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Alkaabi FA, Maghelal PK, AlShkeili JA. Determinants of sickness absence in police: Case study of Abu Dhabi police department, UAE. Heliyon 2024; 10:e23714. [PMID: 38187343 PMCID: PMC10767504 DOI: 10.1016/j.heliyon.2023.e23714] [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: 03/06/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024] Open
Abstract
Sickness absence among employees is reported to reduce organization profits and performance and thus threaten the organization's existence in the market. The monitoring and reporting of data on sickness absence is considered a crucial element of reactive health and safety control systems in organizations. It is one of the major indicators of organizational continuous commitment to improving the quality of working conditions. However, sickness absence in Police in the United Arab Emirates (UAE) is less investigated. The Occupational Health and Safety Survey developed for this study was distributed to 1317 employees of the Capital Police Directorate of Abu Dhabi Police. The survey was answered by 760 employees (58 %). While 230 (17 %) refused to participate, 259 (20 %) did not return the surveys, and 68 (5 %) were not surveyed as they were on authorized long-term leave for various reasons (and did not receive the survey). This study analyzes if the psychosocial work factors, physical work exposure factors, and employee's perception of the health and safety management system predict sickness absence in the Abu Dhabi Police after taking into account the other covariates. This study found no association between job control and the risk of sickness absence, in contrast to findings from other studies. There was also no association between psychological job demand and the perception of health and safety management with the risk of sickness absence in this study. Officers who fit the 'job strain' category did not have a significant increase in the risk of sickness absence in this study. However, high levels of combined physical exposures reported a significant relation with sickness absence. In conclusion, this, being one of the first studies in the region, provides insights on work factors and perception of HSE on sickness absence and provides recommendations within the context of the region for future studies and address sickness absence among police in the UAE.
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Trends and socioeconomic inequities in insomnia-related symptoms among Japanese adults from 1995 to 2013. J Affect Disord 2023; 323:540-546. [PMID: 36462611 DOI: 10.1016/j.jad.2022.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Although insomnia prevalence is increasing in developed countries, little is known about trends in sleep problems among Japanese adults according to socioeconomic status. Therefore, we aimed to determine trends and socioeconomic inequalities in insomnia-related symptom (IRS) in Japan using nationally representative data. METHODS The IRSs were based on past subjective sleeping difficulty. Using data from the Comprehensive Survey of Living Conditions for every 3 years from 1995 to 2013, we built multivariable Poisson regression models, with IRS as an outcome and survey year and socioeconomic status variables as explanatory variables. RESULTS Data from 513,223 Japanese adults were analyzed. Age- and sex-adjusted IRS prevalence was the lowest in 1995, highest in 2007, and decreased from 2007 to 2013. The IRSs were more frequently reported in unemployed or self-employed individuals aged 20-64 years; those with the lowest household expenditure level, except among women aged ≥65 years; and those divorced, separated, or single, especially among women aged 20-64 years. LIMITATIONS First, the repeated cross-sectional study design prevented the exclusion of the possibility of reversal of causality between factors. Second, data on insomnia-related lifestyle behaviors were unavailable. Third, the IRSs examined did not meet established clinical criteria for clinical insomnia. Fourth and fifth, information and selection biases could exist because of self-reported data and a small sample size, respectively. CONCLUSIONS These results could aid in developing more effective prevention strategies for sleep problems and provide benchmarks for monitoring sleep health trends in Japan and other East Asian countries.
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Loy SL, Ku CW, Tiong MMY, Ng CST, Cheung YB, Godfrey KM, Lim SX, Colega MT, Lai JS, Chong YS, Shek LPC, Tan KH, Chan SY, Chong MFF, Yap F, Chan JKY. Modifiable Risk Factor Score and Fecundability in a Preconception Cohort in Singapore. JAMA Netw Open 2023; 6:e2255001. [PMID: 36749588 PMCID: PMC10408273 DOI: 10.1001/jamanetworkopen.2022.55001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/15/2022] [Indexed: 02/08/2023] Open
Abstract
IMPORTANCE Although multiple modifiable risk factors have been identified for reduced fecundability (defined as lower probability of conception within a menstrual cycle), no scoring system has been established to systematically evaluate fecundability among females who are attempting to conceive. OBJECTIVE To examine the association of a risk score based on 6 modifiable factors with fecundability, and to estimate the percentage reduction in incidence of nonconception if all study participants achieved a minimal risk score level. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study obtained data from the S-PRESTO (Singapore Preconception Study of Long-Term Maternal and Child Outcomes) prospective cohort study. Females of reproductive age who were trying to conceive were enrolled from February 2015 to October 2017 and followed for 1 year, ending in November 2018. Data were analyzed from March to May 2022. EXPOSURES A reduced fecundability risk score was derived by giving participants 1 point for each of the following factors: unhealthy body mass index, unhealthy diet, smoking, alcohol intake, folic acid supplement nonuser, and older maternal age. Total scores ranged from 0 to 6 and were classified into 5 levels: level 1 (score of 0 or 1), level 2 (score of 2), level 3 (score of 3), level 4 (score of 4), and level 5 (score of 5 or 6). MAIN OUTCOMES AND MEASURES Fecundability, measured by time to conception in cycles, was analyzed using discrete-time proportional hazards models with confounder adjustment. RESULTS A total of 937 females (mean [SD] age, 30.8 [3.8] years) were included, among whom 401 (42.8%) spontaneously conceived within 1 year of attempting conception; the median (IQR) number of cycles before conception was 4 (2-7). Compared with participants with a level 1 risk score, those with level 2, 3, 4, and 5 risk scores had reductions in fecundability of 31% (adjusted fecundability ratio [FR], 0.69; 95% CI, 0.54-0.88), 41% (FR, 0.59; 95% CI, 0.45-0.78), 54% (FR, 0.46; 95% CI, 0.31-0.69) and 77% (FR, 0.23; 95% CI, 0.07-0.73), respectively. Assessment of the population attributable fraction showed that all participants achieving a minimal (level 1) risk level would be associated with a reduction of 34% (95% CI, 30%-39%) in nonconception within a year. CONCLUSIONS AND RELEVANCE Results of this study revealed the co-occurrence of multiple modifiable risk factors for lowered fecundability and a substantially higher conception rate among participants with no or minimal risk factors. The risk assessment scoring system proposed is a simple and potentially useful public health tool for mitigating risks and guiding those who are trying to conceive.
