Early life and adult multiple risk behaviours in the 1958 British Birth Cohort: a prospective study of associations with midlife central adiposity

BackgroundCauses of obesity are multifactorial, including modifiable risk behaviours from early and later life such as physical inactivity and diet. Such risk behaviours are known to co-occur, but effects of co-occurrence on central obesity are not well understood. In the 1958 British Birth Cohort, we aimed to establish the extent of co-occurrence of early life and adult risk behaviours and associations with waist circumference.MethodsWe used data from the ongoing 1958 cohort study of all births across Britain during 1 week in March, 1958. From prospectively collected information we assessed two risk behaviours from early life (parental body-mass index ≥25 kg/m², maternal smoking in pregnancy) and four in adulthood at 33 years and 42 years (smoking, physical inactivity [activity less than once a week], low dietary fibre [wholemeal bread consumed occasionally or never], heavy alcohol consumption [≥22 units a week for women, ≥36 for men]). The prevalence of combinations of risk behaviours and their associations with waist circumference at age 45 years were assessed (n=9299) using covariate (eg, education level) adjusted linear regression. Missing values were imputed with multiple imputation chained equations; maximum sample analyses in univariable models gave similar results. South East MREC (ref 01/1/44) gave ethics approval and participants gave written informed consent.FindingsIn fully adjusted models, adult dietary fibre, smoking, and alcohol consumption were not associated with waist circumference. Adults whose mothers smoked in pregnancy had a 1·68 cm larger waist than those whose mothers had not smoked in pregnancy (95% CI 1·13–2·24). Trends were observed for number of overweight or obese parents, compared with having no overweight or obese parents (larger waist of 2·49 cm [1·92–3·06] for one parent, 5·56 [4·66–6·45] for two parents) and ages at which inactive, compared with being inactive at neither age (larger waist of 1·36 cm [0·82–1·89] for one age, 2·57 [1·86–3·29] for two ages). The most common combination of risk behaviours was having one overweight or obese parent and inactivity at one age (9·91%, n=921), which was associated with a 3·15 cm (2·09–4·21) larger waist than individuals with no risk behaviours. Individuals with two overweight or obese parents, maternal smoking in pregnancy, and inactivity at two ages had a 11·46 cm (7·36–15·57) larger waist than individuals with none of these risk factors.InterpretationSelf-reported risk behaviours and possible reverse causation are limitations, but the large, nationwide sample and lifetime risk behaviours are study strengths. Modifiable risk behaviours for large waist circumference are prevalent in the general population and co-occur across the lifetime.FundingPublic Health Research Consortium.     

Prevalence of chronic obstructive pulmonary disease in Greater Glasgow and Clyde: impact of smoking on socioeconomic and sex inequalities

Background

In high-income countries, socioeconomic and sex inequalities in chronic obstructive pulmonary disease (COPD) have been largely linked to smoking. We aimed to assess the effect of smoking status on socioeconomic and sex inequalities in COPD prevalence in Greater Glasgow and Clyde.

Impact of airflow obstruction on long-term mortality in patients with asthma in Japan

BackgroundThe long-term prognosis of asthma with airflow obstruction is poorly understood in Japan. The aim of this retrospective 26-year study was to investigate the long-term mortality risk of airflow obstruction in asthmatics.MethodsUsing data from the Omuta City Air Pollution-related Health Damage Cohort Program, mortality risk ratios of airflow obstruction in Japanese Individuals were analyzed by Cox proportional hazards models. Airflow obstruction was considered to be present when the forced expiratory volume in 1 sec (FEV₁)/forced vital capacity ratio was <0.7 and FEV₁ predicted was <80% based on spirometry.ResultsAmong the 3146 victims with chronic respiratory diseases, 697 with adult asthma were selected. Median follow-up period was 26.3 (range 0.9–40.9) years. The airflow obstruction group (n = 193) showed significantly higher rates of mortality related to respiratory problems (risk ratio [95% confidence interval] 1.51 [1.86–1.93], P = 0.0017) and asthma attacks (1.86 [1.30–2.66], P = 0.0011) than the without airflow obstruction group (n = 504). Airflow obstruction was an independent risk factor for both respiratory-related (1.84 [1.36–2.49], P = 0.0001) and all-cause (1.44 [1.17–1.76], P = 0.0008) mortality after adjustment for age, sex, body mass index, and smoking status. More severe airflow obstruction was significantly associated with poorer prognosis.ConclusionsThis long-term cohort program revealed the impacts of asthma with airflow obstruction as an independent mortality risk. Findings suggest that intervention and prevention of airflow obstruction can reduce long-term mortality in patients with asthma.     

