Influence of parental education, childhood adversities, and current living conditions on daily smoking in early adulthood

Association of somatic comorbidity and treatment adherence in patients with psychotic disorder

BACKGROUND

Increased risk for somatic comorbidity in individuals with schizophrenia has been well established. In addition, psychiatric patients with somatic illnesses are more likely to have more psychiatric readmissions. Increased burden of treatment related to chronic somatic comorbidities may be associated with lower adherence to psychiatric medication.

METHODS

Cross-sectional study of 275 patients with schizophrenia spectrum disorder. A general practitioner performed a complete physical health checkup for all participants, including a complete medical examination and laboratory tests. Patients' adherence, attitudes, insight, and side-effects were evaluated using the Attitudes toward Neuroleptic Treatment Scale. Overall symptomatology was measured using the Brief Psychiatric Rating Scale. Regression analysis was used to investigate interactions and associations among health beliefs, disease burden, and treatment adherence. Separate regression models were utilized to account for the complexity of health behavior and treatment adherence pathways.

RESULTS

Patients' somatic comorbidity and health behavior were not associated with adherence or attitudes toward antipsychotic treatment. High dose of antipsychotics and obesity were related to the need for medical interventions, while a healthy diet reduced the risk. Higher BPRS score and older age were associated with having somatic symptoms. Somatic comorbidities had no negative effects on treatment adherence or attitudes.

CONCLUSION

This study focuses on exploring possible associations between health beliefs and treatment adherence pathways in patients with psychotic disorders. Contrary to our hypotheses, we found no evidence to support our health belief and diseases burden models and their associations.

Changed health behavior improves subjective well-being and vice versa in a follow-up of 9 years

Background

Previous research on health behavior and subjective well-being has mainly focused on interindividual differences or explored certain domains of health behavior. Good health behavior and subjective well-being at baseline can predict each other after a follow-up. In the present cohort study, we explored the outcomes of change for an individual i.e., how changed health behavior is reflected in subsequent subjective well-being and vice versa.

Methods

Data (n = 10,855) originates from a population-based Health and Social Support (HeSSup) study on working-age Finns in 2003 and 2012. A composite measure of health behavior included physical activity, dietary habits, alcohol consumption, and smoking status (range 0–4, worst–best) and a composite measure of subjective well-being (with reversed scoring) included three life assessments, i.e., interest, happiness, and ease in life, and perceived loneliness (range 4–20, best–worst). Different multiple linear regression models were used to study how changes in health behavior predict subjective well-being and the opposite, how changes in subjective well-being predict health behavior.

Results

A positive change in health behavior from 2003 to 2012 predicted better subjective well-being (i.e., on average 0.31 points lower subjective well-being sum score), whereas a negative change predicted poorer subjective well-being (i.e., 0.37 points higher subjective well-being sum score) (both: p < 0.001) compared to those study subjects who had no change in health behavior. Similarly, when a positive and negative change in subjective well-being was studied, these figures were 0.071 points better and 0.072 points worse (both: p < 0.001) health behavior sum score, respectively. When the magnitude of the effect of change was compared to the range of scale of the outcome the effect of health behavior change appeared stronger than that of subjective well-being.

Conclusion

Changes in health behavior and subjective well-being have long-term effects on the level of the other, the effect of the first being slightly stronger than vice versa. These mutual long-term benefits can be used as a motivator in health promotion on individual and societal levels.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-01972-4.

Associations of adverse childhood experiences with smoking initiation in adolescence and persistence in adulthood, and the role of the childhood environment: Findings from the 1958 British birth cohort

Adverse childhood experiences (ACEs) have been identified as a strong determinant of smoking. We aimed to examine the association between ACEs and early smoking initiation and subsequent persistence and the contribution of five pathways including family factors, parental involvement, material living conditions, social activities and conscientiousness. Data are from 7414 individuals born in 1958 in Great Britain included in the National Child Development Study. ACEs were measured at ages 7, 11, and 16. Smoking initiation was derived from smoking variables from ages 16 to 42 and persistent smoking was derived from smoking variables from ages 23 to 42. We modelled the relationship between ACEs and smoking, and further assessed the contribution of each pathway using multinomial logistic regressions. During childhood, 20.9% of respondents experienced one ACE and 6.4% two or more. Those who experienced ACEs had a higher risk of initiating smoking by age 16 and of persistent smoking (RRR _{initiation by 16y} = 1.89 [1.62; 2.20] for one ACE; RRR _{initiation by 16y} = 2.36 [1.81; 3.08] for two or more ACEs, and RRR _{persistent smoking} = 2.07 [1.73; 2.47] for one ACE, RRR _{persistent smoking} = 2.59 [1.92; 3.49] for two or more ACEs). The factors that contributed most to explaining these associations were parental smoking, sibling order and conscientiousness. ACEs remained associated with persistent smoking after further adjusting for young adulthood variables. Smoking prevention measures may need to be tailored when considering adolescents from communities where ACEs are more prevalent to curtail initiation, intensity and persistence. FUNDING: This work was supported by the Institut National du Cancer & the Institut de recherche en santé publique (grant agreement: No. [2019-204]).

Life-Course Influence of Adolescent Behaviour Problems on Type 2 Diabetes in Midlife: Results from 1958 British Birth Cohort Study

PURPOSE

To assess whether there is a long-term relationship between childhood behaviour problems and type 2 diabetes in midlife. The study will also investigate whether any of such relationship is independent of other factors which may be associated with type 2 diabetes.

DESIGN

Cohort study.

PARTICIPANTS

A total of 9377 members of the 1958 British birth cohort participated in the biomedical survey at age 45 years. The cohort has been followed up at regular intervals in childhood (age 7, 11 and 16 years) and adulthood (23, 33, 42 and 45 years).

PREDICTOR VARIABLES

Information regarding childhood behaviour collected during follow-ups at ages 7, 11 and 16 years.

MAIN OUTCOME VARIABLES

Type 2 diabetes assessed using HbA1c at age 45 years.

RESULTS

Unadjusted estimates show that teachers reported adolescent behaviour problems at age of 16 are associated with increased risk of type 2 diabetes in midlife. After adjustment for potential confounders and mediators in childhood and adulthood, a relationship was observed between the severity of adolescent behaviour problems and type 2 diabetes risk in midlife (mild behaviour problems: OR 2.17, 95% CI 1.11-4.23; severe behaviour problems: OR 4.40, 95% CI 1.14-16.99). However, no such relationship was observed between behaviour problems at 7 and 11 years and type 2 diabetes in midlife.

CONCLUSION

There is an association between adolescent behaviour problems and an increased risk of type 2 diabetes in midlife. Further molecular/genetic studies are required to understand the biological basis for this observed association.

Impact of Individual, Familial and Parental Factors on Adolescent Smoking in Turkey

The burden of adolescent cigarette smoking is substantial. We assess mothers’ and fathers’ attitudes and behaviours on adolescent smoking using a cross-sectional study of n = 707 adolescents. Associations between parental attitudes and behaviours in adolescent smoking were assessed using logistic regression separately for boys and girls. Occasional alcohol use by both parents increased odds of smoking once a day (OR = 2.44, 95% CI 1.26, 4.71, OR = 1.51, 95% CI 0.97, 2.35, respectively). Fathers smoking increased odds for girls (OR = 1.59, 95% CI 1.01, 2.52). A democratic mother decreased odds for boys (OR = 0.32, 95% CI 0.10, 0.93) whereas a protective, demanding mother increased the odds for girls (OR = 8.65, 95% CI 1.38, 54.22). Public health smoking prevention programs could support changing parental behaviours and attitudes in early years to address this burden in countries with authoritarian parenting styles.

