Epidemiology, risk factors, and prevention strategies of HIV, HPV, and other sexually transmitted infections among cisgender and transgender youth: a narrative review

Adolescents face an increased risk of contracting sexually transmitted infections (STIs) with alarming data especially concerning HIV. Limited data exists for teenagers regarding the influence of their gender identity (GI) and sexual orientation on the risk of STIs. This narrative review aims to analyse the available data to provide a comprehensive overview of STIs incidence and risk factors among adolescents, taking into account the unique circumstances related to various sexual orientations and GIs. Transgender and gender minority (TGM) youth experience more challenges accessing health services compared to cisgender youth. This is often attributed to non-inclusive health environments, barriers to obtaining medical gender affirmation, and an underestimation of sexual risk perception. Literature analysis has revealed that the majority of adolescents, both cisgender and TGM, have limited awareness regarding the risks associated with their sexual behaviors, the most common sexually transmitted diseases, and strategies for prevention, such as PrEP and HPV vaccination. Moreover, a significant portion of pediatricians possess limited knowledge and comfort in addressing various aspects of sexual health, particularly when it involves discussing topics such as sexual orientation, gender identity, and sexual behaviors with sexually active adolescents. This underscores the pressing need for enhanced education for pediatricians, specifically focusing on STIs diagnosis, prevention, and screening.

Multiple Behavioral Risk Factors As Assets for Chronic Disease Prevention: Observations From Urban Primary Care Settings in Crete, Greece

AIM

This study aimed to assess the health profile of patient-attendees visiting primary healthcare (PHC) practice settings in the midst of the COVID-19 pandemic and to explore the relationships between multiple behavioral risk factors (MBRFs) and consultation-driven health information. Multiple behavioral risk factors involve a variety of unhealthy behaviors that are associated with an increased prevalence of non-communicable diseases (NCDs).

SUBJECTS AND METHODS

The study design was based on a dataset analysis, afterward exploring the feasibility and diagnostic capacity of respiratory morbidity aspects from a study previously conducted. The study dataset contained information regarding socio-demographic characteristics, health habits, clinical information, and reported comorbidities from 183 primary care patient-attendees. A categorical regression analysis was performed, using as a numeric variable the multiple MBRFs (clustering of 0 to four factors) in order to examine relationships with the basic and clinical characteristics of the patient-attendees.

RESULTS

Based on this secondary analysis, it was found that the prevalence of MBRFs is quite common among patient-attendees visiting urban PHC facilities. The prevalence of current smoking, sleep deprivation, increased body weight, and medium/high perceived stress levels were 33.9%, 52.5%, 83.1%, and 35.0%, respectively. An increased occurrence of MBRFs might be significantly predicted by the lower age of patient-attendees (b = -0.221, p = 0.05), by the absence of gray hair at an early age (b = -0.144, p = 0.042), by the physical discomfort during activities (b = 0.191, p = 0.017), or by the lower oxygen saturation (b = -0.184, p = 0.004). Diabetes mellitus (25.1%) was the most prevalent condition, followed by bronchial asthma (18.6%) and depression (15.8%).

CONCLUSIONS

Lower age, absence of premature hair whitening, physical discomfort during activities, and lower oxygen saturation are linked with an increased occurrence of MBRFs, leading to a neglected way of living. Those factors could be used to alert researchers, policymakers, and PHC professionals to act accordingly in order to prevent or early diagnose NCDs.

Sex differentials in the prevalence of behavioral risk factors and non-communicable diseases in adult populations of West Kazakhstan

Introduction

The prevalence of non-communicable diseases (NCDs) is increasing worldwide. Several modifiable risk factors, such as smoking, alcohol drinking, physical inactivity, and obesity, have been linked to the development of NCDs in both genders. Understanding the prevalence of these risk factors and their associated factors is crucial for effective intervention planning in adult populations. This study aimed to provide an overview of the prevalence and associated factors of these risk behaviors among different genders of adults in West Kazakhstan.

Methods

A cross-sectional study was conducted in four regions of West Kazakhstan. A stratified multistage sampling technique was utilized to obtain a representative sample size of 4,800 participants aged 18 -69 years. Trained researchers administered face-to-face interviews using validated questionnaires to gather information pertaining to sociodemographic characteristics, smoking habits, alcohol drinking, dietary patterns, physical activity levels, body mass index (BMI), and prevalent diseases.

Results

This study, which included 4,800 participants from West Kazakhstan, revealed some striking numerical findings. The overall prevalence rates of behavioral risk factors and metabolic conditions were as follows: smoking was 13.6% (95%CI: 3.2-24.0%), alcohol drinking was 47.0% (27.7-66.3%), current obesity was 22.3% (9.0-35.6%), and physical inactivity was 80.7% (55.4-106.0%). In addition, the overall prevalence rates of metabolic conditions were 25.6% (11.3-39.9%) for hypertension, 7.5% (0.2-15.2%) for diabetes, 11.8% (2.1-21.5%) for high cholesterol, and 13.0% (2.8-23.2%) for cardiovascular diseases. Additionally, a higher prevalence of high cholesterol was observed in men, and a greater prevalence of heart disease was identified in women. Multinomial logistic regression revealed that physical inactivity was associated with hypertension, diabetes, and heart disease, while obesity was linked to hypertension, high cholesterol, and heart disease.

Discussion

This study in West Kazakhstan identified variations in the prevalence of behavioral risk factors and NCDs, highlighting gender, age, and regional disparities. Notably, men showed higher rates of smoking and alcohol drinking, while women exhibited a greater prevalence of physical inactivity and obesity. Gender and regional differences were evident, with the West Kazakhstan region standing out for distinct patterns. Tailored interventions are crucial to address these disparities and enhance public health in the region.

Exploring Behavioral Risk Factors for Non-communicable Diseases Among Undergraduate Medical Students in Western Gujarat: A Cross-Sectional Study

Background The burden of morbidity and death caused by non-communicable diseases (NCDs) such as cancer, diabetes, and cardiovascular disease is a significant global health concern influenced by modifiable behavioral risk factors. In India, the burden of NCDs is particularly high, with medical college students being a vulnerable population. This study aims to bridge the knowledge gap by investigating the prevalence and patterns of behavioral risk factors for NCDs among medical college students. Methodology A cross-sectional study was conducted on medical students in Gujarat. Risk factors for NCDs were assessed using various tools, including the General Health Questionnaire-12 (GHQ-12) for stress, the International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, the body mass index (BMI) for obesity, and dietary factors. The chi-square test was employed as a statistical tool to determine the association between socio-demographic variables and various risk factors. A p-value of <0.05 was considered statistically significant. Results Among the 400 students surveyed, the prevalence of single behavioral NCD risk factors was as follows: 248 (62%) reported stress (GHQ-12), 215 (54%) experienced poor sleep quality (PSQI), 251 (63%) had low levels of physical activity (IPAQ), 339 (85%) had inadequate fruit and vegetable intake, 97 (24%) consumed extra salt during meals, 163 (41%) were overweight or obese, and 189 (47%) had three or more risk factors for NCDs. In bivariate logistic regression analysis, factors such as age, male gender, urban residence, hostel stay, and lower socioeconomic status were found to be statistically significant (p < 0.05). Conclusion This study reveals an alarming failure of medical colleges to positively influence students' health behaviors, despite their medical knowledge. The high rates of inactivity, stress, poor diet, and obesity among students demonstrate the curriculum's inability to instill preventative lifestyle practices. This omission in training compromises students' own health and their ability to counsel patients on NCD prevention. Urgent reform is needed to integrate health promotion into the curriculum, providing a supportive campus culture focused on wellness. By overlooking students' behaviors, medical colleges gravely disserve these future providers. This evidence compels curriculum reform to develop exemplary physician role models for NCD prevention.

Most healthy adults in urban centers of Southwest Ethiopia are not meeting the WHO's physical activity recommendations

BACKGROUND

The World Health Organization has set physical activity guidelines to reduce physical inactivity and its consequences. However, 1.4 billion adults worldwide are not meeting the recommendation. Adherence to this recommendation and its correlates has not been assessed in Southwest Ethiopia.

