Emmons K M, Marcus B H, Linnan L, Rossi J S, Abrams D B
Miriam Hospital, Division of Behavioral Medicine, Providence, RI 02906.
Prev Med. 1994 Jul;23(4):481-9. doi: 10.1006/pmed.1994.1066.
Individuals who have multiple poor health behaviors account for a disproportionately large percentage of the preventable U.S. health care cost burden. Understanding the relationships between multiple risk factors is important for the design of both individual and public health interventions. There have been few efforts to examine the co-occurrence of psychosocial and motivational mechanisms that mediate smoking, dietary fat intake, and physical activity in a defined population of blue collar workers.
The sample comprised 1,559 manufacturing workers who participated in a self-help physical activity intervention and who completed a computerized assessment battery about their smoking, dietary fat intake, physical activity, and demographic characteristics.
Twenty-six percent of the sample were smokers, 51% did not exercise regularly, and 35% consumed more than an estimated 40% of calories per day from fat. Almost half of the sample was in the later stages of readiness for physical activity and dietary fat intake, compared with only 3% for smoking. Only 12% of the smokers had smoking as their only risk factor. Smokers were significantly more likely to engage in poor dietary and physical activity behaviors, compared with nonsmokers. The relationship among smoking status and the other risk factors was apparent both in terms of dietary fat and physical activity behaviors, as well as mediators such as motivation for change. Lower dietary fat intake was associated with an absence of the other two risk factors.
The results suggest that there are important mediating mechanisms both within and among workers with one or more risk factors. Smokers are a particularly important target for health promotion interventions, and it may be possible to make initial contact with them through other health programs at the worksite. The role of other lifestyle changes as a gateway to smoking cessation has not yet been explored, but may have potential for reaching smokers who are very low in their motivational readiness to change. The implications of these findings for research and the design of multiple risk factor interventions are discussed.
具有多种不良健康行为的个体在美国可预防的医疗保健成本负担中所占比例过高。了解多种风险因素之间的关系对于设计个体和公共卫生干预措施至关重要。在特定的蓝领工人人群中，很少有人致力于研究介导吸烟、膳食脂肪摄入和身体活动的心理社会和动机机制的共同出现情况。
样本包括1559名制造业工人，他们参与了一项自助式身体活动干预，并完成了一项关于他们的吸烟、膳食脂肪摄入、身体活动和人口统计学特征的计算机化评估测试。
26%的样本是吸烟者，51%的人没有定期锻炼，35%的人每天从脂肪中摄入的热量超过估计的40%。几乎一半的样本处于身体活动和膳食脂肪摄入准备的后期阶段，而吸烟方面只有3%处于该阶段。只有12%的吸烟者将吸烟作为唯一的风险因素。与不吸烟者相比，吸烟者明显更有可能有不良的饮食和身体活动行为。吸烟状况与其他风险因素之间的关系在膳食脂肪和身体活动行为以及诸如改变动机等中介因素方面都很明显。较低的膳食脂肪摄入与不存在其他两个风险因素相关。
结果表明，在有一个或多个风险因素的工人内部和之间存在重要的中介机制。吸烟者是健康促进干预的一个特别重要的目标，并且有可能通过工作场所的其他健康项目与他们进行初步接触。其他生活方式改变作为戒烟途径的作用尚未得到探索，但可能有潜力接触到改变动机非常低的吸烟者。讨论了这些发现对研究和多风险因素干预设计的意义。
