@article {8577, title = {Associations between health literacy and preventive health behaviors among older adults: findings from the health and retirement study.}, journal = {BMC Public Health}, volume = {16}, year = {2016}, month = {2016 07 19}, pages = {596}, abstract = {

BACKGROUND: While the association between inadequate health literacy and adverse health outcomes has been well documented, less is known about the impact of health literacy on health perceptions, such as perceptions of control over health, and preventive health behaviors.

METHODS: We identified a subsample of participants (N = 707) from the Health and Retirement Study (HRS), a nationally representative sample of older adults, who participated in health literacy testing. Self-reported health literacy was measured with a literacy screening question, and objective health literacy with a summed score of items from the Test of Functional Health Literacy. We compared answers on these items to those related to participation in health behaviors such as cancer screening, exercise, and tobacco use, as well as self-referencing health beliefs.

RESULTS: In logistic regression models adjusted for gender, education, race, and age, participants with adequate self-reported health literacy (compared to poorer levels of health literacy) had greater odds of participation in mammography within the last 2~years (Odds ratio [OR] = 2.215, p = 0.01) and participation in moderate exercise two or more times per week (OR = 1.512, p = 0.03). Participants with adequate objective health literacy had reduced odds of participation in monthly breast self-exams (OR = 0.369, p = 0.004) and reduced odds of current tobacco use (OR = 0.456, p = 0.03). In adjusted linear regression analyses, self-reported health literacy made a small but significant contribution to explaining perceived control of health (β 0.151, p = <0.001) and perceived social standing (β 0.112, p = 0.002).

CONCLUSION: In a subsample of older adult participants of the HRS, measures of health literacy were positively related to several health promoting behaviors and health-related beliefs and non-use of breast self-exams, a screening behavior of questionable benefit. These relationships varied however, between self-reported and objectively-measured health literacy. Further investigation into the specific mechanisms that lead higher literacy people to pursue health promoting actions appears clearly warranted.

}, keywords = {Aged, Aged, 80 and over, Female, Health Behavior, Health Knowledge, Attitudes, Practice, Health Literacy, Health Promotion, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Preventive Health Services, Regression Analysis, Retirement, United States}, issn = {1471-2458}, doi = {10.1186/s12889-016-3267-7}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27430477}, author = {Dena M. Fernandez and Janet L. Larson and Brian J Zikmund-Fisher} } @article {8806, title = {Desire for predictive testing for Alzheimer{\textquoteright}s disease and impact on advance care planning: a cross-sectional study.}, journal = {Alzheimers Res Ther}, volume = {8}, year = {2016}, month = {2016 12 13}, pages = {55}, abstract = {

BACKGROUND: It is unknown whether older adults in the United States would be willing to take a test predictive of future Alzheimer{\textquoteright}s disease, or whether testing would change behavior. Using a nationally representative sample, we explored who would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease, and examined how using such a test may impact advance care planning.

METHODS: A cross-sectional study within the 2012 Health and Retirement Study of adults aged 65~years or older asked questions about a test predictive of Alzheimer{\textquoteright}s disease (N = 874). Subjects were asked whether they would want to take a hypothetical free and definitive test predictive of future Alzheimer{\textquoteright}s disease. Then, imagining they knew they would develop Alzheimer{\textquoteright}s disease, subjects rated the chance of completing advance care planning activities from 0 to 100. We classified a score > 50 as being likely to complete that activity. We evaluated characteristics associated with willingness to take a test for Alzheimer{\textquoteright}s disease, and how such a test would impact completing an advance directive and discussing health plans with loved ones.

RESULTS: Overall, 75\% (N = 648) of the sample would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease. Older adults willing to take the test had similar race and educational levels to those who would not, but were more likely to be <=75~years old (odds ratio 0.71 (95\% CI 0.53-0.94)). Imagining they knew they would develop Alzheimer{\textquoteright}s, 81\% would be likely to complete an advance directive, although only 15\% had done so already.

CONCLUSIONS: In this nationally representative sample, 75\% of older adults would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease. Many participants expressed intent to increase activities of advance care planning with this knowledge. This confirms high public interest in predictive testing for Alzheimer{\textquoteright}s disease and suggests this may be an opportunity to engage patients in advance care planning discussions.