OBJECTIVES

To determine the proportion of healthy adults meeting the physical activity recommendations and identify its correlates in urban centers of Southwest Ethiopia.

METHODS AND MATERIALS

A community-based cross-sectional study was conducted in 2021, involving 1191 adults. Data was collected using the Global Physical Activity Questionnaire. Multivariable logistic regression was used to identify factors associated with meeting the physical activity recommendations using a 95% confidence interval of adjusted odds ratio (AOR) at a p-value of < 0.05.

RESULTS

A total of 1191adults participated in this study with a 93.3% response rate. Females accounted for more than half of the participants 643(54.0%). Only 38.8% of participants met the physical activity recommendations. Age 18-29 years (AOR=3.6;95% CI (2.4-5.4)), 30-44 years (AOR=2.8; 95% CI (1.9-4.0)), male sex (AOR=4.2; 95% CI (3.1-5.6)), lower educational status (AOR=1.83; 95%CI (1.35-2.5)), community participation (AOR=2.3;95% CI (1.6-3.4)),physical exercise of family members (AOR=2.4; 95%CI (1.8-3.3)) and physical exercise of friends (AOR=1.9; 95% CI (1.4-2.5)) were significantly associated with meeting the recommendations.

CONCLUSIONS AND RECOMMENDATIONS

The proportion of adults who met the recommendations in the study area is low. Socio-demographic, family, and social characteristics were associated with meeting the recommendations. Community participation and family-based physical activity have to be advocated to avert the consequences of physical inactivity.

Informal caregivers in Germany - who are they and which risks and resources do they have?

Background

The aim of this study is to describe the social characteristics, the health and living situation and the prevalence of behavioral risk factors of adult informal caregivers compared to non-caregivers in Germany.

Methods

We used data from the German Health Update (GEDA 2019/2020-EHIS survey) which is a cross-sectional population-based health interview survey conducted between 04/2019 and 09/2020. The sample comprised 22,646 adults living in private households. Three mutually exclusive groups of providing informal care or assistance were differentiated: intense caregivers (informal care ≥10 h/week), less-intense caregivers (informal care<10 h/week) and non-caregivers. For the three groups weighted prevalences of social characteristics, health status (self-perceived health, health-related activity limitations, chronic diseases, low back disorder or other chronic back defect, depressive symptoms), behavioral risk factors (at-risk drinking, current smoking, insufficient physical activity, non-daily fruit and vegetable consumption, obesity) and social risk factors (single household, low social support) were calculated and stratified by gender. Separate regression analyses adjusted for age-group were conducted to identify significant differences between intense and less-intense caregivers vs. non-caregivers, respectively.

Results

Overall, 6.5% were intense caregivers, 15.2% less-intense caregivers and 78.3% non-caregivers. Women provided care more often (23.9%) than men (19.3%). Informal care was most frequently provided in the age group of 45 to 64 years. Intense caregivers reported worse health status, were more often current smokers, physical inactive, obese and lived less often alone than non-caregivers. However, in age-group adjusted regression analyses only few significant differences were seen: Female and male intense caregivers had more often a low back disorder and lived less often alone compared to non-caregivers. In addition, male intense care-givers reported more often worse self-perceived health, health-related activity limitation, and the presence of chronic diseases. In contrast, less-intense caregivers and non-caregivers differed in favor of the less-intense caregivers.

Discussion

A substantial proportion of the adult German population provides informal care regularly, especially women. Intense caregivers are a vulnerable group for negative health outcomes, especially men. In particular measures to prevent low back disorder should be provided. As the necessity of providing informal care will probably increase in the future, this will be important for the society and public health.

Impact of COVID-19 on health risk behaviors in northern California: A cross-sectional survey

The COVID-19 pandemic has been disruptive, unevenly impacting health behaviors in different geographical regions and population groups. We examined how COVID-19 affected perceived changes in physical activity, sleep, and diet and the impact of socio-demographic variables on a calculated health risk behavior score. In this cross-sectional study, 505 residents of northern California completed a web-based survey from August to November of 2020. Chi-square and multivariable linear regression analyses examined the association between socio-demographic variables and the health risk behavior score. Approximately 84 % of respondents experienced at least one unfavorable behavior change after the pandemic, with 49.5 % indicating a reduction in physical activity, 29.7 % a decrease in sleep, 33.1 % an increase in sugary snack consumption, and 29.3 % a decrease in fruit and vegetable intake. Multivariate analyses indicated a higher health risk behavior score (less favorable) for females compared to males (male beta = -0.815, p < 0.0001) and Hispanics compared to Whites (Hispanics beta = 0.396, p = 0.033). The negative changes in health behavior observed in females could be attributed to a higher reduction in fruit and vegetable consumption, and a larger increase in sugary and salty snacks when compared to males. A higher reduction in exercise, sleep, and fruit and vegetable intake were the main drivers of the unfavorable results seen for Hispanics when compared to Whites. Findings highlight the detrimental behavioral changes during the COVID-19 pandemic and the disproportionate impact on Hispanics and women. These results are valuable to policymakers to identify ways to support those most affected by the pandemic and its potential long-term effects.

The prevalence and burden of four major chronic diseases in the Shanxi Province of Northern China

Background

Chronic non-communicable diseases constitute an important public health problem that is closely related to behavioral risk factors. The study examined the prevalence, burden, and behavioral risk factors relevant to four major chronic diseases in Shanxi Province, China. The results obtained could provide a basis for the formulation of chronic disease prevention and control strategies in north China.

Methods

A multi-stage random sampling method was used to select 14,137 residents aged ≥15 years who completed a questionnaire survey and physical examination. The disease burden was evaluated using the disability-adjusted life years (DALY) index. The extent of disease burden attributable to smoking and drinking behavior was analyzed using counterfactual analysis.

Results

The total DALYs due to the four major chronic diseases was 938,100. The years of life lost due to stroke accounted for 74.86%; the years of life lived with disabilities accounted for 54.0 and 68.1% of the total disease burden of coronary heart disease and diabetes. Coronary heart disease attributed to smoking (105,600) was the highest, followed by stroke (77,200), hypertension (6,000), and diabetes mellitus (5,900). Stroke attributed to drinking (30,700) was the highest followed by coronary heart disease (16,700) and diabetes (1,100). The disease burden caused by smoking and drinking was higher in men (164,000 and 40,700, respectively) than in women (30,700 and 7,300, respectively).

Conclusion

There is a high prevalence and significant burden associated with major chronic diseases in Shanxi Province. Therefore, the need for the application of various interventions to control smoking and drinking (the major predisposing factors) should be applied to reduce this burden.

A Multifactorial Approach for Sarcopenia Assessment: A Literature Review

Simple Summary

Sarcopenia is characterized by an accelerated decline in skeletal muscle mass and strength, which results in poor quality of life, disability, and death. In the literature, sarcopenia is defined as the progressive breakdown of muscle tissue. The prevalence ranges from 5% to 13% in people 60–70 years old and from 11% to 50% in people older than 80 years. The comparison of risk factors associated with sarcopenia based on the European Working Group on Sarcopenia (1 and 2) in Older People, the Asian Working Group for Sarcopenia (1 and 2), the International Working Group on Sarcopenia, and the Foundation for the National Institutes of Health revealed no consistent patterns. Accordingly, the identification of a single risk factor for sarcopenia is unpredictable. Due to its “multifactorial” pathogenesis related to the involvement of a multitude of factors. In this review, we summarize 13 relevant risk factors associated with this disease that are important to consider prior to embarking on any related sarcopenia research. We suggest that researchers should concentrate on the biology of sarcopenia to develop a uniform consensus for screening this condition. In this review, we identify 50 biochemical markers across six pathways that have previously been investigated in subjects with sarcopenia. We suggest that these summarized biomarkers can be considered in future diagnosis to determine the biology of this disorder, thereby contributing to further research findings. As a result, a uniform consensus may also need to be established for screening and defining the disease. Sarcopenia is associated with a number of adverse economic and social outcomes, including disability, hospitalization, and death. In relation to this, we propose that we need to develop strategies including exercise interventions in the COVID-19 era to delay the onset and effects of sarcopenia. This suggestion should impact on sarcopenia’s primary and secondary outcomes, including physical, medical, social, and financial interactions.

