Non-manual Social Class Research Articles

Prostate cancer: how aware is the public?

To assess the public awareness of prostate cancer and willingness to seek medical attention for urinary symptoms, and to determine associated factors. A community survey was conducted using a questionnaire administered by the interviewer to 280 randomly selected Irish men aged 40-69 years. A quarter of the men had not heard of prostate cancer; factors associated with having heard were nonmanual social class, living with a female partner and a history of treatment for urinary disease. Eighty per cent said they would be willing to attend a GP if they had urinary symptoms; associated factors were living with a female partner, having heard of prostate cancer and having seen a GP more than once in the preceding year. Just over half deemed attendance to be urgent/important; associated factors were having heard of prostate cancer, living with a female partner and having a relative with cancer. Having a General Medical Services card (a means-tested medical card entitling the holder to free medical services) was negatively associated. Lower social class was negatively associated with routine questioning by a GP about urinary symptoms. There is a marked social-class gradient in knowledge and willingness to seek medical advice. In the absence of population screening, earlier clinical presentation with prostate cancer is essential if prognosis is to be improved; there is an evident need to improve prostate cancer awareness, particularly in the lower social classes, if this goal is to be achieved.

Infant nutrition and cognitive development in the first offspring of a national UK birth cohort

Several studies show a modest beneficial effect of breastfeeding on cognitive development after controlling for sociodemographic confounders. It is still unclear, however, to what extent this is due to the nutritional advantage of breast milk or to environmental influences associated with breastfeeding. We compared verbal ability scores at age 8 years in 511 first-born offspring of the National Survey of Health and Development who were ever or never breastfed, adjusting for paternal occupation, maternal education, maternal cognitive performance, attendance at nursery school, and maternal age at birth of the participant. A positive association between breastfeeding and cognitive performance was found but this was no longer the case after adjusting for either paternal occupation, maternal education, or maternal cognitive performance in turn. In contrast, an association between breastfeeding and cognitive function was not found for mothers of these offspring. Breastfeeding was increasingly associated with a non-manual social class across the generations although it remains unclear how this might mediate the effect of breastfeeding on cognitive performance.

Socioeconomic status within social class and mortality: a prospective study in middle-aged British men.

It has been suggested that mortality differences between groups in society may be greater than are indicated by social class based on occupation. We have examined the relationship between social class and mortality using home and car ownership as additional indices of socioeconomic status within social class. A prospective study of a cohort of men representative of the social class distribution of middle-aged men in Great Britain. One general practice in each of 24 towns in England, Wales and Scotland. Five years after the initial screening of 7735 men aged 40-59 years, 7262 men (94% of the original cohort) provided information on housing tenure and car ownership by completing a postal questionnaire. Deaths from all causes, cardiovascular, cancer and other non-cardiovascular causes during an average follow-up of 9.8 years (range 8.5-11.0 years) after the postal questionnaire. During the follow-up period there were 946 deaths from all causes among the 7262 men. The lowest mortality rates for all causes, cardiovascular, cancer and other non-cardiovascular causes were seen in non-manual social classes I and II. Manual social classes III and IV+V showed a significant 40% increase in risk of death compared to social classes I+II, even after adjustment for a wide range of risk factors (relative risk [RR] = 1.4, 95% confidence interval [CI]: 1.2-1.7 and RR = 1.4, 95% CI: 1.1-1.7 respectively). Within all social class groups, those owning both home and car showed lower rates than those who owned neither, even after adjustment for a wide range of risk factors and employment status. Compared with social classes I+II owning both home and car, all those not owning home and/or car, in each social group, showed a significant approximately twofold increase in risk of death. Adjusted RR for non-manual I+II = 2.1 (95% CI: 1.5-2.9), non-manual III RR = 2.0 (95% CI: 1.3-2.9), manual III RR = 1.8 (95% CI: 1.4-2.4) and manual IV+V RR = 1.8 (95% CI: 1.3-2.5). Similar relationships were seen in all major geographical regions of Great Britain. Mortality differences within society are greater than indicated by social class based on occupation alone. Irrespective of social class, men with greater material assets have lower rates of mortality from all causes than men less well endowed, independent of a wide range of lifestyle and biological factors. These findings suggest that mortality differences within our society are closely related to relative wealth.

Lifetime socioeconomic position and mortality: prospective observational study

Objectives: To assess the influence of socioeconomic position over a lifetime on risk factors for cardiovascular disease, on morbidity, and on mortality from various causes.Design: Prospective observational study with 21...

