Prevalence of Musculoskeletal Symptoms Among Agricultural Workers in the United States: An Analysis of the National Health Interview Survey, 2004–2008

Ergonomic risks from agricultural tasks can compromise musculoskeletal health of workers. This study estimated prevalence of musculoskeletal symptoms in a sample representing almost 2 million US agricultural industry workers. This study used National Health Interview Survey data from 2004 to 2008. Weighted prevalence was calculated by demographic and employment factors. Prevalence ratios were calculated using generalized linear models with the Poisson distribution assumption. Prevalence rates of low back and neck pain in the previous 3 months were 24.3% and 10.5%, respectively, among agricultural workers. Monthly prevalence of joint pain was 17.0% for hips/knees, 9.8% for shoulders, 9.5% for wrists/hands, 5.4% for elbows, and 4.7% for ankles/toes. Agricultural workers had a significantly higher prevalence of shoulder pain than all other industry workers (prevalence ratios [PR] = 1.28, 95% confidence interval [CI]: 1.02–1.61). This study provides detailed national estimates of musculoskeletal symptom prevalence to understand the burden and the need for intervention among agricultural workers.     

How do economic downturns affect the mental health of children? Evidence from the National Health Interview Survey

Research linking economic conditions and health often does not consider children's mental health problems, which are the most common and consequential health issues for children and adolescents. We examine the effects of unemployment rates and housing prices on well‐validated child and adolescent mental health outcomes and use of special education services for emotional problems in the 2001–2013 National Health Interview Survey. We find that the effects of economic conditions on children's mental health are clinically and economically meaningful; children's mental health outcomes worsen as the economy weakens. The effects of economic conditions on child and adolescent mental health are pervasive, found in almost every subgroup that we examine. The use of special education services for emotional problems also rises when economic conditions worsen. Our analyses of possible mechanisms that link economic conditions to child mental health suggest that parental unemployment cannot fully explain the relationship between economic conditions and child mental health.     

Do Children with Special Health Care Needs with Anxiety have Unmet Health Care Needs? An Analysis of a National Survey

Maternal and Child Health Journal - To describe differences in health care needs between Children with Special Health Care Needs (CSHCN) with and without anxiety and examine the association between...     

Race,Ethnicity, and Self-Reported Hypertension: Analysis of Data From the National Health Interview Survey, 1997–2005

Objective. I estimated the association between race and self-reported hypertension among Hispanics and non-Hispanics and determined whether this association was stronger among non-Hispanics.Methods. With data from the 1997–2005 National Health Interview Survey, I used logistic regression to estimate the strength of the association between race/ethnicity and self-reported hypertension among US adults.Results. The overall prevalence of self-reported hypertension was 24.5%, with lower prevalence among Hispanics (16.7%) than among non-Hispanics (25.2%; P < .01). Blacks, regardless of ethnicity, had the highest prevalence. Compared with non-Hispanic Whites, non-Hispanic Blacks had 48% (odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.41, 1.55) greater odds of reporting hypertension; Hispanic Whites had 23% (OR = 0.81; 95% CI = 0.76, 0.88) lower odds. There was no difference in the strength of the association between race and self-reported hypertension observed among non-Hispanics (OR for Blacks = 1.47) and among Hispanics (OR for Blacks = 1.20; for interaction, P = 0.43).Conclusions. The previously reported hypertension advantage of Hispanics holds for Hispanic Whites only. As Hispanics continue their rapid growth in the United States, race may have important implications on their disease burden, because most US health disparities are driven by race and its socially patterned experiences.Hypertension affects more than 65 million US adults¹ and is a major risk factor for cardiovascular disease (CVD).^2,3 The prevalence of hypertension in the US population increased by 30% between the third National Health and Nutrition Examination Survey (NHANES III, 1988–1994) and NHANES 1999–2000.¹ Previous studies have consistently reported that, compared with non-Hispanic Whites, Hispanics have a lower prevalence of hypertension and that non-Hispanic Blacks have a higher prevalence of hypertension.^1,2,4–7 However, these studies focused mostly on Mexican Americans, ignoring the heterogeneity of the Hispanic population. For example, because of their colonization patterns, Hispanics can be of any race (i.e., White, Black, or some other race).⁸ Despite the impact of race on health in US society^9–11 and the projected growth of the Hispanic population,^12–14 there is a dearth of knowledge addressing the relationship between race and health among Hispanics. However, the evidence that does exist parallels findings observed among non-Hispanics: Hispanic Blacks experience worse health outcomes than do Hispanic Whites.^15–18 Thus, the investigation of race and health outcomes in Hispanics is imperative.Hypertension has been attributed to obesity, sodium and potassium intake, physical inactivity, alcohol consumption, smoking, and psychosocial stress.³ Of these, only psychosocial stress has been shown to be unequally distributed across racial/ethnic groups. Research suggests that racial discrimination—a trigger of psychosocial stress—is common in the everyday life of non-Hispanic Blacks and may lead to CVD.^19–26 Given this, and consistent with the historical pattern of disadvantage among non-Hispanic Blacks,^9,11,27,28 it is possible that Hispanic Blacks could be exposed to the same deleterious experiences of racial discrimination and racism as non-Hispanic Blacks because of the salience and social visibility associated with their race or dark skin color. These experiences may lead to disadvantaged life chances, which then translate into poorer health.The availability of 9 years of data from the National Health Interview Survey (NHIS, 1997–2005) afforded the opportunity to investigate the association between race and self-reported hypertension in Hispanics and non-Hispanics before and after adjustment for selected characteristics and known risk factors and to compare the strength of this association in Hispanics and non-Hispanics. If race as a social construct channels Hispanic Blacks to exposures detrimental to health as it does for non-Hispanic Blacks, the lower odds of hypertension for Hispanics observed in previous studies would apply only to Hispanic Whites whereas Hispanic Blacks would have odds of hypertension similar to those of non-Hispanic Whites or intermediate between non-Hispanic Whites and non-Hispanic Blacks. However, the magnitude of the association between race and hypertension would be stronger among non-Hispanics than among Hispanics.     

