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Context 1
... study was originally located in the Central Clydeside Conurbation (Figure 3), a socially hetero- geneous and predominantly urban region, including Glasgow City, which is known to have generally poor health, although this varies considerably across the study area, for example, in 1981 standardized mortal- ity ratios (SMRs), calculated with Scotland as the standard population, ranged from 62 to 147. 2 The study comprises two distinct but connected samples: the regional sample and the localities sample. Two-stage stratified sampling was used to select subjects. ...
Citations
... We note, however, that the nature of this evidence and how it is used places it within a wider public health discourse in which, as Nye (2003) pointed out, individuals are expected to assume responsibility for their own health, and everyday behaviours (like sitting) become medicalised. We use data from semi-structured interviews with a diverse sample of older adults from two large study cohorts, the Lothian Birth Cohort 1936 (Deary et al., 2012) and Twenty-07 Study (Benzeval et al., 2009). Before describing the methods used to address the paper's aim, we first consider the medicalisation of sitting and the use of 'accounts' in health research. ...
Amidst public health campaigns urging people to sit less as well as being more physically active, this paper investigates how older adults make sense of their sedentary behaviour. Using an accounts framework focusing on how people rationalise their sitting practices, we analysed data from 44 qualitative interviews with older adults. All interviewees had received information about sedentary behaviour and health, visual feedback on their own objectively measured sitting over a week and guidance on sitting less. Participants used accounts to position sitting as a moral practice, distinguishing between ‘good’ (active/‘busy’) and ‘bad’ (passive/‘not busy’) sitting. This allowed them to align themselves with acceptable (worthwhile) forms of sitting and distance themselves from other people whose sitting they viewed as less worthwhile. However, some participants also described needing to sit more as they got older. The findings suggest that some public health messaging may lead to stigmatisation around sitting. Future sedentary behaviour guidelines and public health campaigns should consider more relatable guidelines that consider the lived realities of ageing, and the individual and social factors that shape them. They should advocate finding a balance between sitting and moving that is appropriate for each person.
... Limitations and significant gaps in the science included less than optimal SB measures, CINAHL ((MH "Geriatrics") OR (MH "Aged") OR (MH "Aged, 80 and Over") OR (elderly OR "senior citizen" OR geriatric OR "older adult")) AND ((MH "Accelerometers") OR (MH "Accelerometry") OR (MH "Actigraphy") OR ( Unique studies included in meta-analysis c Sample size was not reported in this article (and authors did not respond to a request for information), but was found in another article about the study sample (Wu et al., 2017) d Predictors of sedentary behavior were measured in earlier waves of the study and sedentary behavior was measured in a later wave e Note: the age range of this cohort was not totally clear, but subjects were born around 1932 (Benzeval et al., 2009) with a mean age of 83.4 (SD 0.62) strongly indicating they meet criteria for this review f Factor was significantly associated with sedentary behavior g This study excluded subjects in nursing homes, but it is not known if any subjects resided in other types of residential living h Specifically sitting time (rather than sitting and lying) i Authors labeled this study community-dwelling, but we noted that one female subject resided in a nursing home j This study did not specify if uniaxial or triaxial data were analyzed k This study did not exclude sleeping time l Factor was significantly associated with sedentary behavior in men only ...