Postal questionnaire study of disability in the community associated with psoriasis.

To study the disability caused by psoriasis in patients recorded as having psoriasis by their general practitioner. Postal questionnaire survey using the psoriasis disability index and SF-36. Five general practices in Cleveland. Of 767 patients identified, 546 completed the questionnaire and 435 were eligible and gave informed consent. Scores on SF-36 and psoriasis disability index. The psoriasis disability index score was highly negatively correlated with all eight of the SF-36 health measures (P < 0.0001 for each), and the manual social classes scored higher than the non-manual social classes (P < 0.0001). The manual social class group scored significantly lower scores than the controls on all the SF-36 scales, and the non-manual group scored significantly lower for physical and mental role limitation (P < 0.0004 and P = 0.026), mental health (P < 0.0001), energy and vitality (P < 0.0004), and health perception (P < 0.0001). Also, the manual group had poorer health perception on five of the SF-36 variables when compared with the non-manual group. Patients with psoriasis have an overall lower perception of their quality of life than healthy controls, and those in the lower social classes suffer a greater degree of disability from their disease than the higher social classes.

Does the decline in child injury mortality vary by social class? A comparison of class specific mortality in 1981 and 1991

To examine whether the decline in child injury death rates between 1981 and 1991 varied by social class. Comparison of class specific child injury death rates for 1979, 1980, 1982, and 1983, with those for the four years 1989-92. England and Wales. Children aged 0-15 years. Death rates from injury and poisoning. Death rates from injury and poisoning have fallen for children in all social classes. The decline for children in social classes IV and V (21% and 2% respectively), however, is smaller than that for children in social classes I and II (32% and 37%). As a result of the differential decline in injury death rates, socioeconomic mortality differentials have increased. In the four years 1979-80 and 1982-83 the injury death rate for children in social class V was 3.5 times that of children in social class I. For the four years 1989-92 the injury death rate for children in social class V was 5.0 times that of children in social class I. Poisson regression modelling showed that the trend in the decline in death rates across the social classes was unlikely to have arisen by chance alone. Socioeconomic inequalities in child injury death rates have increased. If these gradients persist, the Health of the Nation's target is likely to be met for children in the non-manual social classes but not for those in the manual social classes.

Who goes to sexually transmitted disease clinics? Results from a national population survey.

To examine the pattern of attendance at sexually transmitted disease (STD) clinics in Britain. To compare the demographic characteristics, behaviours and attitudes of STD clinic attenders with those of non-attenders, and to assess the extent to which STD clinics are used by those with high-risk sexual lifestyles. Random sample general population survey of sexual attitudes and lifestyle. 18,876 randomly selected men and women resident in Britain aged 16-59 years. Demographic characteristics, pattern of homosexual partnerships, heterosexual partnerships, payment for sex, abortion, drug injection in the last five years, and attitudes to sexual behaviours amongst 512 respondents who had attended STD clinic in the last five years compared with those who had not. 8.3% of men and 5.6% of women had attended a clinic in their lifetime and 3.4% and 2.6% respectively in the last five years. Attendance rates varied substantially with area of residence. 11% of Inner London residents had attended in the last five years. In multivariate analysis, STD clinic attendance for men was most strongly associated with increased numbers of heterosexual partners, (OR = 6.01 (4.44-8.15) and homosexual partnerships (OR = 9.59 (5.83-15.8)) and more weakly associated with payment for sex, non-manual social class, age 25-44, unmarried status and smoking. Clinic attendance for women was most strongly associated with numbers of heterosexual partners (OR = 3.74 (2.76-5.08) and injecting drug use (OR = 4.39 (1.73-11.1)). A weaker independent association was found with a history of abortion, anal sex, non-manual social class, non-married status and age 16-24. From the total population, 1 in 6 men and 1 in 7 women in the top 5% of the distribution for numbers of heterosexual partners and 1 in 5 men paying for sex and 1 in 4 of those with a homosexual partner had attended a clinic in the last five years. The probability of attendance increased with multiple risk behaviours. Of women 64.2% and of men 69.7% attending clinics reported major risk markers for STD transmission. STD clinics in Britain are used by a wide demographic spectrum of the population. The behaviours, but not the attitudes, of attenders differed markedly from those of non-attenders. Clinics are relatively efficient in attracting only those with high-risk lifestyles, but, at a population level, the minority of those reporting risk-markers for STD transmission attend clinics. These findings suggest that STD clinics are an important focus for sexual health promotion, but that community programmes are also important for reaching non-attenders.

