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Dang Y, Duan X, Rong P, Yan M, Zhao Y, Mi B, Zhou J, Chen Y, Wang D, Pei L. Life-course social disparities in body mass index trajectories across adulthood: cohort study evidence from China health and nutrition survey. BMC Public Health 2023; 23:1955. [PMID: 37814213 PMCID: PMC10563291 DOI: 10.1186/s12889-023-16881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The social disparities in obesity may originate in early life or in adulthood, and the associations of socioeconomic position (SEP) with obesity could alter over time. It is unclear how lifetime-specific and life-course SEP influence adult obesity development in China. METHODS Based on the China Health and Nutrition Survey (CHNS), three SEP-related indicators, including the father's occupational position and the participant's education and occupational position, were obtained. The life-course socioeconomic changes and a cumulative SEP score were established to represent the life-course SEP of the participants in the study. The growth mixture modeling was used to identify BMI trajectories in adulthood. Multinomial logistic regression was adopted to assess the associations between SEP and adult BMI trajectories. RESULTS A total of 3,138 participants were included in the study. A positive correlation was found between the paternal occupational position, the participants' occupational position, education, and obesity in males, whereas an inverse correlation was observed among females. Males who experienced social upward mobility or remained stable high SEP during the follow-up had 2.31 and 2.52-fold risks of progressive obesity compared to those with a stable-low SEP. Among females, stable high SEP in both childhood and adulthood was associated with lower risks of progressive obesity (OR = 0.63, 95% CI: 0.43-0.94). Higher risks of obesity were associated with the life-course cumulative SEP score among males, while the opposite relationship was observed among females. CONCLUSIONS The associations between life-course SEP and BMI development trajectories differed significantly by gender. Special emphasis should be placed on males experiencing upward and stable high socioeconomic change.
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Affiliation(s)
- Yusong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, P.R. China
| | - Xinyu Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, P.R. China
| | - Peixi Rong
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, P.R. China
| | - Mingxin Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, P.R. China
| | - Yaling Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, P.R. China
| | - Baibing Mi
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, P.R. China
| | - Jing Zhou
- Department of Pediatrics, The Second Affiliated Hospitical of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, P.R. China
| | - Yulong Chen
- Institute of Basic and Translational Medicine, Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Shaanxi Key Laboratory of Brain Disorders, Xi'an Medical University, Xi'an, 710021, Shaanxi, P.R. China
| | - Duolao Wang
- Biostatistics Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Department of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Leilei Pei
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, P.R. China.
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Keim-Klärner S, Adebahr P, Brandt S, Gamper M, Klärner A, Knabe A, Kupfer A, Müller B, Reis O, Vonneilich N, Ganser MA, de Bruyn C, von der Lippe H. Social inequality, social networks, and health: a scoping review of research on health inequalities from a social network perspective. Int J Equity Health 2023; 22:74. [PMID: 37098617 PMCID: PMC10131340 DOI: 10.1186/s12939-023-01876-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/28/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND This review summarises the present state of research on health inequalities using a social network perspective, and it explores the available studies examining the interrelations of social inequality, social networks, and health. METHODS Using the strategy of a scoping review, as outlined by Arksey and O'Malley (Int J Sci Res Methodol 8:19-32, 2005), our team performed two searches across eight scientific, bibliographic databases including papers published until October 2021. Studies meeting pre-defined eligibility criteria were selected. The data were charted in a table, and then collated, summarised, and reported in this paper. RESULTS Our search provided a total of 15,237 initial hits. After deduplication (n = 6,168 studies) and the removal of hits that did not meet our baseline criteria (n = 8,767 studies), the remaining 302 full text articles were examined. This resulted in 25 articles being included in the present review, many of which focused on moderating or mediating network effects. Such effects were found in the majority of these studies, but not in all. Social networks were found to buffer the harsher effects of poverty on health, while specific network characteristics were shown to intensify or attenuate the health effects of social inequalities. CONCLUSIONS Our review showed that the variables used for measuring health and social networks differed considerably across the selected studies. Thus, our attempt to establish a consensus of opinion across the included studies was not successful. Nevertheless, the usefulness of social network analysis in researching health inequalities and the employment of health-promoting interventions focusing on social relations was generally acknowledged in the studies. We close by suggesting ways to advance the research methodology, and argue for a greater orientation on theoretical models. We also call for the increased use of structural measures; the inclusion of measures on negative ties and interactions; and the use of more complex study designs, such as mixed-methods and longitudinal studies.
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Affiliation(s)
| | - Philip Adebahr
- Institute of Sociology, University of Technology Chemnitz, Chemnitz, Germany
| | - Stefan Brandt
- Landesfrauenrat Mecklenburg-Vorpommern e.V., Rostock, Germany
| | - Markus Gamper
- Institut für vergleichende Bildungsforschung und Sozialwissenschaften, University of Cologne, Cologne, Germany
| | - Andreas Klärner
- Thünen Institute of Rural Studies, Bundesallee 64, Brunswick, Germany
| | - André Knabe
- Rostocker Institut für Sozialforschung und gesellschaftliche Praxis e.V., Rostock, Germany
| | - Annett Kupfer
- Institute of Social Pedagogy, Social Work and Welfare Studies, Technische Universität Dresden, Dresden, Germany
| | - Britta Müller
- Institute of Medical Psychology and Medical Sociology, Rostock University Medical Center, Rostock, Germany
| | - Olaf Reis
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Rostock University Medical Center, Rostock, Germany
| | - Nico Vonneilich
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Roustaei Z, Räisänen S, Gissler M, Heinonen S. Socioeconomic differences in the association between maternal age and maternal obesity: a register-based study of 707,728 women in Finland. Scand J Public Health 2022:14034948221088003. [PMID: 35593408 DOI: 10.1177/14034948221088003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To examine the association between maternal age and maternal obesity across socioeconomic groups and to determine whether socioeconomic status modifies the association between maternal age and maternal obesity with a view to informing public health policies. METHODS Data for this register-based study were sourced from the Finnish Medical Birth Register and Statistics Finland, using the information of 707,728 women who gave birth in Finland from 2004 to 2015. We used multivariable regression models to assess the association between maternal age and maternal obesity across socioeconomic groups. We further assessed interactions on both multiplicative and additive scales. RESULTS Across all socioeconomic groups, the adjusted odds ratio for the association between maternal age and maternal obesity increased, peaking for women 35 years or older. Using women below 20 years of age in the category of upper-level employees as a single reference group, in the category of upper-level employees, the adjusted odds ratio and 95% confidence intervals among women 35 years or older was 1.92 (1.39-2.64) for maternal obesity. Equally, the adjusted odds ratio and 95% confidence intervals in the category of long-term unemployed was 4.35 (3.16-5.98). Synergistic interactions on both multiplicative and additive scales were found across age and socioeconomic groups. CONCLUSIONS The association between maternal age and maternal obesity was strongest among women 35 years or older with lower socioeconomic status. Population-level interventions that address maternal risk factors from teenage years are needed alongside individual-level interventions that target high-risk mothers in areas of low socioeconomic status and maternal obesity.
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Affiliation(s)
- Zahra Roustaei
- Department of Health Sciences, University of Helsinki, Helsinki, Finland
| | - Sari Räisänen
- School of Health Care and Social Services, Tampere University of Applied Sciences, Tampere, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Intergenerational social mobility and body mass index trajectories - A follow-up study from Finland. SSM Popul Health 2021; 13:100723. [PMID: 33385060 PMCID: PMC7770483 DOI: 10.1016/j.ssmph.2020.100723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 01/22/2023] Open
Abstract
Evidence remains unclear on how intergenerational social mobility is associated with body mass index (BMI) and its long-term changes. Our study identified BMI trajectories from middle to older age by intergenerational social mobility groups and stratified the analyses by gender and two birth cohorts (birth years 1940‒1947 and 1950–1962). We used questionnaire-based cohort data that consists of four survey phases: 2000–2002, 2007, 2012, and 2017. In Phase 1, participants were 40–60-year-old employees of the City of Helsinki, Finland. Our analytical sample consisted of 6,971 women and 1,752 men. Intergenerational social mobility was constructed based on self-reported parental and own education—both divided into high and low—yielding four groups: stable high socioeconomic position (SEP) (high-high), upward social mobility (low-high), downward social mobility (high-low), and stable low SEP (low-low). BMI was calculated from self-reported height and weight from all four phases. Using mixed-effects linear regression, we found increasing BMI trajectories in all four social mobility groups until the age of 65. Women and men with stable high SEP had lower BMI trajectories compared to those with stable low SEP. In the younger birth cohort, women with upward social mobility had a lower BMI trajectory than women with stable low SEP. Additionally, women and men with downward social mobility had higher BMI trajectories than those with stable high SEP. In the older birth cohort, however, the BMI trajectories of upward and downward social mobility groups were somewhat similar and settled between the BMI trajectories of stable high and stable low SEP groups. Our results indicate that the associations between intergenerational social mobility and BMI may depend on gender and birth cohort. Nevertheless, to reduce socioeconomic inequalities in unhealthy weight gain, obesity prevention actions that focus on people who are likely to remain in low SEP might be worthwhile. Few studies exist on social mobility and long-term body mass index (BMI) changes. Rising BMI trajectories were found in all social mobility groups. Stable low socioeconomic position (SEP) was related to higher BMI trajectories. Stable high SEP and upward social mobility may protect from excessive weight gain. Social mobility–BMI associations differed by gender and birth cohort.
