Neighbourhood influences on health.
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Epidemiologic Measurements↗
Biomedical subjects
I Kawachi
Publications and source records attributed to I Kawachi.
The impact of multiple role occupancy on health-related behaviours in Japan: differences by gender and age.
OBJECTIVES: We examined gender and age differences in the impact of multiple role occupancy on health-related behaviours and health status among working age Japanese adults. METHODS: We analysed the individually linked, nationally representative data of 5693 respondents aged 20-59, who completed the Comprehensive Survey of the Living Conditions of People on Health and Welfare and the National Nutrition Survey, conducted by the Japanese government in 1995. RESULTS: Younger women benefited from multiple roles (less smoking), while younger men demonstrated more high-risk behaviours (more smoking, heavier drinking). By contrast, middle-aged men benefited from multiple roles (less smoking, fewer health problems), while middle-aged women reported lower health maintenance behaviours (less exercise, fewer health check-ups). CONCLUSIONS: Japanese society appears to be undergoing a transition in gender roles, as reflected by age and gender differences in the impact of multiple roles on health and health-related behaviours. Middle-aged males benefit from multiple roles (being the primary bread-winner and being married), while middle-aged women do not. This pattern seems to break down for younger Japanese men and women.
Adult↗
Bonding versus bridging social capital and their associations with self rated health: a multilevel analysis of 40 US communities.
STUDY OBJECTIVE: Few studies have distinguished between the effects of different forms of social capital on health. This study distinguished between the health effects of summary measures tapping into the constructs of community bonding and community bridging social capital. DESIGN: A multilevel logistic regression analysis of community bonding and community bridging social capital in relation to individual self rated fair/poor health. SETTING: 40 US communities. PARTICIPANTS: Within community samples of adults (n = 24 835), surveyed by telephone in 2000-2001. MAIN RESULTS: Adjusting for community sociodemographic and socioeconomic composition and community level income and age, the odds ratio of reporting fair or poor health was lower for each 1-standard deviation (SD) higher community bonding social capital (OR = 0.86; 95% = 0.80 to 0.92) and each 1-SD higher community bridging social capital (OR = 0.95; 95% CI = 0.88 to 1.02). The addition of indicators for individual level bonding and bridging social capital and social trust slightly attenuated the associations for community bonding social capital (OR = 0.90, 95% CI = 0.84 to 0.97) and community bridging social capital (OR = 0.96, 95% CI = 0.89 to 1.03). Individual level high formal bonding social capital, trust in members of one's race/ethnicity, and generalised social trust were each significantly and inversely related to fair/poor health. Furthermore, significant cross level interactions of community social capital with individual race/ethnicity were seen, including weaker inverse associations between community bonding social capital and fair/poor health among black persons compared with white persons. CONCLUSIONS: These results suggest modest protective effects of community bonding and community bridging social capital on health. Interventions and policies that leverage community bonding and bridging social capital might serve as means of population health improvement.
Adult↗
Lifelong socioeconomic trajectory and premature mortality (35-65 years) in France: findings from the GAZEL Cohort Study.
