Distance From Home to the Nearest Tobacco Outlet May Not Reflect the True Accessibility Reply

Non peer reviewe

Association between changes in lifestyle and all-cause mortality: The Health and Lifestyle Study

Background To examine the combined influence of changes in physical activity, diet, smoking and alcohol consumption on all-cause mortality. Methods Health behaviours were assessed in 1984/1985 and 1991/1992 in 8123 adults from the UK (4666 women, median age 41.0 years). An unhealthy lifestyle score was calculated, allocating one point for smoking, fruits and vegetables 14 units (women) or >21 units of alcohol (men) per week. Results There were 2003 deaths over a median follow-up of 6.6 years (IQR 5.9–7.2) following the resurvey. The modal change in the unhealthy lifestyle score was zero, 41.8% had the same score, 35.5% decreased and 22.7% increased score between surveys. A one unit decrease in the unhealthy lifestyle score was not associated with a beneficial effect on mortality (HR 0.93; 95% CI 0.83 to 1.04). A one unit increase in the unhealthy lifestyle score increased the risk of mortality (adjusted HR 1.09; 95% CI 1.01 to 1.18). Conclusions In this general population sample, the adoption of an unhealthy lifestyle was associated with an increased risk of mortality

Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies

OBJECTIVE:  To examine the role of psychological distress (anxiety and depression) as a potential predictor of site specific cancer mortality. DESIGN:  Pooling of individual participant data from 16 prospective cohort studies initiated 1994-2008. SETTING:  Nationally representative samples drawn from the health survey for England (13 studies) and the Scottish health survey (three studies). PARTICIPANTS:  163 363 men and women aged 16 or older at study induction, who were initially free of a cancer diagnosis, provided self reported psychological distress scores (based on the general health questionnaire, GHQ-12) and consented to health record linkage. MAIN OUTCOME MEASURE:  Vital status records used to ascertain death from 16 site specific malignancies; the three Scottish studies also had information on cancer registration (incidence). RESULTS:  The studies collectively contributed an average of 9.5 years of mortality surveillance during which there were 16 267 deaths (4353 from cancer). After adjustment for age, sex, education, socioeconomic status, body mass index (BMI), and smoking and alcohol intake, and with reverse causality (by left censoring) and missing data (by imputation) taken into account, relative to people in the least distressed group (GHQ-12 score 0-6), death rates in the most distressed group (score 7-12) were consistently raised for cancer of all sites combined (multivariable adjusted hazard ratio 1.32, 95% confidence interval 1.18 to 1.48) and cancers not related to smoking (1.45, 1.23 to 1.71), as well as carcinoma of the colorectum (1.84, 1.21 to 2.78), prostate (2.42, 1.29 to 4.54), pancreas (2.76, 1.47 to 5.19), oesophagus (2.59, 1.34 to 5.00), and for leukaemia (3.86, 1.42 to 10.5). Stepwise associations across the full range of distress scores were observed for colorectal and prostate cancer. CONCLUSION:  This study contributes to the growing evidence that psychological distress might have some predictive capacity for selected cancer presentations, in addition to other somatic diseases

Association of inflammation with specific symptoms of depression in a general population of older people : The English Longitudinal Study of Ageing

Elevated levels of inflammatory markers, such as C-reactive protein, are well documented in people with depression. Few studies have examined whether the association between inflammation and depression is symptom specific, and differs according to antidepressant treatment. Using data from the English Longitudinal Study of Ageing (N = 5909), cross-sectional analyses revealed a significant dose-response association between C-reactive protein and the symptoms of fatigue (P <0.001), restless sleep (P = 0.03), low energy (P = 0.02) and feeling depressed (P = 0.04), but not other symptoms. These associations were absent in users of anti-depressant medication. Our findings suggest the C-reactive protein depression association is symptom-specific and modified by antidepressant treatment. (C) 2016 Elsevier Inc. All rights reserved.Peer reviewe

Longitudinal patterns in physical activity and sedentary behaviour from mid-life to early old age: a substudy of the Whitehall II cohort

