Pro-environmental behaviours and attitudes are associated with health, wellbeing and life satisfaction in multiple occupancy households in the UK Household Longitudinal Study

Pro-environmental behaviours (PEBs) and attitudes (PEAs) may influence different domains of health and wellbeing through several mechanisms. The household plays an important role in this relationship; however, there is no previous research on household level PEBs or the PEAs of other household members in relation to health and wellbeing. We used data from 22,427 people in 9344 multiple occupancy households in the UK Household Longitudinal Study. Explanatory variables were household level PEBs, individual PEAs and PEAs of other household members. We used five common physical and mental health and wellbeing outcome measures. Household PEBs were associated with higher life satisfaction. Individual PEAs were associated with lower life satisfaction and worse mental health. PEAs of other household members were associated with higher physical health, mental health and life satisfaction scores for all outcome measures. Findings suggest that ‘greener’ households can produce a ‘win-win’ result for the environment and public health

Costs of healthy living for older adults: the need for dynamic measures of health-related poverty to support evidence-informed policy-making and real-time decision-making

Objectives This study aimed to examine the dynamic properties of the costs of healthy living for older adults and to compare these costs to the timing and levels of Pension Credit for older adults on low incomes. Study design This was a longitudinal descriptive study. Methods We used monthly inflation data and the concept of a ‘Minimum Income for Healthy Living’ (MIHL) to estimate the dynamic changes in MIHL from 2003 to 2022 and compared these costs with Pension Credit levels for older adults on low incomes. Results Progress in closing the gap between the MIHL and Pension Credit has been reversed by recent sharp increases in costs. From April 2021 to April 2022, the MIHL for single older adults rose from £5.57 per week below to £8.29 per week above Pension Credit levels. Conclusions There is a need for dynamic measures of health-related poverty to support evidence-informed policy-making and real-time decision-making to mitigate the health impacts on older adults

Depression Earlier on in Life Predicts Frailty at 50 Years: Evidence from the 1958 British Birth Cohort Study

Frailty and depression in older ages have a bidirectional relationship, sharing some symptoms and characteristics. Most evidence for this has come from cross-sectional studies, or longitudinal studies with limited follow-up periods. We used data from the National Child Development Study (1958 Birth Cohort) to investigate the relationship between depression and early-onset frailty using a life course perspective. The primary outcome was frailty based on a 30-item inventory of physical health conditions, activities of daily living and cognitive function at 50 years. The main exposure was depression (based on a nine-item Malaise score ≥ 4) measured at 23, 33 and 42 years. We investigated this relationship using multiple logistic regression models adjusted for socio-demographic factors, early life circumstances and health behaviours. In fully adjusted models, when modelled separately, depression at each timepoint was associated with around twice the odds of frailty. An accumulated depression score showed increases in the odds of frailty with each unit increase (once: OR 1.92, 95%CI 1.65, 2.23; twice OR 2.33, 95%CI 1.85, 2.94; thrice: OR 2.95, 95%CI 2.11, 4.11). The public health significance of this finding is that it shows the potential to reduce the physical burden of disease later in life by paying attention to mental health at younger ages

Labour force transitions and changes in quality of life at age 50 to 55 years: evidence from a birth cohort study

In the context of an ageing population and longer working lives, the impact of increasing rates of early exit from the labour force on quality of life is a particularly current concern. However, relatively little is known about the impact on quality of life of later life labour force transitions and various forms of early exit from the labour force, compared to remaining in employment. This paper examines life course labour force trajectories and transitions in relation to change in quality of life prior to the State Pension Age. Life course data on early life circumstances, labour force trajectories and labour force transitions from 3,894 women and 3,528 men in the National Child Development Study (1958 British Birth Cohort) were examined in relation to change in quality of life, measured by a short-form version of CASP, between ages 50 and 55 years. Women and men differed in the types of labour force transition associated with positive change in quality of life, with men more frequent beneficiaries. For both men and women, labour force exit due to being sick or disabled was associated with a negative change in quality of life, whereas joining the labour force was associated with a positive change in quality of life. Moving into retirement was associated with a positive change in men’s quality of life, but not women’s. Moving from full-time to part-time employment was associated with a positive change in women’s quality of life, but not men’s. The findings that stand out for their policy relevance are: the threat to the quality of life of both women and men from early labour force exit due to limiting longstanding illness; and, women are less likely to experience beneficial labour force exit in the later years of their working life, but are more likely to benefit from a reduction in working hours

The role of childhood social position in adult type 2 diabetes: evidence from the English Longitudinal Study of Ageing

