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Health behaviors and survival among middle-aged and older men and women in the NHANES I Epidemiologic Follow-up Study.

BACKGROUND: Since the 1960s there has been a decline in mortality rates for older U.S. adults, suggesting the importance of examining the role of prevention and health promotion in improving the health and survival of older adults. Epidemiologic studies of age and gender differences in the impact of health behaviors on survival for older U.S. adults are needed to provide information for intervention and health promotion efforts for older Americans. METHODS: We examined whether health behavior risk factors (smoking, drinking, physical activity, and body weight) for mortality vary by age and gender among 6,109 adults 45-74 years old in the National Health and Nutrition Examination Survey 1971-1975 (NHANES I) who were traced during the 1982-1984 NHANES I Follow-up Survey. RESULTS: For middle-aged men (45-54 years old) and for older men (65-74 years old), both smoking and nonrecreational physical activity were predictors of survival time. Additionally, for older men, drinking and low body mass index were associated with shorter survival time. Among women, there was less consistency of associations across age groups. As with men, nonrecreational physical activity and low body mass index were associated with shorter survival among older women. CONCLUSIONS: These findings suggest that health behaviors are associated with survival in older adults as well as in middle-aged adults, although the specific behavioral risk factors may vary by age and gender.

Adult↗

The role of self-efficacy in achieving health behavior change.

The concept of self-efficacy is receiving increasing recognition as a predictor of health behavior change and maintenance. The purpose of this article is to facilitate a clearer understanding of both the concept and its relevance for health education research and practice. Self-efficacy is first defined and distinguished from other related concepts. Next, studies of the self-efficacy concept as it relates to health practices are examined. This review focuses on cigarette smoking, weight control, contraception, alcohol abuse and exercise behaviors. The studies reviewed suggest strong relationships between self-efficacy and health behavior change and maintenance. Experimental manipulations of self-efficacy suggest that efficacy can be enhanced and that this enhancement is related to subsequent health behavior change. The findings from these studies also suggest methods for modifying health practices. These methods diverge from many of the current, traditional methods for changing health practices. Recommendations for incorporating the enhancement of self-efficacy into health behavior change programs are made in light of the reviewed findings.

Alcohol Drinking↗

Developmental status, gender, age, and self-reported decision-making influences on students' risky and preventive health behaviors.

This study used decision-making theory to analyze the developmental changes associated with children's and adolescents' health behavior. High school and elementary school children completed surveys concerning (1) the extent to which they engage in a variety of preventive and risky health behaviors, and (2) influence sources used in decision making concerning the enactment of these behaviors. Multiple regression analysis revealed that the sources of influence children and adolescents report considering in making health-related decisions change developmentally and as a function of gender. Moreover, within and across age, children's sources of influence with respect to health decision making are dependent on the health domains being considered. The findings are discussed in relation to decision-making theory and the implications for the content and timing of health education initiatives for adolescents.

Adolescent↗

Associations between occupational health behaviors and occupational dental erosion.

OBJECTIVES: The aim of this study was to evaluate the associations between occupational health behaviors and occupational dental erosion. METHODS: Using data for 943 workers among 34 factories, selected by three-stage stratified cluster sampling from 888 factories using acids, two sets of modified case-control studies were performed. The cases were 242 workers with any dental erosion (G1-5) and 78 with severe dental erosion (G3-5); the controls were 701 workers with no erosion (GO) and 864 workers with no or mild erosion grades, GO-2, respectively. The main explanatory variables were behaviors such as wearing a respiratory mask and gargling at work. The results were adjusted for employment, age, sex, knowledge, and opinion about occupational health, attrition, and abrasion. Bivariate and multivariate logistic regression analyses were conducted. RESULTS: The odds of overall occupational dental erosion (G1-5) was 0.63 (95% CI = 0.42, 0.94) for respiratory mask wearers compared to nonwearers; the odds of severe occupational dental erosion (G3-5) was not significantly less in respiratory mask wearers (OR = 0.94; 95% CI = 0.53, 1.67). Gargling did not show a significant association with occupational dental erosion in this study. CONCLUSIONS: Among occupational health behaviors, wearing personal protective respiratory masks in work was significantly associated with less overall occupational dental erosion.

Acids↗

Assessing the health behaviors of Texas college students.

