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To investigate the relationships between alcohol consumption and physical activity, as understanding whether there are common determinants of health behaviors is critical in designing programs to change risky activities.
The entire United States.
A sample of adults representative of the U.S. population (N = 230,856) from the 2005 Behavioral Risk Factor Surveillance System.
Several measures of drinking and exercise were analyzed. Specifications included numerous health, health behavior, socioeconomic, and demographic control variables.
For women, current drinkers exercise 7.2 more minutes per week than abstainers. Ten extra drinks per month are associated with 2.2 extra minutes per week of physical activity. When compared to current abstainers, light, moderate, and heavy drinkers exercise 5.7, 10.1, and 19.9 more minutes per week. Drinking is associated with a 10.1 percentage point increase in the probability of exercising vigorously. Ten extra drinks per month are associated with a 2.0 percentage point increase in the probability of engaging in vigorous physical activity. Light, moderate, and heavy drinking are associated with a 9.0, 14.3, and 13.7 percentage point increase in the probability of exercising vigorously. The estimation results for men are similar to those for women.
Our results strongly suggest that alcohol consumption and physical activity are positively correlated. The association persists at heavy drinking levels.
The epidemiological literature has firmly established that certain lifestyle health-related choices are associated with an elevated risk of morbidity and mortality.1–3 Excessive alcohol consumption, physical inactivity, smoking, and unhealthy dietary practices account for a large proportion of preventable chronic diseases and deaths in the United States. However, the precise association between these behaviors is still the subject of long-standing debate. There are reasons to believe that health behaviors may not be independent of each other. One view purports that individuals’ motivation to prevent disease or improve health could cause the clustering of health behaviors.4 In other words, health consciousness could lead an individual with a healthy lifestyle orientation (or an unhealthy tendency) to act similarly toward another health-related behavior. Demographic and socioeconomic characteristics might also lead to different health-related practices.5 Biological factors may be yet another influence on the clustering of health behaviors. For example, the co-occurrence of smoking and physical inactivity could be explained by the decline of lung function due to smoking.
Although research has found strong evidence for the association of smoking with a sedentary lifestyle,6 an unhealthy diet,7 and excessive alcohol use,8,9 there is considerable disagreement about the link between other health behaviors. Evidence of an association between physical activity and alcohol intake is inconclusive. Studies have found no association,10–13 a positive relationship,14–16 or a negative correlation.17 Others have found very weak correlations18 or evidence that seems to suggest that moderate drinkers are more likely to adopt physically active lifestyles.19
Lack of research consensus on the relationships between alcohol use and exercise could be due to a number of factors, including sample heterogeneity, inconsistent measures for alcohol use, analysis methods used, and differential statistical power. For example, although the majority of the published literature used dichotomous measures for alcohol consumption, there is great inconsistency in the categories used, as well as the cutoff points used to construct these. Drinking categories include: heavy drinkers,20–22 risky drinkers,23,24 binge drinkers,14 and, most frequently, light, moderate, and heavy drinkers.19,25–27
To provide new and more generalizable information on this important topic, the present study examines the association between drinking and physical activity in a nationally representative sample of the U.S. adult population. It applies both bivariate and multivariate statistical methods that control for several potentially confounding variables. Moreover, the present analysis considers a range of several different measures for alcohol consumption and physical activity.
The main objective of the present analysis is to determine whether the typical number of minutes of physical activity (moderate and vigorous1) in a usual week is significantly related to (1) any alcohol consumption; (2) total quantity/frequency of drinking; (3) drinking types (i.e., abstainer, light, moderate, and heavy), and (4) binge drinking. A secondary objective investigates whether alcohol consumption is significantly related to meeting the U.S. Surgeon General’s recommendations for physical activity (i.e., 30 or more minutes of moderate exercise per day on 5 or more days per week or 20 or more minutes of vigorous exercise per day on 3 or more days per week).28
To investigate the association between alcohol consumption and physical activity, we employed individual-level data from the 2005 cross-section of the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a large, annual, state-administered, cross-sectional telephone survey of the non-institutionalized adult population. It is an ongoing data collection program designed to measure behavioral risk factors in the U.S. population, ages 18 years and older, living in households. The Centers for Disease Control and Prevention (CDC) act in collaboration with the states to maintain the BRFSS. The main objective of the survey is to collect uniform, state-level data on preventive health practices and risk behaviors that are linked to chronic diseases, injuries, and preventable infectious diseases in the adult population. Respondents are identified through telephone-based methods. Overall, coverage ranges from 87 to 98% across states, and varies for subgroups as well. For instance, individuals in lower socioeconomic groups or minorities have lower telephone coverage. The BRFSS employs post-stratification weights to adjust for differences in the probability of selection and non-response, as well as non-coverage.
