To determine whether nutrition interventions widen dietary inequalities across socioeconomic status groups.
Systematic review of interventions that aim to promote healthy eating.
CINAHL and MEDLINE were searched between 1990 and 2007.
Studies were included if they were randomised controlled trials or concurrent controlled trials of interventions to promote healthy eating delivered at a group level to low socioeconomic status groups or studies where it was possible to disaggregate data by socioeconomic status.
Six studies met the inclusion criteria. Four were set in educational setting (three elementary schools, one vocational training). The first found greater increases in fruit and vegetable consumption in children from high-income families after 1 year (mean difference 2.4 portions per day, p<0.0001) than in children in low-income families (mean difference 1.3 portions per day, p<0.0003). The second did not report effect sizes but reported the nutrition intervention to be less effective in disadvantaged areas (p<0.01). The third found that 24-h fruit juice and vegetable consumption increased more in children born outside the Netherlands ("non-native") after a nutrition intervention (beta coefficient = 1.30, p<0.01) than in "native" children (beta coefficient = 0.24, p<0.05). The vocational training study found that the group with better educated participants achieved 34% of dietary goals compared with the group who had more non-US born and non-English speakers, which achieved 60% of dietary goals. Two studies were conducted in primary care settings. The first found that, as a result of the intervention, the difference in consumption of added fat between the intervention and the control group was –8.9 g/day for blacks and –12.0 g/day for whites (p<0.05). In the second study, there was greater attrition among the ethnic minority participants than among the white participants (p<0.04).
Nutrition interventions have differential effects by socioeconomic status, although in this review we found only limited evidence that nutrition interventions widen dietary inequalities. Due to small numbers of included studies, the possibility that nutrition interventions widen inequalities cannot be excluded. This needs to be considered when formulating public health policy.
To assess evidence for residential mobility in childhood having an adverse association with health outcomes through the life course.
A systematic search of medical and social sciences literature was undertaken to identify research defining residential mobility as an independent variable and in which health outcomes were described and objectively measured. Studies were excluded that investigated international migration for asylum or were limited to educational outcomes. Two reviewers assessed each study using quality criteria with particular attention to the consideration of confounders and potential for bias. Data were extracted for analysis using a structured form.
Twenty-two studies were included for this review. Outcomes identified in association with residential mobility included: higher levels of behavioural and emotional problems; increased teenage pregnancy rates; accelerated initiation of illicit drug use; adolescent depression; reduced continuity of healthcare. Studies assessed as having lower quality were less likely to demonstrate statistically significant effects. Heterogeneity precluded meta-analysis.
Residential mobility interacts at neighbourhood, family and individual levels in cumulative and compounding ways with significance for the wellbeing of children. High frequency residential change is potentially a useful marker for the clinical risk of behavioural and emotional problems. The evidence supports the reorientation of health services effectively to engage these residentially mobile children for whom health and psychological needs may be identified. The impact of housing and economic policies on childhood residential mobility should be evaluated considering this evidence.
Almost two-thirds of the coronary death rate decrease in the northern Italian Brianza MONICA male population, between 1993–4 and 1997–8, are attributable to a reduction in 28-day myocardial infarction (MI) case-fatality. The present paper investigates the factors associated with MI case-fatality decrease and in particular the role of socio-occupational classes (SOCs).
Standardised information on acute coronary care and intervention before and during the hospitalisation was collected for all coronary events (n = 1817) registered in 1993–4 and in 1997–8 among 35–64-year-old male residents in Brianza. Deaths within 28 days after MI were carefully investigated. Five SOCs were defined adopting the Erikson-Goldthorpe-Portocarero method. Differences in 28-day MI case-fatality and in acute phase intervention and treatment over time and among SOCs in each period were assessed.
28-day MI case-fatality reduction (27.2%) can be mainly attributed to a decreased proportion of MI events that were fatal before reaching the hospital. In the lower SOCs significant changes in MI case-fatality were detected between 1993–4 and 1997–8. Differences in acute phase intervention and treatment between the periods were observed. SOC differences both in prevalence of out-of-hospital cardiac arrest and in the pre-hospital qualified intervention score were detected in the first period only.
