Health Lifestyle Behaviors Research Articles

Abstract 2813: Vitamin D, calcium, and dairy intake and familial breast cancer

Abstract Background: There is substantial evidence that breast cancer aggregates within some families, accounting for about 25% of incident cases. Known genetic variants, such as BRCA1/BRCA2 mutations, account for less 25% of these familial breast cancer cases, and furthermore 15-30% of mutation carriers will never develop breast cancer. Thus, research into additional risk or protective factors for familial breast cancer may provide valuable information for risk stratification. There is accumulating epidemiological and experimental evidence that vitamin D, calcium, and dairy, are associated with sporadic breast cancer risk, however it is unknown whether these factors are also associated with familial breast cancer. Methods: To address this question, we conducted a case-control study of probands identified from the UCLA Family Cancer Registry; a population enriched with women with a strong family history of breast cancer and BRCA1/BRCA2 mutation carriers. This study included 612 unrelated women who developed breast cancer and 497 unaffected controls within the registry recruited between 1998 and 2006. All participants completed a detailed survey questionnaire that examined reproductive and lifestyle factors, various health and screening behaviors, as well as information on a variety of putative breast cancer risk or protective factors including vitamin D and calcium supplement use (yes or no) and dairy consumption (servings per day). Multivariate logistic regression models controlling for confounding factors were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of vitamin D, calcium, and dairy with familial breast cancer. Results: Cases and controls were similarly distributed by race (80% were non-Hispanic white) and BRCA1 mutation carrier status (12%), however cases on average were five years older than controls and were more likely to be BRCA2 mutation carriers (12% versus 6%). Vitamin D (OR=0.88, 95% CI=0.63-1.24), calcium (OR=0.73, 95% CI=0.56-0.67), and dairy (OR=0.81, 95% CI=0.65-1.01) were inversely associated with breast cancer in this population. These associations did not appear to be modified by BRCA1 or BRCA2 mutation status. For women with three affected first degree relatives, the breast cancer associations with vitamin D (OR=0.19, 95% CI=0.02-1.8) and calcium (OR=0.29, 95% CI=0.06-1.3) were considerably strengthened; however these associations were not statistically significant. No other vitamins (A, B, C, or E), supplements (herbal remedies), or dietary factors (fruits, vegetables, fiber, or fat) were significantly associated with breast cancer. Conclusion: Calcium supplementation was associated with familial breast cancer, independently of BRCA mutation status, and the vitamin D and calcium associations with breast cancer may be modified by family history. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2813.

Preventive, Lifestyle, and Personal Health Behaviors Among Physicians

This study examines personal health behaviors and wellness, health-related lifestyles, and prevention screening practices among licensed physicians. An anonymous questionnaire was mailed to a random sample of 1,875 physicians practicing in California. Data from 763 returned questionnaires (41%) were analyzed. Our data show that 7% of this sample were clinically depressed, 13% reported using sedatives or tranquilizers, over 53% reported severe to moderate stress, and only 38% described their level of daily stress as slight. About 4% self-reported recent marijuana use. More than 6% screened positive for alcohol abuse and 5% for gambling problems. Thirty-five percent of participants reported "no" or "occasional" exercise. About 27% self-reported "never" or "occasionally" eating breakfast. In addition, 34% reported 6 or fewer hours of sleep daily, while 21% self-reported working more than 60 hours per week. Physicians' excessive number of work hours (more than 65 hours per week) was associated with lack of exercise, not eating breakfast, and sleeping fewer than 6 hours per night. California physicians report breast, cervical, colorectal, and prostate cancer screening behaviors that exceeded population estimates in California and Healthy People 2010 national goals. Additional interventions designed to improve physicians' lifestyles and personal health behaviors should be encouraged. A focus on creating healthy lifestyles will benefit physicians as much as the general population.

Gender Differences in Views About Cognitive Health and Healthy Lifestyle Behaviors Among Rural Older Adults

Research suggests that men and women often differ in knowledge and beliefs about causes and treatments of a variety of diseases. This study examines gender differences in views about cognitive health and behaviors that have been associated with its maintenance, focusing on older adults living in rural areas. We conducted 6 focus groups in rural West Virginia. Participants included 37 women and 30 men, aged 55 years and older. Men and women held similar views of cognitive decline, as well as largely similar views about causes of Alzheimer's disease (AD). However, women were more concerned about developing AD than were men. Gender differences were also noted with respect to healthy lifestyle beliefs, including diet, leisure-time physical activity, and strategies to maintain cognitive health. Findings illustrate the importance of considering gender with respect to health beliefs, health behaviors, and health promotion, and emphasize the need to develop interventions designed for specific populations. Results highlight a critical need to translate research findings to the community.

