Based on these results, more than half of all US adults are considered overweight or obese. The prevalence of obesity-related comorbidities emphasizes the need for concerted efforts to prevent and treat obesity rather than just its associated comorbidities.

During 10 years of follow-up, the incidence of diabetes, gallstones, hypertension, heart disease, colon cancer, and stroke (men only) increased with degree of overweight in both men and women. Adults who were overweight but not obese (ie, 25.0 < or = BMI < or = 29.9) were at significantly increased risk of developing numerous health conditions. Moreover, the dose-response relationship between BMI and the risk of developing chronic diseases was evident even among adults in the upper half of the healthy weight range (ie, BMI of 22.0-24.9), suggesting that adults should try to maintain a BMI between 18.5 and 21.9 to minimize their risk of disease.

Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.

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OBJECTIVE: Since the prevalence of adult obesity is increasing in the United States, we examined the effect of changing common habits (exercise, TV viewing, smoking and eating habits) on four year change in body weight. DESIGN: A prospective cohort study of US male health professionals with follow-up from 1988±1992. Participants were 19 478 men aged 40±75 in 1986, who were free of cancer, coronary heart disease, stroke and diabetes. METHODS: Multiple regression was used to determine the association between four year change in body weight (from 1988±1992) and common habits, after adjusting for baseline age, hypertension and hypercholesterolemia. RESULTS: For middle aged men, vigorous activity was associated with weight reduction and TVaVCR viewing and eating between meals with weight gain. Quitting smoking and a history of voluntary weight loss prior to the study period were consistently related to weight increase. Recently being on a diet was more strongly associated with weight loss among older men. Over the four year follow-up period, middle-aged men who increased their exercise, decreased TV viewing and stopped eating between meals, lost an average weight of 71.4 kg (95% con®dence interval (CI)71.6 ± 71.1 kg), compared to a weight gain of 1.4 kg among the overall population. The prevalence of obesity among middle-aged men was lowest among those who maintained a relatively high level of vigorous physical activity, compared to those who were relatively sedentary. CONCLUSION: These data suggest that improvement in the mix of health habits, particularly increasing vigorous activity, as well as decreasing TV use and changing eating habits, results in weight maintenance or a modest weight loss over four years.

. Relationship of job strain and iso-strain to health status in a cohort of women in the United States. ScandJ WorkEnviron Health1998;24(1):54-61. Objective This study examined the relationships of job strain and iso-strain psychosocial work-environment exposures to health status in a cohort of working women in the United States. Methods In a cross-sectional survey, 33 689 woinen responded to the Karasek job content and the MOS SF-36 health status questionnaires. The psychosocial work-environment exposures were characterized using the job strain and iso-strain frameworks. Health status was assessed with the following 6 scales: physical functioning, vitality, freedom from pain, mental health, role limitations due to physical health, and role limitations due to emotional health. Results When compared with active work, high-strain work (high job demands and low job control) was associated with lower vitality, mental health, higher pain, and increased risks of both physical and emotional role limitations. Iso-strain work (high strain and low work-related social support) increased the risks further. Job insecurity was also associated with lower health status. C O~~C~U S~O~SThe analyses supported the hypothesis that the psychosocial work environment is an important determinant of health status among working women. The findings suggest that incorporating social conditions at work into the measurement of psychosocial work-environment exposure improves the identification of highrisk work arrangements.

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OBJECTIVES: This study assessed whether skin color and ways of handling anger can serve as markers for experiences of racial discrimination and responses to unfair treatment in public health research. METHODS: Survey data on 1844 Black women and Black men (24 to 42 years old), collected in the year 5 (1990-1991) and year 7 (1992-1993) examinations of the Coronary Artery Risk Development in Young Adults (CARDIA) study, were examined. RESULTS: Skin color was not associated with self-reported experiences of racial discrimination in 5 of 7 specified situations (getting a job, at work, getting housing, getting medical care, in a public setting). Only moderate associations existed between darker skin color and being working class, having low income or low education, and being male (risk ratios under 2). Comparably moderate associations existed between internalizing anger and typically responding to unfair treatment as a fact of life or keeping such treatment to oneself. CONCLUSIONS: Self-reported experiences of racial discrimination and responses to unfair treatment should be measured directly in public health research; data on skin color and ways of handling anger are not sufficient.