Ethnicity and Health

Addressing ethnic inequalities is a key aspect of initiatives of UK governments and also of international organisations. In spite of considerable research, the causes of ethnic differences in health (e.g. excess hypertension in Black African origin and coronary events in South Asians) remain a scientific and policy challenge. The overall aim of our programme is to focus on how the timing and duration of social exposures are related to ethnic differences in health and health related behaviours over the life course. This allows us to identify key time points when interventions to reduce ethnic inequalities in health could be most effective, but also gives insights into improving health outcomes for all groups, especially where some ethnic groups do better than average.

Our objectives are to investigate:
(1) the extent to which social, economic and psychological circumstances contribute to differences in health at different stages of the life course within and between ethnic groups;
(2) change and stability in key influences on health such as family life, socio-economic disadvantage and neighbourhood environments and
(3) the extent to which and why the health of ethnic groups of similar ancestry varies in different country settings.

We focus on the major ethnic minority groups (Black Caribbean, Black African, Indian, Pakistani and Bangladeshi), critical stages of the life course, generational differences (including UK-born and other born) and major diseases. The lack of longitudinal studies of ethnic minorities has made it difficult to investigate when health differences emerge, and to understand transmission of health potential across generations. Our Determinants in Adolescent Social well-being and Health (DASH) study is a unique resource that we use to track ethnic differences in cardiovascular, respiratory and mental health from youth to adulthood. Our international comparisons of ethnic inequalities in health include countries at different stages of development. Variations in the patterns of inequalities signal influences in the host environment such as educational chances, health behaviours, access to health care, which in turn are associated with and influenced by the political, economic and social fabric of countries.

We use multiple methods including longitudinal studies, national and international surveys and qualitative studies. We complement our explanatory research with experimental research, a shift which we have recently initiated for the prevention of obesity in ethnic minority young people. Our empirical studies are linked to various activities in the communities to foster information exchange and help us ensure culturally appropriate designs.

Publications

Astell-Burt T, Maynard MJ, Lenguerrand E, Harding S. Racism, ethnic density and psychological well-being through adolescence: evidence from the Determinants of Adolescent Social Well-being and Health longitudinal study. Ethnicity & Health [Special Issue: Ethnic Inequalities in Mental Health and Care] (in press).

Bhui K, Lenguerrand E, Maynard MJ, Stansfeld S, Harding S. Does cultural integration explain a mental health advantage for adolescents? International Journal of Epidemiology (in press).

Maynard MJ, Rosato M, Harding S. Trends in suicide mortality among migrant in England and Wales, 1979-2003. Ethnicity & Health (in press).

Akinwale B, Lynch K, Wiggins R, Harding S, Bartley M, Blane D. Work, permanent sickness and mortality risk: a prospective cohort study of England and Wales, 1971-2006. Journal of Epidemiology & Community Health; 65:786-92.

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Bhopal R, Snorri B, Rafnsson CA, Fagot-Campagna A, Giampaoli S, Hammer N, Harding S, Hedlund E, Juel K, Mackenback JP, Primatesta P, Rey G, Rosato M, Wild S, Kunst AE. Mortality from circulatory diseases by specific country of birth across six European countries: test of concept [Epub ahead of print]. European Journal of Public Health 2011.

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Booker C, Harding S, Benzeval M. A systematic review of the effect of retention methods in population-based cohort studies. BMC Public Health 2011; 11:249.

Brueton V, Tierney J, Stenning S, Nazareth I, Meredith S, Darbyshire J, Harding S, Rait G. Strategies to reduce attrition from randomised trials (Protocol). Cochrane Database of Systematic Reviews 2011:2.

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Mitchell R, Astell-Burt TE, Richardson EA. A comparison of green space measures for epidemiological research. Journal of Epidemiology & Community Health 2011; 65:853-8.

