Individual-level Characteristics Research Articles

Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children.

This longitudinal study compared children’s health behaviors before the COVID-19 pandemic versus during the pandemic. This analysis examined the association between individual-level characteristics and health behavior change. Four prospective cohort studies in the Environmental influences on Child Health Outcomes (ECHO) Program contributed data. Children aged 4–12 years and their caregivers were recruited in California, Colorado, North Dakota, and New Hampshire. Dietary intake, physical activity, screen time, and sleep duration were assessed with questionnaires pre-pandemic and during the pandemic. The final sample included 347 children: 47% female and 62% non-Hispanic White. Compared with pre-pandemic, weekday screen time duration was higher during the pandemic (3.0 vs. 4.5 h, p < 0.001). Unadjusted increases in screen time duration differed by race and ethnicity: 1.3 h/day for non-Hispanic White children, 2.3 h/day for Hispanic children, and 5.3 h/day for non-Hispanic Black children. Overall, no changes occurred in sugar-sweetened beverage (SSB) intake (p = 0.26), discretionary food intake (p = 0.93), and physical activity (p = 0.15). Sleep duration increased by 30 min among children who did not meet sleep recommendations pre-pandemic. Child sex and maternal education level were not associated with health behavior change. The pandemic may have exacerbated disparities in some health behaviors. Families may need support to re-establish healthy routines.

Network methods and design of randomized trials: Application to investigation of COVID-19 vaccination boosters.

Network science methods can be useful in design, monitoring, and analysis of randomized trials for control of spread of infections. Their usefulness arises from the role of statistical network models in molecular epidemiology and in study design. Computational models, such as agent-based models that propagate disease on simulated contact networks, can be used to investigate the properties of different study designs and analysis plans. Particularly valuable is the use of these methods to assess how magnitude and detectability of intervention effects depend on both individual-level and network-level characteristics of the enrolled populations. Such investigation also provides an important approach to assessing consequences of study data being incomplete or measured with error. To address these goals, we consider two statistical network models: exponential random graph models and the more flexible congruence class models. We focus first on an historical use of these methods in design and monitoring of a cluster randomized trial in Botswana to evaluate the effect of combination HIV prevention modalities compared to standard of care on HIV incidence. We then present a framework for the design of a study of booster vaccine effects on infection with, and forward transmission of, SARS-CoV-2 variants. Motivation for the study is driven in part by guidance from the United Kingdom to base approval of booster vaccines with "strain changes" that target variants on results of neutralizing antibody tests and information about safety, but without requiring evidence of clinical efficacy. Using designs informed by our agent-based network models, we show it may be feasible to conduct a trial of novel SARS-CoV-2 vaccines in a single large campus to obtain useful information regarding vaccine efficacy against susceptibility and infectiousness. If needed, the sample size could be increased by extending the study to a small number of campuses. Novel network methods may be useful in developing pragmatic SARS-CoV-2 vaccine trials that can leverage existing infrastructure to reduce costs and hasten the development of results.

Toward a Deeper Understanding of Prolific Lying: Building a Profile of Situation-Level and Individual-Level Characteristics

Prior work suggests those who lie prolifically tend to be younger and self-identify as male compared to those who engage in everyday lying, but little research has developed an understanding of prolific lying beyond demographics. Study 1 ( N = 775) replicated the prior demographic effects and assessed prolific lying through situation-level (e.g., opportunistic cheating) and individual-level characteristics (e.g., dispositional traits, general communication patterns) for white and big lies. For these two lie types, prolific lying associated with more opportunistic cheating, the use of fewer adjectives, and being high on psychopathy compared to everyday lying. Study 2 ( N = 1,022) replicated these results and observed a deception consensus effect reported in other studies: the more that people deceived, the more they believed that others deceived as well. This piece develops a deeper theoretical understanding of prolific lying for white and big lies, combining evidence of situational, dispositional, and communication characteristics.

