Visualisation and network analysis of physical activity and its determinants: Demonstrating opportunities in analysing baseline associations in the Let's Move It trial.

Background: Visualisations and readily-accessible web-based supplementary files can improve data reporting and transparency. In this paper, we make use of recent developments in software and psychological network analysis to describe the baseline cohort of a trial testing the Let's Move It intervention, which aimed to increase physical activity (PA) and reduce sedentary behaviours (SB) among vocational school students. Methods: At baseline, 1166 adolescents, distributed across 6 school clusters and four educational tracks, completed measures of PA and SB, theoretical predictors of these behaviours, and body composition. Within a comprehensive website supplement, which includes all code and analyses, data were tabulated and visualised, and network analyses explored relations between predictor variables and outcomes. Results: Average daily moderate-to-vigorous PA was 65 min (CI95: 57min-73 min), and SB 8h44 min (CI95: 8h04min-9h24 min), with 25.8 (CI95: 23.5-28.0) interruptions to sitting. Cluster randomisation appeared to result in balanced distributions for baseline characteristics between intervention and control groups, but differences emerged across the four educational tracks. Self-reported behaviour change technique (BCT) use was low for many but not all techniques. A network analysis revealed direct relationships between PA and behavioural experiments, planning and autonomous motivation, and several BCTs were connected to PA via autonomous motivation. Visualisation uncovered a case of Simpson's paradox. Conclusions: Data-visualisation and data exploration techniques (e.g. network analysis) can help reveal the dynamics involved in complex multi-causal systems - a challenging task with traditional data presentations. The benefits of presenting complex data visually should encourage researchers to publish extensive analyses and descriptions as website supplements, which would increase the speed and quality of scientific communication, as well as help to address the crisis of reduced confidence in research findings. We hope that this example will serve as a template for other investigators to improve upon in the future.

'Let's Move It' - a school-based multilevel intervention to increase physical activity and reduce sedentary behaviour among older adolescents in vocational secondary schools: a study protocol for a cluster-randomised trial.

BACKGROUND: Physical activity (PA) has been shown to decline during adolescence, and those with lower education have lower levels of activity already at this age, calling for targeted efforts for them. No previous study has demonstrated lasting effects of school-based PA interventions among older adolescents. Furthermore, these interventions have rarely targeted sedentary behaviour (SB) despite its relevance to health. The Let's Move It trial aims to evaluate the effectiveness and the cost-effectiveness of a school-based, multi-level intervention, on PA and SB, among vocational school students. We hypothesise that the intervention is effective in increasing moderate-to-vigorous-intensity physical activity (MVPA), particularly among those with low or moderate baseline levels, and decreasing SB among all students. METHODS: The design is a cluster-randomised parallel group trial with an internal pilot study. The trial is conducted in six vocational schools in the Helsinki Metropolitan area, Finland. The intervention is carried out in 30 intervention classes, and 27 control classes retain the standard curriculum. The randomisation occurs at school-level to avoid contamination and to aid delivery. Three of the six schools, randomly allocated, receive the 'Let's Move It' intervention which consists of 1) group sessions and poster campaign targeting students' autonomous PA motivation and self-regulation skills, 2) sitting reduction in classrooms via alterations in choice architecture and teacher behaviour, and 3) enhancement of PA opportunities in school, home and community environments. At baseline, student participants are blind to group allocation. The trial is carried out in six batches in 2015-2017, with main measurements at pre-intervention baseline, and 2-month and 14-month follow-ups. Primary outcomes are for PA, MVPA measured by accelerometry and self-report, and for SB, sedentary time and breaks in sedentary time (accelerometry). Key secondary outcomes include measured body composition, self-reported well-being, and psychological variables. Process variables include measures of psychosocial determinants of PA (e.g. autonomous motivation) and use of behaviour change techniques. Process evaluation also includes qualitative interviews. Intervention fidelity is monitored. DISCUSSION: The study will establish whether the Let's Move It intervention is effective in increasing PA and reducing SB in vocational school students, and identify key processes explaining the results. TRIAL REGISTRATION: ISRCTN10979479 . Registered: 31.12.2015.

Can the accuracy of health behaviour surveys be improved by non-response follow-ups?

