United Kingdom Household Research Articles

Mental health disparities across sexual orientations during the COVID-19 pandemic: Longitudinal analysis of a UK nationally representative cohort

ObjectivesDuring COVID-19, sexual minority groups may have experienced heightened mental health challenges, amplified by unique stressors and the effects of pandemic-related restrictions. This study investigates the differential impact of the pandemic on mental health across sexual orientations, leveraging population-representative data to explore these disparities. Study designProspective cohort design. MethodsData from the United Kingdom Household Longitudinal Study (waves 8–12) was used. Monthly COVID-19 incidence rates at the regional level were used to indicate pandemic severity. Mental health outcomes were evaluated using the Mental Component Score of the Short Form-12 (MCS-12) survey. To examine whether COVID-19 led to differential impacts across sexual orientation, fixed-effect longitudinal models were employed, controlling for individual and time-variant covariates. ResultsLesbian women experienced a significant mental health decline during the COVID-19 pandemic, with a 3.10 MCS-12 score decrease (95 % confidence interval (CI): -5.77 to -0.43) and an 11.0 % higher likelihood of depression (95%CI: -0.3 % to 22.3 %, p = 0.057) compared to heterosexual women. Conversely, the impact on the mental health of heterosexual women was negative but not significant (-0.22; 95%CI: -0.47 to -0.04). Bisexual individuals and other women showed non-significant mental health declines. For men, COVID-19's effect on heterosexuals was similarly non-significant (-0.21; 95%CI: -0.48 to 0.1), with no significant differences observed in gay, bisexual, and other men. ConclusionsSexual minority individuals, especially lesbian women, faced heightened mental health challenges during COVID-19, emphasizing the urgency for targeted interventions.

Extending intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to study individual longitudinal trajectories, with application to mental health in the UK

The intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) approach is gaining prominence in health sciences and beyond, as a robust quantitative method for identifying intersectional inequalities in a range of individual outcomes. However, it has so far not been applied to longitudinal data, despite the availability of such data, and growing recognition that intersectional social processes and determinants are not static, unchanging phenomena. Drawing on intersectionality and life course theories, we develop a longitudinal version of the intersectional MAIHDA approach, allowing the analysis not just of intersectional inequalities in static individual differences, but also of life course trajectories. We discuss the conceptualization of intersectional groups in this context: how they are changeable over the life course, appropriate treatment of generational differences, and relevance of the age-period-cohort identification problem. We illustrate the approach with a study of mental health using United Kingdom Household Longitudinal Study data (2009–2021). The results reveal important differences in trajectories between generations and intersectional strata, and show that trajectories are partly multiplicative but mostly additive in their intersectional inequalities. This article provides an important and much needed methodological contribution, enabling rigorous quantitative, longitudinal, intersectional analyses in social epidemiology and beyond.

Short-term impacts of Universal Basic Income on population mental health inequalities in the UK: A microsimulation modelling study.

