Childhood adversities as a predictor of disability retirement

BACKGROUND: There is a large body of research on adulthood risk factors for retirement due to disability, but studies on the effect of adverse childhood experiences are scarce. AIM: To examine whether adverse childhood experiences predict disability retirement. METHODS: Data were derived from the Health and Social Support Study. The information was gathered from postal surveys in 1998 (baseline) and in 2003 (follow-up questionnaire). The analysed data consisted of 8817 non-retired respondents aged 40-54 years (5149 women, 3668 men). Negative childhood experiences, such as financial difficulties, serious conflicts and alcohol-related problems, were assessed at baseline and disability retirement at follow-up. RESULTS: The risk of disability retirement increased in a dose-response manner with increasing number of childhood adversities. Respondents who had experienced multiple childhood adversities had a 3.46-fold increased risk (95% CI 2.09 to 5.71) of disability retirement compared with those who reported no such adversities. Low socioeconomic status, depression (Beck Depression Inventory-21), use of drugs for somatic diseases as well as health-related risk behaviour, such as smoking, heavy alcohol consumption and obesity, were also predictors of disability retirement. After simultaneous adjustments for all these risk factors, the association between childhood adversities and the risk of disability retirement attenuated, but remained significant (OR 1.90, 95% CI 1.07 to 3.37). CONCLUSIONS: Information on childhood conditions may increase our understanding of the determinants of early retirement, especially due to mental disorders. Childhood adversities should be taken into account when considering determinants of disability retirement and identifying groups at risk.     

Perceived accessibility as a predictor of youth smoking

PURPOSE Youths who smoke are more likely to perceive that cigarettes are easily accessible, but the relationship between perceived accessibility of cigarettes and the risk of smoking is not clear. The objective of this study was to determine whether perceived accessibility predicted future smoking among youths.METHODS This study used data from the second Development and Assessment of Nicotine Dependence in Youth (DANDY-2) study, a 4-year (2002–2006) cohort study that began with 1,246 sixth-grade students in 6 Massachusetts communities. DANDY-2 comprised 11 waves of in-person interviews. A total of 1,195 students who were aged 11 to 14 years at the baseline interview in 2002 were eligible for inclusion in this report. The outcomes for this study were the onset of smoking initiation and regular tobacco use.RESULTS At baseline 1,027 students had never smoked cigarettes, and 168 had previously initiated smoking. During the 4 years of the study, 177 students newly initiated smoking, and 109 became regular smokers. In unadjusted city-stratified Cox proportional hazard models, perceived accessibility increased the risk for smoking initiation among nonsmokers and regular smoking among all participants in a dose-response fashion. Perceived accessibility also increased the risk for smoking progression among initiators in a dose-response fashion. The associations between perceived accessibility and smoking were robust to adjustment for peer and parental smoking. Youths with both perceived accessibility and peer-smokers had a higher risk of regular smoking and progression after initiation than either factor alone. These associations were stable to adjustment for potential confounders other than peer smoking.CONCLUSIONS Perceived accessibility increases the risk for smoking among youths and has a stronger effect among those with peer smokers. There may be a role for identifying this group of youths for targeted interventions in child health care settings. Perceived accessibility should be carefully considered and measured in smoking intervention programs for teens.     

Mental vulnerability as a predictor of early mortality

BACKGROUND: Studies have demonstrated that mental vulnerability (ie, a tendency to experience psychosomatic symptoms or inadequate interpersonal interactions) is associated with various diseases. The objective of our study is to evaluate whether mental vulnerability is a risk factor for early mortality. METHODS: We conducted a prospective cohort study of 3 random samples of the population in Copenhagen County, Denmark selected in 1976, 1982-1984, and 1991 (n = 6435). Baseline data collection included measures of mental vulnerability, social factors, comorbidity, biologic risk markers (eg, blood pressure, lipid levels), and lifestyle factors. We determined vital status of the study sample through linkage to the Civil Registration System until 2001 and to the Cause of Death Registry until 1998. The mean follow-up time was 15.9 years for analysis of total mortality and 13.6 years for analysis of mortality as the result of natural causes. The association between mental vulnerability and survival was examined using Kaplan-Meir plots and Cox proportional-hazard models adjusting for possible confounding factors. RESULTS: With respect to mental vulnerability, 79% of the sample was classified as not vulnerable, 13% as moderately vulnerable, and 8% as highly vulnerable. Compared with the nonvulnerable group, highly vulnerable persons showed increased total mortality (hazard ratio = 1.6; 95% confidence interval = 1.3-1.9) and increased mortality from natural causes (1.6; 1.2-2.0). The inclusion of the mental vulnerability score as a continuous variable gave similar results. CONCLUSIONS: Mental vulnerability may be an independent risk factor for premature mortality. The biologic mechanisms that may underlie this association need further exploration.     

