Cigarette smoking and alcohol consumption among Chinese older adults: do living arrangements matter?

Association between living arrangements and health risk behaviors among the Hakka older adults in Fujian, China

BACKGROUND

Behavioral lifestyles are important social determinants of health. The impact of changes in living arrangements on behavioral lifestyles is currently under-explored. This study aims to examine the association between living arrangements and health risk behaviors among the Hakka older adults.

METHODS

Data were extracted from China's Health-Related Quality of Life Survey for Older Adults 2018. Living arrangements were divided into five categories: living alone, living with spouse only, living with child, mixed habitation, and others. Five health risk behaviors, including unhealthy dietary patterns, drinking, smoking, irregular sleep practices, and physical inactivity were measured. Logistic regression analysis was used to assess the association between living arrangements and specific health risk behaviors, and generalized linear models were established to test the association between living arrangements and the number of health risk behaviors.

RESULTS

A total of 1,262 Hakka older adults were included in this study. Compared to those living alone, those living with spouse only were less likely to have unhealthy dietary patterns (OR = 0.45, P < 0.05) and drinking (OR = 0.50, P < 0.05), those living with the child were less likely to experience unhealthy dietary patterns (OR = 0.35, P < 0.001), drinking (OR = 0.32, P < 0.001), smoking (OR = 0.49, P < 0.05), and physical inactivity (OR = 0.13, P < 0.01). Moreover, those who were living with child (β = -0.78, P < 0.001) or mixed habitation (β = -0.33, P < 0.05) tended to engage in fewer health risk behaviors than those living alone.

CONCLUSIONS

This study suggests significant differences in health risk behaviors among the Hakka older adults with different living arrangements. Living with the child could reduce the occurrence of health risk behaviors in the Hakka older adults and thus maintain their health status.

Exploring Living Arrangements as a Predictor of Canadians' Illicit Drug Use: Quantitative Findings From the Canadian Community Health Survey

Objectives: About four percent of Canadians used illegal drugs in 2019, but it remains unknown whether their living arrangements are a relevant factor. Methods: We use the public version of the 2015-2016 Canadian Community Health Survey Annual Component. The binary logit model and complementary log-log model are applied to investigate to what extent living arrangements predict Canadians' recent illicit drug use. Results: Living alone is significantly associated with Canadians' illicit drug use. For young and older Canadians, those living with spouses/partners, children, or both are less likely to use illicit drugs than their solo-living counterparts. Middle-aged Canadians who lived with spouses/partners only or with children have significantly lower likelihoods of using illicit drugs compared to those living alone. Additionally, differences between men and women have been found. Spouses/partners and children play more positive roles for young and middle-aged women than for men. Conclusion: Our findings suggest that living with core families is a type of collectivity that may have positive effects on Canadians' health behaviours compared to those living alone, who, therefore, need more attention from health officials.

Factors associated with long-term smoking relapse in those who succeeded in smoking cessation using regional smoking cessation programs

It is known that approximately 10% of successful quitters relapse annually. This study aimed to investigate the factors related to long-term smoking relapse in individuals who succeeded in maintaining smoking cessation for 6 months after attending a regional smoking cessation program. This study enrolled 943 individuals registered for the regional smoking cessation program at the Busan Smoking Cessation Center in 2018-2019 who maintained smoking cessation for 6 months. A survey was conducted using a smartphone link or through phone calls, and the data for 305 participants who finally completed the survey were analyzed. The questionnaire addressed individual, inter-individual, organizational, and community-level factors related to smoking relapse. Multivariate logistic regression analysis was performed to evaluate the factors associated with smoking relapse by period. The Cox proportional hazard regression model was used for the factors associated with smoking relapse for the entire period. The smoking relapse rate at the time of the survey was 25.4%. In the analysis of smoking relapse by period, relapse was associated with the belief that smoking relieves stress, the number of single-person households, and poor subjective health status. In the analysis of smoking relapse during the entire period, we observed a significant association with the belief that smoking relieves stress (hazard ratio [HR]: 2.65, 95% confidence interval [CI]: 1.52-4.61), single-person households (HR: 1.95, 95% CI: 1.16-3.26), and high levels of emotional stress (HR: 1.72, 95% CI: 1.04-2.85). Long-term follow-up is necessary to prevent smoking relapse in single-person households, individuals who believe that smoking relieves stress, and those experiencing high levels of subjective emotional stress. Interventional therapies for stress relief and awareness improvement in smokers need to be developed.

