Economic Evaluation of PRIMROSE-A Trial-Based Analysis of an Early Childhood Intervention to Prevent Obesity.

BACKGROUND: Childhood obesity is a major clinical and economic health concern. Alongside the clinical understanding of obesity, there is a growing interest in designing and implementing interventions that are worth their money given the scarce resources in the health care sector. This study is one of the first efforts to provide evidence by assessing the effects and costs of a population-based primary prevention intervention targeting pre-school children attending child health centers in Sweden. METHODS: The economic evaluation is based on the PRIMROSE cluster-randomized controlled trial aiming to establish healthy eating and physical activity among pre-school children (9-48 months of age) through motivational interviewing applied by trained nurses at child health centers. The cost-effectiveness is assessed over the trial period from a societal perspective. The primary outcome was BMI at age 4. Cost data was prospectively collected alongside the trial. Scenario analyses were carried out to identify uncertainty. RESULTS: The estimated additional mean total costs of the PRIMROSE intervention were 342 Euro (95% CI: 334; 348) per child. During pre-school years direct costs mainly consist of training costs and costs for the additional time used by nurses to implement the intervention compared to usual care. Early indirect costs mainly consist of parents' absence from work due to their participation in the intervention. The incremental cost-effectiveness ratio in the base case analysis was 3,109 Euro per 1 BMI unit prevented. CONCLUSION: We cannot provide evidence that the PRIMROSE intervention is cost-effective, given the uncertainty in the effect measure. Until further evidence is provided, we recommend resources to be spent elsewhere within the field of obesity prevention. Furthermore, to achieve valid and reliable cost-effectiveness results, the economic evaluation of obesity prevention programs in early childhood should incorporate the life time impact to capture all relevant costs and benefits.

The association of mobility disability and weight status with risk of disability pension: A prospective cohort study.

BACKGROUND/AIMS: Mobility disability (MD) and obesity are conditions which have been associated with weaker labour market attachment. This study investigates whether the combined burden of MD and obesity increase the risk of disability pension compared with having only one of these conditions (the reference group). METHODS: A nationwide cohort study, based on national surveys made between 1996 and 2011, was conducted including 50,015 individuals aged 19-64 years who were followed-up in a large database in terms of attainment of disability pension until 31 December 2012 (at the latest). Proportional hazards regression models were used to analyse the risk of all-cause and diagnosis-specific disability pension with six exposure groups, established by mobility and weight status (BMI) obtained through self-reports. RESULTS: A total of 2296 participants had received disability pension after a mean follow-up period of 7.2 years (SD 4.6). People with MD, regardless of weight, had 4-8 times higher risk of disability pension (for any reason) compared with the reference group (individuals with normal weight and no MD). CONCLUSIONS: No evidence of a double burden of MD and obesity with disability pension was observed in this study. MD seemed to contribute more to the risk of disability pension than weight status. In a long-term perspective, society and also people at risk of these disabling conditions would benefit from reallocation of resources from disability pensions to health-promoting and preventive policies, not least targeting MD.

Is Obesity More Than a Double Burden among People with Mobility Disability? The Effect of Obesity on HRQoL and Participation in Society.

Obesity is more common in individuals with mobility disability than in those without this condition. Individuals with mobility disability also have lower health-related quality of life (HRQoL) and are limited in their participation in society. Therefore, this study aimed to investigate the body mass index (BMI) status and the association of overweight or obesity on HRQoL and participation in society among those with mobility disability in comparison to those without mobility disability. This cross-sectional study was based on a health survey conducted in Sweden in 2012 (n = 18,322; age, 18-64 years). Logistic regression with and without interaction analysis was applied. Effect modification by overweight status was significant for, moderate pain. For obesity, effect modification was seen for low general health, pain (moderate and severe), and not participating in work. BMI was higher among those with mobility disability, but no associations between overweight or obesity and HRQoL or participation in society were observed for those with mobility disability. Overweight and obesity did not add an additional burden to mobility disability, probably because mobility disability is associated with low HRQoL and low participation in society. Despite these results, population obesity prevention strategies are still needed.

