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PubMed2000

What happens when capitated behavioral health comes to town? The transition from the Fort Bragg demonstration to a capitated managed behavioral health contract.

Capitated managed care contracts for behavioral health services are becoming more prevalent across the country in both public and private sectors. This study followed the transition from a demonstration project for child mental health services to a capitated managed behavioral health care contract with a for-profit managed care company. The focus of the study was on the impact--at both the service system and the individual consumer level--pertaining to the start-up and maintenance of a capitated managed behavioral health program. A case study using multiple methods and multiple sources of information incorporated a program fidelity framework that examined micro to macro levels of program implementation. The findings of this study include the following: access to services decreased, the lengths of stay and average daily census in the more intensive levels of treatment declined, difficult-to-treat children were shifted to the public sector, and ratings of service system performance and coordination fell.

Adolescent↗
PubMed2004

Health behavior models and oral health: a review.

Dental hygienists help their clients develop health promoting behaviors, by providing essential information about general health, and oral health in particular. Individual health practices such as oral self-care are based on personal choices. The guiding principles found in health behavior models provide useful methods to the oral health care providers in promoting effective individual client behaviors. Theories provide explanations about observable facts in a systematic manner. Research regarding health behavior has explored the effectiveness and applicability of various health models in oral health behavior modification. The Health Belief Model, Transtheoretical Model and Stages of Change, Theory of Reasoned Action, Self-Efficacy, Locus of Control, and Sense of Coherence are examples of models that focus on individuals assuming responsibility for their own health. Understanding the strengths of each and their applicability to health behaviors is critical for oral health care providers who work with patients to adopt methods and modify behaviors that contribute to good oral health. This paper describes health behavior models that have been applied to oral health education, presents a critical analysis of the effectiveness of each model in oral health education, and provides examples of application to oral health education.

Behavior Therapy↗
PubMedDate not supplied

The Interaction Model of Client Health Behavior as a conceptual guide in the explanation of children's health behaviors.

This study used the Interaction Model of Client Health Behavior (IMCHB) as a conceptual guide to explain the correlates of children's diet and physical activity and explore the relationships of sex with their diet and physical activity of the school-aged child. A descriptive correlational study was conducted on 371 fifth-grade students and their parents. Information on the family's demographics, health experience, social influence, and environmental resources was collected, as well as data on the children's intrinsic motivation, cognitive appraisal, and affective response to food/physical activity. Children's self-reports on diet and physical activity were collected, as were parents' self-reports on health habits. Food preferences and diet self-efficacy explained the most variance in diet behavior for girls and boys. Girls scored healthier on food preferences and diet self-efficacy than did boys, but no difference was detected in their diet behavior. Girls participated in more low-intensity physical activity, but boys participated in more high-intensity physical activity than did girls. Findings provide strong support for the use of the IMCHB to explain children's diet but weak support for the explanation of children's physical activity. Further study of additional factors predictive of physical activity is indicated.

Child↗
PubMed2005

[Health behaviors between a health promotion demonstration health center and a general health center].

PURPOSE: The purpose of the study was to compare community residents' perceptions, participation, satisfaction, and behavioral changes between a health promotion demonstration health center and general health center. METHOD: The design of the study was ex-post facto that compared community residents in demonstration health centers and general health centers. The sample included 2,261 community residents who were conveniently selected from demonstration (792 participants) and general health centers (1,496 participants). RESULT: The results of the study were as follows: 1) Perception and participation rates of exercise, nutrition, and hypertension management programs were significantly higher in the participants of demonstration health centers than those of general health centers.; 2) Satisfaction rates of all programs except the smoking cessation program were significantly higher in the participants of demonstration health centers than those of general health centers. However, only the exercise rate among risk behaviors of participants was significantly higher in demonstration health centers than general health centers. CONCLUSION: Systematic efforts for health promotion were effective not only in improving the community's awareness, participation, and satisfaction of the program, but also in changing health behaviors. This evidence should be used to foster and disseminate health promotion programs to other health centers to improve community residents' health status and quality of life.

Adult↗
PubMed2003

Health behaviors, self-rated health, and quality of life: a study among first-year Swedish university students.