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Kröger H, Leopold L. Education differences in women's body weight trajectories: The role of motherhood. PLoS One 2020; 15:e0236487. [PMID: 32956409 PMCID: PMC7505466 DOI: 10.1371/journal.pone.0236487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 07/07/2020] [Indexed: 12/27/2022] Open
Abstract
Studies have found that education differences in women's body weight increase until middle adulthood. The explanatory mechanisms behind this increase are not well-understood. This study examined the role of education differences in the prevalence of motherhood as a risk factor for weight gain and in vulnerability to its effects on weight gain. We used longitudinal data from the German Socio-economic Panel Study. Our sample included 2,668 women aged between 17 and 45 and observed at least twice between 2002 and 2016 (n = 13,899 panel observations). We used OLS regression models to estimate initial education differences in body weight and fixed-effects panel regression models to estimate education differences in body-weight trajectories. Motherhood was associated with increasing body weight, and the effects of motherhood on weight gain varied by education. Motherhood partially accounted for the increase of education differences during reproductive age. Until the age of 30, differences in the prevalence of motherhood accounted for about 20% of the bodyweight gap between lower and higher educated women. From age 35 until 45, differential vulnerability to the effects of motherhood on body weight explained about 15% of the education gap in body weight.
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Affiliation(s)
- Hannes Kröger
- German Socio-Economic Panel, German Institute for Economic Research (DIW), Berlin, Germany
| | - Liliya Leopold
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
- Professorship of Demography, University of Bamberg, Bamberg, Germany
- * E-mail:
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Hwang J, Lee EY, Lee CG. Measuring Socioeconomic Inequalities in Obesity among Korean Adults, 1998⁻2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1617. [PMID: 31072072 PMCID: PMC6539011 DOI: 10.3390/ijerph16091617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/05/2019] [Accepted: 05/05/2019] [Indexed: 02/08/2023]
Abstract
Obesity is a prominent global public health challenge as its prevalence has grown. Even though the increase in prevalence of obesity in Korea has been relatively low, it is expected to continually increase in the next several years, leading to social and economic burdens. This study aimed to assess socioeconomic inequalities in obesity among Korean adults. Using nationally representative survey datasets, the concentration index (CI) and decomposition of the CI were used to capture and quantify obesity-related inequalities from 1998 to 2015. The results suggested that pro-poor inequalities in obesity existed in Korea, indicating that obesity was more concentrated among individuals with lower income. In a gender-stratified model, obesity was more concentrated among women with lower income and men with higher income, showing that the trend and magnitude of inequalities in obesity each vary by gender. The decomposition approach revealed that, over the past 17 years, the main contributors to the existing inequalities were higher education and higher income levels. These findings suggest that comprehensive and multifaceted interventions at the local and national levels should be considered to address the identified income- and education-related barriers with respect to obesity among Korean adults.
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Affiliation(s)
- Jongnam Hwang
- Division of Social Welfare & Health Administration, Wonkwang University, Iksan 54538, Korea.
| | - Eun-Young Lee
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Chung Gun Lee
- Institute of Sport Science, Department of Physical Education, Seoul National University, Seoul 08826, Korea.
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Claassen MA, Klein O, Bratanova B, Claes N, Corneille O. A systematic review of psychosocial explanations for the relationship between socioeconomic status and body mass index. Appetite 2019; 132:208-221. [DOI: 10.1016/j.appet.2018.07.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/11/2018] [Accepted: 07/17/2018] [Indexed: 01/21/2023]
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Alves L, Stringhini S, Barros H, Azevedo A, Marques-Vidal P. Inequalities in obesity in Portugal: regional and gender differences. Eur J Public Health 2018; 27:775-780. [PMID: 28407055 DOI: 10.1093/eurpub/ckx041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Obesity levels vary considerably according to geographical region and socio-economic status. We evaluated the prevalence of obesity by education and occupational position across seven Portuguese regions. Relative and absolute inequalities in obesity were also assessed. Methods Data was drawn from the Portuguese Health Survey 2005/6 (26 674 adults, 46.6% women). Education was categorized as ≤4, 5-11 and ≥12 complete years of education. Occupational position was grouped as upper white collar, lower white collar and blue collar. The Relative Index of Inequality (RII) and the Slope Index of Inequality (SII) were used to quantify relative and absolute inequalities in obesity, respectively. Results In women, prevalence of obesity ranged between 10.0% (Algarve) and 20.3% (Azores); in men, it ranged between 13.3% (Algarve) and 16.4% (Lisbon). In women, the educational RII (95% confidence interval) ranged between 2.4 (1.1 to 5.1) in the Centre and 6.6 (3.0 to 14.2) in Alentejo, and the SII (95% CI) between 9.7 (-1.3 to 20.7) and 33.0 (26.0 to 40.0), respectively. In men, the RII ranged between 0.8 (0.4 to 1.5) in Madeira and 1.9 (1.0 to 4.5) in the Centre, and the SII between -8.3 (-19.0 to 2.5) and 9.5 (-0.1 to 19.1), respectively. Occupational RIIs were similar to those for education, although somewhat lower. Conclusion In Portugal, large educational and occupational inequalities in obesity are observed, but they vary considerably by region and are larger among women than men.
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Affiliation(s)
- Luís Alves
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine (IUMSP), University Hospital Centre, Biopole 2, Lausanne, Switzerland
| | - Henrique Barros
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Ana Azevedo
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Boudet-Berquier J, Salanave B, Desenclos JC, Castetbon K. Sociodemographic factors and pregnancy outcomes associated with prepregnancy obesity: effect modification of parity in the nationwide Epifane birth-cohort. BMC Pregnancy Childbirth 2017; 17:273. [PMID: 28841845 PMCID: PMC5574108 DOI: 10.1186/s12884-017-1456-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 08/17/2017] [Indexed: 01/16/2023] Open
Abstract
Background In light of the adverse outcomes for mothers and offspring related to maternal obesity, identification of subgroups of women at risk of prepregnancy obesity and its related-adverse issues is crucial for optimizing antenatal care. We aimed to identify sociodemographic factors and maternal and neonatal outcomes associated with prepregnancy obesity, and we tested the effect modification of parity on these associations. Methods In 2012, 3368 mothers who had delivered in 136 randomly selected maternity wards were included just after birth in the French birth cohort, Epifane. Maternal height and weight before and at the last month of pregnancy were self-reported. Maternal and neonatal outcomes were collected in medical records. Prepregnancy Body Mass Index (pBMI) was classified into underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9) and obesity (≥30.0). Since we found statistically significant interactions with parity, the multinomial logistic regression model estimating associations of pBMI class with sociodemographic characteristics and pregnancy outcomes was stratified on parity (1335 primiparous and 1814 multiparous). Results Before pregnancy, 7.6% of women were underweight, 64.2% were of normal weight, 18.0% were overweight and 10.2% were obese. Among the primiparous, maternal age of 25-29 years (OR = 2.09 [1.13-3.87]; vs. 30-34 years), high school level (OR = 2.22 [1.33-3.73]; vs. university level), gestational diabetes (OR = 2.80 [1.56-5.01]) and hypertensive complications (OR = 3.80 [1.83-7.89]) were independently associated with prepregnancy obesity. Among the multiparous, primary (OR = 6.30 [2.40-16.57]), junior high (OR = 2.89 [1.81-4.64]) and high school (OR = 1.86 [1.18-2.93]) education levels (vs. university level), no attendance at antenatal classes (OR = 1.77 [1.16-2.72]), excess gestational weight gain (OR = 1.82 [1.20-2.76]), gestational diabetes (OR =5.16 [3.15-8.46]), hypertensive complications (OR = 8.13 [3.97-16.64]), caesarean delivery (OR = 1.80 [1.18-2.77]) and infant birth weight ≥ 4 kg (OR = 1.70 [1.03-2.80]; vs. birth weight between 2.5 kg and 4 kg) were independently associated with prepregnancy obesity. Conclusion Obesity before pregnancy is associated with a set of sociodemographic characteristics and adverse pregnancy outcomes that differ across parity groups. Such findings are useful for targeted health policies aimed at attaining healthy prepregnancy weight and organizing perinatal care. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1456-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julie Boudet-Berquier
- Nutritional Surveillance and Epidemiology Team (ESEN), French Public Health Agency, Paris-13 University, Centre de Recherche en Epidémiologie et Statistiques, COMUE Sorbonne Paris Cité, SMBH Building, 1st floor, door 136, 74 rue Marcel Cachin, 93017, Bobigny Cedex, France.
| | - Benoit Salanave
- Nutritional Surveillance and Epidemiology Team (ESEN), French Public Health Agency, Paris-13 University, Centre de Recherche en Epidémiologie et Statistiques, COMUE Sorbonne Paris Cité, SMBH Building, 1st floor, door 136, 74 rue Marcel Cachin, 93017, Bobigny Cedex, France
| | - Jean-Claude Desenclos
- French Public Health Agency (Agence nationale de Santé publique), Saint Maurice, France
| | - Katia Castetbon
- Centre de Recherche « Epidémiologie, Biostatistique et Recherche clinique », School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium
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Avsar G, Ham R, Tannous WK. Modelling Gender Differences in the Economic and Social Influences of Obesity in Australian Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030257. [PMID: 28273825 PMCID: PMC5369093 DOI: 10.3390/ijerph14030257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/03/2017] [Accepted: 02/20/2017] [Indexed: 01/16/2023]
Abstract
In Australia, as in many other developed economies, the prevalence of obesity has risen significantly in all age groups and especially in young males and females over the past decade. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, this paper investigates the influence of economic, personality and social factor demographics on the incidence of obesity in Australian youths. The study uses two random parameters logit models, including one that allows for gender-specific differences in the conditioning variables. The models reveal notable differences between the most important variables affecting the incidence of obesity amongst females compared to males. These differences are notable to consider for policy and intervention programs aimed at reducing the problem of obesity.
