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Title:Adoption and maintenance of health behaviors among middle-aged and older adults: the role of chronic disease diagnosis and depression
Author(s):Xiang, Xiaoling
Director of Research:Larrison, Christopher
Doctoral Committee Chair(s):Larrison, Christopher R.
Doctoral Committee Member(s):Zhan, Min; An, Ruopeng; Gehlert, Sarah
Department / Program:School of Social Work
Discipline:Social Work
Degree Granting Institution:University of Illinois at Urbana-Champaign
Degree:Ph.D.
Genre:Dissertation
Subject(s):Health and Retirement Study
health behavior
chronic disease
depression
older adults
teachable moment
Abstract:This study is a secondary-data analysis of adoption and maintenance of health behavior changes among U.S. middle-aged and older adults. This investigation focused on the impact of a chronic disease diagnosis on the likelihood of a health behavior change and whether the magnitude of change is modified by major or persistent depression prior to the chronic disease diagnosis. Further analyses assessed whether depression and a new chronic disease diagnosis affected long-term maintenance of health behaviors changes, once made. The study sample came from 1996-2010 waves of the Health and Retirement Study and consisted of 11,439 community-dwelling adults aged 50-80 years who were free of diabetes, heart disease, stroke, cancer, and chronic lung disease in 1996. Depression was measured by the 8-item Center for Epidemiologic Studies Depression Scale and the short form of the World Health Organization’s Composite International Diagnostic Interview. Chronic disease diagnosis was ascertained from self-reported physician diagnosis of a specific condition. Health behaviors included six dichotomous measures of current smoking status, drinking level (moderate or excessive), vigorous physical activity (≥ 3 times per week), receipt of influenza vaccination, blood test for cholesterol, prostate exam for men, and mammography for women. Matched case-control difference-in-differences estimator was used to estimate the effect of each chronic disease diagnosis on the likelihood of change in each health behavior. Mixed-effects logistic regression was applied to analyze the longitudinal impact of depression on health behaviors and to examine whether depression modified the impact of a chronic disease diagnosis on health behaviors. Kaplan-Meier estimator and the marginal risk set model were performed to assess the impact of a chronic disease diagnosis, depression, and their interaction on the likelihood of relapse after a health behavior change had been initiated. Middle-aged and older adults tended to reduce smoking and drinking, and increase utilization of preventive health services after a diagnosis of chronic disease. However, they reported a consistent decline in vigorous physical activity post diagnosis across disease conditions. Participants with major or persistent depression at baseline were more likely to remain smoking and less likely to engage in vigorous physical activity during the 14 years of follow-up. Depression also appeared to modify behavioral responses to a chronic disease diagnosis. Participants with depression experienced smaller increase in influenza vaccination utilization after a chronic disease diagnosis compared to their initially non-depressed counterparts. Depression did not seem to modify the impact of a new chronic disease on other health behaviors. The majority of middle-aged and older adults who initiated a health behavior change adhered to the change in the long-term. A new diagnosis of chronic disease did not appear to affect the likelihood of behavior maintenance. Chronic disease diagnosis may be an important teachable moment that can motivate individuals to spontaneously adopt risk-reducing health behaviors. More focused and intensive interventions are needed for those with chronic disease and comorbid depression to produce meaningful behavior change outcomes. Future research needs to elucidate the mechanisms through which chronic disease diagnosis affects health behaviors, develop and test the effectiveness of interventions utilizing the teachable moment effect of a chronic disease diagnosis, along with identifying population-based strategies to promote physical activity among adults with chronic disease.
Issue Date:2015-04-16
Type:Thesis
URI:http://hdl.handle.net/2142/78740
Rights Information:Copyright 2015 Xiaoling Xiang
Date Available in IDEALS:2015-07-22
Date Deposited:May 2015


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