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Ervasti J, Pentti J, Aalto V, Kauppi M, Virtanen M, Kivimäki M, Vahtera J. Association of school neighbourhood socioeconomic disadvantage and teaching staff's risk of violence at work. Scand J Public Health 2024:14034948241252232. [PMID: 38855845 DOI: 10.1177/14034948241252232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
AIM The aim of this study was to determine the association between neighbourhood socioeconomic disadvantage and teaching staff's risk of workplace violence and whether workplace psychosocial resources can act as effect modifiers. METHODS Primary school teaching staff in the six largest cities in Finland responded to a survey in 2018 and were linked to information on school neighbourhood disadvantage obtained from the national grid database (n = 3984). RESULTS After adjustment for confounders, staff working in schools located in the most disadvantaged neighbourhoods had a 1.2-fold (95% confidence interval 1.07-1.35) risk of encountering violence or threat of violence compared with staff working in the most advantaged neighbourhoods. The association was less marked in schools with strong support from colleagues (risk ratio 1.14, 95% confidence interval (95% CI) 0.98-1.32 for high support versus 1.23, 95% CI 1.07-1.43 for low/intermediate support), a strong culture of collaboration (1.08, 95% CI 0.93-1.26 versus 1.31, 95% CI 1.12-1.53), high leadership quality (1.12, 95% CI 0.96-1.31 versus 1.29, 95% CI 1.08-1.54), and high organizational justice (1.09, 95% CI 0.91-1.32 versus 1.29, 95% CI 1.09-1.52). CONCLUSIONS The association between school neighbourhood and teaching staff's risk of violence was weaker in schools with high workplace psychosocial resources, suggesting that targeting these factors might help in minimizing violence at schools, but future intervention studies are needed to confirm or refute this hypothesis.
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Affiliation(s)
- Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jaana Pentti
- Finnish Institute of Occupational Health, Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Finland
- Department of Public Health, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Ville Aalto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Maarit Kauppi
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Finland
- Department of Mental Health of Older People, Faculty of Brain Sciences, University College London, London, UK
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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Malla G, Long DL, Cherrington A, Goyal P, Guo B, Safford MM, Khodneva Y, Cummings DM, McAlexander TP, DeSilva S, Judd SE, Hidalgo B, Levitan EB, Carson AP. Neighborhood Disadvantage and Risk of Heart Failure: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Circ Cardiovasc Qual Outcomes 2024; 17:e009867. [PMID: 38328917 PMCID: PMC10950536 DOI: 10.1161/circoutcomes.123.009867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Heart failure (HF) affects >6 million US adults, with recent increases in HF hospitalizations. We aimed to investigate the association between neighborhood disadvantage and incident HF events and potential differences by diabetes status. METHODS We included 23 645 participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), a prospective cohort of Black and White adults aged ≥45 years living in the continental United States (baseline 2005-2007). Neighborhood disadvantage was assessed using a Z score of 6 census tract variables (2000 US Census) and categorized as quartiles. Incident HF hospitalizations or HF-related deaths through 2017 were adjudicated. Multivariable-adjusted Cox regression was used to examine the association between neighborhood disadvantage and incident HF. Heterogeneity by diabetes was assessed using an interaction term. RESULTS The mean age was 64.4 years, 39.5% were Black adults, 54.9% females, and 18.8% had diabetes. During a median follow-up of 10.7 years, there were 1125 incident HF events with an incidence rate of 3.3 (quartile 1), 4.7 (quartile 2), 5.2 (quartile 3), and 6.0 (quartile 4) per 1000 person-years. Compared to adults living in the most advantaged neighborhoods (quartile 1), those living in neighborhoods in quartiles 2, 3, and 4 (most disadvantaged) had 1.30 (95% CI, 1.06-1.60), 1.36 (95% CI, 1.11-1.66), and 1.45 (95% CI, 1.18-1.79) times greater hazard of incident HF even after accounting for known confounders. This association did not significantly differ by diabetes status (interaction P=0.59). For adults with diabetes, the adjusted incident HF hazards comparing those in quartile 4 versus quartile 1 was 1.34 (95% CI, 0.92-1.96), and it was 1.50 (95% CI, 1.16-1.94) for adults without diabetes. CONCLUSIONS In this large contemporaneous prospective cohort, neighborhood disadvantage was associated with an increased risk of incident HF events. This increase in HF risk did not differ by diabetes status. Addressing social, economic, and structural factors at the neighborhood level may impact HF prevention.
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Affiliation(s)
- Gargya Malla
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D. Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrea Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Boyi Guo
- Departments of Family Medicine and Public Health, East Carolina University, Greenville, North Carolina, USA
| | - Monika M. Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Yulia Khodneva
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Doyle M. Cummings
- Departments of Family Medicine and Public Health, East Carolina University, Greenville, North Carolina, USA
| | - Tara P. McAlexander
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Shanika DeSilva
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Suzanne E. Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bertha Hidalgo
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily B. Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Ascher Bartlett J, Barhouma S, Bangerth S, Mejia V, Weaver C, Kohli R, Emamaullee J. Finance, race, ethnicity, and spoken language impact clinical outcomes for children with acute liver failure. Pediatr Transplant 2024; 28:e14686. [PMID: 38317347 PMCID: PMC10857738 DOI: 10.1111/petr.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Pediatric acute liver failure (PALF) is an emergency, necessitating prompt referral and management at an experienced liver transplant center. Social determinants of health (SDOH) drive healthcare disparities and can affect many aspects of disease presentation, access to care, and ultimately clinical outcomes. Potential associations between SDOH and PALF outcomes, including spontaneous recovery (SR), liver transplant (LT) or death, are unknown. This study aims to investigate how SDOH may affect PALF and therefore identify areas for intervention to mitigate unrecognized disparities. METHODS A retrospective, single-center cohort was analyzed and then compared and validated with data from the multicenter National Institutes of Health PALF Study Group. The single-center review included 145 patients admitted with PALF using diagnostic codes. Medical records were reviewed to extract patient demographics, family structure, inpatient social worker assessments, and clinical outcomes. Data were stratified by outcome. RESULTS This analysis determined that level of family support (p = .02), caretaker employment (p = .02), patient age, race, and language (p = .01) may impact clinical outcomes. Specifically, the cohort of children that died had the largest proportion of non-English speaking patients with limited support systems and parents who worked full-time. Conversely, patients who underwent LT more often belonged to English-speaking families with a homemaker and extensive support systems. CONCLUSION This study suggests that SDOH impact PALF outcomes and highlights patient populations facing additional challenges during an already complex healthcare emergency. These associations may indicate unconscious biases held by transplant teams when evaluating waitlist candidacy, as well as barriers to healthcare access. Strategies to better understand the broader applicability of our findings and, if confirmed, efforts to mitigate social disparities, may improve clinical outcomes in PALF.
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Kalinda C, Phri M, Qambayot MA, Ishimwe MCS, Gebremariam A, Bekele A, Wong R. Socio-demographic and environmental determinants of under-5 stunting in Rwanda: Evidence from a multisectoral study. Front Public Health 2023; 11:1107300. [PMID: 36998275 PMCID: PMC10043183 DOI: 10.3389/fpubh.2023.1107300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
Child stunting is an important household, socio-economic, environmental and nutritional stress indicator. Nationally, 33% of children under 5 in Rwanda are stunted necessitating the need to identify factors perpetuating stunting for targeted interventions. Our study assessed the individual and community-level determinants of under-5 stunting essential for designing appropriate policy and program responses for addressing stunting in Rwanda. A cross-sectional study was conducted between September 6 and October 9, 2022, in five districts of Rwanda including, Kicukiro, Ngoma, Burera, Nyabihu and Nyanza. 2788 children and their caregivers were enrolled in the study and data on the individual level (child, caregiver/household characteristics), and community-level variables were collected. A multilevel logistic regression model was used to determine the influence of individual and community-level factors on stunting. The prevalence of stunting was 31.4% (95% CI: 29.5–33.1). Of this, 12.2% were severely stunted while 19.2% were moderately stunted. In addition, male gender, age above 11 months, child disability, more than six people in the household, having two children below the age of five, a child having diarrhea 1–2 weeks before the study, eating from own plate when feeding, toilet sharing, and open defecation increased the odds of childhood stunting. The full model accounted for 20% of the total variation in the odds of stunting. Socio-demographic and environmental factors are significant determinants of childhood stunting in Rwanda. Interventions to address under-five stunting should be tailored toward addressing individual factors at household levels to improve the nutritional status and early development of children.
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Affiliation(s)
- Chester Kalinda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
- *Correspondence: Chester Kalinda ;
| | - Million Phri
- School of Humanities and Social Sciences, University of Zambia, Great East Road Campus, Lusaka, Zambia
| | | | | | | | - Abebe Bekele
- School of Medicine, University of Global Health Equity, Kigali, Rwanda
| | - Rex Wong
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
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Teshale AB, Amare T. Exploring spatial variations and the individual and contextual factors of uptake of measles-containing second dose vaccine among children aged 24 to 35 months in Ethiopia. PLoS One 2023; 18:e0280083. [PMID: 36598928 PMCID: PMC9812309 DOI: 10.1371/journal.pone.0280083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 12/11/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To eliminate measles, which is a devastating contagious disease, Ethiopia introduced the measles-containing second dose vaccine (MCV2) that will be given in the second year of life. Despite its paramount benefit, the coverage was low worldwide and, in Ethiopia, there is scarce evidence on the geographic variations and factors associated with uptake of MCV2. OBJECTIVE This study aimed to explore the spatial variations and the individual and contextual factors of uptake of measles-containing second dose vaccine among children aged 24 to 35 months in Ethiopia. METHODS We used the 2019 Ethiopian Mini Demographic and Health Survey data. A total weighted sample of 800 children aged 24 to 35 months was used. Multilevel analysis was employed and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported. Factors with a p-value<0.05 in the multivariable analysis were declared to be significant predictors of MCV2 uptake. To explore the spatial variations of MCV2 uptake, we have conducted spatial analysis using both Arc GIS version 10.7 and SaTScan version 9.6 software. RESULTS The proportion of MCV2 uptake was 9.84% (95% CI: 7.96%, 12.11%). Children whose mothers were aged 20-34 years (AOR = 0.19; 95%CI: 0.05, 0.69) and 35-49 years (AOR = 0.21; 95%CI: 0.04, 0.90), being the 4th-5th child (AOR = 4.02; 95%CI: 1.45, 11.14) and 6th and above child (AOR = 4.12; 95%CI: 1.42, 13.05) and children who did not receive full childhood vaccinations (AOR = 0.44; 95%CI: 0.25, 0.77) were significantly associated with MCV2 uptake. Besides, MCV2 uptake was clustered in Ethiopia (Global Moran's I = 0.074, p-value <0.01). The primary cluster spatial window was detected in the Benishangul-Gumuz region with LLR = 10.05 and p = 0.011. CONCLUSION The uptake of MCV2 in Ethiopia was low. Maternal age, birth order, and uptake of the other basic vaccines were associated with MCV2 uptake. Besides, MCV2 uptake was clustered in Ethiopia and the primary cluster spatial window was located in the Benishangul-Gumuz region. Therefore, special concern should be given to regions with lower MCV2 uptake such as the Benishangul-Gumuz region. Besides, it is better to give attention to basic vaccination programs.
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Affiliation(s)
- Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Tsegaw Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mulugeta SS, Fenta SM, Fentaw KD, Biresaw HB. Factors associated with non-use of modern contraceptives among sexually active women in Ethiopia: a multi-level mixed effect analysis of 2016 Ethiopian Demographic and Health Survey. Arch Public Health 2022; 80:163. [PMID: 35794637 PMCID: PMC9258219 DOI: 10.1186/s13690-022-00922-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background Appropriate contraceptive use prevents unintended pregnancy, protects the health of mother and child, and promotes women’s well-being. Use of modern Family planning in Ethiopia was still very low. The purpose of this study was to assess the factors that are associated with non-use of modern family planning services among women of reproductive age. Method A nationally representative 2016 EDHS women data were used for analysis. A total of 15,683 women in the reproductive age group were included in this study. Descriptive and multilevel multivariable binary logistic regression models were used to summarize descriptive data and measure statistical association between the dependent and the individual and community level variable, respectively. Adjusted Odds Ratio (AOR) and confidence interval were respectively used to measure association and its statistical significance. Result Among women in the reproductive age group 79.49% (95% CI: 78.85%, 80.12%) did not use a modern contraceptive method. Women age between 25–34 years (AOR = 0.54, 95% CI: 0.47–0.61) and age between 34–49 year (AOR = 0.62, 95% CI: 0.55–0.71), having primary educated women (AOR = 0.0.77, 95% CI: 0.68–0.87),secondary and above educational (AOR = 0.88, CI: 0.75–1.03), Secondary and above-educated husband (AOR = 0.84, 95% CI: 0.72–0.96), rich women (AOR = 0.74,95%CI:0.65–0.85), health facility delivery (AOR = 0.84, 95%CI: 0.73–0.0.98), being watching TV (AOR = 0.74, 95% CI: 0.65–0.85), having 1–2 living children (AOR = 0.21, 95% CI: 0.19–0.23) are less likely to not use contraception were identified. Furthermore, Muslim women (AOR = 1.43, 95% CI: 1.23–1.62), women living in rural area (AOR = 3.43; 95% CI: 2.72–4.32), and ANC visit 1.25(1.07–1.47) were more likely to not use contraception. Further, Women in Afar, Somali, Gambela, Harari, and Dire Dawa were less likely to use modern contraception methods than women in Tigray, but Amhara region had a lower rate of non-use. Conclusion Family planning interventions should target younger women, women living in rural areas, the poor, and Muslim women. Moreover, initiatives to empower women associated to family planning programs would be beneficial in increasing contraceptive uptake among sexually active women in Ethiopia.
