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The role of acculturation in explaining ethnic differences in the prenatal health-risk behaviors, mental health, and parenting beliefs of Mexican American and European American at-risk women.

OBJECTIVE: To assess: (1) ethnic differences in the health-risk behaviors, mental health problems, and adverse parenting beliefs during pregnancy of low-income Mexican American and European American women; and, (2) the extent to which these risks varied with levels of acculturation among low-income Mexican American women. METHOD: Participants were 594 primiparous, low-income, urban women. A cross-sectional design was used to compare the 331 Mexican American women to the 263 European American. Language was used to assess the level of acculturation of the Mexican American women. Interviews were used to evaluate health-risk behaviors, mental health problems, and adverse parenting beliefs. RESULTS: In comparison to European American women, Mexican American women were at lower risk for cigarette smoking during pregnancy and higher risk for adverse parenting beliefs. Among Mexican American women, Spanish speakers were at lower risk for cigarette smoking and mental health problems during pregnancy, and higher risk for adverse parenting beliefs than bilingual and English speakers. CONCLUSIONS: The findings indicate that ethnic differences in cigarette smoking and parenting beliefs during pregnancy were concentrated on the less acculturated, low-income, and primarily unmarried Spanish speaking Mexican American women. Moreover, acculturation is differentially related to cigarette smoking and parenting beliefs. Therefore, acculturation needs to be considered in the development of preventive interventions in order to appropriately target the specific needs of different sub-populations of Mexican Americans.

Acculturation↗

Factors related to the health knowledge and health behavior of disadvantaged black youth.

The purpose of this study was to investigate the relationship between various factors and the health knowledge and health behavior of disadvantaged black youth. Disadvantaged black male and female youths, age 12 to 17, were surveyed regarding their health knowledge, health locus of control, and health practices. Results of the data analyses using an ANOVA revealed significant differences for scores on the health knowledge test due to sex, age, and health locus of control. Females had higher test means than males, older students had higher knowledge scores than did younger students, and internally-oriented students had higher knowledge scores than did externally-oriented students. No significant interaction was found. An ANOVA on behavior scores revealed a sex by locus of control interaction. Male externals had much lower behavior scores than female externals. A significant interaction also was found between age and health locus of control. Older externals had significantly higher behavior scores than younger externals. Implications for health educators and nurse educators are discussed.

Adolescent↗

Knowledge, perceptions and health behavior pertaining to Schistosoma mansoni related illness in Machakos district, Kenya.

This study on indigenous knowledge, preferences and health behavior among households and traditional healers in an area endemic Schistosomiasis mansoni in central Kenya showed that the population used modern and traditional health services interchangeably for intestinal illness with similar results. Cultural, economic and social factors in the utilization of different health services were identified. Antischistosomal treatment in the study population resulted in higher cure rates than those observed either hospital and health center treatment or the use of herbal medicines. Kamba knowledge and perceptions of the causes of water related intestinal illness, several types of preventive behavior and the role of women as health promoters are evaluated. The utilization of these observations in schistosomiasis control programs using the primary health care approach was discussed.

Adolescent↗

The Millon Behavioral Health Inventory: concurrent and predictive validity in a pain treatment center.

The Millon Behavioral Health Inventory (MBHI) is one of only a few diagnostic instruments designed specifically for psychological evaluations of medical patients. However, despite being available for clinical use for several years, there are virtually no published research evaluations of this inventory. The present study evaluated the MBHI in light of Minnesota Multiphasic Personality Inventory (MMPI) and Beck Depression Inventory (BDI) scores and treatment outcomes of 52 chronic pain patients. MBHI scales were highly correlated with admission and denial of psychopathology, as well as emotional distress, but had little relationship to Hs and Hy of the MMPI. The Pain Treatment Responsivity scale (PP), Allergic Inclination scale (MM), and MMPI D scale predicted the outcome of pain treatment at comparable levels. The specificity of the MBHI scales seems questionable in that 10 of 19 intercorrelations between PP and other MBHI scales were between 0.70 and 0.86. A stepwise regression procedure did not select PP among MBHI variables used to predict treatment outcomes. Results were interpreted as supporting cautious clinical use with pain patients until further research has been carried out.

Adult↗

Schizophrenia, co-occurring substance use disorders and quality of care: the differential effect of a managed behavioral health care carve-out.

This study explores the differential effect of a managed behavioral health Carve-Out (CO) on outpatient treatment quality for persons with schizophrenia (SCHZ) alone and co-occurring substance use disorders (SUD) (SCHZ+SUD). We used claims data from a state Medicaid program and employed a retrospective, quasi-experimental design with logit and difference in difference formula regression models. The results show the CO was associated with greater changes in treatment quality for the SCHZ population, compared to the SCHZ+SUD population. Most pronounced across both populations were decrements in receiving the psychosocial treatments for enrollees in the CO arrangement.