Are people being screened for colorectal cancer as recommended? Results from the National Health Interview Survey

BACKGROUND: The evidence is now compelling that colorectal cancer incidence and mortality can be reduced by screening, and medical organizations recommend regular screening among persons of average risk aged 50 years or older. We sought to determine whether appropriate screening has become more widespread now that consensus over its value has been achieved. METHODS: We analyzed data from the 1992 and 1998 National Health Interview Survey, an in-person survey of a nationally representative sample of the U.S. population. Persons aged > or =50 years (4428 in 1992, 12,629 in 1998) were questioned about their use of colorectal cancer screening. RESULTS: Self-reported use of fecal occult blood testing and proctoscopy increased slightly from 1992 to 1998. In 1998, however, only an estimated 22.9% of Americans aged > or =50 years had been screened with either the home-administered fecal occult blood testing in the past year or proctoscopy within 5 years. Nearly half of fecal occult blood testings were performed with a sample taken during an in-office physical examination rather than with the recommended home kit. CONCLUSION: Most eligible persons are still not meeting the screening recommendations for colorectal cancer. Education is needed for both the public and health care providers to increase their compliance with current guidelines.     

Patient–Provider Discussion of Online Health Information: Results From the 2007 Health Information National Trends Survey (HINTS)

Increasing numbers of people have turned to the Internet for health information. Little has been done beyond speculation to empirically investigate patients' discussion of online health information with health care professionals (HCPs) and patients' perception of HCPs' reactions to such discussion. The author analyzed data from the 2007 Health Information National Trends Survey (HINTS) to identify the characteristics of patients (a) who search for health information on the Internet, (b) who discuss the information found on the Internet with HCPs, and (c) who positively assess HCPs' reaction to the online information. Findings show that men were more likely than were women to have a conversation on online information with HCPs. It is unfortunate that patients who had trouble understanding or trusting online health information were no more likely to ask questions to or seek guidance from HCPs. Reactions of HCPs to online information were perceived as particularly negative by certain groups of patients, such as those who experienced poor health and those who had more concerns about the quality of their searched information. Results are discussed for their implications for patient empowerment and patient–HCP relationships.     

