Affluent Backgrounds Research Articles

Social inequalities in antidepressant treatment and mortality: a longitudinal register study

Despite an increased prevalence of depression among people of low socio-economic position, it remains unclear whether their treatment with antidepressants appropriately matches their increased need compared with people from more affluent backgrounds. This study examined socio-economic differences in antidepressant prescriptions and mortality related to depressive disorders. A longitudinal register study of 17947 male and 47458 female local government employees with linked information on socio-economic indicators (education and occupational status) and data on antidepressant use and mortality associated with depressive disorder (suicide, alcohol-related deaths) during the years 1994 to 2000. In men, antidepressant treatment was less common among low educational groups than among high educational groups (OR 0.87, 95% CI 0.76-0.99) and a corresponding difference was seen between occupational statuses (OR for manual v. upper non-manual 0.72, 95% CI 0.62-0.84). In women, socio-economic position was not associated with antidepressant use. However, both among the men and women, employees with low socio-economic position had increased risk for mental-health-related mortality, as indicated by suicides, deaths from alcohol-related causes, and all-cause mortality. These data suggest a mismatch in the treatment of depression relative to apparent clinical need, with the lowest levels of treatment concentrated in the lower socio-economic groups, despite evidence of their increased prevalence of depression and suicide.

The effectiveness of school dental screening: dental attendance and treatment of those screened positive

To determine dental attendance and treatment outcomes following two models of dental screening. An observational prospective cohort study. Infant, primary and junior schools in the North West of England. Children aged six to nine years at the start of the study. Subjects received a screening examination according to either a 'Traditional model' or 'New model' of school dental screening. Attendance at a dentist within four months of the intervention and treatment received by children referred via the 'New model' with caries in their permanent teeth. In the 'New model' of school dental screening 46% of screened positive and 41% of screened negative children attended a dentist during the study period. Some 44% of children referred with caries in permanent teeth attended a dentist and 53% of those attending received treatment for the referred condition. Larger proportions of children from disadvantaged backgrounds were screened positive but higher proportions of children from more affluent backgrounds attended the dentist and subsequently received treatment. School dental screening has a minimal impact on dental attendance and only a small proportion of screened positive children receive appropriate treatment. The programme fails to reduce inequalities in utilisation of dental services.

Dental screening of school children

Objectives To determine dental attendance and treatment outcomes following two models of dental screening. Design An observational prospective cohort study. Setting Infant, primary and junior schools in the North West of England. Subjects Children aged six to nine years at the start of the study. Results In the 'New model' of school dental screening 46% of screened positive and 41% of screened negative children attended a dentist during the study period. Some 44% of children referred with caries in permanent teeth attended a dentist and 53% of those attending received treatment for the referred condition. Larger proportions of children from disadvantaged backgrounds were screened positive but higher proportions of children from more affluent backgrounds attended the dentist and subsequently received treatment. Conclusions School dental screening has a minimal impact on dental attendance and only a small proportion of screened positive children receive appropriate treatment. The programme fails to reduce inequalities in utilisation of dental services.

Enrolment and baseline characteristics in the WHO Multicentre Growth Reference Study

Abstract Aim: To describe the WHO Multicentre Growth Reference Study (MGRS) sample with regard to screening, recruitment, compliance, sample retention and baseline characteristics. Methods: A multi‐country community‐based study combining a longitudinal follow‐up from birth to 24 mo with a cross‐sectional survey of children aged 18 to 71 mo. Study subpopulations had to have socio‐economic conditions favourable to growth, low mobility and ≥ 20% of mothers practising breastfeeding. Individual inclusion criteria were no known environmental constraints on growth, adherence to MGRS feeding recommendations, no maternal smoking, single term birth and no significant morbidity. For the longitudinal sample, mothers and newborns were screened and enrolled at birth and visited 21 times at home until age 24 mo. Results: About 83% of 13 741 subjects screened for the longitudinal component were ineligible and 5% refused to participate. Low socio‐economic status was the predominant reason for ineligibility in Brazil, Ghana, India and Oman, while parental refusal was the main reason for non‐participation in Norway and USA. Overall, 88.5% of enrolled subjects completed the 24‐mo follow‐up, and 51% (888) complied with the MGRS feeding and no‐smoking criteria. For the cross‐sectional component, 69% of 21 510 subjects screened were excluded for similar reasons as for the longitudinal component. Although low birthweight was not an exclusion criterion, its prevalence was low (2.1% and 3.2% in the longitudinal and cross‐sectional samples, respectively). Parental education was high, between 14 and 15 y of education on average. Conclusion: The MGRS criteria were effective in selecting healthy children with comparable affluent backgrounds across sites and similar characteristics between longitudinal and cross‐sectional samples within sites.