}, keywords = {Advance care planning, Aged, Aged, 80 and over, Alzheimer disease, Cross-Sectional Studies, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Patient Acceptance of Health Care}, issn = {1758-9193}, doi = {10.1186/s13195-016-0223-9}, url = {http://alzres.biomedcentral.com/articles/10.1186/s13195-016-0223-9http://link.springer.com/content/pdf/10.1186/s13195-016-0223-9.pdf}, author = {Sheffrin, Meera and Stijacic-Cenzer, Irena and Michael A Steinman} } @article {8144, title = {Control Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An Observational Study.}, journal = {J Gen Intern Med}, volume = {30}, year = {2015}, note = {Export Date: 29 May 2015 Article in Press}, month = {2015 Aug}, pages = {1156-63}, publisher = {30}, abstract = {

BACKGROUND: Chronic health conditions account for the largest proportion of illness-related mortality and morbidity as well as most of healthcare spending in the USA. Control beliefs may be important for outcomes in individuals with chronic illness.

OBJECTIVE: To determine whether control beliefs are associated with the risk for death, incident stroke and incident myocardial infarction (MI), particularly for individuals with diabetes mellitus (DM) and/or hypertension.

DESIGN: Retrospective cohort study.

PARTICIPANTS: A total of 5,662 respondents to the Health and Retirement Study with baseline health, demographic and psychological data in 2006, with no history of previous stroke or MI.

MAIN MEASURES: Perceived global control, measured as two dimensions--"constraints" and "mastery"--and health-specific control were self-reported. Event-free survival was measured in years, where "event" was the composite of death, incident stroke and MI. Year of stroke or MI was self-reported; year of death was obtained from respondents{\textquoteright} family.

KEY RESULTS: Mean baseline age was 66.2 years; 994 (16.7\%) had DM and 3,023 (53.4\%) hypertension. Overall, 173 (3.1\%) suffered incident strokes, 129 (2.3\%) had incident MI, and 465 (8.2\%) died. There were no significant interactions between control beliefs and baseline DM or hypertension in predicting event-free survival. Elevated adjusted hazard ratios (HRs) were associated with DM (1.33, 95 \% CI 1.07-1.67), hypertension (1.31, 95\% CI 1.07-1.61) and perceived constraints in the third (1.55, 95\% CI 1.12-2.15) and fourth quartiles (1.61, 95\% CI 1.14-2.26). Health-specific control scores in the third (HR 0.78, 95\% CI 0.59-1.03) and fourth quartiles (HR 0.70, 95\% CI 0.53-0.92) were protective, but only the latter category had a statistically significant decreased risk. Combined high perceived constraints and low health-specific control had the highest risk (HR 1.93, 95\% CI 1.41-2.64).

CONCLUSIONS: Control beliefs were not associated with differential risk for those with DM and/or hypertension, but they predicted significant differences in event-free survival for the general cohort.

}, keywords = {Aged, Diabetes Mellitus, Female, Health Knowledge, Attitudes, Practice, Humans, Hypertension, Longitudinal Studies, Male, Middle Aged, Myocardial Infarction, Patients, Retrospective Studies, Risk Factors, Stroke, Treatment Outcome}, issn = {1525-1497}, doi = {10.1007/s11606-015-3275-9}, author = {Wei Duan-Porter and Susan Nicole Hastings and Brian Neelon and Courtney Harold Van Houtven} } @article {8062, title = {Public beliefs and knowledge about risk and protective factors for Alzheimer{\textquoteright}s disease.}, journal = {Alzheimers Dement}, volume = {10}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, month = {2014 Oct}, pages = {S381-9}, publisher = {10}, abstract = {

BACKGROUND: The purpose of this study was to assess public beliefs and knowledge about risk and protective factors for Alzheimer{\textquoteright}s disease (AD).

METHODS: A brief survey module was added to the Health and Retirement Study, a longstanding national panel study of the U.S. population over the age of 50.

