Effects of marital transitions on changes in dietary and other health behaviours in US male health professionals

Relationship transitions and change in health behavior: A four-phase, twelve-year longitudinal study

RATIONALE

Extensive scientific evidence shows an association between involvement in social relationships and healthy lifestyle. Prospective studies with many participants and long follow-ups are needed to study the dynamics and change in social factors within individuals over time.

OBJECTIVE

Our aim was to determine whether a change in relationship status (single, married, divorced, widow, cohabiting) is followed by a change in health behavior (smoking, alcohol consumption, physical activity, and body mass index).

METHODS

We used data from 81,925 healthy adults participating in the prospective longitudinal Finnish Public Sector Study in the period 2000-2013. We analyzed 327,700 person-observations from four data collection phases. Missing data were multiply imputed. A within-individual methodology was used to minimize the possibility of selection effects affecting the interpretation.

RESULTS

All four health behaviors showed associations with relationship status. The effects were very similar and in the same direction in women and men, although there were gender differences in the magnitudes of the effects. The end of a relationship was followed by a decrease in body mass index, increased odds of being a smoker, increase in physical activity, and increase in alcohol consumption (widowed men). The effects were reverse when forming a new relationship.

CONCLUSION

A change in relationship status is associated with a change in health behavior. The association is not explained by socioeconomic status, subjective health status, or anxiety level. People leaving or losing a relationship are at increased risk of unhealthy behavior (smoking and alcohol consumption), but at the same time they have a lower BMI and show higher physical activity compared to the time they were in a relationship. It is not clear if the cumulative health effect of these health behavior changes is positive or negative.

Contrasting Effects of Spousal Education on Depressive Symptoms Among Korean Middle-Aged and Older Adults

Background

Within marital dyads, we focused on the so-called positive spillover effects of one spousal partner’s educational attainment on the health of the other partner. This study examined the relationship between spousal educational attainment and depressive symptoms in Korean older adults.

Methods

Data were obtained from a sample of marital dyads aged 45 or older (total 6,824 husbands and wives) from the baseline survey of the Korean Longitudinal Study of Ageing. Depressive symptoms were measured by the 10-item Center for Epidemiological Studies Depression scale (CES-D 10). A stepwise actor-partner interdependence model was used to examine the association between own and spousal educational attainment and depressive symptoms, conditioning for covariates.

Results

Among men, we found that their wives’ educational attainment did not influence their mental health, whereas, among women, their depressive symptoms were inversely related to their husbands’ level of schooling. With regard to own education, more-educated men reported lower psychological distress, whereas, among women, there was no overall association. However, in a subset of Korean women with the highest level of household income, higher educational attainment was associated with more depressive symptoms.

Conclusion

Our findings underscore the need to incorporate the cultural context in examining the spillover effects of education on health within marriage.

Gender differences in the use of anti-infective medications before and after widowhood: a register-based study

BACKGROUND

Recent findings suggest that bereavement due to spousal loss is associated with a decline in general immune functions, and thus to increased susceptibility to infections among widowed individuals. The present study aims to investigate whether spousal loss weakens immune defences more among men than among women using a 5% random sample of the total Danish population, and anti-infective medication use as a proxy for immune response.

METHODS

We followed 6076 Danish individuals (67% women) aged ≥50 from 5 years before and up to 5 years after widowhood to examine changes in prescriptions of anti-infectives for systemic use.

RESULTS

Women used more anti-infective drugs both before and after spousal loss (women: OR= 1.31; 95% CI 1.21 to 1.42). The age-related changes in the use of anti-infective medications in the period before widowhood were similar to that in the period after widowhood among both men and women. Also, age-related changes in the use of anti-infective medications were similar in both genders.

CONCLUSIONS

The present study shows that individuals are more likely to use anti-infective medication after being widowed than before being widowed, but this change is likely to be related to increasing age and it is similar in both genders.

Differences in Lifestyle Improvements With the Intention to Prevent Cardiovascular Diseases by Socioeconomic Status in a Representative Japanese Population: NIPPON DATA2010

BACKGROUND

The relationships among socioeconomic status and lifestyle improvements have not yet been examined in a representative Japanese population.

METHODS

We analyzed data from 2,647 participants (1,087 men and 1,560 women) who participated in NIPPON DATA2010. This survey inquired about lifestyle improvements and socioeconomic status. Education was categorized as low (≤9 years), middle (10-12 years), and high (≥13 years). Marital status was categorized as married, divorced, widowed, and never married/other. A multivariable logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of lifestyle improvements with the intention of preventing cardiovascular diseases for educational attainment and marital status, with adjustments for age and awareness of cardiovascular disease risk factors.

RESULTS

Overall, 1,507 (56.9%) participants practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome, and the OR of lifestyle improvements was significantly higher with a high education than with a low education in men (OR 2.86; 95% CI, 1.96-4.17) and women (OR 2.36; 95% CI, 1.67-3.33). The number of participants who practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome was significantly lower in divorced than in married men (OR 0.46; 95% CI, 0.22-0.95) and women (OR 0.53; 95% CI, 0.33-0.86).

CONCLUSIONS

Specific differences caused by educational attainment and marital status may exist in lifestyle improvements.

Social networks, leisure activities and maximum tongue pressure: cross-sectional associations in the Nagasaki Islands Study

OBJECTIVES

Social environment is often associated with health outcomes, but epidemiological evidence for its effect on oral frailty, a potential risk factor for aspiration, is sparse. This study aimed to assess the association between social environment and tongue pressure, as an important measure of oral function. The study focused on family structure, social networks both with and beyond neighbours, and participation in leisure activities.

DESIGN

A population-based cross-sectional study.

SETTING

Annual health check-ups in a rural community in Japan.

PARTICIPANTS

A total of 1982 participants, all over 40 years old. Anyone with missing data for the main outcome (n=14) was excluded.

OUTCOME MEASURES

Tongue pressure was measured three times, and the maximum tongue pressure was used for analysis. A multivariable adjusted regression model was used to calculate parameter estimates (B) for tongue pressure.

RESULTS

Having a social network involving neighbours (B=2.43, P=0.0001) and taking part in leisure activities (B=1.58, P=0.005) were independently associated with higher tongue pressure, but there was no link with social networks beyond neighbours (B=0.23, P=0.77). Sex-specific analyses showed that for men, having a partner was associated with higher tongue pressure, independent of the number of people in the household (B=2.26, P=0.01), but there was no association among women (B=-0.24, P=0.72; P-interaction=0.059).

CONCLUSIONS

Having a social network involving neighbours and taking part in leisure activities were independently associated with higher tongue pressure. Marital status may be an important factor in higher tongue pressure in men.

Heterogeneity in Trajectories of Depression in Response to Divorce is Associated with Differential Risk for Mortality

Divorce is a common stressful event associated with both increased rates of depression and mortality. Given evidence of significant individual differences in depression following major life stressors, we examined if heterogeneous depression responses confer differential risk for mortality. Data from a population based longitudinal study was utilized to identify individuals who experienced divorce (n=559). Prospective trajectories of depression severity from before to after divorce were identified using latent growth mixture modeling, and rates of mortality between trajectories were compared as a distal outcome. Four trajectories demonstrated strongest model fit: resilience (67%), emergent depression (10%), chronic pre-to-post divorce depression (12%), and decreasing depression (11%). Mortality base rate was 9.7% by 6 years post-event, and depression that emerged due to divorce was associated with significantly greater mortality risk compared to resilient (OR, 2.46; 95% CI, 1.05-5.81) and to married individuals, while chronic depression was not associated with greater risk.

