Lifestyle Transition Research Articles

Structural and Biochemical Characterization of Linear Dinucleotide Analogues Bound to the c-di-GMP-I Aptamer

The cyclic dinucleotide c-di-GMP regulates lifestyle transitions in many bacteria, such as the change from a free motile state to a biofilm-forming community. Riboswitches that bind this second messenger are important downstream targets in this bacterial signaling pathway. The breakdown of c-di-GMP in the cell is accomplished enzymatically and results in the linear dinucleotide pGpG. The c-di-GMP-binding riboswitches must be able to discriminate between their cognate cyclic ligand and linear dinucleotides in order to be selective biological switches. It has been reported that the c-di-GMP-I riboswitch binds c-di-GMP 5 orders of magnitude better than the linear pGpG, but the cause of this large energetic difference in binding is unknown. Here we report binding data and crystal structures of several linear c-di-GMP analogues in complex with the c-di-GMP-I riboswitch. These data reveal the parameters for phosphate recognition and the structural basis of linear dinucleotide binding to the riboswitch. Additionally, the pH dependence of binding shows that exclusion of pGpG is not due to the additional negative charge on the ligand. These data reveal principles that, along with published work, will contribute to the design of c-di-GMP analogues with properties desirable for use as chemical tools and potential therapeutics.

Determinants of Cardiovascular Disease in the 21st Century- -Insights from Two Diverse Populations

Seminal work by Ancel Keys established the critical role of elevated cholesterol in explaining population differences in rates of CVD. Subsequent work added hypertension and smoking, and major progress has been made in controlling all three. Despite this, world-wide rates of CVD are increasing, and in the US, there are persistent population disparities. We have conducted longitudinal cohort studies in two uniquely-informative populations in order to evaluate the determinants of CVD. The Strong Heart Study is a population based sample of American Indians. Although little CVD was observed in the mid 20 th century, rates of both CHD and stroke now exceed those in other US populations. Most events are in persons with diabetes; renal impairment is another major risk factor. Both obesity and diabetes lead to CVD risk factors and preclinical disease at young ages. The GOCADAN (Genetics of Coronary Artery Disease in Alaska Natives) and ASP (Alaska-Siberia Project) studies involve populations of Alaska Eskimos. Once thought to have little CVD, they now manifest high rates of CHD, stroke and heart failure. Obesity and diabetes in this population are lower than US averages, especially in men. However rates of smoking and subclinical infection are high and there has been a dramatic change from their unique traditional diet and physical activity patterns. These two groups serve as models for the many populations now experiencing increases in CVD. For those with epidemics of obesity and diabetes, control of the inevitable CVD will require both aggressive management of CVD risk factors and reversing the trends in obesity and diabetes. In other populations, perhaps in less developed areas, control of CVD may depend on aggressive smoking cessation and on efforts to facilitate lifestyle transitions.

A Psychiatrist Retires

The author uses his own recent experience as a basis for discussing the actualities of retiring and closing a private, solo, psychiatric practice of psychotherapy and psychoanalysis. The extended process includes a personal decision about whether, when, and how to retire; preparation of patients and arrangements for their ongoing care; dealing with legal requirements and professional obligations; and the mechanics of closing an office one has occupied for decades. Not the least of concerns is one's own personal transitions in lifestyle, professional persona, attachments to patients, and engagement in psychotherapeutic or psychoanalytic treatment relationships.

Changing trend in one decade in the profile of newly diagnosed subjects with type 2 diabetes in India

The aim was to assess the profile of newly diagnosed subjects with type 2 diabetes and to compare with the cases diagnosed a decade earlier. A total of 840 newly diagnosed subjects with type 2 diabetes were included in this analysis. 589 were consecutively diagnosed with diabetes from a tertiary care centre in the year 2009. Data of 251 new cases diagnosed a decade earlier (1999) was obtained retrospectively from the medical records. Demographic, anthropometric, blood pressure, glycemic and lipid parameters, signs and symptoms, presence of complications were noted.The age at onset of diabetes was much younger in 2009 compared to 1999 (4510.6 vs 49.99.8, p<0.0001). BMI was lower in 2009 than 1999 whereas mean waist circumference was higher in 2009. Prevalence of central obesity was significantly higher (84.6%) in 2009 compared to 1999 (56.6%).Educational and socioeconomic status improved in 2009.Dietary assessment revealed that consumption of calories increased in 2009. Mean HbA1c was higher in 2009 compared to 1999. About 79.3% were tested for diabetic complications in 1999 and it was 91.3% in 2009. Among the complications tested, neuropathy was highly prevalent in 1999 and in 2009 complications were less or similar to that reported in 1999. More than 20% had microalbuminuria in both the groups. Lipid abnormalities also varied between the study groups. The population is undergoing life style transition due to socioeconomic growth. Time related changes are noted in the profile of newly diagnosed subjects with type 2 diabetes in India.

