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Abstract
Influenced by social determinants of health (SDoH), health behaviors are often considered separately, despite being interrelated, contributing to poor health outcomes such as depression and anxiety. The synergistic effects of multiple unhealthy behaviors may increase the risk of anxiety and depression, yet most studies focus on these behaviors one at a time. The American Cancer Society (ACS) Guidelines score, which quantifies adherence to the 2020 ACS diet, alcohol, body weight, and physical activity recommendations for cancer prevention, serves as a measure of co-occurring health behaviors. The purpose of this dissertation was to investigate the association between social determinants of health, co-occurring health behaviors, and mental health in a diverse sample of aging adults in the United States. Two studies were conducted using the Cancer Prevention Study-3 epidemiological cohort to: 1) identify SDoH associated with co-occurring health behaviors captured by ACS Guideline scores and 2) examine the association between 2015 ACS Guideline scores and self-reported mental health outcomes for anxiety and depression in 2021. Aim one was investigated using a cross-sectional study of 142,085 participants and multivariate ordinal logistic regression models. Participants with higher ACS Guideline adherence (i.e., better co-occurring health behaviors) were more likely to be female, Asian, hold graduate degrees, have household incomes of $125,000 or more, reside in metropolitan, non-food desert areas, be married or living with a partner, and experience no second-hand smoke (SHS) exposure. Two-way joint variable interaction models demonstrated intersectionality among select SDoH. Findings revealed higher ACS Guideline adherence among never married men, metropolitan females, and individuals with no second-hand smoke exposure making $125,000 or more. 112,016 participants were included in the second, longitudinal study addressing aim two. Higher adherence to the ACS Guidelines demonstrated consistent inverse associations with lower odds of future depression and anxiety symptoms. Together, these studies add to our understanding that people's health is significantly affected by sociodemographic, economic, and geographic factors and it is critical that future health promotion strategies consider the complexities associated with SDoH when developing public health approaches for improving co-occurring health behaviors to reduce the risk of poor health outcomes such as cancer, depression, and anxiety.