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Show reliance on convenience food and they limit exercise activity more than their counterparts perceiving diabetes as not very serious. The disparity in the perception that diabetes is or is not a serious disease exhibited between younger adults who engage in high-risk lifestyles versus those whose lifestyles are low-risk may simply be axiomatic. If one is young, healthy, exercises, and/or is not overweight, he or she is less likely to perceive diabetes as a serious disease than those who, though young, recognize the fact that they are overweight and that they do not exercise. Few individuals in our society could be oblivious to the health impacts of being overweight and not exercising; thus, for those with high-risk lifestyles, it is only a small step to recognizing that diabetes may be one of the serious consequences. On the other hand, middle aged and older adults may be concerned with staving off the aging process; hence, a view of diabetes as very serious, or not, would not directly affect choices regarding lifestyle behaviors. These adults are likely to more be concerned with maintaining their current health status. Those viewing diabetes as very serious may be less likely to engage in high-risk lifestyles than those viewing it as not very serious. These data suggest that those adults in younger age groups who have greater awareness of the seriousness of diabetes are indeed those who have not made the behavioral changes necessary for healthier lifestyles. Behavioral change is a complex process, and awareness is only one of the factors necessary to effect change. While public health messages to increase awareness of diabetes risk factors have had limited success, interventions focused only on improving public awareness fall short in bringing about the behavioral changes required to reduce risk. On the other hand, interventions directed towards improving the environmental and political climate, without addressing the seriousness of diabetes, are ineffective. At a minimum, the public health arena must seek ways to promote awareness, behavioral changes, and environmental changes that work in tandem before a real reduction in numbers of individuals at risk for diabetes can be realized. In summary, awareness of the very serious nature of diabetes does not automatically translate into participation in a low-risk lifestyle that conveys diabetes-prevention benefits. Paradoxically, just the opposite situation seems to prevail among young Utah adults. Whatever benefits may be associated with greater awareness appear to be offset by lifestyles potentially negating such benefits. Therefore, it is important that public health initiatives not only address awareness of the seriousness of diabetes but facilitate lifestyle changes as well. Specific attention to the environmental settings promoting diabetes-preventive lifestyles is needed. Messages intended to merely increase awareness of the seriousness of diabetes may prove to be disappointingly ineffective. References 1. American Diabetes Association (1998). Economic Consequences of Diabetes Mellitus in the U.S. in 1997. Diabetes Care, 21: 296-306. 2. Baranowski, T., C.L. Perry & G.S. Parcel (1997). How Individuals. Environments, and Health Behavior Interact. In K. Glantz, F.M. Lewis & B.K. Rimer (Eds.) Health Behavior and Health Education: Theory Research and Practice, 153-178. San Francisco: Jossey-Bass Publishers. 3. Boyle, J.P.. Honeycutt, A.A.. Venkat Narayan K.M., Hoerger. T.J., Geiss, L.S., Chen, H. & Theodore J. Thompson. T.J. (2001). Projection of Diabetes Burden Through 2050. Diabetes Care, 24: 1936-1940. 4. BRFSS Summary Prevalence Report 2000 (n.d). [Online] http://www. cdc.gov/nccdphp/brfss/pubrfdat.htm/. Retrieved 3/25/02. 5. DHHS (U.S. Department of Health and Human Services) (2000). Healthy People 2010: National Health Promotion and Disease Prevention Objectives. Washington, DC: U.S. Department of Health and Human Services. 6. Hodgson, T., & Cohen, A. (1999). Medicare care expenditures for diabetes, its chronic complications and its comorbidities. Preventive Medicine, 29: 173-186. 7. Mokdad. A.H.. Ford. E.S.. Bowman. B.A., Nelson D.E., Engelgau. M. M., Vinicor, F., & Marks. J.S. (2000) Diabetes Trends in the U.S. 1990-1998. Diabetes Care, 23 (9): 1278-1283. 8. National Heart. Lung, and Blood Institute (1998). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. Obesity Research, 6 (Suppl. 2): 51S-210S. 9. Office of Public Health Assessment (2001). Utah's Behavioral Risk Factor Surveillance System TREND REPORT 1989-1999. Salt Lake City, UT: Utah Department of Health. 10. Rewers M., & Hamman R.F. (1995). Risk factors for non-insulin-dependent diabetes. Diabetes in America (2nd ed.). Bethesda, MD: National Institutes of Health, 179-220. About the Authors Brenda Rails is a research consultant for the Utah Diabetes Control Program, Utah Department of Health. Craig Merrill is a health plan specialist for the Utah Diabetes Control Program, Utah Department of Health. William F. Stinner is professor emeritus, Population Research Laboratory, Department of Sociology, Social Work, and Anthropology, Utah State University. Michael Friedrichs has been a statistician for the Bureau of Health Promotion, Utah Department of Health. Sandra Assasnik is the program manager for the Utah Diabetes Control Program, Utah Department of Health. LaDene Larsen has been the Director for the Bureau of Health Promotion in the Utah Department of Health. 10 Utah's Health: An Annual Review Volume VIII |