Individual Behavioral Risk Factors Research Articles

Predictors of mood-related psychiatric disorders after cancer diagnosis.

e23043 Background: Mood-related psychiatric disorders (MRPDs) such as anxiety and depression are more common among cancer patients vs. the general population and are related to decreased quality of life and poor cancer survival. However, individual risk factors for MRPDs among cancer patients are poorly understood. This study characterized individual predictors of a new MRPD after cancer diagnosis, with a focus on individual behavioral risk factors (IBRFs) (ie., tobacco use and human papillomavirus [HPV]-association). Methods: Single-center retrospective cohort study of 11,712 patients with newly diagnosed breast, prostate, colon, lung, oropharyngeal, anorectal, gynecologic (cervical, vaginal, and vulvar), or penile cancers between 2009-2020. Patients with breast, prostate, and colon cancer were used as controls because of the lack of an association with IBRFs. The primary outcome was a new MRPD post-cancer diagnosis, ascertained via electronic health record data and using ICD10 codes for MRPDs. Covariates included age, sex, race/ethnicity, sexual orientation, disease stage at diagnosis, and IBRFs. We conducted a time-to-event analysis to assess risk factors for MRPDs using a Cox proportional hazards model. Results: The average age of participants was 63 years (SD = 12 years). Most of the study sample was female (59%), non-Hispanic White (72%), heterosexual (67%), and diagnosed with stage I or II disease (63%). Breast (40%), prostate (26%) and lung (21%) were the most common cancers. 328 cases (3%) in the sample consisted of HPV-associated cancers. Half of the sample were current or former smokers. Univariate analyses revealed lower hazard ratios (HRs) of a new MRPD among individuals that identified as Asian/Pacific Islander (API) and among older patients ( > 51 years). Higher HRs of MRPDs were found for females; sexual minorities; former and current smokers; those with HPV-associated cancers; and those with later cancer stages (III and IV). These associations were observed in the adjusted multivariate model: APIs (aHR 0.60, 95%CI 0.46-0.65); 51-64 years (aHR 0.83, 95%CI 0.76-0.92); > 65 years (aHR 0.70, 95%CI 0.63-0.78); females (aHR 1.78, 95%CI 1.64-1.94); sexual minority (aHR 1.78, 95%CI 1.40-2.27); former smoker (aHR 1.40, 95%CI 1.30-1.52); current smoker (aHR 1.79, 95%CI 1.60-2.00); HPV-associated tumors (aHR 1.23, 95%CI 1.02-1.49); stage III diagnosis (aHR 1.58, 95%CI 1.34-1.85); stage IV diagnosis (aHR 2.31, 95%CI 1.96-2.73). Conclusions: IBRFs increased the risk of a new MRPD after being diagnosed with cancer. Prior work has associated HPV-positivity with anxiety and depression in patients without a cancer diagnosis. Our findings build on this and show that individuals diagnosed with HPV-associated cancers have a higher risk of developing new MRPDs after their cancer diagnoses. These findings can help identify patients at risk of developing new MRPDs post-cancer diagnosis to engage them in treatment.

Assessing the relationship between adverse pregnancy outcomes and area-level deprivation in Wales 2014–2019: a national population-based cross-sectional study

ObjectivesThe aim of this study was to assess the relationship between deciles of area-level deprivation and seven adverse pregnancy outcomes in Wales.DesignCross-sectional analysis.Setting64 699 live births in Wales from 31...

Children's oral health-related behaviours and early childhood caries: A latent class analysis.

