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Trait Mindfulness and Health Behaviors: A Meta-Analysis
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Trait mindfulness and health behaviours: a meta-

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Margarita Sala, Catherine Rochefort, P. Priscilla Lui & Austin S. Baldwin
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HEALTH PSYCHOLOGY REVIEW
https://doi.org/10.1080/17437199.2019.1650290
Trait mindfulness and health behaviours: a meta-analysis

Margarita Sala, Catherine Rochefort, P. Priscilla Lui and Austin S. Baldwin
Department of Psychology, Southern Methodist University, Dallas, TX, USA
ABSTRACT ARTICLE HISTORY

Mindfulness is defined as bringing one’s attention to present-moment Received 20 November 2018
experience with acceptance, and is associated with engagement in Accepted 27 July 2019
various health behaviours. To synthesise and evaluate this literature, we
KEYWORDS
conducted a comprehensive meta-analytic review and examined (a) the Mindfulness; physical activity;
associations between trait mindfulness and health behaviours and (b) healthy eating; sleep;
the extent to which these associations were moderated by study and substance use
individual differences. A total of 125 independent samples were
included (N = 31,697, median male percentage = 38.8%, median age =
28.3). A multilevel random-effects model was used to estimate summary
study-level effect sizes, and multilevel mixed-effects models were used
to examine moderator effects. Mindfulness had a positive and small
association with aggregated health behaviours (r = .08). Mindfulness was
positively associated with physical activity, healthy eating, and sleep (rs
= .08–.14), and negatively associated with alcohol use (r = −.06). Effects
were larger for health promoting behaviours, the acting with awareness
facet of mindfulness, and samples involving psychiatric patients.
Although findings indicate that individual differences in trait
mindfulness do not reliably translate into a pattern of healthful
behaviours in general, trait mindfulness shows a stronger associations
with health behaviours under certain conditions.
Engaging in health-promoting behaviours can prevent many chronic diseases, such as cancer, heart
disease, stroke, diabetes, and thereby reduce the risk of premature mortality and improve physical
health (e.g. Khaw et al., 2008; Loef & Walach, 2012). Health behaviours that are particularly important
in promoting health outcomes include physical activity, healthy eating, sleep, and the abstinence or
moderation of substance use (i.e. smoking, illicit drug use, alcohol use) (Khaw et al., 2008; McGinnis &
Foege, 1993; Mokdad, Marks, Stroup, & Gerberding, 2004, 2005; Schroeder, 2007). Given the impact of
health behaviours on physical health, it is important to identify predictors of engagement in health
behaviours. Engagement in different health behaviours often co-occurs, and there are likely shared
individual difference factors that influence these health behaviours (Nielsen et al., 2018). Identifying
common determinants of health behaviours can make for a parsimonious and efficient effort to
better understand human psychology. This approach to health behaviours and outcomes is consist-
ent with the Science of Behavior Change (SOBC) initiative from the U.S. National Institutes of Health
(Riddle & Science of Behavior Change Working Group, 2015).
A large body of research has examined mindfulness as an important common factor that underlies
health behaviours, and in turn health outcomes. Mindfulness is defined as the ability to purposefully
bring one’s attention to present-moment experience with acceptance, non-judgment, and non-reac-
tivity (Kabat-Zinn, 1990, 1994). Higher levels of mindfulness have been found to be associated with
better physical health (Brown & Ryan, 2003; Murphy, Mermelstein, Edwards, & Gidycz, 2012). Higher
CONTACT Margarita Sala msala@smu.edu

© 2019 Informa UK Limited, trading as Taylor & Francis Group
2 M. SALA ET AL.
levels of mindfulness can promote physical health by way of association with health behaviours
(Murphy et al., 2012), specifically a greater degree of engagement in health-promoting behaviours
(e.g. healthy eating, physical activity, sleep) and a lower degree of engagement in health-risk beha-
viours (e.g. substance use; Black, Sussman, Johnson, & Milam, 2012; Bogusch, Fekete, & Skinta, 2016;
Martelli, 2017; Murphy et al., 2012; Roberts & Danoff-Burg, 2010). Yet, the association between mind-
fulness and health behaviours has not been well understood. For example, although research
suggests that higher levels of mindfulness are associated with a higher degree of engagement in
health promoting behaviours and a lower degree of engagement in health risk behaviours,
findings from a few studies suggest the opposite (e.g. that higher levels of mindfulness are associated
with greater drinking and smoking quantity) (e.g. Leigh & Neighbors, 2009; Leigh, Bowen, & Marlatt,
2005). Reasons for these inconsistencies in this research area are unclear. To better understand the
relations between mindfulness and health behaviours, we aimed to synthesise existing research
linking mindfulness and health behaviours, to compare the relation between mindfulness and
specific behavioural domains, and to examine key moderators of these relations.
Conceptualising and measuring mindfulness

Trait vs. state mindfulness
Trait mindfulness reflects individual differences in the general level of mindfulness across situations
and time. Relatedly, state mindfulness refers to the extent to which one is experiencing mindfulness
at any given moment. For example, individuals in a mindful state would be actively attending to the
present moment rather than being preoccupied, distracted, or acting without awareness to their
actions or internal experiences. State and trait mindfulness are related but distinct constructs; they
have been shown to be positively correlated with each other, but also predict other outcomes
above and beyond each other (Brown & Ryan, 2003).
Throughout this article, we adhere to the trait perspective on mindfulness because most of the
theoretical frameworks and empirical data on the association between mindfulness and health beha-
viours have focused on trait mindfulness, and only few studies have focused on state mindfulness. In
addition, whereas trait mindfulness is typically studied in the context of broad stimuli (i.e. health
behaviours), state mindfulness is typically studied in controlled environments and in a narrow
fashion in response to any given stimulus. Nevertheless, higher levels of trait mindfulness may
result in higher levels of state mindfulness while engaging in health behaviours, which should in
turn facilitate a higher degree of engagement in health behaviours. For example, it is possible that
higher levels of trait mindfulness could help individuals to be more mindful of their eating experience
(i.e. helping individuals to fully savour each bite), which may help them enjoy a smaller serving of
unhealthy foods rather than overeating. Similarly, higher levels of trait mindfulness may promote
higher levels of state mindfulness while engaging in substance use, which may help individuals
notice when they are engaging in excessive levels of substance use (e.g. noticing that they may
have had too much alcohol).
Facets of mindfulness
Research on the nomological network of trait mindfulness has identified five intercorrelated facets:
observing, describing, acting with awareness, non-judgment, and non-reactivity (Baer, Smith,
Hopkins, Krietemeyer, & Toney, 2006). Observing refers to noticing internal and external stimuli
(Baer, Smith, & Allen, 2004; Dimidjian & Linehan, 2003; Kabat-Zinn, 1990; Segal, Teasdale, Williams,
& Gemar, 2002). Describing refers to labelling experiences with words (Baer et al., 2006). Acting
with awareness refers to attending to one’s present-moment activities with undivided attention or
focusing awareness on one thing at a time (Baer et al., 2006). Non-judgment refers to taking a
non-evaluative stance towards thoughts and feelings (Baer et al., 2004). Individuals who are more
HEALTH PSYCHOLOGY REVIEW 3
nonjudgmental are typically better able to withhold criticisms of their present experiences (Baer et al.,
2006, 2004; Marlatt & Kristeller, 1999). Non-reactivity refers to permitting thoughts and feelings come
and go without getting caught up in them. Individuals who are more nonreactive are typically better
able to refrain from reacting to events impulsively (Baer et al., 2006). Using exploratory factor analyses
of a combined pool of items from most existing mindfulness questionnaires, Baer et al. (2006) were
able to retrieve these five facets; thus these results provided substantial support for the robustness of
these lower-order factors of mindfulness. Additionally, the five mindfulness facets are distinct but
overlapping: they are only modestly correlated with each other and the variance in each facet is dis-
tinct from the other four (Baer et al., 2006).
Distinctiveness of mindfulness from other constructs

Mindfulness has a close theoretical relation to several constructs relevant to health behaviours,
including self-control, emotion regulation, and flow (Grossman, 2008). Self-control refers to the
ability to override one’s impulses to behave consistently with goals and standards (Baumeister, Gail-
liot, DeWall, & Oaten, 2006). Both mindfulness and self-control require that individuals monitor their
present-moment experiences (Teper, Segal, & Inzlicht, 2013), but only mindfulness is characterised by
a nonjudgmental stance toward present-moment experiences (Bowlin & Baer, 2012). Research has
shown medium to strong correlations between mindfulness and self-control (Bowlin & Baer, 2012).
Emotion regulation refers to emotional awareness, acceptance, distress tolerance, and behavioural
control (Gratz & Roemer, 2004). There is some conceptual overlap between mindfulness and
emotion regulation, with both constructs involving awareness and acceptance of emotions. Research
has shown strong correlations between mindfulness and emotional regulation (Goodall, Trejnowska,
& Darling, 2012). Still, mindfulness and emotion regulation are also distinct conceptually; emotion
regulation involves only awareness and acceptance of emotions whereas mindfulness involves
awareness and acceptance extending beyond emotions (Roemer et al., 2009). It has been suggested
that mindfulness might enhance emotional regulation by promoting an openness to changes in
emotions (Teper et al., 2013). Flow refers to present-moment focus and absorption in the task at
hand (Csikszentmihalyi, 1997). Research has shown small to moderate correlations between mindful-
ness and flow (Cathcart, McGregor, & Groundwater, 2014; Kee & Wang, 2008). Both flow and mind-
fulness encompass focus on the present moment, but flow entails only focusing on the task at
hand whereas mindfulness entails a wider attentional breadth observing all present-moment experi-
ences (Dane, 2011).
Existing measures assessing trait mindfulness

Over the last decade, several unidimensional and multidimensional trait mindfulness questionnaires
have been developed. Several scales [Cognitive and Affective Mindfulness Scale-Revised (CAMS-R;
Feldman, Hayes, Kumar, Greeson, & Laurenceau, 2007), Freiburg Mindfulness Inventory (FMI; Buch-
held, Grossman, & Walach, 2001; Walach, Buchheld, Buttenmüller, Kleinknecht, & Schmidt, 2006),
the Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003), the Southampton Mindfulness
Questionnaire (SMQ; Chadwick et al., 2008), the Mindfulness subscale in the Self-Compassion Scale
(SCS; Neff, 2003), and the Child and Adolescent Mindfulness Measure (CAMM; Greco, Baer, &
Smith, 2011)] assess mindfulness as a unidimensional construct, whereas other scales [Five Facet
Mindfulness Questionnaire (FFMQ; Baer et al., 2006), the Kentucky Inventory of Mindfulness Skills
(KIMS; Baer et al., 2004), Philadelphia Mindfulness Scale (PHLMS; Cardaciotto, Herbert, Forman,
Moitra, & Farrow, 2008), and the trait version of the Toronto Mindfulness Scale (TMS; Davis, Lau, &
Cairns, 2009)] assess multiple facets of mindfulness as subscales.
The available multidimensional measures have generally demonstrated stronger psychometric
properties than unidimensional measures. Additionally, the FFMQ and its subscales (i.e. observing,
describing, acting with awareness, non-judgment, and non-reactivity) have a significant strength
4 M. SALA ET AL.
over other measures because the FFMQ and its subscales emerged by factor analyzing all items from
the KIMS, MAAS, CAMS, and SMQ scales. Please see Table 1 for a summary of mindfulness measures.
Associations between mindfulness and health behaviours

Several studies have evaluated the associations between mindfulness and various health behaviours,
and have concluded that higher levels of mindfulness are associated with higher levels of physical
activity and healthy eating, and lower levels of substance use and risky sex (Black et al., 2012;
Bogusch et al., 2016; Martelli, 2017; Murphy et al., 2012; Roberts & Danoff-Burg, 2010). In addition,
empirical research on the effects of mindfulness-based interventions on behavioural health
domains has tended to show that engaging in mindfulness-meditation increases engagement in
health behaviours (Bowen et al., 2009, 2014; Hülsheger, Feinholdt, & Nübold, 2015; Ong, Shapiro, &
Manber, 2008). Despite being conceived as an important construct in understanding health beha-
viours, the magnitude of the association between trait mindfulness and health behaviours varies
across different studies. Most studies have reported a positive relation between mindfulness and
health behaviours in general (Adams et al., 2015; Bramm, Cohn, & Hagman, 2013; Grinnell, Greene,
Melanson, Blissmer, & Lofgren, 2011; Martelli, 2017; Murphy et al., 2012; Roberts & Danoff-Burg,
2010) but some studies have yielded null results (Bonn-Miller, Vujanovic, Twohig, Medina, &
Huggins, 2010; Campbell et al., 2015; Elander, Duarte, Maratos, & Gilbert, 2014; Hülsheger et al.,
2015; Kang, O’Donnell, Strecher, & Falk, 2017). Other studies have reported a negative relation
between mindfulness and health behaviours (e.g. Leigh et al., 2005; Leigh & Neighbors, 2009).
Hence, it is unclear from the current literature the extent to which trait mindfulness and different
types of health behaviour are associated with each other.
Possible moderators in the mindfulness-health behaviours relation

Currently, it is unclear whether trait mindfulness is consistently related to health behaviours. The
relation between mindfulness and health behaviours may vary due to between-study differences
in: (1) health behaviours; (2) mindfulness facet; (3) mindfulness measure; (4) ways in which health
behaviours were measured (i.e. objective vs. self-report); (5) medical and psychiatric status of the
sample; and (6) the characteristics of participants.
Types of health behaviours

