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Aims: Research shows persistent ethnic inequities in mental health experiences and outcomes, with a higher incidence of illnesses among minoritised ethnic groups. People with psychosis have an increased risk of multiple long-term conditions (MLTC; multimorbidity). However, there is limited research regarding ethnic inequities in multimorbidity in people with psychosis. This study investigates ethnic inequities in physical health multimorbidity in a cohort of people with psychosis. Methods: In this retrospective cohort study, using the Clinical Records Interactive Search (CRIS) system, we identified service-users of the South London and Maudsley NHS Trust with a schizophrenia spectrum disorder, and then additional diagnoses of diabetes, hypertension, low blood pressure, overweight or obesity and rheumatoid arthritis. Logistic and multinomial logistic regressions were used to investigate ethnic inequities in odds of multimorbidity (psychosis plus one physical health condition), and multimorbidity severity (having one or two physical health conditions, or three or more conditions), compared with no additional health conditions (no multimorbidity), respectively. The regression models adjusted for age and duration of care and investigated the influence of gender and area-level deprivation. Results: On a sample of 20 800 service-users with psychosis, aged 13–65, ethnic differences were observed in the odds for multimorbidity. Controlling for sociodemographic factors and duration of care, compared to White British people, higher odds of multimorbidity were found for people of Black African [adjusted Odds Ratio = 1.41, 95% Confidence Intervals (1.23–1.56)], Black Caribbean [aOR = 1.79, 95% CI (1.58–2.03)] and Black British [aOR = 1.64, 95% CI (1.49–1.81)] ethnicity. Reduced odds were observed among people of Chinese [aOR = 0.61, 95% CI (0.43–0.88)] and Other ethnic [aOR = 0.67, 95% CI (0.59–0.76)] backgrounds. Increased odds of severe multimorbidity (three or more physical health conditions) were also observed for people of any Black background. Conclusions: Ethnic inequities are observed for multimorbidity among people with psychosis. Further research is needed to understand the aetiology and impact of these inequities. These findings support the provision of integrated health care interventions and public health preventive policies and actions. [ABSTRACT FROM AUTHOR]

Aims To investigate whether the association of severe mental illness with Type 2 diabetes varies by ethnicity and age. Methods We conducted a cross-sectional analysis of data from an ethnically diverse sample of 588 408 individuals aged ≥18 years, registered to 98% of general practices (primary care) in London, UK. The outcome of interest was prevalent Type 2 diabetes. Results Relative to people without severe mental illness, the relative risk of Type 2 diabetes in people with severe mental illness was greatest in the youngest age groups. In the white British group the relative risks were 9.99 (95% CI 5.34, 18.69) in those aged 18-34 years, 2.89 (95% CI 2.43, 3.45) in those aged 35-54 years and 1.16 (95% CI 1.04, 1.30) in those aged ≥55 years, with similar trends across all ethnic minority groups. Additional adjustment for anti-psychotic prescriptions only marginally attenuated the associations. Assessment of estimated prevalence of Type 2 diabetes in severe mental illness by ethnicity (absolute measures of effect) indicated that the association between severe mental illness and Type 2 diabetes was more marked in ethnic minorities than in the white British group with severe mental illness, especially for Indian, Pakistani and Bangladeshi individuals with severe mental illness. Conclusions The relative risk of Type 2 diabetes is elevated in younger populations. Most associations persisted despite adjustment for anti-psychotic prescriptions. Ethnic minority groups had a higher prevalence of Type 2 diabetes in the presence of severe mental illness. Future research and policy, particularly with respect to screening and clinical care for Type 2 diabetes in populations with severe mental illness, should take these findings into account. [ABSTRACT FROM AUTHOR]

