The Alameda County Study:

A Systematic, Chronological Review

Jeff Housman and Steve Dorman

ABSTRACT

This study is a systematic review of the Alameda County study findings and their importance in establishing a link
between lifestyle and health outcomes. A systematic review of literature was performed and data indicating important links between lifestyle and health were synthesized. Although initial studies focused on the associations between health outcomes and personal health habits known as the Alameda 7, subsequent studies focused on the
relationships between social variables, religiosity, several chronic health problems, and long-term health. Significant findings during periodic assessments of the original 1965 cohort yielded strong support for a link between
lifestyle habits and long-term health outcomes. Additionally, social networks, religiosity, and several demographic
variables were found to be associated with chronic disease development.

INTRODUCTION
In 1965, life expectancy reached a point
at which quality, not merely existence, deserved attention.1 In an effort to discover
the effect of personal health habits on quality of life, chronic conditions, and mortality, several researchers in California developed the Human Population Laboratory.
The group of researchers decided on a design to measure select health practices
among a probability sample of the population of Alameda County in California. The
participants answered initial survey questions concerning their lifestyle habits in
1965 with subsequent collections taking
place in 1973, 1985, 1988, 1994, and 1999.
DEVELOPMENT OF THE ALAMEDA 7
The 1965 panel, known as the Health
and Ways of Living panel, included Lester
Breslow, Nedra Belloc, and George A.
Kaplan. Breslow and Kaplan became the
principal investigators of the Health and

Ways of Living Study, with Belloc making

major contributions to initial studies. Much
of the continued study of health behaviors
occurred at the Human Population Laboratory in Berkeley, California.
In an attempt to assess the effects of
health habits and social relationships on
physical and mental health, Belloc and colleagues1 obtained information from 6,928
respondents in Alameda county. The probability sample included 3,158 men and
3,770 women. The sample included 360
men and 530 women over the age of 65.
This sample would become known as the
1965 Alameda cohort. Each participant answered surveys regarding marital and life
satisfaction, parenting, physical activities,
employment, childhood experiences, and
demographic data. In addition, participants were asked to report levels of disability without complaints, symptomatic,
chronic conditions, disability-less, and
disability-severe. To summarize physical

302 American Journal of Health Education Sept/Oct 2005, Volume 36, No. 5

health status of groups of individuals,

weighted proportions were necessary.
Therefore, each group was classified by a
ridit, or Relative to an Identified Distribution, allowing feasible and meaningful
comparisons between groups.
Belloc and colleagues1 published the initial set of findings from the 1965 Alameda
cohort. Self-reported disability data revealed fewer men were disabled than
women, but the proportion of chronic diseases was nearly equal. Occurrence of disability and chronic disease increased with

Jeff Housman, MEd, is a graduate assistant,

Texas A&M University Department of Health
and Kinesiology, TAMU Mail Stop 4243, College Station, TX 77843; E-mail: jhousman@
hlkn.tamu.edu. Steve Dorman, PhD, MPH, is
chair and professor, Texas A&M University Department of Health and Kinesiology, TAMU
Mail Stop 4243, College Station, TX 77843-4243.

Jeff Housman and Steve Dorman

age, and high-energy levels were found

mostly in younger groups. In an overall
comparison between groups, men were
healthier than women, younger people (45
years or less) were healthier than older
people (over 45 years), and individuals with
inadequate income were less healthy than
individuals with adequate income. Furthermore, those who were employed were
healthier than those who were unemployed
or retired. White and black persons were
equally healthy, but Chinese and Japanese
individuals displayed a favorable status not
related to age, sex, or income. Persons with
higher education levels were healthier than
those with less education, and separated
persons were less healthy than those who
were married. Several of these health disparities including educational level and
marital status continue today.
Belloc and colleagues2 published a follow-up study that examined the relationship between physical health status and
health practices. Using data from the 1965
Alameda cohort, Belloc and colleagues2
examined nightly hours of sleeping, regularity of meals, physical activity, alcohol
consumption, and smoking. Additional
analyses were performed to determine if
these health behaviors had independent or
cumulative effects on health outcomes. The
results revealed that sleeping seven to eight
hours per night, eating regular meals, participating in regular exercise, limiting alcohol consumption, and not smoking were
highly correlated with healthier individuals. In contrast to previous studies, socioeconomic status was found to have no association with health. Further data analyses
suggested a cumulative effect of these behaviors. This study provided initial empirical support for the link between lifestyle and
health outcomes.
In a 5-1/2 year follow up of the 1965
Alameda cohort, Belloc3 investigated the relationship between health practices and
mortality. Health practices included sleep,
weight, smoking, eating, alcohol consumption, physical activity, and other health practices. Analysis of results revealed that those
who ate regular meals including breakfast,

