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PubMedDate not supplied

Behavioral health service use and costs among children in foster care.

This article compares behavioral health service use and cost for foster care versus nonfoster care children; children before, during, and after foster care placement; and successfully reunified versus nonsuccessfully reunified foster care children. Behavioral health service costs for children in foster care were higher than for children not in foster care. Children in foster care used more services during their foster care placement than before placement and after discharge. Nonsuccessfully reunified children received a significantly larger quantity of services than those successfully reunified.

Adolescent↗

PubMed2002

Are biomarkers useful treatment aids for promoting health behavior change? An empirical review.

BACKGROUND: Nearly half of the leading causes of death in our society are attributable to behavioral risk factors. As such, it is critical that we continue to develop and refine effective interventions for health behavior change. Some researchers have suggested that using biomarkers to educate individuals about their health status and disease risk may be an effective strategy to promote behavior change. This tactic is also commonly employed by healthcare providers, but its empirical support is unclear. This article reviews the research literature to determine the effectiveness of using biomarker feedback to motivate and enable health behavior change. Potential limitations of this treatment strategy and issues requiring additional research are also discussed. METHODS: Articles were identified through PubMed (MEDLINE), PsychInfo, and the reference lists of pertinent manuscripts and book chapters. RESULTS: Eight published, randomized trials were identified that met criteria for review. The results of this work were mixed, but suggest that biological information conveying harm exposure, disease risk, or impaired physical functioning may increase motivation to change. Subsequent behavior change is also affected by the availability and intensity of concomitant treatment. CONCLUSIONS: Preliminary findings suggest that combining biomarkers with appropriate behavioral treatment may enhance health behavior change, but more research in this area is warranted.

Disease Transmission, Infectious↗

PubMed2005

Sowing the seeds of hope: providing regional behavioral health supports to the agricultural population.

In 1999, project leaders from seven states (i.e., Iowa, Kansas, Minnesota, Nebraska, North Dakota, South Dakota, and Wisconsin) began to share ideas and resources for providing behavioral health assistance (i.e., mental health counseling and addictions services) to stressed farmers, ranchers, farm workers, and their families. The seven states are among those most impacted by the farm crisis of the 1980s and again by low commodity prices and disasters such as droughts and floods in the 1990s. Project leaders conferred in monthly telephone conference calls and by 2001 began meeting in semi-annual face-to-face meetings to formally agree on a mission, program components, and management structure. Administrative functions were transferred from the Wisconsin Office of Rural Health and Wisconsin Primary Healthcare Association, to AgriWellness, Inc., a regional nonprofit corporation founded to provide technical assistance, grant writing, training of service providers, and other administrative supports. The Sowing the Seeds of Hope program has become a model for the provision of behavioral health supports for the agricultural population, including development of farm stress telephone hotlines, provision of confidential and affordable outpatient mental health and substance abuse counseling, training of professional providers in agricultural behavioral health, training of indigenous farm and rural residents as outreach workers who can respond to disasters of all types, and weekend educational retreats for farm residents. The program has achieved economy of scale by sharing expertise across state boundaries and the formation of a regional administrative structure. Yet, many challenges exist, the greatest of which is obtaining ongoing permanent support for the increasing numbers of uninsured and underinsured people involved in agriculture.

Community Mental Health Services↗

PubMed1992

Oral health behavior of 6-year-old Danish children.

In Denmark the Public Dental Health Service (PDHS) is now in the process of evaluation and revision of oral health education programs. The purpose of the present survey was 1) to evaluate the pattern of oral health behavior among 6-year-old children in relation to family and social characteristics; 2) to describe the level of dental knowledge and attitudes among the parents; and 3) to estimate the relative effect on caries experience of social and behavioral risk factors. The study comprised 212 children (response, 73%), and the parents responded to self-administered questionnaires. Moreover, information on def-s and DMF-S was collected from the epidemiologic recording systems for the PDHS. With regard to dental caries, 98% of the parents were aware of the harmful effect of sugar, and 88% knew about the role of bacteria. The causal effect of bacteria in relation to periodontal disease was stressed by 81%. Most of the parents (93%) believed that the dental diseases are preventable by means of proper oral hygiene habits, restriction of sugar and sweets, and the use of fluorides. The high level of dental knowledge among the parents was related to information given by the PDHS. Toothbrushing at least twice a day was performed by 88% of the children, and most used fluoridated toothpaste. Practical support to the children was given by 45% of the parents, and 55% checked the teeth. On a daily basis, the children had healthy foods like vegetables (59%), fruits (87%), and milk (89%), and orangeade was consumed by 53%; 45% of the children consumed sweets on a specific weekday ('Saturday sweets').(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude to Health↗

