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In two longitudinal studies, we examined to what extent teacher-rated social competence, emotional maturity, and language and cognitive development in kindergarten (measured with the Early Development Instrument, EDI; Janus & Offord, 2007) are associated with children's self-reported social relations with peers, emotional well-being (measured with the Middle Years Development Instrument, MDI; Schonert-Reichl et al., 2013), and numeracy and literacy (assessed with standardized achievement tests) in middle childhood. The studies were conducted using population-based data linkages (N > 7000) from Western Canada. Using multilevel regression analyses, we found that teacher-rated social competence in kindergarten most strongly predicted 4th graders' self-report of their connectedness to peers, and emotional maturity most strongly predicted emotional well-being. Teacher-rated cognitive and language development in kindergarten most strongly predicted 4th graders' standardized numeracy and literacy test results. We discuss our results with regard to previous findings in the literature, and address methodological and conceptual challenges in regard to examining children's early development across interdependent domains.

This paper examines school readiness profiles of kindergarten children for the largest language groups in British Columbia, Canada. School readiness data were drawn from a population-level database that contains teacher ratings of children's school readiness, obtained via the Early Development Instrument (EDI; Janus & Offord, 2007 ). School readiness profiles (N = 95,537) were compared according to children's home language background (English, Cantonese, Mandarin, Punjabi, and Tagalog) serving as a proxy for cultural/ethno-cultural background, and gender (49% female). Furthermore, children speaking Cantonese, Mandarin, Punjabi, or Tagalog as their home language were divided into monolingual and bilingual groups according to their English proficiency, using administrative records of children’s home language and English Language Learner (ELL) status. Analyses were conducted via multilevel modeling, controlling for the nested structure of the data (children within classrooms) and for children's families’ socioeconomic status (i.e., income). The most prominent findings were that bilingual children were rated higher than the overall average on virtually every aspect of school readiness. Cantonese and Mandarin speaking children were rated most highly on pre-academic skills, and Punjabi-speaking children on emotional and social competencies and behaviors. English Language Learners in all language groups were rated as being more shy and reluctant to display socially scripted behaviors than non-English Language Learners.

The goals of this study were to longitudinally examine the association between social and emotional competence (SEC) and academic achievement in early adolescence, exploring the moderating role of gender in this relation. Using a short-term longitudinal design, self- and teacher-reported indicators of SEC were used to predict early adolescents' (N = 461, Mean age = 12.02 years, SD = 0.41, 47% female) achievement in math and reading on a standardized achievement test in grade 7. As hypothesized, teacher-reported SEC in sixth grade significantly predicted higher scores in math and reading on the standardized test in seventh grade. A significant interaction between self-reported SEC and gender in predicting reading scores indicated that SEC was a significant positive predictor for reading outcomes in boys only. Self-reported SEC was not significantly related to math achievement. Results are discussed in line with the literature and practical implications of the findings are discussed.

Life-course associations among cortisol, cognitive development and educational attainment in the general population are not well understood. Using the 1958 British birth cohort, our aim was to establish whether cortisol patterns at age 45y are associated with childhood cognition and qualification level by adulthood. We measured salivary cortisol in 6527 individuals, 45min after waking (t(1)) and 3h later (t(2)). To identify lack of morning cortisol peak and diurnal rhythm, we defined groups with: (a) t(1) cortisol in the bottom 5% of the distribution, or (b) 'flat't(1)-t(2) cortisol. Data on cognitive tests at ages 7, 11 and 16y and educational level were used. All childhood cognitive tests (maths, reading, verbal and non-verbal ability) were inversely associated, although not always significantly, with low t(1) and flat t(1)-t(2) cortisol. For example, at age 11 for males, a standard deviation (SD) increase in maths score was associated with a 28% decreased odds for lowest t(1) cortisol, and with a 13% decreased odds of flat t(1)-t(2) cortisol. Associations for lowest t(1) and flat t(1)-t(2) cortisol were attenuated after adjustment for qualification level at 33y among males, although adjustment for childhood socio-economic position had little effect. Weaker associations for lowest t(1) cortisol among females were either unchanged or strengthened after adjustment for qualification level. Our results for males, but less so for females, are compatible with a causal relationship in either direction, namely from cortisol to cognitive ability or vice versa.

