Background Patients who experience a stroke or transient ischemic attack (TIA) are at high risk of recurrent stroke, but little is known about temporal trends in unselected populations. Reports of low adherence to recommended treatments indicate a need for enhanced secondary preventive follow-up to achieve the full potential of evidence-based treatments. In addition, socioeconomic factors have been associated with poor health outcomes in a variety of contexts. Therefore, it is important to assess the implementation and results of secondary prevention in different socioeconomic groups. Aims The aims of this thesis were to assess temporal trends in ischemic stroke recurrence and evaluate the implementation and results of a nurse-led, telephone-based follow-up program to improve blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels after stroke/TIA. Methods In study I, we collected baseline data for unique patients with an ischemic stroke event between 1998 and 2009 (n=196 765) from the Swedish Stroke Register (Riksstroke). Recurrent ischemic stroke events within 1 year were collected from the Swedish National Inpatient Register (IPR) and the cumulative incidence was compared between four time periods using the Kaplan-Meier survival analysis and the logrank test. Implementation (study II) and 1-year results (study III-IV) for the secondary preventive follow-up were studied in the NAILED (Nurse-based Age-independent Intervention to Limit Evolution of Disease) study. Between 1 Jan 2010 and 31 Dec 2013, the baseline characteristics of consecutive patients admitted to Östersund Hospital for acute stroke or TIA were collected prospectively (n=1776). Consenting patients in a condition permitting telephone-based follow-up were randomized to nurse-led, telephone-based follow-up or follow-up according to usual care. Follow-up was cunducted at 1 and 12 months after discharge and the intervention included BP and LDL-C measurements, titration of medication, and lifestyle counseling. In study II, we analyzed factors associated with non-participation in the randomized phase of the NAILED study, including association with education level. In addition, we compared the 1-year prognosis in terms of cumulative survival between participants and non-participants. In study III, we compared differences in BP and LDL-C levels between the intervention and control groups during the first year of follow-up and, in study IV, in relation to level of education (low, ≤10 years; high, >10 years). Results The cumulative 1-year incidence of recurrent ischemic stroke decreased from 15.0% to 12.0%. Among surviving stroke and TIA patients, 53.1% were included for randomization, 35.7% were excluded mainly due to physical or cognitive disability, and 11.2% declined participation in the randomized phase. A low level of education was independently associated with exclusion, as well as the patient’s decision to abstain from randomization. Excluded patients had a more than 12-times higher risk of death within 1 year than patients who were randomized. After 1 year of follow-up, the mean systolic BP, diastolic BP, and LDL-C levels were 3.3 mmHg (95% CI 0.3 to 6.3), 2.3 mmHg (95% CI 0.5 to 4.2), and 0.3 mmol/L (95% CI 0.1 to 0.4) lower in the intervention group than among controls. Among participants with values above the treatment goal at baseline, the differences in systolic BP and LDL-C levels were more pronounced (8.0 mmHg, 95% CI 4.0 to 12.1; 0.6 mmol/L, 95% CI 0.4 to 0.9). In the intervention group, participants with a low level of education achieved similar or larger improvements in BP and LDL-C than participants with a high level of education. In the control group, BP remained unaltered and the LDL-C levels increased among participants with a low level of education. Conclusion The 1-year risk of ischemic stroke recurrence decreased in Sweden between 1998 and 2010. Nurse-led, telephone-based secondary preventive follow-up is feasible in just over half of the survivors of acute stroke and TIA and achieve better than usual care in terms of BP and LDL-C levels, and equality in BP improvements across groups defined by education level. However, a large proportion of stroke survivors are in a general condition precluding this form of follow-up, and their prognosis in terms of 1-year survival is poor. Patients with a low education level are over-represented within this group and among patients declining randomization for secondary preventive follow-up.

