Associations of socioeconomic and health factors with dental non-attendance: A comparison of three cohorts of women.

OBJECTIVES: Most studies on factors influencing dental attendance are cross-sectional and focus on specific age groups. The associations between private ancillary health insurance, tobacco smoking, alcohol consumption and overweight/obesity with dental attendance were examined in three cohorts of Australian women of different ages using multiple waves of data over similar time periods. METHODS: Data from 10 233, 12 378 and 7892 women born in 1973-1978, 1946-1951 and 1921-1926 participating in the Australian Longitudinal Study on Women's Health were used. Poisson regression using generalized estimating equations was used to investigate factors associated with self-report of not visiting the dentist in the 12 months before completing each wave. RESULTS: The role of dental non-attendance was higher in women without insurance (versus those with insurance) in all cohorts with adjusted rate ratios (RR) of 1.52 95% CI 1.48-1.57, RR 1.45 95% CI 1.41-1.49 and RR 1.32 95% CI 1.28-1.36 in the 1973-78, 1946-51 and 1921-26 cohorts respectively. Current smokers at any intensity (versus never smokers) had a higher risk of non-attendance and the risk was strongest for women in the 1946-51 cohort who smoked ≥20 cigarettes/day (RR 1.35 95% CI 1.30-1.41). Compared with low-risk drinkers, non-drinkers were more likely to be non-attenders, but only in the two older cohorts. Women who were overweight or obese (versus healthy weight) were more likely to be non-attenders in all cohorts, with the risk of non-attendance higher with increasing BMI. CONCLUSIONS: This study emphasizes the continued need to address socioeconomic inequities in access to dental care, along with strategies to overcome barriers for those who are obese or smoke. In this study, barriers to access existed for women of all ages, indicating that interventions need to be appropriate across age groups.

Associations of protective factors with physical function in women with a hysterectomy: A prospective Australian cohort study.

We examined relationships between combinations of protective factors (healthy weight, never smoking, and at least moderate levels of physical activity) and moderate or substantial limitations of physical function (PF) versus minimal PF limitations in women who had had a hysterectomy only (n = 1771) or a hysterectomy and bilateral oophorectomy (BO) (n = 738) participating in the Australian Longitudinal Study on Women's Health. We found a dose-response effect that was strongest for substantial PF limitations; for each additional healthy behaviour, for women who had undergone hysterectomy only the relative risk (RR) was 0.62 (95% confidence interval (CI) 0.56-0.69) and for women who had undergone hysterectomy-BO the RR was 0.70 (95% CI 0.60-0.82). Support to adopt these modifiable factors may improve physical function in women who have had a hysterectomy.

Socioeconomic, behavioural and health factors associated with chlamydia testing in sexually active young women: an Australian observational cohort study.

BACKGROUND: Chlamydia trachomatis is the most frequently notified sexually transmitted infection in Australia. Untreated infections in women can cause health problems. Professional guidelines encourage opportunistic testing of young people. To increase understanding of who is being tested, we investigated factors associated with testing in a population of young women. METHODS: In total, 14002 sexually active women, aged 18-23 years at baseline (2013), from the Australian Longitudinal Study on Women's Health, were included. We used random intercepts, mixed-effects binary logistic regression with robust standard errors to assess associations between socioeconomic, health and behavioural factors and chlamydia testing. RESULTS: Associations between chlamydia testing and partner status varied by a woman's body mass index (BMI). Compared to women with a stable partner/BMI <25kg/m2 , women with a stable partner/BMI ≥25kg/m2 were less likely to be tested (adjusted odds ratios [AOR]=0.79, 95% CI: 0.71-0.88). In contrast, although women without a partner were more likely to be tested irrespective of BMI, the odds were higher for those with a BMI <25kg/m2 (AOR=2.68, 95% CI: 2.44-2.94) than a BMI ≥25kg/m2 (AOR=1.65, 95% CI: 1.48-1.84). Women who reported a prior chlamydia infection were also more likely to be tested (AOR=2.01, 95% CI: 1.83-2.20), as were women engaging in any combination of cannabis use and/or heavy episodic drinking compared to doing neither of these activities. CONCLUSIONS: Women without a partner, women with a prior chlamydia infection and those engaging in risk-taking behaviours are more likely to have chlamydia testing. Additional research is needed to understand whether there are deficits in testing among overweight/obese women.

