L'associazione tra fumo di tabacco e crisi economiche in Italia.

OBJECTIVES: to analyse the association between smoking behaviour and economic crises in Italy between 1993 and 2015. DESIGN: ecological study, carried out on data of the Italian National Institute of Statistics, by means of fixed-effect panel regressions. SETTING AND PARTICIPANTS: the rate of smoking prevalence (disaggregated by gender and age) and the unemployment rate (disaggregated by gender and referring to individuals aged 15 or more) were collected for each of the twenty Italian regions. Also, percentage fluctuations of the national real gross domestic product (GDP) were collected to identify the years of severe economic crisis. MAIN OUTCOME MEASURES: number of people who smoke per 100 people with the same features. RESULTS: among men, increased regional unemployment rate was associated with increased smoking behaviour only in the group aged 25-34 years. Differently, severe economic crises were associated with increased smoking in almost all age groups, except for men aged 15-24 years. A 1-point decrease in GDP was associated with 0.75 more smokers aged 15 years or more. The highest coefficient was reported among men aged 35-44 years, where a 1-point decrease in GDP was associated with 1.16 more smokers (every 100 men). This age group is also featured by the second highest prevalence of tobacco smoking (36.8%). Among women, a 1-point increase in the regional unemployment rate was associated with 0.08 less smokers every 100 women. Similarly, periods of severe economic crisis at national level were associated with reduced smoking behaviour among women aged 15 years or more, specifically those aged 15-24 years. Differently, women aged 25-34 and 65 years or more showed an association similar to that reported among men. In these groups, a 1-point decrease in GDP was associated with 0.67 and 1.08 more smokers every 100 women. While among the latter the prevalence of tobacco smoking is the lowest, among the former it is the third highest prevalence (21.69%). Therefore, increased smoking behaviour due to economic crises seems to occur especially among women aged 25-35 years old, as happens among men. CONCLUSIONS: men in almost all age groups and women aged 25-34 and 65 years or more represent vulnerable groups in which smoking behaviour may increase in times of economic hardship. Therefore, specific policies should be implemented to prevent this occurrence, as well as the negative health outcomes of tobacco smoking.

Impact of the economic crisis on health-related behaviors in Italy.

BACKGROUND: Evidence exists supporting the impact of the Great Recession on health-related behaviors internationally, though few studies are available concerning the Italian population. AIM: To assess the impact of the late 2000s economic crisis on health-related behaviors linked to population mental health in Italy. METHODS: Descriptive study. Health indicators came from the Italian Institute of Statistics database (years 2000-2015). Statistics performed by means of linear regression models. RESULTS: Increased smokers (ß = 1.68, p = .03), heavy smokers, that is, people smoking 11-20 cigarettes per day (ß = 2.18, p = .04) or more than 20 cigarettes per day (ß = 1.04, p < .01) and mean number of smoked cigarettes per day (ß = 0.56, p = .02) were noticeable. Also, prevalence of overweight increased (ß = 0.91, p = .04), while the Italian families' expenditure for alcoholic beverages decreased (ß = -812.80, p = .01). Alcohol consumption decreased (ß = -0.60, p < .01), especially in men (ß = -0.95, p < .01); binge drinking increased in years 2009-2010. No change was noticeable in the diet indicators collected. CONCLUSION: The economic crisis may have increased smoking, overweight and binge drinking in Italy (though data on the latter phenomenon are not conclusive), and reduced overall alcohol consumption.

The Potential Impact of the Transatlantic Trade and Investment Partnership (TTIP) on public health.

This article aims to examine the potential health effects of the Transatlantic Trade and Investment partnership (TTIP). Our review indicates that, although proponents of the TTIP claim that the treaty will produce benefits to health-enhancing determinants such as economic growth and employment, evidence shows that previous trade liberalization policies are associated with increasing economic inequities. By reducing Technical Barriers to Trade (TBT) and by promoting increased cooperation between US and EU governmental agencies in the pharmaceutical sector, the TTIP could result in improved research cooperation and reduced duplication of processes. However, the TTIP chapter on Intellectual Property (IP) and Trade-Related Aspects of Intellectual Property Rights (TRIPS) that expand and extend patent monopolies, and delay the availability of generic drugs, are likely to cause underutilization of needed medications among vulnerable populations. The TTIP's Investor to State Dispute Settlement (ISDS) arbitration system, a mechanism that allows transnational companies (TNCs) to sue governments when a policy or law reduces the value of their investment, is likely to generate a negative impact on regulations aimed at increasing access to healthcare, and reducing tobacco, alcohol consumption, and diet-related diseases. The Sanitary and Phytosanitary Standards (SPS) of the TTIP is expected to weaken regulations in the food and agricultural sectors especially in the EU, with potentially negative effects on food safety and foodborne diseases. Finally, the ISDS is likely to infringe the ability of governments to tackle environmental problems such as climate change deemed to be the most important global health threat of the century. Our review concludes by discussing policy implications and the effect of the TTIP on democracy, national sovereignty and the balance of power between large TNCs and governments. It also discusses the adoption of an evidence-based precautionary principle approach in dealing with the health impact of Free Trade Agreements (FTAs) as well as the harmonization of regulations, norms, and standards toward stronger health and environmental protection.

