Unfavorable Health Behaviors Research Articles

Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program

Patients undergoing major surgery are predisposed to a decrease in functional capacity as a response to surgical stress that can delay post-operative recovery. A prehabilitation program consists of patient preparation...

Status quo bias and health behavior: findings from a cross-sectional study

Status quo bias (SQB) has often been referred to as an important tool for improving public health. However, very few studies were able to link SQB with health behavior. Analysis were based on data from the population-based KORA S4 study (1999-2001, n = 2309). We operationalized SQB through two questions. The first asked whether participants switched their health insurance for financial benefits since this was enabled in 1996. Those who did were assigned a 'very low SQB' (n = 213). Participants who did not switch were asked a second hypothetical question regarding switching costs. We assigned 'low SQB' to those who indicated low switching costs (n = 1035), 'high SQB' to those who indicated high switching costs (n = 588), and 'very high SQB' to those who indicated infinite switching costs (n = 473). We tested the association between SQB and physical activity, diet, smoking, alcohol consumption, the sum of health behaviors, and body mass index (BMI) using logistic, Poisson and ordinary least square regression models, respectively. Models were adjusted for age, sex, education, income, satisfaction with current health insurance and morbidity. SQB was associated with a higher rate of physical inactivity [OR = 1.22, 95% CI (1.11; 1.35)], a higher sum of unhealthy lifestyle factors [IRR = 1.05, 95% CI (1.01; 1.10)] and a higher BMI [β = 0.30, 95% CI (0.08; 0.51)]. A high SQB was associated with unfavorable health behavior and higher BMI. Targeting SQB might be a promising strategy for promoting healthy behavior.

Long‐term effect of migration background on the development of physical fitness among primary school children

BackgroundChildren with a low socioeconomic status and migration background are more likely to exhibit unfavorable health behavior patterns and higher BMI scores as well as lower physical activity and physical fitness.AimTo evaluate the effect of migration background on the development of physical fitness among primary school children from first to third grade.MethodsIn this longitudinal study, height, weight, and physical fitness of primary school children from Tyrol/Austria were measured five times over a period of 2.5 years using the German motor performance test DMT 6‐18 consisting of eight items testing different subdomains of physical fitness.ResultsA total of 266 children (45% girls) participated in all five tests, of which 69 (26%) children reported to have a migration background (MB). Mixed‐model ANOVA did not reveal a significantly different development of physical fitness (according to the mean total Z‐score of DMT 6‐18) over time, P = 0.883, partial ƞ 2 < 0.01. However, children with MB showed significantly lower physical fitness compared to children without MB, P < 0.001, partial ƞ 2 = 0.06. Controlling for BMI and age did not alter the interpretation of the results. Analyses of the single test items revealed significant differences in motor tests involving strength and endurance.ConclusionPrimary school children with and without MB significantly increased their physical fitness over time in a comparable manner. However, children with MB showed a significantly lower physical fitness at all test time points, which was only partly explained by a higher mean BMI in children with MB. Children with MB outreached the mean baseline fitness level of children without MB not until the fourth test time point, that is after two years. Therefore, a special focus on physical fitness particularly including strength and endurance capacities should be directed to children with MB already in young ages.

Identification of caries risk in 2-year-olds.

