Multiple health risk behaviors in German first year university students

Changes in Anthropometry and Selected Metabolic Parameters in Young Men During Their First Year of Study at a University of Physical Education

This study aims to determine main health-related anthropometric and metabolic parameters in young physically active male students in their first year of study. Sixty one male students from a Polish university of physical education were studied twice–at the beginning of their first and second academic years. Body weight, height, waist circumference, and body composition were measured. Plasma levels of thyroid-stimulating hormone (TSH), leptin, cortisol, and insulin, as well as insulin resistance (IR) using the homeostatic model assessment (HOMA) were determined. In 64% of the participants body weight and body mass index (BMI) significantly increased during the study. An average students’ weight gain amounted to 1.2 kg. In most of the subjects it resulted from the increase of fat-free mass (r = .886, p < .001). TSH and leptin levels did not change, but a significant increase of cortisol levels and a tendency toward decreased insulin levels and also HOMA-IR values were observed. However, there were no significant correlations identified between the changes in anthropometric and biochemical parameters. The study revealed that body weight gain seen in male students during their first year at the university of physical education was mainly due to the increase in fat-free mass. Apart from anthropometrics, changes in their insulin and cortisol levels were also detected, but further studies are required to evaluate these findings. The documented insufficient energy and carbohydrates consumption in physically active male students proves the need for nutritional education among them.

Licit and illicit substance use patterns among university students in Germany using cluster analysis

BACKGROUND

The use of multiple licit and illicit substances plays an important role in many university students' lives. Previous research on multiple substance use patterns of university students, however, often fails to examine use of different illicit substances and/or hookah. Our objective was to complement and advance the current knowledge about common consumption patterns regarding illicit substances and hookah use in this group.

METHODS

Students from eight German universities completed an online survey as part of the INSIST study ('INternet-based Social norms Intervention for the prevention of substance use among STudents') regarding their consumption of alcohol, tobacco, hookah, cannabis and other illicit substances. Cluster analysis identified distinct consumption patterns of concurrent and non-concurrent substance use and multinomial logistic regressions described key sociodemographic factors associated with these clusters.

RESULTS

Six homogeneous groups were identified: 'Alcohol Abstainers' (10.8%), 'Drinkers Only' (48.2%), 'Drinkers and Cigarette Smokers' (14.6%), 'Cannabis and Licit Substance Users' (11.2%), 'Hookah Users with Co-Use' (9.8%) and 'Illicit Substance Users with Co-Use' (5.4%). Illicit substance use clustered with the consumption of alcohol, tobacco and cannabis. Hookah use was regularly associated with alcohol consumption, less commonly associated with tobacco or cannabis use and very rarely associated with use of other illicit substances. Individuals consuming licit and illicit substances or hookah were mostly male and lived together with other students. Characteristics such as the number of years an individual had spent studying at a university, subject of study, immigrant background and religious affiliation were less commonly associated with cluster membership.

CONCLUSIONS

Although we found substance use patterns in our sample largely similar to previous reports, we identified an important subgroup of individuals using both illicit and licit substances. These individuals may benefit especially from targeted interventions that focus on modifying addictive behavior patterns.

TRIAL REGISTRATION

DRKS00007635 . Registered 17 December 2014 (retrospectively registered).

Just how high-risk are ongoing smokers? Exploring clusters of health risk behaviours among current and ex-smokers

There is limited research about the patterns of multiple health risks among smokers, despite the associated increased risk of poor health. This study aimed to identify which risk behaviours were evident in a sample of smokers and ex-smokers who had previously been offered cessation support. A cross-sectional telephone interview in 2013 involved participants from New South Wales, Australia, from the control condition (self-help materials only) of a randomised smoking cessation trial conducted approximately five years earlier. The interview assessed smoking, weight, height, fruit and vegetable intake, physical activity, alcohol intake and depression. Of the 626 eligible participants, 321 were interviewed (consent rate=85.6%, response rate=51.3%); 62% were current smokers. Most participants (57%) reported four or five health risk behaviours. Three risk clusters were identified using latent class analysis: i) 'high risk' (42% of sample): smokers, overweight, inadequate intake of fruit and vegetables and low levels of physical activity; ii) 'lower risk non-depressed' (22% of sample): adequate physical activity and an absence of depression; and iii) 'lower risk, low alcohol' (36% of sample): low alcohol consumption, overweight and depressed. Males and current smokers were more likely to be 'high risk', while women and ex-smokers were more likely to be members of the 'lower risk, low alcohol' cluster. Those who continue to smoke have multiple additional health risks; as do ex-smokers in the 'lower risk, low alcohol' cluster. Achieving good health outcomes for these sizeable groups will require tailored, intensive or case-management approaches which can address multiple health risk behaviours.

Eating behaviour of university students in Germany: Dietary intake, barriers to healthy eating and changes in eating behaviour since the time of matriculation

A healthy diet plays a key role in preventing obesity and non-communicable diseases such as type 2 diabetes. This is true for all age groups, including young adults. While unhealthy eating habits among young adults, in particular university students, have been identified in former studies, this group has been neglected in existing health promotion strategies. Our aim was to explore baseline dietary intake, common barriers to healthy eating, and changes in eating behaviour among university students since the time of matriculation. We used data from the quantitative part of the Nutrition and Physical Activity Study (NuPhA), a cross-sectional online survey (data collection: 2014/10/31-2015/01/15). Students were recruited from all over Germany. Overall, 689 university students (30.5% male; mean age: 22.69) from more than 40 universities across Germany participated. We found that there is room for improvement with regard to the consumption of specific food groups, for example, fruits and vegetables. The main barriers to healthy eating were lack of time due to studies, lack of healthy meals at the university canteen, and high prices of healthy foods. Cluster analysis revealed that barriers to healthy eating might affect only specific subgroups, for instance freshmen. Changes in eating behaviour since matriculation were found in the consumption of meat, fish, and regular meals. Future qualitative studies may help to explore why university students change their eating behaviour since the time of matriculation. Such knowledge is necessary to inform health promotion strategies in the university setting.

High School Students Residing in Educational Public Institutions: Health-Risk Behaviors

Although several health-risk behaviors of adolescents have been described in the literature, data of high school students who reside at educational institutions in developing countries are scarce. This study aimed to describe behaviors associated with health risks among high school students who reside at an educational public institution and to associate these variables with the length of stay at the institution. This cross-sectional study was conducted during the year 2015 and included 122 students aged 14-19 years at a federal educational institution in the Midwest of Brazil; students were divided into residents of <8 months and those of >20 months. Information concerning the family socioeconomic status and anthropometric, dietary and behavioral profiles was investigated. Despite being physically active, students exhibited risk-associated behaviors such as cigarette and alcohol use and risky sexual behaviors that were exacerbated by fragile socioeconomic conditions and distance from family. A longer time in residence at the institution was associated with an older age (p ≤ 0.001), adequate body mass index (BMI; p = 0.02), nutritional knowledge (p = 0.01), and less doses of alcohol consumption (p ≤ 0.01) compared with those with shorter times in residence. In conclusion, the students exhibited different health-risk behaviors, and a longer institutional residence time, compared with a shorter time, was found to associate with the reduction of health-risk behaviors.

