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Does the Relationship Between Cigarette Smoking and Other Key Health Behaviors Vary by Geographic Area Among US Young Adults? A Multilevel Analysis

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Abstract

Background

Although researchers and practitioners have long been aware of interdependence among health behaviors, they tend to compartmentalize health behaviors in research and practice. This kind of approach often fails to acknowledge the syndemic nature of health behaviors.

Purpose

This study investigated differences in the relationship between cigarette smoking and other key health behaviors, such as vigorous physical activity, fruit and vegetable consumption, and binge drinking among young adults (ages 18 to 30 years) across 180 metropolitan and micropolitan statistical areas (MMSAs) in the USA.

Method

A total of 19,027 young adults in the 2009 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed using multilevel logistic regression models.

Results

Both vigorous physical activity and fruit and vegetable consumption were negatively associated with cigarette smoking, whereas binge drinking was positively associated with smoking. There were significant differences in the relation of smoking with vigorous physical activity, fruit and vegetable consumption, and binge drinking across the 180 MMSAs. These differences were associated with the prevalence of cigarette smoking and binge drinking for each MMSA.

Conclusion

As indicated by the social learning theory, geographic area-specific prevalence of health behaviors appears to reflect group norms regarding those behaviors which, in turn, affect the clustering of health behaviors in the respective area.

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References

  1. King B, Dube S, Kaufmann R, Shaw L, Pechacek T. Vital signs: current cigarette smoking among adults aged greater than or equal to 18 years—United States, 2005–2010. Morb Mortal Wkly Rep. 2011;60(35):1207–12.

    Google Scholar 

  2. Mendez D, Warner KE. Setting a challenging yet realistic smoking prevalence target for Healthy People 2020: learning from the California experience. Am J Public Health. 2008;98:556–9.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Jessor R, Jessor SL. Problem behavior and psychosocial development: a longitudinal study of youth. New York: Academic; 1977.

    Google Scholar 

  4. Jessor R. Risk behavior in adolescence: a psychosocial framework for understanding and action. J Adolesc Health. 1991;12(8):597–605.

    Article  CAS  PubMed  Google Scholar 

  5. Jessor R, Donovan JE, Costa FM. Beyond adolescence: problem behaviour and young adult development. New York: Cambridge University Press; 1991.

    Google Scholar 

  6. Allan JD. Identification of health risks in a young adult population. J Community Health Nurs. 1987;4(4):223–33.

    Article  CAS  PubMed  Google Scholar 

  7. Johnson MF, Nichols JF, Sallis JF, Calfas KJ, Hovell MF. Interrelationships between physical activity and other health behaviors among university women and men. Prev Med. 1998;27(4):536–44.

    Article  CAS  PubMed  Google Scholar 

  8. Werch CE, Bian H, Moore MJ, Ames S, DiClemente CC, Weiler RM. Brief multiple behavior interventions in a college student health care clinic. J Adolesc Health. 2007;41(6):577–85.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Centers for Disease Control and Prevention. Exploring the foundations of a syndemic orientation in public health. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2002.

  10. Gassman RA, Agley J, Johnston JD, Middlestadt SE, van Puymbroeck M, YoussefAgha AH. Catalyzing transdisciplinary studies in public health: a college health survey and data platform. Health Promot Pract. 2012;13(1):90–7.

    Article  PubMed  Google Scholar 

  11. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–45.

    Article  PubMed  Google Scholar 

  12. National Institute of Alcohol Abuse and Alcoholism. What colleges need to know now: an update on college drinking research (NIH Publication No. 07–5010). Bethesda, MD: Author; 2007.

  13. Cook RL, Clark DB. Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review. Sex Transm Dis. 2005;32(3):156–64.

    Article  PubMed  Google Scholar 

  14. Davis L, Uezato A, Newell JM, Frazier E. Major depression and comorbid substance use disorders. Curr Opin Psychiat. 2008;21(1):14–8.

    Article  Google Scholar 

  15. Schaffer M, Jeglic EL, Stanley B. The relationship between suicidal behavior, ideation, and binge drinking among college students. Arch Suicide Res. 2008;12(2):124–32.

    Article  PubMed  Google Scholar 

  16. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009.

  17. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423–34.

