Longitudinal and cross-sectional changes in active commuting to school among Brazilian schoolchildren

Objective

The objective of the study is to evaluate cross-sectional and longitudinal changes in children's commuting to school in a representative sample of a Brazilian city.

Methods

Two school-based studies were carried out in 2002 (n = 2936; 7-10 years old) and 2007 (n = 1232; 7-15 years old) in Florianopolis, Brazil. Cross-sectional data were collected from children aged 7 to 10 years in 2002 and 2007. Longitudinal analyses were performed with data from 733 children participating in both surveys. Children self-reported their mode of transportation to school using a validated illustrated questionnaire. Changes were tested with chi square statistics and McNemar's test.

Results

Cross-sectional data showed a 17% decline in active commuting; a decrease from 49% in 2002 to 41% in 2007. On the other hand, active commuting among the 733 children increased as they entered adolescence 5 years later, rising from 40% to 49%.

Conclusion

Active commuting to school decreased in Brazilian children aged 7-10 years over a five year period; whereas, it increased among children entering adolescence. Policies should focus on safety and environmental determinants to increase active commuting.     

Seroprevalence of varicella zoster virus among pregnant women in Hong Kong: comparison with self-reported history

Objective

To compare seroprevalence (serum IgG titre) with self-reported history of varicella zoster virus (VZV) infection among pregnant women in Hong Kong.

Methods

Pregnant women undergoing first trimester Down screening over a 3-months period were recruited for the study.

Results

Positive immunity was found in 477 (95.4%) of the 500 recruited women, and those with positive, negative, or uncertain history of infection had similarly high seroprevalence (96.4, 90.5, 95.9% respectively). The mean age of infection from self-recalled history was 8.61 (SD 4.69) years, and only 3% recalled infection after age 18. Insufficient knowledge on the disease and vaccination was demonstrated.

Conclusions

Despite the absence of a routine vaccination programme, VZV immunity was high among pregnant women, the majority being infected during childhood and infection above age 18 was very rare. Hence, universal antenatal screening or vaccination for all women in the reproductive age would not be cost-effective in Hong Kong.     

Calcium Intake and 10-Year Weight Change in Middle-Aged Adults

Objective

The goal of this study was to examine the purported effects of calcium on modulating body weight.

Design

Retrospective data was used to assess the relationship between calcium intake and weight change over an 8- to 12-year period among middle-aged adults.

Subjects

Participants were 10,591 men and women aged 53 to 57 years recruited during 2000-2002.

Statistical Analysis

Linear regression was used to model associations of 10-year weight change and calcium intake, adjusted for weight at age 45 years, energy intake, physical activity, and other factors.

Results

Calcium intake was associated with 10-year weight change only in women. Women with current calcium supplement dose of >500 mg/day had a 10-year weight gain of 5.1 kg (95% confidence interval 4.7 to 5.5) compared to 6.9 kg (95% confidence interval 6.5 to 7.4) among nonusers (P for trend=0.001). Trends were similar for total calcium intake from diet plus supplements (P for trend=0.001). Dietary calcium alone had no significant effect on 10-year weight change.

Conclusions

Increasing total calcium intake, in the form of calcium supplementation, may be beneficial to weight maintenance, especially in women during midlife.     

Pharmacoeconomic assessment of implementing a universal PCV-13 vaccination programme in the Valencian public health system (Spain)

Background

Heptavalent pneumococcal conjugate vaccine (PCV-7) was licensed to provide immunity against pneumococcal disease caused by seven serotypes of S. pneumoniae. Thirteen-valent pneumococcal conjugate vaccine (PCV-13) includes 6 additional serotypes for preventing invasive pneumococcal disease.

Objective

The objective of this study was to estimate the potential health benefits, costs, and cost-effectiveness of vaccination with PCV-13 in the Community of Valencia and to generate valuable information for policy makers at regional and country levels.

