Date Presented 04/05/19
Data from the 2015 Behavioral Risk Factor Prevalence Surveillance System were analyzed to investigate the prevalence of five unhealthy behaviors among US adults with and without stroke. Prevalence of low fruit and vegetable consumption, low physical activity, and smoking were higher in adults with stroke; heavy alcohol consumption was lower; and there was no difference for excess weight. Occupation-based lifestyle interventions are needed to modify these unhealthy behaviors in adults with stroke.
Primary Author and Speaker: Ryan Bailey
Contributing Authors: Allison Phad
PURPOSE: Engaging in unhealthy lifestyle behaviors increases risk for cardiovascular disease, diabetes, and premature death, which is of particular concern for stroke survivors whose history of stroke increases cardiometabolic risk (Towfighi, Markovic, & Ovbiagele, 2012; Kernan et al., 2014). Population-based estimates of unhealthy behaviors in adults with stroke are lacking but could be used to inform research, policy, and occupational therapy practice. The objective of this study was to calculate and compare population-based estimates of the prevalence of low fruit and vegetable intake (consuming <1 fruit & <1 vegetable daily), low physical activity (less than 150 minutes/week of moderate-to-vigorous activity), heavy alcohol consumption (>14 drinks/week for men, >7 drinks/week for women), current smoker, and excess weight (body mass index ≥25) among U.S. adults with and without stroke.
DESIGN AND METHOD: This cross-sectional study used data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), an ongoing, state-based, telephone survey that monitors behavioral risk factors among noninstitutionalized U.S. adults aged ≥18 years across the country; thus, all survey questions related to demographics and unhealthy behaviors were obtained via self-report. SAS for Windows, Version 9.4 (SAS Institute Inc.; Cary, NC) was used to analyze data and to account for the complex sampling design, including selection probability and survey non-response. Age-adjusted (to the 2000 U.S. standard population) and weighted prevalence estimates were calculated, and logistic regression was performed to compute odds ratios to compare prevalence of unhealthy behaviors between groups.
RESULTS: Data were available for 440,166 individuals (stroke [n=18,269], no stroke [n=421,897]). Age-adjusted prevalence and adjusted odds ratios (AOR, adjusted for age, sex, race, income, education, and marital status) for 3 unhealthy behaviors were higher in individuals with stroke compared to those without stroke: low fruits/vegetables: 54.8% vs. 48.0%, AOR: 1.18, p<0.001; low physical activity: 57.5% vs. 49.1%, AOR: 1.39, p<0.001; current smoker: 29.2% vs. 16.8%, AOR: 1.34, p<0.001. There was no significant difference in excess weight between groups (67.0% vs. 64.1%, AOR: 1.01, p=0.75). Individuals with stroke had a lower odds of heavy alcohol consumption compared to individuals without stroke (6.0% vs. 5.9%, AOR: 0.78, p=0.004).
CONCLUSIONS: Prevalence of unhealthy behaviors was high in both groups for most behaviors, but higher in adults with stroke. The presence of modifiable risk factors presents an opportunity to develop and test occupation-based lifestyle interventions aimed at reducing cardiometabolic risk and improving health-related quality of life, particularly in adults with stroke.
IMPACT STATEMENT: Prevalence of unhealthy behaviors is high in U.S. adults with and without stroke, and lifestyle interventions that promote healthy behaviors are needed. Interventions that promote health-enhancing occupations and performance patterns would be particularly relevant for achieving desired outcomes and should be informed by occupation-based theory and practice.
References
Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;STR.0000000000000024. DOI: 10.1161/STR.0000000000000024.
Towfighi A, Markovic D, Ovbiagele B. Impact of a healthy lifestyle on all-cause and cardiovascular mortality after stroke in the USA. Journal of Neurology, Neurosurgery, and Psychiatry. 2012;83(2):146-151. DOI: 10.1136/jnnp-2011-300743.