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Affiliation(s)
- See Ling Loy
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Chee Wai Ku
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Carissa Shi Tong Ng
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Yin Bun Cheung
- Program in Health Services and Systems Research and Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Shan Xuan Lim
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Marjorelee T. Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Jun Shi Lai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Yap-Seng Chong
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, Singapore
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Tanaka H, Mackenbach JP, Kobayashi Y. Trends and socioeconomic inequalities in self-rated health in Japan, 1986-2016. BMC Public Health 2021; 21:1811. [PMID: 34625032 PMCID: PMC8501722 DOI: 10.1186/s12889-021-11708-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 08/29/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite having very high life expectancy, Japan has relatively poor self-rated health, compared to other high-income countries. We studied trends and socioeconomic inequalities in self-rated health in Japan using nationally representative data. METHODS The Comprehensive Survey of Living Conditions was analyzed, every 3 years (n ≈ 0.6-0.8 million/year) from 1986 to 2016. Whereas previous studies dichotomized self-rated health as an outcome, we used four categories: very good, good, fair, and bad/very bad. Proportional odds ordinal logistic regression models are used, with ordinal scale self-rated health as an outcome, and age category, survey year and occupational class or educational level as independent variables. RESULTS In 2016, the age-adjusted percentages for self-rated health categorized as very good, good, fair, and bad/very bad, were 24.0, 17.1, 48.7, and 10.2% among working-age men, and 21.6, 17.5, 49.4, and 11.5% among working-age women, respectively. With 1986 as the reference year, the odds ratios (ORs) of less good self-rated health were lowest in 1995 (0.69; 95% Confidence Interval [95% CI]: 0.66-0.71 of working-age men), and highest in 2010 (1.23 [95% CI: 1.19-1.27]). The ORs of male, lower non-manual workers (compared to upper non-manual) increased from 1.12 (95% CI: 1.07-1.17) in 2010 to 1.20 (95% CI: 1.15-1.26) in 2016. Between 2010 and 2016, the ORs of working-age men with middle and low levels of education (compared to a high level of education) increased from 1.22 (95% CI: 1.18-1.27) to 1.34 (95% CI: 1.29-1.38), and from 1.47 (95% CI: 1.39-1.56) to 1.75 (95% CI: 1.63-1.88), respectively. The ORs of working-age women with middle and low levels of education also increased from 1.22 (95% CI: 1.17-1.28) to 1.32 (95% CI: 1.26-1.37), and from 1.74 (95% CI: 1.61-1.88) to 2.03 (95% CI: 1.87-2.21) during the same period. CONCLUSION Japan has the unique feature that approximately 50% of the survey respondents rated their self-rated health as fair, but with important variations over time and between socioeconomic groups. In-depth studies of the role of socioeconomic conditions may shed light on the reasons for the high prevalence of poor self-rated health in Japan.
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Affiliation(s)
- Hirokazu Tanaka
- Department of Public Health, Erasmus University Medical Center, 3000, CA, Rotterdam, The Netherlands
- Department of Public Health and Occupational Medicine, Graduate School of Medicine, Mie University, Tsu, Mie, 514-8507, Japan
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Center, 3000, CA, Rotterdam, The Netherlands
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Miyamoto Y, Ryff CD. Culture and Health: Recent Developments and Future Directions
1. JAPANESE PSYCHOLOGICAL RESEARCH 2021; 64:90-108. [PMID: 35509718 PMCID: PMC9060271 DOI: 10.1111/jpr.12378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Evidence of cultural differences in relationships and emotions has accumulated over the past few decades. As findings on cultural differences in psychological processes have accumulated, there has been growing interest in investigating whether they have implications for other phenomena such as health. Using scientific advances from the MIDUS and MIDJA studies, both publicly available, we examine links between culture and health. We first briefly review the accumulated evidence on cultural influences on health correlates of psychosocial factors. We then feature two recent developments - a more micro-level perspective on biological factors that may be involved in the culture and health linkage, and a more macro-level view of socioeconomic inequality, which also matters for health. Both perspectives inform the pathways through which health effects occur. Finally, we conclude our review by highlighting the changing historical contexts surrounding these cross-cultural investigations. Specifically, we draw attention to widening of economic inequality across cultures and the world-wide COVID-19 pandemic. These happenings bring notable implications for future research on health across cultural contexts.
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Myagmar-Ochir E, Kaneko M, Tomiyama K, Zaitsu M, Watanabe S, Nishino Y, Takahashi K, Haruyama Y, Kobashi G. Occupational difference in use of heated tobacco products: a cross-sectional analysis of retail workers in Japan. BMJ Open 2021; 11:e049395. [PMID: 34429314 PMCID: PMC8386230 DOI: 10.1136/bmjopen-2021-049395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Although heated tobacco products (HTPs) have become popular worldwide, research on occupational differences in smoking HTPs remains scarce. We aimed to examine the prevalence of smoking HTPs among a working population in Japan. SETTING, DESIGN AND PARTICIPANTS In 2018, we conducted a cross-sectional study comprised of 7714 retail business workers in the service industry in Japan. PRIMARY AND SECONDARY OUTCOME MEASURES For the definition of smoking HTPs, we identified current HTP smokers who only smoked HTPs, using five mutual categories of current smoking status (never, former, HTPs only, combustible cigarettes only and dual smokers who smoked both combustible cigarettes and HTPs). Occupational classes were classified into office workers (eg, upper non-manual workers) and other workers. ORs and 95% CIs of office workers were estimated for HTP usage, adjusted for age, sex, employment type and cigarette smoking-related health knowledge. RESULTS The overall prevalence of smoking HTPs was 3.0% (male 5.0%, female 2.2%). The prevalence of HTP smokers differed across occupational classes (5.6% in office workers vs 2.5% in others; p<0.05). Compared with other workers, the adjusted odds of office workers for smoking HTPs remained elevated (OR: 1.97, 95% CI: 1.40 to 2.77). Sensitivity analyses with workers of all smoking status showed the same pattern. When stratified by sex, the occupational difference only remained significant in male workers. CONCLUSIONS We found a positive occupational difference in smoking HTPs, particularly among male workers in the retail sector in Japan. National tobacco control should explicitly address this occupational gap and further encourage individuals to quit smoking.
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Affiliation(s)
- Enkhtuguldur Myagmar-Ochir
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Makiko Kaneko
- Division of Health Support, Department Store Health Insurance Association, Tokyo, Japan
| | - Kiyomi Tomiyama
- Division of Health Support, Department Store Health Insurance Association, Tokyo, Japan
| | - Masayoshi Zaitsu
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Shuichi Watanabe
- Division of Health Support, Department Store Health Insurance Association, Tokyo, Japan
| | - Yoshitaka Nishino
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Kyo Takahashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
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Mawditt C, Sasayama K, Katanoda K, Gilmour S. The Clustering of Health-Related Behaviors in the Adult Japanese Population. J Epidemiol 2021; 31:471-479. [PMID: 32713930 PMCID: PMC8275444 DOI: 10.2188/jea.je20200120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research findings indicate that four health-related behaviors (HRBs), smoking, alcohol, diet, and physical activity, do not co-occur within individuals by chance and therefore cluster. To date, there is a lack of research investigating the clustering of these HRBs in the Japanese population. METHODS The Japanese National Health and Nutrition Survey 2010 was used, containing information on 8,015 community-dwelling adults. Latent profile analysis identified distinct cluster patterns of four HRBs: smoking status, alcohol consumption, calorie intake, and the number of steps per day. RESULTS For men, four distinct HRB clusters were identified. The largest cluster (54%) was characterized by drinking more than Japan's recommended alcohol guidelines and walking an inadequate number of steps per day. A small cluster (4%) also emerged, characterized by smoking, high calorie intake, and exceeding alcohol guidelines. Members of these clusters had higher systolic blood pressure than those in the remaining clusters. For women, five distinct HRB clusters were identified. The largest cluster (57%) was characterized by not smoking or drinking and walking an inadequate number of steps per day. For both genders, there was a relationship between cluster membership and age. Cluster membership was associated with income and health status among men but not women. CONCLUSION Detecting distinct clusters of HRBs in a Japanese population-based survey provides a person-centered understanding of Japanese lifestyles. This approach can assist policy makers in Japan and overseas to identify new strategies for targeting behavioral risk factors and make health promotion policies more effective in their respective countries.
