Cigarette Consumption Patterns of Non-Smokers, Occasional Smokers, and Daily Smokers in Selected ASEAN Countries.

BACKGROUND: This study investigates the socio-demographic factors associated with smoking status in five Southeast Asian countries: Malaysia, Thailand, Indonesia, Vietnam, and Philippines. METHODS: This cross-sectional study utilizes data of adults ≥15 years who completed the Global Adult Tobacco Surveys. Ordered probit analysis is used to account for the smoking statuses of non-smokers, occasional smokers, and daily smokers. RESULTS: Malaysian and Vietnamese households with more family members face lower smoking likelihoods than otherwise. Urbanites in Philippines and rural residents in Thailand and Indonesia are more likely to smoke on occasional and daily basis than others. Males are consistently more likely to smoke occasionally or daily and less likely to be non-smokers than females across all countries. Younger middle-age (retiree) individuals aged 30-35 (≥60) years in Malaysia and Thailand exhibit higher (lower) likelihoods to smoke occasionally or daily than their younger cohorts aged 15-29 years. Individuals aged 30 years and above in Indonesia, Vietnam, and Philippines display higher daily smoking propensities than others. Higher education levels dampens smoking likelihoods and increases non-smoking propensities in all countries. Non-government or self-employed workers in all countries are more likely to smoke occasionally or daily than unemployed persons. Being married is associated with higher non-smoking likelihoods in Thailand although this association is not evident in Malaysia. CONCLUSION: These findings suggest that a portfolio of targeted interventions is necessary to meet the needs of specific subpopulations within the various countries.
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Does Supplemental Nutrition Assistance Program Reduce Food Insecurity among Households with Children? Evidence from the Current Population Survey.

The Supplemental Nutrition Assistance Program (SNAP) is designed to improve household diet and food security-a pressing problem confronting low-income families in the United States. Previous studies on the issue often ignored the methodological issue of endogenous program participation. We revisit this important issue by estimating a simultaneous equation system with ordinal household food insecurity. Data are drawn from the 2009-2011 Current Population Survey Food Security Supplement (CPS-FSS), restricted to SNAP-eligible households with children. Our results add to the stocks of empirical findings that SNAP participation ameliorates food insecurity among adults only, but increases the probabilities of low and very low food security among children. These contradictory results indicate that our selection approach with a single cross section is only partially successful, and that additional efforts are needed in further analyses of this complicated issue, perhaps with longitudinal data. Socio-demographic variables are found to affect food-secure households and food-insecure households differently, but affect SNAP nonparticipants and participants in the same direction. The state policy tools, such as broad-based categorical eligibility (BBCE) and simplified reporting, can encourage SNAP participation and thus ameliorate food insecurity. Our findings can inform policy deliberations.

Body weight and physical activity of adolescents in Malaysia.

BACKGROUND: This study examined the factors associated with body mass index (BMI) categories of Malaysian adolescents by physical activity (PA) status. METHODS: Data were obtained from the 2012 Malaysia Global School-based Student Health Survey. Generalized ordered logit regression analysis was conducted on 24 339 adolescents by PA status. RESULTS: Early- (ages 11-13) and middle-stage (ages 14-16) adolescents were associated with higher overweight and obesity risks than their older peers (ages 17-18). Male adolescents faced higher underweight and obesity likelihoods than females. Hunger due to food shortage at home was associated with higher likelihoods of underweight and normal weight BMI categories. Smokers were more likely to be underweight or normal weight than non-smokers. Segmented-sample analysis by PA status indicated that, while the direction of associations was parallel across PA status, the magnitudes of association between age, hunger and smoking status with BMI status were greater among active than inactive adolescents. CONCLUSIONS: Male adolescents faced a dual burden of underweight and obesity. Other sociodemographic and dietary-lifestyle factors were associated with adolescent BMI categories. Segmented-sample analysis by PA status uncovered varying associations between factors that would otherwise be masked in pooled sample analysis. Public health authorities should take these factors into consideration when deliberating programs to ensure healthy adolescent body weight.

Awareness of diabetes, hypertension, and hypercholesterolemia in Malaysia.

