Women Of Higher Socioeconomic Status Research Articles

Alcohol consumption and social inequality at the individual and country levels—results from an international study

International comparisons of social inequalities in alcohol use have not been extensively investigated. The purpose of this study was to examine the relationship of country-level characteristics and individual socio-economic status (SES) on individual alcohol consumption in 33 countries. Data on 101,525 men and women collected by cross-sectional surveys in 33 countries of the GENACIS study were used. Individual SES was measured by highest attained educational level. Alcohol use measures included drinking status and monthly risky single occasion drinking (RSOD). The relationship between individuals' education and drinking indicators was examined by meta-analysis. In a second step the individual level data and country data were combined and tested in multilevel models. As country level indicators we used the Purchasing Power Parity of the gross national income, the Gini coefficient and the Gender Gap Index. For both genders and all countries higher individual SES was positively associated with drinking status. Also higher country level SES was associated with higher proportions of drinkers. Lower SES was associated with RSOD among men. Women of higher SES in low income countries were more often RSO drinkers than women of lower SES. The opposite was true in higher income countries. For the most part, findings regarding SES and drinking in higher income countries were as expected. However, women of higher SES in low and middle income countries appear at higher risk of engaging in RSOD. This finding should be kept in mind when developing new policy and prevention initiatives.

Prevalence and Determinants of High-risk Human Papillomavirus Infection in Women with High Socioeconomic Status in Seoul, Republic of Korea

We aimed to estimate the prevalence of high-risk human papillomavirus (HPV) infections in women of high socioeconomic status (SES) in Seoul, Republic of Korea and to identify risk factors. This study included 13,386 women visiting a prestigious healthcare center located in Seoul between 2003 and 2008. High-risk HPV infections were detected in 994 (7%) and the age-standardized prevalence was 8%. Abnormal Pap smear results ≥ atypical squamous cells of unknown significance (ASCUS) were observed in 280 of 12,080 women (2%). Based on univariate analysis, age, level of education and number of children were associated with high-risk HPV infections. Based on multivariate analysis, age and high-risk HPV infections had an inverse relationship. In women with high SES in Seoul, the prevalence of high-risk HPV infection was 7% and the age-standardized prevalence was 8%. Age was a strong determinant of high-risk HPV infection.

P1-11-01: Strong Socioeconomic Disparities in Breast Cancer Quality of Care in Switzerland.

Abstract Background Despite substantial research on socioeconomic disparities in breast cancer prognosis, important gaps remain concerning the causes of over mortality among socially deprived patients. In this population-based study, we identify disparities by socioeconomic status (SES) in diagnosis assessment and management of breast cancer in Geneva, Switzerland, where the average income and the health care system cost are among the highest in the world. Methods We included in the study all 1110 women reported with invasive breast cancer at the Geneva Cancer Registry between 2003 and 2005. SES was regrouped in three levels: low (manual employees, skilled and unskilled workers), middle (nonmanual employees and administrative staff) and high (professionals, executive administrators, entrepreneurs) based on the patient's last occupation or, if unemployed, that of the spouse. We compared patients, tumour, treatment characteristics, surgeon caseload and delay of diagnosis as well as some of the management quality indicators established by the European School of Mastology among SES classes by heterogeneity tests. To assess the independent effect of each factor we used multivariate logistic regression, comparing women of high vs. low SES. Results Compared with patients of high SES, low SES patients were older, more often born outside Switzerland and treated in the public system. Low SES women had less often screen detected cancers (29% vs. 41%; OR multi-adjusted for breast self-examination vs. mammography: 1.7, 95%CI: 1.1−2.6, p=0.020), and less frequently magnetic resonance imaging to assess tumour size/focality (4% vs. 15%; OR multi-adjusted for breast MRI vs. ultrasound: 0.2, 95%CI: 0.1−0.5, p=0.001). They had more often a delay longer than 4 weeks between diagnosis and treatment (53.8% vs. 32.7%; OR multi-adjusted for 4 weeks and more vs. less: 2.6, 95%CI: 1.7−4.1, p<0.000). Also, women of low SES were more frequently operated by surgeons with a lower caseload (<5 new breast cancer operations per year) (55% vs. 30%; OR multi-adjusted for surgeon's caseload of 5–15 vs. <5: 0.4, 95%CI: 0.1−0.9, p=0.020), had more often positive surgical margins (11.4% vs. 5.4%; OR multi-adjusted for negative vs. positive margins: 0.4, 95% CI 0.2−1.0, p=0.057) and lower access to anti-aromatase treatments (29.6% vs. 43.6%). In particular, the probability to receive anastrozole vs. tamoxifen was 70% lower (OR multi-adjusted for anastrozole vs. tamoxifen: 0.3, 95%CI: 0.2−0.6, p<0.000). Conclusions: This study shows strong SES differences all along the continuum of breast cancer management, even in the highly medicalized county of Geneva. Only by improving the quality of care provided to women of low SES we will be able to prevent the excess breast cancer mortality observed among these women. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-11-01.