This meta-analysis investigated the association of gender and socioeconomic position with cardiorespiratory fitness in adolescents. Public health professionals know the importance of physical activity level as a modifiable behavior; however, the literature has revealed that more research is needed on the association of sociodemographic variables like gender and socioeconomic position with cardiorespiratory fitness in adolescents. Using the physical fitness and health outcomes conceptual model as a guide, the overall effect sizes across studies were assessed as well as the moderators of study design, sample size, age, and country. A systematic review of literature identified a total of 18 peer-reviewed studies meeting inclusion criteria, which yielded a total of 41 unique effect sizes. Meta-analysis utilizing a random effects model indicated that gender and socioeconomic position are associated with cardiorespiratory fitness and that age and country moderated these effects. The positive social change implication of this meta-analysis may provide evidence-based knowledge to public health officials, physical educators, and health educators who are considering changes in school health promotion policies and health promotion interventions geared toward different gender and socioeconomic groups. Long term results include increased physical activity, decreased clustered cardiovascular risk factors, and lowered all-cause and cardiovascular disease mortality as adolescents track into adulthood.

In Australia, and other Western countries, there are marked socioeconomic inequalities in mortality from chronic, diet-related diseases. Research in these countries has shown that adults from low socioeconomic backgrounds experience greater morbidity and mortality from these conditions compared to their higher-status counterparts. In recent decades, much research has focused on factors that may contribute to these inequalities. Dietary intakes are thought to account for a large proportion of the socioeconomic variability in health, and there is some evidence suggesting that the psychosocial foundations laid down in adolescence are important influences on these dietary intakes. In Australia, however, existing research examining socioeconomic differences in dietary intakes is limited. Most previous research has looked at dietary intakes in adulthood, and have not considered examining for socioeconomic differences in adolescence. Furthermore, not much is known about the health and nutrition-related beliefs, attitudes and perceptions of adolescents that may contribute to socioeconomic differences in dietary intakes. This study examined these issues by analysing for socioeconomic differences in food and nutrient intakes among both adolescents and adults. It also investigated some health and nutrition-related beliefs, attitudes and perceptions of adolescents from different socioeconomic backgrounds. Data from a national cross-sectional survey, the 1995 Australian National Nutrition Survey, were analysed to determine socioeconomic differences in food and nutrient intakes. Qualitative interviews were undertaken with adolescents to investigate their health and nutrition-related beliefs, attitudes and perceptions. The results show that compared to adults, there is less socioeconomic inequality in food and nutrient intakes among adolescents. Intakes of some anti-oxidant vitamins and folate were directly related with socioeconomic position among adults. Adults from low socioeconomic backgrounds were less likely to consume fruits or vegetables. They consumed a lower variety of fruits and vegetables and were less likely to choose fruits and vegetables high in vitamin A, folate and vitamin C. The results showed that these differences may be due to adults from low socioeconomic backgrounds being less likely to want to increase their fruit and vegetable intakes, and perceiving price and storage as barriers to doing so. There were a small number of socioeconomic differences in adolescents' beliefs, attitudes and perceptions about nutrition and health that may contribute to dietary intake inequalities in adulthood. Adolescents from lower socioeconomic backgrounds were less likely to see health as being important for achieving goals, and identified nutrients and sleep as influencing their health less frequently. These adolescents also referred to dietary recommendations, nutrient intakes, dairy foods and avoiding school canteen foods less frequently when describing a healthy diet. A number of recommendations about the design and targeting of nutrition-promotion campaigns and interventions are discussed, as well as future directions for research on socioeconomic differences in dietary intakes.

The aim of the study was to compare how young adults experience their identity formation in relation to both their own as well as to another residential areas class character. The study had a comparative approach and two socioeconomically diverse areas in the Municipality of Växjö were studied. The study's empirical work consists of qualitative interviews with young adults from the residential areas Araby and Öjaby. The empirical data were analysed with the help of Erik H Erikson's theory of identity, Pierre Bourdieu's theory of social class and John L Scotsons and Norbert Elias's theory of established and outsiders. The results of the study showed that young adults feel that their residential area has a considerable impact regarding to their identity formation. The results also showed that an area's reputation has a strong impact on how individuals in the area are perceived. All respondents in the study felt that people from the socioeconomically privileged area had better life conditions than people from the socioeconomically disadvantaged area. These conditions include the school situation as well as the labour market.

