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Adverse health behaviors and chronic conditions in working-age women with disabilities.

This retrospective, cross-sectional, multiple cohort study of women with disabilities addresses two health-related areas in a nationally representative sample of women living in the community. Using data from the 1997-1998 National Health Interview Survey (NHIS), health risk behaviors and chronic conditions were examined for women with mild, moderate, and severe functional limitations, and their responses were compared to those of women who reported no limitations. Women with severe limitations evidenced the highest risk for heavy cigarette smoking. They were also more likely to meet the Body Mass Index criterion for obesity. Adverse health behaviors were strongly associated with the five potentially disabling chronic conditions that were studied.

Activities of Daily Living↗

Prospective study of pneumonia hospitalizations and mortality of U.S. older people: the role of chronic conditions, health behaviors, and nutritional status.

Mortality and hospitalization rates for pneumonia have increased among older Americans during recent years (1979-86), despite a national commitment to the reduction of premature deaths from pneumonia. A prospective study of deaths and hospitalizations attributable to pneumonia was conducted among 5,474 subjects ages 55 and older who participated in the NHANES I Epidemiologic Followup Study. Prevalent chronic conditions, health behaviors, and nutritional status indicators, measured at baseline, were examined in relation to pneumonia hospitalization and death during 12 years of followup. Mortality and hospitalization rates for pneumonia were higher among men than women, and higher among those ages 65 and older than among those 55-64 of both sexes. Risk of pneumonia death was higher among subjects with a history of congestive heart failure, stroke, cancer, or diabetes. Risk of pneumonia hospitalization was higher among subjects with a history of chronic obstructive pulmonary disease and among men who were current smokers. Daily alcohol consumption did not increase risk of pneumonia in this study population. Four measures of nutritional status were examined taking age, prevalent chronic conditions, and cigarette smoking into account: body mass index, arm muscle area, and serum albumin and hemoglobin levels. Risk of pneumonia death was 2.6 times higher in men in the lowest quartile, compared with men in the highest quartile, of body mass index. Similarly, the risk was 4.5 times higher among men in the lowest quartile of arm muscle area. Risk of death from pneumonia was 3.6 times higher among women in the lowest quartile of serum albumin levels compared with women in the highest quartile. Relative risks for these nutritional status indicators remained elevated after adjusting for age and the medical history risk factors. These risk factors should be taken into account when designing and evaluating pneumonia vaccination trials and community prevention programs.

Adult↗

AIDS, empire, and public health behaviorism.

Much of the current health approach to designing HIV/AIDS interventions in resource-poor settings involves behavior-change initiatives, particularly those adopting education-based and "culturally competent" frameworks for the reduction of HIV-associated "risk behaviors." This article reviews the evidence and social assumptions behind this approach to preventing HIV transmission, and argues that these approaches are often inadequate or misguided, particularly in their conflation of the concept of "culture" with social circumstances. By analyzing the socioeconomic circumstances that constrain individual agency, and by combining data from prevention literature with analyses of international trade agreements and the controversies over antiretroviral drug distribution, the author argues that the movement of capital and the maintenance of inequality are central to the problems associated with behavior-change initiatives and must be addressed through new paradigms in order to respond appropriately to the global AIDS pandemic. Hardt and Negri's paradigm of "Empire"--that is, examining the system through which social inequalities are maintained not only between countries but also within them--offers prospects for the design of new interventions and targets for public health workers and social movements.

Acquired Immunodeficiency Syndrome↗

Attitudes, subjective norms, and intentions to engage in health behaviors.

The theory of reasoned action was used as the conceptual framework for analyzing the relationships among attitudes, subjective norms, and intentions to exercise regularly, maintain/attain recommended weight, and avoid highly stressful life situations. The sample (N = 377) consisted of adults between the ages of 18 and 66 living in two midwestern communities. Data were collected using a structured questionnaire designed according to guidelines developed by Ajzen and Fishbein (1980). The theory was supported in part by study results. Attitudes were useful in explaining intentions to engage in all three health behaviors studied. Subjective norms contributed only to the explanation of intentions to engage in regular exercise. Three factors, attitudes, subjective norms, and weight, affected intentions to engage in regular exercise, R = .364, p less than .01. Attitudes, weight, and perceived health status were the principle determinants of intention to eat a diet consistent with weight control, R = .428, p less than .001. Of the variables studied, only attitude was associated with intention to manage stress, R = .271, p less than .01.

