The overall aim of the thesis was to explore social inequalities in: a) mortality during mid-life, b) health in later life, and c) old-age mortality, from a life-course perspective. The studies are based on longitudinal Swedish survey and registry data. The results from Study I showed substantial inequalities in health, based on social class and gender, among older adults (aged 55+). Moreover, the magnitude of these inequalities did not change during the period 1991-2002. The results from Study II revealed social inequalities in cognitive functioning among the oldest old (aged 77+). Social turbulence and social class during childhood, education and social class in adulthood were all independently associated with level of cognitive functioning in later life. In Study III, social inequalities in mortality during mid-life (i.e., between ages 25 and 69) were explored. The results showed that childhood living conditions were associated with marital status and social class in adulthood and that, in turn, these conditions were associated with mid-life mortality. Thus, the results suggested that childhood disadvantage may serve as a stepping stone to a hazardous life-course trajectory. Study IV explored the association between income in mid-life, income during retirement and old-age mortality (i.e., mortality during retirement). The results showed that both income during mid-life and income during retirement were associated with old-age mortality. Mutually adjusted models showed that income in mid-life was more important for women’s mortality and that income during retirement was more important for men’s. Thus, the results of the present thesis suggest that there are substantial social inequalities in the likelihood of reaching old age, as well as in health and mortality among older adults. These inequalities are shaped by differential exposures throughout the life-course that affect health in later life both through direct effects and through processes of accumulation. / At the time of the doctoral defense, the following papers were unpublished  and had a status as follows: Paper 3: Manuscript. Paper 4: Manuscript.

This thesis described socioeconomic inequalities in fruit and vegetable consumption in Stockholm County. A comparative descriptive analysis was carried out with the use of secondary data from the 2006 Stockholm County Public Health Survey. The data was analyzed through cross tabulations that were conducted in SPSS. The findings showed that people with high socioeconomic position consumed fruit and vegetables more frequently than those of low socioeconomic position. Differences in fruit and vegetable consumption were found for the three measures of socioeconomic position; education, occupation and income. These differences were pronounced to a larger extent across different education levels compared to levels of occupation and income. Further research is needed to investigate which factors may explain the observed differences.

This thesis study women’s possibility to take reproductive decisions in Babati, Tanzania. Tanzania has one of the highest total fertility rates in Sub-Saharan Africa and hence a high child- and maternal mortality rate. Family planning service can help individuals to reach their reproductive goals but it is not always available or accessible. The purpose is to see what socioeconomic factors affect women’s ability to influence family planning, make a comparison between urban and rural settings, and see if women perceive themselves to have the freedom to choose. A field work in Babati was conducted during three weeks in the spring of 2009. The research questions were answered through a qualitative study with semi structured group interviews, mainly done with women but also with health personnel. The result was analysed through the concepts of gender, power and education. The respondents expressed that the husband is the main obstacle for their possibility to decide over their own fertility. Urban women generally felt free to take reproductive decisions, but rural women did not. The difference between the two settings is explained by women’s negotiating skills that depend on their status within the family and the society. Urban women are more often educated and therefore have more status and more power to influence decision-making, including reproductive decisions. Other problems in rural areas are that family planning services are less accessible and facilities sometimes lack resources. Rural health workers do not always keep statistics which makes it difficult for health planners to know what needs to be improved. The Ministry of Health and other actors need to promote women’s access to the facilities. Further recommendations suggest programs that empower women and educate men in family planning issues.

Drawing from Pierre Bourdieu’s socio-cultural approach, this qualitative research project aimed to: (a) understand the responses to current body norms and expectations tied to health and physical appearances amongst underprivileged young women; and; (b) understand to what extent the dominant obesity discourse is inscribed in these women’s bodily habits. Results highlight that participants were aware of the dominant obesity discourse through their perceptions, sentiments, and dispositions towards bodily norms and expectations. Despite their awareness, underprivileged living conditions generated other sets of priorities, such as motherhood, achieving economic stability, completing education, and gaining physical independence which were far greater preoccupations. Underprivileged young women’s ‘choice of the necessary’ is based on optimizing resources and prioritizing needs and responsibilities. Findings support the use of Pierre Bourdieu’s concepts which consider the effects of various aspects of underprivileged living conditions on lifestyles.

Although several studies have demonstrated that differential parenting has a negative impact on the children exposed to it, only a small number of studies have attempted to understand why differential parenting occurs within families. The goal of the present study was to examine the contextual correlates of differential parenting. Specifically, the association between parental socioeconomic status (SES) and differential parenting and the association between objective and subjective indices of neighbourhood quality and differential parenting were investigated. Data were collected as part of the Kids, Families, and Places (KFP) study and analyzed using multilevel modeling. Six hundred and fifty families provided data on 881 children. Five hundred and ninety nine families included a father in the home. Close to seventy five percent of children included in the sample were less than six years of age. Differential parenting was assessed separately for mothers and fathers and across positive and negative parenting outcomes. The findings revealed that parental SES was significantly associated with differential parenting for three of four parenting outcomes. For mothers, SES was negatively associated with differential positivity and negativity. For fathers, SES was negatively associated with differential positivity but not negativity. The objective quality of neighbourhoods in which families resided (i.e., measured as a composite score that combined census tract data on neighbourhood disadvantage and interviewer observations of neighbourhood physical and social disorder) was positively associated with maternal differential negativity; however, this association was also moderated by mothers’ subjective perceptions of their neighbourhoods (i.e., measured using maternal reports of neighbourhood collective efficacy). In other words, when mothers perceived their neighbourhoods to be highly cohesive and supportive, exposure to objectively unfavourable neighbourhood conditions was less strongly associated with differential negativity. Objective neighbourhood quality was not associated with the other three differential parenting outcomes of interest. These findings highlight the important relationship that exists between contextual influences both within and outside of the immediate family and differential parenting. Moreover, they speak to the importance of including both mothers and fathers in studies of differential parenting. The merits of using multilevel modelling to investigate differential parenting and suggestions for future research are discussed.