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Richardson EA, Mitchell R, Hartig T, de Vries S, Astell-Burt T, Frumkin H. Green cities and health: a question of scale? [Epub ahead of print].  Journal of Epidemiology & Community Health 2011 .

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Twamley K, Puthussery S, Macfarlane A, Harding S, Baron I. UK born ethnic minority women and their experiences of feeding their newborn baby. Midwifery 2011; 27:595-602.

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Vandenheede H, Deboosere P, Stirbu I, Agyemang CO, Harding S, Juel K, Rafnsson SB, Regidor E, Rey G, Rosato M, Mackenbach JP, Kunst AE. Migrant mortality from diabetes mellitus across Europe: the importance of socio-economic change [Epub ahead of print]. European Journal of Epidemiology 2011.

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Astell-Burt T, Maynard MJ, Lenguerrand E, Harding S. Influence of racism and context on ethnic differences in adolescent mental health trajectories: the Determinants of Adolescent Social well-being and Health (DASH) study Conference of Epidemiological Longitudinal Studies in Europe. Paphos, Cyprus: Longitudinal and Life Course Studies, 2010:108.

Bhala N, Rosato M, Wild S, Bhopal R, Harding S. Peptic ulcer disease: further work is required to reduce inequalities (letter). The Lancet 2010; 375:553.

Harding S, Whitrow MJ, Lenguerrand E, Maynard MJ, Teyhan A, Cruickshank K, Der G. Emergence of ethnic differences in blood pressure in adolescence: The Determinants of Adolescent Social Well-being and Health study. Hypertension 2010; 55:1063-9.

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Maynard MJ, Harding S. Perceived parenting and psychological wellbeing in UK ethnic minority adolescents. Child: Care, Health and Development 2010; 36:630-8.

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Molaodi OR, Harding S, Leyland AH, Ellaway A, Kearns A. Area deprivation, ethnic density and fast food outlets, supermarkets and physical activity structures in England. SSM (Society for Social Medicine) Annual Scientific Meeting. Belfast, UK: Journal of Epidemiology and Community Health, 2010: A48.

Puthussery S, Twamley K, Macfarlane A, Harding S, Ahmed S, Mirsky J. ‘You need that loving tender care’: Maternity care experiences and expectations of British-born ethnic minority women in the United Kingdom. Journal of Health Services Research & Policy 2010; 15:156-162.

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Whitrow M, Harding S, Maynard M. The influence of parental smoking and family type on saliva cotinine in UK ethnic minority children: a cross sectional study. BMC Public Health 2010; 10:262.

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Whitrow M, Harding S. Asthma in Black African, Black Caribbean and South Asian adolescents in the MRC DASH study: a cross sectional analysis. BMC Pediatrics 2010; 10:18.

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Akinwale B, Lynch K, Wiggins R, Harding S, Bartley M, Blane D. Labour market position and health at older ages in England and Wales, 1971-2001. Journal of Epidemiology & Community Health doi:10.1136/jech.2009.099325

Atkin H, Harding S, Bradby H. A welcome from the new editors. Ethnicity & Health 2009; 14:419-21.

Harding S, Rosato M, Teyhan A. Trends in cancer mortality among migrants in England and Wales, 1979-2003. European Journal of Cancer 2009; 45:2168-79.

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Maynard M, Baker G, Rawlins E, Harding S. Developing obesity prevention interventions among minority ethnic children in schools and places of worship: The DEAL (DiEt and Active Living) study. BMC Public Health 2009; 9:480.

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Maynard M, Blane D. Dietary assessment in early old age: experience from the Boyd Orr Cohort. European Journal of Clinical Nutrition 2009; 63:S58-S63.

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Maynard M, Harding S. Ethnic differences in psychological well-being in adolescence in the context of time spent in family activities. Social Psychiatry and Psychiatric Epidemiology 2010; 45:115-23.

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Twamley K, Puthussery S, Macfarlane A, Harding S, Ahmed S, Mirsky J. Recruiting UK-Born ethnic minority women for health research: lessons learned. Research Policy and Planning 2009; 27:25-38.

