Relation of employment status to socioeconomic position and physical activity types

Polymorphism Patterns and Socioeconomic Characteristics and Their Influence on the Risk of Preeclampsia

Background: Preeclampsia (PE) is a critical condition affecting pregnancies worldwide. Understanding its etiology, particularly the genetic factors, is vital. This study aims to investigate the association between ACE gene polymorphisms, specifically the ACE G2350A (rs4343) variant, and the predisposition to PE, offering insights into the genetic predisposition towards this complex condition. Methods: A case-control study was conducted with 140 participants without PE (Control Group) and 128 participants diagnosed with PE (PE Group). The study focused on comparing the prevalence of the rs4343 polymorphism between the groups. Results: The analysis identified a significantly reduced risk associated with the AG genotype and an insignificant increase in risk with the AA genotype. Statistically significant differences in demographic and clinical characteristics, such as BMI and marital status, were observed between the groups, suggesting a multifaceted risk profile for PE that includes genetic, environmental, and socio-economic factors. Conclusions: The study highlight the significant role of genetic variations, specifically the ACE G2350A (rs4343) polymorphism, in influencing PE predisposition. It highlights the intricate interplay between genetic predispositions and other risk factors in the development of PE. Further research is encouraged to expand on these findings and explore a wider range of genetic polymorphisms and their interactions with environmental factors.

Independence and Sex Differences in Physical Activity and Sedentary Behavior Trends from Middle Adolescence to Emerging Adulthood: A Latent Class Growth Curve Analysis

The purpose of this study was to examine the relationship and sex differences in the growth patterns of moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) from middle adolescence (around age 15) to emerging adulthood (18–29 years old). We used the secondary data from the National Longitudinal Study of Adolescent Health’s (Add Health) publicly accessible database. MVPA and SB were assessed four times (1995, 1996, 2000–2001, and 2008–2009) for a total of 681 individuals from middle adolescence to emerging adulthood. Latent class growth modeling was utilized to identify heterogeneous growth patterns in MVPA and SB. Chi-square tests were used to assess group dependence and sex differences in MVPA and SB growth patterns. Seven quadratic growth patterns for MVPA and two linear growth patterns for SB were found. Both MVPA and SB growth patterns exhibited slow or rapid rate of change at different periods of adolescence and emerging adulthood. MVPA growth patterns included: decline (slow)-and-rise (rapid), rise-and-decline (both rapid), decline-and-rise (both rapid), consistently low, consistently high, decline (rapid)-and-decline (slow), and decline (rapid)-and-rise (slow). SB growth patterns included: consistently low (slow decline) and consistently high (rapid decline). While women were more likely to be involved in consistently low group for MVPA and consistently low (slow decline) group for SB, men were more likely to be involved in rise-and-decline (both rapid) group, consistently high group, and decline (rapid)-and-rise (slow) group for MVPA and consistently high (rapid decline) group for SB. SB growth patterns were independent of MVPA growth patterns. SB should not be assumed to decrease as a result of MVPA intervention. Treatment of MVPA should prioritize adolescence over emerging adulthood, with an emphasis on preventing men’s MVPA levels from decreasing in emerging adulthood and increasing women’s overall MVPA levels.

Job Characteristics, Well-Being and Physical Activity: A Field Study Using a Consumer Fitness Tracker

The relation between job characteristics and health is one of the most important fields of research within work and organizational psychology. Another prominent variable influencing health is physical activity. The physical activity mediated Demand-Control (pamDC) model (Häusser & Mojzisch, 2017, https://doi.org/10.1080/02678373.2017.1303759) combines these health indicators in a new theoretical framework. Based on the pamDC model the current study aims to clarify the role of leisure time physical activity (LTPA) in the interplay of job demands, job control and well-being. We expect physical activity to partially mediate the impact of job characteristics on health. To avoid self-report bias considering physical activity we used a consumer fitness tracker to collect additional data. In total, 104 white-collar workers participated in the study. The results show that job control and job demands could predict well-being in cross-sectional analyses. In longitudinal analyses, this was only the case for job demands. Regarding the proposed mediating effect of LTPA between job characteristics and health, we could not detect a significant mediation in our sample. This was true for both self-reported and objective data on physical activity. This study provides a first step in validating the pamDC model and has implications for future research.

Fatigue is associated with physical inactivity in people with multiple sclerosis despite different environmental backgrounds: Merging and comparing cohorts from Turkey and Israel

BACKGROUND

Examining leisure-time physical activity in people with multiple sclerosis (PwMS) from different environmental backgrounds might increase understanding and awareness of inactivity in PwMS. Therefore, the study objective was twofold; to compare the level of physical activity in PwMS in Israel and Turkey and to examine the relationship between the level of physical activity with common disease-related symptoms and demographical characteristics of PwMS.