High harm avoidance and low self-directedness in euthymic young adults with recurrent, early-onset depression

Background The personality dimensions of harm avoidance (HA) and self-directedness (SD), as measured by the Temperament and Character Inventory (TCI), have been widely associated with depression and there is preliminary evidence that they may represent trait markers for depression. However, many studies in this area are limited by the use of heterogeneous samples of depressed patients and by the confounding effect of depressed mood during personality testing. The current study compares TCI personality dimension scores in a group of euthymic young adults with recurrent early-onset major depressive disorder (RE-MDD) to well-matched euthymic controls. Methods Fifty-two young adults with a past history of RE-MDD were recruited from consecutive referrals to a psychiatric clinic at a university health service. Eighty nine controls were also recruited. Euthymia was established in patients by a score of less than 9 on the Hamilton Rating Scale for Depression (HRSD) and in controls by a Becks Depression Inventory (BDI) score of less than 10. All participants completed the TCI-125. Results Patients and controls were well matched in terms of sociodemographic profile. Euthymic RE-MDD patients scored significantly higher than controls on the temperament dimension of harm avoidance (HA; mean score 14.5 versus 7.8, p < 0.0001) and significantly lower than controls on the character dimension of self-directedness (SD; mean score 14.1 versus 19.9, p < 0.0001). Covariance analysis suggested that both HA and SD contributed independently to the familial risk of depression. Limitations Subjects and controls all came from relatively affluent social backgrounds—these findings may not generalise to more socioeconomically diverse populations. The possibility of a ‘scarring effect’ of depressive episodes on self-reported personality dimension scores cannot be excluded. Conclusions High HA and low SD represent trait markers for liability to recurrent major depressive disorder in young adults. Further research is needed to replicate these findings and to assess the contribution that the experience of depressive episodes makes to self-reported personality dimension scores.

Comparison of academic, application form and social factors in predicting early performance on the medical course.

To compare the relative importance of social, academic and application form factors at admission in predicting performance in the first 3 years of a medicine course. Retrospective cohort study. A single UK medical school. A total of 738 students who entered medical school between 1994 and 1997. Performance in Year 3 objective structured clinical examination (OSCE). School-leaving grades were significant predictors of success in the OSCE. Non-academic activities as assessed from the application form were associated with poorer performance. Mature students performed extremely well, and male and ethnic minority students performed less well. Socioeconomic status and type of school attended were not found to affect performance on the course. The relatively poor performance of male and ethnic minority students urgently needs further investigation. Our results carry no suggestion that, other things being equal, widening access to medical school for mature students and those from less affluent backgrounds would result in poorer performance.

