AIM: To study the association between self-reported peptic ulcer and childhood adversities.
METHODS: The Health and Social Support Study (HeSSup) population consisted of a stratified random sample drawn from the Finnish Population Register in four age groups: 20-24, 30-34, 40-44 and 50-54. The survey was carried out by postal questionnaire during 1998, with a response rate of 40.0%. A follow-up questionnaire was sent during 2003 to all those who responded to the first. Altogether 19 626 individuals returned the follow-up questionnaire; a response rate of 75.8%. The subjects were asked whether a doctor had told them that they have or have had peptic ulcer. The analyses covered those who responded affirmatively to both the baseline and the follow-up enquiries (n = 718). Those not reporting a peptic ulcer in either of the two questionnaires (n = 17 677) were taken as controls. The subjects were further requested (through six questions) to think about their childhood adversities.
RESULTS: The most common adversities mentioned were long-lasting financial difficulties in the family, serious conflicts in the family, and a family member seriously or chronically ill. All the adversities reported, except parental divorce, were more common among peptic ulcer patients than among controls (P values varied between < 0.001 and 0.003). Age- and sex-adjusted odds ratios (OR) of childhood adversities in the multivariate logistic analysis for self-reported peptic ulcer varied between 1.45 and 2.01. Adjusting for smoking, heavy drinking, stress and nonsteroidal anti-inflammatory drug use had no further influence (ORs between 1.22 and 1.73).
CONCLUSION: Our findings suggest that childhood adversities maintain a connection with and have a predictive role in the development of peptic ulcer.
Peptic ulcer; Working-aged; Childhood adversities; Stress factors; Predictive role
Previous studies have shown that age, physical and mental health status and working circumstances, along with different socio-economic and psychosocial factors affect the retirement process. However, the role of psychological resources, such as sense of coherence (SOC), on the retirement process is still poorly understood. This study investigated the associations between SOC and intentions to retire early and whether these associations were explained by socio-economic, psychosocial and work and health related factors.
The data were derived from the Finnish Health and Social Support (HeSSup) Study. The information was gathered from postal surveys in 1998 (baseline) and in 2003 (follow-up). The analyzed data consisted of 7409 women and 4866 men aged 30-54 at baseline. SOC and background factors including childhood circumstances, language, education, working circumstances, social support, health behaviour and somatic and mental health status were assessed at baseline. The intentions to retire early were assessed at follow-up using logistic regression analysis.
SOC was associated with intentions to retire early among both genders. Socio-economic, psychosocial and work and health behaviour related factors did not influence the association between SOC and intentions to retire early among women and men reporting somatic or mental illness. Further, the association between SOC and intentions to retire early remained among (somatically and mentally) healthy men. Among healthy women the association was weaker and statistically non-significant. Among unhealthy women, the odds ratios of SOC was 0.97 (CI 95% 0.96-0.98) and 0.97 among ill men (CI 95% 0.96-0.98), i.e., each additional SOC score reduced the risk of intentions by 3% among both genders.
Unhealthy employees with low SOC and low education were in the greatest risk to have reported intentions to retire early. SOC had an independent effect on intentions to retire early, and a strong SOC may have a potential to prevent early retirement in groups otherwise at risk. An important challenge would be to target the resources of SOC to the most vulnerable and design appropriate interventions in order to strengthen the level of SOC and hence prolong working years of the aging employees.
Pet ownership is thought to have health benefits, but not all scientific explorations have been founded on proper applications of representative samples or statistically correct methodologies. Databanks have been too small for proper statistical analyses; or, instead of a random sample, participation has been voluntary. The direction of causality has been evaluated incorrectly or control of relevant factors noted deficient. This study examined the associations of pet ownership with perceived health and disease indicators by taking into account socio-demographic background factors together with health risk factors, including exercise.
The present study used baseline data from the 15-year Health and Social Support Study (the HeSSup Study). The Finnish Population Register Centre was used to draw population-based random samples stratified according to gender and four age groups (20–24, 30–34, 40–44, and 50–54 years). A total of 21,101 working-aged Finns responded to the baseline survey questionnaire of the 15-year HeSSup Study in 1998. Ordinal and binary logistic regression was used to analyze the cross-sectional data. Pet ownership was associated with poor rather than good perceived health. BMI surfaced as the risk factor most strongly associated with pet ownership.