RESULTS: Respondents were 1641 adults (mean age=64.4 years, 53.6\% female, 81.7\% White). Most (60.1\%) indicated interest in learning their AD risk, with 29.4\% expressing active worry. Many failed to recognize that medications to prevent AD are not available (39.1\%) or that having an affected first-degree relative is associated with increased disease risk (32\%). Many respondents believed that various actions (e.g., mental activity, eating a healthy diet) would be effective in reducing AD risk.

CONCLUSION: Older and middle-aged adults are interested in their AD risk status and believe that steps can be taken to reduce disease risk. Tailored education efforts are needed to address potential misconceptions about risk and protective factors.

}, keywords = {Aged, Alzheimer disease, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Protective factors, United States}, issn = {1552-5279}, doi = {10.1016/j.jalz.2013.07.001}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84895853906andpartnerID=40andmd5=336a2df47951d1d5c021f44b8055d10e}, author = {J Scott Roberts and Sara J McLaughlin and Cathleen M. Connell} } @article {8016, title = {Satisfaction with aging and use of preventive health services.}, journal = {Prev Med}, volume = {69}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Dec}, pages = {176-80}, publisher = {69}, abstract = {

OBJECTIVE: Preventive health service use is relatively low among older age groups. We hypothesized that aging satisfaction would be associated with increased use of preventive health services four years later.

METHOD: We conducted multiple logistic regression analyses on a sample of 6177 people from the Health and Retirement Study, a nationally representative study of U.S. adults over the age of 50 (M age=70.6; women n=3648; men n=2529).

RESULTS: Aging satisfaction was not associated with obtaining flu shots. However, in fully-adjusted models, each standard deviation increase in aging satisfaction was associated with higher odds of reporting service use for cholesterol tests (OR=1.10, 95\% CI=1.00-1.20). Further, women with higher aging satisfaction were more likely to obtain a mammogram/x-ray (OR=1.17, 95\% CI=1.06-1.29) or Pap smear (OR=1.10, 95\% CI=1.00-1.21). Among men, the odds of obtaining a prostate exam increased with higher aging satisfaction (OR=1.20 95\% CI=1.09-1.34).

CONCLUSION: These results suggest that aging satisfaction potentially influences preventive health service use after age 50.

}, keywords = {Aged, Aged, 80 and over, Aging, Chronic disease, Female, Health Behavior, Health Knowledge, Attitudes, Practice, Humans, Influenza Vaccines, Logistic Models, Male, Mammography, Middle Aged, Patient Acceptance of Health Care, Patient Satisfaction, Personal Satisfaction, Preventive Health Services, Prostatic Neoplasms, Surveys and Questionnaires, United States, Vaginal Smears}, issn = {1096-0260}, doi = {10.1016/j.ypmed.2014.09.008}, author = {Eric S Kim and Kyle D Moored and Hannah L. Giasson and Jacqui Smith} } @article {7737, title = {Beware of being unaware: racial/ethnic disparities in chronic illness in the USA.}, journal = {Health Econ}, volume = {21}, year = {2012}, month = {2012 Sep}, pages = {1040-60}, abstract = {

We study racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 Health and Retirement Study. We explore two alternative definitions of awareness and estimate a trivariate probit model with selection, which accounts for common, unmeasured factors underlying the following: (1) self-reporting chronic disease; (2) participating in biomarker collection; and (3) having disease, conditional on participating in biomarker collection. Our findings suggest that current estimates of racial/ethnic disparities in chronic disease are sensitive to selection, and also to the definition of disease awareness used. We find that African-Americans are less likely to be unaware of having hypertension than non-Latino whites, but the magnitude of this effect falls appreciably after we account for selection. Accounting for selection, we find that African-Americans and Latinos are more likely to be unaware of having diabetes compared to non-Latino whites. These findings are based on a widely used definition of awareness - the likelihood of self-reporting disease among those who have disease. When we use an alternative definition of awareness, which considers an individual to be unaware if he or she actually has the disease conditional on self-reporting not having it, we find higher levels of unawareness among racial/ethnic minorities versus non-Latino whites for both hypertension and diabetes.

