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Stress, health-related behavior and quality of life on depressive symptomatology in a sample of adolescents.

This study examined the correlations of 21 variables categorized into sociodemographic, subjective quality of life, stress, problem behavior, and health behavior predictors of at-risk and low-risk depressive symptomatology for a sample of 1056 adolescents attending public school. Discriminant function analysis showed lower life satisfaction, higher stress, and perceived unattractiveness as major discriminating variables for at-risk (CES-Depression score greater than 23) versus low-risk depressed adolescents. Only two problem behaviors were significant, smoking for girls and hard drug use for boys.

Adaptation, Psychological↗

Health status, behavior, and care utilization in the Geneva Gay Men's Health Survey.

BACKGROUND: Recent reviews and studies suggest distinctive health needs among gay men. METHODS: Swiss residents in the Geneva Gay Men's Health Survey (GGMHS, n=477) were matched with controls from the Swiss Health Survey (SHS, n=477) along sex, age, nationality, and region of residence and compared along standard indicators of health status, health behaviors, and health care utilization. Both health surveys were conducted in 2002 using probability sampling--i.e., time-space sampling (GGMHS) and household probability telephone sampling (SHS). RESULTS: Although gay men were significantly less likely to be overweight (adjusted odds ratio (AOR)=0.54), they reported significantly more and severe physical symptoms (AOR ranged from 1.72 to 9.21), short-term disability (AOR=2.56), risk factors for chronic disease--i.e., high cholesterol, high blood pressure, high glucose, and smoking (AOR ranged from 1.67 to 3.89), and greater health services utilization (AOR ranged from 1.62 to 4.28), even after adjustment for differences in socio-demographic characteristics and health behaviors. CONCLUSIONS: Evidence of greater morbidity among a community sample of gay men along standard health indicators underlines the relevance of sexual orientation as a socio-demographic indicator in public health in general and in the health inequalities discourse in particular.

Adolescent↗

From risky behavior to health risk: continuity across two generations.

The purpose of this study was to determine the impact of childhood aggression and social withdrawal on adolescent health risk behaviors and adult health outcomes, and to examine the transfer of health risk to preschool offspring. This was a prospective, longitudinal, and intergenerational study of 114 mothers from disadvantaged neighborhoods, who were identified in childhood as being highly aggressive and/or withdrawn or with low scores on these 2 behavioral risk dimensions, and their preschool offspring aged 1 to 6 years old. The health histories of mothers (adolescent health risk behavior, health during pregnancy, current symptoms) and target children were taken during structured interviews conducted at home. Regression analyses tested the relationship between maternal childhood risk status and subsequent health outcomes, and these were followed by structural equation modeling of a proposed intergenerational pathway. Maternal childhood aggression predicted current health risk behaviors (e.g., daily cigarette smoking), whereas maternal childhood social withdrawal was not associated with maternal health risk at the time of testing. Mothers who had high scores on both aggression and withdrawal were more likely to engage in adolescent health risk behavior, which was directly related to health problems in preschoolers (even after controlling for covariates, such as neonatal health status and sex). In summary, there are distinct health trajectories for women who are highly aggressive and socially withdrawn in childhood, with implications for women's long-term health. Specifically, aggression in girls is likely to lead to health risk behaviors that may also place the next generation at risk for pediatric illness. Results are interpreted in terms of the health-hostility link, best known in adult men and intergenerational models.

Adolescent↗

Associations of health-related behaviors, school type and health status to physical activity patterns in 16 year old boys and girls.

Sedentary behavior often begins in childhood and is associated with the development of risk factors for many chronic diseases in adulthood. Physical activity is considered important in the prevention of unfavorable changes in the risk factors. We investigated whether health-related behaviors, school type and health status are associated to physical activity among adolescents. A questionnaire was sent to all Finnish 16-year-old twins in 1991-93. A total of 3,254 twins responded. The response rate was 88%. Physical activity was classified into five categories (very active, active, moderately active, hardly active, inactive) based on self-reported frequency and intensity of physical activity. The analysis considered all subjects as individuals. Smoking was strongly associated with physical activity among girls and boys. Those who smoked regularly were less active. The type of school was also associated with physical activity. In general, those who attended comprehensive school or high school were physically more active, while those in vocational schools, particularly boys, were less active. Girls in lower physical activity groups reported more psychosomatic symptoms. Associations of self-reported health-related behaviors, school type and health status to physical activity seem to be the same among boys and girls. However, as the more active students are in comprehensive school or high school and the less active in vocational school, and physical inactivity is related to smoking and use of alcohol, health education should be tailored by school type.

Adolescent↗

Cumulative sexual intercourse patterns among middle adolescents: problem behavior precursors and concurrent health risk behaviors.

PURPOSE: The purpose of this study is to document associations among problem behaviors in childhood and early adolescence and several health risk behaviors in middle adolescence, including a cumulative index of sexual intercourse risk. METHOD: A nontreatment sample of 1167 10th and 11th grade students was recruited from three homogeneous suburban high schools in western New York. Intercourse activity and number of sexual partners were assessed four times at 6-month intervals over a 2-year period via self-report questionnaires administered in classroom settings. RESULTS: Sexual intercourse activity, once initiated, was found to be relatively persistent, rather than sporadic, for most adolescents. Repeated intercourse experience with multiple partners over the assessed time periods was associated with higher levels of externalizing childhood behavior problems, earlier onset of antisocial behaviors and substance use, and higher concurrent substance use. An avoidant, withdrawn behavioral style in childhood was associated with lower rates of sexual involvement in adolescence. CONCLUSIONS: Temporal linkages among childhood precursors and adolescent sexual behaviors were identified as critical to understanding adolescent risk behaviors. These cross-time relationships may identify potential targets for future intervention/prevention efforts among high risk subsamples of children and adolescents.

Adolescent↗

Cultural and personal behavioral factors and women's reproductive tract infections.

OBJECTIVE: To review the relationship between personal behavior and cultural factors and reproductive tract infections (RTIs). METHODS: An English-language literature search using MEDLINE (1994-1998), Social Science Index (1994-1998), and informal discovery. Any original researches and reviews related to RTIs' epidemiology, behavior and culture were selected. RESULTS: RTIs have become a silent epidemic that is devastating women's lives each year. CONCLUSION: The influencing factors include sexual behavior, health related behavior (preventive health behavior, health-seeking behavior, reproductive behavior etc.) and culture, belief, etc. A holistic point of view should be taken.

Bacterial Infections↗

[Leisure time physical activity and its association with demographic variables and other behaviors related with health].

OBJECTIVES: To describe leisure-time physical activity at the levels considered more beneficial for health and to analyze the association with sociodemographic variables and other health behaviors, among the population older than 14 years in Barcelona, Spain. METHODS: A sample of 4,171 adults answered the Health Interview Survey of Barcelona in 1992. Those who had participated less than three times (20 minutes at least) in moderate and/or intense exercise in the week before to the interview were considered inactive. Bivariate and multivariate analyse using logistic regression were used to study the association of leisure-time physical activity and the study variables. RESULTS: 80.7% of population older than 14 years in Barcelona participated less than three times in moderate and/or intense leisure-time physical activity and 20% did not participate in any exercise. Inactivity was higher in women, and increased significantly with age and in people with a low socioeconomic level. Men and women with incomplete primary studies were more likely to be inactive than people with graduate studies (ORa-adjusted odds ratio-1.8, 95% confidence interval-CI-: 1.1-2.9 and 1.5, 95% CI: 1.0-2.4 respectively). For men working eight or more hours with interruption per day the ORa for inactivity was 1.9 (95% CI: 1.2-2.9) with respect to men working less than eight hours without interruption. Smoking men were more inactive than non smokers. CONCLUSIONS: These result suggest that health promotion programmes to promote physical activity for adult in Barcelona should facilitate the incorporation of older people, women, people with low socioeconomic level and the working population, besides reinforcing sports habits among the youngest population.

Adolescent↗

Medical care-seeking and health-risk behavior in patients with head and neck cancer: the role of health value, control beliefs and psychological distress.

Health behavior plays an important role in the development, detection and course of cancer of the head and neck. Relevant health behavior includes prompt medical care seeking, and smoking and drinking cessation after diagnosis. This study examines the relationship between these health behaviors and health value and control beliefs, as well as psychological distress. Two hundred and sixty-four recently diagnosed head and neck cancer patients were interviewed about their health behavior, and they filled in a questionnaire on health beliefs and psychological distress. The results showed that one-quarter (25%) of the patients had waited more than 3 months before seeking medical care, 50% had continued to smoke and 80% had continued to drink after the diagnosis. The patients, particularly those who smoked and drank before diagnosis, reported lower levels of health value and perceived health competence than a general population sample with which they were compared. Patients who engaged in patient delay reported a lack of perceived health competence. Psychological distress and lack of perceived health competence were found to be more common among patients who continued to smoke. The implications of these findings are discussed with regard to interventions aimed at promoting these specific health behaviors.

Aged↗

Patterns of interrelations among health-promotion behaviors.