Background: Supervised exercise and delivered education are first step treatment for knee, hip and hand osteoarthritis (OA) according to international guidelines. It is uncertain whether OA outcomes from participation in the Swedish self-management program “Better management of Osteoarthritis (BOA)” differs for participants with different sociodemographic background. The aim of this master thesis was thus to assess to what extent there were differences by level of education and immigration status among participants in the self-management program in terms of Health, Health-related quality of life, Mobility, Health-related behaviours and Adherence to the self-management program, measured at baseline, three and 12 months. Methods: Analysis of covariance (ANCOVA), logistic and multinomial regression was used to analyse outcomes for 22 741 participants. Results: For most adjusted outcomes, there were sociodemographic inequalities at all measurement points. However, there were no educational differences in mobility and attitude to physical activity at baseline, but at the follow-ups such inequalities emerged. Conversely, the willingness to undergo joint surgery differed by immigration status at baseline, but not at the follow-ups, and immigrants were more adherent towards the self-management program than domestic born participants. Conclusion: These results are pioneer findings showing that it exists sociodemographic differences related to OA treatment.

Introduction. La notion d'" embodiment " propose que chaque humain est à la fois un être social ainsi que biologique, intégrant le monde dans lequel il/elle vit. Nous faisons l'hypothèse que la position socioéconomique pendant l'enfance peut être biologiquement incorporée, conduisant à la production des inégalités sociales de santé entre les sous-groupes de population. La charge allostatique (CA) est un concept qui tente de capturer l'usure physiologique globale du corps liée à l'activation répétée des mécanismes physiologiques compensatoires en cas d'exposition à des stress chroniques. La CA pourrait permettre une meilleure compréhension des voies biologiques qui jouent un rôle potentiel dans la construction du gradient social de santé des adultes. Objectif. Pour explorer l'hypothèse d'incorporation biologique, nous avons examiné les voies de médiation entre les adversités psychosociales et la position socioéconomique précoces et la CA à 44 ans. Nous avons également confronté l'indice de CA à une mesure multidimensionnelle de santé latente à 50 ans. Méthodes. Les données sont issues de la cohorte Britannique de naissance de 1958 (n=18 000). La CA a été construite avec les données de l'enquête biomédicale conduite à 44 ans, comme une mesure physiologique synthétique, multi-système, à l'aide de 14 biomarqueurs représentant les systèmes neuroendocrinien, métabolique, immunitaire / inflammatoire et cardiorespiratoire. Résultats. L'ensemble de nos résultats suggèrent que la CA pourrait être un indice approprié pour capturer partiellement la dimension biologique des processus d'embodiment. Discussion. Comprendre comment l'environnement affecte notre santé en se " glissant sous la peau " et pénétrant dans les cellules, les organes et les systèmes physiologiques de notre corps est un principe clé dans la recherche en santé publique. Promouvoir le recueil de marqueurs biologiques dans des grandes études prospectives et représentatives est crucial pour continuer la recherche sur ce sujet. Les études de réplication pourraient faire partie des futures perspectives de recherche, pour comparer entre populations avec des contextes culturels différents pour observer si un index de CA peut être considéré comme "universel ". / Introduction. The notion of embodiment proposes that every human being is both a social and a biological organism that incorporates the world in which (s)he lives. It has been hypothesized that early life socioeconomic position (SEP) can be biologically embedded, potentially leading to the production of health inequalities across population groups. Allostatic load (AL) is a concept that intends to capture the overall physiological wear-and-tear of the body triggered by the repeated activation of compensatory physiological mechanisms as a response to chronic stress. AL could allow a better understanding of the potential biological pathways playing a role in the construction of the social gradient in adult health. Objective. To explore the biological embedding hypothesis, we examined the mediating pathways between early SEP and early adverse psychosocial experiences and higher AL at 44 years. We also confronted an AL index with a latent multidimensional and integrative measure of health status at 50y. Methods. Data are from the 1958 British birth cohort (n=18 000) follow-up to age 50. AL was operationalized using data from the biomedical survey collected at age 44 on 14 parameters representing the neuroendocrine, metabolic, immune-inflammatory and cardiovascular systems. Results. Overall, our results suggest that AL could be a suitable index to partially capture the biological dimensions of embodiment processes. Discussion. Understanding how human environments affect our health by 'getting under the skin' and penetrating the cells, organs and physiological systems of our bodies is a key tenet in public health research. Promoting the collection of biological markers in large representative and prospective studies is crucial to continue to investigate on this topic. Replication studies could be part of the future research perspectives, to compare with other cultural context and to observe if an AL index can be 'universal'.

