Skip to main content

The Clustering of Lifestyle Behaviours in New Zealand and their Relationship with Optimal Wellbeing



The purpose of this research was to determine (1) associations between multiple lifestyle behaviours and optimal wellbeing and (2) the extent to which five lifestyle behaviours—sleep, physical activity, sedentary behaviour, sugary drink consumption, and fruit and vegetable intake—cluster in a national sample.


A national sample of New Zealand adults participated in a web-based wellbeing survey. Five lifestyle behaviours—sleep, physical activity, sedentary behaviour, sugary drink consumption, and fruit and vegetable intake—were dichotomised into healthy (meets recommendations) and unhealthy (does not meet recommendations) categories. Optimal wellbeing was calculated using a multi-dimensional flourishing scale, and binary logistic regression analysis was used to calculate the relationship between multiple healthy behaviours and optimal wellbeing. Clustering was examined by comparing the observed and expected prevalence rates (O/E) of healthy and unhealthy two-, three-, four-, and five-behaviour combinations.


Data from 9425 participants show those engaging in four to five healthy behaviours (23 %) were 4.7 (95 % confidence interval (CI) 3.8–5.7) times more likely to achieve optimal wellbeing compared to those engaging in zero to one healthy behaviour (21 %). Clustering was observed for healthy (5 %, O/E 2.0, 95 % CI 1.8–2.2) and unhealthy (5 %, O/E 2.1, 95 % CI 1.9–2.3) five-behaviour combinations and for four- and three-behaviour combinations. At the two-behaviour level, healthy fruit and vegetable intake clustered with all behaviours, except sleep which did not cluster with any behaviour.


Multiple lifestyle behaviours were positively associated with optimal wellbeing. The results show lifestyle behaviours cluster, providing support for multiple behaviour lifestyle-based interventions for optimising wellbeing.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    Seligman M. Positive health. Appl Psychol Meas. 2008;57(S1):3–18. doi:10.1111/j.1464-0597.2008.00351.x.

    Article  Google Scholar 

  2. 2.

    Vazquez C, Hervas G, Rahona J, Gomez D. Psychological well-being and health: contributions of positive psychology. Annuary Clin Health Psychol. 2009;5:15–27.

    Google Scholar 

  3. 3.

    Evers KE, Castle PH, Prochaska JO, Prochaska JM. Examining relationships between multiple health risk behaviors, well-being, and productivity. Psychol Rep. 2014;114(3):843–53. doi:10.2466/13.01.PR0.114k25w4.

    Article  PubMed  Google Scholar 

  4. 4.

    Huppert F, So TC. Flourishing across Europe: application of a new conceptual framework for defining well-being. Soc Indic Res. 2013;110(3):837–61. doi:10.1007/s11205-011-9966-7.

    Article  PubMed  Google Scholar 

  5. 5.

    Prendergast KB, Schofield GM, Mackay LM. Associations between lifestyle behaviours and optimal wellbeing in a diverse sample of New Zealand adults. BMC Public Health. 2016;16(62). doi:10.1186/s12889-016-2755-0.

  6. 6.

    Walsh R. Lifestyle and mental health. Am Psychol. 2011;66(7):579–92.

    Article  PubMed  Google Scholar 

  7. 7.

    Conner TS, Brookie KL, Richardson AC, Polak MA. On carrots and curiosity: eating fruit and vegetables is associated with greater flourishing in daily life. Br J Health Psychol. 2015. doi:10.1111/bjhp.12113.

    Google Scholar 

  8. 8.

    Conry MC, Morgan K, Curry P, et al. The clustering of health behaviours in Ireland and their relationship with mental health, self-rated health and quality of life. BMC Public Health. 2011. doi:10.1186/1471-2458-11-692.

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Prochaska JJ, Spring B, Nigg CR. Multiple health behavior change research: an introduction and overview. Prev Med. 2008;46(3):181–8. doi:10.1016/j.ypmed.2008.02.001.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    McAloney K, Graham H, Law C, Platt L. A scoping review of statistical approaches to the analysis of multiple health-related behaviours. Prev Med. 2013;56(6):365–71. doi:10.1016/j.ypmed.2013.03.002.

    Article  PubMed  Google Scholar 

  11. 11.