The 2005 cross-section of the BRFSS included 356,112 respondents. A large percentage (about 14%) of the respondents failed to report annual household income. We used gender-specific average values to impute the missing income values. We then deleted all observations with incomplete information [e.g. missing values for any of the other variables (except for income) used in our analysis]. The analysis sample for the present study included 230,856 individuals between the ages of 21 and 65 (inclusive). Elderly persons were excluded as there are significant changes in alcohol consumption and the level of physical activity once individuals enter typical retirement age. Respondents under age 21 were excluded because possession of alcohol among persons under this age is illegal.
As mentioned above, the primary aim of the present study is to examine the association between physical activity (moderate and vigorous) and alcohol consumption.
To address this aim, the following core measures of physical activity were used: typical number of minutes of total (moderate and vigorous) exercise in a usual week, typical number of minutes of vigorous exercise in a usual week, as well as a dichotomous variable equal to one when respondents report engaging in any vigorous physical activities in a typical week. The typical numbers of minutes of exercise in a usual week are provided in the BRFSS dataset. Their calculation is based on items in the questionnaire that ask respondents about the number of days per week and the total time per day spent exercising for at least 10 minutes at a time.
About half of the respondents in the sample reported that they typically did not engage in any vigorous physical activity. Thus, to account for the high prevalence of zero values in the dependent variable, we chose a two-part statistical model (described in the Analysis section below) that warranted the construction of an additional measure of vigorous physical activity: a dichotomous variable equal to one if the respondent reported engaging in any vigorous exercise and zero otherwise.
The majority of studies examining the association between drinking and exercise used an alternative dichotomous variable: meeting the U.S. Surgeon General’s recommendations for physical activity.21–24,27,29 Nevertheless, we chose the continuous measures described above for our core analysis as we thought the results would provide a more detailed and informative picture of the association between drinking and physical activity.
Nevertheless, we also followed the literature21–24,27,29 and used a dichotomous variable equal to one if the respondent’s reported level of exercise met the U.S. Surgeon General’s recommendations for physical activity (i.e., 30 or more minutes of moderate exercise per day on 5 or more days per week or 20 or more minutes of vigorous exercise per day on 3 or more days per week), and zero otherwise. This measure was constructed in the BRFSS dataset based on previously reported total time per day and number of days per week spent exercising.
The explanatory variables of interest are measures of alcohol consumption. These correspond to the 30 days prior to interview date. We constructed three drinking variables for the core analysis.
First, as previous studies found that current drinkers and abstainers have distinct physical activity behaviors,26,27 a measure for current drinking was set equal to one when the respondent indicated having at least one drink in the 30 days prior to the interview, and zero otherwise.
Second, to assess the presence of a linear association between drinking and exercise, a continuous variable denoting the total number of alcoholic drinks consumed in the previous month was used next. The BRFSS calculated this measure according to respondents’ answers to questions about the number of days per week when they had at least one drink and the average number of drinks they had on such days.
Third, previous studies suggest that moderate drinkers exercise more than abstainers or other drinking categories.19 To account for different relationships across the drinking continuum, we used the constructed measure of number of drinks and categorized the alcohol use data into four drinking categories: current abstainers (did not consume alcohol within the 30 days prior to interview date), current light drinkers (consumed 1 to 14 alcoholic drinks if female and 1 to 29 alcoholic drinks if male within the 30 days prior to interview date), current moderate drinkers (consumed 15 to 45 alcoholic drinks if female and 30 to 75 alcoholic drinks if male within the 30 days prior to interview date), and current heavy drinkers (consumed more than 46 alcoholic drinks if female and more than 76 alcoholic drinks if male within the 30 days prior to interview date). Several published studies that analyzed the clustering of different health risk behaviors19,26,27 used similarly constructed drinking categories.
