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PubMed2005

Health behaviors associated with better quality of life for older bereaved persons.

BACKGROUND: Bereavement is a risk factor for declines in health, adverse health behaviors, increased physician visits, and mortality, and occurs with greatest frequency in later life. Little is known about health behaviors that are associated with better quality of life among recently bereaved older persons. OBJECTIVE: The objective of this community-based longitudinal, observational study was to examine the influence of health behaviors on the quality of life of 200 elderly bereaved persons. DESIGN AND MEASUREMENTS: Health behaviors (i.e., exercise, monitoring caloric intake, sleep, daily vitamin intake, annual health check-ups) were examined at approximately 6 months postloss (baseline) and 11 months postloss (Wave 2). Quality of life was assessed at approximately 11 months postloss and 19 months postloss (Wave 3), using the RAND 36-Item Health Survey, which measures 8 domains of health and functioning, plus a single item assessing change in health. RESULTS: Consistently exercising 1 or more days per week at Waves 1 and 2 significantly (p < .05) predicted better self-rated health, physical functioning, fewer physical role limitations, and greater energy at Wave 3 in models that adjusted for age, gender, prior psychiatric disorder, baseline reports of functional disabilities and chronic conditions. Consistently monitoring caloric intake at Waves 1 and 2 predicted better self-rated health (p < .05), greater energy (p < .01), and positive change in health (p < .05) at Wave 3 in models that adjusted for the above set of control variables. Sleeping 6.5-9 hours per night at baseline alone predicted better social functioning (p < .001), fewer emotional role limitations (p < .01), better emotional health (p < .001), and greater energy (p < .01). CONCLUSIONS: Should future research confirm these results, clinicians would be advised to recommend the identified preventive and protective health behaviors to recently bereaved older patients.

Aged↗

PubMed2003

The relationship between chronic pain, immune function, depression, and health behaviors.

The objectives of this study were 1) to determine the relationships between pain perceptions, immune function, depression and health behaviors and 2) to examine the effects of chronic pain on immune function using depression and health behaviors as covariates. A nonexperimental cross-sectional design was used to compare 24 chronic back pain patients with 33 asymptomatic no-pain healthy subjects. Immune function measures using natural killer (NK) cell activity, percent and numbers of NK cells, and T-cell lymphocyte proliferation with mitogens concanavalin A (ConA) and pytohemagglutinin (PHA) as well as self-report measures for depression and health behaviors were collected on all subjects. Pain perceptions showed positive significant correlations with depression (P = 0.01) and total percent of NK cells (P = 0.04). Depression and health behaviors were negatively correlated (P = 0.01). Positive associations were observed for depression and 2 PHA mitogen levels (P < 0.05). Comparison of group means, controlling for depression and health behaviors, showed that chronic pain patients' immune function, as measured by the combined NK effector to target (E:T) cell ratio levels, was significantly higher than the no-pain comparison group. Pain perceptions may have a deleterious effect on enumerative NK cell measures and depression levels. However, people with chronic pain may not experience attenuation in functional immune parameters.

Adult↗

PubMed2005

[The relations of socioeconomic status to health status, health behaviors in the elderly].

OBJECTIVES: To analyze the relationships of socioeconomic status(SES) to health status and health behaviors in the elderly. METHODS: Data were obtained from self-administered questionnaire of 4,587 persons, older than 65 years, living in a community. We measured the sociodemographic characteristics, socioeconomic status, health status (subjective health status, acute disease, admission experience, dental state, chronic disease etc.), activities of daily living (ADL), instrumental activities of daily living (IADL), and mini-mental state examination-Korean (MMSE-K). Binary and multinominal logistic regression analyses were employed to analyze factors affecting on the socioeconomic status of the elderly. RESULTS: With regard to the SES and health status, those with a low SES had poorer subjective health states and lower satisfaction about their physical health. Also, acute disease experiences, admission rates and tooth deciduation rates were higher in those of low SES. In the view of physical and cognitive functions, the ADL, IADL and MMSE-K scores were also lower in those of low SES. However, with regard to health behaviors, lower smoking and alcohol drinking rates were found in the low SES group, and a similar trend was shown with regular physical exercise, eating breakfast, and regular physical health check-up. From these findings, we surmise that those with low SES have a poorer health condition and less money to spend on health, therefore, they can not smoke or drink alcohol, exercise and or have a physical health check-up. CONCLUSION: This study suggests that socioeconomic status plays an important role in health behaviors and status of the elderly. Low socioeconomic status bring about unhealthy behavior and poor health status in the elderly. Therefore, more specific target oriented(esp. low SES persons) health promotion activities for the elderly are very important to improve not only their health status, but their health inequity also.