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Individual- and Neighborhood-Level Factors of Measles Vaccination Coverage in Niamey, Niger: A Multilevel Analysis. Vaccines (Basel) 2022; 10:vaccines10091513. [PMID: 36146591 PMCID: PMC9505597 DOI: 10.3390/vaccines10091513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccination is a proven equitable intervention if people take advantage of the opportunity to get vaccinated. Niger is a low-income country in West Africa, with a 76% measles 1 vaccination coverage rate in 2016. This study was conducted to identify individual- and neighborhood-level factors that could improve measles 1 vaccination coverage in Niamey, the capital. In October 2016, 460 mothers with children aged 12-23 months were surveyed. The outcome was to determine whether the mother's child had been vaccinated against measles 1 or not. For individual-level variables of measles 1 vaccination status, the following were included: mother's age group, mother tongue, maternal education level, husband's job, where the mother gave birth (at home or at a health center) and whether the mother discussed vaccination with friends. Neighborhood-level factors were access time to the health center, household access to electricity, and a grand-mean-centered wealth score. Multilevel logistic regression analysis was performed. At the individual-level, primary and secondary-educated mothers were more likely to vaccinate their children against measles 1 (aOR 1.97, 95% CI 1.11-3.51). At the neighborhood-level, no factors were identified. Therefore, a strengthened focus on equity-based, individual factors is recommended, including individual motivation, prompts and ability to access vaccination services.
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Geographical variation and determinants of women unemployment status in Ethiopia; A multilevel and spatial analysis from 2016 Ethiopia Demographic and Health Survey data. PLoS One 2022; 17:e0270989. [PMID: 35797384 PMCID: PMC9262193 DOI: 10.1371/journal.pone.0270989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/21/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Unemployment is a major problem in both developed and developing countries. In Ethiopia, women unemployment is particularly high, and this makes it a grave socio-economic concern. The aim of this study is to assess the spatial distribution and identify the determinant factors of women unemployment in Ethiopia.
Methods
The data used for the study is the Ethiopian Demographic and Health Surveys of 2016. A total of 15683 women are involved in the study. Global Moran’s I statistic and Poisson-based purely spatial scan statistics are employed to explore spatial patterns and detect spatial clusters of women unemployment, respectively. To identify factors associated with women unemployment, multilevel logistic regression model is used.
Results
A spatial analysis showed that there was a major spatial difference in women unemployment in Ethiopia with Global Moran’s index value of 0.3 (p<0.001). The spatial distribution of women’s unemployment varied significantly across the country. The major areas of unemployment were Afar and Somalia; southwest Tigray; North and west Oromia, and Eastern and southern parts of Amhara. Women with primary level of education(AOR = 0.88, 95%CI: 0.80, 0.98), secondary and above level of education (AOR = 0.71, 95%CI: 0.62, 0.82), women with rich wealth index (AOR = 0.79, 95% CI: 0.70, 0.90), pregnant women (AOR = 1.24, 95% CI: 1.06, 1.5), women with a male household head(AOR = 1.4, 95% CI: 1.28, 1.50), and urban women(AOR = 0.60, 95% CI: 0.50, 0.70) statistically associated with women unemployment.
Conclusion
The unemployment rate of women in Ethiopia showed variation across different clusters. Improving entrepreneurship and women’s education, sharing business experiences, supporting entrepreneurs are potential tools for reducing the unemployment women. Moreover, creating community-based programs that prioritize participation of poor households and rural women as well as improving their access to mass media and the labor market is crucial.
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Ortiz C, López-Cuadrado T, Rodríguez-Blázquez C, Simón L, Perez-Vicente R, Merlo J, Galán I. Physical and social environmental factors related to co-occurrence of unhealthy lifestyle behaviors. Health Place 2022; 75:102804. [PMID: 35462183 DOI: 10.1016/j.healthplace.2022.102804] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/04/2022]
Abstract
Previous work identifying determinants of co-occurrence of behavioral risk factors have focused on their association with individuals' characteristics with scant attention paid to their relationship to contextual factors. Data came from 21,007 individuals ≥15 years of age who participated in the cross-sectional 2011-2012 Spanish National Health Survey. Two indicators were defined by tobacco consumption, alcohol intake, diet, physical activity, and body mass index. The first indicator, based on dichotomized measures, ranges from 0 to 5. The second one (unhealthy lifestyle index), ranges from 0 to 15, with 0 denoting the healthiest score. Among the determinants, we examined social support, five perceived characteristics of the neighborhood, and the socioeconomic deprivation index of the census tract of residence. Data were analyzed using multilevel linear and logistic regression models adjusted for the main sociodemographic characteristics. Using the dichotomized indicator, the probability of having 3-5 risk factors versus <3 factors was associated with low social support (Odds Ratio [OR] 1.50; 95% Confidence Interval [CI]: 1.25-1.80). Issues surrounding neighborhood cleanliness (OR = 1.18; 95%CI: 1.04-1.33), air pollution (OR = 1.38; 95%CI: 1.16-1.64), and street crime (OR = 1.21; 95%CI: 1.03-1.42) were associated with determinants of co-occurrence. Risk factors co-occurrence increased as deprivation level increased: the OR for the highest deprivation quintile versus the lowest was 1.30 (95%CI: 1.14-1.48). Similar results were observed when using the unhealthy lifestyle index. Poorer physical and social environments are related to greater co-occurrence of risk factors for chronic diseases. Health promotion interventions targeting the prevention of risk factors should consider the contextual characteristics of the neighborhood environment.
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Affiliation(s)
- Cristina Ortiz
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa López-Cuadrado
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health. Autonomous University of Madrid/IdiPAZ, Madrid, Spain
| | | | - Lorena Simón
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Perez-Vicente
- Research Unit of Social Epidemiology. Faculty of Medicine, Lund University, Malmö, Sweden
| | - Juan Merlo
- Research Unit of Social Epidemiology. Faculty of Medicine, Lund University, Malmö, Sweden; Centre for Primary Health Care Research, Region Skåne, Malmö, Sweden
| | - Iñaki Galán
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health. Autonomous University of Madrid/IdiPAZ, Madrid, Spain.
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Nieboer AP, Cramm JM. Age-friendly communities and well-being realization among older native and immigrant populations in the Netherlands: a theory-guided study protocol. BMC Geriatr 2022; 22:273. [PMID: 35366821 PMCID: PMC8976267 DOI: 10.1186/s12877-022-02880-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background With rapid population aging, policy makers and service providers are becoming increasingly aware of the importance of building and maintaining age-friendly communities. Clearly, “age-friendly” relates to the impact of context on people’s well-being. But how? What is an age-friendly community, and does that differ for native and immigrant older people? Up until now, how native and immigrant older people in the Netherlands perceive community age-friendliness, and whether and how age-friendly communities help them realize well-being, remains unknown which limits opportunities to develop appropriate interventions. This article presents a study protocol to identify, theoretically and empirically, how and under what conditions age-friendly communities help native and immigrant older people in the Netherlands realize well-being. We present a theory-guided approach to elucidate differences in neighborhood age-friendliness and requirements for age-friendly community development between native Dutch and immigrant older people. Good interventions are built on good theory. The proposed research will add to theory building by systematically examining what older people get from their neighborhoods and the conditions that influence well-being realization, including the role of individual and neighborhood resources. We posit that physical and social well-being realization will be enhanced in age-friendly communities that support realization of multiple well-being needs and development of solidarity within and between groups in the neighborhood via cross-cutting sharing arrangements. Methods We present a mixed-methods design among native and immigrant older people (Turkish, Surinamese and Moroccan) consisting of: (i) Q-studies (combining in-depth interview-based and quantitative analyses); (ii) a pilot survey study; (iii) a main survey study in Rotterdam, the Hague, Utrecht, and Amsterdam; and (iv) focus groups. Discussion By exploring truly new ground in the field of age-friendly communities, the results of the proposed research will provide new empirical evidence, advance theory, and be helpful for the development of interventions aimed at improving age-friendliness and well-being for native and immigrant older populations, thereby contributing to resolving the societal challenges of caring for and supporting older people in the community.
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Diet quality in preschool children and associations with individual eating behavior and neighborhood socioeconomic disadvantage. The STEPS Study. Appetite 2022; 172:105950. [PMID: 35090977 DOI: 10.1016/j.appet.2022.105950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/07/2022] [Accepted: 01/24/2022] [Indexed: 11/23/2022]
Abstract
A good quality diet in childhood is important for optimal growth as well as for long-term health. It is not well established how eating behaviors affect overall diet quality in childhood. Moreover, very few studies have considered the association of diet quality and a neighborhood socioeconomic disadvantage in childhood. Our aim was to investigate how diet quality is associated with eating behaviors and neighborhood disadvantage and their interaction in preschool age children in Finland. The participants were from the Steps to Healthy Development Study at age 2 y (n = 780) and 5 y (n = 653). Diet quality was measured with a short questionnaire on habitual food consumption and eating behavior was assessed with the child eating behavior questionnaire to indicate the child's eating style regarding food approach and food avoidance dimensions. Information on neighborhood socioeconomic disadvantage were obtained from the statistics Finland grid database. We found that diet quality was higher at 5 years compared to 2 years of age (p < 0.001). Food approach subscale, enjoyment of food, was positively associated with the diet quality (p < 0.001 for 2 and 5 y) while subscale desire to drink was negatively associated with the diet quality (p = 0.001 for 2 and 5 y). Food avoidance was negatively associated with the diet quality both at 2 and at 5 years of age (p < 0.001). A higher neighborhood disadvantage was negatively associated with the diet quality at the age of 2 years (p = 0.02), but not at the age of 5 years. Eating behavior had similar associations with diet quality both in affluent and deprived neighborhoods. Our results suggest that both the eating behavior and neighborhood disadvantage are, already in the early age, important factors when considering children's diet quality.
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Shiferaw K, Mengistie B, Gobena T, Dheresa M, Seme A. Adequacy and timeliness of antenatal care visits among Ethiopian women: a community-based panel study. BMJ Open 2021; 11:e053357. [PMID: 34949623 PMCID: PMC8704979 DOI: 10.1136/bmjopen-2021-053357] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The purposes of the study are; (A) to identify whether Ethiopian women's antenatal care (ANC) visits are adequate and timely and (B) to explore factors that determine these. DESIGN Panel study design. SETTING Ethiopia. PARTICIPANTS A total of 2855 women nested within 217 enumeration areas. PRIMARY OUTCOME MEASURES Adequacy and timeliness of ANC visits. RESULTS Of all the 2855 respondents, 65% had made an ANC visit once, while 26.8% initiated ANC visits in a timely way and 43.3% attended adequate ANC visits. Rural residence (adjusted OR (AOR)=0.55, 95% CI: 0.36 to 0.84), attending higher level of education (AOR=2.64, 95% CI: 1.47 to 4.77), being multipara (AOR=0.53, 95% CI: 0.32 to 0.89) and encouragement by partners to attend clinic for ANC (AOR=1.98, 95% CI: 1.14 to 3.44) were significantly associated with timeliness of ANC visit. Similarly, residing in rural areas (AOR=0.20, 95% CI: 0.12 to 0.35), attending higher level of education (AOR=2.96, 95% CI: 1.38 to 6.15), encouragement by partners to attend clinic for ANC (AOR=2.11, 95% CI: 1.31 to 3.40) and timeliness of ANC visit (AOR=4.59, 95% CI: 2.93 to 7.21) were significantly associated with adequacy of ANC visits. CONCLUSIONS A quarter of the pregnant women started ANC visits during the first trimester and nearly half attended adequate ANC visits with wider disparities across regions of their origin and their background characteristics. Concerted efforts on tailored interventions for rural residents, female education and partner involvement are recommended for early and adequate ANC visit(s).
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Affiliation(s)
- Kasiye Shiferaw
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Bezatu Mengistie
- School of Public Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfaye Gobena
- Environmental Health Science, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
- Public Health, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Andargie NB, Debelew GT. Effectiveness of checklist-based box system intervention (CBBSI) versus routine care on improving postnatal care utilization in Northwest Ethiopia: a cluster randomized controlled trial. Reprod Health 2021; 18:234. [PMID: 34801045 PMCID: PMC8606053 DOI: 10.1186/s12978-021-01283-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background The period after childbirth poses a substantial risk both to the mother and the newborn. Yet, this period received less attention as compared to the cares provided during pregnancy and childbirth. Hence, this study aimed to assess the effectiveness of checklist-based box system intervention on improving three postnatal care visit utilization. Methods A double blind, parallel group, two-arm cluster randomized controlled trial design was used to assess effectiveness of checklist-based box system intervention on improving third postnatal care visit. Pregnant mothers below 16 weeks of gestation were recruited from 15 intervention and 15 control clusters, which were randomized using simple randomization. Data from baseline and end line surveys were collected using open data kit and analyzed using STATA version 15.0. The status of three postnatal care visit between intervention and control groups over time was assessed using difference in difference estimator. The predictors of the outcome variable were then analysed using mixed effects multilevel logistic regression model. Result Of 1200 mothers considered from each of the baseline and end line studies, this study included data from 1162 and 1062 mothers at baseline and end line surveys, respectively. As it is shown from the difference-in-difference estimation (14.8%, 95%CI 5.4–24.2%, p = 0.002) and the final model (AOR 4.45, 95%CI 2.31–8.54), checklist-based box system intervention was effective on improving third postnatal care visit. In addition, institutional delivery (AOR 1.62, 95%CI 1.15–2.28) and knowledge on danger signs during postnatal period (AOR 5.20, 95%CI 3.71–7.29) were found to be significant predictors of the outcome variable. In the contrary, mothers who got influenced by older generations of individuals were (AOR 0.32, 95%CI 0.18–0.59) less likely to attend three postnatal care visit. Conclusions The implementation of checklist-based box system intervention was found to be effective in improving utilization of the recommended three postnatal care visits. The contribution of the trial on improving third postnatal care visit can be enhanced by minimizing practical level challenges, as well as expanding health messages to reach unreached mothers and significant others who can influence the mother’s decision. Trial registration: ClinicalTrials.gov, NCT03891030, Retrospectively registered on 26 March, 2019, https://clinicaltrials.gov/ct2/show/NCT03891030. Postnatal care is a care that a delivered women and her newborn baby receive after delivery and up to 42 days of childbirth, regardless of place of delivery. This period is considered critical in minimizing morbidity and mortality of both the mother and the baby. In Ethiopia, the coverage of postnatal care utilization remained low. Recent studies showed only 33.8% of mothers received postnatal care, this becomes very low for mothers who delivered at home, of which only 8.2% of them received the care. On top of other factors that hinder maternal health care utilization, in Ethiopia there are widely accepted and persistent cultural ceremonies after childbirth that encourages a women to stay in door. This study introduced a new intervention called Checklist-based box system intervention, which aimed to improve postnatal care utilization through demand creation and dropout tracing mechanisms. The intervention was carried out by health professionals in health centers and community health workers (health extension workers) who visited mothers in their homes. Despite some practical challenges, its implementation demonstrated an improvement over clusters that did not receive the intervention. This intervention is recommended to be implemented on a larger scale. Simultaneously, practical level challenges need to be addressed in order for the intervention’s effect to be seen in its best form.