Finally, occasional binge drinking may affect exercise choices in a different way than regular moderate drinking, even though total consumption might be similar.22 Thus, we included two alternative binge drinking measures to be used in sensitivity analyses. First, we used a continuous measure of the number of binge drinking episodes reported by the respondent (provided by the BRFSS). Second, based on this measure, we constructed a dichotomous variable indicating whether the respondent had at least one binge drinking episode per week in the 30 days before interview date. A binge drinking episode was defined as having 5 or more drinks on one occasion.
The BRFSS provides detailed socioeconomic and demographic information on respondents. Most studies examining the level of physical activity adjust for age.10,16,30 Race and ethnicity have also been identified as important correlates in previous studies.16,31 The present analysis includes dichotomous indicators for race. Because adjustment for urbanization is conventional in the literature,19 a binary measure of urbanization is included in the analysis. Education is a standard control variable within the literature19,30–37 and educational attainment is characterized with three binary measures. Dichotomous measures of current employment and marital status are also entered as control variables.19,23,31 Two measures of socioeconomic status (number of people in the household and total equivalent household income in the past year) are included. Current and past smoking status measures are entered into the models as indicators of risky behavior that could also impact physical activity.20,38 Health indicators are included in all specifications as health limitations may influence an individual’s ability to engage in physical activity.19 Two binary variables capture health status as perceived by the respondents. In addition, we include a dichotomous variable equal to one when respondents report that they are limited in any way in their activities because of physical, mental, or emotional problems and six dummy variables to capture the lifetime prevalence of various chronic health conditions that are often correlated with the level of physical activity: heart attack, angina, stroke, asthma, diabetes, and high blood pressure.
We began with a bivariate analysis of the association between drinking and exercise. Given the non-normal distributions, we conducted non-parametric Kruskal-Wallis39 rank-sum tests to identify statistically significant differences (p<0.05) in physical activity measures across four alcohol use groups: current abstainers, light, moderate, and heavy drinkers. As with any bivariate analysis, finding statistically significant differences between groups could be the result of confounding factors. For example, certain chronic diseases could discourage respondents from drinking, as well as keep them from being physically active. To incorporate these potential confounders, we used multivariate regression analysis. Our empirical model takes the following form:
where Exercise is a measure of moderate or vigorous physical activity, Alcohol denotes one of the alcohol consumption measures, X is a vector of exogenous control variables, and α1 and α2 are coefficient estimates. The function f is either linear or a probit, depending on whether the dependent variable, Exercise, is continuous or dichotomous. We ran all the models separately for men and women because of gender differences in alcohol consumption and exercise.
We considered employing a two-part model to estimate the association between drinking and exercise. Two-part models are generally used to analyze continuous non-negative outcome measures with a large number of zero values. If many respondents report no exercise in a usual week, we can first model the effect of drinking on the choice to engage in any exercise. The second part of the model estimates the association between alcohol consumption and the typical number of minutes engaged in exercise during a week for those with positive minutes of physical activity. Because only about 12% of the sample reported no moderate or vigorous exercise during a typical week, we decided against a two-part model for the aggregate measure of exercise.
Using the full sample, Ordinary Least Squares (OLS) was employed to estimate models with the number of minutes of total physical activity in a usual week as the dependent variable. Three specifications were estimated with the following alcohol consumption measures as the independent variables: (1) current drinker, (2) total number of alcoholic drinks consumed in the previous month, and (3) binary measures of light, moderate, and heavy drinking (with current abstainers as the comparison group).
Unlike the high prevalence rate for any physical activity, a large percentage of the respondents in the sample (56% for women and 42% for men) reported that they typically did not engage in vigorous physical activity. Therefore, as the zero values for this variable are too common to be ignored statistically, we estimated the effect of drinking on vigorous physical activity with a two-part model. First, we estimated probit regressions to determine the effect of alcohol consumption on the probability of engaging in any vigorous physical activity. In the second part of the model, we used OLS to estimate the effect of drinking on the number of minutes of vigorous physical activity in a usual week, but only for respondents who reported exercising vigorously. We estimated three two-part models corresponding to each of the drinking measures/groups specified above.
The final statistical issue concerns the possible endogeneity of alcohol use. It is possible, for example, that variables correlated with both drinking and exercise are unintentionally omitted from the outcome equations or that alcohol use is directly influenced by physical activity (i.e. reverse causality). If one or both of these situations exist, then estimates generated from such models will be biased. One way to overcome this endogeneity problem is to employ an instrumental variables technique. We discuss our attempt to address this issue in the Results section.