The authors conducted a baseline investigation of male and female university students' health behaviors and self-rated health and quality of life (QOL). The study population consisted of all full-time, first-year students registered in a comprehensive study program offered at a Swedish university in autumn 1998. In spring 1999, the researchers sent self-administered questionnaires dealing with health status, lifestyle, and living conditions to the students at their home addresses. Male respondents used tobacco, were frequent drinkers, and engaged in binge drinking in larger proportions than expected by chance. A majority of the respondents rated their physical and psychological health as very good or good, but male students' ratings were higher than those of female students, whereas the males' average scores on self-perceived QOL were lower than those of females. Both male and female students' self-perceived QOL was more strongly associated with self-rated psychological than with physical health.

Adult↗
PubMed2004

Sad, blue, or depressed days, health behaviors and health-related quality of life, Behavioral Risk Factor Surveillance System, 1995-2000.

BACKGROUND: Mood disorders are a major public health problem in the United States as well as globally. Less information exists however, about the health burden resulting from subsyndromal levels of depressive symptomatology, such as feeling sad, blue or depressed, among the general U.S. population. METHODS: As part of an optional Quality of Life survey module added to the U.S. Behavioral Risk Factor Surveillance System, between 1995-2000 a total of 166,564 BRFSS respondents answered the question, "During the past 30 days, for about how many days have you felt sad, blue, or depressed?" Means and 95% confidence intervals for sad, blue, depressed days (SBDD) and other health-related quality of life (HRQOL) measures were calculated using SUDAAN to account for the BRFSS's complex sample survey design. RESULTS: Respondents reported a mean of 3.0 (95% CI = 2.9-3.1) SBDD in the previous 30 days. Women (M = 3.5, 95% CI = 3.4-3.6) reported a higher number of SBDD than did men (M = 2.4, 95% CI = 2.2-2.5). Young adults aged 18-24 years reported the highest number of SBDD, whereas older adults aged 60-84 reported the fewest number. The gap in mean SBDD between men and women decreased with increasing age. SBDD was associated with an increased prevalence of behaviors risky to health, extremes of body mass index, less access to health care, and worse self-rated health status. Mean SBDD increased with progressively higher levels of physically unhealthy days, mentally unhealthy days, unhealthy days, activity limitation days, anxiety days, pain days, and sleepless days. CONCLUSION: Use of this measure of sad, blue or depressed days along with other valid mental health measures and community indicators can help to assess the burden of mental distress among the U.S. population, identify subgroups with unmet mental health needs, inform the development of targeted interventions, and monitor changes in population levels of mental distress over time.

Adolescent↗
PubMed1977

Sex roles as variables in preventive health behavior.

Preventive health behavior is broadly defined to encompass a spectrum of actions that range from voluntary exposure to the risk of disease, injury, or death to active efforts at prevention or detection of disease. Data are presented to show that men, in our culture engage in more risk-taking behavior and take preventive measures less frequently than women, while women avoid risks and take preventive action, particularly when this action requires medical intervention. The literature review supports the hypothesis that these differences in behavior arise out of the socialization and adult role patterns that our society defines as appropriate for each sex. Women, in particular, are encouraged to define their problems in medical terms and to seek help for them within the medical care system.

Attitude to Health↗
PubMed1998

Parental influences on adolescents' oral health behavior: two-year follow-up of the Norwegian Longitudinal Health Behavior Study participants.

This study explores the influences of parents' behavior and the parent-child relationship upon adolescents' smoking, oral hygiene performance and intake of sugared foods. In 1993 (Time 1), a representative sample of 709 16-yr-old adolescents in Hordaland County, Norway and their parents completed questionnaires at home. A postal follow-up 2 yr later (Time 2) provided 781 answers. The present analyses included 597 cohort participants who responded on both occasions, and 460 mothers and 399 fathers who replied in 1993. Influence of the parent-child relationship was assessed in terms of two scales: parental support and parental control of the youngsters. Multivariate regression analyses indicated that adolescents' oral health behaviors at Time 1, were each powerful predictors of their corresponding behaviors at Time 2. When the Time 1 parental behavior and the Time 2 parent-child relationship scales were added, mothers' oral hygiene performance and sugar intake accounted for a significant amount of the variance in the corresponding behaviors of adolescents at Time 2. Fathers' smoking and the parental control scale contributed to the prediction of adolescents' Time 2 smoking. These results extend previous ones obtained from cross-sectional studies and give further support to the importance of including the family in prevention campaigns aimed at adolescents.

Adolescent↗
PubMed1985

Milk production, health, behavior, and endocrine responses of cows exposed to electrical current during milking.

