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Irankhah K, Asadimehr S, Kiani B, Jamali J, Rezvani R, Sobhani SR. Investigating the role of the built environment, socio-economic status, and lifestyle factors in the prevalence of chronic diseases in Mashhad: PLS-SEM model. Front Public Health 2024; 12:1358423. [PMID: 38813428 PMCID: PMC11133713 DOI: 10.3389/fpubh.2024.1358423] [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: 12/19/2023] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Background Chronic diseases remain a significant contributor to both mortality and disability in our modern world. Physical inactivity and an unhealthy diet are recognized as significant behavioral risk factors for chronic diseases, which can be influenced by the built environment and socio-economic status (SES). This study aims to investigate the relationship between the built environment, SES, and lifestyle factors with chronic diseases. Methods The current study was conducted in Mashhad's Persian cohort, which included employees from Mashhad University of Medical Sciences (MUMS). In the study, 5,357 participants from the cohort were included. To assess the state of the built environment in Mashhad, a Geographic Information System (GIS) map was created for the city and participants in the Persian Mashhad study. Food intake and physical exercise were used to assess lifestyle. A food frequency questionnaire (FFQ) was used to assess food intake. To assess food intake, the diet quality index was computed. To assess the link between variables, the structural model was created in accordance with the study's objectives, and partial least square structural equation modeling (PLS-SEM) was utilized. Results The chronic diseases were positively associated with male sex (p < 0.001), married (p < 0.001), and higher age (p < 0.001). The chronic diseases were negatively associated with larger family size (p < 0.05), higher SES (p < 0.001), and higher diet quality index (DQI) (p < 0.001). No significant relationship was found between chronic disease and physical activity. Conclusion Food intake and socioeconomic status have a direct impact on the prevalence of chronic diseases. It seems that in order to reduce the prevalence of chronic diseases, increasing economic access, reducing the class gap and increasing literacy and awareness should be emphasized, and in the next step, emphasis should be placed on the built environment.
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Affiliation(s)
- Kiyavash Irankhah
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Asadimehr
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Kiani
- UQ Center for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Jamshid Jamali
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Biostatistics, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Rezvani
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyed Reza Sobhani
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Adeniji FIP, Obembe TA. Cardiovascular Disease and Its Implication for Higher Catastrophic Health Expenditures Among Households in Sub-Saharan Africa. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:59-67. [PMID: 36945240 PMCID: PMC10024946 DOI: 10.36469/001c.70252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Background: Cardiovascular diseases (CVDs) impose an enormous and growing economic burden on households in sub-Saharan Africa (SSA). Like many chronic health conditions, CVD predisposes families to catastrophic health expenditure (CHE), especially in SSA due to the low health insurance coverage. This study assessed the impact of CVD on the risks of incurring higher CHE among households in Ghana and South Africa. Methods: The World Health Organization (WHO) Study on Global AGEing and Adult Health (WHO SAGE), Wave 1, implemented 2007-2010, was utilized. Following standard procedure, CHE was defined as the health expenditure above 5%, 10%, and 25% of total household expenditure. Similarly, a 40% threshold was applied to household total nonfood expenditure, also referred to as the capacity to pay. To compare the difference in mean CHE by household CVD status and the predictors of CHE, Student's t-test and logistic regression were utilized. Results: The share of medical expenditure in total household spending was higher among households with CVD in Ghana and South Africa. Households with CVD were more likely to experience greater CHE across all the thresholds in Ghana. Households who reported having CVD were twice as likely to incur CHE at 5% threshold (odds ratio [OR], 1.946; confidence interval [CI], 0.965-1.095), 3 times as likely at 10% threshold (OR, 2.710; CI, 1.401-5.239), and 4 times more likely to experience CHE at both 25% and 40% thresholds, (OR, 3.696; CI, 0.956-14.286) and (OR, 4.107; CI, 1.908-8.841), respectively. In South Africa, households with CVD experienced higher CHE across all the thresholds examined compared with households without CVDs. However, only household CVD status, household health insurance status, and the presence of other disease conditions apart from CVD were associated with incurring CHE. Households who reported having CVD were 3 times more likely to incur CHE compared with households without CVD (OR, 3.002; CI, 1.013-8.902). Conclusions: Our findings suggest that CVD predisposed households to risk of higher CHE. Equity in health financing presupposes that access to health insurance should be predicated on individual health needs. Thus, targeting and prioritizing the health needs of individuals with regard to healthcare financing interventions in SSA is needed.
