Damp housing,mould growth,and symptomatic health state.

OBJECTIVE--To examine the relation between damp and mould growth and symptomatic ill health. DESIGN--Cross-sectional study of random sample of households containing children; separate and independent assessments of housing conditions (by surveyor) and health (structured interview by trained researcher). SETTING--Subjects'' homes (in selected areas of public housing in Glasgow, Edinburgh, and London). SUBJECTS--Adult respondents (94% women) and 1169 children living in 597 households. END POINTS--Specific health symptoms and general evaluation of health among respondents and children over two weeks before interview; and score on general health questionnaire (only respondents). MEASUREMENTS AND MAIN RESULTS--Damp was found in 184 (30.8%) dwellings and actual mould growth in 274 (45.9%). Adult respondents living in damp and mouldy dwellings were likely to report more symptoms overall, including nausea and vomiting, blocked nose, breathlessness, backache, fainting, and bad nerves, than respondents in dry dwellings. Children living in damp and mouldy dwellings had a greater prevalence of respiratory symptoms (wheeze, sore throat, runny nose) and headaches and fever compared with those living in dry dwellings. The mean number of symptoms was higher in damp and mouldy houses and positively associated with increasing severity of dampness and mould (dose response relation). All these differences persisted after controlling for possible confounding factors such as household income, cigarette smoking, unemployment, and overcrowding. Other possible sources of bias that might invalidate the assumption of a causal link between housing conditions and ill health--namely, investigator bias, respondent bias, and selection bias--were also considered and ruled out. CONCLUSION--Damp and mouldy living conditions have an adverse effect on symptomatic health, particularly among children.     

Effects of some indoor environmental factors on respiratory symptoms and lung function in a sample of young non smokers in North Italy

Summary We evaluated the effects of some indoor environmental factors in a non smoking subsample (n=381, age 8–19 years) of the general population living in the Po River Delta. Each subject completed an interviewer-administered standardized questionnaire on respiratory symptoms and risk factors. Acceptable maneuvers of forced vital capacity and slope of alveolar plateau of nitrogen were obtained in 96% and 59% of the subjects, respectively. In the houses there were more frequently natural gas for cooking (86%) than bottled gas (14%) and central heating (82%) than stove (18%). As regards passive smoking exposure, 18% of subjects had both parents smoking, 50% had one parent smoking. Significantly higher prevalence rates of wheeze, dyspnea, diagnosis of asthma were found in subjects of both sexes using bottled gas for cooking in comparison to those using natural gas, when also exposed to passive smoking. An insignificant trend towards higher symptom rates was shown by those using stove, instead of central heating. Lung function was affected only in females: those with both parents smoking had reduced forced expirograms, those with bottled gas for cooking or stove for heating had a decreased peak expiratory flow. Interactions of stove and passive smoking on peak expiratory flow and on slope of alveolar plateau were statistically significant. These findings confirm the mild adverse respiratory effects of certain home environment factors shown by other epidemiologic surveys in North Europe and in the USA. They have been a basis for the implementation, under the auspices of National Research Council and Electric Energy Authority, of future specific studies in which continuous monitoring of indoor pollutants and repeated recording of symptoms and lung function in North and Central Italy will be performed.     

Large differences in publicly visible health behaviours across two neighbourhoods of the same city

Background

There are socioeconomic disparities in the likelihood of adopting unhealthy behaviours, and success at giving them up. This may be in part because people living in deprived areas are exposed to greater rates of unhealthy behaviour amongst those living around them. Conventional self-report surveys do not capture these differences in exposure, and more ethological methods are required in order to do so.

Methodology/Principal Findings

We performed 12 hours of direct behavioural observation in the streets of two neighbourhoods of the same city which were similar in most regards, except that one was much more socioeconomically deprived than the other. There were large differences in the publicly visible health behaviours observed. In the deprived neighbourhood, we observed 266 more adults smoking (rate ratio 3.44), 53 more adults drinking alcohol (rate ratio not calculable), and 38 fewer adults running (rate ratio 0.23), than in the affluent neighbourhood. We used data from the Health Survey for England to calculate the differences we ought to expect to have seen given the individual-level socioeconomic characteristics of the residents. The observed disparities between the two neighbourhoods were considerably greater than this null model predicted. There were also different patterns of smoking in proximity to children in the two neighbourhoods.