BACKGROUND: Prevalence estimates may be biased if the characteristics of respondents differ from those of non-respondents in surveys. In this study, we used a follow-up telephone interview of initial non-respondents to examine the differences--in terms of self-rated health and health behaviours--to initial postal respondents and to assess improvements in prevalence estimates. METHODS: Following a postal questionnaire survey using a random sample (n = 5000) of the Finnish working-age population with a response rate of 57% (n = 2826), a follow-up telephone survey was performed based on 1261 non-respondents (response rate 56%, n = 708) in 2010. Prevalence of smoking, alcohol use, body mass index, physical activity, self-rated fitness, dietary habits and self-rated health were calculated for the survey population with and without a telephone interview. Logistic regression models were used to examine differences in health behaviours and health between the initial postal questionnaire respondents and follow-up telephone interview respondents. RESULTS: The total response rate increased from 57% to 71% when the telephone respondents were included. The telephone survey indicated that both male and female telephone respondents were more often smokers, and female telephone respondents were more often heavy episodic drinkers and less often reported poor self-rated fitness than postal respondents. Nonetheless, the prevalence rates of outcome variables did not change significantly when telephone respondents were included. CONCLUSION: The response rate of surveys can be increased by using a telephone survey in follow-up contacts with non-respondents. As non-respondents differ from respondents, this contributes to an improvement--although small--in internal validity.

Sense of coherence and incidence of periodontal disease in adults.

AIM: To assess whether sense of coherence (SOC) predicts the 4-year incidence of periodontal disease in adults. METHODS: Data from 848 adults who participated in both the Health 2000 Survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed. At baseline, participants provided information on demographic characteristics, education level, the SOC scale, pre-existing diabetes and dental behaviours. The outcome measure was the change in number of teeth with pocketing ≥ 4 mm over 4 years over 4 years. Two separate sets of longitudinal analyses were conducted. The first set was conducted with all the 848 subjects who participated in both surveys and the second set was conducted with the 305 subjects who had no pocketing ≥ 4 mm at baseline. RESULTS: In the full sample, baseline SOC was not associated with change in number of teeth with pocketing over 4 years (coefficient from linear regression: -0.28; 95% CI: -0.74 to 0.18). Similarly, baseline SOC was not associated with number of teeth with pocketing after 4 years (Rate Ratio: 0.94; 95%CI: 0.80 to 1.11) among those with no pocketing at baseline. CONCLUSION: This 4-year prospective study suggests that SOC measured in adulthood does not explain change in the number of teeth with periodontal pocketing ≥ 4 mm.

Multiple approaches and participation rate for a community based smoking cessation intervention trial in rural Kerala, India.

BACKGROUND: To illustrate multiple approaches and to assess participation rates adopted for a community based smoking cessation intervention programme in rural Kerala. MATERIALS AND METHODS: Resident males in the age group 18-60 years who were 'current daily smokers' from 4 randomly allocated community development blocks of rural Thiruvananthapuram district, Kerala (2 intervention and 2 control groups) were selected. Smoking status was assessed through house-to-house survey using trained volunteers. Multiple approaches included awareness on tobacco hazards during baseline survey and distribution of multicolour anti-tobacco leaflets for intervention and control groups. Further, the intervention group received a tobacco cessation booklet and four sessions of counselling which included a one-time group counselling cum medical camp, followed by proactive counselling through face-to-face (FTF) interview and mobile phone. In the second and fourth session, motivational counselling was conducted. RESULTS: Among 928 smokers identified, smokers in intervention and control groups numbered 474 (mean age: 44.6 years, SD: 9.66 years) and 454 respectively (44.5 years, SD: 10.30 years). Among the 474 subjects, 75 (16%) had attended the group counselling cum medical camp after completion of baseline survey in the intervention group, Among the remaining subjects (n=399), 88% were contacted through FTF and mobile phone (8.5%). In the second session (4-6 weeks time period), the response rate for individual counselling was 94% (78% through FTF and 16% through mobile phone). At 3 months, 70.4% were contacted by their mobile phone and further, 19.6% through FTF (total 90%) while at 6 months (fourth session), the response rate was 74% and 16.4% for FTF and mobile phone respectively, covering 90.4% of the total subjects. Overall, in the intervention group, 97.4% of subjects were being contacted at least once and individual counselling given. CONCLUSION: Proactive community centred intervention programmes using multiple approaches were found to be successful to increase the participation rate for intervention.