A systematic review on the clustering and co-occurrence of multiple risk behaviours

BACKGROUND

Risk behaviours, such as smoking and physical inactivity account for up to two-thirds of all cardiovascular deaths, and are associated with substantial increased mortality in many conditions including cancer and diabetes. As risk behaviours are thought to co-occur in individuals we conducted a systematic review of studies addressing clustering or co-occurrence of risk behaviours and their predictors. As the main aim of the review was to inform public health policy in England we limited inclusion to studies conducted in the UK.

METHODS

Key databases were searched from 1990 to 2016. We included UK based cross-sectional and longitudinal studies that investigated risk behaviours such as smoking, physical inactivity, unhealthy diet. High heterogeneity precluded meta-analyses.

RESULTS

Thirty-seven studies were included in the review (32 cross-sectional and five longitudinal). Most studies investigated unhealthy diet, physical inactivity, alcohol misuse, and smoking. In general adult populations, there was relatively strong evidence of clustering between alcohol misuse and smoking; and unhealthy diet and smoking. For young adults, there was evidence of clustering between sexual risk behaviour and smoking, sexual risk behaviour and illicit drug use, and sexual risk behaviour and alcohol misuse. The strongest associations with co-occurrence and clustering of multiple risk behaviours were occupation (up to 4-fold increased odds in lower SES groups) and education (up to 5-fold increased odds in those with no qualifications).

CONCLUSIONS

Among general adult populations, alcohol misuse and smoking was the most commonly identified risk behaviour cluster. Among young adults, there was consistent evidence of clustering found between sexual risk behaviour and substance misuse. Socio-economic status was the strongest predictor of engaging in multiple risk behaviours. This suggests the potential for interventions targeting multiple risk behaviours either sequentially or concurrently particularly where there is evidence of clustering. In addition, there is potential for intervening at the social or environmental level due to the strong association with socio-economic status.

[Translation, adaptation and validation of the Fantastic Lifestyle Assessment questionnaire with students in higher education]

The scope of this study was to make the translation, cultural adaptation and validation of the Fantastic Lifestyle Assessment questionnaire in a group of students in higher education in Portugal. The process of translation and validation consisted of translation, back translation, expert committee review, pre-testing and testing of the psychometric properties. The final version adapted with 30 questions was applied to a sample of 707 university students. The results showed that the instrument demonstrated good overall internal consistency for an instrument used to measure a latent variable. When the items were grouped into domains, it was found that they all contributed equally to the stability of the instrument. The reproducibility assessed by intraclass correlation was high. Construct validity tested by the classification capacity of the instrument in four, three and two categories was 67.6%, 67.6% and 100%, with a Kappa index of 0.55, 0.55 and 1.00, respectively. The concurrent validity was also evaluated by correlating it with "My Lifestyle," namely another instrument measuring the same construct. The conclusion was that the Fantastic Lifestyle Assessment, is a reliable and valid instrument for lifestyle assessment in young adults.

Gender differences in the prevalence and clustering of multiple health risk behaviours in young adults

AIMS

To estimate the sex-stratified prevalence and clustering of 14 behavioural and metabolic health risk factors in emerging adulthood.

BACKGROUND

The high prevalence and the clustering of risk factors multiply health consequences and increase the threat to the future health and quality of life of young adults.

DESIGN

Descriptive cross-sectional study.

METHODS

During November-December 2012, we assessed 14 lifestyle characteristics of 1058 1st year university students' that were classified as: healthy (score = 0), unhealthy (score = 1) and high-risk unhealthy (score = 2). We subsequently created a Multiple Health Risk Behaviours Index by summing the score of each behaviour adjusted to 0-100.

RESULTS

Only 0·3% of the students had one risk behaviour and 21·3% (male: 31·5%; female: 12·6%) had ≥10 of 14. Male students had higher risk index score. In adjusted regression analyses, female students had higher odds of reporting healthier behaviours in oral hygiene (tooth brushing), red meat and junk food consumption, binge drinking, cannabis/hashish/marijuana use and lower number of sexual partners and Body Mass Index. Male students reported higher physical activity. No statistically significant gender differences were noted for screen time/sedentary behaviours, condom use, smoking, sunburns, breakfast and fruit and vegetable consumption.

CONCLUSION

Although health-compromising behaviours are highly prevalent in both men and women, they are gender-related, with males engaging in more health risk behaviours than females. Preventive interventions may need to focus on gender-informed approaches when targeting multiple health risk behaviours.

Development and evaluation of the efficacy of a web-based 'social norms'-intervention for the prevention and reduction of substance use in a cluster-controlled trial conducted at eight German universities

BACKGROUND

Previous research suggests that perceptions of peer substance use are associated with personal use. Specifically, overestimating use in the peer group is predictive of higher rates of personal substance use. 'Social norms'-interventions are based on the premise that changing these misperceived social norms regarding substance use by providing feedback on actual norms is associated with a reduction in personal substance use. Studies conducted in the U.S.A. suggest that 'social norms'-feedback is an effective strategy for reducing substance use among university students. It is unknown whether the effects of a 'social norms'-feedback on substance use can be replicated in a sample of German university students. The objective of this article is to describe the study design and aims of the 'INternet-based Social norms-Intervention for the prevention of substance use among Students' (INSIST)-study, a cluster-controlled trial examining the effects of a web-based 'social norms'- intervention in students enrolled at four intervention universities with those enrolled at four delayed intervention control universities. The INSIST-study is funded by the German Federal Ministry of Health.

METHODS/DESIGN

Eight universities in four regions in Germany will take part in the study, four serving as intervention and four as delayed intervention control universities (randomly selected within a geographic region). Six hundred students will be recruited at each university and will be asked to complete a web-based survey assessing personal and perceived substance use/attitudes towards substance use at baseline. These data will be used to develop the web-based 'social norms'-feedback tailored to gender and university. Three months after the baseline survey, students at intervention universities will receive the intervention. Two months after the launch of the intervention, students of all eight universities will be asked to complete the follow-up questionnaires to assess changes in perceptions of/attitudes toward peer substance use and rates of personal substance use.

DISCUSSION

This study is the first German cluster-controlled trial investigating the influence of a web-based 'social norms'-intervention on perceptions of/attitudes towards substance use and substance use behavior in a large university student sample. This study will provide new information on the efficacy of this intervention strategy in the German university context.

TRIAL REGISTRATION

DRKS00007635 at the 'German Clinical Trials Register' (17.12.2014).

