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Flores-Barrantes P, De Miguel-Etayo P, Iglesia I, ChinAPaw MJ, Cardon G, De Craemer M, Iotova V, Usheva N, Kułaga Z, Kotowska A, Koletzko B, Birnbaum J, Manios Y, Androutsos O, Moreno LA, Gibson EL. Longitudinal associations between food parenting practices and dietary intake in preschool children: The ToyBox Study. Nutrition 2024; 124:112454. [PMID: 38788341 DOI: 10.1016/j.nut.2024.112454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/24/2024] [Accepted: 03/29/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Food Parenting Practices (FPPs) include the practices parents use in the act of feeding their children, which may further influence their health. OBJECTIVES To assess associations between changes in FPPs (permissiveness, food availability, guided choices, water encouragement, rules and limits and the use of food as reward) over 1 year and dietary intake (water, energy-dense/nutrient-poor and nutrient-dense foods) at follow-up in 4- to 6-year-old preschool-aged children. METHODS Longitudinal data from the control group of the ToyBox study, a cluster-randomized controlled intervention study, was used (NCT02116296). Multilevel ordinal logistic regression analyses including FPP as the independent variables and dietary intake as outcome. RESULTS Nine hundred sixty-four parent-child dyads (50.5% boys and 95.0% mothers) were included. Limited changes on the use of FPPs were observed over time. Nevertheless, in boys, often having F&V at home was associated with higher F&V consumption (OR = 6.92 [1.58; 30.38]), and increasing home availability of F&V was directly associated with higher water consumption (OR = 7.62 [1.63; 35.62]). Also, not having sweets or salty snacks available at home was associated with lower consumption of desserts (OR = 4.34 [1.75; 10.75]). In girls, having F&V availability was associated with higher F&V consumption (OR = 6.72 [1.52; 29.70]) and lower salty snack consumption (OR = 3.26 [1.50; 7.10]) and never having soft drinks at home was associated with lower consumption of sweets (OR = 7.89 [6.32; 9.86]). Also, never being permissive about soft drink consumption was associated with lower soft drink consumption (OR = 4.09 [2.44; 6.85]). CONCLUSION Using favorable FPPs and avoiding the negative ones is prospectively associated with healthier dietary intake, especially of F&V, and less intake of soft drinks, desserts, and salty snacks.
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Affiliation(s)
- Paloma Flores-Barrantes
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto De Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto De Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Iris Iglesia
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto De Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0012, Instituto de Salud Carlos III, Madrid, Spain.
| | - Mai Jm ChinAPaw
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, The Netherlands
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University. Ghent, Belgium
| | | | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, Bulgaria
| | - Natalya Usheva
- Department of Social Medicine and Health Care Organization, Medical University of Varna, Varna, Bulgaria
| | - Zbigniew Kułaga
- Public Health Department, The Children's Memorial Health Institute, Warsaw, Poland
| | - Aneta Kotowska
- Public Health Department, The Children's Memorial Health Institute, Warsaw, Poland
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children's Hospital, LMU-Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Julia Birnbaum
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children's Hospital, LMU-Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece; Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece; Lab of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto De Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - E Leigh Gibson
- School of Psychology, University of Roehampton, London, United Kingdom
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Grice-Jackson T, Rogers I, Ford E, Dickinson R, Frere-Smith K, Goddard K, Silver L, Topham C, Nahar P, Musinguzi G, Bastiaens H, Van Marwijk H. A community health worker led approach to cardiovascular disease prevention in the UK-SPICES-Sussex (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and Sub-saharan Africa): an implementation research project. FRONTIERS IN HEALTH SERVICES 2024; 4:1152410. [PMID: 38784704 PMCID: PMC11113076 DOI: 10.3389/frhs.2024.1152410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/20/2024] [Indexed: 05/25/2024]
Abstract
Background This paper describes a UK-based study, SPICES-Sussex, which aimed to co-produce and implement a community-based cardiovascular disease (CVD) risk assessment and reduction intervention to support under-served populations at moderate risk of CVD. The objectives were to enhance stakeholder engagement; to implement the intervention in four research sites and to evaluate the use of Voluntary and Community and Social Enterprises (VCSE) and Community Health Worker (CHW) partnerships in health interventions. Methods A type three hybrid implementation study design was used with mixed methods data. This paper represents the process evaluation of the implementation of the SPICES-Sussex Project. The evaluation was conducted using the RE-AIM framework. Results Reach: 381 individuals took part in the risk profiling questionnaire and forty-one women, and five men participated in the coaching intervention. Effectiveness: quantitative results from intervention participants showed significant improvements in CVD behavioural risk factors across several measures. Qualitative data indicated high acceptability, with the holistic, personalised, and person-centred approach being valued by participants. Adoption: 50% of VCSEs approached took part in the SPICES programme, The CHWs felt empowered to deliver high-quality and mutually beneficial coaching within a strong project infrastructure that made use of VCSE partnerships. Implementation: Co-design meetings resulted in local adaptations being made to the intervention. 29 (63%) of participants completed the intervention. Practical issues concerned how to embed CHWs in a health service context, how to keep engaging participants, and tensions between research integrity and the needs and expectations of those in the voluntary sector. Maintenance: Several VCSEs expressed an interest in continuing the intervention after the end of the SPICES programme. Conclusion Community-engagement approaches have the potential to have positively impact the health and wellbeing of certain groups. Furthermore, VCSEs and CHWs represent a significant untapped resource in the UK. However, more work needs to be done to understand how links between the sectors can be bridged to deliver evidence-based effective alternative preventative healthcare. Reaching vulnerable populations remains a challenge despite partnerships with VCSEs which are embedded in the community. By showing what went well and what did not, this project can guide future work in community engagement for health.
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Affiliation(s)
- Thomas Grice-Jackson
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Imogen Rogers
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Robert Dickinson
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Kat Frere-Smith
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Katie Goddard
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Linda Silver
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Catherine Topham
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Papreen Nahar
- Department of Global Health Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Geofrey Musinguzi
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Central Region, Uganda
| | - Hilde Bastiaens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Harm Van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
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Holmes E, Dixon P, Mathieson A, Ridsdale L, Morgan M, McKinlay A, Dickson J, Goodacre S, Jackson M, Foster D, Hardman K, Bell S, Marson A, Hughes D, Noble AJ. Developing an alternative care pathway for emergency ambulance responses for adults with epilepsy: A Discrete Choice Experiment to understand which configuration service users prefer. Part of the COLLABORATE project. Seizure 2024; 118:28-37. [PMID: 38615478 DOI: 10.1016/j.seizure.2024.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION To identify service users' preferences for an alternative care pathway for adults with epilepsy presenting to the ambulance service. METHODS Extensive formative work (qualitative, survey and knowledge exchange) informed the design of a stated preference discrete choice experiment (DCE). This hypothetical survey was hosted online and consisted of 12 binary choices of alternative care pathways described in terms of: the paramedic's access to medical records/ 'care plan', what happens next (described in terms of conveyance), time, availability of epilepsy specialists today, general practitioner (GP) notification and future contact with epilepsy specialists. DCE scenarios were described as: (i) typical seizure at home. (ii) typical seizure in public, (iii) atypical seizure. Respondents were recruited by a regional English ambulance service and by national public adverts. Participants were randomised to complete 2 of the 3 DCEs. RESULTS People with epilepsy (PWE; n = 427) and friends/family (n = 167) who completed the survey were representative of the target population. PWE preferred paramedics to have access to medical records, non-conveyance, to avoid lengthy episodes of care, availability of epilepsy specialists today, GP notification, and contact with epilepsy specialists within 2-3 weeks. Significant others (close family members or friends) preferred PWE experiencing an atypical seizure to be conveyed to an Urgent Treatment Centre and preferred shorter times. Optimal configuration of services from service users' perspective far out ranked current practice (rank 230/288 possible configurations). DISCUSSION Preferences differ to current practice but have minimal variation by seizure type or stakeholder. Further work on feasibility of these pathways in England, and potentially beyond, is required.
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Affiliation(s)
- Emily Holmes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Pete Dixon
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Amy Mathieson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK; Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, UK
| | - Alison McKinlay
- Department of Basic and Clinical Neuroscience, King's College London, London, UK; Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Jon Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | | | | | - Steve Bell
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Dyfrig Hughes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
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Siersbaek R, Ford J, Ní Cheallaigh C, Thomas S, Burke S. How do health system factors (funding and performance) impact on access to healthcare for populations experiencing homelessness: a realist evaluation. Int J Equity Health 2023; 22:218. [PMID: 37848878 PMCID: PMC10583475 DOI: 10.1186/s12939-023-02029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND People experiencing long-term homelessness face significant difficulties accessing appropriate healthcare at the right time and place. This study explores how and why healthcare performance management and funding arrangements contribute to healthcare accessibility or the lack thereof using long-term homeless adults as an example of a population experiencing social exclusion. METHODS A realist evaluation was undertaken. Thirteen realist interviews were conducted after which data were transcribed, coded, and analysed. RESULTS Fourteen CMOCs were created based on analysis of the data collected. These were then consolidated into four higher-level CMOCs. They show that health systems characterised by fragmentation are designed to meet their own needs above the needs of patients, and they rely on practitioners with a special interest and specialised services to fill the gaps in the system. Key contexts identified in the study include: health system fragmentation; health service fragmentation; bio-medical, one problem at a time model; responsive specialised services; unresponsive mainstream services; national strategy; short health system funding cycles; and short-term goals. CONCLUSION When health services are fragmented and complex, the needs of socially excluded populations such as those experiencing homelessness are not met. Health systems focus on their own metrics and rely on separate actors such as independent NGOs to fill gaps when certain people are not accommodated in the mainstream health system. As a result, health systems lack a comprehensive understanding of the needs of all population groups and fail to plan adequately, which maintains fragmentation. Policy makers must set policy and plan health services based on a full understanding of needs of all population groups.
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Affiliation(s)
- Rikke Siersbaek
- Discipline of Clinical Medicine, School of Medicine, Trinity College Dublin Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.
| | - John Ford
- Wolfson Institute for Population Health, Queen Mary University, Charterhouse Square, London, EC1M 6BQ, UK
| | - Clíona Ní Cheallaigh
- Discipline of Clinical Medicine, School of Medicine, Trinity College Dublin Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
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Tennfjord MK, Strand MF, Østby N, Harbø KMT, Fredriksen PM. A school-based physical activity intervention on psychosocial health outcomes among 11- and 12-year-olds - HOPP-project. Scand J Med Sci Sports 2023; 33:455-464. [PMID: 36420609 DOI: 10.1111/sms.14278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
The purpose was to investigate the effect of a school-based physical activity (PA)-intervention among 11- and 12-year-olds (6th- and 7th graders) across 4 years. Seven primary schools in Horten municipality in Norway received 45 min daily extra PA as part of the curriculum. The intervention started in 2015 with follow-up in 2016-2019. The effect was measured after 1-4 years of participation, among the same children (6th to 7th grade) and among new children starting in 6th grade. Two control schools received no additional PA beyond the regular PA at school. The Self-reported Strength and Difficulties Questionnaire (SDQ-S) focusing on internalizing and externalizing difficulties were administrated. A statistical model for repeated measurements was used and adjusted for parents' educational level, sex, age, and waist-to-height ratio (WHtR). The significance level was p ≤ 0.01. In total, 1221 children completed the SDQ-S. SDQ-S scores were stable, and difficulties were relatively low. The control group had significantly lower SDQ-S scores than the intervention group at start, indicating fewer difficulties. The adjusted effect within the intervention schools showed a borderline significant increase in total difficulty scores between 2018 and 2019 (mean difference: 1.02, 95% CI: -1.82, -0.23, p ≤ 0.01). Educational level showed a weak negative correlation with total difficulty score (r = -0.1). No significant change was reported within the control schools. Few psychosocial health problems among 11- and 12-year-olds were detected. The borderline increase in total difficulty score that was seen for the intervention schools, is believed to be of limited clinical relevance.
