Journal of Epidemiology & Community Health最新文献

{"title":"P40 A meta-framework for incorporating socio-economic health inequalities in systematic reviews","authors":"M. Maden","doi":"10.1136/jech-2018-SSMabstracts.166","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.166","url":null,"abstract":"Background Recent equity systematic review guidance encourages reviewers to consider whether it is likely that their findings may impact on health inequalities. Much of the guidance assumes that health inequalities have either already been identified as the focus of the review, or that reviewers are able to recognise if and how health inequalities matter. However, our experience is that this is not necessarily true. Furthermore, theorising if and how health inequalities matter is not normally integrated into the systematic review process. This presentation describes a novel approach to the development of a theory-led meta-framework to inform socio-economic health inequality considerations in systematic reviews. Methods Following the best-fit framework synthesis approach, a meta-framework was generated by ‘deconstituting’ concepts from theories relating to complex interventions and socio-economic health inequalities into a single framework. Theories were identified via; i) searches in MEDLINE, CINAHL, The Cochrane Library (CDSR, Other reviews, HTA), the Database of Promoting Health Effectiveness Reviews (DoPHER), the Campbell Collaboration Library of Systematic Reviews, 3ie (International Initiative for Impact Evaluation) database of systematic reviews, Google Scholar, Campbell and Cochrane Equity Methods Group website), ii) scanning of known relevant theoretical papers, iii) theories identified in a published work on the use of programme theory in socio-economic focused systematic reviews and iv) informal discussions with health inequality experts. Feedback was sought from health inequality experts and reviewers. Results Four complex intervention theories identify four domains and key factors that may influence effectiveness; intervention design, implementation, context and participant response. Applying an equity lens, 16 socio-economic health inequality theories identify key factors and mechanisms associated with these domains that may lead to differential effects across disadvantaged populations. Conclusion The meta-framework has the potential to i) facilitate the identification and understanding of when, why and how intervention effectiveness may be moderated by socio-economic status, ii) promote a theory-led approach to incorporating socio-economic health inequality considerations in systematic reviews iii) help reviewers identify the type of data to extract and inform a priori analysis on what factors are associated with differential effects across socio-economic groups, iv) help reviewers to decide whether it is likely that their review findings may have the potential for an intervention to indirectly widen or narrow socio-economic health inequalities, even when evidence of an impact in the primary research is lacking. The meta-framework aims to increase the usefulness of systematic reviews in informing and implementing changes to practice.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"233 1","pages":"A79"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77460608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RF16 An agent-based model of social care supply and demand in the UK","authors":"Es Silverman, U. Gostoli","doi":"10.1136/jech-2018-SSMabstracts.105","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.105","url":null,"abstract":"Background Social care provision is vital for ensuring the health of ageing and vulnerable populations. The UK relies on informal care for 50% of care provision, meaning that social care policies have significant implications for health services sustainability in this context. We present an agent-based simulation of UK informal care provision, demonstrating how this framework captures troubling trends and inequalities in social care. Methods We constructed an agent-based model in Python that simulates individual human agents in a virtual UK from the year 1860 to 2022. Population dynamics are driven by UK birth rates and mortality rates. Agents can form partnerships, reproduce, migrate domestically for work or other purposes, change jobs, and provide social care. Care decisions are taken based on employment status, salary, age, health status, geographical location, and their relationship to those in need of care. Simulated agents participate in a detailed economy, and are members of different socioeconomic status groups depending on their income. Output files track agents’ socioeconomic status, social mobility, informal care provision, and payment for formal care services. Simulation output includes individual-level agent statistics and population-level analyses of care provision by age, sex, socioeconomic status, and employment status. Simulation results were calibrated against 2011 UK Census data for key population dynamics measures. Results Simulation results in the year 2022 show significant inequalities in social care need and provision by gender and SES group. Agents in the lowest SES quintile (Group I) show a mean unmet care need of 19 hours/week, as compared