Bauer, Amy M.; Collins, Laura; Dugdale, David C.
Abstract Depression is one of the more common diagnoses encountered in primary care, and primary care in turn provides the majority of care for patients with depression. Many approaches have been tried in efforts to improve the outcomes of depression management. This article outlines the partnership between the University of Washington (UW) Neighborhood Clinics and the UW Department of Psychiatry in implementing a collaborative care approach to integrating the management of anxiety and depression in the ambulatory primary care setting. This program was built on the chronic care model, which utilizes a team approach to caring for the patient. In addition to the patient and the primary care provider (PCP), the team included a medical social worker (MSW) as care manager and a psychiatrist as team consultant. The MSW would manage a registry of patients with depression at a clinic with several PCPs, contacting the patients on a regular basis to assess their status, and consulting with the psychiatrist on a weekly basis to discuss patients who were not achieving the goals of care. Any recommendation (eg, a change in medication dose or class) made by the psychiatrist was communicated to the PCP, who in turn would work with the patient on the new recommendation. This collaborative care approach resulted in a significant improvement in the number of patients who achieved care plan goals. The authors believe this is an effective method for health systems to integrate mental health services into primary care. (Population Health Management 2016;19:81–87) PMID:26348355
Hine, Jeffrey F; Grennan, Allison Q; Menousek, Kathryn M; Robertson, Gail; Valleley, Rachel J; Evans, Joseph H
As the benefits of integrated behavioral health care services are becoming more widely recognized, this study investigated physician satisfaction with ongoing integrated psychology services in pediatric primary care clinics. Data were collected across 5 urban and 6 rural clinics and demonstrated the specific factors that physicians view as assets to having efficient access to a pediatric behavioral health practitioner. Results indicated significant satisfaction related to quality and continuity of care and improved access to services. Such models of care may increase access to care and reduce other service barriers encountered by individuals and their families with behavioral health concerns (ie, those who otherwise would seek services through referrals to traditional tertiary care facilities).
McQuestion, Michael J.; Calle, Ana Quijano; Drasbek, Christopher; Harkins, Thomas; Sagastume, Lourdes J.
This study explores the effects of social integration on behavioral change in the course of an intensive, community-based public health intervention. The intervention trained volunteers and mobilized local organizations to promote 16 key family health practices in rural San Luis, Honduras, during 2004 to 2006. A mixed methods approach is used.…
Kramer, Kathryn D.; Geller, E. Scott
The article examines community dental health promotion for children in terms of factors impacting children's dental health (water fluoridation, dental health education, behavior change strategies, use of dental services, and dental phobias). Proposed is a large scale behavior change approach to public dental health which integrates applied…
Ratzliff, Anna; Phillips, Kathryn E.; Sugarman, Jonathan R.; Unützer, Jürgen; Wagner, Edward H.
Behavioral health problems are common, yet most patients do not receive effective treatment in primary care settings. Despite availability of effective models for integrating behavioral health care in primary care settings, uptake has been slow. The Behavioral Health Integration Implementation Guide provides practical guidance for adapting and implementing effective integrated behavioral health care into patient-centered medical homes. The authors gathered input from stakeholders involved in behavioral health integration efforts: safety net providers, subject matter experts in primary care and behavioral health, a behavioral health patient and peer specialist, and state and national policy makers. Stakeholder input informed development of the Behavioral Health Integration Implementation Guide and the GROW Pathway Planning Worksheet. The Behavioral Health Integration Implementation Guide is model neutral and allows organizations to take meaningful steps toward providing integrated care that achieves access and accountability. PMID:26698163
Kurti, Allison N; Dallery, Jesse
The use of mobile devices is growing worldwide in both industrialized and developing nations. Alongside the worldwide penetration of web-enabled devices, the leading causes of morbidity and mortality are increasingly modifiable lifestyle factors (e.g., improving one's diet and exercising more). Behavior analysts have the opportunity to promote health by combining effective behavioral methods with technological advancements. The objectives of this paper are (1) to highlight the public health gains that may be achieved by integrating technology with a behavior analytic approach to developing interventions, and (2) to review some of the currently, under-examined issues related to merging technology and behavior analysis (enhancing sustainability, obtaining frequent measures of behavior, conducting component analyses, evaluating cost-effectiveness, incorporating behavior analysis in the creation of consumer-based applications, and reducing health disparities). Thorough consideration of these issues may inspire the development, implementation, and dissemination of innovative, efficacious interventions that substantially improve global public health.
KURTI, ALLISON N.; DALLERY, JESSE
The use of mobile devices is growing worldwide in both industrialized and developing nations. Alongside the worldwide penetration of web-enabled devices, the leading causes of morbidity and mortality are increasingly modifiable lifestyle factors (e.g., improving one’s diet and exercising more). Behavior analysts have the opportunity to promote health by combining effective behavioral methods with technological advancements. The objectives of this paper are (1) to highlight the public health gains that may be achieved by integrating technology with a behavior analytic approach to developing interventions, and (2) to review some of the currently, under-examined issues related to merging technology and behavior analysis (enhancing sustainability, obtaining frequent measures of behavior, conducting component analyses, evaluating cost-effectiveness, incorporating behavior analysis in the creation of consumer-based applications, and reducing health disparities). Thorough consideration of these issues may inspire the development, implementation, and dissemination of innovative, efficacious interventions that substantially improve global public health. PMID:25774070
Cerully, Jennifer L.; Collins, Rebecca L.; Wong, Eunice C.; Seelam, Rachana; Roth, Elizabeth; Yu, Jennifer
Abstract Describes the methods and results of a RAND evaluation of the Integrated Behavioral Health Project's efforts to promote the integration of mental and physical health care among various health care stakeholders in California. PMID:28083420
Kolko, David J; Perrin, Ellen
Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.
Kolko, David J.; Perrin, Ellen C.
Objective Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This paper examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. Method This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices (EBP), and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. Results There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and addressing methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Discussion Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare. PMID:24588366
Monson, Samantha Pelican; Sheldon, J Christopher; Ivey, Laurie C; Kinman, Carissa R; Beacham, Abbie O
The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.
Torrence, Nicole D; Mueller, Anne E; Ilem, Allison A; Renn, Brenna N; DeSantis, Brian; Segal, Daniel L
Integrated behavioral health increases service utilization and treatment success, particularly with high-risk populations. This study assessed medical personnel's attitudes and perceptions of behavioral health clinicians (BHCs) in primary care using a brief self-report measure. A 6-item survey was given to medical providers (n = 45) from a health care system that includes integrated behavioral health services. Survey items assessed providers' attitudes and perceptions about BHCs. Attitudes about behavioral health were largely favorable. For all items, 73.3% to 100% of participants endorsed strongly agree or agree. Chi-square analyses revealed that those who interacted more frequently with BHCs were more comfortable discussing behavioral health issues with their patients, χ²(6, n = 45) = 13.43, p < .05, and that physicians believe that BHCs help patients effectively address their behavioral health problems, χ²(2, n = 45) = 6.36, p < .05. Age, gender, and health center in which the providers worked were not significantly related to any survey items. Medical providers surveyed believe that BHCs are valuable members of integrated health care, improving their abilities to provide care and to address their patients' physical and behavioral health problems. Although these preliminary results are promising, the setting surveyed has well-integrated behavioral health care services and thus might not be representative of other settings without such integration. Future studies should address medical providers' opinions of BHCs in a variety of settings with larger samples.
Klein, William M P; Grenen, Emily G; O'Connell, Mary; Blanch-Hartigan, Danielle; Chou, Wen-Ying Sylvia; Hall, Kara L; Taber, Jennifer M; Vogel, Amanda L
Health behaviors often co-occur and have common determinants at multiple levels (e.g., individual, relational, environmental). Nevertheless, research programs often examine single health behaviors without a systematic attempt to integrate knowledge across behaviors. This paper highlights the significant potential of cross-cutting behavioral research to advance our understanding of the mechanisms and causal factors that shape health behaviors. It also offers suggestions for how researchers could develop more effective interventions. We highlight barriers to such an integrative science along with potential steps that can be taken to address these barriers. With a more nuanced understanding of health behavior, redundancies in research can be minimized, and a stronger evidence base for the development of health behavior interventions can be realized.
Fleming, Theresa; Lucassen, Mathijs FG; Bridgman, Heather; Stasiak, Karolina; Shepherd, Matthew; Orpin, Peter
Background Internet interventions for improving health and well-being have the potential to reach many people and fill gaps in service provision. Serious gaming interfaces provide opportunities to optimize user adherence and impact. Health interventions based in theory and evidence and tailored to psychological constructs have been found to be more effective to promote behavior change. Defining the design elements which engage users and help them to meet their goals can contribute to better informed serious games. Objective To elucidate design elements important in SPARX, a serious game for adolescents with depression, from a user-centered perspective. Methods We proposed a model based on an established theory of health behavior change and practical features of serious game design to organize ideas and rationale. We analyzed data from 5 studies comprising a total of 22 focus groups and 66 semistructured interviews conducted with youth and families in New Zealand and Australia who had viewed or used SPARX. User perceptions of the game were applied to this framework. Results A coherent framework was established using the three constructs of self-determination theory (SDT), autonomy, competence, and relatedness, to organize user perceptions and design elements within four areas important in design: computer game, accessibility, working alliance, and learning in immersion. User perceptions mapped well to the framework, which may assist developers in understanding the context of user needs. By mapping these elements against the constructs of SDT, we were able to propose a sound theoretical base for the model. Conclusions This study’s method allowed for the articulation of design elements in a serious game from a user-centered perspective within a coherent overarching framework. The framework can be used to deliberately incorporate serious game design elements that support a user’s sense of autonomy, competence, and relatedness, key constructs which have been found
Scott, Victoria C; Kenworthy, Tara; Godly-Reynolds, Erin; Bastien, Gilberte; Scaccia, Jonathan; McMickens, Courtney; Rachel, Sharon; Cooper, Sayon; Wrenn, Glenda; Wandersman, Abraham
Integration of behavioral health and primary care services is a promising approach for reducing health disparities. The growing national emphasis on care coordination has mobilized efforts to integrate behavioral health and primary care services across the United States. These efforts align with broader health care system goals of improving health care quality, health equity, utilization efficiency, and patient outcomes. Drawing from our work on a multiyear integrated care initiative (Integrated Care Leadership Program; ICLP) and an implementation science heuristic for organizational readiness (Readiness = Motivation x General Capacity and Innovation-Specific Capacity; R = MC2), this article describes the development and implementation of a tool to assess organizational readiness for integrated care, referred to as the Readiness for Integrated Care Questionnaire (RICQ). The tool was piloted with 11 health care practices that serve vulnerable, underprivileged populations. Initial results from the RICQ revealed that participating practices were generally high in motivation, innovation-specific capacities, and general capacities at the start of ICLP. Additionally, analyses indicated that practices particularly needed support with increasing staff capacities (general knowledge and skills), improving access to and use of resources, and simplifying the steps in integrating care so the effort appears less daunting and difficult to health care team members. We discuss insights from the initial use of RICQ and practical implications of the new tool for driving integrated care efforts that can contribute to health equity. (PsycINFO Database Record
Thai, Le; Saw, Anne
Health equity for individuals with serious mental illness (SMI) requires collaborative partnerships between primary care and behavioral health organizations. This paper presents the experiences and perspectives of a nurse practitioner in a large-scale pilot program to integrate primary care and behavioral health between an FQHC and a community mental health center, both serving predominantly Asian immigrant populations. This paper discusses lessons learned through program implementation and provides insights on developing a truly integrated system involving equal and full cooperation across disciplines to provide quality and holistic care for patients with SMI. Implications for clinical practice and policy are discussed. PMID:26900384
Pourat, Nadereh; Hadler, Max W; Dixon, Brittany; Brindis, Claire
More than 70 percent of behavioral health conditions are first diagnosed in the primary care setting. Yet physical and behavioral health care are typically provided separately, compelling many vulnerable patients to navigate the complexities of two separate systems of care. This policy brief examines five community health centers (CHCs) in California that have taken preliminary steps toward creating "one-stop shopping" for both physical and behavioral health care. The steps taken to increase integration by the CHCs include employing behavioral health providers, using a single electronic health record that includes both physical and behavioral health data, transforming the physical space, and developing mechanisms for effective transition of patients between providers. The findings emphasize the importance of changes to Medi-Cal reimbursement policies to promote same-day visits, as well as the importance of cultural changes to integrate behavioral health. They also highlight the need for comprehensive tools to assess and promote integration and to identify solutions for the most challenging activities required to achieve full integration.
Theis, Gerald A; Kozlowski, Deirdre; Behrens, Jenna
The escalating health care costs attributed to high-risk populations have fueled a need for a proactive approach to deal with people affected by complex mental health issues that often coexist with chronic medical conditions. Through an in-home behavioral health case management (CM) program, patients with mental illnesses (some with coexisting medical conditions) receive integrated medical and mental health services through a disease-management approach that has proven effective in treating high-risk patients.
Yoo, Sun-Wook; Kim, Jarim; Lee, Yeunjae
Social media have recently gained attention as a potential health campaign tool. This study examines this line of expectation concerning the role social media may play in health campaigns by testing an integrated health campaign model that combines insights from research on social media-specific perceptions and communicative behaviors in order to predict health behaviors. Specifically, this study aims to (a) develop a more holistic social media campaign model for predicting health behaviors in the social media context, (b) investigate how social media channel-related perceptions affect preventive health behaviors, and (c) investigate how communicative behaviors mediate perceptions and behavioral intention. The study conducted an online survey of 498 females who followed the Purple Ribbon Twitter campaign (@pprb), a cervical cancer prevention campaign. The results indicated that information acquisition mediated perceived risk's effect on intention. Information acquisition also mediated the relationships between intention and information selection and information transmission. On the other hand, social media-related perceptions indirectly impacted behavioral intention through communicative behaviors. The findings' theoretical and practical implications are discussed.
Christy, Shannon M; Mosher, Catherine E; Rawl, Susan M
Colorectal cancer (CRC) is the third most common cause of cancer deaths among men in the United States. Although CRC screening has been found to reduce CRC incidence and mortality, current screening rates among men are suboptimal due to various practical and psychosocial barriers. One potential barrier to CRC screening identified in qualitative studies with men is the threat to masculinity that endoscopic screening methods pose. Indeed, beliefs about masculinity have been predictive of other preventive health behaviors among men. In this review article, we propose a novel conceptual framework to explain men's CRC screening behavior that integrates masculinity norms, gender role conflict, men's health care experiences, behaviors, and beliefs, and social and background variables. This framework has the potential to guide future research on men's CRC screening behaviors and other health behaviors and may inform gender-sensitive interventions that target masculinity beliefs to increase preventive health behaviors.
Christy, Shannon M.; Mosher, Catherine E.; Rawl, Susan M.
Colorectal cancer (CRC) is the third most common cause of cancer deaths among men in the United States. Although CRC screening has been found to reduce CRC incidence and mortality, current screening rates among men are suboptimal due to various practical and psychosocial barriers. One potential barrier to CRC screening identified in qualitative studies with men is the threat to masculinity that endoscopic screening methods pose. Indeed, beliefs about masculinity have been predictive of other preventive health behaviors among men. In this review paper, we propose a novel conceptual framework to explain men’s CRC screening behavior that integrates masculinity norms, gender role conflict, men’s health care experiences, behaviors, and beliefs, and social and background variables. This framework has the potential to guide future research on men’s CRC screening behaviors and other health behaviors and may inform gender-sensitive interventions which target masculinity beliefs to increase preventive health behaviors. PMID:23813927
Miller, Benjamin F; Ross, Kaile M; Davis, Melinda M; Melek, Stephen P; Kathol, Roger; Gordon, Patrick
The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet. However, challenges to implementing the PCMH framework are compounded for real-world practitioners because payment reform rarely happens concurrently. Nowhere is this more evident than in attempts to integrate behavioral health clinicians into primary care. As behavioral health clinicians find opportunities to work in integrated settings, a comprehensive understanding of payment models is integral to the dialogue. This article describes alternatives to the traditional fee for service (FFS) model, including modified FFS, pay for performance, bundled payments, and global payments (i.e., capitation). We suggest that global payment structures provide the best fit to enable and sustain integrated behavioral health clinicians in ways that align with the Triple Aim. Finally, we present recommendations that offer specific, actionable steps to achieve payment reform, complement PCMH, and support integration efforts through policy. (PsycINFO Database Record
Fluet, Norman R.; Reis, Michael D.; Stern, Charles H.; Thompson, Alexander W.; Jolly, Gillian A.
The integration of behavioral health services in primary care has been referred to in many ways, but ultimately refers to common structures and processes. Behavioral health is integrated into primary care because it increases the effectiveness and efficiency of providing care and reduces costs in the care of primary care patients. Reimbursement is one factor, if not the main factor, that determines the level of integration that can be achieved. The federal health reform agenda supports changes that will eventually permit behavioral health to be fully integrated and will allow the health of the population to be the primary target of intervention. In an effort to develop more integrated services at Baylor Scott and White Healthcare, models of integration are reviewed and the advantages and disadvantages of each model are discussed. Recommendations to increase integration include adopting a disease management model with care management, planned guideline-based stepped care, follow-up, and treatment monitoring. Population-based interventions can be completed at the pace of the development of alternative reimbursement methods. The program should be based upon patient-centered medical home standards, and research is needed throughout the program development process. PMID:27034543
Simmons, Leigh Ann; Wolever, Ruth Q
As rates of preventable chronic diseases and associated costs continue to rise, there has been increasing focus on strategies to support behavior change in healthcare. Health coaching and motivational interviewing are synergistic but distinct approaches that can be effectively employed to achieve this end. However, there is some confusion in the literature about the relationship between these two approaches. The purpose of this review is to describe a specific style of health coaching-integrative health coaching-and motivational interviewing, including their origins, the processes and strategies employed, and the ways in which they are similar and different. We also provide a case example of how integrative health coaching and motivational interviewing might be employed to demonstrate how these approaches are synergistic but distinct from each other in practice. This information may be useful for both researchers and clinicians interested in investigating or using behavior change interventions to improve health and cost outcomes in chronic disease.
Wolever, Ruth Q.
As rates of preventable chronic diseases and associated costs continue to rise, there has been increasing focus on strategies to support behavior change in healthcare. Health coaching and motivational interviewing are synergistic but distinct approaches that can be effectively employed to achieve this end. However, there is some confusion in the literature about the relationship between these two approaches. The purpose of this review is to describe a specific style of health coaching—integrative health coaching—and motivational interviewing, including their origins, the processes and strategies employed, and the ways in which they are similar and different. We also provide a case example of how integrative health coaching and motivational interviewing might be employed to demonstrate how these approaches are synergistic but distinct from each other in practice. This information may be useful for both researchers and clinicians interested in investigating or using behavior change interventions to improve health and cost outcomes in chronic disease. PMID:24416683
Gillen, Emily M.; Hassmiller Lich, Kristen; Yeatts, Karin B.; Hernandez, Michelle L.; Smith, Timothy W.; Lewis, Megan A.
This article describes a process for integrating health behavior and social science theories with practice-based insights using participatory systems thinking and diagramming methods largely inspired by system dynamics methods. This integration can help close the gap between research and practice in health education and health behavior by offering…
Vogel, Mark E; Kanzler, Kathryn E; Aikens, James E; Goodie, Jeffrey L
Integrated behavioral health in primary care has spread rapidly over the past three decades, although significant questions remain unanswered regarding best practices in clinical, financial and operational worlds. Two key models have emerged over time: care management and Primary Care Behavioral Health. Research to date has been promising; however, there is a significant need for more sophisticated multi-level scientific methodologies to fill in the gaps in current knowledge of integrated primary care. In this paper, we summarize current scientific knowledge about integrated primary care and critically evaluate the strengths and weaknesses of this knowledge base, focusing on clinical, financial and operational factors. Finally, we recommended priorities for future research, dissemination, real-world implementation, and health policy implications.
Horevitz, Elizabeth; Manoleas, Peter
The Affordable Care Act has led to a widespread movement to integrate behavioral health services into primary care settings. Integrated behavioral health (IBH) holds promise for treating mild to moderate psychiatric disorders in a manner that more fully addresses the biopsychosocial spectrum of needs of individuals and families in primary care, and for reducing disparities in accessing behavioral health care. For behavioral health practitioners, IBH requires a shift to a brief, outcome-driven, and team-based model of care. Despite the fact that social workers comprise the majority of behavioral health providers in IBH settings, little research has been done to assess the extent to which social workers are prepared for effective practice in fast-paced primary care. We conducted a survey of social workers (N = 84) in IBH settings to assess the following: (1) Key competency areas for social work practice in IBH settings and (2) Self-rated preparedness for effective practice in IBH settings. Online snowball sampling methods were used over a period of 1 month. Results indicate that social workers feel prepared for general practice in IBH settings, but would benefit from additional training in IBH-specific competency areas identified in the survey. Findings can help guide social work training to improve workforce preparedness for practice in IBH settings in the wake of health care reform.
Harrison, Albert A
"Safe Passage: Astronaut Care for Exploration Missions," (Ball JR, Evans CH, eds. Washington, DC: National Academy Press; 2001) draws attention to behavioral health, an overarching topic that subsumes psychological, interpersonal, and cultural adaptation in space. On December 2-3, 2003, the University of California, Davis, was the site of a NASA-funded workshop entitled "New Directions in Behavioral Health: Integrating Research and Application." The purpose of the Workshop was to promote fruitful dialogue between researchers and operational personnel in the interests of expanding our understanding of behavioral health on Exploration missions including a return to the Moon and a voyage to Mars. This paper presents an overview of the rationale and findings of that workshop.
Manderscheid, Ron; Kathol, Roger
The integration of behavioral health (BH) and primary care services has been the subject of considerable attention for almost a decade. Such work has been motivated by the prevalence of chronic health problems in persons with BH conditions and correspondingly high rates of early death. Service integration efforts typically included cross-referral or bidirectional efforts to add some features of primary care to specialty BH settings or the reverse. This article proposes a third approach based on full service and financial integration and shows how it differs substantially from the other 2 models. This new model has the potential to bring much-needed BH services to persons served in primary care settings who have these conditions, while fostering integrated services in specialty settings for those with the most severe mental or substance use conditions. The Patient Protection and Affordable Care Act could provide a valuable opportunity to implement this third model.
Phatisena, Panida; Eaksanti, Tawatchai; Wichantuk, Pitsanee; Tritipsombut, Jaruwan; Kaewpitoon, Soraya J; Rujirakul, Ratana; Wakkhuwattapong, Parichart; Tongtawee, Taweesak; Matrakool, Likit; Panpimanmas, Sukij; Norkaew, Jun; Kujapun, Jirawoot; Chavengkun, Wasugree; Kompor, Porntip; Pothipim, Mali; Ponphimai, Sukanya; Padchasuwan, Natnapa; Kaewpitoon, Natthawut
This study aimed to modify behavior regarding liver fluke and cholangiocarcinoma prevention in Chumphuang district, Nakhon Ratchasima province, Thailand through integrated learning. A total of 180 participants were included through purposive selection of high-risk scores on verbal screening. Participants attended the health education program which applied the health belief model included family based, knowledge station based, academic merit based and community based learning. Data were collected using a questionnaire composed of 4 parts: 1) personal information, 2) knowledge, 3) perceived susceptibility, severity, benefits, and barriers, 4) practice regarding liver fluke and cholangiocarcinoma prevention. The result revealed that the majority were female (79.9%), age ≥60 years old (33.2%), primary school educational level (76.1%), and agricultural occupation (70.1%). The mean scores of knowledge, perception, and practice to liver fluke and cholangiocarcinoma prevention, before participated the integrative learning were low, moderate, and low, respectively. Meanwhile, the mean score of knowledge, perceived susceptibility, severity, benefits, and barriers, and practice regarding liver fluke and cholangiocarcinoma prevention, were higher with statistical significance after participation in the integrated learning. This finding indicates that health education programs may successfully modify health behavior in the rural communities. Therefore they may useful for further work behavior modification in other epidemic areas.
Steinfeld, Bradley; Franklin, Allie; Mercer, Brian; Fraynt, Rebecca; Simon, Greg
Progress monitoring implementation in an integrated health care system is a complex process that must address factors such as measurement, technology, delivery system care processes, patient needs and provider requirements. This article will describe how one organization faced these challenges by identifying the key decision points (choice of measure, process for completing rating scale, interface with electronic medical record and clinician engagement) critical to implementation. Qualitative and quantitative data will be presented describing customer and stakeholder satisfaction with the mental health progress monitoring tool (MHPMT) as well as organizational performance with key measurement targets.
Dickinson, W Perry
The articles in this supplement contain a wealth of practical information regarding the integration of behavioral health and primary care. This type of integration effort is complex and greatly benefits from support from outside organizations, as well as collaboration with other practices attempting similar work. This editorial extracts from these articles some of the key lessons learned regarding the integration of behavioral health and primary care for practices and for organizations that support practice transformation.
Merrick, Elizabeth S Levy; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M; Greenfield, Shelly F; McCann, Bernard
New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral health care (MBHC) organization's integrated EAP/MBHC product (N = 1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan, and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of the clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes.
Schueller, Stephen M; Montague, Enid; Burns, Michelle Nicole; Rashidi, Parisa
A growing number of investigators have commented on the lack of models to inform the design of behavioral intervention technologies (BITs). BITs, which include a subset of mHealth and eHealth interventions, employ a broad range of technologies, such as mobile phones, the Web, and sensors, to support users in changing behaviors and cognitions related to health, mental health, and wellness. We propose a model that conceptually defines BITs, from the clinical aim to the technological delivery framework. The BIT model defines both the conceptual and technological architecture of a BIT. Conceptually, a BIT model should answer the questions why, what, how (conceptual and technical), and when. While BITs generally have a larger treatment goal, such goals generally consist of smaller intervention aims (the "why") such as promotion or reduction of specific behaviors, and behavior change strategies (the conceptual "how"), such as education, goal setting, and monitoring. Behavior change strategies are instantiated with specific intervention components or “elements” (the "what"). The characteristics of intervention elements may be further defined or modified (the technical "how") to meet the needs, capabilities, and preferences of a user. Finally, many BITs require specification of a workflow that defines when an intervention component will be delivered. The BIT model includes a technological framework (BIT-Tech) that can integrate and implement the intervention elements, characteristics, and workflow to deliver the entire BIT to users over time. This implementation may be either predefined or include adaptive systems that can tailor the intervention based on data from the user and the user’s environment. The BIT model provides a step towards formalizing the translation of developer aims into intervention components, larger treatments, and methods of delivery in a manner that supports research and communication between investigators on how to design, develop, and deploy
Mohr, David C; Schueller, Stephen M; Montague, Enid; Burns, Michelle Nicole; Rashidi, Parisa
A growing number of investigators have commented on the lack of models to inform the design of behavioral intervention technologies (BITs). BITs, which include a subset of mHealth and eHealth interventions, employ a broad range of technologies, such as mobile phones, the Web, and sensors, to support users in changing behaviors and cognitions related to health, mental health, and wellness. We propose a model that conceptually defines BITs, from the clinical aim to the technological delivery framework. The BIT model defines both the conceptual and technological architecture of a BIT. Conceptually, a BIT model should answer the questions why, what, how (conceptual and technical), and when. While BITs generally have a larger treatment goal, such goals generally consist of smaller intervention aims (the "why") such as promotion or reduction of specific behaviors, and behavior change strategies (the conceptual "how"), such as education, goal setting, and monitoring. Behavior change strategies are instantiated with specific intervention components or "elements" (the "what"). The characteristics of intervention elements may be further defined or modified (the technical "how") to meet the needs, capabilities, and preferences of a user. Finally, many BITs require specification of a workflow that defines when an intervention component will be delivered. The BIT model includes a technological framework (BIT-Tech) that can integrate and implement the intervention elements, characteristics, and workflow to deliver the entire BIT to users over time. This implementation may be either predefined or include adaptive systems that can tailor the intervention based on data from the user and the user's environment. The BIT model provides a step towards formalizing the translation of developer aims into intervention components, larger treatments, and methods of delivery in a manner that supports research and communication between investigators on how to design, develop, and deploy BITs.
van Eeghen, Constance; Littenberg, Benjamin; Holman, Melissa D.; Kessler, Rodger
Background Primary care offices are integrating behavioral health (BH) clinicians into their practices. Implementing such a change is complex, difficult, and time consuming. Lean workflow analysis may be an efficient, effective, and acceptable method for integration. Objective Observe BH integration into primary care and measure its impact. Design Prospective, mixed methods case study in a primary care practice. Measurements Change in treatment initiation (referrals generating BH visits within the system). Secondary measures: primary care visits resulting in BH referrals, referrals resulting in scheduled appointments, time from referral to scheduled appointment, and time from referral to first visit. Providers and staff were surveyed on the Lean method. Results Referrals increased from 23 to 37/1000 visits (P<.001). Referrals resulted in more scheduled (60% to 74%, P<.001) and arrived visits (44% to 53%, P=.025). Time from referral to first scheduled visit decreased (Hazard Ratio (HR) 1.60; 95% Confidence Interval (CI) 1.37, 1.88; P<0.001) as did time to first arrived visit (HR 1.36; 95% CI 1.14, 1.62; P=0.001). Surveys and comments were positive. Conclusions This pilot integration of BH showed significant improvements in treatment initiation and other measures. Strengths of Lean included workflow improvement, system perspective, and project success. Further evaluation is indicated. PMID:27170796
Morrow, Connie E.; Mansoor, Elana; Hanson, K. Lori; Vogel, April L.; Rose-Jacobs, Ruth; Genatossio, Carolyn Seval; Windham, Amy; Bandstra, Emmalee S.