Purpose: People with severe mental illnesses (SMI) experience a 17- to 20-year reduction in life expectancy. One-third of deaths are due to cardiovascular disease. This study will establish the relationship of SMI with cardiovascular disease in ethnic minority groups (Indian, Pakistani, Bangladeshi, black Caribbean, black African and Irish), in the UK.Methods: E-CHASM is a mixed methods study utilising data from 1.25 million electronic patient records. Secondary analysis of routine patient records will establish if differences in cause-specific mortality, cardiovascular disease prevalence and disparities in accessing healthcare for ethnic minority people living with SMI exist. A nested qualitative study will be used to assess barriers to accessing healthcare, both from the perspectives of service users and providers.Results: In primary care, 993,116 individuals, aged 18+, provided data from 186/189 (98 %) practices in four inner-city boroughs (local government areas) in London. Prevalence of SMI according to primary care records, ranged from 1.3-1.7 %, across boroughs. The primary care sample included Bangladeshi [n = 94,643 (10 %)], Indian [n = 6086 (6 %)], Pakistani [n = 35,596 (4 %)], black Caribbean [n = 45,013 (5 %)], black African [n = 75,454 (8 %)] and Irish people [n = 13,745 (1 %)]. In the secondary care database, 12,432 individuals with SMI over 2007-2013 contributed information; prevalent diagnoses were schizophrenia [n = 6805 (55 %)], schizoaffective disorders [n = 1438 (12 %)] and bipolar affective disorder [n = 4112 (33 %)]. Largest ethnic minority groups in this sample were black Caribbean [1432 (12 %)] and black African (1393 (11 %)).Conclusions: There is a dearth of research examining cardiovascular disease in minority ethnic groups with severe mental illnesses. The E-CHASM study will address this knowledge gap. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the association between sexual activities, problems and satisfaction, and ED and PDE5 inhibitor (PDE5i) use. A nationally representative sample of men (n=2612) aged 51-87 years from the English Longitudinal Study of Ageing completed an in-depth Sexual Relationships and Activities Questionnaire. Associations between ED and/or PDE5i use and sexual outcomes were explored using logistic regression models adjusted for age, health and lifestyle factors. PDE5i use in the preceding 3 months was reported by a total of 191 (7%) men, whereas 542 (21%) reported ED but no PDE5i use (untreated ED). Compared with men without ED, PDE5i users were more likely to be sexually active and report more frequent sexual intercourse. Men with untreated ED reported the lowest frequency of sexual activities. Compared with men without ED, both PDE5i users and those with untreated ED were more likely to report being concerned about their level of sexual desire, frequency of sexual activities, erectile function, waking erections and orgasmic experience. PDE5i users were also more concerned about and dissatisfied with their overall sex life than men without ED. This population-based study shows that while PDE5i use is associated with improved sexual functioning, this is not equally reflected in decreased levels of concern and dissatisfaction with their overall sexual health. Clinicians should be aware of this disparity between functional gains and continuing sexual concerns and dissatisfaction, and, where appropriate, offer psychosexual counselling as an adjunct to PDE5i medication. [ABSTRACT FROM AUTHOR]

Objective:Racial/ethnic patterning in the risk of obesity and overweight has been observed in early childhood; however, little research has compared these disparities between the United Kingdom (UK) and United States (US) using detailed ethnic classifications. We use comparable nationally representative cohort studies to examine racial/ethnic disparities in mean body mass index (BMI) and in the odds of obesity/overweight in the UK and US. The contribution of sociodemographic, cultural and family routine factors are assessed.Methods:Data on BMI, obesity and overweight in 5-year-old children from the MCS (Millennium Cohort Study) and ECLS-B (Early Childhood Longitudinal Study, Birth Cohort) were examined. We investigated race/ethnic disparities in mean BMI and in the odds of obesity and overweight, as compared to normal weight. We assessed the independent contribution of sociodemographic, cultural and family routine factors to observed disparities.Results:In the UK, after adjustment for sociodemographic, cultural and family routine factors and maternal BMI, we found Black Caribbean children to have higher odds ratio (OR=1.7, confidence interval (CI)=1.1-2.6), Pakistani children to have lower odds of obesity (OR=0.60, CI=0.37-0.96) and Black African children were more likely to be overweight (OR=1.40, CI=1.04-1.88). In the US, in fully adjusted models, there were no race/ethnic disparities in children's odds of obesity and overweight.Conclusion:Disparities for Bangladeshi children in the UK and Mexican, other Hispanic and American Indian children in the US can be explained by socioeconomic disadvantage, whereas a range of cultural and family characteristics partially explain disparities for other groups in the UK. Future public health initiatives focused on reducing risk of overweight and obesity should consider the diverse socioeconomic and cultural profiles of all race/ethnic groups. [ABSTRACT FROM AUTHOR]

