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Nusselder WJ, Long D, Waterlander WE, Stronks K, Boshuizen HC. Estimating the contribution of overweight and obesity to ethnic inequalities in cardio-metabolic diseases in the Netherlands: a simulation study. Public Health 2024; 232:45-51. [PMID: 38733960 DOI: 10.1016/j.puhe.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES Overweight and obesity (OWOB) starts in childhood, influences adult cardiovascular risk, and is not equally distributed across ethnic groups. It is unclear which effects can be expected from reductions in OWOB across the life course on inequalities in cardio-metabolic diseases in a multi-ethnic population. This study aims to estimate the effects of three scenarios of changes in OWOB (the Normal-Weight-for-All scenario, the No-Ethnic-Difference-over-the-Life-Course scenario, the and No-Ethnic-Differences-in-Childhood scenario). STUDY DESIGN A simulation study. METHODS We combine data from multiple data sources and use the Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA) model to estimate the effects of three scenarios on the cumulative incidence of diabetes mellitus, ischaemic heart disease (IHD) and stroke between 18 and 70 years in the five largest ethnic groups in the Netherlands. RESULTS In the scenario where all individuals have normal weight, the cumulative incidence decreased in all ethnic minority groups for all diseases, with largest decreases among South-Asian Surinamese, where the reduction of diabetes incidence exceeded 50%. In the scenario where the prevalence of OWOB in each ethnic-minority group was reduced to the current level among the Dutch-origin population, ethnic inequalities in cardio-metabolic diseases were substantially reduced, particularly when lowered prevalence of OWOB persisted across the lifespan. Reductions were the largest for diabetes and for the Asian Surinamese population. CONCLUSIONS A substantial part of the well-known ethnic inequalities in incidence of diabetes, IHD, and stroke can be attributed to OWOB. Interventions aimed at reducing OWOB have clear potential to reduce the health inequalities in these outcomes, especially for diabetes, in particular when they have an impact across the lifespan.
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Affiliation(s)
- W J Nusselder
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - D Long
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - W E Waterlander
- Department of Public and Occupational Health, Academic Medical Centers Amsterdam/Universiteit of Amsterdam, Amsterdam, the Netherlands
| | - K Stronks
- Department of Public and Occupational Health, Academic Medical Centers Amsterdam/Universiteit of Amsterdam, Amsterdam, the Netherlands
| | - H C Boshuizen
- Department Statistics, Data Science and Mathematical Modelling, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
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Milkovska E, van Baal PH. Health outcomes in Bulgaria: Simulated effects of obesogenic environmental changes in adulthood versus childhood. Prev Med 2023; 175:107700. [PMID: 37690671 DOI: 10.1016/j.ypmed.2023.107700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Bulgarian government efforts to tackle obesity are focused mainly on guidelines affecting children. However, it is unclear whether targeting children for obesity-related health policies yields better long-term health outcomes as opposed to changing the risk of obesity in adulthood. This study aims to evaluate where policy efforts should be directed to alleviate the health burden associated with obesity. METHODS We compare the impact on population health of two simulated scenarios when (a) the prevalence of obesity upon entering adulthood is lowered; (b) the risk of getting an unhealthy weight as an adult is reduced. Additionally, we run (c) combinations of the two and (d) childhood obesity prevention on the one hand, and worsening (increasing) obesity incidence later in adulthood on the other. RESULTS Our findings show that obesogenic environmental changes throughout adulthood have a stronger effect on life expectancy (LE), diabetes-free life expectancy (DFLE) and type 2 diabetes prevalence outcomes compared to lowering the proportion of individuals with obesity during adolescence. Nevertheless, a sizable reduction in the number of young adults with unhealthy weight has the potential to recover years of LE/DFLE that would be lost if the risk of obesity in adulthood would continue to grow in time. CONCLUSIONS The two types of policies' (a-b) effects are not equivalent in strength and the best way forward is dependent on future obesity incidence trends.
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Affiliation(s)
- Elena Milkovska
- Erasmus School of Health Policy & Management (ESHPM), Department of Health Economics, Erasmus University Rotterdam, the Netherlands.
| | - Pieter Hm van Baal
- Erasmus School of Health Policy & Management (ESHPM), Department of Health Economics, Erasmus University Rotterdam, the Netherlands
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Salarzadeh Jenatabadi H, Shamsi NA, Ng BK, Abdullah NA, Mentri KAC. Adolescent Obesity Modeling: A Framework of Socio-Economic Analysis on Public Health. Healthcare (Basel) 2021; 9:healthcare9080925. [PMID: 34442062 PMCID: PMC8392515 DOI: 10.3390/healthcare9080925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 02/07/2023] Open
Abstract
Bayesian Structural Equation Modeling (SEM-Bayesian) was applied across different research areas to model the correlation between manifest and latent variables. The primary purpose of this study is to introduce a new framework of complexity to adolescent obesity modeling based on adolescent lifestyle through the application of SEM-Bayesian. The introduced model was designed based on the relationships among several factors: household socioeconomic status, healthy food intake, unhealthy food intake, lifestyle, body mass index (BMI) and body fat. One of the main contributions of this study is from considering both BMI and body fat as dependent variables. To demonstrate the reliability of the model, especially in terms of its fitting and accuracy, real-time data were extracted and analyzed across 881 adolescents from secondary schools in Tehran, Iran. The output of this study may be helpful for researchers who are interested in adolescent obesity modeling based on the lifestyle and household socioeconomic status of adolescents.
