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PubMed1997

Managed behavioral health care: a key component of integrated regional delivery systems.

Managed behavioral health care is a key component of integrated regional delivery systems. Mental health and chemical dependency services are of growing importance in developing insurance programs and establishing health systems. Primary features include full involvement of the medical community, development of a free-standing organization, joint ventures with existing entities, and effective contract negotiations.

Academic Medical Centers↗

PubMed2002

Hand-held devices ease burden of behavioral health assessment.

Numerous studies show that people suffering from depression and other behavioral health disorders are among the highest utilizers of care, but primary care physicians often miss behavioral diagnoses because they don't have the time to administer and analyze effective screens for these conditions. To ease this burden, a Denver, CO-based company has developed an approach that takes advantage of a hand-held device and an array of quick evidence-based screens that can point providers in the right direction in a matter of minutes.

Behavior Therapy↗

PubMed1994

Relation of the content of prenatal care to the risk of low birth weight. Maternal reports of health behavior advice and initial prenatal care procedures.

OBJECTIVE: Numerous studies have found a relationship between the quantity of prenatal care received and birth outcomes. Few studies have had the opportunity to examine the content of prenatal care. This study examined the relationship between two components of the content of prenatal care: maternal reports of health behavior advice received and initial prenatal care procedures performed during the first two visits and low birth weight in a national sample of women. Advice and initial procedures were categorized based on the recommendations of the US Public Health Service Expert Panel on the Content of Prenatal Care. DESIGN: Interview survey of a nationally representative sample of women who had live births in 1988. PARTICIPANTS: A total of 9394 women, with data from the National Maternal and Infant Health Survey. MAIN OUTCOME MEASURE: Low birth weight (< 2500 g) as reported on the birth certificate. RESULTS: After controlling for other sociodemographic, utilization, medical, and behavioral factors, women who reported not receiving all the types of advice recommended by the Expert Panel on the Content of Prenatal Care were more likely to have a low-birth-weight infant compared with women who reported receiving the optimal level of advice (odds ratio = 1.38; 95% confidence interval, 1.18 to 1.60). There were no differences between women who reported receiving all the recommended initial prenatal care procedures and those who reported not receiving all recommended prenatal care (odds ratio = 1.00; 95% confidence interval, 0.87 to 1.14). CONCLUSION: These data suggest that women who report receiving sufficient health behavior advice as part of their prenatal care are at lower risk of delivering a low-birth-weight infant.

Female↗

PubMed1991

Mental health, stress, and poor health behaviors in two community samples.

BACKGROUND: The relationships of obesity, smoking, drinking, and lack of exercise to mental health and stress were evaluated in separate community samples of men and women. RESULTS: Among men, the only significant positive relationship was between history of depression and smoking. Among women, four psychosocial factors were associated with smoking: history of depression, increased marital conflict, greater number of undesirable life events, and full-time employment. Depression and marital conflict were also associated with higher drinking levels, and full-time employment was associated with lack of exercise. History of emotional disorders was not found to exacerbate the effects of stress on poor health behaviors. However, some combinations of stress were detrimental. Among men, the joint effect of high job demands and low decision latitude was significantly associated with a greater likelihood of smoking. Among women, the interaction of full-time employment and greater marital conflict was associated with increased alcohol use. CONCLUSION: These results emphasize the importance of considering gender-specific risk factors in the design of intervention programs.

Alcohol Drinking↗

PubMedDate not supplied

Costs and incentives in a behavioral health carve-out.

A carve-out of mental health and substance abuse services initiated in 1993 by the Group Insurance Commission (GIC) of the Commonwealth of Massachusetts resulted in changes in the costs of those services. Those changes were related to incentives in the contract between the GIC and its managed behavioral health vendor. Total and plan costs were reduced by 30-40 percent after adjusting for trends. Incentives to produce savings of this magnitude not only were a consequence of the payer/vendor contract but, we speculate, derive from the growth potential facing companies in the managed behavioral health care market.

Contract Services↗

PubMed2003

Health behaviors and quality of care among Latinos with diabetes in managed care.

