Community-based Sample Of Adults Research Articles

Illness Beliefs About Cancer Among Healthy Adults Who have and have not Lived with Cancer Patients

Illness representations have been proposed as key determinants for facing health risks and managing disease, and consequently for health outcomes. This study aims to know and compare non-specialised illness representations of cancer among adults who had not suffered from cancer and who had/had not lived with cancer patients. The revised Illness Perception Questionnaire was adapted to assess illness perceptions among healthy people. Cancer representations were explored in a community-based sample of adults of both genders from different educational backgrounds and who had differing experience with cancer, none being a patient. The participants' beliefs about cancer included both biomedical and folk knowledge. Compared to age, sex, and educational level, family experience with cancer (having lived or not with a patient) had the strongest impact on the contents of the representations on cancer. Further, people with a family experience with the disease, compared to those not having a relative diagnosed with cancer, reported significantly more symptoms and stronger emotional impact. This study allowed us to establish the perceptions on cancer of non-patients with no specialised knowledge. Findings may help in designing and implementing tailored preventive interventions taking into account family experience with the disease, as well as interventions aimed at enhancing family and social care and support given to cancer patients.

The positive mental health instrument: development and validation of a culturally relevant scale in a multi-ethnic asian population

BackgroundInstruments to measure mental health and well-being are largely developed and often used within Western populations and this compromises their validity in other cultures. A previous qualitative study in Singapore demonstrated the relevance of spiritual and religious practices to mental health, a dimension currently not included in exiting multi-dimensional measures. The objective of this study was to develop a self-administered measure that covers all key and culturally appropriate domains of mental health, which can be applied to compare levels of mental health across different age, gender and ethnic groups. We present the item reduction and validation of the Positive Mental Health (PMH) instrument in a community-based adult sample in Singapore.MethodsSurveys were conducted among adult (21-65 years) residents belonging to Chinese, Malay and Indian ethnicities. Exploratory and confirmatory factor analysis (EFA, CFA) were conducted and items were reduced using item response theory tests (IRT). The final version of the PMH instrument was tested for internal consistency and criterion validity. Items were tested for differential item functioning (DIF) to check if items functioned in the same way across all subgroups. Results: EFA and CFA identified six first-order factor structure (General coping, Personal growth and autonomy, Spirituality, Interpersonal skills, Emotional support, and Global affect) under one higher-order dimension of Positive Mental Health (RMSEA = 0.05, CFI = 0.96, TLI = 0.96). A 47-item self-administered multi-dimensional instrument with a six-point Likert response scale was constructed. The slope estimates and strength of the relation to the theta for all items in each six PMH subscales were high (range:1.39 to 5.69), suggesting good discrimination properties. The threshold estimates for the instrument ranged from -3.45 to 1.61 indicating that the instrument covers entire spectrums for the six dimensions. The instrument demonstrated high internal consistency and had significant and expected correlations with other well-being measures. Results confirmed absence of DIF.ConclusionsThe PMH instrument is a reliable and valid instrument that can be used to measure and compare level of mental health across different age, gender and ethnic groups in Singapore.

Household food insecurity and symptoms of neurologic disorder in Ethiopia: an observational analysis.

BackgroundFood insecurity (FI) has been shown to be associated with poor health both in developing and developed countries. Little is known about the relation between FI and neurological disorder. We assessed the relation between FI and risk for neurologic symptoms in southwest Ethiopia.MethodsData about food security, gender, age, household assets, and self-reported neurologic symptoms were collected from a representative, community-based sample of adults (N = 900) in Jimma Zone, Ethiopia. We calculated univariate statistics and used bivariate chi-square tests and multivariate logistic regression models to assess the relation between FI and risk of neurologic symptoms including seizures, extremity weakness, extremity numbness, tremors/ataxia, aphasia, carpal tunnel syndrome, vision dysfunction, and spinal pain.ResultsIn separate multivariate models by outcome and gender, adjusting for age and household socioeconomic status, severe FI was associated with higher odds of seizures, movement abnormalities, carpal tunnel, vision dysfunction, spinal pain, and comorbid disorders among women. Severe FI was associated with higher odds of seizures, extremity numbness, movement abnormalities, difficulty speaking, carpal tunnel, vision dysfunction, and comorbid disorders among men.ConclusionWe found that FI was associated with symptoms of neurologic disorder. Given the cross-sectional nature of our study, the directionality of these associations is unclear. Future research should assess causal mechanisms relating FI to neurologic symptoms in sub-Saharan Africa.

