Social class and social cohesion: a content validity analysis using a nonrecursive structural equation model.
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Neurosis and social class. I. Social interaction.
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Humans↗
An evaluation of prenatal care and its relationship to social class and social disorganization.
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Anomie↗
Social class differences in social support among older adults.
The purpose of this study is to test for social class differences in social support among older adults. Data on a comprehensive range of social support measures provided by a nationwide sample of elderly people suggests that social class differences emerge when measures of contact with friends, support provided to others, and satisfaction with support are examined. However, significant differences fail to emerge with indicators of contact with family, support received from others, and negative interaction.
Aged↗
Social class and suicidal behaviour: the associations between social class and the characteristics of deliberate self-harm patients and the treatment they are offered.
BACKGROUND: Rates of deliberate self-harm (DSH) in the United Kingdom are much higher in lower than upper social class groups. Previous investigations have shown differences in socio-demographic and clinical characteristics of male patients according to social class. In two studies of DSH patients in Edinburgh the extent of provision of psychiatric aftercare was inversely related to social class. These findings have not been investigated in other areas. METHOD: Data collected through the Oxford Monitoring System for Attempted Suicide were used to examine the association between social class and socio-demographic and clinical characteristics in male and female DSH patients who presented to the general hospital in Oxford between mid-1988 and 1996 and to determine whether the previously reported social class differences in provision of psychiatric aftercare were replicated. RESULTS: Data on social class were available for 2,828 DSH patients (1,290 males, 1,538 females). In both genders, lower social class group tended to be associated with younger age. In males, the main social class differences were found in under-35-year-olds, in whom lower social class was related to criminal record, violence to others and drug misuse. In females, psychiatric disorders were diagnosed more frequently in the higher social class groups, but only in the under-35 age group. In neither gender was there a significant association between social class and the frequency of offer of psychiatric aftercare following DSH. CONCLUSIONS: There are considerable variations in socio-demographic and clinical characteristics of both male and female DSH patients in different social classes, especially in younger patients. The reason for the absence of a marked social class gradient in psychiatric aftercare found in this study in contrast to the results from previous investigations may be related to differences in styles of service.
Adolescent↗
Functional recovery after myocardial infarction in men: the independent effects of social class.
BACKGROUND: Social class has been repeatedly associated with cardiovascular-related illness and death, but no studies have examined the effect of social class on recovery from myocardial infarction. Moreover, few studies have simultaneously evaluated a broad array of f1p4graphic, clinical, and psychosocial factors that may influence health outcomes after myocardial infarction. OBJECTIVE: To determine whether social class remains independently associated with functional recovery after myocardial infarction, even after controlling for clinical, demographic, and psychosocial factors known to influence outcomes after infarction. DESIGN: Analysis of prospective data from a multicenter, randomized, double-blind clinical trial. SETTING: 25 hospitals or clinical settings in the United States and Canada that participated in the Beta Blocker Heart Attack Trial, including the Health Insurance Plan substudy. PATIENTS: 2145 men 29 to 69 years of age who were hospitalized with acute myocardial infarction and were recruited into the Beta Blocker Heart Attack Trial. MEASUREMENTS: The primary outcome was change in New York Heart Association functional class between baseline assessment and 12 months after infarction, dichotomized as improved or not improved (that is, no change, decline in at least one category, or death). RESULTS: Social class maintained its independent effect on improved functional status, even after controlling for pertinent prognostic factors. Persons of high social class were significantly more likely than persons of low or middle social class to have improved functional status 1 year after infarction. Certain clinical, demographic, and psychosocial features were related to recovery, but the effect of social class could not be explained by these additional features. CONCLUSIONS: Social class has a substantial influence on recovery from myocardial infarction and may explain differences in clinical outcomes.
Activities of Daily Living↗
Social class and substance use disorders: the value of social class as distinct from socioeconomic status.