Gender and socioeconomic disparities in BMI trajectories in the Seychelles: a cohort analysis based on serial population-based surveys

BackgroundThe relationship between body mass index (BMI) and socioeconomic status (SES) tends to change over time and across populations. In this study, we examined, separately in men and women, whether the association between BMI and SES changed over successive birth cohorts in the Seychelles (Indian Ocean, African region).MethodsWe used data from all participants in three surveys conducted in 1989, 1994 and 2004 in independent random samples of the population aged 25-64 years in the Seychelles (N = 3'403). We used linear regression to model mean BMI according to age, cohort, SES and smoking status, allowing for a quadratic term for age to account for a curvilinear relation between BMI and age and interactions between SES and age and between SES and cohorts to test whether the relation between SES and BMI changed across subsequent cohorts. All analyses were performed separately in men and women.ResultsBMI increased with age in all birth cohorts. BMI was lower in men of low SES than high SES but was higher in women of low SES than high SES. In all SES categories, BMI increased over successive cohorts (1.24 kg/m2 in men and 1.51 kg/m2 for a 10-year increase in birth cohorts, p < 0.001). The difference in BMI between men or women of high vs. low SES did not change significantly across successive cohorts (the interaction between SES and year of birth of cohort was statistically not significant). Smoking was associated with lower BMI in men and women (respectively -1.55 kg/m2 and 2.46 kg/m2, p < 0.001).ConclusionsAlthough large differences exist between men and women, social patterning of BMI did not change significantly over successive cohorts in this population of a middle-income country in the African region.

Pregnancy outcome of the obese in Ilorin.

Obesity is a nutritional disorder that is fast becoming a public health issue in the developing world. It is associated with increased incidence of maternal complications and adverse perinatal outcome. This is a case-control study of obesity in pregnancy carried out in the maternity wing of University of Ilorin Teaching Hospital, Nigeria. The subjects and controls were 156 obese and 80 non-obese women booked at this hospital for antenatal care. The controls were matched for age and parity. Obesity occurred more commonly among the well educated (P = 0.00) and those in social classes I and II (P = 0.00). The occurrence of other medical conditions was not significantly different. The obese women also had more caesarean sections (P = 0.00), more assisted vaginal deliveries (P = 0.00) and fewer spontaneous vaginal deliveries (P = 0.00) than the non-obese parturients. The mean birth weight of infants of the obese mothers was 4.06 ± 0.13 kg (mean±SD) while the mean for the controls was 3.36 ± 0.49 kg. The difference was statistically significant (P = 0.000). Also, the obese parturients had more macrosomic babies (defined as birth weight >4.2 kg) than the non-obese (P = 0.00). The risks of perinatal asphyxia, birth trauma, neonatal admission and low birth weight were not increased among obese women in this study. This study suggests that in our community, obesity occurs more commonly among women of high socioeconomic status and is a risk factor for maternal and fetal complications.

