Socioeconomic Status and Physical Activity in Chinese Adults: A Report from a Community-Based Survey in Jiaxing, China

Is Scotland Walking in the Right Direction? A Cross-Sectional Analysis of Trends in Walking by Socioeconomic Status

BACKGROUND

Walking is a key target behavior for promoting population health. This paper charts the 30-year history of walking policy in Scotland. We assess whether population walking levels among adults in Scotland have changed in recent years and identify the characteristics of those least likely to report any walking.

METHODS

We pooled 9 years (2012-2019 and 2021) of data from adult (≥16 y) respondents of the Scottish Health Survey (n = 41,470). The outcomes of interest were the percentage reporting (1) any walking and (2) any walking with an average pace that is of at least moderate intensity. We also investigated the contribution of walking to total nonoccupational moderate to vigorous physical activity. We used linear and logistic regressions to test linear trends over time and to identify inequalities by age, sex, and the Scottish Index of Multiple Deprivation quintile.

RESULTS

There was an increase in all measures of walking over the period 2012-2021; for example, the percentage reporting any walking increased by 7 percentage points (81.4%-88.4%). Inequalities still exist by age, sex, and the Scottish Index of Multiple Deprivation but have not grown over time. Inequalities by sex and age are most pronounced in the least affluent Scottish Index of Multiple Deprivation quintiles; less affluent older women are least likely to report any walking.

CONCLUSIONS

Scotland appears to be walking in the right direction. Surveillance data support a positive trend after decades of policy and promotion efforts. The policies do not appear to be exacerbating existing inequalities, but narrowing them will require more concentrated efforts.

Dose-response relationship between weekly physical activity level and the frequency of colds in Chinese middle-aged and elderly individuals

Background

Engaging in appropriate physical activity can significantly lower the risk of various diseases among middle-aged and older adults. Investigating optimal levels of physical activity (PA) is crucial for enhancing the health of this demographic. This study aims to explore the dose-response relationship between weekly PA levels and the frequency of colds among Chinese middle-aged and elderly individuals, identifying the necessary PA level to effectively diminish the risk of colds.

Methods

We conducted a cross-sectional study using a web-based survey targeting individuals aged 40 and older (n = 1, 683) in China. The survey collected information on PA and the frequency of colds. Data was analyzed using Kruskal-Wallis test and the χ2 test. We explored the dose-response relationship between weekly PA and cold frequency over the past year through an ordered multivariate logistic regression model and a restricted cubic spline model.

Results

(1) Brisk walking emerged as the preferred physical exercise for those over 40. The findings suggest that engaging in moderate (odds ratio (OR) = 0.64, P < 0.001, 95% confidence interval (CI) [0.50-0.81]) and high (OR = 0.64, P < 0.001, 95% CI [0.51-0.79]) levels of PA weekly significantly reduces the risk of catching a cold. Individuals with one (OR = 1.47, P < 0.001, 95% CI [1.20-1.80]) or multiple chronic diseases (OR = 1.56, P < 0.001, 95% CI [1.21-2.00]) were at increased risk. Those residing in central (OR = 1.64, P < 0.001, 95% CI [1.33-02.01]) and western China (OR = 1.49, P = 0.008, 95% CI [1.11-02.00]) faced a higher risk compared to their counterparts in eastern China. (2) According to the restricted cubic spline model, adults who experienced one cold in the past year had a weekly PA level of 537.29 metabolic equivalent-minutes per week (MET-min/wk) with an OR value of 1. For those reporting two or more colds, the PA level was 537.76 MET-min/wk with an OR of 1.

Conclusions

(1) Brisk walking is the most favored exercise among the Chinese middle-aged and elderly, with the prevalence of colds being affected by the number of chronic diseases and the geographic location. (2) Regular, moderate exercise is linked to a lower risk of colds. To effectively reduce cold frequency, it is recommended that middle-aged and elderly Chinese individuals engage in a minimum of 538 MET-min/wk of exercise.

Socioeconomic inequalities in employees' health-enhancing physical activity: Evidence from the SHAHWAR cohort study in Iran

BACKGROUND

Increasing level of physical activity (PA) among working population is of particular importance, because of the high return of investment on employees' PA. This study was aimed to investigate socioeconomic inequalities in Health-Enhancing Physical Activity (HEPA) among employees of a Medical Sciences University in Iran.

METHODS

Data were extracted from the SHAHWAR Cohort study in Iran. Concentration index (C) and Wagstaff decomposition techniques were applied to determine socioeconomic inequality in the study outcomes and its contributors, respectively.

RESULTS

Nearly half of the university employees (44.6%) had poor HEPA, and employees with high socioeconomic status (SES) suffered more from it (C = 0.109; 95% CI: 0.075, 0.143). Also, we found while poor work-related PA (C = 0.175; 95% CI: 0.142, 0.209) and poor transport-related PA (C = 0.081, 95% CI: 0.047, 0.115) were more concentrated among high-SES employees, low-SES employees more affected by the poor PA at leisure time (C = -0.180; 95% CI: -0.213, -0.146). Shift working, and having higher SES and subjective social status were the main factors that positively contributed to the measured inequality in employees' poor HEPA by 33%, 31.7%, and 29%, respectively, whereas, having a married life had a negative contribution of -39.1%. The measured inequality in poor leisure-time PA was mainly attributable to SES, having a married life, urban residency, and female gender by 58.1%, 32.5%, 28.5%, and -32.6%, respectively. SES, urban residency, shift working, and female gender, with the contributions of 42%, 33.5%, 21.6%, and -17.3%, respectively, were the main contributors of poor work-related PA inequality. Urban residency, having a married life, SES, and subjective social status mainly contributed to the inequality of poor transport-related PA by 82.9%, -58.7%, 36.3%, and 33.5%, respectively, followed by using a personal car (12.3%) and female gender (11.3%).

