Risky Health-related Behaviors Research Articles

Cross-sectional associations of gender identity and sexual orientation, with co-occurrence and clustering of health-related behaviours among British adolescents: Millennium cohort study

PurposeWe examined whether gender identity and sexual orientation were associated with seven health-related behaviours, and with co-occurrence and clustering of these behaviours among British adolescents. MethodsMillennium Cohort Study (age 17 wave) provided data on the exposures, gender identity (male, female, genderqueer) and sexual orientation (heterosexual, bisexual, gay or lesbian, or other), and seven self-reported health-related behaviours (binge drinking, drug use, no consumption of breakfast, no consumption of fruits or vegetables, physical inactivity, poor sleep, and smoking or vaping). Poisson regressions examined associations between the exposures and single behaviours (reporting prevalence ratios (PRs)); and multinomial logistic regressions were used for behavioural cumulative co-occurrence score (reporting PRs). Cluster patterns were identified using Ward's agglomerative hierarchical cluster analysis while associations with cluster membership were performed using logistic regressions (reporting odds ratios (ORs)). ResultsOur sample included 6022 adolescents (55.4% female, 1.5% genderqueer, 11.6% non-heterosexual). Adolescents who identified as genderqueer had the highest prevalence of not eating breakfast (PR: 60.5% [95%CI 48.4–71.4]) and poor sleep (68.7% [95%CI 55.6–79.3]). Those who identified as bisexual had a higher PR of co-occurring behaviours (2.46 [95%CI 1.39–4.27]). Among the three clusters identified (1: Multiple risk behaviours; 2: Physical inactivity and binge drinking; 3: Poor diet and physical inactivity), adolescents who identified as genderqueer or other sexual orientation showed the highest prevalence in cluster 3. ConclusionGender and sexual minority British adolescents showed a higher prevalence of risky health-related behaviours, and higher risk of co-occurring behaviours. Physical inactivity and poor diet behaviours commonly clustered together for these groups.

Adverse childhood experiences, sexual risk-taking and non-consensual sexual experiences in a nationally representative study of 15–29-year-old Danes

BackgroundAdverse childhood experiences (ACEs) have been linked with risky health-related behaviors and poor health. ObjectiveThis study aimed to investigate associations of ACEs with a broad panel of sexual risk-taking behaviors and non-consensual sexual experiences among young people in Denmark. Participants and settingBaseline questionnaire data from 15 to 29-year-old participants in the nationally representative cohort study Project SEXUS were used in combination with data from Danish national registers to include a total of 13,132 individuals. MethodsIn logistic regression analyses, confounder-adjusted odds ratios (aORs) with 95 % confidence intervals (CIs) were obtained for associations of five ACE categories (Household challenges, Loss or threat of loss, Material deprivation, Abuse, and Neglect) and a cumulative ACE score with measures of sexual risk-taking and non-consensual sexual experiences. ResultsStatistically significant associations were observed between ACEs and multiple sexual risk-taking behaviors and non-consensual sexual experiences with particularly increased odds among individuals with a history of Abuse, Neglect, or an ACE score of 3 or more. Specifically, Abuse was associated with having received payment for sex (women: aOR 5.38; 95 % CI 2.73–10.61; men: aOR 2.11; 95 % CI 1.22–3.64), with having paid for sex (men: aOR 1.88; 95 % CI 1.41–2.51), and with having been the victim of a sexual assault after age 18 years (women: aOR 3.33; 95 % CI 2.36–4.68). ConclusionsIn this Danish study, multiple measures of sexual risk-taking and non-consensual sexual experiences were markedly more common among young people with ACEs than in those without ACEs. This knowledge should be considered in future initiatives to promote sexual health among young people.

Integrating health geography and behavioral economic principles to strengthen context-specific behavior change interventions.

The long-term economic viability of modern health care systems is uncertain, in part due to costs of health care at the end of life and increasing health care utilization associated with an increasing population prevalence of multiple chronic diseases. Control of health care spending and sustaining delivery of health care services will require strategic investments in prevention to reduce the risk of disease and its complications over an individual's life course. Behavior change interventions aimed at reducing a range of harmful and risky health-related behaviors including smoking, physical inactivity, excess alcohol consumption, and excess weight, are one approach that has proven effective at reducing risk and preventing chronic disease. However, large-scale efforts to reduce population-level chronic diseases are challenging and have not been very successful at reducing the burden of chronic diseases. A new approach is required to identify when, where, and how to intervene to disrupt patterns of behavior associated with high-risk factors using context-specific interventions that can be scaled. This paper introduces the need to integrate theoretical and methodological principles of health geography and behavioral economics as opportunities to strengthen behavior change interventions for the prevention of chronic diseases. We discuss how health geography and behavioral economics can be applied to expand existing behavior change frameworks and how behavior change interventions can be strengthened by characterizing contexts of time and activity space.

