Modifiable Health Risk Factors Research Articles

Ten Modifiable Health Risk Factors and Employees' Medical Costs-An Update.

To estimate the relationship between employees' health risks and health-care costs to inform health promotion program design. An observational study of person-level health-care claims and health risk assessment (HRA) data that used regression models to estimate the relationship between 10 modifiable risk factors and subsequent year 1 health-care costs. United States. The sample included active, full-time, adult employees continuously enrolled in employer-sponsored health insurance plans contributing to IBM MarketScan Research Databases who completed an HRA. Study criteria were met by 135 219 employees from 11 employers. Ten modifiable risk factors and individual sociodemographic and health characteristics were included in the models as independent variables. Five settings of health-care costs were outcomes in addition to total expenditures. After building the analytic file, we estimated generalized linear models and conducted postestimation bootstrapping. Health-care costs were significantly higher for employees at higher risk for blood glucose, obesity, stress, depression, and physical inactivity (all at P < .0001) than for those at lower risk. Similar cost differentials were found when specific health-care services were examined. Employers may achieve cost savings in the short run by implementing comprehensive health promotion programs that focus on decreasing multiple health risks.

PNS146 WHAT APPROACH SHOULD BE TAKEN IN ORDER TO EFFECTIVELY MANAGE BEHAVIORAL HEALTH RISK FACTORS? A CONSENSUS PANEL ANALYSIS FOR GREECE

To assess which modifiable health risk factors should be the priorities of health policy and which management approaches would be most feasible and effective in the Greek environment. A digital delphi panel was conducted, consisting of experts in healthcare and health policy, seeking convergence with the use of a close-end questionnaire. The risk factors prioritized in the study were: road safety, physical activity, dietary risks, smoking, alcohol consumption, unsafe sexual behavior, obesity and substance use. Additionally, various health policy measures were assessed on terms of effectiveness and importance for each risk factor. Overall, 23 health professionals participated in the panel. Regarding prioritization, smoking ranked first (9.45/10), followed by obesity (8.35/10) and dietary risks (8.00/10), while unsafe sexual behavior ranked last (5.16/10). Current health policy for the selected risk factors was assessed ineffective, since road safety policy ranked first with 2.48/5, while health policy on obesity ranked last at 1.37/5. Sin taxes on products related to the selected risk factors were assessed quite effective by the panel, as higher taxation on sugary beverages gathered the highest score of 3.95/5, while VAT increase in red meat gathered the lowest score of 2.86/5. Regarding individual measures for each risk factor, prohibition of use in public spaces ranked as the most important measure for the management of smoking (9.22/10), expansion of sport facilities for the promotion of physical activity (8.65/10), while health promotion ranked as the most important approach for the management of alcohol consumption (9.18/10), dietary risks (9.09/10), obesity (8.70/10), substance use (8.64/10) and road safety (8.86/10). Based on the results, effective health policy for the management of the main behavioral risk factors is yet to be achieved. Health promotion and sin taxes are considered the most efficient approach to be utilized in health policies for the management of behavioral risk factors.

Physical activity and sedentary behaviour research in Ghana: A systematic review protocol

IntroductionMortality caused by preventable non-communicable diseases such as diabetes, cancer, stroke and cardiovascular disease is on the increase. In 2016, noncommunicable diseases (NCDs) caused 41 million of the world's 57 million deaths. Two modifiable behavioural health risk factors namely physical inactivity and sedentary behaviour are associated with many of these NCDs. In Ghana, several studies have reported the prevalence of physical activity and/or sedentary behaviours. However, to date no systematic review has synthesised the findings from these studies. The aim of this systematic review is to synthesise studies that reported the prevalence of physical activity and/or sedentary behaviours in Ghana. MethodsThe Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guideline will be followed to conduct and report the outcomes of this systematic review. EMBASE, MEDLINE (OVID), PsycINFO, PsychARTICLES, CINAHL and SCOPUS are electronic databases that will be searched to identify eligible studies. Only quantitative studies that reported the prevalence of physical activity and/or sedentary behaviours using cross-sectional design, observational cohort design and case-control design will be included. Two members of the review team will independently screen the articles to determine eligibility, ascertain the quality of eligible studies, and extract data. Any discrepancy that arise at any stage of the review will be resolved through discussion between the two. The outcome of the review will be reported as a narrative synthesis if there is no homogeneity across studies and a meta-analyses will be conducted if there sufficient homogeneity across studies. DiscussionThis systematic review will synthesise the available literature on prevalence of physical activity and/or sedentary behaviours in Ghana. It is expected that the outcome of this systematic review will provide an understanding of the trend of these two health risk factors among Ghanaians. Systematic review registrationPROSPERO CRD42019119574

