Elsevier

Preventive Medicine

Volume 51, Issues 3–4, September–October 2010, Pages 268-274
Preventive Medicine

Multiple healthy behaviors and optimal self-rated health: Findings from the 2007 Behavioral Risk Factor Surveillance System Survey

https://doi.org/10.1016/j.ypmed.2010.07.010Get rights and content

Abstract

Objective

The aim of this study was to examine the association between the number of healthy behaviors (i.e., not currently smoking, not currently drinking excessively, physically active, and consuming fruits and vegetables five or more times per day) and optimal self-rated health (SRH) among U.S. adults or adults with cardiovascular diseases (CVDs) or diabetes.

Methods

We estimated the age-standardized prevalence of optimal SRH among a total of 430,912 adults who participated in the 2007 Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using number of healthy behaviors as a predictor; status of optimal SRH was used as an outcome variable while controlling for sociodemographic and health risk factors.

Results

The age-standardized prevalence of reporting optimal SRH was 83.5%, 55.6%, and 56.3% among adults overall, and adults with CVDs or diabetes, respectively. Also in the aforementioned order, adults who reported having four healthy behaviors had 33%, 85%, and 87% increased likelihoods of reporting optimal SRH, when compared to their counterparts who reported none of these behaviors.

Conclusion

The findings of this study indicate that number of healthy behaviors is associated with optimal SRH among adults, especially adults with CVDs or diabetes. These findings reinforce the support for identifying and implementing clinical and population-based intervention strategies that effectively promote multiple healthier lifestyle behaviors among adults.

Introduction

Unhealthy behaviors are the modifiable risk factors for the development of leading chronic diseases, including cardiovascular diseases (CVDs) and type 2 diabetes (Fine et al., 2004, Noar et al., 2008, Prochaska et al., 2008b). In particular, cigarette smoking, excessive drinking, physical inactivity, and inadequate daily consumption of fruits and vegetables are four modifiable unhealthy lifestyle behaviors that contribute to the development of many chronic diseases or conditions, such as heart attack, angina or coronary heart disease, stroke, and type 2 diabetes in the adult population (Fine et al., 2004, Greenlund et al., 2004, Khaw et al., 2008, Orozco et al., 2008, WHO, 2007). Individuals who have more than one unhealthy behavior are often at heightened risk for severe health consequences, including developing chronic conditions, co-morbidities, complications, disabilities, and premature death (Ford et al., 2009, Khaw et al., 2008). Nevertheless, many unhealthy behaviors are interrelated and amenable to interventions. In addition, the success in changing one unhealthy behavior may increase individuals' self-efficacy and motivation to modify other unhealthy behaviors (Eriksson et al., 2006a, Prochaska et al., 2008b, Schwarzer, 2008). Accumulating evidence shows that multiple health behavior change (MHBC) is an effective prevention strategy for individuals at risk for or already diagnosed with CVDs or diabetes (Eriksson et al., 2006b, Gaede et al., 2003, Goldstein et al., 2004, Jones et al., 2003, Jrgensen et al., 2003, Praet & van Loon, 2009). Interventions that address multiple health behaviors simultaneously or sequentially could not only confer increased efficacy, decreased likelihoods of co-morbidity, and improved quality of life, but could also prevent initiation of high-risk behaviors, reduce health care burden and socioeconomic costs among adult population (Edington, 2001, Eriksson et al., 2006a, Johnson et al., 2008, Ketola et al., 2000, Mills et al., 2007, Norris et al., 2001, Orozco et al., 2008, Prochaska et al., 2008b, Prochaska et al., 2006, Smith et al., 2005).

Self-rated health (SRH) is a validated, overall health indicator that is highly predictive of future morbidity and mortality, functional decline, and health care utilization among adults including those with CVDs and diabetes (DeSalvo et al., 2006, Idler & Benyamini, 1997, Idler et al., 2000, Jylha, 2009). Several previous studies evaluated the relationship between number of unhealthy behaviors and suboptimal SRH (i.e., fair or poor) (Li et al., 2008, Pisinger et al., 2009, Tsai et al., 2010b). To the best of our knowledge, no studies have evaluated an association between the number of healthy behaviors (i.e., cumulative and clustering patterns) and optimal SRH (i.e., excellent, very good, or good) pertaining to the general population of U.S. adults—especially those with CVDs or diabetes conditions. Population-based epidemiologic studies can provide important observational evidence to inform healthier lifestyle choices that foster optimal health and well-being among individuals and at-risk populations. Therefore, the aim of this study was to examine the association between the number of healthy behaviors (i.e., not currently smoking, not currently drinking excessively, physically active, and consuming fruits and vegetables five or more times per day) and optimal SRH among adults overall, as well as adults with CVDs or diabetes in the United States by using the data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey.

Section snippets

Participants

The BRFSS is the largest ongoing, state-based, random-digit-dialed telephone survey that collects information on health-related risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury (CDC, 2009a). With a survey median cooperation rate of 72.1% in 2007, a total of 430,912 individuals aged 18 years and older from all 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands participated in the survey (CDC, 2009a).

Results

The age-standardized prevalence of reporting optimal SRH was 83.5%, 55.6%, and 56.3%, among adults overall, and adults with CVDs or diabetes, respectively (Table 2). Regardless of status of CVDs or diabetes, a greater prevalence of optimal SRH was found among participants who had a college education, were employed, were non-excessive drinkers, were physically active, or had no history of arthritis, when compared to their respective counterparts (p < 0.001 for χ2 test). Additionally, the

Discussion

Whereas several previous studies demonstrated a graded relationship between the number of unhealthy behaviors and suboptimal SRH, our study extends previous research by assessing the association between optimal SRH and multiple healthy behaviors specific to the general population of U.S. adults, as well adults with CVDs or diabetes. Furthermore, several population representative estimates, including the prevalence of optimal SRH, as well as the clustering patterns of healthy behaviors among

Conclusions

The findings of this study indicate that number of healthy behaviors is associated with optimal SRH among adults, especially adults with CVDs or diabetes. These findings reinforce the support for identifying and implementing clinical and population-based intervention strategies that effectively promote multiple lifestyle healthy behaviors among adults.

Conflict of interest statement

No potential conflicts of interest relevant to this article were reported.

Acknowledgments

The authors of this study sincerely thank BRFSS coordinators for all participating states and territories, the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, for making data available.

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