to 12.5/week in in the highest (Group V). Carers in Group I supply an average 8.6 hours/week of care, compared to 3.6 hours/week in Group V. Thus, agents in Group I not only make a lower wage, they also lose more hours of work to care provision, and need more care themselves. In addition, female agents provide 1.9 times more informal care than males, while receiving lower average wages. Finally, the simulation shows a trend of growth in unmet care need from 1.17 hours per capita in 1976 to 2.38 by 2022. Conclusion This work demonstrates that a well-constructed agent-based simulation can provide a platform for investigating the influence of economic and social factors on social care provision. This framework thus provides a means to develop and test new social care policies which better account for the complexities and challenges facing informal carers across the country, and in turn better protect health services sustainability.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"38 1","pages":"A51"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86112727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OP45 Allostatic load and effort-reward imbalance: associations over the working-career","authors":"JI Cuitun Coronado, T. Chandola, A. Steptoe","doi":"10.1136/jech-2018-SSMabstracts.45","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.45","url":null,"abstract":"Background Although associations between work stressors and stress-related biomarkers have been reported in cross-sectional studies, the use of single time measurements of work stressors could be one of the reasons for previously inconsistently reported associations. This study examines whether repeated reports of work stress towards the end of the working career predicts allostatic load, a measure of chronic stress related physiological processes. Methods Data from waves 2 to 6 of the English Longitudinal Study of Ageing (ELSA) were analysed, with a main analytical sample of 2663 older adults (aged 50+) who had at least one measurement of effort-reward imbalance between waves 2–6 and a measurement of allostatic load at wave 6. From this main analytical sample, a subsample of 1020 respondents had their allostatic load measured at wave 2. Cumulative work stress over waves 2–6 were measured by the effort-reward imbalance model. Negative binomial regression models were used to estimate the association between effort-reward imbalance and allostatic load after controlling for covariates (categorized age, gender, ethnicity, smoking status, general health, number of medications used, depressive symptoms using the Centre for Epidemiologic Studies Depression Scale, physical activity, and alcohol use in the last 12 months). Results Employees with effort-reward imbalance at the more recent waves 5 (0.09, –0.002–0.17) and 6 (0.13, 0.03–0.22) had higher levels of wave 6 allostatic load compared to those who did not report any imbalance at those waves. The predicted levels of allostatic load by cumulative reports of effort-reward imbalance from the model controlling for wave 2 allostatic load showed that workers who reported two or more occasions of effort-reward imbalance had a higher estimate of the allostatic load index (0.11, 95% CI 0.01 to 0.22) compared to workers who never reported effort-reward imbalance. Conclusion The study finds some evidence that older adults aged 50+ living in England who repeatedly reported work related stressors had higher levels of the allostatic load index than those who did not report any effort-reward imbalance. This association was robust to controlling for a range of potential health and socio-demographic confounders, as well as baseline levels of allostatic load. The findings of a dose-response association between effort-reward imbalance and allostatic load, as well as the timing of the stressor and stress response, suggest that exposure to work-related stressors may have adverse consequences for physiological health through increasing adverse levels of stress related biomarkers.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"1 1","pages":"A22"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89476531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OP64 Impact of poverty trajectories on children’s health and maternal mental health: evidence from the UK millennium cohort study","authors":"S. Wickham, Etc Lai, Benjamin Barr, D. Taylor-Robinson","doi":"10.1136/JECH-2018-SSMABSTRACTS.63","DOIUrl":"https://doi.org/10.1136/JECH-2018-SSMABSTRACTS.63","url":null,"abstract":"Background The number of children living in poverty in the United Kingdom (UK) is rising. Child poverty has been shown to cause poor mental and physical health outcomes that last into adulthood. Poverty also puts families in distress. The aim of the study was to understand the prevalence of different poverty trajectories for UK children, and their associations with multiple child health and maternal mental health outcomes. Methods We analysed data on 11 565 children who participated in sweeps of the UK Millennium Cohort Study from ages 9 months to 14 years. Outcomes were: (i) mental health at age 14, measured by the Strengths and Difficulties Questionnaire (SDQ); (ii) physical health at age 14, measured by overweight/obese and any longstanding