The West of Scotland Twenty-07 Study
The Twenty-07 Study was established in 1987 to examine the social processes that produce or maintain differences in health by key social positions over time. The study is following three cohorts of people, living in and around Glasgow, for twenty years - initially aged 15, 35 and 55, they will be 35, 55 and 75 in 2007 the final year of the Study. As a result, the Twenty-07 Study provides researchers with unique opportunities to:
examine the effect of people's circumstances on their health across 60 years of the life span
compare the experiences of different generations of people at the same points in history
explore the health of people of the same age at different points in time
In addition to the general sample of people living in and around Glasgow, a more intensive sample was selected in two key areas in Glasgow to facilitate the study of the interaction of people's environment and their circumstances on their health. This is described below
Here we describe the work in the Unit that explores how people's social circumstances affect different aspects of their health, and how changes in their circumstances and health influence each other over time (For information about studies using the Twenty-07 study to explore issues of gender see Gender & Health and for those focusing on youth see Youth and Health). Five themes of research are currently important:
the effect of accumulation and change in different aspects of people's socioeconomic position on their health over time;
the differences in health behaviours between social groups ;
the role of people' social relationships, life events and stress in protecting and harming health;
how different dimensions of health relate to each other over time;
people's own understanding of their health and the causes of ill health and how these affect their help-seeking behaviours.
When the Twenty-07 Study was first established, results showed the significant differences in health that exist between different social groups. People living in more disadvantaged circumstances had poorer health across a range of health measures when aged 35 and 55, but not during adolescence at age 15 see. Since then the Twenty-07 Study has been used to examine how different aspects of people's socioeconomic circumstances - such as income, housing, car ownership and ownership of other significant household items - and people's own perceptions of their circumstances affect their health.
Studies are also focusing on the effect on health of changes in people's circumstances - especially their occupations and income - both from before the Study started and during the period that people have been followed. The results suggest that social circumstances in childhood and adulthood are important for health, and that the more time someone spends in poverty and disadvantaged circumstances the more harmful it is for their health. This work is now trying to identify the pathways across time that relate childhood and adult experiences and health.
One important pathway between people's social circumstances and their health is their health behaviours - whether they smoke and drink, what kind of diet they have, and whether or not they take part in physical activity. Research using the Twenty-07 Study confirms other findings that behaviours such as these are socially patterned, with those in disadvantaged circumstances, for example, being more likely to smoke and have an unhealthy diet. Exploring people's behaviours more deeply, however, shows a much richer pattern of differences. For example, the Twenty-07 Study shows how people's diets have changed over time, with some positive improvements in line with the government's recommendations, especially among more disadvantaged groups. On the other hand, opportunities for physical activity change as people's circumstances change, for example, as they move from work to retirement, which may be detrimental to their health. Other research is investigating changes in smoking behaviours over time, and how changes in circumstances among different social groups can affect their health behaviours, in order to identify ways of supporting people to improve their health.
Social Relationships and Health
It has been suggested that the social support that people have and their participation in social activities may affect their health, and these issues are being examined in the Twenty-07 Study. In one case we are exploring whether different kinds of social activities, such as attending church, educational classes, political activities and sporting groups, have different effects on various dimensions of health. Another aspect of people's lives that may affect their health is significant events - good and bad - such as getting married, having a baby, the death of a family member or losing your job. In exploring these issues, it is essential to see how changes in social factors result in biological changes in the body which lead to different health outcomes. For example, working with Doug Carroll we are examining the effect of stressful life events on people's immune systems and the reaction of their blood pressure to stress.
Obesity and Depression
As well as focusing on aspects of people's socioeconomic circumstances, it is also valuable to examine their health in more detail. Research using the Twenty-07 Study is exploring how different aspects of people's health relate to each other, and the effect that having particular health problems has on people's lives more generally. For example, there is considerable policy concern about obesity. As well as examining the causes of obesity in general, work on the Twenty-07 Study is investigating how it is related to other physical health problems, such as joint pain, and to people's mental health. A key issue here is whether obesity might cause people to become depressed or depression might lead people to gain weight.
Work with Alison Elliot and colleagues in Aberdeen is examining the very detailed information people have provided as part of the Twenty-07 Study on the symptoms that they experience. It is important to understand which of these lead on to significant health problems, and how this varies across social groups. Twenty-07 Study participants provide very detailed information about the effect of health problems on their ability to perform a wide range of tasks and the different kinds of disability that they experience as a result. Work with Joy Adamson and colleagues with the MOBILE programme at the MRC Health Services Research Collaboration is exploring the relationships between a wide range of health measures and people's experience of pain and different kinds of disability, and how these vary by sex and socioeconomic position.