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Affiliation(s)
- Folashayo Ikenna Peter Adeniji
- Department of Health Policy & Management, Faculty of Public Health, College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Taiwo Akinyode Obembe
- Department of Health Policy & Management, Faculty of Public Health, College of Medicine University of Ibadan, Ibadan, Nigeria
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Dang J, Ma N, Liu Y, Zhong P, Shi D, Cai S, Dong Y, Zou Z, Ma Y, Song Y, Ma J. The independent and combined effects of single-child status and ideal lifestyle on clustered cardio-metabolic risk factors among Chinese children and adolescents. Front Nutr 2022; 9:987334. [PMID: 36105575 PMCID: PMC9464906 DOI: 10.3389/fnut.2022.987334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCardio-metabolic risk factors (CMRFs) represent the accumulation of metabolic abnormalities, significantly increasing the likelihood of cardiovascular diseases. Although studies assessed the independent association of single-child status and lifestyle risk factors with components of CMRFs or clustered CMRFs, little has been known about the combined effect of single-child status and lifestyles on clustered CMRFs as well as sex differences.Materials and methodsData was collected from a cross-sectional survey conducted in September 2013 in China. A total of 13,859 children and adolescents aged 7–18 years with blood samples were included. Anthropometric measurements and serum biochemical indexes were collected to assess clustered CMRFs, while questionnaires were used to obtain single-child status, lifestyle information, and characteristics of children and their parents. Mixed effect logistic regression was applied to analyze the independent and the combined effects of single-child status and ideal lifestyle category on clustered CMRFs.ResultsThe prevalence of clustered CMRFs was 3.4%, with a higher prevalence in boys (4.0%) than girls (2.7%). Children and adolescents with clustered CMRFs had a higher proportion of single children (76.6 vs. 69.7%) and unfavorable lifestyles (62.1 vs. 29.2%) compared with their peers with non-clustered CMRFs. Both single children (OR = 1.67, 95% CI: 1.32–2.11) and unfavorable lifestyles (OR = 9.03, 95% CI: 6.26–13.02) were associated with an increased risk of clustered CMRFs. The risk of clustered CMRFs increased significantly (OR = 12.79, 95% CI: 6.67–24.52) when single children and an unfavorable lifestyle were combined, which was almost neutralized (OR = 1.33, 95% CI: 0.63–2.82) when single children adhered to a favorable lifestyle. However, no sex differences were observed in this study.ConclusionSingle children with unfavorable lifestyles were associated with an obvious risk of clustered CMRFs, which might be partially offset by expanding family size (the number of siblings) or establishing a favorable lifestyle. A birth-friendly social environment as well as a family environment with a favorable lifestyle are encouraged in China.
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Affiliation(s)
- Jiajia Dang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Ning Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Yunfei Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Panliang Zhong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Di Shi
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Shan Cai
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- *Correspondence: Yi Song,
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Jun Ma,
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Cham B, Scholes S, Groce NE, Badjie O, Mindell JS. High level of co-occurrence of risk factors for non-communicable diseases among Gambian adults: A national population-based health examination survey. Prev Med 2020; 141:106300. [PMID: 33121964 DOI: 10.1016/j.ypmed.2020.106300] [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] [Received: 12/12/2019] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality globally. Co-occurrence of risk factors predisposes an individual to NCDs; the burden increases cumulatively with the number of risk factors. Our study aimed to examine the co-occurrence of NCD risk factors among adults in The Gambia. This study is based on a random nationally representative sample of 4111 adults aged 25-64 years (78% response rate) with data collected between January and March 2010 in The Gambia using the WHO STEPwise survey methods. We restricted our analysis to non-pregnant participants with valid information on five NCD risk factors: high blood pressure, smoking, obesity, low fruit and vegetable consumption, and physical inactivity (n = 3000 adults with complete data on all risk factors). We conducted age-adjusted and fully-adjusted gender stratified multinomial logistic regression analysis to identify factors associated with the number of NCD risk factors. More than 90% of adults had at least one risk factor. Only 7% (95% CI: 5.2-9.8) had no risk factor; 22% (95% CI: 19.1-24.9) had at least three. Older age and ethnicity were significantly associated with having three or more risk factors (versus none) among men in the fully adjusted model. Lower education, older age, and urban residence were significantly associated with three or more risk factors (versus none) among women. The burden of NCDs is expected to increase in The Gambia if preventive and control measures are not taken. There should be an integrated approach targeting all risk factors, including wider treatment and control of hypertension.
