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Effects of racial discrimination and health behaviors on mental and physical health of middle-class African American men.

This research is an examination of the effects of racial discrimination and health-promoting behaviors on the physical and mental health of a sample of 399 well-educated African American men. One would think that the attainment of higher education would increase health-promoting behaviors and might decrease discriminatory experiences that impact health. However, regression analysis indicated a more complex picture. Health-promoting behaviors were positively related to mental health, whereas experiences of racial discrimination contributed to poorer mental health. Relationships between health-promoting behaviors and that of racial discrimination to physical health were found to be nonsignificant. In conclusion, the authors discuss the importance of culturally appropriate health-promotion efforts.

Black or African American↗

Health behaviors and their relation to metabolic control and periodontal status in type 2 diabetic patients: a model tested using a linear structural relations program.

BACKGROUND: Although it has been reported that diabetic control is beneficial in managing periodontal disease, there are few studies in the literature where the relationship between singular behavioral factors and periodontal status has been examined. The aim of this study was to examine the simultaneous interrelationships among selected medical/dental variables and 5 behavior components with general health behavior (GHB), perceived fatigue (PF), diet control (DC), regular diet (RD), and dental behavioral inventory (HU-DBI) scores, using data from a study of 102 type 2 diabetic patients. METHODS: A hypothesized model was tested by a linear structural relations program (LISREL). RESULTS: There was a significant correlation between oral health behavior and calculus accumulation (r = 0.399; P<0.001). Correlations were found between calculus and periodontal status measured by gingivitis index and probing depth (r = 0.232; P<0.05, r = 0.279; P<0.01, respectively). The final model was found to be consistent with the data (chi2 = 55.0, df = 47, P = 0.197; GFI = 0.922). Oral health behavior affected periodontal status through its effect on calculus but not plaque accumulation. General health behavior had significant effects on oral health behavior and diet behavior (P<0.05 and P<0.001, respectively). Diet behavior affected both plaque accumulation and metabolic control (P<0.05 and P<0.01, respectively). However, the result was the virtual absence of a significant pass coefficient between metabolic control and periodontal status. CONCLUSIONS: The severity of the 2 diseases seemed to be connected indirectly through health behaviors such as diet behavior and oral health behavior.

Chi-Square Distribution↗

Combat exposure, posttraumatic stress disorder symptoms, and health behaviors as predictors of self-reported physical health in older veterans.

We used path analysis to model the effects of combat exposure, posttraumatic stress disorder (PTSD) symptoms, and health behaviors on physical health. Participants were 921 male military veterans from the Normative Aging Study. Their mean age at time of study was 65. Measures of combat exposure, PTSD symptoms, smoking, and alcohol problems were used to predict subsequent self-reported physical health status. Both combat exposure and PTSD were correlated with poorer health. In path analysis, combat exposure had only an indirect effect on health status, through PTSD, whereas PTSD had a direct effect. Smoking had a small effect on health status but did not mediate the effects of PTSD, and alcohol was unrelated to health status. We conclude that PTSD is an important predictor of physical health and encourage further investigation of health behaviors and other possible mediators of this relationship.

Age Factors↗

Improving the health and health behaviors of women aging with physical disabilities: A peer-led health promotion program.

OBJECTIVE: To examine the efficacy of a health promotion program for women aging with physical disabilities. METHOD: A sample of 137 middle-aged and older women with physical disabilities was randomly assigned to either an 8-week health promotion program or to a wait-list control group. Both groups completed questionnaires before, immediately after, and 3 months after the intervention. RESULTS: Relative to women in the control group, women in the health-promotion program demonstrated improvements in health behaviors, most of which were maintained at follow-up. The intervention group showed some improvements on measures of physical health, but there was little evidence of improvement in psychological health outcomes. Testing our theoretical model, self-efficacy was supported as a mediator of the effect of the intervention on health behaviors, and health behaviors combined with self-efficacy were supported as mediators of the effect of the intervention on physical health outcomes. Contrary to our hypotheses, our measures of social support and social connectedness were not affected by the intervention. CONCLUSIONS: A brief, peer-led, group health promotion program resulted in improved scores on measures of self-efficacy, increased health behavior, and physical health. Self-efficacy, which was supported as a mediator in the effect of the intervention on behaviors and health outcomes, should remain an important focus of future interventions with this population.

Aged↗

A typology of organizational and contractual arrangements for purchasing and delivery of behavioral health care.

