Mawditt, Claire; (2017) Investigating social influences on and changes in health-related-behaviour clustering during mid-adulthood, using data from two British birth cohort studies. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

INTRODUCTION: This thesis examines how four health-related behaviours (HRBs) – smoking, alcohol, diet, physical activity – cluster within individuals during mid-adulthood, the relationship between socio-economic position (SEP) in pre-adolescence and mid-adulthood and HRB cluster membership in mid-adulthood and the extent to which mid-adulthood SEP influences change in HRB cluster membership during mid-life. METHODS: The research used datasets from two British birth cohort studies: The National Child Development Study (born in 1958) and the British Birth Cohort study (born in 1970). Latent variable modelling was employed to: (i) identify cross-sectional membership of clusters, who shared patterns of HRBs: (ii) examine changes in cluster membership during mid-life: and iii) validate the relationship between SEP in pre-adolescence and mid-adulthood and HRB cluster membership. RESULTS: Three distinct clustered patterns of HRBs were identified and subsequently labelled: ‘Risky’ (1–9%), ‘Moderate Smokers’ (20–30%) and ‘Mainstream’ (68–77%). The Mainstream cluster was characterised by more health-promoting behavioural patterns, i.e. not smoking, frequent fruit and vegetable consumption, less frequent consumption of chips and fried food, being more physically active, although frequent consumption of sweet foods was common. HRB cluster patterns were largely consistent across cohort and gender groups, with some differences in prevalence. More disadvantaged SEP in pre-adolescence predicted more disadvantaged SEP in mid-adulthood which increased the probability of membership of the ‘Risky’ and ‘Moderate Smokers’ clusters compared to the ‘Mainstream’ cluster. HRB cluster membership was found to be relatively stable during mid-life, although there was evidence of transitions to more health-promoting clusters. These transitions were not influenced by mid-adulthood SEP. DISCUSSION: Consistent findings for the two cohorts imply HRB clustering and their social patterning persists across time and provides a person-centred understanding that can inform interventions to improve HRBs. The contemporaneous influence of mid-adulthood SEP on cluster membership provides optimism, suggesting that mid-adulthood lifestyles may be modifiable.

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