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PubMed2001

Use of preventive care services, beneficiary characteristics, and Medicare HMO performance.

Medicare health maintenance organization (HMO) enrollees use more preventive care services than their fee-for-service (FFS) counterparts. This may be because those who enroll in HMOs have characteristics that make them more disposed to use preventive care. To investigate this possibility, we examined the use of four preventive care services by respondents to the 1996 Medicare Current Beneficiary Survey (MCBS). Unadjusted preventive care use rates for HMO enrollees were slightly higher than rates for non-HMO enrollees with private supplemental insurance. However, after adjusting for enrollee characteristics (sociodemographics, health behaviors, health status, and functioning) we found that preventive care use rates for HMO enrollees were substantially higher--consistent with HMO enrollees being less disposed to use preventive care. In comparing preventive care service rates across groups, managers and policymakers may want to consider taking into account beneficiary characteristics that are correlated with the disposition to use preventive care.

Aged↗
PubMed1992

Correlates of knee pain among US adults with and without radiographic knee osteoarthritis.

We examined the associations of sociodemographic variables, health behaviors, health status and psychological well being with radiographic knee osteoarthritis (OA) and self-reported knee pain for 4056 US adults aged 45-74 years. Among persons with or without knee OA known correlates of radiographic knee OA (age, sex, race, obesity) were generally not associated with knee pain. Radiographic severity, psychological well being and health status were associated with knee pain, both among persons with and without radiographic knee OA, suggesting that nonradiographic correlates of self-reported knee pain are independent of whether a person has radiographic knee OA.

Age Factors↗
PubMedDate not supplied

The Health Self-Determinism Index.

This study is a psychometric evaluation of a new measure of motivation in health behavior. The Health Self-Determinism Index was completed by 202 randomly selected adults via a mail survey. The multidimensionality of the construct was supported through the factorial isolation of four subscales: self-determined health judgments, self-determined health behavior, perceived competency in health matters, and internal-external cue responsiveness. These four factors accounted for 56% of the total explained variance in the measure. The alpha reliability coefficient for the total scale is .84; the internal consistency of the four subscales is supported by alpha reliability coefficients of .75, .75, .67, and .69, respectively. With refinement, this measure will enable exploration of client antecedents and correlates of motivation in health behavior. Further, specific nursing interventions can be examined for their ability to alter clients' motivation in relation to specific health behaviors. Finally, the role of motivation in predicting health outcomes can be explored.

Attitude to Health↗
PubMed1998

Skepticism toward medical care and health care utilization.

OBJECTIVES: As health care moves toward systems that assume accountability for defined populations, there has been increasing emphasis on developing performance measures for those systems and their providers, with little attention given to patient demand or attitudinal factors. The impact of skepticism toward health care providers on health behavior and health care utilization was assessed using a cross-sectional analysis of data from the 1987 National Medical Expenditure Survey (NMES). METHODS: A nationally representative sample from the United States comprising 18,240 persons 25 years and older was surveyed. Skepticism, defined as doubts about the ability of conventional medical care to appreciably alter one's health status, was assessed through a 4-item scale. Outcome measures included health behavior, access (health care insurance, having a regular source of care, and physician type), utilization (annual number of physician or emergency department visits and hospitalizations), total annual health care expenditures, and preventive health care behavior (having had a Pap smear within 3 years or ever having had a mammogram). RESULTS: In multivariate analyses, skepticism was associated with younger age, white race, lower income, less education, and higher health perceptions. After adjusting for these variables, skepticism was associated with less healthy behavior, with not having health insurance, not having one's own physician, choice of a physician, fewer physician and emergency department visits, less frequent hospitalizations, lower annual health care expenditures, and less prevention compliance. CONCLUSIONS: Medical skepticism represents a relevant patient demand factor that demonstrates significant associations with a variety of health care access and utilization measures with important policy implications.

Adult↗
PubMed1999

A population-based study of age and gender differences in patterns of health-related behaviors.