METHODS

Cross-sectional data collected by two centers were combined. The physical activity level was determined by the Godin Leisure-Time Exercise Questionnaire, and subsequently, classified into one of three subgroups: "active", "moderately active" and "insufficiently active". Logistic regressions determined the risks of insufficiently active PwMS, according to age, gender, body mass index, disability, impact of walking impairment, disease duration, type of MS and perceived fatigue. The analysis of variance test determined the differences between countries in terms of outcome variables.

RESULTS

The study comprised 458 patients from Israel and 575 from Turkey; 68.2% Turkish PwMS were classified as insufficiently active compared with 52.0% of Israeli PwMS. The percentage of insufficiently active PwMS was significantly higher in those categorized as fatigued compared to non-fatigued in the total cohort (72.4% vs. 51.9%, p<0.001) and in each country separately. Based on the regression analysis, fatigue was the main factor associated with the insufficiently physically active group; odds ratio=1.968.

CONCLUSION

PwMS with increased fatigue tend to participate in less leisure-time physical activities compared with the non-fatigued. This observation is supported by the merged data collected from two countries, Turkey and Israel, representing PwMS from different environmental backgrounds.

Social inequality in type 2 diabetes mellitus in the Faroe Islands: a cross-sectional study

Aims: The Faroe Islands is considered a homogeneous society and has a low Gini coefficient, but the knowledge about the social distribution of health and disease is sparse. In a large population-based sample we investigated: (a) the association between socioeconomic position defined by level of education and the prevalence of type 2 diabetes mellitus by self-report in the Faroe Islands; and (b) to what degree lifestyle factors mediate the association. Methods: We used cross-sectional data from the population-based Public Health Survey Faroes 2015 (n=1095). We present odds ratios for type 2 diabetes mellitus by socioeconomic position from logistic regression models. In our main model we adjusted for potential confounders and in a secondary model we additionally adjusted for potential mediating lifestyle factors. Results: Individuals with middle and low levels of education display higher odds ratios of type 2 diabetes mellitus of 2.80 (95% confidence interval 1.32-5.92) and 4.65 (95% confidence interval 1.93-11.17) in adjusted analysis, respectively, compared to their counterparts with high education. After adjustment for potentially mediating lifestyle factors the estimates were attenuated slightly, but a significant statistical association remained, with lifestyle-related mediating factors in total explaining 21% for middle education and 34% for low education participants. Conclusions: Our results demonstrate that there may be a social gradient in the distribution of type 2 diabetes mellitus in the Faroe Islands, and that the association is partly mediated by lifestyle factors.

Physical activity barriers according to social stratification in Europe

Objectives

To analyse relationships of social stratification on physical activity (PA) prevalence and barriers in the European population.

Methods

Data were retrieved from Eurobarometer 88.4, a cross-sectional survey conducted in 2017 with 28,031 over 15-year-old inhabitants of the European Union. PA prevalence was calculated along with the probability to be physically inactive by social stratification. Logistic regressions were run in the inactive population to show the social class effect on each barrier adjusted by sociodemographic factors employing a propensity score matched method.

Results

Low social class presented higher inactivity prevalence (43.11%), whilst the high social class reported the lowest prevalence (23.30%). Also, the low (OR 0.52; 95% CI 0.47–0.58) and middle (OR 0.71; 95% CI 0.64–0.79) social classes were less likely to be active compared to high social class. In the inactive population, the low social class had mostly higher odds to report each barrier.

Conclusions

Social class is a relevant factor for low PA, with more barriers in the lower social classes. Public health institutions should implement strategies on more influential PA barriers and disadvantaged social groups.

Electronic supplementary material

The online version of this article (10.1007/s00038-020-01488-y) contains supplementary material, which is available to authorized users.

Spatial index relating urban environment to health lifestyle and obesity risk in men and women from different age groups

The challenge in the search for relationships between urban space, physical mobility, and health status, is detecting indicators able to link the environment with healthy life habits. Therefore, the objective was to design an urban index for the identification of urban environment propensity for physical activity (PA) and to determine how it relates to lifestyle and anthropometric parametrization of obesity. Participants (N = 318–60.4% women and 39.6% men) were recruited from a mid-sized city with epidemiology and morbidity rates below the average for the mid-west region of Brazil. Body mass index (BMI) was measured and a questionnaire was applied to gather information about PA and life habits. The spatial urban health index (SUHI) was designed in a geographic information system using data from demographic, environmental and urban physical features. The relationship between BMI and PA was verified with multiple linear regression, controlled for SUHI levels. Regarding the BMI of the population, 69.5% were classified in the eutrophic or overweight ranges, with no effect of gender and age. The SUHI classified 63.7% of the urban area favorable to PA. The PA routine was adequate (≥3 sessions with ≥1 h each) for ~80% of the population, as well as healthy habits such as non smoking (~94%) and non alcohol abuse (~55%). The SUHI strengthens the relationships of BMI to weekly frequency (r = -0.68; t = -9.4; p<0.001) and session duration (r = -0.66; t = -2.8; p<0.001) for the whole group by improving the explanatory coefficient in ~25% (R²_Adj = 0.61 to R²_Adj = 0.85). The SUHI indicated that the urban environment is able to promote healthy life habits by diminishing the “obesogenic” features of the city when physical structures are planned to facilitate PA, whatever the gender and age group.

