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Multiple behavioral risk factors among youth & young adult populations. Karly Geller, Assistant Professor Kinesiology & Health, Health Promotion. overview . 1. education & training. 2. the public is sick, I know the cure. 3. current research. 4. data collection & future directions.
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Multiple behavioral risk factors among youth & young adult populations. Karly Geller, Assistant Professor Kinesiology & Health, Health Promotion
overview. • 1.education & training. • 2. the public is sick, I know the cure. • 3. current research. • 4. data collection & future directions.
education. Dr. Gertraud Maskarinec Dr. Claudio Nigg Dr. Cheryl Albright Dr. Rachel Novotny Dr. Larry Kolonel Dr. Susan Schembre Dr. Nicholas Ollberding • University of West Florida • BA in Psychology • BA in Criminal Justice PhD, Human Nutrition Human Ecology M.Ed., Sports & Exercise Psychology Kinesiology, School of Education Dr. Maureen Weiss Dr. Diane Whaley Post-Doctoral, Prevention & Control NCI R25 CA90956 Dr. David Dzewaltowski Dr. Ric Rosenkranz
The Big PicturePublic Health Chronic Disease Lifestyle Research Methods & Measurement Multiple Levels of Influence Intervention
What’s the largest health concern facing the US? (no pun intended).
Obesity Trends* U.S. Adults (BRFSS, 2008) obesity epidemic. • ≈ 60 million (30%) of US adults are obese. > doubled since 1980.
obesity. 2018 estimates. • ≈$344 billion medical-related expenses. >50% of population obese (INCLUDING 50% OF OHIO!) ≈21% of health-care spending.
Our children. families. 5%to 18%increase; 12 to 19 year-olds
Heart Heart Lungs Lungs Liver Liver Bladder Bladder Knee Joint Knee Joint
cardiovascular disease. Claims more lives than next 5 leading causes of death combined If all major forms were eliminated, life expectancy would increase by 7 years 1st (heart disease) & 2nd (stroke) leading cause of death Source: http://www.cdc.gov/cvh/maps/pdfs/heart_disease_map_all.pdf
early onset, persistent risk. • Personal choice? Unhealthy kids become unhealthy parents. Dependent on adults, vulnerable to surrounding environments. Child abuse?
What happened? evolution? (couldn’t be).
Not enough activity? US residents meeting PA Recommendations Ohio residents meeting physical activity recommendations (2009)
too sedentary? % of trips by transport (US 1977-95)
obesity-related risk factors. Soft drink (“liquid candy”) Ludwig et al. (1998) Fast food Thompson et al., (2004) Larger portion sizes Rolls (2003) Physical activity & sedentary behavior Albright et al., 2000; Grundy et al., 1999)
similar CVD risk factors. physical inactivity. sedentary lifestyle. tobacco use & excessive alcohol intake. high-fat diet. Plus.. obesity. stress.
health is > a single behavior; determined largely by lifestyle.
What behaviors determine your lifestyle? MULTIPLE HEALTH BEHAVIOR.
During TV-time,what else are you doing? • not outside; inactive • snacking, mindless eating; junk food? • popcorn w/ movies, not fruits & veggies
When exercising regularly, what else are you doing? • eating healthier • being active takes time away from the devil (i.e., TV). • go outside more; actively commute.to work
Behavioral Risk Factors Chronic Disease Lifestyle (i.e., multiple health behaviors) Research Methods & Measurement Intervention Multiple Levels of Influence What did the risk factors for obesity, CVD, & diabetes have in common? MODIFIABLE!
multiple health behaviors. • common health behaviors cluster or co-occur among individuals & populations. lifestyle patterns strongly influence disease-risk. -Centers for Disease Control. The power of prevention. 2009, National Center for Chronic Disease Prevention and Health Promotion: Atlanta, GA. -Bagnardi, V., et al., Alcohol consumption and the risk of cancer: a meta-analysis. Alcohol Res Health, 2001. 25(4): p. 263-70. -Berrigan, D., et al., Patterns of health behavior in U.S. adults. Prev Med, 2003. 36(5): p. 615-23. -Fine, L.J., et al., Prevalence of multiple chronic disease risk factors. 2001 National Health Interview Survey. Am J Prev Med, 2004. 27(2 Suppl): p. 18-24. -Berrigan, D., et al., Patterns of health behavior in U.S. adults. Prev Med, 2003. 36(5): p. 615-23. -Klesges, R.C., et al., Smoking status: effects on the dietary intake, physical activity, and body fat of adult men. Am J ClinNutr, 1990. 51(5): p. 784-9.
