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K= Em 0 t 0 A ReportCurcl On the 11'a#ioii's Health A Project of the Prevention Research Center N-11 w ...-.~:. . _ . ~?. . ._ . Ld?":175 2Q25l[78"#378

other subgroups tend'to be rather small and undramatic. It is not' possible to say exactly how these responses translate into. actual dav=to-dav behavior-that is, how often and to what extent people are practicing good nutritional habits: At the same time, it is. obviously desirable thatas many people as possible ••try a lot"'to" achieve the stated nutritional goals. Children's Diet and Nutrition Adults who have children in the household watch the children's diett and nutrition more closely than they watch their own. This finding is consistent across both years of the Prevention Index survev: An average of 64% of the child proxies interviewed say they "try a lot" to watch eight aspects of the child's nutrition. This ranges from a high of M who say they try a lot to see that the child gets enough vitamins and minerals, to a low of 43% who sav the% trv a lut to see thao the child avoid§ eating too manv high- cholesterol foods. Children's preven- tive behavior regarding fiber and cholesterol consumption seems to have slackened slightly since 1983. However, each of.the eight figures for children is higher than the corre- sponding figure for adults themselves in.those same house- holds, an average of abour20 points higher. Concemiwith children's nutri- tion does not vary among income groups, just as it did not, vary in the case of adult nutrition. However, itt does vary by age, with adults paying closer attention to the nutri- tion of youngsters than to the nutri- tion of teenagers. When it comes to eating breakfast, moreover, theree are alsosome interesting differ- ences: Lower income children aree less apt to eat breakfast almost every dav than are more afYl uent ehildren: Teenagers are also less apt to dosu:than are younger children. These patterns, also identiilied in last year's surveN% appear to be persistent ones. N-li2 sFCTiow 3:. NONNsMOKING A IND BESTRIC'FE D LSF OF'AL.COHOL ANDDRI''•r•~GS g an+d Nbnsmclong Seventy-two percent of Ameri- can adults sav thev dvnot smoke cigarettes; 28% sav thev do. This is the lowest smoking rate andlthe highest nonsmoking rate ever recorded in aiHarris surve\ designedlto measure this trend of smoking versus nonsmoking: While these figures are not dramatically different, frum the level registered in~ last year's sun•ey,,thev represent a continuing decline of 15 points in smoking over the past, decade. Nonsmoking is a crucial preven- tive step that people can take: Onee hundred and three health experts. interviewed as part of last year 's surver, rated nunstnukini; as the tunuhcv-urte preventive health priwi- itY fiur adults. The groups with.the largest pe.txrntages of nun,mukers include older peuple:,cul lct*e I*raduateh, those in,the hiighcrr incume brac.kets: and those in households whus'<• head

T A B L E 3 - 1, ~ Who restricts their aiicohoi~ tiobacco, and drug wse . OO NOf ..~ 00 MD, c... .110.0lNI[ , .CCOM .M..KN. ., IM x JI&CONX r~W ,oft,, DVxM r t th f h u ti Tbtol 'Iudutfs 1983 1252 % 70 34 92 z c r w o.- as an occ on a pa I siunal. managrr. or proprietor level. U401 Achdh ~~ a; % 72 30 5M 9M 1 autrrrns rlsu idcntiliod in Thrx , r la+t vear's- survxv, secnn to be lxrsi.; s R.g1on lent ones. Table 3-l l shuws who East 321 % 69 23 84 89 tcrads tu be a nunsmuker. Midwest 326 % 72 23 76' 92 A striking finding is the cwnxer- South 373 % 72 39 82 93 gence in srnoking bKhavitur uf men Wesf 233' %' 74 32' 85 86' and women. There has been a dramatAc conver'gence over the past sox Male 619 % 73' 25 77 87 ten ycYars. and'by the time of the ~~ ~~ 634 % 70 34 86 94 the two rates had fiullv 1984 surve y converged. Today, women