Vitamin Information Center

Behavioral Patterns
MARTIN SIEPMANN
Forschungsverbund Public Health Sachsen-
Sachsen Anhalt e.V., Medizinische Fakultät,
Technische Universität, Dresden, Germany
martin.siepmann@tu-dresden.de
Definition
Behavioral patterns such as tobacco smoking, excess
alcohol consumption,  substance dependence, inappropriate
nutrition, lack of  physical activity, failure
to use safety equipment including automobile seat belts,
certain  sexual practices, and failure to follow preventive
guidelines and  disease screening are all associated
with elevated risk of disease or death. Causal conclusions
have been strengthened, dose/response relationships
have been clarified, the influence of many of these
behaviors on overall public health has been quantified,
and scientific guidelines have been formulated.
Basic Characteristics
Risk behaviors rarely occur in isolation, but cluster in
patterns that in combination influence a person’s risk of
disease. Thus, a sedentary life-style in industrial societies
connotes a pattern of mutually influencing behaviors
such as taking little exercise, eating foods of poor
nutritional value, consuming caloric drinks and possibly
also smoking cigarettes. While these factors do
not determine disease in an inevitable sense, they place
the person at elevated risk of  obesity, high blood
pressure, and subsequently of cardiovascular disease as
well as impairment of  musculoskeletal health. Other
unhealthful behavioral patterns include the connections
among smoking behavior,malnutrition, and drug taking,
and those among  alcoholism, aggression, violence
and suicide. Each of these patterns is reinforced
by membership in a social milieu that brings similar
people together, as well as by individual personal traits.
Each pattern also trends to correspond to personal values
and beliefs, which form the connection between
behavior and culture.
Two general explanations have been suggested for
unhealthy behavior. The first theorizes that some people
are unaware about the harmful effects of substance
abuse, smoking and obesity. An alternative explanation
emphasizes that people engaging in unhealthy behaviors
do not correctly weigh the health/lifestyle pros and
contras regarding these behaviors (Wagner et al. 2005).
It seems doubtful that the first explanation is reasonable.
For example, virtually all women and most
men recognize that lowering weight is desirable from
a health perspective. While it is clear that obese people
often differ in their energy metabolism from thin
people, it is also obvious that some of the obesity in
the developed countries results from eating foods considerably
in excess of the amount that is known to be
healthy. The attempt to control food intake by dieting is
nearly universal at some point in the lifetime of women
in the US and Northern Europe. Studies of incoming
college freshmen women demonstrate that only 8–13%
of women do not adhere to a diet (Krahn et al. 1992).
With the median age of onset of dieting close to age 12,
it is unlikely that the message is not getting to young
women or is reaching them too late (Drewnowski and
Hann 1999). Whether food preferences reflect dietary
habits is an interesting issue. Data from epidemiological
studies suggest that food consumption patterns show
parallel influences of age, sex, health status, education,
and income (Harnack et al. 1997). Generally, age influences
both food preferences and food intake patterns in
