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PubMed1994

Considerations under capitated behavioral health care services.

A leading concern in the health care marketplace is the sharp cost increases associated with behavioral health care benefits over the past few years. Payers are desperately seeking alternative approaches for holding down managed behavioral health care costs and improving the quality of care. Many are focusing their attention on an integrated delivery system with capitated arrangements and direct contracting. The author discusses the requirements to succeed in this new delivery system.

Capitation Fee↗

PubMed1998

Protective factors in adolescent health behavior.

The role of psychosocial protective factors in adolescent health-enhancing behaviors--healthy diet, regular exercise, adequate sleep, good dental hygiene, and seatbelt use--was investigated among 1,493 Hispanic, White, and Black high school students in a large, urban school district. Both proximal (health-related) and distal (conventionality-related) protective factors have significant positive relations with health-enhancing behavior and with the development of health-enhancing behavior. In addition, in cross-sectional analyses, protection was shown to moderate risk. Key proximal protective factors are value on health, perceived effects of health-compromising behavior, and parents who model health behavior. Key distal protective factors are positive orientation to school, friends who model conventional behavior, involvement in prosocial activities, and church attendance. The findings suggest the importance of individual differences on a dimension of conventionality-unconventionality. Strengthening both proximal and distal protective factors may help to promote healthful behaviors in adolescence.

Adolescent↗

PubMed1996

Environmental conditions, health behavior, and mortality in siblings as risk indicators of night blindness.

The purpose of the study was to estimate the association of environmental factors (water and sanitation), health behavior (breast feeding practice and vaccination), and mortality among siblings with night blindness. A total of 5,420 children were enrolled in a cross-sectional study from 2,101 households in the northern part of Bangladesh, a high risk area for night blindness. One hundred twenty-four children were reported by parents to have night blindness. Our results indicated that environmental factors, health behavior, and the death of siblings were significantly associated with the occurrence of night blindness in crude analyses, as well as in analyses with adjustment for a number of potential confounding variables. The strongest association was noted for sibling death. The findings support the notion that night blindness should not be viewed as an isolated health problem and that approaches aimed at improving vitamin A status should also include interventions directed to environmental and health-associated behavioral factors.

Adolescent↗

PubMed1990

Positive and negative health behaviors used to ensure compliance with the U.S. Army's weight control standards by a reserve component unit.

This paper describes the results of a nonexperimental descriptive research study in which specific positive and negative health behaviors used by soldiers in a medical reserve unit to ensure compliance with the Army Weight Control standards were surveyed using a questionnaire. The findings of the survey, particularly the prevalent use of negative health behaviors to control or maintain weight, were startling. The authors offer their conclusions and propose solutions relative to changing the emphasis of the program from having a single focus, i.e., weight control, to a comprehensive focus, i.e., physical fitness and wellness.

Adipose Tissue↗

PubMed1998

Total quality management in behavioral health care.

The literature on total quality management or continuous quality improvement in the behavioral health care field is just beginning to emerge. Although most of the evidence on its effectiveness remains anecdotal, it seems clear that it can work in behavioral health care organizations with strong leadership support and a long-term commitment.

Humans↗

PubMed2002

History of sport participation in relation to obesity and related health behaviors in women.

BACKGROUND: Organized sport participation in youth is a common form of physical activity; yet, little is known about how it is associated with adult obesity and related health behaviors. The purpose of this study was to investigate whether a history of youth sport participation was related to adult obesity, physical activity, and dietary intake among women. METHODS: Participating women (209 African American, 277 Caucasian; ages 18-39), recruited from the community, completed laboratory measures, a paper and pencil survey assessing past sport participation and current physical activity level, and dietary records. RESULTS: Linear regression revealed that a history of sport participation predicted lower adult body mass index and higher total and sport activity levels for both ethnic groups and higher work-related physical activity among Caucasians (all P < 0.001). Past sports participation did not predict dietary intake. CONCLUSIONS: The results suggest that girls' participation in sports may lay the foundation for adult health and health behaviors and that sports participation could be an important component of obesity prevention programs.