are statis- Roec tiicalnv indistinguishable fr>Jm men. White 1089 % 72 28 81 9C in terms of their rate oflsmoking Black 110 % 67 38 84 87 versus nonsmoking. NNspornic 72 % 68 31 74 86 AVcahol USie Age 18-29 years 363, % 69 20 70 79 Ttiree in ten.a'dults sav that 30-39 years 283' % 69 23 76 89 they never consume alcoholic bever- 40-49 years 175 % 70i 29 90 95 ages. Another 57% drink moderately 50"64 yean' 238 % 70 36 92 100 or lightli; i.e., they average three or 65 atwf iover 190 % 83 49 93' 99 fewer drinks on days when they do Iducetion drink. Twelve percent ofadults say Not high school they drink more than this on a day graduate 233 % 68 54 80 94 when they consume all:ohol; These Ngh school figures are virtually, unchanged graduate 445 % 69 28 77 92 from last year's stuvey, as shown in some palk" 287' % 70 24 77 88 Table 3-1. Four.year college Of those who do drink, 8 out of' gmduate 286 % 81 17 90 89 110 can, be considered moderate (or ll light) ~drinkers.Thaseadultswho Houmholb i imm $7-5M ,orleas 139 % 66 51 731 8& are most likelly to be nondrinkers vs. S7,W415A00 230 % 67 36 80 90 moderate drinkers can also be seen $15•001-$25:000 1 268 % 69 27 74 89 in rthe Table. SY5,0p1-M000 237 % 72 26 79 91 $35•00'1-$50i000 159 % 71 14' 92 941 $50.00•t and lowrer 112 % 82 15' 87 93'. :at-o..er+e.a Health slaho Exceilent 297' % 801 25 83 93 Very qcrocf or pood 751 % 70 27 80 90 Fair or poor 200 % 66 46 80 92 % suenenmes dr 'Bdsrd un drr70~i , of all adtdt>n0v r ur4; this p.urnnrhur iss rx.r rw.xzwcrli r.num+v urm+'.. s,thKnNfps. "Atudnsate''d•+nkmt; ~ y ;izwrlrN'd/KKGrtj rX(~11rI,dIrrll:fiUnaid(f\"ill'w'!nl'~IYIa"..~H/r l.t'f.ffallft.'.~ I I -'MiN nn4t'd.

4i C gious occupations. These tend to be people who have more formal educatiun; pay cluser attention to the news media, and might be expected to have learned' more about many subjects, including the subject uf'chokytcrul. Effort To Avoid High ~ Cholesterol Foods /As discw.kd in, Suctiun2.4'3% of adults say they "try a lot" to avoid high-cholesterol foods. Groups who are particufarlv likely to make this effurt include women and those aged165 rears and older. Thuse with the lowest level of educatiitn are also more likely to try to avoid chules- tcrul', buti they tend to overlap hcavilt with tht: oldest generatiun: There is no si¢nificant difference between incumc gruups or uccupa- tiunal categoriusin thc degree of cfUurt they make to avoid1chuics- trrul_ People -,vhu deuribr their currenti health as fair or poor arc also more likelv to trc• a lot tuavuidd high-chul-c-stet'ol fuucds. Importance to Food Purchasing DecWws Taventy-,.vrnpenrcvmtluf adulits sav that the chulU.tetwl content uf lixod is "vrrc important"'tu thrnn tivlien thrv decide whether to buc ur catnpcn-ticular tuudl:: Thur.,r particu- larlN liikrl~ tu.an so inclueti thuw over at:v 50 aiud tlhur...• \% ith the lvast cducation (%%hu al~,u tend to be in tlhc uld.-wtiFrwratiiun). Thc„e in tniir ur 1x.~ur hraltll are all:u lil..•Ifi tu tnlacc Ra iurk\ , urn chulrstrnol cuntc,nt whvn thc\ purcha.w hxucl. Annual Blood Test tor Cholesterol, Forty-three percent of adults say ther have a bliDod'test for chr,les- terol at least once a.•ear. Those who are most Iikelir to have such a test include those over 50 years of age and those with the leasteducatiwn (who tend to overlap with the oldest generat iun)i Those who say their health is only fair or poor are also more Iikely to ha.•e an annual blood test: Wkytch%ng Chafesterol as. Prevention vs. Treatrnent The pattrrns in Table 12-1' suggest that watching one's choles- terol intake and level is, at the present time, more salient as treat- rurttt than it is as pretvntiotr. This is shuwn b.• the fact those in~fair or poor health are particularly likel.