We evaluated the Starting Early Starting Smart (SESS) national initiative to integrate behavioral health services (parenting, mental health, and drug treatment) into the pediatric health care setting for families with young children. Data are presented from five pediatric care (PC) sites, drawing from families at risk due to demographic and…
Oppenheim, Jennifer; Stewart, Whitney; Zoubak, Ekaterina; Donato, Ingrid; Huang, Larke; Hudock, William
In 2008, the Substance Abuse and Mental Health Services Administration (SAMHSA) created a national grant program, Project LAUNCH (Linking Actions for Unmet Needs in Children's Health), to improve behavioral health and developmental outcomes for young children through the incorporation of prevention and wellness promotion practices in key early childhood settings. Project LAUNCH supports states, tribal nations, and territories to improve coordination across early childhood systems and implement 5 core strategies of prevention and promotion. This article focuses on the lessons learned from 1 of the 5 core strategies: integration of behavioral health into primary care for young children. This paper analyzes the experiences of a sample of Project LAUNCH grantees, describing 10 common elements of integration approaches and exploring some of the challenges of promoting health and preventing social, emotional, and behavioral problems at a population level. (PsycINFO Database Record
Richardson, Laura P; McCarty, Carolyn A; Radovic, Ana; Suleiman, Ahna Ballonoff
Despite the recognition that behavioral and medical health conditions are frequently intertwined, the existing health care system divides management for these issues into separate settings. This separation results in increased barriers to receipt of care and contributes to problems of underdetection, inappropriate diagnosis, and lack of treatment engagement. Adolescents and young adults with mental health conditions have some of the lowest rates of treatment for their conditions of all age groups. Integration of behavioral health into primary care settings has the potential to address these barriers and improve outcomes for adolescents and young adults. In this paper, we review the current research literature for behavioral health integration in the adolescent and young adult population and make recommendations for needed research to move the field forward.
Howard, Anita R.
Oral health is managed based on objective measures such as the presence and severity of dental caries and periodontal disease. In recent years, oral health researchers and practitioners have shown increasing interest in a widened array of physical, psychological, and social factors found to influence patients’ oral health. In this article, we introduce a behavior change coaching approach that can be used to enhance psychosocial diagnosis and client-centered delivery of health-promoting interventions. Briefly, this health coaching approach is based on an interactive assessment (both physical and psychological), a non-judgmental exploration of patients’ knowledge, attitudes, and beliefs, a mapping of patient behaviors that may contribute to disease progression, gauging patient motivation, and tailoring health communication to encourage health-promoting behavior change. Developed in a clinical setting, this coaching model is supported by interdisciplinary theory, research, and practice on health behavior change. We suggest that, with supervision, this coaching process may be learned. PMID:26457237
Bonham, Caroline A.; Sommerfeld, David; Willging, Cathleen; Aarons, Gregory A.
Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities. PMID:24772411
Gillen, Emily M; Hassmiller Lich, Kristen; Yeatts, Karin B; Hernandez, Michelle L; Smith, Timothy W; Lewis, Megan A
This article describes a process for integrating health behavior and social science theories with practice-based insights using participatory systems thinking and diagramming methods largely inspired by system dynamics methods. This integration can help close the gap between research and practice in health education and health behavior by offering a systematic approach to bring together stakeholders across multiple domains. In this process we create a diagram using constructs from multiple health behavior theories at all levels of the social ecological framework as variables in causal loop diagrams. The goal of this process is to elucidate the reciprocal relationships between explanatory factors at various levels of the social ecological framework that render so many public health problems intractable. To illustrate, we detail a theory-based, replicable process for creating a qualitative diagram to enrich understanding of caregiver and provider behavior around adherence to pediatric asthma action plans. We describe how such diagramming can serve as the foundation for translating evidence into practice to address real-world challenges. Key insights gained include recognition of the complex, multilevel factors affecting whether, and how effectively, parents/caregivers and medical providers co-create an asthma action plan, and important "feedback" dynamics at play that can support or derail ongoing collaboration. Although this article applies this method to asthma action plan adherence in children, the method and resulting diagrams are applicable and adaptable to other health behaviors requiring continuous, daily action.
Buchholz, Melissa; Fischer, Collette; Margolis, Kate L.; Talmi, Ayelet
Primary care settings are optimal environments for providing comprehensive, family-centered care to young children and their families. Primary care clinics with integrated behavioral health clinicians (BHCs) are well-positioned to build trust and create access to care for marginalized and underserved populations. Refugees from around the world are…
Crowley, Ryan A; Kirschner, Neil
Behavioral health care includes care for patients around mental health and substance abuse conditions, health behavior change, life stresses and crises, and stress-related physical symptoms. Mental and substance use disorders alone are estimated to surpass all physical diseases as a major cause of worldwide disability by 2020. The literature recognizes the importance of the health care system effectively addressing behavioral health conditions. Recently, there has been a call for the use of the primary care delivery platform and the related patient-centered medical home model to effectively address these conditions. This position paper focuses on the issue of better integration of behavioral health into the primary care setting. It provides an environmental scan of the current state of conditions included in the concept of behavioral health and examines the arguments for and barriers to increased integration into primary care. It also examines various approaches of integrated care delivery and offers a series of policy recommendations that are based on the reviewed information and evidence to inform the actions of the American College of Physicians and its members regarding advocacy, research, and practice.
Background Childhood obesity is a ‘wicked’ public health problem that is best tackled by an integrated approach, which is enabled by integrated public health policies. The development and implementation of such policies have in practice proven to be difficult, however, and studying why this is the case requires a tool that may assist local policy-makers and those assisting them. A comprehensive framework that can help to identify options for improvement and to systematically develop solutions may be used to support local policy-makers. Discussion We propose the ‘Behavior Change Ball’ as a tool to study the development and implementation of integrated public health policies within local government. Based on the tenets of the ‘Behavior Change Wheel’ by Michie and colleagues (2011), the proposed conceptual framework distinguishes organizational behaviors of local policy-makers at the strategic, tactical and operational levels, as well as the determinants (motivation, capability, opportunity) required for these behaviors, and interventions and policy categories that can influence them. To illustrate the difficulty of achieving sustained integrated approaches, we use the metaphor of a ball in our framework: the mountainous landscapes surrounding the ball reflect the system’s resistance to change (by making it difficult for the ball to roll). We apply this framework to the problem of childhood obesity prevention. The added value provided by the framework lies in its comprehensiveness, theoretical basis, diagnostic and heuristic nature and face validity. Summary Since integrated public health policies have not been widely developed and implemented in practice, organizational behaviors relevant to the development of these policies remain to be investigated. A conceptual framework that can assist in systematically studying the policy process may facilitate this. Our Behavior Change Ball adds significant value to existing public health policy frameworks by
Newman, Kathy; Harrison, Lynda; Dashiff, Carol; Davies, Susan
Research over the past 20 years suggests that the quality of the parent-adolescent relationship significantly affects the development of risk behaviors in adolescent health. The purpose of this paper is to present a review of studies published between 1996-2007 that address specific relationships between parenting styles and six priority adolescent risk behaviors. The review supports the substantial influence of parenting style on adolescent development. Adolescents raised in authoritative households consistently demonstrate higher protective and fewer risk behaviors than adolescents from non-authoritative families. There is also considerable evidence to show that parenting styles and behaviors related to warmth, communication and disciplinary practices predict important mediators, including academic achievement and psychosocial adjustment. Careful examination of parenting style patterns in diverse populations, particularly with respect to physical activity and unintentional injury, will be a critical next step in the development of efficacious, culturally tailored adolescent health promotion interventions.
Roby, Dylan H; Jones, Erynne E
The potential expansion of insurance coverage through the Patient Protection and Affordable Care Act of 2010 can facilitate the reduction of access barriers and improved quality for behavioral health care. More than 5 million of the newly insured are expected to have mental health and substance use disorders. In addition, state and federal efforts to integrate behavioral and medical health needs through patient-centered medical home models and innovations in payment strategies provide an unprecedented opportunity to use federal financial support to improve not only access to care, but also improve quality through active care coordination, use of interdisciplinary teams, colocating services, and engaging in warm hand-offs between providers in the same setting. These potential advances are hindered in 24 different states because of Medicaid payment policy, with 7 explicitly limiting the ability to reimburse for physical health and behavioral health services on the same day for all providers. Without the ability for providers to be reimbursed for different services on the same day to improve behavioral and medical health care coordination, these states could be limited in their ability to improve care via patient-centered approaches and interdisciplinary team-based care that would involve physicians, clinical psychologists, psychiatrists, and other mental health professionals. Limits on same-day billing in Medicaid programs could impact up to 36.7 million people in 24 states, which is approximately 52.6% of all Medicaid enrollees.
Summary of the Behavioral Health and Performance Operations Group’s work including an overview of astronaut selection, behavioral health services provided to astronauts, the psychological aspects o...
Cuno, Kate; Krug, Laura M.; Umylny, Polina
This article presents an overview of the Healthy Steps for Young Children (Healthy Steps) program at Montefiore Medical Center, in the Bronx, NY. The authors review the theoretical underpinnings of this national program for the promotion of early childhood mental health. The Healthy Steps program at Montefiore is integrated into outpatient…
Adams, Carolyn D.; Hinojosa, Sara; Armstrong, Kathleen; Takagishi, Jennifer; Dabrow, Sharon
This article discusses an innovative example of integrated care in which doctoral level school psychology interns and residents worked alongside pediatric residents and pediatricians in the primary care settings to jointly provide services to patients. School psychologists specializing in pediatric health are uniquely trained to recognize and…
Villalobos, Bianca T; Bridges, Ana J; Anastasia, Elizabeth A; Ojeda, Carlos A; Rodriguez, Juventino Hernandez; Gomez, Debbie
The discrepancy between the growing number of Spanish speakers in the U.S. and the availability of bilingual providers creates a barrier to accessing quality mental health care. Use of interpreters provides one strategy for overcoming this linguistic barrier; however, concerns about whether sessions with interpreters, versus bilingual providers, impede therapeutic alliance remain. The current study explored associations between the use of interpreters and therapeutic alliance in a sample of 458 Spanish-speaking patients seen for integrated behavioral health visits at primary care clinics. Patients completed a brief (4 item) therapeutic alliance scale at their behavioral health appointment. In addition, to supplement the quantitative study data, a pilot study of 30 qualitative interviews was conducted with a new sample of 10 Spanish-speaking patients, 10 behavioral health consultants (BHCs), and 10 trained interpreters. Quantitative results showed that interpreter use did not relate to therapeutic alliance, even when controlling for relevant demographic variables. However, qualitative interviews suggested major themes regarding the relative benefits and challenges of using interpreters for patients, interpreters, and BHCs. In interviews, patients expressed a strong preference for bilingual providers. Benefits included greater privacy, sense of trust, and accuracy of communication. However, in their absence, interpreters were seen as increasing access to services and facilitating communication with providers, thereby addressing the behavioral health needs of patients with limited English proficiency. BHCs and interpreters emphasized the importance of interpreter training and a good collaborative relationship with interpreters to minimize negative effects on the quality of care.
Freeman, Jan Sweet
Integrated primary care in a patient-centered medical home is the best way to invite patients to engage in better self-care, to move from provider-based care to team-based care, and to address whole-person needs. However, primary care-whether rural or urban, public or private-cannot become the default mental health system for North Carolinians with severe mental illness.
Klontz, Bradley T; Bivens, Alex; Michels, Stanton; DeLeon, Patrick H; Tom, Lyndsey
As a result of difficulties with access to care and resulting low levels of service utilization, the mental health problems of children often go undiagnosed and untreated. One of the most promising approaches to increasing access to care is the delivery of mental health services in school settings, where almost all of the children in a community can be accessed. However, as a result of competing needs, cultures, and objectives, integrating mental health services into schools can be challenging. In the wake of a devastating hurricane in 1992 and efforts to identify and treat children with posttraumatic stress, many of these barriers were overcome on the island of Kauai, Hawaii and led to the development of the Mokihana Program, an integrated Department of Education and Hawaii Department of Health initiative for providing school-based behavioral health services. This study examined the effectiveness of the Mokihana Program in the treatment of 123 elementary age children and 56 adolescents by comparing teacher ratings of behavior problems and adaptive skills at intake and at 1-year follow-up. It was hypothesized that symptom severity would decrease from pretreatment to follow-up. Findings showed statistically significant improvements across a wide spectrum of behavioral problems and adaptive functioning. The authors explore the challenges and opportunities in sustaining and replicating this type of departmental integration in the service of children and youth.
Pisani, Anthony R; leRoux, Pieter; Siegel, David M
Pediatric residency practices face the challenge of providing both behavioral health (BH) training for pediatricians and psychosocial care for children. The University of Rochester School of Medicine and Dentistry and Rochester General Hospital developed a joint training program and continuity clinic infrastructure in which pediatric residents and postdoctoral psychology fellows train and practice together. The integrated program provides children access to BH care in a primary care setting and gives trainees the opportunity to integrate collaborative BH care into their regular practice routines. During 1998-2008, 48 pediatric residents and 8 psychology fellows trained in this integrated clinical environment. The program's accomplishments include longevity, faculty and fiscal stability, sustained support from pediatric leadership and community payers, the development in residents and faculty of greater comfort in addressing BH problems and collaborating with BH specialists, and replication of the model in two other primary care settings. In addition to quantitative program outcomes data, the authors present a case example that illustrates how the integrated program works and achieves its goals. They propose that educating residents and psychology trainees side by side in collaborative BH care is clinically and educationally valuable and potentially applicable to other settings. A companion report published in this issue provides results from a study comparing the perceptions of pediatric residents whose primary care continuity clinic took place in this integrated setting with those of residents from the same pediatric residency who had their continuity clinic training in a nonintegrated setting.
Frey, Andy; Young, Scott; Gold, Allene; Trevor, Earl
Although experts in early childhood mental health services make clear the need to infuse mental health services into all program components, many have suggested that the mental health services in the majority of Head Start programs are narrowly focused and that mental health consultants are often used in limited ways (see D. J. Cohen, Solnit, &…
Anderson, Norman B; Belar, Cynthia D; Cubic, Barbara A; Garrison, Ellen G; Johnson, Suzanne Bennett; Kaslow, Nadine J
Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011), presented by the Working Party Group on Integrated Behavioral Healthcare. The American Psychological Association (APA) shares concerns about the lack of reference to behavioral health care in the original 2007 Joint Principles of the Patient-Centered Medical Home for which this new document is intended to supplement but not replace. The decision to support the supplemental Joint Principles was not an easy one for APA, as there is one area of significant concern. That concern is related to the use of the term "physician-directed medical practice"
Leveton, Lauren B.
The project goal is to develop behavioral health prevention and maintenance system for continued crew health, safety, and performance for exploration missions. The basic scope includes a) Operationally-relevant research related to clinical cognitive and behavioral health of crewmembers; b) Ground-based studies using analog environments (Antarctic, NEEMO, simulations, and other testbeds; c) ISS studies (ISSMP) focusing on operational issues related to behavioral health outcomes and standards; d) Technology development activities for monitoring and diagnostic tools; and e) Cross-disciplinary research (e.g., human factors and habitability research, skeletal muscle, radiation).
Halbesleben, Jonathon R B; Leroy, Hannes; Dierynck, Bart; Simons, Tony; Savage, Grant T; McCaughey, Deirdre; Leon, Matthew R
While previous research has identified that leaders' safety expectations and safety actions are important in fostering occupational safety, research has yet to demonstrate the importance of leader alignment between safety expectations and actions for improving occupational safety. We build on safety climate literature and theory on behavioral integrity to better understand the relationship between the leader's behavioral integrity regarding safety and work-related injuries. In a time-lagged study of 658 nurses, we find that behavioral integrity for high safety values is positively associated with greater reporting of fewer and less severe occupational injuries. The effects of behavioral integrity regarding safety can be better understood through the mediating mechanisms of safety compliance and psychological safety toward one's supervisor. We discuss the implications of our findings for future research on safety climate.
Behavioral health risks during long-duration space exploration missions are among the most difficult to predict, detect, and mitigate. Given the anticipated extended duration of future missions and their isolated, extreme, and confined environments, there is the possibility that behavior conditions and mental disorders will develop among astronaut crew. Pulsar Informatics, Inc., has developed a health monitoring tool that provides a means to detect and address behavioral disorders and mental conditions at an early stage. The tool integrates all available behavioral measures collected during a mission to identify possible health indicator warning signs within the context of quantitatively tracked mission stressors. It is unobtrusive and requires minimal crew time and effort to train and utilize. The monitoring tool can be deployed in space analog environments for validation testing and ultimate deployment in long-duration space exploration missions.
Hsieh, Hui-Lung; Kuo, Yu-Ming; Wang, Shiang-Ru; Chuang, Bi-Kun; Tsai, Chung-Hung
The personal health record (PHR) is a system that enables borderless medical care services by combining technological innovation and human consideration. This study explored factors affecting the adoption of PHR from technical, medical, and social perspectives according to the Protection Motivation Theory (PMT) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. A survey using a structured questionnaire was subsequently conducted, which produced the following results: (1) The PMT and UTAUT were effective at predicting PHR usage behaviors; (2) Perceived ease-of-use was the most decisive factor influencing the use of PHR, followed by self-efficacy and perceived usefulness; and (3) Behavioral intention for PHR was significantly and positively correlated with usage behavior. From the obtained results, this study recommends that health authorities and medical institutions promote self-efficacy in the use of PHR to improve the levels of behavioral intention and usage behavior among the people. Additionally, medical care institutions are recommended to promote health management and preventive healthcare concepts to help improve public acceptance of the PHR system as a means to self-manage their health. Finally, community centers, medical institutions, and health authorities are urged to work together to enhance public medical knowledge and pool resources for the PHR system, both of which are essential for improving the popularity of the PHR, public quality of life, and the effectiveness of health management. PMID:28025557
Hsieh, Hui-Lung; Kuo, Yu-Ming; Wang, Shiang-Ru; Chuang, Bi-Kun; Tsai, Chung-Hung
The personal health record (PHR) is a system that enables borderless medical care services by combining technological innovation and human consideration. This study explored factors affecting the adoption of PHR from technical, medical, and social perspectives according to the Protection Motivation Theory (PMT) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. A survey using a structured questionnaire was subsequently conducted, which produced the following results: (1) The PMT and UTAUT were effective at predicting PHR usage behaviors; (2) Perceived ease-of-use was the most decisive factor influencing the use of PHR, followed by self-efficacy and perceived usefulness; and (3) Behavioral intention for PHR was significantly and positively correlated with usage behavior. From the obtained results, this study recommends that health authorities and medical institutions promote self-efficacy in the use of PHR to improve the levels of behavioral intention and usage behavior among the people. Additionally, medical care institutions are recommended to promote health management and preventive healthcare concepts to help improve public acceptance of the PHR system as a means to self-manage their health. Finally, community centers, medical institutions, and health authorities are urged to work together to enhance public medical knowledge and pool resources for the PHR system, both of which are essential for improving the popularity of the PHR, public quality of life, and the effectiveness of health management.
Royak-Schaler, Renee; Feldman, Robert H. L.
Examined the health behaviors practiced by psychotherapists (N=86) themselves and the extent to which they focus on these behaviors with their clients. Results indicated that psychotherapists actively evaluate and make recommendations to their clients in the areas of diet, physical exercise, and relaxation practice. (JAC)
Robinson, Thomas N; King, Abby C
Developing effective digital interventions to change health behavior has been a challenging goal for academics and industry players alike. Guiding intervention design using the best combination of approaches available is necessary if effective technologies are to be developed. Behavioral theory, design thinking, user-centered design, rigorous evaluation, and dissemination each have widely acknowledged merits in their application to digital health interventions. This paper introduces IDEAS, a step-by-step process for integrating these approaches to guide the development and evaluation of more effective digital interventions. IDEAS is comprised of 10 phases (empathize, specify, ground, ideate, prototype, gather, build, pilot, evaluate, and share), grouped into 4 overarching stages: Integrate, Design, Assess, and Share (IDEAS). Each of these phases is described and a summary of theory-based behavioral strategies that may inform intervention design is provided. The IDEAS framework strives to provide sufficient detail without being overly prescriptive so that it may be useful and readily applied by both investigators and industry partners in the development of their own mHealth, eHealth, and other digital health behavior change interventions. PMID:27986647
Mummah, Sarah Ann; Robinson, Thomas N; King, Abby C; Gardner, Christopher D; Sutton, Stephen
Developing effective digital interventions to change health behavior has been a challenging goal for academics and industry players alike. Guiding intervention design using the best combination of approaches available is necessary if effective technologies are to be developed. Behavioral theory, design thinking, user-centered design, rigorous evaluation, and dissemination each have widely acknowledged merits in their application to digital health interventions. This paper introduces IDEAS, a step-by-step process for integrating these approaches to guide the development and evaluation of more effective digital interventions. IDEAS is comprised of 10 phases (empathize, specify, ground, ideate, prototype, gather, build, pilot, evaluate, and share), grouped into 4 overarching stages: Integrate, Design, Assess, and Share (IDEAS). Each of these phases is described and a summary of theory-based behavioral strategies that may inform intervention design is provided. The IDEAS framework strives to provide sufficient detail without being overly prescriptive so that it may be useful and readily applied by both investigators and industry partners in the development of their own mHealth, eHealth, and other digital health behavior change interventions.
Farrar, C. R.
Structural health monitoring is the implementation of a damage detection strategy for aerospace, civil and mechanical engineering infrastructure. Typical damage experienced by this infrastructure might be the development of fatigue cracks, degradation of structural connections, or bearing wear in rotating machinery. The goal of the research effort reported herein is to develop a robust and cost-effective structural health monitoring solution by integrating and extending technologies from various engineering and information technology disciplines. It is the authors opinion that all structural health monitoring systems must be application specific. Therefore, a specific application, monitoring welded moment resisting steel frame connections in structures subjected to seismic excitation, is described along with the motivation for choosing this application. The structural health monitoring solution for this application will integrate structural dynamics, wireless data acquisition, local actuation, micro-electromechanical systems (MEMS) technology, and statistical pattern recognition algorithms. The proposed system is based on an assessment of the deficiencies associated with many current structural health monitoring technologies including past efforts by the authors. This paper provides an example of the integrated approach to structural health monitoring being undertaken at Los Alamos National Laboratory and summarizes progress to date on various aspects of the technology development.
Farrar, Charles R.; Sohn, Hoon; Fugate, Michael L.; Czarnecki, Jerry J.
Structural health monitoring is the implementation of a damage detection strategy for aerospace, civil and mechanical engineering infrastructure. Typical damage experienced by this infrastructure might be the development of fatigue cracks, degradation of structural connections, or bearing wear in rotating machinery. The goal of the research effort reported herein is to develop a robust and cost-effective structural health monitoring solution by integrating and extending technologies from various engineering and information technology disciplines. It is the author's opinion that all structural health monitoring systems must be application specific. Therefore, a specific application, monitoring welded moment resisting steel frame connections in structures subjected to seismic excitation, is described along with the motivation for choosing this application. The structural health monitoring solution for this application will integrate structural dynamics, wireless data acquisition, local actuation, micro-electromechanical systems (MEMS) technology, and statistical pattern recognition algorithms. The proposed system is based on an assessment of the deficiencies associated with many current structural health monitoring technologies including past efforts by the authors. This paper provides an example of the integrated approach to structural health monitoring being undertaken at Los Alamos National Laboratory and summarizes progress to date on various aspects of the technology development.
Pagoto, Sherry; Bennett, Gary G
The field of behavioral science has produced myriad data on health behavior change strategies and leveraged such data into effective human-delivered interventions to improve health. Unfortunately, the impact of traditional health behavior change interventions has been heavily constrained by patient and provider burden, limited ability to measure and intervene upon behavior in real time, variable adherence, low rates of implementation, and poor third-party coverage. Digital health technologies, including mobile phones, sensors, and online social networks, by being available in real time, are being explored as tools to increase our understanding of health behavior and to enhance the impact of behavioral interventions. The recent explosion of industry attention to the development of novel health technologies is exciting but has far outpaced research. This Special Section of Translational Behavioral Medicine, Smartphones, Sensors, and Social Networks: A New Age of Health Behavior Change features a collection of studies that leverage health technologies to measure, change, and/or understand health behavior. We propose five key areas in which behavioral science can improve the impact of digital health technologies on public health. First, research is needed to identify which health technologies actually impact behavior and health outcomes. Second, we need to understand how online social networks can be leveraged to impact health behavior on a large scale. Third, a team science approach is needed in the developmental process of health technologies. Fourth, behavioral scientists should identify how a balance can be struck between the fast pace of innovation and the much slower pace of research. Fifth, behavioral scientists have an integral role in informing the development of health technologies and facilitating the movement of health technologies into the healthcare system.
Mocan, Naci; Altindag, Duha T
Using data from NLSY97, we analyze the impact of education on health behavior. Controlling for health knowledge does not influence the impact of education on health behavior, supporting the productive efficiency hypothesis. Accounting for cognitive ability does not significantly alter the relationship between education and health behavior. Similarly, the impact of education on health behavior is the same between those with and without a learning disability, suggesting that cognition is not likely to be a significant factor in explaining the impact of education on health behavior.
Rasch, Randolph F R; Davidson, Dawn; Seiters, John; MacMaster, Samuel A; Adams, Susie; Darby, Kathleen; Cooper, R Lyle
This paper provides outcomes from an evaluation of a federally funded program combining HIV prevention services with an integrated mental health and substance abuse treatment program to a population of primarily African American ex-offenders living with, or at high risk for contracting HIV in Memphis, Tennessee. During the 5-year evaluation, data were collected from 426 individuals during baseline and 6-month follow-up interviews. A subset of participants (n = 341) completed both interviews. Results suggest that the program was successful in reducing substance use and mental health symptoms but had mixed effects on HIV risk behaviors. These findings are important for refining efforts to use an integrated services approach to decrease (a) the effects of substance use and mental health disorders, (b) the disproportionate impact of criminal justice system involvement, and (c) the HIV infection rate in African American ex-offenders in treatment.
Prue, Donald M.; And Others
A review of theoretical and experimental literature on school health education indicates that most programs have focused on health knowledge despite conflicting information on the impact of knowledge based programs on health behaviors. Needed are interventions that include environmental engineering to support health behaviors and use of…
Matjasko, Jennifer L.; Cawley, John H.; Baker-Goering, Madeleine M.; Yokum, David V.
