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Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers).
Methods
Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs).
Results
Smoking (HRs range 1.04–1.10) and physical inactivity (HRs range 1.01–1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03–1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01).
Conclusions
Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.
At least since the publication of ‘Rules rather than discretion’ by Nobel Prize winners Kydland and Prescott (1977), an undisputed principle in monetary economics is that central bankers should be politically independent. Politicians have an electoral incentive to jack-up the money supply to finance programmes the electorate favours, ignoring the inflation this will result in. Monetary policy is therefore best separated from fiscal policy, leaving the latter to politicians, while entrusting the former to central bankers, whose sole calling is to ensure moderate inflation and financial stability by determining the conditions (i.e., interest rate and collateral) under which private banks can borrow from the central bank. Although central banks’ independence might be undemocratic, it is nonetheless in the long-run interest of the citizenry.
As the subtitle of her new book suggests, Mazzucato aims to distinguish value creators from value extractors. This distinction between making and taking, between earning and deserving, between rent-seeking and value-contributing, is posited as crucial, yet it can no longer be made from within the paradigm of neoclassical economics, which has defined the distinction out of existence. Mazzucato shows this was not always so: classical economists did make the distinction, as did preceding economic schools such as the Physiocrats. This, however, is not a purely intellectual exercise; Mazzucato seeks to influence public debate, stating that “only by debunking ideas about value … can a long-lasting solution be found” (213), the problem being that what the financial sector, pharmaceutical companies, and national account statisticians call ‘value creation’ is in fact typically the opposite.
Chapter 5 explores the reasons why the Sheffield area settlement (as well as those located by marriage records for other British towns) has remained largely unnoticed by historians and questions the prior assumption that the presence of non-white immigrants in an area can always be located by remarkable instances of resistance by state institutions or by the working-class population. It also closely examines evidence and personal testimony of the everyday lived experiences of natives and newcomers who inhabited the same neighbourhoods. These individuals frequently describe integrated lives and point to a non-ideologically aligned phenomenon, here described as ‘everyday tolerance’, which existed within many working-class communities. Fostered by values of ‘getting by’ and ‘mucking in together’ and of bonds of family, work and neighbourhood, many neighbourhoods were able to accept the inward migration and intermarriage of non-white newcomers without the hostility and violence displayed during the port riots of 1919–1920. To view the period through a historical lens focused on hostility is to overlook much of the nuance and fine grain of quotidian relations between natives and newcomers.
Tracking rural South Asians from their lives as peasant farmers to their roles as lascar seamen, waged labourers and petty traders, Chapter 3 examines their remarkable working lives. It situates their experience of waged labour within that of other non-white immigrants, as well as that of the (mostly white) native working class. It proposes that current understanding incorrectly concludes that the fluidity of South Asian men’s working lives was a response to structural discrimination in the British labour market. In contrast, it asserts that many maintained their own agenda for economic independence. The chapter contends that South Asians often self-financed their migration to take up self-employment as pedlars in Britain, rather than simply being lascar seafarers jumping ship. This undermines claims that peddling was an imposed form of precarity. As fare-paying passengers, the growing number of pedlars during the 1930s resembles the economic migration of the post-Partition era. Thus the forms and networks of immigration were created prior to, and were bolstered by, the Second World War, rather than being solely a product of the post-war era.
The ’inter-racial’ or ‘mixed’ marriage should be, Chapter 4 argues, central to discussion of South Asian immigration to Britain in the first half of the twentieth century. The chapter examines evidence from the marriage records and argues that the role and widespread distribution of mixed marriages across Britain have been neglected by historians. It explores the backgrounds and social position of women who entered into relationships with South Asian men and questions J. B. Priestley’s assertion that mixed working-class couples were formed from ‘the riff-raff of the stokeholds and the slatterns of the slums’. Couples in mixed marriages have also been presented by historians as isolated from the neighbourhoods they inhabited. This chapter, however, argues that these couples were often thoroughly integrated into their neighbourhoods and maintained frequent contact not just with close friends, but also with blood relations, in-laws and neighbours. Additionally, these marriages, and the families and households they formed, played a significant, if not crucial, role in acting as anchor points in enduring chains of migration spanning the inter-war period and into post-Partition era.
