Why are there social gradients in preventative health behavior? A perspective from behavioral ecology

Individual characteristics associated with perceptions of control over mortality risk and determinants of health effort

People who believe they have greater control over health and longevity are typically more likely to invest in their long-term health. Investigating individual differences in perceived control over risk and exploring different determinants of health effort may help to tailor health promotion programs to more effectively encourage healthy behaviors. From a sample of 1500 adults, we measured perceived control over 20 causes of death, overall perceived uncontrollable mortality risk (PUMR), state-level optimism, self-reported health effort, and the accuracy of estimations of avoidable deaths. We found individual differences in perceptions of control over specific causes of death based on age, gender, and income. PUMR was predicted by socioeconomic variables expected to influence exposure to risk and resource availability. Higher levels of PUMR, not perceptions of control over specific causes of death, predicted self-reported health effort. The strength of relationship between PUMR and lower health effort was not moderated by state-level optimism. Age and education both positively predicted greater accuracy in assessing the prevalence of avoidable deaths. We suggest that PUMR may capture people's "general sense" of mortality risk, influenced by both exposure to hazards and the availability of resources to avoid threats. Conversely, perceived control over specific risks may involve more deliberate, considered appraisals of risk. This general sense of risk is thought to play a more notable role in determining health behaviors than specific assessments of control over risk. Further study is needed to investigate the degree to which PUMR accurately reflects objective measures of individual risk.

The Uncontrollable Mortality Risk Hypothesis: Theoretical foundations and implications for public health

The 'Uncontrollable Mortality Risk Hypothesis' employs a behavioural ecological model of human health behaviours to explain the presence of social gradients in health. It states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviours. We outline the theoretical assumptions of the hypothesis and stress the importance of incorporating evolutionary perspectives into public health. We explain how measuring perceived uncontrollable mortality risk can contribute towards understanding socioeconomic disparities in preventative health behaviours. We emphasize the importance of addressing structural inequalities in risk exposure, and argue that public health interventions should consider the relationship between overall levels of mortality risk and health behaviours across domains. We suggest that measuring perceptions of uncontrollable mortality risk can capture the unanticipated health benefits of structural risk interventions, as well as help to assess the appropriateness of different intervention approaches.

Perception of uncontrollable mortality risk is associated with food insecurity and reduced economic effort among resource-insecure college students during COVID-19

In the framework of the uncontrollable mortality risk hypothesis, resource scarcity intersects with mortality risk, shaping resource allocation strategies with enduring impacts on human health and wellbeing. Despite rising economic and food insecurity among US college students, little is known about how these insecurities relate to mortality risk, or how scarcity and mortality risk interact to shape college students' resource allocation strategies. We examine perceptions of resource scarcity and mortality risk and their associations with food insecurity and resource allocation strategies among economically insecure college students during COVID-19 lockdowns. Participants were recruited through an economic crisis response center at a major public university in the United States. A total of 118 participants completed an online Qualtrics survey assessing sociodemographic characteristics, perceptions of mortality risk and resource availability, food security, economic effort, and time perspective; a subset (n = 51) also participated in a telephone interview assessing psychological distress. In general, participants reported more environmental adversity and economic effort during COVID-19 lockdowns compared to before. Students experiencing higher levels of uncontrollable (and not controllable) mortality risk report lower levels of economic effort, and the association was strongest among students perceiving the fewest resources. We also found significant associations between uncontrollable mortality risk and food insecurity. Our results highlight uncontrollable mortality risk's influence on human well-being. Public health efforts should target the experiences and root structural causes of uncontrollable mortality risk, which among economically insecure college students increasingly involves food insecurity.

The Relationship Between Perceived Uncontrollable Mortality Risk and Health Effort: Replication, Secondary Analysis, and Mini Meta-analysis

BACKGROUND

The Uncontrollable Mortality Risk Hypothesis (UMRH) states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviors. Greater levels of perceived uncontrollable mortality risk (PUMR) have been associated with lower health effort in previous research, but the topic remains understudied.

PURPOSE

To examine the evidence for the UMRH by replicating a previous study investigating the effects of PUMR on social gradients in health effort, and conducting a mini meta-analysis of the overall relationship between PUMR and health effort.

METHODS

We replicated Pepper and Nettle (2014), who reported a negative relationship between PUMR and health effort, and that the positive effect of subjective socioeconomic position on health effort was explained away by PUMR. We also compared the predictive effect of PUMR on health effort with that of dimensions from the Multidimensional Health Locus of Control scale-a well-used measure of a similar construct, which is frequently found to be associated with health behavior. Finally, we conducted a mini meta-analysis of the relationship between PUMR and health effort from the available research.

RESULTS

PUMR was negatively associated with health effort, and mediated 24% of the total effect of subjective socioeconomic position on health effort, though this mediation effect was weaker than in Pepper and Nettle (2014). PUMR was shown to be a substantially stronger predictor of health effort than the relevant dimensions of the MHLC scale. Finally, our mini meta-analysis indicated a medium-sized negative relationship between PUMR and health effort.

CONCLUSIONS

Our findings offer support for the role of PUMR in mediating the relationship between subjective socioeconomic position and health effort. The results highlight the importance of measuring and understanding PUMR in studying socioeconomic inequalities in health behaviors. We discuss potential areas for future research, including determining the accuracy of PUMR, investigating influential cues, examining the role of media in shaping risk perceptions, and understanding individuals' awareness of their own perceptions of mortality risk.

Shorter Goals for the Faster Life: Childhood Unpredictability Is Associated With Shorter Motivational Time Horizons

Models of adaptive calibration provide an overarching theoretical framework for understanding the developmental roots of psychological and behavioral outcomes in adulthood. An adaptive calibration framework was used to examine an important dimension of motivation: goal timing. Across two studies, we saw mixed support for the hypothesis that unpredictability experienced in childhood would be negatively associated with the time horizons people use to set their goals, such that people who reported experiencing more unpredictability in their childhood tended to set goals on relatively shorter time horizons. The association was observed based on independent ratings of goal timing, but not based on participants' self-reported ratings of goal timing, and was statistically mediated by people's tendency to consider the short- versus long-term future consequences of their actions. These studies isolate a key component of childhood adversity-unpredictability-potentially underlying the time horizons people use to set, prioritize, and pursue their goals.

