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Chung W. Deconstructing subjective unmet healthcare needs: a South Korean case study with policy implications. Front Public Health 2024; 12:1385951. [PMID: 38799680 PMCID: PMC11122008 DOI: 10.3389/fpubh.2024.1385951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Background Despite widespread efforts by many countries to reduce the prevalence of unmet healthcare needs within their populations, there remains a scarcity of research systematically exploring the components of these needs. Objectives This study aims to deconstruct subjective unmet healthcare needs into two distinct components: the experience of subjective healthcare needs (the "Needs" component) and the experience of unmet needs contingent on those healthcare needs (the "Unmet" component). Methods This analysis utilizes data from 13,359 adults aged 19 or older, collected through the 2018 Korea Health Panel survey, with the aim of minimizing the influence of the coronavirus disease 19 pandemic. The two dependent variables are the experience of subjective healthcare needs and whether these needs have been met. The independent variables include 15 socio-demographic, health, and functional characteristics. The study employs both a population proportion analysis and a multivariable bivariate probit model with sample selection. Results In South Korea, 11.6% (CI [confidence interval] = 11.0-12.3%) of the population experienced subjective unmet healthcare needs. Upon deconstructing these, 96.7% (CI = 96.2-97.1%) of the population exhibited the Needs component, and 12.0% (CI = 11.4-12.7%) displayed the Unmet component. Each independent variable showed different associations between the two components. Furthermore, effective interventions targeting the characteristics associated with each component could reduce the proportion of the population experiencing subjective unmet healthcare needs from 11.6 to 4.0%. Conclusion South Korea faces a significant challenge due to the considerable prevalence of subjective unmet healthcare needs. To address this challenge effectively, the universal healthcare coverage system should adapt its approach based on the characteristics associated with both the Needs and Unmet components of subjective unmet healthcare needs. To achieve this goal, it is highly recommended that the government prioritize strengthening community-based primary healthcare, which currently suffers from insufficient resources.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
- Korea Peace Institute, Seoul, Republic of Korea
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Pagano A, McCuistian C, Le T, Campbell BK, Delucchi K, Woodward-Lopez G, Guydish J. Smoking Behavior and Wellness among Individuals in Substance Use Disorder Treatment. J Psychoactive Drugs 2023; 55:330-341. [PMID: 35815722 PMCID: PMC9826798 DOI: 10.1080/02791072.2022.2095942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 01/11/2023]
Abstract
Tobacco-related morbidity and mortality disproportionately affect people with substance use disorders (SUD). Encouraging overall wellness may support tobacco use cessation. We investigated relationships between wellness (health status, physical activity, sugar-sweetened beverage (SSB) consumption), cigarette smoking, and smoking cessation among SUD treatment patients to inform clinical care. Cross-sectional surveys were conducted with 395 patients in 20 California residential SUD programs. Using multivariate regression, we examined associations between smoking status and wellness. Among smokers, we examined associations between lifetime smoking exposure, cessation behaviors and attitudes, and wellness. Compared to nonsmokers (n = 121), smokers (n = 274) reported more SSB consumption, poorer physical health, and more respiratory symptoms. Among smokers, SSB consumption and respiratory symptoms increased per ten pack-years of smoking. Smokers with respiratory symptoms reported higher motivation to quit and more use of nicotine replacement therapy (NRT). Smokers with more days of poor mental health reported lower motivation to quit. Overall, cigarette smoking was associated with other health-risk behaviors among SUD treatment patients. Respiratory symptoms may increase, and poor mental health may decrease, SUD patients' intent to quit smoking. To reduce chronic disease risk among SUD patients, treatment programs should consider promoting overall wellness concurrently with smoking cessation.
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Affiliation(s)
- Anna Pagano
- Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, Floor 7, San Francisco, CA 94158
| | - Caravella McCuistian
- Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, Floor 7, San Francisco, CA 94158
| | - Thao Le
- Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, Floor 7, San Francisco, CA 94158
| | - Barbara K. Campbell
- Division of General & Internal Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098
| | - Kevin Delucchi
- Department of Psychiatry & Behavioral Sciences, 401 Parnassus Ave, University of California, San Francisco, San Francisco, CA 94143
| | - Gail Woodward-Lopez
- University of California Nutrition Policy Institute, 1111 Franklin St, Fifth Floor, Oakland, CA 94607
| | - Joseph Guydish
- Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, Floor 7, San Francisco, CA 94158
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Chung W. Changes in Barriers That Cause Unmet Healthcare Needs in the Life Cycle of Adulthood and Their Policy Implications: A Need-Selection Model Analysis of the Korea Health Panel Survey Data. Healthcare (Basel) 2022; 10:2243. [PMID: 36360584 PMCID: PMC9691171 DOI: 10.3390/healthcare10112243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 01/31/2024] Open
Abstract
Using 68,930 observations selected from 16,535 adults in the Korea Health Panel Survey (2014-2018), this study explored healthcare barriers that prevent people from meeting their healthcare needs most severely during adulthood, and the characteristics that are highly associated with the barrier. This study derived two outcome variables: a dichotomous outcome variable on whether an individual has experienced healthcare needs, and a quadchotomous outcome variable on how an individual's healthcare needs ended. An analysis was conducted using a multivariable panel multinomial probit model with sample selection. The results showed that the main cause of unmet healthcare needs was not financial difficulties but non-financial barriers, which were time constraints up to a certain age and the lack of caring and support after that age. People with functional limitations were at a high risk of experiencing unmet healthcare needs due to a lack of caring and support. To reduce unmet healthcare needs in South Korea, the government should focus on lowering non-financial barriers to healthcare, including time constraints and lack of caring and support. It seems urgent to strengthen the foundation of "primary care", which is exceptionally scarce now, and to expand it to "community-based integrated care" and "people-centered care".
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
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Self-Efficacy, Social-Support, and Physical Activity Measures Among Hospital Employees: A Multisite Cross-Sectional Study. J Phys Act Health 2020; 17:548-556. [PMID: 32272452 DOI: 10.1123/jpah.2018-0561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/23/2020] [Accepted: 03/01/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Associations across self-efficacy, social support, and multiple measures of physical activity (PA) have not been thoroughly explored in hospital employees. METHODS Validated surveys assessed psychosocial factors; the IPAQ-long assessed PA, and mixed-effects analyses examined relations between psychosocial variables and PA in 920 employees from 6 Texas hospitals. RESULTS At P <.05, self-efficacy was significantly associated with light (β = 1.67), moderate (β = 1.63), and vigorous (β = 2.78) leisure PA; with domestic PA (β = 1.64); and with moderate commute PA (β = 0.03). At P < .05, family social-support was significantly associated with light (β = 0.94), moderate (β = 0.63), and vigorous (β = .74) leisure PA; with moderate (β = 0.46) and vigorous (β = 1.24) occupation PA; with light (β = 0.58) and moderate (β = 0.20) commute PA; and with domestic PA (β = 1.18). At P < .05, social support from friends was significantly associated with light (β = 0.74), moderate (β = 0.58), and vigorous (β = .91) leisure PA; with moderate commute (β = 0.21); and with domestic PA (β = 0.82). CONCLUSION Interventions must emphasize self-efficacy-building strategies and the role of family support to meaningfully impact PA behaviors in this unique population.
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Choi HR, Rim TH, Lee JH, Lee SW, Baek J, Kim K, Youm Y, Kim HC. Prevalence of and factors related with abnormal fundoscopic findings among the elderly population in a rural community in South Korea. Semin Ophthalmol 2020; 35:41-49. [PMID: 32026733 DOI: 10.1080/08820538.2020.1722182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We aimed to report the results of fundus photography ophthalmic examinations among older adults in a rural community in South Korea. We used data from the Korean Social Life, Health, and Aging Project cohort study, which was designed to examine the entire population of individuals aged 60 years or older and their spouses living in a rural Village K of Ganghwa Island, South Korea. At baseline, a total of 860 people was targeted as the study population. From December 2011 to January 2019, five health examinations were conducted, including baseline and follow-up tests. During the fifth wave of the study, we performed fundus photography to assess eye health. Ophthalmic and physical examinations were conducted for 387 people who participated in the fifth wave by trained researchers. Systemic factors were evaluated via blood and diagnostic tests. After excluding eight people who did not undergo follow-up fundoscopy, a total of 379 participants was included for analysis. We classified the participants into two groups with either no (zero) or one or more suspicious ophthalmic diseases. The abnormalities included media opacity, suspected glaucoma, and suspicion of retinal disease as diagnosed by a trained specialist. We further categorized ophthalmic conditions as clinically insignificant, follow-up needed, semi-urgent, and urgent conditions. We included 379 participants, of which 225 (59.4%) were women. The mean age of the participants was 76.4 ± 6.2 years. Among all participants, 81% (n=307) had one or more abnormalities on fundus screening. Older age, living alone, high blood pressure, and high fasting insulin were associated with an increased risk of having ≥ one eye disease. In terms of triage, 3.7% (n= 14) of the observed conditions were urgent, and 25.9% (n= 98) were semi-urgent. Therefore, we documented fundoscopy results among the elderly population in a rural community in South Korea. Elderly people living alone were more likely to have eye disease. Policies to improve eye health are needed to prevent vision loss in this population.
