Socio-economic determinants of health behaviours across age groups: results of a cross-sectional survey

Associations between tobacco smoking status and patch test results-A cross-sectional pilot study from the Information Network of Departments of Dermatology (IVDK)

BACKGROUND

Earlier studies suggested a potential association between tobacco smoking and nickel sensitization, but little is known about other contact allergens.

OBJECTIVES

To investigate the association of smoking status and contact sensitizations as well as subtypes of dermatitis, and to analyse the sensitization profiles of tobacco smokers.

PATIENTS AND METHODS

Within the Information Network of Departments of Dermatology (IVDK), we performed a cross-sectional multicentre pilot study comprising 1091 patch-tested patients from 9 departments, comparing 541 patients with a history of cigarette smoking (281 current and 260 former smokers) with 550 never-smokers.

RESULTS

We could not confirm the previously reported association between nickel sensitization and tobacco smoking. Moreover, sensitizations to other allergens, including colophony, fragrance mix I, Myroxylon pereirae and formaldehyde, were not increased in cigarette smokers compared with never smokers. Hand dermatitis (50.6% vs. 33.6%) and occupational cause (36.2% vs. 22.5%) were significantly more frequent among cigarette smokers compared with never-smokers as shown by non-overlapping 95% confidence intervals.

CONCLUSIONS

Although our study does not allow a firm conclusion on whether smoking status contributes to certain contact sensitizations, it confirms an association of smoking with hand dermatitis and occupational cause.

An intersectionality framework for identifying relevant covariates in health equity research

Introduction

Health equity research uses impact evaluations to estimate the effectiveness of new interventions that aim to mitigate health inequities. Health inequities are influenced by many experiential factors and failure of research to account for such experiential factors and their potential interactions may jeopardize findings and lead to promoted methods that may unintentionally sustain or even worsen the targeted health inequity. Thus, it is imperative that health equity impact evaluations identify and include variables related to the circumstances, conditions, and experiences of the sample being studied in analyses. In this review, we promote intersectionality as a conceptual framework for brainstorming important yet often overlooked covariates in health equity related impact evaluations.

Methods

We briefly review and define concepts and terminology relevant to health equity, then detail four domains of experiential factors that often intersect in ways that may obscure findings: Biological, Social, Environmental, and Economic.

Results

We provide examples of the framework's application to lupus-related research and examples of covariates used in our own health equity impact evaluations with minority patients who have lupus.

Discussion

Applying an intersectionality framework during covariate selection is an important component to actualizing precision prevention. While we do not provide an exhaustive list, our aim is to provide a springboard for brainstorming meaningful covariates for health equity evaluation that may further help unveil sustainable solutions to persisting health inequities.

Health behaviours of patients with affective disorders: a cross-sectional study

BACKGROUND

Severe mental disorders, including affective disorders (AD), are associated with high rates of physical illnesses that lead to premature patient death. Excess somatic comorbidity may be partially explained by lifestyle factors. This study aimed to investigate the health behaviours (HBs) of patients with AD in comparison to the HBs of patients with type 2 diabetes (T2D) and healthy controls (HCs) and to examine associations among HBs and sociodemographic and clinical factors, subjective quality of life and health status, and health locus of control.

METHODS

The sample consisted of 108 patients with AD, including 60 with bipolar disorder (BP) and 48 with unipolar disorder (UAD). Analyses included comparisons with a subgroup of AD individuals, patients with T2D and HCs matched in age and sex. The Health Behaviour Inventory was used to evaluate the overall levels of HBs and 4 HB categories. To identify independent determinants of health behaviours, a multivariate linear regression analysis was performed with factors identified as significant in bivariate analyses.

RESULTS

Most AD patients had a low level of HBs (40%), followed by moderate (35%) and high levels (25%), and there were no significant differences in HBs between the BP and UAD groups. Compared with the T2D and HC groups, the AD group had a significantly lower level of overall HBs and lower levels of HBs in one of the categories. Independent predictors of overall HBs were quality of life (β = 0.28, p < 0.001), age (β = 0.27, p = 0.002), and depressive symptoms (β = 0.23, p = 0.008). A total of 30% of the variance in HBs was explained.

