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STUDY OBJECTIVE: To describe the mental health of men and women with differing histories of partnership transitions. DESIGN: Data from nine waves of the British Household Panel Survey, a stratified general population sample, were used to calculate age standardised ratios and 95% confidence intervals for mean General Health Questionnaire scores for groups with different partnership transition histories. PARTICIPANTS: 2127 men and 2303 women aged under 65 who provided full interviews at every survey wave. MAIN RESULTS: Enduring first partnerships were associated with good mental health. Partnership splits were associated with poorer mental health, although the reformation of partnerships partially reversed this. Cohabiting was more beneficial to men's mental health, whereas marriage was more beneficial to women's mental health. The more recently a partnership split had occurred the greater the negative outcome for mental health. Women seemed more adversely affected by multiple partnership transitions and to take longer to recover from partnership splits than men. Single women had good mental health relative to other women but the same was not true for single men relative to other male partnership groups. CONCLUSIONS: Partnership was protective of mental health. Mental health was worse immediately after partnership splits, and the negative outcomes for health were longer lasting in women. Future work should consider other factors that may mediate, confound, or jointly determine the relation between partnership change and health. [ABSTRACT FROM AUTHOR]

Purpose: Educational attainment is associated with multiphysiological wear and tear. However, associations with measures of socioeconomic position (SEP) across different life-stages are not established., Methods: Using regression models and data from 8105 participants from the UK Household Longitudinal Study (Understanding Society), we examined associations of lifecourse SEP with an overall biological health score (BHS). BHS is broader than usual measures of biological 'wear and tear' and is based on six physiological subsystems (endocrine, metabolic, cardiovascular, inflammatory/immune, liver, and kidney), with higher scores indicating worse health. Lifecourse SEP was based on respondents' parental, first, and most recent occupations., Results: Associations with SEP at all life-stages demonstrated higher BHS with increasing disadvantage (e.g. slope index of inequality (SII) (95 % CI) for most recent SEP: 0.04 (0.02, 0.06)). There was little difference in the magnitude of associations for SEP measured at each life-stage. Cumulative disadvantage across the lifecourse showed a stepped association with increasing BHS (SII (95 % CI): 0.05 (0.04, 0.07)). Associations were largely driven by metabolic, cardiovascular, and inflammatory systems., Conclusion: Our results suggest that disadvantaged SEP across the lifecourse contributes cumulatively to poorer biological health, highlighting that every life-stage should be a target for public health policies and intervention., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 University of Glasgow. Published by Elsevier Inc. All rights reserved.)

Gender role attitudes have been found to be associated with the mental health of adults and adolescents, but little is known about whether parents' gender attitudes are associated with their children's mental health. Using data from Understanding Society, the UK Household Longitudinal Study (UKHLS), a large-population representative sample, we examine the links between parental gender role attitudes and child mental health outcomes as measured by the total and five components of the strengths and difficulties questionnaire (SDQ). We construct structural equation models, separately for mothers and for fathers and for children aged 5 and 8, and adjust for key sociodemographic variables. We find that children aged 5 years exhibit fewer emotional and peer relationship problems and are more prosocial when their mothers have more egalitarian (compared to traditionalist) gender role attitudes. We also find that children are more prosocial at age 8 when their mothers have more egalitarian gender role attitudes. No statistically significant mediation effect is observed via maternal parenting behaviour. Fathers' more egalitarian gender role attitudes were associated with higher hyperactivity at age 5 and more prosocial behaviour at age 8. Further, engaging in less negative parenting behaviour completely mediates the association of fathers' more egalitarian gender attitudes with children's mental health across the majority of the SDQ scales. This suggests that parental gender attitudes may be a possible target for the prevention of mental health difficulties among children; however, future research will be required to examine the extent to which the associations we identified reflect causality., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: There