bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP17 Area Deprivation Across the Life Course and Cognitive Capability in Mid-Life: Findings from the 1946 British Birth Cohort
Authors: Murray E T , Hardy R , Tilling K , Southall H , Aucott P , Kuh D , Ben-Shlomo Y , Richards M 
Published: September 2013

BackgroundRecent work has shown that area conditions at single points in time have been found to be associated with cognitive capability outcomes. However, a life course perspective is required to take into account life time processes of cognitive development, changes in residence and secular trends of areas.MethodsData from the 1946 British Birth Cohort were used to estimate associations of area deprivation (indicated by % of employed people in each area in partly- or un-skilled occupations) at ages 4, 26 and 53 years (residential addresses linked to census data in 1950, 1972 and 1999) with three measures of cognitive capability at age 53 years: verbal ability [NART], memory and letter cancellation speed. Cross-classified multilevel models were fitted with individuals nested within areas at all three ages. Step-wise models were fitted to assess whether area deprivation was independent of area deprivation at prior time points and current and prior individual socioeconomic position (SEP).ResultsThe percent of variance explained by lifetime area was 9.9% for NART and 6.8% for word learning scores. There was no variation across areas, or associations with, cancellation speed for any year. For the NART and word learning outcomes, associations were found between higher area deprivation and lower scores, independent of adjustment for individual social class at the same age (i.e. area deprivation at age 4 years adjustment for childhood SEP); however the longitudinal patterns differed. For the NART, an approximately 2 point lower mean score for a 1-standard deviation increase in area deprivation, for each age, was reduced by half but still apparent, when all three area deprivation measures were fitted in the same model [4 years: -1.0 (-1.8, -0.2); 26 years: -1.5 (-2.2, -0.7); 53 years: -1.4 (-2.1, -0.8)]. Yet all were attenuated with the addition of individual SEP measures at all three ages. For memory, both area deprivation at ages 4 and 53 years were independent of adjustment for area deprivation at the other 2 years [4 years: -0.9 (-1.5, -0.2) and 53 years: -1.9 (-2.6, -1.1)], and the latter was still apparent in full models containing all three area deprivation and individual SEP measures [-0.9 (-1.7, -0.2)].ConclusionThe deprivation of the area in which a person resides at different ages in their lives may affect cognitive capability in mid-life, with evidence that long-term exposure to area deprivation may negatively affect cognitive ageing (memory).
OP23 Associations between Active Travel to Work and Overweight, Hypertension and Diabetes in the United Kingdom
Authors: Laverty A A , Webb E A , Mindell J , Millett C 
Published: September 2013

BackgroundIncreasing active travel (walking & cycling, including to/from public transport) is increasingly seen as integral to strategies to raise population levels of physical activity. This study examined: (1) socio-demographic correlates of active travel to work; (2) associations between active travel and cardiovascular disease risk factors in the United Kingdom.MethodsData come from Understanding Society, a nationally representative survey of residents of the four countries of the United Kingdom in 2009–2011. Data come from the 20,000 respondents to the first wave of the survey who were aged 16 – 65 years and in work. Being overweight/obese was defined using self-reported height and weight. Hypertension and diabetes were identified based on responses to the questions “has a doctor ever told you that you have…”Multinomial logistic regression was used to assess associations between socio-demographic factors and mode of transport to work. Logistic regression was used to examine associations between mode of travel and being overweight/obese, having hypertension or diabetes. Analyses were adjusted for age, sex, ethnicity, educational qualifications, social class, and region of residence in the UK.ResultsFor 69% of respondents the main mode of travel to work was inactive transport, with public transport, walking and cycling used by 16%, 12% and 3% respectively. Use of active travel was most often reported by respondents living in London. Those with professional/managerial jobs were less likely to use each form of active transport than those with routine jobs (AOR 0.49 [95% CI 0.43, 0.56] for walking). Black respondents were more likely to walk (1.41 [1.08, 1.84]) or take public transport (2.34 [1.88, 2.90]) than white respondents. Using public transport was associated with a lower likelihood of being overweight than inactive transport (0.85 [0.77, 0.95]). Walking and cycling were each associated with a lower likelihood of being overweight (0.80 [0.73, 0.90] for walking and 0.63 [0.53, 0.75] for cycling) or having diabetes than inactive transport, and walking with a lower likelihood of hypertension (0.83 [0.71, 0.95]).ConclusionThere are wide variations in the mode of travel to work across regions and socio-demographic groups in the United Kingdom. The potentially protective effect of active travel on cardiovascular risk demonstrated in this large, nationally representative study adds to growing evidence that a concerted policy focus in this area will benefit population health.
OP33 How Well do Volunteer Web Panel Surveys Measure Sensitive Behaviours in the General Population, and can they be Improved? A Comparison with the Third British National Survey of Sexual Attitudes & Lifestyles (Natsal3)
Authors: Erens B , Burkill S , Copas A , Couper M , Conrad F 
Published: September 2013

