Preliminary evidence suggests that sequentially changing smoking alongside other risk behaviors was more effective than simultaneous change .
Follow-up period and intervention characteristics impacted effectiveness for some outcomes .
Interventions comprising education ( e.g. , providing information about behaviors associated with health risks ) and skills training ( e.g. , teaching skills that equip participants to engage in less risky behavior ) and targeting multiple risk behaviors concurrently are associated with small changes in diet and physical activity .
Although on average smoking was reduced , it appeared changes in smoking were negatively associated with changes in other behaviors , suggesting it may not be optimal to target smoking simultaneously with other risk behaviors
CONTEXT Multiple risk behaviors are common and associated with developing chronic conditions such as heart disease , cancer , or Type 2 diabetes .
Combined effect of health behaviours and risk of first ever stroke in 20 040 men and women over 11 years’ follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study
Objective To quantify the potential combined impact of four health behaviours on incidence of stroke in men and women living in the general community . Design Population based prospect i ve study ( EPIC-Norfolk ) . Setting Norfolk , United Kingdom . Participants 20 040 men and women aged 40 - 79 with no known stroke or myocardial infa rct ion at baseline survey in 1993 - 7 , living in the general community , and followed up to 2007 . Main outcome measure Participants scored one point for each health behaviour : current non-smoking , physically not inactive , moderate alcohol intake ( 1 - 14 units a week ) , and plasma concentration of vitamin C ≥50 µmol/l , indicating fruit and vegetable intake of at least five servings a day , for a total score ranging from 0 to 4 . Results There were 599 incident strokes over 229 993 person years of follow-up ; the average follow-up was 11.5 years . After adjustment for age , sex , body mass index ( BMI ) , systolic blood pressure , cholesterol concentration , history of diabetes and aspirin use , and social class , compared with people with the four health behaviours the relative risks for stroke for men and women were 1.15 ( 95 % confidence interval 0.89 to 1.49 ) for three health behaviours , 1.58 ( 1.22 to 2.05 ) for two , 2.18 ( 1.63 to 2.92 ) for one , and 2.31 ( 1.33 to 4.02 ) for none ( P<0.001 for trend ) . The relations were consistent in subgroups stratified by sex , age , body mass index , and social class , and after exclusion of deaths within two years . Conclusion Four health behaviours combined predict more than a twofold difference in incidence of stroke in men and women
Preliminary evidence suggests that sequentially changing smoking alongside other risk behaviors was more effective than simultaneous change .
Follow-up period and intervention characteristics impacted effectiveness for some outcomes .
Interventions comprising education ( e.g. , providing information about behaviors associated with health risks ) and skills training ( e.g. , teaching skills that equip participants to engage in less risky behavior ) and targeting multiple risk behaviors concurrently are associated with small changes in diet and physical activity .
Although on average smoking was reduced , it appeared changes in smoking were negatively associated with changes in other behaviors , suggesting it may not be optimal to target smoking simultaneously with other risk behaviors
CONTEXT Multiple risk behaviors are common and associated with developing chronic conditions such as heart disease , cancer , or Type 2 diabetes .