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  • 51.
    Kien, Vu Duy
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam.
    Van Minh, Hoang
    Giang, Kim Bao
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Horizontal inequity in public health care service utilization for non-communicable diseases in urban Vietnam2014Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, artikel-id 24919Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI) in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs). DESIGN: A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. RESULTS: The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. CONCLUSION: Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas.

  • 52. Kowal, Paul
    et al.
    Chatterji, Somnath
    Naidoo, Nirmala
    Biritwum, Richard
    Fan, Wu
    Lopez Ridaura, Ruy
    Maximova, Tamara
    Arokiasamy, Perianayagam
    Phaswana-Mafuya, Nancy
    Williams, Sharon
    Snodgrass, J Josh
    Minicuci, Nadia
    D'Este, Catherine
    Peltzer, Karl
    Boerma, J Ties
    Yawson, A
    Mensah, G
    Yong, J
    Guo, Y
    Zheng, Y
    Parasuraman, P
    Lhungdim, H
    Sekher, TV
    Rosa, R
    Belov, VB
    Lushkina, NP
    Peltzer, K
    Makiwane, M
    Zuma, K
    Ramlagan, S
    Davids, A
    Mbelle, N
    Matseke, G
    Schneider, M
    Tabane, C
    Tollman, Stephen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kahn, Kathy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ng, Nawi
    Juvekar, S
    Sankoh, O
    Debpuur, CY
    Nguyen, TK Chuc
    Gomez-Olive, FX
    Hakimi, M
    Hirve, Siddhivinayak
    Abdullah, S
    Hodgson, A
    Kyobutungi, C
    Egondi, T
    Mayombana, C
    Minh, HV
    Mwanyangala, MA
    Razzaque, A
    Wilopo, S
    Streatfield, PK
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Scholten, F
    Mugisha, J
    Seeley, J
    Kinyanda, E
    Nyirenda, M
    Mutevedzi, P
    Newell, M-L
    Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE)2012Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, nr 6, s. 1639-1649Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Population ageing is rapidly becoming a global issue and will have a major impact on health policies and programmes. The World Health Organization's Study on global AGEing and adult health (SAGE) aims to address the gap in reliable data and scientific knowledge on ageing and health in low- and middle-income countries. SAGE is a longitudinal study with nationally representative samples of persons aged 50+ years in China, Ghana, India, Mexico, Russia and South Africa, with a smaller sample of adults aged 18-49 years in each country for comparisons. Instruments are compatible with other large high-income country longitudinal ageing studies. Wave 1 was conducted during 2007-2010 and included a total of 34 124 respondents aged 50+ and 8340 aged 18-49. In four countries, a subsample consisting of 8160 respondents participated in Wave 1 and the 2002/04 World Health Survey (referred to as SAGE Wave 0). Wave 2 data collection will start in 2012/13, following up all Wave 1 respondents. Wave 3 is planned for 2014/15. SAGE is committed to the public release of study instruments, protocols and meta- and micro-data: access is provided upon completion of a Users Agreement available through WHO's SAGE website (www.who.int/healthinfo/systems/sage) and WHO's archive using the National Data Archive application (http://apps.who.int/healthinfo/systems/surveydata).

  • 53. Kowal, Paul
    et al.
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Centre for Global Health Research Umeå, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa and INDEPTH Network, Accra, Ghana.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Centre for Global Health Research Umeå, INDEPTH Network, Accra, Ghana and Purworejo HDSS, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Naidoo, Nirmala
    Abdullah, Salim
    Bawah, Ayaga
    Binka, Fred
    Chuc, Nguyen T K
    Debpuur, Cornelius
    Ezeh, Alex
    Xavier Gómez-Olivé, F
    Hakimi, Mohammad
    Hirve, Siddhivinayak
    Hodgson, Abraham
    Juvekar, Sanjay
    Kyobutungi, Catherine
    Menken, Jane
    Van Minh, Hoang
    Mwanyangala, Mathew A
    Razzaque, Abdur
    Sankoh, Osman
    Kim Streatfield, P
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Centre for Global Health Research Umeå.
    Wilopo, Siswanto
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Centre for Global Health Research Umeå.
    Chatterji, Somnath
    Tollman, Stephen M
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Centre for Global Health Research Umeå, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa and INDEPTH Network, Accra, Ghana.
    Ageing and adult health status in eight lower-income countries: the INDEPTH WHO-SAGE collaboration2010Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, nr Supplement 2, s. 11-22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Globally, ageing impacts all countries, with a majority of older persons residing in lower- and middle-income countries now and into the future. An understanding of the health and well-being of these ageing populations is important for policy and planning; however, research on ageing and adult health that informs policy predominantly comes from higher-income countries. A collaboration between the WHO Study on global AGEing and adult health (SAGE) and International Network for the Demographic Evaluation of Populations and Their Health in developing countries (INDEPTH), with support from the US National Institute on Aging (NIA) and the Swedish Council for Working Life and Social Research (FAS), has resulted in valuable health, disability and well-being information through a first wave of data collection in 2006-2007 from field sites in South Africa, Tanzania, Kenya, Ghana, Viet Nam, Bangladesh, Indonesia and India.

    Objective: To provide an overview of the demographic and health characteristics of participating countries, describe the research collaboration and introduce the first dataset and outputs. Methods: Data from two SAGE survey modules implemented in eight Health and Demographic Surveillance Systems (HDSS) were merged with core HDSS data to produce a summary dataset for the site-specific and cross-site analyses described in this supplement. Each participating HDSS site used standardised training materials and survey instruments. Face-to-face interviews were conducted. Ethical clearance was obtained from WHO and the local ethical authority for each participating HDSS site.

    Results: People aged 50 years and over in the eight participating countries represent over 15% of the current global older population, and is projected to reach 23% by 2030. The Asian HDSS sites have a larger proportion of burden of disease from non-communicable diseases and injuries relative to their African counterparts. A pooled sample of over 46,000 persons aged 50 and over from these eight HDSS sites was produced. The SAGE modules resulted in self-reported health, health status, functioning (from the WHO Disability Assessment Scale (WHODAS-II)) and well-being (from the WHO Quality of Life instrument (WHOQoL) variables). The HDSS databases contributed age, sex, marital status, education, socio-economic status and household size variables.

    Conclusion: The INDEPTH WHO-SAGE collaboration demonstrates the value and future possibilities for this type of research in informing policy and planning for a number of countries. This INDEPTH WHO- SAGE dataset will be placed in the public domain together with this open-access supplement and will be available through the GHA website (www.globalhealthaction.net) and other repositories. An improved dataset is being developed containing supplementary HDSS variables and vignette-adjusted health variables. This living collaboration is now preparing for a next wave of data collection.

  • 54.
    Krishnan, Anand
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Amarchand, Ritvik
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Pandav, Chandrakant
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    "No one says 'No' to money": a mixed methods approach for evaluating conditional cash transfer schemes to improve girl children's status in Haryana, India.2014Ingår i: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 13, nr 1, s. 11-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Haryana was the first state in India to launch a conditional cash transfer (CCT) scheme in 1994. Initially it targeted all disadvantaged girls but was revised in 2005 to restrict it to second girl children of all groups. The benefit which accrued at girl attaining 18 years and subject to conditionalities of being fully immunized, studying till class 10 and remaining unmarried, was increased from about US$ 500 to US$ 2000. Using a mixed methods approach, we evaluated the implementation and possible impact of these two schemes.

    METHODS: A survey was conducted among 200 randomly selected respondents of Ballabgarh Block in Haryana to assess their perceptions of girl children and related schemes. A cohort of births during this period was assembled from population database of 28 villages in this block and changes in sex ratio at birth and in immunization coverage at one year of age among boys and girls was measured. Education levels and mean age at marriage of daughters were compared with daughters-in-law from outside Haryana. In-depth interviews were conducted among district level implementers of these schemes to assess their perceptions of programs' implementation and impact. These were analyzed using a thematic approach.

    RESULTS: The perceptions of girls as a liability and poor (9% to 15%) awareness of the schemes was noted. The cohort analysis showed that while there has been an improvement in the indicators studied, these were similar to those seen among the control groups. Qualitative analysis identified a "conspiracy of silence" - an underplaying of the pervasiveness of the problem coupled with a passive implementation of the program and a clash between political culture of giving subsidies and a bureaucratic approach that imposed many conditionalities and documentary needs for availing of benefits.

    CONCLUSION: The apparent lack of impact on the societal mindset calls for a revision in the current approach of addressing a social issue by a purely conditional cash transfer program.

  • 55.
    Krishnan, Anand
    et al.
    Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
    Dwivedi, Purva
    Gupta, Vivek
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Pandav, Chandrakant S
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Socioeconomic development and girl child survival in rural North India: solution or problem?2013Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, nr 5, s. 419-426Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Socioeconomic development has been considered as a solution to the problem of sex differentials at birth and under-five mortality. This paper analyses longitudinal data from the Ballabgarh Health and Demographic Surveillance System (HDSS) site in north India to check its veracity.

    METHODS: A cohort of children born between 1 January 2006 and 31 December 2011 at Ballabgarh HDSS were followed till death, emigration, 3 years of age or end of the study. Socioeconomic status (SES) was measured by caste, parental combined years of schooling and wealth index and divided into low, mid and high strata for each of them. Sex ratio at birth (SRB) was reported as the number of girls per 1000 boys. The Kaplan-Meier survival curves were drawn and a Cox Proportional HR of girls over boys was estimated.

    RESULTS: A total of 12 517 native born children (25 797 child years) were enrolled of which 710 died (death rate of 56.7/1000-live births and 27.5/1000 child-years. Socioeconomically advantaged children had significantly lower death rates. The SRB (10-16% lower) and neonatal death rate were consistently adverse for girls in the advantaged groups by all the three indicators of SES. The first month survival rates were better for girls in the lower SES categories (significant only in caste (HR 0.58; 0.37 to 0.91). High SES categories consistently showed adverse survival rates for girls (HR of 1.22 to 1.59).

