Health and voting over the course of adulthood: Evidence from two British birth cohorts.
ABSTRACT: Systematic differences in voter turnout limit the capacity of public institutions to address the needs of under-represented groups. One critical question relates to the role of health as a mechanism driving these inequalities. This study explores the associations of self-rated health (SRH) and limitations in everyday activities with voting over the course of adulthood in the 1958 National Child Development Study and the 1970 British Cohort Study. We used data from participants who reported voting in the last general election at least once between the ages of 23 and 55 in the 1958 cohort and between the ages of 30 and 42 in the 1970 cohort. We examined associations controlling for a range of early-life and adult circumstances using random-effects models. Compared with those in good or better health: those in fair health had 15% and 18% lower odds of voting in the 1958 and 1970 cohorts; those in poor or worse health had 17% and 32% lower odds of voting in the 1958 and 1970 cohorts. These effects varied with age and were most marked among those in poor health at the ages of 23/30 in the 1958 and 1970 cohorts. Controlling for SRH, having limitations in everyday activities was not associated with voting in main models. Examining age-based differences, however, we found that reporting limitations was associated with a higher probability of voting at the age of 55 in the 1958 cohort and at the age of 30 in the 1970 cohort. Building on the qualities of the British birth cohorts, we offer nuanced evidence about the role of health on voting, which involves considerable life-course processes. Future studies need to examine how these findings progress after the age of 55, extend to mental wellbeing and health practices, and contribute to explain social inequalities in voter turnout.
Project description:OBJECTIVE:To explore health literacy as a marker of voter confusion in order to understand the basis for public opposition to community water fluoridation. DESIGN:A cross-sectional study. SETTING:Conducted in three large US cities of San Antonio, Texas (602 voting precincts); Wichita, Kansas (171 voting precincts); and Portland, Oregon (132 voting precincts). Precinct-level voting data were compiled from community water fluoridation referendums conducted in San Antonio in 2002, Wichita in 2012 and Portland in 2013. PARTICIPANTS:Voter turnout expressed as a percentage of registered voters was 38% in San Antonio (n=2?92?811), 47% in Wichita (n=129?199) and 38% in Portland (n=164?301). MAIN OUTCOME MEASURES:The dependent variable was the percentage of votes in favour of fluoridating drinking water. Precinct-level voting data were mapped to precinct scores of health literacy, and to US Census and American Community Survey characteristics of race/ethnicity, age, income and educational attainment. Multilevel regression with post-stratification predicted the precinct mean health literacy scores, with weights generated from the National Association of Adult Literacy health literacy survey, with item response theory computed scoring for health literacy. Predictive models on voter support of community water fluoridation were compared using robust linear regression to determine how precinct-level characteristics influenced voter support in order to determine whether health literacy explained more variance in voting preference than sociodemographic characteristics. RESULTS:Precinct-level health literacy was positively associated with voter turnout, although sociodemographic characteristics were better predictors of turnout. Approximately 60% of voters opposed community water fluoridation in Wichita and Portland, whereas in San Antonio, a small majority (53%) voted in favour of it. Models suggest that a one SD increase in health literacy scores predicted a 12 percentage point increase support for community water fluoridation. CONCLUSION:Educational attainment and health literacy are modifiable characteristics associated with voting precincts' support for community water fluoridation.
Project description:PURPOSE:The ongoing coronavirus disease 2019 (COVID-19) severely impacted both health and the economy. Absent an effective vaccine, preventive measures used, some of which are being relaxed, have included school closures, restriction of movement, and banning of large gatherings. Our goal was to estimate the association of voter turnout with county-level COVID-19 risks. METHODS:We used publicly available data on voter turnout in the March 10 primary in three states, COVID-19 confirmed cases by day and county, and county-level census data. We used zero-inflated negative binomial regression to estimate the association of voter turnout with COVID-19 incidence, adjusted for county-level population density and proportions: over age 65 years, female, Black, with college education, with high school education, poor, obese, and smokers. RESULTS:COVID-19 risk was associated with voter turnout, most strongly in Michigan during the week starting 3 days postelection (risk ratio, 1.24; 95% confidence interval, 1.16-1.33). For longer periods, the association was progressively weaker (risk ratio 0.98-1.03). CONCLUSIONS:Despite increased absentee-ballot voting in the primary, our results suggest an association of voter turnout in at least one state with a detectable increase in risks associated with and perhaps due to greater exposures related to the primary.
