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This study estimates and decomposes components of different measures of inequality in health and healthcare use among millennial adolescents, a sizeable cohort of individuals at a critical stage of life. Administrative data from the UK Hospital Episode Statistics are linked to Next Steps, a survey collecting information about millennials born between 1989 and 1990, providing a uniquely comprehensive source of health and socioeconomic variables. Socioeconomic inequalities in psychological distress, long-term illness and the use of emergency and outpatient hospital care are measured using a corrected concentration index. Shapley-Shorrocks decomposition techniques are employed to measure the relative contributions of childhood socioeconomic circumstances to adolescents' health and healthcare inequality of opportunity. Results show that income-related deprivation contributes to significant inequalities in mental and physical health among adolescents aged between 15 and 17 years old. There are also pro-rich inequalities in the use of specific outpatient hospital services (e.g., orthodontic and mental healthcare), while pro-poor disparities are found in the use of emergency care services. Regional and parental circumstances are leading factors in influencing inequality of opportunity in the use of hospital care among adolescents. These findings shed light on the main drivers of health inequalities during an important stage of human development and have potentially important implications on human capital formation across the life-cycle. • Socioeconomic deprivation contributes to significant health inequalities for millennial adolescents. • There are pro-rich inequalities in the use of mental health and orthodontic outpatient hospital services. • Pro-poor disparities are found in the use of, and waiting times for, emergency hospital services. • Findings have important implications on human capital formation across life-cycles. [ABSTRACT FROM AUTHOR]

The Mental Well-being Adjusted Life Year (MWALY) is an alternative outcome measure to the quality-adjusted life year (QALY) in economic evaluations of interventions aimed at improving mental well-being. However, there is a lack of preference-based mental well-being instruments for capturing population mental well-being preferences. To derive a UK preference-based value set for the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). 225 participants that were interviewed between December 2020 and August 2021 completed 10 composite time trade-off (C-TTO) and 10 discrete choice experiment (DCE) interviewer-administered exercises. Heteroskedastic Tobit and conditional logit models were used to model C-TTO and DCE responses respectively. The DCE utility values were rescaled to a C-TTO comparable scale through anchoring and mapping. An inverse variance weighting hybrid model (IVWHM) was used to derive weighted-average coefficients from the modelled C-TTO and DCE coefficients. Model performance was assessed using statistical diagnostics. The valuation responses confirmed the feasibility and face validity of the C-TTO and DCE techniques. Apart from the main effects models, statistically significant associations were estimated between the predicted C-TTO value and participants' SWEMWBS scores, gender, ethnicities, education levels, and the interaction terms between age and useful feeling. The IVWHM was the most optimal model with the fewest logically inconsistent coefficients and the lowest pooled standard errors. The utility values generated by the rescaled DCE models and the IVWHM were generally higher than those of the C-TTO model. The predictive ability of the two DCE rescaling methods was similar according to the mean absolute deviation and root mean square deviation statistics. This study has produced the first preference-based value set for a measure of mental well-being. The IVWHM provided a desirable blend of both C-TTO and DCE models. The value set derived by this hybrid approach can be used for cost-utility analyses of mental well-being interventions. • This is the first attempt to derive a preference-based value set for a generic mental well-being instrument. • The valuation responses supported the face validity and feasibility for the valuation of the SWEMWBS. • The Inverse Variance Weighting hybrid model is firstly applied in preference elicitation research. • Units of QALY gain and MWALY gain have different implications for economic evaluations of mental well-being interventions. • This study tests the use of remote-control function in videoconferencing during the interview. [ABSTRACT FROM AUTHOR]