CONCLUSIONS

To reduce the measured inequalities in employees' PA, workplace health promotion programs should aim to educate and support male, urban resident, high-SES, high-social-class, and non-shift work employees to increase their PA at workplace, and female, married, rural resident, and low-SES employees to increase their leisure-time PA. Active transportation can be promoted among female, married, urban resident, high-SES, and high-social-class employees and those use a personal car.

Correlations between physical activity and quality of life in entrepreneurs from Wrocław, Poland

BACKGROUND

Limited physical activity is one of the main reasons for the rapid increase in the prevalence of diseases of affluence, which can lead to premature deaths in adults. Quality of life may be one of potential determinants of physical activity. The aim of this article is to identify the relationships between physical activity and quality of life in entrepreneurs from Wroclaw, Poland.

METHODS

A cross-sectional study was conducted on a group of 616 entrepreneurs (216 women and 400 men). A diagnostic survey method was used with a direct interview technique. The research tools included the International Physical Activity Questionnaire Short Form and the World Health Organization Quality of Life Questionnaire.

RESULTS

Among the studied entrepreneurs, along with their higher ratings of overall quality of life, the odds of high rather than low levels of physical activity increased nearly fivefold (OR 4.86, CI 3.34-7.07). Entrepreneurs with higher assessment levels of their perceived health condition were nearly twice as likely to report high rather than low physical activity levels (OR 1.92, CI 1.42-2.59). The conditional probability of high rather than low levels of physical activity also increased in the entrepreneurs with higher assessments of quality of life in the physical, psychological, social, and environmental domains, by 34%, 11%, 5%, and 6%, respectively.

CONCLUSION

Programs promoting physical activity among entrepreneurs, which focus on moderate and high intensity exercise, should be considered desirable in the context of the study findings. Activities aimed at improving quality of life in the physical and psychological domains as a potential determinant of the level of physical activity of entrepreneurs are also worth recommending.

Association of Physical Activity Level, Income and Environmental Factors Among Chinese Adults

The purpose of this study was to evaluate associations between physical activity level and income and environmental factors among chinese adults. Through the empirical study of the survey data, it is found that: (1) after controlling for the relevant variables, residents' income has a positive impact on residents' participation in physical activities, and the regression coefficient is 0.541 (P < 0.01) (2) In the regression model after adding environmental variables, the regression coefficient of environmental variables increased from 0.401 (P < 0.01) to the highest 1.32 (P < 0.01) (3) Through the comparison of the KHB decomposition method, the intermediary effect of residents' income on environmental factors and participation in physical activities is 0.134 (P < 0.01), and the intermediary effect ratio is 27.01%. Suggestions: first, the government and society should actively provide public goods needed for physical activities to meet the needs of residents for physical activities; second, the government should strengthen the supply of sports facilities in residential areas, speed up the transformation of villages in cities and improve the living conditions in residential areas; third, through legislation to protect residents' income, improving income is not only to give citizens enough sense of security and happiness but also a way to improve residents' participation in physical activities.

Gestational Diabetes Mellitus Among Pregnant Women Attending Ante-natal Clinic at a Secondary Care Health Facility in Haryana, India

Introduction: Gestational diabetes has serious health effects during pregnancy and childbirth. We estimated the occurrence of gestational diabetes mellitus (GDM) among pregnant women in a secondary care hospital in Haryana.

Methods: It was a hospital-based cross-sectional study, done in an ante-natal clinic (ANC) at a sub-district hospital (SDH), Faridabad district of Haryana, India. Eligible pregnant women attending the ANC clinic were recruited. An oral glucose tolerance test (OGTT) with 75 g of glucose was done with a collection of blood for fasting blood sugar (FBS) and two-hour post-OGTT blood glucose. A pre-tested semi-structured interview schedule was administered. Both the modified International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) and the Diabetes in Pregnancy Study Group of India (DIPSI) criteria were used. Data were presented as percentages, means, standard deviation, and 95% confidence interval (CI). Bi-variable and multi-variable logistic regressions were done. The level of significance was set at 0.05.

Results: Of the 623 eligible participants, 66.1% were within the 20-25 age group. The GDM was found in 14.1% (95%CI: 11.5-17.1) participants as per modified IADPSG criteria and 6.7% (95%CI: 4.9-9.0) participants as per DIPSI criteria, respectively. Increasing age [adjusted odds ratio (AOR): 1.24 (95% CI: 1.05-1.47), p=0.008] and increasing years of schooling [AOR: 1.19 (1.01-1.41), p=0.032] were significantly associated with GDM by DIPSI criteria. Family history of DM was also found to have an increased odds with GDM using modified IADPSG criteria [AOR 2.87 (95% CI: 1.09-7.54), p=0.032]. 

Conclusion: Considerable proportion of pregnant women were found to have GDM in a Sub-district hospital at Ballabgarh in north India. The study highlighted the need and generated evidence about the feasibility of GDM screening utilizing routine staff in a secondary care facility.

Regular Physical Activities Inhibit Risk Factors of the Common Cold Among Chinese Adults

Background

Physical activity (PA) has a significant health impact worldwide and has been linked to a lower risk of the common cold.

Objective

The aim of this study was to estimate the form of PA among Chinese adults and the correlation between PA and number of the common cold in China's eastern, central, and western areas.

Design

A cross-sectional study.

Setting

China's eastern, central, and western regions from 30 November 2020 to 30 March 2021.

Patients

A total of 1,920 healthy participants, who aged over 18 years old, with Internet access, were enrolled, and then self-reported PA behaviors and number of the common cold were collected.

Measurements

The authors calculated preference, intensity, frequency, and duration of PA in Chinese based on gender, age, and broad occupational categories and explored the potential effect between these factors and the common cold.

