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Positive Affect and Health Behaviors Across 5 Years in Patients With Coronary Heart Disease

The Heart and Soul Study

Sin, Nancy L. PhD; Moskowitz, Judith Tedlie PhD, MPH; Whooley, Mary A. MD

doi: 10.1097/PSY.0000000000000238

Objectives Positive psychological states are linked to superior health and longevity, possibly due to behavioral factors. We evaluated cross-sectional and 5-year associations between positive affect and health behaviors in patients with coronary heart disease (CHD).

Methods Outpatients with CHD reported positive affect, physical activity, sleep quality, medication adherence, cigarette smoking, and alcohol use at baseline (n = 1022) and 5 years later (n = 662). Covariates in regression analyses included demographics, cardiac disease severity, and depressive symptoms.

Results At baseline, higher positive affect (per 1 standard deviation) was associated with better health behaviors: physical activity (odds ratio [OR] = 1.52, 95% 95% confidence interval [CI] = 1.30–1.77, p < .001), sleep quality (OR = 1.24, 95% CI = 1.04–1.48, p = .015), medication adherence (OR = 1.46, 95% CI = 1.12–1.90, p = .005), and nonsmoking (OR = 1.29, 95% CI = 1.06–1.57, p = .012), but was unrelated to alcohol use. Baseline positive affect did not predict health behaviors at follow-up, accounting for baseline behaviors. However, increases in positive affect across 5 years co-occurred with improvements in physical activity (B = 0.023, standard error [SE] = 0.008, p = .002), sleep quality (B = 0.011, SE = 0.005, p = .039), and medication adherence (B = 0.014, SE = 0.004, p < .001), but not smoking status (OR = 1.07, 95% CI = 0.73–1.55, p = .74).

Conclusions Positive affect was associated with health behaviors among patients with CHD. Efforts to sustain or enhance positive affect may be promising for promoting better health behaviors.

From the Center for Healthy Aging and Department of Biobehavioral Health (Sin), The Pennsylvania State University, University Park, Pennsylvania; Department of Medical Social Sciences (Moskowitz), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Departments of Medicine and Epidemiology & Biostatistics (Whooley), University of California, San Francisco, California; and Veterans Affairs Medical Center (Whooley), San Francisco, California.

Supplemental Content

Address correspondence and reprint requests to Nancy L. Sin, PhD, Center for Healthy Aging, The Pennsylvania State University, 422 Biobehavioral Health Building, University Park, PA 16802. E-mail:

Received for publication May 1, 2014; revision received May 29, 2015.

Copyright © 2015 by American Psychosomatic Society
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