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Recent Advances in Multiple Health Behavior Change

Jayson J. Spas, PhD, MS, LMFT, Multiple Health Behavior Change SIG co-chair; and Lori A. J. Scott-Sheldon, PhD, Multiple Health Behavior Change SIG chair

Multiple health behavior change (MHBC) is increasingly recognized as critical to reducing modifiable risk behaviors that often occur in clusters and are associated with chronic diseases (Prochaska et al., 2008; Spring et al., 2012). Growing evidence demonstrates that interventions targeting multiple co-occurring health risk behaviors, rather than a single health risk behavior one at a time, may have a greater impact preventing chronic illness and ultimately improving public health (Prochaska, 2008). The National Institutes of Health's (NIH's) report on the science of behavior change (2009) identified the simultaneous change in multiple health risk behaviors as a top priority. Understanding the why, how, and under what circumstances of changing multiple health behaviors will be critical for guiding research and practice toward an integrative model of multiple behavior change.

MHBC is grounded in the ever-growing demands for more rigorous evaluation of intervention efficacy, effectiveness, and cost-efficiency. Toward that end, there have been several advances in MHBC including the recent move to link treatment outcomes from separate behaviors to behavior pairs when evaluating intervention efficacy on multiple health behavior risks. This shift is innovative for several reasons. First, it challenges the separate behavior paradigm that dominates current methodology to establish intervention efficacy and effectiveness. Second, it provides a novel approach to help advance the knowledge-base and scientific evaluation of the underlying mechanisms and interrelationships of behavioral interventions for MHBC. Third, it provides an alternative analytic approach that may reveal synergistic effects that are currently undetected by the dominant separate behavior paradigm and its analytic approaches. One example is using stage-based, interactive, and computer-tailored interventions from the Transtheoretical Model (TTM) when investigating smoking, diet, and several other behavioral risks. Recent research found that individuals exposed to an intervention who progressed to a healthy criterion on one behavior were more likely to progress to a healthy criterion on a second behavior compared to those participants in the same intervention who did not move to a healthy criterion on the first behavior (Paiva et al., 2012). This phenomenon is defined as coaction and it refers to the extent to which change on one behavior is associated with change on a second behavior at the same follow-up time point.

Presently, MHBC is in its nascent stages and many important questions remain unanswered including: How does change in one behavior affect change in another behavior? Are there synergistic effects to simultaneous intervention? How does MHBC vary by different behavior pairs? Are there differences when addictive behaviors (e.g., smoking, alcohol use) are paired together with energy balance behaviors (e.g., exercise, diet) and preventive care behaviors (e.g., screenings)? These unanswered questions and the recent advances in MHBC make this an especially exciting time for MHBC research. Taken together, not only can MHBC help the NIH achieve its mission of turning discovery into health, but it can help translate behavioral interventions from "bench to bedside to public health" in order to help extend healthy life and reduce the burdens of illness and disability.


Paiva AL, Prochaska JO, Yoin H, Redding C, Rossi JS, Blissmer B, Robbins M, Velicer WF, Lipschitz J, Amoyal N, Babbin S, Blaney C, Sillice M, Fernandez A, McGee H, Horiuchi S (2012): Treated individuals who progress to action or maintenance for one behavior are more likely to make similar progress on another behavior: Coaction results of a pooled data analysis of three trials. Preventive Medicine, 54 (5), 331-334.

Prochaska, J.O. (2008). Multiple health behavior research represents the future of preventive medicine. Preventive Medicine, 46, 281-285.

Spring, B., Moller, A. C., & Coons, M. J. (2012). Multiple health behaviours: Overview and implications. Journal of Public Health, 34 (Suppl 1), i3-i10.