Change in maternal smoking behaviour between the first two singleton live pregnancies and childhood obesity: analysis of a UK population-based cohort

BackgroundMaternal smoking during pregnancy has been linked to offspring adiposity. We examined interpregnancy changes in maternal smoking behaviour and the risk of age-specific and sex-specific obesity (≥95^th centile) in the second child (C2).MethodsWe used a population-based cohort of antenatal health-care records (August, 2004–August, 2014) at University Hospital Southampton, linked to measured child body-mass index (BMI) at 4–5 years obtained from child health records at two community NHS Trusts (Solent and Southern). We analysed the first two singleton live pregnancies of 6515 women using logistic regression to examine interpregnancy changes in self-reported maternal smoking in relation to C2 obesity (adjusting for maternal age, ethnicity, BMI, educational attainment, employment, folate supplementation, previous losses, infertility treatment, pre-existing and gestational diabetes and hypertension, interpregnancy interval, C2's birthweight, caesarean section delivery, and gestation).FindingsUnadjusted C2 obesity prevalence for children whose mothers never smoked, smoked at the start of both pregnancy 1 (P1) and pregnancy 2 (P2), P2 only, P1 only, and stopped smoking when both pregnancies were confirmed was 6·9% (215/3118 children), 12·5% (87/698 children), 12·4% (22/178 children), 10·3% (28/271 children), and 13·1% (29/222 children), respectively. Compared with women who never smoked, smoking at the start of both pregnancies was associated with higher odds of C2 obesity (adjusted odds ratio [aOR] 2·03, 95% CI 1·49–2.78). Women not smoking in P1 who smoked at the start of P2, and those who stopped when each pregnancy was confirmed had increased C2 obesity odds (aOR 1·80 [95% CI 1·09–3·00] and 1·73 [1·11–2·69], respectively). Smokers maintaining cessation having quit by P1 confirmation, P1 smokers who ceased by P2 confirmation, and those who smoked between pregnancies but who quit before C2 conception, did not have higher odds of C2 obesity (aOR 1·21 [95% CI 0·95–1·55], 1·39 [0·89–2·17], and 1·13 [0·78–1·63], respectively).InterpretationA mother smoking at the start of her first two pregnancies has twice the odds of having an obese second child compared with a non-smoker. Smoking in the second pregnancy only and between pregnancies up to the first trimester of P2 is also associated with childhood obesity. The interpregnancy period is an opportunity to intervene on modifiable risk factors such as smoking.FundingNIHR Southampton Biomedical Research Centre and University of Southampton Primary Care and Population Sciences PhD studentship (to EJT) and an Academy of Medical Sciences and Wellcome Trust grant (grant number AMS_HOP001\1060; to NAA).     

Estimated effects of health conditions and risk factors on social and socioeconomic outcomes: mendelian randomisation of UK Biobank data

BackgroundA person's health might influence their ability to attend and concentrate at school, obtain, maintain, and be productive in employment, and maintain wellbeing and an active social life. We aimed to better understand the causal effects of health on social and socioeconomic outcomes, to help establish the broader benefits of investing in effective health policy, thereby strengthening the case for cross-governmental action to improve health and its wider determinants at the population level.MethodsWe used a mendelian randomisation approach to analyse data from the UK Biobank to estimate the effect of eight health conditions (asthma, breast cancer, coronary heart disease, depression, diabetes, eczema, migraine, osteoarthritis) and five risk factors (alcohol intake, body-mass index [BMI], cholesterol, systolic blood pressure, smoking) with known genetic determinants on 19 socioeconomic outcomes in men and women of white British ancestry, aged between 39 and 72 years. The main outcome measures were annual household income, deprivation (measured using the Townsend deprivation index [TDI]), degree-level education, satisfaction with health, and self-reported happiness and loneliness. UK Biobank received ethical approval from the Research Ethics Committee (11/NW/0382).FindingsOur cohort consisted of 337 009 men and women. Of the five risk factors, our results showed that higher BMI, smoking, and alcohol use affected socioeconomic outcomes. Smoking was estimated to reduce household income (mean difference –£24 394 [95% CI –£33 403 to –£15 384]), the chance of owning accommodation (absolute percentage change [APC] –21·5% [95% CI –29·3 to –13·6), being satisfied with health (APC –32·4% [–48·9 to –15·8), and of receiving a university degree (APC –73·8% [–90·7 to –56·9), and increased deprivation (mean difference in TDI 1·89 [1·13 to 2·64]). Of the eight health conditions, asthma decreased household income (mean difference –£13 519 [–£18 794 to –£8 243]), the chance of having a university degree (APC –17·0% [–25·3 to –8·7), and the chance of cohabiting (APC –11·0% [–18·0 to –4·0]), and migraine reduced the chance of having a weekly leisure or social activity (APC –43·7% [–66·0 to –21·3]), especially in men. No other associations were found.InterpretationHigher BMI, smoking, and alcohol use were all estimated to negatively affect multiple social and socioeconomic outcomes. Associations were not detected between health conditions and socioeconomic outcomes with the exceptions of depression, asthma, and migraine. Our findings might reflect true null associations, or be a result of selection bias (given the relative good health and older age of participants in UK Biobank compared with the eligible UK population), or a lack of power to detect effects.FundingThe Health Foundation.     

