a combination of factors, such as accumulated life-course susceptibility, deprived socio-economic conditions upon arrival, and the enthusiastic uptake of behaviours related to the classic risk factors of smoking, high saturated fat and salt diet. Our analysis provides a more contextualised understanding of the scale and timing of the epidemic of CHD in the US.

Effects of husbands’ and wives’ education on each other's mortality

Education is an important predictor of one's own cardiovascular disease (CVD) and overall mortality. Little is known, however, regarding the effect of other individuals, specifically a spouse, on these risks. In the present study, we examine the contribution of a spouse's educational attainment and the effect of educational discrepancy between spouses on CVD and overall mortality. Data were taken from the Israel Longitudinal Mortality Study, which linked a 20% sample of the 1983 census to mortality records through 1992. The study cohort comprised 37,618 married couples aged 45-69 years. During the 9.5-year follow-up 6,058 men and 2,568 women died. Overall and CVD mortality hazard ratios were calculated using Cox proportional hazard regression models. We found that the educational attainment of both spouses were significant predictors of one's own overall mortality. For CVD mortality, however, a wife's educational attainment was a stronger predictor of her husband's risk of dying than his own educational level, while for women a husband's education had little affect. Educational discrepancy between partners did not affect overall mortality and had a varied effect on CVD mortality by sex. Specifically, highly educated women had an almost two-fold increased risk of CVD mortality when married to less educated husbands, while lesser-educated women were not affected by their spouses' educational attainment. Spouses' education adds valuable information when assessing mortality differentials among married persons, and socioeconomic characteristics of one's immediate family are important influences on one's health.

The impact of fathers' physical and psychosocial work conditions on attempted and completed suicide among their children

BACKGROUND

Adverse employment experiences, particularly exposure to unemployment and the threat of unemployment, have been strongly associated with several adverse mental and physical health outcomes including suicide. However, virtually no research has been conducted on the trans-generational impact of parental working conditions on attempted or completed suicide among their children.

METHODS

We conducted a nested case control study based on a cohort, gathered in the western Canadian province of British Columbia, of male sawmill workers and a second cohort of their children. Physical and psychosocial work conditions to which fathers were exposed during the first 16 years of their children's lives, measured using the demand/control model, were linked to hospital suicide records (attempted and completed) among their children.

RESULTS

Two hundred and fifty children in the cohort attempted or committed suicide between 1985 and 2001. Multivariate models, with partial control for father's mental health outcomes prior to their child's suicide demonstrate, 1) a strong association between low duration of father's employment at a study sawmill and attempted suicide for their male children, 2) elevated odds for attempted suicide among female children of fathers' employed in a sawmill job with low control and, 3) a strong association between fathers in jobs with low psychological demand and completed suicides among male children.

CONCLUSION

Exposure of fathers to adverse psychosocial work conditions during the first 16 years of their children's life was associated with greater odds for attempted and completed suicide among their children.

Explaining the social gradient in smoking in pregnancy: Early life course accumulation and cross-sectional clustering of social risk exposures in the 1958 British national cohort

Smoking in pregnancy is a major determinant of low birthweight and a range of adverse infant health outcomes. There is a well-established social gradient in smoking in pregnancy in the US and northern Europe. Social gradients in health-related behaviours may result from longitudinal accumulation and cross-sectional clustering of social risk exposures. There is, however, no published confirmation of this explanation in empirical data with smoking in pregnancy as the outcome. This study aimed to test the effects of longitudinal accumulation and cross-sectional clustering of social risk exposures on smoking in pregnancy using data on the first pregnancies of 3163 female members of the 1958 British national cohort. Social class at birth and aged 11 years was used to create three dichotomous variables representing cumulative social class (both manual, one manual and one non-manual, both non-manual) early in the lifecourse. Cross-sectional clustering of social risk was represented by four dichotomous variables created from combinations of maternal age (<20 vs. 20+), own social class (manual vs. non-manual) and educational attainment (low vs. other). Cumulative social class in early childhood was associated with smoking in pregnancy in bivariate analysis but not after adjustment for cross-sectional clustering of social risk exposures. However, women who had been in the manual social groups at birth and 11 years were at increased risk of cross-sectional clustering of social risk exposures around pregnancy suggesting a pathway from early lifecourse risk exposure to social risk factors associated with a high risk of smoking in pregnancy. These findings suggest that the social gradient in smoking in pregnancy results from longitudinal accumulation and cross-sectional clustering of social risk exposures. Interventions aimed at reducing social inequalities in smoking in pregnancy need to account for cumulative and cross-sectionally clustered effects of social risk exposures.