Quantitative indicators of fruit and vegetable consumption

The quantitative research of the market is often based on surveys and questionnaires which are finding out the behavior of customers in observed areas. Before purchasing process consumers consider where they will buy fruit and vegetables, what kind to choose and in what quantity of goods. Consumers' behavior is affected by the factors as: regional gastronomic traditions, price, product appearance, aroma, place of buying, own experience and knowledge, taste preferences as well as specific health issues of consumers and others. The consumption of fruit and vegetables brings into the human body biological active substances that favorably affect the health of consumers. In the presented research study we were interested in differences of consumers' behavior in the consumption of fruit and vegetables according to the place of residence and gender. In the survey 200 respondents has participated; their place of residence was city or village. The existence of dependences and statistical significance were examined by selected statistical testing methods. Firstly we analyzed the responses via statistical F-test whether observed random samples have the same variance. Then we applied two-sample unpaired t-test with equal variance and χ2-test of statistical independence. The statistical significance was tested by corresponding p values. Correlations were proved by the Cramer's V coefficient. We found that place of residence has no impact on the respondents' consumption of fruit. The gender of respondents does not affect their consumption of fruit. Equally, the gender does not affect the respondents' consumption of vegetables. Only in one observed case the significant differences proved that the place of respondent residence has impact on the consumption of vegetables. Higher consumption of vegetables is due to the fact that the majority of citizens, who live in villages, have a possibility to grow their own vegetables and, thus, the demand for it in village shops is low.

Associations of Truancy, Perceived School Performance, and Mental Health With Alcohol Consumption Among Adolescents

BACKGROUND

This study examined associations of truancy, perceived school performance, and mental health with adolescents' week, weekend, and binge drinking.

METHODS

A cross-sectional study was conducted among 1167 secondary school students of Dutch ethnicity (mean age, 15.9 years, SD = 0.69). Alcohol consumption, truancy, perceived school performance, and mental health status were assessed with self-report questionnaires. Ordinal regression analyses were performed to assess the associations.

RESULTS

Truancy (odds ratio [OR] = 2.53; 95% confidence interval [CI], 1.70-3.77) and poorer mental health (OR = 1.04; 95% CI, 1.02-1.07) were associated with binge drinking more often. Truancy (OR = 1.89; 95% CI, 1.14-3.16) and poorer mental health (OR = 1.06; 95% CI, 1.02-1.09) were also associated with drinking (more) alcohol on week days. Furthermore, truancy (OR = 2.60; 95% CI, 1.76-3.83) and having an average (OR = 1.81; 95% CI, 1.19-2.77) or less than average (OR = 3.65; 95% CI, 1.93-6.90) perceived school performance were associated with drinking (more) alcohol on the weekend.

CONCLUSIONS

Findings of this study suggest that adolescents who are truant and/or have a poor mental health status are at increased risk of binge and week drinking. Furthermore, adolescents who are truant and/or have an average or less than average perceived school performance are at increased risk of weekend drinking.

Eating Behaviours of British University Students: A Cluster Analysis on a Neglected Issue

Unhealthy diet is a primary risk factor for noncommunicable diseases. University student populations are known to engage in health risking lifestyle behaviours including risky eating behaviours. The purpose of this study was to examine eating behaviour patterns in a population of British university students using a two-step cluster analysis. Consumption prevalence of snack, convenience, and fast foods in addition to fruit and vegetables was measured using a self-report “Student Eating Behaviours” questionnaire on 345 undergraduate university students. Four clusters were identified: “risky eating behaviours,” “mixed eating behaviours,” “moderate eating behaviours,” and “favourable eating behaviours.” Nineteen percent of students were categorised as having “favourable eating behaviours” whilst just under a third of students were categorised within the two most risky clusters. Riskier eating behaviour patterns were associated with living on campus and Christian faith. The findings of this study highlight the importance of university microenvironments on eating behaviours in university student populations. Religion as a mediator of eating behaviours is a novel finding.

Associations between multiple health risk behaviors and mental health among Chinese college students

Although there is substantial evidence that health risk behaviors increase risks of premature morbidity and mortality, little is known about the multiple health risk behaviors in Chinese college students. Here, we investigated the prevalence of multiple health risk behaviors and its relation to mental health among Chinese college students. A cross-sectional study was conducted in Wuhan, China from May to June 2012. The students reported their health risk behaviors using self-administered questionnaires. Depression and anxiety were assessed using the self-rating depression scale and self-rating anxiety scale, respectively. A total of 2422 college students (1433 males) aged 19.7 ± 1.2 years were participated in the study. The prevalence of physical inactivity, sleep disturbance, poor dietary behavior, Internet addiction disorder (IAD), frequent alcohol use and current smoking was 62.0, 42.6, 29.8, 22.3, 11.6 and 9.3%, respectively. Significantly increased risks for depression and anxiety were found among students with frequent alcohol use, sleep disturbance, poor dietary behavior and IAD. Two-step cluster analysis identified two different clusters. Participants in the cluster with more unhealthy behaviors showed significantly increased risk for depression (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.83, 2.67) and anxiety (OR: 2.32; 95% CI: 1.85, 2.92). This study indicates that a relatively high prevalence of multiple health risk behaviors was found among Chinese college students. Furthermore, the clustering of health risk behaviors was significantly associated with increased risks for depression and anxiety.

An investigation into the lifestyle, health habits and risk factors of young adults

This project examined the lifestyle, health habits and risk factors of young adults at Qatar University. It explored the clustering and differences in dietary habits, body mass index (BMI) and physical activity (PA) amongst male and female students, both Qatari and non-Qatari. Seven hundred thirty two students aged 18–25 years completed a self-reported questionnaire and an objective measure of BMI. Males and females had a high prevalence of being overweight and obesity and low levels of PA, according to well-established international standards. Three clusters were identified based on the students’ lifestyle and dietary habits. Cluster 1 (high risk factors) included those who engaged the least in healthy dietary practices and consumed the most unhealthy foods, participated in less PA and had the highest BMI. Cluster 2 (moderate risk factors) included those with considerably more habits falling into the moderate category, engagement in the most PA, the least TV and computer viewing time and had the lowest BMI. Cluster 3 (low risk factors) included those who engaged the most with the four healthy dietary practices, the least with the four unhealthy dietary practices and participated in moderate PA per week. This project provides valuable data that could be used by policy makers to address issues concerning student’s health.

