Nr Smith

Intergenerational continuities of ethnic inequalities in general health in England

Background: Previous research strongly suggests that ethnic minority groups are more likely to suffer a poorer health profile compared with the overall population, although it is not clear whether these inequalities persist over generations. This study aimed to establish the degree to which ethnic inequalities in health are transmitted from the first to the second generation, and to determine the extent to which intergenerational changes in socioeconomic status and health behaviours might explain any variation that exists. Methods: Data from the 1999 and 2004 Health Surveys for England assessed the prevalence of fair/poor general health across first (n = 4492) and second (n = 5729) generations of six ethnic minority populations. A white population was selected as reference (n = 18 407). The risk of fair/poor general health was estimated by applying logistic regression models and stepwise inclusion of demographic, socioeconomic and behavioural variables. Generational movement relative to the white baseline was assessed for all ethnic groups adjusted for age and sex. Results: No significant differences in levels of reported fair/poor general health were observed between generations. After adjusting for improved socioeconomic position, the second generation became more likely to report worse health, whereas adjusting for differences in health behaviours had no effect. The Bangladeshi population showed significant intergenerational improvement in general health relative to the white reference, showing a reduction in the odds ratio (95% CI) from 2.75 (2.14 to 3.56) for the first generation to 1.58 (1.17 to 2.13) in the second generation. Conclusion: Ethnic minorities in England report consistent rates of fair/poor general health across generations, despite the health benefits resulting from upward social mobility. These health inequalities are unaffected by changes in health behaviours. Understanding these intergenerational pathways will have important public health policy implications as the migrant population not only ages, but also reproduces.

The effects of acculturation on obesity rates in ethnic minorities in England: evidence from the Health Survey for England

OBJECTIVES To investigate the extent of generational differences in adult health-related lifestyles and socio-economic circumstances, and explore whether these differences might explain changing patterns of obesity in ethnic minorities in England. METHODS Seven ethnic minority groups were selected from the ethnically boosted 1999 and 2004 Health Survey for England (Indian n = 1580; Pakistani n = 1858; Bangladeshi n = 1549; Black Caribbean n = 1472; Black African n = 587; Chinese n = 1559; and Irish n = 889). Age and sex adjusted odds of being obese in the second generation when compared with the first were estimated before and after adjusting for generational differences in health-related behaviours (snacking, eating cakes and fried foods, low levels of physical exercise, any drinking, current smoker, etc.) and socio-economic factors (social class, equivalized income and highest qualification). RESULTS Indian [OR: 1.76 (1.14-2.71)] and Chinese [OR: 3.65 (1.37-9.78)] groups were more likely to be obese in the second generation than the first after adjusting for age and sex, with no significant differences observed in all other groups. However, the risk of obesity in all groups converged between generations to the risk observed in the White reference group, with exception to the Black Caribbean group. Adjusting independently for the mixed patterns of acculturative changes and the uniform upward social mobility in all groups increased the risk of obesity in the second generation. CONCLUSIONS Obesity converged to the risk in the majority population following acculturation. Future research needs to consider generation and trans-cultural identities as a fundamental variable in determining the causes of ethnic health inequalities.

The Olympic Regeneration in East London (ORiEL) study: protocol for a prospective controlled quasi-experiment to evaluate the impact of urban regeneration on young people and their families