People's Own Understanding of Health and Causes of Ill Health
Health practitioners need to know what different groups of people think about their health, what they believe causes ill health, and what factors affect their decision to seek medical help when they are feeling ill. An investigation of men and women's perceptions of who experienced different health problems showed that each tended to think the risks were higher for their own sex than for the other. It is also useful for researchers to know if different social groups answer survey questions about their health differently as this allows them to interpret the findings from the types of studies described above. Research with the Twenty-07 Study is addressing these issues. For example, it is often believed that people from more disadvantaged circumstances may, at any given level of health, be less likely to report that they have poor health (because they have lower expectations). However, detailed investigation of key health questions within the Twenty-07 survey revealed that this was not necessarily true.
Ellaway A, Benzeval M, Green M, Leyland AH, Macintyre S. 'Getting sicker quicker': does living in a more deprived neighbourhood mean your health deteriorates faster?. Health & Place 2012;18:132-7pubmed open access
Shareck M, Ellaway A. Neighbourhood crime and smoking: the role of objective and perceived crime measures. BMC Public Health 2011;11:930pubmed open access
Benzeval M, Der G, Ellaway A, Hunt K, Sweeting H, West P, Macintyre S. Cohort profile: West of Scotland 20-07 study - health in the community. International Journal of Epidemiology 2009;38:1215-1223pubmed open access
Ellaway A, Macintyre S. Are perceived neighbourhood problems associated with the likelihood of smoking?. Journal of Epidemiology & Community Health 2009;63:78-80pubmed open access
Emslie C, Lewars H, Batty GD, Hunt K. Are there gender differences in levels of heavy, binge and problem drinking? Evidence from three generations in the West of Scotland. Public Health 2009;123:12-14pubmed open access
Phillips AC, Der G, Hunt K, Carroll D. Haemodynamic reactions to acute psychological stress and smoking status in a large community sample. International Journal of Psychophysiology 2009;73:273-8pubmed open access
Phillips AC, Der Geoff, Mutrie N, Carroll D. Self-reported health and cardiovascular reactions to psychological stress in a large community sample: Cross-sectional and prospective association. Psychophysiology 2009;46:1020-7pubmed open access
Ebrahimi-Mameghani M, Scott JA, Der G, Lean MEJ, Burns CM. Changes in weight and waist circumference over 9 years in a Scottish population. European Journal of Clinical Nutrition 2008;62:1208-1214pubmed
Emslie C, Hunt K. The weaker sex? Exploring lay understandings of gender differences in life expectancy: a qualitative study. Social Science & Medicine 2008;67:808-16pubmed open access
Gallagher S, Phillips AC, Evans P, Der G, Hunt K, Carroll D. Caregiving is associated with low secretion rates of immunoglobulin A in saliva. Brain, Behavior, and Immunity 2008;22:565-572pubmed
Phillips AC, Der G, Carroll D. Stressful life-events exposure is associated with 17-year mortality, but it is health-related events that prove predictive. British Journal of Health Psychology 2008;13:647-57pubmed
Townsend A, Wyke S, Hunt K. Frequent consulting and multiple morbidity: a qualitative comparison of 'high' and 'low' consulters of general practitioners. Family Practice 2008;25:168-175pubmed open access
Mutrie N, Hannah MK. The importance of both setting and intensity of physical activity in relation to non-clinical anxiety and depression. International Journal of Health Promotion and Education 2007;45:24-32
Adamson J, Ebrahim S, Dieppe P, Hunt K. Prevalence and risk factors for joint pain among men and women in the West of Scotland Twenty-07 study. Annals of the Rheumatic Diseases 2006;65:520-524pubmed
Adamson J, Ebrahim S, Hunt K. The psychosocial versus material hypothesis to explain observed inequality in disability among older adults: data from the West of Scotland Twenty-07 study. Journal of Epidemiology & Community Health 2006;60:974-980pubmed open access
Carroll D, Smith DG, Phillips AC, Ring C, West P. Birth-weight, adult blood pressure and blood pressure reactions to acute psychological stress. Journal of Epidemiology & Community Health 2006;60:144-145pubmed
Furlong A, Cartmel F, Biggart A, Sweeting H, West P. Social class in an 'individualised' society. Sociology Review 2006;15:28-32
Macintyre S, McKay L, Ellaway A. Lay concepts of the relative importance of different influences on health: are there major socio-demographic variations?. Health Education Research 2006;21:731-9pubmed open access
