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Health behaviors of school-age children: evidence from one large city.

Relatively little is known about risk behaviors of elementary school children. A recent evaluation of a comprehensive school health education curriculum provided an opportunity to survey elementary school children about their perceived health status, knowledge, attitudes, health self-efficacy, and health and risk behaviors. For the evaluation, a total of 4273 surveys were completed by 2 cohorts of school children, grades 2 and 4, in 24 schools in a large urban school district during the spring semesters of 2002; the cohorts were surveyed a second time when they were in third and fifth grade in spring 2003. Older children scored higher than younger ones on factors generally associated with improved health behaviors (such as health knowledge and refusal skills); yet, they scored lower than younger children on healthy behaviors, especially risk behaviors and those things presumed to be associated with later adolescent risk taking. The interrelationships among behavior, knowledge, age, and school-level attributes are explored. As health knowledge, refusal skills, and other protective factors increase, health behaviors improve slightly, but the most important factor in explaining health behaviors is grade level. This article points to the need to study the development of risk behaviors throughout elementary school and the need for additional work on the measurement of risk behaviors during the elementary school years.

Chicago↗

Experimental evidence for stages of health behavior change: the precaution adoption process model applied to home radon testing.

Hypotheses generated by the precaution adoption process model, a stage model of health behavior, were tested in the context of home radon testing. The specific idea tested was that the barriers impeding progress toward protective action change from stage to stage. An intervention describing a high risk of radon problems in study area homes was designed to encourage homeowners in the model's undecided stage to decide to test, and a low-effort, how-to-test intervention was designed to encourage homeowners in the decided-to-act stage to order test kits. Interventions were delivered in a factorial design that created conditions matched or mismatched to the recipient's stage (N = 1,897). Both movement to a stage closer to testing and purchase of radon test kits were assessed. As predicted, the risk treatment was relatively more effective in getting undecided people to decide to test than in getting decided-to-act people to order a test. Also supporting predictions, the low-effort intervention proved relatively more effective in getting decided-to-act people to order tests than in getting undecided people to decide to test.

Adult↗

The Massachusetts Behavioral Health Program year 5: transition to a new managed care organization.

Year 5 of the Massachusetts Behavioral Health Program was a transition to management by a new private managed care organization. Fifty-eight providers interviewed for an ongoing panel survey reported slightly lower levels of quality, access, utilization, and length of stay than a year earlier. Relationships with providers and advocates improved after an initial difficult period, while consumer and family involvement at all levels remained low. The greatest changes in managed care appeared to take place during the initial transition from fee-for-service care, but intractable problems continue, and full participation of stake-holders seems difficult to achieve.

Attitude of Health Personnel↗

[Health behavior and social inequality in the Swiss population. Results from the SOMIPOPS study (Sociomedical Model Indicators of the Population of Switzerland)].

In the context of the first representative Swiss national health survey, the relationship between social inequality and health behavior was assessed in 3419 Swiss citizens. Social inequality was measured by an indicator model including occupational position and education. Utilization of preventive services was better among women than men, a trend not dependent on social class. Women of lower social position and education used cervical screening services less often. Unskilled men made less use of preventive services offered. Health behavior was better in women than in men, independently of social class. Working women had significantly worse health attitudes than housewives. Among males, unskilled workers' and white collar employees' consumption of alcohol and tobacco was highest. In both sexes overweight was highly correlated with a low occupational position and low educational level.

Attitude to Health↗

Health behavior correlates among colon cancer survivors: NC STRIDES baseline results.

OBJECTIVE: To examine health behaviors (fruit/vegetable intake and physical activity) and their association with social cognitive theory (SCT) constructs among colorectal cancer (CRC) survivors (n=304) and comparable non-CRC-affected participants (n = 521). METHODS: Baseline data were analyzed bivariately and modeled with linear regression. Participants were 48% female, 36% African American (mean age = 67). RESULTS: Behaviors were comparable between groups, but survivors perceived more social support for behaviors (P <.05). Lack of employment was associated with greater frequency of healthy behaviors (P <.05) as were more modifiable factors including higher self-efficacy and lower barriers. CONCLUSIONS: SCT constructs were associated with behavior and may be targets for future interventions, but other variables may be important as well.