Social equalization in youth: evidence from a cross-sectional British survey

BACKGROUND

A number of studies have suggested that social inequalities in health disappear or are attenuated in early adolescence possibly due to changing risk exposures. The present study examines social equalization in youth in a representative sample of British households with children aged 0-18 years.

METHODS

Secondary analysis of a cross-sectional survey of a representative sample of British households with children and youth with parent-reported less than good health, long-standing illness, and chest problems as outcomes.

RESULTS

Data were available on 15 756 children aged 0-18 years in 8541 households in the third sweep (2001) of the British government's Families and Children Study. Parent-rated health status, long-standing illness, and chest problems all showed social patterning among children who were 0-11 years of age. Among 12- to 14-year-olds, the social gradients in these outcomes noted in childhood associated with income, social class, and education were lost but inequalities in parent-rated health status and long-standing illness but not chest problems persisted associated with measures of household work status and wealth. Among 15- to 18-year-olds, income inequalities appeared to reassert themselves, particularly among girls, but gradients by maternal education noted among 0- to 11-year-olds were absent in both sexes. Inequalities persisted with measures of household worklessness and wealth.

CONCLUSIONS

In this cross-sectional study, the social equalization in youth was noted for some health outcomes and by some measures of socioeconomic status but not for others. Inequalities in parent-rated health status and long-standing illness persist among young people in workless households and those experiencing severe material hardship.

The influence of birth weight and socioeconomic position on cognitive development: Does the early home and learning environment modify their effects?

OBJECTIVE

To establish whether effects of birth weight and socioeconomic position on cognition are explained or modified by home or learning environments.

STUDY DESIGN

Prospective birth cohort (n = 13,980) with math tests at 7, 11, and 16 years of age and qualifications by 33 years of age.

RESULTS

For 1 kg increase in birth weight, 7-year math Z score increased 0.23 (0.19 adjusted for parental interest in child's progress) and adult qualifications increased 0.22 (on a 5-point scale). Maternal reading benefited math less among lower than higher birth weights (p < .05). The birth weight effect remained unchanged 7 to 16 years of age. For each increment in social class (4 categories; IV&V to I&II), 7-year math increased 0.19 (0.12 adjusted for parental interest). Benefits of mother's reading and father's interest were greatest in classes IV&V (interaction p < .05). The difference in Z scores between classes I&II to IV&V was 0.57 at 7 years; 1.12 at 16 years of age. Estimates were little affected by home and school factors. Adult qualifications increased 0.40 per unit social class (0.33 adjusted for parental interest). Maternal interest reduced the chances of those from unskilled manual origins gaining few qualifications (p < .05). Similarly, interactions were seen for maternal reading and paternal interest.

CONCLUSION

Influences in the home partly underlie associations between social background and cognition, but they do little to explain a birth weight/cognition association.

Behavioral science at the crossroads in public health: extending horizons, envisioning the future

The social and behavioral sciences are at a crossroads in public health. In this paper, we attempt to describe a path toward the further integration of the natural and behavioral sciences with respect to the study of behavior and health. Three innovations are proposed. First, we extend and modify the "stream of causation" metaphor along two axes: time, and levels of nested systems of social and biological organization. Second, we address the question of whether 'upstream' features of social context are causes of disease, fundamental or otherwise. Finally, we propose the concept of a risk regulator to advance the study of behavior and health in populations. To illustrate the potential of these innovations, we develop a multilevel framework for the study of health behaviors and obesity in social and biological context.