Prevalence of Giardia lamblia and Cryptosporidium parvum co-infections among young adults in a private University in South-Western Nigeria

Background: Giardia lamblia and Cryptosporidium parvum are major causes of diarrhoeal diseases of humans worldwide and are included in the World Health Organization’s ‘Neglected Diseases Initiative’. Aim: This research was designed to assess the prevalence of G. lamblia and C. parvum co-infections among undergraduate Students of Babcock University, Ilishan-Remo, Ogun State, Nigeria. Methods: An aggregate of 120 faecal specimens were obtained from 120 partakers (60 females and 60 males) who met the inclusion criteria. The clinical and demographic data of the participants were compiled with the use of patterned survey. Diagnosis was carried out using standard laboratory methods for the detection of these parasites. Results: The outcome of this study shows that there was no record of G. lamblia and C. parvum co-infections among the study participants; however, G. lamblia and C. parvum mono-infection exist among the examined participants with a preponderance of 10% and 4.2%, respectively. There were no substantial differences (P&gt;0.05) in the percentage occurrences of the two parasites established on the individual-level characteristics of the partakers. All participants who tested positive for mono-infection by each parasite had a history of diarrhoea (14.2%). Meanwhile, the 12(10%) participants who tested positive for G. lamblia mono-infection indicated abdominal pain (10), nausea and bloating (2.5%), presence of foul smelling watery stool (0.8%), presence of blood and mucus in stool (0.8%) and weight loss (0.8%). While all the 5 participants who tested positive for C. parvum indicated that they had only abdominal pain (4.2%). Significant risk factors associated with the occurrence of these parasitic infections include: lack of awareness, history of diarrhea, poor toilet hygiene, poor toilet-student ratio, as well as infrequent visits to the hospital for medical check-ups/laboratory tests. Conclusion: Giardia lamblia and Cryptosporidium parvum co-infection does .......

The association of prison security level with mortality after release from prison: a retrospective national cohort study (2000–16)

Incarceration might contribute to increased mortality in an already marginalised population. A better understanding of the prison-related factors that are associated with mortality is important for preventing the negative health consequences of incarceration. We aimed to investigate all-cause and cause-specific mortality following release from high-security and low-security prisons. In this retrospective national cohort study, we used data from the Norwegian Prison Release study (nPRIS), which includes complete national register data for 96 859 individuals from the Norwegian Prison Register linked to the Norwegian Cause of Death Register from Jan 1, 2000, to Dec 31, 2016. The study cohort included all people in Norway released from a high-security or low-security prison unit. Cause of death was categorised into internal causes (infectious, cancerous, endocrine, circulatory, respiratory, digestive, nervous system diseases, and mental health disorders) and external causes (accidents, suicides, and homicides) according to the 10th revision of the International Classification of Diseases. We calculated crude mortality rates (CMR) and estimated Cox proportional-hazards models. There were 151 790 releases in the study period (68·4% from low-security and 31·6% from high-security prisons) from 91 963 individuals. The overall CMR was 854·4 [95% CI 834·7-874·2] per 100 000 person-years (436·2 [422·1-450·3] per 100 000 person-years for internal causes and 358·3 [345·5-371·1] per 100 000 person-years for external causes). The overall post-release mortality rate was higher in those released from high-security prisons (1142·5 [95% CI 1102·6-1182·5] per 100 000 person-years) than in those released from low-security prisons (714·6 [692·6-736·6] per 100 000 person-years). Our results suggest an association between release from high-security prisons and elevated mortality due to both external causes (adjusted hazard ratio [aHR] 1·75 [95% CI 1·60-1·91]) and internal causes (1·45 [1·33-1·59]), compared to release from low-security prisons. Imprisonment and the post-release period can be an important point for public health interventions. Particular attention to health is warranted for individuals incarcerated in and released from high-security prisons. The potential impact of both individual-level characteristics of people incarcerated in high-security facilities, and of the prison environment itself, on mortality outcomes, should be investigated further. The South-Eastern Norway Regional Health Authority and The Norwegian Research Council.

Impact of prison security level on mortality

Impact of prison security level on mortality

Comparing proxy and formal measures of county-level racial isolation in race-stratified models: A case study in Tennessee, 2005–2014

