The European Journal of Public Health - recent issues

Public health, the environment and the 21st century: a wider field of vision

McMichael, A. J. — 2008-03-13

A Lisbon agenda on health innovation

Sakellarides, C. — 2008-03-13

Decentralization, re-centralization and future European health policy

Saltman, R. B. — 2008-03-13

Towards Bamako: a European perspective on the global health research agenda

McKee, M., Ricciardi, W. — 2008-03-13

'All under one roof?' differences in food availability and shopping patterns in Southern France and Central England

Pettinger, C., Holdsworth, M., Gerber, M. — 2008-03-13

Background: This study investigates patterns of food shopping and availability of fruit and vegetables and snack foods in a northern European (Central England) and southern European region (Southern France). Methods: Two studies were conducted in England (Nottingham) and France (Montpellier): (i) Cross-sectional population surveys using self-administered postal questionnaires to assess type of outlets used for food shopping in random population samples (England: n = 826; Montpellier: n = 766). (ii) Food availability studies to determine: the number of food outlets in defined comparable geographical areas; the number stocking fruit and vegetables, their quality and energy dense snacks. Results: The English respondents used supermarkets most regularly (P < 0.001), whereas the French preferred to use smaller local shops, such as bakers (P < 0.001), butchers (P < 0.001) and markets (P < 0.001). Overall a larger proportion of outlets in Montpellier than Nottingham sold fresh fruit and vegetables and a wider variety of fresh fruit. However, a range of vegetables and all other types of fruit were as widely available in English shops. Although the quality of fresh fruit and vegetables tended to be better in Montpellier, the difference was not significant. Crisps (P < 0.05) and confectionary items (P < 0.05) were more widely available in England. Conclusions: Food shopping was done ‘under one roof’ more often in England, whereas in France, shopping was done in smaller specialist shops, which was reflected in their presence within the locality. Even though availability of fruit and vegetables was good in both countries, snack foods were more abundant in England. This clearly impacts on the food environment and could explain the higher prevalence of obesity in England, factors which are also influenced by culture, habits and convenience.

Food-allergic consumers' labelling preferences: a cross-cultural comparison

2008-03-13

Background: Recent changes in European food safety legislation have resulted in the implementation of statutory requirements regarding the traceability and labelling of 12 food allergens. This article describes research conducted to establish if current food labelling practices are perceived to be adequate by food-allergic consumers, and whether further policy changes need to be implemented in order to optimize consumer protection. Methods: A total of 40 food-allergic consumers were recruited in both the Netherlands and Greece. Participants were people suffering from one or more of the three most common food-allergies, milk, egg, and/or peanut or tree nut. In a retail environment, participants were given a list of 15 potentially problematic food products which they were asked to buy as if for their own household. The participants were observed during the course of product selection and questioned about specific problems they experienced, as well as information preferences for food allergy information. Results: Participants reported many problems linked to the readability of the label (e.g. font size, contrast). Not all packages contained relevant allergy information, and many participants reported that the ingredients list was insufficient for their needs. Personal experience of particular products was an important factor in the selection process. Dutch participants reported frustration regarding frequent changes in recipes of products available in the supermarket. Conclusions: In general, food-allergic consumers were not satisfied with the current labelling practices. Information was thought to be unclear or insufficient, which resulted in personal stress and feelings of insecurity. Further research is needed to identify how best allergy information might be provided.

Trends in overweight, obesity and blood pressure among Israeli working adults--implications for public health

Sheffer, R., Calderon-Margalit, R. — 2008-03-13

Backgrounds: Reports from the last decade suggest an epidemic of overweight and obesity in Western countries. Since obesity has been associated with increased blood pressure, we aimed to describe the secular trends in overweight and obesity and blood pressure among Israeli working adults. Methods: Two cross-sectional studies were conducted in the setting of the Civil Servant Registry, Tel-Aviv District Health Office, Ministry of Health, Israel, including 1949 adults aged 17–69 years, who entered the Israeli civil service in 1993 and 2002. Results: Compared with other reports, the overall prevalence rate (32.2%) of overweight and obesity was relatively low in our study population, however, an increase of 34% in the odds of being overweight or obese was noted during the study period (adjusted odds ratio: 1.34, 95% CI: 1.09–1.65). Despite this increase, the adjusted mean systolic blood pressure significantly fell from 119.3 (18.2) to 117.0 (14.3) mmHg (P < 0.001) during the 10-year period, and the respective mean diastolic blood pressure declined from 74.5 (9.0) mmHg to 73.2 (9.8) mmHg (P < 0.001). Conclusion: Israel joined the universal trend of increase in overweight and obesity. This study demonstrated a concomitant decline in blood pressure that could not be attributed to antihypertensive treatment. The decrease in blood pressure could partially explain the decrease in cardiovascular morbidity and mortality seen in Israel.

Differences in prevalence of overweight and stunting in 11-year olds across Europe: The Pro Children Study

2008-03-13

Objectives: To assess country differences in prevalence of overweight, obesity, underweight and stunting in the Pro Children Survey. Methods: A cross-sectional study conducted in a random sample of schools in nine European countries in 2003. The subjects were 8317 11-year-old children from Austria, Belgium, Denmark, Iceland, The Netherlands, Norway, Portugal, Spain and Sweden. Parents reported height and weight of the children, and BMI values were analysed using the US Centers of Disease Control and Prevention and the International Obesity Task Force reference populations. Continuous variables were compared with one-way analysis of variance (ANOVA) with Games-Howell post hoc tests. Categorical variables were analysed using chi-square tests. Results: The prevalence of overweight + obesity varied between the countries from 8.6% to 30.6% and 5.9% to 26.5%, respectively, depending on the reference population, with the lowest prevalence in Dutch girls, the highest in Portuguese boys. Obesity prevalence varied from 1.1% (Dutch and Danish girls) to 10.7% (Portuguese boys) and from 0.3% (Dutch girls) to 6.2% (Portuguese boys), respectively. Portugal and Spain had the highest prevalence of overweight and obesity for both genders. The ranking of the countries according to overweight and obesity prevalence was roughly the same, independent of reference population. The prevalence of underweight varied from 2.3% (Swedish boys) to 12.3% (Belgian boys), using the American reference population. The proportion of stunted children was highest in Portugal, Spain and Belgium. Conclusions: The highest levels of overweight, obesity and stunting in the pro children material are found in Portugal and Spain.

Do risk factors explain more of the social gradient in self-reported health when adjusting for baseline health?

Arendt, J. N., Lauridsen, J. — 2008-03-13

Background: It has often been debated the extent to which known risk factors explain socio-economic differences in health. While common in mortality studies, few studies of morbidity adjust for baseline health. In this study, we argue that there are sound reasons to do so, and examine whether a set of risk factors explain a larger part of social gradients in men and women's self-rated health (SRH) in Denmark when controlling for previous health. Methods: We use interval regression models on longitudinal survey data from 1990 and 1995 separately for Danish male and female workers aged 18–59. Results: Large social gradients are found in SRH for both men and women. The included risk factors (smoking, body mass index, high blood pressure and job satisfaction) reduce the educational gradient in SRH by 40% (based on highest versus no education), the wage gradient by 18% and leaves occupational gradients (based on no employment versus white collar workers) unaltered for men. For women, similar gradients are altered by 6 and 22 and 14% in cross-sectional models. Controlling for baseline health 5 years earlier, the risk factors reduce the education, occupation and wage gradients by 45, –15 and 17% for men and by 5, 25 and 15% for women. Conclusion: The findings suggest that common risk factors do not explain a larger fraction of social health inequalities in dynamic than in static models of self-reported health.