Population mental health in the United Kingdom (UK) has deteriorated, alongside worsening socioeconomic conditions, over the last decade. Policies such as Universal Basic Income (UBI) have been suggested as an alternative economic approach to improve population mental health and reduce health inequalities. UBI may improve mental health (MH), but to our knowledge, no studies have trialled or modelled UBI in whole populations. We aimed to estimate the short-term effects of introducing UBI on mental health in the UK working-age population. Adults aged 25 to 64 years were simulated across a 4-year period from 2022 to 2026 with the SimPaths microsimulation model, which models the effects of UK tax/benefit policies on mental health via income, poverty, and employment transitions. Data from the nationally representative UK Household Longitudinal Study were used to generate the simulated population (n = 25,000) and causal effect estimates. Three counterfactual UBI scenarios were modelled from 2023: "Partial" (value equivalent to existing benefits), "Full" (equivalent to the UK Minimum Income Standard), and "Full+" (retaining means-tested benefits for disability, housing, and childcare). Likely common mental disorder (CMD) was measured using the General Health Questionnaire (GHQ-12, score ≥4). Relative and slope indices of inequality were calculated, and outcomes stratified by gender, age, education, and household structure. Simulations were run 1,000 times to generate 95% uncertainty intervals (UIs). Sensitivity analyses relaxed SimPaths assumptions about reduced employment resulting from Full/Full+ UBI. Partial UBI had little impact on poverty, employment, or mental health. Full UBI scenarios practically eradicated poverty but decreased employment (for Full+ from 78.9% [95% UI 77.9, 79.9] to 74.1% [95% UI 72.6, 75.4]). Full+ UBI increased absolute CMD prevalence by 0.38% (percentage points; 95% UI 0.13, 0.69) in 2023, equivalent to 157,951 additional CMD cases (95% UI 54,036, 286,805); effects were largest for men (0.63% [95% UI 0.31, 1.01]) and those with children (0.64% [95% UI 0.18, 1.14]). In our sensitivity analysis assuming minimal UBI-related employment impacts, CMD prevalence instead fell by 0.27% (95% UI -0.49, -0.05), a reduction of 112,228 cases (95% UI 20,783, 203,673); effects were largest for women (-0.32% [95% UI -0.65, 0.00]), those without children (-0.40% [95% UI -0.68, -0.15]), and those with least education (-0.42% [95% UI -0.97, 0.15]). There was no effect on educational mental health inequalities in any scenario, and effects waned by 2026. The main limitations of our methods are the model's short time horizon and focus on pathways from UBI to mental health solely via income, poverty, and employment, as well as the inability to integrate macroeconomic consequences of UBI; future iterations of the model will address these limitations. UBI has potential to improve short-term population mental health by reducing poverty, particularly for women, but impacts are highly dependent on whether individuals choose to remain in employment following its introduction. Future research modelling additional causal pathways between UBI and mental health would be beneficial.

Trick or treat? The Brexit effect on immigrants’ mental health in the United Kingdom

This paper investigates changes in the mental health of immigrants living in the United Kingdom (UK) during the European Union (EU) referendum. Using the UK Household Longitudinal Study, this paper assesses how the mental health of immigrants has changed before and after the referendum, compared to natives. Findings suggest that following the EU referendum result, mental health significantly improved overall for naturalised immigrants as a whole and for non-EU immigrants, relative to the changes in natives. Further, there is no evidence that mental health worsened even for EU immigrants. Our results vary by gender, with non-EU women experiencing a statistically significant improvement in mental health. The results are robust to several checks, including using balanced panel data and individual fixed effects. Our findings are consistent with the idea that the end of free movement for EU immigrants has alleviated the perception of discrimination against non-EU immigrants. This interpretation is supported by empirical results from a multinomial logit showing that non-EU migrants, particularly women, are more likely to perceive discrimination for race-related reasons when denied a job, an effect which is no longer significant in the post-referendum period.

The Economic Cost of Unpaid Care to the Public Finances: Inequalities in Welfare Benefits, Forgone Earnings-related Tax Revenue, and Health Service Utilisation

Abstract There is limited research on the effect of unpaid care on the public finances, and on the inequalities present when providing support to those with caring responsibilities. The aims of this research are to estimate the overall costs to the State of providing care, and to identify sub-groups of carers with relatively greater costs to the government who may need more support. We used waves eight to ten from the United Kingdom Household Longitudinal Survey and performed two-part Generalised Linear Models and Propensity Score Matching. We found that providing care is associated with excess and potentially avoidable costs to government in terms of forgone earnings-related tax revenue, welfare benefits, and health service use. Older carers have lower healthcare costs, indicating, perhaps, issues related to accessing to services due to their role (as they may neglect their own health, worry about safety and costs of public transport). Older carers were also found to have lower levels of welfare benefits, suggesting challenges associated with applying for support (such as navigating cumbersome application processes and stigma-related barriers).