Individual factors and school-based policies related to adherence to physical activity recommendations in Spanish adolescents

Our objective was to identify individual- and school-level contextual factors related to adherence to the recommendations for physical activity in adolescents. The study used a representative sample of 15,902 students from 328 schools aged 11-18 years participating in the Spanish Health Behaviour in School-aged Children (HBSC) survey 2006. In addition to the student questionnaire, the school management board completed a questionnaire about school-based policies related to physical activity. Adherence to the recommendations was defined as "having carried out moderate and/or vigorous physical activity for at least 60 min a day on five or more days during the last week". Analysis was undertaken using multilevel logistic regression models. Individual factors associated in a statistically significant way with a higher non-compliance were: being female; being older; immigrants; tobacco smoking; being overweight or obese; low consumption of fruit and vegetables; low level of satisfaction with life; not having a high level of academic achievement; and spending a lot of time studying. The family variables were: not undertaking sports activities with the family; low socioeconomic status; and a low level of satisfaction with family relationships. Compared with schools that have a low level of policies to promote physical activities, those with a high level of promotion had an odds ratio of 0.76 (CI 95 %, 0.61-0.94). In summary, irrespective of personal and family factors, students from schools with better policies of promotion of physical activity showed a higher compliance with the recommendations.

Correlates of sexual activity versus non-activity of incoming first-year students at a South African university

In order to contribute to the design of more effective programmes to curb the spread of HIV at tertiary institutions, this study compares the profile of students who are sexually active versus those who are not yet sexually active when entering university. The study was conducted among three cohorts of first-year university students at the University of the Western Cape from 2007 to 2009. A range of correlates of sexual activity versus non-activity were explored using logistic regression analysis. The predicted probabilities of the logit link function depict marked differences between genders and racial groups. Males were more likely than females to be sexually active when entering university and the Black racial group was more likely than other racial groups to be sexually active. Risk-taking behaviours such as smoking, alcohol and drug use were shown to increase the likelihood of being sexually active when entering university, as did indicators of depression and suicidal ideation. The results indicate that religion plays an important role in influencing sexual behaviour, highlighting the important potential role that religious organisations can play in addressing HIV risk at tertiary institutions.

Characteristics of interventions targeting multiple lifestyle risk behaviours in adult populations: a systematic scoping review

BACKGROUND

Modifiable lifestyle risk behaviours such as smoking, unhealthy diet, physical inactivity and alcohol misuse are the leading causes of major, non-communicable diseases worldwide. It is increasingly being recognised that interventions which target more than one risk behaviour may be an effective and efficient way of improving people's lifestyles. To date, there has been no attempt to summarise the global evidence base for interventions targeting multiple risk behaviours.

OBJECTIVE

To identify and map the characteristics of studies evaluating multiple risk behaviour change interventions targeted at adult populations in any country.

METHODS

Seven bibliographic databases were searched between January, 1990, and January/ May, 2013. Authors of protocols, conference abstracts, and other relevant articles were contacted. Study characteristics were extracted and inputted into Eppi-Reviewer 4.

RESULTS

In total, 220 studies were included in the scoping review. Most were randomised controlled trials (62%) conducted in the United States (49%), and targeted diet and physical activity (56%) in people from general populations (14%) or subgroups of general populations (45%). Very few studies had been conducted in the Middle East (2%), Africa (0.5%), or South America (0.5%). There was also a scarcity of studies conducted among young adults (1%), or racial and minority ethnic populations (4%) worldwide.

CONCLUSIONS

Research is required to investigate the interrelationships of lifestyle risk behaviours in varying cultural contexts around the world. Cross-cultural development and evaluation of multiple risk behaviour change interventions is also needed, particularly in populations of young adults and racial and minority ethnic populations.

Exercise and Alcohol Consumption: What We Know, What We Need to Know, and Why it is Important

Exercise provides a wealth of benefits to brain and body, and is regarded as a protective factor against disease. Protective factors tend to cluster together - that is, people who engage in one healthy behavior, such as exercise, also engage in other healthy behaviors, such as maintaining a nutritious diet and getting sufficient sleep. In contrast to exercise, alcohol consumption is not typically regarded as a health-promoting behavior, although moderate intake has been associated with a lower risk of cardiovascular disease. Surprisingly, several large, population-based studies have shown a positive association between physical activity and alcohol intake. The present review focuses on what is known about this relationship, including potential neural bases as well as moderating factors, and discusses important directions for further study, such as a more thorough characterization of people who both drink and exercise. We focus on ramifications for intervening with people who have alcohol use disorders, as exercise has been assessed as both a treatment and preventive measure, with mixed results. We believe that, in order for such interventions to be effective, clinical trials must distinguish treatment-seeking populations from non-treatment-seeking ones, as well as ensure that the use of exercise as a tool to decrease alcohol consumption is made explicit. We posit that a better understanding of the relationship between physical activity and alcohol intake will maximize intervention efforts by informing the design of clinical trials and research-driven prevention strategies, as well as enable individuals to make educated decisions about their health behaviors.

Correlates of healthy fruit and vegetable diet in students in low, middle and high income countries

OBJECTIVES

The aim of this study was to assess the prevalence of fruits and vegetable consumption and associated factors among university students from 26 low, middle and high income countries.

METHODS

Using anonymous questionnaires, data were collected in a cross-sectional survey from 17,789 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas.

RESULTS

Overall, 82.8% of the university students consumed less than the recommended five servings of fruits and/or vegetables. The mean fruit and vegetable consumption varied by country, ranging from ≤ 2.5 mean daily servings in Jamaica, Philippines and Barbados to ≥ 3.9 mean daily servings in Mauritius, Tunisia and Ivory Coast. In multivariate logistic regression analysis, sociodemographic factors, psychosocial factors, and behavioural factors (inadequate dietary behaviours, binge drinking and physical inactivity) were associated with low prevalence of fruit and vegetable intake.

CONCLUSIONS

Findings stress the need for intervention programmes aiming at increased consumption of fruit and vegetables considering the identified sociodemographic, psychosocial and behavioural risk factors.

Trading between healthy food, alcohol and physical activity behaviours

BACKGROUND

While recent lifestyle studies have explored the role that food, alcohol or physical activity have on health and wellbeing, few have explored the interplay between these behaviours and the impact this has on a healthy lifestyle. Given the long term health advantages associated with leading healthier lifestyles, this study seeks to: 1) explore the interplay between the food, alcohol and physical activity behaviours of young adults (aged 19-26 years) in the North East of England; 2) explore the trade-offs young adults make between their food, alcohol and physical activity behaviours; and 3) recognise the positive and negative associations between the three behaviours.

METHODS

Qualitative self-reported lifestyle diaries and in-depth interviews were conducted with 50 young adults from the North East of England between February and June 2008. Qualitative thematic analysis was undertaken using Nvivo QSR software, and diary coding using Windiets software.

RESULTS

Young adults who attempt to achieve a 'healthy lifestyle' make trade-offs between the food and alcohol they consume, and the amounts of physical activity they undertake. There are negative reasons and positive consequences associated with these trade-offs. Young adults recognise the consequences of their behaviours and as a result are prepared to undertake healthy behaviours to compensate for unhealthy behaviours. They prefer certain strategies to promote healthier behaviours over others, in particular those that relate to personalised advice and support, more affordable ways to be healthier and easily-accessed advice from a range of media sources.

CONCLUSIONS

Young adults seek to compensate unhealthy behaviours (e.g. binge drinking) with healthy behaviours (e.g. physical activity). Creative solutions may be required to tackle these trade-offs and promote a balance across the food, alcohol and physical activity behaviours of this age group. Solutions that may be effective with this age group include environmental changes (e.g. green spaces and increasing the price of alcohol) designed to encourage and facilitate young people making healthier choices and improving their access to, and lowering the price of, healthy food products. Solutions must recognise these trade-offs and in particular, the strong reluctance of young adults to alter their higher-than-recommended levels of alcohol consumption.

A longitudinal examination of the interrelationship of multiple health behaviors

BACKGROUND

Evaluating the interrelationship of health behaviors could assist in the development of effective public health interventions. Furthermore, the ability to identify cognitive mediators that may influence multiple behavioral changes requires evaluation.

PURPOSE

To evaluate covariation among health behaviors, specifically alcohol consumption, leisure-time physical activity, and smoking, and examine whether mastery acts as a mediating social-cognitive mechanism that facilitates multiple health behavior change in a longitudinal analysis.

METHODS

In 2010, secondary data analysis was conducted on the first seven cycles of the Canadian National Population Health Survey. Data collection began in 1994-1995 and has continued biennially. At the time of this analysis, only seven cycles of data (2006-2007) were available. Parallel process growth curve models were used to analyze covariation between health behaviors and the potential mediating effects of perceived mastery.

RESULTS

Increases in leisure-time physical activity were associated with reductions in tobacco use, whereas declines in alcohol consumption were associated with decreases in tobacco use. Covariation between alcohol consumption and leisure-time physical activity did not reach statistical significance. For the most part, mastery was unsuccessful in mediating the interrelationship of multiple behavioral changes.

CONCLUSIONS

Health behaviors are not independent but rather interrelated. In order to optimize limited prevention resources, these results suggest that population-level intervention efforts targeting multiple modifiable behavioral risk factors may not need to occur simultaneously.

A cross-sectional investigation of depressive, anxiety, and stress symptoms and health-behavior participation in Australian university students

Transitioning to university involves a major life change that can have implications for physical and mental health. This study had three objectives: first, assess the mental health and health-behavior participation of Australian university students; second, evaluate clustering of health behaviors; and third, examine how mental health relates to health behaviors. University students (n = 751) enrolled at an Australian regional university completed an online survey containing the Depression, Anxiety, and Stress Scales and a health-behavior questionnaire. Over one-third of students reported mild or higher mental illness symptoms and most reported engaging in multiple unhealthy behaviors. Furthermore, mental health was associated with unhealthy behaviors. For males, depressive symptoms were associated with skipping breakfast and poor sleep quality. For females, depressive symptoms were associated with skipping breakfast, inadequate vigorous physical activity, and short or long sleep hours. Stress symptoms in females were associated with healthy sleep hours, but poor sleep quality. Future research may consider whether an intervention targeting one or two key health behaviors has utility in improving participation in other health behaviors and mental health.

Associations between physical activity and health-related factors in a national sample of college students

OBJECTIVE

To examine associations between meeting the current moderate to vigorous physical activity (MVPA) recommendation and health-related factors in a national sample of college students.

PARTICIPANTS

Participants (N = 67,861) completed the National College Health Assessment II during the Fall 2008/Spring 2009 academic year.

METHODS

Hierarchical binary logistic regression was used to examine the contribution of 19 variables in explaining whether or not participants met the MVPA recommendation.

RESULTS

Meeting the MVPA recommendation was associated with several protective factors among college students, including adequate daily fruit and vegetable consumption, positive perception of general health, healthy body mass index, consistent seatbelt use, not smoking cigarettes, less perceived depression, and adequate sleep. In addition, meeting the MVPA recommendation was also significantly associated with a few risky behaviors including binge drinking, physical fighting, and multiple sexual partners.

CONCLUSIONS

College student PA interventions should consider also addressing fruit/vegetable consumption and binge drinking.

The pattern of fruit and vegetable consumption among Saudi university students

The positive benefits of consumption fruit and vegetable are well documented in studies of health and body weight maintain. A cross sectional study was conducted utilized street based survey among 960 female students at King Faisal University in AL-Hasa, Saudi Arabia, to investigate the daily consumption of fruits and vegetables and the psychosocial factors related to the consumption. Seventy-eight percent of students consuming <5 servings/day of fruit and vegetable with only 22% of them consuming >=5 servings/day, majority of them are in the normal BMI category. For psychosocial factors the higher consumption group more knowledgeable about the daily consumption of fruit and vegetable, and had more confidence in eating fruit and vegetables under difficult circumstances with significant differences between the groups (P=0.000, P=0.045; respectively). Self efficacy was significantly predictor for recommended daily fruit and vegetable consumption (?=0.303, SE=0.023, P=0.000), but perceived barriers and knowledge not predictor for recommended daily consumption. The results of this study can be useful to design an intervention to promote fruit and vegetable intake among this target group.

Gender differences related to the health and lifestyle patterns of university students

One of the transitions from adolescence to adulthood is the admission of students to a university setting. Accompanying this transition is a new-found independence which results in university students having more autonomy over their lifestyles and behaviours. The assumption in this setting is that many students are likely to engage in unhealthy and risky lifestyle behaviours which include alcohol abuse, tobacco use, physical inactivity and unhealthy dietary practices which may adversely affect their health in the long-term. In South Africa, research with regard to health and lifestyle patterns amongst both male and female young adults remains limited. The purpose of this study was, therefore, to investigate whether male and female students differed in relation to their health and lifestyles, as well as the related consequences thereof. A convenience sampling technique was used, where questionnaires were administered to 400 students at three university campuses in the Gauteng province of South Africa. An exploratory data analysis for health factors was used in order to retrieve relevant factors from a factor and regression analysis. Differences in gender were tested by using cross-tabulation for descriptive statistics and Chi-square analysis. The study found no statistically-significant differences between genders relating to the three emerging health factors, namely Gastrointestinal, Upper Respiratory Infections and Total Health Problems. However, descriptive statistics of lifestyle habits revealed that more female students exercised, smoked and binged on food than their male counterparts. It was also found that female students reported a higher incidence of stress than male students. It was concluded that university students do indeed engage in behaviours and lifestyles that place them at risk for serious health problems.In die oorgang van adolessensie na jong volwassene, bevind studente hulself binne ’n universiteitsomgewing. Gepaartgaande met hierdie oorgang word nuutgevonde vryheid verkry, wat veroorsaak dat universiteitstudente meer beheer oor hul lewenstyl en gedrag uitoefen. Die waarskynlikheid bestaan dat baie studente in hierdie omgewing betrokke sal raak by ’n ongesonde en gewaagde lewenstyl, wat alkohol misbruik, tabak gebruik, fisieke onaktiwiteit en ongesonde eetgewoontes insluit. Bogenoemde is faktore wat student se gesondheid oor die langtermyn nadelig sal beïnvloed. Navorsing in Suid-Afrika oor gesondheid en lewenstylpatrone van verskillende geslagsgroepe onder jong volwassenes is skaars. Die doel van hierdie studie was dus om ondersoek in te stel aangaande geslagsverskille in gesondheid en lewenstyl van studente, asook die betrokke nagevolge daarvan. ’n Gerieflikheids-steekproeftegniek is gebruik waartydens 400 vraelyste aan studente by drie verskillende universiteitskampusse in die Gauteng provinsie in Suid-Afrika versprei is. ’n Ondersoekende data analiese vir gesondheidsfakore is gebruik om toepaslike faktore te verkry vanuit ’n faktor- en regressie analiese. Geslagsverskille is getoets deur gebruik te maak van kruis-tabulering vir beskrywende statistiek asook ’n ‘Chi-square’ analiese. Die studie het geen statisties-betekenisvolle verskille tussen geslagte getoon ten opsigte van die drie gesondheidsfaktore naamlik Gastro-intestinale, Boonste Asemhalingstelsel en Totale Gesondheid Probleme nie. Nietemin het beskrywende statistiek ten opsigte van lewenstyl gewoontes egter onthul dat meer vroulike studente aan fisieke aktiwiteit delneem, rook en hul vergryp aan kos. Daar is ook gevind dat vroulike studente meer gevalle van spanning gerapporteer het as manlike studente. Die gevolgtrekking is dus dat universiteitstudente wel betrokke raak by gedrag en lewenstyle wat hul in gevaar stel vir ernstige gesondheidsprobleme.

