Head of Scientific Laboratory Epidemiology of Hypertension, Almazov Federal heart, Blood and Endocrinology Centre, Saint-Petersburg, Russia
Received June 11, 2012; Accepted July 16, 2012; Published July 20, 2012
Citation: Oxana R (2012) Health Behaviors and Attitudes in Young and Middle-Aged Saint-Petersburg Citizens (Russia): A Pilot Study. J Addict Res Ther S8:003. doi:10.4172/2155-6105.S8-003
Copyright: © 2012 Oxana R. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Objective: To assess influence of health attitudes on health behavior and cardiometabolic risk in young and middleaged Saint-Petersburg (Russia) citizens. Design and methods: 103 participants (30 males, 73 females) aged 16-59 years were screened during a cultural health promotion event “Heart of the World”. Lifestyle characteristics, anthropometry, blood pressure and blood glucose were measured. Questions about internal and external barriers to health behavior were asked and health locus of control was assessed. Results: The study revealed a high prevalence of cardiometabolic risk factors, especially in men. In the participants’ implicit beliefs about appropriate care of health a number of healthy lifestyle norms (concerning alcohol consumption, smoking, sleep duration, fish, fruit and vegetable intake) were not represented. Among most prevalent subjective barriers to health lifestyle and regular preventive medical examinations were “lack of time”, “lack of wish” (more typical in men) and “lack of willpower” (more typical in women). Attitude risk factors of unhealthy lifestyle and cardiomeatbolic disturbances in were “lack of wish” as the main subjective barrier to care of health and chance health locus of control. Conclusion: Implicit beliefs about healthy lifestyle and controllability of disease risk, as well as subjective barriers to care of health should be taken into account in developing and carrying out preventive medical programs and routine medical practice.
Health attitudes; Cardiomeatbolic disturbances; Saint-Petersburg
Healthy lifestyle is considered nowadays one of the most important issues for preventive medicine and the healthcare system in general. Attention to this problem is affected, on one hand, by the large impact of behavioral risk factors for morbidity and mortality, in particular cardiovascular, on the other hand: by lack of scientific base for effective medical prevention, inconsistency of health-behavior theoretical models and only empirical evidence [1,2]. Deficiency of well-argumented healthbehavior theories in Russia leads to specific difficulties in development and implementation of preventive programs. Meanwhile, sufficient data have been accumulated in sociological and epidemiological studies that document insufficiency and contradictions in health beliefs in Russian population. Besides, there is convincing evidence for high prevalence of behavioral and other standard cardiovascular risk factors in Russia that can explain a considerable part of the overall disease burden [3-7]. The general idea of genetics as a major determinant of cardiovascular risk can be a cofounder for less attention to lifestyle risk factors and a reason for fatalistic behavior in the population. Moreover additional gender discrepancies in health behavior remain unclear, and relationships between health beliefs, lifestyle and cardio metabolic parameters need further investigation in order to find specific psychological targets for the prevention and treatment of cardiovascular and other widespread noninfectious diseases.
The aim of the present study was to identify health attitudes and health behaviors and their relation to cardio metabolic risk in young and middle-aged Saint-Petersburg inhabitants, who were potentially interested to participate in prevention medical programs.
The data were collected during two days in December 2011 within an open health promotion event “Heart of the World”, organized by Almazov Federal Heart, Blood and Endocrinology Centre with a supervision of Healthcare Committee of St. Petersburg Administration.
The event was organized in an Arts-and-entertainment centre of Saint-Petersburg and comprised of an art exhibition and medical examination including lifestyle counseling. The primary objective of the study was cardio metabolic risk factors screening. All examinations were performed on the voluntary and anonymous basis by trained medical specialists. All respondents were informed about examination results and were provided by recommendations concerning health behavior, lifestyle changes and treatment in case of increased cardiometabolic risk.
In this paper we focused on young and middle-aged respondents who represent the most favorable target for prevention strategies. From 30% of the visitors the informed consent was obtained for participation in the survey and examination. One-hundred and three (30 males, 73 females) young and middle aged subjects (from 16 to 60 years old) were included into analyses.
