bluuebunny/crossref_metadata_2025 huggingface dataset:
OP01 Did Health Inequality Increase in English Children and Young People between 1999 and 2009? Evidence from two Cross-Sectional Surveys and Inpatient Activity Data
Authors: Hargreaves DS , Djafari-Marbini A
Published: September 2012

Background

From 1999, the English government pursued a systematic strategy to reduce health inequalities. For interventions affecting children and young people, intermediate indicators may be more useful for evaluating short/medium term impact than the mortality targets chosen. This article investigates trends in inequalities for self/parent-reported health and use of health services by children and young people between 1999 and 2009.

Methods

Through the UK Data Archive (http://www.data-archive.ac.uk/), data were accessed for the Health Survey for England 1999 (SN4365) (N=2638(0–12 years), 874(13–16), 1148(17–24), 5573(25+)) and the Health Survey for England 2009 (SN6732) (N=3022(0–12), 969(13–16), 451(17–24), 4160(25+)). Self-reported health and General Health Questionnaire data (participants aged 13+) and parent/carer report of health (participants aged 0–12) were used, with appropriate binary outcomes created. Using logistic regression in SPSS (v19), adjusted odds ratios (AORs) of poor health were calculated between the highest and lowest socio-economic tertiles, defined by occupation of household members. Analyses were stratified by age, adjusted for sex and weighted to be nationally representative. Hospital Episode Statistics on Finished Consultant Episodes were analysed by Index of Multiple Deprivation decile, derived from the patient’s postcode. Concentration indices of inpatient activity were calculated for those aged 0–12 and 13–19 in 1999/2000 (N=1843862) and 2009/2010 (N=1774139).

Results

Compared to those in the highest occupations, parents/carers in the lowest tertile were more likely to report poor health in their children. The difference increased significantly from 1999 (AOR 1.7, 95% CI 1.2–2.4) to 2009 (AOR 4.1, 95% CI 2.5 to 6.7). Among adolescents, there was a non-significant increase in poor self-reported health over this time (AOR 2.3(1.2–4.3) vs. 3.2(1.6–6.4)). For young adults, there was a persistently weaker association between low socio-economic status and poor health (AOR 1.3(0.8–2.2) and 1.3(0.7–2.4)) than for older adults (AOR 3.1(2.6–3.6) and 3.2(2.6–3.9)). AORs for high General Health Questionnaire scores by age group showed a similar pattern.

The concentration index for inpatient activity in adolescents (13–19) decreased from –0.102 in 1999 to –0.082 in 2009 (Males) and –0.247 to –0.189 (Females). The changes in the concentration index for 0-12s were much smaller (Male –0.136 vs. –0.139; Female –0.136 vs. –0.142).

Conclusion

Despite the policy importance given to tackling health inequalities, this decade saw inequality in parents’ reports of their children’s health widen significantly. Adolescent findings were mixed, with a non-significant increase in inequality for self-reported health but a reduction in inequality related to inpatient activity.
OP02 Socioeconomic Patterning of fat and lean mass in Later Life: Findings from a British Birth Cohort Study
Authors: Bann D , Cooper R , Wills A , Adams J , Kuh D
Published: September 2012

Background

Fat and lean mass have important implications for health and physical functioning. Studies have reported associations between low socioeconomic position (SEP) and high body mass index (BMI) in adulthood, but few have examined associations with fat and lean mass which BMI does not completely distinguish. We examined the associations between multiple indicators of SEP across life and objective measures of fat and lean mass in later adulthood.

Methods

Data were from 1350 men and women in England, Scotland and Wales participating in the MRC National Survey of Health and Development who underwent dual-energy X-ray absorptiometry scans at age 60–64 years and had valid data for all indicators of SEP were included in analyses. Whole body fat and appendicular lean mass were ascertained and, to account for differences in height across SEP groups, height-adjusted indices were created. Associations of prospectively ascertained childhood SEP (paternal occupational class at 4 years), educational attainment (at 26 years) and adult SEP (household income at 60–64 years) with these outcomes were examined using the slope index of inequality (SII). Since high fat mass may increase muscle loading and lead to higher lean mass, associations with lean mass were adjusted for fat mass.

Results

Low SEP was consistently associated with high fat mass index: childhood SEP (mean difference in fat mass index comparing the lowest with the highest SEP (SII) in males: 0.92kg/m1.2, 95% CI –0.04 to 1.89; females: 2.49, 1.17 to 3.82), education (males: 1.61, 0.69 to 2.53; females: 2.20, 0.88 to 3.53), and adult SEP (males: 1.42, 0.47 to 2.38; females: 2.20, 0.88 to 3.53). In males, after adjustment for fat mass childhood SEP (0.16kg/m2, –0.07 to 0.38) and education (0.09, –0.13 to 0.30) were not associated with lean mass index, however, low adult SEP was associated with low lean mass index (–0.21, –0.44 to 0.01). Low SEP was consistently associated with low lean mass index in females after adjustment for fat mass: childhood SEP (–0.24, –0.42 to –0.07), education (–0.36, –0.55 to –0.17) and adult SEP (–0.20, –0.38, –0.03).

