Health-Related Quality of Life in a National Sample of Caregivers: Findings from the Behavioral Risk Factor Surveillance System

Purpose Recent national public health agendas, such as Healthy People 2010, call for improved public health surveillance and health promotion programs for people with disabilities and their caregivers. The goal of this study was to understand the public health impact of caregiving on health-related quality of life (HRQoL) using population-level data. Design & Methods A cross-sectional study design was used. 184,450 adults surveyed during the 2000 national Behavioral Risk Factor Surveillance System survey formed the sample. Binary logistic regression models ascertained differences between caregivers and non-caregivers in reporting reduced (“fair” or “poor”) health. Ordinary least squares regression (OLS) and multinomial logistic regression models examined the influence of caregiving status on HRQoL, measured as categories of healthy days reported in the last 30 days and the number of days reported as physical and mental health not good in the last 30 days. Results Sixteen percent (16%) of the survey respondents were caregivers. There was an interaction effect between caregiving status and age of the caregiver. In the fully adjusted models, caregivers <55 years old had a 35% increased risk of having fair or poor health (odds ratio [OR] = 1.35, 95% confidence interval [CI] 1.28, 1.43) as compared to non-caregivers in that age group, while caregivers 55 years and older had a 3% decreased risk in having fair or poor health (OR = 0.97, 95% confidence interval [CI] 0.92, 1.03) compared to non-caregivers of the same age. In the adjusted models that examined the association of caregiving and healthy days, younger caregivers similarly showed larger deficits in both mental and physical HRQoL compared to older caregivers. For example combining mental and physical days, caregivers <55 had 1.44 fewer healthy days (β = −1.44, standard error (SE) = 0.07), while caregivers 55+ had 0.55 fewer days *β = −0.55, standard error (SE) = 0.13 (compared to non-caregivers in their respective age groups). Implications With increasing population age and the projected increase in caregivers, it is important that we understand the social and public health burden of caregiving and begin to identify interventions to sustain the HRQoL of caregivers. We found that caregivers have a slight to modest decline in HRQoL compared to non-caregivers, and that caregiving affects the HRQoL of younger adults more than older adults. Further research at the population level as to the type and level of burden of caregiving is needed.     

Scale structure: processing minimum standard and maximum standard scalar adjectives

Gradable adjectives denote a function that takes an object and returns a measure of the degree to which the object possesses some gradable property [Kennedy, C. (1999). Projecting the adjective: The syntax and semantics of gradability and comparison. New York: Garland]. Scales, ordered sets of degrees, have begun to be studied systematically in semantics [Kennedy, C. (to appear). Vagueness and grammar: the semantics of relative and absolute gradable predicates. Linguistics and Philosophy; Kennedy, C. and McNally, L. (2005). Scale structure, degree modification, and the semantics of gradable predicates. Language, 81, 345-381; Rotstein, C., and Winter, Y. (2004). Total adjectives vs. partial adjectives: scale structure and higher order modifiers. Natural Language Semantics, 12, 259-288.]. We report four experiments designed to investigate the processing of absolute adjectives with a maximum standard (e.g., clean) and their minimum standard antonyms (dirty). The central hypothesis is that the denotation of an absolute adjective introduces a 'standard value' on a scale as part of the normal comprehension of a sentence containing the adjective (the "Obligatory Scale" hypothesis). In line with the predictions of Kennedy and McNally (2005) and Rotstein and Winter (2004), maximum standard adjectives and minimum standard adjectives systematically differ from each other when they are combined with minimizing modifiers like slightly, as indicated by speeded acceptability judgments. An eye movement recording study shows that, as predicted by the Obligatory Scale hypothesis, the penalty due to combining slightly with a maximum standard adjective can be observed during the processing of the sentence; the penalty is not the result of some after-the-fact inferencing mechanism. Further, a type of 'quantificational variability effect' may be observed when a quantificational adverb (mostly) is combined with a minimum standard adjective in sentences like "The dishes are mostly dirty", which may receive either a degree interpretation (e.g., 80% dirty) or a quantity interpretation (e.g., 80% of the dishes are dirty). The quantificational variability results provide suggestive support for the Obligatory Scale hypothesis by showing that the standard of a scalar adjective influences the preferred interpretation of other constituents in the sentence.     

Hindsight bias after receiving self-relevant health risk information: a motivational perspective

The phenomenon of hindsight bias was explored in the context of self-relevant health risk information. Participants in a community screening estimated their cholesterol level (foresight measure) before receiving positive or negative feedback based on their actual cholesterol level. Hindsight estimations were then assessed twice: once immediately after the feedback, and again several weeks later. While the unexpected positive feedback group showed no systematic recall bias, hindsight estimations of individuals receiving unexpectedly negative feedback showed a dynamic change over time. Immediately after the feedback, participants' recollection of their expected cholesterol level were shifted towards their actual cholesterol level (hindsight bias). In contrast, several weeks later, foresight estimations were recalled as less accurate than they had been (reversed hindsight bias). These data might reflect a change of the motivational focus from "hot affect" and fear control, which occur immediately after receiving negative feedback, to danger control, which occurs some time after the feedback, as proposed by the dual process model.     

