Preventive Medicine 50 (2010) 1–2

Contents lists available at ScienceDirect

Preventive Medicine
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / y p m e d

This Month in Preventive Medicine

Multiple health behavior change interventions:

Tell us what you see

Three articles in this dual issue of Preventive Medicine provide contrasted perspectives on the
state of multiple health behavior change (MHBC) interventions, with respect to both its
representation in the minds of those health professionals and researchers who apply it, and its
real-life applications. MHBC interventions are meant to simultaneously or sequentially address
several health behaviors such as smoking, substance abuse, physical activity, nutrition, stress, and so
on. They are based on the principle that people tend to accumulate unhealthy behaviors: for
example, someone who smokes cigarettes would be more likely to smoke marijuana, drink alcohol,
and avoid physically challenging activities. These topics were also covered in the March 2008
Special Issue of PM, “Multiple Health Behavior Change (MHBC) Research (Allegrante et al., 2008; de
Vries et al., 2008; dePue et al., 2008; Driskell et al., 2008; Dutton et al., 2008; Hall and Rossi, 2008;
Ickovics, 2008; Johnson et al., 2008; Keller et al., 2008; Noar et al., 2008; Prochaska et al., 2008a,b,c;
Prochaska, 2008; Sanchez et al., 2008; Vandelanotte et al., 2008).
Prochaska et al. (2010) asked members of a group of the Society for Behavioral Medicine what
were the benefits and challenges of MHBC interventions (Prochaska et al., 2010). Of the 55 items
identified, there were more challenges (n = 31) than benefits (n = 24). However, when it came to
scoring the importance of each of these items, all benefits but one (recruitment efficiency) versus
only one challenge (the difficulty of delivering the MHBC messages in an integrated way) were
deemed very important by a majority of the respondents. Of note, 80% or more of the respondents
believed that the greater the real-world applicability, the greater the potential health impact, and
the ability to inform about treatments for co-occurring behaviors were very important benefits of
MHBC interventions.
Werch et al. (2010) report the results of a randomized controlled trial of a MHBC intervention
performed among college students in the southwestern United States (Werch et al., 2010). Half of
283 students were randomly allocated to receive: (a) a one-to-one consultation in which the health
behaviors were reframed in terms of images (e.g., “Regularly engaging in moderate physical activity,
while avoiding too much alcohol and cigarettes, will help you continue to be a physically active
young adult, and reach your fitness goals of keeping slim and trim.”); and (b) a goal plan about
physical activity, alcohol use, smoking, and other fitness behaviors. The other half of the students
comprised the control group who only received a commercially available brochure about fitness.
This one-time intervention had no impact on alcohol or marijuana use, physical and mental health,
and sleep, but it did have some impact on spiritual and social health, driving after drinking, and
moderate exercise (i.e., the control group did worse after 3 and 12 months, while the intervention
group did better after 3 months and seemed to maintain the advantage after 12 months). All
differences, however, amounted to fractions of the scale units.
Koelewijn-van Loon et al. (2010) report the results of a cluster-randomized controlled trial of a
practice nurse-led MHBC intervention on lifestyle behaviors and risk perception of 615 patients
eligible for CVD risk management in 25 general practices (Koelewijn-van Loon et al., 2010). The
intervention consisted of a 2-day training course for the practice nurses involving: (a) individual
risk assessment; (b) risk communication; (c) use of a decision aid tool; and (d) targeted
motivational interviews. The control group nurses received only a 2-h course on risk assessment,
after which they applied usual care. At the 12-week follow-up improvements were seen in the
intervention group patients' risk perception, anxiety, and satisfaction with the communication, but
there were no additional intervention effects on smoking, alcohol, diet, or physical activity
behaviors.
The studies of Werch et al. (2010) among healthy college students and Koelewijn-van Loon et al.
(2010) among patients eligible for CVD risk management provide telling illustrations of the great
potential of MHBC interventions in practice, but also of the sobering reality of their challenges. We

0091-7435/$ – see front matter © 2009 Published by Elsevier Inc.

doi:10.1016/j.ypmed.2009.12.016
2 This Month in Preventive Medicine

need more authors of studies like these to tell us what they see in real-world applications so the
MHBC experts can design more effective interventions based on better empirical evidence.

