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PubMed2004

Epidemiology of overweight and obesity in a Greek adult population: the ATTICA Study.

OBJECTIVE: To evaluate the status of overweight and obesity in a Greek random sample. RESEARCH METHODS AND PROCEDURES: From 2001 to 2002, 1514 men (20 to 87 years old) and 1528 women (20 to 89 years old) were enrolled into the study. Among several sociodemographic, lifestyle, and bioclinical factors, anthropometric characteristics were also recorded. Overweight and obesity were defined according to the World Health Organization classification. RESULTS: The prevalences of overweight and obesity were 53% and 20% in men and 31% and 15% in women (p for gender differences < 0.05). The age-adjusted peak prevalence of obesity was observed in men older than 40 years old and women between 50 and 59 years old (Bonferonni alpha < 0.001). Central obesity prevailed in 36% of men and 43% of women (p for gender differences < 0.001). Obesity varied from 10% in rural to 25% in urban areas, but this difference was explained mainly by differences in occupational status (p = 0.9). Moreover, obese and overweight participants were older, less educated, more frequently sedentary, consumed higher quantities of alcoholic beverages, and were devoted to an unhealthier diet as compared with those of normal weight (all p < 0.05). A positive association was also observed between BMI and diastolic and systolic blood pressures, total cholesterol, triglycerides, and glucose levels (all p < 0.001). DISCUSSION: Overweight and obesity seem to be a great health problem in the Greek population, especially in middle-aged and older adults. Unfavorable lifestyle habits, low education, and the classical cardiovascular risk factors were associated with the prevalence of these health conditions.

Adult↗
PubMed1996

Job strain and psychological distress in white-collar workers.

OBJECTIVES: In line with Karasek's job strain model, the objective of the study was to determine whether workers submitted to high job strain, a combination of high psychological demand and low decision latitude, develop more psychological distress than workers not submitted to high job strain. A second objective was to determine whether social support at work modifies the association between job strain and psychological distress. METHODS: The design was cross-sectional and included white-collar workers in the Québec city area. A self-administered 26-item questionnaire (the Job Content Questionnaire) measured psychological demand, decision latitude, and social support at work. Psychological distress was measured by the Psychiatric Symptom Index, a 14-item self-administered instrument. RESULTS: Among the 2889 participants, the prevalence of psychological distress was 27.8%. High job strain was present in 20.5% of the subjects. The crude odds ratio (OR) of high job strain with psychological distress was 3.52 [95% confidence interval (95% CI) 2.54-4.88]. The OR adjusted for age, gender, employment status, occupation, social support at work, nonwork social support, cynicism, hostility, domestic load, and stressful life events during the last 12 months was still significant (OR 2.45, 95% CI 1.66-3.62). CONCLUSIONS: Our results support the association between job strain and psychological distress. Social support at work, although significantly associated with psychological distress, did not modify the association between job strain and psychological distress.

Adolescent↗
PubMed2005

Childhood IQ, smoking, and cognitive change from age 11 to 64 years.

We investigated whether smoking is a risk factor for relative cognitive decline from age 11 to 64 years. The potentially confounding effects of childhood IQ, occupational status, level of education, presence of heart disease, hypertension, and lung function were examined. Subjects were nondemented and living independently. They were all born in 1936, had been participants in the same Scottish national IQ survey in 1947, and were reexamined at age about 64 years in 2000-2002. Current smokers and nonsmokers had significantly different mental test scores at age 64. This difference remained after adjustment for childhood IQ. Multiple linear regression identified childhood IQ, level of education, occupational code, lung function, and smoking history as significant independent predictors of mental function at age 64. In this sample, smoking makes a small (<1% variance) independent negative contribution to cognitive aging.

Aging↗
PubMed2002

Sunlight and mortality from breast, ovarian, colon, prostate, and non-melanoma skin cancer: a composite death certificate based case-control study.

