Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher ...purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants ( n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test odds ratio (OR) = 1.18, 95% confidence interval (CI) = 1.08–1.29 or colonoscopy (OR = 1.06, 95% CI = 0.99–1.14). Furthermore, females were more likely to receive a mammogram/X-ray (OR = 1.27, 95% CI = 1.16–1.39) or pap smear (OR = 1.16, 95% CI = 1.06–1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95% CI = 1.18–1.45). Each unit increase in purpose was also associated with 17% fewer nights spent in the hospital (rate ratio = 0.83, 95% CI = 0.77–0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society.
Significance Less than 50% of people over the age of 65 are up-to-date with core preventive services. Identifying modifiable factors linked with preventive services are important targets for research and practice. Purpose in life, recently the focus of multiple intervention studies, has been linked with better health (mental and physical) as well as improved health behaviors. However, its association with health care use has been understudied. We found that higher purpose was linked with greater use of several preventive health care services and also fewer nights spent hospitalized. These results may facilitate the development of new strategies to increase use of preventive health care services and improve health, thereby offsetting the burden of rising health care costs in our aging society.
Objective: Having a strong sense of purpose in life is associated with positive health behaviors. However, the processes through which purpose leads to health are unclear. The current study compared ...neural activity among individuals with higher versus lower purpose while they made health-related decisions in response to messages promoting health behavior change. Method: A total of 220 adults with a sedentary lifestyle who were likely to feel conflicted in response to health messages underwent functional MRI while viewing messages encouraging physical activity and indicated the self-relevance of the messages. We focused on activity within dorsal anterior cingulate cortex (dACC), anterior insula (AI), dorsolateral prefrontal cortex (DLPFC), and ventrolateral prefrontal cortex (VLPFC) as identified by meta-analytically defined maps of regions previously implicated in conflict-related processing, while participants considered the self-relevance of the messages. Results: Individuals with higher (vs. lower) purpose showed less activity in dACC, AI, DLPFC, and VLPFC while making health-decisions. Lower brain response in these regions mediated the effect of higher purpose on greater endorsement of the messages. Conclusions: Individuals with strong purpose may be less likely to experience conflict-related regulatory burden during health decision-making, which may in turn allow them to accept conflicting yet beneficial health messages. Reduced brain reactivity in dACC, AI, DLPFC, and VLPFC may reflect reduced conflict-related processing during health decision-making relevant to longer term lifestyle goals. This adds to mounting evidence linking purpose and a range of positive health-related outcomes, as well as evidence suggesting that dACC, AI, DLPFC, and VLPFC track conflict-related processes relevant to longer term goals and values.
Health communications can be an effective way to increase positive health behaviors and decrease negative health behaviors; however, those at highest risk are often most defensive and least open to ...such messages. For example, increasing physical activity among sedentary individuals affects a wide range of important mental and physical health outcomes, but has proven a challenging task. Affirming core values (i.e., self-affirmation) before message exposure is a psychological technique that can increase the effectiveness of a wide range of interventions in health and other domains; however, the neural mechanisms of affirmation’s effects have not been studied. We used functional magnetic resonance imaging (fMRI) to examine neural processes associated with affirmation effects during exposure to potentially threatening health messages. We focused on an a priori defined region of interest (ROI) in ventromedial prefrontal cortex (VMPFC), a brain region selected for its association with self-related processing and positive valuation. Consistent with our hypotheses, those in the self-affirmation condition produced more activity in VMPFC during exposure to health messages and went on to increase their objectively measured activity levels more. These findings suggest that affirmation of core values may exert its effects by allowing at-risk individuals to see the self-relevance and value in otherwise-threatening messages.
Despite the clear public health significance of herd immunity to COVID-19, a host of individual differences influence willingness to get vaccinated. One factor likely to motivate individuals is the ...extent they have a sense of purpose in life, based on the health correlates of purpose and purposeful individuals’ desire to return to their pre-pandemic environments.
The current study examined sense of purpose as a predictor of COVID-19 vaccination willingness in the United States immediately following the initial approval of a COVID-19 vaccine in the United States in 2020.
A nationwide sample of U. S. adults (N = 2009) completed a poll including information on their sense of purpose in life, demographic factors, and depressive symptoms, immediately following the initial approval of a COVID-19 vaccine in the United States in 2020. In addition, they reported on how willing they would be to get the vaccine, assuming that the costs would be covered, as well as their motivations to get the vaccine.