Impact of sleep health on self-perceived health status

Although sleep habits have long been recognized as a promoter of health, the World Health Organization 2014 report on non-communicable diseases (NCDs) only listed smoking, alcohol intake, diet and physical activity (PA) as key modifiable risk factors that could enhance health and prevent NCDs. Cross-sectional data on 4385 surveys from the 2015 Catalan Health Survey, representative of the 2015 non-institutionalized Catalan population over age 14, were used to assess and compare the independent associations of low PA (International Physical Activity Questionnaire (IPAQ): low activity); poor diet (PREvención con DIeta MEDiterránea questionnaire (PREDIMED): low-adherent); poor sleep health (Satisfaction, Alertness, Timing, Efficiency and Duration scale (SATED): <8); smoking status; and, alcohol intake (high-risk drinker based on standard drink units) with having a poor self-perceived health status. Logistic regression models adjusted by age, gender, education level and number of comorbidities showed that poor sleep health had the strongest independent association with poor self-perceived health status (OR = 1.70; 95%CI: 1.37–2.12), followed by poor diet (OR = 1.37; 95%CI: 1.10–1.72) and low PA (OR = 1.31; 95%CI: 1.01–1.69). This suggests that sleep habits should be included among the important modifiable health risk factors and be considered a key component of a healthy lifestyle.

Modifiable Risk Factors and Readiness to Change among Homeless Adults.

Objectives: In this study, we examined the prevalence of modifiable health risk factors (eg, smoking, unsafe sexual practices, at-risk drinking, low fruit/vegetable consumption, inadequate physical activity, and overweight/obesity) and readiness to change among homeless adults in Oklahoma City, OK. A secondary aim was to examine the relationship between self-rated health and readiness to change. Methods: We examined readiness to change using "ladder of change" variables. We used linear regression models to predict self-rated health and readiness to change. Results: Participants (N = 581) were largely smokers (79%), consumed less than 5 fruit and vegetable servings per day (64%) and were overweight or obese (64%). Many participants were ready to change at-risk drinking (56%), fruit/vegetable consumption (74%), and overweight/obesity (74%). Regression analyses indicated that low fruit/vegetable consumption and physical activity were associated with lower self-rated health. Lower self-rated health was not significantly related to readiness to change any health risk factors. Conclusions: Among homeless adults, the prevalence of modifiable health risk factors was high, as was readiness to change. Research is needed to reduce individual risk factors in this understudied population.

Modifiable health risk factors, related counselling, and treatment among patients in health centres.

Chronic disease burden and its related health risk factors are especially concentrated among the poor. Community health centres reach the nation's most vulnerable population. This study explored the prevalence, racial/ethnic, and gender disparities of five modifiable health risk factors and the receipt of related counselling and treatment among patients in U.S. federally qualified health centres. The 2014 Health Center Patient Survey was used for this study. We performed a cross-sectional study. Measures included tobacco use, excessive alcohol consumption, obese/overweight, high blood pressure, high blood cholesterol, and five related counselling/treatment measures. Logistic regression models were conducted to examine the multivariable-adjusted putative associations of several sociodemographic and health-related factors with modifiable health risk and counselling/treatment measures. Preliminary findings revealed differences in modifiable health risk factors across different racial/ethnic groups, while few racial/ethnic differences existed in related counselling/treatment measures. In the multivariable-adjusted logistic regression models, these differences in health risk factors were still apparent, while associations between race/ethnicity status and counselling/treatment measures were not detected. Gender was also a predictor for four types of health risk measures and two types of counselling/treatment measures. Health centre patients had high rates of modifiable health risk factors. The rates were different across race/ethnicity groups, and the differences found did not always favour non-Hispanic Whites. However, the findings reveal equitable access to related counselling/treatment service among patients across race/ethnicity groups.

