Longitudinal patterns and predictors of multiple health risk behaviors among adolescents: The TRAILS study. Multiple health behaviors in an ethnically diverse sample of adults with risk factors for cardiovascular disease. Multiple Health Behavior Changes and Co-variation in a Telephone Counseling Trial Multiple behavioral risk factors among adolescent survivors of childhood cancer in the Survivor Health and Resilience Education (SHARE) program. Type a behaviours and heart disease: epidemiological and experimental foundations. Common Factors Predicting Long-term Changes in Multiple Health Behaviors The @RISK Study: Risk communication for patients with type 2 diabetes: design of a randomised controlled trial Multiple risk behaviors among smokers in the childhood cancer survivors study cohort. Healthy Behavior Change and Cardiovascular Outcomes in Newly Diagnosed Type 2 Diabetic Patients: A Cohort Analysis of the ADDITION-Cambridge Study Seven-year follow-up of a multiple-health-behavior diabetes intervention. Outcomes from a Multiple Risk Factor Diabetes Self-Management Trial for Latinas: ¡Viva Bien! Family predictors of disease management over one year in Latino and European American patients with type 2 diabetes. A survey to assist in targeting the adults who undertake risky behaviours, know their health behaviours are not optimal and who acknowledge being worried about their health Patients with Type 2 Diabetes experiences of making multiple lifestyle changes: a qualitative study. Composite cardiovascular risk outcomes of a work-site intervention trial. Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien! Behavioral risk factors in emergency department patients: a multisite survey.
BACKGROUND Most studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants . PURPOSE To examine the prevalence , longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents . METHODS Eight health risk behaviors  ( no regular consumption of fruit , vegetables or breakfast , overweight or obesity , physical inactivity , smoking , alcohol use and cannabis use ) were assessed in a prospect i ve population study ( second and third wave ) . Participants were assessed in three waves between ages 10 and 17 ( 2001 - 2008 ; n=2230 ) .  Multiple linear regression was used to assess the influence of gender , self-control , parental health risk behaviors , parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors ( analysis : 2013 - 2014 ) . RESULTS Rates of > 5 health risk behaviors were high : 3.6 % at age 13.5 and 10.2 % at age 16 . Smoking at age 13.5 was frequently associated with health risk behaviors at age 16 . No regular consumption of fruit , vegetables and breakfast , overweight or obesity , physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up . Significant predictors of the development of multiple health risk behaviors were  adolescents ' levels of self-control , socioeconomic status and maternal smoking . CONCLUSIONS Multiple health risk behaviors are common among adolescents . Individual and social factors predict changes in multiple health risk behaviors , showing that prevention targeting multiple risk behaviors is needed . Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes BACKGROUND Health behaviors of adults living with cardiovascular disease ( CVD ) risk factors affect additional risk , where lifestyle behavioral choices become even more important in controlling disease and preventing additional negative health outcomes . In addition , both lifestyle behaviors and CVD risk factor prevalence can vary by ethnicity . OBJECTIVE We compared multiple health behaviors of adults with diabetes , hypertension , high cholesterol , and obesity to the behaviors of adults without those conditions in a diverse ethnic sample to determine if significant differences existed between groups . METHODS Data were obtained from  30-minute r and om-digit-dial telephone surveys in 2007 ( n = 3607 ) . All data were self-reports . Healthy behaviors  included meeting recommendations for intake of fruits and vegetables ; consuming low or very low amounts of dietary fat ; eating breakfast six or seven days per week ; having a healthy diet ; and meeting recommendations for walking , moderate , and vigorous physical activity . Unhealthy behaviors included  frequent consumption of soda and fast food , smoking , binge drinking ,  and high stress .  RESULTS More than 6 % of respondents had diabetes , 15.9 % had hypertension , 16.4 % had high cholesterol , and 18.5 % were obese . Significantly fewer healthy and more unhealthy behaviors were reported for those who had CVD risk factors than were reported by those who did not have such conditions . Ethnic differences in CVD risk factor prevalence and health behaviors existed as well ( p < 0.001 ) . Logistic regression models indicated that not eating a healthy diet ( odds ratio [ OR ] = 1.82 ) was a significant predictor for diabetes ; not eating a healthy diet ( OR = 1.52 ) and not doing vigorous physical activity ( OR = 1.79 ) were significant predictors for hypertension ; consumption of high amounts of dietary fat ( OR = 1.70 ) and of fast food ( OR = 1.51 ) were significant predictors for high cholesterol levels ; and not eating a healthy diet ( OR = 1.52 ) , high consumption of dietary fat ( OR = 2.20 ) , not eating breakfast ( OR = 1.33 ) and not performing vigorous physical activity ( OR = 1.63 ) , but less consumption of fast food ( OR = 0.64 ) were significant predictors for obesity . CONCLUSIONS Specifically tailored and culturally sensitive interventions that address multiple health behaviors may be necessary for these high-risk population Background Delivering effective multiple health behavior interventions to large numbers of adults with chronic conditions via primary care setting s is a public health priority . Purpose Within a 12-month , telephone-delivered diet and physical activity intervention with multiple behavioral outcomes , we examined the extent and co-variation of multiple health behavior change . Methods A cluster-r and omized trial with 434 patients with type 2 diabetes or hypertension were recruited from 10 general practice s , which were r and omized to receive telephone counseling or usual care .  