Introduktion/Bakgrund: Enligt ett flertal vetenskapliga rapporter är misshandel och utnyttjande av äldre ett växande problem i Europa och övriga världen. Det kommer att ställas högre krav på vårdgivare både inom familjen och inom välfärden på grund av en åldrande europeisk befolkning. Det förutses att en tredjedel av den europeiska befolkningen kommer att vara 60 år eller äldre år 2050. Tillförlitliga data och forskning är dock en bristvara när det kommer till misshandel och utnyttjande av äldre. Syfte: Att granska den tillgängliga forskningen om vilken effekt olika socioekonomiska faktorer (utbildning, yrke och förmögenhet) har huruvida äldre människor (60 år eller äldre) riskerar att utsättas för fysisk och/eller psykisk misshandel. Metod: En litteraturstudie valdes som arbetsmetod. Vetenskapliga artiklar och relevant litteratur har granskats och valts ut via olika databaser. Resultat: Studien kom fram till att olika socioekonomiska faktorer (utbildning, yrke och förmögenhet) påverkar huruvida äldre människor riskerar att utsättas för fysisk och/eller psykisk misshandel. Av de studerade faktorerna var utbildning den socioekonomiska faktor som främst påverkade huruvida en äldre människa riskerade att bli utsatt för misshandel eller inte. De andra faktorerna, yrke och förmögenhet/inkomst, var inte representerade i samma utsträckning som utbildning i studiens resultat. En annan påverkande faktor som hänger ihop med socioekonomiska faktorer visade sig vara könstilhörighet. Majoriteten av den granskade litteraturen bekräftar att det finns ett mönster som innebär att äldre kvinnor löper en större risk än män att utsättas för psykisk och/eller fysisk misshandel. Det var svårt att identifiera likheter eller skillnader mellan olika europeiska regioner på grund av att studiemetod och studiedesign skiljde sig allt för mycket åt mellan de olika vetenskapliga artiklarna. Slutsats: Resultatet från litteraturgranskningen visade att utbildning har en större påverkan än yrke och förmögenhet huruvida en äldre människa riskerar att bli utsatt för psykisk och/eller fysisk misshandel eller inte. Studien fann även att könsskillnader var tydliga och innebär äldre kvinnor löper större risk än män att bli utsatta. Något som också måste tas i beaktning i framtida forskning. Bristen på forskning och litteratur inom ämnet vittnar om att det finns ett stort behov av mer forskning. En bättre förståelse för relationen mellan socioekonomisk position och misshandel av äldre är viktigt för framtiden. / Abstract Introduction: The issue of elder abuse is described as increasing in Europe and beyond according to several scientific reports. An ageing European population combined with longer life expectancy will increase demands on family caregivers and a well-functioning health and social care workforce. It is estimated that in year 2050 one third of the European population will be 60 years or older. However there is still a shortage of confident data across European countries regarding the extent, features, determinants and effects of elder abuse. Aim: To review existing knowledge of the impact of various measures of socioeconomic position (education, occupation and wealth) on physical and psychological abuse among elderly people (60 years of age and over) in Europe. Method: A literature study was chosen as working method. Scientific articles and relevant literature were examined using different databases. Results: The review found that socioeconomic position factors (education, occupation, wealth) have an impact on the likelihood of elderly individuals experiencing abuse. Of the assessed factors, education has shown to be the socioeconomic factor which has the most impact on the likelihood of elder abuse. Other factors such as occupation and wealth and income, were not represented in the results at the same extent as education. Another important factor related to elderly people’s socio-economic position was found to be gender. The majority of articles analysed in this thesis confirms that there is a pattern where elderly women are more likely to experience abuse than are men. Due to different study designs and measures in the analysed scientific articles and reports differences according to