The first aim was to describe presence of plaque, caries and oral health behaviours in 2-year-old children. The second aim was to measure increments in caries experience from 2 to 5 years of age and to study whether national background, visible plaque, caries and oral health behaviour at 2years of age were associated with increments in caries experience. The study population consisted of 392 children, of whom 211 were monitored from 2 to 5 years of age. At age 2years, parents completed a questionnaire about family background and oral health behaviour. The presence of plaque and caries at tooth level was obtained from dental records. Data were tested with chi-square statistics and Mann-Whitney U test. Negative binomial regression analysis was conducted to explore the association between caries increment between 2 and 5 years of age and national background, visible plaque, caries and oral health behaviour at 2years of age. Caries was found in 4.6% of 2-year-olds, and 4.6% had visible plaque. More than half of these children (57.9%) brushed twice daily, toothbrushing was introduced when the child was 7months or older in 61.0% of the children, and 15.6% consumed sugary snacks daily. Non-Western children more often had caries, visible plaque and unfavourable oral health behaviour than Western children (P<.05). At age 5years, 28.9% of the children had caries experience. Non-Western background, toothbrushing less than twice daily, not using fluoridated toothpaste, not using fluoride lozenges, consuming sugary drinks at night, consuming sugary snacks daily, presence of plaque and caries at 2years of age were associated with caries increment between 2 and 5 years of age in bivariable analyses. The results from multivariable analysis showed that children who started toothbrushing late, children who brushed less than twice daily at 2years of age and children of non-Western background had a higher probability of having caries increment from 2 to 5 years of age than other children. A small proportion of 2-year-olds had caries, but these children had several decayed teeth. Substantial differences in oral health and oral health behaviour were found between Western and non-Western children. The preventive care delivered to the studied children failed to prevent caries increment from 2 to 5 years of age.

Psychogeriatric Diagnoses in Old People's Homes and Negative Health Behavior.

The study was designed as a gerontologic-public health analysis of the relationship between the leading and accompanying psychogeriatric diagnoses and negative health behaviors recorded in the old people's home users, with the aim to evaluate and redefine gerontologic-public health priorities and geroprophylactic measures, with special reference to persons suffering from Alzheimer's disease and other dementias. Gerontologic-public health indicators obtained by monitoring health care needs of the elderly in specific institutional primary health care at 10 old people's homes (N=1185) in Croatia in 2013 were analyzed using the professional methodology developed at Department of Health Gerontology, Andrija Štampar Teaching Institute of Public Health (Registry List 1 that refers to monitoring specific primary health care needs of elderly at old people's homes). Study results revealed that essential arterial hypertension was the principal (leading) principal diagnosis in the old people's home users as of 2013, accounting for 13% of all leading diagnoses recorded in the elderly in institutional health care. In the study population, psychogeriatric diagnoses were recorded among the first five accompanying and leading diagnoses. Refusal of occupational therapy was the most common unfavorable health behavior recorded in the old people's home users, accounting for 22%, followed by poor personal and environmental hygiene (19%), physical inactivity (18%), mental inactivity (15%), obesity (13%) and smoking (5%) of 861 unfavorable behaviour characteristics recorded in study subjects. Study results showed the leading diagnoses in the old people's home users (such as circulatory system diseases, hip fracture, non-insulin dependent diabetes mellitus) to be associated with negative health behaviors that can be considered as risk factors for the development or progression of the disease, in psychogeriatric patients in particular. The results obtained by gerontological-public health indicator analysis indicate that programs of geroprophylaxis, gerontologic and psychogeriatric measures should be implemented in old people's homes as a priority, with day centers for Alzheimer's disease patients. It is necessary to identify and evaluate risk factors for the occurrence of preventable diseases, change the negative health behaviors in the elderly, and apply the nutritional-gerontologic dietary standards at old people's homes including follow up of dietary intake of nutrients such as vitamins and mineral, with special reference to psychogeriatric patients.