In this cross-sectional study in a large community-based sample of preschool-age children, we sought to identify distinct clusters of modifiable early childhood oral health-related behaviours (OHBs) and quantify their association with clinical and parent-reported measures of early childhood oral health. We relied upon a questionnaire (n=8033; 11% in Spanish) and clinical oral health data (n=6404; early childhood caries [ECC] prevalence=54%] collected in the context of an epidemiologic study of early childhood oral health among 3- to 5-year-old children in North Carolina. Latent class analysis was used to identify clusters of modifiable OHBs based on parents' responses to 6 questionnaire items pertaining to their children's oral hygiene, diet and dental home. The optimal number of clusters was determined based on measures of model fit and interpretability. We examined associations of OHB clusters with clinical and parent-reported child oral health status (ie, ECC prevalence, severity and proportion with untreated disease) using bivariate association tests and multivariable regression modelling with marginal effects estimation accounting for clustered data. We used Mplus v.8.6 (Muthén & Muthén, Los Angeles, CA, USA) and Stata v.16.1 (StataCorp, College Station, TX, USA) for data analyses. We identified 2 OHB clusters, a favourable (74%) and an unfavourable (26%) one. Children in the favourable OHB cluster had better oral hygiene practices (ie, tooth brushing frequency and fluoridated toothpaste use), lower consumption frequency of sugar-containing snacks and beverages, less frequent reports of night-time bottle-feeding history and a higher likelihood of a dental home. Children in the unfavourable cluster had significantly higher ECC prevalence (57% vs 53%), caries burden (mean dmfs=9.3 vs 7.6), untreated disease (43% vs 33%) and worse parent-reported oral health status than the favourable cluster. Our findings demonstrate the importance and utility of clustering common, modifiable ECC risk factors in population studies - health promotion efforts may centre on groups of people rather than individual behavioural risk factors.

Geographic Information System as a health improvement tool: a resettlement camp in Mozambique

Abstract Cyclone Idai have devastated and displaced an estimated 1.85 million individuals across Mozambique. Around 90,000 cyclone survivors have been relocated to 66 resettlement camps. Doctors of the World Portuguese Delegation team is supporting the Sanitary Post of a resettlement camp, located in a remote rural area with limited resources. The first intervention was to build an epidemiological surveillance system in order to prevent and control communicable and non-communicable diseases and to improve access to health care. The health status in the resettlement camp using conventional and geographic information system techniques were attempted as a community-based census-type cross-sectional study. Location of tents, water holes and latrines were mapped. There were 2,170 people living in the 402 households interviewed. The reported age range of population was 1 day to 99 years, with a mean 19.3 years and a median of 15 years. Among residents, 4% (n = 90) reported a non-communicable disease: hypertension (75.5%), respiratory disease (22.2%), and a range of conditions (2.3%). The prevalence of mental and physical disabilities was 1.8% (n = 39). Regarding individual behavioral risk factors, 6.7% and 5.6% of the residents over 15 years, were currently using tobacco and alcohol, respectively. The distance from any household to the nearest waterpoint is less than 500 meters and almost all households (98.5%) distance more than 50 meters from the nearest toilet, as the standard recommended. The average number of people in the camp are in the standard recommended of 20 people per toilet facility with a ratio 15.8 person per latrine. Geographic information system technology was helpful for the improvement of strategies on surveillance, prevention and control regarding communicable and non-communicable diseases, in the resettlement camp. Also made it possible to set up a home health care system, promoting access to health care for the disabled residents. Key messages Geographic information systems proved to be very useful in the implementation and organization of the epidemic surveillance system of resettlement camp. The epidemic surveillance system allowed us to implement a home care system for patients with disabilities, to respond to acute illnesses and chronic diseases agudizations, and to identify outbreaks.

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

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

A scoping review of caries risk management protocols in Australia and New Zealand

To identify and map the caries risk management protocols with multiple strategies, which were used in Australia and New Zealand and reported in the existing literature, a scoping review was carried out by electronically searching PubMed, Web of Science, Scopus, Embase and Dentistry and Oral Science. Studies on caries risk management protocols, written in English, limited to Australia and New Zealand and published up to March 2018 were included in the review. There was no restriction on participants' age. Of 257 studies identified, seven were included in the review. These seven studies were reported in Australia and all but six were based on the caries management system (CMS). There were two descriptive studies, one 3-year multicentre cluster randomized controlled trial (RCT), one 2 to 4-year post-RCT follow-up and two cost-effective evaluations based on Markov decision analytic models. While concentrating on assessing individual behavioural risk factors for dental caries, studies indicated that the CMS would be more cost-effective if its protocol was properly adhered to. Future studies on caries risk management protocols are suggested to consider both the individual characteristics and the social context of different population groups in view of enhancing the effectiveness of oral care.

Sudden infant death and social justice: A syndemics approach.

Sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) prevention has focused on modifying individual behavioural risk factors, especially bedsharing. Yet these deaths are most common among poor and marginalized people in wealthy countries, including U.S. Blacks, American Indians/Alaskan Natives, New Zealand Māori, Australian Aborigines, indigenous Canadians, and low-income British people. The United States now has the world's highest prevalence of SUID/SIDS, where even Whites' SIDS prevalence now approaches that of the Māori. Using public databases and the literature, we examine SUID/SIDS prevalence and the following risk factors in selected world populations: maternal smoking, preterm birth, alcohol use, poor prenatal care, sleep position, bedsharing, and formula feeding. Our findings suggest that risk factors cluster in high-prevalence populations, many are linked to poverty and discrimination and have independent effects on perinatal outcomes. Moreover, populations with the world's lowest rates of SUID/SIDS have low income-inequality or high relative wealth, yet have high to moderate rates of bedsharing. Employing syndemics theory, we suggest that disproportionately high prevalence of SUID/SIDS is primarily the result of socially driven, co-occurring epidemics that may act synergistically to amplify risk. SUID must be examined through the lens of structural inequity and the legacy of historical trauma. Emphasis on bedsharing may divert attention from risk reduction from structural interventions, breastfeeding, prenatal care, and tobacco cessation. Medical organizations play an important role in advocating for policies that address the root causes of infant mortality via poverty and discrimination interventions, tobacco control, and culturally appropriate support to families.

Barriers to cardiovascular disease secondary prevention care in the West Bank, Palestine \u2013 a health professional perspective

BackgroundNon-communicable diseases (NCDs) - including cardiovascular disease (CVD), cancer and diabetes - have become a significant global burden on health. Particularly concerning are CVD rates, causing approximately 18 million deaths worldwide every year. The statistics show that the disease is no longer a predominantly high-income country phenomenon, but affects, increasingly, countries in both developing regions and conflict-affected areas. In the occupied Palestinian territory (oPt), the focus of this article, CVD ranks top of ten NCD killers, accounting for approximately 37.6% of deaths. Key risk factors discerned in primary care settings have been related to both structural determinants (i.e. the Israeli occupation) and individual behavioural factors. Unfortunately, no data are available for secondary care settings in the region and, consequently, little is known about patients and their capacity for risk factor behaviour change to manage their CVD.To begin closing this gap in knowledge, our study provides insight into cardiovascular disease secondary prevention care with the overall aim to enhance the understanding of the complexities of managing NCDs like CVD in conflict-affected settings. Specifically, research was carried out among Palestinian health professionals who specialise in coronary artery disease in the West Bank to elicit their views on (a) how socio-political, health system and individual behavioural factors might hinder patients to change their health behaviour and impact on the provision of healthcare and (b) possible solutions for overcoming identified barriers to behaviour change on societal as well as individual-patient levels within secondary care provision in a context of protracted conflict.MethodsThis study is based on a qualitative approach in order to provide more in-depth information about health beliefs and behaviours, experiences and views of health professionals with regards to CVD secondary care. In total, 12 semi-structured interviews were conducted among doctors providing treatment to patients with CVD in secondary care settings. Interviews focused on health professionals’ perspectives on risk factors and perceived barriers to behaviour change among known CVD patients receiving secondary care. Interviewees were also asked to propose possible actions that could be taken to overcome the identified barriers at both societal and individual patient levels. All interviews were digitally recorded, transcribed and analysed using thematic analysis.ResultsStudy results confirmed our prior theory of the complex entanglement of socio-political, health system and individual-level factors with regards to CVD experience, health-seeking and treatment. Also confirmed was our assumption that it is crucial to understand experts’ definitions and approaches to treatment in order to grasp their visions for appropriate and improved prevention and treatment options. In particular, study participants highlighted how political determinants, notably the detrimental impact of the Israeli occupation, and social determinants, directly and indirectly influence behavioural determinants due to physical and bureaucratic barriers to accessing health facilities, economic hardship and chronic stress. These stressors, in turn, were perceived as having a negative effect on individual behavioural risk factors including smoking, unhealthy diet and an increasingly sedentary lifestyle. Proposed solutions included more focused interventions from the Ministry of Health as well as surveillance, primary prevention and health promotion, and management to positively effect behaviour change in order to address the growing burden of CVD in the region.ConclusionsThe study has highlighted medical professionals’ perceptions of how structural and individual behavioural determinants influence their own and individual patient’s abilities to manage cardiovascular risk factors in a setting affected by chronic conflict. Consequently, we propose that medical and social intervention strategies generally used to address CVD risk, be strategically adapted in order to be useful and effective in contexts of armed conflict. Specifically, we call for a solid understanding of the socio-political context and existing health services as well as health providers’ and patients’ health beliefs and related behaviours when developing future health options aimed at addressing CVD in the region. Moreover, for health provision to be effective as well as sustainable, attention needs to be given above all towards a solution for political change.

