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Rissanen I, Nerg I, Oura P, Huikari S, Korhonen M. Productivity costs of lifelong smoking-the Northern Finland Birth Cohort 1966 study. Eur J Public Health 2024; 34:572-577. [PMID: 38552215 PMCID: PMC11161164 DOI: 10.1093/eurpub/ckae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Smoking is one of the leading causes of impaired health and mortality. Loss of paid and unpaid work and replacements due to morbidity and mortality result in productivity costs. Our aim was to investigate the productivity costs of lifelong smoking trajectories and cumulative exposure using advanced human capital method (HCM) and friction cost method (FCM). METHODS Within the Northern Finland Birth Cohort 1966 (NFBC1966), 10 650 persons were followed from antenatal period to age 55 years. The life course of smoking behaviour was assessed with trajectory modelling and cumulative exposure with pack-years. Productivity costs were estimated with advanced HCM and FCM models by using detailed, national register-based data on care, disability, mortality, education, taxation, occupation and labour market. A two-part regression model was used to predict productivity costs associated with lifelong smoking and cumulative exposure. RESULTS Of the six distinct smoking trajectories, lifetime smokers had the highest productivity costs followed by late starters, late adult quitters, young adult quitters and youth smokers. Never-smokers had the lowest productivity costs. The higher the number of pack-years, the higher the productivity costs. Uniform patterns were found in both men and women and when estimated with HCM and FCM. The findings were independent of other health behaviours. CONCLUSIONS Cumulative exposure to smoking is more crucial to productivity costs than starting or ending age of smoking. This suggests that the harmful effects of smoking depend on dose and duration of smoking and are irrespective of age when smoking occurred.
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Affiliation(s)
- Ina Rissanen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Iiro Nerg
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Economics, Oulu Business School, University of Oulu, Oulu, Finland
| | - Petteri Oura
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Sanna Huikari
- Department of Economics, Oulu Business School, University of Oulu, Oulu, Finland
| | - Marko Korhonen
- Department of Economics, Oulu Business School, University of Oulu, Oulu, Finland
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Bernard G, Paradis H, Côté S, Tremblay RE, Boivin M, Petitclerc A. The intergenerational continuity of alcohol use in a population sample. Addict Behav 2024; 152:107954. [PMID: 38301588 DOI: 10.1016/j.addbeh.2024.107954] [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: 09/27/2023] [Revised: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Research shows that parental alcohol use predicts youths' alcohol use, but this intergenerational continuity may vary across countries, and little is known about its moderators. This study examined for the first time the intergenerational continuity in alcohol use in a population sample of families in Canada, and tested whether it varied by youths' sex, family income, or family structure. METHODS We used prospective longitudinal data on 1632 families from the Quebec Longitudinal Study of Child Development (QLSCD), a representative sample from the province of Quebec, Canada. Youths self-reported alcohol use and binge drinking frequency at seven timepoints from early adolescence to early adulthood. Predictors were mothers' and fathers' self-reported alcohol use from youths' infancy through age 13, and mother-reported socioeconomic variables. RESULTS We identified three trajectories of alcohol use from ages 13 to 21 years: normative, late-onset and early-onset. Maternal alcohol use increased the youths' risk of following the early-onset trajectory of alcohol use, while both parents' alcohol use decreased the odds of the youths following the late-onset trajectory, compared to the normative trajectory. Insufficient family income increased youths' risk of following either the early-onset or late-onset trajectories. Mothers' and fathers' alcohol use did not interact in predicting youths' trajectory, and we found no moderating effects of the youths' sex, insufficient income, or years as a single-parent family. CONCLUSION The results suggest modest intergenerational continuity of alcohol use in Quebec families which may be used, with income insufficiency, to help identify at-risk children for targeted interventions.
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Affiliation(s)
| | | | - Sylvana Côté
- Université de Montréal, École de santé publique - Département de médecine sociale et préventive, Canada.
| | - Richard E Tremblay
- Université de Montréal, Faculté de médecine - Département de pédiatrie, Canada.
