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Background: It is not clear how respiratory morbidity during early childhood varies across ethnic groups in the UK. This article seeks to determine whether asthma and wheeze illnesses during early childhood differ across ethnic groups and what factors explain observed differences., Methods: Data from the UK Millennium Cohort Study on 14,630 children were analyzed from the second sweep of interviews. Parental interviews were conducted when the cohort member was aged approximately 3(1/2) years. Data collected included the occurrence of asthma and wheezing symptoms, biological and socio-economic factors and markers of cultural tradition., Results: At age 3, 12.3% (n = 1,902) of children had ever had asthma and 20.0% (n = 3,030) had wheezed in the last 12 months. 18.2% of Black Caribbean children and 5.0% of Bangladeshi children reported ever asthma compared with 11.6% of White children. 25.5% of Black Caribbean children and 8.7% of Bangladeshi reported recent wheeze compared with 19.4% of White children. After adjustments, the disadvantage in asthma and recent wheeze for Black Caribbeans was mostly explained by socio-economic factors (adjusted odds ratios (OR) for asthma 1.42, 95% confidence interval (CI) 0.96-2.09; recent wheeze 1.18, 0.85-1.64). The Bangladeshi advantage lost statistical significance, mostly due to adjustment for markers of cultural tradition (adjusted OR for asthma 0.40, 95% CI 0.15-1.09; recent wheeze 0.44, 0.18-1.19)., Conclusion: Our results point to the need to locate child health within the unique context of each ethnic group and to recognize that potential explanations for observed differences do not necessarily hold for all groups.

Objectives: Psychiatric morbidity among the physically ill is an important issue, particularly in the light of research documenting the difficulties in accurately diagnosing and effectively treating psychiatric disorders in this group. The objectives of this study were: (1) To compare psychiatric morbidity in 11 physical conditions and a healthy comparison group. (2) To compare psychiatric morbidity between respondents with one of the 11 illnesses to those with more than one physical illness., Design: The sample was derived from the cross-sectional Household Survey of Psychiatric Morbidity., Methods: Psychiatric morbidity (excluding psychosis) was assessed by interview using the revised Clinical Interview Schedule (CIS-R) and physical illness through self-report in 10,108 adults., Results: Eight of the 11 illness groups were more likely to be classified as having psychiatric morbidity on the CIS-R than the physically healthy group. There were no differences in psychiatric morbidity between the different illness groups. The presence of more than one physical illness significantly increased the likelihood of psychiatric morbidity in 10 of the 11 groups., Conclusions: This study further supports the association between physical and psychiatric illness. Importantly, it suggests an increased likelihood of psychiatric morbidity in the presence of more than one physical condition.

Objective: To describe differences in trajectories of self reported health in an ageing cohort according to occupational grade., Design: Prospective cohort study of office based British civil servants (1985-2004)., Participants: 10 308 men and women aged 35-55 at baseline, employed in 20 London civil service departments (the Whitehall II study); follow-up was an average of 18 years., Main Outcome Measures: Physical component and mental component scores on SR-36 measured on five occasions., Results: Physical health deteriorated more rapidly with age among men and women from the lower occupational grades. The average gap in physical component scores between a high and low grade civil servant at age 56 was 1.60 and this gap increased by 1 over 20 years. The average physical health of a 70 year old man or woman who was in a high grade position was similar to the physical health of a person from a low grade around eight years younger. In mid-life, this gap was only 4.5 years. Although mental health improved with age, the rate of improvement is slower for men and women in the lower grades., Conclusions: Social inequalities in self reported health increase in early old age. People from lower occupational grades age faster in terms of a quicker deterioration in physical health compared with people from higher grades. This widening gap suggests that health inequalities will become an increasingly important public health issue, especially as the population ages.