Results Those receiving telephone counseling were significantly more likely than those in usual care to make greater reductions in multiple behaviors after adjusting for baseline risk behaviors ( OR 2.42 ; 95%CI 1.43 , 4.11 ) . Controlling for baseline risk and group allocation , making changes to either physical activity , fat , vegetable , or fiber intake was associated with making significantly more improvements in other behaviors . Conclusions For patients with chronic conditions , telephone counseling can significantly improve multiple health behaviors , with behavioral changes tending to co-vary BACKGROUND Health-compromising behaviors among survivors of childhood cancer may increase their risks of cancer recurrence and the onset of chronic disease in adulthood . Regardless of whether such behaviors occur singly or in combination with one another , multiple behavioral risk factors must be identified and addressed early to promote better health outcomes within this special population . Adolescent survivors may be especially vulnerable , as reported rates of smoking and other risky behaviors are at or near levels of their healthy peers . The psychological literature suggests stress may play a role in risk behavior initiation and maintenance , including multiple behavioral risks , and that adolescent survivors are stress-prone . This report focuses on the prevalence and co-occurrence of three behavioral risk factors ( cigarette use , insufficient physical activity , and non-adherence to sun protection recommendations ) and describes stress-health behavior relationships in this special population . PROCEDURE All patients in this study ( n = 75 ) were adolescent survivors of childhood cancer and completed a baseline assessment of their  health behaviors and stress  as part of a r and omized controlled trial of health promotion . RESULTS Twenty-eight percent of the patients reported one of three risk factors , 12 % reported two of three risk factors , and 7 % reported all three risk factors . Non-adherence to sun protection was the single most common risk factor ; physical inactivity and non-adherent sun protection were the most common co-occurring risk factors . Greater age and stress were significantly associated with the presence of more behavioral risk factors . CONCLUSIONS The evidence suggests interventions to reduce multiple health-compromising behaviors in these patients are warranted , and that efforts to address these patients ' personal and family stress levels are important as well This paper critically examines three str and s of evidence that concern the relationship between type A behaviours and coronary heart disease ; prospect i ve epidemiological studies of healthy population s , studies of those at high risk for coronary heart disease , and angiographic studies of atherosclerosis . The first of these would seem to provide the strongest test . Method ological and conceptual issues mean that the results of studies using the other methods should be interpreted with care . It is concluded that there is relatively strong evidence of an association between Type A behaviour as measured by  Structured Interview and coronary heart disease . Hostility and anger appear to be the most powerful determinants of CHD . However , it is likely that they interact with other type A behaviours and related environmental factors in determining risk This study was design ed to assess if there are consistent treatment , stage , severity , effort and demographic effects which predict long-term changes across the multiple behaviors of smoking , diet and sun exposure . A secondary data analysis integrated data from four studies on smoking cessation ( N = 3927 ) , three studies on diet ( N = 4824 ) and four studies on sun exposure ( N = 6465 ) . Across all three behaviors , behavior change at 24 months was related to treatment , stage of change , problem severity and effort effects measured at baseline . There were no consistent demographic effects . Across multiple behaviors , long-term behavior changes are consistently related to four effects that are dynamic and open to change . Behavior changes were not consistently related to static demographic variables . Future intervention research can target the four effects to determine if breakthroughs can be produced in changing single and multiple behaviors Background Patients with type 2 diabetes mellitus ( T2DM ) have an increased risk to develop severe diabetes related complications , especially cardiovascular disease ( CVD ) . The risk to develop CVD can be estimated by means of risk formulas . However , patients have difficulties to underst and the outcomes of these formulas . As a result , they may not recognize the importance of changing lifestyle and taking medication in time . Therefore , it is important to develop risk communication methods , that will improve the patients ' underst and ing of risks associated with having diabetes , which enables them to make informed choices about their diabetes care . The aim of this study is to investigate the effects of an