Conclusions/Significance

The differences in observed smoking, drinking alcohol, and physical activity between these two neighbourhoods of the same city are strikingly large, and for smoking and running, their magnitude suggests substantial area effects above and beyond the compositional differences between the neighbourhoods. Because of these differences, individuals residing in deprived areas are exposed to substantially more smoking and public drinking, and less physical activity, as they go about their daily lives, than their affluent peers. This may have important implications for the initiation and maintenance of health behaviours, and the persistence of health inequalities.     

Home Accidents to Children under 15 Years: Survey of 910 Cases

Out of 910 accidents sustained by children under 15 seen at the casualty department of a local hospital 678 (74·5%) were to children under 5 years of age. Boys were more prone to accidents than girls, and in preschool children the highest incidence of accidents was among the 2-to 3-year-olds of both sexes. Social class had no significant bearing on the accident rate. The fact that the average size of families with children under 5 was higher among families living in council houses than among those living in private houses appeared to have some bearing on the higher incidence of accidents among children under 5 living in council houses. There appeared to be no peak month when accidents were more frequent and the incidence of accidents was not significantly high on any particular weekday. In 95% of the cases one or both parents were in charge of the child at the time of the accident.Cuts were the most common types of accident followed by falls and poisoning. Among other accidents crushed fingers were as frequent as burns. A total of 62 patients (6·8% of all cases) were admitted as inpatients. Of the actual causes of the cuts and falls playing, fighting, and misbehaving were the most common followed by falling from beds, chairs, etc. While there is a need for health education programmes to draw attention to the specific dangers evidenced there clearly will always be home accidents.     

Respiratory effects of non-tobacco cigarettes.

Data from the Tucson epidemiological study of airways obstructive disease on smoking of non-tobacco cigarettes such as marijuana were analysed to determine the effect of such smoking on respiratory symptoms and pulmonary function. Among adults aged under 40, 14% had smoked non-tobacco cigarettes at some time and 9% were current users. The prevalence of respiratory symptoms was increased in smokers of non-tobacco cigarettes. After tobacco smoking had been controlled for men who smoked non-tobacco cigarettes showed significant decreases in expiratory flow rates at low lung volumes and in the ratio of the forced expiratory volume in one second to the vital capacity. This effect on pulmonary function in male non-tobacco cigarette smokers was greater than the effect of tobacco cigarette smoking. These data suggest that non-tobacco cigarette smoking may be an important risk factor in young adults with respiratory symptoms or evidence of airways obstruction.     

Impact of a waste disposal site on adult respiratory health

Introduction. This study evaluated the impact of the presence of a dump on respiratory health in adults older than 50 years of age, living in its area of influence. Materials and methods. A cohort study was conducted with 313 adults older than 50 years of age living near the Navarro Dump (Cali, Colombia) and compared with 359 adults in an unexposed area. Each was examined monthly during a 6 month period to compare the incidence of respiratory symptoms and alterations in peak expiratory flow. Results. Exposure to the Navarro Dump was associated with occurrence of respiratory symptoms (odds ratio=1.25, 95% C.I. 1.01-1.56), in particular with mild respiratory symptoms (odds ratio=1.28, 95% C.I. 0.98-1.66). This result was obtained after adjusting for age, sex, education level, humidity, health insurance, comorbidity, smoking and previous occupational exposure. A higher recurrence of symptoms was found in adults in the area of exposure (correlation coefficient=0.29, 95% C.I. 0.23-0.33, p<0.001) and a significant reduction in the lung function defined by peak expiratory flow; the average decrease was15.2 L/min (95% C.I. -30.2 to +0.22). Conclusion. Independent of potential confounding factors, the respiratory health of adults exposed to the Navarro Dump was affected and exhibited an increased occurrence and recurrence of mild respiratory symptoms as well as decreased lung function.     