Parental divorce and offspring smoking and alcohol use: a systematic review and meta-analysis of observational studies

OBJECTIVE

This study was conducted to investigate the relationship between parental divorce and smoking and alcohol consumption in offspring, which is based on a systematic review method and ultimately meta-analysis. Method: In a systematic search, three databases were selected. The manuscripts were searched based on the keywords and the time limit for the search was published manuscripts in English until November 2020. For the relationship between parental divorce and smoking/alcohol use in offspring, one main analysis, and four analyses based on sex, study design, adjusted level, and continents were performed. Result: Forty-three studies were synthesized from the collection of manuscripts. The odds of smoking in offspring whose parents were separated was 1.45 (CI 1.37-1.54) and this odds in men was equal to 1.38 (CI 1.11-1.71; Z = 2.91; p = 0.004; I² = 81.5%) and in women, 1.78 (CI 1.51-2.10; Z = 6.88; p < 0.001; I² = 69.6%). The odds of alcohol use in offspring whose parents were separated was 1.43 (CI 1.15-1.77) and this odds in men was equal to 1.69 (CI 1.16-2.47; Z = 2.73; p = 0.006; I² = 99.6%) and in women 1.79 (CI 1.07-2.99). Discussion: The findings of the present study can be used in health-related policies, prevention, and clinical interventions. This study was a subject with limitations, also.

Prevalence and factors associated with smoking among Tunisian secondary school-adolescents

OBJECTIVES

This study aimed to estimate the extent of smoking experience among high and middle school adolescents in Southern Tunisia and to delineate its potential associated factors.

METHODS

We conducted a cross-sectional study among middle and high school-adolescents in the governorate of Sfax, South of Tunisia in the 2017-2018 school-years. A questionnaire was anonymously administered to a representative sample of 1,210 school-adolescents randomly drawn.

RESULTS

The mean age of the school-adolescents was 15.6 ± 4.2 years. The prevalence of lifetime smoking was 16.7% (95% CI=[14.7-18.8%]) (boys 32.6%; girls 5.9%;p<0.001). Among the respondents, 13.9% (95% CI=[11.9-15.8%]) were current smokers. In multivariate logistic regression analysis, independent associated factors of current smoking were male gender (Adjusted (AOR)=10.2; p<0.001), 16-17 and 18-19-year age-groups (AOR=2; p=0.005 and AOR=2.6; p=0.001, respectively), below average academic performance (AOR=5.2; p=0.012), divorced parents (AOR=3.9; p=0.007), family monthly income ≥800 dollars (AOR=2.1; p=0.001), having a part time job (AOR=3.9; p<0.001) and a perceived high stress level (AOR=1.98; p=0.008). Secondhand smoke (AOR=1.8; p=0.011) and concomitant alcohol drink (AOR=14.56; p<0.001) were independent predictors of current smoking, while high education level of the father was independently associated with lower prevalence of current smoking (AOR=0.17; p<0.001).

CONCLUSION

The prevalence of lifetime and current smoking were relatively high in Southern Tunisian middle and high schools. Multilevel influences on youth smoking behavior had been identified, which reflected the need to conceive appropriate school interventions and effective antismoking education program.

School learning climate in the lens of parental involvement and school leadership: lessons for inclusiveness among public schools

Prior literature has shown that school learning climate is critical in helping individual learners meet their educational objectives. In this paper, the role of parental involvement in shaping the school learning climate is explored within a multilevel and hierarchical modeling framework using data from the 2015 PISA round.

As the schools’ social and relational character, we find that reducing learning barriers is a critical challenge for school leadership. A welcoming environment for parents, as well as the effective design of effective forms of two-way communications, are positively associated with a substantial reduction in the barriers to improving teacher management’s learning climate.

We also find that public schools facing social and educational inclusiveness challenges can dramatically enhance their learning environment by activating specific parental involvement mechanisms. Similarly, principal’s leadership in framing and communicating goals and curricular development to the school is also found to be significant for inclusiveness.

However, parental involvement is also found to have potential tensions with school management. The worsening of the learning climate may arise due to pressures brought about by laws requiring parental involvement in schools. Because the learning climate is composed of a wide variety of relationships between and within schools, this work demonstrates that parental involvement is an integral part of school leadership and the school improvement process. Further research attention is encouraged to understand the tensions between teacher roles, principal leadership, and parental involvement through employing other quantitative or qualitative research designs.

Unravelling the relationship between parental resources and disability pension in young adulthood

A vast literature exists on the relationship between family background and health outcomes. However, there is a shortage of evidence on the relationship between parental resources and offsprings' disability pension, a severe form of general poor health and functionability. This article analyses how parental income and education are associated with offsprings' disability pension in young adulthood (19-27 years) among 1980-1985 birth cohorts using Finnish register data. The results of discrete-time event history analysis demonstrate that parental income and education have contrasting impacts. High parental income is found to decrease, and parental education to increase, the probability of offspring having disability pension, although mainly among offspring with compulsory education. Further, young adults with high parental resources are better off two years after their first disability pension. We conclude that the influence of parental resources operates via offsprings' educational attainment but also has divergent direct impacts on offsprings' disability pension.

Adverse Childhood Experiences, Early and Nonmarital Fertility, and Women's Health at Midlife

Adverse childhood experiences (ACEs) have powerful consequences for health and well-being throughout the life course. We draw on evidence that exposure to ACEs shapes developmental processes central to emotional regulation, impulsivity, and the formation of secure intimate ties to posit that ACEs shape the timing and context of childbearing, which in turn partially mediate the well-established effect of ACEs on women's later-life health. Analysis of 25 years of nationally representative panel data from the National Longitudinal Study of Youth (NLSY79; n = 3,893) indicates that adverse childhood experiences predict earlier age at first birth and greater odds of having a nonmarital first birth. Age and marital status at first birth partially mediate the effect of ACEs on women's health at midlife. Implications for public health and family policy aimed at improving maternal and child well-being are discussed.

Association between adverse childhood experiences and adult diseases in older adults: a comparative cross-sectional study in Japan and Finland

OBJECTIVE

We aimed to examine the association between adverse childhood experiences (ACEs) and diseases in older adults in Japan and Finland.

DESIGN

Cross-sectional comparative study.

SETTING

Data from a gerontological study in Japan and two public health studies in Finland were evaluated.

PARTICIPANTS

A total of 13 123 adults (mean age, 69.5 years) from Japan and 10 353 adults (mean age, 64.4 years) from Finland were included in this study. Logistic regression was used to examine the association of each of, any of and the cumulative number of ACEs (parental divorce, fear of a family member and poverty in childhood; treated as ordered categorical variables) with poor self-rated health (SRH), cancer, heart disease or stroke, diabetes mellitus, smoking and body mass index. Models were adjusted for sex, age, education, marital status and working status.

RESULTS

Of the respondents, 50% of those in Japan and 37% of those in Finland reported having experienced at least one of the measured ACEs. Number of ACEs was associated with poor SRH in both countries, and the point estimates were similar (OR: 1.35, 95% CI: 1.25 to 1.46 in Japan; OR: 1.34, 95% CI: 1.27 to 1.41 in Finland). Number of ACEs was associated with the prevalence of cancer, heart disease or stroke, diabetes mellitus, current smoking and an increase in body mass index in both countries.

CONCLUSIONS

The association between ACEs and poor SRH, adult diseases and health behaviours was similar among older adults in both Japan and Finland. This international comparative study suggests that the impact of ACEs on health is noteworthy and consistent across cultural and social environments.

Parental separation/divorce in childhood and tobacco smoking in adulthood: A population-based study

Aims: The aim was to investigate associations between the experience of parental separation/divorce in childhood and tobacco smoking in adulthood, adjusting for economic stress in childhood and adulthood and psychological health (General Health Questionnaire GHQ12). Methods: The 2012 public-health survey in Skåne, southern Sweden, is a cross-sectional postal questionnaire population-based study with 28,029 participants aged 18-80 (51.7% response rate). Associations between parental separation/divorce in childhood and tobacco smoking were investigated in multiple logistic regression models, with adjustments for economic stress in childhood and adulthood and psychological health. Results: A 17.6% weighted prevalence of men and 17.1% of women reported tobacco smoking. Significantly higher odds ratios of tobacco smoking were observed for men who had experienced parental separation/divorce in childhood at ages 0-4, 5-9 and 15-18 years and for women with this experience in childhood at ages 0-4, 5-9, 10-14 and 15-18 years, even after inclusion of economic stress in childhood in the final multiple models. No effect modification was observed for parental separation and psychological health and for parental separation and economic stress in childhood with regard to smoking. Conclusions: Experience of parental separation/divorce in childhood was significantly associated with tobacco smoking in adulthood for both sexes. There seems to be no specific critical period.

