Repeat Cross-sectional Surveys Research Articles

Refuting tobacco-industry funded research: empirical data shows decline in smoking prevalence following introduction of plain packaging in Australia

1. Framework Convention on Tobacco Control. Guidelines forImplementation of Article 11 (Packaging and Labelling of Tobacco Products). 2008. Available from: http://www.who.int/entity/fctc... (accessed 11 Oct 2015). Google Scholar

Did school food and nutrient-based standards in England impact on 11-12Y olds nutrient intake at lunchtime and in total diet? Repeat cross-sectional study.

IntroductionIn September 2009, middle and secondary schools in England were required to comply with food and nutrient-based standards for school food. We examined the impact of this policy change on children’s lunchtime and total dietary intake.MethodsWe undertook repeat cross-sectional surveys in six Northumberland middle schools in 1999–2000 and 2009–10. Dietary data were collected from 11–12 y olds (n = 298 in 1999–2000; n = 215 in 2009–10). Children completed two consecutive 3-day food diaries, each followed by an interview. Linear mixed effect models examined the effect of year, lunch type and level of socio-economic deprivation on children’s mean total dietary intake.ResultsWe found both before and after the introduction of the food and nutrient-based standards children consuming a school lunch, had a lower per cent energy from saturated fat (−0.5%; p = 0.02), and a lower intake of sodium (−143 mg; p = 0.02), and calcium (−81 mg; p = 0.001) in their total diet, compared with children consuming a home-packed lunch. We found no evidence that lunch type was associated with mean energy, or absolute amounts of NSP, vitamin C and iron intake. There was marginal evidence of an association between lunch type and per cent energy NMES (p = 0.06). In 1999–2000, children consuming a school lunch had a higher per cent energy from fat in their total diet compared with children consuming a home-packed lunch (2.8%), whereas by 2009–10, they had slightly less (−0.2%) (year by lunch type interaction p<0.001; change in mean differences −3%).ConclusionsWe found limited evidence of an impact of the school food and nutrient-based standards on total diet among 11–12 year olds. Such policies may need to be supported by additional measures, including guidance on individual food choice, and the development of wider supportive environments in school and beyond the school gates.

Age-related differences in patterns of criminal activity among a large sample of polydrug injectors in Australia

Background: The relationship between age and criminal activity among drug-using populations is poorly understood.Methods: Data from 10 years of repeat cross-sectional surveys of sentinel samples of regular people who inject drugs (PWID) across Australia (n = 5844) were used to explore the relationship between age and past-month drug dealing, property crime and violent crime, and past-year arrest. Descriptive statistics were used to explore the prevalence and frequency of each outcome. The relationship between age and each outcome was measured using multivariable Poisson regression with robust error variance.Results: After adjusting for confounding factors, each 5-year increase in age was associated with significant reductions in drug dealing (adjusted incidence rate ratio [AIRR]: 0.90, 95% confidence interval [CI]: 0.87–0.94), property crime (AIRR: 0.85, 95% CI: 0.82–0.89) and violent crime (AIRR: 0.77, 95% CI: 0.70–0.85). Older participants were also significantly less likely to report being arrested in the past 12 months (AIRR: 0.91, 95% CI: 0.88–0.93).Conclusions: Younger PWID are more heavily involved in criminal activity compared with their older counterparts. This study highlights the need for early intervention programmes to prevent offending behaviour becoming entrenched, as well as continued efforts to redirect young PWID away from the criminal justice system and into treatment and education programmes.

Using repeated cross-sectional travel surveys to enhance forecasting robustness: Accounting for changing mode preferences

Transportation system capacity and performance, urban form and socio-demographics define the influences and constraints conditioning the preferences of urban residents for different transport modes. Changes in characteristics of urban areas are likely to lead to changes in preferences for alternative modes of transport over time; as a consequence, statistical models to forecast mode choice need to be sensitive to both purposeful changes to urban systems as well as exogenous shocks. We make use of the 1996, 2001 and 2006 household surveys conducted in the Greater Toronto and Hamilton Area to study mode preference evolution and model forecasting performance. These repeated cross-sectional household surveys provide an opportunity to investigate aggregate structural changes in commuting mode preferences over time, in a manner sensitive to changes in the urban area. We focus on commuting mode choices because these trips are prime determinants of peak period congestion and peak spreading. We then address how to combine the three cross-sections econometrically in a robust way that allows for use of a single mode choice model across the entire period. Using independent data from 2012, we are able to compare the individual year and combined models in terms of forecasting performance to demonstrate the combined model’s more robust forecasting performance into the future.