Adult↗

New tools help behavioral health providers boost quality while documenting value.

One California-based provider of behavioral health services was in that position until it implemented a system that not only documents the progress of treatment for payers, but also helps the organization provide better care by supplying continuous updates on patient status. The system uses two research-based tools that look at critical triggers as well as a patient's overall level of distress. See how implementation of this innovative approach has facilitated provider/payer discussions while fueling quality improvement.

Algorithms↗

[Health beliefs and health behavior in older employees of medium-size and large enterprises].

BACKGROUND: In view of the aging process in our population there is a need to identify effective methods to prevent disadvantageous effects of this trend. In this paper the state of particular health-related behaviors and elements of health awareness among retirement-approaching employees are presented as a basis for developing efficient health promotion programs for this age group. MATERIALS AND METHODS: The data presented in this paper have been gathered during the study conducted on a random sample of 1138 employees of two 25-35 and 45-55 age groups. The study was carried out in the form of a questionnaire-based interview. RESULTS: There is no significant difference between older and younger employees with regard to their attitude towards one's own health. There are two major problems common to both age groups, the lack of awareness of very close relationship between everyday behavior and health, and a low locus of control manifested by finding excuse for health negligence in numerous problems faced each day or lack of strong will. The most specific feature in older workers is that they concentrate their health-related thinking and acting on the use of services provided by medical specialists. CONCLUSIONS: There are no sound grounds to justify the development of health promotion programs addressed only to older employees. The effective solution to this problem could be the introduction of workplace health promotion programs focused on enhancing the workers' sense of responsibility for their health and on developing skills to shape conditions favorable to health conducive behaviors.

Adult↗

[Health status, health behavior and attitudes of young Geneva adults].

This study was aimed at assessing the health status, health-related life-styles and health concerns among young urban adults, 41% of them university students. Two mailed surveys were conducted in Geneva (Switzerland), in 1992 among 1007 persons and in 1993 among 1424 persons. Participation rates were over 80%. Study participants were aged 18-45 (mean age 31 years in 1993). For most health status dimensions, men declared to be healthier than women. Mental health-related concerns were frequent, especially among university students. Prevalence of health-related life-styles were: smoking 39%, drinking-and-driving at least once in past year 18%, always wear a seat belt 35%, had several sexual partners in past year but did not always use condoms 11%, exercise each week 46%. The more educated persons had healthier life styles, for all aspects except for unprotected sex with several sexual partners. These results are worrying and call for more active prevention strategies, directed at mental health problems, use of seat belts, drinking-and-driving, smoking and sexually transmitted diseases.

Adolescent↗

Understanding health behavior change among couples: an interdependence and communal coping approach.

Marriage is a ubiquitous social status that consistently is linked to health. Despite this, there has been very little theory development or related research on the extent to which couple members are jointly motivated to and actively engage in health-enhancing behaviors. In this paper we propose an integrative model, based on interdependence theory and communal coping perspectives, that explicitly considers dyadic processes as determinants of couple behavior. Our integrated model applies these constructs to consider how couple dynamics might influence adoption of risk-reducing health habits. Accordingly, we suggest that the couple's interdependence can transform motivation from doing what is in the best interest of the self (person-centered), to doing even selfless actions that are best for the continuation of the relationship (relationship-centered). In turn, this transformation can lead to enhanced motivation for the couple to cope communally or act cooperatively in adopting health-enhancing behavior change. Implications for research related to couples and health behavior change are also highlighted.

Adaptation, Psychological↗

Behavioral health: setting the rural health research agenda.

This article seeks to identify current research priorities in the area of rural behavioral health. The method for accomplishing this task begins by identifying several domains where policy has a potential to effect improvements in access or quality but has been hampered by lack of empirical knowledge. In each domain a synthesis of current research summarizes what is known and draws attention to knowledge gaps. Research questions in each domain are proposed. The policy domains are theoretically based, using a conceptual model of access to health care, with a focus on illness level (prevalence), enabling factors (the delivery system, organization and financing, the promise of telemedicine), and predisposing factors (special populations, beliefs, values, stigma).

Behavioral Medicine↗

Husbands' and wives' reports of women's decision-making power in Western Guatemala and their effects on preventive health behaviors.

