Changes in the clustering of health-related behaviors during the COVID-19 pandemic: examining predictors using latent transition analysis.

The COVID-19 pandemic has had a significant impact on daily life, affecting both physical and mental health. Changes arising from the pandemic may longitudinally impact health-related behaviors (HRB). As different HRBs co-occur, in this study, we explore how six HRBs - alcohol (past-week and binge-drinking), tobacco, marijuana, benzodiazepine use, and unhealthy food consumption - were grouped and changed over time during the COVID-19 pandemic. A sample of 1038 university students and staff (18 to 73 years old) of two universities completed an online psychometrically adequate survey regarding their recalled HRB (T0, pre-COVID-19 pandemic) and the impact of COVID-19 on their behaviors during July (T1) and November (T2). Latent Transition Analysis (LTA) was used to identify HRB cluster membership and how clusters changed across T0, T1, and T2. Four clusters emerged, but remained mainly stable over time: 'Lower risk' (65.2-80%), 'Smokers and drinkers' (1.5-0.01%), 'Binge-drinkers and marijuana users' (27.6-13.9%), and 'Smokers and binge-drinkers' (5.6-5.8%). Participants who moved from one cluster to another lowered their HRB across time, migrating from the 'Binge-drinkers and marijuana users' cluster to 'Lower risk'. Participants in this cluster were characterized as less affected economically by the COVID-19 pandemic, with lower reported stress levels, anxiety, depression, and loneliness than the other clusters. Our results provide evidence of how HRBs clustered together and transitioned longitudinally during the COVID-19 pandemic. HRB clustering across time offers a valuable piece of information for the tailoring of interventions to improve HRB.

Comparing relationships between health-related behaviour clustering and episodic memory trajectories in the United States of America and England: a longitudinal study.

BACKGROUND: Health-related behaviours (HRBs) cluster within individuals. Evidence for the association between HRB clustering and cognitive functioning is limited. We aimed to examine and compare the associations between three HRB clusters: "multi-HRB cluster", "inactive cluster" and "(ex-)smoking cluster" (identified in previous work based on HRBs including smoking, alcohol consumption, physical activity and social activity) and episodic memory trajectories among men and women, separately, in the United States of America (USA) and England. METHODS: Data were from the waves 10-14 (2010-2018) of the Health and Retirement Study in the USA and the waves 5-9 (2010-2018) of the English Longitudinal Study of Ageing in England. We included 17,750 US and 8,491 English participants aged 50 years and over. The gender-specific HRB clustering was identified at the baseline wave in 2010, including the multi-HRB (multiple positive behaviours), inactive and ex-smoking clusters in both US and English women, the multi-HRB, inactive and smoking clusters in US men, and only the multi-HRB and inactive clusters in English men. Episodic memory was measured by a sum score of immediate and delayed word recall tests across waves. For within country associations, a quadratic growth curve model (age-cohort model, allowing for random intercepts and slopes) was applied to assess the gender-stratified associations between HRB clustering and episodic memory trajectories, considering a range of confounding factors. For between country comparisons, we combined country-specific data into one pooled dataset and generated a country variable (0 = USA and 1 = England), which allowed us to quantify between-country inequalities in the trajectories of episodic memory over age across the HRB clusters. This hypothesis was formally tested by examining a quadratic growth curve model with the inclusion of a three-way interaction term (age × HRB clustering × country). RESULTS: We found that within countries, US and English participants within the multi-HRB cluster had higher scores of episodic memory than their counterparts within the inactive and (ex-)smoking clusters. Between countries, among both men and women within each HRB cluster, faster declines in episodic memory were observed in England than in the USA (e.g., b England versus the USA for men: multi-HRB cluster = -0.05, 95%CI: -0.06, -0.03, b England versus the USA for women: ex-smoking cluster = -0.06, 95%CI: -0.07, -0.04). Additionally, the range of mean memory scores was larger in England than in the USA when comparing means between two cluster groups, including the range of means between inactive and multi-HRB cluster for men (b England versus the USA = -0.56, 95%CI: -0.85, -0.27), and between ex-smoking and multi-HRB cluster for women (b England versus the USA = -1.73, 95%CI: -1.97, -1.49). CONCLUSIONS: HRB clustering was associated with trajectories of episodic memory in both the USA and England. The effect of HRB clustering on episodic memory seemed larger in England than in the USA. Our study highlighted the importance of being aware of the interconnections between health behaviours for a better understanding of how these behaviours affect cognitive health. Governments, particularly in England, could pay more attention to the adverse effects of health behaviours on cognitive health in the ageing population.