Adolescent↗

PubMed2000

Assessment of the Massachusetts Behavioral Health Program Year 6.

After a difficult transition from the previous vendor to the Massachusetts Behavioral Health Partnership (MBHP), Year 6 was a year of stability and incremental changes for the Massachusetts Behavioral Health Program. This assessment of Year 6 is based on interviews with key players, data provided by the MBHP, a survey of providers, as well as on the fifth year of an ongoing review of the program. Results indicate that enrollment grew, and new services were developed in response to identified needs. Providers considered access, utilization, and quality of care to be the same or better than a year earlier. Coordination improved, but was not optimal. Clinical and overall decisions with MBHP were collaborative or negotiated and less hierarchical in manner than the previous year. Providers rated MBHP better than other managed care organizations on quality of care and utilization review decisions, access, flexibility, and administration.

Child↗

PubMed1998

Health behavior in persons with spinal cord injury: development and initial validation of an outcome measure.

OBJECTIVE: To describe the development and initial psychometric properties of a new outcome measure for health behaviors that delay or prevent secondary impairments associated with spinal cord injury (SCI). DESIGN: Persons with SCI were surveyed during routine annual physical evaluations. SETTING: Veterans Affairs Medical Center Spinal Cord Injury Unit, which specializes in primary care for persons with SCI. PARTICIPANTS: Forty-nine persons with SCI, aged 19-73 years, 1-50 years post-SCI. MAIN OUTCOME MEASURE: The newly developed Spinal Cord Injury Lifestyle Scale (SCILS). RESULTS: Internal consistency is high (alpha = 0.81). Correlations between clinicians' ratings of participants' health behavior and the new SCILS provide preliminary support for construct validity. CONCLUSIONS: The SCILS is a brief, self-report measure of health-related behavior in persons with SCI. It is a promising new outcome measure to evaluate the effectiveness of clinical and educational efforts for health maintenance and prevention of secondary impairments associated with SCI.

Adolescent↗

PubMed2003

Understanding health behavior and perceptions.

Oral health and general health status depend on a dynamic interplay of many factors, including the individual's personal characteristics, behaviors, and perceptions. There are differences and disparities among different racial and ethnic groups in terms of oral health status, and in the physical, socioeconomic, cultural, and political environment. Furthermore, response to the environment may vary among individuals and populations. Access to care and patient-provider interactions are key issues to consider. This article presents a conceptual model of the variable influences on behaviors and perceptions that determine oral health status in minority and other populations.

Delivery of Health Care↗

PubMed2006

Home-based behavioral health intervention: Use of a telehealth model to address poor adherence to type-1 diabetes medical regimens.

Youth with insulin-dependent diabetes mellitus face complex treatment regimens and often have difficulty adhering to treatment requirements. Many behavioral-health intervention strategies, such as psychoeducational groups, diabetes summer camps, individual therapy, and residential treatment have been utilized to address this issue. While some have been effective, many barriers exist that limit the number of youth who are able to utilize these treatments. Additionally, the effectiveness of these treatments does not typically generalize to the home environment. Telephone-based, intensive, behavioral-health interventions may address barriers to treatment access by providing lower cost treatment that is easier to access for youth who do not live near a knowledgeable behavioral-health specialist. Additionally, delivery via telephone enables the interventions to take place in the home. This, in combination with parental involvement in the treatment, may increase generalization of the positive treatment outcomes to the home environment. The purpose of this paper is to describe a controlled trial of a telehealth intervention for youth whose diabetes is poorly managed. Preliminary outcome data for the trial are promising. Representative cases from the trial are presented in case-study format.

Adolescent↗

PubMed2005

Validation of a behavioral health treatment outcome and assessment tool designed for naturalistic settings: The Treatment Outcome Package.