OBJECTIVES: We evaluated whether ethnicity and language are associated with diabetes care for Latinos in managed care. METHODS: Using data from 4685 individuals in the Translating Research Into Action for Diabetes (TRIAD) Study, a multicenter study of diabetes care in managed care, we constructed multivariate regression models to compare health behaviors, processes of care, and intermediate outcomes for Whites and English- and Spanish-speaking Latinos. RESULTS: Latinos had lower rates of self-monitoring of blood glucose and worse glycemic control than did Whites, higher rates of foot self-care and dilated-eye examinations, and comparable rates of other processes and intermediate outcomes of care. CONCLUSIONS: Although self-management and quality of care are comparable for Latinos and Whites with diabetes, important ethnic disparities persist in the managed care settings studied.

Adult↗

PubMed2006

Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males.

PURPOSE: This study addresses the question, "Does body satisfaction matter?" by examining longitudinal associations between body satisfaction and weight-related health-promoting and health-compromising behaviors five years later among adolescents. METHODS: Project EAT-II followed an ethnically and socioeconomically diverse sample of 2516 adolescents from 1999 (Time 1) to 2004 (Time 2). Associations between body satisfaction at Time 1 and health behaviors at Time 2 were examined, adjusting for sociodemographic characteristics and Time 1 health behaviors, with and without adjustment for body mass index (BMI). RESULTS: In females, lower body satisfaction predicted higher levels of dieting, unhealthy and very unhealthy weight control behaviors and binge eating, and lower levels of physical activity and fruit and vegetable intake. After adjusting for BMI, associations between body satisfaction and dieting, very unhealthy weight control behaviors, and physical activity remained statistically significant. In males, lower body satisfaction predicted higher levels of dieting, healthy, unhealthy, and very unhealthy weight control behaviors, binge eating, and smoking, and lower levels of physical activity. After adjusting for BMI, associations between body satisfaction and dieting, unhealthy weight control behavior, and binge eating remained statistically significant. CONCLUSIONS: The study findings indicate that, in general, lower body satisfaction does not serve as a motivator for engaging in healthy weight management behaviors, but rather predicts the use of behaviors that may place adolescents at risk for weight gain and poorer overall health. Interventions with adolescents should strive to enhance body satisfaction and avoid messages likely to lead to decreases in body satisfaction.

Adolescent↗

PubMed2003

Performance measures and their benchmarks for assessing organizational cultural competency in behavioral health care service delivery.

A project is described in which performance measures of cultural competency in behavioral health care were selected and benchmarked. Input from an Expert Panel representing the four major ethnic and racial groups in the U.S. and persons with extensive experience in implementing cultural competency in health care, along with survey data from 21 sites were used in the process. Measures and benchmarks are made specific to organizations that administrate care networks, and to service entities that deliver care. Measures were selected to parallel an implementation process, and benchmarks were set at "gold standard" levels.

Attitude of Health Personnel↗

PubMed1998

Gender, health beliefs, health behaviors, and alcohol consumption.

We conducted a study of the relationship between health beliefs, health practices, and alcohol consumption among women and men using the Health Belief Model (HBM). The study sample (N = 41,104) was drawn from the 1990 National Health Interview Survey. A 15% random sample was selected from the total data set for the purpose of selecting variables. Alcohol consumption was defined as a health-related behavior and was regressed on demographic characteristics, health beliefs, and health practices. Quantity and frequency of alcohol consumption were assessed for each gender, using the HBM. The HBM explained similar amounts of the variance in alcohol use for women and men. Quantity of alcohol consumed accounted for more variance than did frequency of consumption. We conclude that health beliefs and behaviors are related to alcohol consumption after adjustment for demographic characteristics, and that differences exist between perceived risks and behaviors for both women and men.

Adult↗

PubMed2006

Experiences of beginning health educators and changes in their high school students' health behaviors and attitudes.

This study explored the instructional experiences of beginning health educators and changes in their high school students' health-related behaviors and attitudes. Qualitative data were collected through observations and personal interviews from five novice health teachers two times per week over an 8-week period. Quantitative data were collected from 92 high school student participants using a 60-item survey with a pretest/posttest administration. Dependent t tests were calculated to detect mean differences between total sample pretest and posttest scores with a significance level, where p < .05. Mean raw scores were calculated in 12 health categories to detect differences between pretest and posttest scores for each of the five individual health classes. A deeper understanding of beginning health teachers' practices, thoughts, and potential effectiveness offered insight into the interplay between teaching, learning, and health. The contribution to the enhancement of professional teacher preparation programs is provided.