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Affiliation(s)
- Bai Cham
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom; Department of Public Health, University of The Gambia, Brikama Campus, P.O.Box, 3530, Serrekunda, The Gambia; Disease Control and Elimination theme, Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, P.O.Box 273, Banjul, The Gambia.
| | - Shaun Scholes
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom
| | - Nora E Groce
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom
| | - Omar Badjie
- Non-Communicable Diseases Unit, Ministry of Health, Banjul, The Gambia
| | - Jennifer S Mindell
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom
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Self-Reported Changes in Risk Behaviours of Cardiovascular Diseases among School Adolescents in Nepal: Application of an Integrated Experiential Learning Approach. Glob Heart 2020; 15:40. [PMID: 32923334 PMCID: PMC7413148 DOI: 10.5334/gh.818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular diseases (CVDs) account for the largest proportion of all deaths in Nepal (30%). Studies report that CVDs often begin with modifiable lifestyle risk behaviours established during adolescence which manifest later. This study aimed to measure changes in the five mortality-associated CVD risk behaviours (i.e., consumption of tobacco, alcohol, and junk food, physical inactivity, and stress among school adolescents) using an integrative intervention with the experiential learning approach. The study was carried out for 24 weeks (25 credit hours) among 4,225 students from grades 8 to 10 in community schools in seven provinces in Nepal. Pre- and post-intervention in-class self-reported surveys were conducted for assessing change in the students’ aggregate risk behaviours. These percent changes were assessed through bivariate analysis. Key-informant interviews of teachers were conducted to assess their perceptions of the effectiveness of the intervention. At 24 weeks, the percentages of students reporting consumption of cigarettes and smokeless tobacco declined by 25% and 28% respectively, consumption of alcohol declined by 29%, consumption of instant noodles by 11%, and consumption of coke by 43%. The proportion of students reporting ‘going to school by foot every day’ increased by 11%, and those ‘exercising until they sweat’ increased by 29%. The percentage of students who reported feeling that their ‘life has been running as desired’ increased by 16%. Key-informant interviews of the teachers revealed that the intervention had contributed to improved motivation, knowledge, and attitude among students towards mitigating the risk behaviours. These interviews also recommended continuation of the intervention. The sample in this study has shown positive changes in school adolescents’ self-reported aggregate CVD risk behaviours using the experiential learning approach. However, further research should be conducted to explore the sustainability and scaling of these learning modules through the existing non-communicable disease (NCD) school curriculum activities in Nepal.
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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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Patterson KAE, Ferrar K, Gall SL, Venn AJ, Blizzard L, Dwyer T, Cleland VJ. Cluster patterns of behavioural risk factors among children: Longitudinal associations with adult cardio-metabolic risk factors. Prev Med 2020; 130:105861. [PMID: 31654729 DOI: 10.1016/j.ypmed.2019.105861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 09/19/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
Much of what is known about childhood clusters of cardiovascular disease behavioural risk factors (RFs) comes from cross-sectional studies, providing little insight into the long-term health impacts of different behavioural cluster profiles. This study aimed to establish the longitudinal relationship between cluster patterns of childhood behavioural RFs and adult cardio-metabolic RFs. Data were from an Australian prospective cohort study of 1265 participants measured in 1985 (ages 9-15 yrs), and in 2004-06 (ages 26-36 yrs). At baseline, children self-reported smoking status, alcohol consumption, physical activity (PA), dietary behaviour and psychological well-being. At follow-up, participants completed questionnaires and attended study clinics where the following component indicators of the metabolic syndrome (MetS) score were measured: waist circumference, blood pressure, fasting blood glucose and lipids. TwoStep cluster analyses were carried out to identify clusters in childhood. Linear regression was used to examine the longitudinal associations between cluster patterns of childhood behavioural RFs and adult cardio-metabolic RFs. Four childhood cluster patterns of behavioural RFs labelled 'most healthy', 'high PA', 'most unhealthy', and 'breakfast skippers' were identified. The unhealthier childhood clusters predicted a significantly higher adult MetS score ('most unhealthy': β = 0.10, 95%CI = 0.01, 0.19) and adult waist circumference ('most unhealthy': β = 2.29, 95%CI = 0.90, 6.67; 'breakfast skippers': β = 2.15, 95%CI = 0.30, 4.00). These associations were independent of adult behavioural RFs and socio-economic position. These findings emphasise the impact of multiple childhood behavioural RFs on important adult health outcomes and may be useful for the development of early intervention strategies, where identification of children at higher risk of poorer adult cardio-metabolic health is vital.
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Affiliation(s)
- Kira A E Patterson
- School of Education, University of Tasmania, Launceston, Tasmania, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Katia Ferrar
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; The George Institute for Global Health, University of Oxford, Wellington Square, Oxford, United Kingdom.