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Affiliation(s)
- Claire Mawditt
- Canon Foundation in Europe, Amstelveen, Netherlands
- Graduate School of Public Health, St. Luke’s International University, OMURA Susumu & Mieko Memorial, St. Luke’s Center for Clinical Academia, Tokyo, Japan
| | - Kiriko Sasayama
- Graduate School of Public Health, St. Luke’s International University, OMURA Susumu & Mieko Memorial, St. Luke’s Center for Clinical Academia, Tokyo, Japan
| | - Kota Katanoda
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke’s International University, OMURA Susumu & Mieko Memorial, St. Luke’s Center for Clinical Academia, Tokyo, Japan
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Tatsuse T, Sekine M, Yamada M, Cable N, Chandola T, Marmot MG. The Role of Facets of Job Satisfaction in the National and Socioeconomic Differences in Overall Job Satisfaction: A Comparison Between Studies of Civil Servants in Great Britain and Japan. J Occup Environ Med 2021; 63:679-685. [PMID: 34397660 DOI: 10.1097/jom.0000000000002226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore national and socioeconomic differences in overall job satisfaction, we examined whether those differences can be explained by what job-related factors. METHODS Our datasets for this study are from the Whitehall II study and the Japan Civil Servant Study. Of the participants who were 5540 cases, with 3250 people from Great Britain and 2290 from Japan. RESULTS The odds ratio for job dissatisfaction was more than double in Japan compared with Britain. However, after adjusting the related factors-especially the facets of job satisfaction variables-the difference was reversed. Also, regarding the occupational differences, lower occupational grades had lower risks of overall job dissatisfaction, after adjusting for related factors. CONCLUSIONS The national and socioeconomic differences in overall job satisfaction were strongly related to facets of job satisfaction rather than job stress factors.
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Affiliation(s)
- Takashi Tatsuse
- Department of Epidemiology and Health Policy, University of Toyama, Toyama, Japan (Dr Tatsuse, Dr Sekine, Dr Yamada); Department of Epidemiology and Public Health, University College London, London (Dr Cable, Dr Marmot); Social Statistics, University of Manchester, Manchester (Dr Chandola), United Kingdom
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Lea AJ, Waigwa C, Muhoya B, Lotukoi F, Peng J, Henry LP, Abhyankar V, Kamau J, Martins D, Gurven M, Ayroles JF. Socioeconomic status effects on health vary between rural and urban Turkana. Evol Med Public Health 2021; 9:406-419. [PMID: 34987823 PMCID: PMC8697843 DOI: 10.1093/emph/eoab039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/15/2021] [Indexed: 11/14/2022] Open
Abstract
Background and objectives Understanding the social determinants of health is a major goal in evolutionary biology and human health research. Low socioeconomic status (often operationalized as absolute material wealth) is consistently associated with chronic stress, poor health and premature death in high-income countries. However, the degree to which wealth gradients in health are universal—or are instead made even steeper under contemporary, post-industrial conditions—remains poorly understood. Methodology We quantified absolute material wealth and several health outcomes among a population of traditional pastoralists, the Turkana of northwest Kenya, who are currently transitioning toward a more urban, market-integrated lifestyle. We assessed whether wealth associations with health differed in subsistence-level versus urban contexts. We also explored the causes and consequences of wealth-health associations by measuring serum cortisol, potential sociobehavioral mediators in early life and adulthood, and adult reproductive success (number of surviving offspring). Results Higher socioeconomic status and greater material wealth predicts better self-reported health and more offspring in traditional pastoralist Turkana, but worse cardiometabolic health and fewer offspring in urban Turkana. We do not find robust evidence for either direct biological mediators (cortisol) or indirect sociobehavioral mediators (e.g. adult diet or health behaviors, early life experiences) of wealth–health relationships in either context. Conclusions and implications While social gradients in health are well-established in humans and animals across a variety of socioecological contexts, we show that the relationship between wealth and health can vary within a single population. Our findings emphasize that changes in economic and societal circumstances may directly alter how, why and under what conditions socioeconomic status predicts health. Lay Summary High socioeconomic status predicts better health and more offspring in traditional Turkana pastoralists, but worse health and fewer offspring in individuals of the same group living in urban areas. Together, our study shows that under different economic and societal circumstances, wealth effects on health may manifest in very different ways.
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Affiliation(s)
- Amanda J Lea
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - Charles Waigwa
- Mpala Research Centre, Nanyuki, Kenya
- Department of Biochemistry, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Benjamin Muhoya
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
- Mpala Research Centre, Nanyuki, Kenya
| | | | - Julie Peng
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - Lucas P Henry
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - Varada Abhyankar
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - Joseph Kamau
- Department of Biochemistry, School of Medicine, University of Nairobi, Nairobi, Kenya
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Dino Martins
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Mpala Research Centre, Nanyuki, Kenya
| | - Michael Gurven
- Department of Anthropology, University of California: Santa Barbara, Santa Barbara, CA, USA
| | - Julien F Ayroles
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
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Zaitsu M, Kato S, Kim Y, Takeuchi T, Sato Y, Kobayashi Y, Kawachi I. Occupational Class and Risk of Cardiovascular Disease Incidence in Japan: Nationwide, Multicenter, Hospital-Based Case-Control Study. J Am Heart Assoc 2020; 8:e011350. [PMID: 30845875 PMCID: PMC6475056 DOI: 10.1161/jaha.118.011350] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background In contemporary Western settings, higher occupational class is associated with lower risk for cardiovascular disease (CVD) incidence, including coronary heart disease (CHD) and stroke. However, in non‐Western settings (including Japan), the occupational class gradient for cardiovascular disease risk has not been characterized. Methods and Results Using a nationwide, multicenter hospital inpatient data set (1984–2016) in Japan, we conducted a matched hospital case‐control study with ≈1.1 million study subjects. Based on a standard national classification, we coded patients according to their longest‐held occupational class (blue‐collar, service, professional, manager) within each industrial sector (blue‐collar, service, white‐collar). Using blue‐collar workers in blue‐collar industries as the referent group, odds ratios and 95% CIs were estimated by conditional logistic regression with multiple imputation, matched for sex, age, admission date, and admitting hospital. Smoking and drinking were additionally controlled. Higher occupational class (professionals and managers) was associated with excess risk for CHD. Even after controlling for smoking and drinking, the excess odds across all industries remained significantly associated with CHD, being most pronounced among managers employed in service industries (odds ratio, 1.19; 95% CI, 1.08–1.31). On the other hand, the excess CHD risk in higher occupational class was offset by their lower risk for stroke (eg, odds ratio for professionals in blue‐collar industries, 0.77; 95% CI, 0.70–0.85). Conclusions The occupational “gradient” in cardiovascular disease (with lower risk observed in higher status occupations) may not be a universal phenomenon. In contemporary Japanese society, managers and professionals may experience higher risk for CHD.
