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.
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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
References
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TL;DR: In a meta-analytic synthesis of prior research on behavior prediction and in a primary research investigation as mentioned in this paper, the relationship between past behavior and future behavior is substantiated in a meta analytic synthesis.
Abstract: Past behavior guides future responses through 2 processes. Well-practiced behaviors in constant contexts recur because the processing that initiates and controls their performance becomes automatic. Frequency of past behavior then reflects habit strength and has a direct effect on future performance. Alternately, when behaviors are not well learned or when they are performed in unstable or difficult contexts, conscious decision making is likely to be necessary to initiate and carry out the behavior. Under these conditions, past behavior (along with attitudes and subjective norms) may contribute to intentions, and behavior is guided by intentions. These relations between past behavior and future behavior are substantiated in a meta-analytic synthesis of prior research on behavior prediction and in a primary research investigation. In everyday explanations of behavior, habits denote one's customary ways of behaving. Claiming that one performed a behavior because of habit provides an understandable explanation for an act that otherwise might seem irrational or even harmful. Habits also are featured in the popular psychology literature in the form of self-help books designed to identify readers' existing habits, evaluate habits' effectiveness in meeting goals, and establish more desirable habits. Habits are not, however, important constructs in most contemporary social psychological models of human behavior. Early in their careers, most psychology graduate students learn that frequency of past behavior, a standard indicator of habit strength (Triandis, 1977, 1980), is the best predictor of
3,099 citations
"Health behavior change following ch..." refers background in this paper
...Moreover, habitual behavior may influence subsequent health behavior even when past behavior is inconsistent with beliefs and intentions (Ouellette & Wood, 1998; Verplanken, Aarts, van Knippenberg, & Moonen, 1998)....
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TL;DR: To increase professional health workers’ knowledge of selected research findings and theory so that they may better understand why and under what conditions people take action to prevent, detect and diagnose disease, this paper aims to increase awareness among qualified behavioral scientists about the kinds of behavioral research opportunities and needs that exist in public health.
Abstract: Aims of the Paper
The principal aims of this paper are (1) to increase professional health workers’ knowledge of selected research findings and theory so that they may better understand why and under what conditions people take action to prevent, detect and diagnose disease; and (2) to increase awareness among qualified behavioral scientists about the kinds of behavioral research opportunities and needs that exist in public health.
A matter of personal philosophy of the author is that the goal of understanding and predicting behavior should appropriately precede the goal of attempting to persuade people to modify their health practices, even though behavior can sometimes be changed in a planned way without clear understanding of its original causes. Efforts to modify behavior will ultimately be more successful if they grow out of an understanding of causal processes. Accordingly, primary attention will here be given to an effort to understand why people behave as they do. Only then will brief consideration be given to problems of how to persuade people to use health services.
2,847 citations
"Health behavior change following ch..." refers background in this paper
...the benefits of change are clear, then health behaviors are expected to improve (Rosenstock, 1966)....
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...Key Words: Chronic disease—Disease management—Health behavior—Rehabilitation—Secondary prevention. the benefits of change are clear, then health behaviors are expected to improve (Rosenstock, 1966)....
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15 Jul 2005
2,618 citations
TL;DR: Among women, adherence to lifestyle guidelines involving diet, exercise, and abstinence from smoking is associated with a very low risk of coronary heart disease.
Abstract: Background Many lifestyle-related risk factors for coronary heart disease have been identified, but little is known about their effect on the risk of disease when they are considered together. Methods We followed 84,129 women participating in the Nurses' Health Study who were free of diagnosed cardiovascular disease, cancer, and diabetes at base line in 1980. Information on diet and lifestyle was updated periodically. During 14 years of follow-up, we documented 1128 major coronary events (296 deaths from coronary heart disease and 832 nonfatal infarctions). We defined subjects at low risk as those who were not currently smoking, had a body-mass index (the weight in kilograms divided by the square of the height in meters) under 25, consumed an average of at least half a drink of an alcoholic beverage per day, engaged in moderate-to-vigorous physical activity (which could include brisk walking) for at least half an hour per day, on average, and scored in the highest 40 percent of the cohort for consumption ...
1,614 citations
Journal Article•
1,583 citations
"Health behavior change following ch..." refers methods in this paper
...—Latent growth curve models using all available data assume that the data are at least missing at random (Little & Rubin, 2002), and the pattern of missing data from this study may not meet this criterion (i.e., nonignorable missingness)....
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