Is Fear Relative?

As I listened to the days top news on NBC.com I had a thought....

Whether or not the radiation from the disaster in Japan is reaching our country; air, land, water or food and whether or not it is at levels that may harm us - I do not know.  I take the word of our safety agencies with some hesitation - sadly.  At the same time, I have no sense of panic or fear at this point.  Some people are quite fearful. 

People in America (and elsewhere I suppose) are doing things that they think (often mistakenly) will protect them from radiation.  Whether or not the level is harmful - it is still considered a small amount.  [I am of the notion that there is no safe level of radiation though there may be necessary levels of radiation]

I imagine the amount is no more (and likely much less) than we get riding in airplanes or I KNOW going through a full body scanner  - and certainly it is nowhere near the level of a CT scan. 

 I have to wonder - are the people who are (exceptionally) concerned about the radiation from Japan afraid of these other things as well?

Your County's Health

If you click on this link you will come to a website which has a map of the USA.  If you click on a state you will then be able to select a county.  There you can view health outcomes and health factors.  The counties are ranked and compared to the national average on certain factors.  Factors include obesity and smoking rates, percent of women receiving mammograms, people reporting poor health and a county's rates of premature death, etc.  Click on any highlighted area for more information.  It is a very interesting and interactive awareness tool. Don't be afraid to explore the web page. If you get lost somewhere, just come back to this blog and click on the main link again.

Quality Time

In an email newsletter that I receive there is a column by an "expert" from the Cooper Institute (I have actually met this researcher and like her very much).  In this newsletter, she notes how sometimes we get busy and cannot fit in all of our workouts, but we could make the ones we did get in, have more punch - if you will.  Thus if you cannot increase the quantity just now you can increase the quality - the intensity.

Read her suggestions here.

Odds and Ends

Oatmeal and Fruit: Okay the official title of this McDonald's breakfast is Maple and Fruit - but it is oatmeal.  I saw a sign for it at the store so I came home to look it up.  As I was browsing/searching the online menu I was distracted by the Cinnamon Melt.  The oatmeal breakfast is not so bad with 290 calories and 7 g of sat fat (the cream adds some).  I do not know the weight of the meal and cannot tell if this is low energy dense or not.  The Cinnamon dish has 460 calories and half the sat fat that you or an average person who does not exist would need in a day.

Living Large and Aging: I seem to recall that Elizabeth Taylor lived a big life.  She and Zsa Zsa Gabor are examples of how that can catch up with you.  Today I watched a movie, The Whales of Autumn which stared two Hollywood megastars from years past, Lillian Gish and Bette Davis.  The movie was made in 1987 and they played women in their 80s.  As I watched them move about with tentative steps and stooped postures, I thought of two women of similar age that are important to me. They are my father's sister and my mother. The women in the movie were frail like my aunt.  She has enjoyed her food and drink and a sedentary later life.  She is also a breast cancer survivor.  However, there was zero resemblance between these characters and my mother.  She is fit and hardy and healthy and active and robust.  Clearly her real age is decades younger than her given age.  How we live has everything to do with how we will die - most of the time it correlates, but before anyone challenges me, yes there are exceptions.  I thought more about this post when I was eating dinner and wanted to add, my Mother's good health does not appear to be related to genetics - in case someone is going to suggest that!  She has several siblings with diabetes, two of which are deceased.  One of her sisters died of lung cancer.  Yes that aunt was a smoker and my other maternal aunts liked their sweets and their seats.  Just to emphasize, my Mom's Facebook status earlier this afternoon was, "just got back from riding my bike, it was a little windy but I did it." Crazy madness :)


The Resistance to Avoid: Resistance training involves exercises that increase your strength.  Resistance training has a positive impact on weight, agility, balance and ones continued ability to engage in activities of daily living - i.e. independence.  The type of resistance you do not want is insulin related.  Insulin is released in the body when there is excess sugar in our blood.  We all have too much sugar in our bloodstream after certain meals and the body regulates that for us, usually without any problems.  Persons who are overweight and who do not exercise AND who sit for long periods of time will increase their chances of having insulin resistance.  If nothing is done to reverse this problem, i.e. eat better, exercise daily AND sit less, then one's risk for diabetes increases.  Diabetes can lead to vascular disease - a disease related to blood flow and this can negatively impact many systems and organs.  (see the note avove about my aunts)

Marketing:  In yesterday's blog there was a concept model that listed the environment as having the potential for being obesogenic.  This is a relatively new term that is used to describe conditions that make obesity easy.  Being exposed to cheap, high calorie food in your school, work and neighborhood is one of those factors, as is marketing.  I say this just so I can include a quote from my newest favorite researcher, Boyd Swinburn from Australia.  He has recently published the results of research on children in that country.  The rates of overweight and obesity have come down a few percentage points.  In a news story, he is quoted as saying, ''The marketing of junk food to children ... is still an enormous force undermining parents' attempts to create healthy diets for their children and regulatory action by government is long overdue.''