The contribution of breakfast to the diets of a sample of 136 primary-schoolchildren in Edinburgh.

The contribution of breakfast to mean daily energy and nutrient intakes was investigated in a sample of 7-8-year-old children recruited by letter from five Scottish schools. After eighteen families dropped out of the study and three dietary records were discarded, the final sample numbered 136 (51%). Dietary data were collected using the 7 d weighed inventory, while a questionnaire was used to classify children into manual or non-manual social class groups. Mean daily energy intakes were close to estimated average requirements (Department of Health, 1991), while intakes of most micronutrients were in excess of reference nutrient intakes (RNI; Department of Health, 1991). The most popular breakfast consumed by the children was one including a ready-to-eat breakfast cereal (RTEBC). Differences in macronutrient content were seen between breakfasts of boys and girls, while manual-social-class children ate breakfasts which were lower in energy, NSP and certain micronutrients than those of non-manual-class children. Breakfast contributed 14% of energy and 9-36% of micronutrient intakes to the overall diets. Breakfasts including RTEBC contributed significantly more energy and nutrients than other types of breakfast. Children who ate RTEBC nearly every day had overall diets which had a higher nutrient density and were lower in fat than those of children who ate RTEBC less frequently or not at all. Intakes of most micronutrients were above the RNI in both these groups, with the exception of folate, Fe and vitamin A, which were below the RNI for those consuming RTEBC infrequently. However, the type of breakfast eaten did not appear to influence energy and nutrient intakes at other meals during the day. Nevertheless, it was concluded that breakfast, particularly one containing RTEBC, had a strong influence on the daily energy and nutrient intakes of 7-8-year-old children, particularly by reducing the proportion of energy from fat.

The climacteric, osteoporosis and hormone replacement; views of women aged 45-49.

We report climacteric symptoms among women aged 45-49, and their attitudes towards HRT and osteoporosis prevention. Semi-structured questionnaires were administered to 481 women attending for bone density screening after random invitation. We recorded social class, menopausal status, history of HRT exposure and climacteric symptoms, awareness of HRT and osteoporosis, and potential willingness to consider HRT before and after bone densitometry. In total, 294 (61%) were from non-manual social classes; 338 (70%) were premenopausal, 68 (14%) postmenopausal and 75 (16%) uncertain; 101 (21%) were current/previous HRT users. Three or more climacteric symptoms were experienced by 189 (56%) of premenopausal women, compared to 64 (94%) of postmenopausal women. Most women had heard of HRT (96%) and osteoporosis (84%), usually from women's magazines or friends. HRT was usually prescribed for climacteric symptoms and, in one case, for osteoporosis prevention. Side effects were reported with most HRT preparations and affected 38% of all users. Of the 380 (79%) women who had never taken HRT, half had concerns about such treatment, and few wanted it at the menopause. However, 364 (96%) said they would consider HRT if their bone scan suggested increased osteoporosis risk. In conclusion, women around the menopause experience considerable climacteric morbidity, but are often anxious about HRT use. Better health education might improve HRT uptake, while long-term compliance might be enhanced by disclosure of fracture risk.

Damp housing and adult health: results from a lifestyle study in Worcester, England.

To explore the relationship between damp housing and adult health using two separate measures of ill health and taking into account the confounding effects of health related lifestyles and social factors. Analysis of responses gathered in a cross sectional, postal questionnaire survey of a randomly selected sample of 5347 residents of Worcester. Altogether 2353 people aged 16 to 64 years responded to the survey (adjusted response 52%). Nine per cent of respondents lived in housing which they reported to be damp. Rates were highest among young women. People who lived in damp housing were more likely to report long standing illness, disability, or infirmity; the increased prevalence could not be attributed to any particular medical condition. Perceived ill health, as measured by the sleep, energy, and social isolation dimensions of the Nottingham Health Profile, was also more common in this group. These associations could not be explained by lifestyle factors; the relationship proved strongest among people in non-manual social classes living in owner occupied housing. The prevalence of ill health increased as the severity of dampness increased. Self reported damp housing and ill health in adults were strongly associated, most noticeably among people in non-manual social classes living in owner occupied housing. The association met many of the epidemiological criteria necessary for suggesting causality: alternative explanations are discussed.