National trends in main causes of hospitalization: a multi-cohort register study of the finnish working-age population, 1976-2010.

BACKGROUND: The health transition theory argues that societal changes produce proportional changes in causes of disability and death. The aim of this study was to identify long-term changes in main causes of hospitalization in working-age population within a nation that has experienced considerable societal change. METHODOLOGY: National trends in all-cause hospitalization and hospitalizations for the five main diagnostic categories were investigated in the data obtained from the Finnish Hospital Discharge Register. The seven-cohort sample covered the period from 1976 to 2010 and consisted of 3,769,356 randomly selected Finnish residents, each cohort representing 25% sample of population aged 18 to 64 years. PRINCIPAL FINDINGS: Over the period of 35 years, the risk of hospitalization for cardiovascular diseases and respiratory diseases decreased. Hospitalization for musculoskeletal diseases increased whereas mental and behavioral hospitalizations slightly decreased. The risk of cancer hospitalization decreased marginally in men, whereas in women an upward trend was observed. CONCLUSIONS/SIGNIFICANCE: A considerable health transition related to hospitalizations and a shift in the utilization of health care services of working-age men and women took place in Finland between 1976 and 2010.

Perceived teacher unfairness and headache in adolescence: a cross-national comparison.

OBJECTIVES: The present study examines the prevalence of headache in early adolescents in 21 European and North-American countries and the role of perceived teacher unfairness in predicting this health complaint across different countries. METHODS: Data were taken from the "Health Behaviour in School-aged Children" study (HBSC), a World Health Organization cross-national survey on health behaviors in 11-, 13- and 15-year-old students. Headache and perceived teacher unfairness were measured through a self-administered questionnaire filled out by 115,212 adolescents. RESULTS: The overall prevalence of frequent headaches (at least once a week) was 28.8%, ranging from 18.9% in Slovenia to 49.4% in Israel. After adjusting for gender, grade, family affluence, school achievement, being bullied and lifestyles (drinking, smoking, eating and physical activity), teacher unfairness showed a significant association with frequent headache in all but two countries (Ukraine and Luxembourg). CONCLUSIONS: Our results show that headache is a common health symptom in European and North-American countries, even though there are substantial differences in its prevalence across countries. The study indicates that perceived teacher unfairness can be a significant predictor of frequent headache during adolescence, and this association is consistent across countries.

Organisational justice and cognitive function in middle-aged employees: the Whitehall II study.

BACKGROUND: Little is known about the role that work-related factors play in the decline of cognitive function. This study examined the association between perceived organisational justice and cognitive function among middle-aged men and women. METHODS: Perceived organisational justice was measured at phases 1 (1985-8) and 2 (1989-90) of the Whitehall II study when the participants were 35-55 years old. Assessment of cognitive function at the screening clinic at phases 5 (1997-9) and 7 (2003-4) included the following tests in the screening clinic: memory, inductive reasoning (Alice Heim 4), vocabulary (Mill Hill), and verbal fluency (phonemic and semantic). Mean exposure to lower organisational justice at phases 1 and 2 in relation to cognitive function at phases 5 and 7 were analysed using linear regression analyses. The final sample included 4531 men and women. RESULTS: Lower mean levels of justice at phases 1 and 2 were associated with worse cognitive function in terms of memory, inductive reasoning, vocabulary and verbal fluency at both phases 5 and 7. These associations were independent of covariates, such as age, occupational grade, behavioural risks, depression, hypertension and job strain. CONCLUSIONS: This study suggests an association between perceived organisational justice and cognitive function. Further studies are needed to examine whether interventions designed to improve organisational justice would affect employees' cognition function favourably.