    CONCLUSIONS: Better socioeconomic situation worsened the sex differentials, especially at birth. Therefore, specific interventions targeting gender issues are required, at least as a short-term measure.

  • 56.
    Krishnan, Anand
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Chandrakant, S
    Kapoor, Suresh K
    Sex specific trends in under-five mortality in rural Ballabgarh2014Ingår i: Indian Pediatrics, ISSN 0019-6061, E-ISSN 0974-7559, Vol. 51, nr 1, s. 48-51Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We analyzed data from the electronic database of Health and Demographic Surveillance System (HDSS) site in Ballabgarh in North India to assess sex-specific differentials in child survival from 1992-2011. Sex ratio at birth was adverse for girls throughout the study period (821 to 866 girls per 1,000 boys) and was lowest in the period 2004-2006 at 821 girls per 1,000 boys. Overall, under-five mortality rates during the period 1992-2011 remained stagnant due to increasing neonatal mortality rate (9.2 to 27.7 P< 0.001). Mortality rates among girls were consistently and significantly higher than boys during the post-neonatal period (160% to 200% higher) as well as in childhood (160% to 230% higher). We recommend strategies to address the neonatal mortality and gender differences for further reductions in child mortality in India.

  • 57.
    Krishnan, Anand
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kapoor, Suresh K
    Pandav, Chandrakant S
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Temporal trends and gender differentials in causes of childhood deaths at Ballabgarh, India: need for revisiting child survival strategies2012Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, s. 555-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Relating Information on causes of deaths to implementation of health interventions provides vital information for program planning and evaluation. This paper from Ballabgarh Health and Demographic Surveillance System (HDSS) site in north India looks at temporal trends and gender differentials in the causes of death among under-five children.

    Methods: Data on causes of death for 1972-74, 1982-84, 1992-94, 2002-04 were taken from existing HDSS publications and database. Physicians' assigned causes of death were based on narratives by lay health worker till 1994 and later by verbal autopsy. Cause Specific Mortality Fractions (CSMF) and Cause Specific Mortality Rates (CSMR) per 1000 live births were calculated for neonatal (<1 month) and childhood (1-59 months) period. Gender difference was estimated by calculating ratio of CSMR between girls and boys. Available information on coverage of childhood interventions in the HDSS was retrieved and compiled.

    Results: The CSMF of prematurity and sepsis was 32% and 17.6% during neonatal period in 2002-04. The share of infections in all childhood deaths decreased from 55.2% in 1972-74 to 43.6% in 2002-04. All major causes of mortality (malnutrition, diarrhea and acute lower respiratory infection) except injuries showed a steep decline among children and seem to have plateued in last decade. Most of disease specific public health interventions were launched in mid eighties. Girls reported significantly higher mortality rates for prematurity (RR 1.52; 95% CI 1.01-2.29); diarrhea (2.29; 1.59 - 3.29), and malnutrition (3.37; 2.05 - 5.53).

    Conclusions: The findings of the study point out to the need to move away from disease-specific to a comprehensive approach and to address gender inequity in child survival through socio-behavioural approaches.

  • 58.
    Krishnan, Anand
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Srivastava, R
    Dwivedi, P
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Pandav, CS
    Non-specific sex-differential effect of DTP vaccination may partially explain the excess girl child mortality in Ballabgarh, India.2013Ingår i: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 18, nr 11, s. 1329-1337Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To test the hypothesis that a gender differential exists in the effect on child mortality of BCG, DTP, measles vaccine as administered under programme conditions in Ballabgarh HDSS area.

    METHODS: All live births in 28 villages of Ballabgarh block in North India from 2006 to 2011 were followed until 31 December 2011 or 36 months of age whichever was earlier. The period of analysis was divided into four time periods based on eligibility for vaccines under the national immunisation schedule (BCG for tuberculosis, primary and booster doses of diphtheria-tetanus-pertussis and measles). Cox proportional hazards regression was used to assess the association between sex and risk of mortality by vaccination status using age as the timescale in survival analysis and adjusting for wealth index, access to health care, the presence of a health facility in the village, parental education, type of family, birth order of the child and year of birth.

    RESULTS: 702 deaths (332 boys and 370 girls) occurred among 12 142 children in the cohort in the 3 years of follow-up giving a cumulative mortality rate of 57.5 per 1000 live births with 35% excess girl child mortality. Age at vaccination for the four vaccines did not differ by sex. There was significant excess mortality among girls after immunisation with DTP, for both primary (HR 1.65; 95% CI:1.17-2.32) and DTPb (2.21; 1.24-3.93) vaccinations. No significant excess morality among girls was noted after exposure to BCG 1.06 (0.67-1.67) or measles 1.34 (0.85-2.12) vaccine.

    CONCLUSION: This study supports the contention that DTP vaccination is partially responsible for higher mortality among girls in this study population.

  • 59. Kusuma, Dian
    et al.
    Kusumawardani, Nunik
    Ahsan, Abdillah
    K Sebayang, Susy
    Amir, Vilda
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    On the verge of a chronic disease epidemic: comprehensive policies and actions are needed in Indonesia2019Ingår i: International Health, ISSN 1876-3413, E-ISSN 1876-3405, Vol. 11, nr 6, s. 422-424Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In the midst of tackling the persistent burden of maternal mortality and infectious diseases, Indonesia is facing an increasing burden of non-communicable diseases (NCDs). Although there are increasing national efforts in NCD prevention and control, the worsening trend of NCD risk factors and morbidity is alarming. We provided assessment and discussion on the policies and actions needed in the country including comprehensive efforts to reduce tobacco use and unhealthy diet, the need to reorient the health systems for better NCD prevention and control, and the promotion of NCD-related research that are still lacking.

  • 60.
    Lestari, Septi K
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Ng, Nawi
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Kowal, Paul
    Santosa, Ailiana
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison2019Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 8, artikel-id 1341Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The low- and middle-income countries (LMICs) are experiencing rapid population ageing, yet knowledge about disability among older populations in these countries is scarce. This study aims to identify the prevalence and factors associated with disability among people aged 50 years and over in six LMICs. Cross-sectional data from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007-2010) in China, Ghana, India, Mexico, the Russian Federation, and South Africa was used. Multivariable logistic regression analyses were undertaken to examine the association between sociodemographic factors, health behaviours, chronic conditions, and activities of daily living (ADL) disability. The prevalence of disability among older adults ranged from 16.2% in China to 55.7% in India. Older age, multimorbidity, and depression were the most common factors related to disability in all six countries. Gender was significant in China (OR = 1.14, 95% CI: 1.01-1.29), Ghana (OR = 1.22, 95% CI: 1.01-1.48) and India (OR = 1.65, 95% CI: 1.37-1.99). Having no access to social capital was significantly associated with ADL disability in China (OR = 2.57, 95% CI: 1.54-4.31) and South Africa (OR = 4.11, 95% CI: 1.79-9.43). Prevalence data is valuable in these six ageing countries, with important evidence on mitigating factors for each. Identifying determinants associated with ADL disability among older people in LMICs can inform how to best implement health prevention programmes considering different country-specific factors.

  • 61.
    Lindahl, Bernt
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindvall, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nordin, Steven
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Näslund, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Persson, Amanda
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Vanoli, Davide
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Schulz, Peter J.
    Institute of Communication and Health, University of Lugano, Switzerland.
    Health literacy is independently and inversely associated with carotid artery plaques and cardiovascular risk2019Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: Health literacy, the degree to which individuals understand and act upon health information, may have a pivotal role in the prevention of cardiovascular disease (CVD), with low health literacy potentially explaining poorer adherence to prevention guidelines. We investigated the associations between health literacy, ultrasound-detected carotid atherosclerosis and cardiovascular risk factors.

    Methods: Baseline data (cross-sectional analysis) from a randomized controlled trial, integrated within the Västerbotten Intervention Program, Northern Sweden, was used. We included 3459 individuals, aged 40 or 50 years with ≥1 conventional risk factor or aged 60 years old. The participants underwent clinical examination, blood sampling, carotid ultrasound assessment of intima-media wall thickness (CIMT) and plaque formation, and answered a questionnaire on health literacy – the Brief Health Literacy Screen. The European Systematic Coronary Risk Evaluation and Framingham Risk Score were calculated.

    Results: About 20% of the participants had low health literacy. Low health literacy was independently associated with the presence of ultrasound-detected carotid artery plaques after adjustment for age and education, odds ratio (95% confidence interval) 1.54 (1.28–1.85), demonstrating a similar level of risk as for smoking. Health literacy was associated with CIMT in men. Low health literacy was associated with higher CVD risk scores. Sensitivity analyses with low health literacy set to 9% or 30% of the study sample, respectively, yielded essentially the same results.

    Conclusions: Low health literacy was independently associated with carotid artery plaques and a high level of CVD risk scores. Presenting health information in a fashion that is understood by all patients may improve preventive efforts.