Pet owners set in their ways and getting older were found to have a slightly higher BMI than the rest. Additional research is needed for the testing of hypotheses involving effects of pet ownership with various health dimensions within population groups that are composed of different kinds of background characteristics.
Although significant associations of childhood adversities with adult
mental disorders are widely documented, most studies focus on single childhood
adversities predicting single disorders.
To examine joint associations of 12 childhood adversities with first onset
of 20 DSM–IV disorders in World Mental Health (WMH) Surveys in 21
Nationally or regionally representative surveys of 51 945 adults assessed
childhood adversities and lifetime DSM–IV disorders with the WHO
Composite International Diagnostic Interview (CIDI).
Childhood adversities were highly prevalent and interrelated. Childhood
adversities associated with maladaptive family functioning (e.g. parental
mental illness, child abuse, neglect) were the strongest predictors of
disorders. Co-occurring childhood adversities associated with maladaptive
family functioning had significant subadditive predictive associations and
little specificity across disorders. Childhood adversities account for 29.8%
of all disorders across countries.
Childhood adversities have strong associations with all classes of
disorders at all life-course stages in all groups of WMH countries. Long-term
associations imply the existence of as-yet undetermined mediators.
To examine how childhood adversity (ie, parental death, parental divorce, suspension of school education due to financial strain or being raised in a relative's house due to financial strain) is associated with prevalence and incidence of adulthood depressive symptoms and whether this association differs by gender and by age in South Korea.
Prospective cohort design.
Nationally representative longitudinal survey in South Korea.
11 526 participants in South Korea.
Prevalence and incidence of adulthood depressive symptoms were assessed as a dichotomous variable using the Centers for Epidemiologic Studies Depression (CES-D) Scale in 2006 and 2007.
In the prevalence analysis, each of the four childhood adversities was significantly associated with a higher prevalence of adulthood depressive symptoms. The higher incidence of depressive symptoms was associated with suspension of school education (OR 1.55, 95% CI 1.32 to 1.82) and parental divorce (OR 1.65, 95% CI 1.00 to 2.71). In the age-stratified analyses, prevalence of depressive symptoms was associated with all CAs across different adulthoods, except for parental divorce and late adulthood depressive symptoms. After being stratified by gender, the association was significant for parental divorce (OR 3.76, 95% CI 2.34 to 6.03) in the prevalence analysis and for being raised in a relative’s house (OR 1.89, 95% CI 1.21 to 2.94) in the incidence analysis only among women.
This study suggests that childhood adversity may increase prevalence and incidence of adulthood depressive symptoms, and the impact of parental divorce or being raised in a relative's house due to financial strain on adulthood depressive symptoms may differ by gender.
Depression & mood disorders < PSYCHIATRY; Childhood adversity; Life-course epidemiology; South Korea
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.
To examine whether adverse childhood experiences predict disability retirement.
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.
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).
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.
Strong relationships between exposure to childhood traumatic stressors and smoking behaviours inspire the question whether these adverse childhood experiences (ACEs) are associated with an increased risk of lung cancer during adulthood.
Baseline survey data on health behaviours, health status and exposure to adverse childhood experiences (ACEs) were collected from 17,337 adults during 1995-1997. ACEs included abuse (emotional, physical, sexual), witnessing domestic violence, parental separation or divorce, or growing up in a household where members with mentally ill, substance abusers, or sent to prison. We used the ACE score (an integer count of the 8 categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. Two methods of case ascertainment were used to identify incident lung cancer through 2005 follow-up: 1) hospital discharge records and 2) mortality records obtained from the National Death Index.
