Microcredit services—the awarding of small loans to individuals who are too poor to take advantage of traditional financial services—are an increasingly popular scheme for poverty alleviation. Several studies have examined the ability of microcredit programmes to influence the financial standing of borrowers, but only a few studies have examined whether the added household income improves health and nutritional outcomes among household members. This study examined the hypothesis that longer participation in microcredit services would be associated with better nutritional status in women.
Cross-sectional data were obtained in February 2007 from 1593 female clients of a microcredit organisation in Peru. The primary predictor variable was length of time as a microcredit client measured in number of completed loan cycles (range 0 to 5.5 years, average loan size US$350). The outcome variables were age-adjusted body mass index (BMI), haemoglobin levels (g/dl) and food insecurity measured using the US household food security survey module. Extensive data on demographic and socioeconomic status were also collected.
Longer microcredit participation was associated with higher BMI (β=0.05, p=0.06), higher haemoglobin levels (β=0.07, p<0.01) and lower food insecurity (β=–0.13, p<0.01). With the inclusion of demographic and socioeconomic variables, the associations with higher haemoglobin (β=0.03, p=0.04) and lower food insecurity (β=–0.08, p<0.01) were sustained.
This study supports the notion that microcredit participation has positive effects on the nutritional status of female clients. Further research should explore more definitive causal pathways through which these effects may occur and should examine the effects on other household members.
Despite widespread apartheid-related human rights violations (HRV) and intimate partner violence (IPV) in South Africa, research investigating the influence of HRV on IPV perpetration is scarce.
This study analysed data from the South Africa Stress and Health Study, a cross-sectional survey conducted from 2003 to 2004 with 4351 South Africans examining public health concerns associated with apartheid. Analyses were restricted to men who had ever been married or had ever cohabited with a female partner. Logistic regression was used to examine associations between experiences of HRV and lifetime physical IPV perpetration.
A total of 772 South Africa men met the study criteria (389 liberation supporters and 383 government supporters). Adjusted logistic regression analyses indicated that among liberation supporters, a significant association existed between experiencing major HRV (AOR 2.40, 95% CI 1.20 to 4.81), custody-related HRV (AOR 6.61, 95% CI 2.00 to 21.83), victimisation of close friends/family members (AOR 3.38, 95% CI 1.26 to 9.07) and physical IPV perpetration. Among government supporters, a significant association was observed between experiencing HRV (AOR 2.99, 95% CI 1.34 to 6.65) and victimisation of close friends/immediate family (AOR 5.42, 95% CI 1.44 to 19.02) and IPV perpetration.
This work indicates the importance of men's experiences with HRV with regard to IPV perpetration risk. Future work is needed to understand the mechanisms underlying the observed relationships, particularly regarding mental health and gender norms as suggested by current literature, in order to inform interventions in South Africa and other regions affected by politically motivated conflict.
Workplace bullying has been associated with mental health, but longitudinal studies confirming the association are lacking. This study examined the associations of workplace bullying with subsequent common mental disorders 5–7 years later, taking account of baseline common mental disorders and several covariates.
Baseline questionnaire survey data were collected in 2000–2002 among municipal employees, aged 40–60 years (n=8960; 80% women; response rate 67%). Follow-up data were collected in 2007 (response rate 83%). The final data amounted to 6830 respondents. Workplace bullying was measured at baseline using an instructed question about being bullied currently, previously or never. Common mental disorders were measured at baseline and at follow-up using the 12-item version of the General Health Questionnaire. Those scoring 3–12 were classified as having common mental disorders. Covariates included bullying in childhood, occupational and employment position, work stress, obesity and limiting longstanding illness. Logistic regression analysis was used.
After adjusting for age, being currently bullied at baseline was associated with common mental disorders at follow-up among women (OR 2.34, CI 1.81 to 3.02) and men (OR 3.64, CI 2.13 to 6.24). The association for the previously bullied was weaker. Adjusting for baseline common mental disorders, the association attenuated but remained. Adjusting for further covariates did not substantially alter the studied association.
The study confirms that workplace bullying is likely to contribute to subsequent common mental disorders. Measures against bullying are needed at workplaces to prevent mental disorders.