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Affiliation(s)
- Gulay Avsar
- School of Business, Western Sydney University, Sydney 2751, Australia.
| | - Roger Ham
- School of Business, Western Sydney University, Sydney 2751, Australia.
| | - W Kathy Tannous
- School of Business, Western Sydney University, Sydney 2751, Australia.
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11
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Long-Lasting Obesity Predicts Poor Work Ability at Midlife: A 15-Year Follow-Up of the Northern Finland 1966 Birth Cohort Study. J Occup Environ Med 2016; 57:1262-8. [PMID: 26641822 DOI: 10.1097/jom.0000000000000579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the effect of adulthood obesity on work ability in early midlife during a 15-year follow-up. METHODS The study population included men and women (n = 5470), born in northern Finland in 1966. Participants evaluated their current perceived work ability compared with their lifetime best at the age of 46. Participants' weight and height were measured at 31 years and self-reported at 46 years, and body mass indexes were calculated. RESULTS Obesity at both ages, and developing obesity between the ages of 31 and 46 increased the relative risk of poor work ability at 46 years among sexes, and among those in both low and high physically strenuous work. CONCLUSIONS Long-term obesity and developing obesity in mid-adulthood increase the risk of poor work ability. Thus, the promotion of healthy behaviors by policies, healthcare services, and at workplaces is important.
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12
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Neighborhood-Level Poverty at Menarche and Prepregnancy Obesity in African-American Women. J Pregnancy 2016; 2016:4769121. [PMID: 27418977 PMCID: PMC4932170 DOI: 10.1155/2016/4769121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/11/2016] [Accepted: 05/25/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction. Menarche is a critical time point in a woman's reproductive system development; exposures at menarche may influence maternal health. Living in a poorer neighborhood is associated with adult obesity; however, little is known if neighborhood factors at menarche are associated with prepregnancy obesity. Methods. We examined the association of neighborhood-level poverty at menarche with prepregnancy body mass index category in 144 pregnant African-American women. Address at menarche was geocoded to census tract (closest to year of menarche); neighborhood-level poverty was defined as the proportion of residents living under the federal poverty level. Cumulative logistic regression was used to examine the association of neighborhood-level poverty at menarche, in quartiles, with categorical prepregnancy BMI. Results. Before pregnancy, 59 (41%) women were obese. Compared to women in the lowest neighborhood-level poverty quartile, women in the highest quartile had 2.9 [1.2, 6.9] times higher odds of prepregnancy obesity; this was slightly attenuated after adjusting for age, marital status, education, and parity (odds ratio: 2.3 [0.9, 6.3]). Conclusions. Living in a higher poverty neighborhood at menarche is associated with prepregnancy obesity in African-American women. Future studies are needed to better understand the role of exposures in menarche on health in pregnancy.
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Udo T, Grilo CM. Perceived weight discrimination, childhood maltreatment, and weight gain in U.S. adults with overweight/obesity. Obesity (Silver Spring) 2016; 24:1366-72. [PMID: 27112217 DOI: 10.1002/oby.21474] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Perceived weight discrimination and childhood maltreatment have been independently associated with physical and mental health issues, as well as weight gain. It is not known, however, whether childhood maltreatment modifies the relationship between perceived weight discrimination and weight changes. METHODS This study examined the relationship between perceived weight discrimination, childhood maltreatment, and changes in body mass index (BMI) over 3 years in 21,357 men and women with overweight and obesity from Wave 1 and Wave 2 surveys of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). RESULTS Reporting childhood maltreatment, regardless of the specific form of maltreatment, was associated with a significantly greater likelihood of perceived weight discrimination in women. Perceived weight discrimination was associated with a significantly greater increase in BMI in both genders. Among all women with perceived weight discrimination, those who also reported having experienced childhood maltreatment had significantly less BMI increase compared to those reporting not having experienced childhood maltreatment. CONCLUSIONS Perceived weight discrimination may foster weight gain rather than encouraging weight loss in individuals with overweight/obesity and should be addressed in prevention efforts and clinical settings. Childhood maltreatment may perhaps sensitize individuals to subsequent stressors and increase vulnerability to perceived weight discrimination, particularly in women.
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Affiliation(s)
- Tomoko Udo
- School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- National Center on Addiction and Substance Abuse (at Yale), New Haven, Connecticut, USA
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Holowko N, Chaparro MP, Nilsson K, Ivarsson A, Mishra G, Koupil I, Goodman A. Social inequality in pre-pregnancy BMI and gestational weight gain in the first and second pregnancy among women in Sweden. J Epidemiol Community Health 2015. [DOI: 10.1136/jech-2015-205598] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVES This review focuses on the relationship between obesity and aging and how these interact to affect cognitive function. The topics covered are guided by the Scaffolding Theory of Aging and Cognition (STAC [Park and Reuter-Lorenz. Annu Rev Psychol 2009;60:173-96]-a conceptual model designed to relate brain structure and function to one's level of cognitive ability. METHODS The initial literature search was focused on normal aging and was guided by the key words, "aging, cognition, and obesity" in PubMed. In a second search, we added key words related to neuropathology including words "Alzheimer's disease," "vascular dementia," and "mild cognitive impairment." RESULTS The data suggest that being overweight or obese in midlife may be more detrimental to subsequent age-related cognitive decline than being overweight or obese at later stages of the life span. These effects are likely mediated by the accelerated effects obesity has on the integrity of neural structures, including both gray and white matter. Further epidemiological studies have provided evidence that obesity in midlife is linked to an increased risk for Alzheimer's disease and vascular dementia, most likely via an increased accumulation of Alzheimer's disease pathology. CONCLUSIONS Although it is clear that obesity negatively affects cognition, more work is needed to better understand how aging plays a role and how brain structure and brain function might mediate the relationship of obesity and age on cognition. Guided by the STAC and the STAC-R models, we provide a roadmap for future investigations of the role of obesity on cognition across the life span.
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Affiliation(s)
- Gérard N. Bischof
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX 75235
| | - Denise C. Park
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX 75235
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Hooper CM, Ivory VC, Fougere G. "Dinner's ready!" A qualitative exploration of the food domain across the lifecourse. Appetite 2015; 92:133-42. [PMID: 25936292 DOI: 10.1016/j.appet.2015.04.073] [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: 05/22/2014] [Revised: 04/09/2015] [Accepted: 04/26/2015] [Indexed: 11/26/2022]
Abstract
The influence of the childhood food domain on adult food-related practices is only partially understood. Through an interpretive study using in-depth life-story interviewing and narrative analysis, we aimed to discover how preferences and perceptions relating to the food domain become embodied during childhood, and once embodied, how these influence practices in adulthood. We observed distinct 'food mood' pathways seemingly anchored in childhood memories about dinnertime. One pathway led to food philosophies participants perceived to be beneficial for their health and wellbeing, whilst another led to perceptions of food as a chore and bore they would rather ignore. Parental attitudes were very important to the food domain of childhood, as this is now recalled through life-story narratives. Our findings suggest a positive relationship with the food domain needs to be fostered during childhood for the long-term protection and promotion of health and wellbeing in adulthood.
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Affiliation(s)
- Carolyn May Hooper
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, 23a Mein Street, Newtown, PO Box 7343, Wellington 6242, New Zealand.
| | - Vivienne Chisholm Ivory
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, 23a Mein Street, Newtown, PO Box 7343, Wellington 6242, New Zealand
| | - Geoff Fougere
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, 23a Mein Street, Newtown, PO Box 7343, Wellington 6242, New Zealand
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Crandall CJ, Karlamangla AS, Merkin SS, Binkley N, Carr D, Greendale GA, Seeman TE. Adult bone strength of children from single-parent families: the Midlife in the United States Study. Osteoporos Int 2015; 26:931-42. [PMID: 25510582 PMCID: PMC4344315 DOI: 10.1007/s00198-014-2990-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 12/05/2014] [Indexed: 11/30/2022]
Abstract
UNLABELLED Bone health may be negatively impacted by childhood socio-environmental circumstances. We examined the independent associations of single-parent childhood and parental death or divorce in childhood with adult bone strength indices. Longer exposure to a single-parent household in childhood was associated with lower bone strength in adulthood. INTRODUCTION Because peak bone mass is acquired during childhood, bone health may be negatively impacted by childhood socio-environmental disadvantage. The goal of this study was to determine whether being raised in a single-parent household is associated with lower bone strength in adulthood. METHODS Using dual-energy X-ray absorptiometry data from 708 participants (mean age 57 years) in the Midlife in the United States Biomarker Project, we examined the independent associations of composite indices of femoral neck bone strength relative to load (in three failure modes: compression, bending, and impact) in adulthood with the experience of single-parent childhood and parental death or divorce in childhood. RESULTS After adjustment for gender, race, menopause transition stage, age, and body mass index, each additional year of single-parent childhood was associated with 0.02 to 0.03 SD lower indices of adult femoral neck strength. In those with 9-16 years of single-parent childhood, the compression strength index was 0.41 SD lower, bending strength index was 0.31 SD lower, and impact strength index was 0.25 SD lower (all p values < 0.05). In contrast, parental death or divorce during childhood was not by itself independently associated with adult bone strength indices. The magnitudes of these associations were unaltered by additional adjustment for lifestyle factors and socioeconomic status in childhood and adulthood. CONCLUSIONS Independent of parental death or divorce, growing up in a single-parent household is associated with lower femoral neck bone strength in adulthood, and this association is not entirely explained by childhood or adult socioeconomic conditions or lifestyle choices.