received adequate sleep (78 hours), maintained a healthy weight for their height, did
not smoke, limited alcohol consumption,
and participated in regular physical activity
lived longer than those who did not practice
these behaviors. These seven healthy behaviors would become known as the Alameda
7. In a final analysis, men and women practicing six of the seven health behaviors lived
11 and 7 years longer, respectively, than those
practicing fewer than 6 health behaviors.
Belloc3 concluded that there was a striking
inverse correlation between the number of
health practices and mortality levels for
older age groups.
These initial studies provided data indicating a relationship between personal
health habits (Alameda 7) and health outcomes. Additionally, data indicated health
disparities based on demographic variables
including socioeconomic status, ethnicity,
age, and educational level. Analyses of subsequent data collections in 1973, 1985, 1988,
1994, and 1999 would continue to support
the conclusions. Additional studies would
expand on these findings to determine links
between social interactions, religiosity, obesity, and other chronic conditions.

FOLLOW-UP STUDIES
In an attempt to further establish understanding of the relationship between health
behaviors and quality of life, Gottleib and
colleagues 4 examined the Alameda 7
health behaviors, life events, and social networks. Data from the 1965 Alameda cohort
were analyzed in an attempt to correlate
income, educational level, age, five health
practices, social networks, and life events.
Although some of the analyses were inconclusive, there was a positive relationship
between social networks and health practices for both men and women. Furthermore, church participation and marriage
were positively correlated with health outcomes. These findings supported the belief
that social networks and certain elements
of spirituality were associated with longterm health outcomes.
In a 9-1/2 year follow up of the 1965
Alameda cohort, Breslow and colleagues5

examined the Alameda 7 health habits and

mortality. The results supported the hypothesis that good health practices and not
the initial health status of the survey respondents are largely responsible for the observed mortality rates. Although no health
practice behaviors had been measured in
five years, it was assumed that most individuals were consistent with regard to
health practices. In a similar follow-up
study, Wiley and colleagues6 found significant correlations between the Alameda 7
health behaviors and positive health outcomes.
Roberts and colleagues7 used data from
the 1965 cohort to specifically differentiate
health practices based on ethnicity. The
health practices of Anglo, African-American or African, and Chicano people were
compared within the 1965 Alameda cohort.
Age, sex, family income, education, marital
status, perceived health status, and physical
health status were assessed. In general,
Chicanos reported less disability, fewer
chronic conditions, and fewer symptoms of
ailments. However, in contrast to other ethnic groups, higher levels of severe mortality were found among Chicano women.
Overall, Chicanos health practices and conditions compared favorably to Anglos and
people of African descent. Furthermore, the
data analyses supported previous hypotheses that good health practices were associated with a longer and better quality of life.
Using a multivariate analysis of the seven
health behaviors and seven demographic
variables identified by previous Human
Population Laboratory studies, Wingard
and colleagues8 converted nine-year mortality rates and health practice ridits into
logits (log odds units). By converting the
previous ridit scores to logits, researchers
were able to make linear comparisons. In
nearly all age groups and health practice
groups, five of seven health behaviors were
significant and independently associated
with mortality. In contrast to previous studies, eating breakfast and snacking between
meals had no substantial association with
mortality. The linear model supported previous findings, indicating regular exercise,

