Gender bias in the assessment of physical activity in population studies

OBJECTIVES: Despite their generally more health promoting behaviours, women are found to participate less in physical activity than men. This study explores possible gender bias in measurement of physical activity in population studies. METHODS: Data collected by telephone (CATI) from the Berne Lifestyle Panel in 1996 is utilised. A representative samples of the population of the city of Berne comprised N = 1119 cases. Gender differences are assessed for the weekly frequency of three measurements of physical activities. RESULTS: An indicator of sport and exercise showed higher physical activity among men, while the indicator of habitual physical activity showed higher rates of daily walking and biking among women. A combined indicator of general physical activity showed no significant gender differences. CONCLUSIONS: The results provide empirical evidence on potential risk of underestimation of physical activity among women and of misclassification with respect to high or low risk behaviour patterns.     

Prevalence and sociodemographic correlates of substance use in a university-student sample in Turkey

Background:  Limited data is available on substance use among university students in Turkey. This study aims to determine the prevalence of substance use among this target group. Methods:  A total of 1,720 students were surveyed to assess substance use, and relationships between sociodemographic variables and substance use were assessed using both univariate and multivariate analyses. Results:  Of the recorded student sample, 6.4 % reported having used a substance; 2.8 % used one within the past year. Prevalence of cannabis use at least once during life-time was 5.9 %. Males living alone, or students with families residing abroad increased the risk of substance use. Conclusion:  Preventive interventions for substance use problems should consider factors related with family relations of the youth. Submitted: 20 June 2007; revised: 07 May 2008; accepted: 14 May 2008     

A practical approach to estimate resting energy expenditure in frail elderly people

Objectives: Some prediction equations of resting energy expenditure (REE) are available and can be used in clinical wards to determine energy requirements of patients. The aim of the present study was to assess the accuracy of those equations in sick elderly patients, using the Bland & Altman methods with our database of 187 REE measurements.Design: The 3 equations tested were Harris & Benedict equation of 1919, WHO/FAO/UNU equation of 1985 and Fredrix et al. equation of 1990. In addition, three models developed from the present data were tested.Results: The present study shows that the Fredrix et al equation gave an accurate prediction of REE without significant bias along the whole range of REE. It also shows that under-weight sick elderly patients (BMI ≤ 21 kg/m²) had a greater weight-adjusted REE than their normal weight counterparts.Conclusion: A simple formula using a factor multiplying body weight, i.e. 22 kcal/kg/d in under-weight and 19 kcal/kg/d in normal weight sick elderly was accurate to predicting REE and bias was not influenced by the level of REE. This model included half of the group in the range of ±10% of the difference between predicted REE and measured REE, but the confidence interval of the bias was ±400 kcal/d. Conversely, the Harris & Benedict and WHO formulae did accurately predict REE.     

Cigarette smoking among adolescents in Thessaloniki, Greece

OBJECTIVES: Epidemiological characteristics in tobacco smoking among adolescents were investigated in Thessaloniki, Greece. METHODS: The target sample was 1,221 students coming from 15 high schools. RESULTS: Cigarette smoking was higher among girls than boys (40.9 % vs. 34.3 %). However, the percentage of boys who were smoking more than 20 cigarettes per day was found larger than the relevant percentage of girls (81.2 % vs. 75 % of total smokers). The boys also reported an earlier initiation of tobacco use (12.7 years vs. 12.9 years in girls). Physical activity was negatively correlated with smoking, whereas drinking alcohol and low parental education were positively correlated with smoking. CONCLUSIONS: Health promotion programs should be instituted not only during adolescence, but rather before the age of 14.     

Neighbourhood socioeconomic indicators and depressive symptoms in the Czech Republic: a population based study

Objectives:  Previous research shows only limited evidence on the contextual (neighbourhood-based) socioeconomic influences on mental health and depression. We investigated the association between individual and neighbourhood socioeconomic characteristics and depressive symptoms in the Czech Republic. Methods:  Dichotomized CESD score of depressive symptoms was used as the outcome in a random sample of 3534 men and 4082 women aged 45–69 years in the Czech HAPIEE Study. 220 small areas were characterized by the proportion of university educated persons and the proportion of unemployed from the economically active population in the 2001 Census. Multilevel logistic regression was used for the analysis. Results:  After controlling for individual-level variables, the effects of area-based characteristics were largely eliminated. The strongest area-based effect was that of the proportion of university educated persons; the ORs for 2^nd, 3^rd and 4^th quartile, compared with the 1^st quartile, were 1.02, 0.93, and 0.82, respectively (p-value for trend 0.06). There were no cross-level interactions between socioeconomic variables. Conclusions:  The effects of neighbourhood characteristics in this study were largely explained by individual socioeconomic variables. Submitted: 27 February 2008; revised: 17 November 2008, accepted: 20 January 2009     

