The effect of smoking on years of healthy life (YHL) lost among middle-aged and older Americans

OBJECTIVE: To estimate the effects of smoking on quality of life over time, using the Years of Healthy Life (YHL) construct. DATA SOURCES/STUDY SETTING: The Health and Retirement Study (HRS) survey (N=12,652) of persons 50 to 60 years old and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (N=8,124) of persons > or =70 years old, plus spouses regardless of age, followed from 1992/1993 to 2000. STUDY DESIGN: Years of healthy life from baseline to death were estimated. Regression models were developed with smoking as the main explanatory variable and with both YHL and years of life remaining as the outcome variables. PRINCIPAL FINDINGS: Smoking was strongly and consistently related to YHL lost. In HRS, individuals who had quit smoking at least 15 years prior to baseline had a similar number of YHL left as never smokers. CONCLUSIONS: Efforts to encourage smoking cessation should emphasize the impact of these factors on quality of life.     

乡镇企业农民工健康知识、行为与健康教育现状调查分析

目的 调查乡镇企业农民工的健康相关知识掌握情况和健康相关行为形成情况及在该群体中开展的健康教育和健康促进活动的现状.方法 采用随机整群抽样方法选择浙江省湖州市南浔区408名15岁以上农民工为研究对象,进行问卷调查.结果 被调查对象中40岁以下的占74.5%;小学文化程度的占43.4%,初中文化程度的占36.8%,文盲的占18.1%.68.3%的人在砖瓦厂上班,22.6%在纺织企业上班.69.6%的人和家属住在一起;79.2%的人居住在企业提供的集体宿舍,20.8%的人租房.健康知识知晓率男性为43.2%,女性为40.5%.文盲、小学文化程度、初中文化程度、高中文化程度的人健康知识知晓率分别为25.6%、36.6%、55.5%、60.3%.被调查的农民工有41.4%的人吸烟.有16.7%的人和家人共用一块毛巾.有14.0%的人经常喝生水.有40.9%的人生病了不去医院.农民工的业余生活比较单调,76.0%的人仅仅喜欢和老乡聊天交流.90.7%的人表示会积极参与企业组织的健康教育活动.文化程度越高,对健康教育的需求越高.结论 农民工的健康知信行水平处于比较低的水平.应该根据农民工的需求开展健康教育和健康促进工作.     

Effects on mortality of getting the basic health examination under the Health Services for the Elderly Act and modification of the effects by health status among elderly persons in a rural community

This longitudinal study examines the effect on mortality of regular use of the basic health examination under the Health Services for the Elderly Act and heterogeneity of the effect according to levels of physical and mental health status among community dwelling elderly persons. Of persons aged 65 and older who lived in Otsuki town, Kochi prefecture, and completed a questionnaire survey about health in February 1991, 1,470 survivors on the anniversary of the baseline survey were followed by the end of March 1996. Regularity of getting the examination was determined by the history of use of the examination in 1990 and 1991. Mortality reduction associated with annual use of the examination was observed in both the 65-74 and the 75 and older age groups and the benefit got smaller with advancing in age. In the 75 and older age group, the benefit from annual use of the examination was restricted to persons having no impairment in physical activities of daily living and those having favorable mental health. Biennial use of the examination was associated with the same amount of mortality reduction as annual use among persons having chronic conditions under treatment in the 65-74 age group. Regular use of the basic health examination at old ages is effective and the effectiveness varies by age range and level of functional health status.     

Positive changes in sun-related behavior in Israel (1994-1998)

BACKGROUND: Current preventive measures against skin cancer focus on individual sun protection and early detection. Solar radiation in Israel is powerful, and about one-half of its population is fair skinned. We investigated whether public awareness efforts yielded changes in sun-related behaviors in Israel from 1994 to 1998. METHODS: The Department of Health Promotion in the Ministry of Health in Israel has been conducting an ongoing research on health knowledge, attitude, and practice, including six closed questions about sun-related behaviors in a general questionnaire. Independent samples of about 3,000 people representing the adult Jewish population (18 years old and above) were surveyed in 1994, 1996, and 1998. Response rates in 1994 and 1996 were about 85 and 80% in 1998. RESULTS: The number of people reporting sun protection behaviors increased from 34% in 1994 to 41% in 1996 and to 46% in 1998. Periodic medical skin examination increased from 9% of the responders in 1994, to 13% in 1996 and to 16% in 1998. The number of people reporting having fair skin increased from 28% in 1994 to 41% in 1996 and to 43% in 1998. CONCLUSIONS: There were positive changes in sun-related awareness and behaviors in Israel between 1994 and 1998. These findings support the conclusion that positive gains were associated with the health promotion efforts conducted by the Israel Cancer Society, Ministry of Health, and other Israeli organizations throughout these years.     