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Affiliation(s)
| | | | - Nora Østby
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | | | - Per Morten Fredriksen
- School of Health Sciences, Kristiania University College, Oslo, Norway.,Inland Norway University of Applied Science, Faculty of Health and Social Sciences, Lillehammer, Norway
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Sigurðardóttir S, Aspelund T, Guðmundsdóttir DG, Fjorback L, Hrafnkelsson H, Hansdóttir I, Juul L. Mental health and sociodemographic characteristics among Icelanders, data from a cross-sectional study in Iceland. BMC Psychiatry 2023; 23:30. [PMID: 36635641 PMCID: PMC9835021 DOI: 10.1186/s12888-022-04504-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Mental health challenges are on the rise worldwide. In Iceland, little is known about the sociodemographic factors associated with poor mental health. This study aimed to investigate symptoms of depression, anxiety, stress, and psychiatric medication for mental disorders in a nationally representative sample in Iceland and to explore its associations with sociodemographic factors. METHODS This Icelandic cross-sectional study 'Health and Wellbeing of Icelanders' was conducted in 2017 and included 9,887 randomly chosen adults. Participants' depression, anxiety, and stress levels were measured with the Depression Anxiety and Stress scale-21(DASS-21) and the association with sociodemographic factors and prescribed psychiatric medication was assessed in a multinominal logistic regression analysis. RESULTS The youngest age group (18 to 29 years old) had the poorest mental health. Males had a higher risk of medium and high depression scores than females, RRR 1.23 (95% CI 1.06-1.44) and RRR 1.71 (95% CI 1.25-2.33) when adjusted for sociodemographic factors (age, sex, education, marital status, financial status, living area, employment) and use of psychiatric medication. Participants with the most considerable financial difficulties had the highest risk of high scores on depression RRR 11.19 (95% CI 5.8-21.57), anxiety RRR 12.35 (95% CI 5.62-27.14) and stress RRR 11.55 (95% CI 4.75-28.04) when compared to those that do not. CONCLUSIONS The youngest participants and those with the most extensive financial difficulties had the highest depression, anxiety, and stress scores. Males scored higher than females on depression. There was a trend towards worse mental health with lower sociodemographic status. Higher education, living with someone, and financial security were associated with better mental health. These results implicate the importance of government actions to counteract social inequalities in the Icelandic nation.
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Affiliation(s)
- Svala Sigurðardóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101, Reykjavik, Iceland. .,Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark.
| | - Thor Aspelund
- grid.14013.370000 0004 0640 0021Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101 Reykjavik, Iceland
| | | | - Lone Fjorback
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
| | | | - Ingunn Hansdóttir
- grid.14013.370000 0004 0640 0021Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101 Reykjavik, Iceland
| | - Lise Juul
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
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Ghanbari R, Lovasi GS, Bader MDM. Exploring potential for selection bias in using survey data to estimate the association between institutional trust and depression. Ann Epidemiol 2023; 77:61-66. [PMID: 36519721 DOI: 10.1016/j.annepidem.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/21/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We tested the hypothesis that low institutional trust would be associated with depressive symptom elevation, with attention to potential selection bias. METHODS The District of Columbia Area Survey (DCAS) was conducted by mail in 2018. Invitations sent to 8800 households resulted in a sample of 1061 adults. Institutional trust questions referenced nonprofit organizations, businesses, and government. Depressive symptom elevation was assessed using PHQ-9. Logistic regression model estimates were compared with and without adjustment for sociodemographic characteristics and neighborhood satisfaction; among complete cases and following multiple imputation of missing covariate data; and with and without survey weights or correction for collider selection bias. RESULTS Of 968 participants without missing depressive symptom or trust data, 24% reported low institutional trust. Low institutional trust was associated with elevated depressive symptoms (adjusted OR following multiple imputation: 2.0; 95% CI: 1.1, 3.4), although the association was attenuated with use of survey weights (adjusted OR incorporating multiple imputation and survey weights: 1.6; 95% CI: 0.7, 3.2). CONCLUSIONS Under contrasting scenarios where low institutional trust and depressive symptoms jointly increase nonresponse, selection bias could lead to under- or overestimation of this association. Future research could explore posited selection bias scenarios that differ in direction of bias.
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Affiliation(s)
- Rozhan Ghanbari
- Drexel University Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Philadelphia, PA
| | - Gina S Lovasi
- Drexel University Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Philadelphia, PA; Drexel University Dornsife School of Public Health, Urban Health Collaborative, Philadelphia, PA.
| | - Michael D M Bader
- Johns Hopkins University, Department of Sociology and 21st Century Cities Initiative, Baltimore, MD
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Bothongo PL, Jitlal M, Parry E, Waters S, Foote IF, Watson CJ, Cuzick J, Giovannoni G, Dobson R, Noyce AJ, Mukadam N, Bestwick JP, Marshall CR. Dementia risk in a diverse population: A single-region nested case-control study in the East End of London. THE LANCET REGIONAL HEALTH. EUROPE 2022; 15:100321. [PMID: 35558994 PMCID: PMC9088197 DOI: 10.1016/j.lanepe.2022.100321] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Koschollek C, Kajikhina K, Bartig S, Zeisler ML, Schmich P, Gößwald A, Rommel A, Ziese T, Hövener C. Results and Strategies for a Diversity-Oriented Public Health Monitoring in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:798. [PMID: 35055619 PMCID: PMC8775825 DOI: 10.3390/ijerph19020798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Abstract
Germany is a country of immigration; 27% of the population are people with a migration background (PMB). As other countries, Germany faces difficulties in adequately including hard-to-survey populations like PMB into national public health monitoring. The IMIRA project was initiated to develop strategies to adequately include PMB into public health monitoring and to represent diversity in public health reporting. Here, we aim to synthesize the lessons learned for diversity-oriented public health monitoring and reporting in Germany. We also aim to derive recommendations for further research on migration and health. We conducted two feasibility studies (interview and examination surveys) to improve the inclusion of PMB. Study materials were developed in focus groups with PMB. A systematic review investigated the usability of the concept of acculturation. A scoping review was conducted on discrimination as a health determinant. Furthermore, core indicators were defined for public health reporting on PMB. The translated questionnaires were well accepted among the different migrant groups. Home visits increased the participation of hard-to-survey populations. In examination surveys, multilingual explanation videos and video-interpretation services were effective. Instead of using the concept of acculturation, we derived several dimensions to capture the effects of migration status on health, which were more differentiated. We also developed an instrument to measure subjectively perceived discrimination. For future public health reporting, a set of 25 core indicators was defined to report on the health of PMB. A diversity-oriented public health monitoring should include the following: (1) multilingual, diversity-sensitive materials, and tools; (2) different modes of administration; (3) diversity-sensitive concepts; (4) increase the participation of PMB; and (5) continuous public health reporting, including constant reflection and development of concepts and methods.
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Affiliation(s)
- Carmen Koschollek
- Robert Koch Institute, 13353 Berlin, Germany; (K.K.); (S.B.); (M.-L.Z.); (P.S.); (A.G.); (A.R.); (T.Z.); (C.H.)
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Jitlal M, Amirthalingam GNK, Karania T, Parry E, Neligan A, Dobson R, Noyce AJ, Marshall CR. The Influence of Socioeconomic Deprivation on Dementia Mortality, Age at Death, and Quality of Diagnosis: A Nationwide Death Records Study in England and Wales 2001-2017. J Alzheimers Dis 2021; 81:321-328. [PMID: 33780372 DOI: 10.3233/jad-210089] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Socioeconomic deprivation may be an important determinant of dementia risk, mortality, and access to diagnostic services. Premature mortality from other causes and under-representation of deprived individuals in research may lead to this effect being overlooked. OBJECTIVE We assessed the relationship between deprivation and dementia mortality using comprehensive death certificate data for England and Wales from 2001 to 2017. METHODS We used standardized mortality ratios (SMR) and a Poisson model to compare likelihood of dying from dementia in each deprivation decile. We also examined the associations of deprivation with age at death from dementia, and with likelihood of receiving a diagnosis of unspecified dementia. RESULTS Risk of dying from dementia was higher in more deprived deciles (Mean SMR [95% CI] in decile 1 : 0.528 [0.506 to 0.550], decile 10:0.369 [0.338 to 0.400]). In 2017, 14,837 excess dementia deaths were attributable to deprivation (21.5% of all dementia deaths that year). There were dose-response associations of deprivation with likelihood of being older at death with dementia (odds ratio [95% CI] for decile 10 (least deprived): 1.31 [1.28 to 1.33] relative to decile 1), and with likelihood of receiving a diagnosis of unspecified dementia (odds ratio [95% CI] for decile 10:0.78 [0.76 to 0.80] relative to decile 1). CONCLUSION Socioeconomic deprivation in England and Wales is associated with increased dementia mortality, younger age at death with dementia, and poorer access to specialist diagnosis. Reducing social inequality may have a role in the prevention of dementia mortality.
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Affiliation(s)
- Mark Jitlal
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Guru N K Amirthalingam
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Tasvee Karania
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Eve Parry
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Aidan Neligan
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,Department of Neurology, Homerton University Hospital NHS Foundation Trust, London, UK.,Department of Experimental & Clinical Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,Department of Neurology, Barts Health NHS Trust, London, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,Department of Neurology, Barts Health NHS Trust, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,Department of Neurology, Barts Health NHS Trust, London, UK.,Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
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11
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Beck MS, Fjorback LO, Juul L. Associations between mental health and sociodemographic characteristics among schoolchildren. A cross-sectional survey in Denmark 2019. Scand J Public Health 2021; 50:463-470. [PMID: 33845684 DOI: 10.1177/14034948211002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: We aimed to investigate associations between mental health and sociodemographic characteristics among schoolchildren in Denmark. Methods: We performed a cross-sectional survey from January to October 2019 among 4th to 9th graders (N=1247) based on pilot data from a nationwide research project Stress-free Everyday LiFe for Children and Adolescents REsearch (SELFCARE). We assessed mental health using the five-item World Health Organization Well-Being Index and the self-report version of the Strengths and Difficulties Questionnaire. We investigated associations between mental health and sex, age in terms of grade, type of school, family setting and geographic region using regression analysis. Results: Mental health was poorer among girls in the older classes compared to girls in 4th grade, and better among boys in the older classes compared to boys in 4th grade. We found no difference in mental health among schoolchildren in municipal and private schools. Mental health was poorer among both girls and boys living alternately with their parents compared to residing with both of them. Mental health varied across geographic regions. Conclusions: We found associations between mental health and sex, age in terms of grade, family setting and geographic region.