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Affiliation(s)
- Hye Rin Choi
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea.,Cardiovascular and Metabolic Diseases Etiology Research Center, Seoul, Republic of Korea
| | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore National Eye Centre, Bukit Merah, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Bukit Merah, Singapore.,Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongmin Baek
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwanghyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoosik Youm
- Department of Sociology, Yonsei University College of Sociology, Seoul, Republic of Korea
| | - Hyeon Chang Kim
- Cardiovascular and Metabolic Diseases Etiology Research Center, Seoul, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Ching S, Chia YC, Chew BN, Soo MJ, Lim HM, Sulaiman WAW, Hoo FK, Saw ML, Ishak A, Palanivelu T, Caruppaiya N, Devaraj NK. Knowledge on the action to be taken and recognition of symptoms of stroke in a community: findings from the May Measurement Month 2017 blood pressure screening Programme in Malaysia. BMC Public Health 2019; 19:1602. [PMID: 31783831 PMCID: PMC6884890 DOI: 10.1186/s12889-019-7922-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/08/2019] [Indexed: 01/04/2023] Open
Abstract
Background Information regarding the knowledge on the action to be taken during stroke and good recognition of stroke symptoms is mandatory in helping to plan out educational strategies to deliver health education to the community. Methods This is a cross-sectional study of adults aged 18 and above attending a blood pressure screening program in community in conjunction with May Measurement Month 2017 in Malaysia. A structured self-administered questionnaire was given to the participants who gave verbal consent. Data analysis was done using SPSS v. 23 and multiple logistic regression was used to identify the determinants of knowledge on actions to be taken during stroke and recognition of stroke symptoms. Results Out of 4096 respondents, 82.9–92.1% of them able to recognise the common stroke symptoms. and 74.2% of the study respondents will go to hospital within 4.5 h of stroke onset. According to binomial logistic regression analyses, adults aged 45 years old and above (OR 1.39 95%CI 1.01–1.92), being Malay (OR 1.74, 95% CI 1.27–2.40), being non-smokers (OR = 2.491, 95% CI: 1.64–3.78), hypertensives (OR: 1.57, 95% CI: 1.02–2.42)and diabetics (OR: 2.54, 95% CI:1.38–4.69) are determinants of right actions to be taken during stroke. Meanwhile, respondents aged 45 years old and older (OR = 1.68, 95% CI: 1.39–2.03), being Malay (OR = 1.49, 95% CI: 1.24–1.79), hypertensive (OR = 1.32, 95% CI: 1.04–1.66) and those who had a previous history of stroke (OR = 2.25, 95% CI: 1.01–5.00) are determinants of good recognition of stroke symptoms. Conclusions The overall knowledge of stroke in our study population was good. Older age, being Malay, non-smokers, hypertensives and diabetics are determinants of right actions to be taken during stroke. Meanwhile, older age, being Malay, hypertensive and those who had a previous history of stroke are determinants of good recognition of stroke symptoms.
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Affiliation(s)
- SiewMooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.,Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia.,Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Subang Jaya, Selangor, Malaysia
| | - Yook Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Subang Jaya, Selangor, Malaysia.
| | - Bee Nah Chew
- Staff & Student Health Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Man Jun Soo
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hooi Min Lim
- Department of Primary Care Medicine, University Malaya Medical Center, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Aliaa Wan Sulaiman
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang,Selangor, Malaysia
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang,Selangor, Malaysia
| | - Mar Lar Saw
- Staff & Student Health Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Azlina Ishak
- Department of Family Medicine, School of Medical Sciences, Health Campus, UniversitiSains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Tharmalingam Palanivelu
- Department of Medicine, Hospital Sultan Abdul Halim Kuala, Sg.Petani, Kedah, Malaysia.,Faculty of Medicine, Asian Institute of Medicine, Science and Technology (AIMST) University, Semeling, Sg.Petani, Kedah, Malaysia
| | - Nadarajan Caruppaiya
- Department of Medicine, Hospital Sultan Abdul Halim Kuala, Sg.Petani, Kedah, Malaysia
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.,Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Ussher MH, Faulkner GEJ, Angus K, Hartmann‐Boyce J, Taylor AH. Exercise interventions for smoking cessation. Cochrane Database Syst Rev 2019; 2019:CD002295. [PMID: 31684691 PMCID: PMC6819982 DOI: 10.1002/14651858.cd002295.pub6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Taking regular exercise, whether cardiovascular-type exercise or resistance exercise, may help people to give up smoking, particularly by reducing cigarette withdrawal symptoms and cravings, and by helping to manage weight gain. OBJECTIVES To determine the effectiveness of exercise-based interventions alone, or combined with a smoking cessation programme, for achieving long-term smoking cessation, compared with a smoking cessation intervention alone or other non-exercise intervention. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register for studies, using the term 'exercise' or 'physical activity' in the title, abstract or keywords. The date of the most recent search was May 2019. SELECTION CRITERIA We included randomised controlled trials that compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme alone or another non-exercise control group. Trials were required to recruit smokers wishing to quit or recent quitters, to assess abstinence as an outcome and have follow-up of at least six months. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison, as either smoking cessation or relapse prevention. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. MAIN RESULTS We identified 24 eligible trials with a total of 7279 adult participants randomised. Two studies focused on relapse prevention among smokers who had recently stopped smoking, and the remaining 22 studies were concerned with smoking cessation for smokers who wished to quit. Eleven studies were with women only and one with men only. Most studies recruited fairly inactive people. Most of the trials employed supervised, group-based cardiovascular-type exercise supplemented by a home-based exercise programme and combined with a multi-session cognitive behavioural smoking cessation programme. The comparator in most cases was a multi-session cognitive behavioural smoking cessation programme alone. Overall, we judged two studies to be at low risk of bias, 11 at high risk of bias, and 11 at unclear risk of bias. Among the 21 studies analysed, we found low-certainty evidence, limited by potential publication bias and by imprecision, comparing the effect of exercise plus smoking cessation support with smoking cessation support alone on smoking cessation outcomes (RR 1.08, 95% CI 0.96 to 1.22; I2 = 0%; 6607 participants). We excluded one study from this analysis as smoking abstinence rates for the study groups were not reported. There was no evidence of subgroup differences according to the type of exercise promoted; the subgroups considered were: cardiovascular-type exercise alone (17 studies), resistance training alone (one study), combined cardiovascular-type and resistance exercise (one study) and type of exercise not specified (two studies). The results were not significantly altered when we excluded trials with high risk of bias, or those with special populations, or those where smoking cessation intervention support was not matched between the intervention and control arms. Among the two relapse prevention studies, we found very low-certainty evidence, limited by risk of bias and imprecision, that adding exercise to relapse prevention did not improve long-term abstinence compared with relapse prevention alone (RR 0.98, 95% CI 0.65 to 1.47; I2 = 0%; 453 participants). AUTHORS' CONCLUSIONS There is no evidence that adding exercise to smoking cessation support improves abstinence compared with support alone, but the evidence is insufficient to assess whether there is a modest benefit. Estimates of treatment effect were of low or very low certainty, because of concerns about bias in the trials, imprecision and publication bias. Consequently, future trials may change these conclusions.
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Affiliation(s)
- Michael H Ussher
- St George's, University of LondonPopulation Health Research InstituteCranmer TerraceLondonUKSW17 0RE
- University of StirlingInstitute for Social MarketingStirlingUK
| | - Guy E J Faulkner
- University of British ColumbiaSchool of Kinesiology2146 Health Sciences MallVancouverCanadaV6T 1Z3
| | - Kathryn Angus
- University of StirlingInstitute for Social MarketingStirlingUK
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Adrian H Taylor
- University of PlymouthFaculty of Health: Medicine, Dentistry and Human SciencesRoom N32, ITTC Building, Tamar Science ParkDerrifordPlymouthUKPL6 8BX
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Ruggiero E, Di Castelnuovo A, Costanzo S, Persichillo M, Bracone F, Cerletti C, Donati MB, de Gaetano G, Iacoviello L, Bonaccio M. Socioeconomic and psychosocial determinants of adherence to the Mediterranean diet in a general adult Italian population. Eur J Public Health 2019; 29:328-335. [PMID: 30020486 DOI: 10.1093/eurpub/cky127] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To evaluate the adherence to Mediterranean diet (MD) and its major socioeconomic and psychosocial determinants in a large sample of the Italian population, covering three main geographical areas of the Country (Southern, Central and Northern). METHODS Data were obtained from the Italian Nutrition & Health Survey (INHES), including a total of 7, 430 participants (age >20) recruited from all over Italy (2010-13). Dietary information was collected by the European Food Propensity Questionnaire. Adherence to MD was assessed by using the MedDietScore based on 11 food groups. Associations were tested by multivariable logistic regression analysis (Odds ratio [OR] with 95% CI). RESULTS Adherence to MD was higher in Southern Italy as compared with the Northern (OR = 1.34; 95% CI 1.18-1.53), and was closely associated with adult age (OR= 2.40; 1.61-3.58 for those aged > 75 years as compared with 20-34 years) and higher educational level (OR = 1.77; 1.40-2.24 for post-secondary education as opposed to lowest educational attainment). Subjects reporting adverse life events and those with family-related stress were less likely to show an optimal adherence to MD (OR = 0.55; 0.46-0.67 and OR = 0.44; 0.28-0.69, for highest vs. lowest tertile, respectively) as compared with adequate controls. A number of eating behaviours were also inversely associated with MD, such as consuming higher amount of alcohol in the weekend than in week days. CONCLUSIONS Adherence to MD is strongly determined by age, geographical area and educational level. Psychosocial factors and several eating behaviours are also closely associated.
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Affiliation(s)
- Emilia Ruggiero
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Augusto Di Castelnuovo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Mariarosaria Persichillo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Francesca Bracone
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Maria Benedetta Donati
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy.,Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
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Lee A, Lee KS, Park H. Association of the Use of a Heated Tobacco Product with Perceived Stress, Physical Activity, and Internet Use in Korean Adolescents: A 2018 National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060965. [PMID: 30889838 PMCID: PMC6466447 DOI: 10.3390/ijerph16060965] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 01/08/2023]
Abstract
The awareness and use of the recently introduced heated product in the global tobacco market is rapidly increasing. Few studies have investigated the association of this product’s use with health-related factors. To examine the association of the heated tobacco product (HTP)’s use with perceived stress, physical activity, and internet use, we analyzed data from the Korea Youth Risk Behavior Survey using multinomial logistic regression models. The participants included 60,040 students from middle school and high school. There were significant associations between high perceived stress and cigarette use only, dual use of cigarette and e-cigarette, triple use of cigarette, e-cigarette, and HTP; a negative association between HTP’s use and perceived stress; positive association between physical activity and tobacco use; and not using the internet significantly increased the odds of use of all types of tobacco products. A smoking prevention program, tailored to meet the needs of different types of tobacco product users, is recommended. A program aimed at not only increasing awareness of perceived risk but also decreasing perceived benefits of risky behaviors, should also be considered. Further research using a longitudinal design to test the causal relationship of tobacco product use with perceived stress, physical activity, and internet use is warranted.