Concept Models

I want to share the concept model that I have been working on - it is still in the early stages but it is moving in the right direction.  I find it humbling - the hours of reading and thinking that go into just a few boxes of text - but here is my working model on obesity and how to intervene.

A Report from the Robert Wood Johnson Foundation

EXPLORING THE SOCIAL DETERMINANTS OF HEALTH

 WHAT SHAPES HEALTH-RELATED BEHAVIORS? is a report from the RWJF.  It explains why I have shifted my focus of obesity prevention efforts from the individual to the community and why opportunity for health is limited by the environment in which people live.

Here is one quote from the article:
"While no government or private program can take the place of people making healthy choices for themselves and their families, society bears a responsibility as well: to pursue programs and policies that both encourage and enable all Americans—and particularly those who face the greatest obstacles—to choose health".

If you have the time to take a look at the report I encourage you to do so.  It can be accessed here.

Mercury Headlines

A quick note on a new research as mercury in fish is one of the issues that I blog about relatively often and of which I try to stay informed.  A study published in the NEJM is making headlines today and it is the headline (another reason I write this blog) that has me concerned.

Here is the one that I read "No heart risk from mercury in fish, a new study says" 
What the study authors say is that those with higher levels of mercury (as measured from toenail samplings) did not have more heart attack or stroke events than matched controls. 

I believe that seafood/fish is heart healthy because of the anti-inflammatory properties of Omega 3s and I advocate its consumption (when sustainable) but also warn my friends, family and readers about watching which fish they eat.  Certain types have high levels of mercury - from our environment.  The process involves coal fired powerplants which emit mercury into the air.  It gets into the water and into our marine life - where it is transformed into methyl mercury.  Bigger fish, those that eat the most little fish :)), have higher concentrations of the neurotoxin. 

The authors of this study specifically state that fish advisories should remain in effect and that efforts to stop contamination must continue.  But here is the most important thing to say about the results of this study - the people to whom the analysis was applied are NOT you and me.  The study involved about 7000 persons - half were the cases (had an event [heart attack or stroke) and the other half (no event) were controls.  Of this 7000 plus American group, 66% were women and all had more than a high school education  and were in the health care field.  Oh, and they were said to be mostly white.  So if this country consists of mostly white, college educated women in the health care field - then the headline might be more accurate - but there is still a lot of maybe involved. BTW, it is fine if a study involves a homogenous group of persons, the problem is when we apply a standard or a finding that is based on one group of people to a group that is not like them.  Here is the study abstract.

No More Cows

I wasn't planning to post this evening because the week is starting off crazy - but as I was reviewing some web articles - (BTW we are now getting too fat for our buses and gastric banding causes more problems than obesity - though I hear eating less works remarkably well) - I saw the same Groupon ad that I mentioned in the O&Es yesterday but with a NEW caption.  Here it is:

So I am thinking 1) they saw my blog and changed the holy cows title for me - ha ha and 2) those should be hot dogs, hot dang - hot dog and not burgers.... Lordy - you'd think I had too much time on my hands - but I do not - just gotta take a break from the serious stuff sometimes....

Be back in a few days....

Odds and Ends

I do have a few notes to go by this week - oh, well... they are not notes really just a list of one word items.   I have to tell you this first.  As I was falling asleep the night before last - after posting about people eating too much, I thought, "Oh dear.  I may have just contradicted myself."  Had I not just written that I prefer to eat often?  So before getting to the O&Es let me clarify - my mini meals are generally 2 to 4 hours apart :) 

Milk vs CT: To be honest, I didn't pay attention to the full story but I wrote myself this note because I heard a newscaster (CNN or NBC) or someone the anchor was interviewing - equate the radiation found in milk in Japan to a CT scan.  I heard a person say that drinking a glass of the radiated milk a day for a year would equal the amount of radiation in a CT scan.  WELL! well - what does that mean exactly... recall that the machine used and the organ scanned will impact the amount of radiation absorbed. Also note, the radiation news from Japan has been discussed as milisierverts - that should sound familiar to you.  Even knowing that the amount of radiation per CT can vary, there has been growing concern about cumulative effects (adding up over time) of the medical scans.  Thus attempting to ease a person's mind by telling them not to worry about the milk because it is like getting a CT can, is well, thoughtless AND stupid.  [it's my blog I can say stupid!]

