environmental epidemiological associations of psychosomatic symptoms of 7–11 year old children,...

Environmental epidemiological associationsEnvironmental epidemiological associations

of psychosomatic symptomsof psychosomatic symptoms

of 7–11 year old children,of 7–11 year old children,Hungary, 1997–2002Hungary, 1997–2002

Mihály János Varró, Zoltán Virágh, Péter RudnaiMihály János Varró, Zoltán Virágh, Péter Rudnai

Fodor József National Center of Public HealthFodor József National Center of Public Health

National Institute for Environmental Health,National Institute for Environmental Health,

Budapest, HungaryBudapest, Hungary

"NEW CHALLENGES OF ENVIRONMENTAL HEALTH" "NEW CHALLENGES OF ENVIRONMENTAL HEALTH"

Meeting of theMeeting of the Central and Eastern European Chapter Central and Eastern European Chapter of theof the

International Society for Environmental EpidemiologyInternational Society for Environmental Epidemiology

Budapest, Hungary, 9–11 June 2005Budapest, Hungary, 9–11 June 2005

ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005

IntroductionIntroduction

In a survey series, In a survey series,

data on data on

– – respiratory/other respiratory/other symptomssymptoms,,

– – demographic demographic (gender, age, settlemenet type)(gender, age, settlemenet type),,

– – hereditary, perinatal, hereditary, perinatal, environmentalenvironmental,,

–– lifestyle, social, etc. lifestyle, social, etc. factors factors

of of 7–11 year old children7–11 year old children were collected were collected

by highly by highly standardised questionnairesstandardised questionnaires in Hungary. in Hungary.


ObjectiveObjective

To assess To assess associationsassociations

between between environmental factors environmental factors andand

psychosomatic symptomspsychosomatic symptoms of school children. of school children.


Methods 1.Methods 1.

““Psychosomatic symptom”Psychosomatic symptom”::

at least one symptom out of at least one symptom out of

– – fatigue fatigue

– – headache headache

– – irritability irritability

– – anxietyanxiety


Methods 2.Methods 2.Data processingData processing

– – Data entry:Data entry: Epi Info 6.0xEpi Info 6.0x

– – Analysis:Analysis: Stata 7.0Stata 7.0

–– Crude Crude odds ratiosodds ratios (cORs)(cORs)

–– Adjusted odds ratios Adjusted odds ratios (aORs): (aORs):

– – in a validatedin a validated logistic regressionlogistic regression

backward modelbackward model

– – fix adjustment w. that modelfix adjustment w. that model

–– 95% confidence intervals (95% confidence intervals (95% CI95% CI))


ResultsResults

Psychosomatic symptomsPsychosomatic symptoms (n=13 973; (n=13 973; 28.9%28.9%))

ModelModel (n=9461)(n=9461)– – Gender, age, town Gender, age, town

– – Parents’ any respiratory/allergic illnessParents’ any respiratory/allergic illness

– – Child’s serious chest illness (0–2 y)Child’s serious chest illness (0–2 y)

– – Use of the kitchen gas cooker for additional heatingUse of the kitchen gas cooker for additional heating

– – Mouldy flat; >20 cigarettes/day smoked in the flatMouldy flat; >20 cigarettes/day smoked in the flat

– – Mothers’educationMothers’education

Pseudo-RPseudo-R22= 5.2%; = 5.2%; Hosmer-Lemeshow p=0.558Hosmer-Lemeshow p=0.558

Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby gender, age and settlement typeby gender, age and settlement type

Hungary, 1997–2002Hungary, 1997–2002

Girls Boys 7y 8y 9y 10y 11y Girls Boys 7y 8y 9y 10y 11y Towns VillagesTowns VillagesAge of the childAge of the child

%%4040

3030

2020

1010

00


DEMOGRAPHIC FACTORSDEMOGRAPHIC FACTORS

Boys vs. girlsBoys vs. girls (n=9461; (n=9461; 50.0%50.0%))aOR=1.05,aOR=1.05, 95% CI=0.96–1.16 95% CI=0.96–1.16

AgeAge (n=9461; (n=9461; --))aORaOR1y raise1y raise==1.18***1.18***, 95% CI=1.12–1.24, 95% CI=1.12–1.24

Town/county of villageTown/county of village (n=9461; (n=9461; --) )

Living in villagesLiving in villages (n=9461; (n=9461; 23.1%23.1%))aOR=aOR=1.34***1.34***, , 95% CI=1.20–1.49 95% CI=1.20–1.49

