Benjamin Schüz

Adoption and maintenance of four health behaviors: Theory-guided longitudinal studies on dental flossing, seat belt use, dietary behavior, and physical activity

Background: Adoption and maintenance of health behaviors are often poorly predicted by behavioral intentions. To bridge the gap between intentions and behavior, strategic planning and recovery self-efficacy have been suggested as proximal predictors.Purpose: The aim was to examine the usefulness of a prediction model that includes planning and self-efficacy as postintentional mediator variables.Methods: Four longitudinal studies were conducted on dental flossing (Study I, N = 157), seat belt use (Study II, N = 298), dietary behaviors (Study III, N = 700), and physical activity (Study IV, N = 365). Dental flossing and seat belt use were assessed in students by paper-and-pencil questionnaires, whereas dietary behavior and physical activity inventories were presented to the general public in the internet.Results: By structural equation modeling, it was found that one common model fits all four data sets well. Results differed in terms of variance accounted for, but the overall patterns of estimated parameters were similar across samples.Conclusions: Self-efficacy and planning seemed to be functional as proximal predictors of health behaviors, whereas health risk perception appeared to be a negligible factor. When predicting health behaviors, self-regulatory variables should be used in addition to the behavioral intention.

Beyond behavioural intentions: Planning mediates between intentions and physical activity

OBJECTIVES Health-behaviour change is not predicted well by behavioural intentions alone. Action planning and coping planning are two self-regulatory strategies that may help bridge the gap between intentions and behaviour. Action planning comprises the when, where and how of implementing a behaviour. Coping planning involves the anticipation of barriers and ways to overcome them. The study examines whether the inclusion of these two planning constructs would improve the overall prediction of physical activity. The main research question is which kind of planning would be beneficial for the initiation of behaviour and which one for its maintenance. Moreover, it is examined whether intentions moderate the planning-behaviour relationship. METHODS A 5-week longitudinal on-line study was conducted with 354 participants. Differences in prediction patterns between formerly active and formerly inactive individuals were compared using multigroup structural equation modelling. Moderating effects of intentions were tested by means of latent interactions. RESULTS Inclusion of the two planning factors accounted for substantially more behaviour variance than intention alone did. Coping planning mediated the intention-behaviour relationship only in formerly active, but not in formerly inactive participants. Moreover, intentions moderated the effects of both types of planning on behaviour. CONCLUSIONS Action planning appears to predict behaviour only when intentions are high. For actors, coping planning represents a critical self-regulation strategy to maintain their physical activity levels.

Disentangling the relation between intentions, planning, and behaviour: A moderated mediation analysis

Action planning is assumed to mediate between intentions and health behaviours. Moreover, intentions are assumed to moderate the planning-behaviour relation, because people with high intentions are more likely to enact their plans. The present studies extend these suppositions by integrating both assumptions to a novel and parsimonious model of moderated mediation: the mediation effect is hypothesised to be stronger in individuals who report higher intention levels. In two longitudinal studies on physical activity (N = 124) and interdental hygiene (N = 209), intentions and action planning were assessed at baseline, and behaviour was measured four (Study 1), and respectively, three (Study 2) months later. The moderated mediation hypothesis was tested with continuously measured intentions using regression analyses with non-parametric bootstrapping. Results from both studies suggest that levels of intentions moderate the mediation process: The strength of the mediated effect increased along with levels of intentions. Planning mediates the intention-behaviour relation, if individuals hold sufficient levels of intentions. Implications for theory advancement and intervention development are discussed.

Benefits of Having Friends in Older Ages: Differential Effects of Informal Social Activities on Well-Being in Middle-Aged and Older Adults

OBJECTIVES It has been considered a fact that informal social activities promote well-being in old age, irrespective of whether they are performed with friends or family members. Fundamental differences in the relationship quality between family members (obligatory) and friends (voluntary), however, suggest differential effects on well-being. Further, age-related changes in networks suggest age-differential effects of social activities on well-being, as older adults cease emotionally detrimental relationships. METHOD Longitudinal representative national survey study with middle-aged (n = 2,830) and older adults (n = 2,032). Age-differential effects of activities with family members and friends on changes in life satisfaction, positive affect (PA), and negative affect (NA) were examined in latent change score models. RESULTS In the middle-aged group, activities with friends and families increased PA and life satisfaction and were unrelated to NA. In the older age group, family activities increased both PA and NA and were unrelated to changes in life satisfaction, but activities with friends increased PA and life satisfaction and decreased NA. DISCUSSION Social activities differentially affect different facets of well-being. These associations change with age. In older adults, the effects of social activities with friends may become more important and may act as a buffer against negative effects of aging.