Commentary: The epidemiology of failure-to-thrive in infants

Although failure to thrive (FTT) is a common problem, precise epidemiological data is lacking. FTT accounts for 1‐5% of paediatric hospital admissions under 2 year of age. This will be an underestimate of its true incidence, however, as FTT is identified and treated primarily in the community. The population prevalence of FTT has been found to range anywhere between 1.3% and 20.9% depending on the definition of FTT that is used. The imprecision of this data is a reflection of the difficulties in assessing the frequency of the occurrence of FTT in children. Some of the difficulties in interpretation of findings are related to a preconception by health workers and researchers that FTT is always linked with poverty. As a consequence of this, most studies of FTT have focused on highly deprived groups and produced skewed and unhelpful results. There is, in fact, little objective evidence to support this putative link with poverty. The report from the Avon Longitudinal Study of Parents and Children (ALSPAC) 1 in this issue of the International Journal of Epidemiology is, therefore, a welcome addition to the FTT literature as it also fails to demonstrate a systematic effect of social variables on poor weight gain in infants. Recent studies suggest, in fact, that the majority of children with FTT come from the larger population of more ‘average’ income backgrounds. In particular, it has been noted that because of this assumption that deprivation is a risk factor, children with a weight less than the third centile who are from a low socioeconomic class are more likely to be labelled as FTT (and hence referred). However, similar children from a higher socioeconomic class are more likely to be described as ‘constitutional short stature’ (this is generally considered a normal variation of growth. These children usually present with a severe deceleration in growth in the first 2 years of life with a subsequent realignment to a centile line and normal growth increments until adolescence when a growth spurt occurs. It can be very difficult during this period of reduced growth velocity to be confident that such a child is not failing to thrive.) Consequently, those children from more affluent backgrounds may be being missed and/or present later than they should. A study from an urban area of the UK which identified children with FTT using the thrive index (defined as the ratio between the predicted weight gain and actual weight gain) showed (1) that the majority were not from the most deprived areas of the city, (2) that overt neglect was rare, and (3) that 76% were living in apparently caring homes but were nevertheless undernourished. 2 ALSPAC is a cohort study of child growth and development based on pregnant mothers who were recruited in the South West of England between 1991 and 1992. Cases of FTT were identified (with an elegant handling of the data which takes into account regression to the mean) as those whose weight gain was a below a z-score of � 1.645. Having excluded premature infants and those with congenital abnormalities growth data was available on 11 718 infants who were measured at birth, 6‐8 weeks, and 9 months. This data was then compared with demographic data (obstetric history, parental anthropometry, and socio-economic status etc.) obtained by questionnaire. Slow weight gain was identified in 531/11 187 (4.5%) of infants in whom complete data was available at 9 months. Significant associations between slow weight gain and both maternal and paternal height and high parity were identified. The risk of poor weight gain was also shown to be increased in subsequent siblings. Although there was no significant association between poor weight gain and parental occupation or socio-economic class there was an association with living in rented accommodation or not having the use of a car or telephone. An important message from this study is that the authors attribute the absence of a systematic effect of social variables on poor weight gain in infants to the ready availability of social security aid in UK which reduces the level of poverty and increases food availability in families with small children.

Young women's views on teenage motherhood: a possible explanation for the relationship between socio‐economic background and teenage pregnancy outcome?

While teenagers from relatively affluent backgrounds usually abort their pregnancies, those from relatively deprived backgrounds tend to keep theirs. It has been suggested that this situation is due to some form of acceptance of teenage motherhood existing among disadvantaged groups. This theory, however, is still to be established. Two hundred and forty‐eight women (mean age 15.6 years) from diverse social and economic backgrounds completed a questionnaire that gathered information on their lives and views of teenage motherhood. Six discussion groups were then held with selected subgroups of these women in order to explore their views in greater detail. It was evident that most participants viewed teenage motherhood in a predominately negative light, but that women from relatively deprived areas were more likely than their relatively affluent peers to predict they would keep a teenage pregnancy. Possible explanations for this difference are discussed, and the validity of the acceptance theory considered.