Pills:  In a nearby city - near to where I live in NC, there was a pill drop off today or maybe it was yesterday.  It was sponsored by a police department.  The drop off was for both prescription and over the counter medications.  The medications could be expired,  no longer needed, or just in need of disposal.  No questions were asked during the drop off.  The reason I mention it  is two-fold. The programs are meant to reduce prescription drug abuse AND improper disposal of medications and supplements.  Why do you think the disposal of these chemicals is a concern?  It is because ground water contamination - or any body of water - can occur and then we end up ingesting the chemicals in our water and foods.  This is not a good thing and it IS a real thing - if not, they wouldn't set aside times to collect the pills from you.  Please then, don't flush or pour down drains.  When in doubt - just keep medications until you visit your doctor or pharmacist and ask if they will dispose of them for you.  It is equally important that you DO get rid of them as our youth seem to like to take things just for the "high" and as pain relievers are quite amply prescribed, this is also a real problem.

CVS: I am engaged in work to address a lack of access to healthy foods in neighborhoods.  When a neighborhood does not have a grocery store (within 5 miles) which provides produce, for example, it is termed a food desert.  A great program that helps communities address these issues in rather creative ways is the Healthy Corner Store Network. I am passionate about updating existing stores - stores that are already within walking distance of homes.  For example, a convenience store.  I had not thought of drug stores, but today I went by CVS and two groups of kids were walking through the parking lot with bags of chips and soda.  That is exactly why we need to get healthy foods into the stores that kids are already patronizing.

EEEOW:  Even if I did eat meat I think I would scrunch my nose up at this ad.  I was on my Yahoo page earlier today and there was a Groupon advertisement in the corner.  The picture was of three big, juicy (?) burgers and the caption was Holy Cows!  I guess the excitement was about the great deal that you could get on those burgers... but really?  holy cows?

TCC: This is completely a Greensboro NC promotion but there must be similar ones where you are - a challenge to "share the ride and clean the air."  I took the pledge.  You can read about it here.

Eating Too Much

My research area of interest is obesity and chronic disease.  (I am purposefully leaving physical activity and sedentary behavior to the side - they are also related to chronic disease and all cause mortality.  I exercise more and sit less than most people I know - thus it is a personal passion of mine, just not a professional one.  I continue to review all chronic disease research but my own research will address obesity)
That being said.  Obesity is a state of excess body fat and it can be determined with a BMI but the better measure is waist to hip ratio.  This can be found in multiple past blog posts. (you can find them in the search this blog box)  The state of being overweight or obese is related to over consumption.  Eating too much.  But here is where the simplicity ends and where my area of interests peak (because I have more than one).

Why do people eat more than they need?  I can give you a list of about 30 reasons, my colleagues could add more and still more are as of yet undiscovered. 
It is important to know that the reasons can be biological, individual, societal, environmental, structural, psychological, and educational.
We, as individuals,  do not need the same amount of calories even when holding everything else constant.  We are just different.  So we start at one unique place - and then we go about our lives doing different things in different ways.  We may have a low metabolism, we may be on a medication, we may need less calories because of a genetic imperfection.  
One of the main issues however is that we do not KNOW our conditions- we have a lack of insight into the amount of calories our own body needs. Another central issue is a lack of knowledge or education on calories in general and calories in foods.  Until recently, access to labels that explain nutrient content have been sparse.

Even those that have understanding, knowledge and will may not have the opportunity to use any of it. Some of us do not have choices of what to buy or how to cook it.  For example, people who eat at soup kitchens, work sites and schools - they have to make the best of whatever the option is.

But this last one may be the most frustrating because it is the easiest (relatively speaking) to control. Some of us consistently eat when we are not hungry.  Social pressures to eat exist in many cultures and environments. All of this is said to get to this example.

