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. 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. 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). 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.

Background: People with chronic obstructive pulmonary disease (COPD) are stigmatized by smoking history. Although little is known about COPD-related stigma, it can adversely affect self-management and quality of life. Objective: To synthesize relevant scientific literature exploring stigma experiences and their impacts on people with COPD. Methods: CINAHL/PsycINFO/PubMed/Scopus were searched for relevant studies. Findings were organized using Major et al’s conceptual model. Results: Fifteen studies documented COPD-related stigma processes: enacted, felt, internalized, and anticipated. Moderating factors included visibility, origin, and illness perception. Individual-level stigma responses included emotional distress, limited social interactions, and negative effects on medication adherence and help-seeking. Social/community-level stigma experiences included healthcare provider and employer behaviors. Smoking is interwoven throughout all domains of stigma processes and responses to stigma. Conclusion: Substantial evidence documents processes, moderating factors, and individual and social/community responses to the complex phenomenon of COPD-related stigma; however, prevalence of COPD-related stigma and its health effects are unclear.

Ution of disease severity, body composition, symptoms, and functional capacity. Functional performance was defined as the activities that people choose to engage in on a day-to-day basis. Methods: People (n = 108) with chronic obstructive pulmonary disease were enrolled and followed yearly for 3 yr with self-reported functional performance (Functional Performance Inventory), spirometry, lung volumes, diffusion capacity, body composition (dual-energy x-ray absorptiometry), dyspnea and fatigue (Chronic Respiratory Disease Questionnaire), and functional capacity (6-min walk distance (6MWD), isokinetic strength of knee flexors and extensors, handgrip strength, and maximal inspiratory pressure). A total of 88 subjects completed a (mean ± SD) of 2.7 ± 0.9 yr of follow-up. Results: Significant negative slopes were observed for functional performance (P = 0.001), spirometry (the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC), P < 0.0001), diffusion capacity (P < 0.0001), and muscle strength (P < 0.0001)). The slopes for dyspnea, fatigue, and functional capacity were not significantly different from zero, but there was a wide individual variation. Hierarchical regression demonstrated that 31% of the variance in the slope of functional performance was accounted for by the hierarchical model, and the primary predictors were the slopes of the FEV1/FVC, 6MWD, and muscle strength (knee flexors/extensor and handgrip). Conclusions: Subjects experienced a slow decline in functional performance, associated with declines in functional capacity and increases in body fat. Symptoms were relatively stable and not associated with declines in functional performance....

The prevalence of metabolic syndrome (MetS) in people with chronic obstructive pulmonary disease (COPD) varies in European and Asian countries and does not always mirror the prevalence of the general population in a given country. We compared the prevalence of MetS in people with COPD with a comparison group in the United States. The National Health and Nutrition Evaluation Survey data set (2007-2010) was used to identify 94 people with COPD (mean age = 62). Data for demographic and clinical characteristics were obtained by interview and physical examination. Descriptive and inferential statistics were used to analyze the data. The prevalence of MetS was 57.5% in the COPD group and 53.6% in the comparison group. In people with COPD, the factors most significantly associated with MetS were age, income level, marital status, and respiratory symptoms. People with COPD should be screened for MetS.

While a majority of older adults fail to engage in recommended levels of physical activity (PA), lower-income older adults face unique challenges. They are at greater risk for low levels of PA, but little is known about the barriers they face. Objectives: This study aimed to investigate self-reported PA and barriers to PA for older adult residents of subsidized low-income senior housing, comparing barriers for those with lower and higher levels of PA. Methods: Ninety-two older adults (mean age 76.57 (SD = 7.50)) were recruited from low-income senior housing facilities. They completed a demographic questionnaire, the International Physical Activity Questionnaire (IPAQ), which measures MET-minutes/week of engaging in vigorous, moderate, and light PA levels, and the 27-item Inventory of Physical Activity Barriers (IPAB), which measures multifaceted barriers to PA. Results: The most common barrier for all residents was the PA priority. Independent t-tests revealed that the low-active group faced greater barriers than the high-active group in physical health barriers (t = 2.329, p = 0.022), PA priority of (t = 2.836, p = 0.006), environmental barriers (t = 2.072, p = 0.042), and total PA barriers (t = 2.281, p = 0.025). No significant differences were found between the low-active and high-active groups for emotional health barriers, skill barriers, external factor barriers, and social barriers. Conclusions: The low-active older adults were less likely to overcome barriers, such as physical health issues, PA priority, and environmental factors. Further research is necessary to gain a deeper understanding of the characteristics and underlying mechanisms of these barriers and to develop effective strategies for addressing them. However, findings should be interpreted cautiously due to the small and convenient sample and potential bias from self-reported PA measures.