Factors associated with non-participation in a physical activity promotion trial.

BACKGROUND: Non-participation can bias outcome in intervention studies of physical activity. OBJECTIVES: To compare characteristics, knowledge and attitudes to physical activity in participants and non-participants of a physical activity intervention trial in primary care. STUDY DESIGN: Cross-sectional survey. METHODS: Patients aged 40-64 years were recruited opportunistically during surgery visits in an inner city general practice in Newcastle upon Tyne, UK. Attitudes to physical activity, views of its health benefits, and barriers to participation were elicited in interviews with participants, and by postal questionnaire from non-participants. Data held by general practitioners were used to compare anthropometry and lifestyle between groups. RESULTS: Of 842 eligible patients, 276 (33%) refused outright (non-volunteers) and 566 volunteered for the intervention study, of which 353 (42%) attended a baseline assessment and 213 (25%) subsequently defaulted. The initial refusal rate was higher amongst men, smokers and those with addresses in more deprived areas. The response rate to the postal survey of non-volunteers was 45%. Compared with participants, the non-volunteers were more likely to be an adult carer and to report poorer health, and were less likely to have had higher education or to have children living at home. Far more non-volunteers considered that they already did enough exercise to maintain health. Non-volunteers had slightly less knowledge of the benefits of physical activity; attached far less importance to it in maintaining health; were more likely to cite 'fear of leaving their home unattended', 'do not enjoy exercise' and 'poor health' as barriers to exercise; and were less likely to cite 'no one to exercise with' as a barrier to exercise. CONCLUSION: Recruitment of 'hard to engage' individuals requires careful phrasing of the message to focus on their personal goals and to address gaps in their knowledge about physical activity and the principal barriers they perceive. Differential uptake across population subgroups could lead to a widening of health inequalities.

Smoking and alcohol consumption in a UK Chinese population.

Little research has been conducted on health in Chinese communities in the UK and there are few representative data on smoking, alcohol consumption or other aspects of lifestyle. We undertook a cross sectional population-based study of 380 Chinese and 625 European men and women aged 25 to 64 y, using self-completion and interview questionnaires in Newcastle upon Tyne, UK between 1991 and 1995. We measured self-reported prevalence of cigarette smoking, number of cigarettes smoked per week and age at starting smoking; self-reported prevalence of alcohol consumption and units of alcohol consumed per week. In age-adjusted comparisons smoking was less common in Chinese (24%) than European men (35%) (P=0.00002) and among Chinese (1%) compared with European women (33%) (P<0.00001). Number of cigarettes smoked was similar among Chinese and European male smokers. Median age at starting smoking was higher among Chinese (18.5 y) compared with European men (15 y) (P=0.00001). Smoking was commonest in older Chinese and in younger Europeans. The prevalence of alcohol consumption was lower among Chinese (63%) than European men (93%) (P<0.00001) and among Chinese (29%) compared to European women (89%) (P<0.00001). Median alcohol consumption was significantly lower among Chinese (2 units/week) than European men (16 units/week) (P<0.00001), and among Chinese (1 unit/week) compared to European women (6 units/week) (P<0.00001). Among those who drank alcohol, Chinese men were less likely to drink above recommended limits than European men (1% vs 39%; P<0.00001). Chinese men and women currently have relatively favourable patterns of smoking compared to European adults in Newcastle. Average alcohol consumption among Chinese who drink is lower than among Europeans, and a substantial proportion of the Chinese population in Newcastle drink no alcohol. Patterns of health related behaviour should be tracked over time in ethnic minority populations to identify changes that pose risk to health and which deserve appropriate intervention.

Identifying Chinese populations in the UK for epidemiological research: experience of a name analysis of the FHSA register. Family Health Services Authority.