Results

Approximately 20.4% of participants reported not participating in sports regularly. Except for gender, there were significant differences in PA preference and intensity among the remaining individuals (P <0.05). Sixteen common exercises were divided into three intensity levels by the Borg CR10 Scale: low- (5), moderate- (8), and high-intensity exercises (3), and the corresponding intensity, frequency, and duration were computed with significant differences (P <0.05). The most popular workouts are “Brisk walking” and “Running.” Age, sex, and occupation had no significant effect on colds (P > 0.05). However, intensity shows a U-shaped dose-response relationship with colds, whereas the frequency and duration have an inverse dose-response relationship (P <0.05). High intensity combined with high frequency increased colds the most. Nevertheless, non-exercise groups always have the most colds in each comparison.

Limitations

The result may be vulnerable to recall bias.

Conclusion

Intensity showed that U-shape, frequency, and duration showed inverse response to the number of colds last year, but age, sex, and occupation had no significant effects. High intensity and high frequency mixed increased colds the most, regardless of duration.

Socio-Economic and Rural-Urban Differences in Healthcare and Catastrophic Health Expenditure Among Cancer Patients in China: Analysis of the China Health and Retirement Longitudinal Study

Objective: In China, cancer accounts for one-fifth of all deaths, and exerts a heavy toll on patients, families, healthcare systems, and society as a whole. This study aims to examine the temporal trends in socio-economic and rural-urban differences in treatment, healthcare service utilization and catastrophic health expenditure (CHE) among adult cancer patients in China. We also investigate the relationship between different types of treatment and healthcare service utilization, as well as the incidence of CHE.

Materials and Methods: We analyzed data from the 2011 and 2015 China Health and Retirement Longitudinal Study, a nationally representative survey including 17,224 participants (234 individuals with cancer) in 2011 and 19,569 participants (368 individuals with cancer) in 2015. The study includes six different types of cancer treatments: Chinese traditional medication (TCM); western modern medication (excluding TCM and chemotherapy medications); a combination of TCM & western medication; surgery; chemotherapy; and radiation therapy. Multivariable regression models were performed to investigate the association between cancer treatments and healthcare service utilization and CHE.

Results: The age-adjusted prevalence of cancer increased from 1.37% to 1.84% between 2011 and 2015. More urban patients (54%) received cancer treatment than rural patients (46%) in 2015. Patients with high socio-economic status (SES) received a higher proportion of surgical and chemotherapy treatments compared to patients with low SES in 2015. Incidence of CHE declined by 22% in urban areas but increased by 31% in rural areas. We found a positive relationship between cancer treatment and outpatient visits (OR = 2.098, 95% CI = 1.453, 3.029), hospital admission (OR = 1.961, 95% CI = 1.346, 2.857) and CHE (OR = 1.796, 95% CI = 1.231, 2.620). Chemotherapy and surgery were each associated with a 2-fold increased risk of CHE.

Conclusions: Significant improvements in health insurance benefit packages are necessary to ensure universal, affordable and patient-centered health coverage for cancer patients in China.

Physical activity and socio-economic status of single and married urban adults: a cross-sectional study

Background

Changing family models have resulted in a large increase in the number of single-person households. This phenomenon has certain implications for society and the economy as single people often exhibit different behaviours, including their engagement in health-related physical activity, than those who are married and living with partners. However, the results of studies on determinants of physical activity in people of different marital status have been inconclusive. The aim of this study was to identify associations between physical activity and socioeconomic status in single and married urban adults.

Methods

The study material consisted of 4,460 persons (1,828 single and 2,632 married and living with partners). A cross-sectional study was conducted in Wroclaw (Poland). A diagnostic survey-direct interview method was used. Two research tools were applied: the International Physical Activity Questionnaire Short Form (IPAQ-SF) and the Socioeconomic Status Questionnaire (S-ESQ). The level of respondents’ physical activity was assessed following WHO recommendations. The descriptive statistics included the number and frequency of categories of dependent and independent variables as well as measures of association between them, i.e., crude and adjusted odds ratios.

Results

The odds ratio of meeting the WHO physical activity recommendations was almost 70% higher in single than in married respondents (OR = 1.67; CI [1.46–2.19]), and slightly more than 40% higher after adjusting for sex, age and education (aOR = 1.42; CI [1.21–1.67]). In both groups socioeconomic the respondents’ status revealed a significant and slightly different association with their levels of physical activity. Occupational status and financial savings significantly affected the level of physical activity in single respondents, while net disposable income was a significant modifier of physical activity levels in respondents who were married or lived with their partners.

Conclusions

Assessment of the levels and determinants of physical activity among people of different marital status should be continued and extended to other subpopulations. This will allow effective preventive and therapeutic measures to be taken for groups most at risk of hypokinesia. Programs aimed at improving physical activity accounting for the socioeconomic status and marital status of their beneficiaries are particularly important.

Level of engagement of recreational physical activity of urban villagers in Luohu, Shenzhen, China

Physical activity is important for health. However, there is a lack of literature related to the physical activity levels of adults living in urban villagers, which is a vulnerable population in China. The aim of this study is to compare the physical activity and sedentary behavior engagements between urban villagers and non-urban villagers using the 2019 Luohu Shenzhen, China Community Diagnosis Questionnaire. A total of 1205 adults living in urban villages and non-urban villages were included in the analysis. Unadjusted and multiple multivariate logistic regression were conducted for the dependent variable of engagement in recreational physical activity, frequency of recreational physical activity per week, and hours spent in sedentary behaviors per day. Descriptive analysis was conducted to identify the reasons for not engaging in physical activity among urban villagers and non-urban villagers. Across the included sample, 29.05% were urban villagers and 70.95% were non-urban villagers. The results suggested that urban villagers are more likely to engage in physical activity than non-urban villager (OR = 1.90, 95% CI [1.40, 2.59], p < 0.001). However, it was also found that urban village status had no significant association for frequency in engaging in physical activity and average hours spent in sedentary behaviors. Both urban villagers and non-urban villages indicated that lack of time, lack of safe and appropriate environment, and working in labor intensive occupations as some of the reasons for not engaging in physical activity. There is a need for tailed interventions and policies for promoting physical activity among urban villagers and non-urban villagers. Additional studies are needed to further our understanding of the physical activity behaviors among urban villagers in China.