| | - Verity J Cleland
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
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Paudel R, Lee K, Singh JK, Yoo SJ, Acharya D, Kadel R, Adhikari S, Paudel M, Mahotra N. Prevalence of behavioral risk factors of cardiovascular diseases and associated socio-economic factors among pregnant women in a rural area in Southern Nepal. BMC Pregnancy Childbirth 2018; 18:484. [PMID: 30526512 PMCID: PMC6286585 DOI: 10.1186/s12884-018-2122-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) have dramatically infiltrated populations living in abject poverty in Low- and Middle-income Countries (LMICs), and poor maternal and child health outcomes have been frequently reported for those with CVD risk factors. However, few studies have explored the behavioral risk factors of CVDs among pregnant women in rural settings. This study aimed at determining the prevalence and identifying the socio-economic predictors of behavioral risk factors of CVDs among pregnant women in rural area in Southern Nepal. METHODS A Community-based cross-sectional study was conducted in 52 clusters of Dhanusha District of Nepal in a total of 426 pregnant women in their second trimester using multistage cluster sampling method. Multivariable logistic regression model was used to assess independent associations between behavioral risk factors during pregnancy and maternal socio-economic characteristics. RESULTS Of the 426 study participants, 86.9, 53.9, 21.3 and 13.3%, respectively, reported insufficient fruits and vegetables consumption, insufficient physical activity, tobacco use, and harmful alcohol drinking. Socio-economic factors significantly associated with more than one behavioral risk factors in expectant mothers with a primary level education (adjusted odds ratio (AOR) 2.78; 95% Confidence Interval (CI) (1.35-5.72)), 20-34 years age group (Adjusted Odds Ratio (AOR) 0.27; 95% CI (0.13-0.56)), and those with the highest wealth index (AOR 0.36; 95% CI (0.16-0.84)). CONCLUSION Higher prevalence of behavioral risk factors for CVDs and their socio-economic factors prevailing among pregnant women living in rural Nepal call for immediate health promotion interventions such as community awareness and appropriate antenatal counseling.
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Affiliation(s)
- Rajan Paudel
- Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Kwan Lee
- Department of Preventive Medicine, College of Medicine, Dongguk University, 123 Dongdae-ro, Gyeongju-si, 38066 Republic of Korea
| | - Jitendra Kumar Singh
- Department of Community Medicine and Public Health, Janaki Medical College, Tribhuvan University, Janakpur, Nepal
| | - Seok-Ju Yoo
- Department of Preventive Medicine, College of Medicine, Dongguk University, 123 Dongdae-ro, Gyeongju-si, 38066 Republic of Korea
| | - Dilaram Acharya
- Department of Preventive Medicine, College of Medicine, Dongguk University, 123 Dongdae-ro, Gyeongju-si, 38066 Republic of Korea
- Department of Community Medicine, Kathmandu University, Devdaha Medical College and Research Institute, Rupandehi, Nepal
| | - Rajendra Kadel
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Samaj Adhikari
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Mohan Paudel
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Narayan Mahotra
- Department of Physiology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Kilpatrick M, Blizzard L, Sanderson K, Teale B, Jose K, Venn A. Barriers and facilitators to participation in workplace health promotion (WHP) activities: results from a cross-sectional survey of public-sector employees in Tasmania, Australia. Health Promot J Austr 2017; 28:225-232. [DOI: 10.1071/he16052] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/11/2016] [Indexed: 11/23/2022] Open
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Wesonga R, Guwatudde D, Bahendeka SK, Mutungi G, Nabugoomu F, Muwonge J. Burden of cumulative risk factors associated with non-communicable diseases among adults in Uganda: evidence from a national baseline survey. Int J Equity Health 2016; 15:195. [PMID: 27905949 PMCID: PMC5133748 DOI: 10.1186/s12939-016-0486-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/25/2016] [Indexed: 12/20/2022] Open
Abstract
Background Modification of known risk factors has been the most tested strategy for dealing with non-communicable diseases (NCDs). The cumulative number of NCD risk factors exhibited by an individual depicts a disease burden. However, understanding the risk factors associated with increased NCD burden has been constrained by scarcity of nationally representative data, especially in the developing countries and not well explored in the developed countries as well. Methods Assessment of key risk factors for NCDs using population data drawn from 3987 participants in a nationally representative baseline survey in Uganda was made. Five key risk factors considered for the indicator variable included: high frequency of tobacco smoking, less than five servings of fruit and vegetables per day, low physical activity levels, high body mass index and raised blood pressure. We developed a composite indicator dependent variable with counts of number of risk factors associated with NCDs per participant. A statistical modeling framework was developed and a multinomial logistic regression model was fitted. The endogenous and exogenous predictors of NCD cumulative risk factors were assessed. Results A novel model framework for cumulative number of NCD risk factors was developed. Most respondents, 38 · 6% exhibited one or two NCD risk factors each. Of the total sample, 56 · 4% had at least two risk factors whereas only 5.3% showed no risk factor at all. Body mass index, systolic blood pressure, diastolic blood pressure, consumption of fruit and vegetables, age, region, residence, type of residence and land tenure system were statistically significant predictors of number of NCD risk factors (p < 0 · 05). With exception to diastolic blood pressure, increase in age, body mass index, systolic blood pressure and reduction in daily fruit and vegetable servings were found to significantly increase the relative risks of exhibiting cumulative NCD risk factors. Compared to the urban residence status, the relative risk of living in a rural area significantly increased the risk of having 1 or 2 risk factors by a multiple of 1.55. Conclusions The non-communicable disease burden is on the increase, with more participants reporting to have at least two risk factors. Our findings imply that, besides endogenous factors, exogenous factors such as region, residence status, land tenure system and behavioral characteristics have significant causal effects on the cumulative NCD risk factors. Subsequently, while developing interventions to combat cumulative risk factors of NCDs, the Ministry of Health needs to employ a more holistic approach to facilitate equitable health and sensitization across age, residence and regional divide.