  • 62.
    Minh, Hoang Van
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Bonita, Ruth
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hakimi, Mohammad
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Smoking epidemics and socio-economic predictors of regular use and cessation: Findings from WHO STEPS risk factor surveys in Vietnam and Indonesia2006Ingår i: Internet Journal of Epidemiology, ISSN 1540-2614, Vol. 3, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A population-based surveys were carried out in two demographic surveillance sites (DSSs) in Vietnam and Indonesia using the WHO STEPS approach to surveillance of non-communicable disease risk factors in order to characterize smoking epidemics in rural communities of Vietnam and Indonesia by identifying associations between socio-economic status and changes in smoking status among adult populations. The paper reveals that

    the prevalence of smoking among people aged 25-54 years was higher in Indonesia than in Vietnam. Indonesian men started smoking regularly earlier and ceased less than Vietnamese men. While low income was found to be a significant predictor of becoming regular smokers in Vietnam, old birth cohort and low education significantly increased the probability of being a regular smoker in Indonesia. Economic status was also found to be a significant predictor of smoking cessation in Vietnam while education and occupation played an important role in Indonesia

  • 63.
    Muindi, Kanyiva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Egondi, Thaddaeus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kimani-Murage, Elizabeth
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    "We are used to this": a qualitative assessment of the perceptions of and attitudes towards air pollution amongst slum residents in Nairobi2014Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, s. 226-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: People's perceptions of and attitudes towards pollution are critical for reducing exposure among people and can also influence the response to interventions that are aimed at encouraging behaviour change. This study assessed the perceptions and attitudes of residents in two slums in Nairobi regarding air pollution. Methods: We conducted focus group discussions with residents aged 18 years and above using an emergent design in the formulation of the study guide. A thematic approach was used in data analysis. Results: The discussions revealed that the two communities experience air pollution arising mainly from industries and dump sites. There was an apparent disconnect between knowledge and practice, with individuals engaging in practices that placed them at high risk of exposure to air pollution. Residents appear to have rationalized the situation in which they live in and were resigned to these conditions. Consequently, they expressed lack of agency in addressing prevalent air pollution within their communities. Conclusions: Community-wide education on air pollution and related health effects together with the measures needed to reduce exposure to air pollution are necessary towards reducing air pollution impacts. A similar city-wide study is recommended to enable comparison of perceptions along socio-economic groups and neighbourhoods.

  • 64.
    Muindi, Kanyiva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kimani, E
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lay perceptions of the health impacts of air pollution: voices from Nairobi's slums.Ingår i: Artikel i tidskrift (Refereegranskat)
  • 65.
    Muindi, Kanyiva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kimani-Murage, Elizabeth
    Egondi, Thaddaeus
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Household Air Pollution: Sources and Exposure Levels to Fine Particulate Matter in Nairobi Slums2016Ingår i: TOXICS, ISSN 2305-6304, Vol. 4, nr 3, artikel-id 12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    With 2.8 billion biomass users globally, household air pollution remains a public health threat in many low- and middle-income countries. However, little evidence on pollution levels and health effects exists in low-income settings, especially slums. This study assesses the levels and sources of household air pollution in the urban slums of Nairobi. This cross-sectional study was embedded in a prospective cohort of pregnant women living in two slum areasKorogocho and Viwandaniin Nairobi. Data on fuel and stove types and ventilation use come from 1058 households, while air quality data based on the particulate matters (PM2.5) level were collected in a sub-sample of 72 households using the DustTrak II Model 8532 monitor. We measured PM2.5 levels mainly during daytime and using sources of indoor air pollutions. The majority of the households used kerosene (69.7%) as a cooking fuel. In households where air quality was monitored, the mean PM2.5 levels were high and varied widely, especially during the evenings (124.6 mu g/m(3) SD: 372.7 in Korogocho and 82.2 mu g/m(3) SD: 249.9 in Viwandani), and in households using charcoal (126.5 mu g/m(3) SD: 434.7 in Korogocho and 75.7 mu g/m(3) SD: 323.0 in Viwandani). Overall, the mean PM2.5 levels measured within homes at both sites (Korogocho = 108.9 mu g/m(3) SD: 371.2; Viwandani = 59.3 mu g/m(3) SD: 234.1) were high. Residents of the two slums are exposed to high levels of PM2.5 in their homes. We recommend interventions, especially those focusing on clean cookstoves and lighting fuels to mitigate indoor levels of fine particles.

  • 66.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Chronic disease risk factors in a transitional country: the case of rural Indonesia2006Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: The epidemic of chronic diseases is largely neglected. Although a threatening burden of chronic diseases is emerging, developing public health efforts for their prevention and control is not yet a priority for trans-national and national health policy makers. Understanding the population burden of risk factors which predict chronic diseases is an important step in reducing the impact of the diseases themselves.

    Objective: This thesis responds to the increasing burden of chronic diseases worldwide, and aims to illustrate the gap in chronic disease risk factor research in developing countries. The thesis describes and analyses the distribution of chronic disease risk factors in a rural setting in Indonesia. It also describes how smoking, one of the most common risk factors, is viewed by rural Javanese boys. Ultimately, therefore, this thesis aims to contribute to policy and programme recommendations for community interventions in a rural setting in Indonesia

    Methods: The studies were conducted in Purworejo District, where a Demographic Surveillance System (DSS) has been running since 1994. The Purworejo DSS is part of the INDEPTH network (International Network of field sites for continuous Demographic Evaluation of Populations and Their Health in developing countries). Two representative cross-sectional studies (in 2001 and 2005) were conducted to assess the chronic disease risk factors (including smoking, elevated blood pressure, and overweight and obesity). The first cross-sectional study was followed up in 2002 and 2004. In each study, a total of 3 250 participants (approximately 250 individuals in each sex and age group among 15–74 year olds stratified into 10-year intervals) were randomly selected from the surveillance database from each enumeration area in the surveillance area. Instruments were adopted from the WHO STEPS survey and adapted to local setting. Since many Indonesians start to smoke at an earlier age, a qualitative study using a focus group discussion approach was conducted among school boys aged 13-17 years old to describe and explore beliefs, norms, and values about smoking in a rural setting in Java.

    Result: Both the rural and urban populations in Purworejo face an unequal distribution of risk factors for chronic diseases. The burden among the most well-off group in the rural area has already reached a level similar to that found in the urban area. Most of the risk factors increased in all age, sex and socioeconomic groups during the period of 2001 to 2005. However, women and the poorest group experienced the greatest increase in risk factor prevalence. The qualitative study showed that cultural resistance against women smoking in Indonesia remains strong. Smoking is being viewed as a culturally internalised habit that signifies transition into maturity and adulthood for boys. Smoking is utilised as a means for socialisation and signifies better socioeconomic status. The use of tobacco in the construction of masculinity underlines the importance of gender specific interventions. National tobacco control policy should emphasise a smoking free society as the norm, especially among boys and men, and regulations regarding the banning of smoking should be enforced at all levels and areas of the community.

    Within the demographic surveillance setting, it is possible to assess the population and health dynamics. Utilisation of a standardised methodology across sites in INDEPTH will produce comparable population-based data in developing countries. Such comparisons are important in global health. A comparison of smoking transition patterns between a Vietnamese DSS and an Indonesian DSS shows that Indonesian men started smoking regularly earlier and ceased less than Vietnamese men. Compared with Vietnam, which has already signed and ratified the Framework Convention on Tobacco Control, tobacco control activities in Indonesia are still deficient.

    Conclusion: The thesis concludes that the rural population is not spared from the emerging burden of chronic disease risk factors. The patterning of risks across different socioeconomic groups provides a macro picture of the vicious cycle between poverty and chronic diseases. Understanding of risk factors in a local context through a qualitative study provides insight into cultural aspects relating to risk factor adoption, and will allow the fostering and tailoring of culturally appropriate interventions. Combining data from demographic surveillance sites with the WHO STEP approach to chronic disease risk factor Surveillance addresses basic epidemiological questions on chronic diseases. The use of such data is a powerful advocacy tool in public health decision-making for chronic disease prevention in developing countries. With substantial existing evidence on the effectiveness of chronic disease prevention and intervention programmes, it is vital that Indonesia to starts planning intervention programmes to control the impending chronic disease epidemic, and most importantly, to translate all this evidence into public health action.

    Keywords: chronic disease, risk factor, demographic surveillance system, smoking, elevated blood pressure, overweight and obesity, population-based intervention

  • 67.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Global health action: surviving infancy and taking first steps2013Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, s. 22815-Artikel i tidskrift (Refereegranskat)
  • 68.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Trends of blood pressure levels and management in Västerbotten County, Sweden, during 1990-20102012Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, s. 1-12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Availability of longitudinal data on hypertension and blood pressure levels are important to assess changes over time at the population level. Moreover, detailed information in different population sub-groups is important to understand inequity and social determinants of blood pressure distribution in the population.

    Objectives: The objectives of this study are to: (1) describe the trends of population blood pressure levels in men and women between different educational levels and geographic areas in Sweden during 1990-2010; (2) identify prevalences of hypertension, awareness, treatment, and control in the population; and (3) assess the 10-year risk of developing hypertension among individuals with normal and high normal blood pressures.

    Methods: This study is based on data from the Vasterbotten Intervention Program (VIP) in Vasterbotten County, Sweden. The cross-sectional analysis includes 133,082 VIP health examinations among individuals aged 30, 40, 50, and 60 years from 1990 to 2010. The panel analysis includes 34,868 individuals who were re-examined 10 years after the baseline examination. Individuals completed a self-administered health questionnaire that covers demographic and socio-economic information, self-reported health, and lifestyle behaviours. Blood pressure measurement was obtained prior to the questionnaire. In the cross-sectional analysis, trends of blood pressure by sex, and between educational groups and geographic areas are presented. In the panel analysis, the 10-year risk of developing hypertension is estimated using the predicted probability from logistic regression analysis for each sex, controlling for age and educational level.

    Results: The prevalence of hypertension decreased from 1990 to 2010; from 43.8 to 36.0% (p<0.001) among men, and 37.6 to 27.5% among women (p<0.001). Individuals with basic education had a significantly higher prevalence of hypertension compared to those with medium or high education. Although the decreases were observed in all geographic areas, individuals in rural inland areas had a much higher prevalence compared to those who lived in Umea City. The proportion of hypertensive women who were aware of their hypertension (61.7%) was significantly higher than men (51.6%). About 34% of men and 42% of women with hypertension reported taking blood pressure medication. Over time, awareness and control of hypertension improved (from 46.5% in 1990 to 69% in 2010 and from 30 to 65%, respectively). The gaps between educational groups diminished. This study shows a significantly higher risk of developing hypertension for men and women with high normal blood pressure compared to those with normal blood pressure at baseline in all age cohorts and educational groups. The average risks of developing hypertension among men with high normal blood pressure were 21.5, 45.8, and 56.3% in the 30, 40, and 50-year cohorts, respectively. Corresponding numbers for women were 22.6, 47.4, and 57.9%.

