Tobacco outlet density near home and school: Associations with smoking and norms among US teens

This study examined whether living or going to school in neighborhoods with higher tobacco outlet density is associated with higher odds of cigarette smoking among teens, and with perceptions of greater smoking prevalence and peer approval. Using an Internet panel that is representative of US households, we matched data from teen-parent pairs (n = 2771, surveyed June 2011–December 2012) with environmental data about home and school neighborhoods. Density was measured as the number of tobacco outlets per square mile for a ½-mile roadway service area around each participant's home and school. Logistic regressions tested relationships between tobacco outlet density near home and schools with ever smoking. Linear regressions tested relationships between density, perceived prevalence and peer approval. Models were adjusted for teen, parent/household and neighborhood characteristics. In total, 41.0% of US teens (ages 13–16) lived within ½ mile of a tobacco outlet, and 44.4% attended school within 1000 ft of a tobacco outlet. Higher tobacco outlet density near home was associated with higher odds of ever smoking, although the relationship was small, OR = 1.01, 95% CI (1.00, 1.02). Higher tobacco outlet density near home was also associated with perceptions that more adults smoked, coef. = 0.09, 95% CI (0.01, 0.17). Higher tobacco outlet density near schools was not associated with any outcomes. Living in neighborhoods with higher tobacco outlet density may contribute to teen smoking by increasing access to tobacco products and by cultivating perceptions that smoking is more prevalent. Policy interventions to restrict tobacco outlet density should not be limited to school environments.     

Seafood intake and blood cadmium in a cohort of adult avid seafood consumers

Although the benefits of fish consumption are widely recognized, seafood may also be a source of exposure to heavy metals such as cadmium. Many types of seafood are rich in cadmium, but bioavailability and potential for toxicity after consumption is less clear. This study investigates the relationship between seafood intake and the level of cadmium (Cd) in the blood in a 252 person cohort of avid seafood consumers in the Long Island Study of Seafood Consumption (New York). Blood cadmium is an established biomarker of cadmium exposure, reflecting both recent and decade-long exposure. Data on the amounts and frequency of eating various types of seafood were self-reported by avid seafood consumers recruited in 2011–2012. After adjusting for age, BMI, sex, current smoking status, and income in a linear regression model, we found no association between regular seafood intake (β = −0.01; p = 0.11) but did identify an association between salmon intake in cups/week (ln transformed) (β = 0.20; p = 0.001) and blood cadmium. After accounting for salmon, no other types of seafood were meaningfully associated with blood cadmium. No association was found between rice intake, blood zinc, or dietary iron or calcium and blood cadmium. Results suggest that seafood is not a major source of cadmium exposure, but that salmon intake does marginally increase blood cadmium levels. Given that cadmium levels in salmon are not higher than those in many other seafood species, the association with salmon intake is likely attributed to higher consumption of salmon in this population.     

Sleep insufficiency and the natural environment: Results from the US Behavioral Risk Factor Surveillance System survey

BackgroundExposure to the natural environment may improve health behaviors and mental health outcomes such as increased levels of physical activity and lower levels of depression associated with sleep quality. Little is known about the relationship between insufficient sleep and the natural environment.PurposeTo determine whether exposure to attributes of the natural environment (e.g., greenspace) attenuates the likelihood of reporting insufficient sleep among US adults.MethodsMultiple logistic regression models were used to explore the association between self-reported days of insufficient sleep (in the past 30 days) and access to the natural environment in a multi-ethnic, nationally representative sample (n = 255,171) of US adults ≥ 18 years of age enrolled in the 2010 Behavioral Risk Factor Surveillance System.ResultsUsing 1-to-6 days of insufficient sleep as the referent group for all analyses, lower odds of exposure to natural amenities were observed for individuals reporting 21-to-29 days (OR = 0.843, 95% confidence interval (CI) = 0.747, 0.951) of insufficient sleep. In stratified analyses, statistically significant lower odds of exposure to natural amenities were found among men reporting 7-to-13-days (OR = 0.911, 95% CI = 0.857, 0.968), 21-to-29-days (OR = 0.838, 95% CI = 0.759, 0.924), and 30-days (OR = 0.860, 95% CI = 0.784, 0.943) of insufficient sleep. Greenspace access was also protective against insufficient sleep for men and individuals aged 65 +.ConclusionsIn a representative sample of US adults, access to the natural environment attenuated the likelihood of reporting insufficient sleep, particularly among men. Additional studies are needed to examine the impact of natural environment exposure on sleep insufficiency across various socio-demographic groups.     

