Change in neighborhood disadvantage and change in smoking behaviors in adults: a longitudinal, within-individual study

BACKGROUND: Evidence for an association between neighborhood disadvantage and smoking is mixed and mainly based on cross-sectional studies. To shed light on the causality of this association we examined whether change in neighborhood socioeconomic disadvantage is associated with within-individual change in smoking behaviors. METHODS: The study population comprised participants of the Finnish Public Sector study who reported a change in their smoking behavior between surveys in 2008/09 and 2012/13. We linked participants' residential addresses to a total population database on neighborhood disadvantage with 250 × 250m resolution. The outcome variables were changes in smoking status (being a smoker vs. not) as well as the intensity (heavy/moderate vs. light smoker). We used longitudinal case-crossover design, a method that accounts for time-invariant confounders by design. We adjusted models for time-varying covariates. RESULTS: Of the 3443 participants, 1714 quit while 967 began to smoke between surveys. Smoking intensity increased among 398 and decreased among 364 participants. The level of neighborhood disadvantage changed for 1078 participants because they moved residence. Increased disadvantage was associated with increased odds of being a smoker (odds ratio (OR) of taking up smoking 1.23 (95% CI 1.04-1.47) per 1 standard deviation (SD) increase in standardized national disadvantage score). OR for being a heavy/moderate (vs. light) smoker was 1.14 (95% CI 0.85-1.52) when disadvantage increased by 1 SD. CONCLUSIONS: These within-individual results link an increase in neighborhood socioeconomic disadvantage, due to move in residence, with subsequent smoking behaviors

Preterm birth and the risk of multimorbidity in adolescence: a multiregister-based cohort study

BACKGROUND: Multimorbidity affects people of all ages, but the risk factors of multimorbidity in adolescence are unclear. The aim of this study was to examine preterm birth (<37 weeks) as a shared risk factor for multiple health outcomes and the role of gestational age (degree of prematurity) in the development of increasingly complex multimorbidity (two, three, or four health outcomes) in adolescence (age 10-18 years). METHODS: We used population-wide data from Finland (1 187 610 adolescents born 1987-2006) and Norway (555 431 adolescents born 1998-2007). Gestational age at birth was ascertained from medical birth registers and categorised as 23-27 weeks (extremely preterm), 28-31 weeks (very preterm), 32-33 weeks (moderately preterm), 34-36 weeks (late preterm), 37-38 weeks (early term), 39-41 weeks (term, reference category) and 42-44 weeks (post-term). Children who died or emigrated before their 10th birthday, and those with missing or implausible data on gestational age, birthweight, or covariates, were excluded. Health outcomes at age 10-18 years were ascertained from specialised health care and mortality registers. We calculated hazard ratios (HRs) and population attributable fractions (PAFs) with 95% CIs for multiple health outcomes during adolescence. FINDINGS: Individuals were followed up from age 10 to 18 years (mean follow-up: 6 years, SD: 3 years). Preterm birth was associated with increased risks of 20 hospital-treated malignant, cardiovascular, endocrinological, neuropsychiatric, respiratory, genitourinary, and congenital health outcomes, after correcting for multiple testing and ignoring small effects (HR <1·2). Confounder-adjusted HRs comparing preterm with term-born adolescents were 2·29 (95% CI 2·19-2·39) for two health outcomes (PAF 9·0%; 8·3-9·6), and 4·22 (3·66-4·87) for four health outcomes (PAF 22·7%; 19·4-25·8) in the Finnish data. Results in the Norwegian data showed a similar pattern. We observed a consistent dose-response relationship between an earlier gestational age and elevated risks of increasingly complex multimorbidity in both datasets. INTERPRETATION: Preterm birth is associated with increased risks of diverse multimorbidity patterns at age 10-18 years. Adolescents with a preterm-born background could benefit from diagnostic vigilance directed at multimorbidity and a multidisciplinary approach to health care. FUNDING: European Union Horizon 2020, Academy of Finland, Foundation for Pediatric Research, Sigrid Jusélius Foundation, Signe and Ane Gyllenberg Foundation

Association Between Distance From Home to Tobacco Outlet and Smoking Cessation and Relapse