In one of my classes, which contains only women, the instructor and some of the students bring food to share (every week).  We sit at a long conference table during our lesson.  The food choices are often cookies, fruit, cheese, nuts and candies.  The class meets at 1pm.  I always bring my lunch to this class.  Some of my classmates also bring their lunch.  I remember the first or second day when one of my classmates ate a very nice salad.  A while later, the teacher passed out cookies.  This young lady (overweight) took a few and later a few more.  Because observation IS a research skill - I pay attention to these things.  I thought, dang, she did so well with her salad and now she just added 300 calories to it.

This past week gives another example of why obesity happens.  It was the typical class with foods on the table and some of us eating lunch.  The lady next to me had a sandwich from subway.  After everyone had eaten the snacks and maybe their lunches, another professor stopped in and said she had extra pizza and put two boxes on the table.  The lady who had just finished the sandwich said "oh well, I might be hungry later," and ate some pizza.  So did many others.

So - that's a problem.  Eating when we are not hungry - another reason we take in more calories than our body needs. 

(PS - I know MOM - if you're still reading this - it went a little long - sorry)

Is Subway a Breakfast Destination?

Okay - that title should really say - "should" Subway be a destination.  That is what I wondered when the weather channel imposed an ad for the "build a better breakfast" on me the other day. 
As an ever curious health educator, I was tempted by the advertisement. I had every expectation of reporting that you should in fact, NOT build your breakfast at Subway - but as long as you don't add any caloric beverage or side (potato) to your meal - i.e. as long as you don't really build a breakfast - you would be fine.

The breakfast sandwiches that they offer have anywhere from 160 to 490 calories.  Individual meal calories matter only in that they add up to your total.  IF you like to eat often - who doesn't?- then you can try my strategy and choose the low numbers and repeat often :)  For instance, I eat about eight times a day.  I am eating right now...

Longer not Necessarily Better

Wow - busy thought day  - but it isn't Sunday so I am only going with this last one that occurred to me.

In reviewing the day's headlines, I noticed that our life expectancy had inched up - really - the number usually only changes by tenths - for example - 78.1 years to 78.3.
  The headline also said, death rate down.

It was that part that led me to tonight's post.  Just because we are not dying at the rate we were before does not mean, by any stretch, that we are living better.  In fact, we have become very good at keeping people from death - but not so good at keeping them from morbidity (disease).  That, I'm afraid, has more to do with the fact that we do not take good care of OURSELVES.

A Colorful Plate

March is National Nutrition Month - the only thing surprising about this is that I didn't mention it sooner!
Good nutrition has everything to do with what you put on your plate - if you get that right - all the vitamins and minerals you need will be taken care of - with your fork!

I received this flyer in my inbox today - from the ADA via the University Nutrition Club - feel free to print, share and "do as it says!"

weight loss strategy

Of course that would get your attention!  Truth is  - I don't really focus on weight loss and certainly not diets - as they do not work.  Research backs me up on that one.  In order to maintain a low/healthy weight one must behave a certain way all the time.  The does not mean an end to all indulgence, but an acknowledgement that some things are indulgences and should be treated as such. 
Anyways, that is not the main topic of today.  Instead, I wanted to share something that I came across during some literature reviews this morning.  One article had a table of several studies that had been completed.  The studies were explained by number of participants, type of design, setting, outcomes etc.  In some instances, the program themes or lesson plans were listed.  It is there that I noticed this strategy - not the actual "how to" - but the category - ready?

"How to deal with food pushers" 

Now that IS a great topic for a future blog  - in the mean time - refrain from being one yourself :)

Odds and Ends

This week's edition may have a little bit of a travel theme as the day after the "size matters" post, I returned to NC.  I had been on a short visit with family and friends in the most awesome state of Florida.  Since getting back, I have been busy with conferences, meetings and proposal writing and spring break wasn't even over yet!  That explains my recent absence and classes resume tomorrow which will explain this weeks sparsity of blogs.

Foods: Blogging during my travels has often been a pleasure of mine though I did not give a play by play this time I do have something to share regarding meals.  Uncharacteristically, I had only packed a couple of things for my trip home. I then was laid over in Atlanta for hours and hours.  I arrived home (after flying to a different city and renting a car) eight hours later then scheduled.  Interestingly,  earlier in the evening while waiting for my connecting flight I noticed that a lot of foods in the stores and kiosks actually had nutrient labels.  The foods were not always low calorie, but some healthier options were available.  Later,I did cave in and buy a tuna fish sandwich.  It was labeled as having 300 calories.  The turkey and cheese sandwich had twice as many - weird.  The labels allow us to make the better choice even if the choices are the best ones.

