http://jech.bmj.com/ Latest from JECH en-us http://jech.bmj.com/cgi/content/full/jech-2012-202296v1?rss=1 BackgroundBirth order is associated with outcomes such as birth weight and adult socioeconomic position (SEP), but little is known about the association with adult height. This potential birth order-height association is important because height predicts health, and because the association may help explain population-level height trends. We studied the birth order-height association and whether it varies by family characteristics or birth cohort. MethodsWe used the Swedish Military Conscription Register to analyse adult height among 652 518 men born in 1951-1983 using fixed effects regression models that compare brothers and account for genetic and social factors shared by brothers. We stratified the analysis by family size, parental SEP and birth cohort. We compared models with and without birth weight and birth length controls. ResultsUnadjusted analyses showed no differences between the first two birth orders but in the fixed effects regression, birth orders 2, 3 and 4 were associated with 0.4, 0.7 and 0.8 cm (p<0.001 for each) shorter height than birth order 1, respectively. The associations were similar in large and small and high-SEP and low-SEP families, but were attenuated in recent cohorts. Birth characteristics did not explain these associations. ConclusionsBirth order is an important determinant of height. The height difference between birth orders 3 and 1 is larger than the population-level height increase achieved over 10 years. The attenuation of the effect over cohorts may reflect improvements in living standards. Decreases in family size may explain some of the secular-height increases in countries with decreasing fertility. http://jech.bmj.com/cgi/content/full/jech-2012-202296v1?rss=1 Fri, 3 May 2013 00:00:00 +0000 Journal of Epidemiology and Community Health Subject Collection: Open access http://jech.bmj.com/cgi/content/full/67/5/385?rss=1 Introduction Epidemiology research is a truly multidisciplinary subject, relying on areas of knowledge as diverse as medicine, biology, statistics, sociology and geography.1 The creation of large-scale epidemiological models and the development of effective model-based prediction methods can only be achieved if efficient data collection techniques based on reliable policies for data sharing between research communities and health authorities are adopted.2 As a research domain that so strongly depends on heterogeneous data from diverse origins, epidemiology greatly requires a proper integrative framework to cope with its inherent multidisciplinarity. One promising way to meet these requirements is the adoption by the epidemiology community of Semantic Web technologies. The Semantic Web is a vision of information management and sharing that promotes intelligent access to data on the world wide w ... http://jech.bmj.com/cgi/content/full/67/5/385?rss=1 Wed, 1 May 2013 00:00:00 +0000 Journal of Epidemiology and Community Health Subject Collection: Open access http://jech.bmj.com/cgi/content/full/67/5/398?rss=1 BackgroundTheoretically, there may be benefit in augmenting school-based sexual health education with sexual health services, but the outcomes are poorly understood. Healthy Respect 2 (HR2) combined sex education with youth-friendly sexual health services, media campaigns and branding, and encouraged joint working between health services, local government and the voluntary sector. This study examined whether HR2: (1) improved young people's sexual health knowledge, attitudes, behaviour and use of sexual health services and (2) reduced socioeconomic inequalities in sexual health. MethodsA quasi-experiment in which the intervention and comparison areas were matched for teenage pregnancy and terminations, and schools were matched by social deprivation. 5283 pupils aged 15-16 years (2269 intervention, 3014 comparison) were recruited to cross-sectional surveys in 2007, 2008 and 2009. ResultsThe intervention improved males' and, to a lesser extent, females' sexual health knowledge. Males' intention to use condoms, and reported use of condoms, was unaffected, compared with a reduction in both among males in the comparison arm. Although females exposed to the intervention became less accepting of condoms, there was no change in their intention to use condoms and reported condom use. Pupils became more tolerant of sexual coercion in both the intervention and comparison arms. Attitudes towards same-sex relationships remained largely unaffected. More pupils in the HR2 area used sexual health services, including those from lower socioeconomic backgrounds. This