Informal Helping and Subsequent Health and Well-Being in Older U.S. Adults

BACKGROUND

Growing evidence suggests that informal helping (unpaid volunteering not coordinated by an organization or institution) is associated with improved health and well-being outcomes. However, studies have not investigated whether changes in informal helping are associated with subsequent health and well-being.

METHODS

This study evaluated if changes in informal helping (between t0;2006/2008 and t1;2010/2012) were associated with 35 indicators of physical, behavioral, and psychosocial health and well-being (at t2;2014/2016) using data from 12,998 participants in the Health and Retirement study - a national cohort of US adults aged > 50.

RESULTS

Over the four-year follow-up period, informal helping ≥ 100 (versus 0) hours/year was associated with a 32% lower mortality risk (95% CI [0.54, 0.86]), and improved physical health (e.g., 20% reduced risk of stroke (95% CI [0.65, 0.98])), health behaviors (e.g., 11% increased likelihood of frequent physical activity (95% CI [1.04, 1.20])), and psychosocial outcomes (e.g., higher purpose in life (β = 0.15, 95% CI [0.07, 0.22])). However, there was little evidence of associations with various other outcomes. In secondary analyses, this study adjusted for formal volunteering and a variety of social factors (e.g., social network factors, receiving social support, and social participation) and results were largely unchanged.

CONCLUSIONS

Encouraging informal helping may improve various aspects of individuals' health and well-being and also promote societal well-being.

Long-term Impacts of Civic Engagement during Emerging Adulthood: A Nationally-representative Study

PURPOSE

We examined if civic engagement during emerging adulthood positively impacted a broad array of outcomes in middle adulthood, and if associations varied based on race, gender, age, and urban-rural status.

DESIGN

Prospective design used to determine if civic engagement during emerging adulthood (M age = 21.81) predicted outcomes 15 years later.

SETTING

Restricted data from the National Longitudinal Study of Adolescent to Adult Health.

SUBJECTS

Wave 1 participants who completed surveys 7 years (77% follow-up rate), 14 years (80% follow-up rate), and 22 years later (follow-up rate 72%) and who had valid sampling weight to ensure national representativeness (n = 9349).

MEASURES

Predictor - civic engagement; Outcomes-mental health, substance use, criminal behaviors, and healthy behavior.

ANALYSIS

Linear regression using MPLUS 7.2.

RESULTS

Civic engagement predicted lower levels of depressive symptoms (b = -1.05, SE = .28), criminal behaviors (b = -.47, SE = .12), and substance use (b = -.66, SE = .13), and higher levels of healthy behaviors (b = 1.26, SE = .19), after controlling for demographics, family, peer, neighborhood, and school-related background variables. Moderation analyses revealed that civic engagement benefited females and white participants more.

CONCLUSION

Civic engagement during emerging adulthood has a positive impact on a broad array of outcomes in middle adulthood. Implications and future research recommendations will be discussed.

Who Benefits From Helping? Moderators of the Association Between Informal Helping and Mortality

BACKGROUND

While informal helping has been linked to a reduced risk of mortality, it remains unclear if this association persists across different levels of key social structural moderators.

PURPOSE

To examine whether the longitudinal association between informal helping and all-cause mortality differs by specific social structural moderators (including age, gender, race/ethnicity, wealth, income, and education) in a large, prospective, national, and diverse sample of older U.S. adults.

METHODS

We analyzed data from the Health and Retirement Study, a national sample of U.S. adults aged >50 (N = 9,662). Using multivariable Poisson regression, we assessed effect modification by six social structural moderators (age, gender, race/ethnicity, wealth, income, and education) for the informal helping (2006/2008) to mortality (2010-2016/2012-2018) association on the additive and multiplicative scales.

RESULTS

Participants who reported ≥100 hr/year of informal helping (vs. 0 hr/year), had a lower mortality risk. Those who engaged in 1-49 hr/year most consistently displayed lower mortality risk across moderators, while those who engaged in 50-99 and ≥100 hr/year only showed decreased mortality risk across some moderators. When formally testing effect modification, there was evidence that the informal helping-mortality associations were stronger among women and the wealthiest.