Scanners:  You might recall from my last visit to Florida that the airport there has a full body scanner.  It was working this time - the person who checked my license said.  I told her that I did not want to do that and she said that when I got over there, if I was sent to that line, I could simply opt out.  As I approached I asked, "is that the full body scanner "- actually, I might have asked, "is that the X Ray scanner?"  The employee told me that it was fine that it was the wave one and did not have any radiation.  I went in and turned this way and that as the door closed and swirled.  Later I wondered about the veracity of the employee.  Last night I saw that the radiation tests that have been done on the airport scanners are being questioned and all machines will be reevaluated.  If someone such as me, who is concerned about this stuff, was ill equipped to make a decision I imagine that others will be confused as well.  I did review this today and the millimeter wave machine is not supposed to have radiation and the back scatter devices are the ones that are problematic.  In the story I am linking you to here, and in the one I read last night, it is noted that the amount of radiation in a machine is the same that one gets during two minutes of air travel.  This is quite upsetting to me as most flights are hours in length.  If I am concerned about a two minute dose, why in the heck am I flying??  Here is a list of the airports and their scanners.

Image: When I was waiting to board the plane to Atlanta, I was in full people watching mode.  Airports and shopping malls are the best for this.  As I looked at the people in the gate area- OH! side note- at both airports I found it disturbing that people would sit in their seats for hours and then get on the plane to sit a few more.  Sitting is bad people, sigh.-  I noticed that many of the people were overweight, plain, imperfect.  Their hair was not always 'just right" and even the prettiest or handsomest had flaws.  This was an important observation because I am very hard on myself and I suppose I am also vain.  I had talked to my Mom about this during my vacation (dissatisfied with my appearance) and as I looked at these normal every day people - amongst whom I fared pretty well, I realized that I had been doing something Mom had warned about years ago.  Can you guess what it is?  A lot of us do it... Comparing ourselves to the famous people who themselves don't even look like they look!

Genes: I've said it before and will say it again, but because my colleagues at an obesity conference this weekend were discussing the impact of genes on obesity, I will say it today.  If there are genetic implications to a condition or disease that ONLY means that lifestyle factors - or things that we CAN control are that much more important if you have the gene.  As far as I am concerned, we all need to act like we have the obesity gene (we do) and eat less and move more.

Helmets:  I saw two children roller blading in the park today and they had on helmets :)

Size Matters

Size matters so much so that they can be changed - not a new blog topic per se, (vanity sizing) but another chance to talk about it.  I am, in case you didn't catch on, referring to clothing sizes.  It may be the same for men, but a man will have to tell me because I have not been wearing men's clothes for the last several decades and as such wouldn't have noticed.

Women's clothing, I have seen and others have confirmed, has gotten bigger while the number on the tag stays the same or even gets smaller.  Well, this is true in children's clothing as well - or girls.  You see we are all getting bigger and trying really hard to deny it.

I was thumbing through a popular magazine recently and saw one of those weight loss stories that have the before and after facts for the weight loser.  This particular one said "before - 164 lbs size 10"  and "after- 137 lbs size 4."  To which I reacted out loud, "WHAT?"

You see,  I once wore sizes ten and twelve - at the time my weight was maxed out at 149 - I have also worn a size 4 in the past and I weighed about 110.  So yeah, that is just crazy math people - crazy math.

Practicing without a License

Though I have said this in my blog and on You Tube, it does not hurt to repeat it.

The only professional that is qualified to give specific caloric and nutrient advice to individuals is a registered/licensed dietitian.  RDs have specialized training that allows them to consider the multitude of factors that inform a persons metabolism.  Even these skilled professionals are making assumptions as there is no exact measure to capture the daily variances in energy expenditure.

I, even as a certified health education specialist cannot tell anyone how many calories they need in a day  (beyond referring to the Dietary Guidelines that suggest caloric limits generally starting at 1500 a day).  Your physician cannot tell you how many calories you need in a day, and most importantly your Personal Trainer cannot tell you.  Personal Trainers are not qualified to determine individual needs, not for calories, not for nutrients (i.e. they are not to prescribe supplements or eating plans).  Personal Trainers who do so can be sanctioned by the American Dietetic Association and legal action could follow. 