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Affiliation(s)
- Michelle S Beck
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Denmark
| | - Lone O Fjorback
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Denmark
| | - Lise Juul
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Denmark
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12
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Ford T, Vizard T, Sadler K, McManus S, Goodman A, Merad S, Tejerina-Arreal M, Collinson D. Data Resource Profile: Mental Health of Children and Young People (MHCYP) Surveys. Int J Epidemiol 2021; 49:363-364g. [PMID: 31953946 DOI: 10.1093/ije/dyz259] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/27/2019] [Accepted: 12/06/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tamsin Ford
- Department of Developmental Psychiatry, University of Cambridge, Cambridge, UK
| | - Tim Vizard
- Office for National Statistics, Newport, Wales, UK
| | - Katharine Sadler
- Health Policy (SM) and Health and Biomedical (KS), National Centre for Social Research, London, UK
| | - Sally McManus
- Health Policy (SM) and Health and Biomedical (KS), National Centre for Social Research, London, UK
| | - Anna Goodman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Salah Merad
- Office for National Statistics, Newport, Wales, UK
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13
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Genetic and Environmental Influences of Dietary Indices in a UK Female Twin Cohort. Twin Res Hum Genet 2021; 23:330-337. [PMID: 33455612 DOI: 10.1017/thg.2020.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A healthy diet is associated with the improvement or maintenance of health parameters, and several indices have been proposed to assess diet quality comprehensively. Twin studies have found that some specific foods, nutrients and food patterns have a heritable component; however, the heritability of overall dietary intake has not yet been estimated. Here, we compute heritability estimates of the nine most common dietary indices utilized in nutritional epidemiology. We analyzed 2590 female twins from TwinsUK (653 monozygotic [MZ] and 642 dizygotic [DZ] pairs) who completed a 131-item food frequency questionnaire (FFQ). Heritability estimates were computed using structural equation models (SEM) adjusting for body mass index (BMI), smoking status, Index of Multiple Deprivation (IMD), physical activity, menopausal status, energy and alcohol intake. The AE model was the best-fitting model for most of the analyzed dietary scores (seven out of nine), with heritability estimates ranging from 10.1% (95% CI [.02, .18]) for the Dietary Reference Values (DRV) to 42.7% (95% CI [.36, .49]) for the Alternative Healthy Eating Index (A-HEI). The ACE model was the best-fitting model for the Healthy Diet Indicator (HDI) and Healthy Eating Index 2010 (HEI-2010) with heritability estimates of 5.4% (95% CI [-.17, .28]) and 25.4% (95% CI [.05, .46]), respectively. Here, we find that all analyzed dietary indices have a heritable component, suggesting that there is a genetic predisposition regulating what you eat. Future studies should explore genes underlying dietary indices to further understand the genetic disposition toward diet-related health parameters.
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14
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Shire K, Andrews E, Barber S, Bruce A, Corkett J, Hill LJB, Kelly B, McEachan R, Mon-Williams M, Tracey L, Waterman AH, Wright J. Starting School: a large-scale start of school assessment within the ‘Born in Bradford’ longitudinal cohort. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.15610.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Born in Bradford (BiB) cohort of 13,776 children born between 2007-2011 and their parents provides a rich data resource for researchers exploring protective and risk factors influencing long-term developmental and health outcomes. Educational attainment is a critical factor related to later health. Literacy and communication, fine motor skills and social and emotional health are key ‘early’ predictors of educational attainment and can be used to identify children in need of additional support. We describe our BiB ‘Starting School’ data collection protocol which assessed literacy and communication, fine motor skills and social and emotional health on 3,444 BiB children aged 4-5 years old. These measures supplement the existing dataset, and complement the routine educational, health and social care data available for the cohort.
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15
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Design and development of a complex narrative intervention delivered by text messages to reduce binge drinking among socially disadvantaged men. Pilot Feasibility Stud 2018; 4:105. [PMID: 29992038 PMCID: PMC5989343 DOI: 10.1186/s40814-018-0298-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/15/2018] [Indexed: 12/02/2022] Open
Abstract
Background Socially disadvantaged men are at high risk of suffering from alcohol-related harm. Disadvantaged groups are less likely to engage with health promotion. There is a need for interventions that reach large numbers at low cost and which promote high levels of engagement with the behaviour change process. The aim of this study was to design a theoretically and empirically based text message intervention to reduce binge drinking by socially disadvantaged men. Results Following MRC guidance, the intervention was developed in four stages. Stage 1 developed a detailed behaviour change strategy based on existing literature and theory from several areas. These included the psychological theory that would underpin the intervention, alcohol brief interventions, text message interventions, effective behaviour change techniques, narratives in behaviour change interventions and communication theory. In addition, formative research was carried out. A logic model was developed to depict the pathways between intervention inputs, processes and outcomes for behaviour change. Stage 2 created a narrative which illustrated and modelled key steps in the strategy. Stage 3 rendered the intervention into a series of text messages and ensured that appropriate behavioural change techniques were incorporated. Stage 4 revised the messages to ensure comprehensive coverage of the behaviour change strategy and coherence of the narrative. It also piloted the intervention and made final revisions to it. Conclusions The structured, systematic approach to design created a narrative intervention which had a strong theoretical and empirical basis. The use of a narrative helped make the intervention realistic and allowed key behaviour change techniques to be modelled by characters. The narrative was intended to promote engagement with the intervention. The intervention was rendered into a series of short text messages, and subsequent piloting showed they were acceptable in the target group. Delivery of an intervention by text message offers a low-cost, low-demand method that can reach large numbers of people. This approach provides a framework for the design of behaviour change interventions which could be used for interventions to tackle other health behaviours. Electronic supplementary material The online version of this article (10.1186/s40814-018-0298-0) contains supplementary material, which is available to authorized users.
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16
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Crombie IK, Irvine L, Williams B, Sniehotta FF, Petrie DJ, Jones C, Norrie J, Evans JMM, Emslie C, Rice PM, Slane PW, Humphris G, Ricketts IW, Melson AJ, Donnan PT, McKenzie A, Huang L, Achison M. Text message intervention to reduce frequency of binge drinking among disadvantaged men: the TRAM RCT. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Socially disadvantaged men are more likely to binge drink frequently and to experience high levels of alcohol-related harm.
Objectives
To test the effectiveness and cost-effectiveness of a text message intervention in reducing the frequency of binge drinking among disadvantaged men.
Study design
A four-centre, parallel-group, pragmatic, individually randomised controlled trial was conducted. Randomisation was carried out using a secure remote web-based system. It was stratified by participating centre and recruitment method and restricted using block sizes of randomly varying lengths.
Setting
The study was conducted in the community. Members of the public helped to develop the study methods.
Participants
Participants were men aged 25–44 years who had ≥ 2 episodes of binge drinking (> 8 units of alcohol in a single session) in the preceding 28 days. Men were recruited from areas of high deprivation.
Interventions
An empirically and theoretically based text message intervention was delivered by 112 interactive text messages over a 12-week period. The control group received an attentional control comprising 89 text messages on general health.
Primary outcome measure
The primary outcome measure was the proportion of men consuming > 8 units of alcohol on ≥ 3 occasions (in the previous 28 days) at 12 months post intervention.
Results
The recruitment target of 798 was exceeded and 825 men were randomised. Retention was high and similar in the intervention (84.9%) and control (86.5%) groups. Most men in the intervention group engaged enthusiastically with the text messages: almost all (92%) replied to text messages and over two-thirds (67%) replied more than 10 times. The intervention was estimated to have had a modest, statistically non-significant effect on the primary outcome at the 12-month follow-up [odds ratio 0.79, 95% confidence interval (CI) 0.57 to 1.08]. This corresponds to a net reduction of 5.7% in regular binge drinking. Five secondary outcomes showed small non-significant and inconsistent effects on alcohol consumption, with one suggesting a positive effect and four suggesting an adverse effect. Both the short- and the long-term cost per quality-adjusted life-year (QALY) analysis suggested that the brief intervention was dominated by a ‘do-nothing’ option. The intervention’s impacts on patterns of alcohol consumption, QALYs and downstream costs were inconsistent and uncertain.
Limitations
The study used an active control that, combined with the recruitment procedures and baseline assessments, could have biased the treatment effect towards the null. The measurement of alcohol consumption relied on self-reported drinking.
Conclusions
The trial has demonstrated that it is possible to recruit and retain large numbers of socially disadvantaged men in a research study. The text messages delivered a complex theoretically and empirically based intervention that fostered enthusiastic engagement with the key components of the behaviour change sequence. The intervention produced a modest, statistically non-significant effect on the primary outcome, with wide CIs. Further research is needed to reduce uncertainty about the treatment effect. The methods developed for this study provide a platform for the design and testing of interventions to reduce inequalities in health.
Future work
A future trial could reduce the uncertainty around the treatment effect of the intervention.
Trial registration
Current Controlled Trials ISRCTN07695192.
Funding
This study was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 6. See NIHR Journals Library website for further information.
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Affiliation(s)
- Iain K Crombie
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Linda Irvine
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Falko F Sniehotta
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Dennis J Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Josie MM Evans
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Carol Emslie
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Peter M Rice
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Peter W Slane
- Erskine Practice, Arthurstone Medical Centre, Dundee, UK
| | - Gerry Humphris
- School of Medicine, Medical and Biological Sciences, University of St Andrews, St Andrews, UK
| | | | - Ambrose J Melson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter T Donnan
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Andrew McKenzie
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Li Huang
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marcus Achison
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
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Mena E, Kroll LE, Maier W, Bolte G. Gender inequalities in the association between area deprivation and perceived social support: a cross-sectional multilevel analysis at the municipality level in Germany. BMJ Open 2018; 8:e019973. [PMID: 29654020 PMCID: PMC5898354 DOI: 10.1136/bmjopen-2017-019973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate the association between area deprivation at municipality level with low perceived social support, independent of individual socioeconomic position and demographic characteristics. To assess whether there are gender inequalities in this association. DESIGN Cross-sectional multilevel analysis of survey data. SETTING Germany. PARTICIPANTS 3350 men and 3665 women living in 167 municipalities throughout Germany participating in the 'German Health Interview and Examination Survey for Adults' (DEGS1 2008-2011) as part of the national health monitoring. OUTCOME Perceived social support as measured by Oslo-3 Social Support Scale. RESULTS Prevalence of low perceived social support was 11.4% in men and 11.1% in women. Low social support was associated in men and women with sociodemographic characteristics that indicate more disadvantaged living situations. Taking these individual-level characteristics into account, municipal-level deprivation was independently associated with low perceived social support in men (OR for the most deprived quintile: 1.80 (95% CI 1.14 to 2.84)), but not in women (OR 1.22 (95% CI 0.78 to 1.90)). CONCLUSION The results of our multilevel analysis suggest that there are gender inequalities in the association of municipal-level deprivation with the prevalence of low perceived social support in Germany independent of individual socioeconomic position. Community health interventions aiming at promotion of social support among residents might profit from a further understanding of the observed gender differences.
