Guixiang Zhao

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Purpose Evidence suggests that high-risk lifestyle behaviors exacerbate the health of cancer survivors and increase cancer mortality. This study examined the prevalence of lifestyle-related risk factors among female breast cancer survivors by duration of survivorship in the United States. Methods We analyzed data from 7,443 women aged ≥18 years who participated in the 2009 Behavioral Risk Factor Surveillance System and reported having ever-diagnosed breast cancer. Adjusted prevalence with 95 % confidence interval for lifestyle-related risk factors (including current smoking, excessive alcohol drinking, obesity, engaging in physical activity ≥150 min/week, and consuming fruits and vegetables ≥5 times/day) was estimated using log-linear regression while controlling for confounders. Results Overall, the prevalence estimates for lifestyle-related risk factors were 10.2 % for current smoking, 6.8 % for excessive alcohol drinking, 24.7 % for obesity, 53.8 % for engaging in physical activity ≥150 min/week, and 33.9 % for consuming fruits and vegetables ≥5 times/day among female breast cancer survivors. After adjustment for covariates, with increasing years of survivorship, a linearly increasing trend was observed for current smoking (P = 0.038), and quadratic trends were observed for excessive alcohol drinking (P < 0.001) and obesity (P = 0.048). The adjusted prevalence estimates for engaging in physical activity ≥150 min/week and consuming fruits and vegetables ≥5 times/day did not vary significantly by duration of survivorship. Conclusion Continuing efforts on counseling and encouraging breast cancer survivors to adopt healthy lifestyles are needed to improve their health. Implications for cancer survivors Understanding the trends of modifiable lifestyle-related risk factors among breast cancer survivors with varying duration of survivorship may assist health care providers to provide appropriate counseling for breast cancer patients to improve their health. Clinical and public health intervention programs should seek to maximize the number of recommended healthy behaviors especially in those women who are at high risk for failing to comply with the healthy lifestyle guidelines.

Physical activity confers multiple health benefits in the general population. This study examined the associations of physical activity with serious psychological distress (SPD) and receipt of mental healthcare services among U.S. adult cancer survivors. We analyzed data from 4,797 cancer survivors (aged ≥18 years) and 38,571 adults without cancer who participated in the 2009 Behavioral Risk Factor Surveillance System. SPD was assessed using the Kessler-6 questionnaire. Adjusted prevalence and prevalence ratios were estimated by conducting log-linear regression analysis while controlling for potential confounders. Overall, 6.6 % of cancer survivors (vs. 3.7 % of adults without cancer, P < 0.001) reported having SPD, and 14.0 % of cancer survivors (vs. 10.0 % of adults without cancer, P < 0.001) reported receiving mental healthcare services; the percentages decreased with increasing physical activity levels. After multivariate adjustment, compared to cancer survivors who were physically inactive, cancer survivors who engaged in physical activity >0 to P < 0.001 for both) less likely to report SPD, respectively; cancer survivors who engaged in physical activity ≥150 min/week were 33 % (P < 0.05) less likely to report receiving mental healthcare services. Additionally, the inverse association between physical activity and receiving mental healthcare services persisted among women with breast or reproductive cancers and among men and women with gastrointestinal cancers. The inverse associations between physical activity and SPD or receiving mental healthcare services suggest that physical activity may play a role in improving mental health among cancer survivors. Healthcare clinicians may consider routinely monitoring and assessing the psychological well-being of cancer survivors and educate them about the potential benefits of physical activity in improving their mental health.

Obesity is associated with increased risks for mental disorders. This study examined associations of obesity indicators including body mass index (BMI), waist circumference, and waist-height ratio with suicidal ideation among U.S. women. We analyzed data from 3,732 nonpregnant women aged 20 years who participated in the 20052008 National Health and Nutrition Examination Survey. We used anthropometric measures of weight, height, and waist circumference to calculate BMI and waist-height ratio. Suicidal ideation was assessed using the Item 9 of the Patient Health Questionnaire-9. Odds ratios with 95% conference intervals were estimated using logistic regression analyses after controlling for potential confounders. The age-adjusted prevalence of suicidal ideation was 3.0%; the prevalence increased linearly across quartiles of BMI, waist circumference, and waist-height ratio (P for linear trend <0.01 for all). The positive associations of waist circumference and waist-height ratio with suicidal ideation remained significant (𝑃<0.05) after adjustment for sociodemographics, lifestyle-related behavioral factors, and having either chronic conditions or current depression. However, these associations were attenuated after both chronic conditions and depression were entered into the models. Thus, the previously reported association between obesity and suicidal ideation appears to be confounded by coexistence of chronic conditions and current depression among women of the United States.