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Holma P, Pesonen P, Karjalainen MK, Järvelin MR, Väyrynen S, Sliz E, Heikkilä A, Seppänen MRJ, Kettunen J, Auvinen J, Hautala T. Low and high serum IgG associates with respiratory infections in a young and working age population. EBioMedicine 2023; 94:104712. [PMID: 37453363 PMCID: PMC10366395 DOI: 10.1016/j.ebiom.2023.104712] [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: 03/16/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND We investigated health consequences and genetic properties associated with serum IgG concentration in a young and working age general population. METHODS Northern Finland Birth Cohort 1966 (NFBC1966, n = 12,231) health data have been collected from birth to 52 years of age. Relationships between life-long health events, medications, chronic conditions, lifestyle, and serum IgG concentration measured at age 46 years (n = 5430) were analysed. Regulatory mechanisms of serum IgG concentration were considered. FINDINGS Smoking and genetic variation (FCGR2B and TNFRSF13B) were the most important determinants of serum IgG concentration. Laboratory findings suggestive of common variable immunodeficiency (CVID) were 10-fold higher compared to previous reports (73.7 per 100,000 vs 0.6-6.9 per 100,000). Low IgG was associated with antibiotic use (relative risk 1.285, 95% CI 1.001-1.648; p = 0.049) and sinus surgery (relative risk 2.257, 95% CI 1.163-4.379; p = 0.016). High serum IgG was associated with at least one pneumonia episode (relative risk 1.737, 95% CI 1.032-2.922; p = 0.038) and with total number of pneumonia episodes (relative risk 2.167, 95% CI 1.443-3.254; p < 0.001). INTERPRETATION CVID-like laboratory findings are surprisingly common in our unselected study population. Any deviation of serum IgG from normal values can be harmful; both low and high serum IgG may indicate immunological insufficiency. Critical evaluation of clinical presentation must accompany immunological laboratory parameters. FUNDING Oulu University Hospital VTR, CSL Behring, Foundation for Pediatric Research.
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Affiliation(s)
- Pia Holma
- Research Unit of Internal Medicine and Biomedicine, University of Oulu and Oulu University Hospital, Division of Infectious Diseases, Oulu, Finland
| | - Paula Pesonen
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Minna K Karjalainen
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland; Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Epidemiology and Biostatistics, MRC Center for Environment & Health, School of Public Health, Imperial College London, London, UK
| | - Sara Väyrynen
- Research Unit of Internal Medicine and Biomedicine, University of Oulu and Oulu University Hospital, Division of Infectious Diseases, Oulu, Finland
| | - Eeva Sliz
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Anni Heikkilä
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mikko R J Seppänen
- Rare Disease Center and Pediatric Research Center, Children and Adolescents, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Johannes Kettunen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Timo Hautala
- Research Unit of Internal Medicine and Biomedicine, University of Oulu and Oulu University Hospital, Division of Infectious Diseases, Oulu, Finland.
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Cáceres-Matos R, Gil-García E, Vázquez-Santiago S, Cabrera-León A. Alcohol, Tobacco and Psychotropic Drugs Use Among a Population with Chronic Pain in Southern Spain. A Cross-Sectional Study. Pain Manag Nurs 2022; 23:494-503. [PMID: 34857475 DOI: 10.1016/j.pmn.2021.10.006] [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: 04/14/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Substance use seems to be higher among populations with chronic pain. AIM The aim of this study is to examine the relationship between the quantity of alcohol, tobacco, and psychotropic drugs consumed and chronic pain among women and men. METHOD Linear and logistic regression analyses were carried out using data from the 2015-2016 adults' version of the Andalusian Health Survey which is a representative cross-sectional population-based study (n = 6,569 adults aged >16 years; 50.8% women; 49.2% men). RESULTS Disabling chronic pain was statistically associated with higher tobacco consumption among men (β = -30.0, 95% confidenct interval [CI] -59.5 to -0.60; t = -2.0; p < .05). Regarding alcohol, non-disabling chronic pain and a higher quantity of alcohol consumed are statistically associated for both sexes (women: β = 30.4, 95% CI 2.3-58.6; t = 2.12; p < .05 vs. men: β = 164.2, 95% CI 24.3-340.1); t = 2.30; p < .05). For women and men, both disabling chronic pain (women: odds ratio [OR] = 8.7, 95% CI 6.0-12.7); p < .05 vs. men: OR = 3.5, 95% CI 1.5-8.2); p < .05) and non-disabling chronic pain (women: OR = 3.7, 95% CI 2.0-7.0); p <.05 vs. men: OR = 4.7, 95% CI 95% CI 1.5-14.9); p < .05) were statistically significantly associated with a higher consumption of psychotropic drugs. CONCLUSIONS Chronic pain may be related to the quantity of alcohol, tobacco, and psychotropic drugs consumed, and disability appears to be one of the factors that modulates this relationship.
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Affiliation(s)
| | | | | | - Andrés Cabrera-León
- Andalusian School of Public Health, Granada, Spain; Biomedical Research Consortium in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain.