Educational differentials in key domains of physical activity by ethnicity, age and sex: a cross-sectional study of over 40 000 participants in the UK household longitudinal study (2013-2015)

OBJECTIVES

To assess whether educational differentials in three key physical activity (PA) domains vary by age, sex and ethnicity.

DESIGN

National cross-sectional survey.

SETTING

UK.

PARTICIPANTS

Altogether 40 270 participants, aged 20 years and over, from the UK Household Longitudinal Study with information on education, PA and demographics collected in 2013-2015.

OUTCOME MEASURES

Participation in active travel (AT), occupational activity (OA) and leisure time physical activity (LTPA) at the time of assessment.

RESULTS

Lower educational attainment was associated with higher AT and OA, but lower weekly LTPA activity; these associations were modified by sex, ethnicity and age. Education-related differences in AT were larger for women-the difference in predicted probability of activity between the highest and the lowest education groups was -10% in women (95% CI: -11.9% to 7.9%) and -3% in men (-4.8% to -0.4%). Education-related differences in OA were larger among men -35% (-36.9% to -32.4%) than women -17% (-19.4% to -15.0%). Finally, education-related differences in moderate-to-vigorous LTPA varied by ethnicity; for example, differences were 17% (16.2% to 18.7%) for white individuals compared with 6% (0.6% to 11.6%) for black individuals.

CONCLUSIONS

Educational differences in PA vary by domain and are modified by age, sex and ethnicity. A better understanding of physically inactive subgroups may aid development of interventions to both increase activity levels and reduce health inequalities.

Urban Open Space Is Associated with Better Renal Function of Adult Residents in New Taipei City

The purpose of this study is to explore the association between proximity to open space and adult renal function. This was a cross-sectional study. Adult residents of Taipei metropolis were recruited in the analysis. The proximity of each subject to open space was measured using the Geographic Information System. Residents were divided into two groups: with and without chronic kidney disease (CKD). We made univariable comparisons between the two groups. The logistic regression models were used to estimate the odds ratio of CKD. Forest plot was used to examine the effect of interaction between distance to open space and subgroup variable on CKD. A total number of 21,656 subjects with mean age 53.6 years were enrolled in the study. Of the subjects, 2226 (10.28%) had CKD. The mean and standard deviation of distance to open space were 117.23 m and 80.19 m, respectively. Every 100 m distance to open space was associated with an odds ratio of 1.071 for CKD. Subgroup analysis revealed that residents of female, without hypertension, or without impaired fasting glucose (IFG) living more than 200 m from open spaces have greater odds of CKD than those living less than 200 m. Conclusions: Proximity to open space was associated with a lower prevalence of CKD among adults in Taiwan. Such association was enhanced among females and healthy adults without hypertension or impaired fasting glucose (IFG).

Are Differences in Physical Activity across Socioeconomic Groups Associated with Choice of Physical Activity Variables to Report?

Despite being challenged in recent years, the hypothesis that individuals of higher socioeconomic status (SES) are more physically active than their lower SES counterparts is generally considered a fact. Recent reviews, however, have suggested that differences across groups might be related to which physical activity (PA) domains have been investigated. In the present review, searches for relevant studies were performed in the MEDLINE, ISI Web of Knowledge and SPORTDiscus databases. Search terms included “socioeconomic”, “socio-economic”, “socio economic” and “social class” to meet all variations of the variable “socioeconomic status” in combination with the term “physical activity”. Studies were included when applying the dimensions of intensity, frequency, type/mode, and duration in measuring PA. Fifty-six studies were included and were subsequently split into four PA domains: transport PA (TPA), occupational PA (OPA), housing PA (HPA) and leisure time PA (LTPA). It turned out that the positive relationship held only for LTPA, whereas the relationship was non-existent or even opposite for all other domains. It is concluded that the assumed positive relationship between SES and PA is mainly a relationship between LTPA and SES. It is further suggested that the PA domain should always be considered when studying said relationships.

Do adults with Down syndrome do the same amount of physical activity as adults without disability? A proof of principle study

BACKGROUND

This study compared levels of physical activity completed by adults with and without Down syndrome.

