Feelings of Usefulness to Others, Disability, and Mortality in Older Adults: the MacArthur Study of Successful Aging

We examined feelings of usefulness to others as a predictor of disability and mortality risk in a sample of older adults (aged 70-79 years) from the MacArthur Study of Successful Aging. We examined participants' perceptions of their usefulness to friends and family, measured at a baseline interview, as a predictor of subsequent increases in self-reported mobility disability, the onset of difficulty in performing activities of daily living, or mortality occurrence over a 7-year follow-up period. Compared with older adults who frequently felt useful to others, those who never or rarely felt useful were more likely to experience an increase in disability or to die over the 7-year period, even when we accounted for a number of demographic, health status, behavioral, and psychosocial factors. This suggests that feelings of usefulness may shape health trajectories in older adults.     

The role of genes in tobacco smoking during adolescence and young adulthood: a multivariate behaviour genetic investigation

Aims To incorporate a psychosocial model of tobacco smoking into a behaviour genetic design to examine genetic and environmental influences on variation in smoking involvement. Design Longitudinal twin study. Setting and participants Twins initially aged between 13 and 18 years and registered with the Australian Twin Registry were surveyed three times between 1988 and 1996. A total of 414 pairs of identical and same‐sex fraternal twin pairs participated in all three surveys, aged between 20 and 25 at wave 3. Biometric modelling estimated the influence of genetic and environmental factors in determining variation in smoking at each wave, both before and after adjusting for perceived smoking behaviours of peers and parents. Measurements Twins answered a questionnaire on their own smoking status and reported on the use of tobacco by parents and friends as they perceived it, at each survey wave. Findings At all three surveys, current smokers were more likely to have parents who smoked and to have smokers among their peers. Genes and environmental factors, both common and unique, contributed to variation in smoking behaviours. However, after controlling for the smoking behaviours of peers and parents, the role of genes in determining variation in smoking involvement was reduced by 100% at wave 1 and by 30% at wave 2. Friends’ smoking reduced the magnitude of the common environment variance by 11%, 30% and 40% at waves 1, 2 and 3, respectively. Parents’ smoking behaviours explained part of the common environment. Biometric modelling of the covariation between smoking involvement and peer smoking suggested that genes might influence smoking involvement at wave 1 by influencing choice of peers. Conclusion Environmental factors play the greatest role in determining variation in tobacco smoking among adolescents and young adults. Among adolescents, genes may influence variation in smoking behaviours indirectly by influencing choice of peers. However, genes seem to have a direct influence on variations in the smoking behaviours of young adults.     

Temporal association between obesity and hyperinsulinemia in children, adolescents, and young adults: the Bogalusa Heart Study.

Obesity is generally associated with hyperinsulinemia. However, whether obesity precedes or follows hyperinsulinemia is not clear. The present study examined the temporal nature of the association between obesity and hyperinsulinemia in a biracial (black-white) community-based population enrolled in the Bogalusa Heart Study. Three longitudinal cohorts of children (n = 427; baseline age, 5 to 7 years), adolescents (n = 674; baseline age, 12 to 14 years), and young adults (n = 396; baseline age, 20 to 24 years) were selected retrospectively, with a follow-up period of approximately 3 years. In general, longitudinal changes in the mean body mass index (kilograms per meter squared), an indicator of adiposity, and fasting insulin level did not parallel each other. In a bivariate analysis, baseline insulin levels correlated significantly with the follow-up body mass index in adolescents and adults, but not in children. On the other hand, the baseline body mass index correlated significantly with follow-up insulin levels in all cases. Logistic regression analysis showed that the proportion of subjects who developed obesity (body mass index > 75th percentile, specific for age, race, gender, and survey year) at follow-up study increased significantly across baseline quintiles (specific for age, race, gender, and survey year) of insulin only among adolescents, irrespective of race and gender. This relationship disappeared after adjusting for the baseline body mass index. By contrast, a significant positive trend between baseline quintiles of the body mass index and incidence of hyperinsulinemia (> 75th percentile) at follow-up study was noted among all age groups independent of race, gender, and baseline insulin levels. Further, in a multiple stepwise regression model, the best predictor of the follow-up insulin level was the baseline body mass index in children and adults and the baseline insulin in adolescents. The baseline body mass index was the best predictor of the follow-up body mass index in all three age groups. These results, by showing the temporal nature of the relation between obesity and hyperinsulinemia beginning in childhood, support the role of obesity in the development of hyperinsulinemia.     