Aged↗

PubMed2004

Preventive health behaviors influenced by self-perceptions of aging.

BACKGROUND: Research has found that the elderly are the age group that is the least likely to engage in preventive health behaviors, even though these behaviors continue to benefit individuals throughout the life span. We investigated for the first time whether an age-specific factor, older individuals' beliefs about their own aging, predicts their likelihood of engaging in preventive health behaviors over time. METHODS: We conducted multivariate linear regression to test the predictive value of aging self-perceptions on the preventive health behaviors of 241 individuals, who participated in the Ohio Longitudinal Study of Aging and Retirement (OLSAR) aged 50-80 years old. The preventive health behaviors included eating a balanced diet, exercising, and following directions for taking prescribed medications. RESULTS: Individuals with more positive self-perceptions of aging tended to practice more preventive health behaviors over the next two decades after controlling for age, education, functional health, gender, self-rated health, and race (P = 0.032). CONCLUSIONS: Our findings suggest that addressing views about aging could help improve efforts to increase preventive health behaviors in the older population.

Aged↗

PubMed2005

General medical and pharmacy claims expenditures in users of behavioral health services.

OBJECTIVE: To quantify the magnitude of general medical and/or pharmacy claims expenditures for individuals who use behavioral health services and to assess future claims when behavioral service use persists. DESIGN: Retrospective cost trends and 24-month cohort analyses. SETTING: A Midwest health plan. PARTICIPANTS: Over 250,000 health plan enrollees during 2000 and 2001. MEASUREMENTS: Claims expenditures for behavioral health services, general medical services, and prescription medications. MAIN RESULTS: Just over one tenth of enrollees (10.7%) in 2001 had at least 1 behavioral health claim and accounted for 21.4% of total general medical, behavioral health, and pharmacy claims expenditures. Costs for enrollees who used behavioral health services were double that for enrollees who did not use such services. Almost 80% of health care costs were for general medical services and medications, two thirds of which were not psychotropics. Total claims expenditures in enrollees with claims for both substance use and mental disorders in 2000 were 4 times that of those with general medical and/or pharmacy claims only. These expenditures returned to within 15% of nonbehavioral health service user levels in 2001 when clinical need for behavioral health services was no longer required but increased by another 37% between 2000 and 2001 when both chemical dependence and mental health service needs persisted. CONCLUSIONS: The majority of total claims expenditures in patients who utilize behavioral health services are for medical, not behavioral, health benefits. Continued service use is associated with persistently elevated total general medical and pharmacy care costs. These findings call for studies that better delineate: 1) the interaction of general medical, pharmacy, and behavioral health service use and 2) clinical and/or administrative approaches that reverse the high use of general medical resources in behavioral health patients.

Adolescent↗

PubMed2004

Changes in health behavior of Lithuanian adolescents and adults over 1994-2002.

UNLABELLED: The aim of the study was to investigate the time trends in health behavior during the period 1994-2002 in Lithuanian schoolchildren and adult population. The data on smoking, alcohol drinking, consumption of fresh vegetables and fruits, physical activity habits are presented in the article. The study material was collected in 1994, 1998 and 2002 within the framework of two international projects: Health Behavior in School-aged children coordinated by WHO and Finbalt Health Monitor assessing health behavior among adults in Finland and Baltic countries. The data of our study showed that since 1994 prevalence of smoking substantially increased among Lithuanian teenagers aged 11-15 years and adult women. The increase in alcohol consumption was recorded in schoolchildren as well as in adult population. The adults started eating fresh vegetables and fruits more frequently while the usage of fresh fruits among teenagers declined. In 2002 70% of schoolboys and 45% of schoolgirls were physically active. There were no changes in physical activity among teenagers over the period of the study. The proportion of physically active persons in adult population has increased since 1994. CONCLUSION: The health behavior is unhealthy in large proportion of Lithuanian teenagers and adults. The negative trends in health behavior especially among teenagers may increase the risk of noncommunicable diseases in Lithuanian population. Therefore the elaboration and implementation of effective health promotion programs, which should start in early childhood and would be adopted to the needs of different age groups, is urgently needed.

Adolescent↗

PubMed2003

Environmental correlates to behavioral health outcomes in Alzheimer's special care units.