The Clustering of Health-Related Behaviors in the Adult Japanese Population.

BACKGROUND: Research findings indicate that four health-related behaviors (HRBs), smoking, alcohol, diet, and physical activity, do not co-occur within individuals by chance and therefore cluster. To date, there is a lack of research investigating the clustering of these HRBs in the Japanese population. METHODS: The Japanese National Health and Nutrition Survey 2010 was used, containing information on 8,015 community-dwelling adults. Latent profile analysis identified distinct cluster patterns of four HRBs: smoking status, alcohol consumption, calorie intake, and the number of steps per day. RESULTS: For men, four distinct HRB clusters were identified. The largest cluster (54%) was characterized by drinking more than Japan's recommended alcohol guidelines and walking an inadequate number of steps per day. A small cluster (4%) also emerged, characterized by smoking, high calorie intake, and exceeding alcohol guidelines. Members of these clusters had higher systolic blood pressure than those in the remaining clusters. For women, five distinct HRB clusters were identified. The largest cluster (57%) was characterized by not smoking or drinking and walking an inadequate number of steps per day. For both genders, there was a relationship between cluster membership and age. Cluster membership was associated with income and health status among men but not women. CONCLUSION: Detecting distinct clusters of HRBs in a Japanese population-based survey provides a person-centered understanding of Japanese lifestyles. This approach can assist policy makers in Japan and overseas to identify new strategies for targeting behavioral risk factors and make health promotion policies more effective in their respective countries.

Similarities and differences in health-related behavior clustering among older adults in Eastern and Western countries: A latent class analysis of global aging cohorts.

AIM: To quantify variations in health-related behaviors (HRB) clustering of older adults in Western and Eastern countries. METHODS: Using six aging cohorts from the USA, England, Europe, Japan, Korea and China, latent class analysis was applied to access the clustering of smoking, alcohol consumption, physical activity and social activity. RESULTS: A total of 104 552 participants (55% women) aged ≥50 years in 2010 were included. Despite a different number of clusters identified, three consistent cluster profiles emerged: "Multiple-HRB" (ex-/never smoking, moderate drinking, frequent physical and social activity); "Inactives" (socially and physically inactive without other risk behaviors); and "(ex-)Smokers with Risk Behaviors". Sex and cohort variations were shown. For men in Western cohorts, "Multiple-HRB" was the predominant cluster, whereas their Asian counterparts were more likely to be members of the "Smokers with risk behavior" and "Inactives" clusters. Most women, particularly those in Asian cohorts, were never smokers and non-drinkers, and most of them belonged to the socially "Inactives" cluster. CONCLUSIONS: We provide a person-centered understanding of HRB clustering of older adults over selected countries by sex, informing tailored health promotion for the target population. Geriatr Gerontol Int 2019; 19: 930-937.

The stability of health-related behaviour clustering during mid-adulthood and the influence of social circumstances on health-related behaviour change.

