Changing Patterns in Health Behaviors and Risk Factors Related to Chronic Diseases, 1990-2000
Winkleby MA, Cubbin C. "Changing patterns in health behaviors and risk factors related to chronic diseases, 1990-2000." Am J Health Promot 2004 Sep-Oct; 19:19-27.
Abstract overview:
This study, which traces risk factors for chronic diseases like cancer, diabetes, and heart disease in black, Hispanic, and white women and men across age groups, is noteworthy due to its national scope and large sample size. Few studies have used national samples that include both men and women to examine differences among the three largest racial/ethnic groups in the United States. The inclusion of Hispanics in a study of this scope is especially important because they are the largest ethnic minority group in the nation, and, if growth rates continue on their current course, will account for a quarter of the U.S. population by 2050.
The study shows significant changes in health behaviors and risk factors over the last ten years in all age and ethnic groups, but there are three main findings worth highlighting: The poor and worsening health profile of young women and men, ages 18 to 24, from all racial/ethnic groups; the positive change among Hispanic women and men and black men ages 65 to 74; and the high prevalence and increases in obesity in every single ethnic subgroup and both genders, and in particular among black women.
The worsening health profile for young women and men from all racial/ethnic groups is especially troubling as it makes certain that chronic diseases associated with health behaviors and avoidable risk factors will remain the main cause of death and disability in the nation for years to come. This study shows that this group of young adults, with the exception of young black women, has the largest overall increases in smoking, with a ten to 12 percent increase in white women and men and a nine percent increase among young Hispanic women. Between 34 and 36 percent of young white women and men currently smoke. Young people are also getting fatter. High levels of sedentary behavior, coupled with low vegetable and fruit intake, may explain, in part, the four to nine percent increase in obesity in this subgroup.
Older Hispanic women and men and black men ages 65 to 74 improved their health profiles in the ten year period. Older Hispanic women had the largest decreases in smoking, Hispanic women and black men had the largest decreases in sedentary behavior, and Hispanic women and men had the largest increases in vegetable and fruit intake. These positive changes are especially notable as they lessen the health disparities between these minority groups and their white counterparts.
Obesity rates climbed in every subgroup, regardless of age, gender, or ethnicity, but black women were hardest hit by this national epidemic. In every age group, black women had the highest percentage of obesity. Almost 20 percent of black women were obese by ages 18 to 24, and this number increased to 35 percent or more after age 25. The large increases in all groups have serious implications for national mortality rates.
Secondary findings of the study:
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Chronic diseases – heart disease, cancer, stroke, lower respiratory disease and diabetes – account for 75 percent of the nation’s medical care costs.
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The burden of chronic diseases will soon increase dramatically because of two significant trends – A) despite efforts, adoption of healthy lifestyles and primary prevention for high-risk groups have not been effective. B) Chronic diseases, many of which manifest primarily in later life, will increase in the next 50 years as the age distribution in the U.S. population changes.
Implications and recommendations from the study:
Smoking prevention and cessation programs must be better tailored to address youths who are at particular risk, i.e. those from low-income families, those who attend continuation high schools where approximately 70 percent of the students are smokers, and those youths not in school at all. Special attention must be paid to the challenges of crafting anti-smoking campaigns in the face of the strong social influence of the tobacco industry. This study recommends neighborhood and policy level changes such as eliminating tobacco advertising to youth, curtailing the sale of low-cost cigarettes, and reducing the number of community events sponsored by tobacco companies.
The high prevalence and increases in obesity among all groups, especially black women, are of special note. To counteract strong social influences that contribute to this rise, societal changes must be made that include: availability of healthy and affordable foods, policy changes regarding processed and fast foods; standards for food portion sizes; safe, convenient places to exercise; and health-promoting work and residential environments. Among other institutional changes for youth, the fat content of school lunches should be reduced, and the intensity and frequency of activity in P.E. classes should be increased.
Proposed news articles and related information:
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What is happening with the health profiles for Latinos? In their native countries, Latinos tend to consume large amounts of fresh fruits and vegetables, and they often get daily exercising by walking. Even after immigrating to the United States, many Latinos are able to hold on to these healthy lifestyle choices, but this study shows that young Latino girls are beginning to smoke at much higher rates than before. Does this foreshadow a serious change in how Latinos are affected by American culture?
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Given that young people, regardless of gender and ethnicity, have a worsening health profile, what should health professionals do to effectively reach these people? Can health information be better targeted to specific ethnic or age groups?