Abstract

Sarcopenia refers to a progressive and generalized weakness of skeletal muscle as individuals age. Sarcopenia usually occurs after the age of 60 years and is associated with a persistent decline in muscle strength, function, and quality. A comparison of the risk factors associated with sarcopenia based on the European Working Group on Sarcopenia (1 and 2) in Older People, the Asian Working Group for Sarcopenia (1 and 2), the International Working Group on Sarcopenia, and the Foundation for the National Institutes of Health revealed no consistent patterns. Accordingly, the identification of a single risk factor for sarcopenia is unpredictable due to its “multifactorial” pathogenesis, with the involvement of a multitude of factors. Therefore, the first aim of this review was to outline and propose that the multiple factors associated with sarcopenia need to be considered in combination in the design of new experimentation in this area. A secondary aim was to highlight the biochemical risk factors that are already identified in subjects with sarcopenia to assist scientists in understanding the biology of the pathophysiological mechanisms affecting the old people with sarcopenia. We also briefly discuss primary outcomes (physical) and secondary outcomes (social and financial) of sarcopenia. For future investigative purposes, this comprehensive review may be useful in considering important risk factors in the utilization of a panel of biomarkers emanating from all pathways involved in the pathogenesis of this disease. This may help to establish a uniform consensus for screening and defining this disease. Considering the COVID-19 pandemic, its impact may be exacerbated in older populations, which requires immediate attention. Here, we briefly suggest strategies for advancing the development of smart technologies to deliver exercise in the COVID-19 era in an attempt regress the onset of sarcopenia. These strategies may also have an impact on sarcopenia’s primary and secondary outcomes.

The Transition to Noncommunicable Disease: How to Reduce Its Unsustainable Global Burden by Increasing Cognitive Access to Health Self-Management

The global epidemic of noncommunicable diseases (NCDs), such as cardiovascular disease and diabetes, is creating unsustainable burdens on health systems worldwide. NCDs are treatable but not curable. They are less amenable to top-down prevention and control than are the infectious diseases now in retreat. NCDs are mostly preventable, but only individuals themselves have the power to prevent and manage the diseases to which the enticements of modernity and rising prosperity have made them so susceptible (e.g., tobacco, fat-salt-carbohydrate laden food products). Rates of nonadherence to healthcare regimens for controlling NCDs are high, despite the predictable long-term ravages of not self-managing an NCD effectively. I use international data on adult functional literacy to show why the cognitive demands of today's NCD self-management (NCD-SM) regimens invite nonadherence, especially among individuals of below-average or declining cognitive capacity. I then describe ways to improve the cognitive accessibility of NCD-SM regimens, where required, so that more patients are better able and motivated to self-manage and less likely to err in life-threatening ways. For the healthcare professions, I list tools they can develop and deploy to increase patients' cognitive access to NCD-SM. Epidemiologists could identify more WHO "best buy" interventions to slow or reverse the world's "slow-motion disaster" of NCDs were they to add two neglected variables when modeling the rising burdens of disease. The neglected two are both cognitive: the distribution of cognitive capacity levels of people in a population and the cognitive complexity of their health environments.

Reaching 80 Years of Age: Clinical, Behavioral, and Psychosocial Related Risk Factors in a Large Cohort of Israeli Working Men

The objective of this study was to estimate the probability of long-term overall survival based on total number of risk factors (RF). We also sought to examine the role of midlife clinical, behavioral, and psychosocial predictors of longevity in a large cohort of Israeli men. This study was based on the Israeli Ischemic Heart Disease (IIHD) cohort that included over 10,000 men who were followed up for mortality over more than four decades. During the 43 years of follow-up, 4634 (46.1%) men survived to 80 years of age or older. We considered cigarette smoking, diabetes mellitus, high systolic blood pressure, hypercholesterolemia, low socioeconomic status, and serious family problems as RF at ages 40–65. Cox proportional hazards regression models, with age as the time scale, were constructed to estimate the hazard ratios (HRs) for failure to survive 80 years of age. Compared with men free of all the above RF, those with one identified RF (HR = 1.58, 95% CI: 1.42–1.75) and counterparts with two identified RF (HR = 2.18, 95% CI: 1.96–2.43) were at a significantly greater risk of death before 80. Additional RF further increased the risk of early mortality (HR = 3.62, 95% CI: 1.50–8.73 for men with 5 RF). The results suggest a role of physiological, behavioral, and psychological risk factors at midlife in predicting longevity.

Effect of community-based lifestyle education intervention to reduce cardiovascular diseases risk factors among vulnerable population in Dodoma city, Tanzania: a cluster randomized controlled trial study protocol

Tanzania is experiencing the rise of cardiovascular diseases (CVDs) and associated risk factors including hypertension, obesity and diabetes mellitus. Health education and healthy lifestyle promotion is an effective approach toward primary prevention of the risk factors and can be achieved through community-based intervention. The objective of this protocol is to test the effectiveness of community-based lifestyle education intervention in reducing CVDs risk factors among vulnerable population in Dodoma City. This protocol is designed as a cluster-randomized controlled trial with a quantitative approach in which participants aged from 31 years will be assigned randomly to a control or intervention group. A total of 800 participants will be recruited in the study. The study will consist of six stages (baseline, first to fourth follow-up, and end-line surveys) in 6 months for both the intervention and the control group. The intervention will be implemented twice-monthly for the first 3 months, then monthly for the last 3 months. In each stage, participants from all groups will be measured for biological and behavioral CVDs risk factors. Health education and a healthy lifestyle promotion for prevention of CVDs risk factors will be provided to the intervention group only during each stage. The main outcome measures will be changes in body weight, blood pressure, blood glucose, dietary habits, and physical exercise in the intervention compared with the control group. Independent and paired t-tests will be employed to make comparisons between and within groups. P-values of less than 0.05 will be considered statistically significant.

Familial Risk and Its Interaction With Body Mass Index and Physical Activity in Anterior Cruciate Ligament Injury Among First-Degree Relatives: A Population-Based Cohort Study

BACKGROUND

Genetic and behavioral risk factors have been suggested to play a role in anterior cruciate ligament (ACL) injury. However, population-based familial risk estimates are unavailable.

PURPOSE

To quantify familial risk of ACL injury among first-degree relatives (FDRs) after controlling for certain behavioral risk factors. To estimate the combined effect of family history and body mass index (BMI) or physical activity on the risk of ACL injury.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Using nationwide data from the Korean National Health Insurance and National Health Screening Program databases on kinship, lifestyle habits, and anthropometrics, 5,184,603 individuals with blood-related FDRs were identified from 2002 to 2018. Familial risk of ACL injury, as represented as incidence risk ratios (IRRs) with 95% CIs, was analyzed using Cox proportional hazards models among individuals with versus without affected FDRs. Analyses were adjusted for age, sex, and behavioral risk factors. Interaction testing between familial history and BMI or physical activity was performed on an additive scale.

RESULTS

The risk of ACL injury was 1.79-fold higher (IRR, 1.79; 95% CI, 1.73-1.85) among individuals with versus without affected FDRs, and the incidence was 12.61 per 10,000 person-years. The IRR (95% CI) was highest with affected twins at 4.49 (3.01-6.69), followed by siblings at 2.31 (2.19-2.44), the father at 1.58 (1.49-1.68), and the mother at 1.52 (1.44-1.61). High BMI and high level of physical activity were significantly associated with the risk of ACL injury. Individuals with positive family history and either high BMI or physical activity had a 2.59- and 2.45-fold increased risk of injury as compared with the general population, respectively, and the combined risks exceeded the sum of their independent risks.

CONCLUSION

Familial factors are risk factors for ACL injury with an additional contribution of 2 behavioral factors: BMI and physical activity level. A significant interaction was observed between family history of ACL injury and high BMI/level of physical activity.

