During the transition to adulthood, many unhealthy behaviors are developed that in turn shape behaviors, health, and mortality in later life. However, research on unhealthy behaviors and risky transitions has mostly focused on one health problem at a time. In this article, we examine variation in health behavior trajectories, how trajectories cluster together, and how the likelihood of experiencing different behavior trajectories varies by sociodemographic characteristics. We use the National Longitudinal Study of Adolescent Health (Add Health) Waves I to IV to chart the most common health behavior trajectories over the transition to adulthood for cigarette smoking, alcohol consumption, obesity, and sedentary behavior. We find that health behavior trajectories cluster together in seven joint classes and that sociodemographic factors (including gender, parental education, and race-ethnicity) significantly predict membership in these joint trajectories.
ArnettJeffrey. 1992. “Reckless Behavior in Adolescence: A Developmental Perspective.” Developmental Review12(4):339–73.
2.
Audrain-McGovernJanetRodriguezDanielMossHoward B.2003. “Smoking Progression and Physical Activity.” Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology12(11Pt 1):1121–29.
3.
BerkmanLisa F.BreslowLester. 1983. Health and Ways of Living: The Alameda County Study. New York: Oxford University Press.
4.
BerriganDavidDoddKevinTroianoRichard P.Krebs-SmithSusan M.BarbashRachel Ballard. 2003. “Patterns of Health Behavior in U.S. Adults.” Preventive Medicine36(5):615–23.
5.
BishConnie L.BlanckHeidi MichelsSerdulaMary K.MarcusMicheleKohlHarold W.KhanLaura Kettel. 2005. “Diet and Physical Activity Behaviors among Americans Trying to Lose Weight: 2000 Behavioral Risk Factor Surveillance System.” Obesity Research13(3):596–607.
6.
BoardmanJason D.AlexanderKari B.2011. “Stress Trajectories, Health Behaviors, and the Mental Health of Black and White Young Adults.” Social Science & Medicine72(10):1659–66.
7.
CastellsagueXavierMuñozNubiaDe StefaniEduardoVictoraCesar G.CastellettoRobertRolónPedro AnibalQuintanaM. Jesús. 1999. “Independent and Joint Effects of Tobacco Smoking and Alcohol Drinking on the Risk of Esophageal Cancer in Men and Women.” International Journal of Cancer82(5):657–64.
8.
CockerhamWilliam C.2000. “Health Lifestyles in Russia.” Social Science & Medicine51(9):1313–24.
9.
CockerhamWilliam C.2005. “Health Lifestyle Theory and the Convergence of Agency and Structure.” Journal of Health and Social Behavior46(1):51–67.
10.
CockerhamWilliam C.2013. “Bourdieu and an Update of Health Lifestyle Theory.” Pp. 127–54 in Medical Sociology on the Move: New Directions in Theory, edited by CockerhamW. C.Dordrecht, Netherlands: Springer.
11.
CockerhamWilliam C.RüttenAlfredAbelThomas. 1997. “Conceptualizing Contemporary Health Lifestyles.” Sociological Quarterly38(2):321–42.
12.
CollinsLinda M.LanzaStephanie T.2009. Latent Class and Latent Transition Analysis: With Applications in the Social, Behavioral, and Health Sciences. Hoboken, NJ: Wiley.
13.
DawJonathanNowotnyKathryn M.BoardmanJason D.2013. “Changing Patterns of Tobacco and Alcohol Co-use by Gender in the United States, 1976–2010.” Demographic Research28(22):637–48.
14.
DonovanJohn E.JessorRichard. 1985. “Structure of Problem Behavior in Adolescence and Young Adulthood.” Journal of Consulting and Clinical Psychology53(6):890–904.
15.
EllicksonPhyllis L.OrlandoMariaTuckerJoan S.KleinDavid J.2004. “From Adolescence to Young Adulthood: Racial/Ethnic Disparities in Smoking.” American Journal of Public Health94(2):293–99.
16.
