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PubMed2005

Online health behavior and disease management programs: are we ready for them? Are they ready for us?

Advancing the science and practice of health promotion and disease management on the Internet requires a systematic program of research examining the population impact of such programs. With impact described as the combination of effectiveness and participation, such research needs to include the examination of the quality and effectiveness of programs that are available to the general public, as well as descriptive and predictive knowledge about population readiness to participate in such programs. There have been few studies examining the quality of interactive health behavior change (HBC) programs on the Internet, and even fewer investigations of the effectiveness of such programs. Based on the review of over 300 HBC programs on the Internet using the "5 A's" of Health Behavior Change on the Internet (HBC-I Screener), which represent standard minimum guidelines for evaluation, it appears HBC on the Internet is in the early stages of development. As health behavior change on the Internet matures from the provision of health information to meeting the requirements necessary to produce health behavior change, and as program developers take advantage of the interactive nature of the Internet, the basic screening and expanded evaluation criteria developed in this project will provide templates for both consumers and developers of programs. The second component necessary for evaluating the impact of HBC on the Internet is the extent to which the population is ready to participate in such programs. We need to move beyond a narrow focus on early adopters and produce a population perspective that includes those not ready, those getting ready, and those ready to use such programs, as well as those already participating. By understanding participation levels of such programs, and what drives this participation, the development and dissemination of practical tailored and targeted interventions can help maximize population participation in Internet programs for health behavior change.

Attitude to Health↗

PubMedDate not supplied

Is knowledge of health behavior associated with low birth weight?

OBJECTIVE: To examine the relationship of patient knowledge concerning seven health behaviors identified by the U.S. Public Health Service Expert Panel and low birth weight. METHODS: Interviews of 538 women delivering at an inner-city hospital in New Orleans were conducted. Information concerning patient characteristics, health behavior knowledge, and birth weight was collected. Data were analyzed as dichotomous and compared using odds ratios. Logistic regression was chosen to calculate adjusted odds ratios, including only factors found to be associated with the tested end point, low birth weight. RESULTS: A majority of women knew all seven health behavior items. Individual items were known by > or =80% of respondents. Knowledge associated with low birth weight included avoidance of alcohol and drugs, taking of prenatal vitamins, and following a proper diet. Information on all seven was not associated with a reduction in low birth weight. Other factors found to be associated with low birth weight included inadequate prenatal care, absence of health insurance (primarily Medicaid), and a prior low birth weight infant. Logistic regression confirmed both the importance of the last three factors, and the lack of association with health knowledge about all seven items. CONCLUSIONS: Knowledge concerning health advice behavior recommended by the U.S. Public Health Service was more widely known than previously thought. While individual components were associated with a reduction in low birth weight, overall knowledge was not.

Adult↗

PubMed2005

Habitual self-control and the management of health behavior among heart patients.

This study examined the predictive power of habitual self-control on health behaviors among 381 heart surgery patients in Germany. Habitual self-control and other trait predictors (dispositional optimism, generalized self-efficacy beliefs, health locus of control beliefs) were assessed before and six months after surgery. Social-cognitive predictors of health behavior (behavior-specific self-efficacy and outcome beliefs, intentions) were assessed only before surgery. Outcomes were dieting, physical exercise, and smoker status before and after surgery. Compared to other trait variables, habitual self-control emerged as a superior predictor of the behavioral outcomes. Further, habitual self-control explained unique variance in dieting and physical exercise beyond proximal behavior-specific predictors (i.e., self-efficacy beliefs, intentions) that are supposed to display direct effects on behavior. Results of hierarchical linear regressions provided partial support for the assumption that habitual self-control strengthens the intention-behavior congruence. In prospective analyses predicting dieting at the 6-month follow-up an interaction between habitual self-control and dieting intentions emerged indicating that self-control supported dieting among patients with imperfect (moderate) dieting intentions only. In sum, the results suggest that habitual self-control may be a useful construct in research on health behavior management, in particular when long-term maintenance of health behavior is the target.

Adaptation, Psychological↗

PubMedDate not supplied

Getting beyond technical rationality in developing health behavior programs with youth.

OBJECTIVE: To explore 2 major components of health behavior research, etiologic research and action research. To argue that action research is both an artistic as well as scientific process. METHODS: Review of the development process of effective health behavior programs with youth. Review of literature on art as part of the scientific process, especially in the field of education. RESULTS: Intervention programs that included explicitly creative components demonstrated success in reducing alcohol use and increasing healthful eating and activity patterns. CONCLUSIONS: Health behavior researchers might involve art and creativity in action research to enhance program retention and outcomes.