Objectives: We reviewed literature on comparative social policy and life course research and compared associations between health and socioeconomic circumstances during an 11-year period in the United States and the United Kingdom., Methods: We obtained data from the US Panel Study of Income Dynamics and the British Household Panel Survey (1990-2002). We used latent transition analysis to examine change in self-rated health from one discrete state to another; these health trajectories were then associated with socioeconomic measures at the beginning and at the end of the study period., Results: We identified good and poor latent health states, which remained relatively stable over time. When change occurred, decline rather than improvement was more likely. UK populations were in better health compared with US populations and were more likely to improve over time. Labor market participation was more strongly associated with good health in the United Kingdom than in the United States., Conclusions: National policies and practices may be keeping more US workers than UK workers who are in poor health employed, but British policies may give UK workers the chance to return to better health and to the labor force.

Objective: The objective of this study was to measure the effect of breastfeeding on hospitalization for diarrheal and lower respiratory tract infections in the first 8 months after birth in contemporary United Kingdom., Methods: The study was a population-based survey (sweep 1 of the United Kingdom Millennium Cohort Study). Data on infant feeding, infant health, and a range of confounding factors were available for 15,890 healthy, singleton, term infants who were born in 2000-2002. The main outcome measures were parental report of hospitalization for diarrhea and lower respiratory tract infection in the first 8 months after birth., Results: Seventy percent of infants were breastfed (ever), 34% received breast milk for at least 4 months, and 1.2% were exclusively breastfed for at least 6 months. By 8 months of age, 12% of infants had been hospitalized (1.1% for diarrhea and 3.2% for lower respiratory tract infection). Data analyzed by month of age, with adjustment for confounders, show that exclusive breastfeeding, compared with not breastfeeding, protects against hospitalization for diarrhea and lower respiratory tract infection. The effect of partial breastfeeding is weaker. Population-attributable fractions suggest that an estimated 53% of diarrhea hospitalizations could have been prevented each month by exclusive breastfeeding and 31% by partial breastfeeding. Similarly, 27% of lower respiratory tract infection hospitalizations could have been prevented each month by exclusive breastfeeding and 25% by partial breastfeeding. The protective effect of breastfeeding for these outcomes wears off soon after breastfeeding cessation., Conclusions: Breastfeeding, particularly when exclusive and prolonged, protects against severe morbidity in contemporary United Kingdom. A population-level increase in exclusive, prolonged breastfeeding would be of considerable potential benefit for public health.

We examined the effects of adolescent social disinhibition expectancies and adult psychological distress on alcohol use and misuse in adulthood, using the 1970 British Cohort Study data. Multivariate imputation by chained equations filled in incomplete cases for 7023 men and 6896 women. A propensity to heavy alcohol use and misuse was predicted by social expectations of the releasing effects of alcohol acquired in adolescence (adolescent social disinhibition expectancies). Psychological distress at age 30 increased the likelihood of very heavy alcohol use in men and misuse of alcohol in men and women. An absence of adolescent social disinhibition expectancies protects adults from drinking alcohol. Moreover, among men without these expectancies, psychological distress did not predict heavy alcohol use, whereas this association was present among men with expectations of alcohol. Policies that aim to manage adult alcohol use should be initiated in adolescence. Reduction of psychological distress will prevent both men and women from misusing alcohol.

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 9.2 mo [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.

Objective: We investigated whether the duration and exclusivity of breastfeeding affects the likelihood of gross and fine motor delay in infants and examined the effect of factors that might explain any observed differences., Methods: The study sample included all term singleton infants who weighed > 2500 g at birth and were not placed in a special care infant unit and whose mothers participated in the first survey of the Millennium Cohort Study. Missing data reduced the sample to 14660 (94%) with complete data., Results: Almost half (47%) of the infants initially were exclusively breastfed, but only 3.5% of these infants were still being fed exclusively on breast milk after 4 months of age, and 34% of infants were not breastfed at all; 9% of the infants were identified with delays in gross motor coordination and 6% with fine motor coordination delays at age 9 months. The proportion of infants who mastered the developmental milestones increased with duration and exclusivity of breastfeeding. Infants who had never been breastfed were 50% more likely to have gross motor coordination delays than infants who had been breastfed exclusively for at least 4 months (10.7% vs 7.3%). Any breast milk also was positively related to development: infants who had never been breastfed were 30% more likely to have gross motor delays than infants who were given some breast milk for up to 2 months (10.7% vs 8.4%). The odds ratios for gross motor delay were not attenuated after adjustment for biological, socioeconomic, or psychosocial factors. Infants who were never breastfed had at least a 40% greater likelihood of fine motor delay than infants who were given breast milk for a prolonged period., Conclusion: Our results suggest that the protective effect of breastfeeding on the attainment of gross motor milestones is attributable to some component(s) of breast milk or feature of breastfeeding and is not simply a product of advantaged social position, education, or parenting style, because control for these factors did not explain any of the observed association. In contrast, the association between breastfeeding and fine motor delay was explained by biological, socioeconomic, and psychosocial factors.