No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades: a natural experiment.

BACKGROUND: A strict high legal age limit for alcohol purchases decreases adolescents' access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality. METHODS: A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5%-5.6% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14-20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95% CIs were obtained by Cox regression analysis. RESULTS: In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95% CI 0.96 to 1.02) or mortality (HR: 1.02, 95% CI 0.95 to 1.10) was found. CONCLUSION: The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.

Long-term effects of youth unemployment on mental health: does an economic crisis make a difference?

BACKGROUND: Ill health is a risk factor and a consequence of unemployment, which might vary depending on the national rate of unemployment. We investigated the long-term effect of youth unemployment on mental health and explored the possible interaction during periods of high (economic crisis) and low (non-crisis) unemployment rates. METHODS: A register-linked population-based cohort study was conducted including individuals aged 17-24 years. The crisis cohort (n=6410) took part in the Labour Force Survey during the economic crisis (1991-1994) in Sweden and the non-crisis cohort (n=8162) took part in the same survey before the crisis (1983-1986). Follow-up was 19 years. Adjusted HRs and 95% CIs for an inpatient care discharge mental diagnosis with employed people as the reference group were calculated by Cox regressions models. RESULTS: In fully adjusted models, <3 months (HR: 1.69; 95% CI 1.14 to 2.49), 3-6 months (2.19; 1.43 to 3.37) and >6 months (2.70; 1.71 to 4.28) of unemployment were associated with increased risks of getting a mental diagnosis in the crisis cohort. In the non-crisis cohort the risks were: 1.92; 1.40 to 2.63, 2.60; 1.72 to 3.94 and 3.33; 2.00 to 5.57, respectively. No interactions between labour force status and level of unemployment were found. CONCLUSIONS: Youth unemployment is related to mental health problems, independent of the overall national rate of unemployment, which is important as the youth unemployment rates are currently at stable high level.

Effects of increased alcohol availability during adolescence on the risk of all-cause and cause-specific disability pension: a natural experiment.

AIM: To test if being exposed to increased alcohol availability during adolescence is associated with an increased risk of receiving disability pension due to all-cause, alcohol use disorders and mental disorders. DESIGN: Register-based population-based study using a natural experiment setting, the alcohol policy change in Sweden (1967-68), with increased access to strong beer in a narrow time window and geographical area. The individuals exposed to the policy change were compared with non-exposed individuals living in the rest of Sweden, excluding a border area. SETTING: Sweden. PARTICIPANTS: A total of 518 810 individuals (70 761 in the intervention group; 448 049 in the control group) born 1948-1953, aged 14-20 years during the policy change. MEASUREMENTS: Date and diagnosis of the outcome variable of disability pension due to all-cause, alcohol use disorders and mental disorders were obtained from the Swedish National Social Insurance Agency database from 1971 to 2013. Individual and family level socio-demographic and health-related covariates, as well as a regional level covariate, were included. FINDINGS: Compared with the control group, adolescents exposed to the alcohol policy change were at an increased risk of receiving disability pension due to all-causes [hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.07-1.11], alcohol use disorders (HR = 1.17, 95% CI = 1.05-1.30) and mental disorders (HR = 1.19, 95% CI = 1.15-1.23). CONCLUSION: In Sweden, a natural experiment with a 43-year follow-up suggests that exposure to increased alcohol availability during adolescence is associated with an increased risk of receiving a disability pension due to all-cause, alcohol use disorder and mental disorder diagnoses.

The bidirectional association between body weight and mobility disability: A population-based cohort.

