Helen L. Metzner

Occupational stress and health among men and women in the Tecumseh Community Health Study.

This paper reports data from the Tecumseh Community Health Study relating measures of occupational characteristics and stresses collected in 1967-69 to biomedical and questionnaire assessments of health behavior and morbidity taken at the same time, and to mortality over the succeeding nine-to-twelve-year period. Overall, our findings show only slight evidence of associations between job characteristics or stresses and health behavior and morbidity. Consistent with prior research, however, the few positive associations found among the employed-irrespective of sex-are strongest between job pressures or demands, and health behavior and morbidity. By contrast, job rewards and satisfactions and occupation-education discrepancies show little consistent relation to health behavior and morbidity, while differences by occupation and self-employment are modest. None of the 1967-69 reported job characteristics and stresses, all of which were ascertained in a single data collection, predicts mortality by 1979. However, in a subsample of 288 men first interviewed in 1967-69 and still working and reinterviewed in 1970, those with moderate to high levels of job pressures or tensions at both interview points were three times as likely to die between 1970 and 1979 as men whose level of pressure or tension was low on at least one interview point, even if high at the other. Future research must monitor subjectively experienced stress over time if we are to relate such stress to types of morbidity or mortality that have a long etiology.

Habitual physical activity and blood pressure.

ABSTRACTHabitual physical activity of about 1,700 males, age 16 years and over, in a total community was assessed by questionnaire and interview. Systolic and diastolic blood pressure was recorded as part of their medical examination. The present analysis is concerned with the relationship between h

Characteristics of individuals and long term reproducibility of dietary reports: The Tecumseh diet methodology study

Food frequency reports in 1967-1969 were compared to frequency reports of the same foods asked retrospectively in 1982-1983 and 1967-1969 for 1184 respondents aged 45-64 years in the Tecumseh Community Health Study. The kappa statistic for concordance of the retrospective and baseline reports was used as a summary measure of the individuals ability to reproduce his or her earlier diet report. Reproducibility was estimated for total diet, represented by 83 foods, and for 9 subsets of foods of epidemiologic interest. In bivariate and multivariate analyses, reproducibility was strongly related to stability of diet; those whose diets changed least over the 15-year period had greatest diet reproducibility. Greater total diet reproducibility was also found among men with higher education, among women of less than 110% desirable weight reporting no special diet and among women reporting no medications. Consistent with current models of memory, the retrospective report of diet was strongly related to the current report of diet. Agreement between the retrospective and baseline diet reports was greater than agreement between the current and baseline diet reports. This indicates that, as a proxy for past diet, the retrospective report of diet is superior to the current report. Similar relationships were found for the 9 subset of foods.

Health practices, risk factors, and chronic disease in Tecumseh

Seven health practices previously found to be associated with a self-report index of good health and with lower mortality in the Alameda County studies were related to several measures of health in a cohort of 880 men and 973 women, ages 35-69, who were participants in the Tecumseh Community Health Study. The health measures were prevalence of three diagnoses--coronary heart disease (CHD), hypertension, and chronic bronchitis--and levels of five risk factors--systolic and diastolic blood pressures, serum total cholesterol, blood glucose, and FEV1. Four of the practices--desirable relative weight, physical activity, never having smoked, and moderate or no alcohol drinking--were associated significantly with one or more of the health measures. Eating breakfast, limited between-meal eating, and sleeping 7 or 8 hr were not related to the health measures. Combining all seven health practices into an index produced a measure that was more strongly associated negatively with CHD prevalence than was any one of the component practices. However, the index was no more strongly associated with any of the other health measures than were the relevant separate practices. Desirable weight was more highly associated (negatively) with hypertension and blood pressure than the index was, as was never having smoked with chronic bronchitis (negatively) and FEV1 (positively).

The Tecumseh Study

The Tecumseh Community Health Study has been described in terms of its history, aims, design, conduct and current results, work in progress and future plans. This prospective epidemiological investigation of health and disease, especially cardiovascular disease and related disorders, in a total, natural community has its emphasis on the early detection of disease precursors in susceptible individuals, families, and other groups; the outlook is on prevention. An extensive and intensive study of this kind has been shown to be both feasible and productive. It represents what Dr. Thomas Francis, Jr., has called “clinical investigation on a community level,” including data on man and his environment. The key contribution of Dr. Francis in the establishment and conduct of the study is recalled and remembered with deep appreciation and respect.

Comparison of surrogate and subject reports of dietary practices, smoking habits and weight among married couples in the tecumseh diet methodology study

Agreement between surrogate and subject reports of current food frequencies and other eating habits, smoking behavior and weight was assessed in 1982-1983 for 180 husbands and wives, aged 45 through 64 years. Agreement was measured by per cent exact agreement and weighted kappa for frequencies of 30 itemized foods or food groups, and for surrogate- and subject-based quintiles of frequencies of eight broad food groups and of vitamin A and C consumption indexes. Surrogate and subject mean frequencies were generally similar, but at the individual level of analysis, agreement varied widely. Agreement was greatest, among the food items and groups, for alcoholic beverages, and among the other items, for smoking status. Extreme misclassification by quintile was very small, but only 40% of persons self-classified in either extreme quintile were similarly classified by their spouses. This level of misclassification may result in the dilution of real relationships between diet and health.

