Journal of Epidemiology and Community Health最新文献

Background: The Swedish Targeted Health Dialogue (THD) is a widely implemented, individual-focused intervention involving screening and health counselling for mid-life individuals. Previous research has shown somewhat mixed results; therefore, this study aims to provide rigorous evidence on the population-level impact of the THD programme on ischaemic heart disease (IHD) in Sweden.

Methods: This study used the number of recorded county-specific IHD events and mortality among 40-69-year-olds between 1987 and 2023 in Sweden to estimate the effect of the THD programme. Six out of 21 counties had implemented THD fully during the study period. These six counties were used to evaluate the effect of the programme by estimating the change in IHD incidence trend post implementation compared with controls where the programme was not implemented at that specific time. This intervention effect was estimated using generalised multilevel controlled interrupted time-series models.

Results: In men, the intervention showed no statistically significant effect on IHD events compared with the controls, with an estimated increased annual rate of 0.1% (95% CI -0.1% to 0.2%). In women, a similar non-significant increase in incidence rate of 0.2% (95% CI -0.1% to 0.5%) per year was observed in the intervention counties. These figures can be contrasted with an annual linear reduction of 3.2% in IHD incidence among men and 1.5% among women. Similar results were attained regarding IHD mortality.

Conclusion: These findings do not support evidence for any beneficial population effect of the THD programme on future IHD. Hence, revisiting the fundamental concern on the effectiveness of the programme is pertinent.

Introduction: Prior studies have observed associations between poverty measured at single or across diffuse periods of the life course and cognitive function measured in later life. Few studies examine the relationship between cumulative poverty exposure and midlife cognition or address confounding of this relationship by early-life cognitive ability.

Methods: To estimate the effect of cumulative poverty with midlife cognitive function, we analysed data from National Longitudinal Survey of Youth 1979 participants with ≥3 family income measures over a 20-year period (1990-2010) who completed the modified Telephone Interview for Cognitive Status when ~48 years of age (N=2923). We defined participants' cumulative poverty status by the proportion of their family income measures <200% of the Federal Poverty Limit: 0 (never), <1/3 but >0 (sometimes), ≥1/3 but less than all (often) and all (always). Armed Forces Qualification Test score defined early-life cognitive ability. We used linear regression models to examine the association between cumulative poverty and sample-standardised z-scores for memory, attention and global cognitive function.

Results: Overall, 37.9% of participants were never, 26.6% were sometimes, 27.5% were often and 8.0% were always in poverty. In fully adjusted models and relative to participants never in poverty, those often (beta: -0.13; 95% CI -0.23 to -0.04) and always (beta: -0.37; 95% CI -0.53 to -0.22) in poverty had lower z-scores for midlife global cognitive function. Likewise, their z-scores were lower for midlife memory function.

Conclusions: Longer durations of poverty exposure may be more detrimental for midlife cognition. This relationship was not fully explained by early-life cognitive ability.

Background: Problematic gaming is a known risk factor for adolescent well-being. Yet, socioeconomic factors that might contribute to problematic gaming in adolescence have not been fully explored. This study examined the association between relative deprivation, defined as an individual's financial gap relative to their classmates, and problematic gaming in a representative sample of Italian adolescents.

Methods: We analysed data on family material assets and self-reported symptoms of problematic gaming from 58 881 participants in the 2021/2022 Italian Health Behaviour in school-aged children study. Relative deprivation was measured using the Yitzhaki index, with classmates as a social reference group. Associations with problematic gaming were tested using a two-level multiple logistic regression model while accounting for the effects of economic, sociodemographic and psychological factors.

Results: Adolescents reporting higher relative deprivation were eight times more likely to be classified as problematic gamers compared with their better-off peers, after controlling for individual and class-level deprivation, and self-efficacy beliefs. Males, younger adolescents and adolescents with lower self-efficacy were more at risk of being problematic gamers.

Conclusion: The current study expands the existing literature on the detrimental impact of inequalities on adolescent behaviours by highlighting the association between relative deprivation and problematic gaming. Policymakers are advised to implement measures to reduce inequalities and mitigate maladaptive gaming patterns among adolescents.

Aims: Electronic nicotine delivery system (ENDS) use by youth remains a significant public health concern. Perceived risk is an important predictor of adolescent ENDS use. While state policies have been shown to affect ENDS use, and perceived risk is inversely associated with use, whether policies shape adolescent risk perceptions remains less well studied.

Methods: We used longitudinal (2013-2019) US adolescent data from the Population Assessment of Tobacco and Health study-a population-based sample of adolescents enrolled between ages 12 and 17-and state policy data for ENDS and tobacco policies. Hybrid within-person and between-person panel models estimated associations of policies with three outcomes: perceived harms of ENDS, perceived risk of addiction and perceived risk of ENDS compared with smoking.

