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Changing health behaviors of older adults.

1. Changing lifelong unhealthy habits can have a positive effect on health for older adults. 2. The Transtheoretical Model of behavior change proposes people move through a series of five stages and use a variety of processes as they attempt to change a behavior. 3. Research has shown that tailoring interventions to a individual's stage of change is most effective in promoting behavior change. 4. Specific stage-based strategies are recommended for nurses to use with both individuals and groups of older adults.

Aged↗

The effect of positive and negative health behavior during gestation on pregnancy outcome.

This study examined the effects of substance use (alcohol, tobacco and/or drugs (cocaine and/or marijuana)) and healthy maternal behavior (prenatal care, prenatal class, vitamins, regular exercise) during gestation on pregnancy outcome. Live births from the nationally representative 1988 National Maternal and Infant Health Survey were analyzed. Pregnancy outcomes (infant birth weight, weeks gestation, one and five minute Apgar scores, whether or not the infant was transferred to another hospital after delivery and whether or not the infant was rehospitalized) were studied in multiple linear regression and logistic regression models. The relationship of the interaction of substance use and healthy behaviors and outcome was studied in all models. It was found that women engaging in substance use while pregnant were less likely to engage in healthy behavior. However, in general, engaging in healthy behaviors had the largest positive effects on outcome for those women who engaged in multiple substance use while pregnant. Significant interactions between healthy and unhealthy behavior were found for birth weight, weeks gestation and five minute Apgar scores, indicating that engaging in positive health behavior may help moderate some of the deleterious consequences of substance use during pregnancy.

Adult↗

Surveillance for certain health behaviors among states and selected local areas--behavioral risk factor surveillance system, United States, 2004.

PROBLEM: Continuous monitoring of behaviors that increase the risk for chronic diseases and use of preventive practices are essential for the development, implementation, and evaluation of health promotion programs and policies, and other intervention strategies to prevent morbidity and mortality. Data from states/territories, selected metropolitan and micropolitan statistical areas (MMSAs), and counties provide the impetus for policymakers and other stakeholders to develop and promote the improvement of their community's overall health status. REPORTING PERIOD COVERED: Data in this report were collected during January 1-December 31, 2004, from states/territories, MMSAs, and counties that participated in the 2004 Behavioral Risk Factor Surveillance System (BRFSS). DESCRIPTION OF THE SYSTEM: BRFSS is an ongoing, state-based, random-digit--dialed telephone survey that employs a multistage cluster design. BRFSS collects information on health risk behaviors and preventive health practices related to the leading causes of death from the U.S. civilian, noninstitutionalized population aged > or =18 years. During 2004, a total of 49 states, the District of Columbia (DC), Puerto Rico, and the U.S. Virgin Islands participated in BRFSS. Among these states and territories, completed surveys were collected from a selection of 134 MMSAs and 199 counties. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of specific medical conditions, screening for certain cancers, and use of preventive health services varied substantially by state/territory, MMSA, and county. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied by state/territory, MMSA, and county. In 2004, HP 2010 objectives for 100% health-care coverage and vaccination for pneumonia and influenza among persons aged > or =65 years were not achieved by any state/territory, MMSA, or county. Twelve states/territories, 47 MMSAs, and 74 counties achieved the HP 2010 objective of < or =20% of adults engaged in no leisure-time physical activity or exercise. The HP 2010 objective to reduce the proportion of adults who currently smoke cigarettes to < or =12% was achieved by two states/territories, four MMSAs, and six counties. One MMSA and one county achieved the HP 2010 target of < or =6% who engage in binge drinking during the month preceding the survey. The HP 2010 target of < or =15% of adults who are obese was obtained by one MMSA and eight counties. The HP 2010 objective to reduce the proportion to <20% for older adults who have had all of their natural teeth extracted was achieved by 23 states/territories, 51 MMSAs, and 45 counties. The HP 2010 target for adults aged > or =50 years who have ever received a sigmoidoscopy is 50%. BRFSS measured both sigmoidoscopy and colonoscopy. Using this measure, 38 states, 110 MMSAs, and 154 counties achieved the 50% goal. Four counties achieved the HP 2010 objective of 50% for adults who received a blood stool test within the previous 2 years. The HP 2010 objective to increase the proportion of women aged > or =18 years who had a Papanicolaou (Pap) test within the preceding 3 years is 90%. Twenty-four MMSAs and 49 counties achieved this objective. The HP 2010 objective for women aged > or =40 years who have received a mammogram within the preceding 2 years is 70%. Thirty-nine states, 112 MMSAs, and 168 counties achieved the objective. This report includes several risk behaviors and conditions that, although not included in HP 2010 goals, are important public health problems. These include self-reported fair-to-poor health status, heavy alcohol consumption, asthma, diabetes, and prostate cancer screening. The 2004 BRFSS data indicate great variability in the prevalence of self-reported fair-to-poor health status (5.7%-34.8%) and use of prostate cancer screening (34.7%-65.2%) by states/territories, MMSAs, and counties. Among these areas, the prevalence of current asthma ranged from 4.1% to 12.4%, and the prevalence of diabetes ranged from 3.2% to 12.5%. INTERPRETATION: The findings in this report indicate variations in health risk behaviors and use of preventive health screenings and health services among adults at the state, local, and county levels. These variations substantiate the continued need for public health surveillance in designing, implementing, monitoring, and evaluating public health policies and health-care use programs to reduce morbidity and mortality from the effect of high-risk health behaviors and subsequent chronic disease outcomes. PUBLIC HEALTH ACTION: Data from BRFSS are essential for monitoring prevalence of high-risk health behaviors, specific diseases, and use of preventive health services; dictating the design, focus, implementation, and evaluation of prevention health programs and strategies; and monitoring progress toward obtaining local, state, and national health objectives. Data from the 2004 BRFSS indicate a continual necessity to initiate and implement health promotion strategies for identifying specific health risk behaviors and practices and for assessing progress toward achieving disease prevention and health promotion objectives at state and local levels throughout the United States.

