Richard D. Wiggins

Examining Resilience of Quality of Life in the Face of Health-Related and Psychosocial Adversity at Older Ages: What is “Right” About the Way We Age?

PURPOSEnThis article examines resilience at older ages, focusing on the relationships between quality of life (qol) and adversity. Our objectives are to identify (a) the basis of adversity, (b) the characteristics of resilient individuals, and (c) the attributes that attenuate the full impact of adversity.nnnDESIGN AND METHODSnResilience is defined as flourishing despite adversity. Analysis is carried out in a subsample of the Boyd Orr cohort (aged between 68 and 82 years) using questionnaire data. Adversity was identified as circumstances that produce a significant average decrease in qol (CASP-19 scores). Participants were classified into resilient and vulnerable groups based on high or low qol (CASP-19 scores dichotomized at the median) in the face of significant adversity. Shared characteristics that define these outcomes are reported. Attributes that attenuate the negative impact of adversity were analyzed using stratified logistic regression.nnnRESULTSnAdversity was typified by functional limitation; life getting worse in the domains of health, stress, and general living circumstances; and experiencing a negative life event. The resilient tended to report fewer multiple adversities. Indicators of protective attributes, which also characterized resilient outcomes relative to qol, included good quality relationships (5.105, confidence interval [CI] 95% 1.323-19.699), integration in the community (10.800, 95% CI 1.227-95.014), developmental coping (3.397, 95% CI 1.079-10.690), and adaptive coping styles (3.211, 95% CI 1.041-9.910).nnnIMPLICATIONnOverall results indicate that policies that offer access to protection and help minimize adversity exposure where possible will promote resilience.

Men who have sex with men in Great Britain: comparison of a self-selected internet sample with a national probability sample

Objectives: To compare the characteristics of a self-selected, convenience sample of men who have sex with men (MSM) recruited through the internet with MSM drawn from a national probability survey in Great Britain. Methods: The internet sample (nu200a=u200a2065) was recruited through two popular websites for homosexual men in Great Britain in May and June 2003. This sample was compared with MSM (nu200a=u200a117) from the National Survey of Sexual Attitudes and Lifestyles (Natsal), a probability sample survey of adults resident in Great Britain conducted between May 1999 and February 2001. Results: No significant differences were observed between the samples on a range of sociodemographic and behavioural variables (p>0.05). However, men from the internet sample were younger (p<0.001) and more likely to be students (pu200a=u200a0.001), but less likely to live in London (pu200a=u200a0.001) or report good health (pu200a=u200a0.014). Although both samples were equally likely to report testing for HIV, men from the internet sample were more likely to report a sexually transmitted infection in the past year (16.9% v 4.8%, adjusted odds ratio 4.14, 95% CI 1.76 to 9.74; pu200a=u200a0.001), anal intercourse (76.9% v 63.3%; pu200a=u200a0.001) and unprotected anal intercourse in the past 3 months (45% v 36.6%; pu200a=u200a0.064). Conclusions: The internet provides a means of recruiting a self-selected, convenience sample of MSM whose social and demographic characteristics are broadly similar to those of MSM drawn from a national probability survey. However, estimates of high-risk sexual behaviour based on internet convenience samples are likely to overestimate levels of sexual risk behaviour in the wider MSM population.

Age–period–cohort effects on inequalities in psychological distress, 1981–2000

BACKGROUNDnIn the closing decades of the twentieth century, changes in population sociodemographics took place that might be thought to have an adverse influence on the nations psychological distress. Here, we examine the stability of social and gender inequalities in psychological distress throughout the 1980s and 1990s.nnnMETHODSnThe study uses data from the 1958 National Child Development Study and the 1970 British Cohort Study collected when the cohort members were aged between 23 and 42. Multilevel logistic regression models were used to examine the effects of social class, gender, age, period and cohort on psychological distress as measured by the Malaise Inventory.nnnRESULTSnWe identify clear social inequalities in psychological distress during 1981-2000 that reduced in magnitude over this period. Non-linear age effects were observed: psychological distress improves in early adulthood but declines again on approaching mid-life. The 1970 cohort had poorer psychological distress than the 1958 cohort. Although women had higher rates of psychological distress than men, gender differences reduced in magnitude. Declining rates of womens psychological distress over time have not been matched in men. A reduction in social inequalities over time was also observed. Improvements in the psychological health of those in manual occupations were not equalled among those in non-manual occupations.nnnCONCLUSIONSnBoth social and gender inequalities have narrowed in the last two decades of the twentieth century.

Place and personal circumstances in a multilevel account of women's long-term illness

This paper investigates geographical variations in womens reports of limiting long-term illness in terms of individual inequalities and the contribution of area characteristics among wards and county districts. We use multilevel modelling of linked census data from the Office for National Statistics Longitudinal Study for England and Wales. We follow a random sample of 76.374 women aged between 16 and 45 at the time of the 1971 Census for 20 years to observe their reported limiting long-term illness (LLTI) at the 1991 Census. Car and home ownership were useful markers of social and material advantage, apparently protecting against the risk of reporting LLTI. Migration into the South-East region appeared beneficial, but otherwise there was little difference between those who moved home and those who did not. Differences between county districts persist after adjustment for individual circumstances (education and ethnicity), but almost all of these differences are explained by the social profile of wards in these areas. Geographical differences in LLTI are not, therefore, entirely explained by the distribution of individual characteristics: a woman with the same history may face a different risk of illness in different kinds of area. For women, the social composition of the locality (using the ward as a proxy) is more relevant than the broader economic and industrial classification of the surrounding county district, which is more important for health inequalities among men.