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Affiliation(s)
- Ronald Wesonga
- School of Statistics and Planning, Makerere University, Kampala, Uganda. .,East African Statistics Institute, Kampala, East Africa, Uganda.
| | - David Guwatudde
- School of Public Health, Makerere University, Kampala, Uganda
| | - Silver K Bahendeka
- Department of Internal Medicine St. Francis Hospital Nsambya, Kampala, Uganda
| | - Gerald Mutungi
- Control of Non-communicable Diseases Desk, Ministry of Health, Kampala, Uganda
| | - Fabian Nabugoomu
- Office of DVC, Kyambogo University, Kampala, Uganda.,East African Statistics Institute, Kampala, East Africa, Uganda
| | - James Muwonge
- Division of Socioeconomic Surveys, Uganda Bureau of Statistics, Kampala, Uganda
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Multiple health behaviours among mothers and partners in England: Clustering, social patterning and intra-couple concordance. SSM Popul Health 2016; 2:824-833. [PMID: 28018962 PMCID: PMC5165044 DOI: 10.1016/j.ssmph.2016.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/08/2016] [Accepted: 10/20/2016] [Indexed: 01/01/2023] Open
Abstract
Research on multiple health behaviours is increasing but little is known about parental behaviours and how they covary. Our study investigates cigarette smoking, alcohol intake, fruit and vegetable (F&V) consumption and physical activity among mothers and co-resident partners in England. Using the UK Household Longitudinal Study, we examined (i) clustering of health behaviours using observed-expected ratios and latent class analysis (ii) socio-demographic correlates of the derived latent classes and (iii) intra-couple concordance of individual health behaviours and their latent classes. We identified five latent classes for mothers and partners: Never smoked drinkers (28% of mothers; 29% of partners), Abstainers (25%; 17%), Drinkers and ex-smokers (19%; 26%), Unhealthy low frequency drinkers (18%; 16%) and Unhealthiest behaviour group (11%; 12%). These had distinctive social profiles. Never smoked drinkers were more likely than those in other groups to be white and socially advantaged: married, older, and with higher educational qualifications and incomes. Abstainers were non-smokers who never or occasionally drank, and were disproportionately drawn from ethnic minority groups and middle/lower income families. Drinkers and ex-smokers were the most physically active group and were more likely to be socially advantaged. Unhealthy low frequency drinkers were more likely to be disadvantaged and have a limiting long-standing illness. The Unhealthiest behaviour group had the highest proportion of smokers, heavy smokers and binge drinkers and the lowest F&V intake and physical activity levels. They were largely white and socially disadvantaged: younger, non-married and with lower educational levels. Mothers and their partners typically shared the same risk behaviours, and 44 per cent of partners and mothers belonged to the same latent class. Our findings point to the potential for a broadening of research and policy perspectives, from separate behaviours to combinations of behaviours, and from individuals to the domestic units and communities of which they are part.
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Siren R, Eriksson JG, Vanhanen H. Observed changes in cardiovascular risk factors among high-risk middle-aged men who received lifestyle counselling: a 5-year follow-up. Scand J Prim Health Care 2016; 34:336-342. [PMID: 27822969 PMCID: PMC5217283 DOI: 10.1080/02813432.2016.1248649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the long-term impact of health counselling among middle-aged men at high risk of CVD. DESIGN An observational study with a 5-year follow-up. SETTING AND INTERVENTION All men aged 40 years in Helsinki have been invited to a visit to evaluate CVD risk from 2006 onwards. A modified version of the North Karelia project risk tool (CVD risk score) served to assess the risk. High-risk men received lifestyle counselling based on their individual risk profile in 2006 and were invited to a follow-up visit in 2011. SUBJECTS Of the 389 originally high-risk men, 159 participated in the follow-up visits in 2011. Based on their follow-up in relation the further risk communication, we divided the participants into three groups: primary health care, occupational health care and no control visits. MAIN OUTCOME MEASURES Lifestyle and CVD risk score change. RESULTS All groups showed improvements in lifestyles. The CVD risk score decreased the most in the group that continued the risk communication visits in their primary health care centre (6.1 to 4.8 [95% CI -1.6 to -0.6]) compared to those who continued risk communication visits in their occupational health care (6.0 to 5.4 [95% CI -1.3 to 0.3]), and to those with no risk communication visits (6.0 to 5.9 [95% CI -0.5 to 0.4]). CONCLUSIONS These findings indicate that individualized lifestyle counselling improves health behaviour and reduces total CVD risk among middle-aged men at high risk of CVD. Sustained improvement in risk factor status requires ongoing risk communication with health care providers. KEY POINTS Studies of short duration have shown that lifestyle changes reduce the risk of cardiovascular disease among high-risk individuals. Sustaining these lifestyle changes and maintaining the lower disease risk attained can prove challenging. Cardiovascular disease (CVD) risk assessment and individualized health counselling for high-risk men, when implemented in primary health care, have the potential to initiate lifestyle changes that support risk reduction. Attaining a sustainable reduction in CVD risk requires a willingness to engage in risk-related communication from both health care providers and the individual at high risk.