Prevalence and characteristics of narghile smoking among university students in Syria.

SETTING: Narghile (waterpipe) smoking is increasing in all Arab societies, but little is known about its pattern of use. METHODS: In 2003, a cross-sectional survey was conducted among students at Aleppo University using an interviewer-administered questionnaire. A representative sample of 587 students participated (278 males, 309 females; mean age 21.8 +/- 2.1 years; response rate 98.8%). RESULTS: Ever narghile smoking was seen among 62.6% of men and 29.8% of women, while current smoking was seen among 25.5% of men and 4.9% of women. Only 7.0% of the men used narghile daily. Age of initiation was 19.2 +/- 2.2 and 21.7 +/- 3.2 years for men and women, respectively (P < 0.001). The salient feature of narghile smoking was its social pattern, where most users initiated and currently smoked narghile with friends. Narghile and cigarette smoking were related among students, with narghile smoking most prevalent among daily cigarette smokers. Multivariate correlates of narghile smoking were being older, male, originating from the city, smoking cigarettes, having friends who smoke narghile, and coming from a household where a greater number of narghiles were smoked daily. CONCLUSIONS: Narghile smoking is prevalent among university students in Syria, where it is mainly practiced by men, intermittently, and in the context of social activities with friends.     

Families and the natural history of blood pressure. A 27-year follow-up study

BACKGROUND: Previous studies on familial aggregation of blood pressure (BP) have reported data on family history of hypertension. Data on actual parental BP levels and the subsequent natural history of BP in their offspring are scarce. METHODS: In a population-based study with 596 children aged 5 to 19 years, cardiovascular risk factors were measured annually from 1975 through 2002.Parental data were obtained at baseline. Repeated BP measurements were studied as a function of tertiles of age-adjusted BP measured in their parents at baseline. RESULTS: Systolic BP during follow-up was higher in offspring whose parents were both in the highest tertile compared with children whose parents were not in the highest tertile (difference 2.7 mm Hg, 95% confidence interval 0.2 to 5.2). Having both parents in the highest tertile of diastolic BP resulted in a substantially higher diastolic BP ranging from 1.9 mm Hg at age 15 years to 8.5 mm Hg at age 45 years. These differences were adjusted for age, sex, body mass index, total serum cholesterol, smoking habits, and alcohol consumption. CONCLUSIONS: The results of this study indicate that actual parental BP is an important predictor of BP development from childhood into young adulthood. This is important when constituting cardiovascular risk profiles for children and young adults.     

Disentangling social selection and social influence effects on adolescent smoking: the importance of reciprocity in friendships

AIMS: The goal of this study was to examine social selection and social influence within reciprocal and non-reciprocal friendships, and the role of parents and siblings, as factors explaining similarity of smoking behaviour among adolescent friends. A new social selection-social influence model is proposed. DESIGN: Longitudinal design with two measurements. SETTING: Data were gathered among Dutch high school students in the control group of the European Smoking prevention Framework Approach (ESFA) study. PARTICIPANTS: The sample consisted of 1886 adolescents with a mean age of 12.7 years. MEASUREMENTS: The main outcome measures were the smoking behaviours of the respondents, best friends, parents and siblings. We tested the social selection-social influence model with structural equation modelling techniques. FINDINGS: Social selection and social influence both played an important role in explaining similarity of smoking behaviour among friends. Within non-reciprocal friendships, only social selection explained similarity of smoking behaviour, whereas within reciprocal friendships, social influence and possibly also social selection explained similarity of smoking behaviour. Sibling smoking behaviour was a more important predictor of adolescent smoking behaviour than parental smoking behaviour. CONCLUSIONS: Social selection and social influence both promote similarity of smoking behaviour, and the impact of each process differs with the degree of reciprocity of friendships. These insights may contribute to further refinement of smoking prevention strategies.     