American Journal of Health Education Sept/Oct 2005, Volume 36, No. 5

303

Jeff Housman and Steve Dorman

limited alcohol consumption, abstinence

from smoking, sleeping 78 hours a night,
and maintenance of a healthy weight play
an important role in promoting longevity
and delaying illness and death.
Mortality, behavioral, and demographic
risk factors among older people (over 65
years) in the 1965 Alameda cohort were
examined in 1987. Kaplan and colleagues9
reexamined health practices of the older
people (>65 years of age) in the 1965 cohort and compared current levels of health
practices and demographic factors to
baseline data. Results indicated many behavioral and demographic risk factors remained predictors of seventeen-year mortality risk, even at older ages. In a
multivariate analysis of the Alameda 7
health behaviors, Kaplan and colleagues9
found strong negative associations between
the Alameda 7 health behaviors and cancer, heart disease, stroke, diabetes, high
blood pressure, and trouble breathing. Ethnic disparities in mortality risk decreased
with age, and eating breakfast was more
strongly associated with positive health outcomes in older groups. This study provided
evidence that the relationship between
health practices and mortality was consistent over time.
In the most recent studies concerning
the Alameda 7 health behaviors and mortality, Strawbridge and colleagues10 and
Beebe-Dimmer and colleagues11 examined
self-rated health and disease burden factors during childhood, and the association
between socioeconomic and mortality
among adults in the 1965 Alameda cohort,
respectively. Strawbridge and colleagues10
tested the hypothesis that personal health
behaviors could not predict mortality. After current conditions of the 1965 Alameda
cohort were discovered and analyzed, researchers concluded mortality could not be
predicted by health behaviors alone. However, personal health practices were still the
largest predictor of mortality. Beebe-Dimmer and colleagues 11 concluded lower
childhood socioeconomic status was associated with an increased mortality due to
cardiovascular disease, but was unrelated

to death due to other causes. Overall mortality rates were highest among women
with low educational levels, and low household income was associated with higher
cardiovascular disease. Furthermore, low
socioeconomic status in early and later life
contributed to an increased mortality risk
in women. These effects were stronger for
cardiovascular mortality than non-cardiovascular mortality.
From 1979 to 2004, continued analyses
of subsequent data collections from the
1965 cohort continued to support the hypothesis that the Alameda 7 health behaviors are strongly associated with long-term
health outcomes. Although recent studies
have found no significant correlations between not eating breakfast or snacking between meals and health outcomes, the remaining five have consistently been shown
to be associated with good health.

RELATED STUDIES
Several researchers attempted to determine the generalizability of the Alameda
county study findings using regional and
national samples. Brock and colleagues12 attempted to replicate the Alameda longitudinal study in Michigan. A statewide sample
of 3,259 adult Michigan residents were surveyed regarding their health practices via
telephone. Consistent relationships were
found between physical health status and
individual health practices, including sleep
patterns, eating breakfast, eating between
meals, smoking, weight, and physical activity. However, some of the findings, such as
sleeping 78 hours, eating breakfast and eating between meals, were not found to be statistically significant. Although not all health
practices were significant, the results demonstrated the generalizability of the Alameda
county study.
In an effort to identify prevalence of the
Alameda 7 health practices nationwide,
Schoenborn13 reported results from the
1985 National Health Interview Survey
(NHIS). Questions from the NHIS asked a
nationwide sample about their exercise habits, eating habits, sleeping habits, alcohol
consumption, body weight, and demo-