Introduction Recent systematic reviews suggest that there is a dearth of evidence on the effectiveness of large-scale urban regeneration programmes in improving health and well-being and alleviating health inequalities. The development of the Olympic Park in Stratford for the London 2012 Olympic and Paralympic Games provides the opportunity to take advantage of a natural experiment to examine the impact of large-scale urban regeneration on the health and well-being of young people and their families. Design and methods A prospective school-based survey of adolescents (11–12 years) with parent data collected through face-to-face interviews at home. Adolescents will be recruited from six randomly selected schools in an area receiving large-scale urban regeneration (London Borough of Newham) and compared with adolescents in 18 schools in three comparison areas with no equivalent regeneration (London Boroughs of Tower Hamlets, Hackney and Barking & Dagenham). Baseline data will be completed prior to the start of the London Olympics (July 2012) with follow-up at 6 and 18 months postintervention. Primary outcomes are: pre–post change in adolescent and parent mental health and well-being, physical activity and parental employment status. Secondary outcomes include: pre–post change in social cohesion, smoking, alcohol use, diet and body mass index. The study will account for individual and environmental contextual effects in evaluating changes to identified outcomes. A nested longitudinal qualitative study will explore families’ experiences of regeneration in order to unpack the process by which regeneration impacts on health and well-being. Ethics and dissemination The study has approval from Queen Mary University of London Ethics Committee (QMREC2011/40), the Association of Directors of Childrens Services (RGE110927) and the London Boroughs Research Governance Framework (CERGF113). Fieldworkers have had advanced Criminal Records Bureau clearance. Findings will be disseminated through peer-reviewed publications, national and international conferences, through participating schools and the study website (http://www.orielproject.co.uk).

Individual socio-demographic factors and perceptions of the environment as determinants of inequalities in adolescent physical and psychological health: the Olympic Regeneration in East London (ORiEL) study

BackgroundPopulations living in urban areas experience greater health inequalities as well as higher absolute burdens of illness. It is well-established that a range of social and environmental factors determine these differences. Less is known about the relative importance of these factors in determining adolescent health within a super diverse urban context.MethodsA cross-sectional sample of 3,105 adolescent participants aged 11 to 12 were recruited from 25 schools in the London boroughs of Newham, Tower Hamlets, Hackney and Barking & Dagenham. Participants completed a pseudo-anonymised paper-based questionnaire incorporating: the Warwick-Edinburgh Mental Well-being Scale used for assessing positive mental well-being, the Short Moods and Feelings Questionnaire based on the DSM III-R criteria for assessment of depressive symptoms, the Youth-Physical Activity Questionnaire and a self-assessment of general health and longstanding illness. Prevalence estimates and unadjusted linear models estimate the extent to which positive well-being scores and time spent in physical/sedentary activity vary by socio-demographic and environmental indicators. Logistic regression estimated the unadjusted odds of having fair/(very)poor general health, a long standing illness, or depressive symptoms. Fully adjusted mixed effects models accounted for clustering within schools and for all socio-demographic and environmental indicators.ResultsCompared to boys, girls had significantly lower mental well-being and higher rates of depressive symptoms, reported fewer hours physically active and more hours sedentary, and had poorer general health after full adjustment. Positive mental well-being was significantly and positively associated with family affluence but the overall relationship between mental health and socioeconomic factors was weak. Mental health advantage increased as positive perceptions of the neighbourhood safety, aesthetics, walkability and services increased. Prevalence of poor health varied by ethnic group, particularly for depressive symptoms, general health and longstanding illness suggesting differences in the distribution of the determinants of health across ethnic groups.ConclusionsDuring adolescence perceptions of the urban physical environment, along with the social and economic characteristics of their household, are important factors in explaining patterns of health inequality.

Everyone was looking at you smiling: East London residents' experiences of the 2012 Olympics and its legacy on the social determinants of health.

Mega-sporting event regeneration, as a specific approach to urban renewal, uses impending host-city status as a catalyst for revitalisation and has the potential to improve health both through addressing deprivation and by promoting increased sport and physical activity among the host-citys population. This qualitative study explored how hosting of the London 2012 Games impacted upon the way East London residents perceived and experienced the social determinants of health in their local neighbourhood. We conducted narrative family interviews, go-along interviews and video focus group workshops with 66 Newham residents, aged 12-55 years, immediately after the Games. A narrative analytic approach examined accounts of health and wellbeing experiences in terms of neighbourhood change and the spectacle of the Games. Participants of this qualitative study generally welcomed the respite and the unexpected chance to live in a cleaner, safer and more unified environment. However, this positivity was underscored by an acute awareness that this was a very temporary situation and one that was intended to support the event rather than residents.

