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1 Journal of Preventive Medicine and Public Health January 2010, Vol. 43, No. 1, 7383 doi: /jpmph High Risk Groups in Health Behavior Defined by Clustering of Smoking, Alcohol, and Exercise Habits: National Heath and Nutrition Examination Survey Kiwon Kang, Joohon Sung, Changyup Kim Department of Preventive Medicine, School of Public Health, Seoul National University Objectives: We investigated the clustering of selected lifestyle factors (cigarette smoking, heavy alcohol consumption, lack of physical exercise) and identified the population characteristics associated with increasing lifestyle risks. Methods: Data on lifestyle risk factors, sociodemographic characteristics, and history of chronic diseases were obtained from 7,694 individuals 20 years of age who participated in the 2005 Korea National Health and Nutrition Examination Survey (KNHANES). Clustering of lifestyle risks involved the observed prevalence of multiple risks and those expected from marginal exposure prevalence of the three selected risk factors. Prevalence odds ratio was adopted as a measurement of clustering. Multiple correspondence analysis, Kendall tau correlation, ManWhitney analysis, and ordinal logistic regression analysis were conducted to identify variables increasing lifestyle risks. Results: In both men and women, increased lifestyle risks were associated with clustering of: (1) cigarette smoking and excessive alcohol consumption, and (2) smoking, excessive alcohol consumption, and lack of physical exercise. Patterns of clustering for physical exercise were different from those for cigarette smoking and alcohol consumption. The increased unhealthy clustering was found among men 2064 years of age with mild or moderate stress, and among women 3549 years of age who were nevermarried, with mild stress, and increased body mass index (>30 kg/m 2 ). Conclusions: Addressing a lack of physical exercise considering individual characteristics including gender, age, employment activity, and stress levels should be a focus of health promotion efforts. Key words: Lifestyle, Risk factors, Cluster analysis J Prev Med Public Health 2010;43(1):7383

4 Table 1. Characteristics of the study population Men Women Men Women n % n % n % n % Number of subject Age (yr) Education Elementary High school University Occupation Professionals Clerks Service workers Farmers and Fishers Craft and trade workers Armed forces Students Housewives Unemployed Income (quartile) 1st (lowest) 2nd 3rd 4th (highest) Marital status Married Never married Divorced, widowed, separated Body mass index (kg/m 2 ) < Area of residence Rural Urban 3, , ,635 1, , , , [missing rate : 6.5%] [missing rate : 35.3%] ,239 1,170 1, ,200 1,937 1, , , , [missing rate : 80.0%] [missing rate : 27.6%] Perceived stress Severe Moderate Mild Chronic disease Hypertension Diabetes Dyslipidemia Hypertension duration (yr) < Diabetes duration (yr) < Dyslipidemia duration (yr) < Cigarette smoking Never smokers Exsmokers Current smokers Alcohol consumption None or minimal Moderate Excessive Physical exercise Health enhancing Minimal Inactive , ,247 [missing rate : 39.4%] [missing rate : 27.2%] [missing rate : 88.9%] ,088 1,824 1, , , ,226 2, ,084 [missing rate : 26.5%] [missing rate : 27.0%] [missing rate : 88.6%] , , ,

5 Table 2. Clustering of cigarette smoking, excessive alcohol consumption, and lack of physical exercise Number of risk factors Cigarette smoking Excessive alcohol consumption Lack of physical exercise Observed frequency (O) (%) Men Expected frequency (E) (%) O/E Observed frequency (O) (%) Women Expected frequency (E) (%) O/E Table 3. Observed of expected prevalence odds ratio for each combination of cigarette smoking, excessive alcohol consumption, and lack of physical exercise S() and A() among E() S() and A() among E() S() and E() among A() S() and E() among A() A() and E() among S() A() and E() among S() OR: odds ratio, CI confidence interval S: Cigarette smoking A: Excessive alcohol consumption E: Lack of physical exercise Men OR (95%CI) 2.38 ( ) 1.76 ( ) 1.28 ( ) 0.94 ( ) 0.87 ( ) 0.64 ( ) Women OR (95%CI) 6.93 ( ) 6.42 ( ) ( ) ( ) ( ) ( )0