Socioeconomic position over the life course from childhood and smoking status in mid-adulthood: results from a 25-year follow-up study

Background

It remains unclear how life course socioeconomic position (SEP) variations impact later smoking status. We aimed to investigate the associations using a novel methodology – a structured regression framework and to explore the potential underlying mechanisms.

Methods

Data were from an Australian national cohort (n = 1489). SEP was measured in childhood (aged 7–15 years), young- (aged 26–36 years) and mid-adulthood (aged 31–41 years), including highest parental occupation in childhood and self-occupation in young- and mid-adulthood. Smoking status was self-reported in mid-adulthood. Four smoking-related variables in childhood including exposure to parental smoking, smoking experimentation, self-rated importance to be a non-smoker and intention to smoke were tested as potential mediators. A structured life course modelling approach was used to select the best-fit life course model(s). The log multinomial model was used to estimate the smoking risk in mid-adulthood with never smokers as the excluded category.

Results

63.6% of participants were classified as stable non-manual occupation across the life course from childhood. The sensitive period and the accumulation model described the data equally as well as the saturated model. In the sensitive period model, compared to the non-manual group, those who had highest parental occupation of manual had a 21% lower risk of being former smokers and a 32% greater risk of being current smokers in mid-adulthood, and those who were occupied manually in mid-adulthood reported a 55% greater risk of being current smokers in mid-adulthood. In the accumulation model, compared to those who consistently reported non-manual occupations across the life course, those with manual occupations for longer had higher risk of being current smokers in mid-adulthood, with a 43% risk increase per time point in a manual occupation. Exposure to parental smoking and intention to smoke during childhood explained up to 40.2% of the excess risk of being current smokers in mid-adulthood associated with manual occupations in the sensitive period and the accumulation model.

Conclusions

Childhood, young- and mid-adulthood are all important, but SEP in childhood and mid-adulthood may be of more importance in determining mid-adulthood smoking status. Exposure to parental smoking and intention to smoke in childhood seems to moderately mediate the associations.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6483-0) contains supplementary material, which is available to authorized users.

Education is the strongest socio-economic predictor of smoking in pregnancy

AIMS

To investigate socio-economic disparities in smoking in pregnancy (SIP) by the mother's education, occupational class and current economic conditions.

DESIGN

Cross-sectional analysis with linked survey and register data.

SETTING

South-western Finland.

PARTICIPANTS

A total of 2667 pregnant women [70% of the original sample (n = 3808)] from FinnBrain, a prospective pregnancy cohort study.

MEASUREMENTS

The outcome was smoking during the first pregnancy trimester, measured from the Finnish Medical Birth Register. Education and occupational class were linked from population registers. Income support recipiency and subjective economic wellbeing were questionnaire-based measures of current economic conditions. These were adjusted for age, partnership status, residential area type, parental separation, parity, childhood socio-economic background, childhood adversities (the Trauma and Distressing Events During Childhood scale) and antenatal stress (Edinburgh Postnatal Depression Scale). Logistic regressions and attributable fractions (AF) were estimated.

FINDINGS

Mother's education was the strongest socio-economic predictor of SIP. Compared with university education, adjusted odds ratios (aORs) of SIP were: 2.2 [95% confidence interval (CI) = 1.2-3.9; P = 0.011] for tertiary vocational education, 4.4 (95% CI = 2.1-9.0; P < 0.001) for combined general and vocational secondary education, 2.9 (95% CI = 1.4-6.1; P = 0.006) for general secondary education, 9.5 (95% CI 5.0-18.2; P < 0.001) for vocational secondary education and 14.4 (95% CI = 6.3-33.0; P < 0.001) for compulsory schooling. The total AF of education was 0.5. Adjusted for the other variables, occupational class and subjective economic wellbeing did not predict SIP. Income support recipiency was associated positively with SIP (aOR = 1.8; 95% CI = 1.1-3.1; P = 0.022). Antenatal stress predicted SIP (aOR = 2.0; 95% CI = 1.4-2.8; P < 0.001), but did not attenuate its socio-economic disparities.

CONCLUSIONS

In Finland, socio-economic disparities in smoking in pregnancy are attributable primarily to differences in the mother's educational level (low versus high) and orientation (vocational versus general).

Childhood adversities and clinical symptomatology in first-episode psychosis

In addition to severe traumatic experiences, milder, more common childhood adversities reflecting psychosocial burden may also be common in people with psychotic disorders and have an effect on symptomatology and functioning. We explored eleven negative childhood experiences and their influence on clinical symptoms among young adults with first-episode psychosis (FEP, n = 75) and matched population controls (n = 51). Individuals with FEP reported more adversities than controls. Specifically serious conflicts within the family, bullying at school, maternal mental health problems, and one's own and parents' serious illness during childhood were experienced by the patients more often than by controls. In the FEP group, the severity of adversity was associated with increased anxiety, manic, and obsessive-compulsive symptoms, but not with the severity of positive psychotic symptoms. Adversity produced a more pronounced effect on symptoms in male patients than in female patients. To conclude, in line with earlier studies of more chronic psychosis, a majority of the participants with FEP reported exposure to childhood adversities, with the FEP group reporting more adversities than controls. High levels of mood and anxiety symptoms in patients with FEP may be related to cumulative exposure to childhood adversities. This should be taken into account in the treatment for FEP.

Factors across the life course predict women's change in smoking behaviour during pregnancy and in midlife: results from the National Child Development Study

BACKGROUND

Tobacco smoking before, during and after pregnancy remains one of the few preventable factors associated with poor health outcomes for mothers and their children. We investigate predictors across the life course for change in smoking behaviour during pregnancy and whether this change predicts smoking status in midlife.

METHODS

Data were from the National Child Development Study (1958 British birth cohort). We included female cohort members who reported a first pregnancy up to age 33 years. Among 1468 women who smoked before pregnancy, we examined predictors reported in childhood (age 11 years), adolescence (age 16 years) and early adulthood (age 23 years) of change in smoking behaviour from 12 months before to during pregnancy using log-binomial regression. The association between change in smoking behaviour during pregnancy and smoking status in midlife (age 55 years) was examined while adjusting for predictors across the life course.

RESULTS

Among prepregnancy smokers (39%), 26% reduced and 35% quit smoking during pregnancy. Parental smoking and lower social class during childhood, and early adulthood lower social class, depression, early smoking initiation, high smoking intensity, living with a smoker, no pregnancy planning and early motherhood were associated with lower probability of smoking reduction or cessation in pregnancy. Compared with women who smoked before and during pregnancy, women who reduced or quit were two times more likely to be non-smoker at age 55 years (95% CI 1.76 to 2.20).

CONCLUSIONS

Findings from this population-based birth cohort study lend support for smoking cessation strategies that target those at risk at various stages across the life course.