A comparison of health behaviours in male adolescents with and without offending histories referred for adolescent health services in Turkey

Offending and incarceration are important societal problems that might be reduced by improving early intervention. Most prior work identifying risk factors has focussed on early oppositional or aggressive behaviours and environmental problems. Among adults, it is well recognised that offenders have much poorer health than the wider population. This raises questions about whether behaviours that put health at risk while a teenager may also be good markers of subsequent offending. To examine the relationship between risky health behaviours and delinquency by comparing male teenage offenders with a history of incarceration and male teenagers with no criminal involvement. In this cross-sectional study, 66 male 12-18-year-old offenders with an incarceration history who were referred for evaluation to the Forensic Medicine Polyclinic in 2021 were compared with 74 similar aged adolescents without a criminal record but attending another clinic in the same hospital, using the Risky Health Behaviour Scale (RHBS). This covers dietary, road safety and sexual behaviours as well as exercise, substance use and violent behaviours. Negative items were reverse scored so that higher scores indicated more pro-health activities. Total RHBS scores were significantly lower among the offender-group than the comparison teenagers (Means 93.19±17.00: 107.20±10.83; p≤0.001). This reflected significant differences in each of the subscale scores except dietary and risky sexual behaviour. Only substance use behaviours, however, were independently related to offender group membership, as was family socio-economic status. Our findings add indications of risky health-related behaviours to the already extensive literature on risky social behaviours in the history of young offenders. It is possible that focussing on young offenders referred to a health service, albeit one primarily directed at mental health, has exaggerated such differences, but if substantiated in larger and more diverse samples, these findings may open new avenues for early identification of young people at risk of offending and commensurate early interventions. Focus on substance use by young people seems especially important, but low family socio-economic status needs remedies too.

Multiple health-related behaviours among Fly-In Fly-Out workers in the mining industry in Australia: A cross-sectional survey during the COVID-19 pandemic

BackgroundFly-In-Fly-Out (FIFO) workers travel to work at isolated locations, and rotate continuous workdays with leave periods at home, and such work practice is common in the offshore oil and gas and onshore mining industry worldwide. The COVID-19 pandemic and accompanying public health actions appear to have had a negative impact on several health-related behaviours among the general population. However, little is known about the impact of the COVID-19 pandemic on the health behaviours of FIFO workers, who have shown higher pre-pandemic rates of risky behaviours than the general population in Australia. This study examined the health-related behaviours of FIFO workers in the mining industry during the COVID-19 pandemic.MethodsA descriptive cross-sectional study was conducted. FIFO workers from an Australian mining company who underwent COVID-19 screening between May and November 2020 completed an online survey about their regular health-related behaviours. The independent sample t-test and Pearson’s chi-square test where appropriate were conducted to examine the differences between males and females for the behavioural outcomes.ResultsA total of 768 FIFO workers (633 males and 135 females) participated in the study. Prevalence of smoking was high (32%). Males smoked more cigarettes per day than females (15.2±7.0 vs 13.1±7.1, p = .174). Most participants (74.7%) drank alcohol on more than two days per week. Compared to females, more males (20.2% vs 8.0%) consumed alcohol at short-term harmful levels (p = .010). About a third (34.4%) of the workers (33.5% of males and 38.5% of females, p = .264) engaged in inadequate moderate-vigorous exercises/physical activity. About a third (33.1%) of workers (33.7% of males and 30.4% of females; p = .699) had multiple risk behaviours.ConclusionsPrevalence of multiple risk behaviours was high. Interventions aimed at the prevention of risky health-related behaviours should target the different behavioural patterns and may require emphasis on gender-informed techniques particularly when addressing alcohol consumption.

Mental health promotion for young people - the case for yoga in schools.

