Poor Health Habits Research Articles

Atherosclerosis: Current Status of Prevention and Treatment

The reality of regression of atherosclerotic plaques was established as long ago as 1987 by aggressive cholesterol reduction even before the era of statin therapy. Nevertheless, the most important aspect of patient benefit to prevent cardiovascular (CV) disease events is stabilization of these plaques so they will not rupture. Lowering of low-density lipoproteins is critical to this goal and can be considered the gold standard of preventive CV medicine. The major goal for the high-risk patient and the diabetic patient is lowering these harmful lipoproteins to less than 70 mg/dL. No discussion of CV disease prevention is complete without considering tobacco abuse and its elimination. Even secondhand smoke has been established as harmful. Control of hypertension is another major aspect of CV disease prevention, and a blood pressure less than 120/80 mm Hg is ideal. With obesity a major problem in the developed world, its role in the metabolic syndrome is of major significance as is the high prevalence of this so-called syndrome versus collection of specific risk factors in a population with poor health habits. Control of diabetes mellitus has established benefit from the standpoint of CV disease prevention except that some problems have been reported with extremely tight blood sugar control. Exercise was long considered good but now there are evidence-based reasons to recommend it as essential in CV disease prevention. There are many unforeseen frontiers in CV disease prevention but, for now, everything points to elevation of high-density lipoproteins as the next focus of this prevention.

Can Reform's Prevention Incentives Help to Bend the Cost Curve?

On my various trips to Boston for conferences and meetings, I make a point of having dinner with a close cousin. Our conversations invariably turn to the issue of health care and its reform. While hardly an advocate of comprehensive health reform, my cousin has taken the position that reform would be unnecessary if people took care of themselves. More specifically, he sees much of our current health care spending crisis as emanating from our sedentary lifestyles, poor health habits, lack of discipline regarding exercise and food consumption, and failure to follow recommendations for annual physical exams and other periodic preventive care. body is like a car, I recall him saying. You need to maintain it and every once in a while you have to look under the hood. My cousin does have a point regarding our reluctance to comply with good health practices and recommended preventive care, and I suspect that many others feel the same. Indeed, there can be ample personal rewards for such behavior as well as rewards to society at large. In the context of health reform, promoting preventive care and health-enhancing behaviors are part of the arsenal of cost-containment strategies in the Patient Protection and Affordable Care Act (PPACA), and a recent study sees the use of recommended preventive services as having the potential to reduce loss of life and achieve cost savings (Maciosek et al. 2010). However, in light of the fanfare and push for preventive care and other health-related practices, a critical issue is whether we can expect individuals to respond to reform's incentives for preventive activities, whether the vagaries of human behavior will impede such responses, and most importantly, whether such care can indeed be expected to reliably yield cost savings. In what follows, I explore the issue of whether we should expect incentives for more preventive care to yield substantive savings, and thus to what extent we can expect prevention and good health behaviors to make a meaningful contribution to bending the cost curve. The PPACA and Incentives for Prevention The PPACA includes a variety of provisions directed toward the use of preventive health services and wellness activities. number of these measures entail administration and information gathering: creating administrative bodies to coordinate federal prevention efforts, establishing a national prevention strategy, expanding funds for public health programs, developing evidence-based recommendations for using clinical and community preventive services, and devising outreach campaigns for preventive benefits, among others (this and the following summary are drawn from the Kaiser Family Foundation 2010). The law also includes provisions to eliminate out-of-pocket costs for 41 preventive services rated A or by the U.S. Preventive Services Task Force (2010). It does so by eliminating cost sharing for such services covered by Medicare, and by increasing federal medical assistance to states (by one percentage point) that offer and B preventive services under Medicaid and also remove cost sharing. Additionally, the law authorizes Medicare coverage for personalized prevention plan services, provides incentives for Medicare and Medicaid beneficiaries to enroll in and complete behavior modification programs, and requires Medicaid to cover tobacco cessation programs for pregnant women. Finally, consistent with cost-containment goals, the PPACA permits the Secretary of the Department of Health and Human Services (DHHS) to modify or eliminate Medicare coverage of preventive services as recommended by the task force. Reform also eliminates out-of-pocket costs for and B preventive services for enrollees in qualified private health plans (beginning in September), and such plans are also required to provide, with no out-of-pocket costs, recommended immunizations, preventive care for children and adolescents, and additional preventive care and screening for women. …

Is Abnormal Glucose Tolerance in Antipsychotic-Naive Patients With Nonaffective Psychosis Confounded by Poor Health Habits?