Methods

A decision tree was designed to determine the health and economic outcomes in hypothetical cohorts of vaccinated and unvaccinated children followed over their lifetime. Information about disease incidence and serotype distribution were gathered from local databases and from published and unpublished local records. PCV-13 effectiveness was extrapolated from PCV-7 efficacy data. A 5% of herd effect and a serotype replacement of 25% were considered for the base case scenario. Only direct costs were taken into account and results were expressed in terms of life-years gained (LYG) and quality adjusted life years (QALY).

Results

Implementing a universal PCV-13 vaccination program in the Community of Valencia would decrease the number of hospital admitted pneumonia to less than 4571 cases while avoiding 310 cases of IPD and 82,596 cases of AOM throughout the cohort lifetime. A total of 190 S. pneumoniae related deaths would be averted over the same period. Total medical costs of non-vaccinating the cohort of newborns would reach up to 403,850.859 € compared to 438,762.712 € that would represent vaccinating the cohort. The incremental cost of vaccinating the children was estimated in 12,794 €/LYG and 10,407 €/QALY, respectively.

Conclusions

A universal PCV-13 vaccination program in the Community of Valencia would be a cost-effective intervention from the payer perspective after preventing for pneumococcal infections and for decreasing its associated mortality and morbidity.     

Adoption of preventive measures during and after the 2009 influenza A (H1N1) virus pandemic peak in Spain

Objective

This study describes the preventive measures adopted by the Spanish population towards 2009 influenza A (H1N1) virus and their associated factors.

Method

An anonymous computer-assisted telephone interview survey was conducted in Spain in December 2009 and February 2010. Respondents were asked about their perceptions of influenza A (H1N1) virus and the preventive measures adopted. Factors associated with the adoption of preventive measures were assessed by logistic regression analyses.

Results

Out of 4892 households approached, 1627 valid responses were obtained (response rate of 33.3%). The most commonly adopted preventive measures were respiratory hygiene and hand washing. Factors independently associated with the adoption of the preventive measures recommended by the Spanish Ministry of Health were female gender, higher educational level, size of municipality of residence > 50,000 inhabitants, high perceived susceptibility to infection, high perceived effectiveness of the measures and high perceived usefulness of the information provided by the government. The presence of school-aged children in household was associated with purchasing masks and hand sanitizer.

Conclusion

In addition to demographic factors, modifiable factors such as personal beliefs and expectations play a role in the adoption of preventive measures.     

The immunogenicity and safety of pneumococcal conjugate vaccine in human immunodeficiency virus-infected Thai children

Background

HIV-infected children have high risk of invasive pneumococcal disease (IPD) despite receiving highly active antiretroviral therapy (HAART). This study aimed to determine the immunogenicity and safety of a 7-valent pneumococcal conjugate vaccine (PCV-7) in Thai HIV-infected children compared to HIV-exposed uninfected children.

Methods

A prospective study was conducted among children 2 months to 9 years. The number of PCV-7 doses depended upon age and HIV status; 2-6 months of age: 3 doses; 7-23 months of age: 2 doses; HIV-infected child ≥24 months: 2 doses and HIV-exposed child ≥24 months: 1 dose. Serotype-specific pneumococcal IgG antibody concentrations were measured at baseline and 28 days after complete vaccination. The primary end point was the proportion of children who achieved serotype-specific IgG antibody concentration at a cut off level ≥0.35 μg/mL. Secondary end points were a 4-fold increase in serotype-specific IgG antibody, rates of adverse events and predictors for seroconversion among HIV-infected children.

Results

Fifty-nine HIV-infected and 30 HIV-exposed children were enrolled. The median (IQR) age was 97 (67-111) and 61 months (51-73), respectively (p < 0.001). Among HIV-infected children, current and nadir CD4 counts were 1079 cell/mm³ and 461 cell/mm³, respectively. The proportion of children who achieved pneumococcal IgG ≥0.35 μg/mL was in the range of 85-98% in HIV-infected and 83-100% in HIV-exposed children depending on serotype. The lowest response was to serotype 6B in both groups. The 4-fold increase in serotype-specific IgG concentrations was similar between HIV-infected and HIV-exposed groups, except for serotype 9V (p = 0.027). HIV-infected children who had a history of AIDS had a lower antibody response to serotype 23F (p = 0.025). Seven (12%) HIV-infected children had a grade 3 local reaction.

