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