Negative aspects of close relationships as a predictor of increased body mass index and waist circumference: the Whitehall II study.

OBJECTIVES: We investigated whether exposure to negative aspects of close relationships was associated with subsequent increase in body mass index (BMI) and waist circumference. METHODS: Data came from a prospective cohort study (Whitehall II) of 9425 civil servants aged 35 to 55 years at baseline (phase 1: 1985-1988). We assessed negative aspects of close relationships with the Close Persons Questionnaire (range 0-12) at phases 1 and 2 (1989-1990). We measured BMI and waist circumference at phases 3 (1991-1994) and 5 (1997-1999). Covariates at phase 1 included gender, age, marital status, ethnicity, BMI, employment grade, smoking, physical activity, fruit and vegetable consumption, and common mental disorder. RESULTS: After adjustment for sociodemographic characteristics and health behaviors, participants with higher exposure to negative aspects of close relationships had a higher likelihood of a 10% or greater increase in BMI and waist circumference (odds ratios per 1-unit increase 1.08 [95% confidence interval (CI) =1.02, 1.14; P = .007] and 1.09 [CI = 1.04, 1.14; P ≤ .001], respectively) as well as a transition from the overweight (25 ≤ BMI  < 30) to the obese (BMI  ≥ 0) category. CONCLUSIONS: Adverse social relationships may contribute to weight gain.

Association of CRP and IL-6 with lung function in a middle-aged population initially free from self-reported respiratory problems: the Whitehall II study.

To assess whether two inflammatory markers, C-reactive protein (CRP) and interleukin-6 (IL-6), and change in their concentrations over 12 years, are associated with lung function (FVC and FEV(1)) 12 years after baseline. Data are from over 1,500 participants free from self-reported respiratory problems in a large-scale prospective cohort study of white-collar male and female civil servants. CRP and IL-6 measured at baseline (1991-1993) and follow-up (2002-2004) and FVC and FEV(1), measured at follow-up. Results adjusted for sociodemographic and anthropometric characteristics, health behaviours, biological factors, chronic conditions and medications, and corrected for short-term variability in CRP and IL-6 concentrations. Higher baseline levels of CRP and IL-6 were strongly associated with lower FVC and FEV(1), independent of potential confounders. A 10% increase serum CRP from baseline to follow-up was associated with lower values of FVC and FEV(1) at follow-up, 4.7 and 3.0 ml, respectively. The corresponding values for a 10% increase in IL-6 were 12.6 ml for FVC and 7.3 ml for FEV(1). Systemic low-grade inflammation is associated with only slightly poorer pulmonary function in a population free from self-reported respiratory problems 12 years earlier. These data provide evidence linking inflammation to adverse outcomes beyond cardiovascular disease. Interventions targeting inflammation may prevent lung function impairment.

Adolescent smoking risk increases with wider income gaps between rich and poor.

Data from a state-wide survey of California middle and high school students (N=20,203) were used to assess whether county income inequality and poverty rates were associated with adolescent smoking. Greater county income inequality, but not poverty rates, was associated with higher established smoking risk (p=0.0019). The association was stronger in males than females, whites than other ethnic groups, and urban than rural settings. Neither county income inequality nor poverty rates were associated with experimental smoking. The findings suggest that it may be important to consider and address economic inequality in the prevention and control of adolescent tobacco use.

Organisational justice and markers of inflammation: the Whitehall II study.

OBJECTIVES: Low organisational justice has been shown to be associated with increased risk of various health problems, but the underlying mechanisms remain unclear. We tested whether organisational injustice contributes to chronic inflammation in a population of middle-aged men and women. METHODS: This prospective cohort study uses data from 3205 men and 1204 women aged 35-55 years at entry into the Whitehall II study (phase 1, 1985-1988). Organisational justice perceptions were assessed at phase 1 and phase 2 (1989-1990) and circulating inflammatory markers C-reactive protein (CRP) and interleukin (IL)-6 at phase 3 (1991-1993) and phase 7 (2003-2004). RESULTS: In men, low organisational justice was associated with increased CRP levels at both follow-ups (phase 3 and 7) and increased IL-6 at the second follow-up (phase 7). The long term (phase 7) associations were largely independent of covariates, such as age, employment grade, body mass index and depressive symptoms. In women, no relationship was found between organisational justice and CRP or IL-6. CONCLUSIONS: This study suggests that organisational injustice is associated with increased long-term levels of inflammatory markers among men.