The associations between US state and local social spending,income inequality,and individual all-cause and cause-specific mortality: The National Longitudinal Mortality Study

ObjectiveTo investigate government state and local spending on public goods and income inequality as predictors of the risks of dying.MethodsData on 431,637 adults aged 30–74 and 375,354 adults aged 20–44 in the 48 contiguous US states were used from the National Longitudinal Mortality Study to estimate the impacts of state and local spending and income inequality on individual risks of all-cause and cause-specific mortality for leading causes of death in younger and middle-aged adults and older adults. To reduce bias, models incorporated state fixed effects and instrumental variables.ResultsEach additional $250 per capita per year spent on welfare predicted a 3-percentage point (− 0.031, 95% CI: − 0.059, − 0.0027) lower probability of dying from any cause. Each additional $250 per capita spent on welfare and education predicted 1.6-percentage point (− 0.016, 95% CI: − 0.031, − 0.0011) and 0.8-percentage point (− 0.008, 95% CI: − 0.0156, − 0.00024) lower probabilities of dying from coronary heart disease (CHD), respectively. No associations were found for colon cancer or chronic obstructive pulmonary disease; for diabetes, external injury, and suicide, estimates were inverse but modest in magnitude. A 0.1 higher Gini coefficient (higher income inequality) predicted 1-percentage point (0.010, 95% CI: 0.0026, 0.0180) and 0.2-percentage point (0.002, 95% CI: 0.001, 0.002) higher probabilities of dying from CHD and suicide, respectively.ConclusionsEmpirical linkages were identified between state-level spending on welfare and education and lower individual risks of dying, particularly from CHD and all causes combined. State-level income inequality predicted higher risks of dying from CHD and suicide.     

Tobacco use disparities by racial/ethnic groups: California compared to the United States

Racial/ethnic disparities in cigarette use and cessation persist. This study compared cigarette consumption and former smoking trends in California (CA) with the rest of the United States (US) by racial/ethnic categories of non-Hispanic White, Black, Hispanic/Latino, and Asian/Pacific Islander groups. Data were analyzed from the 1992 to 2011 Tobacco Use Supplement to the Current Population Survey. Consumption levels across decades were examined and adjusted logistic regression models were fit to compare across CA and US.Results indicated steady declines in ever smoking prevalence for all groups with much lower magnitudes of change among US Blacks and Whites compared to their CA counterparts. After controlling for age, gender, and education, CA had significantly fewer heavy smokers (OR = 0.45, 95% CI:0.38–0.54), more light and intermittent smokers (LITS; OR = 1.68, 95%CI: 1.45–1.93), and a greater proportion of former smokers (OR = 1.35, 95%CI: 1.24–1.48) than the rest of US. Data were stratified by race/ethnicity and the patterns shown were mostly consistent with CA performing statistically better than their US counterparts with the exception of Black LITS and Asian/Pacific Islander former smokers. California's success in reducing tobacco use disparities may serve as a prime example of tobacco control policy for the country. CA and the US will need to continue to address tobacco use and cessation in the context of the growing diversity of the population.     