multiple risk behavior. Reported as strongest contributor to mortality When unhealthy behaviors cluster, negative health outcomes multiply Health-care & disabilitycosts increase dramatically • Most US adults report habitually carrying out 2+ health-risk behaviors -Centers for Disease Control. The power of prevention. 2009, National Center for Chronic Disease Prevention and Health Promotion: Atlanta, GA. -Danaei, G., et al., Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet, 2005. 366(9499): p. 1784-93. -Berrigan, D., et al., Patterns of health behavior in U.S. adults. Prev Med, 2003. 36(5): p. 615-23. -Bagnardi, V., et al., Alcohol consumption and the risk of cancer: a meta-analysis. Alcohol Res Health, 2001. 25(4): p. 263-70. -Shinton, R., Lifelong exposures and the potential for stroke prevention: the contribution of cigarette smoking, exercise, and body fat. J Epidemiol Community Health, 1997. 51(2): p. 138-43. -Edington, D.W., L.T. Yen, and P. Witting, The financial impact of changes in personal health practices. J Occup Environ Med, 1997. 39(11): p. 1037-46. -Edington, D.W., Emerging research: a view from one research center. Am J Health Promot, 2001. 15(5): p. 341-9. -American Heart Association. Heart and Stroke Statistical Update. 1997, American Heart Association: Dallas, TX. -Prochaska, J.J., B. Spring, and C.R. Nigg, Multiple health behavior change research: an introduction and overview. Prev Med, 2008. 46(3): p. 181-8. -Fine, L.J., et al., Prevalence of multiple chronic disease risk factors. 2001 National Health Interview Survey. Am J Prev Med, 2004. 27(2 Suppl): p. 18-24.
MHB. the good news.. • Burden minimized by replacing health-risk behaviors with healthy lifestyle behaviors. Widespread adoption of healthy lifestyle is estimated to save >$16 billion in annual medical costs. -American Heart Association. Heart and Stroke Statistical Update. 1997, American Heart Association: Dallas, TX. -.Haapanen-Niemi, N., I. Vuori, and M. Pasanen, Public health burden of coronary heart disease risk factors among middle-aged and elderly men. Prev Med, 1999. 28(4): p. 343-8. -Prevention for a healthier America: investments in disease prevention yield significant savings, stronger communities. 2008, Trust for America's Health: Washington, D.C.
To promote MHB effectively, a holistic perspective is necessary. Evidence-based understanding of multilevel influences; most salient?
individual. age, gender, race, BMI, etc. cognition, skill, personality, confidence, etc. SOCIAL ECOLOGICAL MODEL.
interpersonal. close friends, family, social support network (e.g., exercise partner). SOCIAL ECOLOGICAL MODEL.
institutional. schools, churches, worksites (e.g., worksite wellness program) SOCIAL ECOLOGICAL MODEL.
community/neighborhood. neighborhood, city/town (e.g., walking trail). SOCIAL ECOLOGICAL MODEL.
policy. Can we do more than just suggest behavior change? SOCIAL ECOLOGICAL MODEL.
multiple health behavior, MHB. MHB examination across THREE critical developmental windows. HOLISTIC RESEARCH ACROSS DEVELOPMENT.
middle-school youth.1 college sample. • N=105 recruited from 2 schools in neighboring states 95% 7thgrade; 50% female; 90% White, Non-Hispanic students self-reported 9 behaviors Funded by Miami University Undergraduate summer scholars (2012)
high school students. 3 separate samples, Oahu. • 2. Native Hawaiian students (n=59; 100% @ least partial heritage) & parents (n=47). • Youth-led parent interviews • 70% parent survey return • Youth-led community assessment • 73% completed • Qualitative & quantitative data • In-school surveys w/ corresponding focus groups 1. Diverse youth (n=43; 86% Filipino; 86% female; age=16.5, SD=0.6) & parents (n=31). 3. Diverse adolescents (N=124); 90% Filipino
young adults.1 college sample. • N=208 college undergrads; online survey Age =20.44 (SD= 1.87); 79% female; 88% White, Non-Hispanic Funded by Miami University Undergraduate summer scholars (2012)
MHB Risk Prevalence. RESULTS across DEVELOPMENT
RESULTS across DEVELOPMENTMHB Risk Prevalence. Caucasian Middle School Student (N=105)
RESULTS across DEVELOPMENTMHB Risk Prevalence. Caucasian Middle School Student (N=105)
RESULTS across DEVELOPMENTMHB Risk Prevalence. Caucasian Middle School Student (N=105)
RESULTS across DEVELOPMENTMHB Risk Prevalence. Filipino High School Student (N=114)
RESULTS across DEVELOPMENTMHB Risk Prevalence. college-aged, young adults (n=208)
RESULTS across DEVELOPMENTMHB Risk Prevalence. college-aged, young adults (n=208)
INDIVIDUAL.young adults. Enjoyment mediated relationship between physical activity & perceived health Self-Efficacy mediated relationship between physical activity & perceived health
SOCIAL ECOLOGICAL MODEL. Proxy Efficacy Social cognitive theory Confidence in ability to successfully request healthy opportunities1