Smoking cessation among European older adults: the contributions of marital and employment transitions by gender

Knowledge about the potential effects of stressful events on smoking cessation is helpful for the design of health interventions. Previous studies on this topic tended to group together adults of all ages and of both genders. We investigate the contribution of marital and employment losses on smoking cessation by gender, specifically among older adults in Europe. We used panel data from waves 4 (2011) and 5 (2013) of the Survey of Health, Ageing and Retirement in Europe for 3345 male and 3115 female smokers at baseline aged 50 and over from 13 countries. The associations between marital and employment losses and smoking cessation were derived from logistic regression models for each gender, controlling for age, educational attainment, diseases incidence and country of residence. Interactions between gender and marital and employment losses were tested. Over the analysed period, 119 smokers became widowed or divorced (1.8 %), 318 became retired (4.9 %) and 100 became unemployed (1.5 %). Becoming widowed or divorced was associated with lower probability of smoking cessation among both men (OR 0.36, 95 % CI 0.14-0.94) and women (OR 0.46, 95 % CI 0.21-0.99). Transitions to unemployment and to retirement were not significantly associated with smoking cessation (OR 0.62, 95 % CI 0.25-1.49; and OR 0.68, 95 % CI 0.43-1.07, respectively). Gender differences in the association between marital and employment losses and smoking cessation were not statistically significant (p value > 0.05 for all interactions). Health interventions should take into account that male and female older adults affected by marital loss are at risk of continuing smoking.

Partnering and parenting transitions associate with changing smoking status: a cohort study in young Australians

OBJECTIVES

To examine the effects of partnering and parenting transitions on smoking continuity in young adults.

METHODS

A prospective cohort study was conducted involving 1084 young smokers and former smokers who completed questionnaires at baseline (2004-2006, aged 26-36 years) and 5 years later.

RESULTS

233/570 (40.9%) smokers quit and 58/514 (11.3%) former smokers resumed smoking during follow-up. For partnering transitions, compared with remaining not partnered, the likelihood of quitting was higher among men who became (RR 2.84 95% CI 1.62, 4.98) or stayed (RR 2.12, 95% CI 1.18, 3.80) partnered and women who became partnered (RR 1.50, 95% CI 1.03, 2.18). People who became (RR 0.14, 95% CI 0.03, 0.58) or stayed (RR 0.51, 95% CI 0.27, 0.95) partnered had a lower risk of resuming smoking than their continuously not partnered peers. For parenting transitions, having a first child born increased women's probability of quitting smoking relative to remaining childless (RR 1.74, 95% CI 1.30, 2.33), while having additional children did not.

CONCLUSIONS

The benefits of partnering were greater for men than women and transition into parenthood was of greater benefit to women.

Association between the Eating Family Meal and the Prevalence of Metabolic Syndrome Using Data from Korea National Health and Nutrition Examination Survey (2007-2012)

Background

Several studies have shown that family meals promote a well-balanced and healthier diet and weight status. Metabolic syndrome is related to eating behavior. This study investigated the association between eating family meals and the prevalence of metabolic syndrome.

Methods

This cross-sectional study included 4,529 subjects who participated in the Korea National Health and Nutrition Examination Survey IV and V (2007–2012). A self-reported questionnaire was used to assess dietary status. Metabolic syndrome was defined according to the guidelines of the modified version of the National Cholesterol Education Program Adult Treatment Panel III. We compared the overall quality of dietary intake in family meal.

Results

Nutritional adequacy ratios for energy, protein, calcium, vitamin A, vitamin B₁, vitamin B₂, vitamin C, niacin, and potassium, and the mean adequacy ratio were significantly higher in the family meal group (P<0.05). The prevalence of metabolic syndrome was lower in the family meal group (P<0.05). However, we observed no significant association between eating family meals and the prevalence of metabolic syndrome.

Conclusion

This study demonstrated that eating family meals appeared to be associated with nutrient adequacy. However, we observed no significant differences in prevalence of metabolic syndrome between the 2 groups.

Changes in the living arrangement and risk of stroke in Japan; does it matter who lives in the household? Who among the family matters?

Previous studies have suggested associations of family composition with morbidity and mortality; however, the evidence of associations with risk of stroke is limited. We sought to examine the impact of changes in the household composition on risk of stroke and its types in Japanese population. Cox proportional hazard modelling was used to assess the risk of incident stroke and stroke types within a cohort of 77,001 Japanese men and women aged 45-74 years who experienced addition and/or loss of family members [spouse, child(ren), parent(s) and others] to their households over a five years interval (between 1990-1993 and 1995-1998). During 1,043,446 person-years of the follow-up for 35,247 men and 41,758 women, a total of 3,858 cases of incident stroke (1485 hemorrhagic and 2373 ischemic) were documented. When compared with a stable family composition, losing at least one family member was associated with 11-15% increased risk of stroke in women and men; hazard ratios (95% confidence interval) were 1.11 (1.01-1.22) and 1.15 (1.05-1.26), respectively. The increased risk was associated with the loss of a spouse, and was evident for ischemic stroke in men and hemorrhagic stroke in women. The addition of any family members to the household was not associated with risk of stroke in men, whereas the addition of a parent (s) to the household was associated with increased risk in women: 1.49 (1.09-2.28). When the loss of a spouse was accompanied by the addition of other family members to the household, the increased risk of stroke disappeared in men: 1.18 (0.85-1.63), but exacerbated in women: 1.58 (1.19-2.10). In conclusion, men who have lost family members, specifically a spouse have higher risk of ischemic stroke, and women who gained family members; specifically a parent (s) had the higher risk of hemorrhagic stroke than those with a stable family composition.

Adiposity, CVD risk factors and testosterone: Variation by partnering status and residence with children in US men

Background and objectives: In many settings, partnered, invested fathers have lower testosterone than single men or fathers who are not involved in caregiving. Reduced testosterone has been identified as a risk factor for multiple chronic diseases, and men's health also commonly varies by life history status. There have been few tests of whether variation in testosterone based on partnering and parenting has implications for men's health. Methodology: We analysed data from a US population-representative sample (NHANES) of young-to-middle aged US men (n = 875; mean age: 29.8 years ± 6.0 [SD]). We tested for life history status differences in testosterone, adiposity levels and biomarkers of cardiovascular disease (CVD)-risk (HDL cholesterol; triglycerides; white blood cell count [WBC]). Results: Partnered men residing with children (RC) had lower testosterone and elevated abdominal adiposity compared to never married men not residing with children. While they did not significantly differ for WBC or triglycerides, partnered RC men also had comparatively lower HDL. Partnered RC males' lower testosterone accounted for their relatively elevated adiposity, but testosterone, adiposity, and health-related covariates did not explain their relatively reduced HDL. Conclusions and implications: Our results linking life history status-based differences in testosterone and adiposity, alongside our complementary HDL findings, indicate that testosterone-related psychobiology might have implications for partnered RC men's CVD risk in the US and other similar societal settings. These types of socially contextualized observations of men's health and physiological function particularly merit incorporation in clinical discussions of fatherhood as a component of men's health.

Life-course partnership history and midlife health behaviours in a population-based birth cohort

Background

Marital and partnership history is strongly associated with health in midlife and later life. However, the role of health behaviours as an explanatory mechanism remains unclear. The aim of this study was to investigate prospective associations between life-course partnership trajectories (taking into account timing, non-marital cohabitation, remarriage and marital transitions) and health behaviours measured in midlife.

Methods

We analysed data from the British National Child Development Study, a prospective cohort study that includes all people born in 1 week of March 1958 (N=10 226). This study included men and women with prospective data on partnership history from age 23 to 42–44 and health behaviours collected at ages 42–46 (2000–2004). Latent class analysis was used to derive longitudinal trajectories of partnership history. We used multivariable regression models to estimate the association between midlife health behaviours and partnership trajectory, adjusting for various early and young adult characteristics.

Results

After adjustment for a range of potential selection factors in childhood and early adulthood, we found that problem drinking, heavy drinking and smoking were more common in men and women who experienced divorce or who had never married or cohabited. Women who married later had a lower prevalence of smoking and were less likely to be overweight than those who married earlier. Overall marriage was associated with a higher body mass index. Individuals who never married or cohabited spent less time exercising.

Conclusions

Some aspects of partnership history such as remaining unpartnered and experiencing divorce are associated with more smoking and drinking in midlife, whereas marriage is associated with midlife weight gain. Despite these offsetting influences, differences in health behaviours probably account for much of the association between partnership trajectories and health found in previous studies.

Improved survival for elderly married glioblastoma patients : Better treatment delivery, less toxicity, and fewer disease complications

OBJECTIVES

Marital status is a well-described prognostic factor in patients with gliomas but the observed survival difference is unexplained in the available population-based studies.