Some but not all previous studies have found abnormal glucose tolerance or fasting glucose concentrations in antipsychotic-naïve patients with nonaffective psychosis. Our finding of abnormal glucose tolerance in patients with nonaffective psychosis could not be attributed to confounding by age, ethnicity, gender, smoking, socioeconomic status (SES), hypercortisolemia, or body mass index (BMI). However, other factors merit consideration as potential confounders of this association. An extended sample of newly diagnosed, antipsychotic-naive patients with schizophrenia and related disorders and matched controls were administered an oral glucose tolerance test. Confounding factors related to diet, self-care/access to care, and drug abuse were evaluated. After accounting for the variance due to age, ethnicity, gender, smoking, SES, morning cortisol concentrations, BMI (or waist-hip ratio), our previous finding of abnormal glucose tolerance in these patients was confirmed. This difference could not be attributed to confounding by substance abuse; blood concentrations of vitamin B12, folate, or homocysteine; aerobic conditioning as measured by resting heart rate; or duration of untreated psychosis. These results provide further evidence that people with schizophrenia and related disorders have abnormal glucose tolerance and an increased risk of diabetes prior to antipsychotic treatment and independent of health habits and access to care. Other measures should also be examined.

Stress in special groups

Stress occurs when homeostasis is threatened or perceived to be so. The stress system with its central and peripheral effectors regulate the brain's cognitive, reward and fear systems, wake-sleep centers as well as the growth, reproductive and thyroid hormone axes, and influence the gastrointestinal, cardiorespiratory, metabolic and immune systems. Malfunction of the stress system might impair growth, development, behavior and metabolism, which potentially lead to various acute and chronic disorders. The speech will be focused: a) On linguistics, where stress is the relative emphasis that may be given to certain syllables in a word and stress manifests itself in the speech stream are highly language dependent. b) Gender is an important biological determinant of vulnerability to psychosocial stress. Research studies focused on the sex differences in stress responses revealed individual differences in stress reactivity in addition to genetic, socio-cultural, hormonal and developmental factors. Women appear more physiologically reactive to social rejection challenges, but men react more to achievement challenges. Women's greater reactivity to rejection stress may contribute to the increased rates of affective disorders in women. Another study specifically indicates that women with the BDNF Val/Met genotype and men with the Val/Val may be particularly vulnerable to social stress mediated by brain stress system activity (Psychoneuroendocrinology, 2009). c) Poor self-concept, impatience, poor consequential thinking, inability to set realistic goals and to prioritize, poor resource management, poor health habits, over-dependence, inflexibility are some of personality-related stressors. d) Stress responses associated with possible implications for psychopathology during childhood, adolescents and older adults. Prenatal stress and maternal exposure to exogenous glucocorticoids can lead to permanent modification of hypothalamo-pituitary-adrenal function and stress-related behaviour. Childhood stress and trauma have been related to adult psychopathology in different psychiatric disorders. e) Some transitions and dynamics can lead families to excessive stress. There are many stresses in healthy and dysfunctional families. Research revealed that secure-base interactions between parents and adolescents facilitate physiological regulation of stress, especially for adolescents with externalising symptomatology. f) Finally, the effects of stress reactivity may lead to physical symptoms and disorders (e.g. hypertension, appetite and gastrointestinal problems, skeletal muscles increased tension, smooth muscles increased contraction, visceral obesity, hyperlipidemia, hyperglycemia, cardiovascular disease, type II diabetes, suppression of immune system). There is also a link between stress and fertility. Women with infertility report equivalent levels of anxiety and depression as women with cancer, HIV status, and heart disease. Men also suffer fertility related stress, though they frequently keep their anxiety to themselves for fear of adding to their partner's burden.

