The DOI matches its Crossref record; 51 of the 52 references it cites were found in a registry or an index.
Patterns of health behavior in U.S. adults
Abstract
Background Associations between health-related behaviors are important for two reasons. First, disease prevention and health promotion depend on understanding both prevalence of health behaviors and associations among such behaviors. Second, behaviors may have synergistic effects on disease risk.Methods We document patterns of adherence to recommendations concerning five behaviors (physical activity, tobacco use, alcohol consumption, fruit and vegetable consumption, and dietary fat intake) in U.S. adults (n = 15,425) using data from the Third National Health and Nutrition Examination Survey. Division of individuals into categories associated with adherence or nonadherence to lifestyle recommendations results in 32 patterns of adherence/nonadherence.Results Proportions of U.S. adults with 21 of 32 behavior patterns characterized here deviated from proportions expected if health behaviors are independent of each other. The two extreme patterns, all adherence (5.9%) and all nonadherence (4.9%), were found in about double the proportion expected. Age, gender, race/ethnicity, education, and income were associated with a number of patterns, including the two extremes.Conclusions This analysis of behavior patterns highlights population subgroups of public health importance, provides a benchmark for studies of multivariate associations between health behaviors, and supports a multidimensional model of health behavior.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“these highly prevalent HRBs are known to cluster within individuals and populations.27–29”
From Early life adversity and health-risk behaviors: Proposed psychological and neural mechanisms (2018) · cites this paper as [27]
In the citing paper
“Low adherence has clear implications for research and clinical practice, as it can: (i) skew interpretations of efficacy if not clearly measured and reported, and (ii) moderate intervention outcomes, with longer exposure to an intervention yielding greater benefits [20, 23-26].”
From Uptake and adherence to an online intervention for cancer-related distress: older age is not a barrier to adherence but may be a barrier to uptake (2017) · cites this paper as [25]
In the citing paper
“Low adherence has clear implications for research and clinical practice, as it can: (i) skew interpretations of efficacy if not clearly measured and reported, and (ii) moderate intervention outcomes, with longer exposure to an intervention yielding greater benefits [20, 23-26].”
From Uptake and adherence to an online intervention for cancer-related distress: older age is not a barrier to adherence but may be a barrier to uptake (2017) · cites this paper as [25]
Citations
Cites
Self-efficacy: Toward a unifying theory of behavioral change
Bandura, A. (1977) · Psychological Review · doi:10.1037/0033-295x.84.2.191 · Cited by 43,925
Health Behavior and Health Education: Theory, Research, and Practice
(1992) · Annals of Internal Medicine · doi:10.7326/0003-4819-116-4-350_1 · Cited by 13,232
Historical Origins of the Health Belief Model
Rosenstock, I. M. (1974) · Health Education Monographs · doi:10.1177/109019817400200403 · Cited by 6,116
Actual causes of death in the United States
McGinnis, J. M. (1993) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1993.03510180077038 · Cited by 5,480
Compendium of Physical Activities: Classification of energy costs of human physical activities
AINSWORTH, B. E., HASKELL, W. L., LEON, A. S., JACOBS, D. R., MONTOYE, H. J., SALLIS, J. F., & PAFFENBARGER, R. S. (1993) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199301000-00011 · Cited by 4,102
The Causes of Cancer: Quantitative Estimates of Avoidable Risks of Cancer in the United States Today
Doll, R., & Peto, R. (1981) · JNCI: Journal of the National Cancer Institute · doi:10.1093/jnci/66.6.1192 · Cited by 3,927
The Causes of Cancer: Quantitative Estimates of Avoidable Risks of Cancer in the United States Today
Peto, R. (1983) · Springer eBooks · doi:10.1007/978-1-4757-1117-2_30 · Cited by 3,504
Health behavior and health education
(1990) · Choice Reviews Online · doi:10.5860/choice.28-2173 · Cited by 2,919
Subar, A. F., Thompson, F. E., Kipnis, V., Midthune, D., Hurwitz, P. E., McNutt, S., McIntosh, A., & Rosenfeld, S. (2001) · American Journal of Epidemiology · doi:10.1093/aje/154.12.1089 · Cited by 1,401
SUDAAN User's Manual, Release 7.5,
Bieler, G. S., Barnwell, B., & Shah, B. V. (1997) · Cited by 1,273
Relationship of physical health status and health practices
Belloc, N. B., & Breslow, L. (1972) · Preventive Medicine · doi:10.1016/0091-7435(72)90014-x · Cited by 1,136
Korn, E. L., & Graubard, B. I. (1999) · Wiley eBooks · doi:10.1002/9781118032619 · Cited by 1,081
(2001) · Technometrics · doi:10.1198/tech.2001.s612 · Cited by 990
Dietary Assessment Methodology
Thompson, F. E., & Subar, A. F. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-802928-2.00001-1 · Cited by 978
Cancer epidemiology in the last century and the next decade
Peto, J. (2001) · Nature · doi:10.1038/35077256 · Cited by 688
Actual causes of death in the United States
McGinnis, J. M. (1993) · JAMA · doi:10.1001/jama.270.18.2207 · Cited by 579
PATE, R. R., Heath, G. W., Dowda, M. C., & Trost, S. G. (1996) · American Journal of Public Health · doi:10.2105/ajph.86.11.1577 · Cited by 529
Health-Protective Behavior: An Exploratory Study
Harris, D. M., & Guten, S. (1979) · Journal of Health and Social Behavior · doi:10.2307/2136475 · Cited by 422
Ariefdjohan, M. W., Baer, M. T., Barnes, J. L., Batch, B. C., Bhriain, S. N., Boushey, C. J., Harris, A. B., Brown-Esters, O. N., Burke, L. E., Cadmus‐Bertram, L., et al. (2012) · Elsevier eBooks · doi:10.1016/b978-0-12-391884-0.00055-x · Cited by 364
Dietary Factors in Oral and Pharyngeal Cancer
McLaughlin, J. K., Gridley, G., Block, G., Winn, D. M., Preston‐Martin, S., Schoenberg, J. B., Greenberg, R. S., Stemhagen, A., Austin, D. F., Ershow, A. G., et al. (1988) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/80.15.1237 · Cited by 337
Doll, R. (2001) · PubMed · Cited by 322
Relationships between exercise or physical activity and other health behaviors.
