Modifiable lifestyle behaviors and functional health in the European Prospective Investigation into Cancer (EPIC)-Norfolk population study
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.
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Study population
Men and women aged 40–79 were recruited between 1993 and 1997 from general practice registers as part of the European Prospective Investigation into Cancer (EPIC)-Norfolk. The Norwich Local Research Ethics Committee approved the study. Detailed descriptions of the recruitment and methods have been reported previously (Day et al., 1999). Briefly, 30445 men and women aged 40–79 years at the base line consented to participate. A total of 20,921 EPIC-Norfolk participants (73.2% of the eligible
Results
SF-36 summary scores were available for 19,535 men and women. There were no material differences in terms of age, sex, BMI, systolic blood pressure and cholesterol level compared to non-responders. Excluding those who did not have data on smoking, physical activity and alcohol consumption left 7374 men and 9304 women in the current analyses. The main reason for exclusions was for participants who did not complete FFQs.
Table 1 shows the sex-specific distribution of variables. Table 2A, Table 2B
Discussion
In this study, we examined the independent relationships between smoking, alcohol consumption and physical activity, and functional health measured by SF-36 summary scores in a free-living general community. We also quantified the potential magnitude of impact of these behavioral factors in terms of the physical functional decline reported with increasing age and the differences in prevalences of those in good and poor functional health.
Those who had never smoked, those who consumed alcohol in
Conclusion
Our study confirms a strong independent relationship between modifiable behavioral factors and functional health. Current smoking and physical inactivity were associated with poorer physical functioning equivalent to being over 7 years and 10–13 years older, respectively. The combined effect of smoking and physical inactivity on level of physical functioning (mean PCS score of − 5.8 in men and − 4.8 in women) is comparable to having a chronic medical condition such as stroke (Surtees et al., 2003
Acknowledgments
We would like to thank participants and general practitioners who took part in the study. We also thank the staff of EPIC-Norfolk and our funders.
Funding: PIC-Norfolk is supported by research programme frant funding frm Center Research UK and the Medical Research Council with additional support from the Stroke Association, British Heart Foundation, Department of Health, Europe Against Cancer Programme Commission of the European Union, Food Standards Agency and Wellcome Trust. The PIC-Norfolk
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