Anja Heilmann

Social relationships and health related behaviors among older US adults.

BackgroundHealth behaviors are a key determinant of health and well-being that are influenced by the nature of the social environment. This study examined associations between social relationships and health-related behaviors among a nationally representative sample of older people.MethodsWe analyzed data from three waves (1999–2004) of the US National Health and Nutrition Examination Survey (NHANES). Participants were 4,014 older Americans aged 60 and over. Log-binomial regression models estimated prevalence ratios (PR) for the associations between social relationships and each of the following health behaviors: alcohol use, smoking, physical activity and dental attendance.ResultsHealth-compromising behaviors (smoking, heavy drinking and less frequent dental visits) were related to marital status, while physical activity, a health-promoting behavior, was associated with the size of friendship networks. Smoking was more common among divorced/separated (PR = 2.1; 95% CI: 1.6, 2.7) and widowed (PR = 1.7; 95% CI: 1.3, 2.3) respondents than among those married or cohabiting, after adjusting for socio-demographic background. Heavy drinking was 2.6 times more common among divorced/separated and 1.7 times more common among widowed men compared to married/cohabiting men, while there was no such association among women. For women, heavy drinking was associated with being single (PR = 1.7; 95% CI: 1.0, 2.9). Being widowed was related to a lower prevalence of having visited a dentist compared to being married or living with a partner (PR = 0.92; 95% CI 0.86, 0.99). Those with a larger circle of friends were more likely to be physically active (PR = 1.17; 95% CI:1.06, 1.28 for 5–8 versus less than 5 friends).ConclusionsSocial relationships of older Americans were independently associated with different health-related behaviors, even after adjusting for demographic and socioeconomic determinants. Availability of emotional support did not however mediate these associations. More research is needed to assess if strengthening social relationships would have a significant impact on older people’s health behaviors and ultimately improve their health.

London Charter on Oral Health Inequalities

Oral diseases, despite being largely preventable, remain a major global public health problem. Dental caries and periodontal diseases, the main oral diseases, are highly prevalent chronic conditions that have a significant negative impact on quality of life across the life course. Globally, >3 billion people suffer from untreated dental caries, making this the most common chronic disease of humankind (Marcenes et al. 2013). Oral diseases are expensive to treat, and their cost is considerable to both the individuals affected and the whole of society (Listl et al. 2015). In recent decades, significant overall improvements have occurred in levels of dental caries in many highand middle-income countries. However, in low-income countries, caries levels appear to be increasing, linked to economic development and the associated lifestyle changes, including higher consumption of free sugars. A major concern almost everywhere in the world is the existence of stark social inequalities in oral health (Lee and Divaris 2014). Oral diseases disproportionally affect socially disadvantaged members of society (Petersen and Kwan 2011; Schwendicke et al. 2015). Oral health inequalities are therefore considered differences in levels of oral health that are avoidable and deemed unfair and unjust. (The terms disparities and inequities are also used in different contexts but essentially have a similar meaning to inequality.) Oral health inequalities are not merely the differences in oral health status between the rich and the poor. As is the case in general health, a consistent stepwise relationship exists across the entire social spectrum, with oral health being worse at each point as one descends along the social hierarchy (Sanders, Slade, et al. 2006; Sabbah et al. 2007). Known as the social gradient, this consistent relationship between oral health and social status has profound implications for policy. The social gradient in oral health is a universal phenomenon found at all points in the life course and in different populations across the world.

Social capital: theory, evidence, and implications for oral health.

In the last two decades, there has been increasing application of the concept of social capital in various fields of public health, including oral health. However, social capital is a contested concept with debates on its definition, measurement, and application. This study provides an overview of the concept of social capital, highlights the various pathways linking social capital to health, and discusses the potential implication of this concept for health policy. An extensive and diverse international literature has examined the relationship between social capital and a range of general health outcomes across the life course. A more limited but expanding literature has also demonstrated the potential influence of social capital on oral health. Much of the evidence in relation to oral health is limited by methodological shortcomings mainly related to the measurement of social capital, cross-sectional study designs, and inadequate controls for confounding factors. Further research using stronger methodological designs should explore the role of social capital in oral health and assess its potential application in the development of oral health improvement interventions.

