environmental epidemiological associations of psychosomatic symptoms of 7–11 year old children,...
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Environmental epidemiological associationsEnvironmental epidemiological associations
of psychosomatic symptomsof psychosomatic symptoms
of 7–11 year old children,of 7–11 year old children,Hungary, 1997–2002Hungary, 1997–2002
Mihály János Varró, Zoltán Virágh, Péter RudnaiMihály János Varró, Zoltán Virágh, Péter Rudnai
Fodor József National Center of Public HealthFodor József National Center of Public Health
National Institute for Environmental Health,National Institute for Environmental Health,
Budapest, HungaryBudapest, Hungary
"NEW CHALLENGES OF ENVIRONMENTAL HEALTH" "NEW CHALLENGES OF ENVIRONMENTAL HEALTH"
Meeting of theMeeting of the Central and Eastern European Chapter Central and Eastern European Chapter of theof the
International Society for Environmental EpidemiologyInternational Society for Environmental Epidemiology
Budapest, Hungary, 9–11 June 2005Budapest, Hungary, 9–11 June 2005
ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
IntroductionIntroduction
In a survey series, In a survey series,
data on data on
– – respiratory/other respiratory/other symptomssymptoms,,
– – demographic demographic (gender, age, settlemenet type)(gender, age, settlemenet type),,
– – hereditary, perinatal, hereditary, perinatal, environmentalenvironmental,,
–– lifestyle, social, etc. lifestyle, social, etc. factors factors
of of 7–11 year old children7–11 year old children were collected were collected
by highly by highly standardised questionnairesstandardised questionnaires in Hungary. in Hungary.
ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
ObjectiveObjective
To assess To assess associationsassociations
between between environmental factors environmental factors andand
psychosomatic symptomspsychosomatic symptoms of school children. of school children.
ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
Methods 1.Methods 1.
““Psychosomatic symptom”Psychosomatic symptom”::
at least one symptom out of at least one symptom out of
– – fatigue fatigue
– – headache headache
– – irritability irritability
– – anxietyanxiety
ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
Methods 2.Methods 2.Data processingData processing
– – Data entry:Data entry: Epi Info 6.0xEpi Info 6.0x
– – Analysis:Analysis: Stata 7.0Stata 7.0
–– Crude Crude odds ratiosodds ratios (cORs)(cORs)
–– Adjusted odds ratios Adjusted odds ratios (aORs): (aORs):
– – in a validatedin a validated logistic regressionlogistic regression
backward modelbackward model
– – fix adjustment w. that modelfix adjustment w. that model
–– 95% confidence intervals (95% confidence intervals (95% CI95% CI))
ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
ResultsResults
Psychosomatic symptomsPsychosomatic symptoms (n=13 973; (n=13 973; 28.9%28.9%))
ModelModel (n=9461)(n=9461)– – Gender, age, town Gender, age, town
– – Parents’ any respiratory/allergic illnessParents’ any respiratory/allergic illness
– – Child’s serious chest illness (0–2 y)Child’s serious chest illness (0–2 y)
– – Use of the kitchen gas cooker for additional heatingUse of the kitchen gas cooker for additional heating
– – Mouldy flat; >20 cigarettes/day smoked in the flatMouldy flat; >20 cigarettes/day smoked in the flat
– – Mothers’educationMothers’education
Pseudo-RPseudo-R22= 5.2%; = 5.2%; Hosmer-Lemeshow p=0.558Hosmer-Lemeshow p=0.558
Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby gender, age and settlement typeby gender, age and settlement type
Hungary, 1997–2002Hungary, 1997–2002
Girls Boys 7y 8y 9y 10y 11y Girls Boys 7y 8y 9y 10y 11y Towns VillagesTowns VillagesAge of the childAge of the child
%%4040
3030
2020
1010
00
ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
DEMOGRAPHIC FACTORSDEMOGRAPHIC FACTORS
Boys vs. girlsBoys vs. girls (n=9461; (n=9461; 50.0%50.0%))aOR=1.05,aOR=1.05, 95% CI=0.96–1.16 95% CI=0.96–1.16
AgeAge (n=9461; (n=9461; --))aORaOR1y raise1y raise==1.18***1.18***, 95% CI=1.12–1.24, 95% CI=1.12–1.24
Town/county of villageTown/county of village (n=9461; (n=9461; --) )