In the study population MI case-fatality reduction can be mainly attributed to a more effective and prompt management before hospitalisation and to an improvement in acute treatment during hospitalisation. This enhancement is made available to the whole population overtaking social differences.
To examine the associations between childhood socioeconomic and family circumstances, health and behavioural and cognitive development, and health and mental well-being outcomes in adulthood; exploring whether associations are different for cohorts born in 1958 and 1970, or for men and women.
Pooled analysis of two prospective, population-based, British birth cohort studies.
11 327 men and women born in 1958 and 11 177 men and women born in 1970 who responded in the adult follow-up investigations at ages 33 and 30 respectively.
Self-rated general health, Rutter malaise scale indicating mental well-being, and presence of a long-standing illness limiting daily activities; assessed at ages 33 and 30 for the 1958 and 1970 birth cohorts respectively.
A diversity of family background (socioeconomic deprivation, housing tenure, family disruption and parental interest), health and development (cognition and behaviour) measures each provided powerful independent indications for general health and mental well-being. Indications for limiting long-standing illness in adulthood were focused most strongly upon health difficulties in childhood. Few interactions between either birth cohort or gender and childhood measures were observed, and excepting these interactions consistency in associations between the childhood measures and the outcomes by gender and cohort was observable.
This study emphasises the importance of cognitive and behavioural development in childhood, as well as deprivation, family background and childhood health in indicating future adult health and mental well-being, emphasising time-persistent effects and important indications for men and women.
In developed western populations longer legs have been shown to be a marker of better early childhood conditions. In the first generations to experience the epidemiologic transition and associated economic development, epigenetic constraints on growth might preclude improved childhood conditions from increasing leg growth or height.
Multivariable linear regression was used to assess the association of parental growth environment, proxied by parental literacy, and childhood conditions, proxied by parental possessions, with leg length, sitting height and height in a cross-sectional sample from 2005–6 of 9998 Chinese people aged at least 50 years from phase 2 of the Guangzhou Biobank Cohort Study.
Adjusted for age and sex, the association of childhood conditions with leg length and height varied with parental literacy (interaction p values <0.01 and 0.03), but not for sitting height (p value 0.43), with statistically significant trends (p values <0.01) for parental possessions to be associated with longer legs and greater height only in the offspring of two literate parents where legs were longer by 0.56 cm (95% CI 0.27 to 0.86) and height greater by 1.16 cm (95% CI 0.74 to 1.58) for participants with most, compared with least, parental possessions in childhood.
Epigenetic influences originating in earlier generations may constrain growth during the infancy and/or childhood phases in very recently developed populations. Neither height nor leg length should be assumed to be consistent proxies of early life environment with corresponding implications for economic history, the aetiology of some chronic diseases and the monitoring of population health.
To evaluate the strength of the evidence provided by epidemiological literature investigating drinking pattern as effect modifier of alcohol intake on the risk of coronary heart disease (CHD).
Meta-analysis of observational studies.
Medline, citation tracking, from 1966 to 2006.
Original studies investigating the amount of alcohol intake, combined with the frequency of alcohol consumption and/or pattern of alcohol drinking affecting the risk of CHD were extracted. Among them, cohort and case–control studies reporting sufficient data to perform statistical analyses and using people who abstained from alcohol as the reference were included.
Six (4 cohort and 2 case–control) out of 118 studies reviewed met the inclusion criteria. Compared with those who abstained from alcohol, regular heavy drinkers and heavy irregular or binge drinkers showed significantly different pooled relative risks of 0.75 (95% confidence interval 0.64 to 0.89) and 1.10 (1.03 to 1.17) respectively. The dose–response relation between the amount of alcohol intake and CHD risk was significantly different in regular and irregular drinkers. A J-shaped curve, with nadir around 28 grams of alcohol per week, and last protective dose of 131 grams per week, was obtained including drinkers who consumed alcohol for 2 days a week or less. Conversely, in people who consumed alcohol for more than 2 days a week a significant protective effect was seen even when drinking high amounts of alcohol.