Association between acculturation and childhood vaccination coverage in migrant populations: a population based study from a rural region in Bavaria, Germany

OBJECTIVES: The aim of our analysis was to investigate the association between acculturation and the vaccination coverage among pre-school children. METHODS: We performed a study of vaccination status for measles-mumps-rubella and hepatitis B among pre-school children, during mandatory school entry examinations, in a district of Bavaria, Germany, in 2004 and 2005 (N = 2,043). Prior to the examinations, parents were asked to fill out a self-administered questionnaire assessing socio-demographic information, including variables related to migration background (response rate 73 %, N = 1,481). We used Categorical Principal Component Analysis (CATPCA) to create an acculturation index and assessed the association between the acculturation and vaccination status for both vaccines. RESULTS: We found no difference in vaccination status with the measles-mumps-rubella vaccine in relation to acculturation. The coverage with at least three doses of hepatitis B vaccine was similar among migrants and in the indigenous population, but the risk of incomplete (1 or 2 doses) versus full vaccination was higher (OR = 2.74, 95%CI 1.34-5.61) and the risk of lacking vaccination lower (OR = 0.30, 95%CI 0.12-0.77) among less acculturated migrants compared to the indigenous population. CONCLUSIONS: For multi-dose vaccines lower acculturation was associated with incomplete vaccination, but the partial protection in this group was higher compared to indigenous population.     

Domestic violence: variation in case-management by the general practitioner in Belgium

Objectives:  to describe the medical interventions and referrals carried out by the general practitioner (GP) when taking care of victims and to quantify the between-physician variability in management of domestic violence. Methods:  A nationwide sentinel network of 150 general practitioners, covering 1.5 % of the Belgian population, registered in 2002–2004 all episodes of domestic violence for which they were consulted, via paper registration forms. A multilevel analysis was carried out by fitting a random effects logistic regression model for every intervention/referral. Results:  The most frequent interventions of the GP were providing a certificate of injury (54 %), and making an appointment for a next visit (33 %). Half of the patients were referred or hospitalised upon the first consultation, most frequently they were advised to go to the police (17 %) or referred to a psychologist or psychiatrist (11 %). The intra cluster correlation coefficient (ICC) of the interventions varied between 11 % and 39 % and the median odds ratios between 1,82 and 3,96. Conclusions:  GP consultations for domestic violence are frequent and involve considerable between-physician variability in care. Submitted: 01 August 2007; revised: 08 October 2008; accepted: 15 December 2008     

Bullying and subjective health among adolescents at schools in Latvia and Lithuania

OBJECTIVES: To investigate the prevalence of bullying among adolescents in Latvia and Lithuania and to study its association with self-rated health, health complaints, and life satisfaction. METHODS: A total of 3417 students in Latvia and 5626 in Lithuania were surveyed using the Health Behaviour Study among School-aged Children 2001/2002 (HBSC) questionnaire and research protocol. RESULTS: Being a victim, bully, or bully/victim was reported by 30.1% adolescents in Latvia and 52.3% in Lithuania with the highest proportion reporting being a victim. Bullying was associated with poor subjective health and low life satisfaction. CONCLUSIONS: The factors explaining the difference of bullying prevalence between both countries should be studied to develop effective anti-bullying interventions relevant to local conditions.     

On the influence of a raffle upon responses to an urban transportation survey in New York City

Objectives:  Determine whether raffling off prizes to increase participation in surveys triggers multiple responses from the same participants. Methods:  All staff, instructors, and students of Queens College, New York, were invited to a 5 minute online survey about commuting in winter 2007. Entry in the raffle to win one of two iPODs was not conditional upon survey completion. Results:  Participation was 18.7 %, and 3913 eligible responses. Of the 183 (4.7 %) participants with two answers, responses were consistent, with weighted kappas ranging between 0.48 and 1.00, and Pearson r’s between 0.81 and 1.0. Kappa’s were lower for opinion than for factual questions. The duplicate responses came from people with characteristics similar to the full sample. Commute modes included car (46 %), bus but no subway (28 %), and bus and subway (21 %). The median commute time was 90 minutes round-trip, and was greater than 120 minutes for 1/4 of the respondents. Conclusion:  Participation was low despite the raffle. The small percentage of duplicate answers, maybe prompted by the reminding emails, had a negligible impact on the results.     