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Affiliation(s)
- Emily Mena
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Lars Eric Kroll
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Ball K, Abbott G, Wilson M, Chisholm M, Sahlqvist S. How to get a nation walking: reach, retention, participant characteristics and program implications of Heart Foundation Walking, a nationwide Australian community-based walking program. Int J Behav Nutr Phys Act 2017; 14:161. [PMID: 29162125 PMCID: PMC5698941 DOI: 10.1186/s12966-017-0617-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/14/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Community-based walking programs represent a low-cost, accessible approach to increasing physical activity among inactive adults. However, recruiting participants from vulnerable and hard-to-reach groups remains a challenge. This study examined the reach, retention, sociodemographic and health characteristics, physical activity levels and motivators of participants in Heart Foundation Walking, a nationwide Australian community-based walking program. METHODS Descriptive cross-sectional analyses were undertaken with data from 22,416 participants aged 15+ years in the Heart Foundation Walking registration database in December 2015, and from four surveys of participants in 2010 (n = 2400), 2011 (n = 3274), 2012 (n = 4158) and 2015 (n = 1890). RESULTS Heart Foundation Walking reached participants in every geographic region of Australia, including remote and sparsely populated regions, and engaged sizeable proportions of the following at-risk participants: older than 60 years (>70%); with very low incomes (17-25%); who were overweight or obese (around 60%); and with one or more chronic disease or disease risk factors (57-81%). For all demographic groups, one-year retention rates were at least 75%. Seventy percent of participants met physical activity recommendations. Over 75% reported joining the program for health and fitness reasons while the most cited motivator for continuing was the social aspect (57-73%). CONCLUSIONS Volunteer-run, group-based walking programs can have substantial reach and retention, in particular among those at risk for physical inactivity. The provision of opportunities for social interaction appears to be a key program element in promoting long-term participation, including among high-risk groups.
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Affiliation(s)
- Kylie Ball
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Melbourne Burwood Campus, 221 Burwood Hwy, Burwood, VIC 3125 Australia
| | - Gavin Abbott
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Melbourne Burwood Campus, 221 Burwood Hwy, Burwood, VIC 3125 Australia
| | - Michelle Wilson
- Heart Foundation, 155-159 Hutt St, Adelaide, SA 5000 Australia
| | - Melanie Chisholm
- North Western Melbourne PHN, 369 Royal Parade, Parkville, VIC 3052 Australia
| | - Shannon Sahlqvist
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Melbourne Burwood Campus, 221 Burwood Hwy, Burwood, VIC 3125 Australia
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Mikkelsen SH, Hohwü L, Olsen J, Bech BH, Liew Z, Obel C. Parental Body Mass Index and Behavioral Problems in Their Offspring: A Danish National Birth Cohort Study. Am J Epidemiol 2017; 186:593-602. [PMID: 28535165 DOI: 10.1093/aje/kwx063] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/25/2016] [Indexed: 11/12/2022] Open
Abstract
Maternal obesity has been associated with increased risk of offspring behavioral problems. We examined whether this association could be explained by familial factors by comparing associations for maternal body mass index (BMI) with associations for paternal BMI. We studied 38,314 children born to mothers enrolled in the Danish National Birth Cohort during 1996-2002. Data on maternal BMI was collected at 15 weeks of gestation, and paternal BMI was assessed when the child was 18 months old. When the child was 7 years old, the Strengths and Difficulties Questionnaire was completed by the parents. We estimated odds ratios for behavioral problems in offspring born to overweight/obese parents, and we found that maternal BMI was associated with offspring behavioral problems. Maternal BMI of 25.0-29.9 was associated with a 33% (odds ratio = 1.33, 95% confidence interval: 1.13, 1.57) higher risk of total difficulties in offspring, and maternal BMI of ≥30.0 was associated with an 83% (odds ratio = 1.83, 95% confidence interval: 1.49, 2.25) higher risk. Paternal obesity was also associated with higher risk of offspring behavioral problems, but stronger associations were observed with maternal prepregnancy obesity. Our results suggest that part of the association between maternal BMI and behavioral problems can be accounted for by genetic and social factors, but environmental risk factors may also contribute to the etiology of behavioral problems.
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20
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Crombie IK, Irvine L, Falconer DW, Williams B, Ricketts IW, Jones C, Humphris G, Norrie J, Slane P, Rice P. Alcohol and disadvantaged men: A feasibility trial of an intervention delivered by mobile phone. Drug Alcohol Rev 2017; 36:468-476. [PMID: 28295794 PMCID: PMC5516166 DOI: 10.1111/dar.12455] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Disadvantaged men suffer substantial harm from heavy drinking. This feasibility study developed and evaluated the methods for a trial of a brief intervention delivered by text messages to disadvantaged men. It aimed to test the methods for recruitment and retention, to monitor engagement with the intervention and assess the overall acceptability of study methods. DESIGN AND METHODS Disadvantaged men aged 25-44 years who had ≥2 episodes of binge drinking (≥8 units in one session) in the preceding month were recruited. Two recruitment strategies were assessed: recruitment from general practice registers and by a community outreach strategy. Theoretically and empirically based text messages were tailored to the target group. RESULTS The study recruited 67 disadvantaged men at high risk of alcohol-related harm, exceeding the target of 60. Evaluation showed that 95% of text messages were delivered, and the men engaged enthusiastically with the intervention. Retention at follow up was 96%. Outcomes were successfully measured on all men followed up. This provided data for the sample size calculation for the full trial. Post-study evaluation showed high levels of satisfaction with the study. DISCUSSION AND CONCLUSIONS This study has shown that disadvantaged men can be recruited and follow-up data obtained in an alcohol intervention study. The study methods were acceptable to the participants. The men recruited were at high risk of alcohol-related harms. It also clarified ways in which the recruitment strategy, the baseline questionnaire and the intervention could be improved. The full trial is currently underway. [Crombie IK, Irvine L, Falconer DW, Williams B, Ricketts IW, Jones C, Humphris G, Norrie J, Slane P, Rice P. Alcohol and disadvantaged men: A feasibility trial of an intervention delivered by mobile phone. Drug Alcohol Rev 2017;36:468-476].
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Affiliation(s)
- Iain K. Crombie
- Division of Population Health SciencesUniversity of DundeeDundeeUnited Kingdom
| | - Linda Irvine
- Division of Population Health SciencesUniversity of DundeeDundeeUnited Kingdom
| | - Donald W. Falconer
- Division of Population Health SciencesUniversity of DundeeDundeeUnited Kingdom
| | - Brian Williams
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUnited Kingdom
| | | | - Claire Jones
- Health Informatics CentreUniversity of DundeeDundeeUnited Kingdom
| | - Gerry Humphris
- Bute Medical SchoolUniversity of St AndrewsSt AndrewsUnited Kingdom
| | - John Norrie
- Edinburgh Clinical Trials Unit (ECTU)University of EdinburghEdinburghUnited Kingdom
| | - Peter Slane
- Arthurstone Medical CentreNHS TaysideDundeeUnited Kingdom
| | - Peter Rice
- Division of Neuroscience, School of MedicineUniversity of DundeeDundeeUnited Kingdom
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21
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Vos AA, van Voorst SF, Posthumus AG, Waelput AJM, Denktaş S, Steegers EAP. Process evaluation of the implementation of scorecard-based antenatal risk assessment, care pathways and interdisciplinary consultation: the Healthy Pregnancy 4 All study. Public Health 2017; 150:112-120. [PMID: 28667879 DOI: 10.1016/j.puhe.2017.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 02/12/2017] [Accepted: 05/18/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the implementation of a complex intervention in the antenatal healthcare field in 14 Dutch municipalities. The intervention consisted of the implementation of a systematic scorecard-based risk assessment in pregnancy, subsequent patient-tailored care pathways, and consultations of professionals from different medical and social disciplines. METHODS Saunders's seven-step method was used for the development of a programme implementation monitoring plan, with specific attention to the setting and context of the programme. Data were triangulated from multiple sources, and prespecified criteria were applied to examine the evidence for implementation. RESULTS Six out of 11 municipalities (54%) met the implementation criteria for the entire risk assessment programme, whereas three municipalities (27%) met the criteria if the three components of implementation were analysed separately. CONCLUSIONS A process evaluation of implementation of a complex intervention is possible. The results can be used to improve understanding of the associations between specific programme elements and programme outcomes on effectiveness of the intervention. Additionally, the results are important for formative purposes to assess how future implementation of antenatal risk assessment can be improved in comparable contexts.
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Affiliation(s)
- A A Vos
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - S F van Voorst
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A G Posthumus
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A J M Waelput
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - S Denktaş
- Department of Social and Behavioural Sciences, Erasmus University College/Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Robb KA, Gatting L, Wardle J. What impact do questionnaire length and monetary incentives have on mailed health psychology survey response? Br J Health Psychol 2017; 22:671-685. [PMID: 28422369 PMCID: PMC5655741 DOI: 10.1111/bjhp.12239] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/02/2017] [Indexed: 02/01/2023]
Abstract
Objectives Response rates to health‐related surveys are declining. This study tested two strategies to improve the response rate to a health psychology survey mailed through English general practices: (1) sending a shortened questionnaire and (2) offering a monetary incentive to return a completed questionnaire. Design Randomized controlled trial. Methods Adults (n = 4,241) aged 45–59 years, from four General Practices in South‐East England, were mailed a survey on attitudes towards bowel cancer screening. Using a 2 × 4 factorial design, participants were randomized to receive a ‘short’ (four A4 pages) or a ‘long’ (seven A4 pages) questionnaire, and one of four monetary incentives to return a completed questionnaire – (1) no monetary incentive, (2) £2.50 shop voucher, (3) £5.00 shop voucher, and (4) inclusion in a £250 shop voucher prize draw. Age, gender, and area‐level deprivation were obtained from the General Practices. Results The overall response rate was 41% (n = 1,589). Response to the ‘short’ questionnaire (42%) was not significantly different from the ‘long’ questionnaire (40%). The £2.50 incentive (43%) significantly improved response rates in univariate analyses, and remained significant after controlling for age, gender, area‐level deprivation, and questionnaire length. The £5.00 (42%) and £250 prize draw (41%) incentives had no significant impact on response rates compared to no incentive (38%). Conclusions A small monetary incentive (£2.50) may slightly increase response to a mailed health psychology survey. The length of the questionnaire (four pages vs. seven pages) did not influence response. Although frequently used, entry into a prize draw did not increase response. Achieving representative samples remains a challenge for health psychology. Statement of contribution What is already known on this subject Response rates to mailed questionnaires continue to decline, threatening the representativeness of data. Prize draw incentives are frequently used but there is little evidence to support their efficacy. Research on interactions between incentives, questionnaire length, and demographics is lacking.
What does this study add Contrary to previous findings, questionnaire length did not influence response rate. A £2.50 incentive increased response, while incentives of £5.00 and a £250 prize draw did not. Achieving representative samples to questionnaires remains a challenge for health psychology.