Summary The influence of adversity over long periods of the life-span on adult cortisol metabolism is not established. We assess whether morning cortisol levels are associated with socio-economic position (SEP) from birth to mid-adulthood, and if so, whether the association is due primarily to SEP in childhood, adulthood or both. Data are from 6335 participants in the 1958 British birth cohort, with salivary cortisol samples collected at 45 yr. Two saliva samples were obtained on the same day: 45 min post-waking (t1) and 3 h later (t2). Median t1 and t2 cortisol values were 18.80 and 7.10 nmol/l for men; 19.60 and 6.60 nmol/l for women. Three outcomes were constructed: (1) extreme t1 cortisol (top and bottom 5%), (2) area-under-curve (AUC), and (3) abnormal t1–t2 pattern. All three outcomes were associated with lifetime SEP but the relative contribution of childhood and adulthood SEP varied by outcome measure. Our results suggest that the impact of less advantaged SEP over a lifetime would lead to an approximate doubling of the proportion of extreme post-waking cortisol levels for both sexes; an 8% and 10% increase, respectively for females and males in AUC, and an increased risk of having an abnormal cortisol pattern of 60% and 91%. SEP differences were independent of time of waking and sample collection, and in most instances, remained after adjustment for smoking and body mas index (BMI). Thus, our study provides evidence for effects of chronic adversity on cortisol in mid-adult life.

This paper uses a comparative case study of Canada and the USA to argue that, in order to fully understand the associations between population health and the socioeconomic environment we must begin to place importance on the dynamic aspect of these factors--examining them as they evolve over time. In particular, for institutional and policy shifts that often unfold over decades, population health must attend to these big, slow moving processes by adopting a historical perspective to the knowledge base. We compare Canada and the USA on basic health outcomes and a range of determinants of health for which routine data have been collected for all or most of the period between 1950 and the present. During the analysis that follows, we are able to establish that, at the level of society (i) greater economic well being and spending on health care does not yield better health outcomes, that (ii) public provision and income redistribution trump economic success where population health is concerned, and (iii) that the gradual development of public provision represents the buildup of social infrastructure that has long-lasting effects on health status. Our case study shows what can be gleaned from a comparative perspective and a long-term view. The long view allows us to detect the gradual divergence in health status between these two societies and to trace potential institutional causes that would otherwise go unnoticed. The perspective introduced here, and in particular the comparison of Canada and the USA, provides strong support for the use of cross-national comparative work, and a historical perspective on the investigation of societies that successfully support population health.

To establish whether effects of birth weight and socioeconomic position on cognition are explained or modified by home or learning environments.Prospective birth cohort (n = 13,980) with math tests at 7, 11, and 16 years of age and qualifications by 33 years of age.For 1 kg increase in birth weight, 7-year math Z score increased 0.23 (0.19 adjusted for parental interest in child's progress) and adult qualifications increased 0.22 (on a 5-point scale). Maternal reading benefited math less among lower than higher birth weights (p.05). The birth weight effect remained unchanged 7 to 16 years of age. For each increment in social class (4 categories; IVV to III), 7-year math increased 0.19 (0.12 adjusted for parental interest). Benefits of mother's reading and father's interest were greatest in classes IVV (interaction p.05). The difference in Z scores between classes III to IVV was 0.57 at 7 years; 1.12 at 16 years of age. Estimates were little affected by home and school factors. Adult qualifications increased 0.40 per unit social class (0.33 adjusted for parental interest). Maternal interest reduced the chances of those from unskilled manual origins gaining few qualifications (p.05). Similarly, interactions were seen for maternal reading and paternal interest.Influences in the home partly underlie associations between social background and cognition, but they do little to explain a birth weight/cognition association.

Many diseases that emerge in adult life have their origins much earlier in the life course. Influences on adult health status occur through latent, pathway and cumulative effects of experiences earlier in life. Latency refers to relationships between an exposure at one point in the life course and a health outcome years or decades later, irrespective of intervening experience. Cumulative refers to multiple exposures over the life course, whose effects on health combine. Pathways are dependent sequences in which an exposure at one stage of the life course influences the probability of other exposures later in the life course, which are the proximate causes of disease expression. The emergence of socioeconomic differences in health status across the life course may be understood as an outcome of the interplay between the developing human, who has particular prospects and vulnerabilities at each point in the life course, and the latent, pathway, and cumulative influences found in their daily living conditions in society. Without consideration of both childhood and adult life experiences, policies designed to improve health status will tend to overlook root causes. Health policies should be based on an understanding that problems emerging today may be related to life experiences years and decades earlier.