Confounding and Statistical Significance of Indirect Effects: Childhood Adversity, Education, Smoking, and Anxious and Depressive Symptomatology

The life course perspective, the risky families model, and stress-and-coping models provide the rationale for assessing the role of smoking as a mediator in the association between childhood adversity and anxious and depressive symptomatology (ADS) in adulthood. However, no previous study has assessed the independent mediating role of smoking in the association between childhood adversity and ADS in adulthood. Moreover, the importance of mediator-response confounding variables has rarely been demonstrated empirically in social and psychiatric epidemiology. The aim of this paper was to (i) assess the mediating role of smoking in adulthood in the association between childhood adversity and ADS in adulthood, and (ii) assess the change in estimates due to different mediator-response confounding factors (education, alcohol intake, and social support). The present analysis used data collected from 1994 to 2008 within the framework of the Tromsø Study (N = 4,530), a representative prospective cohort study of men and women. Seven childhood adversities (low mother's education, low father's education, low financial conditions, exposure to passive smoke, psychological abuse, physical abuse, and substance abuse distress) were used to create a childhood adversity score. Smoking status was measured at a mean age of 54.7 years (Tromsø IV), and ADS in adulthood was measured at a mean age of 61.7 years (Tromsø V). Mediation analysis was used to assess the indirect effect and the proportion of mediated effect (%) of childhood adversity on ADS in adulthood via smoking in adulthood. The test-retest reliability of smoking was good (Kappa: 0.67, 95% CI: 0.63; 0.71) in this sample. Childhood adversity was associated with a 10% increased risk of smoking in adulthood (Relative risk: 1.10, 95% CI: 1.03; 1.18), and both childhood adversity and smoking in adulthood were associated with greater levels of ADS in adulthood (p < 0.001). Smoking in adulthood did not significantly mediate the association between childhood adversity and ADS in adulthood. However, when education was excluded as a mediator-response confounding variable, the indirect effect of childhood adversity on ADS in adulthood was statistically significant (p < 0.05). This study shows that a careful inclusion of potential confounding variables is important when assessing mediation.

Multiple physical healthcare needs among outpatients with schizophrenia: findings from a health examination study

BACKGROUND

Despite the abundant literature on physical comorbidity, the full range of the concurrent somatic healthcare needs among individuals with schizophrenia has rarely been studied.

AIMS

This observational study aimed to assess the distressing somatic symptoms and needs for physical health interventions in outpatients with schizophrenia, and factors predicting those needs.

METHODS

A structured, comprehensive health examination was carried out, including a visit to a nurse and a general practitioner on 275 outpatients with schizophrenia. The required interventions were classified by type of disease. Logistic regression was used to assess the influence of sociodemographic factors, lifestyle, functional limitations, factors related to psychiatric disorder, and healthcare use on the need for interventions.

RESULTS

In total, 44.9% of the patients (mean age 44.9 years) reported somatic symptoms affecting daily life; 87.6% needed specific interventions for a disease or condition, most commonly for cardiovascular, dermatological, dental, ophthalmological, and gastrointestinal conditions, and for altered glucose homeostasis. Smoking and obesity predicted significantly a need of any intervention, but the predictors varied in each disease category. Strikingly, use of general practitioner services during the previous year did not reduce the need for interventions.

CONCLUSIONS

Health examinations for outpatients with schizophrenia revealed numerous physical healthcare needs. The health examinations for patients with schizophrenia should contain a medical history taking and a physical examination, in addition to basic measurements and laboratory tests. Prevention and treatment of obesity and smoking should be given priority in order to diminish somatic comorbidities in schizophrenia.

Dyspepsia and constipation in patients with schizophrenia spectrum disorders

Constipation and dyspepsia are disturbing gastrointestinal symptoms that are often ignored in research on physical comorbidities of schizophrenia. The aim was to assess dyspepsia and constipation in a sample of outpatients with schizophrenia spectrum psychoses. A general practitioner performed a thorough physical health check for 275 outpatients and diagnosed constipation and dyspepsia. This study assessed the possible contribution of several sociodemographic, lifestyle, and clinical variables to constipation and dyspepsia using logistic regression analysis. This study also assessed whether these symptoms were associated with abnormal laboratory findings. The prevalence of constipation was 31.3%, and of dyspepsia 23.6%. Paracetamol (OR =3.07, 95% CI =1.34-7.02) and clozapine use (OR =5.48, 95% CI =2.75-10.90), older age (OR =1.04, 95% CI =1.01-1.06), and living in sheltered housing (OR =2.49, 95% CI =1.16-5.33) were risk factors for constipation. For dyspepsia the risk factors were female sex (OR =2.10, 95% CI =1.15-3.83), non-steroidal anti-inflammatory drugs (OR =2.47, 95% CI =1.13-5.39), and diabetes medication (OR =2.42, 95% CI =1.12-5.25). Patients with dyspepsia had lower haemoglobin and haematocrit and higher glucose values than those without dyspepsia. Patients with constipation had lower thrombocyte values than patients without constipation. However, these findings were explained by factors pre-disposing to constipation and dyspepsia. Clozapine use markedly increases the risk of constipation and may lead to life-threatening complications. In addition, analgesics and diabetes medication were related to gastrointestinal symptoms. These medications and their association to gastrointestinal symptoms should be kept in mind when treating patients with schizophrenia.

Early Life Factors and Adult Leisure Time Physical Inactivity Stability and Change

PURPOSE

Physical inactivity has a high prevalence and associated disease burden. A better understanding of influences on sustaining and changing inactive lifestyles is needed. We aimed to establish whether leisure time inactivity was stable in midadulthood and whether early life factors were associated with inactivity patterns.

METHODS

In the 1958 British birth cohort (n = 12,271), leisure time inactivity (frequency, less than once a week) assessed at 33 and 50 yr was categorized as "never inactive," "persistently inactive," "deteriorating," or "improving." Early life factors (birth to 16 yr) were categorized into three (physical, social, and behavioral) domains. Using multinomial logistic regression, we assessed associations with inactivity persistence and change of factors within each early life domain and the three domains combined with and without adjustment for adult factors.

RESULTS

Inactivity prevalence was similar at 33 and 50 yr (approximately 31%), but 17% deteriorated and 18% improved with age. In models adjusted for all domains simultaneously, factors associated with inactivity persistence versus never inactive were prepubertal stature (8% lower risk/height SD), poor hand control/coordination (17% higher risk/increase on four-point scale), cognition (16% lower/SD in ability) (physical); parental divorce (25% higher), class at birth (7% higher/reduction on four-point scale), minimal parental education (16% higher), household amenities (2% higher/increase in 19-point score (high = poor)) (social); and inactivity (22% higher/reduction in activity on four-point scale), low sports aptitude (47% higher), smoking (30% higher) (behavioral). All except stature, parental education, sports aptitude, and smoking were associated also with inactivity deterioration. Poor hand control/coordination was the only factor associated with improved status (13% lower/increase on four-point scale) versus persistently inactive.

CONCLUSIONS

Adult leisure time inactivity is moderately stable. Early life factors are associated with persistent and deteriorating inactivity over decades in midadulthood but rarely with improvement.

Prevalence and associated factors of smoking in middle and high school students: a school-based cross-sectional study in Zhejiang Province, China

OBJECTIVES

To determine the prevalence and associated factors of smoking in a Chinese adolescent population.

SETTING

A multistage, stratified cluster sampling technique was used in the present cross-sectional study conducted in Zhejiang Province of China. Based on socioeconomic status, school levels and geographical positions, 253 middle school classes, 122 academic school classes and 115 vocational high school classes located in 12 urban areas and 18 rural areas were chosen.

PARTICIPANTS

A total of 9617 middle school students, 5495 academic high school students and 4430 vocational high school students were recruited in this survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

Ever, current smoking status and associated factors were collected via a self-administered questionnaire. Logistic regression models were used to examine the associations between current smoking and the associated factors. ORs with their 95% CIs were reported.

RESULTS

Overall, the prevalence of ever-smokers and current smokers was 33.83% and 7.93%, respectively. Focused on current smokers, significantly higher risks of adolescent smoking were observed in an older age group, boys, rural areas and vocational high school. Other significant factors were parents smoking, secondhand smoke exposure, parental divorce or separation, living with family, school performance and belief that smoking is harmful.

CONCLUSIONS

The prevalence of smoking was relatively high among Chinese adolescents in Zhejiang Province. Factors related to personal characteristics, family and school were associated with adolescent smoking.