Eating Speed, Physical Activity, and Cardiorespiratory Fitness Are Independent Predictors of Metabolic Syndrome in Korean University Students

Background: Little is known regarding the role of eating quickly, physical inactivity, and poor cardiorespiratory fitness (CRF) in assessing the onset of metabolic syndrome (Mets) in Korean young adults. Objectives: This study examined the association between the three risk factors and Mets in 1891 Korean university students (30% female) aged 18–29 years. Methods: Eating speed (slow vs. fast) and physical activity (active vs. inactive) were assessed with a standardized questionnaire. Maximal oxygen uptake as an indicator of CRF was assessed with graded exercise testing. Components of Mets were waist circumference, systolic and diastolic blood pressures, fasting blood glucose (FBG), triglycerides (TG), and high-density lipoprotein cholesterol (HDLC). Results: All the three exposures were positively associated with abdominal obesity, elevated blood pressures, elevated FBG, elevated TG, and decreased HDLC. Logistic regression analysis showed that the odds ratio (OR) of Mets was incremental in the order of physical inactivity (odds ratio, OR = 1.666; 95% confidence interval, CI = 1.024–2.708; p = 0.040), fast eating (OR = 1.687; 95% CI = 1.094–2.601; p = 0.018), and poor CRF (OR = 5.378; 95% CI = 3.475–8.325; p < 0.001). Conclusions: The current findings suggest that a multifaceted intervention targeting at promotion of physical activity and CRF in concert with healthy eating behaviors should be implemented as a preventive strategy against Mets in Korean university students.

Co-occurrence of Behavioral Risk Factors of Non-communicable Diseases and Social Determinants among Adults in Urban Centers of Southwestern Ethiopia in 2020: A Community-Based Cross-Sectional Study

Background

Non-communicable diseases are priority global health problems. Smoking, harmful alcohol consumption, physical inactivity, and an unhealthy diet are four behavioral risk factors of these diseases. Studies in Ethiopia have focused on establishing associations between these factors and incommunicable diseases.

Objective

To assess the prevalence, co-occurrence, and social determinants of behavioral risk factors of non-communicable diseases among adults in urban centers of southwestern Ethiopia.

Methods

This study employed a cross-sectional design. Multistage sampling and the Kish method were used. The WHO's STEPS instrument was used for data collection. Proportions and other descriptive measures are used to describe the data. Bivariate and multivariate logistic regression was run to assess associations. Associations between dependent and independent variables were determined using AORs, 95% CIs, and significance level of P=0.05.

Results

A total of 1,191 adults participated in the study for a 93.3% response rate. In sum, 4.8% of participants were smokers and 15.6% indulge in harmful drinking. Prevalence of physical inactivity was 60.45%, and 94.8% consumed insufficient fruit and vegetables. Regarding co-occurrence of these factors, 65.5% of participants had two or more behavioral risk factors. Female sex (AOR 3.1, 95% CI 1.8-5.5), no formal employment (AOR 1.9, 95% CI 1.02-3.7), greater wealth (AOR 2.44, 95% CI 1.1-5.1), not having a friend who does physical exercise (AOR 2.7, 95% CI 1.5-4.7), having friends who do not drink (AOR 0.20, 95% CI 0.09-0.44), and participating in community activities (AOR 2.95, 95% CI 1.4-6.0) were associated with co-occurrence of behavioral risk factors of non-communicable diseases.

Conclusion

The prevalence and co-occurrence of behavioral risk factors of non-communicable diseases in the study area are alarming. Several factors were associated with co-occurrence of these factors. Community-based interventions have to be implemented considering family settings. Special focus has to be given to physical inactivity and fruit and vegetable consumption.

Effects of Behavioral Risk Factors and Social-Environmental Factors on Non-Communicable Diseases in South Korea: A National Survey Approach

Non-communicable diseases (NCDs) are one of the major health threats in the world. Thus, identifying the factors that influence NCDs is crucial to monitor and manage diseases. This study investigates the effects of social-environmental and behavioral risk factors on NCDs as well as the effects of social-environmental factors on behavioral risk factors using an integrated research model. This study used a dataset from the 2017 Korea National Health and Nutrition Examination Survey. After filtering incomplete responses, 5462 valid responses remained. Items including one's social-environmental factors (household income, education level, and region), behavioral factors (alcohol use, tobacco use, and physical activity), and NCDs histories were used for analyses. To develop a comprehensive index of each factor that allows comparison between different concepts, the researchers assigned scores to indicators of the factors and calculated a ratio of the scores. A series of path analyses were conducted to determine the extent of relationships among NCDs and risk factors. The results showed that social-environmental factors have notable effects on stroke, myocardial infarction, angina, diabetes, and gastric, liver, colon, lung, and thyroid cancers. The results indicate that the effects of social-environmental and behavioral risk factors on NCDs vary across the different types of diseases. The effects of social-environmental factors and behavioral risk factors significantly affected NCDs. However, the effect of social-environmental factors on behavioral risk factors was not supported. Furthermore, social-environmental factors and behavioral risk factors affect NCDs in a similar way. However, the effects of behavioral risk factors were smaller than those of social-environmental factors. The current research suggests taking a comprehensive view of risk factors to further understand the antecedents of NCDs in South Korea.

Exploring the Impact of Modifiable Factors on Serum BDNF in Psychiatric Patients and Community Controls

BACKGROUND

Brain-derived neurotrophic factor (BDNF) has been a focus of psychiatric research for the past two decades. BDNF has been shown to impact neural function and development. Studies have investigated serum BDNF as a biomarker for psychiatric disorders such as depression and schizophrenia. In some studies, investigators attempt to control for variables such as smoking status, exercise, or diet. However, the relationship between these factors and BDNF is not clearly established. Furthermore, some studies have questioned whether a difference in the impact of BDNF exists between psychiatric and healthy populations.

PURPOSE

We aim to examine the association between serum BDNF levels and modifiable risk factors such as body mass index (BMI), smoking, exercise levels, and diet. Subsequently, we aim to examine whether the relationship between these risk factors and serum BDNF is different between psychiatric and control populations.

PATIENTS AND METHODS

We use cross-sectional data from an age- and sex-matched case-control study of participants with psychiatric inpatients and community controls without psychiatric diagnoses. Participants completed comprehensive assessments at study enrolment including sociodemographic information, smoking status, exercise, diet, and BMI. Serum BDNF levels were collected from participants. Linear regression analysis was performed to determine the association between modifiable factors and serum BDNF level.

RESULTS

A significant association was found between sedentary activity level and lower serum BDNF levels (Beta coefficient = -2.49, 95% confidence interval [CI] -4.70, -0.28, p = 0.028). Subgroup analysis demonstrated that this association held for psychiatric inpatients but not for community controls; it also held in females (Beta coefficient = -3.18, 95% CI -6.29, -0.07, p = 0.045) but not in males (Beta coefficient = -1.42, 95% CI -4.61, 1.78, p = 0.383). Antidepressant use had a significantly different association between male (Beta coefficient = 3.20, 95% CI 0.51, 5.88, p = 0.020) and female subgroups (Beta coefficient = -3.10, 95% CI -5.75, -0.46, p = 0.022). No significant association was found between other factors and serum BDNF.

CONCLUSION

Sedentary activity level may lead to lower serum BDNF levels in individuals with psychiatric diagnoses. Our findings support the notion that physical activity can provide a positive impact as part of treatment for psychiatric illness.

