Health Behaviors Associated With Overweight and Obesity Among Physicians.

The Preventive Health Behaviors of Long-Term Survivors of Cancer and Hematopoietic Stem Cell Transplantation Compared with Matched Controls

BackgroundThe COVID-19 pandemic has radically shifted living practices, thereby influencing changes in the health status and behaviors of every person.ObjectiveThe aim of this study was to investigate the impact of COVID-19 on the self-reported health status and health behaviors along with any associated factors in adults in the Republic of Korea wherein no stringent lockdown measures were implemented during the pandemic.MethodsWe conducted a web-based self-reported survey from November 2020 to December 2020. The study participants (N=2097) were identified through quota sampling by age, sex, and geographical regions among residents aged 19 years or older in Korea. The survey collected information on basic demographics, changes in self-reported health status, and health behaviors during the COVID-19 pandemic. Self-reported health status and health behaviors were categorized into 3 groups: unchanged, improved, or worsened. A chi-square test and logistic regression analyses were conducted.ResultsWith regard to changes in the self-reported health status, the majority (1478/2097, 70.5%) of the participants reported that their health was unchanged, while 20% (420/2097) of the participants reported having worser health after the COVID-19 outbreak. With regard to changes in health behaviors, the proportion of participants who increased tobacco consumption was similar to that of those who decreased tobacco consumption (110/545, 20.2% vs 106/545, 19.5%, respectively), while the proportion of those who decreased their drinking frequency was more than twice as many as those who increased their drinking frequency (578/1603, 36.1% vs 270/1603, 16.8%, respectively). Further, those who decreased their exercising frequency were more than those who increased their exercising frequency (333/823, 15.9% vs 211/823, 10%, respectively). The factor that had the greatest influence on lifestyle was age. In the subgroup analysis, the group aged 20-29 years had the highest number of individuals with both a worsened (100/377, 26.5%) and an improved (218/377, 15.7%) health status. Further, individuals aged 20-29 years had greater odds of increased smoking (6.44, 95% CI 2.15-19.32), increased alcohol use (4.64, 95% CI 2.60-8.28), and decreased moderate or higher intensity aerobic exercise (3.39, 95% CI 1.82-6.33) compared to individuals aged 60 years and older. Younger adults showed deteriorated health behaviors, while older adults showed improved health behaviors.ConclusionsThe health status and the behavior of the majority of the Koreans were not found to be heavily affected by the COVID-19 outbreak. However, in some cases, changes in health status or health behavior were identified. This study highlighted that some groups were overwhelmingly affected by COVID-19 compared to others. Certain groups reported experiencing both worsening and improving health, while other groups reported unchanged health status. Age was the most influential factor for behavior change; in particular, the younger generation’s negative health behaviors need more attention in terms of public health. As COVID-19 prolongs, public health interventions for vulnerable groups may be needed.

BackgroundAlthough African immigrants represent a large and growing segment of the U.S. population, there are little or no data available on the prevalence of cardiovascular disease (CVD) risk factors among this diverse population. This study compared the prevalence of self-reported CVD risk factors and health behaviors and examined the associations between immigration related characteristics and CVD risk factors and health behaviors across six African immigrants groups.MethodsData were from 996 African immigrants in the U.S., (37.9% Somalis; 26.8% Ethiopians; 14% Liberians; 8.5% Sudanese; 5.1% Kenyans and 7.8% others group) from a cross-sectional survey conducted in the Twin cities of Minnesota. Logistic regression models estimated the associations of demographic characteristics, and immigration-related factors (length of stay in the United states, English proficiency, income and health insurance) with prevalence of CVD risk factors (overweight/obese; hypertension and diabetes mellitus) and self-reported health behaviors (cigarette smoking, physical inactivity, conscious effort to exercise and eating a healthy diet).ResultsWe found a relatively low self-reported prevalence of diabetes, hypertension, and smoking. However, significant differences were noted by country of origin. Using Somalis as our referent country of origin group, we found that Liberians and Kenyans were more likely to report having diabetes or hypertension. On all measures of health behaviors, Liberians were more likely to engage in more health protective behaviors than other individuals.ConclusionsAlthough African immigrants have different prevalence rates for CVD risk factors and health behaviors, there is a need to further explore the differences observed by country of emigration.

