Professor Richard Layte

Summary

A person's physical growth, psychological development and personal behaviours in adolescence are the foundation upon which the life course is built. Health behaviours established in adolescence will likely continue into adulthood with long-term implications for health and life-expectancy. For example, 80% of teenagers measured as obese will remain obese as adults and so experience a substantially higher risk of disease later in life. Health and psychological development in adolescence can also have life-long consequences if they obstruct the person's acquisition of important skills and educational qualifications. Educational failure brings with it more unemployment, lower pay and a greater risk of experiencing poverty across the life-course, all of which are associated with worse psychological and physical health and well-being. This project seeks to understand how family, neighbourhood environment and parental social and economic position interact with individual characteristics such as such as sex, personality and temperament to shape mental health, health behaviours and educational outcomes at the end of secondary schooling and the cusp of adulthood. We ask three inter-linked questions: "how do peer relationships and exposure to social media influence the risk of developing anxiety and depression?"; "how do family, neighbourhood and individual characteristics shape the development of health behaviours such as diet, exercise, smoking and alcohol consumption?"; "did the financial crisis and recession experienced in Ireland between 2008 and 2014 influenced educational outcomes at the end of senior cycle and if so, how?" The project will use innovative statistical methods and quasi-experimental designs to analyse large-scale, longitudinal data from two national cohort studies following child development from birth to 18 years. Research findings from this project will provide evidence about what factors in the child's environment in childhood and adolescence are modifiable and so possible targets for changes in policy and practice.

Funding Agency

Health Research Board

Programme

Secondary Data Analysis

Person Months

4

Summary

The life course approach recognises that SES is an important determinant of a wide range of material, behavioural, environmental, and psychosocial exposures that shape health through multiple, complex and interacting pathways. The pernicious effects of living in low SES environments can be seen every major organ system of the body prompting some investigators to suggest that SES may operate through general mechanisms that contribute to a range of biological processes affecting multiple organ systems. Allostatic Load (AL) has been posited as a potential explanatory framework for understanding the biological embedding of SES over the life course. We propose to examine the theoretical and empirical utility of AL as an intermediate construct on the pathway between SES and health using The Irish Longitudinal Study on Ageing (TILDA).

Funding Agency

Health Research Board

Programme

Emerging Investigators

Summary

Over the past 35 years there has been a sustained increase in the Caesarean section (CS) rate in developed countries including Ireland. In 1993, the Department of Health and Children in Ireland reported a CS rate of 13%. By 1999, the next year for which data are available, the rate was 20.4%, increasing to 26.9% by 2009. To date there has been little research on trends in CS in Ireland. In a recent publication the WHO (WHO et al 2009) have stated that there is no empirical evidence for an optimum percentage but questions remain as to why CS rates have been increasing over time. Significant variation in CS rates across hospitals in Ireland also raise concerns about the efficacy of the procedure in some instances. Rates of CS in Irish hospitals varied from 18.6% to 36.4% in 2009 and all but 3 of the 19 maternity units in the Irish hospital system experienced an increase in their CS rate over the period from 1999 to 2009. This project uses linked data from two national databases, the Hospital In-Patient Enquiry scheme (HIPE) and the National Perinatal Reporting System (NPRS) and an in depth prospective study from a large Dublin maternity hospital to investigate the factors that explain the increase in CS in Ireland and the pattern of variation across Irish hospitals. The project will investigate the role of changing maternal characteristics (e.g. increasing age, lower parity (previous births) and obesity), clinical risk factors for CS (e.g. malpresentation, pre-eclampsia, diabetes), changing clinical practices and organisational structures (e.g. private practice, staffing and policy). By understanding the processes associated with growing use of CS in Irish maternity hospitals the project will contribute to the development and improvement of policy and practice in maternity care.

Funding Agency

Health Research Board

Summary

The presence of pronounced inequalities in mortality and life expectancy across income, education and social class groups is now well established both in Ireland and internationally. Analyses of Irish data from the 1980s and 1990s show that Irish men in unskilled manual jobs had a mortality rate almost three times higher than men in higher professional occupations. Unfortunately, the most recent year for which information on socio-economic inequalities in mortality have been analysed is 1996 and we have no research on what happened in the following decade when employment grew by over 55%, unemployment shrank by over 60% and long term unemployment fell by almost 80%. In the same period Irish gross national product increased from 60 per cent of the EU average to 110 per cent and real incomes, adjusted for inflation, increased across the entire income distribution. Ireland's overall mortality rate had been falling steadily for a number of decades before 1996 but the rate of reduction accelerated significantly around 1999. Research suggests this change can be explained by significantly reduced mortality from circulatory diseases, particularly during the winter months and that this may have be been influenced by the introduction of free primary care for the over 70s in 2001 along with changes in the pattern of cardiovascular prescribing. It is not known what impact this change in circulatory mortality patterns had on socio-economic inequalities in mortality. Methodological problems have hindered past research on mortality differentials. In this proposal we develop solutions to these problems and set out a programme of research on trends in mortality differentials between 1986 and 2006 and variations in trends by cause and geographic location. Only by understanding recent trends will we gain insight into the causes of mortality differentials in Ireland and develop interventions to improve the health and longevity of all social groups.

Funding Agency

Health Research Board

Summary

Across developed nations two pronounced social regularities have emerged in research over the last two decades. The first is the intergenerational transmission of earnings, education and occupational class. Economic and sociological studies suggest that the association between the income and social class of family of origin and own occupational class and income are substantial and may not have declined to any significant extent over the last half century. Research suggests that they may even have increased. The second regularity is the persistent differential in health and mortality across socio-economic groups that have been shown to exist within developed countries. Studies suggest that although exposure to adversity over the life course contributes to adult health inequalities, conditions early life may be particularly important for specific diseases. Studies have largely assumed that adult socio-economic differentials in health result from the interaction of the two regularities identified above operating across the life course. That is, material conditions throughout life accumulate to produce adult health whilst the intergenerational transmission of income, education and class increases the probability that both poor health and social disadvantage will tend to accumulate among those from lower income and social class backgrounds. In this project we investigate whether socio-economic inequalities in childhood health may actually contribute to adult socio-economic position through a process of 'health selection'. Using two large child cohort studies: the "Growing Up in Ireland Survey" from the Republic of Ireland and the "Millennium Cohort" from Northern Ireland the project will measure the extent of inequalities in child health and their determinants. We will then study the manner in which child health inequalities contribute to inequalities in cognitive and educational development across children and the mediating role played by family background, community and institutional structures across the two jurisdictions.

Funding Agency

Health Research Board