Quality of Life and Health Perceptions Among Fish-Eating Communities of the Brazilian Amazon: An Ecosystem Approach to Well-Being

Mercury (Hg) contamination in the Brazilian Amazon constitutes a serious environmental and public health issue. This study is part of the CARUSO Project, which uses an ecosystem approach to human health to examine the sources, transmission, and effects of Hg in the Brazilian Amazon, with a view to developing preventive intervention strategy. To date, studies have focused on measures of Hg exposure through fish consumption in relation to health effects; little attention has been given to quality of life (QoL). The objective of this study was to examine the relations between QoL and health perceptions, Hg exposure, sociodemographics, living conditions, and lifestyle in communities along the Tapajós River. A total of 456 adults from 13 villages were interviewed and provided hair samples for Hg analysis. Results showed that perceptions of QoL and health are relatively positive, despite elevated Hg exposure. Logistic regression analyses showed that a positive perception of QoL was associated with the absence of chronic illnesses, not smoking, fruit consumption, residing on the banks of the Tapajós, and living in an in-migrants’ community. The positive perception of health was associated with younger age, the absence of reported symptoms of chronic illnesses, and drinking alcoholic beverages. Cluster analysis revealed that the group that reported the highest QoL had a traditional lifestyle, involving daily fishing and high fish consumption. However, this traditional lifestyle is associated with elevated Hg levels and early reported symptoms potentially linked to Hg exposure. These findings underline the importance of understanding the factors underlying QoL to develop adequate strategies to reduce Hg exposure and promote well-being.     

Cadmium Profiles in Dental Calculus: a Cross-Sectional Population-Based Study in Hunan Province of China

We aimed to investigate whether the cadmium concentrations differ in human dental calculus obtained from the residents with no smoking living in the contaminated area and those with no smoking living in noncontaminated area. In total, there were 260 samples of dental calculus from the adults (n?=?50) with no smoking living in contaminated area, the adults (n?=?60) with no smoking living in mountainous area, and the adults (n?=?150) with no smoking living in low altitude area in Hunan province of China. All samples were analyzed by inductively coupled plasma mass spectrometry (ICP-MS) for cadmium levels. The cadmium levels in dental calculus were significantly higher in the adults with no smoking living in contaminated area than those living in mountainous area and in low altitude area (p?<?0.01). The cadmium levels in dental calculus were also higher in the adults with no smoking living in low altitude area than those living in mountainous region (p?<?0.01). The results suggested that measuring cadmium levels in dental calculus may be a useful noninvasive method for analysis of environmental exposure to cadmium in the human oral cavity. The low altitude region may have an area contaminated with cadmium in Hunan province of China.     

Cigarette smoking and the young: a national survey.

Cigarette smoking behaviour among the young was examined in the light of the responses of over 78 000 students to a 1972 questionnaire survey of Canadian schools. As few as 2% (8-year-old girls) and as many as 60% (16 year--old boys) were smoking one or more cigarettes per week. The prevalence of smoking was higher than that reported in earlier studies. Students, particularly girls, were beginning to smoke at progressively earlier ages. Some differences in smoking behaviour were found between regions, language groups and groups of children whose parents did or did not smoke. Recognition of immediate rather than long-term effects of smoking on health was reported as an important consideration in not smoking.     

Risk factors for severe acute lower respiratory tract infection in Bogota, 2001

Severity of acute respiratory infection is higher in developing countries, especially among the socioeconomically underprivileged. Viral pneumonias are more common, especially among children. A prospective hospital-based case control study was undertaken in Bogota between November 2000 and August 2001, aimed to identify factors related to severe low acute respiratory infection (SLARI). Cases were limited to children aged between 2 months and 5 years who filled WHO criteria for SLARI. Controls were children at the same hospital with ARI in a similar age range, but without symptoms of chest drawing. A total of 638 children (277 cases and 361 controls) were included. The most important risk factors included the following: living in borrowed houses (odds ratio (OR) = 2.7; 95% Confidence Interval (CI): 1.06-7.07), sharing the bed (OR = 1.88, CI: 1.0-3.7), living with more than 9 people (OR = 1.82, CI: 1.0-3.51), and living with smokers (OR = 1.4, CI: 1.0-2.05). Of the 114 samples collected (from children at third day after beginning of symptoms), 98 had viruses, sincitial respiratory virus was the most frequently identified virus (41.8%), followed by influenza A virus (3.1%) and influenza B virus (1%). All positive isolates for influenza A and B were sent to the United States Center for Disease Control (CDC) in Atlanta, where they were classified as influenza A/PANAMA/2007/99-like and influenza B/SICHUAN/379/99-like, respectively.     