Correlates of internalized homonegativity among black men who have sex with men.

Black men who have sex with men (MSM) carry a disproportionate burden of HIV in the United States. Such disparities cannot be attributed to individual behavioral risk factors alone, prompting the exploration of social and contextual factors experienced by minority MSM. Societal homonegativity and the internalization of those attitudes by Black MSM may play an important role in understanding racial and ethnic disparities in HIV incidence and prevalence. This study explores the correlates of internalized homonegativity in a large multi-site sample of Black MSM. Findings reveal a number of significant contextual and psychosocial factors related to internalized homonegativity including religiosity, resilience, and gay community acculturation, which have important implications for HIV risk, HIV testing, and social and psychological wellbeing for Black MSM.

Socio-economic status and behavioral risk factor in the adult population. Data from the Italian behavioral surveillance system. Italy, 2010-2012

Background Education and economic conditions are associated with individual behavioral risk factors, such as smoking, physical inactivity or unhealthy diet, which are responsible for most cases of chronic diseases. Also the residing geographic area can influence lifestyle differences among socioeconomic classes. Objective To evaluate the impact of socioeconomic status and residing macro-area on lifestyles. Methods PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) is the Italian behavioral risk factor surveillance system …

The colour of AIDS: an analysis of newspaper coverage of HIV/AIDS in the United States from 1992–2007

Although overall HIV rates have declined in the US over the past two decades, these declines have been accompanied by a steady growth in infection rates among African Americans, creating persistent racial disparities in HIV infection. News media have been instrumental in educating and informing the public about the epidemic. This content-analytic study examines the frequency and content of coverage of HIV/AIDS in national and local US daily newspapers from December 1992 through December 2007, with a focus on the presentation of risk by population subgroups. A computerised search term was used to identify HIV/AIDS-related news coverage from 24 daily US newspapers and one wire service across a 15-year period (N = 53 934 stories). Human and computerised coding methods were used to examine patterns in frequency and content in the sample. The results indicate a decline in coverage of the epidemic over the study period. There was also a marked shift in the portrayal of risk in the US, from a domestic to an international focus. When coverage did address HIV/AIDS among groups with disproportionately high risk in the US, it typically failed to provide context for the disparity beyond individual behavioural risk factors. The meta-message of news coverage of HIV during this period may have reduced the visibility of the impact of HIV/AIDS on Americans. The practice of reporting the racial disparity without providing context may have consequences for the general public's ability to interpret these disparities.

AN ASSOCIATION BETWEEN ETHNIC DIVERSITY AND HIV PREVALENCE IN SUB-SAHARAN AFRICA

This paper investigates whether ethnic diversity at the Demographic and Health Surveys (DHS) cluster level predicts HIV serostatus in three sub-Saharan African countries (Kenya, Malawi and Zambia), using DHS household survey and HIV biomarker data for men and women aged 15–59 collected since 2006. The analysis relates a binary dependent variable (HIV positive serostatus) and a weighted aggregate predictor variable representing the number of different ethnic groups within a DHS Statistical Enumeration Area (SEA) or cluster, which roughly corresponds to a neighbourhood. Multilevel logistic regression is used to predict HIV prevalence within each SEA, controlling for known demographic, social and behavioural predictors of HIV serostatus. The key finding was that the cluster-level ethnic diversity measure was a significant predictor of HIV serostatus in Malawi and Zambia but not in Kenya. Additional results reflected the heterogeneity of the epidemics: male gender, marriage (Kenya), number of extramarital partners in the past year (Kenya and Malawi, but probably confounded with younger age) and Muslim religion (Zambia) were associated with lower odds of positive HIV serostatus. Condom use at last intercourse (a spurious result probably reflecting endogeneity), STD in the past year, number of lifetime sexual partners, age (Malawi and Zambia), education (Zambia), urban residence (Malawi and Zambia) and employment (Kenya and Malawi) were associated with higher odds of positive serostatus. Future studies might continue to employ multilevel models and incorporate additional, more robust, controls for individual behavioural risk factors and for higher-level social and economic factors, in order to verify and further clarify the association between neighbourhood ethnic diversity and HIV serostatus.

