Behavioral Health Risk Factors: the Interaction of Personal and Country Effects

Teresa García-Muñoz, Shoshana Neuman, Tzahi Neuman

    Research output: Contribution to journalArticlepeer-review

    2 Scopus citations


    Purpose: This study investigated the relationship between the individual’s self-assessed health status (SAHS) and health-risk factors (smoking, alcohol consumption and obesity), in 16 European countries. The associations were studied for the individual and for the country measures—and in particular, for the unexplored aspect of interaction between individual and country levels of the three risk factors. Method: Data for 47,114 adults, who participated in the Survey of Health Aging and Retirement Europe (SHARE), were analyzed using Multilevel Regression Analysis. The individual data were complemented by OECD data that provided country-specific risk measures: percentage of daily smokers, annual per-capita consumption of alcohol (liters), and percentage of obese individuals. Results: We found that the individual’s SAHS is negatively associated with smoking and with weight-risk factors and is positively associated with her/his alcohol consumption. The most pronounced associations relate to the weight variables, albeit they are attenuated in countries with higher percentages of obese individuals. Significant differences across countries were evidenced in the association between SAHS and smoking and between SAHS and alcohol consumption. Conclusion: Individual health levels are associated with individual risk factors and also with the behaviors in the country. Significant interactions might indicate that psychological factors are at work.

    Original languageEnglish
    Pages (from-to)183-197
    Number of pages15
    JournalInternational Journal of Behavioral Medicine
    Issue number2
    StatePublished - 1 Apr 2018

    Bibliographical note

    Publisher Copyright:
    © 2018, International Society of Behavioral Medicine.


    Funding information Teresa García-Muñoz would like to thank Ministerio de Economía y Competitividad (ECO2013-44879-R) and Junta de Andalucía (SEJ-1436), for the financial support. We appreciate free access to the SHARE database. The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), and FP7 (SHARE-PREP: No. 211909, SHARE-LEAP: No. 227822, SHARE M4: No. 261982). Additional funding from the German Ministry of Education and Research, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_ AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064) and from various national funding sources is gratefully acknowledged (see

    FundersFunder number
    German Ministry of Education and Research
    US National Institute on AgingP01_AG005842, Y1-AG-4553-01, OGHA_04-064, R21_AG025169, IAG_BSR06-11, P30_ AG12815, U01_AG09740-13S2, P01_AG08291
    Fifth Framework ProgrammeQLK6-CT-2001-00360
    European Commission
    Ministerio de Economía y CompetitividadECO2013-44879-R
    Seventh Framework Programme261982, 211909, 227822
    Sixth Framework ProgrammeCIT4-CT-2006-028812, RII-CT-2006-062193, CIT5-CT-2005-028857
    Junta de AndalucíaSEJ-1436


      • Behavioral risk factors
      • Contextual variables
      • Europe
      • Multilevel regression
      • SHARE
      • Self-assessed health status


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