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Background: There is conflicting evidence on whether stress is a risk factor for breast cancer. The present study examined prospectively the relationship between stress at work and risk of breast cancer.Methods: Participants comprised 26 936 postmenopausal women in the Nurses' Health Study ages 46-72 who were in paid employment, and who had no previous history of cancer. Multivariate-adjusted regression analysis was used to examine the relationship between job strain (measured by the Karasek Job Content Questionnaire in 1992) and risk of incident invasive and in situ breast cancer.Results: From 1992 through 1994, 219 women were diagnosed with breast cancer. No evidence was found for a relationship between job stress and risk of breast cancer. Compared with women in low strain jobs, the multivariate-adjusted relative risks of breast cancer were RR = 0.78 (95% CI : 0.52-1.16) for high-strain jobs; RR = 0.76 (95% CI : 0.49-1.17) for active jobs; and RR = 0.94 (95% CI : 0.67-1.34) for passive jobs. Although job strain was related to less breast cancer screening among women in highly demanding jobs, it was not associated with tumour size.Conclusions: Job stress was not related to an increase in the incidence of breast cancer in the present cohort of nurses. [ABSTRACT FROM AUTHOR]

Social class differences in mortality from causes of death amenable to medical intervention were examined. All deaths in New Zealand males aged 15–64 years during the periods 19757ndash;1977 and 1985–1987 were identified. Strong social class gradients in mortality from causes of death amenable to medical intervention were observed during both periods. Furthermore, social class inequalities were more pronounced for amenable causes of mortality than for non-amenable causes. However, a marked decline in the age-standardized mortality rate from amenable causes was observed, with the rate falling by 30% over the 10-year study period. This decline was twice as large as the drop in the non-amenable mortality rate. Despite the fall in the death rate from amenable causes, social class inequalities in mortality persisted among New Zealand men, with the lowest socioeconomic group experiencing a death rate from amenable causes of mortality that was 3.5 times higher than men in the highest socioeconomic group. [ABSTRACT FROM PUBLISHER]

Background: Many countries have been increasing their state pension age (SPA); nonetheless, there is little consensus on whether retirement affects the risk of cardiovascular disease (CVD). This study examined the associations of retirement with CVD and risk factors., Methods: We used harmonized longitudinal datasets from the Health and Retirement Study and its sister surveys in 35 countries. Data comprised 396 904 observations from 106 927 unique individuals aged 50-70 years, with a mean follow-up period of 6.7 years. Fixed-effects instrumental variable regressions were performed using the SPA as an instrument., Results: We found a 2.2%-point decrease in the risk of heart disease [coefficient = -0.022 (95% confidence interval: -0.031 to -0.012)] and a 3.0%-point decrease in physical inactivity [-0.030 (-0.049 to -0.010)] among retirees, compared with workers. In both sexes, retirement was associated with a decreased heart disease risk, whereas decreased smoking was observed only among women. People with high educational levels showed associations between retirement and decreased risks of stroke, obesity and physical inactivity. People who retired from non-physical labour exhibited reduced risks of heart disease, obesity and physical inactivity, whereas those who retired from physical labour indicated an increased risk of obesity., Conclusions: Retirement was associated with a reduced risk of heart disease on average. Some associations of retirement with CVD and risk factors appeared heterogeneous by individual characteristics., (© The Author(s) 2023. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Background: Evidence from a limited number of short-term trials indicates the difficulty in achieving population-level improvements in physical activity (PA) through community-wide interventions (CWIs). We sought to evaluate the effectiveness of a 5-year CWI for promoting PA in middle-aged and older adults using a cluster randomized design., Methods: We randomized 12 communities in Unnan, Japan, to either intervention (9) or control (3). Additionally, intervention communities were randomly allocated to three subgroups by different PA types promoted. Randomly sampled residents aged 40-79 years responded to the baseline survey (n = 4414; 74%) and were followed at 1, 3 and 5 years (78-83% response rate). The intervention was a 5-year CWI using social marketing to promote PA. The primary outcome was a change in recommended levels of PA., Results: Compared with control communities, adults achieving recommended levels of PA increased in intervention communities [adjusted change difference = 4.6 percentage points (95% confidence interval: 0.4, 8.8)]. The intervention was effective for promoting all types of recommended PAs, i.e. aerobic (walking, 6.4%), flexibility (6.1%) and muscle-strengthening activities (5.7%). However, a bundled approach, which attempted to promote all forms of PAs above simultaneously, was not effective (1.3-3.4%, P ≥ 0.138). Linear dose-response relationships between the CWI awareness and changes in PA were observed (P ≤ 0.02). Pain intensity decreased in shoulder (intervention and control) and lower back (intervention only) but there was little change difference in all musculoskeletal pain outcomes between the groups., Conclusions: The 5-year CWI using the focused social marketing strategy increased the population-level of PA.