I say this to you today because two of my friends are using a personal trainer for some very high impact boot camp like training - 3x a week.  They told me tonight that the trainer had told them to consume about 1200 calories a day.  To which they both said to the other, "Oh my gosh, wait till we tell Deirdre."  Rather funny that they know me so well.  And of course, I was aghast.  In addition to the cardio/plyometric boot camp, these women are runners. They were doing intermediate to advanced weight training on their own before signing up for these classes.  In other words, they are both slim  - I am guessing their BMIs are about 18 and if they have any fat on their bodies it is just the amount needed for healthy functioning.  They easily burn upwards of 2000 calories a day - and not more only because they are small. 

I cannot begin to image what that man was thinking.  If he does have overweight clients and wants to convince them that his training program will melt off pounds, yes, telling them to eat 1200 cals a day would do it.  It is not only out of his jurisdiction - but the recommendation is reckless.  My friends of course knew not to listen.

Odds and Ends

This is the calorie version of odds and ends

Note One:  Calories count.  The amount of calories we consume in a day have a greater impact on our weights than the amount we burn in a day.  Calories do not burn with the ease that they accumulate.

Note Two:  Eating frequent meals with low to moderate calorie content (150-300 per meal/serving) throughout the day is practical and helpful.

Note Three:  Foods high in fiber and volume are filling and often healthy.

Note Four:  Several companies are working together to get calorie contents on ALL the foods and beverages they sell.  It would make sense then, that these same companies would reduce the calories in the products they sell. 

Note Five:  Read the serving size information on labels and be clear to either eat what that serving size really is - i.e.not what YOU think a serving size of ice cream is (for example) but what that particular carton of ice cream says it is - if you eat more or less - do the MATH

Noe Six:  Some studies are suggesting that calorie content information on packages and menus is not changing the daily calorie intakes of persons - that would likely be because people do not have a grasp of  Note One.

Now That is Something to Blog About!

Today I went to a Walmart Super Center in Florida.  Outside and to the right of the entrance, a group had a table set up next to a cooker or grill.  They were raising money.  Now I generally avoid making donations at makeshift sites such as this.  Legitimacy seems suspect.  Today was no different, but as I drove past the little table and saw the fixings I also saw two signs.  It looked like one sign (the size of a regular sheet of paper - 8.5 x 11) said something about a place where people who have cancer can go for respite care or just care in general.  Another sign, taped to a pole on the other side of the table said something about Colon Cancer risks and age.  It may have been something about people over age 50 needing to be screened for Colon Cancer.

Now - those of you who have read about colon cancer here or elsewhere, will get the "you must be kidding" moment as soon as I write the words - the rest of you will have to read my explanation and check on the link - 

As I was driving past the table absorbing all of these things, I saw mustard and ketchup and thought - oh my - oh no - seriously?   Are they selling HOT DOGS to raise money to prevent colon cancer????

I parked my car and went over to the table and YES - Hot Dogs.  Probably the only thing that will surprise my family and friends is that I did not tell the people that red and processed meats were in fact considered a lifestyle risk factor for colon cancer.

This is why fund raisers such as this lack legitimacy in my eyes.  Also - and here is the part where it is my blog so I can be opinionated and unprofessional (to a point) -
As I was driving out of the parking lot I noticed several several people putting the fixings on their purchased dogs and they looked like just the people who needed to eat a few less hotdogs....

Risk factors for colon and other cancers (and diseases) are generally listed as those you can change and those you cannot - what you eat is a changeable one  - certainly what you SELL people is another... 

I consider the American Cancer Society to be a good source of information.  You can read about colon cancer on their website - half or three quarters down the page you will see the words hot dogs :) 

the Clinical Exam

A physician speaks regarding high tech tools and good care in medicine -
Read the comments from the New England Journal Of Medicine here

Cancer Causes You Might Avoid

Go to this news story - popular press

Take Home Points - Smoking and being EXPOSED to high levels of OTHER PEOPLE'S SMOKE - increases the risk of breast cancer....  Sitting for long periods of time AND OR not getting regular exercise - increase the risk of cancer and all cause mortality - yes we all die, and we all die of something - but in the absence of disease wouldn't we all rather die LATER than sooner ?