Differential impact of socioeconomic position across life on oral cancer risk in Kerala, India: An investigation of life-course models under a time-varying framework

Objectives The incidence of oral cancer has been rapidly increasing in India, calling for evidence contributing to a deeper understanding of its determinants. Although disadvantageous life‐course socioeconomic position (SEP) is independently associated with the risk of these cancers, the explanatory mechanisms remain unclear. Possible pathways may be better understood by testing which life‐course model most influences oral cancer risk. We estimated the association between life‐course SEP and oral cancer risk under three life‐course models: critical period, accumulation and social mobility. Methods We recruited incident oral cancer cases (N = 350) and controls (N = 371) frequency‐matched by age and sex from two main referral hospitals in Kozhikode, Kerala, India, between 2008 and 2012. We collected information on childhood (0‐16 years), early adulthood (17‐30 years) and late adulthood (above 30 years) SEP and behavioural factors along the life span using interviews and a life‐grid technique. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for the association between life‐course SEP and oral cancer risk using inverse probability weighted marginal structural models. Results Relative to an advantageous SEP in childhood and early adulthood, a disadvantageous SEP was associated with oral cancer risk [(OR = 2.76, 95% CI: 1.99, 3.81) and (OR = 1.84, 95% CI: 1.21, 2.79), respectively]. In addition, participants who were in a disadvantageous (vs advantageous) SEP during all three periods of life had an increased oral cancer risk (OR = 4.86, 95% CI: 2.61, 9.06). The childhood to early adulthood social mobility model and overall life‐course trajectories indicated strong influence of exposure to disadvantageous SEP in childhood on the risk for oral cancer. Conclusions Using novel approaches to existing methods, our study provides empirical evidence that disadvantageous childhood SEP is critical for oral cancer risk in this population from Kerala, India

Assertion, Negotiation and Subjugation of Identity: Understanding the Tamil-Malayali Conflict in Munnar

Social identities play a critical role in the various phases of conflict. Existing literature often examines the role of social identity of groups in inducing conflict in heterogeneous societies. This article puts forward the view that the role of identity is not limited in terms of inducing conflict, but it also plays a vital role in influencing the dynamics of conflict. Based on this conceptual framework, the article outlines the conflict dynamics observable in the Kannan Devan Hills village in Kerala, where several factors, over the course of time in the last century, have led to the perception of conflict between the Tamils and the Malayalis. As a major objective, the article identifies the issues and processes of social interaction between the two groups that necessarily influence the nature of the conflict. The article identifies that the conflict between the two communities, though mostly latent, can be seen through three important aspects: assertion, negotiation and subjugation of identities. Through assertion of identity, the conflict is perceived over ethnic lines, whereas the process of negotiation and subjugation of identity constantly undermines the ethnic nature of conflict to specific grievances, thus giving insight into the dynamic nature of the conflict