• tu have a blood test, tu take chulrs- trrul content into consideration in choosing food, and to try a IuU to avoid Ihigh-chulirsterol fuods. This same pattern is shuwn amung those who say that' health care sen•ictis shuuld1 give greater emphasis to treatment than toprcvention. The more advantaged segments of sucictv-thu.r with more educa- tiun„highcr incumrs, and more prestigious uccupatiiuns-arc more krtuwluth,;r.uhlr about cholesterol but they currcntlv arc no mure l'ikeh thanuther pruplc to uev'un that knowledge. Motivation is reqtnii-vcd in order to tiranslate knuwlrdge into actiiunt and mtotivatiun currentlv sre,nns to hc• at a modest level excrpt among lho.c gruttln., cit.•dlabuve. who are must imntcdiatClVat,risl.. S E' C T 1 0 N 13: llMI EN1:1R0-N A- IENT :~.'1~D PREN UNT 110N While most of the preventive factors studied in this surve.• are things that indixiduals can, at Ikast potentially, do for themselves, there are other important preventivee factors that'lie bevond an ind'o.•idu- al's power. Such factors require societal, collective, or governmental action. The survey for the 1985 Prevention Index is the first year in which we measure aspects of this envirortntettt in H•hich people live as it relates to prevention. The survey investigates public jµdgments as to the outcome of cullectiive action or inactiidn: Air Qklali,fy Twenty-fuur percent u1* adults say that the quality of thrir lucal air is "excelllcnt:' and anuthcr 50?~ say the lucallair quality is "prctty good." Those who are must likely to report acceptable air quality include Midwesterners, thux rf.-iirJ- ing outside mr,utupuliitan arr.as. ancl' thuse inithe hit*ln~-+t incumu category. Thux whu elbscribe their currvtnt health as excellent are alwu nwre likely to rate thuiu- local air quality highly. Thesr pattunos arr shown in Table 13• V 28 ' N-14

:'1 T A B' L E 1 3 - 11 Exposure to ambient cigarette smoke af home IIOUttMOtD{'. CN{aftN. sos. +35a' 46II x x Someone smuokes cigarettes 45 40 No one smokes cigarettes 54 51 Not'sure ' - I IT A B L E I 3 Support for regulation of smoking in pubiic places i1r. Do you tfiirnk ttwt taws should prohibit smoking In pubtic pWces: or snoutd!thew nequire separate srmokinq and nnnsmoking'sectionsg or shoukd srnokinq in public ptoces not be reQukrted by ltrw?, ftter Quality Tdvcntv-thrnr prrccuit' uf a1Jul t, rate the qualit' v ufi their luraf Ji-ink- ing water as ..cxcrllrnt." andl anuthrn3lt% juJge it as"prettY guud!" There are fchx su•iling dilier- ences in watcr rauings across subgroups, except that raUings tend tu bv a bit! higher in the MiilA%,.-.,t and outside mrlrapwlit:nratk.r";. This is possible due to the fart tihatt the water suppl~., unlike the air.,has ustnalNt• gone through a purilicatiiun, processbKfurr it reaches the individual. Therefore, in any given area all'scxial classes are Iikcln tuo use the same water supply; cvhile air I mav varv br'thr 1lrcat~ion caf',une's hwrtor'ur work. 2 aa aou .ouM • a. • o..MO w.oia +.me: r. rouu«orn. WWn so0tow on wons ao.nms rMManoOaro .ouVS r.or NoutE~ wwcn No a. waa= aoratn: no. 1i'2S3 355 216' 679 x x x x ~ Should prohibit 20 10 20 26 Require seporote sections' 60 65 59 58 Should not regulate 151 22 18 10 Not sure 4 3 3 4 Exposure to Ambient Cigaretfe Smoke at Home An emerging rnvirunmrntal issue concerns exposure to anrbient cigarette smoke, bcuthiat home and in public places. Fifty-four prrr.ent, of all'horrsrltolds areirx~r of'this problem. but 45% do have xunnr h<tuseholdI membar who smokes. Fiftw-(m percent cJ . all horrsr- l:olds u•uh chii(dren are free uflthe problem of ambiunt, cigarette smoke, but, 49°lc have some member who does currently smuke. Table 13'-2 shows the figures. 29 K-15