METHOD

Fifteen adults with and 15 adults without Down syndrome matched for age and gender, took part. The intensity and duration of physical activity were measured using RT3 accelerometers worn for seven days.

RESULTS

Only, 12 participants with Down syndrome had complete physical activity data, and these participants and their matched controls (total: six females, 18 males; aged 25.8 ± 9.7) were included in the analyses. There were significantly lower levels of moderate and vigorous physical activity per day for people with Down syndrome (median = 27 min) compared to those without (median = 101 min) (p < .001). Participants without disability were twice more likely to achieve recommended levels of physical activity than people with Down syndrome.

CONCLUSIONS

Adults with Down syndrome appear to participate in lower levels of physical activity than adults without Down syndrome. Further research should validate these estimates.

Is Green Exercise for All? A Descriptive Study of Green Exercise Habits and Promoting Factors in Adult Norwegians

Background: Physical activity (PA) in natural environments, known as green exercise (GE), can provide health benefits above and beyond PA in other environments, but little is known about the extent to which GE is an accessible form of weekly PA across different social groups. This study aims to examine the “GE phenomenon” in Norway, and evaluate possible differences in GE habits and perceived factors that promote GE across sub-groups of this population. Methods: 2168 adults from all over Norway reported weekly GE and other forms of PA, specific forms of GE, and perceived factors that promote GE. Data were examined in the overall sample and in relation with the respondents’ PA status and sociodemographic characteristics. Results: GE, especially “walking in the forest” and “activities by/on the sea”, was the most popular form of weekly PA, even among those with low PA levels. GE was fairly represented across all social groups, and especially among the elderly, those who live with spouse/partner and those who live in the west regions of Norway, while no associations were found in relation to sex, centrality, education level or household income. “Time flexibility” and “PA-supportive places” were generally perceived as the most important factors that promote GE across all social groups. “Accessibility to nature” was generally perceived relatively little important, though a gradient was observed in relation to age, education level and household income. Conclusions: GE is an important source of weekly PA and health among adult Norwegians, especially in sub-groups of interest for public health such as the elderly, those with lower socio-economic status and those who live in non-urban areas. More should be done to understand and address the inequities relative to the perceived accessibility to nature.

Social identity, perceived urban neighborhood quality, and physical inactivity: A comparison study of China, Taiwan, and South Korea

Asian countries are currently witnessing unprecedented increase in physical inactivity and subsequent negative health outcomes; however, few cross-country studies documenting this trend exist. This paper presents the findings of a nationally representative sample, based on the East Asian Social Survey in 2011. The study sought to examine the association of social identity factors, such as objective socio-economic position, perceived social status and neighborhood quality with physical inactivity, while controlling for psychosocial and physical health. A sample of 5222 adults living in urban areas across China, Taiwan, and South Korea were surveyed.

METHODS

Multivariate nested logistic regressions were constructed.

RESULTS

Perceived social status was positively associated with physical activity. Gender difference in physical activity was significant, and this difference widened as educational levels increased. Class division in physical activity was also found. Perceived physical and social features of neighborhood such as suitability for walking and jogging, air quality, and help from neighbors were to different degrees associated with physical inactivity.

CONCLUSION

Gender, marital status, education and perceived social status were common factors associated with physical inactivity in East Asian countries. Perceived urban neighborhood quality is particularly important for Chinese people to stay physically active. Cultural-behavioral norms for physical activity associated with gender and social status call for more studies on cultural perspective for health behaviors in cross-cultural contexts.

Use of new guidance to profile 'equivalent minutes' of aerobic physical activity for adults in England reveals gender, geographical, and socio-economic inequalities in meeting public health guidance: A cross-sectional study

English physical activity guidance now recognises a double weighting of vigorous over moderate activity; 1 min of vigorous activity is the same as two ‘equivalent’ minutes of moderate activity. In addition, concerns of over-estimation of occupational PA led to newly applied measurement methods for this domain. Vigorous activity is associated with higher socio-economic position and occupational PA has the opposite association, so these changes may increase inequalities. We profiled adults' total and domain-specific ‘equivalent minutes’ of weekly PA in England 2012, and investigated inequalities in PA participation, accounting for the new weighting of vigorous PA, and new measurements of occupational PA.

Nationally representative cross-sectional survey data on the self-reported PA of 8158 adults was used to produce a profile of the domain and duration of weekly ‘equivalent minutes’ of PA. Vigorous PA was double-weighted compared to moderate PA, and the percentage contribution from each PA domain quantified, stratified by gender and activity status and split by socio-demographic variables.