The purpose of this study was to understand whether proxy measures of county-level racial isolation (based on racial compositions) would yield similar results as the formal measures of county-level racial isolation (derived from the isolation index of P*). White (non-Hispanic White) and Black (non-Hispanic Black or African American) women residing in the State of Tennessee, USA, and diagnosed with a non-invasive or invasive breast cancer were considered as the study population. Individual-level variables were obtained from the Tennessee Cancer Registry data for the period between 2005 and 2014 (46,983 White women and 7,967 Black women), and county-level variables were obtained from the American Community Survey data for the periods of 2005–2009 and 2010–2014 (95 counties). Using breast cancer condition (non-invasive versus invasive) as the binary outcome of interest, a series of multilevel logistic regression analyses was conducted separately by race. After controlling for individual-level socio-demographic characteristics, proxy measure of county-level White isolation and county-level median household income were not associated with breast cancer condition, but formal measure of county-level White isolation was associated with lower odds of having an invasive breast cancer among White women. On the other hand, neither proxy nor formal measure of county-level Black isolation was associated with breast cancer condition, but county-level median household income was associated with lower odds of having an invasive breast cancer among Black women. These results suggest that using a proxy and formal measure of racial isolation may yield different results, and race-stratified analyses would be helpful for understanding a differential effect of racial isolation on Whites and Blacks. While more detailed examinations are needed in future studies, possible explanations on and reasons behind these findings are discussed.

Estimates of infertility in the United States: 1995–2019

To estimate the changes in infertility from 1995-2019 and determine the association of individual-level characteristics with fertility in the United States. Cross-sectional study. Periodic data from 1995, 2002, 2006-2010, 2011-2013, 2013-2015, 2015-2017, and 2017-2019 cycles of the National Survey for Family Growth were used for this analysis. The National Survey for Family Growth comprises samples of the household-level population of women aged 15-44 years in the United States. Surveyed married and cohabiting women aged 15-44 years. None. The primary outcomes were the rates of infertility across subgroups of married or cohabiting women. For secondary outcomes, we performed bivariable and multivariable logistic regression models using the pooled sample (N = 53,764) to determine the association of individual-level characteristics, including age, parity, pelvic inflammatory disease treatment, education, income, race or ethnicity, and receipt of sexual and reproductive health services, with the odds of 12-month infertility among married or cohabiting women. The fluctuations in infertility over this period, with a low of 5.8% in 2006-2010 and a high of 8.1% in 2017-2019, were not found to be statistically significant. This trend was present across nearly all subgroups. The multivariable model showed that women who were older and nulliparous, had fewer years of education, had lower income, were non-Hispanic black, or were not receiving sexual and reproductive health services were more likely to be infertile. This study confirms that parity, age, race, and education level continue to have an association with infertility. Further, the results demonstrate that access to sexual and reproductive health services plays an important role in infertility. In contrast to previous studies, infertility in the United States is no longer on the decline, and Hispanic ethnicity did not have a significant relationship with infertility. Given the rise of sexually transmitted infections and the persistent lack of access to sexual and reproductive health services, particularly among already vulnerable groups, the connection between access to care and infertility is ripe for further investigation.

Quantifying physical activity across the midlife: Does consideration of perceived exertion matter?

Many questionnaires ascertain physical activity (PA) frequency, duration, and intensity to benchmark achievement of PA recommendations. However, most scoring algorithms utilize absolute intensity estimates when exertion may be influenced by age or health characteristics. This study quantified PA estimates with and without adjustments for perceived exertion and evaluated if differences were associated with individual-level characteristics. Women (n = 2,711) in the United States from the Study of Women’s Health Across the Nation who completed ≥ 3 Kaiser Physical Activity Surveys (KPAS) across 8 biennial visits were included (baseline age: 46.4 ± 2.7 years). KPAS responses about activity mode and exertion were converted to metabolic equivalent of a task (METs) using the 2011 Compendium of Physical Activities to estimate absolute and perceived intensity-adjusted METs. Repeated measures (linear mixed effects) regression models were used to examine associations of sociodemographic and health-related characteristics with change in the difference between absolute MET estimates and perceived intensity-adjusted MET estimates. Older age (p < 0.001), Chinese (p < 0.001) and Japanese (p = 0.01) ethnicity, and current smoking (p = 0.001) were associated with positive differences between absolute and perceived intensity-adjusted MET estimates, which is suggestive of lower perceived-intensity physical activity. However, for most participants, absolute intensity-based estimates closely approximated perceived intensity-adjusted estimates over time. Traditional PA scoring techniques using absolute intensity estimates only may provide sufficient estimates of PA in longitudinal cohort studies of mid-life and older adult women.

