Is an index of co-occurring unhealthy lifestyles suitable for understanding migrant health?

Objective This study investigated variation in unhealthy lifestyles within Australia according to where people were born. Method Multilevel linear regression models were used to explore variation in co-occurring unhealthy lifestyles (from 0 to 8) constructed from responses to tobacco smoking, alcohol consumption, moderate-to-vigorous physical activity and a range of dietary indicators for 217,498 adults born in 22 different countries now living in Australia. Models were adjusted for socio-economic variables. Data was from the 45 and Up Study (2006-2009). Further analyses involved multilevel logistic regression to examine country-of-birth patterning of each individual unhealthy lifestyle. Results Small differences in the co-occurrence of unhealthy lifestyles were observed by country of birth, ranging from 3.1 (Philippines) to 3.8 (Russia). More substantial variation was observed for each individual unhealthy lifestyle. Smoking and alcohol ranged from 7.3% and 4.2% (both China) to 28.5% (Lebanon) and 30.8% (Ireland) respectively. Non-adherence to physical activity guidelines was joint-highest among participants born in Japan and China (both 74.5%), but lowest among those born in Scandinavian countries (52.5%). Substantial variation in meeting national dietary guidelines was also evident between participants born in different countries. Conclusion The growing trend for constructing unhealthy lifestyle indices can hide important variation in individual unhealthy lifestyles by country of birth.