Smoking, drinking, and obesity have all garnered much attention for their detrimental effects on health and other outcomes. Behaviors such as exercise and a healthy diet, in contrast, can have positive effects on health. Similarly, the use of preventive services, such as cholesterol screening and flu shots, can lead to additional years of life. A critical question is how to improve the health of the public by encouraging healthy decisions. This paper focuses on the role of the spouse in shaping individual's health habits and decisions to use preventive care. In particular, it focuses on associations in the behavioral changes of spouses.
Among married couples, there is evidence of initial matching and compatibility in many areas due to endogamy and homogamy in race, religion, socioeconomic status (Mare 1991
; Kalmijn 1998
), physical and mental health (Mathews and Reus 2001
; Wilson 2002
; Nakosteen, Westerlund, and Zimmer 2005
), substance use (Vanyukov et al. 1996
), occupation (Hout 1982
; Smits, Ultee, and Lammers 1999
), and leisure preferences (Houts, Robins, and Huston 1996
). Commonalities generated by assortative mating are well documented and discussed across several disciplines (Becker 1981
; Mare 1991
; Kalmijn 1998
; Alpern and Reyniers 2005
; Van Leeuwen and Maas 2005
). Additionally, concordance has been documented for smoking (Sutton 1980
; Venters, Jacobs, and Luepker 1984
), drinking (Leonard and Das Eiden 1999
), and diet and exercise (Macken, Yates, and Blancher 2000
). The tendency for homogamy in the use of preventive services has not been studied, although both assortative mating and environmental factors are likely to yield a positive association.
Further inquiry has evaluated the transitions that occur in health behaviors after the initial matching, and spouse behavior is considered as an important risk factor for adopting, continuing, or relapsing to poor health behaviors. For instance, studies have estimated the effect of a husband's drinking on the wife's drinking during the transition to marriage and in the newlywed phase (Leonard and Das Eiden 1999
; Leonard and Mudar 2004
). In the case of smoking, both spousal support and spousal smoking status have been studied (Coppotelli and Orleans 1985
; Mermelstein et al. 1986
; Roski, Schmid, and Lando 1996
; Monden, De Graaf, and Kraaykamp 2003
; Homish and Leonard 2005
). However, these studies often concentrate on earlier phases of marriage, such as the newlywed and childbearing phases (McBride et al. 1998
; Leonard and Das Eiden 1999
). Studies typically evaluate one spouse's behavior simply as a risk factor for the other's without taking into account the joint process of change, although there are exceptions (Shattuck, White, and Kristal 1992
; Franks, Pienta, and Wray 2002
The influence of one spouse on the other's use of preventive services has received little attention, yet it is an important addition to the set of health behaviors. Preventive behaviors, like health habits, fit well into a Grossman (1972)
health demand model. Individuals make investments and choices regarding their health across a variety of factors, including preventive services, in order to optimize their utility. Within this context, it is reasonable to propose that behavioral choices could be influenced by behavioral changes of the spouse. These spousal interactions have been theorized within a Grossman- style framework (Jacobson 2000
). However, the magnitude of any effect remains an empirical question.
This paper adds to the literature in multiple ways. First, we analyze and document the changes in behavior of both spouses. Although studies have analyzed spousal influence, they have typically evaluated the behavioral change of one spouse and taken the other spouse's behavior as fixed. Second, we focus on the dynamics of changes in health habits over time. Third, we focus on a set of older individuals. This age category provides fertile ground for studying the dynamics of behavior, because older individuals face a number of changes in their health and the structure of their life (e.g., retirement) that could precipitate changes in behavior. Lastly, we add the use of preventive services to the set of behavioral changes and analyze multiple health habits within a single study in order to provide more general conclusions.
Using data from the Health and Retirement Study (HRS), we examine behavioral changes of spouses over time across a number of health habits: smoking, drinking, exercise, and the use of clinical services (specifically cholesterol screening and flu shots). We find that when one spouse changes a poor health behavior, the other spouse is likely to change behavior as well. This is observed across all the behaviors that we analyze, and it persists even after controlling for other factors. This finding has important implications. Understanding changes in health behavior in the context of the family, especially within marriage and with knowledge of the behavior of the spouse, can add precision to our understanding of key health behaviors, translating into more effective interventions and policies and improving evaluations.