Analyzing the Sociodemographic Factors Impacting the Use of Virtual Reality for Controlling Obesity

Obesity is one of the most pressing issues in society today. Virtual reality has been used in the design of tools that promotes obesity control. However, the design of current VR tools lacks the involvement of prospective users and health practitioners. Such engagement is crucial in gathering semantic information that identifies stakeholders’ needs and ensures that all aspects of health are considered. Therefore, this paper aims to study the sociodemographic factors and individual-level characteristics and preferences that make the design of any obesity-control VR tool effective and satisfactory for a wide range of users. The paper also aims to solicit opinions of health practitioners to identify best health aspects that should be available in the design of any VR tool for obesity control. Organizations, businesses, and people will be able to readily augment such VR technologies on the semantic web, as well as on personal and mobile devices.

Continue or not to continue? Attitudes towards deprescribing among community-dwelling older adults in China.

BackgroundInappropriate prescribing of medications and polypharmacy among older adults are associated with a wide range of adverse outcomes. It is critical to understand the attitudes towards deprescribing—reducing the use of potentially inappropriate medications (PIMs)—among this vulnerable group. Such information is particularly lacking in low - and middle-income countries.MethodsIn this study, we examined Chinese community-dwelling older adults’ attitudes to deprescribing as well as individual-level correlates. Through the community-based health examination platform, we performed a cross-sectional study by personally interviews using the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire (version for older adults) in two communities located in Suzhou, China. We recruited participants who were at least 65 years and had at least one chronic condition and one prescribed medication.Results We included 1,897 participants in the present study; the mean age was 73.8 years (SD = 6.2 years) and 1,023 (53.9%) were women. Most of older adults had one chronic disease (n = 1,364 [71.9%]) and took 1–2 regular drugs (n = 1,483 [78.2%]). Half of the participants (n = 947, 50%) indicated that they would be willing to stop taking one or more of their medicines if their doctor said it was possible, and 924 (48.7%) older adults wanted to cut down on the number of medications they were taking. We did not find individual level characteristics to be correlated to attitudes to deprescribing.ConclusionsThe proportions of participants’ willingness to deprescribing were much lower than what prior investigations among western populations reported. It is important to identify the factors that influence deprescribing and develop a patient-centered and practical deprescribing guideline that is suitable for Chinese older adults.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-022-03184-3.

Are deprivation-specific cancer survival patterns similar according to individual-based and area-based measures? A cohort study of patients diagnosed with five malignancies in England and Wales, 2008–2016

ObjectiveTo investigate if measured inequalities in cancer survival differ when using individual-based (‘person’) compared with area-based (‘place’) measures of deprivation for three socioeconomic dimensions: income, deprivation and occupation.DesignCohort study.SettingData from...

Exploring Lithuanian Real Estate Crowdfunding Investors’ Rationality

Abstract The research aims to assess how rational investors are in making real estate crowdfunding investment decisions and weather similar rationality investors share common individual-level characteristics. The research data was collected through an online survey and investors’ rationality was assessed according to risk &amp; return and behavioral biases criteria. Results revealed that 18% of the respondents were rational and as much as 78.1% of them demonstrated bounded rationality behavior. Further clustering of bounded rationality investors identified three distinct clusters and suggested that bounded rationality proved to be largely based on established behavioral biases rather than on failing to understand and apply risk and return criteria. In terms of individual-level characteristics, rationality of real estate crowdfunding investors significantly related to their financial knowledge, but not to their age, sex, income level, education, occupation, residence and interface with finance sector.

Geographic disparities in breast cancer mortality and place of death in the United States from 2003 to 2019.

