Bjørn Evald Holstein

Socioeconomic position in early life, birth weight, childhood cognitive function, and adult mortality. A longitudinal study of Danish men born in 1953

Objective: To examine the relation between socioeconomic position in early life and mortality in young adulthood, taking birth weight and childhood cognitive function into account. Design: A longitudinal study with record linkage to the Civil Registration System and Cause of Death Registry. The data were analysed using Cox regression. Setting: The metropolitan area of Copenhagen, Denmark. Subjects: 7493 male singletons born in 1953, who completed a questionnaire with various cognitive measures, in school at age 12 years, and for whom birth certificates with data on birth and parental characteristics had been traced manually in 1965. This population was followed up from April 1968 to January 2002 for information on mortality. Main outcome measures: Mortality from all causes, cardiovascular diseases, and violent deaths. Results: Men whose fathers were working class or of unknown social class at time of birth had higher mortality rates compared with those whose fathers were high/middle class: hazard ratio 1.39 (95% CI 1.15 to 1.67) and 2.04 (95% CI 1.48 to 2.83) respectively. Birth weight and childhood cognitive function were both related to father’s social class and inversely associated with all cause mortality. The association between father’s social class and mortality attenuated (HRworking class1.30 (1.08 to 1.56); HRunkown class1.81 (1.30 to 2.52)) after control for birth weight and cognitive function. Mortality from cardiovascular diseases and violent deaths was also significantly higher among men with fathers from the lower social classes. Conclusion: The inverse association between father’s social class at time of birth and early adult mortality remains, however somewhat attenuated, after adjustment for birth weight and cognitive function.

Pathways and mechanisms in adolescence contribute to adult health inequalities

Aims: This paper presents a model that encompasses pathways and mechanisms working over adolescence that contribute to adult health inequalities. We review evidence on the four mechanisms: socially differential exposure, tracking, socially differential tracking, and socially differential vulnerability. Methods: We conducted literature searches in English-language peer-reviewed journals using PubMed (from 1966 to May 2009) and PsycINFO, and combined these with hand-searches of reference lists, journals, and authors of particular relevance. Results: Most health indicators are socially patterned in adolescence and track into adulthood, with higher risks of adverse outcomes among individuals from lower socioeconomic positions. Adolescent health behaviours track into adulthood. Smoking, physical activity, and especially fruit and vegetable intake are socially patterned, while evidence for social patterning of alcohol use is less consistent. Relational dimensions like lone parenthood and bullying are socially patterned and track over time, and there are indications of a socially differential vulnerability to the effects of these types of relational strain. Very little research has investigated the social patterning of the above indicators over time or studied social vulnerability of these indicators from adolescence to adulthood. However, all four mechanisms seem to be active in establishing social differences in adult educational attainment. Conclusions: We find the Adolescent Pathway Model useful for providing an overview of what elements and mechanisms in adolescence may be of special importance for adult health inequalities. There is a lack of knowledge of how social patterns of health, health behaviours, and social relations in adolescence transfer into adulthood and to what extent they reflect themselves in adult health.

Socioeconomic position, macroeconomic environment and overweight among adolescents in 35 countries.

Objective:It is important to understand levels and social inequalities in childhood overweight within and between countries. This study examined prevalence and social inequality in adolescent overweight in 35 countries, and associations with macroeconomic factors.Design:International cross-sectional survey in national samples of schools.Subjects:A total of 11-, 13- and 15-year-olds from 35 countries in Europe and North America in 2001–2002 (N=162 305).Measurements:The main outcome measure was overweight based on self-reported height and weight (body mass index cut-points corresponding to body mass index of 25 kg/m2 at the age of 18 years). Measures included family and school affluence (within countries), and average country income and economic inequality (between countries).Results:There were large variations in adolescent overweight, from 3.5% in Lithuanian girls to 31.7% in boys from Malta. Prevalence of overweight was higher among children from less affluent families in 21 of 24 Western and 5 of 10 Central European countries. However, children from more affluent families were at higher risk of overweight in Croatia, Estonia and Latvia. In Poland, Lithuania, Macedonia and Finland, girls from less affluent families were more overweight whereas the opposite was found for boys. Average country income was associated with prevalence and inequality in overweight when considering all countries together. However, economic inequality as measured by the Gini coefficient was differentially associated with prevalence and socioeconomic inequality in overweight among the 23-high income and 10-middle income countries, with a positive relationship among the high income countries and a negative association among the middle income countries.Conclusion:The direction and magnitude of social inequality in adolescent overweight shows large international variation, with negative social gradients in most countries, but positive social gradients, especially for boys, in some Central European countries. Macroeconomic factors are associated with the heterogeneity in prevalence and social inequality of adolescent overweight.

