Are self-reported health inequalities widening by income? An analysis of British pseudo birth cohorts born, 1920-1970

INTRODUCTION: The health of the British population has been shown to be worsening by self-reported health and improving by self-reported limiting illness for those born before and after 1945. Little is known about the inequality in health difference across British birth cohorts by income. METHODS: Repeated cross-sections from the British General Household Survey, 1979-2011, are used to create pseudo birth cohorts born, 1920-1970, and their gender stratified, age-adjusted limiting illness and self-rated health (SRH) are estimated by household income tertiles. Absolute and relative differences between the poorest and richest income groups are reported. RESULTS: Absolute inequalities in limiting illness between the richest and poorest households have doubled in women and increased by one and a half times in men for those born in 1920-1922 compared with those born in 1968-1970. Relative inequalities in limiting illness increased by a half in women and doubled in men. Absolute inequalities in SRH between the richest and poorest households increased by almost half in women and more than half in men and relative inequalities increased by 18% in women and 14% in men for those born in 1920-1922 compared with those born in 1968-1970. CONCLUSION: Inequalities in self-reported health at the same age by household income have widened for successively later-born British cohorts

Clustering and networking among small independent hotels: developments over ten years

This paper reports on networking activities amongst a cluster of independent hotels with a view to analysing key variables in network development for SMEs. A comparative, longitudinal element is introduced by reference to an earlier study of the same phenomenon, ten years earlier. Of particular interest is the influence of various forms of social capital in the development of informal networks and the inter-play between co-operation and competition over time. Given the time gap between the two studies, the effect of sectoral changes on network development is also examined. The research revisits and extends a previous study of many of the same hotels which were investigated in 1995 over their formal and informal links that were found to be influenced by such factors across two classifications - the business as unit (proximity, perceptions of quality) and the individual respondent (personal social networks and ethnicity). Extending that analysis, social capital concepts and relevant references to embedded networks and kinship groups and co-operative game rules will be introduced in this paper. A highly concentrated population of small, independent hotels in Central London had been identified in the previous research project and it is from this sample that the current research drew and extended its own sample of hotels. With such a high number of hotels in the area a mixture of ‘snowball’ sampling and self-selection was successfully employed. Of the original 29 hotels, 22 have been re-interviewed and complemented by another 19. Of the remainder of the original sample, several had subsequently merged or failed to survive the intervening period. Face-to-face interviews were conducted with owner-managers in all cases using a structured questionnaire that replicated as much as possible of the original questionnaire, with both open and closed questions to allow some individual expression on relevant topics. The quantitative data obtained will be analysed using UCINET software to generate visual representations of networks alongside statistical and cluster analyses. Both academic and policy implications are likely to arise from this research, such as novel insights from such an unique periodic comparison of networks development, the influence of social capital on (formal and informal) network activities and the changing influence and consolidation of hotel groups through mergers and franchising

Are ethnic employment penalties mitigated in deprived neighbourhoods and in ethnically dense neighbourhoods?

Existing research has extensively documented that those living in the most deprived neighbourhoods and individuals from some ethnic minority groups have low rates of labour market participation in the United Kingdom. This paper brings together these two established areas of research to ask whether ethnic minority groups have better employment participation when living in more deprived neighbourhoods. We hypothesise that this could be due to different socialisation processes enabling ethnic minorities to secure employment more easily in deprived neighbourhoods as well as in neighbourhoods where there is greater ethnic density. Data from the United Kingdom Household Longitudinal Study in England are linked to the Index of Multiple Deprivation 2014 and the 2011 Census to model unemployment and economic inactivity between 2009 and 2019 separately for women and men. The results show that some ethnic minority groups face disadvantage in the labour market, especially Pakistani and Bangladeshi women. There is little support to suggest that these penalties are lessened in more deprived neighbourhoods or in more ethnically dense neighbourhoods. There is some suggestion that groups who do not face ethnic penalties compared with the White British group have lower rates of unemployment and economic inactivity in more deprived neighbourhoods. We suggest policies aimed at improving labour market outcomes for disadvantaged ethnic minorities should target them wherever they live

Exploring the Relationship Between Internet Use and Mental Health Among Older Adults in England: Longitudinal Observational Study