EllicksonPhyllis L.PerlmanMichalKleinDavid J.2003. “Explaining Racial/Ethnic Differences in Smoking During the Transition to Adulthood.” Addictive Behaviors28(5):915–31.
17.
ElliottDelbert S.1993. “Health-enhancing and Health-compromising Lifestyles.” Pp. 112–45 in Promoting the Health of Adolescents: New Directions for the Twenty-first Century, edited by MillsteinS. G.PetersenA. C.NightingaleE. O.New York: Oxford University Press.
18.
FrazierA. LindsayFisherLaurieCamargoCarlos A.TomeoCatherineColditzGraham. 2000. “Association of Adolescent Cigar Use with Other High-risk Behaviors.” Pediatrics106(2):e26.
19.
FrechAdrianne. 2012. “Healthy Behavior Trajectories between Adolescence and Young Adulthood.” Advances in Life Course Research17(2):59–68.
20.
GrantBridget F.1998. “Age at Smoking Onset and Its Association with Alcohol Consumption and DSM-IV Alcohol Abuse and Dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey.” Journal of Substance Abuse10(1):59–73.
21.
GrobschädlFranziskaTitzeSylviaBurkertNathalieStroneggerWillibald J.2013. “Moderate- and Vigorous-intensity Exercise Behavior According to the Transtheoretical Model: Associations with Smoking and BMI among Austrian Adults.” Wien Klin Wochenschr125(9–10):270–78.
22.
HansonMargaret D.ChenEdith. 2007. “Socioeconomic Status and Health Behaviors in Adolescence: A Review of the Literature.” Journal of Behavioral Medicine30(3):263–85.
23.
HarrisKathleen Mullan. 2013. The Add Health Study: Design and Accomplishments. Chapel Hill: Carolina Population Center, University of North Carolina at Chapel Hill.
24.
HarrisKathleen MullanGordon-LarsenPennyChantalaKimUdryJ. Richard. 2006. “Longitudinal Trends in Race/Ethnic Disparities in Leading Health Indicators from Adolescence to Young Adulthood.” Archives of Pediatrics & Adolescent Medicine160(1):74–81.
25.
HarrisKathleen MullanPerreiraKrista M.LeeDohoon. 2009. “Obesity in the Transition to Adulthood Predictions across Race/Ethnicity, Immigrant Generation, and Sex.” Archives of Pediatrics & Adolescent Medicine163(11):1022–28.
26.
HawkinsJ. DavidCatalanoRichard F.MillerJanet Y.1992. “Risk and Protective Factors for Alcohol and Other Drug Problems in Adolescence and Early Adulthood: Implications for Substance Abuse Prevention.” Psychological Bulletin112(1):64–105.
27.
HolmenT. L.Barrett-ConnorE.ClausenJ.HolmenJ.BjermerL.2002. “Physical Exercise, Sports, and Lung Function in Smoking versus Nonsmoking Adolescents.” European Respiratory Journal19(1):8–15.
28.
JarvisMartin J.WardleJane. 1999. “Social Patterning of Individual Health Behaviours: The Case of Cigarette Smoking.” Pp. 240–55 in Social Determinants of Health, edited by MarmotM.WilkinsonR.Oxford, UK: Oxford University Press.
29.
JefferyRobert W.HennrikusDeborah J.LandoHarry A.MurrayDavid M.LiuJane W.2000. “Reconciling Conflicting Findings regarding Postcessation Weight Concerns and Success in Smoking Cessation.” Health Psychology19(3):242–46.
30.
JessorRichard. 1991. “Risk Behavior in Adolescence: A Psychosocial Framework for Understanding and Action.” Journal of Adolescent Health12(8):597–605.
31.
JessorRichardChaseJames A.DonovanJohn E.1980. “Psychosocial Correlates of Marijuana Use and Problem Drinking in a National Sample of Adolescents.” American Journal of Public Health70(6):604–13.
32.
JessorRichardJessor.Shirley L.1977. Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth. New York: Academic Press.
33.
