Health behavior change following chronic illness in middle and later life
01 May 2012-Journals of Gerontology Series B-psychological Sciences and Social Sciences (Oxford University Press)-Vol. 67, Iss: 3, pp 279-288
TL;DR: Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.
Abstract: Objectives Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life. Methods Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease. Results Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors. Discussion Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.
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International Agency for Research on Cancer1, University of Milan2, North-West University3, British Heart Foundation4, University of Cambridge5, Imperial College London6, Université Paris-Saclay7, National and Kapodistrian University of Athens8, German Cancer Research Center9, Aarhus University10, University of Barcelona11, Andalusian School of Public Health12, Cancer Epidemiology Unit13, University of Ioannina14, Prevention Institute15, Centre for Health Protection16, Utrecht University17, Umeå University18, Lund University19
TL;DR: Pre-diagnostic healthy lifestyle behaviours were strongly inversely associated with the risk of cancer and cardiometabolic diseases, and with the prognosis of these diseases by reducing risk of multimorbidity.
Abstract: Although lifestyle factors have been studied in relation to individual non-communicable diseases (NCDs), their association with development of a subsequent NCD, defined as multimorbidity, has been scarcely investigated. The aim of this study was to investigate associations between five lifestyle factors and incident multimorbidity of cancer and cardiometabolic diseases. In this prospective cohort study, 291,778 participants (64% women) from seven European countries, mostly aged 43 to 58 years and free of cancer, cardiovascular disease (CVD), and type 2 diabetes (T2D) at recruitment, were included. Incident multimorbidity of cancer and cardiometabolic diseases was defined as developing subsequently two diseases including first cancer at any site, CVD, and T2D in an individual. Multi-state modelling based on Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (95% CI) of developing cancer, CVD, or T2D, and subsequent transitions to multimorbidity, in relation to body mass index (BMI), smoking status, alcohol intake, physical activity, adherence to the Mediterranean diet, and their combination as a healthy lifestyle index (HLI) score. Cumulative incidence functions (CIFs) were estimated to compute 10-year absolute risks for transitions from healthy to cancer at any site, CVD (both fatal and non-fatal), or T2D, and to subsequent multimorbidity after each of the three NCDs. During a median follow-up of 11 years, 1910 men and 1334 women developed multimorbidity of cancer and cardiometabolic diseases. A higher HLI, reflecting healthy lifestyles, was strongly inversely associated with multimorbidity, with hazard ratios per 3-unit increment of 0.75 (95% CI, 0.71 to 0.81), 0.84 (0.79 to 0.90), and 0.82 (0.77 to 0.88) after cancer, CVD, and T2D, respectively. After T2D, the 10-year absolute risks of multimorbidity were 40% and 25% for men and women, respectively, with unhealthy lifestyle, and 30% and 18% for men and women with healthy lifestyles. Pre-diagnostic healthy lifestyle behaviours were strongly inversely associated with the risk of cancer and cardiometabolic diseases, and with the prognosis of these diseases by reducing risk of multimorbidity.
131 citations
TL;DR: Little evidence that a cancer diagnosis motivates health-protective changes among UK cancer survivors is found, and strategies for effective support for behaviour change in cancer survivors need to be identified.
Abstract: A healthy lifestyle following a cancer diagnosis may improve long-term outcomes. No studies have examined health behaviour change among UK cancer survivors, or tracked behaviours over time in survivors and controls. We assessed smoking, alcohol and physical activity at three times (0–2 years before a cancer diagnosis, 0–2 years post-diagnosis and 2–4 years post-diagnosis) and at matched times in a comparison group. Data were from waves 1–5 of the English Longitudinal Study of Ageing; a cohort of older adults in England. Behavioural measures were taken at each wave. Generalised estimating equations were used to examine differences by group and time, and group-by-time interactions. Of the 5146 adults included in the analyses, 433 (8.4%) were diagnosed with cancer. Those with a cancer diagnosis were less likely to be physically active (P<0.01) and more likely to be sedentary (P<0.001). There were no group differences in alcohol or smoking. Smoking, alcohol and activity reduced over time in the whole group. Group-by-time interactions were not significant for smoking (P=0.17), alcohol (P=0.20), activity (P=0.17) or sedentary behaviour (P=0.86), although there were trends towards a transient improvement from pre-diagnosis to immediately post-diagnosis. We found little evidence that a cancer diagnosis motivates health-protective changes. Given the importance of healthy lifestyles, strategies for effective support for behaviour change in cancer survivors need to be identified.