Investigating the Effects of Cancer Risk and Efficacy Perceptions on Cancer Prevention Adherence and Intentions

This study examined the interaction between comparative cancer risk and efficacy perceptions on individuals' adherence for colon, prostate, and breast cancer screenings, intentions to get these screenings in the future, and intentions to adopt health lifestyle behaviors in the next year. A national probability sample of 2,226 adults ages 40 to 70 was surveyed. Overall, a positive interaction effect was found between comparative risk and efficacy on several outcomes. There were some methodological limitations worth noting, but the findings do have implications for health campaigns, particularly the need to increase efficacy beliefs about reducing cancer risks within the general population.

Teaching the “Health At Every Size” Paradigm Benefits Future Fitness and Health Professionals

The “Health At Every Size” (HAES) paradigm “views obesity from the philosophy that dieting and weight obsessions are unhealthful and that our societal obsession with thinness does not allow for diversity in body shapes.… [It] proposes that health is a result of behaviors that are independent of body weight.” 1 Miller W. The weight-loss-at-any-cost environment: how to thrive with a health-centered focus. J Nutr Educ Behav. 2005; 37: S89-S93 Abstract Full Text PDF PubMed Scopus (17) Google Scholar Traditional restrictive dieting has not resulted in sustained weight loss for most people, so HAES encourages adopting healthful lifestyle behaviors to improve health without necessarily losing weight. 2 Ikeda J. Amy N.K. Ernsberger P. et al. The National Weight Control Registry: a critique. J Nutr Educ Behav. 2005; 37: 203-205 Abstract Full Text PDF PubMed Scopus (34) Google Scholar

Physical therapy in the 21st century (Part II): Evidence-based practice within the context of evidence-informed practice

Part II of this two-part introduction to this Special Issue on physical therapy practice in the 21st century outlines a health-focused strategy for physical therapists to lead in the assault on lifestyle conditions, global health care priorities, described in Part I. Consistent with contemporary definitions of physical therapy, its practice, professional education, and research, physical therapy needs to reflect 21st-century health priorities and be aligned with global and regional public health strategies. A proposed focus on health emphasizes clinical competencies, including assessments of health, lifestyle health behaviors, and lifestyle risk factors; and the prescription of interventions to promote health and well-being in every client or patient. Such an approach is aimed to increase the threshold for chronic conditions over the life cycle and reduce their rate of progression, thereby preventing, delaying, or minimizing the severity of illness and disability. The 21st-century physical therapist needs to be able to practice such competencies within the context of a culturally diverse society to effect positive health behavior change. The physical therapist is uniquely positioned to lead in health promotion and prevention of the lifestyle conditions, address many of their causes, as well as manage these conditions. Physical therapists need to impact health globally through public and social health policy as well as one-on-one care. This role is consistent with contemporary definitions of physical therapy as the quintessential noninvasive health care practitioner, and the established efficacy and often superiority of lifestyle and lifestyle change on health outcomes compared with invasive interventions, namely, drugs and surgery. A concerted commitment by physical therapists to health and well-being and reduced health risk is consistent with minimizing the substantial social and economic burdens of lifestyle conditions globally.

Obesity as a Predictor of Self-rated Health

To report on the relationship between self-rated health and obesity. Computer-assisted telephone survey of 5001 randomly selected individuals aged 18 years and over residing in California and Texas. Obese individuals have a 3-fold greater odds of reporting reduced health. After controlling for the effect of demographic factors, health care utilization, chronic disease, and lifestyle behaviors, this relationship persists (OR:2.33; 95% CI: 1.7, 3.2). Results suggest that obesity is a statistically significant predictor of reduced self-rated health. Directly affecting change in people's self-rating of health would be difficult; however, addressing its correlates, such as obesity, may improve self-rated health status over time.

The Use of the Pile Sort Method in Identifying Groups of Healthful Lifestyle Behaviors among Female Community College Students

When encountering new or understudied populations, it is useful to build an understanding of the needs and perceptions of the target audience. This study investigated the application of the qualitative pile sort method for gaining information about nutrition and physical activity behaviors. In a pile sort, individuals make a list of topics relevant to a particular subject, and then they group these topics into related piles. This study investigated whether there was consistency in the ways in which participants grouped behaviors related to having a healthful lifestyle. Pile sorts were conducted during six focus groups among 28 female community college students (46% white; 39% had a 2-year degree or higher). A total of 74 piles of grouped behaviors were coded from the transcripts. Analyses revealed good consistency (identified nine to 12 times) for four groupings: exercise, lifestyle, how you eat, and positive foods. The pile sort method represents an activity that can be incorporated into formative research for interventions focused on complex behaviors with multiple components; in addition, this method may provide structure to counseling sessions and facilitate a better understanding of the perceptions of healthful eating and physical activity from patients' perspectives.

