Transcript NCD-related Lifestyle Patterns

APHA 143rd Annual Meeting and Exposition
NCD-Related Lifestyle Patterns from Childhood to
Adolescence: A 13Years Longitudinal Study
Yi-Han Changa, Lee-Lan Yena,b, Hsing-Yi Changb, Chi-Chen Wub
a
Institute of Health Policy and Management, College of Public Health, National Taiwan University,
Taipei City, Taiwan
b Division of Preventive Medicine and Health Service Research, Institute of Population Health
Science, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan, ROC
Outline
• Background
• Method
• Result
• Conclusion
2
Non-communicable diseases (NCDs)
• Non-communicable diseases (NCDs)
• known as chronic diseases
• 4 main types of NCDs: cardiovascular diseases ,cancers, chronic
respiratory diseases and diabetes (WHO, 2015)
• Burdens of NCDs
• 2012: 38 million people have died of NCDs (68% of all deaths globally)
 Sixteen million NCD deaths occur before the age of 70 (WHO, 2015)
• 2000-2012: NCD deaths have increased the most in the WHO South-East
Asia Region and Western Pacific Region (WHO, 2014)
• In Taiwan,
 eight of the ten leading causes of death were NCDs
 responsible for 66% of deaths in 2013 (MOHW, 2014)
3
Modifiable behavioural risk factors
• most common modifiable behaviors (WHO, 2013)
unhealthy diet
physical inactivity
harmful use of alcohol
tobacco use
• typically establish during adolescence and persist throughout life
(Kipping, Campbell, MacArthur, Gunnell, & Hickman, 2012)
4
Healthy lifestyle
Environment
Lifestyle
43%
19%
27%
11%
Human Biology
Health Care
Organization
(Dever, 1976、1991)
(Lalonde, 1974)
A healthy lifestyle is…
• aggregation of decisions by individuals which affect their health and over which they
more or less have control (Lalonde, 1974)
•Patterns of behavior that maximize one's quality of life and decrease one's
susceptibility to negative health outcomes (Report of the 2000 Joint Committee on Health
Education and Promotion Terminology, 2002)
• “collective patterns of health-related behavior based on choices from options
available to people according to their life chances” (Cockerham, 2000, 2007)
5
Lifestyle or single behavior?
 Lifestyle is a collective pattern of health-related
behaviors
• Risk health behaviors tend to cluster together
• coexistence of risk behaviors increases the likelihood of NCDs
• Interventions targeting the underlying lifestyle and associated
identities may be effective than focusing on a single behavior
6
Knowledge gap in healthy lifestyle research
• focus on single behavior
• most researches in a healthy lifestyle perspective targeted
adults population
• cross-sectional data
• various behavior indicators
• In this study…
using a longitudinal data during childhood and adolescence
finding underlying lifestyle patterns
placing emphasis on the four main behaviors related to NCDs
7
Aim
• To investigates distinct lifestyle development patterns and
the predictors from childhood to adolescence.