Perceived morbidity as a determinant of health behavior

It is hypothesized that perceived morbidity, a concept closely related to perceived vulnerability, is an important determinant of health behaviors. In this cross-sectional study (N = 2740), perceived morbidity was conceptualized as a categorical variable defining six distinct morbidity groups: the hypertension, high cholesterol, angina pectoris, heart attack, stroke and 'morbidity-free' groups. We used analyses of covariance to identify differences in health behaviors between the six groups; the analyses were done separately for middle-aged (40-60 years old) and older ( greater than 60 years old) respondents. Results show that perceived morbidity had a significant effect on fat consumption (P less than 0.001) and on physical activity (P < 0.01). In both age ranges, the morbidity-free group had the highest fat consumption; among the middle-aged respondents, the level of physical activity was significantly lower in the morbidity-free group than in the heart attack group. Furthermore, respondents in the high cholesterol group showed consistently a 'better' health behavior than people in the hypertension group. Overall, these results suggest that the concept of perceived morbidity may be useful in explaining inter-individual differences in health behaviors.     

Perceived environmental risk as a predictor of teenage motherhood in a British population

Previous studies have shown that strong relationships exist between deprived environments and teenage motherhood. However, such studies have predominantly identified deprivation using neighbourhood-wide measures of socio-economic status. Few studies of teenage parenthood have examined how individuals perceive their environment and the importance of this perception on reproductive behaviour and timing. Using data collected from a sample of women living the county of Gloucestershire, UK, this paper explores the predictive value of two methods of assessing the environment: (1) the structural component-deprivation at the neighbourhood level and (2) the individual's subjective experience of her pre-pregnancy environment, when examining how the wider environmental context can influence the decision of becoming a teenage mother. The results indicate that a woman's perception of her neighbourhood of residence at the time she conceived, her perceived environmental risk, may be a more discriminating predictor of teenage motherhood than deprivation measured by ward economic and deprivation indicators.     

Housing tenure and early retirement for health reasons in Sweden

AIMS: To assess the association between housing tenure and early retirement for health reasons in Sweden with a view to psychosocial vs. material values of home ownership. METHODS: The data come from linked registers that cover all people resident in Sweden during 1990-2000. The study population consists of 449,233 people aged 40-63 years in 1997. Of these, 19,350 retired early for health reasons in 1998-99. The remaining 429,883 continued their employment without extended sick leave or income decline. None moved during 1990-2000. We calculated the odds of early retirement for four forms of juridical relationship to one's housing (private owner; part owner in a cooperative; private rental; rental from a public housing company), for men and women separately, controlling for age, education, employment income, household disposable income, region, foreign birth, and housing type. RESULTS: Men in cooperative ownership had lower odds of early retirement than those in the three other tenure forms, for which the odds were similar. Among women, public and private renters had similar odds of early retirement, which were higher than those of women in private or cooperative ownership. For both genders, inclusion of housing type in the model after housing tenure explained little additional variance. CONCLUSIONS: The odds of early retirement for health reasons varied across different housing tenure forms in Sweden in 1998-99. The pattern of associations differed as a function of gender. Home ownership appears to involve health resources independent of basic socio-physical factors captured with differences in housing type.     

Subjective health as predictor for mortality

In the last two decades self-rated health has received growing interest in international studies because of its consistent prediction for mortality. However, for Germany there are no studies confirming a long-term effect independent from objective health indicators in comparison of different follow-up. On the basis of the Life-Expectancy-Study (1984/86 - 1998) from the Federal Institute for Population Research it was possible to analyze the association between subjective health and mortality in relation to the length of observation. A stronger correlation between bad self-rated health and objective health status could be indicated because of a better prediction for mortality in a short-term follow-up. The evidence of a significant effect between self-rated health and mortality in the long-term follow-up not including the deaths from the short-term follow-up indicates that the mechanisms between subjective health and mortality are more complex than those between objective health status and death.     

