Is the self-reporting of mental health problems sensitive to public stigma towards mental illness? A comparison of time trends across English regions (2009-19).

PURPOSE: The prevalence of mental health problems has rapidly increased over time. The extent to which this captures changes in self-reporting due to decreasing stigma is unclear. We explore this by comparing time trends in mental health and stigma-related indicators across English regions. METHODS: We produced annual estimates of self-reported mental disorders (SRMDs) across waves of the Health Survey for England (2009-18, n = 78,226) and three stigma-related indicators (knowledge, attitudes, and intended behaviour) across waves of the Attitudes Towards Mental Illness survey (2009-19, n = 17,287). Differences in trends were tested across nine Government Office Regions using linear models, adjusting for age, sex, ethnicity, marital status, and social class. RESULTS: In 2009, SRMDs did not vary by region (p = 0.916), whereas stigma-related indicators did (p < 0.001), with London having the highest level of stigma and the North East having lowest level of stigma. Between 2009 and 2018, the prevalence of SRMDs increased from 4.3 to 9.1%. SRMDs increased and stigma-related indicators improved at different rates across regions over time (SRMDs p = 0.024; stigma-related indicators p < 0.001). London reported the lowest increase in SRMDs (+ 0.3 percentage point per year) yet among the largest improvements in attitudes and intended behaviour across regions. CONCLUSIONS: Improvements in attitudes towards mental illness did not mirror changes in self-reported mental health problems across English regions over the past decade. The findings do not support the argument that changes in public stigma, at least when defined at this regional scale, have been driving the increase in self-reported mental health indicators in recent years.

Trends in young adults' mental distress and its association with employment: Evidence from the Behavioral Risk Factor Surveillance System, 1993-2019.

Few have examined how employment is linked to trends in mental health among young adults across economic contexts in more recent years. To better understand the burden of non-employment and mental distress in this age group, this study examines the association of short-term (<1 year) and long-term (1+ year) out-of-work status with mental health across three recessions among young men and women ages 18-34. We report sex-stratified estimates of frequent mental distress (FMD), out-of-work status, and their association through adjusted prevalence ratios across 27 cycles of the U.S. Behavioral Risk Factor Surveillance System (1993-2019). We found that FMD increased by 112% in men and 120% in women between 1993 and 2019, with 55% (men) and 44% (women) of this increase occurring between 2016 and 2019. Short-term (PR men = 1.53, 95%CI 1.46-1.61; PR women = 1.34, 95%CI 1.29-1.40) and long-term (PR men = 1.61, 95%CI 1.51-1.71; PR women = 1.28, 95%CI 1.22-1.34) out-of-work status were each associated with a higher risk of FMD during this period. The magnitude of associations between long-term out-of-work status and FMD significantly varied across cycles, and was strongest after the 1991 recession in men and the 2008 recession in women. Whereas employment represents an important determinant of mental health among young adults, particularly during economic downturns, it did not suffice to explain the rise in mental distress in this age group in more recent years.

Socioeconomic inequalities in secondhand smoke exposure before, during and after implementation of Quebec's 2015 'An Act to Bolster Tobacco Control'.

BACKGROUND: To better understand whether tobacco control policies are associated with changes in secondhand smoke (SHS) exposure across socioeconomic groups, we monitored differences in socioeconomic inequalities in SHS exposure in households and private vehicles among youth and adults before, during and after adoption of Quebec's 2015 An Act to Bolster Tobacco Control. METHODS: Using data from the Canadian Community Health Survey, we examined the prevalence of daily exposure to SHS in households and private vehicles among youth (ages 12 to 17) and adults (ages 18+) across levels of household education and income (separately) in 2013/2014, 2015/2016 and 2017/2018. We tested differences in the magnitude of differences in outcomes over time across education and income categories using logistic models with interaction terms, controlling for age and sex. RESULTS: We detected inequalities in SHS exposure outcomes at each time point, most markedly at home among youth (OR of SHS exposure among youth living in the 20% poorest households vs the 20% richest=4.9, 95% CI 2.7 to 6.2). There were decreases in SHS exposure in homes and cars in each education/income group over time. The magnitude of inequalities in SHS exposure in homes and cars, however, did not change during this period. CONCLUSIONS: The persistence of socioeconomic inequalities in SHS exposure despite implementation of new tobacco control laws represents an increasingly worrisome public health challenge, particularly among youth. Policymakers should prioritise the reduction of socioeconomic inequalities in SHS exposure and consider the specific needs of socioeconomically disadvantaged populations in the design of future legislation.