6 Figure 1. Relationship between lifestyle risk factor and demographic, socioeconomic, and healthstatus. * Age_1: age 2034 years, Age_2: age 3549 years, Age_3: age 5064 years, Age_4: age 65 years, Risk_0: number of risk factors 0, Risk_1: number of risk factors 1, Risk_2: number of risk factors 2, Risk_3: number of risk factors 3. Smok_1: never smokers, Smok_2: exsmokers, Smok_3: current smokers, Alcol_1: none or minimal alcohol consumption, Alcol_2: moderate alcohol consumption, Alcol_3: excessive alcohol consumption, Exer_1: health enhancing physical exercise, Exer_2: minimal physical exercise, Exer_3: inactive physical exercise, Job_1: professionals, Job_2: clerks, Job_3: service workers, Job_4: farmers and fishers, Job_5: craft workers Job_6: armed forced, Job_7: students, Job_8: housewives, Job_9: unemployed, Income_1: 1st quartile(lowest) income, Income_2: 2nd quartile income, Income_3: 3rd quartile income, Income_4: 4th quartile(hightest) income, Mar_1: married, Mar_2: never married, Mar_3: divorced, widowed, separated, bmi_1: bmi <23 kg/m 2, bmi_2: bmi 23 ~<25 kg/m 2, bmi_3: bmi 25 ~<30 kg/m 2, bmi_4: 30 kg/m 2, Pla_0: urban, Pla_1: rural, Str_1: mild stress, Str_2: moderate stress, Str_3: severe stress. Htn_0: hypertensionno, Htn_1: hypertensionyes, m_0: diabetesno, Dm_1: diabetesyes, Lid_0: dyslipidemiano, Lid_1: dyslipidemiayes, Htn_age_1: hypertension duration <5 years, Htn_age_2: hypertension duration 59 years, Htn_age_3: hypertension duration 10 years, Dm_1: diabetes duration <5 years, Dm_2: diabetes duration 59 years, Dm_3: diabetes 10 years, Lid_age_1: dyslipidemia duration <5 years, Lid_age_2: dyslipidemia duration 59 years, Lid_age_3: dyslipidemia duration 10 years Invisible label variable (contribution score is low) : Edu_2, Lid_0, Dm_0, Pla_0, Htn_age_1, Lid_age_1

7 Table 4. Association between demographic and health status characteristics, and having multiple health risks Age (yr)* (2034, 3549, 5064, 65) Education* ( elementary, high school, university) Income(quartile)* (1st(lowest), 2nd, 3rd, 4th(highest)) Cigarette smoking (never smokers. exsmokers, current smokers) Alcohol consumption* (none or minimal, moderate, excessive) Lack of physical exercise* (health enhancing, minimal, inactive) Body mass index(kg/m2) (<23, 2324, 2529, 30.0) Perceived stress* (mild, moderate, severe) Diabetes (no, yes) Hypertension (no, yes) Dyslipidemia (no, yes) Diabetes duration (years)* (<5. 59, 10) Hypertension duration (years)* (<5. 59, 10) Dyslipidemia duration (years)* (<5. 59, 10) * Kendall s Tau correlation, MannWhitney U. Men Women Coefficient pvalue Coefficient pvalue Table 5. Odds ratios (OR) and 95% confidence interval (CI) of predictors of the number of lifestyle risk factors Age (yr) Education University High school Elementary Occupation Nonmanual Manual Unemployed, others Income (quartile) 4th (highest) 3rd 2nd 1st (lowest) Marital status Married Never married Divorced, widowed, separated Area of residence Rural Urban Perceived stress Severe Moderate Mild Body mass index (kg/m 2 ) < Men OR (95% CI) Women OR (95% CI) 1.84 ( ) ( ) 3.13 ( ) ( ) 3.11 ( ) 2.90 ( ) 1.16 ( ) ( ) 1.32 ( ) 3.41 ( ) 0.99 ( ) ( ) 1.15 ( ) ( ) 1.11 ( ) ( ) 1.03 ( ) ( ) 1.15 ( ) ( ) 1.42 ( ) 3.82 ( ) 1.14 ( ) ( ) 0.96 ( ) ( ) 1.58 ( ) ( ) 2.01 ( ) ( ) 0.88 ( ) ( ) 0.81 ( ) ( ) 0.84 ( ) 4.55 ( )

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