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HEALTH IMPACTS BY LIFESTYLE AND BEHAVIORAL FACTORS IN GUANGDONG Zhou Jiong Liang, Liang Hao-cai, Jang Zhi Jin, Liu Oing Institute of Preventive Medicine, Sun Yat Sen University of Medical Sciences, Guangdong 510029, P.R.C. In order to evaluate the relationship between health and lifestyle and behavioral changes due to rapid economic development, several epidemiologic studies were conducted in populations in two developing cities (Guangzhou and Zhuhai) during the last ten years. The studies consisted of surveys on the impact of behavioral factors on deaths in two developing cities. These studies analyzed smoking in factories and in the countryside, smoking and its intervention measures among medical university employees and students, and the association of smoking, home ventilation and lung cancer. The main results were as follows: 1. Unhealthy lifestyles and behaviors played a leading role in the cause of death in Guangzhou and Zhuhai. Both the Yuexin district in Guangzhou and Zhuhai city have rather good death reporting systems. This was one of the reasons for choosing those cities for the surveys. 1,104 deaths (1991) in Zhuhai and 893 deaths in Yuexin were selected as subjects for home visits with questionnaires to be answered by relatives. The interviewers were well-trained with standardized procedures. According to Dever's Classification, the leading cause of death in

both cities was shown to be "unhealthy lifestyles and behaviors." (Table 1) This association was found in one-half of the cases and also was the leading cause of death for cerebralvascular disease, malignant tumors, respiratory disease, and heart disease. Table 1. Distribution of Four Factors in Seven Causes of Death (Male and Female) Unhealthy Human/ Lifestyle & Biological tnvironrrtentai Medical Cause of neath % of,the Total Behavior Factors Factors. Services Cerebral 23.28 31.29 34.55 7.94 6.22 Vascular Disease Matignant 19.93 60.65 33.08 8.76 2.51 Tumors Respiratory 11.63 59.04 24.57 8.53 7.85 Disease Accidents 8.04 32.59 1.86 54.04 11.18 Heart Disease 7.79 50.64 35.90 7.05 6.41 Digestive 5.64 53.10 17.70 7.96 21.24 Disease Miscellaneous 20.68 27.78 49.25 7.73 15.23 Total 100.00 49.03 31.32 10.70 8.84 A comparison to other data (Table 2) indicated that the role played by unhealthy lifestyles and behavior in causing death appear to be similar to the data from the U.S. in 1977. Additionally, there was a 12% increase when the data for 1991-92 was compared to those for 1982-83 in China. - 2 -

Table 2. Comparison of the Ratio of Four Factors in Causing Death (%) Unhealthy Numah Lifestyles & (Biological Envirormental Location 8ehavior Factors) , Factors Hedical Services Two Cities in 49.05 31.32 10.79 8.84 Guangdong (1991•1992) * 19 Cities & 37.3 32.1 19.7 10.9 Towns in China (1982••1983) ** U.S.A. 48.9 23.2 17.6 10.3 Nationwide (1977) * ** By Liang Hao From Reports of Health and Human Services, U.S.A. These data suggest that unhealthy lifestyles and behavior would produce more of a health impact on the populations during economic growth. 2. Smoking appears to be the leading unhealthy lifestyle and behavior in various populations and not easy to bee stopped. The nationwide smoking rate in China has been reported to be around 61% for males and 7% for females. Although the smoking rate among the Guangzhou population was lower, the problems were still serious. In one village, most of the smokers had started to smoke as teenagers. Their stated motivation was that it was "refreshing." (41%) In one petrochemical plant known to have a - 3 -

good anti-smoking campaign, 195 out of 350 smokers (54.6%) were found to have stopped smoking but had started again. Surveys in universities showed that the lower the educational level of employees, the higher the smoking rate would be, e.g., 18% for those with university level education, and 66% for those with primary school education. Smoking as a risk factors was poorly recognized, e.g., 75.3% of the university students considered that smoking had nothing to do with health; 55.7% of the university employee smokers believed that smoking had both beneficial and harmful effects. 3. Smoking appeared to be the greatest risk factor for lung cancer, but other indoor pollutants should not be ignored. A case-control study of 203 cases of primary lung carcinoma from eight main hospitals in Guangzhou during 1983-1984 showed that under "conditional logistical analysis," the smoking level (in terms of number of cigarettes/day) had a large standardized regression coefficient value of 5.7728 and a high Odds Ratio of 3.2670, indicating a significant dose-response relationship between smoking and lung cancer risk. It was obvious that smoking would be the most important risk for lung cancer. However, since indoor pollution due to cooking with coal was very frequent, the standardized regression coefficient value for the air - 4 -

monitoring sample in room-kitchen space or kitchen space were: 3.4123 and 2.644, respectively; their Odds Ratio was also high: 3.3173 and 1.8365, respectively. This suggests that working and living in a poorly ventilated room would be another unhealthy lifestyle and behavior related to lung cancer. 5