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Affiliation(s)
- Ahnna Lee
- Department of Public Health, Graduate School, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
| | - Kang-Sook Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
| | - Hanul Park
- Department of Public Health, Graduate School, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
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Trends of Adherence to the Mediterranean Dietary Pattern in Northern Italy from 2010 to 2016. Nutrients 2017; 9:nu9070734. [PMID: 28696362 PMCID: PMC5537848 DOI: 10.3390/nu9070734] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/27/2017] [Accepted: 07/04/2017] [Indexed: 11/17/2022] Open
Abstract
Little information is available on the trends of adherence to the Mediterranean dietary pattern (MDP). This study investigates food consumption trends from 2010 to 2016 in subjects living in Northern Italy. A cross-sectional study of 8584 subjects enrolled between January 2010 and December 2016 was conducted. Socio-demographic, nutrition and lifestyle characteristics were collected. A 14-item questionnaire was used to evaluate adherence to MDP. Multivariable Poisson regression was used to evaluate the trends of and the determinants for the adherence to MDP. The overall prevalence of adherence to MDP was 14% and the trend remained constant over the six years. However, there was a marked increase in nuts consumption and a slight one in white meat consumption. Furthermore, we observed a decrease in the consumption of fruit, red meat, sweets and sugar-sweetened beverages and in the use of soffritto. Finally, higher education, being older, married, physically active, and ex-smoker was associated with greater adherence to MDP, whereas the prevalence of adherence was lower in the obese. In conclusion, the consumption of some Mediterranean and non-Mediterranean food groups changed over the six years. However, overall, the prevalence of adherence to MDP did not change. Additional strategies promoting healthy dietary habits are needed.
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Pengpid S, Peltzer K. Prevalence and behavioural risk factors of light or moderate and heavy cigarette smoking in 32 countries. JOURNAL OF PSYCHOLOGY IN AFRICA 2016. [DOI: 10.1080/14330237.2016.1250424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
- Department of Research & Innovation, University of Limpopo, Polokwane, South Africa
| | - Karl Peltzer
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
- Department of Research & Innovation, University of Limpopo, Polokwane, South Africa
- HIV/AIDS/STIs and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
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Melkonian SC, Daniel CR, Ye Y, Pierzynski JA, Roth JA, Wu X. Glycemic Index, Glycemic Load, and Lung Cancer Risk in Non-Hispanic Whites. Cancer Epidemiol Biomarkers Prev 2016; 25:532-9. [PMID: 26944871 DOI: 10.1158/1055-9965.epi-15-0765] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Postprandial glucose (PPG) and insulin responses play a role in carcinogenesis. We evaluated the association between dietary glycemic index (GI) and glycemic load (GL), markers of carbohydrate intake and PPG, and lung cancer risk in non-Hispanic whites. METHODS GL and GI were assessed among 1,905 newly diagnosed lung cancer cases recruited from the University of Texas MD Anderson Cancer Center (Houston, TX) and 2,413 healthy controls recruited at Kelsey-Seybold Clinics (Houston, TX). We assessed associations between quintiles of GI/GL and lung cancer risk and effect modification by various risk factors. ORs and 95% confidence intervals (CI) were estimated using multivariable logistic regression. RESULTS We observed a significant association between GI [5th vs. 1st quintile (Q) OR = 1.49; 95% CI, 1.21-1.83; P(trend) <0.001] and lung cancer risk and GI(ac) (5th vs. 1st Q OR = 1.48; 95% CI, 1.20-1.81; P(trend) = 0.001) and lung cancer risk. We observed a more pronounced association between GI and lung cancer risk among never smokers (5th vs. 1st Q OR = 2.25; 95% CI, 1.42-3.57), squamous cell carcinomas (SCC; 5th vs. 1st Q OR = 1.92; 95% CI, 1.30-2.83), and those with less than 12 years of education (5th vs. 1st Q OR = 1.75; 95% CI, 1.19-2.58, P(interaction) = 0.02). CONCLUSION This study suggests that dietary GI and other lung cancer risk factors may jointly and independently influence lung cancer etiology. IMPACT Understanding the role of GI in lung cancer could inform prevention strategies and elucidate biologic pathways related to lung cancer risk.
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Affiliation(s)
- Stephanie C Melkonian
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carrie R Daniel
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yuanqing Ye
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeanne A Pierzynski
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xifeng Wu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Garrett NA, Alesci NL, Schultz MM, Foldes SS, Magnan SJ, Manley MW. The Relationship of Stage of Change for Smoking Cessation to Stage of Change for Fruit and Vegetable Consumption and Physical Activity in a Health Plan Population. Am J Health Promot 2016; 19:118-27. [PMID: 15559712 DOI: 10.4278/0890-1171-19.2.118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. The purpose of this study was to examine the relationship between stage of change for smoking cessation and stage of change for (1) fruit and vegetable consumption and (2) physical activity. Design. The data come from a cross-sectional telephone survey administered to a stratified random sample of health plan members (n = 9675). Setting. This study was conducted at a mixed-model health plan with approximately 1 million adult members. Subjects. Respondents were adults age 18 and older, who were randomly selected from five health plan product groups: commercial fully insured, commercial self-insured, two publicly subsidized plans, and Medicare supplemental insurance. Response rates ranged from 74.7% to 90.1% across these groups. Measures. The assessment included demographics and stage of change for smoking cessation, physical activity, and fruit and vegetable intake. Bivariate relationships among variables were analyzed with the use of contingency tables. Ordered logistic regression was used to examine the effects of stage of change for fruit and vegetable consumption and physical activity on stage of change for smoking while controlling for other factors. Results. Stage of change for smoking is more clearly related to stage of change for fruit and vegetable consumption (χ2 = 161.3, p < .001; Cramer's V = .11, p < .001) than to stage of change for physical activity (χ2 = 89.7, p < .001; Cramer's V = .08, p < .001). However, stage of change for fruit and vegetable consumption and physical activity are not strong predictors of stage of change for smoking. Conclusions. This study indicates that stage of change for both fruit and vegetable consumption and physical activity are independent constructs from stage of change for smoking cessation.
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Affiliation(s)
- Nancy A Garrett
- Health Services Analysis and Reporting at HealthPartners in Minneapolis, Minnesota 54410-1309, USA.
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Spencer L, Pagell F, Hallion ME, Adams TB. Applying the Transtheoretical Model to Tobacco Cessation and Prevention: A Review of Literature. Am J Health Promot 2016; 17:7-71. [PMID: 12271754 DOI: 10.4278/0890-1171-17.1.7] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To comprehensively review all published, peer-reviewed research on the Transtheoretical Model (TTM) and tobacco cessation and prevention by exploring the validity of its constructs, the evidence for use of interventions based on the TTM, the description of populations using TTM constructs, and the identification of areas for further research. The three research questions answered were: “How is the validity of the TTM as applied to tobacco supported by research?” “How does the TTM describe special populations regarding tobacco use?” “What is the nature of evidence supporting the use of stage-matched tobacco interventions?” Data Source. Computer Database search (PsychInfo, Medline, Current Contents, ERIC, CINAHL-Allied Health, and Pro-Quest Nursing) and manual journal search. Inclusion/Exclusion Criteria. All English, original, research articles on the TTM as it relates to tobacco use published in peer-reviewed journals prior to March 1, 2001, were included. Commentaries, editorials, and books were not included. Data Extraction and Synthesis. Articles were categorized as TTM construct validation, population descriptions using TTM constructs, or intervention evaluation using TTM constructs. Summary tables including study design, research rating, purpose, methods, findings, and implications were created. Articles were further divided into groups according to their purpose. Considering both the findings and research quality of each, the three research questions were addressed. Results. The 148 articles reviewed included 54 validation studies, 73 population studies, and 37 interventions (some articles fit two categories). Overall, the evidence in support of the TTM as applied to tobacco use was strong, with supportive studies being more numerous and of a better design than nonsupportive studies. Using established criteria, we rated the construct validity of the entire body of literature as good; however, notable concerns exist about the staging construct. A majority of stage-matched intervention studies provided positive results and were of a better quality than those not supportive of stage-matched interventions; thus, we rated the body of literature using stage-matched tobacco interventions as acceptable and the body of literature using non–stage-matched interventions as suggestive. Population studies indicated that TTM constructs are applicable to a wide variety of general and special populations both in and outside of the United States, although a few exceptions exist. Conclusions. Evidence for the validity of the TTM as it applies to tobacco use is strong and growing; however, it is not conclusive. Eight different staging mechanisms were identified, raising the question of which are most valid and reliable. Interventions tailored to a smoker's stage were successful more often than nontailored interventions in promoting forward stage movement. Stage distribution is well-documented for U.S. populations; however, more research is needed for non-U.S. populations, for special populations, and on other TTM constructs.
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Affiliation(s)
- Leslie Spencer
- Department of Health and Exercise Science, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA.
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Masood S, Cappelli C, Li Y, Tanenbaum H, Chou CP, Spruijt-Metz D, Palmer PH, Johnson CA, Xie B. Cigarette smoking is associated with unhealthy patterns of food consumption, physical activity, sleep impairment, and alcohol drinking in Chinese male adults. Int J Public Health 2015; 60:891-899. [PMID: 26321106 DOI: 10.1007/s00038-015-0730-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES According to a recent national survey, tobacco use is a critical public health issue in China, with more than two-thirds of Chinese males smoking. Findings in Western populations suggest that smoking may cluster with other health-risk behaviors. To explore these relationships in Chinese male adults, we utilized baseline data from the China Seven Cities Study (CSCS). METHODS Male adults (n = 12,122) were included. Smoking status was defined as never smokers, ex-smokers, current smokers, and current heavy smokers. Logistic regression was employed to investigate the association of cigarette smoking and patterns of food consumption, physical activity, and alcohol drinking. RESULTS After controlling for age, socioeconomic status, and city residence, heavy smokers consumed significantly less vegetables, fruits, milk and other dairy products, spent significantly more time watching television, slept and exercised less, and got drunk or engaged in binge drinking more frequently compared to never, ex-, or current smokers (p < 0.05). CONCLUSIONS Findings suggest significant associations of heavy cigarette smoking with other health-risk behaviors in Chinese male adults, underscoring the need for tobacco control interventions for Chinese males.