Whitrow, M, Moore, V. M., Rumbold, A. R., & Davies, M. J. Effect of supplemental folic acid in pregnancy on childhood asthma: a prospective birth cohort study. American Journal of Epidemiology 2009; 170:1486-1493.

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Williamson LM, Rosato M, Teyhan A, Santana P, Harding S. AIDS mortality in African migrants living in Portugal: evidence of large social inequalities. Sexually Transmitted Infections 2009; 85:427-31.

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Harding S, Maynard MJ, Cruickshank K, Teyhan A. Overweight, obesity and high blood pressure in an ethnically diverse sample of adolescents in Britain: the Medical Research Council DASH study. International Journal of Obesity 2008; 32:82-90.
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Harding S, Rosato M, Teyhan A. Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups. Heart 2008; 94:463-70.
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Harding S, Teyhan A, Maynard M, Cruickshank JK. Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. International journal of Epidemiology 2008; 37:162-72.
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Harding S, Teyhan A, Rosato M, Santana P. All cause and cardiovascular mortality in African migrants living in Portugal: evidence of large social inequalities. European Journal of Cardiovascular Prevention and Rehabilitation 2008; 15:670-6.

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Puthussery S, Twamley K, Harding S, Mirsky J, Baron M, MacFarlane A. “They’re more like ordinary stroppy British women”: Attitudes and expectations of maternity care professionals to UK-born ethnic minority women. Journal of Health Services Research and Policy 2008; 13:195-201.

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Whitrow MJ, Harding S. Ethnic difference in adolescent lung function: anthropometric, socioeconomic, psychosocial factors. American Journal of Respiratory and Critical Care Medicine 2008; 177:1262-7.
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Bradby H, Varyani M, Oglethorpe R, Raine W, White I, Helen M. British Asian families and the use of child and adolescent mental health services: A qualitative study of a hard to reach group. Social Science & Medicine 2007; 65:2413-24.
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Bradby H. Watch out for the Aunties! Young British Asian's accounts of identity and substance use. Sociology of Health & Illness 2007; 29:656-72.
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Frobisher C, Tilling K, Emmett PM, Maynard M, Ness AR, Davey Smith G, Frankel SJ, Gunnell DJ. Reproducibility measures and their effect on diet-cancer associations in the Boyd Orr cohort. Journal of Epidemiology & Community Health 2007; 61:434-440.