Behavioral Risk Factor Surveillance System↗

[Preliminary evaluation of health behavior in obese students from a selected group of Warsaw adolescents].

The aim of this study was to assess health behaviour in obese pupils aged 11-17 years in one of the districts in Warsaw. Self-assessment about own health, appearance and possibilities was also studied. Questionnaire studies were carried out in pupils with obesity and in a control group of pupils, with normal body weight. We found the biggest deficiency of health promoting behaviour in the field of physical activity and dietary habits. Differences between the two groups of pupils were statistically significant. Significant differences were also found in self-assessment concerning physical fitness and appearance. We did not find any differences between obese and non-obese pupils in health risk behaviour: alcohol drinking, tobacco smoking, frequency of injuries and in psychosocial indicators.

Adolescent↗

Prevalence of adolescent health risk behaviors: school health implications.

This state survey randomly selected 2,037 ninth- and twelfth-grade students to determine the onset and prevalence of health risk behaviors. A higher pattern of risk-taking behavior was found among younger in comparison with older students. Gender differences were also noted. Implications for school health intervention are discussed.

Adolescent↗

Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas.

BACKGROUND: Cancer survivors are at increased risk for developing secondary tumors, diabetes, osteoporosis, and cardiovascular disease, thus making them an important target population for health-related interventions. However, little is known regarding cancer survivors' behaviors and their interest in pursuing healthier diets, exercise, and smoking cessation. METHODS: A 65-item survey was mailed to 1667 patients diagnosed with early stage carcinoma of the breast or prostate that requested data regarding demographics, health behaviors, stage of readiness for smoking cessation, exercise, increased fruit and vegetable (F&V) consumption, and decreased fat intake, as well as interest in specific health programs and when, relative to diagnosis, these programs should be offered. RESULTS: Responses from 978 cancer survivors suggested that the overwhelming majority (85%) reported their health as good to excellent. The majority of respondents (55%) ate fewer than 5 daily servings of F&Vs, with prostate carcinoma patients reporting eating significantly fewer servings than patients with breast carcinoma (P < 0.001). In contrast, 69% of respondents reported adherence to a low fat diet, again with lower practice rates among prostate carcinoma patients than patients with breast carcinoma (P = 0.006). The majority of respondents (58%) reported routine exercise and 8% were current smokers. Significantly more breast carcinoma patients than prostate carcinoma patients were current smokers (P = 0.03). There was strong interest in health promotion programs across behaviors, and a fair amount of concordance between low fat dietary behaviors and exercise, as well as consumption of five daily servings of F&Vs. The majority of patients expressed a preference for programs that could be delivered via mailed brochure, with 57% of respondents indicating that programs should be initiated at the time of diagnosis or soon after (within 6 months). CONCLUSIONS: The results of the current study suggest that although many cancer survivors already practice healthy life-style behaviors, there is a substantial proportion who do not. Interventions especially are needed to increase daily F&V intake; however, given the fair degree of clustering between dietary and exercise behaviors, multiple risk factor interventions also may be warranted. Among cancer survivors, receptivity is high for health promotion programs, especially those that can be delivered by mail and soon after diagnosis.

Adult↗

[Oral health behavior in Germany and Switzerland].