Mental wellbeing among young people is deteriorating. Poor mental wellbeing can be related to unmanaged stress. Adverse Childhood Experiences are widespread and result in young people having stressful lives. Stress has many manifestations, and coping with it can lead to risky health-related behaviours. A safe, scientifically-supported, efficient and effective set of stress-reduction skills is provided by the practice of yoga. At present, yoga is available privately, not publicly. After appropriately designed and evaluated interventions, the public provision of yoga could be integrated within the school curriculum, thereby reducing the high prevalence of prescription medication and offering a preventative strategy to promote positive mental health among young people. We suggest that the long-term benefits of an investment in a curriculum-embedded school-based yoga programme would do much to reduce stress both now for future generations.

Psychosocial factors at work from the job strain model and preventable mortality in France: The STRESSJEM prospective study

The study aimed to explore the prospective associations between psychosocial factors at work from the job strain model and preventable mortality, including smoking- and alcohol-related mortality as well as external causes of death. The study was based on prospective data and relied on a sample of 1,511,456 individuals for which data on job history, mortality and causes of death were linked over the 1976–2002 period. Exposures were the factors from the job strain model imputed through a job-exposure matrix. Various time-varying measures of exposure were used including current exposure and two measures of cumulative exposure. Preventable mortality was defined using the OECD/Eurostat list of preventable causes of death. The associations between exposures and outcomes were studied using Cox proportional hazards models. Effect modification by gender was also assessed. Over the study period, 57,264 preventable deaths occurred before the age of 75 years. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with preventable mortality, and associations of stronger magnitude were found for job strain and isostrain among men. Stronger associations were observed for alcohol-related mortality than for smoking-related mortality and external causes of death. The fractions of preventable mortality attributable to current exposure to job strain and isostrain were significant among men only (5.1% and 3.3%). Psychosocial factors at work from the job strain model may play a role on preventable mortality. Intensifying research and prevention towards the psychosocial work environment may be helpful to reduce risky health-related behaviours and related mortality.

Global executive dysfunction, not core executive skills, mediate the relationship between adversity exposure and later health in undergraduate students

Executive function (EF) represents a set of higher-order cognitive skills that permit engagement in goal-oriented behavior. EF deficits are associated with wide-ranging negative health-related consequences, including psychopathology and engagement in risky health-related behaviors. Because neural substrates supporting EF develop over a protracted period of time, an extended window of vulnerability exists whereby environmental stressors can interrupt development, culminating in lifelong EF deficits. We capitalized on this understanding of the vulnerability of EF-relevant neural structures to elucidate the link between adverse childhood experiences (ACEs) and early mortality. ACEs are highly prevalent in the general population and exert negative downstream implications for many health-related behaviors, ultimately hastening mortality. However, underlying mechanisms linking ACEs with poor health remain less understood. To address this gap in the literature, we assessed ACE history and health factors, including psychopathology and risky alcohol use behaviors in undergraduates. We further assessed EF using performance-based and rating scale measures. Results revealed that some measures of EF mediated the relationship between ACEs and current mental health, but EF did not mediate the association between ACEs and engagement in risky health-related behaviors. These results partially support a neurodevelopmental model of ACE exposure vis-à-vis future health, focusing on the role of EF.

Low cardiac vagal control is associated with genetic liability for elevated triglycerides and risky health behaviors

Low parasympathetic regulation of cardiac activity, known as cardiac vagal control (CVC), is robustly associated with poor health outcomes. However, the etiological mechanism that undergirds this association remains largely unknown. One explanation is a causal relationship wherein health problems cause low CVC, or vice versa. However, an alternative explanation is that a common set of genetic factors contributes to both increased liability for poor health and low CVC (i.e., pleiotropy). The present study uses polygenic risk scores for a number of health-related phenotypes (physical, mental, behavioral) to test whether genetic liability for poor health has pleiotropic effects on CVC. We report evidence for shared genetic liability between low CVC and both poor physical health (elevated triglycerides) and risky health-related behaviors (increased drinking and sexual activity). The present findings are consistent with shared genetic liability explaining, at least in part, the well-documented correlation between CVC and health.

Does Better Media Literacy Protect Against the Desire for Tanned Skin and Propensity for Making Appearance Comparisons?

Media literacy interventions provide education about the way media influence attitudes to tanned skin and promote risky health-related behaviors (e.g., sun exposure). This study tested whether higher levels of media literacy can protect against the internalization of a tanned ideal and participation in appearance comparisons online. A total of 151 young Australians aged 18 to 29 years (61 males, 90 females) completed a measure of media literacy before being randomly assigned to view photos of models with either tanned ( n = 77) or pale skin ( n = 74) on social media. Participants completed measures of internalization of a tanned ideal and tendency to make appearance comparisons following exposure to the photos. There were significant negative relationships between level of media literacy skills and both internalization of a tanned ideal and appearance comparisons. Moreover, exposure to tanned models resulted in a higher tendency to make appearance comparisons than exposure to pale models. Results indicate that media literacy skills protect against skin cancer risk factors associated with media exposure. Future interventions to reduce skin cancer risk should address the role of social networking sites in proclaiming tanned skin as ideal and increase skepticism about photos of tanned models online.