Conclusion

Low SEP across life was associated with high fat mass in early old age. In contrast, low SEP in adulthood in males and across life in females was associated with low lean mass (after adjustment for fat mass). Although further research is required to better understand the pathways underlying these associations, the socioeconomic patterning of these measures is likely to have important public health implications.
OP04 The English North-South Divide: Risk Factors for Cardiovascular Disease Accounting for Cross-Sectional Socioeconomic-Position
Authors: Kumar R , Dalton ARH
Published: September 2012

Background

Geographic inequalities in health are widely discussed, with an English North-South divide a popular notion. Data indicate the North-South divide in all cause mortality has persisted, even widening in recent years. Given the impact of cardiovascular disease (CVD) mortality on health inequalities, we aimed to assess the extent of a salient North-South divide in risk factors for CVD, controlling for markers of socioeconomic-position (SEP).

Methods

We conducted a cross-sectional analysis using the 2006 Health Survey for England using respondents aged 16 years and over. We assessed the population means of systolic blood pressure, total cholesterol, body mass index (BMI) and smoking prevalence. We built nested regression models (all linear regression except for logistic for smoking) adding; demographic (age /sex /ethnicity), SEP indicators (individual income, education attainment, housing tenure, car ownership, occupational classification and area level IMD), behavioural risk factors and vascular disease status. We tested variables for multi-collinearity, assumptions of normality for linear outcomes and use valid survey weights. We finally examine interactions between the North-South divide and age and sex on the risk factors.

Results

The North of England showed more deprived characteristics across markers of SEP; except for greater home-ownership. Controlling for demographic variables, we found a significant North-South difference (excess in North) in systolic blood pressure (1.94 [se=0.38]), BMI (0.47 [0.11]) and smoking prevalence (2.93% [0.50]). The difference in smoking prevalence was entirely abolished by markers of SEP; both systolic blood pressure and BMI differences were attenuated by SEP, behavioural and vascular disease indicators (1.52 [0.38] & 0.31 [0.11] respectively), but remained significant. The North-South divide in systolic blood pressure was attributed to differences in men (2.18 [0.54]), being non-significant in women; and in middle age groups (2.70 [0.76] aged 40- 59, compared with 2.29 [0.78] aged 16–39) and was non-significant aged 60 and over.

Conclusion

Smoking is a major factor behind morbidity and mortality. In line with work from different settings, patterns in smoking can be explained through adverse, cross-sectional patterns of SEP. Addressing underlying poverty and disadvantage may be required to fully tackle smoking inequalities. Using a suite of measures designed to address different constructs of SEP, although cross-sectional, we find excesses in blood pressure and BMI in the North of England. These differences may, in part, explain previously found differences in mortality. If we are to understand, and therefore reduce, geographic inequalities, current measures of SEP may require improvement, for example accounting for aspects of the life-course.
OP13 Diet and Physical Activity Levels Among UK Youth
Authors: McAloney K , Graham H , Hall J , Law C , Platt L , Wardle H
Published: September 2012

Background

Both physical activity levels and dietary behaviours have consistently been linked with the development of chronic disease, obesity and ill-health in both adult and youth samples. Nationally there are established recommendations of minimum levels of physical activity and fruit and vegetable consumption necessary to promote good health. Developing healthy behaviour is particularly important for young people, as adult behaviours that are detrimental or positive for health and well-being are often established in childhood and adolescence. This paper aims to investigate the prevalence of physical activity and fruit and vegetable consumption and to explore the co-occurrence of these behaviours among young people in the UK, using the newly availableUnderstanding Societystudy.

Methods

This study is part of an ongoing secondary analysis ofUnderstanding Society: The UK Household Longitudinal Study. The analysis sample consisted of 4,395 young people aged 10 - 15 living in the UK in 2009/2010 who participated in the first wave of the study. The prevalence of physical activity and fruit and vegetable consumption within the sample, and patterns of co-occurrence across the two behaviours, were explored descriptively. Multinomial regression models were estimated to investigate the social patterning of the health behaviour co-occurrence patterns, using socio-demographic characteristics of the young person and mother.

Results

85.2% of young people did not meet the government recommendation for fruit and vegetable consumption, reporting less than 5 portions of fruit and vegetable daily. 70.6% of young people did not meet the recommendation for participation in daily physical activity. A small minority did not consume any fruits and vegetables (5.0%); and 6.4% reported participating in physical activity less often than weekly. On examining the patterns across combinations of the two behaviours, most young people did not meet both recommendations (62%), while only 6.1% of young people met both recommendations. Multinomial regression models indicated that gender, ethnicity and religion and socio-economic status were significantly associated with health behaviour patterns.