Examination of the extent to which time and place affect people's health has been constrained by the resources available to answer this question. A British longitudinal, nationally representative survey of 8301 adults aged 16 years and older living in private households was used to consider the influence of household membership, area of residence and time using multilevel logistic regression. Self-rated health was assessed by general health and limiting illness during periods characterized by economic decline (1992), economic improvement (1996) and prosperity (2000). There was modest evidence of clustering of poor general health within areas and stronger support for within household similarities in general health which increased over time. Individual, household and area level deprivation accounted for almost all the area-level variability but had little effect on household variance. There was greater evidence of clustering of limiting illness within areas: deprivation did not account for this to any great extent. Area differences in general health reduced as the economy improved but time trends in differences in limiting illness lagged behind the timing of economic recovery. Both time and place are shown to affect self-rated health although the processes may differ depending on the health outcome.

Background: Calls for public health initiatives to increase adolescent leisure-time physical activity suggest that increasing activity in this age group will reduce social inequalities in health. While the public health benefits of exercise are undisputed, there is little evidence on its role in reducing health inequalities. The paper examines the extent to which adolescent leisure-time physical activity promotes adult health and well-being and explores whether adolescent leisure-time physical activity can act to reduce health inequalities arising from material deprivation during childhood., Methods: This is a longitudinal study of the 1958 British birth cohort followed from age 16 to age 33 years (N = 15,452) and the 1970 British birth cohort followed to age 30 years (N = 14,018). Adult self-rated general health and Malaise Inventory scores are regressed on self-reports of leisure time physical activity. Analyses are conducted separately for men and women controlling for adolescent body mass index (BMI) and psychosocial problems., Results: There was a consistent relationship between leisure-time physical activity in adolescence and psychological well-being approximately 15 years later for both the cohorts. This relationship was independent of adolescent BMI and psychosocial problems. More physical activity in adolescence predicted better adult self-assessed health in the 1958 cohort only. Leisure-time physical activity did not affect inequalities in health., Conclusions: Policies aimed at increasing participation in leisure-time physical activities in youth may improve population health but are unlikely to prevent the development of social inequalities in health.

This study examines the relationship between poverty and health in time. Following the argument that time is significant for shaping the experience of being poor or not poor and growing evidence of heterogeneity in long-term patterns of poverty, we investigate whether different kinds of poverty have distinct consequences for long-term health. Using data from the 1968-1996 annual waves of the United States Panel Study of Income Dynamics Data, we estimate a general growth mixture model to assess the relationship between the longitudinal courses of poverty and health. The model allows us to first estimate latent poverty classes in the data and then determine their effects on latent self-rated health. Four types of long-term poverty patterns characterized as stable nonpoor, exiting poverty, entering poverty and stable poor were evident in the data. These different kinds of poverty affected self-rated health trajectories in distinct ways, but worked in concert with age, education and race to create gaps in initial health status that were constant over time.