Motivational Interviewing to Promote Oral Health in Adolescents

PurposeMotivational interviewing (MI) is a counseling strategy to help people change their behaviors. This single-blinded randomized controlled trial evaluated the effectiveness of MI in improving adolescents' oral health. MethodsFifteen secondary schools were randomly assigned to three groups: (I) prevailing health education, (II) MI, and (III) MI coupled with interactive dental caries risk assessment (MI + RA). Adolescents (n = 512) with unfavorable oral health behaviors (infrequent toothbrushing and/or frequent snacking) were recruited; 161, 163, and 188 in groups I–III, respectively. Participants in the three groups received their respective interventions. At baseline and after 6 and 12 months, participants completed a questionnaire on their oral health self-efficacy and behaviors. Their oral hygiene (dental plaque score) and dental caries (number of decayed surfaces/teeth status) were recorded. ResultsCompared with group I, subjects in groups II and III were more likely to reduce their snacking frequency (odds ratios [95% confidence intervals {CIs}]: 7.12 [1.80–28.16] and 11.17 [2.90–42.98], respectively) and increase their toothbrushing frequency (odds ratios [95% CIs]: 5.26 [2.28–12.16] and 11.45 [4.99–26.26], respectively) after 12 months. Taking group I as a reference, groups II and III had lower number of new carious teeth △D ICDAS II 1-6MFT (β [95% CI]: −.24 [−.44 to −.04] and −.31 [−.51 to −.11], respectively). ConclusionsMI was more effective than prevailing health education strategy in eliciting positive changes in adolescents' oral health behaviors and preventing dental caries.

Sociocultural Influence on Obesity and Lifestyle in Children: A Study of Daily Activities, Leisure Time Behavior, Motor Skills, and Weight Status

Background: Juvenile overweight is increasing, and effective preventive measures are needed. After years of arbitrarily assigning these measures disregarding socioeconomic and/or cultural differences, it has become necessary to tailor interventions more specific to these target groups. Providing data for such an intervention is the objective of this study. Methods: Influencing variables on children's weight status, motor skills and lifestyle have been analyzed among 997 first graders (53.2% male) involved in the Children's Health InterventionaL Trial (CHILT). Results: Median age was 6.9 years; 7.3% were obese, 8.8% were overweight. Children with low socioeconomic status (SES) were more likely to be obese (p = 0.029). Low SES (p ˂ 0.001), migration background (p = 0.001) and low sports activity levels (p = 0.007) contributed most to an increased consumption of television. Migration background (p = 0.003) and male gender (p < 0.001) were the strongest factors in predicting a greater consumption of computer/video games. Children with higher SES (p = 0.02), lower BMI (p = 0.035), and males (p = 0.001) performed better in motor tests. Conclusion: Children with a low SES and migration background were more likely to exhibit unfavorable health behavior patterns, higher BMI scores, and poorer motor skills. Interventions should integrate motivational and targeting strategies and consider cultural and educational differences to address these vulnerable groups.

Family functioning is related to health behaviors in patients with type 2 diabetes mellitus

In 2014, 8.5% of people worldwide over the age of 18 had type 2 diabetes mellitus. It is estimated that, in recent years, the prevalence of this disease has increased mainly in low- and middle-income countries. Health behaviors are considered fundamental in the prevention, treatment, and control of this disease. The aim of this study was to determine if there is an association between health behaviors and satisfaction with family functioning in patients diagnosed with type 2 diabetes mellitus. This is an observational, transversal, analytical study. In the Family Medicine Unit No.33 in Chihuahua, Mexico, 297 patients with a diagnosis of type 2 diabetes mellitus were identified. Data was collected regarding sex, age and the Instrument for Measuring Lifestyles in Diabetics (IMEVID, for its acronym in Spanish) and the Family APGAR. We found that of the total number of patients, 91.6% presented some degree of unfavorable health behaviors, while 92.6% presented some type of family dysfunction. The categorical analysis positively correlated good family functionality with favorable health behaviors, Fisher's exact test p

Efficacy of a Communication Skill Training Fostering Health Promotion in Primary Care: A Mixed Method Analysis