Phillips AC, Carroll D, Evans P, Bosch J A, Clow A, Hucklebridge F, Der G. Stressful life events are associated with low secretion rates of immunoglobulin A in saliva in the middle aged and elderly. Brain, Behavior, and Immunity 2006;20:191-197pubmed
Phillips AC, Carroll D, Hunt K, Der G. The effects of the spontaneous presence of a spouse/partner and others on cardiovascular reactions to an acute psychological challenge. Psychophysiology 2006;43:633-40pubmed
Townsend A, Wyke S, Hunt K. Self-managing and managing self: practical and moral dilemmas in accounts of living with chronic illness. Chronic Illness 2006;2:185-194pubmed
Berger U, Der G, Mutrie N, Hannah MK. The impact of retirement on physical activity. Ageing and Society 2005;25:181-195
Carroll D, Phillips AC, Ring C, Der G, Hunt K. Life events and haemodynamic stress reactivity in the middle-aged and elderly. Psychophysiology 2005;42:269-276pubmed
Macintyre S, Der G, Norrie J. Are there socioeconomic differences in responses to a commonly used self report measure of chronic illness?. International Journal of Epidemiology 2005;34:1284-1290pubmed open access
Macintyre S, McKay L, Ellaway A. Are rich people or poor people more likely to be ill? Lay perceptions, by social class and neighbourhood, of inequalities in health. Social Science & Medicine 2005;60:313-317pubmed open access
Macintyre S, McKay L, Ellaway A. Who is more likely to experience common disorders: men, women, or both equally? Lay perceptions in the West of Scotland. International Journal of Epidemiology 2005;34:461-466pubmed open access
Phillips AC, Carroll D, Ring C, Sweeting H, West P. Life events and acute cardiovascular reactions to mental stress: A cohort study. Psychosomatic Medicine 2005;67:384-392pubmed open access
Townsend A. Multiple morbidity and moral identity in mid-life: accounts of chronic illness and the place of the GP consultation in overall management strategies [PhD], MRC Social and Public Health Sciences Unit 2005.open access
Ebrahimi-Mameghani M. A longitudinal study of eating behaviour and weight change in West of Scotland adults in association with socio-demographic and lifestyle factors [PhD], Department of Human Nutrition 2004.
Mutrie N, Hannah MK. Some work hard while others play hard: the achievement of current recommendations for physical activity levels at work, at home, and in leisure time in the West of Scotland. International Journal of Health Promotion and Education 2004;42:109-117
Adamson J, Hunt K, Ebrahim S. Association of measures of morbidity and locomotor disability: diagnosis alone is not enough. Social Science & Medicine 2003;57:1355-1360pubmed
Adamson J, Hunt K, Ebrahim S. Socio-economic position, occupational exposures, and gender: the relationship with locomotor disability in early old age. Journal of Epidemiology & Community Health 2003;57:453-455pubmed
Carroll D, Ring C, Hunt K, Ford G, Macintyre S. Blood pressure reactions to stress and the prediction of future blood pressure: effects of sex, age, and socioeconomic position. Psychosomatic Medicine 2003;65pubmed open access
Ellaway A, Macintyre S, McKay L. The historical specificity of early life car ownership as an indicator of socioeconomic position. Journal of Epidemiology & Community Health 2003;57:277-278pubmed open access
Townsend A, Hunt K, Wyke S. Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use. BMJ 2003;327:837-840pubmed
Wyke S, Hunt K, Walker J, Wilson P. Frequent attendance, socio-economic status and burden of ill health: an investigation in the West of Scotland. European Journal of General Practice 2003;9:48-55pubmed
Gemmell I. Indoor heating, house conditions, and health. Journal of Epidemiology & Community Health 2001;55:928-929pubmed
Hunt K, Ford G, Mutrie N. Is sport for all? Exercise and physical activity patterns in early and late middle age in the West of Scotland. Health Education 2001;101:151-158
Carroll D, Harrison L, Johnston D, Ford G, Hunt K, West P. Cardiovascular reactions to psychological distress: the influence of demographic variables. Journal of Epidemiology & Community Health 2000;54:876-877pubmed
Dunbar M, Ford G, Hunt K, Der G. A confirmatory factor analysis of the Hospital Anxiety and Depression Scale. British Journal of Clinical Psychology 2000;39:79-94pubmed
Dunbar M, Ford G, Hunt K, Der G. Question wording effects in the assessment of global self-esteem. European Journal of Psychological Assessment 2000;16:13-19
Evans P, Der G, Ford G, Hucklebridge F, Hunt K, Lambert S. Social class, sex, and age differences in mucosal immunity in a large community sample. Brain, Behavior, and Immunity 2000;14:41-48pubmed