The ACE score showed a graded relationship to smoking behaviors. We identified 64 cases of lung cancer through hospital discharge records (age-standardized risk = 201 × 100,000-1 population) and 111 cases of lung cancer through mortality records (age-standardized mortality rate = 31.1 × 100,000-1 person-years). The ACE score also showed a graded relationship to the incidence of lung cancer for cases identified through hospital discharge (P = 0.0004), mortality (P = 0.025), and both methods combined (P = 0.001). Compared to persons without ACEs, the risk of lung cancer for those with ≥ 6 ACEs was increased approximately 3-fold (hospital records: RR = 3.18, 95%CI = 0.71-14.15; mortality records: RR = 3.55, 95%CI = 1.25-10.09; hospital or mortality records: RR = 2.70, 95%CI = 0.94-7.72). After a priori consideration of a causal pathway (i.e., ACEs → smoking → lung cancer), risk ratios were attenuated toward the null, although not completely. For lung cancer identified through hospital or mortality records, persons with ≥ 6 ACEs were roughly 13 years younger on average at presentation than those without ACEs.
Adverse childhood experiences may be associated with an increased risk of lung cancer, particularly premature death from lung cancer. The increase in risk may only be partly explained by smoking suggesting other possible mechanisms by which ACEs may contribute to the occurrence of lung cancer.
Although generalized anxiety disorder (GAD) and major depressive episode (MDE) are known to be highly comorbid, little prospective research has examined whether these two disorders predict the subsequent first onset or persistence of the other or the extent to which other predictors explain the time-lagged associations between GAD and MDE.
Data were analyzed from the nationally representative two-wave panel sample of 5001 respondents who participated in the 1990-2 National Comorbidity Survey (NCS) and the 2001-03 NCS follow-up survey. Both surveys assessed GAD and MDE. The baseline NCS also assessed three sets of risk factors that are considered here: childhood adversities, parental history of mental-substance disorders, and respondent personality.
Baseline MDE significantly predicted subsequent GAD onset but not persistence. Baseline GAD significantly predicted subsequent MDE onset and persistence. The associations of each disorder with the subsequent onset of the other attenuated with time since onset of the temporally primary disorder, but remained significant for over a decade after this onset. The risk factors predicted onset more than persistence. Meaningful variation was found in the strength and consistency of associations between risk factors and the two disorders. Controls for risk factors did not substantially reduce the net cross-lagged associations of the disorders with each other
The existence of differences in risk factors for GAD and MDE argues against the view that the two disorders are merely different manifestations of a single underlying internalizing syndrome or that GAD is merely a prodrome, residual, or severity marker of MDE.
We examined whether childhood cognitive ability was associated with two mental health outcomes at age 53 years: the 28 item General Health Questionnaire (GHQ-28) as a measure of internalising symptoms of anxiety and depression, and the CAGE screen for potential alcohol abuse as an externalising disorder. A total of 1875 participants were included from the Medical Research Council National Survey of Health and Development, also known as the British 1946 birth cohort. The results indicated that higher childhood cognitive ability was associated with reporting fewer symptoms of anxiety and depression GHQ-28 scores in women, and increased risk of potential alcohol abuse in both men and women. Results were adjusted for educational attainment, early socioeconomic status (SES) and adverse circumstances, and adult SES, adverse circumstances, and negative health behaviours. After adjusting for childhood cognitive ability, greater educational attainment was associated with reporting greater symptoms of anxiety and depression on the GHQ-28. Although undoubtedly interrelated, our evidence on the diverging effects of childhood cognitive ability and educational attainment on anxiety and depression in mid-adulthood highlights the need for the two to be considered independently. While higher childhood cognitive ability is associated with fewer internalising symptoms of anxiety and depression in women, it places both men and women at higher risk for potential alcohol abuse. Further research is needed to examine possible psychosocial mechanisms that may be associated with both higher childhood cognitive ability and greater risk for alcohol abuse. In addition, the underlying mechanisms responsible for the gender-specific link between childhood cognitive ability and the risk of experiencing internalising disorders in mid-adulthood warrants further consideration.