Findings from contextual studies have shown that living in both poor and affluent neighbourhoods increases the risk of drinking and drug use, but few studies have examined the connection between neighbourhood context and drinking from a gender perspective.
We investigated the association between gender, neighbourhood deprivation and weekly drinking behaviour (number of drinks) in a national sample of 93 457 Canadians using multilevel zero-inflated Poisson regression. A cross-level interaction between gender and neighbourhood deprivation was examined while controlling for other potential risk factors.
53% of Canadians reported having at least one drink in the last year (men=61%; women=46%). Among respondents who were drinkers, the average number of drinks per week was 6.4 with male drinkers reporting an average of 7.9 and female drinkers reporting an average of 4.6. Neighbourhood material deprivation was independently associated with weekly drinking. Findings from multilevel analysis showed a u-shaped curve between neighbourhood deprivation and drinking, but only for men. Men living in the poorest neighbourhoods drank more weekly (8.5 drinks) than men living in neighbourhoods of wealthy (4.5 drinks) and mid-range deprivation (3.7 drinks). No difference in drinking by neighbourhood material deprivation was observed among women.
Men, like women, experience gender-specific health difficulties (eg, alcohol-related problems) suggesting the need for a gendered focus on policies and services related to women's and men's health. The challenge for public health and primary care is to work together to target risk-taking behaviours among men through treatment, prevention and cultural/educational messages aimed at building healthy lifestyles.
The relation between income inequality and mortality in Canada is unclear, and modifying effects of characteristics such as immigration have not been examined.
Using a cohort of 2 million Canadians followed for mortality from 1991–2001, we calculated HRs and 95% CIs for income inequality of 140 urban areas (Gini coefficient, Atkinson index, coefficient of variation; expressed as continuous variables) and working age (25–64 y) or post-working age (≥65 y) mortality in men and women according to immigration status, accounting for individual and neighbourhood income, and sociodemographic characteristics. Major causes of mortality were examined.
Relative to low income inequality, high inequality was associated with greater working age mortality in male (HRGini 1.08, 95% CI 1.04 to 1.13) and female (HRGini 1.12, 95% CI 1.06 to 1.18) non-immigrants for all income inequality indictors. Results were similar for female post-working age mortality. There was no relation between income inequality and mortality in immigrants. Among Canadian-born individuals, associations were greater for alcohol-related mortality (both sexes) and smoking-related causes/transport injuries (women).
Income inequality is associated with mortality in Canadian-born individuals but not immigrants.
Little is known about food insecurity in the UK. The aims of this study were to assess the prevalence and factors associated with food insecurity in a UK cohort and to examine whether the diets, reported health and anthropometry of young food insecure children differed from those of other children.
The Southampton Women's Survey is a prospective cohort study in which detailed information about the diets, lifestyle and body composition of 3000 women was collected before and during pregnancy. Between 2002 and 2006, 1618 families were followed up when the child was 3 years old. Food insecurity was determined using the Household Food Security Scale. The child's height and weight were measured; diet was assessed by food frequency questionnaire.
4.6% of the households were food insecure. Food insecurity was more common in families where the mothers were younger, smokers, of lower social class, in receipt of financial benefits and who had a higher deprivation score (all p<0.05). In comparison with other 3-year-old children, those living in food insecure households were likely to have worse parent-reported health and to have a diet of poorer quality, characterised by greater consumption of white bread, processed meat and chips, and by a lower consumption of vegetables (all p<0.05). They did not differ in height or body mass index.
Our data suggest that there are significant numbers of food insecure families in the UK. The poorer reported health and diets of young food insecure children have important implications for their development and lifelong health.
This study examines discrepancies between census and death registry information in the reporting of the ethnicity of the deceased in Lithuania and shows how these reporting differences influence estimates of mortality inequality by ethnicity.
This study uses a census-linked dataset provided by Statistics Lithuania. The data include all deaths and population exposures between 1 July 2001 and 31 December 2004. The information on the ethnicity of the deceased was available from both the census and the death records. The Poisson regression was applied (1) to measure the effects of socio-demographic variables on the misreporting of ethnicity on death records and (2) to estimate mortality rate ratios by ethnicity based on census-linked and unlinked data.