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Affiliation(s)
- Netsanet Belete Andargie
- Ministry of Health, Addis Ababa, Ethiopia. .,Department of Population and Family Health, Jimma University, Jimma, Ethiopia.
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14
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Akhter N, Fairbairn RS, Pearce M, Warren J, Kasim A, Bambra C. Local Inequalities in Health Behaviours: Longitudinal Findings from the Stockton-On-Tees Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111018. [PMID: 34769536 PMCID: PMC8582866 DOI: 10.3390/ijerph182111018] [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] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 12/02/2022]
Abstract
This paper provides a longitudinal examination of local inequalities in health behaviours during a period of austerity, exploring the role of ‘place’ in explaining these inequalities. Data from the Stockton-on-Tees prospective cohort study of 836 individuals were analysed and followed over 18 months (37% follow-up). Generalised estimating equation models estimated the deprivation gap in health behaviours (smoking status, alcohol use, fruit and vegetable consumption and physical activity practices) between the 20% most- and least-deprived neighborhoods (LSOAs), explored any temporal changes during austerity, and examined the underpinning role of compositional and contextual determinants. All health behaviours, except for frequent physical activity, varied significantly by deprivation (p ≤ 0.001). Smoking was lower in the least-deprived areas (OR 0.21, CI 0.14 to 0.30), while alcohol use (OR 2.75, CI 1.98 to 3.82) and fruit and vegetable consumption (OR 2.55, CI 1.80 to 3.62) were higher in the least-deprived areas. The inequalities were relatively stable throughout the study period. Material factors (such as employment, education and housing tenure) were the most-important and environmental factors the least-important explanatory factors. This study suggests that material factors are the most important ‘place’ determinants of health behaviours. Health promotion activities should better reflect these drivers.
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Affiliation(s)
- Nasima Akhter
- Department of Anthropology, Durham University, Dawson Building, Stockton Road, Durham DH1 3LE, UK;
- Correspondence: ; Tel.: +44-(0)1913340716
| | - Ross Stewart Fairbairn
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (R.S.F.); (M.P.); (C.B.)
| | - Mark Pearce
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (R.S.F.); (M.P.); (C.B.)
| | - Jon Warren
- St. Cuthberts Society, Durham University, Durham DH1 3LE, UK;
- Department of Sociology, Durham University, 32 Old Elvet, Durham DH1 3HN, UK
| | - Adetayo Kasim
- Department of Anthropology, Durham University, Dawson Building, Stockton Road, Durham DH1 3LE, UK;
- Durham Research Methods Center, Durham University, Durham DH1 3LE, UK
| | - Clare Bambra
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (R.S.F.); (M.P.); (C.B.)
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15
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Agahi N, Morin L, Virtanen M, Pentti J, Fritzell J, Vahtera J, Stenholm S. Heavy alcohol consumption before and after negative life events in late mid-life: longitudinal latent trajectory analyses. J Epidemiol Community Health 2021; 76:360-366. [PMID: 34556543 PMCID: PMC8921586 DOI: 10.1136/jech-2021-217204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/08/2021] [Indexed: 11/04/2022]
Abstract
Background People who experience negative life events report more heavy alcohol consumption compared with people without these experiences, but little is known about patterns of change within this group. This study aims to identify trajectories of heavy alcohol consumption before and after experiencing either divorce, or severe illness or death in the family. Furthermore, the aim is to examine characteristics of individuals belonging to each trajectory. Methods Longitudinal study of public sector employees from the Finnish Retirement and Aging Study with up to 5 years of annual follow-ups (n=6783; eligible sample n=1393). Divorce and severe illness or death in the family represented negative life events. Heavy alcohol consumption was categorised as >14 units/week. Results Based on latent trajectory analysis, three trajectories of heavy drinking were identified both for divorce and for severe illness or death in the family: ‘No heavy drinking’ (82% illness/death, 75% divorce), ‘Constant heavy drinking’ (10% illness/death, 13% divorce) and ‘Decreasing heavy drinking’ (7% illness/death, 12% divorce). Constant heavy drinkers surrounding illness or death in the family were more likely to be men, report depression and anxiety and to smoke than those with no heavy drinking. Constant heavy drinkers surrounding divorce were also more likely to be men and to report depression compared with those with no heavy drinking. Conclusions Most older workers who experience divorce or severe illness or death in the family have stable drinking patterns regarding heavy alcohol consumption, that is, most do not initiate or stop heavy drinking.
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Affiliation(s)
- Neda Agahi
- Aging Research Center, Karolinska Institute/Stockholm University, Solna, Sweden
| | - Lucas Morin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.,Inserm CIC 1431, University Hospital of Besançon, Besançon, France
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.,Division of Insurance Medicine, Karolinska Institute, Solna, Sweden
| | - Jaana Pentti
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Johan Fritzell
- Aging Research Center, Karolinska Institute/Stockholm University, Solna, Sweden
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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16
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Muche A, Dewau R. Severe stunting and its associated factors among children aged 6-59 months in Ethiopia; multilevel ordinal logistic regression model. Ital J Pediatr 2021; 47:161. [PMID: 34311750 PMCID: PMC8314542 DOI: 10.1186/s13052-021-01110-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Ethiopia, stunting is the most common form of undernutriton. Identifying the determinants of severe stunting among children is crucial for public health interventions to improve child health. Therefore, this study aimed to identify the determinants of severe stunting among under-five children in Ethiopia. METHODS A community-based cross-sectional study design was employed. A two stage stratified cluster sampling technique was used. A multilevel ordinal logistic regression model was fitted to identify independent determinants. Adjusted odds ratio (AOR) and median odds ratio (MOR) with its 95% confidence interval at p-value< 0.05 were used to declare statistical significance. RESULTS The result of this study showed that about 18% of the children were severely stunted. Being male increased the severity of stunting in children by 26% adjusted odds ratio (AOR): 1.26 (95% CI: 1.09-1.46), compared to female sex; over-weight mothers increased the severity of stunting in their children AOR: 3.43 (95% CI: 2.21-5.33) compared to normal BMI mothers; and children from middle, poorer, and poorest wealth index households were 1.84 (95% CI:1.27-2.67), 2.13 (95% CI, CI:1.45-3.14) and 2.52 (95% CI,1.72-3.68). In contrast, severe stunting was reduced by 62% (AOR: 0.38, 95% CI: 0.20-0.74) and 48% (AOR = 0.52, 95% CI: 0.37-0.72) in children of educated mothers compared to children of uneducated mothers and children of underweight mothers compared with those children of normal BMI mothers respectively. For each one-unit increase in maternal height, there is a 5% significant reduction in the child's odds of being severely stunted. After controlling for other factors, the effect of predictors on the likelihood of stunting in high risk clusters increased by a median odds ratio (MOR) of 1.83 (95% CI: 1.69-2.00). CONCLUSIONS The magnitude of severe childhood stunting was still high with regional variation in Ethiopia. Child age, sex, maternal height, age, education and household wealth index as well as administrative regions were significantly associated factors with severe stunting. Significant interventions shall be implemented at the individual, household and community levels in order to reduce the problem.
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Affiliation(s)
- Amare Muche
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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17
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Fenta SM, Gebremichael SG. Predictors of modern contraceptive usage among sexually active rural women in Ethiopia: A multi-level analysis. ACTA ACUST UNITED AC 2021; 79:93. [PMID: 34088347 PMCID: PMC8176723 DOI: 10.1186/s13690-021-00621-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 05/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Ethiopia is one of the Sub-Saharan Africa countries with the lowest modern contraceptive prevalence rate and the highest fertility rate. This study aimed to assess individual and community-level predictors of modern contraceptive use among sexually active rural women in Ethiopia. DATA AND METHODS A sample of 9450 sexual active rural women aged 15-49 was extracted from the 15, 683 nationally representative samples of 2016 Ethiopian Demographic and Health Survey (EDHS). Multi-level logistic regression model was considered to identify determinant factors of modern contraceptive use among sexually active rural women in Ethiopia. RESULT The prevalence of modern contraceptive use among respondents was 20% in rural Ethiopia. Injection (66.35%) was the most common type of modern contraceptive use. In the last full model of the multilevel analysis, individual and community-level factors accounted for 86.69% of the variation in the use of modern contraceptive methods. Secondary and above-educated women (AOR = 1.39, 95%CI: 1.06, 2.81), having 1-4 living children (AOR = 2.70, 95%CI: 2.07, 3.53), rich wealth status (AOR = 2.26, 95%CI: 1.96, 2.60), married women (AOR = 17.31, 95%CI: 10.72, 27.94), having primary educated husband (AOR = 1.45, 95%CI: 1.27, 1.67) and being working husband (AOR = 2.26, 95%CI: 1.96, 2.60) were significantly positively associated with individual-level factors of the use of modern contraceptive methods. Besides, modern contraceptive use was negatively associated with Muslim women (AOR = 0.29, 95%CI: 0.25, 0.33). Compared to the Tigray region, women living in the Afar, Somali, Harari, and Dire Dawa regions had lower use of modern contraceptive methods. Women who had access to mass media (AOR = 1.35, 95%CI: 1.16, 1.57) were more likely to use contraceptives than their counterparts. CONCLUSION The prevalence of modern contraceptive use among rural women has very low. Both individual and community-level factors were significant predictors of modern contraceptive use. Consequently, the government and other stakeholders need to address educational opportunities; creating awareness about modern contraception and valuable counseling would increase modern contraceptive methods utilization.
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Affiliation(s)
- Setegn Muche Fenta
- Department of Statistics, Faculty of Natural and Computational Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
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18
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Zhang Z, Weichenthal S, Kwong JC, Burnett RT, Hatzopoulou M, Jerrett M, van Donkelaar A, Bai L, Martin RV, Copes R, Lu H, Lakey P, Shiraiwa M, Chen H. A Population-Based Cohort Study of Respiratory Disease and Long-Term Exposure to Iron and Copper in Fine Particulate Air Pollution and Their Combined Impact on Reactive Oxygen Species Generation in Human Lungs. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:3807-3818. [PMID: 33666410 DOI: 10.1021/acs.est.0c05931] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Metal components in fine particulate matter (PM2.5) from nontailpipe emissions may play an important role in underlying the adverse respiratory effects of PM2.5. We investigated the associations between long-term exposure to iron (Fe) and copper (Cu) in PM2.5 and their combined impact on reactive oxygen species (ROS) generation in human lungs, and the incidence of asthma, chronic obstructive pulmonary disease (COPD), COPD mortality, pneumonia mortality, and respiratory mortality. We conducted a population-based cohort study of ∼0.8 million adults in Toronto, Canada. Land-use regression models were used to estimate the concentrations of Fe, Cu, and ROS. Outcomes were ascertained using validated health administrative databases. We found positive associations between long-term exposure to Fe, Cu, and ROS and the risks of all five respiratory outcomes. The associations were more robust for COPD, pneumonia mortality, and respiratory mortality than for asthma incidence and COPD mortality. Stronger associations were observed for ROS than for either Fe or Cu. In two-pollutant models, adjustment for nitrogen dioxide somewhat attenuated the associations while adjustment for PM2.5 had little influence. Long-term exposure to Fe and Cu in PM2.5 and estimated ROS concentration in lung fluid was associated with increased incidence of respiratory diseases, suggesting the adverse respiratory effects of nontailpipe emissions.