We examined the interrelationships among 36 health behaviors for men and 38 for women in a telephone survey of a national sample of 3,025 adults. Wide variations existed in the frequency of respondents engaging in healthy practices, ranging from 9% to 96%. Men practiced an average of 17, and women 19, healthy behaviors. Correlations between health behaviors were weak, with an absolute value averaging r = .07, ranging from r = .00 to r = .71. Factor analysis revealed 10 underlying dimensions among the behaviors, which we interpreted for men as: (1) health care use, (2) exercise and recreation activity, (3) alcohol use, (4) smoking, (5) physical activity, (6) dental care, (7) nutrition, (8) sleep, (9) beverage use, and (10) breakfast. Women had the same 10 factors as men, except for a women's health screening factor instead of a beverage use factor. These findings suggest that engaging in one health behavior is not necessarily associated with practicing others, and that public health and individual counseling efforts to encourage healthy behaviors should be multifaceted and behavior-specific.

Data Collection↗

The relationship of APOE genotype to cognitive functioning in older African-American and Caucasian community residents.

OBJECTIVES: To determine whether cognitive decline associated with the apolipoprotein E (APOE) epsilon4 allele is different in older African Americans than it is in Caucasians. DESIGN: Performance on a brief screen of cognitive functioning was examined at baseline (N = 1,891) and 4 years later (N = 1,389) to determine the extent to which the presence of APOE epsilon4 affected level of and change in performance, and whether this differed as a function of race, age, initial score, and change in score. SETTING: Five adjacent counties in the Piedmont area of North Carolina. PARTICIPANTS: In 1986, a stratified random household sample of community residents age 65 and older (n = 4,162; 54% African-American, 45% Caucasian, 1% other race) formed the Duke Established Populations for Epidemiologic Studies of the Elderly. Of those available at the sixth annual wave, 76% were genotyped, with 1,891 providing baseline data on this wave, and the available survivors (n = 1,389) providing longitudinal data 4 years later. MEASUREMENTS: The Short Portable Mental Status Questionnaire (SPMSQ), a brief screen of cognitive functioning, was administered to all subjects on both occasions. We examined score at baseline and cognitive decline (i.e., increase of 2+ errors) at follow-up. Control measures included demographic characteristics, health behaviors, health and functional status, and medication use. APOE status was coded as epsilon4 present versus absent. RESULTS: APOE epsilon4 was significantly and uniquely related to lower score at baseline and significantly increased the odds of cognitive decline by 59%. There was no statistically significant interaction between APOE epsilon4 and age, race, initial SPMSQ score, or SPMSQ score at follow-up. CONCLUSION: APOE epsilon4 is modestly, if significantly, related to poorer cognitive functioning and to decline in cognitive functioning. No differences were found by age or race in this community representative sample.

Aged↗

A 10-year retrospective of research in new technologies for health communication.

The use of new technologies is growing in virtually all areas of health communication, including consumer, patient, and provider education; decision and social support; health promotion; knowledge transfer; and the delivery of services. Many applications have the potential to make major contributions in meeting the needs of an unhealthy and aging population. Key questions confronting health communication research reflect long-standing concerns about effects of new technology on health knowledge, health behavior, health delivery, and health outcomes. A review of the literature provides useful insights about how technology has been used to communicate health messages and their associated outcomes. Focus is placed on effective health communication, lessons learned, and implications for the future. During the next 10 years, the application of new technologies in health communication will be enriched by a tradition that has evolved to reflect a more dynamic connection between health users and providers. Future applications have the potential to provide cost-effective communications tailored to large numbers of individuals and achieve positive health outcomes. Consequently, we should strive to answer research questions about tailoring communication content, the channel used to deliver the message, and evaluation models that are best suited for examining outcomes of multicomponent tailored, technology-based communication.

Communication↗

Twin study of depressive symptoms among older african-american women.

This study examines factors associated with depressive symptoms in a genetically informative sample of African-American female twins aged 65 years and older. A telephone interview was conducted with 180 pairs of twins. Questions included demographics, health behaviors, health status, activities of daily living (ADLs), instrumental ADLs, and depressive symptoms as measured by the Center for Epidemiologic Studies-Depression scale. Regression methods for clustered data were used to examine the associations. In univariate analyses, ADLs (odds ratio or OR = 1.4, 95% confidence interval or CI = 1.1-1.7), fractures (OR = 4.4, 95% CI = 1.3-15.6), and vision problems (OR = 1.9, 95% CI = 1.0-3.8) were significantly associated with depressive symptoms. In multivariable analyses, ADLs (OR = 1.4, 95% CI = 1.2-1.7) and vision problems (OR = 2.0, 95% CI = 1.2-3.5) remained significantly associated with depressive symptoms. A within-pair analysis, controlling for genetic or familial influences, produced similar results. The results suggest that efforts targeted at reducing levels of disability may reduce depressive symptoms in this population.

Black or African American↗

Health-related quality of life, psychosocial work conditions, and absenteeism in an industrial sample of blue- and white-collar employees: a comparison of potential predictors.