Changes in Patterns of Social Role Combinations at Ages 25-26 among Those Growing Up in England between 1996 and 2015-16: Evidence from the 1970 British Cohort and Next Steps Studies.

Changes across education, employment, and family life over the past 20 years challenges the capacity of previously established social role combinations to continue representing the experiences of young men and women born since the late 1980s. Latent class analysis was used to derive patterns of role combinations at ages 25-26 in those growing up in England, using data from 3191 men and 3921 women in the 1970 British Cohort Study (1996) and 3426 men and 4281 women in the Next Steps study born in 1989-90 (2015-16). Role combinations in 1996 were well defined by five patterns across genders: educated, work-oriented, traditional family, fragile family, and slow starters. Patterns in 2015-16 diverged across genders (e.g., disappearance of home ownership in the traditional family group among men and higher education as a group identifier among women) and included across genders fewer work-oriented, more slow starters, and a new group of "left behind" who are excluded from work and relationships. Young men and women born around 1990 experienced diverging role combinations characterized by increased delays and inequalities, with fewer being able to attain the milestones traditionally associated with the transition to adulthood by the mid-20s.

Considering the age-graded nature of associations between socioeconomic characteristics and smoking during the transition towards adulthood.

Young adulthood is a sensitive period characterized by the accumulation of resources and transitions in and out of education, employment, family, and housing arrangements. The association between these characteristics and smoking outcomes likely varies with age yet few studies address its dynamic age-graded nature. To explore this, we examined 2083 young adults ages 18-25 from the 2011-2012 cross-sectional sample of the Montreal-based Interdisciplinary Study of Inequalities in Smoking. We operationalized participants' socioeconomic characteristics using their resources (e.g., education, income, financial difficulties) and transition stages (i.e., studying, working full-time, living arrangements with parents and children, and being in a relationship). We examined differences in these characteristics' associations with occasional and daily smoking across two-year categories (18-19, 20-21, 22-23, and 24-25) using multinomial logistic regression models with age-based interaction terms. Findings highlighted four characteristics, i.e., educational attainment, personal income, student status, and relationship status, with significant differences in associations with smoking outcomes across age categories. Between the age groups of 18-19 and 24-25: 1) the negative association between low educational attainment and daily smoking increased; 2) the positive association between personal income and daily smoking decreased; 3) the negative association between student status and both outcomes decreased; 4) the negative association between relationship status and occasional smoking increased. Findings support that the associations between young adults' socioeconomic characteristics and smoking outcomes vary substantially during the second and third decades of life. Addressing this has critical implications for identifying vulnerable populations and developing appropriate age-based policies in this age group.

Methodological systematic review of studies on social inequalities in smoking among young adults: A field coming of age?

OBJECTIVE: Socioeconomic circumstances are critically important to addressing smoking. In young adulthood (ages 18-25), dynamic transitions in education, employment, family and housing complicate the measurement of socioeconomic circumstances. To better understand approaches to capturing these circumstances, this methodological systematic review examined how socioeconomic characteristics used to identify social inequalities in smoking among young adults are measured. DATA SOURCES: We searched PubMed/MEDLINE, Scopus, EMBASE, ERIC and Sociological Abstracts, and used three prior reviews. We updated the search in March 2018. STUDY SELECTION: Two reviewers independently screened peer-reviewed records from OECD countries published in English, French, German or Spanish after 1995 whose samples covered at least 1 year between the ages of 18 and 25. We included 89 of 1320 records. DATA EXTRACTION: One reviewer extracted study characteristics, indicators used to operationalise socioeconomic circumstances and each indicator's relation to results on smoking (ie, significance and direction). We found 39 indicators of socioeconomic circumstances related to six broad domains. These indicators were used in 425 results. DATA SYNTHESIS: We descriptively analysed the extracted data using evidence tables. Educational attainment was most common. Evidence of inequalities varied by indicator used. For example, there was inconsistent evidence regarding the role of parental characteristics and transition stages and insufficient evidence regarding personal income on smoking. CONCLUSION: Despite its importance, studies have disproportionally examined inequalities among young adults using traditional indicators. The mismatch between young adults' life transitions and measurement strategies may attenuate evidence of inequalities. We suggest strategies to improve future measurement.