Blood lead levels and risk factors in young children in France, 2008–2009

BackgroundThe exposure of children to lead has decreased in recent years, thanks notably to the banning of leaded gasoline. However, lead exposure remains a matter of public health concern, because no toxicity threshold has been observed, cognitive effects having been demonstrated even at low levels. It is therefore important to update exposure assessments. A national study was conducted, in 2008–2009, to determine the blood lead level (BLL) distribution in children between the ages of six months and six years in France. We also assessed the contribution of environmental factors.MethodsThis cross-sectional survey included 3831 children recruited at hospitals. Two-stage probability sampling was carried out, with stratification by hospital and French region. Sociodemographic characteristics were recorded, and blood samples and environmental data were collected by questionnaire. Generalized linear model and quantile regression were used to quantify the association between BLL and environmental risk factors.ResultsThe geometric mean BLL was 14.9 μg/l (95% confidence interval (CI) = [14.5–15.4]) and 0.09% of the children (95% CI = [0.03–0.15]) had BLLs exceeding 100 μg/l, 1.5% (95% CI = [0.9–2.1] exceeding 50 μg/l. Only slight differences were observed between French regions. Environmental factors significantly associated with BLL were the consumption of tap water in homes with lead service connections, peeling paint or recent renovations in old housing, hand-mouth behavior, passive smoking and having a mother born in a country where lead is often used.ConclusionsIn children between the ages of one and six years in France, lead exposure has decreased over the last 15 years as in the US and other European countries. Nevertheless still 76,000 children have BLL over 50 μg/l and prevention policies must be pursued, especially keeping in mind there is no known toxicity threshold.     

Sexual orientation disparities in smoking vary by sex and household smoking among US adults: Findings from the 2003–2012 National Health and Nutrition Examination Surveys

ObjectiveThis study examined whether sexual orientation-related smoking disparities in males and females varied by household smoking behaviors in a nationally representative sample of American adults.MethodsData were drawn from the 2003–2012 National Health and Nutrition Examination Surveys, which assessed 14,972 individuals ages 20 to 59 years for sexual orientation, current smoking status, and household smoking. Weighted multivariable logistic models were fit to examine whether differences in current smoking status among sexual minority adults compared to heterosexuals was moderated by household smoking and sex, adjusting for covariates.ResultsThe main effects of identifying as a sexual minority, being male, and living with a household smoker were all associated with a significantly higher odds of being a current smoker. However, there also was a significant three-way interaction among these variables (adjusted odds ratio = 3.75, 95% confidence interval: 1.33, 10.54). Follow-up analyses by sex indicated that the interaction between sexual identity and household smoking was significant for both males (AOR = 6.40, 95% confidence interval: 1.27, 32.28) and females (AOR = 0.43, 95% confidence interval: 0.23, 0.81) but was in the opposite direction. Among males, living with a smoker was associated more strongly with greater odds of smoking among gay and bisexual males, compared to heterosexual males. In contrast, among females, living with a smoker was more strongly associated with greater odds of smoking for heterosexuals compared to lesbians and bisexuals.ConclusionsFuture research is warranted to examine characteristics of households, including smoking behaviors and composition, to guide more effective and tailored smoking cessation interventions for males and females by sexual orientation.     

Neurobehavioral function and low-level metal exposure in adolescents

An excessive metal exposure is harmful to the brain. However, many aspects of metal neurotoxicity remain unclear including the magnitude of the low-level exposure effects and the level of exposure that can be assumed safe. The aim of our study was to investigate the association between a low-level metal exposure and three neurobehavioral domains (sustained attention, short-term memory, and manual motor speed). We measured Cd, Cu, Mn, Pb, and Tl in blood, Cd, Ni, and toxicologically relevant As in urine and methyl Hg in hair in 606 adolescents between 13.6 and 17 years of age. A two-fold increase in blood Cu was associated with a 0.37 standard deviations decrease in sustained attention (95% CI: −0.67 to −0.07, p = 0.02) and 0.39 standard deviations decrease in short-term memory (95% CI: −0.70 to −0.07, p = 0.02), accounting for gender, age, smoking, passive smoking, household income per capita, occupation of the parents, and education level of the mother. None of the other metals was significantly associated with the neurobehavioral domains that were measured. The observed associations between blood Cu and neurobehavioral performance are in line with recent studies in elderly. However, the relevance of our results for public health remains to be elucidated.     