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Affiliation(s)
- Zilong Zhang
- Public Health Ontario, Toronto, ON M5G 1V2, Canada
- ICES, Toronto, ON M4N 3M5, Canada
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC H3A 0G4, Canada
- Air Health Science Division, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON M5G 1V2, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Marianne Hatzopoulou
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, ON ON M5S, Canada
| | - Michael Jerrett
- School of Public Health, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Li Bai
- ICES, Toronto, ON M4N 3M5, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
- Harvard-Smithsonian Centre for Astrophysics, Cambridge, Massachusetts 02138, United States
| | - Ray Copes
- Public Health Ontario, Toronto, ON M5G 1V2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Hong Lu
- ICES, Toronto, ON M4N 3M5, Canada
| | - Pascale Lakey
- Department of Chemistry, University of California Irvine, Irvine, California 92697, United States
| | - Manabu Shiraiwa
- Department of Chemistry, University of California Irvine, Irvine, California 92697, United States
| | - Hong Chen
- Public Health Ontario, Toronto, ON M5G 1V2, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON K1A 0K9, Canada
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19
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Raza A, Claeson M, Magnusson Hanson L, Westerlund H, Virtanen M, Halonen JI. Home and Workplace Neighborhood Socioeconomic Status and Behavior-related Health: A Within-individual Analysis. Ann Behav Med 2021; 55:779-790. [PMID: 33580661 PMCID: PMC8311784 DOI: 10.1093/abm/kaaa116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The influence of individual and home neighborhood socioeconomic status (SES) on health-related behaviors have been widely studied, but the majority of these studies have neglected the possible impact of the workplace neighborhood SES. Objective To examine within-individual associations between home and work place neighborhood SES and health-related behaviors in employed individuals. Methods We used participants from the Swedish Longitudinal Occupational Survey of Health who responded to a minimum of two surveys between 2012 and 2018. Data included 12,932 individuals with a total of 35,332 observations. We used fixed-effects analysis with conditional logistic regression to examine within-individual associations of home, workplace, as well as time-weighted home and workplace neighborhood SES index, with self-reported obesity, physical activity, smoking, excessive alcohol consumption, sedentary lifestyle, and disturbed sleep. Results After adjustment for covariates, participants were more likely to engage in risky alcohol consumption when they worked in a workplace that was located in the highest SES area compared to time when they worked in a workplace that was located in the lowest SES area (adjusted odds ratios 1.98; 95% confidence interval: 1.12 to 3.49). There was an indication of an increased risk of obesity when individuals worked in the highest compared to the time when they worked in the lowest neighborhood SES area (1.71; 1.02–2.87). No associations were observed for the other outcomes. Conclusion These within-individual comparisons suggest that workplace neighborhood SES might have a role in health-related behaviors, particularly alcohol consumption.
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Affiliation(s)
- Auriba Raza
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Martin Claeson
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Linda Magnusson Hanson
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Hugo Westerlund
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Marianna Virtanen
- Department of Psychology, University of Eastern Finland, Joensuu, Finland
| | - Jaana I Halonen
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden.,Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
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20
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Namin S, Zhou Y, Neuner J, Beyer K. The role of residential history in cancer research: A scoping review. Soc Sci Med 2021; 270:113657. [PMID: 33388619 DOI: 10.1016/j.socscimed.2020.113657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/18/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
The role of residential history in cancer prevention, diagnosis, treatment, and survivorship is garnering increasing attention in cancer research. To our knowledge, there is no comprehensive synthesis of the current state of knowledge in the field. We reviewed the extant literature on this topic and conducted a scoping analysis to examine two main research questions: (a) To what degree, and how, have researchers accounted for residential history/mobility in cancer research? and (b) What are the gaps in the literature based on a knowledge synthesis using scoping review and concept mapping? To answer these questions, this scoping analysis focuses on how researchers compile, analyze and discuss residential history/mobility in studies on cancer. The study is focused on peer-reviewed articles from 6 different datasets (PubMed, Cinahl, Scopus, Web of Science and JSTOR, ERIC) from 1990 to August 2020. The review captured 1951 results in total, which was scoped to 281 relevant peer-reviewed journal articles. First, we examined these articles based on cancer continuum, cancer type and the main theme. Second, we identified 21 main themes and an additional 16 sub-themes in the pool of the selected articles. We utilized concept mapping to provide a conceptual framework and to highlight the underlying socioecological assumptions and paradigms. Results show that cancer research incorporating residential histories is primarily focused on incidence and estimating cumulative exposure, with little consideration across the cancer continuum. Additionally, our review suggests that although the social environment plays an important role across the cancer continuum, a small number of articles were focused on such factors and this area remains relatively unexplored. Additionally, the expansion of interdisciplinary research on residential mobility before and after cancer diagnosis will enhance understanding of the role of environmental and socioeconomic characteristics and exposures on cancer continuum.
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Affiliation(s)
- S Namin
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Y Zhou
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Neuner
- General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - K Beyer
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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21
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Halonen JI, Pulakka A, Pentti J, Kallio M, Koskela S, Kivimäki M, Kawachi I, Vahtera J, Stenholm S. Cross-sectional associations of neighbourhood socioeconomic disadvantage and greenness with accelerometer-measured leisure-time physical activity in a cohort of ageing workers. BMJ Open 2020; 10:e038673. [PMID: 32801206 PMCID: PMC7430423 DOI: 10.1136/bmjopen-2020-038673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Neighbourhood characteristics may affect the level of physical activity (PA) of the residents. Few studies have examined the combined effects of distinctive neighbourhood characteristics on PA using objective data or differentiated between activity during working or non-working days. We examined the associations of socioeconomic disadvantage and greenness with accelerometer-measured leisure-time PA during working and non-working days. DESIGN Cross-sectional study. SETTING Finnish Retirement and Aging (FIREA) study. PARTICIPANTS 708 workers (604 women, mean age 62.4 ranging from 58 to 64 years,) participating in the FIREA study who provided PA measurement data for at least 1 working and non-working day. PRIMARY AND SECONDARY OUTCOMES PA was measured with wrist-worn accelerometer on average of 4 working and 2 non-working days. Outcomes were total PA, light PA (LPA) and moderate-to-vigorous PA (MVPA). These measurements were linked to data on neighbourhood socioeconomic disadvantage and greenness within the home neighbourhood (750×750 m). Generalised linear models were adjusted for possible confounders. RESULTS On non-working days, higher neighbourhood disadvantage associated with lower levels of total PA (p value=0.07) and higher level of neighbourhood greenness associated with higher level of total PA (p value=0.04). Neighbourhood disadvantage and greenness had an interaction (p value=0.02); in areas of low disadvantage higher greenness did not associate with the level of total PA. However, in areas of high disadvantage, 2 SD higher greenness associated with 46 min/day (95% CI 8.4 to 85) higher total PA. Slightly stronger interaction was observed for LPA (p=0.03) than for the MVPA (p=0.09). During working days, there were no associations between neighbourhood characteristics and leisure-time total PA. CONCLUSIONS Of the disadvantaged neighbourhoods, those characterised by high levels of greenness seem to associate with higher levels of leisure-time PA during non-working days. These findings suggest that efforts to add greenness to socioeconomically disadvantaged neighbourhoods might reduce inequalities in PA.
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Affiliation(s)
- Jaana I Halonen
- Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anna Pulakka
- Centre for Population Health Research, University of Turku, Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Pentti
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Centre for Population Health Research, University of Turku, Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
| | - Minna Kallio
- Geoinformatics Services, Finnish Environment Institute, Helsinki, Finland
| | - Sofia Koskela
- Department of Geography and Geology, University of Turku, Turku, Finland
| | - Mika Kivimäki
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ichiro Kawachi
- Department of Society Human Development, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jussi Vahtera
- Centre for Population Health Research, University of Turku, Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
| | - Sari Stenholm
- Centre for Population Health Research, University of Turku, Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
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Roca-Barceló A, Crabbe H, Ghosh R, Freni-Sterrantino A, Fletcher T, Leonardi G, Hoge C, Hansell AL, Piel FB. Temporal trends and demographic risk factors for hospital admissions due to carbon monoxide poisoning in England. Prev Med 2020; 136:106104. [PMID: 32353574 DOI: 10.1016/j.ypmed.2020106104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/06/2020] [Accepted: 04/22/2020] [Indexed: 05/22/2023]
Abstract
Unintentional non-fire related (UNFR) carbon monoxide (CO) poisoning is a preventable cause of morbidity and mortality. Epidemiological data on UNFR CO poisoning can help monitor changes in the magnitude of this burden, particularly through comparisons of multiple countries, and to identify vulnerable sub-groups of the population which may be more at risk. Here, we collected data on age- and sex- specific number of hospital admissions with a primary diagnosis of UNFR CO poisoning in England (2002-2016), aggregated to small areas, alongside area-level characteristics (i.e. deprivation, rurality and ethnicity). We analysed temporal trends using piecewise log-linear models and compared them to analogous data obtained for Canada, France, Spain and the US. We estimated age-standardized rates per 100,000 inhabitants by area-level characteristics using the WHO standard population (2000-2025). We then fitted the Besag York Mollie (BYM) model, a Bayesian hierarchical spatial model, to assess the independent effect of each area-level characteristic on the standardized risk of hospitalization. Temporal trends showed significant decreases after 2010. Decreasing trends were also observed across all countries studied, yet France had a 5-fold higher risk. Based on 3399 UNFR CO poisoning hospitalizations, we found an increased risk in areas classified as rural (0.69, 95% CrI: 0.67; 0.80), highly deprived (1.77, 95% CrI: 1.66; 2.10) or with the largest proportion of Asian (1.15, 95% CrI: 1.03; 1.49) or Black population (1.35, 95% CrI: 1.20; 1.80). Our multivariate approach provides strong evidence for the identification of vulnerable populations which can inform prevention policies and targeted interventions.
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Affiliation(s)
- Aina Roca-Barceló
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Helen Crabbe
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, UK
| | - Rebecca Ghosh
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Anna Freni-Sterrantino
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Tony Fletcher
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, UK; London School of Tropical Medicine & Hygiene, London, UK
| | - Giovanni Leonardi
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, UK
| | - Courtney Hoge
- Asthma and Community Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), USA; Oak Ridge Institute for Science and Education, USA
| | - Anna L Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Frédéric B Piel
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, UK.
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Roca-Barceló A, Crabbe H, Ghosh R, Freni-Sterrantino A, Fletcher T, Leonardi G, Hoge C, Hansell AL, Piel FB. Temporal trends and demographic risk factors for hospital admissions due to carbon monoxide poisoning in England. Prev Med 2020; 136:106104. [PMID: 32353574 PMCID: PMC7262581 DOI: 10.1016/j.ypmed.2020.106104] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/06/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022]
Abstract
Unintentional non-fire related (UNFR) carbon monoxide (CO) poisoning is a preventable cause of morbidity and mortality. Epidemiological data on UNFR CO poisoning can help monitor changes in the magnitude of this burden, particularly through comparisons of multiple countries, and to identify vulnerable sub-groups of the population which may be more at risk. Here, we collected data on age- and sex- specific number of hospital admissions with a primary diagnosis of UNFR CO poisoning in England (2002-2016), aggregated to small areas, alongside area-level characteristics (i.e. deprivation, rurality and ethnicity). We analysed temporal trends using piecewise log-linear models and compared them to analogous data obtained for Canada, France, Spain and the US. We estimated age-standardized rates per 100,000 inhabitants by area-level characteristics using the WHO standard population (2000-2025). We then fitted the Besag York Mollie (BYM) model, a Bayesian hierarchical spatial model, to assess the independent effect of each area-level characteristic on the standardized risk of hospitalization. Temporal trends showed significant decreases after 2010. Decreasing trends were also observed across all countries studied, yet France had a 5-fold higher risk. Based on 3399 UNFR CO poisoning hospitalizations, we found an increased risk in areas classified as rural (0.69, 95% CrI: 0.67; 0.80), highly deprived (1.77, 95% CrI: 1.66; 2.10) or with the largest proportion of Asian (1.15, 95% CrI: 1.03; 1.49) or Black population (1.35, 95% CrI: 1.20; 1.80). Our multivariate approach provides strong evidence for the identification of vulnerable populations which can inform prevention policies and targeted interventions.
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Affiliation(s)
- Aina Roca-Barceló
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Helen Crabbe
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, UK
| | - Rebecca Ghosh
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Anna Freni-Sterrantino
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Tony Fletcher
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, UK; London School of Tropical Medicine & Hygiene, London, UK
| | - Giovanni Leonardi
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, UK
| | - Courtney Hoge
- Asthma and Community Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), USA; Oak Ridge Institute for Science and Education, USA
| | - Anna L Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Frédéric B Piel
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, UK.
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Cook A, Harris R, Brown HE, Bedrick E. Geospatial characteristics of non-motor vehicle and assault-related trauma events in greater Phoenix, Arizona. Inj Epidemiol 2020; 7:34. [PMID: 32536346 PMCID: PMC7294629 DOI: 10.1186/s40621-020-00258-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/04/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Injury-causing events are not randomly distributed across a landscape, but how they are associated with the features and characteristics of the places where they occur in Arizona (AZ) remains understudied. Clustering of trauma events and associations with areal sociodemographic characteristics in the greater Phoenix (PHX), AZ region can promote understanding and inform efforts to ameliorate a leading cause of death and disability for Arizonans. The outcomes of interest are trauma events unrelated to motor vehicle crashes (MVC) and the subgroup of trauma events due to interpersonal assaults. METHODS A retrospective, ecological study was performed incorporating data from state and national sources for the years 2013-2017. Geographically weighted regression models explored associations between the rates of non-MVC trauma events (n/10,000 population) and the subgroup of assaultive trauma events per 1000 and areal characteristics of socioeconomic deprivation (areal deprivation index [ADI]), the density of retail alcohol outlets for offsite consumption, while controlling for race/ethnicity, population density, and the percentage urban population. RESULTS The 63,451 non-MVC traumas within a 3761 mile2 study area encompassing PHX and 22 surrounding communities, an area with nearly 60% of the state's population and 54% of the trauma events in the AZ State Trauma Registry for the years 2013-2017. Adjusting for confounders, ADI was associated with the rates of non-MVC and assaultive traumas in all census block groups studied (mean coefficients 0.05 sd. 0.001 and 0.07 sd. 0.002 for non-MVC and assaultive trauma, respectively). Alcohol retail outlet density was also associated with non-MVC and assaultive traumas in fewer block groups compared to ADI. CONCLUSION Socioeconomic deprivation and alcohol outlet density were associated with injury producing events in the greater PHX area. These features persist in the environment before and after the traumas occur. Ongoing research is warranted to identify the most influential areal predictors of traumatic injury-causing events in the greater PHX area to inform and geographically target prevention initiatives.
