Date of Award


Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Douglas W. Roblin, Ph.D.

Second Advisor

Fredric D. Wolinsky, Ph.D.


INTRODUCTION: Osteoporotic bone fracture is a major cause of hospitalization, disability, loss of independent living capacity, and mortality among aging adults. Although physical exercise may sustain bone mineral density and prevent falls and fractures among individuals at risk for low bone mineral density, adherence to exercise recommendations is low. Increasing efficacy and effectiveness of treatment for osteoporosis would benefit from examination of heterogeneity of treatment effects. Previous research indicates that poor health literacy (HL) and health numeracy (HN) may be associated with less exercise behavior and heterogeneity of treatment effects may be evident across high and low level of health literacy and/or health numeracy.

AIM: Examine heterogeneity of treatment effects due to HL/HN on post-intervention exercise self-efficacy and exercise behavior among older adults enrolled in a large, multi-site randomized controlled trial designed to increase exercise as part of osteoporosis guideline concordant care.

METHODS: A secondary data analysis was conducted, utilizing a modified intent-to-treat approach. Linear mixed models with and without covariates were conducted to examine heterogeneity of treatment effects by incorporating the treatment by high/low HL/HN interaction. Analyses were conducted using pooled, as well as site-specific samples.