Individual Public Transportation Accessibility is Positively Associated with Self-Reported Active Commuting

Background: Active commuters have lower risk of chronic disease. Understanding which of the, to some extent, modifiable characteristics of public transportation that facilitate its use is thus important in a public health perspective. The aim of the study was to examine the association between individual public transportation accessibility and self-reported active commuting, and whether the associations varied with commute distance, age, and gender.

Methods: Twenty-eight thousand nine hundred twenty-eight commuters in The Capital Region of Denmark reported self-reported time spent either walking or cycling to work or study each day and the distance to work or study. Data were obtained from the Danish National Health Survey collected in February to April 2010. Individual accessibility by public transportation was calculated using a multi-modal network in a GIS. Multilevel logistic regression was used to analyze the association between accessibility, expressed as access area, and being an active commuter.

Results: Public transport accessibility area based on all stops within walking and cycling distance was positively associated with being an active commuter. Distance to work, age, and gender modified the associations. Residing within 10 km commute distance and in areas of high accessibility was associated with being an active commuter and meeting the recommendations of physical activity. For the respondents above 29 years, individual public transportation accessibility was positively associated with being an active commuter. Women having high accessibility had significantly higher odds of being an active commuter compared to having a low accessibility. For men, the associations were insignificant.

Conclusion: This study extends the knowledge about the driving forces of using public transportation for commuting by examining the individual public transportation accessibility. Findings suggest that transportation accessibility supports active commuting and planning of improved public transit accessibility has thus a potential of providing health benefits to commuters.

Epidemiology of concurrent headache and sleep problems in Denmark

AIMS

There are no previous epidemiologic studies on concurrent headache and sleep problems (HSP). This cross-sectional study aimed to determine the prevalence of HSP in Denmark, broadly characterize those with HSP, and examine associations between HSP and socioeconomic/lifestyle factors.

METHODS

A total of 129,150 randomly selected individuals were invited to participate in the Danish National Health Survey 2010. Respondents were asked about headache, sleep problems, depression and anxiety in the last two weeks, health-related lifestyle and quality of life (SF-12). Socioeconomic data were retrieved from national registers. Prevalence proportions were adjusted for stratified sampling and non-response. Regression analyses examined associations between HSP and socioeconomic/lifestyle factors.

RESULTS

Of 68,518 respondents, 16.3% reported only headache, 21.1% only sleep problems, and 18.1% HSP with 2.6% being severely affected. Prevalence was higher among women and the middle-aged. Severe HSP was associated with low socioeconomic position, non-Western ethnicity, unhealthy lifestyle, high stress and anxiety/depression. Those with HSP had substantially reduced quality of life; more so than those having only headache or only sleep problems.

CONCLUSIONS

HSP is a highly prevalent condition. Lifestyle modification, stress reduction, and screening for concurrent depression and anxiety may play important roles in management. The high prevalence of HSP suggests a common pathophysiological mechanism.

Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial

OBJECTIVE

To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level.

DESIGN

Randomised controlled community based trial.

SETTING

Suburbs of Copenhagen, Denmark.

PARTICIPANTS

59,616 people aged 30-60 years randomised with different age and sex randomisation ratios to an intervention group (n = 11,629) and a control group (n = 47,987).

INTERVENTION

The intervention group was invited for screening, risk assessment, and lifestyle counselling up to four times over a five year period. All participants with an unhealthy lifestyle had individually tailored lifestyle counselling at all visits (at baseline and after one and three years); those at high risk of ischaemic heart disease, according to predefined criteria, were furthermore offered six sessions of group based lifestyle counselling on smoking cessation, diet, and physical activity. After five years all were invited for a final counselling session. Participants were referred to their general practitioner for medical treatment, if relevant. The control group was not invited for screening.

MAIN OUTCOME MEASURES

The primary outcome measure was incidence of ischaemic heart disease in the intervention group compared with the control group. Secondary outcome measures were stroke, combined events (ischaemic heart disease, stroke, or both), and mortality.

