Erik R. Sund

Individual, family, and area predictors of BMI and BMI change in an adult Norwegian population: Findings from the HUNT study

The global obesity epidemic is a major public health concern and there is strong evidence that the drivers are varied and operate via diverse pathways. Taking a systems approach allows the contextual influences operating upon the individual to be identified and quantified. We adopt such a perspective in this study, where longitudinal data from a cohort of 24,966 settled individuals participating in two major health surveys, the Nord-Trøndelag Health Study (HUNT 1 and 2) in the county of Nord-Trøndelag, Norway, were used to investigate associations between individual, family and area characteristics and two outcomes: body mass index (BMI) at follow-up and BMI change over an 11 year period. Linear multilevel models were fitted, with individuals nested in 17,500 families, 447 wards and 24 municipalities. A range of putative individual, family, and area predictors were tested. We found both outcomes were strongly associated with individual characteristics, with higher BMIs generally being amongst males, unmarried participants, non-smokers, those of lower education and those undertaking physically demanding work but participating in less physical activity outside work. The characteristics of those in the sample exhibiting higher BMI gain were rather similar except that women gained more and those with no employment income gained less. Contextual influences were also found to be important: although just 1% of the unexplained variance was located on the neighbourhood and municipality levels respectively, and hence suggesting small environmental influences, between 10 and 13% could be attributed to families, highlighting the importance of the familial contextual environment. Rather little is known about the manner by which family influences may operate on bodyweight hence further work is needed to understand likely mechanisms and guide future interventions.

Unemployment and disability pension--an 18-year follow-up study of a 40-year-old population in a Norwegian county.

BackgroundThis study explored the association of unemployment and an increased risk of receiving disability pension, and the possibility that this risk is attributed to municipality-specific characteristics.MethodsA cohort of 7,985 40-42 year olds was followed for 18 years in national registers, identifying new episodes of unemployment and cases of disability pension. The association between an unemployment period and disability pension in the subsequent year was estimated using discrete time multilevel logistic regressions and clustering individuals by municipality. The association between unemployment and disability pension was adjusted for age in the follow up-period, sex, baseline health status, health behaviour and education level. A conditional intra-class correlation coefficient (ICC) was estimated as a measure of inter-municipality variance.ResultsIn the follow-up period, 2784 (35%) of the participants were granted disability pension. The crude odds ratio for receiving disability pension after unemployment (adjusted for age in follow-up period and sex only) was 1.42 (95% CI 1.1-1.8). Adjusting for baseline health indicators reduced the odds ratio of unemployment to 1.33 (CI 1.1-1.7). A fully adjusted model, including education level, further reduced the odds ratio of unemployment to 1.25 (CI 1.00-1.6). The ICC of the municipality level was approximately 2%.ConclusionsBecoming unemployed increased the risk of receiving subsequent disability pension. However, adjusting for baseline health status, health behaviour and education attenuated this impact considerably. The multilevel analysis indicated that a minor, yet statistically significant, proportion of the risk of disability pension can be attributed to the municipality of residence.

Cultural activity participation and associations with self-perceived health, life-satisfaction and mental health: the Young HUNT Study, Norway

BackgroundLeisure time activities and culture participation may have health effects and be important in pulic health promotion. More knowledge on how cultural activity participation may influence self-perceived health, life-satisfaction, self-esteem and mental health is needed.MethodsThis article use data from the general population-based Norwegian HUNT Study, using the cross-sectional Young-HUNT3 (2006–08) Survey including 8200 adolescents. Data on cultural activity participation, self-perceived health, life-satisfaction, self-esteem, anxiety and depression were collected by self-reported questionnaires.ResultsBoth attending meetings or training in an organisation or club, and attending sports events were positively associated with each of the health parameters good self-percieved health, good life-satisfaction, good self-esteem, and low anxiety and depression symptoms. We found differences according to gender and age (13–15 years versus 16–19 years old) for several culture activities, where girls aged 16–19 years seemed to benefit most from being culturally active. The extent of participation seemed to matter. Those who had frequent participation in cultural activities reported better health outcomes compared to inactive adolecents.ConclusionsThe results from this study indicate that participation in cultural activities may be positively associated with health, life-satisfaction and self-esteem in adolescents and thus important in public health promotion. Possible sex and age differences should be taken into account.