Generational differences in the prevalence of postpartum depression among young Australians: a comparison of two cohorts born 17 years apart.

Whether there has been an increase in postpartum depression (PPD) over the generation remains unknown. This study aimed to compare the prevalence in two cohorts of young Australian women born 17 years apart and identified the factors associated with any generational differences. Participants were from the Australian Longitudinal Study on Women's Health, who gave birth between ages 18 and 27 (born in 1973-78 and 1989-95). PPD prevalence was calculated as the percentage of births associated with PPD. Both the prevalence of PPD diagnoses (among 1,610 births) and PPD symptoms (among 953 births) were compared. Relative risks (RRs) and 95% confidence intervals (CIs) were used to report generational differences in the prevalence for PPD diagnoses; Hazard ratios (HRs) and 95% CIs used for PPD symptoms. Factors that differed between cohorts and were associated with PPD diagnoses or PPD symptoms were adjusted. The prevalence of both PPD diagnoses (21.4% vs 10.3%; crude RR: 2.03, 95% CI: 1.59-2.60) and symptoms (20.1% vs 13.3%; crude HR: 1.60, 95% CI: 1.15-2.34) were higher in the 1989-1995 cohort than the 1973-1978 cohort. Generational differences in PPD diagnoses persisted after controlling for potential contributors (RR: 1.53, 95% CI: 1.15-2.04), while generational differences in PPD symptoms were attenuated (HR: 0.98, 95% CI: 0.64-1.49). Of all contributing factors, a history of depression explained most of the generational differences, especially in PPD symptoms (49%), to the extent that when the study sample was stratified by history of depression, no generational differences were detected (without prior depression, HR: 0.65, 95% CI: 0.20-2.08; with prior depression, HR: 1.18, 95% CI: 0.71-1.96). The higher prevalence of PPD in the recent generation was mainly due to the high prevalence of depression. Strategies that well manage pre-existing depression may benefit the prevention of PPD for the current young generation. Further research is warranted to inform detailed prevention approaches.

Association between preconception cannabis use and risk of postpartum depression: Findings from an Australian longitudinal cohort.

BACKGROUND AND AIM: Evidence suggests a positive association between cannabis use and depression however whether preconception cannabis use is associated with postpartum depression (PPD) remains unknown. This study examined the association using a longitudinal design. METHODS: Participants were from the Australian Longitudinal Study on Women's Health (cohort born in 1989-95), a sample broadly representative of similarly aged Australian women. The association of past year cannabis use at 3-15 months prior to pregnancy with PPD at ages 19-24 to 22-27 was examined in 516 women with 570 singleton live births. The associations of chronicity, recency, and initiation of cannabis use before pregnancy with PPD at ages 21-26 to 24-29 were investigated in 538 women with 590 singleton live births. PPD was ascertained from self-report of doctor diagnosis for each birth. Relative risk (RR) and 95 % confidence interval (CI) were used to calculate the associations of interest. RESULTS: Compared with no cannabis use, any past-year cannabis use at 3-15 months before pregnancy may be associated with an increased risk of PPD (1.50, 0.99-2.28). Compared with no cannabis use in the first three annual surveys before pregnancy, chronic use (a past year user in ≥ 2 surveys) was associated with an 80 % higher risk of incident PPD for births in the following 1-4 years (1.80, 1.22-2.68). Compared to never users at ages 20-25, former users who had no use within the past year had no increased risk; past year users had 73 % higher risk (1.73, 1.07-2.81); and past year users who initiated cannabis use at or after age 18 had twice the risk of incident PPD for births in the following 1-4 years (2.02, 1.17-3.49). CONCLUSION: This study provides evidence that preconception cannabis use is associated with increased risk of PPD. More studies are warranted to confirm this finding before cannabis cessation policies can be reinforced on reducing the risk of PPD.