Rapidly expanding economies, such as the post-war Tiger Economies, are associated with increasing health and rapidly contracting economies, such as Central and Eastern Europe in the early 1990s, are associated with declining health. In Central and Eastern Europe health decline in association with economic contraction has been mediated by changes in income distribution and, also, by health-determining aspects of civil society. The nations of Central and Eastern Europe are an example of swift economic and political transformation occurring concurrently with economic decline; with increasing disparity in income distributions; and with high levels of distrust in civil institutions. Concurrent with these declines was a marked reduction in health status, described here in terms of life expectancy. Conversely, the nations of Southeast Asia experienced rapid economic growth and increasing life expectancies. Though data are scarce, the experience of the Tiger Economies appears to be one of economic growth; a virtuous cycle of increased investment in education and housing; and increasing parity in income distribution based upon a relatively equitable distribution of returns on education.

This report presents the process and summative evaluation results from a community-based diabetes prevention and control project implemented in response to the increasing prevalence and impact of non-insulin-dependent diabetes mellitus (NIDDM) in the Canadian Aboriginal population. The 24-month project targeted the registered Indian population in British Columbia's rural Okanagan region. A participatory approach was used to plan strategies by which diabetes could be addressed in ways acceptable and meaningful to the intervention community. The strategies emphasised a combination of changing behaviours and changing environments. The project was quasi-experimental. A single intervention community was matched to two comparison communities. Workers in the intervention community conducted interviews of individuals with or at risk for diabetes during a seven-month pre-intervention phase (n = 59). Qualitative analyses were conducted to yield strategies for intervention. Implementation began in the eighth month of the project. Trend measurements of diabetes risk factors were obtained for 'high-risk' cohorts (persons with or at familial risk for NIDDM) (n = 105). Cohorts were tracked over a 16-month intervention phase, with measurements at baseline, the midpoint and completion of the study. Cross-sectional population surveys of diabetes risk factors were conducted at baseline and the end of the intervention phase (n = 295). Surveys of community systems were conducted three times. The project yielded few changes in quantifiable outcomes. Activation of the intervention community was insufficient to enable individual and collective change through dissemination of quality interventions for diabetes prevention and control. Theory and previous research were not sufficiently integrated with information from pre-intervention interviews. Interacting with these limitations were the short planning and intervention phases, just 8 and 16 months, respectively. The level of penetration of the interventions mounted was too limited to be effective. Attention to process is warranted and to the feasibility of achieving effects within 24 months.

Russia has the lowest life expectancy among industrialised countries, but little is known about other health outcomes and determinants of health in the Russian population. Here we report a cross-sectional study in a national sample of the Russian population of social and psychosocial determinants of two self-reported health indicators: self-rated health (shown to predict mortality in prospective studies) and physical functioning (validated against more objective health measures). A multi-stage sample of the Russian population aged 18 years and more was interviewed (n=1599, response rate 66%). The questionnaire included political attitudes, social and economic circumstances, psychosocial factors, smoking, alcohol consumption, self-rated health and physical functioning (from the SF36 instrument). Scores of perceived control over life and over one's health were calculated from 6 and 3 questions, respectively. Data were analysed in logistic regression for two dichotomised outcomes: poor self-rated health (worse than average) and low physical functioning (less than 60% of maximum). Overall, 25% of subjects rated their health as worse than average; this is substantially more than in western countries. Perceived control over life was strongly related to both outcomes; age- and sex-adjusted OR for 1 standard deviation increase in control were 0.60 (95% CI 0.52-0.69) for poor self-rated health and 0.67 (0.57-0.81) for low physical functioning. Adjustment for a battery of other factors reduced these estimates only slightly. Associations between control over one's health and both outcomes were also significant, but weaker and attenuated in multivariate models. Material deprivation was also strongly related to both outcomes. Education was inversely related to self-rated health, and unmarried men reported poor physical functioning substantially more often. Subjects not approving the economic changes reported poorer health but this association was removed by adjustment for socioeconomic factors and control. Subjects who could not rely on informal social structures when in problems reported worse health; this effect largely persisted in multivariate analyses. These results are consistent with the hypothesis that poor health status in Russia is related to dysfunction of social structures, socioeconomic deprivation, and lack of perceived control. The absence of informal social networks, vital for maintaining general welfare, seems to affect adversely self-rated health. Deprivation and low perceived control may be important mediators between the broad social environment and health in populations undergoing transition and can provide a useful framework for many biological and behavioural factors. Prospective studies are needed to address the issue of temporality and reporting bias, the major problems in interpreting these findings.