BACKGROUND: Studies conducted in the UK and Scandinavia show an inverse association between lifetime socioeconomic position and adult mortality. However, there are virtually no data from other countries and few investigations have examined non-cardiovascular mortality in men and women. METHODS: Lifelong socioeconomic trajectories (father's occupation, own occupation in young adulthood and in mid-life) and premature (< or = 65 years) mortality (all-cause, smoking-related cancer, diseases of the circulatory system and external causes) in the French GAZEL Cohort Study (14,972 men and 5,598 women, followed up between 1990 and 2004) were studied. Hazard ratios (HRs) were estimated using Cox's regression models adjusted for age, marital status, tobacco smoking, alcohol consumption, body mass index, and fruit and vegetable consumption. RESULTS: Men and women who experienced lifelong disadvantage or downward intergenerational mobility were at high risk of dying prematurely compared with those with a favourable trajectory (age-adjusted HRs for all-cause mortality: cumulative disadvantage: HR 1.61, 95% confidence interval (CI) 1.26 to 2.06 in men and HR 1.95, 95% CI 1.10 to 3.47 in women; downward mobility: HR 1.87, 95% CI 1.35 to 2.58 in men and HR 2.05, 95% CI 1.12 to 3.75 in women). Associations were strongest for mortality due to chronic diseases (smoking-related cancers and diseases of the circulatory system). These associations were partly explained by marital status, body mass index, alcohol consumption, cigarette smoking, and fruit and vegetable consumption. CONCLUSIONS: In France, where the leading cause of premature death is cancer, lifelong socioeconomic position is associated with the risk of dying before the age of 65 years. Adult factors seem more relevant than childhood socioeconomic circumstances.
Adult↗
Injustice at work and health: causation or correlation?
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Absenteeism↗
Social capital and collective efficacy in Hungary: cross sectional associations with middle aged female and male mortality rates.
OBJECTIVES: Social capital, collective efficacy, and religious involvement have each been linked to population health. This study examined the relations between these measures and male/female mortality rates in Hungary. DESIGN: Cross sectional, ecological study. SETTING: 150 sub-regions of Hungary. PARTICIPANTS AND METHODS: 12643 people were interviewed in 2002 (the "Hungarostudy 2002" survey). Social capital was measured by lack of social trust, reciprocity between citizens, and membership in civil organisations. Collective efficacy was measured by survey items from the Project on Human Development in Chicago Neighborhoods. Religious involvement was measured by church attendance. MAIN OUTCOME MEASURE: Gender specific all cause mortality rates for the middle aged population (45-64 years) in the 150 sub-regions of Hungary, provided by the Central Statistical Office (CSO). RESULTS: Social capital, collective efficacy, as well as religious involvement were each significantly associated with middle age mortality. After education, collective efficacy showed the strongest association with mortality in both men and women. Among men, socioeconomic status, collective efficacy, social distrust, competitive attitude, reciprocity, and membership of civic organisations explained 68.0% of the sub-regional variations in mortality rates. Among women the same variables explained only 29.3% of the variance in mortality rates. Religious involvement was protective among women. CONCLUSION: Collective efficacy and social capital are significant predictors of mortality rates in both men and women across sub-regions of Hungary. Gender differences in the relative importance of social factors may help to explain the differential impact of economic transformation on mortality rates for men and women in Central-Eastern European countries.
Cross-Sectional Studies↗
Socio-economic status, family disruption and residential stability in childhood: relation to onset, recurrence and remission of major depression.
BACKGROUND: Childhood adversity significantly increases the risk of depression, but it is unclear whether this risk is most pronounced for depression occurring early in life. In the present study, we examine whether three aspects of childhood adversity--low socio-economic status (SES), family disruption, and residential instability--are related to increased risk of depression during specific stages of the life course. We also examine whether these aspects of childhood adversity are related to the severity of depression. METHOD: A sample of 1089 of the 4140 births enrolled in the Providence, Rhode Island cohort of the National Collaborative Perinatal Project was interviewed between the ages of 18 and 39. Measures of parental SES, childhood family disruption and residential instability were obtained upon mother's enrolment and at age 7. Age at onset of major depressive episode, lifetime number of depressive episodes, and age at last episode were ascertained via structured diagnostic interviews. Survival analysis was used to identify risk factors for depression onset and remission and Poisson regression was used to model the recurrence rate of depressive episodes. RESULTS: Low parental SES, family disruption and a high level of residential instability, defined as three or more family moves, were related to elevated lifetime risks of depression; the effects of family disruption and residential instability were most pronounced on depression onset by age 14. Childhood adversity was also related to increased risk of recurrence and reduced likelihood of remission. CONCLUSIONS: Childhood social disadvantage significantly influences risk of depression onset both in childhood and in adulthood. Early childhood adversity is also related to poor prognosis.