Objectives: To study how social inequalities change as people age, this paper presents a growth curve model of self assessed health, which accommodates changes in occupational class and individual health with age., Design: Nationally representative interview based longitudinal survey of adults in Great Britain., Setting: Representative members of private households of Great Britain in 1991., Participants: Survey respondents (n = 6705), aged 21-59 years in 1991 and followed up annually until 2001., Main Outcome Measure: Self assessed health., Results: On average, self assessed health declines slowly from early adulthood to retirement age. No significant class differences in health were observed at age 21. Health inequalities emerged later in life with the gap between mean levels of self assessed health of those in managerial and professional occupations and routine occupations widening approaching retirement. Individual variability in health trajectories increased between ages 40 and 59 years so that this widening of mean differences between occupational classes was not significant. When the analysis is confined to people whose occupational class remained constant over time, a far greater difference in health trajectories between occupational classes was seen., Conclusions: The understanding of social inequalities in health at the population level is enriched by an analysis of individual variation in age related declines by social position.

The aim of this paper is twofold: firstly to investigate whether the association between childhood and adult psychosocial adjustment can be explained by socio-economic adversity experienced during childhood, and secondly to explore the role of family socio-economic disadvantage and psychological development in explaining adult social inequality in psychological well-being. A developmental-contextual perspective is adopted to analyse the pathways linking childhood experiences to adult functioning in a changing socio-historical context. The study draws on longitudinal data collected for two cohorts of about 30,000 individuals born in Great Britain 12 years apart. Structural equation modelling is used to assess the long-term influence of socio-economic adversity on psychosocial adjustment, and to compare different explanatory models of health inequalities. The results reject a simple selection or social causation argument, suggesting that both dynamics operate in life course development. The effects of social risk cumulate throughout the life course, influencing both behaviour adjustment during childhood and adult psychosocial functioning. It is concluded that the explanation of health differences in adult life must account for the reciprocal interaction between individual behaviour and social circumstances.

Background: In health inequalities research there is a growing impetus to examine the development of inequalities in health over time. However, many of the sources of longitudinal data in Britain are not designed specifically for health research. Typically, health status is assessed by self-reported problems and the use of symptom checklists., Methods: The British Household Panel Survey (BHPS) is an annual survey of approximately 5500 private households containing 9000 men and women, which began in 1991. Each year, the BHPS contains a checklist of 13 health problems and symptoms. The findings presented here are based on adult participants aged 16 years and over in 1991. Using eight waves of data from the BHPS, we use latent class analysis (LCA) to model latent health status from a set of observed binary variables. Individuals are assigned to a latent health class on the basis of LCA estimated probabilities of class membership given their response patterns and the estimated unconditional class frequencies. The predictive value of latent health class membership is assessed for self-reported health status and functioning, health and welfare service use, and mortality 1 year later., Results: The LCA supported a suitable four-class model of health status representing good health, psychosomatic health problems, physical health problems and comorbid health problems. Members of the good latent health class were predicted to have better self-reported health and functioning, less health and welfare service use, and lower risk of mortality 1 year later than members of the three problem health classes. Those with comorbid health problems were predicted to have particularly poor outcomes., Conclusions: A latent class approach to modelling self-reported health problems and symptoms has allowed for both quantitative and qualitative dimensions of health status to be captured. This may motivate better informed models of health by users of general population surveys.

We used path analysis on data from the British 1946 birth cohort to model lifetime antecedents of cognitive reserve, represented by the NART at 53 years, and compared this model for verbal memory and psychomotor function at this age, cognitive outcomes that are sensitive to age-associated decline. We showed independent paths from childhood cognition, educational attainment and adult occupation to cognitive reserve, with that from childhood cognition the strongest, and that from adult occupation the weakest. A similar pattern was found for the verbal memory and psychomotor outcomes, although the pathways were weaker than those to the NART. The pattern was also mirrored by the paths from paternal occupation to childhood cognition, educational attainment and adult occupation, with that to childhood cognition the strongest, and that to adult occupation the weakest. The direct influence of paternal occupation on cognitive reserve was negligible, and almost entirely mediated by childhood cognitive ability and educational attainment.