Social and lifestyle characteristics and burden of ill-health associated with self-reported hearing and vision impairments in older men in the British community: a cross-sectional study

BackgroundSensory impairment is common in older adults and we need to understand more about its association with other health conditions. We explored sensory impairment in relation to demographic, lifestyle factors, and health conditions in older men.MethodsIn a cross-sectional study, 3981 men aged 63–85 years (82% of participants recruited to the British Regional Heart Study cohort in 1978–80 and still alive in 2003) were selected from general practices in 24 British towns. Data on hearing aid use and ability to follow television at a volume others find acceptable allowed for four categories of hearing: can hear (n=2851), can hear with an aid (n=482), cannot hear and no aid (n=424), and cannot hear despite an aid (n=168). Vision impairment was defined as not being able to recognise a friend across a road (n=124). Logistic regression was used to investigate associations of hearing impairment and vision impairment with self-reported doctor-diagnosed coronary heart disease, disability (difficulty taking the stairs, difficulty keeping balance), social interaction (attending few social activities), and quality of life (experiencing pain, feeling anxious or depressed).Findings1074 men (27%) reported hearing impairment and 124 (3%) reported vision impairment. Compared with those reporting no hearing problem, hearing impairment was associated with disability, poor social interaction, and poor quality of life. Poor quality of life remained significant after having adjusted for social class, smoking, obesity, and physical activity. Only men who could not hear despite having a hearing aid were more likely to report coronary heart disease (age-adjusted odds ratio 1·89, 95% CI 1·36–2·63) and falls (1·62, 1·05–2·48). Vision impairment was associated with symptoms of coronary heart disease including chest pain (1·58, 1·07–2·40) and breathlessness (2·06, 1·38–3·06), but not with diagnosed coronary heart disease (1·39, 0·93–2·07). Vision impairment was also significantly associated with falls, poor quality of life, poor social interaction, and disability, which remained significant after adjusting for social class, smoking, obesity, and physical activity. Men with a sensory impairment were more likely to be physically inactive, obese (hearing impairment only), and in a manual social class.InterpretationOlder men with hearing impairment and vision impairment have a high risk of disability, poor health, and poor social interaction. Policy efforts for early detection and treatment of sensory impairment could be crucial for independent living in old age.FundingThe British Regional Heart Study is funded by the British Heart Foundation. AEML is funded by the National Institute for Health Research School for Public Health Research. SER is funded by a UK Medical Research Council Fellowship.     

Children passive smoking jeopardises the efficacy of standard anti-allergic pharmacological therapy, while sublingual immunotherapy withstands

BackgroundThe association between genetic predisposition and environmental risk factors such as passive smoke in determining respiratory allergies is still uncertain; even less is known about the role played by passive smoking in influencing the success of therapy for rhinitis and allergic asthma.ObjectiveThe purpose of this prospective, randomised study was to determine whether passive smoking influences the outcome of therapies in paediatric patients with allergic respiratory diseases.MethodsThe study included 68 children (mean age 11.51 years; range: 5-17) suffering from perennial rhinitis and intermittent asthma monosensitised to Dermatophagoides. Thirty-four subjects were exposed to daily passive smoking in their families, 34 were not. The two groups have been then randomised to receive continuous treatment with cetirizine or SLIT for three years.ResultsThere were 3/34 (8.8%) dropouts in the SLIT arm and 4/34 (11.7%) in the cetirizine arm. After three years, the patients exposed to passive smoking showed higher nasal eosinophilia, a worse clinical-symptomatic and pharmacological score with a worsened bronchial reactivity and functional indices of persistent asthma, regardless of how they had been treated. Nevertheless, SLIT prevented the worsening of all the clinical parameters more than the antihistamine alone either among the children exposed to smoking or not.ConclusionsExposure to passive smoking in children suffering from respiratory allergies due to Dermatophagoides decreased the clinical response to both drug therapy and SLIT. Nonetheless, while the children submitted to drug therapy worsened or did not show any significant improvement, the ones treated with SLIT improved.     