Infant-mother interaction as a predictor of child's chronic health problems

BACKGROUND: Psychological stress is associated with physical illnesses like asthma or infections. For an infant, situations perceived as stressful are highly dependent on the relationship with the caregiver. Constantly poor mother-infant interaction increases the child's vulnerability to stressful conditions and experiences. The aim of the study was to investigate the impact of the quality of early mother-infant interaction on the subsequent physical health of the child. Poor mother-infant interaction was hypothesized to be associated with chronic or recurrent health problems in the child. PARTICIPANTS: Fifty-seven mother-infant dyads from families at risk of psychosocial problems and 63 from non-risk families, altogether 120 dyads, participated in the study. Families were drawn from normal population, from well-baby clinics in the city of Tampere, Finland. Infants were full-term and healthy, families with severe risks like psychotic illnesses of the parents or a history of child protection concerns were excluded from the study. METHODS: After the initial interview with the mother, the mother-infant interaction was videotaped when the infants were 8-11 weeks of age and the interaction was assessed using the Global Rating Scale for Mother-Infant Interaction (Murray et al. 1996a). After the 2-year follow-up mothers were interviewed again and the health problems of the child were elicited. RESULTS: Poor dyadic mother-infant interaction and infant's poor interactive behaviour assessed at two months were separately associated with the physical health of the child during the two-year follow-up. After adjusting for other factors in the logistic regression analysis infant's poor interactive behaviour remained as a significant predictor of chronic or recurrent health problems in the child. Infant's health problems at the time of the initial interview and day care centre attendance were also significant predictors. CONCLUSIONS: The results suggest that interactional issues between a mother and her infant are related to the child's subsequent physical health. Children with recurrent or chronic health problems may have relationship difficulties with which they need help. Also, early avoidant behaviour of the infant should be regarded as an indicator of the infant's distress with possibly adverse outcomes in the child's physical health, among other consequences.     

Employer-sponsored health insurance for early retirees: impacts on retirement,health, and health care

The proportion of large employers offering retiree health insurance in the US has declined by half in the past 20 years. This paper examines the potential implications of this change by estimating the effects of a retiree health insurance (RHI) offer on a comprehensive set of labor, health and health care use outcomes in the near-elderly population. An RHI offer increases the probability of early retirement by 37% for both men and women. While the results suggest that an RHI offer has little, if any, effect on health, there is strong evidence that RHI provides significant protection from high out-of-pocket medical costs. In the top 40% of the out-of-pocket spending distribution, those with an offer of retiree coverage spend 22% less on average. Estimates of the value of RHI of over $4,000 per year suggest that increasing opportunities for the near-elderly to purchase coverage at actuarially-fair prices through the individual market or public programs could significantly increase insurance coverage and reduce financial risk for this age group.     

The role of retiree health insurance in the early retirement of public sector employees

Most government employees have access to retiree health coverage, which provides them with group health coverage even if they retire before Medicare eligibility. We study the impact of retiree health coverage on the labor supply of public sector workers between the ages of 55 and 64. We find that retiree health coverage raises the probability of stopping full time work by 4.3 percentage points (around 38 percent) over two years among public sector workers aged 55–59, and by 6.7 percentage points (around 26 percent) over two years among public sector workers aged 60–64. In the younger age group, retiree health insurance mostly seems to facilitate transitions to part-time work rather than full retirement. However, in the older age group, it increases the probability of stopping work entirely by 4.3 percentage points (around 22 percent).     

Perceived instrumental support and children's health across the early life course

A large, venerable literature demonstrates the importance of social relationships and social support for health, though much less research examines whether the benefits of social support to mothers extend to children. This paper examines the relationship between mothers' perceptions of instrumental support and children's health using longitudinal data from the U.S. Fragile Families and Child Wellbeing Study (N = 4342), a cohort of American children born in urban areas to mostly unmarried parents. Results suggest mothers' perceptions of instrumental support is positively associated with children's overall health, and this finding persists despite controlling for a host of individual-level characteristics of mothers and children (including a lagged indicator of children's health) and in fixed-effect models. Mothers' economic security and mothers' wellbeing attenuate some, but not all, of the association between perceived instrumental support and children's overall health. In addition, the link between perceived instrumental support and three specific indicators of health – asthma, overweight/obese, and number of emergency room visits – falls to statistical insignificance after accounting for individual-level characteristics, suggesting these associations result from social selection processes. Taken together, these findings suggest the beneficial health consequences of social support may extend to children across the early life course and demonstrate the need to better understand mothers' reports of children's overall health.     

Social support, early retirement, and a retirement preference: a study of 10,489 Finnish adults.