Multiple regression analyses found that sense of purpose predicted greater willingness to get vaccinated, even when accounting for demographic factors, political affiliation, and psychological wellbeing. Adults higher on sense of purpose reported greater importance of getting the vaccine for personal health, the health of others, and to return to regular activities. Exploratory analyses also suggest that purpose may provide a stronger impetus to vaccinate among those in age groups associated with lower risk for severe COVID-19 complications. Conclusions: Although cross-sectional in nature, the current findings suggest sense of purpose in life may be an important factor in encouraging vaccination. Implications are discussed regarding how purposeful messaging may yield greater vaccination rates among individuals who otherwise may be less motivated due to health concerns.
•Leaders have invoked purpose and common purpose in efforts to increase vaccination.•Results suggest purposeful adults indeed are more willing to get a COVID-19 vaccine.•Findings held when controlling for predictors of vaccine willingness.
Tailored health interventions can be more effective in eliciting positive behavior change than generic interventions, but the underlying neural mechanisms are not yet understood. Here, 91 smokers ...participated in a functional magnetic resonance imaging session and a tailored smoking-cessation program. We found that increases in activation in self-related processing regions, particularly dorsomedial prefrontal cortex, to tailored messages predicted quitting during a 4-month follow-up.
Purpose in life has been linked with better mental health, physical health, and health behaviors, but the association between purpose and sleep is understudied. Sleep disturbances increase with age ...and as the number of older adults rapidly increases, it is ever more important to identify modifiable factors that are associated with reduced incidence of sleep disturbances. We used multiple logistic regression models and data from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, to examine whether higher purpose was linked with a reduced incidence of sleep disturbances. Among 4144 respondents reporting minimal or no sleep disturbances at baseline, higher purpose was associated with a lower incidence of sleep disturbances over the 4-year follow-up. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a 16 % reduced odds of developing sleep disturbances (OR 0.84, 95 % CI 0.77–0.92). The association between purpose and sleep disturbances remained after adjusting for sociodemographic, behavioral, psychological, and health covariates. Should future research replicate our findings, this area of research may lead to innovative efforts that improve the quality of sleep in older adults.
Project Quit was a randomized Web-based smoking cessation trial designed and conducted by researchers from the University of Michigan, where its primary outcome was the 7-day point prevalence. One ...drawback of such an outcome is that it only focuses on smoking behavior over a very short duration, rather than the quitting process over the entire study period.
The aim of this study was to consider the number of quit attempts during the 6-month study period as an alternative outcome, which would better reflect the quitting process. We aimed to find out whether tailored interventions (high vs low) are better in reducing the number of quit attempts for specific subgroups of smokers.
To identify interactions between intervention components of smoking cessation and individual smoker characteristics, we employed Poisson regression to analyze the number of quit attempts. This approach allowed us to construct data-driven, personalized interventions.
A negative effect of the number of cigarettes smoked per day (P=.03) and a positive effect of education (P=.03) on the number of quit attempts were detected from the baseline covariates (n=792). Thus, for every 10 extra cigarettes smoked per day, there was a 5.84% decrease in the expected number of quit attempts. Highly educated participants had a 15.49% increase in their expected number of quit attempts compared with their low-educated counterparts. A negative interaction between intervention component story and smoker's education was also detected (P=.03), suggesting that a high-tailored story given to highly educated people results in 13.50% decrease in the number of quit attempts compared with a low-tailored story.
A highly individually tailored story is significantly more effective for smokers with a low level of education. This is consistent with prior findings from Project Quit based on the 7-day point prevalence.
ABSTRACT
Aim To assess the efficacy of World Wide Web‐based tailored behavioral smoking cessation materials among nicotine patch users.
Design Two‐group randomized controlled trial.
Setting World ...Wide Web in England and Republic of Ireland.
Participants A total of 3971 subjects who purchased a particular brand of nicotine patch and logged‐on to use a free web‐based behavioral support program.
Intervention Web‐based tailored behavioral smoking cessation materials or web‐based non‐tailored materials.
Measurements Twenty‐eight‐day continuous abstinence rates were assessed by internet‐based survey at 6‐week follow‐up and 10‐week continuous rates at 12‐week follow‐up.
Findings Using three approaches to the analyses of 6‐ and 12‐week outcomes, participants in the tailored condition reported clinically and statistically significantly higher continuous abstinence rates than participants in the non‐tailored condition. In our primary analyses using as a denominator all subjects who logged‐on to the treatment site at least once, continuous abstinence rates at 6 weeks were 29.0% in the tailored condition versus 23.9% in the non‐tailored condition (OR = 1.30; P = 0.0006); at 12 weeks continuous abstinence rates were 22.8% versus 18.1%, respectively (OR = 1.34; P = 0.0006). Moreover, satisfaction with the program was significantly higher in the tailored than in the non‐tailored condition.