Conclusion

This paper presents an analysis of the most recently available health-risk behaviour data on children from all four countries of the UK. The results indicate that a high proportion of young people do not achieve levels of fruit and vegetable consumption or levels of participation in physical activity considered to be a minimum for good health, and these two behaviours tend to co-occur. The implications of these behaviour patterns and the associations with socio-demographic characteristics are discussed.
OP20 A Comparative Analysis of Deployment Associated Mental Health Issues in United States and United Kingdom Armed Forces
Authors: Sundin J , Fear NT , Greenberg N , Riviere L , Herrell R , Adler A , Hoge C , Bliese P , Wessely S
Published: September 2012

Background

There are several differences in health outcomes between UK and US military personnel who have deployed to the recent conflicts in Iraq or Afghanistan. Rates of survey-based posttraumatic stress disorder (PTSD) tend to be higher in US personnel, whilst self-reported rates of alcohol use tend to be higher in UK personnel. To explore potential reasons why mental health prevalence rates differ in the two countries a comparative analysis of UK and US Armed Forces combined data was carried out.

Methods

Two samples of UK (n=313) and US (n=1560) regular enlisted Army male personnel who were deployed to Iraq in 2007 were combined. Primary outcomes included PTSD, alcohol use, anger and physical symptoms. The samples were compared on a list of 11 combat experiences, socio-demographics and military characteristics.

Results

There were several differences between the UK and US samples: the UK sample was younger, more likely to hold a degree and a rank of officer, had served for a longer time, more likely to be married or in a long term relationship, and more likely to rate their marriage as good. The US sample reported more combat experiences. The samples did not differ on physical symptoms, but the US sample was more likely to report PTSD, adjusted odds ratio (AOR) 1.75 (95% Confidence Interval 1.01 – 3.03) and less likely to report alcohol misuse, AOR 0.27 (95% CI 0.20 –0.37) compared to the UK sample.

Conclusion

US military personnel deployed to Iraq were more likely to report PTSD whilst UK personnel are more likely to report alcohol misuse. Whilst, there were several differences between the US and UK samples in terms of socio-demographics and combat experiences, these did not explain the difference in health outcomes.

Understanding the differences, as well as the similarities, between the UK and US Armed Forces is important, as it can influence the way military personnel are managed in both nations. It can also influence the way military personnel who have developed mental health problems as a result of their service are treated.
OP22 Projections of Healthcare Costs in the Last Year of life for Older Cancer Patients in European Union Member States (2008-2030)
Authors: Petkova H , Dawoud D , McCrone P , Higginson IJ
Published: September 2012

Background

Despite advances, cancer remains a major cause of pain, suffering and death. The highest incidence and mortality occurs in older people (≥65), and given demographic change the numbers are expected to rise in the coming years. This has financial consequences and key implications for service planning. We estimated the current and future cost of providing care for older cancer patients in the last year of life (LYOL) in the 27 European Union (EU) member-states between 2008 and 2030.

Methods

Our cost projection models combined: a) WHO-GLOBOCAN mortality data; b) an average UK-based estimate of the cost of care per cancer patient in the LYOL; c) country-specific adjustment factor; d) annual cost inflation correction range 5%–15%: 5% (conservative scenario), 10% (realistic scenario), 15% (highest expected increase scenario), and e) an adjustment for ageing to reflect the increasing life expectancy (LE) and the related morbidity expansion.

Results

The total EU cost of care for older cancer patients in the LYOL is expected to increase by 48% (2008–2030) reflecting mortality rates only (baseline model). Assuming 5% cost rise per year (model 1), we projected more than a two-fold increase in the total EU cost by 2030 at an average annual rate of 9.6%. Model 2 involved 10% inflation and no ageing-adjustment, predicting a 3.7 times cost rise during the next two decades. This equated an annual average increase at 16.9%. We predicted a slightly higher cost rise when we allowed for ageing in addition to the 10% annual inflation (model 3) at approximately 17% increase year on year. This represents $81 billion absolute increase during the projected period or $3.6 average annual increase for Europe as a whole. The highest cost increase is expected in model 4 (15% inflation with ageing-adjustment). Costs are predicted to rise more than five times between 2008 and 2030, marking a 24.3% average annual increase. There is a marked cost variation across Europe.

Conclusion

Costs of care for older cancer patients in the LYOL are projected to rise substantially in the foreseeable future. Our models outline cost variation between 2.2% and 24.3%, with the most realistic increase expected at 17% annually. This has key implications for short and medium-term service planning of how to provide care in the LYOL for the rising number of older citizens dying from cancer, taking into account the current economic climate in Europe.
OP36 A Cross-Sectional Assessment of the Effect of the Free Older Persons’ Bus Pass On Active Travel and Regular Walking Among Adults ≥60 Years in England Using Data from the National Travel Survey 2005-2008
Authors: Coronini-Cronberg S , Millett C , Laverty A , Webb E
Published: September 2012

Background

The benefits of physical activity for all age groups is well-documented and there is increasing interest in the promotion of incidental physical activity, such as active transport, which includes walking, cycling and use of public transport. For older adults, even small increases in activity may have significant benefits: for example, the relative risk of disability is reduced by 7% for each additional hour of relatively gentle physical activity undertaken each week. Our study assessed the potential public health benefit of theNational Bus Pass, introduced in 2006, which permits free local bus travel for older adults (≥60 years) in England.