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Affiliation(s)
- Masayoshi Zaitsu
- 1 Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Boston MA.,2 Department of Public Health Graduate School of Medicine The University of Tokyo Japan
| | - Soichiro Kato
- 1 Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Boston MA.,3 Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
| | - Yongjoo Kim
- 1 Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Boston MA
| | | | - Yuzuru Sato
- 5 Department of Gastroenterology Kanto Rosai Hospital Kanagawa Japan
| | - Yasuki Kobayashi
- 2 Department of Public Health Graduate School of Medicine The University of Tokyo Japan
| | - Ichiro Kawachi
- 1 Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Boston MA
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Tanaka H, Nusselder WJ, Bopp M, Brønnum-Hansen H, Kalediene R, Lee JS, Leinsalu M, Martikainen P, Menvielle G, Kobayashi Y, Mackenbach JP. Mortality inequalities by occupational class among men in Japan, South Korea and eight European countries: a national register-based study, 1990-2015. J Epidemiol Community Health 2019; 73:750-758. [PMID: 31142611 PMCID: PMC6678055 DOI: 10.1136/jech-2018-211715] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/01/2019] [Accepted: 05/01/2019] [Indexed: 11/01/2022]
Abstract
BACKGROUND We compared mortality inequalities by occupational class in Japan and South Korea with those in European countries, in order to determine whether patterns are similar. METHODS National register-based data from Japan, South Korea and eight European countries (Finland, Denmark, England/Wales, France, Switzerland, Italy (Turin), Estonia, Lithuania) covering the period between 1990 and 2015 were collected and harmonised. We calculated age-standardised all-cause and cause-specific mortality among men aged 35-64 by occupational class and measured the magnitude of inequality with rate differences, rate ratios and the average inter-group difference. RESULTS Clear gradients in mortality were found in all European countries throughout the study period: manual workers had 1.6-2.5 times higher mortality than upper non-manual workers. However, in the most recent time-period, upper non-manual workers had higher mortality than manual workers in Japan and South Korea. This pattern emerged as a result of a rise in mortality among the upper non-manual group in Japan during the late 1990s, and in South Korea during the late 2000s, due to rising mortality from cancer and external causes (including suicide), in addition to strong mortality declines among lower non-manual and manual workers. CONCLUSION Patterns of mortality by occupational class are remarkably different between European countries and Japan and South Korea. The recently observed patterns in the latter two countries may be related to a larger impact on the higher occupational classes of the economic crisis of the late 1990s and the late 2000s, respectively, and show that a high socioeconomic position does not guarantee better health.
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Affiliation(s)
- Hirokazu Tanaka
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wilma J Nusselder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | | | - Ramune Kalediene
- Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jung Su Lee
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södetörn University, Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Pekka Martikainen
- Population Research Unit, Department of Social Reseach, University of Helsinki, Helsinki, Finland
| | - Gwenn Menvielle
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, Paris, France
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Class and Health Inequality in Later Life: Patterns, Mechanisms and Implications for Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121533. [PMID: 29292775 PMCID: PMC5750951 DOI: 10.3390/ijerph14121533] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 12/22/2022]
Abstract
The growth of the post-retirement population, which has occurred as a result of rapid growth in life expectancy coupled with the ageing of the baby boomer cohort, has led to significant concern. This concern, however, typically neglects the heterogeneity of later life experiences and how these are patterned by inequalities that reflect how process of social stratification continue to operate into later life. This paper draws on a programme of work, based on analysis of the English Longitudinal Study of Ageing, to empirically examine questions of inequality in later life. It begins by illustrating the patterning of health inequality. It then investigates the importance of later life contexts and events in shaping inequality through and after the retirement process. In doing so it examines the extent to which later life continues to reflect stable social structures that shape inequalities and, consequently, health and wellbeing in later life. The paper then illustrates how the effects of socioeconomic position on health in later life can be theorised as a product of class processes, borrowing in part from Bourdieu. Other dimensions of inequality, such as gender, ethnicity, area and sexuality, are not discussed here. The paper concludes with a discussion of the need for a close focus on inequalities in later life in research, policy and practice.
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Miyamoto Y. Culture and social class. Curr Opin Psychol 2017; 18:67-72. [PMID: 28826007 DOI: 10.1016/j.copsyc.2017.07.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
Abstract
A large body of research in Western cultures has demonstrated the psychological and health effects of social class. This review outlines a cultural psychological approach to social stratification by comparing psychological and health manifestations of social class across Western and East Asian cultures. These comparisons suggest that cultural meaning systems shape how people make meaning and respond to material/structural conditions associated with social class, thereby leading to culturally divergent manifestations of social class. Specifically, unlike their counterparts in Western cultures, individuals of high social class in East Asian cultures tend to show high conformity and other-orientated psychological attributes. In addition, cultures differ in how social class impacts health (i.e. on which bases, through which pathways, and to what extent).
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Lahti J, Sabia S, Singh-Manoux A, Kivimäki M, Tatsuse T, Yamada M, Sekine M, Lallukka T. Leisure time physical activity and subsequent physical and mental health functioning among midlife Finnish, British and Japanese employees: a follow-up study in three occupational cohorts. BMJ Open 2016; 6:e009788. [PMID: 26739736 PMCID: PMC4716250 DOI: 10.1136/bmjopen-2015-009788] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The aim of this study was to examine whether leisure time physical activity contributes to subsequent physical and mental health functioning among midlife employees. The associations were tested in three occupational cohorts from Finland, Britain and Japan. DESIGN Cohort study. SETTING Finland, Britain and Japan. PARTICIPANTS Prospective employee cohorts from the Finnish Helsinki Health Study (2000-2002 and 2007, n=5958), British Whitehall II study (1997-1999 and 2003-2004, n=4142) and Japanese Civil Servants Study (1998-1999 and 2003, n=1768) were used. Leisure time physical activity was classified into three groups: inactive, moderately active and vigorously active. PRIMARY OUTCOME MEASURE Mean scores of physical and mental health functioning (SF-36) at follow-up were examined. RESULTS Physical activity was associated with better subsequent physical health functioning in all three cohorts, however, with varying magnitude and some gender differences. Differences were the clearest among Finnish women (inactive: 46.0, vigorously active: 49.5) and men (inactive: 47.8, active vigorous: 51.1) and British women (inactive: 47.3, active vigorous: 50.4). In mental health functioning, the differences were generally smaller and not that clearly related to the intensity of physical activity. Emerging differences in health functioning were relatively small. CONCLUSIONS Vigorous physical activity was associated with better subsequent physical health functioning in all three cohorts with varying magnitude. For mental health functioning, the intensity of physical activity was less important. Promoting leisure time physical activity may prove useful for the maintenance of health functioning among midlife employees.