area context were hard to identify. Conclusion: Results of this thesis showed that education as measure of socioeconomic position had the biggest impact on elder abuse as compared to occupation and wealth. However, gender (a factor strictly linked to socioeconomic position) differentials were remarkable, a subject which needs to be taken into consideration in future research. Further, the lack of literature in the research subject points out to an urgent need for further studies. This is urgently needed, as both ageing and abuse are increasing across Europe. A better understanding of the relation between socioeconomic position and abuse among elderly will be of paramount importance for future interventions aimed to curb the ever growing trend.

The aim of this thesis was to describe inequalities in the use of different health care services according to socioeconomic position (SEP) in Catalonia, Spain and Europe. In addition, we intended to assess whether the public coverage of the services, in particular dental health care, has an influence on the magnitude of inequalities in the use of such services. Finally, we aimed to determine the influence of population-based female cancer screening programmes on the prevalence of screening and on the extent of inequality. To accomplish these objectives four studies were carried out. The sources of information of the four studies were, respectively: several editions of the Catalan Health general practitioner (GP) services are equitable or manual classes use them to a greater extent. However, there are marked SEP inequalities in the use of outpatient specialist services, especially in dental care. Socioeconomic inequalities in use of dental care services exist throughout Europe, but they are larger in countries in which dental care is not covered at all by the public health care system than in countries in which dental care is partially covered. In Europe, socioeconomic inequalities in breast and cervical cancer screening are not found in countries with population-based screening programmes but they are found in those countries with only regional or pilot programmes and in those countries with opportunistic screening. / L'objectiu d'aquesta tesi era descriure les desigualtats en l'ús de diferents serveis sanitaris segons la posició socioeconòmica a Catalunya, Espanya i a Europa. A més a més, es volia avaluar si la cobertura pública dels serveis, en particular la dels serveis dentals, infuencia la magnitud de les desigualtats socioeconòmiques en l'ús d'aquests serveis. Finalment, es va voler determinar la influència dels programes poblacionals de cribratge dels càncers de mama i cèrvix en la prevalença de cribratge i en la magnitud de les desigualtats. Per tal d'assolir aquests objectius es van dur a terme 4 estudis. Les fonts d'informació d'aquests estudis van ser, respectivament: diferents edicions de l'Enquesta de Salut de Catalunya (ESCA), diferents edicions de l'Enquesta Nacional de Salut d'Espanya (ENS), l'Enquesta de Salut, Envelliment i Jubilació a Europa (SHARE) 2006 i dades dels països europeus que van participar a l'Enquesta Mundial de la Salut de l'OMS l'any 2002. Els dos primers estudis eren estudis de tendències mentre que els dos últims van ser transversals. En tots els estudis les desigualtats socioeconòmiques es van mesurar mitjançant índexos relatius (RII) i absoluts (SII) de desigualtat. Els resultats d'aquests estudis mostren que a Catalunya i a Espanya els serveis d'atenció primària són equitatius o fins i tot les persones de classes manuals en presenten una major proporció d'ús. Tanmateix, hi ha marcades desigualtats en visites a l'especialista, en especial en les visites al dentista. Les desigualtats socioeconòmiques en la utilització dels serveis dentals existeixen a tota Europa, però són més grans en aquells països on l'atenció dental no està coberta pel sistema públic de salut que en aquells països on aquesta està parcialment coberta. A Europa, no es troben desigualtats socioeconòmiques en el cribratge dels càncers de mama i cèrvix en aquells països amb programes poblacionals de cribratge, però sí que es troben en aquells països amb programes pilot o regionals o amb només cribratge oportunista.