Background: Health related behavior is an important determinant of chronic disease, with a high impact on public health. Thus, motivating and assisting people to change their unfavorable health behavior is a major challenge for health professionals. Patients increasingly seek more active participation in healthcare decisions. Thus, communication skills of general practitioners (GPs) are crucial for a successful health promotive counseling, and there is a need of sound competences in communication techniques among them. Methods: We developed a training program using case vignettes and standardized patients (SPs) and evaluated its effectiveness among GPs and their patients at different levels using a validated evaluation model. Levels refer to a. acceptance and satisfaction; b. adoption of knowledge and skills; c. behavior change in regard to communication competence; d. impact on daily work with results in the targeted aim. Results: Participants' ratings in all levels were positive, between 3.9 and 5.0 on a 5- point Likert scale. Self-rated communication knowledge and skills improved significantly with ratings of 3.4 to 3.7 before and 4.2 to 4.5 after the training course (p < 0.01). Only the integration of the new role into daily work was not, or not yet, changed by the training, but the perceived communication competence and working quality of participating GPs improved. Conclusion: Communication skills and competence, as well as patient-centeredness and empathy, are crucial for GPs for helping patients to change and sustain their health behavior. Within communication skill trainings for GPs fostering health promotive counseling, the SP method is a promising format of medical education at pre- and postgraduate level, with a potentially high impact on public health.

Brain Responses during the Anticipation of Dyspnea.

Dyspnea is common in many cardiorespiratory diseases. Already the anticipation of this aversive symptom elicits fear in many patients resulting in unfavorable health behaviors such as activity avoidance and sedentary lifestyle. This study investigated brain mechanisms underlying these anticipatory processes. We induced dyspnea using resistive-load breathing in healthy subjects during functional magnetic resonance imaging. Blocks of severe and mild dyspnea alternated, each preceded by anticipation periods. Severe dyspnea activated a network of sensorimotor, cerebellar, and limbic areas. The left insular, parietal opercular, and cerebellar cortices showed increased activation already during dyspnea anticipation. Left insular and parietal opercular cortex showed increased connectivity with right insular and anterior cingulate cortex when severe dyspnea was anticipated, while the cerebellum showed increased connectivity with the amygdala. Notably, insular activation during dyspnea perception was positively correlated with midbrain activation during anticipation. Moreover, anticipatory fear was positively correlated with anticipatory activation in right insular and anterior cingulate cortex. The results demonstrate that dyspnea anticipation activates brain areas involved in dyspnea perception. The involvement of emotion-related areas such as insula, anterior cingulate cortex, and amygdala during dyspnea anticipation most likely reflects anticipatory fear and might underlie the development of unfavorable health behaviors in patients suffering from dyspnea.

The mediating role of cardiovascular risk factors in the relationship between symptoms of apathy and incident cardiovascular disease in community-dwelling older individuals.

In old age, both apathy and depression have been associated with an increased cardiovascular disease (CVD) risk. This study evaluated the mediating role of cardiovascular risk factors in the relationship of apathy and mood symptoms with incident CVD. Prospective cohort study of 1,790 community-dwelling older individuals (70-78 years) without a history of CVD or stroke. At baseline, apathy and mood symptoms were assessed with the 15-item Geriatric Depression Scale (GDS-15), of which three items represent apathy symptoms. The mediational risk factors included were diabetes mellitus (DM), body mass index (BMI), current smoking, physical inactivity, systolic blood pressure, and total cholesterol. Incident CVD was evaluated after two years of follow-up. Data were analyzed using structural equation modeling (SEM). Incident CVD occurred in 59 (3.3%) participants. Apathy symptoms had a significant estimated total effect on incident CVD, with increases of 2.2% for each unit increase in apathy score. Of this total effect, 22.7% was due to the mediational effects of physical inactivity (13.6%), current smoking (4.5%), and DM (4.5%). The remaining 77.3% was due to direct effects reflecting other mediational dynamics. No significant (in)direct effects of mood symptoms on incident CVD were found. Physical inactivity, smoking, and DM account for nearly one-fourth of the variation reflecting the link between apathy symptoms and incident CVD. This illustrates the relevance of unfavorable health behaviors and assessment of DM in older individuals with apathy. The majority of the effect of apathy symptoms on incident CVD is caused by other, yet unknown, factors.

Effect of health risk assessment and counselling on health behaviour and survival in older people: a pragmatic randomised trial.