are concerns that child mental health inequalities may have widened during the COVID-19 pandemic. We investigated whether child mental health inequalities changed in 2020/2021 compared with prepandemic., Methods: We analysed 16 361 observations from 9272 children in the population representative UK Household Longitudinal Study. Child mental health was measured using the Strengths and Difficulties Questionnaire (SDQ) at ages 5 and 8 years in annual surveys 2011-2019, and at ages 5-11 years in July 2020, September 2020 and March 2021. Inequalities in cross-sectional SDQ scores among 5 and 8 year olds, before and during the pandemic, were modelled using linear regression. Additionally, interactions between time (before/during pandemic) and: sex, ethnicity, family structure, parental education, employment, household income and area deprivation on mental health were explored., Results: A trend towards poorer mental health between 2011 and 2019 continued during the pandemic (b=0.12, 95% CI 0.08 to 0.17). Children with coupled, highly educated, employed parents and higher household income experienced greater mental health declines during the pandemic than less advantaged groups, leading to narrowed inequalities. For example, the mean difference in child SDQ scores for unemployed compared with employed parents was 2.35 prepandemic (1.72 to 2.98) and 0.02 during the pandemic (-1.10 to 1.13). Worse scores related to male sex and area deprivation were maintained. White children experienced worse mental health than other ethnicities, and greater declines during the pandemic., Conclusion: Mental health among UK 5 and 8 year olds deteriorated during the pandemic, although several inequalities narrowed. Interventions are needed to improve child mental health while ensuring inequalities do not widen., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: Unpaid carers who look after another member of their household (home-carers) have poorer mental health than the general population. The first COVID-19 national lockdown led to an increasing reliance on home-carers and we investigate the short- and longer-term impacts of lockdown on their mental health., Methods: Data from 9737 adult participants (aged 16+) from the UK Household Longitudinal Study (Understanding Society) were used to explore changes in 12-item General Health Questionnaire (GHQ-12) score between (a) pre-pandemic (2019) and early lockdowns (April 2020) and (b) early and later (July 2020) lockdowns., Results: GHQ-12 scores among home-carers were higher pre-lockdown and increased more than for non-carers from 2019 to April 2020 with further increases for home-carers compared with non-carers between April and July. Compared with respondents caring for a spouse/partner, those caring for a child under 18 had a particularly marked increase in GHQ-12 score between 2019 and April, as did those caring for someone with a learning disability. Home-carers of children under 18 improved from April to July while those caring for adult children saw a marked worsening of their mental health. Home-carers with greater care burden saw larger increases in GHQ-12 score from 2019 to April and from April to July, and increases through both periods were greater for home-carers who had formal help prior to lockdown but then lost it., Conclusions: The mental health of home-carers deteriorated more during lockdown than non-carers. Policies that reinstate support for them and their care-recipients will benefit the health of both vulnerable groups.

Research suggests that individuals living in more disadvantaged neighbourhoods experience higher levels of stress but this has generally been based on self-reported stress. We used survey-based neighbourhood quality indicators and biomarker data from Understanding Society, linked to census and crime statistics to explore associations of allostatic load (AL), an objective biomarker-based measure of cumulative stress, with subjective and objective neighbourhood characteristics. Analyses of 6887 respondents living in England show greater AL among those living in more disadvantaged areas, with objective measure associations stronger than subjective. Neighbourhood inequalities in AL were lower among respondents with higher individual SEP. These results suggest that individual-level SEP mitigates against the impact of negative, particularly objective, neighbourhood characteristics. Policies to reduce health inequalities should consider both individual and neighbourhood circumstances., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Socioeconomic inequalities are well established across health, morbidity and mortality measures. Social class theory describes how social groups relate, interact and accrue advantages/disadvantages relative to one another, with different theorists emphasising different dimensions. In the context of health inequalities, different social class measures are used interchangeably to rank population groups in terms of health rather than