(adjusted not to town/county of village)(adjusted not to town/county of village)

Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby questionnaire completing and by questionnaire completing and

parents’ respiratory-allergic illnessparents’ respiratory-allergic illness Hungary, 1997–2002 Hungary, 1997–2002

-- + + - +- + Father completes qesFather completes qes Parents’ resp.-allergic illness Parents’ resp.-allergic illness

4040

3030

2020

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OTHEROTHER

Only father completes Only father completes the questionnairethe questionnaire (n=9285; (n=9285; 5.1%5.1%))aOR=aOR=0.57***0.57***, 95% CI=0.43–0.74, 95% CI=0.43–0.74

PARENTS’ ILLNESSESPARENTS’ ILLNESSES

...any respiratory-allergic illness...any respiratory-allergic illness (n=9461; (n=9461; 20.9%20.9%))aOR=aOR=1.57***1.57***, 95% CI=1.38–1.77, 95% CI=1.38–1.77

- +- + - + - + -- + + Threatened Postponed labourThreatened Postponed labour Chest illness Chest illness pregnancy pregnancy (0–2y) (0–2y)

Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby perinatal conditionsby perinatal conditions

Hungary, 1997–2002 Hungary, 1997–2002

5050

4040

3030

2020

1010

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PERINATALPERINATAL

Threatened pregnancyThreatened pregnancy (n=9186; (n=9186; 19.7%19.7%))aOR=aOR=1.59***1.59***, 95% CI=1.42–1.79, 95% CI=1.42–1.79

Postponed labourPostponed labour (n=9305; (n=9305; 9.5%9.5%))aOR=aOR=1.59***1.59***, 95% CI=1.42–1.79, 95% CI=1.42–1.79

Serious chest illness of the childSerious chest illness of the child (n=9461; (n=9461; 22.1%22.1%))during the first two years of lifeduring the first two years of lifeaOR=aOR=1.73***1.73***, 95% CI=1.56–1.92, 95% CI=1.56–1.92

-- + + - +- + - + - + - - + + Gas cooker Mould Heavy Gas cooker Mould Heavy Agricult. airborneAgricult. airborne addit. heating addit. heating ETS ETS sprays sprays

Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby environmental factorsby environmental factors

Hungary, 1997–2002 Hungary, 1997–2002

7070

6060

5050

4040

3030

2020

1010

00

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ENVIRONMENTAL FACTORSENVIRONMENTAL FACTORS

Use of the kitchen gas cookerUse of the kitchen gas cookerfor additional heatingfor additional heating (n=9461; (n=9461; 5.1%5.1%))aOR=aOR=1.80***1.80***, 95% CI=1.47–2.21, 95% CI=1.47–2.21

Mouldy flat Mouldy flat (n=9461; (n=9461; 24.4%24.4%))aOR=aOR=1.61***1.61***, 95% CI=1.44–1.79, 95% CI=1.44–1.79

>20 cigarettes/day >20 cigarettes/day smoked in the flatsmoked in the flat (n=9461; (n=9461; 4.1%4.1%))aOR=aOR=2.16***2.16***, 95% CI=1.64–2.84, 95% CI=1.64–2.84

Reported house or garden exposure Reported house or garden exposure to agricult. airborne spraysto agricult. airborne sprays (n=1606; (n=1606; 7.2%7.2%))aOR=aOR=1.78**1.78**, 95% CI=1.19–2.66, 95% CI=1.19–2.66

(practically in one survey only)(practically in one survey only)

<<0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 5 6 0 1 2 3 4 5 6 >>4 0–3 4 0–3 hrs sleeping defic. hrs television/day hrs sport/week hrs sleeping defic. hrs television/day hrs sport/week

Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby lifestyle factorsby lifestyle factors

Hungary, 1997–2002 Hungary, 1997–2002

8080

7070

6060

5050

4040

3030

2020

1010

00

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LIFESTYLELIFESTYLE

Sleeping deficiency, SDSleeping deficiency, SD (n=9066; (n=9066; --))((ifif sleeping hours [SH] sleeping hours [SH]<<1010 thenthen SD=10–SH SD=10–SH elseelse SD=0) SD=0)aORaOR1h raise1h raise==1.17***1.17***, , 95% CI=1.09–1.2595% CI=1.09–1.25

Watching televisionWatching television (n=8838; (n=8838; --))(hours/day, max. 6 hours)(hours/day, max. 6 hours)aORaOR1h raise1h raise==1.10***1.10***, , 95% CI=1.04–1.1695% CI=1.04–1.16

