Association between Parenthood and Health Behaviour in Later Life—Results from the Population-Based CARLA Study

Previous research has focused on comparing health behaviour between parents and non-parents at younger ages, while little is known about the impact of being a parent on health behaviours in later life. We studied whether parenthood is associated with later physical activity (PA), dietary pattern, smoking status and alcohol consumption in German adults of middle and old age. We used data from the baseline examination of the population-based CARLA-study in Halle (Saale), comprising 1779 adults aged 45–83. Linear and logistic regression analyses assessed the relationship between parenthood and health behaviours while controlling for age, partner status, education, income, occupational position, socioeconomic status in childhood, and number of chronic diseases. Of the participants, 89.1% had biological children. Being a father was associated with higher PA in sports (sport index ß = 0.29, 95% confidence interval [0.14; 0.44]), but not with PA in leisure time (excluding sports), dietary pattern, consumption of alcohol and smoking status. No associations were found between being a mother with all outcome variables. Provided that PA of fathers is typically reduced when the children are young, the development towards higher PA at later age needs to be studied in more detail.

Retirement Age Modifies the Association Between Education/Occupation and Cognition

Introduction According to the cognitive reserve and use-it-or-lose-it hypotheses, engagement in stimulating activities seems to benefit cognition, with engagement often associated with more education or higher occupational position. However, whether retirement may modify the association between education/occupation and cognition is unclear. We aimed to assess how age at retirement may modify the relationship between education/occupation and cognition. Methods Older adults (n=360) from the Alzheimer’s Disease Neuroimaging Initiative who were cognitively normal and retired at baseline participated. Linear regression was used to assess how educational attainment (high/low) or occupational position (managerial, intermediate/clerical, routine/manual) related to executive functioning (EF) or memory, controlling for age, sex, depressive symptoms, and health status. Effect modification by retirement (early, on-time, late). Results High education (EF: b=0.37, SE=0.08, p<.001; memory: b=0.22, SE=0.05, p<.001), intermediate (EF: b=0.26, SE=0.11, p=.019; memory: b=0.18, SE=0.08, p=.018) and managerial (EF: b=0.23, SE=0.12, p=.045; memory: b=0.16, SE=0.08, p=.045) occupations (compared to routine/manual occupations) were associated with better EF and memory performance. High education was significantly associated with better EF and memory for participants who retired early (EF: b=0.43, SE=0.12, p<.001; memory: b=0.29, SE=0.10, p=.004) or on-time (EF: b=0.51, SE=0.15, p=.001; memory: b=0.24, SE=0.10, p=.014), but not for participants who retired late (EF: b=0.19, SE=0.15, p=.200; memory: b=0.09, SE=0.09, p=.334). Intermediate occupations were associated with EF only for participants who retired on-time (b=0.58, SE=0.21, p=.007). Conclusion Education and occupational position may influence cognition after retirement differently based on retirement timing, with effects most apparent for on-time retirement and substantially reduced for late retirement.

Contributions of occupation characteristics and educational attainment to racial/ethnic inequities in COVID-19 mortality

Background: Racial/ethnic inequities in COVID-19 mortality are hypothesized to be driven by education and occupation, but limited empirical evidence has assessed these mechanisms. Objective: To quantify the extent to which educational attainment and occupation explain racial/ethnic inequities in COVID-19 mortality. Design: Observational cohort. Setting: California. Participants: Californians aged 18-65 years. Measurements: We linked all COVID-19-confirmed deaths in California through February 12, 2021 (N=14,783), to population estimates within strata defined by race/ethnicity, sex, age, USA nativity, region of residence, education, and occupation. We characterized occupations using measures related to COVID-19 exposure including essential sector, telework-ability, and wages. Using sex-stratified regressions, we predicted COVID-19 mortality by race/ethnicity if all races/ethnicities had the same education and occupation distribution as White people and if all people held the safest educational/occupational positions. Results: COVID-19 mortality per 100,000 ranged from 15 for White and Asian females to 139 for Latinx males. Accounting for differences in age, nativity, and region, if all races/ethnicities had the education and occupation distribution of Whites, COVID-19 mortality would be reduced for Latinx males (-22%) and females (-23%), and Black males (-1%) and females (-8%), but increased for Asian males (+22%) and females (+23%). Additionally, if all individuals had the COVID-19 mortality associated with the safest educational and occupational position (Bachelor's degree, non-essential, telework, highest wage quintile), there would have been 57% fewer COVID-19 deaths. Conclusion: Educational and occupational disadvantage are important risk factors for COVID-19 mortality across all racial/ethnic groups, especially Latinx individuals. Eliminating avoidable excess risk associated with low-education, essential, on-site, and low-wage jobs may reduce COVID-19 mortality and inequities, but is unlikely to be sufficient to achieve equity.

The Influence of Nursing Home, Ward, and Eldercare Workers on the Number of Resident Handlings Performed Per Shift in Eldercare

The purpose of our study was to investigate which organizational levels and factors determine the number of resident handlings in eldercare. We conducted a multi-level study, stratified on day and evening shifts, including information on four levels: nursing homes (n = 20), wards within nursing homes (day, n = 120; evening, n = 107), eldercare workers within wards (day, n = 619; evening, n = 382), and within eldercare workers (i.e., days within eldercare workers; day, n = 5572; evening, n = 2373). We evaluated the influence of each level on the number of resident handlings using variance components analysis and multivariate generalized linear mixed models. All four levels contributed to the total variance in resident handlings during day and evening shifts, with 13%/20% at “nursing homes”, 21%/33% at “wards within nursing homes”, 25%/31% at “elder-care workers within wards”, and 41%/16% “within eldercare workers”, respectively. The percentage of residents with a higher need for physical assistance, number of residents per shift, occupational position (only within day shifts), and working hours per week (only within day shifts) were significantly associated with the number of resident handlings performed per shift. Interventions aiming to modify number of resident handlings in eldercare ought to target all levels of the eldercare organization.