This meta-analysis suggests that binge and heavy irregular drinking modify the favourable effect of alcohol intake on the CHD risk. However, this conclusion should be taken with caution because of the small number of studies considered.
Extensive financial losses caused by the collapse of pyramid savings schemes led to the 1997 turmoil in Albania. The authors' aim was to assess the association of financial loss and social mobility with acute coronary syndrome (ACS) 6–9 years after the precipitous collapse.
A population-based case–control study was conducted in Tirana, the Albanian capital, in 2003–6. 467 non-fatal consecutive ACS patients were recruited (370 men aged 59.1 (SD 8.7) years and 97 women 63.3 (SD 7.1) years, 88% response). The control group comprised 469 men (53.1 (SD 10.4) years) and 268 women (54.0 (SD 10.9) years, 69% response). Information on the absolute financial loss (in US$), relative loss and subjective social mobility was obtained by a structured interviewer-administered questionnaire. Associations of financial loss and social mobility with ACS were assessed by multivariable-adjusted logistic regression.
Financial loss in pyramid scams was frequent in both ACS patients (55%) and controls (41%). Downward subjective social mobility was noted in 31% of patients and 12% of controls. Upon adjustment for sociodemographic and socioeconomic characteristics and conventional coronary risk factors, ACS was associated with both financial loss (OR 1.9, 95% CI 1.4 to 2.6) and downward social mobility (OR 2.2, 95% CI 1.4 to 3.3). Although the association with financial loss was partly mediated through subjective social mobility, both maintained independent associations with ACS.
In the wake of a nationwide catastrophic collapse of savings that led to losses totalling about 40% of the Albanian gross domestic product, the authors detected apparent long-term deleterious health effects of financial loss and downward intragenerational subjective social mobility.
To investigate prospectively the associations between depression and cognitive social capital (social trust, sense of belonging, mutual aid) and structural social capital (volunteer work and community participation).
This was a prospective study that was carried out in the USA. The participants were a nationally representative sample of 724 English-speaking non-institutionalised adults (25–74 years old) who participated in the National Survey of Midlife Development in the United States (MIDUS) in 1995–6 and the MIDUS Psychological Experience Follow-Up study in 1998.
In multivariable adjusted logistic regression analyses, those who trusted their neighbours were less likely to develop major depression (MD) during follow-up than those who reported low levels of social capital on these dimensions (adjusted OR of MD for high vs low trust = 0.43; 95% CI 0.20 to 0.93, adjusted for MD at baseline, age, gender, race, education, working status, marital status, physical health and extroversion traits). Structural dimensions of social capital were not associated with MD in adjusted models.
Perceptions of higher levels of cognitive social capital (trust of neighbours) are associated with lower risks of developing MD during 2–3 year follow-up. However, after excluding participants with MD at the baseline, the association between trust and MD became non-significant. Structural dimensions were not associated with MD.
IgE-mediated hypersensitivity reactions to Anisakis simplex have been described after ingestion of fish, suggesting that sensitisation to this parasite may induce acute urticaria and anaphylaxis. Anisakis simplex allergens are highly resistant to heat and freezing, and sensitisation may occur even in populations with low consumption of raw/undercooked fish. This study aimed to quantify the association between sensitisation to A. simplex and relapsing acute urticaria.
This is the first case–control study on this topic. Cases (n = 200) were patients with a clinical diagnosis of relapsing acute urticaria, consecutively approached at the immunoallergology unit of Porto’s largest paediatric hospital. Controls (n = 200) were consecutively selected at the surgery department of the same hospital, from subjects undergoing programmed orthopaedic, maxillofacial or general surgical procedures. Specific IgE measurements (Anisakis and Ascaris) were taken, and skin-prick tests (A simplex, common aeroallergens, fish, and Ascaris) were done.
Sensitisation to A simplex (OR 3.86, 95% CI 2.04% to 7.29%), Ascaris (OR 3.37, 95% CI 1.89% to 6.02%), fish (OR 4.62, 95% CI 1.85% to 11.52%), and at least one aeroallergen (OR 4.59, 95% CI 2.99% to 7.05%) were associated with increased risk of acute urticaria. Regarding the sensitisation to A simplex, the aeroallergen sensitisation-adjusted OR was 2.61 (95% CI 1.33% to 5.12%) for the whole sample, and 2.72 (95% CI 0.99% to 7.47%) for those not sensitised to Ascaris or fish.