METHODS

A series of 57 elderly glioblastoma patients (≥70 years) were analyzed retrospectively. Patients received radiotherapy or chemoradiation with temozolomide. The prognostic significance of marital status was assessed. Disease complications, toxicity, and treatment delivery were evaluated in detail.

RESULTS

Overall survival was significantly higher in married than in unmarried patients (median, 7.9 vs. 4.0 months; p = 0.006). The prognostic significance of marital status was preserved in the multivariate analysis (HR, 0.41; p = 0.011). Married patients could receive significantly higher daily temozolomide doses (mean, 53.7 mg/m² vs. 33.1 mg/m²; p = 0.020), were more likely to receive maintenance temozolomide (45.7 % vs. 11.8 %; p = 0.016), and had to be hospitalized less frequently during radiotherapy (55.0 % vs. 88.2 %; p = 0.016). Of the patients receiving temozolomide, married patients showed significantly lower rates of hematologic and liver toxicity. Most complications were infectious or neurologic in nature. Complications of any grade were more frequent in unmarried patients (58.8 % vs. 30.0 %; p = 0.041) with the incidence of grade 3-5 complications being particularly elevated (47.1 % vs. 15.0 %; p = 0.004).

CONCLUSION

We found poorer treatment delivery as well as an unexpected severe increase in toxicity and disease complications in elderly unmarried glioblastoma patients. Marital status may be an important predictive factor for clinical decision-making and should be addressed in further studies.

Late-Life Bereavement

Healthy aging is critical for the elderly to be independent and enjoy at least a satisfactory quality of life. However, late-life bereavement threatens healthy aging, as it may lead to adverse health effects. Using data from the Health and Retirement Survey, this study investigates the relationship between weight—specifically, body mass index (BMI)—and the loss of a parent, sibling, or spouse at an older age. It is the first attempt to investigate this relationship among the elderly population in the United States and makes the following notable contributions to the literature: (a) use of a large longitudinal dataset, (b) estimation of the effects of a familial death on a person’s BMI, and (c) investigation of the consequences of the bereavement for older people. Our results suggest that losing a family member at an older age results in a decrease in BMI.

Differences between husbands and wives in colonoscopy use: Results from a national sample of married couples

Marriage is linked to improved colorectal cancer-related health, likely in part through preventive health behaviors, but it is unclear what role spouses play in colorectal cancer screening. We therefore determine whether self-reported colonoscopy rates are correlated within married couples and the characteristics of spouses associated with colonoscopy use in each partner. We use US nationally-representative 2010 data which includes 804 male-female married couples drawn from a total sample of 3137 community-dwelling adults aged 55-90years old. Using a logistic regression model in the full sample (N=3137), we first find married men have higher adjusted colonoscopy rates than unmarried men (61% versus 52%, p=0.023), but women's rates do not differ by marital status. In the couples' sample (N=804 couples), we use a bivariate probit regression model to estimate multiple regression equations for the two spouses simultaneously as a function of individual and spousal covariates, as well as the adjusted correlation within couples. We find that individuals are nearly twice as likely to receive a colonoscopy if their spouse recently has had one (OR=1.94, 95% CI: 1.39, 2.67, p<0.001). Additionally, we find that husbands have higher adjusted colonoscopy rates whose wives are: 1) happier with the marital relationship (65% vs 51%, p=0.020); 2) more highly educated (72% vs 51%, p=0.020), and 3) viewed as more supportive (65% vs 52%, p=0.020). Recognizing the role of marital status, relationship quality, and spousal characteristics on colonoscopy uptake, particularly in men, could help physicians increase guideline adherence.

Marital transitions and associated changes in fruit and vegetable intake: Findings from the population-based prospective EPIC-Norfolk cohort, UK

BACKGROUND

Diet is critical to health and social relationships are an important determinant of diet. We report the association between transitions in marital status and healthy eating behaviours in a UK population.

METHODS

Longitudinal study of middle-age and older adults 39-78y (n = 11 577) in EPIC-Norfolk, a population-based cohort, who completed food frequency questionnaires in 1993-97 and 1998-2002. Multivariable linear regression analyses assessed gender-specific associations between five categories of marital transitions and changes in quantity (g/d), and variety (no/month) of fruits or vegetables.

RESULTS

In 3.6 years of follow-up and relative to men who stayed married, widowed men showed significant declines (mean difference, 95% CI) in all four indicators of healthy eating including fruit quantity (-47.7, -80.6 to -14.9 g/d), fruit variety (-0.6, -1.1 to -0.2 no/month), vegetable quantity (-27.7, -50.5 to -4.9 g/d), and vegetable variety (-1.6, -2.2 to -0.9 no/month). Men who were separated or divorced or who remained single also showed significant declines in three of the indicators. Among women, only those who became separated/divorced or stayed single showed declines in one indicator, vegetable variety.

CONCLUSION

Unhealthy changes to diet accompanying divorce, separation and becoming widowed may be more common among men than women. Moreover, deterioration in fruit and vegetable intakes was more apparent for variety rather than quantity consumed. Programmes to promote healthy eating among older adults need to recognise these social determinants of diet and consider prioritising people who live alone and in particular men who have recently left relationships or who have been widowed.

Marital Transition and Risk of Stroke

Background and Purpose—

There have been consistent findings reported that marital transition (ie, change in marital status during a given time period) is associated with risk of cardiovascular disease; however, few studies have been conducted on stroke risk, particularly stroke subtypes. Moreover, no studies have examined the moderating effect of living arrangement and employment status on the association between marital transition and stroke risk.

Methods—

We examined sex-specific associations between marital transition and stroke risk using data from Japan Public Health Center–based Prospective Study. We included 24 162 men and 25 626 women who were married at prebaseline (5 years before baseline). Marital transition was determined by marital status at baseline. Weighted hazard ratios of stroke risk were estimated by Cox proportional regression analysis with inverse probability of weighting using a propensity score.

Results—

An increased risk of stroke, particularly hemorrhagic stroke, was observed among men and women with marital transition (ie, married to unmarried); weighted hazard ratios (95% confidence interval [CI]) for men and women were 1.26 (1.13–1.41) and 1.26 (1.09–1.45), respectively. Participants with marital transition and lived with children had increased stroke risk. Living with parents buffered the increased stroke risk owing to marital transition among men; however, no such effect was identified among women. Elevated stroke risk owing to marital transition was magnified among women if they were unemployed; weighted hazard ratio=2.98 (95% CI, 1.66–5.33).

Conclusions—

Living arrangement and employment status modified the positive associations between marital transition and stroke risk, which differed by sex.

Cardiovascular Risk in Men Aged Over 40 in Boa Vista, Brazil

Background:

Cardiovascular disease is the most common cause of disease in the developed world. Early detection and risk prediction are a key component in reducing cardiovascular mortality. The Framingham Risk Score uses age, sex, cholesterol, blood pressure, diabetes, and smoking to calculate the 10-year risk probability of developing cardiovascular disease for a given patient. The aim of this study was to examine cardiovascular disease risk in men aged over 40 years in Boa Vista, Brazil and identify socioeconomic factors contributing to the risk.

Methods:

This was an epidemiological, cross-sectional, descriptive study. Physical examination and questionnaire survey were conducted on the participants.

Results:

Of the 598 participants (average age = 55.38 ± 10.77 years), 346 completed all the examinations and answered the survey, while 252 completed the survey and the physical examinations but did not undertake the laboratory tests. A large proportion of participants were overweight (42.6%) or obese (23.6%), 14.5% were hypertensive, and 71.9% were prehypertensive. Consumption of red meat and junk food was high, while participation in the exercise was low. Framingham scores ranged from −3 to 13 (mean score: 3.86 ± 3.16). A total of 204 participants (34.1%) had a low risk of cardiovascular disease, 98 (16.4%) had a medium risk, and 44 (7.4%) possessed high risk. Increased abdominal circumference (P = 0.013), resting pulse (P = 0.002), and prostate-specific antigen levels (P < 0.001) were associated with increased risk of cardiovascular disease.

Conclusions:

Our study highlights a worrying trend in increasing obesity and hypertension, most likely associated with increasingly poor diet and reduced participation in exercises. As the Brazilian population ages, this will drive increasing rates of cardiovascular mortality unless these trends are reversed. This study suggests that such campaigns should focus on men over the age of 40, who are married or divorced and of lower income.