BACKGROUND: Policy interventions for cardiovascular diseases require individual awareness of ailments. Such awareness is also key to individuals making changes to their lifestyle and dietary habits. The present study investigated the association of sociodemographic, health, and lifestyle factors with the awareness and prevalence of three ailments: diabetes, hypertension, and hypercholesterolemia. METHODS: Data were obtained from the Malaysia Non-Communicable Disease Surveillance-1. Logistic regressions were estimated and odds ratios of exposure variables calculated. RESULTS: Diabetes awareness was associated with work hours, age, family history of illnesses, and ethnicity. Individuals with diminished hypertension awareness included those who were younger, without family history of illnesses, not obese, working more hours, and not adhering to a healthy diet. Low awareness of hypercholesterolemia was associated with younger age, lower education level, living in rural areas, female gender, no family history of illnesses, non-obesity, and minority ethnic background. Prevalence generally had the same pattern of association with the exposure variables. CONCLUSIONS: Various sociodemographic and health and lifestyle characteristics were associated with diabetes, hypertension, and hypercholesterolemia awareness in Malaysia, albeit with varying outcomes. Therefore, programs focusing on lifestyle improvements should be targeted at high-risk subgroups, such as individuals working longer hours and young adults, who are less likely to be aware of their health risk factors.

Physical Activity, Gender Difference, and Depressive Symptoms.

OBJECTIVE: To investigate the roles of physical activity (exercise) and sociodemographic factors in depressive symptoms among men and women in the United States. DATA SOURCE: 2011 U.S. Behavioral Risk Factor Surveillance System (BRFSS). STUDY DESIGN: Patient Health Questionnaire Depression Scale (PHQ-8) scores are aggregated and divided into five categories. An ordered switching probability model with binary endogenous physical activity is developed to accommodate ordinality of depression categories and ameliorate statistical biases due to endogeneity of physical activity. PRINCIPAL FINDINGS: Average treatment effects suggest physical activity ameliorates depressive symptoms among mildly and moderately depressed individuals, most notably among mildly depressed women. Gender differences exist in the roles of sociodemographic factors, with age, income, race, education, employment status, and recent mental health condition playing differentiated roles in affecting depressive symptoms. CONCLUSIONS: Regular physical activity reduces depressive symptoms among both men and women with mild to moderate depression, notably among women.

An historical perspective on health-risk awareness and unhealthy behaviour: cigarette smoking in the United States 1949-1981.

OBJECTIVE: This paper investigates the change through time in the perception of smoking-related health harm and smoking behaviour from 1949 to 1981. BACKGROUND AND CONTEXT: A variety of common behaviours can be linked to chronic disease risk-smoking, over-eating, and excessive sitting, to name a few. Changing behaviours to reduce exposure to such risks can be an effort that spans generations and decades. SETTING AND PARTICIPANTS: Respondents to Gallup Poll surveys in the United States from 1949, 1954, 1957, 1971, 1972, 1977 and 1981. METHODS: Graphical analysis and probit regression are used to investigate trends through time and statistical associations of smoking with the perception of smoking-related health risks and other socio-demographic variables. INTERVENTION AND MAIN VARIABLE STUDIED: Perceived smoking health risk. MAIN OUTCOME MEASURE: Smoking participation. RESULTS AND CONCLUSION: Our findings include the proportions of individuals who were self-reported smokers fell between 1949 and 1981, from 0.48 to 0.34. Among smokers, the proportion who believed smoking was harmful increased from 0.52 in 1949 to 0.81 in 1981. By 1981, the proportion of non-smokers who believed smoking was harmful was 0.98. A negative association between belief in smoking harm and the decision to smoke was shown in regression analysis. This association became more pronounced over the three decades under study.

Consumption of fruits and vegetables in Malaysia: profiling the daily and nondaily consumers.

This study examines the sociodemographic factors associated with daily fruit and vegetable (FV) consumption in Malaysia. Based on a cross-sectional sample of 2447 individuals from the Malaysia Non-Communicable Disease Surveillance-1, a multivariate sample selection system is developed and estimated, to accommodate high frequencies of daily FV consumption and the days of servings among nondaily consumers. Results indicate that the authors' attempt to account for endogenous sample selectivity and cross-equation correlations is justified. There exist positive correlations between FV consumption likelihoods and longer work hours, higher levels of education, high income, female gender, nonsmoking status, and being from East Malaysia. Among nondaily consumers, those with longer work hours, singles, and people with diabetes are less inclined to eat fruits on more days. Overall, higher-educated, affluent people, nonsmokers, and East Malaysians display more days of FV consumption. Based on these outcomes, several policy implications are recommended vis-à-vis FV consumption patterns in Malaysia.

