title: A healthy lifestyle composite measure: Significance and potential uses.
abstract: OBJECTIVE
  Our objective was to create and explore potential uses of a composite "Healthy Lifestyle" measure based on Healthy People 2020 (HP2020) Objectives for behaviors shown to be associated with morbidity and mortality.
  
  
  METHODS
  Data were from the 2013 Behavioral Risk Factor Surveillance System (N=412,942) on five modifiable behaviors with HP2020 Objectives (leisure time exercise, eating fruits and vegetables 5 or more times/day, getting ≥7h of sleep/24h, not smoking and not drinking excessively). These indicators were combined to form an all-or-none composite Healthy Lifestyle (HLS) measure. Associations between the HLS measure and demographic and other measures, plus details of component measures, were reported.
  
  
  RESULTS
  Results indicated that only 7.7% of adults reported a HLS with wide variation among states and demographic groups. Both unadjusted and logistic regression results found associations between a HLS and better health, lower rates of chronic disease and better access to health care. Over one fourth of all respondents (28.0%) needed to only improve fruit and vegetable consumption to be practicing a HLS.
  
  
  CONCLUSIONS
  In conclusion, few adults were practicing five behaviors that are generally recognized as healthy. All-or-none metrics like this HLS measure offer a fresh perspective on modifiable behaviors and the need for improvement. Examination of measure components can help explain demographic differences and identify strategies for improvement.
authors.affiliation: On Target Health Data LLC, Suffield, CT, United States. Electronic address: madams.ontargethealthdata@gmail.com.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Adams
authors.affiliation: Yale University Prevention Research Center, Griffin Hospital, Derby, CT, United States; Yale University School of Medicine, New Haven, CT, United States. Electronic address: david.katz@yale.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Katz
authors.affiliation: Yale University Prevention Research Center, Griffin Hospital, Derby, CT, United States; Yale University School of Medicine, New Haven, CT, United States; Sickness Prevention Achieved through Regional Collaboration (SPARC, Inc.), Newton, MA, United States. Electronic address: douglas.shenson@yale.edu.
authors.forename: Douglas
authors.initials: D
authors.lastname: Shenson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D040343:Behavioral Risk Factor Surveillance System; D002908:Chronic Disease / Q000517:prevention & control; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012890:Sleep; D000074606:Smoking Prevention; D014481:United States
keywords: Behavioral Risk Factor Surveillance System; Chronic disease risk; Determinants of health; Fruit and vegetable consumption; Healthy People 2020; Healthy lifestyle; Non-smoking; Physical activity; Sleep duration