Associations of childhood circumstances with physical and mental functioning in adulthood

The aim of this study was to examine the associations of parental education and specific childhood circumstances with adult physical and mental functioning. Self-reported data were collected in 2000, 2001 and 2002 among middle-aged women (n=7,171) and men (n=1,799) employed by the City of Helsinki. Functioning was measured by the physical and mental component summaries of the Short-Form 36 Health Survey (SF-36). The lowest quartile of the scores on each component summary was considered to indicate limited functioning. Adult socio-economic circumstances were measured by their own education. Among women parental education was inversely associated with physical functioning. The association remained after adjusting for specific childhood circumstances but disappeared after adjustment for own education. In contrast, parental education was positively associated with mental functioning among women, and the association remained after adjusting for specific childhood circumstances and the own education. Among women childhood adversities such as own chronic disease, parental mental problems, economic difficulties and having been bullied in childhood were associated with both physical and mental functioning. Parental drinking problems were associated with adult mental functioning among women. Among men, chronic disease, economic difficulties and having been bullied in childhood were associated with physical functioning. Parental mental problems, economic difficulties and having being bullied in childhood were also associated with mental functioning among men. These results suggest that the effect of parental education on physical functioning is mediated through one's own education. The association between parental education and mental functioning and the effects of several specific childhood circumstances may suggest a latency effect. Some evidence of cumulative effects of childhood and adulthood circumstances were found among women in physical functioning. Specific childhood circumstances are therefore important determinants of adult functioning. These circumstances provide detailed information on the association of childhood circumstances with adult functioning over and above parental education.

Determinants of health in early adulthood: what is the role of parental education, childhood adversities and own education?

BACKGROUND

Of the many studies assessing the impact of childhood living conditions on health and health inequalities in adulthood, only few have combined information on current determinants of health with detailed individual level data on different aspects of childhood living conditions and adversities. This study aims (i) to assess the role of parental education, self-reported childhood adversities and family structure as determinants of different dimensions of health in early adulthood, and (ii) to identify the role of the respondent's own education as a modifier of the association between childhood living conditions and health.

METHODS

The study is based on a representative sample (n = 3669; participation rate 83%) of young adults aged 18-39 years in 2000 in Finland. The main outcome measures were poor self-rated health (SRH), psychological distress (by GHQ12) and somatic morbidity.

RESULTS

Parental education, problems in childhood and the respondent's own education were independently related to SRH and psychological distress. The impact of childhood living conditions on health varied by gender and according to the measure of health. Childhood conditions were strongly associated with poor SRH and psychological distress, whereas the connection with somatic morbidity was weaker. The associations remained relatively unchanged after controlling for the respondent's own education.

CONCLUSIONS

Childhood living conditions and adversities are strongly associated with poor SRH and psychological distress in early adulthood. Early recognition of childhood adversities followed by relevant support measures may play an important role in preventing health problems in adulthood.

Statut socio-économique, comportements de santé et santé des adolescents français : l’enquête Health Behaviour in School-aged Children (HBSC)

BACKGROUND

The impact of living conditions on health is not well known, but health inequalities observed in adults seem partly determined by behaviours and health status at an earlier stage, and more particularly during adolescence. So, our aim was to study adolescents' health and their health behaviours function to family socioeconomic status.

METHODS

We analysed French data from the international survey "Health Behavior in School-aged Children" carried out in a representative sample of adolescents aged 13 and 15 years in 1998. A self-administered questionnaire was completed by the adolescents who answered questions concerning their health, health behaviours, and their families' socio-economic status.

RESULTS

Adolescents from blue-collar families were more numerous to report to be in "fairly good health" or "not very good health" (OR = 1.40, CI 95% = 1.12-1.74) and to be overweight or obese (OR = 1.85, CI 95% = 1.25-2.24) than those from executive families. They were also more numerous to have bad health behaviours than those from executive families.

CONCLUSION

This study has established that, in adolescents, differences in health, health behaviours, types of consumption and physical activities depended on the families' socio-economic status.

Relation between early life socioeconomic position and all cause mortality in two generations. A longitudinal study of Danish men born in 1953 and their parents

OBJECTIVE

To examine (1) the relation between parental socioeconomic position and all cause mortality in two generations, (2) the relative importance of mother's educational status and father's occupational status on offspring mortality, and (3) the effect of factors in the family environment on these relations.

DESIGN

A longitudinal study with record linkage to the Civil Registration System. The data were analysed using Cox regression models.

SETTING

Copenhagen, Denmark.

SUBJECTS

2890 men born in 1953, whose mothers were interviewed regarding family social background in 1968. The vital status of this population and their parents was ascertained from April 1968 to January 2002.