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Fuertes E, Marcon A, Potts L, Pesce G, Lhachimi SK, Jani V, Calciano L, Adamson A, Quint JK, Jarvis D, Janson C, Accordini S, Minelli C. Health impact assessment to predict the impact of tobacco price increases on COPD burden in Italy, England and Sweden. Sci Rep 2021; 11:2311. [PMID: 33504847 PMCID: PMC7840977 DOI: 10.1038/s41598-021-81876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022] Open
Abstract
Raising tobacco prices effectively reduces smoking, the main risk factor for chronic obstructive pulmonary disease (COPD). Using the Health Impact Assessment tool "DYNAMO-HIA", this study quantified the reduction in COPD burden that would occur in Italy, England and Sweden over 40 years if tobacco prices were increased by 5%, 10% and 20% over current local prices, with larger increases considered in secondary analyses. A dynamic Markov-based multi-state simulation modelling approach estimated the effect of changes in smoking prevalence states and probabilities of transitioning between smoking states on future smoking prevalence, COPD burden and life expectancy in each country. Data inputs included demographics, smoking prevalences and behaviour and COPD burden from national data resources, large observational cohorts and datasets within DYNAMO-HIA. In the 20% price increase scenario, the cumulative number of COPD incident cases saved over 40 years was 479,059 and 479,302 in Italy and England (populous countries with higher smoking prevalences) and 83,694 in Sweden (smaller country with lower smoking prevalence). Gains in overall life expectancy ranged from 0.25 to 0.45 years for a 20 year-old. Increasing tobacco prices would reduce COPD burden and increase life expectancy through smoking behavior changes, with modest but important public health benefits observed in all three countries.
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Affiliation(s)
- Elaine Fuertes
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK.
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Laura Potts
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Giancarlo Pesce
- Sorbonne Université, INSERM UMR-S 1136, Epidemiology of Allergic and Respiratory Diseases (EPAR), Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Saint-Antoine Medical School, Paris, France
| | - Stefan K Lhachimi
- Health Sciences Bremen, Institute for Public Health and Nursing, University of Bremen, Bremen, Germany
| | - Virjal Jani
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alex Adamson
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Debbie Jarvis
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Cosetta Minelli
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
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Lhachimi SK, Pega F, Heise TL, Fenton C, Gartlehner G, Griebler U, Sommer I, Bombana M, Katikireddi SV. Taxation of the fat content of foods for reducing their consumption and preventing obesity or other adverse health outcomes. Cochrane Database Syst Rev 2020; 9:CD012415. [PMID: 32914461 PMCID: PMC9508786 DOI: 10.1002/14651858.cd012415.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Overweight and obesity are increasing worldwide and are considered to be a major public health issue of the 21st century. Introducing taxation of the fat content in foods is considered a potentially powerful policy tool to reduce consumption of foods high in fat or saturated fat, or both. OBJECTIVES To assess the effects of taxation of the fat content in food on consumption of total fat and saturated fat, energy intake, overweight, obesity, and other adverse health outcomes in the general population. SEARCH METHODS We searched CENTRAL, Cochrane Database of Systematic Reviews, MEDLINE, Embase, and 15 other databases and trial registers on 12 September 2019. We handsearched the reference lists of all records of included studies, searched websites of international organizations and institutions (14 October 2019), and contacted review advisory group members to identify planned, ongoing, or unpublished studies (26 February 2020). SELECTION CRITERIA In line with Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria, we included the following study types: randomized controlled trials (RCTs), cluster-randomized controlled trials (cRCTs), non-randomized controlled trials (nRCTs), controlled before-after (CBA) studies, and interrupted time series studies. We included studies that evaluated the effects of taxes on the fat content in foods. Such a tax could be expressed as sales, excise, or special value added tax (VAT) on the final product or an intermediary product. Eligible interventions were taxation at any level, with no restriction on the duration or the implementation level (i.e. local, regional, national, or multinational). Eligible study populations were children (zero to 17 years) and adults (18 years or older) from any country and setting. We excluded studies that focused on specific subgroups only (e.g. people receiving pharmaceutical intervention; people undergoing a surgical intervention; ill people who are overweight or obese as a side effect, such as those with thyroiditis and depression; and people with chronic illness). Primary outcomes were total fat consumption, consumption of saturated fat, energy intake through fat, energy intake through saturated fat, total energy intake, and incidence/prevalence of overweight or obesity. We did not exclude studies based on country, setting, comparison, or population. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods for all phases of the review. Risk of bias of the included studies was assessed using the criteria of Cochrane's 'Risk of bias' tool and the EPOC Group's guidance. Results of the review are summarized narratively and the certainty of the evidence was assessed using the GRADE approach. These steps were done by two review authors, independently. MAIN RESULTS We identified 23,281 records from searching electronic databases and 1173 records from other sources, leading to a total of 24,454 records. Two studies met the criteria for inclusion in the review. Both included studies investigated the effect the Danish tax on saturated fat contained in selected food items between 2011 and 2012. Both studies used an interrupted time series design. Neither included study had a parallel control group from another geographic area. The included studies investigated an unbalanced panel of approximately 2000 households in Denmark and the sales data from a specific Danish supermarket chain (1293 stores). Therefore, the included studies did not address individual participants, and no restriction regarding age, sex, and socioeconomic characteristics were defined. We judged the overall risk of bias of the two included studies as unclear. For the outcome total consumption of fat, a reduction of 41.8 grams per week per person in a household (P < 0.001) was estimated. For the consumption of saturated fat, one study reported a reduction of 4.2% from minced beef sales, a reduction of 5.8% from cream sales, and an increase of 0.5% to sour cream sales (no measures of statistical precision were reported for these estimates). These estimates are based on a restricted number of food types and derived from sales data; they do not measure individual intake. Moreover, these estimates do not account for other relevant sources of fat intake (e.g. packaged or processed food) or other food outlets (e.g. restaurants or cafeterias); hence, we judged the evidence on the effect of taxation on total fat consumption or saturated fat consumption to be very uncertain. We did not identify evidence on the effect of the intervention on energy intake or the incidence or prevalence of overweight or obesity. AUTHORS' CONCLUSIONS Given the very low quality of the evidence currently available, we are unable to reliably establish whether a tax on total fat or saturated fat is effective or ineffective in reducing consumption of total fat or saturated fat. There is currently no evidence on the effect of a tax on total fat or saturated fat on total energy intake or energy intake through saturated fat or total fat, or preventing the incidence or reducing the prevalence of overweight or obesity.