Did changes to recommended testing criteria affect the rate of vitamin D testing among Australian women.

We examine whether new government criteria designed to reduce overuse of vitamin D testing changed testing rates in Australian women. Although testing initially declined, the reduction was not sustained. Women who had more doctor visits and who had been tested previously were more likely to have vitamin D testing. PURPOSE: Vitamin D testing increased substantially in the 2000s in many countries, particularly in women. Because of concerns about potential over-testing, in 2014, the Australian criteria for subsidised testing were restricted to those at high risk of vitamin D deficiency. We aimed to describe vitamin D testing trends in Australian women (1996 to 2019) and investigate sociodemographic and health factors associated with testing under the new criteria. METHODS: We used joinpoint regression to assess changes in national testing trends in Australian women (aged 15+ years) using universal health insurance system data. Additionally, we investigated the factors associated with vitamin D testing through Poisson regression with robust error variance using survey and linked insurance system data from participants born 1946-51 in the Australian Longitudinal Study on Women's Health (ALSWH). RESULTS: Between 1996 and 2013, vitamin D testing rates increased in all age groups. Rates declined between 2013 and 2016, but increased again between 2016 and 2019. In the ALSWH cohort, a higher likelihood of testing under the new criteria was associated with 12 or more doctor visits per year compared to two or fewer visits per year (relative risk (RR) 1.85; 95% CI 1.61-2.12), and women who had two or more vitamin D tests between 2012 and 2014 compared to no test (RR 1.55; 95% CI 1.48-1.62). CONCLUSION: The introduction of new criteria has not led to sustained declines in testing. High testing rates and repeated testing suggest that over-testing for vitamin D deficiency in Australian women is still occurring.

Seeking Health Information Online: Association with Young Australian Women's Physical, Mental, and Reproductive Health.

BACKGROUND: Relatively little is known about the extent to which young adults use the Internet as a health information resource and whether there are factors that distinguish between those who do and do not go online for health information. OBJECTIVE: The aim was to identify the sociodemographic, physical, mental, and reproductive health factors associated with young women's use of the Internet for health information. METHODS: We used data from 17,069 young women aged 18-23 years who participated in the Australian Longitudinal Study on Women's Health. Multivariable logistic regression was used to estimate the association between sociodemographic, physical, mental, and reproductive health factors associated with searching the Internet for health information. RESULTS: Overall, 43.54% (7433/17,069) of women used the Internet for health information. Women who used the Internet had higher odds of regular urinary or bowel symptoms (OR 1.44, 95% CI 1.36-1.54), psychological distress (very high distress: OR 1.24, 95% CI 1.13-1.37), self-reported mental health diagnoses (OR 1.16, 95% CI 1.09-1.23), and menstrual symptoms (OR 1.25, 95% CI 1.15-1.36) than women who did not use the Internet for health information. Internet users were less likely to have had blood pressure checks (OR 0.85, 95% CI 0.78-0.93) and skin cancer checks (OR 0.90, 95% CI 0.84-0.97) and to have had a live birth (OR 0.74, 95% CI 0.64-0.86) or pregnancy loss (OR 0.88, 95% CI 0.79-0.98) than non-Internet users. CONCLUSIONS: Women experiencing "stigmatized" conditions or symptoms were more likely to search the Internet for health information. The Internet may be an acceptable resource that offers "anonymized" information or support to young women and this has important implications for health service providers and public health policy.

Recruitment via the Internet and social networking sites: the 1989-1995 cohort of the Australian Longitudinal Study on Women's Health.