Time period trends in ethnic inequalities in limiting long term illness in England and Wales

Purpose – This papers aim is to analyse ethnic group differences in self reported limiting long term illness (LLTI) among middle‐aged men and women in England and Wales and compare patterns of variation in 1991 and 2001.Design/methodology/approach – The methodology is a cross‐sectional analysis of two nationally representative cohorts aged 40‐59 in 1991 and 2001, respectively. Seven ethnic minority groups were selected from the Office for National Statistics Longitudinal Study of England and Wales (White Irish, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African and Chinese). Logistic regression estimated the odds ratio for having a LLTI in each ethnic minority group compared to White British. The odds of having a LLTI in 2001 compared to 1991, by sex, were adjusted stepwise for differences in age, social class, car ownership, household overcrowding and tenure and length of residence.Findings – All ethnic groups reported a higher prevalence of LLTI in 2001 than in 1991. The rise in LLTI was la...

Ethnic differences in cognitive development in the first 7 years: does maternal generational status matter?

Background Differences in cognitive development have been observed across a variety of ethnic minority groups but relatively little is known about the persistence of these developmental inequalities over time or generations. Methods A repeat cross-sectional analysis assessed cognitive ability scores of children aged 3, 5 and 7 years from the longitudinal UK Millennium Cohort Study (white UK born n=7630; Indian n=248; Pakistani n=328; Bangladeshi n=87; black Caribbean n=172; and black African n=136). Linear regression estimated ethnic differences in age normed scores at each time point. Multivariable logistic regression estimated within-group generational differences in test scores at each age adjusting stepwise for sociodemographic factors, maternal health behaviours, indicators of the home learning environment and parenting styles. Results The majority of ethnic minority groups scored lower than the white UK born reference group at 3 years with these differences narrowing incrementally at ages 5 and 7 years. However, the black Caribbean group scored significantly lower than the white UK born reference group throughout early childhood. At 3 years, Pakistani, black Caribbean and black African children with UK born mothers had significantly higher test scores than those with foreign born mothers after baseline adjustment for maternal age and child gender. Controlling for social, behavioural and parenting factors attenuated this generational advantage. By 7 years there were no significant generational differences in baseline models. Conclusions Ethnic differences in cognitive development diminish throughout childhood for the majority of groups. Cumulative exposure to the UK environment may be associated with higher cognitive development scores.

OP43 Changes in physical activity in East London’s adolescents following the 2012 Olympic Games: findings from the prospective Olympic Regeneration in East London (ORiEL) cohort study

Background The London 2012 Olympic Games aimed to “inspire a generation” by increasing participation in sport through ‘demonstration effects’ – where individuals’ motivations are influenced by observing the actions of others. Here we evaluate whether adolescents’ participation in Olympic-related sports increased post-games, and whether changes were mediated by level of engagement with the Olympic experience. Methods The Olympic Regeneration in East London (ORiEL) study is a longitudinal controlled quasi-experimental study of a sample of Year 7 adolescents from 25 schools in four East London boroughs. Respondents were surveyed 6 months pre-Games and were followed-up 6 months post-Games (n = 2727). Games engagement was assessed on a 10-point scale ranging from not excited (0) to very excited (10). The Youth Physical Activity Questionnaire (Y-PAQ) assessed participation in ten Olympic sports over the past seven days (cycling, basketball, football, gymnastics, hockey, martial arts, running, swimming, horse riding, racquet sports) transformed to a binary ‘ever/never’ response. Sedentary activities (computer gaming, online browsing, TV viewing) were analysed by duration. Random effects logistic regression estimated the odds of participation in Olympic sports post-Games compared to pre-Games. Changes in the duration of sedentary activities were estimated with random effects linear regression. The effect of engagement was assessed by stepwise inclusion to the model along with confounding variables. Results Overall there was a statistically significant decline in the odds of participating in eight of the ten Olympic sports post-Games controlling for co-variates. The largest decreases were observed for swimming (OR: 0.51 [0.40, 0.64]), gymnastics (0.61 [0.45, 0.81]) and racquet sports (0.65 [0.51, 0.83]. There were no significant differences in pre-post participation in cycling and running. There was a significant increase in the duration per week spent online (p < 0.01), with no significant differences for time spent gaming/watching television. However individuals who were most excited by the prospect of the Olympics pre-games were more likely than the least excited to participate in nine of the ten sports post-games compared to pre-games, though this was only significant for basketball, football, racquet sports and running. Time spent online decreased significantly in the engaged group (p < 0.01). Conclusion Adolescents who were positively engaged with the London 2012 Olympic Games reported a higher frequency of physical activity and less sedentary time spent online than those less engaged. Sporting mega-event demonstration effects are unlikely to motivate population-level increases in sporting participation unless engagement strategies can excite the interest of a greater proportion of young people.

