title: Revisiting lifestyle risk index assessment in a large Australian sample: should sedentary behavior and sleep be included as additional risk factors?
abstract: OBJECTIVE
  Most studies on multiple health behaviors include physical inactivity, alcohol, diet, and smoking (PADS), with few including emerging lifestyle risks such as sleep or sitting. We examined whether adding sitting and sleep to a conventional lifestyle risk index improves the prediction of cross-sectional health outcomes (self-rated health, quality of life, psychological distress, and physical function). We also explored the demographic characteristics of adults with these multiple risk behaviors.
  
  
  METHODS
  We used baseline data of an Australian cohort study (n=191,853) conducted in 2006-2008 in New South Wales. Lifestyle risk index was operationalized as 1) PADS, 2) PADS+sitting, 3) PADS+sleep, and 4) PADS+sitting+sleep. We estimated receiver operating characteristic curve for self-reported binary health outcomes and calculated the area under the curve to illustrate how well each index classified the outcome. We used multiple logistic regression to determine the demographic characteristics of adults with multiple lifestyle risks.
  
  
  RESULTS
  Adding sleep duration but not sitting time to the PADS index significantly improved the classification of all health outcomes. Men, those aged 45-54years, those with 10 years of education or less, and those living in regional/remote areas had higher odds of multiple risk behaviors.
  
  
  CONCLUSIONS
  Future research on multiple health behaviors might benefit from including sleep as an additional behavior. In Australia, unhealthy lifestyles tend to cluster in adults with certain demographic characteristics.
authors.affiliation: Prevention Research Collaboration, Sydney School of Public Health, the University of Sydney, Camperdown, NSW, Australia. Electronic address: melody.ding@sydney.edu.au.
authors.forename: Ding
authors.initials: D
authors.lastname: Ding
authors.affiliation: Prevention Research Collaboration, Sydney School of Public Health, the University of Sydney, Camperdown, NSW, Australia.
authors.forename: Kris
authors.initials: K
authors.lastname: Rogers
authors.affiliation: Prevention Research Collaboration, Sydney School of Public Health, the University of Sydney, Camperdown, NSW, Australia.
authors.forename: Rona
authors.initials: R
authors.lastname: Macniven
authors.affiliation: Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, VIC.
authors.forename: Venugopal
authors.initials: V
authors.lastname: Kamalesh
authors.affiliation: Concord Clinical School, ANZAC Research Institute, the University of Sydney, Camperdown, NSW, Australia.
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides
authors.affiliation: The George Institute for Global Health, the University of Sydney, Camperdown, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: Prevention Research Collaboration, Sydney School of Public Health, the University of Sydney, Camperdown, NSW, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Bauman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004032:Diet / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009517:New South Wales / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D057185:Sedentary Behavior; D012890:Sleep / Q000502:physiology*; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Epidemiologic measurements; Health behavior; Lifestyle; Preventive medicine