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Affiliation(s)
- Carolyn J. Crandall
- Dept. of Medicine, David Geffen School of Medicine at University of California, Los Angeles, UCLA Medicine/GIM, 911 Broxton Ave., 1 floor, Los Angeles, CA, 90024
| | - Arun S. Karlamangla
- Division of Geriatrics, Dept. of Medicine, David Geffen School of Medicine at University of California, Los Angeles, 10945 Le Conte. Ave., Ste 2339, Los Angeles, CA, 90095,
| | - Sharon Stein Merkin
- Division of Geriatrics, Dept. of Medicine, David Geffen School of Medicine at University of California, Los Angeles, 10945 Le Conte. Ave., Ste 2339, Los Angeles, CA, 90095,
| | - Neil Binkley
- Osteoporosis Clinical Center and Research Program and, University of Wisconsin, 2870 University Ave., Suite 100, Madison, Wisconsin, 53705
| | - Deborah Carr
- Department of Sociology, Rutgers University, 112 Paterson Street New Brunswick, NJ 08901,
| | - Gail A. Greendale
- Division of Geriatrics, Dept. of Medicine, David Geffen School of Medicine at University of California, Los Angeles, 10945 Le Conte. Ave., Ste 2339, Los Angeles, CA, 90095,
| | - Teresa E. Seeman
- Division of Geriatrics, Dept. of Medicine, David Geffen School of Medicine at University of California, Los Angeles, 10945 Le Conte. Ave., Ste 2339, Los Angeles, CA, 90095,
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Pei L, Cheng Y, Kang Y, Yuan S, Yan H. Association of obesity with socioeconomic status among adults of ages 18 to 80 years in rural Northwest China. BMC Public Health 2015; 15:160. [PMID: 25886538 PMCID: PMC4349793 DOI: 10.1186/s12889-015-1503-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 02/03/2015] [Indexed: 03/09/2023] Open
Abstract
Background Understanding social disparities in obesity are presently an essential element in establishing public health priorities. However, the association between socioeconomic status (SES) and obesity has not been assessed in rural Northwest China. This study aims to explore the effect of SES on overweight/obesity and abdominal obesity by gender and age in rural Northwest China. Methods A total of 3030 participants between the ages of 18 to 80 years from rural Hanzhong, Shaanxi province, Northwest China were enrolled in our study using a two-level stratified random cluster sampling technique. Adjusted odds ratio (AOR) were used to assess the relationship between socioeconomic status and obesity after controlling for confounding factors using logistic regression. Results Our results indicated that the prevalence of abdominal obesity (38.8%) was the highest in rural Northwest China when compared with overweight (27.8%) and obesity (5.7%). When adjusting for possible risk factors, there were significant gender disparities in SES-obesity association. In men, the likelihoods of overweight/obesity and abdominal obesity were higher in the high SES groups when compared to the low SES groups. However, women with a high level of education were less likely to have overweight/obesity (AOR:0.78, 95% CI: 0.62, 0.98) than their counterparts with a low level of education. After the inclusion of multiple lifestyle factors, we still observed a strong positive association between age and obesity in the population. Conclusions Both gender and age differences in SES-obesity association were clearly observed in our study. Therefore, interventional measures should be employed in rural Northwest China to reduce the obesity epidemic that specifically takes into account gender and age differences.
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Affiliation(s)
- Leilei Pei
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, Shaanxi, 710061, PR China.
| | - Yue Cheng
- Department of Nutrition and Food Safety Research, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China.
| | - Yijun Kang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, Shaanxi, 710061, PR China.
| | - Shuyi Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, Shaanxi, 710061, PR China.
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, Shaanxi, 710061, PR China.
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Boylan SM, Gill TP, Hare-Bruun H, Andersen LB, Heitmann BL. Associations between adolescent and adult socioeconomic status and risk of obesity and overweight in Danish adults. Obes Res Clin Pract 2015; 8:e163-71. [PMID: 24743012 DOI: 10.1016/j.orcp.2013.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/21/2013] [Accepted: 03/24/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND It has been suggested that socioeconomic status (SES) may influence the risk of obesity; however it is important to consider individual changes in SES over the life-course in addition to SES at specific time-points to better understand the complex associations with obesity. We explored the relationship between lifetime-specific and life-course SES and risk of obesity and overweight in Danish adults. METHODS Data were used from the Danish Youth and Sports Study (DYSS) – a 20–22 year follow-up study of Danish teenagers born between 1964 and 1969. Baseline data gathered in 1983 and 1985 included self-reported BMI, SES and physical activity. The follow-up survey (2005) repeated these assessments in addition to an assessment of diet. Complete data on adolescent and adult SES and BMI were available for 623 participants. RESULTS Following adjustments, adolescent SES had no significant association with overweight/obesity in this sample, however females of low or medium adult SES were significantly more likely to be overweight/obese compared to those of high SES (low SES: OR: 2.7; 95% CI: (1.3–5.8); p = 0.008; medium SES: OR: 4.0, 95% CI (1.6–10.2); p = 0.003). Females who decreased in SES during adulthood were significantly more likely to be overweight/obese compared to those who remained of high SES (OR: 3.1; 95% CI (1.1–9.2); p = 0.04). CONCLUSION Effects of early life-factors may be conditional upon the environment in adulthood, particularly for the women. Further research should consider the timing of SES exposure and the mechanisms which may be responsible for the socioeconomic gradients in prevalence of obesity and overweight.
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Affiliation(s)
- Sinead M Boylan
- Institute of Sports Science and Clinical Biomechanics, and National Institute of Public Health, University of Southern Denmark, DK-5230 Odense M, Denmark
| | - Timothy P Gill
- Institute of Sports Science and Clinical Biomechanics, and National Institute of Public Health, University of Southern Denmark, DK-5230 Odense M, Denmark
| | - Helle Hare-Bruun
- Institute of Sports Science and Clinical Biomechanics, and National Institute of Public Health, University of Southern Denmark, DK-5230 Odense M, Denmark
| | - Lars B Andersen
- Institute of Sports Science and Clinical Biomechanics, and National Institute of Public Health, University of Southern Denmark, DK-5230 Odense M, Denmark
| | - Berit L Heitmann
- Institute of Sports Science and Clinical Biomechanics, and National Institute of Public Health, University of Southern Denmark, DK-5230 Odense M, Denmark
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Coll JL, Bibiloni MDM, Salas R, Pons A, Tur JA. Prevalence and Related Risk Factors of Overweight and Obesity among the Adult Population in the Balearic Islands, a Mediterranean Region. Obes Facts 2015; 8:220-33. [PMID: 26159577 PMCID: PMC5644906 DOI: 10.1159/000435826] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/23/2015] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess the prevalence and risk factors of overweight (OW) and obesity (OB) by BMI and abdominal obesity (AO) by waist-to-height ratio, (WHtR) among the Balearic Islands' adult population. METHODS Cross-sectional nutritional survey carried out in the Balearic Islands (2009-2010). A random sample (n = 1,081) of young (18-35 years) and middle-aged adults (36-55 years) were interviewed and anthropometrically measured. OW (BMI 25.0-29.9 kg/m(2)) and OB (BMI ≥ 30 kg/m(2)) were defined according to WHO criteria. AO was defined as WHtR ≥ 0.5. Socio-economic and lifestyle determinants were considered. RESULTS The overall prevalence of OW/OB and AO was 29.4% (95% confidence interval (95% CI) 26.9-32.3%), 11.2% (95% CI 9.5-13.2%) and 33.1% (95% CI 30.4-36.0%), respectively. Men showed higher prevalence of OW (35.9%, 95% CI 31.6-40.5%) and AO (37.9%, 95% CI 33.6-42.5%) than women (OW 24.9%, 95% CI 21.7-28.4%; AO 29.7%, 95%CI 26.2-33.4%). Overall prevalence of OB was 11.8% (95% CI 9.1-15.1%) in men and 10.8% (95% CI 8.6-13.5%) in women. Age and no leisure-time physical activity (LTPA) were main risk factors associated with OW/OB and AO. Living with at least one child at home and to be married in men as well as to be unemployed, to be born in South America, and a low level of education in women were associated with AO. CONCLUSIONS Men showed higher prevalence of OW and AO than women. In both sexes, age is the main risk factor associated with OW/OB and AO; in men also the absence of LTPA plays a significant role.