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Affiliation(s)
- Stefan K Lhachimi
- Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Department for Health Services Research, Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Frank Pega
- Public Health, University of Otago, Wellington, New Zealand
| | - Thomas L Heise
- Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Candida Fenton
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Gerald Gartlehner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
- RTI International, Research Triangle Park, North Carolina, USA
| | - Ursula Griebler
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Isolde Sommer
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Manuela Bombana
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
- Department of Health Promotion, AOK Baden-Württemberg, Stuttgart, Germany
- Department of General Practice and Health Services Research, University Hospital, University of Heidelberg, Heidelberg, Germany
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Schönbach JK, Bolte G, Czwikla G, Manz K, Mensing M, Muellmann S, Voelcker-Rehage C, Lhachimi SK. Equity impacts of interventions to increase physical activity among older adults: a quantitative health impact assessment. Int J Behav Nutr Phys Act 2020; 17:103. [PMID: 32795299 PMCID: PMC7427912 DOI: 10.1186/s12966-020-00999-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Behavioural interventions may increase social inequalities in health. This study aimed to project the equity impact of physical activity interventions that have differential effectiveness across education groups on the long-term health inequalities by education and gender among older adults in Germany. METHODS We created six intervention scenarios targeting the elderly population: Scenarios #1-#4 applied realistic intervention effects that varied by education (low, medium high). Under scenario #5, all older adults adapted the physical activity pattern of those with a high education. Under scenario #6, all increased their physical activity level to the recommended 300 min weekly. The number of incident ischemic heart disease, stroke and diabetes cases as well as deaths from all causes under each of these six intervention scenarios was simulated for males and females over a 10-year projection period using the DYNAMO-HIA tool. Results were compared against a reference-scenario with unchanged physical activity. RESULTS Under scenarios #1-#4, approximately 3589-5829 incident disease cases and 6248-10,320 deaths could be avoided among males over a 10-year projection period, as well as 4381-7163 disease cases and 6914-12,605 deaths among females. The highest reduction for males would be achieved under scenario #4, under which the intervention is most effective for those with a high education level. Scenario #4 realizes 2.7 and 2.4% of the prevented disease cases and deaths observed under scenario #6, while increasing inequalities between education groups. In females, the highest reduction would be achieved under scenario #3, under which the intervention is most effective amongst those with low levels of education. This scenario realizes 2.7 and 2.9% of the prevented disease cases and deaths under scenario #6, while decreasing inequalities between education groups. Under scenario #5, approximately 31,687 incident disease cases and 59,068 deaths could be prevented among males over a 10-year projection period, as well as 59,173 incident disease cases and 121,689 deaths among females. This translates to 14.4 and 22.2% of the prevented diseases cases among males and females under scenario #6, and 13.7 and 27.7% of the prevented deaths under scenario #6. CONCLUSIONS This study shows how the overall population health impact varies depending on how the intervention-induced physical activity change differs across education groups. For decision-makers, both the assessment of health impacts overall as well as within a population is relevant as interventions with the greatest population health gain might be accompanied by an unintended increase in health inequalities.
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Affiliation(s)
- Johanna-Katharina Schönbach
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Bremen, Germany.
- University of Bremen, Health Sciences Bremen, Bremen, Germany.
| | - Gabriele Bolte
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Bremen, Germany
- University of Bremen, Health Sciences Bremen, Bremen, Germany
| | - Gesa Czwikla
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Bremen, Germany
- University of Bremen, Health Sciences Bremen, Bremen, Germany
| | | | | | - Saskia Muellmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Claudia Voelcker-Rehage
- Chemnitz University of Technology, Institute of Human Movement Science and Health, Chemnitz, Germany
- University of Münster, Institute of Sport and Exercise Sciences, Münster, Germany
| | - Stefan K Lhachimi
- University of Bremen, Health Sciences Bremen, Bremen, Germany
- University of Bremen, Institute of Public Health and Nursing Research, Department of Health Services Research, Bremen, Germany
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Bender AM, Sørensen J, Holm A, Simonsen K, Diderichsen F, Brønnum-Hansen H. Simulations of future cardiometabolic disease and life expectancy under counterfactual obesity reduction scenarios. Prev Med Rep 2020; 19:101150. [PMID: 32685361 PMCID: PMC7358723 DOI: 10.1016/j.pmedr.2020.101150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/07/2020] [Accepted: 06/14/2020] [Indexed: 12/05/2022] Open
Abstract
HIAs provide simulations of future disease levels related to an array of obesity scenarios. In a relatively lean population, obesity still contribute to a substantial reduction in life expectancy. Large reductions in diabetes and multi-morbidity is estimated as an effect of reducing obesity. Incremental increase in future stroke and IHD cases is expected.
The aim of this study was to provide decision makers with an assessment of potential future health effects of interventions against overweight and obesity (OWOB). By means of the DYNAMO-HIA tool we conducted a health impact assessment simulating future prevented disease (ischemic heart disease (IHD), diabetes, stroke, and multi morbidity) incidence, prevalence and life expectancy (LE) related to a scenario where OWOB is reduced by 25% and a scenario where obesity is eliminated. The study covered projected number of persons living in Copenhagen, Denmark during year 2014–2040 (n 2040 = 742,129). Reducing the proportion of men/women with OWOB with 25% will increase population LE by 2.4/1.2 months and at the same time decrease LE with diabetes by 3.1/2.2 months. As a result of eliminating obesity, total LE will increase by 6.0/3.6 months and LE with diabetes will decrease with 9.8/10.3 months for men/women. We found no important effects on LE with IHD and stroke. This illustrates that the positive effects of lowering OWOB levels on IHD and stroke incidence is offset due to increasing total LE. Although the population of Copenhagen is relatively lean, reducing obesity levels will result in significant benefits for population cardiometabolic health status and LE. Future public health prevention programs may use the results as reference data for potential impact of reductions in OWOB.