Behavioral economics provides an empirically informed perspective on how individuals make decisions, including the important realization that even subtle features of the environment can have meaningful impacts on behavior. This commentary provides examples from the literature and recent government initiatives that incorporate concepts from behavioral economics in order to improve health, decision making, and government efficiency. The examples highlight the potential for behavioral economics to improve the effectiveness of public health policy at low cost. Although incorporating insights from behavioral economics into public health policy has the potential to improve population health, its integration into government public health programs and policies requires careful design and continual evaluation of such interventions. Limitations and drawbacks of the approach are discussed. PMID:27102853
Heinrich, Katie M; Carlisle, Taran; Kehler, Ainslie; Cosgrove, Sarah J
Group-based training through CrossFit has recently exploded in popularity. Anecdotally, participants often make lifestyle changes and experience improved fitness. Participation factors were mapped to the Integrated Theory of Health Behavior Change and "sense of community" constructs. Key informant interviews were conducted with 6 CrossFit gym owners/coaches. Data were thematically coded with NVivo 10. Results revealed key factors that both facilitated and restricted participation in CrossFit. Findings provide implications for future theory application and highlight how to improve initiation and adherence by capitalizing on community building and taking steps to reduce intimidation and cost, facilitate realistic goals, and ensure social support.
Taflinger, Kimberly; West, Elizabeth; Sunderhaus, Janis; Hilton, Irene V
Health centers are unique health care delivery organizations in which multiple disciplines, such as primary care, dental, behavioral health, pharmacy, podiatry, optometry and alternative medicine, are often located at the same site. Because of this characteristic, many health centers have developed systems of integrated care. This paper describes the characteristics of health centers and highlights the integrated health care delivery system of one early adopter health center, Health Partners of Western Ohio.
Wolever, Ruth Q; Dreusicke, Mark H
Objective Medication adherence requires underlying behavior skills and a supporting mindset that may not be addressed with education or reminders. Founded in the study of internal motivation and health psychology, integrative health coaching (IHC) helps patients gain insight into their behaviors and make long-term, sustainable lifestyle changes. The purpose of the study is to determine whether IHC improves oral medication adherence, glycated hemoglobin (HbA1c), and psychosocial measures, and to assess whether adherence changes are sustained after the intervention. Methods Using a prospective observational design, participants (n=56) received 14 coaching calls by telephone over 6 months. Medication possession ratio (MPR) was calculated for time intervals before, during, and after the intervention. HbA1c and patient-reported psychosocial outcomes were obtained to test interactions with MPR. Results Medication adherence (MPR) increased from 0.74±0.197 to 0.85±0.155 during coaching, and was sustained at 0.82±0.175 during a 6-month period after the study. Better adherence correlated with a greater decrease in HbA1c. HbA1c decreased from 8.0±1.92% to 7.7±1.70% over the 6-month intervention. All psychosocial measures showed significant improvement. In addition to discussing medication adherence strategies with their coach, patients discussed nutrition and exercise (86.9% of calls), stress management (39.8%), and social support and relationships (15.4%). Conclusions IHC targets internal motivation and supports behavior change by facilitating patients’ insight into their own behaviors, and it uses this insight to foster self-efficacy. This approach may yield sustainable results for medication adherence and warrants further exploration for health-related behavior change. PMID:27239318
Saw, Anne; Kim, Jin; Lim, Joyce; Powell, Catherine; Tong, Elisa K
Engagement in modifiable risk behaviors, such as tobacco use, substantially contributes to early mortality rates in individuals with serious mental illness (SMI). There is an alarmingly high prevalence of tobacco use among subgroups of Asian Americans, such as immigrants and individuals with SMI, yet there are no empirically supported effective smoking cessation interventions that have been tailored to meet the unique cultural, cognitive, and psychological needs of Asian immigrants with SMI. In this article, we share the experiences of clinicians in the delivery of smoking cessation counseling to Asian American immigrants with SMI, in the context of an Asian-focused integrated primary care and behavioral health setting. Through a qualitative analysis of clinician perspectives organized with the RE-AIM framework, we outline challenges, lessons learned, and promising directions for delivering smoking cessation counseling to Asian American immigrant clients with SMI.
Stein, Flo; Lancaster, Michael; Yaggy, Susan; Dickens, Regina Schaaf
The North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services works with partners to reduce the impact of behavioral health conditions in communities throughout the state. We review state-funded behavioral health initiatives that provide support to military personnel and their families, with special attention to public services and co-location efforts.
Health is best understood within an ecological context. Accordingly, health promotion involves processes that foster supportive environments and healthful behavior. Thus, effective health promotion programs are typically multilevel, focusing not only on the population at risk but also on the environmental conditions that contribute so importantly…
Huang, Hui-Ting; Kuo, Yu-Ming; Wang, Shiang-Ru; Wang, Chia-Fen; Tsai, Chung-Hung
Disease screening instruments used for secondary prevention can facilitate early determination and treatment of pathogenic factors, effectively reducing disease incidence, mortality rates, and health complications. Therefore, people should be encouraged to receive health examinations for discovering potential pathogenic factors before symptoms occur. Here, we used the health belief model as a foundation and integrated social psychological factors and investigated the factors influencing health examination behavioral intention among the public in Taiwan. In total, 388 effective questionnaires were analyzed through structural model analysis. Consequently, this study yielded four crucial findings: (1) The established extended health belief model could effectively predict health examination behavioral intention; (2) Self-efficacy was the factor that most strongly influenced health examination behavioral intention, followed by health knowledge; (3) Self-efficacy substantially influenced perceived benefits and perceived barriers; (4) Health knowledge and social support indirectly influenced health examination behavioral intention. The preceding results can effectively increase the acceptance and use of health examination services among the public, thereby facilitating early diagnosis and treatment and ultimately reducing disease and mortality rates.
Huang, Hui-Ting; Kuo, Yu-Ming; Wang, Shiang-Ru; Wang, Chia-Fen; Tsai, Chung-Hung
Disease screening instruments used for secondary prevention can facilitate early determination and treatment of pathogenic factors, effectively reducing disease incidence, mortality rates, and health complications. Therefore, people should be encouraged to receive health examinations for discovering potential pathogenic factors before symptoms occur. Here, we used the health belief model as a foundation and integrated social psychological factors and investigated the factors influencing health examination behavioral intention among the public in Taiwan. In total, 388 effective questionnaires were analyzed through structural model analysis. Consequently, this study yielded four crucial findings: (1) The established extended health belief model could effectively predict health examination behavioral intention; (2) Self-efficacy was the factor that most strongly influenced health examination behavioral intention, followed by health knowledge; (3) Self-efficacy substantially influenced perceived benefits and perceived barriers; (4) Health knowledge and social support indirectly influenced health examination behavioral intention. The preceding results can effectively increase the acceptance and use of health examination services among the public, thereby facilitating early diagnosis and treatment and ultimately reducing disease and mortality rates. PMID:27043606
Wells, Rebecca; Chuang, Emmeline
National survey data were used to assess whether child welfare agency ties to behavioral health care providers improved placement stability for adolescents served by both systems. Adolescents initially at home who were later removed tended to have fewer moves when child welfare and behavioral health were in the same larger agency. Joint training…
Bachá-Méndez, Gustavo; Reid, Alliston K; Mendoza-Soylovna, Adela
Two experiments with rats examined the dynamics of well-learned response sequences when reinforcement contingencies were changed. Both experiments contained four phases, each of which reinforced a 2-response sequence of lever presses until responding was stable. The contingencies then were shifted to a new reinforced sequence until responding was again stable. Extinction-induced resurgence of previously reinforced, and then extinguished, heterogeneous response sequences was observed in all subjects in both experiments. These sequences were demonstrated to be integrated behavioral units, controlled by processes acting at the level of the entire sequence. Response-level processes were also simultaneously operative. Errors in sequence production were strongly influenced by the terminal, not the initial, response in the currently reinforced sequence, but not by the previously reinforced sequence. These studies demonstrate that sequence-level and response-level processes can operate simultaneously in integrated behavioral units. Resurgence and the development of integrated behavioral units may be dissociated; thus the observation of one does not necessarily imply the other. PMID:17345948
Agudelo, Carlos A
Despite their shared history, the Andean countries are socially and politically diverse, with heterogeneous health realities and complex integration processes. General developments such as the Latin American Free Trade Association and Latin American Integration Association have existed for decades, along with others of a regional scope, like the Andean Community of Nations, Caribbean Community, and Central American Common Market. The health field has a specific instrument in the Andean Region called the Hipólito Unánue Agreement, created in 1971. Integration processes have concentrated on economic aspects, based on preferential customs agreements that have led to an important long-term increase in trade. Less progress has been made in the field of health in terms of sharing national experiences, knowledge, and capabilities. Analysis of experiences in health has shown that integration depends on the countries' respective strengths and to a major extent on national political processes.
Duffy, Sonia A; Missel, Amanda L; Waltje, Andrea H; Ronis, David L; Fowler, Karen E; Hong, OiSaeng
Operating Engineers (heavy equipment operators in construction) may be at particular risk for heart disease and cancer related to their exposure to environmental dust and smoking, the sedentary nature of their job, and long hours of exposure to the sun. The aim of this study was to characterize the health behaviors of Operating Engineers. This cross-sectional survey from a convenience sample of Operating Engineers (N = 498) used validated instruments to measure smoking, drinking, diet, exercise, sleep, and sun exposure. Univariate and bivariate analyses to detect differences by age were conducted. The sample scored significantly worse on all five health behaviors compared to population norms. Those who were older were less likely to smoke and chew tobacco and more likely to eat fruits and vegetables. Many were interested in services to improve their health behaviors. Health behavior interventions are needed and wanted by Operating Engineers.
Grady, Kathleen E.
A study was designed to assess faculty health behaviors at the beginning of each of the three years of a Health Promotion/Disease Prevention grant for comparisons over time. This article reports the results of the first comparison between the two faculties. (CT)
Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special thought and attention. The Joint Commission on ...
Chin, Jean Lau; Yee, Barbara W K; Banks, Martha E
As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.
Short, Susan E; Mollborn, Stefanie
Health behaviors shape health and well-being in individuals and populations. Drawing on recent research, we review applications of the widely applied "social determinants" approach to health behaviors. This approach shifts the lens from individual attribution and responsibility to societal organization and the myriad institutions, structures, inequalities, and ideologies undergirding health behaviors. Recent scholarship integrates a social determinants perspective with biosocial approaches to health behavior dynamics. Empirical advances model feedback among social, psychological and biological factors. Health behaviors are increasingly recognized as multidimensional and embedded in health lifestyles, varying over the life course and across place and reflecting dialectic between structure and agency that necessitates situating individuals in context. Advances in measuring and modeling health behaviors promise to enhance representations of this complexity.
Short, Susan E.; Mollborn, Stefanie
Health behaviors shape health and well-being in individuals and populations. Drawing on recent research, we review applications of the widely applied “social determinants” approach to health behaviors. This approach shifts the lens from individual attribution and responsibility to societal organization and the myriad institutions, structures, inequalities, and ideologies undergirding health behaviors. Recent scholarship integrates a social determinants perspective with biosocial approaches to health behavior dynamics. Empirical advances model feedback among social, psychological and biological factors. Health behaviors are increasingly recognized as multidimensional and embedded in health lifestyles, varying over the life course and across place and reflecting dialectic between structure and agency that necessitates situating individuals in context. Advances in measuring and modeling health behaviors promise to enhance representations of this complexity. PMID:26213711
Intelligent Integrated System Health Management (ISHM) is the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system (Management: storage, distribution, sharing, maintenance, processing, reasoning, and presentation). Presentation discusses: (1) ISHM Capability Development. (1a) ISHM Knowledge Model. (1b) Standards for ISHM Implementation. (1c) ISHM Domain Models (ISHM-DM's). (1d) Intelligent Sensors and Components. (2) ISHM in Systems Design, Engineering, and Integration. (3) Intelligent Control for ISHM-Enabled Systems
The notion of patient-centered care has long been linked with nursing practice since Florence Nightingale. The discipline of nursing is focused on the holistic care of individuals, families, and communities in times of sickness and/or health. However, in psychiatric-mental health nursing, the concepts of mental health and psychiatric illness still remain marginalized in our health care delivery systems, as well as in nursing education, knowledge development, and practice. Even with the concept of patient-centered homes, acute and primary care providers are reluctant to embrace care of those with psychiatric illness in their respective settings. Psychiatric illness was and continues to be in the shadows, hidden and often ignored by the larger community as well as by health care providers. This paper describes a Health Resources Services Administration (HRSA) Advanced Nursing Education (ANE) training grant's objective of reintegrating psychiatric-mental health practice into ALL health care delivery systems using the concept of patient-centered nursing care as a foundation for, and promotion of, the Psychiatric-Mental Health Nurse Practitioner (PMH-NP) as the "navigator" for not only the patients and their families, but also for their acute and primary care colleagues using an Interprofessional Education Model. The major barriers and lessons learned from this project as well as the need for psychiatric-mental health nurses to reclaim their role as a consultant/liaison in acute, primary, and long-term care settings will be discussed. The PMHNP as a consultant/liaison is being revitalized as an innovative advanced practice nursing health care model in North Carolina.
Brady, Joseph V
Concern about the behavioral effects of spaceflight can be traced back a half century to the earliest preparatory bioastronautics experiments in the mid-1 950s. A central focus of the first primate suborbital flights, as well as the orbital chimpanzee pretest flights of Project Mercury, was the effects of such stressful ventures on the learned performances of these space behavioral health pioneers. The hiatus in spaceflight behavioral health experimental investments that followed these early initiatives began with the advent of the 'human astronaut' era of the mid-1960s, and has dominated the last several decades. Contemporary concerns in this regard have most recently been articulated by a turn-of-the-century Committee of the Institute of Medicine, National Academy of Sciences, providing a visionary view of space medicine during travel beyond Earth orbit. This 2-yr study focused on those most complex behavioral health interactions involving humans in extreme, isolated, and confined microsocieties-areas that have not received the necessary level of attention. The evident behavioral health issues raised by the prospect of long-duration exploratory missions beyond Earth orbit, including performance and general living conditions, recovery and support systems, and the screening, selection, and training of candidate participants are reviewed and discussed.
Stanhope, Victoria; Videka, Lynn; Thorning, Helle; McKay, Mary
With the passage of the Patient Protection and Affordable Care Act (PPACA) and ongoing health care reform efforts, this is a critical time for the social work profession. The approaches and values embedded in health care reform are congruent with social work. One strategy is to improve care for people with co-morbid and chronic illnesses by integrating primary care and behavioral health services. This paper defines integrated health and how the PPACA promotes integrated health care through system redesign and payment reform. We consider how social workers can prepare for health care reform and discuss the implications of these changes for the future of the profession.
Lizarondo, Lucylynn; Turnbull, Catherine; Kroon, Tracey; Grimmer, Karen; Bell, Alison; Kumar, Saravana; McEvoy, Maureen; Milanese, Steve; Russell, Mary; Sheppard, Lorraine; Walters, Julie; Wiles, Louise
Objective South Australia is taking an innovative step in transforming the way its healthcare is organised and delivered to better manage current and future demands on the health system. In an environment of transforming health services, there are clear opportunities for allied health to assist in determining solutions to various healthcare challenges. A recent opinion piece proposed 10 clinician-driven strategies to assist in maximising value and sustainability of healthcare in Australia. The present study aimed to seek the perspectives of allied health clinicians, educators, researchers, policy makers and managers on these strategies and their relevance to allied health. Methods A survey of allied health practitioners was undertaken to capture their perspectives on the 10 clinician-driven strategies for maximising value and sustainability of healthcare in Australia. Survey findings were then layered with evidence from the literature. Results Highly relevant across allied health are the strategies of discontinuation of low value practices, targeting clinical interventions to those getting greatest benefit, active involvement of patients in shared decision making and self-management and advocating for integrated systems of care. Conclusions Allied health professionals have been involved in the South Australian healthcare system for a prolonged period, but their services are poorly recognised, often overlooked and not greatly supported in existing traditional practices. The results of the present study highlight ways in which healthcare services can implement strategies not only to improve the quality of patient outcomes, but also to offer innovative solutions for future, sustainable healthcare. The findings call for concerted efforts to increase the utilisation of allied health services to ensure the 'maximum value for spend' of the increasingly scarce health dollar. What is known about the topic? In medicine, clinician-driven strategies have been proposed to
Samuel, Laura J.; Commodore-Mensah, Yvonne; Dennison Himmelfarb, Cheryl R.
Health behavior theories state that social environments influence health behaviors, but theories of how this occurs are relatively underdeveloped. This article systematically surveys community social capital concepts in health behavior literature and proposes a conceptual framework that integrates these concepts into existing behavioral theory.…
This paper reports in detail on a project of Integrated Health Care in cardiology at Nuremberg, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.
Mackey, Dianne Dee; And Others
These four learning modules present text and exercises designed to help allied health students understand various elements of positive interaction with people. The first module, "Maslow's Hierarchy of Needs" by Dianne Mackey, defines human needs, presents Maslow's theories, and helps the learner identify behaviors that reflect the…
Rakowski, W; Rimer, B K; Bryant, S A
Achieving and maintaining high rates of screening mammography are major public health priorities. This report examines data from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention on the utilization of mammography among women ages 40-75. Results show that progress is being made in some areas--57.7 percent of women "ever had" a mammogram; 50.3 percent, in previous 2 years. However, those not having repeated regular screening appear to be a sizable proportion. Only 28.6 percent of women ages 40-75 had been both screened on the recommended age-specific schedule and expressed an intention to continue screening; another 29.2 percent indicated no intention to have a mammogram in the near future. Income, clinical breast examination, and Pap (Papanicolaou's) test, having no regular source of care, region of the country and residential variables, smoking status, not exercising, not knowing how to do breast self-examination, and race were among the variables having the strongest associations with mammography status. Several groups in the population therefore remain at risk of not receiving regular screening. The combination of mammography status to date and future intention to have the examination provides an important perspective on efforts to reach public health screening objectives and appears to provide a strategy for targeting interventions. PMID:8210259
Gordon, Adam J; Montlack, Melissa L; Freyder, Paul; Johnson, Diane; Bui, Thuy; Williams, Jennifer
The Allegheny Initiative for Mental Health Integration for the Homeless (AIM-HIGH) was a 3-year urban initiative in Pennsylvania that sought to enhance integration and coordination of medical and behavioral services for homeless persons through system-, provider-, and client-level interventions. On a system level, AIM-HIGH established partnerships between several key medical and behavioral health agencies. On a provider level, AIM-HIGH conducted 5 county-wide conferences regarding homeless integration, attended by 637 attendees from 72 agencies. On a client level, 5 colocated medical and behavioral health care clinics provided care to 1986 homeless patients in 4084 encounters, generating 1917 referrals for care. For a modest investment, AIM-HIGH demonstrated that integration of medical and behavioral health services for homeless persons can occur in a large urban environment.
Lee, Shoou-Yih D.; Tsai, Tzu-I; Tsai, Yi-Wen; Kuo, Ken N.
Extant health literacy research is unclear about the contribution of health literacy to health behaviors and is limited regarding women's health issues. The primary purpose of this study is to investigate the association between health literacy and five health behaviors (Pap smear screening, annual physical checkup, smoking, checking food…
Bellg, Albert J
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.
Baicker, Katherine; Mullainathan, Sendhil; Schwartzstein, Joshua
A fundamental implication of standard moral hazard models is overuse of low-value medical care because copays are lower than costs. In these models, the demand curve alone can be used to make welfare statements, a fact relied on by much empirical work. There is ample evidence, though, that people misuse care for a different reason: mistakes, or “behavioral hazard.” Much high-value care is underused even when patient costs are low, and some useless care is bought even when patients face the full cost. In the presence of behavioral hazard, welfare calculations using only the demand curve can be off by orders of magnitude or even be the wrong sign. We derive optimal copay formulas that incorporate both moral and behavioral hazard, providing a theoretical foundation for value-based insurance design and a way to interpret behavioral “nudges.” Once behavioral hazard is taken into account, health insurance can do more than just provide financial protection—it can also improve health care efficiency. PMID:23930294
A study examined the use of sensory integration techniques to reduce the maladaptive behaviors that interfered with the learning of nine high school students with mental impairments attending a special school. Maladaptive behaviors identified included rocking, toe walking, echolalia, resistance to change, compulsive behaviors, aggression,…
Dielman, T E; Leech, S; Becker, M H; Rosenstock, I M; Horvath, W J; Radius, S M
Personal interviews concerning health beliefs and behaviors were conducted with a parent and child in each of 250 households. Index scores were constructed for parental and child health beliefs, and these scores were entered, along with demographic variables, in a series of multiple regression analyses predicting child health beliefs and behaviors. The age of the child was the variable most highly associated with three of four child health behaviors and four of six child health beliefs. The children's snacking between meals and cigarette smoking were related to several parental behaviors and, to a lesser extent, parental health beliefs. The children's health beliefs were less predictable than were their health behaviors, and the observed significant relationships were with parental health beliefs and demographics. The implications for the design of health education programs are discussed.
Wang, Catharine; Bowen, Deborah J.; Kardia, Sharon L. R.
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…
Figueroa, Fernando; Schmalzel, John
Integrated System Health Management (ISHM) describes a set of system capabilities that in aggregate perform: determination of condition for each system element, detection of anomalies, diagnosis of causes for anomalies, and prognostics for future anomalies and system behavior. The ISHM should also provide operators with situational awareness of the system by integrating contextual and timely data, information, and knowledge (DIaK) as needed. ISHM capabilities can be implemented using a variety of technologies and tools. This chapter provides an overview of ISHM contributing technologies and describes in further detail a novel implementation architecture along with associated taxonomy, ontology, and standards. The operational ISHM testbed is based on a subsystem of a rocket engine test stand. Such test stands contain many elements that are common to manufacturing systems, and thereby serve to illustrate the potential benefits and methodologies of the ISHM approach for intelligent manufacturing.
Jesse, D. Elizabeth; Gaynes, Bradley N.; Feldhousen, Elizabeth; Newton, Edward R.; Bunch, Shelia; Hollon, Steven D.
Introduction Cognitive behavioral group interventions have been shown to improve depressive symptoms in adult populations. This article details the feasibility and efficacy of a 6-week culturally tailored cognitive behavioral intervention offered to rural, minority, low-income women at risk for antepartum depression. Methods 146 pregnant women were stratified by high-risk for antepartum depression (Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher) or low-moderate risk (EPDS score of 4-9) and randomized to a cognitive behavioral intervention or treatment-as-usual. Differences in mean change of EPDS and BDI-II scores for low-moderate and high-risk women in the cognitive behavioral intervention and treatment-as-usual for the full sample were assessed from baseline (T1), post-treatment (T2) and 1-month follow-up (T3) and for African-American women in the subsample. Results Both the cognitive behavioral intervention and treatment-as-usual groups had significant reductions in the EPDS scores from T1 to T2 and T1 to T3. In women at high-risk for depression (n=62), there was no significant treatment effect from T1 to T2 or T3 for the Edinburgh Postnatal Depression Scale. However, in low-moderate risk women, there was a significant decrease in the BDI-II scores from T1 to T2 (4.92 vs. 0.59, P=.018) and T1 to T3 (5.67 vs. 1.51, P=.04). Also, the cognitive behavioral intervention significantly reduced EPDS scores for African-American women at high-risk (n=43) from T1 to T2 (5.59 vs. 2.18, P=.02) and from T1 to T3 (6.32 vs. 3.14, P= .04). Discussion A cognitive behavioral intervention integrated within prenatal clinics is feasible in this sample, although attrition rates were high. Compared to treatment-as-usual, the cognitive behavioral intervention reduced depressive symptoms for African-American women at high-risk for antepartum depression and for the full sample of women at low-moderate risk for antepartum depression. These promising findings need to be
Kickbusch, Ilona; Reddy, K Srikanth
Communities are characterized by common interests, common ecology, and common social system or structure. These characteristics, qualities, and processes involved in the community affect both health behaviors and health outcomes during disease outbreaks. Hence, health promotion theorists and practitioners emphasize working 'with' rather than 'on' communities. They believe health promotion, with all its experiences in community mobilization, empowerment, and health literacy programs, should be part of disease prevention and control efforts from the very beginning. Health promotion knowledge needs to be fully integrated into infectious disease control, especially in the context of outbreaks.
Hoffman, Geoffrey J.; Lee, Jihey; Mendez-Luck, Carolyn A.
Purpose of the Study: This study examines health-risk behaviors among "Baby Boomer" caregivers and non-caregivers. Design and Methods: Data from the 2009 California Health Interview Survey of the state's non-institutionalized population provided individual-level, caregiving, and health behavior characteristics for 5,688 informal…
Lopez, Molly; Coleman-Beattie, Brenda; Jahnke, Lauren; Sanchez, Katherine
There is a call across the country and in Texas to improve health care systems through integrated care. Integrated health care is the systematic coordination of physical and behavioral health services. The idea is that physical and behavioral health problems often occur at the same time and that integrating services will provide the best results…
Recently, mental health parity provisions were passed and incorporated retroactively into the Health Insurance Portability and Accountability Act (PL 104-191). Although limited, these provisions were instrumental in focusing national attention and debate on people's need for and right to behavioral health services. A handful of states have also passed parity provisions, but their full impact on the insurance market cannot be assessed. This is because a majority of plans are preempted from compliance with many state insurance mandates by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA is the primary obstacle to state behavioral health mandates, and it threatens the inclusion of behavioral health providers and settings in managed care plans integrating public and private healthcare systems. This article provides basic information on ERISA, its preemption clauses, and its impact on behavioral healthcare services.
Sudano, Laura E; Collins, Greg; Miles, Christopher M
Research suggests that National Collegiate Athletic Association (NCAA) Division I student-athletes have higher levels of stress and other behavioral health issues, including substance use, than nonathletes. For several reasons, student-athletes may be less likely to admit to behavioral health issues and seek mental health care. Integrated care is a model of care that integrates behavioral health into a medical practice. This article explores the newly released NCAA Best Mental Health Practice guidelines and the application of integrated care to a Division I athletic training room setting using the three-worldview framework for successful integration, incorporating clinical outcomes, operational reliability, and financial stability. (PsycINFO Database Record
Bara, Debra; McPhillips-Tangum, Carol; Wild, Ellen L; Mann, Marie Y
Public health agencies at state and local levels are integrating information systems to improve health outcomes for children. An assessment was conducted to describe the extent to which public health agencies are currently integrating child health information systems (CHIS). Using online technology information was collected, to assess completed and planned activities related to integration of CHIS, maturity of these systems, and factors that influence decisions by public health agencies to pursue integration activities. Of the 39 public health agencies that participated, 18 (46%) reported already integrating some or all of their CHIS, and 13 (33%) reported to be planning to integrate during the next 3 years. Information systems most commonly integrated include Early Hearing Detection and Intervention (EHDI), immunization, vital records, and Newborn Dried Bloodspot Screening (NDBS). Given the high priority that has been placed on using technology to improve health status in the United States, the emphasis on expanding the capability for the electronic exchange of health information, and federal support for electronic health records by 2014, public health agencies should be encouraged and supported in their efforts to develop, implement, and maintain integrated CHIS to facilitate the electronic exchange of health information with the clinical healthcare sector.
Sánchez, Delia M
This paper describes the institutional background in Latin American integration in both the economy and health, and proposes a systematization of possible health integration modalities. Facilitating and inhibiting factors for integration according to each modality are identified, and their feasibility is discussed in the present context. The structure and functioning of MERCOSUR health structures (Ministerial Meeting and Sub-group 11) are briefly described, as well as the advances achieved to date, reflecting on the possible causes of uneven progress in different areas.
