Childhood urbanicity and hair steroid hormone levels in ten-year-old children.

BACKGROUND: Research suggests that it may be more stressful for children to grow up in an urban area than in a rural area. Urbanicity may affect physiological stress system functioning as well as the timing of sexual maturation. The purpose of the current study was to investigate whether moderate urbanicity (current and childhood, ranging from rural areas to small cities) was associated with indices of long-term hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axis functioning (cortisol, cortisone, dehydroepiandrosterone and progesterone levels) and whether sex moderated any associations. METHOD: Children (N = 92) were all 10 years old and from the Dutch general population. Hair samples were collected and single segments (the three cm most proximal to the scalp) were assayed for concentrations of steroid hormones (LCMS/MS method). Neighborhood-level urbanicity and socioeconomic status were measured from birth through age ten years. Analyses were controlled for neighborhood- and family socioeconomic status, body mass index and season of sampling. RESULTS: The results from multivariate analyses of variance showed no associations between current or childhood moderate urbanicity and hair steroid hormone concentrations. Interaction terms between moderate urbanicity and sex were not statistically significant. CONCLUSIONS: Associations between urbanicity and steroid hormone levels may only be detectable in highly urban areas and/or during later stages of adolescence. Alternatively, our findings may have been due to most children being from families with a higher socioeconomic status.

A comparison of Rasch item-fit and Cronbach's alpha item reduction analysis for the development of a Quality of Life scale for children and adolescents.

OBJECTIVE: This study compares item reduction analysis based on classical test theory (maximizing Cronbach's alpha - approach A), with analysis based on the Rasch Partial Credit Model item-fit (approach B), as applied to children and adolescents' health-related quality of life (HRQoL) items. The reliability and structural, cross-cultural and known-group validity of the measures were examined. METHODS: Within the European KIDSCREEN project, 3019 children and adolescents (8-18 years) from seven European countries answered 19 HRQoL items of the Physical Well-being dimension of a preliminary KIDSCREEN instrument. The Cronbach's alpha and corrected item total correlation (approach A) were compared with infit mean squares and the Q-index item-fit derived according to a partial credit model (approach B). Cross-cultural differential item functioning (DIF ordinal logistic regression approach), structural validity (confirmatory factor analysis and residual correlation) and relative validity (RV) for socio-demographic and health-related factors were calculated for approaches (A) and (B). RESULTS: Approach (A) led to the retention of 13 items, compared with 11 items with approach (B). The item overlap was 69% for (A) and 78% for (B). The correlation coefficient of the summated ratings was 0.93. The Cronbach's alpha was similar for both versions [0.86 (A); 0.85 (B)]. Both approaches selected some items that are not strictly unidimensional and items displaying DIF. RV ratios favoured (A) with regard to socio-demographic aspects. Approach (B) was superior in RV with regard to health-related aspects. CONCLUSION: Both types of item reduction analysis should be accompanied by additional analyses. Neither of the two approaches was universally superior with regard to cultural, structural and known-group validity. However, the results support the usability of the Rasch method for developing new HRQoL measures for children and adolescents.

Does a minimum-age law for purchasing tobacco make any difference? Swedish experiences over eight years.

BACKGROUND: The purpose was to study possible changes in adolescents' opportunities for purchasing tobacco during the period 1996-2005. The study also investigated regional differences in adolescents' opportunities for purchasing tobacco, and elucidated the efforts by the authorities to affect the compliance with the minimum-age law of 18. METHODS: In 1996, 1999, 2002, and 2005, 3150 test purchases of tobacco were conducted in controlled forms by 48 adolescents in three regions of Sweden. In addition, in 2005, 28 structured telephone interviews were conducted with key people in tobacco prevention work. RESULTS: In 1996, 84% of all test purchases in shops with a voluntary age-limit ended with the test purchasers succeeding in purchasing tobacco. This may be compared with 48% in 2005, 8 years after the age-limit law was introduced. The result of the test purchases and of the interviews showed differences between the three regions in compliance and in activities connected with the minimum-age tobacco law. CONCLUSIONS: The study shows that the minimum-age law for the purchase of tobacco has had an effect on adolescents' opportunities for purchasing tobacco and that compliance has improved since its introduction in 1997. The result also indicates avenues for further improving compliance with the age-limit law.

Evaluating composite health measures using Rasch modelling: an illustrative example.

OBJECTIVES: The purpose of the present article is to elucidate the opportunities provided by Rasch modelling in epidemiology and public health research in order to evaluate composite measures of health. METHODS: The article gives a review of Rasch modelling in conjunction with illustrative examples based on adolescent survey data. RESULTS: The article demonstrates how the Rasch-model enables examinations of the way items work across different samples/subgroups, e.g., detection of possible differential item functioning. CONCLUSIONS: It is concluded that Rasch modelling may serve as a useful tool in the evaluation and the development of composite health measures intended to be used in epidemiology and public health research.

Economic stress and perceived health among adolescents in Sweden.

PURPOSE: To describe the link between economic stress and perceived health among Swedish adolescents. METHODS: The study is based mainly on data collected during 1995 from over 2400 adolescents in ninth grade. Data were collected by a self-administered questionnaire. The relationship between economic stress and perceived health was analyzed using descriptive statistics as well as multinomial logit. RESULTS: Worry about family finances is strongly linked to the adolescents' perceived health, though their own relative economic deprivation also plays a significant part. The occurrence of perceived poor health is much greater among those who are frequently or constantly worried about their family's finances than among those who seldom or never experience such worry. The relationship between economic stress and perceived health is also stronger than the relationships between other types of stress and perceived health. In addition, those adolescents who, during the last month, have often been unable to afford various recreational activities, exhibit a greater degree of perceived poor health than others. CONCLUSIONS: Economic stress among young people in Sweden is emerging as an important determinant of perceived health. In view of the deterioration of the Swedish welfare system, great attention should be paid to the question of economic stress among young people, in terms of both research and public health.

Community types, socio-economic structure and IHD mortality--a contextual analysis based on Swedish aggregate data.

The importance of social and economic conditions for people's health has been receiving more and more attention during the past 10 years. The question that is raised in this study is if the link between socio-economic factors in society, seen in the more composite sense, and cardiovascular mortality are dependent on different socio-geographical contexts? Two contextual situations are used; one concerns the dimension which places the analysis in an urban-rural context and the other, the dimension placing it in a context which describes people's forms of work. The study is based on aggregated data on the social and economic conditions for men in the municipalities in Sweden for the period 1983-1987. The results show that the link between various dimensions of the socio-economic structure and IHD rates is more pronounced in the urban and white-collar community types than in rural and blue-collar communities. In the community type where the links are more pronounced the IHD rate is lower and in the type where the links are less pronounced the IHD rate is higher. The results are discussed in relation to different theoretical perspectives.