Women, older adults, and adults without qualifications, from deprived areas, with worse employment conditions, or living in the North of England were significantly less likely to meet MVPA guidance. Type of activity was also socially patterned, particularly sport participation, which contributed a higher percentage of PA in adults of higher socioeconomic status. For active men, sporting activity was the most prevalent domain, and sports and walking for active women.

In England, there are important socio-demographic differences in how adults participate in PA, and in percentage meeting public health guidance.

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We present a nationally-representative profile of MVPA for adults in England.

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This uses the latest MVPA guidelines and improved occupational PA measurement.

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There are socio-economic inequalities in the percentage of adults meeting guidance.

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The way adults participate in physical activity is also socially patterned.

Environmental conditions around itineraries to destinations as correlates of walking for transportation among adults: the RECORD cohort study

Introduction

Assessing the contextual factors that influence walking for transportation is important to develop more walkable environments and promote physical activity. To advance previous research focused on residential environments and overall walking for transportation, the present study investigates objective environmental factors assessed around the residence, the workplace, the home – work itinerary, and the home – supermarket itinerary, and considered overall walking for transportation but also walking to work and to shops.

Methods

Data from the RECORD Study involving 7290 participants recruited in 2007–2008, aged 30–79 years, and residing in the Paris metropolitan area were analyzed. Multilevel ordinal regression analyses were conducted to investigate environmental characteristics associated with self-reported overall walking for transportation, walking to work, and walking to shops.

Results

High individual education was associated with overall walking for transportation, with walking to work, and walking to shops. Among workers, a high residential neighborhood education was associated with increased overall walking for transportation, while a high workplace neighborhood education was related to an increased time spent walking to work. The residential density of destinations was positively associated with overall walking for transportation, with walking to work, and with walking to shops, while the workplace density of destinations was positively associated with overall walking for transportation among workers. Environmental factors assessed around the itineraries were not associated with walking to work or to the shops.

Conclusion

This research improves our understanding of the role of the environments on walking for transportation by accounting for some of the environments visited beyond the residential neighborhood. It shows that workers' walking habits are more influenced by the density of destinations around the workplace than around the residence. These results provide insight for the development of policies and programs to encourage population level active commuting.

Accessibility and use of urban green spaces, and cardiovascular health: findings from a Kaunas cohort study

BACKGROUND

The aims of this study were to explore associations of the distance and use of urban green spaces with the prevalence of cardiovascular diseases (CVD) and its risk factors, and to evaluate the impact of the accessibility and use of green spaces on the incidence of CVD among the population of Kaunas city (Lithuania).

METHODS

We present the results from a Kaunas cohort study on the access to and use of green spaces, the association with cardiovascular risk factors and other health-related variables, and the risk of cardiovascular mortality and morbidity. A random sample of 5,112 individuals aged 45-72 years was screened in 2006-2008. During the mean 4.41 years follow-up, there were 83 deaths from CVD and 364 non-fatal cases of CVD among persons free from CHD and stroke at the baseline survey. Multivariate Cox proportional hazards regression models were used for data analysis.

RESULTS

We found that the distance from people's residence to green spaces was not related to the prevalence of health-related variables. However, the prevalence of cardiovascular risk factors and the prevalence of diabetes mellitus were significantly lower among park users than among non-users. During the follow up, an increased risk of non-fatal and fatal CVD combined was observed for those who lived ≥629.61 m from green spaces (3rd tertile of distance to green space) (hazard ratio (HR) = 1.36), and the risk for non-fatal CVD-for those who lived ≥347.81 m (2nd and 3rd tertile) and were not park users (HR = 1.66) as compared to men and women who lived 347.8 m or less (1st tertile) from green space. Men living further away from parks (3rd tertile) had a higher risk of non-fatal and fatal CVD combined, compared to those living nearby (1st tertile) (HR = 1.51). Compared to park users living nearby (1st tertile), a statistically significantly increased risk of non-fatal CVD was observed for women who were not park users and living farther away from parks (2nd and 3rd tertile) (HR = 2.78).

CONCLUSION

Our analysis suggests public health policies aimed at promoting healthy lifestyles in urban settings could produce cardiovascular benefits.

How is post-industrial decline associated with the geography of physical activity? Evidence from the Health Survey for England

In recent decades, the prevalence of physical activity has declined considerably in many developed countries, which has been related to rising levels of obesity and several weight-related medical conditions, such as coronary heart disease. There is evidence that areas exhibiting particularly low levels of physical activity have undergone a strong transition away from employment in physically demanding occupations. It is proposed that such processes of deindustrialisation may be causally linked to unexplained geographical disparities in physical activity. This study investigates how geographical variations in deindustrialisation are associated with current levels of physical activity across different activity domains and relevant macro-economic time periods in England. The analysis includes data on 27,414 adults from the Health Survey for England 2006 and 2008 who reported total, occupational, domestic, recreational and walking activity. Based on employment change in industries associated with heavy manual work, a local measurement of industrial decline was developed, covering the period 1841–2001. We applied a multilevel modelling approach to study associations between industrial decline and physical activity. Results indicate that the process of deindustrialisation appears to be associated with patterns of physical activity and that this is independent of household income. The effects observed were generally similar for men and women. However, the nature of the association differed across areas, time periods and employment types; in particular, residents of districts characterised by a history of manufacturing and mining employment had increased odds of reporting low activity levels. We conclude that post-industrial change may be a factor in explaining present-day variations in physical activity, emphasising the plausible impact of inherited cultures and regional identities on health related behaviours.