illness; and (iii) maternal mental health, measured by Kessler 6 scale. The main exposure of interest was relative poverty (less than 60% of median of equivalised household income). Poverty trajectories measured at 9 months, 3, 5, 7, 11 and 14 years were characterised using latent class analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression models, adjusted for child sex, maternal education and maternal ethnicity. Results Four poverty trajectories were identified: class 1 (61.2% of children) (stable never-poor, reference group), class 2 (14.2%) (poverty in early childhood), class 3 (5.2%) (poverty in late childhood) and class 4 (19.4%) (persistent poverty). Any exposure to poverty was associated with increased risk of longstanding illness, and worse mental health outcomes for both mothers and children, with the largest effects for persistent poverty. Compared with children who were never poor, those from persistently poor households were at a higher risk of having mental health problems [SDQ score ≥17 (aOR: 2.76; 95% CI 2.29 to 3.34)], physical health problems [being overweight/obese (aOR: 1.23; 95% CI 1.07 to 1.41); longstanding illness (aOR: 1.82, 95% CI 1.55 to 2.15)] and mothers under psychological distress [Kessler 6 scale score ≥6 (aOR: 2.60; 95% CI 2.26 to 3.00)]. Conclusion Persistent poverty affects one in five UK children and is associated with negative impacts on child and maternal health, particularly mental health. Any exposures to poverty mainly in early or late childhood were also associated with worse outcomes. One of the limitations of this study is that household income was self-reported. Policies that reduce child poverty and its consequences are likely to improve health across the life course.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"8 1","pages":"A31"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89591638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P37 Relationship between physical activity and blood glucose markers during pregnancy amongst a multi-ethnic maternal cohort: results from the born in bradford cohort study","authors":"E. Petherick, L. Sherar, S. Barber, M. Hamer, John Wright","doi":"10.1136/jech-2018-SSMabstracts.163","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.163","url":null,"abstract":"Background Physical activity is associated with positive health biomarker profiles during pregnancy and resultant birth outcomes. Furthermore, there is some evidence to suggest that physical activity both prior to and during pregnancy may reduce the risk of gestational diabetes. In this study we aim to investigate the relationship between physical activity and biomarkers associated with gestational diabetes (GDM) risk and clinical diagnoses of GDM. Methods Participants were pregnant women recruited to the Born in Bradford cohort study who completed phase 1 or 2 of the baseline questionnaire and provided a fasting blood sample between approx. 26–28 weeks of gestation, and had a singleton birth. Where mothers had two births during the study period, only the first was included in the present analyses. Physical activity level was measured using the General Practice Physical Activity Questionnaire (GPPAQ) and questions about usual walking speed. The relationship of self-reported physical activity, using both of the two definitions above, with levels of fasting blood glucose was evaluated using multivariate linear regression. GDM risk was assessed using logistic regression analyses. Models were adjusted for other key covariables including age, ethnicity, body mass index and parity. Results Data were available for 6119 maternal participants. White British women reported higher levels of physical activity and physical function (i.e. higher self-reported average walking speed) relative to their Pakistani and Other ethnic group peers. Despite the higher GPPAQ scores in the White British group, over 67 per cent still fell into the inactive or moderately inactive category. Higher levels of activity as measured by GPPAQ scores was not associated with fasting blood glucose or odds of gestational diabetes. Walking speeds were associated with lower levels of fasting glucose, and remained so after adjustment for other relevant covariables (−0.04 (−0.08, –0.05). Adjusted odds of gestational diabetes diagnosis were also lower in those reporting the highest self-reported walking speeds OR 0.49 (0.27–0.87). Conclusion Faster self-reported walking speeds, which may result from greater residual fitness prior to pregnancy, were shown to be associated with lower fasting blood glucose levels and lower odds of a gestational diabetes diagnosis. These results provide first time evidence that self-reported walking speed, an indicator of functional reserve, is associated with positive pregnancy related biomarker profiles and require independent confirmation. Given the lower physical activity and functional profile of Pakistani women, there remains high potential for behaviour change interventions in this population group. To realise this ambition further research must focus on understanding specific cultural and socio-economic barriers to implementation.