Identification of health-related behavioural clusters and their association with demographic characteristics in Irish university students

BackgroundStudents engage in risky health-related behaviours that influence their current and future health status. Health-related behaviours cluster among adults and differently based on sub-populations characteristics but research is lacking for university populations. Examining the clustering of health- related behaviours can inform our initiatives and strategies, while examining cluster members’ characteristics can help target those who can prosper most from health promotion efforts. This study examines the clustering of health-related behaviours in Irish university students, and investigates the relationship with students’ sex, age, field of study and accommodation type.MethodsAn online survey was completed by 5672 Irish university students (51.3% male; 21.60 ± 5.65 years) during 2014. Two-step cluster analysis was used to understand how health-related behaviours (physical activity, smoking, alcohol intake, drug use and dietary habits) cluster among male and female students. Binary logistic regressions were conducted to examine the likelihood of students falling into certain clusters based on their characteristics.ResultsFive cluster groups were identified in males and four in females. A quarter of males were categorised as ideal healthy with older students and those from certain fields of study having a higher likelihood of being classified in a low physical activity and poor diet (OR = 1.06–2.89), alcohol consumption (OR = 1.03–3.04), or smoking and drug use (OR = 1.06–2.73) cluster. Forty-five percent of females were categorised as ideal healthy with older females more likely to be in a low active and smoking cluster (OR = 1.03), and less likely to be in a convenience food cluster (OR = 0.96). Females from certain fields of study were also more likely to be classified in these clusters (OR = 1.59–1.76). Students living away from their family home had in increased likelihood of being in a cluster related to a higher frequency of alcohol consumption (OR = 1.72–3.05).ConclusionHealth-related behaviours cluster among this population and need to be taken into account when designing multi-health interventions and policies. These findings can be used to target student groups at risk, leading to more efficient and successful health promotion efforts. The addition of modules providing information regarding health-related behaviours are advised in all fields of study.

Sensitivity to reward and risky driving, risky decision making, and risky health behaviour: A literature review

Young driver road safety has persisted as a global problem for decades, despite copious and diverse intervention. Recently the influence in reward sensitivity, which refers to the individual’s personal sensitivity to rewards, has received attention in health-related research, including more generally through decision making in risky circumstances, and in risky driving behaviour specifically. As such, a literature review and synthesis of the literature regarding reward sensitivity in relation to risky driving, risky decision making, and risky health behaviour, with a focus on literature in which adolescents and young adults feature, is timely. Thirty-one papers were identified, and the literature revealed that young drivers with greater reward sensitivity engage in more risky driving behaviours including speeding, crashes and traffic violations; and that individuals with greater reward sensitivity engage in more risky decision making and other risky health-related behaviours (such as drinking and drug use). Adolescents and young adults exhibit heightened sensitivity to rewards in the presence of peers, which has considerable implications for young driver road safety as research consistently demonstrates that carrying peer passengers places all vehicle occupants at greater risk of being involved in a road crash. Consideration of the influence of reward sensitivity in young driver road safety, and other adolescent/young adult health-related safety, appears to be a promising avenue of intervention, with gain-framed messages more likely to be accepted by young drivers with greater reward sensitivity. Future research in jurisdictions other than Australia and Europe will increase our understanding of the influence of reward sensitivity, and exploration of the differential impacts of reward-responsiveness and fun-seeking specifically are warranted.

Geographic variation and socio-demographic determinants of the co-occurrence of risky health behaviours in 27 European Union member states.