Living in villagesLiving in villages (n=9461; (n=9461; 23.1%23.1%))aOR=aOR=1.34***1.34***, , 95% CI=1.20–1.49 95% CI=1.20–1.49
(adjusted not to town/county of village)(adjusted not to town/county of village)
Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby questionnaire completing and by questionnaire completing and
parents’ respiratory-allergic illnessparents’ respiratory-allergic illness Hungary, 1997–2002 Hungary, 1997–2002
-- + + - +- + Father completes qesFather completes qes Parents’ resp.-allergic illness Parents’ resp.-allergic illness
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1010
00
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ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
OTHEROTHER
Only father completes Only father completes the questionnairethe questionnaire (n=9285; (n=9285; 5.1%5.1%))aOR=aOR=0.57***0.57***, 95% CI=0.43–0.74, 95% CI=0.43–0.74
PARENTS’ ILLNESSESPARENTS’ ILLNESSES
...any respiratory-allergic illness...any respiratory-allergic illness (n=9461; (n=9461; 20.9%20.9%))aOR=aOR=1.57***1.57***, 95% CI=1.38–1.77, 95% CI=1.38–1.77
- +- + - + - + -- + + Threatened Postponed labourThreatened Postponed labour Chest illness Chest illness pregnancy pregnancy (0–2y) (0–2y)
Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby perinatal conditionsby perinatal conditions
Hungary, 1997–2002 Hungary, 1997–2002
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ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
PERINATALPERINATAL
Threatened pregnancyThreatened pregnancy (n=9186; (n=9186; 19.7%19.7%))aOR=aOR=1.59***1.59***, 95% CI=1.42–1.79, 95% CI=1.42–1.79
Postponed labourPostponed labour (n=9305; (n=9305; 9.5%9.5%))aOR=aOR=1.59***1.59***, 95% CI=1.42–1.79, 95% CI=1.42–1.79
Serious chest illness of the childSerious chest illness of the child (n=9461; (n=9461; 22.1%22.1%))during the first two years of lifeduring the first two years of lifeaOR=aOR=1.73***1.73***, 95% CI=1.56–1.92, 95% CI=1.56–1.92
-- + + - +- + - + - + - - + + Gas cooker Mould Heavy Gas cooker Mould Heavy Agricult. airborneAgricult. airborne addit. heating addit. heating ETS ETS sprays sprays
Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby environmental factorsby environmental factors
Hungary, 1997–2002 Hungary, 1997–2002
7070
6060
5050
4040
3030
2020
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ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
ENVIRONMENTAL FACTORSENVIRONMENTAL FACTORS
Use of the kitchen gas cookerUse of the kitchen gas cookerfor additional heatingfor additional heating (n=9461; (n=9461; 5.1%5.1%))aOR=aOR=1.80***1.80***, 95% CI=1.47–2.21, 95% CI=1.47–2.21
Mouldy flat Mouldy flat (n=9461; (n=9461; 24.4%24.4%))aOR=aOR=1.61***1.61***, 95% CI=1.44–1.79, 95% CI=1.44–1.79
>20 cigarettes/day >20 cigarettes/day smoked in the flatsmoked in the flat (n=9461; (n=9461; 4.1%4.1%))aOR=aOR=2.16***2.16***, 95% CI=1.64–2.84, 95% CI=1.64–2.84
Reported house or garden exposure Reported house or garden exposure to agricult. airborne spraysto agricult. airborne sprays (n=1606; (n=1606; 7.2%7.2%))aOR=aOR=1.78**1.78**, 95% CI=1.19–2.66, 95% CI=1.19–2.66
(practically in one survey only)(practically in one survey only)
<<0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 5 6 0 1 2 3 4 5 6 >>4 0–3 4 0–3 hrs sleeping defic. hrs television/day hrs sport/week hrs sleeping defic. hrs television/day hrs sport/week
Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby lifestyle factorsby lifestyle factors
Hungary, 1997–2002 Hungary, 1997–2002
8080
7070
6060
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ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
LIFESTYLELIFESTYLE
Sleeping deficiency, SDSleeping deficiency, SD (n=9066; (n=9066; --))((ifif sleeping hours [SH] sleeping hours [SH]<<1010 thenthen SD=10–SH SD=10–SH elseelse SD=0) SD=0)aORaOR1h raise1h raise==1.17***1.17***, , 95% CI=1.09–1.2595% CI=1.09–1.25
Watching televisionWatching television (n=8838; (n=8838; --))(hours/day, max. 6 hours)(hours/day, max. 6 hours)aORaOR1h raise1h raise==1.10***1.10***, , 95% CI=1.04–1.1695% CI=1.04–1.16