Dental caries and gingivitis among pregnant and non-pregnant women in Chiang Mai, Thailand.

The aims of this study were to identify dental caries and gingivitis among pregnant women, and to compare it with those in non-pregnant women in Chiang Mai, Thailand. Data were collected from 197 women (94 pregnant and 103 non-pregnant) from June to August, 2008. Dental caries and gingivitis was defined clinically according to the World Health Organization (WHO) diagnostic criteria. Over 74.0% of pregnant women had caries, and 86.2% had gingivitis. There were significant differences between pregnant and non-pregnant women with regard to dental caries (p < 0.001) and gingivitis (p = 0.021). The pregnant women were 2.9 times more likely to suffer from dental caries (95% confidence intervals (CI), 1.6-5.4), and 2.2 times more (95% CI, 1.1-4.7) from gingivitis compared to non-pregnant women. Farmers (Odd ratio (OR), 7.0; 95% CI, 1.8-26.3), high school graduation (OR, 3.0; 95% CI, 1.2-7.3), and universal health insurance coverage (OR, 2.1; 95% CI, 1.0-4.3) were significant predictors for gingivitis. Only high school graduates were found to be significant predictors of dental caries with an OR of 2.8 (95% CI, 1.2-6.3). Poor oral hygiene (OR, 2.2; 95% CI, 0.8-6.5), lack of knowledge (OR, 2.0; 95% CI, 0.6-6.3), and poor oral hygiene habits (OR, 3.0; 95% CI, 1.1-8.6) were important risk factors for dental caries. Similarly, inadequate oral hygiene status (OR, 24.8; 95% CI, 5.5-112.2), and poor oral health habits (OR, 5.2; 95% CI, 1.1-25.2) were found to be significant risk factors for gingivitis among pregnant women indicating, that most women should be trained in proper oral hygiene practices. Community awareness programs should be conducted to increase women's awareness of such hygienic practices.

Position of the American Dietetic Association: Providing Nutrition Services for People with Developmental Disabilities and Special Health Care Needs

It is the position of the American Dietetic Association that nutrition services provided by registered dietitians (RDs) and dietetic technicians, registered (DTRs), are essential components of comprehensive care for all people with developmental disabilities and special health care needs. Nutrition services should be provided throughout life in a manner that is interdisciplinary, family-centered, community-based, and culturally competent. People with developmental disabilities and special health care needs frequently have nutrition concerns, including growth alterations (failure to thrive, obesity, or growth retardation), metabolic disorders, poor feeding skills, medication–nutrient interactions, and sometimes partial or total dependence on enteral or parenteral nutrition. Individuals with special needs are also more likely to develop comorbid conditions such as obesity or endocrine disorders that require nutrition interventions. Poor health habits, limited access to services, and long-term use of multiple medications are considered health risk factors. Health maintenance and avoidance of complications can be promoted by timely and cost-effective nutrition interventions. Public policy for individuals with special needs has evolved over time, resulting in a transition from institutional facilities and programs to community living. The expansion of public access to technology and health information on the Internet challenges RDs and DTRs to provide accurate scientific information for those with developmental disabilities and special health care needs. Nationally credentialed RDs and DTRs are best prepared to provide appropriate nutrition information for wellness and quality of life.

Nurses' satisfaction with shiftwork and associations with work, home and health characteristics: a survey in the Netherlands

This paper is a report of a study conducted to determine if satisfaction with irregular working hours that are a form of shiftwork operates as a mediator between work and home characteristics and health problems. Shiftwork contributes to health problems, decreased well-being and poorer health habits. It also affects employees' decisions to leave the healthcare sector. Although many nurses voluntarily work shifts, there have been few studies of their satisfaction with irregular working hours when these are a form of shiftwork. A survey was carried out with 144 nurses working in three nursing homes and one care home in the Netherlands. Questionnaires were distributed in 2003 to 233 nurses who worked shifts (response rate 60%). The questionnaire contained items on work and home characteristics, satisfaction with irregular working hours that are a form of shiftwork and health. A new scale to measure satisfaction with irregular working hours was constructed. All work characteristics, but no home characteristics, were associated with satisfaction with irregular working hours. The work characteristics 'job demands' and the home characteristics 'autonomy at home' and 'home demands' were associated with health. Satisfaction with irregular working hours did not mediate between work/home characteristics and health. Those reporting more social support, lower job demands and more job autonomy were more satisfied with their irregular working times that were a form of shiftwork. Satisfaction with irregular working hours is a useful construct that requires further longitudinal study. The results also underline the importance of considering home characteristics when predicting health outcomes.