Traumatic dental injuries and socioeconomic position - findings from the Children's Dental Health Survey 2013

OBJECTIVES The aim of this study was to assess whether traumatic dental injuries (TDI) were socially graded among children and adolescents in England, Wales and Northern Ireland, using nationally representative data from the Childrens Dental Health Survey (CDHS) 2013. METHODS This cross-sectional study used data from the Childrens Dental Health Survey 2013 which was conducted among a nationally representative sample of schoolchildren in England, Wales and Northern Ireland. Childrens family socioeconomic position (SEP) was measured through free school meal eligibility and relative area deprivation using the Indices of Multiple Deprivation. The analytical sample included 6707 schoolchildren aged 8, 12 and 15. Multiple logistic regression was used to model the associations between experience of TDI and the two markers of SEP, after adjusting for sex and age. RESULTS The overall prevalence of traumatic dental injuries to permanent incisors was 9% (n = 590). There were no statistically significant associations between TDI and either SEP measure. Further subgroup analyses (n = 2650) showed also no significant associations between TDI and additional SEP markers (parental education and social class). The odds of having sustained a traumatic dental injury were higher for boys than for girls and were greater in older age groups. CONCLUSIONS This study found no significant relationships between the experience of traumatic dental injuries and two markers of family socioeconomic position among children living in England, Wales and Northern Ireland. This implies that rather than specifically targeting the more deprived sectors of society, TDI prevention policies should use upstream public health strategies incorporating a whole-population approach.

Oral Health Over the Life Course

Oral diseases refer to conditions of the teeth, gums and mouth, and include dental caries, periodontal disease, and oral cancers. The impact of these conditions on quality of life is high, they are very common and their treatment is costly, therefore they are considered a major public health problem. Oral diseases are socially patterned, disproportionately affecting socially disadvantaged and marginalised populations. Because oral health and general health are inextricably linked and share common risk factors, caries and periodontal disease are useful markers of general health, and overall patterns of health inequalities. The literature on life course epidemiology applied to oral health is still limited, although there is a strong argument for studying oral diseases within a dynamic life course framework: they are chronic in nature and cumulative over time. Critical periods, as well as accumulation of risk models are applicable to oral diseases. Given that childhood diet and oral hygiene are related to socioeconomic and psychosocial factors, and that tooth loss is irreversible, adult oral health is rooted in early life conditions, while upward and downward social mobility influences oral health trajectories. In this chapter we review the theoretical and empirical developments in life course research on oral health, and suggest ways forward.

Longitudinal associations between television in the bedroom and body fatness in a UK cohort study

Objective:To assess longitudinal associations between screen-based media use (television (TV) and computer hours, having a TV in the bedroom) and body fatness among UK children.Methods:Participants were 12 556 children from the UK Millennium Cohort Study who were followed from age 7 to age 11 years. Associations were assessed between screen-based media use and the following outcomes: body mass index (BMI), fat mass index (FMI), and overweight.Results:In fully adjusted models, having a bedroom TV at age 7 years was associated with significantly higher BMI and FMI (excess BMI for boys=0.29, 95% confidence interval (CI) 0.06–0.52; excess BMI for girls=0.57, 95% CI 0.31–0.84; excess FMI for boys=0.20, 95% CI 0.04–0.37; excess FMI for girls=0.39, 95% CI 0.21–0.57) and increased risk of being overweight (relative risk (RR) for boys=1.21, 95% CI 1.07–1.36; RR for girls=1.31, 95% CI 1.15–1.48) at age 11 years, compared with having no bedroom TV. Hours spent watching TV or digital versatile disks were associated with increased risk of overweight among girls only. Computer use at age 7 years was not related to later body fatness for either gender.Conclusion:Having a TV in the child’s bedroom was an independent risk factor for overweight and increased body fatness in this nationally representative sample of UK children. Childhood obesity prevention strategies should consider TVs in children’s bedrooms as a risk factor for obesity.

Assessing the feasibility of screening and providing brief advice for alcohol misuse in general dental practice: a clustered randomised control trial protocol for the DART study

Introduction Alcohol misuse is a significant public health problem with major health, social and economic consequences. Systematic reviews have reported that brief advice interventions delivered in various health service settings can reduce harmful drinking. Although the links between alcohol and oral health are well established and dentists come into contact with large numbers of otherwise healthy patients regularly, no studies have been conducted in the UK to test the feasibility of delivering brief advice about alcohol in general dental settings. Methods and analysis The Dental Alcohol Reduction Trial (DART) aims to assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice in patients attending National Health Service (NHS) general dental practices in North London. DART is a cluster randomised control feasibility trial and uses a mixed methods approach throughout the development, design, delivery and evaluation of the intervention. It will be conducted in 12 NHS general dental practices across North London and will include dental patients who drink above the recommended guidance, as measured by the Alcohol Use Disorders Identification Test (AUDIT-C) screening tool. The intervention involves 5 min of tailored brief advice delivered by dental practitioners during the patients appointment. Feasibility and acceptability measures as well as suitability of proposed primary outcomes of alcohol consumption will be assessed. Initial economic evaluation will be undertaken. Recruitment and retention rates as well as acceptability of the study procedures from screening to follow-up will be measured. Ethics and dissemination Ethical approval was obtained from the Camden and Islington Research Ethics Committee. Study outputs will be disseminated via scientific publications, newsletters, reports and conference presentations to a range of professional and patient groups and stakeholders. Based on the results of the trial, recommendations will be made on the conduct of a definitive randomised controlled trial. Trial registration number ISRCTN81193263.