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"76 1","pages":"A77–A78"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76443859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P27 Setting research priorities for learning difficulties in children and young people","authors":"R. Wood, A. Keow Lim, S. Rhodes, A. O'hare","doi":"10.1136/JECH-2018-SSMABSTRACTS.153","DOIUrl":"https://doi.org/10.1136/JECH-2018-SSMABSTRACTS.153","url":null,"abstract":"Background Our project aims to identify the top 10 research priorities for learning difficulties in children and young people (CYP). The project is a collaboration between Scottish charity The Salvesen Mindroom Centre (SMC), the SMC Research Centre within the University of Edinburgh, and the James Lind Alliance (JLA) (http://www.jla.nihr.ac.uk/priority-setting-partnerships/learning-difficulties-scotland/). The definition of learning difficulties that we are working to is ‘a problem of understanding or an emotional difficulty that affects a person’s ability to learn, get along with others, and follow convention’ (http://www.mindroom.org/index.php/about_us). Methods Following standard JLA methodology, we asked people from across Scotland who have learning difficulties, their families, and the professionals working alongside them, to tell us what they would want researchers to find out about learning difficulties using online and paper survey tools. Additional potential research priorities were gathered through review of NICE and Scottish Intercollegiate Guidelines Network (SIGN) research recommendations. After removing the out-of-scope submissions, the remaining submissions were allocated into categories. Duplicates were combined. Potential research priorities were then verified against up-to-date, relevant and reliable systematic reviews and guidelines to confirm ongoing uncertainty. Future work will include an interim survey to rank the priorities and a final stakeholder workshop to identify and rank the top 20 questions. Results The first survey was completed in 2017. We received 828 questions from 367 respondents, with 3% coming from CYP with learning difficulties, 5% adults who experienced learning difficulties as a child, 40% parents/carers, and 52% professionals. An innovative aspect of this project is the cross-sector input from education (37%), health (57%) and third sector (7%) professionals. Out of the 828 questions, 761 were classified as in-scope. The 761 questions were summarised into 40 questions under 9 themes. Respondents from 28 out of 32 Scottish local authorities participated in the survey. 32% of the CYP with learning difficulties and adults who experienced learning difficulties as a child, 8% of the parents and carers (postcode of residence), and 10% of the professionals (work postcode) were from the 20% Scottish Index of Multiple Deprivation most deprived data zones in Scotland. Conclusion The James Lind Alliance methodology provided a systematic and transparent approach to identifying research priorities that included people who have learning difficulties, families, and professionals who have typically not contributed to setting the research agenda. The top 10 research priorities will inform future research work into learning difficulties, including the work of the SMC Research Centre.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"83 1","pages":"A73"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77272951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RF17 What makes adolescents binge drink so often? research evidence from a population school survey in chile","authors":"Mf Roman, N. Cable","doi":"10.1136/jech-2018-SSMabstracts.106","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.106","url":null,"abstract":"Background Binge drinking is known to cause alcohol-related harm among young people. Although the link between adolescent binge drinking and adolescents’ own, parental or peer factors were established, little is known about the factors that associate with the frequency of binge drinking in the school contexts. The aim of this study is to examine the contextual associations between parental, peer and school factors and the frequency of binge drinking among Chilean school children aged 13 to 18. We hypothesised that severe school level deprivation would be associated with an increased number of binge drinking events as well as lower levels of parental supervision, and parental and peer drinking. Data Information on frequency of binge drinking in the past month, parental supervision, paternal and maternal drinking and peer drinking was extracted from the Tenth Chilean School Population National Substance Use Survey conducted in 2013. Frequency of binge drinking was analysed among those reporting alcohol use. The individual-level information was linked to school-level information (percentage of free school meal children) obtained from the Ministry of Education Methods Hierarchical data, individuals (n=41,146) nested within schools (n=1,687), were analysed using multilevel zero-inflated Poisson regression. Coefficients from the Poisson part were exponentiated to obtain Incidence Rate Ratios (IRR). Estimates were adjusted for parental education, child’s age and school type and boys and girls were analysed separately. Results Results from the Poisson part in the final model showed significant associations between lower levels of parental supervision and