Background:Ethnic minority groups in Western European countries tend to have higher levels of overweight than the majority populations for reasons that are poorly understood. Investigating relative differences between countries could enable an investigation of the importance of national context in determining these inequalities.Objective:To explore: (1) whether Indian and African origin populations in England and the Netherlands are similarly disadvantaged compared with the White populations in terms of the prevalence of overweight and central obesity; (2) whether the previously known Dutch advantage of relatively low overweight prevalence is also observed in Dutch ethnic minority groups and (3) the contribution of health behaviour and socio-economic position to the differences observed.Methods:Secondary analyses of population-based studies of 16 406 participants from England and the Netherlands. Prevalence ratios were estimated using regression models.Results:Except for African men, ethnic minority groups in both countries had higher rates of overweight and central obesity than their White counterparts. However, the Dutch minority groups were relatively more disadvantaged than English minority groups as compared with the majority populations. The Dutch advantage of the low prevalence of obesity was only seen in White men and women and African men. In contrast, English-Indian (prevalence ratio=0.87, 95% confidence interval (CI): 0.81-0.93) and English-Caribbean (prevalence ratio=0.82, 95% CI: 0.76-0.89) women were less centrally obese than their Dutch equivalents. The Dutch-Indian men were very similar to the English-Indian men. The contribution of health behaviour and socio-economic position to the observed differences were small.Conclusion:Contrary to the patterns in White groups, the Dutch ethnic minority women were more obese than their English equivalents. More work is needed to identify factors that may contribute to these observed differences. [ABSTRACT FROM AUTHOR]

BACKGROUND: Birthweight varies according to ethnic group, but it is not clear why such differences exist. We examine the contribution of socioeconomic, maternal and behavioural factors to differences in mean birthweight and the prevalence of low birthweight across ethnic groups. METHODS: Data from the nationally representative UK Millennium Cohort Study (n = 16,157) on White, Indian, Pakistani, Bangladeshi, Black Caribbean and Black African infants were analysed. Cohort members were born in 2000-02, and data on birthweight, maternal, infant, behavioural and socioeconomic factors were collected by home interviews. RESULTS: Indian, Pakistani and Bangladeshi infants were 280-350 g lighter, and 2.5 times more likely to be low birthweight compared with White infants. Black Caribbean infants were 150 g and Black African infants 70 g lighter compared with White infants, and Black Caribbean and Black African infants were 60% more likely to be low birthweight compared with White infants. For Black Caribbean, Black African, Bangladeshi and Pakistani infants, socioeconomic factors were important in explaining birthweight differences and, for Indian and Bangladeshi infants, maternal and infant factors were important in explaining birthweight differences. CONCLUSION: Future policies aimed at reducing inequalities in birthweight must pay attention to the different socioeconomic and culturally-related profiles of ethnic minority groups in the UK. [ABSTRACT FROM AUTHOR]