Measures of Violence within the United Kingdom Household Longitudinal Survey and the Crime Survey for England and Wales: An Empirical Assessment

Criminology has been hampered by a lack of longitudinal data to examine the consequences of victimisation. However, recently, ‘Understanding Society’, the United Kingdom Household Panel Survey (UKHLS), began fielding a small battery of questions relating to violence experience. Here, we examined the strengths and weaknesses of these UKHLS measures with similar indices from the Crime Survey for England and Wales (CSEW), a widely used and regarded but cross-sectional survey. We empirically assessed the extent to which the UKHLS variables are comparable with those in the CSEW to determine the viability of the UKHLS for the longitudinal study of (fear of) violence and its consequences. Overall, we regarded the UKHLS to provide an important resource for future panel research on the consequences of victimisation. We found the indicators measuring physical assault to be similar in both sets of data, but also noted differences in prevalence and/or different distributions by socioeconomic group for the indices relating to being threatened and of feeling unsafe. Nonetheless, we maintain their utility for researchers in this field, allowing researchers to uncover new inequalities in violence exposure.

The association of long-term exposure to outdoor air pollution with all-cause GP visits and hospital admissions by ethnicity and country of birth in the United Kingdom.

Air pollution is associated with poor health. Yet, more research is needed to reveal the association of long-term exposure to outdoor air pollution with less studied health outcomes like hospital admissions and general-practitioner (GP) visits and whether this association is stronger for ethnic minorities compared to the rest of population. This study investigates the association between air pollution and all-cause GP visits and hospital admissions by ethnicity in the United-Kingdom (UK). We used individual-level longitudinal data from the "UK Household Longitudinal Study" including 46,442 adult individuals who provided 140,466 responses across five years (2015-2019). This data was linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) outdoor pollution using the Lower Super Output Area (LSOA) of residence for each individual. Multilevel mixed-effects ordered logistic models were used to assess the association between air pollution and all-cause GP visits and hospital admissions. We found higher odds of hospital admissions per 1 μg/m3 increase in annual concentrations of NO2 (OR = 1.008; 95%CI = 1.004-1.012), SO2 (OR = 1.048; 95%CI = 1.014-1.083), PM10 (OR = 1.011; 95%CI = 1.003-1.018), and PM2.5 (OR = 1.018; 95%CI = 1.007-1.029) pollutants. Higher odds of GP visits were also observed with increased exposure to NO2 (OR = 1.010; 95%CI = 1.006-1.014) and SO2 (OR = 1.114; 95%CI = 1.077-1.152) pollutants. The observed associations did not differ across ethnic groups, but by country of birth, they were more pronounced in individuals born outside UK than those born in UK. This study supports an association between higher exposure to outdoor air pollution and increased all-cause hospital admissions and GP visits. Further longitudinal studies with longer follow-up time periods may be able to reveal more definite conclusions on the influence of ethnicity on the association between long-term outdoor air pollution and both hospital admissions and GP visits.

Counteracting Stigma-Power: An Ethnographic Case Study of an Independent Community Food Hub

The need for emergency food aid is increasing across the United Kingdom (UK). Prior to the COVID-19 pandemic, an estimated 2.5% of UK households accessed food banks. As of June 2022, 15% of households were using food banks, and emerging evidence suggested increased stigma, shame and embarrassment associated with food aid use, food poverty, and food insecurity. This ethnographic study explored food aid user experiences of stigma-power, and antistigma strategies utilized by both food aid users and volunteers, at one North East of England Independent Community Food Hub (ICFH) during the COVID-19 pandemic. Findings revealed that stigma-power and the negative dominant narrative adversely affected food aid users, who created stigma avoidance techniques to reduce the perceived stigma of food bank usage. Findings also showed ways in which the ICFH implemented numerous antistigma strategies to reduce the stigma, shame, and embarrassment felt by food aid users.