Retrospective Assessment of Risk Factors for Head and Neck Cancer Among World Trade Center General Responders

Objective: To assess the reliability of a questionnaire designed to reconstruct risk factors for head and neck cancer relative to the 9/11 World Trade Center (WTC) response and over the lifetime. Methods: As part of a nested case-control study, 200 WTC Health Program (WTCHP) General Responder Cohort (GRC) members completed a newly-developed study questionnaire via telephone (with a trained interviewer) or online (self-administered). We assessed agreement between measures of tobacco and alcohol use in our questionnaire results and data collected previously during WTCHP-GRC monitoring visits using Cohens Kappa (κ) and intraclass correlation coefficient (ICC) for categorical and continuous measures, respectively. We compared agreement by disease status, survey mode, and year of WTCHP enrollment. Results: We observed high agreement between measures of lifetime, pre-WTC, and post-WTC smoking prevalence (all κ > 0.85) and smoking duration (all ICC > 0.84). There was moderate agreement between measures of smoking frequency (ICC: 0.61-0.73). Agreement between measures of smoking frequency, but not duration, differed by disease status, and agreement between smoking measures was higher for participants who completed our survey by phone than by web. Among cases, there were no differences based on enrollment in the WTCHP before or after diagnosis. Conclusion: Agreement between measures was generally high, although potential reporting bias and a mode effect that should be considered when interpreting analyses of self-reported data in this population; however differential misclassification appears to be minimal. Our questionnaire may be useful for future studies examining similar behavioral risk factors among disaster-exposed populations.

Prostate cancer in Pennsylvania: The role of older age at diagnosis, aggressiveness, and environmental risk factors on treatment and mortality using data from the Pennsylvania Cancer Registry

Background

To assess: (a) cancer treatment in prostate cancer survivors (PCS) by age at diagnosis (ADx) and prostate cancer (PC) aggressiveness; (b) potential impact on PC mortality; and (c) these results in the context of environmental/behavioral risk factors on PCS in Pennsylvania.

Methods

Prostate cancer survivors ages ≥40 years were identified from the 2004‐2014 Pennsylvania Cancer Registry (PCR). Demographic/clinical descriptors and PC treatment were extracted from PCR. Prostate cancer aggressiveness was defined by clinical/pathologic Gleason score and tumor stage. Logistic and Cox regression analyses tested associations between treatment received and PC‐specific mortality. County‐level data from the Pennsylvania BRFSS were used to estimate cancer‐related behavioral risk factors (eg, smoking, physical inactivity, fruit/vegetable consumption [FV], alcohol use) and used as covariates.

Results

There were 90 694 PCS ages 40‐105 years (mean age = 66.19 years, SD = 9.25) included. Most were non‐Hispanic white men (83%). Prostate cancer survivors ≥75 years were least likely to receive any treatment but men ages 65‐74 were more likely to receive combined therapies (OR = 1.47; 95% CI 1.28, 1.69) vs PCS ages 40‐54 years, controlling for covariates. Prostate cancer survivors 55‐75+ with aggressive PC who received any treatment vs no definitive treatment had significantly reduced mortality. Men from counties with high obesity and smoking rates were significantly less likely to receive any treatment than men living in counties with lower rates of these risk factors. Prostate cancer survivors who lived in counties with high rates of physical inactivity and had high rates of sufficient FV consumption were slightly more likely to receive cancer treatment vs no definitive treatment compared to men who lived in counties with high rates of physical activity and lower FV consumption.

Conclusions

We observed a general age‐related decline in receipt of treatment. Prostate cancer survivors ages ≥75 years were significantly less likely to get any cancer treatment compared to younger PCS. However, most men with more aggressive disease who received any treatment had greatly reduced PC mortality, regardless of age. Considering environmental/behavioral risk factors may attenuate PC risk and inform treatment options.

"There's Not Really Much Consideration Given to the Effect of the Climate on NCDs"-Exploration of Knowledge and Attitudes of Health Professionals on a Climate Change-NCD Connection in Barbados

Despite widespread awareness of the rise of non-communicable diseases (NCDs) and the growing threat of climate change, little research has explored future health outcomes that will occur at the intersection of these challenges. Ten Barbadian health professionals were interviewed to assess their knowledge of health risks of climate change as it relates to NCDs in Barbados as a case study of a small island state at risk. There is widespread concern among health professionals about the current and future prevalence of non-communicable diseases among Barbadians. There is less concern about the future burden of NCDs in the context of a changing climate, largely because of a lack of knowledge among the majority of the health experts interviewed. Those knowledgeable about potential connections noted the difficulty that climate change would pose to the prevention and management of NCDs, given the impacts of climate stressors to food security, the built environment, and physiological and psychosocial health impacts. Lack of awareness among health professionals of the risk climate change poses to NCD prevalence and impact is reflective of the country’s health priorities that fail to recognize the risk of climate change. We recommend efforts to disseminate information about climate change to stakeholders in the health sector to increase awareness.

Acceptability and Use of Interactive Voice Response Mobile Phone Surveys for Noncommunicable Disease Behavioral Risk Factor Surveillance in Rural Uganda: Qualitative Study

Background

There is need for more timely data to inform interventions that address the growing noncommunicable disease (NCD) epidemic. With a global increase in mobile phone ownership, mobile phone surveys can bridge this gap.

Objective

This study aimed to explore the acceptability and use of interactive voice response (IVR) surveys for surveillance of NCD behavioral risk factors in rural Uganda.

Methods

This qualitative study employed user group testing (UGT) with community members. The study was conducted at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Eastern Uganda. We conducted four UGTs which consisted of different categories of HDSS members: females living in urban areas, males living in urban areas, females living in rural areas, and males living in rural areas. Participants were individually sent an IVR survey, then were brought in for a group discussion using a semistructured guide. Data were analyzed thematically using directed content analysis.

Results

Participants perceived that IVR surveys may be useful in promoting confidentiality, saving costs, and raising awareness on NCD behavioral risk factors. Due to the clarity and delivery of questions in the local language, the IVR survey was perceived as easy to use. Community members suggested scheduling surveys on specific days and sending reminders as ways to improve their use for surveillance. Social issues such as domestic violence and perceptions toward unknown calls, technological factors including poor network connections and inability to use phones, and personal issues such as lack of access to phones and use of multiple networks were identified as barriers to the acceptability and use of mobile phone surveys. However, incentives were reported to motivate people to complete the survey.

Conclusions

Community members reflected on contextual and sociological implications of using mobile phones for surveillance of NCD behavioral risk factors. The opportunities and challenges that affect acceptability and use of IVR surveys should be considered in designing and implementing surveillance programs for NCD risk factors.

Prevalence and Correlates of Behavioral Non-Communicable Diseases Risk Factors among Adolescents in the Seychelles: Results of a National School Survey in 2015

The aim of this study was to investigate the prevalence and correlates of behavioral non-communicable disease (NCD) risk factors among a national sample of school-going adolescents in the Seychelles. Cross-sectional data were analyzed from 2540 school adolescents (median age 14 years, interquartile range = 2), in the Seychelles "Global School-Based Student Health Survey (GSHS)" in 2015. Behavioral NCD risk factors (current tobacco use, current alcohol use, inadequate fruit and vegetable consumption, soft drink consumption, overweight or obesity, physical inactivity, and leisure-time sedentary behavior) were assessed by self-report. Among the seven individual behavioral risk factors, the highest prevalence was physical inactivity (82.7%), followed by daily soft drink consumption (68.3%), inadequate fruit and vegetable consumption (60.9%), leisure-time sedentary behavior (51.0%), current alcohol use (47.6%), overweight or obesity (28.2%), and current tobacco use (23.4%). The total mean number of behavioral NCD risk factors was 3.6 (Standard Deviation = 1.3), and the proportion of co-occurrence of having three or more behavioral NCD risk factors was 80.7%. In adjusted linear regression analysis, male sex, older age, and psychological distress were positively, and school attendance and peer support were negatively associated with the total number of behavioral NCD risk factors. A high prevalence of multiple behavioral NCD risk factors were found and several associated factors were identified, such as male sex, older age, psychological distress, school truancy, and lack of peer support, which may help in aiding intervention programs in this population.