}, keywords = {Aged, Biomarkers, Black People, Chronic disease, Data collection, Diabetes Mellitus, ethnicity, Female, Health Knowledge, Attitudes, Practice, Health Status Disparities, Hispanic or Latino, Humans, Hypertension, Male, Racial Groups, Self Report, United States, White People}, issn = {1099-1050}, doi = {10.1002/hec.2856}, author = {Chatterji, Pinka and Heesoo Joo and Kajal Chatterji Lahiri} } @article {7718, title = {The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status.}, journal = {Patient Educ Couns}, volume = {87}, year = {2012}, note = {Zulman, Donna M Rosland, Ann-Marie Choi, Hwajung Langa, Kenneth M Heisler, Michele U01 AG09740/AG/NIA NIH HHS/ Ireland Patient Educ Couns. 2012 Apr;87(1):74-80. Epub 2011 Aug 15.}, month = {2012 Apr}, pages = {74-80}, publisher = {87}, abstract = {

OBJECTIVE: To examine the influence of diabetes psychosocial attributes and self-management on glycemic control and diabetes status change.

METHODS: Using data from the Health and Retirement Study, a nationally representative longitudinal study of U.S. adults >51 years, we examined cross-sectional relationships among diabetes psychosocial attributes (self-efficacy, risk awareness, care understanding, prioritization of diabetes, and emotional distress), self-management ratings, and glycemic control. We then explored whether self-management ratings and psychosocial attributes in 2003 predicted change in diabetes status in 2004.

RESULTS: In multivariate analyses (N=1834), all diabetes psychosocial attributes were associated with self-management ratings, with self-efficacy and diabetes distress having the strongest relationships (adj coeff=8.1, p<0.01 and -4.1, p<0.01, respectively). Lower self-management ratings in 2003 were associated cross-sectionally with higher hemoglobin A1C (adj coeff=0.16, p<0.01), and with perceived worsening diabetes status in 2004 (adj OR=1.36, p<0.05), with much of this latter relationship explained by diabetes distress.

CONCLUSION: Psychosocial attributes, most notably diabetes-related emotional distress, contribute to difficulty with diabetes self-management, poor glycemic control, and worsening diabetes status over time.

PRACTICE IMPLICATIONS: Self-management and adherence interventions should target psychosocial attributes such as disease-related emotional distress.

}, keywords = {Aged, Blood Glucose Self-Monitoring, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Disease Management, Female, Glycated Hemoglobin, Health Knowledge, Attitudes, Practice, Health Status, Humans, Interviews as Topic, Male, Middle Aged, Multivariate Analysis, Risk Factors, Self Care, Self Efficacy, Severity of Illness Index, Social Support, Stress, Psychological, Surveys and Questionnaires, Treatment Outcome}, issn = {1873-5134}, doi = {10.1016/j.pec.2011.07.013}, url = {http://www.ncbi.nlm.nih.gov/pubmed/21840149}, author = {Donna M Zulman and Ann Marie Rosland and Choi, Hwajung and Kenneth M. Langa and Michele M Heisler} } @article {7710, title = {Predictors of self-report of heart failure in a population-based survey of older adults.}, journal = {Circ Cardiovasc Qual Outcomes}, volume = {5}, year = {2012}, month = {2012 May}, pages = {396-402}, publisher = {5}, abstract = {

BACKGROUND: Little research has been conducted on the predictors of self-report or patient awareness of heart failure (HF) in a population-based survey. The objective of this study was to (1) test the agreement between Medicare administrative and Health and Retirement Study (HRS) survey data and (2) determine predictors associated with self-report of HF, using a validated Medicare claims algorithm as the reference standard. We hypothesized that those who self-reported HF were more likely to have a higher number of HF-related claims.

METHODS AND RESULTS: Secondary data analysis was conducted using the 2004 wave of the HRS linked to 2002 to 2004 Medicare claims (n=5573 respondents aged >= 67 years). Concordance between self-report of HF in the HRS and Medicare claims was calculated. Logistic regression was performed to identify predictors associated with self-report HF. HF prevalence by self-report was 4.6\%. Self-report of HF and claims agreement was 87\% (κ=0.34). The presence of >1 HF inpatient claims was associated with greater odds of self-report (odds ratio [OR], 1.92; 95\% CI, 1.23-3.00). Greater odds of self-reporting HF was also associated with >= 4 HF claims (OR, 2.74; 95\% CI, 1.36-5.52). Blacks (OR, 0.28; 95\% CI, 0.14-0.55) and Hispanics (OR, 0.30; 95\% CI, 0.11-0.83) were less likely to self-report HF compared with whites in the final model.