Conclusion

PCV-7 is highly immunogenic and safe among HIV-infected children treated with HAART. The use of the pneumococcal conjugate vaccine among HIV-infected children is encouraged in order to prevent IPD.     

Listeria monocytogenes encephalitis in France

Purpose

The authors had for aim to describe the characteristics of listeriosis encephalitis patients enrolled in a national study.

Methods

Listeria monocytogenes was identified as the forth etiology of encephalitis, in a prospective study in France, in 2007. We analyzed 12 cases with confirmed listeriosis (seven with rhombencephalitis, five with encephalitis) and compared them with encephalitis of other etiologies and with listeriosis encephalitis, mandatorily notified during the same year.

Results

L. monocytogenes strains were genoserotyped as IVb (n = 6), IIa (n = 3), and IIb (n = 3). Cerebrospinal fluid (CSF) median protein level was 2.5 g/L and the median WBC counts was 367 cells/mm³. Among twelve patients, seven patients had ongoing comorbidities. The case fatality rate during hospitalization was 50%. Patients presenting with listeriosis enrolled in the study did not differ from those reported to the mandatory surveillance system according to their demographical characteristics and comorbidities. They were older, presented more frequently with cancer, or were more often under corticosteroid treatment than patients presenting with encephalitis due to other etiologies.

Conclusions

Neurolisteriosis has a poor prognosis, thus it should be considered early in patients presenting with encephalitis to improve its management.     

Blood lead and cadmium levels and relevant factors among children from an e-waste recycling town in China

Background

Primitive electronic waste (e-waste) recycling is ongoing in Guiyu, and thus toxic heavy metals may keep on threatening to the health of local children. Some related factors may contribute to the elevation of blood lead levels (BLLs) or blood cadmium levels (BCLs).

Objective

To investigate the children's BLLs and BCLs in Guiyu and Chendian as compare to discuss the effects of primitive e-waste recycling activities on children's health.

Methods

Two hundred and seventy-eight children less than 8 years who lived in Guiyu and Chendian were observed, and their BLLs and BCLs were determined by graphite atomizer absorption spectrophotometer. Questionnaire survey for risk factors was also performed and data were analyzed using spearman correlation analyses and logistic regression analyses.

Results

Children living in Guiyu had significantly higher BLLs and BCLs as compared with those living in Chendian (p<0.01). In Guiyu, 70.8% of children (109/154) had BLLs>10 μg/dL, and 20.1% of children (31/154) had BCLs>2 μg/L, compared with 38.7% of children (48/124) had BLLs>10 μg/dL and 7.3% of children (9/124) had BCLs>2 μg/L in Chendian (p<0.01, respectively). We also observed a significant increasing trend in BLLs with increasing age in Guiyu (p<0.01). Mean height of children in Guiyu was significantly lower than that in Chendian (p<0.01). The risk factors related to children's BLLs and BCLs mainly included father's engagement in the work related to e-waste, children's residence in Guiyu and the amount of time that children played outside near the road everyday.

Conclusions

There are close relationships between the BLLs, BCLs in children and the primitive e-waste recycling activities in Guiyu. Environmental pollution, especially lead pollution, has threatened the health of children living around e-waste recycling site.     

Retrospective cohort study highlighted outcome reporting bias in UK publicly funded trials

Objective

To assess outcome reporting bias and dissemination bias in trials funded by the National Health System (NHS) Health Technology Assessment (HTA) program.

Study Design and Setting

A retrospective cohort study of HTA monographs and corresponding journal publications including all clinical effectiveness randomized controlled trials published as HTA monographs between 1999 and 2005 by the NHS HTA program.