Workplace wellness programs aim to improve employee health and lower health care spending. Recent randomized studies have found modest short-run effects on health behaviors, but longer-run effects remain poorly understood. We analyzed a clustered randomized trial of a workplace wellness program implemented at a large multisite US employer. Twenty-five randomly selected treatment worksites received the program, with five of the worksites added at the trial's midpoint, and 135 randomly selected control worksites did not. The program included modules on nutrition, physical activity, and stress reduction, implemented by registered dietitians. The effects of program availability and participation were assessed. At the end of three years, employees at the treatment worksites had better self-reported health behaviors, including a higher rate of actively managing their weight. No significant differences were found in self-reported health; clinical markers of health; health care spending or use; or absenteeism, tenure, or job performance. Improvements in health behaviors after three years were similar to those at eighteen months, but the longer follow-up did not yield detectable improvements in clinical, economic, or employment outcomes.

Introduction : 'Gesundes Kinzigtal' (GK) is a population-based integrated care pilot in Germany and is commonly rated a ‚flagship project‘ among Germany’s integrated care approaches. Founded in 2006, GK is managed by Gesundes Kinzigtal Ltd., in which the local physicians’ network has the majority of shares. GK cooperates with two statutory health insurers, AOK and LKK, whose insurants (about 33.000 people) are entitled to enroll into GK Integrated Care. About 10.000 insureds have enrolled into GK until now as active members. Besides GK’s general emphasis on prevention and health promotion, an important focus of GK’s strategy is to activate and empower patients. Correspondingly, the majority of GK members participate in preventive or health management programs offered by GK, and members are encouraged to agree on individual health or treatment goals with their respective doctors of trust. Since 2013, a trend study surveys GK members’ satisfaction every two years. In this contribution we will give interim answers to the following questions: 1) How do GK members assess some key features of GK Integrated Care? 2) What is the level of global patient satisfaction with GK, i.e. in what degree would GK members recommend others to become a member? 3) To which degree do these parameters change over time? Methods : The first survey of the trend study was conducted in 2013, the first follow-up survey in 2015. In 2013, 3.034 GK members were randomly selected and received a standardized questionnaire by mail (in which they were asked to participate in the survey). In 2015, 3.471 members were asked to participate. Participating members sent their completed questionnaire to an independent research institution. Target variables in the questionnaire were: Satisfaction with the doctor of trust (Weisse-Liste-Arzte questionnaire), patient activation (PAM-13-D), health-related quality of life (EQ-5D, EQ-VAS), satisfaction with GK (3 self-developed items), perceived health maintenance and health behaviour (2 self-developed items). In the following we present bivariate analyses of variables indicating patient satisfaction with GK, perceived change of overall care quality, perceived change of health behaviour and health maintenance. Results : The response rates (evaluable response) amounted to 23 % (n=711) in the first survey and to 25 % (n=863) in the first follow-up survey. Among the responders, women and older people were slightly over-represented. In 2013, 39.9 % (95% CI: 36.2 – 44.1) of the respondents felt “somewhat” or “considerably better cared for“ after they had enrolled into GK; in 2015 this proportion amounted to 41.1 % (95% CI: 37,5 - 44,3). When adjusted for age and sex, the results amount to 39.0% (95% CI: 35.4 - 42.7) in 2013 and 41.5% (95% CI: 38.1 - 45.0) in 2015. The proportion of respondents who indicated that they knew now “better how to maintain or improve“ their own health, compared to the time prior to their enrollment, practically remained the same (2013: 57,4%; 2015: 57,7 %; adjusted for age and sex: 56.9% in 2013 vs. 58.1% in 2015). The proportion of those who indicated a more effective health behaviour after their enrollment (2013: 26.1%, 95% CI: 22.8 – 29.8) increased remarkably in the first follow-up survey (2015: 30.6%, 95% CI: 27.3 – 33.7). When adjusted for age and sex, these proportions amount to 25.6% (95% CI: 22.3 - 28.9) in 2013 vs. 30.7% (95% CI: 27.6 - 34.0) in 2015; this increase is statistically significant (p Discussion and conclusion : Members‘ global satisfaction with GK Integrated Care seems to be fairly high: more than 90% would recommend also their friends or relatives to become a member of GK. High global satisfaction values are a very common phenomenon. Therefore the changes of the respective parameters over time seem to provide more valid insights than the levels of these parameters at a given point of time. Our interim results show a largely stable satisfaction with GK Integrated Care over time. This is not surprising after only one follow-up survey. Nonetheless, one parameter displays a noteworthy increase between the first and the second survey: Members’ self-reported health behaviour has significantly improved between 2013 and 2015 (when adjusted for age and sex). This might be attributed to GK’s attempts to activate and empower their members. Biannual surveys will assess future trends of the above-mentioned indicators.