Prevent 2nd Stroke: a pilot study of an online secondary prevention program for stroke survivors

Objective:The prevalence of modifiable health risk factors and psychological distress following a stroke is high and markedly increase the chance of a second stroke. This study aimed to examine the usability and acceptability of an online secondary prevention program addressing modifiable psycho‐behavioural risk factors for stroke survivors. Methods:A pre–post pilot study was conducted in Australia between 2016 and 2017. Participants were recruited through the Australian Stroke Clinical Registry and completed measures of health‐related quality of life, physical activity, smoking status, depression and anxiety, alcohol status, nutrition and internet use. Participants also used an online secondary prevention program (Prevent 2nd Stroke) over a two‐week period. At follow‐up, acceptability and usability of the program were assessed. Results:A total of 18 out of 19 participants reported engaging in multiple health risk behaviours. Participants reported that they were interested in receiving an online program that provided health information (73.7%). Participants indicated Prevent 2nd Stroke was easy to use (63.1%) and that they would recommend the program to other stroke survivors (63.1%). Conclusions:The results indicated that online programs are an acceptable way to address these health outcomes. Implications to public health:Further research is needed to assess the effectiveness of these interventions using powered trials.

Tobacco Smoking and Antisocial Deviance among Vietnamese, Vietnamese-American, and European-American Adolescents.

Tobacco smoking is one of the most significant modifiable behavioral health risk factors worldwide. Although smoking rates in some high-income countries (HIC) have declined, rates in many low-and-middle-income countries (LMIC) remain high. Adolescence is a key developmental risk period for smoking initiation. Research indicates that a major adolescent risk factor for tobacco smoking is antisocial deviance, which includes such behaviors as aggression, risk-taking, and rule-breaking. The linkages between antisocial deviance and smoking suggest that these behaviors and their underlying attitudes can be important targets for smoking prevention programs, but for public health efficiency it is important to target the components of antisocial deviance most closely linked smoking. However, although 80% of smokers live in LMIC, most relevant research has been conducted in HIC and its applicability to LMIC is unclear, given cultural differences between many HIC and LMIC. The purpose of the present study was to assess cross-cultural variations in relations among components of antisocial deviance and self-reported tobacco smoking among 2,724 10th and 11th grade Vietnamese, Vietnamese-American, and European-American students. Within the combined sample the relation between self-reported smoking and overall antisocial deviance was β = 0.33. However, the component of antisocial deviance most strongly related to smoking varied across groups, with Risk-taking most strongly related to smoking for Vietnamese-American (β = 0.37) and Vietnamese (β = 0.36) adolescents, and Rule-breaking Behavior most strongly related to smoking for European-American (β = 0.51) adolescents. These and other findings suggest the possible importance of culturally-tailored foci for smoking prevention programs emphasizing different aspects of antisocial deviance.

Factors Influencing the use of Preventive Medical Care in Malaysia: Evidence from National Health and Morbidity Survey Data

An increase in the prevalence of modifiable health risk factors, such as diabetes, hypertension and hypercholesterolemia, has become a serious public health issue in developed and developing countries. It is the main contributing factor to the rise in non-communicable diseases (NCD). The use of preventive medical care remains the best method to prevent NCD. The objective of the present study is to examine the factors affecting the decisions of people to use preventive medical care (e.g. blood glucose tests, blood cholesterol tests and blood pressure test). An ordered logit model is estimated based on a nationally representative sample. The present study finds that income, age, education, ethnicity, employment status, health insurance and smoking are significantly associated with the use of preventive medical care. As a measure towards increasing the prevalence of the preventive medical care usage, the government should pay special attention to low income earners, the young and the elderly, the less-educated, the ethnic minorities, employed individuals, individuals whose medical expenses are not paid by insurance carriers, as well as smokers.