BackgroundSurveys play an important role in providing public health data for researchers and policy-makers. Traditional interviewer-administered surveys are subject to declining response rates and increasing costs. With the spread of the internet among the general population, web surveys potentially provide a cost-effective alternative mode. Volunteer web panels are now widely used for market research and opinion polling, but less for academic and government research due to concerns about their representativeness. Various methods attempt to make web panels more “representative” of the general population. We compared results from four web panels with a national probability sample survey (Natsal3).MethodsA shortened Natsal3 questionnaire was included on four web panels: two used standard demographic quota controls, and two were “modified” using variables correlated with key outcomes as additional quota controls. After weighting for age and sex, comparisons were made with Natsal3 for demographic characteristics, key behaviour outcomes and attitudes, in order to examine whether surveys using modified quotas would lead to “improved” results.ResultsAll four web panels gave significantly different results from Natsal3 on a majority of the variables. Compared with Natsal3, there were more differences among men than women for all the web panels. There were more differences between the web panels and Natsal3 questions asked in CAPI (Computer Assisted Personal Interview) than in CASI (Computer Assisted Self Interview) format. The web panels also differed significantly from each other. One of the modified quota web panels produced estimates closer to Natsal3 than the standard quota panels, but still significantly differed on three-fifths of the variables. Moreover, meeting the modified quotas proved difficult, and the quotas had to be relaxed for both web panels.ConclusionWhen measuring sensitive sexual behaviours in the British population, volunteer web panels provided significantly different estimates than a probability CAPI/CASI survey. Modifying web panel quota controls did not lead to much improvement.
OP39 Are Adverse Effects of Obesity on Cardiovascular Risk Factors Modifiable: the Role of Physical Activity and Sedentary Behaviour in Mid-Life in the 1958 British Cohort
Authors: Power C , Pereira S M Pinto , Law C , Ki M 
Published: September 2013

BackgroundObesity is associated with increased mortality, cardiovascular disease (CVD), type 2 diabetes (T2D) and associated biomarkers. A key priority is to minimise such obesity-related consequences for the substantial proportion of adults now at risk. Potential modifiable factors, such as physical activity (PA) and sedentary lifestyles could mediate or moderate the obesity - ill-health association. However, research is scant on whether benefits of activity vary by obesity status across multiple biomarkers and whether there are corresponding patterns for sedentary behaviour. To establish whether the obesity −CVD and T2D risk associations can be lessened by PA or lower sedentary behaviour we aimed to assess whether (i) obesity, PA and sedentary behaviour are independently associated with biomarkers for CVD and T2D, and (ii) PA or sedentary behaviour moderate the obesity-biomarker associations.MethodsIn the 1958 British birth cohort (N = 9377) we examined associations between early adulthood obesity (33y) with subsequent biomarkers (45y) together with PA and sedentary behaviour (indicated by TV-viewing) recorded before or at 45y. The temporal sequence follows the ordering of potential interventions to reduce health burdens associated with obesity. Analyses were sex-specific, adjusted for covariates and used multiple imputation to account for missing data.ResultsObesity was associated with lower HDL-cholesterol and higher systolic (SBP), diastolic (DBP) blood pressure, glycosylated haemoglobin (HbA1c) and triglycerides in both sexes (LDL-cholesterol in women only) by 4.30% (95% CI 3.19, 5.41) for SBP to 24.7% (18.8, 30.4) for triglycerides. Men active at least weekly had 1.09% (0.28, 1.90) lower DBP than less active men; triglycerides were 2.08% (0.52, 3.64) lower per unit higher PA (on 4-point scale). TV-viewing was independently associated with several biomarkers, e.g. per unit higher TV-viewing (on 4-point scale) DBP was raised by 0.50% (0.09, 0.90) and triglycerides by 3.61% (1.58, 5.64). For both TV-viewing and PA, associations with HbA1c were greatest for the obese (p-interaction≤0.04): compared to a reference value of 5.20 HbA1c% in non-obese men viewing 0–1h/day, HbA1c% differed little for those viewing >3 h/day; however, among obese men HbA1c% was 5.36 (5.22, 5.51) and 5.65 (5.53, 5.76), for 0–1 and >3 h/day respectively. For PA in non-obese men, the reduction associated with activity at least weekly was negligible compared to a reference value of 5.20 HbA1c% for those less active; but there was a benefit among obese men, HbA1c% was 5.50 (5.40, 5.59) vs 5.66 (5.55, 5.77) respectively.ConclusionReduced sedentary behaviour and prevention of infrequent activity has greatest benefit among obese groups, particularly for glucose metabolism.
OP59 Social Mobility Matters for Children’s Well-Being – what are the Mechanisms? Findings from a UK Longitudinal Cohort Study
Authors: Kelly Y , Bartley M , Sacker A 
Published: September 2013