References

Allegrante, J.P., Peterson, J.C., Boutin-Foster, C., Ogedegbe, G., Charlson, M.E., 2008. Multiple health-risk behavior in a chronic
disease population: what behaviors do people choose to change? Prev. Med. 46, 247–251.
de Vries, H., van't Riet, J., Spigt, M., Metsemakers, J., van den Akker, M., Kremers, S., 2008. Clusters of lifestyle behaviors:
results from the Dutch SMILE study. Prev. Med. 46, 203–208.
DePue, J.D., Goldstein, M.G., Redding, C.A., et al., 2008. Cancer prevention in primary care: Predictors of patient counseling for
across four risk behaviors over 24 months. Prev. Med. 46, 252–259.
Driskell, M.M., Dyment, S., Mauriello, L., Castle, P., Sherman, K., 2008. Relationships among multiple behaviors for childhood
and adolescent obesity prevention. Prev. Med. 46, 209–215.
Dutton, G.R., Napolitano, M.A., Whiteley, J.A., Marcus, B.H., 2008. Is physical activity a gateway behavior for diet? Findings
from a physical activity trial. Prev. Med. 46, 216–221.
Hall, K.L., Rossi, J.S., 2008. Meta-analytic examination of the strong and weak principles across 48 health behaviors. Prev.
Med. 46, 266–274.
Ickovics, J.R., 2008. “Bundling” HIV prevention: integrating services to promote synergistic gain. Prev. Med. 46, 222–225.
Johnson, S.S., Paiva, A.L., Cummins, C.O., et al., 2008. Transtheoretical model-based multiple behavior intervention for weight
management: effectiveness on a population basis. Prev. Med. 46, 238–246.
Keller, S., Maddock, J.E., Hannöver, W., Thyrian, J.R., Basler, H.D., 2008. Multiple health risk behaviors in German first-year
university students. Prev. Med. 46, 189–195.
Koelewijn-van Loon, M.S., van der Weijden, T., Ronda, G., et al., 2010. Improving lifestyle and risk perception through patient
involvement in nurse-led cardiovascular risk management: a cluster-randomized trial in primary care. Prev. Med. 50,
35–40.
Noar, S.M., Chabot, M., Zimmerman, R.S., 2008. Applying health behavior theory to multiple behavior change: considerations
and approaches. Prev. Med. 46, 275–280.
Prochaska, J.J., Spring, B., Nigg, C.R., 2008a. Multiple health behavior change research: an introduction and overview. Prev.
Med. 46, 181–188.
Prochaska, J.J., Velicer, W.F., Nigg, C.R., Prochaska, J.O., 2008b. Methods of quantifying change in multiple risk factor
interventions. Prev. Med. 46, 260–265.
Prochaska, J.O., Butterworth, S., Redding, C.A., et al., 2008c. Initial efficacy of MI, TTM tailoring and HRI's with multiple
behaviors for employee health promotion. Prev. Med. 46, 226–231.
Prochaska, J.J., Nigg, C.R., Spring, B., Velicer, W.F., Prochaska, J.O., 2010. The benefits and challenges of multiple health
behavior change in research and in practice. Prev. Med. 50, 26–29.
Prochaska, J.O., 2008. Multiple health behavior research represents the future of preventive medicine. Prev. Med. 46,
281–285.
Sanchez, A., Norman, G.J., Sallis, J.F., Calfas, K.J., Rock, C., Patrick, K., 2008. Patterns and correlates of multiple risk behaviors in
overweight women. Prev. Med. 46, 196–202.
Vandelanotte, C., Reeves, M.M., Brug, J., De Bourdeaudhuij, I., 2008. A randomized trial of sequential and simultaneous
multiple behavior change interventions for physical activity and fat intake. Prev. Med. 46, 232–237.
Werch, C.E., Moore, M.J., Bian, H., et al., 2010. Are effects from a multiple behavior intervention for college students sustained
over time? Prev. Med. 50, 30–34.

Alfredo Morabia
Center for the Biology of Natural Systems, Queens College, CUNY,
163-03 Horace Harding Expressway, Flushing, NY 11365, USA

Michael C. Costanza
6 Newbury Close, Rushden, Northamptonshire NN10 0EU, UK
E-mail address: Preventive.Medicine@qc.cuny.edu.