Background: There is uncertainty about the impact of internet use on mental health in older adults. Moreover, there is very little known specifically about the impact of particular purposes of internet use. Objective: This study aims to investigate the longitudinal relationship between two distinct concepts of mental health with the frequency of internet use among older adults: the moderating role of socioeconomic position (SEP) and the association between specific purposes of internet use. Methods: Longitudinal fixed and random effects (27,507 person-years) models were fitted using waves 6-8 of the English Longitudinal Study of Ageing to examine the relationship between different aspects of internet use (frequency and purpose) and two mental health outcomes (depression and life satisfaction). The potential moderating effect of SEP on these associations was tested using interaction terms. Results: Infrequent internet use (monthly or less vs daily) was predictive of deteriorating life satisfaction (β=−0.512; P=.02) but not depression. Education and occupational class had a moderating effect on the association between frequency of internet use and mental health. The associations were stronger in the highest educational group in both depression (P=.09) and life satisfaction (P=.02), and in the highest occupational group in life satisfaction (P=.05) only. Using the internet for communication was associated with lower depression (β=−0.24; P=.002) and better life satisfaction (β=.97; P<.001), whereas those using the internet for information access had worse life satisfaction (β=−0.86; P<.001) compared with those who did not. Conclusions: Policies to improve mental health in older adults should encourage internet use, especially as a tool to aid communication

Mental health and ethnic density among adolescents in England: A cross-sectional study

This paper determines the association of neighbourhood ethnic density on adolescent mental health and its interplay with ethnic minority status and neighbourhood deprivation. 4145 cross-sectional responses to the 2009–2011 UK Household Longitudinal Study (UKHLS) youth self-completion questionnaire for youths aged 10–15 living in England were combined with household responses to the household UKHLS interview and 2011 Census data. Regression models were used to predict a Strengths and Difficulties Questionnaire (SDQ) score (range 0–40) with higher values indicating worse mental health. Ethnic density was operationalised using two distinct measures: co-ethnic density and diversity index. There was no difference in the mental health of ethnic minority youths by whether they lived in neighbourhoods of differing levels of ethnic density or neighbourhood deprivation. White British youths had poorer mental health when living in deprived neighbourhoods where their ethnic group was the vast majority. The difference compared to all other neighbourhoods was two points on the SDQ score. Interventions should seek to encourage adolescents living in white-working class neighbourhoods to explore ethnic diversity to determine whether it improves their mental health

Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis

BACKGROUND: With growing numbers of older people worldwide, improving and maintaining quality of life during the extended years of life are a major focus for healthcare providers and policymakers. Some studies have suggested frailty may be associated with worse quality of life. OBJECTIVES: To review the associations between frailty and quality of life among community-dwelling older people. METHODS: A systematic literature search was performed using five databases for cross-sectional and longitudinal studies examining associations between frailty and quality of life among community-dwelling older people published in 2000 or later. Reference lists of relevant studies were also manually searched. Authors were requested for data for a meta-analysis if necessary. Meta-analysis was attempted for studies using the same frailty criteria and quality-of-life instrument. Methodological quality, heterogeneity and publication bias were assessed. RESULTS: The systematic review identified 5145 studies, among which 11 cross-sectional studies and two longitudinal studies were included in this review. Meta-analysis including four cross-sectional studies using the Fried Phenotype and 36-Item Short Form Health Survey showed that those classified as frail and prefrail had significantly lower mental and physical quality-of-life scores than those classified as non-frail. High heterogeneity and possible publication bias were noted. CONCLUSIONS: This systematic review and meta-analysis has demonstrated the evidence of a consistent inverse association between frailty/prefrailty and quality of life among community-dwelling older people. Interventions targeted at reducing frailty may have the additional benefit of improving corresponding quality of life. More longitudinal analysis is required to determine this effect

Heterogeneity in the association between youth unemployment and mental health later in life: a quantile regression analysis of longitudinal data from English schoolchildren