Prevalence and patterns of physical activity, sedentary behaviour, and their association with health-related quality of life within a multi-ethnic Asian population

OBJECTIVE

The study aimed to examine the prevalence and sociodemographic correlates of physical activity and sedentary behaviour in the general population of the multi-ethnic nation of Singapore as part of the Knowledge, Practice and Attitudes towards Diabetes study, a cross-sectional and population-based survey. It also examined the relationship between physical activity, sedentary behaviour, and health-related quality of life (HRQoL).

METHODS

Physical activity and sedentary behaviour were assessed via the Global Physical Activity Questionnaire (GPAQ), while physical and mental HRQoL was assessed via the Short Form Health Survey (SF-12v2). Survey weights were employed to account for complex survey design. Multivariable logistic regression models were utilized to examine sociodemographic correlates of physical activity (insufficient vs. sufficient physical activity) and sedentary behaviour (< 7 h/day vs ≥7 h/day). Descriptive statistics were calculated to examine the percentage of time spent in different domains of physical activity. Multivariable linear regressions were conducted to examine the association between physical activity and sedentary behaviour with physical and mental HRQoL.

RESULTS

Two thousand eight hundred sixty seven participants recruited from February 2019 to March 2020 (prior to COVID-19 lockdown and related restrictions in Singapore) were included in the analyses. 83.3% of respondents had sufficient physical activity. Age (65 years and above) and income (SGD 2000 to 3999) were associated with a higher likelihood of insufficient physical activity. In contrast, those of Malay ethnicity and having one chronic physical condition were associated with a lower likelihood of insufficient physical activity. 47.7% reported that they had sedentary behaviour of ≥7 h/day. Older age and a primary school education were related to a lower likelihood of sedentary behaviour, while being single, having higher income, obesity, and multimorbidity were associated with higher sedentary behaviour. Insufficient physical activity was significantly associated with lower physical HRQoL but was not significantly associated with mental HRQoL. Sedentary behaviour was not significantly associated with mental or physical HRQoL.

CONCLUSION

About 17% of the population did not meet the minimum requirements for physical activity, while around half of the population spent a considerable time being sedentary. As insufficient physical activity was associated with poorer physical HRQoL, policymakers should promote moderate physical activity and encouraging the breaking up of prolonged sedentary periods within the middle- and high-income groups, especially at the workplace. Increased leisure-time exercise should be encouraged for those in the lower- income group.

A cohort study on the relationship between education level and high-risk population of stroke

Objective

To explore the relationship between education level and high-risk population among stroke screening populations in Zunyi City, China.

Methods

The cluster sampling method was adopted to collect the medical history, laboratory examinations and physical examinations for the permanent residents of Zunyi City, Guizhou Province. Taking education level as a key socioeconomic status (SES) indicator, multivariate logistic regression analysis was used to evaluate the risk factors of high-risk groups with different education levels.

Results

Among the included 4149 subjects, 494 were in the high-risk group and 3655 were in the non-high-risk group. The proportion of the high-risk population with education level ≥ high secondary school (8.7%) was significantly higher than that of the low-risk population. After adjusting for age, gender, and BMI, the OR of those with education leve l ≥ high secondary school was 2.8 (95% CI 1.9-4.2), which was significantly higher than those with education level of illiterate/primary school. In the model adjusted for all confounding factors, compared with illiterate/primary school, people with education level ≥ high secondary school were more likely to be at high risk of stroke (OR 3.0, 95% CI 1.9-4.6).

Conclusion

Education level ≥ high secondary school is an independent influencing factor for the high-risk population of stroke in Zunyi, which may be related to smoking and lipid metabolism abnormalities of people with high education level. Key interventions for high-risk populations with high education levels may have positive significance in reducing the incidence of stroke.

Sociodemographic disparity in health-related behaviours and dietary habits among public workers in China: a cross-sectional study

OBJECTIVE

We aimed to estimate the distribution of health-related behaviours and dietary habits by sociodemographics among public workers in China.

DESIGN

Cross-sectional study.

SETTING

A representative sample was obtained from 10 government-run institutions in Hunan province of China.

PARTICIPANTS

A total of 5029 public workers were included in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence on their sociodemographic characteristics, health-related behaviours and dietary habits. Socioeconomic status (SES) scores were calculated by multiplying ordinal numerical values assigned to consecutive categories of education level and annual household income. Multivariate logistic regression analysis and categorical principal component analysis were used to estimate differences in health-related behaviours and dietary habits by sociodemographics.

RESULTS

The distribution of health-related behaviours and dietary habits was varied by sociodemographic groups. Middle-aged groups (41-60 years) were more likely to smoke (for men, 34.5%), use alcohol (for men, 22.5%), and have short sleep duration (for men, 36.3%; for women, 39.6%). Young participants (≤30 years) were more likely to have multiple unhealthy behaviours and dietary habits. Those in low-SES have a significant higher rate of smoking (OR_adj=1.46, 95% CI: 1.15 to 1.85) and leisure-time physical inactivity (OR_adj=1.18, 95% CI: 1.02 to 1.37), but a lower rate of late sleeping (OR_adj=0.69, 95% CI: 0.57 to 0.83) than those in high-SES. Notably, older men (≥51 years) with low-SES preferred the 'smoked and pickled foods and dessert' and 'fish and nut' pattern. In high-SES groups, 41-50 year old people preferred the 'traditional foods' and 'cereals and dairy product' pattern. No difference in dietary patterns by sociodemographics was found among women (p<0.05).

