Charles J. Holahan - US grants

Modern treatments for cardiovascular disease that enhance survival have increased the need to understand and improve corresponding aspects of quality of life. The overall purpose of the proposed research is to develop an integrative predictive model of long-term quality of life in cardiovascular disease that emphasizes adaptive processes and outcomes. The increasing interest in prevention and health promotion in contemporary cardiovascular care emphasizes reducing risk factors that have major behavioral components, such as smoking, diet, and exercise. Personal and social resources and psychological coping strategies are associated with quality of life both directly and indirectly, through such positive health behaviors. Specific purposes of the proposed research include: 1) Developing and testing an integrative prospective structural equation model of the interrelationships among social resources, coping strategies, positive health behaviors, and quality of life in cardiovascular disease over a four-year time-period. 2) Contrasting predictive findings relating to cardiac illness, stroke, and hypertension with predictive findings from matched-control groups of healthy individuals and individuals with very serious (cancer) and moderately serious (arthritis) noncardiovascular disease. Findings from this research will provide an essential foundation for continued investigation focusing on longer-term changes in health status and quality of life in a planned ten-year follow-up with the present sample. The proposed research will involve secondary data analysis with a large sample of individuals surveyed recently through the Center for Health Care Evaluation at the Stanford University Medical School. The sample includes individuals between the ages of 55 and 65 who used medical services in two large medical centers. Extensive psychosocial and physical health data are available from mail-out inventories at three points in time over a four- year period. Of eligible respondents contacts, 92% agreed to participate in the initial survey, and 89% (1884) of them provided complete data. Participation in one-year and four-year follow-ups approaches 90% of surviving respondents from the previous survey. At the initial testing, 411 respondents (22% reported diagnosed cardiac illness (excluding stroke and hypertension), 83 respondents (5%) reported diagnosed strokes, and 593 respondents (31%) reported diagnosed hypertension. The data base at all three measurement times includes extensive information in the quality of life, positive health behaviors, personal and social resources, and coping strategies domains. Computerized hospital medical records are available for one-third of the sample, and will be used to evaluate the reliability of subjects' self-reports of medical conditions and health status. Group comparisons will be made on two dimensions: illness type and post-illness time interval. Longitudinal analyses will be used to examine causal influences on positive health behaviors and quality of life, and to develop and test an integrative predictive model.

This proposal is in response to the NIA: PILOT RESEARCH GRANT PROGRAM (Research Objective 22, "Personality and Experimental Social Psychology"). The proposed research integrates coping-based and resource deterioration models of the stress process in an innovative predictive framework that is especially relevant to aging. The early aging years from age 60 to 70 are developmentally significant because the potential for successful aging is considerable during this life stage. At the same time, early aging presents adaptive challenges because the loss of social resources associated with aging often begins during these years. Specific objectives of the research fall into two categories. The first category involves identifying how social resource change-particularly resource loss-relates to psychological adjustment between the ages of 60 and 70. These objectives include investigating: a) predictors of change in social resources, b) functional outcomes of change in social resources, and c) the role of social resource change in mediating between life change events and psychological functioning. The second category of objectives involves integrating coping strategies in the predictive model to provide a fuller understanding of adaptive functioning during this life stage. These objectives include investigating: a) the role of coping strategies early in the stress process in moderating the association between life change and change in social resources, and b) the role of coping strategies later in the stress process in mediating between change in social resources and psychological functioning. The research uses a 10-year longitudinal database available through the Center for Health Care Evaluation at the VA Palo Alto Health Care System and Stanford University School of Medicine. The research involves a sample of 1884 adults between the ages of 55 and 65 at baseline. The database includes extensive data on life change events, social resources, coping strategies, and psychological functioning. All variables were assessed at four points in time over a 10-year period (i.e., baseline and 1-year, 4-year, and 10- year follow-ups). The proposed research will provide an essential foundation for acquiring funding for data collection with a new minority sample, focusing on proactive coping and social resources in the context of health-related stresses during aging, as well as new data collection with this sample, which can provide a fuller understanding of adaptive functioning into middle and later aging.