Methods

Data from the year prior to the pass being introduced (2005) to the most recently available (2008) were extracted from an annual cross-sectional survey, the National Transport Survey, resulting in a sample size of 15 175 older adults. Models assessed associations between possessing a bus pass and our main outcome measures: use of active transport (walking, cycling and use of public transport), use of buses and walking three or more times a week. Since participants were sampled by household, all models were adjusted for clustering at the household level, as well as a range of confounders, including: age, sex, and socio-economic status.

Results

Preliminary results show that having a free pass is significantly associated with greater use of active travel among both disadvantaged and advantaged groups. It is also associated with increased use of buses and a greater likelihood of walking three or more times a week.

Conclusion

Older people in England with a free bus pass are more likely to use active transport, buses and undertake regular walking than those without, regardless of their socio-economic status. This suggests public subsidies enabling free bus travel for older persons may confer significant population health benefits through increasing incidental physical activity levels.
OP40 Selenium Supplementation for the Primary Prevention of Cardiovascular Disease (CVD) – A Cochrane Systematic Review
Authors: Rees K , Hartley L , Day C , Clarke A , Stranges S
Published: September 2012

Background

Selenium is a key component of a number of selenoproteins which protect against oxidative stress and have the potential to prevent chronic diseases including CVD. However, observational studies have shown inconsistent associations between selenium intake and CVD risk; in addition there is concern around an increased risk of type 2 diabetes with high selenium exposure.

Objective

To determine the effectiveness of selenium only supplementation for the primary prevention of CVD and examine potential adverse effects on type 2 diabetes.

Methods

The following electronic databases were searched with no language restrictions from their inception to July 2011: MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Library and trial registers. Studies were included if they fulfilled the following criteria: study design - RCTs, participants - free of CVD (includes those at high risk), intervention - selenium only supplementation, comparator – no intervention or placebo, outcomes – diagnosis of CVD or change in the risk factor profile for CVD (blood pressure, lipids) or adverse effects (type 2 diabetes). Two reviewers independently screened titles and abstracts, assessed shortlisted studies for formal inclusion/exclusion, abstracted data and assessed methodological quality. Data were analysed using RevMan 5.1 software.

Results

Database searching resulted in 1310 hits of which 43 went forward for formal inclusion/exclusion; 9 RCTs met the inclusion criteria. Included trials were heterogeneous in the participants recruited, dose of selenium, intervention and follow-up periods, outcomes reported, country of recruitment and baseline selenium status. Meta-analysis was possible for 2 trials reporting clinical events, but the analysis was dominated by the SELECT trial which carried over 80% of the weight. There were no statistically significant effects of selenium supplementation on total mortality (RR 0.97, 95% CI 0.88, 1.08), CVD mortality (RR 0.97, 95% CI 0.79, 1.2) or non-fatal CVD events (RR 0.97, 95% CI 0.9, 1.05). Similarly, the SELECT trial dominated the findings from 3 trials reporting type 2 diabetes, where selenium supplementation increased the risk of type 2 diabetes (RR 1.06, 95%CI 0.97, 1.16) although this did not reach statistical significance. There were no statistically significant effects of selenium on total or HDL cholesterol (measured in 2 trials (5 intervention arms) with varying doses of selenium supplementation).

Conclusion

There is still a lack of evidence of the effects of selenium supplementation in the primary prevention of CVD. More trial evidence is needed especially to clarify the potential adverse effect of selenium supplementation on type 2 diabetes.
OP49 Socioeconomic Status and Late Adolescent Trajectories of Smoking, Drinking, and Psychiatric Distress
Authors: Green MJ , Leyland AH , Sweeting H , Benzeval M
Published: September 2012

Background

Problems with smoking, alcohol use and psychiatric distress usually develop in adolescence and often co-occur. These problems may be inter-related but their co-occurrence could result from a common cause such as socioeconomic disadvantage.

Methods

The Twenty–07 Study includes self-reported data on smoking, alcohol use and psychiatric symptoms (GHQ–12) from 1,515 adolescents at approximate ages of 15 (baseline), 16 and 18. Latent class analysis (n=1238 with valid data) was used to identify distinct patterns of late adolescent development in smoking, alcohol use and psychiatric distress and relate these to various indicators of socioeconomic status (leaving school at 16, baseline area deprivation, and baseline parental measures of social class, education, housing tenure, income, employment status and family structure) whilst adjusting for gender.