Health-risk behaviors and quality of life among young men

PURPOSE

To examine the associations between substance use and other health-risk behaviors and quality of life (QOL) among young men.

METHODS

The analytical sample consisted of 5,306 young Swiss men who participated in the Cohort Study on Substance Use Risk Factors. Associations between seven distinct self-reported health-risk behaviors (risky single-occasion drinking; volume drinking; cigarette smoking; cannabis use; use of any other illicit drugs; sexual intercourse without a condom; low physical activity) were assessed via chi-square analysis. Logistic regression analyses were conducted to study the associations between each particular health-risk behavior and either physical or mental QOL (assessed with the SF-12v2) while adjusting for socio-demographic variables and the presence of all other health-risk behaviors.

RESULTS

Most health-risk behaviors co-occurred. However, low physical activity was not or negatively related to other health-risk behaviors. Almost all health-risk behaviors were associated with a greater likelihood of compromised QOL. However, sexual intercourse without a condom (not associated with both physical and mental QOL) and frequent risky single-occasion drinking (not related to mental QOL after adjusting for the presence of other health-risk behaviors; positively associated with physical QOL) differed from this pattern.

CONCLUSIONS

Health-risk behaviors are mostly associated with compromised QOL. However, sexual intercourse without a condom and frequent risky single-occasion drinking differ from this pattern and are therefore possibly particularly difficult to change relative to other health-risk behaviors.

Prevalence of and intention to change dietary and physical activity health risk behaviours

Poor nutrition and insufficient physical activity contribute to high rates of obesity. Prevalence, intention to change and co-occurrence of four health risk behaviours (inadequate fruit and vegetables, excessive dietary fat, excessive sugary beverages and inadequate physical activity in comparison to public health recommendations) were investigated in an Australian population of working adults. Participants (n=105) completed sociodemographic and stage of change questionnaires. A subsample (n=40) were assessed twice to estimate test-retest repeatability. In the full sample, 73% were female, mean age was 33.8 years and mean BMI was 23.8 kg/m(2). Eighty-seven percent of participants consumed inadequate fruit and vegetables, 43% had excessive dietary fat, 42% had excessive sugary beverages and 29% had inadequate physical activity. The proportions intending to change each behaviour were 57%, 25%, 18% and 24%, respectively. Two-thirds exhibited multiple risk behaviours and 38% intended to change multiple risk behaviours. Fruit and vegetables and dietary fat were the most commonly paired risk behaviours (39%) and the pair most intended to change (19%). Occurrence of multiple risk behaviours was associated with being male (OR 3.10, 95% CI 1.06-9.03) or overweight/obese (OR 2.66, 95% CI 1.02-6.93). Targeting two risk behaviours, particularly fruit and vegetables and dietary fat, may be appropriate when designing health promotion programs in working populations.

Associations between healthy lifestyle behaviors and academic performance in U.S. undergraduates: a secondary analysis of the American College Health Association's National College Health Assessment II

PURPOSE

To examine associations between academic performance and moderate-vigorous physical activity, strength training, fruit and vegetable intake, and sleep.

DESIGN

Cross-sectional observational study.

SETTING

Forty U.S. colleges and universities participating in the Fall 2008 National College Health Assessment-II (NCHA-II) (median response, 27%).

SUBJECTS

A total of 16,095 undergraduate students (18-24 years; 70.3% female).

MEASURES

Self-reported lifestyle variables from the NCHA-II questions were dichotomized as meeting or not meeting public health recommendations. Grade average ranged from 1.00 to 4.00 points.

ANALYSIS

Linear regression, adjusting for sociodemographic and health-related variables.

RESULTS

The prevalence of meeting public health recommendations was as follows: moderate-vigorous physical activity, 41.9%; strength training, 32.4%; fruit and vegetable intake, 4.6%; and sleep, 23.6 %. Grade average was higher in students meeting moderate-vigorous physical activity, fruit and vegetable intake, and sleep recommendations (p ≤ .019). If moderate-vigorous physical activity was met, grade average was higher by .03 points, .15 points higher when meeting fruit and vegetable intake recommendations, and .06 points higher for sleep. There was no significant change in grade average in those meeting strength-training recommendations.

CONCLUSION

College students who adhere to public health recommendations for lifestyle behaviors have modestly higher grade averages after adjusting for sociodemographic and negative health behaviors.

A scoping review of statistical approaches to the analysis of multiple health-related behaviours

BACKGROUND

Smoking, diet, exercise, and alcohol are leading causes of chronic disease and premature death, many engage in two or more of these behaviours concurrently. The paper identified statistical approaches used to investigate multiple behavioural risk factors.

METHOD

A scoping review of papers published in English from 2000 to 2011 was conducted; papers are related to concurrent participation in at least two of the behaviours. Statistical approaches were recorded and categorised.

RESULTS

Across 50 papers, two distinct approaches were identified. Co-occurrence analyses focused on concurrent but independent behaviours, represented by prevalence of behavioural combinations and/or by the summing behaviours into risk indexes. Clustering analyses investigated underlying associations between the concurrent behaviours, with clustering identified by divergences in observed and expected prevalence of combinations or through identification of latent or unobservable clusters. Co-occurrence was more frequently reported, but the use of clustering techniques and, in particular, cluster analytic and latent variable techniques increased across the study period.