Adult↗

A managed behavioral health organization operated by an academic psychiatry department.

As a means of adapting to managed care, the psychiatry department at Wake Forest University developed a managed behavioral health organization (MBHO) to manage the care of enrollees in QualChoice, the health maintenance organization of the Wake Forest University Baptist Medical Center. Before the academic MBHO was created, care was managed by a for-profit MBHO. In this case study, financial and utilization data were obtained from both MBHOs and from QualChoice. The data confirm that the academic MBHO was able to offer competitive rates for its services. It also was able to increase enrollees' use of the medical center's own providers and facilities by making more referrals than were made by the for-profit MBHO. Developing a managed behavioral health organization can allow academic psychiatry departments, either individually or as consortia, to preserve the patient base they require for teaching, research, and financial stability.

Academic Medical Centers↗

Violence and associated high-risk health behavior in adolescents. Substance abuse, sexually transmitted diseases, and pregnancy of adolescents.

The intricate relationship between the social and health behaviors of persons of all ages has long been described. In adolescent health care, the risk-taking behaviors that are recognized in the areas of sexuality, drug and alcohol abuse, and violence need to be addressed. This article discusses adolescent risk behaviors and their relationships to violence. Health care providers need to consider these risk behaviors as they care for adolescents.

Adolescent↗

A sustainable behavioral health program integrated with public health primary care.

The need for behavioral healthcare for the poor and indigent is well documented in rural North Carolina, and integrated behavioral healthcare--that is, mental health screening and treatment offered as part of primary care services--has proven a very effective and efficient method to improve patients' health. In 2000, the Buncombe County Health Center (BCHC) began a grant-funded program treating depressed patients in its public health clinics and school health programs. The Health Center used the opportunity to send a team to the Management Academy for Public Health to learn business principles that could be applied to the challenge of sustaining this program as part of its ongoing public health service delivery for the county. Using their business plan from the Management Academy, the BCHC sought funding from various stakeholders, and, through their support, was able to institute a fully integrated behavioral health program in 2004. The BCHC has now joined forces with other partners in the state to address statewide policy changes in support of such programs. These efforts are an example of how a community health center can apply entrepreneurial thinking and strategic business planning to improve healthcare and effect wide-ranging change.

Behavioral Medicine↗

Changes in health behaviors of older adults: the San Diego Medicare Preventive Health Project.

BACKGROUND: This study presents behavioral outcomes at 1-year follow-up from a preventive services intervention trial with Medicare beneficiaries. METHODS: The health promotion package consisted of goal setting and counseling based on a health risk appraisal and a series of eight educational sessions. All subjects completed a health risk appraisal questionnaire immediately prior to the intervention and 1 year later; this served as the dependent measure. RESULTS: Results indicated that there were significant, positive changes in intervention subjects in activity level and selected nutrition behaviors relative to control subjects. The strengths and weaknesses of a broad-based approach to intervention are discussed.

Aged↗

Effect of the Heart At Work program on awareness of risk factors, self-efficacy, and health behaviors.

This study evaluates the effects of the American Heart Association's Heart At Work program on cardiovascular disease risk factor awareness, self-efficacy, and health behaviors. A prospective, quasi-experimental research design was used to assess the impact of the program at two factory sites (one intervention and one control). A total of 633 employees participated. Intervention site respondents significantly improved their knowledge of blood pressure management, the relationship between nutrition and cardiovascular disease, and heart attack risk factors. They also were more likely to begin treatment for hypertension, to report fewer sick days, and to have plans to improve their diet and lose weight. These findings suggest that the Heart At Work program had a favorable overall impact.

Adult↗

[Telephone versus face-to-face household interviews in the assessment of health behaviors and preventive practices].

