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PubMed1980

Secondary preventive health behavior.

A comprehensive model of secondary preventive health behavior, defined as the use of physician services for preventive care, is constructed which specifies the interrelationships among people's health beliefs, their health status, their accessibility to care, their sociodemographic characteristics, and their use of services. The model is tested by applying path analysis to a household survey of adult residents of Washtenaw County, Michigan. The results support the contention that many factors influence secondary preventive utilization, some principally directly and some largely indirectly through their effects on other variables. Accessibility to care, health status, health beliefs, and sex all directly influence use, while education and age have indirect effects. Income has indirect effects on use which, because they are in opposing directions, cancel each other out.

Attitude to Health↗

PubMedDate not supplied

Associations between measures of socioeconomic status and maternal health behavior.

Lower socioeconomic status (SES) is consistently associated with adverse pregnancy outcomes. One mechanism that may account for this association is that maternal health behaviors vary with SES. To examine this possibility, we addressed how women may be differently categorized by diverse measures of SES and the effect that choice of measure has on the relationship between SES and maternal health behaviors. We used population-based data for Caucasian women (n = 10,055) from Alaska, Maine, Oklahoma, and West Virginia who delivered a live infant in 1990-1991 and participated in the Pregnancy Risk Assessment Monitoring System. Five SES measures were evaluated: education; poverty status; Medicaid payment for delivery; Women, Infants, and Children (WIC) enrollment during pregnancy; and residential crowding. Three maternal health behaviors (smoking, delayed/no prenatal care, unintended pregnancy) were examined to assess the variation among the associations between SES measures and behaviors. Item response rates were high for all SES measures (range: 88.9%-100.0%), and there was low correlation between measures. Most of the SES measures were related to maternal health behaviors. However, the strength of association varied between each measure and behavior and was weaker for women who were younger than 20 years old or not married. In view of the multifaceted nature of SES, several measures may be needed to appropriately assess the relationship between SES and maternal health behaviors.

Female↗

PubMed1995

Measurement of social interaction in change of health behavior.

A social network approach to measuring social interaction related to change of health behavior required 460 participants in a health promotion program to nominate up to five network members and to rate the supportiveness of each person in changing health behavior during the previous year. Exploratory factor analysis of intercorrelations of the eight items suggested two factors representing supportive and negative interaction with internal consistency reliability of .89 and .61, respectively.

Adult↗

PubMed1998

Selected key issues in the development and drafting of public managed behavioral health care carve-out contracts.

The development of managed behavioral health care carve-out contracts covering a discrete subset of benefits available for use by persons with mental health and/or substance abuse disorders poses major challenges for public purchasers. This Issue Brief explores several key issues that arise when drafting such agreements. Many of the issues that arise in the drafting of carve-out agreements will require the public purchaser to resolve basic policy questions well before the drafting of requests for proposals or contracts can proceed. Analyses of public sector managed behavioral health care contracts by attorneys at the Center for Health Policy Research suggest that there are four essential areas that must be addressed if mental health and substance abuse services are carved-out (either by the purchaser or by a comprehensive managed health care entity): (1) what population is eligible for enrollment; (2) what services is the contractor expected to furnish; (3) what triggers a duty on the part of the mental health or substance abuse carve-out contractor to provide services; and (4) how are services furnished by the managed behavioral health care contractor integrated with or coordinated with services furnished by a beneficiary's primary health care provider, with pharmaceutical benefits, and with other services that may be available to a beneficiary through a fee-for-service or other mechanism. However a purchaser chooses to resolve these four issues, it is essential that parallel clarifying clauses are also built into the contracts of primary health care providers and other entities providing needed services for persons whose mental health and substance abuse service needs are covered by the carve-out. Underlying all of these issues is the fact that ambiguity, vagueness, or failure to define terms and responsibilities can create unexpected and unwelcome clinical and financial liabilities to purchasers.

Behavioral Medicine↗

PubMed2001

Psychometric evaluation of Breast Health Behavior Questionnaire: Spanish version.

