Temporal and regional trends in the prevalence of healthy lifestyle characteristics: United States, 1994-2007

Objectives. We examined temporal and regional trends in the prevalence of health lifestyles in the United States.Methods. We used 1994 to 2007 data from the Behavioral Risk Factor Surveillance System to assess 4 healthy lifestyle characteristics: having a healthy weight, not smoking, consuming fruits and vegetables, and engaging in physical activity. The concurrent presence of all 4 characteristics was defined as a healthy overall lifestyle. We used logistic regression to assess temporal and regional trends.Results. The percentages of individuals who did not smoke (4% increase) and had a healthy weight (10% decrease) showed the strongest temporal changes from 1994 to 2007. There was little change in fruit and vegetable consumption or physical activity. The prevalence of healthy lifestyles increased minimally over time and varied modestly across regions; in 2007, percentages were higher in the Northeast (6%) and West (6%) than in the South (4%) and Midwest (4%).Conclusions. Because of the large increases in overweight and the declines in smoking, there was little net change in the prevalence of healthy lifestyles. Despite regional differences, the prevalence of healthy lifestyles across the United States remains very low.In developed countries, and increasingly in developing countries, chronic diseases account for the majority of the population disease burden in terms of mortality, morbidity, and medical expenditures.1 Most major chronic diseases share multiple, common lifestyle characteristics or behaviors, particularly smoking, inadequate fruit and vegetable consumption, physical inactivity, and obesity.^2,3 There is now an overwhelming body of clinical and epidemiological evidence illustrating the dramatic impact of a healthy lifestyle on reducing all-cause mortality and preventing chronic diseases such as coronary heart disease, stroke, diabetes, and cancer.^4–9The definition of a healthy lifestyle varies across studies but generally includes a combination of healthy lifestyle characteristics such as having a healthy weight, not smoking, and engaging in regular physical activity. Despite the known benefits of following a healthy lifestyle, the available data consistently show that very few Americans are able to do so. Previous work has shown, depending on the definition of healthy lifestyle used, that only between 3% and 10% of US residents have a healthy lifestyle^10,11 despite the presence of substantial public health investments in programs designed to promote healthy lifestyles over the past few decades.^12–14 Some of these investments have resulted in sustained improvements in individual healthy lifestyle characteristics, particularly tobacco use,^14,15 whereas others, such as physical activity promotion and obesity prevention programs, have met with limited success.^16,17In the United States, strong temporal trends in individual healthy lifestyle characteristics—particularly declines in tobacco use and increases in obesity—have been described.^14,16,17 Marked regional differences in the prevalence of certain individual healthy lifestyle characteristics have also been demonstrated. For example, in 2007 the prevalence of cigarette smoking ranged from 9% to 31% across states, and the prevalence of recommended physical activity ranged from 31% to 61%.¹⁸Although much information exists on individual healthy lifestyle characteristics, there has been little reported on temporal and regional differences in the prevalence of individuals with healthy lifestyles. Using Reeves and Rafferty''s definition of a healthy lifestyle¹⁰—the presence of 4 modifiable healthy lifestyle characteristics—we examined temporal and regional US trends in the prevalence of healthy lifestyles as well as these 4 individual characteristics from 1994 to 2007.