CONCLUSIONS

These findings emphasise the need for a systematic assessment of single and multiple health behaviours to provide better care for patients with AD and reduce the potential adverse effects of an unhealthy lifestyle.

Are there gender based differences in participation and time spent in physical activity in Albania? Evidence from 2017-18 demographic and health survey

Background

Since 1990, Albania has embraced the market economy and globalization. Prosperity and modernization have also brought significant lifestyle changes toward unhealthy behaviours, doubling the mortality from non-communicable diseases (NCDs). While Physical Activity (PA) can mitigate the NCDs burden, participation is low in Albania. To date, research on PA determinants that could meaningfully inform policy is lacking. To fill this gap, this study examines the PA behaviour among Albanian adults. Specifically, we assess the decisions to participate, and the time spent in PA.

Methods

Using the 2017–2018 Albania Demographic and Health Survey data and a double-hurdle regression model, we simultaneously assess the influence of demographic, socioeconomic and lifestyle factors on the likelihood of participating (extensive margin) and the time spent (intensive margin) in PA. To understand gender differences regarding PA decisions, we run separate models for men and women.

Results

Results show significant variations in the likelihood of participation and the time spent in PA, by household economic status, administrative regions, occupation, and education. We find that likelihood of participation in PA increases with household wealth, but conditional on participation, affluent Albanians spent less time in PA. Education and employment status also have opposite effects on participation and time spent margins. Results show notable gender-based differences in PA behaviour (either for participation or time spent) related to education, age, family structure (marital status and the number of young children), regions, occupation, and lifestyle factors.

Conclusions

Insights in understanding the PA behaviour of Albanian adults allow policymakers to identify socio-demographic groups most in need of intervention effort. To effectively support PA among Albanians, policymakers should target males and females differently and address gender-specific needs accordingly.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00930-2.

Food Patterns of Hospitalized Patients with Heart Failure and Their Relationship with Demographic, Economic and Clinical Factors in Sergipe, Brazil

Background: The high rates of hospitalization and mortality caused by Heart Failure (HF) have attracted the attention of health sectors around the world. Dietary patterns that involve food combinations and preparations with synergistic or antagonistic effects of different dietary components can influence the worsening and negative outcomes of this disease. Objectives: To describe the dietary patterns of patients hospitalized for HF decompensation and associate them with demographic, economic, and clinical factors, and the type of care provided in Sergipe. Materials and Methods: Cross-sectional study that is part of the Congestive Heart Failure Registry (VICTIM-CHF)” of Aracaju/SE. Prospective data collection took place with all patients hospitalized between April 2018 and February 2021 in cardiology referral hospitals, 2 public and 1 private. The data collected were sociodemographic, clinical, lifestyle, anthropometric and food consumption variables. Daily dietary intake was estimated by applying a semiquantitative food frequency questionnaire. The extraction of dietary patterns, by exploratory factor analysis, was performed after grouping the foods according to the nutritional value and form of preparation into 34 groups. To assess the association between the factorial scores for adherence to the standards and the variables studied, the Mann-Whitney U test was applied. Linear regressions were also performed, considering the dietary pattern (one for each pattern) as a dependent variable. Results: The study included 240 patients hospitalized for HF decompensation, most of them elderly (mean age 61.12 ± 1.06 years), male (52.08%) and attended by the Unified Health System—SUS (67.5%). Three dietary patterns were identified, labeled “traditional” (typical foods of the Brazilian northeastern population added to ultra-processed foods), “Mediterranean” (foods recommended by the Mediterranean diet) and “dual” (healthy foods combined with fast and easy-to-prepare foods like snacks, bread, sweets and desserts). Adherence to the “traditional” pattern was greater among men (p < 0.031) and non-diabetics (p < 0.003). The “Mediterranean” was more consumed by the elderly (p < 0.001), with partners (p = 0.001) and a lower income (p < 0.001), assisted by the SUS (p < 0.001) and without hypertension (p = 0,04). The “dual” diet pattern had greater adherence by the elderly (p < 0.001), self-declared non-black (p = 0.012), with higher income (p < 0.001), assisted in the private sector (p < 0.001) and with less impaired functional capacity (p = 0.037). It was also observed that being female (p = 0.031) and being older reduced the average scores of performing the “traditional” pattern (p = 0.002). Regarding the type of service, being from the public service reduced the average scores for adhering to the “dual” pattern (p = 0.008). Conclusions: Three dietary patterns representative of the population were found, called traditional, Mediterranean and dual, which were associated with demographic, economic and clinical factors. Thus, these standards must be considered in the development of nutritional strategies and recommendations in order to increase adherence to diets that are more protective against cardiovascular diseases.