UK; Adult mental health; Prospective cohort; Childhood cognitive ability; Educational attainment; Gender
This study characterizes adults who report being physically abused during childhood, and examines associations of reported type and frequency of abuse with adult mental health. Data were derived from the 2000–2001 and 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions, a large cross-sectional survey of a representative sample (N = 43,093) of the U.S. population. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between child physical abuse and adult psychiatric disorders adjusted for sociodemographic characteristics, other childhood adversities, and comorbid psychiatric disorders. Child physical abuse was reported by 8% of the sample and was frequently accompanied by other childhood adversities. Child physical abuse was associated with significantly increased adjusted odds ratios (AORs) of a broad range of DSM-IV psychiatric disorders (AOR = 1.16–2.28), especially attention-deficit hyperactivity disorder, posttraumatic stress disorder, and bipolar disorder. A dose-response relationship was observed between frequency of abuse and several adult psychiatric disorder groups; higher frequencies of assault were significantly associated with increasing adjusted odds. The long-lasting deleterious effects of child physical abuse underscore the urgency of developing public health policies aimed at early recognition and prevention.
To assess the association of having been breast fed with social class mobility between childhood and adulthood.
Historical cohort study with a 60‐year follow‐up from childhood into adulthood.
16 urban and rural centres in England and Scotland.
3182 original participants in the Boyd Orr Survey of Diet and Health in Pre‐War Britain (1937–39) were sent follow‐up questionnaires between 1997 and 1998. Analyses are based on 1414 (44%) responders with data on breast feeding measured in childhood and occupational social class in both childhood and adulthood.
Odds of moving from a lower to a higher social class between childhood and adulthood in those who were ever breast fed versus those who were bottle fed.
The prevalence of breast feeding varied by survey district (range 45–86%) but not with household income (p = 0.7), expenditure on food (p = 0.3), number of siblings (p = 0.7), birth order (p = 0.5) or social class (p = 0.4) in childhood. Participants who had been breast fed were 41% (95% CI 10% to 82%) more likely to move up a social class in adulthood (p = 0.007) than bottle‐fed infants. Longer breastfeeding duration was associated with greater odds of upward social mobility in fully adjusted models (p for trend = 0.003). Additionally controlling for survey district, household income and food expenditure in childhood, childhood height, birth order or number of siblings did not attenuate these associations. In an analysis comparing social mobility among children within families with discordant breastfeeding histories, the association was somewhat attenuated (OR 1.16; 95% CI 0.74 to 1.8).
Breast feeding was associated with upward social mobility. Confounding by other measured childhood predictors of social class in adulthood did not explain this effect, but we cannot exclude the possibility of residual or unmeasured confounding.
Although many studies have indicated that psychosocial factors contribute to hypertension, and that early childhood adversity is associated with long-term adverse mental and physical health sequelae, the association between early adversity and later hypertension is not well studied.
Data from 10 countries participating in the World Health Organization (WHO) World Mental Health (WHM) Surveys (N = 18,630) were analyzed to assess the relationship between childhood adversity and adult-onset hypertension, as ascertained by self-report. The potentially mediating effect of early-onset depression-anxiety disorders, as assessed by the WHM Survey version of the International Diagnostic Interview (WMH-CIDI), on the relationship between early adversity and hypertension was also examined.
Two or more early childhood adversities, as well as early-onset depression-anxiety, were significantly associated with hypertension. A range of specific childhood adversities, as well as early-onset social phobia and panic/agoraphobia, were significantly associated with hypertension. In multivariate analyses, the presence of 3 or more childhood adversities was associated with hypertension, even when early-onset depression-anxiety or current depression-anxiety was included in the model.
Although caution is required in the interpretation of self-report data on adult-onset hypertension, the results of this study further strengthen the evidence base regarding the role of psychosocial factors in the pathogenesis of hypertension.
STUDY OBJECTIVE: To examine the contribution of childhood health to the explanation of socioeconomic inequalities in health in early adult life. DESIGN: Retrospective data were used, which were obtained from a postal survey in the baseline of a prospective cohort study (the Longitudinal Study on Socio-Economic Health Differences in the Netherlands). Adult socioeconomic status was indicated by educational level, while health was indicated by perceived general health. Childhood health was measured by self reported periods of severe disease in childhood. Relations were analysed using logistic regression models. The reduction in odds ratios of "less than good" perceived general health for different educational groups after adjustment for childhood health was used to estimate the contribution of childhood health. SETTING: The population of the city of Eindhoven and surroundings in the south east of the Netherlands in 1991. PARTICIPANTS: 2511 respondents, aged 25-34 years, men and women, of Dutch nationality, were included in the analysis. MAIN RESULTS: There was a clear association between childhood health and adult health, as well as an association between childhood health and adult socioeconomic status. Approximately 5% to 10% of the increased risk of the lower socioeconomic groups of having a "less than good" perceived general health can be explained by childhood health. CONCLUSIONS: Childhood health contributes to the explanation of socioeconomic inequalities in early adult health. Although this contribution is not very large, it cannot be ignored and has to be interpreted largely in terms of selection on health.