The evolution of behavioral health care financing and delivery has led to a wide variety of arrangements connecting consumers to behavioral health services. In this paper, we present a typology based on three distinguishing features of behavioral health arrangements along which there is a high degree of variability and this variability has been shown to affect the cost and quality of behavioral health care: (1) the extent to which sponsor oversight over care is outsourced by way of contracts rather than performed directly; (2) whether financing for behavioral health is partitioned from health care financing overall; and (3) the amount of financial risk shared by the sponsor with third parties.

Behavioral Medicine↗

A path analysis on prisoners' health behavior and medical utilization.

In this thesis, Korean prisoners' health behavior and the characteristics of their medical utilization were surveyed and analysed. Because prisoners are inclined to be mediators of communicable diseases or unhealthy behaviors between prison institution and the outside world, health care for prisoners is directly related to the national population. Data were collected through a self-administered survey of 5 Korean prisons out of a total of 38 correctional facilities and analysed in accordance with a causal model based on a path frame, by serial multiple regressions on health behavior, health status, and medical utilization, etc. According to the survey analysis, while prisoners were generally concerned with their health much more than they were before imprisonment, they perceived that their health status had deteriorated after imprisonment, and that their need for health services was increasing gradually during their time in prison. In the path analysis on the causal relations among variables related to the prisoners' health status and medical utilization, the prisoners' characteristics affected their health concern and health behavior, and subsequently affected their health status and medical utilization, respectively. To sum up these exploratory studies on prisoners' health behavior and health service utilization, some efforts to organize a health care system embracing the correctional institution and health care administration should be made on the level of establishing a health care delivery system for special social groups like prisoners.

Adult↗

Can the theory of planned behavior explain patterns of health behavior change?

This article tested the ability of the theory of planned behavior (TPB) to predict patterns of behavior change associated with health screening. Attitudes, subjective norms, perceived behavioral control, and intentions were used to predict objective measures of attendance 1 month and 13 months later among participants who had never previously been screened (N = 389). Findings showed that the TPB predicted attendance on each occasion and also predicted frequency of attendance. However, the model was unable to reliably distinguish among consistent attendees, participants who delayed attending, and participants who initially attended but relapsed. Thus, the TPB needs to be extended to understand behaviors that must be performed promptly and repeatedly for health benefits to accrue.

Adult↗

Communication about behavioral health risks: a study of videotaped encounters in 2 internal medicine practices.

BACKGROUND: As behavioral health risks account for the major causes of preventable morbidity and mortality in the United States, national guidelines recommend that physicians routinely screen patients for risk factors, and counsel as appropriate. OBJECTIVES: To assess the scope of health risk screening and characterize the communication content of counseling for health behavior change in 2 general internal medicine practices. DESIGN AND PARTICIPANTS: We studied videotapes of 125 new patient visits to General Internists affiliated with academic medical centers in Chicago, IL (70%) and Burlington, VT (30%). All videotapes were content analyzed to examine (1) the incidence and outcome of screening for diet, exercise, tobacco, alcohol, drugs, sex, seatbelt use, helmet use, firearms, smoke detectors, and sun exposure; (2) the content of counseling for at-risk behaviors, with a focus on 11 counseling tasks associated with health behavior change. RESULTS: Patient age in these 125 initial visits ranged from 22 to 85 years. Within the 91 visits that included at least 1 screening attempt, there were a total of 361 distinct screening discussions (mean=3.9, SD=2.2, range=1 to 9). Seventy-four (20.5%) of the 361 screening discussions revealed an at-risk behavior. On average, 2.4 of the 11 counseling tasks were accomplished for each of the 74 behavioral health risks (SD=2.2, range 0 to 9); only education about the problem (56.8%) and general advice about the solution (62.2%) were evident in more than half of the counseling attempts. CONCLUSIONS: This observational study reveals that communication tasks associated with successful counseling were relatively infrequent occurrences during initial visits in 2 primary care practices.

Communication↗

Direct observation and patient recall of health behavior advice.

BACKGROUND: Patient recall of health behavior change discussions with physicians is an important intermediate outcome to adherence with recommendations and subsequent behavior change. This study reports patient recall of health behavior discussions during outpatient visits and tests patient and visit characteristics associated with recall. METHODS: In a cross-sectional study of 2670 adult outpatients visiting 138 family physicians in 84 practices, provision of health behavior advice was measured by direct observation. Patient recall of discussion of each health behavior topic was assessed by patient survey. RESULTS: Patient recall rates ranged from 11% for substance use assessment to 75% of smokers recalling smoking cessation advice. Patient demographics were not associated with recall. In multivariable models, the strongest predictor of patient recall of diet and exercise advice was the duration of the advice. Advice provided during well care visits was more likely to be recalled by patients than during illness visits, but presence of a health behavior-relevant diagnosis during an illness visit was associated with a 2-fold increase in patient recall. CONCLUSIONS: Patient recall of health behavior advice is enhanced by longer duration of advice and by linking advice to visit contexts that represent teachable moments.