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Affiliation(s)
- Jouni Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Séverine Sabia
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mika Kivimäki
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Takashi Tatsuse
- Department of Epidemiology and Health Policy, University of Toyama, Toyama, Japan
| | - Masaaki Yamada
- Department of Epidemiology and Health Policy, University of Toyama, Toyama, Japan
| | - Michikazu Sekine
- Department of Epidemiology and Health Policy, University of Toyama, Toyama, Japan
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Finnish Institute of Occupational Health, Helsinki, Finland
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McGovern P, Nazroo JY. Patterns and causes of health inequalities in later life: a Bourdieusian approach. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:143-60. [PMID: 25601070 DOI: 10.1111/1467-9566.12187] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study explores the relationship between social class and health change in older people in a path analysis, using data from the English Longitudinal Study of Ageing (n = 6241) in a Bourdieusian theoretical framework. Bourdieu drew a distinction between the occupational characteristics by which people are classified and the secondary properties of class that relate to lifestyle (economic, cultural and social capitals). Our path model includes both occupational and secondary characteristics of objective social class as well as a measure of subjective social class. We investigate the effects of the predictors on change in three health outcomes (self-rated health, number of symptoms of depression and number of difficulties with the activities of daily living). The analysis adds to Bourdieusian research by showing how the effects of objective social class on health are partially mediated by perceived social status. It also adds to substantive research on the relationship between class and health by suggesting that class-related health inequalities do persist for older people, even for those who are not in paid employment. It suggests that a large amount of the effect of occupation on the health of older people is not direct but indirect; through their personal wealth and lifestyle.
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Affiliation(s)
- Pauline McGovern
- Cathie Marsh Institute for Social Research, School of Social Science, University of Manchester
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Lahelma E, Pietiläinen O, Rahkonen O, Kivimäki M, Martikainen P, Ferrie J, Marmot M, Shipley M, Sekine M, Tatsuse T, Lallukka T. Social class inequalities in health among occupational cohorts from Finland, Britain and Japan: a follow up study. Health Place 2014; 31:173-9. [PMID: 25545770 DOI: 10.1016/j.healthplace.2014.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 11/17/2014] [Accepted: 12/03/2014] [Indexed: 01/22/2023]
Abstract
We examined whether relative occupational social class inequalities in physical health functioning widen, narrow or remain stable among white collar employees from three affluent countries. Health functioning was assessed twice in occupational cohorts from Britain (1997-1999 and 2003-2004), Finland (2000-2002 and 2007) and Japan (1998-1999 and 2003). Widening inequalities were seen for British and Finnish men, whereas inequalities among British and Finnish women remained relatively stable. Japanese women showed reverse inequalities at follow up, but no health inequalities were seen among Japanese men. Health behaviours and social relations explained 4-37% of the magnitude in health inequalities, but not their widening.
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Affiliation(s)
- Eero Lahelma
- Department of Public Health, PO Box 41, University of Helsinki, Helsinki 00014, Finland.
| | - Olli Pietiläinen
- Department of Public Health, PO Box 41, University of Helsinki, Helsinki 00014, Finland
| | - Ossi Rahkonen
- Department of Public Health, PO Box 41, University of Helsinki, Helsinki 00014, Finland
| | - Mika Kivimäki
- Department of Public Health, PO Box 41, University of Helsinki, Helsinki 00014, Finland
| | - Pekka Martikainen
- Department of Public Health, PO Box 41, University of Helsinki, Helsinki 00014, Finland
| | - Jane Ferrie
- Department of Public Health, PO Box 41, University of Helsinki, Helsinki 00014, Finland
| | - Michael Marmot
- Department of Public Health, PO Box 41, University of Helsinki, Helsinki 00014, Finland
| | - Martin Shipley
- Department of Public Health, PO Box 41, University of Helsinki, Helsinki 00014, Finland
| | - Michikazu Sekine
- Department of Public Health, PO Box 41, University of Helsinki, Helsinki 00014, Finland
| | - Takashi Tatsuse
- Department of Public Health, PO Box 41, University of Helsinki, Helsinki 00014, Finland
| | - Tea Lallukka
- Department of Public Health, PO Box 41, University of Helsinki, Helsinki 00014, Finland
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Asai K, Yamori M, Yamazaki T, Yamaguchi A, Takahashi K, Sekine A, Kosugi S, Matsuda F, Nakayama T, Bessho K. Tooth loss and atherosclerosis: the Nagahama Study. J Dent Res 2014; 94:52S-58S. [PMID: 25406168 DOI: 10.1177/0022034514559127] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Several epidemiologic studies have suggested that oral disease is a risk factor for cardiovascular disease (CVD). However, whether a clinically significant association exists between the 2 disorders remains controversial. Here, we investigated the association between tooth loss, as an indicator of oral disease, and arterial stiffness, as a marker of atherosclerosis, in Japanese adults. Cross-sectional data were collected for 8,124 persons aged 30 to 75 y with no history of tooth loss for noninflammatory reasons, such as orthodontic treatment, malposition, and trauma. Participants received a comprehensive dental examination and extensive in-person measurements of CVD risk factors, and arterial stiffness was evaluated using the cardio-ankle vascular index (CAVI). We examined the association between CAVI and tooth loss using general linear models with adjustment for age, sex, body mass index, smoking status, hemoglobin A1c, and a history of insulin or hypoglycemic medication depending on the model. In addition, we performed an analysis that included interaction terms of the centered variables tooth loss, sex, and age. The results of the multiple regression analysis that included the interaction terms detected that the relationship between CAVI and tooth loss was dependent on sex, with only men showing a positive correlation (β for interaction = 0.04; 95% confidence interval, 0.02-0.06). The findings from this study suggest that a linear relationship exists between tooth loss and degree of arterial stiffness and that the association differed depending on sex.
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Affiliation(s)
- K Asai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - M Yamori
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Yamazaki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - A Yamaguchi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - K Takahashi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - A Sekine
- EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - S Kosugi
- Department of Biomedical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - F Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - K Bessho
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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18
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Fujimura Y, Sekine M, Tatsuse T. Sex differences in factors contributing to family-to-work and work-to-family conflict in Japanese civil servants. J Occup Health 2014; 56:485-97. [PMID: 25374422 DOI: 10.1539/joh.14-0045-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES As the number of dual-earner couples in Japan has increased, work-life balance has become important. This study aimed to examine the factors that contribute to work-family conflict. METHODS The participants included 3,594 (2,332 men and 1,262 women) civil servants aged 20-59 working for local government on the west coast of Japan. Logistic regression analysis was used to evaluate whether work, family, or lifestyle characteristics were associated with work-family conflict. RESULTS For men, family-to-work conflict was associated with being elderly, having low-grade employment, working long hours, raising children, and sleeping shorter hours. For women, being married and raising children were strong determinants of family-to-work conflict, and being middle-aged, working long hours, and sleeping shorter hours were also associated with this type of conflict. Regarding work-to-family conflict, working long hours was the strongest determinant of conflict in both sexes. In men, being elderly, living with family, eating dinner late, and sleeping shorter hours were also associated with work-to-family conflict. In women, having high-grade employment, being married, raising children, and eating dinner late were associated with work-to-family conflict. CONCLUSIONS This study showed that working long hours was the primary determinant of work-to-family conflict in both sexes and that being married and raising children were strong factors of family-to-work conflict in women only. Sex differences may reflect divergence of the social and domestic roles of men and women in Japanese society. To improve the work-life balance, general and sex-specific health policies may be required.
