Gender-Specific Clustering of Lifestyle Behaviors and Its Impacts on Cardiovascular Health.

BACKGROUND: Unhealthy lifestyle behaviors associated with cardiovascular risk manifest a clustering pattern. OBJECTIVE: Our aim was to identify behavioral clusters by using 5 unhealthy lifestyle behaviors among the Korean population and examine the impacts of identified behavioral clusters on cardiovascular health (CVH). METHODS: A cross-sectional study was conducted using data from the sixth Korea National Health and Nutrition Examination Survey. The participants were 7898, aged 19 to 64 years. The cluster analysis was performed using the behaviors of current smoking, binge drinking, physical inactivity, insufficient fruit intake, and sugar-sweetened beverage drinking. Cardiovascular health was defined as a composite modified z score calculated using biophysical factors. RESULTS: Men manifested 4 clusters (ie, risky binge drinkers, dominant smokers, dominant sugar-sweetened beverage drinkers, and nonsubstance/low-fruit eaters) characterized predominantly by substance use; women had 4 clusters (ie, substance users, physically inactive/low-fruit eaters, physically inactive/fruit eaters, and active adherers) characterized predominantly by physical inactivity. Among men, the clusters of dominant smokers and risky binge drinkers had significantly lower CVH scores than those with poor eating behaviors. Among women, the clusters of substance users and physically inactive/low-fruit eaters had significantly lower CVH scores than the active adherers. All the clusters in men had lower CVH scores than the worst cluster in women. CONCLUSIONS: There was a gender difference in the clustering pattern. The clusters with smoking and binge drinking in men and women were associated with negative impacts on CVH. Healthcare professionals should pay attention to the clustering pattern to design an efficient lifestyle intervention for cardiovascular disease prevention.

Serum long-chain n-3 polyunsaturated fatty acids and aortic calcification in middle-aged men: The population-based cross-sectional ERA-JUMP study.

BACKGROUND AND AIM: Few studies have examined the association of long-chain n-3 polyunsaturated fatty acids (LCn-3PUFAs) with the measures of atherosclerosis in the general population. This study aimed to examine the relationship of total LCn-3PUFAs, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) with aortic calcification. METHODS AND RESULTS: In a multiethnic population-based cross-sectional study of 998 asymptomatic men aged 40-49 years (300 US-White, 101 US-Black, 287 Japanese American, and 310 Japanese in Japan), we examined the relationship of serum LCn-3PUFAs to aortic calcification (measured by electron-beam computed tomography and quantified using the Agatston method) using Tobit regression and ordinal logistic regression after adjusting for potential confounders. Overall 56.5% participants had an aortic calcification score (AoCaS) > 0. The means (SD) of total LCn-3PUFAs, EPA, and DHA were 5.8% (3.3%), 1.4% (1.3%), and 3.7% (2.1%), respectively. In multivariable-adjusted Tobit regression, a 1-SD increase in total LCn-3PUFAs, EPA, and DHA was associated with 29% (95% CI = 0.51, 1.00), 9% (95% CI = 0.68, 1.23), and 35% (95% CI = 0.46, 0.91) lower AoCaS, respectively. Results were similar in ordinal logistic regression analysis. There was no significant interaction between race/ethnicity and total LCn-3PUFAs, EPA or DHA on aortic calcification. CONCLUSIONS: This study showed the significant inverse association of LCn-3PUFAs with aortic calcification independent of conventional cardiovascular risk factors among men in the general population. This association appeared to be driven by DHA but not EPA.

Mediating effects of exercise capacity on the association between physical activity and health-related quality of life among adolescents with complex congenital heart disease.