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Affiliation(s)
- Anne Mette Bender
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jan Sørensen
- Centre for Health Economics Research (COHERE), University of Southern Denmark, Odense, Denmark.,Health Outcome Research Centre (HORC), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Astrid Holm
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Fundação Oswaldo Cruz - IAM, Recife, Brazil
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To what extent could cardiovascular diseases be reduced if Germany applied fiscal policies to increase fruit and vegetable consumption? A quantitative health impact assessment. Public Health Nutr 2020; 24:2570-2576. [PMID: 32662362 PMCID: PMC8145472 DOI: 10.1017/s1368980020000634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: This study aimed to dynamically model and quantify expected health effects of four scenarios: (i) a reference scenario with an unchanged fruit and vegetable intake, (ii) the removal of value-added tax (VAT) on fruits and vegetables, (iii) the implementation of a 20 % subsidy on fruits and vegetables and (iv) a guideline scenario with a population-wide fruit and vegetable intake of five portions per day. Design: Baseline fruit and vegetable intake data was derived from the GEDA 2012 study. We used price elasticities for Germany to calculate the change in fruit and vegetable consumption under the zero VAT and the 20 % subsidy scenario. All scenarios were modelled over a 10-year projection period using DYNAMO-HIA. Setting: Germany. Participants: A projected real-life population. Results: Cumulated over the 10-year projection period, an estimated 4450 incident ischaemic heart disease (IHD) cases, 7010 stroke cases and 13 960 deaths would be prevented under the zero VAT scenario. Under the 20 % subsidy scenario, 17 990 incident IHD cases, 27 390 stroke cases and 54 880 deaths would be averted. Although this corresponds to only a fraction of the incidents that would occur under the reference scenario, the averted cases translate to 2 % (for the zero VAT scenario) and 9 % (for the 20 % subsidy scenario) of IHD, stroke and death cases that would be prevented if the whole population consumed the recommended five portions of fruits and vegetables per day. Conclusions: Fiscal policies on fruits and vegetables provide a non-negligible step towards the removal of the health burden induced by low fruit and vegetable intake.
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9
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Motivational interviewing to prevent early childhood caries: A randomized controlled trial. J Dent 2020; 97:103349. [PMID: 32330548 DOI: 10.1016/j.jdent.2020.103349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/15/2020] [Accepted: 04/19/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Prevailing health education (PE) often fails to achieve sustained behavioral changes. This randomized controlled trial integrated motivational interviewing (MI) and a patient communication tool featuring interactive caries risk assessment (RA) into PE and investigated the effectiveness of PE, PE + MI, and PE + MI + RA in preventing early childhood caries. METHODS This study targeted children aged 3-4 years with unfavorable oral health behaviors. 692 parent-child dyads were recruited, randomly assigned into three groups (PE, PE + MI, and PE + MI + RA), and received respective interventions. A questionnaire was completed at baseline and after 6 and 12 months to collect information on socio-demographic background, parental efficacy and children's oral health behaviors. Children's oral hygiene status and dental caries were recorded at baseline and after 12 months. RESULTS 655 (94.7%) parent-child dyads remained in the study after 12 months. Caries increment was significantly lower in PE + MI group (β=-0.717, 95% CI: -1.035, -0.398) and PE + MI + RA group [β=-0.600, 95% CI: -0.793, -0.407] than in PE group. There was significantly greater reduction in plaque score in PE + MI group (β=-0.077, 95% CI: -0.106, -0.048) and PE + MI + RA group (β=-0.075, 95% CI: -0.113, -0.036), as compared with PE group. Significantly greater improvements were found in parental efficacy and children's oral health behaviors in PE + MI and PE + MI + RA groups than in PE group (all p < 0.05). There was no significant difference between PE + MI group and PE + MI + RA group across all outcome measures (all p > 0.05). CONCLUSIONS Intergration of motivational interviewing improves the effectiveness of prevailing health education in preventing early childhood caries, enhancing parental efficacy, and improving children's oral health behaviors. Incorporation of the communication tool for caries risk assessment does not further improve the effectiveness of motivational interviewing in protecting children's oral health. CLINICAL SIGNIFICANCE The findings of this study provide much needed evidence for dentists, dental auxiliary staff and public health workers to select effective intervention to empower parents for improving children's oral health behaviors and preventing early childhood caries.
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Füssenich K, Nusselder WJ, Lhachimi SK, Boshuizen HC, Feenstra TF. Potential gains in health expectancy by improving lifestyle: an application for European regions. Popul Health Metr 2019; 17:1. [PMID: 30654828 PMCID: PMC6337827 DOI: 10.1186/s12963-018-0181-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023] Open
Abstract
Background Prevention aiming at smoking, alcohol consumption, and BMI could potentially bring large gains in life expectancy (LE) and health expectancy measures such as Healthy Life Years (HLY) and Life Expectancy in Good Perceived Health (LEGPH) in the European Union. However, the potential gains might differ by region. Methods A Sullivan life table model was applied for 27 European countries to calculate the impact of alternative scenarios of lifestyle behavior on life and health expectancy. Results were then pooled over countries to present the potential gains in HLY and LEGPH for four European regions. Results Simulations show that up to 4 years of extra health expectancy can be gained by getting all countries to the healthiest levels of lifestyle observed in EU countries. This is more than the 2 years to be gained in life expectancy. Generally, Eastern Europe has the lowest LE, HLY, and LEGPH. Even though the largest gains in LEPGH and HLY can also be made in Eastern Europe, the gap in LE, HLY, and LEGPH can only in a small part be closed by changing smoking, alcohol consumption, and BMI. Conclusion Based on the current data, up to 4 years of good health could be gained by adopting lifestyle as seen in the best-performing countries. Only a part of the lagging health expectancy of Eastern Europe can potentially be solved by improvements in lifestyle involving smoking and BMI. Before it is definitely concluded that lifestyle policy for alcohol use is of relatively little importance compared to smoking or BMI, as our findings suggest, better data should be gathered in all European countries concerning alcohol use and the odds ratios of overconsumption of alcohol. Electronic supplementary material The online version of this article (10.1186/s12963-018-0181-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Koen Füssenich
- National Institute for Public Health and the Environment, Postbus 1, 3720 BA, Bilthoven, The Netherlands. .,Department of Epidemiology, University Medical Center, Groningen University, Groningen, The Netherlands.