    Conclusions: Levels of blood pressure and hypertension decreased significantly among the Vasterbotten population in the last 21 years. Hypertension management has improved and there is increased awareness, treatment, and control of blood pressure. Despite these achievements, the persisting social gaps in blood pressure levels and management demand further investigation and action from policy makers. Future research should attempt to identify and address the root causes of these health inequities to ensure better and equal health for the whole population.

  • 69.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Social capital and self-rated health in older population in lower- and upper- middle income countries in Africa and Asia2015Ingår i: Social capital as a health resource in later life: the relevance of context / [ed] Fredrica Nyqvist och Anna K. Forsman, Dordrecht: Springer Netherlands, 2015, s. 157-176Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    Evidence on how access to social capital influences health among older populations in lower- and middle-income countries (LMICs) is generally lacking. The existing evidence indicates that associations with health might be stronger for cognitive forms of social capital compared to structural forms. This chapter presents the comparative patterns of levels of individual social capital, and its association with self-rated health among older populations. Data from the WHO Study on global AGEing and adult health (SAGE) conducted in nationally representative samples of adults in China, Ghana, India, Mexico, the Russian Federation and South Africa were used. This study shows that (i) older men consistently reported better health than older women across the six countries; (ii) there is considerable gender heterogeneity in access to structural and cognitive social capital within each country and across the countries; and (iii) the associations between access to social capital and self-rated health differ between men and women within the same cultural context, as well as between cultural contexts across different countries. Access to bridging social capital and personal trust shows a positive and significant effect on self-rated health in both sexes, while access to bonding social capital and general trust have positive health effects only among women, and access to safety has a positive effect on health only among men. A better understanding of both individual and social determinants in the relationship between social capital and health in different settings is warranted and would allow for better-tailored public health recommendations for achieving health improvement in different settings.

  • 70.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Flygare Wallén, Eva
    Ahlström, Gerd
    Mortality patterns and risk among older men and women with intellectual disability: a Swedish national retrospective cohort study2017Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, artikel-id 269Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Sweden has closed all institutions and imposed legislation to ensure service and support for individuals with intellectual disability (ID). Understanding mortality among older individuals with ID is essential to inform development of health promotion and disease control strategies. We investigated patterns and risk of mortality among older adults with ID in Sweden.

    METHODS: This retrospective cohort study compared older adults aged 55 years and older with ID with a control population. Participants were followed during 2002-2015 or death, and censored if they moved out of Sweden. Individuals with ID were identified from two national registers: one covering all specialist health-care visits (out-patient visits and hospitalisation) and the other covering people accessing social/support services. Individuals with ID (n = 15,289) were matched with a control population by sex, birth year, and year of first hospitalisation/out-patient visit/access to LSS services. Cause-of-death data were recorded using International Classification of Diseases, Tenth Revision. Cox proportional hazards regression were conducted to assess if overall and cause-specific mortality rate among individuals with ID was higher than in the Swedish population.

    RESULTS: The overall mortality rate among individuals with ID was 2483 per 100,000 people compared with 810 in the control population. Among those who died, more individuals with ID were younger than 75 years and unmarried. Leading causes of death among individuals with ID were circulatory diseases (34%), respiratory diseases (17%) and neoplasms (15%). Leading causes of death in a sub-sample with Down syndrome (DS) were respiratory diseases (37%), circulatory diseases (26%) and mental/behavioural disorders (11%). Epilepsy and pneumonitis were more common among individuals with ID than controls. Alzheimer's disease was common in the control population and individuals with DS, but not among those with ID when DS was excluded. Individuals with ID had a higher overall mortality risk (hazard ratio [HR] 4.1, 95% confidence interval [CI] 4.0-4.3) and respiratory disease death risk (HR 12.5, 95% CI 10.9-14.2) than controls.

    CONCLUSION: Older adults with ID in Sweden carry a higher mortality risk compared with the general population, mainly attributable to respiratory, nervous and circulatory diseases. Care for this group, particularly during the terminal stage of illness, needs to be tailored based on understanding of their main health problem.

  • 71.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hakimi, M.
    Centre for Reproductive Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Wilopo, S.
    Centre for Reproductive Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Does education modify the association between self-rated health and mortality among older people in Indonesia?2011Ingår i: IEA World Congress of Epidemiology, 7–11 August 2011, Edinburgh International Conference Centre, Edinburgh, Scotland: Programme and abstracts, 2011, Vol. 65, s. A438-Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction: Evidences on whether poor self-reported health (SRH) predicts subsequent mortality across different socio-economic groups are inconsistent. This study assesses whether education modifies how poor SRH influences mortality among older people in Indonesia.

    Methods: A cohort of 11 753 men and women aged 50 years and over was recruited in the INDEPTH/WHO Study on Adult Health and Global Ageing (SAGE) in Purworejo Health and Demographic Surveillance (HDSS) site in 2007. SRH was measured using the single global SRH question with 5-point response scales (very good, good, moderate=moderately good SRH; bad, very bad=poor SRH). The baseline data were linked to the HDSS mortality data in 2010. HR for mortality was calculated for poor SRH using Cox proportional hazard regression after adjustment for age, education levels, age, marital status, living area, history of chronic diseases, and presence of disabilities.

    Results: During follow-up (median duration=37 months), 1199 deaths (10.2%) and 1.9% lost to follow-up were identified. Poor SRH increased the mortality risk in men (HR 3.59, 95% CI 1.96 to 6.57) and women (HR 3.16, 1.12 to 8.90). Education levels were not associated with mortality risk. The association between poor SRH and mortality did not differ across education groups, neither in men nor in women. Presence of disabilities, history of chronic diseases, and living alone increased the mortality risk.

    Conclusion: Poor SRH predicts mortality among older population in Indonesia. Education does not modify the association between poor SRH and mortality. Health promotion in the general population is important for the reduction of the mortality risk among older people.

  • 72.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hakimi, Mohammad
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wilopo, Siswanto
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Health and quality of life among older rural people in Purworejo District, Indonesia2010Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, nr Supplement 2, s. 78-87Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Increasing life expectancy and longevity for people in many highly populated low- and middleincome countries has led to an increase in the number of older people. The population aged 60 years and over in Indonesia is projected to increase from 8.4% in 2005 to 25% in 2050. Understanding the determinants of healthy ageing is essential in targeting health-promotion programmes for older people in Indonesia. Objective: To describe patterns of socio-economic and demographic factors associated with health status, and to identify any spatial clustering of poor health among older people in Indonesia. Methods: In 2007, the WHO Study on global AGEing and adult health (SAGE) was conducted among 14,958 people aged 50 years and over in Purworejo District, Central Java, Indonesia. Three outcome measures were used in this analysis: self-reported quality of life (QoL), self-reported functioning and disability, and overall health score calculated from self-reported health over eight health domains. The factors associated with each health outcome were identified using multivariable logistic regression. Purely spatial analysis using Poisson regression was conducted to identify clusters of households with poor health outcomes. Results: Women, older age groups, people not in any marital relationship and low educational and socioeconomic levels were associated with poor health outcomes, regardless of the health indices used. Older people with low educational and socio-economic status (SES) had 3.4 times higher odds of being in the worst QoL quintile (OR=3.35; 95% CI=2.73-4.11) as compared to people with high education and high SES. This disadvantaged group also had higher odds of being in the worst functioning and most disabled quintile (OR=1.67; 95% CI=1.35-2.06) and the lowest overall health score quintile (OR=1.66; 95% CI=1.36-2.03). Poor health and QoL are not randomly distributed among the population over 50 years old in Purworejo District, Indonesia. Spatial analysis showed that clusters of households with at least one member being in the worst quintiles of QoL, functioning and health score intersected in the central part of Purworejo District, which is a semi-urban area with more developed economic activities compared with other areas in the district. Conclusion: Being female, old, unmarried and having low educational and socio-economic levels were significantly associated with poor self-reported QoL, health status and disability among older people in Purworejo District. This study showed the existence of geographical pockets of vulnerable older people in Purworejo District, and emphasized the need to take immediate action to address issues of older people’s health and QoL.

  • 73.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hakimi, Mohammad
    Santosa, Ailiana
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wilopo, Siswanto Agus
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Is Self-Rated Health an Independent Index for Mortality among Older People in Indonesia?2012Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, nr 4, s. e35308-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Empirical studies on the association between self-rated health (SRH) and subsequent mortality are generally lacking in low- and middle-income countries. The evidence on whether socio-economic status and education modify this association is inconsistent. This study aims to fill these gaps using longitudinal data from a Health and Demographic Surveillance System (HDSS) site in Indonesia.

    METHODS: In 2010, we assessed the mortality status of 11,753 men and women aged 50+ who lived in Purworejo HDSS and participated in the INDEPTH WHO SAGE baseline in 2007. Information on self-rated health, socio-demographic indicators, disability and chronic disease were collected through face-to-face interview at baseline. We used Cox-proportional hazards regression for mortality and included all variables measured at baseline, including interaction terms between SRH and both education and socio-economic status (SES).

    RESULTS: During an average of 36 months follow-up, 11% of men and 9.5% of women died, resulting in death rates of 3.1 and 2.6 per 1,000 person-months, respectively. The age-adjusted Hazard Ratio (HR) for mortality was 17% higher in men than women (HR = 1.17; 95% CI = 1.04-1.31). After adjustment for covariates, the hazard ratios for mortality in men and women reporting bad health were 3.0 (95% CI = 2.0-4.4) and 4.9 (95% CI = 3.2-7.4), respectively. Education and SES did not modify this association for either sex.

    CONCLUSIONS: This study supports the predictive power of bad self-rated health for subsequent mortality in rural Indonesian men and women 50 years old and over. In these analyses, education and household socio-economic status do not modify the relationship between SRH and mortality. This means that older people who rate their own health poorly should be an important target group for health service interventions.