the direction of more healthful diets (Block and Subar
1992).
In the area of substance abuse, there is even more
convincing data, documenting that knowledge is not
the key problem. Studies of several school-based substance
abuse prevention ( prevention and health promotion)
programs found that these programs definitely
increased student’s knowledge regarding the health
risk of these substances but, unfortunately had no effect
or even increased the rate of substance abuse (Hansen
1992). Therefore, it appears unlikely that a simple lack
of knowledge is what prevents people from avoiding
harmful behavior.
Another area of research has examined the tendency to
novelty seeking. For example, many adolescents begin
smoking as novel behavior that seems to offer relief
from thinking they are not as “with it” (Pomerleau et al.
1992). People who evidence early alcoholism are significantly
higher on the dimension of novelty than are
other individuals (Cloninger 1987). At the other end
of the spectrum are those who are focused on avoiding
harm (Harkness et al. 1995). Those high in novelty
seeking and low in harm avoidance are thought to
be most impulsive. People who are highly impulsive
tend to be vulnerable to the short-term rewards offered
by many high-risk behaviors (Newman and Wallace
1993). In a laboratory reward versus risk situation,
highly impulsive people behave more quickly and give
themselves less time to consider options. Behavioral
intervention programs aim at introducing some delay
in decision-making, so that the participants have some
time to reflect on short-term benefits versus long-termharm.
Cross-References
 Alcoholism
 Disease Screening Practices
 Musculoskeletal Health
 Obesity
 Physical Activity
 Prevention and Health Promotion
 Sexual Practices
 Smoking Behavior
 Substance Dependence
 Suicide
References
Block G, Subar AF (1992) Estimates of nutrient intake from
a food frequency questionnaire: the 1987 National Health
Interview Survey. J Am Diet Assoc
Cloninger CR (1987) Neurogenetic adaptive mechanisms in alcoholism.
Science 236:410–416
Drewnowski A, Hann C (1999) Food preferences and reported
frequencies of food consumption as predictors of current diet
in healthy women. Am J Clin Nutr 70:28–36
Hansen WB (1992) School-based substance abuse prevention:
a review of the state of the art in curriculum, 1980–1990.
Heal Educ Res 7:403–430
Harkness AR, Tellegen A, Waller N (1995) Differential converge
of self-report and informant data for multidimensional personality
questionnaire traits: implications for the construct
of negative emotionality. J Personality Assess 64:185–204
Harnack L, Block G, Lane S (1997) Influence of selected environmental
and personal factors on dietary behaviour for chronic
disease prevention: a review of the literature. J Education
Nutr 29:306–312
Krahn DD, Kurth C, Demitrack M, Drewnowski A (1992) The
relationship of dieting severity and bulimic behaviors to alcohol
and other drug use in young women. J Subst Abus 4:341–
353
Newman JP, Wallace JF (1993) Psychopathy and cognition. In:
Kendall PC, Dobson KS (eds) Psychopathology and cognition.
Academic Press, New York, NY, pp 293–349
Pomerleau CS, Pomerleau OF, Flessland KA, Basson SM
(1992) Relationship of tridimensional personality questionnaire
scores and smoking variables in female and male smokers.
J Subst Abus 4:143–154
Wagner N, Meusel D, Kirch W (2005) Nutrition education for