Development of Depressive Symptoms During Early Community Reintegration After Traumatic Brain Injury

The early onset of depression following traumatic brain injury (TBI) is associated with poorer psychosocial outcomes; however, the direction of this relationship is unclear. This study investigated the relationship between progress in resuming preinjury lifestyle (transition events), change in perceived functioning and level of depressive symptoms at discharge and 3-months postdischarge. As part of a prospective longitudinal study of brain injury outcomes, 96 consecutively discharged patients with TBI completed measures of transition events (Sentinel Events Questionnaire) and perceived functioning (Mayo-Portland Adaptability Inventory-4 Ability and Adjustment indices) at discharge and 3-months follow-up. Level of depressive symptoms was assessed at discharge and 3-months follow-up using the Depression Anxiety Stress Scale 21. After controlling for age and discharge depressive symptoms, change in perceived functioning was found to mediate the relationship between total transition events and depressive symptoms at 3-months postdischarge (β reduced from .21 to .14), with a significant indirect effect observed. The present findings indicate that lack of progress in resuming preinjury lifestyle contributes to postdischarge depressive symptoms through an influence on perceived functioning, thus providing an improved conceptualization of reactive depression in the context of brain injury.

Inuvialuit adults in the Canadian Arctic have a high body mass index and self‐reported physical activity

Inuvialuit in Arctic Canada are undergoing nutrition and lifestyle transitions that encourage decreased physical activity (PA) and increased body mass index (BMI), although data specific to PA and BMI within this unique population are not currently available. The present study aimed to characterise current PA and BMI levels in a sample of Inuvialuit adults. Inuvialuit adults randomly selected from a cross-sectional survey of three communities in the Northwest Territories, Canada, completed an adapted International Physical Activity Questionnaire (IPAQ) and an anthropometric questionnaire to obtain height and weight. Data were analysed using the standardised IPAQ protocol, and the results are presented by gender and age group (≤50 and >50 years). One hundred and ninety-six Inuvialuit adults [148 women, 48 men; mean (standard deviation (SD)) ages 45 (14) and 41 (14) years, respectively; age range 19-84 years] completed the IPAQ (response rates 65-85%). Seventy-one percent of men and 74% of women allowed height measurements, whilst 81% and 84% allowed weight measurements, respectively; the remainder provided self-reported anthropometrics. Mean (SD) BMIs were 28.6 (7.7) kg/m(2) for males and 30.5 (8.8) kg/m(2) for females. The greatest percentage of participants in both gender and age groups fell into the obese BMI category. Self-reported PA was high, with means for men and participants ≤50 years in the high category of PA and means for women and participants >50 years in the medium category. Almost two-thirds (65%) of participants were classified as being overweight or obese, although 89% reported medium or high levels of PA. The results obtained in the present study indicate widespread overweight/obesity accompanying high levels of self-reported PA.

High levels of physical activity and obesity co‐exist amongst Inuit adults in Arctic Canada

Existing evidence indicates that Inuit in Arctic Canada are undergoing a lifestyle transition leading to decreased physical activity (PA) and increased body mass index (BMI). Data specific to PA and BMI amongst Inuit in Nunavut, Canada, are currently limited. The present study aimed to characterise current PA and BMI levels in a sample of Inuit adults. Inuit adults randomly selected from a cross-sectional survey of three communities in Nunavut, Canada, completed an adapted International Physical Activity Questionnaire (IPAQ) and an anthropometric survey. Data were analysed by gender and age group using standardised IPAQ protocol. Response rates ranged from 69-93%. Two hundred and eighteen Inuit adults [180 women, 38 men; mean (standard deviation (SD)) ages 42.3 (13.0) and 42.4 (14.8) years respectively; age range 19-89 years] completed the IPAQ. All men and 97% of women allowed height and weight measurements; the remainder were self-reported. Mean (SD) BMI was 27.7 (6.3) kg/m(2) for males and 30.3 (8.0) kg/m(2) for females. The largest proportion of women and participants in both age groups had a BMI in the obese category; males were evenly split between the normal and obese categories. Self-reported PA was high, with most men, women and participants ≤50 years in the high category of PA. Participants >50 years were evenly split across the medium and high categories. Most participants (72%) were classified as being overweight or obese, yet reported medium or high levels of PA (89%). The findings obtained in the present study indicate the co-existence of high BMI and high self-reported PA amongst Inuit adults.