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Affiliation(s)
- Shabana Masood
- School of Community and Global Health, Claremont Graduate University, Claremont, USA
| | - Christopher Cappelli
- School of Community and Global Health, Claremont Graduate University, Claremont, USA
| | - Yawen Li
- School of Social Work, San Diego State University, San Diego, USA
| | - Hilary Tanenbaum
- School of Community and Global Health, Claremont Graduate University, Claremont, USA
| | - Chih-Ping Chou
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Donna Spruijt-Metz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Paula H Palmer
- School of Community and Global Health, Claremont Graduate University, Claremont, USA
| | - C Anderson Johnson
- School of Community and Global Health, Claremont Graduate University, Claremont, USA
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University, Claremont, USA
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Association between colorectal cancer screening rate and motivation to quit smoking: the Fourth Korean National Health and Nutrition Examination Survey. Public Health 2014; 128:1039-42. [PMID: 25443129 DOI: 10.1016/j.puhe.2014.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 05/07/2014] [Accepted: 09/04/2014] [Indexed: 11/21/2022]
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Abstract
BACKGROUND Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain. OBJECTIVES To determine whether exercise-based interventions alone, or combined with a smoking cessation programme, are more effective than a smoking cessation intervention alone. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register in April 2014, and searched MEDLINE, EMBASE, PsycINFO, and CINAHL Plus in May 2014. SELECTION CRITERIA We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme (which we considered the control in this review). Studies were required to recruit smokers or recent quitters and have a follow-up of six months or more. Studies that did not meet the full inclusion criteria because they only assessed the acute effects of exercise on smoking behaviour, or because the outcome was smoking reduction, are summarised but not formally included. DATA COLLECTION AND ANALYSIS We extracted data on study characteristics and smoking outcomes. Because of differences between studies in the characteristics of the interventions used we summarized the results narratively, making no attempt at meta-analysis. We assessed risk of selection and attrition bias using standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We identified 20 trials with a total of 5,870 participants. The largest study was an internet trial with 2,318 participants, and eight trials had fewer than 30 people in each treatment arm. Studies varied in the timing and intensity of the smoking cessation and exercise programmes offered. Only one included study was judged to be at low risk of bias across all domains assessed. Four studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three-month follow-up and a benefit for exercise of borderline significance (p = 0.05) at the 12-month follow-up. Another study reported significantly higher abstinence rates at six month follow-up for a combined exercise and smoking cessation programme compared with brief smoking cessation advice. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three-month follow-up but not at the end of treatment or 12-month follow-up. The other studies showed no significant effect for exercise on abstinence. AUTHORS' CONCLUSIONS Only two of the 20 trials offered evidence for exercise aiding smoking cessation in the long term. All the other trials were too small to reliably exclude an effect of intervention, or included an exercise intervention which may not have been sufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions in terms of both exercise intensity and intensity of support being provided, equal contact control conditions, and measures of exercise adherence and change in physical activity in both exercise and comparison groups.
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Affiliation(s)
- Michael H Ussher
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, UK, SW17 0RE
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Furuya-Kanamori L, Kelly MD, McKenzie SJ. Co-morbidity, ageing and predicted mortality in antiretroviral treated Australian men: a quantitative analysis. PLoS One 2013; 8:e78403. [PMID: 24205222 PMCID: PMC3808383 DOI: 10.1371/journal.pone.0078403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/10/2013] [Indexed: 12/27/2022] Open
Abstract
Background Life expectancy has increased in HIV-positive individuals receiving combination antiretroviral therapy (cART); however, they still experience increased mortality due to ageing-associated comorbidities compared with HIV-negative individuals. Methods A retrospective study of 314 Queensland HIV-infected males on cART was conducted. The negative impact of ageing was assessed by estimating the probability of 5-year mortality; comparisons were made between an HIV-specific predictive tool (VACS index) and the Australian Bureau of Statistics (ABS) life-tables to examine potential differences attributed to HIV. The negative impact of ageing was also assessed by the prevalence of comorbidities. Associations between comorbidity and estimates of predicted mortality by regression analysis were assessed. Results The mean predicted 5-year mortality rate was 6% using the VACS index compared with 2.1% using the ABS life-table (p<0.001). The proportion of patients at predicted high risk of mortality (>9%) using the VACS index or ABS life-table were 17% and 1.8% respectively. Comorbidities were also more prevalent in this cohort compared with rates of comorbidities in age-matched Australian men from the general population. Metabolic disease (38.2%) was the most prevalent comorbidity followed by renal (33.1%) and cardiovascular disease (23.9%). Multivariate analysis demonstrated that patients with a history of cardiovascular disease had a higher predicted risk of mortality (OR=1.69;95%CI:1.17-2.45) whereas ex-smokers had a lower predicted risk of mortality (OR=0.61;95%CI:0.41-0.92). Conclusions Using the VACS Index there is an increased predicted risk of mortality in cART-treated HIV infected Australian men compared with age-matched men using the ABS data. This increased predicted mortality risk is associated with cardiovascular disease and the number of comorbidities per subject; which suggests that the VACS Index may discriminate between high and low predicted mortality risks in this population. However, until the VACS Index is validated in Australia this data may suggest the VACS Index overestimates predicted mortality risk in this country.
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Affiliation(s)
- Luis Furuya-Kanamori
- The University of Queensland, School of Population Health, Queensland, Australia
- * E-mail:
| | - Mark D. Kelly
- Brisbane Sexual Health and HIV Service, Queensland, Australia
| | - Samantha J. McKenzie
- The University of Queensland, School of Population Health, Queensland, Australia
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Hu EA, Toledo E, Diez-Espino J, Estruch R, Corella D, Salas-Salvado J, Vinyoles E, Gomez-Gracia E, Aros F, Fiol M, Lapetra J, Serra-Majem L, Pintó X, Portillo MP, Lamuela-Raventos RM, Ros E, Sorli JV, Martinez-Gonzalez MA. Lifestyles and risk factors associated with adherence to the Mediterranean diet: a baseline assessment of the PREDIMED trial. PLoS One 2013; 8:e60166. [PMID: 23637743 PMCID: PMC3639284 DOI: 10.1371/journal.pone.0060166] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 02/22/2013] [Indexed: 11/28/2022] Open
Abstract
Background The traditional Mediterranean dietary pattern (MedDiet) is associated with longevity and low rates of cardiovascular disease (CVD). However, there is little information on who is more likely to follow this food pattern. Aim To evaluate how different factors are associated with lower MedDiet adherence in older Spanish subjects. Methods We included 7305 participants (men aged 55–80 y, women 60–80 y) at high-risk of CVD recruited into the PREDIMED trial (ISRCTN35739639). Socioeconomic, anthropometric, lifestyle characteristics and CVD risk factors were recorded. A validated 14-item questionnaire was used to evaluate MedDiet adherence at baseline. Multivariate models were used to estimate odds ratios (OR) and 95% confidence intervals for lower adherence to the MedDiet (<9 points out of 14) and ascertain factors independently associated with it. Results Former smoking (OR = 0.87; 95% CI, 0.78–0.98), physical activity (OR for the 3rd vs. the 1sttertile: 0.69; 0.62–0.78), and higher educational level (OR for university vs. less than primary school: 0.54; 0.38–0.77) were associated with higher MedDiet adherence. Conversely, having a larger waist-to-height ratio (OR for 0.1 units, 1.35; 1.22–1.49), being diabetic (OR = 1.13; 1.03–1.24), being single (OR = 1.27; 1.01–1.61) or divorced or separated (OR = 1.44; 1.09–1.89), and current smoking (OR = 1.28; 1.11–1.47) were associated with lower adherence. Conclusions Participants with little education, a larger waist-to-height ratio, or diabetes and those who were less physically active, single, divorced or separated, or smokers were less likely to adhere to the MedDiet, an ideal model for food choices. Stronger efforts of health promotion are needed in these groups to foster adoption of the MedDiet.
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Affiliation(s)
- Emily A. Hu
- Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Estefania Toledo
- Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Preventive Medicine and Public Health, School of Medicine-Clinic, University of Navarra, Pamplona, Navarra, Spain
- RETIC RD06/0045, Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- * E-mail:
| | - Javier Diez-Espino
- Department of Preventive Medicine and Public Health, School of Medicine-Clinic, University of Navarra, Pamplona, Navarra, Spain
- RETIC RD06/0045, Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Primary Health Care Center of Tafalla-Osasunbidea, Tafalla, Navarra, Spain
| | - Ramon Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Department of Internal Medicine, Institut d’Investigacions Biomediques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Jordi Salas-Salvado
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Human Nutrition Department, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Ernest Vinyoles
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- La Mina Primary Care Center, University of Barcelona, Spain
- IDIAP JordiGol. Barcelona, Spain
| | - Enrique Gomez-Gracia
- RETIC RD06/0045, Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Department of Preventive Medicine, University of Malaga, Malaga, Spain
| | - Fernando Aros
- RETIC RD06/0045, Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Department of Cardiology, University Hospital of Alava, Vitoria, Spain
| | - Miquel Fiol
- RETIC RD06/0045, Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Institute of Health Sciences IUNICS, University of Balearic Islands, and Hospital Son Espases, Palma de Mallorca, Spain
| | - Jose Lapetra
- RETIC RD06/0045, Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Department of Family Medicine, Primary Care Division of Sevilla, San Pablo Health Center, Sevilla, Spain
| | - Lluis Serra-Majem
- RETIC RD06/0045, Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Xavier Pintó
- RETIC RD06/0045, Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Puy Portillo
- RETIC RD06/0045, Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Department of Nutrition and Food Science, School of Pharmacy, University of the Basque County (UPV/EHU), Vitoria, Spain
| | - Rosa M. Lamuela-Raventos
- RETIC RD06/0045, Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Department of Nutrition and Food Science, School of Pharmacy, XaRTA, INSA, University of Barcelona, Barcelona, Spain
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d’Investigacions Biomediques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jose V. Sorli
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Miguel A. Martinez-Gonzalez
- Department of Preventive Medicine and Public Health, School of Medicine-Clinic, University of Navarra, Pamplona, Navarra, Spain
- RETIC RD06/0045, Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Instituto de Salud Carlos III (ISCIII), Spanish Government, Madrid, Spain
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Hirai FE, Tielsch JM, Klein BEK, Klein R. Relationship between retinopathy severity, visual impairment and depression in persons with long-term type 1 diabetes. Ophthalmic Epidemiol 2012; 19:196-203. [PMID: 22775274 DOI: 10.3109/09286586.2012.692006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Our aim was to investigate the proportion of individuals with depression and its association with diabetic retinopathy and visual impairment in a cohort with 25 or more years of type 1 diabetes. METHODS This was a cross-sectional analysis at the 25-year follow-up of the population-based cohort of the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Examinations followed standardized protocols and included clinical and ophthalmic evaluations and questionnaires to assess current and past medical history, use of medications, and cigarette smoking. The Center for Epidemiologic Studies Depression Scale (CES-D) was administered to all participants. Depression was defined as use of antidepressant or CES-D score ≥16. RESULTS A total of 484 individuals were included in the analysis. The proportion of depression was 37.8% (95% confidence interval 33.4-42.3%). A higher proportion of individuals with depression was observed among those with more severe diabetic retinopathy and visual impairment. However these associations were not statistically significant while controlling for other factors in the multivariable analyses. CONCLUSIONS Diabetic retinopathy severity and visual acuity in persons with long duration of type 1 diabetes were not cross-sectionally associated with depression in this cohort.
