Pathways from origins to destinations: Stability and change in the roles of cognition, private schools and educational attainment.

While much attention has been devoted to measuring levels of social mobility over time, less attention has been given to the possibility of changing pathways to social mobility. This paper examines pathways from social origins to socio-economic destinations in midlife for two British cohorts, born in 1958 and 1970 respectively, using Structural Equation Modelling (SEM). We address the roles of cognitive attainment, private schooling and educational attainment in mediating the link between social origins and destinations. Have these mechanisms become more or less important over time, in a context of structural change in the state schooling system and educational expansion? We find that private schools displayed greater academic selectivity and an increased link to high levels of educational attainment for the younger cohort. Essentially, private schools adapted to changing circumstances, becoming more academically selective and less socially selective, and more focused on educational credentials. Childhood social origins were less strongly linked to childhood cognitive scores in the younger cohort, but cognitive scores were also more weakly linked to educational attainment for this cohort. We also find a decreased association between social origins and educational attainment for the younger cohort. While the finding that educational inequalities weakened over this time period is positive, the lack of a corresponding reduction in the overall link between social origins and destinations suggests that reducing educational inequalities was not sufficient to increase social mobility when accompanied by countervailing changes in the role of private schools.

Exploring the role of early-life circumstances, abilities and achievements on well-being at age 50 years: evidence from the 1958 British birth cohort study.

OBJECTIVES: We aim to examine the relative contributions of pathways from middle childhood/adolescence to mid-life well-being, health and cognition, in the context of family socio-economic status (SES) at birth, educational achievement and early-adulthood SES. Our approach is largely exploratory, suspecting that the strongest mediators between childhood circumstances and mid-life physical and emotional well-being may be cognitive performance during school years, material and behavioural difficulties, and educational achievement. We also explore whether the effects of childhood circumstances on mid-life physical and emotional well-being differ between men and women. SETTING/PARTICIPANTS: Data were from the National Child Development Study, a fully-representative British birth cohort sample of 17 415 people born in 1 week in 1958. PRIMARY/SECONDARY OUTCOME MEASURES: Our four primary mid-life outcome measures are: cognitive performance, physical and emotional well-being and quality of life. Our intermediate adult outcomes are early-adulthood social class and educational/vocational qualifications. RESULTS: Using structural equation modelling, we explore numerous pathways through childhood and early adulthood which are significantly linked to our outcomes. We specifically examine the mediating effects of the following: cognitive ability at ages 7, 11 and 16 years; childhood psychological issues; family material difficulties at age 7 years: housing, unemployment, finance; educational/vocational qualifications and social class position at age 42 years.We find that social class at birth has a strong indirect effect on the age 50 outcomes via its influence on cognitive performance in childhood and adolescence, educational attainment and mid-life social class position, together with small direct effects on qualifications and social class position at age 42 years. Teenage cognitive performance has a strong positive effect on later physical health for women, while educational/vocational qualifications have a stronger positive effect on emotional well-being for men. CONCLUSION: Our findings provide an understanding of the legacy of early life on multiple aspects of mid-life health, well-being, cognition and quality of life, showing stronger mediated links for men from childhood social class position to early adult social class position. The observed effect of qualifications supports those arguing that education is positively associated with subsequent cognitive functioning.

Friendships Among Young South African Women, Sexual Behaviours and Connections to Sexual Partners (HPTN 068).

Friends could be influential on young women's sexual health via influences on sexual behaviours and as connections to sexual partners, but are understudied in sub-Saharan Africa. We cross-sectionally surveyed 2326 13-20 year-old young women eligible for grades 8-11 in rural South Africa about their sexual behaviour and up to three sexual partners. Participants each described five specific but unidentified friends and the relationships between them in an 'egocentric' network analysis design. We used logistic regression to investigate associations between friendship characteristics and participants' reports of ever having had sex (n = 2326) and recent condom use (n = 457). We used linear regression with random effects by participant to investigate friendship characteristics and age differences with sexual partners (n = 633 participants, 1051 partners). We found that it was common for friends to introduce young women to those who later became sexual partners, and having older friends was associated with having older sexual partners, (increase of 0.37 years per friend at least 1 year older, 95% CI 0.21-0.52, adjusted). Young women were more likely to report ever having had sex when more friends were perceived to be sexually active (adjusted OR 1.85, 95% CI 1.72-2.01 per friend) and when they discussed sex, condoms and HIV with friends. Perception of friends' condom use was not associated with participants' reported condom use. While this study is preliminary and unique in this population and further research should be conducted, social connections between friends and sexual partners and perceptions of friend sexual behaviours could be considered in the design of sexual health interventions for young women in South Africa.