Tables 1A (females) and and1B1B (males) present summary statistics for all variables used in the analysis. The means and standard deviations are computed using the BRFSS sampling weights so that the data are representative of the U.S. adult population. As several authors have established gender differences in alcohol consumption40,41 and levels of physical activity,42 we conducted separate analyses for each gender.
Table 1A reports weighted variable means for 140,925 women, by drinking category. All control variables reveal statistically significant differences (p<0.01) in median values (Kruskal-Wallis39 rank-sum tests) across the drinking groups. Of particular interest are the statistically significant differences in median values for physical activity measures across groups. The mean number of minutes of total physical activity in a usual week is 70.29 minutes for current abstainers, 78.30 minutes for light drinkers, 84.56 minutes for moderate drinkers, and 95.99 minutes for heavy drinkers. The same linear relationship can be observed for the number of minutes of vigorous physical activity in a usual week.
Table 1B reports weighted variable means and standard deviations for 89,931 men, by drinking category. Non-parametric Kruskal-Wallis39 rank-sum tests show statistically significant differences (p<0.01) between drinking groups for all variables. The typical weekly number of minutes of total (vigorous) physical activity is 95.75 (38.11) minutes for current abstainers, 101.4 (43.44) minutes for light drinkers, 110.8 (46.47) minutes for moderate drinkers, and 128.4 (53.38) minutes for heavy drinkers.
Although we found significant differences in the typical weekly minutes of exercise between the drinking categories, these differences could be attenuated by confounding factors. Tables 2A (women) and 2B (men) present the results of the multivariate analyses. The estimates reveal that alcohol consumption is positively associated with total minutes of any physical activity in all specifications (p<0.01). Reviewing Table 2A first, current female drinkers exercise about 7.2 more minutes per week on average compared to abstainers (around 10% of the mean weekly number of minutes of total physical activity for women). Viewed from a different angle, 10 extra drinks per month are associated with an average of 2.2 more minutes per week of total physical activity. When compared to current abstainers, light, moderate, and heavy drinkers exercise approximately 5.7, 10.1, and 19.9 minutes more per week (around 8%, 14%, and 27% of the mean weekly number of minutes of total physical activity for women), respectively. The results for vigorous physical activity for women indicate that drinking is associated with a 10.1 percentage point increase in the probability of exercising vigorously (about 23% of the mean probability of engaging in any vigorous exercise for women). Ten extra drinks per month is associated with a 2.0 percentage point increase in the probability of engaging in any vigorous physical activity. Light, moderate, and heavy drinking are associated with a 9.0, 14.3, and 13.7 percentage point increase, respectively, in the probability of exercising vigorously (approximately 21%, 33%, and 31% of the mean probability of engaging in any vigorous exercise for women). However, when only women that exercise vigorously are taken into account (i.e., conditional on any vigorous exercise), the OLS coefficient estimates are not always statistically significant and some of the signs change. These results suggest that, although drinking is significantly related to the decision to exercise vigorously, conditional physical activity intensity is not correlated with alcohol consumption.
With a few exceptions, the estimation results for men are qualitatively identical to those for women. Turning to Table 2B, current drinking men exercise about 5.5 more minutes per week on average when compared with current abstainers (about 6% of the mean weekly number of minutes of total physical activity for men). Ten extra drinks per month is associated with an average of 1.1 more minutes per week of total physical activity. When compared to current abstainers, light, moderate, and heavy drinkers exercise approximately 2.2, 9.5, and 22.9 minutes more per week (approximately 2%, 10%, and 23% of the mean weekly number of minutes of total physical activity for men). The results for vigorous physical activity for men indicate that drinking is associated with a 5.9 percentage point increase in the probability of exercising vigorously (about 10% of the mean probability of engaging in any vigorous exercise for men). Ten extra drinks per month is associated with a 0.2 percentage point increase in the probability of engaging in any vigorous physical activity. Light, moderate, and heavy drinking is associated with a 6.1, 6.7, and 4.7 percentage point increase in the probability of exercising vigorously (about 11%, 12%, and 8% of the mean probability of engaging in any vigorous exercise for men). When only men that exercise vigorously are taken into account (i.e., conditional minutes of vigorous exercise), the coefficient estimates decline in magnitude, sometimes turn negative, and are not always statistically significant. Like with women, the association between drinking and vigorous physical activity works primarily through participation in vigorous exercise rather than conditional intensity.