directly exploring the role of social class in creating inequalities. We aim to better understand how four distinct social class mechanisms explain differences in a range of self-reported and biological health outcomes., Methods: We use data from the UK Household Longitudinal Study, a representative population survey of UK adults, to identify measures pertaining to Early years, Bourdieusian, Marxist, and Weberian social class mechanisms. Using logistic and least-squares regression we consider the relative extent to which these mechanisms explain differences in health (Self-reported health, SF12 Physical (PCS) and Mental (MCS) Component Scores, General Health Questionnaire; N = 21,446) and allostatic load, a biomarker-based measure of cumulative stress (N = 5003)., Results: Respondents with higher social position according to all social class measures had better self-rated, physical and mental health, and lower allostatic load. Associations with Marxist social class were among the strongest (e.g. Relative Index of Inequality for very good/excellent self-rated health comparing highest versus lowest Marxist social class: 4.96 (4.45, 5.52), with the Weberian measure also strongly associated with self-rated (4.35 (3.90, 4.85)) and physical health (Slope Index of Inequality for SF12-PCS: 7.94 (7.39, 8.48)). Health outcome associations with Bourdieusian and Marxist measures were generally stronger for women and older respondents, and physical health associations with all measures were stronger among those aged 50+ years., Conclusions: The impact of social class on health is multi-faceted. Policies to reduce health inequalities should focus more on unequal capital ownership, economic democracy and educational inequalities, reflecting Marxist and Weberian mechanisms., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The COVID-19 pandemic in the UK and subsequent lockdown may have affected the mental health of the population. This study examines whether there was an increase in the prevalence and incidence of common mental disorders (CMD) in the UK adult population during the first months of lockdown and whether changes in CMD were associated with stressors related to the pandemic and lockdown., Methods: Longitudinal data from the UK Household Longitudinal Study waves 10-11: 2019-2020 and waves 1-4 of the COVID-19 monthly surveys in April ( n = 17 761) to July 2020 ( n = 13 754), a representative sample of UK adult population, were analysed. CMD was measured using the 12-item General Health Questionnaire (GHQ-12) (cut-off >2). Changes in CMD were analysed in relation to COVID-19 and social stressors., Results: Around 29% of adults without CMD less than a year earlier had a CMD in April 2020. However, by July 2020, monthly incidence of CMD had reduced to 9%. Most employment, financial and psychological 'shocks' were at their highest levels in April and reduced steadily in later months. Despite the lifting of some lockdown conditions by July, stressors related to loneliness, unemployment, financial problems and domestic work continued to influence CMD., Conclusion: Some COVID-19 policy responses such as furloughing may have been effective in mitigating the increase in CMD for some groups of employees. Despite some reduction in levels of pandemic and lockdown-related stressors by the middle of 2020, loneliness and financial stressors remained key determinants of incidence in CMD among the UK adult population.

Background: There are concerns that COVID-19 mitigation measures, including the 'lockdown', may have unintended health consequences. We examined trends in mental health and health behaviours in the UK before and during the initial phase of the COVID-19 lockdown and differences across population subgroups., Methods: Repeated cross-sectional and longitudinal analysis of the UK Household Longitudinal Study, including representative samples of over 27,000 adults (aged 18+) interviewed in four survey waves between 2015 and 2020. A total of 9748 adults had complete data for longitudinal analyses. Outcomes included psychological distress (General Health Questionnaire-12), loneliness, current cigarette smoking, use of e-cigarettes and alcohol consumption. Cross-sectional prevalence estimates were calculated and multilevel Poisson regression assessed associations between time period and the outcomes of interest, as well as differential associations by age, gender, education level and ethnicity., Results: Psychological distress increased 1 month into lockdown with the prevalence rising from 19.4% (95% CI 18.7% to 20.1%) in 2017-2019 to 30.6% (95% CI 29.1% to 32.3%) in April 2020 (RR=1.3, 95% CI 1.2 to 1.4). Groups most adversely affected included women, young adults, people from an Asian background and those who were degree educated. Loneliness remained stable overall (RR=0.9, 95% CI 0.6 to 1.5). Smoking declined (RR=0.9, 95% CI=0.8,1.0) and the proportion of people drinking four or more times per week increased (RR=1.4, 95% CI 1.3 to 