Labour Mobility and Earnings in the Uk, 1992–2017

Abstract We combine information from the British Household Panel Study and the United Kingdom Household Longitudinal Study (also known as Understanding Society) to construct consistent time series of aggregate worker stocks, worker flows and earnings in the United Kingdom over the period 1992–2017. We propose a method to harmonise data between the British Household Panel Study and United Kingdom Household Longitudinal Study, which we validate by checking the consistency of some of our headline time series with equivalent series produced from other sources, notably by the Office for National Statistics. In addition to drawing a detailed aggregate picture of the United Kingdom labour market over the past two and a half decades, we use our constructed data set to compare the impact of industry, occupation and employer tenure on wages in the United Kingdom. We find that returns to occupation tenure are substantial. All else equal, five years of occupation tenure are associated with a 3.3% increase in wages. We also find that industry tenure plays a non-negligible part in driving wage growth.

Longitudinal study of ESBL/AmpC-producing Enterobacterales strains sharing between cohabiting healthy companion animals and humans in Portugal and in the United Kingdom.

Extended-spectrum beta-lactamase (ESBL)- and plasmid-mediated cephalosporinase (AmpC)-producing Enterobacterales (ESBL/AmpC-E) are an increasing healthcare problem in both human and veterinary medicine. The aim of this study was to investigate the possible sharing of ESBL/AmpC-E strains between healthy companion animals and humans of the same household in Portugal (PT) and the United Kingdom (UK). In a prospective longitudinal study, between 2018 and 2020, faecal samples were collected from healthy dogs (n=90), cats (n=20) and their cohabiting humans (n=119) belonging to 41 PT and 44 UK households. Samples were screened for the presence of ESBL/AmpC-E and carbapenemase-producing bacteria. Clonal relatedness between animal and human strains was established by using REP-PCR fingerprinting method, followed by whole-genome sequencing (WGS) of selected strains. ESBL/AmpC-E strains were detected in companion animals (PT=12.7%, n=8/63; UK=8.5%, n=4/47) and humans (PT=20.7%, n=12/58; UK=6.6%, n=4/61) in at least one timepoint. REP-PCR identified paired multidrug-resistant ESBL/AmpC-producing Escherichia coli strains from companion animals and owners in two Portuguese households (4.8%) and one UK household (2.3%). WGS analysis of nine E. coli strains from these three households confirmed that interhost sharing occurred only between the two animal-human pairs from Portugal. Three shared strains were identified: one CTX-M-15-producing E. coli strain in a cat-human pair (O15-H33-ST93) and two CTX-M-15- and CTX-M-55/CMY-2-producing E. coli strains, in a dog-human pair (O8:H9-ST410 and O11:H25-ST457, respectively) at different timepoints. These E. coli clonal lineages are human pandemic, highlighting the role of companion animals living in close contact with humans in the dissemination and persistence of antimicrobial resistance in the household environment.

Sexual Orientation Identity Mobility in the United Kingdom: A Research Note

Sexual identity is fluid. But just how fluid is it? How does such fluidity vary across demographic groups? How do mainstream measures fare in capturing the fluidity? In analyzing data from the United Kingdom Household Longitudinal Study (N = 22,673 individuals, each observed twice), this research note provides new, population-wide evidence of sexual identity mobility—change and continuity in individuals' sexual orientation identification—in the United Kingdom. Overall, 6.6% of the respondents changed their sexual identity reports between 2011–2013 and 2017–2019. Sexual identity mobility follows a convex pattern over the life course, with higher mobility rates at the two ends than in the middle of the age spectrum. Sexual identity mobility is more prevalent among women, ethnic minority individuals, and the less educated. Changes in people's self-reported sexual identity are closely associated with changes in their partnership status and partner's sex. However, inferring individuals' sexual identity from their partner's sex substantially underestimates the degree of sexual fluidity compared with people's self-reported sexual identity. Our findings encourage researchers and data collectors to fully examine sexual identity mobility and consider its implications for measuring sexual identity.