All the models in Tables 2A and 2B were re-estimated with different subsets of control variables to examine the robustness of our findings. The key coefficient estimates were similar in magnitudes, signs, and statistical significance under different specifications. Moreover, the results were robust even when controlling for body mass (i.e., dichotomous variables for overweight and underweight were included as controls, with normal weight as the reference group). We also re-estimated the models separately for two age subgroups: below and above age 45. Again, results were consistent with the aggregate sample results. As studies indicate that the probability of a physically active lifestyle increases from abstinence to moderate drinking, but decreases with heavy drinking,19 we estimated a quadratic model with the total number of alcoholic drinks and its square. Although the negative coefficient on the quadratic term indicates that the relationship between physical activity and alcohol consumption becomes negative at some point (the linear and quadratic terms are jointly significant (p<0.01)), the turning point occurs at a very high value, and sometimes outside the range of actual data. This result suggests a linear relationship between drinking and exercise over a plausible range of alcohol consumption.
We then re-estimated all models with the binge drinking measures described in the Methods section. The results indicate that women (men) who had at least one episode of binge drinking per week engage in 17.0 (13.4) more minutes of total exercise (23  % of the mean weekly number of minutes of total physical activity) and 10.0 (5.6) more minutes of vigorous exercise in a typical week (41  % of the mean weekly number of minutes of vigorous physical activity). Also, an extra episode of binge drinking increases the number of minutes of total and vigorous physical activity per week for both women and men. All the results are statistically significant at p<0.01.
Finally, we re-estimated our models with an alternative measure of our dependent variable (i.e. meeting the U.S. Surgeon General’s recommendations for physical activity). Again, these results were consistent with our core models in that any amount of drinking, and particularly moderate or heavy drinking, was positively associated with meeting the Surgeon General’s recommendations for exercise.
While the exact relationship between exercise and drinking is ambiguous in the published literature,18 there are reasons why physical inactivity and alcohol consumption might be positively correlated. Numerous studies in the literature have explored the clustering of health risk behaviors such as smoking, physical inactivity, unhealthy dietary practices, and heavy alcohol consumption, and conclude that behavioral risk factors tend to concentrate within individuals. Health consciousness might encourage a person who is physically active to avoid heavy drinking as well.
Conversely, for some individuals, heavy drinking is part of a sensation-seeking lifestyle. Heavy drinkers were found to score high on sensation-seeking measures such as the Minnesota Multiphasic Personality Inventory,32 or Zuckerman’s Sensation seeking Scale.33 Also, certain physical activities such as skiing, mountaineering, kayaking, or deep sea diving are considered high-risk activities. It is quite possible to observe the co-occurrence of heavy drinking and a high level of physical exercise in risk-loving individuals that are predisposed to choose such sensation-seeking behaviors as part of a risk-taking lifestyle. A positive correlation between physical activity and alcohol consumption could also be the result of people socializing and drinking after participating in organized group sports. Moreover, individuals who drink heavily may engage in frequent physical exercise to compensate for the extra calories gained through drinking or to counter-balance the negative health effects of drinking. This would explain a surprising finding of several epidemiological studies.34–36 These studies recognize that calories from alcohol are added to the energy intake from other foods rather than substituted, but they find no evidence of a positive correlation between alcohol intake and body weight. It is plausible that the additional energy intake through alcohol is offset by the extra energy consumed through physical activity.
While it is not possible to directly test any of the mechanisms noted above, our results provide evidence that, in a nationally representative sample of U.S. adults, alcohol consumption and physical activity are positively correlated for both women and men. Moreover, this association persists at moderate as well as heavy drinking levels. Finding that exercise and alcohol consumption are positively related contradicts the view that risk behaviors are clustered within individuals. On average, current heavy drinkers exercise about 10 more minutes per week than current moderate drinkers and about 20 more minutes per week than current abstainers. Given the extremely large analysis samples from the BRFSS, even relatively small coefficient estimates can sometimes be statistically different from zero. Indeed, some of the statistically significant estimates for the drinking variables in this study correspond to small absolute differences in minutes of exercise, raising questions about practical significance. As presented in the Results section, however, what appear to be relatively small absolute differences actually correspond to fairly large percentage increases when compared to baseline mean values for weekly minutes of exercise.