Rethinking the relationship between socioeconomic status and health: Challenging how socioeconomic status is currently used in health inequality research.

AIMS: The Scandinavian Journal of Public Health recently reiterated the importance of addressing social justice and health inequalities in its new editorial policy announcement. One of the related challenges highlighted in that issue was the limited use of sociological theories able to inform the complexity linking the resources and mechanisms captured by the concept of socioeconomic status. This debate article argues that part of the problem lies in the often unchallenged reliance on a generic conceptualization and operationalization of socioeconomic status. These practices hinder researchers' capacity to examine in finer detail how resources and circumstances promote the unequal distribution of health through distinct yet intertwined pathways. As a potential way forward, this commentary explores how research practices can be challenged through concrete publication policies and guidelines. To this end, we propose a set of recommendations as a tool to strengthen the study of socioeconomic status and, ultimately, the quality of health inequality research. CONCLUSIONS: Authors, reviewers, and editors can become champions of change toward the implementation of sociological theory by holding higher standards regarding the conceptualization, operationalization, analysis, and interpretation of results in health inequality research.

Multidisciplinarity in health promotion: a bibliometric analysis of current research.

Health promotion (HP) is a relatively recent field that stems from, notably, public health, sociology, political science, psychology and education. This multidisciplinarity has contributed to HP's challenged institutionalization. Scholars have so far predominately explored HP's multidisciplinarity using anecdotal approaches, limiting our understanding of the breadth and interplay of the disciplines constituting HP research. The overall aim of this paper is to contribute to a better understanding of HP's multidisciplinarity using a bibliometric approach. We developed a three-pronged approach: (i) we examined the most cited journals within Health Promotion International; (ii) we asked an international panel of HP scholars (n = 27) to vote on the journals most relevant to their work; (iii) we examined the most common words in article abstracts among journals which received the highest number of votes. We used multiple correspondence analyses to examine similarities between HPI references, scholars' votes and abstracts' words. We found evidence that HP research reached across numerous disciplines but segregated into distinct subgroups with conflicting perspectives. We found that HPI was the only journal that was identified as relevant by a majority (81% of participants). Multidisciplinarity is a key feature of HP. It can strengthen HP by enriching our understanding of health and social issues from a variety of perspectives, but it may also divide experts into disciplinary silos. This may ultimately weaken its institutional pathways and its contribution to public health. More academic venues and institutions should be developed to facilitate collaboration among HP scholars and practitioners.

Social inequalities in health information seeking among young adults in Montreal.

Over their lifecourse, young adults develop different skills and preferences in relationship to the information sources they seek when having questions about health. Health information seeking behaviour (HISB) includes multiple, unequally accessed sources; yet most studies have focused on single sources and did not examine HISB's association with social inequalities. This study explores 'multiple-source' profiles and their association with socioeconomic characteristics. We analyzed cross-sectional data from the Interdisciplinary Study of Inequalities in Smoking involving 2093 young adults recruited in Montreal, Canada, in 2011-2012. We used latent class analysis to create profiles based on responses to questions regarding whether participants sought health professionals, family, friends or the Internet when having questions about health. Using multinomial logistic regression, we examined the associations between profiles and economic, social and cultural capital indicators: financial difficulties and transportation means, friend satisfaction and network size, and individual, mother's, and father's education. Five profiles were found: 'all sources' (42%), 'health professional centred' (29%), 'family only' (14%), 'Internet centred' (14%) and 'no sources' (2%). Participants with a larger social network and higher friend satisfaction were more likely to be in the 'all sources' group. Participants who experienced financial difficulties and completed college/university were less likely to be in the 'family only' group; those whose mother had completed college/university were more likely to be in this group. Our findings point to the importance of considering multiple sources to study HISB, especially when the capacity to seek multiple sources is unequally distributed. Scholars should acknowledge HISB's implications for health inequalities.

