• Ding Ding, Kris Rogers, Rona Macniven, Venugopal Kamalesh, Leonard Kritharides, John Chalmers, and Adrian Bauman.
• Prevention Research Collaboration, Sydney School of Public Health, the University of Sydney, Camperdown, NSW, Australia. Electronic address: melody.ding@sydney.edu.au.
• Prev Med. 2014 Mar 1;60:102-6.

ObjectiveMost 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.MethodsWe 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.ResultsAdding 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.ConclusionsFuture 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.Copyright © 2013 Elsevier Inc. All rights reserved.

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