Exposure to violence in childhood is associated with higher body mass index in adolescence

To determine whether different types of childhood adversity are associated with body mass index (BMI) in adolescence, we studied 147 adolescents aged 13-17 years, 41% of whom reported exposure to at least one adversity (maltreatment, abuse, peer victimization, or witness to community or domestic violence). We examined associations between adversity type and age- and sex-specific BMI z-scores using linear regression and overweight and obese status using logistic regression. We adjusted for potential socio-demographic, behavioral, and psychological confounders and tested for effect modification by gender. Adolescents with a history of sexual abuse, emotional abuse, or peer victimization did not have significantly different BMI z-scores than those without exposure (p>0.05 for all comparisons). BMI z-scores were higher in adolescents who had experienced physical abuse (β=0.50, 95% CI 0.12-0.91) or witnessed domestic violence (β=0.85, 95% CI 0.30-1.40). Participants who witnessed domestic violence had almost 6 times the odds of being overweight or obese (95% CI: 1.09-30.7), even after adjustment for potential confounders. No gender-by-adversity interactions were found. Exposure to violence in childhood is associated with higher adolescent BMI. This finding highlights the importance of screening for violence in pediatric practice and providing obesity prevention counseling for youth.

[Cigarette smoking initiation among Tunisian adolescents: Risk and protective factors]

BACKGROUND

Since smoking is a major public health problem among Tunisian teenagers, it is important to identify the underlying risk and protective factors associated with initiation of this behavior.

METHODS

A cross-sectional, school-based survey of students was conducted by the Tunisian Ministry of Health among a nationally representative sample of 4172 adolescents aged between 12 and 20 years attending public, private, and professional secondary schools across Tunisia who participated in the Survey of the Health of Tunisian adolescents in 2000. For data analysis, we first calculated crude odds ratios (OR) followed by calculating adjusted OR after using multivariate logistic regression models.

RESULTS

Almost one-third of respondents had already started smoking at an average age of 13 years, 6.4% among them smoked daily. Demographic vulnerabilities to smoking behavior were gender (boys more than girls), age and residence in urban areas and particularly in Greater Tunis and the North East. Familial and school factors were parental divorce, poor relationship with parents, poor integration into the peer group, and poor school investment. Psychological and behavioral factors were low self-esteem level and the occurrence of stressful life events, risk taking and alcohol consumption when there was no association with the depression, anxiety and body image. Protective factors against the experimental cigarettes were mainly sports and reading.

CONCLUSION

There are many factors associated with smoking behavior among adolescents. All of these predictors need to be considered in smoking prevention among Tunisian teenagers.

Childhood Psychosocial Adversity and Adult Neighborhood Disadvantage as Predictors of Cardiovascular Disease: A Cohort Study

BACKGROUND

Childhood adverse psychosocial factors (eg, parental divorce, long-term financial difficulties) and adult neighborhood disadvantage have both been linked to increased cardiovascular disease (CVD). However, their combined effects on disease risk are not known.

METHODS AND RESULTS

Participants were 37 699 adults from the Finnish Public Sector study whose data were linked to a national neighborhood disadvantage grid with the use of residential addresses between the years 2000 and 2008 and who responded to a survey on childhood psychosocial adversities and adult CVD risk behaviors in 2008 to 2009. Survey data were also linked to national registers on hospitalization, mortality, and prescriptions to assess CVD risk factors in 2008 to 2009 and to ascertain incident CVD (coronary heart disease or cerebrovascular disease) between the survey and the end of December 2011 (mean follow-up, 2.94 years; SD=0.44 years). Combined exposure to high childhood adversity and high adult disadvantage was associated with CVD risk factors (hypertension, dyslipidemia, diabetes mellitus, obesity, smoking, heavy alcohol use, and physical inactivity) and with a 2.25-fold (95% confidence interval, 1.39-3.63) hazard of incident CVD compared with a low childhood adversity and low adult disadvantage. This hazard ratio was attenuated by 16.6% but remained statistically significant after adjustment for the CVD risk factors (1.96; 95% confidence interval, 1.22-3.16). Exposure to high childhood adversity or high adult neighborhood disadvantage alone was not significantly associated with CVD in fully adjusted models.

CONCLUSIONS

These findings suggest that individuals with both childhood psychosocial adversity and adult neighborhood disadvantage are at an increased risk of CVD. In contrast, those with only 1 of these exposures have little or no excess risk after controlling for conventional risk factors.

Childhood adversity as a predictor of non-adherence to statin therapy in adulthood

Purpose

To investigate whether adverse experiences in childhood predict non-adherence to statin therapy in adulthood.

Methods

A cohort of 1378 women and 538 men who initiated statin therapy during 2008–2010 after responding to a survey on childhood adversities, was followed for non-adherence during the first treatment year. Log-binomial regression was used to estimate predictors of non-adherence, defined as the proportion of days covered by dispensed statin tablets <80%. In fully adjusted models including age, education, marital status, current smoking, heavy alcohol use, physical inactivity, obesity, presence of depression and cardiovascular comorbidity, the number of women ranged from 1172 to 1299 and that of men from 473 to 516, because of missing data on specific adversities and covariates.

Results

Two in three respondents reported at least one of the following six adversities in the family: divorce/separation of the parents, long-term financial difficulties, severe conflicts, frequent fear, severe illness, or alcohol problem of a family member. 51% of women and 44% of men were non-adherent. In men, the number of childhood adversities predicted an increased risk of non-adherence (risk ratio [RR] per adversity 1.11, 95% confidence interval [CI] 1.01–1.21], P for linear trend 0.013). Compared with those reporting no adversities, men reporting 3–6 adversities had a 1.44-fold risk of non-adherence (95% CI 1.12–1.85). Experiencing severe conflicts in the family (RR 1.27, 95% CI 1.03–1.57]) and frequent fear of a family member (RR 1.27, 95% CI 1.00–1.62]) in particular, predicted an increased risk of non-adherence. In women, neither the number of adversities nor any specific type of adversity predicted non-adherence.

Conclusions

Exposure to childhood adversity may predict non-adherence to preventive cardiovascular medication in men. Usefulness of information on childhood adversities in identification of adults at high risk of non-adherence deserves further research.

Capital interplays and the self-rated health of young men: results from a cross-sectional study in Switzerland

Introduction

We apply capital interplay theory to health inequalities in Switzerland by investigating the interconnected effects of parental cultural, economic and social capitals and personal educational stream on the self-rated health of young Swiss men who live with their parents.

Methods

We apply logistic regression modelling to self-rated health in original cross-sectional survey data collected during mandatory conscription of Swiss male citizens in 2010 and 2011 (n = 23,975).

Results

In comparison with sons whose parents completed mandatory schooling only, sons with parents who completed technical college or university were significantly more likely to report very good or excellent self-rated health. Parental economic capital was an important mediating factor in this regard. Number of books in the home (parental cultural capital), family economic circumstances (parental economic capital) and parental ties to influential people (parental social capital) were also independently associated with the self-rated health of the sons. Although sons in the highest educational stream tended to report better health than those in the lowest, we found little evidence for a health-producing intergenerational transmission of capitals via the education stream of the sons. Finally, the positive association between personal education and self-rated health was stronger among sons with relatively poorly educated parents and stronger among sons with parents who were relatively low in social capital.

Conclusions

Our study provides empirical support for the role of capital interplays, social processes in which capitals interpenetrate or co-constitute one another, in the intergenerational production of the health of young men in Switzerland.

Family characteristics and health behaviour as antecedents of school nurses' concerns about adolescents' health and development: a path model approach

BACKGROUND

Family socio-economic factors and parents' health behaviours have been shown to have an impact on the health and well-being of children and adolescents. Family characteristics have also been associated with school nurses' concerns, which arose during health examinations, about children's and adolescents' physical health and psychosocial development. Parental smoking has also been associated with smoking in adolescents.

OBJECTIVES

The aim of this study was to determine to what extent school nurses' concerns about adolescents' physical health and psychosocial development related to family characteristics are mediated through parents' and adolescents' own health behaviours (smoking).

DESIGN

A path model approach using cross-sectional data was used.

SETTINGS

In 2008-2009, information about health and well-being of adolescents was gathered at health examinations of the Children's Health Monitoring Study.

PARTICIPANTS

Altogether 1006 eighth and ninth grade pupils in Finland participated in the study.

METHODS

The associations between family characteristics, smoking among parents and adolescents and school nurses' concerns about adolescents' physical health and psychosocial development were examined using a structural equation model.