1.5), as did binge drinking (RR=1.5, 95% CI 1.3 to 1.7)., Conclusions: Psychological distress increased 1 month into lockdown, particularly among women and young adults. Smoking declined, but adverse alcohol use generally increased. Effective measures are required to mitigate negative impacts on health., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Background: Smoking contributes significantly to socioeconomic health inequalities. Vaping has captured much interest as a less harmful alternative to smoking, but may be harmful relative to non-smoking. Examining inequalities in vaping by smoking status, may offer insights into potential impacts of vaping on socioeconomic inequalities in health., Methods: Data were from 3291 youth (aged 10-15) and 35,367 adults (aged 16+) from wave 7 (2015-17) of the UK Household Longitudinal Study. In order to adjust for biases that could be introduced by stratifying on smoking status, marginal structural models were used to estimate controlled direct effects of an index of socioeconomic disadvantage (incorporating household education, occupation and income) on vaping by smoking status (among adults and youth), adjusting for relevant confounders and for selection into smoking states. We also estimated controlled direct effects of socioeconomic disadvantage on being an ex-smoker by vaping status (among adult ever-smokers; n = 18,128)., Results: Socioeconomic disadvantage was associated with vaping among never smoking youth (OR for a unit increase in the socioeconomic index: 1.17; 95%: 1.03-1.34), and among ex-smoking adults (OR: 1.17; 95% CI: 1.09-1.26), with little to no association among never smoking (OR: 0.98; 95% CI: 0.91-1.07) and current smoking (OR: 1.00; 95% CI: 0.93-1.07) adults. Socioeconomic disadvantage was also associated with reduced odds of being an ex-smoker among adult ever-smokers, but this association was moderately weaker among those who vaped (OR: 0.88; 95% CI: 0.82-0.95) than those who did not (OR: 0.82; 95% CI: 0.80-0.84; p-value for difference = 0.081)., Conclusions: Inequalities in vaping among never smoking youth and adult ex-smokers, suggest potential to widen health inequalities, while weaker inequalities in smoking cessation among adult vapers indicate e-cigarettes could help narrow inequalities. Further research is needed to understand the balance of these opposing potential impacts, and how any benefits can be maximised whilst protecting the vulnerable.

Objectives: To assess whether educational differentials in three key physical activity (PA) domains vary by age, sex and ethnicity., Design: National cross-sectional survey., Setting: UK., Participants: Altogether 40 270 participants, aged 20 years and over, from the UK Household Longitudinal Study with information on education, PA and demographics collected in 2013-2015., Outcome Measures: Participation in active travel (AT), occupational activity (OA) and leisure time physical activity (LTPA) at the time of assessment., Results: Lower educational attainment was associated with higher AT and OA, but lower weekly LTPA activity; these associations were modified by sex, ethnicity and age. Education-related differences in AT were larger for women-the difference in predicted probability of activity between the highest and the lowest education groups was -10% in women (95% CI: -11.9% to 7.9%) and -3% in men (-4.8% to -0.4%). Education-related differences in OA were larger among men -35% (-36.9% to -32.4%) than women -17% (-19.4% to -15.0%). Finally, education-related differences in moderate-to-vigorous LTPA varied by ethnicity; for example, differences were 17% (16.2% to 18.7%) for white individuals compared with 6% (0.6% to 11.6%) for black individuals., Conclusions: Educational differences in PA vary by domain and are modified by age, sex and ethnicity. A better understanding of physically inactive subgroups may aid development of interventions to both increase activity levels and reduce health inequalities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: Lung function is lower in people with disadvantaged socio-economic position (SEP) and is associated with hazardous health behaviours and exposures. The associations are likely to be interactive, for example, exposure to socially patterned environmental tobacco smoke (ETS) in childhood is associated with an increased effect of smoking in adulthood. We hypothesise that disadvantaged childhood SEP increases susceptibility to the effects of hazards in adulthood for lung function. We test whether disadvantaged childhood SEP moderates smoking, physical activity, obesity, occupational exposures, ETS and air pollution's associations with lung function., Methods: Data are from the Nurse Health Assessment (NHA) in waves two and three of the United Kingdom Household Longitudinal Study (UKHLS). Analysis is restricted to English residents aged at least 20 for women and 25 for men, producing a study population of 16,339. Lung function is measured with forced expiratory