Abstract Body (Do not enter title and authors here): Background
Nine lifestyle characteristics have been identified across Blue Zones - 5 regions of the world noted for their longevity - but these factors have yet to be empirically tested. This study aimed to do so by analyzing data from the Women’s Health Initiative (WHI), a 30+ year prospective study of post-menopausal women.

Research Question
Is higher adherence to Blue Zone characteristics associated with a lower mortality risk in women?


Methods
This analytic sample was comprised of 31,099 participants from the WHI Observational Study. Eligible women had no missing values for the nine factors, assessed via questionnaires: 1) moving via physical activity (PA); 2) having purpose via purpose in life constructs; 3) reducing stress via perceived stress; 4) eating less via body mass index (BMI); 5) eating plant-based protein diet via Mediterranean diet intake; 6) consuming light alcohol via weekly alcohol patterns; 7) having faith-based community via frequency of church attendance; 8) putting family first via frequency meeting with family and friends; and 9) having a social circle via MOS social support. Death was determined by medical record review with adjudication and linkage to the National Death Index. Multivariable Cox models estimated hazard ratios (HR) for all-cause and CVD-specific mortality with time beginning at Blue Zones characteristics assessment (2011) through 2024.

Results
During the observational period, 11,420 (38.5/1000 person-years) women died. Factors associated with reduced mortality included lower BMI, higher PA, higher purpose in life, lower perceived stress, light alcohol consumption, higher church attendance, and regularly meeting with family and friends (Table 1). A dose-response relationship was seen for PA and all-cause mortality (P<0.001), with a 44% reduction in mortality for high PA and still a reduction of 22% for light activity. Reporting a strong life purpose and meeting frequently with friends and family were associated with a 33% and 32% lower mortality, respectively. For CVD mortality, factors associated with reduced risk were largely the same, with the exception of higher social support showing a reduced risk of CVD mortality but not all-cause mortality.

Conclusion
In addition to robust findings linking higher physical activity to reduced mortality, psychological components, such as having a purpose and social interactions, were also associated with lower mortality risk. Promoting longevity requires attention to multiple factors.