HIV, syphilis and behavioral risk factors among men who have sex with men in a drug-using area of southwestern China: Results of 3 cross-sectional surveys from 2013 to 2015

To assess human immunodeficiency virus (HIV), syphilis, and behavioral risk factors among men who have sex with men (MSM) in southwestern China, where HIV started as a drug-driven epidemic, and shifted to mainly heterosexual transmission.These cross-sectional studies were conducted yearly in 2013, 2014, and 2015 in Guangxi, China. A total of 1,996, 1,965, and 1,697 participants were recruited in 2013, 2014, and 2015, respectively. The data included demographic and sexual behavioral variables. Other variables included individuals who used illegal drugs, and who received HIV counseling, testing, and free condoms, and peer education. Participants were tested for HIV, syphilis, and hepatitis C virus (HCV) with whole blood specimens. Questionnaires and laboratory testing data were double entered, and validated with EpiData software. The data were then transferred into SPSS software (SPSS Inc, Chicago, IL) and Chi-square test performed.The prevalence of HIV was 6.6% in 2013, 8.4% in 2014, and 11.2% in 2015. The prevalence of syphilis was 9.3% in 2013, 9.8% in 2014, and 6.1% in 2015. And HCV prevalence was 0.5% in 2013 and remained stable at 0.4% in 2014, and 2015. HIV infection, and associated factors among MSM in these 3 annual cross-sectional survey showed that HIV-infected MSM were significantly, more likely, to perform unprotected anal intercourse with any commercial male partners in the past 6 months (adjusted odds ratio [AOR] = 1.81, 95% CI: 1.50-2.20), had sex with any female partners in the past 6 months (AOR = 1.31, 95% CI: 1.01-1.71), used drugs in the past (AOR = 2.73, 95% CI: 1.30-5.71), and are syphilis infected (AOR = 3.53, 95% CI: 2.77-4.49).There is an urgent need for intervention strategies like condom distribution, HIV counseling, free testing, and education regarding safe sex, HIV, and other sex-related diseases in Guangxi to curb, and prevent HIV among MSM.

Organ utilization from increased infectious risk donors: An observational study

BACKGROUND

Donors with an increased risk of transmitting human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) (increased risk donors [IRDs]) are a potential source of organs for transplant. Organs from IRDs can be utilized with appropriate recipient consent and post-transplant follow-up. We reviewed the characteristics and utilization of IRDs in our Organ Procurement Organization (OPO) over a 2-year period.

METHODS

Donor information from April 1, 2013 to March 31, 2015 was obtained through the OPO database. Only consented donors were included. Donors were categorized as IRDs according to Health Canada/Canadian Standards Association (CSA) criteria.

RESULTS

A total of 494 potential donors were identified, of which 92 (18.6%) were IRDs. Of these, at least one organ was transplanted from 76 (82.6%). Risk factors for IRDs included injection drug user (IDU) (12%), men having sex with men (MSM) (7%), commercial sex worker (CSW) (4%), and incarceration (24%). Fifty-nine percent (253/429) of IRD organs were utilized. The most frequently used organ was kidney, followed by liver. Median number of organs recovered per IRD was 3 (interquartile range: 2-5). Nucleic acid testing (NAT) was performed in 18.5% (17/92) of IRDs. Reasons for NAT were IDU (n = 2), MSM (n = 2), CSW (n = 2), and previous incarceration (n = 7). Organ utilization from donors that had NAT was similar to donors who did not (94% vs 80%, P = .29). Follow-up NAT was done in <5% of recipients from IRDs.

CONCLUSIONS

In our cohort, IRDs comprised a significant proportion of donors. Utilization of IRD organs occurred at a significant rate regardless of pre-transplant NAT. These data suggest that multiple factors contribute to the perception of infectious risk from such organs.

Chronic Disease and Health Risk Behaviors Among Rural Agricultural Workforce in Queensland

INTRODUCTION

Little is known of the lifestyle behaviors and prevalence of chronic disease in the Australian agricultural workforce. This study aimed to assess behavioral risk factors and the prevalence of chronic disease among attendees of agricultural events in rural Queensland.

METHODS

Data on lifestyle risk factors and prevalence of diabetes and cardiovascular diseases were collected from participants in four separate cross-sectional studies in rural southern Queensland. Anthropometric measures, blood pressure, serum cholesterol, and glucose levels of consenting participants were assessed by trained medical students under the supervision of rural clinicians. Data were analyzed using SPSS 22 statistical software package and t-tests and chi-square tests were used to compare differences between groups.

RESULTS

A total of 702 attendees participated; the majority were agricultural workers (n = 393). Greater psychological distress was reported among participants from these rural communities (42%) than in the Australian population (31%); however, levels of psychological distress was similar between agricultural workers and others in the sample. Fewer people in these agricultural communities reported smoking (10%), and they reported being more active (86%) than the average Australian, but a greater proportion reported high-risk alcohol consumption (53%) and were found to be hypertensive (31%). These findings were accentuated among agricultural workers.

CONCLUSION

This method of investigation both raises awareness in the community and identifies health risks for further management in a group that has otherwise been poorly defined. Resident agricultural workers have different health risks and behaviors, though psychological distress appears to be borne across these communities.

Postural habits and weight of backpacks of Portuguese adolescents: Are they associated with scoliosis and low back pain?

BACKGROUND

The adoption of incorrect postures or carrying overweight backpacks may contribute to the development of musculoskeletal disorders in school children.

OBJECTIVE

This study evaluated the weight of backpacks and the postural habits adopted in schools by Portuguese adolescents, and their association with scoliosis and low back pain (LBP).

METHOD

The sample comprised 966 Portuguese students, aged between 10 and 16 years. The instruments included a questionnaire to characterize the presence of LBP and the postural habits adopted by students, the weighing of backpacks and a scoliometer to evaluate scoliosis.

RESULTS

No association was observed between assuming incorrect postures and carrying overweight backpacks, in students with scoliosis. Students who adopted incorrect sitting postures had 1.77 times the risk (95% CI: 1.32-2.36; p < 0.001) of developing LBP; those positioned incorrectly whilst watching TV and playing games had 1.44 times the risk (95% CI: 1.08-1.90; p = 0.012) of developing LBP; and those standing incorrectly had 2.39 the risk (95% CI: 1.52-3.78; p < 0.001) of developing LBP.

CONCLUSIONS

The results revealed that students who sat with the spine positioned wrongly, as well as those who were standing incorrectly, were more likely to present with LBP.

[Assessment of caries risk factors among school-age children by comparing EGOHID scores in Minsk and Moscow]

The aim of the study was to assess the acceptability of the objective and subjective indicators for identification of oral diseases risk factors and the quality of dental care of school-aged children. The study included 200 school children of two age groups (12 and 15-year-old) surveyed in Minsk and Moscow cities using European global system of oral health indicators development (EGOHID). The modified WHO questionnaire was used to study behavioral habits of 15-year-old children. There were significant variations in the most indicators studied in different localities. An average DMFT of permanent teeth varied from 3.1 to 4.7 in 12-year-olds and from 5.5 to 6.5 in 15-year-olds. The prevalence of periodontal disease has reached 42%. The complex of objective and subjective evaluation of the teeth and gums status made it possible to reveal a number of risk factors. The majority of EGOHID indicators had shown satisfactory acceptability and specificity in assessing the risk factors and preliminary evaluation of a quality of dental care for school children. The EGOHID system is recommended for monitoring the preventive programs.