Evaluating the health inequalities impact of area-based initiatives across the socioeconomic spectrum: a controlled intervention study of the New Deal for Communities, 2002–2008

BackgroundPrevious evaluations of area-based initiatives have not compared intervention areas with the full range of areas from top to bottom of the social spectrum to evaluate their health inequalities impact.SettingDeprived...

Incursions of Cyprinid herpesvirus 2 in goldfish populations in Australia despite quarantine practices

The international trade in ornamental fish is considered a major factor for the transboundary spread of aquatic pathogens that can affect both wild and farmed fish populations. Nearly 18 million ornamental fish were imported into Australia in 2007, including approximately 3.9 million goldfish. Despite quarantine regulations during importation, there have been several incidents in Australia where exotic pathogens from ornamental fish have become established in farmed or free-living fish species. The exotic virus Cyprinid herpesvirus 2 (CyHV2) was first found in Australia in 2003 in goldfish, suggesting that sub-clinically infected goldfish were passing through quarantine regardless of health certification and three weeks of quarantine. Repeated cross sectional surveys were conducted to determine whether CyHV2 has already established in farmed or wild ornamental fish in Australia. Goldfish populations were tested to OIE standard to detect 2% prevalence with 95% confidence assuming a test of 100% sensitivity and specificity. CyHV2 was found at retail outlets, farms and in several populations of wild goldfish in the ACT and Victoria. The prevalence and moderate to high viral loads in sub-clinically infected goldfish from different domestic populations suggested the introduction was not a recent event. This study demonstrated that CyHV2 has established in Australia and informed quarantine policy to revoke the requirement for goldfish exported to Australia to be certified free of CyHV2. The results provided clear evidence that an aquatic pathogen from imported ornamental fish can become established in farmed and wild populations. This is of particular significance to Australia as there are many endemic and ecologically sensitive populations of fish that may be severely affected by exotic pathogens. The incursion of CyHV2 in Australia should be considered a case study to inform pathway analysis for pathogen establishment.

Location-based HIV behavioural surveillance among MSM in Auckland, New Zealand 2002–2011: condom use stable and more HIV testing

ObjectivesOver the last decade, annual HIV diagnoses among men who have sex with men (MSM) in New Zealand increased, then stabilised in 2006 and have not increased further. The aim...

Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980-2010: repeated cross sectional surveys and ecological comparison of secular trends

The paper Abstract Objective To evaluate the associations between population-wide loss and gain in weight with diabetes prevalence, incidence, and mortality, as well as cardiovascular and cancer mortality trends, in Cuba over a 30 year interval. Design Repeated cross sectional surveys and ecological comparison of secular trends. Setting Cuba and the province of Cienfuegos, from 1980 to 2010. Participants Measurements in Cienfuegos included a representative sample of 1657, 1351, 1667, and 1492 adults in 1991, 1995, 2001, and 2010, respectively. National surveys included a representative sample of 14 304, 22 851, and 8031 participants in 1995, 2001, and 2010, respectively. Main outcome measures Changes in smoking, daily energy intake, physical activity, and body weight were tracked from 1980 to 2010 using national and regional surveys. Data for diabetes prevalence and incidence were obtained from national population based registries. Mortality trends were modelled using national vital statistics. Results Rapid declines in diabetes and heart disease accompanied an average population-wide loss of 5.5 kg in weight, driven by an economic crisis in the mid-1990s. A rebound in population weight followed in 1995 (33.5% prevalence of overweight and obesity) and exceeded pre-crisis levels by 2010 (52.9% prevalence). The population-wide increase in weight was immediately followed by a 116% increase in diabetes prevalence and 140% increase in diabetes incidence. Six years into the weight rebound phase, diabetes mortality increased by 49% (from 9.3 deaths per 10 000 people in 2002 to 13.9 deaths per 10 000 people in 2010). A deceleration in the rate of decline in mortality from coronary heart disease was also observed. Conclusions In relation to the Cuban experience …