The study design made necessary to apply very brief and easy behavior measures and short questionnaires.
The assessed parameters were height, body weight, and waist circumference (WC). The body mass index (BMI) was calculated according to the Kettle’s formula (kg/m2).
|Age, health behavior and cardiometabolic parameters||Females
|Tobacco smoking||smokers||13 (17.8%)||18 (60.0%)||<0.001|
|former smokers||23 (31.5%)||3 (10.0%)|
|non-smokers||37 (50.7%)||9 (30.0%)|
|Alcohol consumption||each day||1 (1.4%)||1 (3.3%)||<0.05|
|one or several times per week||13 (17.8%)||14 (46.7%)|
|several times per month||20 (27.4%)||7 (23.3%)|
|less frequently than several times per month / never||39 (53.4%)||8 (26.7%)|
|Regularly (at least once per week) participate in active leisure or sport||37 (50.7%)||15 (50.0%)||NS|
|Fresh vegetable and fruit intake (days per week) (M±m)||5.3±0.2||3.2±0.4||<0.001|
|Fish intake (days per week) (M±m)||1.7±0.2||1.5±0.3||NS|
|Time of being in a sedentary position (hours per day) (M±m)||7.1±0.4||6.5±0.6||NS|
|Night-sleep duration (hours) (M±m)||7.1±0.2||7.0±0.3||NS|
|Have preventive medical examinations regularly||22 (30.1%)||3 (10.0%)||<0.05|
|Systolic BP (mm HG) (M±m)||127.2±2.6||138.3±3.4||<0.05|
|Systolic BP > 140 mm Hg||11 (15.1%)||15 (50%)||0.001|
|Diastolic BP (mm HG) (M±m)||76.8±1.2||81.9±1.9||<0.05|
|Diastolic BP > 90 mm Hg||7 (9.6%)||5 (16.7%)||NS|
|Systolic BP / Diastolic BP > 140/90 mm Hg||4 (5.5%)||4 (13.3%)||NS|
|Body mass index (Kettle’s index) kg/m2 (M±m)||20.3±0.5||23.9±0.9||<0.01|
|BMI > 25 kg/m2||12 (16.4%)||9 (30%)||<0.01|
|Waist > 80 cm (females) / 94 cm (males)||20 (27.4%)||6 (20.0%)||NS|
|Non-fasting blood glucose level (mmol/l) (M±m)||5.8±0.4||5.5±0.1||NS|
*NS – non significant (p>0.05).
Table 1: Health behavior and cardiometabolic characteristics of the participants.
Blood pressure measurement
It was assessed by an automatic tonometer (Omron, Japan). Blood pressure (BP) was measured in a sitting position after a 5-minute rest three times at 1-minute intervals on the right arm. The average value of the two last BP measurements was calculated.
Blood glucose measurement
It was performed by a portable Accu-Chek glucometer (Roche Diagnostics, Switzerland).
The interview consisted of open and closed questions about lifestyle and health behaviors (tobacco smoking, alcohol consumption, fish, fruit and vegetable intake, physical activity, sleep duration, concomitant diseases, frequency of preventive medical examinations).
Additional questions about health attitudes were included: two questions about subjective barriers for healthy lifestyle and one question assessing health locus of control.
Questions about subjective barriers were “If you don’t give enough attention to healthcare, what is the main cause of that?” and “If you don’t pass preventive medical examination regularly, what is the main cause of that?” The respondents were asked to choose one of the following answers: a) “lack of time”; b) “lack of willpower”, c) “lack of wish”, d) “lack of knowledge/information”, e) “I pay enough attention to healthcare” (or “I pass preventive medical examinations regularly”) or offer their own explanations.
The question aimed to determine health locus of control was: “Please, indicate whether you agree or disagree with the following statement: “Getting ill is a matter of chance, if you are to get sick, nothing can be done”.