Risky health behaviours such as tobacco and alcohol abuse, physical inactivity and poor diet may play an important role in disease development. The aim of the present study was to assess the geographical distribution and socio-demographic determinants of risky health-related behaviours in 27 member states (MSs) of the European Union (EU). Data from the 2009 Eurobarometer survey (wave 72.3; n = 26 788) were analysed. Tobacco use, alcohol consumption, physical activity and fruit consumption were assessed through a self-reported questionnaire provided to participants from 27 EU MSs. Within the analyses, participants with three or more lifestyle risk factors were classified as individuals with co-occurrence of risk factors. Among respondents aged 15 or older, 28.2% had none of the aforementioned behavioural risk factors, whereas 9.9% had three or more lifestyle risk factors. Males [adjusted odds ratio (aOR) = 2.50; 95% confidence interval (95% CI): 2.17-2.88] and respondents of middle (aOR = 1.60; 95% CI: 1.36-1.89) or lower income (aOR = 2.63; 95% CI: 2.12-3.26) were more likely to report co-occurrence of behavioural risk factors, as well as respondents in Northern (aOR = 1.43; 95% CI: 1.14-1.78), Western (aOR = 1.28; 95% CI: 1.06-1.56) and Eastern Europe (aOR = 1.28; 95% CI: 1.06-1.55), when compared with Southern European respondents. The above analyses indicate significant geographical and social variation in the distribution of the co-occurrence of behavioural risk factors for disease development.

Risky health-related behaviours among school-aged adolescents: a rational 'consumer' choice?

Within the contemporary culture of consumption, school-aged adolescents, though neither waged nor salaried producers, are nevertheless treated by the media and the advertisers as if they are active consumers who are engaged in the project of the self. For those adolescents who lack the financial resources to 'buy into' this culture, anxiety may ensue. In order to ease this anxiety, and to acquire social status, some - not all - may make the 'rational' 'consumer' choice to engage in risky health-related behaviour. In situ ethnographic research is needed in order to complement and inform the existing survey-based evidence on the relationship between economic status and health-related behaviour among school-aged adolescents as they deal with the pressures of consumerism.

Developing ‘policy stories’ for state health system benchmarking: a small-N quali-quantitative study

Background: The benchmarking literature has made important advances and offers many different population health indicators that can be used to compare state health systems. However, there is still a need for qualitative, complexity-oriented approaches that allow policy-makers to develop explanatory ‘policy stories’ from combining such indicators that are useful to policy solutions. Methods: A new qualitative method from the social sciences based on Boolean approaches, called Qualitative Comparative Analysis (QCA), was piloted in a ‘real world’ policy consultancy to combine Australian state-level indicators of community and health system inputs, interventions, and population health outcomes. Analyses were provided for state inputs and outcomes in a specific area of chronic disease (mental health), along with state profiling for differences in risky health-related behaviours. Results: The QCA method suggested that the state of Tasmania may resemble South Australia in terms of having lower community inputs, as well as higher levels of mental health system inputs and interventions (such as prescriptions), than other states with the outcome of higher self-reported psychological distress. Theoretically, employment levels explained state-level differences in self-reported psychological distress. In terms of risky health-related behaviours, the QCA suggested that Tasmania leads other states in both socio-economic challenges and risky health behaviours. Theoretically, smoking explained state-level differences in self-assessed health. Conclusions: The QCA method has its weaknesses, but in this study, it allowed for the development of policy stories based on systematic comparisons of different states. It also suggested theoretically plausible explanations for differences in state-level outcomes.

Gender-specific roles and needs in food-health security.

People rely on foods to provide energy and nutrients to sustain life and to ensure health. In the entire chain from acquiring foods to ingesting them, women contribute in unique ways to the food system. Although foods or nutrients requirements for both sexes are biologically similar in many aspects, women go through more complex life-cycles than men and may experience greater risk of nutrient deprivation due to their role to bear and to rear off-spring. Therefore, women and their offspring are particularly vulnerable to food scarcity and to poor dietary quality. On the other hand, the female genome, partly through sex hormones delays the development of many chronic diseases which result from the modern affluent lifestyle. The inherent biological roles of men and women and their socially constructed roles may interact with one another, affecting the health security of each gender, their families, and the well-being of the societies in which they live. Historically and contemporarily, women in general are socially and politically more underprivileged than men. The inequality which women have faced has jeopardized not only their health and that of their female children, but the well-being of all. In developed countries and in more and more developing countries, equal opportunities for education are promoted. Recent research indicates that women have a greater tendency than men to engage in healthy behaviours when empowered with health knowledge. Risky health-related behaviours, including poor food choices, are more often practiced by men and warrant more public health attention.