Urinary triclosan concentrations are inversely associated with body mass index and waist circumference in the US general population: Experience in NHANES 2003–2010

BackgroundHumans are extensively exposed to triclosan, an antibacterial and antifungal agent. Triclosan's effects on human health, however, have not been carefully investigated.ObjectiveTo examine whether triclosan exposure is associated with obesity traits.MethodsThis study included 2898 children (6–19 years old) and 5066 adults (20 years or older) who participated in the National Health and Nutrition Examination Surveys (NHANES) 2003–2010 and had a detectable level of urinary triclosan. Multiple linear regression models were used to examine the association between urinary triclosan and both body mass index (BMI) and waist circumference.ResultsEach standard deviation increase in urinary triclosan was associated with a 0.34 (95% confidence interval, CI: 0.05, 0.64) kg/m² lower level of BMI (P = 0.02) and 0.92 (95% CI: 0.09, 1.74) cm smaller waist circumference (P = 0.03) in boys, and a 0.62 (95% CI: 0.31, 0.94) kg/m² lower level of BMI (P = 0.0002) and 1.32 (95% CI: 0.54, 2.09) cm smaller waist circumference in girls (P = 0.001); a 0.42 (95% CI: 0.06, 0.77) kg/m² lower level of BMI (P = 0.02) and 1.35 (95% CI: 0.48, 2.22) cm smaller waist circumference (P = 0.003) in men, and a 0.71 (95% CI: 0.34, 1.07) kg/m² lower level of BMI (P = 0.0002) and 1.68 (95% CI: 0.86, 2.50) cm smaller waist circumference (P = 0.0001) in women. In both children and adults, there was a consistent trend for lower levels of BMI and smaller waist circumference with increasing levels of urinary triclosan, from the lowest to the highest quartile of urinary triclosan (P ≤ 0.001 in all cases).ConclusionTriclosan exposure is inversely associated with BMI and waist circumference. The biological mechanisms linking triclosan exposure to obesity await further investigation.     

La anemia aumenta el riesgo de mortalidad debido a fragilidad y discapacidad en mayores: Estudio FRADEA

ObjectiveTo analyze if anemia increases 10-year mortality risk associated to frailty and disability in older adults.DesignSubstudy of the FRADEA population-based concurrent cohort study (Frailty and dependence in Albacete), with a 10-year follow-up (2007-2017) in people older than 69 years.SettingAlbacete city, Spain.ParticipantsOf the 993 participants included in the first wave, 790 were selected with valid data on function (frailty and disability), anemia and vital status at 10 years.Main measurementsAnemia was defined according to the criteria of the World Health Organization (hemoglobin < 13 g/dL in men and < 12 g/dL in women). A functional classification variable was created, including frailty and disability, identifying four progressive functional levels: robust, prefrail, frail and disabled in basic activities of daily life, using frailty phenotype and Barthel index respectively. A new eight categories variable was constructed combining the four functional groups with the presence or absence of anemia. The association with mortality was determined by Kaplan-Meier and Cox proportional hazards analysis adjusted for age, sex, comorbidity, polypharmacy, institutionalization and creatinine.ResultsMean age was 79 years and 59.6% were women. 393 participants (49.7%) died during the follow-up period. The median survival was 98.4 months (interquartile range 61). The risk of mortality increased from the levels with better functionality to those with worse functionality, and for each subgroup it was higher in the participants with anemia. Prefrail without anemia HR [hazard ratio] 1.59 (95% CI 1.07-2.36) and with anemia HR 2.37 (95% CI 1.38-4.05). Frail without anemia HR 3.18 (95% CI 1.68-6.02) and with anemia HR 4.42 (95% CI 1.99-9.84). Disabled without anemia HR 3.81 (95% CI 2.45-5.84) and with anemia HR 5.48 (95% CI 3.43-8.76).ConclusionAnemia increases the risk of mortality associated with frailty and disability in older adults.     