CONCLUSIONS: Self-report of HF is an insensitive method for accurately identifying HF cases, especially in those with less-severe disease and who are nonwhite. There may be limited awareness of HF among older minority patients despite having clinical encounters during which HF is coded as a diagnosis.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Algorithms, Awareness, Chi-Square Distribution, Comorbidity, Female, Health Knowledge, Attitudes, Practice, Health Status, Health Surveys, Heart Failure, Humans, Insurance Claim Review, Logistic Models, Male, Medicare, Odds Ratio, Patients, Predictive Value of Tests, Self Report, Socioeconomic factors, United States}, issn = {1941-7705}, doi = {10.1161/CIRCOUTCOMES.111.963116}, author = {Tanya R Gure and Ryan J McCammon and Christine T Cigolle and Todd M Koelling and Caroline S Blaum and Kenneth M. Langa} } @article {7657, title = {Education and health: evidence on adults with diabetes.}, journal = {Int J Health Care Finance Econ}, volume = {11}, year = {2011}, note = {Ayyagari, Padmaja Grossman, Daniel Sloan, Frank 2R37-AG-17473-05A1/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States International journal of health care finance and economics Int J Health Care Finance Econ. 2011 Mar;11(1):35-54. Epub 2011 Jan 7.}, month = {2011 Mar}, pages = {35-54}, publisher = {11}, abstract = {

Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.g., adherence to guidelines for diabetes care) and personal attributes which are plausibly largely time invariant and systematically related to years of schooling completed, including time preference, self-control, and self-confidence. Educational attainment, as measured by years of schooling completed, is systematically and positively related to time to onset of diabetes, and conditional on having been diagnosed with this disease on health outcomes, variables related to efficiency in health production, as well as use of diabetes specialists. However, the marginal effects of increasing educational attainment by a year are uniformly small. Accounting for other factors, including child health and child socioeconomic status which could affect years of schooling completed and adult health, adult cognition, income, and health insurance, and personal attributes from the supplemental survey, marginal effects of educational attainment tend to be lower than when these other factors are not included in the analysis, but they tend to remain statistically significant at conventional levels.

}, keywords = {Aged, Cognition, Cross-Sectional Studies, Diabetes Complications, Diabetes Mellitus, Female, Health Behavior, Health Knowledge, Attitudes, Practice, Health Services, Humans, Male, Patient Education as Topic, Self Efficacy, Sex Factors, Socioeconomic factors, Time Factors}, issn = {1573-6962}, doi = {10.1007/s10754-010-9087-x}, author = {Padmaja Ayyagari and Grossman, Daniel and Frank A Sloan} } @article {7332, title = {Are mature smokers misinformed?}, journal = {J Health Econ}, volume = {28}, year = {2009}, month = {2009 Mar}, pages = {385-97}, publisher = {28}, abstract = {

While there are many reasons to continue to smoke in spite of its consequences for health, the concern that many smoke because they misperceive the risks of smoking remains a focus of public discussion and motivates tobacco control policies and litigation. In this paper we investigate the relative accuracy of mature smokers{\textquoteright} risk perceptions about future survival, and a range of morbidities and disabilities. Using data from the survey on smoking (SOS) conducted for this research, we compare subjective beliefs elicited from the SOS with corresponding individual-specific objective probabilities estimated from the health and retirement study. Overall, consumers in the age group studied, 50-70, are not overly optimistic in their perceptions of health risk. If anything, smokers tend to be relatively pessimistic about these risks. The finding that smokers are either well informed or pessimistic regarding a broad range of health risks suggests that these beliefs are not pivotal in the decision to continue smoking. Although statements by the tobacco companies may have been misleading and thus encouraged some to start smoking, we find no evidence that systematic misinformation about the health consequences of smoking inhibits quitting.