Maternal smoking and smoking in adolescents: a prospective community study of adolescents and their mothers

The associations between maternal smoking and nicotine dependence and patterns of smoking and nicotine dependence in offspring were examined in a large community-based sample of adolescents. Data were derived from baseline and 4-year follow-up assessments of 938 respondents aged 14-17 years at the outset of the Early Developmental Stages of Psychopathology (EDSP) study, a prospective-longitudinal community study of adolescents and young adults and their parents respectively. Smoking and nicotine dependence in respondents were assessed using the Munich Composite International Diagnostic Interview (DSM-IV algorithms). Diagnostic information about smoking behavior in mothers was collected by independent direct diagnostic interviews with the mothers. In comparison to children of non- or occasionally smoking mothers, children of regularly smoking and nicotine-dependent mothers had higher probabilities of using tobacco as well as of developing nicotine dependence. For all ages under consideration, survival analyses revealed a higher cumulative lifetime risk of regular smoking and nicotine dependence among these children. Maternal smoking during pregnancy seems to represent an additional risk for these outcomes in children, specifically with regard to the risk of developing nicotine dependence. Associations were comparable for sons and daughters. Our findings show that maternal smoking predicts escalation of smoking, development of nicotine dependence, and stability of smoking behavior in children. Implications for specific intervention and prevention efforts are discussed.     

The role of smoking intentions in predicting future smoking among youth: findings from Monitoring the Future data

AIMS: To demonstrate that intentions predict long-term future levels of smoking, irrespective of level of past smoking experience. A growing body of research suggests that intentions about future smoking might play an important role in addition to the influence of past smoking experience on the likelihood of smoking in future. DESIGN: Using logistic regression analyses, we assessed the relationship between baseline smoking experience and a firm intention 'not to be smoking cigarettes 5 years from now' with four outcome measures of smoking at follow-up: 30-day smoking at a 3/4- and 5/6-year follow-up and current established smoking (self-described regular smokers or former smokers who had smoked in the past 30 days) at a 3/4- and 5/6-year follow-up. PARTICIPANTS: US nationally representative samples of 12th graders who responded to the Monitoring the Future (MTF) survey from the years 1976 to 1993, inclusive. For these panels, we linked stage of smoking and intentions at 12th grade to follow-up measures of smoking collected at 3/4 years after baseline and 5/6 years after baseline. FINDINGS: Analysis of 3/4-year follow-up data (weighted n = 4544) and 5/6-year follow-up data (weighted n = 3885) for both definitions of smoking outcome indicated that there was a dose-response relationship between levels of baseline smoking experience and the likelihood of future smoking. In addition, independent of baseline smoking experience, there was a statistically significant protective effect for a firm intention not to smoke in five year's time on future smoking behavior. CONCLUSIONS: The findings suggest that evaluative studies of tobacco control policies and programs might usefully employ smoking uptake categories that incorporate smoking intentions as early indicators of outcome.     

The association of current smoking behavior with the smoking behavior of parents,siblings, friends and spouses

Aims To examine the association of current smoking behavior of adolescents and young adults with the smoking behavior of their parents, siblings, friends and spouses. Design Using survey data from a large twin‐family sample, the association between the smoking behavior of participants and that of their family members, friends and spouses was investigated by calculating the relative risk. To disentangle sex and age differences, calculations were carried out separately for males and females and for three different age groups: 12–15, 16–20 and 21–40 years old. Findings The smoking behavior of the participants was significantly influenced by the smoking behavior of parents, siblings and friends, but all relative risks decreased with age. No differences in relative risk were found between having older or younger smoking siblings. Within each age group, the relative risk to smoke when having a smoking friend was comparable to the relative risk to smoke when having a smoking same‐age and same‐sex sibling. For the older participants, the relative risk to smoke was higher for monozygotic (MZ) twins with a smoking co‐twin than for dizygotic (DZ) twins with a smoking co‐twin. Most findings were sex‐dependent: same‐sex smoking family members influenced smoking behavior more than opposite‐sex family members. The significant association of the smoking behavior of spouses decreased with age, which suggests that assortment for smoking is based on similarity at the time dating began. Conclusions The results highlight the importance of both social and genetic influences on smoking behavior, with genetic influences increasing with the age of the participant.     