Adolescent↗

PubMed2004

Coping after cancer: risk perceptions, worry, and health behaviors among colorectal cancer survivors.

This study asks whether the experience of cancer motivates healthy behavior change. Further, we asked whether such changes relate to risk perceptions and worry, as suggested by Leventhal's Parallel Processing Model. Male (n=41) and female (n=40) survivors of colorectal cancer were interviewed 1-14 years after they first completed treatment. Younger age was associated with stronger risk perceptions, more worry, and greater anxiety. Shorter-term, compared to longer-term survivors, reported higher risk perceptions and more frequent intrusive thoughts. Greater perceived risk, worry and anxiety correlated positively with intentions to make positive health behavior changes. Overall, these survivors did not report exaggerated risk perceptions, and they were not overly worried or anxious about cancer recurrence. However, low-level risk perceptions, worry, and anxiety motivated interest in adopting protective health behaviors.

Adaptation, Psychological↗

PubMedDate not supplied

Changing patterns in health behaviors and risk factors related to chronic diseases, 1990-2000.

PURPOSE: Assess changes in chronic disease-related health behaviors and risk factors from 1990 to 2000, by race/ethnicity, age, and gender. DESIGN: Stratified cross-sectional design. SETTING: United States. SUBJECTS: 16,948 black, 11,956 Hispanic, and 158,707 white women and men, ages 18 to 74. MEASURES: Cigarette smoking, obesity, sedentary behavior, low vegetable or fruit intake. From the Behavioral Risk Factor Surveillance System. RESULTS: Young women and men, ages 18 to 24, had poor health profiles and experienced adverse changes from 1990 to 2000. After the variables were adjusted for education and income, these young people had the highest prevalence of smoking (34%-36% current smokers among white women and men), the largest increases in smoking (10%-12% increase among white women and men; 9% increase among Hispanic women), and large increases in obesity (4%-9% increase, all gender and racial/ethnic groups). Young women and men from each racial/ethnic group also had high levels of sedentary behavior (approximately 20%-30%) and low vegetable or fruit intake (approximately 35%-50%). In contrast, older Hispanic women and men and older black men, ages 65 to 74, showed some of the most positive changes. They had the largest decreases in smoking (Hispanic women), largest decreases in sedentary behavior (Hispanic women and black men), and largest increases in vegetable or fruit intake (Hispanic women and men, and black men). CONCLUSION: The poor and worsening health profile of young women and men is a particular concern, as they will soon enter the ages of high chronic disease burden.

Adolescent↗

PubMed1986

The interaction model of client health behavior: application to the study of community-based elders.

The Interaction Model of Client Health Behavior (IMCHB) was used to direct a systematic and comprehensive description of community-based elders. The abstract concepts, constructs, factors, and variables described by one element of the model were able to account for 54% of the variance in elders' health status and 47% of the variance in their well-being. The model, as operationalized in this study, pointed to clear demographic, social, and health profiles that identified the elder at risk for decreased health, well-being, and self-care potential. The IMCHB would appear to be a useful framework with which to establish an empirical base on which nursing interventions could be developed.

Aged↗

PubMed2006

Community-based prevention marketing: organizing a community for health behavior intervention.

This article describes the application and refinement of community-based prevention marketing (CBPM), an example of community-based participatory research that blends social marketing theories and techniques and community organization principles to guide voluntary health behavior change. The Florida Prevention Research Center has worked with a community coalition in Sarasota County, Florida to define locally important health problems and issues and to develop responsive health-promotion interventions. The CBPM framework has evolved as academic and community-based researchers have gained experience applying it. Community boards can use marketing principles to design evidence-based strategies for addressing local public health concerns. Based on 6 years of experience with the "Believe in All Your Possibilities" program, lessons learned that have led to revision and improvement of the CBPM framework are described.

Adolescent↗

PubMed2000

Protecting the public interest: issues in contracting managed behavioral health care.