12034 Background: Breast cancer is the 2nd leading cause of cancer-related death in women with existing barriers in preventive services, access to treatment, and end-of-life care. There are unique sociopolitical challenges to rural healthcare with gaps in national health funding and hospice infrastructure. We investigated rural-urban disparities in age-adjusted mortality rates (AAMRs) and place of death in individuals dying from breast cancer. Methods: CDC WONDER database was utilized to analyze deaths from breast cancer from 2003 to 2019 using population classification per 2013 US Census: large metropolitan (≥1 million), small- or medium-sized metropolitan (50,000-999,999), and rural areas (&lt; 50,000). We extracted AAMRs by geographic area, age, and race/ethnicity. We estimated annual percentage changes (APC) in AAMR using robust linear regression models of the log-scale AAMR, including population size as weights, and assessed differential changes over time by geographic area with interaction tests. We estimated the percent of all deaths occurring in medical, hospice, and nursing facilities, and home. Odds ratios (OR) for the association between each place of death and individual-level characteristics were calculated using logistic regression, adjusting for year of death. Differential changes in place of death over time by geographic region were assessed with interaction tests. Results: From 2003 to 2019, there were 676,532 breast cancer-related deaths (52.9% large metro, medium/small metro 30.3%, rural 16.8%). Total AAMR declined from 39.8 to 30.9 during this period with rural areas noting least improvement (APC -1.24, 95% CI [-1.39, -1.09], p &lt; 0.001 for time trend) compared to large metropolitan (APC -1.74, 95% CI [-1.63, -1.46]). Non-Hispanic Black women had higher AAMRs among all racial/ethnic groups. Across all years, women in large metropolitan (OR 2.02, 95% CI [1.96, 2.07]) and medium/small metropolitan (OR 2.19, 95% CI [2.12, 2.25]) had higher odds of dying in a hospice facility compared to rural areas. Rural women died least often in a hospice facility (9.7% vs 14.5% large metropolitan vs 16.9% medium/small metropolitan in 2019), more often in a nursing facility (19.2% vs 12% large metropolitan vs 13.9% medium/small metropolitan) and slightly more often at home (44.6% vs 41.7% large metropolitan vs 43.4% medium/small metropolitan). Women in large metropolitan areas were most likely to die in a medical facility. Conclusions: Rural women with breast cancer experienced greater mortality and least annual improvement, with notable disparities in place of death. Our findings support interventions to improve access across cancer care continuum and congressional policy to urgently re-invest in cancer care access in rural areas.

Place-based disadvantage, social exclusion and the value of mobility

Connections between mobility and social exclusion have been of research and policy interest for some years, a high monetary value being estimated for additional trips by those at risk of mobility-related exclusion. Those monetary values have been based on individual-level characteristics. To date, the influence of place, or neighbourhood, on risk of social exclusion and on the associated value of trip making by at-risk people has not been considered. This paper adds a measure of neighbourhood to individual factors to explore risk of social exclusion and then shows how the monetary value of additional trips varies by level of social exclusion risk.

Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic?

PurposeTo examine whether declines in the crude U.S. COVID-19 case fatality ratio is due to improved clinical care and/or other factors. MethodsWe used multivariable logistic regression, adjusted for age and other individual-level characteristics, to examine associations between report month and mortality among confirmed and probable COVID-19 cases and hospitalized cases in Georgia reported March 2, 2020 to March 31, 2021. ResultsCompared to August 2020, mortality risk among cases was lowest in November 2020 (OR = 0.84; 95% CI: 0.78–0.91) and remained lower until March 2021 (OR = 0.86; 95% CI: 0.77–0.95). Among hospitalized cases, mortality risk increased in December 2020 (OR = 1.16, 95% CI: 1.07–1.27) and January 2021 (OR = 1.25; 95% CI: 1.14–1.36), before declining until March 2021 (OR = 0.90, 95% CI: 0.78–1.04). ConclusionsAfter adjusting for other factors, including the shift to a younger age distribution of cases, we observed lower mortality risk from November 2020 to March 2021 compared to August 2020 among cases. This suggests that improved clinical management may have contributed to lower mortality risk. Among hospitalized cases, mortality risk increased again in December 2020 and January 2021, but then decreased to a risk similar to that among all cases by March 2021.

Caregivers' perception of the role of the socio-environment on their extremely preterm child's well-being

PurposeThe purpose of this qualitative descriptive study was to explore primary caregivers' perception of how social-environmental characteristics, and their own role as primary caregivers, affected their extremely preterm adolescent's well-being. MethodsParticipants were 20 mothers who identified as the primary caregiver of an adolescent born extremely prematurely (<28 weeks gestation) enrolled in the ELGAN cohort study. Data was collected through individual interviews and was analyzed using inductive content analysis. ResultsA total of three themes, and five subthemes, were identified. The two main themes were “familial impact to health and well-being,” and “contributors and barriers at the community level.” This study described specific familial and community contributors to child and caregiver well-being, including: the importance of advocacy, participating in community activities, and social and familial support networks. ConclusionsOverall, while there are individual level characteristics that contribute to well-being, a support structure at the family and community level is essential to children born extremely prematurely, and their mother's, well-being. Practice implicationsHealthcare providers caring for these families should understand that not only are extremely preterm youth affected by prematurity, but caregivers are also deeply impacted. Therefore, it is essential that maternal and family care is emphasized by nurses and healthcare providers.

Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium

In the United States, Black and Hispanic children have higher rates of asthma and asthma-related morbidity compared with White children and disproportionately reside in communities with economic deprivation. To determine the extent to which neighborhood-level socioeconomic indicators explain racial and ethnic disparities in childhood wheezing and asthma. The study population comprised children in birth cohorts located throughout the United States that are part of the Children's Respiratory and Environmental Workgroup consortium. Cox proportional hazard models were used to estimate hazard ratios (HRs) of asthma incidence, and logistic regression was used to estimate odds ratios of early and persistent wheeze prevalence accounting for mother's education, parental asthma, smoking during pregnancy, child's race and ethnicity, sex, and region and decade of birth. Neighborhood-level socioeconomic indicators defined by US census tracts calculated as z scores for multiple tract-level variables relative to the US average linked to participants' birth record address and decade of birth. The parent or caregiver reported the child's race and ethnicity. Prevalence of early and persistent childhood wheeze and asthma incidence. Of 5809 children, 46% reported wheezing before age 2 years, and 26% reported persistent wheeze through age 11 years. Asthma prevalence by age 11 years varied by cohort, with an overall median prevalence of 25%. Black children (HR, 1.47; 95% CI, 1.26-1.73) and Hispanic children (HR, 1.29; 95% CI, 1.09-1.53) were at significantly increased risk for asthma incidence compared with White children, with onset occurring earlier in childhood. Children born in tracts with a greater proportion of low-income households, population density, and poverty had increased asthma incidence. Results for early and persistent wheeze were similar. In effect modification analysis, census variables did not significantly modify the association between race and ethnicity and risk for asthma incidence; Black and Hispanic children remained at higher risk for asthma compared with White children across census tracts socioeconomic levels. Adjusting for individual-level characteristics, we observed neighborhood socioeconomic disparities in childhood wheeze and asthma. Black and Hispanic children had more asthma in neighborhoods of all income levels. Neighborhood- and individual-level characteristics and their root causes should be considered as sources of respiratory health inequities.

Regional Peripheralization as Contextual Source of Populist Attitudes in Germany and Czech Republic

This article seeks to shed more light on the reasons for the regionally uneven distribution of populist attitudes. We take into account both individual-level and contextual drivers and focus mainly on the latter. We argue that regional peripheralization processes are a key contextual condition driving populist attitudes, especially in post-communist settings. The empirical analysis is based on a unique dataset combining comparable items from two representative surveys covering Germany ( N = 2112) and the Czech Republic ( N = 1000) with economic and demographic characteristics of relevant regional contexts in both countries (167 constituencies in Germany and 77 districts in the Czech Republic). Using multilevel regression models, the article shows that individual-level characteristics do not alone drive populist attitudes. In contrast, the results show that living in peripheral areas of the Czech Republic and eastern Germany increases the likelihood of having populist attitudes. These peripheries are characterized by unfavourable economic conditions in the Czech Republic and demographic decline in eastern Germany.

Attitudes towards homosexuality among ethnic majority and minority adolescents in Western Europe: The role of ethnic classroom composition

Ethnic minorities from more traditional countries tend to hold more conservative views towards homosexuality compared to the ethnic majority population in Western Europe. Assimilation theory predicts that this difference diminishes over time because of exposure and contact between these groups. The role of ethnic classroom composition in this process of cultural assimilation is poorly understood. Therefore, this article examines the role of the country of origin of adolescents and their classroom peers in the assimilation of attitudes towards homosexuality. Using two-wave panel data on 18,058 students in 867 classrooms in England, Germany, the Netherlands, and Sweden, we find that the attitudes towards homosexuality in classroom peers’ country of origin are positively associated with attitudes towards homosexuality of respondents in the first wave but have no effect on subsequent changes in these attitudes over a two-year period. We find some variations in this association according to individual-level characteristics, but these results are not consistent across the countries that we study. Together, these results suggest that the classroom is an important socializing context in the formation of cultural values, and that its influence is relatively uniform across groups.