CONCLUSIONS

Our findings of the disparity distribution of health-related behaviours and dietary habits by specific gender, age and SES among Chinese public workers have important policy implications for developing targeted health interventions to facilitate health-related behaviours and dietary habits in this population.

Economics of physical activity in low-income and middle- income countries: a systematic review

BACKGROUND

Promotion of physical activity (PA) among populations is a global health investment. However, evidence on economic aspects of PA is sparse and scattered in low-income and middle-income countries (LMICs).

OBJECTIVE

The objective of this study was to summarise the available evidence on economics of PA in LMICs, identify potential target variables for policy and report gaps in the existing economic evidence alongside research recommendations.

DATA SOURCES

A systematic review of the electronic databases (Scopus, Web of Science and SPORTDiscus) and grey literature.

STUDY ELIGIBILITY CRITERIA

Cost-of-illness studies, economic evaluations, interventions and descriptive studies on economic factors associated with PA using preset eligibility criteria.

STUDY APPRAISAL AND SYNTHESIS OF METHODS

Screening, study selection and quality appraisal based on standard checklists performed by two reviewers with consensus of a third reviewer. Descriptive synthesis of data was performed.

RESULTS

The majority of the studies were from upper-middle-income countries (n=16, 88.8%) and mainly from Brazil (n=9, 50%). Only one economic evaluation study was found. The focus of the reviewed literature spanned the economic burden of physical inactivity (n=4, 22%), relationship between PA and costs (n=6, 46%) and socioeconomic determinants of PA (n=7, 39%). The findings showed a considerable economic burden due to insufficient PA, with LMICs accounting for 75% of disability-adjusted life years (DALYs) globally due to insufficient PA. Socioeconomic correlates of PA were identified, and inverse relationship of PA with the cost of chronic diseases was established. Regular PA along with drug treatment as a treatment scheme for chronic diseases showed advantages with a cost-utility ratio of US$3.21/quality-adjusted life year (QALY) compared with the drug treatment-only group (US$3.92/QALY) by the only economic evaluation conducted in the LMIC, Brazil.

LIMITATIONS

Meta-analysis was not performed due to heterogeneity of the studies.

CONCLUSIONS AND RECOMMENDATIONS

Economic evaluation studies for PA promotion interventions/strategies and local research from low-income countries are grossly inadequate. Setting economic research agenda in LMICs ought to be prioritised in those areas.

PROSPERO REGISTRATION NUMBER

CRD42018099856.

Association between socioeconomic status and incident stroke in China

Background

Little is known about the impact of socioeconomic status (SES) on incidence of stroke in China. This study aimed to examine the association of SES, which was measured by different indicators, with incidence of stroke and gender differences in the association.

Methods and results

Two prospective cohort studies were conducted including 2852 participants aged ≥60 years in Anhui province and 3016 participants in four other provinces in China. During a median follow-up of 7.1 years, 211 incident stroke cases occurred in the Anhui cohort. The risk of stroke increased with living in rural areas (adjusted HR 2.49, 95% CI 1.19 to 5.22; women 3.64, 95% CI 1.17 to 11.32, men 2.23, 95% CI 0.81 to 6.19), but not significantly with educational level, occupational class, satisfactory income and financial problems (except for women with low education). The four-province cohort had 113 incident stroke cases over the 3.1 years’ follow-up. The five SES indicators were not significantly associated with incident stroke (except for increased risk in men with high occupation), but additional measurement for actual income showed that incident stroke increased in women with low personal income and in men with high family income. Pooled data from the two cohorts demonstrated the impacts of rural living (1.66, 95% CI 1.08 to 2.57) and having high occupational class (1.56, 95% CI 1.01 to 2.38), and gender differences for women with low education (2.26, 95% CI 1.19 to 4.27).

Conclusions

Rural living and being female with low SES are associated with increased stroke risk in China. Strategies to improve public health in the rural communities and gender-specific targets for health inequality should be an integral component of stroke interventions.

Socioeconomic Status and Physical Activity among Mothers of Young Children in an Asian City: The Mediating Role of Household Activities and Domestic Help

Mothers of preschoolers (3 to 5 years old) risk being physically inactive. This study aimed to examine associations between socioeconomic status (education, employment, income) and moderate to vigorous physical activity (MVPA) among mothers of preschoolers in Hong Kong. Family functioning (e.g., having a domestic helper, division of household chores and child-related activities) was explored as a potential mediator of associations between socioeconomic indicators and the mother’s self-reported MVPA. Using zero-inflated negative binomial modelling confounder-adjusted associations between socioeconomic indicators and MVPA (total effects) were estimated. Mediation analyses (joint-significance test) were also performed. Using generalized linear mixed models, intermediate pathways were identified. No significant total effects of any socioeconomic indicator on the mother’s MVPA were found. However, mediation analyses identified a complex network of inconsistent mediators partly explaining their associations via eight pathways. Also, whilst non-residents/extended family playing with the child(ren) was not associated with any socioeconomic indicator, this was negatively associated with the mother’s MVPA. A further pathway was mediated by the mother playing with her child(ren). Extended family playing with the child(ren) was inversely associated with the mother doing so. Associations between socioeconomic indicators and MVPA among preschoolers’ mothers are complex and inconsistent, requiring further investigation in diverse contexts. Encouraging active play with their preschoolers may increase mothers’ physical activity levels.

Correlates of sedentary behaviour in Asian adults: A systematic review

The objective of this study is to systematically review the evidence on correlates of sedentary behaviour (SB) among Asian adults. We searched for studies that examined individual, environmental, and political/cultural correlates of total and domain-specific SB (transport, occupation, leisure, and screen time) in Asian adults published from 2000 onwards in nine scientific databases. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis that considered differences based on SB measurements, regions, and population characteristics (PROSPERO: CRD42018095268). We identified 13 249 papers of which we included 49, from four regions and 12 countries. Researchers conducted cross-sectional analyses and most relied on SB self-report for SB measurement. Of the 118 correlates studied, the following associations were consistent: higher age, living in an urban area (East Asia), and lower mental health with higher total SB; higher education with higher total and occupational SB; higher income with higher leisure-time SB; higher transit density with higher total SB in older East Asians; and being an unmarried women with higher SB in the Middle East. We encourage more research in non-high-income countries across regions, further exploration of important but neglected correlates using longitudinal designs and qualitative research, and the use of objective instruments to collect SB data.

