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i I I I I I I I I I I I I I I , I I HEALTH IMPACTS BY LIFESTYLE AND BEHAVIORAL FACTORS IN GUANGDONG, CHINA Zhou Jiong-liane, Liang Hao-cai, Wang Zhi-jin and Liu Oing Institute of Preventive Medicine, Sun Yat-sen University of Medical Sciences, Guangzhou, China In order to evaluate the relationship between health and lifestyle and behavioral changes due to rapid economic development, several epidemiologic studies were conducted 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 the two developing cities. These studies also 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: Zhuhai. 1. Unhealthy lifestyles and behavior were the major causes of death in Guangzhou and Both the Yuexiu district in Guangzhou and Zhuhai city have reliable death reporting systems and were selected for the surveys. A total of 1,104 deaths (1991) in Zhuhai and 893 deaths in Yuexiu were identified for home visits, during which a questionnaire was given to relatives by trained interviewers. According to Dever's Classification, the leading cause of death in both cities was shown to be "unhealthy lifestyles and behavior." (Table 1) This association was found in one-half of the cases and also was the leading cause of death for cerebral vascular disease, malignant tumors, respiratory disease, and heart disease. Table 1. Distribution or Four Factors in Seven Causes of Death (Male and Female) Cause of Death % of the Total Unhealthy Lifestyle & Behavior Human/Biological Factors Environmental Factors Medical Scrviccs Cerebral Vascular Disease 23.28 31.29 34.55 Z94 6.22 Malignant Tumors 19.93 60.65 33.08 8.76 2.51 Respiratory Disease 11.63 59.04 24.57 8.53 7.85 Accidents 8.04 32.59 1.86 54.04 11.18 Heart Disease 7.79 50.64 35.90 7,05 6.41 Digestive Disease 5.64 53.10 17.70 7.96 21.24 Miscellaneous 20.68 27.78 49.25 7.73 15.23 Total 100.00 49.03 3L32 10.70 8.84 I

A comparison to other data (Table 2) indicated that the contributions by unhealthy lifestyles and behavior in causing death appear to be similar to results obtained in a U.S. survey in 1977. Additionally, there was a 12% increase in deaths attributable to unhealthy lifestyles and behavior when the data for 1991-92 was compared to those for 1982-83. Table 2. Comparison of the Ratio of Four Factors in Causing Death (%) Location Unhealthy Lifeetyles & Behavior Human (Biological Factors) Environmental Factors Medical services Two Cities in Guangdong (1991-1992) 49.05 31.32 10.79 8.84 * 19 Cities & Towns in China (1982-t983) 37.3 32.1 19.7 10.9 ** U.S.A. Nationwide (1977) 48.9 23.2 17.6 10.3 By Liang Hao-cai From Reports of The Department of Health and Human Services, U.S.A. These data suggested that unhealthy lifestyles and behavior would produce most obvious health impact on the populations during economic growth. 2. Smoking appeared to be the leading unhealthy lifestyle and behavior in various populations which is not easily 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 good antismoking 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, e.g., 18% for those with university level education, and 66% for those with primary school education. Smoking as a risk factor 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 by "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 association between smoking and lung cancer risk. However, since indoor pollution due to cooking with coal was very frequent, the standardized regression coefficient value for pollution in room-kitchen area or in kitchens were also high (3.4123 and 2.644, respectively) and corresponded to Odds Ratios of 3.32 and 1.84, respectively. This suggested that working and living in a poorly ventilated room would be another unhealthy lifestyle and behavior related to lung cancer. ' ' I I I I I ' I I 1 I I I I -2- I '