The most incisive guide to issues facing the American family today . . . An invaluable resource for anyone wishing to stay on the cutting edge of research on family trends.

-W. Bradford Wilcox
Associate Professor of Sociology, University of Virginia 

Kicking Tobacco, Finding the Gym—The Difference a Spouse Makes


Bryce J. Christensen and Nicole M. King


Some diseases—such as bone cancer and lupus—fall on their victims like lighting out of a clear sky, so physicians can offer their patients very little advice on how to avoid them. But many diseases—including cardiovascular disease, lung cancer, and Type II diabetes—pose a much larger threat for those who make bad health decisions (such as smoking, spending long hours in front of the TV, or overeating) than for those who make good health decisions. Fortunately, those who have put themselves at risk by indulging in bad behaviors can improve their prospects for good health by breaking their bad habits. However, a study recently completed in the Netherlands raises unpleasant questions about how many people public-health officials can hope to turn from bad habits to good ones in a nation where marriage rates have plummeted in recent decades while single-person households have multiplied. For this new study clearly indicates that it is individuals living with a spouse who are most likely to replace unhealthy lifestyle choices with healthy ones.

Completed by an international team of scholars from Isfahan University and Maastricht University, this new Dutch study focuses on “unhealthy behavior”—specifically, smoking, excessive alcohol use, and physical inactivity—and on “decisions to change those behaviors.” The researchers believe that such behavior and such decisions merit attention because of “a high worldwide prevalence of unhealthy behavior” that has caused “policy-makers to agree on the urgent need for individual lifestyle change,” particularly as these policymakers battle against non-communicable diseases such as diabetes, lung cancer, and heart disease.

To gauge the prevalence of unhealthy behavior and to assess prospects for lifestyle change, the authors of the new study scrutinize data collected between 2004 and 2007 for 1,745 individuals ages 50 and up living in the Netherlands. By analyzing these data, the researchers identify a number of social and demographic predictors of bad health habits and of healthy changes in these habits during the study period. Among these predictors, marital status emerges as one deserving particular attention in an era characterized by a retreat from wedlock.

To be sure, when the researchers determine the marital status of their study participants, they yield to political correctness in assigning these participants to the “two categories of living with or without spouse or partner” (emphasis added). Given the evidence from past studies indicating that married couples enjoy many clear advantages over peers living in non-marital cohabitation, readers may suspect that this new study understates the effects of marital status as defined by wedding vows. But despite the constraints of their political correctness, the researchers recognize and report that marital status predicts poor health habits and that it even more dramatically predicts lifestyle changes that improve such habits. 

When looking at daily smoking, the researchers discern a statistical trend linking this health-endangering practice to single living, those living with a spouse or partner being about a quarter less likely to smoke daily than their single peers (Odds Ratio of 0.74; p < 0.10). In further parsing of the data, however, the researchers discover a much sharper association between marital status and the termination of a smoking habit during the study period. Compared to single smokers in the study, smokers living with a spouse or partner were almost four times as likely to kick the tobacco habit during the study period (Odds Ratio of 3.71; p < 0.05).

Turning their attention to physical activity, the researchers found those living with a spouse or partner were just as likely to be couch potatoes as were their single peers, with no significant difference in “physical inactivity” evident between the two groups in 2004. However, a truly dramatic difference between the two groups emerges in the likelihood that they would by 2007 break out of their coach potato habits by starting some regular exercise. Compared to single peers, physically inactive study participants were almost ten times as likely to become physically active by the end of the study period (Odds Ratio of 9.65; p < 0.05). 

Of course, the researchers see how “living with a partner . . . could encourage positive change in smoking behavior and physical activity.” Curiously, though, these analysts judge marital status to be a social circumstance that does not affect lifestyle changes “in a consistent way,” since the statistics show “no [marital-status] effect on changing drinking behavior.” Given the remarkably strong linkage established in this study between marital status and lifestyle changes affecting smoking and physical activity, however, only blind policymakers will ignore that linkage as they seek “to target policies toward individuals in need of lifestyle change.”

The policies most important for helping older men and women to quit smoking and become physically active would appear to be those that result in more lasting marriages and fewer single-person households.

 (Reza Rezayatmand, Milena Pavlova, and Wim Groot, “Socio-economic Aspects of Health-Related Behaviors and Their Dynamics: A Case Study for the Netherlands,” International Journal of Health Policy and Management 5.4 [2016]: 237-51.)

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