PROBLEM: There is a scarcity of data simultaneously evaluating the relationship of health behavior, health perception, work characteristics, and demographic variables with sickness absenteeism in industrial employees. METHOD: Predictors and possible confounders (smoking, physical activity, alcohol intake, age, gender, body mass index, income) were regressed against frequency indices and the time lost index derived from the day-to-day absence data of 1524 employees at a manufacturing plant in Germany. Frequency indices were the number of sick-leave spells of 1, 2-3, 4-5, and >5 days within 1 year. RESULTS/CONCLUSION: Effort-reward imbalance, lack of support by supervisors or coworkers, negative affectivity, exhaustion, and impaired health perception were significantly associated with absence spells and the time lost index. Job demands and job control as well as overcommitment were unrelated to absenteeism indices. Multivariate models suggest mediation through impaired health-related quality of life.

Adaptation, Psychological↗

Improving EPSDT use: development and application of a practice-based model for public health nursing research.

The purposes of this article are to describe the process of adapting an existing model to create a framework suitable for public health nursing (PHN) practice and to demonstrate how the resulting model can guide research for PHN practice. Using the PRECEDE (predisposing, reinforcing, and enabling causes in educational diagnosis and evaluation) model as a base, we synthesized concepts of health behavior, health education, health promotion/disease prevention, and program evaluation to develop a model for planning and evaluating aggregate-level PHN interventions to improve the use of the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) in rural North Carolina. The model provided the framework for identifying variables relevant to EPSDT use, designing interventions to improve use, and planning a research evaluation of the effectiveness, efficacy, and cost effectiveness of the interventions. This model, and the process used in adapting it for PHN practice, should be helpful for others investigating methods of reaching and bringing effective health-promotion/disease-prevention information to underserved, low-education members of minority groups.

Humans↗

Assessing primary care performance in an obstetrics/gynecology clinic.

OBJECTIVES: Young, low-income women often use ob/gyns for routine care. Yet, little is known about the extent to which these settings achieve primary care goals. This study compared primary care performance among young low-income women using ob/gyns versus other settings as their primary care providers (PCP). METHODS: Anonymous interviews with 158 women on Medical Assistance age 18-44 seen at a university ob/gyn clinic. RESULTS: Sixty women (38.0%) used the ob/gyn setting for primary care, 83 (52.5%) use other places and 15 (9.5%) identified no primary care provider. Compared to women using other places for primary care, women who used the ob/gyn setting as their PCP were younger (OR 0.93, p = .04), had less education (OR 3.9, p = .02), and more frequently had small children (OR 2.8, p = .05) and reported illicit drug use (OR 3.1, p = .05). Performance on first contact care, ongoing care, coordination, and family and community issues did not vary by whether the PCP was an ob/gyn versus another provider, though women with an ob/gyn PCP rated their provider significantly higher on cultural competence. Access to advice on general medical prevention topics differed little by type of PCP; however, women who used the ob/gyn clinic as PCP received advice on more reproductive health, behavioral health, and injury prevention topics, with a mean number of preventive topics of 13.0 (SD 3.6) versus 6.3 (SD 4.1) (p < .01). DISCUSSION: Many young women who rely on hospital-based ob/gyn clinics for primary care may benefit from expanded health promotion efforts. The large portion of young, low-income women using ob/gyn settings for primary care may receive primary care of equal or better quality compared to women using other settings. More research is needed to see if these findings are generalizable.

Adult↗

Sources of data for rural health research: development of an inventory of Canadian databases.

Secondary data sources can often be used to help address questions about the health status, health behavior, health resources allocation, and utilization of health services of rural Canadians. But the task of deciding which Canadian databases are amenable to rural health research remains a challenge. As part of a larger research project titled "Canada's Rural Communities: Understanding Rural Health and Its Determinants," an inventory of 51 Canadian databases that have the potential of being used for rural health research was compiled, and it continues to be maintained and updated. The websites maintained by two of Canada's leading statistical data centers were systematically searched, along with other published articles and national reports, to produce this inventory. The criteria used to determine which data sources to include in this inventory are: (1) databases containing data at the national level that can be accessed by researchers, (2) databases containing data that are relevant to a variety of rural health issues, and (3) databases containing data that could be partitioned into rural and non-rural geographies. Detailed information is available by searching the inventory of national rural health research-related databases through the internet (www.cranhr.ca) or by contacting the lead author of this article. This article examines some of the issues in developing this resource and demonstrates the usefulness of its contents to Canadian and other rural health researchers.

Canada↗

The status of local health care safety nets.

This paper examines variations in the composition, concentration, financing, and community context of local health care "safety nets" and the market pressures that they face. It also reviews financing mechanisms that support these systems and strategies being undertaken to retain publicly insured patients. As safety-net providers compete more aggressively, the availability of the public health, behavioral health, and social services they provide may be affected. Communities may have to consider more explicit investments in these "public goods" if competitive markets remove existing cross-subsidies.

Cost Control↗