BACKGROUND: Faced with the challenge of recruiting young adults for health studies, researchers have increasingly turned to the Internet and social networking sites, such as Facebook, as part of their recruitment strategy. As yet, few large-scale studies are available that report on the characteristics and representativeness of the sample obtained from such recruitment methods. OBJECTIVE: The intent of the study was to describe the sociodemographic and health characteristics of a national sample of young Australian women recruited mainly through the Internet and social networking sites and to discuss the representativeness of their sociodemographic, health, and lifestyle characteristics relative to the population. METHODS: A cohort of 17,069 women (born between 1989 and 1995) was recruited in 2012-13 for the Australian Longitudinal Study on Women's Health. Sociodemographic characteristics (percentages, means, and 95% confidence intervals) from the online survey data were compared with women aged 18-23 years from the 2011 Australian Census. Sample data were compared by age and education level with data from the 2011-13 Australian Health Survey (AHS). RESULTS: Compared to the Australian Census data, study participants were broadly representative in terms of geographical distribution across Australia, marital status (95.62%, 16,321/17,069) were never married), and age distribution. A higher percentage had attained university (22.52%, 3844/17,069) and trade/certificate/diploma qualifications (25.94%, 4428/17,069) compared with this age group of women in the national population (9.4% and 21.7% respectively). Among study participants, 22.05% (3721/16,877) were not in paid employment with 35.18% (5931/16,857) studying 16 or more hours a week. A higher percentage of study participants rated their health in the online survey as fair or poor (rather than good, very good, or excellent) compared with those participating in face-to-face interviews in the AHS (18.77%, 3203/17,069 vs 10.1%). A higher percentage of study participants were current smokers (21.78%, 3718/17,069 vs 16.4%) and physically active (59.30%, 10,089/17,014 were classified as sufficiently active vs 48.3%) but alcohol consumption was lower (59.58%, 9865/16,558 reported drinking alcohol at least once per month vs 65.9% in the AHS). Using self-reported height and weight to determine body mass index (BMI, kg/m(2)), 34.80% (5901/16,956) of the cohort were classified as overweight or obese (BMI of 25 or more), compared with 33.6% respectively using measured height and weight in the AHS. CONCLUSIONS: Findings indicated that using the Internet and social networking sites for an online survey represent a feasible recruitment strategy for a national cohort of young women and result in a broadly representative sample of the Australian population.

Socio-economic position over the life course and all-cause, and circulatory diseases mortality at age 50-87 years: results from a Swedish birth cohort.

Both child and adult socio-economic position (SEP) predict adult mortality, but little is known about the variation in the impact of SEP across the life course. The Uppsala Birth Cohort Study is a representative birth cohort born 1915-1929 in Uppsala, Sweden. For the 5,138 males and 5,069 females alive in 1980, SEP was available at birth; in adulthood (age 31-45); and in later life (age 51-65). Follow-up for mortality (all-cause, and circulatory disease) was from 1980 to 2002. To test which life course model best described the association between SEP and mortality, we compared the fit of a series of nested Cox proportional hazards regression models (representing either the critical, accumulation or sensitive period models) with a fully saturated model. For all-cause mortality in both genders, the sensitive period model best described the influence of SEP across the life course with a heightened effect in later adult life (males: Hazard Ratio (95 % CI) for advantaged SEP: 0.89 (0.81-0.97) at birth, 0.90 (0.81-0.98) in adulthood, 0.74 (0.67-0.82) in later life; females: 0.87 (0.78-0.98), 0.95 (0.86-1.06), 0.73 (0.64-0.83)). The effect of SEP on circulatory diseases mortality in males was cumulative (HR: 0.84 (0.80-0.87) per unit time in advantaged SEP). For circulatory disease mortality among females, a sensitive period model was selected due to SEP in later adult life (HR: 0.64 (0.52-0.80)). These findings suggest that reducing inequality throughout the life course might reduce all-cause and circulatory disease mortality.