volume in the first second (FEV 1 ) and standardised to the percentage of expected FEV 1 for a healthy non-smoker of equivalent age, gender, height and ethnicity (FEV 1 %). Using STATA 14, a mixed linear model was fitted with interaction terms between childhood SEP and health behaviours and occupational exposures. Cross level interactions tested whether childhood SEP moderated household ETS and neighbourhood air pollution's associations with FEV 1 %., Results: SEP, smoking, physical activity, obesity, occupational exposures and air pollution were associated with lung function. Interaction terms indicated a significantly stronger negative association between disadvantaged childhood SEP and currently smoking (coefficient -6.47 %, 95% confidence intervals (CI): 9.51 %, 3.42 %) as well as with formerly smoking and occupational exposures. Significant interactions were not found with physical activity, obesity, ETS and air pollution., Conclusion: The findings suggest that disadvantaged SEP in childhood may make people's lung function more susceptible to the negative effects of smoking and occupational exposures in adulthood. This is important as those most likely to encounter these exposures are at greater risk to their effects. Policy to alleviate this inequality requires intervention in health behaviours through public health campaigns and in occupational health via health and safety legislation.

Background: Neighborhood deprivation has been consistently linked to poor individual health outcomes; however, studies exploring the mechanisms involved in this association are scarce. The objective of this study was to investigate whether objective measures of the physical environment mediate the association between neighborhood socioeconomic deprivation and biomarkers of health in Britain., Methods: We linked individual-level biomarker data from Understanding Society: The UK Household Longitudinal Survey (2010-2012) to neighborhood-level data from different governmental sources. Our outcome variables were forced expiratory volume in 1 s (FEV 1 %; n=16,347), systolic blood pressure (SBP; n=16,846), body mass index (BMI; n=19,417), and levels of C-reactive protein (CRP; n=11,825). Our measure of neighborhood socioeconomic deprivation was the Carstairs index, and the neighborhood-level mediators were levels of air pollutants (sulphur dioxide [SO 2 ], particulate matter [PM 10 ], nitrogen dioxide [NO 2 ], and carbon monoxide [CO]), green space, and proximity to waste and industrial facilities. We fitted a multilevel mediation model following a multilevel structural equation framework in MPlus v7.4, adjusting for age, gender, and income., Results: Residents of poor neighborhoods and those exposed to higher pollution and less green space had worse health outcomes. However, only SO 2 exposure significantly and partially mediated the association between neighborhood socioeconomic deprivation and SBP, BMI, and CRP., Conclusion: Reducing air pollution exposure and increasing access to green space may improve population health but may not decrease health inequalities in Britain.

Background: Grip strength in early adulthood and midlife is an important predictor of disability, morbidity and mortality in later life. Understanding social patterning in grip strength at different life stages could improve insight into inequalities in age-related decline and when in the life course interventions could prevent the emergence of inequalities., Methods: Using United Kingdom Household Longitudinal Study (UKHLS) data on 19,292 people aged 16 to 99, fractional polynomial models were fitted to identify which function of age best described its association with grip strength. Linear regressions were used to establish whether socio-economic position (SEP), as measured by maternal education, highest educational qualification and income, was associated with grip strength. To test whether the association between age and grip strength was modified by SEP, interactions between SEP and the age terms were added. Differentiation was used to identify the age at which grip strength was highest for men and women and predicted levels of grip strength at peak were compared., Results: SEP is significantly associated with grip strength on all SEP measures, except education for men. Grip strength is highest at a younger age, and less strong for all measures of disadvantage for women and most measures for men. Interaction terms were not statistically significant indicating that the association between age and grip strength was not modified by SEP. Grip strength peak was 29.3 kg at age 33 for women with disadvantaged childhood SEP compared with 30.2 kg at age 35 for women with advantaged childhood SEP., Conclusion: The SEP differences in age and level of peak grip strength could be indicative of decline in muscle strength beginning earlier and from a lower base for disadvantaged groups. This could impact on the capacity for healthy ageing for those with disadvantaged SEP.