Results

Four latent classes were identified: 1) a low-risk class with low levels of smoking at all ages, low early drinking, moving towards regular drinking at age 18, and low levels of psychiatric symptoms; 2) a class with similar patterns for smoking and drinking but with high levels of psychiatric distress; 3) a class which engaged with alcohol earlier, many of whom were heavy drinkers by age 18, and had medium levels of distress; and 4) a high-risk class who engaged early with both smoking and drinking, most of whom were heavy smokers by age 18, and had medium and increasing levels of distress. In unadjusted analyses most indicators of socioeconomic disadvantage were associated with raised odds of membership in the high-risk class (reference group: low-risk class). With mutual adjustment for gender and all socioeconomic variables, those leaving school at 16 (OR 6.01; 95% CI 3.93–9.17) and in rented accommodation (OR 1.74; 1.19–2.56) still had significantly raised odds of membership in the high-risk class relative to those staying in school or in owner-occupied accommodation. Rented accommodation was protective for membership in the class with drinking but not smoking problems (OR 0.51; 0.30–0.86) and those in the most deprived areas were less likely to be in the class with psychiatric distress only (OR 0.37; 0.17–0.83) than those in more affluent areas.

Conclusion

Socioeconomic disadvantage is implicated as a common cause of smoking, alcohol use, and psychiatric distress. Relationships with socioeconomic status are complex however and depend on the combination of outcomes, for example, trajectories with drinking but not smoking problems and those with psychiatric distress alone were more likely at the higher end of the socioeconomic distribution.
OP51 Maternal Employment and Socio-Emotional Behaviour at Age 7: Findings from the UK Millennium Cohort Study
Authors: Hope SC , Pearce A , Law C
Published: September 2012

Background

Maternal employment in the UK has increased significantly in recent years, but evidence of its relationship with child socio-emotional behaviour is mixed. Given the policy importance of both family employment and children’s wellbeing, this relationship needs to be better understood. This study seeks to investigate whether cumulative exposure to maternal employment is associated with socio-emotional behaviour at age 7.

Methods

The study comprises a longitudinal analysis of the United Kingdom Millennium Cohort Study (MCS), based on 10,723 singleton children who participated in all four sweeps of the study (at ages 9 months, 3, 5 and 7 years). Socio-emotional behaviour was measured using total Strengths and Difficulties Questionnaire (SDQ) scores, dichotomised using an established cut-off for borderline / abnormal behaviour. Risk ratios (RR) were estimated using Poisson regression for borderline / abnormal SDQ scores at age 7 according to cumulative maternal employment over four sweeps of the MCS (at 9 months, 3, 5 and 7 years), unadjusted (uRR) and adjusted (aRR) for confounders (age at first live birth, ethnicity, family size, lone parenthood, and maternal psychological distress, all recorded at 9 months). In order to disentangle whether there was a differential impact of earlier and current employment, additional analyses estimated the risk associated with employment up to age 5 years, adjusting for employment at age 7.

Results

The risk of borderline/abnormal scores decreased linearly by number of MCS sweeps that mothers were in employment; after adjustment for confounders the gradient attenuated but remained significant. Children growing up in households where mothers were employed in all MCS sweeps were significantly less likely to display borderline / abnormal behaviour at age 7 (compared to never in paid employment): uRR=0.37 (0.32–0.44); aRR=0.68 (0.56–0.81). Analyses differentiating early employment (between ages 9 months and 5 years) and current employment (at age 7) suggest that the cumulative impact of prior non-employment may be ameliorated once a mother gains employment. After adjusting for current employment and confounders, there was no increased risk of borderline / abnormal socio-emotional behaviour associated with non-employment in all earlier sweeps up to age 5 compared to being in paid employment continuously (baseline): aRR=1.01 (0.82–1.23).

Conclusion

This longitudinal analysis supports an association between maternal employment and child socio-emotional behaviour. Possible explanations and implications will be discussed.
OP60 Risk of Future Depression in People who Are Obese but Metabolically Healthy: The English Longitudinal Study of Ageing
Authors: Hamer M , Batty GD , Kivimaki M
Published: September 2012

Background

There is some evidence to suggest that obesity is a risk factor for the development of depression, although this is not a universal finding. This discordance might be ascribed to the existence of a ‘healthy obese phenotype’ – that is, obesity in the absence of the associated burden of cardio-metabolic risk factors. We examined whether the association of obesity with depressive symptoms is dependent on the individual’s metabolic health.

Methods

Participants were 3851 men and women (aged 63.0 ± 8.9 yrs, 45.1% men) from the English Longitudinal Study of Ageing, a prospective study of community dwelling older adults. Obesity was defined as body mass index ≥ 30 kg/m2. Based on blood pressure, HDL-cholesterol, triglycerides, glycated haemoglobin, and C-reactive protein, participants were classified as ‘metabolically healthy’ (0 or 1 metabolic abnormality) or ‘unhealthy’ (≥ 2 metabolic abnormalities). Depressive symptoms were assessed at baseline and at 2 years follow up using the 8-item Centre of Epidemiological Studies Depression (CES-D) scale.

