Longitudinal relationships of cardiovascular disease on preventive care service utilization among midlife adults: The roles of diagnosis, psychological factors, and the intersectionality of race and gender

Although cardiovascular disease (CVD) is the leading cause of disability and mortality among midlife adults in the United States, preventive care utilization remains limited. Previous studies have shown that individuals with CVD are at higher risk for subsequent health problems and may require increased preventive care. However, there is limited research exploring the specific factors that moderate the relationship between CVD diagnosis and preventive care utilization, including the potential role of depression, mastery experience, race, and gender. Informed by teachable moments as a heuristic, this study aimed to investigate the impact of CVD diagnosis on preventive care utilization among midlife adults. Employing the cognitive model of depression and agentic positive psychology, this study further examined whether depression and mastery experience moderate the impact of CVD diagnosis on preventive care utilization. Finally, informed by the theory of intersectionality, this study explored whether race and gender interact with each other in moderating the main relationship. The study employed a longitudinal design with a national representative sample (n = 6,222) from six waves of the National Longitudinal Survey of Youth 1979 (NLSY79) collected between 2006 and 2016. The study used self-reported physician diagnosis of a specific health condition to establish a CVD diagnosis. It measured depression using a seven-item short form from the Center for Epidemiologic Studies Depression Scale (CES-D) and mastery experience with the Pearlin Mastery Scale. Five types of preventive care services were included, namely, influenza vaccination; blood cholesterol, blood sugar, and blood pressure testing; and electrocardiography (EKG) testing. Logistic regression models were used to examine the main relationship and moderation. Intersectionality between race and gender was tested using two two-way moderations, by first treating race and gender as separable unitary entities to examine if race and gender, respectively, moderated the relationship between a CVD diagnosis and preventive care utilization. Then, race and gender were joined together to test for three-way moderation in the main relationship. The results showed that midlife adults with a CVD diagnosis were more likely to utilize all five types of preventive care services, with the most relevant preventive care type, EKG, having the largest strength of likelihood. Likewise, depression strengthened the relationship between a CVD diagnosis and the utilization of blood pressure tests. Mastery experience was not significant in moderating the main relationship. Although race and gender separately did not moderate the main relationship, in both cases of influenza vaccinations and EKG tests, being Hispanic weakened the moderation between women’s moderation and the main relationship. The three-way moderation was supported for influenza vaccinations and EKG tests. These findings demonstrate that a CVD diagnosis may serve as a teachable moment for individuals compelling them to better utilize multiple preventive care services. Therefore, timely interventions through health providers were recommended. In addressing different contributing forces that come into racialized and genderized living experiences, training for physicians on patient-centered communication, organized efforts through local community organizations on health beliefs and trust, and a legal endorsement of better insurance coverage on priority preventive care services were recommended. Future research needs to explore how a CVD diagnosis affects different population groups, develop and test interventions that center on teachable moments and intersectionality, and further explore the roles of depression and mastery experiences with other datasets.

Name thesis:degree_name

Ph.D.

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Social Work

Grantor

University of Illinois at Urbana-Champaign

Year dc:date

2023

Author dc:creator

• Sun, Kang

Contributors dc:contributor

• Zhan, Min
• Andrade, Flavia C. D.
• Tan, Kevin P. H.
• Xia, Yan
• Gehlert, Sarah

• Cardiovascular Disease
• Preventive Care Service Utilization
• Psychological Factor
• Intersectionality

Statement dc:rights

• Copyright 2023 Kang Sun

Language dc:language

en, eng

Handle dc:identifier

https://hdl.handle.net/2142/122110

OAI record oai:identifier

https://www.ideals.illinois.edu/oai-pmh?verb=GetRecord&metadataPrefix=etdms&identifier=oai%3Awww.ideals.illinois.edu%3A2142%2F122110