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Abstract Background Wearable devices are increasingly adopted for personal health monitoring, but evidence on their long-term associations with health-related lifestyle behaviors in real-world population settings remains limited. Objective This study examined the longitudinal association between wearable device adoption and engagement in health-related lifestyle behaviors using a nationally representative panel dataset from South Korea. Methods We analyzed data from the 2016 and 2022 waves of the Korea Media Panel survey. Health-related lifestyle behaviors in the physical, social, and cultural domains were operationalized as estimated annual activity counts based on self-reported frequency measures. We used a difference-in-differences framework with generalized estimating equations to compare changes in these behaviors between new wearable adopters and nonadopters adjusting for demographic and socioeconomic characteristics. Relative changes were estimated using Poisson models with a log link, and subgroup analyses were conducted to explore variation across sociodemographic groups. As a sensitivity analysis, inverse probability of treatment weighting was additionally applied to assess the robustness of the findings to observed baseline imbalance. Results Wearable device adoption was associated with greater increases in total, physical, and cultural health-related lifestyle activities over time. In the difference-in-differences model, adopters showed greater relative increases in total activity (rate ratio RR 1.24, 95% CI 1.08-1.35), physical activity (RR 1.36, 95% CI 1.12-1.64), and cultural activity (RR 1.78, 95% CI 1.31-2.42) than nonadopters. Subgroup analyses showed limited evidence of consistent heterogeneity and should be interpreted cautiously. Sensitivity analyses using inverse probability of treatment weighting showed overall patterns broadly similar to those of the primary analyses. Conclusions In this nationally representative panel study, wearable device adoption was associated with greater increases in total, physical, and cultural health-related lifestyle activities over time, whereas no clear association was observed for social activity. These findings should be interpreted as associative rather than causal given the observational design and the inability to directly assess parallel trends.
Choi et al. (Mon,) studied this question.