Social position and health in old age: the relevance of different indicators of social position

Aims: An analysis was undertaken to investigate social inequalities in health among old men and women in relation to five indicators of social position. Methods: The study is based on a population-based cross-sectional survey among 748 75-year-old men and women, which was performed as clinical examinations and interviews in 1989 in Glostrup, a suburban area west of Copenhagen. Social position was measured by vocational education, occupation, social class, income, and housing tenure. Health was measured by number of chronic diseases, tiredness in relation to mobility, need of help in relation to mobility, oral health (number of teeth), and well-being (the CES-D Scale). The statistical analysis included bivariate contingency tables and logistic regression analyses. Results: Two material wealth variables (income and tenure) were consistently related to nearly all health measures while the relationships between the other social position variables and health showed no consistent patterns. Multiple logistic regression analyses with tenure and income as independent variables and each of the health variables as dependent variables and control for education and occupation showed different patterns for men and women. In men the odds ratios of housing tenure on four health variables were strong and unaffected by education and occupation while in women the odds ratios of income on three health variables were strong and unaffected by education and occupation. Conclusion: This study demonstrates strong, consistent associations between variables of material wealth indicators and various measures of health among 75-year-old men and women.

High agreement on family affluence between children’s and parents’ reports: international study of 11-year-old children

Objective: To examine the agreement between parents’ and children’s reports on four items of family affluence: number of cars, own bedroom, number of family holidays and number of computers, and to analyse predictors of disagreement. Design: Cross-sectional child–parent validation study of selected items from an internationally standardised questionnaire. Setting: Survey conducted in schools in Denmark, Germany, Hungary, Italy, Poland and Scotland. Participants: 972 11-year-old children and their parents responded to the questionnaires. Results: The child item response rates were high (above 93%). The per cent agreement was low for holidays spent with family (52.5%), but high for the other three items of family affluence (76.2–88.1%). The kappa coefficients were good or excellent for all items (between 0.41 and 0.74) and the gamma coefficients were strong for all items (between 0.56 and 0.96). Children from single-parent families were more likely to over-report family affluence (OR 2.67; CI 1.83 to 3.89). Conclusions: Young adolescents’ self-reports of family affluence are fairly valid across the six countries. This finding suggests that the variables measured can be used in epidemiological studies that aim at ranking children according to socioeconomic position.

Overweight, body image and bullying—an epidemiological study of 11- to 15-years olds

BACKGROUND The purpose of this study was to examine the association between weight status and exposure to bullying among 11-, 13- and 15-year-old Danish school children. Furthermore, the purpose was to investigate the potentially mediating effect of body image. METHODS Data from the Danish contribution to the international cross-sectional research project Health Behaviour in School-aged Children (HBSC) 2002 was used. Data were assessed from questionnaires and 4781 students aged 11-, 13- and 15-years old were included in the analyses. Logistic regression was used for the analyses. RESULTS The regression analyses showed that overweight and obese students were more exposed to bullying than their normal weight peers. Among boys, odds ratios (ORs) for exposure to bullying were 1.75 (1.18-2.61) in overweight and 1.98 (0.79-4.95) in obese boys compared with normal weight. Among girls, the corresponding ORs were 1.89 (1.25-2.85) in overweight and 2.74 (0.96-7.82) in obese girls. The mediation analyses showed that body image fully mediated the associations between weight status and exposure to bullying in both boys and girls. CONCLUSIONS This study shows that overweight and obese boys and girls are of higher odds of being exposed to bullying than their normal weight peers. Moreover, this study finds that body image may statistically explain this association between overweight and exposure to bullying. However, the study is cross-sectional, and hypotheses of possibilities for opposite causality are possible.

Cynical hostility, socioeconomic position, health behaviors, and symptom load: a cross-sectional analysis in a Danish population-based study.

Objective: To analyze the cross-sectional association between cynical hostility and high symptom load in a Danish population-based study. Furthermore, the aim was to investigate to what extent health risk behaviors mediated this association. Methods: Data were based on a postal questionnaire in a Danish random sample of 3426 men and 3699 women aged 40 or 50 years. Cynical hostility was measured by the 8-item Cynical Distrust Scale. High symptom load was assessed by physiological and mental symptoms experienced within the last 4 weeks. Confounders were age and socioeconomic position, while potential mediators were alcohol consumption, smoking, physical activity, and BMI. Results: Higher cynical hostility was associated with self-reported symptom load. Health behaviors did not seem to mediate this effect. Socioeconomic position was a strong confounder for the effect on both health and health behaviors. After adjustment the effects of hostility on health remained with odds ratios of 2.1 (1.7–2.6) for women and 2.3 (1.8–2.8) for men. Conclusion: After adjustment for socioeconomic position, cynical hostility has an effect on self-reported high symptom load, and this effect is not mediated by health behaviors.