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Affiliation(s)
- Reijo Siren
- Health Centre of the City of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- CONTACT Reijo Siren Department of General Practice and Primary Health Care, University of Helsinki, P.O. BOX 20, 00014 Helsinki, Finland
| | - Johan G. Eriksson
- National Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhalsan Research Centre, Helsinki, Finland
| | - Hannu Vanhanen
- The Social Insurance Institution of Finland (KELA), Helsinki, Finland
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Roda C, Charreire H, Feuillet T, Mackenbach JD, Compernolle S, Glonti K, Bárdos H, Rutter H, McKee M, Brug J, De Bourdeaudhuij I, Lakerveld J, Oppert JM. Lifestyle correlates of overweight in adults: a hierarchical approach (the SPOTLIGHT project). Int J Behav Nutr Phys Act 2016; 13:114. [PMID: 27809926 PMCID: PMC5095987 DOI: 10.1186/s12966-016-0439-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/19/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Obesity-related lifestyle behaviors usually co-exist but few studies have examined their simultaneous relation with body weight. This study aimed to identify the hierarchy of lifestyle-related behaviors associated with being overweight in adults, and to examine subgroups so identified. METHODS Data were obtained from a cross-sectional survey conducted across 60 urban neighborhoods in 5 European urban regions between February and September 2014. Data on socio-demographics, physical activity, sedentary behaviors, eating habits, smoking, alcohol consumption, and sleep duration were collected by questionnaire. Participants also reported their weight and height. A recursive partitioning tree approach (CART) was applied to identify both main correlates of overweight and lifestyle subgroups. RESULTS In 5295 adults, mean (SD) body mass index (BMI) was 25.2 (4.5) kg/m2, and 46.0 % were overweight (BMI ≥25 kg/m2). CART analysis showed that among all lifestyle-related behaviors examined, the first identified correlate was sitting time while watching television, followed by smoking status. Different combinations of lifestyle-related behaviors (prolonged daily television viewing, former smoking, short sleep, lower vegetable consumption, and lower physical activity) were associated with a higher likelihood of being overweight, revealing 10 subgroups. Members of four subgroups with overweight prevalence >50 % were mainly males, older adults, with lower education, and living in greener neighborhoods with low residential density. CONCLUSION Sedentary behavior while watching television was identified as the most important correlate of being overweight. Delineating the hierarchy of correlates provides a better understanding of lifestyle-related behavior combinations which may assist in targeting preventative strategies aimed at tackling obesity.