The better the worse: risk factors for HIV infection among women in Kenya and Uganda – Demographic and Health Survey

The objective of the study was to investigate socio-economic status (SES) factors as risk factors for HIV among women in Kenya and Uganda. Individual data from cross-sectional, population based 2003-Kenya Demographic and Health Survey (KDHS) and 2004-Uganda AIDS Indicator Survey (AIS) were used and the probability of being HIV-positive was analysed. Contrary to the public health literature, women of high SES were also vulnerable to HIV risk. Both Ugandan and Kenyan women had similar SES risk factors to HIV and harmonising policies in the two countries to deal with the disadvantages of the social and cultural roles of women would help reduce vulnerability to HIV for women. Policies in both countries need to be broad based to cut across all socio-economic groups and deal with the complexity of HIV/AIDS. Nyanza region needs exceptional policies to deal with the high HIV prevalence and reduce risk through cultural practices like widow inheritance.

Changes and correlates in multiple sexual partnerships among Chinese adult women – population-based surveys in 2000 and 2006

The sexual transmission of HIV and STI is becoming a major public health concern in China. However, studies on sexuality in China remain scant, particularly those that analyze female sexuality. This study is to investigate the prevalence of multiple sexual partnerships (MSP) among adult women, and to examine trends and correlates for having more than one lifetime sexual partner. MSP, coded as having one or none vs. two or more lifetime sexual partners, was the key binary outcome measure. The data were from two national probability surveys on sexual behaviors in China carried out in 2000 and 2006. The sample size of adult women was 1899 in 2000 (total sample n=3812), and 2626 in 2006 (n=5404). Overall prevalence of MSP increased from 8.1% in 2000 to 29.6% in 2006 (chi-square test, significance = 0.000). The most rapid changes took place among women with less education, those who worked in blue-collar jobs and lower social-status positions, and those living in rural areas or small towns. Women who were better educated, lived in big cities, and held management-level occupations exhibited less change but had a higher baselines prevalence of MSP, suggesting that changes in MSP behavior may occur initially among women of higher socioeconomic status. Based on the 2006 data-set, significant positive correlates of MSP included more years of education, being in a long-term relationship, being middle aged, having a lower-status job, going out dancing at entertainments venues, and being a state of overall health in the past 12 months. The significant recent increase in MSP among women reinforces the need to examine China's sexual revolution in the context of a rapidly transitioning society. Findings regarding female sexuality also raise new questions to be explored in further sexuality studies, in order to better understand population sexual behaviors and to inform future HIV-prevention efforts.

Socioeconomic status and body size among women in Honduran Miskito communities

Background: This study investigates evidence of the nutrition transition among women in Miskito communities on the northeastern coast of Honduras.Aim: The hypothesis that socioeconomic status (SES) is positively associated with body size and fatness is tested; and dietary and physical activity patterns are examined among SES groups.Subjects and methods: An anthropometric survey was conducted with 200 non-pregnant women following standard procedures. Dietary intake and physical activity data were collected using 24-hour recall methods. Women were categorized into three SES groups (high, medium and low) based on economic and social attributes. Differences in anthropometric measures, diet and physical activity among SES groups were analysed.Results: More than 70% (n = 142) of women in the sample were overweight or obese. Mean height, weight, skin-fold thicknesses, arm and calf circumferences, percentage body fat and upper-arm fat area were significantly greater among high SES women than low SES women. Women with high SES had lower rates of physical activity and higher rates of obesity, perceived food sufficiency, meat consumption, milk/dairy intake and general dietary diversity.Conclusion: High SES women were significantly fatter than low SES women; and variation observed among groups is likely related to different patterns of dietary intake and physical activity.