A comparison of the dietary patterns derived by principal component analysis and cluster analysis in older Australians

BACKGROUND

Despite increased use of dietary pattern methods in nutritional epidemiology, there have been few direct comparisons of methods. Older adults are a particularly understudied population in the dietary pattern literature. This study aimed to compare dietary patterns derived by principal component analysis (PCA) and cluster analysis (CA) in older adults and to examine their associations with socio-demographic and health behaviours.

METHODS

Men (n = 1888) and women (n = 2071) aged 55-65 years completed a 111-item food frequency questionnaire in 2010. Food items were collapsed into 52 food groups and dietary patterns were determined by PCA and CA. Associations between dietary patterns and participant characteristics were examined using Chi-square analysis. The standardised PCA-derived dietary patterns were compared across the clusters using one-way ANOVA.

RESULTS

PCA identified four dietary patterns in men and two dietary patterns in women. CA identified three dietary patterns in both men and women. Men in cluster 1 (fruit, vegetables, wholegrains, fish and poultry) scored higher on PCA factor 1 (vegetable dishes, fruit, fish and poultry) and factor 4 (vegetables) compared to factor 2 (spreads, biscuits, cakes and confectionery) and factor 3 (red meat, processed meat, white-bread and hot chips) (mean, 95% CI; 0.92, 0.82-1.02 vs. 0.74, 0.63-0.84 vs. -0.43, -0.50- -0.35 vs. 0.60 0.46-0.74, respectively). Women in cluster 1 (fruit, vegetables and fish) scored highest on PCA factor 1 (fruit, vegetables and fish) compared to factor 2 (processed meat, hot chips cakes and confectionery) (1.05, 0.97-1.14 vs. -0.14, -0.21- -0.07, respectively). Cluster 3 (small eaters) in both men and women had negative factor scores for all the identified PCA dietary patterns. Those with dietary patterns characterised by higher consumption of red and processed meat and refined grains were more likely to be Australian-born, have a lower level of education, a higher BMI, smoke and did not meet physical activity recommendations (all P < 0.05).

CONCLUSIONS

PCA and CA identified comparable dietary patterns within older Australians. However, PCA may provide some advantages compared to CA with respect to interpretability of the resulting dietary patterns. Older adults with poor dietary patterns also displayed other negative lifestyle behaviours. Food-based dietary pattern methods may inform dietary advice that is understood by the community.

Socio-economic Aspects of Health-Related Behaviors and Their Dynamics: A Case Study for the Netherlands

BACKGROUND

Previous studies have mostly focused on socio-demographic and health-related determinants of health-related behaviors. Although comprehensive health insurance coverage could discourage individual lifestyle improvement due to the ex-ante moral hazard problem, few studies have examined such effects. This study examines the association of a comprehensive set of factors including socio-demographic, health status, health insurance, and perceived change in health insurance coverage with health-related behaviors and their dynamics (ie, changes in behavior).

METHODS

Using Survey of Health, Aging, and Retirement in Europe (SHARE) data (a European aging survey among 50+ years old) for the Netherlands in 2004 and 2007 (sample size: 1745), binary and multinomial logit models are employed to study health-related behaviors (daily smoking, excessive alcohol use, and physical inactivity in 2004) and their corresponding changes (stopping or starting unhealthy behavior between 2004 and 2007).

RESULTS

Our findings show that being older, being female, having higher education and living with a partner increase the likelihood not to be a daily smoker or to stop daily smoking. At the same time, being older (OR = 3.02 [1.31, 6.95]) and being female (OR = 1.77 [1.05, 2.96]) increases the likelihood to be or to become physically inactive. We also find that worse perceived health insurance coverage in 2007 is associated with a lower likelihood (OR = 0.19 [0.06, 0.57]) of stopping excessive alcohol use in that year. However, we do not find a strong association between the type of health insurance and health behavior.

CONCLUSION

Our findings show that all above mentioned factors (ie, socio-demographic and health status factors) are associated with health-related behavior but not in a consistent way across all behaviors. Moreover, the dynamics of each behavior (positive or negative change) is not necessarily determined by the same factors that determine the state of that behavior. We also find that better perceived health insurance coverage is associated with a healthier lifestyle which is not compatible with an ex-ante moral hazard interpretation. Our results provide input to target policies towards elderly individuals in need of lifestyle change. However, further research should be done to identify the causal effect of health insurance on health-related behavior.

Eating alone and depression in older men and women by cohabitation status: The JAGES longitudinal survey

Background: eating by oneself may be a risk factor for mental illness among older adults, but may be influenced by cohabitation status. We examined the association between eating alone and depression in the context of cohabitation status in older adults in Japan.

Design: a longitudinal, population-based study.

Setting: data from the Japan Gerontological Evaluation Study.

Subjects: we analysed 17,612 men and 19,581 women aged ≥65 without depression (Geriatric Depression Scale <5) at baseline in 2010.

Methods: eating status was classified into two categories: eating with others and eating alone. The risk of depression onset by 2013 was estimated using Poisson regression.

Results: after adjusting for socioeconomic status, physical health, nutritional status, social support, social participation, frequency of meet friends, employment status and marital status, the adjusted rate ratio (ARR) for depression onset in men who ate alone compared with those who ate with others was 2.36 (95% confidence intervals [CI]: 1.18–4.71) for those living alone and 1.03 (95% CI: 0.81–1.32) for those living with others. Among women, the ARR for depression for those who ate alone compared with those who ate with others was 1.31 (95% CI: 1.00–1.72) for those living alone and 1.21 (95% CI: 1.01–1.44) for those living with others.

Conclusions: eating alone may be a risk factor for depression. Among men, the effect of eating alone on depression may be reinforced by living alone, but appears to be broadly comparable in women living alone and women living with others.

The Majority of the Migrant Factory Workers of the Light Industry in Shenzhen, China May Be Physically Inactive

Physical inactivity is a strong risk factor of non-communicable diseases (NCD). In China, there are 250 million migrant factory workers, who are susceptible to physical inactivity and hence NCD because of work nature and setting. With random stratified sampling, 807 such workers of the light industry were recruited in Shenzhen, China and completed a self-administered questionnaire with informed consent. The prevalence of inadequate physical activity (defined according to the World Health Organization’s recommendation on level of moderate/vigorous physical activity) was 95.4%. Of all participants, 69.1% showed “a very low level of physical activity” (VLLPA), defined as ≤30 minutes of weekly moderate/vigorous physical activity, which was significantly associated with female sex (Odds ratio [OR]=1.65), lower education level (OR=0.10 to 0.33, primary education as the reference group) and married status (OR=0.63, single status as the reference group). Adjusted for these factors, perceived social support (Adjusted OR=0.87) was negatively associated with VLLPA, while job stress due to workload, which was significant in the univariate analysis (OR=0.98), became non-significant (p=0.184). Significant interaction between perceived social support and perceived job stress onto VLLPA was found (p=0.044), implying that the negative association between job stress and VLLPA, which might reflect a potential response to cope with stress by performing exercises, was stronger among those with weaker social support. The extremely low level of physical activity rings an alarm, as it implies high risk of NCD, and as there are no existing programs promoting physical activity in this group. Interventions need to take into account social support, potential coping to job stress, and structural factors of the factory setting, while involving factories’ management.

Predictors of physical activity change among adults using observational designs

BACKGROUND

Regular physical activity (PA) is foundational to human health, yet most people are inactive. A sound understanding of the determinants of PA may be instructive for building interventions and/or identifying critical target groups to promote PA. Most research on PA correlates has been biased by cross-sectional or passive prospective designs that fail to examine within-person analysis of PA change.

OBJECTIVE

The purpose of this review was to collect and appraise the available literature on the predictors of PA change conceived broadly in terms of increases/decreases from baseline assessment as well as specifically in terms of adoption and maintenance.

METHODS

Eligible studies were from English, peer-reviewed published articles that examined predictors of natural change of PA over 3 months + using observational (non-experimental) data in adult samples. Searches were performed from June 2012 to January 2014 in eight databases.