Health-related quality of life and health risk behaviors among smokers

BACKGROUND: It is well established that smoking has detrimental effects on physical health, but its associations with health-related quality of life (HRQOL) and a variety of health behaviors have not been widely investigated in the U.S. population. METHODS: Data obtained from the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized persons aged > or =18 years in the United States, Guam, Puerto Rico, and the Virgin Islands, were used in this investigation. The BRFSS monitors the prevalence of key health- and safety-related behaviors and characteristics. In 2001 and 2002 combined, trained interviewers administered HRQOL questions in 23 states and the District of Columbia (n=82,918). This analysis was conducted in 2004. RESULTS: Overall, an estimated 22.4% of adults were current smokers, 24.1% were former smokers, and 53.6% never smoked. Current smokers had significantly poorer HRQOL than those who had never smoked, and were more likely to drink heavily, to binge drink, and to report depressive and anxiety symptoms. Additionally, current smokers were significantly more likely than those who never smoked to be physically inactive, to report frequent sleep impairment, to report frequent pain, and to eat less than five servings of fruits and vegetables per day. CONCLUSIONS: While there are strong positive relationships between smoking and both alcohol consumption and mood disturbance, smoking is also associated with an array of other modifiable risk factors meriting assessment and intervention. In addition to smoking cessation, the increased morbidity and mortality characterizing smokers may potentially be further reduced by improvements in diet, physical activity, and sleep.     

The Bavarian Health Survey--goals and selected results

The Bavarian Health Survey (1998/99) is a new element in the Bavarian health reporting system. It was conducted in close connection with the German Health Survey as a combination of a questionnaire and health examination survey with participation of the Bavarian local health offices. Based on a random sample of more than 1,800 persons aged 18 to 79 years, life-prevalence data on diseases of the metabolic system, selected laboratory results and obesity are reported.     

Philippines 1998: results from the Demographic and Health Survey

This article presents summary statistics gathered from the 1998 Philippine National Demographic and Health Survey. The National Statistics Office and the Department of Health within the framework of the Demographic Health Survey Program of Macro International conducted the survey. The nationally representative survey collected data from 12,407 households. Interviews were also conducted with 13,983 women aged 15-49 years between March 3 and the first week of May 1998. The statistical data presented were on fertility trends, fertility differentials, age-specific fertility, fertility preferences, current contraceptive use, contraception, marital and contraceptive status, postpartum variables, infant mortality trends and differentials, and children's health.     

Identifying the energy gap: magnitude and determinants of 5-year weight gain in midage women

OBJECTIVE: The aims of this study were to estimate average yearly weight gain in midage women and to identify the determinants of weight gain and gaining weight at double the average rate. RESEARCH METHODS AND PROCEDURES: The study sample comprised 8071 participants (45 to 55 years old) in the Australian Longitudinal Study on Women's Health who completed mailed surveys in 1996, 1998, and 2001. RESULTS: On average, the women gained almost 0.5 kg per year [average 2.42 kg (95% confidence interval, 2.29 to 2.54) over 5 years]. In multivariate analyses, variables associated with energy balance (physical activity, sitting time, and energy intake), as well as quitting smoking, menopause/hysterectomy, and baseline BMI category were significantly associated with weight gain, but other behavioral and demographic characteristics were not. After adjustment for all of the other biological and behavioral variables, the odds of gaining weight at about twice the average rate (>5 kg over 5 years) were highest for women who quit smoking (odds ratio = 2.94; 95% confidence interval, 2.17, 3.96). There were also independent relationships between the odds of gaining >5 kg and lower levels of habitual physical activity, more time spent sitting, energy intake (but only in women with BMI > 25 at baseline), menopause transition, and hysterectomy. DISCUSSION: The average weight gain equates with an energy imbalance of only about 10 kcal or 40 kJ per day, which suggests that small sustained changes in the modifiable behavioral variables could prevent further weight gain.     

Peru 1996: results from the Demographic and Health Survey

This report presents findings of the 1996 Peru Demographic and Health Survey among 28,951 women 15-49 years old and 2487 men 15-59 years old. Fertility was 3.5 children/woman (5.6 in rural and 2.8 in urban areas). Fertility ranged from 2.1 among higher educated women to 6.9 among women with no formal education. 41.7% wanted the births in the 5 years preceding the survey. 23.2% wanted the birth later. 34.8% wanted no more births. A high percentage of women with 3 or more children wanted no more children. 22.9% currently used modern contraceptive methods. 41.3% used traditional methods. Contraceptive prevalence peaked at ages 35-39 years at 72.9%. Prevalence was 46.0% at 15-19 years old and 40.9% at 45-49 years old. 12% used the IUD. 18% used periodic abstinence. 42.7% of nonusers were menopausal. 12.4% were subfecund. 7.5% feared side effects. The median age at first birth was 21.5 years. Infant mortality was 43/100,000. Infant mortality was very high among rural and uneducated women. Only 1.1% were moderately to severely undernourished, but 25.8% were moderately to severely chronically undernourished.     