High levels of sedentary behavior increase the risk for chronic disease, loss of physical function, disability, and all-cause mortality. Oldest old adults (age 80 and older) and older adults in assisted living are especially at risk for health decline and frailty. Accurate sedentary behavior measurement is critical in order to assess associated health risks and the effectiveness of interventions for reducing sedentary behavior. There is great need for interventions to reduce sedentary behavior and increase light physical activity in older adults in assisted living. This type of intervention could reduce health risks, slow functional decline and frailty, and delay residents’ needs for higher-level care such as a nursing home. The aims of this dissertation are the following: 1) Characterize sedentary behavior in community-dwelling adults age 80 and older by conducting a systematic review and meta-analysis focused on volume of sedentary behavior and factors associated with sedentary behavior in this population; 2) Identify optimal methods for processing objectively measured sedentary behavior data by analyzing ActiGraph vertical axis and vector magnitude data with multiple combinations of filters, non-wear algorithm lengths, and cut-points and by comparing ActiGraph estimates to ActivPAL-measured sedentary time in inactive people with chronic obstructive pulmonary disease; 3) Gather feedback from assisted living residents on a proposed Active for Life in Assisted Living intervention by conducting one-on-one interviews. A secondary aim was to explore contextual factors that may influence how the intervention will be implemented with this population. For aim 1, twenty-one articles were included in the review and meta-analysis showed adults 80 years and older are sedentary for 10.6 hours during the waking day. Although few articles examined factors associated with sedentary behavior in this age group, older age, male gender, non-Hispanic white race/ethnicity, social disadvantage, and declining cognitive function (in men) were associated with increased sedentary time. For aim 2, a secondary data analysis was conducted with a sample of older adults with chronic obstructive pulmonary disease (n=59) who wore ActiGraph and ActivPAL devices for seven days. Thirty techniques for processing ActiGraph sedentary behavior data were compared to ActivPAL-measured sedentary behavior using the Bland-Altman method. The best ActiGraph technique was vector magnitude data with low frequency extension filter, 120-minute non-wear algorithm, and sedentary behavior cut-point of <40 counts/15 seconds (concordance correlation 0.839; mean difference -11.7 minutes/day). For aim 3, one-on-one semi-structured interviews were conducted with 20 assisted living residents. They were presented the proposed Active for Life intervention and asked questions to inform its development. Data were analyzed using content and thematic analysis. Assisted living residents recommended shorter intervention sessions, shorter overall intervention length, and framing the goal of the intervention as increasing light physical activity. The thematic analysis identified factors that could influence intervention implementation, including motivation, safety, beliefs about aging, varying abilities, social influences, and physical activity opportunities in AL. As a whole, the results of this dissertation contribute to our knowledge of sedentary behavior in older adults. Findings highlight the high volume of sedentary behavior in the oldest old, showing opportunity for intervention to reduce sedentary time. We also identified optimal methods for measuring sedentary behavior in older adults, which may guide data processing decisions. In addition, we gathered valuable feedback on a proposed intervention to reduce sedentary behavior of assisted living residents, an important first step in developing an intervention appropriate for this population.
... Such a situation might be investigated using a mutually-adjusted regression model of health on education, occupation and income, but the coefficients or odds ratios (ORs) associated with these three SEP measures represent different causal effects [36]. Table 1 illustrates with data taken from a baseline survey of 35 year-olds in the West of Scotland: Twenty-07 Study (n = 1248) [38]. Data were coded to indicate low education (left school at age 16 or earlier), manual (compared to non-manual) occupations [39], and low income (lowest tertile of equivalised household income). ...
Abstract Research into the effects of Socioeconomic Position (SEP) on health will sometimes compare effects from multiple, different measures of SEP in “mutually adjusted” regression models. Interpreting each effect estimate from such models equivalently as the “independent” effect of each measure may be misleading, a mutual adjustment (or Table 2) fallacy. We use directed acyclic graphs (DAGs) to explain how interpretation of such models rests on assumptions about the causal relationships between those various SEP measures. We use an example DAG whereby education leads to occupation and both determine income, and explain implications for the interpretation of mutually adjusted coefficients for these three SEP indicators. Under this DAG, the mutually adjusted coefficient for education will represent the direct effect of education, not mediated via occupation or income. The coefficient for occupation represents the direct effect of occupation, not mediated via income, or confounded by education. The coefficient for income represents the effect of income, after adjusting for confounding by education and occupation. Direct comparisons of mutually adjusted coefficients are not comparing like with like. A theoretical understanding of how SEP measures relate to each other can influence conclusions as to which measures of SEP are most important. Additionally, in some situations adjustment for confounding from more distal SEP measures (like education and occupation) may be sufficient to block unmeasured socioeconomic confounding, allowing for greater causal confidence in adjusted effect estimates for more proximal measures of SEP (like income).
