Health and Behavior The Interplay of Biological, Behavioral, and Societal Influences (2001) / Chapter Skim
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3 Behavioral Risk Factors
3 Behavioral Risk Factors
Pages 87-137
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From page 87... ...
, 1998a; USDHHS, 20001. Not only floes smoking leac3 to an increased risk of the two leacling causes of death in the United States heart disease and cancer (NCHS, 1998b; 87
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From page 88... ...
One World Health Organization report showed that the burden of disease and death attributable to tobacco in developed countries was substantially higher than that attributable to any other risk factor, including alcohol use, unsafe sex, hypertension, and physical inactivity (Murray and Lopez, 19961. Because there is a long delay between the onset of persistent smoking and the full development of its adverse health consequences, current to' bacco~attributable mortality and morbidity are consequences of smoking that began decades ago.
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From page 89... ...
concluclec3 that cigarette' smoking is the most important modifiable risk factor for coronary heart disease. Cigarette~smoking is also linked with cancer, the seconc3-leacling cause of death in the Unitec3 States (NCHS,1998b)
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From page 90... ...
Seconc3-hanc3 smoke exposure exacerbates asthma anc3 leacis to 500,000 child visits to physicians each year (DiFranza anc3 Lew, 1996; USDHHS, 2000~. Seconc3-hanc3 smoke exposure also has been linked to increased risk of heart disease among adults (Glantz anc3 Parmely, 1995; Howard et al., 1998; USDHHS, 20001.
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From page 91... ...
Several factors place young people at an increased risk of initiating tobacco use (USDHHS, 2000~. Socioclemographic risk factors include low socioeconomic status of one's family.
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From page 92... ...
, and the relationship of weight to the disease has been extensively reviewed in the literature (Kopelman, 2000; Leong anc3 Wilding 1999; National Task Force on the Prevention anc3 Treatment of Obesity, 2000; Scheen, 2000; USDHHS, 19801. Overweight adults also are at an increased risk for hypertension, coronary heart disease, anc3 some forms of cancer (NCHS, 1998a; Pi-Sunyer, 19931.
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From page 93... ...
Furthermore, studies show that dietary factors are associated with 4 of the 10 leading causes of death, including coronary heart disease, stroke, some forms of cancer, and non-insulin-dependent diabetes mellitus (CDC, 1997c; USDHHS, 2000~. This section will review some of the factors that influence obesity, with a particular emphasis on physical activity and diet, and describe the relevance of body weight, physical activity, and diet to cardiovascular disease, cancer, and musculoskeletal problems.
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From page 94... ...
Because overweight anc3 obesity that develop in chilc3hooc3 or adolescence can persist into aclulthooc3, this trenc3 increases the risk for chronic disease later in life (USDHHS, 20001. Relatively few Americans participate in regular physical activity.
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From page 95... ...
, educating school-agec3 children about nutrition can help them establish healthy eating habits early in life. Implementation of curricula that encourage healthy eating anc3 that provide students with the skills they need to adopt anc3 maintain healthy eating habits has led to positive changes in student dietary behaviors anc3 to reductions in cardiovascular disease risk factors (CDC, 1996c; Contento et al., 1995; Lytle anc3 Achterberg, 1995; USDHHS, 2000~.
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From page 96... ...
. Adult Weight Gain Adult weight gain is observed in many inclustrializec3 societies.
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From page 97... ...
, whereas a linear increase in risk of diabetes, hypertension, anc3 coronary heart disease begins well below that value (Chan et al., 1994; Colclitz et al., 1995; Willett et al., 1995~. A 2' to 4-folc3 increase in risk of these diseases is observed among those with BMI 24-25, compared with those whose BMI is 21.
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From page 98... ...
Although consumption of trans~fatty acids in' creases the risk of coronary heart disease (Ascherio et al., 1994; Expert Panel on Trans Fatty Acids anc3 Coronary Heart Disease, 1995; Hu et al., 1997; Willett et al., 1993, Willett anc3 Ascherio, 1994) , eating foods higher
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From page 99... ...