RESULTS

6091 (52.4%) people in the intervention group participated at baseline. Among 5978 people eligible at five year follow-up (59 died and 54 emigrated), 4028 (67.4%) attended. A total of 3163 people died in the 10 year follow-up period. Among 58,308 without a history of ischaemic heart disease at baseline, 2782 developed ischaemic heart disease. Among 58,940 without a history of stroke at baseline, 1726 developed stroke. No significant difference was seen between the intervention and control groups in the primary end point (hazard ratio for ischaemic heart disease 1.03, 95% confidence interval 0.94 to 1.13) or in the secondary endpoints (stroke 0.98, 0.87 to 1.11; combined endpoint 1.01, 0.93 to 1.09; total mortality 1.00, 0.91 to 1.09).

CONCLUSION

A community based, individually tailored intervention programme with screening for risk of ischaemic heart disease and repeated lifestyle intervention over five years had no effect on ischaemic heart disease, stroke, or mortality at the population level after 10 years.Trial registration Clinical trials NCT00289237.

Temporal changes in the attitude towards smoking bans in public arenas among adults in the Capital Region of Denmark from 2007 to 2010

AIM

The population's attitude towards smoking bans in public arenas is important for their passing, implementation and compliance. Smoking bans are believed to reduce the social acceptability of smoking, and once people experience them, public support increases--also among pre-ban sceptics. This study aimed to examine the temporal changes in public attitude towards smoking bans in public arenas from 2007 to 2010 and whether these changes differed across educational attainment, smoking status and intention to quit among smokers.

METHODS

Data from two surveys among adults (aged 25-79 years) in 2007 and 2010 in the Capital Region of Denmark (n=36,472/42,504, response rate = 52.3) was linked with data on sex, age and educational attainment from central registers. Age-standardised prevalence of supportive attitude towards smoking bans was estimated. Temporal changes in supportive attitude were explored in workplaces, restaurants and bars using logistic regression models.

RESULTS

The prevalence of supportive attitude towards smoking bans increased significantly in all arenas from 2007 to 2010. Positive temporal changes in supportive attitude towards smoking bans were seen across educational attainment, smoking status and intention to quit smoking in restaurants and across smoking status for smoking bans in workplaces and bars.

CONCLUSIONS

The results of this study show that the public's attitude towards smoking in public arenas has changed after the implementation of a comprehensive smoking ban. This change in attitude can support implementation of future legislation on smoking and may lead to positive changes in smoking norms.

Individual Public Transportation Accessibility is Positively Associated with Self-Reported Active Commuting

BACKGROUND

Active commuters have lower risk of chronic disease. Understanding which of the, to some extent, modifiable characteristics of public transportation that facilitate its use is thus important in a public health perspective. The aim of the study was to examine the association between individual public transportation accessibility and self-reported active commuting, and whether the associations varied with commute distance, age, and gender.

METHODS

Twenty-eight thousand nine hundred twenty-eight commuters in The Capital Region of Denmark reported self-reported time spent either walking or cycling to work or study each day and the distance to work or study. Data were obtained from the Danish National Health Survey collected in February to April 2010. Individual accessibility by public transportation was calculated using a multi-modal network in a GIS. Multilevel logistic regression was used to analyze the association between accessibility, expressed as access area, and being an active commuter.

RESULTS

Public transport accessibility area based on all stops within walking and cycling distance was positively associated with being an active commuter. Distance to work, age, and gender modified the associations. Residing within 10 km commute distance and in areas of high accessibility was associated with being an active commuter and meeting the recommendations of physical activity. For the respondents above 29 years, individual public transportation accessibility was positively associated with being an active commuter. Women having high accessibility had significantly higher odds of being an active commuter compared to having a low accessibility. For men, the associations were insignificant.

CONCLUSION

This study extends the knowledge about the driving forces of using public transportation for commuting by examining the individual public transportation accessibility. Findings suggest that transportation accessibility supports active commuting and planning of improved public transit accessibility has thus a potential of providing health benefits to commuters.