Out-of-pocket expenditures on traditional and Western medicine in Taiwan.

OBJECTIVES: Coexistence of traditional and modern medicine is common in Asian countries. This paper investigates out-of-pocket expenditures on traditional medicine, traditional medical service, and Western medicine by households in Taiwan. METHODS: Using a national sample of 13,765 households, the three expenditure equations are estimated with a censored system procedure. Effects of socio-demographic variables are explored by calculating marginal effects on probabilities and levels of medical expenses. RESULTS: Different types of medical expenditures are correlated. Households with higher income and more aging members use more traditional medicine than others, as do households in agricultural sector and in urban areas. In addition, households living in rural areas relative to those in the cities are more likely to use and also spend more on traditional service. Regional disparity of health care utilization is found. CONCLUSIONS: Higher income households spend more on traditional medicine, likely due to the fact that patients usually pay out-of-pocket for herbal materials needed in preparation of traditional medicine. To ensure equity in health care utilization, establishment of hospitals and clinics in rural areas should be considered.

Smoking cessation and body weight: evidence from the Behavioral Risk Factor Surveillance Survey.

OBJECTIVE: To investigate the role of smoking cessation in body weight. DATA SOURCES: 2004-2005 and 2009-2010 Behavioral Risk Factor Surveillance Surveys (BRFSS) (N = 349,000), Centers for Disease Control and Prevention; Tax Burden on Tobacco (Orzechowski and Walker 2010). STUDY DESIGN: The Gaussian treatment effect model is estimated for three age categories by gender. Treatment effects of quitting smoking on body mass index (BMI) by quit length are calculated. PRINCIPAL FINDINGS: Quitting is found to be endogenous. Differentiated effects of quitting smoking on BMI are found among quitters by gender, between age groups, and by length of time since quitting smoking, and positive association between smoking cessation and body weight confirmed. Declining smoking rates have only a modest effect in the overweight population. The effects of quitting on BMI are considerably lower among younger men and women. CONCLUSION: The price that must be paid, in terms of weight gain, to enjoy the health benefits of smoking cessation is trivial even for the obese population.

Who are eating and not eating fruits and vegetables in Malaysia?

OBJECTIVE: To investigate the roles of sociodemographic factors in fruit and vegetable (FV) consumption in Malaysia. METHODS: Data are obtained from the Malaysia Non-Communicable Disease Surveillance-1. Logistic regressions are conducted using a multiracial (Malay, Chinese, Indian and other ethnic groups) sample of 2,447 observations to examine the factors affecting individual decisions to consume FV on a daily basis. RESULTS: Based on the binary outcomes of whether individuals consumed FV daily, results indicate that work hours, education, age ethnicity, income, gender, smoking status, and location of residence are significantly correlated with daily fruit consumption. Daily vegetable consumption is significantly correlated with income, gender, health condition, and location of residence. CONCLUSIONS: Our results imply the need for programs to educate and motivate consumers to make healthier dietary choices. Interventions to increase FV consumption by changing behaviors should be considered, as should those that increase public awareness of the dietary benefits of FV. These intervention programs should be targeted at and tailored toward individuals who are less educated, younger, less affluent, males, smokers, and metropolitan dwellers.

Association between obesity and depression: evidence from a longitudinal sample of the elderly in Taiwan.

OBJECTIVES: Obesity has been identified as an epidemic worldwide. In Taiwan, the highest prevalence of obesity is observed in adults age ≥65. This article investigates the effects of body weight status on the likelihood of depression among the elderly in Taiwan. METHOD: A longitudinal sample of the elderly (1351 males and 1165 females) interviewed in both the 1999 and 2003 Surveys of Health and Living Status of the Elderly in Taiwan is used. A random effect logit model is estimated to examine the effects of body weight status, lifestyle, and socio-demographic characteristics on the likelihood of depression. RESULTS: About 10.4% of the elderly men are overweight and 13.4% are obese in 2003. A higher prevalence of obesity is found among elderly women, with 19.3% being overweight and 26.4% obese. Elderly men who are underweight are more likely to be depressed (odds ratio; OR = 2.36) than those from other weight categories, while overweight and obese women are less likely to be depressed (ORs = 0.72 and 0.61) than elderly women of the normal weight category. CONCLUSIONS: In contrast to most findings for the Western countries, a negative association between obesity and depression of the elderly is evident in Taiwan. The different findings between Western and Asian countries may be due to the cultural differences. Unlike the Western countries that stigmata are attached to excessive overweight, being overweight is not a symbol of unhealthiness because only the wealthy can afford to eat more and put on more weight in the Chinese society.