Six cows were exposed during milkings to electrical current to assess its effects on behavior, health, milking performance, and endocrine responses. Three treatments (0, 4, and 8 mA) were applied in a changeover design over three consecutive 1-wk periods. A cow received the same current treatment during 14 consecutive milkings, beginning with the evening milking (d 1) and ending with the morning milking (d 8). Treatments began 5 min before milking and continued until milking unit removal. Treatments consisted of 60 Hz square wave current of 5-s duration applied every 30 s from udder to hooves. Milk accumulation curves provided information about milk yields, milking times, peak milk flow rates, and times of peak milk flow. Residual milk yields also were measured. Milk was analyzed for protein, fat, and somatic cells. Blood samples from 60 min before to 60 min after treatment were collected, and oxytocin, prolactin, and cortisol concentrations were measured. Behavioral responses to current decreased with time. Changes of milking performance and milk composition were not significant. Changes of milking related cortisol responses during 8-mA current stimulation were significant. Oxytocin release was delayed during 8-mA treatments. Current treatments did not affect prolactin.

Animals↗
PubMedDate not supplied

Physical and behavioral health of adults with mental retardation across residential settings.

OBJECTIVES: This article presents survey data about the health and behavioral characteristics of a randomly selected sample of 629 adults with mental retardation (MR) living in Massachusetts in 2000. The goals of this analysis were to: describe the health, behavioral, and functional characteristics of the sample; examine relationships between consumer health, behavior problems, and functioning; and analyze variations in health and behavior problems by type of residential setting (parent/relative home, community residence, or institutional setting). METHODS: The authors analyzed data obtained from interviews with proxies (relatives, guardians, advocates, or program staff) on behalf of consumers and from state agency records. Chi-square analyses were conducted to examine the relationships between health, behavioral, and functional characteristics of consumers and differences in health and behaviors by type of residence. RESULTS: More than 80% of consumers were reported to have either "excellent" or "good" health. Overall health status did not significantly vary by residential type, but was significantly related to the presence of additional disabilities and some functional limitations. Several health and behavioral measures varied significantly by residential type: recent physical, dental, and ob/gyn exams; medication usage; problem behaviors; and functional level. CONCLUSIONS: As large numbers of individuals with MR reach adulthood and old age, public health and medical professionals face the challenges of addressing the health and behavioral needs of this population, preventing secondary health conditions, and improving environmental conditions that may influence health and mental health.

Activities of Daily Living↗
PubMed1998

Behavioral health issue brief: Medicaid managed care and behavioral health: an overview of 1915(b) and statewide 1115 waivers.

Section 1115 and Section 1915(b) of the Social Security Act permit federal waivers for States mandating mental health benefits to Medicaid recipients in managed care plans. Prevalent "carve-in" or "carve-out" provisions of these plans vary by type of coverage (e.g. substance abuse), geographic scope and eligible population targeted, including AFDC and low-income families.

Humans↗
PubMedDate not supplied

Effects of enhanced calling efforts on response rates, estimates of health behavior, and costs in a telephone health survey using random-digit dialing.

Public health researchers frequently rely on random-digit dialing (RDD) telephone surveys in monitoring trends in health behavior and evaluating health promotion interventions. RDD response rates have declined during the past decade, and cost-effective methods to increase response rates are needed. The authors evaluated two levels of enhanced calling efforts in an RDD survey of cancer-related health behavior in the State of Washington. The first level of enhanced calling effort was 1 month after 11 original calling attempts to a household, when the authors attempted up to 11 recalls. The second level was 6 months after the first answered call, when the authors recalled those persons who could not be interviewed. Enhanced calling efforts increased the overall survey response rate by 11 percent. Nine percentage points of the increase were attributable to call backs. There were demographic differences among the participants reached at different levels of calling effort, but no consistent associations of level of calling effort with health behavior related to alcohol use, smoking, diet, or health screening. Marginal costs for interviews completed with enhanced calling efforts were about 50 percent higher than costs for interviews reached in the first 11 calls. The authors concluded that enhanced calling efforts may be justified, because they increase confidence in the generalizability of survey results. However, the authors found very little change in survey results by including interviews from persons who were difficult to reach and to interview.

Adolescent↗
PubMed2003

Maintenance of health behavior change in preventive cardiology. Internalization and self-regulation of new behaviors.