Objective: To assess health improvement and differential changes in health across various sociodemographic groups in neighbourhood renewal areas. Design and setting: A longitudinal survey of 10 390 residents in New Deal for Communities (NDC) areas and 977 residents in comparator areas in England. Measures and methods: Changes on several outcomes across five domains (health, unemployment, education, crime and the physical environment) were assessed by sex, age, educational and ethnic group. Results: Small overall improvements were seen on all domains in NDC areas but similar improvements were also seen in comparator areas. In NDC areas, higher educational groups were more likely to stop smoking, less likely to develop a limiting long-term illness, more likely to find employment and more likely to participate in education or training (p for trend <0.05). Older people and women were less likely to find employment and experienced smaller increases in income. These patterns were generally mirrored in comparator areas, although the education gradient in participation in education or training was less steep in NDC areas. Conclusions: Evidence from two-year follow-up does not support an NDC effect, either overall or for particular population groups. Residents with lower education experienced the least favourable health profiles at baseline and the smallest improvements. Programme leaders should consider how to encourage participation among those with the lowest education. A shallower social gradient in participation in education and training in NBC areas and a lack of gradient in income, crime and environmental outcomes indicate that some aspects of the programme may be reaching all sections of the community. [ABSTRACT FROM AUTHOR]

The majority of new HIV diagnoses in the UK occur in people with heterosexually acquired HIV infection, the majority of whom are migrant Africans. In the UK HIV positive Africans access HIV services at a later stage of disease than non-Africans (Burns et al., 2001; Sinka et al., 2003). Employing purposive sampling techniques, semi-structured interviews were conducted with key informants to identify the key issues affecting utilization of HIV services for Africans in Britain. Considerable agreement about the major issues influencing uptake of HIV services existed amongst the key informants. Respondents felt there was high HIV awareness but this did not translate into perception of individual risk. Home country experience and community mobilization was highly influential on HIV awareness, appreciation of risk, and attitudes to health services. Institutional barriers to care exist; these include lack of cultural understanding, lack of open access or community clinics, failure to integrate care with support organizations, and the inability of many General Practitioners to address HIV effectively. Community involvement should include input to ensure there is: better cultural understanding within the health care system; normalization of the HIV testing process; and a clear message on the effectiveness of therapy. [ABSTRACT FROM AUTHOR]

This paper examines ethnic differences in the attainment of developmental milestones during infancy and possible explanations for observed differences are investigated. Data from the first survey of the Millennium Cohort Study (n=15 994; 8212 males, 7782 females; mean age 9.2mo [SD 0.5]) were examined. We found that Black Caribbean (odds ratio [OR]=0.23, 95% confidence interval [CI]=0.11-0.48), Black African (OR 0.31, 95% CI 0.18-0.55), and Indian (OR 0.55, 95% CI 0.33-0.93) infants were less likely to show delay in the attainment of gross motor milestones compared with White infants after adjustment for a range of explanatory variables. Pakistani and Bangladeshi infants were more likely to have delays in fine motor development (OR 1.69, 95% CI 1.21-2.35 and OR 2.17, 95% CI 1.17-4.02 respectively) and communicative gestures (OR 4.19, 95% CI 1.47-11.94 and OR 7.64, 95% CI 3.96-14.76 respectively), but these differences were explained by socioeconomic factors and markers of cultural tradition. In conclusion, unexplained ethnic differences were seen in the attainment of gross motor milestones, with Indian, Black Caribbean, and Black African children less likely to be delayed (in adjusted models). Increased likelihood of fine motor and communicative gesture delays among Pakistani and Bangladeshi infants, that disappear when socioeconomic factors are taken into account, point to the need to address deprivation among these groups to reduce the likelihood of developmental delay and possible longer term behavioural and cognitive problems and consequent opportunities throughout life. [ABSTRACT FROM AUTHOR]

Objective: Human papillomavirus (HPV) testing has been proposed for inclusion in the UK cervical screening programme. While testing may bring some benefits to the screening programme, testing positive for HPV, a sexually transmitted virus, may have adverse social and psychological consequences for women. The aim of this study was to examine the social and psychological impact of HPV testing in the context of cervical cancer screening. Method: In-depth interviews generating qualitative data were carried out with 74 women participating in HPV testing in England between June 2001 and December 2003. Purposive sampling was used to ensure heterogeneity in age, ethnic group, marital status, socioeconomic background, cytology, and HPV results among participants. Results: Testing positive for HPV was associated with adverse social and psychological consequences, relating primarily to the sexually transmitted nature of the virus and its link to cervical cancer. Women described feeling stigmatised, anxious and stressed, concerned about their sexual relationships, and were worried about disclosing their result to others. Anxiety about the infection was widespread, but the impact of testing positive varied. The psychological burden of the infection related to women's relationship status and history, their social and cultural norms and practices around sex and relationships, and their understanding of key features of HPV. Conclusion: HPV testing should be accompanied by extensive health education to inform women and to de-stigmatise infection with the virus to ensure that any adverse impact of the infection on women's wellbeing is minimised. [ABSTRACT FROM AUTHOR]