| | - Wilma J Nusselder
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan K Lhachimi
- Research Group for Evidence Based Public Health, Institute for Public Health and Nursing, University Bremen & Leibniz Institute for Epidemiology and Prevention Research, Bremen, Germany
| | - Hendriek C Boshuizen
- National Institute for Public Health and the Environment, Postbus 1, 3720 BA, Bilthoven, The Netherlands.,Department of Agrotechnology and Food Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Talitha F Feenstra
- National Institute for Public Health and the Environment, Postbus 1, 3720 BA, Bilthoven, The Netherlands.,Department of Epidemiology, University Medical Center, Groningen University, Groningen, The Netherlands
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11
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Schönbach JK, Thiele S, Lhachimi SK. What are the potential preventive population-health effects of a tax on processed meat? A quantitative health impact assessment for Germany. Prev Med 2019; 118:325-331. [PMID: 30468795 DOI: 10.1016/j.ypmed.2018.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 11/07/2018] [Accepted: 11/17/2018] [Indexed: 01/28/2023]
Abstract
The International Agency for Research on Cancer considers processed meat to be carcinogenic. Further, processed meat is associated with diabetes, ischemic heart disease (IHD) and all-cause mortality. We aimed to assess health gains of four processed meat taxation scenarios in comparison to the reference and a minimum-risk-exposure-scenario. To estimate the shift in processed meat intake following respective taxes, we calculated price elasticities for processed meat. DYNAMO-HIA was used to dynamically project policy-attributable differences in the prevalence of diseases and deaths. In projection year 10, an extra 9300 males and 4500 females would be alive under the lowest tax scenario (4% tax), compared to the reference scenario. Prevalent IHD, diabetes and colorectal cancer cases in males would be 8400, 9500 and 500 lower, respectively, and there would be 4600, 7800 and 300 less cases in females. Of the respective death and disease reduction that would be achieved under the minimum-risk-exposure-scenario, the lowest tax reaches 2.84% (colorectal cancer in males) to 6.02% (diabetes in females). Under the highest tax scenario (33.3% tax), an extra 76,700 males and 37,100 females would be alive, compared to the reference scenario. Prevalent IHD, diabetes and colorectal cancer cases would be 70,800, 77,900 and 4900 lower in males and 29,900, 48,900 and 2300 lower in females, which represents 27.84% (colorectal cancer in males) to 37.76% (diabetes in females) of the maximal preventable death and disease burden. Further research needs to examine to what extent these health benefits are outweighed by a simultaneous tax-induced decrease in fish intake.
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Affiliation(s)
- Johanna-Katharina Schönbach
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany; Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany.
| | - Silke Thiele
- ife Institute of Food Economics, Science Park Kiel, Fraunhoferstraße 13, 24118 Kiel, Germany
| | - Stefan K Lhachimi
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany; Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany
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12
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Weight change and 15 year mortality: results from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) cohort study. Eur J Epidemiol 2017; 33:37-53. [PMID: 29264789 PMCID: PMC5803289 DOI: 10.1007/s10654-017-0343-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 12/09/2017] [Indexed: 11/24/2022]
Abstract
Studies have reported a higher mortality risk associated with weight loss, particularly in middle-aged and older adults, although some of these studies did find that gaining weight was also associated with an increased mortality risk. We examined changes in weight in relation to mortality in a prospective population-based cohort study of men and women, resident in Norfolk, UK. Participants were assessed at baseline (1993–1997) and at a second examination (1998–2000), as part of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study, and followed up to 2015 for mortality. Participants with a self-reported history of cancer or cardiovascular disease, body mass index < 18.5 kg/m2 or missing data on adjustment variables, at either time-point were excluded, leaving 12,580 participants, aged 39–78 in 1993–1997, eligible for analyses. Cox proportional hazards models were used to determine Hazard Ratios (HRs) for all-cause (2603 deaths), cardiovascular (749 deaths), cancer (981 deaths), respiratory (226 deaths) and other causes of mortality (647 deaths) by categories of weight change. After multivariate adjustment, the HRs (95% CIs) for all-cause mortality for men and women who lost more than 5 kg were 1.85 (1.48–2.31) and 1.64 (1.31–2.05) respectively. Higher hazards were also found for specific causes of mortality and weight loss > 5 kg. Similar associations were observed after excluding deaths in the first 5 years of follow-up. Results for weight gain were inconclusive. We conclude that objectively measured weight loss, but not weight gain, was associated with subsequent higher mortality risk in this population-based study of middle-aged and elderly men and women. However, undiagnosed, pre-existing disease and the inability to account for weight cycling need to be remembered when interpreting these results. Unravelling the causal pathways underlying this association will require more detailed studies, including that of changes in body composition.