The death-record-based information on ethnicity under-reports the deaths of people of Russian, Polish and other ethnicities and over-reports the deaths of people of Lithuanian ethnicity. This leads both to the underestimation of mortality in the three ethnic minority groups and to biased mortality rate ratios. The misreporting is higher in death records for women, persons younger than 80 years, divorced persons, urban residents and those dying from ill-defined causes.
Studies based on unlinked data may provide biased estimates of ethnic mortality differences.
Previous research shows a positive link between the amount of green area in one's residential neighbourhood and self-reported health. However, little research has been done on the quality of the green area, as well as on quantity and quality of smaller natural elements in the streetscape. This study investigates the link between the objectively assessed quantity and quality of (1) green areas and (2) streetscape greenery on the one hand and three self-reported health indicators on the other.
80 Dutch urban neighbourhoods were selected, varying in the amount of nearby green area per dwelling, as determined by Geographic Information System analysis. The quality of green areas, as well as the quantity and quality of streetscape greenery, was assessed by observers using an audit tool. Residents of each neighbourhood were asked to complete a questionnaire on their own health (N=1641). In multilevel regression analyses, we examined the relationship between greenspace indicators and three health indicators, controlling for socio-demographic and socioeconomic characteristics.
Both indicators for the quantity of greenspace were positively related to all three health indicators. Quantity and quality indicators were substantially correlated in the case of streetscape greenery. Nevertheless, the quality indicators tended to have added predictive value for the health indicators, given that the quantity information was already included in the model.
The quantity and also the quality of greenspace in one's neighbourhood seem relevant with regard to health. Furthermore, streetscape greenery is at least as strongly related to self-reported health as green areas.
Low socioeconomic status (SES) has been linked to increased risk of hypertension, a known risk factor for cardiovascular disease. How the risk is altered by intergenerational social mobility is not well known. The aim of this study is to investigate parental SES, adult SES and the intergenerational social mobility in relation to hypertension risk.
By using data from the Swedish Twin Registry, the authors obtained information about both parental and adult SES and hypertension in 12 030 individuals born from 1926 to 1958. Generalised estimating equations were used to estimate ORs with 95% CIs.
Low parental SES was associated with increased odds of hypertension (OR 1.42, 95% CI 1.14 to 1.76). Low SES in adulthood was associated with increased odds for women but not for men (OR 1.40, 95% CI 1.15 to 1.70 and OR 1.01, 95% CI 0.83 to 1.24, respectively). Compared with the stable low social status group, the upward mobile group had lower odds of hypertension (OR 0.82, 95% CI 0.70 to 0.97). Compared with the stable high social status group, the results for the downward mobile group indicated an increased risk. A co-twin case-control analysis indicated that the results were independent of familial factors.
These findings suggest that the risk of hypertension associated with low parental social status can be modified by social status later in life. Possibly, this could be targeted by public health or political interventions. As parental social status has an impact on later health, such interventions should be introduced early.
Improving Access to Psychological Therapies (IAPT) is a new programme designed to reduce disease burden to the individual and economic burden to the society of common mental health problems (CMHP). This is the first study to look at the impact of IAPT on health service utilisation and sickness absence using routine data.
The authors used pseudonymised secure and privately linked (SAPREL) routinely collected primary, secondary care and clinic computer data from two pilot localities. The authors explored antidepressant prescribing, accident and emergency and outpatients attendances, inpatient stays, bed days, and sick certification. The authors compared the registered population with those with CMHP. The authors then made a 6 months before and after comparison of people referred to IAPT with age–sex and practice-matched controls.
People with CMHP used more health resources than those without CMHP: more prescriptions of antidepressants 5.25 (95% CI 5.38 to 5.13), inpatient episodes 4.89 (95% CI 5.0 to 4.79), occupied bed days 1.25 (95% CI 0.95 to 1.55), outpatient 1.5 (95% CI 1.40 to 1.63) and emergency department attendances 0.34 (95% CI 0.31 to 0.37), and medical certificates 0.29 (95% CI 0.26 to 0.32). Comparison of service utilisation 6 months before and after referral to IAPT was associated with reduced use of emergency department attendances (mean difference: 0.12 (95% CI 0.06 to 0.19, p<0.001)). However, the number of prescriptions of antidepressants increased mean difference –0.15 (95% CI 0.02–0.29, p=0.028).