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Holma P, Pesonen P, Mustonen O, Järvelin MR, Kauma H, Auvinen J, Hautala T. 52-year follow-up of a birth cohort reveals a high pneumonia incidence among young men. ERJ Open Res 2022; 8:00707-2021. [PMID: 35769422 PMCID: PMC9234435 DOI: 10.1183/23120541.00707-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/02/2022] [Indexed: 11/05/2022] Open
Abstract
Background Knowledge of pneumonia incidence and risk factors in adults is mainly based on clinical studies of selected patient data and registers with ageing populations. Prospective population-based investigations, such as birth cohort studies, are needed to understand pneumonia incidence and risk factors among young and working-age populations. Methods Northern Finland Birth Cohort (NFBC) 1966 data (n=6750) were analysed for pneumonia incidence and risk factors. Incidence analysis was replicated using data from an independent NFBC 1986 cohort (n=9207). Pneumonia in relation to chronic conditions and lifestyle factors was analysed. Results A peak with a maximum of 227 pneumonia episodes per 10 000 among men between the ages of 19 and 21 years was found in two independent cohorts. Pneumonia was associated with male sex (relative risk 1.72, 95% CI 1.45-2.04; p<0.001), low educational level (relative risk 2.30, 95% CI 1.72-3.09; p<0.001), smoking (relative risk 1.55, 95% CI 1.31-1.84; p<0.001), asthma (relative risk 2.19, 95% CI 1.73-2.75; p<0.001), cardiovascular diseases (relative risk 2.50, 95% CI 2.04-3.07; p=0.001), kidney diseases (relative risk 4.14, 95% CI 2.81-6.10; p<0.001), rheumatoid arthritis (relative risk 2.69, 95% CI 1.80-4.01; p<0.001), psoriasis (relative risk 2.91, 95% CI 1.92-4.41; p<0.001) and type II diabetes (relative risk 1.80, 95% CI 1.34-2.42; p<0.001). Men with excessive alcohol consumption at age 31 years were at risk of future pneumonia (relative risk 2.40, 95% CI 1.58-3.64; p<0.001). Conclusions Birth cohort data can reveal novel high-risk subpopulations, such as young males. Our study provides understanding of pneumonia incidence and risk factors among young and working age populations.
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Affiliation(s)
- Pia Holma
- Research Unit of Internal Medicine, Dept of Internal Medicine, Division of Infectious Diseases, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Paula Pesonen
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Olli Mustonen
- Research Unit of Internal Medicine, Dept of Internal Medicine, Division of Infectious Diseases, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Dept of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health, Imperial College London, London, UK
- Center for Life Course Health Research, University of Oulu, Unit of Primary Care, Oulu University Hospital, Oulu, Finland
- Dept of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Heikki Kauma
- Research Unit of Internal Medicine, Dept of Internal Medicine, Division of Infectious Diseases, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Timo Hautala
- Research Unit of Internal Medicine, Dept of Internal Medicine, Division of Infectious Diseases, University of Oulu and Oulu University Hospital, Oulu, Finland
- Research Unit of Biomedicine, University of Oulu, Oulu, Finland
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Rotonen S, Auvinen J, Bloigu A, Härkönen P, Jokelainen J, Timonen M, Keinänen-Kiukaanniemi S. Long-term dysglycemia as a risk factor for faster cognitive decline during aging: A 12-year follow-up study. Diabetes Res Clin Pract 2021; 180:109045. [PMID: 34508737 DOI: 10.1016/j.diabres.2021.109045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/18/2021] [Accepted: 09/06/2021] [Indexed: 12/01/2022]
Abstract
AIMS This longitudinal study evaluated associations between glucose metabolism and cognitive performance during a 12-year follow-up. METHODS We included 714 subjects, which were followedfrom the age 55 to 70 years. Using oral glucose tolerance tests the population was classified as normoglycemic (NGT) and based on WHO diagnostic criteria for diabetes and prediabetes. Cognitive performance was assessed with a verbal fluency (category) test and wordlist learning tests of CERAD-nb, a verbal fluency (letter) test, and trail-making tests A and B. RESULTS Compared to the normal group subjects with long-lasting prediabetes showed significantly greater decline (4.6 versus 2.9 words) on the verbal fluency (category) test (p = 0.041); subjects with long-lasting type 2 diabetes showed significantly greater decline (13 versus 6 s) on the trail making A test (p = 0.021) and on the wordlist learning test (3.3 versus 1.7 words) (p = 0.013); and a combined group of subjects with prediabetes or incident type 2 diabetes showed significantly greater cognitive decline (3.8 versus 2.9 words) in the verbal fluency (category) test (p = 0.039). CONCLUSION Prediabetes was associated with cognitive decline during aging. This finding should be incorporated into prevention strategies, because both type 2 diabetes and dementia are increasing world-wide.