The relationship between social class and substance use disorders (SUDs) is explored and compared to the relationship between SES and SUDs. Social class and SES are two different conceptualizations of socioeconomic inequality (SEI) which emanate from two different theoretical orientations in sociology. SES is commonly used in epidemiological research and is usually measured in terms of education, income or occupational prestige. Social class is less known and less used. Here, following the work of Wright et al. (Wright, E. O., Hachen, D. and Costello, C. et al. (1982) The American class structure. American Sociological Review 47, 709-726) it is measured in terms of four types of control people have in their work place: ownership, control over budget decisions, control over other workers, and control over one's own work. Data are derived from an epidemiological survey, conducted in Israel, using a two stage sampling procedure for the identification of cases. In the first stage 4914 respondents were screened with the Psychiatric Epidemiological Research Interview (PERI). In the second stage (n = 2741), those who screened positive (and a sample of the negatives) were diagnosed by psychiatrists using a structured interview that yielded diagnoses according to the Research Diagnostic Criteria (RDC). The results indicate that those who are advantaged in terms of ownership, i.e. self-employed, have higher rates of SUDs compared to employees. Furthermore, it appears that most disorders have an onset subsequent to entry into the current job, indicating that ownership plays a causal role in the onset of SUDs rather than the other way around. These results are contrasted with those of a previous report from the same study by Dohrenwend et al. (Dohrenwend, B. P., Levav, I. and Shrout, P. E. et al. (1992) Socioeconomic status and psychiatric disorders: the causation selection issue. Science 255, 946-952) which showed just the opposite association between SES and SUDs, i.e. those who are advantaged in terms of SES have lower rates of SUDs. As an explanation of these apparently conflicting results, the possibility is entertained that social class and SES represent independent causal pathways to the onset of SUDs with social class mainly related to primary SUDs and SES mainly to secondary SUDs.
Adult↗
Prospective study of attainment of social class of severely obese subjects in relation to parental social class, intelligence, and education.
Cross sectional population studies have shown that subjects who are severely obese are of lower social class than comparable subjects who are not obese. This may be ascribed to lower parental social class, poorer education, and lower intelligence test scores of the obese subjects. In this study based on 242 633 draftees appearing before the draft board in Copenhagen between 1956 and 1977, 1144 extremely overweight men (body mass index greater than or equal to 31 kg/m2) were compared with 2123 young men randomly chosen from the remainder of the population. The two groups were followed up for an average period of 12 X 5 years, after which time their occupation was obtained from the National Population Register. Social class was derived from a ranking of occupations based on prestige from 0 (unskilled, manual worker) to 7 (for example, judge, professor). Among the obese subjects, only 300 (30%) out of 1006 attained a position above social class 2, compared with 988 (51%) out of 1948 in the control group. At each level of education and intelligence test score, as registered at the draft board, the obese subjects still showed a significantly lower attainment of social class than the controls. Inclusion of parental social class, information which was available for part of the population, did not eliminate the difference in attainment of social class. The results of this study show that obese subjects not only suffer from a higher risk of somatic diseases but have to live with a social handicap that is independent of parental social class, intelligence, and education.
Educational Status↗
Job control, job demands, or social class? The impact of working conditions on the relation between social class and health.
BACKGROUND: The aim of the study was to investigate (1) how much of the association between health and social class is accounted by psychosocial working conditions, and (2) whether health is related to working conditions after controlling for social class. METHODS: The data derive from the surveys of the Helsinki health study, collected in 2000, 2001, and 2002 from 40-60 year old employees working for the City of Helsinki (n=8970, response rate 67%). The study measured occupation based social class and Karasek's demand-control model. The health outcomes were self rated health as less than good and limiting longstanding illness. Age adjusted prevalence percentages and fitted logistic regression models were calculated. RESULTS: The individual effects of social class and psychosocial working conditions on self rated health and limiting longstanding illness were strong among both men and women. The relation between social class and both health outcomes considerably attenuated when job control was controlled for, but was reinforced when controlling for job demands. Controlling for both job control and job demands attenuated the relation between social class and self rated health and limiting longstanding illness among women, however, was reinforced among men. CONCLUSIONS: A substantial part of the relation between social class and health could be attributed to job control, however, job demands reinforced the relation. Although the effect of social class is mediated by psychosocial working conditions, both social class and working conditions were related to health after mutual adjustments.
Adult↗
Measuring social class differences in cancer patient survival: is it necessary to control for social class differences in general population mortality? A Finnish population-based study.