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Affiliation(s)
- Flavio E Hirai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
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Sangthong R, Wichaidit W, McNeil E, Chongsuvivatwong V, Chariyalertsak S, Kessomboon P, Taneepanichskul S, Putwatana P, Aekplakorn W. Health behaviors among short- and long- term ex-smokers: results from the Thai National Health Examination Survey IV, 2009. Prev Med 2012; 55:56-60. [PMID: 22569485 DOI: 10.1016/j.ypmed.2012.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 04/25/2012] [Accepted: 04/27/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although numerous studies have shown the health behaviors of ex-smokers to be better than those in regular smokers, the differences in health behaviors among ex-smokers at varying durations of cessation have not been investigated. This study aims to examine the relationship between different durations of smoking cessation and health behaviors. METHODS Data on dietary intake, alcohol consumption, physical activity, and smoking behavior from the Thai National Health Examination Survey IV for subjects aged 15-98 years (n=19 371) were included in the analysis. Trends between health behaviors among regular smokers, ex-smokers with different durations of smoking (<1 year, 1-10 years, >10 years), and never smokers were tested. Logistic regression models adjusted for sex, age, and economic status were used. RESULTS The prevalences of regular smoking, ex-smoking, and never smoking were 22.3%, 12% , and 65.7%, respectively. A trend was found for consumption of fruit, beans and meats, dairy and soy milk, whole-grain products, nutritional supplements, and eating habits. Average daily alcohol consumption (g) was lowest among ex-smokers who had quit for>10 years ex-smokers (16.4) followed by 1-10 years ex-smokers (27.2), and <1 year ex-smokers (33.7). CONCLUSION A longer duration of smoking cessation correlated with better health behaviors.
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Affiliation(s)
- Rassamee Sangthong
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Thailand.
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Haibach JP, Homish GG, Giovino GA. A Longitudinal Evaluation of Fruit and Vegetable Consumption and Cigarette Smoking. Nicotine Tob Res 2012; 15:355-63. [DOI: 10.1093/ntr/nts130] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Ussher M, Ah-Yoon M, West R, Straus L. Factors Associated With Exercise Participation and Attitudes to Exercise Among Pregnant Smokers. J Smok Cessat 2012. [DOI: 10.1375/jsc.2.1.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AbstractObjective: We assessed exercise levels and psychosocial aspects of exercise among pregnant smokers. Methods: A cross-sectional telephone survey of 88 pregnant smokers assessed levels of participation in exercise and psychosocial aspects of exercise; namely, self-efficacy, beliefs, perceived social support, perceived barriers, intentions and stage of change. Results: The women reported slightly higher levels of physical activity than for the general population of young women. The vast majority of women interviewed reported that exercise was important in their pregnancy, that they intended exercising regularly during pregnancy and were interested in exercise classes as an aid to smoking cessation. Fatigue was the most commonly reported barrier to physical activity during pregnancy, followed by ‘it takes too much time’, ‘uncomfortable when I exercise’ or ‘not sure what to do’. The vast majority of women expressed very little confidence and social support towards exercising. Conclusion: The results suggest that there is potential for using physical activity as an aid to smoking cessation during pregnancy. However, such interventions would need to be sufficiently intensive to address perceived barriers to exercise, lack of social support, low self-efficacy and be tailored to different stages of pregnancy.
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Abstract
BACKGROUND Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain. OBJECTIVES To determine whether exercise-based interventions alone, or combined with a smoking cessation programme, are more effective than a smoking cessation intervention alone. SEARCH METHODS In July 2011, we searched the Cochrane Tobacco Addiction Group Specialized Register for studies including the terms 'exercise' or 'physical activity'. We also searched MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts and CINAHL using the terms 'exercise' or 'physical activity' and 'smoking cessation'. SELECTION CRITERIA We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme, recruiting smokers or recent quitters, and with a follow up of six months or more. DATA COLLECTION AND ANALYSIS We extracted data on study characteristics and smoking outcomes. Because of differences in studies we summarized the results narratively, making no attempt at meta-analysis. MAIN RESULTS We identified 15 trials, seven of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Three studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three-month follow up and a benefit for exercise of borderline significance (p = 0.05) at the 12-month follow up. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three-month follow up but not at the end of treatment or 12-month follow up. The other studies showed no significant effect for exercise on abstinence. AUTHORS' CONCLUSIONS Only one of the 15 trials offered evidence for exercise aiding smoking cessation at a 12-month follow up. All the other trials were too small to reliably exclude an effect of intervention, or included an exercise intervention which was insufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions, equal contact control conditions, and measures of exercise adherence and change in physical activity in both exercise and comparison groups.
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Affiliation(s)
- Michael H Ussher
- Division of PopulationHealth Sciences and Education, StGeorge’s,University of London,CranmerTerrace, London, SW17 0RE, UK.
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Falasinnu TO. A Population-Based Evaluation of the Intention to Quit Smoking, Cervical Cancer Screening Behaviour, and Multiple Health Behaviours Among Female Canadian Smokers. J Smok Cessat 2011. [DOI: 10.1375/jsc.6.2.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AbstractIntroduction:Proschaska's transtheoretical model (TTM) of behaviour change suggests that a population of smokers varies along many dimensions, including readiness to quit and the presence of other risk factors. This study examines whether smokers contemplating quitting are more likely to be contemplating another change (e.g., Pap testing and physical activity).Methods:The study used self-reported cross-sectional data (n= 2,873) from the Canadian Community Health Survey (CCHS) Cycle 4.1 2007/2008. The association between the smoking stage of change (SOC) and Pap testing behaviour was assessed. Control variables included sociodemographic and behavioural characteristics (e.g. doctor visits and number of cigarettes smoked). The distribution of health behaviours (e.g., dietary changes and exercise) by smoking SOC among women with recent Pap tests was also examined.Results:Female smokers contemplating or preparing to quit smoking had higher odds of having a recent Pap test, OR = 1.40, 95% CI (1.19, 1.65), and OR = 1.82, 95% CI (1.47, 2.25) respectively, compared to smokers who had no intention of quitting. This association remained statistically significant after adjusting for confounders, AOR = 1.28, 95% CI (1.08, 1.52), and AOR = 1.63, 95% CI (1.31, 2.04) respectively. Fruit and vegetable consumption, physical activity, and recent dental visit were associated with advanced smoking SOC among women with recent Pap tests (P< .05).Conclusions:Advanced smoking SOC was associated with the increased likelihood of having a recent Pap test and engaging in other healthy behaviours. These findings show that targeting several health behaviours simultaneously may be an effective health promotion strategy.
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Gucciardi E, Mathew R, Demelo M, Bondy SJ. Profiles of smokers and non-smokers with type 2 diabetes: initial visit at a diabetes education centers. Prim Care Diabetes 2011; 5:185-194. [PMID: 21481661 DOI: 10.1016/j.pcd.2011.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 02/07/2011] [Accepted: 03/12/2011] [Indexed: 11/18/2022]
Abstract
AIMS This study explores differences in psychosocial, behavioral and clinical characteristics among smoking and non-smoking individuals with diabetes attending diabetes education centers (DEC). METHODS A questionnaire was administered to 275 individuals with type 2 diabetes attending two DECs between October 2003 and 2005. The participants' characteristics were analyzed and multivariable linear and ordinal regressions were performed to adjust for variables correlated with smoking. RESULTS Findings revealed that smokers, compared to non-smokers, had lower outcome expectations of the benefits of self-management, lower diastolic blood pressure, and followed their recommended diet and tested blood glucose levels less often than non-smokers. Smokers also had lower intentions to use resources outside and within the DEC. CONCLUSIONS Results demonstrate poorer self-care behaviors among smokers compared to non-smokers and further suggest cognitive and behavioral differences between smokers and non-smokers regarding participation and attitudes toward self-management practices. These findings identify issues that need to be addressed in diabetes self-management programs to allow for more effective interventions tailored to the healthcare needs of this specific population.
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Affiliation(s)
- Enza Gucciardi
- Ryerson University, School of Nutrition, 350 Victoria Street, Toronto, Ontario, Canada M5B 2K3.
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Elibero A, Janse Van Rensburg K, Drobes DJ. Acute effects of aerobic exercise and Hatha yoga on craving to smoke. Nicotine Tob Res 2011; 13:1140-8. [PMID: 21849414 DOI: 10.1093/ntr/ntr163] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Recent studies have examined the effects of physical activity on craving to smoke and smoking withdrawal. The current study was designed to compare and contrast the effects of 2 different forms of physical activity on general and cue-elicited craving to smoke. METHODS Following 1-hr nicotine abstinence, 76 daily smokers were randomly assigned to engage in a 30-min bout of cardiovascular exercise (CE; brisk walk on a treadmill), Hatha yoga (HY), or a nonactivity control condition. Participants completed measures of craving and mood, and a smoking cue reactivity assessment, before, immediately following, and approximately 20 min after the physical activity or control conditions. RESULTS Compared with the control condition, participants in each of the physical activity groups reported a decrease in craving to smoke, an increase in positive affect, and a decrease in negative affect. In addition, craving in response to smoking cues was specifically reduced among those who engaged in CE, whereas those who engaged in HY reported a general decrease in cravings. CONCLUSIONS This study provides further support for the use of exercise bouts for attenuating cigarette cravings during temporary nicotine abstinence. Results also suggest that CE can attenuate cravings in response to smoking cues. There are several areas for further research that may improve integration of exercise within smoking cessation treatment.