Adolescent↗

PubMed2005

The influence of health behavior clusters on dietary change.

BACKGROUND: The goal of this study was to identify cancer preventive health behavior clusters and to determine if clusters responded differently to a year-long intervention to increase fruit and vegetable consumption. METHODS: The North Carolina Strategies for Improving Diet, Exercise, and Screening (NC STRIDES) is a health communications intervention (n = 595) among colorectal cancer survivors and a comparison population. Cluster analysis was used to identify nonoverlapping groups based on fruit and vegetable intake (servings/day), physical activity (minutes/day), multivitamin use (yes/no), and body mass index (kg/m2). Logistic regression was performed to assess positive change in fruit and vegetable servings, using the healthiest cluster as the reference group. RESULTS: Five clusters were formed; they differed significantly by health behaviors and demographics. Clusters 1 and 2 (those following the "Healthy Choices" and "Eating Well" patterns) were eating more than 5 A Day before the intervention (8.6 and 6.9 servings/day), and did not show any increase. Cluster 3 ("Physically Active") reported an increase of 1.3 servings/day to reach 5.4 servings/day, and Clusters 4 and 5 ("Average Americans" and "Most Challenged") improved one serving/day for final intakes of 5.2 and 5.0 servings/day. CONCLUSIONS: These findings illustrate some differences in magnitude of response to a fruit and vegetable intervention based on health behavior profiles. Creating clusters or other categories from baseline health behaviors may help to further improve targeting and/or tailoring in health promotion interventions.

Aged↗

PubMed1998

The effects of personal and environmental factors on health behaviors of older adults.

The purpose of this study was to examine the effects of personal factors, self-esteem and functional health and environmental factors, social support and resource availability, on health behaviors of older adults. The interaction effects of personal and environmental factors on health behavior were also examined. Self-reported survey data were collected from a sample of 120 subjects. Results of multiple regression analysis indicated that the combination of personal and environmental factors explained 13% of the variance in health behaviors for the older adult sample population. Resource availability and functional health made significant independent contributions to the explanation. Adding variables to represent the interaction of social support and functional health and the interaction of social support and self-esteem significantly increased the explained variance in health behavior (to 24%) for older residents of resource-poor environments.

Aged↗

PubMedDate not supplied

Comparisons of motivation, health behaviors, and functional status among elders in residential homes in Korea.

This study compared the changes in health behaviors, motivation, and functional status between motivation enhancement exercise-program participants and program dropouts over 6 months. A total of 73 older adults living in residential homes participated in the study. Face-to-face interviews were conducted at pretest and then at 10 weeks and 6 months in the program. The participants exercised using traditional Korean dance movements for 50 min, 4 times per week, for 6 months. The subjects were classified as participants or dropouts by using a cutoff attendance rate of 80%. Repeated ANOVA revealed the following results over 6 months: 1 The motivation to perform health behaviors, especially for perceived benefits, improved significantly for the participants than for the dropouts. 2 Significant differences in the performance of overall health behaviors and exercise-related behaviors were found between the participants and the dropouts. 3 The sickness impact profile (SIP) of the participants improved significantly, compared with the dropouts. Significant group differences were found for total SIP, physical dimensions, and enjoyment of recreation and pastimes. In conclusion, the study found that the 6-month motivation enhancement program was effective in motivating older adults to perform health behaviors and to improve their functional status.

Activities of Daily Living↗

PubMedDate not supplied

The relationship between prenatal health behavior advice and low birth weight.

OBJECTIVES: The purposes of the study were (a) to examine the relationship between the health behavior advice recommended by the Public Health Service Expert Panel on the Content of Prenatal Care and the risk of low birth weight and (b) to describe the type and frequency of health behavior advice offered to a group of pregnant women. METHODS: The authors used data from the National Institute of Child Health and Human Development/Missouri Maternal and Infant Health Survey, a follow-back survey of women who had delivered very low birth weight infants and of matched control subjects who had delivered moderately low birth weight and normal birth weight infants. Frequency distributions for different types of prenatal health behavior advice were examined for the 2205 participants, and logistic regression analyses were used to determine whether there was a relationship between birth weight and receiving the advice recommended by the Expert Panel. RESULTS: Only 10.4% of mothers reported receiving all seven types of health behavior advice recommended by the Expert Panel. Women who did not receive all seven types of advice were 1.5 times more likely to deliver a very low birth weight infant than a normal birth weight infant. CONCLUSIONS: Further research is needed to better understand the relationship between health education and birth weight.

