Health-related behaviours and their correlates in a general population sample of 45-year old women

A systematic review on the clustering and co-occurrence of multiple risk behaviours

BACKGROUND

Risk behaviours, such as smoking and physical inactivity account for up to two-thirds of all cardiovascular deaths, and are associated with substantial increased mortality in many conditions including cancer and diabetes. As risk behaviours are thought to co-occur in individuals we conducted a systematic review of studies addressing clustering or co-occurrence of risk behaviours and their predictors. As the main aim of the review was to inform public health policy in England we limited inclusion to studies conducted in the UK.

METHODS

Key databases were searched from 1990 to 2016. We included UK based cross-sectional and longitudinal studies that investigated risk behaviours such as smoking, physical inactivity, unhealthy diet. High heterogeneity precluded meta-analyses.

RESULTS

Thirty-seven studies were included in the review (32 cross-sectional and five longitudinal). Most studies investigated unhealthy diet, physical inactivity, alcohol misuse, and smoking. In general adult populations, there was relatively strong evidence of clustering between alcohol misuse and smoking; and unhealthy diet and smoking. For young adults, there was evidence of clustering between sexual risk behaviour and smoking, sexual risk behaviour and illicit drug use, and sexual risk behaviour and alcohol misuse. The strongest associations with co-occurrence and clustering of multiple risk behaviours were occupation (up to 4-fold increased odds in lower SES groups) and education (up to 5-fold increased odds in those with no qualifications).

CONCLUSIONS

Among general adult populations, alcohol misuse and smoking was the most commonly identified risk behaviour cluster. Among young adults, there was consistent evidence of clustering found between sexual risk behaviour and substance misuse. Socio-economic status was the strongest predictor of engaging in multiple risk behaviours. This suggests the potential for interventions targeting multiple risk behaviours either sequentially or concurrently particularly where there is evidence of clustering. In addition, there is potential for intervening at the social or environmental level due to the strong association with socio-economic status.

Predictors of intentions to use hormone replacement therapy in clinical postmenopausal women

OBJECTIVES

To investigate the contribution of components of the Health Beliefs Model (perceived susceptibility, perceived severity, health motivation, perceived risk and benefits of hormone replacement therapy (HRT) use), sociodemographic variables (age, duration of postmenopause, hysterectomy and social class) and psychological stress to intentions to use HRT for the first time.

METHODS

A quasi-experimental design was used to recruit a clinical sample of 180 postmenopausal women, attending a menopause clinic, with a mean age of 50.74 years (standard deviation 4.75 years). Data were collected using self-report questionnaires. A regression analysis was carried out to establish what predicts intentions to use HRT in this sample; sociodemographic variables were entered in the first step of the regression, followed by health motivation and perceived stress in step two, the third step involved the addition of perceived severity measures, and in the final step susceptibility and perceived risks and benefits were added.

RESULTS

The main predictor of intentions to use HRT, after controlling for all other variables, was the belief that the benefits outweigh the risks associated with taking HRT.

CONCLUSIONS

This information should be used to develop interventions and health awareness materials about HRT in clinical postmenopausal women.

The Women's international study of long-duration oestrogen after menopause (WISDOM): a randomised controlled trial

BACKGROUND

At the time of feasibility work and final design of the trial there was no randomised control trial evidence for the long-term risks and benefits of hormone replacement therapy. Observational studies had suggested that long term use of estrogen was likely to be associated, amongst other things, with reduced risks of osteoporosis and ischaemic heart disease and increased risks of breast and endometrial cancer. Concomitant use of progestogens had been shown to protect against endometrial cancer, but there were few data showing how progestogen might affect estrogen actions on other conditions. Disease specific risks from observational studies suggested that, overall, long-term HRT was likely to be beneficial. Several studies showed that mortality from all causes was lower in HRT users than in non-users. Some secondary cardiovascular prevention trials were ongoing but evidence was also required for a range of outcomes in healthy women. The WISDOM trial was designed to compare combined estrogen and progestogen versus placebo, and estrogen alone versus combined estrogen and progestogen. During the development of WISDOM the Women's Health Initiative trial was designed, funded and started in the US.