An analysis of problem gambling among the Finnish working-age population: a population survey.

BACKGROUND: Gambling problems currently affect approximately 100,000 Finns. In order to prevent and reduce gambling-related harms it is crucial for the Finnish public health authorities to gain a stronger understanding of the association between gambling problems and related socio-demographic factors, other commonly co-occurring dependencies (e.g. alcohol and nicotine) and the type of games gambled. In this article the prevalence of problem gambling in Finland and the socio-demographic profiles of problem gamblers are studied. METHOD: An annual postal survey entitled Health Behaviour and Health among the Finnish Adult Population AVTK was sent to a random sample of Finnish adults (N=5000) aged between 15 and 64. The sample was derived from the Finnish Population Register. The survey was mailed to the participants in April 2010. Gender differences in socio-demographic variables and Problem Gambling Severity Index PGSI were assessed. A multinomial regression model was created in order to explore the association between socio-demographic factors and the severity of gambling. RESULTS: A total of 2826 individuals (1243 males and 1583 females) replied to the survey. Of the respondents, 1.1% (2.1% of males, 0.3% of females) were identified as problem gamblers. Those who were of younger age, gender, had less than twelve years of education, consumed alcohol at risk level and smoked had higher odds of having low or moderate levels of gambling problems. Whereas, unemployment and smoking predicted significantly for problem gambling. Females gambled Lotto and slot machines less frequently than males and had more low level gambling problems. Males gambled more with a higher frequency and had a more severe level of gambling problems. Females were more attracted to scratch card gambling and daily Keno lotteries compared to males. In comparison, males gambled more on internet poker sites than females. Overall, a high frequency of gambling in Lotto, daily lotteries, slot machines, horse race betting and internet gambling was significantly associated with a more severe level of problem gambling. CONCLUSION: Gambling problems affect tens of thousands of individuals annually, therefore certain vulnerabilities should be noted. Comorbid dependencies, smoking in particular, ought to be screened for and recognised in the public health sector. Regulating the availability of slot machine gambling and enforcement of the age limit should be acknowledged. In establishing new gambling venues, prevalence rates in those particular areas should be actively monitored.

Sense of coherence, depressive symptoms, cardiovascular diseases, and all-cause mortality.

OBJECTIVE: There is increasing interest in whether positive and negative psychological constructs are bipolar opposites of the same phenomenon. We examine whether a positive construct--sense of coherence (SOC)--has independent predictive power over and above depressive symptoms for cardiovascular disease (CVD) and all-cause mortality. METHODS: Participants included 3850 men and 4083 women aged 25 to 74 years who had participated in risk factor surveys conducted in 1992 or 1997. Antonovsky's 13-item SOC scale was used to measure SOC, and had a correlation of -0.60 with the Beck Depression Inventory. RESULTS: During a mean follow-up time of 14.2 years, there were 670 deaths and 487 nonfatal and fatal CVD events. Higher SOC scores were associated with a lower risk of all-cause mortality (relative risk [RR] = 0.90, 95% confidence interval [CI] = 0.84-0.97 per unit), especially among men, but this association became nonsignificant after adjustment for depressive symptoms (RR = 0.99, 95% CI = 0.90-1.08). Among participants without a history of CVD, higher SOC scores were related to a lower risk for CVD (RR = 0.90, 95% CI = 0.83-0.98), but this association disappeared after adjustment for cardiovascular risk factors. Depressive symptoms remained significant predictors of CVD among women in a model including also SOC (RR = 1.24, 95% CI = 1.06-1.46). CONCLUSIONS: SOC was related to all-cause mortality among men; the association with CVD events was modest. Measures for SOC and depressive symptoms were significantly correlated, which might result in overlap in their associations with adverse disease and mortality outcomes.

Smoking cessation intervention in rural kerala, India: findings of a randomised controlled trial.