Large inequalities in health and well-being exist between people with and without disability, in part due to poor socio-economic circumstances, and potentially also related to societal factors including issues associated with accessibility and participation. To better understand the contribution of societal factors, we used a unique longitudinal survey of disability in Great Britain to quantify the extent to which barriers to participation contribute to poorer health and well-being. We used data from 2354 individuals who participated in three waves of the Life Opportunities Survey between 2009 and 2014 and compared five health and well-being outcomes (self-rated health, anxiousness, life satisfaction, life worth, happiness) between adults who acquired an impairment and those who remained disability-free. Causal mediation analysis was conducted to quantify how much of the effect of disability acquisition on each outcome was explained by barriers to participation in employment, economic life, transport, community, leisure and civic activities, social contact, and accessibility. People who recently acquired a disability had poorer health and well-being compared to people with no disability. Barriers to participation explained 15% of inequalities in self-rated health, 28% for anxiousness, 32% for life satisfaction, 37% for life worth, and 70% for happiness. A substantial proportion of the inequalities in health and well-being experienced by people with recently acquired disability were socially produced, driven by barriers to participation in different life domains. Furthermore, there was evidence that barriers to participation mediated the effect of well-being measured to a greater extent than the more clinically aligned measures, self-reported health and anxiousness. These findings highlight modifiable factors amenable to public health interventions that could lead to substantial improvements in health and well-being for people with disability. • Inequalities in health and well-being exist between people with and without disability. • Existing evidence suggest inequalities are in part driven by socio-economic factors. • The contribution of upstream societal barriers is not understood. • Barriers to participation mediated a substantial proportion of the inequalities. • Proportion mediated was larger for well-being compared to clinically aligned measures. [ABSTRACT FROM AUTHOR]

Objective: In the UK, approximately 3,200 women are diagnosed with cervical cancer each year. Regular screening is one of the best ways to prevent cervical cancer from developing, yet screening rates are declining and vary by sociodemographic variables. The present stratified online study aimed to investigate relationships between sociodemographic factors and screening intentions and past behaviour. Reasoned Action Approach (RAA) variables were assessed as potential mediators. In total, 500 women living in the UK were recruited via an online research recruitment website to an online cross-sectional survey. Participant recruitment was stratified by age, socioeconomic status and ethnicity to ensure adequate representation of each strata. Participants completed measures on RAA variables (affective attitudes, cognitive attitudes, injunctive norms, descriptive norms, capability, autonomy, and intention) as well as screening past behaviour. Among the demographic variables, age, ethnicity and deprivation were significantly related to screening intention. Younger women, those from less deprived areas, along with white women were more likely to report higher intentions to attend screening. Past behaviour was significantly negatively predicted by deprivation only, indicating that individuals from less deprived areas were more likely to be up to date with their screening. Both intention and past behaviour were significantly positively correlated with all RAA variables. Capability and cognitive attitude partially mediated the relationship between age and intention and fully mediated the relationship between ethnicity and intention. Capability fully mediated the relationships between deprivation and intention and between deprivation and past behaviour. Intentions toward attending cervical cancer screening are related to age, ethnicity, and level of deprivation, with older women and those from areas of greater deprivation and ethnic minority groups reporting lower intentions. Capability (confidence engaging in cervical screening) and cognitive attitudes (how useful/beneficial screening is seen to be) are key variables to target to promote cervical screening attendance and reduce potential inequalities. • Cervical cancer screening intentions are related to age, ethnicity, and deprivation. • Younger, white women, from less deprived areas and white report higher intentions. • Capability fully mediated the relationship between ethnicity and intention. • Capability also fully mediated the relationships between deprivation and intention. • Cognitive attitudes mediated the relationship between ethnicity and intention. [ABSTRACT FROM AUTHOR]

A substantial body of research describes the distribution, causes and potential reduction of health inequalities, yet little scholarship examines public understandings of these inequalities. Existing work is dominated by small-scale, qualitative studies of the experiences of specific communities. As a result, we know very little about what broader publics think about health inequalities; and even less about public views of potential policy responses. This is an important gap since previous research shows many researchers and policymakers believe proposals for 'upstream' policies are unlikely to attract sufficient public support to be viable. This mixed methods study combined a nationally representative survey with three two-day citizens' juries exploring public views of health inequalities and potential policy responses in three UK cities (Glasgow, Manchester and Liverpool) in July 2016. Comparing public opinion elicited via a survey to public reasoning generated through deliberative processes offers insight into the formation of public views. The results challenge perceptions that there is a lack of public support for upstream, macro-level policy proposals and instead demonstrate support for proposals aiming to tackle health inequalities via improvements to living and working conditions, with more limited support for proposals targeting individual behavioural change. At the same time, some macro-economic proposals, notably those involving tax increases, proved controversial among study participants and results varied markedly by data source. Our analysis suggests that this results from three intersecting factors: a resistance to ideas viewed as disempowering (which include, fundamentally, the idea that health inequalities exist); the prevalence of individualising and fatalistic discourses, which inform resistance to diverse policy proposals (but especially those that are more 'upstream', macro-level proposals); and a lack of trust in (local and national) government. This suggests that efforts to enhance public support for evidence-informed policy responses to health inequalities may struggle unless these broader challenges are also addressed. • The UK public favour tackling health inequalities via living and working conditions. • Individual and macro-economic responses are also supported but more controversial. • Fatalism, low trust in government & resistance to disempowerment inform controversy. • Different data provide distinct insights, underlining importance of mixed methods. • Support for macro-economic responses was highest in collective ranking exercise. [ABSTRACT FROM AUTHOR]