Little empirical research has examined the extent to which the relation between trait mindfulness and
health behaviours may vary across different behavioural domains and there are no meta-analyses to
date. Emerging research suggests that mindfulness might be more closely associated with some
health behaviours than others. First, in a meta-analysis of the mindfulness-substance use behaviour
association, Karyadi, VanderVeen, and Cyders (2014) found that mindfulness was more strongly
related to alcohol and tobacco use than marijuana use. They suggested that this may be the case
because alcohol and tobacco use were characterised by processes of dependence (e.g, cue reactivity,
cravings) to a greater extent than marijuana use. They stated that higher levels of trait mindfulness
might help counteract these processes of dependence, which may thereby explain why mindfulness
was more strongly related to alcohol and tobacco use than marijuana use. Second, there are some
individual studies that suggest that mindfulness may be most relevant to healthy eating, followed
by physical activity. For example, both Grinnell et al. (2011) and Murphy et al. (2012) compared
the extent to which trait mindfulness was associated with healthy eating and exercise behaviour.
Both studies showed that trait mindfulness was more strongly correlated with healthy eating
habits than with exercise behaviour. Findings from Roberts and Danoff-Burg (2010) indicated that
trait mindfulness was significantly associated with physical activity, but not with tobacco use and
risky sex.
Table 1. Summary of mindfulness measures.
Convergent
Measure Study Description Reliability Validity Criterion Validity Discriminant Validity Structural Validity
CAMS-R: Feldman Designed to capture a broad α = .74–.77 MAAS: r Higher CAMS-R score correlated Distress: r = −.15–−.44 Confirmatory factor
Cognitive and et al. conceptualisation of a mindful = .46–.51 with lower distress and higher Well-being: r = .45–.47 analysis supported a
Affective (2007) approach to experience, yielding a total FMI: r well-being. Over-engagement: r = −.04– single total
Mindfulness score composed of four-processes = .66–.69 −.46 mindfulness score.
Scale-Revised (awareness, attention, focus on the Overgeneralization: r
present, acceptance/nonjudgment) = .37–.46
which are not measured separately as Under-engagement: r = −.45–
subscales. −.52
Adaptive regulation: r
= .14–.53
Approach to problems
(positive):
r = .21 - .47
Approach to problems
(negative):
r = −.47–−.29
FFMQ: Baer et al. Measures five aspects of mindfulness: Subscale α r between Acting with awareness, non- Openness: r = −.07–.42 Exploratory factor
Five Facet (2006) non-reactivity, observing, acting with = .75–.91 subscales: judgment, and non-reactivity Emotional intelligence: r analysis produced
Mindfulness awareness, describing, non-judgment; −.07–.34 subscales had incremental = .21–.60 five factors that
Questionnaire scale resulted from EFA of 112 items validity in negatively predicting Self-compassion: r = .14–.53 could be replicated
collected from the KIMS, MAAS, FMI, psychological symptoms. Alexithymia: r = −.68–.08 with confirmatory
CAMS, and SMQ. Describe subscale did not have Dissociation/absent- factor analysis, with
incremental validity in mindedness: r = −.27–−.62 the exception of the
predicting psychological Psychological symptoms: r = observing facet.
symptoms. −.50– .17
Neuroticism: r = −.55–.07
Thought suppression: r =
−.56–.16

Emotion dysregulation: r =
−.02–−.52
Experiential avoidance: r =
−.49–.12
FMI: Walach et al. Assesses a broad conceptualisation of Full version: Short and long- Both versions: Both versions: Both versions:
Freiburg (2006) mindfulness encompassing non- α = .86 form r = .95 Higher FMI associated with Private self awareness: r Via principal
Mindfulness judgmental present-moment Inter-item r having meditation experience = .29–.33 components
Inventory observation and openness to = .18 and less psychological distress. Self knowledge: r = .55–.57 analysis, four
experience; intended for individuals Short form: Full version: Found evidence Public self awareness: r = components were
who have familiarity with the principles α = .79–.86 that mindfulness scores −.16–−.18 unstable; therefore,
of mindfulness; authors developed a Inter-item r significantly increase after a Dissociative experiences scale the authors do not
long and short version of the FMI. = .21–.31 meditation retreat. subscales: r = −.05–−.33 recommend using
(Continued )
5
Table 1. Continued.
6
Convergent
Dissociative experiences scale as four subscales.
M. SALA ET AL.
full: r = −.28–−.29 Instead, the scale
Dissociative experiences scale measures
sum scale: r = −.30–−.31 mindfulness as one
Symptoms: r = −.33–−.40 general construct.
KIMS: Baer et al. Measures mindfulness as a multifaceted α = .83–.91 r between All facets except observe were Personality: r = −.42–.50 Exploratory factor
Kentucky (2004) construct with four facets: observing, Inter-item r subscales: lower in the borderline Psychopathology: r = −.01– analysis and
Inventory of describing, acting with awareness, and = .30–.55 −.14–.34 personality sample than student −.38 confirmatory factor
Mindfulness accepting without judgment. Test-retest MAAS: r sample, and negatively Emotional intelligence: r = analysis support the
Scale = .65–.86 = .02–.57 correlated with psychological −.15–.61 proposed four-
symptoms. Alexithymia: r = −.74–.13 factor structure.
Experiential avoidance: r =
−.09–−.35
Absorption: r = −.17–.39
Dissociation: r = −.10–−.28
Satisfaction with life: r =
−.04–.28
Impression management: r =
−.09–.24
MAAS: Brown and Measures unidimensional trait α = .82–.87 Mindfulness/ Higher in Zen practitioners than Openness: r = −.07–.20 Exploratory factor
Mindful Ryan mindfulness in populations without Test-retest r Mindlessness non-practitioners. Neuroticism: r = −.29–−.56 analysis and
Attention (2003) previous meditation experience; = .81 Scale: r Negatively predicted unpleasant Trait meta-mood scale: r confirmatory factor
Awareness includes the attention and awareness Item-total r = .002–.39 affect. = .13–.50 analysis yielded a
Scale but not the attitudinal components of = .25–72 Predicted autonomy. Self-consciousness: r = −.36–.23 single factor
mindfulness. Negatively correlated with mood Rumination: r = −.29–−.39 structure.
disturbance, stress symptoms, Reflection: r = .06–.20
and fatigue. Self-monitoring: r = −.03
Need for cognition: r = .19
Absorption: r = −.15
Self-esteem: r = .36–.50
Optimism: r = .27–.34
Depression/anxiety: r = −.26–
−.42
Negative affect: r = −.33–−.43
Positive affect: r = .16–.40
Life satisfaction: r = .26–.37
Eudaimonic well-being: r
= .28–.68
Physical well-being: r = −.25–
−.51
Day-to-day autonomy r
= .27–.28
PHLMS: Cardaciotto Measures two components of Awareness Awareness Subscales differentiated clinical Awareness Exploratory factor
Philadelphia et al. mindfulness: awareness and α = .75–.86 MAAS: r and non-clinical samples. Acceptance and Action analysis and
Mindfulness (2008) acceptance; no total scored is obtained. Item- = .21–.40 acceptance, but not awareness, Questionnaire: r = .07–.10 confirmatory factor
Scale subscale r KIMS Observe: negatively predicted global White Bear Suppression: r = analysis supported a
= .10–.62 r = .83 severity of illness. −.03–−.16 two-factor solution.
Inter-item r KIMS Act with Rumination Reflection
= .01–.60 Awareness: r Questionnaire: r = −.02–.36
Acceptance = .02 Social desirability: r = −.10–
α = .75–.91 Acceptance −.19
Item- MAAS: r Depression/anxiety: r =
subscale r = .17–.32. −.27–.14
= .23–.67 KIMS Accept: Hopelessness: r = −.12
Inter-item r r = .79 Happiness/Quality of Life: r =
= -.04–.57 −.01–.17
Acceptance
Acceptance and Action
Questionnaire: r = .31–.54
White Bear Suppression: r =
−.35–−.52
Rumination Reflection
Questionnaire: r = −.02–−.43
Social desirability: r = −.13–
−.15
Depression/anxiety: r = −.28–
−.51
Hopelessness: r = −.49
Happiness/quality of life: r
= .33–.42
SMQ: Chadwick Assesses how mindfully one relates to α = .82–.89 MAAS: r = .61 Differentiated meditators, non- Positive subjective mood: r = .48 Principal components
Southampton et al. distressing Item-total r MAAS in meditators, and clinical samples. Negative affect: r = −.62 analysis suggested a
Mindfulness (2008) inner experiences; conceptualised to = .34–.67 clinical group: Among meditators, Positive affect: r = .27 single component.
Questionnaire measure four dimensions of r = .41 differentiated those who Delusion symptoms: r = −.34

mindfulness (decentering, allowing MAAS in non- meditated more than twice a
attention to remain with difficult clinical group: week from those who meditated
cognitions, accepting difficult r = .57 once or twice a week.
thoughts/images, letting difficult
cognitions pass) but yields a single
factor structure.
TMS – Trait: Davis et al. Measures two factors of mindfulness: Curiosity α Curiosity and Curiosity and decentering higher Curiosity and other mindfulness Not reported
Toronto (2009) curiosity and decentering. = .91 FMI, CAMS-R, in meditators than non- facets: r = .10–.54
Mindfulness Decentering SMQ: meditators. Decentering and other
Scale – Trait α = .85 r = .22–.48 mindfulness facets: r = .20–.74
Version Decentering
and FMI,
(Continued )
7
Table 1. Continued.
8
Convergent
CAMS-R, SMQ:
M. SALA ET AL.
r = .47–.69.
SCS – Neff (2003) Measures unidimensional mindfulness. α = .75 Self-Kindness: r Higher in Buddhists than Not reported for mindfulness Mindfulness shown to
Mindfulness: Test-retest = .87 undergraduate students. subscale be part of 6-factors
Self- = .85 Self- Differentiated women from of self-compassion
Compassion Judgment: r men. in confirmatory
Scale – = −.67 factor analysis.
Mindfulness Common
Subscale Humanity: r
= .79
Isolation: r =
−.77
Over-
Identified: r =
−.77
CAMM: Greco et al. Assesses mindfulness in children and α = .80 Not reported Positively correlated with social Somatization: r = −.40 Exploratory factor
Child and (2011) adolescents. skills and academic competence. Externalizing/internalizing analysis and
Adolescent Negatively correlated with symptoms: r = −.37–−.50 confirmatory factor
Mindfulness problem behaviour. Quality of life: r = .25 analysis yielded a
Scale Thought suppression: r = −.58 single factor
Psychological inflexibility: r = structure.
−.60
Mindfulness facets
The various mindfulness facets could potentially differentially influence engagement in health beha-
viours in unique ways. Acting with awareness, non-judging, and non-reactivity (i.e. the ‘how’ skills of
mindfulness; Linehan, 1993) likely have a stronger association with health behaviours than describing
and observing. Acting with awareness has been described as the central defining core of mindfulness,
as mindfulness is compromised when individuals behave without awareness (i.e. automatically)
(Brown & Ryan, 2003). Individual differences in acting with awareness may possibly translate into indi-
vidual differences in how much individuals pay attention to their health behaviours. Higher levels of
acting with awareness could also lead individuals to notice the benefits of engaging in health pro-
moting behaviours, thus increasing satisfaction and promoting continuous engagement in health
promoting behaviours (Tsafou, De Ridder, van Ee, & Lacroix, 2016). In addition, higher levels of aware-
ness could help individuals notice when they are not engaging in healthy behaviours (e.g. notice
when they are not exercising, when they are eating unhealthy). Increased non-reactivity should
help an individual to not react to their emotions, thus decreasing the need to engage in health
risk behaviours to regulate their emotions. Individuals higher in non-judging may be more likely
to accept negative emotions, thus decreasing the need to engage in health risk behaviours aimed
at regulating negative emotions. Indeed, empirica data has shown that acting with awareness,
non-judging, and non-reactivity are the mindfulness facets that are most frequently related to
health behaviours (e.g. Bodenlos, Noonan, & Wells, 2013; Fernandez, Wood, Stein, & Rossi, 2010;
Murphy & MacKillop, 2012).
In contrast, describing and observing (i.e. the ‘what’ skills of mindfulness; Linehan, 1993) likely
have the least robust relation with health behaviours. Observing and describing may be helpful
when an individual is also high in the ‘how’ skills of mindfulness, as the paying attention and labelling
of experiences may be helpful in increasing engagement in health behaviours when this is done in a
nonjudgmental and effective manner. However, higher levels of observing and describing without
higher levels of the ‘how’ skills of mindfulness may lead an individual to observe and describe an
experience in a judgmental and reactive manner, and thereby decrease engagement in health beha-
viours. For example, people high in observing and describing but low in the other mindfulness facets
may notice that they may have been overeating, but judge themselves for their behaviour and react
to the overeating and its associated negative emotions by engaging in further overeating. Finally,
previous research has found that higher levels of observing sometimes predicts greater maladaptive
psychological symptoms (Baer et al., 2006). Overall, it is likely the case that observing and describing
are not reliably and consistently associated with health behaviours.
In support of the proposition that acting with awareness, non-judgment, and non-reactivity may
have stronger relations with health behaviours than observing and describing, Karyadi et al. (2014)
found, in their meta-analysis, that acting with awareness, non-judgment, and non-reactivity were
significantly and negatively related to substance use behaviours, but that observing and describing
were not. However, it is important to note that mindfulness facet was not a significant moderator in
their analysis, likely due to the small number of studies included in each of these associations.
Mindfulness measures
The relation between mindfulness and health behaviours may vary depending on the mindfulness
measures used because existing measures vary in their content and measurement approach. For
example, some measures (i.e. the KIMS, the FFMQ, the CAMS-R) focus on the multidimensional
aspects of mindfulness. Other measures place a large focus on a certain aspect of mindfulness,
such as awareness (e.g. MAAS, PHLMS) or nonjudgmental observation and openness to negative
experience (e.g. the FMI) (Buchheld et al., 2001; Walach et al., 2006). Understanding the extent to
which the relation between mindfulness and health behaviours varies as a result of the mindfulness
measure used may help shed light onto the extent to which all aspects of mindfulness (vs. one aspect)
10 M. SALA ET AL.
may be relevant to each specific health behaviour. Furthermore, understanding the extent to which
the mindfulness measure used influences the strength of the mindfulness-health behaviour relation
may help researchers make informed decisions regarding which mindfulness measure to use when
studying a specific health behaviour.
Measurement of health behaviours

The relation between mindfulness and health behaviours may also vary as a function of the way that
health behaviour is measured. Specifically, the relation between mindfulness and health behaviours
may be different for health-behaviours when using self-reported vs. objective (e.g. actigraphy sleep
data, accelerometer physical activity data) measures. Because a self-report measure of health beha-
viours requires a certain degree of mindfulness (i.e. it requires the individual to be aware of the extent
to which they engage in a health behaviour), it is possible that the relation between mindfulness and
health behaviours differs depending on the type of health behaviour measure used. Additionally,
common method variance can increase the strength of a relation between two self-reported variables
(Podsakoff, MacKenzie, & Podsakoff, 2012).
Psychiatric and medical statuses of the sample

