Juliet Harman

Pathways of disadvantage and smoking careers: evidence and policy implications

Objectives: To investigate in older industrialised societies (a) how social disadvantage contributes to smoking risk among women (b) the role of social and economic policies in reducing disadvantage and moderating wider inequalities in life chances and living standards. Methods: Review and analysis of (a) the effects of disadvantage in childhood and into adulthood on women’s smoking status in early adulthood (b) policy impacts on the social exposures associated with high smoking risk. Main results: (a) Smoking status—ever smoking, current smoking, heavy smoking, and cessation—is influenced not only by current circumstances but by longer term biographies of disadvantage (b) social and economic policies shape key social predictors of women’s smoking status, including childhood circumstances, educational levels and adult circumstances, and moderate inequalities in the distribution of these dimensions of life chances and living standards. Together, the two sets of findings argue for a policy toolkit that acts on the distal determinants of smoking, with interventions targeting the conditions in which future and current smokers live. Conclusions: An approach to tobacco control is advocated that combines changing smoking habits with reducing inequalities in the social trajectories in which they are embedded. Policies to level up opportunities and living standards across the lifecourse should be championed as part of an equity oriented approach to reducing the disease burden of cigarette smoking.

Socioeconomic lifecourse influences on women’s smoking status in early adulthood

Study objective: To incorporate women’s domestic trajectories and circumstances into analyses of the socioeconomic influences on women’s smoking status (current and former smoking) in early adulthood. Design: Cross sectional survey Setting: Southampton, UK. Participants: 8437 women aged 25–34 recruited from 1998–2002 via patient lists of general practices Main results: Domestic lifecourse factors contributed to the odds of being a current smoker and former smoker in models that included conventional measures of the socioeconomic lifecourse. Early motherhood, non-cohabitation, and lone motherhood increased the odds of smoking; early motherhood and non-cohabitation reduced the odds of former smoking. For example, relative to childless women, odds ratios (OR) for women who had become mothers <20 years were 1.71 for smoking and 0.76 for former smoking. The effects of education and current SEP remained strong with the inclusion of childbearing and cohabitation variables for both outcomes. For instance, compared with women in education to age ⩾22, the odds ratio for smoking for those leaving school ⩽16 was 3.37 and for former smoking was 0.42. Conclusions: Both the conventionally measured socioeconomic lifecourse and the domestic lifecourse contributed separately to the odds of smoking and former smoking, suggesting that lifecourse analyses should incorporate women’s domestic circumstances as an important pathway of influence on their smoking status in early adulthood.

Psychosocial needs in cancer patients related to religious belief

In a study of psychosocial needs amongst cancer patients, the possession of a religious faith has been identified as a significant factor in determining a range of psychosocial needs. Of the 354 respondents to a questionnaire, which included a comprehensive psychosocial needs inventory, 83% said they had a religious faith, and in general these patients were less reliant on health professionals, had less need for information, attached less importance to the maintenance of independence and had less need for help with feelings of guilt, with their sexuality or with some practical matters than those who said they had no religious faith. In addition, they had fewer unmet needs overall (32% compared with 52%). The knowledge of a patients spirituality should help service providers to predict aspects of psychosocial need and to respond sensitively and appropriately to a patients experience of cancer.

Identifying future repeat danger from sexual offenders against children: A focus on those convicted and those strongly suspected of such crime

This study provides a 14 – 16-year criminological follow-up, to the end of 2003, of all those convicted or strongly suspected of committing sexual offences against children in one English county, Lancashire, between 1987 and 1989 (inclusive). The main analysis focuses on 124 males (40%) convicted compared with 188 males (60%) strongly suspected but not convicted. The age and sex of the victims and the relationship between offender and victim show no significant association with conviction status, but the former group tend to be older. Of the 103 convicted adult males, 20% were reconvicted for a sexual offence, whereas of the 116 adult males strongly suspected but not convicted, 9% had a subsequent conviction for a sexual offence. However, the difference is largely explained by their predicted risk scores. The risk assessment tool used, Static-99, is shown to be remarkably effective in identifying high-risk members of the two groups. The 93 convicted and strongly suspected males in the total sample aged under 18 tend to offend against acquaintances (54%), and target a female victim (69%) and a younger (5 – 7 years) age group of children (48%). The convicted young males had a higher rate of subsequent sex convictions (14.3%) than those suspected but not convicted (1.4%). The policy implications of the findings are addressed.

What is the Future Repeat Danger from Sexual Offenders against Children? Implications for Policing

This article reports a long-term follow-up study of persons detected for a sexual offence against a child between the ages of 5 and 12. The study focuses on the likelihood of a subsequent conviction, the success (or otherwise) of risk assessment and the geographical mobility of sex offenders. It is estimated that sexual recidivists coming to the attention of the police will come from three sources: just under one third from offenders who are convicted and in high-risk categories, around one third from those who are convicted and in the more numerous low/medium-risk categories and around one third from those strongly suspected of, but not convicted for, a sexual offence.