Andrew Stickley

What has made the population of Japan healthy

People in Japan have the longest life expectancy at birth in the world. Here, we compile the best available evidence about population health in Japan to investigate what has made the Japanese people healthy in the past 50 years. The Japanese population achieved longevity in a fairly short time through a rapid reduction in mortality rates for communicable diseases from the 1950s to the early 1960s, followed by a large reduction in stroke mortality rates. Japan had moderate mortality rates for non-communicable diseases, with the exception of stroke, in the 1950s. The improvement in population health continued after the mid-1960s through the implementation of primary and secondary preventive community public health measures for adult mortality from non-communicable diseases and an increased use of advanced medical technologies through the universal insurance scheme. Reduction in health inequalities with improved average population health was partly attributable to equal educational opportunities and financial access to care. With the achievement of success during the health transition since World War 2, Japan now needs to tackle major health challenges that are emanating from a rapidly ageing population, causes that are not amenable to health technologies, and the effects of increasing social disparities to sustain the improvement in population health.

The Association between Sleep Problems and Psychotic Symptoms in the General Population : A Global Perspective

STUDY OBJECTIVESnTo assess the prevalence of sleep problems and their association with psychotic symptoms using a global database.nnnDESIGNnCommunity-based cross-sectional study.nnnSETTINGnData were analyzed from the World Health Organizations World Health Survey (WHS), a population-based survey conducted in 70 countries between 2002 and 2004.nnnPATIENTS OR PARTICIPANTSn261,547 individuals aged ≥ 18 years from 56 countries.nnnINTERVENTIONSnN/A.nnnMEASUREMENTS AND RESULTSnThe presence of psychotic symptoms in the past 12 months was established using 4 questions pertaining to positive symptoms from the psychosis screening module of the Composite International Diagnostic Interview. Sleep problems referred to severe or extreme sleep problems in the past 30 days. Multivariable logistic regression was used to estimate the associations. The overall prevalence of sleep problems was 7.6% and ranged from 1.6% (China) to 18.6% (Morocco). Sleep problems were associated with significantly higher odds for at least one psychotic symptom in the vast majority of countries. In the pooled sample, after adjusting for demographic factors, alcohol consumption, smoking, and chronic medical conditions, having sleep problems resulted in an odds ratio (OR) for at least one psychotic symptom of 2.41 (95% confidence interval [CI] 2.18-2.65). This OR was 1.59 (1.40-1.81) when further adjusted for anxiety and depression.nnnCONCLUSIONSnA strong association between sleep problems and psychotic symptoms was observed globally. These results have clinical implications and serve as a basis for future studies to elucidate the causal association between psychotic symptoms and sleep problems.

Loneliness and health risk behaviours among Russian and U.S. adolescents: a cross-sectional study

BackgroundFor some adolescents feeling lonely can be a protracted and painful experience. It has been suggested that engaging in health risk behaviours such as substance use and sexual behaviour may be a way of coping with the distress arising from loneliness during adolescence. However, the association between loneliness and health risk behaviour has been little studied to date. To address this research gap, the current study examined this relation among Russian and U.S. adolescents.MethodsData were used from the Social and Health Assessment (SAHA), a school-based survey conducted in 2003. A total of 1995 Russian and 2050 U.S. students aged 13–15 years old were included in the analysis. Logistic regression was used to examine the association between loneliness and substance use, sexual risk behaviour, and violence.ResultsAfter adjusting for demographic characteristics and depressive symptoms, loneliness was associated with a significantly increased risk of adolescent substance use in both Russia and the United States. Lonely Russian girls were significantly more likely to have used marijuana (odds ratio [OR]: 2.28; confidence interval [CI]: 1.17–4.45), while lonely Russian boys had higher odds for past 30-day smoking (OR, 1.87; CI, 1.08–3.24). In the U.S. loneliness was associated with the lifetime use of illicit drugs (excepting marijuana) among boys (OR, 3.09; CI, 1.41–6.77) and with lifetime marijuana use (OR, 1.79; CI, 1.26–2.55), past 30-day alcohol consumption (OR, 1.80; CI, 1.18–2.75) and past 30-day binge drinking (OR, 2.40; CI, 1.56–3.70) among girls. The only relation between loneliness and sexual risk behaviour was among Russian girls, where loneliness was associated with significantly higher odds for ever having been pregnant (OR, 1.69; CI: 1.12–2.54). Loneliness was not associated with violent behaviour among boys or girls in either country.ConclusionLoneliness is associated with adolescent health risk behaviour among boys and girls in both Russia and the United States. Further research is now needed in both settings using quantitative and qualitative methods to better understand the association between loneliness and health risk behaviours so that effective interventions can be designed and implemented to mitigate loneliness and its effects on adolescent well-being.