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Affiliation(s)
- Alan Cook
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler School of Community and Rural Health, 11937 U.S. Highway 271, H252, Tyler, TX 75708 USA
| | - Robin Harris
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Ave., Drachman Hall, Tucson, AZ 85724 USA
| | - Heidi E. Brown
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Ave., Drachman Hall, Tucson, AZ 85724 USA
| | - Edward Bedrick
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Ave., Drachman Hall, Tucson, AZ 85724 USA
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25
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Jimenez MP, Wellenius GA, James P, Subramanian SV, Buka S, Eaton C, Gilman SE, Loucks EB. Associations of types of green space across the life-course with blood pressure and body mass index. ENVIRONMENTAL RESEARCH 2020; 185:109411. [PMID: 32240843 PMCID: PMC9993347 DOI: 10.1016/j.envres.2020.109411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 05/17/2023]
Abstract
Green space has been associated with better health and well-being. However, most studies have been cross-sectional with limited long-term exposure data. Further, research is limited in what type of green space is beneficial for health. We conducted a longitudinal study to assess sensitive periods (birth, childhood or adulthood) of exposure to different types of green space in association with adult blood pressure and body mass index (BMI). Using longitudinal data from the New England Family Study (1960-2000) and multilevel regression analysis, we examined associations between time-varying markers of residential exposure to green space, and adult BMI, systolic (SBP) and diastolic blood pressure (DBP) (N = 517). We created three exposure metrics: distance, average area, and green space count in the neighborhood throughout the life-course. In adjusted models, living one mile farther away from a green space at birth was associated with a 5.6 mmHg higher adult SBP (95%CI: 0.7, 10.5), and 3.5 mmHg higher DBP (95%CI: 0.3, 6.8). One more green space in the neighborhood at birth was also associated with lower DBP (-0.2 mmHg, 95%CI: -0.4, -0.02) in adulthood. Finally, average area of green space was not associated with SBP, DBP nor BMI. Analysis by type of green space suggested that parks may be more relevant than playgrounds, cemeteries or golf courses. Our study suggests that the perinatal period may be a critical time-period where living closer to green spaces may lower hypertension risk in adulthood, but not obesity.
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Affiliation(s)
- Marcia P Jimenez
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Peter James
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H, Chan School of Public Health, USA
| | - Stephen Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Charles Eaton
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Loucks
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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26
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Boing AF, Subramanian SV, Boing AC. Association between area-level education and the co-occurrence of behavior-related risk factors: a multilevel analysis. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190052. [PMID: 31826108 DOI: 10.1590/1980-549720190052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/09/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study aimed to investigate the association of four different risk factors for chronic diseases and accumulation of these health behaviors with area-level education, regardless of individual-level characteristics in Brazil. METHODS A population-based cross-sectional study was carried out in Southern Brazil including 1,720 adults in 2009/2010. The simultaneous occurrence of tobacco smoking, abusive drinking, unhealthy eating habits, and physical inactivity was investigated. Using multilevel models, we tested whether area-level education was associated with each risk factor and with the co-occurrence of them after controlling sociodemographic individual-level variables. RESULTS We observed a between-group variance of 7.79, 7.11, 6.84 and 1.08% for physical inactivity, problematic use of alcohol, unhealthy eating habits, and smoking, respectively. The between-group variance for the combination of four behaviors was 14.2%. Area-level education explained a significant proportion of the variance observed in physical inactivity and unhealthy eating habits. Residents of low educational level neighborhoods showed a 2.40 (95%CI 1.58 - 3.66) times higher chance of unhealthy eating and 1.78 (95%CI 1.19 - 2.67) times higher chance of physical inactivity. The likelihood of individuals with two or three/four risk factors was simultaneously higher among residents of low educational level neighborhoods. CONCLUSION Public policies should consider the area-level characteristics, including education to control risk factors for chronic diseases.
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Affiliation(s)
- Antonio Fernando Boing
- Department of Society, Human Development and Health, T.H. Chan Harvard School of Public Health - Boston, United States.,Post-Graduate Program in Public Health, Universidade Federal de Santa Catarina - Florianópolis (SC), Brazil
| | - S V Subramanian
- Department of Society, Human Development and Health, T.H. Chan Harvard School of Public Health - Boston, United States
| | - Alexandra Crispim Boing
- Department of Society, Human Development and Health, T.H. Chan Harvard School of Public Health - Boston, United States.,Post-Graduate Program in Public Health, Universidade Federal de Santa Catarina - Florianópolis (SC), Brazil
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Jimenez MP, Wellenius GA, Subramanian SV, Buka S, Eaton C, Gilman SE, Loucks EB. Longitudinal associations of neighborhood socioeconomic status with cardiovascular risk factors: A 46-year follow-up study. Soc Sci Med 2019; 241:112574. [PMID: 31593787 DOI: 10.1016/j.socscimed.2019.112574] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Neighborhood characteristics are increasingly recognized as important determinants of cardiovascular disease (CVD) risk. However, longitudinal studies on the health impacts of neighborhood characteristics are rare. We sought to investigate whether neighborhood socioeconomic status (NSES) during birth, childhood and adulthood is associated with CVD risk factors in adulthood. METHODS Using longitudinal data from the New England Family Study (n = 671) with 46-years of follow-up, participants' home addresses were geocoded at birth (mean age = 1.6 months), childhood (mean age = 7.1 years), and adulthood (mean age = 44.2 years) across Massachusetts and Rhode Island in the US from 1961 to 2007. We used multilevel models to evaluate associations of NSES across the life-course with systolic blood pressure, diastolic blood pressure and body mass index (BMI) in adulthood, adjusting for age, sex, race/ethnicity, mother's race, individual SES, and parental SES. RESULTS In fully adjusted models, one standard deviation higher NSES at birth was associated with a 1.9 mmHg lower SBP (95% CI: 3.8, -0.1) and 1.3 mmHg lower DBP (95%CI: 2.6,-0.03) in adulthood; while one standard deviation of higher NSES at adulthood was associated with 0.87 kg/m2 lower BMI (95%CI: 1.7, -0.1). CONCLUSIONS We found that living in a socioeconomically disadvantaged neighborhood early in life and in adulthood was associated with blood pressure and BMI, respectively, two established risk factors for CVD. Our findings support a longitudinal association between exposure to socioeconomically disadvantaged neighborhoods in early life and CVD risk factors in adulthood.
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Affiliation(s)
- Marcia P Jimenez
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA.
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Stephen Buka
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA
| | - Charles Eaton
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA; Department of Family Medicine, Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Loucks
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA
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Geremew TT, Gezie LD, Abejie AN. Geographical variation and associated factors of childhood measles vaccination in Ethiopia: a spatial and multilevel analysis. BMC Public Health 2019; 19:1194. [PMID: 31470822 PMCID: PMC6716824 DOI: 10.1186/s12889-019-7529-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Ethiopia, despite considerable improvement of measles vaccination, measles outbreaks is occurring in most parts of the country. Understanding the neighborhood variation in childhood measles vaccination is crucial for evidence-based decision-making. However, the spatial pattern of measles-containing vaccine (MCV1) and its predictors are poorly understood. Hence, this study aimed to explore the spatial pattern and associated factors of childhood MCV1 coverage. METHODS An in-depth analysis of the 2016 Ethiopia demographic and health survey data was conducted, and a total of 3722 children nested in 611 enumeration areas were included in the analysis. Global Moran's I statistic and Poisson-based purely spatial scan statistics were employed to explore spatial patterns and detect spatial clusters of childhood MCV1, respectively. Multilevel logistic regression models were fitted to identify factors associated with childhood MCV1. RESULTS Spatial hetrogeniety of childhood MCV1 was observed (Global Moran's I = 0.13, p-value < 0.0001), and seven significant SaTScan clusters of areas with low MCV1 coverage were detected. The most likely primary SaTScan cluster was detected in the Afar Region, secondary cluster in Somali Region, and tertiary cluster in Gambella Region. In the final model of the multilevel analysis, individual and community level factors accounted for 82% of the variance in the odds of MCV1 vaccination. Child age (AOR = 1.53; 95%CI: 1.25-1.88), pentavalent vaccination first dose (AOR = 9.09; 95%CI: 6.86-12.03) and third dose (AOR = 7.12; 95%CI: 5.51-9.18, secondary and above maternal education (AOR = 1.62; 95%CI: 1.03-2.55) and media exposure were the factors that increased the odds of MCV1 vaccination at the individual level. Children with older maternal age had lower odds of receiving MCV1. Living in Afar, Oromia, Somali, Gambella and Harari regions were factors associated with lower odds of MCV1 from the community-level factors. Children far from health facilities had higher odds of receiving MCV1 (AOR = 1.31, 95%CI = 1.12-1.61). CONCLUSION A clustered pattern of areas with low childhood MCV1 coverage was observed in Ethiopia. Both individual and community level factors were significant predictors of childhood MCV1. Hence, it is good to give priority for the areas with low childhood MCV1 coverage, and to consider the identified factors for vaccination interventions.
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Affiliation(s)
- Tesfahun Taddege Geremew
- Ethiopian Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 169, Gondar, Ethiopia
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 169, Gondar, Ethiopia
| | - Ayenew Negesse Abejie
- Department of Human Nutrition and Food Sciences, College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
- Academic Center of Excellence for Human Nutrition, Food Science and Post-harvest Technology, Hawassa University, Hawassa, Ethiopia
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Senteio C, Adler-Milstein J, Richardson C, Veinot T. Psychosocial information use for clinical decisions in diabetes care. J Am Med Inform Assoc 2019; 26:813-824. [PMID: 31329894 PMCID: PMC7647218 DOI: 10.1093/jamia/ocz053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/26/2019] [Accepted: 03/31/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE There are increasing efforts to capture psychosocial information in outpatient care in order to enhance health equity. To advance clinical decision support systems (CDSS), this study investigated which psychosocial information clinicians value, who values it, and when and how clinicians use this information for clinical decision-making in outpatient type 2 diabetes care. MATERIALS AND METHODS This mixed methods study involved physician interviews (n = 17) and a survey of physicians, nurse practitioners (NPs), and diabetes educators (n = 198). We used the grounded theory approach to analyze interview data and descriptive statistics and tests of difference by clinician type for survey data. RESULTS Participants viewed financial strain, mental health status, and life stressors as most important. NPs and diabetes educators perceived psychosocial information to be more important, and used it significantly more often for 1 decision, than did physicians. While some clinicians always used psychosocial information, others did so when patients were not doing well. Physicians used psychosocial information to judge patient capabilities, understanding, and needs; this informed assessment of the risks and the feasibility of options and patient needs. These assessments influenced 4 key clinical decisions. DISCUSSION Triggers for psychosocially informed CDSS should include psychosocial screening results, new or newly diagnosed patients, and changes in patient status. CDSS should support cost-sensitive medication prescribing, and psychosocially based assessment of hypoglycemia risk. Electronic health records should capture rationales for care that do not conform to guidelines for panel management. NPs and diabetes educators are key stakeholders in psychosocially informed CDSS. CONCLUSION Findings highlight opportunities for psychosocially informed CDSS-a vital next step for improving health equity.
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Affiliation(s)
- Charles Senteio
- Department of Library and Information Science, Rutgers School of Communication and Information, New Brunswick, New Jersey, USA
| | - Julia Adler-Milstein
- Department of Medicine, University of California San Francisco, San Francisco, California USA
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan USA
| | - Tiffany Veinot
- School of Information, School of Public Health, University of Michigan, Ann Arbor, Michigan USA
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Yan X, Chen L, Yan H. Socio-economic status, visual impairment and the mediating role of lifestyles in developed rural areas of China. PLoS One 2019; 14:e0215329. [PMID: 30973943 PMCID: PMC6459527 DOI: 10.1371/journal.pone.0215329] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/30/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To examine the impacts of socio-economic status (SES) on visual impairment (VI), and the mediating role of lifestyles in developed rural areas of China. METHODS A cross-sectional study was conducted among people living in rural districts of Tianjin, a developed municipality in China. An interviewer-administered survey along with free eye screenings was conducted with participants. The questionnaire included questions about demographic characteristics, SES, medical histories and lifestyles. Presenting visual acuity (PVA) and main causes of VI were identified by ophthalmologists. χ2 test was undertaken to determine whether significant differences (p<0.05) exist between VI and demographic, SES, medical history and lifestyle factors. A stepwise regression method was conducted to investigate whether lifestyles play mediating roles between SES and VI. Multivariable logistic and ordinal logistic regression were used contingent on different types of dependent variables in each regression, and adjusted odds ratio (OR) values were estimated. RESULTS Of the 12,233 participants, 6,233 were male (50.59%); the mean age was 34.61 years; 310 (2.54%) had VI. Hypertension, diabetes and cardiopathy were main medical histories, with 1,640 had hypertension (13.41%), 854 had diabetes (6.98%) and 483 had cardiopathy (3.95%). About SES factors, higher education level (Adjusted OR, 0.84; 95% CI, 0.75-0.95) and higher income level (Adjusted OR, 0.54; 95% CI, 0.39-0.76), were significantly associated with VI in a gradient across severity of VI. Lifestyles including smoking (Adjusted OR, 1.55; 95% CI, 1.31-1.83) and drinking (Adjusted OR, 1.36; 95% CI, 1.06-1.74) played mediating roles between SES and VI when considering the full sample. Besides smoking and drinking, reading every week (Adjusted OR, 2.07; 95% CI, 1.53-2.82) and exercising more than 2h every day (Adjusted OR, 0.39; 95% CI, 0.15-1.00) also played mediating roles between SES and VI when considering the subsample (age≥16). CONCLUSION This study revealed the crucial impacts of SES factors on VI, and the mediating role played by several lifestyles. Targeted public health interventions for reducing VI should thus be proposed in developed rural areas of China.