Income- and education-based inequalities of edentulism and dental services utilization in Brazil

OBJECTIVE

Tooth loss is a worldwide public health problem affecting mainly socioeconomically disadvantaged groups. Dental services utilization may increase access to preventive actions and conservative treatment, reducing the prevalence of tooth loss. This study evaluated the income- and education-based inequalities in edentulism according to the utilization of dental services among adults and older adults in Brazil.

METHODS

Data from the National Oral Health Survey (SB Brazil, 2010) of adults (ages 35-44 years, n = 9779) and older adults (ages 65-74 years, n = 7619) were analysed. Socioeconomic indicators (SES) included education and income. The magnitude of inequality in edentulism by education and income levels was estimated by the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). The changes in the RII and SII according to the utilization of dental services were estimated. Regression models estimated the association between SES and edentulism and whether dental services utilization modified this association.

RESULTS

Higher edentulism prevalence was observed among those with lower education and income levels. The utilization of dental services changed the education-based inequality index in edentulism for adults, with percentage changes of 17.4% (RII) and 56.8% (SII). For adults with low education (0-4 years of study), the odds of edentulism were 80% (OR 0.2; 95% CI 0.1-0.6) and 90% (OR 0.1; 95% CI 0.01-0.2) lower for those who had used dental services within the preceding year and within 1-2 years compared with those who had used such services within the preceding 3 or more years, respectively.

CONCLUSION

There was a social gradient in the prevalence of edentulism in adults and older adults, and the education-based inequalities in edentulism were lower among adults reporting utilization of dental services in the preceding year.

Perceptions of control over different causes of death and the accuracy of risk estimations

Background

A large number of deaths could be avoided by improving health behaviours. The degree to which people invest in their long-term health is influenced by how much they believe they can control their risk of death. Identifying causes of death believed to be uncontrollable, but likely to occur, may provide actionable targets for health interventions to increase control beliefs and encourage healthier behaviours.

Method

We recruited a nationally representative online sample of 1500 participants in the UK. We assessed perceived control, perceived personal likelihood of death, certainty of risk estimation, and perceived knowledge for 20 causes of death. We also measured overall perceived uncontrollable mortality risk (PUMR) and perceived prevalence for each of the Office for National Statistics' categories of avoidable death.

Findings

Risk of death due to cancer was considered highly likely to occur but largely beyond individual control. Cardiovascular disease was considered moderately controllable and a likely cause of death. Drugs and alcohol were perceived as risks both high in control and low in likelihood of death. However, perceptions of control over specific causes of death were found not to predict overall PUMR, with the exception of cardiovascular disease. Finally, our sample substantially overestimated the prevalence of drug and alcohol-related deaths in the UK.

Conclusions

We suggest that more can be done by public health communicators to emphasise the lifestyle and behavioural changes that individuals can make to reduce their general cancer risk. More work is needed to understand the barriers to engaging with preventative behaviours and maintaining a healthy heart. Finally, we call for greater journalistic responsibility when reporting health risks to the public.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01910-8.

Reflections on oral health inequalities: Theories, pathways and next steps for research priorities

Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.

Predicting attitudes towards screening for neurodegenerative diseases using OCT and artificial intelligence: Findings from a literature review

Recent developments in artificial intelligence (AI) and machine learning raise the possibility of screening and early diagnosis for neurodegenerative diseases, using 3D scans of the retina. The eventual value of such screening will depend not only on scientific metrics such as specificity and sensitivity but, critically, also on public attitudes and uptake. Differential screening rates for various screening programmes in England indicate that multiple factors influence uptake. In this narrative literature review, some of these potential factors are explored in relation to predicting uptake of an early screening tool for neurodegenerative diseases using AI. These include: awareness of the disease, perceived risk, social influence, the use of AI, previous screening experience, socioeconomic status, health literacy, uncontrollable mortality risk, and demographic factors. The review finds the strongest and most consistent predictors to be ethnicity, social influence, the use of AI, and previous screening experience. Furthermore, it is likely that factors also interact to predict the uptake of such a tool. However, further experimental work is needed both to validate these predictions and explore interactions between the significant predictors.

Income-related inequality and decomposition of edentulism among aged people in China

Background

The aim of this study was to assess the income-related inequality of edentulism among the aged in China and identify the contributing factors.

Methods

A secondary analysis of data from the 4th National Oral Health Epidemiology Survey in China was conducted, and 65–74 years old were selected for the analysis of income-related inequality of edentulism. The concentration curve, Concentration index (CI) and Erreygers-corrected concentration index (EI) were used to represent inequality and its degree qualitatively and quantitatively, respectively. A decomposition method based on probit model was employed to determine the contributors of inequality, including demographic factors, income status, oral health-related knowledge, attitude and practices and self-perceived general health status.

Results

In China, aged people with edentulism were concentrated in the poor. The CI was − 0.2337 (95% CIs: − 0.3503, − 0.1170). The EI was − 0.0413 (95% CIs: − 0.0619, − 0.0207). The decomposition results showed that income (75.02%) and oral health-related knowledge, attitude and practices (15.52%) were the main contributors to the inequality.

Conclusion

This study showed that pro-poor inequality among the elderly with edentulism existed in China. Corresponding policies against the contributors could be considered to promote the health equality of the elders.

Exploring smoke: an ethnographic study of air pollution in rural Malawi

Air pollution adversely affects human health, and the climate crisis intensifies the global imperative for action. Low-/middle-income countries (LMIC) suffer particularly high attributable disease burdens. In rural low-resource settings, these are linked to cooking using biomass. Proposed biomedical solutions to air pollution typically involve ‘improved cooking technologies’, often introduced by high-income country research teams. This ethnography, set in a rural Malawian village, aimed to understand air pollution within its social and environmental context. The results provide a multifaceted account through immersive participant observations with concurrent air quality monitoring, interviews and participatory workshops. Data included quantitative measures of individuals’ air pollution exposures paired with activity, qualitative insights into how smoke is experienced in daily life throughout the village, and participants’ reflections on potential cleaner air solutions. Individual air quality monitoring demonstrated that particulate levels frequently exceeded upper limits recommended by the WHO, even in the absence of identified sources of biomass burning. Ethnographic findings revealed the overwhelming impact of economic scarcity on individual air pollution exposures. Scarcity affected air pollution exposures through three pathways: daily hardship, limitation and precarity. We use the theory of structural violence, as described by Paul Farmer, and the concept of slow violence to interrogate the origins of this scarcity and global inequality. We draw on the ethnographic findings to critically consider sustainable approaches to cleaner air, without re-enacting existing systemic inequities.