Gesundheit und Krankheit im Alter

ISBN 978-3-89606-193-5 Deutschland ist eine Gesellschaft des langen Lebens. Bereits heute leben in Deutschland mehr 65-jahrige und altere Menschen als 15-jahrige und jungere. Und die Altersstruktur wird sich weiter zugunsten der alteren Menschen verschieben. Gesundheit im Alter ist heute und zukunftig ein Thema von hoher individueller und gesellschaftlicher Bedeutung. Mit fortschreitendem Alter ist ein deutlicher Anstieg von Gesundheitsproblemen zu beobachten. Auch die Komplexitat der vorliegenden Beeintrachtigungen wachst mit dem Alter. Ein groser Teil der Gesundheitsprobleme alterer Menschen kann durch primar-, sekundaroder tertiarpraventive Masnahmen gunstig beeinflusst werden. Zudem gibt es mit Blick auf den Wandel der Gesundheit in den letzten Jahrzehnten positive Nachrichten. Im vorliegenden Buch geht es um die Gesundheit und Krankheit von Menschen, die 65 Jahre und alter sind. Es werden somatische und psychische Gesundheit, funktionale Gesundheit und Pflegebedurftigkeit sowie subjektive Gesundheit behandelt. Die Einflusse von Lebenslagen und Lebensstilen auf die Gesundheit von alter werdenden und alten Menschen wird analysiert. Anhand der Angebote, die professionelle, familiare und ehrenamtliche Seite bereitstellen, wird die gesundheitliche und pflegerische Versorgung alter Menschen untersucht. Vor dem Hintergrund des demografischen Wandels werden schlieslich die okonomischen Chancen und Herausforderungen des Alterns fur das Gesundheitswesen analysiert. Hier werden wichtige Erklarungsansatze fur das Kostengeschehen geliefert, und es wird die Bedeutung des Gesundheitswesen als Wirtschaftszweig dargestellt Beitrage zur Gesundheitsberichterstattung des Bundes

Medication beliefs predict medication adherence in older adults with multiple illnesses

OBJECTIVE To examine factors preventing medication nonadherence in community-dwelling older adults with multiple illnesses (multimorbidity). Nonadherence threatens successful treatment of multimorbidity. Adherence problems can be intentional (e.g., deliberately choosing not to take medicines or to change medication dosage) or unintentional (e.g., forgetting to take medication) and might depend on a range of factors. This study focused in particular on the role of changes in beliefs about medication to explain changes in adherence. METHODS Longitudinal study with N = 309 individuals aged 65-85 years with two or more diseases at three measurement points over six months. Medication adherence and beliefs about medicines were assessed by questionnaire. Hierarchical weighted least squares regression analyses were used to predict individual intentional and unintentional nonadherence. RESULTS Changes in intentional nonadherence were predicted by changes in specific necessity beliefs (B = -.19, P<.01), after controlling for sociodemographic factors, health status and number of prescribed medicines. Changes in unintentional nonadherence were predicted by changes in general overuse beliefs (B = .26, P<.01), controlling for the same covariates. CONCLUSION Beliefs about medication affect both intentional and unintentional adherence to medication in multimorbid older adults. This points to the importance of addressing medication beliefs in patient education to improve adherence.

How do negative self-perceptions of aging become a self-fulfilling prophecy?