The aim of the study was to examine associations of social support with early retirement and reported retirement preference. Logistic regression analyses of early retirement (retired before the age of 55) were based on a cohort of 10,489 respondents (5960 female, 4529 male) aged 40-55 years. Analyses of retirement preference (planning of early retirement) were based on a sub-cohort of 7759 full-time employees (4233 female, 3526 male). The measures for social support were the social network size (number of close personal relationships) and social network heterogeneity (number of different roles as sources of social support). Among women, early retirement was associated with small social networks (OR 5.1, 95% CI = 2.8-9.2) and low social network heterogeneity (OR 9.1, 95% CI = 3.2-25.9). Among men, the corresponding associations were somewhat smaller (1.5; 0.9-2.6 and 8.0; 1.8-35.7, respectively). Adjustments for age, occupational training, and spouse at home did not considerably affect these associations. Among men, the association between social network heterogeneity and early retirement was not statistically significant after additional adjustments had been made for marital status and perceived health status. The characteristics of the social network were not associated with a retirement preference among employed men. Among women, the lack of social relations was associated with low retirement preference. Our findings suggested that social support is not independently associated with a retirement preference among men. Socially isolated women prefer retirement less often than other women do. Being retired before the age of 55 years may be predicted by limited social support or it may restrain one's possibilities to establish and maintain social relationships.     

An occupational health intervention programme for workers at risk for early retirement; a randomised controlled trial

Aims: To evaluate an occupational health intervention programme for workers at risk for early retirement.

Methods: Between April 1997 and May 1998, 116 employees of a large company who were older than 50 years indicated that they would not be able to work up to their retirement. They were randomly assigned to an intervention (n = 61) or control group (n = 55). The intervention programme lasted six months and was executed by an occupational physician. Job position and number of sick leave days after two years were collected from the company's computer database. A questionnaire was sent to the employees at baseline, after six months, and after two years; it included the Work Ability Index, the Utrecht Burn Out Scale, and the Nottingham Health Profile measuring quality of life.

Results: Fewer employees (11%) in the intervention group retired early than in the control group (28%). The total average number of sick leave days in two years was 82.3 for the intervention group and 107.8 for the control group. Six months after baseline, employees in the intervention group had better work ability, less burnout, and better quality of life than employees in the control group. Two years after randomisation no differences between the two groups were found.

Conclusions: This occupational health intervention programme proved to be a promising intervention in the prevention of early retirement.

     

Sickness absence and early retirement on health grounds in the construction industry in Ireland

OBJECTIVE—To establish a detailed pattern of the nature and extent of illnesses and injuries among construction workers in Ireland which cause temporary absence from work, and to identify diseases and disabilities which lead to premature retirement from the industry on health grounds.
METHODS—The population base for the study consisted of construction workers who were members of the Construction Federation operatives pension and sick pay scheme. Records of sickness absence since 1981, stored on computer disks, and records of early retirement on health grounds since 1972, stored on microfiche film, were examined. Pertinent data were extracted and transferred to a database; after cleaning and the exclusion of unvalidated data, records of 28 792 absences and 3098 records of early retirement were available for analysis. Data were analysed with Access 97 and Epi Info.
RESULTS—Over the period of the study the mean annual absences were 7.8/100 workers. Three quarters of absences were among younger workers; however, the rate of absence increased with age, as did the mean duration of absence. Injury was the most frequent reason for absence, followed by infectious disease, then musculoskeletal disorders. The mean annual rate of early retirement on health grounds was 5.3/1000 workers. The median age at retirement was 58 years. Cardiovascular disease and musculoskeletal disorders each accounted for nearly one third of the conditions leading to permanent disability on the grounds of which early retirement was granted. During the period of the study, over 677 000 working days were lost due to sickness absence, and over 24 000 potential years of working lives were lost due to early retirement on health grounds.
CONCLUSIONS—The study has shown patterns of sickness absence and early retirement on health grounds in the Irish construction industry which will contribute to the further development of health promotion strategies for construction workers.


Keywords: construction industry; sickness absence; early retirement     

Respiratory health as a predictor of questionnaire return in a sample of United States underground coalminers

A logistic model was used to analyse questionnaire return in a postal survey of 311 coalminers who had left their place of employment between 1977 and 1982. Three measures of respiratory health, obstruction, restriction, and presence of chronic bronchitis symptoms, were included in the model as predictors together with the possibly confounding factors of age, education, and marital and smoking status. Age was positively associated with questionnaire return (p less than 0.001). Speed of return, and whether the return was in response to a prompt, were not predicted by either the respiratory health measures or any of the other possibly confounding variables.