Tracy A. Falba

Spousal Concordance in Health Behavior Change

OBJECTIVE This study examines the degree to which a married individuals health habits and use of preventive medical care are influenced by his or her spouses behaviors. STUDY DESIGN Using longitudinal data on individuals and their spouses, we examine changes over time in the health habits of each person as a function of changes in his or her spouses health habits. Specifically, we analyze changes in smoking, drinking, exercising, cholesterol screening, and obtaining a flu shot. DATA SOURCE This study uses data from the Health and Retirement Study (HRS), a nationally representative sample of individuals born between 1931 and 1941 and their spouses. Beginning in 1992, 12,652 persons (age-eligible individuals as well as their spouses) from 7,702 households were surveyed about many aspects of their life, including health behaviors, use of preventive services, and disease diagnosis. SAMPLE The analytic sample includes 6,072 individuals who are married at the time of the initial HRS survey and who remain married and in the sample at the time of the 1996 and 2000 waves. PRINCIPAL FINDINGS We consistently find that when one spouse improves his or her behavior, the other spouse is likely to do so as well. This is found across all the behaviors analyzed, and persists despite controlling for many other factors. CONCLUSIONS Simultaneous changes occur in a number of health behaviors. This conclusion has prescriptive implications for developing interventions, treatments, and policies to improve health habits and for evaluating the impact of such measures.

The impact of late career job loss on myocardial infarction and stroke: a 10 year follow up using the health and retirement survey.

Background: Involuntary job loss is a major life event associated with social, economic, behavioural, and health outcomes, for which older workers are at elevated risk. Objective: To assess the 10 year risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers over 50 years of age. Methods: Analysing data from the nationally representative US Health and Retirement Survey (HRS), Cox proportional hazards analysis was used to estimate whether workers who suffered involuntary job loss were at higher risk for subsequent MI and stroke than individuals who continued to work. The sample included 4301 individuals who were employed at the 1992 study baseline. Results: Over the 10 year study frame, 582 individuals (13.5% of the sample) experienced involuntary job loss. After controlling for established predictors of the outcomes, displaced workers had a more than twofold increase in the risk of subsequent MI (hazard ratio (HR) = 2.48; 95% confidence interval (CI) = 1.49 to 4.14) and stroke (HR = 2.43; 95% CI = 1.18 to 4.98) relative to working persons. Conclusion: Results suggest that the true costs of late career unemployment exceed financial deprivation, and include substantial health consequences. Physicians who treat individuals who lose jobs as they near retirement should consider the loss of employment a potential risk factor for adverse vascular health changes. Policy makers and programme planners should also be aware of the risks of job loss, so that programmatic interventions can be designed and implemented to ease the multiple burdens of joblessness.

Health events and the smoking cessation of middle aged Americans.

This study investigates the effect of serious health events including new diagnoses of heart attacks, strokes, cancers, chronic lung disease, chronic heart failure, diabetes, and heart disease on future smoking status up to 6 years postevent. Data come from the Health and Retirement Study, a nationally representative longitudinal survey of Americans aged 51–61 in 1991, followed every 2 years from 1992 to 1998. Smoking status is evaluated at each of three follow-ups, (1994, 1996, and 1998) as a function of health events between each of the four waves. Acute and chronic health events are associated with much lower likelihood of smoking both in the wave immediately following the event and up to 6 years later. However, future events do not retrospectively predict past cessation. In sum, serious health events have substantial impacts on cessation rates of older smokers. Notably, these effects persist for as much as 6 years after a health event.

The Impact of Occupation on Self-Rated Health: Cross-Sectional and Longitudinal Evidence from the Health and Retirement Survey

BACKGROUND The objective of this study is to estimate occupational differences in self-rated health, both in cross-section and over time, among older individuals. METHODS We use hierarchical linear models to estimate self-reported health as a function of 8 occupational categories and key covariates. We examine self-reported health status over 7 waves (12 years) of the Health and Retirement Study. Our study sample includes 9,586 individuals with 55,389 observations. Longest occupation is used to measure the cumulative impact of occupation, address the potential for reverse causality, and allow the inclusion of all older individuals, including those no longer working. RESULTS Significant baseline differences in self-reported health by occupation are found even after accounting for demographics, health habits, economic attributes, and employment characteristics. But contrary to our hypothesis, there is no support for significant differences in slopes of health trajectories even after accounting for dropout. CONCLUSIONS Our findings suggest that occupation-related differences found at baseline are durable and persist as individuals age.