... As expected in a general population longitudinal survey, men, those in the oldest cohort and people from manual occupations were more likely to have died. The study design is described in more detail elsewhere [41]. The Tayside Committee on Medical Research Ethics approved the study. ...
Background
There is a substantial gap in health and longevity between more affluent and more deprived areas, and more knowledge of the determinants of this health divide is required. Experience of the local residential environment is important for health although few studies have examined this in relation to biological markers of age such as telomere length. We sought to examine if residents’ perceptions of neighbourhood stressors over time were associated with telomere length in a community study.
Methodology/Principal findings
In a prospective cohort study of 2186 adults in the West of Scotland, we measured neighbourhood stressors at three time points over a 12-year period and telomere length at the end of the study. Using linear regression models, we found that a higher accumulation of neighbourhood stressors over time was associated with shorter telomere length, even after taking cohort, social class, health behaviours (smoking status, diet, physical activity), BMI and depression into account among females only (Beta = 0.007; 95%CI [0.001, 0.012]; P<0.014).
Conclusions/Significance
Neighborhood environments are potentially modifiable, and future efforts directed towards improving deleterious local environments may be useful to lessen telomere attrition.
... The main Twenty-07 study ended in 2008, following 5 waves of data collection. See Benzeval et al. [53] for further details regarding recruitment and assessment procedures. ...
Background
Sedentary behaviour is related to poorer health independently of time spent in moderate to vigorous physical activity. The aim of this study was to investigate whether wellbeing or symptoms of anxiety or depression predict sedentary behaviour in older adults.
Method
Participants were drawn from the Lothian Birth Cohort 1936 (LBC1936) (n = 271), and the West of Scotland Twenty-07 1950s (n = 309) and 1930s (n = 118) cohorts. Sedentary outcomes, sedentary time, and number of sit-to-stand transitions, were measured with a three-dimensional accelerometer (activPAL activity monitor) worn for 7 days. In the Twenty-07 cohorts, symptoms of anxiety and depression were assessed in 2008 and sedentary outcomes were assessed ~ 8 years later in 2015 and 2016. In the LBC1936 cohort, wellbeing and symptoms of anxiety and depression were assessed concurrently with sedentary behaviour in 2015 and 2016. We tested for an association between wellbeing, anxiety or depression and the sedentary outcomes using multivariate regression analysis.
Results
We observed no association between wellbeing or symptoms of anxiety and the sedentary outcomes. Symptoms of depression were positively associated with sedentary time in the LBC1936 and Twenty-07 1950s cohort, and negatively associated with number of sit-to-stand transitions in the LBC1936. Meta-analytic estimates of the association between depressive symptoms and sedentary time or number of sit-to-stand transitions, adjusted for age, sex, BMI, long-standing illness, and education, were β = 0.11 (95% CI = 0.03, 0.18) and β = − 0.11 (95% CI = − 0.19, −0.03) respectively.
Conclusion
Our findings indicate that depressive symptoms are positively associated with sedentary behavior. Future studies should investigate the causal direction of this association.
... Secondary analyses of The West of Scotland Twenty-07 Cohort Study (Twenty-07). Twenty-07 was established in 1986 at the Medical Research Council (MRC) Social and Public Health Sciences Unit, University of Glasgow [16]. The aim of the twenty-07 study was to track study participants from the Central Clydeside Conurbation (Glasgow city and environs) across five waves and to investigate the progress of inequalities in health, based on the social factors of gender, age, marital status, social class and area of residence [16]. ...
... Twenty-07 was established in 1986 at the Medical Research Council (MRC) Social and Public Health Sciences Unit, University of Glasgow [16]. The aim of the twenty-07 study was to track study participants from the Central Clydeside Conurbation (Glasgow city and environs) across five waves and to investigate the progress of inequalities in health, based on the social factors of gender, age, marital status, social class and area of residence [16]. Twenty-07 involves three cohorts 20 years apart (n = 4510) of participants born around 1932, 1952 and 1972. ...
