International Journal of Behavioral Medicine

, Volume 25, Issue 2, pp 183–197 | Cite as

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

  • Teresa García-MuñozEmail author
  • Shoshana Neuman
  • Tzahi Neuman



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.


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.


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.


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.


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



Part of this study was conducted when Shoshana Neuman was staying at The Institute of Labor Economics—IZA (summer 2015 and summer 2016). She would like to thank the IZA for their hospitality and excellent research facilities.

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

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© International Society of Behavioral Medicine 2018

Authors and Affiliations

  1. 1.Department of Quantitative MethodsUniversity of GranadaGranadaSpain
  2. 2.CELSIBratislavaSlovakia
  3. 3.Department of EconomicsBar-Ilan UniversityRamat-GanIsrael
  4. 4.IZABonnGermany
  5. 5.Hebrew University—Hadassah School of MedicineJerusalemIsrael

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