Results

Obesity prevalence was 27.5%, but 34.3% of this group was categorized as metabolically healthy at baseline. Relative to non-obese healthy participants, after adjustment for baseline CES-D score and other covariates, the metabolically unhealthy obese participants had elevated risk of depressive symptoms at follow-up (odds ratio [OR] = 1.50, 95% CI, 1.05 – 2.15), although the metabolically healthy obese did not (OR=1.38, 95% CI, 0.88 – 2.17). We repeated the main analysis after excluding 451 participants with existing depressive symptoms (CES-D≥4) at baseline. There were 238 incident cases of depression at follow up, and in comparison with healthy non-obese participants only the metabolically unhealthy obese participants had elevated odds of incident depression (OR=1.56, 95% CI, 1.09 – 2.22), but not their metabolically healthy obese counterparts (OR=1.45, 95% CI, 0.92 – 2.30) nor unhealthy non-obese participants (OR=1.38, 95% CI, 0.98 – 1.94). In further analysis we examined the associations between individual metabolic risk factors and depression. There was a dose-response association between the number of metabolic risk factors and risk of depression, although the risk only became significant in participants with more than one risk factor. Adverse triglycerides, impaired glycaemic control, and low grade inflammation were associated with depression at follow-up in models adjusted for age, sex and baseline CES-D score.

Conclusion

The association between obesity and risk of depressive symptoms appears to be partly dependent on metabolic health, although further work is required to confirm these findings.
OP61 Is Maternal Iron Status Associated with offspring’s Blood Pressure and Adiposity? A Mendelian Randomization Study
Authors: Alwan NA , Lawlor DA , McArdle HJ , Greenwood DC , Cade JE
Published: September 2012

Background

Iron deficiency during pregnancy is a common problem. Experimental animal studies suggest that mothers deficient in iron during pregnancy are more likely to have offspring who become obese and have higher blood pressure. The use of random assortment of genes from parents to offspring can provide a method for assessing the causal impact of nutritional exposures, which is less likely to be influenced by confounding and reverse causality. The C282Y mutation in theHFEgene is robustly associated with iron stores, with those who carry the mutation having higher iron stores. Thus, this variant could be used as an instrumental variable to examine whether the association of maternal iron with offspring body mass index (BMI), waist circumference (WC) and blood pressure (BP) is causal.

Methods

We conducted a Mendelian randomization study to examine the association between maternal iron status with offspring adiposity and BP in adulthood. Instrumental variable (IV) analysis, using maternal C282Y as a genetic instrument for mother’s ferritin, was performed. IV analysis uses the proportion of the variation in maternal ferritin that is explained by C282Y to provide an unconfounded estimate of the relationship with offspring outcomes. The results were compared to the results of multivariable ordinary least squares (OLS) regression examining the same relationship. Male and female offspring of mothers from the UK Women Cohort Study (UKWCS) were approached, of whom 348 with mean age of 41 years completed the study. About half were offspring of C282Y carriers. Offspring’s BP, height and weight were measured at their local medical practice. Participants were also asked to self-measure their WC at home.

Results

Maternal C282Y was associated with maternal ferritin (mean difference per allele=84 g/l, 95% CI 31, 137, P=0.002). Using IV analyses, maternal ferritin was not associated with offspring’s BP, BMI or WC. The first stage F statistic for the strength of the instrument was 10 ( Kleibergen-PaaprkLM P-value=0.009). Maternal ferritin was associated with offspring diastolic BP, WC and BMI in univariable, but not in multivariable OLS analysis. There was no strong statistical evidence of a difference between the OLS and the IV models coefficients for any of the outcomes considered.

Conclusion

We found no association between maternal iron status and offspring’s BP and adiposity using both multivariable OLS and IV modeling with maternal C282Y mutation as the instrument. Further exploration of this relationship is needed in larger studies that have genetic variation assessed in both mother and offspring.
OP73 Exploring Impacts of Survey Non-Response using Record-Linkage of Scottish Health Survey Data (2003 to 2008)
Authors: Gray L , McCartney G , White IR , Given L , Katikireddi SV , Leyland AH
Published: September 2012

Background

Inference on population health is commonly derived from health survey data, based on the assumption that they are representative of the target communities. Departure from representativeness may weaken external validity leading to biased estimates, with important implications for public health evidence, particularly in relation to prevalence and quantity estimates such as population alcohol consumption. A key aspect determining the extent to which surveys are representative is the level of participant response. Inverse probability weights based on a limited range of demographic variables are usually applied in an attempt to correct for non-response. We aimed to investigate whether weighted estimates of all-cause mortality and mortality from alcohol-related conditions derived from the 2003 Scottish Health Survey (SHeS) – with household response of 67% – reflect those in the population of Scotland.

Methods

Baseline observations from SHeS were individually record-linked to mortality data for the 91% of respondents consenting to linkage, and directly age-standardised survey-weighted mortality rates were calculated for the 3117 men and 3980 women aged 20 years and older at interview. Equivalent mortality rates were calculated for the whole of Scotland in the same age group using population estimates and mortality data contemporaneous with the linked survey data.

Results

There were 201 (6.4%) male deaths and 215 (5.4%) female deaths in the 2003 SHeS by the end of 2008. Among men, all-cause mortality was markedly lower in the SHeS sample (918 per 100,000 person-years [95% CI:850–987]) than in the Scottish population (1361 [95% CI:1357–1365]). Figures for women were also highly significantly different (739 [95% CI:682–795] for the SHeS and 928 [95% CI:925–931] for the Scottish population). Alcohol-related mortality was lower in the SHeS sample (38 [95% CI:18–57] in men and 11 [95% CI:0–22] in women) relative to the Scottish population (57 [95% CI:56–58] in men [non-significant] and 25 [95% CI:24–25] in women [significant]).