OBJECTIVES: An association between youth unemployment and poorer mental health later in life has been found in several countries. Little is known about whether this association is consistent across individuals or differs in strength. We adopt a quantile regression approach to explore heterogeneity in the association between youth unemployment and later mental health along the mental health distribution. DESIGN: Prospective longitudinal cohort of secondary schoolchildren in England followed from age 13/14 in 2004 to age 25 in 2015. SETTING: England, UK. PARTICIPANTS: 7707 participants interviewed at age 25.Primary and secondary outcome measures12-Item General Health Questionnaire (GHQ) Likert score, a measure of minor psychiatric morbidity. RESULTS: Youth unemployment was related to worse mental health at age 25. The association was several times stronger at deciles of GHQ representing the poorest levels of mental health. This association was only partly attenuated when adjusting for confounding variables and for current employment status. In fully adjusted models not including current employment status, marginal effects at the 50th percentile were 0.73 (95% CI -0.05 to 1.54, b=0.11) points, while marginal effects at the 90th percentile were 3.76 (95% CI 1.82 to 5.83; b=0.58) points. The results were robust to different combinations of control variables. CONCLUSIONS: There is heterogeneity in the longitudinal association between youth unemployment and mental health, with associations more pronounced at higher levels of psychological ill health. Youth unemployment may signal clinically relevant future psychological problems among some individuals

How robust is the association between youth unemployment and later mental health? An analysis of longitudinal data from English schoolchildren

BACKGROUND: Several studies show that youth unemployment is associated with worse mental health later in life. However, existing studies report results for only one model, or a few models, and use regression adjustment to support causal claims. We use two novel methods to address these gaps in the literature. METHODS: We use data from Next Steps, a cohort study of English schoolchildren who entered the labour market in the aftermath of the 2008-2009 global financial crisis, and measure mental health using the 12-item General Health Questionnaire (GHQ-12) at age 25. We use specification curve analysis and a negative control outcome design (a form of placebo test) to test whether associations between youth unemployment and later GHQ-12 scores are sensitive to model specification or are likely to be confounded by unobserved factors. RESULTS: We find that the association between unemployment and later GHQ-12 is qualitatively similar across 99.96% of the 120 000 models we run. Statistically significant associations with two placebo outcomes, height and patience, are not present when regression adjustments are made. CONCLUSIONS: There is clear evidence that youth unemployment is related to later mental health, and some evidence that this cannot be easily explained by unobserved confounding

Fruit and Vegetable Consumption and Incident Prefrailty and Frailty in Community-Dwelling Older People: The English Longitudinal Study of Ageing

Background: There is limited evidence in the literature regarding associations between fruit and vegetable consumption and risk of frailty. Objective: To examine associations between fruit and vegetable consumption and risk of incident frailty and incident prefrailty/frailty. Design: A prospective panel study. Setting and Subjects: 2634 non-frail community-dwelling men and women aged 60 years or older from the English Longitudinal Study of Ageing (ELSA). Methods: Fruit and vegetable consumption/day was measured using a self-completion questionnaire at baseline. Frailty status was measured at baseline and follow-up was based on modified frailty phenotype criteria. Four-year incident frailty was examined among 2634 robust or prefrail participants, and incident prefrailty/frailty was measured among 1577 robust participants. Results: Multivariable logistic regression models adjusted for age, gender, and other confounders showed that fruit and vegetable consumption was not associated with incident frailty risks among robust or prefrail participants. However, robust participants consuming 5–7.5 portions of 80 g per day (odds ratio (OR) = 0.56, 95% confidence interval (CI) = 0.37–0.85, p < 0.01) and 7.5–10 portions per day (OR = 0.46, 95%CI = 0.27–0.77, p < 0.01) had significantly lower risk of incident prefrailty/frailty compared with those consuming 0–2.5 portions/day, whereas those consuming 10 or more portions/day did not (OR = 1.10, 95%CI = 0.54–2.26, p = 0.79). Analysis repeated with fruit and vegetable separately showed overall similar results. Conclusions: Robust older adults without frailty who eat current U.K. government recommendations for fruit and vegetable consumption (5–10 portions/day) had significantly reduced risks of incident prefrailty/frailty compared with those who only eat small amount (0–2.5 portions/day). Older people can be advised that eating sufficient amounts of fruit and vegetable may be beneficial for frailty preventio