CONCLUSIONS

Informal helping is associated with decreased mortality. Yet, there appear to be key differences in who benefits from higher amounts of informal helping across social structural moderators. Further research is needed to evaluate how the associations between informal helping and health and well-being are patterned across key social structural moderators.

Individual-Level Psychosocial Resiliencies as Mediators of the Relationship Between Internalized Homophobia and Depressive Symptoms Among Middle-Aged and Older Men Living With and Without HIV

Among sexual minority men (SMM), internalized homophobia (IH) has been consistently associated with increased depression symptoms. However, some SMM experiencing IH demonstrate resilience to buffer against depression symptoms. In this analysis, we used the Stress Process Model (SPM) as a conceptual framework to explore individual-level psychosocial resilience (ILPR) factors serving as a buffer of the IH-depression relationship. To utilize the SPM to explore whether four ILPR factors, including volunteerism, optimism, religiosity/spirituality, and global resiliency measure mediate the relationship between IH and depression symptoms among middle-aged and older SMM living with and without HIV. We used exploratory and confirmatory factor analysis to construct measurement models for the four ILPR factors. We examined whether the four ILPR factors mediated the IH-depression relationship. IH was significantly and positively associated with depression symptoms. There was a partial mediation of the IH-depression association by the four ILPR. Specifically, we found statistically significant indirect effects of optimism and the global resilience measure and supporting buffering effects of the IH-depression association. Although, the indirect effects religiosity/spirituality on the IH-depression relationship was significant, it did not support a buffering of effect. The indirect effects of volunteerism were not statistically significant. Our findings highlight the potential role of ILPR factors in the development of resilience against the negative effects of IH. Implications of these results for future research and practice are discussed.

Introduction to Special Issue: Interventions to Modify Psychological Well-Being and Population Health

Psychological ill-being is on the rise, with 1 in 5 Americans suffering from a mental disorder in any given year. Additional evidence demonstrates that psychological well-being has also decreased over time. These trends are particularly worrisome given the substantial and growing body of evidence demonstrating that psychological ill-being (e.g., depression, anxiety, anger) is associated with an elevated risk of developing chronic diseases and premature mortality, while aspects of psychological well-being (e.g., positive affect, sense of purpose and meaning, life satisfaction) are independently associated with improved physical health outcomes. An underexplored but promising approach to enhancing both psychological and physical health is through developing a set of tools that specifically target psychological well-being (often referred to as positive psychological interventions (PPIs) although many interventions developed outside the field of positive psychology also achieve these goals). Such interventions hold promise as a strategy for improving population health. However, critical knowledge gaps hold us back, and we have not yet developed a robust set of intervention strategies that can improve psychological well-being in meaningful, durable, and scalable ways that would also have downstream effects on physical health. The goal of this special issue is to help address these knowledge gaps by bringing together current conceptual frameworks, critical examination of key constructs, and novel empirical evidence needed to identify and examine interventions that can modify psychological well-being, particularly those that have the potential to be scaled at the population level and with durable effects.

Reduced epigenetic age in older adults who volunteer

BACKGROUND

Volunteering is associated with improved health and well-being outcomes, including a reduced risk of mortality. However, the biological mechanisms underlying the association between volunteering and healthy aging and longevity have not been well-established. We evaluated if volunteering was associated with reduced epigenetic age acceleration in older adults.

METHODS

We evaluated associations between volunteering and age acceleration, measured by 13 DNA methylation (DNAm) "epigenetic clocks" in 4011 older adults (M_age=69 years; SD_age=10 years) who participated in the Health and Retirement Study. We assessed 9 first-generation clocks (Horvath, Hannum, Horvath Skin, Lin, Garagnani, Vidalbralo, Weidner, Yang, and Bocklandt, which predict chronological age) and 4 second-generation clocks (Zhang, PhenoAge, GrimAge, and DunedinPoAm, which predict future disease or longevity). We quantified the total associations between volunteering and DNAm age acceleration as well as the extent to which these associations might be attributable to potential confounding by individual demographics (e.g., race), social demographics (e.g., income), health factors (e.g., diabetes), and health behaviors (e.g., smoking).