  • 74.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Purworejo Health and Demographic Surveillance Systems, Indonesia.
    Hakimi, Mohammad
    Purworejo Health and Demographic Surveillance System, Indonesia.
    Van Minh, Hoang
    Filabavi Health and Demographic Surveillance System, Vietnam.
    Juvekar, Sanjay
    Vadu Health and Demographic Surveillance System, India.
    Razzaque, Abdur
    Matlab Health and Demographic Surveillance System, Bangladesh.
    Ashraf, Ali
    AMK Health and Demographic Surveillance System, Bangladesh.
    Masud Ahmed, Syed
    WATCH Health and Demographic Surveillance System, Bangladesh.
    Kanungsukkasem, Uraiwan
    Kanchanaburi Health and Demographic Surveillance System, Thailand.
    Soonthornthada, Kusol
    Kanchanaburi Health and Demographic Surveillance System, Thailand.
    Huu Bich, Tran
    Chililab Health and Demographic Surveillance System, Vietnam.
    Prevalence of physical inactivity in nine rural INDEPTH health and demographic surveillance systems in five Asian countries2009Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, nr 1, s. 44-53Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Physical inactivity leads to higher morbidity and mortality from chronic non-communicable diseases (NCDs) such as stroke and heart disease. In high income countries, studies have measured the population level of physical activity, but comparable data are lacking from most low and middle-income countries.

    OBJECTIVE: To assess the level of physical inactivity and its associated factors in selected rural sites in five Asian countries. METHODS: The multi-site cross-sectional study was conducted in nine rural Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network in Bangladesh, India, Indonesia, Thailand, and Vietnam. Using the methodology from the WHO STEPwise approach to Surveillance (STEPS), about 2,000 men and women aged 25-64 years were selected randomly from each HDSS sampling frame. Physical activity at work and during leisure time, and on travel to and from places, was measured using the Global Physical Activity Questionnaire version 2 (GPAQ2). The total activity was calculated as the sum of the time spent in each domain of activities in metabolic equivalent-minutes per week, and was used to determine the level of physical activity. Multivariable logistic regression was used to assess demographic factors associated with a low level of physical activity.

    RESULTS: The prevalence of physical inactivity ranged from 13% in Chililab HDSS in Vietnam to 58% in Filabavi HDSS in Vietnam. The majority of men were physically active, except in the two sites in Vietnam. Most of the respondents walked or cycled for at least 10 minutes to get from place to place, with some exceptions in the HDSSs in Indonesia and Thailand. The majority of respondents, both men and women, were inactive during their leisure time. Women, older age, and high level of education were significantly associated with physical inactivity.

    CONCLUSION: This study showed that over 1/4 men and 1/3 women in Asian HDSSs within the INDEPTH Network are physically inactive. The wide fluctuations between the two HDSS in Vietnam offer an opportunity to explore further urbanisation and environmental impacts on physical activity. Considering the importance of physical activity in improving health and preventing chronic NCDs, efforts need to be made to promote physical activity particularly among women, older people, and high education groups in these settings.

  • 75.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Johnson, Owe
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    A reversal of decreasing trends in population cholesterol levels in Västerbotten County, Sweden2012Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, s. 10367-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: High cholesterol is identified as a major risk factor for chronic non-communicable diseases, especially cardiovascular and cerebrovascular diseases. Monitoring trends of cholesterol levels and comparing trends across population groups are important to assess population distribution and risks related to cholesterol change over time. Cholesterol surveillance data are lacking, even in high-income countries.

    OBJECTIVES: To describe the trends in cholesterol and triglyceride levels in different population groups and to estimate the risk of developing hypercholesterolemia and hypertriglyceridemia in Västerbotten County, Sweden during 1990-2010.

    DESIGNS AND METHODS: Since 1990, 133,082 individuals living in Västerbotten County, Northern Sweden, invited on their 30th, 40th, 50th and 60th birthdays, participated in the Västerbotten Intervention Program. Ten years after baseline data collection, 34,868 individuals were surveyed for a second time. In addition to a self-administered health questionnaire (that included information on socioeconomic status, demographics, self-reported health and lifestyle behaviours), blood cholesterol and triglyceride were examined.

    RESULTS: The level and prevalence of hypercholesterolemia decreased significantly from 1990 to 2007, but the trends began to increase during 2008-2010 in men, women, and in all educational groups. Men had significantly higher serum triglyceride levels than women and their cholesterol levels were similar to those of the women. This study shows that those with basic education and who live in rural inlands had consistently higher triglyceride level than those who live in the city and have higher educational attainments. People with basic education are also at higher risk of developing hypercholesterolemia and hypertriglyceridemia at 10-year follow-up; the risk is much higher among the older cohorts, particularly women. During 1990-2010, the proportion of participants who reported treatment with lipid-lowering agents increased from 1.1% to 9.6% among men and 0.5% to 5.3% among women. About 60% of those treated achieved treatment goals for cholesterol or triglycerides.

    CONCLUSIONS: The increasing trend in cholesterol level in the Västerbotten population during 2008-2010 needs to be closely monitored. Addressing the unequal distribution of cholesterol, as well as other risk factors such as obesity, physical inactivity, high blood glucose, among those with basic education, and particularly among populations in rural areas are important to prevent higher burdens of chronic non-communicable diseases in this population.

  • 76.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. INDEPTH Network, Accra, Ghana and Purworejo HDSS, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Kowal, Paul
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. INDEPTH Network, Accra, Ghana and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Naidoo, Nirmala
    Abdullah, Salim
    Bawah, Ayaga
    Binka, Fred
    Chuc, Nguyen T K
    Debpuur, Cornelius
    Egondi, Thaddeus
    Xavier Gómez-Olivé, F
    Hakimi, Mohammad
    Hirve, Siddhivinayak
    Hodgson, Abraham
    Juvekar, Sanjay
    Kyobutungi, Catherine
    Van Minh, Hoang
    Mwanyangala, Mathew A
    Nathan, Rose
    Razzaque, Abdur
    Sankoh, Osman
    Kim Streatfield, P
    Thorogood, Margaret
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wilopo, Siswanto
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Tollman, Stephen M
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. INDEPTH Network, Accra, Ghana and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Chatterji, Somnath
    Health inequalities among older men and women in Africa and Asia: evidence from eight Health and Demographic Surveillance System sites in the INDEPTH WHO-SAGE Study2010Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, nr Supplement 2, s. 96-107Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Declining rates of fertility and mortality are driving demographic transition in all regions of the world, leading to global population ageing and consequently changing patterns of global morbidity and mortality. Understanding sex-related health differences, recognising groups at risk of poor health and identifying determinants of poor health are therefore very important for both improving health trajectories and planning for the health needs of ageing populations.

    Objectives: To determine the extent to which demographic and socio-economic factors impact upon measures of health in older populations in Africa and Asia; to examine sex differences in health and further explain how these differences can be attributed to demographic and socio-economic determinants.

    Methods: A total of 46,269 individuals aged 50 years and over in eight Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network were studied during 2006-2007 using an abbreviated version of the WHO Study on global AGEing and adult health (SAGE) Wave I instrument The survey data were then linked to longitudinal HDSS background information. A health score was calculated based on self-reported health derived from eight health domains. Multivariable regression and post-regression decomposition provide ways of measuring and explaining the health score gap between men and women.

    Results: Older men have better self-reported health than older women. Differences in household socioeconomic levels, age, education levels, marital status and living arrangements explained from about 82% and 71% of the gaps in health score observed between men and women in South Africa and Kenya, respectively, to almost nothing in Bangladesh. Different health domains contributed differently to the overall health scores for men and women in each country.

    Conclusion: This study confirmed the existence of sex differences in self-reported health in low- and middleincome countries even after adjustments for differences in demographic and socio-economic factors. A decomposition analysis suggested that sex differences in health differed across the HDSS sites, with the greatest level of inequality found in Bangladesh. The analysis showed considerable variation in how differences in socio-demographic and economic characteristics explained the gaps in self-reported health observed between older men and women in African and Asian settings. The overall health score was a robust indicator of health, with two domains, pain and sleep/energy, contributing consistently across the HDSS sites. Further studies are warranted to understand other significant individual and contextual determinants to which these sex differences in health can be attributed. This will lay a foundation for a more evidence-based approach to resource allocation, and to developing health promotion programmes for older men and women in these settings.

  • 77.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kusnato, Hari
    Yogyakarta, Indonesia.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Schröders, Julia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Inequities in child health and nutrition in Indonesia: Policy brief2013Ingår i: Evidence for Policy and Implementation, EPI-4, Stockholm: Swedish Agency for International Development Cooperation (SIDA), 2013Konferensbidrag (Övrigt vetenskapligt)
  • 78.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nichter, Mark
    Padmawati, Retna Siwi
    Prabandari, Yayi Suryo
    Muramoto, Myra
    Nichter, Mimi
    Bringing smoking cessation to diabetes clinics in Indonesia2010Ingår i: Chronic Illness, ISSN 1742-3953, E-ISSN 1745-9206, Vol. 6, nr 2, s. 125-135Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study demonstrates the feasibility of disease-centred doctors' messages about smoking cessation for patients with diabetes, supported by the presence of a CC motivating clinicians to routinely give patients cessation messages.

  • 79.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Padmawati, R S
    Prabandari, Y S
    Nichter, M
    Smoking behavior among former tuberculosis patients in Indonesia: intervention is needed.2008Ingår i: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 12, nr 5, s. 567-72Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    SETTING: Five lung clinics in Jogjakarta Province, Indonesia. OBJECTIVE: To document smoking patterns among tuberculosis (TB) patients before diagnosis and following treatment, to identify smoking-related messages given by health professionals and DOTS providers and to identify predictors of smoking relapse. DESIGN: A cross-sectional survey of 239 male TB patients completed DOTS-based treatment during 2005-2006. Subjects were interviewed at home using a semi-structured questionnaire. Female patients were excluded, as very few smoke. RESULTS: Most TB patients quit smoking when under treatment, but over one third relapsed at 6 months post-treatment. About 30% were never asked about their smoking behavior or advised about quitting. Of relapsed smokers, 60% received only general health messages and not TB-specific smoking messages. DOTS providers are not currently involved in cessation activities. The perception that any level of smoking is harmless for ex-TB patients was a significant predictor for smoking relapse. CONCLUSION: Physicians and DOTS providers should be actively involved in smoking cessation activities among TB and ex-TB patients. Based on these data, the Quit Tobacco Indonesia Project is mounting a pilot intervention to train DOTS providers, who are mostly family members of patients, to deliver smoking cessation messages and reinforce the cessation advice provided by physicians during and following TB treatment.