Diabetes and cardiovascular events in women with polycystic ovary syndrome: a 20-year retrospective cohort study

BackgroundPolycystic ovary syndrome (PCOS) is the most common endocrine problem in women of reproductive age with a reported prevalence of up to 15%. Women with PCOS are potentially at increased risk of cardiovascular (CV) diseases from well-established risk factors, including insulin resistance, obesity, and type 2 diabetes. However data showing excess CV events in this population are still lacking.MethodsWe investigated the incidence and prevalence of type 2 diabetes and cardiovascular events (myocardial infarction, angina, heart failure, stroke and CV death) in a retrospective cohort of women with PCOS (total follow-up >12 000 person-years) The cohort consisted of 2301 women attending a specialty clinic from 1988 to 2009 in Leicestershire, UK (mean age 29·6 years [SD 9·1]).FindingsIncidence of type 2 diabetes, myocardial infarction, angina, heart failure, stroke, and CV death was respectively 3·6, 0·8, 1·0, 0·3, 0·0, and 0·4 per 1000 person-years. At the end of follow-up, prevalence of myocardial infarction in the age groups 45–54, 55–64, and older than 65 years were, respectively, 1·9%, 6·0%, and 27·3%, and of angina were 2·6%, 6·0%, and 27·3%. Age-group-specific odds ratios for prevalence of myocardial infarction and angina compared with the local female population (n=434 859) ranged between 2·6 (95% CI 1·0–6·3) and 12·9 (3·4–48·6) with the highest ratio being for myocardial infarction in the over-65 age group. Age, history of hypertension, and smoking had significant correlations with CV outcomes in women with PCOS (adjusted odds ratio 1·08 [95% CI 1·03–1·12], p<0·01 vs 9·94 (3·77–26·19), p<0·01 vs 3·33 [1·23–8·59], p<0·01).InterpretationWe have shown a high incidence and age-group-specific prevalence of type 2 diabetes, myocardial infarction, and angina in women with PCOS, with more than a quarter of those aged over 65 years having had a myocardial infarction or angina. These findings should be considered in treatment strategies, long-term planning, and CV risk reduction programmes for women with PCOS.FundingBritish Endocrine Society, National Institute for Health Research, and University of Leicester.     

Cardiovascular risk in patients with psoriasis,psoriatic arthritis,and rheumatoid arthritis: a prospective study of data from the Secure Anonymised Information Linkage databank

BackgroundThe increased risk of cardiovascular disease in individuals with rheumatoid arthritis, psoriatic arthritis, and psoriasis is well known. However, the precise cardiovascular risk in psoriasis and psoriatic arthritis is less understood, particularly the relative contribution of traditional cardiovascular risk factors, such as obesity, smoking, and systemic inflammation as measured by C-reactive protein and erythrocyte sedimentation rate. The objective of this study was to compare the incidence of major adverse cardiac events (MACE) among patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis with population controls adjusting for traditional cardiovascular risk factors, systemic inflammation, and disease-modifying anti-rheumatic drug (DMARD) treatment to better define cardiovascular risk in patients with these conditions.MethodsThe study used linked, routinely collected Welsh health data from 1999 to 2013 available from the Secure Anonymised Information Linkage (SAIL) databank, which includes datasets from general practice (GP), hospitals, and rheumatology clinics. Incidence and first occurrence of a MACE was investigated in individuals who were present in the GP system and positive for Read codes for rheumatoid arthritis (n=8650), psoriatic arthritis (2128), psoriasis (24 630), and controls without codes for the conditions investigated (1 187 706). We controlled for traditional cardiovascular risk factors, such as age, sex, smoking, body-mass index, comorbidities (hyperlipidaemia, diabetes, and hypertension), and medication (non-steroidal anti-inflammatory drugs, DMARDs, and steroids). We used a Cox proportional hazard model with the st command in Stata (version 13).FindingsWhen controlling for traditional risk factors, cardiovascular risk was significantly increased for individuals with rheumatoid arthritis (number of MACE events 548, hazard ratio 1·2, 95% CI 1·0–1·3; p=0·038) and psoriasis (879, 1·1, 1·0–1·3; p=0·025), but not for those with psoriatic arthritis (43, 1·0, 0·7–1·5; p=0·887). No interaction between DMARDs and MACE occurrence was observed.InterpretationThere is an increased incidence of cardiovascular disease for patients with rheumatoid arthritis and psoriasis, but not for those with psoriatic arthritis. This finding demonstrates the varying mediators of cardiovascular risk across these conditions and highlights the importance of cardiovascular risk reduction strategies, especially for patients with rheumatoid arthritis and psoriasis, who may benefit from closer monitoring to help reduce the incidence of MACE.FundingSupported by a Pfizer Inflammation Competitive Research Programme grant. The funder had no involvement in the study.     

