Health behaviors and psychological distress: changing associations between 1997 and 2016 in the United States

Objectives
Smoking rates have declined with a slower pace among those with psychological distress compared to those without. We examined whether other health behaviors (heavy alcohol consumption, physical inactivity, short sleep duration) showed similar trends associated with sychological distress. We also examined differences by age and birth cohort.
Methods
Data were from the annually repeated cross-sectional U.S. National Health Interview Surveys (NHIS) of 1997-2016 (total n = 603,518). Psychological distress was assessed with the 6-item Kessler Psychological Distress Scale (K6).
Results
Psychological distress became more strongly associated with smoking (OR 1.09 per 10 years; 95% CI 1.07, 1.12), physical inactivity (OR 1.08; 1.05, 1.11), and short sleep (OR 1.12; 1.06, 1.18), but less strongly associated with heavy alcohol consumption (OR 0.93; 0.89, 0.98). The associations of smoking and alcohol consumption attenuated with age, whereas the association with physical inactivity strengthened with age. Compared to older birth cohorts, smoking became more strongly associated with psychological distress among younger birth cohorts up to those born in the 1980s.
Conclusions
The strength of associations between psychological distress and health behaviors may vary by time period, age, and birth cohort.