Adolescent↗
Income inequality and health: multilevel analysis of Chilean communities.
STUDY OBJECTIVE: The evidence supporting the effect of income inequality on health has been largely observed in societies far more egalitarian than the US. This study examines the cross sectional multilevel associations between income inequality and self rated poor health in Chile; a society more unequal than the US. DESIGN: A multilevel statistical framework of 98 344 people nested within 61 978 households nested within 285 communities nested within 13 regions. SETTING: The 2000 National Socioeconomic Characterization Survey (CASEN) data from Chile. PARTICIPANTS: Adults aged 18 and above. The outcome was a dichotomised self rated health (0 if very good, good or average; 1 if poor, or very poor). Individual level exposures included age, sex, ethnicity, marital status, education, employment status, type of health insurance, and household level exposures include income and residential setting (urban/rural). Community level exposures included the Gini coefficient and median income. MAIN RESULTS: Controlling for individual/household predictors, a significant gradient was observed between income and poor self rated health, with very poor most likely to report poor health (OR: 2.94) followed by poor (OR: 2.77), low (OR: 2.06), middle (OR: 1.73), high (OR: 1.38) as compared with the very high income earners. Controlling for household and community effects of income, a significant effect of community income inequality was observed (OR:1.22). CONCLUSIONS: Household income does not explain any of the between community differences; neither does it account for the effect of community income inequality on self rated health, with more unequal communities associated with a greater probability of reporting poor health.
Adolescent↗
Social capital in a changing society: cross sectional associations with middle aged female and male mortality rates.
OBJECTIVES: Social capital has been linked to self rated health and mortality rates. The authors examined the relations between measures of social capital and male/female mortality rates across counties in Hungary. DESIGN: Cross sectional, ecological study. SETTING: 20 counties of Hungary. PARTICIPANTS AND METHODS: 12,640 people were interviewed in 1995 (the "Hungarostudy II" survey), representing the Hungarian population according to sex, age, and county. Social capital was measured by three indicators: lack of social trust, reciprocity between citizens, and help received from civil organisations. Covariates included county GDP, personal income, education, unemployment, smoking, and alcohol spirit consumption. MAIN OUTCOME MEASURE: Gender specific mortality rates were calculated for the middle aged population (45-64 years) in the 20 counties of Hungary. RESULTS: All of the social capital variables were significantly associated with middle age mortality, but levels of mistrust showed the strongest association. Several gender differences were observed, namely male mortality rates were more closely associated with lack of help from civic organisations, while female mortality rates were more closely connected with perceptions of reciprocity. CONCLUSION: There are gender differences in the relations of specific social capital indicators to mortality rates. At the same time, perceptions of social capital within each sex were associated with mortality rates in the opposite sex.
Cross-Sectional Studies↗
Tobacco control in Australia.
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Advertising↗
Stress and suicide in the Nurses' Health Study.
STUDY OBJECTIVES: Although stress is thought to be a risk factor for suicide, most research has been retrospective or has focused on attempted suicides or suicide ideation. This study examined prospectively the associations between self perceived stress, diazepam use, and death from suicide among adult women. DESIGN: A cohort study was conducted with 14 years of follow up. Stress at home and at work were assessed by questionnaire and scored on a four point scale: minimal, light, moderate, or severe. SETTING: Eleven states within the United States. PARTICIPANTS: Female nurses (n=94 110) who were 36 to 61 years of age when they answered questions on stress and diazepam use in 1982. RESULTS: During 1 272 000 person years of observation 73 suicides were identified. After adjustment for age, smoking, coffee consumption, alcohol intake, and marital status, the relation between self reported stress and suicide remained U shaped. Compared with the light home and work stress categories, which had the lowest incidences of suicide, risks were increased among women reporting either severe (relative risk (RR) = 3.7, 95% confidence intervals (CI) 1.7 to 8.3) or minimal (RR=2.1, 95% CI 1.0 to 4.5) home stress and either severe (RR=1.9, 95% CI 0.8 to 4.7) or minimal (RR=2.4, 95% CI 0.9 to 6.1) work stress. When responses to home and work stress were combined, there was an almost fivefold increase in risk of suicide among women in the high stress category. Risk of suicide was over eightfold among women reporting high stress or diazepam use compared with those reporting low stress and no diazepam use. CONCLUSIONS: The relation between self reported stress and suicide seems to be U shaped among adult women. The excess risk for those reporting minimal stress may reflect denial or undiagnosed depression or an association with some other unmeasured risk factor for suicide.