Objectives Preterm birth is the leading pregnancy outcome associated with perinatal morbidity and mortality and remains difficult to prevent. There is evidence that some modifiable maternal health characteristics may influence the risk of preterm birth. Our aim was to investigate the relationships of self-reported maternal health behaviour and psychological characteristics in nulliparous women with spontaneous preterm birth in prenatal primary care. Methods The data of our prospective study was obtained from the nationwide DELIVER multicentre cohort study (September 2009–March 2011), which was designed to examine perinatal primary care in the Netherlands. In our study, consisting of 2768 nulliparous women, we estimated the relationships of various self-reported health behaviours (smoking, alcohol consumption, folic acid supplementation, daily fruit, daily fresh vegetables, daily hot meal and daily breakfast consumption) and psychological characteristics (anxious/depressed mood and health control beliefs) with spontaneous preterm birth as a dichotomous outcome. Due to the clustering of clients within midwife practices, Generalized Estimating Equations was used for these analyses. Results Low health control beliefs was the sole characteristic significantly associated with spontaneous preterm birth (odds ratio 2.26; 95 % confidence interval 1.51, 3.39) after being adjusted for socio-demographics, anthropometrics and the remaining health behaviour and psychological characteristics. The other characteristics were not significantly associated with spontaneous preterm birth. Conclusions for Practice Maternal low health control beliefs need to be explored further as a possible marker for women at risk for preterm birth, and as a potentially modifiable characteristic to be used in interventions which are designed to reduce the risk of spontaneous preterm birth.

Employers have increasingly invested in workplace wellness programs to improve employee health and decrease health care costs. However, there is little experimental evidence on the effects of these programs. To evaluate a multicomponent workplace wellness program resembling programs offered by US employers. This clustered randomized trial was implemented at 160 worksites from January 2015 through June 2016. Administrative claims and employment data were gathered continuously through June 30, 2016; data from surveys and biometrics were collected from July 1, 2016, through August 31, 2016. There were 20 randomly selected treatment worksites (4037 employees) and 140 randomly selected control worksites (28 937 employees, including 20 primary control worksites [4106 employees]). Control worksites received no wellness programming. The program comprised 8 modules focused on nutrition, physical activity, stress reduction, and related topics implemented by registered dietitians at the treatment worksites. Four outcome domains were assessed. Self-reported health and behaviors via surveys (29 outcomes) and clinical measures of health via screenings (10 outcomes) were compared among 20 intervention and 20 primary control sites; health care spending and utilization (38 outcomes) and employment outcomes (3 outcomes) from administrative data were compared among 20 intervention and 140 control sites. Among 32 974 employees (mean [SD] age, 38.6 [15.2] years; 15 272 [45.9%] women), the mean participation rate in surveys and screenings at intervention sites was 36.2% to 44.6% (n = 4037 employees) and at primary control sites was 34.4% to 43.0% (n = 4106 employees) (mean of 1.3 program modules completed). After 18 months, the rates for 2 self-reported outcomes were higher in the intervention group than in the control group: for engaging in regular exercise (69.8% vs 61.9%; adjusted difference, 8.3 percentage points [95% CI, 3.9-12.8]; adjusted P = .03) and for actively managing weight (69.2% vs 54.7%; adjusted difference, 13.6 percentage points [95% CI, 7.1-20.2]; adjusted P = .02). The program had no significant effects on other prespecified outcomes: 27 self-reported health outcomes and behaviors (including self-reported health, sleep quality, and food choices), 10 clinical markers of health (including cholesterol, blood pressure, and body mass index), 38 medical and pharmaceutical spending and utilization measures, and 3 employment outcomes (absenteeism, job tenure, and job performance). Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months. Although limited by incomplete data on some outcomes, these findings may temper expectations about the financial return on investment that wellness programs can deliver in the short term. ClinicalTrials.gov Identifier: NCT03167658.