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Affiliation(s)
- Sanna Rotonen
- Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland; Oulunkaari Health Center, Ii, Finland.
| | - Juha Auvinen
- Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Aini Bloigu
- Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland
| | - Pirjo Härkönen
- Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland
| | - Jari Jokelainen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Finland; Unit of Primary Care, Oulu University Hospital and Medical Research Center Oulu, Oulu, Finland
| | - Markku Timonen
- Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland; Unit of Primary Care, Oulu University Hospital and Medical Research Center Oulu, Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland; Unit of Primary Care, Oulu University Hospital and Medical Research Center Oulu, Oulu, Finland; Healthcare and Social Services of Selänne, Pyhäjärvi, Finland
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Skourlis N, Massara P, Patsis I, Peppa E, Katsouyanni K, Trichopoulou A. Long-Term Trends (1994-2011) and Predictors of Total Alcohol and Alcoholic Beverages Consumption: The EPIC Greece Cohort. Nutrients 2021; 13:3077. [PMID: 34578956 PMCID: PMC8469614 DOI: 10.3390/nu13093077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 01/21/2023] Open
Abstract
The aim of this study was to evaluate the longitudinal changes in alcohol consumption (total alcohol and types of alcoholic beverages) of the Greek EPIC cohort participants (28,572) during a 17-year period (1994-2011), with alcohol information being recorded repeatedly over time. Descriptive statistics were used to show crude trends in drinking behavior. Mixed-effects models were used to study the consumption of total alcohol, wine, beer and spirits/other alcoholic beverages in relation to birth cohort, socio-demographic, lifestyle and health factors. We observed a decreasing trend of alcohol intake as age increased, consistent for total alcohol consumption and the three types of beverages. Older birth cohorts had lower initial total alcohol consumption (8 vs. 10 g/day) and steeper decline in wine, spirits/other alcoholic beverages and total alcohol consumption compared to younger cohorts. Higher education and smoking at baseline had a positive association with longitudinal total alcohol consumption, up to +30% (vs. low education) and more than +25% (vs. non-smoking) respectively, whereas female gender, obesity, history of heart attack, diabetes, peptic ulcer and high blood pressure at baseline had a negative association of -85%, -25%, -16%, -37%, -22% and -24% respectively. Alcohol consumption changed over age with different trends among the studied subgroups and types of alcohol, suggesting targeted monitoring of alcohol consumption.
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Affiliation(s)
- Nikolaos Skourlis
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece; (P.M.); (I.P.); (E.P.); (K.K.); (A.T.)
| | - Paraskevi Massara
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece; (P.M.); (I.P.); (E.P.); (K.K.); (A.T.)
| | - Ioannis Patsis
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece; (P.M.); (I.P.); (E.P.); (K.K.); (A.T.)
| | - Eleni Peppa
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece; (P.M.); (I.P.); (E.P.); (K.K.); (A.T.)
| | - Klea Katsouyanni
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece; (P.M.); (I.P.); (E.P.); (K.K.); (A.T.)
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece; (P.M.); (I.P.); (E.P.); (K.K.); (A.T.)
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Rissanen I, Paananen M, Harju T, Miettunen J, Oura P. Maternal smoking trajectory during pregnancy predicts offspring's smoking and substance use - The Northern Finland birth cohort 1966 study. Prev Med Rep 2021; 23:101467. [PMID: 34194967 PMCID: PMC8237583 DOI: 10.1016/j.pmedr.2021.101467] [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: 02/28/2021] [Revised: 05/25/2021] [Accepted: 06/17/2021] [Indexed: 01/01/2023] Open
Abstract
The aim was to characterize the association of maternal smoking trajectory during pregnancy with offspring's smoking, alcohol and substance use behavior. We used the prospective Northern Finland Birth Cohort 1966 study including 11,653 mothers and their offspring followed up from mothers' mid-pregnancy to age of 46 years. Main exposure was number of smoked cigarettes per day at each month of pregnancy. Outcome measures were offspring's smoking, alcohol and drug use at age 14, starting age of smoking, ever-smoking, and smoked pack-years until age 46. Four maternal smoking trajectories during pregnancy were identified with latent class trajectory modelling, namely "non-smokers" (86.0% of mothers), "early quitters" (2.0%), "late quitters" (2.1%), and "consistent smokers" (9.9%). In comparison to non-smokers, all maternal smoking was associated with offspring's increased odds of lifetime smoking adjusted for sex of the child, father's smoking, occupational status and place of residence of family, marital status and mood of mother, and desirability of pregnancy. The consistent smoker's class was associated with offspring's number of smoked pack years by midlife (median [interquartile range]: 8.3 [1.4-17.4] vs. 4.8 [0.0-13.0], p = 0.028), and alcohol use in young age (odds ratio 1.23 [95% confidence interval 1.05-1.43]). Overall, to prevent parent-offspring transmission of smoking, the cessation support should target women planning pregnancy. Negative effects of maternal continuous smoking during pregnancy include all substance use and reach up to offspring's middle age.