The path from social origins to top jobs: social reproduction via education.

This paper provides a comprehensive account of the way in which cognitive and educational attainment mediate the link between social origins and elite social class destinations in mid-life. Using the 1970 British Cohort Study (BCS70), we assess the roles of a range of pathways through which educational advantage may lead to occupational attainment: cognitive development; private and selective secondary schools; school level qualifications; and higher education, including institution and field of study. Whereas past research has shown a residual direct effect of social origins on class destinations, we find that, once a sufficiently detailed picture of educational attainment is taken into account, education fully explains the link between social origins and top social class destinations. In contrast, the gap between men and women in achieving top social class positions is in no part accounted for by education.

Associations between friendship characteristics and HIV and HSV-2 status amongst young South African women in HPTN-068.

INTRODUCTION: Prevalence of HIV among young women in South Africa remains extremely high. Adolescent peer groups have been found to be an important influence on a range of health behaviours. The characteristics of young women's friendships might influence their sexual health and HIV risk via connections to sexual partners, norms around sexual initiation and condom use, or provision of social support. We investigated associations between young women's friendships and their Herpes Simplex Virus Type 2 (HSV-2) and HIV infection status in rural South Africa. METHODS: Our study is a cross-sectional, egocentric network analysis. In 2011 to 2012, we tested 13- to 20-year-old young women for HIV and HSV-2, and collected descriptions of five friendships for each. We generated summary measures describing friend socio-demographic characteristics and the number of friends perceived to have had sex. We used logistic regression to analyse associations between friend characteristics and participant HIV and HSV-2 infection, excluding likely perinatal HIV infections. RESULTS: There were 2326 participants included in the study sample, among whom HIV and HSV-2 prevalence were 3.3% and 4.6% respectively. Adjusted for participant and friend socio-demographic characteristics, each additional friend at least one year older than the participant was associated with raised odds of HIV (odds ratio (OR) = 1.37, 95% CI 1.03 to 1.82) and HSV-2 (adjusted OR=1.41, 95% CI 1.18 to 1.69). Each additional friend perceived to have ever had sex also raised the odds of HIV (OR = 1.29, 95% CI 1.03 to 1.63) and HSV-2 (OR=1.18, 95% CI 1.03 to 1.35). DISCUSSION: We found good evidence that a greater number of older friends and friends perceived to have had sex were associated with increased risk for HSV-2 and HIV infection among young women. CONCLUSIONS: The characteristics of young women's friendships could contribute to their risk of HIV infection. The extent to which policies or programmes influence age-mixing and young women's normative environments should be considered.

Is the sexual behaviour of young people in sub-Saharan Africa influenced by their peers? A systematic review.

Adolescents in sub-Saharan Africa are highly vulnerable to HIV, other sexually transmitted infections (STIs) and unintended pregnancies. Evidence for the effectiveness of individual behaviour change interventions in reducing incidence of HIV and other biological outcomes is limited, and the need to address the social conditions in which young people become sexually active is clear. Adolescents' peers are a key aspect of this social environment and could have important influences on sexual behaviour. There has not yet been a systematic review on the topic in sub-Saharan Africa. We searched 4 databases to find studies set in sub-Saharan Africa that included an adjusted analysis of the association between at least one peer exposure and a sexual behaviour outcome among a sample where at least 50% of the study participants were aged between 13 and 20 years. We classified peer exposures using a framework to distinguish different mechanisms by which influence might occur. We found 30 studies and retained 11 that met quality criteria. There were 3 cohort studies, 1 time to event and 7 cross-sectional. The 11 studies investigated 37 different peer exposure-outcome associations. No studies used a biological outcome and all asked about peers in general rather than about specific relationships. Studies were heterogeneous in their use of theoretical frameworks and means of operationalizing peer influence concepts. All studies found evidence for an association between peers and sexual behaviour for at least one peer exposure/outcome/sub-group association. Of all 37 outcome/exposure/sub-group associations tested, there was evidence for 19 (51%). There were no clear patterns by type of peer exposure, outcome or adolescent sub-group. There is a lack conclusive evidence about the role of peers in adolescent sexual behaviour in Sub-Saharan. We argue that longitudinal designs, use of biological outcomes and approaches from social network analysis are priorities for future studies.