Bartlett-Healy, Kristen; Hamilton, George; Healy, Sean; Crepeau, Taryn; Unlu, Isik; Farajollahi, Ary; Fonseca, Dina; Gaugler, Randy; Clark, Gary G.; Strickman, Daniel
The goal of this study was to evaluate the effectiveness of a public health educational campaign to reduce backyard mosquito-larval habitats. Three communities each, within two New Jersey counties, were randomly selected to receive: (1) both education and mosquito control, (2) education only, and (3) no education or mosquito control. Four separate educational events included a 5-day elementary school curriculum in the spring, and three door to door distributions of educational brochures. Before and after each educational event, the numbers of mosquito-larval container habitats were counted in 50 randomly selected homes per study area. Container surveys allowed us to measure source reduction behavior. Although we saw reductions in container habitats in sites receiving education, they were not significantly different from the control. Our results suggest that traditional passive means of public education, which were often considered the gold standard for mosquito control programs, are not sufficient to motivate residents to reduce backyard mosquito-larval habitats. PMID:21655124
Purpose The purpose of this paper is to expand attention to responsible leader behavior in the world's health sectors by explaining how this concept applies to health sectors, considering why health sector leaders should behave responsibly, reviewing how they can do so, and asserting potential impact through an applied example. Design/methodology/approach This paper is a viewpoint, reflecting conceptualizations rooted in leadership literature which are then specifically applied to health sectors. A definition of responsible leader behavior is affirmed and applied specifically in health sectors. Conceptualizations and viewpoints about practice of responsible leader behavior in health sectors and potential consequences are then discussed and asserted. Findings Leadership failures and debacles found in health, but more so in other sectors, have led leadership researchers to offer insights, many of them empirical, into the challenges of leadership especially by more clearly delineating responsible leader behavior. Practical implications Much of what has been learned in the research about responsible leader behavior offers pathways for health sector leaders to more fully practice responsible leadership. Social implications This paper asserts and provides a supporting example that greater levels of responsible leader behavior in health sectors hold potentially important societal benefits. Originality/value This paper is the first to apply emerging conceptualizations and early empirical findings about responsible leader behavior specifically to leaders in health sectors.
While the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act of 2009, provided $20.6 billion for incentive payments to support the adoption and meaningful use of health information technology (HIT), behavioral health organizations were not eligible to receive facility payments. The consequences of excluding behavioral health from HIT incentive payments are found in the results of the "HIT Adoption and Meaningful Use Readiness in Community Behavioral Health" survey. The survey found that only 2% of community behavioral health organizations are able to meet federal meaningful use (MU) requirements-compare this to the 27% of Federally Qualified Health Centers and 20% of hospitals that already meet some level of MU requirements. Behavioral health organizations, serving more than eight million adults, children, and families with mental illnesses and addiction disorders, are ready and eager to adopt HIT to meet the goals of better healthcare, better health, and lower costs. But reaching these goals may prove impossible unless behavioral health achieves "parity" within healthcare and receives resources for the adoption of HIT.
Coddington, D C; Moore, K D; Fischer, E A
Cooperation among the traditionally adversarial factions of physicians and hospitals has arisen in the early 1990s to develop the integrated health care system. Authors Dean C. Coddington, Keith D. Moore and Elizabeth A. Fischer explain how these two groups have been joined in the integration by an unlikely participant: health plans.
Thorpe, Roland J; Kennedy-Hendricks, Alene; Griffith, Derek M; Bruce, Marino A; Coa, Kisha; Bell, Caryn N; Young, Jessica; Bowie, Janice V; LaVeist, Thomas A
Although understanding race differences in health behaviors among men is an important step in reducing disparities in leading causes of death in the United States, progress has been stifled when using national data because of the confounding of race, socioeconomic status, and residential segregation. The purpose of this study is to examine the nature of disparities in health behaviors among African American and white men in the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore, which was conducted in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. After adjusting for age, marital status, insurance, income, educational attainment, poor or fair health, and obesity status, African American men in National Health Interview Survey had greater odds of being physically inactive (odds ratio [OR] = 1.48; 95% confidence interval [CI], 129-1.69), reduced odds of being a current smoker (OR = 0.77; 95% CI, 0.65-0.90), and reduced odds of being a current drinker (OR = 0.58; 95% CI, 0.50-0.67). In the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore sample, African American and white men had similar odds of being physically inactive (OR = 0.79; 95% CI, 0.50-1.24), being a current smoker (OR = 0.86; 95% CI, 0.60-1.23), or being a current drinker (OR = 1.34; 95% CI, 0.81-2.21). Because race disparities in these health behaviors were ameliorated in the sample where African American and white men were living under similar social, environmental, and socioeconomic status conditions, these findings suggest that social environment may be an important determinant of health behaviors among African American and white men. Public health interventions and health promotion strategies should consider the social environment when seeking to better understand men's health disparities.
Leventhal, Elaine A.; And Others
Health behavior may be influenced by age, beliefs, and symptomatology. To examine age-related health beliefs and behaviors with respect to six diseases (the common cold, colon-rectal cancer, lung cancer, heart attack, high blood pressure, and senility), 396 adults (196 males, 200 females) divided into three age groups completed a questionnaire…
Washington State Dept. of Social and Health Services, Olympia.
The 1992 Washington State Survey of Adolescent Health Behaviors (WSSAHB) was created to collect information regarding a variety of adolescent health behaviors among students in the state of Washington. It expands on two previous administrations of a student tobacco, alcohol, and other drug survey and includes questions about medical care, safety,…
... 2009 † Health-Risk Behaviors Percentage of U.S. high school students who engaged in each risk behavior, by type of grades mostly earned A’s B’s C’s D’s/F’s Unintentional Injury and Violence-Related Behaviors Rarely or never wore a seat ...
Lush, L.; Cleland, J.; Walt, G.; Mayhew, S.
Since 1994, integrating human immunodeficiency virus/sexually transmitted disease (HIV/STD) services with primary health care, as part of reproductive health, has been advocated to address two major public health problems: to control the spread of HIV; and to improve women's reproductive health. However, integration is unlikely to succeed because primary health care and the political context within which this approach is taking place are unsuited to the task. In this paper, a historical comparison is made between the health systems of Ghana, Kenya and Zambia and that of South Africa, to examine progress on integration of HIV/STD services since 1994. Our findings indicate that primary health care in Ghana, Kenya and Zambia has been used mainly by women and children and that integration has meant adding new activities to these services. For the vertical programmes which support these services, integration implies enhanced collaboration rather than merged responsibility. This compromise between comprehensive rhetoric and selective reality has resulted in little change to existing structures and processes; problems with integration have been exacerbated by the activities of external donors. By comparison, in South Africa integration has been achieved through political commitment to primary health care rather than expanding vertical programmes (top-down management systems). The rhetoric of integration has been widely used in reproductive health despite lack of evidence for its feasibility, as a result of the convergence of four agendas: improving family planning quality; the need to improve women's health; the rapid spread of HIV; and conceptual shifts in primary health care. International reproductive health actors, however, have taken little account of political, financial and managerial constraints to implementation in low-income countries. PMID:10534902
People often make decisions in health care that are not in their best interest, ranging from failing to enroll in health insurance to which they are entitled, to engaging in extremely harmful behaviors. Traditional economic theory provides a limited tool kit for improving behavior because it assumes that people make decisions in a rational way, have the mental capacity to deal with huge amounts of information and choice, and have tastes endemic to them and not open to manipulation. Melding economics with psychology, behavioral economics acknowledges that people often do not act rationally in the economic sense. It therefore offers a potentially richer set of tools than provided by traditional economic theory to understand and influence behaviors. Only recently, however, has it been applied to health care. This article provides an overview of behavioral economics, reviews some of its contributions, and shows how it can be used in health care to improve people's decisions and health.
Hewins-Maroney, Barbara; Schumaker, Alice; Williams, Ethel
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.
Alonzo, A A
American medicine faces many contradictions and dilemmas. This is especially the case with regard to preventive health behavior. This paper explores the effects of several issues, contradictions and dilemmas on the American experience with primary preventive health behavior. These issues include: individualism, victim blaming, therapeutic nihilism, the over abundance of health information, America as a culture of risk takers, and the dilemma of the jungle vs the zoo. Four types of health behavior are defined. The first type of health behavior is the primary prevention of disease, defect, injury or disability. The second type is detection of asymptomatic disease, injury and defect. Third, is the promotion of enhanced levels of health, wellness and quality of life. And the fourth, at a more societal level, protective behaviors to make environmental transactions safe from disease, injury, defect and disability. These four types of health behavior are each explored in relation to societal values, technology and economics to determine which of these facilitate or impede health behavior at both the individual and societal levels.
Leveton, Lauren; Whitemire, Alexandra
This poster reviews the working of the Behavioral Health and Performance (BHP) group, which supports the research element which manages an integrated program for future space flight. The BHP operations group supports astronauts and their families in all phases of the International Space Station Mission, and post mission effects.
Fertig, Angela R.; Reingold, David A.
This paper explores the relationship between public housing, health outcomes, and health behaviors among low-income housing residents. While public housing can be a dangerous and unhealthy environment in which to live, the subsidized rent may free up resources for nutritious food and health care. In addition, public housing may be of higher…
Podein, Rian J; Hernke, Michael T
Unsustainable development around the world has contributed to ecological degradation and human suffering while compromising the ability of ecosystems and social institutions to support human life. The United States health care system and its institutions are significant contributors to unsustainable development, but leaders of change are emerging from the health care arena. Health professionals, including primary care providers, are poised to serve as models for sustainability and to facilitate the necessary transformation toward more sustainable practices. Health professionals must, within a practical framework, embrace an objective definition of sustainability and then act to achieve it.
Lutgendorf, Susan K; Costanzo, Erin S
The biopsychosocial model describes interactions between psychosocial and biological factors in the etiology and progression of disease. How an individual interprets and responds to the environment determines responses to stress, influences health behaviors, contributes to the neuroendocrine and immune response, and may ultimately affect health outcomes. Health psychology interventions are designed to modulate the stress response and improve health behaviors by teaching individuals more adaptive methods of interpreting life challenges and more effective coping responses. These interactions are discussed in the context of aging.
Hogue, Aaron; Bobek, Molly; Tau, Gregory Z.; Levin, Frances R.
Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions. PMID:25505817
Pfleiderer, Klaus; Stoessel, Rainer; Busse, Gerhard
Advanced high performance materials and components such as CFRP, GFRP and Smart Structures require improved testing techniques. The first part of our contribution deals with nonlinear vibrometry as a defect selective non-destructive testing method. This method uses higher harmonics (which are generated only at defects) to locate the defect by scanning across the surface of the sample with a laser interferometer. For input coupling of the elastic wave both an external (like ultrasound welding converters) or internal (integrated piezo actuators) excitation source can be used. The external detection tools are a microphone or a scanning laser vibrometer. With this technique, we characterized Smart Structures made of aerospace materials and composites with embedded piezoelectric actuators. The next part is about health monitoring techniques and diagnostics where integrated elements are used for excitation and detection. Thus, we monitored the transfer function over a large frequency spectrum and especially its changes caused e.g. by defects. Changes in the properties of structures by fatigue, impacts, and thermoplasticity have been successfully observed. Also the changes in reinforced plastics under tensile stress have been monitored. The results were correlated with destructive measurements. For health monitoring we also present the impedance analysis of embedded piezo ceramic sensors. A defect causes changes in the modal response of the hole structure and that effect can be detected using the phase angle of the electric impedance of the piezo element. Additionally some types of defects cause a non-linear behavior of the structure which was verified by extracting higher harmonics as a reaction to sinusoidal single frequency excitation.
Mishra, Meenoo; Lupi, Monica Valdes; Miller, Wm Jahmal; Nolfo, Tamu
Behavioral health disparities are not usually considered part of the same system of health disparities. However, the California Department of Public Health focused its health equity strategies on reducing behavioral health disparities through its California Statewide Plan to Promote Health and Mental Health Equity. This statewide plan was developed through a community-wide stakeholder engagement and outreach process. In addition, the California Reducing Disparities Project is a prevention and early intervention effort to reduce mental health disparities in underserved populations. This strategic plan represents the voice of several racial/ethnic communities, such as African American, Asian and Pacific Islander, Latino, Native American, as well as lesbian, gay, bisexual, transgender, and queer and questioning communities in California, through 5 strategic planning workgroups. The workgroups were composed of a broad range of stakeholders, including community leaders, mental health care providers, consumer and family members, individuals with lived experience, and academia. This case example highlights the various efforts of California's Office of Health Equity in eliminating behavioral health disparities and promoting mental health equity, as well as discusses the unique statutory and regulatory role of the Office of Health Equity's deputy director.
This conference will bring together scientist and professionals to discuss the complex relationships between people, the planet, and all living beings. The focus will specifically be integrating environment and health.
Interconnections between Human Health and Ecological Integrity emanates from a June 2000 Pellston Workshop in Snowbird, Utah, USA. Jointly sponsored by the Society of Environmental Toxicology and Chemistry (SETAC) and the Society of Toxicology (SOT), the workshop was motivated by...
Hall, Lisa Anne
This study explored the relationship between student adjustment theory and college student health behaviors. Specifically, this research examined first-year freshmen college student physical activity and nutrition behaviors and impact on adjustment to college (N = 37,564). The design for this study was a non-experimental "ex post facto"…
Terre, Lisa; And Others
Investigated relative influence of background characteristics (age, gender, race, socioeconomic status, family type) and peer status on health-related behaviors (physical activity, eating habits, smoking, alcohol use, stress-related behaviors) in 589 junior high school students. Peer popularity provided no significant increment in prediction of…
Walker, Peter; Portnoy, Barry
This study sought to determine the effects of a high blood pressure education program for sixth graders on the preventive hypertension health attitudes and behaviors of their parents. Attention was focused on the role of students ("significant others") in affecting parental attitude and behavior changes relating to the three risk factors of…
Thorpe, Roland J.; Kennedy-Hendricks, Alene; Griffith, Derek M.; Bruce, Marino A.; Coa, Kisha; Bell, Caryn N.; Young, Jessica; Bowie, Janice V.; LaVeist, Thomas A.
Although understanding race differences in health behaviors among men is an important step in reducing disparities in leading causes of death in the United States, progress has been stifled when using national data because of the confounding of race, socioeconomic status (SES), and residential segregation. The purpose of this study is to examine the nature of disparities in health behaviors among African American and White men in the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore (EHDIC-SWB) which was conducted in a racially a racially-integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey (NHIS). After adjusting for age, marital status, insurance, income, educational attainment, poor or fair health, and obesity status, African American men in NHIS had greater odds of being physically inactive (odds ratio [OR] =1.48, 95% confidence interval [CI] 129, 1.69), reduced odds of being a current smoker (OR= 0.77, 95% CI 0.65, 0.90), and reduced odds of being a current drinker (OR= 0.58, 95% CI 0.50, 0.67). In the EHDIC-SWB sample, African American and white men had similar odds of being physically inactive (OR = 0.79, 95% CI 0.50, 1.24), being a current smoker (OR = 0.86, 95% CI 0.60, 1.23), or being a current drinker (OR = 1.34, 95% CI 0.81, 2.21). Because race disparities in these health behaviors were ameliorated in the sample where African American and white men were living under similar social, environmental and SES conditions, these findings suggest that social environment may be an important determinant of health behaviors among African American and White men. Public health interventions and health promotion strategies should consider the social environment when seeking to better understand men’s health disparities. PMID:26291190
Prochaska, James O
Given the disease and cost burdens, Multiple Health Behavior Research represents the future of preventive medicine. Growing evidence in this special issue and beyond indicates that simultaneous and sequential interventions can be effective. The challenge for the future is to make such interventions more effective, cost effective and less demanding. Co-variation represents one innovative approach in which effective change on one treated behavior increases the odds of effective action on a second targeted behavior. Co-variation can occur when all behaviors received full treatment, when one receives full treatment and the others receive minimal treatment and when only one behavior is treated and others co-vary without treatment. Integrative treatments represent another innovation in which higher order constructs drive change on multiple behaviors related to the construct and treatment has to be only on one higher order behavior. A more integrated approach to research and practice involves new paradigms complementing established paradigms. Multiple behaviors proactively treated in populations at home or work by computer-based and stage-based interventions designed to generate co-variation that produces greater impacts can complement traditional paradigms that treat single behaviors in individual patients in clinics by clinicians with action-oriented modular interventions designed for specific behaviors to produce significant efficacy. More inclusive research to support more inclusive practices can hopefully lead to more inclusive care.
Kuhn, Wendy; Bellinger, Jillian; Stevens-Manser, Stacey; Kaufman, Laura
Peer specialists are people in recovery employed to share their experiences to promote the recovery of others affected by mental illness. Examining workplace integration indicators that predict the job satisfaction of peer specialists employed in a variety of behavioral health settings is critical to ensure the retention and effectiveness of this viable workforce. A survey of Texas Certified Peer Specialists (n = 86) examined workplace integration indicators. Results suggest that supervisor's understanding of the peer specialist job role has a significant impact on job satisfaction. Better workforce integration may be achieved through targeted efforts to educate supervisors about peer specialist job roles.
Homoeopathy is a therapy which involves many components and three main agents: the patient, with his or her condition and personal characteristics; the medication used, with its composition and manufacturing procedure; and the physician, with his or her approach to treatment and concepts of health. The development of research and evaluation structures, combined with a critical education in the discipline, would help to improve practices and define homoeopathy's potential role in relation to the other therapies, both conventional and unconventional, used in Western health systems. PMID:10083716
Reed, Derek D.; Fienup, Daniel M.; Luiselli, James K.; Pace, Gary M.
With rising interest in the role of treatment integrity on student outcomes, research has primarily focused on isolating the techniques and procedures necessary to improve staff's acquisition and maintenance of adequate levels of integrity. Despite increasing numbers of publications on this topic, there has been little discussion of the variables…
Yu, Qunqun; Risk, Benjamin B; Zhang, Kai; Marron, J S
A major goal in neuroscience is to understand the neural pathways underlying human behavior. We introduce the recently developed Joint and Individual Variation Explained (JIVE) method to the neuroscience community to simultaneously analyze imaging and behavioral data from the Human Connectome Project. Motivated by recent computational and theoretical improvements in the JIVE approach, we simultaneously explore the joint and individual variation between and within imaging and behavioral data. In particular, we demonstrate that JIVE is an effective and efficient approach for integrating task fMRI and behavioral variables using three examples: one example where task variation is strong, one where task variation is weak and a reference case where the behavior is not directly related to the image. These examples are provided to visualize the different levels of signal found in the joint variation including working memory regions in the image data and accuracy and response time from the in-task behavioral variables. Joint analysis provides insights not available from conventional single block decomposition methods such as Singular Value Decomposition. Additionally, the joint variation estimated by JIVE appears to more clearly identify the working memory regions than Partial Least Squares (PLS), while Canonical Correlation Analysis (CCA) gives grossly overfit results. The individual variation in JIVE captures the behavior unrelated signals such as a background activation that is spatially homogeneous and activation in the default mode network. The information revealed by this individual variation is not examined in traditional methods such as CCA and PLS. We suggest that JIVE can be used as an alternative to PLS and CCA to improve estimation of the signal common to two or more datasets and reveal novel insights into the signal unique to each dataset.
Wood, Norma J.
The purpose of this study was to investigate the relationships among health status, personal definition of health, and health behavior choice in the elderly. Self-assessed health status was measured using a modified Cantril Ladder, personal definition of health was measured using the Laffrey Health Conception Scale (LHCS), and health behavior…
Manafo, Elizabeth; Wong, Sharon
Objective: To explore older adults' (55-70 years) health information-seeking behaviors. Methods: Using a qualitative methodology, based on grounded theory, data were collected using in-depth interviews. Participants were community-living, older adults in Toronto, Canada who independently seek nutrition and health information. Interview transcripts…
Osborn, Chandra Y.; Paasche-Orlow, Michael K.; Bailey, Stacy Cooper; Wolf, Michael S.
Objective To examine the mechanisms linking health literacy to physical activity and self-reported health. Methods From 2005–2007, patients (N=330) with hypertension were recruited from safety net clinics. Path analytic models tested the pathways linking health literacy to physical activity and self-reported health. Results There were significant paths from health literacy to knowledge (r=0.22, P<0.001), knowledge to self-efficacy (r=0.13, P<0.01), self-efficacy to physical activity (r=0.17, P<0.01), and physical activity to health status (r=0.17, P<0.01). Conclusions Health education interventions should be literacy sensitive and aim to enhance patient health knowledge and self-efficacy to promote self-care behavior and desirable health outcomes. PMID:20950164
Bender, Bruce G
Many Americans are failing to engage in both the behaviors that prevent and those that effectively manage chronic health conditions, including pulmonary disorders, cardiovascular conditions, diabetes, and cancer. Expectations that health care providers are responsible for changing patients' health behaviors often do not stand up against the realities of clinical care that include large patient loads, limited time, increasing co-pays, and restricted access. Organizations and systems that might share a stake in changing health behavior include employers, insurance payers, health care delivery systems, and public sector programs. However, although the costs of unhealthy behaviors are evident, financial resources to address the problem are not readily available. For most health care organizations, the return on investment for developing behavior change programs appears highest when addressing treatment adherence and disease self-management, and lowest when promoting healthy lifestyles. Organizational strategies to improve adherence are identified in 4 categories: patient access, provider training and support, incentives, and information technology. Strategies in all 4 categories are currently under investigation in ongoing studies and have the potential to improve self-management of many chronic health conditions.
He, David; Bechhoefer, Eric; Dempsey, Paula; Ma, Jinghua
In this paper, an integrated approach for gear health prognostics using particle filters is presented. The presented method effectively addresses the issues in applying particle filters to gear health prognostics by integrating several new components into a particle filter: (1) data mining based techniques to effectively define the degradation state transition and measurement functions using a one-dimensional health index obtained by whitening transform; (2) an unbiased l-step ahead RUL estimator updated with measurement errors. The feasibility of the presented prognostics method is validated using data from a spiral bevel gear case study.
George, Melissa W; Trumpeter, Nevelyn N; Wilson, Dawn K; McDaniel, Heather L; Schiele, Bryn; Prinz, Ron; Weist, Mark D
The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program.
George, Melissa W.; Trumpeter, Nevelyn N.; Wilson, Dawn K.; McDaniel, Heather L.; Schiele, Bryn; Prinz, Ron; Weist, Mark D.
The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program. PMID:24297005
Payne, Julianne; Razi, Sima; Emery, Kyle; Quattrone, Westleigh; Tardif-Douglin, Miriam
Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.
Integrated Systems Health Management (ISHM) is a system engineering discipline that addresses the design, development, operation, and lifecycle management of components, subsystems, vehicles, and other operational systems with the purpose of maintaining nominal system behavior and function and assuring mission safety and effectiveness under off-nominal conditions. NASA missions are often conducted in extreme, unfamiliar environments of space, using unique experimental spacecraft. In these environments, off-nominal conditions can develop with the potential to rapidly escalate into mission- or life-threatening situations. Further, the high visibility of NASA missions means they are always characterized by extraordinary attention to safety. ISHM is a critical element of risk mitigation, mission safety, and mission assurance for exploration. ISHM enables: In-space maintenance and repair; a) Autonomous (and automated) launch abort and crew escape capability; b) Efficient testing and checkout of ground and flight systems; c) Monitoring and trending of ground and flight system operations and performance; d) Enhanced situational awareness and control for ground personnel and crew; e) Vehicle autonomy (self-sufficiency) in responding to off-nominal conditions during long-duration and distant exploration missions; f) In-space maintenance and repair; and g) Efficient ground processing of reusable systems. ISHM concepts and technologies may be applied to any complex engineered system such as transportation systems, orbital or planetary habitats, observatories, command and control systems, life support systems, safety-critical software, and even the health of flight crews. As an overarching design and operational principle implemented at the system-of-systems level, ISHM holds substantial promise in terms of affordability, safety, reliability, and effectiveness of space exploration missions.
Shank, Nancy; Willborn, Elizabeth; Pytlikzillig, Lisa; Noel, Harmonijoie
Interviews with 32 community behavioral health providers elicited perceived benefits and barriers of using electronic health records. Themes identified were (a) quality of care, (b) privacy and security, and (c) delivery of services. Benefits to quality of care were mentioned by 100% of the providers, and barriers by 59% of providers. Barriers involving privacy and security concerns were mentioned by 100% of providers, and benefits by 22%. Barriers to delivery of services were mentioned by 97% of providers, and benefits by 66%. Most providers (81%) expressed overall positive support for electronic behavioral health records.
Sorensen, Glorian; McLellan, Deborah L; Sabbath, Erika L; Dennerlein, Jack T; Nagler, Eve M; Hurtado, David A; Pronk, Nicolaas P; Wagner, Gregory R
There is increasing recognition of the value added by integrating traditionally separate efforts to protect and promote worker safety and health. This paper presents an innovative conceptual model to guide research on determinants of worker safety and health and to inform the design, implementation and evaluation of integrated approaches to promoting and protecting worker health. This model is rooted in multiple theories and the premise that the conditions of work are important determinants of individual safety and health outcomes and behaviors, and outcomes important to enterprises such as absence and turnover. Integrated policies, programs and practices simultaneously address multiple conditions of work, including the physical work environment and the organization of work (e.g., psychosocial factors, job tasks and demands). Findings from two recent studies conducted in Boston and Minnesota (2009-2015) illustrate the application of this model to guide social epidemiological research. This paper focuses particular attention on the relationships of the conditions of work to worker health-related behaviors, musculoskeletal symptoms, and occupational injury; and to the design of integrated interventions in response to specific settings and conditions of work of small and medium size manufacturing businesses, based on a systematic assessment of priorities, needs, and resources within an organization. This model provides an organizing framework for both research and practice by specifying the causal pathways through which work may influence health outcomes, and for designing and testing interventions to improve worker safety and health that are meaningful for workers and employers, and responsive to that setting's conditions of work.
Ciliska, Donna; Wilson, Douglas M. C.
This article is the second in a series of six on lifestyle assessment and behavior change. The first article presented an assessment tool called FANTASTIC, which has been tested for reliability and is currently in wide use. After assessment, family physicians must help patients decide to change—and give them guidance on how to change—unhealthy behaviors. This article explains how the family physician can use educational, behavioral and relaxation strategies to increase patients' motivation, maintain their commitment and teach them the skills needed to effect changes in health behavior.
Adler, Amy B; Saboe, Kristin N; Anderson, James; Sipos, Maurice L; Thomas, Jeffrey L
The impact of stress on mental health in high-risk occupations may be mitigated by organizational factors such as leadership. Studies have documented the impact of general leadership skills on employee performance and mental health. Other researchers have begun examining specific leadership domains that address relevant organizational outcomes, such as safety climate leadership. One emerging approach focuses on domain-specific leadership behaviors that may moderate the impact of combat deployment on mental health. In a recent study, US soldiers deployed to Afghanistan rated leaders on behaviors promoting management of combat operational stress. When soldiers rated their leaders high on these behaviors, soldiers also reported better mental health and feeling more comfortable with the idea of seeking mental health treatment. These associations held even after controlling for overall leadership ratings. Operational stress leader behaviors also moderated the relationship between combat exposure and soldier health. Domain-specific leadership offers an important step in identifying measures to moderate the impact of high-risk occupations on employee health.
The goal of this study was to evaluate the effectiveness of a public health educational campaign to reduce backyard mosquito-larval habitats. Three communities each, within two New Jersey counties, were randomly selected to receive (1) both education and mosquito control, (2) education only, and (3)...