Gender differences in related influential factors of regular exercise behavior among people in Taiwan in 2007: A cross-sectional study

Purpose

The purpose was to explore the exercise behavior of the Taiwanese population during leisure time and to examine the gender differences in related influential factors.

Methods

The Leisure Time and Sport Questionnaire (LTSQ) conducted by the Academia Sinica in 2007 was used for analysis. Participants were drawn from the Taiwanese population aged over 18 years old. Multinomial logistic regression models were used to test the association between the frequency of exercise and related factors in all the participants, male, and female participants, respectively.

Results

In the total 2,147 participants, 47.8% reported they regularly exercised, 34.1% irregularly exercised, and 18.1% never exercised. There were no significant gender differences in the frequency of exercise, but a significant gender difference was found in the types of exercise most often practiced. Participants in one of following conditions, over 65 and under 40 years old, living in the city, having higher education levels, having a spouse or partner, enjoying exercise, feeling worthwhile to spend money on exercise, and not having to take care of others, were more likely to be engaged in regular exercise in the total population. The “enjoyment” in exercise was a significant influential factor for both sexes. Women were more likely to exercise regularly if they were aged 40–64 years old compared with those over 65 years old, have lower self-rated health scores, felt it was more worthwhile to spend money on exercise and did not have to care for another, whereas men who have higher education level and did not feel a lack of time were more likely to exercise regularly.

Conclusions

There are gender differences in regular exercise behavior during leisure time and related influential factors among Taiwanese adults. The findings of the present study can be used when designing gender-specific health promotion programs.

Sociodemographic Associations of Physical Activity in People of Working Age

The aim of this study was to identify relationships between the physical activity and sociodemographic status of respondents aged 18–64 years. The research was conducted in 2014 and 2015 in Wrocław, Poland. The study group comprised 4460 people. The sample selection was random and stratified. The research tool was the International Physical Activity Questionnaire—Short Form. Levels of physical activity declared by respondents were compared with the recommendations of the American College of Sports Medicine (ACSM). Data on respondents’ sociodemographic status was also obtained. The Mann–Whitney U test for samples, Kruskal–Wallis test by ranks, and total and binary logistic regression were used in statistical analysis. Among the respondents, the ACSM health recommendations were met by 43.7% in total (43.2% women and 44.3% men). All analyzed sociodemographic variables differentiated respondents’ physical activity. The youngest respondents were found to be the most physically active. Wrocław residents with a secondary education declared the highest level of physical activity. Among the respondents, manual workers revealed the highest, and the unemployed the lowest odds of meeting the ACSM standards of health-related physical activity. The level of physical activity of unmarried respondents was higher than that of married respondents. The highest percentage of respondents (50.9% women and 54.2% men) with sufficient physical activity levels was found among people living alone. Measures aimed at reducing hypokinesia should be addressed primarily in vulnerable groups, i.e., the unemployed and oldest men.

The association of overall diet quality with BMI and waist circumference by education level in Mexican men and women

OBJECTIVE

The present study evaluated the association of two measures of diet quality with BMI and waist circumference (WC), overall and by education level, among Mexican men and women.

DESIGN

We constructed two a priori indices of diet quality, the Mexican Diet Quality Index (MxDQI) and the Mexican Alternate Healthy Eating Index (MxAHEI), which we examined relative to BMI and WC. We computed sex-specific multivariable linear regression models for the total sample and by education level.

SETTING

Mexico.

PARTICIPANTS

Mexican men (n 954) and women (n 1356) participating in the Mexican National Health and Nutrition Survey 2012.

RESULTS

Total dietary scores were not associated with BMI in men and women, but total MxDQI was inversely associated with WC in men (-0·10, 95 % CI -0·20, -0·004 cm). We also found that some results differed by education level in men. For men with the lowest education level, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean reduction in BMI of 0·11 (95 % CI -0·18, 0·04) and 0·18 (95 % CI -0·25, -0·10) kg/m2, respectively. Likewise, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean change in WC of -0·30 (95 % CI -0·49, -0·11) and -0·53 (95 % CI -0·75, -0·30) cm, respectively, in men with the lowest level of education. In women, the association of diet quality scores with BMI and WC was not different by education level.

CONCLUSIONS

Our findings suggest that a higher diet quality in men with low but not high education is associated with lower BMI and WC.

Effects of socioeconomic status on risk of ischemic stroke: a case-control study in the Guangzhou population

BACKGROUND

The association between socioeconomic status (SES) and stroke risk remains controversial around the world. It is not clear that the effect of SES on stroke in China due to the lack of relevant research. We aimed to assess the association between SES and risks of first-ever ischemic stroke in Guangzhou, China.

METHODS

Cases were recruited from neurology department in the First Affiliated Hospital of Guangdong Pharmaceutical University during September 2016-October 2017. Age- and sex-matched controls were derived from surgical departments, over the same period. SES was assessed based on education, occupation, and income. Education was divided into ≤6 years, 6-9 years, 10-12 years, and > 12 years. Family monthly income per capita was categorized into ≤¥1000, ¥1001-3000, ¥3001-5000, and > ¥5001. Occupation was stratified into manual, non-manual, no job, and retired. A multivariate logistic regression model was used to determine the association between SES and risk of ischemic stroke.

