Associations between urbanisation and components of the health-risk transition in Thailand. A descriptive study of 87,000 Thai adults

BACKGROUND: Social and environmental changes have accompanied the ongoing rapid urbanisation in a number of countries during recent decades. Understanding of its role in the health-risk transition is important for health policy development at national and local level. Thailand is one country facing many of the health challenges of urbanisation. OBJECTIVE: To identify potential associations between individual migration between rural and urban areas and exposure to specific social, economic, environmental and behavioural health determinants. DESIGN: Baseline data from a cohort of 87,134 Thai open university students surveyed in 2005 (mean age 31 years). Four urbanisation status groups were defined according to self-reported location of residence (rural: R or urban: U) in 2005 and when the respondent was 10 12 years old (yo). RESULTS: Fourty-four percent were living in rural areas in 2005 and when they were 10 12yo (Group RR: ruralites); 20% always lived in urban areas (UU: urbanites); 32% moved from rural to urban areas (RU: urbanisers); 4% moved in the other direction (UR: de-urbanisers). The ruralites and urbanites often were the two extremes, with the urbanisers maintaining some of the determinants patterns from ruralites and the deurbanisers maintaining patterns from urbanites. There was a strong relationship between urbanisation status, from RR to RU to UR to UU, and personal income, availability of modern home appliances, car ownership, consumption of ‘junk food’ and physical inactivity. Urbanisers reported worse socio-environmental conditions and worse working conditions than the other groups. De-urbanisers had the highest rates of smoking and drinking. CONCLUSIONS: An urbanisation measure derived from self-reported location of residence gave new insights into the health risk exposures of migrants relative to permanent rural and permanent urban dwellers. Living in urban areas is an important upstream determinant of health in Thailand and urbanisation is a key element of the Thai health-risk transition

Social capital and health in a national cohort of 82,482 Open University adults in Thailand

We report associations between social capital and health among 82,482 adults in a national cohort of Open University students residing throughout Thailand. After adjusting for covariates, poor self-assessed health was positively associated with low social trust (OR = 1.88; 95% CI 1.76–2.01) and low social support (OR = 1.79; 95% CI 1.63–1.95). In addition, poor psychological health was also associated with low social trust (OR = 2.52; 95% CI 2.41–2.64) and low social support (OR = 1.80; 95% CI 1.69–1.92). Females, elderly, unpartnered, low income, and urban residents were associated with poor health. Findings suggest ways to improve social capital and heath in Thailand and other middle-income countries

Personal Wellbeing Index in a National Cohort of 87,134 Thai Adults

Satisfaction with life correlates with other measures of subjective wellbeing and correlates predictably with individual characteristics and overall health. Social indicators and subjective wellbeing measures are necessary to evaluate a society and can be used to produce national indicators of happiness. This study therefore aims to help close the gap in wellbeing data for Thailand. The specific aims are to: (1) calculate the Thai PWI and domain scores using a large scale sample; (2) examine the level of life satisfaction of Thais when compared to international standards; (3) examine the Thai PWI and domains in relation to demographic, socioeconomic, and geographic characteristics. Our report derives from the findings on the Personal Wellbeing Index (PWI) in a large national cohort of Sukhothai Thammathirat Open University adult students living all over Thailand (n = 87,134). This Thai cohort had an overall PWI of 70.0 on a scale from 0 to 100 which is consistent with Western populations. The ‘spirituality and religion’ domain had the highest average score. ‘Standard of living’, ‘future security’ and ‘achievement in life’ made the largest contribution to overall ‘satisfaction in life as a whole’. These domains also show a positive trend with increasing age, being married, higher income, more education, more household assets, and rural residence. The PWI will be an important tool for policymakers to understand the subjective wellbeing of population groups especially as Thailand is undergoing a political and economic transition

Short sleep and obesity in a large national cohort of Thai adults

Objective: To investigate the relationship between short sleep and obesity among Thai adults

Oral Health-Related Quality of Life among a large national cohort of 87,134 Thai adults

Background Oral health has been of interest in many low and middle income countries due to its impact on general health and quality of life. But there are very few population-based reports of adult Oral Health Related Quality of Life (OHRQoL) in developing countries. To address this knowledge gap for Thailand, we report oral health findings from a national cohort of 87,134 Thai adults aged between 15 and 87 years and residing all over the country. Methods In 2005, a comprehensive health questionnaire was returned by distance learning cohort members recruited through Sukhothai Thammathirat Open University. OHRQoL dimensions included were discomfort speaking, swallowing, chewing, social interaction and pain. We calculated multivariate (adjusted) associations between OHRQoL outcomes, and sociodemographic, health behaviour and dental status. Results Overall, discomfort chewing (15.8%), social interaction (12.5%), and pain (10.6%) were the most commonly reported problems. Females were worse off for chewing, social interaction and pain. Smokers had worse OHRQoL in all dimensions with Odds Ratios (OR) ranging from 1.32 to 1.51. Having less than 20 teeth was strongly associated with difficulty speaking (OR = 6.43), difficulty swallowing (OR = 6.27), and difficulty chewing (OR = 3.26). Conclusions Self-reported adverse oral health correlates with individual function and quality of life. Outcomes are generally worse among females, the poor, smokers, drinkers and those who have less than 20 teeth. Further longitudinal study of the cohort analysed here will permit assessment of causal determinants of poor oral health and the efficacy of preventive programs in Thailand

Thailand's work and health transition

Thailand has experienced a rapid economic transition from agriculture to manufacturing and services, and to more formal employment. Its labour market regulation and worker representation, however, are much weaker than they are in developed countries, which underwent these transitions more slowly and sequentially, decades earlier. The authors examine the strengthening of Thailand's policy and legislation on occupational safety and health in response to international standards, a new democratic Constitution, fear of foreign trade embargoes, and fatal workplace disasters. In concluding, they identify key challenges remaining for policy-makers, including enforcement of legislation and measurement of new mental and physical health effects

Association between occupational heat stress and kidney disease among 37 816 workers in the thai cohort study (TCS)

Background: We examined the relationship between self-reported occupational heat stress and incidence of selfreported doctor-diagnosed kidney disease in Thai workers. Methods: Data were derived from baseline (2005) and follow-up (2009) self-report questionnaires from a large national Thai Cohort Study (TCS). Analysis was restricted to full-time workers (n = 17 402 men and 20 414 women) without known kidney disease at baseline. We used logistic regression models to examine the association of incident kidney disease with heat stress at work, after adjustment for smoking, alcohol drinking, body mass index, and a large number of socioeconomic and demographic characteristics. Results: Exposure to heat stress was more common in men than in women (22% vs 15%). A significant association between heat stress and incident kidney disease was observed in men (adjusted odds ratio [OR] = 1.48, 95% CI: 1.01-2.16). The risk of kidney disease was higher among workers reporting workplace heat stress in both 2005 and 2009. Among men exposed to prolonged heat stress, the odds of developing kidney disease was 2.22 times that of men without such exposure (95% CI 1.48-3.35, P-trend <0.001). The incidence of kidney disease was even higher among men aged 35 years or older in a physical job: 2.2% exposed to prolonged heat stress developed kidney disease compared with 0.4% with no heat exposure (adjusted OR = 5.30, 95% CI 1.17-24.13). Conclusions: There is an association between self-reported occupational heat stress and self-reported doctordiagnosed kidney disease in Thailand. The results indicate a need for occupational health interventions for heat stress among workers in tropical climates