Indiana University-Purdue University Indianapolis (IUPUI) / Background: Firefighters are exposed to carcinogens, toxic agents, and other risks for cancer and cardiovascular disease. Research shows that aero-digestive and genitourinary cancers are in excess among firefighters compared to the general population. Studies examining excess cardiovascular mortality are inconsistent. Limited data exist on chronic disease mortality, risk factor profiles, and barriers to a healthy lifestyle among firefighters at the local level. Purpose: This project examines the relationship between firefighting and chronic disease mortality, determines trajectories of cardiovascular risk factors in a cohort of new firefighters, and studies the relationship between barriers to weight management and firefighter health characteristics. Methods: This study used death certificate data from the Indiana State Department of Health and clinical data from a large occupational medical practice serving firefighters. Regression techniques were used to examine excess mortality among firefighters compared to non-firefighters, evaluate changes in cardiovascular disease risk factors among new firefighters over time, and explore correlates of risk factors and barriers to weight management among overweight and obese firefighters. Results: The odds of death due to malignant cancers were significantly higher among firefighters than non-firefighters (OR, 1.19; 95% CI, 1.08-1.30). Body mass index, total cholesterol, LDL cholesterol, and triglyceride levels increased significantly (p<0.001) while HDL cholesterol levels decreased (p<0.001) from baseline during the first 10 years of the firefighter’s career. Overweight firefighters who were “ready to begin a weight management program” were more likely to identify ‘‘lack of knowledge about weight management,’’ ‘‘lack of access to exercise opportunities,’’ and ‘‘eating helps me cope with stress’’ as barriers, and report a greater number of barriers to weight management. Older firefighters were less likely to identify or report one or more barriers to weight management. Conclusion: These studies suggest the importance of early-career and targeted cardiometabolic health and cancer prevention strategies to reduce chronic disease morbidity and mortality among firefighters. / 2021-06-28

Gender and socioeconomic inequalities in health are ubiquitous in developed countries; however, the modifying effect of gender on the relationship between socioeconomic position (SEP) and health over time is less clear. The potentially different health effects of changes in SEP on changes in health for working-age women and men are examined over a 10-year period. Three main questions are addressed: (1) are there gender differences in health over time, (2) do changes in SEP lead to health inequalities and (3) do changes in SEP impact health differently for women and men? Generalized estimating equations (GEE) were used to analyze the Canadian National Population Health Survey for four measures of health, number of chronic conditions, self-rated health, functional health, and psychological distress, and three measures of SEP, income, education and employment status. Men and women in this nationally-representative sample of Canadians do not differentially embody changes in SEP, though both gender and SEP independently impact health.

Available data from the quinquennial Infant Feeding Surveys (IFS) show that breastfeeding rates in Great Britain (GB) rose steadily between 1985 and 2010. However, the rates of breastfeeding continuation and exclusivity remain relatively low, and there is evidence that breastfeeding in public may still be considered unacceptable by many in GB. To date, no study has examined the reasons behind the increase in breastfeeding rates between 1985 and 2010, and the factors which influence women's practice of breastfeeding in public in GB remain under-researched. Therefore, this DPhil research aimed to investigate whether the increase in breastfeeding rates in the first six weeks after childbirth in GB between 1985 and 2010 were driven by changes in the distribution of population characteristics, or changes in the differences in breastfeeding behaviours between subgroups of women. It also aimed to investigate the factors which influenced the practice of breastfeeding in public in GB in 1995 to 2010. Data from the IFS surveys in 1985 to 2010 were analysed to, firstly, describe and summarise the distribution of selected explanatory factors among the childbearing population of GB from 1985 to 2010. This was followed by an estimation of the independent effects of these explanatory factors on breastfeeding initiation, breastfeeding continuation at one week and at six weeks, and breastfeeding in public, in each survey year. There was an assessment of the changes over time in the effects of each factor on breastfeeding initiation, and on breastfeeding continuation at one week and at six weeks. This was followed by an examination of the extent to which changes in the distribution of factors among the childbearing population contributed to the increase in breastfeeding rates in the first six weeks in GB between 1985 and 2010. This DPhil research found no evidence of changes in the effects of factors on breastfeeding in the first six weeks between 1985 and 2010. This suggests that breastfeeding behaviours had not improved over time. At the same time, there were increases in the distribution of those factors which positively influence breastfeeding, suggesting that the increase in breastfeeding rates in the first six weeks between 1985 and 2010 were indeed attributable to population changes rather than improved breastfeeding behaviours. Additionally, breastfeeding in public was seemingly most influenced by women's perceptions of the normality and acceptability of breastfeeding in GB. There is a clear need for more equitable interventions to target the needs and perceptions of those women in GB who remain characteristically less likely to breastfeed.

Syftet med studien var att undersöka vad som motiverar olika åldersgrupper till att utföra gymträning. De valda åldersgrupperna var 16–21, 22–26 och 27–35. För att besvara syftet använde sig studien av två frågeställningar som handlade om hur deltagarna motiveras av samhällets kroppsideal och aktuella hälsotrender. Metoden som användes för undersökningen var en webbenkät med totalt 20 frågor varav 4 var öppna frågor. I undersökningen deltog totalt 56 personer med en jämn fördelning mellan alla grupper. Resultatet från denna studie visade att samtliga åldersgrupper blev motiverade till att gymträna för att de tycker att det är roligt och för att förbättra sin fysik. Åldersgruppen 16–21 var den grupp som var minst nöjda med sina kroppar och påverkades mest negativt av sociala medier även om alla åldersgrupper påverkades. Sociala medier visade sig även vara den största kanalen för hälsotrendernas spridning. Förslag på Vidare forskning är att se i hur stor utsträckning individers träning och hälsa påverkas av media och sociala medier. Ett annat förslag på vidare forskning skulle även kunna vara att undersöka om individers motiv till träning påverkas av hur länge individen varit fysisk aktiv.

No description available.

This thesis investigates gender differences in health and how they have changed between 1992 and 2002 among very old people. It explores gender differences in the association between disability and health, and gender differences in care utilization among our oldest old people. The studies are based on nationally representative data of the population in Sweden aged 77 and older (SWEOLD).  Results from Study I showed that women generally had more health problems than men. Analyses of change between 1992 and 2002 showed increased prevalence rates for both sexes, especially women. However, women’s reporting of poor global self-rated health did not increase. There were no gender differences and there was no change over time in activities of daily living (ADL). Several health indicators seem to be developing differently for women and men.  Study II showed that associations between ADL disability and other health indicators changed between 1992 and 2002, with several health problems and functional limitations becoming less disabling over time. This trend was especially true for women, while for men, the findings were mixed.  Study III found no gender differences in physician visits and dental visits, despite women’s worse health and dental status. Marriage was associated with more physician visits for men and dentist visits for women. Results imply that women and unmarried older adults may have unmet health-care needs.  Study IV examined whether the increase in life expectancy at age 65 observed between 1992 and 2002 consisted of years with or without musculoskeletal pain. Results showed that total years without pain decreased for both women and men, but more so for women. Women also had more years with pain added to life.  The results of this thesis suggest an increase of health problems, but not disability, in the oldest Swedish population. However, gender variations in the findings highlight the importance of analyzing health trends separately for women and men. / At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: In press. Paper 3: Manuscript. Paper 4: Submitted.

<p>This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+).</p><p>Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up.</p><p>Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults.</p><p>Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment.</p><p>The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.</p>

This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+). Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up. Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults. Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment. The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.