304 American Journal of Health Education Sept/Oct 2005, Volume 36, No. 5

graphic characteristics. Although some variables were defined slightly differently, the
author reported results regarding the
Alameda 7 health behaviors. Simple
prevalence statistics, unadjusted for age or
other sociodemographic characteristics,
were used in the analysis. Results of the survey revealed 12 percent of men and 11 percent of women practiced six or seven good
health habits, more than half of both men
and women reported 4 or 5 good health
habits, and 37 percent of men and 33 percent of women reported 0 to 3 good
health habits. Men were more likely to
smoke, consume alcohol, and exercise than
women. Younger people (1844 years)
were more likely to skip breakfast, snack
between meals, and drink alcohol than
older persons (over 45 years). Caucasians
were more likely to eat breakfast, sleep 7
8 hours, and drink five or more drinks at
one sitting than African-Americans. Additionally, persons in socially and economically disadvantaged groups were less likely
to have good health habits. Persons in
older groups were more likely to have a
greater number of good health habits,
and African-Americans tended to have
fewer good health habits than Caucasians. These results showed disparities
among social, economic, ethnic, and age
groups with regard to health practices.
The results of these studies supported
previous findings using data from the 1965
Alameda cohort. Positive correlations were
found between the Alameda 7 health behaviors and positive health outcomes. Additionally, similar disparities were found
based on ethnicity, gender, socioeconomic
status, and educational level. These studies
indicated the generalizability of the
Alameda county study findings, and further
established personal health practices as
major factors in long-term health.
In addition to establishing the link
between personal health practices and
health outcomes, researchers have attempted
to determine the relationship between social interactions, religiosity, depression,
obesity, hearing and vision loss, and other
chronic conditions.

Jeff Housman and Steve Dorman

SOCIAL/MARITAL RELATIONSHIPS
Several follow-up studies involving the
1965 cohort focused on the relationships
among marriage, social interactions, and
mortality. Kotler and colleagues14 concluded
marital status is associated with health outcomes. Married individuals, especially men,
had lower mortality risk than single individuals, and divorced or separated individuals had highest risk. Data analyses performed by Reynolds and colleagues 15
indicated a negative relationship between
social connections, incidence of mortality,
and prognosis of cancer. Although this
study was limited by the complexity of the
variables involved, the relationship between
social connections and reduced risk for cancer was found significant. In addition, Yen
and colleagues16 indicated lower-quality
social environments were associated with an
increased risk of death during an elevenyear follow up. The association remained
after adjustments for age, sex, income, education, race/ethnicity, smoking, body mass
index, alcohol consumption, and perceived
health status were made.
RELIGIOSITY
In addition to studies tracking specific
health behaviors of the Alameda cohort,
several authors have examined social, economic, and psychological factors related to
health practices. Strawbridge and colleagues17 and Oman and colleagues18 studied religious attendance (weekly, monthly,
yearly, never) and its association with mortality and survival. Using data collections
from 1965, 1973, 1985, 1988, and 1994, researchers examined spirituality, religion,
and mortality. Results of these studies indicated high levels of religious involvement
are associated with lower rates of death by
specific causes including circulatory diseases, digestive diseases, respiratory diseases,
and all causes combined. Additionally, wide
ranges of other chronic diseases were inversely correlated with attendance of a religious event (weekly, monthly, yearly, never).
Results indicated that for women the protective effect of weekly attendance at a religious event was strong and fell roughly

between never smoking cigarettes and regular physical activity. More moderate effects
were found for men. In support of these
findings, Strawbridge and colleagues19 concluded that those reporting weekly religious
attendance were more likely to improve
poor health behaviors and maintain good
health behaviors. Weekly religious attendance was also associated with good mental health and social relationships. Again, the
relationship was stronger among women.

DEPRESSION AND OBESITY

Several researchers have attempted to
determine the relationship between health
status and psychological disorders. After
reviewing data from the 1965 Alameda cohort, Roberts and colleagues20 concluded
there was no evidence to suggest that depression is associated with an increase in allcause mortality. In contrast, Camacho and
colleagues21 stated that men and women
with low activity levels at baseline were at a
significantly greater risk for depression at
the 20-year follow-up than those who reported high activity levels. Yen and colleagues22 indicated that residence in a poverty area was associated with declining
perceived health, but risk for developing
high levels of depressive symptoms was not
significantly different for those not living
in a poverty area.
The most recent studies regarding depression focused on the relationships between physical activity, obesity, and depression. Using data collected from the 1965
cohort in 1994 and 1995, Roberts and colleagues23 indicated mixed results regarding
the relationship between obesity and depression. Researchers indicated greater odds
for depression in obese individuals in 1994,
and obesity in 1994 predicted depression in
1995. Although the results of the prospective analyses were not significant, the results
suggested an association between obesity
and depression.
Strawbridge and colleagues24 used data
from 1994 and 1999 to access the relationship between physical activity and depression in older adults (50 to 94 years). After
adjusting for age, sex, ethnicity, socioeco-