... As presented in Fig. 1, they were followed up at 1990/92 (Wave 2), at 1995/ 97 (Wave 3), at 2000/04 (Wave 4) and 2007/08 (Wave 5). Regional and locality samples were included: regional samples were collected by stratifying local districts by census data on socioeconomic groups and unemployment, along with 52 postcode sectors; locality samples were taken from postcode sectors from two areas in Glasgow [16]. For both samples, an enhanced electoral register was used in order to select residents from target age groups [16]. ...
Background
Physical illness and mental disorders play a significant role in fatal and non-fatal suicidal behaviour. However, there is no clear evidence for the effect of physical and mental illness co-occurrence (multimorbidity) in suicidal ideation and attempts. The aim of the current study was to investigate, whether physical/mental health multimorbidity predicted suicidal thoughts and behaviours as outcomes.
Methods
Data from the West of Scotland Twenty-07 cohort were analysed. Twenty-07 is a multiple cohort study following people for 20 years, through five waves of data collection. Participants who responded to past-year suicidal thoughts and suicide attempt items were grouped into four distinct health-groups based on having: (1) neither physical nor mental health condition (controls); (2) one or more physical health condition; (3) one or more mental health condition and; (4) multimorbidity. The role of multimorbidity in predicting suicidal ideation and suicide attempts was tested with a generalised estimating equation (GEE) model and odds ratios (ORs) and 95% CIs are presented. Whether the effect of multimorbidity was stronger than either health condition alone was also assessed.
Results
Multimorbidity had a significant effect on suicidal thoughts and suicide attempts, compared to the control group, but was not found to increase the risk of either suicide-related outcomes, more than mental illness alone.
Conclusions
We identified an effect of physical/mental multimorbidity on risk of suicidal thoughts and suicide attempts. Considering that suicide and related behaviour are rare events, future studies should employ a prospective design on the role of multimorbidity in suicidality, employing larger datasets.
Electronic supplementary material
The online version of this article (10.1186/s12888-019-2032-8) contains supplementary material, which is available to authorized users.
... We set out to examine whether perceived neighbourhood stressors were associated with adiposity using three sweeps of data, covering 13 years of the life course, from three cohorts in the longitudinal West of Scotland Twenty-07 Study. The West of Scotland Twenty-07 Study is a community-based, prospective cohort study, which has followed three cohorts of men and women recruited at the (approximate) ages of 15 (1970s cohort), 35 (1950s cohort), and 55 years (1930s cohort) in 1987 (wave 1) and followed up over 20 years [27].We therefore assessed two models to examine the impact of perceived neighbourhood stressors on adiposity. These comprised: (1) an accumulation model which uses a cumulative measure of neighbourhood perceptions over time; and (2) a critical periods model which separately analyses the relationship between measures of perceived neighbourhood stressors at each wave and subsequent adiposity. ...
... Data were from the West of Scotland Twenty-07 Study, a community-based prospective cohort study which is situated within a large socially heterogeneous and predominantly urban area surrounding the city of Glasgow [27]. This study area was considered suitable for investigating inequalities in health and the determinants of health because it contains areas with the best and the worst health statuses in Europe [29,30]. ...
... West of Scotland Twenty-07 baseline respondents have been shown to be representative of the general population of the sampled area [32]. The methodology and specific study design of the West of Scotland Twenty-07 have been published and described in detail [27]. ...
There is growing interest in understanding which aspects of the local environment influence obesity. Using data from the longitudinal West of Scotland Twenty-07 study (n = 2040) we examined associations between residents’ self-reported neighbourhood problems, measured over a 13-year period, and nurse-measured body weight and size (body mass index, waist circumference, waist–hip ratio) and percentage body fat. We also explored whether particular measures such as abdominal obesity, postulated as a marker for stress, were more strongly related to neighbourhood conditions. Using life course models adjusted for sex, cohort, household social class, and health behaviours, we found that the accumulation of perceived neighbourhood problems was associated with percentage body fat. In cross-sectional analyses, the strongest relationships were found for contemporaneous measures of neighbourhood conditions and adiposity. When analyses were conducted separately by gender, perceived neighbourhood stressors were strongly associated with central obesity measures (waist circumference, waist–hip ratio) among both men and women. Our findings indicate that chronic neighbourhood stressors are associated with obesity. Neighbourhood environments are modifiable, and efforts should be directed towards improving deleterious local environments to reduce the prevalence of obesity.
