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Abstract Rationale While the role of diet in influencing physical health is now well-established, some recent research suggests that increased consumption of fruits and vegetables could play a role in enhancing mental well-being. A limitation with much of this existing research is its reliance on cross-sectional correlations, convenience samples, and/or lack of adequate controls. Objective We aim to add to the emerging literature on the relationship between fruit and vegetable consumption and well-being by using longitudinal data from a study in the United Kingdom (UK). Method We employ panel data analytical techniques on three waves collected between 2010 and 2017 (i.e., following the same individuals over time) in the UK Household Longitudinal Survey. We also control for time-variant confounders such as diet, health, and lifestyle behaviours. Results Fixed effects regressions show that mental well-being (GHQ-12) responds in a dose-response fashion to increases in both the quantity and the frequency of fruit and vegetables consumed. This relationship is robust to the use of subjective well-being (life satisfaction) instead of mental well-being. We also document a hump-shaped relationship between fruit and vegetable consumption and age. Conclusion Our findings provide further evidence that persuading people to consume more fruits and vegetables may not only benefit their physical health in the long-run, but also their mental well-being in the short-run. Highlights • Increased fruit & vegetable consumption can enhance mental well-being. • Increasing frequency and increasing quantity of consumption both matter. • The relationship is robust to different measures of well-being. • A hump-shaped relationship appeared between age and fruit and vegetable consumption. [ABSTRACT FROM AUTHOR]

Abstract Doctors' work and the changing, contested meanings of medical professionalism have long been a focus for sociological research. Much recent attention has focused on those doctors working at the interface between healthcare management and medical practice, with such ‘hybrid’ doctor-managers providing valuable analytical material for exploring changes in how medical professionalism is understood. In the United Kingdom, significant structural changes to medical regulation, most notably the introduction of revalidation in 2012, have created a new hybrid group, Responsible Officers (ROs), responsible for making periodic recommendations about the on-going fitness to practise medicine of all other doctors in their organisation. Using qualitative data collected in a 2015 survey with 374 respondents, 63% of ROs in the UK, this paper analyses the RO role. Our findings show ROs to be a distinct emergent group of hybrid professionals and as such demonstrate restructuring within UK medicine. Occupying a position where multiple agendas converge, ROs' work expands professional regulation into the organisational sphere in new ways, as well as creating new lines of continuous accountability between the wider profession and the General Medical Council as medical regulator. Our exploration of ROs' approaches to their work offers new insights into the on-going development of medical professionalism, pointing to the emergence of a distinctly regulatory hybrid professionalism shaped by co-existing professional, managerial and regulatory logics, in an era of strengthened governance and complex policy change. Highlights • Responsible Officers are a new governance elite group in the UK medical profession. • They work at the nexus of professional, managerial and regulatory spheres. • Differ from other doctor-managers due to accountability for medical performance. • Organisational context shapes experiences of this new role. • Regulatory reform has engendered a new form of hybrid professionalism. [ABSTRACT FROM AUTHOR]

The harmful effects of heavy drinking on health have been widely reported, yet public opinion on governmental responsibility for alcohol control remains divided. This study examines UK public attitudes towards alcohol policies, identifies underlying dimensions that inform these, and relationships with perceived effectiveness. A cross-sectional mixed methods study involving a telephone survey of 3477 adult drinkers aged 16–65 and sixteen focus groups with 89 adult drinkers in Scotland and England was conducted between September 2012 and February 2013. Principal components analysis (PCA) was used to reduce twelve policy statements into underlying dimensions. These dimensions were used in linear regression models examining alcohol policy support by demographics, drinking behaviour and perceptions of UK drinking and government responsibility. Findings were supplemented with a thematic analysis of focus group transcripts. A majority of survey respondents supported all alcohol policies, although the level of support varied by type of policy. Greater enforcement of laws on under-age sales and more police patrolling the streets were strongly supported while support for pricing policies and restricting access to alcohol was more divided. PCA identified four main dimensions underlying support on policies: alcohol availability, provision of health information and treatment services, alcohol pricing, and greater law enforcement. Being female, older, a moderate drinker, and holding a belief that government should do more to reduce alcohol harms were associated with higher support on all policy dimensions. Focus group data revealed findings from the survey may have presented an overly positive level of support on all policies due to differences in perceived policy effectiveness. Perceived effectiveness can help inform underlying patterns of policy support and should be considered in conjunction with standard measures of support in future research on alcohol control policies. [ABSTRACT FROM AUTHOR]