Malaria risk factors in Butajira area, south-central Ethiopia: a multilevel analysis

BackgroundThe highlands of Ethiopia, situated between 1,500 and 2,500 m above sea level, experienced severe malaria epidemics. Despite the intensive control attempts, underway since 2005 and followed by an initial decline, the disease remained a major public health concern. The aim of this study was to identify malaria risk factors in highland-fringe south-central Ethiopia.MethodsThis study was conducted in six rural kebeles of Butajira area located 130 km south of Addis Ababa, which are part of demographic surveillance site in Meskan and Mareko Districts, Ethiopia. Using a multistage sampling technique 750 households was sampled to obtain the 3,398 people, the estimated sample size for this study. Six repeated cross-sectional surveys were conducted from October 2008 to June 2010. Multilevel, mixed-effects logistic regression models fitted to Plasmodium infection status (positive or negative) and six variables. Both fixed- and random-effects differences in malaria infection were estimated using median odds ratio and interval odds ratio 80%. The odds ratios and 95% confidence intervals were used to estimate the strength of association.ResultsOverall, 19,207 individuals were sampled in six surveys (median and inter-quartile range value three). Six of the five variables had about two-fold to eight-fold increase in prevalence of malaria. Furthermore, among these variables, October-November survey seasons of both during 2008 and 2009 were strongly associated with increased prevalence of malaria infection. Children aged below five years (adjusted OR= 3.62) and children aged five to nine years (adj. OR= 3.39), low altitude (adj. OR= 5.22), mid-level altitude (adj. OR= 3.80), houses with holes (adj. OR= 1.59), survey seasons such as October-November 2008 (adj. OR= 7.84), January-February 2009 (adj. OR= 2.33), June-July 2009 (adj. OR=3.83), October-November 2009 (adj. OR= 7.71), and January-February 2010 (adj. OR= 3.05) were associated with increased malaria infection.The estimates of cluster variances revealed differences in malaria infection. The village-level intercept variance for the individual-level predictor (0.71 [95% CI: 0.28-1.82]; SE=0.34) and final (0.034, [95% CI: 0.002-0.615]; SE=0.05) were lower than that of empty (0.80, [95% CI: 0.32-2.01]; SE=0.21).ConclusionMalaria control efforts in highland fringes must prioritize children below ten years in designing transmission reduction of malaria elimination strategy.

Monitoring and evaluating the impact of national school-based deworming in Kenya: study design and baseline results.

BackgroundAn increasing number of countries in Africa and elsewhere are developing national plans for the control of neglected tropical diseases. A key component of such plans is school-based deworming (SBD) for the control of soil-transmitted helminths (STHs) and schistosomiasis. Monitoring and evaluation (M&E) of national programmes is essential to ensure they are achieving their stated aims and to evaluate when to reduce the frequency of treatment or when to halt it altogether. The article describes the M&E design of the Kenya national SBD programme and presents results from the baseline survey conducted in early 2012.MethodsThe M&E design involves a stratified series of pre- and post-intervention, repeat cross-sectional surveys in a representative sample of 200 schools (over 20,000 children) across Kenya. Schools were sampled based on previous knowledge of STH endemicity and were proportional to population size. Stool (and where relevant urine) samples were obtained for microscopic examination and in a subset of schools; finger-prick blood samples were collected to estimate haemoglobin concentration. Descriptive and spatial analyses were conducted. The evaluation measured both prevalence and intensity of infection.ResultsOverall, 32.4% of children were infected with at least one STH species, with Ascaris lumbricoides as the most common species detected. The overall prevalence of Schistosoma mansoni was 2.1%, while in the Coast Province the prevalence of S. haematobium was 14.8%. There was marked geographical variation in the prevalence of species infection at school, district and province levels. The prevalence of hookworm infection was highest in Western Province (25.1%), while A. lumbricoides and T. trichiura prevalence was highest in the Rift Valley (27.1% and 11.9%). The lowest prevalence was observed in the Rift Valley for hookworm (3.5%), in the Coast for A. lumbricoides (1.0%), and in Nyanza for T. trichiura (3.6%). The prevalence of S. mansoni was most common in Western Province (4.1%).ConclusionsThe current findings are consistent with the known spatial ecology of STH and schistosome infections and provide an important empirical basis on which to evaluate the impact of regular mass treatment through the school system in Kenya.