Why Hypothesis Testers Should Spend Less Time Testing Hypotheses

For almost half a century, Paul Meehl educated psychologists about how the mindless use of null-hypothesis significance tests made research on theories in the social sciences basically uninterpretable. In response to the replication crisis, reforms in psychology have focused on formalizing procedures for testing hypotheses. These reforms were necessary and influential. However, as an unexpected consequence, psychological scientists have begun to realize that they may not be ready to test hypotheses. Forcing researchers to prematurely test hypotheses before they have established a sound "derivation chain" between test and theory is counterproductive. Instead, various nonconfirmatory research activities should be used to obtain the inputs necessary to make hypothesis tests informative. Before testing hypotheses, researchers should spend more time forming concepts, developing valid measures, establishing the causal relationships between concepts and the functional form of those relationships, and identifying boundary conditions and auxiliary assumptions. Providing these inputs should be recognized and incentivized as a crucial goal in itself. In this article, we discuss how shifting the focus to nonconfirmatory research can tie together many loose ends of psychology's reform movement and help us to develop strong, testable theories, as Paul Meehl urged.

Explaining socioeconomic disparities in health behaviours: A review of biopsychological pathways involving stress and inflammation

The purpose of this article was to explore how individuals' position in a socioeconomic hierarchy is related to health behaviours that are related to socioeconomic disparities in health. We identified research which shows that: (a) low socioeconomic status (SES) is associated with living in harsh environments, (b) harsh environments are related to increased levels of stress and inflammation, (c) stress and inflammation impact neural systems involved in self-control by sensitising the impulsive system and desensitising the reflective system, (d) the effects are inflated valuations of small immediate rewards and deflated valuations of larger delayed rewards, (e) these effects are observed as increased delay discounting, and (f) delay discounting is positively associated with practicing more unhealthy behaviours. The results are discussed within an adaptive evolutionary framework which lays out how the stress response system, and its interaction with the immune system and brain systems for decision-making and behaviours, provides the biopsychological mechanisms and regulatory shifts that make widespread conditional adaptability possible. Consequences for policy work, interventions, and future research are discussed.

COVID-19 preventive behaviours in White British and Black, Asian and Minority Ethnic (BAME) people in the UK

A model of the effects of ethnicity, political trust, trust in science, perceived ingroup power, COVID-19 risk and fear of COVID-19 upon likelihood of COVID-19 preventive behaviour (CPB) is presented. The structural equation model was a good fit for survey data from 478 White British and Black, Asian and Minority Ethnic (BAME) people. Ethnicity had a direct effect on CPB (BAME reported higher CPB) and an indirect effect on it through political trust, ingroup power, COVID-19 risk and trust in science. Ethnicity was not significantly related to COVID-19 fear. COVID-19 fear and trust in science were positively associated with CPB.

The Gut Microbiota and Unhealthy Aging: Disentangling Cause from Consequence

The gut microbiota changes with age, but it is not clear to what degree these changes are due to physiologic changes, age-associated inflammation or immunosenescence, diet, medications, or chronic health conditions. Observational studies in humans find that there are profound differences between the microbiomes of long-lived and frail individuals, but the degree to which these differences promote or prevent late-life health is unclear. Studies in model organisms demonstrate that age-related microbial dysbiosis causes intestinal permeability, systemic inflammation, and premature mortality, but identifying causal relationships have been challenging. Herein, we review how physiological and immune changes contribute to microbial dysbiosis and the degree to which microbial dysbiosis contributes to late-life health conditions. We discuss the features of the aging microbiota that make it more amenable to diet and pre- and probiotic interventions. Health interventions that promote a diverse microbiome could influence the health of older adults.

Designing trials of Universal Basic Income for health impact: identifying interdisciplinary questions to address

BACKGROUND

A large body of evidence indicates the importance of upstream determinants to health. Universal Basic Income (UBI) has been suggested as an upstream intervention capable of promoting health by affecting material, biopsychosocial and behavioural determinants. Calls are emerging across the political spectrum to introduce an emergency UBI to address socioeconomic insecurity. However, although existing studies indicate effects on health through cash transfers, UBI schemes have not previously been designed specifically to promote health.

METHODS

In this article, we scope the existing literature to set out a set of interdisciplinary research challenges to address in designing a trial of the effectiveness of UBI as a population health measure.

RESULTS

We present a theoretical model of impact that identifies three pathways to health impact, before identifying open questions related to regularity, size of payment, needs-based supplements, personality and behaviour, conditionality and duration.

CONCLUSIONS

These results set, for the first time, a set of research activities required in order to maximize health impact in UBI programmes.

Effects of the Sex Ratio and Socioeconomic Deprivation on Male Mortality

We explored relationships between male mortality and the sex ratio. (We tested relationships across 142 societies and in longitudinal data from Scotland. A male-biased sex ratio was associated with reduced mortality by intentional self-harm across 142 societies. This was replicated in longitudinal Scottish data, and men were less likely to die by suicide and assault when there were more men in the population only when levels of unemployment were low. We argue that this is consistent with a theoretical model in which men increase investment in relationships and offspring as "competition" under a male-biased sex ratio, and that the conflicting results of previous work may stem from divergent effects of the sex ratio on mortality depending upon relative deprivation.

Relationship between Morbidity and Health Behavior in Chronic Diseases

This study aimed to analyze the demographic characteristics and health behaviors related to chronic diseases and to identify factors that may affect chronic diseases. Data from the Seventh Korea National Health and Nutrition Examination Survey were used, and 3795 adults aged above 40 years were included. The following demographic variables were obtained: sex, age, education, income, type of health insurance, and private insurance. The following health behavior factors were also analyzed: medical checkup, drinking, smoking, exercise, obesity, and hypercholesterolemia. Participants with lower socioeconomic status had a higher risk of developing chronic diseases. Meanwhile, those with private health insurance had a lower risk of developing chronic diseases. In addition, participants who underwent medical checkups and performed exercises had a lower risk, while those with obesity and hypercholesterolemia had a higher risk of developing chronic diseases. It is necessary to manage chronic diseases through comprehensive programs, rather than managing these diseases individually, and through community primary care institutions to improve health behaviors.

