1. Environmental epidemiological associations of psychosomatic symptoms of 7–11 year old children, Hungary, 1997–2002 Mihály János Varró, Zoltán Virágh, Péter Rudnai Fodor József National Center of Public Health National Institute for Environmental Health, Budapest, Hungary "NEW CHALLENGES OF ENVIRONMENTAL HEALTH" Meeting of the Central and Eastern European Chapter of the International Society for Environmental Epidemiology International Society for Environmental Epidemiology Budapest, Hungary, 9–11 June 2005

2. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 Introduction In a survey series, data on – respiratory/other symptoms, – demographic (gender, age, settlemenet type), – hereditary, perinatal, environmental, – lifestyle, social, etc. factors of 7–11 year old children were collected by highly standardised questionnaires in Hungary.

3. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 Objective To assess associations between environmental factors and psychosomatic symptoms of school children.

4. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 Methods 1. “Psychosomatic symptom”: at least one symptom out of – fatigue – headache – irritability – anxiety

5. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 Methods 2. Data processing – Data entry:Epi Info 6.0x – Analysis:Stata 7.0 – Crude odds ratios (cORs) – Adjusted odds ratios (aORs): – in a validatedlogistic regression – in a validatedlogistic regression backward model – fix adjustment w. that model – fix adjustment w. that model – 95% confidence intervals (95% CI)

6. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 Results Psychosomatic symptoms(n=13 973; 28.9%) Model (n=9461) – Gender, age, town – Parents’ any respiratory/allergic illness – Child’s serious chest illness (0–2 y) – Use of the kitchen gas cooker for additional heating – Mouldy flat; >20 cigarettes/day smoked in the flat – Mothers’education Pseudo-R 2 = 5.2%; Hosmer-Lemeshow p=0.558

7. Psychosomatic symptoms of 7–11 year olds by gender, age and settlement type Hungary, 1997–2002 Hungary, 1997–2002 Girls Boys 7y 8y 9y 10y 11y Towns Villages Girls Boys 7y 8y 9y 10y 11y Towns Villages Age of the child % 40302010 0

8. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 DEMOGRAPHIC FACTORS Boys vs. girls (n=9461; 50.0%) aOR=1.05, 95% CI=0.96–1.16 Age (n=9461; -) aOR 1y raise =1.18***, 95% CI=1.12–1.24 Town/county of village(n=9461; -) Living in villages (n=9461; 23.1%) aOR=1.34***, 95% CI=1.20–1.49 (adjusted not to town/county of village)

9. Psychosomatic symptoms of 7–11 year olds by questionnaire completing and parents’ respiratory-allergic illness Hungary, 1997–2002 - +- + - +- + Father completes qes Parents’ resp.-allergic illness Father completes qes Parents’ resp.-allergic illness 40302010 0 %

10. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 OTHER Only father completes the questionnaire(n=9285; 5.1%) aOR=0.57***, 95% CI=0.43–0.74 PARENTS’ ILLNESSES...any respiratory-allergic illness(n=9461; 20.9%) aOR=1.57***, 95% CI=1.38–1.77

11. - + - + - + - + - + - + Threatened Postponed labour Chest illness pregnancy (0–2y) Threatened Postponed labour Chest illness pregnancy (0–2y) Psychosomatic symptoms of 7–11 year olds by perinatal conditions Hungary, 1997–2002 5040302010 0 %

12. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 PERINATAL Threatened pregnancy (n=9186; 19.7%) aOR=1.59***, 95% CI=1.42–1.79 Postponed labour (n=9305; 9.5%) aOR=1.59***, 95% CI=1.42–1.79 Serious chest illness of the child(n=9461; 22.1%) during the first two years of life aOR=1.73***, 95% CI=1.56–1.92

13. - +- + - + - + - +- + - + - + Gas cooker Mould Heavy Agricult. airborne addit. heating ETS sprays Gas cooker Mould Heavy Agricult. airborne addit. heating ETS sprays Psychosomatic symptoms of 7–11 year olds by environmental factors Hungary, 1997–2002 70605040302010 0%

14. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 ENVIRONMENTAL FACTORS Use of the kitchen gas cooker for additional heating(n=9461; 5.1%) aOR=1.80***, 95% CI=1.47–2.21 Mouldy flat (n=9461; 24.4%) aOR=1.61***, 95% CI=1.44–1.79 >20 cigarettes/day smoked in the flat(n=9461; 4.1%) aOR=2.16***, 95% CI=1.64–2.84 Reported house or garden exposure to agricult. airborne sprays(n=1606; 7.2%) aOR=1.78**, 95% CI=1.19–2.66 (practically in one survey only)

15. 4 0–3 hrs sleeping defic. hrs television/day hrs sport/week 4 0–3 hrs sleeping defic. hrs television/day hrs sport/week Psychosomatic symptoms of 7–11 year olds by lifestyle factors Hungary, 1997–2002 8070605040302010 0 %

16. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 LIFESTYLE Sleeping deficiency, SD(n=9066; -) (if sleeping hours [SH]<10 then SD=10–SH else SD=0) then SD=10–SH else SD=0) aOR 1h raise =1.17***, 95% CI=1.09–1.25 Watching television(n=8838; -) (hours/day, max. 6 hours) aOR 1h raise =1.10***, 95% CI=1.04–1.16 Sport: 0–3 hours/week(n=6828; 77.8%) aOR=1.43***, 95% CI=1.24–1.64

17. - + >8 ys 8 ys <8 ys Every day Mother school classes Every day Mother school classes chocolate-sweets chocolate-sweets Psychosomatic symptoms of 7–11 year olds by chocolate-sweets consumption and mother’s education Hungary, 1997–2002 5040302010 0 %

18. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 Eating chocolate… every day(n=1846; 29.0%) aOR=1.49***, 95% CI=1.21–1.84 SOCIAL FACTORS Mother with low education (n=9461; 15.8%) (<8 elementary school classes) aOR=1.37***, 95% CI=1.20–1.57

19. 0 1 2 3 4 5 m Psychosomatic symptoms of 7–11 year olds by number of regression model factors Hungary, 1997–2002 100 90 90 80 80 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 %

20. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 NUMBER OF REGRESSION MODEL FACTORS +1, if parents: any respiratory-allergic illness +1, if child: serious chest illness (0–2 y) +1, if use of the kitchen gas cooker for additional heating +1, if mouldy flat +1, if >20 cigarettes/day smoked in the flat m (n=9461; -) aOR raise in m =1.62***, 95% CI=1.55–1.72 (adjusted to gender, age and town)

21. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 Conclusions 1. The environmental factors (found to be associated with respiratory symptoms) had strong associations with psychosomatic symptoms, too.

22. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 Conclusions 2. – Living in villages – Only father completes the questionnaire – Threatened pregnancy, postponed labour – Sleeping deficiency, television seeing, sport, eating chocolate-sweets every day

23. ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 Conclusions 3. Validated backward logistic regression model – Use of the kitchen gas cooker for additional heating: aOR=1.80*** – Mouldy flat:aOR=1.61*** – >20 cigarettes/day smoked in the flat:aOR=2.16*** – Reported house or garden exposure to agricultural airborne sprays:aOR=1.78**

24. „Fodor József” NCPH NIEH DEPT. COMMUNITY HEALTH Annamária Mácsik, Tamás Rudnai, Eszter Szabó, Renáta Szentmihályi, Györgyi Tóth National Public Health and Medical Officer Service All collabourating colleagues SCHOOLS, MUNICIPALITIES, HEALTH SERVICES directorship of schools, class leaders, maires, youth and district nurses FAMILIES FAMILIES parents, children parents, children Thanks

25. Thank you for your attention! ISEE/CEEC Meeting, Budapest, Hungary, 9–11 June 2005 E-mail: varromj@okk.antsz.hu