MAIN OUTCOME MEASURES

All cause mortality in study participants, their mothers, and fathers.

RESULTS

A similar pattern of relations was found between parental social position and all cause mortality in adult life in the three triads of father, mother, and offspring constituted of the cohort of men born in 1953, their parents, and grandparents. The educational status of mothers showed no independent effect on total mortality when father's occupational social class was included in the model in either of the triads. Low material wealth was the indicator that remained significantly associated with adult all cause mortality in a model also including parental social position and the intellectual climate of the family in 1968. In the men born in 1953 the influence of material wealth was strongest for deaths later in adult life.

CONCLUSION

Father's occupational social class is associated with adult mortality in all members of the mother-father-offspring triad. Material wealth seems to be an explanatory factor for this association.

Childhood adversities and health variations among middle-aged men: a retrospective lifecourse study

BACKGROUND

Using a lifecourse approach, this study examines whether childhood adversities act on adult health as latent or pathway effects, and whether not only childhood ill health and material deprivation, but also an adverse psychosocial environment in terms of stressful relations with parents contribute to later ill health.

METHODS

Lifecourse interviews with 380 men born in 1946 were conducted. Outcome variables were perceived health, number of medical conditions, and activity limitations. Ordinal scales indicating levels of exposures as regards childhood health/growth, childhood material deprivation, stressful relations with parents, educational level, and unhealthy adult behaviours were made. Statistical analyses were performed by non-parametric correlation, logistic regression and OLS regression with dummy variables.

RESULTS

Simple regression analyses showed a consistent pattern of more negative health outcomes with higher exposures on each of the lifecourse health determinants, but associations were relatively often not statistically significant. In multivariate analyses, the overall pattern remained with few alterations. The lifecourse determinants differed somewhat in their effects on the three health outcomes. Stressful relations with parents were significantly associated with perceived health and activity limitations.

CONCLUSIONS

Childhood adversities influence later health to a large extent as latent effects. Stressful relations with parents were relatively important for two of the health outcomes, suggesting that not only ill health and material deprivation during childhood, but also an adverse psychosocial environment contributes to ill health among middle-aged men.

KEY POINTS

The study asks whether childhood adversities influence middle-aged men's health through latent or pathway effects. Adjusted for adult circumstances, childhood health problems were associated with activity limitations and medical problems among men aged 55. Stressful relations to parents during childhood had direct negative effects on perceived overall health and activity limitations. Results indicate that childhood adversities often affect adult health as latent effects. Health promotion policies should consider that childhood psychosocial difficulties may have longterm negative health consequences.

Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review

Background

A relatively consistent body of research supports an inverse graded relationship between socioeconomic status (SES) and cardiovascular disease (CVD). More recently, researchers have proposed various life course SES hypotheses, which posit that the combination, accumulation, and/or interactions of different environments and experiences throughout life can affect adult risk of CVD. Different life course designs have been utilized to examine the impact of SES throughout the life course. This systematic review describes the four most common life course hypotheses, categorizes the studies that have examined the associations between life course SES and CVD according to their life course design, discusses the strengths and weaknesses of the different designs, and summarizes the studies' findings.

Methods

This research reviewed 49 observational studies in the biomedical literature that included socioeconomic measures at a time other than adulthood as independent variables, and assessed subclinical CHD, incident CVD morbidity and/or mortality, and/or the prevalence of traditional CVD risk factors as their outcomes. Studies were categorized into four groups based upon life course design and analytic approach. The study authors' conclusions and statistical tests were considered in summarizing study results.

Results

Study results suggest that low SES throughout the life course modestly impacts CVD risk factors and CVD risk. Specifically, studies reviewed provided moderate support for the role of low early-life SES and elevated levels of CVD risk factors and CVD morbidity and mortality, little support for a unique influence of social mobility on CVD, and consistent support for the detrimental impact of the accumulation of negative SES experiences/conditions across the life course on CVD risk.

Conclusions

While the basic life course SES study designs have various methodologic and conceptual limitations, they provide an important approach from which to examine the influence of social factors on CVD development. Some limitations may be addressed through the analysis of study cohorts followed from childhood, the evaluation of CVD risk factors in early and middle adulthood, and the use of multiple SES measures and multiple life course analysis approaches in each life course study.