DESCRIPTION (provided by applicant): Smoking research and intervention efforts have substantially neglected middle-aged and older adults, with older women who smoke particularly underserved. Yet, cigarette smoking is a significant cause of morbidity and mortality among women in midlife and aging, and the hazards of smoking for women increase with age. Although adult smoking is maintained in significant part by nicotine addiction, important aspects of women's smoking in midlife and aging may involve psychosocial factors that are amenable to intervention. Depression in particular plays a significant role in maintaining adult smoking, although much less is known about the role of depression among older smokers. The greater prevalence of depression among women makes depression an important concern in women's health in midlife and aging. Although previous research has focused on clinical depression, increasing evidence indicates that sub-clinical levels of depressive symptoms, which are prevalent among women in midlife and aging, are also linked to smoking. However, the lack of a comprehensive model of social contextual and behavioral factors that affect smoking through depression or that mediate between depression and smoking hinders interventions to reduce smoking among women in later adulthood. The Surgeon General's report on women and smoking calls for longitudinal research on depression and smoking in women across the adult lifespan. This project will examine: (1) the relationship of depressive symptoms to smoking among middle-aged and older women, (2) the predictive role of social contextual and personal factors related to depression and smoking, and (3) demographic and health-related factors that make subgroups of women especially vulnerable to depression-related smoking. In this project we will conduct secondary analyses of data from the Women's Health Initiative (WHI) Observational Study. The WHI Observational Study followed 93,676 women between the ages of 50 and 79 at enrollment for up to 8 years. The WHI Observational Study presents a unique opportunity to examine the link between depressive symptoms and smoking in a large diverse sample of postmenopausal women, with psychosocial and health-related data available at multiple time-points. Our research team will approach the study from complementary perspectives. This project is innovative in its unique focus on depression and smoking in middle-aged and older women, its use of the WHI Observational Sample to follow a socioeconomically and ethnically diverse sample longitudinally, and it's modeling of risk and protective factors in the depression-smoking relationship among women in this population. Consistent with Healthy People 2010 objectives to reduce adult smoking, this project will have a positive impact by providing a conceptual foundation for effective smoking reduction interventions with middle-aged and older women. PUBLIC HEALTH RELEVANCE: Cigarette smoking is a significant cause of morbidity and mortality among women in midlife and aging. Reducing adult smoking is a central goal of Healthy People 2010. This project uses data from the Women's Health Initiative to investigate the relationship of depressive symptoms to smoking among middle-aged and older women.

PROJECT SUMMARY/ABSTRACT Although second-hand tobacco smoke is recognized as a cancer risk, the possibility that living with a smoker fosters a broad household culture of cancer-relevant negative health behaviors is unstudied. Dynamic models of health behavior have considered clustering of different behaviors within individuals and contagion of the same behavior between individuals. Here, we combine these two areas of discovery in proposing a novel process?the possibility that an individual's health behavior may influence another individual's health behavior in a different domain. The proposed project tests an innovative model linking living with a smoker to low physical activity, sedentary behavior, unhealthy diet, and overweight/obesity among middle-aged and older women, a population at risk of exposure to passive-smoking. Our longer-term goal is to develop an R01 application to test a household-level intervention tailored to cross-domain health behaviors among demographically disadvantaged families with a smoker. The objective for the proposed research is to lay a foundation for this planned work by prospectively examining between-individual, cross-domain linkages in overweight/obesity and associated health risk behaviors using data from the Women's Health Initiative (WHI) Observational Study. Our central hypothesis is that individuals' exposure to a household smoker is linked to their own low physical activity, sedentary behavior, unhealthy diet, and overweight/obesity. The rationale for this project is that more rigorous tests of the links between living with a smoker and cancer-relevant negative health behaviors in other domains will provide a foundation for developing more effective cancer prevention strategies. We plan to pursue three specific aims: (1) Examine the role of living with a smoker in predicting overweight/obesity; (2) Identify underlying mechanisms involving health risk behaviors linking living with a smoker to overweight/obesity; and (3) Apply the model to groups of women at increased health risk associated with health disparities and history of cancer. The proposed research is innovative because we examine a neglected social-behavioral pathway in the risk for cancer. Results are expected to have a broader positive impact because understanding the role of social ties in communicating multiple cancer-relevant health habits has potential to advance population health and to reduce health disparities. The contribution of the proposed research is its potential to redirect research and intervention efforts on cancer to an aspect of health behavior change that has been overlooked. This contribution will be significant because it can substantially broaden the reach and effectiveness of preventive efforts for cancer.