The physical health consequences of childhood psychosocial adversities may be as substantial as the mental health consequences but whether this is the case remains unclear because much prior research has involved unrepresentative samples and a selective focus on particular adversities or physical outcomes. The association between early onset mental disorders and subsequent poor physical health in adulthood has not been investigated.
To investigate whether childhood adversities and early onset mental disorders are independently associated with increased risk of a range of adult onset chronic physical conditions in culturally diverse samples spanning the full adult age range.
Cross-sectional community surveys of adults in ten countries.
Adults (>= 18 years; n = 18,303), with diagnostic assessment and determination of age of onset of DSM-IV mental disorders; assessment of childhood familial adversities; and age of diagnosis/onset of chronic physical conditions.
Main Outcome Measures
Risk (hazard ratios) of adult onset (> age 20) heart disease, asthma, diabetes, arthritis, chronic spinal pain, and chronic headache as a function of specific childhood adversities and early onset (< age 21) DSM-IV depressive and anxiety disorders, with mutual adjustment.
A history of three or more childhood adversities was independently associated with onset of all six physical conditions (hazard ratios from 1.44–2.19). Controlling for current mental disorder made little difference to these associations. Early onset mental disorders were independently associated with onset of five physical conditions (hazard ratios from 1.43–1.66).
These results are consistent with the hypothesis that childhood adversities and early onset mental disorders have independent, broad spectrum effects that increase risks of diverse chronic physical conditions in later life. They require confirmation in a prospective design. The long time course of these associations has theoretical and research implications.
The aim of the current study is to estimate the association between childhood physical punishment (CPP) and level of alcohol use disorder (AUD), using two different approaches to take other childhood adversities into account.
Design and Setting
Population survey using face-to-face interviews to a representative sample of non-institutionalized adult residents of Beijing and Shanghai, China.
A total of 5201 participants aged 18 to 70 years old.
A version of the World Mental Health Composite International Diagnostic Interview was used. Standardized assessments covered early life experiences of childhood physical punishment, other childhood adversities, parental drinking problems, childhood conduct problems, and clinical features of AUD.
A robust association linking CPP and level of AUD was found, holding other childhood adversities constant (probit coefficient=0.70, 95% CI=1.40, 1.00) via covariate terms in Structural Equations Modeling. Furthermore, there was evidence that CPP might exert an additional influence on level of AUD over and above a generally noxious family environment (probit coefficient=0.20, 95% CI=0.02, 0.38).
There appears to be a robust association between reports of harsh punishment in childhood and alcohol dependence in adulthood adjusting for a range of possible confounding factors. Whether the association is causal or whether both are related to a common underlying factor or recall bias needs to be investigated further.
Effects of Timing of Adversity on Adolescent and Young Adult Adjustment Abstract Exposure to adversity during childhood and adolescence predicts adjustment across development. Further, adolescent adjustment problems persist into young adulthood. This study examined relations of contextual adversity with concurrent adolescent adjustment and prospective mental health and health outcomes in young adulthood. A longitudinal sample (N = 808) was followed from age 10 through 27. Perceptions of neighborhood in childhood predicted depression, alcohol use disorders, and HIV risk in young adulthood. Further, the timing of adversity was important in determining the type of problem experienced in adulthood. Youth adjustment predicted adult outcomes, and in some cases, mediated the relation between adversity and outcomes. These findings support the importance of adversity in predicting adjustment and elucidate factors that affect outcomes into young adulthood.
This study examined sociodemographic, physical and mental health, and adult and childhood adverse experiences associated with binge drinking in a representative sample of women in the State of California.