The relation between mindfulness and health behaviours may vary as a function of whether the
sample has a psychiatric condition. Psychiatric samples tend to be characterised by maladaptive
psychological processes (e.g. poor emotional regulation) that are associated with a lower degree
of engagement in health promoting behaviours and a higher degree of engagement in health risk
behaviours. Mindfulness is an adaptive counterpart to processes such as rumination (Shapiro,
Oman, Thoresen, Plante, & Flinders, 2008) and may thus be particularly helpful in protecting individ-
uals with psychiatric disorders from psychological factors associated with a lower degree of engage-
ment in health behaviours. In addition, individuals in the psychiatric population may cope with
emotional distress by engaging in health risk behaviours or by withdrawing and stopping engage-
ment in health promoting behaviours. Therefore, higher levels of mindfulness may be particularly
beneficial in promoting health behaviours in psychiatric samples by counteracting reactivity to
emotional distress. Some empirical data show that the relation between mindfulness and health
behaviours is stronger in individuals with psychiatric disorders than in individuals without psychiatric
disorders (e.g. Compare, Callus, & Grossi, 2012). Additionally, a previous meta-analysis has concluded
that the relation between trait mindfulness and substance use is most robust in inpatient psychiatric
samples (Karyadi et al., 2014). It is likely that this pattern of findings also exists for other behavioural
domains.
The relation between mindfulness and health behaviours may also differ depending on whether
individuals have a medical condition. Medical populations often have higher levels of distress than
healthy individuals (e.g. Hodges, Humphris, & Macfarlane, 2005), and higher levels of distress may
contribute to lower degree of engagement in health promoting behaviours and higher degree of
engagement in health risk behaviours. Mindfulness may thus be particularly helpful for medical
populations by relieving distress and subsequently promoting health behaviours as well as by redu-
cing the relationship between distress and engagement in unhealthy behaviours.
The present study

A meta-analysis on the relation between mindfulness and health behaviours is timely given the
growing emphasis on mindfulness interventions in health care. This meta-analysis was aimed to
advance research on mindfulness and health behaviours in several ways. First, it would integrate
findings from various behavioural domains to examine the extent to which trait mindfulness is associ-
ated with health behaviours. Quantifying the correlational effect size linking mindfulness and health
behaviours would help characterise the nature of their associations. Second, it would identify what
aspects of trait mindfulness may be related to various types of health behaviours. Most previous
empirical research examining the relation between mindfulness and health-behaviours has
focused on predicting a single health behaviour (e.g. healthy eating) or a small subset of health beha-
viours (e.g. substance use behaviours), ignoring the commonalities across health behaviours. Focus-
ing on one or a small subset of health behaviours prevents a comprehensive understanding of the
scope of the possible health effect of mindfulness. Third, the meta-analysis would examine the
sources of variability in the magnitude of the relation between mindfulness and health behaviours,
thereby helping to clarify inconsistencies. For example, it is possible that differences in the health
behaviour examined, different facets of mindfulness, measures used, and sample characteristics mod-
erate the mindfulness-health behaviour relationship.
The goal of the current meta-analysis was to: (1) quantify the magnitude of the relation between
trait mindfulness and health behaviours aggregated across studies (i.e. the omnibus test) in order to
provide a comprehensive synthesis; (2) quantify and compare the relation between trait mindfulness
and specific behavioural domains (i.e. physical activity, alcohol use, smoking, drug use, healthy eating,
risky sex, sleep); and (3) determine how the relations vary by (a) mindfulness facet, (b) mindfulness
measure, (c) objective vs. self-report behavioural measure, (d) clinical status of the sample (both psy-
chiatric and medical status), and (e) sample characteristics (i.e. age, gender, ethnicity).
Method
Literature search
Articles were identified for inclusion with title and abstract searches through PsycINFO and Pubmed/
Medline. We selected PsycINFO and Pubmed/Medline because these two databases are the main
international databases for psychology and medicine, respectively. Both published manuscripts
and unpublished manuscripts (i.e. master’s theses and dissertations) were included. Search terms
included mindful* and combinations with eat*, exercis*, physical activity, substance, smok*, tobacco,
drug, marijuana, opioid, cocaine, meth, sleep, insomnia, bing*, bulim*, risky sex, and health behavior.
We also used forward and backward searches to identify additional articles (i.e. research articles
cited in articles we retrieved and research aritcles citing manuscripts we retrieved). The literature
searches were conducted throughout March 2018. The initial search yielded 4,801 research
records identified through database and backward / forward searches. After consolidating abstracts
that were duplicated, 2,285 article abstracts were screened.
Screening and coding

Inclusion criteria
Studies were included if they (1) measured both trait mindfulness and health behaviours, (2) were
published in English, and (3) contained quantitative data to compute study-level analysis of the
associations between mindfulness and health behaviours (e.g. a Pearson’s r correlation, a t-test, fre-
quencies/proportions, means and standard deviations, or other convertible statistics). For interven-
tion studies, we only included correlations before treatment to avoid findings being influenced by
the results of the intervention.
Primary and secondary screening

All authors discussed and developed the inclusion and exclusion criteria. During the initial screening
phase, two independent coders reviewed the titles and abstracts of records to determine their eligi-
bility. The first author reviewed all research reports. The second author double-screened a random set
(10%) of all research reports. There was a 96% inter-rater agreement on study inclusion (kappa = .92).
At the end of the initial screening, 883 articles were retained for further examination. After carefully
12 M. SALA ET AL.
reviewing the full manuscripts, 538 additional research articles were excluded. A total of 345 research
articles were deemed eligible for inclusion in the meta-analysis. Most of the eligible articles (280) did
not report effect sizes concerning the association between mindfulness and health behaviours, with
only 65 articles reporting effect sizes. For the 280 studies with insufficient data, we contacted authors
twice to request additional effect size information (with a one month time lag in between contact
attempts). We received 57 responses, and the final sample consisted of 122 research reports included
in the meta-analysis. See Appendix A for a summary of the included studies and Figure 1 for PRISMA
flowchart.
Figure 1. PRISMA Flow Diagram. (a) Aggregated Health Behaviors; (b) Physical Activity; (c) Healthy Eating; (d) Sleep; (e) Alcohol
Use; (f) Drug Use; (g) Smoking
Coding procedures
All authors discussed and developed the coding protocol. The following variables were coded from
each study: authors, title, publication year, publication status, study design, percentage of male par-
ticipants, mean age of the study sample, percentage of European Americans in the sample, percen-
tage of other ethnic groups in the sample, characteristics of the sample, the facet(s) of mindfulness,
measure(s) of mindfulness, ways in which health behaviours were measured (i.e. objectively or via
self-report), the type of effect size information provided (e.g. Pearson’s r correlation, means and
SD, etc.), and the magnitude of the effect size. Percentage agreement on each of the coded variables
ranged from 90% to 100%, and disagreements were resolved via discussions between the two
coders.
The effect sizes were quantified as a Pearson’s r correlation coefficient. If another quantification
(e.g. t statistic, Cohen’s d ) was reported, the quantification was converted to an r value using the Prac-
tical Meta-Analysis Effect Size Calculator (Lipsey & Wilson, 2001). In order to adjust for sampling error,
we converted all r values to a Fisher’s z correlations using a Fisher’s Z transformation. All analyses
were performed using the transformed Fisher’s z correlations. To make the results more interpretable,
we back-transformed all Fisher’s z correlations to Pearson’s r correlations. In order to account for vari-
able sample sizes among studies, all effect-size analyses were weighted using the inverse of their var-
iances. To quantify the magnitude of the relation between trait mindfulness and health behaviours
across studies (i.e. aggregated health behaviours), all correlations with health risk behaviours (e.g.
alcohol use, smoking, drug use, risky sex) had their arithmetic sign reversed (e.g. minus to plus) to
allow for comparability. However, we did not reverse the signs to quantify the relation between
trait mindfulness and health risk behaviours when these outcomes were examined separately (e.g.
the correlation between mindfulness and alcohol use).
Data analytic plan

Analyses were conducted using the R metafor package (Viechtbauer, 2010).
Dependence of data
Most (76.0%) studies examined the relation between multiple facets of mindfulness and/or multiple
health behaviours. For studies with multiple effect sizes linking mindfulness and health behaviours,
within-study effects are likely intercorrelated because they are nested within the same group of par-
ticipants and thus pose risk of dependencies. Therefore, we used multilevel modelling (MLM), a
method for modelling dependence among effect sizes that avoids violating the assumption of inde-
pendent effect sizes. In the MLM analyses, each sample is used as a cluster variable and the effect size
is used as the dependent variable (Hox, Moerbeek, & van de Schoot, 2010). MLM is useful when mul-
tiple effect sizes are nested within the same study designs and samples. We first tested a model eval-
uating the effect across aggregated health behaviours. Separate models were then conducted to
estimate the summary effects for physical activity, healthy eating, sleep, alcohol use, drug use,
smoking, and risky sex.
Publication bias
Through a series of sensitivity analysis, we examined the likelihood and estimated the degree of pub-
lication bias in the literature because statistically significant results may be more likely to be pub-
lished than nonsignificant results. First, we visually inspected the symmetry in funnel plots. In a
funnel plot, study effect sizes typically are plotted against a measure of precision, such as the stan-
dard errors of the effect sizes. Asymmetrical funnel plots would suggest that publication bias was
present. Second, we conducted the Egger’s regression test (Egger, Smith, Schneider, & Minder,
1997), which tests whether the study effect sizes were related to the respective sample sizes. For
any health behaviour with a statistically significant Egger’s regression test, we conducted a trim
14 M. SALA ET AL.
and fill analysis (Duval & Tweedie, 2000). These tests are a series of sensitivity analyses that help esti-
mate the degree to which a body of literature is affected by publication bias. The trim and fill test aims
to identify and correct funnel plot asymmetry arising from publication bias by first removing the
smaller studies that are causing the funnel plot asymmetry, then using the trimmed funnel plot to
estimate the ‘true’ effect size, and finally replacing the omitted studies and their missing counterparts.
Finally, we used the precision effect test-precision effect estimate with standard errors technique
(PET-PEESE; Stanley & Doucouliagos, 2014). The PET-PEESE involves two regression models: the PET
and the PEESE. The PET model regresses the observed effect sizes on their standard error. If the
PET estimate is larger than zero, a less biased estimate (i.e. the PEESE estimate) is produced by
using the variance instead of the standard errors. The PEESE estimate represents the hypothetical
effect size under no publication bias. Finally, we tested whether publication type (thesis / dissertation
vs. published manuscript) moderated the strength of the associations.
We used multiple methods for sensitivity analysis of publication bias becase each method has its
own utility and limitations. First, we used the trim and fill analysis to estimate the degree of publi-
cation bias. The trim and fill analysis is optimal for a moderate degree of underlying bias;
however, it often performs poorly when there are high levels of hetereogenity (e.g. Terrin, Schmid,
Lau, & Olkin, 2003), as was the case for some of the health behaviours in our meta-analysis. The cover-
age of the trim and fill decreases as heterogeneity increases because the trim and fill analysis often
estimates and inputs hypothetically ‘missing’ studies even in the absence of publication bias (Sterne,
Egger, & Smith, 2001). Additionally, in a recent simulation study, the trim and fill analysis showed
overestimation and high false-positive rates when there was publication bias combined with a
small true effect size (Carter, Schönbrodt, Gervais, & Hilgard, 2019). Second, we also used the PET-
PEESE method to estimate the degree of publication bias. PET-PEESE reduces publication bias to prac-
tical nonsignificance and its utility is well supported by some simulation studies (Stanley & Doucou-
liagos, 2014). Still, the PET-PEESE performs poorly when (1) a large degree of heterogeneity is present,
(2) there are few studies in the meta-analysis, (3) the research literature is comprised of only small-
sample studies, (4) there is publication bias, and (5) there are increasing levels of questionable
research practices (Carter et al., 2019; Reed, Florax, & Poot, 2015; Stanley, 2017).
Weighted mean effect size estimates

We used a random-effects model to estimate the weighted mean correlation between mindfulness
and health behaviours, and the 95% confidence intervals around this summary effect. We used a
random-effects model to calculate the overall weighted mean effect size, as we assumed that
there would be a number of true effect sizes due to study characteristics. Additionally, the use of a
random-effects model would allow us to generalise our results to studies that were not included
in the current analyses (Rosenthal, 1995).
Heterogeneity and moderator analyses

We conducted the Cochran’s Q homogeneity test to evaluate whether there was larger heterogeneity
in the current meta-analysis than what would be expected from sampling error. We also calculated I2
to estimate the percentage of variability due to true hetereogenity. I2 values of 25%, 50%, and 75%
respectively would indicate that low, moderate, and high proportion of dispersion in the observed
effects would remain once the variability due to sampling error was removed (Borenstein, 2009).
We calculated τ2 to quantify the between-study variability around the true effect sizes.
We used a mixed-effects model to evaluate the extent to which the moderators affected between-
study variability in the mindfulness – health behaviours correlations. In these analyses, it was
assumed that a common fixed effect underlies this relation across subgroups of studies and that
the effects within our moderator subgroups follow a random distribution (Borenstein, 2009).
Each of the following categorical moderators were examined separately as a predictor of the
association between mindfulness and health behaviours: mindfulness facet, mindfulness measure,
self-reported or objective health behaviour measure, psychiatric status of the sample, and medical
status of the sample. In addition, we included the following continuous moderators in exploratory
analyses: average sample age, the proportion of European Americans in the sample, and the pro-
portion of males in the sample.
Results
Descriptive information
There were 125 independent samples in the 122 papers included in the meta-analysis. From the 125
samples, a total of 957 effect sizes were coded. There were five papers that used multiple samples in
one paper. In addition, there were three papers that overlapped in their use of samples. Each of the
125 independent study samples contained 1–63 effect sizes.
All studies were published or made available in dissertation / thesis repositories after 2005. Sample
sizes for the study samples ranged from 8 to 5,287, with a median sample size of 150 participants. The
median percentage of men in the studies was 38.8%. The median age of the sample was 28.3 years
old. Only 12.8% of the study samples consisted of participants recruited from a psychiatric setting,
and only 8.9% of the study samples consisted of participants recruited from a medical setting.
Overall average study-level effect size