Toward Youth Self-Report of Health and Quality of Life in Population Monitoring

This paper addresses population monitoring of youth health and quality of life, including the concepts used, methodological and practical criteria for indicators, and existing surveys and measures. Current population surveys of youth generally focus on poor health, such as disability or health-risk behaviors. Although these are important end points, indicators of illness or risk do not reflect the health or life perspective of the majority of youth who do not experience health problems. The measures used to monitor youth health should be appropriate and sensitive to future needs and capture the perspectives of youths. Two potential concepts for this "scorecard" are self-perceived health and quality of life, which have been shown to be useful in adults. For youth, the quality of life framework seems particularly relevant as it incorporates both positive and negative aspects of health and well-being and also captures salient aspects of health other than physical health, such as sense of self, social relationships, environment and culture, and life satisfaction.

Life-course experiences and mortality by adult social class among young men

Circumstances over the life-course may contribute to adult social class differences in mortality. However, it is only rarely that the life-course approach has been applied to mortality studies among young adults. The aim of this study is to determine to what extent social class differences in mortality among young Finnish men are explained by living conditions in the parental home and life paths related to transitions in youth. The data for males born in 1956-60 based on the 1990 census records are linked with death records (3184 deaths) by cause of death for 1991-98, and with information on life-course circumstances from the 1970, 1975, 1980, and 1985 censuses. Controlling for living conditions in the parental home-social class, family type, number of siblings, language and region of residence-reduced the high excess mortality of the lower non-manual (RR 1.51, 95% CI: 1.28-1.79), skilled manual (RR 2.94, 2.54-3.40), and unskilled manual class (RR 4.08, 3.51-4.73) by 10% in all-cause mortality. The equivalent reduction for cardiovascular disease was 28% and for alcohol-related causes 16%. The effect of parental home on mortality differences was mainly mediated through its effect on youth paths (pathway model). Educational, marital, and employment paths had a substantial effect-independent of parental home-on social class differences from various causes of death. When all these variables were controlled for adult social class differences in cause specific mortality were reduced by 75-86%. Most of this reduction in mortality differences can be attributed to educational path. However, marital and employment paths had their independent effects, particularly on the excess mortality of unskilled manual workers with disproportionately common exposure to long-term unemployment and living without a partner. In summary, social class differences in total mortality among men in their middle adulthood were only partly determined by parental home but they were mainly attributable to educational, marital, and employment paths in youth.

Health, ageing and social differentials: a case study of Soweto, South Africa

This article analyses the relationship between health of people over sixty and a range of social differentials in a specific social context of a relatively deprived community in South Africa. Basic measures of social inequality as well as more sophisticated indicators of social relationships and access to social resources and how they are linked to peoples' perception of their own health are explored. The paper is based on a secondary analysis of data collected in a comprehensive social survey of Soweto conducted in 1997 by a team of researchers based mainly in the Department of Sociology at the University of the Witwatersrand, Johannesburg. The results present an interesting scenario, which, while reaffirming the already established connection between social differentials, social ties and health, also sheds light on a different social context and specific relationships with regard to health.

Measuring contextual characteristics for community health

OBJECTIVE

To conceptualize and measure community contextual influences on population health and health disparities.

DATA SOURCES

We use traditional and nontraditional secondary sources of data comprising a comprehensive array of community characteristics.

STUDY DESIGN

Using a consultative process, we identify 12 overarching dimensions of contextual characteristics that may affect community health, as well as specific subcomponents relating to each dimension.

DATA COLLECTION

An extensive geocoded library of data indicators relating to each dimension and subcomponent for metropolitan areas in the United States is assembled.

PRINCIPAL FINDINGS

We describe the development of community contextual health profiles, present the rationale supporting each of the profile dimensions, and provide examples of relevant data sources.

CONCLUSIONS

Our conceptual framework for community contextual characteristics, including a specified set of dimensions and components, can provide practical ways to monitor health-related aspects of the economic, social, and physical environments in which people live. We suggest several guiding principles useful for understanding how aspects of contextual characteristics can affect health and health disparities.

Advancing health disparities research: can we afford to ignore measurement issues?

BACKGROUND

Research on racial and ethnic health disparities in the United States requires that self-report measures, developed primarily in mainstream samples, are appropriate when applied in diverse groups. To compare groups, mean scores must reflect true scores and have minimal bias, assumptions that have not been tested for many self-report measures used in this research.