In conclusion, these results point to a complex set of relationships between health behaviors that do not always follow expected patterns. Similar to an unhealthy diet and cigarette smoking, heavy drinking and physical inactivity are two behavioral practices that are strongly discouraged by health professionals because they significantly contribute to preventable chronic disease morbidity and mortality.1–3 For the reasons discussed earlier, individuals may be making behavioral decisions based on aggregate risk rather than incremental risk. If this is the case, then perhaps health professionals and policy makers should consider aggregate risks as well as individual risks when they advise patients and formulate health promotion, disease prevention, alcohol abuse programs.
One potential limitation of the present study is the unknown reliability of self-reported data in the BRFSS, especially for measures such as alcohol consumption or physical activity. It is sometimes hypothesized that individuals tend to over-report exercise and under-report drinking.43 Such measurement error, if present and systematic, could bias our estimates. Nevertheless, the standard measures of physical activity and alcohol consumption used in the BRFSS are thought to have high reliability.25,44 A second limitation directly pertains to the exercise and drinking measures reported in the BRFSS dataset. Namely, these health behaviors are reported only for the past 30 days instead of the past year or longer. If the past 30 days is atypical of drinking and/or exercise for some respondents, and the measurement error is systematic, then our results could be biased. While it is not possible to rigorously explore this possibility, we have no reasons to believe that any misreporting or atypical behavior is systematic across the drinking groups.
Another limitation is related to the interpretation of our findings. If alcohol use is strictly exogenous, our estimates represent unbiased and causal effects of alcohol consumption on physical activity. However, it is possible that alcohol use is endogenous in some specifications whereby key unobserved or unavailable explanatory variables in the exercise equations (e.g., motivation, discipline) are significantly correlated with the alcohol use measures. Moreover, alcohol use could be directly influenced by physical activity (i.e. reverse causality). In the absence of panel data (the BRFSS draws a new sample every year), we attempted to address this endogeneity issue by employing instrumental variables techniques.45 The exhaustive list of possible instruments included state-specific alcohol taxes,46 alcohol prices,47 and alcohol policies.48 Unfortunately, we were unable to find a common set of valid and reliable instrumental variables for all specifications. Thus, we cautiously view the reported findings as evidence of associations between alcohol use and exercise rather than causal effects.
The results of this study strongly suggest that alcohol consumption and exercise are positively associated and that this correlation persists even at heavy drinking levels, a finding that contradicts the view advanced by numerous previous studies that health risk behaviors tend to cluster within individuals. According to these studies, the correlation between different health behaviors point towards the development of complementary programs that can address overall lifestyle improvements. Moreover, they suggest that individuals with multiple risk behaviors could be identified by primary care clinicians by simply examining one behavioral risk factor.49 In addition, health researchers are encouraged by the authors of these studies to conduct evaluations of interventions targeting clustered risk behaviors. In contrast, the findings of our study signal the need for independent strategies addressing specific behaviors. Clinicians and health promotion professionals should be cautious and consider this new knowledge when screening for health risk behaviors. For example, taking into account only the patients’ level of physical activity and perhaps diet would overlook potential alcohol use problems that could be detected and treated. Physically active individuals that engage in problematic drinking are often “healthy looking,” as alcohol use consequences are sometimes delayed. This could lead to undetected alcohol-related problems with critical consequences for the individual, as well as negative externalities for society as a whole.
Financial assistance for this study was provided by the National Institute on Alcohol Abuse and Alcoholism (R01 AA015695 and R01 AA13167). The authors are entirely responsible for the research and results reported in this paper and their position or opinions do not necessarily represent those of the University of Miami, Cornell University, or the National Institute on Alcohol Abuse and Alcoholism.
1Moderate exercise denotes activities that cause small increases in breathing and heart rate (e.g. brisk walking, vacuuming, or gardening). Vigorous exercise denotes activities that cause large increases in breathing and heart rate (e.g. running, aerobics, or heavy yard work).
Michael T. French, Department of Sociology, University of Miami.
Ioana Popovici, Department of Sociology, University of Miami.
Johanna Catherine Maclean, Department of Policy Analysis and Management, Cornell University.