Update on prevalence, trend and socio-demographic association of five modifiable lifestyle risk factors for cancer in Alberta and Canada.

Li, Feng Xiao ; Hatcher, Juanita

Dear Editor,

Our analyses of prevalence, trend and socio-demographic associations of five modifiable lifestyle risk factors for cancer were published in April 2009 (1) (see also our article in this issue, pp. 453-58). A downward trend for cigarette smoking and physical inactivity and an upward trend for excessive alcohol consumption and overweight or obesity were observed in Alberta and Canada between 1994 and 2005. Being female, single, more highly educated or having higher income decreased the odds of having multiple lifestyle risk factors.

We would like to update our findings with additional data (Table 1) from a 2006 survey (Canadian Community Health Survey 2007). (2) Compared with the previous survey, smoking continues to drop in all groups (by 0.7% and 1.0% among male and female Albertans, respectively, and by 0.5% among female Canadians) except male Canadians (increased by 1.0%). Physical inactivity increased in all groups (by 0.6% among female Albertans and by 1.4% and 2.1% among male and female Canadians, respectively) except male Albertans (dropped by 0.8%). The changes in prevalence of smoking and physical inactivity, however, are small. Excessive alcohol consumption in 2006 was less prevalent than in any of the previous six surveys for Canada (rate for Alberta unavailable because of zero count), reversing the previous upward trend. Overweight/obesity also dropped (by 0.9% to 4.2%) to the average (women) or lower than average (men) level of the previous six surveys for Alberta and Canada. Insufficient intake of fruits and vegetables continues to drop in Alberta (data incomplete for Canada in previous surveys) by 1.0% (men) and 4.9% (women).

The associations observed in 2006 (Table 2) in general resemble those of the previous surveys, but there are several exceptions or additions. First, in previous surveys, the odds of having multiple lifestyle risk factors was 6 to 12 times higher in those aged 20-39 years and 40-59 years than in those aged 12-19 years, as compared with 3 to 4 times higher in the current survey. One plausible explanation for this discrepancy is that the youngest group (12-19 years) picked up more lifestyle risk factors in 2006. This is feasible because the drop in odds was consistent across all age groups, and it is unlikely that all three older age groups dropped some of the lifestyle risk factors in a year.

Second, the upward, over-time monotonic trend previously observed in the odds in the oldest group (>60 years) disappeared with the addition of the new survey data; again, this was likely due to the youngest group picking up more lifestyle risk factors. Third, supplementary to the previous findings, the upward, over-time monotonic trend observed previously in the odds in those with poor health conditions held true with the addition of the new survey data.

In conclusion, the downward trend previously observed in smoking and physical inactivity continues to hold in Alberta and Canada in 2006. The upward trend previously observed in excessive alcohol consumption and overweight or obesity was, however, reversed or disrupted. There was some evidence that young Albertans and Canadians picked up more lifestyle risk factors in 2006. Before 2006, Statistics Canada released survey data biennially (full cycle). The current survey covered only 2006 (half cycle). This may somewhat contribute to the new findings.

Acknowledgements

We wish to express our gratitude to Statistics Canada for granting our access to the Research Data Centre (RDC) where this data analysis was conducted. We would also like to thank Ms. Irene Wong at the RDC for her full support and assistance when the data analysis was conducted at the RDC. The research and analysis are based on data from Statistics Canada, and the opinions expressed do not represent the views of Statistics Canada.

Feng Xiao Li, PhD

Juanita Hatcher, PhD

Surveillance, Health Promotion, Disease and Injury Prevention Cancer

Bureau, Population and Public Health, Alberta Health

Services, Edmonton, AB

E-mail: fengxiao.li@albertahealthservices.ca

REFERENCES

(1.) Li FX, Robson PJ, Chen Y, Qiu Z, Lo Siou G, Bryant HE. Prevalence, trend and sociodemographic association of five modifiable lifestyle risk factors for cancer in Alberta and Canada. Cancer Causes Control 2009;20(3):395-407.

(2.) Statistics Canada. Canadian Community Health Survey (CCHS 2007)--User Guide. Ottawa, ON: Statistics Canada, 2008. Available at: http://www.statcan.gc.ca/imdb-bmdi/document/3226_D7_T9_V4- eng.pdf (Accessed July 23, 2009).