Alcohol mortality in Russia: A historical perspective

OBJECTIVEnTo examine major changes in the supply of alcohol in Russia and its impact on health in late-tsarist and early-Soviet society.nnnSTUDY DESIGN AND METHODSnStatistical data on acute forms of alcohol mortality were drawn from official publications and medical literature published in the period 1860-1930 that covered the 50 provinces of European Russia and some of the major cities in the Russian Empire. These data were examined for across-time changes in alcohol mortality in relation to changes in the availability of alcohol products, both in terms of increased and decreased levels of supply.nnnRESULTSnRapid changes in the supply of alcoholic products in earlier periods of Russian history resulted in quick and marked changes in the levels of acute alcohol mortality. However, while restrictions on the availability of spirits have sometimes been effective in reducing alcohol mortality, there has often been a rapid recourse to alternative forms of alcohol, i.e. alcohol surrogates.nnnCONCLUSIONnThe lesson of history suggests that any attempt to deal with the problem of hazardous drinking in Russia must deal with all sources of alcohol, both legal and illegal, as individuals have demonstrated a high degree of ingenuity in identifying alternative sources of alcohol, both in the past and the present.

Changes in Smoking Prevalence in 8 Countries of the Former Soviet Union Between 2001 and 2010

OBJECTIVESnWe sought to present new data on smoking prevalence in 8 countries, analyze prevalence changes between 2001 and 2010, and examine trend variance by age, location, education level, and household economic status.nnnMETHODSnWe conducted cross-sectional household surveys in 2010 in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine. We compared smoking prevalence with a related 2001 study for the different countries and population subgroups, and also calculated the adjusted prevalence rate ratios of smoking.nnnRESULTSnAll-age 2010 smoking prevalence among men ranged from 39% (Moldova) to 59% (Armenia), and among women from 2% (Armenia) to 16% (Russia). There was a significantly lower smoking prevalence among men in 2010 compared with 2001 in Belarus, Kazakhstan, Kyrgyzstan, and Russia, but not for women in any country. For all countries combined, there was a significantly lower smoking prevalence in 2010 than in 2001 for men aged 18 to 39 years and men with a good or average economic situation.nnnCONCLUSIONSnSmoking prevalence appears to have stabilized and may be declining in younger groups, but remains extremely high among men, especially those in lower socioeconomic groups.

The persistence of irregular treatment of hypertension in the former Soviet Union

Background Hypertension is one of the leading causes of avoidable mortality in the former Soviet Union (fSU). In previous work, the authors described patterns of irregular hypertension treatment in eight countries of the fSU in 2001. This paper presents new data on changes in the use of hypertension treatment in the same countries. Methods Using household survey data from 18u2008420 (2001) and 17u2008914 (2010) respondents from Armenia, Azerbaijan (2010 only), Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine, the authors describe changes in rates of irregular treatment use (less than daily) between 2001 and 2010. Multivariate logistic regression was also used to analyse the characteristics associated with irregular treatment. Results Irregular treatment was extremely high at 74% in 2001 and only fell to 68% in 2010 (all countries combined). Irregular treatment remained particularly high in 2010 in Armenia (79%), Kazakhstan (73%) and Moldova (73%). Recurring characteristics associated with irregular treatment included gender (men), younger age, higher fitness levels, and consuming alcohol and tobacco. Conclusions Irregular hypertension treatment continues to be a major problem in the countries of the fSU and requires an urgent response.

Alcohol Consumption and Psychological Distress in Adolescents: A Multi-Country Study

PURPOSEnTo examine the association between alcohol use and psychological distress among adolescents in a range of developing countries.nnnMETHODSnSecondary data analysis of the Global School-Based Student Health Survey was conducted using nationally representative data from 12 developing countries: Botswana, Grenada, Indonesia, Kenya, Myanmar, the Philippines, Saint Lucia, Saint Vincent and the Grenadines, the Seychelles, Thailand, Trinidad and Tobago, and Uganda. The surveys were conducted between 2003 and 2008 and involved 32,001 adolescents primarily aged 13-15 years. We used multivariate logistic regression analysis to determine the association between alcohol use and psychological distress.nnnRESULTSnThe prevalence of past 30-day alcohol use and lifetime drunkenness varied widely across countries, as did the occurrence of psychological distress (anxiety-induced sleeplessness and/or depression). The risk of psychological distress was significantly higher among adolescents when using alcohol in all countries except Myanmar. In nine of the 12 countries, past 30-day alcohol use was associated with psychological distress, while students who had been drunk at least once in their lifetime had an increased risk of experiencing psychological distress in 11 of the study countries.nnnCONCLUSIONSnThe high prevalence of alcohol use among adolescents and the strength of the association with psychological distress present a major public health challenge in developing countries. The urgent need to reduce adolescent alcohol use necessitates the implementation of context- and culture-specific strategies that reduce the physical availability of alcohol.