Effect of Traffic Exposure on Sick Building Syndrome Symptoms among Parents/Grandparents of Preschool Children in Beijing,China

Introduction

Sick building syndrome (SBS) includes general, mucosal and skin symptoms. It is typically associated with an individual''s place of work or residence. The aim of this study was to explore the effect of traffic exposure on SBS symptoms in Beijing, China.

Methods

From January to May, 2011, recruitment occurred at kindergartens in 11 districts in Beijing. Self-administered questionnaires were distributed by teachers to legal guardians of children and then returned to teachers. The questionnaire asked them to recall the presence of 12 SBS symptoms from the previous three months. Living near a highway or main road (within 200 meters) was used as a proxy for traffic exposure. Multivariable logistic regression was used to test the association between traffic exposure and a higher number of SBS symptoms, controlling for key covariates.

Results

There were 5487 valid questionnaires (65.0% response rate). Univariate analysis showed that living near a main road or highway (OR = 1.40), female gender (OR = 1.44), and environmental tobacco smoking (ETS) (OR = 1.13) were significant risk factors for general symptoms. Grandparent’s generation (OR = 0.32) and home ownership (owner vs. renter) (OR = 0.89) were significant protective factors. The adjusted odds ratio (aOR) for the association between living close to a highway and general symptoms remained significant in the multivariable model (aOR = 1.39; 95% CI = 1.21: 1.59). ORs and aORs were similar for mucosal and skin symptoms.

Conclusions

This study found traffic exposure to be significantly associated with SBS symptoms. This finding is consistent with current literature that indicates an association between adverse health effects and living near highway or main road.     

Influence of passive smoking on admissions for respiratory illness in early childhood.

An association was sought between passive smoking and inpatient admissions for respiratory illness in 1058 children born between 1 June and 31 December 1981 and living in the neighborhoods of Nan-Jing Western Road and Yan-An Western Road in Jing-An District, Shanghai. The admission rate for first episodes of respiratory illness was positively correlated with the total daily cigarette consumption of family members during the children''s first 18 months of life. The relative risk of developing a first episode of respiratory illness was 1.80 for children living in families including people who smoked 10 or more cigarettes a day compared with those living in non-smoking families. Multiple logistic regression analysis showed that the effect of passive smoking on inpatient admission for respiratory illness was independent of the child''s birth weight, type of feeding, father''s education, size of the home, and chronic respiratory disease among adults in the family. The adjusted odds ratios compared with the non-smoking group were 1.17 in families smoking 1.9 cigarettes daily and 1.89 in families smoking 10 or more cigarettes daily. These data suggest that exposure to household cigarette smoke of children in early life increases the risk of severe respiratory illness.     

Urban Sprawl,Water Insecurity,and Enteric Diseases in Children from Mexico City

An ecosystem approach was adopted to investigate the interactions among anthropogenic habitat alterations, overcrowding, water insecurity, and enteric diseases in young children in Mexico City. A geographic information system (GIS) was used to define eligible wells and surrounding homesteads. Water quality was obtained from previously published investigations, and bacterial indicators included fecal coliforms and fecal streptococci. A cross-sectional survey was conducted during the rainy season 2002. A total of 1250 eligible households were visited on a random sample basis, and only those with children younger than 5 years of age were interviewed. Data on diarrheal disease (with a recall period of the last 2 weeks) were obtained from 950 children, and their guardians also provided information on housing, water supply, sanitation, and socioeconomic variables. The study found that the risk of diarrheal diseases was higher in children from the households that received drinking water from contaminated wells than from clean wells (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.00–2.86). The final analysis showed that the rate of diarrhea was higher in children from nonowned homes than in those living in owned dwellings (OR, 1.7; 95% CI, 1.04–2.77); the risk was also higher in children from houses with poor sanitation facilities (e.g., latrines or septic tank) than in those from houses connected to a sewage disposal system (OR, 1.7; 95% CI, 1.00–2.93). Children from households perceiving unpleasant characteristics of drinking water showed a higher risk than those without complaints (OR, 2.2; 95% CI, 1.28–3.76). This approach underlines the benefits of interdisciplinary research and may contribute to environmental health protection policy.     