DISCUSSION

The two approaches investigate concurrent participation in multiple health behaviours but differ in conceptualisation and analysis. Despite differences, inconsistency in the terminology describing the study of multiple health behaviours was apparent, with potential to influence understandings of concurrent health behaviours in policy and practice.

Cancer awareness changes after an educational intervention among undergraduate students

The objectives of this study are to assess undergraduate awareness of cancer risk factors, prevention strategies, and warning signs and to evaluate whether an educational intervention increases cancer awareness. This study adopts a nonequivalent control group pretest-posttest design. Of the 386 students who completed the pretest, only 35-39 % identified low fruit and vegetable intake, being overweight, and physical inactivity as cancer risk factors, and <30 % recognized persistent changes in bowel or bladder habits and persistent cough or hoarseness as cancer warning signs. After the educational intervention, the analysis of variance of changes from baseline (the pretest score) for all four experimental groups were all significantly higher than those of the two control groups (p ≤.001), except for the change of the retention test score from the pretest score for experimental group 3. This study highlights the need to improve undergraduates' cancer awareness and the effectiveness of educational intervention.

Factors associated with choice of web or print intervention materials in the healthy directions 2 study

BACKGROUND

Many U.S. adults have multiple behavioral risk factors, and effective, scalable interventions are needed to promote population-level health. In the health care setting, interventions are often provided in print, although accessible to nearly everyone, are brief (e.g., pamphlets), are not interactive, and can require some logistics around distribution. Web-based interventions offer more interactivity but may not be accessible to all. Healthy Directions 2 was a primary care-based cluster randomized controlled trial designed to improve five behavioral cancer risk factors among a diverse sample of adults (n = 2,440) in metropolitan Boston. Intervention materials were available via print or the web. Purpose. To (a) describe the Healthy Directions 2 study design and (b) identify baseline factors associated with whether participants opted for print or web-based materials.

METHODS

Hierarchical regression models corrected for clustering by physician were built to examine factors associated with choice of intervention modality.

RESULTS

At baseline, just 4.0% of participants met all behavioral recommendations. Nearly equivalent numbers of intervention participants opted for print and web-based materials (44.6% vs. 55.4%). Participants choosing web-based materials were younger, and reported having a better financial status, better perceived health, greater computer comfort, and more frequent Internet use (p < .05) than those opting for print. In addition, Whites were more likely to pick web-based material than Black participants.

CONCLUSIONS

Interventions addressing multiple behaviors are needed in the primary care setting, but they should be available in web and print formats as nearly equal number of participants chose each option, and there are significant differences in the population groups using each modality.

[Regular consumption of fruits and vegetables by university students in Rio Branco, Acre State, Brazil: prevalence and associated factors]

This cross-sectional study with university students examined the prevalence of regular consumption of fruits and vegetables and associated factors among students at a Federal university in Rio Branco, Acre State, Brazil. 863 undergraduates were interviewed in 2010. Overall prevalence of regular consumption of fruits and vegetables was 14.8%. Factors associated with regular consumption of fruits and vegetables were: socioeconomic classes A and B (PR = 1.70; 95%CI: 1.10-2.62), living with a partner (PR = 1.53; 95%CI: 1.02-2.29), regular physical activity (PR = 1.69; 95%CI: 1.11-2.56), and consumption of fast food twice a week or less (PR = 1.49; 95%CI: 1.04-2.13). A minority of the students met the recommendation to consume fruits and vegetables 5 or more days a week. Regular fruit and vegetable consumption was associated with socioeconomic status and healthy habits such as physical exercise and low consumption of fast food.

Health-promoting lifestyle behaviour for cancer prevention: a survey of Turkish university students

BACKGROUND

Health risks associated with unhealthy behaviours in adolescent and university students contribute to the development of health problems in later life. During the past twenty years, there has been a dramatic increase in public, private, and professional interest in preventing disability and death through changes in lifestyle and participation in screening programs. The aim of the study was to evaluate university students' health-promoting lifestyle behaviour for cancer prevention.

METHOD

This study was carried out on university students who had education in sports, health and social areas in Celal Bayar University, Manisa, Turkey. The health-promoting lifestyles of university students were measured with the "health-promoting lifestyle profile (HPLP)" The survey was conducted from March 2011 to July 2011 and the study sample consisted of 1007 university students. T-test, ANOVA and multiple regression analyses were used for statistical analyses.

RESULTS

In the univariate analyses, the overall HPLP score was significantly related to students' school, sex, age, school grades, their status of received health education lessons, place of birth, longest place of residence, current place of residence, health insurance, family income, alcohol use, their status in sports, and self-perceived health status. Healthier behaviour was found in those students whose parents had higher secondary degrees, and in students who had no siblings. In the multiple regression model, healthier behaviour was observed in Physical Education and Sports students, fourth-year students, those who exercised regularly, had a good self-perceived health status, who lived with their family, and who had received health education lessons.

CONCLUSION

In general, in order to ensure cancer prevention and a healthy life style, social, cultural and sportive activities should be encouraged and educational programmes supporting these goals should be designed and applied in all stages of life from childhood through adulthood.

Using the temporal self-regulation theory to examine the influence of environmental cues on maintaining a healthy lifestyle

OBJECTIVES

The aim of the current study is to explore the predictive utility of the temporal self-regulation theory (TST) for maintaining a healthy lifestyle (Hall & Fong, 2007, Health Psychology Review, 1, 6). According to TST, the influence of intention, self-regulation, and behavioural prepotency differs depending on the environmental context in which the behaviour is performed. This study examined the influence of perceptions about the supportiveness of the environmental context on TST-related factors.

DESIGN

Temporal self-regulation theory was tested using a prospective design with a 1-week follow-up.

METHODS

One hundred and fifty-two undergraduates were administered three executive functioning tasks and an online questionnaire regarding their intentions to maintain a healthy lifestyle, environmental responsiveness, and previous behaviour. One week later, they completed a follow-up questionnaire.

RESULTS

Participants who were supported by the environment were significantly more likely to maintain a healthy lifestyle than those distracted by the environment. Behavioural prepotency was significantly predictive of behaviour performance for 'supported' participants. Behavioural prepotency, planning, and response inhibition were significantly predictive of 'unsupported' participants' behaviour.

CONCLUSIONS

These findings provided preliminary support for the use of TST for the prediction of healthy lifestyle behaviour. Importantly, this study provided support for the contention that the influence of TST-related factors would vary according to the perceived supportiveness of the environment. These findings suggest that environmental responsiveness may be an important determinant to close the intention-behaviour gap for maintaining a healthy lifestyle.

