Abstract
Background: Tobacco use, physical inactivity (PA), and sedentary behavior (SB) are leading behavioral risk factors for mental and physical health problems. The combination of smoking and other unhealthy lifestyle behaviors heightens the risk from smoking alone. Examining the relationships between health behaviors and health problems in a representative sample of California smokers enables quantification of the negative health effects of engaging in multiple unhealthy lifestyle behaviors over and above any adverse health effects from smoking alone. Methods: The 2011 California Longitudinal Smokers Survey (CLSS) surveyed smokers who participated in the previous 2009 California Health Interview Survey (CHIS), a population-based random sample of California residents. The present analyses included 1,718 current smokers surveyed again two years after participating in CHIS. The sample respondents were weighted to the age, gender, geographic place of residence, and ethnicity of the population of all adult California smokers. For the current analyses, physical inactivity was defined as <10 minutes of sustained PA per week; a high level of SB was defined as ≥2 hours of leisure screen time per day; obesity was determined via calculated body mass index (BMI≥30) based on respondents’ self-reported height and weight; and elevated depressive and anxiety symptoms were determined via responses to two questions comprised of clusters of symptoms for each condition on the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) instrument. Results: Results revealed a significant relationship between physical inactivity and obesity (t=3.5, p < 0.001) and an interaction between sex and physical inactivity, such that male smokers who reported <10 min/week of PA were more likely than male smokers who reported ≥10 min/week of PA to be obese (t=2.8, p< 0.01). Physical inactivity was also associated with elevated anxiety symptoms among smokers (t=2.9, p<0.01). Smokers who reported ≥2 hours/day of leisure time SB were more likely to report ever receiving a diagnosis of heart disease by a physician (t=3.3, p<0.005). SB was also associated with elevated depressive symptoms among smokers (t=3.7, p<0.001). Conclusion: The combination of smoking and physical inactivity or excessive SB is associated with worse mental and physical health than smoking alone. The American Heart Association encourages individuals to improve their cardiovascular health by quitting smoking, increasing PA, reducing SB, and maintaining a healthy weight. Public health efforts to increase awareness of the significant benefits of improving these and other health behaviors rely upon the collection, analysis, and publication of data demonstrating the associations between health behaviors and outcomes.
Published Version
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