Abstract and Introduction
Background and Objectives: The aim of this study was to examine the link between internet use and preventive health behaviors. We focused on couples to examine whether there were cross-partner associations between internet use and preventive health behaviors.
Research Design and Methods: The data for this study came from the 2010 and 2012 waves of the Health and Retirement Study and the sample consisted of 5,143 pairs of coupled-individuals. Preventive health behaviors included cancer screenings (mammogram and prostate tests), cholesterol tests, and flu shots. Logistic multilevel actor–partner interdependence models were employed to test the study hypotheses.
Results: Internet use was associated with a higher likelihood of receiving prostate exams and cholesterol tests for husbands, net of demographic and health characteristics, and insurance status. We found that wives' internet use was associated with a higher likelihood of receiving flu shots and prostate exams for husbands, but husbands' internet use was not associated with wives' preventive health behaviors.
Discussion and Implications: Research linking internet use and preventive health behaviors is important because such behaviors are associated not only with health of the older population but also with substantial reductions in health care expenditures. Our findings suggested that internet use of older adults is associated with their own preventive health behaviors, as well as their spouses' preventive health behaviors. Interventions and programs to facilitate older adults' preventive health behaviors should consider couple-based approaches.
Older adults' use of preventive health care services reduces health risks, affects well-being, and saves lives (Krist et al., 2012). Preventing disease by using health care services not only helps individuals stay healthy, but also has broader positive impacts for the national economy (Centers for Disease Control [CDC], 2017). Researchers have suggested that increasing the use of clinical preventive services could significantly contribute to the health and longevity of older adults in the United States (Farley, Dalal, Mostashari, & Frieden, 2010). For example, cancer screenings such as mammograms and prostate tests when preformed in recommended time periods have been shown to reduce mortality (Centers for Disease Control and Prevention [CDC], Administration on Aging [AOA], Agency for Healthcare Research and Quality [AHRQ], & Centers for Medicare and Medicaid Services [CMS], 2011). Despite the effectiveness of these preventive health services, less than 50% of older Americans aged 65 or older used these services; and even individuals whose insurance provided partial or full coverage for these services received no services or fewer services than for which they were eligible (CDC, 2017; Krist et al., 2012). Specifically, eliminating costs did not seem to significantly increase the use of preventive health care services among older adults (Ozminkowski et al., 2006). To address the chronic disease burden of both individuals and the larger society, various interventions have been implemented and tested (Bauer, Briss, Goodman, & Bowman, 2014). However, broad public support to promote preventive health behaviors and efforts from multiple initiatives have not been highly effective to increase the delivery of preventive health care services (Krist et al., 2012). The literature on the use of preventive health care services of older adults suggested that logistical challenges, lack of knowledge, limited information and motivation, and insufficient collaboration of local and national agencies may work as barriers (Krist et al., 2012; National Prevention Council [NPC], 2011).
A common strategy underlying recent efforts to facilitate the use of preventive health care services is providing health-related information using the internet (CDC, AOA, AHRQ, & CMS, 2011; NPC, 2011). Although the link between internet use and access to health information has been examined, prior research has mostly focused on the age related digital health divide (Hall, Bernhardt, Dodd, & Vollrath, 2015; Koch-Weser, Bradshaw, Gualtieri, & Gallagher, 2010; Moorhead et al., 2013), possible harm caused by inaccurate health information on the web (Chesser, Burke, Reyes, & Rohrberg, 2016; Cole, Watkins, & Kleine, 2016), and intervention programs using the internet (Bennett & Glasgow, 2009; Payne, Lister, West, & Bernhardt, 2015; Widmer et al., 2015). Findings from previous studies suggest that the internet can be a source of online health consultations and elimination of false beliefs about certain health conditions (Lo, Esser, & Gordon, 2010; Lu, Shaw, & Gustafson, 2011). However, less is known about of the link between older adults' internet use and preventive health care behaviors. Further, even less is known about the couple dynamics underlying the link between internet use and preventive health care behaviors (Webb, Joseph, Yardley, & Michie, 2010; Xavier et al., 2013). Most studies to date focused on individual characteristics associated with preventive health care behaviors; this is surprising, given that spouses represent the most important source of care and medical information across the life course (Meyler, Stimpson, & Peek, 2007; Smith, 2011). Findings from earlier studies are also limited by small, non-representative samples and cross-sectional designs (Amante, Hogan, Pagoto, English, & Lapane, 2015; Ayers & Kronenfeld, 2007; Xavier et al., 2013). In this study, we addressed some of these shortcomings by using nationally representative data from the Health and Retirement Study and examining the association between internet use and subsequent preventive health behaviors more than a 2-year study period. Further, we examined whether there are cross-partner associations between internet use and preventive health behaviors.