RESULTS

Paternal education had a direct, and, through fathers' and boys' smoking, an indirect association with school nurses' concerns about the physical health of boys. Paternal labour market status and family income were only indirectly associated with concerns about the physical health of boys by having an effect on boys' smoking through paternal smoking, and a further indirect effect on concerns about boys' health. In girls, only having a single mother was strongly associated with school nurses' concerns about psychosocial development through maternal and adolescent girl smoking.

CONCLUSIONS

Socio-economic family characteristics and parental smoking influence adolescent smoking and are associated with school nurses' concerns about adolescents' physical health and psychosocial development. The findings underline the importance of comprehensively taking into account adolescents' and parents' health behaviours and the family situation in health-care contacts when providing health counselling.

Adverse experiences in childhood, adulthood neighbourhood disadvantage and health behaviours

BACKGROUND

Early life adversities may play a role in the associations observed between neighbourhood contextual factors and health behaviours.

METHODS

We examined whether self-reported adverse experiences in childhood (parental divorce, long-term financial difficulties, serious conflicts, serious/chronic illness or alcohol problem in the family, and frequent fear of a family member) explain the association between adulthood neighbourhood disadvantage and co-occurrence of behavioural risk factors (smoking, moderate/heavy alcohol use, physical inactivity). Study population consisted of 31 271 public sector employees from Finland. The cross-sectional associations were analysed using two-level cumulative logistic regression models.

RESULTS

Childhood adverse experiences were associated with the sum of risk factors (cumulative OR 1.32 (95% CI 1.25 to 1.40) among those reporting 3-6 vs 0 adversities). Adverse experiences did not attenuate the association between neighbourhood disadvantage and risk factors; this cumulative OR was 1.52 (95% CI 1.43 to 1.62) in the highest versus lowest quartile of neighbourhood disadvantage when not including adversities, and 1.50 (95% CI 1.40 to 1.60) when adjusted for childhood adversities. In adversity-stratified analyses those reporting 3-6 adversities had 1.60-fold (95% CI 1.42 to 1.80) likelihood of risk factors if living in the neighbourhood of the highest disadvantage, while in those with fewer adversities this likelihood was 1.09-1.34-fold (95% CI 0.98 to 1.53) (p interaction 0.07).

CONCLUSIONS

Childhood adverse experiences and adulthood neighbourhood disadvantage were associated with behavioural risk factors. Childhood experiences did not explain associations between neighbourhood disadvantage and the risk factors. However, those with more adverse experiences may be susceptible for the socioeconomic conditions of neighbourhoods.

Educational differences in smoking among adolescents in Germany: what is the role of parental and adolescent education levels and intergenerational educational mobility?

Background: Adolescence is the period in which smoking onset usually occurs and the course for future socioeconomic status (SES) is set. However, because of the transitional nature of adolescence, it is questionable whether health inequalities are best measured by indicators of parental SES or rather by indicators of the adolescents’ own developing SES. We examine the independent effects of parental and adolescent education and intergenerational educational mobility on adolescent smoking behaviour while controlling for differences in parental and close friends’ smoking behaviour. Methods: The study is based on data from a subsample (12–17 years, n = 5,053) of the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Participants reported their education level as well as their personal and close friends’ smoking behaviour. Information on parental education and smoking behaviour was obtained via parent interviews. Adolescent and parental education data were dichotomized (low/high), leading to four categories of intergenerational educational mobility: stable high, potentially upwardly mobile, potentially downwardly mobile, and stable low. Results: After adjustment for parental and close friends’ smoking behaviour, adolescent smoking habits were strongly related to their personal education level, but not that of their parents. Among boys, both stable low and downwardly mobile adolescents had a 2.7-fold increased risk of being a smoker compared with peers with a stable high education. Among girls, only those with a stable low education had a 2.2-fold increased risk of smoking. Among both genders, educational upward mobility was associated with significantly lower smoking rates compared with peers with a stable low education (boys: OR 0.32; 95% CI 0.20–0.53; girls: OR 0.52; 95% CI 0.37–0.73). Conclusions: Our results show that the risk of an adolescent smoking is influenced by their own education level rather than that of their parents. Educational upward mobility seems to be protective against becoming a smoker in youth. Boys who experience downward mobility tend to have a significantly higher inclination to smoke than their peers with a stable high education. These findings illustrate the potential public health benefits of investments in education and help identify high-risk groups for smoking onset.

A life-course perspective on economic stress and tobacco smoking: a population-based study

AIMS

To investigate the associations between economic stress in childhood and adulthood and tobacco smoking, with reference to the accumulation, critical period and social mobility hypotheses from life-course epidemiology.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

The 2008 public health survey in Skåne, Sweden is a cross-sectional postal questionnaire study based on a random sample which yielded 28 198 participants aged 18-80 years (55% participation). Logistic regression models were used to investigate associations between economic stress in childhood and adulthood and tobacco smoking.

FINDINGS

A 17.4% prevalence of men and 19.1% of women reported tobacco smoking. Tobacco smoking was more prevalent among middle-aged men and young women, among those born outside Sweden, with low occupational status, low social support, low trust, economic stress in childhood and adulthood. The accumulation hypothesis was confirmed because combined childhood and adulthood exposures to economic stress were associated (P < 0.001) with tobacco smoking in a graded manner. The critical period hypothesis was not supported because the associations between economic stress in childhood as well as adulthood, respectively, and tobacco smoking were significant (P = 0.004 and P < 0.001) throughout the analyses. The social mobility hypothesis was confirmed because upward social mobility was associated significantly (P < 0.001) with lower odds of smoking, while downward social mobility was associated significantly (P < 0.001) with higher odds of smoking.

CONCLUSIONS

Downward social mobility and economic stress in both childhood and adulthood should be considered as risk factors for tobacco smoking over the life-course.

Cardiovascular risk factors in young male adults: impact of physical activity and parental education

BACKGROUND

This study was conducted to assess whether choices of physical activity, smoking status, and parental education and income were correlated with the health status of young adult males which are important for preventive health policy.

METHODS

491 18-29-year old males from lower socioeconomical districts in Turkey participated in this study. Information about demographic characteristics, parental education, household income, smoking status, and physical activity was obtained by means of a standardized questionnaire. BMI and metabolic parameters (serum lipid profile) were assessed.

RESULTS

Mean total cholesterol, LDL, HDL and triglyceride levels were in the normal range. The physically active group displayed a better lipid profile. No relationship was found between parental education and serum lipids. Smoking was slightly correlated with household income (r=103, p=0.022).

CONCLUSION

Young adult males who participate in relatively high levels of physical activity are at lower CHD risk than less active ones. The present study also showed that lower socioecnomic status does not always correlate with higher levels of cardiovascular risk factors. In conclusion, data supports that while family history cannot be changed, HDL levels can be modulated by lifestyle factors as in other populations and that with the determined benefits of increasing physical activity and thus, HDL levels, policy reform in schools to promote physical activity are warranted.

Lifecourse SEP and tobacco and cannabis use

BACKGROUND

Social inequalities in substance use have been well-documented; however, the impact of changes in socio-economic position from childhood to adulthood is unclear. We examined the relationship between intergenerational trajectories of social position and tobacco and cannabis use among young adults.

METHODS

Data come from 1103 participants (mean age: 28.9 years) of the Trajectoires Epidémiologiques en Population (TEMPO) study and their parents, participants of the GAZEL study, France. Multinomial regression analyses were used to examine associations between lifecourse socio-economic position (SEP) assessed using the parent's reports of family income (1989 and 2002) and the participant's educational attainment, occupational grade and job stability in 2009, with self-reported tobacco and cannabis use in 2009.

RESULTS

Compared with participants with stable intermediate/high SEP, those with stable low SEP and those with declining SEP were more likely to use tobacco (age- and sex-adjusted ORs = 2.03 and 2.26). Participants who experienced declining SEP were also disproportionately likely to use and abuse cannabis (adjusted ORs = 2.22 and 2.73). Associations remained significant after adjusting for family (parental smoking, alcohol use, ill health, unemployment, depression and divorce) and individual (early tobacco and cannabis use, academic difficulties, juvenile internalizing and externalizing problems) risk factors.