BACKGROUND: Obesity is more common in people with mobility disability than in non-disabled individuals, but less is known about the longitudinal effects leading to this health state. OBJECTIVE: To explore the potential bidirectional association between mobility disability and obesity. METHODS: Participants were identified in the population-based Stockholm Public Health Cohort (2002-2010, n = 17 945). Observations with schizophrenia, depression, eating disorder, or cancer within 5 years during and prior to baseline were excluded. Mobility disability and height and weight to calculate BMI (kg/m(2)) were self-reported. We used multivariate-adjusted regression models to estimate relative risks (RRs) and 95% confidence intervals (CI) based on new cases of mobility disability in cohorts that were obese, overweight or normal weight at baseline, and increases in BMI over time by mobility disability status. RESULTS: Obesity at baseline was associated with incident mobility disability. The highest risk was observed in middle-aged women (RR = 3.95, CI = 2.35-6.65). Young men and middle-aged women with long-term mobility disability increased more in BMI (men: 1.55 kg/m(2), 0.61-2.49; women: 0.38, 0.01-0.75), as well as young and middle-aged people with incident mobility disability (young men: 0.68 kg/m(2), 0.10-1.27; middle-aged men: 0.49, 0.20-0.77; young women: 1.41, 0.94-1.87; middle-aged women: 0.64, 0.36-0.93) compared to the groups without any mobility disability. CONCLUSIONS: In this paper, we demonstrated the bidirectional and longitudinal associations between body weight and mobility disability and thus the increased risk of developing the combination over time from either condition. Effective health-promotion and prevention strategies are needed to prevent worse health for these vulnerable groups in society.

Stability in the prevalence of Swedish children who were overweight or obese in 2003 and 2011.

AIM: We aimed to explore the prevalence and determinants of overweight including obesity among children in Sweden in 2003 and 2011. METHODS: Two population-based cross-sectional surveys included 7728 and 12 882 12-year-old children in Sweden, and 1198 and 2699 eight-year-old children in Stockholm County, in 2003 and 2011. Weighted prevalence of overweight including obesity and multivariate-adjusted relative risks (RRs) with 95% confidence intervals (CIs) was calculated. RESULTS: In 2011, the overweight prevalence was lower for 12-year-old girls than boys (RR=0.84, CI=0.77-0.92), lower for girls and boys with a higher rather than a lower educated mother (for example, RRgirls =0.76, CI=0.65-0.88), but higher for girls and boys in smaller rather than main cities (RRgirls =1.52, CI=1.28-1.82). There was no difference in overweight prevalence between 2003 and 2011 among the 12-year-old children. However, eight-year-old girls had a lower overweight prevalence in 2011 than in 2003 (RR=0.76, CI=0.59-0.97). The strongest decrease in overweight was among eight-year-old girls with mothers with lower levels of education (RR=0.63, CI=0.47-0.86). CONCLUSION: The prevalence of overweight including obesity was stable among Swedish children between 2003 and 2011. Gradients in the determinants of overweight persisted. There was some evidence of a less steep socio-economic gradient in overweight in eight-year-old girls over time.

The association of mobility disability, weight status and job strain: A cross-sectional study.

AIMS: The study investigated whether people with mobility disability (MD) and/or obesity had higher job strain than people without it, and whether social support at work modifies this association. METHODS: The study included 35,160 individuals (25-64 years of age) from the Stockholm Public Health Surveys of 2006 and 2010. Data on MD and obesity (BMI ⩾ 30 kg/m(2)calculated from weight (kg) and height (m)) were self-reported. According to the Demand-Control-Support theory job strain, collective strain, and isolated strain were calculated for six groups of people based on the presence of MD and obesity, using the subtraction approach (demand minus control). Differences in job strain mean scores were estimated by multivariate linear regression. Social support at work was analyzed as a potential effect modifier (high/low). RESULTS: Obese people with MD had the highest job strain (ß = 0.92, 95% CI 0.64-1.19), compared to normal weight people without MD (reference group). We found that social support at work significantly (p<0.001) modifies the association between job strain, MD and obesity. Obese people with MD had the highest isolated strain (ß = 2.92, 95% CI 2.52-3.31), and the highest collective strain, although of smaller magnitude (ß = 0.34, 95% CI 0.05-0.63), compared to the reference group. CONCLUSIONS: Obese people with MD perceive higher job strain than non-disabled people of normal weight. Strategies aiming to increase the social support at work may be important for this group of people to prevent them from experiencing unhealthy job strain.