BACKGROUND: Prevalence of tobacco use is higher in the rural than urban areas of India. Unlike tobacco cessation clinics located in urban areas, community-based smoking cessation intervention has the potential to reach a wider section of the community to assist in smoking cessation in the rural setting. The present study aimed to assess the effectiveness of a cessation intervention in rural Kerala state, India. MATERIALS AND METHODS: Current daily smoking resident males in the age group 18-60 years from four community development blocks in rural Kerala were randomly allocated to intervention and control groups. The intervention group received multiple approaches in which priority was given to face-to-face interviews and telephone counselling. Initially educational materials on tobacco hazards were distributed. Further, four rounds of counselling sessions were conducted which included a group counselling with a medical camp as well as individual counselling by trained medical social workers. The control group received general awareness training on tobacco hazards along with an anti-tobacco leaflet. Self-reported smoking status was assessed after 6 and 12 months. Factors associated with tobacco cessation were estimated using binomial regression method. RESULTS: Overall prevalence of smoking abstinence was 14.7% in the intervention and 6.8% in the control group (Relative risk: 1.85, 95% CI: 1.05, 3.25). A total of 41.3% subjects in the intervention area and 13.6% in the control area had reduced smoking by 50% or more at the end of 12 months. Lower number of cigarettes/ bidi used, low nicotine dependence and consultation with a doctor for a medical ailment were the statistically significant predictors for smoking cessation. CONCLUSIONS: Rigorous approaches for smoking cessation programmes can enhance quit rates in smoking in rural areas of India.

Assessment of nicotine dependence among smokers in a selected rural population in Kerala, India.

OBJECTIVES: An attempt was made to understand the nicotine dependence of smokers selected for an ongoing smoking cessation intervention programme in rural Kerala, India. METHODS: Data were collected from resident males in the age group of 18 to 60 years from 4 randomly allocated community development blocks of rural Thiruvananthapuram district (2 intervention and 2 control groups). Trained accredited social health activist workers were utilised to collect data from all groups through face to face interview. Nicotine dependence among participants was assessed by means of the six-item Fagerstrom Test for Nicotine Dependence (FTND) translated into the local language. The internal consistency of FTND was computed using Cronbach's alpha coefficient. Criterion validity (concurrent) was assessed by correlations of nicotine dependence scores with age at initiation of smoking and cumulative smoking volume in pack-years. RESULTS: Among the 928 smokers identified, 474 subjects were in the intervention area (mean age =44.6 years, SD =9.66 years) and 454 in the control area (mean age= 44.5 years, SD =10.30 years). The overall FTND score among current daily smokers was 5.04 (SD: 5.05). FTND scores in the control and intervention areas were 4.75 (SD: 2.57) and 4.92 (SD: 2.51) respectively. The FTND scores increased with age and decreased with higher literacy and socioeconomic status. The average FTND score was high among smokers using both bidi and cigarettes (mean 6.10, SD 2.17). Internal consistency analysis yielded a Cronbach's alpha coefficient of 0.70 in a subsample of 150 subjects, a moderate result. The association of the scale was strongest, with the number of pack-years smoked (rho = 0.677, p < 0.001). CONCLUSION: A moderate level of nicotine dependence was observed among smokers in the current study. Tobacco cessation strategies could be made more cost effective and productive if a baseline assessment of nicotine dependence is completed before any intervention.

Symptom-detected and screen-detected celiac disease and adult height: a large cohort study.

OBJECTIVE: Nowadays, most patients with celiac disease are diagnosed in adulthood. However, undetected disease may already have been present in childhood and may have subsequently affected growth. Earlier data on the eventual adult height of patients with celiac disease have been scant and inconsistent. We aimed to assess the final height in a large cohort of symptom-detected and screen-detected patients with celiac disease diagnosed in adulthood. PATIENTS AND METHODS: The height of 1084 patients with celiac disease diagnosed in adulthood was determined in five separate birth cohorts between the years 1920 and 1989. Further, the patients were evaluated in three different subgroups depending on whether they were diagnosed on the basis of gastrointestinal or extraintestinal symptoms or by serological screening. The population-based control group included 112 340 patients in equal birth cohorts. RESULTS: In general, the mean adult height of patients with celiac disease was at the same level as in the population at large. In subgroup analysis, men with intestinal symptoms were shorter than the population controls in the birth cohort 1948-1961, and a similar trend was observed in the older cohorts. In women, the mean height was also reduced in the older birth cohorts, but predominantly among screen-detected patients. In the younger birth cohorts, height was reduced in neither sex compared with the population. CONCLUSION: In general, the mean adult height of patients with celiac disease is at the same level as that of the general population. In a subgroup analysis, reduced height was observed in some of the older, but not younger, birth cohorts.