Alcoholism
Synonyms
Alcohol abuse; Alcohol dependency
Definition
Alcohol abuse and dependency are commonly called
alcoholism. Alcohol intoxication can cause irritability,
violent behavior, feelings of depression, and in rare
instances hallucinations and delusions. Longer-term,
escalating levels of alcohol consumption can produce
tolerance as well as such intense adaptation of the body
that cessation of use can precipitate a withdrawal syndrome
usually marked by insomnia, evidence of hyperactivity
of the autonomic nervous system, and feelings
of anxiety.

Alcohol Consumption
GUNDULA BARSCH
HochschuleMerseburg,Merseburg, Germany
gundula.barsch@hs-merseburg.de
Definition
Different forms of alcohol have different functions: as
part of cleaners, fuel,medicine, etc.Worldwide the substance
ETHANOL is well known as a component of different
alcoholic beverages. These beverages differ not
only in taste, look and quantity of alcohol, but also within
various populations the forms of usage are very different
too. People use alcohol as a luxury, as part of
their lifestyle; integrated into daily life, to cope with
stressful situations for example. The general level of
alcohol consumption of a population depends on sociocultural
factors, availability, production, trade, the distribution
network and the regulations concerning sale.
Therefore, throughout the world, there is a wide variation
between countries and regions in forms and rates
of alcohol consumption. For national health planning it
is helpful to monitor trends of per capita production of
beer, wine and spirits in different regions as well as per
capita alcohol consumption of the population in general
and in social groups in particular.
At the individual level alcohol consumption can be distinguished
in three general forms: moderate drinking,
heavy drinking and excessive drinking that is linked
with dependence on alcohol. These different forms of
alcohol consumption are integrated into individual daily
lives, and misuse is connected with alcohol related
problems. The terms “alcohol-related problems” and
“alcohol problems” refer to the damaging consequences
of alcohol consumption and the various adverse effects
not only on the individual drinker but also on the family
and society at large.
Trends in Rates of Alcohol Consumption
There have been considerable increases in average rates
per capita alcohol consumption in recent years. Certain
countries show a high rate of increase in per capita
consumption of each category of alcoholic beverage. In
considering the changing trends of consumption within
a given population it is necessary to take account
of changing demographic structures (data collecting).
For instance, in many developed countries the population
is aging and the average consumption level is much
lower than in developing countries with a younger population,
and, whereas most females may not drink, the
average consumption level of adult males may be four
times that of the total population.
Although in alcohol-producing areas the dominant type
of alcoholic beverage consumed is the type produced in
that area and accounts for most of the increase in consumption,
the use of additional beverage types also contributes
significantly to the increase. In countries with
traditional wine drinking, for instance, there has been
a marked increase in consumption of beer and spirits,
whereas in countries where beer was the preferred
drink, the consumption of wine and spirit has become
more general.
Socio-Cultural Factors
Socio-cultural factors are involved in both the causes
and the consequences of moderate and heavy drinking.
Such factors also determine whether or not the consequences
of drinking are labeled as problems ( cultural
beliefs). Among the factors that have been studied
are the cultural beliefs about the value and symbolic
functions of alcohol and the consequences of drinking,
drinking contexts (such as use in rituals, functions, public
and family occasions) and use of alcohol by different
social and occupational groups.
Possible alcohol culture effects are:
• drinking is integrated into the community, not a banished
or discredited conduct;
• drinking is an act of common life and not a private
behavior;
• drinking is part of given rituals;
• drinking rules are made with common sense;
• drinking rules have a strong authority derived from
common knowledge and shared experiences;
• drinking rules give rhythm (quality, quantity, frequency)
and good order;
• drinking is not allowed everywhere and every time –
given a place and special time, so it has a start and
an end.
• drinking rules keep drinking in a frame and give orientation;
• drinking rules take no responsibility away but
demand it from everyone.
That is why in any population where alcohol is socially
acceptable there is a far higher percentage of moderate
drinkers than of heavy drinkers.
When a positive alcohol culture prevails, alcohol consumption
can be a beneficial experience within a supportive
and protective environment; physical and mental
health problems are minimized. With changing
socio-cultural conditions, resulting partly from the
impact of opposing cultures, many forms of sociocultural
control seem to be breaking down: alternative
customs are being followed, the limits of acceptable
behavior and drinking are no longer clear and rapid
increases in alcohol consumption are occurring in some
population groups.
Socio-Demographic Groups
To understand the effects of alcohol consumption within
a given population, consideration has to be given to
specific socio-cultural situations and variations between
population groups and the way social control is maintained
and strengthened. The relaxation of cultural controls
and emancipation of certain socio-demographic
groups probably account in part for the increasing number
of young people and women taking up drinking
and often running the risk of suffering from the adverse
effects of alcohol consumption and of causing alcohol
problems.
To understand the dominant patterns of drinking, for
instance in women and young people, it is necessary
to have a look at the specific functions that alcohol
consumption has in each of these socio-demographic
groups. Drinking patterns in youth groups are not comparable
with the drinking patterns in groups of adults,
and the risks and alcohol-related problems are not the
same.
Developmental factors affecting alcoholic consumption
in youths:
• Special motives to start: come together, have fun
together, feelings of social get-together.
• Special functions of drinking: access to peer-groups,
bonding rituals, mimicking adult behavior, feeling
male, feeling strong.
• The effects of strong drinking: often there is a standstill
in developmental progress.
It is known that alcohol problems disappear as development
progresses, so strong drinking is normally quit by
the time youngsters grow to adulthood. Finally addiction
seldom starts early in youth; that means help and
support for young drinkers is more educational than
therapeutic.
Alcohol Related Problems
Alcohol problems affect the health and development of
individuals and nations and have political, economic
and social implications. Alcohol problems may be the
consequence of either acute episodes of heavy drinking
or of prolonged drinking ( drug abuse). The development
of alcohol problems can be viewed in the perspective
of the public health model as complex interaction
between the agent (ethanol), the host (drinker) and the
environment (physical, mental and socio-cultural setting,
the family and the general community).
Consequences of Acute Episodes of Heavy Drinking
• Short-term impairment of functioning and control,
with aggressiveness and accident proneness
• Exposure to climatic conditions and physical disorders
• Arrest for drunkenness
• Alcohol poisoning
Consequences of Prolonged Heavy Drinking
• Increase risk of certain disorders, including liver cirrhosis,
certain cancers, cardiovascular diseases and
brain atrophy
• Aggravation of other physical disorders, e. g. malnutrition
• Prolonged impairment of functioning and control
with increased proneness to accidents and impairment
of working capacity
• Alcohol dependence syndrome
• Alcoholic psychosis
• Premature death
• Suicide
Possible Concomitants
Loss of friends, of family, of self-esteem, job, means of
support and liberty.
Evidence is accumulating that a number of pathological
conditions may however be related to the consumption
of a small amount of alcohol, and may cause a much
greater burden on the community than resulting from
the alcohol dependence syndrome (costs of illness –
utilities).
Preventing and Managing Alcohol
Related Problems
If health is to be looked upon as an integral part of economic
and social development measures to solve alcohol
problems must be part of general health programs
and must be planned with the primary care approach in
mind; responding to alcohol problems must be a joint
responsibility of people and government.
Prevention
• Reducing the availability of alcohol beverages (control
of distribution, price regulation)
• Reducing the demand for alcohol (information and
education on alcohol and alcohol problems, inform
about the upper “safe” level of daily consumption.
Restrictions on advertising, moral and religious
forces)
• Additional preventive measures (control measures
focus on limiting the amounts of alcohol available
to the drinker, educational measures concentrate
on building up the host’s resistance and reducing
demand for alcohol, measures might be developed
from consideration of links between the putative
drinker and his environment).
Treatment
• Treatment and management of persons identified as
being “alcoholics” and “heavy drinkers”
• Family support
• Management in occupational settings (initiated discussions
with key personnel in a range of occupational
settings to identify and reduce alcohol problems)
• Programs related to traffic safety (legislation regarding
drinking and driving, high-risk drivers).
Alcohol Policies in a Health Context
A policy statement concerning alcohol availability and
problemsmay be seen as an essential contribution to the
formulation of national health policies, strategies and
plans of action. It may be valuable to formulate at a high
level the principles that should underlie the action to
be taken and to establish priorities and strategies. The
following have to be considered:
• Value of policy statement
• Focus on substance abuse or on alcohol problems
• Participation in policy development (range of participants,
community involvement, coordinating bodies)
• Constraints on policy formulation and implementation
• Information needed for policy formulation
• Preparation to implement a national policy.
Cross-References
 Cultural Beliefs
 Data Collecting
 Drug Abuse
References
Moser, Joy (1985): Alcohol Policies in National Health and
development Planning. WHO Offset Publication No. 89,
Geneva