Adult↗
Income inequality and economic residential segregation.
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Health Status Indicators↗
Development and validation of an instrument to measure perceived neighbourhood quality in Taiwan.
STUDY OBJECTIVE: s: Social epidemiologists have hypothesised that neighbourhood quality may exert an important contextual influence on mental and physical health. However, validated instruments do not exist for measuring neighbourhood quality in Taiwan. A self reported instrument to measure perceived neighbourhood quality in Taiwan was developed and tested. DESIGN: Community survey. SETTING: Southern Taiwan, including the metropolitan Kaohsiung area and eight surrounding communities, representing urban, suburban, and rural districts. PARTICIPANTS: A total of 1084 residents, aged 18 to 75, were surveyed during 1999 to 2000. MAIN RESULTS: Using factor analysis with varimax rotation, three subscales explained 54.8% of the variance in our 15 item Neighbourhood Quality Index: perceived social capital (Cronbach alpha=0.84), perceived security (alpha=0.78), and adequacy of services and facilities (alpha=0.67). Lower perceived neighbourhood social capital (odds ratio, OR, 1.26; 95% CI: 1.21 to 1.32), lower neighbourhood security (OR 1.37; 95% CI: 1.26 to 1.48), and inadequate neighbourhood services and facilities (OR 1.17; 95% CI: 1.06 to 1.28) were all related to higher residential dissatisfaction. CONCLUSIONS: A Neighbourhood Quality Index was developed for use in Taiwan with good internal consistency and test-retest reliability, as well as convergent validity. Future studies will examine the association between this index and measures of individual mental and physical health.
Adult↗
A glossary for health inequalities.
In this glossary, the authors address eight key questions pertinent to health inequalities: (1) What is the distinction between health inequality and health inequity?; (2) Should we assess health inequalities themselves, or social group inequalities in health?; (3) Do health inequalities mainly reflect the effects of poverty, or are they generated by the socioeconomic gradient?; (4) Are health inequalities mediated by material deprivation or by psychosocial mechanisms?; (5) Is there an effect of relative income on health, separate from the effects of absolute income?; (6) Do health inequalities between places simply reflect health inequalities between social groups or, more significantly, do they suggest a contextual effect of place?; (7) What is the contribution of the lifecourse to health inequalities?; (8) What kinds of inequality should we study?
Health Status↗
Japanese cases of familial hemiplegic migraine with cerebellar ataxia carrying a T666M mutation in the CACNA1A gene.
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Adult↗
Cigarette nicotine yields and nicotine intake among Japanese male workers.
