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
References
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TL;DR: Intentional weight loss was associated with substantial reductions in mortality in this observational study of overweight individuals with diabetes.
Abstract: OBJECTIVE: To estimate the effect of intentional weight loss on mortality in overweight individuals with diabetes. RESEARCH DESIGN AND METHODS: We performed a prospective analysis with a 12-year mortality follow-up (1959-1972) of 4,970 overweight individuals with diabetes, 40-64 years of age, who were enrolled in the American Cancer Society9s Cancer Prevention Study I. Rate ratios (RRs) were calculated, comparing overall death rates, and death from cardiovascular disease (CVD) or diabetes in individuals with and without reported intentional weight loss. RESULTS: Intentional weight loss was reported by 34% of the cohort. After adjustment for initial BMI, sociodemographic factors, health status, and physical activity, intentional weight loss was associated with a 25% reduction in total mortality (RR = 0.75; 95% CI 0.67-0.84), and a 28% reduction in CVD and diabetes mortality (RR = 0.72; 0.63-0.82). Intentional weight loss of 20-29 lb was associated with the largest reductions in mortality (approximately 33%). Weight loss >70 lb was associated with small increases in mortality CONCLUSIONS: Intentional weight loss was associated with substantial reductions in mortality in this observational study of overweight individuals with diabetes.
541 citations
"Health behavior change following ch..." refers background in this paper
...Healthy behaviors following the onset of disease are critical because they can lower the risk of recurrence, reduce severity of disease, increase functioning, and extend longevity (Aldana et al., 2003; Jolliffe et al., 2001; Speck, Courneya, Masse, Duval, & Schmitz, 2010; Williamson et al., 2000)....
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...Healthy behaviors following the onset of disease are critical because they can lower the risk of recurrence, reduce severity of disease, increase functioning, and extend longevity (Aldana et al., 2003; Jolliffe et al., 2001; Speck, Courneya, Masse, Duval, & Schmitz, 2010; Williamson et al., 2000)....
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TL;DR: Moderate alcohol consumption was independently associated with a decreased risk of ischemic stroke in the elderly, multiethnic, urban subjects, while heavy alcohol consumption had deleterious effects.
Abstract: ContextModerate alcohol consumption has been shown to be
protective for coronary heart disease, but the relationship between
moderate alcohol consumption and ischemic stroke is more controversial.ObjectiveTo determine the association between alcohol
consumption and risk of ischemic stroke.DesignPopulation-based case-control study conducted between July
1993 and June 1997.SettingMultiethnic population in northern Manhattan, New York,
NY, aged 40 years or older.Patients and Other ParticipantsCases (n=677) had first
ischemic stroke and were matched to community controls (n=1139)
derived through random digit dialing by age, sex, and race/ethnicity.
Mean ± SD age of cases was 70.0 ± 12.7 years; 55.8% were women;
19.5% were white, 28.4% black, and 50.7% Hispanic.Main Outcome MeasureFirst ischemic stroke (fatal or nonfatal).ResultsModerate alcohol consumption, up to 2 drinks per day, was
significantly protective for ischemic stroke after adjustment for
cardiac disease, hypertension, diabetes, current smoking, body mass
index, and education (odds ratio [OR], 0.51; 95% confidence interval
[CI], 0.39-0.67). This protective effect of alcohol consumption was
detected in both younger and older groups, in men and women, and in
whites, blacks, and Hispanics. In a quadratic model of stroke risk,
increased risk of ischemic stroke was statistically significant among
those consuming 7 or more drinks per day (OR, 2.96; 95% CI,
1.05-8.29).ConclusionsModerate alcohol consumption was independently
associated with a decreased risk of ischemic stroke in our elderly,
multiethnic, urban subjects, while heavy alcohol consumption had
deleterious effects. Our data support the National Stroke Association
Stroke Prevention Guidelines regarding the beneficial effects of
moderate alcohol consumption.
499 citations
"Health behavior change following ch..." refers background in this paper
...…due to less excessive or occasionally excessive drinking, which should be beneficial (King, Mainous, & Geesey, 2008; Kuntsche, Rehm, & Gmel, 2004; Sacco et al., 1999), it was also due to increases in abstinence and the reduction of moderate consumption, which are generally found to be associated…...
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13 Mar 2007
TL;DR: In this paper, an extension of the Theory of Reasoned action and its successors to multiple behavior interventions is presented. But the authors do not discuss the role of implicit and explicit attitudes in the prediction of behavior.