RESULTS

Volunteering was associated with reduced epigenetic age acceleration across 6 epigenetic clocks optimized for predicting health and longevity (False Discovery Rate [FDR] q < 0.0001 for epigenetic clocks: PhenoAge, GrimAge, DunedinPoAm, Zhang mortality, Yang mitotic; FDR q < 0.01: Hannum). These associations were mostly independent of demographic and health factors, but substantially attenuated after adjusting for health behaviors.

CONCLUSION

Volunteering was associated with reduced epigenetic age acceleration in 6 of 13 (mostly second-generation) epigenetic clocks. Results provide preliminary evidence that volunteering might provide health benefits through slower biological aging and implicate health behaviors as one potential mechanism of such effects.

Identifying pathways to increased volunteering in older US adults

While growing evidence documents strong associations between volunteering and improved health and well-being outcomes, less is known about the health and well-being factors that lead to increased volunteering. Using data from 13,771 participants in the Health and Retirement Study (HRS)—a diverse, longitudinal, and national sample of older adults in the United States—we evaluated a large range of candidate predictors of volunteering. Specifically, using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (over a 4-year follow-up between t₀; 2006/2008 and t₁; 2010/2012) were associated with volunteer activity four years later (t₂; 2014/2016). After adjusting for a rich set of covariates, certain changes in some health behaviors (e.g., physical activity ≥ 1x/week), physical health conditions (e.g., physical functioning limitations, cognitive impairment), and psychosocial factors (e.g., purpose in life, constraints, contact with friends, etc.) were associated with increased volunteering four years later. However, there was little evidence that other factors were associated with subsequent volunteering. Changes in several indicators of physical health, health behaviors, and psychosocial well-being may predict increased volunteering, and these factors may be novel targets for interventions and policies aiming to increase volunteering in older adults.

How Ready Are Young Adults to Participate in Community Service? An Application of the Transtheoretical Model of Behavior Change

PURPOSE

Engaging in community service, or unpaid work intended to help people in a community, is generally associated with greater overall well-being. However, the process of beginning and maintaining community service engagement has been sparsely examined. The current study applied the Transtheoretical Model (TTM) of behavior change to understanding community service readiness among young adults.

DESIGN

Cross-sectional design using an online survey.

SETTING

Participants were undergraduate students recruited at a mid-sized Northeastern US university in Spring 2018.

SAMPLE

Participants (N = 314) had a mean age of 20.36 years (SD = 3.69), were primarily White (78%), female (72%), and from moderately high socioeconomic backgrounds (as measured by parental level of education).

MEASURES

Socio-demographics including age, gender, race-ethnicity, and parental level of education; readiness, pros, cons, and self-efficacy for community service; civic engagement behavior; well-being.

ANALYSIS

Participants were classified into very low (n = 62), low (n = 59), moderate (n = 92), high (n = 46), and very high (n = 55) readiness for community service groupings. A MANOVA was conducted to assess relationships between groupings and community service TTM constructs, civic engagement, and well-being.

RESULTS

There were significant differences between readiness groupings on all main outcome variables, F(20, 1012) = 10.34, p < .001; Wilks' Λ = 0.54, η² = .14. Post-hoc Games-Howell tests showed that those exhibiting higher levels of readiness reported fewer cons, greater pros, higher self-efficacy, more overall civic engagement, and greater well-being compared to lower readiness individuals.

CONCLUSION

Consistent with previous TTM applications, self-efficacy and the importance of pros increased across readiness groupings while the importance of cons decreased. Study findings may be used to inform readiness-tailored interventional work for increasing community service. This area of study would benefit from longitudinal research examining community service readiness beyond the college environment.

Civic Engagement and Well-Being: Examining a Mediational Model Across Gender

PURPOSE

The relationship between civic engagement and mental health is generally positive, yet particularly complex among those from low socioeconomic backgrounds and women. The current study examined pathways between civic engagement and well-being to clarify its merit as a health promotional tool for young adults.

DESIGN

Cross-sectional design using an online questionnaire.

SETTING

Participants were recruited at a mid-sized Northeastern US university.

SAMPLE

Participants (N = 438) were primarily White (78%) and female (72%).

MEASURES

Demographics, socioeconomic status, civic engagement behavior, well-being, meaning in life, self-efficacy toward service, and social support.