The group density effect, where a group member's psychiatric risk is associated with the proportion of the local population their group comprises, demonstrates the importance of minority group status to mental health. Previous research, focusing on ethnicity, has been correlational, but newly-formed identities provide opportunities for natural experiments, with greater scope for causal inference. This study examines whether such a group density effect can be found for the novel Brexit identities of 'leaver' and 'remainer' following the UK's divisive 2016 referendum on EU membership. Mixed effects models were fitted to the Understanding Society panel survey series (N = 25,555, 19,767 for analyses controlling for pre-referendum mental health data), predicting mental health as a function of individual opinion on EU membership and local referendum results. These interacted such that those holding the local majority opinion had better mental health (Odds ratio (OR):875 [0.766- 0.9995]), compared to those in the minority. This result survived adjustment for individual and area-level economic circumstances (OR:866 [0.758-0.989]), and, strikingly, pre-referendum mental health (OR: 0.841 [0.709-0.998]), as well as a number of other potential confounding variables. The results provide evidence for rapidly forming group density effects based on de novo identities, and suggest that identity may be a causal mechanism for group density effects more broadly. They also speak to the extent of polarisation in the Brexit-era UK, and its public health consequences. • Previous group density studies correlational and unable to establish causation. • Novel identities from UK's EU referendum allow study of formation of this effect. • Density effect evident post-referendum but not beforehand. • Effect robust to adjustment for a number of possible confounding variables. [ABSTRACT FROM AUTHOR]

Studies identify the existence of inequalities in adolescent subjective well-being (SWB) across levels of community socio-economic disadvantage. One posited explanation is that community disadvantage harms SWB through undermining positive social relations among residents (often termed social capital). However, social relations can be both positive and negative; for example, social interactions between residents can be friendly or unfriendly, or involve being helped or harmed. Little work has explored negative social relations in communities and their impact on SWB. This study therefore examines the role that local negative social relations may play, alongside positive relations, in understanding inequalities in SWB across communities. Data are taken from a nationally representative survey of 16–17-year olds in England in 2015. Applying multilevel models, findings demonstrate that adolescents living in more disadvantaged communities exhibit lower SWB. In line with current theories, part of this association can be accounted for by weaker positive social relations: the results show that while positive local interactions are important for youth SWB (primarily via higher neighbour trust), young people in more disadvantaged communities report fewer local positive social interactions. However, the models also demonstrate that part of the negative association between community disadvantage and SWB is also accounted for by stronger negative social relations: the results show that negative local interactions are harmful for youth SWB (both directly, and indirectly via lower neighbour-trust), and young people in disadvantaged communities report more frequent negative local social interactions. Importantly, the negative indirect-effect of community disadvantage via increasing negative social interactions is almost twice as strong as the negative indirect-effect of disadvantage via reducing positive interactions. Taken together, community disadvantage appears to harm SWB not only by reducing positive relations but also increasing negative relations. These form dual, independent, social relations pathways through which community disadvantage affects SWB. • Youth in socio-economically disadvantaged areas report lower subjective well-being (SWB). • This emerges, in part, because community disadvantage weakens positive local social relations. • However, community disadvantage also harms SWB by increasing negative local social relations. • The impact of community disadvantage via negative relations is twice as strong as its impact via positive relations. • Negative relations are a vital, overlooked relational-pathway linking area disadvantage to SWB. [ABSTRACT FROM AUTHOR]