    Pronk NP, Anderson LH, Crain AL, et al. Meeting recommendations for multiple healthy lifestyle factors: prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. Am J Prev Med. 2004;27(2 Suppl):25–33. doi:10.1016/j.amepre.2004.04.022.

    Article  PubMed  Google Scholar 

  12. 12.

    Tobias M, Jackson G, Yeh L-C, Huang K. Do healthy and unhealthy behaviours cluster in New Zealand? Aust N Z J Public Health. 2007;31(2):155–63. doi:10.1111/j.1753-6405.2007.00034.x.

    Article  PubMed  Google Scholar 

  13. 13.

    Williden M, Duncan S, Schofield G. Do health behaviours cluster in a working population in New Zealand? Health Promot J Aust. 2012;23(3):234–6.

    Google Scholar 

  14. 14.

    Poortinga W. The prevalence and clustering of four major lifestyle risk factors in an English adult population. Prev Med. 2007;44(2):124–8. doi:10.1016/j.ypmed.2006.10.006.

    Article  PubMed  Google Scholar 

  15. 15.

    Baruth M, Addy C, Wilcox S, Dowda M. Clustering of risk behaviours among African American adults. Health Educ J. 2011;71(5):565–75. doi:10.1177/0017896911411761.

    Article  Google Scholar 

  16. 16.

    Berrigan D, Dodd K, Troiano RP, Krebs-Smith SM, Barbash RB. Patterns of health behavior in U.S. adults. Prev Med. 2003;36(5):615–23. doi:10.1016/s0091-7435(02)00067-1.

    Article  PubMed  Google Scholar 

  17. 17.

    French S, Rosenberg M, Knuiman M. The clustering of health behaviours in a Western Australian adult population. Health Promot J Aust. 2008;19(3):203–9.

    Google Scholar 

  18. 18.

    Helmerhorst HJF, Wijndaele K, Brage S, Wareham NJ, Ekelund U. Objectively measured sedentary time may predict insulin resistance independent of moderate- and vigorous-intensity physical activity. Diabetes. 2009;58(8):1776–9.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33(5):585–92.

    PubMed  PubMed Central  Google Scholar 

  20. 20.

    Brown CM, Dulloo AG, Montani JP. Sugary drinks in the pathogenesis of obesity and cardiovascular diseases. Int J Obes. 2008;32(S6):S28–34. doi:10.1038/ijo.2008.204.

    CAS  Article  Google Scholar 

  21. 21.

    Atkin A, Adams E, Bull F, Biddle S. Non-occupational sitting and mental well-being in employed adults. Ann Behav Med. 2012;43(2):181–8. doi:10.1007/s12160-011-9320-y.

    Article  PubMed  Google Scholar 

  22. 22.

    Jarden A, Mackay L, White K, et al. The sovereign New Zealand wellbeing index. Psychol Aotearoa. 2013;5(1):22–7.

    Google Scholar 

  23. 23.

    European Social Survey. ESS Round 3 source questionnaire. London: Centre for Comparative Social Surveys, City University London; 2006.

    Google Scholar 

  24. 24.

    Kutner NG, Bliwise DL, Zhang R. Linking race and well-being within a biopsychosocial framework: variation in subjective sleep quality in two racially diverse older adult samples. J Health Soc Behav. 2004;45(1):99–113.

    Article  PubMed  Google Scholar 

  25. 25.

    Burgard SA, Ailshire JA. Putting work to bed: stressful experiences on the job and sleep quality. J Health Soc Behav. 2009;50(4):476–92.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Hone LC, Jarden A, Duncan S, Schofield GM. Flourishing in New Zealand workers: associations with lifestyle behaviors, physical health, psychosocial, and work-related indicators. J Occup Environ Med. 2015;57(9):973–83. doi:10.1097/JOM.0000000000000508.

    Article  PubMed  Google Scholar 

  27. 27.

    Ministry of Health. Eating and activity guidelines for New Zealand adults. Wellington: Ministry of Health; 2015.

    Google Scholar 

  28. 28.

    Ministry of Health. 2006/07 New Zealand health survey: adult questionnaire. Wellington: Ministry of Health; 2006.

    Google Scholar 

  29. 29.

    Ministry of Health. New Zealand health strategy. Wellington: Ministry of Health; 2000.

    Google Scholar 

  30. 30.

    Hone L, Jarden A, Schofield G. Measuring flourishing: the impact of operational definitions on the prevalence of high levels of wellbeing. Int J Wellbeing. 2014;4(1):62–90. doi:10.5502/ijw.v4i1.4.