OBJECTIVE

To identify conceptual and psychometric issues that need to be addressed to assure the quality of self-report measures being used in health disparities research.

METHODS

We present 2 broad conceptual frameworks for health disparities research and describe the main research questions and measurement issues for 4 key concepts hypothesized as potential mechanisms of health disparities: socioeconomic status, discrimination, acculturation, and quality of care. This article is based on a small conference convened by 6 Resource Centers for Minority Aging Research (RCMAR) measurement cores. We integrate written materials prepared for the conference by quantitative and qualitative measurement specialists and cross-cultural researchers, conference discussions, and current literature.

RESULTS

Problems in the quality of the conceptualizations and measures were found for all 4 concepts, and little is known about the extent to which measures of these concepts can be interpreted similarly across diverse groups. Many problems also apply to other concepts relevant to health disparities. We propose an agenda for accomplishing this challenging measurement research.

CONCLUSIONS

The current national commitment to reduce health disparities may be compromised without more research on measurement quality. Integrated, systematic efforts are needed to move this work forward, including collaborative efforts and special initiatives.

Self-assessed health--a case study of social differentials in Soweto, South Africa

The study of the relationship between health and social differentials as a focus of research is not new. However, most of the studies originate in the Western-developed world and are thus informed by this specific social and cultural context. The aim of the paper was to analyse the relationship between health and a range of social factors in a specific social context of a relatively deprived community in South Africa. It is based on a secondary analysis of data collected in a comprehensive social survey of Soweto conducted in 1997. A total of 2947 interviews were used for the current analysis. An attempt was made to explore basic measures of social inequality as well as more sophisticated indicators of social relationships and access to "social resources" and how they are linked to people's perception of their own health. The results reveal a clear relationship between health and a range of socio-economic indicators of inequalities. Health is significantly associated with a good "perception about the living environment" and "access to social resources". This paper presents an interesting scenario which -while reaffirming the already established connection between social differentials and health-also sheds light on a different social context and specific relationships with regard to health. It also points towards the ways people try to cope with the psycho-social stressor emanating from their specific context.

Effect of social variation on the Irish diet

Both jurisdictions of Ireland have high rates of chronic degenerative diseases, particularly of the cardiovascular system, and Irish migrants have worse health profiles, often lasting at least two generations. The influence of socio-demographic variation over the life course, and what role diet plays, has not been well researched in epidemiological terms. There is a long history of an unusual Irish diet. Estimated dietary fat intake (% total energy intake) in 1863 was only 9, but had reached 30 in 1948 and 34 in 1999. Conversely, carbohydrate intake has fallen steadily over 150 years. From 1948 onwards household budget survey data illustrate patterns of increasing urbanisation and socio-economic gradients in food availability. The National Survey of Lifestyles, Attitudes and Nutrition, (n 6539, 62.2% response rate) provides clear evidence of inverse social-class gradients in intake of fruit and vegetables and dairy products and in reported patterns of healthy eating. Median carbohydrate and vitamin C levels are higher among social classes 1-2 and mean saturated fat intake is lower. International comparisons indicate a continuing, if narrowing, north-south gradient across Europe. Data from the Boston-Ireland study suggest a crossover in both dietary intake patterns and risk of heart disease in Ireland and the USA in the 1970s. Contemporary comparative data of middle-aged Irish and American women demonstrate patterns of diet intake and inactivity consistent with the modern epidemic of obesity and non-insulin-dependent diabetes. Thus, dietary variations within and between countries and over time are consistent with chronic disease patterns in contemporary Ireland.

Life course health development: an integrated framework for developing health, policy, and research

The life course health development (LCHD) framework organizes research from several fields into a conceptual approach explaining how individual and population health develops and how developmental trajectories are determined by interactions between biological and environmental factors during the lifetime. This approach thus provides a construct for interpreting how people's experiences in the early years of life influence later health conditions and functional status. By focusing on the relationship between experiences and the biology of development, the LCHD framework offers a better understanding of how diseases occur. By suggesting new strategies for health measurement, service delivery, and research, as well as for improving health outcomes, this framework also supports health care-purchasing strategies to develop health throughout life and to build human health capital.