Prevalence of finding sexual partners online and associations with sexual behaviour and sexual health outcomes: a British national probability survey

BackgroundOnline venues provide opportunities to facilitate sexual encounters, but the extent to which finding partners online is associated with risky sexual behaviour and poor sexual health outcomes is unclear; much of the research to date has focused on subpopulations, or convenience samples. We aimed to describe individuals' use of the internet to find sexual partners in a representative sample of the British population.MethodsThe third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) was a cross-sectional probability survey of 15 162 adults aged 16–74 years, which used computer-assisted personal-interview and self-interview, undertaken during 2010–12. The sample was weighted to account for selection probability and non-response, and corrected for differences in demographics according to the UK 2011 census. We estimated the prevalence of, and identified factors associated with, finding sexual partners online in the past year among 5698 men and 8198 women who reported sexual experience ever.FindingsUse of the internet to find sexual partners in the past year was reported by 5·2% of men (95% CI 4·7–5·8) (unweighted n=389) and 2·4% of women (2·1–2·8) (unweighted n=249), and was associated with younger age. After adjustment for age, individuals reporting a non-heterosexual identity (adjusted odds ratio for men 8·87, 5·95–13·22; for women 3·56, 2·20–5·78) were more likely to report finding partners online. This outcome was also associated with reporting sexual risk behaviours including sex without a condom with two or more partners (men 5·24, 3·71–7·39; women 6·36, 4·25–9·53), reporting five or more partners (11·19, 6·36–19·67; 17·44, 7·32–41·52), and reporting a new partner (13·27, 9·49–18·54; 14·93, 9·97–22·37). Sexual health clinic attendance (men 1·92, 1·18–3·15; women 2·25, 1·08–4·69), HIV testing (2·91, 1·91–4·44; 1·82 1·09–3·03), and diagnoses of sexually transmitted infections (men only 2·19, 1·17–4·12) were more common among individuals reporting finding partners online after adjustment for age and number of partners.InterpretationFinding partners online was strongly associated with markers of sexual risk and health-service uptake. Online opportunities have increased since 2010–12, so these data might underestimate the importance of this social phenomenon for public health and control of sexually transmitted infections. Given the cross-sectional survey design, neither directionality nor causality can be inferred.FundingNatsal-3 was supported by grants from the Medical Research Council (G0701757) and the Wellcome Trust (084840), with contributions from the Economic and Social Research Council and Department of Health.     

Premature mortality in adult survivors of child abuse and neglect: a nationwide birth cohort study