For health behaviour, we included any measure of physical activity, alcohol use, smoking, drug use,
healthy eating, risky sex, and sleep. We included any variations of enactment of the health behaviour
(e.g. frequency or quantity of the behaviour; presence of the behaviour). We did not include studies
that measured cognitions (e.g. attitudes, intentions) or outcomes presumed to be consequences of
health behaviours (e.g. weight), as we were interested in the extent to which mindfulness is associ-
ated with the behaviours themselves. If a scale contained both a behaviour and the consequences of
a behaviour [e.g, the Alcohol Use Disorders Identification Test (AUDIT)], we contacted authors for the
correlation with only the behaviour portion of the measures (e.g. alcohol consumption in the AUDIT).
There were a total of 125 study samples. The total number of study samples for each of the health
behaviours were 42 for physical activity, 42 for alcohol use, 26 for smoking, 26 for sleep, 24 for healthy
eating, 14 for drug use, and 1 for risky sex. Because there was only one study that included a corre-
lation between mindfulness and risky sex – and a minimum of two studies is needed to conduct a
meta-analysis (Valentine, Pigott, & Rothstein, 2010) – we were unable to examine the effect of mind-
fulness on risky sex separately, but included it in the omnibus test.
Table 2 summarised the weighted mean correlations linking mindfulness and health-behaviours
and tests of heterogeneity. Mindfulness was positively associated with health behaviours aggregated
together (r = .08, p < .001). Considering distinct types of health behaviours, mindfulness was posi-
tively associated with physical activity, healthy eating, and sleep (rs = .08–.14, ps <.001) and nega-
tively associated with alcohol use (r = −.06, p = <.001). Mindfulness was not statistically
significantly associated with smoking behaviour (r = −.04, p = .17) and drug use (r = −.05, p = .09).
Table 2. Weighted average correlations and heterogeneity statistics for mindfulness and health behaviours.
Health Behavior No. of effect sizes k r 95% CI Q I2 τ2
Aggregated 957 125 .08*** [ .06, .10] 2694.15*** 68.06 .01
Physical Activity 257 42 .09*** [ .06, .12] 647.90*** 51.05 .01
Healthy Eating 173 24 .14*** [ .08, .19] 701.07*** 79.95 .02
Sleep 132 26 .08*** [ .04, .13] 195.54*** 48.47 .01
Alcohol Use 211 42 −.06*** [−.09, −.03] 496.85*** 58.04 .01
Drug Use 62 14 −.05 [−.11, .01] 132.50*** 71.28 .01
Smoking 119 26 −.04 [−.09, .02] 394.11*** 76.51 .02
Note: k = number of observed studies, r = weighted-mean Pearson’s r correlation, 95% CI = 95% confidence intervals. An r for risky
sex is not reported because there was only one sample for risky sex. * p < .05, ** p < .01, *** p < .001.
16 M. SALA ET AL.
The homogeneity test was significant for all the health-behaviours, indicating between-study hetero-
geneity for all of the health beahviors. The I2 and τ2 were highest for healthy eating and smoking,
suggesting that the highest heterogeneity occurred for these health behaviours (see Table 2).
Publication bias
See Figure 2 for funnel plots of the data. The Egger’s regression test indicated that the funnel plots for
our data were not asymmetric for agreggated health behaviours (t = −1.90, p = .06), alcohol use (t
= .15, p = .89), drug use (t = .90, p = .37), and sleep (t = −1.30, p = .20).
Because the funnel plots were asymmetric for healthy eating, physical activity, and smoking, we
conducted trim and fill analyses for these behavioural domains. The funnel plot of our data was asym-
metric for healthy eating (t = 2.95, p = .004). Using the observed and imputed effect sizes, the overall
average estimate for healthy eating was only slightly reduced and still significant (r = .11, p < .001).
The funnel plot for our data was asymmetric for physical activity (t = −3.38, p = .001). Using the
observed and imputed effect size, the overall average estimate for physical activity was unchanged
(r = .09, p < .001). The funnel plot for our data was asymmetric for smoking (t = −2.14, p = .03). Using
the observed and imputed effect sizes, the overall average estimate for smoking was now significant
and in the expected direction (r = - .06, p < .001).
We also conducted PET-PEESE analyses. For all health behaviours except drug use, the PET esti-
mate was significant. Therefore, we use the PET estimate for drug use and the PEESE estimate for
the rest of the health behaviours. The PET estimate was not significant for drug use (r = .00, p
= .91). The PEESE estimate was significant for aggregated health behaviours (r = .07, p < .001), physical
activity (r = .11, p < .001), healthy eating (r = .08, p < .001), sleep (r = .06, p < .001), alcohol (r = −.06, p
< .001), and smoking (r = −.08, p < .001).
Finally, we tested whether the strength of the correlation differed by study type (published manu-
script vs. dissertation / thesis). The association between mindfulness and health behaviours differed
depending on the publication type for aggregated health behaviours (QB = 64.56, p < .001), healthy
eating (QB = 26.35, p < .001), physical activity (QB = 32.75, p < .001), smoking (QB = 6.16, p = .05), and
sleep (QB = 11.95, p = .002). The moderator analysis for drug use was not significant (QB = 3.63 p
= .16). In the case of healthy eating and smoking, the correlation was larger for published studies
(healthy eating r = .15 p < .001; smoking r = −.07, p = .02) than dissertations (healthy eating r = .09
p < .001; smoking r = .05, p = .33). In contrast, in the case of physical activity, the correlation was
slightly larger for dissertations (r = .10, p < .001) than published studies (r = .08, p < .001). In the
case of alcohol use and sleep, the magnitude of the correlation barely differed for dissertations
(alcohol r = −.07, p < .001; sleep r = .08, p = .07) and published studies (alcohol r = −.06, p < .001;
sleep r = .08, p = .003).
Moderator analyses
Mindfulness facet
We mapped each of the facets from the various measures onto the five facets of the FFMQ. We chose
the FFMQ to organise the facets because the FFMQ emerged from factor analyzing all the items from
most of the other mindfulness scales (Baer et al., 2006). The following subscales were coded as
observing: (1) FFMQ observing, (2) KIMS observing, (3) FMI mind/body awareness, and (4) PHLMS
awareness. The following subscales were coded as describing: (1) FFMQ describing and (2) KIMS
describing. The following subscales were coded as acting with awareness: (1) KIMS acting with aware-
ness and (2) FFMQ acting with awareness. The following subscales were coded as non-judgment: (1)
FFMQ non-judgment, (2) KIMS accepting without judgment, (3) FMI openness, and (4) PHLMS accep-
tance. The following subscales were coded as non-reactivity: (1) FFMQ non-reactivity and (2) FMI non-
attachment subscale. These decisions were based on suggestions by Bergomi, Tschacher, and Kupper
(2013) (e.g. that FMI mind/body awareness and PHLMS awareness represent observing), a previous
Figure 2. Funnel plots showing precision of the correlation effects between mindfulness and (a) aggregated health behaviours, (b)
physical activity, (c) healthy eating, (d) sleep, (e) alcohol use, and (f) drug use (g) smoking. Filled circles represent observed studies
in each study, and line represent the observed summary correlation effects
18 M. SALA ET AL.
meta-analysis (Karyadi et al., 2014) (e.g. that KIMS accepting without judgment represents non-judg-
ment), and the authors review of mindfulness measures.
The association between mindfulness and health behaviours differed depending on the mindful-
ness facet for aggregated health behaviours (QB = 117.29, p < .001). The association between mind-
fulness and health behaviours also differed depending on the mindfulness facet for each of the
separate behavioural domains (QB = 18.40–97.36, ps < .003) with the exception of smoking (QB =
9.32, p = 0.10). Tables 3–9 show the average correlation of each of the five facets of mindfulness
and each behavioural domain. Acting with awareness had the strongest correlation with agreggated
health behaviours. In addition, the relation between acting with awareness and health behaviours
was statistically significant for all of the behavioural domains with the exception of smoking.
Higher levels of non-judgment predicted all of the health behaviours in the expected direction
with the exception of smoking and drug use. Higher levels of non-reactivity only predicted more
aggregated health behaviours and health promoting behaviours. Non-judging did not predict sub-
stance use. Higher levels of describing predicted more aggregated health behaviours, health promot-
ing behaviours, and less alcohol use. Observing was the least consistent facet. It was positively
associated with physical activity, healthy eating, and drug use, and it did not significantly predict
agreggated health behaviours, sleep, alcohol use, or smoking.
Mindfulness measure
We included any studies that had a measure of trait mindfulness or its facets. Measures included in
the meta-analysis included the MAAS (Brown & Ryan, 2003), SCS – Mindfulness Subscale (Neff, 2003),
FMI (Buchheld et al., 2001), KIMS (Baer et al., 2004), FFMQ (Baer et al., 2006), CAMM (Greco et al., 2011),
Table 3. Moderators of the relation between mindfulness and aggregated health behaviours.
Categorical Moderator r 95% CI QBetween
Mindfulness Facet 117.29***
Observing .02 [.00, .05]
Describing .06*** [ .03, .09]
Acting with Awareness .11*** [ .08, .14]
Non-judgment .06*** [ .03, .09]
Non-reactivity .05** [ .02, .08]
Mindfulness Measure 89.28***
MAAS .11*** [ .09, .14]
SCS-Mindfulness .08 [ .00, .15]
FMI −.03 [−.14, .07]
KIMS .08*** [ .05, .11]
FFMQ .07*** [ .05, .09]
CAMM .06 [−.14, .24]
CAMS-R .07 [−.18, .32]
PHLMS .10 [−.01, .20]
Researchers own .13*** [ .08, .18]
Psychiatric Status 69.48***
Non-Psychiatric .08*** [ .06, .10]
Psychiatric .13*** [ .08, .19]
Medical Status 66.82***
Non-Medical .08*** [ .06, .10]
Medical .13*** [ .06, .20]
Continuous Moderator b 95% CI QBetween
% European American −.02 [−.09, .05] .32
Average age .00 [ .00, .00] 2.05
% men −.01 [−.07, .05] .21
Note: r = weighted-mean Pearson’s r correlation, 95% CI = 95% confidence intervals, MAAS =
Mindful Attention Awareness Scale, SCS = Self-Compassion Scale, FMI = Freiburg Mindfulness
Inventory, KIMS = Kentucky Inventory of Mindfulness Skills, FFMQ = Five Facet Mindfulness
Questionnaire; CAMM = Child and Adolescent Mindfulness Measure Scale; CAMS-R = Cognitive
and Affective Mindfulness Scale-Revised; PHLMS = Philadelphia Mindfulness Scale.* p < .05 ** p
< .01; ***p < .001.
Table 4. Moderators of the relation between mindfulness and physical activity.

Mindfulness Facet 20.39**
Observing .11*** [ .05, .17]
Describing .11** [ .05, .16]
Acting with Awareness .09** [ .03, .15]
Non-judgment .07* [ .00, .12]
Non-reactivity .11*** [ .05, .17]
MAAS .06** [ .02, .09]
SCS-Mindfulness .14** [ .04, .24]
FMI .16** [ .05, .26]
KIMS .26*** [ .18, .33]
FFMQ .08*** [ .05, .11]
CAMM
CAMS-R
PHLMS .11* [ .01, .21]
Researchers own −.04 [−.18, .11]
Psychiatric .08 [−.21, .36]
Non-Medical .09*** [ .06, .12]
Medical .06 [−.05, .17]
Health Behavior Measure 32.09***
Self-Report .09*** [ .06, .12]
Objective .07 [−.06, .19]
Average age .00 [ .00, .00] .01
% men −.11 [−.21, −.01] 4.76*
< .01; ***p < .001.
CAMS-R (Feldman et al., 2007), PHLMS (Cardaciotto et al., 2008), and researchers’ own mindfulness
measures.
The association between mindfulness and health behaviours differed depending on the mindful-
ness measure for aggregated health behaviours (QB = 89.28, p < .001) as well as for all of the separate
behavioural domains (QB = 15.59–85.73, ps < .02) (see Tables 3–9). The relation between trait mind-
fulness and agreggated health behaviours was strongest when the MAAS, researchers’ own
measures, and the PHLMS were used. For sleep and substance use, the relation between trait mind-
fulness and health behaviours was strongest when the MAAS was used. For physical activity, the
relation between trait mindfulness and health behaviours was strongest when the KIMS was used.
For healthy eating, the relation between mindfulness and health behaviours was strongest when
the KIMS, FFMQ, and researchers’ own measures were used.
Health behaviour measure: objective vs. self-report

We were able to test whether the objectivity of the measure of health behaviour moderated the
relation between mindfulness and health behaviour only for behavioural domains where at least
some studies included objective measures: physical activity and sleep (see Tables 4 and 6). The objec-
tivity of the health behaviour measure moderated the association between both mindfulness and
physical activity (QB = 32.09, p < .0001), as well as mindfulness and sleep (QB = 12.35, p = .002). For
physical activity, the correlation was larger for self-reported physical activity measures (r = .09, p
< .001) than objective measures (r = .07, p = .31). For sleep, the correlation was larger for objective
20 M. SALA ET AL.
Table 5. Moderators on the relations between mindfulness and healthy eating.