Obesity-related non-communicable diseases: South Asians vs White Caucasians

South Asians are at higher risk than White Caucasians for the development of obesity and obesity-related non-communicable diseases (OR-NCDs), including insulin resistance, the metabolic syndrome, type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD). Rapid nutrition and lifestyle transitions have contributed to acceleration of OR-NCDs in South Asians. Differences in determinants and associated factors for OR-NCDs between South Asians and White Caucasians include body phenotype (high body fat, high truncal, subcutaneous and intra-abdominal fat, and low muscle mass), biochemical parameters (hyperinsulinemia, hyperglycemia, dyslipidemia, hyperleptinemia, low levels of adiponectin and high levels of C-reactive protein), procoagulant state and endothelial dysfunction. Higher prevalence, earlier onset and increased complications of T2DM and CHD are often seen at lower levels of body mass index (BMI) and waist circumference (WC) in South Asians than White Caucasians. In view of these data, lower cut-offs for obesity and abdominal obesity have been advocated for Asian Indians (BMI; overweight >23 to 24.9 kg m(-2) and obesity ≥ 25 kg m(-2); and WC; men ≥ 90 cm and women ≥ 80 cm, respectively). Imbalanced nutrition, physical inactivity, perinatal adverse events and genetic differences are also important contributory factors. Other differences between South Asians and White Caucasians include lower disease awareness and health-seeking behavior, delayed diagnosis due to atypical presentation and language barriers, and religious and sociocultural factors. All these factors result in poorer prevention, less aggressive therapy, poorer response to medical and surgical interventions, and higher morbidity and mortality in the former. Finally, differences in response to pharmacological agents may exist between South Asians and White Caucasians, although these have been inadequately studied. In view of these data, prevention and management strategies should be more aggressive for South Asians for more positive health outcomes. Finally, lower cut-offs of obesity and abdominal obesity for South Asians are expected to help physicians in better and more effective prevention of OR-NCDs.

A novel role of ammonia in appressorium formation of Alternaria alternata (Fries) Keissler, a tobacco pathogenic fungus

Alternaria alternata (Fries) Keissler is a facultative parasitic fungus which causes brown spot disease of senescing tobacco (Nicotiana tabacum L.) leaves. To test whether ammonia accumulation at the infection site plays a role in differentiation of infection structures and lifestyle transition of A. alternata, an artificial ammonia environment was set up to imitate and manipulate the host ammonia environment that pathogens would encounter both on leaf cuticle and in extracellular spaces. Light microscopy showed that, within 6 h after ammonia exposure, appressoria and penetration pegs could be detected at the tips of germ tubes incubated on glass slides and on host leaf surfaces, and foliar epidermal cells influenced by appressoria turned chlorotic and necrotic. Neither appressorium formation nor necrotic lesion was found in control experiments (ammonia free). Moreover, a compatible interaction between A. alternata and a resistant tobacco cultivar Jingyehuang was induced by ambient ammonia, resulting in expanding, ring-like lesions on its excised leaves within 60 h. In the absence of ammonia treatment, however, no spot symptoms could be found on the leaves of a susceptible cultivar K326 during the same period. These results suggest that A. alternata can respond to ambient ammonia and use it as a stimulator to invade the host by differentiating into infection structures and to switch to a necrotrophic lifestyle, next to secrete pathogenicity factors.