The purpose of the study was to test the psychometric properties of a culturally sensitive and theory-based instrument: the Breast Health Behavior Questionnaire. This instrument was translated into Spanish and back-translated at a third- to fourth-grade reading level. The pilot group consisted of 70 Hispanic women who attended a class at a local church. Subsequent to pilot testing, another 40 Hispanic women who attended a class at the local health department comprised the study sample. The participants responded to the 15-item questionnaire, which is formatted as a Likert scale. Content validity of the Breast Health Behavior Questionnaire was determined by a panel of experts. A factor analysis of this instrument showed five separate dimensions accounting for 71.82% of the instrument's variance. The three major components of self-regulation theory (schema, coping, and appraisal criteria) were found clustered within the first three dimensions after three items were discarded. The Breast Health Behavior Questionnaire demonstrated an internal consistency reliability coefficient of .7172. The psychometric properties of the Spanish version of this questionnaire warrant further research. The instrument may support a better understanding of the Hispanic woman's practice of breast health behavior. Eventually, the Breast Health Behavior Questionnaire may assist nurses in the formulation of culturally grounded interventions.

Adult↗

PubMedDate not supplied

Perceived susceptibility to heart disease and preventive health behavior among Type A and Type B individuals.

Although the Type A behavior pattern has been the subject of extensive research, surprisingly little information is available about the preventive health behavior of this population. Measures of perceived susceptibility, preventive health behavior, current stress, and risk for cardiovascular disease were obtained from 37 Type A and 37 Type B college students. Results indicated that the Type A students generated susceptibility judgments that covaried significantly with perceived stress. Susceptibility judgments for the Type B group, however, covaried significantly with nonbehavioral cardiovascular risk-factor status. Correlations between perceived susceptibility and preventive health behavior also differed between the two groups. For the Type A group, increments in perceived susceptibility were associated with decrements in preventive behavior. For the Type B group, however, increments in perceived susceptibility were associated with increments in preventive behavior. Between-group comparisons of preventive health behavior indicated that Type A participants were less likely to use relaxation and avoidance of overwork but were more likely than those who were Type B to regulate their diets.

Adult↗

PubMed2002

Relationships between comorbidity and health behaviors related to hypertension in NHANES III.

BACKGROUND: Health behaviors such as diet, exercise, and smoking are frequently studied among persons with one particular diagnosis; however, comorbidities that complicate our understanding of behavior patterns are often present. In addition, behaviors and conditions may vary by demographic factors. This study describes the prevalence of behaviors related to hypertension among persons with one to three diagnoses and investigates the relative contribution of demographic factors and increased morbidity on these measures. METHODS: Data are from a nationally representative sample of adults over age 30 from the NHANES III. Behaviors are compared among three groups: those with hypertension alone (N = 2,944), hypertension plus type 2 diabetes (N = 557), and hypertension, type 2 diabetes, and history of a heart attack (N = 116). RESULTS: Demographic factors explained more of the variance in behavioral measures than morbidity level. Trends in behavior prevalence across morbidity levels were apparent for measures of alcohol and smoking. No group differences were found for exercise, fat intake, or sodium intake after controlling for demographic factors. CONCLUSIONS: Some behaviors were more strongly associated with increased levels of morbidity than others. Longitudinal studies are needed to better describe the reasons for behavior change in the face of various health conditions.

Adult↗

PubMedDate not supplied

Time preferences and preventive health behavior: acceptance of the influenza vaccine.

BACKGROUND: Many preventive health behaviors involve immediate costs and delayed benefits. Time preference is the extent to which decision makers value future outcomes relative to immediate ones. Consequently, people with future-oriented time preferences should be more likely to adopt preventive measures. The relationship between time preferences and acceptance of a free influenza vaccination was examined. SAMPLE: The participants were 412 corporate employees who were offered free influenza vaccinations at their workplace. MEASURES: Participants' time preferences were measured in each of two domains: money and health. They also reported on whether they had accepted the influenza vaccination and their beliefs and attitudes about the vaccine. RESULTS: There was a small (OR = 2.38) relationship of vaccination acceptance to monetary time preferences but not to the health time-preference measures. Other variables, such as perceived effectiveness of the vaccine, were more predictive. CONCLUSION: This study provides some evidence of a small relationship between time preferences and preventive health behavior.

