In this study, we examined the socio-demographic correlates of unhealthy lifestyle factors in Ethiopia, with a focus on smoking, excessive alcohol intake, physical inactivity, low daily fruit and vegetable consumption, and overweight and obesity. A high prevalence of unhealthy lifestyle factors was reported, with 16.7% having three or more unhealthy lifestyle factors. Unhealthy lifestyles were significantly associated with gender, marital status urban residence, old age, and higher income
Several large, nationally representative surveys such as the Global Burden of Disease study identified that a significant proportion of NCDs and disability-adjusted life years lost across the globe – including in LMICs – are due to mainly modifiable lifestyle factors such as smoking, unhealthy diet, physical inactivity, and inappropriate alcohol consumption (30). In the current study, we found that participants were more likely to engage in two or more unhealthy behaviours. Previous studies (8, 31, 32) reported similar findings. High prevalence and co-occurrence of unhealthy lifestyle factors are in turn associated with high burden of morbidity and premature mortality from chronic illnesses, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, and some types of cancer (33). This may eventually lead to healthcare system strain and increased cost of disease management, and productivity loss due to illnesses.
Our findings revealed that a high prevalence of co-occurrence of unhealthy lifestyle factors was significantly associated with place of residence, where participants from urban areas were more likely to have unhealthy lifestyles than their counterparts. This may be because people in urban areas in developing countries, including Ethiopia, are increasingly exposed to unhealthy environments, thence behaviours, compared to rural areas due to economic and social developments. In line with, a relatively sedentary lifestyle, other lifestyle factors, such as smoking, alcohol consumption and overweight and obesity are more rampant (34–37)
Similarly, the current study showed that the likelihood of co-occurrence of risk factors or unhealthy lifestyle increases among participants with higher income, which is in line with previous studies from Ethiopia, Ghana, and Chile. Risk factors, such as overweight and obesity, and low physical activity were associated with wealthier socioeconomic groups (33–35). This is a common occurrence in developing countries’ contexts, where people tend to consume energy-dense and high-fat foods and follow a sedentary lifestyle as their economic condition improves (34, 38). However, the study showed participants with higher educational status are more prone to engage in physical activity and have a good diet. This finding is similar to a study done in Ghana that; Ghanaian adults were more likely to live a healthier lifestyle with increasing levels of educational attainment (34). This may be because educated people could easily access educational messages on health and risk factors to choose their unhealthy behaviour.
The study also showed variations in the co-existence of unhealthy lifestyle risk factors by socio-demographic factors such as gender, age, and marital status. It was observed that despite mixed findings on gender and the number of unhealthy lifestyles, obesity and insufficient physical activity, were higher among females than males, while males had higher risks for excessive alcohol intake and smoking (35, 39). Likewise, our study showed that older participants were more likely to have an unhealthy lifestyle than younger groups. The current finding is in line with other similar studies that the prevalence of unhealthy lifestyles, such as smoking, excessive alcohol drinking, and obesity, increased with age (38, 39). In the study, those who were married also showed a significant association with higher odds of an unhealthy lifestyle. In Ethiopia or other developing countries, evidence indicates that married people are more likely to adopt a sedentary lifestyle (38, 40, 41).
Overall, the study shows that the co-occurrence of unhealthy lifestyle factors is alarmingly high. Individual-level risk factors such as excessive alcohol intake and overweight and obesity were found to be associated with diabetes and high blood pressure. There is a need to emphasize providing continuous and focused health promotion and behavioural support to adopt healthy lifestyle habits.
Implication for policy and practice
Consistent with the rapid socio-economic development and lifestyle changes Ethiopia has seen over the last few decades, there has been a stark epidemiological transition from one that is predominantly communicable disease towards the double burden of communicable and non-communicable diseases. While several studies in Ethiopia have documented the prevalence of unhealthy lifestyle behaviours individually, our study is the first to document the co-occurrence of these risk factors according to sociodemographic characteristics. Findings from this study can be used by policymakers as an input to implement comprehensive, policy-level behavioural and public health interventions that will ultimately reduce the burden of NCDs in Ethiopia through a healthy lifestyle program.
Furthermore, understanding the increasing risk of NCDs due to the co-occurrence of multiple risk factors will also help to design comprehensive and coordinated interventions that will reduce the burden on the already overstretched healthcare system. Our findings also call for designing context-specific and tailored interventions in addressing the risk factors for NCDs. Risk factors, such as age, sex, and others must be taken into consideration when designing healthy lifestyle programs.
This study has both strengths and limitations. The main strengths are that: (1) it is the first study that assesses the co-occurrence NCD risk factors, and (2) the study was performed nationally with relatively large sample size. The limitations are: (1) most of the study participants are from rural areas, (2) we used the 2015 survey, and the data may not reflect the current unhealthy lifestyle factors.