A reassessment of the additive scoring of health practices

Over the past 20 years, investigators have been refining the connection between behavioral practices, popularly known as health habits, and health status. Repeated study has demonstrated that the number of healthful practices, regardless of which ones are adopted, provides a reliable predictor of mortality. Few studies, however, have questioned the validity of summing such diverse practices as smoking and physical activity together to form a single practice score. The purpose of this study was to raise some questions about this widely adopted scoring procedure and to reasses the problems connected with its use. Data are drawn from the Texas Behavioral Risk Factor Survey of 1982. The approach contrasts practice profiles formed from all possible combination of practices, representing full information about them, and the scores produced by collapsing practices onto a single dimension. Special attention is given to the meaningfulness of the information lost in the scoring process and to the implications this may have for the health practice-to-health status relationship.