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Management coursework in graduate behavioral health programs.

Many behavioral health professionals eventually assume managerial roles; therefore the extent to which graduate behavioral health programs adequately prepare them for these roles is of concern. To examine this issue, directors from graduate behavioral health training programs were surveyed about whether organizational behavior coursework was routinely provided to their students. Results indicated that while this coursework was provided in most social work and psychiatric nursing programs, only a minority of clinical psychology and psychiatry residency programs offered it. These findings suggest that psychiatrists and psychologists may need more preparation than their non-doctoral-level colleagues to assume administrative positions, and that health administration programs may do well to develop continuing education programs geared specifically toward these groups.

Administrative Personnel↗

Health behavior survey of California School Health educators.

The purpose of this survey was to assess the health behaviors of California School Health Association members to determine whether or not these individuals utilized their professional knowledge to maintain themselves at a high level of health and consequently act as positive role models in the school health program. The survey was designed to investigate behavior patterns in categories relating to nutrition, drugs, exercise, risk and medical profiles. A questionnaire was designed to determine what percent of the respondents practiced positive health behaviors. The survey results provide strong evidence that the majority of those surveyed practiced what they have learned and teach. Sound nutritional habits were exhibited. Reasonable drug and risk taking behavior was practiced. Excellent medical profiles also were maintained. Exercise was a basic component to most of the respondents lives, however, increased participation and regular exercise programs could be improved. The results showed good overall health practices, making CSHA members potentially good role models.

Adult↗

Health promotion in context: the effects of significant others on health behavior change.

Maintenance of health behavior change over the long-term has been routinely difficult. One of the reasons for this difficulty is that only individuals' attitudes or behavior are changed, without concomitant support from the social environment. The purpose of this study was to explore several of the ways in which significant others--family members, friends, and coworkers--may affect changes in health behavior. Eighty-four participants in a work site health promotion program were the subjects of the study. Self-reports of health behaviors were gathered at baseline and at the end of the 7-week program; in addition, subjects reported the extent to which significant others generally supported health behavior changes, encouraged them to maintain changes they had made, and made changes in their own health behaviors. Results provide support for the general hypothesis that one individual attempting to change health behavior may be positively influenced by significant others during the course of the change process. Family members were particularly helpful, and overall supportiveness was more helpful than others' change in health habits or encouragement. Behaviors most influenced by others were exercise and fat consumption. Suggestions for future theoretical development, research, and intervention are discussed.

Attitude to Health↗

Stepping back from social norms campaigns: comparing normative influences to other predictors of health behaviors.

Recent health campaigns on college campuses have used a social norms approach, which suggests that one's perceptions of others' attitudes and behaviors are the key components in attitude and behavior change. However, the efficacy of social norms campaigns has been mixed. This study was conducted to assess the relationships among sociodemographics, normative perceptions, and individual attitudes on 3 health behaviors. Students at 2 universities (N = 393) completed questionnaires assessing how these variables related to their consumption of alcohol, tobacco use, and exercise behaviors. Regressions indicated that each of these variables was associated with behavior, but varied independent variables emerged as the salient predictors among behaviors. In several conditions the effect of normative perceptions on behaviors was not significant, a finding in direct opposition to social norms marketing. In all 3 behavioral conditions, the variable accounting for the greatest variance was whether or not the individual liked participating in that particular behavior. Thus, although some social norms marketing may be meeting with success, it may be the case that predicted attitudinal and behavioral changes will not be found when applied across diverse health topics.

Adolescent↗

Theory-comparison and multiple-behavior research: common themes advancing health behavior research.

Research that seeks to compare and contrast theories of behavior change and assess the utility of a particular theoretical model for changing two or more health-related behaviors is critical to advancing health behavior research. Theory-comparison can help us learn more about the processes by which people change and maintain health behaviors than does study of any single theory alone and thus has the potential to better guide the development of intervention. Multiple-behavior interventions promise to have much greater impact on public health than single-behavior interventions. However, theory-comparison and multiple-behavior research presents several emerging challenges. These include finding new ways to enhance recruitment and retention, especially among diverse populations; improving treatment fidelity; developing common metrics across behaviors that can be used to advance the measurement and assessment of behavioral change; and expanding the reach and translation of intervention approaches that have demonstrated efficacy. This paper discusses the rationale for conducting theory-comparison and multiple-behavior research and presents several common themes that have emerged from the work of the National Institutes of Health Behavior Change Consortium (BCC). The activities of each BCC workgroup and the potential contribution of each to these common themes to advance health behavior research are also described.

Health Behavior↗

Do health behaviors mediate the association between social capital and health?