PURPOSE: Most research on preventive health behaviors has focused on individual rather than groups of behaviors. This study examined interrelationships among multiple preventive health behaviors in different age and gender groups. METHODS: From 1990 to 1992, Maryland residents were surveyed by telephone through the Behavioral Risk Factor Surveillance System. The study sample of 4455 was divided into 8 groups based on age (18-24, 25-39, 40-54, and 55+) and gender. Correlation and oblique rotated factor analyses were used to examine patterns of 8 to 11 preventive health behaviors in each age-gender group. RESULTS: Medical checkup and cholesterol test formed one behavioral cluster in the four male age groups. Breast and cervical cancer screening (mammogram, clinical breast examination [CBE], and Pap Smear) did not form one cluster until age 55 or older; Pap smear, CBE formed one cluster for women of all ages. Risk-taking behaviors were only prominent in the youngest age group: Seatbelt non-use, smoking, and drinking formed one cluster in younger males, and drinking and driving after drinking clustered in younger females. CONCLUSION: Screening and risk-taking behaviors form distinct groups, and behavioral patterns differ by age and gender. Public health programs should consider multi-behavioral approaches, and be sensitive to the gender and age of the target population.

Adolescent↗
PubMedDate not supplied

Health promoting behaviors among rural southern early adolescents.

A central element in attaining the goals and objectives of Healthy People 2010 is promoting healthy behavior lifestyles. Health promotion continues to be sanctioned as the long term most cost effective approach to a reduction in preventable health problems. Adolescents are presently an age group in jeopardy of making the transition into adulthood with healthy lifestyles. This paper describes the use of the Health Promoting Lifestyle Profile (HPLP) (Walker, Sechrist, and Pender, 1987) as a measure of health promoting behaviors in a group of rural southern early adolescents (1036 seventh and eight graders; 81% were African American). The findings suggest that rural southern adolescents perceive themselves to be enganging in health promoting lifestyle behaviors. However, some HPLP subscales seemed to be especially difficult for adolescents.

Adolescent↗
PubMedDate not supplied

The Youth Risk Behavior Surveillance System: measuring health-risk behaviors.

OBJECTIVE: To measure priority health-riskbehaviors among youth. METHODS: The Youth Risk Behavior Surveillance System (YRBSS) monitors priority health-risk behaviors among youth. RESULTS: In 1999, many high school students practiced behaviors that contribute to leading health problems--16.4% rarely or never wore safety belts and, during the past 30 days, 17.3% carried a weapon, 34.8% smoked cigarettes, and 26.7% used marijuana. Also, 49.9% had had sexual intercourse. One quarter (26.0%) were at risk for becoming overweight or were overweight. CONCLUSION: YRBSS data are used to improve policies and programs to reduce priority health-risk behaviors among youth.

Adolescent↗
PubMed2005

Health seeking behaviors of African Americans: implications for health administration.

Disparities in health care and good health between African Americans and other populations while established in the literature are traditionally based on socioeconomic measures of race, income, age, and education (Bailey, 2000; Lillie-Blanton, Brodie, Rowland, Altman and McIntosh, 2000; Ren and Amick, 1996; Watson, 2001; Weinick, Zuvekas, and Cohen, 2000). This study broadens the scope by exploring how sociocultural (poverty, racism, prejudice, and discrimination) and psychosocial factors (perceived health status, the lack of personal efficacy in contributing to decisions about health care. feelings of helplessness, and the lack of trust in the health care providers) relate to health-seeking behaviors of African Americans (Bailey, 1991; Ren and Amick, 1996, Watson, 2001). Interviews were conducted with 111 African American adult patients at a community health center, focusing on health-seeking behaviors, and sociocultural and psychosocial factors. Results suggest that when these negative factors are removed, the health seeking behaviors of African Americans closely mirror the behaviors of the majority population. Subjects did not view themselves in poorer health, fail to seek medical attention when needed, or distrust their primary health care providers. In general, fears associated with health care were attributed to illness rather than health care providers, although a weak linkage was found between patient self-esteem and fear or dislike of future treatment by physicians (adj R2= .362, S.E. =15, F=21, sig. <.001). The study highlights the need for further study in two areas: cultural competency of health care providers, especially those from Asia and Africa who are often assigned to community health centers, and the impact of an accessible community health center on the health seeking behaviors and health status of predominately African American communities.

Adult↗
PubMed1998

Effectiveness of a personalized Health Profile for blue-collar workers.

