Does social status predict adult smoking and obesity? Results from the 2000 Mexican National Health Survey

Abstract

Socioeconomic status is generally associated with better health, but recent evidence suggests that this ‘social gradient’ in health is far from universal. This study examines whether social gradients in smoking and obesity in Mexico – a country in the midst of rapid socioeconomic change – conform to or diverge from results for richer countries. Using a nationally representative sample of 39,129 Mexican adults, we calculate the odds of smoking and of being obese by educational attainment and by household wealth. We conclude that socioeconomic determinants of smoking and obesity in Mexico are complex, with some flat gradients and some strong positive or negative gradients. Higher social status (education and assets) is associated with more smoking and less obesity for urban women. Higher status rural women also smoke more, but obesity for these women has a non-linear relationship to education. For urban men, higher asset levels (but not education) are associated with obesity, whereas education is protective of smoking. Higher status rural men with more assets are more likely to smoke and be obese. As household wealth, education and urbanisation continue to increase in Mexico, these patterns suggest potential targets for public health intervention now and in the future.     

Prostate-specific antigen test use reported in the 2000 National Health Interview Survey

BACKGROUND: In 2000, the National Health Interview Survey (NHIS) collected information about prostate-specific antigen (PSA) test use in a representative sample of U.S. men. METHODS: This study examined PSA test use in subgroups defined by personal and social characteristics. RESULTS: Among men aged 50 and older with no history of prostate cancer, 56.8% reported ever having had a PSA test, 34.1% reported having had a screening PSA test during the previous year, and 30.0% reported having had three or more tests during the previous 5 years. Screening was greater among men aged 60-79 years, those with greater access to care, and those practicing other preventive behaviors. Among men in their 40s, use tended to be higher among African-American men. CONCLUSIONS: The prevalence and patterns of PSA screening suggest that PSA is used like other cancer screening tests among about a third of U.S. men. Because of the lack of scientific consensus on whether prostate cancer screening is beneficial, more information is needed on how knowledgeable both patients and practitioners are about the potential benefits and harms of screening and how prostate cancer screening decisions are made.     

Decision making in prostate-specific antigen screening National Health Interview Survey, 2000

BACKGROUND: The net benefits and harms of prostate cancer screening with the prostate-specific antigen (PSA) test are uncertain, and professional organizations recommend that physicians discuss these uncertainties with patients before initiating screening. Using a nationally representative sample of men reporting past PSA screening, we aimed to determine the extent to which screening was initiated by physicians and preceded by physician-patient discussions. METHODS: Cross-sectional analysis of data from the 2000 National Health Interview Survey; 2,676 men aged 40 and older underwent PSA screening and met study inclusion criteria. We analyzed the proportions of men for whom PSA screening was (1) was initiated by the physician versus the patient, and (2) preceded by discussions about the test's advantages and disadvantages. RESULTS: Overall, 74% (95% CI=71.8-76.0) of recipients reported that PSA screening was initiated by their physician, and the proportion increased with advancing age, declining health status, lack of family history of prostate cancer, presence of a usual source of medical care, and non-Hispanic ethnicity. Sixty-five percent (95% CI=63.1-67.1) of screening recipients reported prescreening discussions with their physicians. Discussions were more common with physician-initiated screening than with patient-initiated screening, and among patients reporting a usual source of medical care, non-blue-collar occupation, and black race. CONCLUSIONS: Among U.S. men receiving PSA screening, screening is usually initiated by physicians, frequently in men relatively less likely to benefit from it, and often without prior discussion of the test's advantages and disadvantages. Further examination of the PSA decision-making process among screened and unscreened men is warranted.     

Anthropometric profile of the elderly Brazilian population: results of the National Health and Nutrition Survey, 1989

This paper presents the nutritional status of the elderly Brazilian population (60 years and older) based on a probabilistic sample survey in 1989. Nutritional assessment used the BMI (kg/m2), with cut-off points recommended by the WHO (1995). Socio-demographic variables included age, gender, region and place of residence in the country (urban/rural area), income, education, and housing conditions. Prevalence rates for thinness (BMI < 18.5) and overweight (BMI ( 25) were 7.8% and 30.4% in men and 8.4% and 50.2% in women, higher than in the young adult population. Thinness was more frequent in older women, in rural areas from the Midwest/Northeast regions (women) and Southeast/Midwest (men), in groups with lower income, less schooling, and worse housing conditions. Overweight was more frequent in women from urban areas in the South and Southeast and groups with higher income, more schooling, and better housing conditions. The results indicate problematic nutritional status in the Brazilian elderly, particularly women.     