In 1994, the American Psychological Association and the Society for Psychotherapy Research convened a Core Battery Conference to develop a set of criteria for the selection of a universal core battery that could be used as a common outcome tool across all outcome studies. The Treatment Outcome Package (TOP) is a behavioral health assessment and outcome battery with modules for assessing a wide array of behavioral health symptoms and functioning, demographics, case-mix, and treatment satisfaction. It was developed to follow the design specifications set forth by the Core Battery Conference, but also to ensure the battery's applicability to naturalistic treatment settings in which randomization may be impossible. In this article we discuss a number of studies that evaluate the initial psychometrics of the items that comprise the mental health symptom and functional modules of the TOP. We conclude that the TOP has an excellent factor structure, good test-retest reliability, promising initial convergent and discriminant validity, measures the full range of pathology on each scale, and has some ability to distinguish between behavioral health clients and members of the general population.

Adult↗

PubMed2003

Association between job characteristics and health behaviors in Japanese rural workers.

Associations between job characteristics defined by the Karasek's job demand-control model and health behaviors were investigated in a cross-sectional analysis of 6,759 Japanese rural workers. High psychological demands were associated with heavy smoking, exaggerated prevalence of alcohol drinking, and high work-related physical activity. Low job control was associated with lower consumption of vegetables, a smaller quantity number of cigarettes smoked, and a low level of work-related physical activity. Job strain, a combined measure obtained from the ratio of demands to control, was associated with lower vegetable consumption, low prevalence of smoking, and high prevalence of current alcohol drinking. Stratified analyses by occupations and gender provided some but not all of the explanations for the unexpected findings. The results indicate a possible association between psychosocial job characteristics and health behaviors. A few unexpected findings prevent complete support to one of the hypothetical pathways that the job characteristics lead to cardiovascular disease through behaviors.

Adult↗

PubMed1991

Efficacy of a self-directed behavioral health change program: weight, body composition, cardiovascular fitness, blood pressure, health risk, and psychosocial mediating variables.

This study assessed the efficacy of a comprehensive behavioral health program designed to promote self-initiated change in overweight healthy middle-aged adults (M = 49 years). Three treatment groups (total n = 25) differing in type of social support provided (i.e., group plus professional versus group plus peer versus group only) received 13 treatment sessions and 6 maintenance sessions scheduled over a full year. A self-directed change intervention taught several cognitive-behavioral techniques as they applied to exercise adherence, weight reduction/maintenance, and stress management. Combined treatment groups (n = 25) improved significantly more than an assessment only control group (n = 9) in weight, percentage body fat, cardiovascular fitness, exercise adherence, health-risk appraisal, chronic tension (MBHI, scale A), and systolic and diastolic blood pressure at both post-treatment and 6-month follow-up assessments. Self-motivation, group treatment attendance, and health-risk appraisal significantly related (r's = .30-.56) to several posttreatment and follow-up measures of behavioral health change. No significant differences were found among the three treatment groups on any of the outcome measures.

Anxiety↗

PubMedDate not supplied

Life events and their impact on health attitudes and health behavior.

A representative sample of non-institutionalized elderly persons between 65 and 74 years living in Stockholm county, Sweden responded to a self-report health questionnaire. Special life events and their subsequent effects were examined in the context of health attitudes and health behavior. Of the 370 respondents, 128 reported experiencing a special life event. The resulting effects of life events were categorized into one of six groups: smoking, alcohol, diet, restricted mobility, existential circumstances and a miscellaneous group. Positive associations between life events and health attitudes and health behavior were discovered. This was particularly evident in the diet and the restricted mobility group. The findings suggest that the occurrence of life events and subsequent effects can contribute to health promotive behavior despite the potential worries, poor health and diseases which may also be associated with them.

Journal Article↗

PubMed1993

[A study of knowledge, attitude and health behavior toward tuberculosis among non-immigrant Korean people in Japan].