IMPORTANCE: Reduced availability of tobacco outlets is hypothesized to reduce smoking, but longitudinal evidence on this issue is scarce. OBJECTIVE: To examine whether changes in distance from home to tobacco outlet are associated with changes in smoking behaviors. DESIGN, SETTING, AND PARTICIPANTS: The data from 2 prospective cohort studies included geocoded residential addresses, addresses of tobacco outlets, and responses to smoking surveys in 2008 and 2012 (the Finnish Public Sector [FPS] study, n = 53 755) or 2003 and 2012 (the Health and Social Support [HeSSup] study, n = 11 924). All participants were smokers or ex-smokers at baseline. We used logistic regression in between-individual analyses and conditional logistic regression in case-crossover design analyses to examine change in walking distance from home to the nearest tobacco outlet as a predictor of quitting smoking in smokers and smoking relapse in ex-smokers. Study-specific estimates were pooled using fixed-effect meta-analysis. EXPOSURES: Walking distance from home to the nearest tobacco outlet. MAIN OUTCOMES AND MEASURES: Quitting smoking and smoking relapse as indicated by self-reported current and previous smoking at baseline and follow-up. RESULTS: Overall, 20 729 men and women (age range 18-75 years) were recruited. Of the 6259 and 2090 baseline current smokers, 1744 (28%) and 818 (39%) quit, and of the 8959 and 3421 baseline ex-smokers, 617 (7%) and 205 (6%) relapsed in the FPS and HeSSup studies, respectively. Among the baseline smokers, a 500-m increase in distance from home to the nearest tobacco outlet was associated with a 16% increase in odds of quitting smoking in the between-individual analysis (pooled odds ratio, 1.16; 95% CI, 1.05-1.28) and 57% increase in within-individual analysis (pooled odds ratio, 1.57; 95% CI, 1.32-1.86), after adjusting for changes in self-reported marital and working status, substantial worsening of financial situation, illness in the family, and own health status. Increase in distance to the nearest tobacco outlet was not associated with smoking relapse among the ex-smokers. CONCLUSIONS AND RELEVANCE: These data suggest that increase in distance from home to the nearest tobacco outlet may increase quitting among smokers. No effect of change in distance on relapse in ex-smokers was observed

Daily physical activity patterns among aging workers: the Finnish Retirement and Aging Study (FIREA)

Objectives Physical activity is associated with the aging workers' ability to work and predicts working beyond retirement age. To better understand physical activity behaviour in this growing population group, we aimed at characterising 24-hour physical activity patterns among aging workers, and to describe the association between occupational category and total, occupational and leisure-time physical activities.Methods We included 878 workers (mean age 62.4 years, SD 1.1, 85% women) from the Finnish Retirement and Aging Study, who wore an accelerometer on their non-dominant wrist for 1 week. We plotted mean hourly activity counts per minute (CPM) for working days and days off. We also compared mean daily CPM between genders and occupations between working days and days off, and work and leisure time by using repeated measures analysis of variance.Results Activity patterns were different between genders, occupations and types of the day. Women (2580, 95% CI 2540 to 2620) had higher daily mean CPM than men (2110, 95% CI 2020 to 2000). Women in manual occupations were more active than women in non-manual occupations during working days. The differences among men were in the same direction but less pronounced than among women. We found no differences in activity levels between occupations during days off and leisure time on working days.Conclusions In aging workers, physical activity differs by gender and occupation during working time, but not during leisure time. As low physical activity is associated with increased risk of early exit from employment, physical activity should be promoted at workplaces, especially among men and people in non-manual occupations.</div