RESULTS

Sixty-seven independent data-sets, from 12 countries, primarily of medium quality/risk of bias, were identified with 26 correlates spanning demographic, behavioral, intra-individual, inter-individual, and environmental categories. Only intention and the onset of motherhood could reliably predict overall PA change. Among datasets configured to predict PA adoption, affective judgments and behavioral processes of change were the only reliable predictors, although both only have a small number of available studies. There were no reliable predictors of maintenance when compared to PA relapse.

CONCLUSION

The results underscore the importance of individual-level motivation and behavioral regulation in PA change, but also denote critical social variables. These findings, however, are constrained by PA measurement bias and limited studies that employed time-varying covariation between predictor variables and PA.

Divorce and Death: A Meta-Analysis and Research Agenda for Clinical, Social, and Health Psychology

Divorce is a relatively common stressful life event that is purported to increase risk for all-cause mortality. One problem in the literature on divorce and health is that it is fragmented and spread across many disciplines; most prospective studies of mortality are based in epidemiology and sociology, whereas most mechanistic studies are based in psychology. This review integrates research on divorce and death via meta-analysis and outlines a research agenda for better understanding the potential mechanisms linking marital dissolution and risk for all-cause mortality. Random effects meta-analysis with a sample of 32 prospective studies (involving more than 6.5 million people, 160,000 deaths, and over 755,000 divorces in 11 different countries) revealed a significant increase in risk for early death among separated/divorced adults in comparison to their married counterparts. Men and younger adults evidenced significantly greater risk for early death following marital separation/divorce than did women and older adults. Quantification of the overall effect size linking marital separation/divorce to risk for early death reveals a number of important research questions, and this article discusses what remains to be learned about four plausible mechanisms of action: social selection, resource disruptions, changes in health behaviors, and chronic psychological distress.

Determinants of tobacco smoking among rural-to-urban migrant workers: a cross-sectional survey in Shanghai

Background

Although there are several studies to investigate the smoking behaviors among rural-to-urban Chinese migrants, no study has focused individually on this population in Shanghai. This study was performed to estimate the prevalence and identify the determinants of tobacco smoking among rural-to-urban migrants in Shanghai.

Methods

In this cross-sectional study, multi-stage quota sampling was used to select 5,856 rural-to-urban migrants aged 18 years or older from seven districts in Shanghai between July and October 2012. A structured questionnaire was administered to assess smoking knowledge, attitude, behavior and demographic characteristics. Mental health was assessed by the self-reported SCL-90. Multiple logistic regression analysis was used to determine the risk factors of smoking behavior.

Results

A total of 5,380 of the 5,856 migrants enrolled completed the questionnaire, among whom 45.0% of male and 2.0% of female participants reported current smoking. Multivariate analysis revealed current smoking in female migrants to be significantly associated with working at construction (OR, 8.08; 95% CI, 1.80-36.28), hotels/restaurants (OR, 5.06; 95% CI, 1.68-15.27), entertainment sector (OR, 6.79; 95% CI, 2.51-18.42), with monthly income > 3500 yuan (OR, 2.69; 95% CI, 1.21-5.98), number of migratory cities of 2 (OR, 2.39; 95% CI, 1.23-4.65), and SCL-90 total score > 160 (OR, 2.03; 95% CI, 1.03-3.98), while the male migrants working at construction (OR, 1.30; 95% CI, 1.04-1.62), entertainment sector (OR, 1.86; 95% CI, 1.36-2.56), being divorced/widowed (OR, 2.20; 95% CI, 1.02-4.74), with duration of migration of 4 or more than 4 years (OR, 1.42; 95% CI, 1.06-1.91), number of migratory cities of 3 or more than 3 (OR, 1.42; 95% CI, 1.13-1.80), and SCL-90 total score > 160 (OR,1.39; 95% CI, 1.07-1.79) showed an excess smoking prevalence.

Conclusion

Migration lifestyle and mental status were associated with current smoking behaviors. The identifications of risk factors for current smoking may help to target health promotion interventions.

Long-term dynamics in physical activity behaviour across the transition to parenthood

OBJECTIVES

Gaining a deeper understanding of the dynamic relationships between the transition to parenthood and moderate-to-vigorous physical activity (MVPA) amongst men and women in Australia.

METHODS

12 years of nationally representative panel data from the Household, Income and Labour Dynamics in Australia Survey and a piecewise pre/post fixed-effect modelling strategy that controls for person-specific unobserved effects and allows for non-linear associations are used.

RESULTS

Both men and women decrease the frequency of MVPA in the years preceding the birth of their first child. An abrupt fall amongst men and a smooth, non-linear decreasing trend amongst women are apparent in the post-birth years. Neither men nor women recover their pre-birth MVPA frequency in subsequent years.

CONCLUSIONS

Parenthood is an important factor influencing MVPA, with more marked impacts on women's than men's behaviour. Policymakers interested in promoting MVPA should focus on parenthood as a critical deterring factor that can trigger long-term trends of low MVPA. The proposed model can be expanded to explore the influence on MVPA of other life-course transitions.

Someone to live for: effects of partner and dependent children on preventable death in a population wide sample from Northern Ireland

How to allocate resources between somatic maintenance and reproduction in a manner that maximizes inclusive fitness is a fundamental challenge for all organisms. Life history theory predicts that effort put into somatic maintenance (health) should vary with sex, mating and parenting status because men and women have different costs of reproduction, and because life transitions such as family formation alter the fitness payoffs from investing in current versus future reproduction. However, few tests of how such life history parameters influence behaviours closely linked to survival exist. Here we examine whether specific forms of preventable death (accidents/suicides, alcohol-related causes, and other preventable diseases) are predicted by marital status and dependent offspring in a modern developed context; that of Northern Ireland. We predict that men, non-partnered individuals and individuals who do not have dependent offspring will be at higher risk of preventable death. Running survival analyses on the entire adult population (aged 16-59, n = 927,134) controlling for socioeconomic position (SEP) and other potential confounds, we find that being single (compared to cohabiting/married) increases risk of accidental/suicide death for men (but not for women), whereas having dependent children is associated with lower risk of preventable mortality for women but less so for men. We also find that the protective effect of partners is larger for men with low SEP than for high SEP men. Findings support life history predictions and suggest that individuals respond to variation in fitness costs linked to their mating and parenting status.

Time for change? Food choices in the transition to cohabitation and parenthood

OBJECTIVE

We compared the dietary behaviour of three different household types and explored developmental trends in food choices following a life event.

DESIGN

The study is based on data from three Swiss Food Panel survey periods. A cross-sectional comparison between household types was conducted by using a one-way independent ANOVA. Repeated measures were analysed with a mixed ANCOVA to examine changes in dietary behaviour following a life event.

SETTING

Participants in the survey filled in a questionnaire in the years 2010, 2011 and 2012.

SUBJECTS

The final sample consisted of 3559 persons with a mean age of 56 years (range 22-94 years; 46 % men). Seventy-two people moved in with their partner and sixty-five people reported the birth of their first child.

RESULTS

Cross-sectional evidence confirmed that women living in households with a partner reported higher consumption frequencies for meat and processed meats compared with those living alone. Men living in cohabitation had a higher vegetable intake. The transitional effect of moving in with a partner, however, resulted in a higher intake of processed meats for both genders and a higher intake of pork and savoury items for men. Transition to motherhood was linked to an increase in vegetable consumption, while the transition to fatherhood did not change consumption patterns significantly.

CONCLUSIONS

Individuals in life-stage transitions are more likely to change their nutritional strategies and life events can be a window of opportunity for changes towards better food choices.

Major stressful life events in adulthood and risk of multiple sclerosis

OBJECTIVE

It is unclear whether psychological stress is associated with increased risk of multiple sclerosis (MS). We studied the association between major stressful life events and MS in a nationwide cohort study using death of a child or a spouse or marital dissolution as indicators of severe stress.

METHODS

We created two study cohorts based on all Danish men and women born 1950-1992. One cohort consisted of all persons who became parents between 1968 and 2010, and another cohort consisted of all persons who married between 1968 and 2010. Members of both cohorts were followed for MS between 1982 and 2010 using data from the National Multiple Sclerosis Registry. Associations between major stressful life events and risk of MS were evaluated by means of MS incidence rate ratios (RR) with 95% confidence interval (CI) obtained in Poisson regression analyses.