Under-use of smoking-cessation treatments: results from the National Health Interview Survey, 2000

OBJECTIVE: To describe the use of treatment for tobacco dependence in relation to insurance status and advice from a healthcare provider in a population-based national sample interviewed in 2000. METHODS: Analyses are based on 3996 adult smokers who participated in the National Health Interview Survey in 2000, and who provided information on tobacco-cessation treatments used at their most recent quit attempt occurring in the last year. Age-adjusted and weighted categorical analysis was used to compute prevalence estimates of self-reported treatments (pharmacotherapy and behavioral counseling) for tobacco dependence. Multivariate logistic regression analyses were used to examine factors associated with use of treatments. RESULTS: Overall, 22.4% of smokers who tried to quit in the previous year used one or more types of cessation aid compared to 15% in 1986. Treatment usually involved pharmacotherapy (21.7%) rather than behavioral counseling (1.3%). Smokers attempting to quit were more likely to use cessation aids if covered by private (25.4%) or military (25.0%) insurance than by Medicare (17.8%), Medicaid (15.5%), or no insurance (13.2%). In a multivariate analysis of factors related to use of cessation aids, advice from a healthcare provider to quit smoking and the number of cigarettes smoked per day were significant predictors of treatment use, regardless of insurance status. CONCLUSIONS: Cessation aids are under-used across insurance categories. Advice by a healthcare provider to quit is associated with increased use of effective therapies for tobacco dependence. Systematic efforts are needed to eliminate barriers to appropriate treatment.     

Dietary Sodium and Potassium Intake: Data from the Mexican National Health and Nutrition Survey 2016

Population studies have demonstrated an association between sodium and potassium intake and blood pressure levels and lipids. The aim of this study was to describe the dietary intake and contribution of sodium and potassium to the Mexican diet, and to describe its association with nutrition status and clinical characteristics. We analyzed a national survey with 4219 participants. Dietary information was obtained with a 24-h recall. Foods and beverages were classified according to level of processing. The mean intake (mg/d) of Na was 1512 in preschool children, 2844 in school-age children, 3743 in adolescents, and 3132 in adults. The mean intake (mg/d) of K was 1616 in preschool children, 2256 in school-age children, 2967 in adolescents, and 3401 in adults. Processed and ultra-processed foods (UPF) contribute 49% of Na intake in preschool children, 50% in school-age children, 47% in adolescents, and 39% in adults. Adults with high Na intake had lower serum concentrations of cholesterol, HDL-c, and LDL-c. A significant proportion of the Mexican population has a high intake of Na (64–82%) and low K (58–73%). Strategies to reduce Na and increase K intake need to reduce the possibility of having high BP and serum lipid disturbances.     

Risk factors associated with cardiovascular diseases in Turkey: Evidence from National Health Survey

Background

Cardiovascular diseases (CVDs), their causes and the precautions that can be taken have been studied by researchers from different fields and countries. Evidence from this wide literature suggest a close relationship between socio-economic factors and risk of CVDs.

Blood pressure in Mexican Americans, whites, and blacks. The Second National Health and Nutrition Examination Survey and the Hispanic Health and Nutrition Examination Survey

Previous studies of Mexican Americans have shown mean diastolic and systolic blood pressures and prevalence rates of hypertension which are either lower than or similar to those for non-Hispanic whites despite the predominance of obesity in Mexican Americans. However, those results are based on restricted samples from California and Texas. Using data from the Second National Health and Nutrition Examination Survey (1976-1980) and the Hispanic Health and Nutrition Examination Survey (1982-1984), the authors examined ethnic differences in blood pressure and hypertension. Regression analyses, stratified by sex, were used to compare mean blood pressures and rates of hypertension in Mexican Americans with those for whites and blacks. Mean diastolic and systolic blood pressures, as well as the prevalence of hypertension, were lower in Mexican Americans than in non-Hispanic whites or in blacks, with whom they shared a remarkably similar risk profile. This effect was unchanged after adjustment for age, body mass index (weight (kg)/height (cm)2 x 100), and education, indicating that blood pressure differences between Mexican Americans, whites, and blacks were not explained by the established correlates of high blood pressure. There are several possible reasons for lower blood pressure in Mexican Americans, including genetic, life-style, and cultural factors.     

