Effects Of Behavioral Risk Factors Research Articles

Study on behavioral risk factors and lagging effect analysis with liver cancer mortality in rural critical areas of 4 provinces of China from 2009 to 2019

Objective: To analyze the trend of liver cancer mortality in rural key areas of Jiangsu Province, Anhui Province, Shandong Province, and Henan Province (4 provinces) from 2009 to 2019 and to explore the influence of behavioral risk factors on liver cancer mortality and its lagging effect, and provide a reference for the prevention and treatment of liver cancer in China. Methods: Based on the 2009-2019 National Cause of Death Surveillance Database of the Chinese Center for Disease Control and Prevention, and the survey data of tumor and risk factor behavior of residents in key areas of 4 provinces, Joinpoint 4.2 software was used to calculate the average annual percentage change (AAPC) for assessing the temporal trend of standardized mortality of liver cancer; Chi-square test and trend Chi-square test were used to analyze the regional distribution difference and temporal change trend of behavioral habit factors. Stata 16 was used to establish a panel model to analyze the correlation and lagging effect of behavioral risk factors with liver cancer. Results: The standardized mortality rate of liver cancer in Jinhu County, Sheyang County, Lingbi County, Shou County, Mengcheng County, Wenshang County, Juye County, Luoshan County, Shenqiu County, and Xiping County showed a downward trend (AAPC<0, P<0.05) from 2009 to 2019. The consumption frequency of pickles/salted fish, red meat, and aquatic products showed a downward trend. The consumption frequency of healthy foods such as fresh vegetables, fresh fruits, and dairy products in all counties and districts showed an upward trend, and the consumption frequency of fried foods, kimchi, smoked foods, moldy foods, coffee, and soy products remained at a low level (P<0.05); but the consumption frequency of soy products and dairy products was still <20.00%. Fried food, pickles/salted fish, current smoking rate, alcohol consumption rate, and unvaccinated hepatitis B vaccine rate were positively correlated with liver cancer death, and there was a lag effect, and the lag period was 4, 1, 6, 5, 4 years respectively. Conclusions: From 2009 to 2019, the mortality rate of liver cancer in rural key areas of 4 provinces shows a downward trend. There is a correlation and lagging effect between behavioral risk factors such as fried food, smoking, and alcohol consumption and liver cancer death.

Behavioral Risk Factor and Primary Healthcare Utilization in South Africa.

(1) Background: An effective and efficient primary healthcare service is one of the reforms designed to achieve universal healthcare coverage. The success of the reform however depends on the ability to identify factors that could undermine through avoidable use, the effectiveness of various deployed scarce resources. The prevalence of unhealthy lifestyle risk factors that have been identified as a critical public health issue, which stimulate vulnerability and mortality through the development of non-communicable diseases, also have implications for government health spending through healthcare utilization. (2) Objective: This study aims to investigate the effect of behavioral risk factors on primary healthcare utilization in South Africa. (3) Methods: Using the NIDS wave 4 data set and a binary logistic estimation technique, the study is premised on a modified Anderson model of health service utilization. (4) Results: The binary logistic regression estimation results clearly show the intercepting effect of smoking in public primary healthcare utilization. Equally, the effect of these lifestyle behavior risk factors on public PHC is evident in urban communities. (5) Conclusion: This study suggests that there is a need to intensify awareness on the health effect of smoking; strengthen and broaden law that bans smoking; and introduce the screening of smoking patients for recurring counselling sessions and intervention at primary healthcare facilities in the country's urban communities.