BackgroundPotentially avoidable risk factors continue to cause unnecessary disability and premature death in older people. Health risk assessment (HRA), a method successfully used in working-age populations, is a promising method for cost-effective health promotion and preventive care in older individuals, but the long-term effects of this approach are unknown. The objective of this study was to evaluate the effects of an innovative approach to HRA and counselling in older individuals for health behaviours, preventive care, and long-term survival.Methods and FindingsThis study was a pragmatic, single-centre randomised controlled clinical trial in community-dwelling individuals aged 65 y or older registered with one of 19 primary care physician (PCP) practices in a mixed rural and urban area in Switzerland. From November 2000 to January 2002, 874 participants were randomly allocated to the intervention and 1,410 to usual care. The intervention consisted of HRA based on self-administered questionnaires and individualised computer-generated feedback reports, combined with nurse and PCP counselling over a 2-y period. Primary outcomes were health behaviours and preventive care use at 2 y and all-cause mortality at 8 y. At baseline, participants in the intervention group had a mean ± standard deviation of 6.9 ± 3.7 risk factors (including unfavourable health behaviours, health and functional impairments, and social risk factors) and 4.3 ± 1.8 deficits in recommended preventive care. At 2 y, favourable health behaviours and use of preventive care were more frequent in the intervention than in the control group (based on z-statistics from generalised estimating equation models). For example, 70% compared to 62% were physically active (odds ratio 1.43, 95% CI 1.16–1.77, p = 0.001), and 66% compared to 59% had influenza vaccinations in the past year (odds ratio 1.35, 95% CI 1.09–1.66, p = 0.005). At 8 y, based on an intention-to-treat analysis, the estimated proportion alive was 77.9% in the intervention and 72.8% in the control group, for an absolute mortality difference of 4.9% (95% CI 1.3%–8.5%, p = 0.009; based on z-test for risk difference). The hazard ratio of death comparing intervention with control was 0.79 (95% CI 0.66–0.94, p = 0.009; based on Wald test from Cox regression model), and the number needed to receive the intervention to prevent one death was 21 (95% CI 12–79). The main limitations of the study include the single-site study design, the use of a brief self-administered questionnaire for 2-y outcome data collection, the unavailability of other long-term outcome data (e.g., functional status, nursing home admissions), and the availability of long-term follow-up data on mortality for analysis only in 2014.ConclusionsThis is the first trial to our knowledge demonstrating that a collaborative care model of HRA in community-dwelling older people not only results in better health behaviours and increased use of recommended preventive care interventions, but also improves survival. The intervention tested in our study may serve as a model of how to implement a relatively low-cost but effective programme of disease prevention and health promotion in older individuals.Trial RegistrationInternational Standard Randomized Controlled Trial Number: ISRCTN 28458424

What is wrong with non-respondents? Alcohol-, drug- and smoking-related mortality and morbidity in a 12-year follow-up study of respondents and non-respondents in the Danish Health and Morbidity Survey.

AimResponse rates in health surveys have diminished over the last two decades, making it difficult to obtain reliable information on health and health‐related risk factors in different population groups. This study compared cause‐specific mortality and morbidity among survey respondents and different types of non‐respondents to estimate alcohol‐, drug‐ and smoking‐related mortality and morbidity among non‐respondents.DesignProspective follow‐up study of respondents and non‐respondents in two cross‐sectional health surveys.SettingDenmark.ParticipantsA total sample of 39 540 Danish citizens aged 16 years or older.MeasurementsRegister‐based information on cause‐specific mortality and morbidity at the individual level was obtained for respondents (n = 28 072) and different types of non‐respondents (refusals n = 8954; illness/disabled n = 731, uncontactable n = 1593). Cox proportional hazards models were used to examine differences in alcohol‐, drug‐ and smoking‐related mortality and morbidity, respectively, in a 12‐year follow‐up period.FindingsOverall, non‐response was associated with a significantly increased hazard ratio (HR) of 1.56 [95% confidence interval (CI) = 1.36–1.78] for alcohol‐related morbidity, 1.88 (95% CI = 1.38–2.57) for alcohol‐related mortality, 1.55 (95% CI = 1.27–1.88) for drug‐related morbidity, 3.04 (95% CI = 1.57–5.89) for drug‐related mortality and 1.15 (95% CI = 1.03–1.29) for smoking‐related morbidity. The hazard ratio for smoking‐related mortality also tended to be higher among non‐respondents compared with respondents, although no significant association was evident (HR = 1.14; 95% CI = 0.95–1.36). Uncontactable and ill/disabled non‐respondents generally had a higher hazard ratio of alcohol‐, drug‐ and smoking‐related mortality and morbidity compared with refusal non‐respondents.ConclusionHealth survey non‐respondents in Denmark have an increased hazard ratio of alcohol‐, drug‐ and smoking‐related mortality and morbidity compared with respondents, which may indicate more unfavourable health behaviours among non‐respondents.