Project description:Studies on advanced maternal age-defined here as age 35 or older-and children's cognitive ability report mixed evidence. Previous studies have not analysed how the time period considered in existing studies influences the association.We analysed trends in the association between maternal age and cognitive ability using data from the 1958 National Child Development Study ( n ?=?10?969), the 1970 British Cohort Study ( n ?=?9362) and the 2000-2002 Millennium Cohort Study ( n ?=?11?600). The dependent variable measures cognitive ability at age 10/11 years. Cognitive scores were standardised to a mean of zero and a standard deviation of one.For the 1958-70 cohort studies, maternal ages 35 -39 were negatively associated with children's cognitive ability compared with maternal ages 25-29 (1958 cohort ??=?-0.06 standard deviations (SD) 95% confidence interval (CI): -0.13, -0.00; 1970 cohort ??=?-0.12 SD 95% CI: -0.20, -0.03). By contrast, for the 2000-2002 cohort study maternal ages 35-39 were positively associated with cognitive ability (??=?0.16 SD 95% CI: 0.09, 0.23). For maternal ages 40+, the pattern was qualitatively similar. These cross-cohort differences were explained by the fact that in the earlier cohorts advanced maternal age was associated with high parity, whereas in the 2000-2002 cohort it was associated with socioeconomically advantaged family background.The association between advanced maternal age and children's cognitive ability changed from negative in the 1958 and 1970 cohorts to positive in the 2000-2002 cohort because of changing parental characteristics. The time period considered can constitute an important factor in determining the association between maternal age and cognitive ability.
Project description:Three randomized experiments found that subtle linguistic cues have the power to increase voting and related behavior. The phrasing of survey items was varied to frame voting either as the enactment of a personal identity (e.g., "being a voter") or as simply a behavior (e.g., "voting"). As predicted, the personal-identity phrasing significantly increased interest in registering to vote (experiment 1) and, in two statewide elections in the United States, voter turnout as assessed by official state records (experiments 2 and 3). These results provide evidence that people are continually managing their self-concepts, seeking to assume or affirm valued personal identities. The results further demonstrate how this process can be channeled to motivate important socially relevant behavior.
Project description:BACKGROUND:High body mass index (BMI) is an important contributor to the global burden of ill-health and health inequality. Lower socioeconomic position (SEP) in both childhood and adulthood is associated with higher adult BMI, but how these associations have changed across time is poorly understood. We used longitudinal data to examine how childhood and adult SEP relates to BMI across adulthood in three national British birth cohorts. METHODS AND FINDINGS:The sample comprised up to 22,810 participants with 77,115 BMI observations in the 1946 MRC National Survey of Health and Development (ages 20 to 60-64), the 1958 National Child Development Study (ages 23 to 50), and the 1970 British Cohort Study (ages 26 to 42). Harmonized social class-based SEP data (Registrar General's Social Class) was ascertained in childhood (father's class at 10/11 y) and adulthood (42/43 years), and BMI repeatedly across adulthood, spanning 1966 to 2012. Associations between SEP and BMI were examined using linear regression and multilevel models. Lower childhood SEP was associated with higher adult BMI in both genders, and differences were typically larger at older ages and similar in magnitude in each cohort. The strength of association between adult SEP and BMI did not vary with age in any consistent pattern in these cohorts, but were more evident in women than men, and inequalities were larger among women in the 1970 cohort compared with earlier-born cohorts. For example, mean differences in BMI at 42/43 y amongst women in the lowest compared with highest social class were 2.0 kg/m2 (95% CI: -0.1, 4.0) in the 1946 NSHD, 2.3 kg/m2 (1.1, 3.4) in the 1958 NCDS, and 3.9 kg/m2 (2.3, 5.4) the in the 1970 BCS; mean (SD) BMI in the highest and lowest social classes were as follows: 24.9 (0.8) versus 26.8 (0.7) in the 1946 NSHD, 24.2 (0.4) versus 26.5 (0.4) in the 1958 NCDS, and 24.2 (0.3) versus 28.1 (0.8) in the 1970 BCS. Findings did not differ whether using overweight or obesity as an outcome. Limitations of this work include the use of social class as the sole indicator of SEP-while it was available in each cohort in both childhood and adulthood, trends in BMI inequalities may differ according to other dimensions of SEP such as education or income. Although harmonized data were used to aid inferences about birth cohort differences in BMI inequality, differences in other factors may have also contributed to findings-for example, differences in missing data. CONCLUSIONS:Given these persisting inequalities and their public health implications, new and effective policies to reduce inequalities in adult BMI that tackle inequality with respect to both childhood and adult SEP are urgently required.