There is a paucity of research on health in the UK Chinese community partly due to the difficulties of identifying and accessing study populations. For a survey of cardiovascular disease we aimed to identify and recruit all Chinese adults aged 25-64 y living in Newcastle-upon-Tyne, UK. One thousand, eight hundred and sixty-five potential subjects were identified using a variety of methods. Of the 1702 potential subjects identified from a name analysis of the 1991 FHSA register (FHSA group), 638 students in halls of residence were excluded and the remaining 1064 were invited to participate. Non-respondents were followed up. Of the 1064, 658 (65.5%) addresses were no longer valid, 21 (2%) were reclassified as non-Chinese and no contact was made with 18 individuals (1.6%). A further 163 subjects (non-FHSA group) came forward in response to publicity, giving a total of 530 Chinese actually identified in Newcastle. Three hundred and eighty subjects took part in the study. Compared to the 1991 Census, the recruitment procedure underestimated the total population size, particularly for men and younger ages. In the FHSA group, men were significantly more likely to be current drinkers, and women were more likely to smoke and have a lower educational attainment that the non-FHSA group. There were no other important differences in the distribution of CHD risk markers in the two groups. Our experience indicates that the FHSA register is suitable for identifying Chinese but should be used alongside other complementary methods to augment samples for ethnicity and health research.

Low levels of cardiovascular risk factors and coronary heart disease in a UK Chinese population.

OBJECTIVE: To compare the prevalence of cardiovascular risk factors and coronary heart disease in Chinese and Europid adults. DESIGN: Population based, cross sectional survey. SETTING: Newcastle upon Tyne, UK, 1991-93. SUBJECTS: Altogether 380 Chinese and 625 Europid adults, aged 25-64 years. MAIN OUTCOME MEASURES: Fasting lipid levels, blood pressure, body mass index (BMI), the proportions who smoked, and the prevalence of coronary heart disease based on the Rose angina questionnaire and major electrocardiographic abnormalities on resting 12 lead electrocardiogram (Minnesota codes 1.1-1.2). All figures were age adjusted to the 1991 England and Wales population. RESULTS: Altogether 183 and 197 Chinese, and 310 and 315 Europid men and women respectively were seen. Compared with Europid men, Chinese men had a lower mean total cholesterol concentration (5.1 versus 5.6 mmol/l, p < 0.001) and LDL cholesterol (3.2 versus 3.6 mmol/l, p < 0.001); lower BMI values (23.8 versus 26.1 kg/m-2, p < 0.001); and smoked less (23% versus 35%, p < 0.01)). Compared with Europid women, Chinese women also had lower mean lipid levels (total cholesterol: 4.9 versus 5.4 mmol/l p < 0.001, LDL cholesterol: 2.8 versus 3.1 mmol/l p < 0.001); BMI values (23.5 versus 26.1 kg/m-2, p < 0.001); and far fewer were smokers (1.4% versus 33%, p < 0.001). Chinese women, however, had higher mean systolic (121 versus 117 mmHg, p > 0.05) and diastolic (75 versus 68 mmHg, p < 0.001) blood pressures. The prevalence of coronary heart disease was significantly lower in Chinese than Europid men (4.9% versus 16.6%, p < 0.001) but not significantly different in women (7.3% versus 11.1%, p = 0.16). CONCLUSION: Strategies for UK Chinese are needed to maintain this favourable risk factor profile and prevent any potential increase in the risk of coronary heart disease associated with increasing acculturation.

Microalbuminuria and associated cardiovascular risk factors in the community.

The prevalence of microalbuminuria and relationship to cardiovascular risk factors was examined in a cross-sectional community survey of cardiovascular risk factors. Microalbuminuria (when classified as albumin concentration greater than 20 micrograms/ml) was present in 6.3% of subjects but in conjunction with an albumin/creatinine ratio greater than 3.5 in only 2.2%. Diastolic blood pressure, prevalence of abnormal electrocardiographs, and to a lesser extent systolic blood pressure and fibrinogen concentration, were greater in those with albuminuria concentrations greater than 20 micrograms/ml. The strongest positive univariate correlates of albumin/creatinine ratios in those with detectable albuminuria were age, fibrinogen, blood pressure, total- and low density lipoprotein-(LDL) cholesterol, apo B and alcohol intake, whereas fasting insulin and insulin resistance were inversely correlated. Multiple regression analysis revealed that age, gender, systolic blood pressure and insulin resistance independently accounted for 37% of the variability in albumin/creatinine ratios. When those 10 subjects with microalbuminuria and albumin/creatinine ratios greater than 3.5 were matched with 20 with normoalbuminuria for age, gender and body mass index, the microalbuminuric subjects had significantly lower LDL cholesterol/apo B ratios and a tendency to lower high density lipoprotein (HDL) cholesterol and HDL cholesterol/apo A1 ratios. Microalbuminuria is uncommon in the general population, and is related to ageing, blood pressure and other vascular risk factors. It may reflect the presence of established cardiovascular disease.