OBJECTIVES: There is little evidence on interrelationships between physical activity, sedentary behaviors, and health-related quality of life (HRQOL) among adolescents with congenital heart disease (CHD). We hypothesized that exercise capacity would have a mediating effect on the associations of either physical activity or sedentary behavior with HRQOL. METHODS: Adolescents with complex CHD (n = 111) were consecutively recruited from an outpatient clinic in a general hospital in South Korea. Physical activity and sedentary behavior were assessed using the global physical activity questionnaire. Exercise capacity was directly measured by peak oxygen uptake using a symptom-limited maximal treadmill exercise test. HRQOL was evaluated by both adolescents and their parents using the Pediatric Quality of Life Inventory questionnaire. RESULTS: The self-reported and parent proxy-reported HRQOL were positively associated with physical activity (ß = 0.16, P = .003; ß = 0.12, P = .049) and exercise capacity (ß = 0.63, P < .001; ß = 0.66, P < .001), but not with sedentary behavior in adjusted regression models. When both variables were entered in the same regression models, only exercise capacity remained significantly associated with the self-reported (ß = 0.50, P = .008) and parent proxy-reported HRQOL (ß = 0.62, P = .003). Exercise capacity acted as a full mediator variable on the relationship between physical activity and HRQOL (P < .05 for both). CONCLUSIONS: The present findings suggest that exercise capacity mediates the association between physical activity and HRQOL, highlighting the importance of improving exercise capacity to potentially enhance HRQOL in adolescents with complex CHD.

Socioeconomic inequalities in self-rated health: role of work-to-family conflict in married Korean working women.

Little evidence exists on the role of work-to-family conflict (WFC) in explaining socioeconomic inequality in self-rated health (SRH). We examined the association between socioeconomic status (SES) and SRH and tested the mediating effect of WFC in the association between SES and SRH among married Korean working women. A cross-sectional study was conducted using data from the 2014 Korean Longitudinal Survey of Women and Family. Participants were 3,226 women. Three SES indicators were used: income as measured by income-to-needs ratio; education categorized into college vs. noncollege education levels; and occupation classified by white vs. pink/blue-collar occupations. Lower levels of all the SES indicators were significantly associated with poor SRH and higher levels of WFC. The higher levels of WFC were also significantly associated with poor SRH. In the relation between SES and SRH, WFC showed a partial mediating effect for income (z = -4.13, p < .001) and full mediating effects for education (z = -3.79, p < .001) and occupation (z = -4.59, p < .001). WFC played a mediating role in explaining socioeconomic health inequality among married Korean working women. Workplace strategies focused on alleviating the WFC levels of socioeconomically disadvantaged married women may be crucial for improving their health status.

A Significant Positive Association of Vitamin D Deficiency with Coronary Artery Calcification among Middle-aged Men: For the ERA JUMP Study.

OBJECTIVE: Although a significant positive association of vitamin D deficiency with coronary heart disease has been demonstrated in cross-sectional as well as prospective studies, only a few studies have examined the association of vitamin D deficiency with subclinical atherosclerosis. We examined whether vitamin D deficiency is associated with subclinical atherosclerosis, as measured by coronary artery calcification (CAC) in asymptomatic adults. METHODS: In a population-based cross-sectional study, 195 men aged 40 to 49 years without cardiovascular disease were randomly selected (98 Caucasian and 97 Japanese American men). Liquid chromatography-tandem mass spectrometry was utilized to measure serum vitamin D. CAC was examined by electron beam computed tomography using standardized protocols and read centrally at the University of Pittsburgh using Agatston's methods. To investigate an association between vitamin D deficiency (defined as 25-hydroxyvitamin D [25(OH)D] < 20 ng/mL) and CAC (defined as Agatston score ≥ 10), we utilized multivariable logistic regression models. RESULTS: Prevalence of CAC and vitamin D deficiency was 27.2% and 10.3%, respectively. Participants with CAC were significantly older, had significantly higher body mass index (BMI), and had higher rates of smoking. Those with CAC were 3.31 times likely to be vitamin D deficient, after adjusting for traditional cardiovascular risk factors (odds ratio [OR] = 3.31, 95% confidence interval [CI], 1.12-9.77). CONCLUSIONS: In this population-based study of healthy middle-aged men, vitamin D deficiency had a significant positive association with the presence of CAC.

Predictors of initial weight loss among women with abdominal obesity: a path model using self-efficacy and health-promoting behaviour.