Standard descriptive statistics (frequency, the mean, standard error of mean) was used for assessment of prevalence and distribution of different behavioral and cardio metabolic characteristics. Kolmogorov-Smirnov criterion was applied for checking normality of distribution. Assessment of discrepancies between subgroups by quantitative variables was carried out with nonparametric Mann- Whitney test. Spearmen’s rank correlation was applied to evaluate associations between quantitative variables, in the case of quantitative and qualitative variables -Chi-square test was used for association assessment.
(<40 years old)
(≥40 years old)
|Tobacco smoking||smokers||26 (34.7%)||5 (17.9%)||NS|
|former smokers||16 (21.3%)||10 (35.7%)|
|non-smokers||33 (44.0%)||13 (46.4%)|
|Alcohol consumption||each day||1 (1.3%)||1 (3.6%)||<0.05|
|one or several times per week||23 (30.7%)||4 (14.3%)|
|several times per month||23 (30.7%)||4 (14.3%)|
|less frequently than several times per month / never||28 (37.3%)||19 (67.8%)|
|Regularly (at least once per week) participate in active leisure or sport||40 (53.3%)||12 (42.9%)||NS|
|Fresh vegetable and fruit intake (days per week) (M±m)||4.7±0.3||4.7±0.4||NS|
|Fish intake (days per week) (M±m)||1.7±0.2||1.6±0.3||NS|
|Time of being in a sedentary position (hours per day) (M±m)||7.1±0.3||6.4±0.6||NS|
|Night-sleep duration (hours) (M±m)||7.1±0.2||7.2±0.3||NS|
|Have preventive medical examinations regularly||17 (22.7%)||8 (28.6%)||NS|
|Report adequate care of health||9 (12.0%)||3 (10.7%)||NS|
|Systolic BP (mm HG) (M±m)||123.9±1.9||147.2±4.6||<0.001|
|Systolic BP > 140 mm Hg||11 (14.7%)||15 (53.6%)||<0.001|
|Diastolic BP (mm HG) (M±m)||75.8±1.1||84.8±1.9||<0.001|
|Diastolic BP > 90 mm Hg||7 (9.3%)||5 (17.9%)||NS|
|Systolic BP / Diastolic BP > 140/90 mm Hg||3 (4.0%)||5 (17.9%)||<0.05|
|Body mass index (Kettle’s index) kg/m2 (M±m)||20.7±0.6||22.8±0.7||<0.05|
|BMI > 25 kg/m2||14 (18.7%)||7 (25.0%)||NS|
|Waist > 80 cm (females) / 94 cm (males)||12 (16.0%)||14 (50.0%)||<0.001|
|Non-fasting blood glucose level (mmol/l) (M±m)||5.4±0.1||5.7±0.1||NS|
*NS – non significant (p>0.05).
Table 2: Behavior and cardiometabolic differences between younger and older participants.
Health behavior and cardio metabolic status
Results of survey interview with gender discrepancies are shown in Table1.
Cardio metabolic risk factors were highly prevalent among the respondents, especially in men. This was documented concerning behavioral risk factors, as well as objective parameters. Both men and women reported low fish, fruit and vegetable intake and frequently avoided to pass medical examination.
Table 2 illustrates differences in cardio metabolic and behavior parameters between younger (<40 years old) and older ( ≥ 40 years old) participants.
Older subjects have more cardio metabolic disturbances: higher systolic and diastolic BP, waist measurement and Kettle’s BMI, but health behavior characteristics are mainly similar between older and younger participants, except for alcohol consumption.
Agreement between health behaviors: whether the respondents are consistent?
Generally describing lifestyle, only 11.7% of the respondents reported that they concentrate sufficient time and attention on their health. Comparing their particular health behaviors with those of persons, indicating insufficient care (Table 3), revealed only moderate differences, concerning the amount of physical activity and preventive medical examinations. Also participants with reported good care of health had lower non-fasting blood glucose level. There were no differences between the groups in alcohol consumption, smoking, sleep duration, fish, fruit and vegetable intake.
|Health behavior and cardio metabolic parameters||Participants
reporting good care of health
reporting poor care of health
|Regularly (at least once per week) participate in active leisure or sport||10 (83.3%)||42 (46.2%)||<0.05|
|Have preventive medical examinations regularly||6 (50.0%)||19 (20.9%)||<0.05|
|Non-fasting blood glucose level (mmol/l) (mean ranks)||23.2||44.1||<0.01|
Table 3: Significant behavior and cardio metabolic differences between participants reporting good and poor care of health.