Initiation of Traditional Cigarette Smoking after Electronic Cigarette Use Among Tobacco-Naïve US Young Adults

Background

Although electronic cigarettes (e-cigarettes) may help some smokers quit, some young adult never-smokers are now using e-cigarettes recreationally, potentially increasing their risk for initiation of smoking. We aimed to determine the association between baseline e-cigarette use and subsequent initiation of cigarette smoking among initially never-smoking young adults.

Effects of cognitive function on functional decline among community-dwelling non-disabled older Japanese

This study examined whether cognitive impairment, falls, and urinary incontinence (UI) were independent predictors of functional decline using a 2-year observation of a non-disabled older Japanese cohort living in a community from 1999 to 2001. A total of 139 men and 214 women aged 70-94 years at the baseline who were independent in both activities of daily living (ADL) and instrumental activities of daily living (IADL) were analyzed in this study. Independent variables, such as cognitive impairment, falls, UI, and other possible factors associated with functional decline were obtained from an interview survey at the baseline. A dependent variable was functional status in ADL and IADL obtained at the time of the 2-year follow-up. During the 2-year follow-up, cognitive function was a significant predictor for both IADL dependence and ADL and/or IADL dependence. Using a group of subjects with Mini Mental State Examination (MMSE) scores of 30-27 points as a reference group, a significant correlation was identified between lower MMSE scores and an increased odds ratio for functional decline. Lower cognitive function was a significant predictor of functional decline, even among those older Japanese whose cognitive function was deemed to be within the normal range.     

Walking speed as a good predictor for maintenance of I-ADL among the rural community elderly in Japan: A 5-year follow-up study from TMIG-LISA

Background   A population-based prospective cohort study was undertaken to examine the predictors of functional decline in instrumental activities of daily living (I-ADL) among non-disabled older Japanese subjects living in a rural community during a five-year interval from 1992 to 1997.
Methods   The subjects consisted of 624 men and women aged from 65–89 years and independent in I-ADL at baseline, who could be completely followed for five years. Independent variables were various physical factors potentially associated with higher level of functional capacity obtained from an interview survey and medical examinations at baseline. Dependent variables were functional status in I-ADL obtained at the time of the 5-year follow-up.
Results   Significant predictors of functional decline in I-ADL during a 5-year follow-up period included: (1) older age; (2) higher blood pressure; and (3) lower maximum walking speed at baseline. Among these predictor, the maximum walking speed is likely to the strongest predictor for the decline in I-ADL.
Conclusion   The ability to walk faster in the old age is strongly associated with independence in the other I-ADL, and walking speed should be modified by the lifestyle to strengthen muscles of the lower extremities in daily life.     

Psychological symptoms and physical health and health behaviours in adolescents: a prospective 2-year study in East London

AIMS: To examine whether physical health and health-risk behaviours in young people are risk factors for psychological distress and depressive symptoms over a 2-year period. DESIGN/SETTING: A 2-year, prospective epidemiological cohort study in East London. PARTICIPANTS: A total of 1615 adolescents from the Research with East London Adolescents: Community Health Survey (RELACHS)-a representative cohort of young people aged 11-12 and 13-14 years at baseline, followed-up after 2 years. MEASUREMENTS: Psychological distress and depressive symptoms identified by the self-report Strengths and Difficulties Questionnaire and the Short Moods and Feelings Questionnaire at baseline and follow-up. Data on overweight/obesity, general health, long-standing illness, physical activity, smoking, alcohol use and drug use were collected from questionnaires completed by the adolescents at baseline and follow-up. FINDINGS: At follow-up, 10.1% of males and 12.9% of females reported psychological distress; 20% of males and 33.7% of females reported depressive symptoms. Having tried drugs or engaged in two or more health-risk behaviours (smoking, alcohol use or drug use) at baseline predicted psychological distress and depressive symptoms at follow-up. Smoking on its own, long-standing illness, obesity/overweight and activity levels were not associated with later psychological health. Risk of poor psychological health at follow-up was associated strongly with psychological health at baseline. CONCLUSIONS: Psychological health at baseline was the strongest predictor of psychological health at follow-up. Engaging in two or more health-risk behaviours moderately increased the risk of poor psychological health, suggesting that prevention strategies targeting co-occuring substance use may reduce burden of disease.     