Paradoxes in Obesity With Mid-Life African American Women

PurposeTo examine the relationship among socioeconomic status, psychological factors (ie, health locus of control, health satisfaction), and health behaviors (ie, physical exercise, eating patterns) in a volunteer sample of mid-life African American women residing within Washington, DC. MethodsThe study's sample included 351 African American women who participated in the 12-week Prime Time Sister Circles (PTSC) intervention and completed the initial self-report survey. Of the women completing the baseline survey, clinical assessments were taken on 277 participants. ResultsThe majority (64.4%) of the women were either obese or extremely obese based upon their body mass index (BMI). Fewer than one-third of the women were satisfied with their weight. Despite these outcomes, most (61.8%) of the sample rated their health, in comparison to other African American women, as either good or very good. Further, more than one-half of the women were somewhat to very satisfied with their health knowledge, attitudes, behaviors, and their physical, emotional, and spiritual health. There was no significant relationship between obesity level and socioeconomic status, as measured by education, personal income, and total household income. Additionally, there were no significant differences in weight or eating behaviors by education, personal income, and total household income. The findings revealed a significant difference in the number of days the women reported engaging in physical exercise by personal income (p < .01) and total household income (p = .05), surprisingly, with the women in the lower-income categories reporting engaging in more days of physical exercise than women in the higher-income categories. ConclusionsThis study documents the paradoxes of obesity in mid-life African American women related to socioeconomic status inasmuch as there were no differences observed in the prevalence of obesity by socioeconomic status indicators. The obese women of lower socioeconomic status reported exercising more than obese women of high socioeconomic status. Paradoxically, most of the obese women were dissatisfied with their body weight, shape, andphysical health, but more than 50% were satisfied with their health attitudes and behaviors and 61.8% rated their health favorably. The paradoxes of obesity and African American women across various income levels are important to understand for interventions to success.

The Relationship of Stress to Health-Promoting Behaviors of College-Educated African American Women

Background: More research has been done involving obese and overweight African American women who have low and middle socioeconomic status (SES) and have a high school education or some college. Fewer studies have involved African American women who have completed college, and even fewer numbers of studies have involved African American women of middle and high SES with bachelor's and graduate degrees. Methods: Quantitative analysis, using analysis of variance (ANOVA), Pearson's product moment statistics, and stepwise multiple regression, was performed. Utilizing Pender's health promotion model, the relationships among weight, body image, self-efficacy, stress, and health-promoting behaviors were determined in a purposive sampling of 167 subjects who were members of an organization of women in the Metropolitan Washington, D.C., area, whose membership consists primarily of college-educated African American members. These participants were compared for the association of weight, body image, self-efficacy, and stress in relation to increased commitment to engage in health-promoting behaviors, such as increased physical activity and consumption of healthy foods. Results: Among these women, low levels of stress were likely to influence a participant's decision to adopt health-promoting behaviors. The results showed a significant negative relationship (r = −.365, p < .05), indicating that among these college-educated African American women, low levels of stress were likely to influence one's decision to adopt health-promoting behaviors; and there was no significant difference in any of the mean scores (F(2,163) = .854, p > .05) of health-promoting behaviors between those who were normal weight, overweight, or obese. Conclusions: In this cohort, levels of stress were found to negatively influence a participant's decision to adopt health-promoting behaviors. Further, positive body image and positive self-efficacy were related to intent to engage in health-promoting behaviors. Information from this study can enable nurses and other health care providers design culturally and educationally sensitive interventions aimed at helping such women achieve and maintain a healthier lifestyle.

Postergación de la maternidad en Chile: Una realidad oculta

Delayed motherhood is a common phenomenon in the developed world, where the age at first delivery is around 30 years. In Chile the National Institute of Statistics established that this age has remained around 23 years for more than two decades. Motherhood postponement may be modulated by socioeconomic status.To determine whether the age at first delivery is higher in a private clinic compared to a public hospital.Two cohorts of primiparous women delivering in 1998 and 2008 in the public hospital San Borja Arriarán (HSBA) and a private setting Clínica Las Condes (CLC), were analyzed.The age of all delivering women was significantly lower in HSBA than in CLC in both study periods (26.3 ± 0.8 and 25.7 ± 0.9 compared to 31.6 ± 0.1 and 32.7 ± 0.1 years, respectively). Likewise, the frequency of adolescent pregnancy was significantly higher in HSBA than CLC in both study periods (38.8 and 42.2% compared to 1.7 and 1.6% respectively). The age at first delivery was significantly lower in both periods in HSBA (21.8 and 21.3 years compared to 28.6 and 30.6 years, respectively). Excluding primiparous women of less than 20 years, the difference in age was smaller, but remained still significant (24.6 and 24.2 versus 29.9 and 31.0 years, respectively).In Santiago, the postponement of motherhood is more marked among women of high socioeconomic status.