Sport: 0Sport: 0––3 hours/week3 hours/week (n=6828; (n=6828; 77.8%77.8%))aOR=aOR=1.43***1.43***, , 95% CI=1.24–1.6495% CI=1.24–1.64

-- + + >8 ys >8 ys <<8 ys8 ys Every dayEvery day Mother school classes Mother school classes chocolate-sweetschocolate-sweets

Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby chocolate-sweets consumption and by chocolate-sweets consumption and

mother’s educationmother’s education Hungary, 1997–2002 Hungary, 1997–2002

5050

4040

3030

2020

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Eating chocolate… every dayEating chocolate… every day (n=1846; (n=1846; 29.0%29.0%))aOR=aOR=1.49***1.49***, 95% CI=1.21–1.84, 95% CI=1.21–1.84

SOCIAL FACTORSSOCIAL FACTORS

Mother with low education Mother with low education (n=9461; (n=9461; 15.8%15.8%))((<<8 elementary school classes)8 elementary school classes)aOR=aOR=1.37***1.37***, 95% CI=1.20–1.57, 95% CI=1.20–1.57

0 1 2 3 4 50 1 2 3 4 5 m m

Psychosomatic symptoms of 7–11 year oldsPsychosomatic symptoms of 7–11 year oldsby number of regression model factorsby number of regression model factors

Hungary, 1997–2002 Hungary, 1997–2002

100100 9090 8080 7070 6060 5050 4040 3030 2020 1010 00

%%


NUMBER OF REGRESSION MODEL FACTORSNUMBER OF REGRESSION MODEL FACTORS

+1, if parents: any respiratory-allergic illness+1, if parents: any respiratory-allergic illness

+1, if child: serious chest illness (0–2 y)+1, if child: serious chest illness (0–2 y)

+1, if use of the kitchen gas cooker for additional heating+1, if use of the kitchen gas cooker for additional heating

+1, if mouldy flat+1, if mouldy flat

+1, if >20 cigarettes/day smoked in the flat+1, if >20 cigarettes/day smoked in the flat

mm (n=9461; (n=9461; --))aORaORraise in mraise in m==1.62***1.62***, 95% CI=1.55–1.72, 95% CI=1.55–1.72

(adjusted to gender, age and town)(adjusted to gender, age and town)


Conclusions 1.Conclusions 1.

The The environmental factors environmental factors

(found to be associated (found to be associated

with respiratory symptoms)with respiratory symptoms)

had had strong associationsstrong associations

with with psychosomatic symptomspsychosomatic symptoms, too., too.



– – Living in villages Living in villages

– – Only father completes the questionnaireOnly father completes the questionnaire

– – Threatened pregnancy, postponed labourThreatened pregnancy, postponed labour

– – Sleeping deficiency, television seeing, sport, Sleeping deficiency, television seeing, sport,

eating chocolate-sweets every dayeating chocolate-sweets every day



Validated backward logistic regression model Validated backward logistic regression model

– – Use of the kitchen gas cooker Use of the kitchen gas cooker

for additional heating: for additional heating: aOR=aOR=1.80***1.80***

– – Mouldy flat:Mouldy flat: aOR=aOR=1.61***1.61***

– – >20 cigarettes/day smoked in the flat:>20 cigarettes/day smoked in the flat: aOR=aOR=2.16***2.16***

–– Reported house or garden exposure Reported house or garden exposure

to agricultural airborne sprays:to agricultural airborne sprays: aOR=aOR=1.78**1.78**

„„Fodor József” NCPH NIEH Fodor József” NCPH NIEH DEPT. COMMUNITY HEALTHDEPT. COMMUNITY HEALTH

Annamária Mácsik, Tamás Rudnai, Eszter Szabó, Annamária Mácsik, Tamás Rudnai, Eszter Szabó, Renáta Szentmihályi, Györgyi TóthRenáta Szentmihályi, Györgyi Tóth

National Public Health and Medical Officer ServiceNational Public Health and Medical Officer ServiceAll collabourating colleaguesAll collabourating colleagues

SCHOOLS, MUNICIPALITIES, HEALTH SERVICESSCHOOLS, MUNICIPALITIES, HEALTH SERVICES directorship of schools, class leaders, maires, directorship of schools, class leaders, maires,

youth and district nursesyouth and district nurses

FAMILIESFAMILIES parents, childrenparents, children

ThanksThanks

Thank you for your Thank you for your

attention!attention!


E-mail: [email protected]: [email protected]

environmental epidemiological associations of psychosomatic symptoms of 7–11 year old children,...

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