}, keywords = {Aged, Deception, Female, Health Knowledge, Attitudes, Practice, Health Surveys, Humans, Male, Middle Aged, Risk Assessment, Smoking, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2008.12.004}, author = {Ahmed Khwaja and Daniel S. Silverman and Frank A Sloan and Wang, Yang} } @article {7336, title = {Preferences, beliefs, and self-management of diabetes.}, journal = {Health Serv Res}, volume = {44}, year = {2009}, note = {PMID: 19674433}, month = {2009 Jun}, pages = {1068-87}, publisher = {44}, abstract = {

OBJECTIVE: To assess relationships between self-assessed control over life events, subjective beliefs about longevity, time and risk preference, and other factors on use of recommended care for diabetes mellitus (DM), self-assessed control of diabetes, general health, and laboratory measures of HbA1c levels.

DATA SOURCES: Health and Retirement Study (HRS) and 2003 HRS Diabetes Study (HRS-DS).

STUDY DESIGN: We used logit and ordered logit analyses to assess use of recommended care, and subjective and objective measures of health outcomes.

DATA COLLECTION: Secondary analysis of HRS and HRS-DS data.

PRINCIPAL FINDINGS: Individuals with higher self-assessed control over life events and higher subjective probabilities of living 10 years engaged in more recommended DM care practices and had better self-assessed DM control and general health. However, these beliefs did not influence HbA1c levels. More highly educated and cognitively able persons were more likely to follow care recommendations. There were differences by race/ethnicity in health outcomes, but not in health investment among Hispanics.

CONCLUSIONS: Individuals{\textquoteright} beliefs about control over life events and longevity influenced health investment and subjective health outcomes, although these beliefs did not translate into differences in HbA1c levels. Hispanics may realize lower returns on health investments, at least for diabetes care.

}, keywords = {Black or African American, Choice Behavior, Cross-Sectional Studies, Diabetes Mellitus, Female, Glycated Hemoglobin, Health Knowledge, Attitudes, Practice, Health Status, Hispanic or Latino, Humans, Internal-External Control, Logistic Models, Longevity, Longitudinal Studies, Male, Patient Compliance, Risk Assessment, Self Care, Self-Assessment, Socioeconomic factors, Surveys and Questionnaires}, issn = {1475-6773}, doi = {10.1111/j.1475-6773.2009.00957.x}, author = {Frank A Sloan and Padr{\'o}n, Norma A and Alyssa C Platt} } @article {7388, title = {Risk perception and preference for prevention of Alzheimer{\textquoteright}s disease.}, journal = {Value Health}, volume = {12}, year = {2009}, month = {2009 Jun}, pages = {450-8}, publisher = {12}, abstract = {

OBJECTIVES: To understand how older adults perceive their risk of Alzheimer{\textquoteright}s Disease (AD) and how this may shape their medical care decisions, we examined whether presence of established risk factors of AD is associated with individuals{\textquoteright} perceived risk of AD, and with preference for preventing AD.

PARTICIPANTS: Data came from the US Health and Retirement Study participants who were asked questions on AD risk perception (N = 778).

MEASUREMENTS: Perceived risk of AD was measured by respondents{\textquoteright} estimate of their percent chance (0-100) developing AD in the next 10 years. Preference for AD prevention was measured with questions eliciting willingness to pay for a drug to prevent AD.

ANALYSIS: Multivariate linear regressions were used to estimate correlates of perceived risk and preference for prevention.

RESULTS: Better cognitive functioning and physical activity are associated with decreased perceived risk. Neither age nor cardiovascular disease is associated with perceived risk. African Americans have lower perceived risk than non-Latino whites; the difference is wider among people age 65 and above. Only 4\% to 7\% of the variation in perceived risk was explained by the model. Preference for prevention is stronger with increased perceived risk, but not with the presence of risk factors. Persons with better cognitive functioning, physical functioning, or wealth status have a stronger preference for prevention.