... Data were obtained from five British cohort studies: the European Prospective Investigation of Cancer, Norfolk Cohort (EPIC-N) [24]; the Medical Research Council's National Survey of Health and Development 1946 (NSHD) [25]; West of Scotland Twenty-07: 1930s (T07-1930s) [26]; West of Scotland Twenty-07: 1950s (T07-1950s) [26] and Whitehall II (WII) [27]. Further data were obtained from an additional French cohort: Gaz et Electricité (GAZEL) [28]. ...
... Data were obtained from five British cohort studies: the European Prospective Investigation of Cancer, Norfolk Cohort (EPIC-N) [24]; the Medical Research Council's National Survey of Health and Development 1946 (NSHD) [25]; West of Scotland Twenty-07: 1930s (T07-1930s) [26]; West of Scotland Twenty-07: 1950s (T07-1950s) [26] and Whitehall II (WII) [27]. Further data were obtained from an additional French cohort: Gaz et Electricité (GAZEL) [28]. ...
Background:
Studies have shown that alcohol intake trajectories differ in their associations with biomarkers of cardiovascular functioning, but it remains unclear if they also differ in their relationship to actual coronary heart disease (CHD) incidence. Using multiple longitudinal cohort studies, we evaluated the association between long-term alcohol consumption trajectories and CHD.
Methods:
Data were drawn from six cohorts (five British and one French). The combined analytic sample comprised 35,132 individuals (62.1% male; individual cohorts ranging from 869 to 14,247 participants) of whom 4.9% experienced an incident (fatal or non-fatal) CHD event. Alcohol intake across three assessment periods of each cohort was used to determine participants' intake trajectories over approximately 10 years. Time to onset for (i) incident CHD and (ii) fatal CHD was established using surveys and linked medical record data. A meta-analysis of individual participant data was employed to estimate the intake trajectories' association with CHD onset, adjusting for demographic and clinical characteristics.
Results:
Compared to consistently moderate drinkers (males: 1-168 g ethanol/week; females: 1-112 g ethanol/week), inconsistently moderate drinkers had a significantly greater risk of incident CHD [hazard ratio (HR) = 1.18, 95% confidence interval (CI) = 1.02-1.37]. An elevated risk of incident CHD was also found for former drinkers (HR = 1.31, 95% CI = 1.13-1.52) and consistent non-drinkers (HR = 1.47, 95% CI = 1.21-1.78), although, after sex stratification, the latter effect was only evident for females. When examining fatal CHD outcomes alone, only former drinkers had a significantly elevated risk, though hazard ratios for consistent non-drinkers were near identical. No evidence of elevated CHD risk was found for consistently heavy drinkers, and a weak association with fatal CHD for inconsistently heavy drinkers was attenuated following adjustment for confounding factors.
Conclusions:
Using prospectively recorded alcohol data, this study has shown how instability in drinking behaviours over time is associated with risk of CHD. As well as individuals who abstain from drinking (long term or more recently), those who are inconsistently moderate in their alcohol intake have a higher risk of experiencing CHD. This finding suggests that policies and interventions specifically encouraging consistency in adherence to lower-risk drinking guidelines could have public health benefits in reducing the population burden of CHD. The absence of an effect amongst heavy drinkers should be interpreted with caution given the known wider health risks associated with such intake.
Trial registration:
ClinicalTrials.gov, NCT03133689 .
... They were interviewed in their homes by trained interviewers at baseline and on up to four further occasions over the following 20 years. Further details of the study are given elsewhere (Benzeval et al., 2008). A comparison with data from the 1991 UK Census showed it to be representative of the underlying population in terms of sex, social class, car ownership and household tenure (Der, 1998). ...