Non-cancer effects of chemical agents on children's health

This paper provides an overview about the non-cancer health effects for children from relevant chemical agents in our environment. In addition, a meta-analysis was conducted on the association between sudden infant death syndrome (SIDS) and maternal smoking during pregnancy as well as postnatal exposure to environmental tobacco smoke (ETS).In children, birth deformities, neurodevelopment, reproductive outcomes and respiratory system are mainly affected by chemical exposures. According to recent systematic reviews, evidence is sufficient for cognitive impairments caused by low lead exposure levels. Evidence for neurotoxicity from prenatal methylmercury exposure is sufficient for high exposure levels and limited for low levels. Prenatal exposure to polychlorinated biphenyls (PCB) and related toxicants results in cognitive and motor deficits.Maternal smoking during pregnancy is a risk factor for preterm birth, foetal growth deficit and SIDS. The meta-analytic pooled risk estimate for SIDS based on 15 studies is 2.94 (95% confidence interval: 2.43–3.57). Postnatal exposure to ETS was found to increase the SIDS risk by a factor of 1.72 (95% CI: 1.28–2.30) based on six studies which took into account maternal smoking during pregnancy. Additionally, postnatal ETS exposure causes acute respiratory infections, ear problems, respiratory symptoms, more severe asthma, and it slows lung growth. These health effects are also of concern for postnatal exposure to ambient and indoor air pollution.Children differ from adults with respect to several aspects which are relevant for assessing their health risk. Thus, independent evaluation of toxicity in childhood populations is essential.     

Ethnomedical Syndromes and Treatment-Seeking Behavior among Mayan Refugees in Chiapas,Mexico

This survey investigated the prevalence of ethnomedical syndromes and examined treatments and treatment-seeking in Mayan Guatemalans living in United Nations High Commissioner for Refugee (UNHCR) camps in Chiapas, Mexico. Methods included a rapid ethnographic assessment to refine survey methods and inform the cross-sectional survey, which also examined mental health outcomes; 183 households were approached for interview, representing an estimated 1,546 residents in five refugee camps and 93% of all households. One adult per household (N = 170) was interviewed regarding his or her health; an additional 9 adults in three surveyed households participated and were included in this analysis; of the 179 participants, 95 primary child-care providers also answered a children’s health questionnaire for their children. Results indicated that ethnomedical syndromes were common in this sample, with 59% of adults and 48.4% of children having experienced susto (fright condition) and 34.1% of adults reporting ataques de nervios (nervous attacks); both conditions were significantly associated with symptoms consistent with posttraumatic stress disorder, anxiety and depression and are mental health conditions recognized by the American Psychiatric Association. Combining healthcare provider and indigenous treatments such as physician prescribed medication (65%), medicinal plants (65.7%), and limpias (spiritual cleansings) (40.6%) was reported. Most participants (86%) sought routine medical treatment from UNHCR trained health promoters in their camp. Assessing ethnomedical health is important for informing mental health programs among this population.     

Which population level environmental factors are associated with asthma,rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One

The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here.In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit.     

Lead (Pb) is Now a Non-Threshold Substance: How Does this Affect Soil Quality Guidelines?

Risk-based concentrations (RBCs) for lead (Pb) in soil were estimated using equations for development of Canadian soil quality guidelines. Based on the latest toxicological assessments by various health agencies, risk specific doses for Pb were defined for children (for impacts on intelligence quotient [IQ]) and adults (for impacts on systolic blood pressure [SBP] as well as protection of fetal effects in the case of pregnant women). The analysis suggests that a RBC in soil of 180 μg/g (dry weight) for residential and other areas where children routinely play is protective of a 1 IQ point decrement on a population basis and may actually be associated with decrements of less than 0.2 to 0.35 IQ points when the weight of evidence is considered. For soils that children do not contact on a frequent basis, RBCs as great as 8800 μg/g are considered to be protective of a 1 mmHg SBP increase in adults (as well as IQ effects to the fetus). It is stressed that non-soil sources of Pb may be even more important than soil. The approach may also be useful in jurisdictions outside of Canada as the importance of considering IQ decrements on a population basis rather than an individual basis and uncertainties in soil ingestion rates are considered.     