CONCLUSIONS

Cross-sectional studies indicate social inequalities in substance use. Our longitudinal findings suggest that individuals who experienced declining SEP from childhood to adulthood may be twice as likely to use tobacco and cannabis compared with individuals with a stable/high trajectory. Interventions targeting substance abuse should take into account lifecourse determinants including the interplay between individuals' socio-economic origins and later attainment.

Adolescent tobacco use and its determinants: evidence from Global Youth Tobacco Survey, Bangladesh 2007

Adolescent tobacco use (ATU) is on the rise worldwide and the problem is particularly severe in developing countries. Based on nationally representative data, this study aims to investigate the association between ATU and its possible correlates for Bangladesh, where the prevalence rate of ATU is high. The data set is extracted from the Global Youth Tobacco Survey for Bangladesh conducted in 2007. The survey collected information from a total of 3113 students from 52 schools, with a response rate of 100% at the school level, while a response rate of 88.9% was achieved from the students. Students covered in the survey were in grades 7, 8, 9, and 10, with age ranging from 11 to 17 years. The prevalence rate of ATU at the time of the survey was 8.4%, while 35.6% of the students had used at least a type of tobacco products before. Logistic regressions were used to obtain the odds ratios (ORs) in favor of ATU for each of the possible determinants and the confidence intervals (CIs) of these ratios. Use of tobacco among friends (OR = 3.46; CI = 2.37-5.05), the experience of seeing others smoking at home (OR = 2.10; CI = 1.36-3.22) or other places (OR = 1.6; CI = 1.02-2.57), receiving pocket money (OR = 7.6; CI = 4.59-13.28), receiving free tobacco from vendors (OR = 2.3; CI = 1.44-3.78), and exposure to advertisements and promotions of tobacco products (OR = 1.83; CI = 1.23-2.79) were associated with a higher likelihood of ATU. Increased awareness of health hazards of tobacco use through education in schools helped mitigate the problem of ATU. The findings of this study have ramifications for tobacco control prevention strategies in Bangladesh.

Gender differences in the association between parental divorce during childhood and stroke in adulthood: findings from a population-based survey

BACKGROUND

Although there is a substantial literature examining the mental health consequences of parental divorce, less attention has been paid to possible long-term physical health outcomes.

AIMS

The aim of this study was to examine the gender-specific association between childhood parental divorce and later incidence of stroke, while controlling for age, race ethnicity, socioeconomic status, health behaviors, diabetes, social support, marital status, mental health, and health care utilization.

METHODS

Secondary analysis of the population-based Behavioral Risk Factor Surveillance System survey; logistic regression analyses were conducted. The final sample included 4074 males and 5886 females. Respondents were excluded if they had experienced parental addictions to drugs or alcohol, any form of childhood abuse (physical, sexual, or emotional), or witnessed domestic violence.

RESULTS

A threefold risk of stroke was found for males who had experienced parental divorce before the age of 18 in comparison with males whose parents had not divorced [age- and race ethnicity-adjusted model odds ratio (OR) = 2·99, 95% confidence interval (CI) = 1·79, 4·98; fully adjusted model OR = 3·01, 95% CI = 1·68, 5·39]. Parental divorce was not significantly associated with stroke among women (fully adjusted OR = 1·64, 95% CI = 0·89, 3·02).

CONCLUSIONS

There is a robust association between parental divorce and stroke among males, even after adjustment for many known risk factors and the exclusion of respondents who had experienced parental addictions or family violence. Further research is needed to investigate plausible pathways linking parental divorce and stroke in males.

Environmental factors associated with overweight and obesity in taiwanese children

BACKGROUND

We explored the relationship among sociodemographic, behavioural, household environmental and perinatal factors, and risks of childhood overweight and obesity in Taiwan.

METHODS

A total of 7930 children aged 9 to 14 years were recruited from 14 randomly selected Taiwanese communities in 2007 and 2010. Height and weight were measured using standard protocols during school visits. Questionnaires that contained children's family information, birth conditions, exercise habits and household environmental factors were answered by the parents. Associations between risk factors and childhood overweight and obesity were estimated through odds ratio and 95% confidence interval from mixed models.

RESULTS

In this cohort, 32.3% of the children were overweight and 17.5% were obese. Male gender, high birthweight, exposure to in utero maternal smoking and current exposure to household environmental tobacco smoke (stronger effect of maternal than paternal smoking) were positively associated with childhood overweight/obesity. In contrast, higher parental education level, number of siblings, active exercise habits and taking vitamins were associated with reduced risks of childhood obesity. Birthweight revealed a J-shaped relationship with the probability of childhood overweight/obesity.

CONCLUSIONS

This study uncovers several modifiable risk factors for childhood overweight and obesity, and parents are encouraged to provide an anti-obesity environment such as quitting smoking, controlling birthweight of child during pregnancy and building up exercise habits.

Late-onset smokers: How many, and associations with health behaviours and socioeconomic status

Aims: Adolescence is considered a critical phase for smoking initiation, while smoking initiation in adulthood has received less attention. In the present study, we investigated smoking initiation in early adulthood, with an additional focus on how socioeconomic status (SES) relates to late-onset smoking. Methods: The Norwegian Longitudinal Health Behaviour Study followed a representative sample of adolescents ( n=530) from age 13 (7th grade) to age 30 (years 1990–2007) through 9 waves of data collection. Information was collected on the adolescents’ gender, smoking, alcohol use, cannabis use, physical activity, and SES. Those reporting to be smokers at age 30, but not at age 18, were defined as “late-onset smokers”. Results: At age 30, 21% were daily smokers, of which 45% met our definition of late-onset smoking. Participants with a low SES had a higher odds ratio for late-onset smoking (OR=3.42) and a lower odds ratio for quitting smoking (OR=0.40) after adjusting for confounders. Conclusions: Early adulthood is an additional critical phase for daily smoking initiation. The clear and consistent negative association between SES and late-onset smoking, as well as the positive association between SES and smoking cessation, contribute to the association between SES and smoking in the general adult population.

Determinants of smoking behaviour among secondary school students in Bangladesh

Despite established country's tobacco control law, cigarette smoking by the young people and the magnitude of nicotine dependence among the students is alarming in Bangladesh. This study was aimed to determine the prevalence of smoking and factors influencing it among the secondary school students. A two-stage cluster sampling was used for selection of schools with probability proportional to enrollment size followed by stratified random sampling of government and private schools. The 70-item questionnaire included 'core GYTS' (Global Youth Tobacco Survey) and other additional questions were used to collect relevant information. Analysis showed that the prevalence of smoking was 12.3% among boys and 4.5% among girls, respectively. The mean age at initiation of smoking was 10.8 years with standard deviation of 2.7 years. Logistic regression analysis revealed that boys are 2.282 times likely to smoked than girls and it was 1.786 times higher among the students aged 16 years and above than their younger counterparts. Smoking by teachers appeared to be the strong predictor for students smoking behaviour (OR 2.206, 95% CI: 1.576, 3.088) followed by peer influence (OR 1.988, 95% CI: 1.178, 3.356). Effective smoking prevention program should to be taken to reduce smoking behaviour. The school curricula had less impact in preventing smoking except teacher's smoking behaviour.

Suicidal ideation among individuals whose parents have divorced: findings from a representative Canadian community survey

This study used a large, nationally representative sample to examine the gender-specific association between parental divorce and the cumulative lifetime incidence of suicidal ideation. Known risk factors for suicidal ideation, such as childhood stressors, socioeconomic factors, adult health behaviors and stressors, marital status, and any history of mood and/or anxiety disorders were controlled. Gender-specific analyses revealed that for men, the parental divorce-suicidal ideation relationship remained statistically significant even when the above-listed cluster of risk factors were included in the analyses (odds ratio (OR)=2.36, 95% confidence interval (CI)=1.56, 3.58). For women, the association between parental divorce and suicidal ideation was reduced to non-significance when other adverse childhood experiences were included in the analyses (full adjustment OR=1.04, 95% CI=0.72, 1.50). These findings indicate a need for screening of suicidal ideation among individuals, particularly men and those with mood and/or anxiety disorders, who have experienced parental divorce. Future research should focus on the mechanisms linking parental divorce and suicidal ideation.

