Melanie Bartley

The persisting effect of unemployment on health and social well-being in men early in working life

In our studies of the effects of unemployment in the early working life of men in a British national birth cohort we have shown elsewhere that this experience was part of a longer term accumulation of social and health disadvantage. This present study asks whether mens unemployment also inflicted potential longterm damage to future socio-economic chances and health. We therefore constructed indicators of socio-economic circumstances and health at 33 years from factors already shown to be associated with health in later life. For the socio-economic indicator we used a combination of income, occupational status and home ownership and described this as socio-economic capital. For the health indicator we combined scores of body mass index, leisure time exercise, frequency of eating fresh fruit and of smoking, and described this as health capital. After controlling for pre-labour market socio-economic and health factors, prolonged unemployment is shown here to reduce significantly both socio-economic and health capital by age 33 years. We conclude that the experience of prolonged unemployment early in the working life of this population of young men looks likely to have a persisting effect on their future health and socio-economic circumstances.

Socio-economic adversity and psychosocial adjustment: a developmental-contextual perspective

The aim of this paper is twofold: firstly to investigate whether the association between childhood and adult psychosocial adjustment can be explained by socio-economic adversity experienced during childhood, and secondly to explore the role of family socio-economic disadvantage and psychological development in explaining adult social inequality in psychological well-being. A developmental-contextual perspective is adopted to analyse the pathways linking childhood experiences to adult functioning in a changing socio-historical context. The study draws on longitudinal data collected for two cohorts of about 30,000 individuals born in Great Britain 12 years apart. Structural equation modelling is used to assess the long-term influence of socio-economic adversity on psychosocial adjustment, and to compare different explanatory models of health inequalities. The results reject a simple selection or social causation argument, suggesting that both dynamics operate in life course development. The effects of social risk cumulate throughout the life course, influencing both behaviour adjustment during childhood and adult psychosocial functioning. It is concluded that the explanation of health differences in adult life must account for the reciprocal interaction between individual behaviour and social circumstances.

Who you live with and where you live: setting the context for health using multiple membership multilevel models

Study objective: Previous studies into the effect of area of residence on individuals’ health have not accounted for changing residency over time, although few people remain resident in the same area throughout their life. Furthermore, few studies of area effects on health have accounted for the clustering of health at the household level. These methodological problems may have led previous studies to under estimate or over estimate the size of area level effects. This study uses multiple membership multilevel models to investigate whether longitudinal analyses of area effects on health need to take account of clustering at the household level. Setting and participants: A longitudinal survey (1991–1999) of a nationally representative sample of British households (5511 households with 10 264 adult members). Design: Two level (individuals within households or areas) and three level (individuals within households within areas) multiple membership models of SF-36 physical and mental health functioning scores at wave nine were analysed adjusting for age, gender, education, marital, employment, and smoking status from previous waves. Results: Physical and mental health functioning seem to cluster within households. Accounting for changes in household membership over time increases estimates of the clustering in functioning at the household level. The clustering of functioning within area wards is reduced when the clustering within households and risk factors for functioning are taken into account. Conclusions: Clustered sampling units within study designs should be taken account of in individual level analyses. Changes in these units over time should be accounted for in longitudinal analysis.

Socio-economic position has no effect on improvement in health-related quality of life and patient satisfaction in total hip and knee replacement: a cohort study.

Introduction Considerable evidence suggests that patients with more advantaged Socio-Economic Positions undergo Total Hip and Knee Replacement (THR/TKR) more often, despite having a lower need. We questioned whether more disadvantaged Socio-Economic Position is associated with an lower improvement in Health-Related Quality of Life (HRQoL) and a lower patient satisfaction after THR/TKR. Methods Patients who underwent primary THR/TKR in one academic and three community hospitals between 2005 and 2009, were eligible for inclusion. The highest completed levels of schooling were aggregated to index social class. We compared the improvement in HRQoL and postoperative satisfaction with surgery (measured using the Short-Form 36 (SF36) and an 11-point numeric rating scale of satisfaction) between the aggregated groups of highest completed levels of schooling, using linear mixed model analysis, with center as a random effect and potential confounders (i.e. age, gender, Body Mass Index and Charnleys comorbidity classification) as fixed effects. Results 586 THR patients and 400 TKR patients (40% of all eligible patients) agreed to participate and completed all questionnaires sufficiently. We found no differences in HRQoL improvement in any dimension of the SF36 in THR patients. Patients with a higher completed level of schooling had a larger improvement in role-physical (9.38 points, 95%-CI:0.34–18.4), a larger improvement in general health (3.67 points, 95%-CI:0.56–6.79) and a smaller improvement in mental health (3.60 points, 95%-CI:0.82–6.38) after TKR. Postoperative patient satisfaction did not differ between different highest completed level of schooling groups. Discussion Completed level of schooling has no effect on the improvement in HRQoL and patient satisfaction in a Dutch THR population and a small effect in a similar TKR population. Undertreatment of patients with more disadvantaged Socio-Economic Position cannot be justified, given the similar improvement in HRQoL and postoperative level of satisfaction with surgery between the social groups examined.