Definitions of medication-overuse headache in population-based studies and their implications on prevalence estimates: a systematic review

BACKGROUND

Case definitions of medication-overuse headache (MOH) in population-based research have changed over time. This study aims to review MOH prevalence reports with respect to these changes, and to propose a practical case definition for future studies based on the ICHD-3 beta.

METHODS

A systematic literature search was conducted to identify MOH prevalence studies. Findings were summarized according to diagnostic criteria.

RESULTS

Twenty-seven studies were included. The commonly used case definition for MOH was headache ≥15 days/month with concurrent medication overuse ≥3 months. There were varying definitions for what was considered as overuse. Studies that all used ICHD-2 criteria showed a wide range of prevalence among adults: 0.5%-7.2%.

CONCLUSIONS

There are limits to comparing prevalence of MOH across studies and over time. The wide range of reported prevalence might not only be due to changing criteria, but also the diversity of countries now publishing data. The criterion "headache occurring on ≥15 days per month" with concurrent medication overuse can be applied in population-based studies. However, the new requirement that a respondent must have "a preexisting headache disorder" has not been previously validated. Exclusion of other headache diagnoses by expert evaluation and ancillary examinations is not feasible in large population-based studies.

Association between parental socioeconomic position and prevalence of asthma, atopic eczema and hay fever in children

AIM

To determine the prevalence of asthma, atopic eczema and hay fever among children in different age groups and examine the associations with parental socioeconomic position.

METHODS

A cross-sectional health survey of four complete birth-cohorts in the municipality of Copenhagen was conducted. Children aged 11 and 15 years and parents of children aged 3 and 6 years completed questionnaires on symptoms and diseases. Data were linked to national registers on demographics and socioeconomic position measured as education, employment and income. In total, 9720 children/parents responded (50.5%).

RESULTS

The prevalence of asthma and hay fever increased with increasing age; asthma: from 3.2% among children aged 3 years to 15.4% among children aged 15 years; hay fever: from 3.1% among children aged 3 years to 21.3% among children aged 15 years. The prevalence of atopic eczema did not vary with age and ranged between 15.5% and 17.8%. Odds Ratios for children of parents with the lowest vs. the highest educational level were 1.50 (95% CI = 1.17-1.91) for asthma; 1.68 (95% CI = 1.35-2.10) for hay fever; and 0.75 (95% CI = 0.64-0.89) for atopic eczema. Unemployment was significantly associated with a decreased risk of atopic eczema and eczema symptoms. There was no independent association between household income and any of the outcomes.

CONCLUSIONS

The prevalence of asthma and hay fever, but not atopic eczema, increased with increasing age. Atopic eczema was associated with high parental educational level, whereas asthma and hay fever were associated with low educational level. No association with household income was found.

Association between neighbourhood green space and sedentary leisure time in a Danish population

Aim: Sedentary behaviour is a risk factor for diabetes, cardiovascular disease etc., independently of level of physical activity. Availability of recreational green space is associated with physical activity, but is unknown in relation to sedentary behaviour. The aim of this study is to examine the association between availability of green space and sedentary leisure time in a Danish population. Methods: The study was based on a random sample of 49,806 adults aged 16 + who answered a questionnaire in 2010, including sedentary leisure time. Objective measures of density green were calculated for each respondent using Geographical Information System (GIS). A multilevel regression analysis, taking neighbourhood and individual factors into account, was performed. Results: 65% of the respondents were sedentary in leisure time for more than 3h/day. We found that poor availability of forest and recreational facilities in the neighbourhood is associated with more sedentary leisure time; OR: 1.11 (95% CL: 1.04–1.19), after adjusting for individual, and neighbourhood, level characteristics. Conclusions: Among adult inhabitants, sedentary leisure time of more than 3h/day was more frequent in neighbourhoods with less green surroundings. Intervention efforts may benefit from emphasising the importance of having recreations options in residential areas to provide alternatives to sedentary activities.