  • 80.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Prabandari, Yayi Suryo
    Padmawati, Retna Siwi
    Okah, Felix
    Haddock, C Keith
    Nichter, Mark
    Nichter, Mimi
    Muramoto, Myra
    Poston, Walker SC
    Pyle, Sara A
    Mahardinata, Nurazid
    Lando, Harry A
    Physician assessment of patient smoking in Indonesia: a public health priority2007Ingår i: Tobacco Control, ISSN 0964-4563, E-ISSN 1468-3318, Vol. 16, nr 3, s. 190-196Artikel i tidskrift (Refereegranskat)
  • 81.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Sandberg, M
    Ahlström, G
    Prevalence of older people with intellectual disability in Sweden: a spatial epidemiological analysis.2015Ingår i: Journal of Intellectual Disability Research, ISSN 0964-2633, E-ISSN 1365-2788, Vol. 59, nr 12, s. 1155-1167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The expected increase in longevity of individuals with intellectual disabilities (ID) in many countries of the world is a direct result of medical and social advances, which have also extended the longevity of the general population. It is important to assess the need for social services for people with ID across different administrative levels to ensure sufficient resources are allocated to where they are most needed. This study estimates the annual prevalence of older people with ID from 2004 to 2012 and in different counties and municipalities in Sweden, by sex and age group; identifies proxy indicators related to the care of older people with ID in different counties in 2012 in Sweden and analyses the spatial distribution and clustering of municipalities with a high prevalence of older people with ID.

    METHODS: Individuals with ID were identified through the national register based on the Swedish Act concerning Support and Service for Persons with Certain Functional Impairments (the LSS act) and the national death register. This study focuses on older individuals aged 55+ during the period of 2004-2012. The estimated prevalence was calculated at the county and municipality level and plotted on a municipality-level map. Moran's I statistics was used to identify any spatial clustering of municipalities with a large number of individuals with ID.

    RESULTS: The prevalence of ID among older individuals aged 55+ in Sweden increased from 2004 to 2012. The prevalence was consistently higher among men, and the gender gap increased slightly in recent years. Age-specific prevalence estimates showed ID to be higher in younger age groups, and the gender gap decreased in older age groups. The prevalence was higher in northern counties in Sweden (over 500 individuals per 100 000 population aged 55+). Higher prevalence areas were clustered in northern municipalities, whereas municipalities with high prevalence of older individuals with ID in the middle and southern regions of Sweden demonstrated a more widespread distribution.

    CONCLUSIONS: The existence of clusters of counties with a high prevalence of older individuals with ID necessitates further assessment of how resources have been allocated to different counties and municipalities in Sweden. Investigations of the quality of social services provided to individuals with ID across different counties in Sweden are warranted. It is important to ensure that high quality supports are being provided to older individuals with ID in order to grant them the same right to healthy ageing as their counterparts living without ID throughout their life course.

  • 82.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Santosa, Ailiana
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Kowal, P.
    Sitting time and obesity among older adults in low- and middle-income countries2017Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr Suppl_3, s. 415-416Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: Global industrialisation and economic development lead to changes in physical activity patterns with more sedentary behaviours and increasing sitting time, which are related to obesity. This study aims to identify the association between sedentary behaviour and obesity among older people aged 50+ in six low- and middle-income countries.

    Methods: This study utilises data from the WHO's Study on Global Ageing and Adult Health in China, Ghana, India, Mexico, the Russian Federation and South Africa. Physical activity level was measured using the Global Physical Activity Questionnaire Version 2 and daily sitting time was recorded in hour. Overweight and obesity was measured through height and weight, with BMI > =25. We conducted logistic regression to analyse the association between physical activity level and total daily sitting time and obesity, controlling for age, sex, highest education level, and living area.

    Results: Overweight and obesity prevalence ranged from 14% in India to 76% in the Russian Federation, and was significantly higher among women. The prevalence of low-to-moderate physical activity ranged from 36% in Ghana to 76% in South Africa. About 25% of the Russian population sat 2 hours or less daily, in contrast to 83% of the Mexican population who did so. Sitting more than 2 hours a day increased the odds of overweight and obesity (odds ratio 1.18; 95% confidence interval 1.09-1.29). The associated odds were 1.21 (95%CI 1.08-1.35) and 1.41 (95%CI 1.27-1.56) for those with moderate and low physical activity, compared to those who were more active.

    Conclusions: Independent of physical activity level during work, leisure and transport, longer daily sitting time is significantly associated with obesity among older adults. Public health intervention to promote physical activity among older people is crucial in preventing premature chronic disease deaths and promoting active and healthy ageing.

    Key messages:

    • The levels of sedentary behaviours among older people in low-and middle-income country are worrying, and are significantly associated with the level of obesity.
    • Reducing sitting time and promoting physical activity among older people are essential strategies to prevent obesity and its impacts on chronic disease and ensuring an active and healthy ageing.
  • 83.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Santosa, Ailiana
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Malmberg, Gunnar
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för geografi.
    Living alone and mortality among older people in Västerbotten County in Sweden: a survey and register-based longitudinal study2020Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, artikel-id 7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Living alone is increasingly common and has been depicted as an important cause of mortality. We examined the association between living alone and mortality risks among older men and women in northern Sweden, by linking two unique longitudinal datasets.

    METHODS: We used the Linnaeus database, which links several population registers on socioeconomic and health. This register-based study included 22,226 men and 23,390 women aged 50 and 60 years in Västerbotten County who had participated in the Västerbotten Intervention Program (VIP) during 1990-2006, with a total of 445,823 person-years of observation. We conducted Cox-proportional hazard regression to assess the risk of living alone on the mortality that was observed between 1990 and 2015, controlling for socio-demographic factors, chronic disease risk factors and access to social capital.

    RESULTS: Older men and women who lived alone with no children at home were at a significantly higher risk of death compared to married/cohabiting couples with children at home (with an adjusted hazard ratio of 1.38, 95% CI of 1.26-1.50 in men and 1.27, 95% CI of 1.13-1.42 in women). Living alone was an even stronger factor than the well-established chronic disease risk factors and a lack of access to social capital.

    CONCLUSIONS: A significant association between living alone and mortality among the older adult population in Sweden was observed. Providing good social support for older people is important in preventing the negative health impact of living alone.

  • 84.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Bonita, Ruth
    Hakimi, Mohammad
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Preventable risk factors for noncommunicable diseases in rural Indonesia: prevalence study using WHO STEPS approach.2006Ingår i: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 84, nr 4, s. 305-313Artikel i tidskrift (Refereegranskat)
  • 85.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Söderman, Kerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Increasing physical activity, but persisting social gaps among middle-aged people: trends in Northern Sweden from 1990 to 20072011Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, s. 6347-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Physical activity is identified as one important protective factor for chronic diseases. Physical activity surveillance is important in assessing healthy population behaviour over time. Many countries lack population trends on physical activity.

    OBJECTIVE: To present trends in physical activity levels in Västerbotten County, Sweden and to evaluate physical activity among women and men with various educational levels.

    METHODS: opulation-based cross-sectional and panel data from the Västerbotten Intervention Programme (VIP) during 1990-2007 were used. All individuals in Västerbotten County who turned 40, 50, or 60 years old were invited to their local primary health care for a health screening. Physical activity during commuting, recreational activities, physical exercise, and socio-demographic data were collected using a self-administered questionnaire. Respondents were categorised as sedentary, moderate physically active, or physically active.

    RESULTS: The prevalences of physically active behaviours increased from 16 to 24.2% among men and from 12.6 to 30.4% among women. Increases are observed in all educational groups, but gaps between educational groups widened recently. The level of sedentary behaviour was stable over the time period studied. The 10-year follow-up data show that the prevalences of physically active behaviours increased from 15.8 to 21.4% among men and 12.7 to 23.3% among women. However, 10.2% of men and 3.8% of women remained sedentary.

    CONCLUSION: Despite the promising evidence of increasing physical activity levels among the population in Västerbotten County, challenges remain for how to reduce the stable levels of sedentary behaviours in some subgroups. Persisting social gaps in physical activity levels should be addressed further. An exploration of people's views on engaging in physical activity and barriers to doing so will allow better formulation of targeted interventions within this population.

  • 86.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Van Minh, Hoang
    Juvekar, Sanjay
    Razzaque, Abdur
    Huu Bich, Tran
    Kanungsukkasem, Uraiwan
    Ashraf, Ali
    Masud Ahmed, Syed
    Soonthornthada, Kusol
    Using the INDEPTH HDSS to build capacity for chronic non-communicable disease risk factor surveillance in low and middle-income countries2009Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, nr Supplement 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Chronic non-communicable diseases (NCDs) are the leading cause of morbidity, mortality, and disability worldwide. More than 80% of chronic disease deaths occur in low-income and middle-income countries. Epidemiological data on the burden of chronic NCD and the risk factors which predict them are lacking in most low-income countries. The INDEPTH Network (http://www.indepth-network.org) which includes the Health and Demographic Surveillance System (HDSS) with many surveillance sites in low-middle income countries provided an opportunity to establish surveillance of the major chronic NCD risk factors in 2005 using a standardised approach.

    OBJECTIVE: This paper presents the conceptual framework and research design of the chronic NCD risk factor surveillance within nine rural INDEPTH HDSS settings in Asia.