Food and alcohol disturbance among young adults during the COVID-19 lockdown in Italy: risk and protective factors

PURPOSE

The COVID-19 lockdown measures have had a significant impact on risk behaviors as alcohol use and disordered eating. However, little is known about a serious health-risk-behavior named "food and alcohol disturbance" (FAD), characterized by engaging in dysfunctional eating on days of planned alcohol consumption. The aim of the present study was to investigate potential factors that may have put young adults at risk or protected against FAD during the COVID-19 lockdown.

METHODS

A sample of 447 young adults (280 females, 167 males; range 18-26) completed an online survey during the country's nationwide lockdown composed of self-reported measures assessing FAD behaviors, alcohol consumption, compensatory behaviors, eating and weight concerns, social support, emotion regulation strategies, and living arrangement.

RESULTS

Our findings showed that FAD was significantly and positively correlated to alcohol consumption, use of laxatives, self-induced vomiting, eating and weight concerns, and expressive suppression, and negatively correlated to social support and living with family. Hierarchical regression analysis revealed that alcohol consumption, eating concern, and expression suppression positively predicted FAD, while social support and living with family were negative predictors.

CONCLUSIONS

Our results suggest that during the COVID-19 lockdown, preoccupation with eating and the use of expressive suppression may have increased vulnerability to FAD; conversely, perceived social support and living with family may have been a source of protection against this dysfunctional behavior.

LEVEL OF EVIDENCE

Level V, descriptive study.

Differences in Dietary Patterns among the Polish Elderly: A Challenge for Public Health

The aim of the study was to assess the diversity of dietary patterns within the elderly, in relation to the region of residence, household structure, and socioeconomic status. The questionnaire was conducted in a group of 427 Polish adults aged 60 and older from June to September 2019. The sample was selected by means of the snowball method in two regions. Principal component analysis (PCA) was used to extract and identify three dietary patterns (factors) from the frequency of eating 32 groups of foods. Logistic regression analysis was used to determine the relationship between the identified dietary patterns (DPs), region, household status, and socioeconomic index (SES). Adherence to the identified DPs, i.e., traditional, prudent, and adverse, was associated with socioeconomic status (SES) and living environment, i.e., living alone, with partner, or with family, while the region did not differentiate them. Less people living with their family were characterized by the frequent consumption of traditional food (the upper tertile of this DP), while more of them often consumed food that was typical for both prudent and adverse DPs (the upper tertiles of these DPs). The presence of a partner when living with family did not differentiate the adherence to DPs. A high SES decreased the chances of adhering to the upper tertiles of the “prudent” and “traditional” DPs, while living with family increased the chances of adhering to both the upper and middle tertiles of the “prudent” DP. Identifying the dietary patterns of the elderly contributes to a better understanding of the food intake of the senior citizens living in different social situations, in order to support public policies and nutritional counseling among this age group.