Family composition and age at menarche: Findings from the international Health Behaviour in School-aged Children study

Background

Early menarche has been associated with father absence, stepfather presence and adverse health consequences in later life. This article assesses the association of different family compositions with the age at menarche. Pathways are explored which may explain any association between family characteristics and pubertal timing.

Methods

Cross-sectional, international data on the age at menarche, family structure and covariates (age, psychosomatic complaints, media consumption, physical activity) were collected from the 2009–2010 Health Behaviour in School-aged Children (HBSC) survey. The sample focuses on 15-year old girls comprising 36,175 individuals across 40 countries in Europe and North America (N = 21,075 for age at menarche). The study examined the association of different family characteristics with age at menarche. Regression and path analyses were applied incorporating multilevel techniques to adjust for the nested nature of data within countries.

Results

Living with mother (Cohen’s d = .12), father (d = .08), brothers (d = .04) and sisters (d = .06) are independently associated with later age at menarche. Living in a foster home (d = −.16), with ‘someone else’ (d = −.11), stepmother (d = −.10) or stepfather (d = −.06) was associated with earlier menarche. Path models show that up to 89% of these effects can be explained through lifestyle and psychological variables.

Conclusions

Earlier menarche is reported amongst those with living conditions other than a family consisting of two biological parents. This can partly be explained by girls’ higher Body Mass Index in these families which is a biological determinant of early menarche. Lower physical activity and elevated psychosomatic complaints were also more often found in girls in these family environments.

Are mothers less likely to breastfeed in harsh environments? Physical environmental quality and breastfeeding in the Born in Bradford study

We use the United Kingdom's Born in Bradford study to investigate whether women in lower quality environments are less likely to breastfeed. We use measures of physical environmental quality (water disinfectant by-products [DBPs], air pollution, passive cigarette smoke, and household condition) alongside socio-economic indicators, to explore in detail how different exposures influence breastfeeding. Drawing on evolutionary life history theory, we predict that lower environmental quality will be associated with lower odds of initiating, and higher hazards of stopping, breastfeeding. As low physical environmental quality may increase the risk of adverse birth outcomes, which may in turn affect breastfeeding chances, we also test for mediation by gestational age, birthweight, head circumference, and abdominal circumference. Our sample is composed of mothers who gave birth at the Bradford Royal Infirmary in West Yorkshire between March 2007 and December 2010 for whom breastfeeding initiation data was available. Analyses were stratified by the two largest ethnic groups: White British (n = 3,951) and Pakistani-origin (n = 4,411) mothers. After controlling for socio-economic position, Pakistani-origin mothers had lower chances of initiating and higher chances of stopping breastfeeding with increased water DBP exposure (e.g., OR for 0.03-0.61 vs. <0.02 μg/day dibromochloromethane exposure 0.70 [0.58-0.83], HR 1.16 [0.99-1.36]), greater air pollution exposure predicted lower chances of initiation for both ethnic groups (e.g., OR for 10 μg/m³ increase in nitrogen dioxide 0.81 [0.66-0.99] for White British mothers and 0.79 [0.67-0.94] for Pakistani-origin mothers) but also a reduced hazard of stopping breastfeeding for White British mothers (HR 0.65 [0.52-0.80]), and exposure to household damp/mould predicted higher chances of breastfeeding initiation amongst White British mothers (OR 1.66 [1.11-2.47]). We found no evidence that physical environmental quality effects on breastfeeding were mediated through birth outcomes amongst Pakistani-origin mothers and only weak evidence (p < 0.10) amongst White British mothers (exposure to passive cigarette smoke was associated with having lower birthweight infants who were in turn less likely to be breastfed whereas greater air pollution exposure was associated with longer gestations and in turn reduced hazards of stopping breastfeeding). Overall, our findings suggest that there is differential susceptibility to environmental exposures according to ethnicity. Although the water DBP results for Pakistani-origin mothers and air pollution-initiation results for both ethnic groups support our hypothesis that mothers exhibit reduced breastfeeding in poorer quality environments, several physical environmental quality indicators showed null or positive associations with breastfeeding outcomes. We consider physiological explanations for our findings and their implications for life history theory and public health policy.

Adaptive principles of weight regulation: Insufficient, but perhaps necessary, for understanding obesity

We reflect on the major issues raised by a thoughtful and diverse set of commentaries on our target article. We draw attention to the need to differentiate between ultimate and proximate explanation; the insurance hypothesis (IH) needs to be understood as an ultimate-level argument, although we welcome the various suggestions made about proximate mechanisms. Much of this response is concerned with clarifying the interrelationships between adaptationist explanations like the IH, constraint explanations, and dysfunction explanations, in understanding obesity. We also re-examine the empirical evidence base, concurring that it is equivocal and only partially supportive. Several commentators offer additional supporting evidence, whereas others propose alternative explanations for the evidence we reviewed and suggest ways that our current knowledge could be strengthened. Finally, we take the opportunity to clarify some of the assumptions and predictions of our formal model.

Broadening horizons: Sample diversity and socioecological theory are essential to the future of psychological science

The present lack of sample diversity and ecological theory in psychological science fundamentally limits generalizability and obstructs scientific progress. A focus on the role of socioecology in shaping the evolution of morphology, physiology, and behavior has not yet been widely applied toward psychology. To date, evolutionary approaches to psychology have focused more on finding universals than explaining variability. However, contrasts between small-scale, kin-based rural subsistence societies and large-scale urban, market-based populations, have not been well appreciated. Nor has the variability within high-income countries, or the socioeconomic and cultural transformations affecting even the most remote tribal populations today. Elucidating the causes and effects of such broad changes on psychology and behavior is a fundamental concern of the social sciences; expanding study participants beyond students and other convenience samples is necessary to improve understanding of flexible psychological reaction norms among and within populations. Here I highlight two examples demonstrating how socioecological variability can help explain psychological trait expression: (i) the role of environmental harshness and unpredictability on shaping time preference and related traits, such as impulsivity, vigilance, and self-efficacy; and (ii) the effects of industrialization, market integration, and niche complexity on personality structure. These cases illustrate how appropriate theory can be a powerful tool to help determine choices of diverse study populations and improve the social sciences.

Do transgender men have equal access to health care and engagement in preventive health behaviors compared to cisgender adults?