DESIGN

Randomised, placebo, controlled, trial.

METHODS

The trial was set in general practices in the UK (384), Australia (94), and New Zealand (24). In these practices 284175 women aged 50-69 years were registered with 226282 potentially eligible. We sought to randomise 22300 postmenopausal women aged 50 - 69 and treat for ten years. The interventions were: conjugated equine estrogens, 0.625 mg orally daily; conjugated equine estrogens plus medroxyprogesterone acetate 2.5/5.0 mg orally daily; matched placebo. Primary outcome measures were: major cardiovascular disease, osteoporotic fractures, breast cancer and dementia. Secondary outcomes were: other cancers, all cause death, venous thromboembolism and cerebro-vascular disease.

RESULTS

The trial was prematurely closed during recruitment following publication of early results from the Women's Health Initiative. At the time of closure, 56583 had been screened, 8980 entered run-in, and 5694 (26% of target of 22,300) randomised. Those women randomised had received a mean of one year of therapy, mean age was 62.8 years and total follow-up time was 6491 person years.

DISCUSSION

The WISDOM experience leads to some simple messages. The larger a trial is the more simple it needs to be to ensure cost effective and timely delivery. When a trial is very costly and beyond the resources of one country, funders and investigators should make every effort to develop international collaboration with joint funding.

Patient experiences of anxiety, depression and acute pain after surgery: a longitudinal perspective

This study sought to explore the impact of the psychological variables anxiety and depression, on pain experience over time following surgery. Eighty-five women having major gynaecological surgery were assessed for anxiety, depression and pain after surgery. To gain further understanding, 37 patients participated in a semi-structured taped telephone interview 4-6 weeks post-operatively. Pre-operative anxiety was found to be predictive of post-operative anxiety on Day 2, with patients who experienced high levels of anxiety before surgery continuing to feel anxious afterwards. By Day 4 both anxiety and depression scores increased as pain increased and one-third of the sample experienced levels of anxiety in psychiatric proportions whilst under one-third experienced similar levels of depression. These findings have significant implications for the provision of acute pain management after surgery. Future research and those managing acute pain services need to consider the multidimensional effect of acute pain and the interface between primary and secondary care.

After the Fall: Women's Views of Fractures in Relation to Bone Health at Midlife

Past research has established the link between low energy fractures and the risk for future fractures. These fractures are potential markers for investigation of bone health, and may be precursors for osteoporosis. In spite of its significant public health burden, including burden of illness and economic costs, many individuals are not aware of the risk factors for and consequences of osteoporosis. This is a study of women aged 40 and older who experienced low energy fractures (e.g., from non-trauma sources and falls from no higher than standing height). We gathered data, using focus group interviews, about their experiences and understanding of the fractures in relation to bone health. Women often attributed the fractures to particular situations and external events (e.g., slipping on ice, tripping on uneven ground), and viewed the fractures as accidents. Women often felt that others are at risk for poor bone health, but believed that they themselves are different from those really at risk. Although the fractures are potential triggers for preventive efforts, few women connected their fracture to future risk. What is perceived by women (and others) as random and an accident is often a predictable event if underlying risk factors are identified. Only when there is more awareness of poor bone health as a disease process and fractures as markers for bone fragility will women, men and health care providers take action to prevent future fractures and established bone disease.

Self-efficacy impacts self-care and HbA1c in young adults with Type I diabetes

OBJECTIVE

The present study examined self-efficacy and self-esteem as basic aspects of the self that influence self-care and physiological outcomes among young adults with Type I diabetes. The two aims of this study were 1) to examine the cross-sectional and longitudinal role of the self-variables as they predict self-care and HbA1c and 2) to test whether self-care mediates the association between the self variables and HbA1c using cross-sectional and longitudinal data.

METHODS

One hundred ten participants were recruited from a regional diabetes outpatient clinic. Inclusion criteria were age (18-35 years) and duration of diabetes (>1 year before recruitment). Participants were 61% female and 88% white. In addition, the sample had an average annual income between $24,999 and $34,999, and 85% had completed some or all of college. The average duration of diabetes was 15 years.

