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A direct relationship reflects an immediate linkage between a determinant and the problem, where the problem flows straightforwardly from or is a function of the determinant. For example, there is a direct association between caffeine and nicotine intake close to bedtime and insomnia; caffeine and nicotine are stimulants that interfere with sleep.

An indirect relationship can take either of two forms: mediated or moderated. The relationship between a determinant and the health problem is considered mediated when another factor intervenes between the two, whereby the determinant influences the mediator (also called intervening factor), which in turn affects the health problem (MacKinnon & Fairchild, 2009). For example, cognitions are erroneous beliefs, resulting from worry or rumination about sleep‐related issues such as inability to get eight hours of sleep and the negative impact of insomnia on daytime functions. These cognitions increase arousal and drive engagement in sleep behaviors in an attempt to alleviate arousal; however, these behaviors may be ineffective and the repeated experience of arousal in bed results in conditional arousal (i.e. associating the bed with wakefulness), which contributes to insomnia (Schwartz & Carney, 2012). The relationship between a determinant and the health problem is characterized as moderated when it is affected by another factor (also called moderator). The moderator is the condition (e.g. personal or environmental feature) under which the relationship exists, that is, the presence, strength or magnitude, and/or direction of the relationship between the determinant and the health problem vary according to the value of the moderator (Fleury & Sidani, 2018). For instance, gender could moderate the association between arousal and insomnia; women may experience life stress (because of multiple roles' demands) and worry, which is likely to strengthen the relationship between arousal and insomnia if not well managed.