Obesity and Asthma Morbidity in a Community-Based Adult Cohort in a Large Urban Area: The Chicago Initiative to Raise Asthma Health Equity (CHIRAH)

Background. Urban minority populations experience increased rates of obesity and increased asthma prevalence and severity. Objective. The authors sought to determine whether obesity, as measured by body mass index (BMI), was associated with asthma quality of life or asthma-related emergency department (ED)/urgent care utilization in an urban, community-based sample of adults. Methods. This is a cross-sectional analysis of 352 adult subjects (age 30.9 ± 6.1, 77.8% females, forced expiratory volume in one second (FEV1)% predicted = 87.0% ± 18.5%) with physician-diagnosed asthma from a community-based Chicago cohort. Outcome variables included the Juniper Asthma Quality of Life Questionnaire (AQLQ) scores and health care utilization in the previous 12 months. Bivariate tests were used as appropriate to assess the relationship between BMI or obesity status and asthma outcome variables. Multivariate regression analyses were performed to predict asthma outcomes, controlling for demographics, income, depression score, and β-agonist use. Results. One hundred ninety-one (54.3%) adults were obese (BMI > 30 kg/m2). Participants with a higher BMI were older (p = .008), African American (p < .001), female (p = .002), or from lower income households (p = .002). BMI was inversely related to overall AQLQ scores (r = −.174, p = .001) as well as to individual domains. In multivariate models, BMI remained an independent predictor of AQLQ. Obese participants were more likely to have received ED/urgent care for asthma than nonobese subjects (odds ratio [OR] = 1.8, p = .036). Conclusions. In a community-based sample of urban asthmatic adults, obesity was related to worse asthma-specific quality of life and increased ED/urgent care utilization. However, compared to other variables measured such as depression, the contribution of obesity to lower AQLQ scores was relatively modest.

Onset of depressive symptoms among adults with asthma: results from a longitudinal observational cohort

Individuals with asthma may be at increased risk of depression, but few studies have identified precursors to the onset of depression. The study goal was to identify risk factors for depression onset among a community-based sample of adults with asthma. Data were obtained from three telephone interviews conducted at 2-yearly intervals on a longitudinal cohort of adults with asthma (n=439). The Center for Epidemiologic Studies Depression scale (CESD) was used to measure depressive symptoms. Multiple regression analyses tested associations of sociodemographic and health-related variables with depression prevalence (cross-sectional analyses) and incident depression (longitudinal analyses). 15% of subjects were classified as "depressed" (CESD> or =23) at each interview. Individuals depressed at baseline were more likely to drop out (OR=1.76 [95% CI 1.05, 2.96]). Low perceived control of asthma (measured with the Perceived Control of Asthma Questionnaire [PCAQ]) exhibited the most consistent association with depression. Lower PCAQ was cross-sectionally associated with depression (OR=0.51 per 0.5 SD difference in PCAQ [0.35, 0.75]). Onset of depression was noted in 38 individuals. Decrease in perceived control at follow-up was associated with depression onset (OR=7.47 [2.15, 26.01]). Low perceived control of asthma predicted depression onset among adults with asthma. This risk factor may respond to self-management education.

Filipino Americans and racism: A multiple mediation model of coping.

Although the literature on Asian Americans and racism has been emerging, few studies have examined how coping influences one's encounters with racism. To advance the literature, the present study focused on the psychological impact of Filipino Americans' experiences with racism and the role of coping as a mediator using a community-based sample of adults (N = 199). Two multiple mediation models were used to examine the mediating effects of active, avoidance, support-seeking, and forbearance coping on the relationship between perceived racism and psychological distress and self-esteem, respectively. Separate analyses were also conducted for men and women given differences in coping utilization. For men, a bootstrap procedure indicated that active, support-seeking, and avoidance coping were mediators of the relationship between perceived racism and psychological distress. Active coping was negatively associated with psychological distress, whereas both support seeking and avoidance were positively associated with psychological distress. A second bootstrap procedure for men indicated that active and avoidance coping mediated the relationship between perceived racism and self-esteem such that active coping was positively associated with self-esteem, and avoidance was negatively associated with self-esteem. For women, only avoidance coping had a significant mediating effect that was associated with elevations in psychological distress and decreases in self-esteem. The results highlight the importance of examining the efficacy of specific coping responses to racism and the need to differentiate between the experiences of men and women.