STUDY OBJECTIVES: Estimation of cancer patient survival by social class has been performed using observed, corrected (cause specific), and relative (with expected survival based on the national population) survival rates. Each of these measures are potentially biased and the optimal method is to calculate relative survival rates using social class specific death rates to estimate expected survival. This study determined the degree to which the choice of survival measure affects the estimation of social class differences in cancer patient survival. SETTING AND PARTICIPANTS: All Finnish residents diagnosed with at least one of 10 common malignant neoplasms during the period 1977-1985 were identified from the Finnish Cancer Registry and followed up for deaths to the end of 1992. DESIGN: Survival rates were calculated by site, sex, and age at 5, 10, and 15 years subsequent to diagnosis for each of three measures of survival; relative survival, corrected (cause specific) survival, and relative survival adjusted for social class differences in general mortality. Regression models were fitted to each set of rates for the first five years of follow up. MAIN RESULTS: The degree of variation in relative survival resulting from social class decreased, although did not disappear, after controlling for social class differences in general mortality. The results obtained using corrected survival were close to those obtained using relative survival with a social class correction. The differences between the three measures were largest when the proportion of deaths from other causes was large, for example, in cancers with high survival, among older patients, and for longer follow up times. CONCLUSIONS: Although each of the three measures gave comparable results, it is recommended that relative survival rates are used with expected survival adjusted for social class when studying social class variation in cancer patient survival. If this is not an available option, it is recommended that corrected survival rates are used. Relative survival rates without the social class correction overestimate social class differences and should be used with caution.
Adolescent↗
Social class and psychiatric diagnosis: differential findings in a lower-class sample.
Social class and the American Psychiatric Association Diagnostic and Statistical Manual II Diagnosis were examined for all patients contracting the Department of Psychiatry over a year at a large county hospital. This sample was primarily lower class -50 per cent Class V and 33 per cent in Class IV. All diagnoses showed average class between IV and V. Organic brain syndrome, both psychiatric and non-psychotic, and mental retardation had lower average social class than other diagnoses. A small sample of the diagnosis behaviour disorder of childhood and adolescence was also lower than other diagnoses. Class V patients with mental malfunction may present differently than patients from other social classes. The absence of differences on neurosis and functional psychosis may have been due to the predominance of lower class patients, diagnosticians more familiar with lower class patients, or the allowable choice of diagnoses.
Adolescent↗
Effects of social class differences and social mobility on growth in height, weight and body mass index in a British cohort.
By longitudinally linking follow-up restudies of the National Child Development Study it has been possible to examine not only the well-known association of social class with the size of the child, but also with longitudinal growth, and, in addition the effect of social mobility on growth. The relation of type of occupation of the male head of household to height and weight of the child is seen at all ages (7, 11 and 16) but class influence on growth from 7 years onward is minimal. Social mobility is a significant factor especially in relation to stature but is not significantly related to growth after age 7 so the effect of underlying conditions on the children precedes the change of type of occupation by their fathers.
Adolescent↗
Social class, income, education, area of residence and psychological distress: does social class have an independent effect on psychological distress in Antalya, Turkey?
AIM: The aim of this study is to determine the separate effects of social class, income, education and area of residence on psychological distress. The study also assesses whether the association between prevalence of high score on the 12-item General Health Questionnaire (GHQ 12) and social class is independent of other variables. METHOD: Psychological distress was assessed by means of the GHQ 12. The study covered 1,092 adults aged 15 years or more living in two different quarters of Antalya. Social class status was defined by occupational position, with income, education and area of residence treated as confounders. Chi-square and logistic regression analyses were used to evaluate the data. RESULTS: Large inequalities in psychological distress by all variables were observed. Psychological distress was significantly associated with class status, after adjusting for income, education, area of residence and other potential confounders (age, sex and marital status). Class inequalities in psychological distress were observed between blue-collar workers/unqualified employees and bourgeoisie. CONCLUSIONS: These findings support the view that the recent widening of inequalities among social classes in Turkey pose a substantial threat to health.
Adolescent↗
[The Goldthorpe Social Class Classification: reference framework for a proposal for the measurement of social class by the Working Group of the Spanish Society of Epidemiology].
Two of the most important theory-based social class classifications are that of the neo-Weberian Goldthorpe and that of the neo-Marxist Wright. The social class classification proposal of the SES Working Group employed the Goldthorpe schema as a reference due to the empirical and mainly pragmatic aspects involved. In this article, these aspects are discussed and it is also discussed the problem of the validation of the measurements of social class and the problem of the use of the social class as an independent variable.