AIM: To identify predictors of initial weight loss among women with abdominal obesity by using a path model. BACKGROUND: Successful weight loss in the initial stages of long-term weight management may promote weight loss maintenance. DESIGN: A longitudinal study design. METHODS: Study participants were 75 women with abdominal obesity, who were enrolled in a 12-month Community-based Heart and Weight Management Trial and followed until a 6-month assessment. The Weight Efficacy Lifestyle, Exercise Self-Efficacy and Health Promoting Lifestyle Profile-II measured diet self-efficacy, exercise self-efficacy and health-promoting behaviour respectively. All endogenous and exogenous variables used in our path model were change variables from baseline to 6 months. Data were collected between May 2011-May 2012. FINDINGS: Based on the path model, increases in both diet and exercise self-efficacy had significant effects on increases in health-promoting behaviour. Increases in diet self-efficacy had a significant indirect effect on initial weight loss via increases in health-promoting behaviour. Increases in health-promoting behaviour had a significant effect on initial weight loss. CONCLUSION: Among women with abdominal obesity, increased diet self-efficacy and health-promoting behaviour were predictors of initial weight loss. A mechanism by which increased diet self-efficacy predicts initial weight loss may be partially attributable to health-promoting behavioural change. However, more work is still needed to verify causality. Based on the current findings, intensive nursing strategies for increasing self-efficacy for weight control and health-promoting behaviour may be essential components for better weight loss in the initial stage of a weight management intervention.

Factors associated with health-related quality of life among overweight and obese Korean women.

Health-related quality of life (HRQOL) tends to be lower among individuals who are overweight and obese than those of normal weight, and women may be more vulnerable to lower HRQOL associated with obesity than men. Identifying factors associated with HRQOL may be crucial for improving HRQOL for overweight/obese women. We aimed to determine the factors associated with obesity-specific HRQOL among overweight/obese Korean women. A cross-sectional study was conducted with 125 women aged 20-64 years, who comprised a baseline sample in the Community-based Heart and Weight Management Trial. The data were collected from September 2010 to November 2011. The Weight Efficacy Lifestyle, Beck Depression Inventory-II, Interpersonal Social Evaluation List, and Impact of Weight on Quality of Life (IWQOL)-Lite scales were used to measure self-efficacy for weight control, depressive symptoms, social support, and HRQOL, respectively. Increased body mass index, lower self-efficacy for weight control, and higher levels of depressive symptoms were significantly associated with greater impairment in total IWQOL in the regression models. However, social support was not significantly associated with IWQOL. Along with weight loss strategies, other strategies for improving self-efficacy and alleviating depressive symptoms may be essential for improving HRQOL among overweight and obese women.

Effects of weight management by exercise modes on markers of subclinical atherosclerosis and cardiometabolic profile among women with abdominal obesity: a randomized controlled trial.

BACKGROUND: Few studies have examined the differential effects of weight management by exercise mode on subclinical atherosclerosis. We hypothesized that 3 modes of aerobic, resistance, and combination exercises have differential effects on the flow-mediated dilation (FMD), carotid-femoral pulse wave velocity (PWV), and carotid intima-media thickness (IMT) as well as cardiometabolic profile in weight management. METHODS: A randomized, single-blind trial (ISRCTN46069848) was conducted in Seoul, South Korea between November 2011 and December 2012. Randomized participants were 110 women with abdominal obesity (aerobic group n = 50; resistance group n = 30; combination exercise group n = 30). The treatment period was 12 months with 3-month follow up: A diet-alone intervention for the first 3 months and a diet-plus-exercise intervention for the next 9 months according to exercise modes. The exercise training was designed with an intensity of 50-70% heart rate reserve for 3 days a week in 60-minute-long sessions for 9 months, consisting of 30-minute treadmill and 30-minute bike exercises for aerobic group; upper and lower body exercises with an intensity target of 2 sets and 8-12 repetitions for resistance group; 30-minute resistance and consecutive 30-minute aerobic exercises for combination group. RESULTS: Ninety-two and 49 participants were analyzed for modified intention-to-treat analysis and per-protocol (PP) analysis, respectively. The 3 exercise modes had no significant differential effects on FMD, PWV, and IMT over time; however, the combination group was found to have significantly lower levels of fasting glucose than the aerobic group (p = .034) in the PP analysis. Nevertheless, we observed significant time effects such as reductions in PWV (p = .048) and IMT (p = .018) in cubic and quadratic trends, respectively, and improvements in body weight, waist circumference, low-density and high-density lipoprotein cholesterol levels, fasting glucose levels, and cardiorespiratory fitness in linear, quadratic, or cubic trends. CONCLUSIONS: For women with abdominal obesity, a combination of aerobic and resistance exercises may be preferable to a single exercise mode for effective glucose control. Regardless of exercise mode, exercise interventions combined with dietary interventions in weight management may be beneficial in reducing the risk of subclinical atherosclerosis and cardiometabolic risk.