People with CMHP use more healthcare resources. Referral to the IAPT programme is associated with a subsequent reduction in emergency department attendances, sickness certification and improved adherence to drug treatment.
Income inequality has been associated with worse health outcomes in several but not all studies. The heterogeneity across studies may be explained by the variations in the size of area or population over which income inequality was evaluated. Moreover, the studies above a certain inequality threshold, conducted more recently, and incorporating a time lag may have stronger associations between income inequality and health. The authors investigated if the strength of the association between income inequality and health was altered by these factors.
The authors conducted a multivariate meta-regression analysis using nine multilevel cohort studies on income inequality and mortality and 14 multilevel cross-sectional studies on income inequality and self-rated health.
Among cross-sectional studies, studies evaluating country-level inequality (average population>24 million) were more likely to show a stronger association between income inequality and poor health compared with those evaluating income inequality within small average populations (<820 000). There were no significant differences in the effect size of inequality–health association relating to the differences in the population size within a country across which income inequality was evaluated in both cross-sectional and cohort studies. The authors found that the threshold effects, period effects and lag effects were independent of the population size.
Income inequality at the country level may have stronger adverse contextual effects on health than inequality in smaller areas, perhaps by best reflecting social stratification in a society. Furthermore, we found that threshold, period and lag effects were independent of area unit for evaluating inequality, which may have important policy implications.
Evidence for a cross-sectional relationship between income and health is strong but is probably biased by substantial confounding. Longitudinal data with repeated income and health measures on the same individuals can be analysed to control completely for time-invariant confounding, giving a more accurate estimate of the impact of short-term changes in income on health.
4 years of annual data (2002–2005) from the New Zealand longitudinal Survey of Family, Income and Employment were used to investigate the relationship between annual household income and self-rated health (SRH) using a fixed-effects ordinal logistic regression model. Possible effect modification of the income–SRH relationship by poverty and baseline health was tested with interactions.
An increase in income of $10 000 over the past year increased the odds of reporting better SRH by 1% (OR 1.01, 95% CI 1.00 to 1.02). Poor baseline health significantly modified the association between income and SRH. A $10 000 increase in income increased the odds of better SRH by 10% for those with two or more chronic conditions. Poverty or deprivation did not modify the income–health association.
The overall small, positive, but statistically non-significant, income–health effect size is consistent with similar analyses from other longitudinal studies. Despite the overwhelming consensus that income matters for health over the medium and long-term, evidence free of time-invariant confounding for the short-run association remains elusive. However, measurement error in income and health has probably biased estimates towards the null.
The USSR failed to establish a modern pharmaceutical industry and lacked the capacity for reliable distribution of drugs. Patients were required to pay for outpatient drugs and the successor states have inherited this legacy, so that those requiring long-term treatment face considerable barriers in receiving it. It was hypothesised that citizens of former Soviet republics requiring treatment for hypertension may not be receiving regular treatment.
To describe the regularity of treatment among those diagnosed with hypertension and prescribed treatment in eight countries of the former Soviet Union, and explore which factors are associated with not taking medication regularly.
Using data from over 18 000 respondents from eight former Soviet countries, individuals who had been told that they had hypertension by a health professional and prescribed treatment were identified. By means of multivariate logistic analysis the characteristics of those taking treatment daily and less than daily were compared.
Only 26% of those prescribed treatment took it daily. The probability of doing so varied among countries and was highest in Russia, Belarus and Georgia, and lowest in Armenia (although Georgia's apparent advantage may reflect low rates of diagnosis). Women, older people, those living in urban areas, and non-smokers and non-drinkers were more likely to take treatment daily.
A high proportion of those who have been identified by health professionals as requiring hypertension treatment are not taking it daily. These findings suggest that irregular hypertension treatment is a major problem in this region and will require an urgent response.
In the 1990s pneumonia hospitalisation rates in Western Australia (WA) were 13 times higher in Indigenous children than in non-Indigenous children. Rates of invasive pneumococcal disease in Indigenous children declined following the introduction in 2001 of 7-valent pneumococcal conjugate vaccine (7vPCV) in a 2–4–6 month schedule with an 18-month pneumococcal polysaccharide booster (PPV). We investigated population trends for pneumonia hospitalisations between 1996 and 2005.
