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Health Educ Behav. 2019 Aug;46(4):569-581. doi: 10.1177/1090198119831756. Epub 2019 Feb 27.

Is There a Spillover Effect of Targeted Dietary Change on Untargeted Health Behaviors? Evidence From a Dietary Modification Trial.

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1 Stony Brook University, Stony Brook, NY, USA.
2 University of Iowa, Iowa City, IA, USA.
3 Northwestern University, Chicago, IL, USA.


Background. The gateway behavior hypothesis posits that change in a health behavior targeted for modification may promote positive changes in other untargeted health behaviors; however, previous studies have shown inconsistent results. Aims. To examine the patterns and predictors of change in untargeted health behaviors in a large health behavior change trial. Method. Using repeated-measures latent class analysis, this study explored patterns of change in untargeted physical activity, alcohol consumption, and smoking behavior during the first year of the Women's Health Initiative dietary modification trial that targeted total fat reduction to 20% kcal and targeted increased fruit and vegetable intake. Participants were healthy postmenopausal women who were randomly assigned to either the low-fat dietary change intervention (n = 8,193) or a control (n = 12,187) arm. Results. Although there were increases in untargeted physical activity and decreases in alcohol consumption and smoking in the first year, these changes were not consistently associated with study arm. Moreover, although the results of the repeated-measures latent class analysis identified three unique subgroups of participants with similar patterns of untargeted health behaviors, none of the subgroups showed substantial change in the probability of engagement in any of the behaviors over 1 year, and the study arms had nearly identical latent class solutions. Discussion and Conclusion. These findings suggest that the dietary intervention did not act as a gateway behavior for change in the untargeted behaviors and that researchers interested in changing multiple health behaviors may need to deliberately target additional behaviors.


diet intervention; health behavior; multiple health behavior change; women’s health


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