Work environment and disability pension – an 18-year follow-up study in a Norwegian working population

Aims: To investigate the associations between work environment indicators and health- related work disability. Methods: A health survey of 5,749 working 40–42-year-old Norwegians from Nordland County were linked to a national register for disability pension during a follow-up of over 18 years. The risk for disability pension following various self-reported physical and psychosocial work environmental exposures (individual and cumulative) were estimated using Cox regression analysis. Results: Both cumulative physical and psychosocial work environmental exposures were associated with an increased risk for disability pension, although this association was attenuated for most variables after adjusting for health and education. An increase in five poor psychosocial work environmental exposures was associated with a 22% increased risk for disability (adjusted hazard ratio, aHR, 1.22, 95% CI 1.04–1.44), whereas a similar increase in five poor physical work environmental exposures was associated with a 29% increased risk (aHR, 1.29, 95% CI 1.16-1.44). There were no indications of statistical interaction between either sex or education and work exposures. Conclusions: People who report a poor work environment are at a higher risk for subsequent work disability. This finding suggests that improving working conditions may be an area of intervention in order to reduce the number of people who leave the labour market with a disability pension.

Gender differences and gender convergence in alcohol use over the past three decades (1984-2008), the HUNT Study, Norway

BackgroundTo examine changes in men‘s and women’s drinking in Norway over a 20-year period, in order to learn whether such changes have led to gender convergence in alcohol drinking.MethodsRepeated cross-sectional studies (in 1984–86, 1995–97, and 2006–08) of a large general population living in a geographically defined area (county) in Norway. Information about alcohol drinking is based on self-report questionnaires. Not all measures were assessed in all three surveys.ResultsAdult alcohol drinking patterns have changed markedly over a 20-year period. Abstaining has become rarer while consumption and rates of recent drinking and problematic drinking have increased. Most changes were in the same direction for men and women, but women have moved towards men’s drinking patterns in abstaining, recent drinking, problematic drinking and consumption. Intoxication (among recent drinkers) has decreased in both genders, but more in men than in women. The declines in gender differences, however, were age-specific and varied depending on which drinking behavior and which beverage was taken into account.ConclusionsThere has been a gender convergence in most drinking behaviours, including lifetime history of problem drinking, over the past 2–3 decades in this Norwegian general population, but the reasons for this convergence appear to be complex.

Associations between primary healthcare and unplanned medical admissions in Norway: a multilevel analysis of the entire elderly population

Objective To examine if individual risk of unplanned medical admissions (UMAs) was associated with municipality general practitioner (GP) or long-term care (LTC) volume among the entire Norwegian elderly population. Design Cross-sectional population-based study. Setting 428 of 430 Norwegian municipalities in 2009. Participants All Norwegians aged ≥65 years (n=721 915; 56% women—15% of the total population). Main outcome measure Individual risk of UMA. Results Using a multilevel analytical framework, consisting of individuals (N=722 464) nested within municipalities (N=428), nested within local hospital areas (N=52) we found no association between municipality GP or LTC volume and UMAs. However, we found that higher LTC levels of provision were associated with fewer hospitalisations among the older age groups. A modest geographical variability was observed for UMA in adjusted analysis. Conclusions A higher primary healthcare volume was only associated with fewer UMAs among the oldest old in a universally accessible healthcare system.

Rehabilitation time before disability pension

BackgroundThe decision to grant a disability pension is usually the end of a long process of medical examinations, treatment and rehabilitation attempts. This study investigates to what extent the time spent on rehabilitation time prior to disability pension is associated with characteristics of the individual or the local employment and welfare office, measured as municipality variance.MethodsA study of 2,533 40 to 42 year olds who received disability pension over a period of 18 years. The logarithm of the rehabilitation time before granting a disability pension was analysed with multilevel regression.ResultsThe rehabilitation time before a disability pension was granted ranged from 30 to 5,508 days. Baseline health characteristics were only moderately associated with rehabilitation time. Younger people and people with unemployment periods had longer rehabilitation time before a disability pension was granted. There were only minor differences in rehabilitation time between men and women and between different levels of education. Approximately 2% of the total variance in rehabilitation time could be attributed to the municipality of residence.ConclusionsThere is a higher threshold for granting a disability pension to younger persons and those who are expecting periods of unemployment, which is reflected in the extended rehabilitation requirements for these groups. The longer rehabilitation period for persons with psychiatric disorders might reflect a lack of common knowledge on the working capacity of and the fitted rehabilitation programs for people with psychiatric disorders.