Sport: 0Sport: 0––3 hours/week3 hours/week (n=6828; (n=6828; 77.8%77.8%))aOR=aOR=1.43***1.43***, , 95% CI=1.24–1.6495% CI=1.24–1.64
-- + + >8 ys >8 ys <<8 ys8 ys Every dayEvery day Mother school classes Mother school classes chocolate-sweetschocolate-sweets
Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby chocolate-sweets consumption and by chocolate-sweets consumption and
mother’s educationmother’s education Hungary, 1997–2002 Hungary, 1997–2002
5050
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ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
Eating chocolate… every dayEating chocolate… every day (n=1846; (n=1846; 29.0%29.0%))aOR=aOR=1.49***1.49***, 95% CI=1.21–1.84, 95% CI=1.21–1.84
SOCIAL FACTORSSOCIAL FACTORS
Mother with low education Mother with low education (n=9461; (n=9461; 15.8%15.8%))((<<8 elementary school classes)8 elementary school classes)aOR=aOR=1.37***1.37***, 95% CI=1.20–1.57, 95% CI=1.20–1.57
0 1 2 3 4 50 1 2 3 4 5 m m
Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby number of regression model factorsby number of regression model factors
Hungary, 1997–2002 Hungary, 1997–2002
100100 9090 8080 7070 6060 5050 4040 3030 2020 1010 00
%%
ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
NUMBER OF REGRESSION MODEL FACTORSNUMBER OF REGRESSION MODEL FACTORS
+1, if parents: any respiratory-allergic illness+1, if parents: any respiratory-allergic illness
+1, if child: serious chest illness (0–2 y)+1, if child: serious chest illness (0–2 y)
+1, if use of the kitchen gas cooker for additional heating+1, if use of the kitchen gas cooker for additional heating
+1, if mouldy flat+1, if mouldy flat
+1, if >20 cigarettes/day smoked in the flat+1, if >20 cigarettes/day smoked in the flat
mm (n=9461; (n=9461; --))aORaORraise in mraise in m==1.62***1.62***, 95% CI=1.55–1.72, 95% CI=1.55–1.72
(adjusted to gender, age and town)(adjusted to gender, age and town)
ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
Conclusions 1.Conclusions 1.
The The environmental factors environmental factors
(found to be associated (found to be associated
with respiratory symptoms)with respiratory symptoms)
had had strong associationsstrong associations
with with psychosomatic symptomspsychosomatic symptoms, too., too.
ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
Conclusions 2.Conclusions 2.
– – Living in villages Living in villages
– – Only father completes the questionnaireOnly father completes the questionnaire
– – Threatened pregnancy, postponed labourThreatened pregnancy, postponed labour
– – Sleeping deficiency, television seeing, sport, Sleeping deficiency, television seeing, sport,
eating chocolate-sweets every dayeating chocolate-sweets every day
ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
Conclusions 3.Conclusions 3.
Validated backward logistic regression model Validated backward logistic regression model
– – Use of the kitchen gas cooker Use of the kitchen gas cooker
for additional heating: for additional heating: aOR=aOR=1.80***1.80***
– – Mouldy flat:Mouldy flat: aOR=aOR=1.61***1.61***
– – >20 cigarettes/day smoked in the flat:>20 cigarettes/day smoked in the flat: aOR=aOR=2.16***2.16***
–– Reported house or garden exposure Reported house or garden exposure
to agricultural airborne sprays:to agricultural airborne sprays: aOR=aOR=1.78**1.78**
„„Fodor József” NCPH NIEH Fodor József” NCPH NIEH DEPT. COMMUNITY HEALTHDEPT. COMMUNITY HEALTH
Annamária Mácsik, Tamás Rudnai, Eszter Szabó, Annamária Mácsik, Tamás Rudnai, Eszter Szabó, Renáta Szentmihályi, Györgyi TóthRenáta Szentmihályi, Györgyi Tóth
National Public Health and Medical Officer ServiceNational Public Health and Medical Officer ServiceAll collabourating colleaguesAll collabourating colleagues
SCHOOLS, MUNICIPALITIES, HEALTH SERVICESSCHOOLS, MUNICIPALITIES, HEALTH SERVICES directorship of schools, class leaders, maires, directorship of schools, class leaders, maires,
youth and district nursesyouth and district nurses
FAMILIESFAMILIES parents, childrenparents, children
ThanksThanks
Thank you for your Thank you for your
attention!attention!
ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005
E-mail: [email protected]: [email protected]