Background: : The health consequences of genocides on children of survivors are increasingly discussed but conclusions have been conflicting., Methods: We systematically reviewed studies from five electronic databases (EMBASE, PILOTS, PUBMED, PsycINFO, Web of Science), which used a quantitative study design and included: (i) exposure to the genocides of Armenians in Nazi Germany, Cambodia, Rwanda and Bosnia; (ii) mental health outcomes; (iii) validated instruments; (iv) statistical tests of associations. Study quality was appraised using a quality assessment tool for genocide studies. PRISMA reporting guidelines were followed., Results: From 3352 retrieved records, 20 studies with a total of 4793 participants involving 2431 children of survivors and 2362 controls met the eligibility criteria. Studies were conducted in seven countries: Australia, Canada, Italy, Israel, Norway, Rwanda and the USAs over the past seven decades, using the Genocide Studies Quality Assessment Tool. Data from the high quality studies provide no consistent evidence that children of genocide survivors are more likely to have mental health problems than comparators who were not children of genocide survivors., Conclusions: Methodological characteristics were associated with findings: studies investigating random samples of genocide survivors did not find an impact of genocides on health of children of survivors. Potential confounders (e.g. recent life events, poverty) need further investigation. Future studies of the impact of genocides on mental health should report using a standardized structure, such as the quality tool used here., (© The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association)

Background: Childhood socioeconomic disadvantage has been previously linked to increased mortality risk in adulthood. However, most previous studies have focused on middle-aged adults in Western contexts. Here, we sought to examine the association between childhood socioeconomic status (SES) and mortality among healthy older Japanese adults., Methods: We conducted a 3-year follow-up of participants in the Japan Gerontological Evaluation Study (JAGES), a population-based cohort of 65- to 103-year-old Japanese adults. Childhood SES was assessed by survey at baseline. Mortality from 2010 to 2013 was analysed for 15 449 respondents (7143 men and 8306 women). Cox regression models were used to estimate hazard ratios (HR) for risk of death., Results: A total of 754 deaths occurred during the 3-year follow-up. Lower childhood SES was significantly associated with lower mortality in men, but not in women. Compared with men growing up in more advantaged childhood socioeconomic circumstances, the age-adjusted HR for men from low childhood SES backgrounds was 0.75 [95% confidence interval (CI): 0.56-1.00]. The association remained significant after adjustment for height, education, adult SES, municipalities of residence, health behaviours, disease status and current social relationships (HR = 0.64; 95% CI 0.47-0.87). This association was stronger among men aged 75 years or older, HR = 0.67 (95% CI: 0.47-0.95), compared with men aged 65-74 years, HR = 0.90 (95% CI: 0.54-1.51)., Conclusions: Childhood socioeconomic disadvantage is associated with lower mortality among men aged 75 years or older, which may be due to selective survival, or alternatively to childhood physical training or postwar calorie restriction in this generation of Japanese males., (© The Author 2016. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Background: Smoking, physical inactivity and obesity are modifiable risk factors for morbidity and mortality. The aim of this study was to examine the extent to which the co-occurrence of these behaviour-related risk factors predict healthy life expectancy and chronic disease-free life expectancy in four European cohort studies., Methods: Data were drawn from repeated waves of four cohort studies in England, Finland, France and Sweden. Smoking status, physical inactivity and obesity (body mass index ≥30 kg/m 2 ) were examined separately and in combination. Health expectancy was estimated by using two health indicators: suboptimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years., Results: Compared with men and women with at least two behaviour-related risk factors, those with no behaviour-related risk factors could expect to live on average8 years longer in good health and 6 years longer free of chronic diseases between ages 50 and 75. Having any single risk factor was also associated with reduction in healthy years. No consistent differences between cohorts were observed., Conclusions: Data from four European countries show that persons with individual and co-occurring behaviour-related risk factors have shorter healthy life expectancy and shorter chronic disease-free life expectancy. Population level reductions in smoking, physical inactivity and obesity could increase life-years lived in good health., (© The Author 2016. Published by Oxford University Press on behalf of the International Epidemiological Association.)