Sustainability of Community Coalitions: An Evaluation of Communities That Care

The relationships between community coalition processes during initial 3-year state seed funding and markers of sustainability post-funding were investigated in 20 Communities That Care (CTC) sites in Pennsylvania. Coalition processes were assessed using interviews with coalition members, ratings from the research team and ratings from state technical consultants. We found members' knowledge of prevention, coalition internal functioning, and fidelity to the CTC model during early coalition functioning predictive of later sustained coalition board activity. Findings suggest domains of early coalition functioning that may be important for understanding and promoting sustainability.     

Epidemiology of eczema among Lebanese adolescents

OBJECTIVE: The study aims to determine the prevalence of eczema among Lebanese adolescents and identify demographic, nutritional and environmental characteristics associated with eczema. METHODS: A cross-sectional study conducted on a convenient sample of 3 153 students (13-14 years) selected from five different provinces in Lebanon. Significant unadjusted demographic, nutritional and environmental variables were considered in a stepwise regression model. RESULTS: Ever having an itchy rash that lasted for a period more than six months was reported by 788 (25.0%) adolescents, while 404 (12.8%) reported ever having eczema. Females and passive smokers were at 1.5 increased risk of having eczema than their counterparts. Exercising regularly, living near a busy area, and frequent eating of eggs were positively associated with eczema. Finally, adolescents who suffered from allergic diseases, asthma (Odds ratio (OR): 1.64, 95% CI: 1.16-2.32), rhinitis (OR: 1.35, 95% CI: 1.07-1.70) and hay fever (OR: 2.77; 95% CI: 2.12-3.62) also reported having had eczema. CONCLUSION: Environmental factors were found to play an important role in the prevalence of eczema among adolescents.     

Inequalities in cervical cancer screening in Eastern Europe: perspectives from Bulgaria and Romania

Objectives:  The incidence of cervical cancer in Eastern Europe has been on the rise, in contrast to the reduction in incidence in most countries of Western Europe. The objectives of the paper are to delineate the inequalities in cervical cancer screening in Romania and Bulgaria and identify explanations for these inequalities. Methods:  Representative samples of women – 1 099 in Bulgaria and 1 053 in Romania, were interviewed through a structured questionnaire. Results:  We found multiple dimensions of inequalities in cervical cancer prevalence and prevention, including disparities in comparison to other countries, disparities due to socioeconomic status, education, residency and ethnicity, as well as differential barriers faced by women in access to screening and in relationships with providers. We identified mediators of the effects of socio-economic status on screening history. Conclusions:  The study concludes that the effect of SES on screening is mediated mainly by the structural barriers in accessing the healthcare system, as well as women’s perceptions of the multiple costs of the smear. These conclusions are relevant to the development of national screening programs and health promotion in the two countries. Submitted: 19 March 2008; revised: 29 January 2009; accepted: 19 February 2009     

Social network effect on self-rated health in type 2 diabetic patients – results from a longitudinal population-based study

OBJECTIVES: The aim is to analyse the association between social network and self-rated health in a longitudinal design for persons with type 2 diabetes, comparing them with persons without diabetes. METHODS: The analyses are based on data from the population-based 'KORA-A study' conducted in the region of Augsburg (Germany), with data from 1990/1995 (t (0)) and 1998 (t (1)), including 164 persons with type 2 diabetes and 207 persons without diabetes. The social network was assessed by the Berkman/Syme index. RESULTS: For the type 2 diabetes group, the multivariate analyses show that a high score of social network at t (0) is associated with good self-rated health at t (1), even if self-rated health at t (0) is included in the model (OR 2.69; 95 % CI: 1.21-5.98). For the non-diabetes group, no such association was found. CONCLUSIONS: The results point towards a 'buffer effect' of the social network, indicating that the positive effect on health can be seen mostly among those who are exposed to a high level of burden, in this case exposed to a chronic disease such as type 2 diabetes.     

Nonkin Natural Mentors in the Lives of Older Youths in Foster Care

This study explored the nonkin natural mentoring relationships among older youths in foster care. Three hundred thirty-nine youths nearing their exit from one state’s alternative care system were interviewed. Those that reported the presence of a natural mentor, 62% (n=211), were subsequently asked about how they met their mentor, how long they have known their mentor, how frequently they have contact with their mentor, and the quality of the relationship. Seventy percent of the youth with mentors reported having known their mentors for over 1 year. Youth reported high levels of contact and relationship quality. Ethnic group membership, gender, where youth were living, and clinical characteristics were associated with individual mentoring characteristics. Child and adult service delivery systems might benefit from considering ways to support the continuation of these relationships during the transition period.     