RESULTS

During approximately 30 million person-years of follow-up, bereaved parents experienced no unusual risk of MS compared with parents who did not lose a child (RR=1.12 (95% CI 0.89 to 1.38)). Likewise, neither divorced (RR=0.98 (95% CI 0.89 to 1.06)) nor widowed (RR=0.98 (95% CI 0.71 to 1.32) persons were at any unusual risk of MS compared with married persons of the same sex.

CONCLUSIONS

Our national cohort study provides little evidence for a causal association between major stressful life events (as exemplified by divorce or the loss of a child or a spouse) and subsequent MS risk.

Bachelors, divorcees, and widowers: does marriage protect men from type 2 diabetes?

While research has suggested that being married may confer a health advantage, few studies to date have investigated the role of marital status in the development of type 2 diabetes. We examined whether men who are not married have increased risk of incident type 2 diabetes in the Health Professionals Follow-up Study. Men (n = 41,378) who were free of T2D in 1986, were followed for ≤22 years with biennial reports of T2D, marital status and covariates. Cox proportional hazard models were used to compare risk of incident T2D by marital status (married vs unmarried and married vs never married, divorced/separated, or widowed). There were 2,952 cases of incident T2D. Compared to married men, unmarried men had a 16% higher risk of developing T2D (95%CI:1.04,1.30), adjusting for age, family history of diabetes, ethnicity, lifestyle and body mass index (BMI). Relative risks (RR) for developing T2D differed for divorced/separated (1.09 [95%CI: 0.94,1.27]), widowed (1.29 [95%CI:1.06,1.57]), and never married (1.17 [95%CI:0.91,1.52]) after adjusting for age, family history of diabetes and ethnicity. Adjusting for lifestyle and BMI, the RR for T2D associated with widowhood was no longer significant (RR:1.16 [95%CI:0.95,1.41]). When allowing for a 2-year lag period between marital status and disease, RRs of T2D for widowers were augmented and borderline significant (RR:1.24 [95%CI:1.00,1.54]) after full adjustment. In conclusion, not being married, and more specifically, widowhood was more consistently associated with an increased risk of type 2 diabetes in men and this may be mediated, in part, through unfavorable changes in lifestyle, diet and adiposity.

Divorce and risk of hospital-diagnosed infectious diseases

BACKGROUND

Although, divorce is considered to have a negative impact on morbidity, very little is known concerning exposure to divorce and risk of infectious diseases. We aimed to investigate the association between divorce and subsequent hospital contacts with infectious diseases.

METHODS

We performed a nation-wide cohort study, including all Danish men and women (n≈5.6 million) alive on the 1 January 1982 or later, and followed them for infectious disease diagnosed in hospital settings from 1982 to 2010. The association between divorce and risk of infectious diseases was evaluated through rate ratios (RRs) comparing incidence rates of infectious diseases between divorced and married pesons.

RESULTS

Compared with married persons, divorced persons were overall at a 1.48 fold (RR=1.48 (95% CI: 1.47-1.50)) increased risk of hospital-diagnosed infectious diseases (RR adjusted for sex, age, period, income and education). The risk of infectious diseases was slightly more pronounced for divorced women (RR=1.54 (1.52-1.56)) than divorced men ((RR=1.42 (1.41-1.44)). The increased risk remained almost unchanged even more than 15 years after the divorce. Young age at divorce, short duration of marriage and number of divorces further increased the risk of infectious diseases, whereas number of children at time of divorce had no impact on risk of hospital-diagnosed infectious diseases following the divorce.

CONCLUSIONS

Divorce appears to have a moderate but long lasting impact on the risk of infectious diseases the underlying mechanism is unknown but shared risk factors predicting divorce and infectious diseases could contribute to our findings.

The effect of widowhood on husbands' and wives' physical activity: the Cardiovascular Health Study

This prospective study examined the effect of widowhood on physical activity by comparing widowed elders to health status-, age-, and sex-matched married controls. Participants included 396 married controls and 396 widows/widowers age 64-91 (M age = 72.7 years) who experienced the death of their spouse while participating in the Cardiovascular Health Study. Compared to married controls, widowed men, but not women, were more likely to increase their physical activity following the death of their spouse. However, this increased level of activity was not sustained and declines as time since spousal death passes. Moreover, during the year before spousal death, soon-to-be widowed men, but not women, increase their physical activity. Our results suggest that widowed men experience significant changes in physical activity and that the transition to widowhood contribute to these changes.

Changes in routine health behaviors following late-life bereavement: a systematic review

This systematic review examines the relationship between late-life spousal bereavement and changes in routine health behaviors. We review six behavioral domains/modifiable risk factors that are important for maintaining health among elderly populations: physical activity, nutrition, sleep quality, alcohol consumption, tobacco use, and body weight status. Thirty-four articles were identified, derived from 32 studies. We found strong evidence for a relationship between bereavement and nutritional risk and involuntary weight loss, and moderate evidence for impaired sleep quality and increased alcohol consumption. There was mixed evidence for a relationship between bereavement and physical activity. We identify several methodological shortcomings, and describe the clinical implications of this review for the development of preventive intervention strategies.

The association between depression and widowhood and nutritional status in older adults

This study aimed to investigate the association of depression and widowhood on the nutritional status of older adults. A cross-sectional study of community-dwelling older adults in the rural United States was conducted. Dietary intake was measured via questionnaires. Depression status was classified by asking participants if they have ever been diagnosed with the condition, or by review of medical records. The final sample consisted of 1065 participants with 141 (13.2%) depressed, 384 (36.1%) widowed, and 67 (6.3%) both depressed and widowed. Mean caloric intake for total study population was low; widows and widowers had the lowest energy consumption among all groups. Greater intake of several nutrients was observed in depressed and/or widowed subjects. Nutritional services, such as congregate and home delivered meal programs, were not identified as significant contributors to the nutritional intake in older adults who were depressed, widowed, or both. Health care professionals may contribute to meal-based nutrition programs by offering their assistance in aspects of nutritional education and counseling for the promotion of healthy aging.

Social relationships and health related behaviors among older US adults

BACKGROUND

Health behaviors are a key determinant of health and well-being that are influenced by the nature of the social environment. This study examined associations between social relationships and health-related behaviors among a nationally representative sample of older people.

METHODS

We analyzed data from three waves (1999-2004) of the US National Health and Nutrition Examination Survey (NHANES). Participants were 4,014 older Americans aged 60 and over. Log-binomial regression models estimated prevalence ratios (PR) for the associations between social relationships and each of the following health behaviors: alcohol use, smoking, physical activity and dental attendance.

RESULTS

Health-compromising behaviors (smoking, heavy drinking and less frequent dental visits) were related to marital status, while physical activity, a health-promoting behavior, was associated with the size of friendship networks. Smoking was more common among divorced/separated (PR = 2.1; 95% CI: 1.6, 2.7) and widowed (PR = 1.7; 95% CI: 1.3, 2.3) respondents than among those married or cohabiting, after adjusting for socio-demographic background. Heavy drinking was 2.6 times more common among divorced/separated and 1.7 times more common among widowed men compared to married/cohabiting men, while there was no such association among women. For women, heavy drinking was associated with being single (PR = 1.7; 95% CI: 1.0, 2.9). Being widowed was related to a lower prevalence of having visited a dentist compared to being married or living with a partner (PR = 0.92; 95% CI 0.86, 0.99). Those with a larger circle of friends were more likely to be physically active (PR = 1.17; 95% CI:1.06, 1.28 for 5-8 versus less than 5 friends).

CONCLUSIONS

Social relationships of older Americans were independently associated with different health-related behaviors, even after adjusting for demographic and socioeconomic determinants. Availability of emotional support did not however mediate these associations. More research is needed to assess if strengthening social relationships would have a significant impact on older people's health behaviors and ultimately improve their health.

The influence of bereavement on body mass index: results from a national Swedish survey

Background

Previous findings suggest that the loss of a family member is associated with health and mortality. The purpose of this study was to investigate the association between bereavement experiences and BMI, and whether there are socio-demographic differences in this association.

Objective

To investigate the association between bereavement experiences and BMI, and whether there are socio-demographic differences in this association.