OBJECTIVES: To explore whether mortality from female breast, ovarian, colon, and prostate cancer were negatively associated with exposure to sunlight. METHODS: A death certificate based case-control study of mortality was conducted into five cancers: female breast, ovarian, colon, prostate, and non-melanoma skin cancer (as a positive control) to examine associations with residential and occupational exposure to sunlight. Cases were all deaths from these cancers between 1984 and 1995 in 24 states of the United States. Controls, which were age frequency matched to a series of cases, excluded deaths from cancer and certain neurological diseases. Multiple logistic regression was used in a model that included age, sex, race, residential exposure to sunlight (based on region), and socioeconomic status, occupational exposure to sunlight, and physical activity (the last three based on usual occupation). RESULTS: Residential exposure to sunlight was negatively and significantly associated with mortality from female breast, ovarian, prostate, and colon cancer. Only female breast and colon cancer, however, also showed significant negative associations with jobs with the highest occupational exposure to sunlight (odds ratio (OR) 0.82 (95% confidence interval (95% CI) 0.70 to 0.97) for female breast cancer; OR 0.90 (95% CI 0.86 to 0.94) for colon cancer). For both cancers, the negative association with occupational sunlight was greatest in the geographical region of highest exposure to sunlight and was independent of physical activity on the job. Non-melanoma skin cancer, as expected, was positively associated with both residential and occupational sunlight. CONCLUSIONS: In this exploratory study, unlike mortality from non-melanoma skin cancer, mortality from female breast cancer and colon cancer were negatively associated with both residential and occupational sunlight.

Adult↗
PubMed1999

Nonfamilial roles of alcoholic women in treatment.

This study compared the educational achievement and employment-related experiences of a sample of 301 alcoholic women in treatment with 137 non-alcoholic matched controls. Alcoholic women were significantly more likely than controls to marry at a younger age and have their first child earlier, had less education, and were more likely to be employed in blue collar settings than non-alcoholic women. Alcoholic women were significantly less likely to be working outside the home, and employed alcoholic women were more likely to report boredom in the workplace than employed non-alcoholic women. The lives of alcoholic women include more than their familial roles. More attention to issues of education, employment, and occupational status on the part of health care providers is needed.

Adult↗
PubMed2004

Sex differences in first-year students at Canadian medical schools.

OBJECTIVES: To compare male and female medical students by age, level of education before admission to medical school, race/ethnicity, parental education level, socioeconomic status, and attitudes toward public health care. METHODS: In 2001, we conducted an Internet-based survey of all students enrolled in the 16 medical schools across Canada. Based on the high response rate, first-year medical students at Canadian medical schools outside of Quebec were included in this analysis. The interactions between sex and age, years of premedical education, race/ethnicity, parental occupation, education and household income, impact of finances on choice of medical school, future specialty and practice location, attitudes toward private funding in the Canadian health care system were examined using descriptive statistics and chi2 tests. RESULTS: There were no significant differences between male and female medical students in age, level of education before admission, and race/ethnicity. Female students' fathers (p=.046) and mothers (p=.061) were more likely to hold positions of higher occupational status than were those of male students. There was no significant difference between the parental household incomes of male and female students. Male students were more likely than female students to state that financial considerations would affect their choice of specialty (p=.002) and practice location (p=.002). Male students were more likely to express a positive attitude toward private funding in the health care system, both with respect to increasing the amount of private funding (p=.007) and the addition of private paying patients (p=.002). CONCLUSION: Although women have almost reached equity with men in undergraduate medical education, female students are more likely than male students to have highly educated parents, suggesting that some barriers to access may still exist. The differences in attitudes of female and male medical students to finances and the public health care system become increasingly important as more women practice medicine. These sex differences need to be investigated further, as they could have implications for health policy.

Adult↗
PubMed1996

Long-term symptom patterns in duodenal ulcer: psychosocial factors.

Seventy-five patients with recent-onset dyspepsia and endoscopically visible duodenal ulcer underwent psychological evaluation. Following ranitidine treatment, they were reinterviewed periodically for 12 to 76 months (mean 38.6). Ulcer symptoms were present during a mean of 14.9% of follow-up months. Patients did significantly worse if they had a low-status occupation, low education, depression, stressful life events, or abnormal Minnesota Multiphasic Personality Inventory at baseline. Of patients recalling premorbid life stress, those with a normal MMPI had a particularly benign course, whereas those with an abnormal MMPI did particularly poorly (6% versus 29% of months symptomatic: p < 0.04). Age, gender, smoking, drinking, antiinflammatory drugs, pepsinogen, Helicobacter pylori titers, and initial healing had no prognostic effect. Low socioeconomic status, life stress, depression, and psychopathology each predict a relatively poor symptom outcome for duodenal ulcer treated with antisecretory therapy, but psychologically stable individuals who develop an ulcer under stress have an excellent long-term prognosis.

Adolescent↗
PubMedDate not supplied

Voluntary childlessness among American men and women in the late 1980's.