Kim, Hak-Seon; Ahn, Joo
The purpose of this research was to investigate how university students' nutrition beliefs influence their health behavioral intention. This study used an online survey engine (Qulatrics.com) to collect data from college students. Out of 253 questionnaires collected, 251 questionnaires (99.2%) were used for the statistical analysis. Confirmatory Factor Analysis (CFA) revealed that six dimensions, "Nutrition Confidence," "Susceptibility," "Severity," "Barrier," "Benefit," "Behavioral Intention to Eat Healthy Food," and "Behavioral Intention to do Physical Activity," had construct validity; Cronbach's alpha coefficient and composite reliabilities were tested for item reliability. The results validate that objective nutrition knowledge was a good predictor of college students' nutrition confidence. The results also clearly showed that two direct measures were significant predictors of behavioral intentions as hypothesized. Perceived benefit of eating healthy food and perceived barrier for eat healthy food to had significant effects on Behavioral Intentions and was a valid measurement to use to determine Behavioral Intentions. These findings can enhance the extant literature on the universal applicability of the model and serve as useful references for further investigations of the validity of the model within other health care or foodservice settings and for other health behavioral categories. PMID:23346306
perceived usefulness of the Internet and attitude toward Internet use for health purposes for women who were health conscious and who perceived their health to be at risk. Conclusions The integrated model proposed and tested in this study shows that the HBM, when combined with the TAM, is able to predict Internet use for health purposes. For women who subjectively evaluate their health as vulnerable to diseases and are concerned about their health, cognition beliefs in and positive affective feelings about the Internet come into play in determining the use of health-related Internet use. Furthermore, this study shows that engaging in health-related Internet use is a proactive behavior rather than a reactive behavior, suggesting that TAM dimensions have a significant mediating role in Internet health management. PMID:25700481
Leathers, Sonya J.; Spielfogel, Jill E.; Gleeson, James P.; Rolock, Nancy
Objectives Adoption is particularly important for foster children with special mental health needs who are unable to return home, as adoption increases parental support often critically needed by youth with mental health issues. Unfortunately, significant behavior problems frequently inhibit foster parents from adopting, and little is known about factors that predict adoption when a child has behavior problems. Previous research suggests that foster parent behavioral training could potentially increase rates of successful adoptions for pre-school-aged foster children with behavior problems (Fisher, Kim, & Pears, 2009), but this has not been previously tested in older samples. In older children, effective treatment of behavior problems might also increase adoption by reducing the interference of behavior problems and strengthening the child’s foster home integration. This pilot study focused on this question by testing associations between behavior problems, foster home integration, an evidence-based foster parent intervention, and adoption likelihood. Methods This study used an intent-to-treat design to compare foster home integration and adoption likelihood for 31 foster children with histories of abuse and neglect whose foster parents received a foster behavioral parenting intervention (see Chamberlain, 2003) or usual services. Random effect regression analyses were used to estimate outcomes across four time points. Results As expected, externalizing behavior problems had a negative effect on both integration and adoption, and foster home integration had an independent positive effect on adoption. Internalizing behavior problems (e.g., depression/anxiety) were not related to adoption or integration. However, the intervention did not have a direct effect on either foster home integration or adoption despite its positive effect on behavior problems. Conclusions Results from this preliminary study provide further evidence of the negative effect of externalizing
Dumont, Dora M; Wildeman, Christopher; Lee, Hedwig; Gjelsvik, Annie; Valera, Pamela; Clarke, Jennifer G
Parental incarceration is associated with mental and physical health problems in children, yet little research directly tests mechanisms through which parental incarceration could imperil child health. We hypothesized that the incarceration of a woman or her romantic partner in the year before birth constituted an additional hardship for already-disadvantaged women, and that these additionally vulnerable women were less likely to engage in positive perinatal health behaviors important to infant and early childhood development. We analyzed 2006-2010 data from the Pregnancy Risk Assessment and Monitoring System to assess the association between incarceration in the year prior to the birth of a child and perinatal maternal hardships and behaviors. Women reporting incarceration of themselves or their partners in the year before birth of a child had .86 the odds (95 % CI .78-.95) of beginning prenatal care in the first trimester compared to women not reporting incarceration. They were nearly twice as likely to report partner abuse and were significantly more likely to rely on WIC and/or Medicaid for assistance during pregnancy. These associations persist after controlling for socioeconomic measures and other stressors, including homelessness and job loss. Incarceration of a woman or her partner in the year before birth is associated with higher odds of maternal hardship and poorer perinatal health behaviors. The unprecedented scale of incarceration in the US simultaneously presents an underutilized public health opportunity and constitutes a social determinant of health that may contribute to disparities in early childhood development.
Gwinn, Marta; MacCannell, Duncan R; Khabbaz, Rima F
Advances in laboratory and information technologies are transforming public health microbiology. High-throughput genome sequencing and bioinformatics are enhancing our ability to investigate and control outbreaks, detect emerging infectious diseases, develop vaccines, and combat antimicrobial resistance, all with increased accuracy, timeliness, and efficiency. The Advanced Molecular Detection (AMD) initiative has allowed the Centers for Disease Control and Prevention (CDC) to provide leadership and coordination in integrating new technologies into routine practice throughout the U.S. public health laboratory system. Collaboration and partnerships are the key to navigating this transition and to leveraging the next generation of methods and tools most effectively for public health.
Most traditional conceptions of reinforcement are based on a simple causal model in which responding is strengthened by the presentation of a reinforcer. I argue that reinforcement is better viewed as the outcome of constraint of a functioning causal system comprised of multiple interrelated causal sequences, complex linkages between causes and effects, and a set of initial conditions. Using a simplified system conception of the reinforcement situation, I review the similarities and drawbacks of traditional reinforcement models and analyze the recent contributions of cognitive, regulatory, and ecological approaches. Finally, I show how the concept of behavior systems can begin to incorporate both traditional and recent conceptions of reinforcement in an integrative approach. PMID:8354963
Conrad, D A; Shortell, S M
Today's ¿virtually¿ and vertically integrated health systems increasingly are much better positioned than the multihospital systems of the 1980s to respond to the healthcare challenges of the twenty-first century. The authors argue that the control of the health services ¿value chain¿ will devolve naturally to those market players who have the comparative advantage in coordinating the flows of information, human, and physical resources along the continuum of services required to improve and maintain the health of populations. Available evidence does not render a clear verdict on whether superior performance is generated by the virtual integration of strategic alliances and affiliations or the vertical integration represented by unified single ownership of all system components. While inertia, acute care-based ¿mental models,¿ weak incentives, and insufficiently developed information systems represent important barriers to the creation and sustainability of integrated systems, the authors argue that system evolution is occurring and offers promise of enhanced efficiency and patient benefit. However, the full potential of these systems will only be realized as they accept explicit accountability for meeting the health needs of their local communities. The transition from ¿covered lives¿ to accountability for the community population is crucial.
Oral health is often not a priority during cancer treatment; however, patients with cancer are at increased risk for oral complications during and after treatment. This article focuses on the importance of oral health care before, during, and after cancer treatment using the head, eyes, ears, nose, oral cavity, and throat, or HEENOT, approach. AT A GLANCE: Oral health is linked to overall health, and healthcare providers must be cognizant of the oral-systemic connection with patients undergoing cancer treatment, which may cause acute and chronic oral health problems. Oral assessment, prevention, early recognition, and treatment of oral problems must be incorporated into cancer care, particularly with the aid of an interprofessional team to meet patients' oral care needs. The head, eyes, ears, nose, oral cavity, and throat, or HEENOT, approach integrates oral care into patients' history taking, physical examination, and plan of cancer care. .
This report is to present the work that was performed during the summer in the Advance Computing Application office. The NFFP (NASA Faculty Fellow Program) had ten summer faculty members working on IVHM (Integrated Vehicle Health Management) technologies. The objective of this project was two-fold: 1) to become familiar with IVHM concepts and key demonstrated IVHM technologies; and 2) to integrate the research that has been performed by IVHM faculty members into the MASTLAB (Marshall Avionic Software Test Lab). IVHM is a NASA-wide effort to coordinate, integrate and apply advanced software, sensors and design technologies to increase the level of intelligence, autonomy, and health state of future vehicles. IVHM is an important concept because it is consistent with the current plan for NASA to go to the moon, mars, and beyond. In order for NASA to become more involved in deep exploration, avionic systems will need to be highly adaptable and autonomous.
Mellins, Claude A; Tassiopoulos, Katherine; Malee, Kathleen; Moscicki, Anna-Barbara; Patton, Doyle; Smith, Renee; Usitalo, Ann; Allison, Susannah M; Van Dyke, Russell; Seage, George R
In a sample of perinatally HIV-infected (PHIV+) and perinatally HIV-exposed, uninfected (PHEU) adolescents, we examined the co-occurrence of behavioral health risks including mental health problems, onset of sexual and drug use behaviors, and (in PHIV+ youth) nonadherence to antiretroviral therapy (ART). Participants, recruited from 2007 to 2010, included 349 youth, ages 10-16 years, enrolled in a cohort study examining the impact of HIV infection and ART. Measures of the above behavioral health risks were administered to participants and primary caregivers. Nearly half the participants met study criteria for at least one behavioral health risk, most frequently, mental health problems (28%), with the onset of sexual activity and substance use each reported by an average of 16%. Among the sexually active, 65% of PHIV+ and 50% of PHEU youth reported unprotected sex. For PHIV +youth, 34% reported recent ART nonadherence, of whom 45% had detectable HIV RNA levels. Between 16% (PHIV+) and 11% (PHEU) of youth reported at least two behavioral health risks. Older age, but not HIV status, was associated with having two or more behavioral health risks versus none. Among PHIV+ youth, living with a birth mother (versus other caregivers) and detectable viral load were associated with co-occurrence of behavioral health risks. In conclusion, this study suggests that for both PHIV+ and PHEU youth, there are multiple behavioral health risks, particularly mental health problems, which should be targeted by service systems that can integrate prevention and treatment efforts.
Figueroa, Fernando; Melcher, Kevin
The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.
Reis, S; Morris, G; Fleming, L E; Beck, S; Taylor, T; White, M; Depledge, M H; Steinle, S; Sabel, C E; Cowie, H; Hurley, F; Dick, J McP; Smith, R I; Austen, M
Scientific investigations have progressively refined our understanding of the influence of the environment on human health, and the many adverse impacts that human activities exert on the environment, from the local to the planetary level. Nonetheless, throughout the modern public health era, health has been pursued as though our lives and lifestyles are disconnected from ecosystems and their component organisms. The inadequacy of the societal and public health response to obesity, health inequities, and especially global environmental and climate change now calls for an ecological approach which addresses human activity in all its social, economic and cultural complexity. The new approach must be integral to, and interactive, with the natural environment. We see the continuing failure to truly integrate human health and environmental impact analysis as deeply damaging, and we propose a new conceptual model, the ecosystems-enriched Drivers, Pressures, State, Exposure, Effects, Actions or 'eDPSEEA' model, to address this shortcoming. The model recognizes convergence between the concept of ecosystems services which provides a human health and well-being slant to the value of ecosystems while equally emphasizing the health of the environment, and the growing calls for 'ecological public health' as a response to global environmental concerns now suffusing the discourse in public health. More revolution than evolution, ecological public health will demand new perspectives regarding the interconnections among society, the economy, the environment and our health and well-being. Success must be built on collaborations between the disparate scientific communities of the environmental sciences and public health as well as interactions with social scientists, economists and the legal profession. It will require outreach to political and other stakeholders including a currently largely disengaged general public. The need for an effective and robust science-policy interface has
Higgins, Stephen T.
This Special Issue of Preventive Medicine (PM) focuses on behavior change, health, and health disparities, topics of fundamental importance to improving population health in the U.S. and other industrialized countries. While the U.S. health care system and those of other industrialized countries were developed to manage infectious disease and acute illnesses, it is chronic health conditions that most need to be understood and managed in the 21st century. The evidence is clear that personal behavior patterns like cigarette smoking and physical inactivity/obesity are critically important proximal causes of chronic disease (cardiovascular disease, site-specific cancers, type-2 diabetes) and as such behavior change will need to be a key component of their management. As the outstanding contributions to this Special Issue illustrate, substantial headway is being made in advancing knowledge including developing effective prevention and treatment strategies, with cigarette smoking being an excellent example that change is possible. That said, cigarette smoking continues to be responsible for approximately 480,000 premature deaths annually in the U.S. alone and 5 million globally. So more needs to be done, especially in economically disadvantaged populations. The same certainly applies to the challenges of the obesity epidemic, which of course is a more recent problem and understandably efforts to curtail it are in earlier stages of development. PMID:25456804
Dineen, Brian R; Lewicki, Roy J; Tomlinson, Edward C
The authors examined the effects of supervisory guidance (providing instruction to employees) and behavioral integrity (a pattern of word-deed alignment) on employee organizational citizenship behavior (OCB) and deviant behavior. Results revealed a pattern of Supervisory Guidance x Behavioral Integrity interaction effects, such that relationships between guidance and outcome variables were dependent on the level of behavioral integrity exhibited by supervisors. The interactions suggest a positive relationship between supervisory guidance and OCBs when behavioral integrity is high but also a positive relationship between guidance and deviant behavior when behavioral integrity is low. These results were consistent across 2 independent field samples: 1 assessing individual employee perceptions of supervisory behavior and the other assessing aggregate perceptions of supervisory behavior among employees in bank branches.
Cuellar, Alison Evans; Cheema, Jehanzeb
The 2010 Patient Protection and Affordable Care Act (ACA) has a number of important features for individuals who are involved with the criminal justice system. Among the most important changes is the expansion of Medicaid to more adults. The current study estimates that 10% of the total Medicaid expansion could include individuals who have experienced recent incarceration. The ACA also emphasizes the importance of mental health and substance abuse benefits, potentially changing the landscape of behavioral health treatment providers willing to serve criminal justice populations. Finally, it seeks to promote coordinated care delivery. New care delivery and appropriate funding models are needed to address the behavioral health and other chronic conditions experienced by those in criminal justice and to coordinate care within the complex structure of the justice system itself.
Berkman, L F; Glass, T; Brissette, I; Seeman, T E
It is widely recognized that social relationships and affiliation have powerful effects on physical and mental health. When investigators write about the impact of social relationships on health, many terms are used loosely and interchangeably including social networks, social ties and social integration. The aim of this paper is to clarify these terms using a single framework. We discuss: (1) theoretical orientations from diverse disciplines which we believe are fundamental to advancing research in this area; (2) a set of definitions accompanied by major assessment tools; and (3) an overarching model which integrates multilevel phenomena. Theoretical orientations that we draw upon were developed by Durkheim whose work on social integration and suicide are seminal and John Bowlby, a psychiatrist who developed attachment theory in relation to child development and contemporary social network theorists. We present a conceptual model of how social networks impact health. We envision a cascading causal process beginning with the macro-social to psychobiological processes that are dynamically linked together to form the processes by which social integration effects health. We start by embedding social networks in a larger social and cultural context in which upstream forces are seen to condition network structure. Serious consideration of the larger macro-social context in which networks form and are sustained has been lacking in all but a small number of studies and is almost completely absent in studies of social network influences on health. We then move downstream to understand the influences network structure and function have on social and interpersonal behavior. We argue that networks operate at the behavioral level through four primary pathways: (1) provision of social support; (2) social influence; (3) on social engagement and attachment; and (4) access to resources and material goods.
Bryan, Craig J.; Corso, Meghan L.; Corso, Kent A.; Morrow, Chad E.; Kanzler, Kathryn E.; Ray-Sannerud, Bobbie
Objective: To model typical trajectories for improvement among patients treated in an integrated primary care behavioral health service, multilevel models were used to explore the relationship between baseline mental health impairment level and eventual mental health functioning across follow-up appointments. Method: Data from 495 primary care…
Ramos, Mary M.; Greenberg, Cynthia; Sapien, Robert; Bauer-Creegan, Judith; Hine, Beverly; Geary, Cathy
Background: As members of interdisciplinary teams, school nurses provide behavioral health services. Studies indicate that school nurses may lack sufficient continuing education in adolescent behavioral health and in the management of behavioral health emergencies, specifically. We conducted this study to describe the adolescent behavioral health…
Tsasis, Peter; Evans, Jenna M; Forrest, David; Jones, Richard Keith
Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care.
Tsasis, Peter; Evans, Jenna M; Forrest, David; Jones, Richard Keith
Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care. PMID:23526058
Choi, Won S.; Ellerbeck, Edward F.; Kaur, Harsohena; Nazir, Niaman; Ahluwalia, Jasjit S.
Behaviors developed in adolescence influence health later in life. The purpose of this study was to investigate the frequency of health care provider's discussion of health behaviors with overweight and non-overweight adolescents and identify demographic and health behaviors related to exercise, hours of television viewing, and weight issues…
Begashaw, Bayu; Tessema, Fasil; Gesesew, Hailay Abrha
Background Rural and urban populations have disparate socio-demographic and economic characteristics, which have an influence on equity and their health seeking behavior. We examined and compared the health care seeking behavior for perceived morbidity between urban and rural households in Southwest Ethiopia. Methods Analytic cross-sectional study was conducted among urban and rural households living in Esera district of Southwest Ethiopia. A random sample of 388 head of households (126 urban and 262 rural) were selected. A pretested and structured questionnaire was used for data collection with face-to-face interview. In addition to descriptive methods, binary logistic regression was used to identify factors associated with health seeking behavior at p value of less than 0.05. Results Of the sample household heads, 377 (97.2%) (119 urban and 258 rural) were successfully interviewed. Among these, 58.4% (95% CI, 53.3–63.3%) of the households sought care from modern health care that was lower among rural (48.1%) than urban (80.7%) households. The prevalence of self-treatment was 35.3% in urban and 46.1% in rural households. Among the factors considered for modern health care utilization, higher monthly income (AOR, 5.6; 95% CI, 2.04–15.4), perceived severity of disease (AOR, 2.5; 95% CI, 1.1–5.8), acute duration of disease (AOR, 8.9; 95% CI, 2.4–33.3) and short distance from health facilities (AOR, 3; 95% CI, 1.2–8.4) among rural and being married (AOR, 11.3; 95% CI, 1.2–110.2) and perceived severity of disease (AOR, 6.6; 95% CI, 1.1–10.9) among urban households showed statistically significant association. Conclusions The general health seeking behavior of households on perceived morbidity was satisfactory but lower in rural compared to urban households. Self-medication was also widely practiced in the study area. The findings signal the need to work more on accessibility and promotion of healthcare seeking behavior especially among rural households
Bagley, Shirley P.; Angel, Ronald; Dilworth-Anderson, Peggye; Liu, William; Schinke, Steven
Race, ethnicity, and cultural attitudes and practices are among the variables that influence health behaviors, including adaptive health behaviors. The following discussions highlight the important role of social conditions in shaping health behaviors and the central role of family in promoting health across the Asian, Hispanic, Native American, and African American ethnic groups. Factors that may lead to health-damaging behaviors are also discussed. The need for additional research that identifies correlations among physiological, social, and behavioral factors and health behaviors, as well as underlying mechanisms, is called for. PMID:8654341
Dumont, Dora M.; Wildeman, Christopher; Lee, Hedwig; Gjelsvik, Annie; Valera, Pamela A.; Clarke, Jennifer G.
Background Parental incarceration is associated with mental and physical health problems in children, yet little research directly tests mechanisms through which parental incarceration could imperil child health. We hypothesized that the incarceration of a woman or her romantic partner in the year before birth constituted an additional hardship for already-disadvantaged women, and that these additionally vulnerable women were less likely to engage in positive perinatal health behaviors important to infant and early childhood development. Methods We analyzed 2006-2010 data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) to assess the association between incarceration in the year prior to the birth of a child and perinatal maternal hardships and behaviors. Results Women reporting incarceration of themselves or their partners in the year before birth of a child had 0.86 the odds (95% CI .78-.95) of beginning prenatal care in the first trimester compared to women not reporting incarceration. They were nearly twice as likely to report partner abuse and were significantly more likely to rely on WIC and/or Medicaid for assistance during pregnancy. These associations persist after controlling for socioeconomic measures and other stressors, including homelessness and job loss. Conclusions Incarceration of a woman or her partner in the year before birth is associated with higher odds of maternal hardship and poorer perinatal health behaviors. The unprecedented scale of incarceration in the U.S. simultaneously presents an underutilized public health opportunity and constitutes a social determinant of health that may contribute to disparities in early childhood development. PMID:24615355
Fleming, Paul J.; Agnew-Brune, Christine
Gender norms are recognized as one of the major social determinants of health and gender norms can have implications for an individual’s health behaviors. This paper reviews the recent advances in research on the role of gender norms on health behaviors most associated with morbidity and mortality. We find that (1) the study of gender norms and health behaviors is varied across different types of health behaviors, (2) research on masculinity and masculine norms appears to have taken on an increasing proportion of studies on the relationship between gender norms and health, and (3) we are seeing new and varied populations integrated into the study of gender norms and health behaviors. PMID:26075291
Centers for Disease Control and Prevention, 2011
The national Youth Risk Behavior Survey (YRBS) monitors priority health risk behaviors that contribute to the leading causes of death, disability, and social problems among youth and adults in the United States. The national YRBS is conducted every two years during the spring semester and provides data representative of 9th through 12th grade…
Cutler, David M.; Lleras-Muney, Adriana
Using a variety of data sets from two countries, we examine possible explanations for the relationship between education and health behaviors, known as the education gradient. We show that income, health insurance, and family background can account for about 30 percent of the gradient. Knowledge and measures of cognitive ability explain an additional 30 percent. Social networks account for another 10 percent. Our proxies for discounting, risk aversion, or the value of future do not account for any of the education gradient, and neither do personality factors such as a sense of control of oneself or over one’s life. PMID:19963292
Malin, Jane T.; Oliver, Patrick J.
This paper identifies work needed by developers to make integrated system health management (ISHM) technology ready and by programs to make mission infrastructure ready for this technology. This paper examines perceptions of ISHM technologies and experience in legacy programs. Study methods included literature review and interviews with representatives of stakeholder groups. Recommendations address 1) development of ISHM technology, 2) development of ISHM engineering processes and methods, and 3) program organization and infrastructure for ISHM technology evolution, infusion and migration.
King, Abby C
The careful application of theory often is used in the behavioral health field to enhance our understanding of how the world currently works. But theory also can help us visualize what the world can become, particularly through its potential impacts on population-wide health. Applying a multi-level ecological perspective can help in expanding the field's focus upward toward the population at large. While ecological frameworks have become increasingly popular, arguably such perspectives have fallen short of their potential to actively bridge conceptual constructs and, by extension, intervention approaches, across different levels of population impact. Theoretical and conceptual perspectives that explicitly span levels of impact offer arguably the greatest potential for achieving scientific insights that may in turn produce the largest population health effects. Examples of such "bridging" approaches include theories and models that span behavioral + micro-environment, behavioral + social/cultural, and social + physical environment constructs. Several recommendations are presented related to opportunities for leveraging theories to attain the greatest impact in the population health science field. These include applying the evidence obtained from person-level theories to inform methods for positively impacting the behaviors of community gatekeepers and decision-makers for greater population change and reach; leveraging the potential of residents as "citizen scientists"--a resource for enacting behavioral health changes at the individual, environmental, and policy levels; using empirical observations and theory in equal parts to build more robust, relevant, and solution-oriented behavior change programs; exploring moderators and mediators of change at levels of impact that go beyond the individual; and considering the circumstances in which applying conceptual methods that embrace a "complexity" as opposed to "causality" perspective may lead to more
Hoge, Michael A; Paris, Manuel; Adger, Hoover; Collins, Frank L; Finn, Cherry V; Fricks, Larry; Gill, Kenneth J; Haber, Judith; Hansen, Marsali; Ida, D J; Kaplan, Linda; Northey, William F; O'Connell, Maria J; Rosen, Anita L; Taintor, Zebulon; Tondora, Janis; Young, Alexander S
Competency-based training approaches are being used more in healthcare to guide curriculum content and ensure accountability and outcomes in the educational process. This article provides an overview of the state of competency development in the field of behavioral health. Specifically, it identifies the groups and organizations that have conducted and supported this work, summarizes their progress in defining and assessing competencies, and discusses both the obstacles and future directions for such initiatives. A major purpose of this article is to provide a compendium of current competency efforts so that these might inform and enhance ongoing competency development in the varied behavioral health disciplines and specialties. These varied resources may also be useful in identifying the core competencies that are common to the multiple disciplines and specialties.
Coulter, Ian D.; Khorsan, Raheleh; Crawford, Cindy; Hsiao, An-Fu
This article is based on an extensive review of integrative medicine (IM) and integrative health care (IHC). Since there is no general agreement of what constitutes IM/IHC, several major problems were identified that make the review of work in this field problematic. In applying the systematic review methodology, we found that many of those captured articles that used the term integrative medicine were in actuality referring to adjunctive, complementary, or supplemental medicine. The objective of this study was to apply a sensitivity analysis to demonstrate how the results of a systematic review of IM and IHC will differ according to what inclusion criteria is used based on the definition of IM/IHC. By analyzing 4 different scenarios, the authors show that, due to unclear usage of these terms, results vary dramatically, exposing an inconsistent literature base for this field. PMID:23843689
Poole, Gary D.
It was hypothesized that a person's estimates of the preventability of health problems would be related to health behaviors such that a person who engages in healthful behavior should make higher estimates of preventability. A study was conducted to investigate the relationship between causal attribution of health problems and health-related…
Background Individuals with posttraumatic stress disorder (PTSD) are more likely to undertake harmful health behaviors like substance use. Less is known about the association of PTSD with healthful behaviors such as healthy diet and exercise. The purpose of this study was to examine differences across physical health indicators and health behaviors in individuals with and without PTSD. Methods A cross-sectional, case–control study of health indicators and self-reported health behaviors in a community and military veteran sample was used. Results Based on a structured psychiatric interview, 25 participants had PTSD, and the remaining 55 without PTSD served as the comparison group. Participants were 40 years old on average and 45% were female. Multivariate analysis of variance analyses revealed that participants with PTSD had significantly higher body mass index (p = 0.004), had more alcohol use (p = 0.007), and reported fewer minutes of vigorous exercise (p = 0.020) than those without PTSD. Chi-square analysis of diet content and eating behavior constructs found that individuals with PTSD ate fewer fruits (p = 0.035) and had more guilt after overeating (p = 0.006). Conclusions These findings replicate prior research on the link between PTSD and negative health outcomes and engagement in harmful health behaviors and highlight the need for further examination of the association between PTSD and other health behaviors like diet content, eating behaviors, and exercise. PMID:24070007
Liang, Jian; Iannella, Renato; Sahama, Tony
Web-based social networking applications have become increasingly important in recent years. The current applications in the healthcare sphere can support the health management, but to date there is no patient-controlled integrator. This paper proposes a platform called Multiple Profile Manager (MPM) that enables a user to create and manage an integrated profile that can be shared across numerous social network sites. Moreover, it is able to facilitate the collection of personal healthcare data, which makes a contribution to the development of public health informatics. Here we want to illustrate how patients and physicians can be benefited from enabling the platform for online social network sites. The MPM simplifies the management of patients' profiles and allows health professionals to obtain a more complete picture of the patients' background so that they can provide better health care. To do so, we demonstrate a prototype of the platform and describe its protocol specification, which is an XMPP (Extensible Messaging and Presence Protocol)  extension, for sharing and synchronising profile data (vCard²) between different social networks.
Rew, Lynn; Horner, Sharon D; Brown, Adama
The major morbidities and mortalities of adolescents are related to preventable risky behaviors, but how, when, and in whom these behaviors develop in early adolescence is unknown. The purpose of this study was to determine which set of risk factors and protective resources of school-age children were best predictors of health-risk behaviors in early adolescence. A longitudinal, cohort sequential design was used with a diverse sample of 1,934 children in grades 4 through 8. Parents provided demographic and neighborhood data for children through a mailed survey. Children completed valid scales annually at schools, using audio-computer-assisted self-interviewing (A-CASI) technology. Significant gender and racial/ethnic differences were found in carrying a weapon and using alcohol. Higher perceived levels of stress increased the risk for alcohol use as did riding in a car with a driver who was drinking. Health behaviors exhibited while in 4th through 6th grades protected early adolescents from alcohol use and riding in a car with a driver who was drinking. A parent's education and perceived safety in neighborhood protected against carrying a weapon and smoking. Many findings are similar to those of national samples, but others show positive differences in this localized sample, over 50% of whom were Latino. Protective resources suggest numerous nursing interventions to promote healthy adolescent development.
Jennings, J Richard; Pardini, Dustin A; Matthews, Karen A
Hostility is a risk factor for cardiovascular events. When challenged, individuals high on hostility exhibit a hyperreactive psychophysiological response to stressors, thereby increasing risk for developing cardiovascular disease. However, low resting heart rate (HR) is associated with physical aggression and hostility in children, adolescents, and adults. Based on a community sample of 296 men (mean age = 32.0), we (a) address whether aggression/hostility relates to physical health through relationships with cardiovascular levels at rest and in response to stressors, and (b) determine how relations between aggression and health are altered by including psychophysiological indices in statistical models. The Cook-Medley cynical/hostile attitudes and the Buss-Perry physical aggression and hostility measures assessed aggression. Health was assessed as systolic blood pressure (SBP), report of medical conditions, and a metabolic composite. Reactivity to stressors was assessed with HR, SBP, and diastolic blood pressure. Aggression was negatively related to both resting HR and reactivity. High resting HR and reactivity were, however, positively related to poor health. Thus, the relationship between aggression and HR and reactivity suppressed an overall relationship between high aggression/hostility and poor health. In the presence of covariates for socioeconomic status, race, health behaviors, and medications, the relationship between aggression and health was significantly strengthened when HR level and reactivity were included in models. In sum, at early midlife, low HR among aggressive and hostile individuals is related to less health risk. Aggression and hostility have a deleterious influence on health, but primarily among individuals with higher HR and possibly greater cardiovascular reactivity.