An Olympic Legacy? Does the urban regeneration associated with the London 2012 Olympic Games impact on adolescent mental health?

Public expenditure on large events such as the London 2012 Olympic Games is often justified by the potential legacy of urban regeneration and its associated health and well-being benefits for local communities. In the Olympic Regeneration in East London Study, we examined whether there was an association between urban regeneration related to the 2012 Games and improved mental health in young people. Adolescents aged 11-12 years attending schools in the Olympic host borough of Newham in London or in 3 adjacent comparison London boroughs completed a survey before the 2012 Games and 6 and 18 months after the Games (in 2013 and 2014, respectively). Changes in depressive symptoms and well-being between baseline and each follow-up were examined. A total of 2,254 adolescents from 25 randomly selected schools participated. Adolescents from Newham were more likely to have remained depressed between baseline and the 6- and 18-month follow-up surveys (for 6-month follow-up, relative risk = 1.78, 95% confidence interval: 1.12, 2.83; for 18-month follow-up, relative risk = 1.93, 95% confidence interval: 1.01, 3.70) than adolescents from the comparison boroughs. No differences in well-being were observed. There was little evidence that urban regeneration had any positive influence on adolescent mental health and some suggestion that regeneration may have been associated with maintenance of depressive symptoms. Such programs may have limited short-term impact on the mental health of adolescents.

OP40 The Olympics as respite: a qualitative study of the health and wellbeing impacts of London 2012 on residents of Newham, East London

Background Health and wellbeing are strongly influenced by the physical and social environment, especially in areas of high deprivation. East London contains some of the most deprived neighbourhoods in England. The London 2012 bid predicted a legacy of health, economic, and cultural benefits for East London residents. Hosting the Olympics involved substantial changes and improvements to the immediate locality. However, the long-term impact of sporting mega-event regeneration remains unproven, especially in relation to health and wellbeing. This qualitative study explored how lived experiences of the social determinants of health for residents in the Olympic borough of Newham were shaped by the staging of the 2012 Games. Methods This study is part of a prospective mixed methods project on the health and social legacy of the London Olympic Games. Participants in the quantitative cohort were written to and invited to participate in qualitative data collection immediately after the Games. Narrative family interviews, go-along interviews and video focus group workshops with a total of 66 Newham residents (both adolescents and adults) were used. A narrative analytic approach served to identify and compare accounts of health and wellbeing experiences in terms of neighbourhood change and the spectacle of the Games. The analysis explored how people construct causal accounts and draw upon shared meanings, especially in relation to the lived experiences of the social determinants of health and the interaction between life chances and health-related life choices. Results Participants’ narratives addressed three main themes: aesthetic improvements to the area, community awareness and pride, and increased security measures. Residents described Newham as an unsafe and run-down place and so making it a temporarily more attractive, socially united and securitised Olympic space was welcomed and had an impact upon their neighbourhood perceptions, interactions and wellbeing. Putting Newham in the Olympic spotlight meant that the social determinants of health that shaped and constrained residents’ day-to-day lives were addressed and improved. However, the enhanced sense of wellbeing was short-lived and once the Olympic spectacle had passed, life in Newham largely reverted back to what it was before. Conclusion The regeneration activities in Newham served to lessen participants’ sense of social exclusion and seemed to generate a temporary sense of inclusion and respite. These findings challenge claims for an enduring health and social legacy from sporting mega-events and raise questions about the mechanisms by which such interventions might address area deprivation in the long term.