Urinary concentrations of dichlorophenol pesticides and obesity among adult participants in the U.S. National Health and Nutrition Examination Survey (NHANES) 2005–2008

Accumulating evidence from recent studies has suggested a possible link between exposure to environmental pesticides and obesity. In this study, we assessed the potential associations between exposure to dichlorophenol pesticides and obesity in adults. Study participants aged 20–85 years were selected from the 2005 to 2006 and 2007 to 2008 U.S. National Health and Nutrition Examination Survey, and were categorized as obese and non-obese based on body mass index. Creatinine-corrected urinary concentrations of dichlorophenols were determined to assess level of exposure to environmental pesticides. Multivariate logistic regression was performed using SAS 9.3 to assess the association between 2,4-dichlorophenol (2,4-DCP) and 2,5-dichlorophenol (2,5-DCP) levels in urine and obesity with adjustment for potential confounders. Significantly higher geometric means of urinary concentrations of both 2,5-DCP (p < 0.0001) and 2,4-DCP (p = 0.0170) were seen in obese adults, compared to that in non-obese adults. A dose-dependent increase in the prevalence of obesity was observed in the study participants across increasing levels of urinary 2,5-DCP (p-trend < 0.0001). Urinary concentrations of 2,5-DCP were significantly associated with obesity among the second (AOR: 1.47, 95% CI: 1.12, 1.93), third (AOR: 1.41, 95% CI: 1.07, 1.87), and fourth (AOR: 1.62, 95% CI: 1.21, 2.17) inter-quartiles after adjustment for age, gender, race, education, total fat intake, and physical activity. A statistically significant association was not seen between urinary 2,4-DCP and obesity. Our findings suggest a potential relationship between exposure to the fumigant insecticide paradichlorobenzene, measured as urinary concentrations of 2,5-DCP, and obesity in adults. Because we cannot rule out the possibility of reverse causality in our study, prospective studies measuring exposure during etiologically relevant periods are warranted.     

Social inequalities and smoking-associated breast cancer — Results from a prospective cohort study

ObjectiveThe association between smoking and breast cancer has been found in most recent, large cohort studies. We wanted to investigate how smoking-associated breast cancer varies by level of education, a well-established measure of socioeconomic status.MethodsWe included 302,865 women with 7490 breast cancer cases. Participants were assigned to low, moderate or high level of education and analyzed by smoking status (ever/never), and stratified by birth cohorts (≤ 1950 >). We used Cox proportional hazard to estimate hazard ratios (HRs) and confidence intervals (CIs), adjusting for age, number of children, age at first childbirth, BMI, age at enrollment and physical activity.ResultsWomen born ≤ 1950 with low and moderate levels of education had a 40% increase in smoking-associated breast cancer risk (HR = 1.40, 95% CI 1.25–1.57 and HR = 1.14, 95% CI 1.05–1.24, respectively). Women in the same age group with high level of education did not have an increase in risk. No increased breast cancer risk was found among women born after 1950 for any level of education, when analyzed by smoking status. Longer duration of smoking before first childbirth was consistently associated with increasing risk of breast cancer in all three categories of education (all p for trends < 0.01).ConclusionSmoking for several years before first childbirth increases the risk of breast cancer, regardless of educational level.     