Brief behaviour change counselling in non-communicable diseases in Mangochi, Southern Malawi: a hypothetical acceptability study

IntroductionBrief behaviour change counselling (BBCC) approaches have shown some potential in reversing and/or decreasing the effects of behavioural risk factors (harmful alcohol, smoking, physical inactivity and unhealthy diets). However, BBCC is new in Malawi. Thus, we explored the acceptability of brief behaviour change counselling using 5 As and a guiding style from motivational interviewing (BBCC + 5 As + GS) among health providers, policy-makers and patients living with noncommunicable diseases (NCDs) in the Mangochi district located in Malawi.MethodsAn exploratory qualitative cross-sectional study used purposive sampling to select 44 respondents. We conducted group discussions with five focus groups that included patients. We also carried out nine key-informant interviews with healthcare providers and policy-makers. Data were managed and organized with Atlas.ti. cloud and analysed using the thematic framework approach.FindingsSeveral themes, categories, and their subcategories emerged from the interviews. Participants perceived the introduction and delivery of BBCC + 5As + GS in Mangochi as smooth. However, they predicted a few challenges such as time and space to conduct the intervention, cultural bottlenecks caused by low education level, age differences between healthcare providers and patients, low provider- to- patient ratio and high provider turnover. For this method to be adopted, a simplified format is deemed necessary to improve effectiveness with patients. This technique can only be sustained if training opportunities are provided and if positive testimonies are given by beneficiaries. Incorporation of a continuous quality improvement cycle targeting challenges must be part of the intervention. Participants perceived that BBCC will contribute to developing the listening ability of healthcare providers. This would help in providing personalized and cost-effective care relevant to Mangochi. The participants also perceived that BBCC + 5As + GS will be affordable, credible and useful.ConclusionWe found a high acceptability rate of BBCC among stakeholders in NCDs clinics in Mangochi. There are a number of areas where BBCC + 5As + GS could be improved to increase the acceptability. Accordingly, a study of feasibility and preliminary efficacy is warranted to determine other prerequisites for the implementation of a large-scale trial using this BBCC+ 5 As + GS, and to fully understand the implementation requirements of a full trial in Mangochi.

АНАЛИЗ ФАКТОРОВ РИСКА РАЗВИТИЯ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ У ЛИЦ ТРУДОСПОСОБНОГО ВОЗРАСТА

Relevance. Cardiovascular diseases, according to the World Health Organization, are one of the leading causes of mortality among the population of developed countries of the world, including the Russian Federation. The development of cardiovascular diseases is closely related to behavioral risk factors such as smoking, unhealthy diet, insufficient physical activity and a number of other factors. The planning of preventive programs at the population level and the organization of effective preventive activities of the primary health care unit requires detailed and reliable information on the prevalence of risk factors for the development of cardiovascular diseases. Currently, there is a need to raise awareness of patients about the risk factors for the development of diseases; to increase the patient's responsibility for maintaining his health; to form skills and abilities in patients to reduce the adverse effects of behavioral risk factors The purpose to analysis of risk factors for the development of cardiovascular diseases in people of working age in the practice of medical office operating of the arterial hypertension prevention. Materials and methods. Retrospective analysis of the complex of automated integrated assessment of the state of the cardiovascular system with statistical processing of the data obtained. For qualitative indicators, the statistical criterion for the significance of differences is χ2 (chi-squared). Descriptive statistics are given in the form of N(n%), that is, the number of objects with this feature and the percentage of the total number of objects in the sample. Results. Results. In the office of prevention of arterial hypertension, the average polyclinic of the GBUZ "City Polyclinic No. 91" of the city of St. Petersburg, for 5 years (2014-2018), 983 appeals of the adult population were noted. In 807 cases, there are persons aged 18 to 65 years with risk factors for the development of cardiovascular diseases. Of these, men applied 382 times, and women 425 times, which was (47.4%) and (52.5%), respectively. According to the frequency of appeals, it was noted that people over 41 years of age were more likely to apply than younger people. Analysis of the dynamics of risk factors for the development of cardiovascular diseases in people of working age revealed that hypercholysteremia, hereditary predisposition to hypertension, are most common. Conclusions. The appeal rate of persons over 41 years of age is higher than that of younger persons. The frequency of smoking, alcohol consumption, physical inactivity, overweight and obesity is increasing in 2/3 of patients. Among the studied patients of the prevention of hypertension, hypercholesterolemia was significantly more common in women, and at the age of 18 to 40 years. And, tobacosmoking, as a factor in the development of cardiovascular diseases, was significantly more common in men over the age of 50.

Association between behavioural risk factors and metabolic syndrome among adult population in India: A systematic review and meta-analysis of observational studies

AimsThe impact of behavioural risk factors on the metabolic syndrome has not been well understood by the researchers. This information is important to the policymakers for developing effective strategies and implement relevant policies or programs. Hence, we undertook this meta-analysis to estimate the effect of behavioural risk factors on the burden of metabolic syndrome. Data synthesisWe conducted a search in the databases, such as PubMed Central, EMBASE, MEDLINE, and Cochrane library, and search engines, such as ScienceDirect and Google Scholar, from inception until March 2021. We used the Newcastle–Ottawa Scale (NOS) to assess the quality of published studies. We carried out a meta-analysis with random-effects model and reported pooled odds ratio (OR) with 95% confidence interval (CI).In total, we analysed 30 studies with 41,090 participants. The majority of the studies had good to satisfactory quality as per NOS. Physical activity had a statistically significant association with the prevalence of metabolic syndrome (pooled OR = 1.57; 95%CI: 1.28 to 1.93, I2 = 91%). However, smoking (pooled OR = 0.96; 95%CI: 0.75 to 1.23, I2 = 90.5%) and alcohol (pooled OR = 1.00; 95%CI: 0.75 to 1.33, I2 = 90.8%) did not reveal a statistically significant association with the burden of metabolic syndrome. ConclusionPhysical inactivity was found to be a significant risk factor for metabolic syndrome. Given the evidence, it is important that the clinicians and policymakers are alike to recommend regular physical activity among the patients and general population.

The Affect of Behavioral Risk Factors on Healthcare System Performance

Behavioural risk factors are known to have an impact on countries' health system performance. Behavioral risk factors include habits such as alcohol consumption, smoking, and patterns of food consumption which might lead to different types of obesity among different age groups in every community. In the context of OECD countries, this study aims at investigating whether behavioral risk factors have an impact on healthcare system performance or not. Data Envelopment Analysis (DEA) and then Ordinary Least Squares Regression (OLS) was utilized to bring into the open the factors that affect health performance scores of OECD countries. In OLS, the obtained health performance score was utilized as a dependent variable and alcohol and tobacco consumption and obesity rate were utilized as independent variables. According to the OLS results, The only variable that has a statistically significant effect on the health performance scores of OECD countries is the alcohol consumption rate. To reduce health expenditures and improve health system performance, OECD countries need to develop more effective, macro and micro, level policies to eliminate the negative effects of behavioral risk factors. Such policies might include health awareness campaigns and more strict taxing policies upon the risk factor products, in addition to increasing community-based healthcare services.

The combined effect of behavioural risk factors on disability in aging adults from the Canadian Longitudinal Study on Aging (CLSA)

The objective of this study was to explore how behavioural risk factors (smoking, physical activity, and nutrition) cluster together and assess how clusters of behavioural risk factors are associated with functional disability by age and sex at the individual and population level. We used currently available baseline cross-sectional data from the Canadian Longitudinal Study on Aging (CLSA). The CLSA is a national, population-based longitudinal study established to understand and examine health of an aging population. This study included 51,338 Canadian men and women aged 45 to 85 years residing in the community in 10 Canadian provinces. Behavioural risk factors included smoking, physical activity, and nutrition. The main outcome used in the study was functional disability, which was assessed using a questionnaire adapted from the Older Americans Resources and Services Multidimensional Assessment Questionnaire. In this analyses of unique combinations of the risk factors of smoking, physical activity, and nutritional risk, the magnitude of the association of the behavioural risk factors with functional disability was dependent on which risk factors were included and differed by age and sex strata. Of the risk factors, physical activity accounted for between 70% to 90% of the total population level risk in individuals with all three risk factors, suggesting it is a key driver of the population burden of disability. Together, these results show that considering unique clusters of risk factors, as well as age and sex, is essential for tailoring public health strategies to reduce the burden of disability among aging populations.