The spatial–temporal effect of air pollution on individuals’ reported health and its variation by ethnic groups in the United Kingdom: a multilevel longitudinal analysis

BackgroundAir pollution is associated with poor health; though it is unclear whether this association is stronger for ethnic minorities compared to the rest of the population. This study uses longitudinal data to investigate the spatial–temporal effect of air pollution on individuals’ reported health and its variation by ethnicity in the United-Kingdom (UK).MethodsLongitudinal individual-level data from Understanding Society: the UK Household Longitudinal Study including 67,982 adult individuals with 404,264 repeated responses over 11 years (2009–2019) were utilized and were linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) pollution once at the local authority and once at the census Lower Super Output Area (LSOA) of residence for each individual. This allows for analysis at two geographical scales over time. The association between air pollution and individuals’ health (Likert scale: 1–5, Excellent to poor) and its variation by ethnicity was assessed using three-level mixed-effects ordered logistic models. Analysis distinguished between spatial (between areas) and temporal (across time within each area) effects of air pollution on health.ResultsHigher concentrations of NO2, SO2, PM10, and PM2.5 pollution were associated with poorer health. Decomposing air pollution into between (spatial: across local authorities or LSOAs) and within (temporal: across years within each local authority or LSOA) effects showed a significant between effect for NO2 and SO2 pollutants at both geographical scales, while a significant between effect for PM10 and PM2.5 was shown only at the LSOAs level. No significant within effects were detected at an either geographical level. Indian, Pakistani/Bangladeshi, Black/African/Caribbean and other ethnic groups and non-UK-born individuals reported poorer health with increasing concentrations of NO2, SO2, PM10, and PM2.5 pollutants in comparison to the British-white and UK-born individuals.ConclusionUsing longitudinal data on individuals’ health linked with air pollution data at two geographical scales (local authorities and LSOAs), this study supports the presence of a spatial–temporal association between air pollution and poor self-reported health, which is stronger for ethnic minorities and foreign-born individuals in the UK, partly explained by location-specific differences. Air pollution mitigation is necessary to improve individuals’ health, especially for ethnic minorities who are affected the most.

Prosocial behaviour helps to ease physical pain: Longitudinal evidence from Britain

ObjectivePrior studies suggest that prosocial behaviour can lead to better mental and physical health. Yet little is known about whether engaging in prosocial behaviour contributes to reducing physical pain. The objective of this study is to investigate longitudinal associations of two prosocial behaviours, donating money to charity and/or volunteering time to an organisation, with pain. MethodsData are from the United Kingdom Household Longitudinal Survey (UKHLS, approximate N = 48,000 individuals). Both prosocial behaviours were assessed in 2011 and pain was assessed annually through 2020, according to the extent to which it interfered with respondents' ability to do work. Using a prospective longitudinal study design, linear mixed models examined associations of each prosocial behaviour separately and both combined on pain interference across 10 years of follow-up adjusting for a broad range of covariates including demographics, initial health status, and depression. ResultsPeople who did versus did not donate or volunteer reported lower pain interference over 10 years of follow-up (donating b = −0.059, p < 0.001; volunteering b = −0.086, p < 0.001). Individuals who donated more versus less money reported lower pain interference although volunteering more hours was not associated with lower pain interference. Finally, findings suggested that engaging in both donating and volunteering versus neither was associated with lower pain interference over follow-up. ConclusionThere is a longitudinal association between donating money to charity and/or volunteering time to an organisation with pain interference with work. Understanding factors that help to reduce pain is relevant for the design of public health policies.

Social action as a route to the ballot box: Can youth volunteering reduce inequalities in turnout?

AbstractA serious challenge facing Western democracies is the falling propensity of successive cohorts of citizens to vote. Over the last 50 years, newly eligible voters – particularly from poorer backgrounds – have become less likely to vote in their first elections, and more likely to develop habits of non‐voting. This trend has prompted greater interest in policies with the potential to increase first‐time voter turnout, such as lowering the voting age or compulsory political education. Despite a growing academic interest in volunteering as a means of youth political expression or route to civic revival, however, the promotion of youth volunteering has not been seriously considered as a potential tool to help address generational turnout decline.An extensive literature argues that volunteering can increase first‐time voter turnout, but it is hindered by the limited use of panel data and failure to account for confounding and selection effects. It has not, moreover, considered the potential for the effects of childhood volunteering to be conditional on prior political socialisation, particularly the influence of parents, which is necessary to assess its potential to reduce turnout gaps reflecting socio‐economic status. This study uses the United Kingdom Household Longitudinal Study and structural equation modelling to overcome these limitations and examine the impact of childhood volunteering on the turnout of newly eligible voters. It shows that for most young volunteers there is no significant benefit, but for the children of politically disengaged parents, volunteering does have a significant, positive effect.