PubMedDate not supplied

Psychosocial and demographic factors related to health behaviors in the 1st trimester.

OBJECTIVE: To explore the relationship of psychosocial and demographic variables to health behaviors in early pregnancy. DESIGN: First trimester findings presented from a prospective study of weight gain in pregnancy. SETTING: A comprehensive health care system in central Texas. PARTICIPANTS: 114 pregnant women (75% white, 13% African American, 10% Hispanic, 2% Asian) of 12 weeks gestation or less. OUTCOME MEASURE: Self-Care Inventory, which includes diet/eating, substance abuse, recklessness, hygiene-related practices, sleep/rest, and exercise behaviors. RESULTS: In regression analysis the final model of demographic and psychosocial variables showed that higher depressive symptoms, lower internal locus of control for fetal health, and lower family income were related to poorer health behaviors in the 1st trimester of pregnancy. CONCLUSIONS: Health behaviors in early pregnancy may be affected by psychosocial factors such as depressive symptoms. Greater emphasis should be given to such factors in research and prenatal assessments.

Adolescent↗

PubMed2006

Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need.

The purpose of this study was to investigate the dental health behavior and self-perceived dental treatment need, in relation to depressive symptoms and symptoms of anxiety, among a general population drawn from a sample of 31-yr-old-men and women born in Northern Finland in 1966 (n = 8463). The dental health behavior included toothbrushing frequency and the frequency of dental check-ups. Depressive symptoms, as well as symptoms of anxiety, were determined on the basis of the Symptom Checklist-25 (SCL-25). The participants were also asked about their education and family income. Subjects with a high number of depressive symptoms had lower toothbrushing frequency as well as a lower frequency of dental visits than subjects with no or only a few depressive symptoms. Morover, the self-perceived dental treatment need was more common among those with a high number of depressive symptoms. Symptoms of anxiety were significantly associated with lower toothbrushing frequency. The results support the view that there is an increased risk for impaired dental health among subjects with depressive symptoms or symptoms of anxiety.

Adult↗

PubMed2006

Health behavior in psychiatric in-patients compared with a German general population sample.

OBJECTIVE: To compare the health relevant behavior of psychiatric patients and the general population. METHOD: Health behavior of 363 psychiatric in-patients with ICD-10 diagnoses of schizophrenia, bipolar disorders, major depressive disorders and neurotic, and somatoform disorders was compared with health behavior of a representative sample of 7200 persons from German general population. RESULTS: Increased prevalence rates for smoking and illicit drug use were found for all diagnostic groups. Risk alcohol consumption was increased in patients with schizophrenia and depression. Smokers with schizophrenia had an excess cigarette consumption compared with general population. The number of unhealthy food habits was increased in all diagnostic groups, and the body mass index was found to be increased for patients with schizophrenia. Patients with depression were more physically active than general population. CONCLUSION: Poor health behavior is widespread in patients with all major psychiatric diagnoses. Interventions to reduce risk behavior and strengthen health preventive lifestyles are necessary.

Demography↗

PubMed2002

Physical health and preventive health behaviors among Thai women in Brisbane, Australia.

