Understanding the role of psychological attitudes in health behaviors and health care utilization has important implications for improving health and reducing health care costs. This is particularly important among the elderly, who require more and costlier health services. This dissertation explores the relationship between optimism (positive future expectation) and cynical hostility (mistrust of others) on smoking cessation, physical activity, and preventive service use in post-menopausal women.
Chapter one assesses the relationship between optimism and cynical hostility on smoking cessation. Women with higher cynical hostility were less likely to quit smoking over time. Smoking cessation programs may consider incorporating attitudes measures to better target smokers who are less likely to quit on their own.
Chapter two focuses on understanding the role of optimism and cynical hostility in use of screening mammograms and lipid screenings and in particular how these attitudes mediate or moderate the established relationships with race/ethnicity, and socioeconomic status. Optimism predicts screening mammograms for some, but not all, racial/ethnic groups even when adjusting for various demographic, social, and health factors. Incorporating psychological factors
such as optimism scores into health risk modeling may prove useful especially among specific racial and ethnic minority groups.
Chapter three investigates the link between optimism and cynical hostility on strenuous physical activity. Women with higher optimism report higher levels of strenuous physical activity across the lifespan. Modeling reveals that much of this relationship is explained by other variables such as demographics and health status. Higher cynical hostility is associated with increased post-menopausal strenuous physical activity only in fully corrected models. This attitude may therefore play a particularly important role in activity levels depending on the presence or absence of barriers to physical activity.
The public health relevance of this dissertation rests in identifying individuals at higher risk of developing illness burden due to health behaviors such as smoking and physical activity and potential under-use of preventive health services. Understanding how attitudes influence these behaviors may pave the way for physicians and health systems to employ novel approaches to improve health-related quality of life and ultimately reduce costs by reducing disease burden