Association between Course of Study at University and Cause-Specific Mortality

Although socioeconomic position is clearly related to mortality and one measure of this is length of education, it is not known whether the choice of course at university determines future health. We therefore investigated the association between faculty of study and all-cause and cause-specific mortality in a prospective follow-up of male students who underwent health examinations while attending Glasgow University from 1948 to 1968. Among the 9887 (84%) alumni traced by means of the NHS Central Register, 8367 (85%) had full data on important potential confounding variables; 939 of these men had died. Physiological variables differed little between students from the various faculties. Medical students were most likely to come from affluent social backgrounds and, after law students, were most likely to be smokers. Compared with former medical students, former arts and law students had excess all-cause and cardiovascular disease mortality, while science and engineering alumni had similar risks. Former medical students had lower lung cancer mortality than other alumni but higher mortality from alcohol-related causes including accidents, suicide and violence. The lower mortality risks observed among former medical and engineering students may be due to their better employment prospects and healthier lifestyle behaviours, although the high mortality from alcohol-related causes among former medical students underscores the complexity of choice of health behaviour. The findings point to the potential for disease prevention among the large proportion of the population who now have third-level education.

Association between course of study at university and cause-specific mortality.

Although socioeconomic position is clearly related to mortality and one measure of this is length of education, it is not known whether the choice of course at university determines future health. We therefore investigated the association between faculty of study and all-cause and cause-specific mortality in a prospective follow-up of male students who underwent health examinations while attending Glasgow University from 1948 to 1968. Among the 9887 (84%) alumni traced by means of the NHS Central Register, 8367 (85%) had full data on important potential confounding variables; 939 of these men had died. Physiological variables differed little between students from the various faculties. Medical students were most likely to come from affluent social backgrounds and, after law students, were most likely to be smokers. Compared with former medical students, former arts and law students had excess all-cause and cardiovascular disease mortality, while science and engineering alumni had similar risks. Former medical students had lower lung cancer mortality than other alumni but higher mortality from alcohol-related causes including accidents, suicide and violence. The lower mortality risks observed among former medical and engineering students may be due to their better employment prospects and healthier lifestyle behaviours, although the high mortality from alcohol-related causes among former medical students underscores the complexity of choice of health behaviour. The findings point to the potential for disease prevention among the large proportion of the population who now have third-level education.

Health-related quality of life in urban elementary schoolchildren.

Health disparities between children from urban minority backgrounds and children from more affluent backgrounds are well-recognized. Few studies specifically address urban children's perceptions of their health-related quality of life (HRQOL) or the factors that contribute to these perceptions. Since schools are pivotal to children's intellectual, social, and emotional development, school connectedness may be a factor that contributes to their perception of HRQOL. To examine children's perceptions of HRQOL in an elementary school-based population of urban children. The study population consisted of 2nd, 3rd, and 5th graders from 6 urban kindergarten to 8th grade schools and their parents. Children completed a survey that included questions on HRQOL and school connectedness. Parents completed a telephone survey that assessed demographics, the child's health, health care usage, and parental health status. Data on school absences and mobility from the computerized school database were linked to survey data. Bivariate analyses were used to evaluate the association between child report of HRQOL and collected variables, including school connectedness. Multivariable linear regression was conducted to identify the factors best predicting HRQOL in these urban children. Of the 1150 eligible students, parent and child survey data were available for 525 (45.6%). Fifty-one percent of students were male and 89% were black. Ninety-four percent of parents were female, 29% were married, and 62% had family incomes below 20,000 dollars per year. The mean total score for HRQOL was 67.2, with a possible range of 0 to 100 (higher scores reflecting better HRQOL). In the multivariable analysis, child grade, the relationship of the " parent" to the child, employment, family income, type/presence of insurance, and school connectedness were significantly associated with the HRQOL total score. Young urban children self-report low HRQOL scores and do so as early as the 2nd grade. These low scores, which reflect children's own perceptions of impaired psychological and physical health, have potential implications for the success of urban children in their learning environments. The association between HRQOL and school connectedness might suggest that health and educational programs that improve a child's attachment to school could result in improved perceptions of health by urban children.