BackgroundChild neglect and abuse are not uncommon. Both are associated with deleterious outcomes in adulthood, but there is sparse evidence on the association between such trauma and premature adult mortality. We aimed to establish whether different types of child maltreatments were associated with all-cause mortality in mid-adulthood and examined potential intermediaries of this association.MethodsUsing the 1958 British birth cohort (n=9310), we examined associations between child neglect (prospectively recorded at years 7 and 11 of age) and abuse (physical, psychological, witnessing and sexual; self-reported at years 44–45 of age) with all-cause mortality, using Cox proportional hazard models adjusted for early-life covariates and other maltreatment types. We tested interactions between each maltreatment type and sex; there was little evidence of effect modification (p_interaction>0·001), hence models also adjust for sex. Mortality follow-up was between 2002–03 and December 2016 (participants aged 44–45 to 58 years). Death was ascertained from the National Health Service Central Register (n=296) or from survey updates (n=16). Potential intermediaries included: adult social factors, health behaviours, adiposity, mental health, cardiometabolic markers, and growth (height) at years 7 to 45 of age. Missing data were imputed via multiple imputation.FindingsChild maltreatment prevalence varied from 1·6% (n=149; sexual abuse) to 11% (n=1000; physiological abuse); 77% (n=6536) reported no maltreatment. Neglect and abuse (physical and sexual) were associated with increased risk of premature death, independent of covariates and other maltreatment types; adjusted hazard ratios (HRs) were 1·47 (95% CI 1·05–2·05) for neglect, 1·73 (1·10–2 ·71) for physical abuse, and 2·60 (1·49–4·52) for sexual abuse. Associations for neglect and physical abuse disappeared after adjustment for adult health behaviours, and, for neglect only, social factors; other intermediaries had little effect on these associations. Sexual abuse associations were largely unexplained by examined intermediaries. Risk of all-cause mortality increased with the number of maltreatments (versus none): adjusted HRs were 1·44 (1·07–1·93) for one maltreatment and 2·04 (1·45–2·87) for at least two maltreatments.InterpretationChild neglect and physical and sexual abuse are associated with increased risk of premature mortality in mid-adulthood. Our findings highlight the importance of preventing specific child maltreatments and of supporting survivors to potentially mitigate differences in premature mortality. Child abuse was reported retrospectively and estimated associations for sexual abuse might be imprecise due to low prevalence. However, child neglect, potential confounders, and mediators were ascertained prospectively.FundingUS National Institute on Aging, the UK Economic and Social Research Council, the UK Biotechnology and Biological Sciences Research Council, and the UK National Institute for Health Research Biomedical Research Centre.     

Employment status and impact on mental wellbeing in the UK working age population: a cross-sectional analysis

BackgroundGlobal evidence suggests that exposure to non-permanent or precarious employment can have negative effects on mental wellbeing, but research from the UK is sparse. This study explored whether these findings were applicable to the UK working population. As the employment market is evolving with more precarious working opportunities, we also ascertained whether any type of employment contract arrangement was more beneficial to mental wellbeing than being unemployed.MethodsWe retrospectively analysed the Understanding Society Wave 7 dataset (anonymous pan-UK dataset from 2015). In this study, we only included respondents aged 18–64 years, in paid employment or unemployed (n=18 525, 8473 men, 10 052 women). We used the seven components of, and the overall, Short Warwick Edinburgh Mental Wellbeing Score. A score lower than 18·82 determined low mental wellbeing. Part-time contracts were defined as working 30 h or less per week. To examine the associations between the respective employment statuses (contract types, in or out of employment) and mental wellbeing, we did a χ² analysis and calculated odds ratios (adjusted for age group and gender).FindingsThe prevalence of low mental wellbeing was highest in those unemployed (30·1%, n=438/1457), followed by those in non-permanent (14·3%, n=135/945) and permanent (12·1%, n=1943/16 123) employment arrangements. Compared with individuals employed on permanent contracts, those in non-permanent arrangements were more likely to report struggling to deal with problems (odds ratio 1·26, 95% CI 1·01–1·58, p=0·042), being unable to make up their mind (1·57, 1·20–2·06, p=0·001) or think clearly (1·35, 1·06–1·72, p=0·014), and report not feeling close to others (1·48, 1·21–1·81, p<0·0001). The association between contract types (permanent vs non-permanent) and low mental wellbeing was not significant (1·16, 0·96–1·40, p=0·13) as were the associations between contract types and future optimism, feeling useful, or feeling relaxed. Unemployed individuals were more likely to report low mental wellbeing than permanent (3·07, 2·72–3·47, p<0·0001), non-permanent (2·59, 2·09–3·21, p<0·0001), full-time (3·16, 2·79–3·58, p<0·0001), or part-time (2·60, 2·25–3·01, p<0·0001) workers.InterpretationPrecarious employment is associated with components of poorer mental wellbeing. However, the strongest associations for low mental wellbeing are observed in currently unemployed people. To understand and explore these complex relationships in greater detail, longitudinal research is required.FundingNone.     