Interestingly, different health behaviors only slightly correlated with each other: smokers had reduced fruit and vegetable intake (Chisquare= 14.2, p<0.05), sedentary lifestyle was associated with less fruit and vegetable consumption (rho=-0.25, p<0.05), frequency of fish, fruit and vegetable intake directly correlated (rho=0.34, p=0,001). There were no other correlations between health behaviors.
Health behavior and cardio metabolic risk: whether the respondents’ self-care of health is effective?
Surprisingly, we found rather weak correlations between health behaviors and anthropometrical parameters. Women with sedentary life had higher BMI (rho=0.23, p<.05). In men shorter sleep duration was associated with higher systolic BP (rho=-0.49, p<0.05).
Among younger subjects less that 40 years old frequency of alcohol consumption correlated with BMI (rho=0.29, p<0.05) and waist measurement (rho =0.43, p<0.01). Moreover, current smokers had higher BMI (mean ranks are 44.6 vs. 31.3 U=328.0, p=0.01). Among older respondents more sedentary time was associated with higher blood glucose (rho=0.45, p<0.05).
Respondents’ explanations for insufficient attention to health
In order to specify obstacles to healthy lifestyle the respondents’ answers to the questions about barriers were analyzed. Insufficiency of attention to health was explained by “lack of time” in 47.3% of cases, by “lack of wish”- in 28.6%, by “lack of willpower” in 18.7%, by “lack of knowledge/information” only - in 3.3%, specific answer “lack of trust to medicine and physicians” were provided by 2.2% subjects. Moreover, 42.3% of subjects did not attend regular medical examinations due to the “lack of time”, 42.3% - due to the “lack of wish”, 5.4% - due to the “lack of willpower”, 5.4% - due to the “lack of knowledge/information”, and 4.6% offered alternative answers (“lack of trust”, “organizational difficulties”, etc).
Both genders more frequently reported “lack of time” to be the barrier for healthy lifestyle, but other explanations were gender related: women appear to be more inclined to report inability to be persistent with health behaviors (“lack of willpower” was reported by - 34.2% females vs. 11.8% males, p<0.05). Alternatively, poor motivation was more typical for male gender (50% males vs. 21.9% females; p<0.01). Men were also more likely to report the “lack of knowledge/ information” as the main perceived barrier to attend medical examinations (p<0.05).
Subjective barriers for healthy behavior
The most “favorable” explanation for inadequate care about health was “lack of time”: subjects, who gave this answer didn’t differ from those, who reported adequate care of health in most behavioral and physical characteristics except the level of physical activity: 55.8% participated regularly in active leisure or sport compared to 84.6% in the other group (p<0.05). “Lack of time” as a subjective barrier to regular medical examinations was also associated with shorter sleep duration compared to respondents with regular medical examinations (mean ranks 22.8 vs. 31.7 U=233.5, p<0.05).
On the other hand, the most “unfavorable” choice concerning cardio metabolic risk was “lack of wish”. Respondents who pointed out this subjective barrier had lower fruit and vegetable intake, less physical activity and sleep duration, than those, who indicated adequate care and those who mentioned any other obstacle. Thus, in 48.0% of “lack of wish” answering subjects sleep duration was ≤ 6 hours (vs. 31.3% in the two other groups, p<0.05); 60% of them consumed fresh fruit and vegetable less than 4 days per week (vs. 27.3% in the two other groups, p<0.05); 65.4% didn’t participate in active rest or sports (vs. 15.4% of those who indicated adequate care of health, p < 0,01).
“Lack of wish” as the main cause of non-participation in medical preventive examinations was associated with smoking status (Chisquare = 4.06, p<0.05), less sleep duration (Chi-square = 30.0, p<0.001) and more frequent alcohol consumption (Chi-square = 8.2, p<0.05).