The authors of this study examined the health behaviors of Texas college students, using a telephone survey to assess 1,408 randomly selected students enrolled in 23 institutions of higher education. Eighty-nine percent of those surveyed had consumed alcohol at least once, and nearly one third considered themselves regular smokers. More than 81% reported they had had sexual intercourse at least once, and one fourth of the sexually active men had had more than 10 partners. However, of the 1,148 students who were sexually active, only 40.1% reported using a condom at last intercourse. Almost 59% of the students surveyed had never been taught about HIV or AIDS in any of their college classes. Given the large sample size and the random methods employed, the authors suggest that the results of this study can be used to establish a baseline of information regarding health behaviors of college students that can be extrapolated to college populations across the country.

Adult↗

Association of perceived family criticism with health behaviors.

BACKGROUND: Criticism from family members has been implicated in psychiatric illnesses such as schizophrenia, depression, and eating disorders. Perceived family criticism has also been linked to primary health care use. In our study, we examined the association between perceived family criticism and health behaviors, as well as the potential mediating role of negative affect. METHODS: A questionnaire was mailed to patients receiving care at a family medicine center. Perceived family criticism was measured using the Family Emotional Involvement and Perceived Criticism Scale. Diet, regular exercise, smoking status, and levels of depression, hostility, and physical health were also assessed through self report. RESULTS: Nine hundred twenty-two (62%) active family medicine patients responded to our questionnaire. Complete data were available for 875 patients. In univariate analysis, a high level of perceived family criticism was associated with various demographic characteristics, poorer physical health, negative affect, higher fat intake, lack of exercise, and smoking. In multivariate analysis, the association between a high level of perceived criticism and health behavior was independent of demographic characteristics and physical health, for example, high-fat diet (odds ratio [OR] = 1.47; 95% confidence interval [CI], 1.11 - 1.95), no regular exercise (OR = 1.37; 95% CI, 1.02 - 1.84) and current smoking (OR = 1.38; 95% CI, 1.00 - 1.90). None of these associations was statistically significant after controlling for depression and hostility. CONCLUSIONS: A high level of perceived family criticism is associated with adverse health behaviors. This association appears to be explained by resultant depression and hostility.

Affect↗

Stability of dental health behavior: a 3-year prospective cohort study of 15-, 16- and 18-year-old Norwegian adolescents.

UNLABELLED: There is a need for a descriptive epidemiology of patterns of dental health behavior through adolescence. OBJECTIVES: The purpose of this study was to assess the tracking (degree of stability) of several categories of self-reported dental health behavior in adolescence over a 3-year period. METHODS: In 1992, a representative sample of 970 15-year-old adolescents of Hordaland county, Norway, completed questionnaires under supervision at school. Postal follow-up studies 1 and 3 years later provided 709 and 781 answers, respectively. The present analyses included 581 adolescents who participated on all three occasions and 670 adolescents who replied in 1992 and 1995. Paired sample t-tests, cross-tabulations and Pearson's correlation coefficients were used to assess stability. For use in the cross-tabulations all variables were transformed into binary categories (active and inactive). RESULTS: A substantial proportion of adolescents remained consistently in the same behavioral category for all 3 survey years. Toothbrushing (80%) and use of dental floss (64%) were the most stable activities, while consumption of sugared mineral water (53%), intake of chocolate/sweets (52%) and use of F-rinse (54%) were less stable. However, Pearson's correlations between corresponding behaviors assessed in 1992 and 1995 were moderate and varied from 0.59 (toothbrushing) to 0.22 (F-rinse) (P<0.001). CONCLUSION: The results do not conclusively indicate a pattern of tracking. The tendency is, however, clear enough to support the assumption that dental health behavior continues during adolescence into adulthood.

Adolescent↗

Behavioral health in Antarctica: implications for long-duration space missions.

Ideally, evidence from long-duration spaceflight should be used to predict likely occurrences of behavioral health events and for planning management strategies for such events. With small numbers of space travelers, and limited long-duration missions of a year or more, Earth analogues and simulations must be used as the evidence base, despite such analogues lacking microgravity, radiation, rapidly altering photoperiodicity, and fidelity to space. Antarctic health data are reviewed and an assessment made of the likely frequency of behavioral health events. Based on the Antarctic evidence, the likelihood of behavioral health problems in space is low. However, such cases may be serious and of high consequence, placing considerable demands on the mission crew and ground support to achieve a successful outcome, given the availability of pharmaceuticals and resources.