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Affiliation(s)
- Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.,Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Markus Paananen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Terttu Harju
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Petteri Oura
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Ikonen H, Lumme J, Seppälä J, Pesonen P, Piltonen T, Järvelin MR, Herzig KH, Miettunen J, Niinimäki M, Palaniswamy S, Sebert S, Ojaniemi M. The determinants and longitudinal changes in vitamin D status in middle-age: a Northern Finland Birth Cohort 1966 study. Eur J Nutr 2021; 60:4541-4553. [PMID: 34137914 PMCID: PMC8572212 DOI: 10.1007/s00394-021-02606-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Populations living in the Nordic countries are at high risk for vitamin D (VitD) deficiency or insufficiency. To reduce the risk, nationwide interventions based on food fortification and supplementation are being implemented. However, there is limited evidence about the impact of such public health campaigns on target populations. METHODS We studied an unselected sample of 3650 participants (56.2% females) from the longitudinal Northern Finland Birth Cohort 1966 with repeated measures of serum 25-hydroxyvitamin D [25(OH)D] at ages 31 (1997) and 46 (2012-2013). Timepoints corresponded to the period before and during the food fortification. We examined the effect of VitD intake from the diet and supplementation, body mass index and previous 25(OH)D concentration on 25(OH)D concentration at 46 years using a multivariable linear regression analysis. A 25(OH)D z score adjusted for sex, season, latitude and technical effect was used in the analysis. RESULTS We observed an increase of 10.6 nmol/L in 25(OH)D, when the baseline 25(OH)D was 54.3 nmol/L. The prevalence of serum 25(OH)D below < 50 nmol/L was halved. The changes were found for both sexes and were more pronounced in winter compared to summer months. Regular VitD supplementation had a significant positive effect on 25(OH)D at the age of 46, as well as had the dietary intake of fortified dairy products and fish, and the previous 25(OH)D concentration. However, the intake of fat-spreads albeit VitD-fortified, did not predict 25(OH)D. CONCLUSION Our results demonstrated the positive impact of the fortification programme on VitD status in middle-aged population.
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Affiliation(s)
- Helmi Ikonen
- Center for Life-Course Health Research, Faculty of Medicine, University of Oulu, 90014, Oulu, Finland
| | - Johanna Lumme
- PEDEGO Research Unit, University of Oulu, 90014, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014, Oulu, Finland.,Department of Obstetrics and Gynecology, Oulu University Hospital, 90220, Oulu, Finland
| | - Jussi Seppälä
- Center for Life-Course Health Research, Faculty of Medicine, University of Oulu, 90014, Oulu, Finland.,Department of Mental and Substance Use Disorders, South Carelia Social and Healthcare District, 53130, Lappeenranta, Finland.,Social Insurance Institute of Finland, 70 110, Kuopio, Finland
| | - Paula Pesonen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90014, Oulu, Finland
| | - Terhi Piltonen
- PEDEGO Research Unit, University of Oulu, 90014, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014, Oulu, Finland.,Department of Obstetrics and Gynecology, Oulu University Hospital, 90220, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Center for Life-Course Health Research, Faculty of Medicine, University of Oulu, 90014, Oulu, Finland. .,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, London, W2 1PG, UK. .,Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, Middlesex, UK. .,Unit of Primary Care, Oulu University Hospital, 90220, Oulu, Finland.
| | - Karl-Heinz Herzig
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014, Oulu, Finland.,Institute of Biomedicine, Medical Research Center, University of Oulu, 90014, Oulu, Finland.,Institute of Pediatrics, Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 60-572, Poznań, Poland
| | - Jouko Miettunen
- Center for Life-Course Health Research, Faculty of Medicine, University of Oulu, 90014, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014, Oulu, Finland
| | - Maarit Niinimäki
- PEDEGO Research Unit, University of Oulu, 90014, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014, Oulu, Finland.,Department of Obstetrics and Gynecology, Oulu University Hospital, 90220, Oulu, Finland
| | - Saranya Palaniswamy
- Center for Life-Course Health Research, Faculty of Medicine, University of Oulu, 90014, Oulu, Finland.,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, London, W2 1PG, UK
| | - Sylvain Sebert
- Center for Life-Course Health Research, Faculty of Medicine, University of Oulu, 90014, Oulu, Finland.