Materials and methods
Data were from the 2003 to 2004 (response rates of 72% and 74%, respectively) California Women's Health Survey (CWHS), a population-based, random-digit-dial annual probability survey sponsored by the California Department of Health Services. The sample was 6,942 women aged 18 years or older.
The prevalence of binge drinking was 9.3%. Poor physical health, and poorer mental health (i.e., symptoms of PTSD, anxiety, and depression, feeling overwhelmed by stress), were associated with binge drinking when demographics were controlled, as were adverse experiences in adulthood (intimate partner violence, having been physically or sexually assaulted, or having experienced the death of someone close) and in childhood (living with someone abusing substances or mentally ill, or with a mother vicimized by violence, or having been physically or sexually assaulted). When adult mental health and adverse experiences were also controlled, having lived as a child with someone who abused substances or was mentally ill was associated with binge drinking. Associations between childhood adverse experiences and binge drinking could not be explained by women's poorer mental health status in adulthood.
Identifying characteristics of women who engage in binge drinking is a key step in prevention and intervention efforts. Binge drinking programs should consider comprehensive approaches that address women's mental health symptoms as well as circumstances in the childhood home.
Little is known about the distribution of asthma severity in men and women in the general population. The objective of our study was to describe asthma severity and change in severity according to gender in a cohort of adult asthmatics
Subjects with asthma were identified from random samples of the 22 to 44 year-olds from the general population, screened for asthma from 1991 to 1993 in 48 centers from 22 countries and followed-up during 1998–2002, as part of the European Community Respiratory Health Survey (ECRHS). All participants to follow-up with current asthma at baseline were eligible for the analysis. To assess change over the follow-up, asthma severity at the two surveys was defined using standardized data on respiratory symptoms, lung function and medication according to the Global Initiative for Asthma (GINA) Guidelines. Another quantitative score (Ronchetti) further considering hospitalizations was also analysed.
The study included 685 subjects with asthma followed-up over a mean period of 8.65 yr (min 4.3-max 11.7). At baseline, asthma severity according to GINA was distributed as intermittent: 40.7%, 31.7% as mild persistent, 14% as moderate persistent, and 13.5% as severe persistent. Using the Ronchetti score derived classification, the distribution of asthma severity was 58% mild, (intermittent and mild persistent), 25.8% moderate, and 15.4% severe. Whatever the classification, there was no significant difference in the severity distribution between men and women. There was also no gender difference in the severity distribution among incident cases which developed asthma between the two surveys. Men with moderate-to-severe asthma at baseline were more likely than women to have moderate-to-severe asthma at follow-up. Using GINA, 69.2% of men vs. 53.1% of women (p = 0.09) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up. Using Ronchetti score, 53.3% of men vs. 36.2% of women (p = 0.03) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up.
There was no gender difference in asthma severity at the two surveys. However, our findings suggest that asthma severity might be less stable in women than in men.
The prevalence and incidence of asthma in relation to cigarette smoking habits was studied in a population of 14,729 Finnish adult men and women who participated in a postal health survey in 1975. Of those invited to participate in a new survey in 1981, 89.7% replied. Asthma was diagnosed on the basis of self reporting of asthma diagnosed by a physician and by record linkage to a national register of hospital admissions to all general and tuberculosis hospitals during 1972 and 1983. The prevalence of diagnosed asthma in 1975 was significantly higher among male smokers than among male non-smokers (relative risk (RR) = 1.73); no significant difference was observed for women (RR = 1.33). People with asthma were slightly but not significantly more likely to stop smoking during the six year follow up period (RR = 1.23). The incidence of asthma among those who had neither reported asthma in 1975 nor been admitted to hospital for asthma before the 1975 questionnaire study was not significantly higher among smokers than among non-smokers during follow up. Although possible mechanisms exist to explain how smoking could have a role in the aetiology of asthma, this study suggests that smoking is not a strong risk factor for asthma.
The status of stressful life events as a risk factor for asthma is unclear and may be dependent on pre-existing allergic rhinitis. This study examined whether exposure to stressful life events predicted the onset of asthma in adults.
This is a prospective, population-based cohort study of 16,881 men and women, aged 20–54 and free of diagnosed asthma at the beginning of the follow-up (January 1, 2004). Data about stressful life events were gathered with a postal survey. The onset of asthma was ascertained through national registers until December 31, 2005.