nomic status, chronic conditions, disability, body mass index, alcohol consumption,
smoking, and social relations, authors revealed that physical activity was protective
for both prevalent and incident depression.
Using data collected in 1995 and 1999, Roberts and colleagues25 investigated the reciprocal effect of depression on obesity. Results
indicated obesity in 1995 was associated
with an increased risk for depression in
1999, but depression did not increase the
risk for future obesity.

HEARING AND VISION LOSS

Research suggests hearing and vision loss
is increasingly common among older persons and is negatively associated with wellbeing.26 Using data collected in 1994 and
1999, researchers assessed the impact of
hearing and vision loss on subsequent disability, physical functioning, mental health,
and social functioning.27 Both hearing and
vision loss had significant negative impacts
on quality of life. Specifically, physical functioning and social interaction abilities were
greatly impaired. Although this study supported previous findings,28 little was known
about the effects of hearing loss on ones
spouse.
Wallhagen and colleagues29 investigated
the relationship between a spouses hearing
loss and his or her partners physical, psychological, and social well-being. Using data
collected in 1994 and 1999, researchers concluded that a husbands hearing loss greatly
increased the likelihood of subsequent decreases in physical, psychological, and social well-being in their spouses. The relationship between wives hearing loss and
husbands subsequent decreases in wellbeing was weaker, but significant.
SLEEP DISTURBANCE
Sleep problems are relatively common
among older persons and may have a significant negative impact on well-being.30
Roberts and colleagues31 analyzed data collected in 1995 and 1999 from the 1965
cohort to assess the prevalence of sleep complaints and the relationship between sleep
problems and health outcomes. Insomnia

American Journal of Health Education Sept/Oct 2005, Volume 36, No. 5

305

Jeff Housman and Steve Dorman

was reported by 23.4% of participants in

1994 and incidence of insomnia and hypersomnia (too much sleep) increased with
age. Women reported greater sleep disturbance and insomnia was strongly correlated
with chronic disease. Recently, Strawbridge
and colleagues32 investigated the impact of
a spouses sleep problems on his or her partner. Data collected in 1999 from the 1965
cohort were analyzed to determine the effects on spousal sleep disturbance on partners physical health, mental health, wellbeing, social involvement, and marital
quality. Although associations between
sleep disturbance and ones own health outcomes were stronger, spousal sleep problems were associated with a partners poor
health, depression, unhappiness with social
relationships, and unhappy marriages.

CHRONIC DISEASES
Some of the most recent findings from
the 1965 cohort have provided further evidence for the relationship between chronic
diseases and the Alameda 7 health behaviors. Seavey and colleagues33 examined risk
factors associated with self-reported arthritis symptoms in a 20-year follow-up. Authors found significant associations between arthritis and age (>45 years of age),
BMI, sex (female), and depressive symptoms. Physical activity was found to have
protective effects on development of arthritis. Kotz and colleagues34 investigated the
effect of osteoporosis on physical and mental outcomes in the 1965 cohort. Participants with osteoporosis were more likely to
report frailty, difficulty with balance, weakness, fair/poor perceived health, and not
enjoying free time. Research suggests frailty
and weakness are associated with reduced
physical activity, poorer mental health, and
lower quality of life.35
CONCLUSION
Although the last data collection of the
1965 Alameda cohort occurred in 1999,
additional current analyses continue to provide supporting results indicating a link
between personal health behaviors, social
interactions, socioeconomic status, educa-

tional level, and long-term health outcomes,

quality of life, and mortality. Initial findings of the Alameda county study along
with subsequent studies form the basis for
much of what we know and practice in
health education and promotion. This work
has firmly established lifestyle as a major
determinant of health outcomes in the
United States and reinforces the beliefs of
health professionals that healthy behaviors
are necessary in maintenance and improvement of health status. Breslow, a principal
investigator of the Alameda county study,
stated:
A step beyond treatment and even the
prevention of disease is coming onto the
health agenda: health promotion or the
advancement of well-being and the
avoidance of health risks by achieving
the optimal levels of the behavioral, societal, environmental and biomedical
determinants of health. Health promotion is aimed at maintaining the level of
health and, insofar as possible, strengthening the potential resources for
health.36