Five-factor personality profiles among Norwegian musicians compared to the general workforce:

The aim of the study was to investigate differences in personality traits between professional musicians and the general workforce, as well as differences in personality traits across subgroups of musicians according to types of employment and instrument group. In 2013, 1,600 members of the Norwegian Musicians’ Union answered a questionnaire regarding type of employment, instrument group and a shortened version of the Big Five Inventory (BFI-20). The musicians were compared to a sample of the general Norwegian workforce (n = 6,372) that answered the same personality questionnaire in the Norwegian Generation and Gender Survey of 2007. Multivariable linear regression, adjusted for age, gender, marital status and education, showed that musicians displayed higher degrees of neuroticism and openness to experience, as well as lower degrees of conscientiousness, than the general workforce. A higher degree of openness to experience was especially evident among freelance musicians and those who combined freelance work with employment. Findings also differed according to musicians’ instrument groups, with vocalists scoring higher on openness to experience and bowed string players scoring higher on neuroticism and introversion. In sum, musicians displayed somewhat different patterns of personality traits compared to the general workforce, but our results did not support some of the previously held notions of a specific distinguishable personality structure of musicians. Somewhat unsurprisingly, the major distinguishable trait of musicians was a heightened degree of openness to experience.

Intergenerational Hazardous Alcohol Use and Area Factors: The HUNT Study, Norway

Background: Alcohol use among adolescents has been found to be associated with parental alcohol abuse, but its relation to more prevalent forms of hazardous drinking patterns among parents has been less explored. Few studies have included area factors when investigating alcohol use across generations. Objectives: The aims of this study were to investigate whether adolescent intoxication was associated with parental heavy episodic drinking (HED) and intoxication, area-level socioeconomic status (SES), and rates of area-level HED. Methods: General Estimation Equations (GEE) was applied to analyze data from the Nord-Trøndelag Health Study (2006–08) including 2,306 adolescents. Adolescent alcohol use was defined by self-reported frequency of intoxication. Parental alcohol use was defined by parental self-reports of drinking five glasses of alcohol at one occasion (HED), whether they had been strongly intoxicated, and adolescent reports of seeing parents intoxicated. Area-level SES and HED were based on data from HUNT3 and Statistics Norway. Results: Parental and offspring alcohol use were associated, although this varied to some extent with gender and exposures. The strongest associations were found between offspring intoxication and offspring reports of seeing their parent intoxicated (girls: OR 3.3, 95% CI 2.3–4.7; boys: OR 3.4, 95% CI 2.4–4.7). Intoxication was more common among girls, who lived in areas with a higher level of adult HED. Living in areas with higher SES was associated with less intoxication among adolescents. Conclusion: Intoxication in adolescence was associated with factors at both family and area level, which emphasize the need of both population and high risk preventive approaches.

Factors associated with basic and instrumental activities of daily living in elderly participants of a population-based survey: the Nord-Trøndelag Health Study, Norway

Objectives To investigate factors associated with the need for assistance in basic and instrumental activities of daily living in Norwegian elderly. Design Prospective cohort study. Setting The Nord-Trøndelag Health Study (HUNT), a large population-based health survey in Norway. Participants 5050 individuals aged 60–69 years old at baseline in HUNT2 (1995–1997) who also participated in HUNT3 (2006–2008) were included in the study. 676/693 individuals were excluded in the analyses due to missing outcomes. Outcomes Needing assistance in one or more basic or instrumental activities of daily living reported in HUNT3. Results In adjusted multinomial logistic regression analyses, poor self-rated health and depression were the strongest risk factors for needing assistance in one or more basic activities of daily living in HUNT3, with ORs of 2.13 (1.35 to 3.38) and 1.58 (0.91 to 2.73). Poor self-rated health and poor life satisfaction were the strongest risk factors for needing assistance in one or more instrumental activities of daily living in HUNT3, with ORs of 2.30 (1.93 to 2.74) and 2.29 (1.86 to 2.81), respectively. Excessive sitting time, short or prolonged sleeping time, and physical inactivity seemed to be the most important lifestyle risk factors for basic/instrumental activities of daily living (ADL/IADL) disability. The studied factors were, in general, greater risk factors for mortality during follow-up than for ADL/IADL disability. Smoking was the strongest risk factor for mortality during follow-up and non-participation in HUNT3. Smoking and low social participation were the strongest risk factors for non-participation in HUNT3. Conclusions Subjective health perception, life satisfaction and depression were the strongest risk factors for needing assistance in one or more basic/instrumental activities of daily living later in life. These factors could be possible targets for prevention purposes.