Social origins, school type and higher education destinations

To what extent and why do social origins matter for access to higher education, including access to elite universities? What is the role of private and selective schooling? This paper uses the 1970 British Cohort Study (BCS70) to analyse the trajectories of a generation currently in early middle age. We find that the influence of social origins, especially parental education, remains when both a wide range of cognitive measures and school attainment are controlled. Attending a private school is powerfully predictive of gaining a university degree, and especially a degree from an elite institution, while grammar schooling does not appear to confer any advantage.

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 60–64u2005years 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.

A decade of research using the CASP scale: key findings and future directions.

Since the publication of A Measure of Quality of Life in Early Old Age: The Theory, Development and Properties of a Needs Satisfaction Model (CASP-19) just over 10 years ago, the scale has gone on to be used in a wide variety of studies in over 20 countries across the world and the original paper has become the most highly cited paper for Aging and Mental Health. Therefore it was felt that it was a good time to look back and reflect on the developments in the use of the scale as well as to look forward to what new research is being done and could be done with the measure. To this end we are extremely grateful for the editors for allowing us to bring together a collection of papers that represent cutting edge research using the CASP scale. These papers cover a wide variety of issues, from working conditions to religiosity, from a range of countries, covering Western and Eastern Europe as well as Africa. Each makes an important individual contribution to our understanding of the factors that influence quality of life in later life as well as pointing to the limitations of the measure and future work that can be done in this area.

Is the sexual behaviour of young people in sub-Saharan Africa influenced by their peers? A systematic review

Adolescents in sub-Saharan Africa are highly vulnerable to HIV, other sexually transmitted infections (STIs) and unintended pregnancies. Evidence for the effectiveness of individual behaviour change interventions in reducing incidence of HIV and other biological outcomes is limited, and the need to address the social conditions in which young people become sexually active is clear. Adolescents peers are a key aspect of this social environment and could have important influences on sexual behaviour. There has not yet been a systematic review on the topic in sub-Saharan Africa. We searched 4 databases to find studies set in sub-Saharan Africa that included an adjusted analysis of the association between at least one peer exposure and a sexual behaviour outcome among a sample where at least 50% of the study participants were aged between 13 and 20 years. We classified peer exposures using a framework to distinguish different mechanisms by which influence might occur. We found 30 studies and retained 11 that met quality criteria. There were 3 cohort studies, 1 time to event and 7 cross-sectional. The 11 studies investigated 37 different peer exposure-outcome associations. No studies used a biological outcome and all asked about peers in general rather than about specific relationships. Studies were heterogeneous in their use of theoretical frameworks and means of operationalizing peer influence concepts. All studies found evidence for an association between peers and sexual behaviour for at least one peer exposure/outcome/sub-group association. Of all 37 outcome/exposure/sub-group associations tested, there was evidence for 19 (51%). There were no clear patterns by type of peer exposure, outcome or adolescent sub-group. There is a lack conclusive evidence about the role of peers in adolescent sexual behaviour in Sub-Saharan. We argue that longitudinal designs, use of biological outcomes and approaches from social network analysis are priorities for future studies.

Distribution and determinants of risk of teenage motherhood in three British longitudinal studies: implications for targeted prevention interventions

Purpose In order to consider the potential contribution of universal versus targeted prevention interventions, the authors examined what is the distribution of established risk variables for teenage motherhood? from where in these distributions do births arise? and how does this distribution/determination of risk vary between studies? Methods Secondary data analysis of three British longitudinal studies. Results For all cohorts and variables, the ‘risk’ category was the least frequent. Continuous risk factors were normally distributed. A high rate of teenage motherhood within a risk category often translated into low ‘contribution’ to the overall rate (eg, expectation to leave school at the minimum age among the 1989/1990-born cohort) and vice versa. Most young women had a low probability of teenage motherhood. For any targeting strategy, combining risk factors and a low threshold of predicted probability would be necessary to achieve adequate sensitivity. Assessing between-cohort applicability of findings, the authors find that the numbers of teenage parents is poorly estimated and estimates of the variability and direction of risk may also be inadequate. Conclusions With reference to a number of established risk factors, there is not a core of easily identifiable multiply disadvantaged girls who go on to constitute the majority of teenage mothers in these studies. While individual risk factors are unlikely to enable targeting, a composite may have some limited potential, albeit with a low threshold for ‘risk’ and with the caveat that evidence from one population may not inform good targeting in another. It is likely that universal approaches will have more impact.

Social integration, a sense of belonging and the Centotaph service: old soldiers reminisce about Remembrance

Objectives: This study explored how war commemorations such as the Cenotaph Service in the UK enable older veterans to benefit from a feeling of integration and belonging gained from both comradeship and acknowledgement from wider society. Method: Focus groups preceded by a video clip of the Cenotaph Service with 45 veterans were used to discuss the significance of collective commemorations for older veterans. Results: Findings indicated that social integration and a sense of belonging are fostered both by comradeship and societal support during collective commemorations allowing veterans to reminisce safely. Spontaneous reminiscences involving troubling memories may be processed more easily with the support, social integration and sense of belonging which occurs at collective commemorations. Many Korean War and female World War II veterans felt forgotten and socially isolated, but described gaining vicarious support via collective commemorations. Cohen and Wills (1985) main-effects and buffering models of social support are used to discuss the findings further. Conclusion: Collective commemorations can be important sources of support for many older veterans. Both comradeship and societal support promote social integration and a sense of belonging (main-effects), which enabled reminiscing and processing (buffering) to occur. 1In memory of Mark Condron 1960–2007.