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Affiliation(s)
- Kathryn A Robb
- Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, UK.,Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
| | - Lauren Gatting
- Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
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Miller CJ, Burgess JF, Fischer EP, Hodges DJ, Belanger LK, Lipschitz JM, Easley SR, Koenig CJ, Stanley RL, Pyne JM. Practical application of opt-out recruitment methods in two health services research studies. BMC Med Res Methodol 2017; 17:57. [PMID: 28410585 PMCID: PMC5391553 DOI: 10.1186/s12874-017-0333-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/28/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Participant recruitment is an ongoing challenge in health research. Recruitment may be especially difficult for studies of access to health care because, even among those who are in care, people using services least often also may be hardest to contact and recruit. Opt-out recruitment methods (in which potential participants are given the opportunity to decline further contact about the study (opt out) following an initial mailing, and are then contacted directly if they have not opted out within a specified period) can be used for such studies. However, there is a dearth of literature on the effort needed for effective opt-out recruitment. METHODS In this paper we describe opt-out recruitment procedures for two studies on access to health care within the U.S. Department of Veterans Affairs. We report resource requirements for recruitment efforts (number of opt-out packets mailed and number of phone calls made). We also compare the characteristics of study participants to potential participants via t-tests, Fisher's exact tests, and chi-squared tests. RESULTS Recruitment rates for our two studies were 12 and 21%, respectively. Across multiple study sites, we had to send between 4.3 and 9.2 opt-out packets to recruit one participant. The number of phone calls required to arrive at a final status for each potentially eligible Veteran (i.e. study participation or the termination of recruitment efforts) were 2.9 and 6.1 in the two studies, respectively. Study participants differed as expected from the population of potentially eligible Veterans based on planned oversampling of certain subpopulations. The final samples of participants did not differ statistically from those who were mailed opt-out packets, with one exception: in one of our two studies, participants had higher rates of mental health service use in the past year than did those mailed opt-out packets (64 vs. 47%). CONCLUSIONS Our results emphasize the practicality of using opt-out methods for studies of access to health care. Despite the benefits of these methods, opt-out alone may be insufficient to eliminate non-response bias on key variables. Researchers will need to balance considerations of sample representativeness and feasibility when designing studies investigating access to care.
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Affiliation(s)
- Christopher J. Miller
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Harvard Medical School Department of Psychiatry, Boston, Massachusetts USA
| | - James F. Burgess
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Boston University School of Public Health, Boston, Massachusetts USA
| | - Ellen P. Fischer
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, and University of Arkansas for Medical Sciences Department of Psychiatry, Little Rock, Arkansas USA
| | - Deborah J. Hodges
- Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, Arkansas USA
| | - Lindsay K. Belanger
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Boston University School of Public Health, Boston, Massachusetts USA
| | - Jessica M. Lipschitz
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Harvard Medical School Department of Psychiatry, Boston, Massachusetts USA
| | - Siena R. Easley
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Boston University School of Public Health, Boston, Massachusetts USA
| | - Christopher J. Koenig
- San Francisco VA Health Care System and San Francisco State University Department of Communication Studies, San Francisco, California USA
| | - Regina L. Stanley
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas USA
| | - Jeffrey M. Pyne
- Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences Department of Psychiatry, Little Rock, Arkansas USA
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Mindell JS, Giampaoli S, Goesswald A, Kamtsiuris P, Mann C, Männistö S, Morgan K, Shelton NJ, Verschuren WMM, Tolonen H. Sample selection, recruitment and participation rates in health examination surveys in Europe--experience from seven national surveys. BMC Med Res Methodol 2015; 15:78. [PMID: 26438235 PMCID: PMC4595185 DOI: 10.1186/s12874-015-0072-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/24/2015] [Indexed: 11/10/2022] Open
Abstract
Background Health examination surveys (HESs), carried out in Europe since the 1950’s, provide valuable information about the general population’s health for health monitoring, policy making, and research. Survey participation rates, important for representativeness, have been falling. International comparisons are hampered by differing exclusion criteria and definitions for non-response. Method Information was collected about seven national HESs in Europe conducted in 2007–2012. These surveys can be classified into household and individual-based surveys, depending on the sampling frames used. Participation rates of randomly selected adult samples were calculated for four survey modules using standardised definitions and compared by sex, age-group, geographical areas within countries, and over time, where possible. Results All surveys covered residents not just citizens; three countries excluded those in institutions. In two surveys, physical examinations and blood sample collection were conducted at the participants’ home; the others occurred at examination clinics. Recruitment processes varied considerably between surveys. Monetary incentives were used in four surveys. Initial participation rates aged 35–64 were 45 % in the Netherlands (phase II), 54 % in Germany (new and previous participants combined), 55 % in Italy, and 65 % in Finland. In Ireland, England and Scotland, household participation rates were 66 %, 66 % and 63 % respectively. Participation rates were generally higher in women and increased with age. Almost all participants attending an examination centre agreed to all modules but surveys conducted in the participants’ home had falling responses to each stage. Participation rates in most primate cities were substantially lower than the national average. Age-standardized response rates to blood pressure measurement among those aged 35–64 in Finland, Germany and England fell by 0.7-1.5 percentage points p.a. between 1998–2002 and 2010–2012. Longer trends in some countries show a more marked fall. Conclusions The coverage of the general population in these seven national HESs was good, based on the sampling frames used and the sample sizes. Pre-notification and reminders were used effectively in those with highest participation rates. Participation rates varied by age, sex, geographical area, and survey design. They have fallen in most countries; the Netherlands data shows that they can be maintained at higher levels but at much higher cost.
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Affiliation(s)
- Jennifer S Mindell
- Research Department of Epidemiology & Public Health, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Simona Giampaoli
- Istituto Superiore di Sanità, Viale Regina Elena n. 299, Rome, Italy.
| | - Antje Goesswald
- Department 2 Epidemiology and Health Monitoring Division 25, Robert Koch Institute, Examination surveys and Cohort studies, General-Pape-Str. 62-66, Berlin, 12101, Germany.
| | - Panagiotis Kamtsiuris
- Department 2 Epidemiology and Health Monitoring Division 25, Robert Koch Institute, Examination surveys and Cohort studies, General-Pape-Str. 62-66, Berlin, 12101, Germany.
| | - Charlotte Mann
- Research Department of Epidemiology & Public Health, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Satu Männistö
- Department of Health, National Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, FI-00271, Finland.
| | - Karen Morgan
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland. .,Perdana University, Serdang, Malaysia.
| | - Nicola J Shelton
- Research Department of Epidemiology & Public Health, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - W M Monique Verschuren
- Department Chronic Diseases Determinants, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands.
| | - Hanna Tolonen
- Department of Health, National Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, FI-00271, Finland.
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Kekkonen V, Kivimäki P, Valtonen H, Hintikka J, Tolmunen T, Lehto S, Laukkanen E. Sample selection may bias the outcome of an adolescent mental health survey: results from a five-year follow-up of 4171 adolescents. Public Health 2015; 129:162-72. [DOI: 10.1016/j.puhe.2014.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 11/26/2014] [Accepted: 11/28/2014] [Indexed: 11/30/2022]
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Exeter DJ, Sabel CE, Hanham G, Lee AC, Wells S. Movers and stayers: The geography of residential mobility and CVD hospitalisations in Auckland, New Zealand. Soc Sci Med 2014; 133:331-9. [PMID: 25483929 DOI: 10.1016/j.socscimed.2014.11.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The association between area-level disadvantage and health and social outcomes is unequivocal. However, less is known about the health impact of residential mobility, particularly at intra-urban scales. We used an encrypted National Health Index (eNHI) number to link individual-level data recorded in routine national health databases to construct a cohort of 641,532 participants aged 30+ years to investigate the association between moving and CVD hospitalisations in Auckland, New Zealand. Residential mobility was measured for participants according to changes in the census Meshblock of usual residence, obtained from the Primary Health Organisation (PHO) database for every calendar quarter between 1/1/2006 and 31/12/2012. The NZDep2006 area deprivation score at the start and end of a participant's inclusion in the study was used to measure deprivation mobility. We investigated the relative risk of movers being hospitalised for CVD relative to stayers using multi-variable binomial regression models, controlling for age, gender, deprivation and ethnicity. Considered together, movers were 1.22 (1.19-1.26) times more likely than stayers to be hospitalised for CVD. Using the 5×5 deprivation origin-destination matrix to model a patient's risk of CVD based on upward, downward or sideways deprivation mobility, movers within the least deprived (NZDep2006 Quintile 1) areas were 10% less likely than stayers to be hospitalised for CVD, while movers within the most deprived (NZDep2006 Q5) areas were 45% more likely than stayers to have had their first CVD hospitalisation in 2006-2012 (RR: 1.45 [1.35-1.55]). Participants who moved upward also had higher relative risks of having a CVD event, although their risk was less than those observed for participants experiencing downward deprivation mobility. This research suggests that residential mobility is an important determinant of CVD in Auckland. Further investigation is required to determine the impact moving has on the risk of CVD by ethnicity.
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Affiliation(s)
- Daniel J Exeter
- School of Population Health, The University of Auckland, New Zealand.