Psychological distress after stroke and aphasia: the first six months.

OBJECTIVE: We explored the factors that predicted psychological distress in the first six months post stroke in a sample including people with aphasia. DESIGN: Prospective longitudinal observational study. SETTING AND SUBJECTS: Participants with a first stroke from two acute stroke units were assessed while still in hospital (baseline) and at three and six months post stroke. MAIN MEASURES: Distress was assessed with the General Health Questionnaire-12. Other measures included: NIH Stroke Scale, Barthel Index, Frenchay Aphasia Screening Test, Frenchay Activities Index, MOS Social Support Scale and social network indicators. Logistic regression was used to identify predictors of distress at each stage post stroke; and to determine what baseline factors predicted distress at six months. RESULTS: Eighty-seven participants were able to self-report on measures used, of whom 32 (37%) had aphasia. 71 (82%) were seen at six months, including 11 (16%) with aphasia. Predictors of distress were: stroke severity at baseline; low social support at three months; and loneliness and low satisfaction with social network at six months. The baseline factors that predicted distress at six months were psychological distress, loneliness and low satisfaction with social network (Nagelkerke R(2) = 0.49). Aphasia was not a predictor of distress at any time point. Yet, at three months post stroke 93% of those with aphasia experienced high distress, as opposed to 50% of those without aphasia (chi(2) (1) = 8.61, P<0.01). CONCLUSIONS: Factors contributing to distress after stroke vary across time. Loneliness and low satisfaction with one's social network are particularly important and contribute to long-term psychological distress.

Examining resilience of quality of life in the face of health-related and psychosocial adversity at older ages: what is "right" about the way we age?

PURPOSE: This article examines resilience at older ages, focusing on the relationships between quality of life (qol) and adversity. Our objectives are to identify (a) the basis of adversity, (b) the characteristics of resilient individuals, and (c) the attributes that attenuate the full impact of adversity. DESIGN AND METHODS: Resilience is defined as flourishing despite adversity. Analysis is carried out in a subsample of the Boyd Orr cohort (aged between 68 and 82 years) using questionnaire data. Adversity was identified as circumstances that produce a significant average decrease in qol (CASP-19 scores). Participants were classified into resilient and vulnerable groups based on high or low qol (CASP-19 scores dichotomized at the median) in the face of significant adversity. Shared characteristics that define these outcomes are reported. Attributes that attenuate the negative impact of adversity were analyzed using stratified logistic regression. RESULTS: Adversity was typified by functional limitation; life getting worse in the domains of health, stress, and general living circumstances; and experiencing a negative life event. The resilient tended to report fewer multiple adversities. Indicators of protective attributes, which also characterized resilient outcomes relative to qol, included good quality relationships (5.105, confidence interval [CI] 95% 1.323-19.699), integration in the community (10.800, 95% CI 1.227-95.014), developmental coping (3.397, 95% CI 1.079-10.690), and adaptive coping styles (3.211, 95% CI 1.041-9.910). IMPLICATION: Overall results indicate that policies that offer access to protection and help minimize adversity exposure where possible will promote resilience.

Social integration, a sense of belonging and the Cenotaph Service: old soldiers reminisce about Remembrance.

