Prevalence of Healthy Lifestyle Characteristics — Michigan, 1998 and 2000

Morbidity and Mortality Weekly Report, Sept 7, 2001

Most persons with chronic diseases such as cardiovascular disease, cancer, diabetes, and chronic lung disease share multiple common risk factors and lifestyle behaviors [1]. Tobacco use, poor diet, and physical inactivity have been identified as the leading contributors to overall mortality in the United States, accounting for one third of all deaths [2]; Michigan has a particularly high burden of chronic disease-related mortality [3]. To characterize the prevalence of four healthy lifestyle characteristics (HLCs) (i.e., healthy weight, adequate fruit and vegetable consumption, regular leisure-time physical activity [LTPA], and not smoking) in Michigan residents, data were analyzed from Michigan's Behavioral Risk Factor Surveillance System (BRFSS) for 1998 and 2000. This report summarizes the results of the analysis, which indicate that the proportion of Michigan residents who engaged in all four healthy lifestyle practices was extremely low, and that the prevalence was influenced by sex, education and self- reported health status. The comprehensive assessment of HLCs may be a useful adjunct to chronic disease surveillance.

BRFSS is a random-digit-dialed telephone survey of the noninstitutionalized U.S. population aged [greater than or equal to]18 years. Data were analyzed from 4816 adults for 1998 and 2000 combined. Missing data from 502 persons resulted in a sample size of 4314. Healthy weight was defined as having a body mass index between 18.5 and 25.0. Adequate fruit and vegetable consumption was defined as eating five or more fruits and vegetables daily. Regular LTPA was defined as at least 30 minutes of physical activity five or more times per week. Not smoking was defined according to self-reported absence of current cigarette use (i.e., former or never versus current). Data were weighted to adjust for the probability of selection and the distribution of the state's population by age, race/ethnicity, and sex. Descriptive analyses, including age-adjusted prevalence estimates, were generated for each demographic variable (age, race/ethnicity, education, and household income) and self-reported health status using SUDAAN. D ata were standardized by age to the projected 2000 U.S. population. Significant differences in the adjusted odds ratios (AORs) for engaging in all four HLCs were identified using a multiple logistic regression model that contained all independent variables.

An estimated 37.9% (95% confidence interval [Cl]=36.3%-39.5%) of Michigan adults had a healthy body weight, 22.8% (95% Cl=21.4%-24.2%) ate the recommended amount of fruits and vegetables, 25.9% (95% Cl=24.4%-27.4%) engaged in regular LTPA, and 72.3% (95% Cl=70.8%-73.8%) did not smoke. Overall, 11.2% (95% Cl=10.1%-12.3%) of adults engaged in none of these practices, 38.6% (95% Cl=37.0%-40.2%) in one, 33.3% (95% Cl=31.7%-34.9%) in two, 13.9 % (95% Cl=12.8%-15.0%) in three, and 3.0% (95% Cl=2.5%-3.5%) in all four.

The prevalence of engaging in all four HLCs was significantly different by sex, education, and health status (p[less than]0.05) (Table 1). The prevalence of engaging in all four HLCs was lower in men (age-adjusted prevalence=1.6%) than in women (age-adjusted prevalence=4.5%; AOR=0.3; 95% Cl=0.2-0.5). The prevalence of engaging in all four HLCs increased with education. The prevalence in college graduates was more than three times higher than in those with a high school education or less (AOR=3.2; 95% Cl=1.7-6.1). However, the age-adjusted prevalences were still very low in all three education groups (Table 1). The prevalence of engaging in all four HLCs decreased with decreasing health status. Persons reporting excellent health had a much higher age-adjusted prevalence (7.1% [95% Cl=5.3%-8.9%]) than adults with fair or poor health (1.0% [95% Cl=0.1%-1.9%; AOR=0.1; 95% Cl=0.04-0.4]). However, the prevalence rates in all four groups were low (Table 1).

Reported by: MJ Reeves, PhD, Dept of Epidemiology, College of Human Medicine, Michigan State Univ, East Lansing; A Rafferty, PhD, H McGee, MPH, C Miller, PhD, Bur of Epidemiology, Michigan Dept of Community Health. Cardiovascular Health Br, Div of Adult and Community Health, and Physical Activity and Health Br, Div of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note: The findings in this report document the low prevalence of healthy lifestyles in Michigan. The prevalence of HLCs in this report is consistent with that in the Nurses Health Study for a similar grouping of five healthy lifestyle behaviors [4] and is indentical to that from the overall 2000 BRFSS data. When compared with other states, obesity and smoking in Michigan are higher than the national average [5]. However, the daily consumption of five fruits and vegetables in Michigan is consistent with the national average, and Michigan ranked among the top 10 states for participation in regular and sustained physical activity in 2000.

Disease risk, especially that related to cardiovascular disease, has usually been examined separately. Some studies have measured disease risk more comprehensively by combining factors such as smoking, obesity, hypertension, and high blood cholesterol [6]. This study used a similar approach by assessing the combination of healthy factors that reduce disease risk, which may be a useful adjunct to the more traditional risk factor surveillance method.