Effect of passive smoking,asthma, and respiratory infection on lung function in Australian children

We have calculated normal standards for lung function of Australian children and have estimated the effects on lung function of passive smoking, current asthma, past asthma, and a current respiratory infection. Three cross-sectional samples of children in school years 3–5 (aged 8–11 years) were studied. The 2765 children were from two rural regions of NSW and from the city of Sydney. Details of passive smoking and respiratory illness were collected by a questionnaire sent to parents. Forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV₁), peak expiratory flow rate (PEFR), and forced mid-expiratory flow rate (FEF_25–75%) were used as measures of lung function. Airway responsiveness was assessed by histamine inhalation test. Data from 1278 “normal” children were used in regression analysis to calculate prediction models for lung function. Passive smoking was associated with reduced FEV₁, PEFR, and FEF_25–75%. Children with current asthma had reduced FEV₁ and FEF_25–75% and children with past asthma had reduced FEF_25–75%. Children with a current respiratory infection had reduced FVC₁, FEV₁, PEFR, and FEF_25–75% The effects of these deficits on the future lung function of these children is not known but is likely to be important. Pediatr Pulmonol. 1994;18:323–329 © Wiley-Liss, Inc.     

Sensory impairments and incident disability in older men living in a British community: a 2 year follow-up study

BackgroundSensory impairments are common in older adults, who are a rapidly growing proportion of the UK population, making age-related sensory impairments an increasingly important public health concern. We explored the association between impairments in hearing and vision and the risk of incident mobility disability, activities of daily living (ADL), and instrumental ADL (IADL).Methods3981 men aged 63–85 years from the population-based British Regional Heart Study were followed from Jan 1, 2003, to April 30, 2005. Self-reported data on hearing aid use and ability to follow television at a volume acceptable to others allowed for four categories of hearing: could hear (reference group), could hear with hearing aid, could not hear and no aid, and could not hear despite aid. Vision impairment was defined as not being able to recognise a friend across a road. Measures of disability included mobility disability (defined as unable to take stairs up or down, or unable to walk 400 yards, or a combination of these movements), ADL difficulties, and IADL difficulties. Logistic regression was used to assess associations. All participants provided written, informed consent. Ethics approval was obtained from local research ethics committees.FindingsAt baseline, 3108 men were free from mobility disability, 3346 were free from ADL difficulties, and 3410 were free from IADL difficulties. New cases of disability at follow-up included mobility disability (n=238), ADL (n=260), and IADL (n=207). Men who could not hear and did not use a hearing aid had greater risks of mobility disability (age-adjusted relative risk 2·24, 95% CI 1·29–3·89). Being unable to hear, irrespective of hearing aid, was associated with increased risks of ADL (without aid 1·74, 1·19–2·55; with aid 2·01, 1·16–3·46). Men who could hear and used a hearing aid and men who could not hear despite an aid had increased risks of IADL (1·86, 1·29–2·70 and 2·74, 1·53–4·93, respectively). Vision impairment was not associated with incident mobility disability.InterpretationOlder men with hearing impairment have an increased risk of subsequent disability. Prevention and correction of hearing impairment could enhance independent living in later life. Further research is warranted on the possible pathways underlying the associations, to prevent adverse health outcomes associated with age-related hearing impairment.FundingThe British Regional Heart Study is funded by the British Heart Foundation. AEML is funded by the National Institute for Health Research School for Public Health Research (509546). SER is funded by a UK Medical Research Council Fellowship (G1002391).     

How does our decision to smoke and drink in midlife affect our cognition in later life? Findings from the 1946 British Birth Cohort

BackgroundThere are current public health concerns about increasing disability secondary to cognitive decline in ageing populations, with a less clear understanding of the potential time window for lifestyle interventions. This study examined how smoking and harmful drinking during early midlife affect cognitive performance in later life.MethodsData are from the Medical Research Council National Survey of Health and Development (NSHD), a study of 5362 children born in March, 1946, who are being monitored across their entire life. Cognitive abilities were measured at age 60–64 years with a 15 item word-list short-term memory task and a timed letter-search task devised by the NSHD team. The scores were categorised as low or moderate to high. Information about alcohol consumption was collected via food diaries at ages 36, 43, 53, and 60–64 years and classified according to the Department of Health as no drinking, light-to-moderate drinking (3–4 units per day for men, 2–3 for women), heavy drinking (4–8 and 3–6, respectively), and harmful drinking (>8 and >6, respectively). Information about smoking was collected via interviews and questionnaires at ages 20, 25, 31, 36, 43, 53, and 60–64 years. Multivariable logistic regression was used, adjusting for sex, childhood cognition at age 8 years, education, and socioeconomic status.FindingsDrinking in moderation across midlife seems to be protective against poor memory in later life (odds ratio 0·86, 95% CI 0·63–1·16). By contrast, harmful drinking at 43 and 53 years was associated with higher odds of poor memory (1·36, 0·79–2·33 and 1·26, 0·65–2·43, respectively). Drinking heavily, particularly at 43 years of age, was also associated with higher odds of slow search-speed at the same age (1·66, 1·01–2·76). Number of smoking pack-years was strongly associated with low memory (2·17, 1·33–3·54) and slow search-speed (1·65, 1·03–2·64).InterpretationThese results suggest that a possible sensitive period for harmful effects of smoking and drinking occurs after the age 36 years and is observed consistently between the ages of 43 and 53 years. By contrast, sensible drinking, particularly from the age of 53 years, might be protective of speed performance, suggesting that intervention could be more beneficial in the decades preceding clinical manifestation of neuropathological burden.FundingMedical Research Council (unit programme no MC_UU_12019/1).     