A latent class typology of young women smokers

AIMS: Despite aggressive anti-smoking campaigns, smoking rates are increasing among young women, suggesting the need for new approaches to reach this population. Segmenting audiences can facilitate targeting interventions to specific populations, based on association of smoking behaviors with other health behaviors and psychological and social antecedents. Using latent class analysis, we sought to profile patterns of behavioral, attitudinal and cognitive variables related to tobacco use among young women. DESIGN: This study is part of an ongoing Midwestern longitudinal self-report survey of the natural history of cigarette smoking. PARTICIPANTS: Participants were 18-25-year-old women smokers (n = 443). MEASUREMENTS: Variables included a comprehensive range of demographic characteristics, smoking-related variables and general attitudinal variables. FINDINGS: Three distinct classes emerged with the following characteristics: (1) working women who tended to smoke daily but reported high levels of positive affect and life satisfaction (n = 212); (2) light-smoking college students who exercised regularly, began smoking after high school and quit successfully at follow-up 5 years later (n = 86); and (3) heavy smokers who were more likely to have children, report high levels of negative affect and smoke for addictive reasons, for stimulation and to control affect (n = 145). Differences in smoking cessation at a 5-year follow-up were significant across the classes (18.1%, 34.4% and 13.0% had quit for at least 6 months, respectively). CONCLUSIONS: The psychosocial and behavioral profiles of these classes can potentially be used to tailor smoking interventions more effectively within this population.     

The course of early smoking: a population-based cohort study over three years

Aims. To examine the uptake and course of smoking in a representative adolescent cohort. Design. Six-wave cohort study. Participants. Secondary school students initially aged 14-15 years at 44 schools in the state of Victoria, Australia. Measurements. Computerized questionnaire including 7-day retrospective recall for tobacco use. Findings. Prevalence rates for smoking in the past month rose from 25% to 31% and daily smoking 9% to 18% across the 3-year follow-up. Forty-five per cent of the sample smoked at some point but only 18% were daily smokers at the end-point. High rates of short-term cessation were observed for both experimental and daily smokers, but 70% of daily smokers relapsed within 12 months. Occasional smoking at the outset was the strongest predictor of later daily smoking and was also predictive of lower cessation and higher relapse rates. Parental divorce and parental daily smoking were associated with smoking at the outset and parental smoking was strongly predictive of the course of daily smoking. In contrast, prevalence rates of smoking in a subject's school did not significantly predict either smoking initiation or subsequent course. Female daily smokers were half as likely as males to cease smoking, a finding that accounted for gender differences in smoking prevalence in this sample. Conclusions. The strength of association between occasional and later daily smoking indicates the importance of primary prevention but the variability in the early course indicates that there should be much scope for promotion of adolescent efforts to quit. Both the diminished likelihood of smoking cessation in young women and parental influences on smoking course deserve further exploration.     

Insulin-dependent diabetes mellitus mortality. The risk of cigarette smoking

The relation between cigarette smoking and mortality was examined prospectively in a population of adult insulin-dependent diabetes mellitus (IDDM) patients. In 1981, information on smoking history and other health and lifestyle factors was obtained by questionnaire from 93% of the 723 patients included in the Children's Hospital of Pittsburgh IDDM registry who were diagnosed between 1950 and 1964. Vital status as of January 1, 1988 was ascertained for 98% of the 548 patients who participated in the baseline survey and were alive as of January 1, 1982. Fifty-four cases died during the 6-year follow-up (32 male, 22 female). Proportional hazards analysis revealed that heavy smoking was a significant independent predictor of all-cause mortality among females but not males. The excess mortality in female diabetics was explained primarily by a marked excess risk of coronary heart disease mortality in smokers. These data strongly suggest that cigarette smoking, especially among diabetic females, should be avoided in order to improve longevity.     