Work, permanent sickness and mortality risk: a prospective cohort study of England and Wales, 1971–2006

Background In recent decades, labour market participation has fallen in men, with large amounts of this decline accounted for by increases in permanent sickness. There is speculation that the rising numbers of permanently sick incorporate more people with less severe conditions than was previously the case. This paper examines the relationship between labour market position and subsequent mortality around State Pension Age. Methods Using linked census and death records in the ONS Longitudinal Study, samples of men aged 55–69 and women aged 50–64 were selected from each decennial census, 1971–2001 and their health followed up. Differences between the employed, unemployed and economically inactive in age-specific death rates, Standardised Mortality Ratios and odds of reporting limiting long-term illness were examined. Results Labour market activity in late middle age has changed since 1971. For example, the proportion of men employed at ages 60–64 years has fallen by 39%, and the proportion permanently sick has more than doubled. Despite this change, there has been stability in the RR of mortality between labour market positions. Working people have the lowest risk of premature death, while, relative to working people, the permanently sick continue to have mortalities around three times higher among men and four to five times higher among women. Conclusion The evidence does not support the notion that the permanently sick are becoming less seriously ill. The persistence of the groups raised mortality suggests that measures aimed at encouraging later life employment should ensure provision of work environments suitable for people with chronic illnesses.

082 Maternal employment and child socio-emotional behaviour: longitudinal evidence from the Millennium Cohort Study

Objective To examine the effects of parental employment in the early years on child socio-emotional behaviour at age 5 in a recent birth cohort study in the UK. Design Prospective cohort study. Setting The Millennium Cohort Study (MCS): a large, representative sample of children born in the UK between September 2000 and January 2002 (n=18 819 at sweep 1). Participants Singleton births in households in which a mother was present in the first three sweeps of the MCS, when participants were 9 months, 3 years and 5 years. Analysis was restricted to white children as there was large ethnic variation in maternal employment, but inadequate power to stratify by ethnicity. Main outcome measure The Strengths and Difficulties Questionnaire (SDQ) with clinically relevant cut-points for problem behaviours. The SDQ is a widely used instrument for assessing socio-emotional difficulties in children. Methods Data on parental employment across the three sweeps were used to investigate: (i) whether children whose mothers were in paid work during their first five years were more likely than children whose mothers were at home full-time to display adverse behavioural symptoms at age 5, independent of maternal education, mental health or economic position; (ii) whether effects of maternal employment on child socio-emotional development were cumulative in nature, or whether children were more sensitive to the effects of maternal employment during their first year; and (iii) the effects of different types of parental work arrangements on child socio-emotional behaviour at age 5. Results No evidence of detrimental effects of maternal employment in the early years on subsequent child socio-emotional behaviour was seen. There were significant gender differences in the effects of parental work arrangements on behavioural outcomes. Girls whose mothers were not in paid work during their first 5 years were 77% (95% CI 1.21 to 2.57) more likely to have behavioural difficulties at age 5 than girls whose mothers were in paid work throughout their early years, independent of maternal characteristics and household income. For boys this was not the case, but boys in two-parent households in which their father was not in paid work for at least one period during their first five years were at an increased risk for behavioural problems at age 5. The most beneficial working arrangement for both girls and boys was that in which both mothers and fathers were present in the household and in paid work, independent of parental educational attainment and household income.

OP59 Social Mobility Matters for Children’s Well-Being – what are the Mechanisms? Findings from a UK Longitudinal Cohort Study

Background Social mobility features high on political agendas and debates around inequalities in health but little is known about the impact of social mobility on well-being in children. Firstly, we assess whether child well-being is linked to social mobility in the first few years of life. Secondly, we examine two hypothesised mechanisms by which social mobility could influence markers of child well-being: i) via material resources - mobility is plausibly linked to changes in income and housing conditions; ii) via changes in parenting behaviours - mobility might result in changes in the home learning environment. Methods We used data on over 9000 children from the UK Millennium Cohort Study. Social mobility was considered as change in parental occupational class (professional/managerial, intermediate, routine) in the first five years of life. Markers of child well-being were socio-emotional difficulties and performance on tests of reading, maths and spatial abilities at age 7. Results 13.7% of families were upwardly mobile and 14.5% were downwardly mobile. There were finely graded relationships between occupational class mobility and markers of child well-being. The prevalence of clinically relevant socioemotional difficulties according to mobility categories ranged from 2.9% in children whose parents remained in the professional/managerial class for all five years to 10% in children of parents remaining in routine occupations, 5.0% of children of parents who moved from any other class to professional had difficulties, as did 8.2% of those moving from any class to routine (all p < 0.01). The equivalent mobility groups’ reading scores were: stable professional 118, stable routine 106, up to professional 113, down to routine 109 (all p < 0.01). Similar patterns were observed for maths and spatial ability scores. The contribution of changes in material and parenting behavioural influences to markers of child well-being will be examined. Conclusion Health, educational and developmental outcomes are known to be more favourable in children of more advantaged social classes, but the reasons for this are contested. Here we examine the relationships in children whose parent’s social class changes during their first 5 years. Upwardly mobile children do better than those in their class of origin but not as well as their class of destination; downwardly mobile children do better than their class of destination but not as well as their class of origin. We test the extent to which this may be because social mobility is accompanied by changes in material circumstances and/or parenting behaviours that improve the home learning environment.