Blair, S. N., Jacobs, D. R., & Powell, K. E. (1985) · PubMed · Cited by 296
Salivary gland malignant myoepithelioma
Nagao, T., Sugano, I., Ishida, Y., Tajima, Y., Matsuzaki, O., Konno, A., Kondō, Y., & Nagao, K. (1998) · Cancer · doi:10.1002/(sici)1097-0142(19981001)83:7 · Cited by 282
Self-citationEmmons, K. M., Marcus, B. H., Linnan, L. A., Rossi, J. S., & Abrams, D. B. (1994) · Preventive Medicine · doi:10.1006/pmed.1994.1066 · Cited by 237
Choose a Variety of Fruits and Vegetables Daily: Understanding the Complexities
Krebs‐Smith, S. M., & Kantor, L. S. (2001) · Journal of Nutrition · doi:10.1093/jn/131.2.487s · Cited by 175
Self-citationSchlecht, N. F., Franco, E. L., Pintos, J., Negassa, A., Kowalski, L. P., Oliveira, B. V., & Curado, M. P. (1999) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009938 · Cited by 170
A population-based study of age and gender differences in patterns of health-related behaviors
Liang, W., Shediac‐Rizkallah, M. C., Celentano, D. D., & Rohde, C. A. (1999) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(99)00040-9 · Cited by 156
Health Lifestyle Patterns of U.S. Adults
Patterson, R. E., Haines, P. S., & Popkin, B. M. (1994) · Preventive Medicine · doi:10.1006/pmed.1994.1062 · Cited by 155
Ma, J., Betts, N. M., & Hampl, J. S. (2000) · American Journal of Health Promotion · doi:10.4278/0890-1171-15.2.107 · Cited by 152
Clustering of cardiovascular disease risk factors
Criqui, M. H., Barrett-Connor, E., Holdbrook, M. J., Austin, M., & Turner, J. D. (1980) · Preventive Medicine · doi:10.1016/0091-7435(80)90047-x · Cited by 131
Johnson, M. F., Nichols, J. F., Sallis, J. F., Calfas, K. J., & Hovell, M. F. (1998) · Preventive Medicine · doi:10.1006/pmed.1998.0320 · Cited by 100
Interrelationships among preventive health behaviors: a test of competing hypotheses.
Langlie, J. K. (1979) · PubMed · Cited by 99
Interrelationship of Preventive Actions in Health and Other Areas
Williams, A. F., Williams, A. F., & Wechsler, H. (1972) · Health Services Reports · doi:10.2307/4594704 · Cited by 94
Multivariate Statistical Methods
Somorjai, R. L. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-803224-4.00090-x · Cited by 82
Dietary patterns of women smokers and non-smokers
Larkin, F. A., Basiotis, P. P., Riddick, H., Sykes, K. E., & Pao, E. M. (1990) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(21)01499-1 · Cited by 81
Characterizing food intake patterns of American adults
Krebs‐Smith, S., Cleveland, L., Ballard-Barbash, R. R., Cook, D., & Kahle, L. (1997) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/65.4.1264s · Cited by 69
Self-citationEthnicity and Lifestyle Health Risk: Some Possible Mechanisms
Gottlieb, N. H., & Green, L. W. (1987) · American Journal of Health Promotion · doi:10.4278/0890-1171-2.1.37 · Cited by 68
Modern Applied Biostatistical Methods Using S-Plus
Ziegel, E. R., & Selvin, S. (2000) · Technometrics · doi:10.1080/00401706.2000.10486031 · Cited by 60
Be Physically Active Each Day. How Can We Know?