Work-place social capital and smoking cessation: the Finnish Public Sector Study.

AIMS: To examine whether high social capital at work is associated with an increased likelihood of smoking cessation in baseline smokers. DESIGN: Prospective cohort study. SETTING: Finland. PARTICIPANTS: A total of 4853 employees who reported to be smokers in the baseline survey in 2000-2002 (response rate 68%) and responded to a follow-up survey on smoking status in 2004-2005 (response rate 77%). MEASUREMENTS: Work-place social capital was assessed using a validated and psychometrically tested eight-item measure. Control variables included sex, age, socio-economic position, marital status, place of work, heavy drinking, physical activity, body mass index and physician-diagnosed depression. FINDINGS: In multi-level logistic regression models adjusted for all the covariates, the odds for being a non-smoker at follow-up were 1.26 [95% confidence interval (CI)=1.03-1.55] times higher for baseline smokers who reported high individual-level social capital than for their counterparts with low social capital. In an analysis stratified by socio-economic position, a significant association between individual-level social capital and smoking cessation was observed in the high socio-economic group [odds ratio (OR) (95% CI)=1.63 (1.01-2.63)], but not in intermediate [(OR=1.10 (0.83-1.47)] or low socio-economic groups [(OR=1.28 (0.86-1.91)]. Work unit-level social capital was not associated with smoking cessation. CONCLUSIONS: If the observed associations are causal, these findings suggest that high perceived social capital at work may facilitate smoking cessation among smokers in higher-status jobs.

Positive and negative affect and risk of coronary heart disease: Whitehall II prospective cohort study.

OBJECTIVE: To examine the associations between positive and negative affect and subsequent coronary heart disease events independently of established risk factors. DESIGN: Prospective cohort study with follow-up over 12 years. SETTING: 20 civil service departments originally located in London. PARTICIPANTS: 10,308 civil servants aged 35-55 years at entry into Whitehall II study in 1985. MAIN OUTCOME MEASURES: Fatal coronary heart disease, clinically verified incident non-fatal myocardial infarction, and definite angina (n=619, mean follow-up 12.5 years). RESULTS: In Cox regression analysis adjusted for age, sex, ethnicity, and socioeconomic position, positive affect (hazard ratio=1.01, 95% confidence interval 0.82 to 1.24) and the balance between positive and negative affect, referred to as the affect balance score (hazard ratio=0.89, 0.73 to 1.09), were not associated with coronary heart disease. Further adjustment for behaviour related risk factors (smoking, alcohol consumption, daily fruit and vegetable intake, exercise, body mass index), biological risk factors (hypertension, blood cholesterol, diabetes), and psychological stress at work did not change these results. However, participants in the highest third of negative affect had an increased incidence of coronary events (hazard ratio=1.32, 1.09 to 1.60), and this association remained unchanged after adjustment for multiple confounders. CONCLUSIONS: Positive affect and affect balance did not seem to be predictive of future coronary heart disease in men and women who were free of diagnosed coronary heart disease at recruitment to the study. A weak positive association between negative affect and coronary heart disease was found and needs to be confirmed in further studies.

Unfairness and the social gradient of metabolic syndrome in the Whitehall II Study.

OBJECTIVES: Little work has investigated the relationship between unfairness and risk factors for heart disease. We examine the role of unfairness in predicting the metabolic syndrome and explaining the social gradient of the metabolic syndrome. METHODS: The design is a prospective study with an average follow-up of 5.8 years. Participants were 4128 males and 1715 females of 20 civil service departments in London (Whitehall II study). Sociodemographics, unfairness, employment grade, behavioral risk factors, and other psychosocial factors were measured at baseline (Phase 3, 1991-1993). Waist circumference, triglycerides, high-density lipoprotein (HDL) cholesterol, fasting glucose, and hypertension were used to define metabolic syndrome at follow-up (Phase 5, 1997-2000), according to the National Cholesterol Education Program/Adult Treatment Panel III guidelines. RESULTS: Unfairness is positively associated with waist circumference, hypertension, triglycerides, and fasting glucose and negatively associated with serum HDL cholesterol. High levels of unfairness are also associated with the metabolic syndrome [odds ratio (OR)=1.72, 95% CI=1.31-2.25], after adjustment for age and gender. After additional adjustment for employment grade, behavioral risk factors, and other psychosocial factors, the relationship between high unfairness and metabolic syndrome weakened but remained significant (OR=1.37, 95% CI=1.00-1.93). When adjusting for unfairness, the social gradient of metabolic syndrome was reduced by approximately 10%. CONCLUSION: Unfairness may be a risk factor for the metabolic syndrome and its components. Future research is needed to study the biological mechanisms linking unfairness and the metabolic syndrome.