Abstract: Obesity is a global health concern. This is the first study to explore if the relationship between body fatness and time preference is consistent across different ways of objectively measuring body fatness. Our second aim is to explore if there are differential associations between educational attainment and being a saver to determine if education can be used to change saving behaviour and subsequently body fatness. This paper uses data on 15,591 individuals from 2010/2011 of the Understanding Society Survey (UK) to explore the relationship between time preference, measured as being a saver and three objective measures of body fatness: BMI, percent body fatness (PBF), and waist circumference (WC). Our findings show that there is a negative relationship between the three measures of body fatness and being a saver. The strongest relationship is found for WC and being a saver for both genders. Overall, a stronger association is found for women than men. Our results suggest that differential effects by educational attainment can be found in the relationship between being a saver and body fatness. Educational interventions to improve savings behaviour and subsequently obesity may be more effective for women with lower levels of education. [ABSTRACT FROM AUTHOR]

The persistently low employment rate among disabled individuals has been an enduring concern of governments across developed countries and has been the subject of a succession of policy initiatives, including labour market activation programmes, equality laws and welfare reform. A key indicator of progress is the trend in the disability-related employment gap, the percentage point difference between the employment rate for disabled and non-disabled individuals. Confusingly for the UK, studies undertaken between 1998 and 2012 have simultaneously reported both a widening and a narrowing of the gap. The source of the discrepancy can be found in the choice of survey, the General Household Survey (GHS) or the Labour Force Survey (LFS), although both use a common conception of disability and collect self-reported information from a random sample of households. The literature has analysed these surveys separately from each other and ignored inter-survey differences in findings. The Health Survey for England (HSE), a third national household survey, replicates the GHS questions on disability but has had limited use in this context. This empirical study compares the trends in disability prevalence and the disability-related employment gap across the three surveys using a three-stage harmonisation process. The negative relationship between the prevalence of disability and the employment gap found in cross-section inter-survey comparisons prompts an initial focus on differences in the definition of disability as an explanation of the discrepancy. This is broadened to include differences in survey methods and sample composition. Differences in the trend in disability prevalence and the employment gap remain following harmonisation for definition, survey method and sample composition. It is the LFS, the main policy-influencing and policy-assessment survey, which generates outlying results. As such, we cannot be confident that the disability-related employment gap has narrowed in the UK since 1998. [ABSTRACT FROM AUTHOR]

There is ongoing debate regarding the shape of life-course trajectories in mental health. Many argue the relationship is U-shaped, with mental health declining with age to mid-life, then improving. However, I argue that these models are beset by the age–period–cohort (APC) identification problem, whereby age, cohort and year of measurement are exactly collinear and their effects cannot be meaningfully separated. This means an apparent life-course effect could be explained by cohorts. This paper critiques two sets of literature: the substantive literature regarding life-course trajectories in mental health, and the methodological literature that claims erroneously to have ‘solved’ the APC identification problem statistically (e.g. using Yang and Land's Hierarchical APC–HAPC-model). I then use a variant of the HAPC model, making strong but justified assumptions that allow the modelling of life-course trajectories in mental health (measured by the General Health Questionnaire) net of any cohort effects, using data from the British Household Panel Survey, 1991–2008. The model additionally employs a complex multilevel structure that allows the relative importance of spatial (households, local authority districts) and temporal (periods, cohorts) levels to be assessed. Mental health is found to increase throughout the life-course; this slows at mid-life before worsening again into old age, but there is no evidence of a U-shape – I argue that such findings result from confounding with cohort processes (whereby more recent cohorts have generally worse mental health). Other covariates were also evaluated; income, smoking, education, social class, urbanity, ethnicity, gender and marriage were all related to mental health, with the latter two in particular affecting life-course and cohort trajectories. The paper shows the importance of understanding APC in life-course research generally, and mental health research in particular. [ABSTRACT FROM AUTHOR]

Censuses have traditionally been a key source of localised information on the state of a nation's health. Many countries are now adopting alternative approaches to the traditional census, placing such information at risk. The purpose of this paper is to inform debate about whether existing social surveys could provide an adequate 'base' for alternative model-based small area estimates of health data in a post traditional census era. Using a case study of 2011 UK Census questions on self-assessed health and limiting long term illness, we examine the extent to which the results from three large-scale surveys - the Health Survey for England, the Crime Survey for England and Wales and the Integrated Household Survey - conform to census output. Particularly in the case of limiting long term illness, the question wording renders comparisons difficult. However, with the exception of the general health question from the Health Survey for England all three surveys meet tests for convergent validity. [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]