Observing .10** [ .03, .18]
Describing .14*** [ .07, .22]
Acting with Awareness .19*** [ .11 .26]
Non-judgment .12** [ .05, .20]
Non-reactivity .13** [ .05, .21]
MAAS .12* [ .01, .22]
SCS-Mindfulness .12 [−.13, .36]
FMI .06 [−.18, .30]
KIMS .14 [−.01, .29]
FFMQ .15*** [ .08, .22]
CAMM .
CAMS-R .
PHLMS .
Researchers own .16 [−.05, .36]
Psychiatric .29*** [ .12, .44]
Non-Medical .14*** [ .08, .20]
Medical .12 [−.15, .38]
% European American .01 [−.15, .16] .01
Average age .00 [ .00, .01] .66
% men .21 [−.07, .49] 2.21
< .01; ***p < .001.
sleep measures (r = .12, p = .17) than self-reported measures (r = .08, p < .001). However, there were
only 12 effect sizes with objective sleep measures and the correlation between objective sleep
measures and mindfulness was not significant.
Clinical status
Data were coded based on whether participants met criteria for a psychiatric disorder (e.g. insomnia,
substance use disorder, binge eating disorder) and/or whether participants were in treatment for a
psychiatric disorder. Of note, all samples that met criteria for any psychiatric disorder were coded
as psychiatric, regardless of whether this psychiatric disorder was related to the health behaviour
in question for the separate behavioural domains. We made this decision because having any psy-
chiatric diagnosis (related or unrelated to the behavioural domain) is associated with psychological
factors that may be associated with a lower degree of engagement in health behaviours (e.g. rumina-
tion, experiential avoidance). The psychiatric status of the sample moderated the association
between health behaviour and mindfulness for aggregated health behaviours (QB = 69.48, p
< .0001) and all the behavioural domains (QB = 8.71–33.79, ps < .02) except for smoking (QB = 4.68,
p = .10). As hypothesised, the relations between trait mindfulness and health behaviours were stron-
ger for psychiatric than non-psychiatric samples. This appeared to be the case for most of the behav-
ioural domains examined, with a few exceptions (see Tables 3–9).
We also coded the data as to whether participants in the sample had a medical diagnosis (e.g.
cancer, diabetes). The medical diagnoses of the sample moderated the association between health
behaviours and mindfulness for all of the behavioural domains (QB = 16.04–66.82, ps < .001)
except for drug use and smoking. The relations between trait mindfulness and aggregated health
Table 6. Moderators on the relations between mindfulness and sleep.

Observing −.02 [−.07, .03]
Describing .09*** [ .05, .14]
Acting with Awareness .08*** [ .04, .13]
Non-judgment .05* [ .01, .10]
Non-reactivity .05* [ .01, .09]
Mindfulness Measure 19.68**
MAAS .15*** [ .08, .23]
SCS-Mindfulness −.06 [−.31, .20]
FMI . .
KIMS .06 [−.17, .29]
FFMQ .06* [ .01, .11]
CAMM .17 [−.46, .69]
CAMS-R . .
PHLMS .01 [−.25, .27]
Researchers own . .
Psychiatric Status 12.39**
Non-Medical .06* [ .01, .11]
Medical .16*** [ .06, .24]
Health Behavior Measure 12.35**
Self-Report .08*** [ .03, .12]
Objective .12 [−.05, .30]
% European American .61** [ .25, .98] 10.71**
Average age .00 [ .00, .00] .60
% men −.01 [−.14, .12] .03
< .01; ***p < .001.
behaviours, sleep, and alcohol use were stronger for medical than non-medical samples. The relations
between trait mindfulness and physical activity and healthy eating were stronger for non-medical
than medical samples (see Tables 3–9).
Exploratory analyses: ethnicity, age, and gender

Ethnicity significantly moderated the correlation between mindfulness and smoking (QB = 24.91, ps <
.001), as well as mindfulness and sleep (QB = 10.71, ps = .001), such that the more European Americans
in the study, the larger the relation between mindfulness and smoking (b = .16, SE = .03, p < .001) and
sleep (b = .61, SE = .19, p < .01). The percentage of men in the sample significantly moderated the cor-
relation between mindfulness and physical activity (QB = 4.76, p = .03), such that the more men in the
study, the lower the relation between mindfulness and physical activity (b = −.11, SE = .05, p = .03).
The average age of the sample did not significantly moderate the correlation between mindfulness
and agreggated health behaviours or any behavioural domain (QB = .01–2.41, ps > .12).
Discussion
This meta-analysis was the first to quantify the association between trait mindfulness and health
behaviours and to identify moderators of this relation. Trait mindfulness showed a small correlation
with several health behaviours (i.e. physical activity, healthy eating, sleep, alcohol use) but was unre-
lated to drug use and smoking. Among the different facets of mindfulness, acting with awareness was
22 M. SALA ET AL.
Table 7. Moderators on the relations between mindfulness and alcohol use.

Observing .02 [−.01, .05]
Describing −.04* [−.07, −.01]
Acting with Awareness −.12*** [−.15, −.09]
Non-judgment −.06*** [−.09, −.03]
Non-reactivity .01 [−.02, .04]
MAAS −.12*** [−.16, −.09]
FMI .09* [ .02, .17]
KIMS −.07** [−.11, −.02]
FFMQ −.05*** [−.08, −.03]
CAMM −.06 [−.17, .05]
CAMS-R . .
PHLMS . .
Researchers own −.10** [−.17, −.04]
Clinical Status 22.72***
Non-Psychiatric −.05*** [−.08, −.02]
Psychiatric −.11** [−.17, −.04]
Non-Medical −.06*** [−.09, −.03]
Medical −.10 [−.27, .08]
% European American .06 [−.05, .16] 1.08
Average age .00 [ .00, .00] 2.41
% men −.08 [−.22, .06] 1.34
< .01; ***p < .001.
relatively the strongest and most consistent correlate of health behaviours. The association between
mindfulness and health behaviours was also stronger in samples with psychiatric diagnoses than in
samples with no psychiatric diagnoses.
Mindfulness and health behaviors: agreggated effects

We found a small and positive relation between trait mindfulness and health behaviours. Depending
on the behavioural domain, the correlation between mindfulness and health behaviours ranged from
.04 to .14. For comparison to other trait measures, the relation between health behaviours and trait
conscientiousness ranges from .05 to .28 (Bogg & Roberts, 2004), and the correlation between phys-
ical activity and trait extraversion and trait neuroticism are .23 and −.11, respectively (Rhodes & Smith,
2006). Thus, the association between trait mindfulness and health behaviours falls within a similar
range of magnitude as other personality traits, albeit on the lower end of the range. The small
overall association suggests that individual differences in trait mindfulness likely does not reliably
translate into a pattern of healthful behaviours. Instead, engagement in healthful behaviours is
likely more strongly influenced by active self-regulatory and control strategies than dispositional
traits, as a recent meta-analysis on the effects of monitoring goal progress demonstrated a more sub-
stantial effect (d = .40) on behaviour (Harkin et al., 2016).
In comparison, a meta-analysis that examined the health benefits of mindfulness-based interven-
tions indicated a moderate-sized effect of the interventions on physical health (d = .53, which is
equivalent to an r of .26) (Grossman, Niemann, Schmidt, & Walach, 2004). Meta-analyses examining
single health behaviours have suggested that mindfulness-based interventions have a large effect on
Table 8. Moderators on the relations between mindfulness and drug use.

Mindfulness Facet 18.40**
Observing .06** [ .02, .11]
Describing .04 [−.01, .08]
Acting with Awareness −.06** [−.10, −.02]
Non-judgment −.01 [−.05, .03]
Mindfulness Measure 15.59*
MAAS −.10*** [−.16, −.04]
FMI . .
KIMS −.01 [−.08, .06]
FFMQ .00 [−.06, .06]
CAMM −.03 [−.18, .13]
CAMS-R . .
PHLMS . .
Researchers own −.07 [−.16, .02]
Psychiatric Status 8.71*
Non-Psychiatric −.01 [−.07, .05]
Psychiatric −.13** [−.21, −.04]
Medical Status 3.64
Non-Medical −.06 [−.12, .00]
Medical −.01 [−.13, .12]
Average age −.00 [−.01, .01] .02
% men −.06 [−.28, .16] .31
< .01; ***p < .001.
reducing binge eating (Godfrey, Gallo, & Afari, 2015), a small effect on promoting substance absti-
nence (Cavicchioli, Movalli, & Maffei, 2018), but do not have a significant effect on smoking cessation
(Maglione et al., 2017). There are several potential reasons regarding why we observed a much
smaller effect than some meta-analyses examining mindfulness-based interventions. First, Grossman
et al.’s (2004) meta-analysis included various measures of physical health (e.g. pain, medical symp-
toms) and did not examine health behaviours specifically. Second, trait mindfulness is a general dis-
positional tendency; it does not capture changes in mindfulness and is not specific to behavioural
domains. Thus, it is not surprising that its associations with specific health behaviours are modest.
Finally, mindfulness-based interventions may affect mechanisms that are parallel to trait mindfulness
that nevertheless are relevant to engagement in health behaviours (e.g. stress reactivity; Gu, Strauss,
Bond, & Cavanagh, 2015).
Sources of variability
We found that there was a considerable amount of between-study variability accounted for by meth-
odological and individual difference factors. Overall, the correlations varied depending on the behav-
ioural domain, mindfulness facet, mindfulness measure, type of health behaviour measure, clinical
status of the sample, and sample characteristics.
Behavioural domains
The relation between trait mindfulness and health behaviours was relatively stronger for healthy
eating, physical activity, and sleep than other health behaviours. This pattern suggests trait mindful-
ness may be more helpful for engaging in health promoting behaviours (e.g. healthy eating, physical
24 M. SALA ET AL.
Table 9. Moderators on the relations between mindfulness and smoking.

Mindfulness Facet 9.32
Observing .02 [−.03, .07]
Describing .03 [−.02, .08]
Acting with Awareness −.04 [−.09, .00]
Non-judgment .01 [−.04, .06]
MAAS −.12*** [−.17, −.06]
SCS-Mindfulness . .
FMI .16 [−.03, .33]
KIMS −.04 [−.09, .03]
FFMQ −.01 [−.06, .04]
CAMM . .
CAMS-R . .
PHLMS −.07 [−.16, .03]
Psychiatric Status 4.68
Non-Psychiatric −.05 [−.10, .00]
Medical Status 3.25
Non-Medical −.03 [−.09, .02]
Medical −.18 [−.49, .27]
% European American .16*** [ .10, .23] 24.91**
Average age .00 [ .00, .01] 1.06
% men −.01 [−.11, .09] .05
< .01; ***p < .001.
activity, and sleep) than for forgoing health risk behaviours (e.g. drug use, alcohol use, smoking). Trait
mindfulness showed a stronger relation with healthy eating (r = .14) than with the other behavioural
domains. This may be because individuals who are higher in trait mindfulness have skills or attributes
that are particularly beneficial in promoting healthier eating behaviour. For example, individuals who
score higher in trait mindfulness may have increased awareness for hunger and fullness cues, may be
beter able to regulate serving sizes, and may be less likely to engage in emotional eating (i.e. eating to
cope with emotions; Bruch, 1973) (Beshara, Hutchinson, & Wilson, 2013).
Mindfulness also showed a stronger relation with physical activity than other behavioural
domains. Trait mindfulness is correlated with state mindfulness (Brown & Ryan, 2003), and it is poss-
ible that higher levels of trait mindfulness increases the likelihood of higher levels of state mindful-
ness during physical activity. Higher state mindfulness during physical activity should result in higher
satisfaction with physical activity and thus reinforce physical activity (Tsafou et al., 2016; Tsafou,
Lacroix, van Ee, Vinkers, & De Ridder, 2017). It may also be that physical activity increases trait mind-
fulness (Mothes, Klaperski, Seelig, Schmidt, & Fuchs, 2014; Shelov, Suchday, & Friedberg, 2009).
Finally, mindfulness may influence the relation between motivation to engage in physical activity
and physical activity behaviour (Brown & Ryan, 2003; Ryan & Deci, 1985). Indeed, recent research
shows that mindfulness moderates the relation between intrinsic motivation and engagement in
physical activity (Ruffault, Bernier, Juge, & Fournier, 2016). Specifically, mindful individuals are
more likely to have an increased physical activity level when intrinsically motivated, whereas mind-
less individuals have difficulties with engaging in physical activity even when intrinsically motivated
(Ruffault et al., 2016).
The positive relation between mindfulness and sleep may be due to the acceptance and letting-go
principles of mindfulness that may enable individuals to reduce sleep-related arousal (Ong et al.,
2008) and stress (Carlson & Garland, 2005). Sleep-related arousal has been identified as a contributing
factor to the development and maintenance of insomnia (Ong et al., 2008). Elements of mindfulness
such as acceptance are congruent with a lower degree of sleep-related arousal (e.g. accepting that
sleep may not come; Ong et al., 2008). Additionally, stress can disturb sleep (Hall et al., 2000), and
research has shown that mindfulness may reduce stress and thereby improve sleep (Carlson &
Garland, 2005). Finally, the enhanced acceptance that mindful individuals have may result in lower
levels of engagement with worries and rumination before sleeping, which should result in better
sleep (Harvey, 2000).
In contrast, mindfulness may be less beneficial to health risk behaviours because health risk factors
may be better explained by other factors outside of mindfulness. For example, evidence suggests that
experiential avoidance (Kingston, Clarke, & Remington, 2010) and coping motives (i.e. engaging in
health-risk behaviours to cope with negative psychological symptoms) (de Dios et al., 2010) are
important determinants of health risk behaviours.
Of note, the relations between mindfulness and smoking and between mindfulness and drug use
were not statistically significant. The non-significant relation between mindfulness and drug use is in
line with the meta-analysis by Karyadi et al. (2014), which found a non-significant relation between
mindfulness and marijuana use. The non-significant relation between mindfulness and smoking
differs from Karyadi et al. (2014), who found that mindfulness was significantly related to smoking.
Our findings may differ from those of Karyadi et al. (2014) because that meta-analysis included
measures of substance misuse (e.g. substance use disorder, substance dependence), whereas our
meta-analysis focused exclusively on behaviours (e.g. substance use quantity, substance use fre-
quency). Karyadi et al. (2014) found that mindfulness was most strongly associated with problematic
substance use behaviours than non-problematic substance use behaviours.
Mindfulness facets
Partially supporting our hypothesis, acting with awareness was the most consistent predictor across
the health behaviours and had the strongest association with agreggated health behaviours. This is
likely the case because the acting with awareness facet of mindfulness is the central defining core of
mindfulness (Brown & Ryan, 2003). This finding suggests that the development of mindfulness-
focused health behaviour interventions may consider having an increased focus on targeting
acting with awareness. For example, interventions focused on targeting acting with awareness
could teach individuals to engage in the present moment with undivided attention and reduce
their proneness to distraction (e.g, by engaging in focused-attention meditation; Lutz, Slagter,
Dunne, & Davidson, 2008). However, it is important to note that other facets were still associated
with health behaviours, and may therefore also be targeted in mindfulness-focused health behaviour
interventions. It has been suggested that the ‘what’ skills of mindfulness (e.g. observing, describing)
are necessary before one can engage in the ‘how’ skills of mindfulnesss (e.g. nonjudgment, acting
with awareness, non-reactivity) (Linehan, 1993). For example, the skills of observing and describing
may be necessary for individuals to notice their unhealthy habits before they are able to change
them. However, individuals already high in observing and describing could be directly trained in
acting with awareness. Nevertheless, given that the current meta-analysis focuses on trait mindful-
ness, caution should be used before making clinical conclusions.
It also appears that different facets are relevant in promoting different health behaviours. In the
case of physical activity and healthy eating, all of the facets had statistically significant relations.
These findings suggest that noticing and labelling internal and external experiences as well as
greater attention to, acceptance of, and unattachement to these experiences should promote heal-
thier eating and physical activity. Higher levels of acting with awareness may decrease behavioural
automaticity, encouraging individuals to be deliberate about their eating and physical activity.
Higher levels of non-reactivity and non-judgment may encourage individuals to accept their
thoughts and feelings regarding their eating and physical activity (e.g. a desire to eat unhealthy
food or be sedentary) without reacting to them. Higher levels of observing and describing may
26 M. SALA ET AL.
help individuals to notice and label their unhealthy eating and physical activity habits, and therefore
be in a better position to change these.
In the case of sleep, acting with awareness and describing appeared to be most important.
Describing may be particularly important to sleep because this skill should afford a greater under-
standing of experiences. This understanding of experiences may be important in helping individuals
understand what behaviours facilitate more sleep (e.g. reduced caffeine intake, a consistent wake
time, etc.). In addition, describing should facilitate the articulation of feelings, which may reduce
hyperarousal (Lieberman et al., 2007) and thereby facilitate sleep.
In the case of alcohol use, acting with awareness and non-judging had the highest correlations.
These findings suggest that the ability to maintain awareness as well as the ability to accept thoughts
and emotions may be relatively important in reducing alcohol use. Non-judging may be important for
preventing alcohol use because higher levels of non-judging are related to an increased ability to
accept negative emotions and adaptive emotion regulation (Cash & Whittingham, 2010) as well as
lower levels of mood-regulatory drinking motives (Roos, Pearson, & Brown, 2015). A greater ability
to tolerate negative emotions due to higher levels of non-judging may reduce substance use that
may occur to cope with negative emotions. In the case of drug use, only acting with awareness
appears to be important. Individuals who are higher in acting with awareness may be less likely to
engage in drug use and alcohol use in order to escape cognitive awareness.
As expected, observing was unrelated to many health behaviours (e.g. alcohol use, sleep) and
even predicted greater problems (e.g. drug use, smoking), suggesting that observing without
other aspects of mindfulness may not be beneficial for most health behaviours. Our findings regard-
ing the observing facet of mindfulness highlight the importance of how one notices internal experi-
ences (e.g. with an attitude of acceptance). Higher levels of observing without other facets of
mindfulness may result in observing one’s experiences in a judgmental and reactive way, thereby
potentially encouraging individuals to avoid these experiences through maladaptive behaviours
(e.g. substance use). For example, some research suggests that higher levels of observing are associ-
ated with lower levels of substance use for individuals who are high in nonreactivity, but higher levels
of substance use for individuals who are low in nonreactivity (Eisenlohr-Moul, Walsh, Charnigo Jr,
Lynam, & Baer, 2012).
Overall, findings from our meta-analysis provide increased understanding of the association
between each specific mindfulness facet and each specific health behaviour, and therefore highlight
the potential utility of targeting each specific facet in interventions for each specific health behaviour.
One limitation of the current study is that we only examined how these facets separately relate to
health behaviours. Future research should explore how mindfulness facets work in combination
with one another in encouraging health behaviours, thereby allowing us to elucidate the distinct
vs. overlapping role of each facet in relation to each health behaviour
Mindfulness measure
As hypothesised, the relation between mindfulness and agreggated health behaviours was strongest
when mindfulness was measured with scales that placed an extensive emphasis on awareness (i.e.
the MAAS and PHLMS). The relation between mindfulness and substance use (i.e. alcohol use,
smoking, drug use) and sleep was strongest when mindfulness was measured with the MAAS,
further supporting the importance of awareness in decreasing substance use behaviour and improv-
ing sleep. This finding is in line with our facet findings for these health behaviours. Notably, debates
exist regarding the construct validity, specifically the structural validity, of the MAAS (Carlson &
Brown, 2005; Christopher, Charoensuk, Gilbert, Neary, & Pearce, 2009; Cordon & Finney, 2008; Gross-
man, 2008, 2011; Johnson, Wiebe, & Morera, 2014; Van Dam, Earleywine, & Borders, 2010). This should
be taken into consideration when interpretting finding from the MAAS.
In contrast, the relation between mindfulness and physical activity and healthy eating was stron-
gest when mindfulness was measured with mindfulness scales that measure multidimensional
aspects of mindfulness (i.e. the KIMS and FFMQ), suggesting that all aspects of mindfulness are
important in promoting physical activity and healthy eating. This finding is also in line with our facet
findings for physical activity and healthy eating. Of note, it may be worth paying special attention to
the relation between the FFMQ and the various health behaviours, as the FFMQ emerged from factor
analyzing all the items from most of the other mindfulness scales and has demonstrated superior psy-
chometric properties (Baer et al., 2006).
Health behaviour measure (objective vs. self-report)