Older Adults' Internet use and Preventive Health Behaviors
The internet has become an important source of health-related information over the past two decades (Brodie et al., 2000). The expansion of technology has resulted in a rapid increase in the use of the internet to seek health information (Hayward, Hummer, & Sasson, 2015). In addition, a main reason older adults use the internet is to seek health-related information (Heart & Kalderon, 2013). In particular, people who have limited health care services were more likely to use the internet to obtain health information (Amante et al., 2015). Research literature also indicates that internet use influences positive health behaviors such as better diet, daily exercise, and smoking abstinence (Redmond, Baer, Clark, Lipsitz, & Hicks, 2010; Shahab, Brown, Gardner, & Smith, 2014; Xavier et al., 2013). Other studies have shown that the internet provides an accessible resource for obtaining health information (Kivits, 2009), and older adults have also been shown to refer to the internet for health information once they identify a trustworthy source (e.g., WebMD; Walker et al., 2017). Older adults' acquisition of health information on the internet may influence their health behaviors. As such, health care professionals have been working to develop various web-based interventions and programs to educate older adults with accurate and appropriate health information (Calvillo, Román, & Roa, 2013). Taken together, these findings suggest that internet use may also be associated with other forms of health behaviors, but the link between internet use and preventive health care behaviors remains an understudied area of research. One study showed that older internet users in the United Kingdom were more likely to receive colorectal cancer screenings, but internet use was not associated with receiving mammograms (Xavier et al., 2013). In sum, this literature provides a basis for our hypothesis that internet use would be positively associated with preventive health behaviors among individuals (i.e., actor effects).
Older Couples' Internet use and Preventive Health Behaviors
Life course scholarship has long emphasized the importance of family relationships for well-being in later life. In particular, a substantial body of work has highlighted the principle of linked lives to emphasize the interconnectedness of family relationships and their impact for health and well-being (Elder, Johnson, & Crosnoe, 2003; Gilligan et al., 2017). In this context, the marital dyad is considered to be one of the most important family relationships affecting individuals in later life (Thomas, Liu, & Umberson, 2017). Marital relationships are not only understood to confer significant health benefits, but the health of individuals in marital dyads is also known to be concordant (Meyler et al., 2007; Pai, Godboldo-Brooks, & Edington, 2010). Such health concordance is in part attributable to shared information and health behaviors among couples, as well as the social control function that spouses exert on each other (Thomas et al., 2017). For example, health beliefs and behaviors of a spouse have been shown to influence the other partners' health behaviors (Manne, Kashy, Weinberg, Boscarino, & Bowen, 2012). Others have shown that marital satisfaction predicts use of cancer screenings among older couples (Kotwal, Lauderdale, Waite, & Dale, 2016). Marriage predicted older men's colonoscopy use, but not their partners' use, suggesting some cross-spousal influences in preventive health care behavior (Kotwal et al., 2016). Due to the interdependence of married couples in later life, it is possible that one spouse's internet use could affect the preventive health behaviors of the other spouse. Therefore, we used a sample of older coupled-individuals to examine cross-partner associations between internet use and preventive health behaviors.
Other Factors Affecting Older Adult's Internet use and Preventive Health Behaviors
Previous literature has demonstrated associations between factors such as race/ethnicity, education, income, and employment status and preventive health care service utilization. For example, older, low-income and ethnic-minority Americans were disproportionately less likely to use these services (CDC, AOA, AHRQ, & CMS, 2011). However, age, education, and race/ethnicity were not significant factors affecting colonoscopy use, whereas higher income was associated with this use (Kotwal et al., 2016). History of medical conditions was also related with preventive health behaviors (Kotwal et al., 2016; Manne et al., 2012). Taken together, this work indicates that certain populations are less likely to use preventive health care services; however, the mechanisms explaining these disparities are somewhat equivocal and not well understood (CDC, AOA, AHRQ, & CMS, 2011; Ozminkowski et al., 2006). Therefore, we will take these demographic factors into consideration when examining the association between older adult's internet use and preventive health behaviors.
In sum, the purpose of this study is to examine the association between internet use and preventive health care behaviors among older couples. Using nationally representative household data for coupled-individuals in the Health and Retirement Study, we investigate whether internet use of older adults and their spouses are prospectively associated with the use of preventive health care services, including influenza vaccinations and cancer screenings, over a 2-year period. Based on the empirical findings discussed previously, we hypothesized that internet use would be positively associated with preventive health care behavior among individuals. We also hypothesized that there would be cross-partner relationships between internet use and preventive health care behavior.
Gerontologist. 2019;59(1):69-77. © 2019 Oxford University Press