Joint effects of alcohol use, smoking and body mass index as an explanation for the alcohol harm paradox: causal mediation analysis of eight cohort studies.

Lower socio-economic status (SES) is associated with higher alcohol-related harm despite lower levels of alcohol use. Differential vulnerability due to joint effects of behavioural risk factors is one potential explanation for this 'alcohol harm paradox'. We analysed to what extent socio-economic inequalities in alcohol-mortality are mediated by alcohol, smoking and body mass index (BMI), and their joint effects with each other and with SES. Cohort study of eight health examination surveys (1978-2007) linked to mortality data. Finland. A total of 53 632 Finnish residents aged 25+years. The primary outcome was alcohol-attributable mortality. We used income as an indicator of SES. We assessed the joint effects between income and mediators (alcohol use, smoking and BMI) and between the mediators, adjusting for socio-demographic indicators. We used causal mediation analysis to calculate the total, direct, indirect and mediated interactive effects using Aalen's additive hazards models. During 1 085 839 person-years of follow-up, we identified 865 alcohol-attributable deaths. We found joint effects for income and alcohol use and income and smoking, resulting in 46.8 and 11.4 extra deaths due to the interaction per 10 000 person-years. No interactions were observed for income and BMI or between alcohol and other mediators. The lowest compared with the highest income quintile was associated with 5.5 additional alcohol deaths per 10 000 person-years (95% confidence interval=3.7, 7.3) after adjusting for confounders. The proportion mediated by alcohol use was negative (-69.3%), consistent with the alcohol harm paradox. The proportion mediated by smoking and BMI and their additive interactions with income explained 18.1% of the total effect of income on alcohol-attributable mortality. People of lower socio-economic status appear to be more vulnerable to the effects of alcohol use and smoking on alcohol-attributable mortality. Behavioural risk factors and their joint effects with income may explain part of the alcohol harm paradox.

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.

Evaluation of Cardiovascular Disease Prediction Using Decision making trial and Evaluation Laboratory Method

Predict a patient with heart disease Classify like Logistic Regression and KNN Different algorithms of machine learning We used How to improve the accuracy of this model Very useful for controlling what can be used approach was used predicting myocardial infarction in any given individual. The most important behavior for heart disease and stroke Risk factors include unhealthy diet, physical inactivity Temperament, tobacco use and alcohol harm result in Effects of behavioral risk factors are high Blood pressure, increased blood glucose, increased blood In fat and overweight and obesity manifested in persons. Alternative: Abnormal TG, Abnormal TC, Abnormal LDL, Abnormal HDL And extraordinary FPG. Evaluation Preference: Abnormal TG, Abnormal TC, Abnormal LDL, Abnormal HDL And extraordinary FPG. From the result it is seen that Abnormal HDL and is got the first rank whereas is the Abnormal TG got is having the lowest rank. The value of the dataset for Range of Cardiovascular Disease Prediction in DEMATEL Method shows that it results in Abnormal HDL and top ranking.

12-year follow-up study of the c-reactive protein in Iranian middle-aged women: Isfahan cohort study

Background: As an important inflammatory marker, study of C-reactive protein (CRP) changes over time may lead to better identification of risk factors of cardiovascular disease. We evaluated the relationship between CRP changes and lifestyle, metabolic syndrome (MS) and body mass index (BMI) in middle-aged women and explored potential bias from attrition. Materials and Methods: We studied 1234 participants in the Isfahan cohort study – a longitudinal population-based study of adults older than 35 years living in urban and rural areas of three counties in central Iran. Data were collected every 6 years since 2001 (3 points). Random effects model was used to evaluate the effects of behavioural risk factors and MS on CRP, with pattern mixture model to account for cohort attrition. Results: Mean CRP levels decreased over time (Est = −0.066, P

Effects of behavioural risk factors on high-cost users of healthcare: a population-based study