OBJECTIVES: To analyse brand nicotine yield including "ultra low" brands (that is, cigarettes yielding less-than-or-equal 0.1 mg of nicotine by Federal Trade Commission (FTC) methods) in relation to nicotine intake (urinary nicotine, cotinine and trans-3'-hydroxycotinine) among 246 Japanese male smokers. DESIGN: Cross sectional study. SETTING: Two companies in Osaka, Japan. SUBJECTS: 130 Japanese male workers selected randomly during their annual regular health check up and 116 Japanese male volunteers taking part in a smoking cessation programme. MAIN OUTCOME MEASUREMENTS: Subjects answered a questionnaire about smoking habits. Following the interview, each participant was asked to smoke his own cigarette and, after extinguishing it, to blow expired air into an apparatus for measuring carbon monoxide concentration. Urine was also collected for the assays of nicotine metabolites. RESULTS: We found wide variation in urinary nicotine metabolite concentrations at any given nicotine yield. Based on one way analysis of variance (ANOVA), the urinary nicotine metabolite concentrations of ultra low yield cigarette smokers were significantly lower compared to smokers of high (p = 0.002) and medium yield cigarettes (p = 0.017). On the other hand, the estimated nicotine intake per ultra low yield cigarette smoked (0.59 mg) was much higher than the 0.1 mg indicated by machine. CONCLUSIONS: In this study of Japanese male smokers, actual levels of nicotine intake bore little relation to advertised nicotine yield levels. Our study reinforces the need to warn consumers of inappropriate advertisements of nicotine yields, especially low yield brands.
Administration, Inhalation↗
Rotating night shifts and risk of breast cancer in women participating in the nurses' health study.
BACKGROUND: Melatonin shows potential oncostatic action, and light exposure during night suppresses melatonin production. There is little information, however, about the direct effect of night work on the risk of cancer. We investigated the effect of night work in breast cancer. METHODS: We examined the relationship between breast cancer and working on rotating night shifts during 10 years of follow-up in 78 562 women from the Nurses' Health Study. Information was ascertained in 1988 about the total number of years during which the nurses had worked rotating night shifts with at least three nights per month. From June 1988 through May 1998, we documented 2441 incident breast cancer cases. Logistic regression models were used to calculate relative risks (RRs) and 95% confidence intervals (CIs), adjusted for confounding variables and breast cancer risk factors. All statistical tests were two-sided. RESULTS: We observed a moderate increase in breast cancer risk among the women who worked 1-14 years or 15-29 years on rotating night shifts (multivariate adjusted RR = 1.08 [95% CI = 0.99 to 1.18] and RR = 1.08 [95% CI = 0.90 to 1.30], respectively). The risk was further increased among women who worked 30 or more years on the night shift (RR = 1.36; 95% CI = 1.04 to 1.78). The test for trend was statistically significant (P =.02). CONCLUSIONS: Women who work on rotating night shifts with at least three nights per month, in addition to days and evenings in that month, appear to have a moderately increased risk of breast cancer after extended periods of working rotating night shifts.
Adult↗
Dendritic cells presenting pyruvate kinase M1/M2 isozyme peptide can induce experimental allergic myositis in BALB/c mice.
Polymyositis (PM) is an inflammatory muscle disease caused by autoimmune dysfunction, considered to be caused by cytotoxic CD8 T cells. To date, no autoantigens have been identified. We attempted to induce an experimental allergic myositis (EAM) in BALB/c mice by inoculating syngeneic dendritic cells (DC) presenting peptides that are expected to match the binding anchor motif of H-2K(d) (BALB/c). We selected peptides that are highly expressed in skeletal muscle. Only when we inoculated syngeneic bone marrow-derived DC presenting pyruvate kinase M1/M2 peptide 464-472 in BALB/c mice, 41.7% of the mice (EAM) developed pathological changes in skeletal muscle compatible to human PM. Under other conditions (when we inoculated DC presenting no synthetic peptides into BALB/c or C57BL/6 mice and DC presenting pyruvate kinase M1/M2 peptide into C57BL/6 mice), there were no necrotizing and inflammatory lesions. Induction of EAM in the same manner as above also induced CTL activity against P815 cells with the same peptide and syngeneic differentiated cultured myotubes without peptides by the chromium release assay. Consistent with the similarity of the binding anchor motif of H-2K(d) (BALB/c) and HLA A*2402, we conclude that pyruvate kinase M1/M2 peptide is a candidate autoantigen not only in BALB/c-EAM but also in human-PM with the HLA A*2402 allele.
Animals↗