Interaction between Education and Household Wealth on the Risk of Obesity in Women in Egypt

Obesity is a growing problem in lower income countries particularly among women. There are few studies exploring individual socioeconomic status indicators in depth. This study examines the interaction of education and wealth in relation to obesity, hypothesising that education protects against the obesogenic effect of wealth

Education is associated with lower levels of abdominal obesity in women with a non-agricultural occupation: an interaction study using China's Four Provinces survey.

The prevalence of obesity is increasing rapidly in low- and middle-income countries (LMICs) as their populations become exposed to obesogenic environments. The transition from an agrarian to an industrial and service-based economy results in important lifestyle changes. Yet different socioeconomic groups may experience and respond to these changes differently. Investigating the socioeconomic distribution of obesity in LMICs is key to understanding the causes of obesity but the field is limited by the scarcity of data and a uni-dimensional approach to socioeconomic status (SES). This study splits socioeconomic status into two dimensions to investigate how educated women may have lower levels of obesity in a context where labour market opportunities have shifted away from agriculture to other forms of employment. The Four Provinces Study in China 2008/09 is a household-based community survey of 4,314 people aged ≥60  years (2,465 women). It was used to investigate an interaction between education (none/any) and occupation (agricultural/non-agricultural) on high-risk central obesity defined as a waist circumference ≥80 cm. An interaction term between education and occupation was incorporated in a multivariate logistic regression model, and the estimates adjusted for age, parity, urban/rural residence and health behaviours (smoking, alcohol, meat and fruit & vegetable consumption). Complete case analyses were undertaken and results confirmed using multiple imputation to impute missing data. An interaction between occupation and education was present (P = 0.02). In the group with no education, the odds of central obesity in the sedentary occupation group were more than double those of the agricultural occupation group even after taking age group and parity into account (OR; 95%CI: 2.21; 1.52, 3.21), while in the group with any education there was no evidence of such a relationship (OR; 95%CI: 1.25; 0.92, 1.70). Health behaviours appeared to account for some of the association. These findings suggest that education may have a protective role in women against the higher odds of obesity associated with occupational shifts in middle-income countries, and that investment in women's education may present an important long term investment in obesity prevention. Further research could elucidate the mechanisms behind this association

The Chernobyl Disaster and Beyond: Implications of the Sendai Framework for Disaster Risk Reduction 2015-2030.

On the 30th anniversary of the Chernobyl disaster, Amina Aitsi-Selmi and Virginia Murray reflect on the importance of disaster preparedness

Addressing non-communicable diseases in disaster risk reduction – an issue of equity

The issues raised by noncommunicable diseases (NCDs) during and after disasters are a challenge to equity within local communities, as well as between countries. Individuals with NCDs are particularly vulnerable in disasters and their aftermath given health systems are disrupted. Although welcome progress has been made in taking NCDs and equity into account in the UN General Assembly ratified agreement, the Sendai Framework for disaster risk reduction 2015–2030, there is need now for a clear plan of implementation

Under-reporting of tobacco use among Bangladeshi women in England.

BACKGROUND: This study investigates the prevalence of under-reported use of tobacco among Bangladeshi women and the characteristics of this group. METHODS: The 1999 and 2004 Health Survey for England included 996 Bangladeshi women aged 16 years and above, 302 with a valid saliva sample and 694 without. The main outcome measure was the prevalence of under-reported tobacco use. RESULTS: Fifteen per cent of Bangladeshi women with a saliva sample under-reported their personal tobacco use. Under-reporters were very similar to self-reported users except for being much more likely to report chewing paan without tobacco (47% versus 9%, P < 0.001). Under-reporters differed significantly from cotinine-validated non-users in most respects. Regression analyses confirmed that under-reporters and self-reported users were similar in age, education level and exposure to passive smoking. Under-reporters were older and less educated than cotinine-validated non-users. Both self-reported users [odds ratio (OR): 0.11, 95% confidence interval (CI): 0.04-0.30] and cotinine-validated non-users (OR: 0.42, 95% CI: 0.20-0.89) were far less likely to report chewing paan without tobacco compared with under-reporters. CONCLUSIONS: Contrary to our a priori hypothesis, under-reporters were not young, British-born, English-speaking women likely to be concealing smoking but resembled self-reported tobacco users except for being much more likely to report chewing paan without tobacco

Education modifies the association of wealth with obesity in women in middle-income but not low-income countries: an interaction study using seven national datasets, 2005-2010.

BACKGROUND:Education and wealth may have different associations with female obesity but this has not been investigated in detail outside high-income countries. This study examines the separate and inter-related associations of education and household wealth in relation to obesity in women in a representative sample of low- and middle-income countries (LMICs). METHODS:The seven largest national surveys were selected from a list of Demographic and Health Surveys (DHS) ordered by decreasing sample size and resulted in a range of country income levels. These were nationally representative data of women aged 15-49 years collected in the period 2005-2010. The separate and joint effects, unadjusted and adjusted for age group, parity, and urban/rural residence using a multivariate logistic regression model are presented. RESULTS:In the four middle-income countries (Colombia, Peru, Jordan, and Egypt), an interaction was found between education and wealth on obesity (P-value for interaction <0.001). Among women with no/primary education the wealth effect was positive whereas in the group with higher education it was either absent or inverted (negative). In the poorer countries (India, Nigeria, Benin), there was no evidence of an interaction. Instead, the associations between each of education and wealth with obesity were independent and positive. There was a statistically significant difference between the average interaction estimates for the low-income and middle-income countries (P<0.001). CONCLUSIONS:The findings suggest that education may protect against the obesogenic effects of increased household wealth as countries develop. Further research could examine the factors explaining the country differences in education effects

Prevalence of obesity by sociodemographic characteristic in each country, DHS data.

1<p>SE  =  standard error of the estimated proportion x 100.</p