Regional pulse wave velocities and their cardiovascular risk factors among healthy middle-aged men: a cross-sectional population-based study.

BACKGROUND: Both carotid-femoral (cf) pulse wave velocity (PWV) and brachial-ankle (ba) PWV employ arterial sites that are not consistent with the path of blood flow. Few previous studies have reported the differential characteristics between cfPWV and baPWV by simultaneously comparing these with measures of pure central (aorta) and peripheral (leg) arterial stiffness, i.e., heart-femoral (hf) PWV and femoral-ankle (fa) PWV in healthy populations. We aimed to identify the degree to which these commonly used measures of cfPWV and baPWV correlate with hfPWV and faPWV, respectively, and to evaluate whether both cfPWV and baPWV are consistent with either hfPWV or faPWV in their associations with cardiovascular (CV) risk factors. METHODS: A population-based sample of healthy 784 men aged 40-49 (202 white Americans, 68 African Americans, 202 Japanese-Americans, and 282 Koreans) was examined in this cross-sectional study. Four regional PWVs were simultaneously measured by an automated tonometry/plethysmography system. RESULTS: cfPWV correlated strongly with hfPWV (r = .81, P < .001), but weakly with faPWV (r = .12, P = .001). baPWV correlated moderately with both hfPWV (r = .47, P < .001) and faPWV (r = .62, P < .001). After stepwise regression analyses with adjustments for race, cfPWV shared common significant correlates with both hfPWV and faPWV: systolic blood pressure (BP) and body mass index (BMI). However, BMI was positively associated with hfPWV and cfPWV, and negatively associated with faPWV. baPWV shared common significant correlates with hfPWV: age and systolic BP. baPWV also shared the following correlates with faPWV: systolic BP, triglycerides, and current smoking. CONCLUSIONS: Among healthy men aged 40 - 49, cfPWV correlated strongly with central PWV, and baPWV correlated with both central and peripheral PWVs. Of the CV risk factors, systolic BP was uniformly associated with all the regional PWVs. In the associations with factors other than systolic BP, cfPWV was consistent with central PWV, while baPWV was consistent with both central and peripheral PWVs.

Psychometric properties of the Perceived Therapeutic Efficacy Scale for adhering to a cholesterol-lowering diet.

BACKGROUND: Outcome expectancy may play an important role in behavior change. Previous studies tested the validity and the reliability of the Perceived Therapeutic Efficacy Scale (PTES), a scale that measures outcome expectancy related to adhering to a cholesterol-lowering diet. Further study was needed to examine its psychometric properties in a larger sample. OBJECTIVE: The aim of this study was to test the psychometric properties of the 10-item PTES in a large sample. METHODS: The PTES and the Connor Diet Habit Survey were administered to adults enrolled in a cardiac rehabilitation program. RESULTS: The final sample for the analysis (N = 224) was, on average, 69.35 years old and was predominantly men (66.50%) and white (92.40%); nearly all (96.00%) completed high school. The inter-item correlation matrix revealed that correlation coefficients were greater than 0.80 between 4 pairs of items, suggesting that the 4 items were redundant. After consulting with a content expert and an examination of item content, we removed the 4 redundant items (items 2, 3, 4, and 10) and reduced the scale to 6 items. Principal component analysis revealed a 1-factor scale with high loadings for the 6 items, each greater than 0.70. The reliability of the scale, measured by Cronbach's α, was 0.91. The total PTES score had a moderate correlation with self-reported behaviors of adhering to a cholesterol-lowering diet, as measured by the Connor Diet Habit Survey subscale for cholesterol and fat intake (r = 0.36, P < 0.05). CONCLUSIONS: This study demonstrated that the revised and shortened PTES scale is reliable and valid to measure outcome expectancy related to adhering to a cholesterol-lowering diet.