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This study is the first to link different physical activity domains to the historical context of deindustrialisation

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We found some evidence that processes of deindustrialisation may be associated with lower physical activity

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Lower overall activity was generally seen in areas with historically high employment then decline in manufacturing and mining

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Findings suggest cultures of non-participation in physical activity may persist in areas experiencing losses in manual jobs

Spatial accessibility to specific sport facilities and corresponding sport practice: the RECORD Study

BACKGROUND

Physical activity is considered as a major component of a healthy lifestyle. However, few studies have examined the relationships between the spatial accessibility to sport facilities and sport practice with a sufficient degree of specificity. The aim of this study was to investigate the associations between the spatial accessibility to specific types of sports facilities and the practice of the corresponding sports after carefully controlling for various individual socio-demographic characteristics and neighborhood socioeconomic variables.

METHODS

Data from the RECORD Study involving 7290 participants recruited in 2007-2008, aged 30-79 years, and residing in the Paris metropolitan area were analyzed. Four categories of sports were studied: team sports, racket sports, swimming and related activities, and fitness. Spatial accessibility to sport facilities was measured with two complementary approaches that both take into account the street network (distance to the nearest facility and count of facilities around the dwelling). Associations between the spatial accessibility to sport facilities and the practice of the corresponding sports were assessed using multilevel logistic regression after adjusting for individual and contextual characteristics.

RESULTS

High individual education and high household income were associated with the practice of racket sports, swimming or related activities, and fitness over the previous 7 days. The spatial accessibility to swimming pools was associated with swimming and related sports, even after adjustment for individual/contextual factors. The spatial accessibility to facilities was not related to the practice of other sports. High neighborhood income was associated with the practice of a racket sport and fitness.

CONCLUSIONS

Accessibility is a multi-dimensional concept that integrates educational, financial, and geographical aspects. Our work supports the evidence that strategies to increase participation in sport activities should improve the spatial and financial access to specific facilities, but also address educational disparities in sport practice.

Educational Disparities in Distribution of Cardiovascular Risk Factors and Quality of Care in Korean Adults: Korean National Health and Nutrition Survey IV

Background

The purpose of this study was to investigate how educational status influences cardiovascular risk factors and care of diabetes mellitus and hypertension.

Methods

From Korean National Health and Nutrition Survey IV, we obtained survey results of 6,835 men and 9,067 women more than 30 years old. We performed multivariate logistic regression to compare cardiovascular risk factors and care of hypertension and diabetes respective to educational status.

Results

There were disparities in cardiovascular risk factors by educational status. In men, impaired fasting glucose, high triglyceride, and smoking were less frequently found in the highest educated group than in the middle educated group. In women, the prevalence of abdominal obesity, impaired fasting glucose, high blood pressure, high triglyceride, and metabolic syndrome among the highest educated group were significantly lower. The proportion of those with proper physical activity in the highest educated group was found to be less than that of the middle educated group, regardless of gender. For care of diabetes mellitus and hypertension, disease recognition and treatment were lower among the lowest educated group in men, while these disparities were not shown in women. Instead, the lowest educated group in diabetic women received screening exams for eye and kidney complications less than the middle education group. In both genders, the high education group had a higher chance of receiving education about diabetes mellitus.

Conclusion

There were educational disparities in cardiovascular risk factors and care of hypertension and diabetes mellitus. The disparities were found to be different by gender.

Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review

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.

The influence of the macro-environment on physical activity: a multilevel analysis of 38 countries worldwide

BACKGROUND

As indicated by the ANGELO framework and similar models, various environmental factors influence population levels of physical activity (PA). To date attention has focused on the micro-level environment, while evidence on the macro-level environment remains scarce and mostly limited to high-income countries. This study aims to investigate whether environmental factors at macro-level are associated with PA among a broader range of countries.

METHODS

Data from the World Health Survey (WHS) was used to analyze 177,035 adults from 38 (mostly low and middle income) countries. The International Physical Activity Questionnaire-Short Form (IPAQ-S) was used to measure PA. Respondents were classified as active or inactive for vigorous PA, moderate PA and walking. Multilevel logistic regression was performed to assess associations between macro-level environmental factors and the prevalence of PA, with control for individual-level socioeconomic factors.