Background:Higher levels of religious involvement are? modestly associated with better health, after taking account of other influences. However, most research takes little account of spiritual beliefs that are not tied to personal or public religious practice.Objectives: To compare prevalence and characteristics of religious and spiritual views of life in representative samples of all principal ethnic groups in England and to examine associations between these views and common mental disorders (CMD).Method: Face-to-face interviews with 4281 adults from six ethnic groups living in private households in England. Data were collected on common mental disorders, religious and spiritual beliefs, quality of life, social function and support, and psychotic symptoms.Results: There was no difference in prevalence of CMD between people who were religious and those who were not. However, people who held a spiritual life view but without religious practice were more likely to have CMD (OR = 2.01, CI 1.15, 3.51) than people who held a religious life view, after adjustment for relevant confounding variables.Conclusions: Lack of religious belief was associated with a higher prevalence of CMD, but only in people who reported having a spiritual life view.Declaration of interest: None. [ABSTRACT FROM AUTHOR]

Introducing human papillomavirus (HPV) testing into cervical cancer screening has the potential to change the way that women understand cervical cancer, the psychological impact of abnormal screening results and the likelihood of future participation in screening. The study used in-depth interviews to examine how women make sense of information about HPV in the context of cervical cancer screening. A total of 74 women were recruited following participation in HPV testing. Women varied widely in their beliefs about the aetiology of cervical cancer and its relationship with sexual activity, as well as in their understanding of the sexually transmitted nature of HPV. While some women who understood that HPV is sexually transmitted were able to integrate this into their existing model of cervical cancer, others were shocked by the link between cervical cancer and sex, of which they had been previously unaware. Women were generally reassured to know that HPV is common, has no symptoms, can lie dormant for many years, can clear up on its own and need not raise concerns about transmission to sexual partners. Women's understanding of HPV varied considerably, even after participation in testing. The way in which information is presented to women will be crucial in minimising the negative psychological impact of testing positive and ensuring that participation in screening remains high. [ABSTRACT FROM AUTHOR]

Background. There is little population-based evidence on ethnic variation in the most common mental disorders (CMD), anxiety and depression. We compared the prevalence of CMD among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England using a standardized clinical interview.Method. Cross-sectional survey of 4281 adults aged 16-74 years living in private households in England. CMD were assessed using the Revised Clinical Interview Schedule (CIS-R), a standardized clinical interview.Results. Ethnic differences in the prevalence of CMD were modest, and some variation with age and sex was noted. Compared to White counterparts, the prevalence of CMD was higher to a statistically significant degree among Irish [adjusted rate ratios (RR) 2.09, 95% CI 1.16-2.95, p=0.02] and Pakistani (adjusted RR 2.38, 95% CI 1.25-3.53, p=0.02) men aged 35-54 years, even after adjusting for differences in socio-economic status. Higher rates of CMD were also observed among Indian and Pakistani women aged 55-74 years, compared to White women of similar age. The prevalence of CMD among Bangladeshi women was lower than among White women, although this was restricted to those not interviewed in English. There were no differences in rates between Black Caribbean and White samples.Conclusions. Middle-aged Irish and Pakistani men, and older Indian and Pakistani women, had significantly higher rates of CMD than their White counterparts. The very low prevalence of CMD among Bangladeshi women contrasted with high levels of socio-economic deprivation among this group. Further study is needed to explore reasons for this variation. [ABSTRACT FROM AUTHOR]

Editorial. Provides information on the British Fourth National Survey of Ethnic Minorities. Relationship between ethnic background and mental health in Great Britain; Rates of depression for Carribeans; Difficulty in interpreting the findings for the Asian group; Methodological limitations of the survey.

