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A life course perspective on health in childhood and adulthood with special focus on health effects of smoking

Hansen, Kristina LU (2015) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2015:109.
Abstract (Swedish)
Popular Abstract in Swedish

Enligt Världshälsoorganisationen (WHO) är en god hälsa ett "tillstånd av fullständigt fysiskt, socialt och mentalt välbefinnande, och inte enbart avsaknad av sjukdom eller funktionshinder". Vår hälsa påverkas under hela vår levnad av en mängd faktorer såsom exempelvis våra gener, biologiska faktorer, sociodemografiska faktorer, beteendefaktorer och livsstil samt miljöfaktorer. Det stora flertalet studier av orsaker till ohälsa och sjuklighet i den vuxna befolkningen har fokuserat på riskfaktorer i vuxen ålder. Senare års studier har dock kunnat visa att även faktorer tidigt i livet - under fostertiden, barnaåren, tonåren och unga vuxenlivet – har betydelse för individens hälsa senare i livet.... (More)
Popular Abstract in Swedish

Enligt Världshälsoorganisationen (WHO) är en god hälsa ett "tillstånd av fullständigt fysiskt, socialt och mentalt välbefinnande, och inte enbart avsaknad av sjukdom eller funktionshinder". Vår hälsa påverkas under hela vår levnad av en mängd faktorer såsom exempelvis våra gener, biologiska faktorer, sociodemografiska faktorer, beteendefaktorer och livsstil samt miljöfaktorer. Det stora flertalet studier av orsaker till ohälsa och sjuklighet i den vuxna befolkningen har fokuserat på riskfaktorer i vuxen ålder. Senare års studier har dock kunnat visa att även faktorer tidigt i livet - under fostertiden, barnaåren, tonåren och unga vuxenlivet – har betydelse för individens hälsa senare i livet. Rökning är en sådan riskfaktor som har visats kunna påverka uppkomsten och utvecklingen av ohälsa långt senare i livet, men även under olika skeden av livet. I Sverige har andelen rökare minskat under de senaste 40 åren och idag röker 9 % av vuxna män och 11 % av vuxna kvinnor dagligen. Trots detta är rökning den riskfaktor efter högt blodtryck som bidrar mest till den totala sjukdomsbördan i Sverige. Tre av fyra artiklar i denna avhandling studerar rökningens effekter på hälsan med fokus på rökning och rökexponering under olika skeden av livet och hur tidigare exponering för rökning påverkar hälsan senare i livet. De empiriska underlagen utgjordes av data från en enkät som delades ut i anslutning till 4-årskontrollen på BVC, data från Malmö Kost Cancer studiens kardiovaskulära kohort, data från Folkhälsoenkät Barn och Unga 2012 respektive Folkhälsoenkät Skåne 2008.

Syftet med den första studien var att studera sambandet mellan tidig exponering för passiv rökning och förekomst av allergi vid 4-års ålder. Resultaten visade att allergiutveckling bland 4-åringarna var betydligt vanligare om barnet hade minst en allergisk förälder. Det fanns även ett samband mellan tidig exponering för passiv rökning och allergiutveckling bland barn med allergiska föräldrar. Även tidigare studier har visat på samband mellan passiv rökning tidigt i livet och allergiutveckling.

Syftet med den andra studien var att undersöka sambanden mellan aktiv rökning, tidigare rökning och passiv rökning och tillväxttakten av åderförkalkningsförändringar i halsartären (mätt med ultraljud). Resultaten visade att progressionstakten ökade med ökande rökexponering oberoende av andra riskfaktorer såsom exempelvis höga blodfetter, högt blodtryck eller diabetes. Dessa effekter kunde inte förklaras av traditionella riskfaktorer eller låggradig inflammation. Bland tidigare rökare sågs dessutom en tydlig sänkning av tillväxttakten av åderförkalkningsförändringar efter mer än 5 år sedan rökstopp.

I den tredje artikeln studerades den självskattade hälsan bland ungdomar i gymnasiets årskurs två i relation till rökvanor och rökdebut (före respektive efter 14 års ålder). Under de tidiga tonåren sker stora fysiska och känslomässiga förändringar i kroppen och det kan teoretiskt vara så att den snabbt växande kroppen är mer sårbar för skadlig exponering såsom exempelvis rökning. Resultaten visade att både nuvarande och tidigare rökare skattade sin hälsa sämre än icke rökare. Sämst självskattad hälsa sågs hos rökare och tidigare rökare som börjat röka före 14 års ålder. Bland pojkar sågs en sådan dålig självskattad hälsa även efter rökstopp. Endast en del av skillnaderna i dålig självskattad hälsa kunde förklaras av skillnader i hälsorelaterade beteenden, sociodemografiska och psykosociala faktorer. Resultaten bör dock konfirmeras i prospektiva studier.