The Resilience for Eating and Activity Despite Inequality (READI) cohort was established to address the following two key aims: to investigate the pathways (personal, social and structural) by which socio-economic disadvantage influences lifestyle choices associated with obesity risk (physical inactivity, poor dietary choices) and to explore mechanisms underlying 'resilience' to obesity risk in socio-economically disadvantaged women and children. A total of 4349 women aged 18-46 years and 685 children aged 5-12 years were recruited from 80 socio-economically disadvantaged urban and rural neighbourhoods of Victoria, Australia, and provided baseline (T1: 2007-08) measures of adiposity, physical activity, sedentary and dietary behaviours; socio-economic and demographic factors; and psychological, social and perceived environmental factors that might impact on obesity risk. Audits of the 80 neighbourhoods were undertaken at baseline to provide objective neighbourhood environmental data. Three-year follow-up data (2010-11) have recently been collected from 1912 women and 382 children. Investigators welcome enquiries regarding data access and collaboration.

Background: More years of schooling is generally associated with better health. However, this association may be confounded by unobserved common prior causes such as inherited ability, personality such as patience, or early family circumstances. The twin fixed-effect approach can potentially address this problem by cancelling these factors between twin pairs. The purpose of this study is to identify the causal effects of education on health and health behaviours using a twin fixed-effect approach., Methods: We used twin data from the National Survey of Midlife Development in the United States, 1995-1996. The study population included 302 male [55.6% monozygotic (MZ) and 44.4% dizygotic (DZ)] and 387 female twin pairs (47.3% MZ and 52.7% DZ). A range of health outcomes [perceived global, physical and mental health, body mass index (BMI), waist circumference, waist-hip ratio, number of depressive symptoms] and health behaviours (smoking and physical activity) were examined among twin pairs who were discordant on years of schooling., Results: Among MZ twins, more years of education was associated with better perceived global health. For all other health outcomes/behaviours, the point estimates of the effect of education in the fixed-effect analyses suggested a weak protective association. Among DZ male twins, each additional year of schooling lowered the prevalence of smoking by 32% [odds ratio (OR): 0.68, 95% confidence interval (CI): 0.48-0.97] in the fixed-effect analysis., Conclusion: The widely reported associations between schooling and health outcomes/behaviours may not reflect causal relationships in every instance. Although low statistical power may explain some of the null associations, our twin fixed-effect analyses suggest that at least some cases of the education/health relationship reflect confounding by unobserved third variables.

Background: Although numerous studies of type A behaviour and risk of coronary heart disease (CHD) have been reported in the west (with mixed findings), few studies have been carried out in Asian populations., Methods: We examined prospectively the association between type A-behaviour and risk of CHD incidence within a cohort of 86 361 Japanese men and women aged 40-69 years. A total of 669 cases of newly diagnosed CHD occurred between the baseline questionnaire (1990-94) and the end of follow-up in January 2004., Results: We found no overall evidence of an association between type A and CHD incidence. The multivariate hazard ratio (HR) and 95% confidence intervals for CHD incidence in the highest vs lowest level of type A was 1.19 (0.94-1.51) overall. Contrary to expectation, Japanese men with lower levels of type A behaviour (lower levels of impatience, aggressiveness and competitiveness) appeared to be at significantly increased risk of CHD incidence (HR = 1.32; 95% CI 1.02-1.72). In contrast to men, there was insignificant but a tendency for reduced risk of CHD incidence (HR = 0.79, 95% CI 0.46-1.34) for women with lower levels of type A behaviour., Conclusions: Type A behaviour does not predict CHD incidence in the Japanese population. Among males, type B behavioural patterns appear to confer increased CHD risk. Our findings suggest that the cardio-toxic effect of type A behaviour is gender-specific and culturally contingent.