Conclusions The results of this study demonstrate a benefit of the web‐based tailored behavioral support materials used in conjunction with nicotine replacement therapy. A web‐based program that collects relevant information from users and tailors the intervention to their specific needs had significant advantages over a web‐based non‐tailored cessation program.
Abstract
Psychosocial risk factors have been linked with accelerated epigenetic aging, but little is known about whether psychosocial resilience factors (eg, Sense of Purpose in Life) might reduce ...epigenetic age acceleration. In this study, we tested if older adults who experience high levels of Purpose might show reduced epigenetic age acceleration. We evaluated the relationship between Purpose and epigenetic age acceleration as measured by 13 DNA methylation (DNAm) “epigenetic clocks” assessed in 1 572 older adults from the Health and Retirement Study (mean age 70 years). We quantified the total association between Purpose and DNAm age acceleration as well as the extent to which that total association might be attributable to demographic factors, chronic disease, other psychosocial variables (eg, positive affect), and health-related behaviors (heavy drinking, smoking, physical activity, and body mass index BMI). Purpose in Life was associated with reduced epigenetic age acceleration across 4 “second-generation” DNAm clocks optimized for predicting health and longevity (false discovery rate FDR q < 0.0001: PhenoAge, GrimAge, Zhang epigenetic mortality index; FDR q < 0.05: DunedinPoAm). These associations were independent of demographic and psychosocial factors, but substantially attenuated after adjusting for health-related behaviors (drinking, smoking, physical activity, and BMI). Purpose showed no significant association with 9 “first-generation” DNAm epigenetic clocks trained on chronological age. Older adults with greater Purpose in Life show “younger” DNAm epigenetic age acceleration. These results may be due in part to associated differences in health-related behaviors. Results suggest new opportunities to reduce biological age acceleration by enhancing Purpose and its behavioral sequelae in late adulthood.
Approximately half of American adults do not meet recommended physical activity guidelines. Face-to-face lifestyle interventions improve health outcomes but are unlikely to yield population-level ...improvements because they can be difficult to disseminate, expensive to maintain, and inconvenient for the recipient. In contrast, Internet-based behavior change interventions can be disseminated widely at a lower cost. However, the impact of some Internet-mediated programs is limited by high attrition rates. Online communities that allow participants to communicate with each other by posting and reading messages may decrease participant attrition.
Our objective was to measure the impact of adding online community features to an Internet-mediated walking program on participant attrition and average daily step counts.
This randomized controlled trial included sedentary, ambulatory adults who used email regularly and had at least 1 of the following: overweight (body mass index BMI ≥ 25), type 2 diabetes, or coronary artery disease. All participants (n = 324) wore enhanced pedometers throughout the 16-week intervention and uploaded step-count data to the study server. Participants could log in to the study website to view graphs of their walking progress, individually-tailored motivational messages, and weekly calculated goals. Participants were randomized to 1 of 2 versions of a Web-based walking program. Those randomized to the "online community" arm could post and read messages with other participants while those randomized to the "no online community" arm could not read or post messages. The main outcome measures were participant attrition and average daily step counts over 16 weeks. Multiple regression analyses assessed the effect of the online community access controlling for age, sex, disease status, BMI, and baseline step counts.
Both arms significantly increased their average daily steps between baseline and the end of the intervention period, but there were no significant differences in increase in step counts between arms using either intention-to-treat or completers analysis. In the intention-to-treat analysis, the average step count increase across both arms was 1888 ± 2400 steps. The percentage of completers was 13% higher in the online community arm than the no online community arm (online community arm, 79%, no online community arm, 66%, P = .02). In addition, online community arm participants remained engaged in the program longer than no online community arm participants (hazard ratio = 0.47, 95% CI = 0.25 - 0.90, P = .02). Participants with lower baseline social support posted more messages to the online community (P < .001) and viewed more posts (P < .001) than participants with higher baseline social support.
Adding online community features to an Internet-mediated walking program did not increase average daily step counts but did reduce participant attrition. Participants with low baseline social support used the online community features more than those with high baseline social support. Thus, online communities may be a promising approach to reducing attrition from online health behavior change interventions, particularly in populations with low social support.
NCT00729040; http://clinicaltrials.gov/ct2/show/NCT00729040 (Archived by WebCite at http://www.webcitation.org/5v1VH3n0A).
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