Trust, self-rated health and mortality: a longitudinal study among ageing people in Southern Finland.

Poor self-rated health (SRH) predicts mortality significantly. High trust has been shown to associate with better SRH in cross-sectional studies and survival in longitudinal studies. However, little is known about the associations between trust, SRH and mortality among ageing people. The present study examined whether low trust at the baseline predicted higher all-cause mortality in a follow-up of over five years among ageing people, and whether the trust to mortality relationship varied by SRH. The study used longitudinal, questionnaire-based survey data gathered in 2002 (n = 2815; 66%) among three age cohorts (born in 1926-30, 1936-40 and 1946-50) living in the Lahti region, Southern Finland. Two survey follow-ups were done, the first in 2005 (n = 2476, 60%) and the second in 2008 (n = 2064, 73%). Deaths during the follow-up were obtained from the covering National Population Registry. Those who died within the first one year of follow-up were excluded from the analyses to reduce potential bias due to early deaths. Cox proportional hazard models were used to derive the results. Mortality proved to be higher among men with low trust, even if their SRH had been good at the baseline. Among women, no significant associations were found. The risk attenuated after adjustment for background health-related covariates, but the gradient remained statistically significant in all models. Initial SRH did not substantially explain the gradient of trust in mortality among men. Moreover, a Sobel test of indirect effects showed that SRH had no significant mediating role in links between trust and mortality. Thus, low trust is a sensitive indicator of higher mortality risk among ageing men.

The Beck Depression Inventory and General Health Questionnaire as measures of depression in the general population: a validation study using the Composite International Diagnostic Interview as the gold standard.

The Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ) are commonly used in population studies as measures of depression. We examined in a population sample the validity of four scales for depressive symptoms, the GHQ-12, the 21- and 13-item versions of the BDI, and a new 6-item version of the BDI developed for this study. A total of 5561 participants in the "Health 2000" survey (30-79 years) completed the four scales and were assessed with the Composite International Diagnostic Interview (CIDI), which was used as the validation criterion. We selected items for the BDI-6 through an exploratory factor analysis for the BDI-21. The accuracy of the scales, including the BDI-6, was satisfactory (c-statistics 0.88-0.92 for depression within the past 2 weeks and 0.80-0.83 within the past 12 months) and slightly better for men (0.92-0.96 and 0.85-0.87) than for women (0.86-0.88 and 0.78-0.79). Higher scores in all the scales were associated with more severe depression and more recent depressive episodes. This study suggests that various versions of the BDI and the GHQ-12 are useful in detecting depressive disorders in the general population. Even the 6-item version of the BDI showed acceptable criterion validity, although replication in an independent dataset is needed to confirm its validity.

Childhood socioeconomic position, adult sense of coherence and tooth retention.

OBJECTIVE: To explore the role of sense of coherence (SOC) as a mediator in the relationship between childhood socioeconomic position (SEP) and tooth retention in adulthood. METHODS: Data from 5401 dentate adults aged 30 and over who participated in the nationally representative Finnish Health 2000 Survey were analysed. Participants provided information on demographic characteristics (sex and age), childhood SEP (parental education), adulthood SEP (years of education and household income), the SOC scale and oral health-related behaviours (dental attendance, toothbrushing frequency, sugar intake frequency and daily smoking). They also had a clinical oral health examination. Structural equation modelling was used to test a model including adulthood SEP, SOC and oral health-related behaviours as mediators of the relationship between childhood SEP and tooth retention. Multigroup comparison was also conducted to test the hypothesized model within each sex and age group (<45 years, 45-59 years and 60+ years). RESULTS: The relationship between childhood SEP and tooth retention in adulthood was to a large extent mediated by adulthood SEP and to a much lesser extent by SOC. There was only a weak association between childhood SEP and adult SOC, but favourable oral health-related behaviours appeared to link a strong SOC with greater tooth retention. The model was invariant across sexes and age groups. CONCLUSIONS: SOC is associated with tooth retention through oral health-related behaviours, but contributes little to the relationship between childhood SEP and tooth retention.