Results

There was a higher median P-value (P = 0.33, interquartile range [IQR]: 0.02-0.54) among trials without a journal publication compared with those with a journal publication (P = 0.14, IQR: 0.007-0.43), although the difference was not statistically significant (Mann-Whitney U test, z = −0.70; P = 0.48). A higher proportion of statistically significant findings were reported in journal articles when compared with the outcomes reported in the HTA monographs. Trials published in general medical journals tended to have smaller P-values (median: 0.05, IQR: 0.001-0.22) than those published in more specialist journals (median: 0.33 IQR: 0.008-0.58), although this result was not significant (Mann-Whitney U test, z = −1.63; P = 0.10).

Conclusions

Among journal-published trials, there were a greater proportion of statistically significant findings included in the journal reports compared with those in the HTA monographs.     

Regular Sugar-Sweetened Beverage Consumption between Meals Increases Risk of Overweight among Preschool-Aged Children

Objective

To examine the relationship between consumption of sugar-sweetened beverages (eg, nondiet carbonated drinks and fruit drinks) and the prevalence of overweight among preschool-aged children living in Canada.

Design

Data come from the Longitudinal Study of Child Development in Québec (1998-2002).

Subjects/setting

A representative sample (n=2,103) of children born in 1998 in Québec, Canada. A total of 1,944 children (still representative of the same-age children in this population) remaining at 4 to 5 years in 2002 participated in the nutrition study.

Statistical analyses performed

Data were collected via 24-hour dietary recall interview. Frequency of sugar-sweetened beverage consumption between meals at age 2.5, 3.5, and 4.5 years was recorded and children’s height and weight were measured. Multivariate regression analysis was done with Statistical Analysis System software. Weighted data were adjusted for within-child variability and significance level was set at 5%.

Results

Overall, 6.9% of children who were nonconsumers of sugar-sweetened beverages between meals between the ages of 2.5 to 4.5 years were overweight at 4.5 years, compared to 15.4% of regular consumers (four to six times or more per week) at ages 2.5 years, 3.5 years, and 4.5 years. According to multivariate analysis, sugar-sweetened beverage consumption between meals more than doubles the odds of being overweight when other important factors are considered in multivariate analysis. Children from families with insufficient income who consume sugar-sweetened beverages regularly between the ages of 2.5 and 4.5 years are more than three times more likely to be overweight at age 4.5 years compared to nonconsuming children from sufficient income households.

Conclusions

Regular sugar-sweetened beverage consumption between meals may put some young children at a greater risk for overweight. Parents should limit the quantity of sweetened beverages consumed during preschool years because it may increase propensity to gain weight.     

Reasons related to non-vaccination and under-vaccination of children in low and middle income countries: findings from a systematic review of the published literature, 1999-2009

Objective

Despite increases in routine vaccination coverage during the past three decades, the percent of children completing the recommended vaccination schedule remains below expected targets in many low and middle income countries. In 2008, the World Health Organization Strategic Advisory Group of Experts on Immunization requested more information on the reasons that children were under-vaccinated (receiving at least one but not all recommended vaccinations) or not vaccinated in order to develop effective strategies and interventions to reach these children.

Methods

A systematic review of the peer-reviewed literature published from 1999 to 2009 was conducted to aggregate information on reasons and factors related to the under-vaccination and non-vaccination of children. A standardized form was used to abstract information from relevant articles identified from eight different medical, behavioural and social science literature databases.

Findings

Among 202 relevant articles, we abstracted 838 reasons associated with under-vaccination; 379 (45%) were related to immunization systems, 220 (26%) to family characteristics, 181 (22%) to parental attitudes and knowledge, and 58 (7%) to limitations in immunization-related communication and information. Of the 19 reasons abstracted from 11 identified articles describing the non-vaccinated child, 6 (32%) were related to immunization systems, 8 (42%) to parental attitudes and knowledge, 4 (21%) to family characteristics, and 1 (5%) to communication and information.