Population-based retrospective data linkage cohort study of singleton live births from 1996–2005. Hospitalisations for acute lower respiratory infections in Indigenous and non-Indigenous children less than 5 years of age were extracted and trends in age-specific incidence rates were examined using log-linear modelling.
From 245 249 births (7.1% Indigenous), there were 7727 pneumonia episodes. Between 1996 and 2000 and 2001 and 2005 all-cause pneumonia hospitalisations fell by 28–44% in Indigenous children aged 6–35 months with no equivalent decline in non-Indigenous children or for other acute lower respiratory infections. Incidence rate ratios for pneumonia comparing Indigenous with non-Indigenous children aged 6–11 months fell from 14.6 (95% CI 12.3 to 17.2) in 1996–2000 to 9.9 (8.4 to 11.6) in 2001–2005. Log-linear modelling showed a steady decline in Indigenous children of 9%/annum (5–12%) at age 12–23 months for all-cause pneumonia and 37%/annum (20–50%) at age 6–11 months for pneumococcal pneumonia from 1996 to 2005, including the years prior to introduction of pneumococcal vaccines.
Pneumonia hospitalisations and the disparity between Indigenous and non-Indigenous children has declined by a third. The unique Australian pneumococcal vaccine programme is likely to have had a significant effect but changes in socioeconomic factors have also contributed to the declines.
Measuring the distribution of health is a part of assessing health system performance. This study aims to estimate health inequality between different socioeconomic groups and its determinants in Tehran, the capital of Iran.
Self-rated health (SRH) and demographic characteristics, including gender, age, marital status, educational years, and assets, were measured by structured interviews of 2464 residents of Tehran in 2008. A concentration index was calculated to measure health inequality by economic status. The association of potential determinants and SRH was assessed through multivariate logistic regression. The contribution to concentration index of level of education, marital status and other determining factors was assessed by decomposition.
The mean age of respondents was 41.4 years (SD 17.7) and 49% of them were men. The mean score of SRH status was 3.72 (range: 1–5; SD 0.93). 282 respondents (11.5%) rated their health status as poor or very poor. The concentration index was –0.29 (SE 0.03; p<0.001). Age, marital status, level of education and household economic status were significantly associated with SRH in both the crude and adjusted analyses. The main contributors to inequality in SRH were economic status (47.8%), level of education (29.2%) and age (23.0%).
Sub-optimal SRH was more in lower than in higher economic status. After controlling for age, the levels of education and household wealth have the greatest contributions to SRH inequality.
Most of the standard verbal autopsy tools are long and are used in a research setting. This study aims to compare a short verbal autopsy (VA) tool developed at Ballabgarh, India to be used by health workers for routine mortality surveillance with a standard tool.
A short VA tool was developed which was used by health workers during their routine house visits while a standard International Network of Field Sites with continuous Demographic Evaluation (INDEPTH) VA tool was filled by trained research workers for all adult deaths that occurred in 2008. The cause-specific mortality fraction using two tools, validity of the Comprehensive Rural Health Services Project (CRHSP) VA tool with INDEPTH VA tool as reference and agreement between the two tools, was compared.
The cause-specific mortality fraction was 11.6% and 12% for ischaemic heart disease (IHD), 10.6% and 11.8% for chronic pulmonary obstructive disease (COPD), and 9.4% and 7.3% for tuberculosis, using the INDEPTH and CRHSP VA tool, respectively. 16% and 21% of the deaths could not be classified using the INDEPTH and CRHSP VA tool respectively. The sensitivity of the CRHSP VA tool was 78.5% for IHD, 80% for COPD, 58.3% for tuberculosis, 92.8% for malignant neoplasm and 97.2% for intentional self harm. The kappa between two tools for IHD, COPD, tuberculosis, malignant neoplasm and intentional self harm was 0.754, 0.711, 0.628, 0.876 and 0.892 respectively.
The short VA tool had a good sensitivity and fair to excellent agreement with the standard tool in different age groups across the major causes of death. It can be used within the routine healthcare delivery framework and can fill the gap in mortality surveillance.