Lifestyle Parameters in Patients with Diabetes Mellitus and in the General Adult Population-Trends over Five Years: Results of the Austrian National Health Interview Series

Background: Not smoking, performing >150 min of aerobic physical activity (PA) and muscle strengthening exercises/week, and consuming >5 portions of fruit and vegetables/day are lifestyle recommendations for both the general population and people with diabetes mellitus (DM). Methods: A total of 15,771 and 15,461 persons from the Austrian Health Interview Surveys 2014 and 2019, respectively, including 4.9% and 6.0% of people with DM, were analysed in terms of their smoking, PA, and nutritional behaviours. Logistic regression models were performed for the lifestyle factors, adjusted for socio-demographic and health-related factors. Adjusted interactions between the survey year and DM on the lifestyle factors were computed. Results: The proportions of smokers were 23.9% and 20.2%, of people complying with the PA recommendations were 24.9% and 21.4%, and with fruit and vegetables recommendations were 7.1% and 5.5%, respectively, with significantly lower proportions of smokers and persons complying with the PA recommendations among people with DM. The fully adjusted odds ratios (95% confidence interval) for people with DM were 1.09 (0.94–1.26), 1.44 (1.23–1.69), and 0.90 (0.71–1.13) for smoking, not complying with PA recommendations, and not complying with fruit and vegetables recommendations, respectively. The proportion of people complying with PA recommendations decreased to a greater extent (p < 0.001) in people with DM (16.5% to 8.3%) compared to people without DM (25.3% to 22.3%). Conclusion: Diabetogenic lifestyle behaviours increased in the general Austrian population in recent years, which was especially true for people with DM regarding PA.

The Influence of Occupational Categories on Overall and Domain-Specific Physical Activity and the Association with Chronic Diseases. An Analysis Using the Austrian Health Interview Survey

Background: The performance of physical activity (PA) in different domains varies between different occupational groups and they contribute differently to the prevention and management of chronic diseases. This study aimed to give a fuller picture of the potential influence occupational categories have on the different domains of PA among the Austrian population of working age. Methods: A total of 8251 gainfully employed persons in 9 major and 39 sub-major occupational groups from the Austrian Health Interview Survey 2014 were analyzed. PA was measured with the Physical Activity Questionnaire of the European Health Interview Survey (EHIS-PAQ) and the prevalence of 17 chronic diseases was obtained. Results: A total of 48.2% were mostly active when working, 18.4% reported transport-related PA in the upper quintile, 50.4% performed at least 150 min per week of moderate PA or cycling, 32.7% performed muscle-strengthening PA at least twice a week, and 76.3% were either mostly physically active when working or complied with the aerobic PA guidelines. As a general rule, people in physically active occupational groups tended to perform less PA in their leisure time and vice versa. Occupational groups with especially low amount of PA were Information Technology workers, directors, and secretarial staff. People with a chronic disease tended to perform less PA, but there was an interaction between occupation and chronic disease on PA. Conclusions: Domain-specific programs to promote PA should be developed for various occupational categories.

Health behaviors and hypertension control: the results of ELSI-BRASIL

This study aimed to measure the contribution of selected health behaviors to the prevalence of hypertension control in Brazilian adults 50 years or older, based on data from the ELSI-Brasil study. The study included 4,318 individuals 50 years or older who reported having received a medical diagnosis of hypertension and were taking antihypertensive medication. The selected health behaviors were: physical activity, healthy diet, not consuming excessive alcohol, and never having smoked. The contribution of each health behavior to prevalence of hypertension control was estimated by the attribution method, via adjustment of the binomial additive hazards model, stratified by sex. Prevalence of hypertension control was 50.7% (95%CI: 48.2; 53.1). Overall, health behaviors made a larger contribution to hypertension control in women (66.3%) than in men (36.2%). Moderate alcohol consumption made the largest contribution in both sexes, but particularly in women (52.7% in women versus 19% in men). Physical activity contributed 12.6% in women and 10.7% in men. The other behaviors were more relevant in men: never having smoked (3.4%) and regular consumption of vegetables, legumes, and fruits (3.1%). These results underline the need for measures to promote the adoption of healthy behaviors by hypertensive individuals to reduce blood pressure levels, improve the effectiveness of antihypertensive medication, and decrease their cardiovascular risk.