Project description:There is growing interest in the idea of elected members on health service governing boards as a means to induce public participation in planning and decision making, yet studies of elected boards are limited. Whether elected boards are an effective mechanism for public participation remains unclear.This article discusses the experiences of New Zealand where, since 2001, there have been three sets of elections for District Health Boards. Information on candidates and election results is presented along with data gathered via post-election voter surveys. The article also considers the broader regulatory context within which the elected boards must operate.The New Zealand experience illustrates that elected health boards may not be an effective mechanism for public participation. Voter turnout has declined since the inaugural elections of 2001, and non-voters form the majority. Reasons for not voting include failure to receive voting papers, a lack of interest, or no knowledge of elections. The elections have also failed to produce minority representation, while the capacity for elected members to represent their communities is subject to constraints. On the upside, elections have enabled public involvement in various dimensions of participation, including oversight and processes of governance. New Zealand's mixed performance suggests that elected boards may need to be complemented with other participatory channels, if increased public participation is the goal.
Project description:<h4>Background</h4>Worldwide, the Irish diaspora experience health inequalities persisting across generations. The present study sought to establish the prevalence of psychological morbidity in the children of migrant parents from Ireland, and reasons for differences.<h4>Methods</h4>Data from two British birth cohorts were used for analysis. Each surveyed 17 000 babies born in one week in 1958 and 1970 and followed up through childhood. Validated scales assessed psychological health.<h4>Results</h4>Relative to the rest of the cohort, second-generation Irish children grew up in material hardship and showed greater psychological problems at ages 7, 11 (1958 cohort) and 16 (both cohorts). Adjusting for material adversity and maternal psychological distress markedly reduced differences. Relative to non-Irish parents, Irish-born parents were more likely to report chronic health problems (odds ratio [OR]: 1.29; 95% confidence interval [CI]: 1.08-1.54), and Irish-born mothers were more likely to be psychologically distressed (OR: 1.44; 95% CI: 1.13-1.84, when child was 10). Effect sizes diminished once material adversity was taken into account.<h4>Conclusions</h4>Second-generation Irish children experienced high levels of psychological morbidity, but this was accounted for through adverse material circumstances in childhood and psychological distress in parents. Public health initiatives focusing on settlement experiences may reduce health inequalities in migrant children.
Project description:BACKGROUND:Few studies have investigated the prevalence of multiple gastrointestinal diseases in the general British population. AIM:To examine the prevalence of Crohn's disease (CD), ulcerative colitis (UC), irritable bowel syndrome (IBS), gall stones (GS), and peptic ulcer disease (PUD). SUBJECTS:The 1970 British Cohort Study (BCS70) and the National Child Development Study (NCDS) are two one week national birth cohorts born in 1970 and 1958, respectively. All cohort members living in Great Britain were interviewed in 1999/2000. METHODS:The prevalence rates of the five diseases were calculated, and associations with sex and childhood social class were investigated using logistic regression. RESULTS:At age 30 years, the prevalence rates per 10,000 (95% confidence interval (CI)) in the 1970 and 1958 cohorts, respectively, were: CD 38 (26-49), 21 (13-30); UC 30 (20-41), 27 (18-37); IBS 826 (775-877), 290 (267-330); GS 88 (71-106), 78 (62-94); and PUD 244 (214-273), 229 (201-256). There was a significantly higher proportion with CD (p=0.023) and IBS (p=0.000) in the 1970 cohort compared with the 1958 cohort at age 30 years. Comparing the cohorts in the 1999/2000 sweep, UC, GS, and PUD were significantly (p=0.001, p=0.000, p=0.000) more common in the 1958 cohort. There was a statistically significant trend for a higher risk of GS with lower social class in both cohorts combined (p=0.027). CONCLUSION:The study indicates an increasing temporal trend in the prevalence of CD and suggests a period effect in IBS, possibly due to adult life exposures or variation in recognition and diagnosis of IBS.