Sensitisation to A simplex increases the risk of relapsing acute urticaria in subjects not sensitised to Ascaris or fish, and this is independent of aeroallergen sensitisation.
The study was designed to provide evidence of a cascade effect linking socioeconomic position to anthropometric indicators of cardiovascular disease (CVD) risk through effects on psychosocial stress, psychological distress and health-related behaviours, and consider implications for disease prevention and health promotion.
A cross-sectional stratified two-stage probability sample of occupied housing units in three areas of Detroit, Michigan, was used in the study. 919 adults aged >=25 years completed the survey (mean age 46.3; 53% annual household income <$20 000; 57% non-Hispanic black, 22% Latino, 19% non-Hispanic white). Variables included self-report (eg, psychosocial stress, depressive symptoms, health behaviours) and anthropometric measurements (eg, waist circumference, height, weight). The main outcome variables were depressive symptoms, smoking status, physical activity, body mass index and waist circumference.
Income was inversely associated with depressive symptoms, likelihood of current smoking, physical inactivity and waist circumference. These relationships were partly or fully mediated by psychosocial stress. A suppressor effect of current smoking on the relationship between depressive symptoms and waist circumference was found. Independent effects of psychosocial stress and psychological distress on current smoking and waist circumference were found, above and beyond the mediated pathways.
The results suggest that relatively modest improvements in the income of economically disadvantaged people can set in motion a cascade of effects, simultaneously reducing exposure to stressful life conditions, improving mental well-being, increasing health-promoting behaviours and reducing anthropometric risks associated with CVD. Such interventions offer important opportunities to improve population health and reduce health disparities.
The prevalence of childhood asthma in the USA increased by 50% from 1980 to 2000, with especially high prevalence in poor urban communities.
Data on the prevalence of asthma among children aged 4–5 years and on hospitalisations for asthma among children less than 15 years old were available for 42 health service catchment areas within New York City. Street tree counts were provided by the New York City Department of Parks and Recreation. The proximity to pollution sources, sociodemographic characteristics and population density for each area were also measured.
Controlling for potential confounders, an increase in tree density of 1 standard deviation (SD, 343 trees/km2) was associated with a lower prevalence of asthma (RR, 0.71 per SD of tree density; 95% CI, 0.64 to 0.79), but not with hospitalisations for asthma (RR, 0.89 per SD of tree density; 95% CI, 0.75 to 1.06).
Street trees were associated with a lower prevalence of early childhood asthma. This study does not permit inference that trees are causally related to asthma at the individual level. The PlaNYC sustainability initiative, which includes a commitment to plant one million trees by the year 2017, offers an opportunity for a large prospective evaluation.
To investigate whether cancer service standards are associated with survival for breast, colorectal and lung cancers at population level.
Standards of hospital cancer services in England, measured in 2001, were aggregated for 30 cancer networks covering populations of between 500 000 and 3 million people, and compared with 1-year and 5-year relative cancer survival for the incident period 1996–2001, using rank correlation.
Relative survival and the cancer standards each showed statistically significant differences across cancer networks. For tumour-specific services, the total score of 35 standards was associated with longer relative survival for both colorectal and lung cancers (p<0.05), but not breast cancer, while colorectal cancer survival was strongly (p<0.01) associated with the specific standard "written agreement describing referral guidelines", and lung cancer (p<0.05) with two other guideline standards. There were also associations of longer survival with two measures of nursing staff specialist qualifications. Compliance with general standards for cancer services was not associated with survival for breast cancer, and showed only borderline (p<0.1) associations for colo-rectal cancer, while some standards on medical and management lead staff were significantly associated (p<0.05) with poorer survival for lung cancer. Overall, compliance with standards for hospital pathology and radiology services also showed no associations with survival.
This study suggests that compliance with some clinical service standards, such as guidelines, could contribute to better survival at population level, while more general organisational aspects of cancer services may not directly improve survival.