Longitudinal analysis of lifestyle habits in relation to body mass index, onset of overweight and obesity: results from a large population-based cohort in Sweden.

AIMS: It is currently unknown whether the prevalence of obesity is increasing or has levelled off in Sweden and other Westernised countries. Given the major importance of lifestyle habits on weight status, we aimed to explore associations of longitudinal changes in lifestyle habits with changes in body mass index (BMI), and the onset of overweight and obesity. METHODS: Participants (aged 18-84 years at baseline) were included from the Stockholm Public Health Cohort 2002-2010 (n=23,108). Weight status was from self-reported height and weight. Investigated lifestyle habits were leisure-time physical activity, and fruit, alcohol and smoking habits. We estimated associations of stable, improving or worsening lifestyle habits with longitudinal changes in BMI and onset of overweight or obesity between 2002 and 2010. RESULTS: Both men and women increased in weight during the eight years of follow-up. Incidence of obesity was lower in men who increased their leisure-time physical activity (Relative Risk [RR]=0.58, 95% confidence interval 0.42-0.81) than in inactive individuals; the same applied to women (RR=0.37, 0.25-0.54), and similar patterns were identified for overweight and BMI in both genders. Smoking cessation was associated with onset of obesity for men (RR=1.69, 1.15-2.50) and women (RR=1.99, 1.39-2.85). Stable low alcohol intake or decreasing alcohol intake and daily fruit intake was associated with less weight gain, but only in men. CONCLUSIONS: Improving physical activity in both men and women, and alcohol habits and fruit intake in men, prevents excess weight gain among adult people in Sweden. Such an improvement might diminish weight gain after smoking cessation.

The impact on social capital of mobility disability and weight status: the Stockholm Public Health Cohort.

BACKGROUND: People with mobility disability are more often overweight or obese and have lower social capital than people without mobility disability. It is unclear whether having a combination of mobility disability and overweight or obesity furthers negative development of social capital over time. OBJECTIVE: To explore whether there were differences in social capital between normal-weight, overweight and obese people with or without mobility disability over a period of 8 years. METHODS: We included 14,481 individuals (18-64 at baseline) from the Stockholm Public Health Cohort that started in 2002. Mobility disability, weight status, and social capital (structural: social activities, voting; cognitive: trust in authorities, and trust in people) were identified from self-reports. Risk ratios with 95% confidence intervals were estimated in multivariate longitudinal regression analyses. RESULTS: We found no significant differences in social activities and voting between the groups over time. However, when compared with the reference group, the groups with mobility disability had less trust in authorities and public institutions over time. Notably, obese people with mobility disability showed the largest decrease in trust in the police (RR = 2.29; 1.50-3.50), the parliament (RR = 2.00; 1.31-3.05), and local politicians (RR = 2.52; 1.61-3.94). CONCLUSIONS: People with mobility disability experience lower cognitive social capital over time than people without mobility disability. Being burdened by both mobility disability and obesity may be worse in terms of social capital than having just one of the conditions, especially regarding cognitive social capital. This finding is of public health importance, since social capital is related to health.

The association between physical environment and cycling to school among Turkish and Moroccan adolescents in Amsterdam.

OBJECTIVES: This study examined the effect of physical environment on cycling to and from school among boys and girls of Turkish and Moroccan origin living in Amsterdam. METHODS: The LASER study (n = 697) was an interview study that included information on cycling to and from school and the perceived physical environment. Objective information on physical environment was gathered from Statistics Netherlands and the Department for Research and Statistics at the Municipality of Amsterdam. Structural equation modelling with latent variables was applied, taking into account age, gender, self-assessed health, education, country of origin, and distance to school. RESULTS: For every unit increase in the latent variable scale for bicycle-friendly infrastructure, we observed a 21% increase in the odds for cycling to and from school. The association was only borderline statistically significant and disappeared after controlling for distance to school. The enjoyable environment was not associated with cycling to and from school after controlling for all background factors. CONCLUSIONS: Bicycle-friendly infrastructure and an enjoyable environment were not important factors for cycling to and from school among those with no cultural cycling background.