PURPOSE: We systematically measured the associations between environmental design features of nursing home special care units and the incidence of aggression, agitation, social withdrawal, depression, and psychotic problems among persons living there who have Alzheimer's disease or a related disorder. DESIGN AND METHODS: We developed and tested a model of critical health-related environmental design features in settings for people with Alzheimer's disease. We used hierarchical linear modeling statistical techniques to assess associations between seven environmental design features and behavioral health measures for 427 residents in 15 special care units. Behavioral health measures included the Cohen-Mansfield physical agitation, verbal agitation, and aggressive behavior scales, the Multidimensional Observation Scale for Elderly Subjects depression and social withdrawal scales, and BEHAVE-AD (psychotic symptom list) misidentification and paranoid delusions scales. Statistical controls were included for the influence of, among others, cognitive status, need for assistance with activities of daily living, prescription drug use, amount of Alzheimer's staff training, and staff-to-resident ratio. Although hierarchical linear modeling minimizes the risk of Type II-false positive-error, this exploratory study also pays special attention to avoiding Type I error-the failure to recognize possible relationships between behavioral health characteristics and independent variables. RESULTS: We found associations between each behavioral health measure and particular environmental design features, as well as between behavioral health measures and both resident and nonenvironmental facility variables. IMPLICATIONS: This research demonstrates the potential that environment has for contributing to the improvement of Alzheimer's symptoms. A balanced combination of pharmacologic, behavioral, and environmental approaches is likely to be most effective in improving the health, behavior, and quality of life of people with Alzheimer's disease.

Aged↗

PubMed2006

Using sequential e-mail messages to promote health behaviors: evidence of feasibility and reach in a worksite sample.

BACKGROUND: US adults report suboptimal physical activity and fruit and vegetable intake. Innovative strategies to promote healthy behaviors are needed. Employee health promotion programs have been associated with reductions in health risks but are labor-intensive and costly to implement. E-mail and Web-based worksite programs have the potential to reach a broad adult population and to provide a cost-effective approach to employee wellness programming. OBJECTIVE: To assess the feasibility of using sequential e-mail messages to promote physical activity and increase fruit and vegetable intake among employed adults. METHODS: Employees at one worksite of a large insurance company in New York State were invited to participate. Interested workers provided written consent. After completing a baseline survey, participants received daily e-mails, Monday through Friday, for 26 weeks. The e-mails provided (a) succinct strategies to encourage physical activity or increase fruit and vegetable intake and (b) links to detailed Web-based information and tools. Program reach was assessed by the number of e-mails opened, measures of sustained participation over 6 months, and the number of health-related Web-links clicked. RESULTS: Of 960 employees, 388 (40%) consented to participate; of these, 345 (89%) completed the baseline health survey. After 6 months, 70% of the 345 participants had opened 50% or more of the daily e-mails. In addition, 75% of participants continued to open at least one e-mail a week through week 26 of the study. E-mail opening rates did not vary by gender, age, income, education, ethnicity, or baseline health behavior. CONCLUSIONS: The rate of enrollment and sustained participation document the feasibility, broad reach, employee acceptance, and potential value of using electronic communications for health promotion in the workplace.

Adult↗

PubMedDate not supplied

Implementing health behavior change in primary care: lessons from prescription for health.

PURPOSE: Our objective was to identify themes that emerged from the evaluation of 17 interventions funded by the Robert Wood Johnson Foundation's Prescription for Health that aimed to enhance adherence to healthy behaviors in the primary care setting. METHODS: We performed a content analysis of diary data from this 16-month initiative. Other data sources used to complement this analysis include funded grant applications and field notes from interviews with investigative teams and a limited number of site visits. Participants were 17 practice-based research networks (PBRNs) that had projects funded during Round 1 of Prescription for Health. RESULTS: Five themes emerged regarding implementation of health behavior change: (1) health behavior change resources are enthusiastically received by practices and patients, and when given a choice, patients prefer methods of assistance that involve personal contact; (2) practice extenders require extensive training, as well as careful case management and support, in order to function fully and avoid burnout; (3) integrating behavior change tools into the primary care setting requires time, effort, and often specialized expertise; (4) even simple interventions require practice change, and use of a practice change model to guide implementation efforts is crucial; and (5) research philosophy and project management approaches vary across PBRNs and have implications for the potential sustainability of an intervention. CONCLUSIONS: A more versatile, multifaceted solution involving new tools, technologies, and multidisciplinary care teams is needed in order to integrate health behavior change into everyday primary care routines. Even the best interventions require a model to articulate how to integrate an innovation into practices.