Background: Previous studies have indicated that married people have lower mortality and are generally healthier. Most previous studies have been cross-sectional and few studies investigated the effect of marital transition on health. With a prospective design and repeated measures of variables, we sought to analyse the temporal relation between marital transition and change in health behaviours., Methods: We followed up 80 944 women aged 46-71 for 4 years (1992-1996). All information was self-reported. We used multivariate-adjusted linear and logistic regression models to examine the impact of changes in marital status on concomitant changes in health behaviours, controlling for potential confounders and baseline health behaviours., Results: Compared with women who remained married, women who divorced/widowed had body mass index (BMI) decreases of 0.65 kg/m(2) (P < 0.001) and 0.44 kg/m(2) (P < 0.001), respectively. Compared with women who remained unmarried, women who remarried had an increase in mean BMI of 0.41 kg/m(2) (P < 0.001). Women who divorced increased physical activity by 1.23 metabolic equivalent hours (MET)/week (P = 0.07) compared with women who stayed married. Among non-smokers and past smokers, women who divorced/widowed had more than a twofold increased risk of relapsing/starting smoking (OR = 2.47, 95% CI: 1.56, 3.89; OR = 2.08, 95% CI: 1.56, 2.76, respectively) than women who stayed married. Divorced and widowed women had decreased vegetable intake relative to women who stayed married (-2.93 servings/week [P < 0.001] and -1.67 servings/week [P < 0.001], respectively)., Conclusions: These patterns suggest both health-damaging and health-promoting changes accompanying divorce and widowhood, and generally health-promoting changes following remarriage.

Objective: To determine the shape of the income-mortality association, before and after adjusting for confounding by other socioeconomic variables., Methods: Poisson regression analyses were conducted on 11.7 million years of follow-up of 25-59 year old New Zealand census respondents spanning four separate cohort studies (1981-1984, 1986-1989, 1991-1994, and 1996-1999)., Results: Mortality among low-income people was approximately two times that among high-income people. Adjustment for potential socioeconomic confounders (marital status, education, car access, and neighbourhood socioeconomic deprivation) halved the strength of the income-mortality association, but did not appreciably change the shape of the association. Further adjustment for labour force status largely removed the income-mortality association. The association of non-transformed income with mortality was non-linear, with a flattening out of the slope at higher incomes. Both the logarithm and rank of income appeared to have a better linear fit with the mortality rate, although the association of mortality with the logarithm of income flattened out notably at low incomes., Conclusions: Much, but not all, of the crude association of income with mortality could be due to confounding. Adjusting income-mortality associations for labour force status (also a proxy for health status) is problematic: on the one hand, it over-adjusts the association as poor health will be on the pathway from income to mortality; on the other hand, it appropriately adjusts for both confounding by labour force status and reverse causation whereby income changes as a result of poor health. Both logarithmic and rank transformations of income have a reasonable linear fit with income.

Background: The relationship between income inequality and health across US states has been challenged recently on grounds that this relationship may be confounded by the effect of racial composition, measured as the proportion of the state's population who are black., Methods: Using multilevel statistical models, we examined the association between state income inequality and poor self-rated health. The analysis was based on the pooled 1995 and 1997 Current Population Surveys, comprising 201 221 adults nested within 50 US states., Results: Controlling for the individual effects of age, sex, race, marital status, education, income, health insurance coverage, and employment status, we found a significant effect of state income inequality on poor self-rated health. For every 0.05-increase in the Gini coefficient, the odds ratio (OR) of reporting poor health increased by 1.39 (95% CI: 1.26, 1.51). Additionally controlling for the proportion of the state population who are black did not explain away the effect of income inequality (OR = 1.30; 95% CI: 1.15, 1.45). While being black at the individual level was associated with poorer self-rated health, no significant relationship was found between poor self-rated health and the proportion of black residents in a state., Conclusion: Our finding demonstrates that neither race, at the individual level, nor racial composition, as measured at the state level, explain away the previously reported association between income inequality and poorer health status in the US.