Alcohol Policy Changes and Trends in Adolescent Drinking in Finland from 1981 to 2011

To test if changes in national alcohol policy have had an impact on alcohol use among 12- to 18-year-old adolescents in Finland over a 30-year period. Frequencies of drinking any amounts of alcohol and drinking alcohol until really drunk from bi-annual repeated cross-sectional surveys from 1981 to 2011 were examined against a national alcohol policy review using nationally representative samples of 12-, 14-, 16- and 18-year-old adolescents (n = 99,724) in Finland. Twelve-year-olds' alcohol drinking remained rare throughout the period. Drinking among 18-year-olds generally increased throughout the period. Significant increases until the late 1990s and decreases thereafter were observed in 14- and 16-year-olds' drinking patterns. A sharp increase was predicted between 2003 and 2005 as a result of EU-related processes, but instead decrease was observed among 14-16-year-olds. The tests of hypothesized decrease from 2005 to 2011 due to tightening alcohol policy including several tax raises produced mixed results. Alcohol policy changes between 1981 and 2011 seem not to have had noticeable influence on alcohol drinking or drunkenness among the under-aged in Finland. Conspicuous increases seen in population total consumption in association with EU-related developments have not materialized among adolescents.

Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980-2010: repeated cross sectional surveys and ecological comparison of secular trends

Objective To evaluate the associations between population-wide loss and gain in weight with diabetes prevalence, incidence, and mortality, as well as cardiovascular and cancer mortality trends, in Cuba over a...

Direct-to-consumer television advertising exposure, diagnosis with high cholesterol, and statin use.

While statin drugs are recommended for secondary prevention of coronary heart disease (CHD), there is no medical consensus on whether or not a statin should be added to lifestyle change efforts for primary prevention of CHD. Previous research suggests that exposure to direct-to-consumer advertising (DTCA) increases drug demand among those at comparatively low risk. Research has yet to examine whether individual-level DTCA exposure may influence statin use among men and women at high, moderate, or low risk for future cardiac events. To determine the relationship between estimated exposure to DTCA for statin drugs and two clinical variables: diagnosis with high cholesterol and statin use. We used logistic regression to analyze repeated cross-sectional surveys of the United States population, merged with data on the frequency of DTCA appearances on national, cable, and local television, between 2001 and 2007. American adults (n=106,685) aged 18 and older. Levels of exposure to statin DTCA, based on ad appearances and TV viewing patterns; self-reports of whether or not a respondent has been diagnosed with high cholesterol, and whether or not a respondent took a statin in the past year. Adjusting for potential confounders, we estimate that exposure to statin ads increased the odds of being diagnosed with high cholesterol by 16 to 20 %, and increased statin use by 16 to 22 %, among both men and women (p<0.05). These associations were driven almost exclusively by men and women at low risk for future cardiac events. There was also evidence of a negative association between DTCA exposure and statin use among high-risk women (p<0.05) CONCLUSIONS: This study provides new evidence that DTCA may promote over-diagnosis of high cholesterol and over-treatment for populations where risks of statin use may outweigh potential benefits.