Adverse employment histories and allostatic load: associations over the working life

BackgroundMost studies on the health impact of occupational stress use single-point measures of stress at work. This study analyses the associations of properties of entire employment trajectories over an extended time period with a composite score of allostatic load (AL).MethodsData come from the French CONSTANCES cohort, with information on adverse employment histories between ages 25 and 45 and a composite score of AL (based on 10 biomarkers, range 0–10) among people aged 45 or older (47 680 women and 45 035 men). Data were collected by questionnaires (including retrospective employment histories) or by health examinations (including blood-based biomarkers). We distinguish six career characteristics: number of temporary jobs, number of job changes, number of unemployment periods, years out of work, mode occupational position and lack of job promotion.ResultsFor both men and women, results of negative binomial regressions indicate that adverse employment histories are related to higher levels of AL, particularly histories that are characterised by a continued disadvantaged occupational position, repeated periods of unemployment or years out of work. Findings are adjusted for partnership, age and education, and respondents with a health-related career interruption or early retirement are excluded.ConclusionsOur study highlights physiological responses as a mechanism through which chronic stress during working life is linked to poor health and calls for intervention efforts among more disadvantaged groups at early stages of labour market participation.

Socioeconomic inequalities in lung cancer – a time trend analysis with German health insurance data

Background Lung Cancer (LC) is one of the most prevalent cancer diseases. Due to the lack of databases which allow the combination of information on individual socioeconomic status (SES) and cancer incidence, research on social inequalities in LC among the German population is rare. The aim of the study is to analyse time trends in social inequalities in LC in Germany. Methods The analyses are based on data of a large statutory health insurance provider. The data contain information on diagnoses, occupation and education (working age), and income (full age range) of the insurance population. Trends were analysed for two subpopulations (retirement age and working age) and stratified by sex. The analyses are based on incidence rates and proportional hazard models spanning the periods 2006–2009, 2010–2013 and 2014–2017. Results Incidence rates declined in men but increased in women. For men, inequalities were strongest in terms of income and the decline in incidence was most pronounced in middle- and higher-income men. Among women at retirement age, a reversed income gradient was found which disappeared in the second period. The educational gradient among the working-age population decreased over time due to the trend towards increasing incidence among individuals with higher education. Declining gradients were also found for occupational position. Conclusion The findings reveal considerable inequalities in LC and that trends vary with respect to SES, sex and age. Widening income inequalities were found in the retired population, while educational and occupational inequalities tend to narrow among the working-age population.

The Prospective Association Between Socioeconomic Status and Falls Among Community-Dwelling Older Men

Background Socioeconomic status (SES) has been suggested as a risk factor for falls but the few prospective studies to test this have had mixed results. We evaluated the prospective association between SES and falls in the Concord Health and Ageing in Men Project (CHAMP). Methods CHAMP is a population-based prospective cohort study of men aged ≥70 years in Sydney, Australia. Incident falls were ascertained by triannual telephone calls for up to 4 years. SES was assessed with 4 indicators (education, occupation, source of income, home ownership) and cumulative SES score. We tested for interaction between SES indicators and country of birth and conducted stratified analyses. Results We evaluated 1624 men (mean age: 77.3 ± 5.4 years). During a mean ± SD follow-up of 42.6 ± 8.7 months, 766 (47%) participants reported ≥1 incident falls. In nonstratified analyses, there were no associations between SES indicators and falls. In stratified analyses, falls rates were higher among Australian-born men with less formal education (incidence rate ratio [IRR] 1.66, 95% confidence interval [CI] 1.16–2.37, compared with those with more education) and those with low occupational position (1.45; 1.09–1.93). However, among men born in non-main English-speaking countries the rate of falls was lower among those with low educational level and no associations were evident for occupational position. Conclusions Lower educational level and occupational position predicted a higher falls rate in Australian-born men; the opposite relationship was evident for educational level among migrants born in non-main English-speaking countries. Further studies should test these relationships in different populations and settings and evaluate targeted interventions.

Re-Imagining Social Mobility: The Role of Relationality, Social Class and Place in Qualitative Constructions of Mobility

Discussions around social mobility have increasingly gained traction in both political and academic circles in the last two decades. The current, established conceptualisation of social mobility reduces ‘success’ down to individual level of educational achievement, occupational position and income, focusing on the successful few who rise up and move out. For many in working-class communities, this discourse is undesirable or antithetical to everyday life. Drawing upon 13 interviews with 9 families collected as part of an ethnographic study, this article asks, ‘how were social (im)mobility narratives and notions of value constructed by residents of one working-class community?’ Its findings highlight how alternative narratives of social (im)mobility were constructed; emphasising the value of fixity, anchorage, and relationality. Three key techniques were used by participants when constructing social (im)mobility narratives: the born and bred narrative; distancing from education as a route to mobility; and the construction of a distinct working-class discourse of fulfilment. Participants highlighted the value of anchorage to place and kinship, where fulfilment results from finding ontological security. The findings demonstrate that residents of a working-class community constructed alternative social mobility narratives using a relational selfhood model that held local value. This article makes important contributions to the theorisation of social mobility in which it might be understood as a collective rather than individual endeavour, improving entire communities that seek ontological security instead of social class movement and dislocation.