Thus, “non-wish” explanation for insufficient care of health and avoiding preventive examinations in young and middle-aged adults may be considered as an indirect marker of unhealthy lifestyle and increased cardio metabolic risk.
Health locus of control beliefs: fatalism as a risk cofactor
To identify the role of health locus of control in determining health behavior answers to the question about level of agreement with the statement “Getting ill is a matter of chance, if you are obese or sick nothing can be done” were analyzed. According to the survey results 33.0% of the respondents absolutely disagree with the statement, 36.9% – “rather disagree”, 24.3% – “rather agree” and 5.8% - “absolutely agree”. There was no significant difference between men and women and between age groups in this issue. Thus it could be supposed that almost one third of the respondents have chance (external) health locus of control or were fatalistic.
Respondents, seeing the association of diseases with “fate” had more prevalent hypertension (47.8% compared to 18.0% in non-fatalistic subjects for systolic BP over 140 mmHg, p<0.05), (34.8% compared to 8.2% for diastolic BP over 90 mmHg p<0.05), were more likely to be current smokers (48,4% vs. 23,6%, p<0,05) and had a lower sleep duration (mean ranks 35.5 vs. 53.0 U=580.5, p<0,01). Only two (6.7%) of “fatalistic externals” had regular medical examinations (compared to 31.5% of non-fatalistic subjects, p<0.01) and only 30% went for sports and/or active leisure (vs. 57.5%, p<0.05).
Interestingly, health locus of control was not associated with the respondents’ perceived level of care of health and explanation of its insufficiency. This allows supposing, that health locus of control and perceived barriers to healthy lifestyle can affect health behavior more or less independently.
The current study was aimed to identify health behaviors, attitudes, and cardio metabolic characteristics in St.Petersburg (Russia) inhabitants. Because only 30% of the Art gallery visitors agreed to participate in the survey we can conclude that the screened group was potentially interested in health assessment and prevention.
The necessity of this research is determined first of all by the significant influence of behavioral factors on health, including risk of cardiovascular and metabolic diseases. Thus, according to the WHO experts report, 70-80% of mortality can be explained by lifestyledependent conditions. Both in males and females the major risk factors associated with disease burden are lifestyle-dependent. The most prevalent of them in Russia are alcohol consumption, tobacco smoking and increased blood pressure in men; and increased blood pressure, hypercholesteremia and overweight in women . The prevalence of these well-known risk factors is reported to be extremely high , and this is supported by the results of our pilot study.
Taking into account the general idea and advertisement of the event we had expected the visitors to be interested in medical information and motivated to healthy lifestyle. On the contrary, respondents showed a high prevalence of cardio metabolic risk factors, especially males, comparable to epidemiological data [3-7].
The study revealed significant disproportions in the respondents’ general lifestyle: different health behaviors only moderately correlated with each other. These results provide evidence in favor of “specific” (versus “general”) model of adherence to medical recommendations, that is the necessity to consider and manage adherence to every lifestyle factor separately, taking into account a person’s view on its benefits, implementability etc. [8-10].
Implicit beliefs about healthy lifestyle were analyzed by comparing health behaviors of respondents who reported adequate care about one’s health and those, who admitted insufficiency of attention devoted to health. Interestingly that only one difference was revealed suggesting that the only stable component of healthy-lifestyle beliefs was the level of physical activity. There were no significant difference between the groups by alcohol intake, tobacco smoking, fish, fruit and vegetable intake and sleep duration. In other words all traditional healthy lifestyle characteristics except physical activity are primarily absent among health beliefs of young and middle-aged adults.
Our results only partly agree with results of surveys that use direct questioning about what healthy lifestyle is. For example, in a study conducted by the Russian Academy of State Service survey (2010)  respondents reported the following main components of healthy lifestyle: healthy diet, balanced work and rest regimen, sufficient sleep duration, avoiding “bad habits”, sports. Discrepancies between these results and the results of our study could be considered as an evidence of disagreement between a person’s declared and implicit beliefs about healthy lifestyle. This disagreement may be a determinant of inadequate health behavior and need to be further investigated in the context of beliefs and behavior relationships.