RESULTS

Using multiple regression analyses we found that, compared with self-esteem, self-efficacy was a better predictor of all aspects of self-care and HbA1c in cross-sectional analyses, in addition to diet and exercise self-care, and a better predictor of HbA1c in longitudinal analyses. The data also supported the cross-sectional and longitudinal mediational model in which better self-care helped account for the association between greater self-efficacy and better HbA1c.

CONCLUSIONS

Self-efficacy is an important factor for management of self-care practices and physiological outcomes among young adults with Type I diabetes, and self-care may be an important mechanism by which self-efficacy influences HbA1c levels.

'I'll worry about that when it comes along': osteoporosis, a meaningful issue for women at mid-life?

This paper reports findings from a qualitative study of the health concerns and perceptions of health risks and osteoporosis of women in the age group 40-55 years. Osteoporosis has been increasingly put forward in the popular and scientific press as an important issue for women in mid-life. A variety of preventive measures, including use of hormone replacement therapy (HRT), are suggested. The medicalization of women's experiences and associated use of HRT at this point in the life course is the subject of considerable debate in the medical, social scientific and feminist literatures, although, to date, this issue has received less attention in health promotion. Much of this debate is informed by quantitative and survey data, and there is a lack of in-depth qualitative information on women's own views. This study casts doubt on the salience of osteoporosis for women at mid-life. Our qualitative research suggests that, unless they had experiential knowledge which had rendered osteoporosis particularly salient, most women in this study evidenced a surprising degree of disinterest in this health issue. To make sense of this disinterest we examined women's wider accounts of their lives, health and the lifecourse, and the menopause. These findings would appear to present a challenge for those in health promotion who might wish to emphasize early preventive strategies for osteoporosis.

Life satisfaction and health-related quality of life (SF-36) of middle-aged men and women

OBJECTIVES

To investigate life satisfaction and health-related quality of life (SF-36) in a general population sample of middle-aged women and men. The effects of menopausal status and hormone replacement therapy (HRT) use upon life satisfaction and health-related quality of life (HrQOL) were also examined for the female sample.

DESIGN

All men and women aged 49-55 years from the age/sex register of a large general practice in London were contacted and asked to complete a questionnaire about their health.

SUBJECTS

A total of 103 women (55%) and 86 men (40%) participated; of the women, 15% were premenopausal, 68% peri- or postmenopausal and 17% taking HRT.

RESULTS

Women and men reported similar levels of HrQOL, life satisfaction and general health, although women reported more physical problems (SF-36). The significant predictors of HrQOL were serious illness, employment and marital status, but HRT use and menopausal status were not significantly associated with life satisfaction nor HrQOL (for women).

CONCLUSIONS

Gender differences in health and HrQOL may be less apparent during mid-life, although there were some subtle differences between men and women in reported health concerns and reasons given for (dis)satisfaction with their lives.

Preparation for menopause: prospective evaluation of a health education intervention for mid-aged women

Many women approach menopause with uncertainty about what will happen and how to deal with changes that occur. The current study aimed to evaluate the short-term outcome of a health education intervention devised to prepare 45-year old women in general practices. One hundred and seventy-eight 45-year old women registered at five general practices in south London were targeted for the research; 106 of the women responded and 86 of these women formed a usable pre-menopausal sample which was randomly allocated to the preparation intervention and control conditions. Preparation involved two health education sessions carried out in small groups and covering information and discussion of the normal menopause transition in the context of mid-life. The women completed pre- and post-intervention (3 and 15 months) questionnaires which assessed knowledge and beliefs about menopause and a number of health-related behaviours. Knowledge improved significantly at the follow-up assessments for the preparation group but not for the control group. On the whole, the prepared women's beliefs about menopause became less negative following the intervention, although there were also some changes reported by the control group. The proportion of smokers decreased from 25 to 20% for the prepared women although this did not reach statistical significance. There was no change in the prevalence of regular exercise. There was also a decrease in the intention to take hormonal treatments following the intervention. Suggestions for further development of health promotion services for mid-aged women and more holistic health care practices are proposed.