Cross-National Comparisons of Time Trends in Overweight Inequality by Socioeconomic Status Among Women Using Repeated Cross-Sectional Surveys From 37 Developing Countries, 1989–2007

Chronic diseases are now among the leading causes of morbidity and mortality in lower income countries. Although traditionally related to higher individual socioeconomic status (SES) in these contexts, the associations between SES and chronic disease may be actively changing. Furthermore, country-level contextual factors, such as economic development and income inequality, may influence the distribution of chronic disease by SES as well as how this distribution has changed over time. Using overweight status as a health indicator, the authors studied repeated cross-sectional data from women aged 18-49 years in 37 developing countries to assess within-country trends in overweight inequalities by SES between 1989 and 2007 (n=405,550). Meta-regression was used to examine the associations between gross domestic product and disproportionate increases in overweight prevalence by SES, with additional testing for modification by country-level income inequality. In 27 of 37 countries, higher SES (vs. lower) was associated with higher gains in overweight prevalence; in the remaining 10 countries, lower SES (vs. higher) was associated with higher gains in overweight prevalence. Gross domestic product was positively related to faster increase in overweight prevalence among the lower wealth groups. Among countries with a higher gross domestic product, lower income inequality was associated with faster overweight growth among the poor.

Cross-National Comparisons of Time Trends in Overweight Inequality by Socioeconomic Status Among Women Using Repeated Cross-Sectional Surveys From 37 Developing Countries, 1989–2007

Cross-National Comparisons of Time Trends in Overweight Inequality by Socioeconomic Status Among Women Using Repeated Cross-Sectional Surveys From 37 Developing Countries, 1989–2007

The spatial-temporal clustering of Plasmodium falciparum infection over eleven years in Gezira State, The Sudan

BackgroundMalaria infection and disease exhibit microgeographic heterogeneity which if predictable could have implications for designing small-area intervention. Here, the space-time clustering of Plasmodium falciparum infections using data from repeat cross-sectional surveys in Gezira State, a low transmission area in northern Sudan, is investigated.MethodsData from cross-sectional surveys undertaken in January each year from 1999-2009 in 88 villages in the Gezira state were assembled. During each survey, about a 100 children between the ages two to ten years were sampled to examine the presence of P. falciparum parasites. In 2009, all the villages were mapped using global positioning systems. Cluster level data were analysed for spatial-only and space-time clustering using the Bernoulli model and the significance of clusters were tested using the Kulldorff scan statistic.ResultsOver the study period, 96,022 malaria slide examinations were undertaken and the P. falciparum prevalence was 8.6% in 1999 and by 2009 this had reduced to 1.6%. The cluster analysis showed the presence of one significant spatial-only cluster in each survey year and one significant space-time cluster over the whole study period. The primary spatial-only clusters in 10/11 years were either contained within or overlapped with the primary space-time cluster.ConclusionThe results of the study confirm the generally low malaria transmission in the state of Gezira and the presence of spatial and space-time clusters concentrated around a specific area in the south of the state. Improved surveillance data that allows for the analysis of seasonality, age and other risk factors need to be collected to design effective small area interventions as Gezira state targets malaria elimination.

Protocol for a mixed methods study investigating the impact of investment in housing, regeneration and neighbourhood renewal on the health and wellbeing of residents: the GoWell programme.

BackgroundThere is little robust evidence to test the policy assumption that housing-led area regeneration strategies will contribute to health improvement and reduce social inequalities in health. The GoWell Programme has been designed to measure effects on health and wellbeing of multi-faceted regeneration interventions on residents of disadvantaged neighbourhoods in the city of Glasgow, Scotland.Methods/DesignThis mixed methods study focused (initially) on 14 disadvantaged neighbourhoods experiencing regeneration. These were grouped by intervention into 5 categories for comparison. GoWell includes a pre-intervention householder survey (n = 6008) and three follow-up repeat-cross sectional surveys held at two or three year intervals (the main focus of this protocol) conducted alongside a nested longitudinal study of residents from 6 of those areas. Self-reported responses from face-to-face questionnaires are analysed along with various routinely produced ecological data and documentary sources to build a picture of the changes taking place, their cost and impacts on residents and communities. Qualitative methods include interviews and focus groups of residents, housing managers and other stakeholders exploring issues such as the neighbourhood context, potential pathways from regeneration to health, community engagement and empowerment.DiscussionUrban regeneration programmes are 'natural experiments.' They are complex interventions that may impact upon social determinants of population health and wellbeing. Measuring the effects of such interventions is notoriously challenging. GoWell compares the health and wellbeing effects of different approaches to regeneration, generates theory on pathways from regeneration to health and explores the attitudes and responses of residents and other stakeholders to neighbourhood change.