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Affiliation(s)
- Andrea Elibero
- Tobacco Research and Intervention Program, Moffitt Cancer Center, University of South Florida, Tampa, FL 33617, USA
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Pronk NP, Katz AS, Gallagher J, Austin E, Mullen D, Lowry M, Kottke TE. Adherence to Optimal Lifestyle Behaviors Is Related to Emotional Health Indicators Among Employees. Popul Health Manag 2011; 14:59-67. [DOI: 10.1089/pop.2010.0007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicolaas P. Pronk
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
- HealthPartners Research Foundation, University of Minnesota, Minneapolis, Minnesota
| | - Abigail S. Katz
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Jason Gallagher
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Erin Austin
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Deborah Mullen
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Marcia Lowry
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Thomas E. Kottke
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
- HealthPartners Research Foundation, University of Minnesota, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Pronk NP, Lowry M, Kottke TE, Austin E, Gallagher J, Katz A. The Association Between Optimal Lifestyle Adherence and Short-Term Incidence of Chronic Conditions among Employees. Popul Health Manag 2010; 13:289-95. [DOI: 10.1089/pop.2009.0075] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicolaas P. Pronk
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
- HealthPartners Research Foundation, University of Minnesota, Minneapolis, Minnesota
| | - Marcia Lowry
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Thomas E. Kottke
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
- HealthPartners Research Foundation, University of Minnesota, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Erin Austin
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Jason Gallagher
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
| | - Abigail Katz
- JourneyWell, University of Minnesota, Minneapolis, Minnesota
- HealthPartners, University of Minnesota, Minneapolis, Minnesota
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Rodríguez-Romo G, García-López Ó, Garrido-Muñoz M, Barriopedro M, Barakat-Carballo R, Cordente-Martínez C. Relaciones entre el consumo de tabaco y la práctica de actividad físico-deportiva en una muestra de la población de Madrid. (The relationship between smoking and leisure time physical activity in a sample of the population of Madrid). REVISTA INTERNACIONAL DE CIENCIAS DEL DEPORTE 2010. [DOI: 10.5232/ricyde2010.02004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tart CD, Leyro TM, Richter A, Zvolensky MJ, Rosenfield D, Smits JAJ. Negative affect as a mediator of the relationship between vigorous-intensity exercise and smoking. Addict Behav 2010; 35:580-5. [PMID: 20171786 PMCID: PMC2839032 DOI: 10.1016/j.addbeh.2010.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 11/24/2009] [Accepted: 01/22/2010] [Indexed: 11/15/2022]
Abstract
The present cross-sectional study evaluated whether people who engage in vigorous-intensity exercise are better able to regulate negative affective states, thereby changing core maintenance factors of smoking. Participants were a community sample of adults (n = 270) who completed self-report measures of physical activity, cigarette smoking, anxiety sensitivity, and negative affect. Consistent with hypothesis, vigorous-intensity exercise was related to lower levels of cigarette smoking, accounting for 10% of the variance in smoking. Additionally, negative affect mediated the relationship between vigorous-intensity physical activity and cigarette smoking, accounting for about 12% of this relation. Furthermore, these relationships were stronger for individuals with high anxiety sensitivity than for those with low anxiety sensitivity; including anxiety sensitivity as a moderator of the mediated relationship increased the amount of variance accounted for by negative affect to 17%. The findings are discussed in relation to developing further scientific insight into the mechanisms and pathways relevant to understanding the association among vigorous-intensity exercise, smoking, and emotional vulnerability.
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Affiliation(s)
- Candyce D. Tart
- Department of Psychology, Southern Methodist University, P.O. Box 750442 Dallas, TX 75275-0442, USA
| | - Teresa M. Leyro
- Department of Psychology, University of Vermont, Room 246 John Dewey Hall, 2 Colchester Ave., Burlington VT 05405-0134, USA
| | - Ashley Richter
- Department of Psychology, University of Vermont, Room 246 John Dewey Hall, 2 Colchester Ave., Burlington VT 05405-0134, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Vermont, Room 246 John Dewey Hall, 2 Colchester Ave., Burlington VT 05405-0134, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, P.O. Box 750442 Dallas, TX 75275-0442, USA
| | - Jasper A. J. Smits
- Department of Psychology, Southern Methodist University, P.O. Box 750442 Dallas, TX 75275-0442, USA
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Rundle A, Richie J, Steindorf K, Peluso M, Overvad K, Raaschou-Nielsen O, Clavel-Chapelon F, Linseisen JP, Boeing H, Trichopoulou A, Palli D, Krogh V, Tumino R, Panico S, Bueno-De-Mesquita HB, Peeters PH, Lund E, Gonzalez CA, Martinez C, Dorronsoro M, Barricarte A, Tormo MJ, Quiros J, Agudo A, Berglund G, Jarvholm B, Bingham S, Key TJ, Gormally E, Saracci R, Kaaks R, Riboli E, Vineis P. Physical activity and lung cancer among non-smokers: a pilot molecular epidemiological study within EPIC. Biomarkers 2010; 15:20-30. [PMID: 20050820 DOI: 10.3109/13547500903186452] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The association between physical activity, potential intermediate biomarkers and lung cancer risk was investigated in a study of 230 cases and 648 controls nested within the European Prospective Investigation of Cancer and Nutrition. Data on white blood cell aromatic-DNA adducts by (32)P-post-labelling and glutathione (GSH) in red blood cells were available from a subset of cases and controls. Compared with the first quartile, the fourth quartile of recreational physical activity was associated with a lower lung cancer risk (odds ratio (OR) 0.56, 95% confidence interval (CI) 0.35-0.90), higher GSH levels (+1.87 micromol GSH g(-1) haemoglobin, p = 0.04) but not with the presence of high levels of adducts (OR 1.05, 95% CI 0.38-2.86). Despite being associated with recreational physical activity, in these small-scale pilot analyses GSH levels were not associated with lung cancer risk (OR 0.95, 95% CI 0.84-1.07 per unit increase in GSH levels). Household and occupational activity was not associated with lung cancer risk or biomarker levels.
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Affiliation(s)
- Andrew Rundle
- Columbia University Mailman School of Public Health, New York, NY, USA
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Can lifestyle factors explain why body mass index and waist-to-hip ratio increase with increasing tobacco consumption? The Inter99 study. Public Health 2009; 123:110-5. [DOI: 10.1016/j.puhe.2008.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 06/13/2008] [Accepted: 10/16/2008] [Indexed: 12/13/2022]
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Abstract
AIMS To identify the prevalence and major determinants of anxiety and depression symptoms in patients with diabetes. METHODS A cross-sectional study of 2049 people with Types 1 and 2 diabetes, selected from patients experiencing three different models of care in Ireland: (i) traditional mixed care; (ii) hospital/general practitioner (GP) shared care; (iii) structured GP care. Anxiety and depression symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS). Analyses were conducted primarily using logistic regression with adjustment for relevant confounders. RESULTS The overall response rate was 71% (n = 1456). Based on the HADS, there was evidence of high levels of anxiety and depression symptoms in patients with diabetes; 32.0% (95% confidence interval = 29.5-34.6%) exceeded the HADS cut-off score of 'mild to severe' anxiety and 22.4% (95% confidence interval = 20.2-24.7%) exceeded the HADS cut-off score of 'mild to severe' depression. Diabetes complications, smoking, uncertainty about glycaemic control and being an ex-drinker or a heavy drinker were risk factors for both higher anxiety and depression scores in multivariate analysis. Female gender and poor glycaemic control were risks factors associated only with higher anxiety scores. Higher socio-economic status and older age were protective factors for lower anxiety and depression scores. Type of diabetes, insulin use, marital status and models of care were not significant predictors of anxiety and depression scores. CONCLUSIONS The prevalence of anxiety and depression symptoms in patients with diabetes is considerably higher than in general population samples. These data serve as a benchmark for the prevalence of anxiety and depression symptoms in patients with diabetes.
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Affiliation(s)
- M M Collins
- University of California Cooperative Extension, Sonora, CA, USA
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Abstract
BACKGROUND Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain. OBJECTIVES To determine whether exercise-based interventions alone or combined with a smoking cessation programme are more effective than a smoking cessation intervention alone. SEARCH STRATEGY In July 2008, we searched the Cochrane Tobacco Addiction Group Specialized Register for studies including the terms 'exercise' or 'physical activity'. We also searched MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts and CINAHL. SELECTION CRITERIA We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme, recruiting smokers or recent quitters, and with a follow up of six months or more. DATA COLLECTION AND ANALYSIS We extracted data on study characteristics and smoking outcomes. Because of differences in studies we summarized the results narratively, making no attempt at meta-analysis. MAIN RESULTS We identified 13 trials, six of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Three studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three-month follow up and a benefit for exercise of borderline significance (P = 0.05) at the 12-month follow up. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three-month follow up but not at the end of treatment or 12-month follow up. The other studies showed no significant effect for exercise on abstinence. AUTHORS' CONCLUSIONS Only one of the 13 trials offered evidence for exercise aiding smoking cessation at a 12-month follow up. All the other trials were too small to exclude reliably an effect of intervention, or included an exercise intervention which was insufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions, equal contact control conditions, measures of exercise adherence and change in physical activity in both exercise and comparison groups.
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Affiliation(s)
- Michael H Ussher
- Division of Community Health Sciences, St George's, University of London, Cranmer Terrace, London, UK, SW17 0RE.
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Pisinger C, Jorgensen T. Weight concerns and smoking in a general population: the Inter99 study. Prev Med 2007; 44:283-9. [PMID: 17222451 DOI: 10.1016/j.ypmed.2006.11.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 11/13/2006] [Accepted: 11/15/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE No previous studies have explored weight concerns in relation to smoking habits, or investigated how weight concerns affect smoking cessation in a general population. METHOD Inter99 is a population-based lifestyle interventional study, conducted in 1999-2001 in Copenhagen, Denmark, comprising 30-60 year old men and women. All daily smokers (N=2408) were offered help to quit. The baseline investigation (N=6784) was used for analysing associations of smoking status with weight concerns (cross-sectional design). To analyse how weight concerns affected smoking cessation we included the 1387 daily smokers attending 1-year follow-up; 221 of these were verified quitters (longitudinal design). RESULTS Daily smoking men and women had a significantly lower body mass index than never smokers (men: 3%, women 5%) but reported to be significantly less concerned of their weight (men: OR=0.64, 95%CI=0.4-0.9), women: 0.78(0.6-1.0)). Ex-smoking normal weight women were significantly more likely to be frequently concerned of their weight than never smoking normal weight women (OR=2.06, 95CI%=1.6-2.7). Fifty-two percent of the women and 32% of the men with a previous quit attempt reported that weight gain was a reason for relapse. Neither weight concerns nor eating patterns were predictive of point abstinence at 1-year follow-up. CONCLUSION Smokers are believed to be very concerned of their weight but in this population-based study, daily smokers more frequently ate what they wanted, had a lower BMI and were significantly less concerned of their weight than never smokers. Weight concerns and eating patterns did not predict abstinence at 1-year follow-up. It seems that weight gain and weight concerns are independent factors.