There is extensive evidence to suggest that social support improves breastfeeding outcomes. Building on this evidence-base, public health services and interventions aiming to improve breastfeeding rates have primarily targeted informational and emotional support to mothers, reflecting an individual behaviour-change approach. However, mothers exist within a wider social network, and the characteristics of their broader support networks may be an important predictor of breastfeeding outcomes. Here we explore the typologies of postnatal support for mothers in the UK; a population with one of the lowest breastfeeding rates in Europe. Using retrospective data from an online survey (data collection period December 2017 - February 2018), we carry out a latent class regression (n = 432) to identify "clusters" of postnatal support in our data. Mothers in our sample were most likely to report receiving practical and emotional support from partners and maternal grandmothers, and breastfeeding information from health professionals. We identify three distinct typologies of postnatal support: 1) Extensive support, where mothers received support from a wide range of supporters including partners, maternal grandmothers, friends and health professionals, but mothers were the only ones to feed the infant; 2) Family support, where mothers received support from partners and maternal grandmothers, including with infant feeding, but less likely to receive support from health professionals; and 3) Low support, where mothers primarily received support from partners. 94% of women with extensive support were predicted to be breastfeeding at two months, followed by 48% of mothers in the low support group, and 13% in the family support group. Our findings highlight the complexities of family support and its potential impact on breastfeeding, as well as the significance of professional support. Overall, our results hint at the potential value for health professionals to engage with wider family in order to achieve extensive support for mothers. We identify three types of postnatal support networks in our sample of UK mothers. "Extensive support" mothers were supported by family, friends and professionals. "Family support" mothers were mainly supported by family; less so by professionals. "Low support" mothers reported lower support across all potential supporters. Mothers who breastfed for > two months were most likely to report extensive support. [ABSTRACT FROM AUTHOR]

The share of workers who work part-time because full-time jobs are not available remains larger compared to the period prior to the 2008 crisis. For part-time workers, being available to work more hours than offered may have negative mental health implications. Drawing on two nationally representative British surveys, we tested whether working less than 30 hours per week while preferring to work longer hours (underemployment) is associated with increased psychological distress. Distress was assessed using responses to the 12-item General Health Questionnaire in both samples. In the National Child Development Study (N = 6,295), propensity score estimates indicated that the hours-underemployed workers experienced higher levels of psychological distress (β = 0.25, p <0.001) than full-time workers matched on observable characteristics, including prior distress levels. Fixed effects estimates using 18 years of the British Household Panel Survey (N = 8,665) showed that transitioning from full-time employment to underemployment predicted an increase in distress levels (β = 0.19, p <0.01). Conversely, transitioning from underemployment to full-time employment forecasted a reduction in distress (β = -0.18, p <0.001). On average, job earnings and perceptions of job security explained a small (≈ 10%) portion of the potential psychological impact of hours-underemployment. These findings highlight the possibility that underemployment among part-time workers may have detrimental psychological consequences. Policy interventions geared towards improving career opportunities for part-time workers would potentially ameliorate losses in psychological well-being experienced by this group. • Examined underemployment defined as part-time workers preferring to work more hours. • Underemployment predicts increases in distress in matched sample of workers. • Moving to underemployment predicts elevated distress in fixed-effect models. • Underemployment effect is comparable to distress increases after job loss. • Returning to full-time work may reverse the effect of underemployment. [ABSTRACT FROM AUTHOR]

Mental health and its complexity, measurement and social determinants are increasingly important avenues of research for social scientists. Quantitative social science commonly investigates mental health as captured by population screening metrics. One of the most common of these metrics is the 12-Item General Health Questionnaire (GHQ-12). Despite itscanonical use as an outcome of interest in social science, the traditional use of the summed scores of summed questionnaires carries empirical and substantive assumptions which are often not fully considered or justified in the research. We outline the implications of these assumptions and the restrictions imposed by traditional modelling techniques and advocate for a more nuanced approach to population mental health modelling and inference. We use novel Exploratory Structural Equation Modelling (ESEM) on a large, representative UK sample taken from the first wave of the Understanding Society Survey, totalling 40,452 respondents. We use this to exemplify the potential of traditional, restrictive assumptions to bias conclusions and policy recommendations. ESEM analysis identifies a 4-factor structure for the GHQ-12, including a newly proposed "Emotional Coping" dimension. This structure is then tested against leading proposed factor structures from the literature and is demonstrated to perform better across all metrics, under both Maximum Likelihood and Bayesian estimation. Moreover, the proposed factors are more substantively dissimilar than those retrieved from previous literature. The results highlight the inferential limitations of using simple summed scores as population health outcomes. We advocate for the use of the highlighted methods, which in combination with population studies offer quantitative social scientists the opportunity to explore predictors and patterns of underlying processes of population mental health outcomes, explicitly addressing the complexity and measurement error inherent to mental health analysis. • Modelling the GHQ-12 as unidimensional is very likely to reduce inferential power. • Bayesian and ESEM are demonstrated to offer methodological solutions to this issue. • We derived a four-factor GHQ-12 structure for Wave 1 of Understanding Society. • This structure contains two dimensions not evidenced before in UK survey context. • This structure outperforms previous canonical GHQ-12 structures. [ABSTRACT FROM AUTHOR]