Inflow Angle of Small Paraophthalmic Aneurysms Is a Determinant of Adjacent Sphenoid Bone Remodeling.

OBJECTIVE: Large internal carotid artery aneurysms can cause remodeling of the sphenoid bone with subsequent hemorrhage into the sinus. No reports have demonstrated small unruptured lesions causing similar bone remodeling. The purpose of this study was to demonstrate our experience with small unruptured paraophthalmic aneurysms causing sphenoid bone remodeling, specifically when the optimal aneurysm inflow angle is present. METHODS: We searched our database for computed tomography angiography studies of small paraophthalmic aneurysms and assessed adjacent sphenoid bone remodeling and inflow angle. RESULTS: We found that aneurysms causing sphenoid remodeling represent 19.51% of all small paraophthalmic aneurysms at our institution and that the average inflow angle for these aneurysms was 94.38 degrees, significantly greater than for those not causing remodeling. CONCLUSIONS: Our findings add support to using computed tomography angiography in the follow-up of aneurysms to assess surrounding bone changes and to the development of a more evidence-based approach in the management of small paraophthalmic aneurysms, which currently may be managed conservatively.

Inequalities in Hypertension and Diabetes in Canada: Intersections between Racial Identity, Gender, and Income.

A growing body of research from the United States informed by intersectionality theory indicates that racial identity, gender, and income are often entwined with one another as determinants of health in unexpectedly complex ways. Research of this kind from Canada is scarce, however. Using data pooled from ten cycles (2001-2013) of the Canadian Community Health Survey, we regressed hypertension (HT) and diabetes (DM) on income in subsamples of Black women (n = 3,506), White women (n = 336,341), Black men (n = 2,806) and White men (n = 271,260). An increase of one decile in income was associated with lower odds of hypertension and diabetes among White men (ORHT = .98, 95% CI (.97, .99); ORDM = .93, 95% CI (.92, .94)) and White women (ORHT = .95, 95% CI (.95, .96); ORDM = .90, 95% CI (.89, .91)). In contrast, an increase of one decile in income was not associated with either health outcome among Black men (ORHT = .99, 95% CI (.92, 1.06); ORDM = .99, 95% CI (.91, 1.08)) and strongly associated with both outcomes among Black women (ORHT = .86, 95% CI (.80, .92); ORDM = .83, 95% CI (.75, .92)). Our findings highlight the complexity of the unequal distribution of hypertension and diabetes, which includes inordinately high risks of both outcomes for poor Black women and an absence of associations between income and both outcomes for Black men in Canada. These results suggest that an intersectionality framework can contribute to uncovering health inequalities in Canada.

Cultural capital and smoking in young adults: applying new indicators to explore social inequalities in health behaviour.

BACKGROUND: Associations between social status and health behaviours are well documented, but the mechanisms involved are less understood. Cultural capital theory may contribute to a better understanding by expanding the scope of inequality indicators to include individuals' knowledge, skills, beliefs and material goods to examine how these indicators impact individuals' health lifestyles. We explore the structure and applicability of a set of cultural capital indicators in the empirical exploration of smoking behaviour among young male adults. METHODS: We analysed data from the Swiss Federal Survey of Adolescents (CH-X) 2010-11 panel of young Swiss males (n = 10 736). A set of nine theoretically relevant variables (including incorporated, institutionalized and objectified cultural capital) were investigated using exploratory factor analysis. Regression models were run to observe the association between factor scores and smoking outcomes. Outcome measures consisted of daily smoking status and the number of cigarettes smoked by daily smokers. RESULTS: Cultural capital indicators aggregated in a three-factor solution representing 'health values', 'education and knowledge' and 'family resources'. Each factor score predicted the smoking outcomes. In young males, scoring low on health values, education and knowledge and family resources was associated with a higher risk of being a daily smoker and of smoking more cigarettes daily. CONCLUSION: Cultural capital measures that include, but go beyond, educational attainment can improve prediction models of smoking in young male adults. New measures of cultural capital may thus contribute to our understanding of the social status-based resources that individuals can use towards health behaviours.