OBJECTIVES: This study explored how war commemorations such as the Cenotaph Service in the UK enable older veterans to benefit from a feeling of integration and belonging gained from both comradeship and acknowledgement from wider society. METHOD: Focus groups preceded by a video clip of the Cenotaph Service with 45 veterans were used to discuss the significance of collective commemorations for older veterans. RESULTS: Findings indicated that social integration and a sense of belonging are fostered both by comradeship and societal support during collective commemorations allowing veterans to reminisce safely. Spontaneous reminiscences involving troubling memories may be processed more easily with the support, social integration and sense of belonging which occurs at collective commemorations. Many Korean War and female World War II veterans felt forgotten and socially isolated, but described gaining vicarious support via collective commemorations. Cohen and Wills' (1985) main-effects and buffering models of social support are used to discuss the findings further. CONCLUSION: Collective commemorations can be important sources of support for many older veterans. Both comradeship and societal support promote social integration and a sense of belonging (main-effects), which enabled reminiscing and processing (buffering) to occur.

Pathways to obesity: identifying local, modifiable determinants of physical activity and diet.

Many studies document small area inequalities in morbidity and mortality and show associations between area deprivation and health. However, few studies unpack the "black box" of area deprivation to show which specific local social and physical environmental characteristics impact upon health, and might be amenable to modification. We theorised a model of the potential causal pathways to obesity and employed path analysis using a rich data set from national studies in England and Scotland to test the model empirically. Significant associations between obesity and neighbourhood disorder and access to local high street facilities (local shops, financial services and health-related stores found in a typical small UK town) were found. There was a tendency for lower levels of obesity in areas with more swimming pools and supermarkets. In turn, policing levels, physical dereliction and recorded violent crime were associated with neighbourhood disorder. The analysis identifies several factors that are associated with (and are probably determinants of) obesity and which are outside the standard remit of the healthcare sector. They highlight the role that public and private sector organisations have in promoting the nation's health. Public health professionals should seek to work alongside or within these organisations to capitalise on opportunities to improve health.

Self-rated health trajectories in the United States and the United Kingdom: a comparative study.

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.

Men who have sex with men in Great Britain: comparison of a self-selected internet sample with a national probability sample.

OBJECTIVES: To compare the characteristics of a self-selected, convenience sample of men who have sex with men (MSM) recruited through the internet with MSM drawn from a national probability survey in Great Britain. METHODS: The internet sample (n = 2065) was recruited through two popular websites for homosexual men in Great Britain in May and June 2003. This sample was compared with MSM (n = 117) from the National Survey of Sexual Attitudes and Lifestyles (Natsal), a probability sample survey of adults resident in Great Britain conducted between May 1999 and February 2001. RESULTS: No significant differences were observed between the samples on a range of sociodemographic and behavioural variables (p>0.05). However, men from the internet sample were younger (p<0.001) and more likely to be students (p = 0.001), but less likely to live in London (p = 0.001) or report good health (p = 0.014). Although both samples were equally likely to report testing for HIV, men from the internet sample were more likely to report a sexually transmitted infection in the past year (16.9% v 4.8%, adjusted odds ratio 4.14, 95% CI 1.76 to 9.74; p = 0.001), anal intercourse (76.9% v 63.3%; p = 0.001) and unprotected anal intercourse in the past 3 months (45% v 36.6%; p = 0.064). CONCLUSIONS: The internet provides a means of recruiting a self-selected, convenience sample of MSM whose social and demographic characteristics are broadly similar to those of MSM drawn from a national probability survey. However, estimates of high-risk sexual behaviour based on internet convenience samples are likely to overestimate levels of sexual risk behaviour in the wider MSM population.

Intimate relationships and changing patterns of money management at the beginning of the twenty-first century.