Adverse Childhood Events and Current Depressive Symptoms Among Women in Hawaii: 2010 BRFSS, Hawaii

Research on the association between adverse childhood events (ACEs) and depression among women in Hawaii is scarce. ACEs have been linked to unfavorable health behaviors such as smoking and binge drinking which are more prevalent in the state compared to the US overall. The concomitant presence of ACEs with smoking or binge drinking may explain the excess depression prevalence in Hawaii compared to the national average. Using data of women residing in the state (2010 Hawaii Behavioral Risk Factor Surveillance System Survey), we examined the association between ACEs count or type (household dysfunction and physical, verbal and sexual abuse) and current depressive symptoms (CDS), in addition to modification by current smoking status (smoked >100 cigarettes in a lifetime and currently smoke) and binge drinking (consumed ≥4 alcoholic beverage within the past month and in ≥1 occasion(s)). Evaluation of ACEs before age 18 consisted of 11 indicators. Eight indicators of the Patient Health Questionnaire (PHQ-8) were used to assess CDS. All analyses utilized logistic regression taking into account sampling design. The odds ratio of having CDS between those with versus without ACEs increased per increasing number of ACEs (1 ACE: OR = 2.11, CI = 1.16-3.81; 2 ACEs: OR = 2.90, CI = 1.51-5.58; 3 or 4 ACEs: OR = 3.94, CI = 2.13-7.32; 5+ ACEs: OR = 4.04, CI = 2.26-7.22). Household dysfunction (OR = 2.10, CI = 1.37-3.23), physical abuse (OR = 1.67, CI = 1.08-2.59), verbal abuse (OR = 3.21, CI = 2.03-5.09) and sexual abuse (OR = 1.68, CI = 1.04-2.71) were all positively associated with CDS. Verbal abuse had the strongest magnitude of association. Neither current smoking status nor binge drinking modified the relationship between ACEs count (or type) and CDS. In conclusion, the presence of ACEs among women in Hawaii was indicative of CDS in adulthood, notably verbal abuse. Further, a dose response existed between the number of ACEs and the odds for CDS. The concomitant exposure to ACEs and current smoking status or binge drinking did not elevate odds for CDS.

The "Health Coaching" programme: a new patient-centred and visually supported approach for health behaviour change in primary care.

BackgroundHealth related behaviour is an important determinant of chronic disease, with a high impact on public health. Motivating and assisting people to change their unfavourable health behaviour is thus a major challenge for health professionals. The objective of the study was to develop a structured programme of counselling in primary care practice, and to test its feasibility and acceptance among general practitioners (GPs) and their patients.MethodsOur new concept integrates change of roles, shared responsibility, patient-centredness, and modern communication techniques—such as motivational interviewing. A new colour-coded visual communication tool is used for the purpose of leading through the 4-step counselling process. As doctors’ communication skills are crucial, communication training is a mandatory part of the programme. We tested the feasibility and acceptance of the “Health Coaching” programme with 20 GPs and 1045 patients, using questionnaires and semistructured interviewing techniques. The main outcomes were participation rates; the duration of counselling; patients’ self-rated behavioural change in their areas of choice; and ratings of motivational, conceptual, acceptance, and feasibility issues.ResultsIn total, 37% (n=350) of the patients enrolled in step 1 completed the entire 4-Step counselling process, with each step taking 8–22 minutes. 50% of ratings (n=303) improved by one or two categories in the three-colour circle, and the proportion of favourable health behaviour ratings increased from 9% to 39%. The ratings for motivation, concept, acceptance, and feasibility of the “Health Coaching” programme were consistently high.ConclusionsOur innovative, patient-centred counselling programme for health behaviour change was well accepted and feasible among patients and physicians in a primary care setting. Randomised controlled studies will have to establish cost-effectiveness and promote dissemination.