BackgroundSocial mobility features high on political agendas and debates around inequalities in health but little is known about the impact of social mobility on well-being in children. Firstly, we assess whether child well-being is linked to social mobility in the first few years of life. Secondly, we examine two hypothesised mechanisms by which social mobility could influence markers of child well-being: i) via material resources - mobility is plausibly linked to changes in income and housing conditions; ii) via changes in parenting behaviours - mobility might result in changes in the home learning environment.MethodsWe used data on over 9000 children from the UK Millennium Cohort Study. Social mobility was considered as change in parental occupational class (professional/managerial, intermediate, routine) in the first five years of life. Markers of child well-being were socio-emotional difficulties and performance on tests of reading, maths and spatial abilities at age 7.Results13.7% of families were upwardly mobile and 14.5% were downwardly mobile. There were finely graded relationships between occupational class mobility and markers of child well-being. The prevalence of clinically relevant socioemotional difficulties according to mobility categories ranged from 2.9% in children whose parents remained in the professional/managerial class for all five years to 10% in children of parents remaining in routine occupations, 5.0% of children of parents who moved from any other class to professional had difficulties, as did 8.2% of those moving from any class to routine (all p < 0.01). The equivalent mobility groups’ reading scores were: stable professional 118, stable routine 106, up to professional 113, down to routine 109 (all p < 0.01). Similar patterns were observed for maths and spatial ability scores. The contribution of changes in material and parenting behavioural influences to markers of child well-being will be examined.ConclusionHealth, educational and developmental outcomes are known to be more favourable in children of more advantaged social classes, but the reasons for this are contested. Here we examine the relationships in children whose parent’s social class changes during their first 5 years. Upwardly mobile children do better than those in their class of origin but not as well as their class of destination; downwardly mobile children do better than their class of destination but not as well as their class of origin. We test the extent to which this may be because social mobility is accompanied by changes in material circumstances and/or parenting behaviours that improve the home learning environment.
OP74 Is ‘volunteering’ a Public Health Intervention: A Systematic Review and Meta-Analysis
Authors: Richards S , Jenkinson C , Dickens A , Jones K , Thompson-Coon J , Taylor R , Rogers M , Bambra C , Lang I 
Published: September 2013

BackgroundCommunity participation interventions such as volunteering have been identified in the UK Government’s ‘Building the Big Society’ policy (2010) as a way of engaging people in their local communities and improving social capital, while the Marmot Review (2010) concluded they may have potential public health benefits such as improving wellbeing and decreasing health inequalities. Internationally, 2011 saw the European ‘Year of the Volunteer’, while the US Corporation for National and Community Service Strategic Plan (2011-2015) advocates supporting volunteer’s wellbeing and prioritising recruitment and engagement of underrepresented populations. Within this context, we examined the effect of formal volunteering on volunteer’s physical and mental health and survival, and explored the influence of volunteering type and intensity on health outcomes.MethodsWe sought evidence from experimental and cohort studies comparing the physical and mental health outcomes and mortality for a volunteering group (intervention) compared with a non-volunteering group (control). We searched electronic databases (Cochrane Library, Medline, Embase, PsychINFO, CINAHL, ERIC, HMIC, SSCI, ASSIA, Social Care Online, Social Policy and Practice) from inception to January 2013 and used citation tracking. No language, country or date restrictions were applied. Methodological quality was appraised and a risk of bias score generated. Data were synthesised using vote counting and random effects meta-analysis of mortality risk ratios.Results40 papers were selected: 5 randomised controlled trials (RCTs, 7 papers); 4 non-RCTs; and 17 cohort studies (29 papers). While most cohort studies were large and well designed (25/29 low risk bias, 4/29 moderate risk), most RCTs (4 studies) were at moderate or high risk of bias (e.g. small samples). Cohort studies show volunteering has favourable effects on depression, life satisfaction, wellbeing but not on physical health. However, these findings were largely unconfirmed by experimental studies. Meta-analysis of 5 cohort studies found volunteers to be at lower risk of mortality (risk ratio: 0.78 [95% CI 0.66, 0.90]). There was insufficient evidence to demonstrate a consistent influence of volunteering type or intensity on outcomes.ConclusionObservational evidence suggests that volunteering benefits mental health and survival although the causal mechanisms are unclear and selection effects cannot be discounted. Consequently, there is limited robustly designed research to guide the development of volunteering as a public health promotion intervention. Future studies should explicitly map intervention design to clear health outcomes as well as use pragmatic RCT methodology to test effects.
OP91 Are there Gender Differences in Consultation Patterns Prior to Melanoma, CRC and Lung Cancer Diagnosis and Cancer Survival: An Analysis of Routinely Collected General Practice Data?
Authors: Wang Y , Hunt K , Nazareth I , Freemantle N , Peterson I 
Published: September 2013