Adolescent↗

Use of performance standards in behavioral health carve-out contracts among Fortune 500 firms.

OBJECTIVE: To determine the prevalence and nature of performance standards in specialty managed behavioral healthcare contracts among Fortune 500 companies. STUDY DESIGN: This was a cross-sectional survey of all companies listed on the Fortune 500 during 1994, 1995, or both. METHODS: From April 1997 to May 1998 we conducted a mailed survey with phone follow-up. Of the 68% of firms that responded, over one third reported carve-out contracts. The survey focused on whether companies had behavioral health carve-out contracts with specialty vendors and characteristics of these contracts, including the use of performance standards. RESULTS: More than three quarters of the Fortune 500 companies reporting specialty behavioral healthcare contracts used at least one performance standard. Most common were administrative standards (70.2%) and customer service standards (69.4%). About half of the companies used quality standards, whereas only a third used provider-related standards. Most (58.8%) companies using performance standards also specified financial consequences. Larger Fortune 500 firms were significantly more likely to use performance standards. Risk contracts and contracts that included all covered employees were also more likely to include some categories of standards. CONCLUSIONS: Administrative and customer service standards may be most common because companies find it easier to specify those standards, especially compared with clinical quality measures. To the extent that employers want to obtain the most value from their behavioral healthcare purchasing, we expect that more will begin to adopt quality standards in their contracts, especially as performance measures become more refined. Reliance on accreditation, however, is an alternative approach for employers.

Behavioral Medicine↗

Personality traits, health behavior, and risk for cancer: a prospective study of Swedish twin court.

BACKGROUND: The authors conducted a prospective investigation into the relation between personality traits and the risk for cancer. METHODS: The study cohort consisted of 29,595 Swedish twins from the national Swedish Twin Registry who were ages 15-48 years at time of entry. In 1973, the twins completed a questionnaire eliciting information on personality traits and health behavior. The Eysenck Personality Inventory was used to measure neuroticism and extroversion as two personality dimensions. A Cox proportional hazards model was used to estimate hazard ratios and 95% confidence intervals for extroversion and neuroticism separately as well as for their joint effect, and conditional logistic regression analyses were conducted to estimate the relation between personality traits and risks for cancer in twin pairs who were discordant for cancer. All analyses were conducted for six etiologically different groups of cancers: hormone-related organ cancers, virus-related and immune-related cancers, digestive organ cancers (excluding liver), respiratory organ cancers, cancers in other sites, and all cancer sites. RESULTS: Follow-up in the Swedish Cancer Registry for 1974-1999 revealed 1898 incidents of primary cancer. The authors found no significant association between neuroticism, extroversion, their joint effects and the risk for any cancer group. CONCLUSIONS: The current results did not support the hypothesis that certain personality traits are associated with cancer risk.

Adolescent↗

Confessions of a managed behavioral health care physician.

The author describes his early association with several pediatric practitioners in Rhode Island in the 1950s who were among the first to use stimulant drugs in the treatment of children with attentional problems. He also discusses some of the later applications of their work. Since the early 1970s there has been a great deal of public interest in and apprehension about the use of these medications in school children. Since the early 1990s there has been concern about the influence of mental health service delivery systems on the prescriptive practices of physicians. Carved-out behavioral health care systems have the potential to improve the standard of care in the pediatric populations they serve.

Child↗

Wantedness of pregnancy and prenatal health behaviors.

This study examined the relationships between wantedness of pregnancy and the initiation of prenatal care as well as smoking and drinking alcohol during pregnancy. Three hundred and eighty post-partum women were interviewed in a randomly selected sample of Chicago area hospitals. Approximately half of the women said that they had wanted their recently completed pregnancy. Unadjusted analyses revealed that women who wanted their pregnancies were more likely to begin prenatal care in the first trimester and were less likely to smoke while there was no relationship between wantedness and alcohol use during pregnancy. After adjustment for sociodemographic variables, women who wanted their pregnancies were less likely to have smoked cigarettes or drunk alcohol during pregnancy, but were not more likely to have initiated prenatal care in the first trimester. These results suggest that positive health behaviors during pregnancy are influenced by wantedness of pregnancy as well as sociodemographic characteristics. Therefore, efforts to reduce unwanted pregnancies are an important strategy to improve the health of women and children.