Is income or employment a stronger predictor of smoking than education in economically less developed countries? A cross-sectional study in Hungary

Background

In developed European countries in the last phase of the smoking epidemic, education is a stronger predictor of smoking than income or employment. We examine whether this also applies in economically less developed countries.

Methods

Data from 7218 respondents in the 25-64 age group came from two National Health Interview Surveys conducted in 2000 and 2003 in Hungary. Independent effects of educational level, income and employment status were studied in relation to smoking prevalence, initiation and continuation for all age groups combined and separately for 25-34, 35-49 and 50-64 years old. Absolute levels were evaluated by using age-standardized prevalence rates. Relative differences were assessed by means of logistic regression.

Results

Education and income, but not employment, were associated with equally large differences in smoking prevalence in Hungary in the 25-64 age group. Among men, smoking initiation was related to low educational level, whereas smoking continuation was related to low income. Among women, low education and low income were associated with both high initiation and high continuation rates. Considerable differences were found between the age groups. Inverse social gradients were generally strongest in the youngest age groups. However, smoking continuation among men had the strongest association with low income for the middle-aged group.

Conclusions

Patterns of inequalities in smoking in Hungary can be best understood in relation to two processes: the smoking epidemic, and the additional effects of poverty. Equity orientated tobacco control measures should target the low educated to prevent their smoking initiation, and the poor to improve their cessation rates.

The effect of lone motherhood on the smoking behavior of young adults

We provide evidence that living with an unmarried mother during childhood raises smoking propensities for young adults in Germany.

Attitudes to new smoking restrictions and second-hand smoke among young Finnish males

Aims: Relatively little is known about the attitudes of young people to restrictions on smoking in public places and to environmental second-hand smoke in housing estates. The objective was to explore the attitudes of young male adults after the new smoke-free legislation was implemented in Finland. Methods: A survey of 1167 Finnish male military conscripts was performed. The main outcome variables were their attitudes to the new restrictions on smoking in public places and concerns about second-hand smoke in the home originating from their neighbours. Results: Almost half of the youths (43.5%) reported that they supported the more restrictive smoking regulations, with 44.8% having a neutral view. Only 16.0% of the respondents were irritated about the second-hand smoke entering to their house from outside and 48.6% were not concerned about smoking in their neighbourhood. A total of 555 (47.6%) conscripts were current smokers. Current smokers were more often totally opposed to the legislation and had less negative views about the exposure to second-hand smoke than non-smokers. Strong nicotine dependence increased the feelings of anxiety and stigmatisation when the new restrictions were introduced. Conclusions: Finnish young men do accept new smoking restrictions. However, smoking with high nicotine dependence was surprisingly common among these young men and the negative attitude to the legislation can be traced to this group of smokers. The repulsion felt towards second-hand smoke by non-smokers represents an opportunity for public health initiatives to guarantee a smoke-free environment in public and private places.

Effects of childhood socio-economic conditions on educational differences in leisure-time physical activity

BACKGROUND

Our purpose was to assess the direct and indirect contribution of childhood socio-economic conditions to educational differences in leisure-time physical activity among women and men.

METHODS

Population-based data were derived from a representative sample of Finns aged >or=30 years (N = 7112) as part of Health 2000 Survey. Multinomial logistic regression analysis was applied. Leisure-time physical activity was divided into inactivity, moderate and high activity.

RESULTS

Childhood socio-economic conditions had both a direct and indirect effect through adulthood socio-economic conditions on educational differences in leisure-time physical activity. The direct effect of childhood socio-economic conditions on educational differences in inactivity was stronger than its indirect effects through adulthood socio-economic conditions and other health behaviours and related factors. Adulthood socio-economic conditions had a considerable indirect effect on educational differences in leisure-time physical activity through other adulthood health behaviours and related factors among men.

CONCLUSIONS

In order to narrow educational differences in leisure-time physical activity, we should secure a childhood environment that enables a physically active lifestyle, support leisure-time physical activity in diverse occupational groups, guarantee equal physical activity possibilities across different educational careers and support those with insufficient material resources.

Health disparities beginning in childhood: a life-course perspective

In this article we argue for the utility of the life-course perspective as a tool for understanding and addressing health disparities across socioeconomic and racial or ethnic groups, particularly disparities that originate in childhood. Key concepts and terms used in life-course research are briefly defined; as resources, examples of existing literature and the outcomes covered are provided along with examples of longitudinal databases that have often been used for life-course research. The life-course perspective focuses on understanding how early-life experiences can shape health across an entire lifetime and potentially across generations; it systematically directs attention to the role of context, including social and physical context along with biological factors, over time. This approach is particularly relevant to understanding and addressing health disparities, because social and physical contextual factors underlie socioeconomic and racial/ethnic disparities in health. A major focus of life-course epidemiology has been to understand how early-life experiences (particularly experiences related to economic adversity and the social disadvantages that often accompany it) shape adult health, particularly adult chronic disease and its risk factors and consequences. The strong life-course influences on adult health could provide a powerful rationale for policies at all levels--federal, state, and local--to give more priority to investment in improving the living conditions of children as a strategy for improving health and reducing health disparities across the entire life course.

The contribution of childhood circumstances, current circumstances and health behaviour to educational health differences in early adulthood

BACKGROUND

The life course approach emphasises the contribution of circumstances in childhood and youth to adult health inequalities. However, there is still a lot to know of the contribution of living conditions in childhood and youth to adult health inequalities and how later environmental and behavioural factors are connected with the effects of earlier circumstances. This study aims to assess a) how much childhood circumstances, current circumstances and health behaviour contribute to educational health differences and b) to which extent the effect of childhood circumstances on educational health differences is shared with the effects of later living conditions and health behaviour in young adults.

METHODS

The data derived from the Health 2000 Survey represent the Finnish young adults aged 18-29 in 2000. The analyses were carried out on 68% (n = 1282) of the sample (N = 1894). The cross-sectional data based on interviews and questionnaires include retrospective information on childhood circumstances. The outcome measure was poor self-rated health.

RESULTS

Poor self-rated health was much more common among subjects with primary education only than among those in the highest educational category (OR 4.69, 95% CI 2.63 to 8.62). Childhood circumstances contributed substantially (24%) to the health differences between these educational groups. Nearly two thirds (63%) of this contribution was shared with behavioural factors adopted by early adulthood, and 17% with current circumstances. Health behaviours, smoking especially, were strongly contributed to educational health differences.

CONCLUSION

To develop means for avoiding undesirable trajectories along which poor health and health differences develop, it is necessary to understand the pathways to health inequalities and know how to improve the living conditions of families with children.

Life course socioeconomic conditions, passive tobacco exposures and cigarette smoking in a multiethnic birth cohort of U.S. women

Low socioeconomic status (SES) and exposure to passive tobacco smoke are associated with increased risk of smoking in adults, but the influences of these factors in earlier life periods on adult smoking behavior are not well understood. We investigated the relationship of SES and passive tobacco exposure over the lifecourse with adult smoking status in a multiethnic cohort of U.S. women (n = 262, average age = 41.8), using prospective data on maternal smoking during pregnancy and childhood SES, and follow-up data on current smoking, adult SES and household tobacco exposure. Low adolescent and adult SES consistently increased the risk of current smoking, but most associations were not statistically significant in multivariable models. Blue collar parental occupation at birth increased the risk of smoking, particularly for current smoking relative to former smoking (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.2-5.9). After adjusting for SES, current and former smokers were more likely than never smokers to have exposures to prenatal tobacco (OR = 4.4, 95% CI = 2.1-9.4 and OR = 2.0, 95% CI = 1.0-4.2, respectively) and adult household tobacco (OR = 2.7, 95% CI = 1.3-5.8 and OR = 2.4, 95% CI = 1.2-4.8, respectively). Our results show that early life conditions have enduring influences on women's smoking behavior in middle adulthood, even after considering similar types of conditions in later life periods.