Comorbidity of Axis I and II Mental Disorders with Schizophrenia and Psychotic Disorders: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

To examine the comorbidity of Axis I and II disorders within a community-based sample of adults with schizophrenia. The study was conducted using data from the National Epidemiologic Survey of Alcohol and Related Conditions. A diagnosis of schizophrenia was based on respondents' self-report that they had been diagnosed by a health professional with schizophrenia or a psychotic illness or episode (SPIE). Axis I disorders and Axis II personality disorders (PDs) were assessed using the Alcohol Use Disorders and Associated Disabilities Interview Schedule. Mental and physical quality of life were assessed using the Medical Outcomes Study Short Form 12 questionnaire. The prevalence of SPIE was 0.9%. We used multiple logistic regression to examine the association between the presence and absence of SPIE in Axis I and II mental disorders. Each of the Axis I and II mental disorders examined were significantly associated with a diagnosis of SPIE after controlling for age, sex, education, marital status, and household income. Clinicians should be aware of the patterns and extent of psychiatric comorbidities that may exist in schizophrenia. Possible mechanisms of these associations are discussed.

Anxiety Sensitivity as a Moderator of the Association between Smoking Rate and Panic‐Relevant Symptoms among a Community Sample of Middle‐aged Adult Daily Smokers

The aim of the present investigation was to evaluate the moderating role of anxiety sensitivity (AS) in the relation between smoking rate and panic vulnerability variables among a community-based sample of adults. Results indicated that the interaction between AS and smoking rate significantly predicted anxious arousal, agoraphobic avoidance, and anticipatory anxiety. Specifically, participants who reported higher levels of AS and heavier smoking rates reported the highest levels of panic vulnerability. These data suggest that this combination of high AS and heavier smoking is particularly problematic in regard to panic symptoms.

The relationship of self-management and disease modifying therapy use to employment status among adults with multiple sclerosis

Peoplewithmultiplesclerosis(MS)mayfacenumerousbarrierstoemploymentretention.Comprehensivelyunderstand- ing these barriers is important for implementing effective vocational rehabilitation interventions. Although several demographic and MS-related variables have consistently been found to be related to employment status, self-management and adherence to treatment have infrequently been evaluated in this context. This article explores the relationships between employment status and the use of disease-modifying therapy and self-management among a community-based sample of adults with MS using both bivariate and multivariate analyses. Group comparisons between employed and unemployed adults with MS suggested that both self-management and DMT use are significantly related to employment. In a stepwise binary logistic regression analysis, age, duration in years diagnosed with MS, and scores on a multi-dimensional MS self-management scale were positively related to employment. The results are discussed in terms of their implications for rehabilitation intervention.

Influence of social network characteristics on cognition and functional status with aging

To determine whether more frequent engagement in larger social networks, and more emotional support protect against cognitive and functional decline with aging. We examined the influence of social networks on cognition and instrumental activities of daily living (IADLs) over a median interval of 10.9 years. Data were from the Baltimore follow-up of the Epidemiologic Catchment Area (ECA) study, a community-based sample of adults in eastern Baltimore. Eight hundred and seventy-four participants completed cognitive testing at both the third and fourth study waves (1993-1996 and 2003-2004) on the Mini-Mental State Examination (MMSE) and a delayed word recall task. Functional status at both waves was self-reported on the Lawton-Brody IADL scale. Social network characteristics, assessed at the third study wave, included network size, frequency of contact, and emotional support. In cross-sectional analyses at wave 3, larger networks were associated with higher MMSE and better delayed recall scores. This association persisted after adjustment for covariates. More emotional support was associated with better functional status, before and after adjustment. By contrast, social networks were not longitudinally associated with cognitive change, with two counter-intuitive exceptions: more frequent contact and more emotional support were associated with worse delayed recall and IADL scores after adjustment. There was no evidence of a longitudinal association between social networks and cognition or IADLs, although a clear cross-sectional association exists. Together, these findings suggest the emergence of social isolation in individuals declining in cognition and functioning, rather than a protective effect of social networks.