Adolescent↗

Health behavior correlates of depression in a sample of high school students.

Frequency of symptoms of depression and selected health-related practices and events were measured in a sample of 219 high school students. Students reported numerous symptoms of depression. Relative proportions of boys and girls reporting symptoms of depression were not significantly different. However, girls reported experiencing more severe depression than their male counterparts. Depression correlated significantly with several of the 22 health practices and states of affect examined. Both the determinants and manifestations of depression in adolescent cohorts require in-depth investigation. Possible implications for school health personnel are discussed.

Adolescent↗

Do social class differentials in health and health behaviors exist in young people (15-to-24-year-olds) in Belgium?

BACKGROUND: Socio-economic differentials in health are a reality in adults but their postulated persistence throughout the life-course is a subject of discussion. METHODS: Given the real socio-economic inequalities in the health of the adult population in Belgium, we used the 1997 national health survey data to measure these inequalities in the population between the ages of 15 and 24 years, inclusive. Concentration indices were calculated for three health-related variables, namely, subjective health, smoking, and drinking, in connection with various socio-economic indicators specific to the individual and/or the household (occupation, education, income, poverty, socio-economic insecurity). RESULTS: These concentration indices confirmed the existence of socio-economic differentials in the health of these 15-to-24-year-olds in Belgium. The data showed that a "poor health" status for subjective health and smoking was more frequent in the most disadvantaged socio-economic groups and for daily drinking more frequent in the better-off socio-economic groups. CONCLUSIONS: We found a relative diversity in the magnitudes of the inequalities measured depending on the parameters used for their quantification. However, there was an overlapping convergence and reproducibility of the patterns in the general directions of the inequality measurements, as follows: the results for a given indicator were remarkably consistent, regardless of the socio-economic variable studied. This consistency argues in favour of the confirmation of socio-economic class differentials in health in 15- to 24-year-olds in Belgium.

Adolescent↗

Physical activity and the initiation of high-risk health behaviors in adolescents.

The association of physical activity to the initiation of health risk behaviors was examined in a 3-yr prospective study of a population-based cohort of 1245 adolescents aged 12-16 yr. Four hundred thirty-seven students (35% of the cohort) were identified at baseline via self-report survey as never having smoked cigarettes, consumed alcohol, used marijuana, or carried a weapon. Three measures of physical activity were obtained at baseline: leisure-time physical activity (LTPA), level of aerobic fitness (AF), and participation in competitive athletics. Significant associations, with notable gender differences, were observed between physical activity and the initiation of cigarette smoking and alcohol use. The cumulative proportion of male students initiating alcohol use was 48%, 42%, and 24% for high, moderate, and low LTPA, respectively (P < 0.01). Males who participated in competitive athletics were significantly more likely than nonathletes to initiate alcohol use (44% vs 17%, P < 0.01). The cumulative proportion of female students initiating cigarette use was 10%, 23%, and 22% for high, moderate, and low LTPA, respectively (P < 0.05) and 7%, 28%, and 16% for high, moderate, and low AF, respectively (P < 0.05). No association was found between physical activity and weapon carrying. These results indicate that in this cohort of adolescents, the most active or most fit females were less likely to initiate cigarette smoking. In contrast, the most active males or males who participated in competitive athletics appeared more at-risk for initiating alcohol consumption than their less active counterparts.

Adolescent↗

Surveillance for certain health behaviors among states and selected local areas--Behavioral Risk Factor Surveillance System, United States, 2003.