Chapter 1 explores the development of Sheffield, the ’Steel City’, and its steel-making, cutlery and flatware and coal-mining industries. Its character as a town and surrounding conurbation whose culture was dominated by the working classes rather than by the middle classes or industrialists is also examined. Sheffield, a town formerly renowned as the world’s foremost centre of steel production, had notoriety as a hotbed of working-class radicalism. This is discussed, as are its cultural insularity (largely through geography) and relative isolation from other major economic centres. The chapter discusses the crucial role of immigration in Sheffield’s remarkable rate of population growth during the nineteenth century. It provides context for an emerging non-white immigration within a period of rapid demographic change. Immigration – first from the rural hinterland, then from further afield and abroad – was particularly apparent in the growth of Sheffield’s East End steelworking district. The chapter’s aim is to provide a social, economic and cultural context for close analysis of the arrival and successful settlement of non-elite South Asians from the later years of the First World War until Indian Partition in 1947, the British Nationality Act of 1948 and the Windrush era of mass non-white immigration.
Today, Sheffield’s East End is mostly gone. Its streets and terraced houses have been demolished. The men, women and children who populated its soot-blackened neighbourhoods, huddled beneath the looming, thundering steelworks, have been scattered to newer housing developments. The seemingly endless landscape of steelworks and coal pits has also been consigned to memory. While the steel makers Forgemasters and Outokumpu remain, the land surrounding them has been cleared of their illustrious forebears and no longer teems with their workers. Light industries, retail parks and leisure outlets have taken their place. Attercliffe Road, once the main artery of a proudly self-contained district boasting its own schools, churches, pubs and even a department store, now accommodates little to please the eye of the passing observer. The constant bustle of thousands of workers maintaining a twenty-four-hour, three-shift system no longer fills the air with the clanging of trams, the clatter of bicycles and the scrape of hobnail boots on flagstones.
The first half of the twentieth century is often characterised as a period of economic, political and moral collapse among European nations. Widespread ultra-nationalism, racist and eugenic theories, anti-Semitism, imperialism and world war are all closely and inseparably linked with the period. The rise of fascism across Europe had its British analogue in the Blackshirts of Sir Oswald Mosley’s British Union of Fascists, notorious for organising and marching for a ‘Greater Britain’ and in defence of the Empire, within working-class districts.1 Indeed the sporadic rioting and disorder which accompanied the Blackshirts’ attempt to march through London’s East End, together with the race riots that took place in a number of British ports in the immediate aftermath of the First World War, are viewed as symptomatic of the febrile atmosphere of racial tension during the inter-war period in Britain. ‘Hitlerism’, as the philosopher Hannah Arendt noted in January 1944, exercised its strong international and inter-European appeal during the 1930s ‘because racism, although a state doctrine only in Germany, had been everywhere a powerful trend in public opinion’.2
Chapter 2 focuses on the social networks of South Asian immigrants to the Sheffield area. It begins with an exploration of the origins and reasons for the migration of Pashtuns, mostly from Chhachh in northern Punjab. This ethnic group was the first and most numerically dominant South Asian migration to the area during the period. The chapter also examines the crucial primary role of the biradari (clan) in facilitating and sponsoring this pioneering migration from the villages of Punjab, North West Frontier Province (NWFP) and Kashmir. Through the more cosmopolitan environment of employment aboard British merchant ships as lascar seamen, the kinship-based networks supporting migration were bolstered by contact with those outside the biradari. Pioneering immigrants were thus able to establish contacts ashore in Britain. The chapter argues that these early links, which included white natives within a working-class milieu, were crucial in the establishment of successful early South Asian immigration and settlement, not only in the Sheffield area, but in towns and cities across Britain.