| | - Clive E Sabel
- School of Geographical Sciences, University of Bristol, England, United Kingdom
| | - Grant Hanham
- School of Population Health, The University of Auckland, New Zealand
| | - Arier C Lee
- School of Population Health, The University of Auckland, New Zealand
| | - Susan Wells
- School of Population Health, The University of Auckland, New Zealand
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Crombie IK, Falconer DW, Irvine L, Williams B, Ricketts IW, Humphris G, Norrie J, Rice P, Slane PW. Reducing alcohol-related harm in disadvantaged men: development and feasibility assessment of a brief intervention delivered by mobile telephone. PUBLIC HEALTH RESEARCH 2013. [DOI: 10.3310/phr01030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AbstractBackgroundSocially disadvantaged men suffer substantial harm from heavy drinking. Brief alcohol interventions are effective in reducing consumption when delivered via health care. There is a need for tailored brief interventions for disadvantaged men who seldom attend health care.Objectives(1) To investigate the best ways to recruit and retain disadvantaged men in a study aimed at reducing the frequency of heavy drinking. (2) To identify the type of content and timing of the delivery that is most likely to engage disadvantaged young to middle-aged men in an intervention delivered by text messages. (3) To determine whether or not the intervention is likely to be an acceptable way to influence the frequency of heavy drinking.DesignA three-phase study involving the development of the recruitment strategy and the intervention, an assessment of the feasibility of a randomised controlled trial, and a post-study evaluation.SettingCommunity-based study, conducted in Dundee, UK.ParticipantsDisadvantaged men aged 25–44 years who had two or more episodes of heavy drinking (≥ 8 units in a single session) in the preceding month. Two recruitment strategies were employed: recruitment through general practice (GP) registers and recruitment through a community outreach strategy.InterventionsFocus groups explored drinking motives and behaviours of the target group. The intervention also drew on reviews of the literature on: alcohol brief interventions, text message studies, communication theory and behaviour change theories and techniques. The intervention group received 36 text messages with images sent over a 28-day period.Main outcome measuresThe outcome measures evaluated the likely success of a full trial: recruitment of the participants; construction and delivery of a theoretically and empirically based intervention that successfully engages disadvantaged men; potential for the intervention to influence binge drinking.ResultsThe focus group analyses identified that personal experience and knowledge of the harmful effects of alcohol was widespread. Furthermore, there was a discrepancy between frequent binge drinking and perceived social expectations and duties. This could usefully be targeted in the intervention. Theoretically and empirically based behaviour change strategies were successfully rendered in attractive, colourful, brief text messages. Both recruitment strategies (GP registers and community outreach) proved successful and a total of 67 men were recruited, exceeding the target of 60. The participants were at high risk of harm because of frequent episodes of heavy binge drinking. Baseline interviews established that those recruited through community outreach drank substantially more and had more frequent binge drinking sessions than those recruited through GP registers. Retention at follow-up was 96%. Extensive process evaluation was conducted. The evaluation showed that 95% of text messages were successfully delivered to participants' telephones. Furthermore, there was a high level of engagement with text messages which sought responses. Most men replied to these texts, often giving carefully structured personal responses. Analyses of the responses indicated a high level of engagement with key components of the behaviour change strategy. Post-trial evaluation showed high levels of satisfaction with the intervention.ConclusionsThis study has shown that disadvantaged men can be recruited and retained in an alcohol intervention trial. A theoretically and empirically based intervention was successfully delivered by text message. Furthermore, the messages were well received and elicited the types of response intended. A full trial of the intervention, incorporating a cost-effectiveness study, should be carried out.Study registrationThis study is registered as ISRCTN10515845.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- IK Crombie
- School of Medicine, University of Dundee, Dundee, UK
| | - DW Falconer
- School of Medicine, University of Dundee, Dundee, UK
| | - L Irvine
- School of Medicine, University of Dundee, Dundee, UK
| | - B Williams
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - IW Ricketts
- School of Computing, University of Dundee, Dundee, UK
| | - G Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | - J Norrie
- Centre for Health Care Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - P Rice
- NHS Substance Abuse Services, Stracathro Hospital, Brechin, UK
| | - PW Slane
- The Erskine Practice, Arthurstone Medical Centre, Dundee, UK
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Crombie IK, Falconer DW, Irvine L, Norrie J, Williams B, Slane PW. Risky single-occasion drinking and disadvantaged men: will recruitment through primary care miss hazardous drinkers? Alcohol Clin Exp Res 2013; 37:1577-81. [PMID: 23731186 DOI: 10.1111/acer.12123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 01/27/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Men who are socially disadvantaged are at a substantially higher risk of developing alcohol-related diseases. People from deprived areas are known to be more difficult to recruit to research studies. As part of a feasibility assessment for an intervention study, 2 recruitment strategies were investigated. This article compares the drinking patterns of the disadvantaged men identified by the 2 strategies. METHODS A cross-sectional survey compared 2 strategies for recruiting disadvantaged men to a study on alcohol consumption: recruitment through general practice (GP) registers and through a community outreach strategy, respondent-driven sampling (RDS). Men aged 25 to 44 years were recruited from deprived areas in the community. The entry criterion was binge drinking (≥8 units in a single session) at least twice in the previous 4 weeks. Demographic characteristics, total consumption of alcohol, frequency of binge drinking (≥8 units in a session), and heavy binge drinking (≥16 units in a session) were measured. RESULTS Men recruited by RDS drank more than twice as much as the men recruited through GP (137 units in the previous 30 days compared with 62 units; p = 0.003). They also had many more binge drinking days: more than half (57%) of men from RDS had 6 or more binge drinking days in the previous 30 days, whereas only 16% of the GP sample had 6 or more binge drinking days (p = 0.001). Many more men recruited by RDS (37% vs. 5%; p = 0.002) had more than 5 very heavy drinking sessions in the previous month (≥16 units in a session). The RDS group also had fewer alcohol-free days. CONCLUSIONS The 2 sampling strategies recruited different types of drinkers. The men recruited through RDS were much more likely to engage in frequent harmful drinking. The results indicate that the 2 methods recruit different samples of disadvantaged men. Intervention studies that are only conducted through primary care may miss many harmful drinkers.
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Affiliation(s)
- Iain K Crombie
- Department of Public Health, School of Medicine , University of Dundee, Dundee, United Kingdom
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Regber S, Novak M, Eiben G, Lissner L, Hense S, Sandström TZ, Ahrens W, Mårild S. Assessment of selection bias in a health survey of children and families - the IDEFICS Sweden-study. BMC Public Health 2013; 13:418. [PMID: 23634972 PMCID: PMC3662638 DOI: 10.1186/1471-2458-13-418] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 04/08/2013] [Indexed: 11/10/2022] Open
Abstract
Background A health survey was performed in 2007–2008 in the IDEFICS/Sweden study (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) in children aged 2–9 years. We hypothesized that families with disadvantageous socioeconomic and -demographic backgrounds and children with overweight and obesity were underrepresented. Methods In a cross-sectional study, we compared Swedish IDEFICS participants (N=1,825) with referent children (N=1,825) using data from Statistics Sweden population registers. IDEFICS participants were matched for age and gender with a referent child living in the same municipality. Longitudinal weight and height data from birth to 8 years was collected for both populations (n=3,650) from the children’s local health services. Outcome measures included the family’s socioeconomic and demographic characteristics, maternal body mass index (BMI) and smoking habits before pregnancy, the children’s BMI standard deviation score (SDS) at the age of inclusion in the IDEFICS study (BMISDS-index), and the children’s BMI-categories during the age-span. Comparisons between groups were done and a multiple logistic regression analysis for the study of determinants of participation in the IDEFICS study was performed. Results Compared with IDEFICS participants, referent families were more likely to have lower education and income, foreign backgrounds, be single parents, and have mothers who smoked before pregnancy. Maternal BMI before pregnancy and child’s BMISDS-index did not differ between groups. Comparing the longitudinal data-set, the prevalence of obesity was significantly different at age 8 years n= 45 (4.5%) versus n= 31 (2.9%) in the referent and IDEFICS populations, respectively. In the multivariable adjusted model, the strongest significant association with IDEFICS study participation was parental Swedish background (odds ratio (OR) = 1.91, 95% confidence interval (CI) (1.48–2.47) followed by parents having high education OR 1.80, 95% CI (1.02-3.16) and being married or co-habiting OR 1.75 95% CI (1.38-2.23). Conclusion Families with single parenthood, foreign background, low education and income were underrepresented in the IDEFICS Sweden study. BMI at inclusion had no selection effect, but developing obesity was significantly greater among referents.
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Affiliation(s)
- Susann Regber
- Nordic School of Public Health NHV, Box 12 133, SE- 402 42, Gothenburg, Sweden.
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Association between variables used in the field substitution and post-stratification adjustment in the Belgian health interview survey and non-response. Int J Public Health 2013; 59:197-206. [DOI: 10.1007/s00038-013-0460-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 01/26/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022] Open
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Millar K, Lloyd SM, McLean JS, Batty GD, Burns H, Cavanagh J, Deans KA, Ford I, McConnachie A, McGinty A, Mõttus R, Packard CJ, Sattar N, Shiels PG, Velupillai YN, Tannahill C. Personality, socio-economic status and inflammation: cross-sectional, population-based study. PLoS One 2013; 8:e58256. [PMID: 23516457 PMCID: PMC3596406 DOI: 10.1371/journal.pone.0058256] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/05/2013] [Indexed: 12/14/2022] Open
Abstract
Background Associations between socio-economic status (SES), personality and inflammation were examined to determine whether low SES subjects scoring high on neuroticism or hostility might suffer relatively higher levels of inflammation than affluent subjects. Methods In a cross-sectional design, 666 subjects were recruited from areas of high (most deprived – “MD”) and low (least deprived – “LD”) deprivation. IL-6, ICAM-1, CRP and fibrinogen were measured along with demographic and health-behaviour variables, and personality traits of neuroticism, extraversion and psychoticism (hostility). Regression models assessed the prediction of inflammation as a function of personality, deprivation and their interaction. Results Levels of CRP and IL-6 were an increasing function of neuroticism and extraversion only in LD subjects opposite trends were seen in MD subjects. The result was ascribed parsimoniously to an inflammatory ceiling effect or, more speculatively, to SES-related health-behaviour differences. Psychoticism was strongly associated with ICAM-1 in both MD and LD subjects. Conclusions The association between neuroticism, CRP and IL-6 may be reduced in MD subjects confirming speculation that the association differs across population sub-groups. The association between psychoticism and ICAM-1 supports evidence that hostility has adverse effects upon the endothelium, with consequences for cardiovascular health. Health interventions may be more effective by accounting for personality-related effects upon biological processes.
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Affiliation(s)
- Keith Millar
- College of Medical, Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Suzanne M. Lloyd
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | | | - G. David Batty
- MRC Social and Public Health Sciences Unit, Glasgow, Scotland
- Department of Epidemiology and Public Health, University College London, London, England
| | | | - Jonathan Cavanagh
- College of Medical, Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Kevin A. Deans
- Department of Vascular Biochemistry, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, Scotland
- Department of Clinical Biochemistry, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, Scotland
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Agnes McGinty
- Glasgow Clinical Research Facility, Tennent Building, Western Infirmary, Glasgow, Scotland
| | - Réne Mõttus
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, Scotland
| | - Chris J. Packard
- Glasgow Clinical Research Facility, Tennent Building, Western Infirmary, Glasgow, Scotland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Paul G. Shiels
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Yoga N. Velupillai
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Mundt AP, Aichberger MC, Kliewe T, Ignatyev Y, Yayla S, Heimann H, Schouler-Ocak M, Busch M, Rapp M, Heinz A, Ströhle A. Random sampling for a mental health survey in a deprived multi-ethnic area of Berlin. Community Ment Health J 2012; 48:792-7. [PMID: 22294508 DOI: 10.1007/s10597-012-9483-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 01/18/2012] [Indexed: 11/27/2022]
Abstract
The aim of the study was to assess the response to random sampling for a mental health survey in a deprived multi-ethnic area of Berlin, Germany, with a large Turkish-speaking population. A random list from the registration office with 1,000 persons stratified by age and gender was retrieved from the population registry and these persons were contacted using a three-stage design including written information, telephone calls and personal contact at home. A female bilingual interviewer contacted persons with Turkish names. Of the persons on the list, 202 were not living in the area, one was deceased, 502 did not respond. Of the 295 responders, 152 explicitly refused(51.5%) to participate. We retained a sample of 143 participants(48.5%) representing the rate of multi-ethnicity in the area (52.1% migrants in the sample vs. 53.5% in the population). Turkish migrants were over-represented(28.9% in the sample vs. 18.6% in the population). Polish migrants (2.1 vs. 5.3% in the population) and persons from the former Yugoslavia (1.4 vs. 4.8% in the population)were under-represented. Bilingual contact procedures can improve the response rates of the most common migrant populations to random sampling if migrants of the same origin gate the contact. High non-contact and non-response rates for migrant and non-migrant populations in deprived urban areas remain a challenge for obtaining representative random samples.
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Affiliation(s)
- Adrian P Mundt
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin,Germany.