Background Ethnic differences in obesity have been well documented, but comparatively little is known about whether these differences vary according to the degree of exposure to the new environment following migration. Objectives To investigate the extent of generational differences in adult health-related lifestyles and socioeconomic circumstances, and explore whether these differences might explain changing patterns of obesity in ethnic minorities in England. Method Seven ethnic minority groups were selected from the ethnically boosted 1999 and 2004 Health Survey for England (Indian n=887; Pakistani n=603; Bangladeshi n=275; Black Caribbean n=762; Black African n=147; Chinese n=413; and Irish n=1438). A White group was used as a reference population (n=5899). Age and sex adjusted logistic regression estimated the odds of having a poor health behaviour in the second generation compared to the first. Age- and sex-adjusted odds of being obese in the second generation compared to the first were estimated before and after adjusting for generational differences in health related behaviours (snacking, eating cakes and fried foods, having low levels of physical exercise, any drinking including binges, current smoking status) and socioeconomic factors (social class, equivalised income and highest qualification). Results Overall, second generation ethnic minority men and women were significantly more likely than the first to have low vegetable consumption (

Background Ethnic differences in obesity have been well documented, but comparatively little is known about whether these differences vary according to the degree of exposure to the new environment following migration. Objectives To investigate the extent of generational differences in adult health-related lifestyles and socioeconomic circumstances, and explore whether these differences might explain changing patterns of obesity in ethnic minorities in England. Method Seven ethnic minority groups were selected from the ethnically boosted 1999 and 2004 Health Survey for England (Indian n=887; Pakistani n=603; Bangladeshi n=275; Black Caribbean n=762; Black African n=147; Chinese n=413; and Irish n=1438). A White group was used as a reference population (n=5899). Age and sex adjusted logistic regression estimated the odds of having a poor health behaviour in the second generation compared to the first. Age- and sex-adjusted odds of being obese in the second generation compared to the first were estimated before and after adjusting for generational differences in health related behaviours (snacking, eating cakes and fried foods, having low levels of physical exercise, any drinking including binges, current smoking status) and socioeconomic factors (social class, equivalised income and highest qualification). Results Overall, second generation ethnic minority men and women were significantly more likely than the first to have low vegetable consumption (

Background: Ethnic/racial inequalities in access to and quality of healthcare have been repeatedly documented in the USA. Although there is some evidence of inequalities in England, research is not so extensive. Ethnic inequalities in use of primary and secondary health services, and in outcomes of care, were examined in England. Methods: Four waves of the Health Survey for England were analysed, a representative population survey with ethnic minority oversamples. Outcome measures included use of primary and secondary healthcare services and clinical outcomes of care (controlled, uncontrolled and undiagnosed) for three conditions--hypertension, raised cholesterol and diabetes. Results: Ethnic minority respondents were not less likely to use GP services. For example, the adjusted odds ratios for Indian, Pakistani and Bangladeshi versus white respondents were 1.29 (95% confidence intervals 1.07 to 1.54), 1.32 (1.10 to 1.58) and 1.35 (1.10 to 1.65) respectively. Similarly, there were no ethnic inequalities for the clinical outcomes of care for hypertension and raised cholesterol, and, on the whole, no inequalities in outcomes of care for diabetes. There were ethnic inequalities in access to hospital services, and marked inequalities in use of dental care. Conclusion: Ethnic inequalities in access to healthcare and the outcomes of care for three conditions (hypertension, raised cholesterol and diabetes), for which treatment is largely provided in primary care, appear to be minimal in England. Although inequalities may exist for other conditions and other healthcare settings, particularly internationally, the implication is that ethnic inequalities in healthcare are minimal within NHS primary care. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]