This survey compares attitudes between populations in Switzerland and Germany, deemed to be important for maintaining oral health. Among others, three aspects were singled out: sugar consumption, smoking and oral hygiene. The annual sugar consumption per capita in Switzerland is 42% higher than in Germany, or 47 kg compared to 33 kg in Germany. The amount recommended by WHO, 22 kg per annum, is exceeded in Switzerland by 114%, in Germany by 50%. The annual cigarette consumption in Switzerland amounts to 2880 per capita, which is 59% higher than that of Germany with 1814. The annual use of tooth paste in Switzerland is an average 333 ml per capita, which corresponds to 53% of the minimal amount (628 ml) recommended by authorities. The annual per capita use of tooth paste in Germany averages 336 ml, or 54% of what is recommended. The annual usage of dental floss in Switzerland is on average 0.15 packets per capita, which is 4.1% of what is seen to be an adequate quantity of 3.65 packets. In Germany the corresponding figures are 0.08 packets and 2.2%. The usage of interdental brushes is minute in both countries with 0.05 packets in Switzerland and 0.04 packets in Germany. These data are contrary to what is often claimed in dental medical literature and mass media which is that the Swiss population is far better at an active oral health maintenance than the German population, due to the financial pressure on Swiss patients (private payments for dental services).

Cross-Cultural Comparison↗

Health behaviors of adults: United States, 1999-2001.

This report presents prevalence estimates for key indicators of alcohol use, cigarette smoking, leisure-time physical activity, and body weight status among U.S. adults, using data from the 1999-2001 National Health Interview Surveys (NHIS). The NHIS is conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics. Estimates are shown for several sociodemographic subgroups for both sexes combined and for men and women separately. Subgroups are compared in terms of prevalence of healthy and unhealthy behaviors. Methods Data for the U.S. civilian noninstitutionalized population were collected using computer-assisted personal interviews (CAPI). Questions on health behaviors were asked in the Sample Adult component of the basic core questionnaire. All data were self-reported. This report is based on a total of 96,501 completed interviews with sample adults aged 18 years and over, representing an overall sample adult response rate of 71.8% for the 3 years combined. Statistics were age adjusted to the 2000 U.S. standard population. Results Overall, 6 in 10 U.S. adults were current drinkers in 1999-2001; about 1 in 4 adults (23.1%) were lifetime abstainers. About 1 in 4 adults (23.1%) were current smokers and over one-half of adults (54.3%) had never smoked cigarettes. About 6 in 10 adults engaged in at least some leisure-time physical activity with about 3 in 10 regularly engaging in such activities. About 6 in 10 adults were overweight or obese (BMI > or = 25), with 4 in 10 adults having a healthy weight.

Adolescent↗

Health behaviors of adults: United States, 2002-04.

OBJECTIVE: This report presents selected prevalence estimates of alcohol use, cigarette smoking, leisure-time physical activity, body weight status, and sleep habits among U.S. adults, using data from the 2002-04 National Health Interview Surveys (NHIS). NHIS is conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics. Estimates are shown for several sociodemographic subgroups for both sexes combined and for men and women separately. The subgroups are compared in terms of their prevalence of "healthy" and "unhealthy" behaviors. METHODS: Data for the U.S. civilian noninstitutionalized population were collected by NHIS using computer-assisted personal interviews. Questions on health behaviors were asked of one randomly selected adult per family in the Sample Adult component of the basic core questionnaire. This report is based on a total of 93,222 completed interviews with sample adults aged 18 years and over, representing an overall sample adult response rate of 73.6% for the 3 years combined. Statistics shown in this report were age adjusted to the 2000 U.S. standard population. RESULTS: Six in 10 U.S. adults were current drinkers in 2002-04; about 1 in 4 adults were lifetime abstainers. About 1 in 5 adults (21.5%) were current smokers, and over one-half of adults (56.6%) had never smoked cigarettes. About 4 in 10 (42.4%) current smokers tried to quit smoking in the past year. About 6 in 10 adults engaged in at least some leisure-time physical activity, with about 3 in 10 regularly engaging in such activities. About 6 in 10 adults were overweight or obese (BMI is equal to or more than 25), with 4 in 10 adults being of healthy weight. About 6 in 10 adults usually slept 7-8 hours in a 24-hour period.

Adolescent↗

Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.

OBJECTIVES: This study evaluated the effectiveness (changes in health behaviors, health status, and health service utilization) of a self-management program for chronic disease designed for use with a heterogeneous group of chronic disease patients. It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities. METHODS: The study was a six-month randomized, controlled trial at community-based sites comparing treatment subjects with wait-list control subjects. Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease, lung disease, stroke, or arthritis. Health behaviors, health status, and health service utilization, as determined by mailed, self-administered questionnaires, were measured. RESULTS: Treatment subjects, when compared with control subjects, demonstrated improvements at 6 months in weekly minutes of exercise, frequency of cognitive symptom management, communication with physicians, self-reported health, health distress, fatigue, disability, and social/role activities limitations. They also had fewer hospitalizations and days in the hospital. No differences were found in pain/physical discomfort, shortness of breath, or psychological well-being. CONCLUSIONS: An intervention designed specifically to meet the needs of a heterogeneous group of chronic disease patients, including those with comorbid conditions, was feasible and beneficial beyond usual care in terms of improved health behaviors and health status. It also resulted in fewer hospitalizations and days of hospitalization.

Adult↗