Recent temporal trends in sleep duration, domain-specific sedentary behaviour and physical activity. A survey among 25–79-year-old Danish adults

Background: Prevalence of sedentary behaviour is high in many countries, but little is known about temporal trends in sitting time. Objective: To examine temporal changes in sleep and domain-specific sedentary behaviour and moderate to vigorous leisure time physical activity (MVPA). Methods: Two cross-sectional population-based surveys of 25–79-year-old inhabitants were conducted in The Capital Region of Denmark in 2007 ( N = 69.800, response rate 52.3%) and 2010 ( N = 77.517, response rate 54.8%). Information on sedentary behaviour and physical activity was obtained from self-report questionnaire and sociodemographic information from central registers. Data were weighted for survey design and for non-response and were analysed by multiple regression analyses. Results: In 2007, the entire survey population reported a mean daily sleeping duration of 7.4 hours, leisure time sitting of 3.4 hours per day, occupational sitting of 4.4 hours per day, MVPA of 0.87 hours per day and a total 24-hour energy expenditure of 40.12 METs per day. In 2010, duration of sleep was unaltered ( p = 0.1), sedentary leisure time and sedentary work time had increased by 12.6 minutes ( p < 0.0001) and 13.2 minutes ( p < 0.0001) per day, respectively. Time spent on MVPA had increased by 2.9 minutes per day ( p < 0.0001). The 24-hour energy expenditure had decreased by 0.41 METs ( p < 0.0001). Conclusions: Adult Danish men and women spend an increased amount of time sitting down at work and during leisure time, but also on leisure time MVPA. As duration of sleep is unaltered findings suggest that low intensity physical activity may be displaced in everyday life.

Effect of survey mode on response patterns: comparison of face-to-face and self-administered modes in health surveys

BACKGROUND

While face-to-face interviews are considered the gold standard of survey modes, self-administered questionnaires are often preferred for cost and convenience. This article examines response patterns in two general population health surveys carried out by face-to-face interview and self-administered questionnaire, respectively.

METHOD

Data derives from a health interview survey in the Region of Southern Denmark (face-to-face interview) and The Danish Health and Morbidity Survey 2010 (self-administered questionnaire). Identical questions were used in both surveys. Data on all individuals were obtained from administrative registers and linked to survey data at individual level. Multiple logistic regression analyses were used to examine the effect of survey mode on response patterns.

RESULTS

The non-response rate was higher in the self-administered survey (37.9%) than in the face-to-face interview survey (23.7%). Marital status, ethnic background and highest completed education were associated with non-response in both modes. Furthermore, sex and age were associated with non-response in the self-administered mode. No significant mode effects were observed for indicators related to use of health services, but significant mode effects were observed for indicators related to self-reported health-related quality of life, health behaviour, social relations and morbidity (long-standing illness).

CONCLUSIONS

The same factors were generally associated with non-response in both modes. Indicators based on factual questions with simple answers categories were overall more comparable according to mode than indicators based on questions that involved more subjective assessments. Other measures such as efficiency and cost-effectiveness of the mode should also be considered when determining the most appropriate form of data collection.

Municipal tobacco control in the Capital Region of Denmark can be improved

INTRODUCTION

Smoking remains the single preventable factor with the highest impact on morbidity and mortality in Denmark. The aims of this study were to assess the quality of municipal tobacco control (TC) in the 29 municipalities of the Capital Region of Denmark, and to compare the quality of the TC and the priority given to TC with the prevalence of daily smoking across municipalities.

MATERIAL AND METHODS

In March 2012 a questionnaire regarding municipal TC was sent to the 29 municipalities of the Region. The response rate was 100%. Data were merged with information from the Health Survey under-taken in the Capital Region in 2010 which included 49,806 respondents. We assessed the quality of TC using two measures: self-reported priority (scale 1-10) and calculated quality score (scale 0-70), and compared these measures with the prevalence of daily smoking two years before.