Association of Socioeconomic Status, Problem Behaviors, and Disordered Eating in Mexican Adolescents: Results of the Mexican National Health and Nutrition Survey 2006

Purpose

To explore the association of socioeconomic status (SES) with disordered eating behaviors (DEB) in Mexican adolescents, and the coexistence of DEB and other problem behaviors.

Methods

Information about adolescents (10–19 years) was retrieved from the Mexican National Health and Nutrition Survey 2006 database. Associations were evaluated through ordinal regression.

Results

Higher SES was associated with DEB (odds ratio [OR]: 2.05, 95% confidence interval [CI]: 1.52–2.75). Use of tobacco (OR: 2.10, 95% CI: 1.58–2.81), alcohol (OR: 2.03, 95% CI: 1.51–2.56), and suicide intent (OR: 5.13, 95% CI: 3.46–7.60) were associated with DEB.

Conclusion

DEB were more frequent among adolescents from higher SES households. The lack of association between SES and DEB reported by other studies might be because of the lack of variability in samples. The association of DEB and other problem behaviors highlights the importance of an integral approach to teenagers' mental health.     

A comparison of prevalence estimates for selected health indicators and chronic diseases or conditions from the Behavioral Risk Factor Surveillance System, the National Health Interview Survey, and the National Health and Nutrition Examination Survey, 2007-2008

Objective

To compare the prevalence estimates of selected health indicators and chronic diseases or conditions among three national health surveys in the United States.

Methods

Data from adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2007 and 2008 (n = 807,524), the National Health Interview Survey (NHIS) in 2007 and 2008 (n = 44,262), and the National Health and Nutrition Examination Survey (NHANES) during 2007 and 2008 (n = 5871) were analyzed.

Results

The prevalence estimates of current smoking, obesity, hypertension, and no health insurance were similar across the three surveys, with absolute differences ranging from 0.7% to 3.9% (relative differences: 2.3% to 20.2%). The prevalence estimate of poor or fair health from BRFSS was similar to that from NHANES, but higher than that from NHIS. The prevalence estimates of diabetes, coronary heart disease, and stroke were similar across the three surveys, with absolute differences ranging from 0.0% to 0.8% (relative differences: 0.2% to 17.1%).

Conclusion

While the BRFSS continues to provide invaluable health information at state and local level, it is reassuring to observe consistency in the prevalence estimates of key health indicators of similar caliber between BRFSS and other national surveys.     

1998 Quebec Social and Health Survey: determinants of chronic respiratory diseases

In the course of the "1998 Health and Social Survey", questions were included to verify the prevalence of chronic respiratory diseases and also of wheezing. The objectives of this study were 1) to verify the prevalence of wheezing and its validity as an indicator of chronic respiratory diseases in Québec; and 2) to examine the relationship between chronic respiratory diseases and some of their potential determinants. A total of 30,386 individuals participated in the study. For all ages, the prevalence of wheezing was 5.4%. It was associated with asthma, allergies, chronic bronchitis and emphysema. A low familial income and tobacco smoking were associated with wheezing, asthma, chronic bronchitis and emphysema. Passive smoking was associated with wheezing whereas the presence of carpets was associated with wheezing and asthma. Between 32 and 48% of families with an asthmatic or an allergic member modified their dwelling to alleviate respiratory problems. The prevalence of wheezing documented here was lower than in anglosaxon countries. This result could be explained by a cultural factor (the French translation or the perception of wheezing). This study emphasizes the role of reducing tobacco smoking in the prevention of chronic respiratory diseases.     

Association between diabetes mellitus and hypertension with anthropometric indicators in older adults: Results of the Mexican Health Survey, 2000