ObjectivesHigh-cost users (HCUs) are known to disproportionally incur the majority of healthcare utilization costs relative to their counterparts. A number of studies have highlighted the detrimental effects of risky health behaviours; however, only a few have demonstrated the link to HCUs, a meaningful endpoint for program and policy decision-makers. We investigated the association between health behaviour risks and downstream high-cost healthcare utilization.MethodsA combined cohort of participants from the Canadian Community Health Survey (CCHS) cycles 2005–2009 was linked to future population-based health administrative data in Ontario. Using person-centered costing methodology, CCHS respondents were ranked according to healthcare utilization costs and categorized as ever having HCU status in the 4 years following interview. Logistic regression models were used to estimate the association between various health behaviours on future HCU status.ResultsModels estimated that smoking and physical inactivity were associated with a significant increase in the odds of becoming an HCU. Compared to individual behaviours, increasing the number of health behaviour risks significantly strengthened the odds of becoming an HCU in subsequent years.ConclusionThe analyses provide evidence that upstream health behaviours affect high-cost healthcare utilization. Health behaviours are a meaningful target for health promotion programs and policies. These findings can inform decision-makers on appropriate behavioural targets for those on an HCU trajectory and promote public health efforts to support healthcare system sustainability.

Melatonin Level Variations with Different Behavioural Risk Factors in Obese Female Patients.

AIM:The role of behavioural factors and sleep duration and quality is important in the pathogenesis of obesity. The aim of our study was to evaluate the effects of behavioural risk factors on melatonin secretion in women.SUBJECTS AND METHODS:In total, 120 female patients were enrolled in the study and divided into two groups according to the body mass index. Detailed history, anthropometric measurements, urine and blood samples were evaluated for each patient.RESULTS:Two groups significantly differed in weight, BMI, and waist circumference, and were 94.2 ± 14.9 kg, 33.4 ± 5.23 kg/m2 and 99.2 ± 12.6 cm for the study group and 56.0 ± 5.2 kg, 20.0 ± 1.8 kg/m2 and 60.1 ± 10.4 cm for the control group, respectively, sleep disruptions were detected in 48 patients from study group, with mean score 6.76 ± 3.6, and only 10 patients were detected in the control group, with mean score 4.42 ± 1.68. Eating disturbances were revealed in 66 patients from the study group and 21 patients from the control group. Melatonin levels were 17% higher in the study group, compared to control group.CONCLUSION:Higher melatonin levels in patients with obesity and concomitant behavioural impairments may be due to its protective effect to fight free radicals and to induce vasodilatation. Further studies are needed to confirm our finding.

Behavioural Risk Factors Health Spending Gap, Social Determinants, and Burden of Non- Communicable Diseases-Related Health Outcomes in Developing Countries

Non-communicable diseases (NCDs) are seriously affecting poor countries, posing challenges of double burden of communicable and NCDs diseases. This paper examined the behavioral risk factors health spending gap and social determinants of health on burden of NCD-related health outcomes in developing countries. Using 2008 data from a sample 140 countries in six regions, I estimated an aggregate health production function. Results show tobacco use, pollution, urbanization, and prevalence of low birth weight significantly contribute to burden of NCD-related health outcomes in developing countries. The results demonstrate no statistical significance effect of alcohol use, obesity, literacy, and health spending on burden of NCDs. While health spending has no statistical significance, there is evidence of differential effect of behavioural risk factors on YLL, especially when countries are split based on size of health spending. Behavioural risk factors contribute more to burden of NCDs in relatively higher health spending developing countries as compared to low health spending countries. Furthermore, NCD-related health outcomes are on average highest in Eastern European region and lowest in Africa compared to other regions. The study controlled for potential endogeneity of health spending with health outcomes and found health spending to be exogenous.