Troiano, R. P., Ballard-Barbash, R. R., & Macera, C. A. (2001) · Journal of Nutrition · doi:10.1093/jn/131.2.451s · Cited by 57
Self-citationRelationships between health protective behaviors
Krick, J. P., & Sobal, J. (1990) · Journal of Community Health · doi:10.1007/bf01350183 · Cited by 55
Achieving a healthy lifestyle among United States adults: a long way to go.
Ford, E. S., Ford, M. A., Will, J. C., Galuska, D. A., & Ballew, C. (2001) · PubMed · Cited by 54
A factor analytic study of health habits
Tapp, J. T., & Goldenthal, P. (1982) · Preventive Medicine · doi:10.1016/0091-7435(82)90035-4 · Cited by 53
Patterns of Interrelationships Atnong Health-Promotion Behaviors
Sobal, J., Revicki, D. A., & DeForge, B. R. (1992) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(18)30779-7 · Cited by 52
Dixon, L. B., & Ernst, N. D. (2001) · Journal of Nutrition · doi:10.1093/jn/131.2.510s · Cited by 50
Smoking status and the practice of other unhealthy behaviors.
Revicki, D. A., Sobal, J., & DeForge, B. R. (1991) · PubMed · Cited by 45
Hahn, R. A., Heath, G. W., & Chang, M. (1998) · PubMed · Cited by 39
If You Drink Alcoholic Beverages Do So in Moderation: What Does This Mean?
Dufour, M. C. (2001) · Journal of Nutrition · doi:10.1093/jn/131.2.552s · Cited by 38
Prevalence and correlates of recreational physical activity in women aged 50-64 years.
McTiernan, A., Stanford, J. L., Daling, J. R., & Voigt, L. F. (1998) · PubMed · Cited by 37
Prevalence and Correlates of Recreational Physical Activity in Women Aged 50???64 Years
McTiernan, A., Stanford, J. L., Daling, J. R., & Voigt, L. F. (1998) · Menopause The Journal of The North American Menopause Society · doi:10.1097/00042192-199805020-00007 · Cited by 22
Smoking and unhealthy food habits. How stable is the association?
Prättälä, R. (1998) · European Journal of Public Health · doi:10.1093/eurpub/8.1.28 · Cited by 16
Research works printed but not linked: 3
- Langlie, 1979, Interrelationships among preventive health behaviors, Public Health Rep, 94, 216
- Hahn, 1998, Cardiovascular disease risk factors and preventive practices among adults—United States, 1994, MMWR CDC Surveill Summ, 47, 35
- Ford, 2001, Achieving a healthy lifestyle among United States adults, Ethn Dis, 11, 224
Cited by
Sorted by citations
Kushi, L. H., Byers, T., Doyle, C., Bandera, E. V., McCullough, M., Gansler, T., Andrews, K. S., Thun, M. J., & The American Cancer Society 2006 Nutrition and Physical Activity Guidelines Advisory Committee (2006) · CA A Cancer Journal for Clinicians · doi:10.3322/canjclin.56.5.254 · Cited by 1,901
The prevalence and clustering of four major lifestyle risk factors in an English adult population
Poortinga, W. (2006) · Preventive Medicine · doi:10.1016/j.ypmed.2006.10.006 · Cited by 569
Noble, N., Paul, C. L., Turon, H., & Oldmeadow, C. J. (2015) · Preventive Medicine · doi:10.1016/j.ypmed.2015.07.003 · Cited by 522
Prevalence of multiple chronic disease risk factors
Fine, L. J., Philogene, G. S., Gramling, R., Coups, E. J., & Sinha, S. (2004) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2004.04.017 · Cited by 434
Nelson, M. C., & Gordon-Larsen, P. (2006) · Pediatrics · doi:10.1542/peds.2005-1692 · Cited by 419
Metadata
- Authors
- Berrigan, D., Dodd, K., Troiano, R. P., Krebs-Smith, S. M., & Barbash, R. B.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Berrigan, David
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2003-05
- Volume
- 36
- Issue
- 5
- Pages
- 615-623
- ISSN
- 0091-7435 (ISSN-L)
- OpenAlex
- W2026395256
- Cited by
- 382
- References
- 52
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 7 · 2023: 15 · 2022: 14 · 2021: 10 · 2020: 24 · 2019: 11 · 2018: 19 · 2017: 13 · 2016: 27 · 2015: 27 · 2014: 24 · 2013: 27 · 2012: 19
- FWCI
- 34.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health and Lifestyle Studies
- Health Sciences › Health Professions › General Health Professions › Health and Wellbeing Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- health behavior patterns, lifestyle adherence, physical activity, tobacco use, alcohol consumption, fruit and vegetable intake, dietary fat intake, disease prevention, health promotion, sociodemographic differences
- MeSH terms
- Smoking Prevention, Adult, Alcohol Drinking, Demography, Ethnicity, Female, Fruit, Health Surveys, Humans, Life Style, Male, Patient Compliance, United States, Vegetables, Health Behavior, Exercise, Diet, Fat-Restricted
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