Using 2015 Behavioral Risk Factor Surveillance System data, this study investigates whether transgender men have equal access to health care and engagement in preventive health behaviors compared to cisgender adults in the U.S. and whether race/ethnicity, socioeconomic status, and rural residence moderate these relationships. Once controlling for sociodemographic factors, we do not find differences for transgender men. Rural transgender men were less likely to have a personal doctor or receive a blood cholesterol screening than their urban peers; transgender men with less education were more likely to have a cholesterol screening. We detail implications for social workers within health care.

Exploring how structural and cognitive social capital influence preventive health behavior

Purpose

People living on poverty-level incomes in developing nations face unique health challenges as compared to those in developed nations. New insights emerge from a bottom of the pyramid context (India) where culture-based health notions, preventive orientation and health resources differ from developed western health orientations and resources. The purpose of this paper is to explore how structural and cognitive social capital indirectly influence preventive health behavior (PHB) through perceived health value.

Design/methodology/approach

The participants for this study include rural people from Tamil Nadu, a state of India who are classified as those living below poverty level based on a per capita/per day consumption expenditure of Rupees 22.50 (an equivalent of US$0.40 a per capita/per day) (Planning Commission, Government of India, 2012). The study included a total number of 635 participants (312 males and 323 females). Relatively a high response rate (79 percent) was achieved through personal contacts and telephone solicitation, cash incentive and multiple follow-ups. Participants completed a questionnaire assessing structural and cognitive social capital, preventative health behavior, perceived health value, and health locus of control (HLC).

Findings

The results show that perceived health value mediates the relationship between cognitive social capital and PHB. Specifically, cognitive social capital influences BoP people’s assessment of benefits of engaging in PHB, that, in turn, influences PHB. In addition, the findings showed that HLC moderates the effect of social capital on PHB. Social capital positively related to enhanced PHB only among those who believe that health outcomes are controllable.

Originality/value

The authors findings indicate that cognitive social capital has enormous potential in promoting health intervention and the health of poor communities, a sentiment shared by prior researchers (Glenane-Antoniadis et al., 2003; Fisher et al., 2004; Martin et al., 2004; Weitzman and Kawachi, 2000). Overall, from a theoretical, empirical and methodological perspective, the current study offers a unique contribution to the social capital and PHB literature. First, drawing from the HBM and HLC, the findings provide a more nuanced explanation of how distinct aspects of social capital predict PHB. Specifically, the relationship between social capital and PHB is qualified by the extent one perceives personal control over her health. In addition, the cognitive component of social capital influences PHB through perceptions of health value.

Psychological origins of the Industrial Revolution

Since the Industrial Revolution, human societies have experienced high and sustained rates of economic growth. Recent explanations of this sudden and massive change in economic history have held that modern growth results from an acceleration of innovation. But it is unclear why the rate of innovation drastically accelerated in England in the eighteenth century. An important factor might be the alteration of individual preferences with regard to innovation resulting from the unprecedented living standards of the English during that period, for two reasons. First, recent developments in economic history challenge the standard Malthusian view according to which living standards were stagnant until the Industrial Revolution. Pre-industrial England enjoyed a level of affluence that was unprecedented in history. Second, behavioral sciences have demonstrated that the human brain is designed to respond adaptively to variations in resources in the local environment. In particular, Life History Theory, a branch of evolutionary biology, suggests that a more favorable environment (high resources, low mortality) should trigger the expression of future-oriented preferences. In this paper, I argue that some of these psychological traits - a lower level of time discounting, a higher level of optimism, decreased materialistic orientation, and a higher level of trust in others - are likely to increase the rate of innovation. I review the evidence regarding the impact of affluence on preferences in contemporary as well as past populations, and conclude that the impact of affluence on neurocognitive systems may partly explain the modern acceleration of technological innovations and the associated economic growth.

Low perceived control over health is associated with lower treatment uptake in a high mortality population of Bolivian forager-farmers

Indigenous people worldwide suffer from higher rates of morbidity and mortality than neighboring populations. In addition to having limited access to public health infrastructure, indigenous people may also have priorities and health perceptions that deter them from seeking adequate modern healthcare. Here we propose that living in a harsh and unpredictable environment reduces motivation to pursue deliberate, costly action to improve health outcomes. We assess whether variation in Health Locus of Control (HLC), a psychological construct designed to capture self-efficacy with respect to health, explains variation in treatment uptake behavior among Tsimane Amerindians (N = 690; age range: 40-89 years; 55.8% female; data collection: 2008-2012), a high mortality and morbidity indigenous population in the Bolivian Amazon, Beni Department. Comparisons with two industrialized populations in Japan (Miyagi prefecture; e0 = 76.6 years) and the United Kingdom (Caerphilly county borough; e0 = 81.2 years) confirm that Tsimane (e0 = 54.1 years) have a more externalized HLC. Multilevel level models were used to investigate whether HLC predicts treatment uptake, and mediates the relationship between modernization and treatment uptake. External HLC scores were predictive of treatment outcomes: Powerful others scores were positively associated with probability of receiving modern treatment (adjusted odds ratio [OR] = 1.33), while Chance scores were negatively associated with probability of receiving modern treatment (adjusted OR = 0.76). We found no effects, however, of Internal HLC or educational capital on treatment uptake. Overall, our findings indicate that health-related decision-making is influenced more by a psychological orientation affecting self-efficacy, shaped in part by perceptions of environmental unpredictability and harshness, than by limited knowledge, education or other indicators of modernization.

The contribution of genetics and environment to obesity

BACKGROUND

Obesity is a global health problem mainly attributed to lifestyle changes such as diet, low physical activity or socioeconomics factors. However, several evidences consistently showed that genetics contributes significantly to the weight-gain susceptibility.

SOURCES OF DATA

A systematic literature search of most relevant original, review and meta-analysis, restricted to English was conducted in PubMed, Web of Science and Google scholar up to May 2017 concerning the contribution of genetics and environmental factors to obesity.

AREAS OF AGREEMENT

Several evidences suggest that obesogenic environments contribute to the development of an obese phenotype. However, not every individual from the same population, despite sharing the same obesogenic environment, develop obesity.

AREAS OF CONTROVERSY

After more than 10 years of investigation on the genetics of obesity, the variants found associated with obesity represent only 3% of the estimated BMI-heritability, which is around 47-80%. Moreover, genetic factors per se were unable to explain the rapid spread of obesity prevalence.

GROWING POINTS

The integration of multi-omics data enables scientists having a better picture and to elucidate unknown pathways contributing to obesity.