aside, sexual health inequalities remained. ConclusionsCombining school-based sex education and sexual health clinics has a limited impact. Interventions that address the upstream causes of poor sexual health, such as a detrimental sociocultural environment, represent promising alternatives. These should prioritise the most vulnerable young people. http://jech.bmj.com/cgi/content/full/67/5/398?rss=1 Wed, 1 May 2013 00:00:00 +0000 Journal of Epidemiology and Community Health Subject Collection: Open access http://jech.bmj.com/cgi/content/full/67/5/412?rss=1 BackgroundResearch comparing mortality by socioeconomic status has found that inequalities are not the smallest in the Nordic countries. This is in contrast to expectations given these countries' policy focus on equity. An alternative way of studying inequality has been little used to compare inequalities across welfare states and may yield a different conclusion. MethodsWe used average life expectancy lost per death as a measure of total inequality in mortality derived from death rates from the Human Mortality Database for 37 countries in 2006 that we grouped by welfare state type. We constructed a theoretical lowest mortality comparator country' to study, by age, why countries were not achieving the smallest inequality and the highest life expectancy. We also studied life expectancy as there is an important correlation between it and inequality. ResultsOn average, Nordic countries had the highest life expectancy and smallest inequalities for men but not women. For both men and women, Nordic countries had particularly low younger age mortality contributing to smaller inequality and higher life expectancy. Although older age mortality in the Nordic countries is not the smallest. There was variation within Nordic countries with Sweden, Iceland and Norway having higher life expectancy and smaller inequalities than Denmark and Finland (for men). ConclusionsOur analysis suggests that the Nordic countries do have the smallest inequalities in mortality for men and for younger age groups. However, this is not the case for women. Reducing premature mortality among older age groups would increase life expectancy and reduce inequality further in Nordic countries. http://jech.bmj.com/cgi/content/full/67/5/412?rss=1 Wed, 1 May 2013 00:00:00 +0000 Journal of Epidemiology and Community Health Subject Collection: Open access http://jech.bmj.com/cgi/content/full/jech-2012-201927v2?rss=1 BackgroundWhile various measures of common mental disorders (CMD) have been found to be associated with mortality, a comparison of how different measures predict mortality may improve our understanding of the association. This paper compares how the Hospital Anxiety and Depression Scale (HADS) and the 30-item General Health Questionnaire (GHQ-30) predict all cause and cause-specific mortality. MethodsData on 2547 men and women from two cohorts, aged approximately 39 and 55 years, from the West of Scotland Twenty-07 Study who were followed up for mortality over an average of 18.9 (SD 5.0) years. Scores were calculated for HADS depression (HADS-D), HADS Anxiety (HADS-A) and GHQ-30. Cox Proportional Hazards Models were used to determine how each CMD measure predicted mortality. ResultsAfter adjusting for serious physical illness, smoking, social class, alcohol, obesity, pulse rate and living alone, HRs (95% CI) per SD increase in score for all-cause mortality were: 1.15 (1.07 to 1.25) for HADS-D; 1.13 (1.04 to 1.23) for GHQ-30 and 1.05 (0.96 to 1.14) for HADS-A. After the same adjustments, cardiovascular disease mortality was also related to HADS-D (HR 1.24 (1.07 to 1.43)), to GHQ-30 (HR 1.24 (1.11 to 1.40)) and to HADS-A (HR 1.15 (1.01 to 1.32)); respiratory mortality to GHQ-30 (HR 1.33 (1.13 to 1.55)) and mortality from other causes, excluding injuries, to HADS-D (HR 1.28 (1.05 to 1.55)). ConclusionsThere were associations between CMD and both all-cause and cause-specific mortality which were broadly similar for GHQ-30 and HADS-D and were still present after adjustment for important confounders and mediators. http://jech.bmj.com/cgi/content/full/jech-2012-201927v2?rss=1 Thu, 25 Apr 2013 00:00:00 +0000 Journal of Epidemiology and Community Health Subject Collection: Open access http://jech.bmj.com/cgi/content/full/67/4/299?rss=1 BackgroundPeople living in areas of multiple deprivation are more likely to smoke and less likely to quit smoking. This study examines the effect on smoking and intention to quit smoking for those who have experienced housing improvements (HI) in deprived areas of Glasgow, UK, and investigates whether such effects can be explained by improved mental