Social class differences in mortality using the National Statistics Socio-economic Classification--too little, too soon: a reply to Chandola

Researching Health Inequities among African Americans: The Imperative to Understand Social Class

Racial and ethnic inequities in health abound in many disease categories. African-American communities suffer from an increased burden of illness, with higher incidence and mortality rates and more severe morbidity in cerebrovascular disease, heart disease, several cancers, diabetes, and many other ailments. Healthy People 2010, the federal government's health plan, calls for eliminating health disparities by race, ethnicity, gender, education, income, disability, geographic location, or sexual orientation. Research aimed at increasing our understanding of these health disparities and designing and evaluating interventions to improve African-American health is hampered by a liberal, classless approach. The authors argue for a theoretical framework in this research that recognizes that class exploitation sets the stage for and interacts with racial discrimination to determine racial inequities in health.

The Relationship Between Life Course Factors, Parental Demographics, Dental Coping Beliefs and Its Influence on Adolescents Dental Visit: a Cross Sectional Study

Background

Oral Disease is a multifactorial one that includes behavioral and cultural components, and the severity of the disease depends on regularity of dental visits. The purpose of the study was to evaluate the relationship between parental demographics, life course factors, dental coping beliefs with therecent dental attendance among adolescents in Udupi Taluk.

Methods

Three hundred and fifty adolescents aged 16–19 years from four randomly selected schools in Udupi Taluk participated in this cross sectional study. Information was obtained regarding their parental demographics, their early life course, dental coping beliefs and recent dental attendance. Bivariate followed by multiple logistic regression analysis was performed to elicit variables which predict recent dental attendance.

Results

Out of the 324 adolescents who completed the questionnaire, 25.3% reported visiting a dentist within a period of one year. Childhood dental visit, childhood dental experience, housing, internal and external locus of control and self-efficacy were significantly associated with recent dental visit (p<0.05). Participants who lived in cement/brick houses were 4.3 times more likely to visit a dentist within one year compared to those living in hut/mud/combined houses (p<0.05). Adolescents with lower external (OR= 0.11, P<0.003) and low internal (OR=0.05, P<0.001) locus of control had lower odds of visiting a dentist within a year when compared with those having higher locus of control.

Conclusion

Childhood financial hardships, childhood dental visits and experiences and dental coping beliefs affect dental attendance pattern during adolescence. These factors should be considered while tailoring interventions to promote the oral health and dental attendance behaviors of adolescents.

Class divisions and health chances in Brazil

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.

Socioeconomic differences in service use, payment and receipt of illness-related benefits in the last year of life: findings from the British Household Panel Survey

BACKGROUND

Terminal illness presents a financial challenge to many households, but in Britain the situation should be eased by state benefits, such as attendance allowance, which is available to everyone in the last six months of life without means testing.

AIM

To investigate the use of health and social services, payments and benefit receipt by individuals in differing financial circumstances in the year before death.

METHODS

Analysis of individual level panel data for 1652 community-dwelling decedents from 12 waves of the British Household Panel Study (1991-2003).

RESULTS

In the year before death, over 90% of decedents saw their GP, and around one-third spent some time in hospital. More than 80% paid no fees for any services. Over a third of decedents aged over 65 reported financial strain, but only 13.9% of these were receiving attendance allowance. People who felt that they were having financial difficulties were more likely to be frequent attenders in primary care, taking age, health status and other factors into account (adjusted OR=1.9, 95% CI=1.3-2.6, P<0.001). Older age was associated with less use of primary, but not secondary care.

CONCLUSIONS

Financial strain was common, but benefit uptake low. Primary health care professionals saw nearly all decedents in their last year, and could play an important role in ensuring that the elderly and the less well off are aware of the services and benefits available to them.

Socio-demographic predictors of quitting smoking: how important are household factors?

AIMS

To compare different socio-demographic predictors of quitting smoking in a cohort representative of adult smokers in the British population using appropriate models that take into account the clustering of smoking behaviours at the household and area levels.

DESIGN

A longitudinal, population representative survey of British adults (the British Household Panel Survey, BHPS) from 1991 to 2000.

SETTING AND PARTICIPANTS

At wave 1 of the BHPS, 10264 adults living in 5511 households were interviewed. Around 30% of the wave 1 respondents reported smoking cigarettes. Of these, 21% had quit smoking over a 10-year period.

MEASUREMENTS

'Quitters' (quitting smoking) were defined as smokers who had subsequently described themselves as non-smokers for at least 2 consecutive waves (years) of the BHPS. Degree of dependence was indexed using the number of cigarettes currently smoked per day.

FINDINGS

Degree of dependence was the strongest predictor of quitting smoking, followed by occupational social class, social support, marital status and the proportion of smokers in the household. There was some evidence of clustering of quitting smoking behaviour within households-members of the same household had similar quitting smoking behaviours. This clustering at the household level appeared to be explained by mechanisms related to the household level. However, there was little evidence for clustering of smoking behaviour within areas.

CONCLUSIONS

In addition to reducing addiction to cigarettes, policies designed to encourage smokers to quit may need to take into account factors related to household support and employment relations, in order to encourage smokers from all socio-demographic groups to quit

Social inequalities in health by individual and household measures of social position in a cohort of healthy people

STUDY OBJECTIVE

It is increasingly recognised that different dimensions of social inequality may be linked to health by different pathways. Furthermore, factors operating at the individual level such as employment conditions may affect health in a different way from household level factors. The paper examines the associations between self rated health and four measures of social position- occupational class, household social advantage, personal and household income.

DESIGN

Multilevel logistic regression models were used to predict self rated health using longitudinal data from the British Household panel survey (BHPS) with respondents nested within households. Separate analyses were carried out for economically active and inactive respondents.

SETTING

Interview based surveys of adults living within households that are representative of British households.

PARTICIPANTS

Adult respondents from the BHPS.

MAIN RESULTS

Occupational class has relatively strong effects on the self rated health of the economically active, although household level factors also seem to influence their health. Household social advantage has relatively strong effects on the self rated health of the economically inactive.

CONCLUSIONS

The paper found evidence in support of the view that different dimensions of social inequality have different pathways to self rated health. There are unexplained similarities in health between household members, which require further investigation.