increased binge drinking frequencies in boys and girls. For girls, maternal drinking during weekends increased their binge drinking episodes by 10% (IRR=1.11 95% CI 1.03; 1.20), while mother’s daily drinking habits increased them by 24% (IRR=1.24 95% CI 1.18; 1.38). Maternal daily drinking also showed increases in boy’s binging episodes by 21% (IRR=1.21 95% CI 1.11; 1.31). Having at least half of friends that consumed alcohol increased the average number of binge drinking episodes by 21% (IRR=1.21 95% CI 1.13; 1.28) for boys, but by 60% (IRR=1.58 95% CI 1.45; 1.71) for girls. School deprivation was positively associated with the number of events of binge drinking for girls only (IRR=1.0034 95% CI 1.002; 1.005). Norms, especially mother’s supporting alcohol use and peer influences were major contributor for frequent binge drinking among Chilean adolescents. Girls are likely to be more vulnerable to frequent binge drinking, influenced by their peer groups and school environment.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"40 1","pages":"A51"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90211706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OP50 Stakeholder framing of advertising legislation: an analysis of media and parliamentary representations of the loi Évin in the UK","authors":"A. Ayorinde, E. Raja, A. Shetty, Peter Danielian, Sohinee Bhattacharya","doi":"10.1136/jech-2018-SSMabstracts.50","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.50","url":null,"abstract":"Background The Loi Évin legislation restricts alcohol advertising in France, and is more comprehensive than the self-regulation-based UK approach. This project aimed to analyse how the Loi Évin has been represented in UK media and parliament by the advertising and alcohol industries, politicians and non-governmental organisations. It is important to understand this because it can potentially shed light on how stakeholders, including industry, frame the debate around public health policy. Methods Qualitative analysis of media and parliamentary documents using the hermeneutic method, assessing contexts in which the Loi Évin was mentioned by stakeholders in the media and in parliament. Print and trade media articles referencing the Loi Évin were retrieved from the PROQUEST media archive [from 1985–2016]. UK parliamentary representations referencing the Loi Évin were obtained from the parliamentary database for publications and the Hansard parliamentary record. In total, 109 documents referencing the Loi Évin were identified, of which 71 (44 articles from ProQuest, 27 from parliamentary sources) contained direct quotes from stakeholders and were therefore included. These were analysed thematically using the hermeneutic method, which involved reading and understanding meanings of individual texts, in this case the contexts in which the Loi Évin was mentioned, identifying sub-themes or ‘codes’, grouping these into broader thematic clusters of codes, triangulating findings between different sources (for example, identifying similar arguments in print media and evidence submissions), assessing the reliability/validity of findings (through verification of coding by a second researcher), and illustrative use of representative case material. All coding was performed using NVivo 11.3.2. Results The alcohol and advertising industries have framed the Loi Évin as incompatible with EU principles, irrational and ineffective, with their arguments changing over time in response to landmark events and rulings. Supporters of Loi Évin-style legislation by contrast failed to counter industry framing of arguments around the link between regulations and overall consumption changes. Conclusion The portrayal of the Loi Évin by industry in the UK is an important case study of policy framing, and provides evidence of the synergy between the advertising and alcohol industries in combatting legislation that could potentially harm profit. Public health professionals practitioners, academics and advocates should be aware of the nature of such industry arguments when considering submissions to policy development processes.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"83 1","pages":"A25"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90677759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RF13 The impact of life events on later life: a latent class analysis of the english longitudinal study of ageing","authors":"OO Enwo, J. Ford, E. Player, N. Steel","doi":"10.1136/jech-2018-SSMabstracts.102","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.102","url":null,"abstract":"Background Events over an individual’s life course can positively or negatively affect their health and wellbeing in older age. We aimed to identify associations between groups of older people with similar life events and their health, behaviours and social interactions in older age. Methods We undertook a latent class analysis of the English Longitudinal Study of Ageing wave 3. Groups of participants with similar life events were generated based on eight life events; maternal and paternal closeness, educational opportunities in childhood, financial hardship, bereavement due to war, involvement in conflict, violence, and experiencing a natural disaster. The number of groups