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Affiliation(s)
- Josep L. Coll
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, IdISPa, and CIBERobn (Physiopathology of Obesity and Nutrition CB12/03/30038), Palma de Mallorca, Spain
| | - Maria del Mar Bibiloni
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, IdISPa, and CIBERobn (Physiopathology of Obesity and Nutrition CB12/03/30038), Palma de Mallorca, Spain
| | - Rogelio Salas
- Faculty of Public Health Nutrition, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Antoni Pons
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, IdISPa, and CIBERobn (Physiopathology of Obesity and Nutrition CB12/03/30038), Palma de Mallorca, Spain
| | - Josep A. Tur
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, IdISPa, and CIBERobn (Physiopathology of Obesity and Nutrition CB12/03/30038), Palma de Mallorca, Spain
- *Dr. Josep A. Tur, Research Group on Community Nutrition and Oxidative Stress, Universitat de les Illes Balears, Guillem Colom Bldg, Campus, 07122 Palma de Mallorca, Spain,
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Educational mobility and weight gain over 13 years in a longitudinal study of young women. BMC Public Health 2014; 14:1219. [PMID: 25424466 PMCID: PMC4289243 DOI: 10.1186/1471-2458-14-1219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/10/2014] [Indexed: 11/17/2022] Open
Abstract
Background Limited evidence exists about the role of education and own educational mobility on body weight trajectory. A better understanding of how education influences long term weight gain can help us to design more effective health policies. Methods Using random effects models, the association between i) highest education (n = 10 018) and ii) educational mobility over a 9 year period (n = 9 907) and weight gain was analysed using five waves of data (over 13 years) from the Australian Longitudinal Study on Women’s Health 1973–78 cohort (from 18–23 years to 31–36 years). Results Highest educational attainment was inversely associated with weight at baseline and weight gain over 13 years. Compared to high educated women, those with a low (12 years or less) or intermediate (trade/certificate/diploma) education, respectively, weighed an additional 2.6 kg (95% CI:1.9 to 3.1) and 2.5 kg (95% CI:1.9 to 3.3) at baseline and gained an additional 3.9 kg (95% CI:2.6 to 5.2) and 3.1 kg (95% CI:2.6 to 3.9) over 13 years. Compared to women who remained with a low education, women with the greatest educational mobility had similar baseline weight to the women who already had a high education at baseline (2.7 kg lighter (95% CI:-3.7 to -1.8) and 2.7 kg lighter (95% CI:-3.4 to -1.9), respectively) and similarly favourable weight gain (gaining 3.1 kg less (95% CI:-4.0 to -2.21) and 4.2 kg less (95% CI:-4.8 to -3.4) over the 13 years, respectively). Conclusions While educational attainment by mid-thirties was positively associated with better weight management, women’s weight was already different in young adult age, before their highest education was achieved. These findings highlight a potential role of early life factors and personality traits which may influence both education and weight outcomes. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1219) contains supplementary material, which is available to authorized users.
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Cohen AK, Rai M, Rehkopf DH, Abrams B. Educational attainment and obesity: a systematic review. Obes Rev 2013; 14:989-1005. [PMID: 23889851 PMCID: PMC3902051 DOI: 10.1111/obr.12062] [Citation(s) in RCA: 260] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/14/2013] [Accepted: 05/28/2013] [Indexed: 01/17/2023]
Abstract
Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.
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Affiliation(s)
- A K Cohen
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
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León-Muñoz LM, Gutiérrez-Fisac JL, Guallar-Castillón P, Regidor E, López-García E, Martínez-Gómez D, Graciani A, Banegas JR, Rodríguez-Artalejo F. Contribution of lifestyle factors to educational differences in abdominal obesity among the adult population. Clin Nutr 2013; 33:836-43. [PMID: 24183662 DOI: 10.1016/j.clnu.2013.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/23/2013] [Accepted: 10/17/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS This is the first study to systematically examine the behavioral factors that may explain the inverse association between education and abdominal obesity in adults. METHODS Cross-sectional study conducted among 3541 men and 3564 women representative of the population aged 25-64 years in Spain. Abdominal obesity was defined as waist circumference >102 cm in men and >88 cm in women. Analyzes were performed with logistic regression, with progressive adjustment for obesity-related behaviors. RESULTS The age-, sex- and town size-adjusted odds ratios for abdominal obesity were 1.69 in men and 1.85 in women among individuals with lowest versus highest education. After adjustment for all the studied behaviors, the odds ratio was reduced to 1.49 in men and to 1.45 in women. The factors with the largest contribution to the higher prevalence of abdominal obesity in individuals with lowest versus highest education were more time spent watching TV and less time spent in exercising, as well as a higher energy intake in women. Tobacco and alcohol consumption, physical activity at home, leisure walking, sedentary behaviors other than TV watching, and sleep duration did not explain the educational gradient in abdominal obesity. CONCLUSION Watching TV, physical exercise and energy intake explain a substantial part of the inverse association between education and abdominal obesity.
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Affiliation(s)
- Luz Ma León-Muñoz
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - Juan L Gutiérrez-Fisac
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - Pilar Guallar-Castillón
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther López-García
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - David Martínez-Gómez
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - Auxiliadora Graciani
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - José R Banegas
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain
| | - Fernando Rodríguez-Artalejo
- CIBER of Epidemiology and Public Health (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid 28029, Spain.
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Obese women's perceptions and experiences of healthcare and primary care providers: a phenomenological study. Nurs Res 2013; 62:252-9. [PMID: 23817283 DOI: 10.1097/nnr.0b013e318299a6ba] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nearly two thirds of the adult population in the United States is overweight or obese. Adults who are overweight or obese require the same high-quality healthcare from their providers as any other adult. Unfortunately, stigma is a reality experienced by individuals who are overweight or obese, and healthcare professionals' views have sometimes been reported to be biased against individuals who are overweight or obese. However, there are gaps and inconsistencies in the literature regarding the types of experiences and perceptions of obese women receiving healthcare and whether stigma is present. OBJECTIVE The aim of this study was to describe the experiences and perceptions of obese women with regard to stigma in healthcare and from their healthcare provider. METHODS A phenomenological research approach using the Colaizzi method was utilized to examine and describe the lived experience of overweight and obese women with healthcare. Semistructured interviews were conducted with a diverse, purposive sample of 26 English-speaking women with a body mass index of over 30 kg/m. Participants were asked to describe their perceptions and experiences with regard to healthcare and their relationship with their healthcare providers. RESULTS Four themes emerged from the analysis of the data: (a) perceptions of health and healthcare, (b) respect me as a person, (c) establishing a healthcare connection, and (d) assertiveness is necessary. Although stigma was not named by women in this study, all acknowledged some negative treatment by healthcare providers. DISCUSSION Discussion relating to the current professional literature is presented. Implications for nursing education and research are discussed.
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Social inequality in excessive gestational weight gain. Int J Obes (Lond) 2013; 38:91-6. [PMID: 23711774 DOI: 10.1038/ijo.2013.62] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/17/2013] [Accepted: 04/25/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Optimal gestational weight gain (GWG) leads to better outcomes for both the mother and child, whereas excessive gains can act as a key stage for obesity development. Little is known about social inequalities in GWG. This study investigates the influence of education level on pre-pregnancy body mass index (BMI) and GWG. DESIGN Register-based population study. SETTING Sweden PARTICIPANTS Four thousand and eighty women born in Sweden who were a part of the third generation Uppsala Birth Cohort Study. Register data linkages were used to obtain information on social characteristics, BMI and GWG of women with singleton first births from 1982 to 2008. MAIN OUTCOME MEASURE Pre-pregnancy BMI and the Institute of Medicine's (IOM) categories of GWG for a given pre-pregnancy BMI. RESULTS were adjusted for calendar period, maternal age, living arrangements, smoking, history of chronic disease and pre-pregnancy BMI when appropriate. RESULTS Although most women (67%) were of healthy pre-pregnancy BMI, 20% were overweight and 8% were obese. Approximately half of all women in the sample had excessive GWG, with higher pre-pregnancy BMI associated with higher risk of excessive GWG, regardless of education level; this occurred for 76% of overweight and 75% of obese women. Lower educated women with a healthy pre-pregnancy BMI were at greater risk of excessive GWG-odds ratio 1.76 (95% confidence interval 1.28-2.43) for elementary and odds ratio 1.32 (1.06-1.64) for secondary compared with tertiary educated, adjusted for age and birth year period. Nearly half of women with an elementary or secondary education (48%) gained weight excessively. CONCLUSION Education did not provide a protective effect in avoiding excessive GWG among overweight and obese women, of whom ∼75% gained weight excessively. Lower educated women with a BMI within the healthy range, however, are at greater risk of excessive GWG. Health professionals need to tailor their pre-natal advice to different groups of women in order to achieve optimal pregnancy outcomes and avoid pregnancy acting as a stage in the development of obesity.
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Regber S, Novak M, Eiben G, Lissner L, Hense S, Sandström TZ, Ahrens W, Mårild S. Assessment of selection bias in a health survey of children and families - the IDEFICS Sweden-study. BMC Public Health 2013; 13:418. [PMID: 23634972 PMCID: PMC3662638 DOI: 10.1186/1471-2458-13-418] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 04/08/2013] [Indexed: 11/10/2022] Open
Abstract
Background A health survey was performed in 2007–2008 in the IDEFICS/Sweden study (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) in children aged 2–9 years. We hypothesized that families with disadvantageous socioeconomic and -demographic backgrounds and children with overweight and obesity were underrepresented. Methods In a cross-sectional study, we compared Swedish IDEFICS participants (N=1,825) with referent children (N=1,825) using data from Statistics Sweden population registers. IDEFICS participants were matched for age and gender with a referent child living in the same municipality. Longitudinal weight and height data from birth to 8 years was collected for both populations (n=3,650) from the children’s local health services. Outcome measures included the family’s socioeconomic and demographic characteristics, maternal body mass index (BMI) and smoking habits before pregnancy, the children’s BMI standard deviation score (SDS) at the age of inclusion in the IDEFICS study (BMISDS-index), and the children’s BMI-categories during the age-span. Comparisons between groups were done and a multiple logistic regression analysis for the study of determinants of participation in the IDEFICS study was performed. Results Compared with IDEFICS participants, referent families were more likely to have lower education and income, foreign backgrounds, be single parents, and have mothers who smoked before pregnancy. Maternal BMI before pregnancy and child’s BMISDS-index did not differ between groups. Comparing the longitudinal data-set, the prevalence of obesity was significantly different at age 8 years n= 45 (4.5%) versus n= 31 (2.9%) in the referent and IDEFICS populations, respectively. In the multivariable adjusted model, the strongest significant association with IDEFICS study participation was parental Swedish background (odds ratio (OR) = 1.91, 95% confidence interval (CI) (1.48–2.47) followed by parents having high education OR 1.80, 95% CI (1.02-3.16) and being married or co-habiting OR 1.75 95% CI (1.38-2.23). Conclusion Families with single parenthood, foreign background, low education and income were underrepresented in the IDEFICS Sweden study. BMI at inclusion had no selection effect, but developing obesity was significantly greater among referents.