Geissler, Kimberley H; Leatherman, Sheila
The simultaneous burdens of communicable and chronic non-communicable diseases cause significant morbidity and mortality in middle-income countries. The poor are at particular risk, with lower access to health care and higher rates of avoidable mortality. Integrating health-related services with microfinance has been shown to improve health knowledge, behaviors, and access to appropriate health care. However, limited evidence is available on effects of fully integrating clinical health service delivery alongside microfinance services through large scale and sustained long-term programs. Using a conceptual model of health services access, we examine supply- and demand-side factors in a microfinance client population receiving integrated services. We conduct a case study using data from 2010 to 2012 of the design of a universal screening program and primary care services provided in conjunction with microfinance loans by Pro Mujer, a women's development organization in Latin America. The program operates in Argentina, Bolivia, Mexico, Nicaragua, and Peru. We analyze descriptive reports and administrative data for measures related to improving access to primary health services and management of chronic diseases. We find provision of preventive care is substantial, with an average of 13% of Pro Mujer clients being screened for cervical cancer each year, 21% receiving breast exams, 16% having a blood glucose measurement, 39% receiving a blood pressure measurement, and 46% having their body mass index calculated. This population, with more than half of those screened being overweight or obese and 9% of those screened having elevated glucose measures, has major risk factors for diabetes, high blood pressure, and cardiovascular disease without intervention. The components of the Pro Mujer health program address four dimensions of healthcare access: geographic accessibility, availability, affordability, and acceptability. Significant progress has been made to meet basic
Joska, J A; Sorsdahl, K R
Mental disorders are highly prevalent across all health settings. Where they are co-morbid with other chronic physical disorders, a complex bidirectional relationship exists between them. While mental disorders may result in an increase in adverse healthrelated outcomes, they are amenable to cost-effective treatments. In resource-limited settings, many barriers to the detection and treatment of mental disorders exist. One approach to the effective targeting of the available resources is to utilize a "risk-flag" approach, wherein individuals at-risk of treatment failure are identified and routed into more intensive mental health screening and intervention. This paper discusses how lessons from HIV services may inform how to improve mental health care and integration in HIV settings, as well as in other chronic diseases.
Tahir, Ruhma; Tahir, Hasan; McDonald-Maier, Klaus
Convergence of technologies from several domains of computing and healthcare have aided in the creation of devices that can help health professionals in monitoring their patients remotely. An increase in networked healthcare devices has resulted in incidents related to data theft, medical identity theft and insurance fraud. In this paper, we discuss the design and implementation of a secure lightweight wearable health sensing system. The proposed system is based on an emerging security technology called Integrated Circuit Metric (ICMetric) that extracts the inherent features of a device to generate a unique device identification. In this paper, we provide details of how the physical characteristics of a health sensor can be used for the generation of hardware "fingerprints". The obtained fingerprints are used to deliver security services like authentication, confidentiality, secure admission and symmetric key generation. The generated symmetric key is used to securely communicate the health records and data of the patient. Based on experimental results and the security analysis of the proposed scheme, it is apparent that the proposed system enables high levels of security for health monitoring in resource optimized manner.
Tahir, Ruhma; Tahir, Hasan; McDonald-Maier, Klaus
Convergence of technologies from several domains of computing and healthcare have aided in the creation of devices that can help health professionals in monitoring their patients remotely. An increase in networked healthcare devices has resulted in incidents related to data theft, medical identity theft and insurance fraud. In this paper, we discuss the design and implementation of a secure lightweight wearable health sensing system. The proposed system is based on an emerging security technology called Integrated Circuit Metric (ICMetric) that extracts the inherent features of a device to generate a unique device identification. In this paper, we provide details of how the physical characteristics of a health sensor can be used for the generation of hardware “fingerprints”. The obtained fingerprints are used to deliver security services like authentication, confidentiality, secure admission and symmetric key generation. The generated symmetric key is used to securely communicate the health records and data of the patient. Based on experimental results and the security analysis of the proposed scheme, it is apparent that the proposed system enables high levels of security for health monitoring in resource optimized manner. PMID:26492250
May, Michael E; Kennedy, Craig H
Good health significantly improves a person's quality of life. However, people with intellectual disabilities disproportionately have more health problems than the general population. Further complicating the matter is that people with more severe disabilities often cannot verbalize health complications they are experiencing, which leads to health problems being undiagnosed and untreated. It is plausible these conditions can interact with reinforcement contingencies to maintain problem behavior because of the increased incidence of health problems among people with intellectual disabilities. This paper reviews common health problems influencing problem behavior and reinforcement processes. A clear implication of this review is the need for comprehensive functional assessments of problem behavior involving behavior analysts and health professionals.
Figueroa, Fernando; Melcher, Kevin
The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. Management implies storage, distribution, sharing, maintenance, processing, reasoning, and presentation. ISHM is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this chapter, concepts, procedures, and approaches are presented as a foundation for implementing an ISHM capability relevant to intelligent systems. The capability stresses integration of DIaK from all elements of a system, emphasizing an advance toward an on-board, autonomous capability. Both ground-based and on-board ISHM capabilities are addressed. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.
Much of the current health approach to designing HIV/AIDS interventions in resource-poor settings involves behavior-change initiatives, particularly those adopting education-based and "culturally competent" frameworks for the reduction of HIV-associated "risk behaviors." This article reviews the evidence and social assumptions behind this approach to preventing HIV transmission, and argues that these approaches are often inadequate or misguided, particularly in their conflation of the concept of "culture" with social circumstances. By analyzing the socioeconomic circumstances that constrain individual agency, and by combining data from prevention literature with analyses of international trade agreements and the controversies over antiretroviral drug distribution, the author argues that the movement of capital and the maintenance of inequality are central to the problems associated with behavior-change initiatives and must be addressed through new paradigms in order to respond appropriately to the global AIDS pandemic. Hardt and Negri's paradigm of "Empire"--that is, examining the system through which social inequalities are maintained not only between countries but also within them--offers prospects for the design of new interventions and targets for public health workers and social movements.
Salinas-Martínez, A M; Martinez-Sanchez, C; Perez-Segura, J
Educational interventions represent an alternative for the reproductive well-being. The objective of this investigation was to identify in a mexican community, attitudes and behaviors related to reproductive health, with the goal of implementing a specific health education program. The study population consisted of women between 12 and 44 years old, living in non-residential areas of the Delegation Miguel Hidalgo, D.F. Variables of interest were analyzed only in women with parity (n = 300). Data were collected through interview. The mean age was 31 +/- 8 years. 93.3% were married or in consensual union. 63% had elementary, junior high or prevocational studies. 89% answered that would visit the doctor before considering a pregnancy (junior high+, p < .05), 99% would seek prenatal care if they were pregnant, and 92.7% would have a hospital delivery (parity < or = 3, p < .003). 69.5% had a preconceptional visit before their last pregnancy and 89.9% received prenatal care (junior high+, p < .008). 92.5% had only hospital deliveries (< or = 30 years, p < .05, junior high+, p < .0001, primigravida p < .002, with institutionalized medical services, p < .001), 1.7% had only out-of-hospital deliveries, and 5.8% both. Agreement between attitudes and behaviors are presented. An educational program consisting of confirmation and support to positive attitudes, values and beliefs, and reinforcement to decision making, will result in a final behavior: early assistance to medical care.
Stolley, Melinda R.; Sharp, Lisa K.; Tangney, Christy; Schiffer, Linda; Arroyo, Claudia; Kim, Yoonsang; Campbell, Richard; Schmidt, Mary Lou; Breen, Kathleen; Kinahan, Karen E.; Dilley, Kim; Henderson, Tara; Korenblit, Allen D.; Seligman, Katya
Background Available data suggest that childhood cancer survivors (CCSs) are comparable to the general population on many lifestyle parameters. However, little is known about minority CCSs. This cross-sectional study describes and compares the body mass index (BMI) and health behaviors of African-American, Hispanic and White survivors to each other and to non-cancer controls. Methods Participants included 452 adult CCS (150 African-American, 152 Hispanic, 150 white) recruited through four childhood cancer treating institutions and 375 ethnically-matched non-cancer controls (125 in each racial/ethnic group) recruited via targeted digit dial. All participants completed a 2-hour in-person interview. Results Survivors and non-cancer controls reported similar health behaviors. Within survivors, smoking and physical activity were similar across racial/ethnic groups. African-American and Hispanic survivors reported lower daily alcohol use than whites, but consumed unhealthy diets and were more likely to be obese. Conclusions This unique study highlights that many minority CCSs exhibit lifestyle profiles that contribute to increased risk for chronic diseases and late effects. Recommendations for behavior changes must consider the social and cultural context in which minority survivors may live. PMID:25564774
Meade, Michelle A.; Krause, James S.
Objective: The purpose of this study was to examine the relationship between employment and psychological health and health management as described by individuals with spinal cord injury (SCI) who were employed at least once following injury. Methods: A qualitative approach used 6 focus groups at 2 sites with 44 participants who were at least 10 years post SCI. All had been employed at some point since injury. Heterogeneous and homogeneous groups were delineated based on specific characteristics, such as education, gender, or race. Group sessions followed a semi-structured interview format with questions about personal, environmental, and policy related factors influencing employment following SCI. All group sessions were recorded, transcribed, and coded into conceptual categories to identify topics, themes, and patterns. Inferences were drawn about their meaning. NVivo 10 software using the constant comparative method was used for data analysis. Results: Narratives discussed the relationship between employment and psychological and emotional health and health management. Four themes were identified: (1) adjustment and dealing with emotional reactions, (2) gaining self-confidence, (3) preventing burnout, and (4) attitudes and perspectives. Most themes reflected issues that varied based on severity of injury as well as stage of employment. Conclusions: Individuals with SCI who are successful in working following injury must determine how to perform the behaviors necessary to manage their health and prevent emotional or physical complications. The emotional consequences of SCI must be recognized and addressed and specific behaviors enacted in order to optimize employment outcomes.
Leveton, Lauren B.; Whitmire, Alexandra
BHP Program Element Goal: Identify, characterize, and prevent or reduce behavioral health and performance risks associated with space travel, exploration and return to terrestrial life. BHP Requirements: a) Characterize and assess risks (e.g., likelihood and consequences). b) Develop tools and technologies to prevent, monitor, and treat adverse outcomes. c) Inform standards. d) Develop technologies to: 1) reduce risks and human systems resource requirements (e.g., crew time, mass, volume, power) and 2) ensure effective human-system integration across exploration mission.
The Bamako Call for Action on Research for Health stresses the importance of inter-disciplinary, inter-ministerial and inter-sectoral working. This challenges much of our current research and postgraduate research training in health, which mostly seeks to produce narrowly focused content specialists. We now need to compliment this type of research and research training, by offering alternative pathways that seek to create expertise, not only in specific narrow content areas, but also in the process and context of research, as well as in the interaction of these different facets of knowledge. Such an approach, developing 'integrative expertise', could greatly facilitate better research utilisation, helping policy makers and practitioners work through more evidence-based practice and across traditional research boundaries. PMID:19643021
Barrera, Manuel, Jr.; Castro, Felipe G.; Strycker, Lisa A.; Toobert, Deborah J.
Objective: To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe…
Pretest comparisons on Health Behavior Inventory do not support hypothesis that low class students have less desirable health habits than do middle class ones. Differences occur on five specific items pertaining to weight control, social behavior, dental health, infection prevention, and responsibility for community health. (Author/CJ)
Noar, Seth M; Zimmerman, Rick S
Although research on Health Behavior Theory (HBT) is being conducted at a rapid pace, the extent to which the field is truly moving forward in understanding health behavior has been questioned. This issue is examined in the current article. First, we discuss the problems within the HBT literature. Second, we discuss the proliferation of HBT and why theory comparison is essential to this area of research. Finally, we reflect on ways that the field might move forward by suggesting a new agenda for HBT research. It is argued that increased recognition of the similarity of health behavior constructs as well as increased empirical comparisons of theories are essential for true scientific progress in this line of inquiry.
Haibach, Jeffrey P; Haibach, Michael Ann; Hall, Katherine S; Masheb, Robin M; Little, Melissa A; Shepardson, Robyn L; Dobmeyer, Anne C; Funderburk, Jennifer S; Hunter, Christopher L; Dundon, Margaret; Hausmann, Leslie R M; Trynosky, Stephen K; Goodrich, David E; Kilbourne, Amy M; Knight, Sara J; Talcott, Gerald W; Goldstein, Michael G
There are 2.1 million current military servicemembers and 21 million living veterans in the United States. Although they were healthier upon entering military service compared to the general U.S. population, in the longer term veterans tend to be of equivalent or worse health than civilians. One primary explanation for the veterans' health disparity is poorer health behaviors during or after military service, especially areas of physical activity, nutrition, tobacco, and alcohol. In response, the Department of Defense and Department of Veterans Affairs continue to develop, evaluate, and improve health promotion programs and healthcare services for military and veteran health behavior in an integrated approach. Future research and practice is needed to better understand and promote positive health behavior during key transition periods in the military and veteran life course. Also paramount is implementation and evaluation of existing interventions, programs, and policies across the population using an integrated and person centered approach.
Breslau, Joshua; Engel, Charles C.
Abstract The dramatic evolution in information and communication technologies (ICTs) online and on smartphones has led to rapid innovations in behavioral health care. To assist the U.S. Air Force in developing a strategy for use of ICTs, the authors reviewed the scientific literature on their use to prevent and treat behavioral health conditions, such as major depression, posttraumatic stress disorder, and alcohol misuse. There is currently little scientific evidence supporting additional investment in ICT-based psychosocial programs for resilience or prevention of posttraumatic stress symptoms, depression, or anxiety. Instead, preventive interventions might prioritize problems of alcohol misuse and intimate partner violence. ICT applications that play a role in the treatment process may be used for patient education and activation, to improve decisionmaking by clinicians, to provide a therapy, to improve adherence to treatment, or to maintain treatment gains over time. However, partly due to the rapid pace of development of the technology, there is little or no evidence in the literature regarding the efficacy of the most recently developed types of ICTs, in particular those using smartphones. Despite the lack of solid research evidence to date, ICTs hold promise in addressing the challenges of mental health care. One promising avenue is development of reliable methods for patient-clinician communication between therapy sessions; another is Internet-based cognitive behavioral therapy. The authors recommend that the Air Force should take an incremental approach to adopting the use of ICTs—one that involves a program of measurement-based implementation and process and outcome monitoring rather than urgent dissemination. PMID:28083427
Peeples, Malinda M.; Iyer, Anand K.; Cohen, Joshua L.
Background: Responses to the chronic disease epidemic have predominantly been standardized in their approach to date. Barriers to better health outcomes remain, and effective management requires patient-specific data and disease state knowledge be presented in methods that foster clinical decision-making and patient self-management. Mobile technology provides a new platform for data collection and patient–provider communication. The mobile device represents a personalized platform that is available to the patient on a 24/7 basis. Mobile-integrated therapy (MIT) is the convergence of mobile technology, clinical and behavioral science, and scientifically validated clinical outcomes. In this article, we highlight the lessons learned from functional integration of a Food and Drug Administration-cleared type 2 diabetes MIT into the electronic health record (EHR) of a multiphysician practice within a large, urban, academic medical center. Methods: In-depth interviews were conducted with integration stakeholder groups: mobile and EHR software and information technology teams, clinical end users, project managers, and business analysts. Interviews were summarized and categorized into lessons learned using the Architecture for Integrated Mobility® framework. Results: Findings from the diverse stakeholder group of a MIT–EHR integration project indicate that user workflow, software system persistence, environment configuration, device connectivity and security, organizational processes, and data exchange heuristics are key issues that must be addressed. Conclusions: Mobile-integrated therapy that integrates patient self-management data with medical record data provides the opportunity to understand the potential benefits of bidirectional data sharing and reporting that are most valuable in advancing better health and better care in a cost-effective way that is scalable for all chronic diseases. PMID:23759392
34 and five indicates "never." The independent variables are the ones discussed above to measure the family life course as well as a set of contrasts...STRONGLY M’EE 13. 1. have a lot of job satisfaction 1 2 3 4 .5 __________ 14. I am proud of this organization. 1 2 3 4 S ___________ 15. This is a well ...DTI# FLE COpy’_ "A"Do ARMY FAMILY HEALTH SEEKING BEHAVIOR AND SATISFACTION In ANNUAL REPORT 1 N OTTO VON MERING AUGUST 10, 1989 Supported by U.S
Ferreira, Luale Leão; Brandão, Gustavo Antônio Martins; Garcia, Gustavo; Batista, Marília Jesus; Costa, Ludmila da Silva Tavares; Ambrosano, Gláucia Maria Bovi; Possobon, Rosana de Fátima
Overall health surveys have related family cohesion to socio-economic status and behavioral factors. The scope of this study was to investigate the association between family cohesion and socio-economic, behavioral and oral health factors. This was a, cross-sectional study with two-stage cluster sampling. The random sample consisted of 524 adolescents attending public schools in the city of Piracicaba-SP. Variables were evaluated by self-applied questionnaires and caries and periodontal disease were assessed by DMF-T and CPI indices. The adolescent's perception of family cohesion was assessed using the family adaptability and cohesion scale. Univariate and multinomial logistic regression shows that adolescents with low family cohesion were more likely than those with medium family cohesion to have low income (OR 2,28 95% CI 1,14- 4,55), presence of caries (OR 2,23 95% CI 1,21-4,09), less than two daily brushings (OR 1,91 95% CI 1,03-3,54). Adolescents with high family cohesion were more likely than those with medium family cohesion to have high income and protective behavior against the habit of smoking. Thus, the data shows that adolescent perception of family cohesion was associated with behavioral, socio-economic and oral health variables, indicating the importance of an integral approach to patient health.
Goldenberg, Jamie L.; Arndt, Jamie
This article introduces a terror management health model (TMHM). The model integrates disparate health and social psychology literatures to elucidate how the conscious and nonconscious awareness of death can influence the motivational orientation that is most operative in the context of health decisions. Three formal propositions are presented.…
Anders, Sven; Schroeter, Christiane
High-quality diets play an important role in diabetes prevention. Appropriate dietary adherence can improve insulin sensitivity and glycemic control, and thus contribute to lifestyle improvement. However, previous research suggests that dietary adherence is arguably among the most difficult cornerstones of diabetes management. The objectives of this study are (1) to estimate whether and to what extent individuals diagnosed with diabetes show significant differences in diet quality [healthy eating index (HEI)] compared to healthy individuals, (2) to quantify whether and to what extent diabetics experience significantly higher outcomes of body mass index (BMI), and (3) to estimate whether and to what extent dietary supplementation impacts diabetes patient’s diet quality and/or BMI outcomes. We use data from the 2007–2008 U.S. National Health and Nutrition Examination Survey (NHANES). The NHANES is the primary, randomized, and nationally representative survey used to assess the health and nutritional status in the U.S. We apply propensity score matching (PSM) to account for selection bias and endogeneity between self-reported diet and health behavir (treatment) and BMI outcomes. We control for an individual’s BMI as to capture the impact of past dietary behavior in its impact on HEI. Matching results suggest that regular dietary supplement consumption is associated with significant lower BMI outcomes of almost 1 kg/m2. The close relationship between diabetes and obesity has been at the center of the diet-health policy debate across Canada and the U.S. Knowledge about this linkage may help to improve the understanding of the factors that impact dietary choices and their overall health outcomes, which may lead to a more efficient and effective promotion of dietary guidelines, healthy food choices, and targeted consumer health and lifestyle policies. PMID:25852643
Godin, Gaston; Kok, Gerjo
The literature review discussed here located 56 studies examining 87 behaviors that predicted future health-related behaviors using the theory of planned behavior. About 41% of variance in intentions and 34% of variance in future behavior were explained by the theory. Perceived behavioral control explained 11.5% of variance in behavior above…
Objective. The goal of this study was to assess the appropriateness of the theory of planned behavior in predicting health care waste segregation behaviors and to examine the factors that influence waste segregation behaviors. Methodology. One hundred and sixty-three health workers completed a self-administered questionnaire in a cross-sectional survey that examined the theory of planned behavior constructs (attitudes, subjective norms, perceived behavioral control, and intention) and external variables (sociodemographic factors, personal characteristics, organizational characteristics, professional characteristics, and moral obligation). Results. For their most recent client 21.5% of the health workers reported that they most definitely segregated health care waste while 5.5% did not segregate. All the theory of planned behavior constructs were significant predictors of health workers' segregation behavior, but intention emerged as the strongest and most significant (r = 0.524, P < 0.001). The theory of planned behavior model explained 52.5% of the variance in health workers' segregation behavior. When external variables were added, the new model explained 66.7% of the variance in behavior. Conclusion. Generally, health workers' health care waste segregation behavior was high. The theory of planned behavior significantly predicted health workers' health care waste segregation behaviors. PMID:28115950
Akulume, Martha; Kiwanuka, Suzanne N
Objective. The goal of this study was to assess the appropriateness of the theory of planned behavior in predicting health care waste segregation behaviors and to examine the factors that influence waste segregation behaviors. Methodology. One hundred and sixty-three health workers completed a self-administered questionnaire in a cross-sectional survey that examined the theory of planned behavior constructs (attitudes, subjective norms, perceived behavioral control, and intention) and external variables (sociodemographic factors, personal characteristics, organizational characteristics, professional characteristics, and moral obligation). Results. For their most recent client 21.5% of the health workers reported that they most definitely segregated health care waste while 5.5% did not segregate. All the theory of planned behavior constructs were significant predictors of health workers' segregation behavior, but intention emerged as the strongest and most significant (r = 0.524, P < 0.001). The theory of planned behavior model explained 52.5% of the variance in health workers' segregation behavior. When external variables were added, the new model explained 66.7% of the variance in behavior. Conclusion. Generally, health workers' health care waste segregation behavior was high. The theory of planned behavior significantly predicted health workers' health care waste segregation behaviors.
Dobmeyer, Anne C; Hunter, Christopher L; Corso, Meghan L; Nielsen, Matthew K; Corso, Kent A; Polizzi, Nicholas C; Earles, Jay E
The expansion of integrated, collaborative, behavioral health services in primary care requires a trained behavioral health workforce with specific competencies to deliver effective, evidence-informed, team-based care. Most behavioral health providers do not have training or experience working as primary care behavioral health consultants (BHCs), and require structured training to function effectively in this role. This article discusses one such training program developed to meet the needs of a large healthcare system initiating widespread implementation of the primary care behavioral health model of service delivery. It details the Department of Defense's experience in developing its extensive BHC training program, including challenges of addressing personnel selection and hiring issues, selecting a model for training, developing and implementing a phased training curriculum, and improving the training over time to address identified gaps. Future directions for training improvements and lessons learned in a large healthcare system are discussed.
Osofsky, Howard J; Osofsky, Joy D; Wells, John H; Weems, Carl
This column describes an integrated behavioral health initiative in primary care clinics in Louisiana parishes affected by the Deepwater Horizon oil spill. The Louisiana Mental and Behavioral Health Capacity Project is an integral part of the Gulf Region Health Outreach Program and is funded from the Deepwater Horizon Medical Benefits Class Action Settlement. Using a public health approach, the Department of Psychiatry of the Louisiana State University Health Sciences Center developed an interprofessional collaboration model of care to provide culturally tailored and time-sensitive on-site and telemedicine services to adults and children affected by the disaster. Results indicate a high level of acceptance of the services and reductions in both mental health symptoms and general medical symptoms. Primary care clinic staff also report increased confidence and resilience to meet future disasters. The approach could be used by communities at risk of disasters and by rural communities with limited mental health resources.
Approved for public release, distribution unlimited General Medicine: 500A, Public Health Data 2011 Behavioral Health Risk Assessment Data...REPORT DATE 30 SEP 2015 2. REPORT TYPE Annual 3. DATES COVERED 01 JAN 2011 - 31 DEC 2011 4. TITLE AND SUBTITLE 2011 Behavioral Health Risk...ABSTRACT This publication describes characteristics of Soldiers who completed a behavioral health (BH) screening at the two post-deployment Touch Points
Davis, Siena F; Ellsworth, Marisa A; Payne, Hannah E; Hall, Shelby M; Nordhagen, Amber L
Background Although the Health & Fitness category of the Apple App Store features hundreds of calorie counting apps, the extent to which popular calorie counting apps include health behavior theory is unknown. Objective This study evaluates the presence of health behavior theory in calorie counting apps. Methods Data for this study came from an extensive content analysis of the 10 most popular calorie counting apps in the Health & Fitness category of the Apple App Store. Results Each app was given a theory score to reflect the extent to which health behavior theory was integrated into the app. The highest possible score was 60. Out of the 10 apps evaluated, My Diet Coach obtained the highest theory score of 15. MapMyFitness and Yumget received the lowest scores of 0. The average theory score among the apps was 5.6. Conclusions Most of the calorie counting apps in the sample contained minimal health behavior theory. PMID:26935898
Research Unit—Europe, Walter Reed Army Insti- tute of Research, Nachrichten Kaserne, Karlsruher Strasse 144, 69126 Heidelberg, Germany. †Behavioral Health...Division, Europe Regional Medical Command, Nachrichten Kaserne, Karlsruher Strasse 144, 69126 Heidelberg, Germany. The views expressed in this...Institute of Research, Nachrichten Kaserne,Karlsruher Strasse 144, 69126,Heidelberg, Germany, , 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING
Laugesen, Miriam J; France, George
Integration in health care is a key goal of health reform in United States and England. Yet past efforts in the 1990s to better integrate the delivery system were of limited success. Building on work by Bevan and Janus on delivery integration, this article explores integration through the lens of economic theories of integration. Firms generally integrate to increase efficiency through economies of scale, to improve their market power, and resolve the transaction costs involved with multiple external suppliers. Using the United States and England as laboratories, we apply concepts of economic integration to understand why integration does or does not occur in health care, and whether expectations of integrating different kinds of providers (hospital, primary care) and health and social services are realistic. Current enthusiasm for a more integrated health care system expands the scope of integration to include social services in England, but retains the focus on health care in the United States. We find mixed applicability of economic theories of integration. Economies of scale have not played a significant role in stimulating integration in both countries. Managerial incentives for monopoly or oligopoly may be more compelling in the United States, since hospitals seek higher prices and more leverage over payers. In both countries the concept of transaction costs could explain the success of new payment and budgeting methods, since health care integration ultimately requires resolving transaction costs across different delivery organizations.
Rojas-Guyler, Liliana; King, Keith A.; Montieth, Brigid A.
Background: Latinos experience disproportionate negative health status and health care access. Expanding understanding of factors impacting Latino immigrant health is imperative. Purpose: This study identified health-seeking behaviors among Latinas in a large Midwestern city with rapid immigrant population growth. Health-seeking behaviors like…
Henson, James M.; Carey, Michael P.; Carey, Kate B.; Maisto, Stephen A.
Previous research suggests that time perspective relates to health behavior; however, researchers have frequently employed inconsistent operational definitions and have often used projective or unpublished measures. The Zimbardo Time Perspective Inventory was created to provide a sound, objective measure of five distinct time perspective components. We examined the independent prediction of both risky and protective health behaviors from future, hedonistic, and fatalistic time perspective in 1,568 undergraduates using the ZTPI. Health behaviors included alcohol, drug, tobacco, and seat belt use, sex behaviors, and exercise. Future time perspective was related to increased protective and decreased risky health behaviors, whereas hedonism exhibited an opposite pattern though was a stronger predictor; fatalism was related only to health-destructive behaviors. Gender interactions reveal that hedonism is a stronger predictor of risky health behaviors for females. PMID:16421652
Ranallo, Piper A; Kilbourne, Amy M; Whatley, Angela S; Pincus, Harold Alan
The use of health information technology (IT) in general health care has been shown to have significant potential to facilitate the delivery of safe, high-quality, and cost-effective care. However, its application to behavioral health care has been slow, limiting the extent to which consumers seeking care for mental health or substance use disorders can derive its benefits. The goal of this article is to provide an overview of the use of health IT in behavioral health and to describe some unique challenges experienced in that domain. We also highlight current obstacles to, and recommendations for, the use of health IT in improving the quality of behavioral health care. We conclude with recommendations for prioritizing the work that we believe will move the US health care system toward more effective, efficient, and patient-centric care in behavioral health.