Negative aspects of close relationships and heart disease.

BACKGROUND: The aims of the study were to (1) analyze the association between negative aspects of close relationships and increased risk for coronary heart disease and (2) examine whether the association is stronger among women and people of lower social position. METHODS: Prospective cohort study of 9011 British civil servants (6114 men and 2897 women). Negative aspects of close relationships and other social support measures (confiding/emotional and practical) were assessed with the Close Persons Questionnaire during phase 2 (1989-1990) or phase 1 (1985-1988). Associations between negative aspects of close relationships and incident coronary events were determined during an average follow-up period of 12.2 years. Covariates included sociodemographic characteristics (age, sex, marital status, and employment grade), biological factors (obesity, hypertension, diabetes mellitus, and cholesterol level), psychosocial factors (negative affectivity, depression, and work stress), and health behaviors (smoking, alcohol intake, exercise, and fruit and vegetable consumption). RESULTS: After adjustment for sociodemographic characteristics, biological factors, and other dimensions of social support, individuals who experienced negative aspects of close relationships had a higher risk of incident coronary events (hazard ratio, 1.34; 95% confidence interval, 1.10-1.63). The association was attenuated but remained statistically significant after additional adjustment for negative affectivity and depression (hazard ratio, 1.25; 95% confidence interval, 1.02-1.55). Although women and men in a lower employment grade were more likely to be exposed to negative aspects of close relationships, sex and social position had no statistically significant interaction effects. Confiding/emotional and practical support were not associated with incident coronary events. CONCLUSION: Adverse close relationships may increase the risk of heart disease.

Unfairness and health: evidence from the Whitehall II Study.

OBJECTIVE: To examine the effects of unfairness on incident coronary events and health functioning. DESIGN: Prospective cohort study. Unfairness, sociodemographics, established coronary risk factors (high serum cholesterol, hypertension, obesity, exercise, smoking and alcohol consumption) and other psychosocial work characteristics (job strain, effort-reward imbalance and organisational justice) were measured at baseline. Associations between unfairness and incident coronary events and health functioning were determined over an average follow-up of 10.9 years. PARTICIPANTS: 5726 men and 2572 women from 20 civil service departments in London (the Whitehall II Study). MAIN OUTCOME MEASURES: Incident fatal coronary heart disease, non-fatal myocardial infarction and angina (528 events) and health functioning. RESULTS: Low employment grade is strongly associated with unfairness. Participants reporting higher levels of unfairness are more likely to experience an incident coronary event (HR 1.55, 95% CI 1.11 to 2.17), after adjustment for age, gender, employment grade, established coronary risk factors and other work-related psychosocial characteristics. Unfairness is also associated with poor physical (OR 1.46, 95% CI 1.20 to 1.77) and mental (OR 1.54, 95% CI 1.19 to 1.99) functioning at follow-up, controlling for all other factors and health functioning at baseline. CONCLUSIONS: Unfairness is an independent predictor of increased coronary events and impaired health functioning. Further research is needed to disentangle the effects of unfairness from other psychosocial constructs and to investigate the societal, relational and biological mechanisms that may underlie its associations with health and heart disease.

The lack of social gradient of health behaviors and psychosocial factors in Northern Italy.

OBJECTIVES: To examine inequalities in health behaviors and psychosocial factors in Northern Italy. METHODS: The study was based on a computer-assisted telephone interview (CATI) of 4 002 non-institutionalized adults living in the Veneto region of Italy. RESULTS: Cigarette smoking, binge drinking, fruit and vegetables consumption and stress failed to show a social gradient. Only physical activity was significantly associated with social class. Stress was a significant predictor of physical inactivity, smoking and low fruit and vegetable intake. Lack of emotional support was associated with smoking and physical inactivity among males, and low fruit and vegetable intake for both genders. CONCLUSIONS: Three proposed explanations may account for the lack of consistent social gradient of health behaviors in Northern Italy: a) socio-economic context; b) uncompleted epidemiological transition of behavioral risk factors across social classes; c) lack of systematic health promotion efforts. Future research is needed to examine the plausibility of such explanations.