During the follow-up period, 192 incident cases of asthma were identified. High total exposure to stressful life events, as indicated by a cumulative severity score, predicted the onset of asthma (HR 1.96; 95% CI 1.22–3.13). This association was robust to adjustment for demographics, smoking, and having a cat/dog at home, and it was observed both among those with and without allergic rhinitis at the baseline. Of the 10 most stressful life events, the illness of a family member, marital problems, divorce or separation, and conflicts with a supervisor were associated with the onset of asthma.
Our study suggests that stressful life events may increase the onset of asthma.
asthma; asthma epidemiology; asthma onset; stressful life events
The life course approach emphasises the contribution of circumstances in childhood and youth to adult health inequalities. However, there is still a lot to know of the contribution of living conditions in childhood and youth to adult health inequalities and how later environmental and behavioural factors are connected with the effects of earlier circumstances. This study aims to assess a) how much childhood circumstances, current circumstances and health behaviour contribute to educational health differences and b) to which extent the effect of childhood circumstances on educational health differences is shared with the effects of later living conditions and health behaviour in young adults.
The data derived from the Health 2000 Survey represent the Finnish young adults aged 18–29 in 2000. The analyses were carried out on 68% (n = 1282) of the sample (N = 1894). The cross-sectional data based on interviews and questionnaires include retrospective information on childhood circumstances. The outcome measure was poor self-rated health.
Poor self-rated health was much more common among subjects with primary education only than among those in the highest educational category (OR 4.69, 95% CI 2.63 to 8.62). Childhood circumstances contributed substantially (24%) to the health differences between these educational groups. Nearly two thirds (63%) of this contribution was shared with behavioural factors adopted by early adulthood, and 17% with current circumstances. Health behaviours, smoking especially, were strongly contributed to educational health differences.
To develop means for avoiding undesirable trajectories along which poor health and health differences develop, it is necessary to understand the pathways to health inequalities and know how to improve the living conditions of families with children.
The mechanisms underlying socioeconomic inequalities in mortality from cardiovascular diseases (CVD) are largely unknown. We studied the contribution of childhood socioeconomic conditions and adulthood risk factors to inequalities in CVD mortality in adulthood.
The prospective GLOBE study was carried out in the Netherlands, with baseline data from 1991, and linked with the cause of death register in 2007. At baseline, participants reported on adulthood socioeconomic position (SEP) (own educational level), childhood socioeconomic conditions (occupational level of respondent’s father), and a broad range of adulthood risk factors (health behaviours, material circumstances, psychosocial factors). This present study is based on 5,395 men and 6,306 women, and the data were analysed using Cox regression models and hazard ratios (HR).
A low adulthood SEP was associated with increased CVD mortality for men (HR 1.84; 95% CI: 1.41-2.39) and women (HR 1.80; 95%CI: 1.04-3.10). Those with poorer childhood socioeconomic conditions were more likely to die from CVD in adulthood, but this reached statistical significance only among men with the poorest childhood socioeconomic circumstances. About half of the investigated adulthood risk factors showed significant associations with CVD mortality among both men and women, namely renting a house, experiencing financial problems, smoking, physical activity and marital status. Alcohol consumption and BMI showed a U-shaped relationship with CVD mortality among women, with the risk being significantly greater for both abstainers and heavy drinkers, and among women who were underweight or obese. Among men, being single or divorced and using sleep/anxiety drugs increased the risk of CVD mortality. In explanatory models, the largest contributor to adulthood CVD inequalities were material conditions for men (42%; 95% CI: −73 to −20) and behavioural factors for women (55%; 95% CI: -191 to −28). Simultaneous adjustment for adulthood risk factors and childhood socioeconomic conditions attenuated the HR for the lowest adulthood SEP to 1.34 (95% CI: 0.99-1.82) for men and 1.19 (95% CI: 0.65-2.15) for women.
Adulthood material, behavioural and psychosocial factors played a major role in the explanation of adulthood SEP inequalities in CVD mortality. Childhood socioeconomic circumstances made a modest contribution, mainly via their association with adulthood risk factors. Policies and interventions to reduce health inequalities are likely to be most effective when considering the influence of socioeconomic circumstances across the entire life course and in particular, poor material conditions and unhealthy behaviours in adulthood.