Background Socioeconomic circumstances in childhood and early adulthood may influence the later onset of chronic disease, although such research is limited for type 2 diabetes and its risk factors at the different stages of life. The main aim of the present study is to examine the role of childhood social position and later inflammatory markers and health behaviours in developing type 2 diabetes at older ages using a pathway analytic approach. Methods Data on childhood and adult life circumstances of 2,994 men and 4,021 women from English Longitudinal Study of Ageing (ELSA) were used to evaluate their association with diabetes at age 50 years and more. The cases of diabetes were based on having increased blood levels of glycated haemoglobin and/or self-reported medication for diabetes and/or being diagnosed with type 2 diabetes. Father’s job when ELSA participants were aged 14 years was used as the measure of childhood social position. Current social characteristics, health behaviours and inflammatory biomarkers were used as potential mediators in the statistical analysis to assess direct and indirect effects of childhood circumstances on diabetes in later life. Results 12.6 per cent of participants were classified as having diabetes. A disadvantaged social position in childhood, as measured by father’s manual occupation, was associated at conventional levels of statistical significance with an increased risk of type 2 diabetes in adulthood, both directly and indirectly through inflammation, adulthood social position and a risk score constructed from adult health behaviours including tobacco smoking and limited physical activity. The direct effect of childhood social position was reduced by mediation analysis (standardised coefficient decreased from 0.089 to 0.043) but remained statistically significant (p = 0.035). All three indirect pathways made a statistically significantly contribution to the overall effect of childhood social position on adulthood type 2 diabetes. Conclusions Childhood social position influences adult diabetes directly and indirectly through inflammatory markers, adulthood social position and adult health behaviours

Evaluating the Performance of the Indian Diabetes Risk Score in Different Ethnic Groups

Aim To evaluate the performance of Madras Diabetes Research Foundation -Indian Diabetes Risk Score (MDRF-IDRS score) in different ethnic groups including Indians, Hispanic, Non-Hispanic Whites, Non-Hispanic Blacks and other American. Methods The MDRF-IDRS score is calculated based on a risk equation that includes age, waist circumference, family history of diabetes and physical activity. The National Health and Nutrition Examination Survey (NHANES) data on American and Chennai Urban Rural Epidemiology Study data on Indians were used in this study. Study participants aged ≥ 20 years with and without type 2 diabetes were included. Performance of the MDRF-IDRS score was assessed using sensitivity, specificity, positive predictive value, negative predictive value and the area under the receiver operating characteristic curve measures within each ethnic group. IDRS scores' performance was then compared with existing non-invasive American diabetes risk scores. Results Total number of participants included was 11,035 (2292 Indians and 8743 American). MDRF-IDRS score (cut off≥ 60) performed well in Indians with an AUC, sensitivity and specificity of 0.73, 80.2% and 57.3% respectively. MDRF-IDRS score cut off ≥ 70 had the highest discriminative performance among Hispanic, Non-Hispanic Whites and Non-Hispanic Blacks with sensitivity and specificity of between 70.1-86.9% and 61.2-72.2% respectively. The AUC for American was between 0.77-0.81 with the highest and lowest AUC in Non-Hispanic Black and Non-Hispanic White respectively. With a smaller number of variables, IDRS score showed almost the same performance in predicting diabetes among American compared with the existing non-invasive American diabetes risk score. Conclusion The MDRF-IDRS score performs well among Indians and American including Hispanic, Non-Hispanic White, Non-Hispanic Black and other American. It can be used as a screening tool to help in early diagnosis, management and optimal control of diabetes mainly in mass screening programmes in India and America

Clustering of lifestyle risk behaviours among residents of forty deprived neighbourhoods in London: lessons for targeting public health interventions

Background Clustering of lifestyle risk behaviours is very important in predicting premature mortality. Understanding the extent to which risk behaviours are clustered in deprived communities is vital to most effectively target public health interventions. Methods We examined co-occurrence and associations between risk behaviours (smoking, alcohol consumption, poor diet, low physical activity and high sedentary time) reported by adults living in deprived London neighbourhoods. Associations between sociodemographic characteristics and clustered risk behaviours were examined. Latent class analysis was used to identify underlying clustering of behaviours. Results Over 90% of respondents reported at least one risk behaviour. Reporting specific risk behaviours predicted reporting of further risk behaviours. Latent class analyses revealed four underlying classes. Membership of a maximal risk behaviour class was more likely for young, white males who were unable to work. Conclusions Compared with recent national level analysis, there was a weaker relationship between education and clustering of behaviours and a very high prevalence of clustering of risk behaviours in those unable to work. Young, white men who report difficulty managing on income were at high risk of reporting multiple risk behaviours. These groups may be an important target for interventions to reduce premature mortality caused by multiple risk behaviours

Country-level welfare-state measures and change in wellbeing following work exit in early old age: evidence from 16 European countries

Background Although the effects of individual-level factors on wellbeing change following work exit have been identified, the role of welfare-state variables at the country level has yet to be investigated. Methods Data on 8037 respondents aged 50 years and over in 16 European countries were drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA). We employed multilevel models to assess determinants of change in wellbeing following work exit, using CASP-12 change scores. After adjusting for institutionally defined route and timing of work exit, in addition to other individual-level variables, we tested country-level variables including welfare-state regime and measures of disaggregated welfare spending to determine their associations with wellbeing change and the proportion of between-country variance explained. Results Individuals whose exit from paid work was involuntary or diverged from the typical retirement age experienced declines in wellbeing. Country effects accounted for 7% of overall variance in wellbeing change. Individuals residing in countries with a Mediterranean welfare regime experienced more negative changes in wellbeing, with a difference of –2.15 (–3.23, –1.06) CASP-12 points compared with those in Bismarckian welfare states. Welfare regime explained 62% of between-country variance. National per-capita expenditure on non-healthcare in-kind benefits (services) was associated with more positive wellbeing outcomes. Conclusions National expenditure on in-kind benefits, particularly non-healthcare services, is associated with more favourable wellbeing change outcomes following work exit in early old age. Welfare-state effects explain the majority of between-country differences in change in wellbeing