To examine associations of abstention, alcohol consumption and problem drinking with subsequent disability pensioning (DP), and whether previous excessive consumption ('sick-quitting') could explain some of the increased risk for DP among abstainers.
Prospective population-based study.
Data were from two waves of the Nord-Tr?ndelag Health Study (HUNT) linked with the national insurance database. The two main analyses included 37,729 (alcohol consumption) and 34,666 (problem drinking) participants.
Alcohol consumption was measured by self-reported consumption, while problem drinking was assessed by the Cut down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire. Information on subsequent DP, including diagnosis for which the DP was awarded, was gathered from the national insurance database. Covariates included somatic illness and symptoms, mental health, health-related behaviour, socio-economic status and social activity.
Those reporting the highest level of alcohol consumption were not at increased risk for DP [hazard ratio (HR) 1.12, 95% confidence interval (CI): 0.92-1.38], whereas problem drinking was a strong predictor (HR 2.79, 95% CI: 2.08-3.75) compared to their corresponding reference groups. Alcohol abstainers were also at increased risk for DP, but among them, the previous consumers (HR 1.95, 95% CI: 1.48-2.57) and previous excessive consumers (HR 1.67, 95% CI: 1.01-2.74) were at higher risk for DP than constant abstainers.
Problem drinking is linked to subsequent requirement for a disability pension but mere alcohol consumption is not. This is partly explained by 'sick-quitting'.
The association between depression and smoking is firmly established, but how the association develops remains unclear. The aim of this study was to examine development of the smoking-depression association from early adolescence to adulthood.
Cross-sectional and longitudinal analyses of the smoking-depression association from adolescence to adulthood.
A cohort of adolescents (initially, 924 pupils) in the Norwegian Longitudinal Health Behaviour Study (NLHB) was followed over nine data collection waves from ages 13 to 30 years.
Daily smoking and depressed mood were measured in each wave.
In the cross-sectional analyses, daily smoking and depression were significantly associated (P-value range from P?
Background Findings from studies on the association between smoking and socioeconomic status are mixed. While adolescent smoking is reduced in many countries, use of smokeless tobacco seems to increase. Associations between socioeducational status and smoking as well as use of snus (smokeless tobacco), and to what extent these associations had changed significantly from 2004 to 2007 (a period of relatively abrupt changes in tobacco use in Norway), were examined. Methods Data from two national representative cross-sectional studies of Norwegian 16-20 year olds, where participants were asked questions allowing us to construct indicators of socioeducational status, was used. Information was also collected about the adolescents' smoking and use of snus, as well as their intentions with regard to future use of these products. Results Adolescents with a lower socioeducational status had much higher odds for smoking compared to those with higher socioeducational status (ORs ranged from 2.9 to 3.8). There was no similar association between socioeducational status and snus use (ORs ranged from 0.6 to 1.2). No support was found for a change in the socioeducational status-smoking/snus use association from 2004 to 2007. Conclusions Adolescents' socioeducational status was associated with smoking for boys and girls, while there was no similar association with snus use. This may indicate that snus truly deviates from how smoking is distributed across social strata or that snus is at a much earlier stage in the social diffusion process.
Schools are an important arena for smoking prevention. In many countries, smoking rates have been reduced among adolescents, but the use of smokeless tobacco is on the rise in some of these countries. We aimed to study the associations between schools' restrictions on smoking and snus and on the use of these tobacco products among students in upper secondary school. We employed data from a national representative study of 1444 Norwegian students, aged 16-20 years. Respondents were asked about their schools' restrictions on snus and smoking and own use of these products. We examined associations between restrictions and the use, controlling for age, gender, type of school and regional differences. We found clear consistent associations between schools' restrictions on tobacco use and less use of these products. More explicit pervasive restrictions were strongly associated with the prevalence of use. This first study on the associations between schools' restrictions on snus and the prevalence of snus use corroborate what has been found in many studies on smoking restrictions and smoking. Strict school tobacco policies may be an important tool if health authorities are interested in implementing measures to limit or reduce snus use among adolescents.
Depression and insomnia are closely linked, yet our understanding of their prospective relationships remains limited. The aim of the current study was to investigate the directionality of association between depression and insomnia.