In this article we describe the health status of Thai migrant women in Australia. Women's physical health, their use of health services, and adherence to preventive health behaviors are presented. The results are based on data from a descriptive study of 139 women living in Brisbane who completed a structured questionnaire. This information was supplemented with data from in-depth interviews with 17 of the women to gain additional information and insight into immigration, language, social support, and the use of health services. Although the majority of women reported being in good health and only a small percentage suffered from chronic diseases, inherent problems can influence their future health status. These include women's low participation in preventive health programs, unhealthy life style and behavior, perceptions of health services, availability of social support during illness, and issues related to care from general practitioners. Women's understanding of health education and information was influenced by their language skills. Language difficulties and the perceived high costs of medical care in Australia were contrasted with the lower cost and perceived efficiency and efficacy of Thai medical practitioners, and as a result some women delayed medical attention until home visits to Thailand.

Adult↗

PubMedDate not supplied

Involvement in health behaviors among youth with diabetes.

PURPOSE: The purpose of this study was to examine involvement in a broad range of health behaviors among adolescents and young adults with diabetes. METHODS: The sample consisted of 107 adolescents and young adults (12 to 24 years old) with Type 1 diabetes mellitus. Participants were asked to report involvement in health-enhancing, health-compromising, and diabetes mismanagement behaviors. RESULTS: The participants reported low levels of health-compromising behaviors and high levels of health-enhancing behaviors. Females reported significantly higher levels of diabetes mismanagement than males. Males in late adolescence (18 to 24 years) reported significantly higher levels of health-compromising behaviors than males in early (12 to 14 years) and middle (15 to 17 years) adolescence. Females in late adolescence (18 to 24 years) reported significantly higher levels of health-compromising behaviors than females in early adolescence (12 to 14 years). CONCLUSIONS: Diabetes educators who work with youth may want to assess all of these health behaviors, keeping in mind age and gender differences.

Adolescent↗

PubMed1999

Managed care, meet community support: ten reasons to include direct support services in every behavioral health plan.

In this article, the performance of community support programs over three decades is assessed through a review of the professional literature, with emphasis on clinical outcomes, cost-effectiveness, and consumer satisfaction. The author argues that for managed behavioral health organizations to serve disabled customers adequately, community support is required. Ten field-tested reasons to include community support services in every behavioral health plan are presented. The author concludes that social workers are uniquely qualified to adapt proven interventions from model community support programs to the mission of managed behavioral health organizations, with the potential to remedy problems of access, continuity, and accountability in providing treatment for serious and persistent mental illness.

Behavior Therapy↗

PubMed1989

Anxiety levels, health behaviors, and support systems of pregnant women.

The purpose of this correlational descriptive study was to assess health behaviors, anxiety levels, and social support of pregnant women, ages 20 to 40, who were without complications and were patients of four private obstetrical practices in a large metropolitan city. Although sampling was a nonprobability approach, various socioeconomic, racial, and religious groups were represented. The three instruments used to test the hypotheses included the State-Trait Anxiety Inventory (STAI), the Personal Resource Questionnaire (PRQ) and a detailed Health Behavior Demographic Questionnaire. Results of the data indicated no significant differences between pregnant smokers' and pregnant nonsmokers' STAI or PRQ scores. Significant positive correlations were revealed between the following variables: Trait anxiety with increased age of pregnancy (r = .77, p = .008); trait anxiety with high educational level (r = .72, p = .001); trait anxiety with state anxiety (r = .64, p = .001); trait anxiety with years married (r = .68, p = .018); trait anxiety with numbers of children (r = .82, p = .005); trait anxiety with high occupation level (r = .68, p = .001), increased age with PRQ support (r = -.88, p = .001); caucasian women examined breast more frequently (r = .47, p = .005); pregnant women who were smokers also were more likely to drink (r = .66, p = .03). Significant negative correlations were: Increased state anxiety with decreased social support (r = -.28, p = .05); higher trait anxiety with lower PRQ (r = -.59, p = .001), and more drinks of alcohol per day with decreased social support (r = .88, p = .04). The study indicated that the subjects who continue to smoke while pregnant were highly educated. All had at least two years of college with 45% having completed graduate school. All were working in managerial or professional jobs. This has implications for nursing interventions focused on enhancing health coping strategies at the workplace and specific health promotion activities designed to reduce job-related stress during pregnancy.

Adaptation, Psychological↗

PubMed1997

ERISA preemption and its impact on behavioral health services.

