Most individuals engage in multiple unhealthy lifestyle behaviors with the potential for negative health consequences. Yet most health promotion research has addressed risk factors as categorically separate entities, and little is known about how to effectively promote multiple health behavior change (MHBC). This review summarizes the recent literature (January 2004 to December 2009) on randomized clinical trials evaluating MHBC interventions for primary prevention. Combining all the studies across all the reviews, fewer than 150 studies were identified. This is a fraction of the number of trials conducted on changing individual behavioral risks. Three primary behavioral clusters dominated: (1) the energy balance behaviors of physical activity and diet; (2) addictive behaviors like smoking and other drugs; and (3) disease-related behaviors, specifically cardiovascular disease (CVD) and cancer related. Findings were largely disappointing for studies of diet and physical activity, particularly with youth. Treating 2 addictions, including smoking, resulted in greater long-term sobriety from alcohol and illicit drugs. MHBC intervention effects were stronger and more consistent for cancer prevention than CVD prevention. MHBC interventions offer a new paradigm for broader, more comprehensive health promotion; however, the potential value in maximizing intervention impact is largely unmet.

Regular physical activity can have a positive effect on health at any age. Today's lifestyles, however, can often be characterised as sedentary. Therefore, the promotion of physical activity and sports has become an integral part of public health measures. The representative data of adults aged 18 to 79 years in Germany obtained from the "German Health Interview and Examination Survey for Adults" (DEGS1) provide an overview of self-estimated current physical activity behaviour. The results show that one third of the adult population claims to pay close attention to reaching a sufficient level of physical activity and one fourth participates in sports for at least 2 h/week on a regular basis. Thus, the percentage of adults regularly engaged in sports has increased compared to the previous "German National Health Interview and Examination Survey 1998". Still, four out of five adults do not achieve at least 2.5 h/week of moderate-intensity physical activity as recommended by the World Health Organisation. Consequently, future individual-level and population-level interventions should focus on target group-specific measures while continuing to promote regular physical activity in all segments of the population. An English full-text version of this article is available at SpringerLink as supplemental.

To assess the negative health consequences and associated costs of cigarette smoking in Germany in 2003 and to compare them with the respective results from 1993. The number of deaths, years of potential life lost (YPLL), direct medical and indirect costs caused by active cigarette smoking in Germany in 2003 is estimated from a societal perspective. The method is similar to that applied by Welte et al, who estimated the cost of smoking in Germany in 1993. Therefore, a direct comparison of the results was possible. Methodological and data differences between these two publications and their effect on the results are analysed. In 2003, 114,647 deaths and 1.6 million YPLL were attributable to smoking. Total costs were euro21.0 billion, with euro7.5 billion for acute hospital care, inpatient rehabilitation care, ambulatory care and prescribed drugs; euro4.7 billion for the indirect costs of mortality; and euro8.8 billion for costs due to work loss days and early retirement. From 1993 to 2003, the proportionate mortality attributable to smoking remained relatively stable, rising from 13.0% to 13.4%. The smoking-attributable deaths in men is lowered by 13.7% whereas that in women increased by 45.3%. Total real direct costs rose by 35.8%, and total real indirect costs declined by 7.1%, rendering an increase of 4.7% to real total costs. Accountable factors are changes in cigarette smoking prevalence and in disease-specific mortality and morbidity, as well as a rise in general healthcare expenditure. Despite the growing knowledge about the hazards of smoking, the smoking-attributable costs increased in Germany. Further, female mortality attributable to smoking is much higher than it was in 1993.