Reduction of socioeconomic inequality in cancer incidence in the South of the Netherlands during 1996–2008

Background Cancer incidence varies according to socioeconomic status (SES) and time trends. SES category may thus point to differential effects of lifestyle changes but early detection may also affect this. Patients and methods We studied patients diagnosed in 1996–2008 and registered in the South Netherlands Cancer registry. Incidence rates and estimated annual percentage changes were calculated according to SES category, age group (25–44, 45–64 and ⩾65) and sex. Results People with a low SES exhibited elevated incidence rates of cancer of the head and neck, upper airways (both sexes), gastro-intestinal tract, squamous cell skin cancer, breast (⩾65) and all female genital, bladder, kidney and mature B-cells (all in females only), whereas prostate cancer, basal cell skin cancer (BCC) and melanoma (both except in older females) were most common among those with a high SES. Due to the greater increase in prostate cancer and melanoma in high SES males and the larger reduction of lung cancer in low SES males, incidence of all cancers combined became more elevated among males of ⩾45 years with a high and intermediate SES, and approached rates for low SES men aged 45–64. In spite of more marked increases in the incidence of colon, rectal and lung cancer in high SES women, the incidence of all cancers combined remained highest for low SES women of ⩾45 years. However, at age 25–44 years, the highest incidence of cancer of the breast and melanoma was observed among high SES females. During 1996–2008 inequalities increased unfavourably among higher SES people for prostate cancer, BCC (except in older women) and melanoma (at middle age), while decreasing favourably among low SES people for cancers of the oesophagus, stomach, pancreas and kidney (both in females only), breast (⩾65 years), corpus uteri and ovary. Conclusions Although those with a low SES exhibited the highest incidence rates of the most common cancers, higher risks were observed among those with high SES for melanoma and BCC (both except older females) and for prostate and breast (young females) cancer. Altogether this might also have contributed to the recent higher cancer awareness in Dutch society which is usually promoted more by patients of high SES and those who know or surround them.

A Mixed-Methods Analysis of Extramarital Sex in Contemporary China

Extramarital affairs and divorce are controversial issues in China. Using a mixed-methods approach, extramarital sex (EMS) was investigated by combining statistical data about behaviors and attitudes with a textual reading of contemporary newspaper and magazine articles related to EMS in China. On the basis of the 1999–2000 Chinese Health and Family Life Survey, this study indicated that about 15% of married men and 5% of married women in China have engaged in EMS. Opportunity and permissive attitudes were related to the likelihood of engaging in EMS, especially for men. The prevalence of EMS may reflect a redistribution of power, both between and within gender groups, with Chinese men and women of higher socioeconomic status more likely to engage in EMS.

Toe representation in the primary somatosensory cortex

Obesity has been associated with increased risk of antenatal depression, but little is known about this relationship. This study tested whether socio-economic status (SES) influences the relationship between obesity and antenatal depression.Data were taken from the Screening for Pregnancy Endpoints (SCOPE) cohort. BMI was calculated from measured height and weight at 15±1 weeks' gestation. Underweight women were excluded. SES was indicated by self-reported household income (dichotomised around the median: low SES ≤£45,000; high SES >£45,000). Antenatal depression was defined as scoring ≥13 on the Edinburgh Postnatal Depression Scale at both 15±1 and 20±1 weeks' gestation, to identify persistently elevated symptoms of depression.Five thousand five hundred and twenty two women were included in these analyses and 5.5% had persistently elevated antenatal depression symptoms. There was a significant interaction between SES and BMI on the risk of antenatal depression (p=0.042). Among high SES women, obese women had approximately double the odds of antenatal depression than normal weight controls (AOR 2.11, 95%CI 1.16–3.83, p=0.014, adjusted for confounders). Among low SES women there was no association between obesity and antenatal depression. The interaction effect was robust to alternative indicators of SES in sensitivity analyses.1) Antenatal depression was assessed with a self-reported screening measure; and 2) potential mediators such as stigma and poor body-image could not be examined.Obesity was only associated with increased risk of antenatal depression among high SES women in this sample. Healthcare professionals should be aware that antenatal depression is more common among low SES women, regardless of BMI category.