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Affiliation(s)
- Yuko Fujimura
- Department of Epidemiology and Health Policy, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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The contribution of lifestyle and work factors to social inequalities in self-rated health among the employed population in Switzerland. Soc Sci Med 2014; 121:74-84. [PMID: 25310888 DOI: 10.1016/j.socscimed.2014.09.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/11/2014] [Accepted: 09/21/2014] [Indexed: 11/21/2022]
Abstract
We sought to examine the joint and independent contributions of working conditions and health-related behaviours in explaining social gradients in self-rated health (SRH). Nationally representative cross-sectional data from the Swiss Health Survey of 2007 were used for this study. Bi- and multivariate statistical analyses were carried out on a sample of 6950 adult employees of working age. We examined a comprehensive set of five health behaviours and lifestyle factors as well as twelve physical and psychosocial work factors as potential mediators of the relationship between social status and SRH. Analyses were stratified by sex and performed using two measures of social status, educational level and occupational position. Strong social gradients were found for SRH, but mainly in men whereas in women the associations were either not linear (educational level) or not statistically significant (occupational position). Social gradients were also found for most lifestyle and all physical and psychosocial work factors studied. These three groups of factors equally contributed to and largely accounted for the social gradients in SRH although not all of the individual factors turned out to be independent and significant risk factors for poor SRH. Such risk factors included physical inactivity and obesity, poor posture and no or low social support at work (both sexes), heavy smoking (men) and underweight, overweight, uniform arm or hand movements at work, monotonous work and job insecurity (women). In conclusion, social inequalities (or more precisely educational and occupational status differences) in SRH were more pronounced in men and can be attributed for the most part to a sedentary lifestyle and to a physically demanding and socially unsupportive and insecure work environment. Apart from this main finding and overall pattern, sex-specific risk profiles were observed with regard to SRH and need to be taken into consideration.
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20
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Silventoinen K, Tatsuse T, Martikainen P, Rahkonen O, Lahelma E, Sekine M, Lallukka T. Occupational class differences in body mass index and weight gain in Japan and Finland. J Epidemiol 2013; 23:443-50. [PMID: 24140817 PMCID: PMC3834282 DOI: 10.2188/jea.je20130023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Occupational class differences in body mass index (BMI) have been systematically reported in developed countries, but the studies have mainly focused on white populations consuming a Westernized diet. We compared occupational class differences in BMI and BMI change in Japan and Finland. Methods The baseline surveys were conducted during 1998–1999 among Japanese (n = 4080) and during 2000–2002 among Finnish (n = 8685) public-sector employees. Follow-up surveys were conducted among those still employed, in 2003 (n = 3213) and 2007 (n = 7086), respectively. Occupational class and various explanatory factors were surveyed in the baseline questionnaires. Linear regression models were used for data analysis. Results BMI was higher at baseline and BMI gain was more rapid in Finland than in Japan. In Finland, baseline BMI was lowest among men and women in the highest occupational class and progressively increased to the lowest occupational class; no gradient was found in Japan (country interaction effect, P = 0.020 for men and P < 0.0001 for women). Adjustment for confounding factors reflecting work conditions and health behavior increased the occupational class gradient among Finnish men and women, whereas factors related to social life had no effect. No statistically significant difference in BMI gain was found between occupational classes. Conclusions The occupational class gradient in BMI was strong among Finnish employees but absent among Japanese employees. This suggests that occupational class inequalities in obesity are not inevitable, even in high-income societies.
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Affiliation(s)
- Karri Silventoinen
- Population Research Unit, Department of Social Research, University of Helsinki
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21
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White HL, O’Campo P, Moineddin R, Matheson FI. Modeling the cumulative effects of social exposures on health: moving beyond disease-specific models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:1186-201. [PMID: 23528813 PMCID: PMC3709312 DOI: 10.3390/ijerph10041186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/13/2013] [Accepted: 03/19/2013] [Indexed: 11/25/2022]
Abstract
The traditional explanatory models used in epidemiology are “disease specific”, identifying risk factors for specific health conditions. Yet social exposures lead to a generalized, cumulative health impact which may not be specific to one illness. Disease-specific models may therefore misestimate social factors’ effects on health. Using data from the Canadian Community Health Survey and Canada 2001 Census we construct and compare “disease-specific” and “generalized health impact” (GHI) models to gauge the negative health effects of one social exposure: socioeconomic position (SEP). We use logistic and multinomial multilevel modeling with neighbourhood-level material deprivation, individual-level education and household income to compare and contrast the two approaches. In disease-specific models, the social determinants under study were each associated with the health conditions of interest. However, larger effect sizes were apparent when outcomes were modeled as compound health problems (0, 1, 2, or 3+ conditions) using the GHI approach. To more accurately estimate social exposures’ impacts on population health, researchers should consider a GHI framework.
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Affiliation(s)
- Heather L. White
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada; E-Mail:
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada; E-Mails: (R.M.); (F.I.M.)
| | - Patricia O’Campo
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada; E-Mails: (R.M.); (F.I.M.)
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5C 1N8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Author to whom correspondence should be addressed; E-Mail: co’; Tel.: +1-416-864-5403; Fax: +1-416-864-5485
| | - Rahim Moineddin
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada; E-Mails: (R.M.); (F.I.M.)
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5C 1N8, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Flora I. Matheson
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada; E-Mails: (R.M.); (F.I.M.)
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5C 1N8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
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Brännlund A, Hammarström A, Strandh M. Education and health-behaviour among men and women in Sweden: A 27-year prospective cohort study. Scand J Public Health 2013; 41:284-92. [DOI: 10.1177/1403494813475531] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Previous research has found a positive association between health-behaviour and health. Only a few longitudinal studies have been performed, and as far as we found, none have followed a cohort for 27 years. Methods: This study used a cohort study, the “Northern Swedish Cohort”, which consisted of all graduates, n = 1080, from a compulsory school in a Swedish town. Data were collected with a comprehensive questionnaire; response rate 96.4%. Health-behaviour was analysed with binary logistic regression, with health-behaviour at age 21, 30 and 43 years as dependent variable. Besides baseline health-behaviour, gender, somatic and psychological health and socioeconomic background, the analyses were adjusted for work situation and social network. Results: The main findings were that education reduces the probability of unhealthy behaviour over the life course, which held after controlling for early life health-behaviour and possible confounders. The general education effect on health-behaviour was stronger among men than among women. Conclusions: Higher education reduces the probability of unhealthy behavior. Thus, investments in higher education should be an important public goal.
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Affiliation(s)
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Mattias Strandh
- Department of Sociology, Umeå University, Sweden, and Centre for Applied Psychological Research, School of Psychology, Social Work and Social Policy, University of South Australia, Australia
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Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review. Int J Behav Nutr Phys Act 2012; 9:116. [PMID: 22992350 PMCID: PMC3491027 DOI: 10.1186/1479-5868-9-116] [Citation(s) in RCA: 320] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 09/04/2012] [Indexed: 11/24/2022] Open
Abstract
Background This study systematically reviewed the evidence pertaining to socioeconomic inequalities in different domains of physical activity (PA) by European region. Methods Studies conducted between January 2000 and December 2010 were identified by a systematic search in Pubmed, Embase, Web of Science, Psychinfo, Sportdiscus, Sociological Abstracts, and Social Service Abstracts. English-language peer-reviewed studies undertaken in the general population of adults (18–65 years) were classified by domain of PA (total, leisure-time including sport, occupational, active transport), indicator of socioeconomic position (education, income, occupation), and European region. Distributions of reported positive, negative, and null associations were evaluated. Results A total of 131 studies met the inclusion criteria. Most studies were conducted in Scandinavia (n = 47). Leisure-time PA was the most frequently studied PA outcome (n = 112). Considerable differences in the direction of inequalities were seen for the different domains of PA. Most studies reported that those with high socioeconomic position were more physically active during leisure-time compared to those with low socioeconomic position (68% positive associations for total leisure-time PA, 76% for vigorous leisure-time PA). Occupational PA was more prevalent among the lower socioeconomic groups (63% negative associations). Socioeconomic differences in total PA and active transport PA did not show a consistent pattern (40% and 38% positive associations respectively). Some inequalities differed by European region or socioeconomic indicator, however these differences were not very pronounced. Conclusions The direction of socioeconomic inequalities in PA in Europe differed considerably by domain of PA. The contradictory results for total PA may partly be explained by contrasting socioeconomic patterns for leisure-time PA and occupational PA.
