title: Does the Relationship Between Cigarette Smoking and Other Key Health Behaviors Vary by Geographic Area Among US Young Adults? A Multilevel Analysis.
abstract: BACKGROUND
  Although researchers and practitioners have long been aware of interdependence among health behaviors, they tend to compartmentalize health behaviors in research and practice. This kind of approach often fails to acknowledge the syndemic nature of health behaviors.
  
  
  OBJECTIVE
  This study investigated differences in the relationship between cigarette smoking and other key health behaviors, such as vigorous physical activity, fruit and vegetable consumption, and binge drinking among young adults (ages 18 to 30 years) across 180 metropolitan and micropolitan statistical areas (MMSAs) in the USA.
  
  
  METHODS
  A total of 19,027 young adults in the 2009 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed using multilevel logistic regression models.
  
  
  RESULTS
  Both vigorous physical activity and fruit and vegetable consumption were negatively associated with cigarette smoking, whereas binge drinking was positively associated with smoking. There were significant differences in the relation of smoking with vigorous physical activity, fruit and vegetable consumption, and binge drinking across the 180 MMSAs. These differences were associated with the prevalence of cigarette smoking and binge drinking for each MMSA.
  
  
  CONCLUSIONS
  As indicated by the social learning theory, geographic area-specific prevalence of health behaviors appears to reflect group norms regarding those behaviors which, in turn, affect the clustering of health behaviors in the respective area.
authors.affiliation: Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, 1025 E. Seventh Street, Bloomington, IN, 47405-7109, USA, leechun@imail.iu.edu.
authors.forename: Chung Gun
authors.initials: CG
authors.lastname: Lee
authors.forename: Dong-Chul
authors.initials: DC
authors.lastname: Seo
authors.forename: Susan E
authors.initials: SE
authors.lastname: Middlestadt
authors.forename: Hsien-Chang
authors.initials: HC
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D055361:Multilevel Analysis; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D055815:Young Adult