Moderate alcohol consumption is associated with a decreased risk of type 2 diabetes. However, the relationship between drinking patterns, such as the weekly frequency of alcohol consumption and the quantity per drinking day, and the incidence of type 2 diabetes has not been sufficiently addressed.
Study participants included 10 631 Japanese men aged 40–55 years without type 2 diabetes at entry. Type 2 diabetes was diagnosed if a fasting plasma glucose level was ≥7.0 mmol/l or if participants were taking diabetes medications. Data on alcohol consumption were obtained from questionnaires.
During the 37 172 person-years of follow-up, we confirmed 878 cases of type 2 diabetes. Frequent alcohol consumption was associated with a low risk of type 2 diabetes. Compared to non-drinkers, the multiple-adjusted HR for those who drank 4–7 days weekly was 0.76 (95% CI, 0.63 to 0.92). To assess the association between drinking pattern and type 2 diabetes, we examined the joint association of the weekly frequency and the quantity per drinking day with type 2 diabetes. Men who consumed 0.1–2.0 or 2.1–4.0 US standard drinks per drinking day on 4–7 days weekly had a lower risk of type 2 diabetes (HR 0.74, 95% CI 0.58 to 0.95; HR 0.74, 95% CI 0.60 to 0.91, respectively) compared to non-drinkers.
More frequent alcohol consumption lowered the risk of type 2 diabetes. Light to moderate alcohol consumption per drinking day on 4–7 days weekly lowered the risk of type 2 diabetes compared to non-drinkers.
In this study, the authors investigate gender-specific effects of childhood socio-economic position (SEP) on adiposity and blood pressure at three time points in adulthood.
Mixed models were used to assess the association of childhood SEP with body mass index (BMI), waist circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP) at ages 36, 43 and 53 years in a British birth cohort.
The adverse effect of lower childhood SEP on adiposity increased between ages 36 and 53 years in women (BMI: trend test: p=0.03) and remained stable in men, but the opposite was seen for SBP, where inequalities increased in men (p=0.01). Childhood SEP inequalities in DBP were stable with age in both men and women. Educational attainment mediated some but not all of the effects of childhood SEP on adiposity and SBP, and their rate of change; adult social class was a less important mediator.
Childhood SEP is important for adult adiposity and blood pressure across midlife, especially for BMI in women and for blood pressure in men. Thus, pathways to adult health differ for men and women, and public health policies aimed at reducing social inequalities need to start early in life and take account of gender.
The authors aimed to determine whether, and by how much, diabetes mellitus (DM) increases the risk of tuberculosis (TB) and conversely whether TB increases the risk of DM.
Retrospective cohort analyses using data from two Oxford Record Linkage Study (ORLS) datasets, containing information on hospital admissions and day-case care between 1963 and 1998 (ORLS1) and between 1999 and 2005 (ORLS2), were carried out. The rate ratio (RR) for tuberculosis after admission to hospital with diabetes and for diabetes after hospital admission with tuberculosis was calculated.
In ORLS1, the RR for TB in people admitted to hospital with DM, comparing the latter with a reference cohort, was 1.83 (95% CI 1.26 to 2.60), and in ORLS2 the RR was 3.11 (1.17 to 7.03). RRs for pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) within ORLS1 were similar at, respectively, 1.80 (1.16 to 2.67) and 1.98 (0.88 to 3.92). In ORLS 2 the RR for PTB was 2.63 (0.91 to 6.30). In ORLS1, there was no indication that TB was a risk factor for DM (RR 1.12, 0.76 to 1.60). The ORLS2 dataset was too small to analyse whether TB led to DM.
DM was associated with a two- to threefold increased risk of TB within this predominantly white, English population. The authors found no evidence that TB increases the risk of DM. Our findings suggest that the risks of PTB and EPTB were both raised among individuals with DM. As DM prevalence rises, this association will become increasingly important for TB control and treatment.