BackgroundStudies have suggested associations between self-reported engagement in health behaviors and reduced risk of cognitive decline. Most studies explore these relationships using one health behavior, often cross-sectionally or with dementia as the outcome. In this study, we explored whether several individual self-reported health behaviors were associated with cognitive decline when considered simultaneously, using data from the Wisconsin Registry for Alzheimer’s Prevention (WRAP), an Alzheimer’s disease risk-enriched cohort who were non-demented and in late midlife at baseline.MethodWe analyzed longitudinal cognitive data from 828 participants in WRAP, with a mean age at baseline cognitive assessment of 57 (range = 36–78, sd = 6.8) and an average of 6.3 years (standard deviation = 1.9, range = 2–10) of follow-up. The primary outcome was a multi-domain cognitive composite, and secondary outcomes were immediate/delayed memory and executive function composites. Predictors of interest were self-reported measures of physical activity, cognitive activity, adherence to a Mediterranean-style diet (MIND), and interactions with each other and age. We conducted linear mixed effects analyses within an Information-theoretic (IT) model averaging (MA) approach on a set of models including covariates and combinations of these 2- and 3-way interactions. The IT approach was selected due to the large number of interactions of interest and to avoid pitfalls of traditional model selection approaches.ResultsModel-averaged results identified no significant self-reported health behavior*age interactions in relationship to the primary composite outcome. In secondary outcomes, higher MIND diet scores associated with slower decline in executive function. Men showed faster decline than women on delayed memory, independent of health behaviors. There were no other significant interactions among any other health behaviors and cognitive trajectories.ConclusionsWhen multiple covariates and health behaviors were considered simultaneously, there were limited weak associations with cognitive decline in this age range. These results may be explained alone or in combination by three alternative explanations: 1) the range of cognitive decline is in middle age is too small to observe relationships with health behaviors, 2) the putative associations of these health behaviors on cognition may not be robust in this age range, or 3) the self-reported measures of the health behaviors may not be optimal for predicting cognitive decline. More study may be needed that incorporates sensitive measures of health behaviors, AD biomarker profiles, and/or other disease comorbidities.

BackgroundThe objective of this study was to estimate changes over time in health status and selected health behaviours during the Great Recession, in the period 2011/12, in Spain, both overall, and according to socioeconomic position and gender.MethodsWe applied a before-after estimation on data from four editions of the Spanish National Health Survey: 2001, 2003/04, 2006/07 and 2011/12. This involved applying linear probability regression models accounting for time-trends and with robust standard errors, using as outcomes self-reported health and health behaviours, and as the main explanatory variable a dummy “Great Recession” for the 2011/12 survey edition. All the computations were run separately by gender. The final sample consisted of 47,156 individuals aged between 25 and 64 years, economically active at the time of the interview. We also assessed the inequality of the effects across socio-economic groups.ResultsThe probability of good self-reported health increased for women (men) by 9.6 % (7.6 %) in 2011/12, compared to the long term trend. The changes are significant for all educational levels, except for the least educated. Some healthy behaviours also improved but results were rather variable. Adverse dietary changes did, however, occur among men (though not women) who were unemployed (e.g., the probability of declaring eating fruit daily changed by −12.1 %), and among both men (−21.8 %) and women with the lowest educational level (−15.1 %).ConclusionsSocioeconomic inequalities in health and health behaviour have intensified, in the period 2011/12, in at least some respects, especially regarding diet. While average self-reported health status and some health behaviours improved during the economic recession, in 2011/12, this improvement was unequal across different socioeconomic groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2204-5) contains supplementary material, which is available to authorized users.