Impact of behavioural risk factors on death within 10 years for women and men in their 70s: absolute risk charts

BackgroundEstimates of the absolute risk of death based on the combined effects of sex, age and health behaviours are scarce for elderly people. The aim of this paper is to calculate population based estimates and display them using simple charts that may be useful communication tools for public health authorities, health care providers and policy makers.MethodsData were drawn from two concurrent prospective observational cohort studies of community-based older Australian women (N = 7,438) and men (N = 6,053) aged 71 to 79. The outcome measure was death within ten years. The predictor variables were: sex, age, smoking status, alcohol consumption, body mass index and physical activity.ResultsPatterns of risks were similar in men and women but absolute risk of death was between 9 percentage points higher in men (17 %) than in women (8 %) in the lowest risk group (aged 71–73 years, never smoked, overweight, physically active and consumed alcohol weekly) and 21 % higher in men (73-74 %) than women (51-52 %) in the highest risk group (aged 77–79 years, normal weight or obese, current smoker, physically inactive and drink alcohol less than weekly).ConclusionsThese absolute risk charts provide a tool for understanding the combined effects of behavioural risk factors for death among older people.

The effect of behavioural risk factors on osteoporosis in Irish women

Osteoporosis constitutes a major public health concern and its underlying pathogenesis is complex and multifactorial. Although hereditary factors strongly contribute to bone health, behavioural factors can modulate the genetically determined pattern of skeletal modelling and remodelling. The aim of this study was to investigate the effect(s) of behavioural risk factors on osteoporosis in Irish women. Pre- and post-menopausal adult women (n = 189; 44 ± 15 years) participated in this cross-sectional study. Demographic, anthropometric and lifestyle data were collected during a single clinic visit. Dietary calcium intake and lifetime physical activity (PA) were assessed for each subject. Lumbar and femoral bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA). Multivariate analysis was used to determine the independent predictors of low BMD. Low BMD was present in 59% of subjects (42% pre- and 77% post-menopausal). Smoking was the strongest behavioural predictor of lumbar and femoral BMD. Age, height, family history, smoking, metabolic (MET) and mechanical (MECH) PA (lifetime) and weight (body mass) accounted for 39% of the variance in lumbar BMD. Age, height, family history, alcohol consumption, MET and MECH PA (lifetime) and weight accounted for 41% of the variance in femoral BMD. Prevalence of osteopenia and osteoporosis is high in Irish women and is associated with modifiable risk factors. A clearer focus should be paid to educate Irish women on preventative health behaviours for osteoporosis to curb the prevalence of this disease and the human and fiscal costs associated with it.

Association of health behaviour with heart rate variability: a population-based study

BackgroundReduced heart rate variability (HRV), a non-invasive marker of autonomic dysfunction, and an unhealthy lifestyle are associated with an increased morbidity and mortality of cardiovascular diseases (CVD). The autonomic dysfunction is a potential mediator of the association of behavioural risk factors with adverse health outcomes. We studied the association of HRV with behavioural risk factors in an elderly population.MethodsThis analysis was based on the cross-sectional data of 1671 participants (age range, 45-83 years) of the prospective, population-based Cardiovascular Disease, Living and Ageing in Halle (CARLA) Study. Physical activity, smoking habits, alcohol consumption and dietary patterns were assessed in standardized interviews. Time and frequency domain measures of HRV were computed from 5-min segments of highly standardized 20-min electrocardiograms. Their association with behavioural risk factors was determined by linear and non-parametric regression modelling.ResultsThere were only weak and inconsistent associations of higher physical activity, moderate consumption of alcohol, and non-smoking with higher time and frequency domain HRV in both sexes, and no association with dietary pattern. Results changed only marginally by excluding subjects with CVD, diabetes mellitus and use of cardioactive medication.ConclusionWe hypothesized that HRV is associated with behavioural factors and therefore might be a mediator of the effect of behavioural risk factors on CVD, but this hypothesis was not confirmed by our results. These findings support the interpretation that there may be no true causal association of behavioural factors with HRV.