Godfrey, Erin B.
Integrating social psychological research with work in child development, this study explored relationships between system justification (Jost & Banaji, 1994), maternal mental health and child externalizing behavior among low-income immigrants and racial/ethnic minorities. Dominican, Mexican and African-American families (N = 239) were assessed when children were 14-, 24- and 36-months old. SEM was used to explore longitudinal relationships between maternal system justification and mental health and associations with child behavior. Earlier mental health was negatively related to later system justification and system justification was negatively related to children’s externalizing behavior. Implications for system justification theory, child development and immigration are discussed. PMID:25035527
Kathol, Roger G; Degruy, Frank; Rollman, Bruce L
Because a high percentage of primary care patients have behavioral problems, patient-centered medical homes (PCMHs) that wish to attain true comprehensive whole-person care will find ways to integrate behavioral health services into their structure. Yet in today's health care environment, the incorporation of behavioral services into primary care is exceptional rather than usual practice. In this article, we discuss the components considered necessary to provide sustainable, value-added integrated behavioral health care in the PCMH. These components are to: (1) combine medical and behavioral benefits into one payment pool; (2) target complex patients for priority behavioral health care; (3) use proactive onsite behavioral "teams;" (4) match behavioral professional expertise to the need for treatment escalation inherent in stepped care; (5) define, measure, and systematically pursue desired outcomes; (6) apply evidence-based behavioral treatments; and (7) use cross-disciplinary care managers in assisting the most complicated and vulnerable. By adopting these 7 components, PCHMs will augment their ability to achieve improved health in their patients at lower cost in a setting that enhances ease of access to commonly needed services.
Liu, Yong-Bing; Liu, Liu; Li, Yan-Fei; Chen, Yan-Li
Background: Despite the large volume of research dedicated to health-related behavior change, chronic disease costs continue to rise, thus creating a major public health burden. Health literacy, the ability to seek, understand, and utilize health information, has been identified as an important factor in the course of chronic conditions. Little research has been conducted on the relationship between health literacy and health-related behaviors and health status in elderly Chinese. The aim of this study was to elucidate the relationship between health literacy and health-related behaviors and health status in China. Methods: The subjects enrolled in this study were selected based on a stratified cluster random sampling design. Information involving >4500 older adults in 44 pension institutions in Urumqi, Changji, Karamay, and Shihezi of Xinjiang between September 2011 and June 2012 was collected. The Chinese Citizen Health Literacy Questionnaire (China Health Education Centre, 2008) and a Scale of the General Status were administered and the information was obtained through face-to-face inquiries by investigators. A total of 1452 respondents met the inclusion criteria. A total of 1452 questionnaires were issued and the valid response rate was 96.14% (1396 of 1452). Factors affecting health literacy and the relationship to health literacy were identified by one-way ANOVA and a multiple linear regression model. Results: The average health literacy level of the elderly in nursing homes was relatively low (71.74 ± 28.35 points). There were significant differences in the health literacy score among the factors of age, gender, race, education level, household income, marital conditions, and former occupation (p < 0.001). The health literacy score was significantly associated with smoking, drinking, physical exercise, and health examination (p < 0.001). The elderly with higher health literacy scores were significantly less likely to have risky behaviors (smoking, regular
Samuel, Laura J; Commodore-Mensah, Yvonne; Himmelfarb, Cheryl R Dennison
Health behavior theories state that social environments influence health behaviors, but theories of how this occurs are relatively underdeveloped. This article systematically surveys community social capital concepts in health behavior literature and proposes a conceptual framework that integrates these concepts into existing behavioral theory. Fifty-three studies tested associations between community social capital concepts and physical activity (38 studies), smoking (19 studies), and diet (2 studies). Trustworthiness of community members was consistently associated with more health-promoting and less disease-promoting behaviors in 19 studies. Neighborly reciprocity showed mixed results in 10 studies. Reporting a good sense of community was associated with more physical activity in only 5 of 16 studies. Neighborhood collective efficacy, which includes social cohesion and informal social control, was inconsistently associated with behaviors in 22 studies. Behavioral social norms were associated with smoking and physical activity in 2 of 6 studies, and neighborhood modeling of physical activity was associated with increased activity in 12 of 17 studies, with 1 opposing result. This review identifies several community social capital-related concepts that are, at times, associated with both health-promoting and disease-promoting behaviors and often have no associations. Theory explains these findings by describing the relationships and interactions among these concepts. Using these findings, this article proposes a conceptual framework that integrates community social capital concepts into existing behavioral theory. Iterative empirically based theory development is needed to address these concepts, which affect behaviors. These results can also inform theoretically based community-based and socially tailored interventions.
Well-aware that patients will be much more likely to take advantage of mental health services in a primary care setting, a new model is being tested in Hawaii that seeks to further integrate mental health and traditional care by having physicians work alongside behavioral health specialists in their offices and exam rooms. The model borrows heavily from an earlier study that produced dramatic outcomes in chronically ill individuals who received targeted behavioral health interventions. Revisit the earlier study and see how researchers are now hoping to further push the envelope with a fresh approach.
Ortabag, Tulay; Ozdemir, Serpil; Bakir, Bilal; Tosun, Nuran
Adolescents experience the onset and development of several health-related behaviors. The purpose of this study is to determine health risk and promotion behaviors of adolescents between the ages of 11 and 19 who were attending and to test the reliability and validity analysis of the Turkish version of Adolescent Health Promotion Scale (AHPS). The…
Coakley, Barbara F.
This report discusses the implementation of integrated intervention strategies to improve the classroom behavior of 30 third-grade students. Students' disruptive behavior was identified from two classroom observations, teacher questionnaires, and interviews with the school counselor. Objectives projected for the intervention were that students…
Yang, Chi-Ta; Hung, Yu-Shiang; Deng, Guang-Feng
Health promotion must be emphasized to achieve the World Health Organization goal of health for all. Since the global population is aging rapidly, ComCare elder health-promoting service was developed by the Taiwan Institute for Information Industry in 2011. Based on the Pender health promotion model, ComCare service offers five categories of health-promoting functions to address the everyday needs of seniors: nutrition management, social support, exercise management, health responsibility, stress management. To assess the overall ComCare service and to improve understanding of the health-promoting behavior of elders, this study analyzed health-promoting behavioral data automatically collected by the ComCare monitoring system. In the 30638 session records collected for 249 elders from January, 2012 to March, 2013, behavior patterns were identified by fuzzy c-mean time series clustering algorithm combined with autocorrelation-based representation schemes. The analysis showed that time series data for elder health-promoting behavior can be classified into four different clusters. Each type reveals different health-promoting needs, frequencies, function numbers and behaviors. The data analysis result can assist policymakers, health-care providers, and experts in medicine, public health, nursing and psychology and has been provided to Taiwan National Health Insurance Administration to assess the elder health-promoting behavior.
Devlin, Sarah; Healy, Olive; Leader, Geraldine; Hughes, Brian M.
The objective of the current study was to compare the effects of sensory-integration therapy (SIT) and a behavioral intervention on rates of challenging behavior (including self-injurious behavior) in four children diagnosed with Autism Spectrum Disorder. For each of the participants a functional assessment was conducted to identify the variables…
Saunders, Carla; Carter, David J
Objective Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned.Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans.Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care.Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW.What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems.What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of its
Lybeck, Nancy; Coble, Jamie B.; Tawfik, Magdy; Bond, Leonard J.
In order to meet the ever increasing demand for energy, the United States nuclear industry is turning to life extension of existing nuclear power plants (NPPs). Economically ensuring the safe, secure, and reliable operation of aging NPPs presents many challenges. The 2009 Light Water Reactor Sustainability Workshop identified online monitoring of active and structural components as essential to better understanding and management of the challenges posed by aging NPPs. Additionally, there is increasing adoption of condition-based maintenance (CBM) for active components in NPPs. These techniques provide a foundation upon which a variety of advanced online surveillance, diagnostic, and prognostic techniques can be deployed to continuously monitor and assess the health of NPP systems and components. The next step in the development of advanced online monitoring is to move beyond CBM to estimating the remaining useful life of active components using prognostic tools. Deployment of prognostic health management (PHM) on the scale of an NPP requires the use of an integrated health management (IHM) framework - a software product (or suite of products) used to manage the necessary elements needed for a complete implementation of online monitoring and prognostics. This paper provides a thoughtful look at the desirable functions and features of IHM architectures. A full PHM system involves several modules, including data acquisition, system modeling, fault detection, fault diagnostics, system prognostics, and advisory generation (operations and maintenance planning). The standards applicable to PHM applications are indentified and summarized. A list of evaluation criteria for PHM software products, developed to ensure scalability of the toolset to an environment with the complexity of an NPP, is presented. Fourteen commercially available PHM software products are identified and classified into four groups: research tools, PHM system development tools, deployable architectures
Devlin, Sarah; Healy, Olive; Leader, Geraldine; Hughes, Brian M
The objective of the current study was to compare the effects of sensory-integration therapy (SIT) and a behavioral intervention on rates of challenging behavior (including self-injurious behavior) in four children diagnosed with Autism Spectrum Disorder. For each of the participants a functional assessment was conducted to identify the variables maintaining challenging behavior. Results of these assessments were used to design function-based behavioral interventions for each participant. Recommendations for the sensory-integration treatment were designed by an Occupational Therapist, trained in the use of sensory-integration theory and techniques. The sensory-integration techniques were not dependent on the results of the functional assessments. The study was conducted within an alternating treatments design, with initial baseline and final best treatment phase. For each participant, results demonstrated that the behavioral intervention was more effective than the sensory integration therapy in the treatment of challenging behavior. In the best treatment phase, the behavioral intervention alone was implemented and further reduction was observed in the rate of challenging behavior. Analysis of saliva samples revealed relatively low levels of cortisol and very little stress-responsivity across the SIT condition and the behavioral intervention condition, which may be related to the participants' capacity to perceive stress in terms of its social significance.
Latkin, Carl A.; Knowlton, Amy R.
Social networks provide a powerful approach for health behavior change. This article documents how social network interventions have been successfully utilized for a range of health behaviors including HIV risk practices, smoking, exercise, dieting, family planning, bullying, and mental health. We review the literature that suggests relationship between health behaviors and social network attributes demonstrate a high degree of specificity. The article then examines hypothesized social influence mechanisms including social norms, modeling, and social rewards and the factors of social identity and social rewards that can be employed to sustain social network interventions. Areas of future research avenues are highlighted, including the need to examine and analytically adjust for contamination and social diffusion, social influence versus differential affiliation, and network change. Use and integration of mhealth and face-to-face networks for promoting health behavior change are also critical research areas. PMID:26332926
Latkin, Carl A; Knowlton, Amy R
Social networks provide a powerful approach for health behavior change. This article documents how social network interventions have been successfully used for a range of health behaviors, including HIV risk practices, smoking, exercise, dieting, family planning, bullying, and mental health. We review the literature that suggests the relationship between health behaviors and social network attributes demonstrates a high degree of specificity. The article then examines hypothesized social influence mechanisms including social norms, modeling, and social rewards and the factors of social identity and social rewards that can be employed to sustain social network interventions. Areas of future research avenues are highlighted, including the need to examine and to adjust analytically for contamination and social diffusion, social influence versus differential affiliation, and network change. Use and integration of mhealth and face-to-face networks for promoting health behavior change are also critical research areas.
Kagawa Singer, Marjorie
Culture is often cited as an underlying cause of the undue burden of disease borne by communities of color along the entire life cycle. However, culture is rarely defined or appropriately measured. Scientifically, culture is a complex, integrated, and dynamic conceptual framework that is incongruent with the way it is operationalized in health behavior theories: as a unidimensional, static, and immutable character element of a homogeneous population group. This paper lays out this contradiction and proposes a more scientifically grounded approach to the use of culture. The premise is that if the concept of culture were better operationalized, results from studies of diverse population groups would produce findings that are more scientifically valid and relevant to the community. Practitioners could then use these findings to develop more effective strategies to reduce health disparities and improve the health of all population groups. Six steps are proposed to increase our ability to achieve greater clarity on what culture is and to identify how it impacts health behavior and ultimately health outcomes, enabling researchers to build a stronger science of cultural diversity.
The integrity and health of society's life-supporting ecosystems establishes a fundamental constraint on economic growth and development. Energy Systems Theory provides a theoretical basis for defining, measuring and interpreting the concepts of ecological integrity and ecosystem...
Colton, Ben; Davis, Andrew
Three integrated revenue cycle models reflect the various levels of integration a health system'might find desirable or feasible based on its current circumstances and environment: Model A: A single health system executive provides oversight, but physician and hospital revenue cycles are managed separately. Model B: A single health system leader provides oversight, with a functional framework for management at the director level. Model C: Integration is complete for all processes.
troops’ risk for STIs, UIPs, alcohol/substance misuse, and sexual violence . Given current trends toward integrated military training of males and females...armed force include high rates of sexually transmitted infections (STIs), unintended pregnancies (UIPs), misuse of alcohol/substances, and sexual ... violence . The common thread through these negative health outcomes is volitional behavior. Such behaviors not only result in illness or injury, but also
Cretenet, Joël; Mullet, Etienne; Dru, Vincent
Performing approach vs. avoidance behaviors (arm flexion vs. arm extension) on the one hand, and lateralized peripheral activations (left side vs. right side) of the motivational systems of approach vs. avoidance, on the other hand, have been shown to impact on cognitive functioning (Cretenet, & Dru, 2009), mainly in judgment tasks. When a unilateral motor congruent behavior; that is, a behavior that activates the same motivational system (e.g., flexion of the right arm) was performed during a judgment task, participants' use of complex, interactive information integration rules was facilitated. No effect was, however, found when simpler, additive rules were involved (Mullet, Cretenet, & Dru, 2014). Three experiments are reported here that examined the effect of bilateral motor behaviors (e.g., flexion of the right arm and extension of the left arm) on the implementation of information integration rules. In Studies 1 and 2, two judgment tasks similar to the ones used by Mullet et al. (2014) were used: (a) a complex task in which participants judged a person's attractiveness from personality information, and (b) a simpler task in which they attributed blame according to bad deeds. It was found that similar motor behaviors performed by the two arms (e.g., flexion of both arms), in contrast to dissimilar ones, facilitated the use of complex, interactive information integration rules. No effect was found in the case of simpler integration rules. In Study 3, these results were replicated in a judgment task in which the complexity of the integration rule varied depending on the instructions given. Overall, when bilateral motor behaviors were performed during judgment, facilitation in the use of complex integration rules no longer depended on motivational congruence as in the case of unilateral motor behavior. It depended on symmetry/similarity of behaviors.
Tsutsumi, Atsuro; Izutsu, Takashi; Matsumoto, Toshihiko
Although it seems evident that attention should be paid to risky sexual behaviors and their association with mental health among young people, this topic has not been thoroughly investigated. The present study aims to explore the relationship between sexual risk behaviors and mental health among adolescents. The participants were 251 adolescents in a juvenile detention facility (221 males and 31 females) as the "delinquent" group and 367 high school students (167 males and 200 females) as the "non-delinquent" group. A questionnaire including the Kessler 10, the Impact of Event Scale-Revised, and the Adolescent Dissociative Experience Scale was employed to measure mental health status as well as sexual risk behaviors, suicidal ideation/attempts, and abuse history. Having a history of sexual abuse or of physical abuse was associated with age when one first had sex among males with delinquent behaviors, while same tendency was observed among males without delinquent behaviors. Among the female with delinquent behaviors group, past abuse history was significantly associated with higher number of sex partners. In the non-delinquent group, better mental health among males and, contrarily, worse mental health among females were associated with having more sex partners. The results highlight the importance of addressing abuse history among females and males. Given that poor mental health status in the adolescents was associated with risky sexual behaviors, adolescents are a vulnerable group that requires attention in terms of sexual and reproductive health that integrates mental health and psychosocial components.
Background Oral health behavior (OHB), one major factor contributing to proper oral health status, has been addressed insufficiently in addiction literature. The aim of our study was to investigate OHB and its determinants among drug addicts in withdrawal treatment. Methods Through a stratified cluster sampling method, we collected the data from 685 patients in withdrawal treatment in Tehran using self-administered questionnaires on OHB components and conducting interviews about patients’ characteristics and addiction history. The T-test, ANOVA, and a linear regression model served for statistical analysis. Results Of the patients, 48% reported brushing their teeth less than once a day, more than 90% used fluoride toothpaste almost or always, and 81% flossed their teeth rarely or never. Eating sugary products twice a day or more was reported by 57% of the patients and 85% of them were current smokers. Poor OHB was associated with male gender, lower education, being addicted mainly to crystalline heroin, starting drug abuse at a younger age, and having a longer history of addiction (p < .05). Conclusion Poor OHB was found among the participants in drug withdrawal treatment. Preventive strategies on oral health should be planned and be integrated into other health promotion programs for addicts along with their withdrawal treatment taking into account special groups at higher risk. PMID:23368406
Bylund, Carma L.; Imes, Rebecca S.; Baxter, Leslie A.
The authors compared parents' perceptions of their college student children's health and health risk behaviors with the college students' own reports. One hundred sixty-four parent-college student child dyads completed questionnaires regarding the students' health, illness status, and health risk behaviors. Parents tended to be overoptimistic…
Horton, Shalonda E B
Studies suggest we capitalize upon religion's health benefits to prevent obesity. The purpose of this qualitative descriptive study was to determine how emerging adults used religion to manage their health. Two focus groups were conducted among White and African American participants. Content analysis of the data revealed categories about their attitudes regarding parental and religious influences, religion's influence on behavior, negative health effects of religion, barriers, obesity prevention, and health promotion programs. Society sends out "easy" solutions for unhealthy behaviors, but we should focus on healthy behavior benefits, remove barriers, and consider religion's part in health promotion (obesity prevention).
Bleakley, Amy; Hennessy, Michael; Fishbein, Martin; Jordan, Amy
Published research demonstrates an association between exposure to media sexual content and a variety of sex-related outcomes for adolescents. What is not known is the mechanism through which sexual content produces this "media effect" on adolescent beliefs, attitudes, and behavior. Using the Integrative Model of Behavioral Prediction, this article uses data from a longitudinal study of adolescents ages 16 to 18 (N = 460) to determine how exposure to sexual media content influences sexual behavior. Path analysis and structural equation modeling demonstrated that intention to engage in sexual intercourse is determined by a combination of attitudes, normative pressure, and self-efficacy but that exposure to sexual media content only affects normative pressure beliefs. By applying the Integrative Model, we are able to identify which beliefs are influenced by exposure to media sex and improve the ability of health educators, researchers, and others to design effective messages for health communication campaigns and messages pertaining to adolescents' engaging in sexual intercourse.
Persson, Roger; Cleal, Bryan; Jakobsen, Mette Øllgaard; Villadsen, Ebbe; Andersen, Lars L.
Objective: To examine the help preferences of employees in the Danish police who had acknowledged that they wished to change health behaviors. In addition, we explored whether preferences varied with age, gender, chronic health concerns, positive expectations of good health, and past experiences of in-house health promotion services (i.e.,…
Suter, Esther; Oelke, Nelly D.; Adair, Carol E.; Armitage, Gail D.
Integrated health systems are considered part of the solution to the challenge of sustaining Canada’s healthcare system. This systematic literature review was undertaken to guide decision-makers and others to plan for and implement integrated health systems. This review identified 10 universal principles of successfully integrated healthcare systems which may be used by decision-makers to assist with integration efforts. These principles define key areas for restructuring and allow organizational flexibility and adaptation to local context. The literature does not contain a one-size-fits-all model or process for successful integration, nor is there a firm empirical foundation for specific integration strategies and processes. PMID:20057244
Karlan, Dean; Thuysbaert, Bram; Gray, Bobbi
We evaluate whether health education integrated into microcredit lending groups reduces health risks by improving health knowledge and self-reported behaviors among urban and rural borrowers in eastern Benin. In 2007, we randomly assigned 138 villages in the Plateau region of Benin to one of four variations of a group liability credit product, varying lending groups' gender composition and/or inclusion of health education using a 2 × 2 design. Women in villages receiving health education, regardless of gender composition of the groups, showed improved knowledge of malaria and of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), but not of childhood illness danger signs. No significant changes in health behavior were observed except an increase in HIV/AIDS prevention behavior, a result predominantly driven by an increase in respondents' self-reported ability to procure a condom, likely an indicator of increased perceived access rather than improved preventative behavior. Women in villages assigned to mixed-gender groups had significantly lower levels of social capital, compared with villages assigned to female-only groups. This suggests there may be an important trade-off to consider for interventions seeking improved health outcomes and social capital through provision of services to mixed-gender groups. Although bundling health education with microcredit can expand health education coverage and lower service-delivery costs, the approach may not be sufficient to improve health behaviors.
Sandefer, Ryan H; Westra, Bonnie L; Khairat, Saif S; Pieczkiewicz, David S; Speedie, Stuart M
Patients are increasingly using the Internet and other technologies to engage in their own healthcare, but little research has focused on the determinants of consumer eHealth behaviors related to Internet use. This study uses data from 115,089 respondents to four years of the National Health Interview Series to identify the associations between one consumer eHealth behavior (information seeking) and demographics, health measures, and Personal Health Information Management (PHIM) (messaging, scheduling, refills, and chat). Individuals who use PHIM are 7.5 times more likely to search the internet for health related information. Just as health has social determinants, the results of this study indicate there are potential social determinants of consumer eHealth behaviors including personal demographics, health status, and healthcare access.
Sandefer, Ryan H.; Westra, Bonnie L.; Khairat, Saif S.; Pieczkiewicz, David S.; Speedie, Stuart M
Patients are increasingly using the Internet and other technologies to engage in their own healthcare, but little research has focused on the determinants of consumer eHealth behaviors related to Internet use. This study uses data from 115,089 respondents to four years of the National Health Interview Series to identify the associations between one consumer eHealth behavior (information seeking) and demographics, health measures, and Personal Health Information Management (PHIM) (messaging, scheduling, refills, and chat). Individuals who use PHIM are 7.5 times more likely to search the internet for health related information. Just as health has social determinants, the results of this study indicate there are potential social determinants of consumer eHealth behaviors including personal demographics, health status, and healthcare access. PMID:26958251
the antecedents of these behavioral dimensions should help define potential targets for behavior modification programs and permit evaluations of those...defining observations that can be used for measurement. The behavior modification implications are linked to the assumption that behaviors which co-occur
Giurgiutiu, Victor; Soutis, Constantinos
This paper discusses the topic of how the integrity of safety-critical structural composites can be enhanced by the use of structural health monitoring (SHM) techniques. The paper starts with a presentation of how the certification of flight-critical composite structures can be achieved within the framework of civil aviation safety authority requirements. Typical composites damage mechanisms, which make this process substantially different from that for metallic materials are discussed. The opportunities presented by the use of SHM techniques in future civil aircraft developments are explained. The paper then focuses on active SHM with piezoelectric wafer active sensors (PWAS). After reviewing the PWAS-based SHM options, the paper follows with a discussion of the specifics of guided wave propagation in composites and PWAS-tuning effects. The paper presents a number of experimental results for damage detection in simple flat unidirectional and quasi-isotropic composite specimens. Calibrated through holes of increasing diameter and impact damage of various energies and velocities are considered. The paper ends with conclusions and suggestions for further work.
Feather, Martin S.; Uckun, Serdar; Hicks, Kenneth A.
Despite two decades of significant investments in R&D of Integrated System Health Management (ISHM), mission-critical applications of it in aerospace are few and far between. ISHM is subject to the general difficulty of transitioning technologies out of R&D labs and into practical applications. New and unproven methods such as ISHM introduce multiple mission risks (technology, schedule, cost), and may require a transition to unconventional and as-yet-unproven operations concepts in order to be effective. Laboratory and flight demonstrations are necessary but insufficient to adequately reduce those risks. What is needed is a solid business case before a new technology can be considered for fleetwide deployment. To address these problems, we recently applied a technology maturation assessment process developed at NASA's Jet Propulsion Laboratory to study the challenges of ISHM technology maturation. This application resulted in identification of the technologies (and technology maturation activities) that would result in the greatest risk reduction per investment dollar. Our approach and its results are described herein.
May, Michael E; Kennedy, Craig H
Good health significantly improves a person's quality of life. However, people with intellectual disabilities disproportionately have more health problems than the general population. Further complicating the matter is that people with more severe disabilities often cannot verbalize health complications they are experiencing, which leads to health problems being undiagnosed and untreated. It is plausible these conditions can interact with reinforcement contingencies to maintain problem behavior because of the increased incidence of health problems among people with intellectual disabilities. This paper reviews common health problems influencing problem behavior and reinforcement processes. A clear implication of this review is the need for comprehensive functional assessments of problem behavior involving behavior analysts and health professionals. PMID:22532888
Ellingsen, Gunnar; Monteiro, Eric
The notion of 'integration' in the context of health information systems is ill-defined yet in widespread use. We identify a variety of meanings ranging from the purely technical integration of information systems to the integration of services. This ambiguity (or interpretive flexibility), we argue, is inherent rather than accidental: it is a necessary prerequisite for mobilizing political and ideological support among stakeholders for integrated health information systems. Building on this, our aim is to trace out the career dynamics of the vision of 'integration/ integrated'. The career dynamics is the transformation of both the imaginary and the material (technological) realizations of the unfolding implementation of the vision of integrated care. Empirically we draw on a large, ongoing project at the University Hospital of North Norway (UNN) to establish an integrated health information system.
Background Mental health problems are prevalent and costly in working populations. Workplace interventions to address common mental health problems have evolved relatively independently along three main threads or disciplinary traditions: medicine, public health, and psychology. In this Debate piece, we argue that these three threads need to be integrated to optimise the prevention of mental health problems in working populations. Discussion To realise the greatest population mental health benefits, workplace mental health intervention needs to comprehensively 1) protect mental health by reducing work–related risk factors for mental health problems; 2) promote mental health by developing the positive aspects of work as well as worker strengths and positive capacities; and 3) address mental health problems among working people regardless of cause. We outline the evidence supporting such an integrated intervention approach and consider the research agenda and policy developments needed to move towards this goal, and propose the notion of integrated workplace mental health literacy. Summary An integrated approach to workplace mental health combines the strengths of medicine, public health, and psychology, and has the potential to optimise both the prevention and management of mental health problems in the workplace. PMID:24884425
Merrick, Elizabeth Levy; Horgan, Constance M; Garnick, Deborah W; Hodgkin, Dominic; Morley, Melissa
Although the disease management industry has expanded rapidly, there is little nationally representative data regarding medical and behavioral health disease management programs at the health plan level. National estimates from a survey of private health plans indicate that 90% of health plan products offered disease management for general medical conditions such as diabetes but only 37% had depression programs. The frequency of specific depression disease management activities varied widely. Program adoption was significantly related to product type and behavioral health contracting. In health plans, disease management has penetrated more slowly into behavioral health and depression program characteristics are highly variable.
Holahan, Carole K.; Suzuki, Rie
This study investigated adulthood predictors of health-promoting behavior in later aging. The participants were 162 members of the Terman Study of the Gifted (Terman et al., 1925), who responded in 1999 at an average age of 86 to a mailout questionnaire which included questions concerning their positive health behavior. Adulthood variables were…
Wallander, Jan L., Ed.; Siegel, Lawrence J., Ed.
This book examines the relationship between adolescent risk-taking behaviors and health. The health-related problems of adolescents frequently are manifestations of social, economic, or behavioral factors. Following an overview (Siegal), the chapters in the first section of the book explore general and conceptual issues: (1) "Epidemiology of…
Norris, Cynthia; McFall, Stephanie
This study assessed the association of lifestyle and clinical health behaviors with prostate specific antigen (PSA) tests. The study used cross-sectional data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). We used Stata 8.0 to take into account the complex sample design in analyses. Both lifestyle and clinical health behaviors…
Salzman, Stephanie A.; Girvan, James T.