Self-reported medicine use among 11- to 15-year-old girls and boys in Denmark 1988-1998

Aims: To describe the self-reported medicine use for common health complaints among 11 - 15-year-olds in Denmark during a ten year period, 1988 - 1998. The paper focuses on medicine for headache, stomach ache, cough, cold, nervousness, and difficulties in getting to sleep. Methods: Four cross-sectional surveys of 11 - 15-year-old students in random samples of schools in Denmark, conducted in 1988 (n=1,671), 1991 (n=1,860), 1994 (n=4,046) and 1998 (n=5,205). The surveys were similar with regard to sampling and data collection. Data were collected by self-administered questionnaires in the classroom. Results: A large proportion of 11 - 15-year-olds reported medicine use during the past month. It was most common to take medicines for headache (used by 55% of 15-year-old girls and 36% of 15-year-old boys in 1998) and stomach ache (33% among 15-year-old girls in 1998). Pain reliever use was higher among girls than boys and this sex difference increased with age. There was an upward trend in reported medicine use from 1988 to 1998, in particular regarding medicine for stomach-ache among 13- and 15-year-old girls. A large proportion of girls were frequent users of medicine for headache, stomach-ache, and sleeping difficulties. Conclusion: A high proportion of 11 - 15-year-old girls and boys reported medicine use in relation to common health complaints. The proportion of users increased during the past decade. It is suggested that more information about medicine be built into health education programs in the future.

Is victimization from bullying associated with medicine use among adolescents? A nationally representative cross-sectional survey in Denmark

OBJECTIVE. The goal was to examine whether being a victim of bullying was associated with medicine use, taking into account the increased prevalence of physical and psychological symptoms. METHODS. The study population included all students in grades 5, 7, and 9 (mean ages: 11.6, 13.6, and 15.6 years, respectively) in a random sample of schools in Denmark (participation rate: 88.5%; N = 5205). The students reported health problems, medicine use, bullying, and a range of psychosocial conditions in an anonymous standardized questionnaire. The outcome measure was self-reported medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness. The determinant was frequency of exposure to bullying, measured with 1 item. RESULTS. In multivariate models adjusted for age and social class, we found that adolescent victims of bullying used medicine for pains and psychological problems more often than did adolescents who were not bullied. The increased odds of using medicine were not explained by the higher prevalence of symptoms among the bullied children. CONCLUSIONS. We found victimization from bullying to be associated with medicine use, even when we controlled for the higher prevalence of symptoms among bullied victims. The medications that adolescents use can have adverse effects, in addition to the potentially health-damaging effects of bullying. Policy makers, health care professionals, and school staff should be aware that the adolescent victims of bullying are prone to excess use of medicine, and preventive actions should be taken to decrease the level of bullying as well as the use of medicine among adolescents.

Fruit and vegetable intake is associated with frequency of breakfast, lunch and evening meal: cross-sectional study of 11-, 13-, and 15-year-olds

BackgroundFrequency of eating breakfast, lunch and evening meal as a determinant of fruit and vegetable intake among young people is little studied. We investigated whether irregular meal consumption was associated with fruit and vegetable intake among adolescents. We used separate analyses, and special emphasis was on the potentially modifying effect of sex and age.MethodsData were from the Danish contribution to the international collaborative Health Behavior in School-Aged Children Study (HBSC) in 2002. We used a questionnaire-based, cross-sectional design to study schoolchildren aged 11, 13 and 15 years (n = 3913) selected from a random sample of schools in Denmark. Fruit intake and vegetable intake were measured by a food frequency questionnaire and analyses were conducted using multivariate logistic regression.ResultsOverall, statistically significant associations were found between irregular breakfast, lunch and evening meal consumption and low frequency of fruit intake and vegetable intake (breakfast: fruit OR = 1.42, vegetables OR = 1.48; lunch: fruit OR = 1.68, vegetables OR = 1.83; evening meal: vegetables OR = 1.70). No association was found for irregular evening meal consumption and low frequency of fruit intake. Analyses stratified by sex showed that the associations between irregular breakfast consumption and both fruit and vegetable intake remained statistically significant only among girls. When analyses were stratified by both sex and age, different patterns appeared. Overall, skipping meals seemed to be a less serious risk factor for low frequency of fruit and vegetable intake among younger participants compared with those who were older. This was especially evident for skipping breakfast. The same tendency was also seen for skipping lunch and evening meal, although the age pattern varied between boys and girls and between fruit and vegetable intake.ConclusionOur results showed that irregular breakfast, lunch and evening meal consumption among adolescents was associated with a low frequency of fruit and vegetable intake and that sex and age may play a modifying role. The different associations observed in different age and sex groups indicate the importance of analysing fruit and vegetable intake and meal types separately. The results highlight the importance of promoting regular meal consumption when trying to increase the intake of fruit and vegetables among adolescents.