Abstract: Preface. I. Ajzen, D. Albarracin, Predicting and Changing Behavior: A Reasoned Action Approach. D. Trafimow, Distinctions Pertaining to Fishbein and Ajzen's Theory of Reasoned Action. J.N. Cappella, The Role of Discrete Emotions in the Theory of Reasoned Action and Its Successors: Quitting Smoking in Young Adults. R. Hornik, An Extension of the Theory of Reasoned Action and Its Successors to Multiple Behavior Interventions. J. Jaccard, H. Blanton, A Theory of Implicit Reasoned Action: The Role of Implicit and Explicit Attitudes in the Prediction of Behavior. H.C. Triandis, Commentary on Attitudes and Behavior. V. Ottati, N.D. Krumdick, Attitudes and Behavior: Critical Issues. M. Yzer, Does Perceived Control Moderate Attitudinal and Normative Effects on Intention? A Review of Conceptual and Methodological Issues. S.E. Middlestadt, What Is the Behavior? Strategies for Selecting the Behavior to Be Addressed by Health Promotion Interventions. D. Kasprzyk, D.E. Montano, Application of an Integrated Behavioral Model to Understand HIV Prevention Behavior of High Risk Men in Rural Zimbabwe. R.J. Wolitski, J. Zhang, Understanding and Motivating Condom Use Among At-Risk and HIV-Seropositive Persons: A Review and Demonstration of the Applicability of the Theories of Reasoned Action and Planned Behavior. L. Sherr, Through the Theoretical Microscope? Comments on Kasprzyk and Montano, Wolitski and Zhang, and Middlestadt and Yzer. G. Gorn, Commentary on the Theories of Reasoned Action and Planned Behavior and Their Use in Health Promotion. E. Hopkins, C.A. Rietmeijer, Exploring HIV Serosorting as a Preventive Behavior Among Men Who Have Sex With Men Using a Comprehensive Approach to Behavioral Science Theory. S. Pick, Extension of Theory of Reasoned Action Principles for Health Promotion Programs With Marginalized Populations in Latin America. L.S. Jemmott, J.B. Jemmott, Applying the Theory of Reasoned Action to HIV Risk Reduction Behavioral Interventions. S.C. Kalichman, The Theory of Reasoned Action and Advances in HIV/AIDS Prevention. D. Holtgrave, Applied Aspects of Health Promotion Interventions Based on Theory of Reasoned Action and Theory of Planned Behavior. M. Fishbein, A Reasoned Action Approach: Some Issues, Questions, and Clarifications.
482 citations
"Health behavior change following ch..." refers background in this paper
...Subjective norms in favor of changing behavior (Ajzen & Albarracín, 2007) are likely to be salient when a chronic illness has been diagnosed and also should lead to healthier behavior....
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TL;DR: A novel population-level model is developed for projecting future direct spending on diabetes and the natural history of diabetes and its complications over the next 25 years that can be used in the federal budget process to estimate the cost implications of alternative policies.
Abstract: OBJECTIVE We developed a novel population-level model for projecting future direct spending on diabetes. The model can be used in the federal budget process to estimate the cost implications of alternative policies. RESEARCH DESIGN AND METHODS We constructed a Markov model simulating individuals9 movement across different BMI categories, the incidence of diabetes and screening, and the natural history of diabetes and its complications over the next 25 years. Prevalence and incidence of obesity and diabetes and the direct spending on diabetes care and complications are projected. The study population is 24- to 85-year-old patients characterized by the Centers for Disease Control and Prevention9s National Health and Nutrition Examination Survey and National Health Interview Survey. RESULTS Between 2009 and 2034, the number of people with diagnosed and undiagnosed diabetes will increase from 23.7 million to 44.1 million. The obesity distribution in the population without diabetes will remain stable over time with ∼65% of individuals of the population being overweight or obese. During the same period, annual diabetes-related spending is expected to increase from $113 billion to $336 billion (2007 dollars). For the Medicare-eligible population, the diabetes population is expected to rise from 8.2 million in 2009 to 14.6 million in 2034; associated spending is estimated to rise from $45 billion to $171 billion. CONCLUSIONS The diabetes population and the related costs are expected to at least double in the next 25 years. Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened health care system.
439 citations
TL;DR: Musculoskeletal disorders are associated with largest losses of HRQoL in the Finnish population, followed by psychiatric conditions, which may systematically emphasize different conditions.
Abstract: Background
Health-related quality of life (HRQoL) is an essential outcome of health care, but there is no gold standard of HRQoL measurement. We investigated the impact of major chronic conditions on HRQoL using 15D and EQ-5D in a representative sample of Finns.
387 citations
"Health behavior change following ch..." refers background in this paper
...The impact of chronic conditions on quality of life is not the same across conditions (Saarni et al., 2006), and thus, behavior change may differ because of varying perceptions of the illness as threat to health or quality of life....
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