Family‐centered collaborative negotiation: A model for facilitating behavior change in primary care

To describe a parent-child-based model that melds a family-centered interaction approach, Touchpoints, with brief negotiation strategies (an adaptation of motivational interviewing) to address health risks in children. An application of the model for addressing childhood overweight in the primary care setting is presented. Selected research, theoretical, and clinical articles; national recommendations and guidelines; and a clinical case. Lifestyle health behaviors are learned and reinforced within the family; thus, changes to promote child health require family involvement. Interventions that engage parents and support parent-child relationships, while enhancing motivation and the abilities to change behavior, are recommended. Primary care is an appropriate setting for addressing lifestyle health behaviors. A collaborative partnership, rather than a prescriptive manner, is advocated for primary care providers when working to facilitate health-promoting behavior.

Lifestyle behaviors, obesity, and perceived health among men with and without a diagnosis of prostate cancer: A population-based, cross-sectional study

BackgroundA better understanding of how prostate cancer survivors differ from men without prostate cancer and whether these potential differences vary across demographic subgroups will help to focus and prioritize future public health interventions for improving the health and well-being of prostate cancer survivors. Therefore, our study aims were to compare lifestyle behaviors, body mass index (BMI), and perceived health in men with and without a diagnosis of prostate cancer in a national, population-based sample and to explore whether these comparisons differ for demographic subgroups.MethodsIn a cross-sectional study, men aged ≥ 40 were identified from the Behavioral Risk Factor Surveillance System (BRFSS) 2002 data (n = 63,662). Respondents reporting history of prostate cancer (n = 2,524) were compared with non prostate cancer controls (n = 61,138) with regard to daily fruit and vegetable servings (FVPD), smoking, alcohol, sedentary behavior, BMI, and perceived health. Multivariable logistic regression calculated adjusted odds ratios (OR) and 95% confidence intervals (CI) for the entire sample and for age, race, education, and urbanicity subgroups.ResultsMen with prostate cancer did not differ from men without prostate cancer with regard to smoking, alcohol, sedentary behavior, and obesity but were more likely to consume ≥ 5 FVPD (OR, 95% CI: 1.30, 1.09–1.56) and report poor or fair health (OR, 95% CI: 1.62, 1.33–1.97). Subgroup analyses demonstrated attenuation of the higher likelihood of ≥ 5 FVPD among prostate cancer survivors in rural respondents (OR, 95% CI: 0.98, 0.72–1.33). Poorer perceived health was greatest if ≤ 65 years of age (OR, 95% CI: 2.54, 1.79–3.60) and nonsignificant if black (OR, 95% CI: 1.41, 0.70–2.82). Smoking and alcohol which were not significant for the sample as a whole, demonstrated significant associations in certain subgroups.ConclusionAlthough efforts to enhance perceived health and healthy lifestyle behaviors among prostate cancer survivors are warranted, demographic subgroups such as prostate cancer survivors ≤ 65 and rural populations may require more aggressive interventions.

The “Trusted Clinician”: An Alternative Approach to Worksite Health Promotion?

A trusted primary care clinician located in the workplace and serving all employees is presented as a desirable model for delivering prevention services to employees in this edition of The Art of Health Promotion. Many of the clinical studies that support this model are reviewed by the authors and their implications are discussed. Finally, the authors call for large scale experimentation to test the potential of the model to improve health risks status, lifestyle behaviors and health care utilization and cost.

