Cohort Profile: The Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan.

The Social Environment and Biomarkers of Aging Study (SEBAS) is a nationally representative longitudinal survey of Taiwanese middle-aged and older adults. It adds the collection of biomarkers and performance assessments to the Taiwan Longitudinal Study of Aging (TLSA), a nationally representative study of adults aged 60 and over, including the institutionalized population. The TLSA began in 1989, with follow-ups approximately every 3 years; younger refresher cohorts were added in 1996 and 2003. The first wave of SEBAS, based on a sub-sample of respondents from the 1999 TLSA, was conducted in 2000. A total of 1023 respondents completed both a face-to-face home interview and, several weeks later, a hospital-based physical examination. In addition to a 12-h (7 pm-7 am) urine specimen collected the night before and a fasting blood specimen collected during the examination, trained staff measured blood pressure, height, weight and waist and hip circumferences. A second wave of SEBAS was conducted in 2006 using a similar protocol to SEBAS 2000, but with the addition of performance assessments conducted by the interviewers at the end of the home interview. Both waves of SEBAS also included measures of health status (physical, emotional, cognitive), health behaviours, social relationships and exposure to stressors. The SEBAS data, which are publicly available at [http://www.icpsr.umich.edu/icpsrweb/NACDA/studies/3792/version/5], allow researchers to explore the relationships among life challenges, the social environment and health and to examine the antecedents, correlates and consequences of change in biological measures and health.

Child Sexual Abuse and Its Relationship With Health Risk Behaviors Among Adolescents and Young Adults in Taipei.

This study explores the association of child sexual abuse (CSA) with subsequent health risk behaviors among a cross-section of 4354 adolescents and young adults surveyed in urban and rural Taipei. Descriptive analysis and logistic regressions were employed. The overall proportion of CSA was 5.15%, with more females (6.14%) than males (4.16%) likely to experience CSA. CSA was differently associated with multiple adverse health outcomes, after adjusting other factors, such as age, residence, economic status, education, employment status, and household instability. Both males and females with CSA experience were more likely to report drinking, gambling, and suicidal ideation compared with those who had no history of CSA. However, the significant association between CSA and smoking, fighting, and suicidal attempt was not observed among females. Effective interventions are needed to reduce CSA and its adverse effects on adolescent well-being.

Working hours and risk of gestational hypertension and pre-eclampsia.

BACKGROUND: The potential impact of employment on maternal health, particularly in relation to gestational hypertension and pre-eclampsia, has been subject to research. However, there is limited evidence on associations between shift work and long working hours on the incidence of these conditions. AIMS: To evaluate potential associations between maternal shift work and long working hours during pregnancy and gestational hypertension or pre-eclampsia. METHODS: Multistage stratified systematic sampling was used to recruit 24 200 post-partum women from the Taiwan national birth registration database in 2005. Subjects underwent home interview 6 months after their deliveries by structured questionnaire to obtain characteristics of maternal employment and potential confounders. Diagnosis of gestational hypertension and pre-eclampsia was obtained from the birth registration. RESULTS: There was no association between employment status and gestational hypertension or pre-eclampsia. Also, no significant association between gestational hypertension or pre-eclampsia and maternal shift work or long working hours during pregnancy was found in all or primiparous women. CONCLUSIONS: There was no convincing evidence that maternal shift work or long working hours had a higher risk of gestational hypertension or pre-eclampsia. However, further research is warranted to confirm these negative findings.

Exposure to and attitudes regarding secondhand smoke among secondary students in Taiwan.

The 2003 School Health Act of Taiwan stipulated that school campuses of senior high and below should be smoke free, but data from the Global Youth Tobacco Survey show that the majority of students are exposed to smoke in public and at home. More than 50% of nonsmokers indicated that they had been exposed to secondhand smoke (SHS) in public places, with the exposure rate as high as 90% among smokers. More than 40% of junior and senior high school students were exposed to SHS at home. Support for banning smoking in public places ranged from almost 60% to almost 80%. More than 60% of current smokers and almost 90% of never smokers think that smoke from others is harmful to them. With a clear body of evidence detailing the harmful effects, reduction and eventual elimination of exposure to SHS should be the goal of the tobacco control community.