was determined based on model fit and team discussion. Linear and logistic regression were used to explore associations between these groups and pre-specified health and wellbeing factors, adjusted for age, gender, ethnicity and socioeconomic class and weighted for group probability. Results 7555 participants were allocated to one of four groups: Group A ‘few life events’ (n=6,250), Group B ‘emotionally cold mother’ (n=724), Group C ‘violence in combat’ (n=274) and Group D ‘many life events’ (n=307). Participants in Group D were statistically significantly more likely than those in Group A to experience disability (coefficient 0.35, 95% CI 0.20 to 0.50), reduced quality of life (coefficient −5.33, 95% CI −6.61 to −4.05), psychological disorders (OR 3.01, 95% CI 2.18 to 4.17) and social detachment (OR 2.60, 95% CI 1.36 to 4.97). Group C membership compared to Group A was associated with reduced quality of life (coefficient –1.95, 95% CI −3.08 to −0.82) and a life-threatening illness or accident (OR 1.98, 95% CI 1.52 to 2.59). Group B membership, compared to Group A, was associated with reduced quality of life (coefficient −1.89, 95% CI −2.62 to −1.15), psychological disorders (OR 1.73, 95% CI 1.34 to 2.23), social detachment (OR 2.60, 95% CI 1.68 to 4.04) and the perceived long-term effect of ill health (OR 1.42, 95% CI 1.10 to 1.84). Conclusion We have identified four broad groups of older people; those with few life events, those with many life events, those with an emotionally cold mother and those who have experienced violence in combat. Compared to the group with few life events, all other groups had adverse health and wellbeing in later life, especially those with an emotionally cold mother or many life events. Policies to improve health and wellbeing in later life should have a life course perspective focusing on at risk groups.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"23 1","pages":"A49–A50"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87528516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OP57 #Does parental smoking explain impacts of smoke-free public places legislation on youth smoking initiation in the UK?","authors":"Pe Anyanwu, P. Craig, S. Katikireddi, M. Green","doi":"10.1136/jech-2018-SSMabstracts.56","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.56","url":null,"abstract":"Background Evidence on the impact of the smoke-free public places legislation in the UK on youth smoking initiation is not well established. Changes in parental smoking behaviour may be a major mechanism by which smoke-free legislation impacts on youth smoking. Smoke-free legislation could also displace parental smoking behaviour into the home (by restricting alternative smoking spaces) or out of the home (by increasing awareness of risks to others from second-hand smoke exposure), potentially either strengthening or weakening its influence. We investigated how much of any impact of the legislation on youth smoking initiation could be explained by parental smoking, and whether associations between parental smoking and youth smoking initiation differed before or after the legislation. Methods Longitudinal data from the annual British Household Panel Survey and Understanding Society (1994–2016) were examined with discrete-time event history analyses. 14 992 youths contributed data for up to five observations (67 556 person-years) representing ages 11–15 years, with data right-censored at the year of smoking initiation (or age 15). We examined associations between smoking ban implementation (2006 for Scotland, 2007 for other UK countries) and youth smoking initiation (i.e. trying smoking for the first time), before and after adjustment for parental smoking, and tested for interactions between parental smoking and the ban implementation. Multiple imputation was used to handle missing data. Analyses were adjusted for youth sex, age, UK country, socioeconomic status, and temporal trends in initiation. Results Youth initiation of smoking was less likely after the implementation of the smoke-free legislation than before (OR: 0.16; 95% CI 0.14 to 0.18), and this difference further increased with each year after implementation (OR per year after the ban:0.88; 95% CI 0.82 to 0.94). Adjustment for parental smoking only marginally attenuated the association with ban implementation (OR: 0.20; 95% CI 0.16 to 0.24) and the per-year decrease after the ban (OR: 0.86; 95% CI 0.80 to 0.92) was similar. There was an interaction between the ban implementation and parental smoking (p-value: 0.001) such that parental smoking was more strongly associated with youth smoking initiation before the ban (OR: 1.41; 95% CI 1.26 to 1.58) than after (OR: 0.92; 95% CI 0.65 to 1.32). Discussion Changes in parental smoking behaviour did not seem to be a major explanation for the strong impacts of smoke-free legislation on youth smoking initiation, suggesting other mechanisms may be at work. The influence of parental smoking on youth initiation weakened after the ban which may indicate the displacement of parental smoking behaviour out of the home.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"45 1","pages":"A27–A28"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90960757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}