An exploratory study of parents' approaches to health promotion in families of adolescents with physical disabilities

The life expectancy of children with physical disabilities now extends into adulthood and has been accompanied by the transfer of rehabilitation services from institutions to the home. Thus, families must increasingly partner with health service providers to promote their child's health and prevent the development of secondary conditions that may contribute to heart disease, stroke, respiratory diseases, low endurance and emotional difficulties. To investigate within a family context the health promotion efforts of parents on behalf of a child with a physical disability. The Long Interview Method was used to interview 15 families (11 two-parent and 4 single-parent) having a child 11-16 years of age with a physical disability including cerebral palsy (7), spina bifida (3), muscular dystrophy (3) and other conditions (2). Parents' health promotion efforts were characterized by three main themes. First, parents emphasized traditional lifestyle health behaviours including nutrition, physical activity, tobacco, alcohol and drug use, and personal hygiene. Second, parents tried to foster their adolescent's social life and friendships. They expressed particular concern about how, and if, their child would develop a sense of purpose and have a productive future. Third, parents invested a great deal of effort into observing daily routines, making arrangements for their child's social inclusion and supporting their child in a way that balanced independence with safety and energy conservation. Parents recognize that their child with a physical disability faces greater obstacles, and work hard at health promotion. Healthcare workers need to work with parents to: (1) provide information about specific lifestyle health behaviours including nutrition, physical activity and sexuality; (2) advocate for resources to foster social inclusion; and (3) discuss family strategies that balance parental involvement with their child's need for independence and energy conservation for daily activities.

Will health trainers reduce inequalities in health?

The Health Trainer initiative was a public policy initiative designed to tackle health inequalities. Despite considerable improvements in the health of the population in the United Kingdom, there continues to be a gap between the rich and the poor in terms of deaths from cancer, stroke and coronary heart disease. There is a relationship between these health problems and lifestyle behaviours such as smoking, physical inactivity and poor diet. The Health Trainer initiative was created as part of the white paper Choosing Health. Following initial implementation across targeted Primary Care Trusts (The Spearhead Group), a rigorous evaluation of the initiative is taking place prior to a national roll out. This paper uses Whitehead's framework to examine the decision to implement health trainers as a stated aim of tackling health inequalities. The four purposes of health policy as identified by Whitehead (1995) and the categories of healthy living initiatives (Visram and Drinkwater 2005) are examined and applied to the health trainer initiative and its potential for reducing health inequality.

Use and Awareness of Prostate Specific Antigen Tests and Race/Ethnicity

This study is an assessment of racial and ethnic differences in the awareness and use of prostate specific antigen tests. This is a secondary analysis of the 2000 National Health Interview Survey cancer control supplement. The subsample was 4,717 men 50 years old or older without prior prostate cancer. Outcomes were awareness and use of prostate specific antigen in a lifetime or the last year. Covariates included race/ethnicity, family income, education, age, perceived risk, health insurance and usual source of care. Multiple logistic regression was used to assess the effect of race/ethnicity on awareness and use of prostate specific antigen, controlling for covariates. Survey analysis procedures were used to account for the complex survey design. The association of race/ethnicity and the outcomes of awareness and lifetime prostate specific antigen use persisted when controlling for socioeconomic status, access and other variables. The largest differences were between Hispanic and non-Hispanic white men. Hispanic-American and black men were disadvantaged with respect to education, income and access to care, characteristics associated with lower use and awareness. In alternative models restricted to men aware of prostate specific antigen, neither race/ethnicity nor socioeconomic status was associated with use of prostate specific antigen. Race/ethnicity is associated with prostate specific antigen awareness and use. Lack of awareness of the prostate specific antigen test contributes to its lower use by racial/ethnic minorities. Future research should explore factors associated with lower use of the prostate specific antigen test by Hispanic men.

African-American women: health beliefs, lifestyle, and osteoporosis.

Cultural beliefs of African-American women, manifested in lifestyle behaviors, may influence osteoporosis development. Genetics may have a positive influence on bone density, but the risks increase from other diseases that may contribute to the development of secondary osteoporosis. Health beliefs, lifestyle behaviors, and secondary osteoporosis causes are explored, focusing on relationships with osteoporosis. African-American women must be informed of the risks involved with some of the traditional health beliefs and practices. Healthcare providers have a challenge and responsibility to explore cultural beliefs with African-American women and to develop an acceptable approach to osteoporosis prevention.

The impact of a cancer diagnosis on the health behaviors of cancer survivors and their family and friends

The aim of this study was to examine the effect of a cancer diagnosis on the health behaviors of cancer survivors and their family and friends, and to determine whether a cancer diagnosis could be a teachable moment for intervention. This was a cross-sectional study of the health behaviors of individuals taking part in a cancer fundraising event. The questionnaire was completed by 657 participants. Participants were 81.4% women, had a mean age of 46 years, and comprised of 17.2% cancer survivors. For cancer survivors, 31.3% reported an increase in physical activity, 50% of smokers quit, and 59 to 72% reported dietary improvements within 1 month of diagnosis. Significant differences in behavior change were found by age, but not by gender or education. For individuals without cancer, 24.3% reported improved physical activity and the majority reported some dietary changes. A greater proportion of family and friends who perceived they were at greater risk of developing cancer increased physical activity and sun-smart behavior but did not improve dietary habits. The results indicate that the cancer survivors made significantly more positive health behavior changes compared to the non-cancer group. For this sample, a personal diagnosis of cancer, or a diagnosis in a family member or friend, may have acted as a 'cue to action' to improve lifestyle health behaviors. This field of research is still at an early stage, and further studies are needed to confirm if this situation could be useful as a 'teachable moment' for intervention purposes.

