National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health. Autonomous University of Madrid/IdiPAZ, Madrid, Spain.
Health Place. 2022 May;75:102804. doi: 10.1016/j.healthplace.2022.102804. Epub 2022 Apr 21.
Previous work identifying determinants of co-occurrence of behavioral risk factors have focused on their association with individuals' characteristics with scant attention paid to their relationship to contextual factors. Data came from 21,007 individuals ≥15 years of age who participated in the cross-sectional 2011-2012 Spanish National Health Survey. Two indicators were defined by tobacco consumption, alcohol intake, diet, physical activity, and body mass index. The first indicator, based on dichotomized measures, ranges from 0 to 5. The second one (unhealthy lifestyle index), ranges from 0 to 15, with 0 denoting the healthiest score. Among the determinants, we examined social support, five perceived characteristics of the neighborhood, and the socioeconomic deprivation index of the census tract of residence. Data were analyzed using multilevel linear and logistic regression models adjusted for the main sociodemographic characteristics. Using the dichotomized indicator, the probability of having 3-5 risk factors versus <3 factors was associated with low social support (Odds Ratio [OR] 1.50; 95% Confidence Interval [CI]: 1.25-1.80). Issues surrounding neighborhood cleanliness (OR = 1.18; 95%CI: 1.04-1.33), air pollution (OR = 1.38; 95%CI: 1.16-1.64), and street crime (OR = 1.21; 95%CI: 1.03-1.42) were associated with determinants of co-occurrence. Risk factors co-occurrence increased as deprivation level increased: the OR for the highest deprivation quintile versus the lowest was 1.30 (95%CI: 1.14-1.48). Similar results were observed when using the unhealthy lifestyle index. Poorer physical and social environments are related to greater co-occurrence of risk factors for chronic diseases. Health promotion interventions targeting the prevention of risk factors should consider the contextual characteristics of the neighborhood environment.
先前针对行为风险因素共同发生的决定因素的研究主要集中在它们与个体特征的关联上，而对与背景因素的关系关注甚少。数据来自于 21007 名年龄在 15 岁及以上的参加了 2011-2012 年西班牙国家健康调查的个体。两个指标由吸烟、饮酒、饮食、身体活动和体重指数来定义。第一个指标基于二分测量，范围从 0 到 5。第二个指标（不健康生活方式指数）范围从 0 到 15，0 表示最健康的分数。在决定因素中，我们检查了社会支持、五个感知到的邻里特征和居住的普查区的社会经济剥夺指数。使用多水平线性和逻辑回归模型，根据主要的社会人口统计学特征进行调整，对数据进行了分析。使用二分指标，与 <3 个风险因素相比，具有 3-5 个风险因素的可能性与低社会支持相关（优势比 [OR] 1.50；95%置信区间 [CI]：1.25-1.80）。与共同发生的决定因素相关的还有邻里清洁度（OR=1.18；95%CI：1.04-1.33）、空气污染（OR=1.38；95%CI：1.16-1.64）和街头犯罪（OR=1.21；95%CI：1.03-1.42）等问题。风险因素共同发生的可能性随着剥夺水平的增加而增加：与最低五分位数相比，最高五分位数的 OR 为 1.30（95%CI：1.14-1.48）。当使用不健康的生活方式指数时，也观察到了类似的结果。较差的身体和社会环境与慢性病风险因素的共同发生更为相关。针对预防风险因素的健康促进干预措施应考虑邻里环境的背景特征。