Alcohol consumption in 0.5 million people from 10 diverse regions of China: prevalence, patterns and socio-demographic and health-related correlates

Background Drinking alcohol has a long tradition in Chinese culture. However, data on the prevalence and patterns of alcohol consumption in China, and its main correlates, are limited.Methods During 2004–08 the China Kadoorie Biobank recruited 512 891 men and women aged 30–79 years from 10 urban and rural areas of China. Detailed information on alcohol consumption was collected using a standardized questionnaire, and related to socio-demographic, physical and behavioural characteristics in men and women separately.Results Overall, 76% of men and 36% of women reported drinking some alcohol during the past 12 months, with 33% of men and 2% of women drinking at least weekly; the prevalence of weekly drinking in men varied from 7% to 51% across the 10 study areas. Mean consumption was 286 g/week and was higher in those with less education. Most weekly drinkers habitually drank spirits, although this varied by area, and beer consumption was highest among younger drinkers; 37% of male weekly drinkers (12% of all men) reported weekly heavy drinking episodes, with the prevalence highest in younger men. Drinking alcohol was positively correlated with regular smoking, blood pressure and heart rate. Among male weekly drinkers, each 20 g/day alcohol consumed was associated with 2 mmHg higher systolic blood pressure. Potential indicators of problem drinking were reported by 24% of male weekly drinkers.Conclusion The prevalence and patterns of drinking in China differ greatly by age, sex and geographical region. Alcohol consumption is associated with a number of unfavourable health behaviours and characteristics.

Disposable Income With Tobacco Smoking Among Young Adolescents: A Multilevel Analysis

Prior studies examining the connection between disposable income and adolescent smoking often yielded mixed results, partly due to the lack of consideration for contextual variables. In the present study, we sought to broaden understanding of disposable income on adolescent smoking behaviors via both absolute and relative perspectives in the school context. We obtained data from the 2010 Global Youth Tobacco Survey (GYTS) in Taiwan. Information concerning sociodemographics, disposable income, smoking history, and contextual smoking exposure (e.g., school) were assessed via self-report. Recent-onset smokers were defined as those who had their first cigarette within two years of the survey. Complex survey and multilevel analyses were carried out to estimate association. Adolescents with higher monthly disposable income were 2∼5 times more likely to start smoking and become regular smokers. Having the least disposable income in a class appeared linked with increased risk of tobacco initiation by 40% (95% confidence interval [CI]: 2%-91%). Pupils' odds to start smoking were lowered to .70 when the majority of schoolmates had low disposable income (95% CI: .51-.99). Adolescent risk of smoking initiation may be differentially affected by individual- and contextual-level absolute and relative disposable income. Future research is needed to delineate possible mechanisms underlying unfavorable health behaviors associated with disposable incomes in early adolescence.