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Demarest S, Van der Heyden J, Charafeddine R, Tafforeau J, Van Oyen H, Van Hal G. Socio-economic differences in participation of households in a Belgian national health survey. Eur J Public Health 2012. [DOI: 10.1093/eurpub/cks158] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Internet psychological interventions are efficacious and may reduce traditional access barriers. No studies have evaluated whether any sampling bias exists in these trials that may limit the translation of the results of these trials into real-world application. We identified 7999 potentially eligible trial participants from a community-based health cohort study and invited them to participate in a randomized controlled trial of an online cognitive behavioural therapy programme for people with depression. We compared those who consented to being assessed for trial inclusion with nonconsenters on demographic, clinical and behavioural indicators captured in the health study. Any potentially biasing factors were then assessed for their association with depression outcome among trial participants to evaluate the existence of sampling bias. Of the 35 health survey variables explored, only 4 were independently associated with higher likelihood of consenting-female sex (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.05-1.19), speaking English at home (OR 1.48, 95% CI 1.15-1.90) higher education (OR 1.67, 95% CI 1.46-1.92) and a prior diagnosis of depression (OR 1.37, 95% CI 1.22-1.55). The multivariate model accounted for limited variance (C-statistic 0.6) in explaining participation. These four factors were not significantly associated with either the primary trial outcome measure or any differential impact by intervention arm. This demonstrates that, among eligible trial participants, few factors were associated with the consent to participate. There was no indication that such self-selection biased the trial results or would limit the generalizability and translation into a public or clinical setting.
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Gilinsky AS, Hughes AR, McInnes RJ. More Active Mums in Stirling (MAMMiS): a physical activity intervention for postnatal women. Study protocol for a randomized controlled trial. Trials 2012; 13:112. [PMID: 22818406 PMCID: PMC3480874 DOI: 10.1186/1745-6215-13-112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/28/2012] [Indexed: 11/16/2022] Open
Abstract
Background Many postnatal women are insufficiently physically active in the year after childbirth and could benefit from interventions to increase activity levels. However, there is limited information about the efficacy, feasibility and acceptability of motivational and behavioral interventions promoting postnatal physical activity in the UK. Methods The MAMMiS study is a randomized, controlled trial, conducted within a large National Health Service (NHS) region in Scotland. Up to 76 postnatal women will be recruited to test the impact of two physical activity consultations and a 10-week group pram-walking program on physical activity behavior change. The intervention uses evidence-based motivational and behavioral techniques and will be systematically evaluated using objective measures (accelerometers) at three months, with a maintenance measure taken at a six-month follow-up. Secondary health and well-being measures and psychological mediators of physical activity change are included. Discussion The (MAMMiS study will provide a test of a theoretical and evidence-based physical activity behavior change intervention for postnatal women and provide information to inform future intervention development and testing within this population. Trial registration Current Controlled Trials ISRCTN79011784
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Affiliation(s)
- Alyssa S Gilinsky
- Sport, Health and Exercise Sciences Research Group, School of Sport, University of Stirling, Stirling, Scotland FK9 4LA, UK
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Dickinson HO, Rapp M, Arnaud C, Carlsson M, Colver AF, Fauconnier J, Lyons A, Marcelli M, Michelsen SI, Parkes J, Parkinson K. Predictors of drop-out in a multi-centre longitudinal study of participation and quality of life of children with cerebral palsy. BMC Res Notes 2012; 5:300. [PMID: 22704327 PMCID: PMC3502092 DOI: 10.1186/1756-0500-5-300] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 05/08/2012] [Indexed: 11/23/2022] Open
Abstract
Background SPARCLE is a study across nine European regions which examines the predictors of participation and quality of life of children with cerebral palsy. Children and their families were initially interviewed in 2004/2005 when the children were aged 8–12 years (SPARCLE1); they were approached again in 2009/2010 at age 13–17 years (SPARCLE2). The objective of this report is to assess potential for bias due to family non-response in SPARCLE2. Logistic regression was used to assess whether socio-demographic factors, parental stress and child impairment were related to non-response, both overall and by category (failure to trace families, death of child, traced families declining to participate). Results Of the 818 families who participated in SPARCLE1, 224/818 (27%) did not participate in SPARCLE2. 51/818 (6%) were not traced. Among the 767 traced families, 32/767 (4%) children with cerebral palsy had died, seven children had been incorrectly diagnosed as having cerebral palsy, thirteen families had moved out of the region and one family had language problems. Of the remaining 714 families, 120/714 (17%) declined to participate. Drop-out between SPARCLE1 and SPARCLE2 varied significantly between regions; families were more difficult to trace and more likely to decline to participate if the parents’ educational qualifications, as recorded in SPARCLE1, were lower; they were also more likely to decline to participate if SPARCLE1 recorded that they were more stressed or if they had not completed a SPARCLE1 stress questionnaire. Conclusions To reduce the risk of bias, all SPARCLE2 analyses should allow for factors (region and walking ability) which determined the sampling strategy, either by adjusting for these factors or by using sampling weights. Further analyses should be performed, adjusting for additional factors that were associated with non-response: parents' educational qualifications, family structure and parental stress. To allow for differential non-response in studies which sample from population registers, such registers should routinely record socio-demographic information.
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Affiliation(s)
- Heather O Dickinson
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
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Syse A, Aas GB, Loge JH. Children and young adults with parents with cancer: a population-based study. Clin Epidemiol 2012; 4:41-52. [PMID: 22442635 PMCID: PMC3307636 DOI: 10.2147/clep.s28984] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Today many people are choosing to have children later in life. Additionally, the use of sophisticated diagnostic tools and screening modalities has increased over recent years. Because of these factors, cancer is being diagnosed more frequently during the child-rearing years. Sociodemographic and cancer-related information on families and minor (0–18 years) and young adult (YA) (19–25 years) children experiencing parental cancer is scarce, but this information is vital for healthcare initiatives aimed toward those potentially adversely affected. Therefore, the aim of this study was to describe features of families and minor and YA children affected by parental cancer in a nationwide population. Methods Complete Norwegian birth cohort data were obtained from national registries. Descriptive prevalence and incidence statistics were collected for parents and minor and YA children. Logistic regression models were used to assess factors likely to influence parental death. Results Every year around 0.3% of all families with children under the age of 18 years encounter parental cancer, and 3.1% of minors and 8.4% of YAs have a parent who has been diagnosed with cancer. This study found skin, breast, testicular, and colorectal cancers were the most common forms of cancer diagnosed. The sociodemographic features of those affected were fairly similar to those of the general population. One in five children experienced parental death from cancer; parental death was more often paternal than maternal and was most common in parents diagnosed with leukemia or brain, colorectal, and lung tumors. Deaths are uncommon among parents without cancer. Conclusion Adequate assistance for minor and YA children affected by parental cancer requires knowledge of their number and characteristics. Parental cancer is more common than previously suggested: the annual incidence of parental cancer for children under 18 years of age is 0.3%, whereas approximately 4% of children aged 0–25 years have or have had parents diagnosed with cancer, corresponding to a population prevalence of 1.4%. Around 20% of these children experience parental death, and surveys of live respondents should account for this.
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Abstract
BACKGROUND The non-response rates in surveys are increasing which is problematic as it means that a progressively smaller proportion of the population represents the majority, and it is uncertain how health survey results are affected. This follow-up was performed on the non-responders to the postal questionnaire in the public health survey Life and Health, conducted in Örebro County Council, Sweden, where large differences in response rates had been found between different socio-demographic groups and geographical areas. The main objective was to analyse non-response bias regarding self-rated health. METHODS This follow-up study was conducted as a census to all non-responders in the area that had the lowest response rate and, in one other geographical area used as a control. It was carried out by telephone interviews, 49.3% (580 individuals) answered the follow-up. The outcome variable was self-rated health, a main variable in public health surveys. Differences in response patterns between responders and initial non-responders were approximated by prevalences with confidence intervals and adjusted odds ratios. RESULTS Poor health was more common in the initial non-response group than among the responders, even with consideration given to sex, age, country of birth and education. However, good health was equally common among responders and initial non-responders. CONCLUSIONS Public health surveys can be biased due to certain groups being under-represented or not represented at all. For this reason, in repeated public health surveys, we recommend selective follow-ups of such groups at regular intervals.
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Ullebø AK, Posserud MB, Heiervang E, Obel C, Gillberg C. Prevalence of the ADHD phenotype in 7- to 9-year-old children: effects of informant, gender and non-participation. Soc Psychiatry Psychiatr Epidemiol 2012; 47:763-9. [PMID: 21499807 PMCID: PMC3328684 DOI: 10.1007/s00127-011-0379-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 03/31/2011] [Indexed: 11/03/2022]
Abstract
PURPOSE To estimate the prevalence of the ADHD phenotype based on parent and teacher reports in a general population sample of 7- to 9-year-old Norwegian children and evaluate the effect of parent attrition, gender and informant on the prevalence estimate. METHODS The population consisted of all children (N = 9,430) attending 2nd-4th grade in the City of Bergen, Norway. The 18 symptoms of ADHD corresponding to the SNAP-IV and DSM-IV were included in the Bergen Child Study questionnaire to teachers and parents. Teacher information was available for 9,137 children (97%) and information from both informants was available for the 6,237 children (66%) whose parents agreed to participate in the study. RESULTS The prevalence of the ADHD phenotype based on the combination of parent and teacher reports was 5.2% among participants. Teacher ratings of non-participants had a doubled rate of ADHD high scorers with an OR of 2.1 (95% CI, 1.9-2.4). The non-participant ADHD high scorers had more inattentive and fewer hyperactive/impulsive symptoms as compared to participating ADHD high scorers. Teachers reported high scores of hyperactivity/impulsivity and the combined symptom constellation much more frequently in boys than girls, while the difference between genders was less marked according to parent reports. CONCLUSIONS The ADHD phenotype was twice as prevalent among non-participants as among participants. Reported prevalences in population studies are therefore likely to be underestimates, if such attrition bias is not accounted for. Choice of informant, criteria for symptom count, definitions of subtypes and gender differences influence the prevalence estimates of the ADHD phenotype.
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Affiliation(s)
- Anne Karin Ullebø
- Centre for Child and Adolescent Mental Health, Unifob Health, Bergen, Norway.
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Hagger-Johnson G, Bewick BM, Conner M, O'Connor DB, Shickle D. Alcohol, conscientiousness and event-level condom use. Br J Health Psychol 2011; 16:828-45. [PMID: 21988067 DOI: 10.1111/j.2044-8287.2011.02019.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Alcohol impairs judgement and could be causally implicated in sexual risk taking. However, meta-analytic studies do not find an association between alcohol use and unprotected sexual intercourse at the event level, where both behaviours refer to the same point in time. Associations between personality traits and sexual risk taking have been replicated across several studies. Traits may be better conceptualized as independent risk factors, where alcohol use mediates the association between personality and condom use. The objective of our study was to determine the direct and indirect effects connecting big five personality traits with condom use, potentially mediated through alcohol use during the most recent sexual encounter. DESIGN A sample of community-dwelling adults (N= 190) completed measures of big five personality traits and a detailed assessment of event-level sexual behaviour and alcohol use. RESULTS In regression model adjusting for known confounding factors, including oral contraceptive use, partner type, and hazardous drinking patterns, one standard deviation increase in conscientiousness was associated with a 1.14-fold increase in the odds of using a condom with most recent sexual partner (p= .04). Repeating the analysis using zero-inflated regression for estimated blood alcohol concentration (eBAC) values revealed an association between conscientiousness and eBAC (p= .002). There was no association between alcohol and condom use in either analysis. CONCLUSIONS The results illustrate that personality traits are strong independent risk factors for sexual risk taking and eBAC values during sexual events, and both should be incorporated into research designs. Future research should evaluate specific facets of conscientiousness, and whether eBAC mediates the association between personality and condom use in other samples. The possibility of tailoring interventions to personality traits is discussed.