The Metabolic Syndrome in South Asians: Epidemiology, Determinants, and Prevention

The prevalence of obesity and the metabolic syndrome is rapidly increasing in India and other south Asian countries, leading to increased morbidity and mortality due to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). The literature search has been carried out using the key words "insulin resistance, the metabolic syndrome, cardiovascular risk, diabetes, obesity, Asian Indians, and South Asians" in the medical search engine Pubmed (National Library of Medicine, Bethesda, MD) from 1966 to September 2009. A high prevalence of the metabolic syndrome and associated cardiovascular risk factors has been observed not only in urban South Asian/Asian Indian adults and children but also in economically disadvantaged people residing in urban slums and rural areas. The main drivers are rapid nutrition, lifestyle, and socioeconomic transitions, consequent to increasing affluence, urbanization, mechanization, and rural-to-urban migration. Less investigated determinants of the metabolic syndrome include psychological stress in urban setting, genetic predisposition, adverse perinatal environment, and childhood "catch up" obesity. Data show atherogenic dyslipidemia, glucose intolerance, thrombotic tendency, subclinical inflammation, and endothelial dysfunction are higher in South Asians than Caucasians. Many of these manifestations are more severe and are seen at an early age (childhood) in South Asians than Caucasians. Metabolic syndrome and cardiovascular risk in South Asians is also heightened by their higher body fat, truncal subcutaneous fat, intra-abdominal fat, and ectopic fat deposition (liver fat, etc.). Further, cardiovascular risk cluster manifests at a lower level of adiposity and abdominal obesity. The cutoffs of body mass index and waist circumference for defining obesity and abdominal obesity, respectively, have been lowered and the definition of the metabolic syndrome has been revised for Asian Indians in a recent consensus statement, so that physicians could intervene early with lifestyle management. Data from a major intervention program conducted by us on urban adolescent schoolchildren in north India for prevention of obesity (the MARG project) has shown encouraging results, making it a model for any future intervention program in South Asians. Cardiometabolic risk is high in South Asians, starting at an early age. Increasing awareness of cluster of risk factors and how to prevent them should be emphasized in population-wide prevention strategies in South Asian countries, primarily focusing on children.

Transiting Social Worlds: Accounts of Formerly Married Lesbians

The research presented in this article focuses on understanding the lives of women who transit from heterosexual marriage to lesbian identity. The authors explore the social and interpersonal contexts in which lesbians enter, exist in, and exit heterosexual marital relationships. Substantive information for this study is derived from interviews conducted with women who identify as lesbian and have in the past been heterosexually married. The interviews focus on transitions in lifestyle and identity and the influence of (ex-)spouses, children, parents, friends, and lovers in various contexts and phases of transition. An important element of this research is the illumination of the ways in which women navigate and experience the straight and lesbian social worlds. The life histories of formerly married lesbians highlight the limits of current cultural definitions of social and sexual categories for these women. This research shows the need for greater awareness, understanding, and acceptance of the variances in women's sexual lives by researchers, media, and the public.

Is ethnicity an important determinant of high blood pressure in Nepalese population? A community-based cross-sectional study in Duwakot, Nepal

Objective(s) Hypertension is a rising public health problem in Nepal. Most of the upsurge is attributed to the behavioural and lifestyle transitions. However, the hereditary component such as ethnicity, which may also be an important determinant, has not been studied. Nepal, which lies between China and India, has two broad ethnic groups ‘Tibeto-Burman’ and ‘Indo-Aryan’. This study investigates if ethnicity is a key determinant of having a high blood pressure in the Nepalese population. Design and method(s) A population-based cross sectional study was conducted in the Duwakot village of Bhaktapur District, Nepal in 2008.

A transitions model for sustainable mobility

This paper reports on the development of a model for assessing transitions to sustainable mobility. The model uses the concepts of transition theory as a framework for assessing possible pathways by which a transition to a sustainable mobility society might happen. The modelling approach combines agent-based modelling techniques with a system dynamics structure. It is original in that there are two levels of agent. There are a small number of complex agents, which have an internal structure and are therefore subsystems within society, and a larger number of simple agents. Based on the UK data, the results show that Hydrogen Fuel Cell Vehicles (FCVs) come to dominate, but only in the very long run (after 2030), while biofuels and ICE (Internal Combustion Engine)-electric hybrids are the main alternatives to the regime in the next 10–30 years, because a) they are already developed and b) they fit better into current infrastructures. The model shows that technological transitions are most likely. Lifestyle change transitions require sustained pressure from the environment on society and behavioural change from consumers.