Most studies of childlessness in the United States have relied on unrepresentative, opportunistic samples collected in a variety of ways. Thus, the relationship of various correlates to childlessness is not well known. Some studies have focused on demographic variables, but have not examined attitudinal factors associated with childlessness--something the opportunistic samples have been able to do. In this paper we examine both attitudinal and demographic factors associated with childlessness in the United States. The data used in this paper are from the National Survey of Families and Households collected in 1987 and 1988. The data set includes both demographic data, perceived advantages and disadvantages of having children, and attitudinal data about related social issues. Overall, the rate of voluntary childlessness was not high. Only 3.5 per cent of the men and 2.8 per cent of the women reported that they were childless and did not expect to have children. Only one category of people (unmarried men and women over the age of 35) had rates that exceeded ten per cent. A combined variable of age and marital status was the best predictor of childlessness. A scale of reasons or justifications for having children was the next best predictor. In addition, attendance at religious services, number of hours the respondents desired to work and education (for women only) were related to childlessness. Those who scored highly on measures of support for traditional families and support of extended families also tended to have lower rates of childlessness. Occupational status, religious denomination, and race, on the other hand, were not significantly related to childlessness. Measures of gender equality, religious fundamentalism, and support for mothers working were also not related to childlessness.

Adult↗
PubMed2006

Associations of perceived work strain with nicotine dependence in a community sample.

BACKGROUND: Little is known about work strain and smoking, and even less about work strain and nicotine dependence. AIM: To investigate the relations of perceived work strain with nicotine dependence among an adult general population sample. METHOD: Cross sectional survey with a probability sample of residents of a northern German area with 4075 participants, aged 18-64 years (participation rate 70.2%). The current study is based on 2549 participants who were working 15 or more hours per week. Face to face at-home computer aided interviews (World Health Organization Composite International Diagnostic Interview) were carried out. Work strain, defined as high work demand and low work control, was assessed with a questionnaire. Nicotine dependence was diagnosed according to the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association. In addition, the Fagerström Test for Nicotine Dependence (FTND) was used. RESULTS: Subjects with work strain had an odds ratio of 1.6 (95% CI 1.2 to 2.3) for nicotine dependence compared to those who had no work strain. In a general linear model, higher work strain was associated with a stronger relation between work demand and work control and the FTND. The findings were adjusted for alcohol use disorders, occupational status, age, and sex. CONCLUSION: Perceived work strain is related to nicotine dependence in this general adult population.

Adolescent↗
PubMed2002

Life-course perspective on socioeconomic differences in carotid atherosclerosis.

OBJECTIVE: Socioeconomic status (SES) in adulthood is known to be related to carotid atherosclerosis. However, few studies have tried to assess its association with SES from a life-course perspective. METHODS AND RESULTS: We examined the relationship between SES in childhood and in adulthood and carotid atherosclerosis in a general population of Swedish men and women. Carotid stenosis was determined by B-mode ultrasound. Results showed that women whose fathers' occupations involved unskilled manual labor had higher odds of carotid stenosis than did women whose fathers' occupations involved high- or medium-level nonmanual labor, even after adjustment for adult occupational status and risk factors (odds ratio 1.8, 95% CI 1.1 to 2.8). No such association appeared in men. Furthermore, the impact of life-course SES on atherosclerosis was examined by using an additive measure of one's combined SES during childhood and adulthood. Among women, the odds of carotid stenosis increased with a rise in exposure to low SES during the life-course (P for trend <0.001). In men, no such trend was found. CONCLUSIONS: The results indicate that the total life-course exposure to low SES, with contributions from childhood and adulthood, seems to play a role in atherogenesis in women. Such a pattern of association could not be shown in men.

Age Factors↗
PubMed2006

Correlates of vegetable consumption among young men in the Norwegian National Guard.

The aim of this study was to investigate socio-environmental, personal and behavioural factors associated with vegetable consumption among young men in the military. Respondents included 578 male recruits (mean age 19.7) in the Norwegian National Guard (response rate 78%). Data were collected with a food diary (4-day record) and an attitudinal questionnaire. A model including items on personal factors (attitudes, preferences, self-efficacy, knowledge and perceived availability), socio-environmental factors (social influence, socio-economic status, eating habits at home) and behavioural factors (meal frequency, number of hot meals, snack consumption, smoking) was developed to assess correlates of the recruits' vegetable intake. The study showed that the recruits' consumption of vegetables (including potatoes) varied from 0 to 957 g/day with an average of 244 g/day. Overall, 32% of the variance in vegetable consumption was explained by factors included in the model. The most important correlates were occupational status of the parents, frequency of vegetable consumption when living at home, social influence, preferences for cooked vegetables, weight beliefs, number of hot meals for lunch and dinner and smoking habits. In conclusion, the present study indicates that in addition to cognitive factors, socio-environmental and behavioural factors can explain the variance in vegetable intake among young men in the military.