It has been hypothesized that senile cataract may serve as a marker for generalised tissue aging, since structural changes occurring in the proteins of the lens during cataract formation are similar to those which occur elsewhere as part of the aging process. An earlier analysis we carried out to test this hypothesis revealed a strong age-dependent relationship between undergoing cataract surgery and subsequent mortality. Relative risks for dying over 9 yr of follow-up were particularly increased for individuals who had developed cataract requiring operation between the ages of 50-65. This finding prompted us to test the hypothesis that younger patients undergoing surgery for cataract (those in which surgery was undertaken at 50-65 yr of age) would tend disproportionately to be resident in areas of generally lower socioeconomic status. A population-based linked health data resource containing data on all hospital separations in the province of British Columbia was used to examine this hypothesis. Linkage to Canadian census data was used to assign a socioeconomic decile to the area of residence for all individuals in British Columbia who either did, or did not, undergo cataract surgery over a 3 yr period, and were aged 50-95. Relative to those who resided in the highest socioeconomic areas, odds ratios for undergoing cataract surgery between 50 and 65 yr of age were significantly greater than 1 for the four lowest socioeconomic deciles. This association was observed despite a conservative bias in our setting that favoured those of higher socioeconomic status tending to receive earlier treatment. The results of this ecologic study prompt consideration of whether factors which have the dual attributes of being correlates of socioeconomic status and implicated in the development of cataract may play a role in mediating the processes involved in the well known association of socioeconomic status and mortality.

Forestry has been the major industry in British Columbia for the last century. There has been concern that by-products of pulp and paper production and chlorophenol fungicides used in sawmills may present opportunities for residents to be environmentally or occupationally exposed to polychlorinated dibenzo-p-dioxins and dibenzofurans. To examine this possibility, dioxin and furan levels were measured in the adipose tissue of 41 British Columbians selected to match the age and sex distribution of the population and compared with levels in exposed and unexposed populations reported in the literature. Concentrations of dioxins and furans in the adipose tissue of the study subjects were in general very low, on the order of parts per trillion (pg/g lipid) for all furans and for dioxins with low levels of chlorination. Dioxin and furan levels in the British Columbia study group were similar to those of residents of other parts of Canada and to those of industrial populations not known to have direct exposure. Personal characteristics of the study subjects, including age, sex, weight, diet, area of residence, and occupation, were examined to determine whether these factors were related to dioxin and furan levels. Of these, only age showed a consistent effect; dioxin and most furan concentrations increased with age. Residence in a pulp mill town did not influence dioxin and furan concentrations. Additional investigations would be required to determine the effects of occupation and other locations of residence on dioxin concentrations in British Columbia residents.

Several types of data are presented concerning the reliability of counting or estimating the density of nevi (moles), a major risk factor for melanoma, using methods typically employed in epidemiologic studies. First, interviewer-derived counts of nevi on the arm produced estimates of inter-observer, inter-subject, temporal and random variability, and their interactions. Second, interviewer-derived arm counts and respondent self-reports of whole body nevus density were compared. Finally, we compared male and female cases and controls with respect to their reported rates of having a relative with a malignant mole. Overall, the intra-observer reliability ranged from 55 to 81%, and was better for observers with more experience. The correlation between the interviewer counts and respondents' self-reported estimates was 0.41. The data on malignant moles in relatives suggest higher reporting rates in male cases and lower reporting in male controls relative to their female counterparts, but there is little difference by sex in the reporting of one's own nevus density.

Between 1969 and 1985, the British Columbia hospital system allocated an increasing proportion of the province's total hospital days to elderly patients who stayed for 60 days or more. By 1985/86, long stay patients accounted for almost 50% of all days. In this paper, we explore the diagnoses which contributed the greatest number of patient days of increase among the elderly as a first step in evaluating the appropriateness of this response to the pressures of an aging population. Patient days of increase were not distributed smoothly across a large number of diagnoses, but could be explained by a small number of chronic conditions. Most important were conditions related to senility and senile dementia, the chronic sequelae of heart disease and stroke, and persons awaiting admission to adequate facilities elsewhere. Eighty percent of the increases were seen in extended care and rehabilitation beds and 20% in acute care beds. Seventy-seven percent of the increased patient days were attributable to females and only 23% to males. Since the major sources of increase in patient days were not related to conditions for which new, effective hospital care modalities are available, they call into question the appropriateness of the system's response to the health care needs of the elderly population.