Health-promoting behaviour among women with abdominal obesity: a conceptual link to social support and perceived stress.

AIM: To identify a conceptual link among health-promoting behaviour, interpersonal support and perceived stress and to examine whether the link between interpersonal support and health-promoting behaviour would be mediated by perceived stress among women with abdominal obesity. BACKGROUND: Abdominal obesity is a strong risk factor for cardiovascular disease in women and its reduction can be achieved by weight loss. Adopting health-promoting behaviour may be critical for successful weight loss. DESIGN: A cross-sectional, correlational study design. METHOD: Study participants were 126 women with abdominal obesity, who comprised a baseline sample in the Community-based, Heart and Weight Management Trial. The Data were collected between September 2010-November 2011. A multiple regression analysis and Sobel's test were performed. FINDINGS: Higher levels of interpersonal support and lower levels of perceived stress were significantly associated with higher levels of health-promoting behaviour, after controlling for age, obesity-related comorbidity, postmenopausal status and current smoking in the regression models. The association between interpersonal support and health-promoting behaviour was significantly mediated by perceived stress in the Sobel's test; the magnitude of the association between interpersonal support and health-promoting behaviour decreased when adding perceived stress to the predictor variables in the regression model. CONCLUSION: Our findings indicate the practical significance of identifying the levels of interpersonal support and perceived stress among women seeking weight management interventions. Nurses need to develop effective strategies for enhancing social support and stress management skills in weight management interventions for facilitating health-promoting behaviour.

Cigarette Sales to Underage Youth in Seoul, South Korea: Findings From a Mystery Shopping Study.

This study aimed to identify the rates of cigarette sales to underage youth and the factors associated with these sales using a mystery shopping technique. Of the convenience stores selling cigarettes in Seoul, South Korea, 2600 were sampled in 2019 and 2020. Personal and environmental factors were independent variables. Cigarette sales to underage youth were the outcome variable, defined as cases where a seller sold cigarettes to a youth shopper. A multiple logistic regression analysis was performed. Rates of cigarette sales to underage youth were 17.9% in 2019 and 16.3% in 2020, significantly higher when the seller was younger and the store was located in a central area. Administrative actions are needed to enforce strong warnings and training guidelines for convenience store sellers. Differentiation in surveillance intensity based on the location of convenience stores in Seoul is also recommended.

Correlation of a self-report and direct measure of physical activity level in the electron-beam tomography and risk assessment among Japanese and US Men in the post World War II birth cohort (ERA JUMP) study.

BACKGROUND: Physical activity (PA) is complex and a difficult behavior to assess as there is no ideal assessment tool(s) that can capture all contexts of PA. Therefore, it is important to understand how different assessment tools rank individuals. We examined the extent to which self-report and direct assessment PA tools yielded the same ranking of PA levels. METHODS: PA levels were measured by the Modifiable Activity Questionnaire (MAQ) and pedometer at baseline among 855 white (W), African-American (AA), Japanese-American (JA), and Korean (K) men (mean age 45.3 years) in 3 geographic locations in the ERA JUMP study. RESULTS: Korean men were more active than W, AA, and JA men, according to both the MAQ and pedometer (MAQ total PA [mean ± SD]: 41.6 ± 17.8, 20.9 ± 9.9, 20.0 ± 9.1, and 29.4 ± 10.3 metabolic equivalent [MET] hours/week, respectively; pedometer: 9584.4 ± 449.4, 8363.8 ± 368.6, 8930.3 ± 285.6, 8335.7 ± 368.6 steps/day, respectively). Higher levels of total PA in Korean men, as shown by MAQ, were due to higher occupational PA. Spearman correlations between PA levels reported on the MAQ and pedometer indicated positive associations ranging from rho = 0.29 to 0.42 for total activity, rho = 0.13 to 0.35 for leisure activity, and rho = 0.10 to 0.26 for occupational activity. CONCLUSIONS: The 2 assessment methods correlated and were complementary rather than interchangeable. The MAQ revealed why Korean men were more active. In some subpopulations it may be necessary to assess PA domains other than leisure and to use more than 1 assessment tool to obtain a more representative picture of PA levels.

Socioecological Factors Associated With Physical Activity and Sedentary Behavior Among Workers: Using the PRECEDE-PROCEED Model.