Association between physical activity and the utilization of general practitioners in different age groups

BACKGROUND

Physical activity (PA) is an important tool in health promotion, prevention, curation, and rehabilitation and should be part of general practitioners (GP) consultations. For tailoring GP's service it is important to know the PA habits of the clients.

METHODS

Data from the Austrian Health Interview Survey 2014 with 15,770 subjects were analyzed. The association between PA, measured with the Physical Activity Questionnaire of the European Health Intervies Survey (EHIS-PAQ) and having visited a GP within the last 4 weeks was examined in different age groups (15-29, 30-64, and 65+ years). In multivariate analyses we adjusted for sociodemographic and health-related variables (body mass index, 17 chronic diseases, and the use of medication).

RESULTS

In subjects aged 15-29 years and 30-64 years fulfilling aerobic PA recommendations was significantly associated with a lower chance of having consulted the GP with unadjusted OR (95% CI) 0.82 (0.70-0.96) and 0.90 (0.82-0.99), respectively, whereas work-related PA was associated with a higher chance, with OR 1.21 (1.03-1.42) and 1.10 (1.00-1.20), respectively. Adjusting for sociodemographic and health-related factors led to loss of significance. In subjects aged 30-64 years, muscle strengthening PA was associated with a higher chance for GP consultation with OR 1.12 (1.00-1.24) in the fully adjusted model. In subjects aged 65+ years, PA was associated with a lower chance of having visited the GP with OR 0.74 (0.64-0.86) and 0.83 (0.71-0.97) for work related PA and total PA, respectively, in the fully adjusted model.

CONCLUSION

The association of PA and GP consultation is dependent on age and type of PA, and partly mediated by sociodemographic and health-related factors.

The societal costs of chronic pain and its determinants: The case of Austria

BACKGROUND

Chronic pain is among the most burdensome conditions. Its prevalence ranges between 12% and 30% in Europe, with an estimated 21% among Austrian adults. The economic impact of chronic pain from a societal perspective, however, has not been sufficiently researched. This study aims to provide an estimate of the societal costs for working-age adults with chronic pain in Austria. It explores the impact of sex, number of pain sites, self-reported pain severity, health literacy and private health insurance on costs associated with chronic pain.

METHODS

A bottom-up cost-of-illness study was conducted based on data collected from 54 adult patients with chronic pain at three Viennese hospital outpatient departments. Information on healthcare costs including out-of-pocket expenses and productivity losses due to absenteeism and informal care were collected over 12 months. Resource use estimates were combined with unit costs and mean costs per patient were calculated in € for year 2016.

RESULTS

Mean annual societal costs were estimated at EUR 10191. Direct medical costs were EUR 5725 including EUR 1799 out-of-pocket expenses (mainly pain relieving activities and private therapy). Productivity losses including informal care amounted to EUR 4466. Total costs for women and patients with three or more pain sites were significantly higher. No association with health literacy was found but there was a tendency towards higher out-of-pocket expenses for patients with complementary private health insurance.

CONCLUSION

This study is the first to provide a comprehensive assessment of the individual and societal burden of chronic pain in Austria. It highlights that chronic pain is associated with substantial direct medical costs and productivity losses. Patient costs may show systematic differences by health insurance status, implying a need for future research in this area.

Socio-economic factors associated with the 1‑year prevalence of severe pain and pain-related sickness absence in the Austrian population

Background

The aim of this study was to (1) investigate the relation of socio-economic status (SES), measured as education, occupation, and income, with the 12-month prevalence of severe pain and with pain-related sickness absence, and (2) analyse to what extent sociodemographic and medical factors influence these associations.

Methods

The study population comprised 8084 subjects aged between 15 and 65 years from the Austrian Health Interview Survey in 2006/07. Associations of SES with the 1‑year prevalence of severe pain and sickness absence due to pain in those with severe pain was assessed with logistic regression analysis and adjusted for socio-demographic and chronic medical conditions.