Evidence suggests that health-related behaviours (HRBs) cluster in mid-adulthood and are associated with social circumstances (i.e. economic circumstances, cultural norms, employment relations) at the same age. However, little is known about the level of stability in HRB cluster membership during mid-adulthood and how social circumstances in early mid-adulthood may influence movement between HRB clusters during mid-life. Data were taken from a British cohort born in 1958 (N = 12,784), to examine the stability of membership of three HRB clusters: 'Risky', 'Moderate Smokers' and 'Mainstream' (the latter pattern consisting of more beneficial HRBs such as not smoking, moderate alcohol consumption, being physically active), between ages 33 and 42. The relationship between social circumstances at age 33 and movement between HRB clusters during mid-adulthood was also examined. HRB cluster membership was relatively stable during mid-adulthood, over 60% of the participants remained in the same cluster at both ages. However, there was considerable probability of movement from the 'Risky' and 'Moderate Smokers' clusters at age 33 to the 'Mainstream' cluster at age 42. Members of the 'Risky' cluster had a lower probability of transitioning to the 'Mainstream' cluster (men = 17%, women = 9%, p < 0.001) in comparison to the 'Moderate Smokers' cluster (men = 26%, women = 27%, p < 0.001). Social circumstances at age 33 did not influence change in HRB cluster membership between ages 33 and 42 (p > 0.05). Movement from the 'Risky' and 'Moderate Smokers' cluster to the 'Mainstream' cluster during mid-adulthood highlights improvements for most HRBs. Person-centred interventions are required to prevent persistent negative HRBs amongst 'Risky' cluster members.

Social influences on health-related behaviour clustering during adulthood in two British birth cohort studies.

Building upon evidence linking socio-economic position (SEP) in childhood and adulthood with health-related behaviours (HRB) in adulthood, we examined how pre-adolescent SEP predicted membership of three HRB clusters: "Risky", "Moderate Smokers" and "Mainstream" (the latter pattern consisting of more beneficial HRBs), that were detected in our previous work. Data were taken from two British cohorts (born in 1958 and 1970) in pre-adolescence (age 11 and 10, respectively) and adulthood (age 33 and 34). SEP constructs in pre-adolescence and adulthood were derived through Confirmatory Factor Analysis. Conceptualised paths from pre-adolescent SEP to HRB cluster membership via adult SEP in our path models were tested for statistical significance separately by gender and cohort. Adult SEP mediated the path between pre-adolescent SEP and adult HRB clusters. More disadvantaged SEP in pre-adolescence predicted more disadvantaged SEP in adulthood which was associated with membership of the "Risky" and "Moderate Smokers" clusters compared to the "Mainstream" cluster. For example, large positive indirect effects between pre-adolescent SEP and adult HRB via adult SEP were present (coefficient 1958 Women = 0.39; 1970 Women = 0.36, 1958 Men = 0.51; 1970 Men = 0.39; p < 0.01) when comparing "Risky" and "Mainstream" cluster membership. Amongst men we found a small significant direct association (p < 0.001) between pre-adolescent SEP and HRB cluster membership. Our findings suggest that associations between adult SEP and HRBs are not likely to be pre-determined by earlier social circumstances, providing optimism for interventions relevant to reducing social gradients in HRBs. Observing consistent findings across the cohorts implies the social patterning of adult lifestyles may persist across time.

The clustering of health-related behaviours in a British population sample: Testing for cohort differences.

Research findings indicate that health-related behaviours (HRBs) do not co-occur within individuals by chance and therefore cluster. This study uses Latent Profile Analysis (LPA), to identify the clustered patterns and prevalence of four HRBs: smoking, alcohol, diet, physical activity. We used data, collected from participants in their early 30s, from two British cohorts born in 1958 and 1970 (N=21,019). Multi-group LPA models were run separately by gender testing for cohort differences in HRB cluster patterns. For both genders three clusters emerged: 'Risky' (1-9%), 'Moderate Smokers' (20-30%) and 'Mainstream' (68-77%). HRBs amongst members of the 'Mainstream' cluster were more beneficial than HRBs amongst members of the other two clusters, characterised as not smoking, frequent fruit and vegetable consumption, less frequent consumption of chips and fried food and being more physically active. Nevertheless, frequent consumption of sweet foods was common in the 'Mainstream' cluster. There was a large shift in membership to the 'Mainstream' cluster for men and women born in 1970. Amongst women members of the 'Mainstream' cluster, a higher proportion of those born in 1970 appeared to have drunk alcohol above the contemporaneous UK recommended limits but consumed sweet foods less frequently, than those born in 1958. In summary our findings provide additional evidence of HRB clustering, identifying largely consistent HRBs cluster patterns across cohort and gender groups, with some differences in prevalence. This evidence of HRB clustering across time and by gender provides a person-centred understanding that can inform interventions to improve HRBs.