Serum biomarker levels are associated with the risk of complex diseases. Here, we aimed to gain insights into the genetic architecture of biomarker traits which can reflect health status. We performed genome-wide association analyses for twenty serum biomarkers involved in organ function and reproductive health. 9,961 individuals from the UK Household Longitudinal Study were genotyped using the Illumina HumanCoreExome array and variants imputed to the 1000 Genomes Project and UK10K haplotypes. We establish a polygenic heritability for all biomarkers, confirm associations of fifty-four established loci, and identify five novel, replicating associations at genome-wide significance. A low-frequency variant, rs28929474, (beta = 0.04, P = 2 × 10 -10 ) was associated with levels of alanine transaminase, an indicator of liver damage. The variant is located in the gene encoding serine protease inhibitor, low levels of which are associated with alpha-1 antitrypsin deficiency which leads to liver disease. We identified novel associations (rs78900934, beta = 0.05, P = 6 × 10 -12 ; rs2911280, beta = 0.09, P = 6 × 10 -10 ) for dihydroepiandrosterone sulphate, a precursor to major sex-hormones, and for glycated haemoglobin (rs12819124, beta = -0.03, P = 4 × 10 -9 ; rs761772, beta = 0.05, P = 5 × 10 -9 ). rs12819124 is nominally associated with risk of type 2 diabetes. Our study offers insights into the genetic architecture of well-known and less well-studied biomarkers.

Introduction: Epidemiological studies have shown that weaker grip strength in later life is associated with disability, morbidity, and mortality. Grip strength is a key component of the sarcopenia and frailty phenotypes and yet it is unclear how individual measurements should be interpreted. Our objective was to produce cross-sectional centile values for grip strength across the life course. A secondary objective was to examine the impact of different aspects of measurement protocol., Methods: We combined 60,803 observations from 49,964 participants (26,687 female) of 12 general population studies in Great Britain. We produced centile curves for ages 4 to 90 and investigated the prevalence of weak grip, defined as strength at least 2.5 SDs below the gender-specific peak mean. We carried out a series of sensitivity analyses to assess the impact of dynamometer type and measurement position (seated or standing)., Results: Our results suggested three overall periods: an increase to peak in early adult life, maintenance through to midlife, and decline from midlife onwards. Males were on average stronger than females from adolescence onwards: males' peak median grip was 51 kg between ages 29 and 39, compared to 31 kg in females between ages 26 and 42. Weak grip strength, defined as strength at least 2.5 SDs below the gender-specific peak mean, increased sharply with age, reaching a prevalence of 23% in males and 27% in females by age 80. Sensitivity analyses suggested our findings were robust to differences in dynamometer type and measurement position., Conclusion: This is the first study to provide normative data for grip strength across the life course. These centile values have the potential to inform the clinical assessment of grip strength which is recognised as an important part of the identification of people with sarcopenia and frailty.

The concepts of class, race, and ethnicity figure prominently in health services research in Britain. Occupational class has been employed for nearly a century to investigate social inequalities in health and access to care. More recently, researchers have identified differences in health status and utilization between ethnic groups. This article examines how these constructs are defined in Britain and identifies some key research associated with them. It also draws attention to the considerable problems in using class and ethnicity to stratify the population. The authors conclude that a new approach that directly measures individuals' material and social resources needs to be developed.