Health inequalities among older adults in Sweden 1991-2002

Fors, S., Lennartsson, C., Lundberg, O. — 2008-03-13

Background: Current research has shown a decline in health among older adults in Sweden. This study examines health inequalities among older adults in Sweden in 1991–1992 and 2000–2002 and explores the development of these inequalities during this period. Methods: A data set was constructed out of four levels of living surveys, comprising 4085 individuals aged 55 and above. Multivariate logistic regressions were used to assess the association between social class, sex, age and four different domains of self-reported health: global self-rated health, impaired mobility, musculoskeletal pain and psychological distress. Adjustments were made for period of interview. Interaction terms were also used to assess change over time. Levin's attributable risk was used to assess the magnitude of the health inequalities. Results: The results indicate an increase in reports of all specific health problems, but not in the global health measure during the period. Significant sex differences and a clear social gradient in health were discernible during both periods. Women were more likely than men to report problems with impaired mobility, pain and psychological distress. Manual workers were significantly more likely than non-manuals to report problems in all four domains of health. However, both the sex differences and the social gradient seemed to remain constant during the period. Conclusion: Although it seems there are significant differences in health depending on sex and social class among older adults in Sweden, these inequalities appear to be unaffected by the general increase in ill health that has been observed in these groups over the last decade.

Induced abortion in Denmark: effect of socio-economic situation and country of birth

Rasch, V., Gammeltoft, T., Knudsen, L. B., Tobiassen, C., Ginzel, A., Kempf, L. — 2008-03-13

Background: Equal access to health care is considered a key in Scandinavian healthcare policy. However, problematic differences between the socio-economic situation of immigrants and that of native Scandinavians are increasingly challenging this aspect of the Scandinavian welfare model. The present study focuses on how socio-economic characteristics and country of birth are associated with induced abortion. Methods: A structured questionnaire was used to collect information among 1351 women requesting abortion and a control group of 1306 women intending birth. Results: The strongest factor associated with the decision to have an abortion was being single (OR 39.1; 23.8–64.2), followed by being aged 19 years or below (OR 29.6; 13.4–65.5), having two children or more (OR 7.05; 5.29–9.39) and being unskilled (OR 2.48; 1.49–4.10), student (OR 2.29; 1.52–3.43) or unemployed (OR 1.65; 1.11–2.46). When evaluating the effect of social exposure on abortion among Danish-born and foreign-born women, the higher rate of abortion among non-Westerners was found to be caused by the composition of non-Westerners more often being unemployed, having a low income and having two or more children rather than the fact that they are coming from a non-Western country. Conclusion: Immigrant women comprise a vulnerable group, with a poor socio-economic status. This situation exposes immigrant women to increased risk of induced abortion. In a society with an increasing heterogeneous population, the vulnerable situation of immigrant women has to be addressed, if equal access to health care is to be maintained.

Selective international migration by social position, health behaviour and personality

2008-03-13

Background: Immigrants is an important minority in many countries, but little is known how they are self-selected. We analysed differences in psycho-social and health behavioural factors between international migrants and non-migrants prior to migration in a large cohort of Finnish twins. Methods: A questionnaire was sent to Finnish twins in 1975 (response rate 89%, N = 26555 twin individuals). Follow-up data on migration and mortality were derived from population registries in Finland and Sweden up to 31 March 2002. In 1998, another questionnaire was sent to Finnish twins migrated to Sweden and their co-twins (response rate 71%, N = 1534 twin individuals). The data were analysed using Cox and conditional logistic regression models. Results: Life dissatisfaction, higher alcohol use and smoking at baseline predicted future migration. In men additionally, unemployment, neuroticism and extroversion increased the probability to migrate. Similar associations were found for alcohol use in men and smoking in men and women within twin pairs discordant for migration. Twins also reported retrospectively that prior to migration the migrated twin had been less satisfied with his/her educational institution or job and was generally less satisfied with life, used more alcohol (men) and smoked more (women) than the co-twin stayed in Finland. Conclusion: Migrants are self-selected by health behavioural and personality factors, which may compromise their health. The special requirements of migrants should be recognized in health care.

Discrimination, mental problems and social adaptation in young refugees

Montgomery, E., Foldspang, A. — 2008-03-13

Background: Mental problems have been hypothesized to impede social adaptation and vice versa, and discrimination is assumed to interact with both. The available empirical documentation is, however, limited. The objective of this study is to contribute to a more comprehensive understanding of associations and pathways between discrimination, mental problems and social adaptation in young refugees. Methods: Structural Equation Modelling (SEM) was used for the analysis of cross-sectional data from interviews with 131 young Middle Eastern refugees residing in Denmark. Results: Participants reported a mean of 1.8 experiences of discrimination, and the prevalence of five indicators of positive social adaptation was 47–92%. Discrimination, mental problems and social adaptation were strongly mutually associated, without gender difference. Discrimination predicted internalizing behaviour. Improved social adaptation correlated negatively with discrimination and with externalizing and internalizing behaviour. Conclusion: Perceived discrimination among young refugees from the Middle East is associated with mental problems and social adaptation. Discrimination seems to provoke internalizing but not externalizing behaviour. The direction of other pathways is ambiguous, suggesting a certain amount of recursive interaction between mental health, discrimination and social adaptation.

Invasive cervical cancer: a failure of screening

Spayne, J., Ackerman, I., Milosevic, M., Seidenfeld, A., Covens, A., Paszat, L. — 2008-03-13

Background: Cervical screening is an effective prevention measure. It is unclear whether cervical cancer results from non-participation in screening or from failures in detection by screening. Analysis of the screening history of patients with cervix cancer may contribute to understanding failures in prevention. Methods: A cohort of patients presenting during 1 year was identified. Dates and results of cervical smears in the 4 years prior to presentation were extracted from a screening database. Patients were grouped as follows: ‘No screening’—no Pap records; ‘Pre-diagnostic’—one or more Pap tests within 6 months of presentation; ‘Sporadic screening’—one Pap test between 6 and 48 months prior to presentation; and ‘Regular screening’—at least two Pap tests 6–48 months before presentation. Results: 225 patients were identified (median age: 48 years, range 25–107). Eighty- eight had no records of screening; a further 66 were categorized as pre-diagnostic. These two groups (68% of incident cases) were considered not to have participated in routine screening. A further 15% had sporadic screening tests, but only 37 patients (16%) had evidence of regular screening. Clinically, 53, 41 and 6% presented with early, locally advanced and metastatic disease, respectively. Older patients (>50 years) were more likely to present with advanced disease (61 vs 37% at least Stage II). Conclusions: These results suggest that the failure to prevent invasive cervix cancer in this population can largely be attributed to failures in recruitment for screening.

Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities

Weisz, D., Gusmano, M. K., Rodwin, V. G., Neuberg, L. G. — 2008-03-13

Background: Access to timely and effective medical services can reduce rates of premature mortality attributed to certain conditions. We investigate rates of total and avoidable mortality (AM) and the percentage of avoidable deaths in France, England and Wales and the United States, three wealthy nations with different health systems, and in the urban cores of their world cities, Paris, Inner London and Manhattan. We examine the association between AM and an income-related variable among neighbourhoods of the three cities. Methods: We obtained mortality data from vital statistics sources for each geographic area. For two time-periods, 1988–90 and 1998–2000, we assess the correlation between area of residence and age- and gender-adjusted total and AM rates. In our comparison of world cities, regression models are employed to analyse the association of a neighbourhood income-related variable with AM. Results: France has the lowest mortality rates. The US exhibits higher total, but similar AM rates compared to England and Wales. Rates of AM are lowest in Paris and highest in London. Avoidable mortality rates are higher in poor neighbourhoods of all three cities; only in Manhattan is there a correlation between the percentage of deaths that are avoidable and an income related variable. Conclusions: Beyond the well-known association of income and mortality, persistent disparities in AM exist, particularly in Manhattan and Inner London. These disparities are disturbing and should receive greater attention from policy makers.

Coverages and factors associated with influenza vaccination among subjects with chronic respiratory diseases in Spain

2008-03-13

Background: The main influenza complications particularly affect patients over the age of 65 years and those with associated chronic diseases, such as respiratory disorders. This study aims to assess vaccination coverage among Spanish children and adults with chronic respiratory diseases (CRDs), and to describe the factors associated with vaccination in 2003. Methods: We analysed 28 113 records of individuals (6869 children and 21 244 adults) included in the Spanish National Health Survey (NHS) for 2003. As a dependent variable, we used the reply (‘yes’ or ‘no’) to the question: ‘Did you have a ‘flu shot in the latest campaign?’ We calculated influenza vaccine coverage as the percentage of individuals with a respiratory disorder (asthma and/or chronic bronchitis and/or emphysema) who reported having been vaccinated against influenza in the most recent campaign. We analysed the influence of sociodemographic, health-status, medical visits and lifestyle variables on vaccination. Results: Vaccination coverage was 19.9% in children and 54.7% in adults suffering CRD. In both age groups, coverages were significantly higher than those observed for non-CRD sufferers. Among adults, older age, not smoking and medical visits to their physician in the preceding 2 weeks were the variables independently and significantly associated with a higher likelihood of receiving the vaccine. Among children, financial factors influence vaccination. Conclusions: Vaccination coverage among children with CRDs is very low. Also among adult CRD sufferers, vaccination remains below the desired level, thereby making it necessary for strategies to be implemented aimed at improving the use of influenza vaccine.

Health indicators in the European regions--ISARE II

2008-03-13

Background: Most comparisons of health data in Europe take place at the national level. However, there is increased interest in looking at health data at a sub-national level. This is because of the increased importance in many European countries, of regions and devolved powers to them. This study aimed to establish the availability of health data at a regional level and to construct an experimental database. Methods: Using a network of country correspondents, data were collected on a series of topics from all the regions of that country. In addition, a supplementary list of data was collected from one region of each country. Results: Out of the then 15 Member States of the European Union (EU), 14 countries participated in the study. Thirteen countries were able to supply data. Where data were available, using the criteria we developed, these were of relatively good quality. Data on mortality was most readily available, but data on the important public health topics such as obesity was much more difficult to obtain, and absent in many cases. Conclusions: It is possible to construct a database and a resultant set of indicators for relevant sub-national areas of Member States in the EU. This is not likely to be achieved through current routine data collection systems unless significant changes are made to the data collection processes such as those undertaken by Eurostat. There is, also, an urgent need to introduce comprehensive sub-national data collections on important public health topics such as obesity and smoking.

Imported malaria in children: a national surveillance in the Netherlands and a review of European studies

Driessen, G. J., Pereira, R. R., Brabin, B. J., Hartwig, N. G. — 2008-03-13

Background: Falciparum malaria or malaria tropica is one of the leading causes of childhood mortality worldwide. Malaria-related deaths occur mainly in sub-Saharan Africa, where an estimated 365 million clinical cases of Plasmodium falciparum malaria occur each year. In Europe, imported malaria cases occur due to returning travellers or immigration mostly from African countries. Children are more at risk than adults. The objective of this study was to identify high risk groups for imported childhood malaria in Europe in order to guide development of strategies for prevention, early recognition and management. Methods: In the period May 2003–January 2005 we reviewed all cases of paediatric malaria in the Netherlands notified by the Dutch Paediatric Surveillance System (Nederland Signalerings Centrum Kindergeneeskunde, NSCK) and the literature on imported malaria in children in Europe published between 1996 and 2006. Results: Malaria occurred mainly in children of long-term (n = 15, 47%) and new (n = 8, 25%) immigrants and was mostly acquired in sub-Saharan Africa. The dominant species was P. falciparum. Only one quarter of children had used adequate malaria chemoprophylaxis. Complicated disease occurred in 10 (31%) of cases. We also reviewed the literature and found 6082 reported cases of imported malaria among children in Europe; among these, four died and only one was reported to develop neurological sequelae. Conclusion: Imported malaria in children remains an important problem and is unlikely to decrease unless the reasons for inadequate prophylaxis are addressed.

The effect of non-response on estimates of health care utilisation: linking health surveys and registers

Gundgaard, J., Ekholm, O., Hansen, E. H., Rasmussen, N. Kr. — 2008-03-13

Background: Non-response in health surveys may lead to bias in estimates of health care utilisation. The magnitude, direction and composition of the bias are usually not well known. When data from health surveys are merged with data from registers at the individual level, analyses can reveal non-response bias. Our aim was to estimate the composition, direction and magnitude of non-response bias in the estimation of health care costs in two types of health interview surveys. Methods: The surveys were (1) a national personal interview survey of 22 484 Danes (2) a telephone interview survey of 5000 Danes living in Funen County. Data were linked with register information on health care utilisation in hospitals and primary care. Health care utilisation was estimated for respondents and non-respondents, and the difference was explained by a decomposition method of bias components. Results: The surveys produced the same pattern of non-response, but with slight differences in non-response bias. Response rates for the interview and telephone surveys were 75 and 69%, respectively. Refusal was the most frequent reason for non-response (22 and 20% of those sampled, respectively), whereas illness, non-contact, and other reasons were less frequent. Respondents used 3–6% less health care than non-respondents at the aggregate level, but the opposite was true for some specific types of health care. Non-response due to illness was the main contributor to non-response bias. Conclusions: Different types of non-response have different bias effects. However, the magnitude of the bias encourages the continued use of interview health surveys.

Sensitivity analysis in summary measure of population health in France

Lapostolle, A., Lefranc, A., Gremy, I., Spira, A. — 2008-03-13

Background: The aim of this study is to provide estimates of the French burden of disease, using the WHO Global Burden of Disease methodology and to perform sensitivity analysis on different set of mortality data. Methods: The burden of disease is measured by disability-adjusted life years (DALYs) that take into account both mortality and morbidity data. Results were obtained using French mortality data for the years 2000 and 2001 and morbidity data estimated by WHO for France. Sensitivity analyses were conducted using different mortality data sets and various life tables as mortality norms. Calculations were also performed with and without discounting and age-weighting. Results: In France, the annual burden of disease was about 12.4 million DALYs. Depending on the mortality data set and the choice of social values used for calculation, results could be quite different. The use of WHO estimates for mortality resulted in an underestimation of 2.6% of total DALYs with respect to French data. Changes of the mortality norm imply changes in the number of years of life lost (YLLs), whereas the use of discounting and age-weighting mainly modifies the ranking of diseases. Conclusion: DALYs constitute a summary measure of population health, which is a powerful tool for the grading of health problems, allowing to compare fatal and non-fatal diseases. Nevertheless, the validity of results obtained depends primarily on the validity of the input data. Collecting morbidity data (mainly incidence) at the national level is hence an important step in order to assess more accurately the specific burden of diseases in France.