Studies using data from the 1965 cohort

since these comments by Breslow continue
to support healthy behaviors as a preventative factor in long term health outcomes.
Further data analyses over the past 5 years
have expanded our knowledge of the original Alameda 7 and have shown the impact
of social interactions, elements of spirituality, hearing/vision loss, and sleep disturbance on health outcomes.
Health promotion as a profession continues to develop and expand as findings
from the Alameda county study reinforce
lifestyle as a determinant in long-term
health. Health professionals continue to focus on these health behaviors, including the
Alameda 7. Other variables identified as
being associated with a healthy lifestyle,
such as social, spiritual, and demographic
variables have begun to receive greater attention. Although efforts of health promoters and other health professionals have impacted some behaviors, other negative
health behaviors remain prevalent. Surveys

306 American Journal of Health Education Sept/Oct 2005, Volume 36, No. 5

indicate declining rates of smoking and use

of other tobacco products since 1983.37
Mixed results are seen in other areas, such
as physical activity and nutrition. For example, recent studies regarding programs
such as the coordinated approach to child
health (CATCH) indicate improvement in
eating habits and physical activity level in
some school-aged children 38. However,
77.4% of adults report consuming fewer
than 5 servings of fruits and vegetables
daily,39 and 73.7% of adults do not meet
recommendation for physical activity.40 Recent data indicate that the incidence of obesity continues to rise in all age groups,41 and
insufficient sleep is becoming more common with adults, who are averaging 6.9
hours per night.42
Other variables related to long-term
health such as demographic variables (e.g.,
age, gender, etc.), social networks, and spirituality have not been fully addressed.
Buchanan43 suggests it is our social surroundings that impact us most. Therefore,
healthy individuals will develop from a society that values health. It may be the lack
of societal value placed on preventative
health behaviors that encourages negative
health practices. Efforts forged by health
professionals to raise awareness of health
issues have been successful in some areas
(i.e., cancer screenings), but have had limited impact in others (i.e., regular exercise,
fruit and vegetable consumption).43 In the
future it will be necessary for health professionals to advocate for healthier policies,
and to bring greater awareness of healthy
behaviors to the general public.
As researchers continue to discover relationships between lifestyle and health outcomes, it is imperative that health promoters and other health professionals focus on
the most pressing issues. Obesity, physical
inactivity, poor dietary habits, and insufficient sleep are becoming more prevalent.
The relationships among diet, exercise, and
body weight are well established, and results
from several recent studies suggest inadequate sleep as a factor in an unhealthy body
weight. With fewer than half of Americans
reporting sufficient sleep,44 the relationship

Jeff Housman and Steve Dorman

between sleep and body weight may be vital to solving the obesity problem in the
United States.
The various studies associated with the
Alameda county project helped to form the
basis of a major public health shift in our
approach to disease prevention and longevity. As more has been learned about the
impact of lifestyle on disease and death,
public health programming has become
more focused on helping the public achieve
these lifestyle objectives. There is still much
work to be done. While the Alameda county
project has had an impact on our past, its
findings must also inform our future public health activities. In the future, health
professionals should continue to improve
programs to raise awareness of prevalent
health issues and measures that may be
taken to prevent negative health outcomes.
Additionally, health professionals should
focus on reducing negative health outcomes
by attempting to provide methods aimed
at increasing the prevalence of the Alameda
7 health behaviors.

