Women?s health in mid-life: life course social roles and agencyas quality

Data from a prospective British birth cohort study showed that women who were childless, lone mothers or full-timehomemakers between the ages of 26 and 54 were more likely to report poor health at age 54 than women who occupiedmultiple roles between these ages. To explain this finding we developed and tested a theory of role quality based on theconcept of agency by drawing on Giddens? theory of structuration and Doyal and Gough?s theory of human needs.According to our theory, the patriarchal structuration (drawing on Giddens? term) of work and family roles provides bothlimitation and opportunity for the expression of agency. Doyal and Gough?s theory of human needs was then used toidentify the restriction of agency as a possible influence on health. This theory of role quality was operationalised using ameasure of work (paid and unpaid) quality at age 36 and a measure of work and family stress between ages 48 and 54. Therelatively poor subjective health in mid-life of lone mothers was explained by work and family stress and adult social class.In contrast, the poor health in mid-life of long-term homemakers and childless women was less easily explained.Homemaker?s excess risk of reporting poor health at age 54 remained strong and significant even after adjusting for rolequality and socioeconomic indicators, and childless women were at an increased risk of reporting poor health despite thesocial advantage inherent in attaining educational qualifications and occupying professional or managerial occupations.This study highlights the need to develop measures of role quality specifically designed to capture agency aspects of socialroles

From paediatrics to geriatrics: a life course perspective on the MRC National Survey of Health and Development

For over 40 years I have enjoyed working collaboratively on research projects to increase understanding of population health with the aim of ultimately improving quality of life. For almost 30 years I have been part of the study team responsible for the MRC National Survey of Health and Development (NSHD), the oldest of the British birth cohort studies; and for the last 10 years have had the privilege of being the NSHD director. Such a long-term study depends on a committed and scientifically productive study team which maintains study member engagement and attracts expert scientific collaborators. For the last 20 years, I have collaborated with Professor Yoav Ben-Shlomo and others to develop the field of life course epidemiology, the study of the long term effects of social and biological exposures and experiences across life on later life health. So at the outset, I acknowledge that this personal opinion piece which I was invited to submit has implicitly and explicitly been influenced by many colleagues. It also should be read in conjunction with an accompanying article in this issue on the recent 24th follow-up of the NSHD at the age of 70 years (Kuh et al., this issue) and a recent updated review of life course epidemiology

Physical Activity and Mental Well-being in a Cohort Aged 60–64 Years

Introduction: Although evidence suggests physical activity (PA) may be associated with mental well-being at older ages, it is unclear whether some types of PA are more important than others. The purpose of this study is to investigate associations of monitored total PA under free-living conditions, self-reported leisure-time PA (LTPA), and walking for pleasure with mental well-being at age 60–64 years. Methods: Data on 930 (47%) men and 1,046 (53%) women from the United Kingdom MRC National Survey of Health and Development collected in 2006–2011 at age 60–64 were used in 2013–2014 to test the associations of PA (PA energy expenditure and time spent in different intensities of activity assessed using combined heart rate and acceleration monitors worn for 5 days, self-reported LTPA, and walking for pleasure) with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS; range, 14–70). Results: In linear regression models adjusted for gender, long-term limiting illness, smoking, employment, socioeconomic position, personality, and prior PA, those who walked for >1 hour/week had mean WEMWBS scores 1.47 (95% CI=0.60, 2.34) points higher than those who reported no walking. Those who participated in LTPA at least five times/month had WEMWBS scores 1.25 (95% CI=0.34, 2.16) points higher than those who did not engage in LTPA. There were no statistically significant associations between free-living PA and WEMWBS scores. Conclusions: In adults aged 60–64 years, participation in self-selected activities such as LTPA and walking are positively related to mental well-being, whereas total levels of free-living PA are not

Educational attainment and women's environmental mastery in midlife: findings from a British Birth Cohort Study

Using data from 1,184 women in the MRC National Survey of Health and Development, we estimated associations between education and Ryff's environmental mastery scale scores at age 52. Confirmatory factor analysis indicated two subscales, here termed mastery skills and mastery accomplishments. Low education was associated with higher mastery skills. This was partly explained by childhood socioeconomic position, as mastery was lower among those with fathers in the most and least advantaged occupational classes. Education was not associated with mastery accomplishments in unadjusted models. Lower ambitions for family/home were associated with higher mastery accomplishments and may have partly suppressed as an association between education and mastery accomplishments. This study highlights childhood as well as adult correlates of mastery and adds to mounting evidence that higher mastery is not universally found among those who are more educated

Health symptoms during midlife in relation to menopausal transition: British prospective cohort study

Objective To characterise symptoms experienced by women during the transition into natural menopause, to classify women into distinct symptom profiles or trajectories, and to relate these profiles to sociodemographic factors and health behaviours

Vascular risk factors for male and female urgency urinary incontinence at age 68 years from a British birth cohort study

OBJECTIVE: To investigate the prevalence of urgency urinary incontinence (UUI) at age 68 years and the contribution of vascular risk factors to male and female UUI pathogenesis in addition to the associations with raised body mass index (BMI). SUBJECTS AND METHODS: In all, 1 762 participants from the Medical Research Council (MRC) National Survey for Health and Development birth cohort who answered the International Consultation on Incontinence Questionnaire short form (ICIQ-SF), at age 68 years, were included. Logistic regression was used to estimate associations between UUI and earlier life vascular risk factors including: lipid status, diabetes, hypertension, BMI, previous stroke or transient ischaemic attack (TIA) diagnosis; adjusting for smoking status, physical activity, co-presentation of stress UI symptoms, educational attainment; and in women only, type of menopause, age at period cessation, and use of hormone replacement therapy (HRT). RESULTS: UUI was reported by 12% of men and 19% of women at age 68 years. Female sex, previous stroke or TIA diagnosis, increased BMI and hypertension (in men only) at age 60-64 years were independent risk factors for UUI. Female sex, increased BMI, and a previous diagnosis of stroke/TIA increased the relative risk of more severe UUI symptoms. Type and timing of menopause and HRT use did not alter the estimated associations between UUI and vascular risk factors in women. CONCLUSION: Multifactorial mechanisms lead to UUI and vascular risk factors may contribute to the pathogenesis of bladder overactivity in addition to higher BMI. Severe UUI appears to be a distinct presentation with more specific contributory mechanisms than milder UUI

Area deprivation across the life course and physical capability in mid-life: findings from the 1946 British Birth Cohort

Physical capability in later life is influenced by factors occurring across the life course, yet exposures to area conditions have only been examined cross-sectionally. Data from the National Survey of Health and Development, a longitudinal study of a 1946 British birth cohort, were used to estimate associations of area deprivation (defined as percentage of employed people working in partly skilled or unskilled occupations) at ages 4, 26, and 53 years (residential addresses linked to census data in 1950, 1972, and 1999) with 3 measures of physical capability at age 53 years: grip strength, standing balance, and chair-rise time. Cross-classified multilevel models with individuals nested within areas at the 3 ages showed that models assessing a single time point underestimate total area contributions to physical capability. For balance and chair-rise performance, associations with area deprivation in midlife were robust to adjustment for individual socioeconomic position and prior area deprivation (mean change for a 1-standard-deviation increase: balance, −7.4% (95% confidence interval (CI): −12.8, −2.8); chair rise, 2.1% (95% CI: −0.1, 4.3)). In addition, area deprivation in childhood was related to balance after adjustment for childhood socioeconomic position (−5.1%, 95% CI: −8.7, −1.6). Interventions aimed at reducing midlife disparities in physical capability should target the socioeconomic environment of individuals—for standing balance, as early as childhood