120 citations
Cites background from "Health behavior change following ch..."
...%) than those without any new serious diagnosis (22.8 to 20.8%), but there was no significant group difference in alcohol intake, and a greater reduction in physical activity in the cancer group (Newsom et al, 2012a)....
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...For two of the studies, this could be because the comparison group was not only free of a cancer diagnosis, but also free from heart disease, diabetes, stroke and lung disease, and these conditions could also contribute to the motivation to change (Keenan, 2009; Newsom et al, 2012a)....
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...Previous research has found evidence for higher rates of smoking cessation following a cancer diagnosis (Falba, 2005; Keenan, 2009; Karlsen et al, 2012; Newsom et al, 2012a)....
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...In a Canadian sample (Newsom et al, 2012b), a cancer diagnosis was associated with a greater reduction in smoking rates (from 17.2% to 13.5...
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TL;DR: The insufficient evidence related to pharmacotherapy as well as providing an overview of using physiologic rather than chronologic age for identifying suitable candidates for bariatric surgery are discussed.
108 citations
TL;DR: Results support the hypothesis that a cancer diagnosis presents a teachable moment that can be capitalized on to promote cessation, and a diagnosis of cancer, even a cancer not strongly related to smoking and with a relatively good prognosis, may be associated with increased quitting well after diagnosis.
Abstract: Purpose Quitting smoking provides important health benefits to patients with cancer. A cancer diagnosis may motivate quitting—potentially providing a teachable moment in which oncologists can encourage and assist patients to quit—but little is known about whether a recent cancer diagnosis (including diagnosis of a cancer that is less strongly linked to smoking) is associated with increased quitting. Methods Cancer Prevention Study-II Nutrition Cohort participants reported smoking status at enrollment in 1992 to 1993 and approximately biennially through 2009. Quit rates of smokers diagnosed with cancer during 2- and 4-year intervals were compared with those of smokers not diagnosed with cancer (12,182 and 12,538 smokers in 2- and 4-year analyses, respectively). Cancers likely to cause physical limitations or symptoms that could influence smoking (cancers of the lung, head and neck, esophagus, or any metastatic cancer) were excluded. Logistic regressions calculated quit rates controlling for age, sex, surve...
102 citations
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TL;DR: Changes in drinking behavior were related to several life events occurring over a 6-year period for a national cohort of individuals in late middle-age, however, the magnitude of these relationships varied by gender and problem drinking history.
Abstract: Objective: Four waves of the Health and Retirement Study were used to examine changes in alcohol consumption co-occurring and following stress associated with major health, family and employment events. Method: The final sample consisted of 7,731 (3,907 male) individuals between the ages of 51 and 61 at baseline. We used multinomial logit analysis to study associations between important life events and changes in alcohol consumption over a 6-year study period. Interactions between stressful life events, gender and problem drinking were also evaluated. Results: Most persons (68%) did not change their use of alcohol over the entire 6 years. Hospitalization and onset of a chronic condition were associated with decreased drinking levels. Retirement was associated with increased drinking. Widowhood was associated with increased drinking but only for a short time. Getting married or divorced was associated with both increases and decreases in drinking, with a complex lag structure. A history of problem drinking...
190 citations
"Health behavior change following ch..." refers background in this paper
...And those with heart disease and stroke were somewhat more likely to reduce daily alcohol consumption than those with other conditions (Perreira & Sloan, 2001)....