Assessment of 2013 AHA/ACC ASCVD risk scores with behavioral characteristics of an urban cohort in India: Preliminary analysis of Noncommunicable disease Initiatives and Research at AMrita (NIRAM) study

Cardiovascular diseases (CVDs) are the leading cause of death and disability in India. Early and sustained exposure to behavioral risk factors leads to development of CVDs.The aim of this study was to determine the baseline risk of a "hard CVD event" in subjects attending comprehensive health clinic and assess behavioral characteristics in "at risk" population.Using WHO STEPwise approach to Surveillance modified questionnaire, prevalence of noncommunicable diseases (NCDs) and risk factors was estimated in this cross-sectional study of 4507 subjects. Baseline cardiovascular risk was determined using Framingham risk score (FRS) and American College of Cardiology (ACC)/American Heart Association (AHA) atherosclerotic cardiovascular disease (ASCVD) algorithms. Modifiable behavior associated with high CVD risk was assessed. Among 40 to 59-year olds, ASCVD risk tool derived both a 10-year and lifetime risk score, which were used to stratify the cohort into 3 risk groups, namely, a high 10-year and high lifetime, a low 10-year and high lifetime, and a low 10-year and low lifetime risks.Dyslipidemia (30.6%), hypertension (25.5%), diabetes mellitus (20%), and obstructive airway disorders (17.6%) were most prevalent NCDs in our cohort. The ASCVD score stratified 26.1% subjects into high 10-yr and 59.5% into high lifetime risk while FRS classified 17.2% into high 10-year risk. Compared with FRS, the ASCVD risk estimator identified a larger proportion of subjects "at risk" of developing CVD. A high prevalence of alcohol use (38.4%), decreased intake of fruits and vegetables (96.2%) and low physical activity (58%) were observed in "at risk" population. Logistic regression analysis showed that in 40 to 59-year group, regular and occasional drinkers were 8.5- and 3.1-fold more likely to be in high 10-year and high lifetime ASCVD risk category than in low 10-year and low lifetime risk group. Similarly, regular drinkers and occasional drinkers were 2.1 and 1.3 times more likely to be in low 10-year and high lifetime risk than in low 10-year and low lifetime risk category. Subjects with inadequate intake of fruits and vegetables were 1.59 times more likely to be in low 10-year and high lifetime risk than the lower 10-year and lifetime risk group. Obese participants were 2.3-fold more likely to be in low 10-year and high lifetime risk.Identification of "at risk" subjects from seemingly healthy population will allow sustainable primary prevention strategies to reduce CVD.

Mapping Unhealthy Behavior Among Economically Active Men Using GIS in Suburban and Rural Areas of Sri Lanka

The burden of noncommunicable diseases (NCDs) and certain behavioral risk factors related to NCDs (unhealthy behaviors) are becoming more common. This survey aims to map out such common unhealthy behaviors among all men 35 to 50 years old in a Medical Officer of Health area in the Western Province of Sri Lanka using a geographical information system (GIS) and an interviewer administered questionnaire by visiting all households in the study area. Data were analyzed with ARC GIS and SPSS software. Geographical areas where men with unhealthy behaviors cluster together (clusters) were identified and visually and statistically related to locations of schools, places of religious worship, and factories in the area. It was revealed that clusters of unhealthy behaviors are mostly seen in areas with less population density. Smoking and alcohol are clustering in estate areas occupied by Tamils. This way GIS mapping could be used to identify and reduce the burden of NCDs by visualizing clusters and how certain locations affect their spread.

Prevalence of cardiovascular health risk behaviors in a remote rural community of Sindhuli district, Nepal

BACKGROUND

Cardiovascular disease (CVD) is emerging as a public health menace among low and middle income countries. It has particularly affected the poorest. However, there is paucity of information about CVD risk factors profile among Nepalese rural communities where the majority of people live in poverty. Therefore, this study aimed to identify the prevalence of cardiovascular health risk behaviors in an outback community of Nepal.

METHODS

We conducted a descriptive cross-sectional study in Tinkanya Village Development Committee (VDC), Sindhuli between January and March, 2014. Total 406 participants of age 20 to 50 years were selected randomly. Data were collected using WHO-NCD STEPwise approach questionnaires and analyzed with SPSS V.16.0 and R i386 2.15.3 software.

RESULT

The mean age of participants was 36.2 ± 9 years. Majority of participants (76.3%) were from lower socio-economic class, Adibasi/Janajati (63.1%), and without formal schooling (46.3%). Smoking was present in 28.6%, alcohol consumption in 47.8%, insufficient fruits and vegetables intake in 96.6%, insufficient physical activity in 48.8%; 25.6% had high waist circumference, 37.4% had overweight and obesity. Average daily salt intake per capita was 14.4 grams ±4.89 grams. Hypertension was detected in 12.3%. It had an inverse relationship with education and socio-economic status. In binary logistic regression analysis, age, smoking, body mass index (BMI) and daily salt intake were identified as significant predictors of hypertension.

CONCLUSION

Present study showed high prevalence of smoking, alcohol consumption, insufficient fruit and vegetable intake, daily salt intake, overweight and obesity and hypertension among remote rural population suggesting higher risk for developing CVD in future. Nepalese rural communities, therefore, are in need of population-wide comprehensive intervention approaches for reducing CVD health risk behaviors.

A systematic literature review of psychosocial and behavioral factors associated with initial medication adherence: a report of the ISPOR medication adherence & persistence special interest group

OBJECTIVES

Numerous factors influencing medication adherence in chronically ill patients are well documented, but the paucity of studies concerning initial treatment course experiences represents a significant knowledge gap. As interventions targeting this crucial first phase can affect long-term adherence and outcomes, an international panel conducted a systematic literature review targeting behavioral or psychosocial risk factors.

METHODS

Eligible published articles presenting primary data from 1966 to 2011 were abstracted by independent reviewers through a validated quality instrument, documenting terminology, methodological approaches, and factors associated with initial adherence problems.

RESULTS

We identified 865 potentially relevant publications; on full review, 24 met eligibility criteria. The mean Nichol quality score was 47.2 (range 19-74), with excellent reviewer concordance (0.966, P < 0.01). The most prevalent pharmacotherapy terminology was initial, primary, or first-fill adherence. Articles described the following factors commonly associated with initial nonadherence: patient characteristics (n = 16), medication class (n = 12), physical comorbidities (n = 12), pharmacy co-payments or medication costs (n = 12), health beliefs and provider communication (n = 5), and other issues. Few studies reported health system factors, such as pharmacy information, prescribing provider licensure, or nonpatient dynamics.

CONCLUSIONS

Several methodological challenges synthesizing the findings were observed. Despite implications for continued medication adherence and clinical outcomes, relatively few articles directly examined issues associated with initial adherence. Notwithstanding this lack of information, many observed factors associated with nonadherence are amenable to potential interventions, establishing a solid foundation for appropriate ongoing behaviors. Besides clarifying definitions and methodology, future research should continue investigating initial prescriptions, treatment barriers, and organizational efforts to promote better long-term adherence.

Health promotion in adolescent and young adult cancer survivors: mobilizing compliance in a multifaceted risk profile

With rising cure rates of childhood cancer, nurse practitioners have an increased chance of encountering a large survivor cohort in practice. A variety of late effects programs exist; however, funding is limited for these programs and is not accessible for all patients. Primary providers may increasingly act as a medical home for childhood cancer survivors (CCS). Understanding the inherent risks of cytotoxic treatment and the progressive consequences of late effects is vital to limit morbidity and mortality. Adolescent and young adult survivors (AYA) are particularly apt to make health behavior decisions that create risks for comorbidities. Developmentally appropriate experimentation with drug, alcohol, or tobacco use and increased ultraviolet ray exposure intensifies the risk for secondary malignancies and novel diseases. The paucity of evidence-based surveillance guidelines and survivor-specific health promotion programs cumulatively widen the gap in noncompliance and misinformation. This article overviews the risk profile of CCS. It explores health practices, as well as emerging health promotion techniques, within the AYA survivor population and the role nurse practitioners have in enhancing health maintenance.

The social patterns of a biological risk factor for disease: race, gender, socioeconomic position, and C-reactive protein

OBJECTIVE

Understand the links between race and C-reactive protein (CRP), with special attention to gender differences and the role of class and behavioral risk factors as mediators.

METHOD

This study utilizes the National Social Life, Health, and Aging Project data, a nationally representative study of older Americans aged 57-85 to explore two research questions. First, what is the relative strength of socioeconomic versus behavioral risk factors in explaining race differences in CRP levels? Second, what role does gender play in understanding race differences? Does the relative role of socioeconomic and behavioral risk factors in explaining race differences vary when examining men and women separately?

RESULTS

When examining men and women separately, socioeconomic and behavioral risk factor mediators vary in their importance. Indeed, racial differences in CRP among men aged 57-74 are little changed after adjusting for both socioeconomic and behavioral risk factors with levels 35% higher for black men as compared to white men. For women aged 57-74, however, behavioral risk factors explain 30% of the relationship between race and CRP.

DISCUSSION

The limited explanatory power of socioeconomic position and, particularly, behavioral risk factors, in elucidating the relationship between race and CRP among men, signals the need for research to examine additional mediators, including more direct measures of stress and discrimination.