Introduction
The association of premorbid cognitive ability with all-cause mortality is now well established. However, since all-cause mortality is relatively uninformative about aetiology, evidence has been sought, and is beginning to accumulate, for associations with specific causes of mortality. Likewise, the underlying causal pathways may be illuminated by considering associations with different measures of cognitive ability. For example, critics of IQ type measures point to possible cultural or social biases and there is, consequently, a need for more culturally neutral measures such as reaction times. We examine the associations of cognitive ability with major causes of mortality, including: cardiovascular disease, cancer and respiratory disease and compare the results for a standard IQ test, the Alice Heim 4 (AH4), with those for simple and four-choice reaction times.
Methods
Data were derived from the oldest cohort of the West of Scotland Twenty-07 Study. Participants were randomly sampled from the Central Clydeside Conurbation, a mainly urban area centred on Glasgow city. At baseline, aged 56, they were interviewed in their homes by trained interviewers; the AH4 was administered and reaction times measured using a portable electronic device. Vital status was ascertained via linkage to the NHS central register. Cox regression was used in SAS 9.4 for the main analyses. Adjustments were made for sex, smoking status and social class.
Results
Full data on AH4, RT and covariates were available for 1350 out of 1551. During 29 years of follow-up, there were 833 deaths: 279 cardiovascular disease (CVD) (168 CHD; 68 stroke); 291 cancer; 97 respiratory disease; 42 digestive disease; and 39 dementia. The 85 remaining deaths were a heterogeneous mixture with no cause accounting for more than 14.
AH4 scores were associated with most major causes. Digestive disease and dementia had similar effect sizes but were not significant. Within cardiovascular disease, there was an association with coronary heart disease but not stroke. The association with cancer was primarily due to those cancers related to smoking.
RT measures were mostly associated with the same causes of death. Where significant, effects were in the same directions and of similar magnitude. That is, lower AH4 scores, longer reaction times, and more variable reaction times were all associated with increased mortality risk from the major causes of death. A summary measure of RT outperformed the AH4 for most causes.
Conclusion
The association between intelligence with mortality from the major causes is also seen with reaction times. That effect sizes are of similar magnitude is suggestive of a common cause. It also implies that the association of cognitive ability with mortality is unlikely to be due to any social, cultural or educational biases that are sometimes ascribed to intelligence measures.
... This study therefore aims to compare the types and context of sitting (and non-sitting) activities and their role in the daily lives of older adults who sit more than average and those who sit less. Access to two existing large study cohorts (the Lothian Birth Cohort 1936 and Twenty-07 Study; see Benzeval et al., 2009;Deary, Gow, Pattie, & Starr, 2012 for full details of the cohorts) allowed us to interview and contrast the accounts of a large, diverse sample of community-living older adults according to gender, age, and SES, as well as their current objectively measured level of sedentary behavior. ...
Background and objectives:
Sitting less can reduce older adults' risk of ill health and disability. Effective sedentary behavior interventions require greater understanding of what older adults do when sitting (and not sitting), and why. This study compares the types, context, and role of sitting activities in the daily lives of older men and women who sit more or less than average.
Research design and methods:
Semistructured interviews with 44 older men and women of different ages, socioeconomic status, and objectively measured sedentary behavior were analyzed using social practice theory to explore the multifactorial, inter-relational influences on their sedentary behavior. Thematic frameworks facilitated between-group comparisons.
Results:
Older adults described many different leisure time, household, transport, and occupational sitting and non-sitting activities. Leisure-time sitting in the home (e.g., watching TV) was most common, but many non-sitting activities, including "pottering" doing household chores, also took place at home. Other people and access to leisure facilities were associated with lower sedentary behavior. The distinction between being busy/not busy was more important to most participants than sitting/not sitting, and informed their judgments about high-value "purposeful" (social, cognitively active, restorative) sitting and low-value "passive" sitting. Declining physical function contributed to temporal sitting patterns that did not vary much from day-to-day.
Discussion and implications:
Sitting is associated with cognitive, social, and/or restorative benefits, embedded within older adults' daily routines, and therefore difficult to change. Useful strategies include supporting older adults to engage with other people and local facilities outside the home, and break up periods of passive sitting at home.