Recently, mental health parity provisions were passed and incorporated retroactively into the Health Insurance Portability and Accountability Act (PL 104-191). Although limited, these provisions were instrumental in focusing national attention and debate on people's need for and right to behavioral health services. A handful of states have also passed parity provisions, but their full impact on the insurance market cannot be assessed. This is because a majority of plans are preempted from compliance with many state insurance mandates by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA is the primary obstacle to state behavioral health mandates, and it threatens the inclusion of behavioral health providers and settings in managed care plans integrating public and private healthcare systems. This article provides basic information on ERISA, its preemption clauses, and its impact on behavioral healthcare services.

Career Mobility↗

PubMed1998

Behavioral health services: carved out and managed.

This article highlights the financial pressures that led to an examination of how mental healthcare was provided and paid for, and discusses the rise, characteristics, and functioning of carved-out behavioral healthcare. The typical characteristics of managed behavioral health carve outs (MBHCOs), including contracts, payment arrangements, provider networks, and data collection are discussed and illustrated using the example of United Behavioral Health. The article details the function of the MBHCO on cost and utilization, access, quality, and the relationship of behavioral health services to general medical care and other human services, but cautions that further research is needed to evaluate the qualitative aspects of care.

Capitation Fee↗

PubMed2002

[Do maternal social factors, health behavior and work conditions during pregnancy increase the risk of low birth weight in Lithuania?].

UNLABELLED: The objective of the paper was to evaluate the importance of maternal social factors, health behavior (smoking, alcohol drinking and drug abuse) and working conditions on incidence of low birth weight (LBW). MATERIAL AND METHODS: Statistical analysis was performed utilizing database of Medical Birth Registry for the years 1995-1998 using the indicators of maternal social factors, health behavior and working conditions. Statistical analysis was carried out using statistical package SPSS 10.0. RESULTS: During 1995-1998 the incidence of LBW (< 2500 g) was 3.6 per cent. Young (< 20 years) and older (> or = 35 years) maternal age, low (primary or basic) education and "lone mother" status (single, divorced or widowed) increased the risk of delivering LBW baby. The odds ratio of smoking mothers to deliver LBW baby was 3.3. Odds ratios of LBW newborns associated with alcohol drinking and drug abuse were 10.3 and 6.1 respectively. The odds ratio of mothers physically abused during pregnancy to deliver LBW baby was 2.7. However, the harmful working conditions were not associated with the higher odds of LBW. Young and older age was attributable for 22.2 and 49.3 per cent LBW cases in the exposed group respectively. While attributable fraction in exposed due to the low educational level and unfavourable marital status accounted to 38.9 and 52.9 per cent LBW cases respectively. Smoking was attributable for 68 per cent LBW cases, alcohol drinking--87.2 per cent, drug abuse--80.5 per cent LBW cases among exposed mothers. Preventable population attributable risk for unfavourable marital status was 11.7 per cent, low education--9 per cent, smoking--8 per cent, older age--6.9 per cent. Drug abuse and hard manual work had minimal association while harmful working conditions were not associated with higher risk to deliver the LBW baby in the total population. CONCLUSIONS: Maternal health behavior peculiarities and hard manual work are related to newborns' birth weight, and medical professionals should encourage quitting the hazardous habits and regulation of workload for expectant mothers. Adverse social factors contribute to the higher incidence of LBW. The solution of social problems should become the priority of State health policy.

Adult↗

PubMedDate not supplied

Predictors of oral health behaviors among elderly Japanese Americans.

As part of a series of studies on oral health behaviors of older persons, 81 elderly Japanese Americans were interviewed regarding their dental service utilization patterns, oral health attitudes, and dental status. The sample consisted of 35 Issei (first generation) and 46 Nisei (second generation) Japanese Americans. Because of the significant age difference between the Issei and Nisei, it was difficult to examine generational differences between the two groups. When age differences were controlled, there was no difference between the two generations in interval since their last dental visit. However, reasons for dental visits differed between the two groups, with the Issei more likely to seek help with dentures or general restorative work while the Nisei were more likely to schedule appointments for dental check-ups and cleaning. The best predictors of dental service utilization for the entire sample were the use of complete dentures, age, and education (R2 = .38), but when the respondent's perceived importance of oral health was entered into the equation, this variable accounted for more variance than age or education. The combination of complete dentures, importance, and age accounted for 41% of the variance in recency of dental service utilization. Locus of control, the belief component of attitudes, and overall attitude scores did not add significantly to the prediction of dental utilization.