Influence of individual behavioral risk factors (smoking, drinking) on mortality in the population cohort of adult people 20—59 years old in Tomsk (17-year prospective study)

In 17-year prospective cohort study, we analyzed the influence of smoking and drinking on the formation of cardiovascular and general mortality of adult people in Tomsk. The cohort included 1 546 people (630 men and 916 women) aged 20—59 years. It has been found that due to smoking the 17-year risk of death by any cause increases 2.4 times among men and 2.7 times among women. The increase in the frequency of drinking in the male population increase the risk of death by any cause 1.6 times (for men drinking once a month or more rarely), 2.4 times (for men drinking once a week and more rarely, but more often than once a month), and 3.8 times (for men drinking more often than once a week). The risk of death by cardiovascular diseases increases 1.7, 2.9, and 4.9 times, respectively.

Prevalence and correlates of multiple cancer risk behaviors in an Australian population-based survey: results from the Queensland Cancer Risk Study

To report on the prevalence, clustering, and correlates of behavioral risk factors for cancer in the Queensland, Australia, population. The Queensland Cancer Risk Study was a population-based survey of 9419 Queensland residents aged 20-75 years. Information was collected through anonymous computer-assisted telephone interviews between February and November 2004. Prevalence of tobacco smoking, alcohol consumption, obesity, physical inactivity, sun exposure, and inadequate fruit and vegetable intake, weighted by age, gender, and geographic region. The majority of respondents reported between two and four cancer risk behaviors (79.4%). Men, those younger than 59 years and those with lower educational attainment had more than twofold increased odds of reporting multiple cancer risk factors. Marital status and geographic region were moderately associated with cancer risk. Smoking, high levels of alcohol consumption, and sun exposure were associated with up to twofold increased odds of engaging in multiple additional risk factors. This study identified key subgroups of the Queensland population with increased odds of engaging in multiple risk behaviors for cancer, particularly younger men and people with lower educational attainment. Individual behavioral risk factors can also exert a significant impact on the overall risk profile, and this may be a useful consideration for public health campaigns that target key health behaviors.

Public policies and the problematic USA population health profile

International interest in the social determinants of health and their public policy antecedents is increasing. Despite evidence that the USA presents one of the worst population health profiles and public policy environments in support of health among wealthy developed nations – a result of systemic inequities in income, influence, and power – the USA public health gaze is firmly – and narrowly – focused on issues of access to health care, racial and ethnic disparities in healthcare, and individual behavioral risk factors. Reasons for the USA's neglect of structural and public policy issues are explored and Ten Tips for American Public Health Researchers and Workers are presented.

A Pedagogical Farm as a Source of Q Fever in a French City

Q fever is a worldwide zoonosis caused by Coxiella burnetii and presents as both acute or chronic cases. The disease can be transmitted from animal reservoirs to humans by inhalation of infected aerosols. A previous study had revealed a hyperendemic focus in South France. A case-control study was carried-out in this area from 1996 to 1999. Besides the role of wind, this study stressed out the exposure to a pedagogical farm as an independent risk factor (4.7% of cases - 0 controls): Exposure to sheep and new-born animals (OR: 3.07 and 4.01 respectively) were not significant after omission of people exposed to the pedagogical farm. Such farms are visited by people who would not have any other contact with farm animals. These farms require a drastic hygiene and control. Q fever, as a public health problem, still requires further studies to identify and confirm individual behavioral risk factors.

Wind in November, Q fever in December.

Q fever, a worldwide zoonosis caused by Coxiella burnetii, can be transmitted from animal reservoirs to humans by the inhalation of infected aerosols. We investigated the epidemiology of Q fever in the Bouches-du-Rhone district of southern France, particularly the role of wind and rainfall in C. burnetii transmission. During the winter of 1998 to 1999, an unexpected number of cases were diagnosed in the area. This statistically higher incidence was associated with an increased frequency of the mistral 1 month before onset of disease, i.e., shortly after the main lambing season. These data confirm that wind plays a role in C. burnetii transmission, a factor that can be monitored but not prevented. Further studies are needed to identify and confirm preventable individual behavioral risk factors for Q fever.