Access to drug and alcohol treatment among a cohort of street-involved youth

Background A number of options for treatment are available to young drug users, but little is known about the youth who actually attempt to access such services. Here we identify characteristics of a cohort of street-involved youth and highlight commonly encountered barriers. Methods From September 2005 to July 2007, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort of 529 drug users aged 14–26 living in Vancouver, Canada. Participants who attempted to access any addiction services in the 6 months prior to enrollment were compared in univariate analyses and multiple logistic regression modeling of socio-demographic and drug-related factors. Results Factors positively associated with attempting to access services included Aboriginal ethnicity (adjusted odds ratio [AOR] = 1.66 [1.05–2.62]), high school education (AOR = 1.66 [1.09–2.55]), mental illness (AOR = 2.25 [1.50–3.38]), non-injection crack use (AOR = 2.93 [1.76–4.89]), and spending >$50 on drugs per day (AOR = 2.13 [1.41–3.22]). Among those who experienced difficulty-accessing services, the most commonly identified barrier was excessively long waiting lists. In a subgroup analysis comparing those who tried to access services but were unsuccessful to those who were successful, risk factors positively associated with failure included drug bingeing (odds ratio [OR] = 2.86 [1.22–6.76]) and homelessness (OR = 3.86 [1.11–13.4]). Conclusions In light of accumulating evidence that drug use among street youth is associated with risky health-related behaviors, improving access to treatment and other addiction services should remain an important public health priority.

Child sexual abuse in Henan province, China: associations with sadness, suicidality, and risk behaviors among adolescent girls

Purpose To assess the prevalence of child sexual abuse (CSA) and possible effects on mental health and risky behavior among female adolescents living in China. Method A retrospective survey was conducted among 351 female students in a medical secondary school in the central China province of Henan in June 2004. The anonymous, self-administered questionnaire included items about unwanted sexual experiences before age 16, depression, suicidality, and risky health-related behaviors. Results Over one in five young women (21.9%) reported at least one type of CSA (any one of 12 forms of nonphysical contact and physical contact CSA) before the age of 16 years, with one in every seven (14.0%) reporting CSA involving physical contact. Risk of CSA was not associated with parents’ education level, existence of siblings, or rural/urban residence during childhood. Although some indicators of poor mental health were slightly elevated among girls who had experienced noncontact CSA only, the most significant impact is among victims of contact CSA, including higher rates of depression, overwhelming sadness, suicidal thinking and planning, alcohol drinking, smoking, fighting, and having sexual intercourse. Conclusions The risk of CSA in this sample of Chinese female adolescents seems similar to young women in many Western countries, and the pattern of associated mental health and behavioral problems is entirely consistent with international research.

Conscientiousness and Health-Related Behaviors: A Meta-Analysis of the Leading Behavioral Contributors to Mortality.

Previous research has established conscientiousness as a predictor of longevity (H. S. Friedman et al., 1993; L. R. Martin & H. S. Friedman, 2000). To better understand this relationship, the authors conducted a meta-analysis of conscientiousness-related traits and the leading behavioral contributors to mortality in the United States (tobacco use, diet and activity patterns, excessive alcohol use, violence, risky sexual behavior, risky driving, suicide, and drug use). Data sources were located by combining conscientiousness-related terms and relevant health-related behavior terms in database searches as well as by retrieving dissertations and requesting unpublished data from electronic mailing lists. The resulting database contained 194 studies that were quantitatively synthesized. Results showed that conscientiousness-related traits were negatively related to all risky health-related behaviors and positively related to all beneficial health-related behaviors. This study demonstrates the importance of conscientiousness' contribution to the health process through its relationship to health-related behaviors.

Acculturation as a risk factor for chronic disease among Cambodian refugees in the United States.

Although the concept of acculturation originated within anthropology, in recent years it has assumed a prominent role within epidemiology as a risk factor for chronic disease. However, these studies often consider acculturation in structural terms, reflected in differences between groups assumed to lie along the same continuum, all moving in the same direction toward greater acculturation to the values and behaviors of the dominant society. This paper addresses how acculturation should be conceptualized when examining it as a potential risk factor for chronic disease and how it should be measured so that it becomes both theoretically and clinically meaningful. Four case studies of Cambodian refugees of San Diego, California are used to illustrate the following: (1) the importance of integrating an acculturation-as-process perspective with an acculturation-as-structure perspective; (2) viewing acculturation as both individual and group experience of conflict and negotiation between two systems of behavior and belief; (3) measuring it longitudinally and as narrative; and (4) understanding that rather than being an inherent health risk, it may also promote health by creating access to certain forms of health care unavailable in the country of origin and by contributing to the abandonment of risky health-related behaviors and the adoption of behaviors that promote good health.