Conclusion

Respondents to the 2003 SHeS differ from the population they are intended to represent, with much lower than expected all-cause mortality in both sexes; alcohol-related mortality rates were somewhat lower than expected suggesting lower alcohol consumption among survey respondents which, if genuine, would lead to inherent underestimation of population consumption levels. Importantly, differences existed despite the application of conventional weighting and age-standardisation methods. Consideration should be given to the levels of resource allocated for increasing survey response and the further development of survey methodology to address the resultant systematic bias in health survey data arising from non-response.
OP74 Measuring Sexual Behaviour Comes of Age: A Comparison of Outcomes in the 2010 Health Survey for England with the National Survey of Sexual Attitudes and Lifestyles
Authors: Mercer CH , Robinson C , Craig R , Nardone A , Johnson AM
Published: September 2012

Background

The Health Survey for England (HSE) is a general health survey administered annually to a probability sample of people living in England. In 2010, the HSE included, for the first time, questions about sexual health, which previously were considered too sensitive for a general health survey. This paper compares the reporting of sexual behaviours by people aged 16–44 in HSE–2010 with data collected by the second British National Survey of Sexual Attitudes and Lifestyles (Natsal–2), Britain’s most recent, dedicated national probability survey of sexual behaviour.

Methods

In HSE–2010, 8,420 people aged 16–69 were interviewed, of whom 2,911 were aged 16–44. Natsal–2 interviewed 12,110 people aged 16–44 in 1999/2001. HSE–2010 used pen-and-paper self-completion questionnaires for the sexual health questions, while Natsal–2 used computer-assisted personal-interviews including computer-assisted self-interview for the more sensitive questions, including those on sexual health. HSE–2010 used the same question wording developed and piloted for Natsal.

Results

Collecting sexual behaviour data was acceptable to HSE–2010 participants with low item non-response (5–10%), albeit slightly higher than in Natsal–2 (<5%). Reported age at first heterosexual intercourse was comparable in the two surveys: median ages of 17 (men) and 16 (women) among those aged 16–24. However, for some very sensitive questions there were lower levels of reporting in HSE–2010 than in Natsal–2: while the proportion reporting same-sex in the last 5 years was similar (2–3%), reporting ofeverhaving same-sex was lower in HSE–2010 for men (2%vs.5% in Natsal–2). Similarly, the mean number of opposite-sex partners reported in HSE–2010 was a little lower than in Natsal–2, particularly among men: 9.5vs.12.7, respectively, in contrast to 5.4vs.6.5, respectively, among women. Men in HSE–2010 were also slightly less likely to report being diagnosed with sexually transmitted infection(s) than in Natsal–2: 8.7%vs.11.1%, respectively; but this was reported by similar proportions of women: 12% in both surveys.

Conclusion

The inclusion of questions on sexual behaviour in HSE–2010 has demonstrated the feasibility and utility of measuring sexual behaviour in general health surveys, albeit in less detail than in a survey focused on sexual behaviour such as Natsal. General health surveys such as the HSE provide a useful vehicle for monitoring sexual risk behaviour more frequently than is possible with decennial Natsal surveys. Health surveys should not shy away from also measuring sexual behaviour, especially in light of the associations between health status and sexual health outcomes of satisfaction, function and behaviour.
OP77 Type a Behaviour Pattern and Coronary Heart Disease: Philip Morris’ “Crown Jewel”
Authors: Petticrew M , Lee K , McKee M
Published: September 2012

Background

The Type A Behaviour Pattern (TABP) – characterised as individuals who are highly competitive, time-conscious and aggressive - has been the subject of research for over fifty years. The concept was developed in the 1950s by U.S. cardiologists Meyer Friedman and Ray Rosenman who argued that TABP was a risk factor for coronary heart disease (CHD), notably among white middle-class males. The theory was initially supported by findings from the Western Collaborative Group study (WCGS) and the Framingham study. However, subsequent studies found no consistent evidence that TABP predicts CHD onset or outcome. This pattern of early positive findings followed by negative findings (a “decline effect”) has long been a puzzle for TABP researchers. Despite this, the concept of Type A behaviour has continued to enjoy public appeal, fostered through popular books by Friedman and Rosenman which describe “how to recognise the deadly Type A pattern in your own personality”. TABP has also remained the subject of contemporary public health research, and it features in discussions on the psychosocial causes of health inequalities. We analysed tobacco industry documents to show that Philip Morris and RJ Reynolds were major funders of TABP research, with selected positive findings used to counter concerns regarding tobacco and health.

Methods

The Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) was systematically searched from 1959 to 2011 to identify relevant documents. The names of key individuals were identified through retrieved documents using a snowballing technique.