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Affiliation(s)
- Susann Regber
- Nordic School of Public Health NHV, Box 12 133, SE- 402 42, Gothenburg, Sweden.
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Lu E, Dayalu R, Diop H, Harvey EM, Manning SE, Uzogara SG. Weight and Mental Health Status in Massachusetts, National Survey of Children’s Health, 2007. Matern Child Health J 2012; 16 Suppl 2:278-86. [DOI: 10.1007/s10995-012-1145-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Familial environment in high- and middle–low-income municipalities: A survey in Italy to understand the distribution of potentially obesogenic factors. Public Health 2012; 126:731-9. [DOI: 10.1016/j.puhe.2012.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 02/19/2012] [Accepted: 05/24/2012] [Indexed: 11/21/2022]
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Frequency of under- and overweight among children and adolescents during the economic transition in Poland. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2012; 63:216-32. [PMID: 22608527 DOI: 10.1016/j.jchb.2012.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 03/01/2012] [Indexed: 11/20/2022]
Abstract
The aim of this study is to examine the prevalence of underweight, overweight and obesity, using International Obesity Task Force (IOTF) criteria, in four cohorts of children and adolescents living in Poland in different economic eras: communist economy (1977/1978), crisis of the 1980s (1987/1988), political and economic transformation (1992/1994) and the free market economy (2002/2004). Analysis was conducted on a database including 10,934 records for children of the age 7-18 years. In Poland, in the last 26 years of economic and political transformations, the epidemic of obesity was not noticed but the growing incidence of children and adolescents with body mass deficit was observed (p<0.0001) (20.2% of girls in 2002/2004 vs. 11.0% in 1977/1978 and 12.1% of boys in 2002/2004 vs. 7.2% in 1977/1978). Lower parental education and a higher number of children in a family resulted in a higher prevalence of underweight (odds ratio [OR] fluctuated from 1.26 to 1.63). The social effects of the political transformation in Poland significantly affected families with low socio-economic status (SES), and especially more eco-sensitive boys. This result is opposite to the trends observed in Western countries and makes an important contribution to the current knowledge of the course of further changes in weight-to-height ratio at a global scale.
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Novak M, Ahlgren C, Hammarstrom A. Social and health-related correlates of intergenerational and intragenerational social mobility among Swedish men and women. Public Health 2012; 126:349-57. [PMID: 22444320 DOI: 10.1016/j.puhe.2012.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 09/07/2011] [Accepted: 01/09/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To explore the pattern and determinants of inter- and intragenerational occupational mobility among Swedish men and women. STUDY DESIGN A Swedish 14-year prospective longitudinal study (response rate 96.5%). METHODS Detailed information on 546 men and 495 women regarding their occupation, health status, health-related behaviour, psychosocial environment at home and school, material recourses and ethnicity prior to mobility were available at 16, 21 and 30 years of age. Odds ratios and 99% confidence intervals were calculated using logistic regression to determine social mobility. RESULTS The results indicated that being popular at school predicted upward mobility, and being less popular at school predicted downward mobility. Additionally, material deprivation, economic deprivation, shorter height (women) and poor health behavioural factors predicted downward mobility. Among this cohort, being less popular at school was more common among subjects whose parents had low socio-economic status. Occupational mobility was not influenced by ethnic background. CONCLUSIONS Apart from height (women), health status was not associated with mobility for men or women either inter- or intragenerationally. Unfavourable school environment was a consistent predictor of mobility for both genders. The results indicate that schools should be used as a setting for interventions aimed at reducing socio-economic health inequities. Targeted school interventions that are designed to assist higher educational attainment of socio-economically disadvantaged youth would help to break the social chain of risk experienced during this time, and thereby alter their life course in ways that would reduce subsequent social inequities in health and well-being.
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Affiliation(s)
- M Novak
- Department of Emergency and Cardiovascular Medicine, The Sahlgrenska Academy, University of Gothenburg SE-416 85, Sweden.
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Gustafsson PE, Persson M, Hammarstrom A. Socio-economic disadvantage and body mass over the life course in women and men: results from the Northern Swedish Cohort. Eur J Public Health 2011; 22:322-7. [DOI: 10.1093/eurpub/ckr061] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Botoseneanu A, Liang J. Social stratification of body weight trajectory in middle-age and older americans: results from a 14-year longitudinal study. J Aging Health 2011; 23:454-80. [PMID: 21068396 PMCID: PMC3470852 DOI: 10.1177/0898264310385930] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To depict the trajectory of BMI from middle to late adulthood and to examine social variations in BMI trajectories. METHOD Eight waves (1992-2006) of the Health and Retirement Study involving a nationally representative sample of Americans aged 51 to 61 years at baseline were used. Changes in BMI were analyzed using hierarchical linear modeling with time-constant and time-varying covariates. RESULTS BMI increased linearly over time. Compared with Caucasians, African-Americans had higher BMI levels, while Hispanics had similar BMI levels, but lower rates of increase over time. Higher education predicted lower BMI levels and was not associated with the rate of change. Younger age-at-baseline predicted lower BMI level and lower rate of increase. No gender differences were found. DISCUSSION Observed racial/ethnic and educational differences in BMI trajectory from middle to old age inform policies and interventions aimed at modifying health risks and reducing health disparities in old age.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
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Due P, Krølner R, Rasmussen M, Andersen A, Trab Damsgaard M, Graham H, Holstein BE. Pathways and mechanisms in adolescence contribute to adult health inequalities. Scand J Public Health 2011; 39:62-78. [PMID: 21382850 DOI: 10.1177/1403494810395989] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS This paper presents a model that encompasses pathways and mechanisms working over adolescence that contribute to adult health inequalities. We review evidence on the four mechanisms: socially differential exposure, tracking, socially differential tracking, and socially differential vulnerability. METHODS We conducted literature searches in English-language peer-reviewed journals using PubMed (from 1966 to May 2009) and PsycINFO, and combined these with hand-searches of reference lists, journals, and authors of particular relevance. RESULTS Most health indicators are socially patterned in adolescence and track into adulthood, with higher risks of adverse outcomes among individuals from lower socioeconomic positions. Adolescent health behaviours track into adulthood. Smoking, physical activity, and especially fruit and vegetable intake are socially patterned, while evidence for social patterning of alcohol use is less consistent. Relational dimensions like lone parenthood and bullying are socially patterned and track over time, and there are indications of a socially differential vulnerability to the effects of these types of relational strain. Very little research has investigated the social patterning of the above indicators over time or studied social vulnerability of these indicators from adolescence to adulthood. However, all four mechanisms seem to be active in establishing social differences in adult educational attainment. CONCLUSIONS We find the Adolescent Pathway Model useful for providing an overview of what elements and mechanisms in adolescence may be of special importance for adult health inequalities. There is a lack of knowledge of how social patterns of health, health behaviours, and social relations in adolescence transfer into adulthood and to what extent they reflect themselves in adult health.
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Affiliation(s)
- Pernille Due
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Dzieciolowska-Baran E, Gawlikowska-Sroka A, Poziomkowska-Gesicka I, Teul-Swiniarska I, Sroczynski T. Influence of body mass index on treatment of breathing-related sleep disorders. Eur J Med Res 2011; 15 Suppl 2:36-40. [PMID: 21147617 PMCID: PMC4360327 DOI: 10.1186/2047-783x-15-s2-36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Breathing-related sleep disorders cover several conditions (isolated snoring, UARS - upper airway resistance syndrome, obstructive sleep apnea, hypopnea, obesity hypoventilation syndrome) characterized by a variety of symptoms and complex etiology. The conditions can be successfully treated in most cases. Excessive body mass is a factor increasing the probability of the disorders. In most patients it is the only reason for breathing-related sleep disorders. However, it often coexists with various anatomical abnormalities in the upper airway, endocrinological diseases or genetic defects of the facial skeleton, and occurs more frequently in older people, especially men. Excessive body mass significantly affects the range and success of the treatment. Objective To analyze treatment outcome in patients treated at the otolaryngology unit for snoring and related diseases with submucosal tissue reduction within the nasal cavity, pharynx, and soft palate. Materials and methods Patients were stratified into three study groups depending on the body mass index (BMI): normal, overweight, and obese. The BMI value was compared to the severity of breathing disorders during sleep, with the incidence of other systemic diseases (e.g., hypertension, diabetes), and with treatment outcome. Results and conclusions The analysis demonstrated a significant influence of body mass on snoring, particularly in complicated and severe types of breathing disorders, such obstructive sleep apnea or hypopnea, and the obesity hypoventilation syndrome. Corrective interventions carried out to eliminate anatomical abnormalities causing obstruction of upper airways provided the best therapeutic effects in patients with normal body mass.