Objective. To examine the prevalence and correlates of vitamin D deficiency and inadequacy among US women of childbearing age. Methods. Data from 1,814 female participants (20–44 y) in the 2003–2006 NHANES were analyzed to estimate the age-adjusted prevalence and prevalence ratios with 95% confidence intervals (CIs) for vitamin D deficiency (defined as serum 25-hydroxyvitamin D [25(OH)D] Results. The age-adjusted prevalence was 11.1% (95% CI: 8.8–14.0%) for vitamin D deficiency and 25.7% (95% CI: 22.3–29.5%) for vitamin D inadequacy. Race/ethnicity other than non-Hispanic white and obesity were associated with increased risks, whereas dietary supplement use, milk consumption of ≥1 time/day, and potential sunlight exposure during May-October were associated with decreased risks for both vitamin D deficiency and inadequacy (). Current smoking and having histories of diabetes and cardiovascular disease were also associated with an increased risk for vitamin D deficiency (). Conclusions. Among women of childbearing age, periconceptional intervention programs may focus on multiple risk factors for vitamin D deficiency and inadequacy to ultimately improve their vitamin D nutrition.

Objectives: Research suggests that serum concentrations of 25-hydroxyvitamin D [25(OH)D] are inversely associated with hypertension incidence. This study examined whether concentrations of 25(OH)D are inversely associated with mortality risk among US adults with hypertension. Methods: We analyzed data from the 2001–2004 National Health and Nutrition Examination Survey with mortality data obtained through 2006. Hazard ratios with 95% confidence intervals (CIs) for all-cause and cardiovascular disease (CVD) mortality were estimated using Cox proportional hazard models. Results: Of 2609 participants with hypertension, 191 died (including 68 CVD deaths) during an average of 3.7-year follow-up. Compared with participants with 25(OH)D concentrations in the highest quartile (≥29 ng/ml), the hazard ratios for all-cause mortality were 1.93 (95% CI 1.06–3.49), 1.32 (95% CI 0.85–2.04), and 1.36 (95% CI 0.84–2.22), respectively (P for trend P for trend P = 0.012) and from CVD (P = 0.010). These relationships were not affected much by adjustment for baseline blood pressure and use of antihypertension medications. Conclusion: Concentrations of 25(OH)D were inversely associated with all-cause and CVD mortality among adults with hypertension in the US. Enhancing vitamin D intake may contribute to a lower risk for premature death.

Increasing evidence suggests that vitamin D benefits both innate and adaptive immunity, thereby eliciting an anti-inflammatory effect and reducing the risk of infectious disease. The present study examined the association between serum 25-hydroxyvitamin D (25(OH)D) levels and the risk of chronic bronchitis among US adults. We analysed data from 6872 US adults aged ≥ 20 years who participated in the 2003–6 National Health and Nutrition Examination Survey. Prevalence and OR with 95 % CI of having self-reported chronic bronchitis were estimated by quintiles of 25(OH)D or vitamin D-deficiency status after adjustment for potential confounders. The results showed that the adjusted prevalence of chronic bronchitis ranged from 2·4 (95 % CI 1·4, 3·3) % among adults in the highest quintile of 25(OH)D ( ≥ 30 ng/ml) to 4·1 (95 % CI 2·5, 5·6) % among adults in the lowest quintile ( < 15 ng/ml; P for trend < 0·01). The adjusted OR for chronic bronchitis was 1·85 (95 % CI 1·06, 3·24) in adults with < 15 ng/ml 25(OH)D and 1·77 (95 % CI 1·19, 2·65) in those with 15 to < 20 ng/ml 25(OH)D compared with adults with ≥ 30 ng/ml 25(OH)D. Additionally, the adjusted OR for chronic bronchitis was 1·52 (95 % CI 1·03, 2·26) among adults with vitamin D deficiency ( < 20 ng/ml 25(OH)D) compared with those with ≥ 20 ng/ml 25(OH)D. For every 1 ng/ml increase in 25(OH)D, the likelihood of having chronic bronchitis fell by 2·6 % (P = 0·016). In conclusion, low serum 25(OH)D levels are associated with the increased risk of chronic bronchitis among US adults. The present results provide support for continuing research on the role of vitamin D in lung diseases.