Results

The 1‑year prevalence of severe pain was 33.7%. Among those with severe pain, 32.9% were on sickness absence due to pain. SES was significantly associated with the prevalence of severe pain and even more strongly with sickness absence due to pain. Stepwise adjustment for socio-demographics and medical factors had only marginal effects on these associations. Multivariate odds ratios (ORs) for severe pain were 1.14; 1.18 and 1.32 for low income, blue-collar workers, and low education, respectively. Related ORs for sickness absence due to pain were 1.52; 1.14 and 2.05.

Conclusions

There was an association between SES, particularly measured as educational level, and the prevalence of severe pain, which was even stronger with sickness absence due to pain.

Clinical setting-based smoking cessation programme and the quality of life in people living with HIV in Austria and Germany

Purpose

To report on the global quality of life (QOL) in people living with HIV (PLWHIV) and how a smoking cessation intervention influences the changes in QOL.

Methods

Participants were asked to fill out a questionnaire during visits to their HIV outpatient clinic consisting of sociodemographic information, general health data and the WHOQOL HIV-Bref. Exhaled carbon monoxide measurements were used to confirm the smoking status, based on which participants classified as smokers received a short 5 min structured intervention and were offered participation in a full smoking cessation programme consisting of five sessions. Follow-up was done 8 months after the baseline.

Results

Overall 447 (mean age = 45.5) participants took part with 221 being classified as smokers. A total of 165 (74.6%) participants received a short intervention and 63 (29.4%) agreed to participate in the full program. At baseline, differences in QoL were observed, where smokers had lower QoL in domains of physical (M = 16.1 vs. 15.3, p = 0.009) and psychological (M = 15.3 vs. 14.6, p = 0.021) well-being, independency level (M = 16.1 vs. 15.2, p = 0.003) and environment (M = 16.5 vs. 16.0, p = 0.036). At study end, 27 (12.2%) participants quit smoking; 12 (19.0%) participants of the full programme and 15 (14.7%) that received the short intervention. There were no significant differences in QoL between those that continued to smoke and quitters at follow-up.

Conclusion

Quality of life results may be used to better understand the underlying motivation of PLWHIV who start cessation programs. In order to reduce the high prevalence and health burden that smoking causes in PLWHIV, it is necessary to introduce effective interventions that can be used in the clinical settings.

[Lifetime socioeconomic status and health-related risk behaviors: the ELSA-Brazil study]

Our objective was to investigate the association between lifetime socioeconomic status and intra-generational social mobility and low consumption of fruits and vegetables, leisure-time physical inactivity, and smoking among 13,216 men and women participating in the baseline of the ELSA-Brazil study (2008-2010). Socioeconomic status in childhood, adolescence, and adulthood was measured by maternal schooling, socio-occupational class of the first occupation, and socio-occupational class of the current occupation, respectively. Social disadvantages in adulthood were consistently associated with higher prevalence of the three behaviors analyzed in men and women. However, socioeconomic status in youth and childhood was less consistently associated with the behaviors. For example, while low maternal schooling reduced the odds of past smoking (women) and current smoking (men and women), it was associated with higher odds of leisure-time physical inactivity in women. Meanwhile, low socioeconomic status in youth increased the odds of past smoking (men and women) and current smoking (women). Analysis of social trajectories lent additional support to the relevance of disadvantages in adulthood for risk behaviors, since only individuals that rose to the high socio-occupational class did not show higher odds of these behaviors when compared to participants that had always belonged to the high socio-occupational class. Our findings indicate that socioeconomic disadvantages in adulthood appear to be more relevant for risk behaviors than disadvantages in childhood and adolescence.