PROBLEM: Data on health risk behaviors (e.g., cigarette smoking, binge drinking, and physical inactivity) for chronic diseases and use of preventive practices (e.g., influenza and pneumococcal vaccination for adults aged > or =65 years and cholesterol screening) are essential for developing effective health education and intervention programs and policies to prevent morbidity and mortality from chronic diseases. Continuous monitoring of these behaviors and practices at the state, city, and county levels can help public health programs in evaluating progress toward improving their community's health. REPORTING PERIOD COVERED: Data collected in 2003 are presented for states, selected metropolitan and micropolitan statistical areas (MMSAs), and their counties. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of the civilian, noninstitutionalized U.S. population aged > or =18 years. All 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands participated in BRFSS during 2003. Within these states and territories, 105 MMSAs and 153 counties that reported data for at least 500 respondents or a minimum sample size of 19 per weighting class were included in the analyses. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of certain medical conditions, and use of preventive health-care services varied substantially by state/territory, MMSA, and county. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied by state/territory, MMSA, and county. Twelve states, 39 MMSAs, and 65 counties achieved the HP 2010 objective to reduce the proportion of adults who engage in no leisure-time physical activity to 20%. Twenty states, 41 MMSAs, and 63 counties achieved the HP 2010 goal of 50% of adults engaging in moderate physical activity for at least 30 minutes per day. The HP 2010 goal of 30% of adults who engage in vigorous physical activity was achieved by 17 states, 33 MMSAs, and 57 counties. Two states, one MMSA, and one county achieved the HP 2010 current cigarette smoking goal of 12% prevalence. One county achieved the HP 2010 binge drinking goal of 6% prevalence among adults. One MMSA and eight counties achieved the HP 2010 goal of 15% for obesity prevalence. The HP 2010 goal for influenza and pneumococcal vaccination coverage of 90% was not achieved by any state, MMSA, or county. No state, MMSA, or county achieved the HP 2010 objective of 17% prevalence of high cholesterol among adults. INTERPRETATION: The findings in this report indicate substantial variation in health risk behaviors and use of preventative services among adults at state and local levels, indicating a need for appropriate public health interventions and continued efforts to evaluate public health programs and policies and health-care-related efforts designed to reduce morbidity and mortality. PUBLIC HEALTH ACTION: Data from BRFSS are useful for assessing national health objectives, for identifying and characterizing at risk populations, and for designing and evaluating health promotion and disease prevention programs and policies. The 2003 BRFSS data indicate a continued need to develop and implement health promotion programs for targeting specific behaviors and practices and provides information for measuring progress towards achieving disease prevention and health promotion goals at state and local levels.

Behavioral Risk Factor Surveillance System↗

Factors associated with receipt of behavioral health services among persons with substance dependence.

OBJECTIVE: This study sought to identify demographic and clinical variables that predict use of behavioral health services among persons with substance dependence. METHODS: Interviews were conducted with 1,893 adults who endorsed items on the National Household Survey on Drug Abuse in 1995 and 1996 that were consistent with a DSM-IV-TR diagnosis of dependence on at least one substance, excluding cigarettes. Logistic regression analyses were conducted to identify significant predictor variables. RESULTS: Among persons with substance dependence, only 18.3 percent had sought substance abuse or mental health treatment, or both, in the previous year. Female sex, high family income, a history of being arrested or booked, concurrent psychiatric comorbidity, self-perception of having a drug or alcohol problem, and the number of substances involved all predicted treatment use. One-third of substance-dependent individuals who used services reported receiving mental health care that did not include any substance use component. Persons with higher education levels were more likely to use mental health care only. In contrast, persons who used public insurance or were uninsured, had been booked or arrested, or perceived themselves as having a drug or alcohol problem were less likely to obtain mental health care only. CONCLUSIONS: Several clinical and demographic variables were predictive of some type of treatment use by substance-dependent individuals. Persons who used mental health care only were more likely to be female, to be of higher socioeconomic status, not to have a history of involvement with the legal system, and to have problems with alcohol or marijuana but not to perceive themselves as needing addiction treatment.

Adult↗

Cultural beliefs and health behaviors of pregnant Mexican-American women: implications for primary care.

A significant aspect of holistic primary care nursing is that it seeks to assess and understand clients' health beliefs and behaviors in the context of culture. This article examines implications for primary care nursing practice based on the cultural beliefs and health behaviors of pregnant Mexican-American women. Giger and Davidhizar's transcultural assessment model is used to evaluate six cultural phenomena present in all cultural groups. Culturally sensitive primary care by certified nurse-midwives in a community health birth center setting is described.

Birthing Centers↗

In-home behavioral health case management: an integrated model for high-risk populations.

The escalating health care costs attributed to high-risk populations have fueled a need for a proactive approach to deal with people affected by complex mental health issues that often coexist with chronic medical conditions. Through an in-home behavioral health case management (CM) program, patients with mental illnesses (some with coexisting medical conditions) receive integrated medical and mental health services through a disease-management approach that has proven effective in treating high-risk patients.

Case Management↗