There has been considerable debate over the importance of the health selection hypothesis for explaining social gradients in health. Although studies have argued that it may not be an important explanation of social gradients in health, previous analyses have not estimated, simultaneously, the relative effect of health on changes in social position and of social position on changes in health (social causation). Cross-lagged longitudinal analyses using structural equation models enable the estimation of the relative size of these pathways which would be useful in determining the relative importance of the health selection hypothesis over the social causation hypothesis. Data from four phases of the Whitehall II study (initially consisting of 10,308 men and women aged 35-55 in the British civil service) were collected over a 10 year period. There was no evidence for an effect of mental (GHQ-30 and SF36) or physical health (SF-36) on changes in employment grade. When financial deprivation was used as a measure of social position, there was a significant effect of mental health on changes in social position among men although this health selection effect was over two and a half times smaller than the effect of social position on changes in health. The results suggest that the development of social gradients in health in the Whitehall II study may not be primarily explained in terms of a health selection effect.

The paper examines the hypothesis that social inequalities in children's developmental resources level off during adolescence against an alternative hypothesis that they continue to exert their influence throughout all of childhood. Using data from the National Child Development Study, the study applies two models. Both are premised on the understanding that the social and physical environments in which children are raised affects their resources in the domains of educational achievement and psychosocial adjustment. A 'class inequalities' model seeks to determine the extent of social class inequalities at three key stages in children's development: the transition from infant to junior schooling at age 7, from primary to secondary education at age 11 and from compulsory education to further education or work at age 16. The second model is a contextual-systems model which seeks to expand our understanding of the pathways from family social class to children's educational achievement and psychosocial adjustment through some more proximal determinants of these resources: material deprivation, school composition, parental involvement and aspirations. Social class inequalities in educational achievement were found to be greater than inequalities in psychosocial adjustment. The same developmental pattern was observed for both outcomes: inequalities increased from age 7 to age 11 and then remained at the same level at 16 yr. The contextual-systems models showed that when social inequalities are interpreted more broadly than a narrow class based definition, they continue to widen in adolescence. In particular, family influences, indicated by parental involvement become less important and social contexts beyond the family, reflected in material conditions and school composition, become more important. At age 16, material deprivation was the strongest determinant of psychosocial adjustment while school composition was most strongly related to educational achievement. The contextual-systems model provides a more complete account of social inequalities in children's educational achievement and psychosocial adjustment than simple estimates of social class effects.

This study investigated the long-term effects of social disadvantage on academic achievement and on subsequent attainments in adulthood. The study drew on data collected for over 30,000 individuals born 12 years apart, following their development from birth to adulthood. The pathways that link social disadvantage to individual development across the life course were analyzed in a developmental-contextual systems model. The results showed that the influence of risk factors associated with socioeconomic disadvantage depended on the developmental stage of the individual, the experience of long-term or continuous disadvantage, and the overall sociohistorical context. Early risk had a moderate influence on the formation of individual competences. The greatest risk was associated with persisting and accumulating experiences of socioeconomic disadvantage throughout childhood and adolescence. Material conditions improved for the later-born cohort, yet pervasive social inequalities existed that affected outcomes during childhood and were consequently reflected in adult attainment.

Background: In the closing decades of the twentieth century, changes in population sociodemographics took place that might be thought to have an adverse influence on the nation's psychological distress. Here, we examine the stability of social and gender inequalities in psychological distress throughout the 1980s and 1990s., Methods: The study uses data from the 1958 National Child Development Study and the 1970 British Cohort Study collected when the cohort members were aged between 23 and 42. Multilevel logistic regression models were used to examine the effects of social class, gender, age, period and cohort on psychological distress as measured by the Malaise Inventory., Results: We identify clear social inequalities in psychological distress during 1981-2000 that reduced in magnitude over this period. Non-linear age effects were observed: psychological distress improves in early adulthood but declines again on approaching mid-life. The 1970 cohort had poorer psychological distress than the 1958 cohort. Although women had higher rates of psychological distress than men, gender differences reduced in magnitude. Declining rates of women's psychological distress over time have not been matched in men. A reduction in social inequalities over time was also observed. Improvements in the psychological health of those in manual occupations were not equalled among those in non-manual occupations., Conclusions: Both social and gender inequalities have narrowed in the last two decades of the twentieth century.