Bread type intake is associated with lifestyle and diet quality transition among Bedouin Arab adults

The traditionally semi-nomadic Bedouin Arabs in Israel are undergoing urbanisation with concurrent lifestyle changes, including a shift to using unfortified white-flour bread instead of wholewheat bread as the main dietary staple. We explored associations between the transition from wholewheat to white-flour bread and (1) lifestyle factors, (2) overall diet quality, and (3) health status. We conducted a nutrition survey among 451 Bedouin adults, using a modified 24 h recall questionnaire. Bread intake accounted for 32.7 % of the total energy intake. Those consuming predominantly white bread (PWB) (n 327) were more likely to be urban (OR 2.79; 95 % CI 1.70, 4.58), eating store-bought rather than homemade bread (OR 8.18; 95 % CI 4.34, 15.41) and currently dieting (OR 4.67; 95 % CI 1.28, 17.11) than those consuming predominantly wholewheat bread (PWWB) (n 124). PWB consumption was associated with a lower intake of dietary fibre (23.3 (se 0.6) v. 41.8 (se 1.0) g/d; P < or = 0.001), a higher intake of saturated fats (26.9 v. 24.6 % of total fat; P = 0.013) and lower intakes of Fe (11.0 (se 0.3) v. 16.7 (se 0.4) mg/d), Mg (262.2 (se 5.9) v. 490.3 (se 9.8) mg/d), vitamin E (6.5 (se 0.2) v. 8.6 (se 0.3) mg/d) and most B vitamins than PWWB consumption (P < 0.001 for all), after adjusting for total energy intake. Among those aged > or = 40 years, PWB consumption was associated with a 9.85-fold risk (95 % CI 2.64, 36.71; P = 0.001) of having one or more chronic conditions, as compared with PWWB consumption, after controlling for other risk factors. White bread intake was associated with a less traditional lifestyle and poorer diet quality, and may constitute a useful marker for at-risk subgroups to target for nutritional interventions.

Reliability and Construct Validity of the Health-Promoting Lifestyle Profile II in an Adult Turkish Population

Little is known about health-promoting lifestyle behaviors among Turkish people, who are experiencing a lifestyle transition from a developing country to one undergoing rapid modernization, although health promotion is receiving increasing attention regarding its prominent role in healthcare. Use of the Health-Promoting Lifestyle Profile II (HPLPII) has the advantage of allowing comparison of different international populations, although cultural adaptations are needed. The aims of this study were to adapt the HPLPII culturally and to assess its psychometric properties. Analyzed were internal reliability among 972 adults and test-retest stability among 160 adults. Construct validity was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Samples sizes for EFA and CFA were 420 and 500, respectively. Cronbach's alpha coefficients surpassed .70 for HPLPII and six subscales. All items, except one, had acceptable item-total correlations of >.20. Test-retest results showed stability for HPLPII and for subscales. Varimax rotation yielded five factors with eigenvalues >1, explaining 41% of the variance. Two items were excluded because their factor loadings differed by <.30 or they had cross-factor loadings. The CFA five-factor model based on EFA represented an acceptable fit. Testing of latent construct measurement models reduced the number of items from 52 to 48. The revised 48-item six-factor model had perfect fit. The HPLPII had satisfactory psychometric properties. It can be used to measure health-promoting lifestyle in the Turkish population.

Unhealthy lifestyles among older adults: exploring transitions in Mexico and the US.

Lifestyle risk factors are important precursors of old age disease and disability, and the population level impact of these factors likely differs across countries that vary in their economic growth and the attributes of the populations that adopt and abandon unhealthy lifestyles. This paper describes the stage of "lifestyle transition" among older adults in two countries with vastly different trajectories of socio-economic development. A series of hypotheses are proposed on the socioeconomic patterns of health risk factors that would be expected in the two countries, given their economic circumstances and the historical timing of policy interventions that were initiated to mitigate lifestyle risks in these populations. The paper compares the prevalence of smoking tobacco, drinking alcohol, obesity, and lack of physical exercise, as well as the socioeconomic and demographic covariates of these risk factors, among adults aged 55 and older in Mexico and the United States. The findings indicate that smoking- and physical-activity-related transitions toward healthier lifestyles are well under way among older adults in the United States but not in Mexico, whereas a trend toward reduced levels of obesity has just begun in the United States but not in Mexico. There is no evidence of a transition in heavy alcohol drinking in either country among older adults.

