The prevalence and clustering of four major lifestyle risk factors in an English adult population

doi:10.1016/j.ypmed.2006.10.006

Preventive Medicine

Volume 44, Issue 2, February 2007, Pages 124-128

https://doi.org/10.1016/j.ypmed.2006.10.006 Get rights and content

Abstract

Background

The aim of this study was to examine the clustering of four major lifestyle risk factors (smoking, heavy drinking, lack of fruit and vegetables consumption, and lack of physical activity), and to examine the variation across different socio-demographic groups in the English adult population.

Methods

The study population was derived from the 2003 Health Survey for England (n = 11,492). Clustering was examined by comparing the observed and expected prevalence of the different possible combinations. A multinomial multilevel regression model was conducted to examine the socio-demographic variation in the clustering of the four risk factors.

Results

The study found that, when using British health recommendations, a majority of the English population have multiple lifestyle risk factors at the same time. Clustering was found at both ends of the lifestyle spectrum and was more pronounced for women than for men. Overall, multiple risk factors were more prevalent among men, lower social class households, singles, and people who are economically inactive, but less prevalent among homeowners and older age groups.

Conclusions

The clustering of multiple risk factors provides support for multiple-behavior interventions as opposed to single-behavior interventions.

Introduction

Smoking, excessive alcohol use, an unhealthy diet, and physical inactivity are the ‘big four’ modifiable causes of morbidity and mortality. There is ample epidemiological evidence that these four lifestyle risk factors contribute to the development of chronic conditions, such as different types of cancer, type-2 diabetes, and cardiovascular disease (e.g., McGinnis and Foege, 1993, Hu et al., 2001, World Health Organisation, 2002, Mokdad et al., 2004). While much is known about the separate lifestyle risk factors, less is known about the prevalence and clustering of multiple risk factors. Research suggests that the lifestyle risk factors cluster within individuals (Emmons et al., 1994, Woodward et al., 1994, Burke et al., 1997, Ma et al., 2000, Laaksonen et al., 2001, Schuit et al., 2002, Fine et al., 2004, Pronk et al., 2004, Chiolero et al., 2006). This means that they are not randomly distributed across the population, but occur in combination with other lifestyle risk factors. Moreover, smoking, excessive alcohol use, an unhealthy diet, and physical inactivity appear to cluster within certain socio-demographic groups. Previous studies have shown that they are more prevalent among men, younger age groups, economically inactives, singles, and those who have a lower socio-economic status and level of education (see e.g., Laaksonen et al., 2001, Schuit et al., 2002, Fine et al., 2004, Pronk et al., 2004, Chiolero et al., 2006).

It is important to investigate the clustering of lifestyle risk factors because of possible synergistic health effects. There is some evidence that combinations of lifestyle risk factors are more detrimental to people's health than can be expected from the added individual effects alone (e.g., Breslow and Enstrom, 1980, McGinnis and Foege, 1993, Schlecht et al., 1999, Slattery and Potter, 2002), suggesting that the health effects of lifestyle risk factors are multiplicative rather than additive. Furthermore, knowing whether and where risk factors cluster will help health professionals to design more effective intervention strategies. Because of the additional and potential synergistic effects, multiple-behavior interventions promise to have a greater impact on public health than single-behavior interventions (Nigg et al., 2002, Atkins and Clancy, 2004, Goldstein et al., 2004).

The aim of this study is to explore the clustering of four major lifestyle risk factors in the English adult population. The focus is on smoking, heavy drinking, lack of fruit and vegetable consumption, and lack of physical activity as these are the main modifiable causes of ill health in the developed world (McGinnis and Foege, 1993, World Health Organisation, 2002, Mokdad et al., 2004). In addition, the study will examine the socio-demographic variation in the clustering of the four lifestyle risk factors in order to identify the groups that are the most at risk.

Section snippets

Study population

The study population was derived from the 2003 Health Survey for England (HSE) that was conducted between June 2003 and March 2004 and targeted the English adult population aged 16 years and over living in private households.¹

Results

About 28% of the study population smoked, 23% drank heavily on at least one occasion in the last week, 76% did not eat enough fruit and vegetables, and 66% had a lack of physical activity (see Table 1). While women were more likely to have a lack of physical activity, men were more likely to have had at least one ‘heavy drinking’ session in the last week—even if the cut-off point for ‘heavy drinking’ was higher for men than for women.

Table 2 shows the observed and expected prevalence of all 16

Discussion

The aim of this study was to investigate the prevalence and clustering of four major lifestyle risk factors, using a recent English dataset. The results show that, when using British health recommendations, a large majority of the English population have multiple lifestyle risk factors at the same time. The four lifestyle risk factors appeared to cluster in specific multiple combinations, which may help to explain risk combinations that have been found in previous studies (Berrigan et al., 2003

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The prevalence and clustering of four major lifestyle risk factors in an English adult population

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Study population

Results

Discussion

Am. J. Prev. Med.

Prev. Med.

Prev. Med.

Prev. Med.

Prev. Med.

Prev. Med.

Am. J. Prev. Med.

Am. J. Prev. Med.

Am. J. Prev. Med.

Am. J. Prev. Med.

Prev. Med.

Prev. Med.

Cigarette smokers do more than just smoke cigarettes

Health Psychol.

Five-a-day Update

At Least Five a Week: Evidence on the Impact of Physical Activity and Its Relationship to Health. A Report from the Chief Medical Officer