Methods

We used cross-sectional data with retrospective questions from the Swedish Level of Living Survey (LNU) of 2000, including 5,142 individuals. The bereavement experiences examined in the study include the loss of a sibling, a parent or a spouse, and time since the death of a parent. BMI (kg/m²) was calculated using self-reported measurements of weight and height. The association between bereavement and BMI was evaluated through linear regressions.

Results

After controlling for possible confounders, most of the models detected an association between bereavement and BMI. The fully-adjusted model showed that loss of parents was associated with a 0.45 increase in BMI (SE = 0.20). The effect also seemed to be dependent on time since the loss and social class position.

Conclusions

The present study is the first to examine associations between different types of familial losses and BMI. We find an association between the death of a family member and BMI, but it appears to be related to time since the death, type of bereavement experience and social class.

Weight gain among men and women who have a child enter their home

Parenthood is associated with decreased physical activity and dietary changes. Previously, mothers have been the focus of studies examining the influence of children on parents' body mass index (BMI), largely ignoring whether parenting affects fathers. This study assessed weight gain in mothers and fathers (by birth or other), using longitudinal repeated-measures models to assess BMI changes over time; parents were compared with nonparents. Data were from the Coronary Artery Risk Development in Young Adults cohort study and included 2,881 black and white adults, ages 18 to 30 years, without children at baseline (1985-1986), and from four urban locations. At each time point (years 2, 5, and 7), changes in BMI from baseline were analyzed, comparing those who had their children in their household at that time point (parents) and those without children (nonparents). The "child effect" is the mean difference in BMI change in parents compared with nonparents. In fathers, overall, the child effect was not significant (black males: 0.30; P=0.09; white males: 0.03; P=0.77). Among black men, however, interactions between age and parental status were significant (P=0.02). Black men who were aged 18 to 24 years at baseline and became fathers during the next 7 years demonstrated a significant child effect, gaining an average of 0.68 more in BMI than nonfathers (P=0.003). Mothers of both races demonstrated the child effect; for blacks it was 0.65 (P=0.003) and for whites it was 1.12 (P≤0.001). These data reveal that becoming a parent can affect the BMI of some adults and suggest that obesity-prevention interventions for children and adult-focused healthy-lifestyle interventions could have additional impact through a family focus targeting both parent and child outcomes.

Does marriage protect against hospitalization with pneumonia? A population-based case-control study

BACKGROUND

To reduce the increasing burden of pneumonia hospitalizations, we need to understand their determinants. Being married may decrease the risk of severe infections, due to better social support and healthier lifestyle.

PATIENTS AND METHODS

In this population-based case-control study, we identified all adult patients with a first-time pneumonia-related hospitalization between 1994 and 2008 in Northern Denmark. For each case, ten sex- and age-matched population controls were selected from Denmark's Civil Registration System. We performed conditional logistic regression analysis to estimate the odds ratios (ORs) for pneumonia hospitalization among persons who were divorced, widowed, or never married, as compared with married persons, adjusting for age, sex, 19 different comorbidities, alcoholism-related conditions, immunosuppressant use, urbanization, and living with small children.

RESULTS

The study included 67,162 patients with a pneumonia-related hospitalization and 671,620 matched population controls. Compared with controls, the pneumonia patients were more likely to be divorced (10% versus 7%) or never married (13% versus 11%). Divorced and never-married patients were much more likely to have previous diagnoses of alcoholism-related conditions (18% and 11%, respectively) compared with married (3%) and widowed (6%) patients. The adjusted OR for pneumonia-related hospitalization was increased, at 1.29 (95% confidence interval [CI]: 1.25-1.33) among divorced; 1.15 (95% CI: 1.12-1.17) among widowed; and 1.33 (95% CI: 1.29-1.37) among never-married individuals as compared with those who were married.

CONCLUSION

Married individuals have a decreased risk of being hospitalized with pneumonia compared with never-married, divorced, and widowed patients.

The impacts of marriage, cohabitation and dating relationships on weekly self-reported physical activity in Germany: a 19-year longitudinal study

Despite the increasing number of non-marital romantic relationships in developed countries, little is known about their effects on health-related behaviors. This paper examined the impact of relationship status (single, dating, cohabiting or married) on physical activity. Three possible mechanisms underlying this association were discussed: social control and support by the partner, time restrictions and the release from the marriage market. Data were obtained from the German Socio-Economic Panel (GSOEP), a random sample of individuals living in private households in Germany. Both random-effects and fixed-effects logit models were estimated. The random-effects analyses referred to 30,201 individuals and the fixed-effects analyses referred to 11,568 individuals who were observed for up to 19 years. After adjusting for age, measurement period and the presence of children, fixed-effects estimates showed reduced physical activity for each type of relationship for both men and women. The effects were strongest for married couples and weakest for dating couples, and remained similar after controlling for discretionary time. However, the effects found partly depended on age: for men, the negative impacts of cohabitation and marriage on physical activity became weaker with increasing age and shifted to positive impacts. For women, the negative effect of marriage on physical activity also decreased but stayed negative into old age. The results suggest that the release from the marriage market may cause the negative effects of relationships on physical activity. Social support and social control may play a role in older age, whereas the amount of discretionary time seems to be of minor importance for explaining relationship effects on physical activity. If the results will be validated by other studies there will be valuable implications for health promotion programs.

Social relationships and healthful dietary behaviour: evidence from over-50s in the EPIC cohort, UK

Social relationships are an important aspect of a person's social environment that can protect against a wide range of chronic conditions and facilitate recovery from disease. Social relationships have also been linked to dietary behaviour which may be an important pathway through which social circumstances exert their influence on health. Yet, questions remain about which structural aspects of social relationships most affect healthful dietary behaviours and whether different structural components interact to produce a combined effect. Using data from adults (≥50 years) in the European Prospective Investigation of Cancer-Norfolk study (1996-2002), we examined marital status, living arrangement and social isolation in relation to scores for variety of fruit and vegetable intake as a marker of diet quality associated with adverse health outcomes. Data were analysed with multivariable linear regression models for gender-specific and interaction associations. We found that being single or widowed was associated with a lower variety score, particularly vegetable variety, and associations were enhanced when combined with male gender, living alone or infrequent friend contact. Lower variety scores for lone-living were also observed, especially for men. Infrequent friend contact interacted with living arrangement to amplify negative associations of lone-living with variety, with statistically significant differences in contact frequency for vegetable variety. Lower levels of friend contact were associated with reduced variety of fruits and vegetables in a graded trend for both genders; the trend was more pronounced among men. Family contact appeared to have limited association with vegetable variety in men; among women, weekly contact was significantly and positively associated with vegetable variety compared to daily family contact. Results highlight the importance of considering living arrangement and/or frequency of social contact when assessing whether widowed, single or lone-living older adults are at risk of lower fruit and vegetable variety.

Dieting and encouragement to diet by significant others: associations with disordered eating in young adults

PURPOSE

Examine the role of perceived significant other's modeling or encouragement of dieting in young adults' disordered eating behaviors.

DESIGN

Online survey data were collected (2008-2009) as part of an ongoing study examining weight and related issues in young people.

SETTING

Participants were originally recruited as students at middle and high schools in Minnesota (1998-1999).

SUBJECTS

One thousand two hundred ninety-four young adults (mean age 25.3, 55% female, 50% white) with significant others.

MEASURES

Participants were asked if their significant other diets or encourages them to diet. Behaviors included unhealthy weight control, extreme weight control, and binge eating.

ANALYSIS

General linear models estimated the predicted probability of using each behavior across levels of significant other's dieting or encouraging dieting, stratifying by gender, and adjusting for demographics and body mass index.

RESULTS

Perceived dieting and encouragement to diet by significant others were common. Disordered eating behaviors were positively associated with significant other's dieting and encouragement to diet, particularly for females. In models including both perceived dieting and encouragement, encouragement remained significantly associated with disordered eating. For example, women's binge eating was almost doubled if their significant other encouraged dieting "very much" (25.5%) compared to "not at all" (13.6%, p = .015).

CONCLUSION

There is a strong association between disordered eating behaviors and perceived modeling and encouragement to diet by significant others in young adulthood.

Dietary patterns and diet quality among diverse older adults: the University of Alabama at Birmingham Study of Aging

OBJECTIVES

To characterize dietary patterns among a diverse sample of older adults (≥ 65 years).