Treatment of Hepatitis C in Children: A Systematic Review

Background

Current guidelines recommend children be treated for hepatitis C virus (HCV) using the same principles applied in adults. There are however few published studies which assess the efficacy and safety of HCV therapy in children.

Methodology/Principal Findings

A systematic review of the literature was completed for studies of any design that evaluated HCV therapy in children. The primary outcome was sustained virologic response (SVR), with sub-group analysis of response rates by genotype. There were 4 randomized controlled trials (RCTs) and 31 non-randomized studies, all involving interferon, pegylated interferon (PEG-IFN), or combinations of these drugs with ribavirin. The SVR rate could not be directly compared as the populations and interventions differed across studies. Genotype was not reported or differed substantially from study to study. The overall SVR rate for PEG-IFN and ribavirin ranged from 30 to 100% which is comparable to the rate in adults. Similar to adults, the SVR rates were significantly higher in children with genotype 2 or 3 compared to genotype 1. Adverse effects were primarily flu-like symptoms and neutropenia. There were insufficient data to assess the applicability of the week 12 stop rule (stopping therapy at week 12 if there is less than a 2 log drop in HCV RNA) or the efficacy of shortening therapy to 24 weeks in children with genotype 2 and 3.

Conclusions/Significance

Current guidelines for the treatment of HCV in children are based on limited data. Further research is needed to define the optimal therapy for HCV in children.     

Longitudinal Predictors of Functional Impairment in Older Adults in Europe – Evidence from the Survey of Health,Ageing and Retirement in Europe

Objective

To examine time-dependent predictors of functional impairment in older adults in Europe longitudinally.

Methods

Data were derived from the Survey of Health Ageing, and Retirement in Europe (2004–2013). Functional impairment was assessed by using activities of daily living (ADL) and instrumental activities of daily living (IADL) indices. Fixed effects regressions were used to estimate the effects of sociodemographic factors (age, marital status, living situation, and income deciles (median split)), lifestyle factors (smoking status and alcohol consumption per week), depression, cognitive function and chronic diseases on the outcome variables.

Results

Longitudinal regressions revealed that functional impairment increased significantly with age, the occurrence of depression, cognitive impairment, the number of chronic conditions, and less than daily alcohol consumption in the total sample and in both sexes. Moreover, the onset of smoking and living without a spouse/partner in household increased functional impairment in the total sample. The effect of depression on functional impairment was significantly more pronounced in men.

Conclusion

Our findings highlight the relevance of changes in age, depression, cognitive function, smoking and chronic diseases for functional impairment. Since particularly depression and smoking may be avoidable, developing strategies to prevent depression or stop smoking might be useful approaches to postpone functional impairment in older adults.     

Smoking and other health factors in patients with head and neck cancer

BackgroundInformation on smoking and other health factors in head and neck cancer (HNC) patients throughout treatment, follow-up and survivorship is limited. This study explores patterns of multiple health factors during radiotherapy (RT) and naturalistic long-term follow-up in a convenience sample of patients with HNC.MethodsSmoking, alcohol use and depression were measured at baseline, 4 and 12 weeks post RT for a sub-group of 99 patients who participated in a randomised controlled trial and completed long-term follow-up. These factors plus healthy eating, physical activity and fatigue are also reported from the long-term follow-up component. Smoking was measured by self-report and biochemically, whilst all other variables were by self-report. Where variables were assessed at multiple time points logistic mixed effects regression models determined within-person changes over time.ResultsThere were important discrepancies between self-reported (4–7%) and biochemically verified (13–29%) rates of smoking. Rates of smoking and hazardous alcohol intake were significantly increased at follow-up compared to baseline. Depression rates were observed to be higher at end of RT compared to baseline. At long-term follow-up, fatigue was common and co-occurred with suboptimal healthy eating and hazardous alcohol use.ConclusionClinically important levels of smoking and alcohol consumption post RT in this sample suggest possible targets for intervention beyond treatment into long-term follow-up of patients.