    Article  PubMed  Google Scholar 

  18. Swain DP, Franklin BA. Comparison of cardioprotective benefits of vigorous versus moderate intensity aerobic exercise. Am J Cardiol. 2006;97(1):141–7.

    Article  PubMed  Google Scholar 

  19. Lee IM, Paffenbarger Jr RS. Associations of light, moderate, and vigorous intensity physical activity with longevity. Am J Epidemiol. 2000;151(3):293–9.

    Article  CAS  PubMed  Google Scholar 

  20. Bertrais S, Preziosi P, Mennen L, Galan P, Hercberg S, Oppert JM. Sociodemographic and geographic correlates of meeting current recommendations for physical activity in middle-aged french adults: the supplementation En vitamines Et mineraux antioxydants (SUVIMAX) study. Am J Public Health. 2004;94(9):1560–6.

    Article  PubMed Central  PubMed  Google Scholar 

  21. US Department of Health and Human Services. Healthy people 2010. Washington: Author; 2000.

    Google Scholar 

  22. Kaczynski AT, Manske SR, Mannell RC, Grewal K. Smoking and physical activity: a systematic review. Am J Health Behav. 2008;32(1):93–110.

    Article  PubMed  Google Scholar 

  23. Joshipura KJ, Hu FB, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, et al. The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med. 2001;134(12):1106–14.

    Article  CAS  PubMed  Google Scholar 

  24. Terry P, Terry JB, Wolk A. Fruit and vegetable consumption in the prevention of cancer: an update. J Intern Med. 2001;250(4):280–90.

    Article  CAS  PubMed  Google Scholar 

  25. Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, et al. AHA Dietary Guidelines: revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102(18):2284–99.

    Article  CAS  PubMed  Google Scholar 

  26. Donovan JE. Problem-behavior theory and the explanation of adolescent marijuana use. J Drug Issues. 1996;26(2):379–404.

    Google Scholar 

  27. Barrera M, Biglan A, Ary D, Li F. Replication of a problem behavior model with American Indian, Hispanic, and Caucasian youth. J Early Adolesc. 2001;21(2):133–57.

    Article  Google Scholar 

  28. Zamboanga BL, Carlo G, Raffaelli M. Problem behavior theory: an examination of the behavior structure system in Latino and non-Latino college students. Interam J Psychol. 2004;38(2):253–62.

    Google Scholar 

  29. Acosta MC, Eissenberg T, Nichter M, Nichter M, Balster RL. Characterizing early cigarette use episodes in novice smokers. Addict Behav. 2008;33(1):106–21.

    Article  PubMed  Google Scholar 

  30. Weitzman ER, Chen YY. The co-occurrence of smoking and drinking among young adults in college: national survey results from the United States. Drug Alcohol Depend. 2005;80(3):377–86.

    Article  PubMed  Google Scholar 

  31. Koh WP, Yuan JM, Sun CL, Lee HP, Mimi CY. Middle-aged and older Chinese men and women in Singapore who smoke have less healthy diets and lifestyles than nonsmokers. J Nutr. 2005;135(10):2473–7.

    CAS  PubMed  Google Scholar 

  32. Osler M, Tjønneland A, Suntum M, Thomsen BL, Stripp C, Grønbaek M, et al. Does the association between smoking status and selected healthy foods depend on gender? A population-based study of 54,417 middle-aged Danes. Eur J Clin Nutr. 2002;56(1):57–63.

    Article  CAS  PubMed  Google Scholar 

  33. Padrao P, Lunet N, Santos AC, Barros H. Smoking, alcohol, and dietary choices: evidence from the Portuguese National Health Survey. BMC Public Health. 2007;7(1):138.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Palaniappan U, Starkey LJ, O’Loughlin J, Gray-Donald K. Fruit and vegetable consumption is lower and saturated fat intake is higher among Canadians reporting smoking. J Nutr. 2001;131(7):1952–8.

    CAS  PubMed  Google Scholar 

  35. Pollard J, Greenwood D, Kirk S, Cade J. Lifestyle factors affecting fruit and vegetable consumption in the UK women’s cohort study. Appetite. 2001;37(1):71–9.

    Article  CAS  PubMed  Google Scholar 

  36. Wilson DB, Smith BN, Speizer IS, Bean MK, Mitchell KS, Uguy LS, et al. Differences in food intake and exercise by smoking status in adolescents. Prev Med. 2005;40(6):872–9.