Health Behavior↗

PubMed2002

Health behaviors of nursing students: a longitudinal study.

To ascertain the degree to which a health science curriculum may influence health-related behaviors among students, nine selected health behaviors of 52 undergraduate nursing students were studied for 3 consecutive years and compared to those of a similar group of education students. In addition, the health behaviors of both student groups were compared to those of the general population. During the study, the nursing students had no significant alterations in the observed health behaviors, and no significant differences were observed between the health behaviors of the two groups of students. Both groups manifested certain health behaviors that were significantly different from the general population. However, nursing students were observed more frequently to be significantly different from the general population. A 3-year nursing curriculum may have facilitated the adoption of some personal health behaviors, but the time demands of academic life may have induced students to reduce time-consuming health behaviors, such as getting enough sleep, eating breakfast, and exercising.

Adult↗

PubMed2006

Associations among health behaviors and time perspective in young adults: model testing with boot-strapping replication.

Previous research suggests that time perspective relates to health behavior; however, researchers have frequently employed inconsistent operational definitions and have often used projective or unpublished measures. The Zimbardo Time Perspective Inventory was created to provide a sound, objective measure of five distinct time perspective components. We examined the independent prediction of both risky and protective health behaviors from future, hedonistic, and fatalistic time perspective in 1,568 undergraduates using the Zimbardo Time Perspective Inventory. Health behaviors included alcohol, drug, tobacco, and seat belt use, sex behaviors, and exercise. Future time perspective was related to increased protective and decreased risky health behaviors, whereas hedonism exhibited an opposite pattern though was a stronger predictor; fatalism was related only to health-destructive behaviors. Gender interactions reveal that hedonism is a stronger predictor of risky health behaviors for females.

Adolescent↗

PubMed1991

Distribution of dental health behaviors in Nordic schoolchildren.

The present study was part of the project "Health Behavior in Schoolchildren. A WHO Cross National Survey". The distribution of eight dental health behaviors among Finnish, Norwegian, and Swedish schoolchildren aged 11, 13, and 15 yr was studied separately for boys and girls. The sample size approximated 3000 individuals for each country, and the samples are considered to be representative for whole countries. The distinction between individual and collective behavior was empirically supported in this study. Thus collective behaviors (supervised fluoride rinsing and distribution of fluoride tablets) did not vary according to sex but declined with increasing age. On the other hand, individual behaviors varied according to sex and tended to increase in frequency with increasing age. The levels of the studied dental health behaviors were different among the three countries. This may be related to country-specific preventive policies as well as social and cultural norms.

Adolescent↗

PubMed2004

Conducting population behavioral health surveillance by using automated diagnostic and pharmacy data systems.

INTRODUCTION: The Walter Reed Army Institute of Research used the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) to conduct population-based behavioral health surveillance among military-health-system beneficiaries. The study analyzed the effectiveness of using prescribing patterns of psychotropic medications to monitor changes in a community's behavioral health status. OBJECTIVES: The objectives of this study were to 1) determine the feasibility of tracking psychiatric illnesses by monitoring prescriptions for psychiatric medications; 2) assess how often psychiatric medications are prescribed for patients with no record of psychiatric illness; 3) determine at what types of clinics these medications are prescribed most often and what other diagnoses are attributed to these patients; and 4) analyze data for potential changes in the population's mental health after high-stress events. METHODS: Correlation analysis and calculations of sensitivity and specificity were used to determine how well prescription medications correlate with outpatient diagnoses and how well they serve as proxies for outpatient diagnoses. A descriptive analysis was conducted of the types of clinics (e.g., primary care, behavioral health, or other specialty clinics) treating patients and the associated percentage of concurrence between prescriptions and diagnostic codes. RESULTS: In military treatment facilities, a diagnosis of depression or anxiety correlated significantly (r = 0.82) with antidepressant or anxiolytic prescriptions. Sensitivity of prescriptions when compared with outpatient visits was 0.76, and specificity was 0.94. Among those patients who visited a primary care clinic either the day before or the same day as an antidepressant or anxiolytic prescription was filled, 60.1% did not receive a diagnosis of any mental health disorder. Behavioral health clinics had the highest correlation between diagnoses and prescriptions; specialty clinics had the lowest. CONCLUSIONS: Behavioral health trends in a population can be monitored by automated analysis of prescribing patterns alone. This method might be a rapid indicator of needed mental health interventions after acute stress-inducing events and be more sensitive than tracking diagnoses alone.