    METHODS: This multi-site study was designed as a baseline cross-sectional survey with sufficient sample size to measure trends over time. In each of nine HDSS sites in five Asian countries, a sample of 2,000 men and women aged 25-64 years, using the WHO STEPwise approach to Surveillance (http://who.int/chp/steps), was selected using stratified random sampling (in each 10-year interval) from the HDSS sampling frame.

    RESULTS: A total of 18,494 men and women from the nine sites were interviewed with an overall response rate of 98%. The major NCDs risk factors included self-reported information on tobacco and alcohol consumption, fruit and vegetable intake, physical activity patterns, and measured body weight, height, waist circumference, and blood pressure. A series of training sessions were conducted for research scientists, supervisors, and surveyors in each site. Data quality was ensured through spot check, re-check, and data validation procedures, including accuracy and completeness of data obtained. Standardised data entry programme, created using the EPIDATA software, was used to ensure uniform database structure across sites. The data merging and analysis were done using STATA Version 10.

    CONCLUSION: This multi-site study confirmed the feasibility of conducting chronic NCD risk factor surveillance in the low and middle-income settings by integrating the chronic NCDs risk factor surveillance into an existing HDSS data collection and management setting. This collaborative work has provided reliable epidemiological data as a basis for developing chronic NCD prevention and control activities.

  • 87.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Van Minh, Hoang
    Tesfaye, Fikru
    Bonita, Ruth
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Combining risk factors and demographic surveillance: potentials of WHO STEPS and INDEPTH methodologies for assessing epidemiological transition.2006Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 34, nr 2, s. 199-208Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: Demographic surveillance systems (DSSs) create platforms to monitor population dynamics. This paper discusses the potential of combining the WHO STEPwise approach to Surveillance (STEPS) within ongoing DSSs, to assess changes in non-communicable disease (NCD) risk factors. METHODS: Three DSSs in Ethiopia, Vietnam, and Indonesia have collected NCD risk factors using WHO STEPS, focusing on self-reported lifestyle risk factors (Step 1) and measurement of blood pressure and anthropometric parameters (Step 2). RESULTS: DSSs provide sampling frames for NCD risk factor surveillance, which reveals the distribution of risk factors and their dynamics at the population level. The WHO STEPS approach with its add-on modules is feasible and adaptable in DSS settings. Available mortality data in the DSSs enable mortality assessment by cause of death using verbal autopsy, which is relevant in estimating the impact of NCDs. DSSs as well as risk factor surveillance data may potentially be a lever for hypothesis-driven research to address specific a priori hypotheses or research questions. CONCLUSION: Combining DSSs with the WHO STEPS approach can potentially address basic epidemiological questions on NCDs, which can be used as a powerful advocacy tool in public health decision-making for NCD prevention.

  • 88.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    'If I don't smoke, I'm not a real man'--Indonesian teenage boys' views about smoking.2007Ingår i: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 22, nr 6, s. 794-804Artikel i tidskrift (Refereegranskat)
  • 89.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Winkler, Volker
    Van Minh, Hoang
    Tesfaye, Fikru
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Becher, Heiko
    Predicting lung cancer death in Africa and Asia: differences with WHO estimates.2009Ingår i: Cancer causes & control : CCC, ISSN 1573-7225, Vol. 20, nr 5, s. 721-30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Reliable cancer burden estimates are rarely available from most developing countries where cancer registration is lacking. This study provided estimates on the current and future number of lung cancer deaths in Indonesia, Vietnam and Ethiopia, and Sub-Saharan Africa at large. METHODS: The number of lung cancer deaths was estimated from detailed smoking prevalence data (obtained from surveys among 8,726 rural individuals aged 25-74 years in Indonesia, Vietnam, and Ethiopia in 2005-2006) and on lung cancer rate estimates among non-smokers. RESULTS: Our estimate for lung cancer deaths in Sub-Saharan Africa is 44,076 in 2005, which is 2.6 times the most recent WHO estimate in 2003 (17,000 deaths). A similar ratio is found for the country-specific estimate in Ethiopia. Our estimates are only slightly higher than the WHO's in Indonesia, and Vietnam. The attributable risk of smoking for lung cancer death among men was 39% in Ethiopia, 80% in Indonesia and 85% in Vietnam. We expect the annual number of lung cancer deaths to double by 2025, even if the smoking prevalence is assumed not to increase further. CONCLUSIONS: WHO estimates on lung cancer deaths in Asia appear to be slightly lower than our study results; however, in Africa, the burden appears to be largely underestimated.

  • 90. Nichter, Mark
    et al.
    Padmawati, Siwi
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Introducing smoking cessation to Indonesian males treated for tuberculosis: The challenges of low-moderate level smoking2016Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 152, s. 70-79Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a dearth of information about the smoking habits of people currently and formerly treated for tuberculosis (TB) in low- and middle-income countries (LMICs). In this paper we describe research carried out in Indonesia between 2007 and 2011 designed to investigate both the impact of TB-specific quit smoking messages in the TB clinic and at home, and shifts in patterns of smoking among those formerly treated for TB who continue to smoke. The results of a modest two-arm smoking cessation trial involving 87 patients undergoing Directly Observed Therapy Short course treatment (DOTS) for TB are presented. In one arm patients received a TB-specific quit smoking message delivered by doctors and a TB and smoking educational booklet and quit smoking guide. In the second, family support arm, patients also received on-going cessation messages delivered by family members trained to be DOTS supporters. The study followed patients twice during their six months of DOTS treatment and twice six months post treatment. Both arms of the study reduced rates of smoking during and following TB treatment significantly with 73% of patients in the doctor arm and 71% in the family support arm remaining quit at the end of the treatment (month 6). When complete abstinence at six months after treatment was taken as a primary outcome measure, no statistical difference was found in the effectiveness of the two arms of the intervention. Notably, 67% of higher-level smokers at baseline and 33% of low-moderate level smokers at baseline quit entirely. Many of those who resumed smoking did so at low-moderate levels (<6 cigarettes a day). Eighty-four percent of patients who quit during treatment maintained their abstinence six months after treatment, 13% resumed smoking at a low-moderate level (<6 cigarettes), and only 3% resumed smoking at a higher level. A purposeful sample of 15 patients who shifted from heavy smoking (20-40 cigarettes per day) to low-moderate levels of smoking post treatment were followed for an additional 12 months. We report on their ability to sustain lower levels of smoking and self-perceived smoking status given their dramatic reduction in cigarette consumption. This is the first study of low-moderate level smoking among patients formerly treated for TB conducted anywhere in South-East Asia.

  • 91. Nichter, Mimi
    et al.
    Nichter, Mark
    Padmawati, Retna Siwi
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Developing a smoke free household initiative: an Indonesian case study2010Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, nr 4, s. 578-581Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Little research has focused on women's exposure to secondhand smoke (SHS) in LMICs, local perceptions of SHS risk to women and children, and women's attempts to limit exposure to tobacco smoke in their households. This paper describes a community based survey in Indonesia that investigated these issues as one step in a movement to initiate community wide household smoking bans. The survey found high levels of exposure to SHS, high levels of awareness among both women and men that SHS placed women and children at risk for illness, a very low percentage of households having indoor smoking rules, great interest on the part of women to participate in a communitywide ban, and a promising level of male smoker agreement to comply with such a ban. Women expressed a low sense of self efficacy in individually getting their husbands to quit smoking in their homes, but a strong sense of collective efficacy that husbands might agree to a well-publicized and agreed-upon community household smoking ban. Men and women expressed concern about the social risk of asking guests not to smoke in their homes without a communitywide ban and visible displays communicating their participation in this movement. The smoke free initiative described requires the participation of doctors in community education programs, and is attempting to introduce household smoking bans as a way of turning tobacco control into a family health and not just a smokers' health issue.

  • 92. Nichter, Mimi
    et al.
    Padmawati, S
    Danardono, M
    Ng, Nawi
    Department of Public Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Prabandari, Y
    Nichter, Mark
    Reading culture from tobacco advertisements in Indonesia2009Ingår i: Tobacco Control, ISSN 0964-4563, E-ISSN 1468-3318, Vol. 18, nr 2, s. 98-107Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Tobacco advertising in Indonesia is among the most aggressive and innovative in the world, and tobacco advertisements saturate the environment. Tobacco companies are politically and financially powerful in the country because they are one of the largest sources of government revenue. As a result, there are few restrictions on tobacco marketing and advertising. National surveys reveal that 62% of men and 1% to 3% of women are smokers. Over 90% of smokers smoke clove cigarettes (kretek). This paper examines the social and cultural reasons for smoking in Indonesia and discusses how the tobacco industry reads, reproduces and works with culture as a means of selling cigarettes. An analysis is provided of how kretek tobacco companies represent themselves as supporters of Indonesian national identity. This analysis is used to identify strategies to break the chains of positive association that currently support widespread smoking.

    METHODS: Between November 2001 and March 2007, tobacco advertisements were collected from a variety of sources, including newspapers and magazines. Frequent photographic documentation was made of adverts on billboards and in magazines. Advertisements were segmented into thematic units to facilitate analysis. In all, 30 interviews were conducted with smokers to explore benefits and risks of smoking, perceptions of advertisements and brand preferences. Focus groups (n = 12) were conducted to explore and pretest counter advertisements.

    RESULTS: Key themes were identified in tobacco advertisements including control of emotions, smoking to enhance masculinity and smoking as a means to uphold traditional values while simultaneously emphasising modernity and globalisation. Some kretek advertisements are comprised of indirect commentaries inviting the viewer to reflect on the political situation and one's position in society.

    CONCLUSIONS: After identifying key cultural themes in cigarette advertisements, our research group is attempting to engage the tobacco industry on "cultural ground" to reduce consumption and social acceptability. To do this, we need to take back social spaces that the tobacco industry has laid claim to through advertising. Active monitoring and surveillance of tobacco advertising strategies is necessary and legislation and enforcement to curb the industry should be put in place.