Measuring socioeconomic position (SEP) in population chronic disease and risk factor surveillance systems is essential for monitoring changes in socioeconomic inequities in health over time. A life course approach in epidemiology considers the long-term effects of physical and social exposures during gestation, childhood, adolescence, and later adult life on health. Previous studies provide evidence that socioeconomic factors at different stages of the life course influence current health status. Measures of SEP during early life to supplement existing indicators of current SEP are required to more adequately explain the contribution of socioeconomic factors to health status and monitor health inequities. The aim of this thesis was to examine how a life course perspective could enhance the monitoring of SEP in chronic disease and risk factor surveillance systems. The thesis reviewed indicators of early life SEP used in previous research, determined indicators of early life SEP that may be useful in South Australian surveillance systems, and examined the association of SEP over the life course and self-rated health in adulthood across different population groups to demonstrate that inclusion of indicators of early life SEP in surveillance systems could allow health inequities to be monitored among socially mobile and stable groups. A variety of indicators, such as parents’ education level and occupation, and financial circumstances and living conditions during childhood, have been used in different study designs in many countries. Indicators of early life SEP used to monitor trends in the health and SEP of populations over time, and to analyse long-term effects of policies on the changing health of populations, need to be feasible to measure retrospectively, and relevant to the historical, geographical and sociocultural context in which the surveillance system is operating. Retrospective recall of various indicators of early life SEP was examined in a telephone survey of a representative South Australian sample of adults. The highest proportions of missing data were observed for maternal grandfather’s occupation, and mother’s and father’s highest education level. Family structure, housing tenure, and family financial situation when the respondent was aged ten, and mother and father’s main occupation had lower item non-response. Respondents with missing data on early life SEP indicators were disadvantaged in terms of current SEP compared to those who provided this information. The differential response to early life SEP questions according to current circumstances has implications for chronic disease surveillance examining the life course impact of socioeconomic disadvantage. While face-to-face surveys are considered the gold standard of interviewing techniques, computer-assisted telephone interviewing is often preferred for cost and convenience. Recall of father’s and mother’s highest education level in the telephone survey was compared to that obtained in a face-to-face interview survey. The proportion of respondents who provided information about their father’s and mother’s highest education level was significantly higher in the face-to-face interview than in the telephone interview. Survey mode, however, did not influence the finding that respondents with missing data for parents’ education were more likely to be socioeconomically disadvantaged. Alternative indicators of early life SEP, such as material and financial circumstances, are likely to be more appropriate than parents’ education for life course analyses of health inequities using surveillance data. Questions about family financial situation and housing tenure during childhood and adulthood asked in the cross-sectional telephone survey were used to examine the association of SEP over the life course with self-rated health in adulthood. Disadvantaged SEP during both childhood and adulthood and upward social mobility in financial situation were associated with a reduced prevalence of excellent or very good health, although this relationship varied across gender, rurality, and country of birth groups. Trend data from a chronic disease and risk factor surveillance system indicated that socioeconomic disadvantage in adulthood was associated with poorer self-rated health. The surveillance system, however, does not currently contain any measures of early life SEP. Overlaying the social mobility variables on the surveillance data indicated how inequities in health could be differentiated in greater detail if early life SEP was measured in addition to current SEP. Inclusion of life course SEP measures in surveillance will enable monitoring of health inequities trends among socially mobile and stable groups. Life course measures are an innovative way to supplement other SEP indicators in surveillance systems. Considerable information can be gained with the addition of a few questions. This will provide further insight into the determinants of health and illness and enable improved monitoring of the effects of policies and interventions on health inequities and intergenerational disadvantage. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1367190 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2009