Disease Outbreaks↗

PubMed1988

Health behavior and beliefs of students in traditional and health-oriented high schools.

Based in part on the national health objectives, a survey of health behavior and beliefs was administered to ninth and 12th grade students at a traditional and a health-oriented high school. Responses indicated a high level of awareness among both groups for the importance of widely acknowledged health practices, but the health-oriented high school students consistently rated the behaviors and beliefs as "more important" than their counterparts. Both groups, however, indicated the practice of beliefs and behavior was yet to be fully realized. These findings suggest the need for continued effort to encourage behavioral practices consistent with the knowledge already present in this school-age population.

Adolescent↗

PubMed2002

[Evaluation of the effect of intervened measures for health behavior of lead exposed workers].

OBJECTIVE: To intervene the health behavior of lead exposed workers by setting down and implementing a series of measures and evaluating the effects of these measures so that the occupational lead poisoning would be decreased. METHODS: 105 lead exposed workers in a factory were chosen as subjects. Blood lead concentration and rate of cognition on relevant health knowledge were examined before and after intervened measures. RESULTS: The cognition rate raised from 56.6% to 97.3% after training. Lead concentration in blood decreased by 17.7% (t = 4.10, P = 0.000) and delta-ALA in urine decreased by 23.9% (t = 4.248, P = 0.000) 12 months after intervention. The prevalence of occupational lead absorption and poisoning also decreased. The number of workers with blood lead content > 2.41 mumol/L was decreased from 6 to 3, and > 1.93 mumol/L from 14 to 10. CONCLUSION: To develope occupational health promotion, enhance health education and improve health behavior are the effective way to prevent from occupational lead poisoning.

Health Behavior↗

PubMed1999

Episodes of mental health and substance abuse treatment under a managed behavioral health care carve-out.

Little is known about the effect of a managed behavioral health care (MBHC) carve-out on treatment episodes for a mental health/substance abuse (MHSA) condition. This study found adoption of a carve-out for Massachusetts state employees associated with a dramatic drop in total MHSA costs per episode (particularly for individuals with certain severe MHSA conditions). The carve-out also was associated with a shift away from the use of facility care toward the use of outpatient care for enrollees with a diagnosis of unipolar depression.

Adult↗

PubMed2004

The impact of individual forms of childhood maltreatment on health behavior.

OBJECTIVE: This study examines the unique contribution of five types of maltreatment (sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect) to adult health behaviors as well as the additive impact of exposure to different types of childhood maltreatment. METHOD: Two hundred and twenty-one women recruited from a VA primary care clinic completed questionnaires assessing exposure to childhood trauma and adult health behaviors. Regression models were used to test the relationship between childhood maltreatment and adult health behaviors. RESULTS: Sexual and physical abuse appear to predict a number of adverse outcomes; when other types of maltreatment are controlled, however, sexual abuse and physical abuse do not predict as many poor outcomes. In addition, sexual, physical, and emotional abuse and emotional neglect in childhood were all related to different adult health behaviors. The more types of childhood maltreatment participants were exposed to the more likely they were to have problems with substance use and risky sexual behaviors in adulthood. IMPLICATIONS: The results indicate that it is important to assess a broad maltreatment history rather than trying to relate specific types of abuse to particular adverse health behaviors or health outcomes.

Adult↗

PubMed2001

The relationship between treatment access and spending in a managed behavioral health organization.

OBJECTIVE: This study replicated an earlier study that showed a linear relationship between level of treatment access and behavioral health spending. The study reported here examined whether this relationship varies by important characteristics of behavioral health plans. METHODS: Access rates and total spending over a five- to seven-year period were computed for 30 behavioral health plans. Regression analysis was used to estimate the relationship between access and spending and to examine whether it varied with the characteristics of benefit plans. RESULTS: A linear relationship was found between level of treatment access and behavioral health spending. However, the relationship closely paralleled that found in the earlier study only for benefit plans with an employee assistance program linked to the managed behavioral health organization and for plans that do not allow the use of out-of-network providers. CONCLUSIONS: The results of this study replicate those of the earlier study in showing a linear relationship between access and spending, but they suggest that the magnitude of this relationship may vary according to key plan characteristics.

Health Benefit Plans, Employee↗