Background There are few longitudinal data on physical activity patterns from mid-life into older age. The authors examined associations of self-reported physical activity, adiposity and socio-demographic factors in mid-life with objectively assessed measures of activity in older age. Methods Participants were 394 healthy men and women drawn from the Whitehall II population-based cohort study. At the baseline assessment in 1997 (mean age 54 years), physical activity was assessed through self-report and quantified as metabolic equivalent of task hours/week. At the follow-up in 2010 (mean age 66 years), physical activity was objectively measured using accelerometers worn during waking hours for seven consecutive days (average daily wear time 891668 min/day). Results Self-reported physical activity at baseline was associated with objectively assessed activity at follow-up in various activity categories, including light-, moderate and vigorous-intensity activity (all ps<0.04). Participants in the highest compared with lowest quartile of self reported activity level at baseline recorded on average 64.1 (95% CI 26.2 to 102.1) counts per minute more accelerometer-assessed activity at follow-up and 9.0 (2.0e16.0) min/day more moderate-to-vigorous daily activity, after adjusting for baseline covariates. Lower education, obesity and self-perceived health status were also related to physical activity at follow-up. Only age and education were associated with objectively measured sedentary time at follow-up. Conclusion Physical activity behaviour in middle age was associated with objectively measured physical activity in later life after 13 years of follow-up, suggesting that the habits in adulthood are partly tracked into older age

Night work and risk of common mental disorders : analyzing observational data as a non-randomized pseudo trial

Objectives The aim of this study was to examine the status of night work as a risk factor for common mental disorders (CMD). Methods A cohort study with three data waves was conducted on populations of social and healthcare employees for a duration of eight years (total N=46 010). Data were analyzed as a non-randomized pseudo trial to examine (i) whether moving from non-night work to night work is associated with the development of CMD, (ii) the extent to which moving back to non-night work biases this association and (iii) whether moving from night to non-night work is associated with the recovery from CMD. Results According to logistic regression with generalized estimating equation and without bias-correction, changing to night work was not associated with the odds of acquiring CMD [odds ratio (OR) 1.03, 95% confidence interval (CI) 0.82-1.30]. However, night workers with CMD had higher odds of recovery from CMD when changing to non-night work compared to continuing night work (1.99, 95% CI 1.20-3.28). When night workers developed CMD, the odds of moving back to non-night work increased by 68%. In analyses corrected for this bias, changing from non-night to night work was associated with a 1.25-fold (95% CI 1.03-1.52) increased odds of acquiring CMD. Conclusions A change from non-night to night work may increase the risk of CMD, while moving back from night to non-night work increased recovery from CMD.Peer reviewe

Long-term adherence to healthy dietary guidelines and chronic inflammation in the prospective Whitehall II study

Background Inflammation plays an important role in the cause of cardiovascular diseases and may contribute to the association linking an unhealthy diet to chronic age-related diseases. However, to date the long-term associations between diet and inflammation have been poorly described. Our aim was to assess the extent to which adherence to a healthy diet and dietary improvements over a 6-year exposure period prevented subsequent chronic inflammation over a 5-year follow-up in a large British population of men and women. Methods Data were drawn from 4600 adults (mean ± standard deviation, age 49.6 ± 6.1 years, 28% were women) from the prospective Whitehall cohort II study. Adherence to a healthy diet was measured using Alternative Healthy Eating Index (AHEI) scores in 1991-1993 (50.7 ± 11.9 points) and 1997-1999 (51.6 ± 12.4 points). Chronic inflammation, defined as average levels of serum interleukin-6 from 2 measures 5 years apart, was assessed in 1997-1999 and 2002-2004. Results After adjustment for sociodemographic factors, health behaviors, and health status, participants who maintained a high AHEI score (ie, a healthy diet, n = 1736, 37.7%) and those who improved this score over time (n = 681, 14.8%) showed significantly lower mean levels of interleukin-6 (1.84 pg/mL, 95% confidence interval [CI], 1.71-1.98 and 1.84 pg/mL, 95% CI, 1.70-1.99, respectively) than those who had a low AHEI score (n = 1594, 34.6%) over the 6-year exposure period (2.01 pg/mL, 95% CI, 1.87-2.17). Conclusions These data suggest that maintaining and improving adherence to healthy dietary recommendations may reduce the risk of long-term inflammation.</p

A Prospective Study of Positive Psychological Well-Being and Coronary Heart Disease