CONCLUSION: Some known risk factors appear to inform, but only modestly, individuals{\textquoteright} perceived risk of AD. Furthermore, decisions about AD prevention may not be determined by objective needs alone, suggesting a potential discrepancy between need and demand for AD preventive care.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Alzheimer disease, Cognition, Female, Health education, Health Knowledge, Attitudes, Practice, Health Surveys, Humans, Linear Models, Male, Multivariate Analysis, Psychometrics, Risk Assessment, Risk Factors, Social Perception, Statistics as Topic, United States}, issn = {1524-4733}, doi = {10.1111/j.1524-4733.2008.00482.x}, author = {Chung, Sukyung and Kala M. Mehta and Shumway, Martha and Alvidrez, Jennifer and Eliseo J Perez-Stable} } @article {7261, title = {Risk perceptions, optimism, and natural hazards.}, journal = {Risk Anal}, volume = {28}, year = {2008}, month = {2008 Dec}, pages = {1763-7}, publisher = {28}, abstract = {

This article uses the panel survey developed for the Health and Retirement Study to evaluate whether Hurricane Andrew in 1992 altered longevity expectations of respondents who lived in Dade County, Florida, the location experiencing the majority of about 20 billion dollars of damage. Longevity expectations have been used as a proxy measure for both individual subjective risk assessments and dispositional optimism. The panel structure allows comparison of those respondents{\textquoteright} longevity assessments when the timing of their survey responses bracket Andrew with those of individuals where it does not. After controlling for health effects, the results indicate a significant reduction in longevity expectations due to the information respondents appear to have associated with the storm.

}, keywords = {Aged, Attitude, Cyclonic Storms, Decision making, Disaster Planning, Disasters, Florida, Health Knowledge, Attitudes, Practice, Humans, Longevity, Middle Aged, Perception, Risk, Risk Assessment, Social Behavior}, issn = {1539-6924}, doi = {10.1111/j.1539-6924.2008.00880.x}, author = {V. Kerry Smith} } @article {6814, title = {Can patient self-management help explain the SES health gradient?}, journal = {Proc Natl Acad Sci U S A}, volume = {99}, year = {2002}, month = {2002 Aug 06}, pages = {10929-34}, publisher = {99}, abstract = {

There are large differences in health outcomes by socioeconomic status (SES) that cannot be explained fully by traditional arguments, such as access to care or poor health behaviors. We consider a different explanation-better self-management of disease by the more educated. We examine differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, and then assess the subsequent impact of differential adherence on health status. One unique component of this research is that for diabetes we combine two different surveys-one cohort study and one randomized clinical trial-that are usually used exclusively by either biomedical or/and social scientists separately. For both illnesses, we find significant effects of adherence that are much stronger among patients with high SES. After controlling for other factors, more educated HIV+ patients are more likely to adhere to therapy, and this adherence made them experience improvements in their self-reported general health. Similarly, among diabetics, the less educated were much more likely to switch treatment, which led to worsening general health. In the randomized trial setting, intensive treatment regimens that compensated for poor adherence led to better improvements in glycemic control for the less educated. Among two distinct chronic illnesses, the ability to maintain a better health regimen is an important independent determinant of subsequent health outcomes. This finding is robust across clinical trial and population-based settings. Because this ability varies by schooling, self-maintenance is an important reason for the steep SES gradient in health outcomes.

}, keywords = {Adolescent, Adult, Antiretroviral Therapy, Highly Active, Diabetes Mellitus, Type 1, Educational Status, Female, Health Knowledge, Attitudes, Practice, HIV Infections, Humans, Insulin, Longitudinal Studies, Male, Patient Compliance, Population Surveillance, Prospective Studies, Randomized Controlled Trials as Topic, Self Care, Social Class}, issn = {0027-8424}, doi = {10.1073/pnas.162086599}, author = {Dana P Goldman and James P Smith} } @article {6547, title = {Retirement expectations: differences by race, ethnicity, and gender.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {373-82}, publisher = {36}, abstract = {

Analyses by race and ethnicity of several important dimensions of labor market behavior have been constrained in the past by limited samples of the African American and Hispanic populations. This article uses data from the first wave of the Health and Retirement Survey, which oversamples these populations, to compare the retirement plans of African American, Hispanic, and white married men and women. Findings suggest that retirement expectations may accurately forecast retirement behavior and that the differences by race and ethnicity, as well as by gender, that are evident in retirement plans are likely to be reflected in retirement outcomes.

}, keywords = {ethnicity, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Models, Theoretical, Pensions, Retirement, Sex Factors, Social Security, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.3.373}, author = {Honig, Marjorie} }