A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors

BACKGROUND

To evaluate the effectiveness of interventions used in primary care to improve health literacy for change in smoking, nutrition, alcohol, physical activity and weight (SNAPW).

METHODS

A systematic review of intervention studies that included outcomes for health literacy and SNAPW behavioral risk behaviors implemented in primary care settings.We searched the Cochrane Library, Johanna Briggs Institute, Medline, Embase, CINAHL, Psychinfo, Web of Science, Scopus, APAIS, Australasian Medical Index, Google Scholar, Community of Science and four targeted journals (Patient Education and Counseling, Health Education and Behaviour, American Journal of Preventive Medicine and Preventive Medicine).Study inclusion criteria: Adults over 18 years; undertaken in a primary care setting within an Organisation for Economic Co-operation and Development (OECD) country; interventions with at least one measure of health literacy and promoting positive change in smoking, nutrition, alcohol, physical activity and/or weight; measure at least one outcome associated with health literacy and report a SNAPW outcome; and experimental and quasi-experimental studies, cohort, observational and controlled and non-controlled before and after studies.Papers were assessed and screened by two researchers (JT, AW) and uncertain or excluded studies were reviewed by a third researcher (MH). Data were extracted from the included studies by two researchers (JT, AW). Effectiveness studies were quality assessed. A typology of interventions was thematically derived from the studies by grouping the SNAPW interventions into six broad categories: individual motivational interviewing and counseling; group education; multiple interventions (combination of interventions); written materials; telephone coaching or counseling; and computer or web based interventions. Interventions were classified by intensity of contact with the subjects (High ≥ 8 points of contact/hours; Moderate >3 and <8; Low ≤ 3 points of contact hours) and setting (primary health, community or other).Studies were analyzed by intervention category and whether significant positive changes in SNAPW and health literacy outcomes were reported.

RESULTS

52 studies were included. Many different intervention types and settings were associated with change in health literacy (73% of all studies) and change in SNAPW (75% of studies). More low intensity interventions reported significant positive outcomes for SNAPW (43% of studies) compared with high intensity interventions (33% of studies). More interventions in primary health care than the community were effective in supporting smoking cessation whereas the reverse was true for diet and physical activity interventions.

CONCLUSION

Group and individual interventions of varying intensity in primary health care and community settings are useful in supporting sustained change in health literacy for change in behavioral risk factors. Certain aspects of risk behavior may be better handled in clinical settings while others more effectively in the community. Our findings have implications for the design of programs.

Preferences for genetic and behavioral health information: the impact of risk factors and disease attributions

Increased availability of genetic risk information may lead the public to give precedence to genetic causation over behavioral/environmental factors, decreasing motivation for behavior change. Few population-based data inform these concerns. We assess the association of family history, behavioral risks, and causal attributions for diseases and the perceived value of pursuing information emphasizing health habits or genes. 1,959 healthy adults completed a survey that assessed behavioral risk factors, family history, causal attributions of eight diseases, and health information preferences. Participants' causal beliefs favored health behaviors over genetics. Interest in behavioral information was higher than in genetic information. As behavioral risk factors increased, inclination toward genetic explanations increased; interest in how health habits affect disease risk decreased. Those at greatest need for behavior change may hold attributions that diminish interest in information for behavior change. Enhancing understanding of gene-environment influences could be explored to increase engagement with health information.

Prevalence of Sexually Transmitted Diseases and Risk Behaviors from the NIMH Collaborative HIV/STD Prevention Trial

This cross-sectional study describes the baseline prevalence and correlates of common bacterial and viral sexually transmitted diseases (STDs) and risk behaviors among individuals at high risk for HIV recruited in five low- and middle-income countries. Correlations of risk behaviors and demographic factors with prevalent STDs and the association of STDs with HIV prevalence are examined. Between 2,212 and 5,543 participants were recruited in each of five countries (China, India, Peru, Russia, and Zimbabwe). Standard protocols were used to collect behavioral risk information and biological samples for STD testing. Risk factors for HIV/STD prevalence were evaluated using logistic regression models. STD prevalence was significantly higher for women than men in all countries, and the most prevalent STD was Herpes simplex virus-type 2 (HSV-2). HIV prevalence was generally low (below 5%) except in Zimbabwe (30% among women, 11.7% among men). Prevalence of bacterial STDs was generally low (below 5% for gonorrhea and under 7% for syphilis in all sites), with the exception of syphilis among female sex workers in India. Behavioral and demographic risks for STDs varied widely across the five study sites. Common risks for STDs included female gender, increasing number of recent sex partners, and in some sites, older age, particularly for chronic STDs (i.e., HSV-2 and HIV). Prevalence of HIV was not associated with STDs except in Zimbabwe, which showed a modest correlation between HIV and HSV-2 prevalence (Pearson coefficient = .55). These findings underscore the heterogeneity of global STD and HIV epidemics and suggest that local, focused interventions are needed to achieve significant declines in these infections.

Lifestyle predicts falls independent of physical risk factors

SUMMARY

Many falls occur among older adults with no traditional risk factors. We examined potential independent effects of lifestyle on fall risk. Not smoking and going outdoors frequently or infrequently were independently associated with more falls, indicating lifestyle-related behavioral and environmental risk factors are important causes of falls in older women.

INTRODUCTION

Physical and lifestyle risk factors for falls and population attributable risks (PAR) were examined.

METHODS

We conducted a 4-year prospective study of 8,378 community-dwelling women (mean age = 71 years, SD = 3) enrolled in the Study of Osteoporotic Fractures. Data on number of falls were self-reported every 4 months. Fall rates were calculated (# falls/woman-years). Poisson regression was used to estimate relative risks (RR).

RESULTS

Physical risk factors (p < or = 0.05 for all) included tall height (RR = 0.89 per 5 in.), dizziness (RR = 1.16), fear of falling (RR = 1.20), self-reported health decline (RR = 1.19), difficulty with Instrumental Activities of Daily Living (IADLs) (RR = 1.12, per item), fast usual-paced walking speed (RR = 1.18, per 2 SD), and use of antidepressants (RR = 1.20), benzodiazepines (RR = 1.11), or anticonvulsants (RR = 1.62). Protective physical factors (p < or = 0.05 for all) included good visual acuity (RR = 0.87, per 2 SD) and good balance (RR = 0.85 vs. poor). Lifestyle predicted fewer falls including current smoking (RR = 0.76), going outdoors at least twice weekly but not more than once a day (RR = 0.89 and vs. twice daily). High physical activity was associated with more falls but only among IADL impaired women. Five potentially modifiable physical risk factors had PAR > or = 5%.

CONCLUSIONS

Fall interventions addressing modifiable physical risk factors with PAR > or = 5% while considering environmental/behavioral risk factors are indicated.

Identification of risk factors for breast cancer for women in istanbul

BACKGROUND

Breast cancer is the most common cancer type seen in women, accounts for 18% of all cancer types in women and the risk of a woman to get breast cancer during her life is 11%. These notified rates enable breast cancer to be defined as a preventable and if pre-diagnosed, a treatable cancer type, despite it was regarded as a terrifying type of cancer in the past.

OBJECTIVE

The aim of the study was to determine the lifestyle pattern of women without breast cancer in Istanbul.

METHOD

The study was carried out as a descriptive and cross-sectional study with 1000 women.

RESULTS

The majority of the women (29.7%) were in the 35-44 year old age group. Out of these 93.1% gave birth before the age of 30, 29.5% breastfed for 7-12 months, 65.8% started menarche between 13-15 years of age (mean of 13.3 years), 15.5% were in menopause and had entered menopause at a mean age of 46.5 years. Their mean body mass index was 24.3kg/m(2) and 24.5% of them preferred foods containing high fat content. The majority of the women (85.4%) did not participate in sports regularly. One third (30.3%) of the women had underwent Breast Self Examination. There was a positive family history of breast cancer for 12.1% of the women.

CONCLUSION

Sedentary lifestyles, lower Breast Self Examination and routine mammography rates and family histories of breast cancer were the risk factors that needed to be given priority for further action.