Support for Regulation of SmoiOng ~ in Public Places Surveys can usefully measure the degree of the public support for policies that would affect the environment. One recent controver- sial issue concerns regulation of smoking in public places. Twenty percent ofladulrc Americans think that laws shouldlprohibit smoking in public places. Sixty percent say, instead, that separate smoking and nonsmoking sections should be required. Fifteen percent believe that smoking in public places should not be subject to regulation (Table 1'3•2). Those who do nor smoke, are twice as likely as those who do smoke to favor outright prohibition of smoking in public places. Nonsmokers who are exposed to ambient cigaretite smoke at home tend to be albit more toleranrof smoke in public places than are adults from households where no one smokes at all. However, sol id' ma jorit iies of' both smokers and I nonsmokers saythey, would support a requirement for separate smoking and nonstnok- ing sections. These findings suggest the political feasibility oCa "separate but equal" strategy for advocates whoare interested in improving the envirvnment in public places.. 30 ;p- ~.~.1~:Y'~'••'fa '~ 4Y.`M.VIV' Procedures for Compu the Preven tion Index The Prevention Index is devel- opedlfrom information collected by . Louis Harris and Associates, Inc. inn two national surveys: 1. Self-reported practice of health-seeki ng, behaviors based on a random sample of' 1,253 members of'the conti- nental United States adult population and 462 adults most familiar with the health of a randomly selected!child in those same households, and. 2. Ratings of the importance of these behaviors wit'h respect to their impact on the overall health of the general adult and!child population, as determined bya sample of 103 representative experts in disease prevention and healthi promotion. Heal'th-seeking behaviors weree chosen using the following criteria: 1. A clear consensus, bothlin the research literature and among representative experts, with respect to a, documented relationship between compliance and the prevention of disease or injtarv;=' 2. The application of each health+seeking bLhavior to the entire adult populatiiun: and 3. A clear abiilit' y on the part of individuals to control their own compliiancc/nuncumpli- ance (therefure, (he exclusion of important environmental detrrminants of healit)n, such as exposure to air pollution or industrial toxins). N-1i6 Compliance with health-seeking, behavior was defined simply: A given respondentl either complied or did not' comply. The characteristics of specific health behaviors deter- mined the definitionlof'compliance/ noncompliance for the behavior. For continuous variables (for example, moderate alcohol consumptioni exercise or frequency of dental examination) compliance was determined by the prevailirog consensus available from the relevant professional literature and from personal communication with various researchers and spokesper- sons forprofrssional organizations. For those health-seeking behav- iors wi't'h no clear consensus on a minimum compliance level (for example, taking steps to control stress or restricting cholesterol I intake), compliance was defined in terms of either always engaging in the behavior (taking steps tiulcontrul stress) or of, trg ing a lot (as in restricting cholesterol intake)~ The specific definition of compliance' noncompliance for each health- seeking behaviur and relevant documentation of thow definitions are presented in the Prevention Index technical report (see box bL60. The overall e.rperd rating for the importance utlracfo separ:uw health- seeking behavior was cumputtid b-, simply deriving the arithmetic mean for the sample of 103 uxpcrts.. The Index is keverl!tu a base ull 100; delined as l0(D per«nt uf'thr ~! adult or child pupulatiiuns uilthr O N Ulnitecl Stateweneaging in allluflthe relevant key health.seckinE btiha~- ~ iurs fiureach pupulatiun. ~ ~ CJ ~ ~. C