Objective: To determine the association between anthropometric indicators of adiposity with type 2 diabetes mellitus (T2DM) and hypertension (HTN) in older adults.Design: Cross-sectional study of participants of the Mexican Health Survey 2000 (MHS).Setting: Mexico, subjects recruited from the general community.Participants: The analytic sample included 7,322 adults who were ≥60 years of age at the time of the survey. T2DM data were available on 6,994 individuals, who represent 95.5% of the original sample; data on HTN was available on 6,268 subjects, which accounted for 86.5% of the original sample.Measurements: Type 2 diabetes mellitus and hypertension, as well as anthropometric indicators including body mass index (BMI), waist circumference (WC), and conicity index (CI).Results: The prevalence of T2DM and HTN in this age group was 34.3% and 73.9%, respectively. After adjusting for other variables, the association between high WC and T2DM (OR=1.59 95%CI=1.26-2.01, P < 0.001) was stronger than the association with overweight (OR=1.26, 95%CI= 1.01–1.58, P=0.04) and obesity (OR=1.38, 95%CI= 1.08–1.79, P< 0.01) using BMI, and slightly higher than tertile 2 of the CI (OR=1.49, 95%CI=1.20–1.88, P< 0.01), while tertile 3 showed a stronger association with T2DM (OR=1.60, 95%CI=1.22–2.08, P< 0.001). However, the association between obesity and HTN measured by BMI (OR=1.98, 95%CI=1.48–2.65, P< 0.001) was stronger than what was observed with overweight (OR=1.42, 95%CI 1.13–1.77, P< 0.01), with high WC (OR=1.62, 95%CI=1.25–2.10, P< 0.001) and tertiles 2 and 3 of the CI (OR=1.23, 95%CI=0.99–1.55, P= 0.09); (OR=1.53, 95%CI= 1.16–2.03, P< 0.01) respectively.Conclusions: BMI and abdominal obesity are significantly and independently associated with an increase in the prevalence of T2DM and HTN among older Mexican adults.     

Inconsistent journalism: the coverage of chronic diseases in the Mexican press

The mass media are recognized by many social scientists as important sources of medical information for lay people and as a positive influence on those working in the health care professions. However, there is a lack of study about print and mass media reporting on major health problems in developing countries such as Mexico. This article presents the findings of a study conducted to identify specific messages that the Mexican print media convey to the general reader about chronic diseases, especially one of the most important and pervasive, diabetes. We undertook a comprehensive review and content analysis of secondary source media reporting in the Boletin (Bulletin)--published by the Department of Education and Health, Universidad Autónoma Metropolitana, Xochimilco. The Boletin summarizes all articles related to health matters published in 12 national daily newspapers and 3 magazines. Our study covered all issues of the Boletin from 1992 through 1996. Our findings indicate that at times the press and popular print media disseminate an incomplete and often biased picture of chronic diseases prevalent in Mexico. Specifically, the press gives equal or more important coverage of acute diseases, or to AIDS, than to other major chronic conditions. The press also reproduces the biomedical model of disease and does not address topics important to certain segments of the population, including the patient. Moreover, the media may present an overly idealized impression of the capability of health services. Consequently, this failure to address the issues of certain widespread, chronic illnesses is severe enough to ask about the role of the press in medical health care reform. We conclude by suggesting areas for further research.     

Dietary intake estimates in the National Health Interview Survey, 2000: methodology, results, and interpretation

OBJECTIVES: To describe the implementation of the Multifactor Screener in the 2000 National Health Interview Survey (NHIS); to provide intake estimates for fruits and vegetables, fiber, and percentage of energy from fat by various demographic and behavioral characteristics; and to discuss the strengths and weaknesses of the method. DESIGN/SUBJECTS: The 2000 NHIS was conducted in 38,632 households in a clustered sample representative of the 48 contiguous states in the United States. The Cancer Control Module was administered to adults (18 years and older) and included 17 dietary intake questions. ANALYSES: After excluding individuals with missing data or unlikely values on the diet questions, we computed individual intake of servings of fruits and vegetables, percentage of energy from fat, and grams of fiber. We estimated median intakes and distributions of intakes using adjusted variance estimates. We present bivariate relationships between diet and demographics and diet and behavioral characteristics in almost 30,000 adults in the United States. RESULTS: In general, intakes of these dietary factors were closer to recommendations among well-educated individuals, those engaged in other healthful behaviors, and underweight and normal weight individuals. Latinos had higher intakes of fruits and vegetables (men: 6 servings; women: 4.8 servings) and fiber (men: 23 g; women: 17 g), and generally a lower percentage of energy intake from fat (men: 33.7%; women: 32.1%) than did non-Latino whites (men: 5.4 servings; women: 4.5 servings; men: 19 g; women: 14 g; men: 33.9%; women: 32.0%) and non-Latino blacks (men: 5.4 servings; women: 4.4 servings; men: 19 g; women: 13 g; men: 34.7%; women: 33.5%). The strengths and limitations of the short dietary assessment method are discussed. CONCLUSIONS: The Multifactor Screener in NHIS, when used in conjunction with external reference data, provides reasonable estimates for three dietary factors and suggests relationships between intakes and other characteristics that are consistent with other data. Thus, these NHIS estimates could provide useful national benchmarks for local surveys using the same instrument.