Cardiovascular diseases; Socioeconomic status; Health behaviour; Life course epidemiology; Mortality determinants
The Shanghai Women’s Asthma and Allergy Study is the first population-based incidence study designed to assess the associations of dietary antioxidant intake and measures of oxidative stress and antioxidant enzyme activity with development of adult-onset asthma and allergic rhinitis. A total of 65,732 participants in the Shanghai Women’s Health Study, an ongoing cohort study in seven districts of Shanghai, People’s Republic of China, were recruited to the Shanghai Women’s Asthma and Allergy Study from 2003 to 2007. Dietary intake was assessed in the parent study by using a validated and quantitative food frequency questionnaire at baseline recruitment and at the first biennial follow-up survey. Blood and urine samples were collected to measure baseline oxidative stress, antioxidant enzyme activity, and nutrient levels at the baseline survey. Incident asthma and allergic rhinitis were assessed by using a modification of the International Study of Asthma and Allergies in Childhood questionnaire during the biennial in-person survey of the Shanghai Women’s Health Study. Diagnosis of asthma was confirmed by either methacholine challenge testing or test of reversibility to beta-agonists. Dietary antioxidant intake, plasma antioxidants, antioxidant enzymes, and urinary isoprostanes, a marker of oxidative stress, were measured prior to disease onset. This paper describes the study objectives, design, population demographics, and recruitment results.
antioxidants; asthma; diet; incidence; oxidative stress; rhinitis; allergic; perennial; rhinitis; allergic; seasonal
To assess how much the association between migraine and depression may be explained by various measures of stress.
National Population Health Survey is a prospective cohort study representative of the Canadian population. Eight years of follow-up time were used in the present analyses.
Canadian adult population ages 18–64.
Incident migraine and major depression.
Adjusting for sex and age, depression was predictive of incident migraine (HR: 1.62; 95% CI 1.03 to 2.53) and migraine was predictive of incident depression (HR: 1.55; 95% CI 1.15 to 2.08). However, adjusting for each assessed stressor (childhood trauma, recent marital problems, recent unemployment, recent household financial problems, work stress, chronic stress and change in social support) decreased this association, with chronic stress being a particularly strong predictor of outcomes. When adjusting for all stressors simultaneously, both associations were largely attenuated (depression–migraine HR: 1.30; 95% CI 0.80 to 2.10; migraine–depression HR: 1.19; 95% CI 0.86 to 1.66).
Much of the apparent association between migraine and depression may be explained by stress.
Although certain media exposures have been linked to the presence of psychiatric conditions, few studies have investigated the association between media exposure and depression.
To assess the longitudinal association between media exposure in adolescence and depression in young adulthood in a nationally representative sample.
Longitudinal cohort study.
Setting and Participants
We used the National Longitudinal Survey of Adolescent Health (Add Health) to investigate the relationship between electronic media exposure in 4142 adolescents who were not depressed at baseline and subsequent development of depression after 7 years of follow-up.
Main Outcome Measure
Depression at follow-up assessed using the 9-item Center for Epidemiologic Studies–Depression Scale.
Of the 4142 participants (47.5% female and 67.0% white) who were not depressed at baseline and who underwent follow-up assessment, 308 (7.4%) reported symptoms consistent with depression at follow-up. Controlling for all covariates including baseline Center for Epidemiologic Studies–Depression Scale score, those reporting more television use had significantly greater odds of developing depression (odds ratio [95% confidence interval], 1.08 [1.01-1.16]) for each additional hour of daily television use. In addition, those reporting more total media exposure had significantly greater odds of developing depression (1.05 [1.0004-1.10]) for each additional hour of daily use. We did not find a consistent relationship between development of depressive symptoms and exposure to videocassettes, computer games, or radio. Compared with young men, young women were less likely to develop depression given the same total media exposure (odds ratio for interaction term, 0.93 [0.88-0.99]).
Television exposure and total media exposure in adolescence are associated with increased odds of depressive symptoms in young adulthood, especially in young men.