One apple a day?—fruit and vegetable intake in the West of Scotland

An examination of the dietary intake of a community sample of people in early and late middle age resident in the West of Scotland showed that the mean weekly intake of fruit was 6.4 portions (SD ± 5.3) and of vegetables was 10.1 portions (SD ± 4.7). Fruit and vegetable intake (FVI) was higher in non-smokers (compared with smokers), owner-occupiers (compared with non-owner-occupiers), women (compared with men), high income households (compared with low and moderate income), adults aged 59–60 (compared with those aged 39–40) and non-manual social classes (compared with manual social classes). However, in every socio-demographic category examined (even those with comparatively high FVI) the majority of respondents fell far short of the WHO recommendation for fruit and vegetables of 400 g per day and no more than 4% in any subgroup examined met or exceeded the WHO's recommendation. FVI was found to be associated with some dietary items (a positive correlation is seen with consumption of chicken, and a negative correlation with sausages and pies). Higher intakes of FVI were also positively associated with intakes of antioxidant vitamins and non-starch polysaccharides, and a lower percentage of energy derived from fat. These results suggest that simplistic health education attempts to increase FVI without considering overall eating patterns are unlikely to be successful.

Intellectual development at 3 years of age of children who underwent major neonatal surgery

Thirty full-term infants born with surgically correctable life-threatening abnormalities who underwent emergency neonatal surgery were followed up from birth to 3 years of age. Comparable data were obtained on a matched group of healthy newborn babies. At 3 years the cognitive functioning of children whose condition had been resolved in the early months of life was similar to the controls. Those children who required further medical or surgical treatment were functioning at lower levels than the controls, with language development being most affected. Number of operations, defined as all procedures under general anesthetic, was the medical factor most strongly associated with poorer outcome at 3 years. Family factors--higher maternal IQ and nonmanual social class--were also positively correlated with language development.

OCCUPATIONAL AND SOCIOECONOMIC FACTORS ASSOCIATED WITH PEPTIC ULCER AND WITH CANCERS FOLLOWING CONSEQUENT GASTRIC SURGERY

Over 3000 patients, treated surgically for peptic ulcers, were assigned to a Social Class and Occupation Group using information obtained either from their death certificates or from their hospital notes. An analysis of the relationship of socioeconomic status and occupation with the site of original ulcer and the risk of cancer is reported. The major observations were: (a) an association of gastric ulcer with manual and of duodenal ulcer with non-manual Social Class; (b) an association of gastric cancer with dusty occupation and colorectal cancer with professional and managerial workers; and (c) no association between post-surgery gastric cancer risk and social class. This implies that the early stages of gastric carcinogenesis are related to poor socioeconomic conditions but the progression from the precursor lesion (in this case gastric ulcer) to gastric cancer is not, and is consistent with the multistage hypothesis of gastric carcinogenesis proposed by Correa [Diet and Human Carcinogenesis (Edited by Joosens, J. V., Hill, M. J. and Geboers, J.), pp. 109-115. Excerpta Medica, Amsterdam (1985)].

Delivery and development: to what extent can one associate cause and effect?

Data on 570 mothers and their children whose development was personally assessed from birth to four years were analysed. Strong associations were found between the incidence of fetal distress during labour, birth asphyxia, and delivery by emergency caesarean section. At the age of four years girls and children in the non-manual social classes were more advanced, developmentally, than boys and children in the manual classes. No associations were found between perinatal factors and total developmental scores; but highly significant differences were found between `at risk' pregnancy groups according to their method of developmental scores. In only one of seven handicapped children could the handicap possibly have been attributable to delivery factors. Case histories of two children illustrate the dangers and difficulties of associating cause and effect in individual patients.

OBESITY IN NINETEEN-YEAR-OLD MEN: FAMILY SIZE AND BIRTH ORDER ASSOCIATIONS

The authors analyzed the prevalence of obesity by family size and birth order for a total population of over 280,000 19-year-old Dutch males, who were born between 1944 and 1947 and who were from one- to five-child families. Obesity was defined by a relative weight index, 120% or more of the standard of weight for height. Overall obesity prevalence was 1.83%; sons of manual workers were more prone to obesity than sons of non-manual workers. Individuals from one-child families (only children) were uniquely at risk for obesity, particularly in the non-manual social class. This result was similar to reported findings for childhood obesity.