INTRODUCTION: There is increasing evidence that social capital is important for people's health. However, there is still considerable disagreement about the specific pathways that links social capital to health. This study investigates the hypothesis that the association between social capital and health is mediated by people's health behaviors. METHOD: Data from the 2002 Health Survey for England (n = 7394) were used and analyzed from a multilevel perspective. The association between social capital and self-rated health were examined before and after controlling for smoking, alcohol intake, and fruit/vegetable consumption. RESULTS: Social capital was found to be associated with self-rated health, as well as with the different health behaviors. In addition, the health behaviors were significantly related to self-rated health. However, controlling for smoking, alcohol intake, and fruit/vegetable consumption did not substantially affect the association between social capital and self-rated health. CONCLUSIONS: The results demonstrate that social capital and support are important determinants of self-rated health and health behaviors. But only limited support was found for the hypothesis that health behaviors mediate the association between social capital and health.

Adolescent↗

Physical and behavioral health of Medicaid children in two southern states.

OBJECTIVES: As the primary insurer of children in the United States, Medicaid covers at least one in four US children. Information on the health and behavioral health needs of this group of children is critical to plan, deliver, and monitor services accordingly. METHODS: Parent interview data from a representative sample of Medicaid children in two Southern states were used to generate information from standardized questionnaires on physical health status, chronic illnesses, physical functioning, emotional and behavioral symptoms, and psychosocial functioning. RESULTS: The levels of physical and behavioral health and co-occurring problems were higher than other estimates available on the general population. CONCLUSIONS: The high levels of health problems among Medicaid-enrolled children need attention in the current struggles over Medicaid reform. Support for improving screening, referral, and integration of services is discussed, as well as the importance of monitoring service system performance in this era of managed care.

Adolescent↗

Dental health behavior and self-reported dental health problems among hospitalized psychiatric patients in Denmark.

The purpose of the present study was to describe dental health behavior and self-reported oral health problems among hospitalized psychiatric patients. Two hundred and forty dentate patients were interviewed with regard to participation in school dental care, dental visiting habits, self-assessment of oral health, dental anxiety, and oral hygiene habits. Dental visiting habits were associated with gender, psychiatric diagnosis, duration of mental disorder, and fear of dental care. Moreover, toothbrushing habits varied with gender, status as inpatient or day-hospital patient, number of admissions, and psychiatric diagnosis. Constant regular dental visits were observed among 31% of the participants, whereas regular toothbrushing was reported by 55%. Compared with reference figures of the general population, these figures reflect a relatively poorer dental health behavior among the study participants. The study underlines the need for specific preventive dental programs, which aim at improving the poor dental health behavior among psychiatric patients.

Adult↗

Long-term consequences of adolescent health behaviors: implications for adolescent health services.

The authors discuss the evidence supporting the effectiveness of adolescent preventive services to influence health outcomes, the magnitude of the long-term consequences of adolescent health-compromising behaviors, and their implications for health policies. Particular attention is given to the contribution that behaviors participated in or begun during adolescence have on long-term health, including cancer and heart disease. They postulate the health benefits that might accrue from the widespread implementation of comprehensive adolescent preventive services, assuming a conservative estimate of effectiveness, could be significant.

Adolescent↗

[Sex differences in health behavior and self assessed health in 11-15 years old children. A comparison between life conditions and health].

A total of 1860 children aged 11, 13 and 15 years from a nationwide random sample of schools completed an anonymous questionnaire on their social backgrounds, social networks, perceived health, life satisfaction, and health behaviour. Boys perceived their health to be better and had fewer psychosomatic symptoms than girls. They also did more physical exercise than girls. Boys and girls showed differences in social networks. Self-reported health status, weekly psychosomatic symptoms and health behaviour (smoking, exercise, and diet) were associated with social networks for both sexes. In particular, a good relationship to adults was found to be associated with positive health behaviour and perceived health.

Adolescent↗

Case study: a medicaid health maintenance organization quality initiative for behavioral health.

The purpose of this case study is to assess a Medicaid health maintenance organization quality initiative designed to screen new members for behavioral health treatment needs on enrollment. New members were screened by the health maintenance organization, which then informed the for-profit managed care organization responsible for the management of the mental health and substance abuse benefit of its findings. Other than the screening, there were no contractual expectations. The managed care organization was given only the names of individuals who "screened positive," but was not required to act on the screening results. Twenty percent of newly enrolled Medicaid health maintenance organization members were screened, and 2.5% were identified to have behavioral health and substance abuse treatment needs. As Medicaid managed care is responsible for the health care of low-income beneficiaries who are inherently vulnerable, it is important to make every effort to evaluate the impact of a quality project meant to improve their treatment.

Adult↗

Effect of cancer screening and desirable health behaviors on functional status, self-rated health, health service use and mortality.

