Study on the Behavioral Health Risk Factors of Sewing Industry Workers in Bulgaria

The chronic non-communicable diseases in the last twenty years have been a major priority of the World Health Organisation (WHO) due to their epidemic character. These diseases lead to morbidity, mortality and invalidization which have a great health, social and economic effect. The main reason for triggering the chronic non-communicable diseases are the behavioral health risk factors of life such as nutrition, physical activity, smoking and the use of alcohol. The risk factors are characteristics at the biological, psychological, family, community, or cultural level that precede and are associated with a higher likelihood of negative outcomes. Since these factors are manageable, it is essential to carry out targeted health policy among the working people aiming at their optimization which correlates to the improved health status of the population as a whole. A suitable group for study of the behavioral risk factors are the organized groups of workers within enterprises. Our study is conducted among 503 working people in an enterprise of the sewing industry in Bulgaria in 2015.


Introduction
The aim of this study is to analyze the main behavioral risk factors among workers in an enterprise from the sewing industry in Bulgaria and to identify measures for their oprimization. The respondents with secondary education have the largest share -85.9% men and 87.0% women. With higher education are 7.0% of men and 5.0% of women. Every 17 th man and 13 th woman attended school until the 8 th grade. With elementary educated workers are respectively 1.4% and 0.8% of men and women, without education -0.2% of women (Table 2).

Nutrition
Rational nutrition is one of the main factors for good health. The survey results show that 71.8% of men and 59.7% of women have regularly breakfast in the morning. Accordingly, 28.2% of men and 40.3% of women do not have breakfast. It is known that breakfast is very important for health; the obesrvation of this statement by the surveyed is relatively satisfiyng ( Table 3). 66.2% of men and 59.0% of women eat three times a day, and twice a day -respectively 19.7% and 27.3% of them. Four times -9.9% of men and 8.3% of women. The percentage of persons eating single time a day is about 2.4%. Those receiving food five times or more also have a small share -2.8% (Table 4). The fat used in the preparation of food is the sunflower oil in 94.6% of cases. Olive oil, grease or similar fats are used rarely -in about 6.0% of cases (Table 5). Bread is another typical product of nutrition for the Bulgarian workers. 79.3% of the respondents consume white bread, more expressed in men -87.3% against 78.0% in women. 92.0% of men and women do not consume rye bread. The consumption of brown bread is slightly higher (8.5%). Other types of bread are consumed by about 0.8% of men and women, and 3.4% of them do not eat bread (Table 6). The consumption of 2 cups of coffee has the highest proportion among men and women -46.9%; 25.0% of the respondents indicated that they drink 1 cup of coffee; 16.9% -3 cups, and 3.8% -more. 19.7% of men and 5.3% of women do not drink coffee (Table 7). The consumption of salt among the population is high, both before and after tasting the food. The data shows that 67.6% of men and 66.0% of women add extra salt to the food after tasting it. 9.9% of men and 11.1% of women add extra salt to the food before tasting it. Only 1.6% of the respondents consume unsalted food (Table 8). 21.9% of the surveyed men and women consume carbonated drinks very often; rarely -64.4%; and 13.7% of them do not consume carbonated drinks (Table 9). 4.2% of men and 5.3% of women follow a diet plan. 15.5 % of men and 28.2% of women indicated that they rarely follow diets. The data shows that about 68.4% of the surveyed men and women do not follow dietary regimes (Table 10). 52.1% of the respondents consider that they are with a normal weight; 32.6 percent -overweighted, and 4.2%underweighted. 5.6% of men and 12.0 % of women are unable to make an estimate (Table 11). The healthy nutrition' principles are unknown to 3.6% for men and women. 57.7% are interested in them, and 38% did not show an interest in them (Table 12). Conclusions: the frequency of eating is triple for 66.2 % of men and 59.0% women; morning breakfast was not accepted by nearly every third man and woman; the consumption of white bread dominates; high proportion of persons adding salt to food after tasting is observed -66.2 % of men and women, and every ninth -before tasting the food; a change in eating habits have undertaken 31.6 % of men and women, as 5.2% -very often, and 26.4% -rarely.

Motor activity
Physical exersising is an important factor for the health and self-esteem of the persons. The low physical activity is a serious risk factor for health in the sewing industry. Doing exercise during leisure time is an investment in health.
The results showed that the share of those who do so is low -only 10.7%; 25.0% of men and 1.4% of women are doing exercise very rarely in the morning or during free time and 64.2% -not at all (Table 13). The visits in the gym also showed extremely unsatisfactory results. Only 2,6 % of the respondents visit the gyms, and 4.4% -do it very rarely (Table 14). The survey results showed that for 15.5% of the men and 13.7 % of women the weekly physical activity is light; in 69.0% of men and 75.2 % of women it is moderate, while in 15.5 % of men and 11.1 % of women -vigorous (Table 15). Walking is the most accessible physical activity for health according to the respondents in the survey. The survey results show that 79.9 % of men and women love walking, as most do it every day for at least 15-20 minutes (Tables 16 and 17).  In the sitting position during 1-2 hours the day are staying 21,7% of men and women, for 3-4 hours a day -10,5%, and more than six hours a day -67,8% (Table 18). Conclusions: The level of the motor activity of the respondents is low, which implies a serious risk for the health.