Impacts of mobility disability and high and increasing body mass index on health-related quality of life and participation in society: a population-based cohort study from Sweden.

BACKGROUND: Increasing obesity in adults with mobility disability has become a considerable health problem, similar to the increasing trend of obesity in the general population. The aims of this study were to investigate the association of mobility disability with overweight status and obesity in a large population-based Swedish cohort of adults, and to investigate whether mobility disability, high body mass index (BMI), and increasing BMI over time are predictors of health-related quality of life and participation in society after 8 years of follow-up. METHODS: The study cohort included 13,549 individuals aged 18-64 years who answered questions about mobility disability, weight, height, health-related quality of life and participation in society in the Stockholm Public Health Survey 2002 and 2010. The cohort was randomly selected from the population of Stockholm County, and divided into six subgroups based on data for mobility disability and overweight status. Multiple binary logistic regression analyses were performed to assess the likelihood for low health-related quality of life and lack of participation. RESULTS: Respondents with mobility disability had a higher mean BMI than those without mobility disability. Respondents both with and without mobility disability increased in BMI, but with no significant difference in the longitudinal changes (mean difference: 0.078; 95% CI: -0.16 - 0.32). Presence of mobility disability increased the risk of low health-related quality of life and lack of participation in 2010, irrespective of low health-related quality of life and lack of participation in 2002. The risk of pain and low general health (parts of health-related quality of life) increased for every 5 units of higher BMI reported in 2010. In respondents without low general health at baseline, the risk of obtaining low general health increased for every 5 units of higher BMI in 2010 (OR:1.60; CI: 1.47 - 1.74). CONCLUSIONS: The greatest risk of low general health after 8 years was observed for respondents with both mobility disability and high BMI. These results indicate the importance of working preventively with persons with mobility disability and overweight status or obesity based on the risk of further weight gain.

Association of physical activity, smoking, and alcohol intake with CVD-related hospital discharge in people of European, South Asian, or African descent.

BACKGROUND: It is unclear whether the beneficial effects of certain lifestyle factors are equally strong in ethnic minority populations in Europe. This study explores whether this association of physical activity, smoking, and alcohol intake with cardiovascular disease (CVD)-related hospital discharge differs among South Asian Surinamese, African Surinamese, or Dutch descent living in the Netherlands. DESIGN: Prospective cohort. METHODS: We obtained baseline data from 370 South Asian, 689 African, and 567 Dutch participants (aged 35-60 years) of the SUNSET study (2001-2003). Follow up ended in December 2007. We used Cox proportional hazards models to study the associations of lifestyle factors with CVD-related hospital discharge. RESULTS: In the overall study population, low amount of physical activity (hazard ratio, HR 1.88, 95% CI 1.23-2.86), current smoking (HR 1.63, 95% CI 1.20-2.22), and nondrinking (HR 1.52, 95% CI 1.04-2.23) were associated with CVD-related hospital admission. There was no statistically significant effect of ethnicity on these associations. For instance, the adjusted HR for CVD-related hospital discharge regarding a low amount of physical activity was 2.77 (95% CI 1.31-5.87) for Africans, 1.53 (95% CI 0.76-3.05) for South Asians, and 1.55 (95% CI 0.73-3.30) for the Dutch. The p-value for ethnicity by lifestyle interaction was 0.41. CONCLUSION: We did not find a different association across ethnic groups of South Asian Surinamese, African Surinamese, or Dutch descent between physical activity, smoking, and alcohol intake and 5-year hazard of a CVD-related hospital discharge. We recommend confirmation in multiethnic studies in other contexts.