Greater frequency of nut consumption is associated with lower prevalence of peripheral arterial disease

Nut consumption has been associated with lower risk of coronary heart disease and all-cause mortality. The association between nut intake and peripheral arterial disease (PAD) is uncertain.ObjectiveWe sought to investigate the association between nut consumption and presence of prevalent PAD in a large cross-sectional sample.MethodsSelf-referred participants at > 20,000 US sites who completed a medical and lifestyle questionnaire were evaluated by screening ankle brachial indices for PAD. Multivariable logistic regression analysis was used to estimate odds of PAD in different nut consumption categories.ResultsAmong 3,312,403 individuals, mean age was 63.6 ± 10.6 years and 62.8% were female. There were 219,527 cases of PAD. After multivariable adjustment there was an inverse association of nut intake with PAD. Compared to subjects with consumption of nuts < once/month, daily nut consumption was associated with a 21% (95% CI 20%–23%) lower odds of having PAD.ConclusionThese observations suggest the need for more rigorous testing evaluating the role of nuts in PAD prevention.     

Association between characteristics of physical activity in leisure time and obesity in Brazilians adults and elderly

ObjectiveTo verify the association of obesity with volume, intensity and types of physical activity in leisure time among Brazilian adults and elderly.Study designCross-sectional study, with a secondary analysis of data from "Surveillance of Risk Factors and Protection for Chronic Diseases by Telephone Survey".MethodsThe target population comprised adults aged ≥18 years. The outcome was obesity (BMI ≥ 30.0 ??kg/m²) and the exposures were the volume, intensity, and main type of physical activity in leisure time. Binary logistic regression was used and the results were expressed as odds ratio (OR) and 95% confidence intervals (CI95%), with a significance level of 5%.ResultsCompared to inactive, the highest volume of leisure time physical activity (≥300 min/week) had a lower occurrence of obesity in adults (OR = 0.76; CI95%: 0.63, 0.92; p = 0.001) and elderly (OR = 0.62; CI95%: 0.46, 0.82; p = 0.001). In adults, vigorous activities (OR = 0.65; CI95%: 0.55, 0.78; p < 0.001) and, in the elderly, light/moderate activities (OR = 0.75; CI95%: 0.62, 0.89; p < 0.001) and vigorous (OR = 0.54; CI95%: 0.37, 0.78; p < 0.001) presented protective effect for obesity. Among the types of physical activity, running was the most strongly associated with a lower occurrence of obesity in adults (OR = 0.54; CI95%: 0.32, 0.92; p = 0.024) and elderly (OR = 0.27; CI95%: 0.10, 0.69; p = 0.006). In adults, strength training (p < 0.001), gymnastics (p = 0.032) and sports (p = 0.013) and in elderly, walking (p = 0.001) and sports (p = 0.003) also had protective effect.ConclusionA greater volume, vigorous intensity and physical activities of a structuring character and intensity progression, such as running, were associated with the lower occurrence of obesity.     

Association of sugar-sweetened beverage intake frequency and asthma among U.S. adults, 2013

ObjectivesSugar-sweetened beverage (SSB) intake among U.S. adults is associated with obesity and type 2 diabetes. An association between SSB intake and asthma has been shown among U.S. children and Australian adults, but scant published information exists for U.S. adults. We examined associations between SSB intake and current asthma among U.S. adults, and the role of obesity in this association.MethodsWe analyzed 2013 Behavioral Risk Factor Surveillance System data for 146,990 adults (≥ 18 years) from 23 states and the District of Columbia. We used multivariable logistic regression to estimate associations between current asthma and frequency (none, < 1 time/day, once/day, ≥ 2 times/day) of SSB intake (soda, fruit drink, sweet tea, and sports/energy drink). SSB intake was measured using two questions. Covariates included age, sex, race/ethnicity, education, and smoking. Obesity, based on self-reported height and weight, was assessed as an effect modifier.ResultsOverall, 9.1% of adults reported current asthma: 8.5% of adults who did not consume SSBs had current asthma vs 12.1% of adults who consumed SSBs ≥ 2 times/day. There was no difference in asthma prevalence with SSB intake < 1 time/day (8.7%) or once/day (8.7%). Among non-obese adults, the odds of having current asthma were higher among those who consumed SSBs ≥ 2 times/day (aOR = 1.66, 95%CI = 1.39, 1.99) than non-SSB consumers. However, SSB intake frequency was not associated with asthma among obese adults.ConclusionsFrequent SSB consumption was associated with asthma among non-obese adults. Research on asthma prevention should further consider the potential adverse effects of high SSB intake among U.S. adults.     