Tieteelliset perusteet varhaisvuosien fyysisen aktiivisuuden suosituksille

AbstractThe proposal to update the Recommendations for physical activity in early childhood education (Guides of the Ministry of Social Affairs and Health 2005:17) was made in the context of the national Joy in Motion programme, where the focus is on early childhood education. The update was started by compiling the most recent scientific knowledge to be used as the basis for preparing the recommendations for physical activity in early childhood. The aim was to set out recommendations that could be applied as broadly as possible. The update and drafting of the recommendations was done as part of the work of the Physical exercise to promote health and wellbeing steering group (TEHYLI), appointed and coordinated jointly by the Ministry of Education and Culture and Ministry of Social Affairs and Health. The steering group commented on and approved the multidisciplinary international group of experts specifically invited to carry out the task. The experts represented different fields of science and some of them were carrying out nationally funded research projects on physical activity and wellbeing among children under eight years of age. The group of experts started its work in January 2016 by compiling the most recent international and national research information on various themes relating to physical activity and exercise and comprehensive development and wellbeing in early childhood. This work produced two publications: Recommendations for physical activity in early childhood 2016 - Joy, play and doing together (Ministry of Education and Culture 2016:21) and Scientific justification for the recommendations for physical activity in early childhood. The recommendations for physical activity in early childhood inform about the amount and type of physical activity for the under eight-year-olds, roles of the physical, psychological and social environments, and planning and implementation of guided physical exercise and education on exercise as part of early childhood education. The scientific justification is intended for early childhood education, physical exercise and healthcare professionals, including teachers and researchers.TiivistelmäVarhaiskasvatukseen keskittyvän valtakunnallisen Ilo kasvaa liikkuen -ohjelman kehittelytyössätehtiin aloite Varhaiskasvatuksen liikunnan suositusten (Sosiaali- ja terveysministeriön oppaita2005:17) päivittämisestä. Päivittämisen lähtökohtana oli erityisesti uusimman tutkimusperustaisentieteellisen tiedon kokoaminen ja niiden pohjalta varhaisvuosien fyysisen aktiivisuudensuositusten laatiminen. Tavoitteena oli kirjata sellaiset suositukset, joita voitaisiin soveltaamahdollisimman laajalle kohdejoukolle. Suositusten päivittäminen ja valmistelu tapahtuivatosana opetus- ja kulttuuriministeriön sekä sosiaali- ja terveysministeriön yhdessä asettamanja koordinoiman Terveyttä ja hyvinvointia edistävän liikunnan (TEHYLI) -ohjausryhmäntyötä. TEHYLI-ohjausryhmä kommentoi ja hyväksyi tehtävään erikseen kutsutun monitieteisenkansallisen asiantuntijaryhmän. Asiantuntijat edustivat eri tieteenaloja ja osalla heistä olikansallista tutkimusrahoitusta saaneita tutkimusprojekteja alle kahdeksan vuotiaiden lastenliikunnasta ja hyvinvoinnista. Asiantuntijaryhmä aloitti työnsä tammikuussa 2016 kokoamallaeri teema-alueilta uusinta kansainvälistä ja kansallista tutkimustietoa varhaiskasvatusikäistenlasten fyysistä aktiivisuutta ja liikuntaa sekä kokonaisvaltaista kehitystä ja hyvinvointia selvittäneistätutkimuksista. Työskentely johti kahteen julkaisuun, joissa toisessa annetaan fyysisenaktiivisuuden suosituksia varhaisvuosille (Varhaisvuosien fyysisen aktiivisuuden suositukset2016. Iloa, leikkiä ja yhdessä tekemistä. Opetus- ja kulttuuriministeriö 2016:21) sekä tähänsuositusten tieteelliset perusteet sisältävään julkaisuun. Varhaisvuosien fyysisen aktiivisuudensuositukset antavat ohjeita alle kahdeksanvuotiaiden lasten fyysisen aktiivisuuden määrästäja laadusta, fyysisen, psyykkisen ja sosiaalisen ympäristön rooleista sekä ohjatun liikunnanja liikuntakasvatuksen suunnittelusta ja toteuttamisesta osana varhaiskasvatusta. Suositustentieteelliset perusteet on tarkoitettu erityisesti varhaiskasvatus-, liikunta- ja terveydenhuollonammattilaisten, kuten opettajien ja tutkijoiden käyttöön.</p

Classification and processing of 24-hour wrist accelerometer data

Background: An important step in accelerometer data analysis is the classification of continuous, 24-hour data into sleep, wake, and non-wear time. We compared classification times and physical activity metrics across different data processing and classification methods. Methods: Participants (n = 576) from the Finnish Retirement and Aging Study (FIREA) wore an accelerometer on their non-dominant wrist for seven days and nights and filled in daily logs with sleep and waking times. Accelerometer data were first classified as sleep or wake time by log, and Tudor-Locke, Tracy, and ActiGraph algorithms. Then, wake periods were classified as wear or non-wear by log, Choi algorithm, and wear sensor. We compared time classification (sleep, wake, and wake wear time) as well as physical activity measures (total activity volume and sedentary time) across these classification methods. Results: M (SD) nightly sleep time was 467 (49) minutes by log and 419 (88), 522 (86), and 453 (74) minutes by Tudor-Locke, Tracy, and ActiGraph algorithms, respectively. Wake wear time did not differ substantially when comparing Choi algorithm and the log. The wear sensor did not work properly in about 29% of the participants. Daily sedentary time varied by 8−81 minutes after excluding sleep by different methods and by 1−18 minutes after excluding non-wear time by different methods. Total activity volume did not substantially differ across the methods. Conclusion: The differences in wear and sedentary time were larger than differences in total activity volume. Methods for defining sleep periods had larger impact on outcomes than methods for defining wear time.</p