Drawing on British data from two annual sweeps of the ISSP eight years apart in 1994 and 2002, for modules focusing on 'Family and Changing Gender Roles', this paper examines the extent to which changes in women's labour market participation, changing ideologies/discourses of gender and changing forms of intimate relationships are affecting the ways in which couples organize household money, and the implications of such changes for recent theories of intimate relationships. The analysis indicates that by 2002, the type of relationship respondents had established, together with their social class position, were both independently related to the ways in which they managed money, after controlling for socio-economic and cultural or discursive factors. Our findings also provide a degree of support for the thesis of a partial decline in the male breadwinner model of gender, as indicated by small declines in the use of the relatively inegalitarian female whole wage and housekeeping allowance systems which were most likely to be used by married couples and cohabiting fathers, expressing relatively traditional ideologies/discourses of breadwinning - and a slight increase in the use of the partial pool, which was most likely to be used by childless cohabiting couples in which male partners expressed less traditional ideologies of breadwinning and women were in middle-class jobs with incomes high enough to facilitate partially separate finances. We also suggest, however, that in so far as cohabiting couples earning different amounts define equality as contributing equally to household expenditure, it is possible that rather than being associated with shifts to greater equality in access to money for personal spending and saving, the partial pool may be associated with marked inequalities, because it may enable gender inequalities generated in the labour market to be more directly transposed into inequalities within households, despite the decline of traditional discourses of male breadwinning and the increasing importance of egalitarian ideologies of co-provisioning.

Time and place: putting individual health into context. A multilevel analysis of the British household panel survey, 1991-2001.

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.

Quality of life at older ages: evidence from the English longitudinal study of aging (wave 1).

OBJECTIVES: To investigate whether longstanding illnesses, social context, and current socioeconomic circumstances predict quality of life. DESIGN: Secondary analysis of wave 1 of the English longitudinal study of aging. Missing data were imputed and multiple regression analyses conducted. SETTING: England, 2002 PARTICIPANTS: Nationally representative sample of non-institutionalised adults living in England (n = 11 234, 54.5% women, age 65.1 (SD 10.2) years). MAIN OUTCOME MEASURE: Quality of life as measured by CASP-19, a 19 item Likert scaled index. RESULTS: The quality of life was reduced by depression (beta -0.265), poor perceived financial situation (beta -0.157), limitations in mobility (beta -0.124), difficulties with everyday activities (beta -0.112), and limiting longstanding illness (beta -0.112). The quality of life was improved by trusting relationships with family (beta 0.105) and friends (beta 0.078), frequent contacts with friends (beta 0.059), living in good neighbourhoods (beta 0.103), and having two cars (beta 0.066). The regression models explained 48% variation in CASP-19 scores. There were slight differences between age groups and between men and women. CONCLUSIONS: Efforts to improve quality of life in early old age need to address financial hardships, functionally limiting disease, lack of at least one trusting relationship, and inability to move out of a disfavoured neighbourhood. There is the potential for improved quality of life in early old age (the third age) if these factors are controlled.

Time on my side? Life course trajectories of poverty and 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.

Social dynamics of health inequalities: a growth curve analysis of aging and self assessed health in the British household panel survey 1991-2001.

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.

Who you live with and where you live: setting the context for health using multiple membership multilevel models.

STUDY OBJECTIVE: Previous studies into the effect of area of residence on individuals' health have not accounted for changing residency over time, although few people remain resident in the same area throughout their life. Furthermore, few studies of area effects on health have accounted for the clustering of health at the household level. These methodological problems may have led previous studies to under estimate or over estimate the size of area level effects. This study uses multiple membership multilevel models to investigate whether longitudinal analyses of area effects on health need to take account of clustering at the household level. SETTING AND PARTICIPANTS: A longitudinal survey (1991-1999) of a nationally representative sample of British households (5511 households with 10 264 adult members). DESIGN: Two level (individuals within households or areas) and three level (individuals within households within areas) multiple membership models of SF-36 physical and mental health functioning scores at wave nine were analysed adjusting for age, gender, education, marital, employment, and smoking status from previous waves. RESULTS: Physical and mental health functioning seem to cluster within households. Accounting for changes in household membership over time increases estimates of the clustering in functioning at the household level. The clustering of functioning within area wards is reduced when the clustering within households and risk factors for functioning are taken into account. CONCLUSIONS: Clustered sampling units within study designs should be taken account of in individual level analyses. Changes in these units over time should be accounted for in longitudinal analysis.

Making sense of symptom checklists: a latent class approach to the first 9 years of the British Household Panel Survey.

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.