Living with a smoker, health risk behaviors, and adiposity: an analysis with middle-aged and older women
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Living with a smoker, health risk behaviors, and adiposity: an analysis with middle‑aged and older women Charles J. Holahan1 · Carole K. Holahan2 · Sangdon Lim3 · Daniel A. Powers4
Received: 18 June 2019 / Accepted: 26 August 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract This study investigated: (a) the association between living with a smoker and weight-related health risk behaviors, and (b) the role of these behaviors in indirectly linking living with a smoker to general and central adiposity. Participants were 83,492 women (age M = 63.5, SD = 7.36) from the Women’s Health Initiative Observational Study. In logistic regression analyses at baseline, living with a smoker was associated with increased odds of no exercise (29%), no walking (33%), high dietary fat (62%), and low fruit and vegetable consumption (43%). Using structural equation modeling, bootstrap confidence intervals confirmed a significant indirect effect from living with a smoker to adiposity through health risk behaviors at baseline and prospectively across 3 and 8 years. Health risk behaviors fully explained the living with a smoker–adiposity relationship. These findings integrate clustering and contagion theoretical perspectives on health behaviors and contribute to understanding a novel pathway to adiposity. Keywords Living with a smoker · Second-hand smoke · Obesity · Waist circumference · Physical activity · Diet · Women’s health
* Charles J. Holahan [email protected] 1
Department of Psychology, University of Texas at Austin, 108 E. Dean Keeton St., Austin, TX 78712, USA
2
Department of Kinesiology and Health Education, University of Texas at Austin, 2109 San Jacinto Blvd., Austin, TX 78712, USA
3
Department of Educational Psychology, University of Texas at Austin, 1912 Speeedway St., Austin, TX 78712, USA
4
Department of Sociology, University of Texas at Austin, 305 E. 23rd St., Austin, TX 78712, USA
Introduction Two theoretical perspectives address the spread of health behaviors. Health behavior clustering describes the cooccurrence of health behaviors in different domains within individuals (Noble et al., 2015; Prendergast et al., 2016). In contrast, health behavior contagion describes the cooccurrence of health behaviors in the same domain across individuals (Blok et al., 2017; Clawson et al., 2018; Perry et al., 2016). However, the co-occurrence of health behaviors in different domains across individuals is essentially unexamined. Here, we examine this process in the context of living with a smoker and health risk behaviors involving physical inactivity and unhealthy diet, using data from the Women’s Health Initiative Observational Study. Substantial evidence supports a direct link between second-hand smoke (SHS) exposure and increased morbidity and mortality (Öberg et al., 2011; Richiardi et al., 2009). The possibility that living with a smoker may also be linked to increased health risk through a behavioral pathway is essentially unexamined. Here, we test a novel hypothesis— that
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