Background: Associations between health-related behaviors are important for two reasons. First, disease prevention and health promotion depend on understanding both prevalence of health behaviors and associations among such behaviors. Second, behaviors may have synergistic effects on disease risk.
Methods: We document patterns of adherence to recommendations concerning five behaviors (physical activity, tobacco use, alcohol consumption, fruit and vegetable consumption, and dietary fat intake) in U.S. adults (n = 15,425) using data from the Third National Health and Nutrition Examination Survey. Division of individuals into categories associated with adherence or nonadherence to lifestyle recommendations results in 32 patterns of adherence/nonadherence.
Results: Proportions of U.S. adults with 21 of 32 behavior patterns characterized here deviated from proportions expected if health behaviors are independent of each other. The two extreme patterns, all adherence (5.9%) and all nonadherence (4.9%), were found in about double the proportion expected. Age, gender, race/ethnicity, education, and income were associated with a number of patterns, including the two extremes.
Conclusions: This analysis of behavior patterns highlights population subgroups of public health importance, provides a benchmark for studies of multivariate associations between health behaviors, and supports a multidimensional model of health behavior.