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Gray L, Harding S, Reid A. Evidence of divergence with duration of residence in circulatory disease mortality in migrants to Australia. European Journal of Public Health 2007; 17:550-4
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Gray L, Harding S, Reid A. Lower circulatory disease mortality among Australian South Asians (e-letter). European Journal of Public Health 2007.
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Harding S, Whitrow M, Maynard MJ, Teyhan A. Cohort profile: The DASH (Determinants of Adolescent Social well-being and Health) Study, an ethnically diverse cohort. International Journal of Epidemiology 2007; 36:512-517.
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Maynard M, Harding S, Minnis H. Psychological well-being in Black Caribbean, Black African, and White adolescents in the UK Medical Research Council DASH study. Social Psychiatry and Psychiatric Epidemiology 2007; 42:759-69.
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Harding S. The epidemiology of cancers in ethnic communities in the UK. In: Ly A, Khayat D, eds. About cancer in Africa: from epidemiology to biomedical research applications and perspectives. Paris: NationalCancer Institute (INCa)/Springer, 2007:523-536.
Bradby H, Williams R. Is Religion or Culture the Key Feature in Changes in Substance Use after Leaving School? Young Punjabis and a Comparison Group in Glasgow. Ethnicity and Health 2006; 11:307-324.
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Harding S, Boroujerdi M, Santana P, Cruickshank K. Decline in, and lack of difference between, birthweights among African and Portuguese babies in Portugal. International Journal of Epidemiology 2006; 35:270-276.
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Harding S, Maynard M, Cruickshank K, Gray L. Anthropometry and blood pressure differences in Black Caribbean, African, South Asian and White adolescents: The MRC DASH study. Journal of Hypertension 2006; 24:1507-1514.
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Harding S, Santana P, Cruickshank K, Boroujerdi M. Birthweights of Black African babies of migrant and non-migrant mothers living in Portugal. Annals of Epidemiology 2006; 16:572-579.
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Maynard M, Gunnell D, Ness A, Abraham L, Bates C, Blane D. What influences diet in early old age? Prospective and cross-sectional analyses of the Boyd Orr cohort. European Journal of Public Health 2006; 16:315-323.
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Scanlon K, Harding S, Hunt K, Petticrew M, Rosato M, Williams R. Potential barriers to the prevention of cancers and to early cancer detection among Irish people living in Britain: a qualitative study. Ethnicity and Health 2006; 11:325-341.
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Anderson A, Bush H, Lean M, Bradby H, Williams R, Lea E. Evolution of atherogenic diets in South Asian and Italian women after migration to a higher risk region. Journal of Human Nutrition & Dietetics 2005; 18:33-43.
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Avendano M, Kunst A, van Lenthe F, Bos V, Costa G, Valkonen T, Cardano M, Harding S, Borgan J, Glickman M, Reid A, Mackenbach J. Trends in socioeconomic disparities in stroke mortality in six European countries between 1981-1985 and 1991-1995. American Journal of Epidemiology 2005; 161:52-61.
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Maynard M, Ness A, Abraham L, Blane D, Bates C, Gunnell D. Selecting a healthy diet score: lessons from a study of diet and health in early old age (the Boyd Orr cohort). Public Health Nutrition 2005; 8:321-326.
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Ness A, Maynard M, Frankel S, Davey Smith G, Frobisher C, Leary S, Emmett P, Gunnell D. Diet in childhood and adult cardiovascular and all-cause mortality: the Boyd Orr cohort. Heart 2005; 91:894-898.
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Walls P, Williams R. Religious discrimination in Scotland: A rebuttal of Bruce et al.'s claim that sectarianism is a myth. Ethnic and Racial Studies 2005; 28:759-767.
Walls P. The health of Irish-descended Catholics in Glasgow: A qualitative study of the links between health risk and ethnic and religious identities [PhD]. MRC Social and Public Health Sciences Unit. Glasgow: University of Glasgow, 2005.

Walls P, Williams R. Accounting for Irish Catholic ill health in Scotland: a qualitative exploration of some links between "religion," class and health. Sociology of Health & Illness 2004; 26:527-556.

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Abbotts J, Harding S, Cruickshank JK. Cardiovascular risk profiles in UK-born Caribbeans and Irish living in England and Wales. Atherosclerosis 2004; 175:295-303.
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Abbotts J, Sweeting H, Williams R, West P. Is going to church good or bad for you? Denomination, attendance, and mental health of children in West Scotland. Social Science & Medicine 2004; 58:645-656.
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Abbotts J, Williams R, West P, Hunt K, Ford G. Catholic socio-economic disadvantage in the West of Scotland: a narrowing of inequality. Scottish Affairs 2004:77-87.
Abbotts J. Irish Catholic health disadvantage in the West of Scotland. Scottish Affairs 2004:131-148.
Arai L, Harding S. A review of the epidemiological literature on the health of UK-born Black Caribbeans: a misplaced focus. Critical Public Health 2004; 14:81-116.
Harding S, Rosato M, Cruickshank JK. Lack of change in birthweights of infants by generational status among Indian, Pakistani, Bangladeshi, Black Caribbean and Black African mothers in a British cohort study. International Journal of Epidemiology 2004; 33:1279-1285.
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Harding S, Rosato M, Cruickshank JK. Mortality of migrants from the Caribbean to England and Wales: effect of duration of residence. International Journal of Epidemiology 2004; 33:382-386.
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Kunst A, Bos V, Andersen O, Cardano M, Costa G, Harding S, Hemström O, Layte R, Regidor E, Reid A, Santana P, Valkonen T, Mackenbach J. Monitoring of trends in socio-economic inequalities in mortality: experiences from a European project. Demographic Research 2004; S2:232-251.
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Williams R, Harding S. Multicultural health care: Britain. In: Healy J, McKee M, eds. Health Care: Responding to Diversity. Oxford: Oxford UP, 2004.
Williams R, Harding S. Poverty, stress and racism as factors in South Asian heart disease. In: Patel K, ed. The epidemic of coronary heart disease in South Asian populations: Causes and consequences: British Heart Foundation and the South Asian Health Foundation, 2004.