Reporting of diabetes on death certificates of 1872 people with type 2 diabetes in Tayside, Scotland

Evans, J. M. M., Barnett, K. N., McMurdo, M. E. T., Morris, A. D. — 2008-03-13

Background: It has been suggested that diabetes is under-recorded on death certificates. Methods: We examined the death certificates of 1,872 people with type 2 diabetes in Tayside, Scotland, to determine how frequently diabetes was recorded. Results: Diabetes was mentioned on the certificates of 42.8% and was the underlying cause of death for 6.4%. There was mention of diabetes for 51.3% of the 811 people for whom cardiovascular disease was the underlying cause of death. Being male was associated with less frequent mention of diabetes, with more frequent mention associated with increasing duration of diabetes, increasing age and underlying cardiovascular cause of death. Conclusions: This study highlights the limitations of using routine mortality data for monitoring the burden of diabetes in populations.

'Ethnic cleansing' bleaches the atrocities of genocide

Blum, R., Stanton, G. H., Sagi, S., Richter, E. D. — 2008-03-13

Genocide has been the leading cause of preventable violent death in the 20th–21st century, taking even more lives than war. The term ‘ethnic cleansing’ is used as a euphemism for genocide despite it having no legal status. Like ‘Judenrein’ and ‘racial hygiene’ in Nazi medicine, it expropriates pseudo-medical terminology to justify massacre. Use of the term reifies a dehumanized view of the victims as sources of filth and disease, and propagates the reversed social ethics of the perpetrators. Timelines for recent genocides (Bosnia, 1991–1996, 200 000; Kosovo 1998–2000, 10 000–20 000; Rwanda, 1994, 800 000; Darfur 2002–2006, >400 000) show that its use bears no relationship to death tolls or the scale of atrocity. Bystanders’ use of the term ‘ethnic cleansing’ signals the lack of will to stop genocide, resulting in huge increases in deaths, and undermines international legal obligations to acknowledge genocide. The term ‘ethnic cleansing’ corrupts observation, interpretation, ethical judgment and decision-making, thereby undermining the aim of public health. Public health should lead the way in expunging the term ‘ethnic cleansing’ from official use. ‘Ethnic cleansing’ bleaches the atrocities of genocide, leading to inaction in preventing current and future genocides.

Response to Hayden: Comment on 'ethnic cleansing' and 'genocide'

Richter, E. D., Stanton, G. H. — 2008-03-13

EUPHA President's column: equity, solidarity and EUPHA * NEWS from EUPHA office: EUPHA-ASPHER collaboration: taking friendship one step further * The Intergovernmental Working Group on Public Health, Innovation and Intellectual Property (IGWG)

Keskimaki, I., Paget, D. Z. — 2008-03-13

The Finnish dance of death: impressions from Helsinki

Mackenbach, J. P. — 2008-01-21

Solidarity in a unified Europe

McKee, M. — 2008-01-21

Integrated care for homeless people--sharing knowledge and experience in practice, education and research: Results of the networking efforts to find Homeless Health Workers

van Laere, I., Withers, J. — 2008-01-21

'Children and obesity: a pan-European project examining the role of food marketing'

Matthews, A. E. — 2008-01-21

Background: Rising levels of obesity in school-age children across Europe are causing increasing concern. The ‘Children, Obesity and associated avoidable Chronic Diseases’ project sought to examine the effects of promotion within food marketing, given the influential role it plays in children's diets. Method: A questionnaire and data-collection protocol was designed for the national co-ordinators, facilitating standardized responses. Co-ordinators collected data from within 20 European Union countries relating to food promotion to children. Results: Results showed that unhealthy foods such as savoury snacks and confectionary were the most commonly marketed and consumed by children across all countries. Television was found to be the prime promotional medium, with in-school and internet marketing seen as growth areas. Media literacy programmes designed specifically to counterbalance the effects of food marketing to children were reported by only a few of the 20 countries. An ineffective and incoherent pattern of regulation was observed across the countries as few governments imposed tough restrictions with most preferring to persuade industry to voluntarily act with responsibly. Most health, consumer and public interest groups supported food marketing restrictions whilst industry and media groups advocated self-regulation. Conclusion: Recommendations include the amendment of the European Union's Television Without Frontiers Directive to ban all TV advertising of unhealthy food to children, the adoption of a commonly agreed European Union definition of an ‘unhealthy’ food, and the establishment of a mechanism for pan-European monitoring of the nature and extent of food marketing to children and its regulation.

Individual, group and community risk and protective factors for alcohol and drug use among Swedish adolescents

Branstrom, R., Sjostrom, E., Andreasson, S. — 2008-01-21

Background: A number of factors have been identified that protect adolescents or, alternatively, put them at risk for drug use and other high-risk behaviours. These factors concern different personal and environmental factors, e.g. the community, the school setting, family, peer group and individual characteristics.The aim of the present study was to examine the associations between risk and protective factors and adolescents’ use of alcohol and drugs. Methods: In both May 2003 and 2004, random samples of 4800 adolescents (a total of 9600) in Sweden were contacted and asked to fill out a questionnaire.It concerned use of alcohol and illicit drugs and a large number of adolescent risk and protective factors. A total of 5445 (57%) adolescents agreed to participate. Results: About 44% of the adolescents in grade 9 (15–16 years of age) had been drunk on at least one occasion and nearly 80% of those in grade 11 (17–18 years of age). Almost 15% in grade 9 and 40% in grade 11 had been drinking heavily during the previous month, and 4% in grade 9 and 12% in grade 11 had used cannabis. Strong associations were found between elevated individual, family, school and community risk factors and use of alcohol and drugs. Conversely, protective factors were negatively related to the use of alcohol and drugs. Conclusions: This study confirms the importance of risk and protective factors within different domains in explaining alcohol and drug use among adolescents. The results support efforts targeting multiple risk and protective factors in alcohol and drug preventive interventions for adolescents.

Boys soccer league injuries: a community-based study of time-loss from sports participation and long-term sequelae

Timpka, T., Risto, O., Bjormsjo, M. — 2008-01-21

Background: Youth soccer is important for keeping European children physically active. The aim of this study is to examine injuries sustained in a community soccer league for boys with regard to age-related incidence, time lost from participation and long-term sequelae. Methods: Primary injury data was collected from a soccer league including 1800 players, comprising approximately 25% of all boys 13–16 years of age in three Swedish municipalities (population 150 000). Injuries were primarily identified based on a time loss definition of sports injury. At the end of the season, a physician interviewed every player who reported injured to determine whether there were any remaining sequelae. If a sequela was confirmed, the physician repeated the interview 6, 18 and 48 months after the end of the season. Results: Forty-four injuries were recorded during 18 720 player game hours (2.4 injuries per 1000 player game hours). The highest injury incidence (6.8 injuries per 1000 player game hours) was recorded in the first-year elite divisions. Thirty-two injuries (73%) were categorized as moderate-severe, and 21 injuries (48%) required medical attention. Eight injuries caused sequelae that remained 6 months after the end of the season, and 3 injuries caused sequelae that lasted 4 years after the injury event. Conclusion: An overall low injury rate makes soccer a suitable sport for inclusion in programmes that promote physical activity among children. When organizing soccer leagues for boys, injury prevention programmes should be provided to adolescent players when they begin playing in competitive divisions.

