Association between US Residents’ Health Behavior and Good Health Status at the City Level

Abstract

Introduction Poor health behaviors, such as physical inactivity, exacerbate the overall health status of residents. Evidence regarding the impact of personal health behaviors on health status at the city level is lacking. Thus, we aimed to examine the association between health behaviors and good health status of residents of large US cities. Methods Our panel study used 2018 to 2022 American Fitness Index® data measured annually for the 100 most populous US cities. The study outcome was good health status of city residents, and exposures were their health behaviors—exercising, meeting aerobic activity guidelines, meeting both aerobic and strength activity guidelines, bicycling or walking to work, using public transportation to work, consuming two or more fruits or three or more vegetables per day, sleeping 7+ h·d−1, and current smoking habits. We adopted crude and multivariable-adjusted linear mixed and general linear models for our analyses. Results Mean values of the majority of health behavior factors were under 50% between 2018 and 2022. Higher percentages of city residents exercising, meeting aerobic activity guidelines, meeting both aerobic and strength activity guidelines, bicycling/walking to work, and consuming three or more vegetables or two or more fruits per day and lower percentage of residents who currently smoke were associated with higher percentages of good health status. Baseline percentages meeting aerobic activity guidelines, meeting both aerobic and strength activity guidelines, using public transportation, consuming two or more fruits per day, and sleeping 7+ h·d−1 and lower percentage of residents who currently smoke were also significantly associated with change in percentage of residents with good health status over time. Conclusion Our study shows room for improvement in health behaviors in all cities. The findings of our study also suggest that all health behaviors measured were associated with the general health status of residents of the most populous US cities.