Associations between behavioural risk factors and smoking, heavy smoking and future smoking among an Australian population-based sample Jaimi M. Iredale a, ⁎, Philip J. Clare a , Ryan J. Courtney a , Kristy A. Martire b , Billie Bonevski c , Ron Borland d , Mohammad Siahpush e , Richard P. Mattick a a National Drug and Alcohol Research Centre (NDARC), University of NSW, Sydney, NSW 2052, Australia b School of Psychology, University of NSW, Sydney, NSW 2052, Australia c School of Medicine & Public Health, University of Newcastle, University Dr, Callaghan, NSW 2308, Australia d Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC 3004, Australia e College of Public Health, University of Nebraska Medical Centre, 42nd and Emile, Omaha, NE 68198, USA abstract article info Available online 2 December 2015 Introduction. Tobacco smoking co-occurs with behavioural risk factors including diet, alcohol use and obesity. However, the association between behavioural risk factors and heavy smoking (N 20 cig/day) compared to light– moderate smoking is unknown. The link between behavioural risk factors and future smoking for both ex and current smokers is also unknown. This study sought to examine these relationships. It is hypothesised that be- havioural risk factors will be more strongly associated with heavy smoking. Method. Data from Wave 7 (2007) of the Household and Labour Dynamics in Australia (HILDA) survey was analysed using logistic regression to determine relationships between diet (fruit and vegetable consumption, and unhealthy diet choices), alcohol consumption, obesity and physical activity with light–moderate smoking and heavy smoking. The association between these risk factors and future smoking (2008) was assessed for cur- rent and ex-smokers (2007). Results. Obese respondents were less likely to be light/moderate smokers (RRR: 0.53; 95% CI: 0.43, 0.66) but not heavy smokers. Those who consume confectionary weekly were less likely to be light/moderate smokers (RRR: 0.73; 95% CI: 0.61, 0.87), but not heavy smokers. Smokers in 2007 were more likely to continue smoking in 2008 if they consumed 1–4 drinks per occasion (OR: 2.52; 95% CI: 1.13, 5.62). Ex-smokers in 2007 were less likely to relapse in 2008 if they consumed recommended levels of both fruit and vegetables (OR: 0.31; CI: 0.10, 0.91). Conclusion. The relationships between heavy smoking and behavioural risk factors differ from moderate–light smoking. Future primary care interventions would benefit from targeting multiple risk factors, particularly for heavy smokers. © 2015 Elsevier Inc. All rights reserved. Keywords: Tobacco Diet Alcohol Obesity Risk Introduction Behavioural risk factors often present in combinations, leading to synergistic health effects associated with decreased longevity (Woodward et al., 1994; Breslow and Enstrom, 1980; Poortinga, 2007; Bryant et al., 2013). In particular, tobacco smoking is the leading risk fac- tor responsible for health and disease globally and occurs concurrently with other behavioural risk factors including diet, alcohol use and obe- sity (Poortinga, 2007). Poor diet and physical inactivity contribute to- wards obesity; the leading cause of death in Australia that is predicted to follow a similar pattern in the United States (Mokdad et al., 2004; Lim et al., 2012). Obesity is defined as having a body mass index (BMI) of 30 or more (World Health Organisation, 1995). While there is conflicting evidence for a link between smoking and physical activity, unhealthy nutrient intake has been demonstrated among smokers compared to non-smokers (Mesquita et al., 2014; Dallongeville et al., 1998; Anokye et al., 2012; Vogl et al., 2012; Coste et al., 2014). In their meta-analysis, Dallongeville et al. (1998) conclud- ed that smokers consume 77.5% more alcohol, and 3.5% more fat in their diet than non-smokers. Research shows that 60% of adults who consume alcohol at harmful levels are also self-reported smokers Preventive Medicine 83 (2016) 70–76 ⁎ Corresponding author. E-mail addresses: j.iredale@unsw.edu.au (J.M. Iredale), p.clare@unsw.edu.au (P.J. Clare), r.courtney@unsw.edu.au (R.J. Courtney), k.martire@unsw.edu.au (K.A. Martire), Billie.bonevski@newcastle.edu.au (B. Bonevski), Ron.Borland@cancervic.org.au (R. Borland), msiahpush@unmc.edu (M. Siahpush), r.mattick@unsw.edu.au (R.P. Mattick). http://dx.doi.org/10.1016/j.ypmed.2015.11.020 0091-7435/© 2015 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed