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

Low vitamin D levels are associated with a higher risk of death, according to a report released on August 11, 2008 in the Archives of Internal Medicine, one of the JAMA/Archives journals.

Vitamin D is a group of prohormones that play important roles in calcium metabolism, bone formation, parathyroid function, and the immune system. Presently, the ideal bood levels of 25-hydroxyvitamin D (25[OH]D) has been suggested as 30 nanograms per milliliter or higher. In the United States, approximately 41% of men and 53% of women have levels lower than 28 nanograms per milliliter.

There are many potential health problems that could contribute to death in individuals with low vitamin D levels, including an effect on blood pressure, insulin response, or risk of obesity and diabetes.

To investigate the potential implications of this deficiency, Michal L. Melamed, M.D., M.H.S., of the Albert Einstein College of Medicine, Bronx, N.Y., and colleagues examined 13,331 individuals in the Third National Health and Nutritional Examination Survey (NHANES III), a large cohort study performed by the Centers for Disease Control and Prevention (CDC). These individuals were examined for Vitamin D levels between 1988 and 1994, and tracked through 2000, with a median 8.7 years of follow-up.

In this period, 1,806 participants died. When divided into groups based on vitamin D levels, the group maintaining the lowest level, defined as less than 17.8 nanograms per milliliter, showed a 26% increased risk of death from any cause in comparison with the group with the highest levels of vitamin D. This was not associated with cardiovascular disease or cancer alone.

The authors conclude that “the lowest 25(OH)D quartile (less than 17.8 nanograms per milliliter) is associated with a higher risk of all-cause mortality in the general U.S. population.” They continue: “Further observational studies are needed to confirm these findings and establish the mechanisms underlying these observations. If confirmed, randomized clinical trials will be needed to determine whether vitamin D supplementation at higher doses could have any potential benefit in reducing future mortality risk in those with 25(OH)D deficiency.”

25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population
Michal L. Melamed, MD, MHS; Erin D. Michos, MD, MHS; Wendy Post, MD, MS; Brad Astor, PhD
Arch Intern Med. 2008;168(15):1629-1637
Click Here For Abstract

Written by Anna Sophia McKenney
Copyright: Medical News Today

Patients turn to alternatives
As many as 61 percent of cancer patients use complementary therapies such as prayer, relaxation, meditation and massage, researchers from the American Cancer Society report.

For the study, published in the Sept. 1 issue of Cancer, researchers collected data on 4,139 cancer survivors. Of these, 61.4 percent of the patients used prayer; 44.3 percent used relaxation techniques; 42.4 percent used faith/spiritual healing; 40.1 percent used nutritional supplements such as vitamins; 15 percent used meditation; 11.2 percent used massage; and 9.7 percent participated in support groups.

On the other hand, only 0.4 percent of the patients used hypnosis; 1 percent used biofeedback therapy; and 1.2 percent used acupressure or acupuncture.

The benefits of these therapies are still unclear, researchers said.

Older neighborhoods good for you
People who live in older neighborhoods appear less likely to be overweight, according to a new study. The key, the researchers say, is walkability. Older communities encourage people to drive less and walk more, they said, because they tend to have better sidewalks, shady trees and businesses nearby to walk to.

The study, which is to appear in the September issue of The American Journal of Preventive Medicine, looked at the fitness and address information of more than 450,000 residents of Salt Lake County in Utah. With each extra decade of a neighborhood’s age, the researchers said, the risk of obesity was 13 percent lower for men and 8 percent lower for women.

Vitamin C used against cancer
New research with mice suggests that intravenous doses of vitamin C could one day reduce the size of cancerous tumors in people. The findings are preliminary and still must be confirmed in humans.

In the study, published in the Proceedings of the National Academy of Sciences, researchers found that intravenous vitamin C produced hydrogen peroxide, which reduced cancerous tumors in the mice by 43 percent to 51 percent.