Levels of change in adolescent sexual behavior in three Asian cities.

Considerable change in the romantic and sexual behaviors of Asian young people may be occurring as traditionally Confucian societies modernize and increase outside contacts. This study explores the dimensions and context of this change in three sites at different stages in the process of modernization: Hanoi (early), Shanghai (intermediate), and Taipei (later stage). A survey was conducted of 17,016 males and females aged 15-24 in urban and rural settings in three large metropolitan areas. Survival analysis and Cox regressions were performed to explore ages of respondents at key transitions and the significance of differences between two age cohorts: 15-19 and 20-24. Significant differences are found in levels of sexual and other transitions, even within the narrow time span reflected by the age cohorts. The findings highlight the differential impact of modernization on adolescent sexual behavior as traditional societies undergo social change, and they underline the importance of context in exploring youthful transitions.

Prevalence of tobacco use among junior high and senior high school students in Taiwan.

BACKGROUND: Tobacco use is a major preventable cause of death in the world. This article describes and compares tobacco use prevalence for students attending junior high schools and senior high schools in Taiwan. METHODS: This report uses data from the Global Youth Tobacco Survey (GYTS) completed among 4689 junior high school students and 4426 senior high school students in Taiwan in 2004-2005. The GYTS uses a 2-stage sampling design to produce nationally representative data for junior and senior high students in general and vocational schools. RESULTS: Higher smoking prevalence was observed among senior high (10.1% general schools and 15.9% vocational schools) than junior high (5.5%) school students. Smoking prevalence of girls in junior high (3.2%) and senior high schools (4.6% general and 11.1% vocational) was almost as high or higher than adult females' (4.3%) smoking rates. The pattern of smoking intensity across school years and type of school shows that the percentage of smokers who were experimenters (47.1%) was higher in junior high school and the percentage of smokers who were regular/established smokers (over 50%) was higher in senior high school. CONCLUSIONS: Smoking prevalence described in this report shows that there are challenges facing the tobacco prevention and control program in Taiwan. The findings suggest that schools should increase their smoking initiation prevention efforts and make available cessation programs and counseling to help students quit smoking. If effective youth tobacco control programs are not developed and implemented in Taiwan, future morbidity and mortality attributed to tobacco will surely increase, especially among women.

Do chronic stressors lead to physiological dysregulation? Testing the theory of allostatic load.

OBJECTIVES: To explore three questions: 1) Do chronic stressors predict physiological dysregulation? 2) Is that relationship moderated by characteristics of the individual and his or her social environment? and 3) Do perceived levels of stress mediate the relationship between stressors and dysregulation? METHODS: Data come from a nationally representative, longitudinal study of older Taiwanese (n = 916). Regression models are used to examine the relationship between the number of life challenges (i.e., stressors) during 1996 to 2000 and physiological dysregulation (in 2000) based on 16 biomarkers that reflect neuroendocrine function, immune system, cardiovascular function, and metabolic pathways. We include interaction terms to test whether psychosocial vulnerability moderates the impact of stressors. Additional models evaluate the mediating effects of perceived stress. RESULTS: We find a positive association between the number of stressors and physiological dysregulation. The results indicate that this relationship is stronger for persons with greater psychosocial vulnerability, but even so, the magnitude of the effect remains modest. We find some evidence that the level of perceived stress mediates the relationship between chronic stressors and physiological dysregulation. CONCLUSIONS: Our results provide some support for the theory of allostatic load, although the relationship between life challenges and physiological dysregulation is weak. The evidence also supports the stress-buffering hypothesis: the combination of low social position, weak social networks, and poor coping ability is associated with greater physiological consequences of life challenges.

Nighttime sleep, Chinese afternoon nap, and mortality in the elderly.