Pathways of change in social mobility: Industrialization, education and growing fluidity in Brazil

This paper explores the change in intergenerational class mobility over the last quarter-century in Brazil. Using repeated cross-sectional surveys between the early 1970s and the late 1990s and a counterfactual approach, we disentangle cohort from period interpretations of change, and examine the mechanisms driving change in fluidity among Brazilian men. We detect a substantial increase in social fluidity over time, which emerges from period transformation, rather than cohort replacement. This trend departs from industrialized nations, where growing fluidity has been found to be entirely driven by the replacement of older, more rigid cohorts by younger, more fluid ones, and to emerge from educational equalization and a “compositional effect”—educational expansion combined with a weaker intergenerational association among those with higher education. In contrast, in a context of rapid late industrialization, two mechanisms account for growing fluidity in Brazil: the decline in the “economic returns to schooling”, and the weakening of the direct influence of class origins on class destination, net of education. We discuss the implications of these patterns for the understanding of mobility dynamics in different national contexts.

Using sediment impact sensors to improve the morphological sediment budget approach for estimating bedload transport rates

Constructing a sediment budget from morphological channel change, typically measured using repeat cross-sectional surveys, has proven a useful technique for estimating mean bedload transport rates in gravel-bed rivers. We apply and suggest improvements to the approach using new data sources from an intensely monitored 5.6 km reach of an upland gravel-bed river in northern England. Sediment impact sensors were placed in the bed to record the instantaneous passage of grains during transport events. These sensors provide valuable information for the budget including: (1) a downstream budget limit from which the rest of the budget can be calculated; (2) estimates of sediment input from tributaries; and (3) a better indication of active transport time used in the calculation of average transport rates. Further information collected from field studies include estimates of lateral inputs from the banks using field surveys and bank erosion pins and estimates of the variability of sediment porosity from bed grain size distributions. Budget calculations for different locations and time periods demonstrate large spatial and temporal variabilities in bedload transport rates over a short distance (< 3 km). Whilst some uncertainty in the new data sources remains, this work highlights some limitations of the traditional budget approach and some potential solutions; in particular the value of sediment impact sensors for sediment transport studies.

The use of artemether‐lumefantrine by febrile children following national implementation of a revised drug policy in Kenya

To examine access to, timing and use of artemisinin-based combination therapy among rural Kenyan febrile children before and following the introduction of artemether-lumefantrine (AL) as first-line antimalarial drug policy. In August 2006, a cohort was established within 72 rural clusters in four sentinel districts to monitor the period prevalence of fever and treatment in children aged 0-4 years through four repeat cross-sectional surveys (one prior to introduction of AL and three post-AL introduction: January-June 2007). Mothers/guardians of children were asked about fever in the last 14 days and related treatment actions including the timing, drugs used, dosing and adherence supported by visual aids of commonly available drug products. A total of 2526 child-observations were recorded during the four survey rounds. The period prevalence of fever was between 20% and 26% with little variation between survey rounds. The overall proportion of children with fever receiving antimalarial drugs for their fever was 31 % (95% CI, 26-36%) and the proportion of febrile children receiving antimalarial drugs within 48 h was 23.3% (95% CI, 18.6-28.0%). The proportion of febrile children who received first-line recommended AL within 48 h was 10.2% (95% CI, 7.0-13.4%), compared to only 4.6% (95% CI, 3.8-5.4%) of children receiving sulphadoxine-pyrimethamine first-line therapy in 2001. Although Kenya was less than a year into the new policy implementation and AL is restricted to the public formal sector, access to antimalarial drugs among children within 48 h and to the first-line therapy has improved. But it remains well below national and international targets. The continued use of amodiaquine and artemisinin monotherapies constrains effective implementation of artemisinin-based combination therapy policy in Kenya.