Smoking and Drinking Behaviors among Older Adults: A Comparative Analysis of Three Southeast Asian Countries

Studies on the two major health-risk behaviors of smoking tobacco and drinking alcohol among older populations, particularly in Southeast Asia, are limited. This paper provides comparative analyses of the prevalences and correlates of smoking tobacco and drinking alcohol among older people in Myanmar, Vietnam, and Thailand, using data from the latest available national aging surveys in the three countries. The analyses were conducted within a multivariate framework. Gender-specific results show that smoking tobacco and drinking alcohol are more common among older men than women in all three countries. However, the prevalence of smoking and drinking among men declines at older ages. The multivariate analyses reveal that a higher level of education has a significant negative association with smoking and drinking in all three settings, but the magnitude and the direction of associations vary considerably between countries and genders. Area of residence is correlated with smoking among men in all three countries, whereas co-residential arrangements with spouse, children, or both significantly reduce alcohol consumption among men in Myanmar and among men and women in Thailand. In all three settings a significant complementary relationship between smoking and drinking is observed. From a policy perspective this implies that a successful reduction in smoking could be achieved through anti-drinking campaigns and vice versa.

An analysis of predictors for heavy alcohol drinking using nationally representative survey data in Japan

Background

Predictors of heavy or moderate alcohol drinking behavior have not been investigated using recent nationally representative survey data in Japan. This study investigated the effects of the predictors of heavy and moderate alcohol drinking in Japan using nationally representative survey data.

Methods

Anonymous data from the 2013 Comprehensive Survey of Living Conditions in Japan were used to compare the predictors of heavy and moderate drinkers with those who abstain. Anonymized data that are resampled from all the survey data from the Ministry of Health, Labour and Welfare were obtained. Age group, marital status, living arrangements, educational level, household income, smoking status, and employment type were used as the explanatory variables. In addition, the drinking status (i.e., heavy drinker, moderate drinker, or abstainer) was used as the outcome variable. A multinomial logistic regression model was used, and an analysis comparing heavy drinkers and abstainers, as well as moderate drinkers and abstainers, was conducted.

Results

Moderate drinking was positively associated with high educational level or high household income for men and women, as well as married status for men. In addition, unemployment was found to be negatively associated with heavy drinking for men and women, and an unmarried status was also found to be negatively associated with heavy drinking for men. Moreover, lower educational levels and smoking prevalence were found to be associated with heavy drinking for men and women. Furthermore, living alone for men and working in a large-scale company for women were also found to be predictors of heavy drinking.

Conclusions

The preventive measures for heavy drinking were suggested to be particularly needed for those with lower educational levels and smokers. A call for attention among men living alone and among female employees in large-scale workplaces is also needed.

Socioeconomic Predictors of Trends in Cancer Mortality among Municipalities in Japan, 2010-2019

Background:

A study investigating associations between various socioeconomic factors and standardized mortality ratios (SMR) of each type of cancer among municipalities in Japan has not been conducted using the data of the past decade. Herein, we investigated the predictors of a recent trend of municipal SMRs of cancer using the Vital Statistics in Japan and revealed the change in the SMRs depending on the identified predictors.

Methods:

Data on cancer mortality for each municipality in 2010 and 2019 were used. We calculated empirical Bayes SMR (EBSMR) for each municipality by type of cancer and sex and then fitted a multiple linear regression model using possible predictors in 2010 as explanatory variables and the EBSMR in 2019 as the outcome variable. We also classified municipalities into quintiles based on the values of an identified predictor in 2010, and SMRs of each type of cancer in 2010 and 2019 were calculated for each quintile.

Results:

The total population was positively associated with EMSMRs of multiple cancer types, whereas educational level was negatively associated with EMSMRs of multiple cancer types. In addition, SMRs of municipalities with the lowest educational level deteriorated from 2010 to 2019 for many cancer types among men and women, and the difference between municipalities with the highest and lowest educational level for the SMR of cancer in all sites widened in 2019 for men. On the other hand, the SMR of municipalities with the highest educational level or the largest total population tended to be higher than municipalities with lower counterparts in both 2010 and 2019 for women.

Conclusion:

There was a difference in the trend of the SMRs of multiple types of cancer depending on municipal educational level, whereas municipalities with larger population or educational level continued to have higher SMRs of cancer in all sites for women.