Betriebliches gesundheitsmanagement — ein neues forschungs-und praxisfeld für gesundheitswissenschaftler

Health promotion at work is an important managerial tool in the upcoming knowledge and service society. The paper reviews the scope and purpose of occupational health management and informs about the available evidence. Because of an increasing demand theory and practice of occupational health management will become an important subject of public health research and teaching. In the future medical doctors, psychologists and sociologists will be trained to become members of occupational health teams together with public health experts and health scientists.     

Suicide and alcohol-related mortality in Hungary in the last two decades

OBJECTIVES: Suicide and alcohol-related mortality are often linked to each other in recent times, especially in the unfavourable mortality trends detected in Russia. Recent study has aimed to investigate suicide and alcohol-related mortality in Hungary between 1986 and 2005. This paper is based on the concept of social anomie and expects to find more favourable trends for both causes of death among those who were less exposed to unfavourable economic and social trends in the last two decades.METHODS: In a cross-sectional design sex, age- and education-specific mortality rates were calculated.RESULTS: We found falling suicide rates in all socio-demographic groups, except well-educated middle aged men. Suicide has fallen more among women than men, more among the elderly than the young and more among the more educated than the less educated. Alcohol-related mortality has risen by 5-10 %, and its occurrence in different socio-demographic groups was found to be changing entirely proportionally.CONCLUSIONS: Developments in suicide mortality are generally in accordance with the hypothesis based on the concept of social anomie while those of alcohol-related mortality showed no relation with this concept.     

Seafaring stressors aboard merchant and passenger ships

Objectives:  The aim of this study was to identify stressors in seafaring aboard merchant and passenger vessels. Furthermore, their dependence on occupational and non-occupational factors was assessed. Methods:  A total of 134 male seafarers sailing under Germanflagged vessels were interviewed (response 81.3 %). The seamen rated the individual stress level of 23 different stressors aboard. Results:  Separation from their family (named 48 times), time pressure (30 times), long working days (28 times), heat in workplaces (24 times), and insufficient qualification of subordinate crew members (16 times) were regarded as the most important stressors aboard. In comparison to non-officers, officers stayed on board for considerably shorter periods (4.8 vs. 8.3 months) but had significantly more often an extremely high number of working hours (63.5 % vs. 21.1 %, Chi-square-test: p < 0.001). Correspondingly, officers complained more frequently of a higher stress level due to time pressure (52.4 % vs. 36.6 %). Conclusions:  Particular attention should be paid to preventive organizational measures such as avoiding long-time separation from family, time-pressure, extremely long working days, and a long stay on board. Submitted: 10 August 2007; revised: 25 September 2008, 16 December 2008; accepted: 23 January 2009     

Counteracting obesity: developing a policy framework to guide action

Summary Objectives:  The purpose of this paper is to stimulate further debate regarding possible courses of policy action aimed at preventing obesity. Gostin’s framework for classifying antiobesity legal interventions is tested and extended to incorporate non-legislative policy initiatives to include a comprehensive array of policy actions available to deal with obesity. Methods:  A web search of the literature has been conducted. Initiatives from USA, Canada and the European Union were discussed in terms of their objectives and fit with the framework. Results:  Gostin’s framework was found to be a useful tool in organizing all the initiatives (legislative and non-legislative). However, sometimes a broader definition of the category was needed. As well, in some categories, few initiatives were implemented to date and several new categories have to be added to the framework to classify all the existing initiatives. Conclusions:  The theoretical developed framework will assist new initiatives assess possible courses of action as well as countries or organizations that have already implemented some measures identify what else can be done to effectively fight overweight and obesity.     

Cultural Adaptations to a Family Life Skills Program: Implementation in Rural Appalachia

Numerous parent education programs have been developed to provide parents with the skills and support necessary to effectively improve their parenting abilities. The Strengthening Families Program (SFP) employs a "family skills training" approach for parents and their children (ages 6 to 10). This study focuses on the implementation and outcomes of a culturally adapted SFP in southwestern Virginia, an area known for its Appalachian culture. Two groups were compared (those that received an adapted curricula and those that did not) on retention rates, parental outcomes, child outcomes, and program satisfaction. Retention rates were significantly improved for those participants in the adapted curricula group; however, parent and child outcomes were not affected. Statistically significant improvements for parents were found in effective discipline practices, family cohesion, family conflict, confidence in parenting, and punishment practices; and for both groups of children in increased child social skills and closeness to mothers between pre- and post-test times.