Results: Within-person findings revealed that ENDS purchase age restrictions were associated with increased odds of reporting categories of greater perceived harm (OR=1.65), perceived risk of addiction (OR=1.14) and risk relative to smoking (OR=1.60). Similarly, smoking bans were associated with perceived harm (OR=1.33), perceived risk of addiction (OR=1.21) and risk relative to smoking (OR=1.36). Between-person models indicated that ENDS excise taxes and purchase age restrictions, as well as smoking bans, were associated with all three perceived risk outcomes.

Conclusions: Implementing smoking bans, excise taxes and purchase age restrictions may present an avenue to heighten perceived risk among youth. As such, policies may enhance prevention of initiation and improve interventions for youth who vape. Further, as greater duration of exposure to policies is associated with increased risk perceptions, maintaining consistently strong policies is important.

Background: This study assessed whether supplementary nutrition provided to pregnant women under the Integrated Child Development Service (ICDS) programme in India has reduced the burden of low birth weight or LBW (weight at birth: <2500 g), very low birth weight (VLBW: <1500 g) and extremely low birth weight (ELBW: <1000 g), among their newborns.

Methods: We analysed data of 148 265 index children from the nationally representative 2019-2021 National Family Health Survey. A quasi-experimental method, Coarsened Exact Matching (CEM), was employed to estimate the causal effects of mother's receipt of supplementary nutrition during pregnancy on the prevalence of LBW, VLBW and ELBW. CEM outperforms conventional matching methods by reducing imbalance between treatment and control groups, model dependence, estimation error, bias, variance, mean square error and related criteria that can challenge study findings.

Results: Mothers of only 62.6% children always benefited from supplementary nutrition programme. The survey-weighted prevalence of LBW, VLBW and ELBW was 17.8% (95% CI: 17.5% to 18%), 1.14% (95% CI: 1.06% to 1.22%) and 0.13% (95% CI: 0.11% to 0.15%), respectively. The CEM analysis revealed that supplementary nutrition reduced the prevalence of LBW in pregnant women by an estimated 1.35 percentage points (β: -0.0135; 95% CI: -0.0211 to -0.0060, p: 0.001) or 7.5%, and VLBW by 0.26 percentage points (β: -0.0026; 95% CI: -0.0046 to -0.0005; p: 0.018) or 20.2%. No effect of supplementary nutrition on ELBW was identified (p: 0.114).

Conclusions: Supplementary nutrition provided to pregnant women under the ICDS programme could be helpful in mitigating the burden of LBW and VLBW in India. Intensified efforts to increase uptake of the programme are warranted.

Background: With global population ageing, frailty poses a growing public-health challenge. Many countries have promoted social participation to mitigate frailty among older adults, but the cross-national consistency of this association remains unclear.

Methods: We harmonised data from four longitudinal cohort studies (N=20 947) conducted in England, the USA, China and Mexico with respect to measures of social participation and frailty. We employed fixed-effects models and cross-national meta-analyses to examine the longitudinal relationship between social participation and frailty. The Arellano-Bond estimator model was further used to evaluate the lagged effects of this association. Finally, a multilevel analysis incorporating country-level factors was conducted to investigate the moderating effects of macro-level variables.

Results: Substantial differences in social participation were observed across countries, ranging from 41.76% in Mexico to 83.43% in the USA. After adjusting for confounders, higher social participation was significantly associated with lower frailty levels (pooled effect=-0.52; 95% CI -0.80 to -0.24), with evidence of a lagged temporal effect. Neither the strength of this association nor the overall rate of social participation was significantly influenced by country-level factors.

Conclusion: The consistent findings across diverse national contexts suggest that promoting equitable social engagement among older adults may effectively reduce the prevalence of frailty. Public-health policies and community programmes should prioritise initiatives that encourage social participation among the elderly, and healthcare services may consider integrating social activities into routine care to foster active ageing.

Social epidemiological studies have shown for decades that wealth shows associations to various health outcomes in addition to more frequently used and established indicators like income, education and occupational status. Measurements of income alone are not able to assess the economic position and resources of individuals, while they neglect transgenerational and cumulative pathways of shaping socioeconomic status (SES) and their impact on health. Despite this established knowledge, the use of measurements of wealth in epidemiological studies is very rare and heterogeneous.Therefore, a number of open questions still need to be answered: How does wealth relate to other socioeconomic and sociodemographic indicators with associations to health? On which pathways is wealth influencing individuals' health? What role does wealth play as a driver for health disparities across populations? Moreover, how does wealth interact with age, gender and race?To further research on these questions, we use this essay to elaborate on the term wealth and its role in social epidemiological research, review results from observational studies, discuss inconsistent results and conclude why it is important to consider wealth as a dimension of SES. In addition, we present a conceptual idea for integrating wealth in a life course-based concept of SES and show what information an assessment of wealth could provide in addition to other established SES indicators.