RESULTS

The prevalence of PA varied widely between countries and types of PA (5.0%-93.8%). A negative association was found between gross domestic product and PA, odds ratios for men were 0.76 (95% CI: 0.65-0.89) for moderate PA and 0.79 (95% CI: 0.63-0.98) for walking. A higher temperature was associated with less PA (all types) and higher urbanization was associated with less vigorous and moderate PA. More gender equality was also associated with more walking for women. Governmental functioning and literacy rate were not found to be associated with any type of PA.

CONCLUSIONS

This exploratory study indicates that factors such as climate, economic development and cultural factors are determinants of the level of overall PA at national levels. This underlines the suggestion that the macro-environment should be regarded as an important influence on PA.

Jordanian acute coronary syndrome patients' learning needs: Implications for cardiac rehabilitation and secondary prevention programs

The identification of patients' learning needs is an essential step for nurses in order to facilitate the recovery of acute coronary syndrome survivors. This study aimed to identify and prioritize the actual learning needs of these patients and to explore the differences in learning needs on the basis of sociodemographic and clinical variables. Descriptive comparative design was used, and patients' learning needs data were collected through the Patient Learning Needs Scale. The results showed that patients need a high amount of information after this syndrome. The 10 most needed educational topics belonged to the medications and treatment and activities of daily living categories. Older patients and those from lower socioeconomic backgrounds requested less information than others did. In conclusion, topics perceived by patients as important and sociodemographic variables should be considered in preparing and providing cardiac rehabilitation and secondary prevention programs. Furthermore, these programs should be redesigned considering patients' actual learning needs rather than the expected needs, and they should incorporate medications, treatment and activities of daily living, complications and symptoms, illness-related concerns, and support in the community.

A physically active occupation does not result in compensatory inactivity during out-of-work hours

AIM

To examine differences in non-occupational physical activity behaviour in workers who engage in high and low occupational physical activity.

DESIGN

Cross-sectional survey of 112 otherwise comparable volunteers in active (56 walking postal delivery workers) or inactive (56 administrative postal workers) occupations in Glasgow (Scotland) in 2007.

METHODS

Twenty four-hour physical activity (steps and time standing, walking and sedentary) patterns were measured using activPAL™ for seven days. Comparisons were made during 8-hour work-shifts, during non-work hours on work-days and during the 2 non-work days.

RESULTS

Age and body mass index of delivery and office staff, respectively, were (means (SD)) 38 (9) years versus 40 (7) years and 26.3 (3) kg m(-2) versus 27.4 (4) kg m(-2). Delivery staff spent substantially longer time than office staff upright (6.0 (1.1) h versus 3.9 (1.5) h) and walking (3.1 (0.7) h versus 1.6 (0.7) h) and amassed more steps (16,035 (4264) versus 6709 (2808)) during 8-hour work-shifts and over 24h on work days. During non-work hours of work-days and during non-work days, there were no significant differences in physical activity between the groups. The results were unchanged when the 15 women were excluded.

CONCLUSION

Having a more active occupation is not associated with more inactivity during non-work hours.

Socio-economic differences in weight-control behaviours and barriers to weight control

Objective

To examine socio-economic differences in weight-control behaviours (WCB) and barriers to weight control.

Design

A cross-sectional study.

Setting

Data were obtained by means of a postal questionnaire.

Subjects

A total of 1013 men and women aged 45–60 years residing in Brisbane, Australia (69·8 % response rate).

Results

Binary and multinomial logistic regression analyses were performed, adjusted for age, gender and BMI. Socio-economically disadvantaged groups were less likely to engage in weight control (OR for lowest income quartile = 0·60, 95 % CI 0·39, 0·94); among those who engaged in weight control, the disadvantaged group had a likelihood of 0·52 (95 % CI 0·30, 0·90) of adopting exercise strategies, including moderate (OR = 0·56, 95 % CI 0·33, 0·96) and vigorous (OR = 0·47, 95 % CI 0·25, 0·89) physical activities, compared with their more-advantaged counterparts. However, lower socio-economic groups were more likely to decrease their sitting time to control their weight compared with their advantaged counterparts (OR for secondary school or lower education = 1·78, 95 % CI 1·11, 2·84). They were also more likely to believe that losing weight was expensive, not of high priority, required a lot of cooking skills and involved eating differently from others in the household.

Conclusions

Marked socio-economic inequalities existed with regard to engaging in WCB, the type of weight-control strategies used and the perceived barriers to weight control; these differences are consistent with socio-economic gradients in weight status. These factors may need to be included in health promotion strategies that address socio-economic inequalities in weight status, as well as inequalities in weight-related health outcomes.

