NCD-Related Lifestyle Patterns from Childhood to Adolescence: A 13

Years Longitudinal StudyYi-Han Changa, Lee-Lan Yena,b, Hsing-Yi Changb, Chi-Chen Wub

a Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwanb Division of Preventive Medicine and Health Service Research, Institute of Population Health Science, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan, ROC

APHA 143rd Annual Meeting and Exposition

Outline

• Background

• Method

• Result

• Conclusion

2

Non-communicable diseases (NCDs)

• Non-communicable diseases (NCDs)• known as chronic diseases• 4 main types of NCDs: cardiovascular diseases ,cancers, chronic

respiratory diseases and diabetes (WHO, 2015)

• Burdens of NCDs• 2012: 38 million people have died of NCDs (68% of all deaths globally)

Sixteen million NCD deaths occur before the age of 70 (WHO, 2015)

• 2000-2012: NCD deaths have increased the most in the WHO South-East Asia Region and Western Pacific Region (WHO, 2014)

• In Taiwan, eight of the ten leading causes of death were NCDsresponsible for 66% of deaths in 2013 (MOHW, 2014)

3

Modifiable behavioural risk factors

• most common modifiable behaviors (WHO, 2013)

• typically establish during adolescence and persist throughout life (Kipping, Campbell, MacArthur, Gunnell, & Hickman, 2012)

unhealthy diet

tobacco use harmful use of alcohol

physical inactivity

4

Healthy lifestyle

(Dever, 1976 、 1991)

5

27%

19%

Human Biology

Environment

43%

11%

Lifestyle

Health Care Organization(Lalonde, 1974)

A healthy lifestyle is…• aggregation of decisions by individuals which affect their health and over which they more or less have control (Lalonde, 1974)

•Patterns of behavior that maximize one's quality of life and decrease one's susceptibility to negative health outcomes (Report of the 2000 Joint Committee on Health Education and Promotion Terminology, 2002)

• “collective patterns of health-related behavior based on choices from options available to people according to their life chances” (Cockerham, 2000, 2007)

Lifestyle or single behavior?

6

Lifestyle is a collective pattern of health-related behaviors

• Risk health behaviors tend to cluster together• coexistence of risk behaviors increases the likelihood of NCDs • Interventions targeting the underlying lifestyle and associated

identities may be effective than focusing on a single behavior

Knowledge gap in healthy lifestyle research

• focus on single behavior• most researches in a healthy lifestyle perspective targeted

adults population• cross-sectional data• various behavior indicators

• In this study…using a longitudinal data during childhood and adolescence finding underlying lifestyle patterns placing emphasis on the four main behaviors related to NCDs

7

Aim

• To investigates distinct lifestyle development patterns and the predictors from childhood to adolescence.

8

Outline

• Background

• Method

• Result

• Conclusion

9

Data• Child and Adolescent Behavior in Long-term Evolution (CABLE) project• 2001-now

10

Methods of repeat measurement

• Latent Growth Curve Model(LGCM)

• Multilevel Modeling

• Growth Mixture Models(GMMs)

• Group-based Trajectory Model

• Repeated-measures Latent Class Analysis

Intercept

behaviortime1

behaviortime2

behaviortime3

ClassLatent class

Categorical variable

Slope

11

Variable- NCD-related Lifestyle Patterns

• four behavior indicators • measured when sample was grade 5th, 7th, 9th, 10th, 12th, 14th

• eating vegetables and fruits everyday

(Yes/ No)•physical activity three times a week

(Yes/ No)•no tobacco use (Yes/

No)•no alcohol use (Yes/

No)

NCD-related Lifestyle Patterns

repeated-measures latent class analysis (RMLCA)

【 Categorical variable 】

12

【 Categorical variable 】

Variables- Focus variables

Gender• Boy, Girl

Mother’s Education • Junior high or below, Senior high, College and above

Husband's education• Junior high or below, Senior high, College and above

Parents marital status • Married, Divorced or single

Family monthly income• < 39,999、 40,000~99,999、 > 100,000 (NTD)

Emotional Variability• 0~10

13

Data Analysis

Statistics Method• repeated-measures latent class analysis (RMLCA)• multinomial logistic regression model

Statistics Software• SAS 9.2

Outline

• Background

• Method

• Result

• Conclusion

15

Characteristics of Participants

• Total : 2,415 students• 51.41% boys• father’s education : 48.73% college and above, 34.94% high

school and 16.33% junior high and under• mother’s education: 46.53% high school, 36.41% college and

above and 17.77% junior high and under • Income: 52.89% middle income family, 27.07% high and

20.04% low• 8% students came from single parent family• mean score of emotional variability is 3.98 (range 0-10)

16

Bayesian information criterion values

17

item probability

18

V: eating vegetables and fruits everydayPA: physical activity three times a week

T: no tobacco use A: no alcohol use

Class 1- persistently inactive lifestyle (18.64%)

19

V: eating vegetables and fruits everydayPA: physical activity three times a week T: no tobacco use A: no alcohol use

Class 2-high risk lifestyle (12.02%)

20

V: eating vegetables and fruits everydayPA: physical activity three times a week T: no tobacco use A: no alcohol use

Class 3- early alcohol use (12.64%)

21

V: eating vegetables and fruits everydayPA: physical activity three times a week T: no tobacco use A: no alcohol use

Class 4- lack of health promotion lifestyle (19.29%)

22

V: eating vegetables and fruits everydayPA: physical activity three times a week T: no tobacco use A: no alcohol use

Class 5-persistent healthy lifestyle (22.97%)

23

V: eating vegetables and fruits everydayPA: physical activity three times a week T: no tobacco use A: no alcohol use

Class 6- non-smoking lifestyle(14.44%)

24

V: eating vegetables and fruits everydayPA: physical activity three times a week T: no tobacco use A: no alcohol use

25

1: persistently inactive lifestyle (18.64%), 2: high risk lifestyle (12.02%), 3: early alcohol use (12.64%), 4: lack of health promotion lifestyle(19.29%), 5: persistently healthy lifestyle (22.97%), 6: non-smoking (14.44%)

Class 1 Class 2 Class 3

Class 4 Class 5 Class 6

Adjusted multinomial logistic regression models of the association of factors with NCD-related trajectory patterns among students in the CABLE cohort

1: persistently inactive lifestyle (18.64%), 2: high risk lifestyle (12.02%), 3: early alcohol use (12.64%), 4: lack of health promotion lifestyle(19.29%), 5: persistently healthy lifestyle (22.97%), 6: non-smoking (14.44%)

Outline

• Background

• Method

• Result

• Conclusion

27

NCD-related lifestyle development patterns were found

• The existence of heterogeneity of NCD-related lifestyle development patterns during childhood and adolescence was found.

• Unhealthy diet and inactivity behaviors existed even among those who presented non-smoking or non-drinking subgroups

• It is interesting to note latent classes that did not emerge in this analysis. For example, the model does not include a latent class characterized by improving healthy lifestyle.Adolescents got decreasing probability to live with healthy

behaviors In all lifestyle patterns

28

Important factors associated with lifestyle• We also found preliminary evidence of differential clustering by

gender, parents’ education level, family income, parents’ marriage status and personal personality.

29

Critical time point • good eating vegetables and fruits behaviors

• relatively stable from elementary school period• alcohol use: junior high school period• tobacco use: grade 7 (entry to junior high school)

Future research…

• To identify the mechanism of subgroups lifestyle patterns and the shared affecting factors, thus policies or interventions aim to multiple behaviors can be designed accordingly.

30

Thank You for Your Attention