Associations between sport participation, demographic and socio-cultural factors in Portuguese children and adolescents

Seabra, A. F., Mendonca, D. M., Thomis, M. A., Peters, T. J., Maia, J. A. — 2008-01-21

Background: The number of studies that focus on factors influencing the sport participation (SP) of children and adolescents is limited. The present study examines the associations between demographic [age, gender and socio-economic status (SES)] and socio-cultural factors (SP of family, and peers and physical educator influences) and the SP of children and adolescents. Methods: A random sample of 3352 Portuguese children/adolescents, 10–18 years, their parents and siblings was surveyed. The assessment of SP was based on a psychometrically established questionnaire. Multivariable logistic regression was used in data analysis. Results: (i) age was not related to children/adolescent's SP; (ii) children/adolescents with high SES (OR:1.7, 95%CI:1.4–2.2) and medium SES (OR:1.4, 95%CI:1.1–1.7) were more involved in sports; (iii) children/adolescents were more likely to participate in sports when their family also participate; (iv) boys were more likely to participate in sports than girls (adjusted OR:3.3, 95%CI:2.8–3.9 from a main effects model), but mother's SP influenced their daughters and sons differently. Daughters showed a greater propensity for practising sports when their mothers did (OR:2.5; 95%CI:1.7–3.6). For sons, sports involvement was similar whether or not their mothers participated (OR:1.1; 95%CI:0.7–1.7); (v) peers had a positive influence on the participants’ SP (OR:2.2, 95%CI:1.9–2.7); (vi) after adjusting for other factors, the influence of a physical education teacher was not found to affect the SP of the children/adolescents. Conclusion: There are important demographic and socio-cultural influences on the SP of children/adolescents—in particular, gender, SES, family members’ SP and peer influence.

Socioeconomic disadvantage, social participation and networks and the self-rated health of English men and women with mild and moderate intellectual disabilities: cross sectional survey

Emerson, E., Hatton, C. — 2008-01-21

Background: Extremely high rates of mortality and morbidity have been reported among people with intellectual disabilities. Virtually no research has addressed the potential social determinants of health status within this very vulnerable population. Method: Cross-sectional survey of self-reported health status and indicators of socioeconomic disadvantage and social connectedness in 1273 English adults with mild or moderate intellectual disabilities. Results: Indicators of socioeconomic disadvantage accounted for a statistically significant proportion of variation in health status, over and above any variation attributable to the personal characteristics and living circumstances of participants. Indicators of social participation and networks did not add to the explanatory power of the model. Among the indicators of socioeconomic disadvantage, hardship was more strongly associated with variation in health status than either employment status or area-level deprivation. Conclusion: As in the general population, self-reported health was associated with indicators of socioeconomic disadvantage, especially hardship. In contrast, there was no evidence of any association between health status and social participation and networks.

Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years

2008-01-21

Background: Health behaviours are potential explanatory factors for socioeconomic differences in mortality. We examined the extent to which seven health behaviours covering dietary habits, smoking and physical avtivity, can account for relative differences in cardiovascular and all-cause mortality by educational level. Methods: Health behaviour data derived from nationwide Finnish health behaviour surveys from the years 1979 to 2001. These annually repeated cross-sectional surveys were linked to register-based information on educational level and subsequent mortality from the year of the survey until the end of 2001 (average follow-up time 11.9 years). The analyses included 29 065 men and 31 543 women of whom 4263 died. Cardiovascular disease (CVD), coronary heart disease (CHD), stroke and all-cause mortality was studied. Results: Educational level showed a graded association with all mortality outcomes. Health behaviours explained 54% of the relative difference between primary and higher educational level in CVD mortality among in men and 22% among in women. For all-cause mortality the corresponding figures were 45 and 38%. Smoking, vegetable use and physical activity were the most important health behaviours explaining educational level differences in all mortality outcomes, while the effects of type of fat used on bread, coffee drinking, relative weight and alcohol use were small. Conclusions: Smoking, low vegetable use and physical inactivity explained a substantial part of educational level differences in cardiovascular and all-cause mortality among men and women. Socioeconomic trends in these behaviours are of crucial importance in determining whether socioeconomic mortality differences will widen or narrow in the future.

A survey of hepatitis B and C prevalence amongst the homeless community of Prague

Volf, V., Marx, D., Pliskova, L., Sumegh, L., Celko, A. — 2008-01-21

Background: Viral hepatitis B (VHB) and C (VHC) are a major health concern worldwide, with 170 million people chronically infected and at risk of liver cancer, cirrhosis or liver failure. Since no vaccination is available against VHC it is important to understand how to prevent future infection. The modes of transmission include intravenous drug use (IDU), blood products, tattooing and, to a lesser extent, sexual intercourse. Homelessness is a risk factor of VHB and VHC because of the environments and behaviours associated with homeless communities such as poor hygiene, nutrition and high levels of IDU. The aim of this project was to determine the prevalence of VHB and VHC and its risk factors amongst homeless community of Prague, Czech Republic. Patients and methods: Ninety-eight individuals of the Prague homeless community were interviewed and tested for VHB and VHC infection markers. Results: The prevalence of both VHB and VHC was 26.5%. The major risk factors in this population were past and present IDU, young age and sharing the paraphernalia used by intravenous drug users (e.g. spoons, foils and filters). Conclusion: With the exception of age, all these risk factors could all be targeted in order to combat the major public health concern that VHB and VHC poses to the homeless community of Prague.

Community-level socio-economic status and cognitive and functional impairment in the older population

Basta, N. E., Matthews, F. E., Chatfield, M. D., Brayne, C., MRC-CFAS — 2008-01-21

Background: This study aimed to determine if people living in communities with higher socio-economic deprivation are at an increased risk of cognitive and functional impairment even after controlling for the effects of individual socio-economic status. Methods: We analysed cross-sectional data from the Medical Research Council Cognitive Function and Ageing Study which consists of a community-based sample of Cambridgeshire, Gwynedd, Newcastle, Nottingham and Oxford. The study included 13 004 men and women aged 65 years and over who were randomly selected from Family Health Services Authority computerized records after being stratified to ensure equal numbers of those aged 75 years and over and those under 75 years. The outcome measures were cognitive impairment (Mini-Mental State Exam 0–21) and functional impairment (Instrumental Activities of Daily Living and/or Activities of Daily Living disability). Results: Individuals living in more deprived areas, as measured by the Townsend deprivation score, were found to have a higher prevalence of cognitive impairment [odds ratio (OR) (most deprived versus least deprived quintile) = 2.3; 95% confidence interval (CI)1.8–3.0; P < 0.001] and functional impairment [OR (most deprived versus least) = 1.6; 95% CI 1.4–1.9; P < 0.001] after controlling for age, sex, centre effects, education and social class. Conclusions: There is a significantly higher prevalence of cognitive impairment and functional impairment in elderly individuals living in socio-economically deprived areas regardless of their own socio-economic status. This evidence is of relevance for informing public health policy and those allocating resources for the long-term care of the elderly.