STUDY OBJECTIVES: Although many epidemiologic studies have shown that both short and long nighttime sleep durations are associated with increased mortality in the general population, limited data have been reported for older persons, especially those taking afternoon nap. Data from a prospective cohort study of the elderly in Taiwan were used to examine the relationship among nighttime sleep, Chinese afternoon nap, and mortality. DESIGN: Prospective cohort study. SETTING: General population. PARTICIPANTS: A nationally representative sample of 3079 Taiwanese community residents aged 64 and over was studied, using reported sleep related information collected in 1993 and subsequent 10-year mortality data. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Cox proportional hazards models, separated by sex, were computed to estimate mortality hazard ratios in relation to nighttime sleep duration and afternoon nap duration, adjusting for potential confounders. Compared to older adults sleeping 7-7.9 hours at night, those with longer sleeping time (> or = 10 hours in males and > or = 8 hours in females) had a significantly higher risk of total mortality. Afternoon nap alone was not associated with total mortality. When nighttime sleep duration and afternoon nap duration were considered together by adding the interaction term in the model or stratifying sleep hours and nap duration, the effect of afternoon nap on mortality risk remained insignificant. CONCLUSIONS: Longer nighttime sleep duration increases mortality risk in older adults. Chinese afternoon nap is not an independent predictor of mortality. There is no significant benefit or harm of practicing afternoon nap in addition to the regular night sleep on elderly mortality.

Education of adult children and mortality of their elderly parents in Taiwan.

In societies in which families are highly integrated, the education of family members may be linked to survival. Such may be the case in Taiwan, where there are large gaps in levels of education across generations and high levels of resource transfers between family members. This study employs 14 years of longitudinal data from Taiwan to examine the combined effects of the education of older adults and their adult children on the mortality outcomes of older adults. We use nested Gompertz hazard models to evaluate the importance of the education of an older adult and his or her highest-educated child after controlling for socioeconomic, demographic, and health characteristics at baseline. To gain further insight, we fit additional models based on the sample stratified by whether older adults report serious diseases at baseline. The results indicate that the educational levels of both older adults and children are associated with older adult mortality, but children's education appears more important when we examine the mortality of only those older adults who already report a serious disease. This finding suggests that there may be different roles for education in the onset versus the progression of a health problem that may lead to death.

Short-term trends in functional limitation and disability among older Asians: a comparison of five Asian settings.

The objective of this paper is to examine short-term trends in the prevalence of limitation in Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Nagi physical functioning tasks among persons age 60 years or older in five Asian settings: Indonesia, the Philippines, Singapore, Taiwan and the Beijing Municipality. The data come from recent panel surveys of older adults that span a period of 3-4 years during the mid to late 1990s. Results suggest a general trend toward an increase in functional limitation in four of the five settings, with the most pronounced increases occurring for the Nagi functioning tasks. Compositional differences in the population accounted for little of the increase. The paper discusses the potential implications of these results and places them in the context of past and current trends in functional limitation observed in the United States.

Areca nut chewing and mortality in an elderly cohort study.

Compared with the well-documented association with betel-related cancer, little is known about the long-term effect of areca nut chewing on other fatal diseases. The authors' analyses were based on a population-based cohort study in Taiwan, including 4,049 participants aged 60 years or older enrolled in 1989 and 2,462 participants aged 50-66 years enrolled in 1996. Information regarding betel quid chewing and covariates was collected at baseline and was updated at subsequent interviews. Proportional hazards analysis was performed to determine the effect of chewing on all-cause and cause-specific deaths. During a mean follow-up of 9.5 years, 2,309 deaths occurred. Ever chewers were at higher risk of only total (hazard ratio = 1.19, 95% confidence interval: 1.05, 1.35) and cerebrovascular (hazard ratio = 1.66, 95% confidence interval: 1.19, 2.30) deaths. Furthermore, increased chewing-years or quid-years appeared to be associated with increased mortality risk (linear trend: p = 0.02 for total mortality and p = 0.001 for cerebrovascular mortality). The authors found that, although betel quid chewing resulted in a statistically significant increase in the risk of total and cerebrovascular deaths in the elderly population, the associations were weak and should be interpreted with caution. Further studies are needed to confirm these findings and to better understand the possible mechanisms of death.

Fertility decline, family structure, and support for older persons in Latin America and Asia.