Syftet med den fjärde artikeln var att undersöka tre olika socioekonomiska livsförloppsteorier, nämligen ackumulationsteorin, kritisk periodteorin och sociala mobilitetsteorin. Resultaten visade ett samband mellan ackumulerad ekonomisk stress (barndomen och vuxenlivet) och dålig självskattad hälsa som vuxen. En social mobilitet uppåt var förknippad med en bättre självskattad hälsa, medan en social mobilitet nedåt var förknippad med en sämre självskattad hälsa. Exponering för ekonomisk stress i barndomen eller i vuxenlivet var båda associerade med dålig självskattad hälsa i vuxenlivet oberoende av varandra. Slutsatsen i studien är att ackumulationsteorin och den sociala mobilitetsteorin bekräftades. Den kritiska periodmodellen bekräftades så till vida att såväl ekonomisk stress i barndomen som vuxenlivet hade effekter på dålig självskattad hälsa i vuxenlivet. Dock bekräftades den inte om man avser att en specifik period (barndom eller vuxenlivet) skulle ha en starkare inverkan än den andra på självskattad hälsa.

Resultaten från denna avhandling understryker att hälsan i en viss ålder påverkas av exempelvis livsstil, sociodemografiska och psykosociala faktorer, men också av exponeringar tidigare i livet. Resultaten pekar även på behovet av ett fortsatt arbete för att förebygga och minska rökning och rökexponering redan i tidig ålder. Att kunna identifiera särskilt sårbara perioder för riskexponering ökar möjligheten till tidiga preventiva insatser. Framtida longitudinella studier i unga kohorter med långa uppföljningstider och ett flertal mätpunkter är önskvärda för att ytterligare öka kunskapen om betydelsen av riskexponering under olika skeden av livet. (Less)
Abstract
Abstract: The complexity of health relates to the interplay between numerous factors, e.g., biological and genetic factors, sociodemographic factors, life-style, environmental factors as well as health care services, all possibly acting throughout the life-course. While earlier health theories mainly have focused on adult life style as causes of adult ill-health, life-course research has in recent years emerged focusing also on earlier life experiences aiming to understand the biological, behavioural and psychosocial factors shaping the development of health and ill-health throughout the life-course and across generations. Smoking is a factor influencing the onset and development of poor health in all stages of life, with far-reaching... (More)
Abstract: The complexity of health relates to the interplay between numerous factors, e.g., biological and genetic factors, sociodemographic factors, life-style, environmental factors as well as health care services, all possibly acting throughout the life-course. While earlier health theories mainly have focused on adult life style as causes of adult ill-health, life-course research has in recent years emerged focusing also on earlier life experiences aiming to understand the biological, behavioural and psychosocial factors shaping the development of health and ill-health throughout the life-course and across generations. Smoking is a factor influencing the onset and development of poor health in all stages of life, with far-reaching health consequences for the unborn child as well as for the full grown adult. Smoking has been causally associated with both short and long-term adverse health effects, but has less often been investigated from a life-course perspective and especially not so among children and adolescents. Furthermore, the knowledge on the association between socioeconomic position and health has in recent years expanded through a broad life-course approach using different conceptual models. In this thesis, health in childhood and adulthood was investigated from a life-course perspective focusing on health effects of smoking. Paper one investigated the association between exposure to secondhand tobacco smoke at an early age and presence of allergic disease in 4 year old children in Malmö, Sweden (n=4278). Paper two investigated the long-term associations between smoking habits, environmental tobacco smoke exposure and progression of carotid intima-media thickening (IMT) and change in lumen diameter reduction due to plaque protrusion in various segments of the carotid artery (n=2992). Paper three investigated self-rated health (SRH) among second grade high school students related to age at smoking initiation (<14 years of age and ≥14 years of age) among current and former smokers, compared to never smokers. Furthermore, in paper four, socioeconomic differences in adult self-rated health was investigated using three socioeconomic life-course models, i.e., critical periods, accumulation of risk and social mobility models, using the participants in the 2008 public health survey in Skåne (n=28198) as the study population. Three out of the four studies were cross-sectional, but with retrospective information on smoking exposure, initiation of smoking and socioeconomic circumstances, respectively. The results showed that children exposed to secondhand tobacco smoke early in life had increased odds of allergic disease later in childhood if at least one parent had an allergic disease (Paper I). Furthermore, progression of IMT and rate of lumen diameter reduction due to carotid plaque protrusion was shown to increase from never smokers through former, moderate and heavy smokers, even after adjustment for traditional risk factors (Paper II). In second grade high school students, early smoking initiation was shown to be associated with poor self-rated health both among current and former smokers (Paper III). Regarding socioeconomic differences in adult self-rated health, the results in Paper IV showed a graded association between the combined effect of childhood and adulthood economic stress and poor SRH in accordance with the accumulation hypothesis. Furthermore, upward social mobility showed a protecting effect, while downward mobility increased odds ratios of poor SRH. The critical period hypothesis was confirmed in the sense that both economic stress in childhood and adulthood had independent effects on poor adult self-rated health. However, it was not confirmed in the sense that a particular window in time had a specifically high impact on self-rated health. In conclusion, the results from this thesis emphasise that health at a certain age is affected by current exposure e.g., life-style, sociodemographic and psychosocial factors, but, that also previous exposures are of importance. Future research should continue the difficult work with establishing causal links and temporal directions between exposure and health over the life-course. The collection of data from various periods in life allows the identification of effects of exposure during specific time periods on a specific outcome. Such knowledge may in turn be used in prevention and intervention. Future prospective cohort studies from early life, may contribute to such increased knowledge of lifelong health determinants, through more detailed assessments of exposure during different stages in life. The results from the thesis further emphasise the need for a continued work to prevent and decrease smoking. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • professor Due, Pernille, Statens Institut for Folkesundhed, Syddansk Universitet, Köpenhamn