Vegetarianism and mental health: Evidence from the 1970 British Cohort Study.

BACKGROUND: Reducing animal product consumption has benefits for population health and the environment. The relationship between vegetarianism and mental health, however, remains poorly understood. This study explores this relationship in a nationally representative cohort in Great Britain. METHODS: We use data from the 1970 British Cohort Study, which collected information on vegetarianism at age 30 in 2000 (n = 11,204) and psychological distress (PD) at ages 26, 30, 34, 42, and 46-48 in 2016/18. We first developed a statistical adjustment strategy by regressing PD at age 30 on vegetarianism and 14 confounders measured at ages 10 and 26. We then ran multilevel growth curve models, testing whether within-person changes in PD between ages 30 and 46-48 differed by vegetarianism, before and after statistical adjustment. RESULTS: At age 30, 4.5 % of participants reported being vegetarian. In the cross-sectional models at age 30, vegetarians reported more distress compared with non-vegetarians in bivariate analysis (b = 0.30, 95%CI 0.09, 0.52), but this difference disappeared in the fully-adjusted model (b = 0.02, 95%CI -0.17, 0.21). In the longitudinal models between ages 30 and 46/48, there were no differences in within-person changes in psychological distress between vegetarians and non-vegetarians (p = .723). Sensitivity analyses using red meat consumption yielded similar findings. CONCLUSION: In this British cohort, vegetarianism at age 30 was not associated with changes in psychological distress during mid-adulthood. Since psychological distress in early adulthood predicted vegetarianism at age 30, more studies are needed to disentangle the progression of this relationship over the life-course.

Changes in economic activity and mental distress among young adults during the COVID-19 pandemic: Differences between the first and second infection waves in the UK.

BACKGROUND: While infection rates, lockdown policies, and labor market conditions substantially varied across COVID-19 waves, the majority of evidence on young adults' mental health remains focused on initial responses in early 2020. The variability of the relationship between economic activity and mental health over time therefore remains poorly understood in this age group. METHODS: Using linear mixed models, we investigated the relationship between current activity and changes in activity and mental distress (GHQ-12) among 1,390 young adults aged 16-34 via the UK Household Longitudinal Study COVID-19 survey. The association was explored in the first (from April to July 2020) and second (from September 2020 to March 2021) infection waves. Current activity was defined as "not working", "working <17.5 hours/week", "17.5-35 hours/week", and "> = 35 hours/week". Changes in activity were derived from current and pre-pandemic working hours and divided into four categories: "working with no reduced hours", "working fewer hours", "no longer working", and "did not work before the pandemic". RESULTS: During the first wave, no association reached statistical significance. During the second wave: 1) compared to "currently not working", working 35 or more hours was associated with decreased distress (b = -1.54; 95%CI -2.39, -0.69) and working less than 17.5 hours was not (b = -0.62; 95%CI -1.66, 0.41); 2) compared to "working with no reduced hours compared with before the outbreak", no longer working was associated with increased distress (b = 1.58, 95%CI 0.61, 2.55) and working with reduced hours was not (b = 0.47, 95%CI -0.24, 1.17). CONCLUSION: Above the mental health inequalities experienced at the start of the pandemic, full-time work-even with variation in work hours-continued to be a protective factor against mental distress among young adults during the second wave in the UK. Stable, full-time work can better support this age group's mental well-being over time.

Social disparities in alcohol consumption among Canadian emerging adults. / Disparités sociales dans la consommation d'alcool chez les jeunes adultes canadiens.