Objective: Research suggests that positive psychological well-being is associated with cardiovascular health. However, much of this research uses elderly samples and has not determined the pathways by which psychological well-being influences cardiovascular disease or whether effects are similar for men and women. This study investigates the association between two aspects of well-being (emotional vitality and optimism) and coronary heart disease (CHD) in a sample of middle-aged men and women, and considers potential mediating factors. Method: Between 1991 and 1994, well-being and coronary risk factors were assessed among 7,942 individuals without a prior cardiovascular event from the Whitehall II cohort. Incident CHD (fatal CHD, first nonfatal myocardial infarction, or first definite angina) was tracked during 5 person-years of follow-up. Results: Positive psychological well-being was associated with reduced risk of CHD with an apparent threshold effect. Relative to people with the lowest levels of well-being, those with the highest levels had minimally adjusted hazard ratios of 0.74, 95% confidence interval [0.55, 0.98] for emotional vitality and 0.73, 95% confidence interval [0.54, 0.99] for optimism. Moreover, the association was strong for both genders and was only weakly attenuated when accounting for ill-being. Neither health-related behaviors nor biological factors explained these associations. Conclusions: Positive psychological well-being was associated with a modest, but consistent reduced risk of incident CHD. The relationship was comparable for men and women, and was maintained after controlling for cardiovascular risk factors and ill-being. Additional research is needed to identify underlying mechanisms and investigate whether interventions to increase well-being may enhance cardiovascular health

Obesity, metabolic health, and history of Cytomegalovirus infection in the general population

Context:Commoncommunity-acquired infections, such as cytomegalovirus (CMV),maycontribute to the development of obesity and metabolic dysfunction, but empirical evidence is scarce. Objective: We examined the associations between CMV, obesity and metabolic characteristics in a large, general population-based sample of adults. Design and setting: An observational study in community dwelling adults from the general population, ‘Understanding Society – the UK Household Longitudinal Study’. Participants: 9,517 men and women (aged 52.4 ± 16.4 yrs; 55.3% female). Measures: CMV infection was measured using Immunoglobulin G (IgG) from serum. Obesity was defined as body mass index ≥30 kg/m2. Based on blood pressure, HDL-cholesterol, triglycerides,glycated haemoglobin A1c, and C-reactive protein, participants were classified as ‘healthy’ (0 or 1 metabolic abnormality) or ‘unhealthy’ (≥2 metabolic abnormalities). Results: A positive CMV test was recorded in 47.5% of the sample. There was no association between CMV and obesity. Of the individual metabolic risk factors, CMV was positively associated with glycated haemoglobin and HDL-cholesterol. In combination, only ‘unhealthy non-obese’ participants had modestly increased odds of CMV (odds ratio compared to healthy normal weight = 1.12, 95% confidence interval 1.00 – 1.26) after adjusting for a range of variables. CMV was associated with an increased prevalence of cardiovascular diseases (odds ratio=1.67; 1.07 – 2.60) independently of obesity, metabolic risk factors, and other covariates. Conclusion: Our findings suggest a weak but statistically significant association between CMV and metabolic dysfunction in non-obese adults. This relationship appears to be masked in the obese, possibly by the effects of excess adiposity on metabolism

Pulse rate reactivity in childhood as a risk factor for adult hypertension: the 1970 Birth Cohort Study

Purpose: Cardiovascular reactivity to mental stress has been used as a tool to predict short-term hypertension risk in adults but the impact of cardiovascular reactivity in childhood on hypertension in adulthood is unknown. Using the 1970 British Cohort study, we examined the association between pulse rate reactivity in childhood and risk of hypertension in adulthood. Methods: A total of 6,507 participants (51.6% female) underwent clinical examination at 10 years of age that involved measurement of blood pressure, body mass index, and pulse rate pre- and post-examination. Hypertension was ascertained by self-reported doctor diagnosis 32 years later at age 42. Results: On average, there was a reduction in pulse rate after the medical examination (-1.2±8.2 bpm), although nearly a third of the sample recorded an increase in pulse rate of ≥3bpm. A total of 488 (7.5%) study members developed hypertension at follow-up. After adjustment for a range of covariates including resting blood pressure and body mass index in childhood, a heightened pulse rate response to the examination (≥3bpm) was associated with greater risk of hypertension in adulthood (odds ratio = 1.30, 95% CI, 1.02, 1.67). The association persisted whether we modelled pulse rate as an absolute measure (post examination) or a change score. Conclusion: These observational data suggest that elevated childhood cardiovascular reactivity could increase risk for hypertension in adulthood