Investment in human capital through upper-secondary and tertiary education

This article examines various efficiency and equity aspects related to the skill acquisition of young people and older adults. The analysis suggests that human capital investment is associated with significant labour-market gains for individuals, including higher post-tax earnings and better employment prospects, which exceed the investment costs, mainly foregone earnings and tuition fees, by a significant margin. It also shows that the net benefits are strongly influenced by policy related factors, such as study length, tuition subsidies and student support. Overall, the estimates reported in the article indicate that there are strong incentives for the average student to continue studying beyond the compulsory schooling age, and also point to the benefits of such investment in education for society as a whole. However, the net gains fall with age, mainly reflecting a shorter period to take advantage of the benefits that come with education. Finally, the article notes that students in higher education tend to come from more affluent backgrounds and that they benefit from large public subsidies, whereas young people from disadvantaged backgrounds are less likely to participate in tertiary education and thus benefit from public subsidies.

The influences on preventive care provided to children who frequently attend the UK General Dental Service.

To identify the relationship between the preventive and restorative care provided to children who frequently attend the General Dental Service in the UK after taking into account socio-economic status, gender and dental caries experience. General dental practices in the North West of England. The study design involved a retrospective investigation of case notes of 677 children who regularly attended 50 general dental practitioners. The complete history of the dental care received by each child during the primary dentition period was recorded. Analyses took place at the patient level. Information was recorded on the total number of carious teeth and restorative and preventive care provided to the children. Preventive care was categorised as dietary advice, oral hygiene instruction, prescription of fluoride tablets and application of fluoride varnish. Socio-economic status was measured using the Townsend score of the electoral ward of residence of each subject. Logistic regression models, taking into account the clustering of the subjects within dental practices were fitted to identify whether or not socio-economic status was significantly associated with provision of each category of preventive care, after controlling for gender, the total number of teeth affected by caries and the proportion of carious teeth which were restored. Children from poorer backgrounds were significantly more likely to receive oral hygiene instruction than their more affluent peers. Socio-economic status did not influence dentists' decisions to prescribe fluoride tablets, but children from affluent backgrounds were significantly more likely to have fluoride varnish applied to their teeth than children from deprived backgrounds after controlling for other factors. The more teeth affected by decay significantly increased the odds of giving dietary advice, prescription of fluoride tablets and application of fluoride varnish, but had no effect on whether or not oral hygiene instruction was given. As the percentage of decayed but filled teeth decreased the odds of giving dietary advice or applying fluoride varnish increased significantly. Conclusion It would appear that dentists are providing appropriate preventive care according to the aetiological causes of dental disease. They also look to be providing preventive care in compensation for decisions not to restore carious primary teeth. However the preventive care provided seems to be reactive to disease patterns, and in this high risk group of patients does not seem to be particularly effective.

Preventive or restorative care for children?

Objectives To identify the relationship between the preventive and restorative care provided to children who frequently attend the General Dental Service in the UK after taking into account socio-economic status, gender and dental caries experience. Setting General dental practices in the North West of England. Subjects and materials The study design involved a retrospective investigation of case notes of 677 children who regularly attended 50 general dental practitioners. The complete history of the dental care received by each child during the primary dentition period was recorded. Analyses took place at the patient level. Information was recorded on the total number of carious teeth and restorative and preventive care provided to the children. Preventive care was categorised as dietary advice, oral hygiene instruction, prescription of fluoride tablets and application of fluoride varnish. Socio-economic status was measured using the Townsend score of the electoral ward of residence of each subject. Logistic regression models, taking into account the clustering of the subjects within dental practices were fitted to identify whether or not socio-economic status was significantly associated with provision of each category of preventive care, after controlling for gender, the total number of teeth affected by caries and the proportion of carious teeth which were restored. Results Children from poorer backgrounds were significantly more likely to receive oral hygiene instruction than their more affluent peers. Socio-economic status did not influence dentists' decisions to prescribe fluoride tablets, but children from affluent backgrounds were significantly more likely to have fluoride varnish applied to their teeth than children from deprived backgrounds after controlling for other factors. The more teeth affected by decay significantly increased the odds of giving dietary advice, prescription of fluoride tablets and application of fluoride varnish, but had no effect on whether or not oral hygiene instruction was given. As the percentage of decayed but filled teeth decreased the odds of giving dietary advice or applying fluoride varnish increased significantly. Conclusion It would appear that dentists are providing appropriate preventive care according to the aetiological causes of dental disease. They also look to be providing preventive care in compensation for decisions not to restore carious primary teeth. However the preventive care provided seems to be reactive to disease patterns, and in this high risk group of patients does not seem to be particularly effective.