INTRODUCTION: Young adult drinking is a public health priority, but knowledge of socioeconomic status (SES) indicators and alcohol use among emerging adults (EAs; aged 18-29 years) is primarily informed by college samples, populations in their late teens and early twenties and non-Canadian data. We compared the association of three different SES indicators with monthly heavy episodic drinking (HED), less-than-monthly HED, no HED, and no drinking among Canadian EAs. METHODS: We pooled the 2015 to 2019 waves of the Canadian Community Health Survey to include participants aged 18 to 29 years (n = 29 598). Using multinomial regression, we calculated weighted estimates of alcohol use by education, household income and area-level disadvantage, adjusting for adult roles and sociodemographic characteristics. RESULTS: Approximately 30% of EAs engaged in monthly HED, whereas 16% did not drink at all in the past year. Compared to those in the lowest household incomes, being in the top income quintile was significantly associated with increased relative odds of monthly HED (e.g. in combined SES model, RRR = 1.21, 95% CI: 1.04-1.39). Higher levels of education, being in higher income quintiles and living in less disadvantaged areas were significantly associated with reduced relative odds of no HED and not drinking. Adjusting for adult roles did not substantially change the associations between SES and alcohol use. CONCLUSION: Higher SES was associated with HED among EAs, although the magnitude of association was small. Universal prevention measures addressing the affordability, availability and marketing of alcohol could be complemented by interventions targeting EA populations at higher risk of HED.

Trends in psychological distress in Great Britain, 1991-2019: evidence from three representative surveys.

BACKGROUND: Previously improving UK mortality trends stalled around 2012, with evidence implicating economic policy as the cause. This paper examines whether trends in psychological distress across three population surveys show similar trends. METHODS: We report the percentages reporting psychological distress (4+ in the 12-item General Health Questionnaire) from Understanding Society (Great Britain, 1991-2019), Scottish Health Survey (SHeS, 1995-2019) and Health Survey for England (HSE, 2003-2018) for the population overall, and stratified by sex, age and area deprivation. Summary inequality indices were calculated and segmented regressions fitted to identify breakpoints after 2010. RESULTS: Psychological distress was higher in Understanding Society than in SHeS or HSE. There was slight improvement between 1992 and 2015 in Understanding Society (with prevalence declining from 20.6% to 18.6%) with some fluctuations. After 2015 there is some evidence of a worsening in psychological distress across surveys. Prevalence worsened notably among those aged 16-34 years after 2010 (all three surveys), and aged 35-64 years in Understanding Society and SHeS after 2015. In contrast, the prevalence declined in those aged 65+ years in Understanding Society after around 2008, with less clear trends in the other surveys. The prevalence was around twice as high in the most deprived compared with the least deprived areas, and higher in women, with trends by deprivation and sex similar to the populations overall. CONCLUSION: Psychological distress worsened among working-age adults after around 2015 across British population surveys, mirroring the mortality trends. This indicates a widespread mental health crisis that predates the COVID-19 pandemic.

Do demographic and socioeconomic characteristics underpin differences in youth smoking initiation across Canadian provinces? Evidence from the Canadian Community Health Survey (2015-2018). / Les caractéristiques démographiques et socioéconomiques sous-tendent-elles les différences d'initiation à l'usage du tabac chez les jeunes entre les provinces canadiennes? Données probantes tirées de l'Enquête sur la santé dans les collectivités canadiennes (2015-2018).

INTRODUCTION: Youth initiation may drive differences in smoking prevalence across Canadian provinces. Provincial differences in initiation relate to tobacco control strategies and public health funding, but have also been attributed to population characteristics. We test this hypothesis by examining the extent to which seven characteristics-immigration, language, family structure, education, income, home ownership and at-school status-explain differences in initiation across provinces. METHODS: We used data from 16 897 youth aged 12 to 17 years in the Canadian Community Health Survey collected from 2015 to 2018. To examine the proportion of provincial differences explained by population characteristics, we compared average marginal effects (AMEs) from partially and fully adjusted models regressing "having ever initiated" on province and other characteristics. We also tested interactions to examine differences in the association between population characteristics and initiation across provinces. RESULTS: Initiation varied from 4% in British Columbia to 10% in Quebec. Being born in Canada, speaking French, not living in a two-parent household, being in the lowest household income quintile, having parents without postsecondary education, living in rented accommodation and not being in school were each associated with initiation. Taking these results into consideration, the AME of residing in another province compared with Quebec was attenuated by between 3% and 9%. Family structure and household income were more strongly associated with initiation in the Atlantic region and Manitoba, but not in Quebec. CONCLUSION: Differences in initiation between Quebec and other provinces are unlikely to be substantially explained by their demographic or socioeconomic composition. Reprioritizing tobacco control and public health funding are likely key in attaining the "tobacco endgame" across provinces.