Factores familiares asociados a codependencia en enfermeras de un hospital de Cancún,Quintana Roo,México

ObjectiveIdentifying family factors associated with the presence of co-dependency in nurses of a regional hospital in Cancún, Quintana Roo, Mexico.DesignCross-sectional, comparative study.LocationCity of Cancun (México).ParticipantsA random sample of 200 nurses who met the inclusion criteria (having a partner for over a year, to be at work on the day of the interview), and who gave informed consent, completed three questionnaires during different shifts.Main measurementsAge, educational level, socioeconomic status, type of family structure, life cycle stage, co-dependency and family functioning.ResultsA total of 200 nurses, with mean age of 36 ± 8 years, took part. The most common socioeconomic status was high (48%), and 47.5% had graduate studies. A co-dependency level of 20.5% (95% CI: 15-26.5) was found. Family factors associated with the presence of co-dependency were; family dysfunction, prevalence ratio (PR) = 9.62 (95% CI: 3.47-27.3), stage of independence, PR = 3.41 (95% CI: 1.44-7.86), single parent, PR = 6.35 (95% CI: 2.41-16.68), and time with partner less than 5 years, PR = 3.41 (95% CI: 1.54-7.85).ConclusionsIt was found that family dysfunction and being a single parent were significantly associated with co-dependency in hospital nurses, therefore, on being able to identify these factors, family physicians can improve their dynamics and functioning by family study, and improving effective communication with nursing staff and their families.     

Cigarette smoking and testosterone in men and women: A systematic review and meta-analysis of observational studies

Recently Health Canada and the Food and Drug Administration warned about the cardiovascular risk of testosterone, making environmental drivers of testosterone potential prevention targets. Cotinine, a tobacco metabolite, inhibits testosterone breakdown. We assessed the association of smoking with testosterone in a systematic review and meta-analysis, searching PubMed and Web of Science through March 2015 using (“testosterone” or “androgen” or “sex hormone”) and (“smoking” or “cigarette”). Two reviewers independently searched, selected, assessed quality and abstracted with differences resolved by consensus or reference to a third reviewer. The initial search yielded 2881 studies; 28 met the selection criteria. In 22 studies of 13,317 men, mean age 18–61 years, smokers had higher mean testosterone than non-smokers (1.53 nmol/L, 95% confidence interval (CI) 1.11 to 1.96) using a random effects model with inverse variance weighting. In 6 studies of 6089 women, mean age 28–62 years, smoking was not clearly associated with testosterone (0.11 nmol/L, 95% CI − 0.08 to 0.30). Fixed effects models provided similar results, but suggested a positive association in women. Whether products which raise cotinine, such as e-cigarettes or nicotine replacement, also raise testosterone, should be investigated, to inform any regulatory action for e-cigarettes, which emit nicotine into the surrounding air, with relevance for both active and passive smokers.     

Poliovirus seroprevalence before and after interruption of poliovirus transmission in Kano State,Nigeria