Parental smoking behaviour and effects of tobacco smoke on children's health in Finland and Russia

2008-01-21

Background: There is little information on potential differences in smoking behaviour of parents between Finland and Russia and on the effects of environmental tobacco smoke (ETS) exposure on allergic and respiratory diseases among Finnish and Russian children. The aim of the study was to compare the smoking behaviour of parents and school children and to assess the relations of tobacco smoke exposure during pregnancy and childhood with occurrence of allergic diseases and respiratory infections among school children. Methods: We conducted a population-based cross-sectional study in the neighbour towns across the border of Imatra in Finland and Svetogorsk in Russia. The study population consisted of 512 Finnish and 581 Russian school children aged 7–16 years (response rate 79%). Results: Children's tobacco smoke exposure differed markedly between Finland and Russia. The risk of asthma was particularly related to high maternal smoking exposure during pregnancy (adjusted OR 3.51, 95% CI 1.00–12.3), infancy (3.34, 1.23–9.07) and currently (3.27, 1.26–8.48), and the risk of common cold was related to high combined parental smoking during infancy (1.83, 1.06–3.17) in Finnish children. Among Russian children allergic conjunctivitis was related to maternal smoking during infancy (4.53, 1.49–13.8) and currently (2.82, 1.07–7.44). Conclusions: Smoking behaviour of parents and ETS exposure during childhood differed markedly between Finland and Russia. Asthma was particularly increased in relation to high exposure to maternal smoking in Finland. The results suggest that more efforts should be directed to reducing tobacco smoke exposure of children in both Finland and Russia. (250 words)

Does smoke-free Ireland have more smoking inside the home and less in pubs than the United Kingdom? Findings from the international tobacco control policy evaluation project

2008-01-21

Background: In March 2004, Ireland implemented comprehensive smoke-free regulations. Some were concerned this would cause pub patrons to move their smoking and drinking from inside pubs to inside homes. This article aims to assess whether nationwide smoke-free policies are associated with more smoking or drinking inside the home. Methods: Participants were 1917 adult smokers (> 18-years old) from Ireland (n = 582), Scotland (n = 507) and the rest of the United Kingdom (n = 828), which did not have smoke-free laws at the time of the interview, who completed a random digit-dialed telephone survey in February to March 2006. The percentage of alcoholic drinks consumed in the home versus pubs was compared by country as well as the percentage of daily cigarette consumption occurring in the home after work. Results: Irish respondents reported a significantly lower percentage of alcoholic drinks consumed in the home compared to Scotland and the rest of the United Kingdom, and cigarette consumption in the home was comparable in all three regions. Conclusions: Smoking and drinking in the home was not greater in smoke-free Ireland than in the United Kingdom, where there was not a smoke-free law at the time of the survey. These findings add further support to the enactment of comprehensive smoke-free laws, as called for in the Framework Convention on Tobacco Control.

Adolescent mental health predicts quitting smoking in adulthood: a longitudinal analysis

Hemmingsson, T., Kriebel, D., Tynelius, P., Rasmussen, F., Lundberg, I. — 2008-01-21

Objectives: Several studies have reported an association between cigarette smoking and psychiatric illness. A common finding is that the prevalence of psychiatric illness among former smokers is much lower than among current smokers and is often similar to that among never-smokers. There are two alternative causal explanations for this association: either improved mental well-being results from smoking cessation; or those with poorer mental well-being are less successful at smoking cessation. The objective was to analyse a unique longitudinal data set to shed light on the direction of causality and to distinguish between these alternative explanations. Methods: Information on smoking status and indicators of poor mental well-being from childhood and adolescence was collected at age 18 in 1969 from 49 321 men at compulsory conscription for military service. Follow-up data on smoking status were collected among a random subset (n = 694) who participated in one or more annual national Swedish Surveys of Living Conditions in 1981–2001. Results: Approximately half of the smokers at age 18 in 1969 had quit by the time they were resurveyed (1981–2002). Those who had not quit and who reported smoking more than 10 cigarettes/day at age 18 (called persistent heavy smokers), were more likely to have had childhood and adolescent indicators of poor mental health measured at age 18 in 1969 than non-smokers or quitters. Conclusion: Our findings indicate that men who would subsequently be successful at smoking cessation reported better mental health and a lower prevalence of childhood mental health indicators at age 18 than persistent heavy smokers.

The interdisciplinary model of hospital administration: do health professionals and managers look at it in the same way?

Vlastarakos, P. V., Nikolopoulos, T. P. — 2008-01-21

Background: To assess health practitioners’ views on the issue of hospital administration and explore possible conflicts. Methods: Questionnaire-based, multi-stage cluster sampling technique was used as the design,in which 124 doctors, 154 certified nurses and 15 hospital managers participated. Results: Only 39% of doctors and 51% of nurses were aware of the manager's basic degree and 70% of them considered it inadequate. Health sciences were chosen as the best basic degree for effective management by 65% of health practitioners. Moreover, 74% of doctors and 96% of nurses believed that an interdisciplinary board of directors, with the manager acting as a chairman could be the ideal administrative model. Even though this model was the current system in the interviewed hospitals, most health practitioners (87%) considered it ineffective. With regard to the acceptance of the manager as authority in the hospital, 76% of the doctors believed that there were related problems (47% considered the manager as an outsider to the health sector), whereas only 45% of the managers admitted such problems. Trainees showed a less tolerant attitude towards managerial administration in comparison to specialists. Conclusion: Most health professionals believe that hospital administration is ineffective. The interdisciplinary model, with a manager having both health sciences and economics degrees and exercising his/her role with flexibility and taking the widest consent of health professionals may improve the very low rates of acceptance and perceived efficacy. Trainees and nurses seem to often have different views, suggesting the importance of their participation in the administrative model.

Chronic conditions and the risk of long-term institutionalization among older people

2008-01-21

Background: As the public expenditure on long-term care is likely to increase with the ageing of the population, identifying chronic medical conditions associated with the risk of long-term institutionalization is of particular interest. However, there is little systematic evidence showing how chronic medical conditions, other than dementia, affect the risk of entering into institutional care in the general older population. Methods: We used population-based follow-up data on Finnish older people aged 65 and over (n = 280 722), to estimate the impact of different chronic conditions on the risk of long-term institutionalization. Furthermore, we analysed which chronic conditions were more strongly associated with the risk of institutionalization than with the risk of death without institutionalization. Cox proportional hazard regression models were used. Results: Our results showed that dementia, Parkinson's disease, stroke, depressive symptoms, other mental health problems, hip fracture and diabetes were strongly associated with increased risk of long-term institutionalization, independent of socio-demographic confounders and the presence of other chronic conditions. All these conditions raised the risk of institutionalization by 50% or more. Dementia, Parkinson's disease, stroke and mental health problems were more strongly associated with the risk of institutionalization than with the risk of death without institutionalization. Conclusions: Overall, these results show that the future demand for institutional care depends not only on the ageing of the population but also on the development of the prevalence and severity of chronic conditions associated with institutionalization.