Determinants of the demand for health screening in Malaysia: The case of the aged population

The increase in the prevalence of heart disease has become a serious public health issue. Hypercholesterolemia and hypertension are two main modifiable health risk factors for heart disease. In a fast ageing society, proper preventive measures should be adopted, particularly to achieve healthy aging. The objective of the present study is to examine the factors affecting the use of two health tests, namely blood cholesterol and blood pressure screenings among adults aged 60 years and above in Malaysia. Nationally representative data collected through the National Health and Morbidity Survey 2011 (NHMS, 2011) by the Ministry of Health, Malaysia were analysed. The survey used a two-stage stratified sampling method. Enumeration Blocks were selected in the first stage, while the second stage involved selection of Living Quarters. The proportions of those not using the blood cholesterol (45.4%) and blood pressure (30.8%) tests are alarmingly high. A bivariate probit model is applied to examine the determinants of the use of these two health screening tests. The results show that education, ethnicity, location of residence, employment status, health insurance and smoking significantly affect the decision of the aged population to undergo these tests. Key findings are, first, time is a more dominant factor than income in determining health screening behaviour among the aged population. Second, being covered by insurance increases the propensity to undergo health screening. Third, smokers have a lower likelihood of screening than non-smokers. The findings suggest that intervention programmes should be targeted at the less-educated, employed individuals, individuals not covered by health insurance and smokers.

Typical patterns of modifiable health risk factors (MHRFs) in elderly women in Germany: results from the cross-sectional German Health Update (GEDA) study, 2009 and 2010

BackgroundModifiable health risk factors (MHRFs) significantly affect morbidity and mortality rates and frequently occur in specific combinations or risk clusters. Using five MHRFs (smoking, high-risk alcohol consumption, physical inactivity, low intake of fruits and vegetables, and obesity) this study investigates the extent to which risk clusters are observed in a representative sample of women aged 65 and older in Germany. Additionally, the structural composition of the clusters is systematically compared with data and findings from other countries.MethodsA pooled data set of Germany’s representative cross-sectional surveys GEDA09 and GEDA10 was used. The cohort comprised 4,617 women aged 65 and older. Specific risk clusters based on five MHRFs are identified, using hierarchical cluster analysis. The MHRFs were defined as current smoking (daily or occasionally), risk alcohol consumption (according to the Alcohol Use Disorders Identification Test, a sum score of 4 or more points), physical inactivity (less active than 5 days per week for at least 30 min and lack of sports-related activity in the last three months), low intake of fruits and vegetables (less than one serving of fruits and one of vegetables per day), and obesity (a body mass index equal to or greater than 30). A total of 4,292 cases with full information on these factors are included in the cluster analysis. Extended analyses were also performed to include the number of chronic diseases by age and socioeconomic status of group members.ResultsA total of seven risk clusters were identified. In a comparison with data from international studies, the seven risk clusters were found to be stable with a high degree of structural equivalency.ConclusionEvidence of the stability of risk clusters across various study populations provides a useful starting point for long-term targeted health interventions. The structural clusters provide information through which various MHRFs can be evaluated simultaneously.

Preventing Disability: The Influence Of Modifiable Risk Factors On State And National Disability Prevalence.

Disability levels in the United States declined during the 1980s and 1990s, but these declines stalled more recently. Using data for 2013 from the Behavioral Risk Factor Surveillance System, we estimated the percentages of national and state disability that could be prevented through reductions in five modifiable health risk factors associated with disability: cigarette smoking, obesity, diabetes, high cholesterol, and hypertension. Taking into account risk-factor prevalence and the association between each risk factor and disability, we evaluated the fraction of disability preventable if risk factors were reduced under two scenarios: complete elimination of risk factors and reduction in all states to the lowest levels observed in states. If all five risk factors were eliminated, 53percent of disability could be prevented nationally. The largest contributors were smoking (17percent), obesity (16percent), and hypertension (12percent). If all states reduced risk-factor levels to the lowest observed levels, up to 7percent of disability could be prevented nationally. Many states in the South and Midwest could experience disability reductions of more than 10percent by attaining the same risk-factor levels as in states that had the lowest levels. Improved risk-factor prevention could result in the resumption of longer-term declines in US disability.