KaczynskiAndrew T.ManskeStephen R.MannellRoger C.GrewalKeerat. 2008. “Smoking and Physical Activity: A Systematic Review.” American Journal of Health Behavior32(1):93–110.
34.
KalmanDavidKimSunDiGirolamoGregorySmelsonDavidZiedonisDouglas. 2010. “Addressing Tobacco Use Disorder in Smokers in Early Remission from Alcohol Dependence: The Case for Integrating Smoking Cessation Services in Substance Use Disorder Treatment Programs.” Clinical Psychology Review30(1):12–24.
35.
KannelW. B.NeatonJ. D.WentworthD.ThomasH. E.StamlerJ.HulleyS. B.KjelsbergM. O.1986. “Overall and Coronary Heart Disease Mortality Rates in Relation to Major Risk Factors in 325,348 Men Screened for the MRFIT.” American Heart Journal112(4):825–36.
36.
KhotUmesh N.KhotMonica B.BajzerChristopher T.SappShelly K.OhmanE. MagnusBrenerSorin J.EllisStephen G.LincoffA. MichaelTopolEric J.2003. “Prevalence of Conventional Risk Factors in Patients with Coronary Heart Disease.” JAMA: The Journal of the American Medical Association290(7):898–904.
37.
KimmSue Y. S.GlynnNancy W.KriskaAndrea M.BartonBruce A.KronsbergShari S.DanielsStephen R.CrawfordPatricia B.SabryZak I.LiuKiang. 2002. “Decline in Physical Activity in Black Girls and White Girls during Adolescence.” New England Journal of Medicine347(10):709–15.
38.
KlesgesRobert C.KlesgesLisa M.1988. “Cigarette Smoking as a Dieting Strategy in a University Population.” International Journal of Eating Disorders7(3):413–19.
39.
KwanMatthew Y.CairneyJohnFaulknerGuy E.PullenayegumEleanor M.2012. “Physical Activity and Other Health-risk Behaviors during the Transition into Early Adulthood: A Longitudinal Cohort Study.” American Journal of Preventive Medicine42(1):14–20.
40.
LantzPaula M.HouseJames S.LepkowskiJames M.WilliamsDavid R.MeroRichard P.ChenJieming. 1998. “Socioeconomic Factors, Health Behaviors, and Mortality.” JAMA: The Journal of the American Medical Association279(21):1703–38.
41.
LanzaStephanie T.DziakJohn J.HuangLiyingWagnerAaron T.CollinsLinda M.2011. LCA Stata Plugin Users’ Guide (Version 1.0). University Park: Methodology Center, Pennsylvania State University. Retrieved February19, 2013 (http://methodology.psu.edu).
42.
MaggsJennifer L.SchulenbergJohn E.2004. “Trajectories of Alcohol Use during the Transition to Adulthood.” Alcohol Research and Health28(4):195–201.
43.
MarshalMichael P.FriedmanMark S.StallRonThompsonAmanda L.2009. “Individual Trajectories of Substance Use in Lesbian, Gay and Bisexual Youth and Heterosexual Youth.” Addiction104(6):974–81.
44.
McGinnisJ. MichaelFoegeWilliam H.1993. “Actual Causes of Death in the United States.” JAMA: The Journal of the American Medical Association270(18):2207–12.
45.
MukamalKenneth J.2006. “The Effects of Smoking and Drinking on Cardiovascular Disease and Risk Factors.” Alcohol Research & Health29(3):199–202.
46.
NelsonMelissa C.StoryMaryLarsonNicole I.Neumark-SztainerDianneLytleLeslie A.2008. “Emerging Adulthood and College-aged Youth: An Overlooked Age for Weight-related Behavior Change.” Obesity16(10):2205–11.
47.
OesterleSabrinaHillKarl G.HawkinsJ. DavidGuoJieCatalanoRichard F.AbbottRobert D.2004. “Adolescent Heavy Episodic Drinking Trajectories and Health in Young Adulthood.” Journal of Studies on Alcohol65(2):204–12.