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Affiliation(s)
- Xiaochang Yan
- School of Economics, Peking University, Beijing, China
| | - Lu Chen
- School of Finance, Nankai University, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
- * E-mail:
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Lehto R, Lehto E, Konttinen H, Vepsäläinen H, Nislin M, Nissinen K, Vepsäläinen C, Koivusilta L, Erkkola M, Roos E, Ray C. Neighborhood Socioeconomic Status and Feeding Practices in Finnish preschools. Scand J Public Health 2019; 47:548-556. [PMID: 30813851 DOI: 10.1177/1403494819832114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Certain feeding practices, such as role modeling healthy eating and encouragement are recommended to be used in preschools. Little is known about whether preschool characteristics are associated with the use of these feeding practices. Our aim was to examine whether the socioeconomic status (SES) of the preschool neighborhood is associated with the feeding practices in preschools. Methods: This study was part of the cross-sectional DAGIS study. We studied 66 municipal preschools and 378 early childhood educators (ECEs). Preschool neighborhood SES was assessed with map grid data. Feeding practices were assessed by questionnaires and lunchtime observation. Associations between preschool neighborhood SES and feeding practices were tested with logistic regression analyses adjusted for ECEs' educational level and municipal policies on ECEs' lunch prices, and on birthday foods. Results: The crude model showed that in high-SES neighborhood preschools ECEs were more likely to eat the same lunch as the children (OR 2.46, 95% CI 1.42-4.24) and to reward children with other food for eating vegetables (OR 2.48, 95% CI 1.40-4.41). Furthermore, in high-SES preschools it was less likely that birthday foods outside of the normal menu were available on birthdays (OR 0.29, 95% CI 0.12-0.71). In the adjusted model, rewarding with other food remained associated with preschool neighborhood SES (OR 2.13, 95% CI 1.12-4.07). Conclusions: After adjustments, preschool neighborhood SES was mostly unassociated with the feeding practices in preschools. Municipal policies may have a significant impact on feeding practices and ultimately on young children's food intake in Finland where most children attend municipal preschools.
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Affiliation(s)
| | - Elviira Lehto
- 1 Folkhälsan Research Center, Helsinki, Finland.,2 University of Helsinki, Faculty of Educational Sciences, Helsinki, Finland
| | - Hanna Konttinen
- 3 University of Helsinki, Department of Food and Environmental Sciences, Helsinki, Finland.,4 University of Helsinki, Sociology, Helsinki, Finland
| | - Henna Vepsäläinen
- 3 University of Helsinki, Department of Food and Environmental Sciences, Helsinki, Finland
| | - Mari Nislin
- 5 The Education University of Hong Kong, Department of Early Childhood Education, Center for Educational and Developmental Sciences, Hong Kong
| | - Kaija Nissinen
- 6 Seinäjoki University of Applied Sciences, Seinäjoki, Finland
| | | | - Leena Koivusilta
- 7 University of Turku, Department of Social Research, Turku, Finland
| | - Maijaliisa Erkkola
- 3 University of Helsinki, Department of Food and Environmental Sciences, Helsinki, Finland
| | - Eva Roos
- 1 Folkhälsan Research Center, Helsinki, Finland.,3 University of Helsinki, Department of Food and Environmental Sciences, Helsinki, Finland.,8 University of Helsinki, Department of Public Health, Helsinki, Finland
| | - Carola Ray
- 1 Folkhälsan Research Center, Helsinki, Finland
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Hand CL, Howrey BT. Associations Among Neighborhood Characteristics, Mobility Limitation, and Social Participation in Late Life. J Gerontol B Psychol Sci Soc Sci 2019; 74:546-555. [PMID: 28158866 PMCID: PMC6377035 DOI: 10.1093/geronb/gbw215] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/30/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Although emerging research suggests neighborhood characteristics can support and restrict social participation in older adults, further research regarding a wider range of neighborhood characteristics and interactions between individual and neighborhood characteristics is needed. This study explored associations between neighborhood characteristics and frequency of participation in three social activities among older adults and interactions between neighborhood characteristics and mobility limitation as they relate to participation. METHOD Data from the 2008 wave of the Health and Retirement Study linked with American Community Survey data were used. Participants included community-dwelling adults aged 65 years or older. Analysis involved multivariate logistic regression. RESULTS High proportion of neighborhood residents aged 65 and older was associated with increased odds of more frequent participation in all three activities. High population density was associated with increased odds of club attendance. High neighborhood social cohesion was associated with increased odds of attending nonreligious meetings. Interactions between walking limitation and population density or social cohesion related to increased odds of participation. DISCUSSION Findings suggest that improving older adults' ability to participate in community life and age in place requires strategies that consider how neighborhood and individual characteristics interact and how these characteristics may differentially affect types of participation.
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Affiliation(s)
- Carri L Hand
- School of Occupational Therapy, University of Western Ontario, London, Canada
| | - Bret T Howrey
- Department of Family Medicine, University of Texas Medical Branch, Galveston
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Schneider A, Bak M, Mahoney C, Hoyle L, Kelly M, Atherton IM, Kyle RG. Health-related behaviours of nurses and other healthcare professionals: A cross-sectional study using the Scottish Health Survey. J Adv Nurs 2019; 75:1239-1251. [PMID: 30536909 DOI: 10.1111/jan.13926] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/17/2018] [Accepted: 11/13/2018] [Indexed: 11/28/2022]
Abstract
AIMS To estimate the prevalence and co-occurrence of health-related behaviours among nurses in Scotland relative to other healthcare workers and those in non-healthcare occupations. DESIGN Secondary analysis of nationally representative cross-sectional data, reported following STROBE guidelines. METHODS Five rounds (2008-2012) of the Scottish Health Survey were aggregated to estimate the prevalence and co-occurrence of health-related behaviours (smoking, alcohol consumption, physical activity, fruit/vegetable intake). The weighted sample (n = 18,820) included 471 nurses (3%), 433 other healthcare professionals (2%), 813 unregistered care workers (4%), and 17,103 in non-healthcare occupations (91%). Logistic regression models compared the prevalence of specific health-related behaviours and principal component analysis assessed co-occurrence of health-related behaviours between occupational groups. RESULTS Nurses reported significantly better health-related behaviours relative to the general working population for smoking, fruit/vegetable intake, and physical activity. No significant difference was found for alcohol consumption between occupational groups. Nurses reported lower levels of harmful co-occurring behaviours (tobacco smoking and alcohol consumption) and higher levels of preventive behaviours (physical activity and fruit/vegetable intake) compared with the general working population. Other healthcare professionals had the lowest level of harmful health behaviours and the highest level of preventive health behaviours. Health-related behaviours were poorest among unregistered care workers. CONCLUSION Nurses' health-related behaviours were better than the general population but non-adherence to public health guidelines was concerning. IMPACT Nurses play an important role in health promotion through patient advice and role-modelling effects. To maximise their impact, healthcare providers should prioritise increasing access to healthy food, alcohol awareness, and smoking cessation programmes.
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Affiliation(s)
- Anna Schneider
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Marieke Bak
- Section of Medical Ethics, Department of General Practice, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Catherine Mahoney
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Louise Hoyle
- Faculty of Health Sciences & Sport, University of Stirling, Stirling, UK
| | - Muireann Kelly
- School of Health & Social Care, London South Bank University, London, UK
| | - Iain M Atherton
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Richard G Kyle
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
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Lagström H, Halonen JI, Kawachi I, Stenholm S, Pentti J, Suominen S, Kivimäki M, Vahtera J. Neighborhood socioeconomic status and adherence to dietary recommendations among Finnish adults: A retrospective follow-up study. Health Place 2018; 55:43-50. [PMID: 30470615 DOI: 10.1016/j.healthplace.2018.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 01/08/2023]
Abstract
Neighborhood socioeconomic status (SES) is associated with dietary habits among the residents, but few studies have examined this association separately among long-term residents and movers. We calculated cumulative neighborhood SES score weighted by residential time in each address over 6 years for non-movers (n = 7704) and movers (n = 8818) using national grid database. Increase in average neighborhood SES was associated with higher adherence to dietary recommendations in both groups. Among the movers, an upward trajectory from low to high neighborhood SES was also associated with better adherence. Our findings suggest high SES areas might offer healthier food environments than low SES areas.
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Affiliation(s)
- Hanna Lagström
- Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland.
| | | | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sari Stenholm
- Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland; School of Health and Education, University of Skövde, Skövde, Sweden; Turku University Hospital, Turku, Finland
| | - Mika Kivimäki
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, England, UK
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland
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Hussein M, Diez Roux AV, Mujahid MS, Hastert TA, Kershaw KN, Bertoni AG, Baylin A. Unequal Exposure or Unequal Vulnerability? Contributions of Neighborhood Conditions and Cardiovascular Risk Factors to Socioeconomic Inequality in Incident Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2018; 187:1424-1437. [PMID: 29186311 DOI: 10.1093/aje/kwx363] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022] Open
Abstract
Risk factors can drive socioeconomic inequalities in cardiovascular disease (CVD) through differential exposure and differential vulnerability. In this paper, we show how econometric decomposition directly enables simultaneous, policy-oriented assessment of these 2 mechanisms. We specifically estimate contributions of neighborhood environment and proximal risk factors to socioeconomic inequality in CVD incidence via these mechanisms. We followed 5,608 participants in the Multi-Ethnic Study of Atherosclerosis (2000-2012) to their first CVD event (median length of follow-up, 12.2 years). We used a summary measure of baseline socioeconomic position (SEP). Covariates included baseline demographics, neighborhood characteristics, and psychosocial, behavioral, and biomedical risk factors. Using Poisson models, we decomposed the difference (inequality) in incidence rates between low- and high-SEP groups into contributions of 1) differences in covariate means (differential exposure) and 2) differences in CVD risk associated with covariates (differential vulnerability). Notwithstanding large uncertainty in neighborhood estimates, our analysis suggested that differential exposure to poorer neighborhood socioeconomic conditions, adverse social environment, diabetes, and hypertension accounted for most of the inequality. Psychosocial and behavioral contributions were negligible. Further, neighborhood SEP, female sex, and white race were more strongly associated with CVD among low-SEP (vs. high-SEP) participants. These differentials in vulnerability also accounted for nontrivial portions of the inequality and could have important implications for intervention.
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Affiliation(s)
- Mustafa Hussein
- Joseph J. Zilber School of Public Health, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Mahasin S Mujahid
- Department of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Theresa A Hastert
- Department of Oncology, School of Medicine and Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Kiarri N Kershaw
- Division of Epidemiology, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ana Baylin
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Bann D, Hamer M, Parsons S, Ploubidis GB, Sullivan A. Does an elite education benefit health? Findings from the 1970 British Cohort Study. Int J Epidemiol 2018; 46:293-302. [PMID: 27170767 PMCID: PMC5407151 DOI: 10.1093/ije/dyw045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 02/06/2023] Open
Abstract
Background: Attending private school or a higher-status university is thought to benefit future earnings and occupational opportunities. We examined whether these measures were beneficially related to health and selected health-related behaviours in midlife. Methods: Data were from up to 9799 participants from the 1970 British birth Cohort Study. The high school attended (private, grammar or state) was ascertained at 16 years, and the university attended reported at 42 years [categorised as either higher (Russell Group) or normal-status institutions]. Self-reported health, limiting illness and body mass index (BMI) were reported at 42 years, along with television viewing, take-away meal consumption, physical inactivity, smoking and high risk alcohol drinking. Associations were examined using multiple regression models, adjusted for gender and childhood socioeconomic, health and cognitive measures. Results: Private school and higher status university attendance were associated with favourable self-rated health and lower BMI, and beneficially associated with health-related-behaviours. For example, private school attendance was associated with 0.56 [95% confidence interval (CI): 0.48, 0.65] odds of lower self-rated health [odds ratio (OR) for higher-status university: 0.32 (0.27, 0.37)]. Associations were largely attenuated by adjustment for potential confounders, except for those of private schooling and higher-status university attendance with lower BMI and television viewing, and less frequent take-away meal consumption. Conclusions: Private school and higher-status university attendance were related to better self-rated health, lower BMI and multiple favourable health behaviours in midlife. Findings suggest that type or status of education may be an important under-researched construct to consider when documenting and understanding socioeconomic inequalities in health.
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Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, UCL Institute of Education, London, UK
| | - Mark Hamer
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,Department of Epidemiology & Public Health, University College London, London, UK
| | - Sam Parsons
- Centre for Longitudinal Studies, UCL Institute of Education, London, UK
| | | | - Alice Sullivan
- Centre for Longitudinal Studies, UCL Institute of Education, London, UK
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Morris T, Manley D, Van Ham M. Context or composition: How does neighbourhood deprivation impact upon adolescent smoking behaviour? PLoS One 2018; 13:e0192566. [PMID: 29420655 PMCID: PMC5805312 DOI: 10.1371/journal.pone.0192566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/25/2018] [Indexed: 11/27/2022] Open
Abstract
Neighbourhood effects studies have demonstrated an association between area deprivation and smoking behaviour whereby people living in deprived neighbourhoods are more likely to smoke than those in non-deprived neighbourhoods. This evidence though is based largely upon data that ignores long term exposures to neighbourhood contexts and is confounded by neighbourhood selection bias. In this study, we investigate the temporal ordering of exposure to neighbourhood deprivation throughout childhood and whether associations between neighbourhood deprivation and cigarette smoking are due to compositional or contextual neighbourhood effects. Data come from a UK cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC). We use longitudinal measures of neighbourhood deprivation and self-reported smoking behaviour for 2744 children to examine the influence of neighbourhood deprivation on smoking status and smoking heaviness at age 17. Our results demonstrate that children who are born into and grow up in deprived neighbourhoods are up to twice as likely to be smokers at age 17 than those in non-deprived neighbourhoods. These associations are largely due to family socioeconomic position and the intergenerational transmission of smoking behaviour from parents to children; compositional rather than direct contextual ‘neighbourhood effects’. Our findings highlight the importance of considering longitudinal exposure to neighbourhood deprivation over cross sectional exposure. In conclusion, we find that it is the family rather than the neighbourhood into which a child is born that determines their smoking behaviour.