    Article  PubMed  Google Scholar 

  37. Woo J, Ho SC, Sham A, Leung SSF, Lam TH, Janus ED. Dietary habit of smokers in a Chinese population. Int J Food Sci Nutr. 2001;52(6):477–84.

    Article  CAS  PubMed  Google Scholar 

  38. Charilaou M, Karekla M, Constantinou M, Price S. Relationship between physical activity and type of smoking behavior among adolescents and young adults in Cyprus. Nicotine Tob Res. 2009;11(8):969–76.

    Article  PubMed  Google Scholar 

  39. Moore MJ, Werch C. Relationship between vigorous exercise frequency and substance use among first-year drinking college students. J Am Coll Health. 2008;56(6):686–90.

    Article  PubMed  Google Scholar 

  40. Olchowski AE, Graham JW, Beverly EA, Dupkanick CW. Cigarette smoking, physical activity, and the health status of college students. J Appl Soc Psychol. 2009;39(3):683–706.

    Article  Google Scholar 

  41. Seo D-C, Nehl E, Agley J, Ma SM. Relations between physical activity and behavioral and perceptual correlates among Midwestern college students. J Am Coll Health. 2007;56(2):187–97.

    Article  PubMed  Google Scholar 

  42. VanKim NA, Laska MN, Ehlinger E, Lust K, Story M. Understanding young adult physical activity, alcohol and tobacco use in community colleges and 4-year post-secondary institutions: a cross-sectional analysis of epidemiological surveillance data. BMC Public Health. 2010;10:208.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215.

    Article  CAS  PubMed  Google Scholar 

  44. Cialdini RB. Descriptive social norms as underappreciated sources of social control. Psychometrika. 2007;72(2):263–8.

    Article  Google Scholar 

  45. Campbell MK, Tessaro I, DeVellis B, Benedict S, Kelsey K, Belton L, et al. Tailoring and targeting a worksite health promotion program to address multiple health behaviors among blue-collar women. Am J Health Promot. 2000;14(5):306–13.

    Article  CAS  PubMed  Google Scholar 

  46. Butterfield RM, Park ER, Puleo E, Mertens A, Gritz ER, Li FP, et al. Multiple risk behaviors among smokers in the childhood cancer survivors study cohort. Psychooncology. 2004;13(9):619–29.

    Article  PubMed  Google Scholar 

  47. Easton A, Kiss E. Covariates of current cigarette smoking among secondary school students in Budapest, Hungary, 1999. Health Educ Res. 2005;20(1):92–100.

    Article  PubMed  Google Scholar 

  48. Bobo JK, Husten C. Sociocultural influences on smoking and drinking. Alcohol Res Health. 2000;24(4):225–32.

    CAS  PubMed  Google Scholar 

  49. Shiffman S, Balabanis M. Associations between alcohol and tobacco. In: Fertig JB, Allen JP, editors. Alcohol and tobacco: from basic science to clinical practice. National Institute on Alcohol Abuse and Alcoholism (NIAAA) Research Monograph No. 30, Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism; 1995. p. 17–36.

  50. Shiffman S, Fischer LA, Paty JA, Gnys M, Kassel JD. Drinking and smoking: a field study of their association. Ann Behav Med. 1994;16(3):203–9.

    Google Scholar 

Download references

Compliance with Ethical Standards

All procedures followed were in accordance with the ethical standards of the Institutional Review Board of the lead author’s institution and with the Helsinki Declaration of 1975, as revised in 2000. This study analyzed a publicly available secondary dataset. No personally identifiable information was available in the data.

Conflict of Interest

The authors Lee, Seo, Middlestadt, and Lin declare that they have no conflict of interest.

Sponsor of Research

This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2012S1A3A2033416).

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Correspondence to Dong-Chul Seo.

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Lee, C.G., Seo, DC., Middlestadt, S.E. et al. Does the Relationship Between Cigarette Smoking and Other Key Health Behaviors Vary by Geographic Area Among US Young Adults? A Multilevel Analysis. Int.J. Behav. Med. 22, 481–488 (2015). https://doi.org/10.1007/s12529-014-9452-0

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  • DOI: https://doi.org/10.1007/s12529-014-9452-0

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