The burden of mortality of obesity at middle and old age is small. A life table analysis of the US Health and Retirement Survey

The evidence of effect of overweight and obesity on mortality at middle and old age is conflicting. The increased relative risk of cardiovascular disease and diabetes for overweight and obese individuals compared to normal weight is well documented, but the absolute risk of cardiovascular death has decreased spectacularly since the 1980s. We estimate the burden of mortality of obesity among middle and old aged adults in the Health and Retirement Survey (HRS), a US prospective longitudinal study. We calculate univariate and multivariate age-specific probabilities and proportional hazard ratios of death in relation to self-reported body mass index (BMI), smoking and education. The life table translates age specific adjusted event rates in survival times, dependent on risk factor distributions (smoking, levels of education and self reported BMI). 95% confidence intervals are calculated by bootstrapping. The highest life expectancy at age 55 was found in overweight (BMI 25-29.9), highly educated non smokers: 30.7 (29.5-31.9) years (men) and 33.2 (32.1-34.3) (women), slightly higher than a BMI 23-24.9 in both sexes. Smoking decreased the population life expectancy with 3.5 (2.7-4.4) years (men) and 1.8 (1.0-2.5) years (women). Less than optimal education cost men and women respectively 2.8 (2.1-3.6) and 2.6 (1.6-3.6) years. Obesity and low normal weight decreased population life expectancy respectively by 0.8 (0.2-1.3) and 0.8 (0.0-1.5) years for men and women in a contemporary, US population. The burden of mortality of obesity is limited, compared to smoking and low education.     

Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years

BACKGROUND: Health behaviours are potential explanatory factors for socioeconomic differences in mortality. We examined the extent to which seven health behaviours covering dietary habits, smoking and physical activity, can account for relative differences in cardiovascular and all-cause mortality by educational level. METHODS: Health behaviour data derived from nationwide Finnish health behaviour surveys from the years 1979 to 2001. These annually repeated cross-sectional surveys were linked to register-based information on educational level and subsequent mortality from the year of the survey until the end of 2001 (average follow-up time 11.9 years). The analyses included 29 065 men and 31 543 women of whom 4263 died. Cardiovascular disease (CVD), coronary heart disease (CHD), stroke and all-cause mortality was studied. RESULTS: Educational level showed a graded association with all mortality outcomes. Health behaviours explained 54% of the relative difference between primary and higher educational level in CVD mortality among in men and 22% among in women. For all-cause mortality the corresponding figures were 45 and 38%. Smoking, vegetable use and physical activity were the most important health behaviours explaining educational level differences in all mortality outcomes, while the effects of type of fat used on bread, coffee drinking, relative weight and alcohol use were small. CONCLUSIONS: Smoking, low vegetable use and physical inactivity explained a substantial part of educational level differences in cardiovascular and all-cause mortality among men and women. Socioeconomic trends in these behaviours are of crucial importance in determining whether socioeconomic mortality differences will widen or narrow in the future.     

Health-promoting behaviors among adults with type 2 diabetes: findings from the Health and Retirement Study

BACKGROUND: Type 2 diabetes has an enormous impact on the health care system and individuals. Dietary habits, exercise, weight management, and smoking status are critical to management and prevention of complications. This study describes the prevalence of these behaviors and their change over time in a national sample of adults with type 2 diabetes. The relationships between behavior change and sociodemographic and health status measures are explored. METHODS: Data are from the first and third longitudinal waves of the Health and Retirement Study. Surveys were conducted face-to-face or via telephone in 1992 and 1996. RESULTS: The sample consisted of 733 persons with type 2 diabetes, ages 50-62. The most common behaviors were being on a special diet (79.6%), and not smoking (76.6%). Sixty-six percent were engaged in some physical activity, and 58.4% were trying to lose weight. Reports of being on a special diet, trying to lose weight, and exercising all diminished over time. CONCLUSIONS: The prevalence of these behaviors is disappointing. Worse, they declined over the 4-year period. A better understanding of factors contributing to a person's decision to begin or discontinue health-promoting behaviors is needed to plan effective supportive or preemptive interventions.     