For physical activity, correlations were stronger for self-reported health behaviour measures than for
objective health behaviour measures, which may be largely due to common variance effects.
Additionally, mindful individuals may be more aware of how much they exercise. However, objective
health behaviour measures have their own limitations. For example, they are only able to assess
health behaviours for the time of the measurement and are not able to assess habits. In adition,
measuring a health behaviour objectively can change the behaviour that is being measured (e.g. a
participant wearing an accelerometer might exercise more).
For sleep, the correlation between mindfulness and health behaviours was stronger for objective
than subjective measures. However, it is important that all of the 12 effect sizes with objective
measures of sleep came from only two research reports. Furthermore, the relationship between
mindfulness and objective sleep measures was not statistically significant. Therefore, this finding
should be interpreted with caution.
Clinical status of the sample

Overall, the relations between trait mindfulness and health behaviours were stronger for psychiatric
than for non-psychiatric samples. Psychiatric samples are characterised by various maladaptive
psychological processes (e.g. negative affect, rumination, stress, poor emotional regulation, depress-
ive symptoms) which are associated with a lower degree of engagement in various health behaviours
(Roberts & Danoff-Burg, 2010). Mindfulness is an adaptive counterpart to these maladaptive psycho-
logical processes (Shapiro et al., 2008). In addition, mindfulness may weaken the association between
these maladaptive processes and unhealthy behavioural response (Bowen & Marlatt, 2009; Bravo,
Pearson, Stevens, & Henson, 2016). Higher levels of mindfulness in psychiatric samples may be par-
ticularly beneficial because they may alleviate maladaptive psychological processes as well as
weaken the association between these processes and unhealthy behavioural response. The finding
that mindfulness processes are most strongly correlated with health behaviours in psychiatric
samples suggests that individuals experiencing maladaptive psychological processes would be
most likely to benefit from mindfulness-based interventions.
Our finding that the relation was strongest in psychiatric samples is in line with results from a
meta-analysis on mindfulness and substance use conducted by Karyadi et al. (2014), which concluded
that the relation between mindfulness and substance use behaviours was strongest in inpatient clini-
cal samples. Our finding is also in line with research that suggests that mindfulness-based treatments
for health behaviours (e.g. substance use) are most beneficial for individuals with high levels of psy-
chopathology (Roos, Bowen, & Witkiewitz, 2017). In regards to specific behavioural domains, the
relation between mindfulness and drug use, alcohol use, and healthy eating was larger in psychiatric
than non-psychiatric samples. It was striking that the relation between mindfulness and healthy
eating was .29 in psychiatric samples (versus .12 in non-clinical samples). About half of the clinical
samples for healthy eating were in individuals with binge eating disorder, whereas the other half
were in individuals with other psychological disorders (e.g. insomnia). Mindfulness may have a stron-
ger relation with healthy eating in individuals with binge eating disorder because individuals with
binge eating disorder are more likely to engage in mindless eating (i.e. eating automatically
without any cognitive processing).
In regards to the medical status of the sample, we found different patterns depending on the
health behaviour. We found that for physical activity and healthy eating, the associations with mind-
fulness were stronger for non-medical than medical populations. For alcohol use and sleep, the
28 M. SALA ET AL.
associations with mindfulness were stronger for medical than non-medical populations. We believe
that our results may be due to the diagnoses that were most common for each particular health
behaviour. Most of the diagnoses for physical activity and healthy eating included individuals with
obesity. It may be that the relations between mindfulness and physical activity and healthy eating
are weaker for obese individuals because obese individuals may have lower variability in physical
activity and healthy eating (the outcome variables) than a sample of healthy individuals, and there
may have been less power to detect an effect of mindfulness. We found the opposite pattern of
findings for alcohol use and sleep. This may be because most of the medical diagnoses studied in
regards to these health behaviours included individuals with medical illnesses outside of obesity
(e.g. cancer). Individuals with medical ilnesses experience a significant amount of distress (Hodges
et al., 2005), which may impact sleep as well as lead to coping with distress by engaging in
alcohol use. Mindfulness may thus be particularly helpful for individuals with medical illnesses, as
it may relieve distress and thus encourage engagement in health behaviours or weaken the relation-
ship between distress and unhealthy behaviour.
Sample characteristics
Most of the results from the exploratory analyses yielded null results. The association between mind-
fulness and health behaviours did not vary as a function of age, gender, and ethnicity, with a few
exceptions. Overall, our results suggest that, for most health behaviours, demographic sample
characteristics do not appear to influence the association between mindfulness and health beha-
viours. We did find that when there were more European Americans in the study, there was a
larger relation between mindfulness and smoking and sleep. Possible reasons for this finding may
be that mindfulness measures are more reliable and valid in European Americans, as most of the
measure development and validation studies have recruited primarily European American
samples. Additionally, European Americans are more likely than individuals from other races / ethni-
cities to seek out and utilize mindfulness practices (and therefore may have higher levels of trait
mindfulness) (Olano et al., 2015), which may have influenced the strength of the correlations
between mindfulness and sleep / smoking. We also found that the more men there were in the
study, the weaker the relation between mindfulness and physical activity. Women are twice as
likely as men to engage in any mindfulness practice (Olano et al., 2015), which may have influenced
the strength of the correlations between mindfulness and physical activity, as research suggests that
whether someone engages in meditation or not can sometimes influence the correlation between
mindfulness and other constructs (Baer et al., 2006). However, these reasons for the potential mod-
eration effects in regards to sample characteristics should also be relevant to other domains, although
our findings suggested they were not. It is not clear why we found moderation effects for some
behavioural domains but not others.
Publication type
We found that, in the case of healthy eating and smoking, the correlation was larger for published
studies than dissertations. The reasons for this finding are currently unclear, but may be related to
sample and study characteristics. In the case of healthy eating, one possibility behind this finding
is that most of the dissertation studies had lower sample sizes (median N = 26) than published
studies (median N = 310). In the case of smoking, there were some very large studies for published
studies (e.g. an N of 5,287) but not for dissertation studies (the N range was 13–602). These features
may have contributed to a less reliable estimate of the correlation between mindfulness and these
health behaviours for dissertations than published studies, as evidenced by larger confidence inter-
vals around the effect size estimates for dissertations than for published studies for both of these
health behaviours. We found the reverse pattern of results for physical activity (i.e. the correlation
was larger for dissertations than published studies). This may have been because all of the disser-
tation studies only had self-reported physical activity measures, and we found that the correlation
between mindfulness and health behaviours was larger for self-reported physical activity measures
than objective physical activity measures. We did not find any substantial differences in the size of the
correlations for the other behavioural domains. These inconsistent differences suggest there are not
consistent methodological differences between published and unpublished studies across behav-
ioural domains. Instead, the methodological differences may be domain specific.
Limitations
An important limitation of this study is that these data are correlational. Therefore, directionality and
causality cannot be inferred. It is unclear whether mindfulness has a causal effect on health beha-
viours, or other confounds exist, and/or whether change in mindfulness can promote healthy beha-
viours and reduce health risk behaviours. For example, personality is related to both mindfulness
(Giluk, 2009) and health behaviours (Bogg & Roberts, 2004), and could at least partially account for
the observed associations. More specifically, neuroticism and conscientiousness are personality
traits that may explain the association between mindfulness and health behaviours. No definite con-
clusions can be made from the current study on whether mindfulness promotes health behaviours
and/or whether health behaviours may increase mindfulness.
A second limitation of this meta-analysis is inconsistencies in the tests for publication bias across
the health behaviours, which prevents us from drawing a clear conclusion about publication bias
from the various tests. A third limitation is that less than half the included studies were used in
the meta-analysis because of insufficient quantitative data, which may have affected the estimates
we report in the manuscript. We attempted to retrieve these data by contacting the authors twice
with a one month lag between contacts. However, we were still unable to include several unpblished
effect sizes. A fourth limitation is that some of the moderator groups were smaller than others. The
small group sizes for some of the moderation groups reduce our confidence in the precision of the
correlations we found for those groups, and there should be more future research for some of the
smaller moderation categories.
Finally, certain characteristics of the included studies limited the ability to test for other moder-
ation effects and the scope of the analyses. For example, there was a lack of information and consist-
ency in the literature on how underrepresented ethnic group members were coded (e.g. many
manuscripts grouped several different ethnic groups together). A large portion of the included manu-
scripts did not include information on the percentage of individuals belonging to ethnic groups
outside of European Americans. Therefore, we only included the percentage of European Americans
as a moderating variable in the study.
Future directions
Future research should examine the effectiveness of different mindfulness-based interventions on
different health behaviours. It would also be of interest to examine how mindfulness could be com-
bined with existing interventions for health behaviours. For example, mindfulness interventions may
be used to strengthen the effect of action planning interventions (i.e, interventions that ask individ-
uals to make plans about when, where, and how they will engage in accordance with one’s goal-
directed actions; Hagger & Luszczynska, 2014). Mindfulness and action planning interventions
could complement each other because both mindfulness and action planning interventions may
help individuals put their intentions and commitments into practice (Chatzisarantis & Hagger,
2007; Hagger & Luszczynska, 2014). Being mindful may help individuals be more aware of and recog-
nise the specific parameters of their intentions and commitments (Chatzisarantis & Hagger, 2007),
and in turn exert greater influence on behavioural outcomes.
Future research should illuminate possible mechanisms by which trait mindfulness may be associ-
ated with health behaviours. Shapiro, Carlson, Astin, and Freedman (2006) developed a prominent
psychological model of mindfulness on health-related outcomes. Their model suggests that mindful-
ness is primarily related to a construct that they termed reperceiving (i.e. a shift in perspective that
30 M. SALA ET AL.
involves observing thoughts and feeling as passing events in the mind rather than reality). Reperceiv-
ing in turn may mobilise other psychological processes proximally related to health-related outcomes,
including values clarification, exposure to unpleasant experiences, self-regulation, and cognitive/
behavioural flexibility. First, mindfulness may help individuals clarify their values and engage in
health-promoting and refrain from health-risk behaviours that speak to these values (Hayes, Strosahl,
& Wilson, 1999; Shapiro et al., 2006). For example, there is research that suggests that higher levels of
purpose in life (which is related to values clarification) are associated with lower temptation to drink
over time (Roos et al., 2015). Second, greater mindfulness may enable individuals to be present with
unpleasant emotional states (i.e. exposure) and thereby not engage in maladaptive behaviours to
cope with unpleasant emotions. Several health deleterious behaviours (e.g. binge eating, risky sex,
substance use) have been theorised to be attempts to avoid cognitive awareness (Heatherton & Bau-
meister, 1991; McKirnan, Ostrow, & Hope, 1996). Third, mindfulness may interrupt habitual patterns of
unhealthy behaviours by increasing the ability to monitor and adapt one’s behaviour in order to
achieve goals rather than act out of habit. Finally, mindfulness may increase cognitive flexibility,
thereby encouraging individuals to process important information in one’s environment in order to
promote healthy behaviours (Shapiro et al., 2006). Emerging evidence suggests that mindfulness
can enhance repeceiving, values clarification, tolerance of unpleasant experiences, self-regulation,
and cognitive/behavioural flexibility (Carmody, 2009). Future research should examine the extent to
which these variables mediate the association between trait mindfulness and health behaviours.
Overall, there is some preliminary evidence that mindfulness may affect some of the proposed
mechanisms (i.e. reperceiving, values clarification, exposure, self-regulation, and cognitive/behav-
ioural flexibility) (Carmody, 2009), as well as evidence that at least some of the proposed mechanisms
may affect health behaviours (Roos et al., 2015). Future research should investigate whether these
findings hold in a mediation model. So far, Brown, Bravo, Roos, and Pearson (2015) examined
whether the mediation mechanism proposed by Shapiro et al. (2006) holds for the relationship
between each of the mindfulness facets and alcohol-related problems, and did not find support
for it. It is also possible that there may be a reciprocal longitudinal relation between mindfulness
and health behaviours (i.e. mindfulness may increase health behaviours and health behaviours
may increase mindfulness). Future longitudinal research with multiple assessments would allow us
to better understand the longitudinal and meditational relationships between mindfulness and
health behaviours.
Conclusion
Overall, we found a statistically significant but small correlation between trait mindfulness and health
behaviours. The small overall association suggests that individual differences in trait mindfulness
likely does not reliably translate into a pattern of healthful behaviours. Therefore, the importance
and utility of mindfulness as a factor in improving health behaviours may be limited in the
general population. However, trait mindfulness had relatively stronger associations with health beha-
viours in some populations, suggesting that there are important boundaries of the assocations
between mindfulness and health behaviours.
Acknowledgement
Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors and do
not necessarily reflect the views of the National Science Foundation.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
Margarita Sala is supported by the National Science Foundation Graduate Research Fellowship under grant number DGE-
1645420.
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40 M. SALA ET AL.
Appendix A. Summary of Included Studies.
Publication Mindfulness % Mean Sample