Impact of Alcohol on Occupational Health and Safety in the Construction Industry at Workplaces with Scaffoldings

The value, care, and customs of workers are essential in terms of occupational health and safety. The abuse of alcohol is widely regarded as a serious threat to the lives, health, and safety of employees. The aim of the research was to identify the main problems that are associated with alcohol abuse and consumption at work among employees in the construction industry, with particular emphasis on workstations where work is carried out on construction scaffoldings. Data for the analysis were obtained from two different sources. The first one was post-accident documentation on occupational accidents. The second one was surveys collected during the research project. This study confirmed that excessive and disproportionate alcohol consumption can be the cause of an accident, and consequently death at workplaces with scaffolding. Of 219 accident reports, 17.4% indicated alcohol as a contributing factor. Analysis of accident documentations shows that in cases where alcohol was indicated as a contributing factor in an accident, the alcohol was consumed during the workday. The results obtained on the basis of the conducted research were able to constitute a justification for the directions of preventive actions carried out in order to reduce the number of occupational accidents in the construction industry caused by alcohol.

Associations between Living Alone and Smoking and Alcohol Consumption in Korean Adults

Background

Recently, single-person households have increased in Korea and this trend may have potential public health implications and affect various health behaviors. This study investigated the associations between living alone and health behaviors such as smoking and alcohol consumption among Korean adults.

Methods

We used data from the 6th Korea National Health and Nutrition Examination Survey between 2013 and 2015 and a total of 17,088 adults were included. We performed a multivariable logistic regression analysis and calculated odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Single-person households accounted for about 10% of the total participants. The proportions of currently smoking and heavy alcohol consumption were higher among individuals living alone than those living together among younger women and middle-aged and elderly men and women. In the multivariable logistic regression analysis, living alone was associated with increased odds of currently smoking compared to living together among middle-aged men and women (OR, 7.37; 95% CI, 2.33–23.32 in men and OR, 2.36; 95% CI, 1.04–5.36 in women) after adjusting for confounding variables.

Conclusion

From this nationwide, population-based study, we found that living alone is associated with increased odds of currently smoking, especially in middle-aged people. Public health concerns may be warranted for middle-aged single-person households to reduce health risks related to smoking.

Anxiety about aging, resilience and health Status among Chinese older adults: Findings from Honolulu and Wuhan

A growing body of literature found that anxiety about aging is related to health and well-being of older adults. However, very few studies have been conducted on Chinese older adults residing in different countries and examined the role of resilience. Using the Pearlin's Stress Process Model, this study aims to fill in this gap by examining the relationship between anxiety about aging as the stressor and health status among Chinese older adults living in Honolulu, the United States (N = 292) and Wuhan, China (N = 532). The survey data were collected through June 2017 to September 2018, using snowball and convenience sampling strategy. The moderating role of resilience on the focal relationship is also explored. Results showed that for both samples, the negative relationship between anxiety about aging and self-rated health was significantly moderated by resilience (18 % and 13 %, respectively), implying the stress-buffering role of resilience. Although both mean levels of resilience and anxiety about aging were lower for the Honolulu sample, the moderating effect appeared to be stronger, implying that older adults in the Honolulu sample might rely more on psychological resources such as resilience in coping with stressors, compared with their counterparts in Wuhan. However, the moderating effect of resilience did not work for the association between anxiety about aging and number of chronic conditions for both samples. Our findings suggest that future research needs to take into account both social and psychological resources when examining anxiety about aging and health status among Chinese older adults residing in different cultural contexts.

Factors Associated with Single-Use and Co-Use of Tobacco and Alcohol: A Multinomial Modeling Approach

Tobacco smoking and alcohol consumption are among the most important public health concerns not only in South Korea but also globally. This study identified the factors associated with single-use and co-use of tobacco and alcohol in Korean adults and provided more accurate estimates using a multinomial modeling approach. This study used the Korea Community Health Survey Data 2017, of which 205,336 respondents were selected as the sample for a multinomial logistic regression analysis. For the group that identified as only drinking monthly compared to the reference group, we found that the direction of the following factors was opposite to that of the results of the only currently smoking group: Age, marital status, educational level, monthly household income, occupation, obesity, self-rated health, hypertension, and hyperlipidemia. For the currently smoking and drinking monthly group relative to the reference group, the overall direction was a mix of the results of only currently smoking and only drinking monthly. These findings support the development of policies that consider the risk of smoking tobacco and consuming alcohol simultaneously.