The mediational role of physical activity, social contact and stroke on the association between age, education, employment and dementia in an Asian older adult population

BackgroundOur study aimed to investigate the pathways by which socio-demographic factors, modifiable health and lifestyle risk factors influence each other, and subsequently, lead to dementia.MethodsWe used data from the Well-being of the Singapore Elderly study, a nationally representative survey of the older adult population aged 60 years and above in Singapore. Dementia diagnosis was established using 10/66 dementia criteria. Structural equation modelling (SEM) without latent variable was applied to confirm the hypothesized model.ResultsThe results of SEM supported the hypothesized model (χ2 = 14.999, df = 10, p = 0.132). The final model showed that those aged 75–84 years and 85 years and over (vs. 60–74 years), having no formal education, who had completed primary or secondary education (vs. completed tertiary), who were homemakers and retired (vs. paid work), and with a history of stroke were directly associated with higher odds of having dementia, while those who had more frequent contact with friends and neighbors as well as being physically active were directly associated with lower odds of having dementia diagnosis. The study also found that physical activity, more frequent contact with friends and stroke played a significant role as mediators in these relationships. The overall pathways model explained 57.7% of the variance in dementia.ConclusionOur results suggest that physical activity, social contact and stroke were potential mediators in the relationship between age, education, employment and dementia. Intervention programmes focusing on physical activity such as exercise and social contact may be useful in reducing the risk of dementia among older adults.

Hired farmworkers in the US: Demographics, work organisation, and services

Farm work is labor-intensive, physically demanding, and incurs a high risk of injury. The aim of this study was to identify characteristics of farmworkers at increased risk of adverse health outcomes to focus targeted interventions. The National Agricultural Workers Survey for 2008-2012 was used to compare characteristics associated with adverse health and safety conditions among US-born and Mexican and Central American-born Latino and Indigenous, documented and undocumented farmworkers, separately for males and females. US-born farmworkers had more secure work, worked less onerous tasks, and earned more per hour than other categories of farmworkers. Undocumented Indigenous workers had more precarious work, worked more onerous tasks, and were more likely to do piece work, than undocumented Latino workers. We highlight disparities in modifiable occupational health risk factors across groups of farmworkers that are associated with increased risks of work-related injury and poor health. Am. J. Ind. Med. 59:644-655, 2016. © 2016 Wiley Periodicals, Inc.

Health Risk Factors and Desire to Change among Homeless Adults.

The prevalence of smoking, at-risk alcohol use, overweight/obesity, inadequate fruit and vegetable consumption, and inadequate physical activity was examined among homeless adults. Desire to change these modifiable health risk factors and the association between desire to change and self-rated health also were examined. A sample of 394 homeless adults completed computer-based questionnaires (read over headphones) that assessed sociodemographic characteristics, health risk factors, desire to address health risk factors, and self-rated health. Participants were primarily men (71.8%) and African Americans (62.8%). Most participants were current smokers (75.9%), 31.0% were at-risk drinkers, 58.8% were over-weight or obese, 66.2% consumed fewer than 5 fruits and vegetables per day, and 29.9% had insufficient physical activity. With the exception of at-risk drinking, more than half of those with each health risk factor reported a desire to address that factor. Poorer self-rated health was associated with desire to reduce drinking (p = .023) and increase fruit and vegetable consumption (p = .027); it was marginally related to desire to lose weight (p = .057). Although the prevalence of modifiable health risk factors in homeless adults is high, the desire to change many risk factors is also high, indicating the need for relevant interventions for homeless adults.

Prime Time Sister Circles®II: Evaluating a Culturally Relevant Intervention to Decrease Psychological and Physical Risk Factors for Chronic Disease in Mid-Life African American Women

This article presents the results of two evaluation studies of the Prime Time Sister Circles(®) (PTSC). The PTSC is a gender, cultural, and age specific, curriculum-based, low-cost, short-term, replicable support group approach aimed at reducing key modifiable health risk factors for chronic illnesses in midlife African American women. Study 1 includes an evaluation of 31 PTSCs (N=656 women) documenting changes in psychological and attitudinal outcomes (health satisfaction, health locus of control), behavioral outcomes (healthy eating patterns, physical activity, stress management), and clinical outcomes (weight, BMI, blood pressure, non-fasting blood sugar). Study 2 includes evaluation of a subset of the PTSC sites (N=211 women) with comparison (N=55 women) data from those same locations. Study 1 showed significant changes (p<.0001) in the PTSC women's reports of (lower) stress, (higher) health locus of control, (increased) health satisfaction, (increased) physical activity, and (healthier) eating patterns. The PTSC women demonstrated a significant weight reduction at posttest (p <.0001) and had slightly better clinical outcomes in BMI, hypertension, and non-fasting blood sugar. Results document the sustainability of selected changes over a six-month period. Findings from the Study 2 strengthen the effectiveness claims of the PTSC intervention with significant changes for the PTSC women on selected outcomes and little changes for the comparison women. Results reaffirm findings regarding the effectiveness of the PTSC, as originally reported in Gaston, Porter, and Thomas (2007) and extends the credibility of findings by examining participants' clinical outcomes in addition to self-reports.