Authors Year type Measures Behavioral Measures N male Age Type
Adams et al. 2015 Journal MAAS Alcohol Quantity and 399 49.1 42.44 N
Frequency
Questionnaire average
number of drinks per
week
Alcohol Quantity and
Frequency
Questionnaire binge
drinking frequency
Heaviness of Smoking
Index (HSI) cigarettes
per day
Adams et al. 2012 Journal FFMQ total and 5 Cigarettes per week 112 0 19.96 N
subscales
Adams et al. 2014 Journal FFMQ total and 5 Cigarettes per day 112 0 19.96 N
subscales
Agagianian 2014 Dissertation FFMQ-SF total Sleep Hygiene Index (SHI) 52 40.38 . N
sleep hygiene
behaviours
Bablas et al. 2016 Journal FFMQ total and 5 Pittsburgh Sleep Quality 8 50 56.28 C
subscales Index (PSQI) sleep
duration
Actigraphy total sleep
time (TST)
Bahl et al.- 2013 Journal Own mindfulness Days eat too much 353 57.2 . N
General measure Days skip meals
Sample Yoga or tai-chi
frequency
Bahl et al. – 2013 Journal Own mindfulness Days eat too much 28 . . N
Sample with measure Days skip meals
Meditation Yoga or tai-chi
Training frequency
Barros et al. 2015 Journal FFMQ total and 5 Smoking status (D) 181 33.70 . N
subscales
Benzo et al. 2017 Journal FFMQ act, Exercise quantity 400 35 45.92 N
nonreact.
Beshara et al. 2013 Journal FFMQ total, Energy Dense Food 171 29.8 39.50 N
describe, act Serving Size
Black et al. 2016 Journal MAAS-SF Current smoking status 409 52.8 58.5 N
(D)
Current alcohol use (D)
American Cancer
Society Third Cancer
Prevention Study
Questionnaire current
physical activity status
(D)
Black et al. 2012 Journal MAAS CDC Youth Risk Behavior 5287 51.2 16.2 N
Survey smoking days
Bodenlos et al. 2015 Journal FFMQ 5 subscales Exercise minutes 310 32 19.7 N
Fast food consumption
frequency
Fruit and vegetable
servings / day
Weekday sleep
duration
Weekend sleep
duration
(Continued)
Continued.
Bogusch et al. 2016 Journal FFMQ-SF total and Exercise frequency 283 13.1 20.37 N
5 subscales PSQI sleep duration
Bonn-Miller et al. 2010 Journal KIMS observe, Marijuana Smoking 97 52.6 21.57 N
describe, act, History Questionnaire
nonjudge marijuana use
frequency
Bowen et al. 2014 Journal FFMQ total and 5 Timeline Followback 286 70.26 38.41 C
subscales (TFLB) percent of heavy
drinking days in past
month
TFLB percent of
drinking days in past
month
TFLB percent of drug
use days in past month
Bowen et al. 2009 Journal FFMQ total and 5 TLFB alcohol use days 168 63.7 40.5 C
subscales TFLB mean drinks per
drinking day
TLFB drug use days
Bramm et al. 2013 Journal MAAS Modified Quantity / 390 52 19 N
Frequency Index of
alcohol consumption
Bravo et al. – 2018 Journal FFMQ total and 5 Alcohol Use Disorders 407 55.5 32.74 N
Military subscales (AUDIT) alcohol
Personnel consumption
Bravo et al.- 2018 Journal FFMQ total and 5 AUDIT alcohol 310 58.7 24.46 N
College subscales consumption
Students
Bravo et al. 2016 Journal FFMQ total and 5 Daily Drinking 448 32.6 22.74 N
subscales Questionnaire (DDQ)
alcohol consumption
Brem et al. 2017 Journal MAAS AUDIT alcohol 184 100 40.82 C
consumption
Drug Use Disorders
(DUDIT) drug
consumption
Brooks et al. 2012 Journal SCS-mindfulness Opiate Treatment Index 77 54.5 . C
Alcohol Scale quantity
and frequency of
alcohol consumption
Caldwell et al. 2011 Journal FFMQ total and 5 PSQI sleep duration 208 63.46 21.27 N
subscales Hours of weekly
exercise
Caldwell et al. 2010 Journal FFMQ total and 5 PSQI sleep duration 166 15.06 21.29 N
subscales Hours of weekly
exercise
Campbell et al. 2015 Journal MAAS PSQI sleep duration 215 39 31.00 N
Chatzisarantis & 2007 Journal MAAS Vigorous physical activity 226 48.67 19.23 N
Hagger – frequency
Study 1
Chatzisarantis & 2007 Journal MAAS Vigorous physical activity 292 48.63 19.48 N
Hagger – frequency
Study 2
Christopher et al. 2013 Journal MAAS Alcohol consumption 125 32.8 24 N
frequency
Compare et al. – 2012 Journal FFMQ total and 5 Eating Disorder 150 34.67 51.40 N
Normal Control subscales Examination-
Sample Questionnaire (EDE-Q)
Objective Binge /
Bulimic Episode
Frequency
2012 Journal 150 34.67 50.10 N
(Continued)
42 M. SALA ET AL.
Continued.
Compare et al.- FFMQ total and 5 EDE-Q Objective Binge /
Obese Sample subscales Bulimic Episode
Frequency
Compare et al. – 2012 Journal FFMQ total and 5 EDE-Q Objective Binge / 150 34.67 49.30 C
BED Sample subscales Bulimic Episode
Frequency
Coppersmith 2017 Dissertation FFMQ total Fruit and vegetable 187 59.9 20.80 N
screener: fruit and
vegetable intake
International Physical
Activity Questionnaire –
Short Form (IPAQ-SF)
Weekly Metabolic
Equivalent of Task
(MET)
Daubenmier 2012 Journal KIMS observe, FFQ % fat caloric intake 47 0 40.89 N
et al. describe, act, FFQ total caloric intake
nonjudge, MAAS
Davis et al. 2014 Journal FFMQ total and 5 Cigarettes per day 196 50 41.65 N
subscales
Davis et al. 2015 Journal FFMQ total and 5 Cigarettes per day 26 42.3 40.50 N
subscales
de Bruin et al. 2016 Journal FFMQ-SF total and Exercise minutes 75 26.67 26.22 N
5 subscales, SCS-
SF mindfulness
De Petrillo et al. 2009 Journal KIMS total, Weekly mileage 25 40.00 34.73 N
observe, Weekly run frequency
describe, act,
nonjudge
Duarte & Pinto- 2015 Journal MAAS EDE-Q over-exercise 512 0 21.81 N
Gouveia EDE-Q binge eating
EDE-Q diuretic use
EDE-Q laxative use
EDE-Q vomiting
Elander et al. 2014 Journal MAAS, SCS-SF Over the counter 112 18 44.5 N
mindfulness painkiller use frequency
Prescription painkiller
use frequency
Erskine et al. 2012 Journal MAAS Cigarettes per day 90 . 24.24 N
Fernandez et al. 2010 Journal FFMQ 5 subscales DDQ weekly drinking 316 44 22 N
episodes
Heavy episodic drinking
episodes
Quantity-Frequency
Questionnaire peak
drinking
Fishbein et al. 2016 Journal FFMQ total and 5 Drug Use Screening 104 44 16.7 N
subscales Inventory- Revised
(DUSI-R) alcohol use
DUSI-R marijuana use
DUSI-R prescription not
prescribed use
Frazier 2018 Journal FFMQ nonreact PSQI sleep duration 362 22 21.29 N
Froeliger et al. 2017 Journal FFMQ total and 5 Average daily cigarettes 13 70.38 49 N
subscales
Gallagher et al. 2010 Journal MAAS National Institute on 167 100 26.35 N
Alcohol Abuse and
Alcoholism’s alcohol
quantity on a typical
drinking day
National Institute on
Alcohol Abuse and
(Continued)
Continued.
Alcoholism’s alcohol
frequency
Garland et al. 2012 Journal FFMQ total and 5 Drinks per day 58 81 39.8 C
subscales
Garland et al. 2015 Journal MAAS Opioid self-medication 79 43.6 35.1 C
for anger
Opioid self-medication
for depression
for anxiety
for global negative
affect
Garland et al. 2013 Journal FFMQ total and 5 PSQI Sleep Duration 111 27.93 58.89 C
subscales
Geller et al. 2015 Journal SCS- mindfulness EDE-Q compulsive 131 0 28.76 N
exercise
EDE-Q binge eating
EDE-Q laxative Use
EDE-Q vomiting
Gonzalez et al. 2009 Journal MAAS Smoking History 174 54 25.32 N
Questionnaire (SHQ)
cigarettes per day
Marijuana Smoking
History Questionnaire
marijuana use
frequency
AUDIT alcohol
consumption
Greeson et al. 2014 Journal CAMS-R; SCS- Medical Outcome Study 90 34 25.4 N
mindfulness (MOSS) Sleep Scale
hours of sleep each
night
Grinnell et al. 2011 Journal MAAS IPAQ-S METS minutes per 75 10.67 18.1 N
week
Fruit and Vegetable
Screener fruit and
vegetable cups / day
Harkess et al. 2017 Journal MAAS IPAQ MET 116 0 48.14 N
Hasan 2014 Dissertation MAAS TLFB alcohol use 102 95 51 C
TLFB cigarette use
TLFB cannabis use
Heppner et al. 2016 Journal MAAS Cigarettes per day 399 49.1 42.44 N
Howell et al. 2010 Journal MAAS SHI 334 34 20.89 N
Hülsheger et al. 2015 Journal MAAS PSQI sleep duration 140 30.7 37.33 N
Jacobs 2011 Dissertation MAAS AUDIT alcohol 198 25.76 21 N
consumption
Jacobs et al. 2016 Journal KIMS total, Multiple Health Behavior 427 5.1 34.1 N
observe, Questionnaire active
describe, act, and lifestyle
nonjudge Multiple Health
Behavior Questionnaire
nutrition
Johnson 2014 Dissertation MAAS Daily diary physical 108 26 36.16 N
activity
Daily diary unhealthy
food and drink servings
Kang et al. 2017 Journal MAAS IPAQ weekly exercise 67 38.81 33.42 N
minutes
Kangasniemi 2014 Journal KIMS total Accelerometer Moderate- 108 21 43 N
et al. to-Vigorous Physical
Activity (MVPA) time
(Continued)
44 M. SALA ET AL.
Continued.
Accelerometer minutes
of health enhancing
physical activity time
Accelerometer steps
per day
Physically active vs. not
active (D)
Karyadi and 2015 Journal FFMQ total and 5 DDQ alcohol use quantity 240 30 19.37 N
Cyders subscales DDQ alcohol use
duration
AUDIT alcohol
consumption
Knight et al. 2014 Journal PHLMS total, Mean # of times 23 30.43 40.74 C
awareness, practicing yoga each
acceptance month
Kovacs 2017 Dissertation FFMQ describe, Total Cigarettes Smoked 128 0 22.87 N
act, nonjudge,
and total of
these 3 subscales
Larouche et al. 2015 Journal FFMQ total and 5 Sleep Diary TST 12 0 54 C
subscales
Leigh et al. 2005 Journal FMI total and Frequent binge drinker 196 36 . N
mind/body (D)
awareness Smoking status (D)
Leigh & 2009 Journal FMI openness, DDQ drinks per week 212 52 19.52 N
Neighbors mind/body
awareness, and
non-attachment
Lengacher et al. 2018 Journal FFMQ total and 5 PSQI sleep duration 15 0 57.00 N
subscales
Levin et al. 2014 Journal FFMQ 5 subscales Rhode Island Bariatric 820 19.2 42.93 N
Surgery Interview
habitual overeating
Rhode Island Bariatric
Surgery Interview rapid
overeating
Surgery Interview binge
eating
Surgery Interview
grazing
Surgery Interview rapid
overeating but never
with loss of control
Luberto et al. 2011 Journal KIMS total, Cigarettes per day 90 52.22 26.60 N
observe,
describe, act, and
nonjudge
Lucas – Study I 2014 Dissertation FFMQ total and 5 PSQI sleep duration 58 0 61.7 N
subscales Food Habit
Questionnaire fruit and
vegetable consumption
Food Habit
Questionnaire fats and
oil consumption
Food Habit
Questionnaire dairy
consumption
Paffenbarger
Questionnaire (PAQ)
(Continued)
Continued.
stair flights climbed per
day
PAQ walking minutes /
week
PAQ weekly caloric
expenditure
Lucas – Study 2 2014 Dissertation FFMQ total and 5 PSQI sleep duration 17 0 61.1 N
subscales; MAAS Food Habit
Questionnaire fruit and
Food Habit
Questionnaire fats and
oil consumption
Food Habit
Questionnaire dairy
consumption
Accelerometer steps /
day
Accelerometer minutes
of light physical activity
/ wk
Accelerometer MVPA
mins / wk
Modified PAQ Physical
Activity
PAQ Walking minutes
Lundwall 2011 Dissertation FFMQ total Physical activity 554 28 20 N
frequency
Malboeuf- 2016 Journal CAMM PSQI sleep duration 13 26.79 15.46 N
Hurtubise et al.
Malouf et al. 2017 Journal Own Measure Marijuana use frequency 40 100 37.2 N
Alcohol use frequency
Marchiori & 2014 Journal FFMQ total and 5 Plate cleaning tendency 110 . 20.90 N
Papies subscales
Martelli 2017 Dissertation MAAS Alcohol consumption 80 32.5 18.77 N
Martin et al. 2013 Journal MAAS Yoga practice 159 0 . N
Cardio-based exercise
participation
Food Frequency
Questionnaire (FFQ)
fruit/vegetables
consumption
FFQ take-away food
consumption
Maxfield 2017 Dissertation MAAS Sleep diary hours in bed 73 0 59.1 N
PSQI sleep duration
Meland et al. 2015 Journal FFMQ total and 5 Physical activity 40 100 36.88 N
subscales frequency
Sleep quantity
Mermelstein 2013 Dissertation FFMQ total Binge drinking episodes 76 50 19.05 N
Morrissey 2017 Dissertation MAAS PSQI sleep duration 287 2.44 51.05 N
AUDIT alcohol quantity
AUDIT alcohol
frequency
AUDIT alcohol binge
drinking frequency
Mothes et al. 2014 Journal MAAS BSA questionnaire 118 100 45.15 N
exercise minutes per
week
BSA questionnaire
activities of daily life
minutes per week
(Continued)
46 M. SALA ET AL.
Continued.
Murphy & 2012 Journal FFMQ 5 subscales AUDIT alcohol 116 19.5 20.3 N
MacKillop consumption
Murphy et al. 2012 Journal MAAS Leisure-Time Exercise 441 0 19.06 N
Questionnaire exercise
frequency
Nakamura et al. 2013 Journal FFMQ total and 5 MOSS Sleep Scale sleep 57 24.56 52.59 N
subscales quantity
Nakamura et al. 2011 Journal FFMQ total and 5 MOSS Sleep Scale sleep 63 95.24 52.07 N
subscales quantity
Nosratabadi et al. 2018 Journal MAAS Experience smoking (D) 350 100 16.80 N
Current smoking (D)
Ong et al. 2008 Journal KIMS total, Sleep Diary TST 30 40 36.4 C
observe,
describe, act, and
nonjudge
Ostafin et al. 2013 Journal FFMQ total National Institute on 61 55.73 19.6 N
Alcohol Abuse and
Alcoholism frequency
of alcohol
consumptions
Alcohol Abuse and
Alcoholism average
drinks per occasion
Alcohol Abuse and
Alcoholism binge
drinking episode
frequency
Ottaviani & 2013 Journal FFMQ total and 5 Alcohol consumption 40 47.5 24.49 N
Couyoumdjian subscales Cigarette consumption
Palmeira et al. 2017 Journal FFMQ-15 total and Physical Activity 73 0 42.36 N
5 subscales, SCS- frequency
Mindfulness Exercise (D)
Pentz et al. 2016 Journal MAAS Past month alcohol use 405 51.7 12.50 N
Lifetime alcohol use (D)
Past month cigarette
use
Lifetime cigarette use
(D)
Peters 2016 Dissertation FFMQ total and 5 Drinking status (D) 30 30 .- C
subscales Smoking status (D)
Caffeine amount per
week
PSQI sleep duration
Actigraphy sleep
duration
Sleep Diary sleep
duration
Philip 2010 Dissertation MAAS DDQ alcohol 427 29 20.42 N
consumption
Marijuana use
Pineau 2014 Dissertation FFMQ total and 5 Non-running exercise 55 47.3 19.35 N
subscales, SCS- Mileage per week on
nindfulness, own
PHLMS Mileage per week with
awareness and team
acceptance
Pivarunas et al. 2015 Journal MAAS EDE Binge eating (D) 114 0 14.50 N
Eating in the Absence
of Hunger
Questionnaire for
(Continued)
Continued.
Children and
Adolescents – external
cues
of Hunger
Questionnaire for
Children and
Adolescents – fatigue
of Hunger
Questionnaire for
Children and
Adolescents – negative
affect
Potts 2015 Dissertation FFMQ 5 subscales; IPAQ-SF moderate 275 . . N
MAAS exercise
IPAQ-SF vigorous
exercise
IPAQ-SF walking
Current yoga practice
Past yoga practice
Past tai-chi practice
Tobacco use
Alcohol use
Rendon 2006 Dissertation KIMS total Alcohol use 284 52.46 20.76 N
Reynolds et al. 2015 Journal KIMS observe, Alcohol use 76 57.89 21.10 N
describe, act, and
nonjudge
Roberts & 2010 Journal FFMQ total and act Youth Risk Behavior 553 30.3 18.8 N
Danoff-Burg Surveillance System
Daily weekly physical
activity frequency
Youth Risk Behavior
Surveillance System
Daily daily physical
activity frequency
Youth Risk Behavior
Surveillance System
Daily number of sex
partners in past 3
months
Youth Risk Behavior
Surveillance System
Daily number of
lifetime sex partners
Youth Risk Behavior
Surveillance System
Daily smoking
frequency
Youth Risk Behavior
Surveillance System
Daily smoking quantity
Robinson et al. 2014 Journal CAMM Current alcohol 1051 51 15.60 N
consumption
Lifetime alcohol use (D)
Current marijuana use
Lifetime marijuana use
(D)
Ross 2012 Dissertation FMI-SF total Yoga practice frequency 1045 15.8 51.68 N
Yoga class frequency
Frequency of standing
yoga poses
(Continued)
48 M. SALA ET AL.
Continued.
Frequency of vigorous
yoga poses
Frequency of inverted
yoga poses
Frequency of gentle
yoga poses
Physical activity
Alcohol quantity
Caffeine quantity
National Cancer
Institute’s Multifactor
Screener fruit and
vegetable quantity
Ruffault et al. 2016 Journal MAAS IPAQ MET 100 52 33.49 N
Ruffault et al. 2017 Journal MAAS IPAQ MET 244 41.79 21 N
Sagui-Henson 2018 Journal FFMQ total IPAQ MET 233 46.8 39.6 N
et al. PAQ Food Frequency
Subscale Fruit and
Schellhas et al. 2016 Journal FFMQ-SF act DDQ alcohol use 125 40.8 20.25 N
Schuman-Olivier 2014 Journal FFMQ nonjudge TFLB cigarettes per day 85 61.17 46.03 N
et al.
Sherr 2010 Dissertation MAAS PSQI sleep duration 127 51 53.00 N
Slonim et al. 2015 Journal FFMQ total and 5 Health Promoting 207 32.9 21.82 N
subscales Lifestyle Profile-II
physical activity
Health Promoting
Lifestyle Profile-
Inutrition
Spinella et al. 2013 Journal Own measure AUDIT alcohol 190 36.84 26.60 N
derived from consumption
FFMQ - total and
5 subscales
Stasiewicz et al. 2013 Journal KIMS total, TLFB alcohol drinks per 77 50.65 45.7 C
observe, drinking day
describe, act, and TFLB percent of days
nonjudge; MAAS abstinent from drinking
Percent heavy drinking
days
Drinks per heavy
drinking day
Tanaka et al. 2011 Journal SCS-mindfulness AUDIT alcohol 117 45.3 18.1 N
consumption
Tarantino et al. 2015 Journal MAAS DUDIT drug use 928 0 19.92 N
Tihanyi et al. 2016 Journal MAAS Sport practice frequency 1057 31.32 30.6 N
Tsafou et al. 2016 Journal MAAS IPAQ-SF exercise quantity 398 49.7 41.28 N
(MET)
Tsafou et al. 2017 Journal MAAS; FFMQ total IPAQ-SF exercise quantity 305 48.9 40.7 N
and 5 subscales (MET)
Ulmer 2006 Dissertation MAAS Adherence to CDC 226 36.7 49.96 N
guidelines (D)
Exercise lapse (2 weeks
of missed exercise) (D)
Exercise relapse (3
months of missed
exercise) (D)
Missed at least one
week of exercise (D)
Regular exerciser (D)
Frequency of exercise
slips
Ussher et al. 2009 Journal MAAS 48 64.58 27.8 N
(Continued)
Continued.
Fagerström Test for
Nicotine Dependence
cigarettes per day
Vidrine et al. 2009 Journal KIMS total; MAAS HSI cigarettes per day 158 55 43.8 N
Vinci et al. 2014 Journal FFMQ total and 5 AUDIT alcohol frequency 207 23.7 20.13 N
subscales question
AUDIT drinks per day
question
AUDIT binge drinking
frequency question
Vinci et al. 2016 Journal KIMS total, Cigarettes per day 72 25 21.44 N
observe,
describe, act, and
nonjudge
Visser et al. 2015 Journal MAAS PSQI sleep duration 219 37.0 72.88 N
Wanner 2017 Dissertation MAAS; FMI total; High vs. low exerciser (D) 54 59.26 19.50 N
FFMQ-SF total Total exercise days
and 5 subscales Total exercise minutes
Smoking behaviour
West 2008 Dissertation MAAS; KIMS Alcohol use 610 35 16.75 N
observe, Cigarette use
describe, act, and Other drug use
nonjudge; FFMQ
5 subscales; own
measure
Wong et al. 2017 Journal FFMQ total and 5 Sleep diary TST 216 21.76 56.09 C
subscales
Notes: MAAS = Mindful Attention Awareness Scale; FFMQ = Five Facet Mindfulness Questionnaire; SF = Short-Form;
KIMS = Kentucky Inventory of Mindfulness Skills; SCS = Self-Compassion Scale; CAMS-R = Cognitive and Affective Mind-
fulness Scale-Revised; PHLMS = Philadelphia Mindfulness Scale; FMI = Freiburg Mindfulness Inventory; CAMM = Child
and Adolescent Mindfulness Measure; D = Dichotomized; N = Non-Clinical; C = Clinical.
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Trait Mindfulness and Health Behaviors: A Meta-Analysis