8
Outline
• Background
• Method
• Result
• Conclusion
9
Data
• Child and Adolescent Behavior in Long-term Evolution (CABLE) project
• 2001-now
POPULATION：
152 primary schools in Taipei City and Hsinchu Country in Taiwan
Schools size: categorized as small, medium or large
(based on the nunber of 1st grade students)
6 small, 2 medium, 1 large schools from each location were selected
SAMPLE：all students in grade one and four
10
Methods of repeat measurement
• Latent Growth Curve Model(LGCM)
• Multilevel Modeling
• Growth Mixture Models(GMMs)
• Group-based Trajectory Model
• Repeated-measures Latent Class Analysis
Latent class
Class
Intercept
Categorical variable
11
behavior
time1
behavior
time2
Slope
behavior
time3
Variable- NCD-related Lifestyle Patterns
• four behavior indicators
• measured when sample was grade 5th, 7th, 9th, 10th, 12th, 14th
• eating vegetables and
fruits everyday (Yes/ No)
•physical activity three
times a week (Yes/ No)
•no tobacco use (Yes/ No)
•no alcohol use (Yes/ No)
repeated-measures
latent class analysis
(RMLCA)
【 Categorical variable 】
NCD-related Lifestyle
Patterns
【 Categorical variable 】
12
Variables- Focus variables
 Gender
•
Boy, Girl
 Mother’s
•
Education
Junior high or below, Senior high, College and above
 Husband's
•
Junior high or below, Senior high, College and above
 Parents
•
marital status
Married, Divorced or single
 Family
•
monthly income
< 39,999、40,000~99,999、 > 100,000 (NTD)
 Emotional
•
education
Variability
0~10
13
Data Analysis
Statistics Method
• repeated-measures latent class analysis (RMLCA)
• multinomial logistic regression model
Statistics Software
• SAS 9.2
Outline
• Background
• Method
• Result
• Conclusion
15
Characteristics of Participants
• Total : 2,415 students
• 51.41% boys
• father’s education : 48.73% college and above, 34.94% high
•
•
•
•
school and 16.33% junior high and under
mother’s education: 46.53% high school, 36.41% college and
above and 17.77% junior high and under
Income: 52.89% middle income family, 27.07% high and 20.04%
low
8% students came from single parent family
mean score of emotional variability is 3.98 (range 0-10)
16
Bayesian information criterion values
17
item probability
V: eating vegetables and fruits everyday
PA: physical activity three times a week
T: no tobacco use
18
A: no alcohol
use
Class 1- persistently inactive lifestyle (18.64%)
V: eating vegetables and fruits everyday
PA: physical activity three times a week
T: no tobacco use
A: no alcohol use
19
Class 2-high risk lifestyle (12.02%)
V: eating vegetables and fruits everyday
PA: physical activity three times a week
T: no tobacco use
A: no alcohol use
20
Class 3- early alcohol use (12.64%)
V: eating vegetables and fruits everyday
PA: physical activity three times a week
T: no tobacco use
A: no alcohol use
21
Class 4- lack of health promotion lifestyle (19.29%)
V: eating vegetables and fruits everyday
PA: physical activity three times a week
T: no tobacco use
A: no alcohol use
22
Class 5-persistent healthy lifestyle (22.97%)
V: eating vegetables and fruits everyday
PA: physical activity three times a week
T: no tobacco use
A: no alcohol use
23
Class 6- non-smoking lifestyle(14.44%)
V: eating vegetables and fruits everyday
PA: physical activity three times a week
T: no tobacco use
A: no alcohol use
24
Class 1
Class 4
Class 2
Class 5
Class 3
Class 6
1: persistently inactive lifestyle (18.64%), 2: high risk lifestyle (12.02%),
3: early alcohol use (12.64%),
4: lack of health promotion lifestyle(19.29%),
5: persistently healthy lifestyle (22.97%), 6: non-smoking (14.44%)
25
Adjusted multinomial logistic regression models of the association of factors
with NCD-related trajectory patterns among students in the CABLE cohort
1: persistently inactive lifestyle (18.64%), 2: high risk lifestyle (12.02%),
3: early alcohol use (12.64%),
4: lack of health promotion lifestyle(19.29%),
5: persistently healthy lifestyle (22.97%), 6: non-smoking (14.44%)
Outline
• Background
• Method
• Result
• Conclusion
27
NCD-related lifestyle development patterns were found
• The existence of heterogeneity of NCD-related lifestyle
development patterns during childhood and adolescence was
found.
• Unhealthy diet and inactivity behaviors existed even among those
who presented non-smoking or non-drinking subgroups
• It is interesting to note latent classes that did not emerge in this
analysis. For example, the model does not include a latent class
characterized by improving healthy lifestyle.
Adolescents got decreasing probability to live with healthy
behaviors In all lifestyle patterns
28
Important factors associated with lifestyle
• We also found preliminary evidence of differential clustering by
gender, parents’ education level, family income, parents’
marriage status and personal personality.
Critical time point
• good eating vegetables and fruits behaviors
• relatively stable from elementary school period
• alcohol use: junior high school period
• tobacco use: grade 7 (entry to junior high school)
29
Future research…
• To identify the mechanism of subgroups lifestyle patterns and
the shared affecting factors, thus policies or interventions aim
to multiple behaviors can be designed accordingly.
30
Thank You for Your Attention