AREAS TIMELY FOR DEVELOPING RESEARCH

New studies based on case-control or gene candidate approach will be important to identify new variants associated with obesity susceptibility and consequently unveiling its genetic architecture. This will lead to an improvement of our understanding about underlying mechanisms involved in development and origin of the actual obesity epidemic. The integration of several omics will also provide insights about the interplay between genes and environments contributing to the obese phenotype.

Local environmental quality positively predicts breastfeeding in the UK's Millennium Cohort Study

Background and Objectives: Breastfeeding is an important form of parental investment with clear health benefits. Despite this, rates remain low in the UK; understanding variation can therefore help improve interventions. Life history theory suggests that environmental quality may pattern maternal investment, including breastfeeding. We analyse a nationally representative dataset to test two predictions: (i) higher local environmental quality predicts higher likelihood of breastfeeding initiation and longer duration; (ii) higher socioeconomic status (SES) provides a buffer against the adverse influences of low local environmental quality. Methodology: We ran factor analysis on a wide range of local-level environmental variables. Two summary measures of local environmental quality were generated by this analysis-one 'objective' (based on an independent assessor's neighbourhood scores) and one 'subjective' (based on respondent's scores). We used mixed-effects regression techniques to test our hypotheses. Results: Higher objective, but not subjective, local environmental quality predicts higher likelihood of starting and maintaining breastfeeding over and above individual SES and area-level measures of environmental quality. Higher individual SES is protective, with women from high-income households having relatively high breastfeeding initiation rates and those with high status jobs being more likely to maintain breastfeeding, even in poor environmental conditions. Conclusions and Implications: Environmental quality is often vaguely measured; here we present a thorough investigation of environmental quality at the local level, controlling for individual- and area-level measures. Our findings support a shift in focus away from individual factors and towards altering the landscape of women's decision making contexts when considering behaviours relevant to public health.

Educational differences in responses to breast cancer symptoms: A qualitative comparative study

OBJECTIVE

Advanced stage at diagnosis for breast cancer is associated with lower socio-economic status (SES). We explored what factors in the patient interval (time from noticing a bodily change to first consultation with a health care professional) may contribute to this inequality.

DESIGN

Qualitative comparative study.

METHODS

Semi-structured interviews with a sample of women (≥47 years) from higher (n = 15) and lower (n = 15) educational backgrounds, who had experienced at least one potential breast cancer symptom. Half the participants (n = 15) had sought medical help, half had not (n = 15). Without making breast cancer explicit, we elicited women's sense-making around their symptoms and help-seeking decisions.

RESULTS

Containment of symptoms and confidence in acting upon symptoms emerged as two broad themes that differentiated lower and higher educational groups. Women from lower educational backgrounds tended to attribute their breast symptoms to trivial factors and were reticent in using the word 'cancer'. Despite 'knowing' that symptoms could be related to cancer, women with lower education invoked lack of medical knowledge - 'I am not a doctor' - to express uncertainty about interpreting symptoms and accessing help. Women with higher education were confident about interpreting symptoms, seeking information online, and seeking medical help.

CONCLUSIONS

Our findings suggest that knowledge of breast cancer alone may not explain socio-economic differences in how women respond to breast cancer symptoms as women with lower education had 'reasons' not to react. Research is needed on how to overcome a wider spectrum of psycho-social factors to reduce future inequality. Statement of contribution What is already known on this subject? Seven of ten breast cancers in the UK are diagnosed after people contact their doctor with symptoms. Women from lower socio-economic backgrounds are more likely to be diagnosed with advanced disease. There is little evidence related to potential drivers of this SES inequality. What does this study add? We qualitatively explored socio-economic (SES) differences in help-seeking for breast symptoms. Women with higher education were more confident about interpreting symptoms and navigating health care. Women with lower education were more reluctant to seek help due to fear of cancer.

Socioeconomic inequalities in attitudes towards cancer: an international cancer benchmarking partnership study

Socioeconomic status (SES) differences in attitudes towards cancer have been implicated in the differential screening uptake and the timeliness of symptomatic presentation. However, the predominant emphasis of this work has been on cancer fatalism, and many studies focus on specific community subgroups. This study aimed to assess SES differences in positive and negative attitudes towards cancer in UK adults. A population-based sample of UK adults (n=6965, age≥50 years) completed the Awareness and Beliefs about Cancer scale, including six belief items: three positively framed (e.g. ‘Cancer can often be cured’) and three negatively framed (e.g. ‘A cancer diagnosis is a death sentence’). SES was indexed by education. Analyses controlled for sex, ethnicity, marital status, age, self-rated health, and cancer experience. There were few education-level differences for the positive statements, and overall agreement was high (all>90%). In contrast, there were strong differences for negative statements (all Ps<0.001). Among respondents with lower education levels, 57% agreed that ‘treatment is worse than cancer’, 27% that cancer is ‘a death sentence’ and 16% ‘would not want to know if I have cancer’. Among those with university education, the respective proportions were 34, 17 and 6%. Differences were not explained by cancer experience or health status. In conclusion, positive statements about cancer outcomes attract near-universal agreement. However, this optimistic perspective coexists alongside widespread fears about survival and treatment, especially among less-educated groups. Health education campaigns targeting socioeconomically disadvantaged groups might benefit from a focus on reducing negative attitudes, which is not necessarily achieved by promoting positive attitudes.

The nature and dynamics of world religions: a life-history approach

In contrast with tribal and archaic religions, world religions are characterized by a unique emphasis on extended prosociality, restricted sociosexuality, delayed gratification and the belief that these specific behaviours are sanctioned by some kind of supernatural justice. Here, we draw on recent advances in life history theory to explain this pattern of seemingly unrelated features. Life history theory examines how organisms adaptively allocate resources in the face of trade-offs between different life-goals (e.g. growth versus reproduction, exploitation versus exploration). In particular, recent studies have shown that individuals, including humans, adjust their life strategy to the environment through phenotypic plasticity: in a harsh environment, organisms tend to adopt a 'fast' strategy, pursuing smaller but more certain benefits, while in more affluent environments, organisms tend to develop a 'slow' strategy, aiming for larger but less certain benefits. Reviewing a range of recent research, we show that world religions are associated with a form of 'slow' strategy. This framework explains both the promotion of 'slow' behaviours such as altruism, self-regulation and monogamy in modern world religions, and the condemnation of 'fast' behaviours such as selfishness, conspicuous sexuality and materialism. This ecological approach also explains the diffusion pattern of world religions: why they emerged late in human history (500-300 BCE), why they are currently in decline in the most affluent societies and why they persist in some places despite this overall decline.