Although several studies have demonstrated that differential parenting has a negative impact on the children exposed to it, only a small number of studies have attempted to understand why differential parenting occurs within families. The goal of the present study was to examine the contextual correlates of differential parenting. Specifically, the association between parental socioeconomic status (SES) and differential parenting and the association between objective and subjective indices of neighbourhood quality and differential parenting were investigated. Data were collected as part of the Kids, Families, and Places (KFP) study and analyzed using multilevel modeling. Six hundred and fifty families provided data on 881 children. Five hundred and ninety nine families included a father in the home. Close to seventy five percent of children included in the sample were less than six years of age. Differential parenting was assessed separately for mothers and fathers and across positive and negative parenting outcomes. The findings revealed that parental SES was significantly associated with differential parenting for three of four parenting outcomes. For mothers, SES was negatively associated with differential positivity and negativity. For fathers, SES was negatively associated with differential positivity but not negativity. The objective quality of neighbourhoods in which families resided (i.e., measured as a composite score that combined census tract data on neighbourhood disadvantage and interviewer observations of neighbourhood physical and social disorder) was positively associated with maternal differential negativity; however, this association was also moderated by mothers’ subjective perceptions of their neighbourhoods (i.e., measured using maternal reports of neighbourhood collective efficacy). In other words, when mothers perceived their neighbourhoods to be highly cohesive and supportive, exposure to objectively unfavourable neighbourhood conditions was less strongly associated with differential negativity. Objective neighbourhood quality was not associated with the other three differential parenting outcomes of interest. These findings highlight the important relationship that exists between contextual influences both within and outside of the immediate family and differential parenting. Moreover, they speak to the importance of including both mothers and fathers in studies of differential parenting. The merits of using multilevel modelling to investigate differential parenting and suggestions for future research are discussed.

This project investigated the diagnosis and psychostimulant treatment rates of Attention Deficit/Hyperactivity Disorder (ADHD) in Manitoba children. These rates were considered according to sex, age, socioeconomic status (SES), geographical region, and comorbidity with learning disabilities (LD) and behavioral disturbances (BD). Data came from the Manitoba Population Health Research Data Repository, a comprehensive collection of administrative, registry, survey and other databases. The research population included all children aged 0 to 19 years in Manitoba (n = 319,506) with a diagnosis of ADHD (n= 9,233), during two Fiscal years (2003/2004 and 2004/2005). The term “gradient” refers to the relationship between SES and health and emphasizes the idea that the change in outcomes is gradual and occurs across the full range of SES. Results from this study indicate that region of residence (urban versus rural) and comorbid BD moderate the SES gradient, as low income, urban dwelling children with a comorbid diagnosis of BD had the highest rates of ADHD diagnoses and prescriptions. Furthermore, whereas age did not moderate the SES gradient, the crude rates indicated that the SES gradient for ADHD diagnoses and prescriptions was most pronounced in urban children 0 to 13 years of age. Otherwise, all main effects tested (sex, age, socioeconomic status, geographical region, and comorbid BD and LD) were significant in both the diagnosis and prescription models for ADHD. Policy considerations that arise out of this study include more stringent diagnostic and prescription treatment practices, additional support resources for children who are most at risk of having ADHD, and increased information about alternate treatment implementation for ADHD. / February 2008

Drawing from Pierre Bourdieu’s socio-cultural approach, this qualitative research project aimed to: (a) understand the responses to current body norms and expectations tied to health and physical appearances amongst underprivileged young women; and; (b) understand to what extent the dominant obesity discourse is inscribed in these women’s bodily habits. Results highlight that participants were aware of the dominant obesity discourse through their perceptions, sentiments, and dispositions towards bodily norms and expectations. Despite their awareness, underprivileged living conditions generated other sets of priorities, such as motherhood, achieving economic stability, completing education, and gaining physical independence which were far greater preoccupations. Underprivileged young women’s ‘choice of the necessary’ is based on optimizing resources and prioritizing needs and responsibilities. Findings support the use of Pierre Bourdieu’s concepts which consider the effects of various aspects of underprivileged living conditions on lifestyles.

Self-reported psychological distress is quite common in the Swedish elderly population. Feelings of psychological distress may have devastating consequences. The overall aim of this study was to explore associations between socioeconomic position and work complexity during midlife with psychological distress in old age. Ordered logistic regression was used to investigate the associations between, (I) socioeconomic position during midlife and psychological distress in old age, (II) work complexity during midlife and psychological distress in old age, (III) the association between socioeconomic position and psychological distress independent of work complexity, and (IV) the association between work complexity and psychological distress independent of socioeconomic position. The results show that (I) higher socioeconomic position during midlife is associated with less psychological distress in old age (II) higher work complexity during midlife is associated with less psychological distress in old age, and that (III) higher work complexity is associated to less psychological distress independent of socioeconomic position, (IV) but the association between socioeconomic position and psychological distress diminishes adjusting for work complexity. The main conclusion from this study is that individuals with high socioeconomic position benefits from both their position in society and from their working conditions while individuals of lower socioeconomic position are more likely to also suffer the drawbacks of disadvantageous working conditions in relation to late life psychological distress.

No description available.