Results

Our document analysis suggests that, in the case of TABP, the decline effects described above may be explained by the influence of tobacco industry funding. Phillip Morris channeled significant funds for TABP research through Duke and Yale Universities, including part-funding the Framingham study. It also funded a 10-year clinical trial of the effectiveness of counselling to reduce TABP, which it referred to as its “Crown Jewel”, and funded Meyer Friedman’s Institute to a total of almost US$11million. A history of the relationship between TABP research and the Tobacco Industry will be presented.

Conclusion

It has not previously been shown that research into TABP was strongly influenced by the Tobacco Industry. This analysis extends further our understanding of the extent to which the tobacco industry has shaped major themes in contemporary public health research. Our findings also help explain the inconsistencies in the findings of epidemiological studies into TABP and mortality.
OP78 Scientists, Competing Interests, and the Media: A Content Analysis of UK Newspaper Reporting in H1N1 Influenza
Authors: Chan KNK , O’Neill S , Mandeville KL
Published: September 2012

Background

Concerns were raised about the competing interests amongst scientists on advisory committees during the 2009/10 H1N1 influenza pandemic, particularly given the substantial public expenditure on antiviral drugs and vaccines. The media is known to strongly influence public demand for new drugs and policy decisions, and many scientists commented on the use of pharmaceutical products/emerging health risks during the 2009 H1N1 pandemic in the UK media. This study assessed competing interests for the scientists promoting or rejecting the use of antivirals and/or vaccines in newspaper articles during the early pandemic.

Methods

We performed a retrospective content analysis of United Kingdom national newspaper articles on H1N1 influenza published during the period when the government decided its policy on antiviral/vaccine provision (20 April and 5 July 2009). Two reviewers coded 436 articles independently and identified those scientists promoting or rejecting the use of antivirals/vaccine according to a pre-specified protocol. Competing interests for these named scientists were then identified through a systematic search for potential or previously declared interests.

Results

One in two scientists commenting on the use of antiviral/vaccines in H1N1 influenza had undisclosed competing interests. Potential competing interests were identified in 6 of the 9 scientists (66.7%) promoting vaccine use; 6 of the 10 scientists (60%) promoting antivirals; and 1 of 4 scientists (25%) rejecting antiviral use. The nature of these competing interests ranged from study funding to directorships of pharmaceutical companies. Only three articles made clear that the scientist concerned had a link with pharmaceutical companies.

Conclusion

This study showed substantial competing interests amongst scientists commenting on the use of antivirals and/or vaccines in H1N1 influenza during the period the UK government was deciding its pharmaceutical policy. Since commentaries in the media provide an alternative route for external pressure on health policy decisions, scientists should declare any potential competing interests for media interviews as for journal articles.
OP83 Does Lunch Type Have an Impact on Dietary Quality over the Whole Day in English Primary School Children?
Authors: Evans CEL , Mandl V
Published: September 2012

Background

Nutrient standards were introduced by the Government to all English primary schools in 2008. By restricting some products and increasing the quantity and quality of others, the standards resulted in a healthier school meal profile. Despite attention to improve the quality of school meals, packed lunches have changed little in recent years and are not covered by similar regulations. There are few published studies that compare weight, body mass index (BMI), energy and nutrient intake over the whole day according to lunch type.

Methods

A dietary assessment tool named CADET was used to assess the diet of 2355 children aged 6 to 8 years attending primary schools across England. Regression analysis which took into account the clustering of children within schools was used to report anthropometric, dietary and nutritional characteristics over one 24 hour period. Nutrient and anthropometric results from children having a packed lunch were compared with children having a school meal. Results were also compared to the reference nutrient intakes (RNIs) and the National Diet and Nutrition Survey (NDNS) in children.

Results

No significant differences in weight, standardised BMI, or daily energy consumption were seen between children in the packed lunch group compared to the school meal group. However, there were nutritional differences, reported here as mean difference and 95% confidence interval (95% CI). The packed lunch group consumed higher daily amounts of carbohydrates (8.1 g, 95% CI 2.2 to 14.0g, P< 0.01), sugar (9.8g, 95% CI 5.4 to 14.3, P< 0.01) and sodium (92.1mg, 95% CI 22 to 162mg, P< 0.01). Conversely, the school meal group consumed higher intakes of protein (3.3g, 95% CI 1.6 to 5g, P< 0.01), fibre (0.8g, 95% CI 0.3 to 1.3g, P<0.01) and zinc (0.2mg, 95% CI 0.05 to 0.5mg, P<0.01). Neither group met the recommended amounts for zinc, fibre or starch and indicated lower levels of sodium and higher levels of fat than the NDNS. Differences found in nutrient intake were independent of measures of child deprivation and ethnicity.

Conclusion

Children taking a packed lunch to school have a less nutritious diet on average over the whole day in terms of sugar, sodium and fibre. A good quality lunch is therefore an important factor for overall dietary quality in children. Policies to encourage parents and children to include nutritious foods such as fruit, vegetables and low fat starchy foods are needed to narrow the gap between school meals and packed lunches.