BACKGROUND: Physical inactivity is a major global health problem. Industrial automation has led to an increased number of workers who are sedentary at work. We examined whether three socioecological factors (i.e., predisposing, reinforcing, and enabling factors) derived from the PRECEDE-PROCEED model would be significantly associated with the physical activity and sedentary behavior among workers. METHODS: A cross-sectional study was conducted among 539 employees at an electronic manufacturing plant in Gumi, South Korea. Physical activity variables of energy expenditure (MET-min/week) and sitting time at work (minutes/day) were measured by the International Physical Activity Questionnaire and the Workforce Sitting Questionnaire, respectively. Of the socioecological factors, a predisposing factor defined as self-determined motivation was measured by the Exercise Self-Regulation Questionnaire; a reinforcing factor defined as autonomy support was measured by the Work Climate Questionnaire; and an enabling factor defined as supportive workplace environment was measured by the Perceived Workplace Environment Scale. FINDINGS: Self-determined motivation (i.e., autonomous and controlled forms of motivation), autonomy support, and a supportive workplace environment were all significantly associated with increased physical activity energy expenditure during leisure-time. However, they were not significantly associated with sitting time on working and non-working days. CONCLUSION/APPLICATIONS TO PRACTICE: Three socioecological factors of the PRECEDE-PROCEED model were significantly associated with leisure-time physical activity among workers. Our findings may help occupational health nurses use a socioecological approach for designing effective workplace strategies to increase leisure-time physical activity among workers.

Development and psychometric testing of the Heart-Healthy Information Questionnaire.

AIMS: This study aimed to develop a reliable and valid scale, i.e. the Heart-Healthy Information Questionnaire (HHIQ). METHODS AND RESULTS: The HHIQ was developed in three phases: (i) creating the item pool, (ii) conducting a preliminary evaluating the items, and (iii) refining the scale and evaluating psychometric properties. An initial item pool of 77 items with a 3-point True/False format with a 'Don't know' option was extracted from the literature review and 54 items reached content validity. The psychometric properties of HHIQ were tested with 1315 individuals without cardiovascular disease. By using the exclusion criteria of the difficulty index (>0.95), discrimination index (<10.0), and item-total correlation (tetrachoric coefficient <0.2), 50 items were finally selected. The construct validity was determined by using the known-groups validation: Individuals (n = 107) who were educated with heart-healthy education sessions showed significantly higher scores of the HHIQ than those (n = 107) who were not educated (P = 0.015). The Kuder-Richardson formula 20 coefficient indicated good internal consistency (0.85), and the test-retest reliability coefficient with a 15-day interval also indicated good stability (0.78). A total score of the HHIQ was significantly correlated with a total score of the Evaluation Tool for Metabolic Syndrome Modification Lifestyles (ρ = 0.23, P < 0.001). CONCLUSION: The HHIQ showed good psychometric properties of validity and reliability and may be useful to evaluate the knowledge levels of heart-healthy information in the areas of cardiovascular disease prevention.

Significant inverse associations of serum n-6 fatty acids with plasma plasminogen activator inhibitor-1.

Epidemiological studies suggested that n-6 fatty acids, especially linoleic acid (LA), have beneficial effects on CHD, whereas some in vitro studies have suggested that n-6 fatty acids, specifically arachidonic acid (AA), may have harmful effects. We examined the association of serum n-6 fatty acids with plasminogen activator inhibitor-1 (PAI-1). A population-based cross-sectional study recruited 926 randomly selected men aged 40-49 years without CVD during 2002-2006 (310 Caucasian, 313 Japanese and 303 Japanese-American men). Plasma PAI-1 was analysed in free form, both active and latent. Serum fatty acids were measured with gas-capillary liquid chromatography. To examine the association between total n-6 fatty acids (including LA and AA) and PAI-1, multivariate regression models were used. After adjusting for confounders, total n-6 fatty acids, LA and AA, were inversely and significantly associated with PAI-1 levels. These associations were consistent across three populations. Among 915 middle-aged men, serum n-6 fatty acids had significant inverse associations with PAI-1.

Coronary artery calcification by computed tomography in epidemiologic research and cardiovascular disease prevention.