Conclusions

Multiple reasons for under-vaccination and non-vaccination were identified, indicating that a multi-faceted approach is needed to reach under-vaccinated and unvaccinated children. Immunization system issues can be addressed through improving outreach services, vaccine supply, and health worker training; however, under-vaccination and non-vaccination linked to parental attitudes and knowledge are more difficult to address and likely require local interventions.     

Scanning the horizon: development and implementation of an early awareness system for anticancer drugs in Austria

Background

Due to increasing expenditures for cancer therapies, an instrument was needed in Austria to facilitate the evidence-based use of new anticancer drugs and to pre-estimate their financial implications.

Objectives

To describe and analyse the development and implementation of a Horizon Scanning System (HSS) in Austria that allows for the evaluation of new anticancer drugs before their routine introduction into clinical practice in order to inform decision-makers.

Methods

Common stages involved in HSSs were identified by a literature review and in cooperation with experts. A first concept for an HSS in Oncology was developed and piloted, and further adjustments were made after several feedback rounds with experts in oncology.

Results

To specifically tailor the five common stages of HSSs to the needs of our HSS, a continually evolving process was required. Now, 21 information sources are regularly scanned, the information is retrieved and extracted in a standardised format, and only anticancer drugs in phase III are included and prioritised by a team of eight experts. Since the HSS in Oncology was implemented as a standard practice, 19 assessments on novel cancer therapies with likely therapeutic and/or financial impacts have been published.

Conclusions

The successful implementation of an HSS necessitates a repetitive cycle of adjustments in order to meet the objectives set by the individual HSS.     

Do social inequalities in cervical cancer screening persist among patients who use primary care? The Paris Prevention in General Practice survey

Objective

Social inequalities in cervical cancer screening may be related to either lack of access to care or inadequate delivery of preventive care by providers. We sought to characterize social inequalities among women consulting general practitioners with a wide range of social position indicators.

Methods

In 2005-06, 59 randomly recruited general practitioners from the Paris metropolitan area enrolled every woman aged 50-69 years seen during a two-week period. Cervical cancer screening status (overdue if the last cervical cancer screening had been more than 3 years earlier) was analyzed for 858 women in a logistic mixed model that considered: occupational class (in 5 levels, based on last occupation), education, income, characteristics related to family, housing, neighborhood, household wealth (social allocations, perceived financial difficulties in 4 levels, income tax), employment status, supplementary health insurance, and social network (4 levels).

Results

The rate of overdue patients did not vary between general practitioners (21%). social position indicators associated with overdue status (odds ratio between 2 adjacent decreasing social levels) were occupational class (1.20, 95% CI: 1.03-1.41), social network (1.52, 95% CI: 1.18-1.94), financial difficulties (1.42, 95% CI: 1.07-1.88), neighborhood safety (2.15, 95% CI: 1.10-4.20), and allocations (3.34, 95% CI: 1.12-9.96).

Conclusions

Even among women visiting general practitioners we observed marked social inequalities that persist above and beyond occupational class.     

Within-person variability in urinary bisphenol A concentrations: Measurements from specimens after long-term frozen storage

Background

Bisphenol A (BPA) is an estrogenic contaminant of food and water associated with adverse developmental effects in laboratory animals. BPA has recently been linked to morbidity in adult humans, but studies of developmental effects in humans are methodologically more difficult. The ability to measure BPA in urine samples after long-term storage could aid in such studies. Because the half-life of BPA is <6 h, a single measurement would be useful only if the environmental exposure is relatively constant over weeks or months. Our aims were to evaluate the stability of BPA in specimens after 22-24 years of storage and to measure within-person temporal variability in urinary BPA.

Methods

We measured total BPA concentration by mass spectrometry in first-morning urine samples from 60 premenopausal women. We selected from each woman's stored daily collections three urine samples approximately 2 and 4 weeks apart. Samples were selected from both the follicular and luteal phases of the menstrual cycle to assess cycle effects. Temporal variability was assessed with mixed model regression and correlations.