Measuring socioeconomic position (SEP) in population chronic disease and risk factor surveillance systems is essential for monitoring changes in socioeconomic inequities in health over time. A life course approach in epidemiology considers the long-term effects of physical and social exposures during gestation, childhood, adolescence, and later adult life on health. Previous studies provide evidence that socioeconomic factors at different stages of the life course influence current health status. Measures of SEP during early life to supplement existing indicators of current SEP are required to more adequately explain the contribution of socioeconomic factors to health status and monitor health inequities. The aim of this thesis was to examine how a life course perspective could enhance the monitoring of SEP in chronic disease and risk factor surveillance systems. The thesis reviewed indicators of early life SEP used in previous research, determined indicators of early life SEP that may be useful in South Australian surveillance systems, and examined the association of SEP over the life course and self-rated health in adulthood across different population groups to demonstrate that inclusion of indicators of early life SEP in surveillance systems could allow health inequities to be monitored among socially mobile and stable groups. A variety of indicators, such as parents’ education level and occupation, and financial circumstances and living conditions during childhood, have been used in different study designs in many countries. Indicators of early life SEP used to monitor trends in the health and SEP of populations over time, and to analyse long-term effects of policies on the changing health of populations, need to be feasible to measure retrospectively, and relevant to the historical, geographical and sociocultural context in which the surveillance system is operating. Retrospective recall of various indicators of early life SEP was examined in a telephone survey of a representative South Australian sample of adults. The highest proportions of missing data were observed for maternal grandfather’s occupation, and mother’s and father’s highest education level. Family structure, housing tenure, and family financial situation when the respondent was aged ten, and mother and father’s main occupation had lower item non-response. Respondents with missing data on early life SEP indicators were disadvantaged in terms of current SEP compared to those who provided this information. The differential response to early life SEP questions according to current circumstances has implications for chronic disease surveillance examining the life course impact of socioeconomic disadvantage. While face-to-face surveys are considered the gold standard of interviewing techniques, computer-assisted telephone interviewing is often preferred for cost and convenience. Recall of father’s and mother’s highest education level in the telephone survey was compared to that obtained in a face-to-face interview survey. The proportion of respondents who provided information about their father’s and mother’s highest education level was significantly higher in the face-to-face interview than in the telephone interview. Survey mode, however, did not influence the finding that respondents with missing data for parents’ education were more likely to be socioeconomically disadvantaged. Alternative indicators of early life SEP, such as material and financial circumstances, are likely to be more appropriate than parents’ education for life course analyses of health inequities using surveillance data. Questions about family financial situation and housing tenure during childhood and adulthood asked in the cross-sectional telephone survey were used to examine the association of SEP over the life course with self-rated health in adulthood. Disadvantaged SEP during both childhood and adulthood and upward social mobility in financial situation were associated with a reduced prevalence of excellent or very good health, although this relationship varied across gender, rurality, and country of birth groups. Trend data from a chronic disease and risk factor surveillance system indicated that socioeconomic disadvantage in adulthood was associated with poorer self-rated health. The surveillance system, however, does not currently contain any measures of early life SEP. Overlaying the social mobility variables on the surveillance data indicated how inequities in health could be differentiated in greater detail if early life SEP was measured in addition to current SEP. Inclusion of life course SEP measures in surveillance will enable monitoring of health inequities trends among socially mobile and stable groups. Life course measures are an innovative way to supplement other SEP indicators in surveillance systems. Considerable information can be gained with the addition of a few questions. This will provide further insight into the determinants of health and illness and enable improved monitoring of the effects of policies and interventions on health inequities and intergenerational disadvantage. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1367190 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2009