This study explored associations among family communication patterns (conversation and conformity orientations), health-specific communication variables, health attitudes, and health behaviors in a sample of 433 family dyads (N = 866). As expected, results of multilevel models revealed that individuals’ health attitudes were strongly associated with their self-reported health behaviors. Findings also suggested that perceived confirmation from a family member during health-specific conversations (a) directly influenced health attitudes, (b) partially accounted for the positive relationship between family conversation orientation and health attitudes, and (c) partially accounted for the inverse relationship between family conformity orientation and health attitudes. Similarly, frequency of health-specific communication (a) directly influenced health attitudes, (b) partially accounted for the positive relationship between family conversation orientation and health attitudes, and (c) directly associated with health behaviors. Results from an actor-partner interdependence model (APIM) supported the aforementioned within-person association between a person's own health attitudes and health behaviors, as well as a positive relationship between young adults’ health attitudes and their influential family member's health behaviors. Implications of these findings are discussed as they relate to theory and obesity prevention.

Health Behaviors and Health Promotion/Disease Prevention Perceptions of Medical Students

This study monitored trends in health behavior and attitudes of 93 adolescents who, according to clinical measures, were classified "at risk" for cardiovascular disease and determined the relationship among their health status, behavior, and attitude over a four-year period. Data collected included biomedical measures and self-reported health behaviors and attitudes. A greater proportion of "at risk" students reported negative health behavior changes in smoking, diet, alcohol, and stress. However, a positive health behavior trend was noted with respect to smokeless tobacco use declining from a high of 14% as freshmen to 8% as seniors. Also, students appeared sensitive to the potentially harmful effects of smoking. In general, a positive relationship existed among health status, health attitudes, and behavior. The findings justify screening to identify students "at risk" and beginning early intervention to prevent chronic disease in later life.

The relationships among physical activity, sedentary behaviour, obesity and quitting behaviours within a cohort of smokers in California

Our study aims to determine whether receipt of a written survivorship care plan (SCP) is associated with five self-reported health behaviors known to be correlated with positive long-term outcomes for cancer survivors: (1) attending a recent medical appointment, (2) exercise in the past month, (3) non-smoking status, (4) mammography in the past 2years, and (5) up-to-date colorectal cancer screening. In this secondary data analysis, we used data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) cancer survivorship module for 1855 off-treatment cancer survivors. Multivariable logistic regression accounting for complex survey design was used to examine the association between SCP receipt and each of the five preventive health behaviors. Overall, 37% (669/1855) of survivors reported receiving a written survivorship care plan. In the logistic regression models adjusted for sociodemographic and disease-related factors, SCP receipt was associated with having a recent medical appointment (OR (95% CI) 2.81 (1.27-6.22)), exercise in the past month (1.78 (1.20-2.63)), non-smoking status (2.27 (1.26-4.12)), and up-to-date mammography (2.25 (1.30-3.88)). Receipt of a survivorship care plan was not associated with colorectal cancer screening (1.2 (0.73-2.03)). This study provides preliminary evidence that SCPs may be helpful in promoting health behaviors among cancer survivors, including attending a regular medical appointment, mammography screening, exercise, and abstinence from smoking. Additionally, the low rates of SCP provision highlight an important missed opportunity and area for intervention. Providing survivors with SCPs may help to increase important health behaviors.

Classes of outpatient quality of care among individuals with substance-related disorders, based on a survey and health insurance registry.