Hepatic inflammation and fibrosis biomarkers are associated with cardiovascular risk factors but not cardiovascular disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

BackgroundBoth cardiovascular disease and liver disease are particularly common in people with type 2 diabetes and it is possible that the two conditions are inter-related. Non-invasive biomarkers are increasingly used to estimate liver inflammation and fibrosis. In this study the association of these biomarkers with cardiovascular risk factors and disease was explored in a large, representative population of people with type 2 diabetes mellitus.MethodsCytokeratin 18 (CK18, biomarker of hepatic inflammation) and the European Liver Fibrosis panel (ELF, biomarker of hepatic fibrosis) were measured in a random subgroup of 564 adults, aged 60–75 years at recruitment, participating in the Edinburgh Type 2 Diabetes Study (ET2DS). Data on conventional CV risk factors (body-mass index [BMI], waist circumference, blood pressure, total cholesterol, triglycerides, smoking status) and prevalent cardiovascular disease (validated myocardial infarction, angina, stroke and transient ischaemic attack events) were also available.FindingsMedian CK18 was 102 U/L [IQR 76–137, range 29–993] and mean ELF was 8·9 U/L [SD 0·8, range 6·9–11·6]. After adjustment for age and sex, increased CK18 was significantly associated with higher triglyceride levels (r=0·157, p=0·002). Increased ELF score was associated with higher BMI (r=0·202, p<0·001), waist circumference (r=0·139, p=0·008), and diastolic blood pressure (r=–0·045, p=0·025). Despite these associations, neither biomarker was significantly associated with prevalent cardiovascular disease (prevalent cardiovascular disease vs no cardiovascular disease, mean CK18 108·1 U/L [SD 26·2] vs 105·5 [22·6], p=0·473 and mean ELF 8·94 [0·77] vs 8·89 [0·76], p=0·442).InterpretationIn people with type 2 diabetes, non-invasive biomarkers of hepatic inflammation and fibrosis are associated with a number of cardiovascular risk factors but do not appear to associate with pre-existing vascular disease. Further investigation is required to determine whether liver biomarkers predict incident cardiovascular disease in this high risk group.FundingDiabetes UK.     

Parental Smoking and the Risk of Respiratory Symptoms Among Schoolboys in Al-Khobar City, Saudi Arabia

The objective of this study was to measure the prevalence of parental smoking and its association with respiratory symptoms among 6- through 15-year-old schoolboys in Al-Khobar City, Saudi Arabia. This was a cross-sectional study. The methodology included the distribution of a self-administered questionnaire, which was completed by the parents of 1482 schoolboys who satisfied the selection criteria of the study. The overall rate of smoking among parents of this sample was 18.2% (32% among fathers and 4% among mothers). There was an increased risk associated with parental smoking and respiratory symptoms among asthmatic and nonasthmatic children. The magnitude of this risk was variable for different respiratory symptoms. The smoking rate among parents of asthmatic children was significantly higher than that of parents of normal children. The logistic regression model showed paternal smoking to be significantly associated with asthmatic children. The study concluded that there is an increased risk of respiratory symptoms among asthmatic and nonasthmatic children because of parental smoking. The smoking rate and trend among fathers and mothers were comparable to those reported earlier, indicating an ongoing problem. Schoolchildren with smoking parents may be better screened for bronchial asthma. Management of children presenting with respiratory symptoms should include an inquiry about exposure to passive smoking. Tobacco smoking should be considered a public health problem with serious implications, and the importation of tobacco should be banned.