Cross national study of leisure-time physical activity in Dutch and English populations with ethnic group comparisons.

BACKGROUND: Variations between countries in leisure-time physical activity (LTPA) can be used to test the convergence thesis, which expects that ethnic minority groups change towards the LTPA levels of the native population of host countries. The aim of this study was to test whether similar differences in LTPA between the native populations of England and the Netherlands are also observed among the Indian and African descent groups living in these countries. METHODS: We used English and Dutch population-based health surveys that included participants aged 35-60 years of European (n(english) = 14,723, n(dutch) = 567), Indian (n(english) = 1264, n(dutch) = 370) and African-Caribbean (n(english) = 1112, n(dutch) = 689) descent. Levels of LTPA (30-minute walking, any reported cycling, gardening, dancing and playing sports) were estimated with age-sex-standardized prevalence rates. Comparisons among groups were made using adjusted Prevalence Ratios (PRs). RESULTS: Within both countries and compared with the European group, Indian and African groups had lower levels of gardening and cycling, whereas the African groups had higher levels of dancing. Between countries, among the European groups, the Netherlands showed higher prevalence of cycling than England, PR = 2.26 (95% CI: 2.06-2.48), and this was 2.85 (1.94-4.19) among Indian descent, and 2.77 (2.05-3.73) among African descent. For playing sports, this was PR = 1.30 (1.23-1.38), 1.43 (1.24-1.66) and 1.22 (1.10-1.34), whereas for gardening this was PR = 0.71 (0.65-0.78), 0.65 (0.52-0.81) and 0.75 (0.62-0.90), respectively. Walking and dancing showed inconsistent differences between the countries and ethnic groups. CONCLUSION: This cross-national comparison supports the expectation that LTPA of Indian and African descent groups converge towards the national levels of England and the Netherlands respectively.

The association of leisure-time physical activity and active commuting with measures of socioeconomic position in a multiethnic population living in the Netherlands: results from the cross-sectional SUNSET study.

BACKGROUND: In most European origin populations measures of socioeconomic position are positively associated with leisure time physical activity (LTPA), this is unclear for active commuting. In addition, these associations have scarcely been studied in ethnic minority groups, who often have a high cardiovascular disease risk. Because of the expected public health potential, we assessed the relationship of active commuting and LTPA with measures of socioeconomic position across two large ethnic minority groups in the Netherlands as compared to the European-Dutch population. METHODS: We included South Asian-Surinamese (n = 370), African-Surinamese (n = 689), and European-Dutch (n = 567) from the cross-sectional population-based SUNSET study (2001-2003). Active commuting and LTPA were assessed by the SQUASH physical activity questionnaire and calculated in square-root-transformed metabolic equivalents of task-hours/week (SQRTMET). Socioeconomic position was indicated by level of education (low/high) and occupational class (low/high). We used age-adjusted linear regression models to assess the association between physical activity and socioeconomic position. RESULTS: Compared to the European-Dutch men, South Asian-Surinamese men engaged in lower levels of commuting activity and LTPA, and South Asian-Surinamese women engaged in lower levels of LTPA than their European-Dutch counterparts. Differences between the African Surinamese and the European-Dutch were small. We observed a positive gradient in active commuting activity for education in European-Dutch men (beta high education was 0.93, 95%CI: 0.45-1.40 SQRTMET higher versus low education), in South Asian-Surinamese men (beta: 0.56, 0.19-0.92), but not in African-Surinamese men (-0.06, -0.45-0.33, p for ethnicity-interaction = 0.002). In women we observed a positive gradient in active commuting activity and occupational class in European-Dutch women, and less strongly in South Asian-Surinamese and African-Surinamese women (p for ethnicity-interaction = 0.02). For LTPA and socioeconomic position, we observed no statistically significant interaction by ethnicity. CONCLUSIONS: The positive gradient for socioeconomic position observed in European-Dutch was less strong, in particular for active commuting, among the South Asian-Surinamese and the African-Surinamese. This indicates that the typical focus on physical activity interventions in lower socioeconomic groups could work for European-Dutch populations, but this strategy may not be entirely applicable in the ethnic minority groups.