health. MethodsQuasi-experimental, 2-year longitudinal study, comparing residents' smoking and intention to quit smoking for HI group (n=545) with non-HI group (n=517), adjusting for baseline (2006) sociodemographic factors and smoking status. SF-12 mental health scores were used to assess mental health, along with self-reported experience of, and General Practitioner (GP) consultations for, anxiety and depression in the last 12 months. ResultsThere was no relationship between smoking and HI, adjusting for baseline rates (OR=0.97, 95% CI 0.57 to 1.67, p=0.918). We found an association between intention to quit and HI, which remained significant after adjusting for sociodemographics and previous intention to quit (OR 2.16, 95% CI 1.12 to 4.16, p=0.022). We found no consistent evidence that this association was attenuated by improvement in our three mental health measures. ConclusionsProviding residents in disadvantaged areas with better housing may prompt them to consider quitting smoking. However, few people actually quit, indicating that residential improvements or changes to the physical environment may not be sufficient drivers of personal behavioural change. It would make sense to link health services to housing regeneration projects to support changes in health behaviours at a time when environmental change appears to make behavioural change more likely. http://jech.bmj.com/cgi/content/full/67/4/299?rss=1 Mon, 1 Apr 2013 00:00:00 +0000 Journal of Epidemiology and Community Health Subject Collection: Open access http://jech.bmj.com/cgi/content/full/67/4/358?rss=1 BackgroundSocioeconomic inequalities are a key policy challenge. Studies to date have not taken a unified approach to assess how socioeconomic inequalities in health, behaviour and educational attainment change as children age. MethodsWe examined maternal education inequalities in multiple offspring health, behavioural and educational outcomes and how these changed across childhood and adolescence in the Avon Longitudinal Study of Parents and Children, a cohort born in 1991/1992 in South-West England (N=5560-11 463). ResultsInequalities were observed for some health measures (blood pressure (BP), height, cholesterol, bone mineral density (BMD) and fat-mass (females)) but not in other measures (parent-assessed child health, triglycerides, fat-mass (males), high-density lipoprotein-cholesterol, C reactive protein). The strongest health inequality was systolic BP (mean difference comparing highest to lowest maternal education -0.28 SD (95% CI -0.35 to -0.20), approximately 2.6 mm Hg. Wide inequalities, similar in magnitude to BP, were observed for behavioural outcomes. Even greater inequalities were observed for offspring academic achievement (mean difference comparing highest to lowest maternal education 1.43 SD (95% CI 1.37 to 1.50), a difference of 22%). For all behavioural outcomes and some health indicators, inequality was stable over childhood. For some outcomes (BP, BMD and most education outcomes), inequality narrowed as children got older. Only for height and attainment in English tests was there evidence of widening inequalities with age. ConclusionsOur results suggest that within this cohort, maternal education inequalities in offspring health, behaviour and educational attainment are established in childhood but do not increase up to adolescence. Maternal education inequalities in behaviour and educational attainment were considerably larger than in health measures. http://jech.bmj.com/cgi/content/full/67/4/358?rss=1 Mon, 1 Apr 2013 00:00:00 +0000 Journal of Epidemiology and Community Health Subject Collection: Open access http://jech.bmj.com/cgi/content/full/jech-2012-201525v2?rss=1 BackgroundResearch comparing mortality by socioeconomic status has found that inequalities are not the smallest in the Nordic countries. This is in contrast to expectations given these countries' policy focus on equity. An alternative way of studying inequality has been little used to compare inequalities across welfare states and may yield a different conclusion. MethodsWe used average life expectancy lost per death as a measure of total inequality in mortality derived from death rates from the Human Mortality Database for 37 countries in 2006 that we grouped by welfare state type. We constructed a theoretical lowest mortality comparator country' to study, by age, why countries were not achieving the smallest inequality and the highest life expectancy. We also studied life expectancy as there is an important correlation between it and inequality. ResultsOn average, Nordic countries had the highest life expectancy and smallest inequalities for men but not