Surveys have attempted to measure married women's decision-making power by asking women who has a say and/or final say in a number of household decisions. In several studies where the same questions were posed to husbands, considerable discrepancies in reports were found. This paper assesses husband and wife reports of decision-making on four matters (whether or not to buy household items; what to do if a child becomes ill; whether or not to buy medicine for a family member who is ill; what to do if a pregnant women becomes very ill) and the relationship of these reports to three recent health behaviors (having an emergency plan during pregnancy; delivering in a health facility; having a postpartum checkup within 4 weeks). A sample of 1000 women in 53 communities in three departments of western Guatemala was selected using a stratified random sampling approach. A standard household questionnaire was used to identify the respondents as well as to obtain data on household characteristics. Husbands of interviewed women were interviewed in every other household giving information on 546 couples for this analysis. Women and men's questionnaires were similar and were designed to obtain information on the respondent's knowledge, attitudes and behaviors regarding maternal health. Consistent with other research, results show that relative to their husbands' report, wives tend to under-report their household decision-making power. In couples with both partners educated and in couples in which women work for pay, both partners were significantly more likely to report that both of them participate in the final decisions than was the case in couples without education or in which the wife did not work for pay. Women's reports of their decision-making power was significantly related to the household having a plan for what to do in case of a maternal emergency, but was not associated with place of childbirth or with having a postpartum checkup, while husband's reports of the wife's decision-making power was negatively associated with the likelihood of having the last birth in a health facility.

Adult↗

A test of the psychosocial vulnerability and health behavior models of hostility: results from an 11-year follow-up study of Mexican Americans.

Previous research has shown that interpersonal conflict and depression are cross-sectionally associated with hostility. Our objective was to determine whether hostility is longitudinally predictive of interpersonal distress and depression and to replicate previous research that suggests that hostility is a risk factor for other health behaviors (e.g., smoking and excessive alcohol use) and psychosocial health problems. We use data from the youngest generation of a three-generation, 11-year follow-up study of Mexican Americans, that represent 251 Mexican Americans between the ages of 18 and 42 years. Our indicator of hostility was the irritability subscale from the Buss-Durkee Hostility Inventory. After statistically controlling for marital status, language acculturation, education, age, and sex, irritability was found to predict subsequent heavy drinking, somatic symptoms associated with depression, psychosomatic symptoms, infectious disease, divorce, marital separation, ending a serious nonmarital relationship, not being married at the follow-up, and more negative feelings associated with divorce, marital separation, and ending a serious relationship. Our research supports theory and research suggesting that hostility is predictive of physical symptoms, poor health habits, and interpersonal conflict.

Adolescent↗

Smoking, health behavior, and value priorities.

In a postal survey, 113 respondents completed the Rokeach terminal value survey with the additional value, health, and questions regarding their preventive health behavior. Analyses showed that lighter nonsmokers displayed better preventive behavior than heavier smokers. Lighter nonsmokers also reported valuing health more than heavier smokers reported, and were oriented toward safety and inner-directedness compared with heavier smokers who were oriented toward satisfaction and outer-directedness. The preventive behavior of lighter nonsmokers increased with the value of social goals while the preventive behavior of heavier smokers was related to personal goals. These results are considered in the context of previous research which suggested that smokers and nonsmokers may have different value priorities. The implications of these findings for health education are discussed.

Adult↗

Hostility and health behaviors in young adults: the CARDIA Study. Coronary Artery Risk Development in Young Adults Study.

Hostility has been associated with coronary heart disease mortality. To assess possible mechanisms linking hostility to coronary heart disease risk, the authors conducted analyses in a cross-sectional study from data collected in 1985 and 1986 on 5,115 young adults, aged 18-30 years, black and white, male and female, in four large urban areas of the United States. The results show that higher levels of hostility as determined by the Cook-Medley Hostility Scale were strongly associated with tobacco and marijuana smoking, increased alcohol consumption, and greater caloric intake in both blacks and whites and in both men and women. The increased caloric consumption was evident in the higher waist/hip ratios, particularly in men (p less than 0.05). The associations were particularly strong (p less than 0.001) for tobacco cigarette smoking and marijuana smoking, with roughly a 1.5 times higher prevalence in the top hostility quartile compared with the bottom quartile after adjusting for age and education. Hostility levels were not related to the percentage of calories from fat or from sucrose intake, to plasma cholesterol levels, or to physical fitness (except for a weak association in the latter in white women). The results describe relations between hostility and health behaviors that may be detrimental to health. The findings provide a possible explanation for the association between hostility and coronary heart disease mortality.

Adolescent↗

Effectiveness of follow-up booster sessions in improving physical status after cardiac rehabilitation: health, behavioral, and clinical outcomes.

There is limited research on booster interventions designed to maintain/improve health outcomes following cardiac rehabilitation (CR). The purpose of this study was to examine the effects of a booster intervention on health, behavioral, and clinical physical status outcomes among CR graduates randomly assigned to one of three groups: structured educational/counseling sessions by telephone ( n = 24), clinic ( n = 20), or usual care ( n = 20). The sessions were provided at 3 and 9 weeks following Phase II CR. A repeated measures experimental design was used to examine outcomes at baseline (completion of CR) and at 3 and 6 months. Although the effects of the booster interventions were not significant, there was evidence to suggest that a booster intervention, compared with usual care, had a positive effect on patients' physical functioning, adherence to the exercise program, frequency of exercise, heart rate, and blood pressure.

Adult↗