intervention focussed on the communication of the absolute 10-year risk to develop CVD on risk perception , attitude and intention to change lifestyle behaviour in patients with T2DM . The conceptual framework of the intervention is based on the Theory of Planned Behaviour and the Self-regulation Theory . Methods A r and omised controlled trial will be performed in the Diabetes Care System West-Friesl and ( DCS ) , a managed care system . Newly referred T2DM patients of the DCS , younger than 75 years will be eligible for the study . The intervention group will be exposed to risk communication on CVD , on top of st and ard managed care of the DCS . This intervention consists of a simple explanation on the causes and consequences of CVD , and possibilities for prevention . The probabilities of CVD in 10 year will be explained in natural frequencies and visualised by a population diagram . The control group will receive st and ard managed care . The primary outcome is appropriateness of risk perception . Secondary outcomes are attitude and intention to change lifestyle behaviour and illness perception . Differences between baseline and follow-up ( 2 and 12 weeks ) between groups will be analysed according to the intention-to-treat principle . The study was powered on 120 patients in each group . Discussion This innovative risk communication method based on two behavioural theories might improve patient 's appropriateness of risk perception and attitude concerning lifestyle change . With a better underst and ing of their CVD risk , patients will be able to make informed choices concerning diabetes care . Trail registration The trial is registered as NTR1556 in the Dutch Trial Register The literature on health behaviors of young adult cancer survivors is very limited , and thus little is known about preventable risk factors in this population . This paper describes the prevalence of five behavioral risk factors among 541 young adult survivors of childhood cancers from the CCSS cohort who were identified as smokers and enrolled in a r and omized controlled trial of a smoking cessation intervention .  The relationship between presence of multiple risk factors and a number of smoking-related factors was examined . About 31 % of the sample engaged in zero or one health-risk behavior in addition to smoking ; 63 % engaged in 2 or 3 , and 6 % engaged in 4 or 5 . There were positive linear relationships between number of risk factors and smoking rate and nicotine dependence . Number of risk factors was not associated with self-efficacy for quitting , but was related to readiness to quit . This study demonstrated that childhood cancer survivors who smoke have a number of other risk factors for the development of preventable disease and the presence of these risks was associated with factors that decrease the likelihood of quitting smoking . Attention to other health behaviors may be an important strategy for helping smokers quit . In particular , helping childhood cancer survivors who smoke to reduce other risk behaviors might also encourage them to quit smoking OBJECTIVE To examine whether improvements in health behaviors are associated with reduced risk of cardiovascular disease ( CVD ) in individuals with newly diagnosed type 2 diabetes . RESEARCH DESIGN AND METHODS Population -based prospect i ve cohort study of 867 newly diagnosed diabetic patients aged between 40 and 69 years from the treatment phase of the ADDITION-Cambridge study . Because the results for all analyses were similar by trial arm , data were pooled , and results were presented for the whole cohort . Participants were identified via  population -based stepwise screening between 2002 and 2006 , and underwent assessment of physical activity  ( European Prospect i ve Investigation into Cancer-Norfolk Physical Activity Question naire ) , diet ( plasma vitamin C and self-report ) , and alcohol consumption ( self-report ) at baseline and 1 year . A composite primary CVD outcome was examined , comprised of cardiovascular mortality , nonfatal myocardial infa rct ion , nonfatal stroke , and revascularization . RESULTS After a median ( interquartile range ) follow-up period of 5.0 years ( 1.3 years ) , 6 % of the cohort experienced a CVD event ( 12.2 per 1,000 person-years ; 95 % CI 9.3–15.9 ) . CVD risk was inversely related to the number of positive health behaviors changed in the year after diabetes diagnosis . The relative risk for primary CVD event in individuals who did not change any health behavior compared with those who adopted three/four healthy behaviors was 4.17 ( 95 % CI 1.02–17.09 ) , adjusting for age , sex , study group , social class , occupation , and prescription of cardioprotective medication ( P for trend = 0.005 ) . CONCLUSIONS CVD risk was inversely associated with the number of healthy behavior changes adopted in the year after the diagnosis of diabetes . Interventions that promote early achievement of these goals in patients with newly diagnosed diabetes could help reduce the burden of diabetes-related morbidity and mortality OBJECTIVE To examine the long-term effects of multiple health-behavior changes from the Mediterranean Lifestyle Program . METHODS The r and omized trial targeted postmenopausal women with type 2 diabetes ( N = 279 ) at high risk for heart disease . The intervention featured a weekend retreat followed by regular meetings over 24 months to enhance healthful eating , physical activity ( PA ) , stress management , and support behaviors .  