RESULTS

In total, 347 ischemic stroke patients and 347 controls were recruited, with mean ages of 60.54 ± 13.13 and 60.56 ± 13.07 years, respectively. After adjusting for confounding factors, odds ratio (OR) for 6-9 years of education was 2.63 (95% confidence interval [CI] 1.45-4.75); > 12 years, 2.18 (1.25-3.82) compared with those for < 6 years of education. ORs for the second lowest, third lowest, and highest incomes were 1.96 (1.21-3.15), 4.16 (2.39-7.22), and 2.83(1.25-6.39), respectively, compared with those for the lowest income. ORs for manual workers and non-manual workers were 1.95 (1.23-3.07) and 1.87 (1.05-3.33), compared with individuals without jobs.

CONCLUSIONS

Higher SES is positively related with risks of ischemic stroke, explained by cardiovascular diseases and unhealthy lifestyles in Guangzhou, China. Thus, effective strategies such as extensive health education, promoting a healthy lifestyle, screening for risk factors to prevent stroke should be implemented to reduce ischemic stroke incidences among the high SES group.

Gender Differences in Predictors of Physical Activity among Korean College Students Based on the Health Promotion Model

Aim: Despite the numerous physical and psychological benefits of physical activity (PA), the prevalence of achieving PA recommendations decreases in college students. Therefore, this study was conducted to identify factors influencing PA in male and female college students based on the Health Promotion Model.

Methods: A quantitative, cross-sectional research design was used to investigate factors influencing PA among male and female college students. A convenience sample of 264 Korean students was recruited from three colleges. Participants completed measures of physical activity, perceived benefits/barriers to PA, PA self-efficacy, activity-related affect, and peer support.

Results: A multiple regression analysis indicated that the factors affecting PA in male college students were PA self-efficacy and subjective economic status, while the factors affecting PA in female students were PA self-efficacy, subjective health status, activity-related affect, and peer support.

Conclusions: School health centers or wellness centers need to develop exercise self-efficacy enhancement programs to provide motivation for PA among college students. It might also be necessary to develop a customized PA program that considers gender differences.

Health, psychological, social and environmental mediators between socio-economic inequalities and participation in exercise among elderly Japanese

This study examined which of the identified health, psychological, social and environmental mediators could most effectively explain the socio-economic status (SES)-based differences in participation in exercise among elderly Japanese. The candidates for mediators were composed based on the socio-ecological model. A representative sample of people 65 years and older living in two areas with different residential SES in Tokyo, Japan produced 739 effective participants. The intensity of exercise was evaluated based on whether the participants exercise for 30 minutes or longer twice a week, or for 20 minutes or longer three times a week. SES was evaluated by education and income. Mediators were assessed through four dimensions: (a) health, (b) psychological status, (c) social relations and (d) environmental context. As a result, SES's indirect effect through the mediators was evaluated using a multiple mediator model. The influence of both education and income on exercise was mediated by self-efficacy for exercise and social support for exercise. Self-efficacy for exercise had the strongest effect, while social support for exercise explained more of the income differences affecting participation in exercise than it did regarding educational differences. Self-efficacy for exercise may have the strongest effect as a mediator, which would explain the differences in participation in exercise among elderly Japanese based on education and income.

The descriptive epidemiology of sitting in Chilean adults: Results from the National Health Survey 2009-2010

BACKGROUND

Although evidence on the health effects of sedentary behavior (SB) has grown systematically in recent years, few developing countries have reported population levels of SB, especially in South America. Our objective was to describe time spent sitting in a representative sample from Chile categorized by age, gender, educational level, and body mass index (BMI).

METHODS

A national health survey was conducted in Chile in a nationally representative sample (n = 5411) in 2009-2010. Sitting time (ST) was measured with the Global Physical Activity Questionnaire Version 2.

RESULTS

Data were from 5031 participants (43.26 ± 0.41 years, mean ± SE; 40.3% male). Overall, there were no gender differences in mean ST (men: 158.10 ± 5.80 min/day, women 143.45 ± 4.77 min/day; p = 0.05). ST was lower in those who lived in rural areas compared with urban areas (99.4 min/day vs. 160.0 min/day; p = 0.001). ST increased significantly with increasing BMI, but only in men (p = 0.009), and was positively related to years of education in both men and women (p < 0.0001).

CONCLUSION

The findings were different from those reported in other countries and contexts, reinforcing the need for international surveillance and monitoring over time to inform policy makers. Differences in ST across different groups emphasize the need to develop tailored messages and interventions for reducing ST in different population subgroups.

Stepping volume and intensity patterns in a multi-ethnic urban Asian population

BACKGROUND

Accelerometer measured physical activity (PA) studies particularly in non-western populations are lacking. Therefore, this study investigated stepping activity in a multi-ethnic urban Asian population.

METHODS

Adult participants from the Singapore Health Study 2 consented to accelerometer activity monitoring for 7-consecutive days. Mean daily step count, peak stepping intensity (i.e. cadence) over 1-min, 30-min and 60-min and time spent in each cadence band: 0 (non-movement), 1-19, 20-39, 40-59, 60-79, 80-99 and ≥ 100 steps/minute (moderate to vigorous PA) were calculated.

RESULTS

A total of 713 participants (42% male, mean age 47.8 years) were included. Overall, the mean daily step count was 7549. Mean daily step count was significantly lower in Indians (7083 adjusted p = 0.02) but not Malays 7140 (adjusted p = 0.052) compared to Chinese (7745 steps). The proportion of Malays, Indians, and Chinese achieving < 5000 daily steps was 26%, 23% and 14%, respectively (p < 0.01). Regardless of ethnicity, approximately half of the recorded time was spent undertaking 0-steps/minute (7.9 h).

CONCLUSIONS

Greater promotion of brisk walking is required in light of the low step volume and pace observed in this multi-ethnic Asian population. Ethnic differences in stepping activity were also identified which indicates a need for targeted ethnic specific health promotion interventions.

