Tobias Martin, Jackson Gary, Yeh Li-Chia, Huang Ken
Public Health Intelligence, New Zealand Ministry of Health, Wellington.
Aust N Z J Public Health. 2007 Apr;31(2):155-63. doi: 10.1111/j.1753-6405.2007.00034.x.
To describe the co-occurrence and clustering of healthy and unhealthy behaviours in New Zealand.
Data were sourced from the 2002/03 New Zealand Health Survey. Behaviours selected for analysis were tobacco use, quantity and pattern of alcohol consumption, level of physical activity, and intake of fruit and vegetables. Clustering was defined as co-prevalence of behaviours greater than that expected based on the laws of probability. Co-occurrence was examined using multiple logistic regression modelling, while clustering was examined in a stratified analysis using age and (where appropriate) ethnic standardisation for confounding control.
Approximately 29% of adults enjoyed a healthy lifestyle characterised by non-use of tobacco, non- or safe use of alcohol, sufficient physical activity and adequate fruit and vegetable intake. This is only slightly greater than the prevalence expected if all four behaviours were independently distributed through the population i.e. little clustering of healthy behaviours was found. By contrast, 1.5% of adults exhibited all four unhealthy behaviours and 13% exhibited any combination of three of the four unhealthy behaviours. Unhealthy behaviours were more clustered than healthy behaviours, yet Maori exhibited less clustering of unhealthy behaviours than other ethnic groups and no deprivation gradient was seen in clustering.
The relative lack of clustering of healthy behaviours supports single issue universal health promotion strategies at the population level. Our results also support targeted interventions at the clinical level for the 15% with 'unhealthy lifestyles'. Our finding of only limited clustering of unhealthy behaviours among Maori and no deprivation gradient suggests that clustering does not contribute to the greater burden of disease experienced by these groups.
描述新西兰健康行为与不健康行为的共现及聚集情况。
数据来源于2002/03年新西兰健康调查。选取用于分析的行为包括烟草使用、酒精消费数量及模式、身体活动水平以及水果和蔬菜摄入量。聚集定义为行为的共同流行率高于基于概率法则预期的水平。使用多元逻辑回归模型检验共现情况，同时在分层分析中通过年龄和（如适用）种族标准化来控制混杂因素，检验聚集情况。
约29%的成年人拥有以不使用烟草、不饮酒或安全饮酒、充足身体活动以及充足水果和蔬菜摄入量为特征的健康生活方式。这仅略高于如果所有四种行为在人群中独立分布时预期的流行率，即几乎未发现健康行为的聚集。相比之下，1.5%的成年人表现出所有四种不健康行为，13%的成年人表现出四种不健康行为中的任意三种组合。不健康行为比健康行为更具聚集性，但毛利人不健康行为的聚集性低于其他种族群体，且在聚集情况中未观察到贫困梯度。
健康行为相对缺乏聚集性支持在人群层面采取单一问题的普遍健康促进策略。我们的结果还支持针对15%“生活方式不健康”的人群在临床层面进行有针对性的干预。我们发现毛利人不健康行为的聚集性有限且无贫困梯度，这表明聚集并非导致这些群体疾病负担更重的原因。