This seems to be even more important, because beliefs and attitudes are considered in the current literature as direct determinants of lifestyle [11-13]. A number of theoretical models of health behavior and adherence to medical recommendations have been suggested [14-16]. Predictive value of such psychological aspects as health knowledge, subjective barriers to healthy lifestyle, perceived social desirability, benefits and shortcomings of different health behaviors, self-efficacy, planning and self-control, health risk beliefs and locus of control were demonstrated [2,17-21].
In our study we tried to find out, whether qualitative characteristics of subjective barriers to healthy lifestyle and chance health locus of control influence on the subjects’ health behavior and cardio metabolic status. It was revealed that in both men and women the leading subjective cause of insufficient care of health was a lack of time. Men are more inclined to explain their non adherence to medical preventive recommendations by “lack of wish”, less motivated to follow healthy lifestyle and more likely than women to consider it meaningless. On the other hand, women have more difficulties in being persistent in carrying out medical recommendation and are more likely than men to report “lack of willpower”. These are quite new results that draw attention to gender-specific aspects of health behavior problems.
As the results show, inner subjective obstacles to care of health are more problematic than outer ones which is consistent with some other studies . Among inner barriers the most “unfavorable” one is openly declared unwillingness (“lack of wish”) to follow healthy lifestyle and pass regular medical examination. This kind of answer was associated with unhealthy risk behavior and cardio metabolic disturbances.
Health locus of control was strongly associated with health behavior and cardio metabolic status. “Fatalistic” persons were more likely to have increased blood pressure and reduced sleep duration, to smoke, avoid medical examinations and have sedentary lifestyle. These results are similar to findings of Grotz. et al.  who have found out that the chance dimension of health locus of control was the major predictor of unhealthy behavior.
Taking together the study demonstrated a substantial influence of some health attitudes on lifestyle and the level of cardio metabolic risk. It seems reasonable that the offered concise list of questions demonstrated an acceptable differential ability and thus could be useful in medical preventive practice for risk assessment and prognosis. The results obtained can be used for implementation of differential approach for education and motivation of different subjects for lifestyle changes. Thus, standard educational programs can be less effective in the fatalistic persons, for whom individual motivation psychotherapy can be applied.
Due to pilot design of the study, the sample was not random; particularly it was not balanced by gender. As only 30% of the attendees became respondents this can be a matter of selection bias.
The organizational circumstances made it difficult to adhere strictly to the standards of anthropometric and blood pressure measurement. Random but not fasting blood samples were obtained.
Health attitudes were assessed by a very limited number of questions not using standard psychological questionnaires and questions about personal causes of low motivation to healthy lifestyle.
We can also suspect that social desirability may have affected respondents’ descriptions of their lifestyles and the level of unhealthy behaviors even higher than it was documented.
We didn’t assess beliefs in genetic predisposition for diseases that nowadays can be of great importance.
Analyzing health attitudes, especially “not wishing” pattern we didn’t assess depression level, which could be an intervening variable in this study.
• The study revealed high prevalence of cardio metabolic risk factors in young and middle-aged St.Petersburg inhabitants, especially in men.
• In the respondents’ implicit beliefs about appropriate care of health a number of healthy lifestyle goals (concerning alcohol consumption, smoking, sleep duration, fish, fruit and vegetable intake) are not represented.
• Among most prevalent subjective barriers for healthy lifestyle and regular medical examinations are “lack of time”, “lack of wish” (in men) and “lack of willpower” (in women).
• Attitude risk factors of unhealthy lifestyle and cardio metabolic disturbances in young and middle-aged adults are “lack of wish” as the main subjective barrier to care of health and chance health locus of control.
Implicit beliefs about healthy lifestyle and risk control, as well as subjective barriers for health attention can be of importance for developing and carrying out preventive medical programs and routine medical practice.
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