Adult↗

PubMed1997

Managed behavioral health care premises, accountable systems of care, and AMBHA'S perms. American Managed Behavioral Healthcare Association.

This article discusses the concepts and approaches underlying managed behavioral health care and the need to assess quality of care. The author describes the Performance Measures for Managed Behavioral Healthcare Programs (PERMS) developed by the American Managed Behavioral Healthcare Association (AMBHA), which is offered as a first step toward enhanced quality of care assessment in managed behavioral health care.

Behavioral Medicine↗

PubMed1992

A longitudinal assessment of the impact of health/fitness status and health behavior on perceived quality of life.

This study extended cross-sectional research associating quality of life with health and fitness factors. Longitudinal analyses were performed on data collected from 519 U.S. Navy personnel to assess changes in quality of life with changes in health/fitness status and health behavior dimensions at 1-yr. and 2-yr. intervals. Multiple regression results showed that such changes were positively associated with changes in health/fitness status and behaviors related to accident control and wellness maintenance, with these predictors accounting for 8% of the variance in change in quality of life at the 1-yr. interval. At the 2-yr. interval, such change was associated with health/fitness status and accident control behaviors, accounting for 11% of the variance. Health behavior change made a unique contribution to change in quality of life after controlling for changes in health/fitness status at both intervals. Findings affirm modest yet consistent associations between changes in fitness and health variables and quality of life and suggest that improvements in health behavior influence quality of life independently of one's health/fitness status.

Adult↗

PubMed1990

Dental health behaviors and periodontal disease indicators in Danish youths. A 10-year epidemiological follow-up.

The purpose of the present study was to analyse the epidemiologic relationship between dental health behaviors and periodontal disease. Indicators of periodontal disease in terms of bleeding and calculus were measured dichotomously (absence/presence). Periodontal pockets were as follows: normal pockets (0-3 mm), shallow pockets (4-5 mm), and deep pockets (6+ mm). The indicators were measured on 4 surfaces on 6 index teeth (16, 11, 26, 36, 31, 46) in 1984-85. The highest value for each tooth of bleeding (0/1), calculus (0/1) and pockets (0/1/2) was used for calculation of the bleeding index, the calculus index and the pocket index. The participation rate in 1984-85 was 86%, and the study population involved 368 males and 388 females. Information concerning dental health behavior was obtained both in childhood (1974) when the individuals were 9-10 years of age, and in adulthood (1984-85) when the individuals were 20-21 years of age. Information concerning dental health behaviors in adulthood, i.e., regularity of dental visits, frequency of tooth brushing, and regular use of interdental aids, was obtained through a self-administered questionnaire (1984-85). Dental health behaviors in childhood (1974) was operationalized as level of plaque, gingivitis, and dmfs. The results showed that dental health behaviors in childhood and in adulthood were together responsible for 9.4-13.8% of the variance in level of periodontal disease indicators. Determinants of early dental health behaviors in terms of plaque and dmfs at age 9-10 years were significant predictors in pocket index at age 20-21.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Cancer awareness and attitudes toward preventive health behavior.

Elevated rates of morbidity and mortality among ethnic minorities have been linked to alterable patterns of behavior, including preventive health practices. African Americans in Louisiana are not only at increased risk for cancer, they also have poorer prognosis. This investigation describes beliefs, knowledge, and attitudes relevant to general and cancer-specific preventive health practices in a sample of African Americans (n = 48). Findings suggest a number of important differences exist between males and females in their attitude toward health issues. Females valued and expressed greater concern over their health status. Females also expressed greater confidence in their doctor's ability to diagnose cancer before it is too serious, while males appear to hold a more pessimistic view of the effectiveness of early detection. Although the use of a convenience sample limits the generalizations that can be made, present findings identify issues germane to the development of effective intervention strategies for this population.

Adolescent↗

PubMed1999

Comparability of a computer-assisted versus written method for collecting health behavior information from adolescent patients.