Changes in Smoking During Retirement Transition: A Longitudinal Cohort Study

AIMS: We examined the effect of retirement transition on changes in smoking, identified trajectories of smoking around the retirement transition, and investigated factors predicting the membership in the trajectories. METHODS: This longitudinal cohort study included 1,432 current or former smokers who entered into statutory retirement in 2000-2011 and who filled out two to four questionnaires sent at four-year intervals. Effect of retirement on smoking was analysed as a non-randomized pseudo-trial in which we compared the likelihood of quitting and relapsing smoking between two subsequent survey waves among those who retired and did not retire. We used latent class analysis to identify trajectories of smoking status and smoking intensity (low: <10 cigarettes/day or high: ⩾10 cigarettes/day), and multinomial logistic regression models to assess pre-retirement factors associated with smoking trajectories. RESULTS: Retirement transition was associated with 1.7-fold odds of quitting smoking (95% confidence intervals 1.3-2.2) compared with no retirement transition. We identified three smoking status trajectories: 'sustained non-smoking' (61% of the participants), 'sustained smoking' (23%) and 'decreasing smoking' (16%). For 489 baseline smokers, we identified three smoking intensity trajectories: 'sustained high intensity smoking' (32% of the participants), 'sustained low intensity smoking' (32%) and 'decreasing high intensity smoking' (35%). Living outside an inner urban area predicted membership in the 'decreasing smoking' versus 'sustained smoking' trajectory. CONCLUSIONS: Smokers are more likely to quit smoking during transition to retirement than before or after it. Characteristics of the smoking environment may affect smoking behaviour around retirement

Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso

BackgroundPrevious reviews have identified 44 risk factors for poor early child development (ECD) in low- and middle-income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD.MethodsWe conducted path analyses of factors associated with 18-month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Ghana (n&nbsp;=&nbsp;1,023), Malawi (n&nbsp;=&nbsp;675 and 1,385), and Burkina Faso (n&nbsp;=&nbsp;1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9&nbsp;months. In multiple linear regression and structural equation&nbsp;models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD.ResultsOut of 42 indicators of the 34 factors examined, 6 were associated with 18-month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6&nbsp;months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts.ConclusionsKey elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status

Changes in prolonged sedentary behaviour across the transition to retirement

AbstractBackground: Prolonged sedentary behaviour is associated with a higher risk of cardiometabolic diseases. This longitudinal study examined changes in daily total, prolonged (≥30 min) and highly prolonged (≥60 min) sedentary time across the transition to retirement by gender and occupational status.Methods: We included 689 aging workers (mean (SD) age before retirement 63.2 (1.6) years, 85% women) from the Finnish Retirement and Aging Study (FIREA). Sedentary time was measured annually using a wrist-worn triaxial ActiGraph accelerometer before and after retirement with on average 3.4 (range 2-4) measurement points.Results: Women increased daily total sedentary time by 22 min (95% CI 13 to 31), prolonged sedentary time by 34 min (95% CI 27 to 42) and highly prolonged sedentary time by 15 min (95% CI 11 to 20) in the transition to retirement, and remained at the higher level of sedentary time years after retirement. The highest increase in total and prolonged sedentary time was observed among women retiring from manual occupations. Men had more total and prolonged sedentary time compared with women before and after retirement. Although no changes in men's sedentary time were observed during the retirement transition, there was a gradual increase of 33 min (95% CI 6 to 60) in prolonged sedentary time from pre-retirement years to post-retirement years.Conclusion: The transition to retirement was accompanied by an abrupt increase in prolonged sedentary time in women but a more gradual increase in men. The retirement transition may be a suitable time period for interventions aiming to decrease sedentary behaviour</div