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Mowafi M, Khadr Z, Subramanian SV, Bennett G, Hill A, Kawachi I. Are neighborhood education levels associated with BMI among adults in Cairo, Egypt? Soc Sci Med 2011; 72:1274-83. [PMID: 21440350 DOI: 10.1016/j.socscimed.2011.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 11/09/2010] [Accepted: 01/22/2011] [Indexed: 11/25/2022]
Abstract
This study examined the association between area-level education and BMI among adults in Cairo, Egypt. A sample of 3993 households including 1990 men and 2003 women were analyzed from the 2007 Cairo Urban Inequity Study, a study which aimed to identify potential intra-urban inequities in health related to the environment and living conditions in Cairo. Using multilevel analysis, we found that residents of high education neighborhoods were significantly less likely to be obese compared to low education neighborhoods. An inverse association between neighborhood education and individual BMI was observed whereby each unit increase in percentage of households with greater than a high school education was associated with a 0.036 kg/m(2) decrease in BMI of individuals. This translated into a difference between high and low education neighborhoods of 6.86 kg (15.1 lb) for women based on an average height of 1.65 m and 6.10 kg (13.4 lb) for men based on an average height of 1.75 m after adjusting for sociodemographic, socioeconomic, health and environmental factors. These findings suggest that programs aiming to reduce BMI among adults in this setting may be well-served by focusing on education since it appears to have an effect at the neighborhood level over and above the impact it has at the individual level. This may be due to several factors such as greater access to knowledge and information regarding health and nutrition, greater food availability, and shifting cultural perceptions of beauty away from an ideal body shape of plumpness in favor of thinness in high education neighborhoods. The cross-sectional nature of our study does not allow for causal interpretations, however, so further studies exploring why the neighborhood education-BMI association is so significant is warranted.
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Affiliation(s)
- Mona Mowafi
- Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02114, United States.
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Proper KI, Singh AS, van Mechelen W, Chinapaw MJM. Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies. Am J Prev Med 2011; 40:174-82. [PMID: 21238866 DOI: 10.1016/j.amepre.2010.10.015] [Citation(s) in RCA: 433] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 08/27/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022]
Abstract
CONTEXT Nowadays, people spend a substantial amount of time per day on sedentary behaviors and it is likely that the time spent sedentary will continue to rise. To date, there is no review of prospective studies that systematically examined the relationship between diverse sedentary behaviors and various health outcomes among adults. PURPOSE This review aimed to systematically review the literature as to the relationship between sedentary behaviors and health outcomes considering the methodologic quality of the studies. EVIDENCE ACQUISITION In February 2010, a search for prospective studies was performed in diverse electronic databases. After inclusion, in 2010, the methodologic quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions. EVIDENCE SYNTHESIS 19 studies were included, of which 14 were of high methodologic quality. Based on inconsistency in findings among the studies and lack of high-quality prospective studies, insufficient evidence was concluded for body weight-related measures, CVD risk, and endometrial cancer. Further, moderate evidence for a positive relationship between the time spent sitting and the risk for type 2 diabetes was concluded. Based on three high-quality studies, there was no evidence for a relationship between sedentary behavior and mortality from cancer, but strong evidence for all-cause and CVD mortality. CONCLUSIONS Given the trend toward increased time in sedentary behaviors, additional prospective studies of high methodologic quality are recommended to clarify the causal relationships between sedentary behavior and health outcomes. Meanwhile, evidence to date suggests that interventions aimed at reducing sedentary behavior are needed.
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Affiliation(s)
- Karin I Proper
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
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General and abdominal obesity in South Korea, 1998-2007: gender and socioeconomic differences. Prev Med 2010; 51:460-5. [PMID: 20955726 DOI: 10.1016/j.ypmed.2010.10.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/07/2010] [Accepted: 10/08/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine national trends in prevalence and socioeconomic inequalities in both general (measured by body mass index) and abdominal obesity (measured by waist circumference) by gender and socioeconomic position (SEP) indicators. METHODS Data were from four rounds of nationally representative cross-sectional surveys for Korean men and women aged 25-64 (6,286 in 1998, 4,839 in 2001, 4,181 in 2005, and 2,006 in 2007). We calculated age-adjusted prevalence rates of overweight and abdominal obesity by gender and SEP indicators (education, occupational class, employment status and income) and examined trends of prevalence and its inequalities. RESULTS Overweight and abdominal obesity has significantly increased in Korean men (P for linear trend <0.01), not in women. For men, high SEP was associated with overweight and abdominal obesity, but the magnitude of socioeconomic differences in obesity measures generally remained unchanged during the study period. Among women, low SEP was associated with overweight. Interestingly, increasing inequalities in abdominal obesity according to education and income were found in women. CONCLUSIONS Clear gender differences were noted in (1) time trends of overweight and abdominal obesity, (2) relationships between the obesity measures and various SEP indicators, and (3) linear time trends of socioeconomic differentials in obesity.
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Tamayo T, Christian H, Rathmann W. Impact of early psychosocial factors (childhood socioeconomic factors and adversities) on future risk of type 2 diabetes, metabolic disturbances and obesity: a systematic review. BMC Public Health 2010; 10:525. [PMID: 20809937 PMCID: PMC2940917 DOI: 10.1186/1471-2458-10-525] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 09/01/2010] [Indexed: 12/10/2023] Open
Abstract
Background Psychological factors and socioeconomic status (SES) have a notable impact on health disparities, including type 2 diabetes risk. However, the link between childhood psychosocial factors, such as childhood adversities or parental SES, and metabolic disturbances is less well established. In addition, the lifetime perspective including adult socioeconomic factors remains of further interest. We carried out a systematic review with the main question if there is evidence in population- or community-based studies that childhood adversities (like neglect, traumata and deprivation) have considerable impact on type 2 diabetes incidence and other metabolic disturbances. Also, parental SES was included in the search as risk factor for both, diabetes and adverse childhood experiences. Finally, we assumed that obesity might be a mediator for the association of childhood adversities with diabetes incidence. Therefore, we carried out a second review on obesity, applying a similar search strategy. Methods Two systematic reviews were carried out. Longitudinal, population- or community-based studies were included if they contained data on psychosocial factors in childhood and either diabetes incidence or obesity risk. Results We included ten studies comprising a total of 200,381 individuals. Eight out of ten studies indicated that low parental status was associated with type 2 diabetes incidence or the development of metabolic abnormalities. Adjustment for adult SES and obesity tended to attenuate the childhood SES-attributable risk but the association remained. For obesity, eleven studies were included with a total sample size of 70,420 participants. Four out of eleven studies observed an independent association of low childhood SES on the risk for overweight and obesity later in life. Conclusions Taken together, there is evidence that childhood SES is associated with type 2 diabetes and obesity in later life. The database on the role of psychological factors such as traumata and childhood adversities for the future risk of type 2 diabetes or obesity is too small to draw conclusions. Thus, more population-based longitudinal studies and international standards to assess psychosocial factors are needed to clarify the mechanisms leading to the observed health disparities.
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Affiliation(s)
- Teresa Tamayo
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.
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Risk factors for overweight and obesity among Thai adults: results of the National Thai Food Consumption Survey. Nutrients 2010; 2:60-74. [PMID: 22253992 PMCID: PMC3257614 DOI: 10.3390/nu20100060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 01/19/2010] [Indexed: 01/02/2023] Open
Abstract
We evaluated the associations between overweight and obesity and socio-economic status (SES), behavioral factors, and dietary intake in Thai adults. A nationally representative sample of 6,445 Thais adults (18-70 years) was surveyed during 2004-2005. Information including demographics, SES characteristics, dietary intake, and anthropometrics were obtained. Overall, 35.0% of men, and 44.9% of women were overweight or obese (BMI ≥ 23 kg/m2) using the Asian cut-points. Regression models demonstrated that age was positively associated with being overweight in both genders. In gender-stratified analyses, male respondents who were older, lived in urban areas, had higher annual household income, and did not smoke were more likely to be classified as overweight and obese. Women who were older, had higher education, were not in a marriage-like relationship and were in semi-professional occupation were at greater risk for being overweight and obese. High carbohydrate and protein intake were found to be positively associated with BMI whereas the frequent use of dairy foods was found to be negatively associated with BMI among men. The present study found that SES factors are associated with being classified as overweight and obese in Thai adults, but associations were different between genders. Health promotion strategies regarding obesity and its related co-morbidity are necessary.
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Risk Factors for Overweight and Obesity among Thai Adults: Results of the National Thai Food Consumption Survey. Nutrients 2010. [DOI: 10.3390/nu2010060] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Trasande L, Cronk C, Durkin M, Weiss M, Schoeller D, Gall E, Hewitt J, Carrel A, Landrigan P, Gillman M. Environment and Obesity in the National Children's Study. CIENCIA & SAUDE COLETIVA 2010; 15:195-210. [DOI: 10.1590/s1413-81232010000100025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 09/11/2008] [Indexed: 11/21/2022] Open
Abstract
We describe the approach taken by the National Children's Study (NCS) to understanding the role of environmental factors in the development of obesity. We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis. Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of factors in the modern built environment and chemical exposures that may have the capacity to disrupt the link between energy intake and expenditure. Through its embrace of the life-course approach to epidemiology, the NCS will be able to study the origins of obesity from preconception through late adolescence, including factors ranging from genetic inheritance to individual behaviors to the social, built, and natural environment and chemical exposures. It will have sufficient statistical power to examine interactions among these multiple influences, including geneenvironment and geneobesity interactions. A major secondary benefit will derive from the banking of specimens for future analysis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Philip Landrigan
- Mount Sinai School of Medicine, USA; Mount Sinai School of Medicine
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Pouliou T, Elliott SJ. Individual and socio-environmental determinants of overweight and obesity in Urban Canada. Health Place 2009; 16:389-98. [PMID: 20022286 DOI: 10.1016/j.healthplace.2009.11.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 11/13/2009] [Accepted: 11/18/2009] [Indexed: 11/28/2022]
Abstract
Overweight/obesity represent a significant public health problem in Canada and abroad. The objective of this paper is to identify potential associations between overweight/obesity and individual as well as socio-environmental determinants. The data sources used are the 2003 Canadian Community Health Survey and the Desktop Mapping Technologies Incorporated database. Geographical Information Systems are first employed to create neighbourhood-level variables such as neighbourhood walkability and fast food accessibility. Multivariate analysis is then applied to estimate the relative effects of individual- and neighbourhood-level risk-factors of overweight/obesity. Results demonstrate the important role of the built-environment after adjustment for demographic, socio-economic and behavioural characteristics. Findings support the rationale that reversing current trends will require a multifaceted public health approach where interventions are developed from the individual- to the neighbourhood-level, with a particular focus on altering obesogenic environments.