Physical Inactivity From Adolescence to Young Adulthood: The Relevance of Various Dimensions of Inequality in a Swedish Longitudinal Sample

As physical inactivity may track from adolescence to adulthood, it is important to identify social determinants of physical inactivity in early life. However, most studies have measured socioeconomic position as one dimension. We examine whether multiple dimensions of socioeconomic position, in addition to other dimensions of inequality (i.e., gender, immigrant background), associate with physical inactivity at two time points in youth. Longitudinal data were drawn from the Swedish Level of Living Survey ( N = 765) and analysed by gender-stratified logistic regression. Among girls, low parental social class (odds ratio [OR] = 2.63, 95% confidence interval [CI; 1.28, 5.42]) and income (OR = 2.28, 95% [CI 1.12, 4.65]) were associated with physical inactivity, while immigrant background (OR = 2.33, 95% CI [1.03, 5.23]) and a low level of parental education (OR = 3.38, 95% CI [1.15, 9.95]) predicted physical inactivity among women. Among boys, low parental income (OR = 3.27, 95% CI [1.39, 7.69]) was associated with physical inactivity, whereas immigrant background (OR = 2.29, 95% CI [1.04, 5.03]) predicted physical inactivity among men. Our results suggest that physical inactivity is socially patterned, but different dimensions of social stratification should not be considered interchangeable as they may operate independently, through intersection with gender, and at different time points in youth in increasing the risk of physical inactivity.

Prevalence and Correlates of Smoking and Readiness to Quit Smoking in People Living with HIV in Austria and Germany

We aimed to investigate the prevalence and correlates of smoking in people living with HIV (PLWHIV) in Germany and Austria and their readiness to quit. A total of 447 consecutive patients with confirmed positive HIV status who were treated in different outpatient HIV centres in Austria and Germany were included. Nicotine dependence and stages of change were assessed by standardized questionnaires, and this was confirmed by measuring exhaled carbon monoxide. Prevalence of smoking was 49.4%. According to a multivariate logistic regression analysis, higher age (for each year of life OR = 0.96; 95% CI 0.92–1.00) and tertiary education level (OR = 0.43; 95% CI 0.15–0.79) were associated with a lower chance, and occasional (OR = 3.75; 95% CI 1.74–8.07) and daily smoking of the partner (OR 8.78; 95% CI 4.49–17.17) were significantly associated with a higher chance of smoking. Moderate (OR = 3.41; 95% CI = 1.30–9.05) and higher nicotine dependency level (OR = 3.40; 95% CI 1.46–7.94), were significantly associated with higher chance, and older age (for each year of life OR = 0.95; 95% CI = 0.91–0.99), with lower chance for readiness to quit smoking. Those results may be used to address preventive measures to quit smoking aimed at PLWHIV and the importance of addressing smoking habits.

Food and Nutrient Intake in African American Children and Adolescents Aged 5 to 16 Years in Baltimore City

OBJECTIVE

This study aimed to describe food and nutrient intake for low-income, urban African American children and adolescents, to highlight the need for further nutrition intervention programs and appropriate tools to address overweight and obesity.

METHODS

This was a cross-sectional study using interviewer-administered single 24-hour dietary recalls. Participants were low-income African American boys and girls aged 5-16 years or their caregivers in Baltimore City. Frequency of food consumption and dietary intakes were analyzed by gender and age groups.

RESULTS

Eighty-one participants were included for analysis. Mean daily energy intakes exceeded Dietary Reference Intakes (DRIs) from 10% to 71% across all gender-age groups: 2304 kcal for children aged 5-8 years; 2429 kcal and 2732 kcal for boys and girls aged 9-13 years, respectively; and 3339 kcal and 2846 kcal for boys and girls aged 14-16 years, respectively. The most frequently reported consumed foods were sweetened drinks, chips, candies, and milk across all age groups. The majority of participants (79-100%) did not meet the DRIs for dietary fiber and vitamin E across all gender-age groups. Milk accounted for 14%, 17%, and 21% of energy, fat, and protein intake, respectively, among children 5-8 years of age, while pizza was the top source of energy, fat, and protein (11%, 13%, and 18%, respectively) among 14-to 16-year-old adolescents. Sweetened drinks and sweetened juices were major sources of sugar, contributing 33% for 5-8 year olds, 29% for 9-13 year olds, and 35% for 14-16 year olds.

CONCLUSIONS

Mean daily energy intake exceeded dietary recommendations across all gender-age groups. This study has provided previously unavailable information on diet and highlights foods to be targeted in nutrition intervention programs.