Parental mediation of adolescent media use and demographic factors as predictors of Kenyan high school students’ exposure to sexual content in television

Research in Western nations suggests that parents’ involvement in their children's media use can make a difference in how adolescents select, process and respond to sexual television messages. Little or no published research has investigated this issue in sub-Saharan Africa, even though adolescents and young adults remain among the groups at highest risk for HIV transmission. This study investigated the relationship between Kenyan adolescents’ level of exposure to sexual television content and their parents’ mediation of their television use. A cluster sample of 427 Nairobi public high school students was surveyed regarding parental mediation of their media use and their intake of sexual television content. Co-viewing with opposite sex friends was associated with higher intake of sexual TV content. This relationship was stronger among boarding school students than among day school students. Parental mediation and co-viewing variables predicted three times as much variance among boarding than among day school students.     

Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities

BACKGROUND: in the primary prevention of disability among older adults it might be useful to identify individuals at high risk for functional decline before it occurs. OBJECTIVE: to examine whether tiredness in daily activities is an independent determinant of onset of mobility disability at 1 1/2-year follow-up among non-disabled older men and women. DESIGN: a prospective study with 1 1/2-year follow-up. SETTING: 34 communities in four counties in Denmark. SUBJECTS: 1396 older non-disabled adults (74-75 and 80 years old) living in 17 of the participating communities. METHODS: questionnaire surveys at baseline and at 1 1/2-year follow-up. Tiredness in daily activities was measured by questions about tiredness in six mobility activities. Onset of mobility disability was measured as onset of need for help in one to six mobility activities. RESULTS: men and women who felt tired in their daily activities at baseline had a higher risk of onset of mobility disability at 1 1/2-year follow-up, when adjusted by the covariates. In addition, low social participation, poor psychological function, and physical inactivity were independent risk factors of onset of mobility disability among men, and home help, low sense of coherence and physical inactivity were independent risk factors of onset of mobility disability among women. CONCLUSION: older people who complain about tiredness are at higher risk of becoming disabled than others. This highlights the need for alertness and management of this early sign of functional decline in a preventive perspective.     

The dynamics of cigarette smoking during military service in Syria.

SETTING: Understanding the dynamics of smoking in different populations is important to be able to tackle this problem rationally. DESIGN: A cross-sectional survey in a military school near Aleppo. Three groups of recruits were studied (total number of participants 596). The mean age of new draftees (group I) was 19.8 +/- 0.02 years, that of draftees after 6 months of service (group II) was 19.7 +/- 0.02 years, and that of draftees after 2 years of service (group III) was 21 +/- 0.02 years. RESULTS: Current and daily smoking was observed among respectively 46.1% and 34.1% of participants. Daily smokers smoked 17.8 +/- 0.7 cigarettes per day. Within a 2-year interval, current smoking increased from 43.2% to 55.1% (P = 0.01), and daily consumption from 15 to 23.8 cigarettes/day (P < 0.001). Smoking among draftee groups I and II was compared with age-matched male university students (314 first year students aged 19.1 +/- 0.04 years and 262 third year students aged 21.3 +/- 0.05 years). Current smoking among recruits was higher at entry and after 2 years than that of age-matched civilians (P < 0.001), but the 2-year increase was not (P > 0.05). CONCLUSION: Although military service in Syria is a scene of intensive smoking dynamics, it cannot be implicated in creating smokers.     

Medical students and tobacco in 2004: a survey in Sousse, Tunisia.

OBJECTIVE: To assess the behaviour, knowledge and attitudes towards smoking among medical students in Sousse, Tunisia. DESIGN: A cross-sectional survey in classroom settings using a self-administered questionnaire was conducted at the School of Medicine during September 2004. RESULTS: The numbers of students who entered the first and the fifth years of medical training at the University of Sousse in 2004 and completed the questionnaire were respectively 120 and 110. The population age ranged from 18 to 21 years (mean 19 +/- 0.62 years) in first year students and from 22 to 30 years (mean 23 +/- 1.38 years) in fifth year students. The prevalence of daily smoking (both sexes combined) was 4.5% among first year students and 16.7% among final year students. The prevalence of daily smoking according to sex was 29.6% among boys and 0.7% among girls. Over 90% of students thought smoking was harmful to health, but there was considerable underestimation of its causal role in a number of diseases, notably coronary heart disease, bladder cancer and peripheral vascular disease. There were important defects in both knowledge and motivation regarding counselling patients to stop smoking. CONCLUSIONS: The results of this study may provide baseline data to develop an anti-smoking programme in the university.