Age Factors↗

PubMedDate not supplied

Tailoring and targeting a worksite health promotion program to address multiple health behaviors among blue-collar women.

PURPOSE: This study examined the relationship between health risks, health behaviors, stages-of-change, and behavior change priorities among blue-collar women participating in a worksite health promotion study. DESIGN: Cross-sectional. SETTING: Rural manufacturing worksites in North Carolina. SUBJECTS: Participants were 859 women aged 18 and over. MEASURES: The self-administered questionnaire assessed smoking, exercise, nutrition (fat, fruits, and vegetables), and breast and cervical cancer screening behaviors. In addition, demographics, body weight, perceived health, stages-of-change, and priority for behavior change were measured. Chi-square tests and regression analysis were used to assess statistical significance. RESULTS: Overall, 28% of women smoked, 37% were completely sedentary, 82% consumed less than five daily servings of fruits and vegetables, and the majority were overweight. The dominant stage of change for each of the lifestyle behaviors was contemplation, whereas most women were in the action stage for cancer screening. When asked to prioritize the behavior they most wanted to change, the majority of women chose healthy eating and/or exercise. CONCLUSIONS: The findings suggest that blue-collar women in this study had multiple health risks and were interested in changing multiple health behaviors. Allowing women to choose the behavior(s) on which they are ready to focus may be a promising approach to tailoring interventions for this population.

Adult↗

PubMedDate not supplied

Using artificial neural networks and the Gutenberg-Richter power law to "rightsize" a behavioral health care system.

The authors propose a new paradigm for designing and managing behavioral health care systems by using artificial neural networks to measure quality of care (Q), using length-of-stay (LOS) prediction and the variation in LOS prediction, and subsequently using the variation of Q to obtain a measure of uncertainty in treatment. The paper proposes that mental illness is fractal in nature (self-similar at all scales) and conforms to power laws like the Gutenberg-Richter (G-R) law, whereby there is a log-log relationship between frequency of episodes (i.e., admissions) and the severity of those episodes. The paper also hypothesizes that 28% is the average uncertainty (residual or excess entropy) in the treatment of mental illness. The authors use the G-R paradigm to calculate the severity of admission and, subsequently, the minimum number of beds for different behavioral health care facilities and propose the optimal partition of beds between community and state services, thereby "balancing" the delivery system. The data presented support the notion that mental illness manifests complexity and "self-organized criticality." The authors hypothesize that correcting deviations from the theoretical G-R curve for each level of care will allow optimum resource distribution, improve quality of care, and reduce costs.

Behavioral Medicine↗

PubMedDate not supplied

Effects of social support on prenatal care and health behaviors of low-income women.

OBJECTIVE: To determine the relationship of social support from partners and others to the adequacy of prenatal care and to the prenatal health behaviors of low-income women. DESIGN: Descriptive, correlational study using self-reports and medical record review. SETTING: Data were collected in five metropolitan prenatal clinics serving low-income women. PARTICIPANTS: Ethnically diverse, primarily single, low-income pregnant women (N = 101) between 28 and 40 weeks of pregnancy. MAIN OUTCOME MEASURES: Subjects completed the Norbeck Social Support Questionnaire, the Prenatal Health Questionnaire, and the Demographic/Pregnancy Questionnaire. RESULTS: Social support provided by the partner correlated positively with adequacy of prenatal care, whereas social support from others (excluding partner relationships) correlated positively with prenatal health behaviors. Professionals such as health care providers and counselors were not considered sources of social support by women. CONCLUSIONS: Nurses who work with low-income pregnant women in a variety of settings should assist partners in recognizing their potential positive contributions, teach women to communicate their expectations to their partners, acknowledge the importance of other family members as providers of social support, and when needed, refer women to programs that increase available social support.

Adolescent↗