This article describes a study on the effectiveness of a Health Profile that was offered to blue-collar workers. The major goal of the Health Profile was to improve workers' awareness of own health behaviors and their intentions to change unhealthy behaviors. The Health Profile consisted of a booklet in A4-format in which tailored information was given on health behaviors. A pretest and posttest design (no control group) was used. The results showed a significant improvement of awareness of own health behaviors. Significant attitudinal changes were also achieved. There were no changes in social support and self-efficacy nor was there a change in the intention to change behaviors. These results suggest that a personalized Health Profile is a promising means to make workers aware of their personal risk behaviors.

Adult↗
PubMed1993

Social relationships and health-related behavior.

The relationship of social ties to health behavior is studied in this paper. The general hypothesis tested is that those with social relationships are more likely to avoid health damaging behavior. Patterns regarding specific social ties and particular health behaviors are examined. Findings indicate the relationships of spouse, organization member, and friend are related to preventive health behavior; spouses are less likely smokers, drinkers, and heavy drinkers. The friend relationship is related to decreased smoking behavior, while the employee relationship is related to increased drinking. A consistent predictor of health behaviors is the social tie of organization member. People with relationships as organization members are more likely always to wear seat belts, smoke and drink less, and consume lower amounts of these substances.

Adult↗
PubMed2004

Health differences among Lumbee Indians using public and private sources of care.

CONTEXT: Of 2.4 million American Indians, approximately 60% are eligible to receive Indian Health Service (IHS) benefits, leaving many to seek care elsewhere. It is unknown if their quality of care, health behaviors, and health status vary by source of care, as demonstrated for other populations. PURPOSE: The purpose of this study was to determine whether preventive services, health behaviors, and number of health conditions vary as a function of having non-IHS public versus private physicians as sources of usual care. METHODS: 1,177 Lumbee Indians, who are ineligible to receive IHS services, completed a telephone interview that included information on receipt of preventive measures, tobacco use, physical activity, breast self-examination, and medical conditions. Frequencies, chi-squares, t tests, odds ratios, and confidence intervals were used to compare variables by source of care. FINDINGS: 939 respondents (80%) had a private and 210 (18%) a public health clinic physician as their usual source of care; 28 (2%) reported having neither. Logistic regression analyses, restricted to the 1,149 participants who reported either a private or public source of care, revealed no differences in receipt of preventive services or health status by usual source of care. Smokeless tobacco use was less common among persons using private than public providers. CONCLUSIONS: Lumbees whose usual source of care was a public clinic physician did not differ in receipt of preventive services or in health status compared to their counterparts who received care from a private physician. More targeted research into health similarities and differences arising from access to public and private sources of care is warranted.

Adult↗
PubMed2003

Influence of health risk behavior and socio-economic status on health of Slovak adolescents.

AIM: To investigate the role of health risk behavior, such as smoking and alcohol consumption, in the explanation of socio-economic health differences among adolescents. The hypothesis of different exposure and the hypothesis of different vulnerability were explored. METHOD: In the study carried out in 1998, the prevalence of health complaints of smokers vs non-smokers, alcohol consumers vs abstainers, and among different socio-economic groups of 2,616 Slovak adolescents (mean age, 14.9-/+0.62 years) were investigated by means of self-reported questionnaires. The adolescents were stratified according to sex and type of secondary school. RESULTS: Socio-economic disadvantage and the presence of health risk behavior were associated with greater frequency of health complaints by adolescents. Prevalence of smokers was higher in lower socio-economic groups, but no such trend was found for the prevalence of alcohol consumers. Socio-economic status and health risk behavior interactively influenced health, when socio-economic status was assessed according to the mother's characteristics. Socio-economic health differences between non-smokers and abstainers were not significant, unlike the differences between the smokers and alcohol consumers. The influence of health risk behavior was weaker in higher socio-economic groups. CONCLUSION: Both hypotheses, of different exposure and different vulnerability, could explain socio-economic health differences among Slovak adolescents, with different exposure playing a more important role.

Adolescent↗
PubMed2002

Associations between health-related behaviors: a 7-year follow-up of adults.