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Affiliation(s)
- Célina Roda
- Équipe de Recherche en Épidémiologie Nutritionnelle (EREN), Université Paris 13, Centre de Recherche en Épidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny, F-93017 France
| | - Hélène Charreire
- Équipe de Recherche en Épidémiologie Nutritionnelle (EREN), Université Paris 13, Centre de Recherche en Épidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny, F-93017 France
- Université Paris-Est, Lab-Urba, Créteil, France
| | - Thierry Feuillet
- Équipe de Recherche en Épidémiologie Nutritionnelle (EREN), Université Paris 13, Centre de Recherche en Épidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny, F-93017 France
| | - Joreintje D. Mackenbach
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Sofie Compernolle
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ketevan Glonti
- ECOHOST – The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - Helga Bárdos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Harry Rutter
- ECOHOST – The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- ECOHOST – The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jean-Michel Oppert
- Équipe de Recherche en Épidémiologie Nutritionnelle (EREN), Université Paris 13, Centre de Recherche en Épidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny, F-93017 France
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 06, Institute of Cardiometabolism and Nutrition, Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Lohse T, Faeh D, Bopp M, Rohrmann S. Adherence to the cancer prevention recommendations of the World Cancer Research Fund/American Institute for Cancer Research and mortality: a census-linked cohort. Am J Clin Nutr 2016; 104:678-85. [PMID: 27488239 DOI: 10.3945/ajcn.116.135020] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/23/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Modifiable lifestyle factors linked to cancer offer great potential for prevention. Previous studies suggest an association between adherence to recommendations on healthy lifestyle and cancer mortality. OBJECTIVES The aim of this study was to examine whether adherence to the cancer prevention recommendations of the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) is associated with reduced all-cause, total cancer, and specific cancer type mortality. DESIGN We built a lifestyle score that included 3 categories, based on the recommendations of the WCRF/AICR. Applying Cox regression models, we investigated the association with all-cause, total cancer, and specific cancer type mortality; in addition, we included cardiovascular disease (CVD) mortality. We used census- and death registry-linked survey data allowing a mortality follow-up for ≤32 y. Our analysis included 16,722 participants. Information on lifestyle score components and confounders was collected at baseline. RESULTS Over a mean follow-up of 21.7 y, 3730 deaths were observed (1332 cancer deaths). Comparing best with poorest category of the lifestyle score showed an inverse association with all-cause (HR: 0.82; 95% CI: 0.75, 0.89) and total cancer (men only, HR: 0.69; 95% CI: 0.57, 0.84) mortality. We estimated that ∼13% of premature cancer deaths in men would have been preventable if lifestyle score levels had been high. Inverse associations were observed for lung, upper aerodigestive tract, stomach, and prostate cancer mortality [men and women combined, HR: 0.72; 95% CI: 0.51, 0.99; HR: 0.49; 95% CI: 0.26, 0.92; HR: 0.34; 95% CI: 0.14, 0.83; HR: 0.48; 95% CI: 0.28, 0.82 (men only), respectively]. CVD mortality was not associated with the lifestyle score (men and women combined, HR: 0.96; 95% CI: 0.82, 1.13). CONCLUSIONS Our results support the importance of adhering to recommendations for a healthy lifestyle with regard to all-cause and cancer mortality. To reduce the burden of cancer in the population, preventive measures should stress the potential of low-risk health behavior patterns rather than of specific risk factors only.
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Affiliation(s)
- Tina Lohse
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and
| | - David Faeh
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and Health Division-Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland
| | - Matthias Bopp
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and
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de Winter AF, Visser L, Verhulst FC, Vollebergh WAM, Reijneveld SA. Longitudinal patterns and predictors of multiple health risk behaviors among adolescents: The TRAILS study. Prev Med 2016; 84:76-82. [PMID: 26656404 DOI: 10.1016/j.ypmed.2015.11.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/25/2015] [Accepted: 11/28/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants. PURPOSE To examine the prevalence, longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents. METHODS Eight health risk behaviors (no regular consumption of fruit, vegetables or breakfast, overweight or obesity, physical inactivity, smoking, alcohol use and cannabis use) were assessed in a prospective population study (second and third wave). Participants were assessed in three waves between ages 10 and 17 (2001-2008; n=2230). Multiple linear regression was used to assess the influence of gender, self-control, parental health risk behaviors, parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors (analysis: 2013-2014). RESULTS Rates of >5 health risk behaviors were high: 3.6% at age 13.5 and 10.2% at age 16. Smoking at age 13.5 was frequently associated with health risk behaviors at age 16. No regular consumption of fruit, vegetables and breakfast, overweight or obesity, physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up. Significant predictors of the development of multiple health risk behaviors were adolescents' levels of self-control, socioeconomic status and maternal smoking. CONCLUSIONS Multiple health risk behaviors are common among adolescents. Individual and social factors predict changes in multiple health risk behaviors, showing that prevention targeting multiple risk behaviors is needed. Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes.
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Affiliation(s)
- Andrea F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, the Netherlands.