Introduction of diagnosis-related groups in Germany: evaluation of impact on in-patient care in a dermatological setting

2008-01-21

Background: German diagnosis-related groups (G-DRG) have been introduced in Germany as a reimbursement system for in-patient care. The aim of this study was to report data-based experiences from the introduction process and to evaluate the impact on in-patient dermatology. Methods: A quantitative analysis including clinical data from two large university centres of dermatology over a time period of 4 years (2003–06) has been performed. Characteristics and trends of case-mix index, number of cases, average age, length of stay (LOS), surgical and medical treatments and in-patient case groups were studied in detail. Results: It was found that the case-mix index values increased after the introduction period, but subsequently declined on the initial value. At the same time, an increase of dermatological hospital admissions can be noticed parallel to a significant reduction of LOS (P < 0.001) and a moderate increase of average age (P < 0.001). Analysis of DRG assignment revealed an initial significant decline of surgical in-patient procedures and increasing medical treatments, however, without obvious long-term changes. Furthermore, a growing importance for dermatological oncology and inflammable skin diseases within the in-patient setting could be observed. Conclusions: The introduction of the G-DRG system in Germany induced changes in in-patient care affecting hospital admission rates, LOS and cases treated in an in-patient setting. In-patient activities have not been reduced with the DRG introduction; however, long-term interdisciplinary research approaches are needed to explore the future impact on health care providing and quality of health care in depth.

Use of health care and drugs by police officers 8.5. years after the air disaster in Amsterdam

2008-01-21

This study examined the use of health care by police officers after the air disaster in Amsterdam. On average 8.5 years post-disaster, involved police officers (n = 834, who reported disaster-related tasks), and their non-involved colleagues (n = 634) completed questionnaires on disaster involvement and health care in the preceding 12 months. Logistic regression showed that involved police officers more often used drugs on their own initiative, sleeping pills or tranquillisers, and consulted a general practitioner or medical specialist, a paramedical specialist, and a privately practicing psychologist or psychiatrist. Thus, even after years, police officers involved in disaster work may use more self-initiated health care.

Thank you

2008-01-21

President's column * NEWS from EUPHA office * A major public health and forensic medicine problem in the future--the acute intoxication in children and adolescents * Is a EUPHA conference evaluation standard needed? * To evaluate health care systems performance: an international comparison * WHO/EURO Column: 'Brain Drain' or ethical recruitment? the migration of health professionals received special attention at the fifty-seventh session of the who regional committee for Europe, in Belgrade, Serbia, in September 2007

2008-01-21

Good governance for the public's health

Brand, H. — 2007-12-14

Public health ethics in Europe let ethicists enter the public health debate

Maeckelberghe, E. L. M., Schroder-Back, P. — 2007-12-14

Patient organizations and public health

Naiditch, M. — 2007-12-14

Patient organizations and prevention in the Netherlands

van Bennekom-Stompedissel, I. — 2007-12-14

'Ethnic cleansing' and 'genocide'

Hayden, R. M. — 2007-12-14

The case for large scale fungible cohorts

Gallacher, J. E. J. — 2007-12-14

Evidence of divergence with duration of residence in circulatory disease mortality in migrants to Australia

Gray, L., Harding, S., Reid, A. — 2007-12-14

Background: Very little is known about how acculturation affects health in different societal settings. Using duration of residence, this study investigates acculturation and circulatory disease mortality among migrants in Australia. Methods: Data from death records, 1998–2002, and from 2001 Census data were extracted for seven migrant groups [New Zealand; United Kingdom (UK)/Ireland; Germany; Greece; Italy; China/Singapore/Malaysia/Vietnam (East Asia); and India/Sri Lanka (South Asia)] aged 45–64 years. Poisson regression models were fitted to estimate the duration of residence effect (categorized in 5-year bands and also as having arrived 2–16, 17–31 and 32 years ago or more), adjusted for sex, 5-year age group and year of death, then additionally for occupational class and marital status (SES) on relative risks (RR) of CVD mortality. Results: Compared with the Australia-born population, CVD mortality was generally lower in each migrant group. Decreasing mortality with increasing duration of residence was observed for migrants from New Zealand (RR 0.95, 95% Confidence Interval 0.92–0.98, P < 0.01, per 5-year increase), Greece (0.90, 0.86–0.94, P < 0.01), Italy (0.94, 0.91–0.97, P < 0.01) and South Asia (0.95, 0.91–0.99, P < 0.01), mainly in older age groups. Trends remained after SES adjustment and also when broader categories of duration of residence were used. CVD mortality among migrants from the UK/Ireland appeared to converge towards those of the Australian-born. Conclusions: These results show divergence in CVD mortality compared with the Australian rate for New Zealanders, Greeks, Italians and South Asians. Sustained cardio-protective behavioural practices in the Australian setting is a potential explanation.

Obesity in asylum seekers' children in The Netherlands the use of national reference charts

Stellinga-Boelen, A. A.M., Wiegersma, P. A., Bijleveld, C. M.A., Verkade, H. J. — 2007-12-14

Background: Growth assessment can be used to monitor health at individual and population level. For asylum seekers’ children with different geographic backgrounds, growth reference values are frequently not available. We assessed nutritional condition and growth of asylum seekers’ children upon arrival and follow-up in The Netherlands, using national growth charts, and related these parameters to geographic origin. Methods: Height and weight of 135 children originating from Africa (n = 47), Central Asia (n = 41), and Eastern Europe (n = 47), were assessed longitudinally (median follow-up 3 years, range 1–8 years). Body-mass-index (BMI) was calculated, and overweight and obesity were defined according the international BMI cut-off values for age and gender. Results: Upon arrival at a median age of 4.5 years (range 0–11.5 years), 13% of the children were small for age (below –2 SD of the Dutch height for age reference), which decreased to 5% during follow-up (P < 0.05). During follow-up, 90% of the height measurements in boys and 85% in girls were within the normal range (±2 SD) of the Dutch references. The proportion of children with overweight including obesity increased from 15% at arrival to 21% during follow-up (P < 0.05). Irrespective of age, children originating from Africa were taller than children from Central Asia or Eastern Europe at follow up (P < 0.05). Overweight and obesity was most prominent among children of Eastern Europe. Conclusion: Dutch national reference values allow monitoring growth and the development of overweight or obesity in asylum seekers’ children in The Netherlands. Prevention strategies to reduce the development of overweight and obesity among these children seem warranted.

Rubella immune status of indigenous and immigrant pregnant women in Catalonia, Spain

2007-12-14

Background: The objective of the study was to determine the prevalence of rubella antibodies in representative samples of pregnant women in Catalonia. Methods: A representative sample of pregnant women in Catalonia was obtained by random sampling by clusters (hospitals with maternity units) stratified by provinces. Blood was obtained from the umbilical cord at childbirth in 1538 women (of whom 308 were immigrants) and was tested for rubella antibodies by ELISA (Enzime-linked immunosorbent assay). Results: The global prevalence of antibodies was 93.4% [95% confidence interval (CI): 93.3–93.5] and was significantly higher in indigenous women (94.9;95%CI:93.3–95.9) compared with immigrants [89.0; 95%CI: 85.5–92.5 (P < 0. 0001)] with crude Odds ratio (OR) of 2.15 (95%CI: 1.40–3.32).The prevalence was higher in women living in rural habitats (97%) and those in higher social classes (96.3%); OR 2.54 (95%CI: 1.22–5.30) and 2.17 (95%CI: 1.24–3.81), respectively. Conclusion: Fertile female immigrants from countries with no vaccination or where vaccination coverage is low should be actively approached for vaccination to reduce the risk of infection and congenital rubella.