BACKGROUND: The study examines pairwise associations between smoking, alcohol use, physical activity, dietary behavior and body mass index using long-term follow-up data of Finnish adults. METHODS: Respondents to large nationwide health behavior surveys conducted in 1989/1990 were recontacted in 1997. First, we examined whether each health behavior predicted other behaviors 7 years later. Second, we examined whether changes in each health behavior were accompanied by changes in other behaviors. RESULTS: Smoking at baseline predicted all other health behaviors except body mass index in men. On the other hand, other behaviors tended to predict smoking. Physical inactivity and unhealthy diet were predictive of each other in men. Those with an unhealthy diet at baseline were less likely to be high alcohol users in the follow-up. Baseline body mass index did not predict any of the other behaviors. Concurrent changes in health behaviors involved either smoking or body mass index. Changes in diet and alcohol use were differently related to changes in body mass index in men than in women. CONCLUSIONS: Overall, smoking seemed to play a central role in the associations between health behaviors. Smoking was predictive of most other health behaviors. Concurrent changes in health behaviors related either to smoking or to body weight. The associations between health behaviors were fairly similar for men and women, but the variation in the associations between body mass index and some other health behaviors suggests gender differences in the behavioral response to body weight.

Adult↗
PubMedDate not supplied

Changing public behavior for better health: is education enough?

While education programs are essential for changing public health behavior, they are not sufficient. Examples drawn from campaigns to reduce drunk driving and to increase the use of child safety seats, seat belts, and motorcycle helmets illustrate how education--both public information and more formalized education--can help catalyze other actions. However, by itself, education has not generally resulted in significant changes in the behaviors targeted. On the other hand, education of the public and advocacy groups has often helped enact necessary legislation. This sequence has frequently resulted in major behavioral changes. Even in such cases, however, when enforcement is inconsistent, public compliance frequently decreases. Education is an important first step in changing public behavior for better health.

Accidents, Traffic↗
PubMed1986

Health protective behaviors in first year medical students.

Individual health behaviors are an important aspect of preventive care. A survey of 164 entering medical students examined their health protective behaviors, including the three things they most frequently did to protect their health and thirty specific health behaviors studied in a previous analysis of the general population. The first semester results show similarities between the students and the general population. Diet and sleep were among the most important health protective behaviors in students and the population, but exercise and relaxation/stress control were more prevalent in students than in the public. Medical students were much more likely to be nonsmokers and wear seat belts than the public, but less likely to get regular checkups or see doctors when they felt healthy. Students also reported fewer personal safety and accident prevention behaviors. A resurvey at the beginning of the second semester showed a very high consistency with original behaviors. Among the students there were few health behavior differences by sex and martial status. These findings suggest students in medical school practice common but not extensive health protective behaviors which do not decline severely upon entry to medical school.

Attitude to Health↗
PubMed2001

Korean adolescents' health risk behaviors and their relationships with the selected psychological constructs.

PURPOSE: To explore the negative health behaviors of Korean adolescents, reveal factors affecting their negative health behavior, and present a substantial correlation model between the negative health behaviors and psychological factors. METHODS: A total of 2124 adolescents randomly selected from junior high and high schools in Seoul were surveyed. Four Korean-version instruments were used to identify the negative health behavior and psychological construct of adolescents: Adolescent Health Survey, Health Locus of Control scale, Self-Esteem scale, and Self-Efficacy scale. RESULTS: Korean adolescents showed high prevalence of smoking, drinking alcohol, bad eating habits, and viewing pornography; and very low prevalence, however, of sexual intercourse and illegal drug use. In addition to this, the findings revealed that the subdomains in adolescents' negative health behavior were statistically correlated with the subdimensions of a psychological factor. A correlation model was an adequate fit to identify a possible relationship between the negative health behaviors and the psychological factors. CONCLUSIONS: This study provides significant and new information about the relatively unstudied Korean adolescents and has the potential to influence the development of better health education and health psychology.

Adolescent↗
PubMed1993

Testing four competing theories of health-protective behavior.

Four competing theories of health-protective behavior are reviewed: the health belief model, the theory of reasoned action, protection motivation theory, and subjective expected utility theory. In spite of their commonalities, these models are seldom tested against one another. The review points out the similarities and differences among these theories and the data and analyses needed to compare them. In addition to describing the content of the models, their conceptualization of key variables, and the combinatorial rules used to make predictions, some general problems in theory development and testing for health behaviors are examined. The article's goal is to help investigators design studies that will clarify the strengths and weaknesses of these models, leading toward a better understanding of health behavior.

Attitude to Health↗