Diet↗

Preschool children's conceptions of health and health behaviors.

Conceptions of health and health related behaviors of 41 four and five year olds were explored, using a picture-interview guide. Areas of interest included feeling tone associated with health, identification of children who are healthy, health promotion behaviors, behaviors deleterious to health, and individuals who help children stay healthy. Subjects' responses to selected questions were scored; choices from groups of pictures concerned with health promotion behaviors and persons who help in maintaining health were ranked, depending on order of selection. Most subjects were able to make the correct association between feeling tone and health status, and determine health status of depicted children. Health promotion behaviors selected--in descending order of mean ranking--were eating, visiting the doctor, brushing teeth, sleeping, running, and washing hands. Most subjects could correctly identify behaviors hazardous to health. Chi-square revealed no significant differences in scores or rankings by age or sex. Subjects in the lowest of the three family income groups tended to have lower scores.

Age Factors↗

Older women: social cognitive theory correlates of health behavior.

Most research about health promoting behaviors has focused on pre-old adults and men, despite clear evidence that the leading cause of death among postmenopausal women is related to health behaviors. This study applied social cognitive theory constructs to exercise, dietary, and stress management health behavior. The purpose of this study was to examine the ability of self-efficacy expectation and outcome expectancy to predict health behavior among older women. Community-dwelling women aged 65 to 92 years were interviewed with previously developed instruments and instruments designed specifically for this study (N = 225). Self-efficacy was the strongest predictor of each of the health behaviors (beta weights: dietary behavior .50; exercise, .39; stress management, .32). Outcome expectancy was not a significant predictor of exercise or dietary behavior. Outcome expectancy was a significant predictor of stress management behavior. The findings of this study, combined with the importance of health promotion behaviors among older women, justify the need for continued research about self-efficacy and health behavior among this vulnerable population.

Aged↗

Age group and health status effects on health behavior change.

The authors explored health behavior change during 5 years, considering age/cohort, health status, and gender effects. The authors divided the sample (n = 1,064) into 4 age/cohort groups: young adults (n = 139; 19-42 years), middle-aged adults (n = 386; 43-62 years), young-old adults (n = 296; 63-72 years), and old-old adults (n = 243; 73+ years) and health status: cardiovascular disease and physical disability. Smoking and seat belt behaviors remained stable, whereas alcohol, food consumption, food preparation, physical activity, dental, and medical behaviors showed change. Change in health behaviors differed by age/cohort group and health status for food consumption, food preparation, and medical care, primarily showing negative change for old-old adults and positive change for individuals with cardiovascular disease. Health behavior interventions need to focus on the old-old, individuals with physical disability, and on smoking and seat belt use. These specific populations and behaviors need to be targeted to promote positive health behavior change, to limit future onsets of disability and morbidity, and to prevent the occurrence of premature death.

Adult↗

Research and practice opportunities at the intersection of health education, health behavior, and genomics.

Researchers and practitioners in health behavior and health education (HBHE) can play a pivotal leadership role in the integration of genomic advances to improve the public's health. The purpose of this article is to outline research and practice opportunities at the intersection of genomics and HBHE. We begin this article by briefly summarizing the existing evidence in the literature pertaining to the public's use of genetic services, the effectiveness of genetic counseling, and the impact of genetic testing. Following this, we outline and expand on several areas that we believe are ripe for further exploration, understanding, and public health application:(a) public understanding of genetic information, (b) interventions for health behavior change, and (c) public health assurance and advocacy. This analysis has identified the need to consider potential application efforts in genomics and HBHE from an ecological perspective, with an emphasis on multiple levels of intervention and analysis.

Genetic Counseling↗

Concordance of parental and adolescent health behaviors.

This paper reports upon an empirical study of health behaviors in adolescents and their parents. The study aimed at assessing: effects of parental health behaviors on that of their adolescent child; whether mother's and father's health behaviors have additive effects on the respective health behaviors of their child; and whether eventual effects of parental health behaviors decrease with increasing age of the child. The data stemmed from the Norwegian national Health Survey in 1985 and comprised separate interviews with two parents and an adolescent child in 337 families. Results from logistic regression analyses showed that the strongest association found between parental and adolescent health behaviors was for fat intake, and the probability of having a low fat intake was 5 times higher if the mother had a low fat intake than if she did not. With the exception of mother's frequency of exercise, all other parental health behaviors were positively and statistically significantly associated with the corresponding health behavior of their adolescent child. Parental fat intake, smoking behavior and alcohol consumption appeared to have additive effects on the corresponding behaviors of their children. No statistically significant interaction between any of the parental health behaviors and age of the adolescent was found. Hence, the effect of parental health behaviors on that of their adolescent child does not seem to decrease with increasing age of the adolescent. The results are discussed with reference to the functions of modeling.