Emerging evidence suggests that low folate anc3 high circulating concentrations of homocysteine are major contributors to risk of coronary heart disease anc3 stroke (Boushey et al., 1995; Chasan-Taber et al., 1996; Rimm et al., 1996; Selbub et al., 1995~. Vitamin E appears to reduce the risk of coronary heart disease (Rimm et al., 1993; Stampfer et al., 19931.
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From page 100... ...
Eviclence linking high-fatty-acic3 diets with cancer are inconclusive, anc3 there is continuing debate about the relationship between colorectal, prostate, anc3 breast cancers anc3 total fat content or type of fat in the diet (NRC 1989; Ip anc3 Carroll, 1997; USDHHS, 20001. Ranclomizec3 clinical trials are attempting to clarify the relationship between dietary total fat anc3 the risk of cancer (Freeman et al., 1993; Schatzkin et al., 1996; USDHHS, 2000~.
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From page 101... ...
Musculoskeletal injury is the most common. Increased risks of roadway accidents also could be associatec3 with running or bicycling on roacis, anc3 various sports are associ
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From page 102... ...
Approximately 100,000 deaths are related to alcohol consumption in the Unitec3 States each year (McGinnis anc3 Foege, 1993; Rose, 1992) , which translates into 15% of potential years of life lost before the age of 65 (Rose, 1992~.
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From page 103... ...
Long-term, heavy drinking also increases the risk of developing cancer of the esophagus, mouth, throat, anc3 voice box anc3 of the colon anc3 rectum (NIAAA, 1993; USDHHS, 2000~. Alcohol consumption appears to increase the risk of breast cancer in women (Smith-Warner et al., 19981; consumption of two or more drinks per clay has been shown to slightly increase women's risk of developing breast cancer (Reichman, 1994; USDHHS,20001.4 The Dietary Guidelirles for Ameri' carts (USDA, 1995a)
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From page 104... ...
Positive Health Effects In contrast with those harmful effects, however, evidence is overwhelming of a beneficial effect of moderate consumption of alcohol (1-2 drinks per clay) on reducing risk of coronary heart disease and thrombotic stroke.
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From page 105... ...
Optimal public health guidelines on alcohol consumption are not the same across or even within populations, because the importance of carcliovascular disease anc3 injuries or trauma varies significantly with age anc3 sex as well as from one society to another. For instance, in Sub-Saharan anc3 Latin American countries, the ratio of deaths from coronary heart disease to deaths from violence is close to 1.0, anc3 sometimes even less than 1.0 among men (Murray anc3 Lopez, 1996~.
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From page 106... ...
, the optimal duration of moderate alcohol consumption is not known in terms of reducing risk of cardiovascular disease mortality in older people. Furthermore, even though some of the benefits of alcohol are the result of long-term, habitual consumption (Jackson et al., 1992)
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From page 107... ...
Other, more common sexually transmitted infections human papilloma virus, gonorrhea, chlamyclia, anc3 genital herpes vary in the severity of their consequences; but if left untreated, these diseases can compromise health anc3 even be' come life threatening.
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From page 108... ...
Despite its prominence in the meclia, AIDS represents only a tiny proportion of sexually transmitted infections, basically less than half of one percent of all the new cases of sexually transmittec3 infection (Laumann, 1994~. The most commonly reportec3 sexually transmittec3 infection in the United States is chiamyclia, with 3 million new cases each year (Tanne, 1998~.
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From page 109... ...
Indirectly, studies show that sexually abused girls engage in highrisk sexual behaviors such as voluntary intercourse at earlier ages anc3 multiple partners, which are risk factors for sexually transmittec3 diseases (Miller et al., 1995; Stock et al., 1997~. There is an association between sexually transmittec3 infections anc3 substance abuse, particularly the abuse of alcohol anc3 other drugs.
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From page 110... ...
. ,~ Disproportionate Affliction of Sexually Transmitted Infections Although people in all communities including all racial, cultural, economic, and religious groups and sexual networks are at risk for sexually transmittec3 infections, some are disproportionately affected by these diseases anc3 their associated complications.
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From page 111... ...
In 1996, African Americans accounted for approxi' mately 78% of the total number of gonorrhea cases reported 32 times the rate for whites. These high rates also apply to African American ado'
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From page 112... ...