Determinants of body weight status in Malaysia: an ethnic comparison.

OBJECTIVE: To investigate the roles of sociodemographic and health lifestyle factors in affecting body mass index (BMI) across ethnic groups in Malaysia. METHODS: Data are obtained from 2,436 observations from the Malaysia Non-Communicable Disease Surveillance-1. The multi-ethnic sample is segmented into Malay, Chinese, and Indian/other ethnicities. Ordered probit analysis is conducted and marginal effects of sociodemographic and health lifestyle variables on BMI calculated. RESULTS: Malays between 41 and 58 years are more likely to be overweight or obese than their 31-40 years counterparts, while the opposite is true among Chinese. Retirees of Chinese and Indian/other ethnicities are less likely to be obese and more likely to have normal BMI than those between 31 and 40 years. Primary educated Chinese are more likely to be overweight or obese, while tertiary-educated Malays are less likely to suffer from similar weight issues as compared to those with only junior high school education. Affluent Malays and Chinese are more likely to be overweight than their low-middle income cohorts. Family illness history is likely to cause overweightness or obesity, irrespective of ethnicity. Malay cigarette smokers have lower overweight and obesity probabilities than non-cigarette smokers. CONCLUSIONS: There exists a need for flexible policies to address cross-ethnic differences in the sociodemographic and health-lifestyle covariates of BMI.

Ethnic disparities in metabolic syndrome in malaysia: an analysis by risk factors.

BACKGROUND: This study investigates ethnic disparities in metabolic syndrome in Malaysia. METHODS: Data were obtained from the Malaysia Non-Communicable Disease Surveillance-1 (2005/2006). Logistic regressions of metabolic syndrome health risks on sociodemographic and health-lifestyle factors were conducted using a multiracial (Malay, Chinese, and Indian and other ethnic groups) sample of 2,366 individuals. RESULTS: Among both males and females, the prevalence of metabolic syndrome amongst Indians was larger compared to both Malays and Chinese because Indians are more likely to exhibit central obesity, elevated fasting blood glucose, and low high-density lipoprotein cholesterol. We also found that Indians tend to engage in less physical activity and consume fewer fruits and vegetables than Malays and Chinese. Although education and family history of chronic disease are associated with metabolic syndrome status, differences in socioeconomic attributes do not explain ethnic disparities in metabolic syndrome incidence. The difference in metabolic syndrome prevalence between Chinese and Malays was not statistically significant. Whereas both groups exhibited similar obesity rates, ethnic Chinese were less likely to suffer from high fasting blood glucose. CONCLUSIONS: Metabolic syndrome disproportionately affects Indians in Malaysia. Additionally, fasting blood glucose rates differ dramatically amongst ethnic groups. Attempts to decrease health disparities among ethnic groups in Malaysia will require greater attention to improving the metabolic health of Malays, especially Indians, by encouraging healthful lifestyle changes.

Knowledge of dietary fats among US consumers.

Dietary advice emphasizes that some dietary fats increase the risk of heart disease, whereas other dietary fats decrease risk if they are substituted for more risk-increasing fats. Thus, it is important that consumers understand the differences between dietary fats. Existing evidence in the United States suggests troublesome consumer misunderstanding. As part of its continuing effort to promote public health, the US Food and Drug Administration measured consumer awareness and understanding of dietary fats in its Health and Diet Survey- 2004 Supplement. After cognitive interviews and pretests of the questionnaire, telephone interviews of randomly selected noninstitutionalized adults aged 18 years and older in the United States were conducted between October 12, 2004, and January 21, 2005. Using cross-sectional data collected from 1,798 respondents who completed the survey, this study estimated the prevalence of awareness and understanding of six dietary fats among US adults and identified the characteristics of adults with different levels of awareness and understanding. Descriptive analyses were used, along with logistic regression models, developed to accommodate the survey design and responses. There was a wide disparity among US consumers in their awareness and understanding. Saturated fat was most recognized and understood, whereas awareness of other fats was much lower. Most importantly, having heard of a fat did not necessarily mean understanding its relationship to heart disease. Only half of those who had heard of trans fat and n-3 fatty acids understood that the fats raise and lower the risk of heart disease, respectively. Only a minority of those who had heard of partially hydrogenated oil and polyunsaturated fat knew the fats raise and lower the risk of heart disease, respectively. Many admitted being uncertain about how a fat relates to the risk of heart disease. College or more-educated adults had better awareness and understanding. Nonwhite adults were less knowledgeable. Findings on the awareness and understanding and how they are related to individual characteristics can inform deliberations about educational messages, nutrition programs, and food labeling about dietary fats to promote public health.