Obesogenic Dietary Practices of Latino and Asian Subgroups of Children in California: An Analysis of the California Health Interview Survey, 2007–2012

Objectives. We examined obesogenic dietary practices among Latino and Asian subgroups of children living in California.Methods. We analyzed 2007, 2009, and 2011–2012 California Health Interview Survey data to examine the differences in dietary practices among Mexican and non-Mexican Latino children and 7 ethnic subgroups of Asian children. We used multivariable regression to examine the sociodemographic factors associated with specific dietary practices.Results. Latino subgroups of children had few differences in obesogenic dietary practices, whereas Asian subgroups of children exhibited significant differences in several obesogenic dietary practices. Korean and Filipino children were more likely than Chinese children to consume fast food and have low vegetable intake. Filipino children, followed by Japanese children, had the most obesogenic dietary practices compared with Chinese children, who along with South Asian children appeared to have the least obesogenic dietary practices. In general, income, education, and acculturation did not explain the dietary differences among Asian groups.Conclusions. Our findings suggest the need to disaggregate dietary profiles of Asian and Latino children and to consider nontraditional sociodemographic factors for messaging and counseling on healthy dietary practices among Asian populations.Dietary practices among pediatric racial and ethnic minority groups highlight possible contributions to the nation’s significant obesity disparities. High consumption of sugar- sweetened beverages (SSBs) and fast food and low consumption of fruits and vegetables have been found among Latino and African American children compared with White children.1–4 These dietary differences have been associated with environmental factors such as access to fresh foods and social factors such as family income, education level, and acculturation. Many of these factors have been understudied among Asian children. This gap in the literature is problematic given the emerging evidence that Asian children have notable differences in dietary practices compared with White children and that Asian Americans with the same body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) are at a higher risk for cardiovascular diseases and type 2 diabetes than non-Hispanic Whites.5–8 Furthermore, children of various Asian and Latino ethnic groups with distinct historical, migration, and social contexts are generally grouped together in research analyses, making it difficult to understand the ethnicity-specific salient roles that education, income, and acculturation may play in specific dietary practices.9,10Acculturation has been described as both a protective factor and a risk factor for healthy dietary practices among immigrants. For example, acculturation among Latinos has been associated with higher consumption of fruits and vegetables but also with higher rates of fast food and sugary food consumption in both pediatric and adult Latino populations.11–13 Less is known about the role of acculturation in dietary practices among Asian and Latino ethnic subgroups.5,6,14,15 We examined dietary practices within ethnic subgroups of Latino and Asian children and the associated role of sociodemographic factors. On the basis of the thin literature that has examined dietary practices among Latino subgroups of children, we hypothesized that children of Mexican descent would have healthy dietary practices compared with other Latino groups and that Asian ethnic groups of children would show a wide variety of dietary practices. In addition, we hypothesized that acculturation, after controlling for education and income, would have an independent effect on dietary practices for all ethnic groups of children.     

Factors Associated with Forgone Care Among Children in the United States: An Analysis of the 2016-2018 National Survey of Children’s Health

Delaying or forgoing health care can have negative consequences for the health and well-being of children. In 2000, Paul Newacheck called for the continued monitoring of unmet health needs among children. While a handful of studies have been conducted since 2000, primarily among children with special healthcare needs (CSHCN), the redesigned National Survey of Children’s Health (NSCH) offers a unique opportunity to examine forgone care among all children ages 0-17. This study provides the most recent prevalence estimates of forgone care among children in the United States, by type of care, and identifies related sociodemographic and health factors. We used data from the combined 2016-2018 NSCH to examine sociodemographic and health factors associated with parent/caregiver-reported forgone care among children ages 0-17 years in the United States. We also examined the association of these factors with different types of forgone care and reasons for forgone care. Survey weighted bivariate and logistic regression analyses were conducted. 101,984 children ages 0-17 years. 3.1% of children (2.2 million) had forgone care in 2016-2018. Forgone dental care was most frequently reported (1.67%), followed by medical care (1.03%) and mental health care (0.83%). Cost was the most frequently reported reason for forgone care (1.83%), followed by problems getting an appointment (1.20%) and lack of eligibility (0.97%). Children, who were older, had greater number of health conditions, were CSHCN, were Hispanic or non-Hispanic black, were uninsured, and had family incomes < 100% of the federal poverty level (FPL) were significantly more likely to have any reported forgone care. Among children with forgone care, the factors associated with reporting different types of forgone care varied. After adjustment, insurance status was the only factor consistently associated with all types of care, except hearing services; CSHCN status, number of health conditions, and insurance status were associated with forgone dental care; race/ethnicity and insurance were associated with forgone vision care; age, number of health conditions, CSHCN status, and insurance were associated with forgone mental care; and FPL was associated with forgone hearing services. The factors associated with the different reasons for forgone care also varied. Insurance status and FPL were associated with forgone care due to lack of eligibility and issues with cost; CSHCN status was associated with services not available in the area; and insurance, CSHCN status, and race/ethnicity were associated with problems getting an appointment. Forgone care remains an issue for over 2.2 million children in the United States. However, the characteristics of children associated with different types of forgone care vary, as do those associated with different reasons for forgoing care. This suggests the need for diverse strategies, in addition to standing efforts to expand insurance coverage, to ensure timely access to needed healthcare services among US children. Efforts to reduce forgone care will need to address both financial and nonfinancial issues and will need to be tailored to address the factors associated with forgoing different types of care.     

Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey

Data from the Third National Health and Nutrition Examination Survey (1988-1994) were used to examine the relation between obesity and depression. Past-month depression was defined using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, and was measured with the Diagnostic Interview Schedule. Obesity was defined as a body mass index (weight (kg)/height (m)2) of 30 or higher. The authors compared risks of depression in obese and normal-weight (body mass index 18.5-24.9) persons. Obesity was associated with past-month depression in women (odds ratio (OR)=1.82, 95% confidence interval (CI): 1.01, 3.3) but was not significantly associated in men (OR=1.73, 95% CI: 0.56, 5.37). When obesity was stratified by severity, heterogeneity in the association with depression was observed. Class 3 (severe) obesity (body mass index > or =40) was associated with past-month depression in unadjusted analyses (OR=4.98, 95% CI: 2.07, 11.99); the association remained strong after results were controlled for age, education, marital status, physician's health rating, dieting for medical reasons, use of psychiatric medicines, cigarette smoking, and use of alcohol, marijuana, and cocaine. These findings suggest that obesity is associated with depression mainly among persons with severe obesity. Prospective studies will be necessary to clarify the obesity-depression relation but await the identification of potential risk factors for depression in the obese.     

Is the English National Health Service meeting the needs of mentally distressed Chinese women?

OBJECTIVES: To identify barriers to communication between health care workers and Chinese women living in England, a group who are known to use the National Health Service (NHS) less than other ethnic groups; to consider whether such barriers lead to inequitable access to NHS mental health treatment; and to determine the extent to which this results from institutional racism. METHOD: A purposive sample of 42 Chinese women living in South-East England aged 29-60 years derived from a primary care group, two secondary mental health service providers and three Chinese associations. Subjects had all consulted a general practitioner and had either experienced mental distress (n= 24) and/or had used traditional Chinese medicine (n = 25). RESULTS: Communication with health care professionals was hindered by a lack of common language and an absence of shared concepts concerning the causes and manifestations of health and illness, particularly mental health. This lack of communication resulted in delayed diagnoses, misunderstood treatment regimens and deterred women from (re-)presenting to the NHS. Among our informants, these types of problem were more acute for those women who were most marginalised from English-language culture. CONCLUSIONS: Linguistic and conceptual problems explain Chinese women's relatively poor access to mental health services. The continuing failure to tackle systematically these communication problems through the routine provision of interpretation and advocacy services lays the health care system open to the charge of "institutional racism".     

What Is the Current Direction of the Research on Carotenoids and Human Health? An Overview of Registered Clinical Trials

Carotenoids have been the object of numerous observational, pre-clinical and interventional studies focused on elucidating their potential impacts on human health. However, the large heterogeneity among the trials, in terms of study duration and characteristics of participants, makes any conclusion difficult to draw. The present study aimed to explore the current carotenoid research trends by analyzing the characteristics of the registered clinical trials. A total of 193 registered trials on ClinicalTrials.gov and ISRCTN were included in the revision. Eighty-three studies were performed with foods, one-hundred-five with food supplements, and five with both. Among the foods tested, tomatoes and tomato-based foods, and eggs were the most studied. Lutein, lycopene, and astaxanthin were the most carotenoids investigated. Regarding the goals, 52 trials were focused on studying carotenoids’ bioavailability, and 140 studies investigated the effects of carotenoids on human health. The main topics included eye and cardiovascular health. Recently, the research has focused also on two new topics: cognitive function and carotenoid–gut microbiota interactions. However, the current research on carotenoids is still mostly focused on the bioavailability and metabolism of carotenoids from foods and food supplements. Within this context, the impacts/contributions of food technologies and the development of new carotenoid formulations are discussed. In addition, the research is still corroborating the previous findings on vision and cardiovascular health. Much attention has also been devoted to new research areas, such as the carotenoid–microbiota interactions, which could contribute to explaining the metabolism and the health effects of carotenoids; and the relation between carotenoids and cognitive function. However, for these topics the research is still only beginning, and further studies are need.     