Adult↗

PubMed1989

Smoking alcohol consumption and dental health behavior among 25-44-year-old Danes.

The purpose of this investigation was to describe smoking and alcohol habits of an adult Danish population and to study whether these habits are influenced by living conditions. Moreover, the purpose was to test the hypothesis of unidimensionality of health behavior. The study comprised 749 persons in the age group 25-44 yr (82% of original sample) and data on smoking, alcohol consumption, diet, and dental health behavior were collected by interviews. Fifty-one percent of the interviewed persons were current smokers, 58% among men and 44% among women. One-fifth of the males and about one-tenth of the females were classified as heavy smokers consuming more than 15 cigarettes per day. Fifty-eight percent reported to have alcoholic drinks weekly 71% of men and 47% of women. All in all, 65% of the study group had a weekly consumption of larger beer, 6% of strong beer, 52% of red or white wine, 12% of dessert wine, and 27% of spirits. Alcohol consumption as well as smoking was more frequent among workers than officials. Multivariate regression analyses showed that smoking and alcohol habits varied according to sex, urbanization, education, shift work, and number of children in family. Correlations between alcohol habits, smoking, and perceived dental health were observed. Furthermore, smoking and dental health behavior were negatively associated. In factor analysis of variables on diet, smoking, alcohol, and dental health behavior, two factors were isolated: 1) alcohol consumption, and 2) active dental care. Only a small proportion of the total variance was explained and, thus, the hypothesis of unidimensionality of health behavior was not confirmed. Because of the multidimensionality different strategies and methods in health education may be needed to modify or change the various types of negative health behavior.

Adult↗

PubMed2005

Pregnancy planning status and health behaviors among nonpregnant women in a California managed health care organization.

CONTEXT: Women's behaviors before and during pregnancy can affect their infants' health. Particularly because many births in the United States are unintended, it is important to understand women's health behaviors and pregnancy planning status before they become pregnant. METHODS: A telephone survey of nonpregnant women of childbearing age who belonged to a Southern California managed care plan was conducted from 1998 through 2000. Survey data were analyzed in logistic regression models assessing differences in selected behaviors between women planning pregnancy and others. RESULTS: Compared with women not planning pregnancy, those planning pregnancy within the next year ("soon") were less likely to report smoking (odds ratio, 0.6), and more likely to report taking a multivitamin regularly (1.4) and having had a health care visit in the past year (1.6). Women planning a pregnancy more than one year in the future had elevated odds of reporting alcohol use (1.4); they were similar to women not planning pregnancy with respect to multivitamin use and smoking behavior. Women planning pregnancy soon were more likely than women not planning pregnancy to report that a health care professional had talked to them about taking a vitamin or mineral supplement (1.6). CONCLUSIONS: All women of childbearing age need information about the importance of engaging in healthy behaviors. Health care providers who have regular contact with such women should send clear messages about the adverse effects of alcohol and smoking during pregnancy and the importance of taking a multivitamin regularly, regardless of women's pregnancy plans, before they become pregnant.

Adolescent↗

PubMed2006

Aggregation of health behaviors among fourth graders in northern Taiwan.

PURPOSE: To investigate the aggregation of health behaviors among fourth graders in northern Taiwan. METHODS: This study conducted an analysis of data collected from the 2001 Child and Adolescent Behaviors in Long-term Evolution (CABLE) project, which included a sample of 2075 fourth grade students. Factor analysis and cluster analysis were used to investigate the aggregation patterns. RESULTS: After factor analysis, we found that the 18 health behaviors could be grouped under five factors. These five factors were named: healthy behavior, rule-breaking behavior, substance use behavior, violent behavior, and pleasure-seeking behavior, according to the characteristics of the various health behaviors grouped under each of them. Each study subject was assigned points for each of these five factors and then cluster analysis was used to divide the subjects into four different clusters. The names of these clusters and the percentage of subjects within them were as follows: healthy group (43.47%), violent group (29.11%), pleasure-seeking group (22.55%), and rebellious group (4.87%). CONCLUSIONS: A total of 56.53% of the study sample were grouped under unhealthy groups (violent group, pleasure-seeking group and rebellious group), which indicates that already more than half of the students had lifestyles that put their health at risk. It was suggested that health and educational organizations need to place importance on behavioral problems in children and adopt early prevention measures.