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Affiliation(s)
- Charlotta Pisinger
- Research Centre for Prevention and Health, Nordre Ringvej, Glostrup University Hospital, Building 84/85, DK-2600 Glostrup, Denmark.
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Korhonen T, Kinnunen T, Quiles Z, Leeman RF, Terwal DM, Garvey AJ. Cardiovascular risk behavior among sedentary female smokers and smoking cessation outcomes. Tob Induc Dis 2005; 3:7-26. [PMID: 19570287 PMCID: PMC2643417 DOI: 10.1186/1617-9625-3-1-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background We examined female sedentary smokers' additional cardiovascular disease (CVD) risk behaviors and their associations to smoking cessation. Methods This study was part of a randomized controlled trial testing the effectiveness of exercise and nicotine gum in smoking cessation. Included in the analyses were 148 participants. Dietary habits and alcohol consumption were measured as additional CVD risk behaviors. High-fat diet and heavy alcohol use were considered those risk behaviors. Nicotine dependence, length of the longest quit attempt, depressive symptoms, self-efficacy, and education were examined as other baseline variables. Abstinence from tobacco was recorded through 12 months. Results Diet was related to depressive symptoms at baseline. Alcohol use was related to nicotine dependence and education level. Heavy alcohol use alone and accumulation of two added risk behaviors predicted poorer smoking cessation outcome. Although diet alone was not associated with cessation outcome the high-fat diet interacted with depressive symptoms, such that the depressed women with high-fat diet were significantly more likely to relapse in their quit attempt compared to other subgroups. Conclusion Non-moderate alcohol use alone and accumulation of multiple CVD risk behaviors seem to be associated with lower success in smoking cessation.
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Affiliation(s)
- Tellervo Korhonen
- Tobacco Dependence Treatment and Research, Harvard School of Dental Medicine, Boston, MA, USA
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Pruthi RS, Tornehl C, Gaston K, Lee K, Moore D, Carson CC, Wallen EM. Impact of race, age, income, and residence on prostate cancer knowledge, screening behavior, and health maintenance in siblings of patients with prostate cancer. Eur Urol 2005; 50:64-9. [PMID: 16364537 DOI: 10.1016/j.eururo.2005.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Accepted: 09/30/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study evaluates self-reported changes in knowledge of prostate cancer (CaP), CaP screening behavior and other health-related activities in men whose brothers have been diagnosed with prostate cancer and to characterize those demographic subgroups of siblings at particular risk of failure to change their behavior. METHODS 112 men were surveyed to self-assess their knowledge of CaP both before and after their brother's diagnosis. In addition, siblings were questioned with regard to other health-related behaviors before and after their brother's diagnosis. Demographic characteristics including age, race, income, and area of residence were also reported. Results were analyzed to determine how a brother's diagnosis with CaP affects changes in prostate cancer knowledge, screening behavior and other health related activities in these high-risk patients. RESULTS The impact of a brother's diagnosis of CaP affects only 40% of siblings with regard to CaP knowledge. This knowledge appears to translate into increased screening behavior and other-health-related activity in these men. Unfortunately, more than half of men have no change in CaP knowledge and correspondingly no change in screening behavior. Siblings who are older, earn less, and live in rural areas have a lower baseline knowledge of CaP and are less likely to improve their self-assessed knowledge. On regression analysis, correlates of improvement in CaP knowledge included (1) those discussing with their primary physician (OR=6.6), (2) Caucasians (OR=2.7) and (3) non-smokers (OR=3.1). Improvements in prostate cancer knowledge were found to be predictive of subsequent participation in CaP screening and annual physical exams. CONCLUSIONS Increased attention should be paid to siblings of CaP patients in efforts to improve their knowledge and thereby participation in screening as these patients are at an increased risk of development of this disease. Efforts should be made to educate siblings who are older, of lower income, African American, and rural residents with regard to CaP, as these subgroups appear less likely to change their knowledge and screening behavior despite their sibling's diagnosis.
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Affiliation(s)
- Raj S Pruthi
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
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Thomas JL, Patten CA, Decker PA, Croghan IT, Cowles ML, Bronars CA, Nirelli LM, Offord KP. Development and preliminary evaluation of a measure of support provided to a smoker among young adults. Addict Behav 2005; 30:1351-69. [PMID: 16022932 DOI: 10.1016/j.addbeh.2005.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Revised: 01/08/2005] [Accepted: 01/21/2005] [Indexed: 11/20/2022]
Abstract
Most studies indicate a positive association between social support and smoking cessation. However, clinic-based interventions to increase support for stopping smoking have had limited success. Prior research has emphasized the smoker's perceptions of support received for smoking cessation while less attention has focused on support persons' reports of supportive behaviors provided to a smoker. This study examined select psychometric properties of the Support Provided Measure (SPM), a self-report questionnaire designed by the investigative team to assess supportive behaviors provided to a smoker. The SPM was administered to a college sample (N=771; 67% female) of young adults, aged 18 to 24 years, who reported knowing a smoker whom they thought should quit smoking. Results indicate that, in this sample, the SPM has a two-factor structure with good internal consistency reliability (Cronbach's alpha=0.77) and appears to assess a wide range of individual differences in the provision of support. Demographic correlates associated with SPM scores are described and suggestions for future research are offered.
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Affiliation(s)
- Janet L Thomas
- Department of Preventive Medicine and Public Health, Mail Stop 1008; University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States.
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Abstract
BACKGROUND Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings. OBJECTIVES To determine whether exercise-based interventions alone or combined with a smoking cessation programme are more effective than a smoking cessation intervention alone. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group specialized register for studies including the terms 'exercise' or 'physical activity' in July 2004. In August 2004 we searched MEDLINE, EMBASE, PsycINFO, CINAHL, Dissertation Abstracts and SPORTDiscus. SELECTION CRITERIA We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme, recruiting smokers or recent quitters, and with a follow up of six months or more. DATA COLLECTION AND ANALYSIS We extracted data on study characteristics and smoking outcomes. Because of differences in studies we summarized the results narratively, making no attempt at meta-analysis. MAIN RESULTS We identified 11 trials, six of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Three studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a benefit for exercise versus control on abstinence at both the three month and 12 month follow-up points. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three month follow up but not at the end of treatment or at 12 month follow up. The other studies showed no significant effect for exercise on abstinence. AUTHORS' CONCLUSIONS Only one of the 11 trials offered evidence for exercise aiding smoking cessation. All but one of the other trials were too small to conclude that the intervention was ineffective, or included an exercise intervention which was insufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense exercise interventions, equal contact control conditions and measures of exercise adherence.
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Affiliation(s)
- M Ussher
- Department of Community Health Sciences (Psychology), St George's Hospital Medical School, Cranmer Terrace, London, UK, SW17 0RE.
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Pronk NP, Peek CJ, Goldstein MG. Addressing multiple behavioral risk factors in primary care. A synthesis of current knowledge and stakeholder dialogue sessions. Am J Prev Med 2004; 27:4-17. [PMID: 15275669 DOI: 10.1016/j.amepre.2004.04.024] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Addressing behavioral risk factors in primary care has become a pressing concern due to the increasing burden of behavioral risk factors on disease, healthcare costs, and public health. Risk factors considered include smoking, risky drinking, sedentary lifestyle, and unhealthy diet-singly or in combination. The already burdened primary care system needs a practical approach to efficiently and effectively address any combination of multiple risk factors. Multiple perspectives and broad insight are urgently needed to gain a deeper understanding of the interacting scientific, systems, and policy issues associated with multiple risk factor interventions (MRFIs). PURPOSE This paper synthesizes findings from literature reviews, epidemiologic analyses, and structured interactive dialogue sessions, and includes a set of recommendations designed to stimulate further action. METHODS Several papers were produced to document current knowledge, research evidence, and salient issues related to multiple risk factor assessment and intervention. Structured interactive dialogue sessions were then conducted with clinician, health system, and health policy leaders regarding what advantage or energy would be liberated by a multiple risk factor approach (rather than separate single risk factor approaches), and how to build a policy framework or constituency for MRFIs. This information is synthesized in this paper. RESULTS There is a clear need to address MRFIs among multiple stakeholders, including patients, purchasers, payers, clinicians, health system leaders, and policy-level stakeholders. MRFIs need to bring with them a compelling value proposition for all stakeholders, and a vision of practical and systematic ways to make it a reality in already-pressed primary care practices. Involving stakeholders in dialogue aimed at helping them see the world through each other's eyes helps overcome discouragement and generates energy for jointly designing new approaches. Recommendations for further action include the creation of multistakeholder dialogue, creation of a policy agenda, development of a translation or integration agenda that connects researchers and practitioners in a two-way exchange, initiation of a series of demonstration projects around MRFIs, and support for research on multiple (rather than only single) risk factor interventions. CONCLUSIONS The need to address multiple behavioral risk factors in primary care is increasingly urgent. Whereas stakeholders by themselves may be willing to address multiple risk factors, they agree that it can only be done successfully with a collaborative approach. Findings based on evidence reviews, hypotheses generation, and stakeholder dialogue provide guidance for appropriate further action that, based on what is known already, can be initiated right away.
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Affiliation(s)
- Nicolaas P Pronk
- HealthPartners, Center for Health Promotion, Minneapolis, Minnesota, USA.