IntroductionIn September 2015, Nigeria was removed from the list of polio-endemic countries after more than 12 months had passed since the detection of last wild poliovirus case in the country on 24 July 2014. We are presenting here a report of two polio seroprevalence surveys conducted in September 2013 and October 2014, respectively, in the Kano state of northern Nigeria.MethodsHealth facility based seroprevalence surveys were undertaken at Murtala Mohammad Specialist Hospital, Kano. Parents or guardians of children aged 6–9 months, 36–47 months, 5–9 years and 10–14 years in 2013 and 6–9 months and 19–22 months (corresponding to 6–9 months range at the time of 2013 survey) in 2014 presenting to the outpatient department, were approached for participation, screened for eligibility and asked to provide informed consent. A questionnaire was administered and a blood sample collected for polio neutralization assay.ResultsAmong subjects aged 6–9 months in the 2013 survey, seroprevalence was 58% (95% confidence interval [CI] 51–66%) to poliovirus type 1, 42% (95% CI 34–50%) to poliovirus type 2, and 52% (95% CI 44–60%) to poliovirus type 3. Among children 36–47 months and older, seroprevalence was 85% or higher for all three serotypes. In 2014, seroprevalence in 6–9 month infants was 72% (95% CI 65–79%) for type 1, 59% (95% CI 52–66%) for type 2, and 65% (95% CI 57–72%) for type 3 and in 19–22 months, 80% (95% CI 74–85%), 57% (49–63%) and 78% (71–83%) respectively. Seroprevalence was positively associated with history of increasing oral poliovirus vaccine doses.ConclusionsThere was significant improvement in seroprevalence in 2014 over the 2013 levels indicating a positive impact of recent programmatic interventions. However the continued low seroprevalence in 6–9 month age is a concern and calls for improved immunization efforts to sustain the polio-free Nigeria.     

Objectively assessed physical activity,fitness and subjective wellbeing

BackgroundThe existing evidence for a cross-sectional association between physical activity and subjective wellbeing is inconsistent, mainly because of the reliance on self reported physical activity, which might have conceptual overlap with subjective health.PurposeTo examine associations of objectively assessed physical activity and cardiorespiratory fitness with subjective wellbeing.MethodsA sub-sample of participants (921 men and women, mean age 44.6 ± 15.0 yrs, 46.4% men) from the 2008 Health Survey for England completed objective measures of physical activity (Actigraph) and an 8 min sub-maximal step test to estimate levels of cardiorespiratory fitness. The General Health Questionnaire and self-rated health was used as indicators of subjective wellbeing.ResultsThe recorded levels of moderate to vigorous physical activity (MVPA) were higher in participants reporting very good health (adjusted mean difference = 6.7, 95% CI, 1.1–12.4 min/d, p = 0.019) compared with participants reporting fair–poor health after adjustment for various confounders and fitness level. Neither physical fitness, objectively assessed sedentary time or light activity was related to self-rated health. There was also no association between objectively measured physical activity and fitness with psychological health, despite a robust association with self reported MVPA in the overall sample.ConclusionsObjectively assessed MVPA is independently associated with self-rated health. Self reported, but not objectively assessed MVPA, was associated with psychological health. The null findings with regards to psychological health might partly reflect selection biases associated with the healthy nature of this sub-sample of participants.     

Prevalence of physical activity in European adults — Compliance with the World Health Organization's physical activity guidelines

BackgroundAdults are recommended to engage in at least 150 min/week of moderate-to-vigorous physical activity (PA).PurposeThis study aimed to examine the level of compliance with PA recommendations among European adults.MethodsUsing data from European Social Survey round 6, PA self-report data was collected from 52,936 European adults from 29 countries in 2012. Meeting PA guidelines was assessed using World Health Organization criteria.Results61.47% (60.77% male, 62.05% female) of European adults reported to be engaged in moderate to vigorous PA at least 30 min on 5 or more days per week. The likelihood of achieving the PA recommended levels was higher among respondents older than 18–24. For those aged 45–64 years the likelihood increased 65% (OR = 1.65, 95% CI: 1.51–1.82, p < 0.001) and 112% (OR = 2.12, 95% CI: 1.94–2.32, p < 0.001) for males and females, respectively. Those who were high school graduates were more likely to report achieving the recommended PA levels than those with less than high school education (males: OR = 1.19, 95% CI: 1.12–1.27, p < 0.001; females: OR = 1.13, 95% CI: 1.06–1.20, p < 0.001).ConclusionAlthough about 60% of European adults reported achieving the recommended levels of PA, there is much room for improvement among European adults, particularly among relatively inactive subgroups.