REFERENCES
1. Belloc B, Breslow L, Hochstim JR. Measurement of physical health in a general population
survey. Am J Epidemio. 1971; 92 (5): 328336.
2. Belloc N, Breslow L. Relationship of physical health status and health practices. Prev Med.
1972; 1: 409421.
3. Belloc N. Relationship of health practices
and mortality. Prev Med. 1973; 2: 6781.
4. Gottlieb N, Green L. Life events, social
network, life-style, and health: An analysis of the
1979 National Survey of Personal Health Practices and Consequences. Health Educ Q. 1984;
11 (1): 91105.
5. Breslow L, Enstrom J. Persistence of health
habits and their relationship to mortality. Prev
Med. 1980; 9: 469483.
6. Wiley J, Camacho T. Life-style and future
health: Evidence from the Alameda County
Study. Prev Med. 1980; 9: 121.
7. Roberts RE, Lee ES. The health of Mexican Americans: Evidence from the Human
Population Laboratory studies. 1980; 70 (4):
375384.
8. Wingard D, Berkman L, Brand R. A mul-

tivariate analysis of health-related practices. Am

J Epidemiol. 1982; 116 (5): 765-775.
9. Kaplan G, Seeman T, Cohen R, et al. Mortality among the elderly in the Alameda County
Study: Behavioral and demographic risk factors.
Am J Public Health. 1987; 77 (3): 307312.
10. Strawbridge W, Wallhagen M. Self-rated
health and mortality over three decades. Research on Aging. 1999; 21(3): 402416.
11. Beebe-Dimmer J, Lynch JW, Turrell G,
et al. Childhood and adult socioeconomic conditions and 31-year mortality risk in women.
Am J Epidemiol. 2004; 159: 481490.
12. Brock BM, Haefner DP, Noble DS.
Alameda County Redux: Replication in Michigan. Prev Med. 1988; 17: 483495.
13. Schoenborn, C. Health habits of U.S.
adults, 1985: the Alameda 7 revisited. Public
Health Reports. 1986; 101 (6): 571580.
14. Kotler P, Wingard D. The effect of occupational, marital and parental roles on mortality: The Alameda County Study. Am J Public
Health. 1989; 79 (5): 607612.
15. Reynolds P, Kaplan G. Social connections
and risk for cancer: Prospective evidence from
the Alameda County Study. Behav Med. 1990;
31 (2): 101110.
16. Yen I, Kaplan G. Neighborhood social
environment and risk of death: Multilevel evidence from the Alameda County Study. Am
Journal Epidemiol. 1999; 149 (10): 898907.
17. Strawbridge W, Cohen R, Shema S. Comparative strength of association between religious attendance and survival. Int J Psychiatry
Med. 2000; 30 (4): 299308.
18. Oman D, Kurata J, Strawbridge W, et al.
Religious attendance and cause of death over 31
years. Int J Psychiatry Med. 2002; 32 (1): 6989.
19. Strawbridge WJ, Shema SJ, Cohen RD,
et al. Religious attendance increases survival by
improving and maintaining good health behaviors, mental health, and social relationships. Ann
Behav Med. 2001; 23 (1): 6874.
20. Roberts R, Kaplan G, Camacho
T.Psychological distress and mortality: Evidence
from the Alameda County Study. Social Science
Medicine. 1990; 31 (5): 527536.
21. Camacho T, Roberts R, Lazarus N, et al.
Physical activity and depression: Evidence from
the Alameda County Study. Am J Epidemiol.
1991; 134 (2): 220231.