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Pronk NP, Anderson LH, Crain AL, Martinson BC, O'Connor PJ, Sherwood NE, Whitebird RR. Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. Am J Prev Med 2004; 27:25-33. [PMID: 15275671 DOI: 10.1016/j.amepre.2004.04.022] [Citation(s) in RCA: 287] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Whereas much is known about single lifestyle-related health risk factor prevalence and covariates, more research is needed to elucidate the interactions among multiple healthy lifestyle factors and variables that may predict adherence to these factors. Such data may guide both clinical and health policy decision making and person-centered approaches to population health improvement. METHODS We document the prevalence and cluster patterns of multiple healthy lifestyle factors among a random sample of adolescents (n =616), adults (n =585), and seniors (n =685) from a large Midwestern health plan. Modifiable, lifestyle-related health factors assessed included physical activity, nonsmoking, high-quality diet, and healthy weight for all subjects; adults and seniors were also asked about their alcohol consumption. Second, we sought to identify characteristics associated with the likelihood of meeting recommendations for healthy lifestyle factors. The healthy lifestyle factors sum score was categorized into three levels, that is, 0 to 2, 3, or 4 to 5 healthy lifestyle factors (4 for adolescents), and we used ordinal logistic regression to estimate the odds of meeting each of these criteria from several demographic characteristics and disease states. RESULTS Overall, only 14.5% of adolescent, adult, and senior health plan members meet recommended guidelines for four common healthy lifestyle factors. Only 10.8% of adults and 12.8% of seniors met all five behavior-related factors. For adolescents, only being nondepressed was associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors (odds ratio [OR]=2.15; p <0.05). For adults, being in the 50- to 64-year-old cohort (OR=1.46, p<0.05), having a college degree (OR=1.65; p <0.05), and having no chronic disease (OR=1.92; p <0.05) were all associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors. For seniors, having a college degree (OR=1.61; p <0.05), was the only variable associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors. CONCLUSIONS A small proportion of health plan members meet multiple recommended healthy lifestyle guidelines at once. This analysis identifies population subgroups of specific interest and importance based on adherence to multiple healthy lifestyle factors, and predictors for increased likelihood to be in adherence to multiple healthy lifestyle factors. It presents a potentially useful summary measure based on person-centered measures of healthy lifestyle factors. Clinicians may derive meaningful information from analyses that address adherence to multiple healthy lifestyle factors. Health systems administrators may use this information to influence health policy and resource allocation decisions. Further studies are needed to assess the usefulness of this comprehensive lifestyle-related health measure as a metric of progress toward public health goals, or as a clinical metric that conveys information on future health status and directs interventions at the individual level.
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Affiliation(s)
- Nicolaas P Pronk
- Center for Health Promotion, HealthPartners Research Foundation, HealthPartners, Minneapolis, Minnesota, USA.
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Solberg LI, Desai JR, O'Connor PJ, Bishop DB, Devlin HM. Diabetic patients who smoke: are they different? Ann Fam Med 2004; 2:26-32. [PMID: 15053280 PMCID: PMC1466617 DOI: 10.1370/afm.36] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2002] [Revised: 01/08/2003] [Accepted: 02/14/2003] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We wanted to identify differences between diabetic patients who smoke and those who do not smoke to design more effective strategies to improve their diabetes care and encourage smoking cessation. METHODS A random sample of adult health plan members with diabetes were mailed a survey questionnaire, with telephone follow-up, asking about their attitudes and behaviors regarding diabetes care and smoking. Among the 1,352 respondents (response rate 82.4%), we found 188 current smokers whose answers we compared with those of 1,264 nonsmokers, with statistical adjustment for demographic characteristics and duration of diabetes. RESULTS Smokers with diabetes were more likely to report fair or poor health (odds ratio [OR] = 1.5, P = .03) and often feeling depressed (OR = 1.7, P = .004). Relative to nonsmokers, smokers had lower rates of checking blood glucose levels, were less physically active, and had fewer diabetes care visits, glycated hemoglobin (A1c) tests, foot examinations, eye examinations, and dental checkups (P < or = .01). Smokers also reported receiving and desiring less support from family and friends for specific diabetic self-management activities and had lower readiness to quit smoking than has been observed in other population groups. CONCLUSIONS Clinicians should be aware that diabetic patients who smoke are more likely to report often feeling depressed and, even after adjusting for depression, are less likely to be active in self-care or to comply with diabetes care recommendations. Diabetic patients who smoke are special clinical challenges and are likely to require more creative and consistent clinical interventions and support.
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Affiliation(s)
- Leif I Solberg
- HealthPartners Research Foundation, Minneapolis, Minn 55440, USA.
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Boudreaux ED, Francis JL, Carmack Taylor CL, Scarinci IC, Brantley PJ. Changing multiple health behaviors: smoking and exercise. Prev Med 2003; 36:471-8. [PMID: 12649056 DOI: 10.1016/s0091-7435(02)00048-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous stage of change research examining health behaviors has tended to examine one behavior at a time. However, one recent study by King et al. (1996) examined the relationship between smoking and exercise across cognitive-behavioral mediators (i.e., decisional balance and self-efficacy) shown to be important in predicting readiness to change. In this study, we seek to replicate the study of King et al. (1996) in a low-income sample, the majority of whom are women, with at least one chronic illness who are attending primary care clinics. METHODS Data were obtained from 270 adult outpatients attending four public primary care clinics in Louisiana. RESULTS Smoking and exercise stage of change were not related. Significant relationships existed between the cognitive variables of smoking and exercise. No significant differences existed within exercise stage of change on the cognitive variables of smoking, and vice versa, no significant differences were noted within smoking stage of change on the cognitive variables of exercise. CONCLUSIONS Smoking and exercise appear to be specific health behaviors that are independent constructs in this particular sample. However, caution should be taken when interpreting the findings since 75% of the sample had at least one chronic illness.
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Affiliation(s)
- Edwin D Boudreaux
- Louisiana State University School of Medicine, Baton Rouge, 70808, USA
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Sánchez-Villegas A, Delgado-Rodríguez M, Martínez-González MA, De Irala-Estévez J. Gender, age, socio-demographic and lifestyle factors associated with major dietary patterns in the Spanish Project SUN (Seguimiento Universidad de Navarra). Eur J Clin Nutr 2003; 57:285-92. [PMID: 12571661 DOI: 10.1038/sj.ejcn.1601528] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2002] [Revised: 04/25/2002] [Accepted: 05/01/2002] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To ascertain the major dietary patterns in the cohort 'SUN' and to assess the association of several sociodemographic (including age and gender) and lifestyle variables with the adherence to these dietary patterns. DESIGN This study is a cross-sectional analysis of 3847 subjects (1587 men and 2260 women) belonging to a prospective cohort study based on self-reported questionnaires. A factor analysis based on 30 predefined food groups was conducted to ascertain the major dietary patterns in the cohort. Multiple regression models were fitted to assess the relationship between several sociodemographic and lifestyle variables and the adherence to these dietary patterns (measured using two scores with observed values ranging from -3.2 to +4.6 for the Western pattern and -3.1 to +5.5 for the Mediterranean pattern). RESULTS Two major dietary patterns were found. The first pattern was labelled as a 'Western' dietary pattern and the other as a 'Spanish-Mediterranean' dietary pattern. Younger subjects were more likely to follow a 'Western' dietary pattern; the coefficient representing the change for every 10 y increase in age was b=-0.24 (P<0.001) for men and b=-0.12 (P<0.001) for women. More physically active subjects were less likely to follow a 'Western' dietary pattern and more likely to follow a 'Spanish-Mediterranean' dietary pattern. CONCLUSIONS An association between a higher level of physical activity during leisure time and adherence to a 'Spanish-Mediterranean' diet was apparent. However, the profile of being a young, sedentary and single male was identified as the most likely to exhibit a departure from the traditional 'Spanish-Mediterranean' diet and follow a 'Western' dietary pattern.
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Affiliation(s)
- A Sánchez-Villegas
- Division of Epidemiology and Public Health, School of Medicine, University of Navarre, Pamplona, Spain
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Kim YO. Dietary Habits of Smokers and Non-smokers in the Korean Health and Nutrition Survey. Prev Nutr Food Sci 2002. [DOI: 10.3746/jfn.2002.7.4.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Many individuals who smoke are hospitalized for extended periods of time for treatment of their diseases. These patients are at increased risk for developing withdrawal symptoms and maladaptive behavior because hospitals have adopted smoke-free policies in accordance with federal law and consumer pressures. Tobacco addiction often is overlooked by healthcare providers or receives low priority on admission. Oncology nurses care for a chronic population of people who often require lengthy treatments and frequent complications resulting in admissions to the hospital. Nurses need to identify high-risk patients; continually educate themselves, their patients, and their patients' families about smoking withdrawal and cessation therapies; anticipate coping difficulties; and be prepared to manage inappropriate behavior when necessary. A multidisciplinary team approach using consistent reinforcement and support offers the best patient outcomes while maximizing safety.
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Palaniappan U, Jacobs Starkey L, O'Loughlin J, Gray-Donald K. Fruit and vegetable consumption is lower and saturated fat intake is higher among Canadians reporting smoking. J Nutr 2001; 131:1952-8. [PMID: 11435513 DOI: 10.1093/jn/131.7.1952] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Understanding differences in dietary patterns by smoking status is important for nutritionists and health educators involved in helping individuals to make healthy dietary and lifestyle choices. Although smokers have a poor quality diet compared with nonsmokers, no study has examined nutritional adequacy and variability in the nutrient intake of smokers. The aim of this study was to compare dietary habits of smokers with nonsmokers in terms of nutrient intake, food groups contributing to nutrient intake, nutritional adequacy and day-to-day variation in nutrient intake. Noninstitutionalized adults aged 18--65 y (n = 1543) who participated in the Food Habits of Canadians Survey (1997--1998) were studied. Subjects, selected from across Canada using a multistage, random-sampling strategy, completed an in-home 24-h dietary recall. Repeat interviews were conducted in a subsample to estimate variability in nutrient intake. Smokers had higher intakes of total and saturated fat, and lower intakes of folate, vitamin C and fiber than nonsmokers. There were no significant differences in calcium, zinc and vitamin A intakes or day-to-day variation in nutrient intake by smoking status. Smokers consumed significantly fewer fruits and vegetables than nonsmokers, leading to lower intakes of folate and vitamin C. In conclusion, smokers have a less healthy diet than nonsmokers, placing them at higher risk for chronic disease as a result of both dietary and smoking habits. Diet may act as a confounder in smoking-disease relationships.
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Affiliation(s)
- U Palaniappan
- School of Dietetics and Human Nutrition, McGill University, Montreal, Canada, H9X 3V9
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