Alcohol Drinking↗

PubMed2006

Oral health behavior and self-esteem in Swedish adolescents over four years.

PURPOSE: Our analysis of data collected in 1995 showed that 12-year-olds' self-esteem was associated with demographic/socioeconomic background variables and lifestyle variables and with the quality of the variable "oral health behavior." The study reported here was conducted to identify changes at ages 14 (in 1997) and 16 years (in 1999) in the strength of the association between self-esteem and "oral health behavior." METHODS: In 1995, 3370 12-year-olds answered questions about their demographic/socioeconomic background, personal attitudes/resources, and lifestyle, including "oral health behavior." Two and four years later the same study group (3105 14-year-olds in 1997 and 2836 16-year-olds in 1999) answered similar questionnaires with redefinition of "oral health behavior" as "tooth-brushing." Multivariate and logistic regression analyses were conducted using "self-esteem" and "oral health behavior/tooth-brushing" as the dependent variables. The association was also analyzed between "oral health behavior/tooth-brushing" and components of "self-esteem" (two cognitive: "How do you think your teacher would rate your school work?," "How do you think you are performing in school?," and one emotional: "How content are you with your body/looks?"). RESULTS: The association between "self-esteem" and "oral health behavior/tooth-brushing" disappeared during adolescence, but whereas the influence of cognitive components decreased, the influence of the emotional component increased. Overall, the strongest predictor of poor oral health behavior (tooth-brushing less than twice per day) was male gender. CONCLUSION: The motives for good oral health behavior changed from age 12 to age 14 years.

Adolescent↗

PubMed2003

Medicaid managed behavioral health in rural areas.

As of 2000, 21 states had implemented Medicaid managed behavioral health (MMBH) programs for a significant portion of their rural population. It is not clear how MMBH programs may work in rural areas since they are primarily designed to control mental health utilization. In rural areas the challenge is often to enhance service delivery, not to reduce it. MMBH programs may also affect important features of rural delivery systems, including access to care and coordination of primary care and specialty mental health providers. This article describes the implementation of MMBH programs in rural areas based on an inventory of states implementing MMBH programs in rural counties conducted between June 1999 and June 2000. The experience of MMBH programs in rural areas is also described based on case studies conducted in six states. All 21 states included the general Medicaid population (Temporary Assistance for Needy Families); 17 states included special Medicaid populations (adults with serious and persistent mental illness and children with serious emotional disturbances). Slightly less than half the states integrated (carved-in) behavioral health with physical health services in serving the general Medicaid population; only one state integrated these services for the special Medicaid population. Access to mental health care in rural areas had generally not been restricted. MMBH had little impact on the linkage between primary care and mental health. Local Managed Behavioral Health Organizations, formed by public sector entities and providers, played an increasingly important role in the evolution of MMBH.

Adult↗

PubMed1992

Patient attitudes concerning health behaviors during pregnancy: initial development of a questionnaire.

The major determinant of infant mortality in the United States is low birthweight (LBW). Health behaviors related to LBW are inadequate prenatal care, poor nutrition, smoking, and moderate to heavy alcohol use. Before interventions can be designed to assist women in modifying these health behaviors, more must be understood about their causes. The Health Belief Model (HBM) is a framework for analyzing beliefs that motivate health behaviors and is well established as a model for understanding health behavior decisions. The chief aim of this study was to develop an instrument to assess women's health beliefs during pregnancy. Questions for the instrument were generated around the four major constructs of the HBM: perceived susceptibility, seriousness, benefits, and barriers. Four focus group interviews, a literature review, and consultation with an HBM expert provided content for questions. The questionnaire was administered to a convenience sample of 127 women. The measurement models were tested using confirmatory factor analysis. Parsimony was achieved by reducing the original 106-item scale to 64 items. The final instrument provides support for the HBM but not for all of its discrete constructs.