Comorbid Depression and Anxiety in Later Life: Patterns of Association, Subjective Well-being, and Impairment

Very little epidemiological work has examined comorbidity between depression and anxiety disorders in community-dwelling older adults, despite the fact these disorders are known to co-occur in younger adults and that this co-occurrence is associated with greater clinical severity. In this study, the authors examine psychiatric comorbidity and associated impairment of four disorders (major depression, panic disorder, social phobia, and agoraphobia) in a community-based sample of adults aged 55 and older. Population-based sample of older adults (N=12,792) from the Canadian Community Health Survey-Mental Health and Well-Being (CCHS 1.2). The World Mental Health Composite International Diagnostic Interview was used to identify cases of 12-month disorder. Descriptive analysis and regression analysis is used to examine patterns of association between disorders and related impairment. Among adults aged 55 years and older, 4.4% met the criteria for at least one disorder and 0.8% had two or more. Social phobia was the most common comorbid disorder among respondents with depression, and depression was the most common comorbid disorder among respondents with any of the anxiety disorders. Respondents who report comorbid disorders reported significantly lower well-being and greater impairment. Although comorbidity between physical health conditions and depression, and between dementias and depression, are well documented among older adults, these results suggest that comorbid depression and anxiety are also prevalent in later life. The significant impact of comorbidity on function and well-being underlines the need to screen for comorbid disorders in this population.

Community Participation After Spinal Cord Injury

Carpenter C, Forwell SJ, Jongbloed LE, Backman CL. Community participation after spinal cord injury. Objectives To describe participation among a community-based sample of adults with spinal cord injury (SCI) and to explore the relationship between participation and life satisfaction. Design Survey. Setting Community. Participants A sample of 357 people (response rate, 44%) with SCI recruited through the British Columbia Paraplegic Association. The mean age ± standard deviation was 46.0±14.7 years, mean time since SCI was 13.0±11.0 years, and 68% of the respondents were men. Interventions Not applicable. Main Outcome Measures Descriptive survey data on community participation specifically related to social involvement, physical activity and relationship with others, transportation, and community access. Life satisfaction and happiness assessed using the Satisfaction With Life Scale and Happiness Scale. Results No limitations to participation were experienced by 18.5% of the respondents. Satisfaction with transportation was associated with owning one’s own vehicle ( P<.001). There was overall satisfaction with access to community buildings (mean score range, 6.9–8.5; where 10 is most satisfied). Being physically active was important to a majority and 75% were currently engaged in physical activity. Those living alone were less satisfied (mean, 7.3±2.7; where 10 is most satisfied) with the support they received than those living with others (8.5±1.7). Respondents were generally happy (5.0±1.4) and satisfied with life (18.6±7.6). Conclusions This study provides a rich description of the multifaceted nature of participation and its association with life satisfaction as identified by people with SCI living in the community.

Cat and dust mite allergen levels, specific IgG and IgG 4, and respiratory symptoms in adults

Exposure to allergen may induce a modified T(H)2 response characterized by high IgG(4) levels, absence of IgE sensitization, and a decreased risk of allergic respiratory symptoms. To assess the association of IgG(4) level with allergic respiratory symptoms in a community-based sample of adults. Information on exposure to cats, respiratory symptoms, and mattress allergen levels was obtained from 2780 adults. Levels of cat and house dust mite (HDM) specific IgE, IgG, and IgG(4) were measured. The association of exposure to allergen with IgG(4) and of IgG(4) with symptoms was assessed. Geometric mean (GM) cat specific IgG and IgG(4) was higher in subjects who had a cat that was allowed in the bedroom than in subjects without a cat (adjusted ratio of GM IgG(4), 1.41; 95% CI, 1.25-1.57). Levels of HDM specific IgG and IgG(4) were similar in subjects with undetectable and high (>20.22 microg/g) mattress Der 1 levels (adjusted ratio of GM IgG(4), 1.02; 95% CI, 0.89-1.17). There was no evidence that high cat or HDM specific IgG(4) levels were associated with less IgE sensitization or with fewer symptoms. In this community-based sample of adults, high IgG(4) levels to cat or HDM were not associated with a lower risk of allergic respiratory symptoms. In adults, high cat allergen exposure does not protect against respiratory symptoms.

Is the impact of depressive complaints on the use of general health care services dependent on severity of somatic morbidity?