BackgroundConsultation rates with general practitioners (GPs) are higher in women than in men from late childhood through middle age, though not in childhood and later life. This gender patterning, and qualitative data documenting men’s apparent reluctance to consult, has fuelled widespread assumptions that men are always more reluctant to consult and this may partly explain gender differences in longevity (delayed consultation leading to later diagnosis and decreased opportunities for treatment in men). However, few studies have critically examined this assumption or compared consultation patterns in men and women with similar morbidity. Here we use UK general practice data to examine whether there are gender differences in incidence, survival and consultation patterns prior to diagnosis in patients with three common non-sex-specific cancers: lung, colo-rectal (CRC) and melanoma.MethodsWe used data from the Health Improvement Network (THIN) database to identify cohorts diagnosed between 1997–2006 with lung cancer (LC) (n = 9,872), CRC (n = 7,075) and melanoma (n = 1,429). Sex-specific annual incidence rates, cumulative probability of survival to 5 years and consultation patterns in the 12 months preceding diagnosis were compared.ResultsIn 5,041 men and 3,292 women who died within 5 years following a LC diagnosis, average survival time was 7.9 months. There was little difference in survival between men and women (HR 0.946, p=0.046); the small survival advantage was in men. On average people diagnosed with LC had 10 consultations in the year prior to diagnosis (men 10.1 [95% CI 10.05, 12.21], women 11.0 [10.87, 11.07]). There were no gender differences in consultation rates in any month in the year preceding diagnosis. 2,903 men and 2,291 women died within 5 years following a CRC diagnosis. Average survival time in months differed little by gender (17.6 (men) and 15.4 (women)). Consultation patterns were again similar in the year prior to diagnosis (men 8.99 [8.89, 9.09], women 9.43 [9.32, 9,54]), and did not differ by gender in any month in that year. Similar results are presented for melanoma.ConclusionIf gender differences in propensity to consult (reluctance amongst men, leading to later diagnosis) were to make a substantial impact on gender differences in mortality, we would expect large gender differences in survival and/or in consultation patterns prior to diagnosis in the most common cancers. This analysis provides strong evidence against this explanation for gender differences in health, and suggests the need for a more critical view of gender and consultation.
OP93 Common Epidemiological Errors: Over-Adjustment for Confounders and Mediators in Lifecourse Research
Authors: Gilthorpe M S , Tilling K , Jiang T , Baxter P D 
Published: September 2013

BackgroundEach year numerous studies evaluate longitudinal data within a lifecourse context with later-life health status (e.g. blood pressure) analysed with respect to repeated measures of early-life experiences (e.g. body mass) using standard multiple linear/logistic regression. Although more sophisticated methods are available, some have been shown to be problematic, hence there remains confusion around which is the most appropriate analytical strategy. Standard multiple regression nevertheless suffers text-book errors in this lifecourse context that are sadly perpetuated despite previous warnings. We revisit these problems with a simulation study to give clear guidance on what happens if basic medical statistics dos and don’ts are ignored.MethodsWe simulated a lifecourse dataset comprising repeated measures of z-score body mass at regular intervals following birth using a multivariate normal (9 outcomes) with correlation between birth weight (BW) and adult weight (AW) of 0.1, and adjacent intermediate outcome correlations derived as (0.1)^1/8. We simulated an adult z-score systolic blood pressure (SBP) with correlations between SBP and BW of -0.1, between SBP and AW of 0.2, and correlations between SBP and each intervening body mass measure extrapolated linearly between -0.1 and 0.2. We conducted a series of basic regression analyses, akin to those frequently seen in lifecourse research. Each simulation contained 5000 subjects (assumed to be of one sex) and was repeated 10,000 times to obtain 95% empirical credible intervals.ResultsAs previously identified, analyses with BW as the exposure saw point estimates move from the null when mediators were inappropriately included, yielding exaggerated interpretation of the impact of BW, and this was persistent irrespective of which mediators were chosen. Analyses with AW as the exposure saw attenuation of the AW effects varying according to which prior body mass measures were included as confounders: early-life confounders attenuated from the null whilst later-life confounders attenuated towards the null. This indicates some confusion around the extent and correct interpretation of confounding. Whilst large standard errors potentially mask these anomalies, they are manifest more for mediators or confounders more distal to the exposure.ConclusionThe common practice to analyse a multitude of longitudinal measures within a lifecourse context in a multiple regression model can lead to confused estimates for the main exposure. More careful consideration of the use of multiple regression is required, with distinction between genuine confounders and mediators becoming more widely understood.