Adolescent↗
PubMed1992

Occupational and other environmental factors and multiple myeloma: a population based case-control study.

Epidemiological studies on the aetiology of multiple myeloma are reviewed as a background to this population based case-control study performed in an area with a high incidence of multiple myeloma. The purpose was to identify and evaluate several suspected environmental factors in relation to this disease. A total of 275 confirmed cases diagnosed in four counties in northern Sweden during four years were compared with the same number of control subjects drawn from population registries. The controls were matched for age, sex, county, and vital status. Occupations and work associated exposures to chemicals and other potential carcinogens were assessed by an extensive questionnaire that also included questions on smoking habits, residential building materials, vicinity to electrical power lines, and leisure time contact with animals, electrical equipment, and chemicals. Information obtained from the questionnaires was completed by telephone interviews when necessary. Univariate analysis and multivariate logistic regression were performed. The study confirmed an association found earlier between farming and multiple myeloma. Some domestic animals (cattle, horses, and goats) and two types of pesticides (phenoxyacetic acids and DDT) were indicated as risk factors within farming. Exposure to electromagnetic fields, asbestos, and organic solvents were negatively associated with myeloma in this study.

Agricultural Workers' Diseases↗
PubMed2005

A widening health gap in general practice? Socio-economic differences in morbidity between 1975 and 2000 in The Netherlands.

BACKGROUND: During the past two decades, socio-economic inequalities in health have been a major research theme in Western Europe. Research has shown that there are persistent differences in health between people with a high socio-economic status (SES) compared with people with a low SES. There are also indications for a widening health gap. The present paper aimed to find out whether this widening health gap exists in The Netherlands using morbidity data from a general practice (GP) registry. METHODS: Incidence data from a GP registry were used, involving over 12,000 patients. Morbidity data from 1975 to 2000 were grouped into 25 disease categories. SES was based on household occupational status. Poisson regression was used to determine the relationship between morbidity and SES and its changes over time. Separate analyses were performed for men and women. RESULTS: In most disease categories, a clear SES gradient disadvantageous to the lowest-SES group was identified: 17 out of 22 morbidity categories for men and 17 out of 24 for women. For seven (men) and eight (women) morbidity categories out of 17, the SES gradient increased between 1975 and 2000. CONCLUSIONS: This study provides new evidence for a widening gap in health between higher and lower SES in The Netherlands, using GP-defined disease data and a wide range of morbidity categories.

Adult↗
PubMed1977

Studies of correlation between progression of coronary artery disease, as assessed by coronary arteriography, left ventricular end-diastolic pressure, ejection fraction, and employability.

The occupational status of a group of 100 male patients, 35 to 68 years of age, with chronic ischaemic heart disease was studied, and related to the severity and distribution of coronary artery stenosis seen on the arteriograms and to left ventricular function. In this series of patients 31 per cent were working, 31 per cent were recorded as temporarily sick, and 38 per cent as permanently disabled. It appears that while the type of previous occupation and physical activity associated with the job were of importance, there was no correlation between employability on the one hand and severity and distribution of coronary artery disease on the other. 'Blue-collar' workers had a higher rate of unemployment than those in 'white collar' occupations, but this could not be explained by differences in severity of coronary artery disease.

Adult↗
PubMed1994

Social inequalities and health status in western Germany.

STUDY OBJECTIVE: To examine social class gradients for seven self-reported diseases in western Germany. DESIGN: A pooled analysis of three cross-sectional representative health surveys in western Germany and three health surveys in the six intervention regions of the German Cardiovascular Prevention Study. PARTICIPANTS: 44,363 study subjects, of both sexes, with German nationality, aged 25-69 years, were examined in the national and regional health surveys from 1984 to 1991. MEASUREMENT AND MAIN RESULTS: Assessment of disease prevalence was carried out by a standardized self-administered questionnaire. Social class was assessed using a composite index combining educational achievement, occupational status and household income. Cigarette smoking and Pattern A behaviour were based on self-report. Height and weight were measured by physical examination and body mass index was calculated. Statistical analysis were performed using multiple logistical regression. Response rates ranged from 66.0 to 71.4% in the national surveys and from 65.9 to 83.8% in the regional surveys. For both sexes, the prevalence of previous myocardial infarction and the prevalence of stroke, diabetes mellitus and chronic bronchitis was significantly higher in the lower social classes. In males only, the prevalence of intervertebral disc damage and peptic ulcer was significantly higher in the lower social classes. In females only, there was a similar gradient for hyperuricaemia and gout. In both sexes, allergies and hay fever were the only diseases with higher prevalence in the higher social classes. Adjusting these trends for smoking, obesity and Pattern A behaviour resulted in only minor changes in the slopes of the disease-specific social class gradients. CONCLUSION: In western Germany, despite a health system with almost free access for the general population, strong social class inequalities exist for many diseases. These inequalities cannot be explained by social class differences in smoking, obesity or Pattern A behaviour. More research is needed to identify underlying causes for these persistent social inequalities in health status.