Prediction of violent recidivism.

To describe the changes and improvements in accuracy of the prediction of violent recidivism. The evolution of better prediction models is described by reviewing the more significant methods used and referring to the results of their application. Development of instruments such as the Psychopathy Checklist-Revised, the Violence Risk Assessment Guide (VRAG), the HCR-20 and the multiple-item comprehensive questionnaire of Monahan and Steadman has substantially improved accuracy in risk assessment. The presence of full-blown psychopathy has proven itself a better predictor of violence than has a diagnosis of antisocial personality disorder according to the Diagnostic and Statistical Manual (DSW-IV). Shortcomings to the efficacy of the current instruments stem from the difficulty in detecting violence-proneness in persons who eventually assault or murder one or two persons (usually family members), but who have no, or a limited, record of past violence. Persons from affluent backgrounds are more adept at evading arrests or convictions than are the poor. Adolescent sons abused by parents are at risk to commit violent acts later on, but the community has little power to detect or intervene until these acts are committed. Prediction of violence has significantly improved over the last 20 years, thanks to the development of objective instruments of risk assessment.

Families with deaf members: American Annals of the Deaf, 1996 to 2000.

The authors provide an overview of 21 articles from several countries focusing on families with deaf members published in the literary issues of the American Annals of the Deaf from 1996 to 2000. Four categories were identified: Interaction and Involvement, Support Services, Stress and Coping, and Decision Making. The articles represent a commendable expansion of focus from the mother-child dyad to increased attention to fathers, siblings, extended family members, and significant nonfamily members such as deaf adults. The heterogeneity of families was a striking factor, even within those studies dealing with relatively homogeneous populations. Services appeared to be most effective within middle-class, educated family units, illustrating the need for more comprehensive services sensitive to the needs of families from less affluent backgrounds and with lower levels of education. In general, services to families with deaf children may be characterized as better than in the past but still in need of significant sensitivity and improvement. The presence of a deaf child in a family with hearing parents may cause stress, but parents have the flexibility to respond in a positive and beneficial way, especially when provided adequate information and support. The idea that hearing parents go through a grieving process involving the identification of deafness in their child seems to be an overstatement.

Psychotherapy of sexual dysfunction.