Results

BPA levels had an inter-quartile range from 1.1 to 3.1 ng/mg creatinine, slightly higher than levels in specimens from NHANES collected 3-11 years later. The Spearman correlation was approximately 0.5 for samples 2 weeks apart and 0.3 for samples 4 weeks apart. Menstrual cycle phase did not influence levels. BPA tended to increase during the three-year collection period, but not significantly.

Conclusions

The similar distribution to NHANES samples and correlation of BPA levels taken at 2-week intervals provide indirect evidence that BPA is relatively stable during long-term freezer storage. The correlations indicate generally stable exposures over periods of weeks. These findings suggest that developmental effects of BPA exposure could be investigated with measurements from stored urine.     

Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors

Background

This study was conducted to determine the relationship between unintended pregnancy and maternal behaviors before, during and after pregnancy.

Study Design

Data were analyzed from a stratified random sample of 9048 mothers who delivered live born infants between 2001 and 2006 and completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey 2 to 9 months after delivery. Binary and ordinal logistic regression methods with appropriate survey weights were used to control for socio-demographic factors.

Results

Compared to women with intended pregnancies, mothers with unwanted pregnancies were more likely to consume less than the recommended amount of preconception folic acid [adjusted odds ratio (OR) 2.39, 95% confidence interval (CI) 1.7-3.2], smoke prenatally (OR 2.03, 95% CI 1.5-2.9), smoke postpartum (OR 1.86, 95% CI 1.35-2.55) and report postpartum depression (OR 1.98, 95% CI 1.48-2.64); they were less likely to initiate prenatal care during the first trimester (OR 0.34, 95% CI 0.3-0.5) and breastfeed for 8 or more weeks (OR 0.74, 95% CI 0.57-0.97). Compared to women with intended pregnancies, women with mistimed pregnancies were also more likely to consume inadequate folic acid, delay prenatal care and report postpartum depression.

Conclusion

Even after controlling for multiple socio-demographic factors, unwanted and mistimed pregnancies were associated with unhealthy perinatal behaviors.     

Comparative effectiveness of mailed reminder letters on mammography screening compliance

Objective

Reminder letters are effective at prompting women to schedule mammograms. Less well studied are reminders addressing multiple preventive service recommendations. We compared the effectiveness of a mammogram-specific reminder sent when a woman was due for a mammogram to a reminder letter addressing multiple preventive services and sent on a woman's birthday on mammography receipt.

Methods

The study included 48,583 women 52-74 years enrolled in Group Health Cooperative, a health plan in Washington State. From 2005 to 2009, women were mailed 88,605 mammogram-specific or birthday letters. In this one group pretest-posttest study, we modeled the odds of obtaining a screening mammogram after receiving a letter by reminder type using logistic regression, controlling for demographic and healthcare use characteristics and stratifying by whether women were overdue or up-to-date with mammography at the mailing.

Results

Among women up-to-date with screening, birthday letters were negatively associated with mammography receipt compared to mammogram-specific letters (birthday letters with 1-2 recommendations: OR = 0.73; 95% CI:0.68-0.79; 3 recommendations: OR = 0.74; 95% CI:0.69-0.78; 4-8 recommendations: OR = 0.62 95% CI:0.55-0.68) after. Among overdue women, birthday letters with 4-8 recommendations were negatively associated with mammography receipt.

Conclusions

Transitioning from mammogram-specific reminder letters to multiple preventive service birthday letters was associated with decreased mammography receipt.     

Differential Influence of Diet and Physical Activity on Components of Metabolic Syndrome in a Multiethnic Sample of Children

Background

Treatment of the metabolic syndrome in adults is generally approached with diet and physical activity. The influence of diet and physical activity on cardiometabolic outcomes in children has not been clearly established.

Objective

The main objective of this study was to test the hypothesis that the distribution of energy from fat and carbohydrate in addition to limited time spent engaging in physical activity would contribute to the prevalence of the metabolic syndrome and its components in a multiethnic pediatric population.

Design

Observational, cross-sectional study. Diet was assessed by two 24-hour recalls, physical activity by accelerometry, body composition by dual-energy absorptiometry, and glucose and lipid levels using fasting sera.