Lifestyles, demographics, dietary behavior, and obesity: a switching regression analysis.

UNLABELLED: OBJECTIVES; To investigate the effects of lifestyles, demographics, and dietary behavior on overweight and obesity. DATA SOURCE: Continuing Survey of Food Intakes by Individuals 1994-1996, U.S. Department of Agriculture. STUDY DESIGN: We developed a three-regime switching regression model to examine the effects of lifestyle, dietary behavior, and sociodemographic factors on body mass index (BMI) by weight category and accommodating endogeneity of exercise and food intake to avoid simultaneous equation bias. Marginal effects are calculated to assess the impacts of explanatory variables on the probabilities of weight categories and BMI levels. PRINCIPAL FINDINGS: Weight categories and exercise are found to be endogenous. Lifestyle, dietary behavior, social status, and other sociodemographic factors affect BMI differently across weight categories. Education, employment, and income have strong impacts on the likelihood of overweight and obesity. Exercise reduces the probabilities of being overweight and obese and the level of BMI among overweight individuals. CONCLUSION: Health education programs can be targeted at individuals susceptible to overweight and obesity. Social status variables, along with genetic and geographic factors, such as region, urbanization, age, and race, can be used to pinpoint these individuals.

Impacts of ozone on the activities of asthmatics: revisiting the data.

This manuscript develops a conditional demand system for three activities (indoor chores and leisure, outdoor chores and active leisure, and outdoor inactive leisure), and considers how individuals' activity schedules respond to ozone pollution and asthma symptom severity. The data are for a sample of individuals living near Los Angeles. Our approach differs from earlier ones in that we use a system of equations that allows for correlations across activity types. The empirical results suggest that increased ozone levels have a statistically significant influence on the amount of time that asthmatics spend in one of the activities, even though the examined time period exhibited relatively low ozone levels. Elasticities are estimated to better indicate the sensitivity of humans' activity schedules to pollution levels, and the one ozone effect is shown to be fairly weak. This study adds to the existing literature on the influence of ozone on asthma and asthma sufferers, some of which finds a causal link while other studies do not. The study results are also of interest because the asthmatics in the sample are all adults, whereas some recent research showing a link between ozone and asthma has focused on children.

Do dietary intakes affect search for nutrient information on food labels?

Nutrition labels on food packages are designed to promote and protect public health by providing nutrition information so that consumers can make informed dietary choices. High levels of total fat, saturated fat and cholesterol in diets are linked to increased blood cholesterol levels and a greater risk of heart disease. Therefore, an understanding of consumer use of total fat, saturated fat, and cholesterol information on food labels has important implications for public health and nutrition education. This study explores the association between dietary intakes of these three nutrients and psychological or demographic factors and the search for total fat, saturated fat, and cholesterol information on food labels. Psychology literature suggests a negative association between intakes of these nutrients and probability of search for their information on food labels. Health behavior theories also suggest perceived benefits and costs of using labels and perceived capability of using labels are associated with the search behavior. We estimate the relationship between label information search and its predictors using logistic regressions. Our samples came from the 1994-1996 Continuing Survey of Food Intakes by Individuals and Diet and Health Knowledge Survey conducted by the United States Department of Agriculture. Results suggest that search for total fat, saturated fat, and cholesterol information on food labels is less likely among individuals who consume more of the three nutrients, respectively. The search is also related to perceived benefits and costs of using the label, perceived capability of using the label, knowledge of nutrition and fats, perceived efficacy of diets in reducing the risk of illnesses, perceived importance of nutrition in food shopping, perceived importance of a healthy diet, and awareness of linkage between excessive consumption of the nutrients and health problems. These findings suggest encouraging search of food label information among consumers with unhealthy dietary habits would need innovative approaches. Yet, nutrition education can be instrumental in encouraging this search by stimulating motivation and providing technical help.