Trends in socio-economic differences in tobacco smoking among German schoolchildren, 1994 2002

Richter, M., Leppin, A. — 2007-12-14

Background: While the graded relationship between socio-economic status (SES) and risk behaviour in adulthood has been the subject of intense research, far less is known about socio-economic differences in health-related behaviour among adolescents. The purpose of the present study is to examine socio-economic differences in adolescent tobacco use in Germany as well as changes in the relationship between 1994 and 2002. Methods: Data were obtained from the ‘Health Behaviour in School-aged Children’ study conducted in the largest federal state of Germany, Northrhine-Westfalia, in 1994, 1998 and 2002. The analysis is based on 11.401 11- to 15-year old students. Socio-economic differences in regular smoking were studied in relation to both parental SES (family affluence) and students own SES (school type). Trends from 1994 to 2002 were analysed for each category of family affluence and school type separately. Results: Family affluence only had a weak effect on regular smoking while for type of school a strong social gradient for smoking was found for both the genders. Trend analyses within the different family affluence and school-type categories showed that smoking has generally increased in all socio-economic groups. The level of socio-economic differences remained virtually unchanged in girls and boys in the past 10 years in Germany. Conclusions: The same relationships of family affluence and school type with smoking have persisted for almost a decade in Germany. Students own SES affects adolescent smoking substantially. Prevention programmes should focus on the school setting in order to tackle current as well as future health inequalities.

Social determinants of ever initiating smoking differ from those of quitting: a cross-sectional study in Estonia

Leinsalu, M., Tekkel, M., Kunst, A. E. — 2007-12-14

Background: To study the association of socioeconomic and demographic indicators with ever initiating regular smoking and quitting smoking among ever regular smokers in Estonia in order to identify target groups for equity-oriented tobacco control policies. Methods: Data for 4277 individuals in the 25–64 age group come from three cross-sectional studies conducted in 2000, 2002 and 2004. Age-standardized prevalence rates and odds ratios with 95% confidence intervals were calculated. Results: High rates of ever initiation were observed for lower educated men and women after controlling for other socioeconomic indicators. This association was not observed for women above age 50. Independent, although weaker associations were found among men who were unemployed or with a low occupational status. Low cessation rates were observed among men who were unemployed, who had a lower occupational position or who had a low income. These associations remained after controlling for other socioeconomic variables. The effect of income became stronger in the older age groups among men. Rates of ever initiation and cessation also varied strongly in relationship to some demographic variables. The highest initiation rates were found among divorced women and among women living in the capital city. The lowest cessation rates were found among divorced women, and among Russian men. Conclusions: While educational level was the strongest predictor of ever initiating regular smoking, smoking cessation was related more directly to aspects of social disadvantage originating in adult life. To be effective, tobacco control interventions should not only target lower educated, but also those in material disadvantage.

Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants

Flacking, R., Nyqvist, K. H., Ewald, U. — 2007-12-14

Background: The propensity to breastfeed is not only of importance with regard to the beneficial effects on the individual, but is also of concern as an indicator of health behaviour related to social conditions. Thus, our aim was to investigate the impact of socioeconomic status (SES) on breastfeeding duration in mothers of preterm and term infants. Methods: Prospective population based cohort study. Data for infants registered in breastfeeding databases of two Swedish counties 1993–2001 were matched with data from two national registries—the Medical Birth Registry and Statistics Sweden. A total of 37 343 mothers of 2093 preterm and 35 250 term infants participated. Results: All socioeconomic factors; maternal educational level, maternal unemployment benefit, social welfare and equivalent disposable income, were strongly associated with breastfeeding when examined individually in mothers of preterm and term infants. Some of the associations attenuated when investigated simultaneously. Independently of SES and confounders, mothers of preterm infants were at higher risk of weaning before the infant was 2 months (adjusted odds ratio (OR) 1.70; 95% confidence interval ((CI) 1.46–1.99)), 4 months (OR 1.79; CI 1.60–2.01), 6 months (OR 1.48; CI 1.33–1.64), and 9 months old (OR 1.19; CI 1.06–1.34), compared with mothers of term infants. Conclusions: In Sweden, despite its social welfare support system and a positive breastfeeding tradition, SES clearly has an impact on the breastfeeding duration. Mothers of preterm infants breastfeed for a shorter time compared with mothers of term infants, even when adjustments are made for SES and confounders.

Increasing social inequality in life expectancy in Denmark

Bronnum-Hansen, H., Baadsgaard, M. — 2007-12-14

Background: The purpose of the study was to determine trends in social inequality in mortality and life expectancy in Denmark. Methods: The study was based on register data on educational level and mortality during the period 1981–2005 and comprised all deaths among Danes aged 30–60. Sex- and age-specific death rates for each of three levels of education were calculated and age-standardized to allow comparisons over time and between groups. As data obtained since 1996 included ages up to 74, partial life expectancy (i.e. expected lifetime of 30-year-olds before the age of 75) was calculated for the period 1996–2005. Results: Between 1981 and 2005, the difference in death rates between people aged 30–60 with low and high educational level increased by two-thirds for men and was doubled for women. During the period 1996–2005, the gap in partial life expectancy from age 30 to 75 between people with low and high educational level increased by 0.3 years. Conclusion: During the past 25 years, the social gap in mortality has widened in Denmark. In particular, women with a low educational level have been left behind.

Increasing life expectancy in Germany: quantitative contributions from changes in age- and disease-specific mortality

Klenk, J., Rapp, K., Buchele, G., Keil, U., Weiland, S. K. — 2007-12-14

Background: Between 1962 and 2002 the average life expectancy in Germany has increased from 67.1 years to 75.6 years in men and from 72.7 years to 81.3 in women. Methods: The cumulative and annual contributions of different age- and disease-groups on life expectancy were calculated using Pollard's actuarial method of decomposing mortality rates. Mortality data were provided by the German Statistical Office. Results: Considering the cumulative contribution over the period of 40 years, the largest contributions came from persons with at least 65 years of age (2.9 years in men and 4.0 years in women). Reductions in cardiovascular disease mortality had the greatest cumulative impact on life expectancy (2.7 years in men and 3.0 years in women). The contribution from reduced cancer mortality on life expectancy was substantially lower (0.6 and 0.9 years, respectively). The annual contributions of several disease-groups varied considerably over time. The positive contribution from cardiovascular diseases started only after 1970, and in men it became solid only after 1980. Regarding malignant neoplasms, the largest cumulative contribution came from stomach cancer (0.4 in both sexes). The annual analyses showed increasing contributions from reduced cancer mortality after 1990. These were strongly influenced by lung, stomach, prostate and colorectal cancer in men, and by breast, colorectal and stomach cancer in women. Conclusions: While life expectancy has increased by about 2.2 years per decade the observed variations in the age- and disease-specific contributions over time have implications for future health care planning and prevention strategies.