Adaptation, Psychological↗

Health beliefs and health behaviors of physical therapists.

The purpose of this study was to examine the health beliefs and health behaviors of physical therapists. A survey questionnaire was sent to a 10% random sample of the physical therapists on the Texas licensure list for 1984, and 234 responses (69%) were used in the data analysis. The respondents tended to have positive health beliefs and good health behaviors in terms of a healthy life style. These findings have implications for physical therapists as role models for encouraging good health habits in their patients.

Adult↗

Selected psychological characteristics and health behaviors of aging marathon runners: a longitudinal study.

This report summarizes the health behaviors and psychological characteristics of fifteen male marathon runners who were first tested in 1969 (N = 8) and 1976 (N = 7). The participants in this study averaged 29 years of age at the outset, and the mean age at the time of follow-up was 50 years. These subjects were found to score in the normal range on all of the psychological variables, and they were characterized by the "iceberg" profile described earlier for elite athletes in various sports. This profile includes scores that fall below the population average on mood states such as tension, depression, anger, fatigue and confusion along with above average scores on vigor. Also, the psychological traits of these former runners have been remarkably stable across the past two decades, with the exception that a uniform decline has been observed for the neuroticism measure. Earlier research by Eysenck has shown that neuroticism decreases with age. These former marathon runners continue to be moderately active, and it is noteworthy that they first became involved as runners while in high school. All but one of the participants had attended college, and each had participated in competitive running while in college. Training for marathon competition took place following the college years. It is likely that much of the early success enjoyed by this group was governed to a substantial degree by heredity. This sample possessed an average aerobic power of 70 ml.kg-1.min-1 along with a unique somatotype when first tested, and these factors are known to have a substantial heritability component. The health behaviors studied in this group were uniformly positive. They were found to be physically active, and their physical self-esteem fell above that of other men in their age group. The subjects reported moderate use of alcohol, no insomnia, few physical problems and good overall mood. The sample of former marathon runners described in this report is unique in a number of respects, and caution is urged in making generalizations. With this qualification in mind, it is concluded that a lifetime of regular physical activity is associated with desirable physical and mental health.

Adult↗

Sex differences in health attitudes and choice of health behaviors.

College students (82 men, 166 women) were assessed on a variety of physical fitness measures and completed questionnaires regarding health behaviors and attitudes. The men's health behaviors focused on physical activity while women's focused on dietary changes for better health.

Adult↗

Joint commission evaluation of behavioral health care organizations.

The joint Commission on Accreditation of Healthcare Organizations has accredited behavioral health care organizations since 1957. Accredited behavioral health care organizations include organizations providing services to persons with psychiatric disorders, substance abuse disorders, or developmental disabilities/mental retardation; or, provide social services to other related populations. In the late 1980s, the Joint Commission initiated the redesign of accreditation to include performance measurement. Performance measurement initiatives include the IMSystem, Requests for Indicators, National Library of Healthcare Indicators, and a national Council on Performance Measurement. These initiatives are steps toward the integration of performance measurement data into the accreditation process.

Humans↗

Child behavioral health service use and caregiver strain: comparison of managed care and fee-for-service Medicaid systems.

This study compares behavioral health service utilization patterns and their determinants among Medicaid-enrolled children, ages 5-17 (N = 676) who were being served under managed care in Tennessee or a traditional fee-for-service system in Mississippi. Children in the fee-for-service program were significantly more likely than their counterparts in the managed care Medicaid program to receive behavioral health services (i.e., any service, support services, traditional outpatient services, day treatment, inpatient/residential care) and to receive more services overall. This finding held after controlling for the influence of other factors. Although child, family, and community variables were related to service use patterns, the relationships differed across systems. Caregiver strain was associated with several service use variables, but its influence was more pronounced in Tennessee. These findings support continued focus on the multi-level factors that shape behavioral health service use among children.

Adolescent↗

Health behaviors of an elderly Filipino group.