Total physical activity might not be a good measure in the relationship with HDL cholesterol and triglycerides in a multi-ethnic population: a cross-sectional study.

BACKGROUND: Evidence suggests that physical activity (PA) has a beneficial effect on high-density lipoprotein cholesterol (HDL) and triglycerides. However, observational studies show contrasting results for this association between different ethnic groups. It is unclear whether this is due to differences in the PA composition. The aim of this study was to assess the relationship of the total PA, along with its intensity and duration, with HDL and triglycerides in a multi-ethnic population. METHODS: The study population was sampled from the SUNSET study and included: 502 European- Dutch, 338 Hindustani-Surinamese, and 596 African-Surinamese participants living in Amsterdam, the Netherlands. We assessed PA with the SQUASH questionnaire. We calculated age-sex-adjusted betas, geometric mean ratios (GMRs), and prevalence ratios (PRs) to assess the relationship of PA with HDL and triglycerides. RESULTS: In the adjusted models, the highest total PA tertile compared to the lowest tertile was beneficially associated with HDL (beta: 0.08, 95% CI: 0.00, 0.16 and PR low HDL 0.59, 95% CI: 0.39, 0.88) and triglycerides (GMR: 0.93, 95% CI: 0.83, 1.03 and PR: 0.56, 95% CI: 0.29, 1.08) for the African-Surinamese. No statistically significant associations appeared for total PA among the European-Dutch and Hindustani-Surinamese. The adjusted models with the intensity score and HDL showed beneficial associations for the European-Dutch (beta: 0.06, 95% CI: 0.03, 0.10) and African-Surinamese (beta: 0.06, 0.02, 0.10), for log triglycerides for the European-Dutch (beta: -0.08, 95% CI: -0.12, 0.03), Hindustani-Surinamese (beta: -0.06, 95% CI: -0.16, 0.03), and African-Surinamese (beta: -0.04, 95% CI: -0.10, 0.01). Excepting HDL in African-Surinamese, the duration score was unrelated to HDL and triglycerides in any group. CONCLUSIONS: Activity intensity related beneficially to blood lipids in almost every ethnic group. The activity duration was unrelated to blood lipids, while the total PA 'summary score' was associated only with blood lipids for African-Surinamese. The difference in total PA composition is the most probable explanation for ethnic differences in the total PA association with blood lipids. Multi-ethnic observational studies should include not only a measure of the total PA, but other measures of PA as well, particularly the intensity of activity.

Blood pressure and BMI in adolescents in Aracaju, Brazil.

OBJECTIVE: To assess the prevalence of high blood pressure (BP) and the association of overweight and obesity with high BP among adolescents in Aracaju, Brazil. DESIGN: Cross-sectional study. The main outcome measure was the proportion of adolescents with high BP (sex-, age- and height-specific ≥ 95th percentile). The main predictor variables were overweight and obesity defined according to the criteria of the International Obesity Task Force. Other covariates included age, socio-economic status and leisure-time physical activity. SETTING: Aracaju, Brazil, capital city of Sergipe State, north-eastern Brazil. SUBJECTS: A random sample of 1002 adolescents (442 boys and 560 girls) aged 12-17 years selected from twenty public schools and ten private schools were studied. RESULTS: The prevalence of high BP was 16.9 % (95 % CI 13.1, 21.7) in boys and 12.9 % (95 % CI 9.0, 18.0) in girls. After adjusting for age, socio-economic status and leisure-time physical activity in both boys and girls, overweight (prevalence ratio (PR) = 1.93, 95 % CI 1.08, 3.48; PR = 4.34, 95 % CI 2.58, 7.30, respectively) and obesity (PR = 4.87, 95 % CI 2.35, 10.11; PR = 5.18, 95 % CI 2.67, 10.06, respectively) were found to be associated with high BP. CONCLUSIONS: These findings indicate a high prevalence of high BP in both boys and girls in Aracaju, Brazil. Overweight and obesity were strongly associated with high BP. These findings underscore the urgent need for public health measures to prevent increasing high BP in adolescents in Brazil. Targeting intervention in adolescence may be a critical method for preventing high BP in later life.