RESULTS

There were large differences in TC between the municipalities of the region. A high smoking prevalence in 2010 was significantly associated with a high priority given to TC in 2012 (p=0.03). The mean priority of TC was 7.1 (range 3-10) and the mean quality score was 37.1 (range 17-55). Smoking cessation services and prevention of second-hand smoking exposure seem to be the main areas of focus, while several at-risk groups were given a low priority.

CONCLUSION

In some municipalities, TC seems to be neglected, while others have achieved high standards. We call for major improvements in TC in the majority of municipalities.

FUNDING

The trial was funded by the Capital Region of Denmark (Region Hovedstaden) and the Health Foundation (Helsefonden).

TRIAL REGISTRATION

Not relevant.

Microvascular retinopathy in subjects without diabetes: the Inter99 Eye Study

PURPOSE

Retinal vascular lesions such as microaneurysms and haemorrhages, while typical of diabetic retinopathy, are also seen in subjects without diabetes where they are associated with elevated cardiovascular mortality. In theory, these lesions could be a consequence of past hyperglycaemia. We examined the prevalence and risk factors for retinopathy, including lens fluorescence, a biomarker of cumulative life-time glycaemia in adults without diabetes.

METHODS

Cross-sectional population-based study of 711 subjects without diabetes (WHO 1999 criteria) aged 30-60 years, including oral glucose tolerance testing, clinical and laboratory examinations, non-invasive ocular lens fluorometry and seven-field fundus photography.

RESULTS

  Retinopathy was present in 8.3% (CI(95) 6.3-10.3%) of subjects. Higher systolic blood pressure (SBP) (p = 0.032), increasing body mass index (BMI) (p = 0.014) and wider waist circumference (p = 0.014) were significantly associated with retinopathy after adjusting for age and sex. Retinopathy was not significantly related to long-term, short-term or current glycaemia (lens fluorescence, HbA(1c) , fasting plasma glucose). In the multivariate analysis, the odds ratio (OR) for retinopathy in subjects with SBP ≥160 mmHg compared to subjects with SBP <130 mmHg was 2.68 (CI(95) 1.07-6.70, p = 0.036) and in subjects with BMI ≥30 compared to subjects with BMI < 25 the OR for retinopathy was 2.14 (CI(95) 1.01-4.57, p = 0.049) when adjusting for both variables, age, sex, the presence of impaired glucose tolerance and impaired fasting glucose.

CONCLUSION

 Retinopathy in subjects without diabetes was associated with hypertension and obesity. The study found no evidence that microvascular retinopathy in non-diabetic subjects was a consequence of past hyperglycaemia.

The Danish National Health Survey 2010. Study design and respondent characteristics

AIMS

In 2010 the five Danish regions and the National Institute of Public Health at the University of Southern Denmark conducted a national representative health survey among the adult population in Denmark. This paper describes the study design and the sample and study population as well as the content of the questionnaire.

METHODS

The survey was based on five regional stratified random samples and one national random sample. The samples were mutually exclusive. A total of 298,550 individuals (16 years or older) were invited to participate. Information was collected using a mixed mode approach (paper and web questionnaires). A questionnaire with a minimum of 52 core questions was used in all six subsamples. Calibrated weights were computed in order to take account of the complex survey design and reduce non-response bias.

RESULTS

In all, 177,639 individuals completed the questionnaire (59.5%). The response rate varied from 52.3% in the Capital Region of Denmark sample to 65.5% in the North Denmark Region sample. The response rate was particularly low among young men, unmarried people and among individuals with a different ethnic background than Danish.

CONCLUSIONS

The survey was a result of extensive national cooperation across sectors, which makes it unique in its field of application, e.g. health surveillance, planning and prioritizing public health initiatives and research. However, the low response rate in some subgroups of the study population can pose problems in generalizing data, and efforts to increase the response rate will be important in the forthcoming surveys.