OBJECTIVE: This study examines the influence of the interview method (telephone or face-to-face in households) on the assessment of health behaviors and preventive practices. MATERIAL AND METHOD: The same questionnaire was completed by two independent samples of the population aged 18-64 years living in the municipality of Madrid. One sample (n = 1,391 subjects) completed the questionnaire by telephone interview and the other (n = 739) by face-to-face interview in households. The results of the two samples for 28 variables related to anthropometry, physical activity, food consumption, tobacco and alcohol use, preventive practices and injuries were compared. RESULTS: The telephone sample had a higher rate of failed contact (31.8% vs. 22.2%) but a greater degree of cooperation than the sample for the face-to-face interview (83.0% vs. 74.0%). In total, 19 of the 28 variables showed a relative variation of less than 10% between the two surveys; the differences found were between 10 and 20% for eight variables and were higher than 20% for one variable. Differences were statistically significant for only four variables (sedentary leisure time, consumption of vegetables, giving up smoking and cholesterol measurement), with a relative variation of 6.1% (p < 0.01), 10% (p < 0.001), 36.7% (p < 0.01) and 8.6% (p < 0.01), respectively. The total cost of the telephone interview was half that of the face-to-face household interview. CONCLUSIONS: The results of both surveys were very similar. Because of its lower cost, the telephone interview is a good option in public health research when data collection by interview is required.

Adolescent↗

A randomized controlled trial of single versus multiple health behavior change: promoting physical activity and nutrition among adolescents.

Targeting multiple behaviors for change may provide significant health benefits. This study compared interventions targeting physical activity and nutrition (PAN) concurrently versus physical activity (PA) alone. Adolescents (N=138) were randomized to the PAN or PA intervention or control condition (n=46 per group). Primary outcomes were change in PA accelerometer and 3-day dietary recording from baseline to 3-month follow-up. The PAN and PA interventions were efficacious in supporting boys' (p<.001) but not girls' (p=.663) PA relative to the control condition. Dietary change was minimal. Although the findings do not reveal a decrement to PA promotion when a nutrition intervention was added, neither do they reveal any additional benefit. More studies comparing single versus multibehavioral interventions are needed.

Body Mass Index↗

Are current health behavioral change models helpful in guiding prevention of weight gain efforts?

Effective procedures are needed to prevent the substantial increases in adiposity that have been occurring among children and adults. Behavioral change may occur as a result of changes in variables that mediate interventions. These mediating variables have typically come from the theories or models used to understand behavior. Seven categories of theories and models are reviewed to define the concepts and to identify the motivational mechanism(s), the resources that a person needs for change, the processes by which behavioral change is likely to occur, and the procedures necessary to promote change. Although each model has something to offer obesity prevention, the early promise can be achieved only with substantial additional research in which these models are applied to diet and physical activity in regard to obesity. The most promising avenues for such research seem to be using the latest variants of the Theory of Planned Behavior and Social Ecology. Synergy may be achieved by taking the most promising concepts from each model and integrating them for use with specific populations. Biology-based steps in an eating or physical activity event are identified, and research issues are suggested to integrate behavioral and biological approaches to understanding eating and physical activity behaviors. Social marketing procedures have much to offer in terms of organizing and strategizing behavioral change programs to incorporate these theoretical ideas. More research is needed to assess the true potential for these models to contribute to our understanding of obesity-related diet and physical activity practices, and in turn, to obesity prevention.

Choice Behavior↗

[Life style and health behavior of southern European and North African immigrants in France].

Using data from a French national survey, preventive and dietary habits, alcohol and smoking consumption of three groups of migrants (Italy, Spain and Portugal, Maghreb) were compared to those of French nationals. Odds ratios were estimated using a logistic regression, after adjustment by age, socio-professional group and place of residence. Differences in attitude were observed, in particular: lower primary and secondary practice of prevention; lower consumption of meat and dairy products and higher consumption of starchy food and dried vegetables; lower consumption of alcohol and higher tobacco intake among Maghrebian migrants. The observed differences were interpreted in the light of other available data in France. They confirm notably imported dietary habits and a weaker perception of preventive messages, as shown in other studies.

Adolescent↗