Large ethnic variations in recommended physical activity according to activity domains in amsterdam, the netherlands.

PURPOSE: The level of recommended physical activity (PA) is met less frequently by people from some ethnic minorities than others. We explored whether these differences in recommended PA between ethnic minority groups and the general population varied by domain and type of culturally-specific activity. METHODS: Participants were sampled from the population based SUNSET study and were from ethnic Dutch (n = 567), Hindustani-Surinamese (n = 370) and African-Surinamese (n = 689) descent. The validated SQUASH-questionnaire measured PA for the following domains: commuting, occupation, household, leisure time. Culturally-specific activities were added as extra question within the leisure time domain. The effect of each domain on ethnic differences in recommended PA prevalence was examined by odds-ratio (OR) analysis through recalculating recommended PA, while, in turn, excluding the contribution of each domain. RESULTS: In the ethnic Dutch population, more vigorous PA in commuting and leisure time was reported compared to the Surinamese groups. The Hindustani-Surinamese and African-Surinamese reported more walking as commuting activity, while the Dutch group reported cycling more frequently. Ethnic differences in recommended PA became smaller in both Surinamese groups compared with the Dutch after removing commuting activity, for example, in Hindustani-Surinamese men (OR = 0.92, 95%CI: 0.62-1.37 vs. OR = 1.33, 0.89-2.00) and women (OR = 1.61, 1.12-2.32 vs. OR = 2.03, 1.41-2.92). Removing occupational activity resulted in larger ethnic differences in both groups compared with the Dutch. Smaller effects were found for yoga and dancing, leisure time and household activities. CONCLUSION: This study shows that differences in PA between ethnic minority groups and the general population vary according to the activity domain. The results indicate that including all relevant domains and activities is essential for assessment of ethnic differences in recommended PA.

Relationship between asthma and high blood pressure among adolescents in Aracaju, Brazil.

BACKGROUND: Asthma has been linked to cardiovascular diseases (CVDs) and related risk factors such as hypertension in adults. It is unclear whether the relationship between asthma and hypertension found among adults is also observed in adolescents. Hence, the authors examined asthma and its association with prehypertension and hypertension among adolescents in Aracaju, Brazil. METHODS: Data on asthma and blood pressure were collected among 1002 adolescents age 12 to 17 years old in 15 public schools, 5 municipal schools, and 10 private schools. Asthma data were ascertained by the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire. Sex-, age-, and height-specific percentile levels were used to define prehypertension (90-94th percentile) and hypertension (>or=95th percentile). RESULTS: The prevalence of asthma was 20.6% in boys and 27.7% in girls. Among boys, the prevalence rates of prehypertension and hypertension were 26.7% and 17.0%, respectively. Among girls, the rates of prehypertension and hypertension were 14.3% and 12.9%, respectively. There were no statistically significant associations between asthma and prehypertension, and hypertension, even after adjusting for age, social economic status, physical activity, and body mass index (BMI) in both boys (prehypertension: odds ratio [OR] = 1.35, 95% confidence interval [CI]: 0.80-2.27; hypertension: OR = 0.60, 95% CI: 0.29-1.23) and girls (prehypertension: OR = 0.71, 95% CI: 0.40-1.28; hypertension: OR = 1.07, 95% CI: 0.60-1.94). CONCLUSIONS: These results suggest no association between asthma and high blood pressure in adolescents. More prospective studies are needed to establish whether hypertension becomes more pronounced at a specific age in asthmatics, and if so, the possible factors that may contribute to this.