Communication inequalities, social determinants, and multiple healthy behaviors: A nationwide cross-sectional survey in Japan

Introduction: The focus of health promotion efforts is being directed at addressing multiple behavioral risks for chronic disease prevention instead of a single risk factor at time. Since multiple behavioral risk factors are not equally distributed but cluster among population, understanding the factors that determine the clustering pattern of multiple health behavioral risks is important to develop effective interventions. This study examined whether social and communication inequality account for clustering pattern of multiple health behavioral risks in Japan. Methods: 1,156 adults from national sample provided information about socio-demographic characteristic, health behaviors, past health information seeking behavior, self-efficacy on seeking health information, access to and trust in various health information sources such as television, magazine and Internet among others. Results: Four clusters were identified by k-means algorithm: Cluster 1(14.1%) characterized by high physically activity (100.0%), low vegetable intake (11.0%) and no smoking (0.0%); Cluster 2 (50.9%) with no physical activity (0.0%), less vegetable intake (10.4%) and no smoking (0.0%); Cluster 3 (5.5%) with more physical activity (98.4%), more vegetable intake (43.8%) and more smoking (75.0%); and Cluster 4 (29.5%) with low physically activity (15.0%), low vegetable intake (5.0%) and high smoking (100.0%). Chi-squared test revealed significant difference in socioeconomic and health communication variables such as education (p=0.012), employment status (p<0.001), subjective socioeconomic status (p=0.016), seeking health information behavior (p=0.006), access to and trust in some health information sources among clusters. Conclusion: This study clusters around multiple risk behaviors and health communication patterns, allowing for the development of customized health communication strategies.