OBJECTIVE: To compare family structures and support for older persons in two Asian countries (Taiwan and the Philippines) and six urban areas in Latin America (Buenos Aires, São Paulo, Havana, Santiago, Mexico City, and Montevideo). METHODS: Using the 1999 Survey of Health and Living Status of the Elderly in Taiwan, the 2000 Philippine Survey of the Near Elderly and Elderly, and the 2001 Pan American Health Organisation surveys on Salud, Bienestar y Envejecimiento en América Latina y el Caribe, descriptive tables show variations across countries in family structure, proximity, and transfers of support by the timing of the fertility transition in each location. RESULTS: Older people in settings with earlier transitions had fewer children and more childlessness, higher levels of solitary living, and lower levels of co-residence with children. In earlier transition settings, receipt of family support was lower and provision higher. DISCUSSION: The timing of the demographic transition has significant implications for kin availability and support.

Genetic and environmental predictors for pediatric atopic dermatitis.

BACKGROUND: The purpose of this study was to evaluate the influence of genetic and various environmental factors for atopic dermatitis (AD) occurring in the first 18 months of life. METHODS: We used the multistage stratified systematic sampling to recruit 2,048 mother-child pairs from the Taiwan National Birth Registry in 2003. Information on family history of atopy and environmental risk factors for AD of children were gathered by questionnaires at 18 months of age. Multiple logistic regressions were performed to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) for risk factors of the AD after adjusting for potential confounders. RESULTS: AD was noted in 147/1618 (9.08%) of the children. We found maternal history of AD, maternal grandparents' history of AD, higher family income, and higher maternal education level increased the risk of pediatric AD. The adjusted ORs and their 95% CIs were 4.10 (1.27-13.25), 4.56 (1.39-15.00), 1.66 (1.00-2.77), and 1.71 (1.56-6.97), respectively. However, duration of breast feeding did not alter the risk estimates of AD. CONCLUSIONS: AD may be inherited preferentially through the maternal line. Prevention of special environmental exposures is urgently needed for children with maternal history of AD.

One-trial 10-item free-recall performance in Taiwanese elderly and near-elderly: A potential screen for cognitive decline.

To explore a one-trial 10-item free-recall test as a potential dementia screening tool, we analyzed recall scores and individualized serial position effects in near-elderly (N = 2,336) and elderly (N = 2,371) participants in a population-based survey in Taiwan. Age and sex were significantly associated with recall score [younger > older (p < 0.001); men > women (p < 0.001)]; after controlling for gender and age group, weak association between recall and education was still observed. By contrast, serial position effects (SPEs), defined for each participant and analyzed aggregated over each age group, were not associated with education and tended not to be associated with sex. Primacy effects were observed in 67 to 80 percent, and recency effects were observed in 41 to 54 percent of respondents. Because SPEs were defined for each respondent, we could determine that loss of the primacy effect was associated with significantly larger losses in total recall score in elderly persons who had exhibited both SPEs at the first survey, as compared to those who maintained both SPEs at successive surveys (p < 0.01). Elderly subjects showed slight longitudinal decline in free recall. A one-trial 10-item free-recall test demonstrated age-related cognitive decline in this Taiwanese population survey cohort; SPEs at the individual level may be useful markers for important cognitive change and warrant further study and benchmarking against valid and reliable tests of memory and cognitive decline.

Participating in social activities helps preserve cognitive function: an analysis of a longitudinal, population-based study of the elderly.

BACKGROUND: This study examines how changes in cognition over time are related to participation in social activities and the extent of social networks. METHODS: Data are drawn from a population-based, longitudinal study that began in 1989 among elderly Taiwanese. An over-dispersed Poisson model is used to regress the number of failed cognitive tasks (0-5) in 1996, 1999, and 2000 on prior measures of cognitive impairment, social activities, social networks, health status, and sociodemographic characteristics. The analysis sample comprises 2387 individuals, who contribute a total of 4603 observations across three survey intervals (1993-96, 1996-99, 1999-2000). RESULTS: After adjusting for prior cognitive impairment, baseline health status, and sociodemographic factors, respondents who participated in one or two social activities failed 13% fewer cognitive tasks (P < 0.01) than those with no social activities; those who engaged in three or more activities failed 33% fewer cognitive tasks (P < 0.001). In contrast, none of the social network measures was related to cognitive impairment. CONCLUSIONS: Despite a social structure where elderly persons often live with their children and social interaction is likely to be more family-centered than in western countries, data from Taiwan suggest that participation in social activities outside the family may have a bigger impact on cognitive function than social contacts with family or non-relatives.

Benchmarking a test of temporal orientation with data from american and taiwanese persons with Alzheimer's disease and american normal elderly.