Effects of local extrinsic mortality rate, crime and sex ratio on preventable death in Northern Ireland

Variation in preventable death can be understood from an evolutionary life history perspective. However, previous studies have failed to isolate ecological effects on preventable death. We use population-wide Census data from Northern Ireland and find that extrinsic mortality rate and crime, but not sex ratio, impacts on male preventable death.

Background and objectives: Individual investment in health varies greatly within populations and results in significant differences in the risk of preventable death. Life history theory predicts that individuals should alter their investment in health (somatic maintenance) in response to ecological cues that shift the perceived fitness payoffs to such investments. However, previous research has failed to isolate the effects of different ecological factors on preventable death, and has often relied on macro-level data without individual controls. Here, we test some key predictions concerning the local ecology—that higher extrinsic mortality rate (EMR), crime rate and mate-scarcity (male/female-biased sex ratio) at the ward-level—will be associated with a higher risk of preventable death.

Methodology: We use census-based data from Northern Ireland (n = 927 150) on preventable death during an 8.7-year period from the 2001 Census and run Cox regressions for (i) accident/suicide or alcohol-related death and (ii) deaths from preventable diseases, for men and women separately, controlling for a wide range of individual variables.

Results: We find evidence of ward-level EMR and crime rate being positively associated with preventable death among men, particularly men with low socioeconomic position. There was a tentative relationship between male-biased sex ratio and preventable death among women, but not among men.

Conclusion and implications: Both behaviours that might lead to ‘risky’ death and health neglect might be adaptive responses to local ecologies. Efforts to reduce crime might be as effective as those to reduce extrinsic mortality, and both could have positive effects on various health behaviours.

Educational expectations and adolescent health behaviour: an evolutionary approach

OBJECTIVES

Previous research finds adolescents expecting to attend university are more likely to demonstrate health-promoting behaviour than those not expecting university attendance. This suggests public health improvements may be achievable by encouraging adolescents to adopt academic goals. We investigate confounders of this putative relationship, focusing on those identified by evolutionary theory.

METHODS

Multi-level logistic regression was used to analyse the 2010 Scottish Health Behaviour in School-aged Children survey (n = 1834).

RESULTS

Adolescents anticipating university attendance exhibited higher levels of engagement in health-protective behaviours (fruit and vegetable consumption, exercise and tooth brushing) and were more likely to avoid health-damaging behaviours (crisps, soft drink and alcohol consumption, tobacco and cannabis use, fighting and intercourse). These relationships persisted when controlling indicators of life history trajectory (pubertal timing, socioeconomic status and father absence). Pupil level: gender, age, perceived academic achievement and peer/family communication and school level: university expectations, affluence, leavers' destinations, exam performance and school climate were also adjusted.

CONCLUSIONS

Encouraging adolescents to consider an academic future may achieve public health benefits, despite social factors that might otherwise precipitate poor health via an accelerated life history trajectory.

Applying symptom appraisal models to understand sociodemographic differences in responses to possible cancer symptoms: a research agenda

BACKGROUND

Sociodemographic inequalities in the stage of diagnosis and cancer survival may be partly due to differences in the appraisal interval (time from noticing a bodily change to perceiving a reason to discuss symptoms with a health-care professional). A number of symptom appraisal models have been developed describing the psychological factors that underlie how people make sense of symptoms, although none explicitly focus on sociodemographic characteristics.

METHODS

We therefore conducted a conceptual review synthesising all symptom appraisal models, and focus on potential links with sociodemographics that could be the focus of future research.

RESULTS

Common psychological elements across nine symptom appraisal models included knowledge, attention, expectation and identity, all of which could be sensitive to sociodemographic factors. For example, lower socioeconomic status (SES), male sex and older age are associated with lower health literacy generally and lower cancer symptom knowledge. Limited attentional resources, lower expectations about health and lack of social support also hamper symptom interpretation, and would be likely to be more prevalent in those from lower SES backgrounds. Symptom heuristics ('rules of thumb') may lead to symptoms being normalised because they are common within the social network, potentially disadvantaging older populations.

CONCLUSIONS

A better understanding of the processes through which people interpret their symptoms, and the way these processes differ by sociodemographic factors, could help guide the development of interventions with the aim of reducing inequalities in cancer outcomes.

Anticipated survival and health behaviours in older English adults: cross sectional and longitudinal analysis of the English Longitudinal Study of Ageing

Background

Individuals may make a rational decision not to engage in healthy behaviours based on their assessment of the benefits of such behaviours to them, compared to other uncontrollable threats to their health. Anticipated survival is one marker of perceived uncontrollable threats to health. We hypothesised that greater anticipated survival: a) is cross-sectionally associated with healthier patterns of behaviours; b) increases the probability that behaviours will be healthier at follow up than at baseline; and c) decreases the probability that behaviours will be ‘less healthy’ at follow than at baseline.

Methods

Data from waves 1 and 5 of the English Longitudinal Survey of Ageing provided 8 years of follow up. Perceptions of uncontrollable threats to health at baseline were measured using anticipated survival. Health behaviours considered were self-reported cigarette smoking, physical activity level, and frequency of alcohol consumption. A wide range of socio-economic, demographic, and health variables were adjusted for.

Results

Greater anticipated survival was cross-sectionally associated with lower likelihood of smoking, and higher physical activity levels, but was not associated with alcohol consumption. Lower anticipated survival was associated with decreased probability of adopting healthier patterns of physical activity, and increased probability of becoming a smoker at follow up. There were no associations between anticipated survival and change in alcohol consumption.

Conclusions

Our hypotheses were partially confirmed, though associations were inconsistent across behaviours and absent for alcohol consumption. Individual assessments of uncontrollable threats to health may be an important determinant of smoking and physical activity.

