Modifiable lifestyle behaviors and functional health in the European Prospective Investigation into Cancer (EPIC)-Norfolk population study

Abstract

Objective

To examine the association between modifiable lifestyle behaviors and functional health.

Method

Population-based cross-sectional study in 16,678 men and women aged 40–79 years at baseline in 1993–1997 participating in the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort.

Results

Smoking and physical inactivity were associated with poorer physical functional health, equivalent to being 7 years and 10–13 years older, respectively, and poorer mental functional health compared to non-smoking or being physically active. After adjusting for age, body mass index, social class, education, prevalent illness, and other lifestyles; men and women who currently smoke were more likely to report poor physical functional health compared to non-smokers {Odds Ratio (OR) = 1.85 (95% confidence interval (CI): 1.49, 2.30) and 1.56 (1.30, 1.87)} and poor mental functional health {1.38 (1.12, 1.70); 1.77 (1.51, 2.07)}, respectively. The OR for good physical function in those who were physically active compared to inactive was 1.67 (1.41, 1.97) in men and 1.63 (1.39, 1.91) in women. Moderate alcohol consumption was positively associated with good physical and mental functional health.

Conclusion

Modifiable behavioral factors are associated with substantial differences in the observed age-related decline in physical functional health and the prevalence of those in good and poor functional health in the community.

Introduction

Most studies examining the relationship between behavioral factors, including smoking, alcohol consumption and physical activity and health have focused on clinical end points, such as death and/or cardiovascular disease. Many studies examining the relationship between behavioral factors and subjective functional health are limited by sample size or composition (e.g. restricted age, sex or patient groups) (Stewart et al., 2003, Woolf et al., 1999, Painter et al., 2000, Kraemer et al., 2002, Arday et al., 2003, Strandberg et al., 2004, Leino-Arjas et al., 2004, Cassidy et al., 2004, Lee and Russell, 2003, Brouwer et al., 2004, Guallar-Castillon et al., 2004, Mitra et al., 2004, Hillsdon et al., 2005). Some studies addressed single factors, for example either smoking or alcohol consumption (Tillmann and Silcock, 1997, Wilson et al., 1999, Van Dijk et al., 2004), and often were unable to examine independent effects or account adequately for confounding from prevalent ill health or social class.

Michael et al. (1999) reported the adverse impact of smoking, excess alcohol consumption and physical inactivity on physical functional health using the SF-36. However, this study was only in women in one occupational class in the US setting. They did not report on the relationship between these behaviors and mental functional health.

Physical functioning generally declines with age (Bond et al., 1993, Adams and White, 2004). However, there is wide variation in the age-related changes that occur with chronological age and the factors that may influence this decline are not well understood or quantified.

We examined the independent relationship between smoking, alcohol consumption and physical activity and self-reported physical and mental well being measured by the anglicised version of the short form 36-item questionnaire (UK SF-36) in men and women in the general community. We also quantified the magnitude of relationship of lifestyle factors compared with chronological age on the observed decline in physical functional health.