| | - Marja Ojaniemi
- PEDEGO Research Unit, University of Oulu, 90014, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014, Oulu, Finland.,Department of Pediatrics and Adolescence, Oulu University Hospital, 90220, Oulu, Finland
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10
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Rissanen I, Oura P, Paananen M, Miettunen J, Geerlings MI. Smoking trajectories and risk of stroke until age of 50 years - The Northern Finland Birth Cohort 1966. PLoS One 2019; 14:e0225909. [PMID: 31846462 PMCID: PMC6917292 DOI: 10.1371/journal.pone.0225909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022] Open
Abstract
Background Smoking is a well-known risk factor for stroke. However, the relationship between smoking trajectories during the life course and stroke is not known. Aims We aimed to study the association of smoking trajectories and smoked pack-years with risk of ischemic and haemorrhagic strokes in a population-based birth cohort followed up to 50 years of age. Methods Within the Northern Finland Birth Cohort 1966, 11,999 persons were followed from antenatal period to age 50 years. The smoking behaviour was assessed with postal questionnaires at ages 14, 31 and 46 years. Stroke diagnoses were collected from nationwide registers using unique study number linkage. The associations between smoking behaviour and stroke risk were estimated using Cox regression models. Results Six different patterns in smoking habits throughout the life course were found in trajectory modelling. During 542,140 person-years of follow-up, 352 (2.9%) persons had a stroke. Continuous smoking during the life course was associated with increased stroke risk (HR = 1.69; 95% CI 1.10–2.60) after adjusting for sex, educational level, family history of strokes, leisure-time physical activity, body mass index, alcohol consumption, hypertension, hypercholesterolemia, and diabetes. Per every smoked pack-year the stroke risk increased 1.04-fold (95% CI 1.03–1.06). Other smoking trajectories were not significantly associated with stroke risk, nor were starting or ending age of smoking. Conclusion Accumulation of smoking history is associated with increased risk of stroke until age of 50 years. The increased stroke risk does not depend on the age at which smoking started. Given that the majority starts smoking at young age, primary prevention of strokes should focus on adolescent smoking.
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Affiliation(s)
- Ina Rissanen
- Department of Neurology, Oulu University Hospital, Oulu, Finland
- Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- * E-mail:
| | - Petteri Oura
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- The Center For Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Markus Paananen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- The Center For Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- The Center For Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mirjam I. Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
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11
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Vladimirov D, Niemelä S, Keinänen-Kiukaanniemi S, Ala-Mursula L, Auvinen J, Timonen M, Miettunen J. Cloninger's Temperament Dimensions and Longitudinal Alcohol Use in Early Midlife: A Northern Finland Birth Cohort 1966 Study. Alcohol Clin Exp Res 2018; 42:1924-1932. [PMID: 30063251 DOI: 10.1111/acer.13857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/27/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Temperament is theorized to be an important factor contributing to the development of alcohol use disorder, but longitudinal studies on how temperament is related to alcohol use among general population in midlife are scarce. Our aims were to investigate potentially reciprocal associations between temperament and changes in alcohol use from age 31 to 46 using prospective birth cohort data. METHOD Within the Northern Finland Birth Cohort 1966, alcohol use and temperament were studied at ages 31 and 46. Participants (N = 5,274) were classified into moderate users, abstainers and heavy users based on their mean alcohol use (g/d). Additionally, participants were categorized as steady users, reducers, or increasers. Multinomial regression analyses were conducted with Cloninger's Temperament and Character Inventory (TCI) scores as factors influencing alcohol use using moderate and stable users as reference groups. Reciprocity of relations was assessed with cross-lagged structural equation modeling. RESULTS Temperament and alcohol use are rather stable in midlife. Novelty seeking (NS) predicted heavy use (OR = 1.4; CI: 1.3 to 1.6 for men, OR = 1.3; CI: 1.1 to 1.5 for women) and increasing use (OR = 1.2; CI: 1.1 to 1.4 for men, OR = 1.1; CI: 1.0 to 1.3 for women), whereas low NS predicted abstaining among women (OR = 0.7; CI: 0.6 to 0.8). High harm avoidance (HA) predicted abstaining (OR = 1.3; CI: 1.1 to 1.5) for men. Low persistence (P) among men predicted both abstaining (OR = 0.9; CI: 0.7 to 0.98) and heavy use (OR = 0.9; CI: 0.8 to 0.98). Among women, low reward dependence (RD) predicted heavy use (OR = 0.8; CI: 0.7 to 0.9). Among TCI scores, only NS predicted increasing use in the cross-lagged models. CONCLUSIONS Temperament has an impact on alcohol use in midlife. Of the TCI dimensions, only NS seems to predispose to increased alcohol use and problem use throughout life. Additionally, RD among women and P among men are significant factors from a life-course perspective. Our results did not support Cloninger's theory on type I alcoholism, as HA showed no relation to problematic alcohol use in midlife.