Data were collected from a prospective population-based study comprising the most recent waves of the Nord-Trøndelag Health Study (HUNT) (the HUNT2 in 1995-1997 and the HUNT3 in 2006-2008). A total of 24,715 persons provided valid responses on the relevant questionnaires from both surveys. Study outcomes were onset of depression or insomnia at HUNT3 in persons not reporting the other disorder in HUNT2.
Both insomnia and depression significantly predicted the onset of the other disorder. Participants who did not have depression in HUNT2 but who had insomnia in both HUNT2 and HUNT3 had an odds ratio (OR) of 6.2 of developing depression at HUNT3. Participants who did not have insomnia in HUNT2 but who had depression in both HUNT2 and HUNT3 had an OR of 6.7 of developing insomnia at HUNT3. ORs were only slightly attenuated when adjusting for potential confounding factors.
The results support a bidirectional relationship between insomnia and depression. This finding stands in contrast to the previous studies, which have mainly focused on insomnia as a risk factor for the onset of depression.
Rates of disability pension (DP) awards remain high in most developed countries. We aimed to estimate the impact of anxiety and depression on DPs awarded both for mental and for physical diagnoses and to estimate the relative contribution of sub case-level anxiety and depression compared with case-level symptom loads.
Information from a large cohort study on mental and physical health in individuals aged 40-46 (N=15,288) was linked to a comprehensive national database of disability benefits. Case-level and sub case-level anxiety and depression were defined as scores on the Hospital Anxiety and Depression Scale of >or=8 and 5-7, respectively. The outcome was incident award of a DP (including ICD-10 diagnosis) during 1-7-year follow-up.
DP awards for all diagnoses were predicted both from case-level anxiety [HR 1.90 (95% CI 1.50-2.41)], case-level depression [HR 2.44 (95% CI 1.65-3.59] and comorbid anxiety and depression [HR 4.92 (95% CI 3.94-6.15)] at baseline. These effects were only partly accounted for by adjusting for baseline somatic symptoms and diagnoses. Anxiety and depression also predicted awards for physical diagnoses [HR 3.26 (95% CI 2.46-4.32)]. The population attributable fractions (PAF) of sub case-level anxiety and depression symptom loads were comparable to those from case-level symptom loads (PAF anxiety 0.07 versus 0.11, PAF depression 0.05 versus 0.06).
The long-term occupational impact of symptoms of anxiety and depression is currently being underestimated. Sub case-level symptom loads of anxiety and depression make an important and previously unmeasured contribution to DP awards.
The aim of this study was to examine the psychometric properties of the CAGE questionnaire, and the questionnaire's concurrent validity with current and previous alcohol consumption. This study employed data from the Nord-Trøndelag Health Survey wave 1 (HUNT-1 in 1984-86: N=24,900) and wave 2 (HUNT-2 in 1995-97: N=36,350). The concurrent validity of the CAGE questionnaire was examined both as a dichotomous variable with the recommended cut-off (=2 affirmative answers) for alcohol problems, and as a categorical scale. The categorical scale was constructed by counting responses from 0 to 4, and a separate category for current abstainers in HUNT-2. Current self-reported consumption above the gender specific 80th percentile was defined as "current excessive consumption". "Previous excessive consumers" were defined by meeting at least one of the two following criteria at the time of HUNT-1: reporting drinking too much alcohol in any period of their life, or reporting a high level of alcohol consumption. The internal reliability of CAGE was adequate, and in relation to alcohol consumption, there was a linear relationship between the CAGE score and both the current and previous excessive consumption. In conclusion, this study indicates good concurrent validity and adequate psychometric properties of the CAGE questionnaire. The dose-response pattern seen between the CAGE score and alcohol consumption, suggests that it can be used as an ordinal measure, rather than with a cut-off of two or more. The concurrent validity of the CAGE is better in women than in men.
For å kunne møte helseutfordringer i befolkningen trenger vi oversikt over befolkningens helsetilstand. I Norge har vi tradisjonelt hatt god oversikt over dødsårsaker, men vi vet mindre om byrden fra tilstander som medfører sykelighet, såkalt ikke-dødelig helsetap. Vårt mål var å beskrive den totale sykdomsbyrden i Norge i 2016, utviklingen de siste ti årene samt kjønnsforskjeller i sykdomsbyrde.