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Affiliation(s)
- Tim Morris
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - David Manley
- School of Geographical Sciences, University of Bristol, Bristol, United Kingdom
- OTB—Research for the Built Environment, Faculty of Architecture and the Built Environment, Delft University of Technology, Delft, The Netherlands
| | - Maarten Van Ham
- OTB—Research for the Built Environment, Faculty of Architecture and the Built Environment, Delft University of Technology, Delft, The Netherlands
- School of Geography and Sustainable Development, University of St Andrews, Fife, United Kingdom
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Kino S, Bernabé E, Sabbah W. The role of healthcare and education systems in co-occurrence of health risk behaviours in 27 European countries. Eur J Public Health 2018; 28:186-192. [PMID: 29346661 DOI: 10.1093/eurpub/ckx071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Contextual factors play an important role in health and related behaviours. This study aims to examine the association of co-occurrence of five health-risk behaviours with healthcare and education contextual factors using nationally representative samples from 27 European countries. Methods Data were from Eurobarometer 72.3, 2009. The outcome was a count variable ranging from 0 to 5 indicating co-occurrence of five health-risk behaviours, namely smoking, excessive alcohol consumption, non-frequent fresh fruit consumption, physical inactivity and non-dental check-ups. Public expenditures on healthcare and education as a percentage of GDP and quality of healthcare and education at a country-level were used as contextual factors. A set of multilevel Poisson regression models were conducted to examine the associations between co-occurrence of health-risk behaviours and each of the contextual factors considering age, gender, marital status, urbanisation, individual socioeconomic positions (education, subjective social status or difficulty in paying bills) and GDP per capita. Results The total population was 23 842. Greater expenditures on healthcare and education, and better quality of healthcare systems had negative associations with co-occurrence of health-risk behaviours in the model adjusted for all individual demographic indicators. However, statistical significance disappeared after adjusting for socioeconomic indicators and GDP per capita. Conclusion While the study highlights the importance of developing high-quality healthcare and education systems generously supported by public fund in relation to co-occurrence of health-risk behaviours, the influence of contextual factors in adopting health-related behaviours is probably attenuated by individual socioeconomic factors.
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Affiliation(s)
- Shiho Kino
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, London, UK
| | - Eduardo Bernabé
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, London, UK
| | - Wael Sabbah
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, London, UK
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Change in Neighborhood Disadvantage and Change in Smoking Behaviors in Adults: A Longitudinal, Within-individual Study. Epidemiology 2018; 27:803-9. [PMID: 27337178 DOI: 10.1097/ede.0000000000000530] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence for an association between neighborhood disadvantage and smoking is mixed and mainly based on cross-sectional studies. To shed light on the causality of this association, we examined whether change in neighborhood socioeconomic disadvantage is associated with within-individual change in smoking behaviors. METHODS The study population comprised participants of the Finnish Public Sector study who reported a change in their smoking behavior between surveys in 2008/2009 and 2012/2013. We linked participants' residential addresses to a total population database on neighborhood disadvantage with 250 × 250-m resolution. The outcome variables were changes in smoking status (being a smoker vs. not) as well as the intensity (heavy/moderate vs. light smoker). We used longitudinal case-crossover design, a method that accounts for time-invariant confounders by design. We adjusted models for time-varying covariates. RESULTS Of the 3,443 participants, 1,714 quit, while 967 began to smoke between surveys. Smoking intensity increased among 398 and decreased among 364 participants. The level of neighborhood disadvantage changed for 1,078 participants because they moved residence. Increased disadvantage was associated with increased odds of being a smoker (odds ratio of taking up smoking 1.23 [95% confidence interval: 1.2, 1.5] per 1 SD increase in standardized national disadvantage score). Odds ratio for being a heavy/moderate (vs. light) smoker was 1.14 (95% confidence interval: 0.85, 1.52) when disadvantage increased by 1 SD. CONCLUSIONS These within-individual results link an increase in neighborhood socioeconomic disadvantage, due to move in residence, with subsequent smoking behaviors.
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Algren MH, Ekholm O, van Lenthe F, Mackenbach J, Bak CK, Andersen PT. Health-risk behaviour among residents in deprived neighbourhoods compared with those of the general population in Denmark: A cross-sectional study. Health Place 2017; 45:189-198. [PMID: 28412595 DOI: 10.1016/j.healthplace.2017.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
This study compares health-risk behaviours (including the co-occurrence of health-risk behaviours) of residents in the deprived neighbourhoods with those of the general population of Denmark. It also examines associations between sociodemographic and socioeconomic characteristics and health-risk behaviours in deprived neighbourhoods in Denmark. Even after adjustment for socioeconomic characteristics there were large differences in health-risk behaviours between residents in deprived neighbourhoods and the general population. In the deprived neighbourhoods large sociodemographic and socioeconomic differences in health-risk behaviours were found among the residents. Our findings highlight the need for health promotion programmes targeting residents in deprived neighbourhoods.
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Affiliation(s)
- Maria Holst Algren
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark.
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, 1353 Copenhagen, Denmark
| | - Frank van Lenthe
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Johan Mackenbach
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Carsten Kronborg Bak
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg, Denmark
| | - Pernille Tanggaard Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
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Cutumisu N, Traoré I, Paquette MC, Cazale L, Camirand H, Lalonde B, Robitaille E. Association between junk food consumption and fast-food outlet access near school among Quebec secondary-school children: findings from the Quebec Health Survey of High School Students (QHSHSS) 2010-11. Public Health Nutr 2017; 20:927-937. [PMID: 27881202 PMCID: PMC10261303 DOI: 10.1017/s136898001600286x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/18/2016] [Accepted: 08/25/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVE We investigated the association between junk food consumption at lunchtime (JCL) and fast-food outlet access near school among secondary-school children in Quebec. DESIGN A geographic information system database was used to characterize the food environment around a sub-sample of 374 public schools in which 26 655 students were enrolled. The outcome variable was JCL during the previous week, dichotomized into low JCL (none or once) v. high JCL (twice or more). Access to fast-food outlets near school was assessed using an existing database of fast-food outlets in Quebec. Covariates included student (age, sex and self-rated perceived health), family (familial status and parental education) and school (urban/rural status and deprivation) variables. Hierarchical logistic regression models were employed for analyses using PROC GLIMMIX of SAS version 9.3. SETTING Province of Quebec, Canada. SUBJECTS We used data from the Quebec Health Survey of High School Students (QHSHSS) 2010-11, a survey of secondary-school Quebec students. RESULTS Exposure to two or more fast-food outlets within a radius of 750 m around schools was associated with a higher likelihood of excess JCL (OR=1·50; 95 % CI 1·28, 1·75), controlling for the characteristics of the students, their families and their schools. CONCLUSIONS The food environment surrounding schools can constitute a target for interventions to improve food choices among secondary-school children living in the province of Quebec. Transforming environments around schools to promote healthy eating includes modifying zoning regulations that restrict access to fast-food outlets around schools.
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Affiliation(s)
- Nicoleta Cutumisu
- INRS (National Institute for Scientific Research/Institut national de la recherche scientifique) – Institut Armand Frappier Research Center, 531 Boul des Prairies, Building 12, Office 109, Laval, Quebec, Canada, H7V 1B7
- National Public Health Institute of Quebec (Institut national de santé publique du Québec), Montreal, Quebec, Canada
| | - Issouf Traoré
- Institute of Statistics of Quebec (Institut de la statistique du Québec), Montreal, Quebec, Canada
| | - Marie-Claude Paquette
- National Public Health Institute of Quebec (Institut national de santé publique du Québec), Montreal, Quebec, Canada
| | - Linda Cazale
- Institute of Statistics of Quebec (Institut de la statistique du Québec), Montreal, Quebec, Canada
| | - Hélène Camirand
- Institute of Statistics of Quebec (Institut de la statistique du Québec), Montreal, Quebec, Canada
| | - Benoit Lalonde
- National Public Health Institute of Quebec (Institut national de santé publique du Québec), Montreal, Quebec, Canada
- Laval University, Quebec City, Quebec, Canada
- Research Centre of the Quebec Heart and Lung Institute (l’Institut universitaire de cardiologie et de pneumologie de Québec – CRIUCPQ), Quebec City, Quebec, Canada
| | - Eric Robitaille
- National Public Health Institute of Quebec (Institut national de santé publique du Québec), Montreal, Quebec, Canada
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Associations between physical activity and the neighbourhood social environment: baseline results from the HABITAT multilevel study. Prev Med 2016; 93:219-225. [PMID: 27370165 DOI: 10.1016/j.ypmed.2016.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/31/2016] [Accepted: 06/27/2016] [Indexed: 11/22/2022]
Abstract
Limitations have arisen when measuring associations between the neighbourhood social environment and physical activity, including same-source bias, and the reliability of aggregated neighbourhood-level social environment measures. This study examines cross-sectional associations between the neighbourhood social environment (perceptions of incivilities, crime, and social cohesion) and self-reported physical activity, while accounting for same-source bias and reliability of neighbourhood-level exposure measures, using data from a large population-based clustered sample. This investigation included 11,035 residents aged 40-65years from 200 neighbourhoods in Brisbane, Australia, in 2007. Respondents self-reported their physical activity and perceptions of the social environment (neighbourhood incivilities, crime and safety, and social cohesion). Models were adjusted for individual-level education, occupation, and household income, and neighbourhood disadvantage. Exposure measures were generated via split clusters and an empirical Bayes estimation procedure. Data were analysed in 2016 using multilevel multinomial logistic regression. Residents of neighbourhoods with the highest incivilities and crime, and lowest social cohesion were reference categories. Individuals were more likely to be in the higher physical activity categories if they were in neighbourhoods with the lowest incivilities and the lowest crime. No associations were found between social cohesion and physical activity. This study provides a basis from which to gain a clearer understanding of the relationship between the neighbourhood social environment and individual physical activity. Further work is required to explore the pathways between perceptions of the neighbourhood social environment and physical activity.
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Azage M, Kumie A, Worku A, Bagtzoglou AC. Childhood diarrhea in high and low hotspot districts of Amhara Region, northwest Ethiopia: a multilevel modeling. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2016; 35:13. [PMID: 27184552 PMCID: PMC5025988 DOI: 10.1186/s41043-016-0052-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/11/2016] [Indexed: 05/15/2023]
Abstract
BACKGROUND Childhood diarrhea is one of the major public health problems in Ethiopia. Multiple factors at different levels contribute to the occurrence of childhood diarrhea. The objective of the study was to identify the factors affecting childhood diarrhea at individual and community level. METHODS A cross-sectional study design was employed from February to March 2015 in high and low hotspot districts of Awi and West and East Gojjam zones in Amhara Region, northwest Ethiopia. Districts with high and low hotspots with childhood diarrhea were identified using SaTScan spatial statistical analysis. A total of 2495 households from ten (five high and five low hotspot) randomly selected districts were included in the study. A semi-structured questionnaire was used to collect data. Data were entered and cleaned in Epi Info 3.5.2 version and analyzed using Stata version 12. A multilevel logistic regression was used to identify factors associated with childhood diarrhea. RESULTS The prevalence of childhood diarrhea was 13.5 % and did not show significant variation between high [14.3 % (95 % CI 12.3-16.2 %)] and low [12.7 % (95 % CI 10.9-14.6 %)] hotspot districts. Individual- and community-level factors accounted for 35 % of childhood diarrhea variation across the communities in the full model. Age of children (6-35 months), complementary feeding initiation below 6 months, inadequate hand washing practices, limited knowledge of mothers on diarrhea, lowest wealth status of households, and longer time interval to visit households by health extension workers were factors for increasing the odds of childhood diarrhea at the individual level. At the community level, lack of improved water supply and sanitation and unvaccinated children with measles and rotavirus vaccine were the factors associated with childhood diarrhea. CONCLUSIONS In this study, childhood diarrhea occurrences remained high. Both individual- and community-level factors determined the occurrence of diarrhea. Interventions should consider both individual- and community-level factors to reduce the occurrence of childhood diarrhea.
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Affiliation(s)
- Muluken Azage
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Abera Kumie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amvrossios C Bagtzoglou
- Department of Civil and Environmental Engineering, School of Engineering, University of Connecticut, Storrs, CT, 06269-3037, USA
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Guhn M, Janus M, Enns J, Brownell M, Forer B, Duku E, Muhajarine N, Raos R. Examining the social determinants of children's developmental health: protocol for building a pan-Canadian population-based monitoring system for early childhood development. BMJ Open 2016; 6:e012020. [PMID: 27130168 PMCID: PMC4853992 DOI: 10.1136/bmjopen-2016-012020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Early childhood is a key period to establish policies and practices that optimise children's health and development, but Canada lacks nationally representative data on social indicators of children's well-being. To address this gap, the Early Development Instrument (EDI), a teacher-administered questionnaire completed for kindergarten-age children, has been implemented across most Canadian provinces over the past 10 years. The purpose of this protocol is to describe the Canadian Neighbourhoods and Early Child Development (CanNECD) Study, the aims of which are to create a pan-Canadian EDI database to monitor trends over time in children's developmental health and to advance research examining the social determinants of health. METHODS AND ANALYSIS Canada-wide EDI records from 2004 to 2014 (representing over 700,000 children) will be linked to Canada Census and Income Taxfiler data. Variables of socioeconomic status derived from these databases will be used to predict neighbourhood-level EDI vulnerability rates by conducting a series of regression analyses and latent variable models at provincial/territorial and national levels. Where data are available, we will measure the neighbourhood-level change in developmental vulnerability rates over time and model the socioeconomic factors associated with those trends. ETHICS AND DISSEMINATION Ethics approval for this study was granted by the Behavioural Research Ethics Board at the University of British Columbia. Study findings will be disseminated to key partners, including provincial and federal ministries, schools and school districts, collaborative community groups and the early childhood development research community. The database created as part of this longitudinal population-level monitoring system will allow researchers to associate practices, programmes and policies at school and community levels with trends in developmental health outcomes. The CanNECD Study will guide future early childhood development action and policies, using the database as a tool for formative programme and policy evaluation.