Epidemiology↗
Social class and coronary disease in rural population of north India. The Indian Social Class and Heart Survey.
OBJECTIVE: To demonstrate the association of socio-economic status with prevalence of coronary artery disease and coronary risk factors. DESIGN AND SETTING: Cross-sectional survey in two randomly selected villages in the Moradabad district in North India. SUBJECTS AND METHODS: One thousand seven hundred and sixty-seven subjects (894 males and 875 females; 25-64 years of age) were randomly selected from two villages. They were divided into social classes 1 to 4, according to education, occupation, housing conditions, ownership of land, ownership of consumer durables and per capita income. The survey was based on questionnaires administered by dietitians and physicians, physical examination and electrocardiography. RESULTS: Social classes 1 and 2 were mainly high and middle socio-economic groups and 3 and 4 low income groups. The prevalence of coronary artery disease was significantly higher among classes 1 and 2 in both sexes, and there was a higher prevalence of hypercholesterolaemia, hypertension, and sedentary lifestyle. This population also showed a significant association with higher serum cholesterol, body mass index, triglycerides and blood pressures. Logistic regression analysis with adjustment for age showed that social class positively related to coronary disease (odds ratio: men 0.83, women 0.61), hypercholesterolaemia (men 0.85, women 0.87), hypertension (men 0.89, women 0.87), body mass index (men 0.91, women 0.93) and smoking in men (0.68). Smoking and sedentary lifestyle were not associated with social class in women. The association between coronary artery disease and social class abated after adjustment for smoking, sedentary lifestyle, body mass index and blood pressure (odds ratio: men 0.96, women 0.81). CONCLUSION: Subjects in social classes 1 and 2 in rural North India have a higher prevalence of coronary artery disease and of the coronary risk factors hypercholesterolaemia, hypertension, higher body mass index and sedentary lifestyle. The overall prevalence of coronary artery disease was 3.3%.
Adult↗
The influence of social class, strain and social support on symptoms of anxiety and depression in mothers of toddlers.
BACKGROUND: The aim of the study was to identify risk and protective factors for anxiety and depression among mothers of toddlers. METHODS: A population-based sample of 921 Norwegian mothers with 18-month-old children completed a questionnaire designed to examine the impact of socioeconomic and demographic factors, somatic health problems, negative life events, chronic strain and social support on symptoms of anxiety and depression (HSCL-25). RESULTS: There was a moderate aversive effect of negative life events and chronic strain and a moderate protective effect of social support on the symptom level, but no interaction effects were found between the risk and protective factors. Behaviour problems among the children clearly seemed to affect the mothers' symptom level. The symptom level varied with background factors like the mothers' education, employment status and age even after controlling for the effect of strain and social support. The largest effect of the background factors seemed to be indirect, however, mediated through their effect on the risk and protective factors. CONCLUSIONS: Although problems with the children's behaviour and child care arrangements were observed to have a strong impact on the mothers' symptom level, the frequencies of such problems appeared to be less dependent on socioeconomic conditions than did other types of strain.
Adult↗
Social class and sickness absences. A comparative study of four ways to measure social class.
Four different class measures (social groups, a socioeconomic classification, a measure by Erik Olin Wright, and a structural class concept) were applied on a gross material of 3,252 persons registered by sickness insurance authorities. The measures were compared by description of absence days, average durations, sickness rates, and sex. No significant differences were found. By associating measures and absence days, differences were found only for doctor certified days, where the structural class concept diverged. Two conclusions are drawn: When dependent variables are of ideological character, practical considerations may decide choice of class measure. In other cases, caution is advised and further research needed.
Absenteeism↗
Adolescents' understanding of social class: a comparison of white upper middle class and working class youth.
PURPOSE: Social class is increasingly being recognized as an important factor in the development of population-based variation in health among teens. However, little consensus exists regarding its measurement or conceptualization. METHODS: This study examined beliefs about social class of 48 working class and 50 upper middle class 16-year-old, white teens. RESULTS: Working class teens were more likely to misclassify themselves with regard to social class position. Significant class differences were present in beliefs regarding social mobility, parents' equity, equality of opportunity within society, and financial status as adults. How this conceptualization of social class translates into population-based variation in health remains an important area for further inquiry.
Adolescent↗