Vitamin Supplement Intake Is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH)

Objective To explore the relationship of multiple-vitamin supplement use with selected food groups, physical activity, lifestyle behaviors, and weight status. Subjects and Methods Two thousand seven hundred sixty-one adolescents in the 12th grade who participated in the fourth Child and Adolescent Trial for Cardiovascular Health study had height and weight measured and completed health behavior survey and food frequency questionnaires. Logistic regression models were used to determine the likelihood of supplement use with health and activity behaviors and dietary intake. Results Prevalence of multiple-vitamin supplement use among adolescents was 25% and varied by sex and race/ethnicity. Supplement users had higher mean daily intakes of most food groups, but lower intakes of total fat and saturated fat than nonusers. Higher food index scores were positively associated with the likelihood of using multiple-vitamin supplements. Supplement users were more likely to be physically active, participate in team and organized sports, and less likely to be overweight and to watch more than an hour of television per day. Conclusions Adolescents who use multiple vitamin supplements have more healthful dietary and lifestyle behaviors than nonusers. Further study on supplement use by adolescents, including other types of supplements used and reasons for use, is warranted.

Models for Delivering Survivorship Care

Survivors of adult cancer face lifetime health risks that are dependent on their cancer, cancer treatment exposures, comorbid health conditions, genetic predispositions, and lifestyle behaviors. Content, intensity, and frequency of health care that addresses these risks vary from survivor to survivor. The aims of this article are to provide a rationale for survivor health care and to articulate a taxonomy of models of survivor care that is applicable to both community practices and academic institutions.

Women's Health Issues with Fibromyalgia Syndrome

Fibromyalgia syndrome (FMS) involves multiple sensory, somatic, and cognitive symptoms that are bound to affect or be affected by physical and mental health status and behavioral components of daily life. From a telephone survey of 442 women with and 205 women without FMS as volunteers, data were compared on (1) general health status, (2) reproductive and sleep-related diagnoses, and (3) lifestyle health behaviors. All multiple or logistics regression analyses for group differences were controlled for age, body mass index (BMI), race, employment status, marital status, having a college degree, low household income, and having ever been diagnosed with depression, with a Bonferroni p value correction for multiple indicators. Accordingly, FMS negatively impacted both perceived physical and mental health status, although relatively more so for physical (p < 0.017). Women with FMS were more likely to have had reproductive health or sleep-related diagnoses, including premenstrual syndrome, dysmenorrhea, breast cysts, bladder cystitis, sleep apnea, restless leg syndrome, and abnormal leg movements (p < 0.0125). They were calculated to use less than half as many calories per week as control women (689 +/- 1293 vs. 1499 +/- 1584 kcal/week, p < 0.05) and had more sleep pattern difficulties (p < 0.0125), more negative changes in sexual function (greater odds for 5 of 10 indicators at p < 0.005), and lower alcohol use (odds ratio = 0.39, p < 0.05). Patients with FMS deserve careful assessment for reproductive conditions and sleep-related functional disorders. Besides more research into mechanisms underlying symptoms, intervention testing specifically to alleviate sleep problems, low physical activity levels, and sexual dysfunction should be paramount.

Lifestyle and Clinical Health Behaviors and PSA Tests

This study assessed the association of lifestyle and clinical health behaviors with prostate specific antigen (PSA) tests. The study used cross-sectional data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). We used Stata 8.0 to take into account the complex sample design in analyses. Both lifestyle and clinical health behaviors were associated with PSA use. Life style behaviors associated with PSA use include not smoking, moderate or no drinking, regular seatbelt use, and leisure physical activity. Clinical health behaviors associated with PSA use were influenza vaccines and colorectal cancer screening. The strongest associations were with colorectal cancer screening and access to care. The strong alignment of PSA testing with positive health behaviors suggests men view PSA tests as protective. This perspective may complicate health education messages to support informed decision making about prostate cancer screening.