Occupational social class,educational level,smoking and body mass index,and cause-specific mortality in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort

OBJECTIVES: To investigate the independent associations between occupational and educational based measures of socioeconomic status (SES) and cause-specific mortality, and the extent to which potentially modifiable risk factors smoking and body mass index (BMI) explain such relationships. DESIGN, SETTING AND PARTICIPANTS: Prospective population study of 22,486 men and women aged 39-79 years living in the general community in Norfolk, United Kingdom, recruited using general practice age-sex registers in 1993-1997 and followed up for total mortality using death certification to 2006. MAIN RESULTS: In men a strong inverse relationship was found between social class and all cause, cardiovascular and cancer mortality, with relative risk of social class V compared to I of 2.21 for all cause mortality (95% CI 1.54-3.17, P < 0.001). This was attenuated but not abolished after adjusting for modifiable risk factors, smoking and BMI, with relative risk of social class V compared to I for all cause mortality of 1.92 (95% CI 1.34-2.77, P < 0.001). A similar, but smaller effect was seen in women. Educational status was not associated with mortality independently of social class. CONCLUSIONS: Social class and education are not necessarily interchangeable measures of SES. Some but not all of the socioeconomic differential in mortality can be explained by potentially modifiable risk factors smoking and BMI. Further understanding of the mechanisms underlying the association of each socioeconomic indicator with specific health outcomes is needed if we are to reduce inequalities in health.     

Uzbekistan 1996: results from the Demographic and Health Survey

This report presents findings of the 1996 Demographic and Health Survey for Uzbekistan among 4415 women 15-49 years old, the first national level health survey. Fertility was 3.3 children/woman during 1992-96 (3.7 in rural and 2.7 in urban areas). Fertility ranged from 2.8 among higher educated women to 3.5 among primary educated women. Fertility was highest among women 20-24 and 25-29 years old in the 4 years prior to the survey and 5-9 and 10-14 years prior. The mean ideal number of children desired increased linearly with increased age and increased parity over 1. 51.5% of currently married women desired a stop to childbearing. Regardless of birth order, 94.7% wanted their births. 51.3% currently used modern contraception. Contraceptive prevalence followed an inverted U-shaped pattern by age. Prevalence peaked at ages 35-39 years at 74.7%. Prevalence remained stable between 62% and 68% after 2 living children. 45.8% used the IUD. 4.2% relied on traditional methods. 28.7% of nonusers were opposed to family planning. 22.1% of nonusers desired more children. 13.1% were menopausal. 24.9% were never married; 70.2% were married. The median age at first birth was 21.6 years. Infant mortality was 49/100,000. 11.6% were moderately or severely undernourished. 31.3% were moderately or severely chronically undernourished.     

上海市民1996、1998年X射线诊断照射频率调查

[目的]了解上海市民1996年和1998年X射线诊断照射的年频率水平。[方法]频率调查分三个层次进行 ,即面上普查、分层抽样调查和个别典型调查。[结果]上海市1996年和1998年X射线诊断的年频率水平分别为536人次/千人口和583人次/千人口 ;>40岁年龄组和女性1998年接受X射线检查的年频率水平比1996年分别增长20 %和16 %。[结论]X射线诊断年频率水平有增长的趋势 ,应注意X射线诊断应用的合理性     

Frequency of attendance at religious services, overweight, and obesity in American women and men: the Third National Health and Nutrition Examination Survey

PURPOSE: Few data have been published on the association of overweight and obesity and indices of religiousness, a putative protective factor for cardiovascular morbidity and mortality, in representative samples of multiethnic total populations. METHODS: To test the hypothesis that frequency of attendance at religious services is unrelated to the prevalence of overweight and obesity, the following data from American men and women aged 20 years and older (N = 16,657) in a cross-sectional survey of a large national sample, the Third National Health and Nutrition Examination Survey, were analyzed: self-reported frequency of attendance at religious services, cigarette smoking, health status, sociodemographic variables, and measured body mass index (BMI). RESULTS: In persons 20 years and older, 58% of frequent attenders (> or = 52 times/y) and 53% of others were overweight or obese (BMI > or = 25 kg/m2). After stratifying to eliminate interactions in a logistic regression model and controlling for sociodemographics, smoking, and health status, no significant association was seen in European-American women overall. In all others, the significant positive associations of frequency of attendance and overweight could be explained by these other variables (fully adjusted odds ratio, 1.16; 95% confidence interval, 0.98-1.36; p = 0.08). The same was true for obesity (BMI > or = 30 kg/m2). CONCLUSION: In a national sample of the US population, the prevalence of overweight or obesity is greater in self-reported frequent attenders of religious services than in others, but the association was explained by controlling for multiple sociodemographic and health variables.