Habitual Physical Activity and Glucose Tolerance: Males Age 16–64 in a Total Community

The data being reported are part of an epidemiologic study of health and disease in an entire community, Tecumseh, Michigan. Approximately 1,300 males age 16–65 were classified into three groups on the basis of their habitual leisure and occupational physical activity. A blood sample was drawn one hour after a glucose challenge and analyzed for glucose concentration. A measure of body fatness (sum of four skinfolds) was also available on the men. Glucose concentration of the three physical activity groups was compared by analyses of variance within narrow age groups. There was no significant relationship between glucose tolerance and habitual physical activity. There was a slight, but in some age groups significant, relationship between glucose tolerance and body fatness. The population was then divided within each age group into subgroups (thirds) by sum of skinfolds. The analysis was repeated in each age-fatness group. Glucose tolerance was better in the active men but only among the leanest subgroup of subjects.

A Limited Comparison of two Methods of Data Collection: The Fixed Alternative Questionnaire and the Open-Ended Interview

A good deal has been w r i t t e n concerning the r e l a t i v e advantages and disadvantages of the fixed alternative questionnaire and the open-ended i n t e r view as methods for the collection of opinion research data* There i s l i t t l e question but that good survey procedure c a l l s for intensive interviewing at some stage i n a program of research i n t o a new f i e l d of inquiry. More often than not, intensive interviews w i t h open-ended questions are used i n the i n i t i a l , exploratory phases of. a research program to determine what the major variables are, and to help sharpen f i r s t working hypotheses. There i s , of course, no reason to r e s t r i c t intensive interviews to the i n i t i a l stages of a research program; they can be used to excellent advantage i n the further study of relationships which are already known. There i s also no question but that a properly developed, ca r e f u l l y pretested and administered fixed alternative questionnaire i s the most economical and useful way of co l l e c t i n g and processing large masses of information. A paper and pencil questionnaire constructed to meet the objectives of a specific study design (e.g. the further testing of tentative findings obtained through intensive interviews) may be developed int o a very precise t o o l . The prudent researcher w i l l use these two methods i n combination to seek out those relationships necessary to meet the objectives of his research program.-]/

RESIDENTIAL MOBILITY AND URBAN-RURAL RESIDENCE WITHIN LIFE STAGES RELATED TO HEALTH RISK AND CHRONIC DISEASE IN TECUMSEH. MICHIGAN

Residential history, diagnosis of three chronic diseases, five clinical measurements and histories of smoking and drinking were obtained from a sample of 615 women and 529 men, aged 35-69, randomly selected from respondents of the Tecumseh Community Health Study. Two measures of residential mobility and one of urban-rural residence, during early life stages and over the entire lifetime, were related to subsequent adult health traits. Greater residential mobility, particularly in childhood but also in later life, was significantly associated with greater prevalence of hypertension and higher mean diastolic blood pressure in older persons. Greater duration of urban residence was associated with greater prevalence of chronic bronchitis. Both residential traits were associated with greater prevalence of CHD, and with behavior patterns, namely cigarette smoking and drinking, that are risk factors for certain chronic diseases.

EARLY LIFE SOCIAL INCONGRUITIES, HEALTH RISK FACTORS AND CHRONIC DISEASE*

Abstract This study tested specific hypotheses concerned with the relationships between three early life stress variables occurring between 0 and 16 yr of age and a variety of adult health status measures ascertained some 20–60 yr later in a 40% sample of the Tecumseh Community Health Study population 35–69 yr of age. The hypotheses stated that each of the following characteristics, relatively greater residential geographic mobility during childhood, being deprived of one or both natural parents for one or more years during this early formative period, and experiencing parental status incongruence, would be associated with higher levels of nine risk factors, greater prevalence of five chronic diseases, and a greater rate of mortality. The risk factors were systolic and diastolic blood pressure, blood glucose level, serum cholesterol, serum uric acid, the F.E.V. 1.0 measure of lung function; adiposity, number of cigarettes smoked currently, and amount of alcohol consumed currently. The chronic conditions were CHD, hypertension, diabetes, chronic bronchitis and asthma. Also measured were the aggregation of these chronic conditions and whether or not the respondents ever smoked cigarettes or drank alcohol. Five mobility measures and an index were developed. As predicted, in general, significant relationships were found among women between the five separate mobility variables and the health measures. Specifically, all five separate measures of mobility were related to CHD among older women, and most were related to cigarette smoking and alcohol consumption among all women. Various of the five mobility measures were related to various other specific health measures. In general, mobility was not related to the health measures studied among men. The hypotheses concerning parental deprivation and parental status incongruency were not substantiated by the data.