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Ishikawa Y, Nishiuchi H, Hayashi H, Viswanath K. Socioeconomic status and health communication inequalities in Japan: a nationwide cross-sectional survey. PLoS One 2012; 7:e40664. [PMID: 22808229 PMCID: PMC3395686 DOI: 10.1371/journal.pone.0040664] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 06/11/2012] [Indexed: 11/18/2022] Open
Abstract
Background Considerable evidence suggests that communication inequality is one potential mechanism linking social determinants, particularly socioeconomic status, and health inequalities. This study aimed to examine how dimensions of health communication outcomes (health information seeking, self-efficacy, exposure, and trust) are patterned by socioeconomic status in Japan. Methods Data of a nationally representative cross-sectional survey of 2,455 people aged 15–75 years in Japan were used for secondary analysis. Measures included socio-demographic characteristics, subjective health, recent health information seeking, self-efficacy in seeking health information, and exposure to and trust in health information from different media. Results A total of 1,311 participants completed the questionnaire, giving a response rate of 53.6%. Multivariate logistic regression revealed that education and household income, but not employment, were significantly associated with health information seeking and self-efficacy. Socioeconomic status was not associated with exposure to and trust in health information from mass media, but was significantly associated with health information from healthcare providers and the Internet. Conclusion Health communication outcomes were patterned by socioeconomic status in Japan thus demonstrating the prevalence of health communication inequalities. Providing customized exposure to and enhancing the quality of health information by considering social determinants may contribute to addressing social disparities in health in Japan.
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Affiliation(s)
- Yoshiki Ishikawa
- Department of Public Health, Jichi Medical University, Shimotuke-shi, Tochigi, Japan.
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Lahelma E, Aittomäki A, Laaksonen M, Lallukka T, Martikainen P, Piha K, Rahkonen O, Saastamoinen P. Cohort Profile: The Helsinki Health Study. Int J Epidemiol 2012; 42:722-30. [DOI: 10.1093/ije/dys039] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Suzuki E, Kashima S, Kawachi I, Subramanian SV. Social and geographic inequalities in premature adult mortality in Japan: a multilevel observational study from 1970 to 2005. BMJ Open 2012; 2:e000425. [PMID: 22389360 PMCID: PMC3293144 DOI: 10.1136/bmjopen-2011-000425] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To examine trends in social and geographic inequalities in all-cause premature adult mortality in Japan. DESIGN Observational study of the vital statistics and the census data. SETTING Japan. PARTICIPANTS Entire population aged 25 years or older and less than 65 years in 1970, 1975, 1980, 1985, 1990, 1995, 2000 and 2005. The total number of decedents was 984 022 and 532 223 in men and women, respectively. MAIN OUTCOME MEASURES For each sex, ORs and 95% CIs for mortality were estimated by using multilevel logistic regression models with 'cells' (cross-tabulated by age and occupation) at level 1, 8 years at level 2 and 47 prefectures at level 3. The prefecture-level variance was used as an estimate of geographic inequalities of mortality. RESULTS Adjusting for age and time-trends, compared with production process and related workers, ORs ranged from 0.97 (95% CI 0.96 to 0.98) among administrative and managerial workers to 2.22 (95% CI 2.19 to 2.24) among service workers in men. By contrast, in women, the lowest odds for mortality was observed among production process and related workers (reference), while the highest OR was 12.22 (95% CI 11.40 to 13.10) among security workers. The degree of occupational inequality increased in both sexes. Higher occupational groups did not experience reductions in mortality throughout the period and was overtaken by lower occupational groups in the early 1990s, among men. Conditional on individual age and occupation, overall geographic inequalities of mortality were relatively small in both sexes; the ORs ranged from 0.87 (Okinawa) to 1.13 (Aomori) for men and from 0.84 (Kanagawa) to 1.11 (Kagoshima) for women, even though there is a suggestion of increasing inequalities across prefectures since 1995 in both sexes. CONCLUSIONS The present findings suggest that both social and geographic inequalities in all-cause mortality have increased in Japan during the last 3 decades.
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Affiliation(s)
- Etsuji Suzuki
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Saori Kashima
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Public Health and Health Policy, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Ichiro Kawachi
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - S V Subramanian
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA
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Boylan S, Lallukka T, Lahelma E, Pikhart H, Malyutina S, Pajak A, Kubinova R, Bragina O, Stepaniak U, Gillis-Januszewska A, Simonova G, Peasey A, Bobak M. Socio-economic circumstances and food habits in Eastern, Central and Western European populations. Public Health Nutr 2011; 14:678-87. [PMID: 20843403 PMCID: PMC3951866 DOI: 10.1017/s1368980010002570] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the relationship between several socio-economic indicators and frequency of consumption of seven predefined healthy foods (consumption of fruit, vegetables, wholegrain bread, vegetable-fat spread, vegetable cooking fat, low-fat milk and low-fat cheese) in populations from Eastern, Central and Western Europe. DESIGN Analysis of baseline data collected in two cross-sectional cohort studies between 2000 and 2005: the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study and the Finnish Helsinki Health Study (HHS). SETTING Urban populations in the Czech Republic, Russia, Poland and Finland. SUBJECTS In the HAPIEE study, random samples of men and women aged 45-69 years were drawn from population registers and electoral lists of selected cities. In the HHS, men and women aged 40-60 years employed by the City of Helsinki were recruited. Data on 21,326 working subjects from both cohorts were analysed. RESULTS Healthy food habits were, in general, positively associated with higher education, occupational position and fewer economic difficulties, but there were differences in the strength of the gradient by food and country. Fruit consumption showed the most consistent gradients, especially in relation to socio-economic status among men (country-specific relative index of inequality (RII)=2.02-5.17) and women (RII=2.09-3.57). CONCLUSIONS The associations between socio-economic indicators and healthy food habits showed heterogeneity between countries. Future studies of dietary behaviours should consider multiple measures of socio-economic position.