Knowledge, skills and health behavior
The awareness of the surveyed persons about the individual elements of the healthy life style varies.
With the harm of smoking on health are familiar 90, 3% of men and women. This information is characteristic for both genders. However, 1,6% are not familiar that tobacco is harmful (Table 19). 86,1% of men and women believe that alcohol abuse leads to negative health effects. In that are not confident 8, 0% and 4, 8% do not know. Alcohol is a stimulant for 1,2 % the respondents (Table 20). The majority of the surveyed workers (90, 1%) believe that the physical activity is of great importance for their health (Table  21). 95,4% of the surveyed are convinced about the importance of the diet on health. 3,8% of the surveyed have no knowledge on the matter, and only 0,8% reported that it was not important (Table 22). Most of surveyed workers receive information about healthy lifestyle from their GP -39.2 %. The media are the main source of information for 36.4 %. 18.7% rely on the experience of friends and 5.8% on the campaigns of the Regional Health Inspectorates (RHI) - Table 23.

Smoking
The results of the survey conducted showed that 49.3% of men and 56.3% of women live in families of smokers (Table 24). It can be said that every 11 th man smoker and every 18 th woman passes over five hours per day in a tobacco smoke environment. Besides them, 14.4% of men and 11.1% of women are in a smoke environment for 1 to 4 hours. For 78.6% of men and 84.6% of women the environment at home and in the workplace is almost tobacco smoke free (Table 25).  The data shows that 40.8% of men and 32.4% of women are smokers. The remaining 59.2% of men and 67.6% of women are non-smokers (Table 26). Every 5 th surveyed man smoker and 7 th woman has started smoking at the age under 18. The largest share is of those who began smoking between 18 and 25 years old for men and women (respectively 75.9% and 75.0%). An interesting fact is that 11.4% of women started smoking after the age of 25, while men share in this case is only 3.4% (Table 27). The intensity of smoking among men and women has significant differences. Women are mostly moderate smokers (1-10 cigarettes daily) -80.7% of them, while for men the proportion is 51.7%. As regards to men, every second is an intense smoker (11-20 cigarettes per day), while for women it can be said for every fifth is a smoker. A positive fact is that in both sexes there are no heavy smokers (> = 21 cigarettes per day) - Table 28.  The data shows that more than half of the smokers of both sexes have tried to quit smoking -59.2%. Almost every third man smoker has never made an attempt to quit smoking and as regards women -41.4% of them (Table 30).

Alcohol Consumption
Alcohol is one of the risk factors for health when abusing with. Survey data showed that 22.5% of men and 59.5% of women do not consume alcohol. Very rarely do so respectively 35.2% and 36.6% of them. Regular consumers of alcohol are 42.3% of the men and 3.9% of the women (Table 31). The data showed that 41.8% of the men and 78.3% of the women consume alcohol once a week. 40.0% of the men and 17.1% of the women consume alcohol 2-3 times per week and 18.2% of the men and 4.6% of the women -every day (Table  32). There are differences in the consumption of different the types of alcoholic beverages, shown on Table 33 below: Concentrates are preferred drink almost every second man and third women. Within men, those consuming the highest share of 1 cup at a time are 64.0%. The relative share of the consumers of 2 (two) cups of concentrate is 28.0%, while the next group (3 cups) are 8.0%.
The case within women is different. In this group the consumption is lower than that of males, most often 1 cup portion at 85.5% of them. Every seventh woman consumed 2 cups. There are no cases with consumption of 3 or more cups at once (Table 34). The vine is a drink for 16,4% of men and 46,9% of the women. For 77,8% of the men the most frequent consumption is of 150-200 ml. at the same time, and the remaining 22,2% consume more that 250-300 ml. 3.3% of the men consume more that 4 cups. Unlike the men, the women consuming 50-100 ml of wine are with the larger share -48,8%, followed by the share of women, consuming 150-200 ml -45,1%. The indicators for the consumption of larger quantities 250-300 ml and more are lower -every 13 th woman -consumer (Table 35). Beer is consumed by 38.2% of men and 21.7 % of women. One bottle of beer at once drank 52.4% of men, two bottles at a time -28.6%, three bottles at a time -14.3%, and more -4.8 % of them. Consumption within women reveals differences from men. All have indicated consumption of one bottle at a time (Table 36). The data showed that 98,3% do not feel the need to drink something alcoholic since the morning. In 1.3% this happens very rarely, and in 0.4% always (Table 37). The overdrink with or without occasion is usually in 2.6% of the persons, and very rarely -in 10.0 %. More common is for men compared to women (Table 38).