Socio-economic distribution of e-cigarette use among recent former regular smokers and current smokers at ages 25-26 in England.

BACKGROUND AND AIMS: E-cigarettes may potentially help young adult smokers to quit smoking, yet little is known about differences among socio-economic groups. We examined associations between key socio-economic characteristics and e-cigarette use among recent former smokers and current smokers in a sample of young adults in England. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: We used data on 346 recent former regular (daily for 12+ months) smokers and 1913 current smokers from the ages 25-26 wave of the Next Steps cohort study (2015-2016). In multinomial logistic regression, we estimated relative risk ratios (RRR) of e-cigarette use (never, former, non-daily, daily) by educational attainment, social class [using the National Statistics Socio-economic classification (NS-SEC)] and employment status [full-time, part-time, unemployed and other 'inactivity' (e.g. stay-at-home parents and permanantly disabled)], adjusting for sex. FINDINGS: Among recent former regular smokers, there were no patterns of association between socio-economic characteristics and e-cigarette use. Among current smokers: (1) compared with higher occupation (NS-SEC I/II), intermediate occupation (NS-SEC III/IV) was positively associated with non-daily e-cigarette use [RRR = 1.77, 95% confidence interval (CI) = 1.03-3.03]; (2) compared with full-time employment, unemployment was negatively associated with non-daily and daily e-cigarette use (RRR = 0.38, 95% CI = 0.18-0.81; RRR = 0.12, 95% CI = 0.02-0.56) and other economic inactivity was negatively associated with daily e-cigarette use (RRR = 0.39, 95% CI = 0.16-0.93). CONCLUSIONS: Among young adult smokers in England, lower-status occupational groups were more likely to use e-cigarettes on a non-daily basis than to have never used compared with higher status occupational groups. Compared with people in full-time employment, those without employment were less likely to use e-cigarettes daily than to have never used.

Time trend analysis of social inequalities in psychological distress among young adults before and during the pandemic: evidence from the UK Household Longitudinal Study COVID-19 waves.

BACKGROUND: Despite concerns about mental health problems among those aged 16-24 in England, which social groups have been most at risk, both over the past decade and during the COVID-19 pandemic, remains unclear. METHODS: We examined trends in psychological distress among young adults 16-24 years old in England using data from the UK Household Longitudinal Study. Using longitudinal data as repeated cross-sectional waves, we examined differences over time in mean General Health Questionnaire (GHQ) scores from wave 1 (2009-2010) to wave 10 (2018-2019) and six COVID-19 waves collected between April and November 2020, by economic activity, cohabitation with parents, parental education, area deprivation, ethnicity, age and sex. RESULTS: Compared with 2009-2010, increases in GHQ scores in 2018-2019 were higher in women than men (2.1 vs 1.3), those aged 16-18 than aged 22-24 (2.6 vs 0.9), those from white UK group versus other ethnic minorities, and those out of the labour force (3.6) or employed part time (2.2) than those employed full time (0.8). Compared with 2018-2019, psychological distress in 2020 also further increased among young adults residing in the most deprived areas (4.1 vs 1.2 in the least deprived areas). In 2020, losing one's job or most of one's work hours was associated with higher psychological distress and attenuated the differences between deprivation quartiles by 17%. CONCLUSION: In England, inequalities in psychological distress among young adults may have changed and increased during the COVID-19 pandemic. Investing in opportunities for young adults, particularly in more deprived areas, may be key to improve population levels of mental health.