Factors associated with elevated consumption of alcohol in older adults-comparison between China and Norway: the CLHLS and the HUNT Study

OBJECTIVES

The primary objective was to investigate the prevalence and factors associated with elevated alcohol consumption among older adults 65 years and above in China and Norway. The secondary objective was to compare the prevalence and factors in the two countries.

DESIGN

A secondary data analysis was conducted using two large cross-sectional studies (Chinese Longitudinal Healthy Longevity Survey data in 2008-2009 and Nord-Trøndelag Health Study data in 2006-2008).

PARTICIPANTS

A total of 3223 (weighted) Chinese older adults and 6210 Norwegian older adults who responded drinking alcohol were included in the analysis.

OUTCOME MEASURES

The dependent variable was elevated alcohol consumption, which was calculated as a ratio of those with elevated drinking among current drinkers. Multivariable logistic regression was used to test the dependent variable.

RESULTS

The prevalence of elevated alcohol consumption among current drinkers for the Chinese and Norwegian samples were 78.3% (weighted) and 5.1%, respectively. Being male was related to a higher likelihood of elevated alcohol consumption in both Chinese and Norwegian samples (OR=2.729, 95% CI 2.124 to 3.506, OR=2.638, 95% CI 1.942 to 3.585). Being older, with higher levels of education and a living spouse or partner were less likely to have elevated drinking in the Chinese sample (OR=0.497, 95% CI 0.312 to 0.794, OR=0.411, 95% CI 0.260 to 0.649, OR=0.533, 95% CI 0.417 to 0.682, respectively). Among Norwegian older adults, a higher level of education was related to higher likelihood of elevated drinking (OR=1.503, 95% CI 1.092 to 2.069, OR=3.020, 95% CI 2.185 to 4.175). Living in rural areas and higher life satisfaction were related to lower likelihood of elevated drinking in the Norwegian sample (OR=0.739, 95% CI 0.554 to 0.984, OR=0.844, 95% CI 0.729 to 0.977, respectively).

CONCLUSIONS

The elevated alcohol consumption patterns were strikingly different between China and Norway in regards to prevalence and socioeconomic distribution. To develop and implement culturally appropriate public health policies regarding alcohol in the future, public health policy makers and professionals need to be aware of the cultural differences and consider the demographic, social and economic characteristics of their intended population.

The Impact of Generativity Awareness on Mid- to Old-Age Smokers in China

Smoking remains a serious health threat to many mid- to old-age Chinese people. Many smoking interventions have been implemented in public areas, but smoking occurring in a private setting, such as at home, has largely been neglected. Generativity is based on evaluating the worth of one's life experience that can be passed on to others. This study evaluated whether generativity awareness can have an impact on smoking reduction. Five hundred and eight Chinese smokers were recruited and demonstrated their strong awareness of generativity, specifically general generativity (e.g., moral ethics), health-related generativity (e.g., living a healthy life), and smoke-free family generativity. The study showed support for a three-dimensional model for generativity, namely general, health, and smoke-free generativity. The three types of generativity varied in their effects on behavioral intention to reduce smoking and to encourage younger family members not to smoke. Family communication patterns also influenced behavioral intention to reduce smoking and to encourage younger family members not to smoke. Theoretical and practical implications are discussed.

Gender differences in cigarette smoking and alcohol drinking among adolescents and young adults in Hanoi, Shanghai, and Taipei

Objective

This study aimed to examine gender differences in smoking and alcohol drinking behaviors in three Asian cities of Hanoi, Shanghai, and Taipei, and to assess the magnitude of gender differences across the three cities.