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TL;DR: Analysis of over 250,000 respondents from four of the largest epidemiological surveys in North America indicates that major health behaviors are largely unrelated to one another, with implications for health behavior theories and interventions predicated on the notion that the health conscious individual attempts to improve his or her health by engaging in more than one of these behaviors at a time.
177 citations
TL;DR: Physical activity protects against poor health irrespective of an increased BMI and smoking, and the major clinical implications are the long-standing benefits of physical activity and not smoking.
Abstract: Background The purpose of this study was to analyse both cross-sectional associations and how longitudinal changes in lifestyle factors from one state in 1980-1981 to another in 1988-1989 influence self-reported health status. Another aim was to estimate the hazard ratios for all-cause mortality for the changes in lifestyle factors and self-reported hypertension during the same period of time. Method The cross-sectional and the longitudinal analyses are based on the same simple random sample of 3,843 adults, aged 25-74, interviewed in 1980-1981 and 1988-1989 and is part of the Swedish Annual Level-of-Living Survey. About 85% of the respondents in the first interview participated in a second interview in 1988-1989. Cross-sectional odds ratios, based on a marginal model, were estimated using the generalized estimating equations. The transitional models were analysed using unconditional logistic regression. A proportional hazard model was applied to investigate the influence of lifestyle transitions on mortality. Results Physical inactivity, being a current or former smoker and obesity (women only) were strong risk factors for poor health either as main effects and/or combined (interactions). There was a strong interaction between physical activity and smoking, and for women, also between body mass index (BMI) and physical activity. Smoking, physically inactive and obese women had about a ten times higher risk of poor health status than non-smoking, physically active, and normal-weight women. The corresponding risk for men was about five times higher. Physically active, but smoking and obese individuals showed only moderately increased risks for poor health status. The transitional model showed that those who were physically inactive in 1980-1981, but did exercise in 1988-1989, improved their health after adjustments for sociodemographic and other lifestyle factors. Continuing to smoke or being physically inactive or having hypertension at both points in time were all associated with higher hazard ratios for all-cause mortality (1.6, 1.9 and 1.8, respectively) than those who reported that they were in good status at both points in time. Conclusions We found that physical activity protects against poor health irrespective of an increased BMI and smoking. The major clinical implications are the long-standing benefits of physical activity and not smoking.
170 citations
"Health behavior change following ch..." refers background in this paper
...Findings indicate that smoking, physical activity, and alcohol consumption are among the most important behavioral determinants of health (Johansson & Sundquist, 1999; Khaw et al., 2008)....
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TL;DR: Subjects were less willing to tolerate the combined distress of an ambiguous symptom and a concurrent life stressor if the stressor onset was not recent; under such conditions, subjects were more likely to seek health care.
Abstract: Analyses tested the following contrasting hypotheses: a) The occurrence of a new symptom in the presence of ongoing life stress increases the attribution of symptoms to illness and increases the use of health care; b) new symptoms occurring in the presence of ongoing life stress are attributed to stressors if they are ambiguous indicators of illness, and they are unlikely to motivate care-seeking if the stressor, i.e., the perceived cause, is of recent onset. The 43-to-92-year old subjects in this longitudinal study were less likely to seek care for the ambiguous symptoms they experienced during the previous week if there was a concurrent life stressor that began during the previous 3 weeks; these symptoms were attributed to stress rather than to illness, and subjects tolerated the emotional distress caused by the combination of a stressor and an ambiguous symptom. Subjects were less willing to tolerate the combined distress of an ambiguous symptom and a concurrent life stressor if the stressor onset was not recent; under such conditions, subjects were more likely to seek health care. Current life stressors did not affect care-seeking for symptoms that were clear signs of disease; these symptoms were readily identified as health threats in need of medical attention. The findings contribute to a better theoretical understanding of how individuals perceive their physical states and how they cope with stress. Practical implications of these findings for increasing efficient use of health care services are also discussed.
169 citations