Is the British National Health Service equitable? The evidence on socioeconomic differences in utilization

Is the British National Health Service (NHS) equitable? This paper considers one part of the answer to this: the utilization of the NHS by different socioeconomic groups (SEGs). It reviews recent evidence from studies on NHS utilization as a whole based on household surveys (macro-studies) and from studies of the utilization of particular services in particular areas (micro-studies). The principal conclusion from the majority of these studies is that, while the distribution of use of general practitioners (GPs) is broadly equitable, that for specialist treatment is pro-rich. Recent micro-studies of cardiac surgery, elective surgery, cancer care, preventive care and chronic care support the findings of an earlier review that use of services was higher relative to need among higher SEGs.     

Does Stigmatization Motivate People to Quit Smoking? Examining the Effect of Stigmatizing Anti-Smoking Campaigns on Cessation Intention

Stigmatization against smokers characterizes many of today’s anti-smoking campaigns in the United States. It is believed that stigmatization motivates people to quit smoking by arousing a state of emotional distress, such as shame, in viewers. However, stagnant cessation rates among socioeconomically disadvantaged smokers imply that stigmatizing campaigns might be ineffective in promoting cessation among those low in socioeconomic status. To understand the effectiveness of stigmatizing campaign messages, we proposed a moderated mediation model and experimentally tested it among current smokers (n = 136). Results show that exposure to a stigmatizing message significantly lowered smokers’ cessation intentions who have lower income and less self-efficacy. The conditional negative effect of the message was accounted for by shame experienced by smokers.     

Are Rates of Functional Limitations Associated with Access to Care? A State-Level Analysis of the National Survey of Children with Special Health Care Needs

Objectives: Health-related services and compensatory mechanisms have a potential role in minimizing functional limitations and increasing quality of life among children with special health care needs (CSHCN). We examined whether rates of functional limitations among CSHCN in the 50 states and District of Columbia were associated with state-level characteristics that reflect access to such services among CSHCN. Methods: We aggregated child-level survey data from the National Survey of CSHCN to create 51 state-level estimates of the proportions who had functional limitations, had ≥1 unmet health needs, and lacked medical insurance coverage. State-level information about Medicaid spending per child enrollee in federal fiscal year 2000 was obtained from The Henry J. Kaiser Family Foundation website. We examined correlations between the percentages of CSHCN having functional limitations and each of the other state-level variables, and conducted multiple regression analyses that examined these associations while controlling for the statewide percentages of children living in poverty. Results: The proportions of CSHCN with functional limitations were higher in states with higher rates of uninsured CSHCN (r = .49; p < .0001) and higher rates of CSHCN with unmet health needs (r = .62; p < .0001). Proportions of CSHCN with functional limitations were unrelated to per child Medicaid spending. These findings were robust when we controlled for percentages of children in poverty across states. Conclusions: Fewer unmet needs for health-related services are associated with lower statewide rates of functional limitations in CSHCN. As health care costs increase and state revenues decrease, CSHCN are at increasing risk of losing access to required services. Were this to happen we might expect an increase in the proportion of CSHCN who experience significant functional limitations. Thus, a key challenge is to provide CSHCN access to the amount and quality of health-related care they require to achieve their potential.     

Is the self‐reported private health insurance status in the National Health Survey representative of private health insurance coverage in Australia?