    Article  Google Scholar 

  31. 31.

    European Social Survey. ESS Round 6 source questionnaire. London: Centre for Comparative Social Surveys, City University; 2012.

    Google Scholar 

  32. 32.

    Ebrahim S, Montaner D, Lawlor DA. Clustering of risk factors and social class in childhood and adulthood in British women’s heart and health study: cross sectional analysis. Br Med J. 2004. doi:10.1136/bmj.38034.702836.55.

    Google Scholar 

  33. 33.

    Wicker P, Coates D, Breuer C. The effect of a four-week fitness program on satisfaction with health and life. Int J Public Health. 2015;60(1):41–7. doi:10.1007/s00038-014-0601-7.

    Article  PubMed  Google Scholar 

  34. 34.

    Gomez-Pinilla F. The influences of diet and exercise on mental health through hormesis. Ageing Res Rev. 2008;7(1):49–62. doi:10.1016/j.arr.2007.04.003.

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Rothman SM, Mattson MP. Activity-dependent, stress-responsive BDNF signaling and the quest for optimal brain health and resilience throughout the lifespan. Neuroscience. 2013;239:228–40. doi:10.1016/j.neuroscience.2012.10.014.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Mattson MP. Dietary factors, hormesis and health. Ageing Res Rev. 2008;7(1):43–8. doi:10.1016/j.arr.2007.08.004.

    Article  PubMed  Google Scholar 

  37. 37.

    Laaksonen M, Prattala R, Karisto A. Patterns of unhealthy behaviour in Finland. Eur J Public Health. 2001;11(3):294–300.

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Spring B, Moller AC, Coons MJ. Multiple health behaviours: overview and implications. J Public Health. 2012;34(S1):S3–10. doi:10.1093/pubmed/fdr111.

    Article  Google Scholar 

  39. 39.

    Lustig RH. Which comes first? The obesity or the insulin? The behavior or the biochemistry? J Pediatr. 2008;152(5):601–2. doi:10.1016/j.jpeds.2008.01.021.

    Article  PubMed  Google Scholar 

  40. 40.

    Mark AL, Rahmouni K, Correia M, Haynes WG. A leptin-sympathetic-leptin feedback loop: potential implications for regulation of arterial pressure and body fat. Acta Physiol Scand. 2003;177(3):345–9. doi:10.1046/j.1365-201X.2003.01085.x.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Isganaitis E, Lustig RH. Fast food, central nervous system insulin resistance, and obesity. Arterioscler Thromb Vasc Biol. 2005;25(12):2451–62. doi:10.1161/01.ATV.0000186208.06964.91.

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    Lustig RH, Sen S, Soberman JE, Velasquez-Mieyer PA. Obesity, leptin resistance, and the effects of insulin reduction. Int J Obes Relat Metab Disord. 2004;28(10):1344–8. doi:10.1038/sj.ijo.0802753.

    CAS  Article  PubMed  Google Scholar 

  43. 43.

    Prochaska JJ, Prochaska JO. A review of multiple health behavior change interventions for primary prevention. Am J Lifestyle Med. 2011;5(3):208–21. doi:10.1177/1559827610391883.

    Article  Google Scholar 

  44. 44.

    van Gelder MM, Bretveld RW, Roeleveld N. Web-based questionnaires: the future in epidemiology? Am J Epidemiol. 2010. doi:10.1093/aje/kwq291.

    PubMed  Google Scholar 

Download references


The authors would like to acknowledge Sovereign’s ongoing support as the funder of this research. KP was supported by a Sovereign Wellbeing Index Doctoral Scholarship.

Author information



Corresponding author

Correspondence to Kate B. Prendergast.

Ethics declarations

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. Ethical approval to conduct the study was granted by the Auckland University of Technology Ethics Committee (AUTEC 12/201).


This study was funded by Sovereign. KP was supported by a Sovereign Wellbeing Index Doctoral Scholarship.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Prendergast, K.B., Mackay, L.M. & Schofield, G.M. The Clustering of Lifestyle Behaviours in New Zealand and their Relationship with Optimal Wellbeing. Int.J. Behav. Med. 23, 571–579 (2016).

Download citation


  • Lifestyle behaviours
  • Wellbeing
  • Positive health
  • Flourishing