Long-term health behavior maintenance remains a challenge for patients and health behavior interventionists. Resource-intensive systems of external reinforcement and behavioral cues can support behavior maintenance; an alternative approach is to promote patient internalization and self-regulation of health behaviors. Based in part on organismic internalization theory, self-determination theory, and the experience of patients successful at maintaining health behaviors, the health behavior internalization model (HBIM) is proposed to describe motivational factors associated with internalization processes and hypothesizes that integrated internalization may be associated with long-term health behavior maintenance. The HBIM identifies four self-needs (ownership, self-determination, security, and support) and four behavior-related needs (preference, context, competence, and coping) as motivating health behavior internalization. Behavior change strategies promoting integrated internalization are identified from self-determination theory, motivational interviewing, and transtheoretical model interventions. Other health behavior change constructs are reviewed in relation to internalization processes, and potential limits to the model are discussed.

Adult↗
PubMed1994

[Factors related to the white collar workers' health behavior and the degree of their health practice in a metropolitan city].

This study attempted to identify the factors related to health behavior and the degree of health practice among the employee of security investment companies in Pusan. The survey data used in the study were collected from 203 white collar employee in 21 companies. The factors considered in the health behavior and the degree of health practice were selected from Pender's model of health promoting behavior and Backer's model of health preventive behavior model. The major findings of the study could be summarized as followings: 1. The most closely associated factors with health behavior were identified as perceived control of disease (r = .393), importance of health (r = .350), pattern of family health care (r = .302), and options of health promotion (r = .215). 2. The study explored that the most closely related factors to the degree of health care practice were annual physical examination and the control of illegal and habitual drug in order. Other behaviors such as hand washing at each return to home, avoidance of indirect smoking, no exchange of glasses, regular exercise, stop or reduction of drinking and smoking, control of high cholesterol food were identified as less effective in the health promotion. 3. The most important factors associated with the less effective behaviors for health promotion were identified as their laziness in continuous practice and the limited time for their habituation. 4. The most important agent contributing to the knowledge and practice of health was identified as mass media.

Health Behavior↗
PubMed2001

Provider-sponsored networks in public sector behavioral health.

Numerous behavioral health and social service providers (primarily not-for-profit community mental health and chemical dependency treatment centers) have been joining forces on a local and regional basis to create their own managed care contracting entities, referred to as provider-sponsored networks. Even though these networks are emerging as an alternative managed care model, little is known about them. This descriptive survey provides baseline information about the status of these networks. Using a structured interview questionnaire, a random sample of 15 networks from 12 states was surveyed. Participants were asked about various organizational characteristics of networks, reasons for formation, managed care readiness, obstacles to success, differential value of networks, and recommendations for success. Findings suggest that regional networks are making gradual progress, although many of the assumed benefits have been elusive.

Behavior Therapy↗
PubMed2004

Health attitudes, health cognitions, and health behaviors among Internet health information seekers: population-based survey.

BACKGROUND: Using a functional theory of media use, this paper examines the process of health-information seeking in different domains of Internet use. OBJECTIVE: Based on an analysis of the 1999 HealthStyles data, this study was designed to demonstrate that people who gather information on the Internet are more health-oriented than non-users of Internet health information. METHODS: The Porter Novelli HealthStyles database, collected annually since 1995, is based on the results of nationally representative postal mail surveys. In 1999, 2636 respondents provided usable data for the HealthStyles database. Independent sample t-tests and logistic regression analyses were conducted. RESULTS: The results showed that individuals who searched for health information on the Internet were indeed more likely to be health-oriented than those who did not. Consumers who sought out medical information on the Internet reported higher levels of health-information orientation and healthy activities, as well as stronger health beliefs than those who did not search for medical news on the Internet. It was observed that those who reported searching for information about drugs and medications on the Internet held stronger health beliefs than the non-searchers. Comparison of individuals who reported seeking out information about specific diseases on the Internet with individuals who did not showed those who sought out disease-specific information on the Internet to be more health-oriented. Finally, consumers who sought out healthy lifestyle information on the Internet were more health conscious and more health-information oriented than those who did not. They were also more likely to hold stronger health-oriented beliefs and to engage in healthy activities. CONCLUSIONS: The results support the functional theory of Internet use. Internet searchers who used the Internet for a wide range of health purposes were typically more health oriented than non-searchers.

Age Factors↗