Regionale Unterschiede des Gesundheitsverhaltens in Bayern - Mehrebenenanalyse einer bevölkerungsrepräsentativen Befragung in Verbindung mit sozioökonomischen Strukturdaten

There are regional differences in mortality in Bavaria. Although these regional dif-ferences in mortality were associated with behavioural risk factors and socioeconomic factors in a study conducted for this reason, the quantitative effect of behavioural risk factors and socio-economic factors as well as the regional structure on the individual health as a predictor of mortality were not known. Persons between the age of 18 and 80 were interviewed with the Behavioral Risk Factor Surveillance System (BRFSS) in two Bavarian regions with high mortality, two Bavarian regions with low mortality and in the capital of Bavaria, Munich. For regional structural data, the INKAR database was used. Data were analysed descriptively, with a multivariable-adjusted logistic regression and with a multilevel analysis. There were lower proportions of persons with a good or very good state of health as well as adverse results for overweight/adipositas, the behavioural risk factors for doing sports, smoking and consuming fruits and vegetables and the socioeconomic factors education and unemployment in the two regions with high mortality "Ostbayerische Grenzregion" and "Oberfranken". In a multivariable adjusted logistic regression, the body mass index, smoking, doing sports, climbing stairs, consuming alcohol, being satisfied with the job and the interaction between education and marital status were found to have an influence on the individual health. The small remaining regional component could be explained in the multilevel analysis by different variables which describe the economical situation of the regions. In accordance with the study hypotheses, a consistency between behavioural risk factors and regional differences in mortality could be observed. Socioeconomic influences and a small regional component are involved. In addition to specific prevention programmes for the target groups, structural support is also meaningful with regard to its potential health impact.

Behavior and Cancer Prevention

This paper reviews research on the effects of behavioral risk factors on cancer incidence, as well as behavioral interventions for cancer prevention. Risk factors discussed here--tobacco use, diet, physical activity, and obesity/energy balance--are all linked with cancer etiology, and effective behavioral interventions have been developed in all of these areas. The most effective interventions appear to incorporate various components; for example, including individual as well as family activities, and involving multiple community organizations in behavior-changing activities. Behavioral theories have guided the design of these interventions, providing support that certain influences on behavior, such as self-efficacy, problem-solving skills, and social support, are important regardless of the specific behavioral target. As illustrated by the recent lowered lung cancer incidence and mortality rates for men and women, behavior change is possible and effective in cancer prevention. Clinical guidelines have been established for behavioral aspects of treatments for smoking cessation, dietary guideline compliance, physical activity, and obesity reduction, and new tools for dissemination of effective intervention materials will be helpful in increasing their use. Documenting the cost-effectiveness of behavioral interventions, using new technology interventions, and building on translational research to tailor interventions to individuals offer considerable promise for the future.

Assessment of sexually transmitted diseases as risk factors for HIV seroconversion in a New Orleans sexually transmitted disease clinic, 1990?1998

This investigation examined the role of ulcerative and non-ulcerative sexually transmitted diseases (STDs) in increasing susceptibility to HIV seroconversion in a large population of uninfected and predominantly heterosexual persons attending a New Orleans STD clinic. A retrospective cohort of clients with repeat HIV tests between January 1990 and April 1998 was constructed using three independent sources of information. Multivariate Cox regression was used to identify risk factors for HIV seroconversion while controlling for the effects of behavioral risk factors. A time-dependent covariate for STD allowed HIV seroconversion to be examined in relation to the timing of STD diagnosis. Having a recent syphilis or GUD diagnosis was associated with significantly increased hazards of seroconversion (among men: hazard ratio [HR], 4.2 [2.4-7.2]; among women: 5.0 [1.9-13.0]). Among men with no history of GUD or syphilis, those with recent gonorrhea within 1 year prior to seroconversion were 2.8 (1.5-5.2) times as likely to seroconvert. This study suggests that both ulcerative and non-ulcerative STD may be associated with increased risk of HIV transmission and therefore comprehensive STD control strategies may be particularly effective tools for HIV prevention.