Influence of oral health related behavior on oral health of adolescents in Belgrade

Introduction. Adolescence is a period of intensive physical, psychological and emotional changes that might affect existing oral health related habits and result in developing risky behaviors. The aim of the present study was to investigate oral health attitudes and behavior and their relation to dental caries experience in the group of adolescents from Belgrade. Material and Methods. This cross-sectional study included 404 high-school students grade one from Belgrade. Two trained and calibrated dentists conducted clinical examination in classrooms to determine oral health status of adolescents (DMFT index and visual signs of gingivitis). Modified Serbian version of Hiroshima University Dental Behavior Inventory (HU-DBI) questionnaire with three additional questions was used to collect data on oral health behavior and attitudes. Results. Mean HU-DBI score was 6.22?1.45 for males and 6.28?1.45 for females (p&lt;0.05). Dental visits at least once in a year reported 67.3% adolescents, more often girls (p&lt;0.05). Only emergency dental visits reported 47.1% of adolescents. Majority of respondents reported brushing teeth twice a day or more (86.2%), girls more often than boys (p&lt;0.001). Only 13.4% reported regular flossing and 30.3% daily use of mouth rinses. Mean DMFT score was 5.84?0.20 with 45% of untreated decayed tooth. Unfavorable oral health related attitudes and behavior were related to poorer oral health status of adolescents. Conclusion. Poor oral health of adolescents is influenced by their inadequate attitudes and habits. Program of oral health promotion for adolescents that would target knowledge, attitudes and skills development should be implemented to enhance adolescents? oral self-care regime and oral health outcome.

Why the Scots die younger: Synthesizing the evidence

To identify explanations for the higher mortality in Scotland relative to other European countries, and to synthesize those best supported by evidence into an overall explanatory framework. Review and dialectical synthesis. Candidate hypotheses were identified based on a literature review and a series of research dissemination events. Each hypothesis was described and critically evaluated in relation to the Bradford-Hill criteria for causation in observational epidemiology. A synthesis of the more convincing hypotheses was then attempted using a broadly 'dialectical' approach. Seventeen hypotheses were identified including: artefactual explanations (deprivation, migration); 'downstream explanations' (genetics, health behaviours, individual values); 'midstream' explanations (substance misuse; culture of boundlessness and alienation; family, gender relations and parenting differences; lower social capital; sectarianism; culture of limited social mobility; health service supply or demand; deprivation concentration); and 'upstream' explanations (climate, inequalities, de-industrialization, political attack). There is little evidence available to determine why mortality rates diverged between Scotland and other European countries between 1950 and 1980, but the most plausible explanations at present link to particular industrial, employment, housing and cultural patterns. From 1980 onwards, the higher mortality has been driven by unfavourable health behaviours, and it seems quite likely that these are linked to an intensifying climate of conflict, injustice and disempowerment. This is best explained by developing a synthesis beginning from the political attack hypothesis, which suggests that the neoliberal policies implemented from 1979 onwards across the UK disproportionately affected the Scottish population. The reasons for the high Scottish mortality between 1950 and 1980 are unclear, but may be linked to particular industrial, employment, housing and cultural patterns. From 1980 onwards, the higher mortality is most likely to be accounted for by a synthesis which begins from the changed political context of the 1980s, and the consequent hopelessness and community disruption experienced. This may have relevance to faltering health improvement in other countries, such as the USA.

Associations between intelligence in adolescence and indicators of health and health behaviors in midlife in a cohort of Swedish women

The objective of this study was to investigate associations between intelligence and indicators of health status and health behaviors at age 43 in a cohort of Swedish women (n=682). Intelligence was measured by standard IQ tests given at ages 10, 13, and 15. At the age of 43, 479 of the women were sampled for a medical examination in which 369 participated (77% participation rate). We performed correlations of IQ and the continuous health variables and we estimated logistic regression models with dichotomous health variables as the dependent variables. No significant correlations were found between IQ and any of the continuous health variables. In unadjusted logistic regression models where the cut-off points were set based on standard health risk levels, four out of sixteen indicators of unfavorable health status and health behaviors showed significant negative associations with intelligence, meaning higher risk with decreasing IQ-score. After adjusting for educational level, two remained statistically significant: being obese, OR 1.51 (95% CI 1.08, 2.12) and having a high systolic blood pressure OR 1.45 (95% CI 1.03, 2.03). For all other health variables, this study finds no support for a sizable association between IQ in adolescence and indicators of health and health behavior in midlife among Swedish women.