22. Yen I, Kaplan G. Poverty area residence

and changes in depression and perceived health
status: Evidence from the Alameda County
Study. Int J Epidemiol. 1999; 28: 9094.
23. Roberts RE, Kaplan GA, Shema SJ, et al.
Are the obese at greater risk for depression? Am
J Epidemiol. 2000; 152 (2): 163170.
24. Strawbridge WJ, Deleger S, Roberts RE,
et al. Physical activity reduces the risk of subsequent depression for older adults. Am J
Epidemiol. 2002; 156 (4): 328334.
25. Roberts RE, Deleger S, Strawbridge WJ,
et al. Prospective association between obesity
and depression: evidence from the Alameda
County Study. Int J Obes. 2003; 27 (4): 514521.
26. Kochkin S. Baby boomers spur growth
in potential market, but penetration rate declines. Hearing Journal. 1999; 52: 3348.
27. Wallhagen JI, Strawbridge WJ, Shema SJ,
et al. Comparative impact of hearing and vision
impairment on subsequent functioning. Hearing
and Vision Impairment. 2001; 49 (8): 10861092.
28. Saddine JB, Narayan V, Engelgau MM, et
al. Prevalence of self-rated visual impairment
among adults with diabetes. Am J Public Health.
1999; 89: 12001205.
29. Wallhagen MI, Strawbridge WJ, Shema
SJ, et al. Impact of self-assessed hearing loss on
a spouse: A longitudinal analysis of couples. J
Gerontol. 2004; 59B (3): 190196.
30. Habte-Gavr E, Wallace RB, Colsher PL,
et al. Sleep patterns in rural elders: demographic,
health, and psychobehavioral correlates. J Clin
Epidemiol. 1991; 44: 513.
31. Roberts RE, Shema SJ, Kaplan GA. Prospective data on sleep complaints and associated risk factors in an older cohort. Psychosom
Med. 1999; 61: 188196.
32. Strawbridge WJ, Shema SJ, Roberts RE.
Impact of spouses sleep problems on partners.
Sleep. 2004; 27 (3): 527531.
33. Seavey WG, Kurata JH, Cohen RD. Risk
factors for incident self-reported arthritis in a
20 year followup of the Alameda County Study
cohort. Jrheumatol. 2003; 30 (1): 21032111.
34. Kotz K, Deleger S, Cohen R, et al. Osteoporosis and health-related quality-of-life
outcomes in the Alameda County Study population. Available at: www.cdc.gov/pcd/issues/
2004/jan/03_0005.htm. Accessed April 3, 2005.
35. Strawbridge WJ, Shema SJ, Balfour JL, et

American Journal of Health Education Sept/Oct 2005, Volume 36, No. 5

307

Jeff Housman and Steve Dorman

al. Antecedents of frailty over three decades in

an older cohort. J Gerontol. 1998; 53B (1): 916.
36. Breslow L. Health status measurement
in the evaluation of health promotion. Medical
Care. 1989; 27 (3): 205216.
37. Center for Disease Control and Prevention. Adult cigarette smoking in the United States:
Current estimates. Available at: http://
www.cdc.gov/tobacco/factsheets AdultCigarette
Smoking_FactSheet.htm. Accessed April 4, 2005.
38. Health EM, Coleman KJ. Evaluation of
the institutionalization of the coordinated approach to child health (CATCH) in a U.S./
Mexico border community. Health Educ Behav.

2002; 29 (4): 444460.

39. Center for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. Available at: http://apps.nccd.cdc.gov/brfss/
list.asp?cat=FV&yr=2003&qkey=4415&state=All.
Accessed April 4, 2005.
40. Center for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. Available at: http://apps.nccd.cdc.gov/brfss/
list.asp?cat=PA&yr=2003&qkey=4419&state=All.
Accessed April 4, 2005.
41. Center for Disease Control and Prevention. U.S. obesity trends 1985-2003. Available
at: http://www.cdc.gov/nccdphp/dnpa/obesity/

308 American Journal of Health Education Sept/Oct 2005, Volume 36, No. 5

trend/maps/index.htm. Accessed April 2, 2005.

42. Vorona RD, Winn MP, Babineau TW, et
al. Overweight and obese patients in a primary
care population report less sleep than patients
with a normal body weight 2005. Arch Intern
Med;165:2330.
43. Buchanan DR. An ethic for health promotion. New York: Oxford University Press; 2000.
44. National Sleep Foundation. National
Sleep Foundation 2005 Sleep in America poll.
Available at: http://www.sleepfoundation.
org/_content/hottopics/2005_summary_
of_findings.pdf Accessed April 1, 2005.