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13
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Ekwaru JP, Ohinmaa A, Tran BX, Setayeshgar S, Johnson JA, Veugelers PJ. Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach. PLoS One 2017; 12:e0177848. [PMID: 28542399 PMCID: PMC5436822 DOI: 10.1371/journal.pone.0177848] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/04/2017] [Indexed: 12/31/2022] Open
Abstract
Background The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) has been recognized as a “best practice” in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project’s cost-effectiveness following a life-course approach. Methods We developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY), from a school system’s cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate. Results The incremental cost-effectiveness ratio(ICER) of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER < CA$50,000. In probabilistic sensitivity analysis, APPLE Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICER<CA$50,000, and more than 93% of the time when using a threshold of ICER<CA$100,000. Conclusion School-based health promotion, such as APPLE Schools is a cost-effective intervention for obesity prevention and reduction of chronic disease risk over the lifetime. Expanding the coverage and allocating resources towards school-based programs like the APPLE Schools program, is likely to reduce the public health burden of obesity and chronic diseases.
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Affiliation(s)
- John Paul Ekwaru
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Solmaz Setayeshgar
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey A. Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Paul J. Veugelers
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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14
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Lhachimi SK, Pega F, Heise TL, Fenton C, Gartlehner G, Griebler U, Sommer I, Pfinder M, Katikireddi SV. Taxation of the fat content of foods for reducing their consumption and preventing obesity or other adverse health outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Stefan K Lhachimi
- Leibniz Institute for Prevention Research and Epidemiology; Research Group for Evidence-Based Public Health; Achterstr. 30 Bremen Germany 28359
- University of Bremen; Institute for Public Health and Nursing Research, Health Sciences Bremen; Bibliotheksstr. 1 Bremen Germany 28359
| | - Frank Pega
- University of Otago; Public Health; 23A Mein Street, Newtown Wellington New Zealand 6242
| | - Thomas L Heise
- Leibniz Institute for Prevention Research and Epidemiology; Research Group for Evidence-Based Public Health; Achterstr. 30 Bremen Germany 28359
- University of Bremen; Institute for Public Health and Nursing Research, Health Sciences Bremen; Bibliotheksstr. 1 Bremen Germany 28359
| | - Candida Fenton
- University of Glasgow; MRC/CSO Social and Public Health Sciences Unit; 200 Renfield Street Glasgow UK G2 3QB
| | - Gerald Gartlehner
- Danube University Krems; Cochrane Austria; Dr.-Karl-Dorrek-Strasse 30 Krems Austria 3500
| | - Ursula Griebler
- Danube University Krems; Department for Evidence-based Medicine and Clinical Epidemiology; Dr.-Karl-Dorrek Str. 30 Krems Austria 3500
| | - Isolde Sommer
- Danube University Krems; Department for Evidence-based Medicine and Clinical Epidemiology; Dr.-Karl-Dorrek Str. 30 Krems Austria 3500
| | - Manuela Pfinder
- University of Bremen; Institute for Public Health and Nursing Research, Health Sciences Bremen; Bibliotheksstr. 1 Bremen Germany 28359
- AOK Baden-Württemberg; Department of Health Promotion/Occupational Health Management; Presselstr. 19 Stuttgart Baden-Württemberg Germany 70191
- University Hospital, University of Heidelberg; Department of General Practice and Health Services Research; Vossstrasse 2 Heidelberg Bremen Germany D-69115
| | - Srinivasa V Katikireddi
- University of Glasgow; MRC/CSO Social and Public Health Sciences Unit; 200 Renfield Street Glasgow UK G2 3QB
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15
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Heise TL, Katikireddi SV, Pega F, Gartlehner G, Fenton C, Griebler U, Sommer I, Pfinder M, Lhachimi SK. Taxation of sugar-sweetened beverages for reducing their consumption and preventing obesity or other adverse health outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012319] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Thomas L Heise
- University of Bremen; Institute for Public Health and Nursing Research, Health Sciences Bremen; Bibliothekstr. 1 Bremen Germany 28359
- Leibniz Institute for Prevention Research and Epidemiology; Research Group for Evidence-Based Public Health; Achterstr. 30 Bremen Germany 28359
| | | | - Frank Pega
- University of Otago; Public Health; 23A Mein Street, Newtown Wellington New Zealand 6242
| | - Gerald Gartlehner
- Danube University Krems; Cochrane Austria; Dr.-Karl-Dorrek-Strasse 30 Krems Austria 3500
| | - Candida Fenton
- University of Glasgow; MRC/CSO Social and Public Health Sciences Unit; Glasgow UK
| | - Ursula Griebler
- Danube University Krems; Department for Evidence-based Medicine and Clinical Epidemiology; Dr.-Karl-Dorrek Str. 30 Krems Austria 3500
| | - Isolde Sommer
- Danube University Krems; Department for Evidence-based Medicine and Clinical Epidemiology; Dr.-Karl-Dorrek Str. 30 Krems Austria 3500
| | - Manuela Pfinder
- University of Bremen; Institute for Public Health and Nursing Research, Health Sciences Bremen; Bibliothekstr. 1 Bremen Germany 28359
- Leibniz Institute for Prevention Research and Epidemiology; Research Group for Evidence-Based Public Health; Achterstr. 30 Bremen Germany 28359
- AOK Baden-Württemberg; Department of Health Promotion/Occupational Health Management; Presselstr. 19 Stuttgart Baden-Württemberg Germany 70191
| | - Stefan K Lhachimi
- University of Bremen; Institute for Public Health and Nursing Research, Health Sciences Bremen; Bibliothekstr. 1 Bremen Germany 28359
- Leibniz Institute for Prevention Research and Epidemiology; Research Group for Evidence-Based Public Health; Achterstr. 30 Bremen Germany 28359
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16