Objective The aim of this study was to examine the effects of depressive complaints and chronic medical illnesses on prospective somatic health care utilization and the possible heterogeneity of the effect of depressive complaints across levels of medical illness severity. Methods Data from a community-based sample of adults ( n=9428) were used, of whom a health survey and claims data, indicating health care use, were available. Assessments of depressive complaints and somatic illnesses were based on self-report. Binomial regression analyses were used to study the expected relations. Results Depressive complaints and somatic morbidity were both positively related to general health care utilization. Somatic morbidity has an attenuating effect on the impact of depressive complaints: If it becomes more severe, the impact of depressive complaints on utilization is reduced. Depressive complaints are especially related to the use of paramedic services, use of prescription drugs, and consultations of medical specialists. Conclusion Depressive complaints predict somatic health care utilization, but somatic morbidity attenuates this relation. Future research on this subject should include interaction effects of depressive complaints and somatic morbidity. Interventions aiming to reduce excess use related to mental distress should be primarily targeted on subjects with mental distress who have no comorbid somatic morbidity.

Individual, social environmental, and physical environmental influences on physical activity among black and white Adults: A Structural Equation Analysis

Social ecological models suggest that conditions in the social and physical environment, in addition to individual factors, play important roles in health behavior change. Using structural equation modeling, this study tested a theoretically and empirically based explanatory model of physical activity to examine theorized direct and indirect effects of individual (e.g., motivation and self-efficacy), social environmental (e.g., social support), and physical environmental factors (e.g., neighborhood quality and availability of facilities). A community-based sample of adults (N = 910) was recruited from 2 public health centers (67% female, 43% African American, 43% < $20,000/year, M age = 33 years) and completed a self-administered survey assessing their current physical activity level, intrinsic and extrinsic motivation for physical activity, perceived social support, self-efficacy, and perceptions of the physical environment. Results indicated that (a) perceptions of the physical environment had direct effects on physical activity, (b) both the social and physical environments had indirect effects on physical activity through motivation and self-efficacy, and (c) social support influenced physical activity indirectly through intrinsic and extrinsic motivation. For all forms of activity, self-efficacy was the strongest direct correlate of physical activity, and evidence of a positive dose-response relation emerged between self-efficacy and intensity of physical activity. Findings from this research highlight the interactive role of individual and environmental influences on physical activity.

Aortic Pulse Wave Velocity Is Associated With the Presence and Quantity of Coronary Artery Calcium

We investigated the relationship of aortic pulse wave velocity (aPWV), a measure of central arterial stiffness, with the presence and quantity of coronary artery calcium (CAC) in a community-based sample of adults without prior history of heart attack or stroke (n=401, mean age 59.8 years, 53% men). ECG-gated waveforms of the right carotid and right femoral artery were obtained by applanation tonometry, and aPWV was calculated using established methods. CAC was measured noninvasively by electron beam computed tomography, and CAC score was calculated. aPWV was significantly correlated with log(CAC +1; r=0.41; P<0.0001) and pulse pressure (r=0.47; P<0.0001). Multivariable logistic and linear regression models were used to identify independent predictors of the presence and quantity of CAC, respectively. In multivariable logistic regression analyses, aPWV was associated with the presence of CAC (P=0.011) after adjustment for age, male sex, total cholesterol, high-density lipoprotein cholesterol, diabetes, history of smoking, systolic blood pressure, body mass index, and use of hypertension and statin medications. In multivariable linear regression analyses, aPWV was significantly associated with log(CAC +1) after adjustment for the covariates enumerated above (P<0.0001). aPWV remained significantly associated with both the presence and quantity of CAC even after the additional adjustment for diastolic blood pressure. We conclude that aPWV is related to subclinical coronary atherosclerosis independent of conventional risk factors (including indices of blood pressure) and may be a biomarker of cardiovascular risk in asymptomatic individuals.

Assessing the construct validity of three indicators of psychological distress in relation to perceived health and physical illness

The aim of this study is to compare three indicators of psychological distress (PD) on the strength of their association with subjective (or perceived) health and to analyse to what extent these associations will change after adjusting for physical illness measures and other possible confounding variables. Data were used from a community-based sample of adults (N=9,428). Psychological distress was measured using three different instruments: the Negative Affect Scale of Bradburn, a nervousness scale, and a self-reported depressive complaints. Physical illness was measured by seven specific chronic conditions, a co-morbidity index of 17 conditions and two disability measures. Subjective health was assessed by a single question. Ordinary least square and logistic regression as well as structural equation modelling were used to analyse the data. The relation between subjective health and PD is strongest in case nervousness and this, or negative affect, are used as indicators of PD. The measure of depressive complaints is less strongly, but still substantially, related to subjective health. After correction for physical illness variables, the change in strength of the association is slightest for depressive complaints and highest for nervousness. Only small differences between negative affect and nervousness were established. These measures, which were more contaminated by physical ill health than depressive complaints, have the strongest association with subjective health both before as well as after correction for physical illness components. Negative affect and nervousness are reliable and valid indicators of PD, which can be used to predict subjective health. However, for this purpose, a correction for the confounding effects of physical illness variables will be necessary. The depressive complaints measure is not only less predictive of subjective health but also less contaminated by physical illness variables, making it a better indicator of PD if correction for physical illness variables is not possible.