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Affiliation(s)
- Sinéad Boylan
- Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
| | - Sofia Malyutina
- Institute of Internal Medicine, Russian Academy of Medical Sciences, Novosibirsk, Russia
| | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | | | - Oksana Bragina
- Institute of Internal Medicine, Russian Academy of Medical Sciences, Novosibirsk, Russia
| | - Urszula Stepaniak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | | | - Galina Simonova
- Institute of Internal Medicine, Russian Academy of Medical Sciences, Novosibirsk, Russia
| | - Anne Peasey
- Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
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Simen-Kapeu A, Veugelers PJ. Socio-economic gradients in health behaviours and overweight among children in distinct economic settings. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2010; 101 Suppl 3:S32-S36. [PMID: 21416800 PMCID: PMC6973696 DOI: 10.1007/bf03403979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The socio-economic gradient in health does not seem to apply to overweight among Canadians adults. In the present study, we sought to determine the socio-economic gradient in overweight among Canadian children in distinct economic settings. We further examined socio-economic gradients in underlying behaviours, healthy eating and active living, as well as parental support for these behaviours. METHODS We surveyed 6430 grade five students and their parents in Alberta and Nova Scotia. Students completed dietary and activity questionnaires and had their height and weight measured. Parents completed questions on socio-economic background and their support for their child's health behaviours. We applied multi-level regression methods to characterize the socio-economic gradients. RESULTS In both Alberta and Nova Scotia, we observed socio-economic gradients whereby children with parents who were more highly educated and had higher earnings were more physically active and less likely overweight. In contrast, we did not observe a socio-economic gradient with respect to healthy eating. Relative to socio-economically disadvantaged parents, those with better education and higher income were more likely to report encouraging their children's healthy eating and physical activity. Socio-economically disadvantaged parents, though, reported more engagement in physical activities with their children. CONCLUSION Whereas the socio-economic gradient in overweight among Canadian adults is fading, we did not observe such a phenomenon among children. The mechanism preserving the socio-economic gradient among children may be related to more encouragement given to healthy eating and physical activity in the more socio-economically advanced families.
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Affiliation(s)
- Aline Simen-Kapeu
- School of Public Health, University of Alberta, 650 University Terrace, 8303 - 112 St., Edmonton, Alberta T6G 2T4 Canada
| | - Paul J. Veugelers
- School of Public Health, University of Alberta, 650 University Terrace, 8303 - 112 St., Edmonton, Alberta T6G 2T4 Canada
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Kirkegaard H, Johnsen NF, Christensen J, Frederiksen K, Overvad K, Tjønneland A. Association of adherence to lifestyle recommendations and risk of colorectal cancer: a prospective Danish cohort study. BMJ 2010; 341:c5504. [PMID: 20978063 PMCID: PMC2965150 DOI: 10.1136/bmj.c5504] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2010] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the association between a simple lifestyle index based on the recommendations for five lifestyle factors and the incidence of colorectal cancer, and to estimate the proportion of colorectal cancer cases attributable to lack of adherence to the recommendations. DESIGN Prospective cohort study. SETTING General population of Copenhagen and Aarhus, Denmark. PARTICIPANTS 55 487 men and women aged 50-64 years at baseline (1993-7), not previously diagnosed with cancer. MAIN OUTCOME MEASURE Risk of colorectal cancer in relation to points achieved in the lifestyle index (based on physical activity, waist circumference, smoking, alcohol intake, and diet (dietary fibre, energy percentage from fat, red and processed meat, and fruits and vegetables)) modelled through Cox regression. RESULTS During a median follow-up of 9.9 years, 678 men and women had colorectal cancer diagnosed. After adjustment for potential confounders, each additional point achieved on the lifestyle index, corresponding to one additional recommendation that was met, was associated with a lower risk of colorectal cancer (incidence rate ratio 0.89 (95% confidence interval 0.82 to 0.96). In this population an estimated total of 13% (95% CI 4% to 22%) of the colorectal cancer cases were attributable to lack of adherence to merely one additional recommendation among all participants except the healthiest. If all participants had followed the five recommendations 23% (9% to 37%) of the colorectal cancer cases might have been prevented. Results were similar for colon and rectal cancer, but only statistically significant for colon cancer. CONCLUSIONS Adherence to the recommendations for physical activity, waist circumference, smoking, alcohol intake, and diet may reduce colorectal cancer risk considerably, and in this population 23% of the cases might be attributable to lack of adherence to the five lifestyle recommendations. The simple structure of the lifestyle index facilitates its use in public health practice.
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Affiliation(s)
- Helene Kirkegaard
- Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark.
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Nettle D. Why are there social gradients in preventative health behavior? A perspective from behavioral ecology. PLoS One 2010; 5:e13371. [PMID: 20967214 PMCID: PMC2954172 DOI: 10.1371/journal.pone.0013371] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 09/22/2010] [Indexed: 11/19/2022] Open
Abstract
Background Within affluent populations, there are marked socioeconomic gradients in health behavior, with people of lower socioeconomic position smoking more, exercising less, having poorer diets, complying less well with therapy, using medical services less, ignoring health and safety advice more, and being less health-conscious overall, than their more affluent peers. Whilst the proximate mechanisms underlying these behavioral differences have been investigated, the ultimate causes have not. Methodology/Principal Findings This paper presents a theoretical model of why socioeconomic gradients in health behavior might be found. I conjecture that lower socioeconomic position is associated with greater exposure to extrinsic mortality risks (that is, risks that cannot be mitigated through behavior), and that health behavior competes for people's time and energy against other activities which contribute to their fitness. Under these two assumptions, the model shows that the optimal amount of health behavior to perform is indeed less for people of lower socioeconomic position. Conclusions/Significance The model predicts an exacerbatory dynamic of poverty, whereby the greater exposure of poor people to unavoidable harms engenders a disinvestment in health behavior, resulting in a final inequality in health outcomes which is greater than the initial inequality in material conditions. I discuss the assumptions of the model, and its implications for strategies for the reduction of health inequalities.
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Affiliation(s)
- Daniel Nettle
- Centre for Behaviour and Evolution, Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom.
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Kriegbaum M, Christensen U, Osler M, Lund R. Excessive drinking and history of unemployment and cohabitation in Danish men born in 1953. Eur J Public Health 2010; 21:444-8. [PMID: 20943991 DOI: 10.1093/eurpub/ckq152] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few studies exist on social inequality of excessive drinking in Denmark and differences seem to be less pronounced than in other European countries. The aims of this study were to investigate how history of employment and cohabitation is associated with excessive drinking and to study interaction between both. METHODS Birth-cohort study of 6112 Danish men born in 1953 with follow-up in 2004 on excessive drinking at age 51 years. RESULTS Excessive drinking (between 22 and 35 units of alcohol per week) differed little depending on history of unemployment and cohabitation. Risk of very excessive drinking (drinking >35 units of alcohol per week) increased with number of job losses-ranging from one job-loss [odds ratio (OR) 1.72, 95% confidence interval (CI) 1.39-2.14] to three or more job-losses (OR 2.48, 95% CI 1.75-3.52)--and duration of unemployment--ranging from 1 to 5 years (OR 1.34, 95% CI 1.11-1.63) to ≥10 years (OR 4.16, CI 3.13-5-53). Very excessive drinking was also associated with number of broken partnerships-ranging from one broken partnership (OR 1.43, 95% CI 1.16-1.77) to three or more broken partnerships (OR 2.69, 95% CI 2.03-3.55)--and with living alone for >5 years--ranging from 6 to 9 years (OR 1.73, 95% CI 1.30-2.29) to ≥10 years (OR 2.55, 95% CI 2.04-3.55). We found an interaction between the number of job-losses and of broken partnerships in relation to very excessive drinking. CONCLUSIONS Very excessive drinking is related to number of job-losses, broken partnerships, living alone and duration of unemployment.
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Affiliation(s)
- Margit Kriegbaum
- Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
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