Recent studies have provided considerable evidence on long-term effects of self-perceptions of aging (SPA) on indicators of successful aging such as health or life satisfaction. To date, little is known about the mechanisms underlying these effects. This study therefore examined whether negative SPA impair the use of self-regulation strategies that include selection, optimization, and compensation (SOC) in case of a serious health event and thus turn into self-fulfilling prophecies for health and life satisfaction. Based on a longitudinal nationwide study with 2 measurement points over a 6-month period in 309 older people (65+ years of age) with multiple illnesses, 2 major findings emerged: First, the occurrence of a serious health event predicted increased use of SOC strategies, which in turn predicted higher self-rated health and life satisfaction. Second, this effect was moderated by negative SPA, that is, in case of a serious health event, the perception that aging is associated with physical losses led to lower use of SOC strategies promoting a healthy lifestyle (B = -0.43, SE = 0.15, p < .01). These findings contribute to a better understanding of the underlying mechanisms of SPA on health by showing that negative SPA as associated with physical losses might impair health-related strategies that are important for maintaining a healthy lifestyle. Future intervention studies could attempt to challenge negative SPA to support effective strategy use in older adults with serious illnesses.

Subjective Well-Being and Mortality revisited: Differential Effects of Cognitive and Emotional Facets of Well-Being on Mortality

OBJECTIVE Subjective well-being (SWB) is an important predictor of mortality. To date, surprisingly little is known about whether cognitive and emotional facets of SWB independently predict mortality, and whether such effects vary by age. METHOD This study examined differential effects of life satisfaction (LS), positive affect (PA), and negative affect (NA) on mortality in a conjoint analysis using data of German adults between the ages of 40 to 85 years (N = 3,124). Effects of SWB facets were analyzed using Cox Proportional Hazards Models. RESULTS LS and PA predicted mortality over and above sociodemographic factors and physical health (HRLS = .89, 95% CI = .79-1.00, p < .05, HRPA = .81, 95% CI = .70-.93, p < .05). However, this effect diminished when including self-rated health and physical activity. NA was not associated with mortality. Age group comparative analyses revealed that PA predicted mortality in older adults (65+) even after controlling for self-rated health and physical activity (HRPA = .82, 95% CI = .70-.97, p < .05). In middle-aged participants, no SWB indicator predicted mortality when controlling for covariates. CONCLUSIONS These findings suggest a differential impact of cognitive and emotional well-being on mortality and suggest that in middle-aged adults the effects of SWB on mortality are attenuated by self-rated health and physical activity. The study underscores the importance of SWB for health and longevity, particularly for older adults.

Changes in intentions, planning, and self-efficacy predict changes in behaviors: An application of latent true change modeling

Can latent true changes in intention, planning, and self-efficacy account for latent change in two health behaviors (physical activity as well as fruit and vegetable intake)? Baseline data on predictors and behaviors and corresponding follow-up data four weeks later were collected from 853 participants. Interindividual differences in change and change—change associations were analyzed using structural equation modeling. For both behaviors, similar prediction patterns were found: changes in intention and self-efficacy predicted changes in planning, which in turn corresponded to changes in behavior. This evidence confirms that change predicts change, which is an inherent precondition in behavior change theories.

Resources for health: differential effects of optimistic self-beliefs and social support according to socioeconomic status.

OBJECTIVE This study examined whether socioeconomic status (SES) determines the degree to which psychological and social resources such as optimistic self-beliefs and social support affect health. DESIGN We used data from the representative German Ageing Survey (N = 2,454, aged 40-85 years). Structural equation modeling was employed to examine whether relationships between psychological (self-esteem, control beliefs, optimism) and social resources (perceived emotional and informational support, network size) and health differ between education and income groups. MAIN OUTCOME MEASURES Self-reported physical health, functional health, and subjective health. RESULTS Psychological resources positively affected health in all groups but were stronger predictors of functional and subjective health in low compared to higher educated participants. A higher level of social resources was associated with better functional and subjective health mainly in the low-income group. Social resources were particularly important for financially disadvantaged older people. CONCLUSION Our results provide evidence for differential effects of optimistic self-beliefs and social support on health depending on whether individuals are challenged by low incomes or low education. Future research, especially aimed at intervention, should consider that different aspects of SES have differential meanings and that the impact of health-protective factors may vary according to SES facet.