Abundant dietary vitamin C may lower the risk of developing type 2 diabetes, say researchers from the Institute of Metabolic Science at Addenbrooke’s Hospital in Cambridge, England.

Scientists there followed 21,831 men and women aged 40 to 75 over a 12-year period, during which they tracked diet, exercise, and blood content. By the end of the study, 423 men and 312 women-3.2 percent of the study group-had developed type 2.

The researchers concluded that the subjects with the highest levels of vitamin C in their blood were 62 percent less likely to develop type 2 than the subjects with lower levels.

Fruit and vegetables were the subjects’ main sources of vitamin C. The researchers said that other factors commonly associated with a risk for diabetes, such as age, sex, smoking, family history, weight, and alcohol consumption, did not significantly alter the beneficial effects of vitamin C.

Is Gum Disease a Precursor to Diabetes?

If you have gum disease, your chances of developing type 2 diabetes are nearly double those of people who don’t have gum disease, according to researchers at Columbia University’s Mailman School of Public Health in New York City.

That was their conclusion after a 20-year study that tracked 9,000 people without diabetes.

The presence of periodontal disease has often been noted as an accompaniment to diabetes, but nobody is sure whether it is a precursor to the disease or possibly even a contributing factor.

Because gum disease, like diabetes, involves tissue inflammation, there is some speculation that it is an indicator of susceptibility to inflammatory disease.

Thirty-five percent of adults have some form of gum disease, and one third of those experience a troubling level of infection.

Researchers don’t know what causes periodontal disease. Theories include genetics, smoking, and dry mouth caused by medications. Treatments include antibiotics, topical gels, extremely deep tooth cleaning, and even surgery to graft tissue from the roof of the mouth onto affected spots to encourage new gum growth.

The hope is that lowering the level of inflammation in the mouth may decrease the likelihood of inflammation developing elsewhere in the body.

Source: Diabetes Care, July 2008

SATURDAY MARCH 1, 2008 (Foodconsumer.org) — University of Cambridge researchers found those who had the highest level of vitamin C in their blood were much less likely to have a stroke, suggesting that intake of vitamin C ma help reduce the risk.

The study published in the Jan, 2008 issue of American Journal of Clinical Nutrition showed those who had the highest level (greater than 66 micromoles per liter) had a 42 percent reduced risk for stroke compared to those who had the lowest level (less than 41 micromoles per liter).

The study did not mean that increasing vitamin C intake through one’s diet or a supplement would definitely reduce the risk of stroke or increased levels of the vitamin was the cause for the reduced risk although the possibility could not be excluded either.

Phyo Myint and colleagues suggested that vitamin C in the blood may be a good biomarker of lifestyle. A high level of it indicates that one follows a healthy lifestyle, minimizing their risk for stroke.

For the study, the researchers followed 20,649 men and women participating in the European Prospective Investigation into Cancer for 9.5 years to record their health status such as incidence of stroke.

Their dietary habits and other lifestyle parameters were surveyed at the entry of the study using a health and lifestyle questionnaire and vitamin C levels in the blood samples were measured. During the follow-up, 448 stroke cases were identified.

The association between the plasma vitamin C level and the risk of stroke existed after a series of other factors were considered including age, sex, smoking habits, alcohol consumption, blood pressure, cholesterol, BMI, physical activity, and use of supplements.

The researchers said the association was probably not due to the supplemental vitamin C because when those who used vitamin C supplements were excluded, the link still held, suggesting that the possible benefit could come from vitamin C-rich foods such as fruit and vegetables.

The US government recommends in dietary guidelines adults should take at least five servings of fruit and vegetables per day to maintain health. But often vitamin C supplementation is not encouraged.

The researchers said although the study did not mean to say taking vitamin C supplements would render this protective effect and trials of vitamin C supplements in preventing cardiovascular disease unlikely occur, the association was substantial and independent of known major risk factors for stroke.

Sebastian Padayatty and Mark Levine from the National Institutes of Health (NIH) said in their commentary accompanying the study report that “Vitamin C is an attractive marker of fruit and vegetable intake because these foods are the primary sources of dietary vitamin C.” and the take-home message is to use five to nine servings of fruits and vegetables.

Vitamin C has proved controversial. Some experts notably Noble Prize laureate Dr. Linus Pauling had been advocating for years that people should use HIGH doses of vitamin C to prevent a whole spectrum of diseases from colds to cancer. But trials proved that vitamin C at low doses does not help prevent diseases.

Dr. Pauling had worked with a doctor to test how vitamin C affects the survival of cancer patients and they found that cancer patients subject to conventional treatments, but using high doses of vitamin C often lived a few more years than those who received only conventional treatments.

Vitamin C is non-toxic and many people use more than 5 grams per day, according to The Vitamin C Foundation, a not-for-profit organization advocating use of vitamin C.

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