Behavioral reactivity to acute stress among Black and White women with type 2 diabetes: The roles of income and racial discrimination

This study investigated relationships of income and self-reported racial discrimination to diabetes health behaviors following an acute stressor. A total of 77 diabetic women (51% Black, 49% White) completed a laboratory public speaking stressor. That evening, participants reported same-day eating, alcohol consumption, and medication adherence; physical activity was measured with actigraphy, and the next morning participants reported sleep quality. Measures were repeated on a counterbalanced control day. There was no mean level difference in health behaviors between stressor and control days. On stressor day, lower income predicted lower physical activity, sleep quality, and medication adherence, and higher racial discrimination predicted more eating and alcohol consumed, even after accounting confounders including race and control day behaviors.

Someone to live for: effects of partner and dependent children on preventable death in a population wide sample from Northern Ireland

How to allocate resources between somatic maintenance and reproduction in a manner that maximizes inclusive fitness is a fundamental challenge for all organisms. Life history theory predicts that effort put into somatic maintenance (health) should vary with sex, mating and parenting status because men and women have different costs of reproduction, and because life transitions such as family formation alter the fitness payoffs from investing in current versus future reproduction. However, few tests of how such life history parameters influence behaviours closely linked to survival exist. Here we examine whether specific forms of preventable death (accidents/suicides, alcohol-related causes, and other preventable diseases) are predicted by marital status and dependent offspring in a modern developed context; that of Northern Ireland. We predict that men, non-partnered individuals and individuals who do not have dependent offspring will be at higher risk of preventable death. Running survival analyses on the entire adult population (aged 16-59, n = 927,134) controlling for socioeconomic position (SEP) and other potential confounds, we find that being single (compared to cohabiting/married) increases risk of accidental/suicide death for men (but not for women), whereas having dependent children is associated with lower risk of preventable mortality for women but less so for men. We also find that the protective effect of partners is larger for men with low SEP than for high SEP men. Findings support life history predictions and suggest that individuals respond to variation in fitness costs linked to their mating and parenting status.

The Role of Behaviour in Inequality in Increments of Dental Caries among Finnish Adults

Background: Evidence from cross-sectional studies implies that dental behaviours partially explain inequalities in oral health. Objective: To assess whether dental behaviours completely eliminate inequality in increments of dental caries in a sample of Finnish adults. Methods: The baseline data were collected from the Health 2000 survey, a nationally representative survey of 8,028 individuals aged 30 years or older living in mainland Finland. Four years later, 1,248 subjects were invited for oral re-examination, and 1,049 agreed to participate (84% response rate). At baseline, participants provided information on demographics, education and dental behaviours (dental attendance, tooth brushing with fluoride toothpaste, sugar consumption and daily smoking). Oral examinations at baseline and follow-up were identical. Results: Adults with basic education had significantly greater increments of DMFT (incidence rate ratio 1.41, 95% CI 1.07-1.85) and DT (incidence rate ratio 2.23, 95% CI 1.27-3.90) than those with high education. Adjusting for single behaviours attenuated but did not eliminate education inequality in DMFT and DT increments, tooth brushing having the greatest impact on inequality. Simultaneous adjustment for all behaviours eliminated the significant relationship between education and caries increment. Conclusions: Accounting for important dental behaviours appears to explain all education inequality in dental caries in Finnish adults. The results should be interpreted with caution when applied to less egalitarian populations.

Disgust sensitivity is not associated with health in a rural Bangladeshi sample

Disgust can be considered a psychological arm of the immune system that acts to prevent exposure to infectious agents. High disgust sensitivity is associated with greater behavioral avoidance of disease vectors and thus may reduce infection risk. A cross-sectional survey in rural Bangladesh provided no strong support for this hypothesis. In many species, the expression of pathogen- and predator-avoidance mechanisms is contingent on early life exposure to predators and pathogens. Using childhood health data collected in the 1990s, we examined if adults with more infectious diseases in childhood showed greater adult disgust sensitivity: no support for this association was found. Explanations for these null finding and possible directions for future research are discussed.

Out of control mortality matters: the effect of perceived uncontrollable mortality risk on a health-related decision

Prior evidence from the public health literature suggests that both control beliefs and perceived threats to life are important for health behaviour. Our previously presented theoretical model generated the more specific hypothesis that uncontrollable, but not controllable, personal mortality risk should alter the payoff from investment in health protection behaviours. We carried out three experiments to test whether altering the perceived controllability of mortality risk would affect a health-related decision. Experiment 1 demonstrated that a mortality prime could be used to alter a health-related decision: the choice between a healthier food reward (fruit) and an unhealthy alternative (chocolate). Experiment 2 demonstrated that it is the controllability of the mortality risk being primed that generates the effect, rather than mortality risk per se. Experiment 3 showed that the effect could be seen in a surreptitious experiment that was not explicitly health related. Our results suggest that perceptions about the controllability of mortality risk may be an important factor in people's health-related decisions. Thus, techniques for adjusting perceptions about mortality risk could be important tools for use in health interventions. More importantly, tackling those sources of mortality that people perceive to be uncontrollable could have a dual purpose: making neighbourhoods and workplaces safer would have the primary benefit of reducing uncontrollable mortality risk, which could lead to a secondary benefit from improved health behaviours.

Socioeconomic position and the association between anticipated and actual survival in older English adults

BACKGROUND

Socioeconomic disadvantage may cause individuals to have lower expectations of longevity and not engage in healthy behaviours because they judge the long-term health benefits of these to be minimal. We explored demographic, health behaviour, health and socioeconomic correlates of subjectively estimated lifespan ('anticipated survival'); the ability of anticipated survival to predict actual survival; and whether the predictive ability of anticipated survival differed by other variables, particularly socioeconomic position.

METHODS

Data were from wave 1 of the English Longitudinal Study of Ageing. Anticipated survival for up to 25 years was measured on a scale of 0-100. Actual survival was measured over a mean of 6 years, and socioeconomic position using education, household income, occupational class and area deprivation.

RESULTS

Of 10 768 participants, 2255 (21%) died during follow-up. Anticipated survival was positively associated with socioeconomic position, and was greater in women, younger individuals, non-smokers and those who were not widowed, consumed more alcohol, were more physically active, and reported better physical and mental health. After full adjustment, anticipated survival remained positively associated with actual survival. Those reporting low anticipated survival were more likely to die over time than those reporting moderate anticipated survival (HR (95% CIs 1.11 (1.00 to 1.23). The relationship differed significantly by income and age, being strongest in younger individuals and those with higher household income.

CONCLUSIONS

Anticipated survival varied with other variables as expected and reflected actual survival. Younger individuals and those with higher household income were better able to identify subtle differences associated with actual survival.