Potential health effects of cell phone use in children have not been adequately examined. As children are using cell phones at earlier ages, research among this group has been identified as the highest priority by both national and international organisations. The authors previously reported results from the Danish National Birth Cohort (DNBC), which looked at prenatal and postnatal exposure to cell phone use and behavioural problems at age 7 years. Exposure to cell phones prenatally, and to a lesser degree postnatally, was associated with more behavioural difficulties. The original analysis included nearly 13 000 children who reached age 7 years by November 2006.
To see if a larger, separate group of DNBC children would produce similar results after considering additional confounders, children of mothers who might better represent current users of cell phones were analysed. This ‘new’ dataset consisted of 28 745 children with completed Age-7 Questionnaires to December 2008.
The highest OR for behavioural problems were for children who had both prenatal and postnatal exposure to cell phones compared with children not exposed during either time period. The adjusted effect estimate was 1.5 (95% CI 1.4 to 1.7).
The findings of the previous publication were replicated in this separate group of participants demonstrating that cell phone use was associated with behavioural problems at age 7 years in children, and this association was not limited to early users of the technology. Although weaker in the new dataset, even with further control for an extended set of potential confounders, the associations remained.
Socio-economic disparities in nutrition are well documented. This study tested the hypothesis that socio-economic differences in nutrient intakes can be accounted for, in part, by diet cost.
A representative sample of 1295 adults in King County (WA) was surveyed in 2008–2009, and usual dietary intakes were assessed based on a food-frequency questionnaire. The monetary value of individual diets was estimated using local retail supermarket prices for 384 foods. Nutrients of concern as identified by the 2005 Dietary Guidelines Advisory Committee were fibre, vitamins A, C and E, calcium, magnesium and potassium. A nutrient density score based on all seven nutrients was another dependent measure. General linear models and linear regressions were used to examine associations among education and income, nutrient density measure and diet cost. Analyses were conducted in 2009–2010.
Controlling for energy and other covariates, higher-cost diets were significantly higher in all seven nutrients and in overall nutrient density. Higher education and income were positively and significantly associated with the nutrient density measure, but these effects were greatly attenuated with the inclusion of the cost variable in the model.
Socio-economic differences in nutrient intake can be substantially explained by the monetary cost of the diet. The higher cost of more nutritious diets may contribute to socio-economic disparities in health and should be taken into account in the formulation of nutrition and public health policy.
Suicide rates changed considerably in men aged <45 years in England and Wales between 1980 and 2005. The impact of these changes on the geographic distribution of suicide is unknown.
Mapping of geo-coded standardised mortality ratios for suicide in 1113 census tracts (mean population 46 000) in England and Wales, smoothed using Bayesian hierarchical models, for 15–44 year old men during 1981–1985, 1991–1995 and 2001–2005.
Young male suicide rates rose by 50% between the early 1980s and the 1990s but declined to pre-1980 levels by 2005. The spatial distribution of suicide changed markedly over these years. The ‘bull's-eye’ pattern of increases in suicide rates from the suburbs to the centre of London was abolished, although they persisted in other major cities. Suicide rates among young men in Wales changed from being relatively lower than other regions to being considerably higher. Similarly, by 2001–2005 suicide rates in northern and south western regions were relatively higher than elsewhere with the predominant feature being a north-west/ south-east divide in suicide. These changes in the spatial epidemiology of suicide were not explained by changes in area levels of single person households, unemployment or the unmarried population.
There has been a marked change in the spatial epidemiology of suicide in young men in the last 25 years, particularly in central London where the RR of suicide has declined and Wales where risks have risen. These changes do not appear to be explained by recognised suicide risk factors and require investigation to inform prevention strategies.
The mean birth weight of offspring of Bangladeshi, Indian and Pakistani women tends to be among the lowest of any ethnic groups regardless of country of residence. However, it is unclear whether the mean birth weight of South Asian offspring born in England and Wales is higher among those whose mothers were themselves born in England and Wales compared to those whose mothers were born in the Indian sub-continent.
We used cross-sectional data from a unique linkage of routine records for the whole of England and Wales (2005–2006, n=861 654) to estimate mean birth weights of the live singleton offspring of Bangladeshi, Indian, Pakistani or White British ethnicity according to whether maternal place of birth was England and Wales or the Indian sub-continent.