RESULTS Long-term analyses indicated that significant improvements made in the targeted behaviors during the active treatment phase of the study ( at 6 , 12 , and 24 months ) were partially maintained during the nontreatment phase of the study , through 5 years postintervention contact for  dietary behavior and stress management , and 1-year posttreatment for  PA .  CONCLUSIONS This moderate-intensity group-based intervention produced health behavior changes that tended to plateau or return to baseline levels 1 to 5 years after treatment Background Culturally appropriate interventions are needed to assist Latinas in making multiple healthful lifestyle changes . Purpose The purpose of this study was to test a cultural adaptation of a successful multiple health behavior change program , ¡ Viva Bien ! Methods R and om assignment of 280 Latinas with type 2 diabetes to usual care only or to usual care + ¡ Viva Bien !  , which included group meetings for building skills to promote the Mediterranean diet , physical activity , stress management , supportive re sources , and smoking cessation . Results ¡ Viva Bien ! participants compared to usual care significantly improved psychosocial and behavioral outcomes ( fat intake , stress management practice , physical activity , and social – environmental support ) at 6 months , and some improvements were maintained at 12 months . Biological improvements included hemoglobin A1c and heart disease risk factors . Conclusions The ¡ Viva Bien ! multiple lifestyle behavior program was effective in improving psychosocial , behavioral , and biological/ quality of life outcomes related to heart health for Latinas with type 2 diabetes ( Clinical Trials.gov no : NCT00233259 ) Family context is thought to influence chronic disease management but few studies have longitudinally examined these relationships . Research on families and chronic illness has focused almost exclusively on European American families . In this prospect i ve study we tested a multidimensional model of family influence on disease management in type 2 diabetes in a bi-ethnic sample of European Americans and Latinos . Specifically , we tested how baseline family characteristics ( structure , world view , and emotion management ) predicted change in disease management over one year in 104 European American and 57 Latino patients with type 2 diabetes . We found that emotion management predicted change in disease management in both groups of patients as hypothesized , while family world view predicted change in both ethnic groups but in the predicted direction only for European Americans . Examining family context within ethnic groups is required to eluci date unique cultural patterns . Attending to culturally unique interpretations of constructs and measures is warranted . The import of family emotion management , specifically  conflict resolution  , in disease management deserves further study to support clinical intervention development . Examining multiple domains of family life and multidimensional health outcomes strengthens our capacity to develop theory about family context s and individual health Background Research indicates that those who are worried about their health are more likely to change their in-appropriate behavioural-related risk factors . A national survey was undertaken to determine adults who correctly perceive and actually undertake in-appropriate behavioural-related risk factors ( smoking , physical activity , alcohol intake , fruit and vegetable consumption , weight and psychological distress ) and are worried about their health . Methods Australian 2010 CATI survey of 3003 r and omly selected adults . Perception and self-reported levels of each risk factor , and whether they worried that the level was affecting their health were assessed using univariate and multivariate analyses . Results The comparisons between perception of healthy behaviour and actual behaviour varied for each risk factor with 44.1 % of people in the un-healthy weight range and 72.9 % of those eating less than sufficient fruit and vegetables having the perception that their behaviour was healthy . The demographic and other related variables in the multivariate analyse for each risk factor varied considerably . For example the variables in the final multivariate model for smokers who were worried about their risk factor were markedly different to the other risk factor models and 45 to 54 year olds were more likely to be included in the final models for nearly all of the risk factor analyses . Conclusion By limiting this analyses to those who are acknowledging ( correctly or otherwise ) that their perception of behaviour is making their health worse , this study has shown that the profile for each risk factor varies considerably . As such , evidence suggests specific targeted programs are required rather than a broad brush approach OBJECTIVES To explore patients newly diagnosed with Type 2 Diabetes Mellitus ( T2DM ) experiences of making single ( diet ) or multiple ( diet and physical activity ) changes in order to ( 1 ) assess whether patients experienced increases in physical activity as supporting or hindering dietary changes and vice versa , and ( 2 ) whether patients found making multiple lifestyle changes counterproductive or beneficial . METHODS In-depth interviews with 30 individuals taking part in a r and omised controlled trial that aim ed to determine the effect of diet and physical activity on T2DM . Interviewees had been r and omised to receive usual care , intensive dietary advice , or intensive dietary advice plus information on physical activity . Respondents were interviewed 6 and 9 months post-r and omisation . They were asked about their experiences of making lifestyle changes . Data were analysed thematically . RESULTS Findings