Food choices and health during military service: increases in sugar- and fibre-containing foods and changes in anthropometric and clinical risk factors.

OBJECTIVE: To analyse changes in food choices, diet-related risk factors and their association during 6 months of military service. DESIGN: Longitudinal cohort study in Finland, where all men are liable to military service and a clear majority of each age group completes service. Dietary intake data were collected by self-administered questionnaire before and at 6 months of service. Three dietary indices based on food frequencies were developed to characterize the diet: Sugar Index, Fibre Index and Fat Index. Thirteen diet-related risk factors were measured at the beginning and at 6 months of service. SETTING: Military environment, two geographically distinct garrisons. SUBJECTS: Male conscripts aged 18-21 years (n 256) performing military service. RESULTS: During 6 months of service, positive changes concerned more frequent use of fibre-rich foods (P = 0·011), improved body composition (BMI, waist circumference, muscle mass, fat mass and percentage body fat, P ≤ 0·003 for all), decreased systolic blood pressure and increased HDL cholesterol (P < 0·001 for both). Negative changes concerned more frequent use of sugar-rich foods and increased total cholesterol, TAG and blood glucose (P < 0·001 for all). The consumption of fibre-rich foods was inversely associated with anthropometric risk factors at baseline and with sugar-rich foods at both time points. CONCLUSIONS: Despite more frequent consumption of sweet foods, military service with a unified, nutritionally planned diet, a controlled environment and high physical load has a positive effect on conscripts' health risk factors. The negative changes in blood lipids and glucose may reflect more varied free-time eating.

Conscripts' attitudes towards health and eating. Changes during the military service and associations with eating.

The study explores young men's (n=290) attitudes towards food and eating before and during military service and their associations with eating of sweet and fatty foods. Before service eating of sweet foods was associated negatively with health interest and positively with craving for sweet foods and using food as a reward, and eating of fatty foods negatively with health interest. At six months of service, craving, using food as a reward and pleasure increased, whereas health interest remained stable. At six months, eating of sweet foods was negatively associated with health interest and positively with craving. Mentally and physically hard conditions and easy access to indulgence items, affect the food related attitudes and food consumption among conscripts.

Exposure to secondhand smoke in Finnish workplaces and compliance with national smoke-free workplace legislation.

AIMS: The present study examined time trends and associations in exposure to secondhand smoke (SHS) at work in Finland in 1985-2008 and compliance with national smoke-free workplace legislation that has been enforced since 1995. METHODS: The study population comprised respondents of nationally representative annual postal surveys from 1985 to 2008. The differences in the prevalence of SHS-exposed respondents were measured with particular reference to workplace size and workplace smoking arrangements. RESULTS: From 1985 to 2008 daily exposure to SHS at work decreased in all workplaces. The annual decrease was largest in 1994-95 when the smoke-free workplace legislation was enacted. The proportion of exposed employees in workplaces with designated smoking rooms was two-fold compared to employees in workplaces where no one smoked, and this ratio remained unchanged between 1995 and 2008. Employees in small workplaces were exposed most and exposure to SHS was lowest in the largest workplaces. CONCLUSIONS: Totally smoke-free workplaces give better protection against the exposure to SHS than workplaces with designated smoking areas. We urge a law reform that does not allow any designated smoking rooms indoors. In the prevention of SHS exposure, special attention should be directed to small workplaces.

Register-based data indicated nonparticipation bias in a health study among aging people.

OBJECTIVES: To examine nonparticipation in a survey by linking it with register information and identify potential nonresponse bias of inequalities in health status among aging people. STUDY DESIGN AND SETTING: Cross-sectional questionnaire survey with clinical checkups carried out in 2002 among persons born in 1926-1930, 1936-1940, and 1946-1950 in Southern Finland. The sample was linked with register information from Statistics Finland and analyzed in terms of participation and health status as measured by medicine reimbursements. RESULTS: Participation in the survey was more frequent among those who were older, female, married or cohabiting, higher educated and nonurban residents, and those with higher income and moderate health. Among nonrespondents, women were less healthy than men, whereas among respondents, the results were reversed. Among nonrespondents, better income was associated with unfavorable health. Poor health was generally more common among nonrespondents than respondents in several subgroups. CONCLUSION: Differences in response rates were found in sociodemographic factors, health, and socioeconomic position. Favorable health was generally more frequent among respondents than nonrespondents. In particular, health inequalities by gender and income differed between respondents and nonrespondents. Thus, nonresponse may lead to bias in analyses of health inequalities among aging people.