Factors predicting nutrition and physical activity behaviors due to cardiovascular disease in tehran university students: application of health belief model

Background:

Disease preventing methods focus mostly on lifestyle factors such as physical activity, healthy diet and not smoking. Previous studies verified using theory and models to change unhealthy behaviors, so that health belief model (HBM) is a useful framework for describing the healthy nutrition behavior.

Objectives:

This study aimed to predict factors related to unhealthy nutrition and inactive life in students of Tehran University, Tehran, Iran based on the Health Belief Model (HBM).

Patients and Methods:

In this cross sectional study, proportional quota sampling from three different educational levels was conducted from October to December 2012. A self-administered validated instrument based on the Health Belief Model (HBM) with 69 items and four sections was used to collect data. In this study through using linear and logistic regression, the effect of body mass index, age, gender, marriage, self-efficacy, cues to action, knowledge, perceived severity, susceptibility, benefits and barriers on nutrition and physical activity behavior were assessed. SPSS version 18 was used to analyze data.

Results:

Totally, 368 students including 318 female students (86.4%) and 50 male students (13.6%) with a mean age of 24.9 years (SD = 4.55) took part in the study. Among all independent variables, gender (P < 0.001), knowledge (P = 0.023) and perceived barriers (P = 0.004) predicted nutrition behavior. In case of physical activity, knowledge (P = 0.011), perceived severity (P = 0.009), perceived barriers (P = 0.019) and self-efficacy (P = 0.033) had significance association with physical activity behavior.

Conclusions:

This study indicated that health belief model contrasts could predict the risky behavior of university students due to heart disease. However, more researches are needed to verify the predictors of high risky behaviors in students.

The improved physical activity index for measuring physical activity in EPIC Germany

In the European Investigation into Cancer and Nutrition study (EPIC), physical activity (PA) has been indexed as a cross-tabulation between PA at work and recreational activity. As the proportion of non-working participants increases, other categorization strategies are needed. Therefore, our aim was to develop a valid PA index for this population, which will also be able to express PA continuously. In the German EPIC centers Potsdam and Heidelberg, a clustered sample of 3,766 participants was re-invited to the study center. 1,615 participants agreed to participate and 1,344 participants were finally included in this study. PA was measured by questionnaires on defined activities and a 7-day combined heart rate and acceleration sensor. In a training sample of 433 participants, the Improved Physical Activity Index (IPAI) was developed. Its performance was evaluated in a validation sample of 911 participants and compared with the Cambridge Index and the Total PA Index. The IPAI consists of items covering five areas including PA at work, sport, cycling, television viewing, and computer use. The correlations of the IPAI with accelerometer counts in the training and validation sample ranged r = 0.40–0.43 and with physical activity energy expenditure (PAEE) r = 0.33–0.40 and were higher than for the Cambridge Index and the Total PA Index previously applied in EPIC. In non-working participants the IPAI showed higher correlations than the Cambridge Index and the Total PA Index, with r = 0.34 for accelerometer counts and r = 0.29 for PAEE. In conclusion, we developed a valid physical activity index which is able to express PA continuously as well as to categorize participants according to their PA level. In populations with increasing rates of non-working people the performance of the IPAI is better than the established indices used in EPIC.

Predictors of participation in preventive health examinations in Austria

Background

Preventive health check-ups in Austria are offered free of charge to all insured adults (98% of the population) and focus on early detection of chronic diseases, primary prevention, and health counseling. The study aims to explore predictors of compliance with the recommended interval of preventive health check-up performance.

Methods

Source of data was the Austrian Health Interview Survey 2006/07 (15,474 subjects). Participation in a preventive health examination during the last three years was used as dependent variable. Socio-demographic and health-related characteristics were used as independent variables in a multivariate logistic regression analysis.

Results

Results show that 41.6% of men and 41.8% of women had attended a preventive health check-up within the last three years. In multivariate analysis, subjects ≥40 years, with higher education, higher income or born in Austria were significantly more likely to attend a preventive health check-up. Furthermore, a chronic disease was associated with a higher attendance rate (OR: 1.21; CI: 1.07-1.36 in men; OR: 1.19; CI: 1.06-1.33 in women).

Conclusions

Attendance rates for health check-ups in the general Austrian population are comparatively high but not equally distributed among subgroups. Health check-ups must increase among people at a young age, with a lower socio-economic status, migration background and in good health.