Knowledge, attitude and health behavior toward tuberculosis among Non-immigrant Korean people in Japan was researched by using questionnaire because of increasing the number of the tuberculosis patients among those group. The Korean member of protestant churches in Tokyo were subjects for the survey. Immigrant Korean people and their descendants were excluded. The questionnaire form was written in Korean language under the guidance of native Korean tuberculosis specialists. Proportion of Response was 53.1%, or 251 among 473 from 10th January to 30th June in 1992. The knowledge of tuberculosis among them was revealed to be higher than among ordinary native Korean people. It was different statistically by generation, namely, younger subjects aged less than 40 years old tended to answer that tuberculosis was a minor illness. The mass screening system in Japan was well known by the subjects, as shown by the fact that 72.4% of them answered that they knew about it. But only 56.6% of them replied that they actually took the mass screening. The source of its information was different statistically by sex, occupation, and generation. As for their health behavior, nearly two third (63.7%) of them visited the hospital or dispensary quickly when they fell sick. A small number of them answered that they could not visit a doctor because of their problems with the Japanese language. More than 80% of them possessed a National Health Insurance certificate. This proportion varied according to the period of stay in Japan. That is to say, The group which stayed in Japan less than one year was significantly the lowest because they were limited in their ability to enter National Health Insurance.

Adult↗

PubMed1987

Making childhood asthma management education happen in the community: translating health behavioral research into local programs.

The public health benefits of research can be realized only if proven new techniques are translated into readily usable processes and materials and widely adopted by professionals and patients alike. To accomplish this, a systematic technology transfer process is needed. One recent outcome of health behavior research has been identification of the skills needed by children and parents to effectively manage childhood asthma. Methods for teaching these skills were tested on hundreds of families in a variety of health care settings. They were then packaged in program manuals that guide health professionals through the teaching process and provide all necessary materials for conducting sessions. The resulting four programs teach attack prevention and control skills. They also emphasize coping skills and help families come to terms with the behavioral factors that impinge on asthma management and affect compliance with medical advice. A technology transfer project for getting initial community adoption of these programs is described. The evolution of the project, including the development of the programs themselves, packaging considerations, establishment of a unique partnership for dissemination, development of a model workshop for stimulating health professionals, implementation of programs, and follow up and evaluation, is described. Successful elements are identified at each step.

Asthma↗

PubMed2005

Referral by pediatricians of children with behavioral health disorders.

A standard interview guide focused on behavioral health referral practices and communication patterns was developed and administered to 47 pediatricians in private practice. Results suggested that the most frequent reasons for referral to a mental health provider were diagnostic uncertainty, failure to respond to treatment, presence of severe affective symptoms, and need for ongoing psychotherapy. Only a third of the providers indicated that their patients frequently followed through with recommendations to receive mental health care. More than half of the pediatricians wanted more information regarding their patients referred for mental health services, and they expressed a strong interest in colocation with a mental health provider.

Adolescent↗

PubMed2004

Improvements in heart health behaviors and reduction in coronary artery disease risk factors in urban teenaged girls through a school-based intervention: the PATH program.

OBJECTIVES: We sought to assess the effects of a school-based intervention program on cardiovascular disease risk factors in urban girls. METHODS: We compared heart health knowledge, health behaviors, cardiovascular risk factors, and physical fitness among a group of 442 multiethnic teenaged girls (310 experimental participants vs 132 control participants). Testing was conducted before and after a 12-week program of vigorous exercises integrated with lectures and discussions on diet, exercise, stress, and smoking. RESULTS: Significant differences in body fat, systolic and diastolic blood pressure, heart health knowledge, and whether breakfast was eaten were observed between experimental participants and control participants. CONCLUSIONS: An integrated program of exercise and heart health-related lectures and discussions had a beneficial effect on health knowledge, health behaviors, and onset of risk factors for coronary artery disease among urban girls.

Adolescent↗