Article in Health Psychology Review · July 2019

Margaret Sala Catherine Rochefort

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P. Priscilla Lui Austin S Baldwin

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ISSN: 1743-7199 (Print) 1743-7202 (Online) Journal homepage: https://www.tandfonline.com/loi/rhpr20

Trait mindfulness and health behaviours: a meta-

Margarita Sala, Catherine Rochefort, P. Priscilla Lui & Austin S. Baldwin

To link to this article: https://doi.org/10.1080/17437199.2019.1650290

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Trait mindfulness and health behaviours: a meta-analysis

ABSTRACT ARTICLE HISTORY

CONTACT Margarita Sala msala@smu.edu

Conceptualising and measuring mindfulness

Distinctiveness of mindfulness from other constructs

Existing measures assessing trait mindfulness

Associations between mindfulness and health behaviours

Possible moderators in the mindfulness-health behaviours relation

Types of health behaviours

HEALTH PSYCHOLOGY REVIEW

HEALTH PSYCHOLOGY REVIEW

Measurement of health behaviours

Psychiatric and medical statuses of the sample

The present study

Screening and coding

Primary and secondary screening

Data analytic plan

Weighted mean eﬀect size estimates

Heterogeneity and moderator analyses

Overall average study-level eﬀect size

Table 4. Moderators of the relation between mindfulness and physical activity.

Health behaviour measure: objective vs. self-report

Table 5. Moderators on the relations between mindfulness and healthy eating.

Table 6. Moderators on the relations between mindfulness and sleep.

Exploratory analyses: ethnicity, age, and gender

Table 7. Moderators on the relations between mindfulness and alcohol use.

Mindfulness and health behaviors: agreggated eﬀects

Table 8. Moderators on the relations between mindfulness and drug use.

Table 9. Moderators on the relations between mindfulness and smoking.

Health behaviour measure (objective vs. self-report)

Clinical status of the sample

Appendix A. Summary of Included Studies.

Publication Mindfulness % Mean Sample

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