suggest providing diet and physical activity information together encourages patients to use physical activity in strategic ways to aid disease management and that most patients find undertaking multiple lifestyle changes helpful . CONCLUSION Increasing physical activity can act as a gateway behaviour , i.e. behaviour that produces positive effects in other behaviours . PRACTICE IMPLICATION S Practitioners should provide diet and physical activity information together to encourage patients to use physical activity strategically to maintain dietary changes OBJECTIVES Two composite outcome measures were used to assess the efficacy of work-site risk factor interventions : the Framingham multiple logistic function and a st and ardized composite equation that was an unweighted combination of risk factors . METHODS Twenty-eight work sites in Sydney , Australia , were r and omly assigned to health risk assessment , risk factor education , behavioral counseling , or behavioral counseling plus incentives . RESULTS Over 12 months , scores on the multiple logistic function increased for the behavioral counseling plus incentives condition relative to the other conditions . St and ardized scores decreased for behavioral counseling relative to the incentive condition and the average of all other conditions . CONCLUSIONS Behavioral counseling produces larger changes in the life-style behaviors contributing to coronary heart disease risk than other commonly used interventions Latinas with type 2 diabetes are in need of culturally sensitive interventions to make recommended long-term lifestyle changes and reduce heart disease risk . To test the longer-term ( 24-month ) effects of a previously successful , culturally adapted , multiple-health-behavior-change program , ¡ Viva Bien ! , 280 Latinas were r and omly assigned to usual care or ¡ Viva Bien!.  Treatment included group meetings to promote a culturally adapted Mediterranean diet , physical activity , supportive re sources , problem solving , stress-management practice s , and smoking cessation . ¡ Viva Bien ! participants achieved and maintained some lifestyle improvements from baseline through 24 months , including significant improvements for psychosocial outcomes , fat intake , social – environmental support , body mass index , and hemoglobin A1c . Effects tended to diminish over time . The ¡ Viva Bien ! multiple-behavior program was effective in improving and maintaining some psychosocial , behavioral , and biological outcomes related to heart health across 24 months for Latinas with type 2 diabetes , a high-risk , underserved population ( Clinical Trials.gov number , NCT00233259 ) BACKGROUND Many people rely on EDs for routine health care . Often , however , screening and counseling for health risks are not provided . OBJECTIVE To determine prevalence rates of chronic disease and injury risk factors and access to routine health care in a r and om sample of ED patients in 3 cities . METHODS A prospect i ve survey was conducted at 3 hospital EDs in Akron , OH , Boston , MA , and Denver , CO . A modified version of the national Behavioral Risk Factor Surveillance Survey was administered by trained research ers to a convenience sample of non-critically ill patients during r and omly selected shifts . RESULTS Of 1,143 eligible patients , 923 ( 81 % ) agreed to participate . Their mean age was 39 ( range = 17 - 96 ) years . Most were female ( 58 % ) , white ( 60 % ) , and unmarried ( 68 % ) . Thirty-eight percent had no access to primary care . Injury-prone behaviors were prevalent : 53 % of the respondents did not wear seat belts regularly ; 15 % had no working smoke detector ; 3 % kept loaded , unlocked h and guns in their homes ; 11 % had attempted suicide ; 23 % had a positive CAGE screen for alcoholism ; 3 % had operated a motor vehicle in the preceding month while alcohol-intoxicated ; and 11 % had ridden in an automobile with an intoxicated driver . Cancer and chronic disease risks were also common : 48 % smoked ; 16 % had not received a blood pressure check in the preceding year ; and 4 % reported unsafe sexual practice s. Among women aged > 50 years , 42 % had not received a Pap test in the prior 2 years and 14 % had never had mammography . Many prevalence rates and access to care varied among the 3 sites . However , for most risk factors , prevalence rates did not differ in patients with and without access to primary health care . CONCLUSIONS ED patients have high rates of injury and chronic disease risks , and many have no other source of routine health care . Research is needed to determine whether ED-based programs , design ed to reduce injury and chronic disease risks , are feasible and cost-effective
Preliminary evidence suggests that sequentially changing smoking alongside other risk behaviors was more effective than simultaneous change .
Follow-up period and intervention characteristics impacted effectiveness for some outcomes .
Interventions comprising education ( e.g. , providing information about behaviors associated with health risks ) and skills training ( e.g. , teaching skills that equip participants to engage in less risky behavior ) and targeting multiple risk behaviors concurrently are associated with small changes in diet and physical activity .
Although on average smoking was reduced , it appeared changes in smoking were negatively associated with changes in other behaviors , suggesting it may not be optimal to target smoking simultaneously with other risk behaviors
CONTEXT Multiple risk behaviors are common and associated with developing chronic conditions such as heart disease , cancer , or Type 2 diabetes .