Association of socioeconomic status with hearing loss in Chinese working-aged adults: A population-based study

Hearing loss is the most common sensory impairment, but limited studies focused on the association of socioeconomic status (SES) with hearing loss among adults of working age. This paper aimed to fill this gap among Chinese adults. We obtained data from Ear and Hearing Disorder Survey conducted in four provinces of China in 2014-2015. The survey was based on WHO Ear and Hearing Disorders Survey Protocol and 25,860 adults aged 25 to 59 years were selected in this study. Trained local examiners performed pure tone audiometry to screen people with hearing loss, and those who were screened positively for hearing loss were referred to audiologists to make final diagnosis. SES was measured by occupation, education and income. Results show after adjusting for SES measures and covariates, in urban areas, compared with white-collar workers, blue-collar workers and the unemployed were more likely to have hearing loss, with an odds ratio of 1.2 (95%CI: 1.0, 1.3) and 1.2 (95%CI: 1.0, 1.4), respectively. Compared with people with education of senior high school or above, those with junior high school, primary school and illiteracy had 1.6 (95%CI: 1.4, 1.8), 2.1(95%CI: 1.7, 2.5) and 2.6 (95%CI: 1.9, 3.7) times as likely to have hearing loss, respectively. In rural areas, the unemployed had 1.5 (95%CI: 1.0, 2.3) times the risk of hearing loss compared with white-collar workers, and illiterates had 1.6 (95%CI: 1.6, 2.1) times the risk of hearing loss compared with people with education of senior high school or above, after SES variables and covariates were taken into considerations. Income was not significantly associated with hearing loss in urban and rural areas. In conclusion, SES, in the form of occupation and education, was associated with hearing loss among working-aged population, and further studies are needed to explore the mechanism of such association.

Income, occupation and education: Are they related to smoking behaviors in China?

BACKGROUND

The association between socioeconomic status (SES) and smoking behaviors may differ across countries. This study aimed to estimate the association between socioeconomic status (income, occupation and education) and multiple measures of smoking behaviors among the Chinese elderly population.

METHODS

Using data from the China Health and Retirement Longitudinal Study in 2013, we examined the relationship between socioeconomic status and smoking behaviors through multivariate regression analysis. Sample selection models were applied to correct for sample selection bias. Smoking behaviors were measured by four indicators: smoking status, cigarette consumption, health risks related to smoking, and smoking dependence. Analyses were stratified by gender and urban-rural residence.

RESULTS

Among Chinese people aged 45 years or older, smokers accounted for 40% of the population in 2013, smoking 19 cigarettes per day. It was also found that 79% of smokers were at an increased health risk. Overall, although the influence of income on smoking behaviors was small and even insignificant, occupation and education levels were significantly associated with smoking behaviors. Managers or professionals were more likely to smoke, however there was no significant relationship with smoking dependence. Individuals with higher educational attainment were less likely to be associated with smoking behaviors. In addition, gender and urban-rural differences existed in the relationship between SES and smoking behaviors.

CONCLUSIONS

Smoking disparities among diverse levels of socioeconomic status existed but varied greatly by SES indicators and population characteristics. Tobacco control policies in China should be increasingly focused on populations with low socioeconomic status in order to break the link between socioeconomic disadvantage and smoking behaviors. Further actions should mitigate inequalities in education, improve the social culture of cigarette use, and tailor interventions based on characteristics of the population.

Understanding the Relationship between Socio-Economic Status, Physical Activity and Sedentary Behaviour, and Adiposity in Young Adult South African Women Using Structural Equation Modelling

Socio-economic status (SES) is an important predictor of obesity, but how it is associated with differences in physical activity and sedentary behaviour is less clear. This cross-sectional study examined the association between SES (sum of household assets), physical activity and sedentary time, and how they predict adiposity. Socio-demographic, anthropometric, and physical activity data on rural (n = 509) and urban (n = 510) South African women (18–23 years) were collected. Overweight and obesity prevalence, and sedentary time, were higher; and moderate-vigorous intensity physical activity (MVPA) was lower, in the urban sample. Structural equation models (SEMs) were constructed for BMI and waist circumference. In the urban sample SES had a direct inverse effect on MVPA (ß; 95% CI, −41.69; −73.40 to −9.98), while in the rural sample SES had a direct effect on BMI (ß; 95% CI, 0.306; 0.03 to 0.59). In the pooled sample, SES had a direct inverse effect on MVPA (ß; 95% CI, −144; −170.34 to −119.04), and MVPA was directly associated with BMI (ß; 95% CI, 0.04; 0.01 to 0.08). The influence of SES, and the role of physical activity and sedentary time on adiposity differs between the urban and rural samples, and the importance of other environmental and behavioural factors must be considered in the development of obesity and the design of effective interventions.

Associations between individual and environmental factors and habitual physical activity among older Chinese adults: A social-ecological perspective

PURPOSE

To examine, within a social-ecological framework, associations between multifaceted individual and environmental factors and habitual physical activity (HPA) among older Chinese adults.

METHODS

Through a mix of qualitative and quantitative methods, a survey instrument assessing various factors underlying 3 social-ecological dimensions of intrapersonal, interpersonal, and community and environmental resources was developed. Using a cross-sectional design, older adults (n = 1580, aged 67 ± 7 years) recruited from 10 communities in Shandong province completed the social-ecological survey of HPA. Data were analyzed using Partial Least Squares Path Modeling.

RESULTS

Factors related to intrapersonal (medical knowledge, motivation, physical function, sport skills, socioeconomic status, and education), interpersonal (social support, social activity, and social norms), and community and physical environmental resources (safety, capacity, availability of and access to physical activity facilities) were found to be significantly associated with older adults' participation in HPA.

CONCLUSION

The findings provide an initial validation of a social-ecological approach to the study of HPA in China, suggesting that strategies aimed at promoting physical activity in older adults should address multiple levels of factors that may contribute to the likelihood of older Chinese adults being physically active.