Methods

A total of 17,016 adolescents (age: 15–19 years) and young adults (age: 20–24 years) were selected using multi-stage sampling methods and surveyed in face-to-face interviews. A total of 16,554 unmarried respondents were included in this analysis.

Results

Gender differences were significant for smoking only, drinking only, and both behaviors in each city. Male respondents were 30.66 times more likely to report smoking only than female respondents in Hanoi, followed by Shanghai and Taipei. This pattern was similar for drinking only and both smoking and drinking behaviors.

Conclusions

The magnitude of gender differences in smoking only, drinking only, and both behaviors widely varies across the three cities. Further research can examine how these differences may be used to prevent and reduce smoking and drinking in the adolescent and young adult population.

Concordance in the Health Behaviors of Couples by Age: A Cross-sectional Study

Objectives

To investigate concordance in the health behaviors of women and their partners according to age and to investigate whether there was a stronger correlation between the health behaviors of housewives and those of their partners than between the health behaviors of non-housewives and those of their partners.

Methods

We used data obtained from women participants in the 2015 Korea Community Health Survey who were living with their partners. The outcome variables were 4 health behaviors: smoking, drinking, eating salty food, and physical activity. The main independent variables were the partners’ corresponding health behaviors. We categorized age into 4 groups (19-29, 30-49, 50-64, and ≥ 65 years) and utilized multivariate logistic regression analysis, stratifying by age group. Another logistic regression analysis was stratified by whether the participant identified as a housewife.

Results

Data from 64 971 women older than 18 years of age were analyzed. Of the 4 health behaviors, the risk of smoking (adjusted odds ratio [aOR], 4.65; 95% confidence interval [CI], 3.93 to 5.49) was highest when the participant’s partner was also a smoker. Similar results were found for an inactive lifestyle (aOR, 2.56; 95% CI, 2.45 to 2.66), eating salty food (aOR, 2.48; 95% CI, 2.36 to 2.62); and excessive drinking (aOR, 1.89; 95% CI, 1.80 to 1.98). In comparison to non-housewives, housewives had higher odds of eating salty food.

Conclusions

The health behaviors of women were positively correlated with those of their partners. The magnitude of the concordance differed by age group.

Effects of living alone versus with others and of housemate type on smoking, drinking, dietary habits, and physical activity among elderly people

OBJECTIVES

This study examined differences in health behaviors between elderly people living alone and with others; it also investigated whether the effect of living with others differs according to housemate type, namely a spouse and/or younger generations.

METHODS

Gender-stratified data from the 2013 Korea Community Health Survey for individuals aged 60 to 74 living in Seoul were analyzed. Logistic regression modeling was conducted to obtain odds ratios (ORs) and 95% confidence intervals (CIs) of the outcome variables (smoking, drinking, eating salty foods, inactive lifestyle) for the variables of interest (living alone/with others, housemate type). Models were adjusted for confounding variables including history of medical conditions, employment type, and adjusted household income.

RESULTS

Analysis involved 1,814 men and 2,199 women. Risk of smoking was 1.80 times (95% CI, 1.21 to 2.67) higher for men living alone than living with others. Risk of eating salty foods was 0.78 times lower (95% CI, 0.62 to 0.98) for men living with a spouse than a spouse and younger generations. Risk of inactive lifestyle was 1.47 times higher (95% CI, 1.13 to 1.92) for women living alone. Risk of smoking was higher for women living alone (OR, 1.41; 95% CI, 1.03 to 1.92) or with younger generations (OR, 9.12; 95% CI, 2.04 to 40.80) than with a spouse and younger generations.

CONCLUSIONS

Living alone was associated with smoking in men and physical activity in women; housemate type was associated with dietary habits in men and smoking in women. These gender-specific findings can help identify groups of individuals vulnerable to risky health behaviors and to develop policies.