48.
OsgoodD. WayneWilsonJanet K.1990. Covariation among Health Compromising Behaviors in Adolescents. In Adolescent Health: Time for a Change (Vol. 7). Washington, DC: U.S. Department of Commerce, National Technical Information Service.
49.
PattersonRuth E.HainesPamela S.PopkinBarry M.1994. “Health Lifestyle Patterns of U.S. Adults.” Preventive Medicine23(4):453–60.
50.
PattonGeorge C.CoffeyCarolynLynskeyMichael T.ReidSophieHemphillSherylCarlinJohn B.HallWayne. 2007. “Trajectories of Adolescent Alcohol and Cannabis Use into Young Adulthood.” Addiction102(4):607–15.
51.
PollardMichael S.TuckerJoan S.GreenHarold D.KennedyDavidGoMyong-Hyun. 2010. “Friendship Networks and Trajectories of Adolescent Tobacco Use.” Addictive Behaviors35(7):678–85.
52.
PrestonSamuel H.StokesAndrew. 2011. “Contribution of Obesity to International Differences in Life Expectancy.” American Journal of Public Health101(11):2137–43.
53.
RogersRichard G.HummerRobert A.NamCharles B.2000. Living and Dying in the USA: Behavioral, Health, and Social Differentials in Adult Mortality. San Diego: Academic Press.
54.
SatreDerek D.GordonNancy P.WeisnerConstance. 2007. “Alcohol Consumption Medical Conditions, and Health Behavior in Older Adults.” American Journal of Health Behavior31(3):238–48.
55.
SchulenbergJohnMaggsJennifer L.HurrelmannKlaus. 1999. “Negotiating Development Transitions During Adolescence and Young Adulthood: Health Risks and Opportunities.” Pp. 1–20 in Health Risks and Developmental Transitions during Adolescence, edited by SchulenbergJ.MaggsJ. L.HurrelmannK.Cambridge, UK: Cambridge University Press.
56.
StringhiniSilviaSabiaSéverineShipleyMartinBrunnerEricNabiHermannKivimakiMikaSingh-ManouxArchana. 2010. “Association of Socioeconomic Position with Health Behaviors and Mortality.” JAMA: The Journal of the American Medical Association303(12):1159–66.
57.
TuckerJoan S.EllicksonPhyllis L.KleinDavid J.2003. “Predictors of the Transition to Regular Smoking during Adolescence and Young Adulthood.” Journal of Adolescent Health32(4):314–24.
58.
van den BreeMarianne B. M.WhitmerMichelle D.PickworthWallace B.2004. “Predictors of Smoking Development in a Population-based Sample of Adolescents: A Prospective Study.” Journal of Adolescent Health35(3):172–81.
59.
WangWei C.WorsleyAnthonyHunterWendy. 2012. “Similar but Different: Health Behavior Pathways Differ between Men and Women.” Appetite58(2):760–66.
60.
WarrenC. WickJonesNathan R.EriksenMichael P.AsmaSamira, and GTSS Collaborative Group. 2006. “Patterns of Global Tobacco Use in Young People and Implications for Future Chronic Disease Burden in Adults.” Lancet367(9512):749–53.
61.
WeitzmanElissa R.ChenYing-Yeh. 2005. “The Co-occurrence of Smoking and Drinking among Young Adults in College: National Survey Results from the United States.” Drug and Alcohol Dependence80(3):377–86.
62.
YangSeungmi M.LynchJohnSchulenbergJohnDiez RouxAna V.RaghunathanTrivellore. 2008. “Emergence of Socioeconomic Inequalities in Smoking and Overweight and Obesity in Early Adulthood: The National Longitudinal Study of Adolescent Health.” American Journal of Public Health98(3):468–77.
63.
ZweigJanine M.LindbergLaura DubersteinMcGinleyKaren Alexander. 2001. “Adolescent Health Risk Profiles: The Co-occurrence of Health Risks among Females and Males.” Journal of Youth and Adolescence30(6):707–28.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