Childhood socioeconomic conditions and teeth in older adulthood: Evidence from SHARE wave 5

OBJECTIVES Dental diseases are the most common chronic diseases worldwide. Healthy teeth are vital for quality of life, particularly diet and nutrition. However, little information exists to inform health policymakers about potentially long-lasting influences of early-life conditions. The purpose of this study was to investigate the relation between early-life socioeconomic conditions and number of natural teeth at age 50 and above. METHODS Analyses were conducted on cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE wave 5), which includes information on 41 560 respondents aged 50 years or older from 14 European countries and Israel. Using SHARE life history information, a series of regression models (OLS, Tobit) were estimated to analyse the relationship between socioeconomic conditions in earlier life and the number of teeth at age 50+. RESULTS Childhood socioeconomic background was associated with the number of natural teeth at age 50 and above, even after controlling for current determinants of oral health. Respondents who had had more than 25 books in their childhood household had a mean 1.4 (95% CI: 1.2-1.5) more teeth than respondents with fewer books. Respondents who reported poor financial conditions during childhood had a mean 0.6 (95% CI: 0.3-0.9) fewer teeth than respondents who reported better financial conditions in childhood. CONCLUSION These findings substantiate the association between socioeconomic conditions in the early years of life and tooth retention to older adulthood and highlight the long-lasting relation between childhood living conditions and oral health through the lifecourse.

Does intergenerational social mobility affect the general health, oral health, and physical function of older adults in England?

Abstract Background Socioeconomic status (SES) affects adult health. Material disadvantage experienced in childhood or adulthood is related to high adult disease levels. However, people transition through different socioeconomic paths over the life course. Changes in SES might counteract the effect of childhood SES on adult health, and research on social mobility takes this possibility into account by adopting a trajectory approach and taking a long-term view of the effect of SES on health. The aim of this research was to examine the effects of intergenerational social mobility on adult general health, oral health, and physical functioning in older adults in England. Methods This study is based on secondary analysis of data from the English Longitudinal Study of Ageing, which follows the lives of about 12 000 English adults aged 50 and over. Data from waves three and four of the study, were used to create nine social trajectories based on parental and adult occupational SES, resulting in three upwardly mobile, three downwardly mobile, and three stable groups. Regression models were used to estimate the associations between social trajectories and the following outcomes: self-rated health, self-rated oral health, oral-health-related quality of life, total tooth loss, and grip strength, while controlling for socioeconomic background and health-related behaviours. Findings Intergenerational social mobility was associated with self-rated health (p Interpretation The results suggest that social mobility is an important determinant of health and function; downward mobility led to worse health and upward mobility led to better adult health. However, for oral health, social mobility is related to lifetime accumulation of oral diseases (total tooth loss) rather than current perception of oral health and quality of life. Funding None.

P84 Does intergenerational social mobility affect general health, oral health and physical function among older adults in England?

Background Socioeconomic position (SEP) influences adult health. People who experienced material disadvantages in childhood or adulthood tend to have higher adult disease levels than their peers from more advantaged backgrounds. Even so, life is a dynamic process and contains a series of transitions that could lead people through different socioeconomic paths. Research on social mobility takes this into account by adopting a trajectory approach, thereby providing a long-term view of the effect of SEP on health. The aim of this research is examine the effects of intergenerational social mobility on adult general health, oral health and functioning in a population aged 50 and over in England. Methods This study is based on the secondary analysis of data from the English Longitudinal Study of Ageing (ELSA). Using cross-sectional data, nine social trajectories were created based on parental and adult occupational socio-economic position. Regression models were used to estimate the associations between social trajectories and the following outcomes: adult self-rated health, self-rated oral health, oral health related quality of life, total tooth loss and grip strength; while controlling for socio-economic background and health related behaviours. Results Associations with adult SEP were generally stronger than with childhood SEP, suggesting a stronger influence of proximal rather than distal SEP on health and oral health. Compared to the stable high group, being in the low SEP groups in childhood and adulthood was associated with poorer health and oral health for all examined outcome measures. For adult self-rated health and edentulousness, graded associations with social mobility trajectories were observed. Conclusion Intergenerational social mobility was associated with self-rated health and total tooth loss. Compared to only those who remained in a low SEP group over time reported worse self-rated oral health and oral health related quality of life, and had lower grip strength measurements. Potential limitations in relation to data quality will be discussed.