“It’s Way out of my League”

The cultural construction of motherhood represents women of low socioeconomic status (SES) as excessively fertile, placing them outside of the infertility discourse. Previous research on infertility reinforces poor women’s exclusion by focusing on the experiences of women receiving medical treatment, typically women of high SES. In this article, the author explores how 20 poor and working-class women negotiate their experiences of infertility. In-depth interviews expose the contextual experiences of infertility among women of low SES, specifically revealing the structural inequality apparent within those experiences. The women are not passive objects of dominant discourses; they are active subjects in resisting, redefining, and accepting the discourses according to their contexts. Women of low SES are outsiders—within to dominant understandings and resolutions to infertility. Their unique insights not only provide a more nuanced understanding of infertility but they also begin to deconstruct the stratified system of reproduction.

Impact of a positive family history on diagnosis, management, and survival of breast cancer: different effects across socio-economic groups

This study aims to investigate whether increased awareness of breast cancer, due to a positive family history (FH), reduces diagnostic, therapeutic, and survival differences between women of low versus high socio-economic status (SES). All breast cancer patients registered between 1990 and 2005 at the population-based Geneva Cancer Registry were included. With multivariate logistic and Cox regression analysis, we estimated the impact of SES and FH on method of detection, treatment, and mortality from breast cancer. SES discrepancies in method of detection and suboptimal treatment, as seen among women without a FH, disappeared in the presence of a positive FH. SES differences in stage and survival remained regardless of the presence of a positive FH. Overall, positive FH was associated with better survival. This effect was the strongest in women of high SES (age-adjusted Hazard Ratio [HR(ageadj)] 0.54 [0.3-1.0]) but less pronounced in women of middle (0.77 [0.6-1.0]), and absent in women of low SES (0.80 [0.5-1.2]). A positive FH of breast cancer may reduce SES differences in access to screening and optimal treatment. However, even with better access to early detection and optimal treatment, women of low SES have higher risks of death from their disease than those of high SES.

Lower-Energy-Density Diets Are Associated with Higher Monetary Costs per Kilocalorie and Are Consumed by Women of Higher Socioeconomic Status

ObjectiveDiets of lower energy density are associated with higher diet quality, lower body weights, and better health outcomes. This study examined associations among dietary energy density, energy-adjusted diet costs, and socioeconomic indicators of study participants. DesignIn this cross-sectional study, energy and nutrient intakes for 164 men and women aged 25 to 65 years were obtained using a food frequency instrument between June 2005 and September 2006. Dietary energy density (kcal/g) was calculated with and without beverages. Energy-adjusted diet costs ($/2,000 kcal) were calculated using food prices in Seattle, WA. Tertile splits of energy density and energy cost were analyzed using tests for linear trend. Linear regression models tested the association between education, income, and dietary variables, adjusting for age and sex. ResultsDiets of lower energy density were associated with higher absolute nutrient intakes. Diets of lower energy density were also associated with higher energy-adjusted diet costs. Conversely, highest energy density diets were associated with lower intakes of micronutrients and fiber and lower costs. Education and household income showed a negative association with dietary energy density in regression models. Education and household incomes showed a positive association with the energy-adjusted cost of the diet. Education was a stronger predictor of both energy density and energy cost than was household income. ConclusionsHigher-quality diets were not only more costly per kilocalorie but were also consumed by persons of higher educational level. The influence of diet quality on health, observed in some epidemiologic studies, might be modulated by unobserved indexes of socioeconomic status.