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Lhachimi SK, Nusselder WJ, Smit HA, Baili P, Bennett K, Fernández E, Kulik MC, Lobstein T, Pomerleau J, Boshuizen HC, Mackenbach JP. Potential health gains and health losses in eleven EU countries attainable through feasible prevalences of the life-style related risk factors alcohol, BMI, and smoking: a quantitative health impact assessment. BMC Public Health 2016; 16:734. [PMID: 27495151 PMCID: PMC4975898 DOI: 10.1186/s12889-016-3299-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 07/13/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Influencing the life-style risk-factors alcohol, body mass index (BMI), and smoking is an European Union (EU) wide objective of public health policy. The population-level health effects of these risk-factors depend on population specific characteristics and are difficult to quantify without dynamic population health models. METHODS For eleven countries-approx. 80 % of the EU-27 population-we used evidence from the publicly available DYNAMO-HIA data-set. For each country the age- and sex-specific risk-factor prevalence and the incidence, prevalence, and excess mortality of nine chronic diseases are utilized; including the corresponding relative risks linking risk-factor exposure causally to disease incidence and all-cause mortality. Applying the DYNAMO-HIA tool, we dynamically project the country-wise potential health gains and losses using feasible, i.e. observed elsewhere, risk-factor prevalence rates as benchmarks. The effects of the "worst practice", "best practice", and the currently observed risk-factor prevalence on population health are quantified and expected changes in life expectancy, morbidity-free life years, disease cases, and cumulative mortality are reported. RESULTS Applying the best practice smoking prevalence yields the largest gains in life expectancy with 0.4 years for males and 0.3 year for females (approx. 332,950 and 274,200 deaths postponed, respectively) while the worst practice smoking prevalence also leads to the largest losses with 0.7 years for males and 0.9 year for females (approx. 609,400 and 710,550 lives lost, respectively). Comparing morbidity-free life years, the best practice smoking prevalence shows the highest gains for males with 0.4 years (342,800 less disease cases), whereas for females the best practice BMI prevalence yields the largest gains with 0.7 years (1,075,200 less disease cases). CONCLUSION Smoking is still the risk-factor with the largest potential health gains. BMI, however, has comparatively large effects on morbidity. Future research should aim to improve knowledge of how policies can influence and shape individual and aggregated life-style-related risk-factor behavior.
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Affiliation(s)
- Stefan K. Lhachimi
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Research Group for Evidence Based Public Health, Institute for Public Health and Nursing, University Bremen & Leibniz Institute for Epidemiology and Prevention Research, Bremen, Germany
- Department of Statistics and Mathematical Modeling, Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Public Health, Heinrich Heine University, Duesseldorf, Germany
| | - Wilma J. Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henriette A. Smit
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Center for Prevention and Health Services Research (PZO), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Paolo Baili
- Descriptive Studies and Health Planning Unit, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity Centre for health sciences, St James’s Hospital, Dublin, Ireland
| | - Esteve Fernández
- Tobacco Control Unit, Institut Català d’Oncologia-IDIBELL, L’Hospitalet de Llobregat Barcelona, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Margarete C. Kulik
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Center for Prevention and Health Services Research (PZO), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Tim Lobstein
- IASO -the International Association for the Study of Obesity, IOTF -the International Obesity TaskForce, London, UK
| | - Joceline Pomerleau
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
| | - Hendriek C. Boshuizen
- Department of Statistics and Mathematical Modeling, Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Johan P. Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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Williams AJ, Wyatt KM, Williams CA, Logan S, Henley WE. Exploring the Potential of a School Impact on Pupil Weight Status: Exploratory Factor Analysis and Repeat Cross-Sectional Study of the National Child Measurement Programme. PLoS One 2015; 10:e0145128. [PMID: 26700027 PMCID: PMC4699206 DOI: 10.1371/journal.pone.0145128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/27/2015] [Indexed: 11/19/2022] Open
Abstract
Schools are common sites for obesity prevention interventions. Although many theories suggest that the school context influences weight status, there has been little empirical research. The objective of this study was to explore whether features of the school context were consistently and meaningfully associated with pupil weight status (overweight or obese). Exploratory factor analysis of routinely collected data on 319 primary schools in Devon, England, was used to identify possible school-based contextual factors. Repeated cross-sectional multilevel analysis of five years (2006/07-2010/11) of data from the National Child Measurement Programme was then used to test for consistent and meaningful associations. Four school-based contextual factors were derived which ranked schools according to deprivation, location, resource and prioritisation of physical activity. None of which were meaningfully and consistently associated with pupil weight status, across the five years. The lack of consistent associations between the factors and pupil weight status suggests that the school context is not inherently obesogenic. In contrast, incorporating findings from education research indicates that schools may be equalising weight status, and obesity prevention research, policy and practice might need to address what is happening outside schools and particularly during the school holidays.