Orientation questions are readily incorporated into longitudinal population surveys, but their value as a screening tool for cognitive impairment is uncertain. We evaluated the screening value of four orientation-to-time items (TTO) from the Mini-Mental State Examination (MMSE) by determining their association with full-scale MMSE scores. Data collected under protocols with strict eligibility criteria in the US (64 normal elderly, 242 persons with probable Alzheimer's disease) and Taiwan (241 persons with probable Alzheimer's disease) were analyzed. The TTO and full-scale MMSE scores were significantly correlated (p < 0.05) in persons with a Clinical Dementia Rating (CDR) score of 0 or 1; this was not significant in persons with a CDR of >1 (p > 0.05). Both TTO and MMSE were significantly associated with education in persons with 0-7 years of education; some MMSE items, but none of the TTO items, were associated with education in persons with more than 7 years of education. TTO may be a useful component of cognitive screening efforts.

Assessment of the nutritional risk of >53-year-old men and women in Taiwan.

OBJECTIVE: The study was conducted to gain an understanding of the status of potential nutrition risks in >53-year-old men and women in Taiwan. METHODS: The study employed a validated nutrition-risk screening questionnaire, the Mini Nutritional Assessment, to assess the potential risk of undernutrition in the elderly population in Taiwan. The questionnaire was translated into the local language, Chinese, and was modified slightly based on cultural considerations. It was administered to 4440 randomly selected subjects by means of face-to-face interviews. The questionnaire included questions on subjective self-evaluations, global parameters, simple dietary assessment and some anthropometric measurements. RESULTS: Results show that the questionnaire can be used effectively as a tool to screen for individuals who are at risk of undernutrition. It showed that the proportion of the elderly population at risk of nutritional inadequacy is relatively low, but does increase with advanced ageing. The proportion of the elderly considered at high risk of undernutrition was found to increase with age, ranging from 0.88% for 53-60-year-old subjects to 1.86% for subjects aged 60-70 years, 3.6% for 70-80-year-olds and 5.3% for >80-year-old subjects. CONCLUSION: The study showed that a simple questionnaire adopted from the Mini Nutritional Assessment can be employed to provide a preliminary screening and to identify individuals who are potentially at increased risk of nutritional inadequacy in the elderly population in Taiwan.

Social environment, life challenge, and health among the elderly in Taiwan.

We use an ongoing longitudinal survey of elderly Taiwanese to examine the linkages among health, the social environment, and exposure to life challenge. Data from three waves of the survey provide measures of social hierarchy, social connection, life challenge, and health outcomes. On the basis of multinomial and binomial logistic models, we explore the effects of social factors and challenge on being unhealthy or deceased at follow-up. The estimates indicate that poor health status at follow-up is associated with (1) low socioeconomic status, not having any living children, limited networks of friends, and low participation in social activities; and (2) three life challenges-chronic financial problems, excessive demands placed by close relatives and friends, and having a spouse in poor health. Respondents facing several challenges or having multiple negative attributes in their social environment are especially likely to be unhealthy at follow-up, although negative attributes appear to be counteracted by positive ones. Many findings from Western societies extend to this Taiwanese population. However, some aspects of social connection and challenge hypothesized to affect health fail to reveal a significant association. The analysis identifies differences between men and women in the effects of specific challenges on health, but sex differences in the effects of socioeconomic status and social connection on health are not significant.

Blood-sample processing for the study of age-dependent gene expression in peripheral blood mononuclear cells.

Although most new biogerontological studies seeking to identify longevity candidate genes and factors involved in successful human aging are population based, and likely to involve the collection of blood from extremely old individuals, to our knowledge no unified protocols have yet been published to describe a methodology permitting the simultaneous generation of different kinds of biological specimens derived from a single source of a very small volume of peripheral blood. Here we describe a method permitting the simultaneous generation of plasma, RNA, DNA, protein, fixed lymphocytes, and frozen blood aliquots from a single 10- to 30-ml blood sample obtained from donors of any age (10-102 years old), and we show that the quality and quantity of DNA, RNA, protein, and fixed lymphocytes obtained do not vary significantly with age. As is frequently observed, the older individuals have higher plasma proportions.