Are ethnic employment penalties mitigated in deprived neighbourhoods and in ethnically dense neighbourhoods?

AbstractExisting research has extensively documented that those living in the most deprived neighbourhoods and individuals from some ethnic minority groups have low rates of labour market participation in the United Kingdom. This paper brings together these two established areas of research to ask whether ethnic minority groups have better employment participation when living in more deprived neighbourhoods. We hypothesise that this could be due to different socialisation processes enabling ethnic minorities to secure employment more easily in deprived neighbourhoods as well as in neighbourhoods where there is greater ethnic density. Data from the United Kingdom Household Longitudinal Study in England are linked to the Index of Multiple Deprivation 2014 and the 2011 Census to model unemployment and economic inactivity between 2009 and 2019 separately for women and men. The results show that some ethnic minority groups face disadvantage in the labour market, especially Pakistani and Bangladeshi women. There is little support to suggest that these penalties are lessened in more deprived neighbourhoods or in more ethnically dense neighbourhoods. There is some suggestion that groups who do not face ethnic penalties compared with the White British group have lower rates of unemployment and economic inactivity in more deprived neighbourhoods. We suggest policies aimed at improving labour market outcomes for disadvantaged ethnic minorities should target them wherever they live.

Model-based Recursive Partitioning to Estimate Unfair Health Inequalities in the United Kingdom Household Longitudinal Study

We measure unfair health inequality in the UK using a novel data-driven empirical approach. We explain health variability as the result of circumstances beyond individual control and health-related behaviours. We do this using model-based recursive partitioning, a supervised machine learning algorithm. Unlike usual tree-based algorithms, model-based recursive partitioning does identify social groups with different expected levels of health but also unveils the heterogeneity of the relationship linking behaviors and health outcomes across groups. The empirical application is conducted using the UK Household Longitudinal Study. We show that unfair inequality is a substantial fraction of the total explained health variability. This finding holds no matter which exact definition of fairness is adopted: using both the fairness gap and direct unfairness measures, each evaluated at different reference values for circumstances or effort.

Inequalities in unpaid carer's health, employment status and social isolation.

Providing higher-intensity unpaid care (higher care hours or care within the household) is associated with negative impacts on people's paid employment, mental health and well-being. The evidence of effects on physical health is mixed and carer's social and financial outcomes have been under-researched. The biggest evidence gap, however, is on how outcomes vary by factors other than type or level of care provision, in particular socio-demographic factors. Our study used two waves of data (2017/19 and 2018/2020) from the United Kingdom Household Longitudinal Study for people aged 16 and older. We investigated the effects of providing care for 10 or more hours a week or within the household in interaction with people's socio-demographic characteristics. Outcomes included mental and physical health, social isolation, employment status and earnings. We found that caring responsibilities interacted with gender, ethnicity, socio-economic status (as measured by highest educational qualification), or age to affect carers differentially in a number of areas of their lives leading to, and exacerbating, key disadvantages and inequalities.