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Affiliation(s)
- Andrew James Williams
- Farr Institute @ Scotland and Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 20 West Richmond Street, Edinburgh EH8 9DX, United Kingdom
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), South Cloisters, St. Luke’s Campus, Exeter EX1 2LU, United Kingdom
- Children’s Health and Exercise Research Centre, Sport and Health Sciences, St. Luke’s Campus, University of Exeter, Exeter, EX1 2LU, United Kingdom
| | - Katrina M. Wyatt
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), South Cloisters, St. Luke’s Campus, Exeter EX1 2LU, United Kingdom
| | - Craig A. Williams
- Children’s Health and Exercise Research Centre, Sport and Health Sciences, St. Luke’s Campus, University of Exeter, Exeter, EX1 2LU, United Kingdom
| | - Stuart Logan
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), South Cloisters, St. Luke’s Campus, Exeter EX1 2LU, United Kingdom
| | - William E. Henley
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), College House, St. Luke’s Campus, Exeter EX1 2LU, United Kingdom
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18
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Baranauskas MN, Johnson KE, Juvancic-Heltzel JA, Kappler RM, Richardson L, Jamieson S, Otterstetter R. Seven-site versus three-site method of body composition using BodyMetrix ultrasound compared to dual-energy X-ray absorptiometry. Clin Physiol Funct Imaging 2015; 37:317-321. [PMID: 26490540 DOI: 10.1111/cpf.12307] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 09/01/2015] [Indexed: 12/01/2022]
Abstract
Obesity is a steadily growing epidemic affecting all segments of the population including college-aged students. The weight gain that is evidenced amid the transitional stage of college years increases the risks associated with cardiovascular and metabolic diseases. The BodyMetrix® BX-2000 (ULTRA) using a seven-site method has been evaluated against dual-energy X-ray absorptiometry (DXA) for estimation of body composition, which has yielded conflicting results. To date, no studies have compared the three-site method Jackson and Pollock three-site method to DXA. PURPOSE The purpose of the study was twofold (i) to compare agreement between Jackson-Pollock seven site (JP7), Jackson-Pollock three site (JP3) and Pollock three site (P3) to predict body fat (%BF) using ULTRA and (ii) and to compare the three ULTRA methodologies against DXA. METHODS Seventy-six healthy college-aged subjects (ages = 22·08 ± 2·50 years) participated in this study. DXA and ULTRA body composition assessments were performed following manufacturer's instructions to estimate %BF. Paired sample t-tests were used to assess agreement between JP7, P3 and JP3. Additionally, a two-tailed sample t-test was performed by sex. ULTRA and DXA results were also performed for agreement and bivariate correlation. RESULTS No significant differences between JP7 and P3, P = 0·38, were observed. In males, no significant differences were observed between JP7 and P3, P = 0·18. Significant differences were observed in all other pairs, P≤0·001 and between ULTRA and DXA. CONCLUSIONS The Pollock 3-site method estimates body fat percentage with comparable accuracy to JP7 using ULTRA.
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Affiliation(s)
- Marissa N Baranauskas
- School of Sport Science and Wellness Education, The University of Akron, Akron, OH, USA
| | - Kelly E Johnson
- School of Sport Science and Wellness Education, The University of Akron, Akron, OH, USA.,Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | | | - Rachele M Kappler
- School of Sport Science and Wellness Education, The University of Akron, Akron, OH, USA
| | - Laura Richardson
- School of Sport Science and Wellness Education, The University of Akron, Akron, OH, USA
| | - Scott Jamieson
- School of Sport Science and Wellness Education, The University of Akron, Akron, OH, USA
| | - Ronald Otterstetter
- School of Sport Science and Wellness Education, The University of Akron, Akron, OH, USA
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19
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Childhood obesity: the impact on long-term risk of metabolic and CVD is not necessarily inevitable. Proc Nutr Soc 2014; 73:389-96. [DOI: 10.1017/s0029665114000111] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The worldwide prevalence of overweight and obesity in the adult population is estimated to be 35 %. These trends are reflected in childhood obesity prevalence, and the potential impact of early-onset obesity is of great concern. The aim of this review was to investigate the long-term implications of childhood obesity for metabolic and cardiovascular health, focusing on the independent contribution of childhood obesity to adult disease risk, as distinct from associations mediated by tracking of obesity across the lifespan. The data systematically reviewed provide little evidence to suggest that childhood overweight and obesity are independent risk factors for metabolic and cardiovascular risk during adulthood. Instead, the data demonstrate that the relationships observed are dependent on tracking of BMI between childhood and adulthood, alongside persistence of dietary patterns and physical activity. Adjustment for adult BMI uncovers unexpected negative associations between childhood BMI and adult disease, suggesting a protective effect of childhood obesity at any given level of adult BMI. Further work is required to explain these findings, both in terms of pathways and statistical artefacts. To conclude, it must be stressed that it is not suggested that childhood obesity is without negative consequence. Childhood obesity is clearly associated with a range of adverse physical and psychological outcomes. However, the data are important in supporting a positive message that the long-term consequences of childhood obesity are avoidable; and that there remains opportunity for intervention across the lifespan. This nuance in understanding long-term risk is important when considering the effectiveness of interventions at different stages of the lifespan.
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20
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Tran BX, Ohinmaa A, Kuhle S, Johnson JA, Veugelers PJ. Life course impact of school-based promotion of healthy eating and active living to prevent childhood obesity. PLoS One 2014; 9:e102242. [PMID: 25025581 PMCID: PMC4099303 DOI: 10.1371/journal.pone.0102242] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 06/17/2014] [Indexed: 11/18/2022] Open
Abstract
Background The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) is a comprehensive school health program that is proven feasible and effective in preventing obesity among school aged children. To support decision making on expanding this program, evidence on its long-term health and economic impacts is particularly critical. In the present study we estimate the life course impact of the APPLE Schools programs in terms of future body weights and avoided health care costs. Method We modeled growth rates of body mass index (BMI) using longitudinal data from the National Population Health Survey collected between 1996–2008. These growth rate characteristics were used to project BMI trajectories for students that attended APPLE Schools and for students who attended control schools (141 randomly selected schools) in the Canadian province of Alberta. Results Throughout the life course, the prevalence of overweight (including obesity) was 1.2% to 2.8% (1.7 on average) less among students attending APPLE Schools relative to their peers attending control schools. The life course prevalence of obesity was 0.4% to 1.4% (0.8% on average) less among APPLE Schools students. If the APPLE Schools program were to be scaled up, the potential cost savings would be $33 to 82 million per year for the province of Alberta, or $150 to 330 million per year for Canada. Conclusions These projected health and economic benefits seem to support broader implementation of school-based health promotion programs.
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Affiliation(s)
- Bach Xuan Tran
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Stefan Kuhle
- Department of Pediatrics, Obstetrics & Gynecology, Dalhousie University, Halifax, NS, Canada
| | - Jeffrey A. Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Paul J. Veugelers
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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