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Gale SL, Magzamen SL, Radke JD, Tager IB. Crime, neighborhood deprivation, and asthma: a GIS approach to define and assess neighborhoods. Spat Spatiotemporal Epidemiol 2011; 2:59-67. [PMID: 22749585 DOI: 10.1016/j.sste.2011.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 12/22/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
Exposure to neighborhood factors remains difficult to quantify when neighborhoods are often predefined and imprecisely measured. This study examines the association between neighborhood deprivation and participation in a community-based asthma case management (CM) program in Oakland, CA. We estimated neighborhoods by calculating walking distances of , and miles around each child's (n=2892) residence. The model assesses deprivation by the addition of weighted factors within a child's neighborhood-crime rates, alcohol outlets, and eight 2000 US Census characteristics. The results illustrate that neighborhood deprivation is weakly associated with greater levels of program participation, but neighborhood education level, measured by percentage of residents with less than a high school education, is strongly associated with greater program participation (OR: 4.43, 95% CI: [1.23, 15.99]). Neighborhood deprivation factors were significantly different between neighborhoods defined by walking distances and census blockgroups (Wilcoxon-signed rank test: p<0.05).
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Affiliation(s)
- Sara L Gale
- School of Public Health, University of California, Berkeley, CA 94704, USA.
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Timmermans S, Bonsel GJ, Steegers-Theunissen RPM, Mackenbach JP, Steyerberg EW, Raat H, Verbrugh HA, Tiemeier HW, Hofman A, Birnie E, Looman CWN, Jaddoe VWV, Steegers EAP. Individual accumulation of heterogeneous risks explains perinatal inequalities within deprived neighbourhoods. Eur J Epidemiol 2011; 26:165-80. [PMID: 21203801 PMCID: PMC3043261 DOI: 10.1007/s10654-010-9542-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 12/20/2010] [Indexed: 11/04/2022]
Abstract
Dutch’ figures on perinatal mortality and morbidity are poor compared to EU-standards. Considerable within-country differences have been reported too, with decreased perinatal health in deprived urban areas. We investigated associations between perinatal risk factors and adverse perinatal outcomes in 7,359 pregnant women participating in population-based prospective cohort study, to establish the independent role, if any, for living within a deprived urban neighbourhood. Main outcome measures included perinatal death, intrauterine growth restriction (IUGR), prematurity, congenital malformations, Apgar at 5 min < 7, and pre-eclampsia. Information regarding individual risk factors was obtained from questionnaires, physical examinations, ultrasounds, biological samples, and medical records. The dichotomous Dutch deprivation indicator was additionally used to test for unexplained deprived urban area effects. Pregnancies from a deprived neighbourhood had an increased risk for perinatal death (RR 1.8, 95% CI [1.1; 3.1]). IUGR, prematurity, Apgar at 5 min < 7, and pre-eclampsia also showed higher prevalences (P < 0.05). Residing within a deprived neighbourhood was associated with increased prevalence of all measured risk factors. Regression analysis showed that the observed neighbourhood related differences in perinatal outcomes could be attributed to the increased risk factor prevalence only, without a separated role for living within a deprived neighbourhood. Women from a deprived neighbourhood had significantly more ‘possibly avoidable’ risk factors. To conclude, women from a socioeconomically deprived neighbourhood are at an increased risk for adverse pregnancy outcomes. Differences regarding possibly avoidable risk factors imply that preventive strategies may prove effective.
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Affiliation(s)
- Sarah Timmermans
- The Generation R Study Group, Erasmus MC Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands.
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The Shanghai Changfeng Study: a community-based prospective cohort study of chronic diseases among middle-aged and elderly: objectives and design. Eur J Epidemiol 2010; 25:885-93. [PMID: 21120588 DOI: 10.1007/s10654-010-9525-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 11/18/2010] [Indexed: 12/14/2022]
Abstract
The Shanghai Changfeng Study is a community-based prospective cohort study of chronic diseases ongoing since February 2009 in Shanghai, China. The study focuses on multiple chronic diseases, including obesity and metabolic syndrome, diabetes, osteoporosis, liver diseases, cardiovascular diseases and neurologic diseases. 15,000 subjects of 40 years or over are planned to be recruited. The rationale, objectives and design of this study are described in this paper.
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Knudsen AK, Hotopf M, Skogen JC, Overland S, Mykletun A. The health status of nonparticipants in a population-based health study: the Hordaland Health Study. Am J Epidemiol 2010; 172:1306-14. [PMID: 20843863 DOI: 10.1093/aje/kwq257] [Citation(s) in RCA: 246] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The authors aimed to examine whether nonparticipation in a population-based health study was associated with poorer health status; to determine whether specific health problems were overrepresented among nonparticipants; and to explore potential consequences of participation bias on associations between exposures and outcomes. They used data from the Hordaland Health Study (HUSK), conducted in western Norway in 1997-1999. Of 29,400 persons invited, 63.1% participated in the study. Information from HUSK was linked with the Norwegian national registry of disability pensions (DPs), including information about DP diagnosis. The risk of DP receipt was almost twice as high among nonparticipants as participants (relative risk = 1.88, 95% confidence interval: 1.81, 1.95). The association was strongest for DPs received for mental disorders, with a 3-fold increased risk for nonparticipation. Substance abuse, psychotic disorders, and personality disorders were especially overrepresented among nonparticipants. The authors simulated the impact of nonparticipation on associations between exposures and outcomes by excluding HUSK participants with higher symptoms of common mental disorders (exposure) and examining the impact on DP (outcome). This selective exclusion modestly reduced associations between common mental disorders and DP. The authors conclude that nonparticipants have poorer health, but this is disorder-dependent. Participation bias is probably a greater threat to the validity of prevalence studies than to studies of associations between exposures and outcomes.
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Affiliation(s)
- Ann Kristin Knudsen
- Research Section for Mental Health Epidemiology, Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway.
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Jaddoe VWV, van Duijn CM, van der Heijden AJ, Mackenbach JP, Moll HA, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Hofman A. The Generation R Study: design and cohort update 2010. Eur J Epidemiol 2010; 25:823-41. [PMID: 20967563 PMCID: PMC2991548 DOI: 10.1007/s10654-010-9516-7] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 09/27/2010] [Indexed: 01/09/2023]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until young adulthood. The study is designed to identify early environmental and genetic causes of normal and abnormal growth, development and health during fetal life, childhood and adulthood. The study focuses on four primary areas of research: (1) growth and physical development; (2) behavioural and cognitive development; (3) diseases in childhood; and (4) health and healthcare for pregnant women and children. In total, 9,778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. General follow-up rates until the age of 4 years exceed 75%. Data collection in mothers, fathers and preschool children included questionnaires, detailed physical and ultrasound examinations, behavioural observations, and biological samples. A genome wide association screen is available in the participating children. Regular detailed hands on assessment are performed from the age of 5 years onwards. Eventually, results forthcoming from the Generation R Study have to contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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Affiliation(s)
- Vincent W V Jaddoe
- The Generation R Study Group (AE006), Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Syse A, Larsen IK, Tretli S. Does cancer in a child affect parents' employment and earnings? A population-based study. Cancer Epidemiol 2010; 35:298-305. [PMID: 20822964 DOI: 10.1016/j.canep.2010.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 08/02/2010] [Accepted: 08/06/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE Cancer in a child may adversely affect parents' work opportunities due to enlarged care burdens and/or altered priorities. Few studies exist, and possible effects on parental employment and earnings were therefore explored. MATERIALS AND METHODS Data on the entire Norwegian population aged 27-65 with children under the age of 20 in 1990-2002 (N=1.2 million) was retrieved from national registries. Employment rates for parents of 3263 children with cancer were compared to those of parents with children without cancer by means of logistic regression models. Log-linear regression models were used to explore childhood cancer's effect on parental earnings for the large majority of parents who remained employed. RESULTS Cancer in a child was in general not associated with a reduced risk of employment, although some exceptions exist among both mothers and fathers. For employed mothers, CNS cancers, germinal cell cancers, and unspecified leukemia were associated with significant reductions in earnings (10%, 21%, and 60%, respectively). Reductions were particularly pronounced for mothers with a young and alive child, and became more pronounced with time elapsed from diagnosis. Fathers' earnings were not affected significantly. DISCUSSION AND CONCLUSION Parents' employment is not adversely affected by a child's cancer in Norway. Earnings are reduced in certain instances, but the overall effects are minor. Generous welfare options and flexible labor markets typical for Nordic welfare states may account for this. In line with traditional caregiving responsibilities, reductions in earnings were most pronounced for mothers.
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Affiliation(s)
- Astri Syse
- Cancer Registry of Norway, Oslo, Norway.
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Knapp CA, Madden VL, Curtis C, Sloyer PJ, Shenkman EA. Assessing non-response bias in pediatric palliative care research. Palliat Med 2010; 24:340-7. [PMID: 20123943 DOI: 10.1177/0269216309351466] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
National experts have recognized a need for increased research in pediatric palliative care. However, when conducting research it is important to use rigorous methods, report significant and non-significant findings, and include information on responders and non-responders. Most studies do not present information on non-responders, yet this is critical as the results many not be generalizable if there are inherent differences between the two groups. Using survey data from parents whose children with life-limiting illnesses were enrolled in Florida's publicly funded pediatric palliative care program called Partners in Care: Together for Kids; this study investigates whether non-response bias exists, and if so, what characteristics are associated with non-response. Bivariate and multivariate analyses were conducted to determine whether individual characteristics differed between responders and non-responders. Throughout our analyses, we conducted the analyses using different ways in which 'non-response' can be defined. Our results suggest that regardless of how non-response is defined, Black, non-Hispanic parents were less likely to participate than White non-Hispanic parents. However, we also found that of the Black, non-Hispanic parents who did not participate, their primary reason for doing so was that they had non-working or disconnected phone numbers. Only 3% of the Black, non-Hispanic parents who did not participate flatly refused. Information from this study can be used to design interventions aimed at increasing minority participation in pediatric palliative care research.
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Affiliation(s)
- Caprice A Knapp
- Departments of Epidemiology and Health Policy Research, University of Florida, Gainesville FL, USA.
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Xun WW, Khan AE, Michael E, Vineis P. Climate change epidemiology: methodological challenges. Int J Public Health 2009; 55:85-96. [DOI: 10.1007/s00038-009-0091-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 09/10/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022] Open
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Hofman A, Breteler MMB, van Duijn CM, Janssen HLA, Krestin GP, Kuipers EJ, Stricker BHC, Tiemeier H, Uitterlinden AG, Vingerling JR, Witteman JCM. The Rotterdam Study: 2010 objectives and design update. Eur J Epidemiol 2009; 24:553-72. [PMID: 19728115 PMCID: PMC2744826 DOI: 10.1007/s10654-009-9386-z] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 08/19/2009] [Indexed: 12/19/2022]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in close to a 1,000 research articles and reports (see www.epib.nl/rotterdamstudy). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam. The Netherlands.
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