Table 1. Prevalence of Five Modifiable Lifestyle Risk
Factors for Cancer, 2006

                                             Alberta

                                       n            Prevalence
                                  (unweighted)       (95% CI)

Men
  Daily/occasional smoking             753       24.9 (22.5-27.4)
  Excessive alcohol
    consumption *                      --        --
  Lack of intake of fruits/
    vegetables ([dagger])             1712       67.1 (64.3-69.9)
  Physical inactivity
    ([double dagger])                 1345       45.6 (42.6-48.6)
  Overweight/obesity
    ([section])                       1589       56.6 (53.7-59.5)
Women *
  Daily/occasional smoking             684       19.0 (17.2-20.8)
  Excessive alcohol
    consumption *                      --        --
  Lack of intake of fruits/
    vegetables ([dagger])             1488       49.8 (47.2-52.4)
  Physical inactivity
    ([double dagger])                 1508       45.1 (42.5-47.8)
  Overweight/obesity
    ([section])                       1320       41.4 (38.9-43.9)

                                              Canada

                                       n            Prevalence
                                  (unweighted)       (95% CI)

Men
  Daily/occasional smoking             7416      24.7 (24.0-25.5)
  Excessive alcohol
    consumption *                      2231      7.7 (7.3-8.1)
  Lack of intake of fruits/
    vegetables ([dagger])            18,065      63.3 (62.4-64.2)
  Physical inactivity
    ([double dagger])                13,588      46.6 (45.8-47.5)
  Overweight/obesity
    ([section])                      16,493      54.8 (53.9-55.7)
Women *
  Daily/occasional smoking             7485      19.4 (18.8-20.0)
  Excessive alcohol
    consumption *                       747       2.3 (2.1-2.5)
  Lack of intake of fruits/
    vegetables ([dagger])            17,131      49.3 (48.5-50.0)
  Physical inactivity
    ([double dagger])                18,628      52.4 (51.6-53.2)
  Overweight/obesity
    ([section])                      15,168      40.1 (39.4-40.8)

* At least 12 drinks in past week

([dagger]) Fewer than five servings of fruits and/or
vegetables consumed per day

([double dagger]) Physical Activity Index (PAI) <1.5

([section]) Body Mass Index (BMI) >25.0

Table 2. Concurrent Exposure to Multiple Lifestyle Risk
Factors in Association with Socio-demographic Factors and
Health Condition, 2006

Variable            Category                     Alberta ([dagger])
                                                     (n = 3638)

Sex                 Male                         Ref
                    Female                         0.5 ** (0.4-0.5)
Age Group (years)   12-19                        Ref
                    20-39                          3.2 ** (2.3-4.6)
                    40-59                          3.4 ** (2.4-5.0)
                    [greater than or equal         2.1 ** (1.4-3.3)
                      to] 60
Marital status      Married/common-law/partner   Ref
                    Single/never married           0.8 (0.6-1.0)
                    Widowed/separated/divorced     1.1 (0.8-1.4)
Education           <Secondary school            Ref
                      graduation
                    Secondary school               0.9 (0.6-1.4)
                      graduation
                    Some post secondary school     1.1 (0.7-1.8)
                    Post secondary school          0.6 ** (0.4-0.9)
                      graduation
Household income    <$30,000                     Ref
                    $30,000-$49,999                0.8 (0.6-1.2)
                    $50,000-$79,999                0.7 * (0.5-0.9)
                    [greater than or equal         0.6 * (0.5-0.9)
                      to] $80,000
Immigrant status    Canadian-born                Ref
                    Immigrant                      0.8 (0.7-1.1)
General health      Excellent/very good/good     Ref
                    Fair/poor                      3.3 ** (2.3-4.7)

Variable            Category                     Canada ([dagger])
                                                    (n = 41,262)

Sex                 Male                         Ref
                    Female                         0.5 ** (0.5-0.6)
Age Group (years)   12-19                        Ref
                    20-39                          3.5 ** (3.1-4.0)
                    40-59                          4.0 ** (3.5-4.5)
                    [greater than or equal         2.4 ** (2.1-2.7)
                      to] 60
Marital status      Married/common-law/partner   Ref
                    Single/never married           0.9 ** (0.8-0.9)
                    Widowed/separated/divorced     1.1 (1.0-1.2)
Education           <Secondary school            Ref
                      graduation
                    Secondary school               0.9 * (0.8-1.0)
                      graduation
                    Some post secondary school     0.8 ** (0.7-0.9)
                    Post secondary school          0.6 ** (0.5-0.6)
                      graduation
Household income    <$30,000                     Ref
                    $30,000-$49,999                0.9 (0.8-1.0)
                    $50,000-$79,999                0.8 ** (0.8-0.9)
                    [greater than or equal         0.7 ** (0.6-0.7)
                      to] $80,000
Immigrant status    Canadian-born                Ref
                    Immigrant                      0.8 ** (0.8-0.9)
General health      Excellent/very good/good     Ref
                    Fair/poor                      2.1 ** (1.9-2.3)

([dagger]) Final weighted ordinal logistic regression
models (odds ratio and 95% confidence interval)

* p <0.05

** p <0.01