Loneliness: its correlates and association with health behaviours and outcomes in nine countries of the former soviet union.

Background Research suggests that the prevalence of loneliness varies between countries and that feeling lonely may be associated with poorer health behaviours and outcomes. The aim of the current study was to examine the factors associated with loneliness, and the relationship between feeling lonely and health behaviours and outcomes in the countries of the former Soviet Union (FSU) – a region where loneliness has been little studied to date. Methods Using data from 18,000 respondents collected during a cross-sectional survey undertaken in nine FSU countries – Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine – in 2010/11, country-wise logistic regression analysis was conducted to determine: the factors associated with feeling lonely; the association between feeling lonely and alcohol consumption, hazardous drinking and smoking; and whether feeling lonely was linked to poorer health (i.e. poor self-rated health and psychological distress). Results The prevalence of loneliness varied widely among the countries. Being divorced/widowed and low social support were associated with loneliness in all of the countries, while other factors (e.g. living alone, low locus of control) were linked to loneliness in some of the countries. Feeling lonely was connected with hazardous drinking in Armenia, Kyrgyzstan and Russia but with smoking only in Kyrgyzstan. Loneliness was associated with psychological distress in all of the countries and poor self-rated health in every country except Kazakhstan and Moldova. Conclusions Loneliness is associated with worse health behaviours and poorer health in the countries of the FSU. More individual country-level research is now needed to formulate effective interventions to mitigate the negative effects of loneliness on population well-being in the FSU.

Knowledge of the health impacts of smoking and public attitudes towards tobacco control in the former Soviet Union

Aims To describe levels of knowledge on the harmful effects of tobacco and public support for tobacco control measures in nine countries of the former Soviet Union and to examine the characteristics associated with this knowledge and support. Methods Standardised, cross-sectional nationally representative surveys conducted in 2010/2011 with 18u2008000 men and women aged 18u2005years and older in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine. Respondents were asked a range of questions on their knowledge of the health effects of tobacco and their support for a variety of tobacco control measures. Descriptive analysis was conducted on levels of knowledge and support, along with multivariate logistic regression analysis of characteristics associated with overall knowledge and support scores. Results Large gaps exist in public understanding of the negative health effects of tobacco use, particularly in Azerbaijan, Kazakhstan, Kyrgyzstan and Moldova. There are also extremely high levels of misunderstanding about the potential effects of ‘light’ cigarettes. However, there is popular support for tobacco control measures. Over three quarters of the respondents felt that their governments could be more effective in pursuing tobacco control. Higher levels of education, social capital (membership of an organisation) and being a former or never-smoker were associated with higher knowledge on the health effects of tobacco and/or being more supportive of tobacco control measures. Conclusions Increasing public awareness of tobaccos health effects is essential for informed decision-making by individuals and for further increasing public support for tobacco control measures.

The influence of concern about crime on levels of psychological distress in the former Soviet Union

Background Previous studies suggest that the fear of crime is associated with worse mental health, with social capital potentially having a mediating influence. However, no studies could be identified on this issue in countries of the former Soviet Union, despite them experiencing increasing rates of crime and profound social change. The aim of this study is to explore the relationship between concern about crime and levels of psychological distress in eight countries of the former Soviet Union. Methods Cross-sectional surveys were conducted in eight former Soviet countries using a standardised questionnaire containing items on psychological distress and concern about five criminal activities. Regression analysis was used to investigate the association between concern about criminal activities and psychological distress. Separate regression models were run to explore the influence of social capital on this relationship. Results The first model (excluding social capital) produced significant positive coefficients of association for all five types of criminal activity with psychological distress, with a range from 0.39 (95% CI 0.24 to 0.54) for suffering abuse because of nationality to 0.56 (95% CI 0.42 to 0.70) for being sexually molested. The second model (including social capital) also showed significant associations for all five criminal activities, but coefficients were slightly smaller. Conclusion This study provides preliminary evidence of a relationship between fear of crime and psychological distress in the study countries, with possibly a small mediating influence of social capital. Further studies are required to explore the relationship between fear of crime, social capital and mental health in the region.