Health Behaviors Among Baby Boomer Informal Caregivers

Baby Boomers, persons born between the years of 1946 and 1964, are exhibiting worrying health trends. Although age-specific mortality rates and the proportion of Baby Boomers reporting poor or fair health declined substantially from 1982 to 1997, recent findings indicate significantly worse outcomes in chronic conditions such as obesity, diabetes, and cardiovascular disease (Martin, Freedman, Schoeni, & Andreski, 2009). Baby Boomers exhibit higher obesity rates and have been obese for longer periods of their lives compared with earlier generations (Leveille, Wee, & Iezzoni, 2005). Moreover, Baby Boomers have high rates of metabolic syndrome (Ford, Giles, & Dietz, 2002), which increases the risk for diabetes and for cardiovascular disease and mortality for middle-aged men (Lakka et al., 2002). Behavioral risk factors may have something to do with these increasingly poor health outcomes. For instance, physical inactivity and being overweight, among other behaviors or characteristics, contribute to chronic illness (Manson, Skerrett, Greenland, & VanItallie, 2004). Additionally, a World Bank study found that certain behavioral risk factors contributed significantly to years of lost life among 40- to 59-year-olds in high-income countries—5% of lost years of life was attributable to low fruit and vegetable intake, 5% to physical inactivity, and 31% to smoking among men (Lopez, Mathers, Ezzati, Jamison, & Murray, 2006). Although behavioral factors such as avoiding smoking, managing weight, and engaging in physical activity are essential to avoiding disability, many U.S. Baby Boomers are not engaging in healthy behaviors. Approximately 22% of 45- to 64-year-old adults are smokers (Centers for Disease Control and Prevention, 2009), and adults aged 55–64 years exhibit eating habits associated with poor nutritional quality (Davis, Murphy, Neuhaus, Gee, & Quiroga, 2000). Epidemiological research also indicates rising soda portion sizes, ranging from 12 to 20 fluid ounces (oz), among Americans (Nielsen & Popkin, 2003). The 2008 Physical Activity Guidelines for Americans indicate that “medium activity” (150–300 min of moderate-intensity activity or 75–150 min of vigorous-intensity physical activity per week) conveys substantial health benefits, but many Americans have low levels of physical activity (Department of Health and Human Services, 2008). Informal caregiving might be an additional cause for concern for Baby Boomers. The burden of caregiving is significant and well documented, and over 10 million adults over the age of 50—primarily Baby Boomers—care for an aging parent (MetLife, 2011). An estimated 3.3 million U.S. adults provided unpaid, informal care for a spouse in the past 12 months, and the percentage of 50- to 64-year-olds providing informal care is growing (National Family Caregivers Association, 2011). However, there is limited research to date regarding the combination of smoking, physical activity, and diet among caregivers—including Baby Boomer caregivers. Some studies have shown that caregivers engage in fewer health-promoting self-care behaviors (Acton, 2002), including their amount of exercise (Janevic & Connell, 2004). Compared with non-caregivers, certain adults caring for family members from multiple generations are less likely to exercise regularly but smoke marginally more cigarettes (Chassin, Macy, Seo, Presson, & Sherman, 2009). However, other earlier studies had insignificant findings. One study observed that caregivers did not significantly reduce their use of preventive services and did not report a higher number of missed meals, missed doctor appointments, missed flu shots, or higher levels of smoking (Burton, Newsom, Schulz, Hirsch, & German, 1997). Another study found that caregivers did not significantly differ from non-caregivers on 10 of 13 health practices or on the total number of positive health behaviors (Scharlach, Midanik, Runkle, & Soghikian, 1997). To further explore health behaviors of Baby Boomer caregivers, the present study used a representative statewide survey and adapted a theoretical stress model (Vitaliano et al., 2002) to examine smoking, sedentary behavior, and eating habits among Baby Boomer caregivers. The proposed model posits several pathways that might separately or jointly influence health behaviors, the first of which is exposure to stress. Stress may lead people to seek out pleasurable stimuli (Zillman & Bryant, 1985) and raises hormone levels that over time may alter health behaviors (Vitaliano, Zhang, & Scanlan, 2003). Stress exposure among younger adults, for instance, has been associated with higher consumption of sweets, including soda (Elfhag, Tholin, & Rasmussen, 2008), and high-fat and high-caloric food (Zellner et al., 2006). Stress has also been associated with lower levels of physical activity and increased rates of smoking among working adults (Ng & Jeffery, 2003). Psychological distress resulting from exposure to caregiving is the second potential pathway to poor health behavior. Distress is negative affect or depressed mood, hassles, burden, and absence of positive experiences in response to chronic stress (Vitaliano et al., 2002). Researchers have observed associations between psychological distress and eating, including sugar and soda consumption (Shi, Taylor, Wittert, Goldney, & Gill, 2010), as well as smoking (Pratt, Dey, & Cohen, 2007). One study found that adults with high stress levels have higher depression levels and lower participation in sports activities (Wijndaelea et al., 2007). Personal or social resources may also affect distress and health behaviors. Women are more likely to engage in stress-induced eating (Greeno & Wing, 1994), and income is negatively associated with depression levels (Schulz, Tompkins, & Rau, 1988) as well as health behaviors such as smoking, physical activity, and diet; additionally, education and occupation may influence health behavior (Laaksonen, Prattala, Helasoja, Uutela, & Lahelma, 2003). Married persons have better psychological well-being compared with those who are single (Shapiro & Keyes, 2008). Although employment may function as a type of personal resource, it may also create “negative spillover” from the workplace to the household, causing psychological distress (Riley & Bowen, 2005). Additionally, individuals living in less socially cohesive neighborhoods are more likely to smoke and less likely to exercise (Clark et al., 2008). Caregiving itself involves chronic stress and psychological distress (Schulz & Sherwood, 2008), and different types or amounts of caregiving may involve varying levels of stress exposure. For instance, spousal caregivers provide the most all-inclusive care (Pinquart & Sorensen, 2003b) and are at risk for psychological distress (Pruchno & Potashnik, 1989) and less nutritious eating (Connell, 1994). Moreover, the number of stressors experienced by spousal caregivers explained roughly one quarter of their depression and one half of their stress levels (Vedhara, Shanks, Anderson, & Lightman, 2000). Although there is some evidence that burden and distress levels do not differ among caregivers caring for biologically related family members compared with in-laws (Pinquart & Sorenson, 2011), caregiver strain is associated with the caregiver living situation (Deimling, Bass, Townsend, & Noelker, 1989). At the same time, the amount or level of caregiving provided are negatively associated with exercise (Sisk, 2000) and health-risk behaviors (Burton, Zdaniuk, Schulz, Jackson, & Hirsch, 2003). In this study, we were interested in testing for associations between caregivers’ exposure to stress and negative health behaviors, controlling for psychological distress, and personal and social resources. The negative health behaviors we examined were smoking, sedentary behavior, regular soda and fast-food consumption, as well as global, negative health behavior. For the present study, we developed three separate hypotheses to test, based on Vitaliano’s stress model: Controlling for other factors, caregivers will be more likely than non-caregivers to engage in negative health behavior (H1); Controlling for other factors, spousal caregivers will be more likely than other caregivers to engage in negative health behavior (H2); and Controlling for other factors, more weekly caregiver hours and a greater total duration of caregiving time will each be associated with negative health behavior (H3).