Vi brukte resultater fra det globale sykdomsbyrdeprosjektet Global Burden of Diseases, Injuries and Risk Factors Study (GBD), som kvantifiserer ikke-dødelig helsetap slik at det kan måles på samme skala som dødelighet i form av tapte leveår. Summen av tapte leveår og ikke-dødelig helsetap gir sykdomsbyrdemålet helsetapsjusterte leveår (DALY).
Ikke-smittsomme sykdommer som hjerte- og karsykdom, kreft, kronisk obstruktiv lungesykdom og demens var viktige årsaker til tapte leveår hos begge kjønn i Norge i 2016. Ikke-dødelig helsetap utgjorde 52 % av sykdomsbyrden målt i helsetapsjusterte leveår. Spesielt muskel- og skjelettsykdommer, psykiske lidelser og ruslidelser var viktige. De siste ti årene har sykdomsbyrden (i aldersjusterte rater) sunket for mange tilstander som medfører tapte leveår, men ikke for tilstander som gir ikke-dødelig helsetap.
Ikke-dødelig helsetap utgjør en stor og økende andel av sykdomsbyrden i den norske befolkningen, noe som vil gi nye utfordringer for helsevesenet.
Studies on adolescent smoking indicate that the smoking behaviours of their parents, siblings and friends are significant micro-level predictors. Parents' socioeconomic status (SES) is an important macro-level predictor. We examined the longitudinal relationships between these predictors and the initiation and development of adolescents' smoking behaviour in Norway.
We employed data from The Norwegian Longitudinal Health Behaviour Study (NLHB), in which participants were followed from the age of 13 to 30. We analysed data from the first 5 waves, covering the age span from 13 to 18, with latent curve modeling (LCM).
Smoking rates increased from 3% to 31% from age 13 to age 18. Participants' smoking was strongly associated with their best friends' smoking. Parental SES, parents' smoking and older siblings' smoking predicted adolescents' initial level of smoking. Furthermore, the same variables predicted the development of smoking behaviour from age 13 to 18. Parents' and siblings' smoking behaviours acted as mediators of parents' SES on the smoking habits of adolescents.
Parents' SES was significantly associated, directly and indirectly, with both smoking initiation and development. Parental and older siblings' smoking behaviours were positively associated with both initiation and development of smoking behaviour in adolescents. There were no significant gender differences in these associations.
Cites: J Health Econ. 2006 Mar;25(2):214-3315964090
Gastrointestinal complaints are very common in the general population and very often co-occur with common mental disorders. We aimed to study the prospective impact of gastrointestinal complaints on long term sickness absence, and address the contribution from co-occurring common mental disorders and other somatic symptoms.
Health data on 13 880 40-45 year olds from the Hordaland Health Study (1997-99) were linked to national registries on sickness absence. As part of a wider health screening, gastrointestinal complaints were ascertained. Participant's anxiety and depression, and the presence of other somatic symptoms were evaluated. In Cox regression models, we predicted sickness absences over an average 5.4 years follow-up, with adjustment for confounders, anxiety and depression and other somatic symptoms.
After adjusting for gender, level of education and smoking, those reporting GI complaints had higher risk for later sickness absence (HR = 1.42, 95% CI 1.34-1.51). GI complaints were associated with both anxiety (OR = 3.66, 95% CI 3.31-4.04) and depression (OR = 3.28, 95% CI 2.89-3.72), and a high level of other somatic symptoms (OR = 8.50, 95% CI 7.69-9.40). The association of GI complaints was still independently associated with future sickness absence (HR = 1.17, 95% CI 1.10-1.16) adjusting for mental illness and other somatic symptoms.
Sickness absence is a complex behavioural outcome, but our results suggest GI complaints contribute by increasing the risk of long term sickness absence independently of comorbid mental illness and presence of other somatic symptoms. Occupational consequences of illness are important, and should also be addressed clinically with patients presenting with GI complaints.