DESIGN

Cross-sectional.

SETTING

Five counties in west central Alabama.

PARTICIPANTS

Community-dwelling Medicare beneficiaries (N=416; 76.8 ± 5.2 years, 56% female, 39% African American) in the University of Alabama at Birmingham (UAB) Study of Aging.

MEASUREMENTS

Dietary data collected via three, unannounced 24-hour dietary recalls was used to identify dietary patterns. Foods were aggregated into 13 groups. Finite mixture modeling (FMM) was used to classify individuals into three dietary patterns. Differences across dietary patterns for nutrient intakes, sociodemographic, and anthropometric measurements were examined using chi-square and general linear models.

RESULTS

Three dietary patterns were derived. A "more healthful" dietary pattern, with relatively higher intakes of fruit, vegetables, whole grains, eggs, nuts, legumes and dairy, was associated with lower energy density, higher quality diets as determined by healthy eating index (HEI)-2005 scores and higher intakes of fiber, folate, vitamins C and B6, calcium, iron, magnesium, and zinc. The "western-like" pattern was defined by an intake of starchy vegetables, refined grains, meats, fried poultry and fish, oils and fats and was associated with lower HEI-2005 scores. The "low produce, high sweets" pattern was characterized by high saturated fat, and low dietary fiber and vitamin C intakes. The strongest predictors of better diet quality were female gender and non-Hispanic white race.

CONCLUSION

The dietary patterns identified may provide a useful basis on which to base dietary interventions targeted at older adults. Examination of nutrient intakes regardless of the dietary pattern suggests that older adults are not meeting nutrient recommendations and should continue to be encouraged to choose high quality diets.

Examining a ripple effect: do spouses' behavior changes predict each other's weight loss?

BACKGROUND

Including spouses in obesity treatment has been found to promote weight loss. We assessed whether spouses' diet and activity changes impacted each other's weight loss when both members attended an active weight loss program (TOGETHER) or only the primary participant attended treatment (ALONE).

METHODS

Heterosexual couples (N = 132) enrolled in an 18-month randomized controlled weight loss trial were weighed and completed measures of dietary intake and physical activity at baseline and 6 months. We conducted dyadic data analyses using the Actor-Partner Interdependence Model.

RESULTS

Participants' weight loss was not predicted by their partners' behavior changes. However, partners' weight loss was predicted by their participants' changes in calorie and fat intake. When partners were coupled with a participant who did not reduce their own calorie and fat intake as much, these partners had higher weight loss when treated in the TOGETHER group but lower weight loss when they were untreated in the ALONE group. There were no reciprocal effects found with physical activity changes.

CONCLUSIONS

Direct treatment had the greatest impact on participants and partners who were treated. Untreated partners' weight losses were positively impacted by their spouses' dietary changes, suggesting a ripple effect from treated spouses to their untreated partners.

Nutrition and depression at the forefront of progress

Depression is a debilitating disorder estimated to become the second cause of morbidity worldwide by the year 2020. The limited efficacy of antidepressant therapy, as well as the major negative consequences of this disorder, has stimulated additional research in order to determine possible adjunctive treatments. There is mounting evidence linking dietary patterns to major depression development. This article presents some of the most significant findings concerning the role of nutrition in major depressive disorder. Although more focused and clear results are needed, the correlation between nutrition and mental health is gaining attention. Now, there is evidence supporting the importance of nutrition in maintaining good mental health. We emphasize multiple findings that support adherence to healthy dietary patterns, taking into account that the production of neurotransmitters need, among others, right amounts of nutrients, a lot of which can only be supplied through diet. Not only certain nutrients are needed for proper brain functioning, but also others can be harmful, promoting depression. The Mediterranean diet has been linked to a low prevalence of depression while fast-food consumption has been found to increase the risk of developing and aggravating this disorder, hence the need for nutritional interventions. From the perspective of discovering modifiable risk factors, the role of nutrition in psychiatry could be more important than it was initially considered.

Marriage, gender and obesity in later life

A large body of literature argues that marriage promotes health and increases longevity. But do these benefits extend to maintaining a healthy body weight, as the economic theory of health investment suggests they should? They do not. Using the Health and Retirement Study (HRS), I find that entry into marriage among both men and women aged 51-70 is associated with weight gain and exit from marriage with weight loss. I evaluate three additional theories with respect to the cross-sectional and longitudinal variation in the data. First, it may be that a broader set of shared risk factors (such as social obligations regarding meals) raises body mass for married couples. However, the shared risk factor model predicts that the intra-couple correlation should increase with respect to marital duration. Instead, it declines. Second, scholars have recently promoted a "crisis" model of marriage in which marital transitions, not marital status, determine differences in body mass. The crisis model is consistent with short-term effects seen for divorce, but not for the persistent weight gains associated with marriage or the persistent weight loss following widowhood. And transition models, in general, cannot explain significant cross-sectional differences across marital states in a population that is no longer experiencing many transitions, nor can it account for the prominent gender differences (in late middle-age, the heaviest group is unmarried women and the lightest are unmarried men). Third, I argue that pressures of the marriage market, in combination with gendered preferences regarding partner BMI, can account for all the longitudinal and cross-sectional patterns found in the data.

Marital Status and Health Behavior in Middle-aged Korean Adults

Background

Marital status is as an important sociodemographic variable for health studies. We assessed the association between marital status and health behavior in middle-aged Korean adults.

Methods

This is a cross-sectional study of 2,522 Korean middle-aged adults (1,049 men, 1,473 women) from the 2010 Korean National Health and Nutrition Examination Survey. The subjects were classified as living with a partner or living without a partner (never married, separated, widowed, and divorced). We assessed the relationship between marital status and five health behaviors (smoking, high-risk alcohol intake, regular exercise, regular breakfast consumption, and undergoing periodic health screening).

Results

Age, income level, educational level, and occupational classification were all significantly associated with marital status. The risk of undergoing health screening (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.32 to 0.90) and having regular breakfast (OR, 0.50; 95% CI, 0.27 to 0.92) were significantly lower in men living without a partner than with a partner. Women living without a partner had a higher smoking risk (OR, 2.27; 95% CI, 1.09 to 4.73) and a higher risk of high-risk alcohol consumption (OR, 5.33; 95% CI, 1.65 to 17.24) than their counterparts.

Conclusion

Korean middle-aged adults living with partners are more likely to have healthier behavior than living without a partner. The association between marital status and health behaviors differed by sex.

Life events and change in leisure time physical activity: a systematic review

The global epidemic of chronic non-communicable diseases is closely related to changes in lifestyle, including decreasing leisure time physical activity (PA). Physical inactivity is a major public health challenge. To respond to that challenge, it is essential to know which personal and environmental factors affect PA behaviour. Certain life events may be one contributing factor, by creating emotional distress and disrupting a person's daily routine. The aim was to examine the literature concerning the effects of life events on changes in PA. A systematic literature search was performed on studies that assessed at least one major change in life circumstances and a change in PA. To be included, studies had to assess PA at two timepoints at least (before and after the event). Diseases as life events were excluded from this review. Thirty-four articles met the inclusion criteria. The studies examined the following life-change events: transition to university; change in employment status; marital transitions and changes in relationships; pregnancy/having a child; experiencing harassment at work, violence or disaster; and moving into an institution. The studies reviewed showed statistically significant changes in leisure PA associated with certain life events. In men and women, transition to university, having a child, remarriage and mass urban disaster decreased PA levels, while retirement increased PA. In young women, beginning work, changing work conditions, changing from being single to cohabiting, getting married, pregnancy, divorce/separation and reduced income decreased PA. In contrast, starting a new personal relationship, returning to study and harassment at work increased PA. In middle-aged women, changing work conditions, reduced income, personal achievement and death of a spouse/partner increased PA, while experiencing violence and a family member being arrested or jailed decreased PA. In older women, moving into an institution and interpersonal loss decreased PA, while longer-term widowhood increased PA. In addition, experiencing multiple simultaneous life events decreased PA in men and women. Major life events have a strong effect on leisure PA behaviour. Consequently, people experiencing life events could be an important target group for PA promotion. More research is needed to examine the short- and long-term effects of different life events on PA, gender differences in the effects of life events and the specific determinants of PA change during life events.