Is Paid Inflexible Work Better than Unpaid Housework for Women’s Mental Health? The Moderating Role of Parenthood

Despite women’s increased participation in the labor market over the last several decades, many women still perform a disproportionate share of housework, and lack the support of flexible working arrangements. Thus, women are facing a trade-off between doing paid inflexible work and doing unpaid housework, both of which have negative impacts on their mental health. However, the effects of work flexibility and unpaid housework are rarely examined together. This study aims to compare the effects of paid inflexible work and unpaid housework on women’s mental health. It also examines whether parenthood affects the mental health impacts of different employment and economic statuses on women. This study applies nationally representative longitudinal data from the United Kingdom Household Longitudinal Study (2010–2020, N = 23,552), and uses two-way fixed effects models to process this data. The results show that women who have paid inflexible work have significantly better mental health than those who do only unpaid housework. This pattern is consistent for women who lack different types of flexible work arrangements. Moreover, the mental health benefits of inflexible working over unpaid housework are particularly pronounced for women without dependent children. Paid work, even paid inflexible work, matters for women’s mental health, especially women without children. Future research needs to incorporate various employment and economic statuses into one theoretical framework to examine women’s mental health and further investigate the role of parenthood in moderating the health effects of employment and economic status.

Racism as the fundamental cause of ethnic inequities in COVID-19 vaccine hesitancy: A theoretical framework and empirical exploration using the UK Household Longitudinal Study

Ethnic inequities in COVID-19 vaccine hesitancy have been reported in the United Kingdom (UK), and elsewhere. Explanations have mainly focused on differences in the level of concern about side effects, and in lack of trust in the development and efficacy of vaccines. Here we propose that racism is the fundamental cause of ethnic inequities in vaccine hesitancy. We introduce a theoretical framework detailing the mechanisms by which racism at the structural, institutional, and interpersonal level leads to higher vaccine hesitancy among minoritised ethnic groups. We then use data from Wave 6 of the UK Household Longitudinal Study COVID-19 Survey (November to December 2020) to empirically examine these pathways, operationalised into institutional, community, and individual-level factors. We use the Karlson–Holm–Breen method to formally compare the relationship between ethnicity and vaccine hesitancy once age and gender, sociodemographic variables, and institutional, community, and individual-level factors are accounted for. Based on the Average Partial Effects we calculate the percentage of ethnic inequities explained by each set of factors.Findings show that institutional-level factors (socioeconomic position, area-level deprivation, overcrowding) explained the largest part (42%) of the inequity in vaccine hesistancy for Pakistani or Bangladeshi people, and community-level factors (ethnic density, community cohesion, political efficacy, racism in the area) were the most important factors for Indian and Black groups, explaining 35% and 15% of the inequity, respectively.Our findings suggest that if policy intervened on institutional and community-level factors – shaped by structural and institutional racism - considerable success in reducing ethnic inequities might be achieved.

Five-factor model personality traits and grip strength: Meta-analysis of seven studies

ObjectiveTo examine the association between Five-Factor Model personality traits and grip strength. MethodAdults aged 16 to 104 years old (N > 40,000) were from the Health and Retirement Study, the Midlife in the United States Study, The English Longitudinal Study of Aging, the National Health and Aging Trends Survey, the United Kingdom Household Longitudinal Study, and the Wisconsin Longitudinal Study graduate and sibling samples. Participants had data on personality traits, demographic factors, grip strength, and mediators such as depressive symptoms, physical activity, body mass index (BMI), and c-reactive protein (CRP). ResultsAcross all samples and a meta-analysis, higher neuroticism was related to lower grip strength (meta-analytic estimate: -0.07, 95%CI: −0.075; −0.056). Higher extraversion (0.04, 95%CI: 0.022; 0.060), openness (0.05, 95%CI: 0.032; 0.062), and conscientiousness (0.05, 95%CI: 0.04; 0.065) were associated with higher grip strength across most samples and the meta-analysis. Depressive symptoms were the most consistent mediators between neuroticism and grip strength. Depressive symptoms and physical activity partly mediated the associations with extraversion, openness, and conscientiousness. Lower CRP partly mediated the association with conscientiousness. Sex moderated the associations for extraversion, openness, and conscientiousness, with stronger associations among males. Age moderated the neuroticism association, with stronger associations among younger individuals. ConclusionThis study provides replicable evidence that personality is related to grip strength and identifies potential moderators and mediators of these associations. Overall, higher neuroticism is a risk factor for low grip strength, whereas high extraversion, openness, and conscientiousness may be protective.