Claudio R. Nigg, PhD - Society of Behavioral Medicine

Interrelationships Across Three
Health Behaviors:
Theory and Research
Sonia Lippke, PhD (Free University Berlin, Germany), &
Claudio R. Nigg, PhD (University of Hawaii-Manoa, USA),
Jason E. Maddock, PhD (University of Hawaii-Manoa, USA)
Contact: cnigg@hawaii.edu
Symposium: Developing Multiple Risk Factor Interventions
Society of Behavioral Medicine, Seattle, April 9, 2010
Support: Hawaii State Department of Health Tobacco Settlement Special Fund &
a travel grant by the German Research Foundation
(Deutsche Forschungsgemeinschaft, DFG).

Rationale
Non-smoking, healthy nutrition and
physical activity (PA) - core factors of a
healthy lifestyle (Mokdad et al., 2004).
Populations with multiple behavior risk
factors:
– ↑ chronic disease & premature death compared
single or no behavioral risk factors, and
– account for a disproportionate percentage of
health care costs

Rationale
Multiple health behavior theory is
developing (Noar et al., 2008)
Inform interventions
– may yield ↑ benefit for prevention,
rehabilitation, disease management, and ↓
health care costs
Therefore, we need to know more about
healthy lifestyle patterns and, in particular,
about their mechanisms (Prochaska et al.,
2008)

Transfer Theory
Transfer - history in teaching and learning
(Barnett & Ceci, 2002)
Transferring depends on dimensions, e.g.,
content and context (Barnett & Ceci, 2002)
Some aspects same in different domains
– intending, planning, and overcoming
temptations
Other aspects might be unique for each
behavior
– such as the concrete “how”

Transfer Theory - example

Compensation Theory
Based on the ideas of the
Compensatory Health Belief Model
(Knauper et al 2004)
People who perform a risk behavior
may compensate by performing a
health behavior

Compensation Theory -
Example

Purpose
To see if people transfer or
compensate health behaviors
– As evidenced by positive or negative
correlations
To investigate if smoking moderates
transfer or compensation effects
– As smoking has been identified as a
gateway drug (Biederman et al., 2007;
Nigg et al., 2009)

Participants
N = 3,519; 60.3% female;
– 34.2% White,
– 19% Japanese,
– 17.9% Native Hawaiian/Part Hawaiian,
– 9.4% Filipinos, and
– 19.4% “Other/Mixed Race.”
Mean age = 46.31, SD = 16.31;
4.7% < high school, 28% high school degree,
27.5% some college, 39.4% graduated college;
BMI = 25.68, SD = 5.27.
– 2.9% underweight (BMI < 18);
– 47.3% normal weight (BMI = 18-24);
– 30.1% overweight (BMI = 25-30);
– 16.3% obese (BMI = 30+).

Procedures
Random digit dialing
Trained interviewers, using CATI
conducted a 20-minute survey
Randomization within household - person
>18 who had the last birthday
UH IRB approved, phone consent
Assessed stage of change
– PA, fruit and vegetable consumption, and
smoking

Stage Prevalence
%
60
50
40
30
20
10
0
PC C PR A M
Stage
Note: 61/9% never smoked; percentages may not add
to 100% due to missing data
PA
FV
Smoking

Non-parametric correlations
between behaviors
0.2
Correlations
0.16
0.12
0.08
0.04
0
PA-Nut PA-Tob Nut-Tob
Behavior Pairs
Note: all p’s

Non-parametric correlations: PA &
nutrition by smoking stages and neversmokers
0.4
0.35
p=.02
Correlations
0.3
0.25
0.2
0.15
0.1
0.05
p=.06
p=.02
ns
p

Discussion –
Support for Transfer
PA, nutrition, and tobacco smoking
are interrelated
PA & nutrition ↑ correlated than
smoking & nutrition or smoking &
exercise
– PA and nutrition are preventive
behaviors and are adopted
– Smoking is a risk behavior which needs
to be reduced

Discussion – Support for
Moderation of Transfer
Ex-smokers - ↑ correlations of nutrition &
PA than never-smokers
– Transfer: Individuals who quit smoking are
more likely to eat healthy if they also do PA
Surprisingly, some current-smokers (e.g.
contemplators) also ↑ interrelation of
nutrition & PA than never-smokers
– Some current-smokers may have a history of
quit attempts

Limitations
Cross-sectional - which behavior
changed first?
Conclusions
– based on theoretical assumptions
– based on stage comparisons, not stage
transitions
Prospective and experimental
studies recommended

So…
“Don’t drink, don’t smoke…”
~Adam Ant