The effect of loneliness and change in loneliness on self-rated health (SRH): a longitudinal study among aging people.

The association between adverse health and loneliness among aging people is known, but most of the studies are cross-sectional. In addition, the associations between changes in loneliness with health are less well known, especially in the case of aging people. The present study examined whether absence of loneliness in 2005 predicted subsequent good SRH in 2008, and whether changes in loneliness were associated with SRH in 2008. Longitudinal, questionnaire-based data were collected from three age cohorts (born in 1926-30, 1936-40, and 1946-50) living in southern Finland. Baseline data was collected in 2002 (n = 2815, 66%); the follow-ups were done in 2005 (n = 2476, 60%) and 2008 (n =2 064, 73%). Logistic regression analyses were used to derive the results. Never or seldom experiencing loneliness was a strong predictor for good SRH. In addition, good health was common among those who never felt lonely. Among men the group experiencing decreasing loneliness had the highest OR of good health. Thus, loneliness is a significant contributor to poor SRH among aging people. In addition, favorable SRH is indicated not only by the absence of loneliness at both measurement points, but also by decreased loneliness. Preventing loneliness is important for health promotion.

A community based smoking cessation intervention trial for rural Kerala, India.

OBJECTIVES: An attempt was made to compare tobacco prevalence and socioeconomic factors of two groups (intervention and control) from a selected rural community in Thiruvananthapuram, Kerala, India. METHODS: Data were collected from resident males in the age group of 18.0 to 60.0 years from 4 randomly allocated Community Development Blocks of rural Thiruvananthapuram district (2 intervention and control groups). Trained Accredited Social Health Activists workers were utilised to collect data from both the groups through a face to face interview. RESULTS: Among 3304 subjects were interviewed, the overall prevalence of smokers was 28% (n=928) (mean age=44.4 years, SD=9.2 years). Socio-economic status (SES) score points indicated that majority of smokers belonged to the upper lower SES category (61%) (mean SES score =10, SD= 3) and among non-smokers, the participants mainly belonged to the lower middle SES score (45%) (mean SES score =12, SD= 3) (p-value=0.0001). Among the 928 smokers, 474 subjects were in the intervention area (mean age =44.56 years, SD =9.66 years) and 454 in the control area (mean age= 44.47 years, SD =10.30 years). No significant difference was found between the intervention and control groups according to age (p=0.89) and SES (p=0.11). Majority of smokers in the intervention and control areas were from the upper lower SES group (64.14% and 57.17%). CONCLUSION: Smoking continues to be a predominant public health problem among males in rural Kerala particularly among lower socio-economic population. Apart from strengthening legislation, multiple cost effective intervention approaches are required to reduce tobacco consumption in the community.

Perceptions of smoking prevalence by youth in countries with and without a tobacco advertising ban.

This study examined a proposed mechanism by which exposure to cigarette advertising may mediate the subsequent smoking of youth. We hypothesized that children's exposure to cigarette advertising leads them to overestimate the prevalence of smoking, and that these distorted perceptions, in turn, lead to increased intentions to smoke. Children in Finland, where there has been a total tobacco advertising ban since 1978, were compared with children in the United States at a time when tobacco advertising was ubiquitous. Samples of 477 8- to 14-year-old Helsinki students and 453 8- to 14-year-old Los Angeles students whose lifetime cigarette use consisted of no more than a puff of a cigarette were administered questionnaires in their classrooms. The primary hypothesis was confirmed. Los Angeles youth were significantly more likely than Helsinki youth to overestimate the prevalence of adult smoking, in spite of the fact that actual adult smoking prevalence in Helsinki was almost twice that of Los Angeles adults. A similar, significant pattern for perceived peer smoking was obtained, with Los Angeles youth being more likely than Helsinki youth to overestimate prevalence, in spite of the actual greater prevalence of youth smoking in Helsinki.