Harding S. Mortality of migrants from the Indian subcontinent to England and Wales: effect of duration of residence. Epidemiology 2003; 14:287-292.

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Blane D, Abraham L, Gunnell D, Maynard M, Ness A. Background influences in dietary choice in early old age. Journal of the Royal Society for the Promotion of Health 2003; 123:204-209.
Harding S. Social mobility and self reported limiting long-term illness among West Indian and South Asian migrants living in England and Wales. Social Science and Medicine 2003; 56:355-361.
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Mackenbach J, Bos V, Andersen O, Cardano M, Costa G, Harding S, Kunst AE. Widening socioeconomic inequalities in mortality in six Western European countries. International Journal of Epidemiology 2003; 32:830-837.
Maynard M, Gunnell DJ, Emmett P, Frankel S, Davey-Smith G. Fruit, vegetables and antioxidants in childhood and risk of adult cancer: the Boyd Orr cohort. Journal of Epidemiology & Community Health 2003; 58:218-225.
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Walls P, Williams R. Sectarianism at work: accounts of employment discriminating against Irish Catholics in Scotland. Ethnic and Racial Studies 2003; 26:632-661.

Harding S, Balarajan R. Mortality data on migrant groups living in England and Wales: issues of adequacy and of interpretation of death rates. In: Haskey J, ed. Population Projections by Ethnic Group. A Feasibility Study. London: The Stationery Office, 2002:115-127.

Arai L, Harding S. Access to and use of health social and other services and care by minority ethnic populations in the United Kingdom: A literature review. Glasgow: MRC Social and Public Health Sciences Unit, Occasional Paper 9, 2002.
Arai L, Harding S. UK-born black Caribbeans: Generational changes in health and well-being. Glasgow: MRC Social and Public Health Sciences Unit, Occasional Paper 6, 2002.
Maynard M. Healthy diet at post-retirement ages: a life course perspective. Journal of the Royal Society for the Promotion of Health 2002; 122:142-143.
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Abbotts J, Sweeting H, Williams R, West P. Poor but healthy? The youngest generation of Irish Catholics in West Scotland. Health Bulletin 2001; 59:373-379.
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Abbotts J, Williams R, Ford G. Morbidity and Irish Catholic descent in Britain: relating health disadvantage to socio-economic position. Social Science and Medicine 2001; 52:999-1005.
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Harding S, Balarajan R. Longitudinal study of socio-economic differences in mortality among South Asian and West Indian migrants. Ethnicity and Health 2001; 6:121-128.
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Harding S, Balarajan R. Mortality of third generation Irish people living in England and Wales. British Medical Journal 2001; 322:466-467.
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Lean MEJ, Han TS, Bush H, Anderson AS, Bradby H, Williams R. Ethnic differences in anthropometric and lifestyle measures related to coronary heart disease risk between South Asian, Italian and general population British women living in the West of Scotland. International Journal of Obesity 2001; 25:1800-1805.
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Frankel S, Gunnell DJ, Peters T, Maynard M, Davey Smith G. Childhood energy intake and adult mortality from cancer: the Boyd Orr cohort. British Medical Journal 1998; 316:499-504.
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