Project description:Since the heyday of cleavage voting in the 1960s and 1970s, the majority of studies presents evidence of a decline in cleavage voting - caused by either structural or behavioural dealignment. Structural dealignment denotes changes in group size responsible for a decrease in cleavage voting, whereas behavioural dealignment concerns weakening party-voter links over time. A third phenomenon posited in this article is the collective voting abstention of certain (social) groups, here referred to as 'political dealignment', which results in a new type of division of voting versus abstention. The purpose of this article is to examine the three underlying mechanisms for the decline in social class and religious cleavage voting across four Western countries (Great Britain, the Netherlands, Switzerland and the United States) over the last 40-60 years using longitudinal post-election data. The results prove a strong presence of political dealignment and increasing turnout gaps regarding both the class and religious cleavage. Furthermore, whenever a decline in cleavage voting is present, it is mainly caused by changes in the social groups' behaviour and less by changing social structures in a country.
Project description:Socioeconomic inequalities in childhood body-mass index (BMI) have been documented in high-income countries; however, uncertainty exists with regard to how they have changed over time, how inequalities in the composite parts (ie, weight and height) of BMI have changed, and whether inequalities differ in magnitude across the outcome distribution. Therefore, we aimed to investigate how socioeconomic inequalities in childhood and adolescent weight, height, and BMI have changed over time in Britain.We used data from four British longitudinal, observational, birth cohort studies: the 1946 Medical Research Council National Survey of Health and Development (1946 NSHD), 1958 National Child Development Study (1958 NCDS), 1970 British Cohort Study (1970 BCS), and 2001 Millennium Cohort Study (2001 MCS). BMI (kg/m2) was derived in each study from measured weight and height. Childhood socioeconomic position was indicated by the father's occupational social class, measured at the ages of 10-11 years. We examined associations between childhood socioeconomic position and anthropometric outcomes at age 7 years, 11 years, and 15 years to assess socioeconomic inequalities in each cohort using gender-adjusted linear regression models. We also used multilevel models to examine whether these inequalities widened or narrowed from childhood to adolescence, and quantile regression was used to examine whether the magnitude of inequalities differed across the outcome distribution.In England, Scotland, and Wales, 5362 singleton births were enrolled in 1946, 17?202 in 1958, 17?290 in 1970, and 16?404 in 2001. Low socioeconomic position was associated with lower weight at childhood and adolescent in the earlier-born cohorts (1946-70), but with higher weight in the 2001 MCS cohort. Weight disparities became larger from childhood to adolescence in the 2001 MCS but not the earlier-born cohorts (pinteraction=0·001). Low socioeconomic position was also associated with shorter height in all cohorts, yet the absolute magnitude of this difference narrowed across generations. These disparities widened with age in the 2001 MCS (pinteraction=0·002) but not in the earlier-born cohorts. There was little inequality in childhood BMI in the 1946-70 cohorts, whereas inequalities were present in the 2001 cohort and widened from childhood to adolescence in the 1958-2001 cohorts (pinteraction<0·05 in the later three cohorts but not the 1946 NSHD). BMI and weight disparities were larger in the 2001 cohort than in the earlier-born cohorts, and systematically larger at higher quantiles-eg, in the 2001 MCS at age 11 years, a difference of 0·98 kg/m2 (95% CI 0·63-1·33) in the 50th BMI percentile and 2·54 kg/m2 (1·85-3·22) difference at the 90th BMI percentile were observed.Over the studied period (1953-2015), socioeconomic-associated inequalities in weight reversed and those in height narrowed, whereas differences in BMI and obesity emerged and widened. These substantial changes highlight the impact of societal changes on child and adolescent growth and the insufficiency of previous policies in preventing obesity and its socioeconomic inequality. As such, new and effective policies are required to reduce BMI inequalities in childhood and adolescence.UK Economic and Social Research Council, Medical Research Council, and Academy of Medical Sciences/the Wellcome Trust.