Offspring of women born in the Indian sub-continent were slightly heavier at birth than offspring of South Asian women born in England and Wales even after adjustment for gestational age, maternal age and parity (Bangladeshi 28 g, 95% CI 10 to 46; Indian 31 g, 95% CI 20 to 42; Pakistani 21 g, 95% CI 12 to 29).
There is no indication that the mean birth weight of South Asian offspring of women born in England and Wales is higher than the mean birth weight of those whose mothers were born in the Indian sub-continent. This suggests a shared physiological tendency for down-regulation of fetal growth transmissible across generations. Within the UK, there is unlikely to be any appreciable increase in mean birth weight of South Asian babies over the next few decades.
Little is known about the role that work-related factors play in the decline of cognitive function. This study examined the association between perceived organisational justice and cognitive function among middle-aged men and women.
Perceived organisational justice was measured at phases 1 (1985–8) and 2 (1989–90) of the Whitehall II study when the participants were 35–55 years old. Assessment of cognitive function at the screening clinic at phases 5 (1997–9) and 7 (2003–4) included the following tests in the screening clinic: memory, inductive reasoning (Alice Heim 4), vocabulary (Mill Hill), and verbal fluency (phonemic and semantic). Mean exposure to lower organisational justice at phases 1 and 2 in relation to cognitive function at phases 5 and 7 were analysed using linear regression analyses. The final sample included 4531 men and women.
Lower mean levels of justice at phases 1 and 2 were associated with worse cognitive function in terms of memory, inductive reasoning, vocabulary and verbal fluency at both phases 5 and 7. These associations were independent of covariates, such as age, occupational grade, behavioural risks, depression, hypertension and job strain.
This study suggests an association between perceived organisational justice and cognitive function. Further studies are needed to examine whether interventions designed to improve organisational justice would affect employees' cognition function favourably.
Few studies have examined the potential difference in the relationship between bonding versus bridging social capital and health outcomes. We sought to examine the association between these different types of social capital and self-rated health in a population-based study.
In February 2009, 4000 residents of Okayama City (aged 20–80 y) were randomly selected for a survey on social capital and health. The survey asked about participation in six different types of associations: Parents and Teachers Association, sports clubs, alumni associations, political campaign clubs, citizen's groups and community associations. We distinguished between bonding and bridging social capital by asking participants about their perceived homogeneity (with respect to gender, age and occupation) of the groups they belonged to. ORs and 95% CIs for poor health were calculated.
Bridging social capital (ie, participation in groups involving people from a diversity of backgrounds) was inversely associated with poor health in both sexes and women appeared to benefit more than men. Compared to those who reported zero participation, high bridging social capital was associated with a reduced odds of poor health (OR 0.25, 95% CI 0.11 to 0.55) in women after controlling for demographic variables, socioeconomic status, smoking habit and overweight. By contrast, bonding social capital was not consistently associated with better health in either gender.
The present study suggests that bonding and bridging social capital have differential associations with health and that the two forms of social capital need to be distinguished in considering interventions to promote health.
In utero tobacco exposure has been associated with adverse pregnancy outcomes but few studies have used longitudinal ultrasound measurements to asses the effects on fetal growth. The aim of this study was to examine the impact of active and passive smoking during pregnancy on fetal biometry in a cohort of Spanish women.
Biparietal diameter (BPD), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW) were evaluated in each trimester of pregnancy. Detailed information on smoking and potential confounders was assessed by questionnaire. SD scores were calculated from longitudinal growth curves adjusted for gestational age and potential determinants of growth. Size was assessed by means of unconditional SD scores at 12, 20, 32 and 38 weeks of pregnancy, while growth between these points was assessed by means of conditional SD scores. The association between smoking and fetal growth was investigated by regression models and adjusted for sociodemographic and lifestyle-related variables.
Maternal smoking was inversely associated with size of all parameters at weeks 32 and 38 and with growth in 20–32, 12–32 and 12–38 week intervals. In 32–38 weeks the effect was significant for AC and EFW. Environmental tobacco smoke (ETS) exposure was inversely associated with growth in BPD in all the intervals except 32–38 weeks.
Active smoking during pregnancy was associated with a reduction in BPD, AC, FL and EFW from mid-gestation. ETS adversely affected BPD from early pregnancy.