Mass media campaigns, for example, have used reinforcing messages to increase knowledge about HIV infection anc3 ways to prevent it. Because only a small percentage of aclolescents receive any prevention information from parents, anc3 because for most teenagers schools are the main source of information about sexually transmitted infections, school-basec3 interventions can be significant in motivating young people to mollify their behaviors (American Social Health Association, 1996; USDHHS, 2000~.
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From page 113... ...
There is a contraceptive tracle-off dilemma with currently existing methocis: the contraceptives with the best record Of preventing pregnancy have the worst record for preventing sexually transmitted infections (Cates, 19961. For instance, oral contraceptives are highly effective at preventing pregnancy, but offer no protection against sexually transmitted infections.
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From page 114... ...
As the tests have become better able to detect very early stages of such diseases as cancer (for example, in situ breast cancer and very small colon polyps) , the boundary between primary anc3 secondary prevention has blurred.
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From page 115... ...
Preventive Services Task Force, 19961. The prevalence of hypertension increases with age, anc3 it is more common in African Americans than whites.
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From page 116... ...
There is also insufficient evidence to recommend for or against routine screening in chilclren, aclolescents, or young aclults; again, however, screening could be recommended for people who have a family history of very high cholesterol, premature coronary heart disease in a first~clegree relative, or major risk factors for coronary heart clisease.
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From page 117... ...
The U.S. Preventive Services Task Force, American Cancer Society, the Na' tional Cancer Institute, the American College of Obstetricians anc3 Gy' necologists, anc3 the American Medical Association recommenc3 that all women who are or have been sexually active, or who are 18 years of age or older, should have annual Pap smears.
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From page 118... ...
Evidence shows that screen' ing with sigmoicloscopy reduces both incidence of anc3 mortality from colorectal cancer (U.S. Preventive Services Task Force, 19961.
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From page 119... ...
Preventive Services Task Force (1996) , sev' eral clinical trials concluctec3 among women aged 40 years and older have shown an overall reduction of breast cancer mortality clue to screening.
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From page 120... ...
During the 1990s, for example, significant progress was macle toward reducing the burden of disease of the common bacterial sexually transmitted diseases in the United States (i.e., gonorrhea anc3 syphilis)
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From page 121... ...
(1998~. Sexually Transmitted Diseases in America: How Marry Cases and at What Cost?
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From page 122... ...
(Eds.) Sexually Transmitted Diseases, grid edition.
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From page 123... ...
(1992~. Family planning, sexually transmitted diseases, and contraceptive choice: A literature update.
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From page 124... ...
Journal of Gerontology, 50A, 147-150. Expert Panel on Trans Fatty Acids and Coronary Heart Disease.
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From page 125... ...
(1997~. Sexually transmitted diseases and adverse outcomes of pregnancy.
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From page 126... ...
Sexually Transmitted Diseases, 22, 60-66. Hagberg, J., Montain, S., Martin, W.I., and Ehsani, A
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From page 127... ...
(1997~. Dietary fat intake and the risk of coronary heart disease in women.
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From page 128... ...
American Journal of Epidemio logy, 1 3 6, 8 1 9-8 24. Joint National Committee on Detection and Treatment of High Blood Pressure.
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From page 129... ...
Sexually Transmitted Diseases, 18, 92-101. Mason, J.B.
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From page 130... ...
(1987~. Effects of changes in smoking and other characteristics on clotting factors and the risk of ischaemic heart disease.
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From page 131... ...
. Breast Cancer Screening for Women Ages 40-49.
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From page 132... ...
(1999~. A biological basis for moderate alcohol consumption and lower coronary heart disease risk: A metaanalysis of effects on lipids and hemostatic factors.
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From page 133... ...
(1998~. Physical activity and breast cancer risk in a cohort of young women.
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From page 134... ...
(Eds.) Sexually Transmitted Diseases, grid edition (pp.
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From page 135... ...
(1997~. Physical activity and the risk of breast cancer.
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From page 136... ...
. Sexually Transmitted Disease Surveillance, 1996.
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From page 137... ...
(1993~. Intake of bans fatty acids and risk of coronary heart disease among women.
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