Adolescent↗

PubMedDate not supplied

Capturing parents' understanding about the health behaviors they practice with their preschool-aged children.

This qualitative, descriptive study first explored parents' concept of health and then examined the health practices they undertook for their preschool-aged children. The purposive sample of 11 parent couples and 3 single parents (14 parent sets in total) with preschool-aged children attending long daycare and preschool/kindergarten centers was equally distributed between parents from two different socioeconomic groups in two suburbs of western Sydney, Australia. Consenting parents were interviewed and transcripts were analyzed concurrently in accordance with a grounded theory approach (Glaser Strauss, 1967). Results revealed the presence of three themes, and practice implications for community nurses stem from them. These themes were Educating About Family Health, The Dynamic, Multidimensional Nature of Teaching Child Health Behavior, and The Intergenerational Theme. There was only minimal support for health-related socioeconomic differences. The study also found that most families with preschool-aged children were engaged in illness prevention rather than health promotion. Unlike those families focused on illness prevention, families focused on a health promotion mode were more sophisticated in their educational strategies and used more educational strategies associated with developing their child's health behaviors. This research validated the importance of the intergenerational transmission of values, particularly by mothers. The health behaviors that mothers considered important, and that they reinforced with their children, were transmitted equally to their daughters and sons.

Adult↗

PubMed2002

Cumulative abuse experiences, physical health and health behaviors.

PURPOSE: Our purpose was to investigate the complex relationship between a range of lifetime abuse experiences with current physical health and health behaviors. METHODS: Between October 1998 and May 1999, interviews were conducted with 557 ethnically diverse women seen at two urban primary care centers. Seven forms of abuse were measured: childhood physical and sexual abuse, past physical and sexual intimate partner violence (IPV), and recent emotional, physical, and sexual IPV. Severity was measured for six of these forms. Multiple non-specific physical symptoms were measured with a modified PRIME-MD, and four health behaviors were ascertained. RESULTS: Approximately 10% of women never experiencing abuse reported multiple non-specific physical symptoms, compared with 25.8% to 78.4% of women reporting a range of abuse experiences. Increases in recent IPV, past IPV, child abuse, and economic hardship were associated with increases in reported symptoms. Women who experienced IPV were more likely to report smoking cigarettes, binge drinking, and having poor nutritional habits. CONCLUSIONS: Recent IPV is associated with physical symptoms and risky health behaviors beyond the effects of child abuse, past IPV, and economic disadvantage. Understanding a person's IPV experiences may inform interventions for health behaviors, such as smoking cessation programs.

Adolescent↗

PubMed1994

Testing the Theory of Transcending Options: health behaviors of single parents.

The Theory of Transcending Options was developed in a grounded theory study of the health behaviors of female single parents. The 2-year study reported in this article is the first statistical test of the associations between the independent variables identified in the theory and the number of health behaviors practiced by divorced women with children. Data on demographics, psychological variables, and social support were collected from 148 women at three points in time over 2 years. These data were entered into three stepwise multiple regression analyses, with health behaviors as the dependent variable. Each analysis was statistically significant. The independent variables that made statistically significant contributions to health behavior practices in one or more of the regression analyses were education, number of years single, depression level, self-esteem, and total social support. The results of this study indicate that further clarification and testing of the theory are warranted.

Adolescent↗

PubMedDate not supplied

Informed-consent issues with adolescent health behavior research.

OBJECTIVE: To identify the informed-consent issues when conducting adolescent health behavior research. METHODS: A literature review was conducted across diverse academic fields about the informed-consent issues that were relevant to adolescent health behavior research. RESULTS: Issues included defining consent, assent and permission, minimal risk, risk assessment; legal issues; adolescent capacity to participate in research, and parental permission. CONCLUSIONS: Integrity in research means doing the right thing. Obtaining adolescent informed consent must be obtained every time data are collected. There seem to be occasions in which waiver of parental permission in some adolescent health behavior research is warranted.

Adolescent↗