In recent years, state governments have begun contracting out behavioral health care to large managed for-profit organizations. This approach to mental health service delivery has resulted in realignment in roles for both state agencies and the managed care organizations. Overnight, state agencies have been transformed into contract managers of multi-million dollar capitated health plans. Managed care companies, in turn, moving into the public-sector market must adjust their service delivery to include key concepts of public interest involvement such as consumer input, public comment, and outreach. This article analyzes three public-sector transitions. Common issues in these transformations are used as a springboard for identifying key concerns which states need to monitor when developing managed care contracts.

Arizona↗

PubMed2005

Oral health-related knowledge, attitudes, and beliefs among 11 to 12-year-old Finnish schoolchildren with different oral health behaviors.

The aim of this study was to explore oral health-related knowledge, attitudes, and beliefs among 11 to 12-year-old schoolchildren with favorable, moderate, or poor behavior related to oral health. The data were gathered by questionnaire. Recommendations commonly used in Finland in oral health education were chosen as the criteria for selection of groups of children with favorable, moderate, and poor oral health behavior. Differences between groups were analyzed using crosstabulations and factors related to unfavorable behavior using logistic regression analysis. The percentage of children with appropriate knowledge was higher in the good behavior group (GB) than in the other groups. The groups differed most in the children's knowledge of the recommendation to use fluoride toothpaste at least twice a day. Most children in the GB group considered it important to brush their teeth for the fresh feeling this gave. The majority of children in all groups considered it important to brush their teeth when going to the dentist. The majority also considered brushing important for avoiding tooth decay and tooth discoloration as well as for having fresh breath. Unfavorable knowledge, attitudes, beliefs, and behavior tended to accumulate in the same children. Factors associated with unfavorable behavior were male sex, mother's low skill occupation level, and child's poor knowledge of oral health-related facts.

Attitude to Health↗

PubMed2003

Optimism and life satisfaction as determinants for dental and general health behavior-oral health habits linked to cardiovascular risk factors.

Oral infections and cardiovascular diseases share common biological and behavioral risk factors. Psychosocial determinants could act as a link between general health behavior and dental health behavior. Our objective was to study optimism and life satisfaction as determinants of general and dental health behavior and to evaluate whether these are connected with cardiovascular risk factors and dental diseases. The 1966 Northern Finland Birth Cohort (N = 12,058) is a general population birth cohort. In a postal questionnaire, respondents (N = 8690) were asked about their health behavior and dental status. Cardiovascular risk factors were assessed in health examinations (N = 6033). Generalized linear regression models were used in analysis. The results showed that health orientation increases with strengthening life satisfaction and optimism. Dental health behavior and general health behavior were associated with both cardiovascular risk factors and self-reported dental diseases, which support the assumption that they share a common behavioral background.

Adult↗

PubMedDate not supplied

Stage of change movement across three health behaviors: the role of self-efficacy.

PURPOSE: In this study, we examined the influence of self-efficacy in predicting stage of change (SOC) movement, without intervention, over a 1-month period for smoking cessation, exercise adoption, and dietary fat reduction. DESIGN: The design of this study was longitudinal. Patients' stage of change and self-efficacy were assessed at baseline, and stage of change was reassessed at a 1-month follow-up. Patients were categorized as (1) Regressors (moved backward at least one stage), (2) Stables (no change), or (3) Progressors (moved forward at least one stage). Chi-square analyses were used to determine the ability of self-efficacy to predict stage movement at 1-month follow-up. SETTING: The data were collected at a large, inner city, academic hospital in the southeastern United States. Patients were attending primary care clinics. SUBJECTS: Five hundred fifty-four low income, predominantly African-American, individuals attending primary care clinics were participants in the study. MEASURES: Previously validated scales of stage of change and self-efficacy from Prochaska's laboratory were used in this study. RESULTS: Results showed statistically significant differences between predicted and actual SOC movement for smoking cessation, exercise adoption, and dietary fat intake reduction. Baseline self-efficacy ratings were significantly related to stage progression, regression, and stability of stage of change for all three health behaviors. Thirty-seven percent of smokers who were predicted to progress on the basis of their self-efficacy scores progressed. For exercise adoption and dietary fat reduction, 50% and 44%, respectively, of individuals expected to progress at least one stage on the basis of self-efficacy scores progressed. CONCLUSION: Self-efficacy influences SOC movement for smoking cessation, dietary fat reduction, and exercise adoption.

Adult↗