Employment patterns and changes in body weight among young women

OBJECTIVE

To investigate the influence of employment patterns on weight gain and weight loss in young adult women.

METHODS

Study sample is 5164 participants in the Australian Longitudinal Study on Women's Health who completed surveys in 2003 and 2006. Logistic regression was used to estimate odds ratios of weight change.

RESULTS

The adjusted odds of gaining weight, compared with women in stable full-time work (49.7%), were lower for women in stable part-time work (47.3%, OR = 0.74, CI: 0.58-0.94), or who transitioned from not in the labour force (NILF) to part-time (42.8%, OR = 0.68, CI: 0.47-0.99) or full-time (37.5%, OR = 0.54, CI: 0.34-0.85) work. Heavy weight gain (>10 kg) was less likely among women in stable part-time work (6.4%, OR=0.59, CI: 0.37-0.93) compared with those in stable full-time work (8.1%). The likelihood of weight loss compared with women in stable full-time employment (22.4%) was higher among stable part-time workers (28.4% OR = 1.34, CI: 1.02-1.75) and those who transitioned from full-time to part-time work (24.8%, OR = 1.30, CI: 1.01-1.67).

DISCUSSION

The lower likelihood of heavy weight gain associated with fewer work hours suggests more time spent at work may contribute to weight gain. Young women in full-time employment may benefit from workplace interventions supporting healthier lifestyles.

Increasing socio-economic inequality in type 2 diabetes prevalence--repeated cross-sectional surveys in England 1994-2006

BACKGROUND

This study aimed to evaluate the association of rising type 2 diabetes prevalence with socio-economic inequality in diabetes.

METHODS

Data from the Health Survey for England were analysed for 1994, 1998, 2003 and 2006. This is a nationally representative annual survey of private households. Data for 41,643 individuals aged ≥35 years were included. The prevalence of self-reported diabetes diagnosed by a doctor was analysed in relation to household income, occupational social class and educational qualifications. Data were standardized for age using the European Standard Population for reference.

RESULTS

Prevalence of diagnosed diabetes increased in men from 3.74% in 1994 to 7.25% in 2006, and in women from 2.28% to 4.88%. In 1994, there were no associations between social class or educational level and diabetes prevalence evident. In 2006, there was evidence of a negative association in women [prevalence ratio for social class (IV + V vs. I) = 4.54, P-value for trend = 0.005; prevalence ratio for educational level ('none' vs. 'A-levels') = 1.96, P-value for trend = 0.001]. The Slope Index of Inequality (SII) for social class in women increased from -1.65 in 1994 to -4.95 [95% Confidence Interval (95% CI -8.52 to -1.38)] in 2006 and for level of education from -1.39 to -6.48 (95% CI -9.03 to -3.93). In men, diabetes prevalence was not associated with social class or level of education.

CONCLUSION

Increasing prevalence of type 2 diabetes has been associated with an increase of socio-economic inequality in women. There was no socio-economic gradient observed in men.

Effect of exposure to natural environment on health inequalities: an observational population study

BACKGROUND

Studies have shown that exposure to the natural environment, or so-called green space, has an independent effect on health and health-related behaviours. We postulated that income-related inequality in health would be less pronounced in populations with greater exposure to green space, since access to such areas can modify pathways through which low socioeconomic position can lead to disease.

METHODS

We classified the population of England at younger than retirement age (n=40 813 236) into groups on the basis of income deprivation and exposure to green space. We obtained individual mortality records (n=366 348) to establish whether the association between income deprivation, all-cause mortality, and cause-specific mortality (circulatory disease, lung cancer, and intentional self-harm) in 2001-05, varied by exposure to green space measured in 2001, with control for potential confounding factors. We used stratified models to identify the nature of this variation.

FINDINGS

The association between income deprivation and mortality differed significantly across the groups of exposure to green space for mortality from all causes (p<0.0001) and circulatory disease (p=0.0212), but not from lung cancer or intentional self-harm. Health inequalities related to income deprivation in all-cause mortality and mortality from circulatory diseases were lower in populations living in the greenest areas. The incidence rate ratio (IRR) for all-cause mortality for the most income deprived quartile compared with the least deprived was 1.93 (95% CI 1.86-2.01) in the least green areas, whereas it was 1.43 (1.34-1.53) in the most green. For circulatory diseases, the IRR was 2.19 (2.04-2.34) in the least green areas and 1.54 (1.38-1.73) in the most green. There was no effect for causes of death unlikely to be affected by green space, such as lung cancer and intentional self-harm.

INTERPRETATION

Populations that are exposed to the greenest environments also have lowest levels of health inequality related to income deprivation. Physical environments that promote good health might be important to reduce socioeconomic health inequalities.