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Affiliation(s)
- Theodora Pouliou
- School of Geography and Earth Sciences, McMaster University, Hamilton, ON, Canada.
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Goh YY, Bogart LM, Sipple-Asher BK, Uyeda K, Hawes-Dawson J, Olarita-Dhungana J, Ryan GW, Schuster MA. Using community-based participatory research to identify potential interventions to overcome barriers to adolescents' healthy eating and physical activity. J Behav Med 2009; 32:491-502. [PMID: 19544091 PMCID: PMC2863037 DOI: 10.1007/s10865-009-9220-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
Abstract
Using a community-based participatory research approach, we explored adolescent, parent, and community stakeholder perspectives on barriers to healthy eating and physical activity, and intervention ideas to address adolescent obesity. We conducted 14 adolescent focus groups (n = 119), 8 parent focus groups (n = 63), and 28 interviews with community members (i.e., local experts knowledgeable about youth nutrition and physical activity). Participants described ecological and psychosocial barriers in neighborhoods (e.g., lack of accessible nutritious food), in schools (e.g., poor quality of physical education), at home (e.g., sedentary lifestyle), and at the individual level (e.g., lack of nutrition knowledge). Participants proposed interventions such as nutrition classes for families, addition of healthy school food options that appeal to students, and non-competitive physical education activities. Participants supported health education delivered by students. Findings demonstrate that community-based participatory research is useful for revealing potentially feasible interventions that are acceptable to community members.
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Affiliation(s)
- Ying-Ying Goh
- Robert Wood Johnson Clinical Scholars Program, Department of Pediatrics, UCLA School of Medicine, Los Angeles, CA, USA
| | - Laura M. Bogart
- RAND Corporation, Santa Monica, CA, USA; Division of General Pediatrics, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA
| | | | - Kimberly Uyeda
- Los Angeles Unified School District, Los Angeles, CA, USA
| | | | | | | | - Mark A. Schuster
- RAND Corporation, Santa Monica, CA, USA; Division of General Pediatrics, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA
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Abstract
Obesity and overweight are linked to a wide range of medical conditions, such as hypertension, diabetes mellitus, osteoarthritis, obstructive sleep apnea, and coronary artery disease. Overweight and obese patients who are unable to lose weight with diet alone can benefit from well-structured exercise. Potentially, an individual exercise prescription can become one of the most important components of an obesity treatment program, along with an appropriate diet. Short-term (<6 months of duration) interventions consisting of exercise combined with appropriate diet and counseling can produce a significant weight loss. No consensus exists on the amount of physical activity necessary to maintain the weight loss achieved during a short-term intervention. Long-term intervention is frequently influenced by weight regain related to complex interactions between physiologic and psychosocial factors.
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Affiliation(s)
- Douglas M Okay
- St. Francis Family Medicine Residency Program, 13450 Hull Street Road, Midlothian, VA 23112, USA.
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Association of socioeconomic status with overall overweight and central obesity in men and women: the French Nutrition and Health Survey 2006. BMC Public Health 2009; 9:215. [PMID: 19573222 PMCID: PMC2714511 DOI: 10.1186/1471-2458-9-215] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 07/02/2009] [Indexed: 11/22/2022] Open
Abstract
Background Identification of subpopulations at high risk of overweight and obesity is crucial for prevention and management of obesity in different socioeconomic status (SES) categories. The objective of the study was to describe disparities in the prevalence of overweight and obesity across socioeconomic status (SES) groups in 18–74 year-old French adults. Methods Analyses were based on a multistage stratified random sample of non-institutionalized adults aged 18–74-years-old from the French Nutrition and Health Survey (ENNS), a cross-sectional national survey carried out in 2006/2007. Collected data included measured anthropometry (weight, height and waist circumference (WC)), demographic and SES data (occupation, education and frequency of holiday trips as a marker of family income). SES factors associated with overweight (BMI ≥ 25) and central obesity (WC above gender-specific references) were identified using multiple logistic regression. Results Almost half (49.3%) of French adults were overweight or obese and 16.9% were obese. In men, the risk of overall overweight or obesity was associated with occupation (p < 0.05), whereas the risk of central obesity was independently associated with occupation (p < 0.05) and frequency of holiday trips (p < 0.01). In women, both overall and central overweight and obesity were independently associated with educational level (respectively p < 10-3 and p < 10-3) and frequency of holiday trips (respectively p < 0.05 and p < 10-3). Conclusion The prevalence of overweight and obesity was found to be similar to that of several neighbouring western European countries, and lower than the UK and eastern Europe. Risk of being overweight or obese varied across SES groups both in men and women, but associations were different between men and women, indicating differing determinants.
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Reither EN, Hauser RM, Swallen KC. Predicting adult health and mortality from adolescent facial characteristics in yearbook photographs. Demography 2009; 46:27-41. [PMID: 19348107 DOI: 10.1353/dem.0.0037] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Several important longitudinal studies in the social sciences have omitted biomarkers that are routinely recorded today, including height and weight. To account for this shortcoming in the Wisconsin Longitudinal Study (WLS), an 11-point scale was developed to code high school senior class yearbook photographs of WLS participants for relative body mass (RBM). Our analyses show that although imperfect, the RBM scale is reliable (alpha = .91) and meets several criteria of validity as a measure of body mass. Measured at ages 17-18, the standardized relative body mass index (SRBMI) was moderately correlated (r = .31) with body mass index (BMI) at ages 53-54 and with maximum BMI reported between ages 16 and 30 (r = .48). Overweight adolescents (> or = 90th percentile of SRBMI) were about three times more likely than healthy-weight adolescents (10th-80th percentile of SRBMI) to be obese in adulthood and, as a likely consequence, significantly more likely to report health problems such as chest pain and diabetes. Overweight adolescents also suffered a twofold risk of premature death from all nonaccidental causes as well as a fourfold risk of heart disease mortality. The RBM scale has removed a serious obstacle to obesity research and lifelong analyses of health in the WLS. We suggest that other longitudinal studies may also be able to obtain photos of participants at younger ages and thus gain a prospectively useful substitute for direct measures of body mass.
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Affiliation(s)
- Eric N Reither
- Population Research Laboratory and Department of Sociology, Social Work and Anthropology, Utah State University, Logan, UT 84322, USA.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, Yale University, New Haven, Connecticut, USA.
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Salsberry PJ, Reagan PB. Comparing the influence of childhood and adult economic status on midlife obesity in Mexican American, white, and African American women. Public Health Nurs 2009; 26:14-22. [PMID: 19154189 DOI: 10.1111/j.1525-1446.2008.00751.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This research addresses the following 2 questions. What is the effect of childhood and adult economic status on midlife obesity in Mexican American women? How do these economic patterns in Mexican American women compare with patterns seen in White women and in African American women? METHOD Data were drawn from the U.S. National Longitudinal Survey of Youths 1979-2002 waves. The sample consisted of 422 Mexican Americans, 2,090 Whites, and 1,195 African Americans. The economic indicator used for childhood economic status was parent education; for adult economic status, the participant's own education and adult per capita income were used. Unadjusted and adjusted odds ratios were estimated for the relationship between midlife obesity and economic indicator, stratified by race/ethnic group. RESULTS There was an increased risk for midlife obesity with disadvantaged economic status measured during childhood and at midlife in Mexican American women. The economic effects on midlife obesity in Mexican American women were similar to those found for White, but not African American women. Few economic influences on obesity at midlife were found for African American women. CONCLUSIONS Strategies that broadly improve the economic conditions of Mexican American women may be one important way to address the obesity epidemic in this population.
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Trasande L, Cronk C, Durkin M, Weiss M, Schoeller DA, Gall EA, Hewitt JB, Carrel AL, Landrigan PJ, Gillman MW. Environment and obesity in the National Children's Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:159-66. [PMID: 19270782 PMCID: PMC2649214 DOI: 10.1289/ehp.11839] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Accepted: 09/11/2008] [Indexed: 05/18/2023]
Abstract
OBJECTIVE In this review we describe the approach taken by the National Children's Study (NCS), a 21-year prospective study of 100,000 American children, to understanding the role of environmental factors in the development of obesity. DATA SOURCES AND EXTRACTION We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis. DATA SYNTHESIS Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of factors in the modern built environment and chemical exposures that may have the capacity to disrupt the link between energy intake and expenditure. The NCS is the largest prospective birth cohort study ever undertaken in the United States that is explicitly designed to seek information on the environmental causes of pediatric disease. CONCLUSIONS Through its embrace of the life-course approach to epidemiology, the NCS will be able to study the origins of obesity from preconception through late adolescence, including factors ranging from genetic inheritance to individual behaviors to the social, built, and natural environment and chemical exposures. It will have sufficient statistical power to examine interactions among these multiple influences, including gene-environment and gene-obesity interactions. A major secondary benefit will derive from the banking of specimens for future analysis.
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Affiliation(s)
- Leonardo Trasande
- Department of Community and Preventive Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1043, New York, NY 10029 USA.
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