The logic of the stimulus

This paper examines the contribution of stimulus processing to animal logics. In the classic functionalist S-O-R view of learning (and cognition), stimuli provide the raw material to which the organism applies its cognitive processes–its logic, which may be taxon-specific. Stimuli may contribute to the logic of the organism's response, and may do so in taxon-specific ways. Firstly, any non-trivial stimulus has an internal organization that may constrain or bias the way that the organism addresses it; since stimuli can only be defined relative to the organism's perceptual apparatus, and this apparatus is taxon-specific, such constraints or biases will often be taxon-specific. Secondly, the representation of a stimulus that the perceptual system builds, and the analysis it makes of this representation, may provide a model for the synthesis and analysis done at a more cognitive level. Such a model is plausible for evolutionary reasons: perceptual analysis was probably perfected before cognitive analysis in the evolutionary history of the vertebrates. Like stimulus-driven analysis, such perceptually modelled cognition may be taxon-specific because of the taxon-specificity of the perceptual apparatus. However, it may also be the case that different taxa are able to free themselves from the stimulus logic, and therefore apply a more abstract logic, to different extents. This thesis is defended with reference to two examples of cases where animals' cognitive logic seems to be isomorphic with perceptual logic, specifically in the case of pigeons' attention to global and local information in visual stimuli, and dogs' failure to comprehend means-end relationships in string-pulling tasks.This contribution is part of the special issue “Animal Logics” (Watanabe and Huber 2006).     

Perception of health risks: How smoker status affects defensive optimism

Abstract

People generally underestimate their risk to come down with a life-threatening disease when comparing themselves to similar others. However, to some extent they do take objective risk status or actual risk behavior into account. The present study examined specific conditions of this phenomenon. It was found that smoker status was associated with a somewhat higher perceived risk of getting lung cancer or smoker's cough or having a heart attack, but not of coming down with other diseases. Still, smokers did not admit that they had an above-average risk for these maladies, thus reflecting defensive optimism. In addition, smokers characterized the behavior of an abstract person, a “risk stereotype”, by estimating the number of years of smoking, the daily number of cigarettes, and the cigarettes' nicotine content necessary to be at high risk for lung cancer. There was evidence that smokers used these risk stereotypes as a reference point for evaluating their own relative risk. Smokers also made higher risk estimates if their own behavior approached that of the risk stereotype. On the whole, the results suggest that people use subjective risk factor theories when estimating their own personal health risks.     

One-Year-Olds Warn Others About Negative Action Outcomes

Warning others is a paradigm case of communicative helping and prospective action understanding. The current study addressed the ontogeny of warning in infants' gestural communication. We found that 12- and 18-month-olds (n = 84) spontaneously warned an adult by pointing out to her an aversive object hidden in her way (problem condition). In control conditions, the object was either positive (no-problem condition) or the adult had witnessed its placing (problem-known condition), which resulted in significantly less pointing. Results show that infants intervene spontaneously to help others avoid a problem before it has occurred. These acts of warning entail an understanding of negatively defined goals (to avoid an outcome) and incorrect representations of reality. Findings support theories of altruism and social–pragmatic competencies in infancy.     

Hindsight bias after receiving self-relevant health risk information: A motivational perspective

The phenomenon of hindsight bias was explored in the context of self-relevant health risk information. Participants in a community screening estimated their cholesterol level (foresight measure) before receiving positive or negative feedback based on their actual cholesterol level. Hindsight estimations were then assessed twice: once immediately after the feedback, and again several weeks later. While the unexpected positive feedback group showed no systematic recall bias, hindsight estimations of individuals receiving unexpectedly negative feedback showed a dynamic change over time. Immediately after the feedback, participants' recollection of their expected cholesterol level were shifted towards their actual cholesterol level (hindsight bias). In contrast, several weeks later, foresight estimations were recalled as less accurate than they had been (reversed hindsight bias). These data might reflect a change of the motivational focus from "hot affect" and fear control, which occur immediately after receiving negative feedback, to danger control, which occurs some time after the feedback, as proposed by the dual process model.     

Gender differences in social cognitive determinants of exercise adoption

Gender differences in lifestyle-related mortality and morbidity suggest a need to investigate gender-specificity of health behaviour change process and factors influencing it. We tested whether changes in self-efficacy beliefs and planning, as well as the level of social support predict change in exercise. Finnish men and women, aged 50–65 years, at an increased risk for type 2 diabetes were recruited from health care centres to participate in the Good Ageing in Lahti Region (GOAL) Lifestyle Implementation Trial. Psychosocial factors were measured with questionnaires and exercise with 7-day physical activity diaries at baseline and at 3 months. At baseline, no gender differences were found in self-efficacy and planning, but men reported receiving more social support than women. At 3 months, women reported having formed more action plans for changing their exercise routines than men. Among women, increase in self-efficacy and planning predicted increase in exercise. Among men, changes in planning played a less significant role. The more salient role of planning for women than for men, and the fact that women receive less social support, may reflect life circumstances allowing less spontaneous lifestyle decisions and a lower acceptance of lifestyle changes by their social environment.