Challenges Facing Minority Women in Achieving Good Health: Voices of Arab Women in Israel

ABSTRACT Arab women citizens of Israel bear a heavier burden of health problems compared with Jewish women. These inequalities were examined by conducting 6 focus groups that explored obstacles to achieving good health and strategies for maintaining good health as articulated by 86 Arab-Moslem women from the Triangle area in central Israel. Perceived obstacles ranged from personal to socio-political: unhealthy lifestyles, obedience to patriarchal norms, rapid lifestyle transitions, the political situation, poverty and lower socioeconomic status, and limited access to specific health care services. These multi-layered obstacles appeared to operate synergistically to limit women's access to social support and health care systems, intensify feelings of powerlessness, and further promote unhealthy behaviors. Moreover, these perceptions differed by the socioeconomic status of the group. The relatively more advantaged groups did not address issues related to poverty or access to health care services. Most health maintenance strategies discussed were personal and conservative, and ‘considerate’ of traditional Arab cultural norms. The findings provide a basis for developing more culturally competent and adequate health care services for Arab women in Israel and for further research concerning Arab women's health in the region.

INTRODUCTION: TRACKING THE CONTEXT OF MOBILE LIVES

Many employees recognize that they are doing major amounts of professional work away from what might be considered their official workspace. Some knowledge workers are beginning to see a different world for themselves where work and home are allowed to blur and where periods of paid work alternate throughout the day with periods devoted to family and leisure. Because of rapid improvements in technology and changes in the global economy, worker mobility and distributed work have become a central topic for employees and companies alike. In this volume we begin to remedy a shortcoming in the literature on these topics by center‐staging accounts of personal experience. Contributors' narratives revolve around observations they made about their own behavior, illustrations of successes, and descriptions of the tensions inherent in mobile life and work. Thus, the articles reflect the authors' self‐conscious awareness of their individual mobile lives and, most importantly, how their lives contribute to and are shaped by larger societal patterns. In this introduction we provide an overview of the individual articles that follow, as well as some background for an informed reading, by discussing some of the driving forces behind the transition from conventional work styles to mobile and distributed patterns of work. We critically review some of the literature on the work and lifestyle transition that constitutes the central theme for this volume, including the effects of globalization, the development of tools for remote collaboration, and the blurring of home and office work. We elaborate our review of the literature on mobility and distributed work to highlight the stylistic, methodological, and topical contributions of this volume, thereby deepening our understanding of how this new mobility fits into the broader cultural and economic landscape.

Nutrition and hemostasis: A focus on urbanization in South Africa

South Africa is experiencing a rapid urbanization of its African population characterized by a demographic, nutrition, lifestyle, and health transition. The resultant high prevalence of high cardiovascular disease, in particular of stroke, is of concern. In this narrative review it is suggested that, together with hypertension, changes in the hemostatic system may be one of the major contributors to stroke in this population. It is further suggested that these changes are related to increased fat and animal protein intakes, decreased intakes of total carbohydrate and dietary fiber, as well as persistent suboptimal micronutrient intakes of Africans in transition. The effects of this nutrition transition on plasma fibrinogen, fibrin network structures, plasminogen activator inhibitor 1 activity levels and some other clotting and fibrinolytic factors are discussed. It is concluded that despite indications of present protective mechanisms against the development of coronary heart disease (CHD) in this population the observed changes in diet and hemostatic profiles may eventually lead to a high prevalence of both stroke and CHD in urban black South Africans. It is further suggested that timely nutritional interventions and research of effects thereof on the hemostatic system are urgently needed.

Chronic Disease and Lifestyle Transitions

This article addresses the association between course of chronic disease and lifestyle. We examined differences in unhealthy lifestyles--smoking, excessive alcohol use, being sedentary--and transitions herein after 6 years in prevalent and incident chronic disease categories--lung and cardiovascular disease, diabetes, and osteoarthritis and/or rheumatic arthritis--among 2,184 respondents aged 55 years and older from the Netherlands. We also examined if transitions in lifestyle co-occurred with changes in disease-related symptomatology. Proportions of respondents who smoked decreased over time, whereas proportions of respondents who were sedentary increased. Respondents with incident cardiovascular disease demonstrated more lifestyle transitions than respondents from other disease categories. Respondents demonstrating healthy lifestyle transitions did not differ from those persisting in unhealthy lifestyles in change in disease-related symptoms. Health promotion may benefit from these findings in a way that patient groups at risk for not initiating healthy lifestyles might be identified sooner.