Patterns and correlates of multiple risk factors for adult-onset cancer among adolescents

The authors investigated patterns and correlates of multiple cancer risk factors (MCRFs) among adolescents. Baseline data from an intervention efficacy trial were analyzed to examine patterns of co-occurring MCRFs and sociodemographic and theoretical (e.g. prevention self-efficacy) correlates of MCRFs among adolescents (N = 50) aged 13-21 years. The mean total MCRFs was 4.6 (SD = 1.6; range = 0-9). The most common risk factors were intentions to use alcohol (n = 40, 80%), <5 daily servings of fruits/vegetables (n = 40, 80%), and lifetime alcohol use (n = 38, 76%). MCRFs commonly co-occurred, suggesting a clustered risk profile. Higher age (B = 0.19, 95% confidence interval [CI]: 0.01, 0.38) and lower prevention self-efficacy (B = -0.16, 95% CI: -0.30, -0.02) were significantly (p < 0.05) associated with MCRFs. Multiple health behavior change interventions are needed to prevent accumulation of risk factors as youth mature. Self-efficacy may be an important target for prevention interventions.

The simultaneous presence of health risk behaviors in freshman college students in Brazil

The objective of this study was to assess the prevalence and factors associated with simultaneous health risk behaviors in freshmen college students enrolled in a Brazilian university. We interviewed 738 students (59.2% men) with average age of 20.1 years (CI 95%: 19.8-20.5). The risk behaviors assessed were smoking habit, alcohol use, unhealthy diet and physical inactivity. Independent variables were sex, age, employment, marital status, maternal education, study shift and socioeconomic level. It was found that 8.7% were smokers, 45.9% showed alcohol abuse, 59.4% had inadequate diet and 18.5% were physically inactive. Of the students, 20.2% showed no risk behavior, 39.1% one behavior, 29.0% two risk behaviors and 11.7% three and/or four risk behaviors. Males (OR: 2.04, CI 95%: 1.13-3.67) and night shift students (OR: 1.83, CI 95%: 1.01-3.33) were more likely to have three and/or four risk behaviors. Health promotion interventions focusing simultaneous behavior changes should be employed at the university.

Health-promoting and health-risk behaviors: theory-driven analyses of multiple health behavior change in three international samples

Background

Co-occurrence of different behaviors was investigated using the theoretical underpinnings of the Transtheoretical Model, the Theory of Triadic Influence and the concept of Transfer.

Purpose

To investigate relationships between different health behaviors' stages of change, how behaviors group, and whether study participants cluster in terms of their behaviors.

Method

Relationships across stages for different behaviors were assessed in three studies with N = 3,519, 965, and 310 individuals from the USA and Germany by telephone and internet surveys using correlational analyses, factor analyses, and cluster analyses.

Results

Consistently stronger correlations were found between nutrition and physical activity (r = 0.16–0.26, p < 0.01) than between non-smoking and nutrition (r = 0.08–0.16, p < 0.03), or non-smoking and physical activity (r = 0.01–0.21). Principal component analyses of investigated behaviors indicated two factors: a “health-promoting” factor and a “health-risk” factor. Three distinct behavioral patterns were found in the cluster analyses.

Conclusion

Our results support the assumption that individuals who are in a higher stage for one behavior are more likely to be in a higher stage for another behavior as well. If the aim is to improve a healthy lifestyle, success in one behavior can be used to facilitate changes in other behaviors—especially if the two behaviors are both health-promoting or health-risky. Moreover, interventions should be targeted towards the different behavioral patterns rather than to single behaviors. This might be achieved by addressing transfer between behaviors.

Treated individuals who progress to action or maintenance for one behavior are more likely to make similar progress on another behavior: coaction results of a pooled data analysis of three trials

OBJECTIVE

This study compared, in treatment and control groups, the phenomena of coaction, which is the probability that taking effective action on one behavior is related to taking effective action on a second behavior.

METHODS

Pooled data from three randomized trials of Transtheoretical Model (TTM) tailored interventions (n=9461), completed in the U.S. in 1999, were analyzed to assess coaction in three behavior pairs (diet and sun protection, diet and smoking, and sun protection and smoking). Odds ratios (ORs) compared the likelihood of taking action on a second behavior compared to taking action on only one behavior.

RESULTS

Across behavior pairs, at 12 and 24 months, the ORs for the treatment group were greater on an absolute basis than for the control group, with two being significant. The combined ORs at 12 and 24 months, respectively, were 1.63 and 1.85 for treatment and 1.20 and 1.10 for control.

CONCLUSIONS

The results of this study with addictive, energy balance and appearance-related behaviors were consistent with results found in three studies applying TTM tailoring to energy balance behaviors. Across studies, there was more coaction within the treatment group. Future research should identify predictors of coaction in more multiple behavior change interventions.

Multiple health behaviours: overview and implications

BACKGROUND

More remains unknown than known about how to optimize multiple health behaviour change.

METHODS

After reviewing the prevalence and comorbidities among major chronic disease risk behaviours for adults and youth, we consider the origins and applicability of high-risk and population strategies to foster multiple health behaviour change.

RESULTS

Findings indicate that health risk behaviours are prevalent, increase with age and co-occur as risk behaviour clusters or bundles.

CONCLUSIONS

We conclude that both population and high-risk strategies for health behaviour intervention are warranted, potentially synergistic and need intervention design that accounts for substitute and complementary relationships among bundled health behaviours. To maximize positive public health impact, a pressing need exists for bodies of basic and translational science that explain health behaviour bundling. Also needed is applied science that elucidates the following: (1) the optimal number of behaviours to intervene upon; (2) how target behaviours are best selected (e.g. greatest health impact; patient preference or positive effect on bundled behaviours); (3) whether to increase healthy or decrease unhealthy behaviours; (4) whether to intervene on health behaviours simultaneously or sequentially and (5) how to achieve positive synergies across individual-, group- and population-level intervention approaches.

Transportation behaviors in Shiraz, Iran

OBJECTIVE

Motor vehicle accidents can occur as a result of improper driver behavior. There needs to be a comprehensive collection of information concerning driver behavior and its predisposing factors.

METHODS

Study participants (500 males and 500 females ≥18 years old) living in Shiraz, Iran, were selected using a multistage sampling methodology. Data came from questionnaires completed using a face-to-face interview process. Independent variables such as age, gender, marital status, occupation, educational level, socioeconomic status (SES), and history of smoking and stress levels were compared to the dependent variables using a private automobile, public transportation, or motorcycle, wearing a seat belts, wearing safety helmets, and obeying the speed limit. Statistical significance was set at a P value of .05 or less.

RESULTS

In general, female, better educated persons, and those with higher SES reported better driving behaviors. Better drivers also did not use tobacco or hookah. Compliance with driving safety factors was disappointing 49.8 percent always wore a seat belt, 22.4 percent always wore a safety helmet (29.4% never wore a helmet), and 49.4 percent always observed the speed limit.

CONCLUSIONS

There is a need to improve driver safety compliance in Shiraz, Iran. One factor that can be addressed concerns regulation of male drivers, especially among lower SES groups.