High job control enhances vagal recovery in media work

Job strain has been linked to increased risk of cardiovascular diseases. In modern media work, time pressures, rapidly changing situations, computer work and irregular working hours are common. Heart rate variability (HRV) has been widely used to monitor sympathovagal balance. Autonomic imbalance may play an additive role in the development of cardiovascular diseases. To study the effects of work demands and job control on the autonomic nervous system recovery among the media personnel. From the cross-sectional postal survey of the employees in Finnish Broadcasting Company (n = 874), three age cohorts (n = 132) were randomly selected for an analysis of HRV in 24 h electrocardiography recordings. In the middle-aged group, those who experienced high job control had significantly better vagal recovery than those with low or moderate control (P < 0.01). Among young and ageing employees, job control did not associate with autonomic recovery. High job control over work rather than low demands seemed to enhance autonomic recovery in middle-aged media workers. This was independent of poor health habits such as smoking, physical inactivity or alcohol consumption.

Schizophrenia as a systemic disease.

Schizophrenia as a systemic disease.

Oral pain and associated factors among adolescents in northern Finland

OBJECTIVES: Our aim was to study the prevalence of oral pain and its association with perceived oral health and with proximal (individual health-related) and distal (sociocultural and environmental) risk factors among adolescents.STUDY DESIGN: Cross-sectional questionnaire survey.METHODS: The data were collected in 2001–2002 by questionnaires as part of the 1986 Northern Finland Birth Cohort Study. The number of eligible replies was 7,344 (response rate 80%) among 15/16-year-old adolescents and 6,985 (response rate 76%) among parents. Of the risk factors, sociocultural factors (distal) and unhealthy habits (proximal) were included. Logistic regression analyses were conducted with oral pain as the dependent variable. The independent variables were unhealthy diet, smoking, alcohol use, mother’s/father’s education, financial status, parents' attentiveness and perceived cavities.RESULTS: The best predictor of oral pain was perceived cavities. Girls and frequent users of alcohol were more likely to report oral pain than were boys and less frequent users of alcohol.CONCLUSIONS: Even though caries contributed to oral pain among adolescents, there were also other factors involved. Poor health habits such as smoking and alcohol consumption were more common among adolescents who experienced oral pain. Thus, an adolescent’s perceived pain should be treated seriously and be properly attended to by oral health personnel.

Quality Improvement in Diabetes Care Using Community Health Workers

Community health centers take care of patients who are at high risk for adverse medical outcomes because of poverty, linguistic isolation, poor education, and poor health habits. Because of their population focus, health centers are positioned to implement systems-level changes affecting many patients. We report here on a successful quality improvement initiative focusing on patients with diabetes in Holyoke, Mass. Holyoke Health Center (HHC) has two sites and serves ∼ 20,000 patients, most of whom are Spanish speaking. At present, > 1,700 of the center's adult patients have diabetes, and this figure has been increasing rapidly. In 1999, HHC adopted an electronic registry to track these patients and their clinical data as part of a larger effort to implement an integrated approach to chronic disease management.1 In 2003, community health workers (CHWs) were added to the diabetes care team to enhance the capability to engage and support patients who were not succeeding in managing their diabetes. The center's CHWs are patients with diabetes who have become good self-managers of their disease. The CHWs have had no previous training as medical personnel. They participate in a 3-day training using the Diabetes Education and Empowerment Curriculum developed by the Midwest Latino Research, Training, and Policy Center,2 a 4-day training in Stanford's Chronic Disease Self-Management Training Program,3 several sessions of training through …

The Impact of Poor Health Behaviors on Workforce Disability

The effects of poor health habits on mortality have been studied extensively. However, few studies have examined the impact of these health behaviors on workforce disability. In the Health and Retirement Study, a nationally representative cohort of 6044 Americans who were between the ages of 51 and 61 and who were working in 1992, we found that both baseline smoking status and a sedentary lifestyle predict workforce disability six years later. If this relationship is causal, cost-benefit analyses of health behavior intervention that neglect workforce disability may substantially underestimate the benefits of such interventions.