PURPOSE: To investigate the comparability of health behavior data obtained from adolescents via notebook computer versus those obtained via written questionnaire. METHODS: We interviewed adolescent patients (ages 13-20 years) receiving services at community adolescent health clinics. Participants anonymously completed either a computer-assisted self-interview (CASI) or a self-administered questionnaire (SAQ), both assessing health-protective behaviors, substance use (i.e., tobacco, alcohol, marijuana) and sexual behaviors. From a pool of 671 adolescent participants (348 completing CASI, 323 completing SAQ), we matched 194 SAQ participants with 194 CASI participants on the basis of gender and race. We could not match individually on the basis of age, but were able to match each gender-race subgroup by mean age. RESULTS: Across the majority of health behaviors (i.e., all health-protective behaviors, tobacco use, sexual behaviors), mode of administration made no significant difference in the reporting of information by adolescents. However, girls reported a greater frequency of alcohol use and marijuana use on CASI than on SAQ, whereas boys reported a lower frequency of alcohol use and marijuana use on CASI than on SAQ. CONCLUSIONS: The findings of this study suggest that there may be gender-related differences between modes of anonymous collection of specific adolescent health behaviors such as alcohol and marijuana use. Future studies should incorporate direct questions regarding adolescents' attitude and comfort levels toward completing different modes of data collection.

Adolescent↗

PubMed1990

Relationships between health protective behaviors.

Health protective behaviors are receiving increasing attention for maintaining health and preventing disease. Most research has examined specific health behaviors individually, with relatively few studies of the relationships between many health protective behaviors. This investigation examined how health protective behaviors were related with each other using data from the American Family Report, a survey of a national sample of 1,247 adults in U.S. families. Eighteen health protective behaviors were not all consistently intercorrelated with each other, with only 39% of the correlations significant at p less than .001. Factor analysis using oblique rotation revealed six underlying dimensions of health protective behaviors: not smoking, planned exercise, routine exercise, moderate drinking, absence of sedative use, and general health behaviors. These dimensions were associated with sociodemographic variables, particularly with higher education being associated with healthier behavior. The multidimensional nature of health protective behaviors needs to be considered in programs for enhancing prevention and health promotion.

Adult↗

PubMed2004

The impact of managed behavioral health care on youth in the juvenile justice system.

The purpose of this study was to describe how managed behavioral health care affects youth in the juvenile justice system with behavioral health disorders. A multiple case study consisting of 30 semistructured interviews of officials in the local, state, and federal juvenile justice system was performed. The study found that agreement exists among officials that managed behavioral health care acts as a barrier to behavioral health care for juvenile justice youth. A major conclusion of the study was that the relinquishment of youth custody to the state for the purpose of accessing behavioral services must cease.

Adolescent↗

PubMed2002

Assessing behavioral health using OASIS: part 2: cognitive impairment, problematic behaviors, and anxiety.

This article is the second of a two-part series on assessing behavioral health in adult and elderly home care patients using OASIS. Part 1 presented an assessment approach for depressive symptoms and suicidality. This article presents the assessment of cognitive impairment, problematic behaviors, and anxiety using OASIS as a framework and stresses the importance of direct questioning. Case scenarios and guidelines for referral for further evaluation and possible treatment are provided.

Aged↗

PubMed1995

Self-esteem and value of health as correlates of adolescent health behavior.

As part of a project aimed at developing an adolescent health education program, 100 subjects aged 12-13 and 16-17 years were studied to determine the possible relationship between self-esteem and value of health and positive health behavior. Self-esteem was measured with the Gordon Personal Profile (Gordon, 1978), and value of health with Costa et al.'s (Costa, Jessor, & Donovan, 1989) Value of Health Scale. Both factors were found to be significantly correlated with certain dimensions of health behavior in both groups of adolescents.

Adolescent↗

PubMed2006

Behavioral health services utilization among older adults identified within a state abuse hotline database.

PURPOSE: This study examined the extent to which older adults identified in a statewide abuse hotline registry utilized behavioral health services. This is important as mental health issues have been identified as a high priority for filling gaps in services for victims of mistreatment. DESIGN AND METHODS: We compared Medicaid and Medicare claims data for two groups of older adults: those using health services and identified within a statewide abuse hotline information system and those claimants not identified within the hotline database. RESULTS: Behavioral health service use was greater among those identified in the abuse hotline database. The penetration rate (percentage of service users out of all enrollees) for Medicaid behavioral health service claims was more than twice that of other service users, with costs of services about 30% greater. Analyses of Medicare data revealed that the penetration rate for those in the hotline data was almost 6 times greater at approximately twice the cost compared to other service users. IMPLICATIONS: The results provide evidence for previous assumptions that mistreated individuals experience a higher rate of behavioral health disorders. As mental health screening by adult protective services is rarely conducted, the results suggest the need to train investigators and other service providers to screen older adults for behavioral health and substance-abuse issues as well as physical signs of abuse. Further research on the relationship of abuse to behavioral health might focus on collection of additional data involving more specific victim-related characteristics and comparisons of cases of mistreatment versus self-neglect.

Aged↗