| | - Leenke Visser
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, the Netherlands; School for Marketing Management, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, the Netherlands
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Lohse T, Rohrmann S, Bopp M, Faeh D. Heavy Smoking Is More Strongly Associated with General Unhealthy Lifestyle than Obesity and Underweight. PLoS One 2016; 11:e0148563. [PMID: 26910775 PMCID: PMC4765891 DOI: 10.1371/journal.pone.0148563] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 01/19/2016] [Indexed: 12/25/2022] Open
Abstract
Background Smoking and obesity are major causes of non-communicable diseases. We investigated the associations of heavy smoking, obesity, and underweight with general lifestyle to infer which of these risk groups has the most unfavourable lifestyle. Methods We used data from the population-based cross-sectional Swiss Health Survey (5 rounds 1992–2012), comprising 85,575 individuals aged≥18 years. Height, weight, smoking, diet, alcohol intake and physical activity were self-reported. Multinomial logistic regression was performed to analyse differences in lifestyle between the combinations of body mass index (BMI) category and smoking status. Results Compared to normal-weight never smokers (reference), individuals who were normal-weight, obese, or underweight and smoked heavily at the same time had a poorer general lifestyle. The lifestyle of obese and underweight never smokers differed less from reference. Regardless of BMI category, in heavy smoking men and women the fruit and vegetable consumption was lower (e.g. obese heavy smoking men: relative risk ratio (RRR) 1.69 [95% confidence interval 1.30;2.21]) and high alcohol intake was more common (e.g. normal-weight heavy smoking women 5.51 [3.71;8.20]). In both sexes, physical inactivity was observed more often in heavy smokers and obese or underweight (e.g. underweight never smoking 1.29 [1.08;1.54] and heavy smoking women 2.02 [1.33;3.08]). A decrease of smoking prevalence was observed over time in normal-weight, but not in obese individuals. Conclusions Unhealthy general lifestyle was associated with both heavy smoking and BMI extremes, but we observed a stronger association for heavy smoking. Future smoking prevention measures should pay attention to improvement of general lifestyle and co-occurrence with obesity and underweight.
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Affiliation(s)
- Tina Lohse
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- * E-mail:
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Matthias Bopp
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - David Faeh
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
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Clustering of lifestyle characteristics and their association with cardio-metabolic health: the Lifestyles and Endothelial Dysfunction (EVIDENT) study. Br J Nutr 2015; 114:943-51. [DOI: 10.1017/s0007114515002500] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractLittle is known about the clustering patterns of lifestyle behaviours in adult populations. We explored clusters in multiple lifestyle behaviours including physical activity (PA), smoking, alcohol use and eating habits in a sample of adult population. A cross-sectional and multi-centre study was performed with six participating groups distributed throughout Spain. Participants (n 1327) were part of the Lifestyles and Endothelial Dysfunction (EVIDENT) study and were aged between 20 and 80 years. The lifestyle and cardiovascular risk (CVR) factors were analysed using a clustering method based on the HJ-biplot coordinates to understand the variables underlying these groupings. The following three clusters were identified. Cluster 1: unhealthy, 677 subjects (51 %), with a slight majority of men (58·7 %), who were more sedentary and smokers with higher consumption of whole-fat dairy products, bigger waist circumference as well as higher TAG levels, systolic blood pressure (SBP) and CVR. Cluster 2: healthy/PA, 265 subjects (20 %), including 24·0 % of males with high PA. Cluster 3: healthy/diet, including 29 % of the participants, with a higher consumption of olive oil, fish, fruits, nuts, vegetables and lower alcohol consumption. Using the unhealthy cluster as a reference, and after adjusting for age and sex, the multiple regression analysis showed that belonging to the healthy/PA cluster was associated with a lower waist circumference, body fat percentage, SBP and CVR. In summary, the three clusters were identified according to lifestyles. The ‘unhealthy’ cluster had the least favourable clinical parameters, the ‘healthy/PA’ cluster had good HDL-cholesterol levels and low SBP and the ‘healthy/diet’ cluster had lower LDL-cholesterol levels and clinical blood pressure.
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Westergaard ML, Glümer C, Hansen EH, Jensen RH. Medication overuse, healthy lifestyle behaviour and stress in chronic headache: Results from a population-based representative survey. Cephalalgia 2015; 36:15-28. [DOI: 10.1177/0333102415578430] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/25/2015] [Indexed: 01/03/2023]
Abstract
Aim This cross-sectional study investigated associations between chronic headache (CH) with and without medication overuse, healthy lifestyle behaviour, and stress. Methods Questionnaires were sent to 129,150 adults. Those with headache ≥15 days per month for three months were classified as having CH then further described as having medication-overuse headache (MOH) or CH without medication overuse. Associations between headache and daily smoking, physical inactivity, obesity, excessive drinking, illicit drug use, and high stress were analysed by logistic regression. Results CH with and without medication overuse (prevalence 1.8% and 1.6%, respectively) had strong, graded associations with stress. Associations with daily smoking, physical inactivity, and obesity were significant only for MOH. Odds for MOH were highest among people who had all three factors compared to those who had none (OR 2.8 in women and 5.1 in men). High stress plus any of these three factors had synergistic effects in MOH but not clearly in those who had CH without overuse. Associations between CH subtypes and excessive drinking or illicit drug use were not statistically significant. Conclusion Results suggest strong links between healthy lifestyle behaviour and stress in MOH. Stress reduction and promoting healthy behaviour are highly relevant in MOH management.
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Affiliation(s)
- Maria Lurenda Westergaard
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
| | - Charlotte Glümer
- Research Center for Prevention and Health, Capital Region of Denmark, Denmark
- Department of Health Science and Technology, University of Aalborg, Denmark
| | | | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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