Adult↗
PubMed2005

Work stress, smoking status, and smoking intensity: an observational study of 46,190 employees.

STUDY OBJECTIVE: To examine the relation between work stress, as indicated by the job strain model, and the effort-reward imbalance model, and smoking. SETTING: Ten municipalities and 21 hospitals in Finland. DESIGN AND PARTICIPANTS: Binary logistic regression models for the prevalence of smoking were related to survey responses of 37,309 female and 8881 male Finnish public sector employees aged 17-65. Separate multinomial logistic regression models were calculated for smoking intensity for 8130 smokers. In addition, binary logistic regression models for ex-smoking were fitted among 16,277 former and current smokers. In all analyses, adjustments were made for age, basic education, occupational status, type of employment, and marital status. MAIN RESULTS: Respondents with high effort-reward imbalance or lower rewards were more likely to be smokers. Among smokers, an increased likelihood of higher intensity of smoking was associated with higher job strain and higher effort-reward imbalance and their components such as low job control and low rewards. Smoking intensity was also higher in active jobs in women, in passive jobs, and among employees with low effort expenditure. Among former and current smokers, high job strain, high effort-reward imbalance, and high job demands were associated with a higher likelihood of being a current smoker. Lower effort was associated with a higher likelihood of ex-smoking. CONCLUSIONS: This evidence suggests an association between work stress and smoking and implies that smoking cessation programmes may benefit from taking into account the modification of stressful features of work environment.

Adolescent↗
PubMed2006

Can gender differences in psychosocial factors be explained by socioeconomic status?

AIMS: The aims of this study were to examine (1) if associations between gender and psychosocial factors could be explained by socioeconomic status (SES) and (2) if associations between gender and psychosocial factors are more salient at lower levels of SES. METHODS: Psychosocial factors such as decision latitude and social integration were studied in a cross-sectional study in two steps. In a public health survey, 4,086 randomly selected men and women aged 30-64 participated. Of these, 257 men and women also participated in an in-depth study. SES was measured in terms of education and occupation. Linear regression models were used to test associations between gender, SES, and a broad range of psychosocial factors. RESULTS: Women reported lower scale scores on decision latitude, coping, and self-esteem, as well as more job strain, depression, and vital exhaustion, while men reported more cynicism (all p<0.05). Observed gender differences were still significant after control for effect of education, while after control for occupational status the effect of gender was lost for decision latitude and job strain. Significant interaction factors were found between gender and educational status for psychological demands, decision latitude, social integration, coping, and hopelessness. CONCLUSIONS: Gender differences, found for a broad range of psychosocial factors, could not be explained by SES. However, associations between gender and psychosocial factors were more salient at lower levels of SES. Psychosocial factors, especially decision latitude and social integration, may help explain why women with low SES experience poorer health.

Adaptation, Psychological↗
PubMed2005

Social inequality in perceived environmental exposures in relation to housing conditions in Germany.

In Germany the impact of socioeconomic factors on environmental exposures and adverse housing conditions has been rarely studied up to now. The aim of our study was to assess whether and, if yes, how perceived exposure to noise and air pollution is influenced by socioeconomic status in Germany. We used data from a large-scale population-based survey. In this survey, data on perceived exposure to noise and air pollution and on socioeconomic status and housing conditions were collected on an individual basis. The study population consisted of 7,275 adults aged 17-98 years (40% women), each representing the head of one household. For the association between perceived environmental exposure and social factors confounder-adjusted odds ratios (OR) with 95% confidence intervals were calculated by binary or ordinal logistic regression. In bivariate analyses subjects with non-German nationality, East Germans, respondents with low income, those with lower educational and occupational status, and subjects living in adverse housing conditions were more likely to report being highly exposed. In multivariate analyses high perceived exposure to noise was associated with low household income (OR 1.52 [95% CI 1.13-2.05] lowest versus highest income group). Perceived air pollution exposure was also related to household income (1.67 [1.14-2.44] lower middle versus highest income group). Further associated variables were need for renovation of the house, type of house, and type of neighborhood. This study shows that in Germany, as in other industrial countries, environmental exposures are distributed unequally and that especially economic differences play important roles.

Adolescent↗