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Affiliation(s)
- Daniel Vladimirov
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Solja Niemelä
- Research Unit of Clinical Neurosciences, University of Oulu, Oulu, Finland
| | | | - Leena Ala-Mursula
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Markku Timonen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
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12
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Saitz R, Heeren TC, Zha W, Hingson R. Transitions To and From At-Risk Alcohol Use in Adults in the United States. JOURNAL OF SUBSTANCE USE 2018; 24:41-46. [PMID: 30559602 DOI: 10.1080/14659891.2018.1497101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction The objective of this research was to study transitions to and from at-risk alcohol use. Methods Logistic regression analyses (done 2015-2016) assessed transitions to and from past-year at-risk drinking in a representative sample of U.S. adults surveyed twice (in 2001-2 and 2004-5). Results Among 34,653 adults, 28% reported at-risk use at time 1. Of those, 73% had at-risk use at time 2. Of those without at-risk use at time 1, 15% reported at-risk use at time 2. Positive high-risk drinking transition predictors were, at time 1, being young, male, white, childless, in good to excellent health, ever smoking, using drugs, military membership (time 1 but not 2), and becoming divorced or separated by time 2. Positive low-risk drinking transition predictors were being elderly (age ≥65), female, non-white, never smoking or using drugs, no alcohol use disorder, alcohol treatment, and, after time 1, having children. Conclusions Many adults transition to and from at-risk alcohol use; youth is the strongest positive predictor of transition to at-risk and not transitioning to low-risk drinking. Persons transitioning to legal drinking age are most likely to transition to high-risk and least likely to low-risk drinking.
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Affiliation(s)
- Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health; Clinical Addiction Research and Education Unit, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Wenxing Zha
- Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
| | - Ralph Hingson
- Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
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13
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Kenney SR, Anderson BJ, Stein MD. Drinking to cope mediates the relationship between depression and alcohol risk: Different pathways for college and non-college young adults. Addict Behav 2018; 80:116-123. [PMID: 29407681 DOI: 10.1016/j.addbeh.2018.01.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is well-established that drinking to cope with negative affective states mediates the relationship between depressed mood and alcohol risk outcomes among college students. Whether non-college emerging adults exhibit a similar pathway remains unknown. In the current study, we compared the mediating role of coping motives in the relationship between depressive symptoms and drinking risk outcomes (heavy episodic drinking and alcohol problems) in college and non-college emerging adult subgroups. METHODS Participants were three hundred forty-one community-recruited 18-25year olds reporting past month alcohol use. We used a structural equation modeling (SEM) for our primary mediation analysis and bias-corrected bootstrap resampling for testing the statistical significance of mediation. RESULTS Participants averaged 20.8 (±1.97) years of age, 49% were female, 67.7% were White, 34.6% were college students, and 65.4% were non-college emerging adults. College and non-college emerging adults reported similar levels of drinking, alcohol problems, and drinking to cope with negative affect, and drinking to cope was associated with alcohol-related problems in both samples. However, while drinking to cope mediated the relationship between depressed mood and alcohol problems among students, it did not mediate the pathway among non-college emerging adults. CONCLUSIONS These findings caution against extending college-based findings to non-college populations and underscore the need to better understand the role of coping motives and other intervening factors in pathways linking depressed mood and alcohol-related risk in non-college emerging adults.
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Affiliation(s)
- Shannon R Kenney
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States; Warren Alpert Medical School, Brown University, Providence, RI 02912, United States.
| | - Bradley J Anderson
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States
| | - Michael D Stein
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States; Boston University School of Public Health, Boston, MA 02118, United States
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14
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Berg N, Kiviruusu O, Huurre T, Lintonen T, Virtanen P, Hammarström A. Associations between unemployment and heavy episodic drinking from adolescence to midlife in Sweden and Finland. Eur J Public Health 2018; 28:258-263. [PMID: 29240887 DOI: 10.1093/eurpub/ckx207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Unemployment and alcohol use have often been found to correlate and to act as risk factors for each other. However, only few studies have examined these associations at longitudinal settings extending over several life phases. Moreover, previous studies have mostly used total consumption or medical diagnoses as the indicator, whereas subclinical measures of harmful alcohol use, such as heavy episodic drinking (HED), have been used rarely. The aim of this study was to examine the associations between HED and unemployment from adolescence to midlife in two Nordic countries. Methods Participants of separate cohort studies from Sweden and Finland were recruited at age 16 in 1981/1983 and followed up at ages 21/22, 30/32 and 43/42, (n = 1080/2194), respectively. Cross-lagged autoregressive models were used to determine associations between HED and unemployment. Results In the Swedish cohort, HED at ages 16 and 30 in men and HED at age 21 in women were associated with subsequent unemployment. In the Finnish cohort, we found corresponding associations at age 16 in women and at age 22 in men. However, the gender differences were not statistically significant. The associations from unemployment to HED were non-significant in both genders, in both cohorts and at all ages. Conclusions Our results suggest that heavy drinkers are more likely to experience unemployment in subsequent years. The associations from HED to unemployment seem to exist through the life course from adolescence to midlife. More emphasis should be put on reducing alcohol related harms in order to improve labour-market outcomes.