  • 93.
    Norberg, Margareta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Malmberg, Gunnar
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för geografi och ekonomisk historia. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Broström, Göran
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS). Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Use of moist smokeless tobacco (snus) and the risk of development of alcohol dependence: a cohort study in a middle-aged population in Sweden.2015Ingår i: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 149, s. 151-157Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Convincing evidence shows that smoking is associated with alcohol dependence (AD) and a positive correlation between snus and alcohol consumption was previously shown in cross-sectional studies. We performed a longitudinal evaluation of the risk of snus users to develop AD.

    METHODS: A cohort study in Västerbotten County, Sweden, linked individual data on socioeconomic situation and health survey data from 21,037 men and women (46.5% men). AD was defined by the CAGE questionnaire and evaluated at baseline 1991-1997 and again after 10 years. The risk of developing AD was assessed using logistic regression analysis and propensity score matching.

    RESULTS: 2370 men and 430 women used snus and were without AD at baseline. Over the 10-year period, 499 men and 257 women developed AD, among whom 191 and 26, respectively, were baseline snus users. The crude relative risks of AD for male and female snus users compared to non-users were 1.8 with 95% CI (1.5, 2.2) and 2.9 (2.0, 4.3), respectively. Adjusted logistic regression showed a positive dose-response relationship between snus use and risk of AD. Analyses involving propensity score matching revealed 33 and 17 new cases of AD in men and women, respectively, after 10 years given 1000 men and 1000 women without AD had been baseline snus users rather than non-users. Results for current, previous and never smokers were similar.

    CONCLUSIONS: The use of snus is prospectively associated with an increased risk of AD with a dose-response relationship that is independent of smoking status.

  • 94.
    Norberg, Margareta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Malmberg, Gunnar
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS). Umeå universitet, Samhällsvetenskapliga fakulteten, Statistiska institutionen.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Broström, Göran
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS). Umeå universitet, Samhällsvetenskapliga fakulteten, Kulturgeografiska institutionen.
    Who is using snus? - Time trends, socioeconomic and geographic characteristics of snus users in the ageing Swedish population2011Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, s. 929-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The prevalence of smoking in Sweden has decreased in recent decades, and is now among the lowest in the world. During the same period, the use of Swedish moist oral snuff, a smokeless tobacco called snus, has increased. Few studies have evaluated time trends of the socioeconomic and geographic characteristics of snus users in Sweden. This paper contributes to filling that gap.

    METHODS: This study utilized the Linnaeus Database, which links national registers with comprehensive individual data on socioeconomic status (SES) to health data from a large ongoing health survey, the Västerbotten Intervention Programme (VIP). The VIP targets the entire middle-aged population of Västerbotten county at ages 40, 50 and 60 years with yearly cross-sectional surveys including self-reported data on tobacco habits. Time trends of snus use among 92,563 VIP-participants across different areas of residence and smoking groups were investigated graphically. Logistic regression was performed to estimate the associations between SES and geographical variables and current use versus non-use of snus.

    RESULTS: Overall, in parallel to decreasing smoking, the increasing trend of snus use in this middle-aged population continues, particularly in 40-year-olds. In both genders, the highest prevalence of snus use was observed among previous smokers. The prevalence of snus use also increased over time among smokers, and was consistently higher compared to those who had never smoked. Among males - both those who had never smoked and previous smokers - low education (OR 1.21, 95%CI 1.06-1.40 and OR 1.28, 95%CI 1.14-1.43), living alone (OR 1.16, 95%CI 1.07-1.27 and OR 1.13, 95%ci 1.04-1.23), low income and living in rural areas was associated with using snus, while this was not seen among male current smokers. Among women, living alone was associated with using snus irrespective of smoking habits. Among female smokers, the OR for snus use increased with higher education.

    CONCLUSIONS: A disadvantaged social profile and also higher prevalence in rural areas is observed among male snus users who had never smoked or were previous smokers. Among male smokers there was no association between SES and use of snus. The prevalence of snus use among women is increasing, but is still considerably lower than that of men. The association between snus and SES characteristics is less pronounced among women, although snus is clearly linked to living alone. These patterns should be taken into consideration in tobacco control policies.

  • 95.
    Näslund, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lundgren, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Fhärm, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Grönlund, Christer
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindahl, Bertil
    Lindvall, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nilsson, Stefan K.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Fysiologisk kemi.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nordin, Steven
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nyman, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vanoli, Davide
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial2019Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, nr 10167, s. 133-142Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.

    METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.

    FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).

    INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.

  • 96.
    Näslund, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Patient-doctor engagement in cardiovascular prevention: Authors' reply2019Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 394, nr 10199, s. E27-E27Artikel i tidskrift (Refereegranskat)
  • 97. Padmawati, Retna Siwi
    et al.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Prabandari, Yayi Suryo
    Nichter, Mark
    Smoking among diabetes patients in Yogyakarta, Indonesia: cessation efforts are urgently needed.2009Ingår i: Tropical medicine & international health : TM & IH, ISSN 1365-3156, Vol. 14, nr 4, s. 412-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To document the prevalence of tobacco use among male diabetes patients in a clinic based population of Yogyakarta Province, Indonesia; to examine patient's perceptions of smoking as a risk factor for diabetes complications; and to investigate whether patients had received cessation messages from their doctors. METHOD: Twelve in-depth interviews and five focus groups (n = 21) with diabetic patients in 2004-2005, followed by a cross-sectional survey of 778 male diabetic patients in diabetes clinics in 2006-2007. RESULTS: 65% of male diabetes patients smoked before being diagnosed, and 32% smoked in the last 30 days. Most patients incorrectly perceived low level smoking safe for diabetics (mean of 3.6 cigarettes). The median range of cigarettes smoked per day was in excess of this 'safe' amount (4-10 cigarettes). Most respondents did not associate smoking with diabetes and its complications. Only 35% of all patients recalled being asked whether they smoked by their doctors, and there were no differences between smokers and non-smokers. Quit messages received by patients were seen as general health advice and not diabetes specific. CONCLUSIONS: Many diabetic patients continue to smoke despite the hazard of smoking on diabetes complications and mortality. Smoking cessation is not commonly encouraged by health-care providers in Indonesia, and is not a routine part of diabetes counselling despite the risk of smoking to those with diabetes. Project Quit Tobacco International is currently developing cessation services for patients with diabetes and encouraging medical and nursing schools to incorporate disease specific tobacco education in its curriculum and skill based classes in tobacco cessation counselling.

  • 98.
    Pujilestari, Cahya Utamie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hakimi, Mohammad
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    "It is not possible for me to have diabetes": Community Perceptions on Diabetes and Its Risk Factors in Rural Purworejo District, Central Java, Indonesia2014Ingår i: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 6, nr 5, s. 35738-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Accumulating evidence suggests that negative perceptions towards diabetes can limit the management and prevention of the disease. The negative perceptions towards diabetes are prevalent in many different settings, especially among rural communities. Few qualitative studies have been performed to understand how the community views diabetes and its associated risk factors. This study aimed to explore general community perceptions of diabetes and its risk factors in rural Indonesia. A total of 68 participants were recruited to 12 focus group discussions (FGDs) comprised of different age groups and sexes. The FGDs were conducted in six villages in rural Purworejo District, Central Java, Indonesia, from 2011 to 2012. All FGDs were recorded and transcribed. Qualitative content analysis was performed to describe and analyse how the rural community perceived diabetes and its risk factors. Diabetes was perceived as a visible and scary sugar disease, and the affected individuals themselves were blamed for getting the disease. Recognised as 'sugar' or 'sweet-pee' disease with terrifying effects, diabetes was believed to be a disease with no cure. The participants seemed to have an unrealistic optimism with regards to the diabetes risk factors. They believed that diabetes would not affect them, only others, and that having family members with diabetes was necessary for one to develop diabetes. Our findings demonstrate that rural communities have negative perceptions about diabetes and at the same time individuals have unrealistic optimism about their own risk factors. Understanding how such communities perceive diabetes and its risk factors is important for planning prevention strategies. Health messages need to be tailored to health-related behaviours and the local culture's concepts of diseases and risk factors.

  • 99.
    Pujilestari, Cahya Utamie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Association between changes in waist circumference and disability among older adults: a WHO-INDEPTH study on global ageing and adult health (SAGE) in IndonesiaManuskript (preprint) (Övrigt vetenskapligt)
  • 100.
    Pujilestari, Cahya Utamie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Association between changes in waist circumferences and disability among older adults: WHO-INDEPTH study on global ageing and adult health (SAGE) in Indonesia2019Ingår i: Obesity Research and Clinical Practice, ISSN 1871-403X, E-ISSN 1878-0318, Vol. 13, nr 5, s. 462-468Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is a lack of evidence regarding the impact of changes in waist circumference on disability among older populations in low- and middle-income countries (LMICs). This research examines the association between changes in waist circumference with disability in the older populations of Indonesia, and whether the associations are dependent on wealth or baseline abdominal obesity levels.

    Methods: In 2007 the INDEPTH-WHO Study on global AGEing and adult health (SAGE) was conducted among 11,753 individuals aged 50 years and older in Purworejo District, Central Java Province, Indonesia. Of these, a total of 8,089 were followed up in 2010. On both occasions, individuals’ waist circumferences were measured and the 12-item version of the WHO Disability Assessment Schedule version 2 (WHODAS-II) was implemented to measure disability.

    Results: A significant positive association was observed between waist circumference and disability at the baseline (β = 0.066; p < 0.001), and between the increase in waist circumference and the level of disability during the three-year follow-up period (β = 0.094; p < 0.001) after adjusting for baseline variables. This association was also significant among the poor, non-obese men, as well as poor and rich obese women. Among the non-obese women, a decrease in waist circumference was associated with more disabilities.

    Conclusions: An increase in waist circumference is associated with increased disability among older people in Purworejo, Indonesia. Health promotion programmes aiming to prevent obesity could have positive effects in preventing and reducing disability among older adults.

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