The Health Challenges of Urban Latino College Students as Revealed Through Student Journaling

Because of the unique health risks faced by the Hispanic population and the notoriously poor health habits of college students, this study examines the health challenges faced by Latino college students enrolled at an urban commuter institution. A thematic analysis reveals the top themes for males and females as healthy eating, weight management, and exercise. Alcohol use management is a theme for males, whereas stress management is found as a theme for females.

Self-rated health: changes, trajectories, and their antecedents among African Americans.

Little is known about changes in self-rated health (SRH) among African Americans. We examined SRH changes and trajectories among 998 African Americans 49 to 65 years old who we reinterviewed annually for 4 years, using multinomial logistic regression and mixed effect models. Fifty-five percent had the same SRH at baseline and 4 years later, 25% improved, and 20% declined. Over time, men were more likely to report lower SRH levels, individuals with hypertension were less likely to report lower SRH levels, and those with congestive heart failure at baseline were more likely to report higher SRH levels. Lower SRH trajectory intercepts were observed for those with lower socioeconomic status, poorer health habits, disease history, and worse functional status. Those with better cognitive status had higher SRH trajectory intercepts. The decline in SRH levels among 49- to 65-year-old African Americans is comparable to that of Whites.

Adolescent Sexual Health

Serious health problems, risky behavior, and poor health habits persist among adolescents despite access to medical care. Most adolescents do not seek advice about preventing leading causes of morbidity and mortality in their age group, and physicians often do not find ways to provide it. Although helping adolescents prevent unintended pregnancy, sexually transmitted infections, unintentional injuries, depression, suicide, and other problems is a community-wide effort, primary care physicians are well situated to discuss risks and offer interventions. Evidence supports routinely screening for obesity and depression, offering testing for human immunodeficiency virus infection, and screening for other sexually transmitted infections in some adolescents. Evidence validating the effectiveness of physician counseling about unintended pregnancy, gang violence, and substance abuse is scant. However, physicians should use empathic, personal messages to communicate with adolescents about these issues until studies prove the benefits of more specific methods. Effective communication with adolescents requires seeing the patient alone, tailoring the discussion to the individual patient, and understanding the role of the parents and of confidentiality.

Maternal and child health problems: The inter-generational consequences of early maternal aggression and withdrawal

The purpose of this study was to determine the impact of childhood aggression and social withdrawal on adult health, and to examine the transfer of health-risk to offspring. Previous studies have linked aggression to poor health habits, whereas social withdrawal has been linked to increased symptom reporting. Little research has attempted to examine the effects of parents’ childhood behaviour problems on health in the next generation. Seventy-four parents from disadvantaged neighbourhoods in Montreal (roughly half of whom were identified in childhood as being highly aggressive and/or withdrawn) and their offspring aged 9–11-years old participated in this prospective, longitudinal study. Health histories of mothers and target children were taken during structured home interviews. Regression analyses tested the relationship between parents’ behaviour problems in childhood and subsequent health outcomes in both generations. Mothers who were high on both aggression and withdrawal in childhood showed the earliest signs of health problems. Maternal childhood aggression predicted lower self-rated health and some current health problems, whereas maternal childhood withdrawal predicted more somatizing symptoms such as frequent headaches. Offspring of socially withdrawn mothers or fathers were more likely to be prescribed medication for respiratory problems and Ritalin, despite no matching maternal reports of higher incidence of behavior or respiratory problems. In summary, there were distinct health patterns for families of individuals who are highly aggressive and socially withdrawn in childhood, with implications for transfer of poor health habits to the next generation.