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Affiliation(s)
- Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Barry Forer
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology and Saskatchewan Population Health and Evaluation Research Unit, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rob Raos
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Haile D, Azage M, Mola T, Rainey R. Exploring spatial variations and factors associated with childhood stunting in Ethiopia: spatial and multilevel analysis. BMC Pediatr 2016; 16:49. [PMID: 27084512 PMCID: PMC4833938 DOI: 10.1186/s12887-016-0587-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/12/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Stunting reflects a failure to receive adequate nutrition over a long period of time. Stunting is associated with adverse functional consequences including poor cognition, low educational performance, low adult wages, and poor reproductive outcomes. The objective of the study was to investigate spatial variations and factors associated with childhood stunting in Ethiopia. METHODS This study is a secondary data analysis of the 2011 Ethiopian Demographic and Health Survey (EDHS). A total of 9893 children aged 0-59 months were included in the analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of stunting. A multilevel multivariable logistic regression was used to identify factors associated with stunting. RESULTS Statistically significant hotspots of stunting were found in northern parts of the country whereas low hotspots where there was less stunting than expected were found in the central, eastern, and western parts of the country. In the final model of multilevel logistic regression analysis, individual and community level factors accounted for 36.6 % of childhood stunting. Short birth interval [AOR = 1.68; 95%CI: (1.46-1.93)], being male [AOR = 1.20; 95%CI: (1.08-1.33)], and being from a male-headed household [AOR = 1.18; 95 % CI: (1.01-1.38)] were the factors that increased the odds of stunting at the individual level. Children in the age group between 24-35 months were more likely to be stunted than children whose age was less than one year [AOR = 6.61; 95 % CI: (5.17-8.44)]. The odds of stunting among children with severe anemia were higher than children with no anemia [AOR = 3.23; 95%CI: (2.35-4.43)]. Children with mothers who had completed higher education had lower odds of being stunted compared to children whose mothers had no formal education [AOR = 0.42; 95%CI: (0.18-0.94)]. The odds of being stunted were lower among children whose fathers completed higher education [AOR = 0.58; 95%CI: (0.38-0.89)] compared to children whose fathers had no formal education. Children whose mothers who had high a Body Mass Index (BMI) (≥25.0 kg/m(2)) were less likely to be stunted compared with children whose mothers had a normal BMI (18.5 kg/m(2)-24.9 kg/m(2))[AOR = 0.69; 95%CI: (0.52-0.90)]. Children from the poorest wealth quintile had higher odds of being stunted compared to children from the richest wealth quintiles [AOR = 1.43; 95 % CI: (1.08-1.88)]. Unavailability of improved latrine facilities and living in the northern parts of the country (Tigray, Affar, Amhara and Benishangul-Gumuzregions) were factors associated with higher odds of stunting from the community-level factors. CONCLUSION Stunting in children under five years old is not random in Ethiopia, with hotspots of higher stunting in the northern part of Ethiopia. Both individual and community-level factors were significant determinants of childhood stunting. The regions with high hotspots of child stunting should be targeted with additional resources, and the identified factors should be considered for nutritional interventions.
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Affiliation(s)
- Demewoz Haile
- Department of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Muluken Azage
- Department of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Tegegn Mola
- Department of Geography and Environmental Studies, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Rochelle Rainey
- United States Agency for International Development (USAID), Washington, DC USA
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Composite Measures of Individual and Area-Level Socio-Economic Status Are Associated with Visual Impairment in Singapore. PLoS One 2015; 10:e0142302. [PMID: 26555141 PMCID: PMC4640712 DOI: 10.1371/journal.pone.0142302] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/20/2015] [Indexed: 12/18/2022] Open
Abstract
Purpose To investigate the independent relationship of individual- and area-level socio-economic status (SES) with the presence and severity of visual impairment (VI) in an Asian population. Methods Cross-sectional data from 9993 Chinese, Malay and Indian adults aged 40–80 years who participated in the Singapore Epidemiology of eye Diseases (2004–2011) in Singapore. Based on the presenting visual acuity (PVA) in the better-seeing eye, VI was categorized into normal vision (logMAR≤0.30), low vision (logMAR>0.30<1.00), and blindness (logMAR≥1.00). Any VI was defined as low vision/blindness in the PVA of better-seeing eye. Individual-level low-SES was defined as a composite of primary-level education, monthly income<2000 SGD and residing in 1 or 2-room public apartment. An area-level SES was assessed using a socio-economic disadvantage index (SEDI), created using 12 variables from the 2010 Singapore census. A high SEDI score indicates a relatively poor SES. Associations between SES measures and presence and severity of VI were examined using multi-level, mixed-effects logistic and multinomial regression models. Results The age-adjusted prevalence of any VI was 19.62% (low vision = 19%, blindness = 0.62%). Both individual- and area-level SES were positively associated with any VI and low vision after adjusting for confounders. The odds ratio (95% confidence interval) of any VI was 2.11(1.88–2.37) for low-SES and 1.07(1.02–1.13) per 1 standard deviation increase in SEDI. When stratified by unilateral/bilateral categories, while low SES showed significant associations with all categories, SEDI showed a significant association with bilateral low vision only. The association between low SES and any VI remained significant among all age, gender and ethnic sub-groups. Although a consistent positive association was observed between area-level SEDI and any VI, the associations were significant among participants aged 40–65 years and male. Conclusion In this community-based sample of Asian adults, both individual- and area-level SES were independently associated with the presence and severity of VI.
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Powell-Wiley TM, Cooper-McCann R, Ayers C, Berrigan D, Lian M, McClurkin M, Ballard-Barbash R, Das SR, Hoehner CM, Leonard T. Change in Neighborhood Socioeconomic Status and Weight Gain: Dallas Heart Study. Am J Prev Med 2015; 49:72-9. [PMID: 25960394 PMCID: PMC4476924 DOI: 10.1016/j.amepre.2015.01.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Despite a proposed connection between neighborhood environment and obesity, few longitudinal studies have examined the relationship between change in neighborhood socioeconomic deprivation, as defined by moving between neighborhoods, and change in body weight. The purpose of this study is to examine the longitudinal relationship between moving to more socioeconomically deprived neighborhoods and weight gain as a cardiovascular risk factor. METHODS Weight (kilograms) was measured in the Dallas Heart Study (DHS), a multiethnic cohort aged 18-65 years, at baseline (2000-2002) and 7-year follow-up (2007-2009, N=1,835). Data were analyzed in 2013-2014. Geocoded addresses were linked to Dallas County, TX, census block groups. A block group-level neighborhood deprivation index (NDI) was created. Multilevel difference-in-difference models with random effects and a Heckman correction factor (HCF) determined weight change relative to NDI change. RESULTS Forty-nine percent of the DHS population moved (263 to higher NDI, 586 to lower NDI, 47 within same NDI), with blacks more likely to move than whites or Hispanics (p<0.01), but similar baseline BMI and waist circumference were observed in movers versus non-movers (p>0.05). Adjusting for HCF, sex, race, and time-varying covariates, those who moved to areas of higher NDI gained more weight compared to those remaining in the same or moving to a lower NDI (0.64 kg per 1-unit NDI increase, 95% CI=0.09, 1.19). Impact of NDI change on weight gain increased with time (p=0.03). CONCLUSIONS Moving to more-socioeconomically deprived neighborhoods was associated with weight gain among DHS participants.
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Affiliation(s)
| | - Rebecca Cooper-McCann
- Blood Institute; Clinical Center, Office of Clinical Research Training and Medical Education, NIH, Bethesda
| | - Colby Ayers
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - David Berrigan
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Min Lian
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | | | - Rachel Ballard-Barbash
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Sandeep R Das
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
| | | | - Tammy Leonard
- Department of Economics, University of Dallas, Irving, Texas
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Halonen JI, Stenholm S, Pentti J, Kawachi I, Subramanian SV, Kivimäki M, Vahtera J. Childhood Psychosocial Adversity and Adult Neighborhood Disadvantage as Predictors of Cardiovascular Disease: A Cohort Study. Circulation 2015; 132:371-9. [PMID: 26068046 DOI: 10.1161/circulationaha.115.015392] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 05/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood adverse psychosocial factors (eg, parental divorce, long-term financial difficulties) and adult neighborhood disadvantage have both been linked to increased cardiovascular disease (CVD). However, their combined effects on disease risk are not known. METHODS AND RESULTS Participants were 37 699 adults from the Finnish Public Sector study whose data were linked to a national neighborhood disadvantage grid with the use of residential addresses between the years 2000 and 2008 and who responded to a survey on childhood psychosocial adversities and adult CVD risk behaviors in 2008 to 2009. Survey data were also linked to national registers on hospitalization, mortality, and prescriptions to assess CVD risk factors in 2008 to 2009 and to ascertain incident CVD (coronary heart disease or cerebrovascular disease) between the survey and the end of December 2011 (mean follow-up, 2.94 years; SD=0.44 years). Combined exposure to high childhood adversity and high adult disadvantage was associated with CVD risk factors (hypertension, dyslipidemia, diabetes mellitus, obesity, smoking, heavy alcohol use, and physical inactivity) and with a 2.25-fold (95% confidence interval, 1.39-3.63) hazard of incident CVD compared with a low childhood adversity and low adult disadvantage. This hazard ratio was attenuated by 16.6% but remained statistically significant after adjustment for the CVD risk factors (1.96; 95% confidence interval, 1.22-3.16). Exposure to high childhood adversity or high adult neighborhood disadvantage alone was not significantly associated with CVD in fully adjusted models. CONCLUSIONS These findings suggest that individuals with both childhood psychosocial adversity and adult neighborhood disadvantage are at an increased risk of CVD. In contrast, those with only 1 of these exposures have little or no excess risk after controlling for conventional risk factors.
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Affiliation(s)
- Jaana I Halonen
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.).
| | - Sari Stenholm
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
| | - Jaana Pentti
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
| | - Ichiro Kawachi
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
| | - S V Subramanian
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
| | - Mika Kivimäki
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
| | - Jussi Vahtera
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
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Halonen JI, Stenholm S, Kivimäki M, Pentti J, Subramanian SV, Kawachi I, Vahtera J. Is change in availability of sports facilities associated with change in physical activity? A prospective cohort study. Prev Med 2015; 73:10-4. [PMID: 25602907 DOI: 10.1016/j.ypmed.2015.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 01/09/2015] [Accepted: 01/11/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined whether change in distance to or number of sports facilities is related to change in metabolic equivalent task (MET) hours/week. METHOD 25,834 Finnish Public Sector study cohort participants reported their weekly physical activity in 2000 and 2008. Distances from each participant's home to the nearest facility and number of facilities within 500m from home were calculated from geographic coordinates. We assessed changes in weekly MET hours of physical activity between the baseline and the follow-up in relation to change in distance to the nearest facility (remained close, decreased, remained distant, increased) and number of facilities <500m from home (remained high, increased, remained low, decreased). RESULTS The average decrease in MET hours was greater for those whose distance to a sports facility increased (-1.4 (95% CI -3.8--0.96)) (vs. remained close). The same was observed for those for whom the number of facilities near home decreased (-2.35 (95% CI -4.84-0.14)) (vs. remained high). Increase in availability was not related to increase in MET hours. CONCLUSIONS An increase in distance to and decrease in number of sports facilities were associated with a decrease in physical activity suggesting that changes in availability of facilities may affect physical activity levels.
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Affiliation(s)
| | - Sari Stenholm
- Department of Public Health, University of Turku, Finland; Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, Helsinki, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Epidemiology and Public Health, University College London Medical School, London, UK
| | - Jaana Pentti
- Finnish Institute of Occupational Health, Turku, Finland
| | - S V Subramanian
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, USA
| | - Ichiro Kawachi
- Department of Epidemiology and Public Health, University College London Medical School, London, UK
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Finland; Finnish Institute of Occupational Health, Turku, Finland; Turku University Hospital, Turku, Finland
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Yom Din G, Zugman Z, Khashper A. The impact of preventive health behaviour and social factors on visits to the doctor. Isr J Health Policy Res 2014; 3:41. [PMID: 25584186 PMCID: PMC4290136 DOI: 10.1186/2045-4015-3-41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 12/02/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The aim of this study is to examine the joint impact of preventive health behavior (PHB) and social and demographic factors on the utilization of primary and secondary medical care under a universal health care system, as measured by visits to the doctor, who were categorized as either a General Practitioner (GP) or Specialist Doctor (SD). METHODS An ordered probit model was utilized to analyze data obtained from the 2009 Israeli National Health Survey. The problem of endogeneity between PHB factors and visits to GP was approached using the two-stage residuals inclusion and instrumental variables method. RESULTS We found a positive effect of PHB on visits to the doctor while the addition of the PHB factors to the independent variables resulted in important changes in explaining visits to GP (in values of the estimates, in their sign, and in their statistical significance), and only in slight changes for visits to SD. A 1% increase in PHB factors results in increasing the probability to visit General Practitioner in the last year in 0.6%. The following variables were identified as significant in explaining frequency of visits to the doctor: PHB, socio-economic status (pro-poor for visits to GP, pro-rich for visits to SD), location (for visits to SD), gender, age (age 60 or greater being a negative factor for visits to GP and a positive factor for visits to SD), chronic diseases, and marital status (being married was a negative factor for visits to GP and a positive factor for visits to SD). CONCLUSIONS There is a need for allowing for endogeneity in examining the impact of PHB, social and demographic factors on visits to GP in a population under universal health insurance. For disadvantaged populations with low SES and those living in peripheral districts, the value of IndPrev is lower than for populations with high SES and living in the center of the country. Examining the impact of these factors, significant differences in the importance and sometimes even in the sign of their influence on visits to different categories of doctors - GP and SD, are found.
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Affiliation(s)
- Gregory Yom Din
- />The Open University of Israel, Raanana, Israel, Faculty of Exact Sciences, Tel-Aviv University, Tel-Aviv, Israel
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