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Health-risk behaviors are a leading cause of preventable human morbidity and mortality. Given that many individuals engage in multiple health risk behaviors, there has been a rising interest in how change in one behavior might influence change in another related health behavior. This study utilized data from the efficacy trial of Project CHOICES, an intervention that targets reduction in risk of alcohol exposed pregnancy by targeting risky drinking and no use or ineffective use of contraception. Research questions included: 1) Are individuals who present with multiple risk behaviors less likely to be successful in behavioral change efforts?; 2) Are individuals who are successful in changing one health behavior more likely to concurrently change an additional behavior than individuals who are not successful in changing the initial behavior?
Project CHOICES participants (N=830) were divided into two groups determined by whether or not they smoked cigarettes in the 60 days prior to their baseline interviews. It was hypothesized that, as a group, smokers at baseline would be less likely than non-smokers to reduce their drinking to below risk levels (defined as any incident in the previous 90 days of consumption of 5 or more drinks in one day, or eight or more drinks in one week) at nine months. It was also hypothesized that smokers who were successful in reducing their risk drinking would be more likely to quit smoking by the nine month follow-up than smokers who were unsuccessful in changing their risk drinking.
Methods: A Chi Square Test of Independence was used to compare rates of reduction in risk drinking between smokers (n=423) and non-smokers (n=156) at nine months (N=579). Analysis was then isolated to the smoking group, and a Chi Square Test of Independence was used to compare rates of smoking cessation between smokers who were successful in reducing their drinking to below risk levels by the nine-month follow up (n=175), and smokers who were not successful (n=248).
Results: 50.6 % (n=79) of baseline non-smokers reduced their drinking to below risk levels by the nine month follow up, as compared to only 41.1 % (n=174) of baseline smokers (χ² =4.186, df=1, p= .041). 19.5 % (n=34) of baseline smokers who reduced their drinking to below risk levels also quit smoking, as compared to only 8.1 % (n=20) of baseline smokers who did not achieve reduction in risk drinking (χ² =12.068, df=1, p<.001).
Discussion: Participants who smoked in the 60 days prior to baseline were less likely than nonsmokers to successfully reduce their risk drinking. Meanwhile, smokers who were successful in reducing their risk drinking had a greater likelihood of smoking cessation at nine months than smokers who did not reduce their risk drinking. These findings suggest that while the presence of multiple risk behaviors may make behavioral change more difficult to achieve, changes in one health behavior may lead to changes in other behaviors. It is possible that strategies one uses to monitor and change one behavior may be helpful in facilitating simultaneous changes in related behaviors.