Background: Previous studies of job strain and coronary heart disease (CHD) in men have established job strain as a predictor of CHD risk. Despite the wealth of convincing evidence in men for an association between job strain and CHD, data in women remain sparse., Methods: We prospectively evaluated the relation between job strain and CHD risk in the Nurses' Health Study. In this analysis, we followed a sample of 35 038 US female nurses aged 46-71 years, who completed questions about job strain in 1992 and who were free of diagnosed CHD, stroke, and cancer at baseline. The main outcome measure was the incidence of CHD occurring between baseline (1 June 1992) and 31 May 1996., Results: During 4 years of follow-up, we documented 146 incident cases of CHD (108 non-fatal cases of myocardial infarction and 38 CHD deaths). No evidence was found for a relationship between job strain and risk of CHD. In multivariate analyses controlling for age, smoking, alcohol intake, body mass index, history of hypertension, diabetes mellitus, and other covariates, women in high strain jobs did not have an increased risk of CHD (relative risk [RR] = 0.71, 95% CI: 0.42-1.19) compared with women in low strain jobs. Neither women in passive jobs (RR = 1.08, 95% CI: 0.69-1.68) nor those in active jobs (RR = 0.91, 95% CI: 0.54-1.53) had an increased risk of CHD., Conclusions: Job strain was not related to an increase in the incidence of CHD in the present cohort of nurses.

Background: Major depression occurs more frequently among people of lower socioeconomic status (SES) and among females. Although the focus of considerable investigation, the development of SES and sex differences in depression remains to be fully explained. In this study, we test the hypotheses that low childhood SES predicts an increased risk of adult depression and contributes to a higher risk of depression among females., Methods: Participants were 1132 adult offspring of mothers enrolled in the Providence, Rhode Island site of the US National Collaborative Perinatal Project between 1959 and 1966. Childhood SES, indexed by parental occupation, was assessed at the time of participants' birth and seventh year. A lifetime history and age at onset of major depressive episode were ascertained via structured interviews according to diagnostic criteria. Survival analyses were used to model the likelihood of first depression onset as a function of childhood SES., Results: Participants from lower SES backgrounds had nearly a twofold increase in risk for major depression compared to those from the highest SES background independent of childhood sociodemographic factors, family history of mental illness, and adult SES. Analyses of sex differences in the effect of childhood SES on adult depression provided modest support for the hypothesis that childhood SES contributes to adult sex differences in depression., Conclusions: Low SES in childhood is related to a higher risk of major depression in adults. Social inequalities in depression likely originate early in life. Further research is needed to identify the pathways linking childhood conditions to SES differences in the incidence of major depression.

Coronary heart disease (CHD) is regarded as a disease of developed 'western' societies. Within developed societies, however, CHD is typically a disease of the less affluent socioeconomic classes. This has not always been the case. Forty years ago. CHD was reported to be more common among the upper social classes. In New Zealand, as in other developed countries, this original trend across social classes was reversed during the past 40 years. In 1975-1977, a gradient across social class was observed for both CHD and cerebrovascular disease mortality, with the lowest social classes experiencing the highest mortality. This study has now been repeated for the period 1985-1987. Employed males aged 15-64 years were categorized by the Elley-Irving scale into six social classes. The overall age-standardized mortality rate from CHD declined over the ten-year period, from 163.0 to 121.7 per 100,000 person-years. Over the same period, however, the social class gradient for coronary mortality actually increased. The overall age-standardized mortality rate from cerebrovascular disease also declined over the ten-year period, from 25.9 to 17.7 per 100,000 person-years. A social class gradient for cerebrovascular mortality was present in both periods. In contrast to coronary mortality, however, the social class gradient diminished slightly over the ten-year period.