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.