OBJECTIVES: To determine whether some health behaviors of older people (e.g., obtaining cancer screens) have a limited and others (e.g., exercise) have a broad association with population-level health status 4 to 6 years later. DESIGN: Longitudinal cohort. SETTING: North Carolina five-county urban and rural area. PARTICIPANTS: Representative community residents aged 71 and older (Duke Established Populations for Epidemiologic Studies of the Elderly; African American, n=1,256; white, n=974) who provided information on cancer screening and health behaviors. MEASUREMENTS: Demographics, health conditions, functional status, health service use, health insurance. Dependent measures were functional status and self-rated health 4 years later, hospitalization within 4 years, and death within 6 years. Data were analyzed using descriptive statistics, multivariable logistic regression, and Cox proportional hazards. RESULTS: In fully adjusted analyses, cancer screening had no significant protective association with functional status, self-rated health, hospitalization, or death. Smoking was a risk factor for hospitalization (odds ratio (OR)=1.48, 95% confidence interval (CI)=1.07-2.05), and death (hazard rate (HR)=1.81, 95% CI=1.47-2.23). Sufficient food reduced hospitalization (OR=0.38, 95% CI=0.15-0.94) and mortality (HR=0.70, 95% CI=0.49-1.02). Regular exercise protected against poor mobility (OR=0.56, 95% CI=0.41-0.77), and poor self-rated health (OR=0.61, 95% CI=0.45-0.82). Lower activity level increased the hazard of death (HR=1.18, 95% CI=1.03-1.36). CONCLUSION: Disease-specific screens are important at an individual level but, because of low incidence of condition and comorbidity, may not be associated with population-level health 4 to 6 years later. Practice of health behaviors with a broader focus is associated, at a population level, with better functional status and self-rated health and lower rates of hospitalization and death 4 to 6 years later.

Activities of Daily Living↗

[Factors affecting health behavior of the people aged forties--a test of the health belief model].

The health behavior of 1120 persons, aged in their forties, living in a city, a mountain village and a fishing village were analyzed according to the Health Belief Model. Women practiced more health behaviors than men. People living in the city and mountain village practiced more than people in fishing village. Company employees, farmers and housewives practiced more than self-employeds and fishermen. Education level had no significant influence in the practice of health behavior. As predicted, people who believed in the effectiveness of health behavior practiced more health behaviors. On the other hand, people who perceived barriers to health behavior practiced less. Paradoxically, people who perceived vulnerability to hypertension, cerebrovascular disease or cancer, and the seriousness of these diseases, practiced less health behaviors. Stepwise multiple regression analysis revealed that health beliefs, social supports and information from mass media could account for 33.0% of the Health Behavior Score variation. Perceived barriers to health behavior was the strongest determinant for practice of health behavior. Perceived barriers may account for gender and occupational differences in health behavior.

Adult↗

Normal and overweight adults: perceived weight and health behavior characteristics.

Perceived weight, perceived health status, health conception, and health behavior choices were studied in 33 normal weight and 26 overweight adults. Data were collected by interview and by weighting the 59 participants (25 men and 34 women). Results indicated that 92% of the overweight and 36% of the normal weight participants perceived themselves to be overweight. The two groups did not differ significantly in perceived health status, health conception, or health behavior choice. Health conception and health behavior choice were significantly related in both groups. Perceived health status was not related to either health conception or health behavior choice in the overweight group but was significantly related to health conception in the normal weight group. Although the overweight participants were aware that they were overweight, they did not perceive themselves to be less healthy than the normal weight group. Further, their health conceptions were as complex and their behavior choices as health promoting as those of the normal weight group.

Adult↗

Hormone replacement therapy and health behavior in postmenopausal polio survivors.

OBJECTIVES: Little is known about menopause and hormone replacement therapy (HRT) use in women with disabilities. The objectives of this study were to explore the health behaviors, health outcomes, and efficacy of HRT in a group of postmenopausal polio survivors and to compare selected outcomes to nationally representative cohorts. METHODS: One hundred and thirty-one postmenopausal polio survivors completed self-report surveys on health behaviors, HRT use, functional status, and psychosocial well-being. During a physical examination, fasting cholesterol and body mass index (BMI) were collected. Independent sample t-tests and Chi-square analysis were used to compare HRT users and non-users on health behaviors and health outcomes; logistic regression was used to predict HRT use. RESULTS: Prevalence of HRT use was 58%. Only BMI predicted HRT use (OR = 0.30, CI: 0.11-0.81). HRT users had better high density lipoprotein (HDL), low density lipoprotein, total cholesterol/HDL ratios, lower BMIs, were more confident when communicating with their physicians, more likely to discuss menopause with their physician, and experienced greater overall stress. HRT was not associated with health behavior, health-related quality of life, mood, or life satisfaction. Compared to non-disabled women, more of these women had higher total cholesterol, obesity, more sleeping problems, and were less likely to vigorously exercise or smoke. CONCLUSIONS: HRT did not confer substantial benefits in these postmenopausal polio survivors to warrant them using HRT at a higher rate than their non-disabled peers. Comparisons to their non-disabled peers suggested they may be at higher risk for adverse health problems associated with postmenopause.

Adult↗