A systematic review of chronic fatigue, its syndromes and ethnicity: prevalence, severity, co-morbidity and coping

Chronic Fatigue Syndrome (CFS) is characterized by unexplained fatigue that lasts for at least 6 months alongside a constellation of other symptoms. CFS was historically thought to be most common among White women of higher socio-economic status. However, some recent studies in the USA suggest that the prevalence is actually higher in some minority ethnic groups. If there are convincing differences in prevalence and risk factors across all or some ethnic groups, investigating the causes of these can help unravel the pathophysiology of CFS. A systematic review was conducted to explore the relationship between fatigue, chronic fatigue (CF--fatigue lasting for 6 months), CFS and ethnicity. Studies were population-based and health service-based. Meta-analysis was also conducted to examine the population prevalence of CF and CFS across ethnic groups. Meta-analysis showed that compared with the White American majority, African Americans and Native Americans have a higher risk of CFS [Odds Ratio (OR) 2.95, 95% confidence interval (CI): 0.69-10.4; OR = 11.5, CI: 1.1-56.4, respectively] and CF (OR = 1.56, CI: 1.03-2.24; OR = 3.28, CI: 1.63-5.88, respectively). Minority ethnic groups with CF and CFS experience more severe symptoms and may be more likely to use religion, denial and behavioural disengagement to cope with their condition compared with the White majority. Although available studies and data are limited, it does appear that some ethnic minority groups are more likely to suffer from CF and CFS compared with White people. Ethnic minority status alone is insufficient to explain ethnic variation of prevalence. Psychosocial risk factors found in high-risk groups and ethnicity warrant further investigation to improve our understanding of aetiology and the management of this complex condition.

Demographic characteristics of patients using a fully integrated psychosocial support service for cancer patients.

BackgroundPsychosocial support services are an important component of modern cancer treatment. A major challenge for all psychosocial services is the achievement of equity of use. Previous studies in the UK have found that women of higher socio-economic status with breast cancer were over-represented amongst those accessing support services. People with other cancer diagnoses, those from socio-economically deprived areas, and men, were under-represented.FindingsThe Oncology Health Service, Kingston Upon Hull, UK, delivers fully integrated psychosocial support and interventions. To assess equity of access in this service, a cross-sectional study of all patients with cancer accessing the service during a 5 day period was carried out. One hundred and forty-five patients attended. Forty four percent were male, and the types of cancer were broadly in the proportions expected on the basis of population prevalence (breast cancer 22%, colorectal cancer 21%, lung cancer 16%). Sixty six percent came from the three most deprived quintiles of the Townsend deprivation Index.ConclusionsThe fully integrated Oncology Health Service in Hull is accessed by a more diverse range of patients than previously reported for other services, and is an example of a model of service by which socially equitable use of psychosocial support in the National Health Service might be achieved.

Socioeconomic Status as a Modifier of the Relationship between Antibiotic Use During Pregnancy and Birthweight

Antibiotics taken during pregnancy treat underlying maternal infections that may otherwise contribute to poor birth outcomes, including decreased birthweight. This study investigated whether antibiotics taken by a diverse sample of North American women were associated with increased mean infant birthweight and whether this relationship was modified by socioeconomic status. The study hypothesized that women of low socioeconomic status, whose babies are at highest risk of low birthweight perhaps due to long-standing undiagnosed infections, might benefit from antibiotic use more than women of higher socioeconomic status. The sample was 868 control women from a case-control study of hemifacial microsomia, a craniofacial birth defect. Participants reported information on antibiotic use during pregnancy (type, indication, and timing) and baby's birthweight in telephone interviews. Nineteen percent of women reported taking at least one antibiotic in the first half of pregnancy, but average birthweights were similar among users and nonusers. However, low-socioeconomic status women who reported taking antibiotics to treat genitourinary infections had babies that were 286 g heavier than those who did not (p = 0.01). No association was seen among higher socioeconomic status women. Differences by socioeconomic status were also seen in treatment for respiratory conditions and use of penicillin antibiotics. These findings suggest that socioeconomic status might modify the association between antibiotics taken during pregnancy and infant birthweight. They emphasize the need to consider socioeconomic status in studies of antibiotic use and birth outcomes and extend previous studies of socioeconomic disparities in birth outcomes.