women. For both men and women, Nordic countries had particularly low younger age mortality contributing to smaller inequality and higher life expectancy. Although older age mortality in the Nordic countries is not the smallest. There was variation within Nordic countries with Sweden, Iceland and Norway having higher life expectancy and smaller inequalities than Denmark and Finland (for men). ConclusionsOur analysis suggests that the Nordic countries do have the smallest inequalities in mortality for men and for younger age groups. However, this is not the case for women. Reducing premature mortality among older age groups would increase life expectancy and reduce inequality further in Nordic countries. http://jech.bmj.com/cgi/content/full/jech-2012-201525v2?rss=1 Fri, 1 Mar 2013 00:00:00 +0000 Journal of Epidemiology and Community Health Subject Collection: Open access http://jech.bmj.com/cgi/content/full/67/3/245?rss=1 ObjectiveTo investigate the association between bed-sharing with the mother at 3 months of age and incidence of hospitalisation due to pneumonia and diarrhoea between 3 and 12 months. MethodsThe 2004 Pelotas Birth Cohort included all live births to mothers living in Pelotas, Brazil, in 2004. Information on bed-sharing was obtained at the 3-month follow-up visit, and on hospitalisations at the 12-month visit, both based on mothers' reports. Only singleton infants with complete information on hospitalisation were analysed. Results3906 infants were included. The bed-sharing prevalence at 3 months was 46.4% (95% CI 44.9 to 48.0%). The incidence of pneumonia admissions between 3 and 12 months was 3.6% (95% CI 3.3 to 4.2%) and diarrhoea, 0.9% (95% CI 0.6 to 1.2%). In crude analyses, bed-sharing with the mother was associated with higher incidence of hospitalisation due to both pneumonia and diarrhoea. There was interaction between bed-sharing and duration of breastfeeding regarding the chance of admission due to pneumonia. Among infants breastfed for 3 months or less, the chance of hospitalisation due to pneumonia among bed-sharers was almost twice as high as among non-bed-sharers (adjusted OR 1.96; 95% CI 1.08 to 3.55). There was no association between bed-sharing and hospitalisation due to pneumonia among infants breastfed for longer than 3 months in crude or adjusted analyses. The association between bed-sharing and admissions due to diarrhoea lost statistical significance after allowing for confounders. ConclusionsThe effect of bed-sharing in infancy on the risk of hospitalisation due to pneumonia depends on breastfeeding, such that weaned children present higher risk. http://jech.bmj.com/cgi/content/full/67/3/245?rss=1 Fri, 1 Mar 2013 00:00:00 +0000 Journal of Epidemiology and Community Health Subject Collection: Open access http://jech.bmj.com/cgi/content/full/67/3/257?rss=1 BackgroundFree school breakfast programmes (SBPs) exist in a number of high-income countries, but their effects on educational outcomes have rarely been evaluated in randomised controlled trials. MethodsA 1-year stepped-wedge, cluster randomised controlled trial was undertaken in 14 New Zealand schools in low socioeconomic resource areas. Participants were 424 children, mean age 9{+/-}2 years, 53% female. The intervention was a free daily SBP. The primary outcome was children's school attendance. Secondary outcomes were academic achievement, self-reported grades, sense of belonging at school, behaviour, short-term hunger, breakfast habits and food security. ResultsThere was no statistically significant effect of the breakfast programme on children's school attendance. The odds of children achieving an attendance rate <95% was 0.76 (95% CI 0.56 to 1.02) during the intervention phase and 0.93 (95% CI 0.67 to 1.31) during the control phase, giving an OR of 0.81 (95% CI 0.59 to 1.11), p=0.19. There was a significant decrease in children's self-reported short-term hunger during the intervention phase compared with the control phase, demonstrated by an increase of 8.6 units on the Freddy satiety scale (95% CI 3.4 to 13.7, p=0.001). There were no effects of the intervention on any other outcome. ConclusionsA free SBP did not have a significant effect on children's school attendance or academic achievement but had significant positive effects on children's short-term satiety ratings. More frequent programme attendance may be required to influence school attendance and academic achievement. Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR)--ACTRN12609000854235. http://jech.bmj.com/cgi/content/full/67/3/257?rss=1 Fri, 1 Mar 2013 00:00:00 +0000 Journal of Epidemiology and Community Health Subject Collection: Open access