There is a palpable tension in the sexological literature between an empirical/biological approach that focuses on the phenomenology of sexual behavior and a theoretical/psychological approach that explores the quality of the subjective experience of the sexual encounter of humans. Both paradigms have made valuable contributions, but any theorizing about human sexuality or description of psychotherapeutic treatments of sexual dysfunction has to take the societal developments of this past century into account. As Tiefer (1) says, Sex is Not a Natural Act. Sexual habits and mores have been influenced by the Americanization of Freud, the Kinsey reports (2,3) and the emergence of pornographic media. Furthermore, the birth control pill, abortion and feminism shaped especially women's sexuality in a profound way. The Stone Wall Riot, Gay Liberation, and the Sexual Revolution of the 60s called longheld sexual beliefs into question. In the past two decades our sexual lives have been impacted upon by new technologies in reproduction, the AIDS epidemic, gender experimentation and transgenderism, the Internet and sex in cyberspace, and last, but not least, the remedicalization of sexuality via Viagra. Rather than of sexuality, we now speak of sexualities: anomie seems to be the condition of modern man/woman. Hence, we feel called upon to continuously reinvent ourselves: what (sexual) version of myself will I be today? Traditional sexual scripts (4) - the Who, Why, Where, What, When and With Whom of sexuality - have to be negotiated and renegotiated as individuals of divergent cultural and religious backgrounds encounter each other in the global marketplace of migrating populations. Radical conceptual changes in our notion of sexual problems and sex therapy have characterized the 20th century. Psychoanalysts, conditioned by theories of hysteria, tended to view sexual difficulties as indicative of repression and focused their efforts on the interpretation of intrapsychic conflict. With the publication of Masters and Johnson's Human Sexual Inadequacy (5), performance anxiety was postulated to be the basic ingredient to all sexual dysfunction. Therapeutic approaches utilized sensate focus and other directive techniques in order to promote an active relearning process. The initial optimism and enthusiasm of Masters and Johnson's pioneering work with quasi miraculous two week cures in St. Louis, however, gave way rather quickly to a sobering appreciation of the complexity of the sexual life of couples. Tiefer (1) challenged the scientific method of Masters and Johnson. She points out that these researchers do not refer to a human sexual response cycle (HSRC), but rather the HSRC, as if it were a natural constant. She questions the empirical validity of their research because the subjects were carefully selected volunteers with higher than average intelligence, more affluent socioeconomic backgrounds, and a greater level of sexual enthusiasm. They had to be able to experience orgasms with masturbation and coitus under laboratory conditions. (Not all of us would qualify! ) Given the selection bias, the findings could hardly be representative of ordinary men/women. Clearly, sexual response is not gender neutral. However, by establishing the semblance of gender equality, Masters and Johnson have, in fact, inadvertently contributed to a trivialization or denial of the social reality of women which is itself shaped by gender inequality. The focus on genital arousal and ability to achieve orgasm as the ultimate goal of a functional sexual encounter without consideration of the quality of the experience and the social context, in which the sexual encounter takes place, seems particularly unrepresentative of the emotional and sensual needs of women. In the long run, the idealized HSRC indeed became reified as a quasi EKG of sexuality. Even though common sense dictates that sexual response does not always follow a predictable pattern, couples define any deviation from the normative curve as BAD SEX and identify themselves as sexual failures. …

Effect of perceived cost on judgments regarding the efficacy of investment

Three experiments examined the effect of costs associated with investments on the judgments of the causal effectiveness of those investments, and on the type of information utilised when making those judgements. Using operant conditioning technology, in an experimental analogue of making economic investments, it was found that greater costs associated with an investment reduced the judgement about the effectiveness of the response (Experiment 1). Greater investment costs tended to bias the subject toward using information integrated over a longer period of time; whereas low costs tended to produce judgements made on the basis of the conditions prevailing immediately prior to the return being acquired (Experiments 1–3). The effect of cost was modulated by the subjects' own financial background. The same absolute cost being treated as “greater” by those from less wealthy backgrounds compared to those from more affluent backgrounds (Experiments 2 and 3). These results suggest that as well as the nature of the schedule relating investment to return, the perceived cost of the investment determines the manner in which it is judged with respect to its efficacy.

The University in the inner city

The traditional university often has a world class reputation for teaching and research. Equally often it is centrally sited in established cities through which the winds of economic change have blown viciously, leaving ivory towers surrounded by neighbourhoods of underprivileged communities. Within these communities, junior and high schools do their best to battle against under-motivation and lack of expectation in the literal shadow of elaborately resourced institutions populated by secure and highly educated staff, teaching students from more affluent backgrounds who look forward on graduation to similar levels of security in employment.For modest investment, we demonstrate that it is possible to bridge the gap between these two communities. An exercise which commenced as a tightly funded service to a small number of inner-city schools has grown to serve a larger number. Of more interest, it has demonstrated the potential to be of direct benefit to a range of students of the university in a way that could not otherwise be provided.

Socioeconomic status and the prevention of child home injuries: a survey of parents of preschool children.

OBJECTIVES: To examine the effect of socioeconomic status on the attitudes parents of preschool children towards child home safety issues and practice of home safety measures. SETTING: A community based...