Expectations and Planning for Future Transportation-Related Mobility in Adults 55-84 by Annie C. Harmon A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Health Behavior and Health Education) in the University of Michigan 2016 Doctoral Committee: Associate Professor Brian J. Zikmund-Fisher, Chair Professor Cathleen M Connell Professor Ruth E. Dunkle Associate Professor Thomas M. Meuser, University of Missouri-St. Louis DEDICATION This dissertation is dedicated to two Amazons who knew I would make it, even though they are not here to see it. To my mother: I would trade all of my tomorrows for a single yesterday. Thank you for bringing me into such an incredible and enthusiastic family. You taught me how to survive without you and always believed I would be a good adult. I’m trying, Mom. I love you like a mother. To my Ga: who showed me how to be strong, told me what to eat, and hypocritically tried to get me to be patient with myself and others. I’m trying, Stara Ga. I love you both. I miss you both. Loku noć. ii ACKNOWLEDGEMENTS First and foremost, sincere thanks to Dr. Brian Zikmund-Fisher, who generously funded the data collection using his University of Michigan research incentive funds; the University of Michigan Claude E. Pepper Center and the Center for Healthier Black Elders (HBEC) for access to their volunteer registries; and to my participants. None of this would be possible without you. To my sisters, Emily and Kelsey: None of us would be complete without the other two. I wouldn't pick anyone else to go through this life with, especially the rocky patches, because we make that shit fun. To Aunt Sam and Auntie: Thank you for your eternal support. You are a credit to your mother and especially gifted at mothering others. If Mom could not be here, I'm so lucky that you two watch over me. To Charae and Carissa: Cousins, you bring joy and laughter and wisdom and understanding to my life every day. Thank you for being you. To MMJ, Liz, and Reba: By our combined wisdom and strength I believe we can do anything. Thank you for inspiring me, providing therapy, and always being there to normalize and mitigate the snowballs thrown at us. To my committee: Thank you for everything you taught me. I will take these lessons with me always. To BZF: You shared this experience, promising to finish this journey with me, and you did. Just wow. Thank you for believing in me and being an incredible role model and mentor. You are an extraordinary human being and a limitless improv artist. You. Are. Awesome!!!!! To all the other amazing professionals, researchers, scholars, and friends who supported me: My cohort (Katrina Ellis, Michelle Johns, Alana Lebron, Massy Mutumba, Jonathon Vivoda and Emily Youatt), Lindsey Robinson, Marla Berg-Weger, Jen Gates, Netflix, Kirsten Herold, Linda Chatters, Robert Taylor, Gary Harper, Jenny Crawford, Jackie Cormany, Kelso Hope, Meg Bakewell, Laura Schram, Alisa & Emmy (Pantanakasame) Young, Amelia Mary Mary and Martha, and Dan Stewart: We did it! iii TABLE OF CONTENTS DEDICATION ii ACKNOWLEDGMENTS iii LIST OF TABLES viii LIST OF FIGURES x LIST OF APPENDICES xi ABSTRACT xii CHAPTER 1. The Importance of Mobility 1 Driving Dependence Among Older Adults 1 Few People Prepare for Driving Retirement 3 Challenges to Addressing Driving Retirement 4 Building a Better Approach to Driving Retirement 6 Specific Aims 7 2. Encouraging Safe Mobility Across the Lifespan 10 The Increasingly Diverse Experience of Aging in the United States 10 Discrepancies in Driving Retirement Patterns 11 The Importance of Context to Maintaining Community Mobility in 15 Later Life Safe Driving at Any Age 20 Age-Related Changes that Threaten Driving Safety 23 Current Strategies to Maintain and Improve Abilities Required for 23 Safe Driving The Challenges of Driving Retirement 26 iv Impacts of Driving Retirement 30 Detroit, MI: A Case Study 31 Preparing for Driving Retirement 33 Gaps in Knowledge About Driving Retirement 36 3. Mobility Planning as Intervention 37 Goals of Planning for Community Mobility 38 Conceptual Model of Community Mobility Planning 39 Barriers to Mobility Planning 41 Lessons from Other Types of Planning 45 Making Better Plans for Driving Retirement 48 4. Using Mental Models to Explore Meanings of Mobility and 50 Driving Retirement A Mental Models Approach 51 Design and Impact of Dissertation Research 53 5. Pilot Interviews: Informing Quantitative Survey Using 57 Stakeholders’ Mental Models of Driving Retirement Development of Interview Protocol Using a Mental Models 58 Framework Pilot Qualitative Data Phase Overview 61 Qualitative Analysis Approach 63 Overview of Interview Sample 64 Thematic Results 67 Summary 81 v 6. Methodology for Quantitative Mobility Planning Survey 83 Quantitative Survey Development 84 Quantitative Survey Sample 99 Data Management 103 Ethical Considerations 105 7. Dissertation Measures and Analysis Plans 106 Analytical Measures 106 Describing and Predicting Mobility Planning: Analytic Approaches 115 8. Descriptive Results from the Mobility Planning Survey 119 Dissertation Sample Demographic Results 119 Current Transportation Context Results 125 Theoretical Construct Results 130 Mobility Planning Results 131 9. Mobility Planning Regression Results 139 Primary Regression Variables Results 140 Missing Data 140 Regression Model Test Results 144 10. New Understanding of Mobility Planning and Suggestions for 162 the Future Deeper Insights into the Challenges of Mobility Planning 162 Key Findings 163 Limitations 172 Next Steps: Research and Practice Implications for Public Health 177 Conclusion 182 vi APPENDICES Appendix A. Expert Stakeholder Interview Guide 184 Appendix B. Older Adult Stakeholder Interview Guide 189 Appendix C. Mobility Planning Survey 196 REFERENCES 214 vii LIST OF TABLES TABLE 1. Characteristics of Expert Interviewees and Interviews 66 2. Characteristics of Older Adult Interviewees and Interviews 67 3. Quantitative Survey Structure 99 4. Age of Dissertation Sample by Gender and Race 121 5. Demographic Characteristics of Dissertation Sample 122 6. Relationship Status by Gender and Race 125 7. Current Transportation Use 128 8. Current Transportation by Age Group 129 9. Information Seeking by Gender and Race 132 10. Information Seeking by Age Group 133 11. Concrete Plans by Gender and Race 135 12. Intention to Plan More by Gender and Race 136 13. Statistics of Primary Regression Outcomes 141 14. Correlation Table of Regression Variables 142 15. Model 1 Baseline Regression Results 144 16. Model 2 Experiential Regression Results 148 17. Model 2a Regression Results by Race 149 18. Model 2b Regression Results by Race 151 19. Model 3 ARMT Regression Results 153 20. Model 3a Regression Results by Race 154 21. Model 4 Theoretical Regression Results 157 22. Model 4a Regression Results by Race 158 viii 23. Model 4b Regression Results by Race 161 ix LIST OF FIGURES FIGURE 1. Ecological Model of Driving Decisions 35 2. Behavioral Model of Nondriving Mobility Planning 39 3. Recruitment Flowchart for Quantitative Survey 102 4. Eligibility Criteria for Dissertation Analyses 106 5. Dissertation Sample Eligibility 120 x