More than 69 million elderly people are expected to be living in the United States by the year 2050 (American Association of Retired Persons, 1991). For public health nurses, this rapidly growing, diverse population poses a challenge. P. Ebersol and P. Hess (1994) suggest that health care professionals must become skilled in understanding the health needs and practices of the diverse, heterogeneous aged if they are to help the elderly achieve more healthful, satisfying existences. According to two studies, M. Nemcek (1990) and J. Flaskerud and C. Rush (1989), health behaviors of the elderly vary among and within cultural groups. The purpose of this descriptive survey study was to examine how culture effects the health behaviors of 52 elderly Filipino women and men. The Health Behavior Survey was designed and used by the researchers in this study. Unhealthy behaviors identified were inclusion of fried foods in diet, weight gain, and little or no exercise. Because of the value placed on personal health by the participants, it appears the group would be receptive to a health promotion program which would increase their probability for a healthy life.

Aged↗

Associations between diet and health behavior: results from the 1992 Rhode Island Behavioral Risk Factor Survey.

The 1992 Rhode Island Behavioral Risk Factor Surveillance System was used to assess self-reported health behaviors of consumers of finfish and raw shellfish. We hypothesized that consumers of finfish, foods considered to be healthy, were more likely than nonconsumers of finfish to partake in health-promoting behaviors. Similarly, we postulated that consumers of raw molluscan shellfish, foods linked to an elevated risk of acquiring various illnesses, were more likely than nonconsumers of raw-shellfish to partake in risk-taking behaviors. Finfish eaters were significantly more likely than abstainers to report recent exercise, efforts to lose weight, periodic monitoring of serum cholesterol, and not currently being smokers. Raw shellfish eaters were significantly more likely than abstainers to report recent acute and chronic alcohol consumption. The results suggest that inquiry into dietary patterns may be an avenue for exploring other health behaviors.

Adolescent↗

The relation between religiosity, selected health behaviors, and blood pressure among adult females.

BACKGROUND: This study examined the association between blood pressure (BP), selected health behaviors, and various dimensions of religiosity among females. METHODS: Data were obtained on 112 females who were at least 35 years of age and of Judeo-Christian faith. Resting BP measures were taken with an automated sphygmomanometer, height and weight were measured to determine body mass index (BMI), and intermediate health variables (e.g., physical activity, smoking, diet, and alcohol consumption) were measured by questionnaire. A multifactorial questionnaire was used to assess various dimensions of religiosity. Multiple regression path analyses were conducted to determine the direct and indirect effects of religiosity on BP with age and BMI controlled statistically. RESULTS: The direct effects of religiosity on SBP and DBP were more substantial than the indirect effects through the intermediate health variables, suggesting that religiosity may be associated with lower levels of BP via a direct pathway, such as improving the ability to cope with stress. In general, DBP was more influenced by religiosity than SBP and the dimensions of "intrinsic religiosity" and "religious coping" were most influential. Results also indicated that "religious experiences" may exert a greater beneficial effect on DBP in older (50-80 years) age groups. CONCLUSIONS: These results support a direct relationship between religiosity and BP, rather than an indirect effect through intermediate health behaviors.

Adaptation, Psychological↗

Value for the future and preventive health behavior.

Many everyday decisions require trade-offs between immediate and delayed benefits. Although much research has assessed discounting of delayed outcomes by using hypothetical scenarios, little research has examined whether these discounting measures correspond to real-world behavior. Three studies examined the relationship between scenario measures of time preference and preventive health behaviors that require an upfront cost to achieve a long-term benefit. Responses to time preference scenarios showed weak or no relationship to influenza vaccination, adherence to a medication regimen to control high blood pressure, and adherence to cholesterol-lowering medication. The finding that scenario measures of time preference have surprisingly little relationship to actual behaviors exemplifying intertemporal trade-offs places limits on the applications of time preference research to the promotion of preventive health behavior.

Adult↗

Covert self-reinforcers, fear of consequences, and health behavior.

A sample of 125 U.S. college students reported how frequently they exercised vigorously; wore seat belts in automobiles; and avoided consumption of red meat and foods high in dietary cholesterol, saturated fat, and salt. They also reported their fears of long-term negative effects from the unhealthful alternatives and both the frequencies and intensities of 6 self-administered covert consequences: 3 positive for healthful behaviors and 3 negative for the unhealthful alternatives. Diet-related health behaviors were best predicated by a single scale composed of all 12 covert-consequence items. Factor analyses suggested the use of 2 scales for exercise and use of seat belts: 1 rating positive consequences and the other rating negative consequences. For both behaviors, only the positive-item scale predicted in multiple regression. Fear was correlated with all health behaviors except exercise, but it contributed independently only to red-meat avoidance.

Adolescent↗