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: A hospital-based smoking cessation program consisting of inpatient counseling and telephone follow-up substantially increases smoking abstinence 1 year after discharge in patients post-MI.
169 citations
26 Aug 2011
TL;DR: This report supplements the Division of Vital Statistics' annual report of final mortality statistics with final 2007 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin.
Abstract: OBJECTIVES: This report presents final 2007 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the Division of Vital Statistics' annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2007. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. RESULTS: In 2007, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Septicemia. They accounted for approximately 76 percent of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2007 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods. Language: en
166 citations
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...Five of the leading causes of death for adults in the United States are heart disease, cancer, cerebral vascular disease (stroke), respiratory disease (chronic obstructive pulmonary disease), and diabetes (Heron, 2011), which are considered preventable because they are substantially influenced by modifiable behaviors (Bornstein, 1994; Knoops et al....
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TL;DR: Part I: What Is Treatment Adherence?
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148 citations
Journal Article•
TL;DR: Demographic and psychosocial correlates of healthy lifestyle changes following a colon cancer diagnosis and health status are examined, with larger fruit/vegetable changes in African Americans than Whites.
Abstract: Lifestyle changes in persons diagnosed with cancer are important because they may impact prognosis, co-morbidities, and survival. This report describes longitudinal changes in lifestyle behaviors and health status among colon cancer survivors (n = 278) and population-based controls (n = 459) in North Carolina (39% African American), and examines demographic and psychosocial correlates of healthy lifestyle changes following a colon cancer diagnosis. Data are from surveys of a population-based cohort of colon cancer patients on diagnosis (the North Carolina Colon Cancer Study, NCCCS) and approximately 2 years post-diagnosis [the North Carolina Strategies to Improve Diet, Exercise, and Screening Study (NC STRIDES)], and population-based controls. Both studies collected information on demographic/lifestyle characteristics and medical history. The NCCCS reflects pre-diagnosis or pre-interview patterns, whereas NC STRIDES queried on current practices. Between the NCCCS and NC STRIDES, colon cancer survivors reported significant increases in vegetable intake, physical activity, and supplement use (all P <0.01) and a non-statistically significant increase in fruit/juice consumption (0.1 serving), with larger fruit/vegetable changes in African Americans than Whites. Controls increased physical activity and supplement use and fewer reported arthritic symptoms (P < 0.05). Survivors who were older and female had an almost 3 times higher likelihood of having used at least one new dietary supplement post-diagnosis, whereas being retired correlated with increased vegetable intake, all P < 0.05. Having more barriers to increasing fruit/vegetable intake was inversely associated with taking a new supplement (P < 0.05 only in controls). Colon cancer survivors reported making significant improvements in multiple health-related behaviors. Health care providers should communicate with persons diagnosed with colon cancer to ensure that they are making healthy lifestyle changes.
140 citations
"Health behavior change following ch..." refers background in this paper
...…may make changes after a recently diagnosed chronic health condition (Hawkes, Lynch, Youlden, Owen, & Aitken, 2008; Patterson et al., 2003; Satia et al., 2004; Steptoe, Sanderman, & Ward, 1995), although many studies have only examined shortterm changes and some have relied on…...
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...Several studies have suggested that individuals may make changes after a recently diagnosed chronic health condition (Hawkes, Lynch, Youlden, Owen, & Aitken, 2008; Patterson et al., 2003; Satia et al., 2004; Steptoe, Sanderman, & Ward, 1995), although many studies have only examined shortterm changes and some have relied on retrospective accounts that may be subject to reporting biases, such as social desirability....
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TL;DR: The parallels between findings from cognitive science and neuroscience and Common-Sense Models in four areas are described: Activation of illness representations by the automatic linkage of symptoms and functional changes with concepts and the transparency of other minds.
Abstract: We describe the parallels between findings from cognitive science and neuroscience and Common-Sense Models in four areas: (1) Activation of illness representations by the automatic linkage of symptoms and functional changes with concepts (an integration of declarative and perceptual and procedural knowledge); (2) Action plans for the management of symptoms and disease; (3) Cognitive and behavioral heuristics (executive functions parallel to recent findings in cognitive science) involved in monitoring and modifying automatic control processes; (4) Perceiving and communicating to “other minds” during medical visits to address the declarative and non-declarative (perceptual and procedural) knowledge that comprise a patient’s representations of illness and treatment (the transparency of other minds).
136 citations