Comparison of Rural and Urban Residents’ Implicit and Explicit Attitudes Related to Seeking Medical Care

The decision whether or not to consult a physician draws from a variety of attitudes within an individual's health schema. While rural Americans are in greater need of health care, many of them have fewer external resources than urbanites available to them. The objective of this study was to elicit implicit and explicit attitudes related to seeking medical treatment for a condition described as fairly serious. Participants were asked to rate how often they comply with treatment regimens and practice good health habits. The sample of rural (N = 586) and urban (N = 433) North Carolina residents was derived based on random-digit dialing. Multiple regression analyses were performed to investigate how attitudes associated with perceived compliance and health behaviors. While rural and urban residents offered very similar responses, the associations between attitudes and behaviors were different. One healthy and 2 unhealthy schema patterns emerged. First, fear of hospitals was associated with effective compliance for rural residents and good health habits for urbanites. Second, affordability concerns were ascribed to rural community residents but seemed to reflect personally relevant implicit attitudes since they were associated with poor health adherence and habits for rural residents. Third, mistrust of doctors predicted low adherence for both groups and was also associated with poorer health habits for urbanites. With inconsistencies among implicit and explicit attitudes and behaviors, some residents seemed to be ambivalent about seeking health care.

Diabetes Treatment Among VA Patients With Comorbid Serious Mental Illness

Diabetes Treatment Among VA Patients With Comorbid Serious Mental Illness

Community unemployment and immigrants’ health in Montreal

This research examines the relationship between community unemployment and the physical and mental health of immigrants in comparison to non-immigrants in Montreal under the hypothesis that high unemployment in the community may generate more negative effects on the health of immigrants than on non-immigrants. Possible gender differences in these associations are also examined. Montreal residents were studied via multilevel analysis, using both individual survey data and neighbourhood data from 49 police districts. Individual-level data were excerpted from a 1998 health survey of Montreal residents, while neighbourhood data originated from survey data collected in the 49 Montreal police districts and the 1996 Canadian Census. The associations between community unemployment and self-rated health, psychological distress and obesity are examined, and hypotheses regarding the modifying mechanisms via which male and female immigrants may run a greater risk of poor health than non-immigrants when living in areas of high unemployment were tested. Between neighbourhoods, variations in the three health outcomes were slight, and differences in health were not associated with differences in community unemployment. The associations between community unemployment and health varied according to immigration status. At the individual level, immigrants do not differ from non-immigrants with respect to the three health indicators, except that second-generation males are slightly heavier. However, when living in areas of high unemployment, immigrants tend to report poor physical and mental health in comparison to non-immigrants. Among first-generation immigrants, community unemployment was associated with psychological distress. Among second-generation immigrants, the probability of obesity and poor self-rated health increased significantly for those living in areas with high unemployment, but these associations reached statistical significance only for men. Findings among first-generation immigrants are interpreted with respect to the effects of possible discrimination in areas with low job availability. Among second-generation men, poor physical health and obesity may be the result of poor health habits stemming from perceived lack of life opportunities.

Isolating a primary dimension within the Cook–Medley hostility scale: a Rasch analysis

The empirically derived Cook–Medley Hostility scale ( Ho) has been shown to be related to a number of poor health habits and general mortality. Researchers attempting to attach psychological meaning to Ho scores have had difficulty reaching consensus in defining a single construct to organize Ho items’ content. While previous psychometric analyses of the 50 Ho items have revealed a strong primary dimension underlying responses, a number of small and unstable factors also influence Ho scores and thus cloud interpretations. The goal of this study was to better understand the relationship between individual Ho items and the primary latent dimension underlying responses to the Ho scale. We believe that this is a first step to clarifying interpretation of Ho scores as a psychological risk factor for poor health outcomes. Using a Rasch logistic item response model, we identified a subset of items that formed a reliable and unidimensional index that maintained strong relationships with the primary construct assessed by the 50-item Ho scale. The subset of 17 Ho items was not differentially influenced by gender in a large psychiatric sample, and the psychometric properties of the 17 Ho items were confirmed in a large medical sample.