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Affiliation(s)
- Noora Berg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Olli Kiviruusu
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Taina Huurre
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.,Department of Health and Social Welfare, City of Vantaa, Vantaa, Finland
| | - Tomi Lintonen
- Finnish Foundation for Alcohol Studies, Helsinki, Finland.,Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland
| | - Pekka Virtanen
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland
| | - Anne Hammarström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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15
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The prevalence of and factors associated with high-risk alcohol consumption in Korean adults: The 2009-2011 Korea National Health and Nutrition Examination Survey. PLoS One 2017; 12:e0175299. [PMID: 28384270 PMCID: PMC5383276 DOI: 10.1371/journal.pone.0175299] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/23/2017] [Indexed: 01/08/2023] Open
Abstract
Background The consequences of alcohol consumption on health outcomes are largely determined by two separate, but related, dimensions of drinking: the total volume of alcohol consumed and the pattern of drinking. Most epidemiological studies focus on the amount of alcohol consumed and do not consider the pattern of drinking. Objectives This study evaluated the prevalence of and factors associated with high-risk and heavy alcohol drinking in Korean adults. Methods This study analyzed 15,215 of the 28,009 participants in the 2009–2011 Korea National Health and Nutrition Examination Survey (KNHANES). High-risk alcohol drinking was defined as Alcohol Use Disorders Identification Test (AUDIT) scores ≥16, which provides a framework for intervention to identify hazardous and harmful drinking patterns as the cause of alcohol-use disorders, according to World Health Organization guidelines. Results The prevalence of high-risk drinking was 15.1%, with the highest prevalence of 17.2% in middle-aged adults (45–64 years). In men, the prevalence of high-risk alcohol drinking was 23.7%, with the highest prevalence found in middle-aged adults. In women, the prevalence of high-risk alcohol drinking was 4.2%, with the highest prevalence found in younger adults. Men had higher weighted mean AUDIT scores than women (10.0 vs. 4.0, P<0.001), and age was negatively associated with the AUDIT score (P<0.001). Elementary school graduates had higher mean AUDIT scores than senior high school (P = 0.003) or college (P<0.001) graduates. Regarding occupation, clerical support workers (P = 0.002) and service and sales workers (P<0.001) had higher mean AUDIT scores than managers and professionals. Logistic regression analyses of high-risk alcohol drinking using sex, age, education level, number of family members, household income, and occupation as covariates was performed. Women had a lower risk of high-risk alcohol drinking (odds ratio (OR) 0.14, 95% CI: 0.13–0.16, P<0.001) than men. Regarding age, compared to control subjects aged 19–29 years, adults aged 60–69 and older than 70 years had 0.67- (95% CI: 0.51–0.89, P = 0.005) and 0.29-fold (95% CI: 0.20–0.70, P<0.001) lower risks, respectively, of high-risk alcohol drinking, whereas adults aged 30–59 had an increased risk of high-risk alcohol drinking. Using elementary school graduates as controls, senior high school (OR: 0.70, 95% CI: 0.55–0.87, P = 0.002) and college (OR: 0.54, 95% CI: 0.42–0. 70, P<0.001) graduates had lower risks of high-risk alcohol drinking. Regarding occupation, compared to managers and professionals as controls, service and sales workers had a greater risk of high-risk alcohol drinking (OR: 1.36, 95% CI: 1.07–1.73, P = 0.011). The number of family members and household income did not influence high-risk alcohol drinking. Conclusions In a representative sample of Korean adults, the prevalence of high-risk alcohol drinking was 15.1%, with the highest prevalence of 28.3% found in middle-aged men (45–64 years). This study suggests that younger age, male sex, low education level, and service and sales workers are at risk for a high-risk drinking pattern.
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16
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Lima Passos V, Klijn S, van Zandvoort K, Abidi L, Lemmens P. At the heart of the problem - A person-centred, developmental perspective on the link between alcohol consumption and cardio-vascular events. Int J Cardiol 2017; 232:304-314. [DOI: 10.1016/j.ijcard.2016.12.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/30/2016] [Accepted: 12/17/2016] [Indexed: 01/03/2023]
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