Both American and European guidelines recommend coronary artery calcification (CAC) as a tool for screening asymptomatic individuals at intermediate risk for coronary heart disease (CHD). These recommendations are based on epidemiologic studies mostly in the United States. We review (1) the use of CAC in primary prevention of CHD in the United States, (2) epidemiologic studies of CAC in asymptomatic adults outside of the United States, and (3) international epidemiologic studies of CAC. This review will not consider clinical studies of CAC among patients or symptomatic individuals. US studies have shown that CAC is a strong independent predictor of CHD in both sexes among middle-aged and old age groups, various ethnic groups, and individuals with and without diabetes and that CAC plays an important role in reclassifying individuals from intermediate to high risk. Studies in Europe support these conclusions. The Electron-Beam Tomography, Risk Factor Assessment Among Japanese and US Men in the Post-World-War-II birth cohort (ERA JUMP) Study is the first international study to compare subclinical atherosclerosis, including CAC among Japanese, Japanese Americans, Koreans, and whites. It showed that as compared with whites, Japanese had lower levels of atherosclerosis, whereas Japanese Americans had similar or higher levels. CAC is being increasingly used as a screening tool for asymptomatic individuals in Europe and the United States. CAC is a powerful research tool, because it enables us to describe differences in atherosclerotic burden across populations. Such research could identify factors responsible for differences among populations, which may improve CHD prevention.

Health-related quality of life among participants in the SMART weight loss trial.

Obesity has been associated with a decreased health-related quality of life (HRQoL); however, the association between weight change and HRQoL is unclear. This secondary analysis of the SMART (Self Monitoring And Recording using Technology) trial, a clinical trial of behavioral weight loss treatment, provides evidence that quality of life improves with weight loss.

Intention to quit electronic cigarette smoking among university students who are e-cigarette users.

OBJECTIVE: To identify factors that are significantly associated with the intention to quit electronic cigarette smoking (ECS) at multiple, ecological levels among university students. PARTICIPANTS: 365 students who were e-cigarette users from Seoul metropolitan areas, South Korea. METHODS: A cross-sectional study through an online survey. RESULTS: Of participants, 62.7% had the intention to quit ECS-17.2% within one month, 14.0% within six months, and 31.5% when the time is right. Factors significantly associated with the intention to quit ECS were identified: "device type," "a shorter duration of ECS," and "having started ECS for quitting traditional cigarette smoking" at the intrapersonal-level; "negative attitudes of either peers or family members toward ECS" at the interpersonal-level; and "exposure to community smoking cessation educations" at the community-level. CONCLUSIONS: Approximately one-thirds of university e-cigarette users had no intention to quit ECS. The factors identified should be integrated into university level, behavioral smoking cessation strategies.

Differential association of docosahexaenoic and eicosapentaenoic acids with carotid intima-media thickness.

BACKGROUND AND PURPOSE: Recent studies reported the differential effect of docosahexaenoic (DHA) and eicosapentaenoic acids (EPA). We examined the differential association of DHA and EPA with carotid intima-media thickness (IMT) in Japanese individuals in Japan and in U.S. white individuals and explored whether DHA or EPA contributes to the difference in IMT between the two groups. METHODS: A population-based cross-sectional study in 608 Japanese and U.S. white men aged 40 to 49 was conducted to assess IMT, serum DHA, EPA, and other cardiovascular risk factors. RESULTS: Japanese compared to U.S. whites had significantly lower IMT (mean±SD, 618±81 and 672±94 µm for Japanese and whites, respectively; P<0.001) and had >2-fold higher levels of DHA and EPA. DHA, but not EPA, had an inverse association with IMT in both Japanese and U.S. whites. The inverse association remained only in Japanese men after adjusting for risk and other factors. The significant difference in multivariable-adjusted IMT became nonsignificant after further adjusting for DHA (mean difference, 17 µm; 95% CI, -8 to 43; P=0.177) but not EPA. In this multivariable-adjusted model, DHA but not EPA was a significant predictor of IMT (P=-0.032 versus 0.863, respectively). CONCLUSIONS: These data suggest that DHA may have a more potent antiatherogenic effect than EPA, especially in levels observed in the Japanese, independent of risk factors.