Value to smokers of improved cessation products: Evidence from a willingness-to-pay survey

The present study demonstrated the use of willingness to pay to value hypothetical new smoking cessation products. Data came from a baseline survey of participants in a clinical trial of medications for smoking cessation (N=356) conducted in New Haven, Connecticut. We analyzed individual willingness to pay for a hypothetical tobacco cessation treatment that is (a) more effective than those currently available and then (b) more effective and attenuates the weight gain often associated with smoking cessation. A majority of the respondents (n=280; 84%) were willing to pay for the more effective treatment, and, of those, 175 (63%) were willing to pay more if the increased effectiveness was accompanied by attenuation of the weight gain associated with smoking cessation. The present study suggests the validity of using willingness-to-pay surveys in assessing the value of new smoking cessation products and products with multifaceted improvements. From these data, we calculated estimates of the value of a quit. For the population studied, this survey suggests a substantial market for more effective smoking cessation treatments.

Burning a hole in the budget: tobacco spending and its crowd-out of other goods.

Smoking is an expensive habit. Smoking households spend, on average, more than

If smoking increases absences, does quitting reduce them?

US1000 annually on cigarettes. When a family member quits, in addition to the former smoker’s improved long-term health, families benefit because savings from reduced cigarette expenditures can be allocated to other goods. For households in which some members continue to smoke, smoking expenditures crowd-out other purchases, which may affect other household members, as well as the smoker. We empirically analyse how expenditures on tobacco crowd-out consumption of other goods, estimating the patterns of substitution and complementarity between tobacco products and other categories of household expenditure. We use the Consumer Expenditure Survey data for the years 1995–2001, which we complement with regional price data and state cigarette prices. We estimate a consumer demand system that includes several main expenditure categories (cigarettes, food, alcohol, housing, apparel, transportation, medical care) and controls for socioeconomic variables and other sources of observable heterogeneity. Descriptive data indicate that, comparing smokers to nonsmokers, smokers spend less on housing. Results from the demand system indicate that as the price of cigarettes rises, households increase the quantity of food purchased, and, in some samples, reduce the quantity of apparel and housing purchased.

Are State Legislatures Responding to Public Opinion When Allocating Funds for Tobacco Control Programs

Objective: This study examined the impact of smoking, quitting, and time since quit on absences from work. Methods: Data from the nationally representative Tobacco Use Supplements of the 1992/93, 1995/96, and 1998/99 Current Population Surveys were used. The study included full time workers aged between 18–64 years, yielding a sample size of 383 778 workers. A binary indicator of absence due to sickness in the last week was analysed as a function of smoking status including time since quit for former smokers. Extensive demographic variables were included as controls in all models. Results: In initial comparisons between current and former smokers, smoking increased absences, but quitting did not reduce them. However, when length of time since quit was examined, it was discovered that those who quit within the last year, and especially the last three months, had a much greater probability of absences than did current smokers. As the time since quitting increased, absences returned to a rate somewhere between that of never and current smokers. Interactions between health and smoking status significantly improved the fit of the model. Conclusions: Smokers who quit reduced their absences over time but increase their absences immediately after quitting. Quitting ill may account for some but not all of this short run impact.

Sex differences in the effects of stressful life events on changes in smoking status

This study explored the factors associated with state-level allocations to tobacco-control programs. The primary research question was whether public sentiment regarding tobacco control was a significant factor in the states’ 2001 budget decisions. In addition to public opinion, several additional political and economic measures were considered. Significant associations were found between our outcome, state-level tobaccocontrol funding per capita, and key variables of interest including public opinion, amount of tobacco settlement received, the party affiliation of the governor, the state’s smoking rate, excise tax revenue received, and whether the state was a major producer of tobacco. The findings from this study supported our hypothesis that states with citizens who favor more restrictive indoor air policies allocate more to tobacco control. Effective public education to change public opinion and the cultural norms surrounding smoking may affect political decisions and, in turn, increase funding for crucial public health programs.