Hannah MK, Mutrie N. Physical activity in the third wave of the Twenty-07 Study. MRC/CSO Social and Public Health Sciences Unit Working Paper no. 5, Glasgow, 2000
Hunt K, Davison C, Emslie C, Ford G. Are perceptions of a family history of heart disease related to health-related attitudes and behaviours?. Health Education Research 2000;15:131-143pubmed open access
Der G, Macintyre S, Ford G, Hunt K, West P. The relationship of household income to a range of health measures in three age cohorts from the West of Scotland. European Journal of Public Health 1999;9:271-277open access
Ellaway A, Wood S, Macintyre S. Someone to talk to? The role of loneliness as a factor in the frequency of GP consultations. British Journal of General Practice 1999;49:363-367pubmed open access
Annandale E, Hunt K. Accounts of disagreements with doctors. Social Science & Medicine 1998;46:119-129pubmed
Dunbar M, Ford G, Hunt K. Why is the receipt of social support associated with increased psychological distress? An examination of three hypotheses. Psychology & Health 1998;13:527-44
Ellaway A, Macintyre S. Does housing tenure predict health in the UK because it exposes people to different levels of housing related hazards in the home or its surroundings?. Health & Place 1998;4:141-150pubmed open access
Graham H, Hunt K. Socioeconomic influences on women's smoking status in adulthood: insights from the West of Scotland Twenty-07 study. Health Bulletin 1998;56:51-58
Macintyre S, Ellaway A, Der G, Ford G, Hunt K. Do housing tenure and car access predict health because they are simply markers of income or self esteem? A Scottish study. Journal of Epidemiology & Community Health 1998;52:657-664pubmed open access
Macintyre S, Hunt K. Socio-economic position, gender and health: how do they interact?. Journal of Health Psychology 1997;2:315-334open access
Anderson AS, Hunt K, Ford G, Finnigan F. One apple a day? Fruit and vegetable intake in the West of Scotland. Health Education Research 1994;9:297-305
Ford G, Ecob R, Hunt K, Macintyre S, West P. Patterns of class inequality in health through the lifespan: class gradients at 15, 35 and 55 years in the West of Scotland. Social Science & Medicine 1994;39:1037-1050pubmed open access
Macintyre S. Socioeconomic variations in Scotland's health: a review. Health Bulletin 1994;52:456-471
West P, Ford G, Hunt K, Macintyre S, Ecob R. How sick is the West of Scotland? Age-specific comparisons with national datasets on a range of health measures. Scottish Medical Journal 1994;39:101-109pubmed
Dunbar M, Ford G, Hunt K. The role of social integration, social support and network demand in explaining class, gender and marital status differences in psychological distress. Glasgow, 1993
Finnigan F, Hunt K, Ford G. Dietary patterns and distribution of nutrient intake among adults living in the Central Clydeside Conurbation in 1991. Glasgow, 1993
Anderson AS, Hunt K. Who are the 'healthy' eaters? Eating patterns and health promotion in the West of Scotland. Health Education Journal 1992;51:3-10
Macintyre S, Annandale E, Ecob R, Ford G, Hunt K, Jamieson B, MacIver S, West P, Wyke S. The West of Scotland Twenty-07 Study: health in the community. In: Martin CJ, McQueen DV, editors Readings for a new public health. Edinburgh: Edinburgh University Press, 1989:56-74.
Macintyre S. A review of the social patterning and significance of measures of height, weight, blood pressure and respiratory function. Social Science & Medicine 1988;27:327-337pubmed open access
- Blood pressure Blood pressure refers to the pressure exerted by the blood against the walls of the blood vessels, especially the arteries. Blood pressure is usually expressed as a ratio, normal blood pressure being below 120/80. The systolic blood pressure, which is the top number, represents the pressure in the arteries as the heart contracts and pumps blood into the arteries. The diastolic pressure, which is the bottom number, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure, therefore, reflects the minimum pressure to which the arteries are exposed.
- cohort age group
- Health behaviours Any actions undertaken by an individual which have the potential to influence health (e.g. diet, smoking, physical activity, consulting with health care professionals)
- Life events Major events in an individual's life (e.g. death of a close relative, divorce, getting into trouble with the police)
- Sample a group selected for study
- social position a generic label for the various aspects of an individual's personal circumstances (e.g. occupation, education)
- socioeconomic involving both economic and social factors