How health-compromising behaviors cluster: insights from a population-based study in Belgium

Abstract Background Health-compromising behaviors such as smoking and physical inactivity are key preventable risk factors for noncommunicable diseases. Although often studied in isolation, these behaviors frequently co-occur in clusters with potential synergistic effects on health. This study examined the clustering of six health-compromising behaviors in the general population of Flanders, Belgium, and assessed associations with socio-demographics. Methods Data came from a representative cross-sectional survey conducted in 2022 among 4,011 adults. Six behaviors were included: poor eating habits, physical inactivity, prolonged sitting, smoking, alcohol consumption, and cannabis use. Each was dichotomized based on national guidelines. Latent class analysis identified clusters, and multinomial logistic regression assessed associations with socio-demographics. Results Four clusters emerged: Low-risk (low probabilities for all six behaviors; 36.7%), Poor diet (only high probability of insufficient fruit and vegetable intake; 33.1%), Inactive, poor diet (high probabilities of insufficient physical activity, prolonged sitting, and poor diet; 20.7%), and Smoking, poor diet (high probabilities of daily smoking and poor diet; 9.5%). Compared to the Low-risk cluster, individuals in the other clusters were more likely to be male, younger, have lower educational attainment, and experience financial difficulties. Conclusions Both healthy and health-compromising behaviors co-occur in clusters in the Flemish adult population. These findings highlight the need for developing and testing integrated health promotion interventions that address co-occurring behaviors-particularly combinations of poor diet, physical inactivity, and smoking. Poor diet was a component in three of four clusters, underlining its importance for health promotion. The socio-demographic patterning further underscores the importance of targeting social determinants in health promotion. Key messages • Health behaviors cluster - poor diet co-occurs with inactivity and smoking, supporting multi-behavior interventions. • Socio-demographic patterns highlight the need to address social determinants.