ANALYSIS

Structural equation modeling to test an a priori model of civic engagement behavior and well-being in young adults. Models were conducted across men and women, covarying for social support.

RESULTS

The full effects model fit well, demonstrating positive relationships between civic engagement and well-being for both men and women with mediation by service self-efficacy and meaning in life (χ²(2) = 1.05, p = .59; CFI = 1.0; RMSEA = .00, 90%CI [.00, .07]; R² = .46). Type of engagement (civic, electoral, sociopolitical) showed mixed results in relation to well-being.

CONCLUSION

Civic activity was associated with well-being when mediated by service self-efficacy while sociopolitical voice correlated to stronger well-being when mediated by meaning in life. Future longitudinal studies should be conducted among more socioeconomically diverse populations to verify the role of civic engagement in health promotion.

Volunteerism and Cardiovascular Health: The HCHS/SOL Sociocultural Ancillary Study

OBJECTIVES

The objective of this study was to examine the association between volunteerism and favorable cardiovascular health (CVH) among Hispanics/Latinos living in the US.

METHODS

Data from the Hispanic Community Health Study/Study of Latinos (2008-2011) Sociocultural Ancillary Study were used (N = 4,926; ages 18-74 years). Favorable CVH was defined as positive profiles of all major CVD risk factors: low total serum cholesterol, blood pressure, and body mass index; not having diabetes; and not smoking. Survey-weighted logistic regression models were adjusted for sociodemographic, lifestyle, and psychological factors. In secondary analyses, we tested whether the volunteerism-CVH association was modified by sex, age, or years lived in the US (<10 vs. ≥10 years; a proxy acculturation measure).

RESULTS

Prevalence of volunteerism was 14.5%. Compared to non-volunteers, volunteers had 1.67 higher odds of favorable CVH in the fully-adjusted model (Odds Ratio [OR] = 1.67, 95% Confidence Interval [CI] = 1.11, 2.52). There was evidence of effect modification by acculturation; only volunteers who had lived in the US ≥10 years had 2.41 higher odds of favorable CVH (OR = 2.41, 95% CI=1.53, 3.80). There was no evidence of effect modification by sex or age.

CONCLUSIONS

Volunteerism was associated with favorable CVH among US Hispanics/Latinos.

When helping helps: exploring health benefits of cancer survivors participating in for-cause physical activity events

BACKGROUND

Over 15.5 million Americans live with cancer and 5-year survival rates have risen to 69%. Evidence supports important health benefits of regular physical activity for cancer survivors, including increased strength and quality of life, and reduced fatigue, recurrence, and mortality. However, physical activity participation among cancer survivors remains low. Cancer organizations provide various resources and support for cancer survivors, including emotional, instrumental, informational, and appraisal support. Many cancer organizations, like the LIVESTRONG Foundation, support the cancer community by sponsoring and hosting for-cause physical activity events, providing opportunities for anyone (including cancer survivors) to "help"/support those living with cancer. The concept of helping others has been positively related with wellbeing, physical activity, and multiple health behaviors for those helping. However, the role of helping others has not been examined in the context of being physically active to help others or its relationship with overall physical activity and quality of life among those helping. Therefore, we developed a path model to examine relationships between cancer survivors' (1) desire to help others with cancer, (2) physically active LIVESTRONG participation to help others, (3) regular physical activity engagement, and (4) quality of life.

METHODS

In 2010, 3257 cancer survivors responded to an online survey sent to all people involved with the LIVESTRONG organization at any level. The hypothesized path model was tested using path analysis (Mplus 8).

RESULTS

After list-wise deletion of missing responses, our final sample size was 3122 (61.8% female, mean age: 48.2 years [SD = 12.7]). Results indicated that the model yielded perfect fit indexes. Controlling for age, sex, income, and survivorship length, desire to help was positively related with physically active LIVESTRONG participation (β = .11, p < .001), which was positively related with regular physical activity (β = .30, p < .001), and regular physical activity was positively related with quality of life (β = .194, p < .001).

CONCLUSIONS

Results suggest that cancer survivors can benefit from participating in for-cause physical activity events, including more regular physical activity. Researchers need to further investigate the role of helping others when examining health behaviors and outcomes, and cancer organizations should continue encouraging cancer survivors to help others by participating in physical activity events.