The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature.

Reported prevalence estimates for fecal incontinence among community-dwelling adults vary widely. A systematic review was undertaken to investigate the studied prevalence of fecal incontinence in the community and explore the heterogeneity of study designs and sources of bias that may explain variability in estimates. A predetermined search strategy was used to locate all studies published that reported the prevalence of fecal incontinence in a community-based sample of adults. Data were extracted onto a proforma for sampling frame and method, sample size, response rate, definition of fecal incontinence used, data-collection method, and prevalence rates. Included studies were critically appraised for possible sources of selection bias, information bias, and imprecision. A total of 16 studies met the inclusion criteria. These could be grouped into definitions of incontinence that included or excluded incontinence of flatus. The estimated prevalence of anal incontinence (including flatus incontinence) varied from 2 to 24 percent, and the estimated prevalence of fecal incontinence (excluding flatus incontinence) varied from 0.4 to 18 percent. Only three studies were found to have a study design that minimized significant sources of bias, and only one of these used a validated instrument for data collection. The prevalence estimate of fecal incontinence from these studies was 11 to 15 percent. No pooling of estimates was undertaken because there was wide variation in study design. A consensus definition of fecal incontinence is needed that accounts for alterations in quality of life. Further cross-sectional studies are required that minimize bias in their design and use validated self-administered questionnaires.

Determinants of Employment Status Among a Community-Based Sample of People with Epilepsy

People with epilepsy may face a number of complex and interacting problems and barriers related to employment. Understanding these barriers is an important step toward implementing effective rehabilitation interventions. This article explores the factors that predicted employment status among a community-based sample of adults with epilepsy. Data for the analysis were collected from 146 adults with epilepsy through Epilepsy Foundation chapters in Wisconsin, Kentucky, and Ohio. Several demographic and epilepsy-related variables were analyzed to explore the determinants of employment status. Results of a binary logistic regression analysis suggest that gender, number of antiepilepsy medications used, seizure frequency, and reported interference in daily functioning created by seizures were the best predictors of employment. Additional analyses suggested that the possession of a driver's license was also associated with employment status. The results are discussed in terms of their implications for rehabilitation-based intervention.

Prevalence and Correlates of Airway Obstruction in a Community-Based Sample of Adults

Virtually all the information available on the prevalence of obstructive airway disease is from Western countries. There are no data from Korea, and reports from other regions of Asia are poorly documented. To evaluate the prevalence and correlates of airway obstruction in a community-based setting in Korea. A cross-sectional, population-based study. Ansan City, near Seoul, South Korea. A sample of 1,160 community-dwelling men and women aged >or= 18 years (73.1% of the men and 4.1% of the women were either current or former smokers). Subjects underwent physical examinations following a standardized protocol. Data on demographic and health-related factors also were collected. Pulmonary function testing was administered according to American Thoracic Society (ATS) recommendations. The prevalence of airway obstruction was 10.3% (men, 17%; women, 5.6%) by ATS criteria. Ninety percent of the cases of airway obstruction were mild in degree. Twenty percent of male current smokers had airway obstruction. After adjusting for age, gender, and alcohol consumption, the odds of disease was 3.2 times greater in subjects who had smoked for >or= 20 pack-years vs never smokers (95% confidence interval [CI], 1.7 to 6.2). The adjusted odds of disease were 4.3-fold higher in subjects >or= 45 years of age vs those who were younger (95% CI, 2.6 to 7.0). Since airway obstruction is strongly related to age and smoking, the prevalence of obstructive airway disease in countries like Korea, where the population is rapidly aging and cigarette smoking is on the rise among younger individuals (particularly among women), can be expected to increase. Further efforts to diagnose early obstructive airway disease and to prevent or delay its onset should be emphasized as a major public health concern.