Factors associated with participation in physical activity among adolescents in Malaysia.

The rising prevalence of non-communicable diseases (NCDs) has become a serious public health issue. Among the multi-factorial drivers behind NCDs are modifiable health risk factors, most notably, physical inactivity. In response to the nearly global policy priority of encouraging regular participation in physical activity, the objective of the present study is to examine the factors that determine participation in physical activity among Malaysian adolescents. Nationally representative data consisting of a large sample size was used. A censored regression model was developed to estimate the likelihood of participation and time spent on physical activity. There are significant relationships between physical activity and gender, ethnicity, self-rated academic performance, maternal education, household size and time spent on physical education. The present study provides new insights into the factors affecting physical activity participation among adolescents. Specifically, self-rated excellent academic performance, household size and physical education can increase the likelihood of being physically active. Evidence of the present study implies that policy makers should pay special attention to females, Chinese, adolescents with self-rated poor academic performance and adolescents who have low maternal education.

Prevention of Age-Related Cognitive Decline: Which Strategies, When, and for Whom?

Brain aging is characterized by the progressive and gradual accumulation of detrimental changes in structure and function, which increase risk of age-related cognitive decline and dementia. This devastating chronic condition generates a huge social and economic burden and accounts for 11.2% of years of disability. The increase in lifespan has contributed to the increase in dementia prevalence; however, there is currently no curative treatment for most causes of dementias. This paper reviews evidence-based strategies to build, enhance, and preserve cognition over the lifespan by examining approaches that work best, proposing when in the life course they should be implemented, and in which population group(s). Recent work shows a tendency to decreased age-specific prevalence and incidence of cognitive problems and dementia among people born later in the first half of the 20th century, citing higher educational levels, improvements in lifestyle, and better handling of vascular risk factors. This implies that we can target modifiable environmental, lifestyle, and health risk factors to modify the trajectory of cognitive decline before the onset of irreversible dementia. Because building cognitive reserve and prevention of cognitive decline are of critical importance, interventions are needed at every stage of the life course to foster cognitive stimulation, and enable healthy eating habits and physical activity throughout the lifespan. Preventive interventions to decrease and delay cognitive decline and its consequences in old age will also require collaboration and action on the part of policy-makers at the political and social level.

The effectiveness of using the workplace to identify and address modifiable health risk factors in deprived populations

ObjectivesTo establish whether a programme of targeted health screening, with referral to appropriate interventions, offered to an employed but socioeconomically deprived group was effective in overcoming barriers to uptake of...

Characterizing Stressors and Modifiable Health Risk Factors Among Homeless Smokers: An Exploratory Pilot Study.

This pilot study was conducted to explore the associations between stressors related to homelessness and modifiable health risk factors (poor diet, insufficient physical activity, and overweight/obesity) and to provide direction for future research. Participants (N = 57) were homeless adults enrolled in a smoking cessation program. Analyses were conducted to characterize the sample as well as the relations between relevant stressors (discrimination, chronic stress, and fear and mistrust) and health risk factors. Inadequate daily consumption of fruits, vegetables, and fiber was common. High-fat diet and insufficient physical activity were also prevalent, and the majority of participants were overweight/obese. Participants commonly endorsed discrimination, fear of victimization, mistrust of others, and several other stressors. Greater endorsement of stressors was associated with a high-fat diet. Results suggest that lifestyle interventions and policy changes may be warranted in homeless shelters to attenuate the potential effects of stressors on high-fat dietary consumption among smokers.