P22 Childhood socioeconomic position and adult smoking: are childhood cognitive ability, psychosocial adjustment and parental involvement important?

Background Studies have shown that childhood socioeconomic position (SEP) is related to smoking in adulthood, independent of adult SEP. Educational attainment partially mediates this association; however, previous studies suggest three childhood factors which may also be important-childhood cognitive ability, psychosocial adjustment and parental involvement. Objective To assess whether childhood psychosocial adjustment, cognitive ability and parental involvement are important in the association between childhood SEP and adult smoking status, over and above educational attainment. Data, Participants and Variables Data on 7709 participants from four sweeps of the 1958 National Child Development Study were used for this study—birth (1958), age 7 (1965), age 16 (1974) and age 42 (2000). Childhood SEP was indicated using fathers social class at birth and adult smoking status was taken at age 42 years (categorised as: 1 never/infrequent smokers, 2 ex-smokers, 3 current smokers). All childhood factors investigated were measured at age 7 years. Childhood cognitive ability was measured using score in the Copying Designs Test, psychosocial adjustment was measured using the teacher-assessed Bristol Social Adjustment Guide (BSAG) and parental involvement was based on questions asked of the mother and father regarding the frequency of occasions spent reading and on outings with the child. Confounding variables included were mothers smoking, age at birth of child and educational level, number of siblings and participants own educational attainment at age 16 years (indicated by exam scores). Those with complete data on all variables used were included in the analysis. Statistical Methods Multinomial logistic regression was used to examine the associations of childhood SEP and childhood factors with adult smoking status, both independently and mutually adjusted, and then adjusted for confounders and participants educational attainment. Analyses were conducted separately for men and women. Results Childhood SEP was an important predictor of current adult smoking status, even after adjustment for childhood factors and educational attainment. Also, parental involvement for men (most vs least frequent parental reading OR 0.75, 95% CI 0.60 to 0.94; most vs least frequent parental outings OR 0.55, 95% CI 0.35 to 0.86), and both parental involvement (most vs least frequent parental reading OR 0.68, 95% CI 0.55 to 0.85) and psychosocial adjustment (most vs least maladjusted OR 1.28, 95% CI 1.01 to 1.64) for women, remained important determinants of current adult smoking over and above childhood SEP, other childhood factors and educational attainment. Conclusions These findings suggest that childhood disadvantage is associated with adult smoking behaviours and the early childhood social environment is important in the development of these.

010 Parental separation and psychological distress in early adulthood: has the effect reduced over time? Evidence from two British birth cohort studies

Background An association between parental separation occurring during childhood and psychological distress has been shown many times. UK divorce rates have increased rapidly since the mid-twentieth century. The “reduced effect hypothesis” suggests that the effect of parental separation may have reduced over time as separation has become more common and consequently less stigmatising. Previous studies have looked at this using outcomes of educational attainment, psychological distress in mid-adulthood and receipt of welfare benefits, finding that the effect has not reduced over time; however the effect upon psychological distress in early adulthood has not yet been investigated. Objective To examine whether the effect of parental separation occurring during childhood on psychological distress in early adulthood has reduced over time, and whether this differs for men and women. Data, participants and variables This study uses data on 9064 and 6906 participants of the 1958 National Child Development Study (NCDS) and 1970 British Cohort Study (BCS70), respectively. Five sweeps of each study were used – birth, age 5/7, age 10/11, age 16 and age 23/26 years. Parental separation was measured from 0 to 16 years and psychological distress was measured using Rutters Malaise Inventory at age 23 (NCDS) or age 26 (BCS70), treated as a binary variable (0–7=no distress, 8–24=distress). Mental illness in the family was treated as a confounder. Statistical methods Logistic regression was used to test the association between parental separation and psychological distress in either cohort, both unadjusted and adjusted for confounders, using a pooled data set of both cohorts. Period changes were assessed by testing a cohort-separation interaction. Analyses were conducted separately for men and women. Results 9.4% of NCDS participants experienced parental separation in comparison to 21.0% of BCS70 participants. After adjusting for confounders parental separation increased the odds of reporting psychological distress in NCDS men (OR 2.18, 95% CI 1.34 to 3.54) and women (OR 1.48, 95% CI 1.05 to 2.08) and this did not differ by gender (p=0.11). Parental separation was not associated with psychological distress in BCS70 adjusted analyses for men or women. However cohort-separation interactions were not statistically significant (men: p=0.11, women: p=0.43). Conclusions Despite finding an effect of separation in the NCDS and not in the BCS70, the cohort-separation interactions tested were statistically insignificant. The findings of this study therefore imply that the impact of parental separation has not changed over time (“reduced effect hypothesis” is not supported) and that men and women are affected equally.