Age Factors↗

Internal structure of prevention and dental health behaviors.

Previous work investigating the internal structure of preventive health behavior (PHB) has not included a representative sample of dental health behaviors. Consequently, it has not been possible to evaluate whether dental dimensions of health behavior exist or whether dental behaviors are part of other health behavior dimensions. The results of a principal-components analysis of PHBs in which a larger sample of dental health behaviors is included shows that purely dental dimensions of health behavior emerge in a sample of 350 university students and faculty. Dental health behavior may need to be conceptualized as a dimension of health behavior separate from other PHBs.

Adult↗

[Comparison between Kanagawa Prefecture and Ohio state of factors related to health behavior among older adults].

Factors related to health behavior of older adults in Japan and the United States were compared. A total of 900 persons from three age groups (45 to 59, 60 to 74 and 75 and over) were interviewed in three communities (major metropolitan, midsized city, and small town), in both Kanagawa Prefecture and Ohio State. To determine the reliability of the results, in addition to analysis for all subjects, each of communities were analyzed separately. Health behaviors were divided into 2 separate levels: 1) preventive health behaviors and 2) coping behaviors for symptoms which may be signs of a serious illness. The latter behaviors were classified into three types: 1) seeing a physician, 2) changing lifestyle and 3) taking OTC drugs. The following results were obtained: 1) In both Kanagawa Prefecture and Ohio State, good preventive health behaviors were unrelated to coping behaviors associated with potentially serious illness. Interviewees who used OTC drugs when experiencing a potentially serious illness had a low tendency toward seeing a physician. In Kanagawa Prefecture, individuals who saw a physician showed a strong tendency toward changing their lifestyle, for symptoms which were potential signs of a serious illness. 2) There were some differences in factors related to preventive health behaviors between Kanagawa Prefecture and Ohio State. In Kanagawa Prefecture, there were sex differences, with males exhibiting preventive health behaviors. In Ohio State, good preventive health behaviors were few among interviewees who were black. 3) There was little difference between Kanagawa and Ohio State as far as the tendency toward seeing a physician when experiencing potentially serious illness. In both places, interviewees with good self-rated health status and having strong self-treatment attitudes showed a lower tendency to see a physician when experiencing symptoms which were potential signs of a serious illness.

Age Factors↗

HIV treatment adherence in women living with HIV/AIDS: research based on the Information-Motivation-Behavioral Skills model of health behavior.

Close and consistent adherence to anti-HIV medication regimens is necessary to achieve the maximum benefit of these potentially effective treatments. The authors examined cognitive and behavioral factors associated with HIV treatment adherence in a convenience sample of 112 women, 72 of whom were currently taking HIV treatments at the time of the study. Women completed confidential surveys and interviews to assess HIV-related health status, treatment regimens, and cognitive behavioral characteristics derived from the Information-Motivation-Behavioral Skills model of health promotion behaviors. Results showed that women who had missed at least one dose of their HIV medications in the past week reported lower intentions (motivation) to remain adherent and lower adherence self-efficacy (skills). Structural equation modeling showed that motivational and skills-building factors significantly predicted the number of medication doses missed. However, treatment-related information did not predict treatment adherence. In addition, women who had missed a dose of medication in the past week were more likely to have ever used devices and strategies to remind them of doses, but were no more likely to currently use such strategies. Interventions that enhance treatment adherence motivation and build adherence skills may help improve HIV treatment adherence in women receiving anti-HIV therapies.

Adult↗

Conceptions of health and health behaviors of preschool children.

A modified version of Flaherty's (1986) Preschool Health Picture Interview was administered to 30 preschool children to explore their conceptions of health and health behaviors. Health was conceptualized as a positive feeling state and the ability to participate in desired activities. Brushing teeth and eating were the highest ranked health-promotion behaviors. Behaviors harmful to health were explained in terms of immediate physical consequences. Responses to all questions were predominantly behavioral. A t test showed that the mean number of moral responses given by boys to all questions was significantly greater (p = 0.04) than the mean number given by girls although no significant differences between boys' and girls' responses were found for any subgroup of questions.

Attitude to Health↗