organization
publishing date
type
Thesis
publication status
published
subject
keywords
secondhand smoke, smoking, allergies, atherosclerosis, self-rated health, economic stress, life-course perspective
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2015:109
pages
70 pages
publisher
Social Medicine and Health Policy
defense location
Lilla Aulan, Jan Waldenströms gata 5, Skånes universitetssjukhus, Malmö
defense date
2015-12-04 09:00
ISSN
1652-8220
ISBN
978-91-7619-188-0
language
English
LU publication?
yes
id
56515919-08bd-4149-8a4c-a8df3a82b151 (old id 8165744)
date added to LUP
2015-11-16 15:51:19
date last changed
2016-09-19 08:44:47
@phdthesis{56515919-08bd-4149-8a4c-a8df3a82b151,
  abstract     = {Abstract: The complexity of health relates to the interplay between numerous factors, e.g., biological and genetic factors, sociodemographic factors, life-style, environmental factors as well as health care services, all possibly acting throughout the life-course. While earlier health theories mainly have focused on adult life style as causes of adult ill-health, life-course research has in recent years emerged focusing also on earlier life experiences aiming to understand the biological, behavioural and psychosocial factors shaping the development of health and ill-health throughout the life-course and across generations. Smoking is a factor influencing the onset and development of poor health in all stages of life, with far-reaching health consequences for the unborn child as well as for the full grown adult. Smoking has been causally associated with both short and long-term adverse health effects, but has less often been investigated from a life-course perspective and especially not so among children and adolescents. Furthermore, the knowledge on the association between socioeconomic position and health has in recent years expanded through a broad life-course approach using different conceptual models. In this thesis, health in childhood and adulthood was investigated from a life-course perspective focusing on health effects of smoking. Paper one investigated the association between exposure to secondhand tobacco smoke at an early age and presence of allergic disease in 4 year old children in Malmö, Sweden (n=4278). Paper two investigated the long-term associations between smoking habits, environmental tobacco smoke exposure and progression of carotid intima-media thickening (IMT) and change in lumen diameter reduction due to plaque protrusion in various segments of the carotid artery (n=2992). Paper three investigated self-rated health (SRH) among second grade high school students related to age at smoking initiation (&lt;14 years of age and ≥14 years of age) among current and former smokers, compared to never smokers. Furthermore, in paper four, socioeconomic differences in adult self-rated health was investigated using three socioeconomic life-course models, i.e., critical periods, accumulation of risk and social mobility models, using the participants in the 2008 public health survey in Skåne (n=28198) as the study population. Three out of the four studies were cross-sectional, but with retrospective information on smoking exposure, initiation of smoking and socioeconomic circumstances, respectively. The results showed that children exposed to secondhand tobacco smoke early in life had increased odds of allergic disease later in childhood if at least one parent had an allergic disease (Paper I). Furthermore, progression of IMT and rate of lumen diameter reduction due to carotid plaque protrusion was shown to increase from never smokers through former, moderate and heavy smokers, even after adjustment for traditional risk factors (Paper II). In second grade high school students, early smoking initiation was shown to be associated with poor self-rated health both among current and former smokers (Paper III). Regarding socioeconomic differences in adult self-rated health, the results in Paper IV showed a graded association between the combined effect of childhood and adulthood economic stress and poor SRH in accordance with the accumulation hypothesis. Furthermore, upward social mobility showed a protecting effect, while downward mobility increased odds ratios of poor SRH. The critical period hypothesis was confirmed in the sense that both economic stress in childhood and adulthood had independent effects on poor adult self-rated health. However, it was not confirmed in the sense that a particular window in time had a specifically high impact on self-rated health. In conclusion, the results from this thesis emphasise that health at a certain age is affected by current exposure e.g., life-style, sociodemographic and psychosocial factors, but, that also previous exposures are of importance. Future research should continue the difficult work with establishing causal links and temporal directions between exposure and health over the life-course. The collection of data from various periods in life allows the identification of effects of exposure during specific time periods on a specific outcome. Such knowledge may in turn be used in prevention and intervention. Future prospective cohort studies from early life, may contribute to such increased knowledge of lifelong health determinants, through more detailed assessments of exposure during different stages in life. The results from the thesis further emphasise the need for a continued work to prevent and decrease smoking.},
  author       = {Hansen, Kristina},
  isbn         = {978-91-7619-188-0},
  issn         = {1652-8220},
  keyword      = {secondhand smoke,smoking,allergies,atherosclerosis,self-rated health,economic stress,life-course perspective},
  language     = {eng},
  pages        = {70},
  publisher    = {Social Medicine and Health Policy},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {A life course perspective on health in childhood and adulthood with special focus on health effects of smoking},
  volume       = {2015:109},
  year         = {2015},
}