Main outcome measures

Presence of metabolic syndrome and its components.

Subjects

202 African-American (n=79), white (n=68), or Hispanic (n=55) healthy children aged 7 to 12 years.

Statistical analysis

The contribution of diet and physical activity to the metabolic syndrome and its components were assessed by logistic regression and multiple linear regression analyses.

Results

Prevalence of the metabolic syndrome in the total sample was 8.4%, with Hispanics more likely than whites and African Americans to meet the criteria. A greater intake of energy from carbohydrate was related to a greater waist circumference and higher concentrations of triglyceride and glucose particularly apparent within the African-American sample (P<0.05). Fat intake was associated with a lower waist circumference (P<0.05) and with lower concentrations of triglyceride (P<0.05) and glucose (P<0.001) in the total sample. Greater moderate/hard physical activity was associated with higher high-density lipoprotein cholesterol concentrations in whites (P<0.05). Increased sedentary behavior was related to greater glucose concentration in whites and Hispanics (P<0.05 for both).

Conclusions

Diet composition was more closely related to the components of the metabolic syndrome than was physical activity, with carbohydrate intake being adversely related to waist circumference, triglyceride levels, and glucose levels. Furthermore, relationships among diet and metabolic syndrome outcomes were stronger among African-American children, suggesting that nutrition interventions in this group may be particularly beneficial.     

Associations of physical activity with neighborhood environments and transportation modes in older Japanese adults

Objective

We investigated associations of walking and other leisure-time physical activity (LTPA) with environmental characteristics and transportation modes in older Japanese adults.

Methods

This cross-sectional study in 2010-2011 used data from 421 community-dwelling older adults aged 65-85 years living in Kasama City, rural Japan. We used the Physical Activity Scale for the Elderly to assess walking and other LTPAs, and the International Physical Activity Questionnaire Environment Module for neighborhood environments.

Results

After adjusting for confounders, we found that good traffic safety and aesthetics were positively associated with high levels of walking (ORs = 1.64-2.12); whereas, good access to public transportation was negatively associated with walking (OR = 0.64, 95% CI = 0.42-0.98). Good access to recreational facilities, presence of sidewalks, absence of hills, seeing people exercise, and aesthetically pleasing surroundings were positively associated with high levels of LTPA except walking (ORs = 1.61-2.13). Individuals who rode bicycles more than once per week were more likely to engage in a LTPA except walking (1-3 days: OR = 1.72, 95% CI = 1.03-2.87; ≥ 4 days: OR = 2.90, 95% CI = 1.71-4.93).

Conclusion

This study adds information on correlates of physical activity among older Japanese adults; the positive association between LTPA except walking and the frequency of bicycle travel is an especially new and intriguing finding.     

Exposure to alcohol advertising and teen drinking

Objective

Assessing the association between alcohol ad exposure and alcohol use in German adolescents, controlling for general ad exposure.

Method

Cross-sectional survey of 3415 sixth to eighth graders (mean 12.5 years) from 29 schools in three German states (June 2008). Exposure to 9 alcohol and 8 non-alcohol advertisements was measured with masked ad images; students indicated contact frequency and brand recall. Main outcomes were ever drinking, current drinking, binge drinking, alcohol use intentions and outcome expectancies.

Results

There was a bivariate association between both exposures (alcohol and non-alcohol ads) and all alcohol use measures. After adjustment for confounding, only alcohol ad exposure retained a significant association with outcomes. Multi-level logistic regressions revealed that compared with quartile one alcohol ad exposure, the adjusted odds ratios for quartile four were 2.4 (95% confidence interval 1.7-3.4) for trying drinking, 2.7 (1.8-3.9) for current drinking and 2.3 (1.6-3.5) for ever binge drinking. There was also an independent association between alcohol ad exposure and alcohol-related attitudes among never drinkers.

Conclusion

This study demonstrates a positive association between exposure to alcohol advertising and multiple youth drinking outcomes, showing that the association is content-specific, not just a function of general ad exposure.