Objective: This study determines whether the distribution of self‐reported private health insurance (PHI) status in the 2004/05 National Health Survey (NHS) is representative of PHI coverage in Australia. Methods: Weighted estimates from the NHS 2004/05 are compared with PHI status reported for 2004/05 by the Private Health Insurance Administration Council (PHIAC, the independent regulator of the private health insurance industry). PHI status was imputed to children in the NHS based on PHI status of the adult in the household. The two data sources were deemed to be different if the PHIAC results were not within the 95% CI range for the NHS estimate. Results: PHI status reported in the NHS and PHIAC are generally comparable except for some categories such as hospital cover of males aged 5–9 years and females aged 85 years and older where the NHS estimates are below PHIAC numbers; and males aged 25–29, 35–39, and 50–54 years where the NHS estimates are higher. Conclusions: The findings suggest that while the NHS 2004/05 estimates may accurately represent coverage in Australia particularly when examined at an aggregated level, there is some variation in the NHS estimates when examined by sex and age group. Implications: Researchers need to be aware of the potential for sampling and reporting bias to contribute to some misrepresentation of PHI status when using the NHS to generalise to the Australian population. Exploring corrective measures will ensure that the NHS continues to be a valuable data resource for health researchers in Australia.     

Has Muslim Got Benefited from the National Health Mission? A Situational Analysis of Maternal Health Services in India

BackgroundIt is a marked recognition that when the population is disaggregated by religion, wide disparities in the utilization of maternal health care services can be observed. The study was aimed to analyze the levels and trends of maternal health services among Muslims in India. The study also delineated the investigation of confounding factors attributed to maternal health services among the selected population.MethodsThe study utilized the data from the third and fourth round of National Family Health Survey (NFHS), conducted in 2005–06 and 2015–16 respectively. The bivariate and multivariate logistic regression models were employed to accomplish the study objectives.ResultThere is an increasing trend in the distributional patterns of all three indicators (full ANC, SBA and PNC) during the last two successive surveys. Muslim women belonging to Southern States were seen to be utilizing more maternal health care services as compared to Muslim women in the Northern States. Muslim populated States like Assam, Bihar, Jharkhand, Uttar Pradesh and West Bengal were far cry to achieve the MDG-15 target of utilization of 100 percent skilled birth attendants in 2015. Education, media exposure and wealth status appeared to be major confounding factors for determining the utilization of maternal health services.ConclusionThe study revealed that the utilizations of maternal health services among Muslims have progressed during the last decade. It can be concluded that the NHM policy has played an instrumental role in increasing the utilization of maternal health services among Muslims.     

Impact of Medical Home on Health Care of Children With and Without Special Health Care Needs: Update from the 2016 National Survey of Children’s Health

Objective The medical home has been promoted as an optimal model of health care delivery for children. The purpose of this study was to examine the association between having access to a medical home and the health care experiences of children with and without special health care needs (SHCN) in the United States. Methods We analyzed data from the 2016 National Survey of Children’s Health. We modeled logistic regressions to assess associations of having access to a medical home with health care experiences for 11,392 CSHCN and 38,820 non-CSHCN. Results We found that not having access to a medical home was negatively associated with preventive medical and dental care visits, greater unmet medical and dental needs, and hospital emergency room visits. Additionally, not having access to a medical home was negatively associated with the physical and oral health among CSHCN and oral health among non-CSHCN. However, we found no significant association between improved physical health status and having access to a medical home among non-CSHCN. Conclusions Results from our analysis suggest that having access to a medical home remains key determinant of improved health care experiences by CSHCN and non-CSHCN in the United States. Our findings underscore the need to develop policies and implement a more concerted program to increase access to health care delivered under the medical home model for CSHCN and non-CSHCN. Policymakers, health care administrators and physician groups can use these findings to inform future policy decisions and service delivery reforms.

     

How important are tobacco prices in the propensity to start and quit smoking? An analysis of smoking histories from the Spanish National Health Survey

This paper presents an econometric analysis of the effect of policy instruments such as prices, restrictions to use and health warnings on the decisions to start and quit smoking. The duration up to starting and up to quitting is represented with several parametric models for the hazard function, and statistical tests are used to choose the best specification. The estimates reveal that prices have a very weak effect on the duration up to starting. On the contrary, the duration up to quitting is shortened by increases in the prices of the cheapest varieties of cigarettes in the Spanish market. This evidence suggests specific directions for change in the structure of tobacco taxes.     

Is the Scottish population living dangerously? Prevalence of multiple risk factors: the Scottish Health Survey 2003

Background  

Risk factors are often considered individually, we aimed to investigate the prevalence of combinations of multiple behavioural risk factors and their association with socioeconomic determinants.