A survey of health risk behaviors was administered to a representative sample of 7,776 Idaho students in grades 8-12. Respondents were 86% White, 6% Hispanic, 4% American Indian, 3% Asian, and 2% Black. These rural adolescents reported that they had engaged in some health risk behaviors at rates comparable to those of other U.S. adolescents: 57%…
Kramer, Mary M.; Stover, Sheri
This quantitative exploratory research study describes the incorporation of Social Norms as a unique pedagogical method in an undergraduate Health Behaviors course (N = 32). With the use of an audience response system (clickers), students anonymously answered health-behavior related questions. Aggregate data from the class was compared to state…
Providing health care services to Native women has become a challenge owing to the severity of illness--in particular, diabetes, alcoholism, and arthritis--in this group today. If comprehensive health care is to be offered, coordination of services between health and mental health practitioners is needed. Gathering together to support each other has been a traditional custom for Native women. An integrated health care model is discussed that offers Native women an opportunity to deal with the challenge of mental health and health issues through traditional activities, enhancing their physical and spiritual health and receiving education while creating an atmosphere of empowerment and mutual support.
Fernández-Abascal, Enrique G.; Martín-Díaz, María Dolores
In this paper the relationship between emotional intelligence (EI) and health is examined. The current work investigated the dimensions of EI are sufficient to explain various components of physical and mental health, and various categories of health-related behaviors. A sample of 855 participants completed two measures of EI, the Trait Meta-Mood Scale and trait emotional intelligence questionnaire, a measure of health, the Health Survey SF-36 Questionnaire (SF-36); and a measure of health-related behaviors, the health behavior checklist. The results show that the EI dimensions analyzed are better predictors of mental health than of physical health. The EI dimensions that positively explain the Mental Health Component are Well-Being, Self-Control and Sociability, and negatively, Attention. Well-Being, Self-Control and Sociability positively explain the Physical Health Component. EI dimensions predict a lower percentage of health-related behaviors than they do health components. Emotionality and Repair predict the Preventive Health Behavior category, and only one dimension, Self-Control, predicts the Risk Taking Behavior category. Older people carry out more preventive behaviors for health. PMID:25859229
Bloom, Michael S.; Choi, Hyunok; Gensburg, Lenore; Hosler, Akiko
Schools of Public Health historically introduced core curriculum courses in the first year of the Master of Public Health program as independent perspectives; these perspectives included epidemiology, biostatistics, environmental health, public health biology, health behaviors, and health policy. We performed a pilot project that integrated the core areas around diabetes as a cross-cutting public health issue to provide early exposure to the interdisciplinary nature of public health. In each core curriculum course, diabetes was explored in the curriculum and related to other core courses. Based on positive evaluations, this project will be replicated using a different health issue. Such an issue can be easily introduced as an overarching umbrella under which students are motivated to work through interdisciplinary collaboration. PMID:25706030
Flatt, Jason D; Agimi, Yll; Albert, Steve M
A common network phenomenon, homophily, involves developing relationships with others who are similar to you. The intent of this study was to determine if older adults' health behaviors were shared within social networks. We interviewed older adults from low-income senior housing (egos) on egocentric social network characteristics and key health behaviors for themselves and for named social ties (alters). Findings suggest strong effects for homophily, especially for those who smoked and were physically inactive. Public health interventions for older adults should consider the influence that social relationships have on personal health behaviors. Network-based interventions may be required.
Webb, Barbara H.; Harrison, Reid R.
The mechanisms by which animals manage sensorimotor integration and coordination of different behaviors can be investigated in robot models. In previous work the first author has build a robot that localizes sound based on close modeling of the auditory and neural system in the cricket. It is known that the cricket combines its response to sound with other sensorimotor activities such as an optomotor reflex and reactions to mechanical stimulation for the antennae and cerci. Behavioral evidence suggests some ways these behaviors may be integrated. We have tested the addition of an optomotor response, using an analog VLSI circuit developed by the second author, to the sound localizing behavior and have shown that it can, as in the cricket, improve the directness of the robot's path to sound. In particular it substantially improves behavior when the robot is subject to a motor disturbance. Our aim is to better understand how the insect brain functions in controlling complex combinations of behavior, with the hope that this will also suggest novel mechanisms for sensory integration on robots.
Doornwaard, Suzan M; ter Bogt, Tom F M; Reitz, Ellen; van den Eijnden, Regina J J M
Research on the role of sex-related Internet use in adolescents' sexual development has often isolated the Internet and online behaviors from other, offline influencing factors in adolescents' lives, such as processes in the peer domain. The aim of this study was to test an integrative model explaining how receptive (i.e., use of sexually explicit Internet material [SEIM]) and interactive (i.e., use of social networking sites [SNS]) sex-related online behaviors interrelate with perceived peer norms in predicting adolescents' experience with sexual behavior. Structural equation modeling on longitudinal data from 1,132 Dutch adolescents (M(age) T1 = 13.95; range 11-17; 52.7% boys) demonstrated concurrent, direct, and indirect effects between sex-related online behaviors, perceived peer norms, and experience with sexual behavior. SEIM use (among boys) and SNS use (among boys and girls) predicted increases in adolescents' perceptions of peer approval of sexual behavior and/or in their estimates of the numbers of sexually active peers. These perceptions, in turn, predicted increases in adolescents' level of experience with sexual behavior at the end of the study. Boys' SNS use also directly predicted increased levels of experience with sexual behavior. These findings highlight the need for multisystemic research and intervention development to promote adolescents' sexual health.
Doornwaard, Suzan M.; ter Bogt, Tom F. M.; Reitz, Ellen; van den Eijnden, Regina J. J. M.
Research on the role of sex-related Internet use in adolescents’ sexual development has often isolated the Internet and online behaviors from other, offline influencing factors in adolescents’ lives, such as processes in the peer domain. The aim of this study was to test an integrative model explaining how receptive (i.e., use of sexually explicit Internet material [SEIM]) and interactive (i.e., use of social networking sites [SNS]) sex-related online behaviors interrelate with perceived peer norms in predicting adolescents’ experience with sexual behavior. Structural equation modeling on longitudinal data from 1,132 Dutch adolescents (Mage T1 = 13.95; range 11-17; 52.7% boys) demonstrated concurrent, direct, and indirect effects between sex-related online behaviors, perceived peer norms, and experience with sexual behavior. SEIM use (among boys) and SNS use (among boys and girls) predicted increases in adolescents’ perceptions of peer approval of sexual behavior and/or in their estimates of the numbers of sexually active peers. These perceptions, in turn, predicted increases in adolescents’ level of experience with sexual behavior at the end of the study. Boys’ SNS use also directly predicted increased levels of experience with sexual behavior. These findings highlight the need for multisystemic research and intervention development to promote adolescents’ sexual health. PMID:26086606
Alias, Siti Noormi; Ismail, Maimunah
Purpose: This paper aims to propose a conceptual model of philanthropic behavior of volunteers in the health care sector. Design/methodology/approach: This study is based on an extensive review of past research on philanthropic behavior. To conduct the literature review, keywords such as philanthropy, philanthropic behavior, giving, donating,…
Dea, R A
Integration of behavioral healthcare and primary care has a number of presumed benefits, including better communication between providers and systems, leading to improved patient care. There are studies showing medical cost offsets, although they tend to be in circumscribed research settings. Northern California Kaiser-Permanente has designed a new primary care system providing mental health clinicians on a primary care team. Those clinicians evaluate patients, create treatment plans, provide brief interventions, coordinate care with specialty behavioral healthcare, and consult with primary care physicians. Those physicians also have an increased role in the detection and treatment of behavioral health problems via guidelines developed with behavioral health. Structural changes within the overall system, including regional call centers and computerized clinical information systems, support the integration. Quality programs also support the ongoing improvement of the integration process. There are investment expenses in this type of re-design, but also expected cost savings. An infrastructure is now in place to measure both clinical outcomes, and cost effects of the new model.
de Leeuw, Evelyne
Health is created largely outside the health sector. Engagement in health governance, policy, and intervention development and implementation by sectors other than health is therefore important. Recent calls for building and implementing Health in All Policies, and continued arguments for intersectoral action, may strengthen the potential that other sectors have for health. This review clarifies the conceptual foundations for integral health governance, policy, and action, delineates the different sectors and their possible engagement, and provides an overview of a continuum of methods of engagement with other sectors to secure integration. This continuum ranges from institutional (re)design to value-based narratives. Depending on the lens applied, different elements can be identified within the continuum. This review is built on insights from political science, leadership studies, public health, empirical Health in All Policy research, knowledge and evidence nexus approaches, and community perspectives. Successful integration of health governance, policy, and action depends on integration of the elements on the continuum.
lead to more effective, efficient health behavior modification programs. Aeoesson 7or ITI GRA&I DTIC TAB5 Unnnnoanced 5 SJu~ti:Icrti or D31tt ’buiOn...further study, however, these barriers might be overcome by designing health behavior modification programs in which participants were assigned to... behavior modification programs matched to their personality predispositions. References Aho, W. R. (1979a). Participation of senior citizens in the
Branscum, Paul; Bhochhibhoya, Amir
Background: The integrated behavioral model (IBM) is a new and emerging theory in the field of health promotion and health education, and more applications are needed to test the usefulness of the model for research and practice. Purpose: The purpose of this study was to operationalize the IBM as it relates to physical activity (PA) among children…
Sturm, Lynne A.; Perry, Deborah F.
This article describes innovative service delivery models and clinical strategies that support the social-emotional development of young children and their families in the pediatric primary care setting. By understanding the trends affecting well-child care, early childhood providers will be better equipped to partner with their pediatric…
Health Impact Assessment (HIA) provides a methodology for incorporating considerations of public health into planning and decision-making processes. HIA promotes interdisciplinary action, stakeholder participation, and timeliness and takes into account equity, sustainability, and...
Meredith, Steven E; Jarvis, Brantley P; Raiff, Bethany R; Rojewski, Alana M; Kurti, Allison; Cassidy, Rachel N; Erb, Philip; Sy, Jolene R; Dallery, Jesse
Behavior plays an important role in health promotion. Exercise, smoking cessation, medication adherence, and other healthy behavior can help prevent, or even treat, some diseases. Consequently, interventions that promote healthy behavior have become increasingly common in health care settings. Many of these interventions award incentives contingent upon preventive health-related behavior. Incentive-based interventions vary considerably along several dimensions, including who is targeted in the intervention, which behavior is targeted, and what type of incentive is used. More research on the quantitative and qualitative features of many of these variables is still needed to inform treatment. However, extensive literature on basic and applied behavior analytic research is currently available to help guide the study and practice of incentive-based treatment in health care. In this integrated review, we discuss how behavior analytic research and theory can help treatment providers design and implement incentive-based interventions that promote healthy behavior. PMID:24672264
Kaljee, Linda M; Chen, Xinguang
Social capital and health research has emerged as a focus of contemporary behavioral epidemiology, while intervention research is seeking more effective measures to increase health protective behaviors and decrease health-risk behaviors. In this review we explored current literature on social capital and health outcomes at the micro-, mesa-, and macro-levels with a particular emphasis on research that incorporates a social capital framework, and adolescent and young adult engagement in risk behaviors. These data indicate that across a broad range of socio-cultural and economic contexts, social capital can affect individuals’ risk for negative health outcomes and their engagement in risk behaviors. Further research is needed which should focus on differentiating and measuring positive and negative social capital within both mainstream and alternative social networks, assessing how social constructions of gender, ethnicity, and race – within specific cultural contexts – mediate the relationship between social capital and risk and/or protective behaviors. This new research should integrate the existing research within historical socioeconomic and political conditions. In addition, social capital scales need to be developed to be both culturally and developmentally appropriate for use with adolescents living in a diversity of settings. Despite the proliferation of social capital research, the concept remains underutilized in both assessment and intervention development for adolescents’ and young adults’ engagement in risk behaviors and their associated short- and long-term poor health outcomes. PMID:23243387
An exploratory study examined the relationship between individual, family, and work variables and working mothers' health. The study also investigated the relationship between health management strategies and health. A cross-sectional survey design was used to gather data from 85 women who were married, employed 20 hours a week or more, and had…
Krstic, Dimitrije; Boll, Werner; Noll, Markus
The courtship behavior of Drosophila melanogaster serves as an excellent model system to study how complex innate behaviors are controlled by the nervous system. To understand how the underlying neural network controls this behavior, it is not sufficient to unravel its architecture, but also crucial to decipher its logic. By systematic analysis of how variations in sensory inputs alter the courtship behavior of a naïve male in the single-choice courtship paradigm, we derive a model describing the logic of the network that integrates the various sensory stimuli and elicits this complex innate behavior. This approach and the model derived from it distinguish (i) between initiation and maintenance of courtship, (ii) between courtship in daylight and in the dark, where the male uses a scanning strategy to retrieve the decamping female, and (iii) between courtship towards receptive virgin females and mature males. The last distinction demonstrates that sexual orientation of the courting male, in the absence of discriminatory visual cues, depends on the integration of gustatory and behavioral feedback inputs, but not on olfactory signals from the courted animal. The model will complement studies on the connectivity and intrinsic properties of the neurons forming the circuitry that regulates male courtship behavior. PMID:19214231
Sheffield, Emilyn A.; And Others
The health status and leisure behavior of victims of sexual assault were studied. Data concerning present illness symptoms, past illness symptoms, negative health behavior, family health history, and female reproductive physiology illness symptoms were obtained and analyzed. Sexual assault victims were similar to nonvictims demographically except…
Montgomery, Ruth; Rider, Mary Ellen
Uses ecological systems theory as a foundation for integrating health care and its public policy issues into family and consumer sciences classrooms. Offers teachers alternative perspectives on consumer behavior changes and needs in heath care systems and policies. Contains 24 references. (JOW)
Davis, Jeffrey R.
Dr. Davis' presentation includes a brief overview of space flight and the lessons learned for health care in microgravity. He will describe the development of policy for health care for international crews. He will conclude his remarks with a discussion of an integrated health care system.
Mezuk, Briana; Rafferty, Jane A; Kershaw, Kiarri N; Hudson, Darrell; Abdou, Cleopatra M; Lee, Hedwig; Eaton, William W; Jackson, James S
Prevalence of depression is associated inversely with some indicators of socioeconomic position, and the stress of social disadvantage is hypothesized to mediate this relation. Relative to whites, blacks have a higher burden of most physical health conditions but, unexpectedly, a lower burden of depression. This study evaluated an etiologic model that integrates mental and physical health to account for this counterintuitive patterning. The Baltimore Epidemiologic Catchment Area Study (Maryland, 1993-2004) was used to evaluate the interaction between stress and poor health behaviors (smoking, alcohol use, poor diet, and obesity) and risk of depression 12 years later for 341 blacks and 601 whites. At baseline, blacks engaged in more poor health behaviors and had a lower prevalence of depression compared with whites (5.9% vs. 9.2%). The interaction between health behaviors and stress was nonsignificant for whites (odds ratio (OR = 1.04, 95% confidence interval: 0.98, 1.11); for blacks, the interaction term was significant and negative (β: -0.18, P < 0.014). For blacks, the association between median stress and depression was stronger for those who engaged in zero (OR = 1.34) relative to 1 (OR = 1.12) and ≥2 (OR = 0.94) poor health behaviors. Findings are consistent with the proposed model of mental and physical health disparities.
Galama, Titus J.
Wealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by exploiting both inheritances and lottery winnings to test a theory of health behavior. We distinguish between the direct monetary cost and the indirect health cost (value of health lost) of unhealthy consumption. The health cost increases with wealth and the degree of unhealthiness, leading wealthier individuals to consume more healthy and moderately unhealthy, but fewer severely unhealthy goods. The empirical evidence presented suggests that differences in health costs may indeed partially explain behavioral differences, and ultimately health outcomes, between wealth groups. PMID:25530621
Karvinen, Kristina H; Carr, Lucas J
The purpose of this study was to examine the associations between God Locus of Health Control, health behaviors, and beliefs utilizing a cross-sectional online survey (N = 549). Results indicated that God Locus of Health Control was correlated with alcohol use, physical activity, perceived risk of chronic disease, and beliefs that poor health behaviors contribute to chronic disease (all p values < .05). Multiple regression analyses including covariates and other locus of control variables revealed that God Locus of Health Control was only an independent correlate of the belief that physical inactivity contributed to chronic disease. Insights from this study may be important for future faith-based health behavior change interventions.
McBride, Colleen M; Bryan, Angela D; Bray, Molly S; Swan, Gary E; Green, Eric D
The National Human Genome Research Institute recommends pursuing "genomic information to improve behavior change interventions" as part of its strategic vision for genomics. The limited effectiveness of current behavior change strategies may be explained, in part, by their insensitivity to individual variation in adherence responses. The first step in evaluating whether genomics can inform customization of behavioral recommendations is evidence reviews to identify adherence macrophenotypes common across behaviors and individuals that have genetic underpinnings. Conceptual models of how biological, psychological, and environmental factors influence adherence also are needed. Researchers could routinely collect biospecimens and standardized adherence measurements of intervention participants to enable understanding of genetic and environmental influences on adherence, to guide intervention customization and prospective comparative effectiveness studies.
Many Medicaid programs have either fully or partially carved out mental health services. The evaluation of carve-out plans requires a case-mix model that accounts for differing health status across Medicaid managed care plans. This article develops a diagnosis-based case-mix adjustment system specific to Medicaid behavioral health care. Several…
McGee, Heather M.; Diener, Lori H.
This article provides a behavioral systems approach to improve operational performance in health and human service organizations. This article provides six performance truths that are relevant to any organization and a case study from a community mental health network of agencies. A comprehensive analysis, as described here, will help health and…
Trieu, Sang Leng; Bratton, Sally; Marshak, Helen Hopp
Objective: To explore the sexual and reproductive health behaviors of students from 13 community college campuses in California. Participants: Heterosexual college students, ages 18 to 24, who have had sexual intercourse (N = 4,487). Methods: The American College Health Association's National College Health Assessment (ACHA-NCHA) survey was…
Russell, Elizabeth B.
This article explores the impact of practitioners' attitudes and knowledge of sexual health on clinical behaviors. Sexual health topics are often areas of concern for clients of any age in counseling. Thus, counselors must be trained and equipped to address sexual health across the life span. This study explored whether child and adolescent…
O'Connell, Janelle K.; Price, James H.
Arguments based on the philosophies of natural law, utilitarianism, paternalism, and distributive justice are examined for their pertinence to health behavior change strategies. Health educators should prepare individuals to make health-generating decisions but may need to limit the conditions under which they intervene. (Author/PP)
DeLoach, Kendra P.; Dvorsky, Melissa; Miller, Elaine; Paget, Michael
Students with emotional and behavioral challenges are significantly impacted by mental health issues. Teachers and other school staff need mental health knowledge to work more effectively with these students. Collaboration with mental health professionals and sharing of information is essential. [For complete volume, see ED539318.
Petosa, R. L.; Smith, Laureen H.
Background: Peer mentoring can be a powerful complement to health instruction. Mentoring has been used to change health behaviors and promote sustainable lifestyle patterns in adults and, more recently, among adolescents. Purpose: This article reviews the use of peer mentoring to promote health practices and describes how this approach can be used…
Zismer, Daniel K; Werner, Mark J
The physics metaphor, as applied to the economics (and financial performance) of the integrated health system, seems appropriate when considered together with the nine principles of management framework provided. The nature of the integrated design enhances leaders' management potential as they consider organizational operations and strategy in the markets ahead. One question begged by this argument for the integrated design is the durability, efficiency and ultimate long-term survivability of the more "traditional" community health care delivery models, which, by design, are fragmented, internally competitive and less capital efficient. They also cannot exploit the leverage of teams, optimal access management or the pursuit of revenues made available in many forms. For those who wish to move from the traditional to the more integrated community health system designs (especially those who have not yet started the journey), the path requires: * Sufficient balance sheet capacity to fund the integration process-especially as the model requires physician practice acquisitions and electronic health record implementations * A well-prepared board13, 14 * A functional, durable and sustainable physician services enterprise design * A redesigned organizational and governance structure * Favorable internal financial incentives alignment design * Effective accountable physician leadership * Awareness that the system is not solely a funding strategy for acquired physicians, rather a fully -.. committed clinical and business model, one in which patient-centered integrated care is the core service (and not acute care hospital-based services) A willingness to create and exploit the implied and inherent potential of an integrated design and unified brand Last, it's important to remember that an integrated health system is a tool that creates a "new potential" (a physics metaphor reference, one last time). The design doesn't operate itself. Application of the management principles
Hansen, Hardaye Ramsaroop; Shneyderman, Yuliya; Belcastro, Philip A.
Background: There is a paucity of evidence associating health literacy metrics with adults' enhanced health knowledge, health status, health practices, or health behaviors. Purpose: Investigate whether health-literate undergraduates exhibit enhanced health knowledge, health status, health practices, or behaviors compared to non-health-literate…
Koh, Seong A.
The purpose of this study was to examine the similarity of outcomes from three different treatment integrity (TI) methods, and to identify the method which best corresponded to the assessment of a child's behavior. Six raters were recruited through individual contact via snowball sampling. A modified intervention component list and 19 video clips…
Mezuk, Briana; Abdou, Cleopatra M.; Hudson, Darrell; Kershaw, Kiarri N.; Rafferty, Jane A.; Lee, Hedwig; Jackson, James S.
Crucial advances have been made in our knowledge of the social determinants of health and health behaviors. Existing research on health disparities, however, generally fails to address a known paradox in the literature: While blacks have higher risk of medical morbidity relative to non-Hispanic whites, blacks have lower rates of common stress-related forms of psychopathology such as major depression and anxiety disorders. In this article we propose a new theoretical approach, the Environmental Affordances Model, as an integrative framework for the origins of both physical and mental health disparities. We highlight early empirical support and a growing body of experimental animal and human research on self-regulatory health behaviors and stress coping that is consistent with the proposed framework. We conclude that transdisciplinary approaches, such as the Environmental Affordances Model, are needed to understand the origins of group-based disparities to implement effective solutions to racial and ethnic group inequalities in physical and mental health. PMID:24224131
Gore, Brian F.; Jarvis, Peter A.
The Man-machine Integration Design and Analysis System (MIDAS) is an integrated human performance modeling software tool that is based on mechanisms that underlie and cause human behavior. A PC-Windows version of MIDAS has been created that integrates the anthropometric character "Jack (TM)" with MIDAS' validated perceptual and attention mechanisms. MIDAS now models multiple simulated humans engaging in goal-related behaviors. New capabilities include the ability to predict situations in which errors and/or performance decrements are likely due to a variety of factors including concurrent workload and performance influencing factors (PIFs). This paper describes a new model that predicts the effects of microgravity on a mission specialist's performance, and its first application to simulating the task of conducting a Life Sciences experiment in space according to a sequential or parallel schedule of performance.
Rafiroiu, Anca Codruta; Sargent, Roger G.; Parra-Medina, Deborah; Drane, Wanzer J.; Valois, Robert F.
Assessed the prevalence of dieting, investigating clusters of risk behaviors among adolescents. Data from the 1999 South Carolina Youth Risk Behavior Survey indicated that weight control behaviors related to several other important health behaviors. Differences existed between adolescents who used extreme weight loss measures and moderate dieters…
Littleton, Heather L.; Grills-Taquechel, Amie E.; Buck, Katherine S.; Rosman, Lindsey; Dodd, Julia C.
Sexual assault is associated with a number of health risk behaviors in women. It has been hypothesized that these risk behaviors, such as hazardous drinking, may represent women's attempts to cope with psychological distress, such as symptoms of depression and anxiety. However, extant research has failed to evaluate these relationships among ethnic minority samples or identify the mechanisms responsible for this association. The current study examined sexual assault history and two health risk behaviors (hazardous drinking and engaging in sexual behavior to regulate negative affect) in a diverse sample of 1,620 college women. Depression and anxiety were examined as mediators of the relationship between sexual assault and health risk behaviors. There was evidence of moderated mediation, such that for European American women, but not for ethnic minority women, both forms of psychological distress were significant mediators of the sexual assault/hazardous drinking relationship. In contrast, among all ethnic groups, the relationship between sexual assault and both forms of psychological distress was mediated by the use of sexual behavior as an affect regulation strategy. Results support a need to evaluate the assault experiences of ethnically diverse women, as well as the impact of the assault on their postassault experiences including health risk behaviors and psychological adjustment. Additionally, results suggest that practitioners should carefully assess health risk behaviors among victims of sexual assault and be aware that there may be differences in the risk factors and motives for these behaviors among women of various ethnic backgrounds. PMID:24223467
Azzalis, L. A.; Giavarotti, L.; Sato, S. N.; Barros, N. M. T.; Junqueira, V. B. C.; Fonseca, F. L. A.
Concepts from disciplines such as Biochemistry, Genetics, Cellular and Molecular Biology are essential to the understanding and treatment of an elevated number of illnesses, but often they are studied separately, with no integration between them. This article proposes a model for basic sciences integration based on problem-based learning (PBL) and…
Sipos, Maurice L; Foran, Heather M; Crane, Maria L; Wood, Michael D; Wright, Kathleen M
Virtual behavioral health (VBH) services are used frequently to address the high demand for behavioral health (BH) services in the military. Few studies have investigated the relationship between the use of VBH services and BH outcomes or preferences for the use of VBH technologies. In this article, we evaluated BH interviews conducted via video teleconferencing (VTC) or face-to-face in terms of BH symptoms, satisfaction rates, stigma, barriers to care, and preferences for future use of BH care. Soldiers (n = 307) from the headquarters element of an operational unit were surveyed 4 months following a 12-month deployment to Iraq. There were no significant differences in satisfaction rates based on interview modality, but significantly more soldiers preferred face-to-face interviews over VTC interviews in the future. Soldiers who preferred face-to-face interviews also reported higher levels of anxiety and depression symptoms than those who preferred VTC interviews. No significant age differences were found in terms of interview modality satisfaction or preference. Soldiers with greater deployment experience were more likely to report that they would not like using VTC if seeking BH care in the future than soldiers with less deployment experience. These findings highlight the importance of promoting choice in type of BH interview modality.
The application of behavioral economics to health and health care has captured the imagination of policymakers across the political spectrum. The idea is that many people are irrational in predictable ways, and that this both contributes to unhealthy behaviors like smoking and holds one of the keys to changing those behaviors. Because health care costs continue to increase, and a substantial portion of costs are incurred because of unhealthy behaviors, employers and insurers have great interest in using financial incentives to change behaviors. However, it is in the details that complexity and controversies emerge. Who should the targets be, and what outcomes should be rewarded? How should incentives be structured, to maximize their effectiveness and minimize unintended consequences? In what situations should we be intervening to affect decisions by people who may prefer to be obese or to smoke, and in what situations should we accept their preferences? To begin to answer these questions, the Penn-CMU Roybal P30 Center on Behavioral Economics and Health held its first annual Behavioral Economics and Health Symposium on March 24-25, 2011 with support from the Robert Wood Johnson Foundation. The symposium drew more than 50 researchers, scholars, and health professionals from a variety of disciplines, including medicine, public health, economics, law, management, marketing, and psychology. They heard perspectives on behavioral economics from public and private funders, the CEO of the University of Pennsylvania Health System, and the CEO of stickK.com, a start-up company that uses online, voluntary commitment contracts to help people achieve their goals. Participants formed eight working groups to review the current state-of-the-art in a variety of clinical contexts and to consider how behavioral economics could inform a research agenda to improve health. This Issue Brief summarizes the findings of these working groups and the symposium.
Shattuck, Eric C; Muehlenbein, Michael P
Sickness behavior, a coordinated set of behavioral changes during infection and elicited by the pro-inflammatory cytokines tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β), is well studied in non-human animals. Over the last two decades, several papers have expanded this research to include humans. However, these studies use a variety of research designs, and typically focus on a single cytokine and only a few of the many behavioral changes constituting sickness behavior. Therefore, our understanding of human sickness behavior remains equivocal. To generate a more holistic, integrative picture of this phenomenon, a meta-analysis of the human sickness behavior literature was conducted. Full model results show that both IL-6 and IL-1β have significant relationships with sickness behavior, and the strength of these relationships is affected by a number of study parameters, such as type of immune stimulus and inclusion of controls. In addition to research design heterogeneity, other issues to address in future studies include an unequal focus on different cytokines and different sickness behaviors.
Fitzgerald-Yau, Natasha; Viner, Russell Mark
We systematically searched 9 biomedical and social science databases (1980–2012) for primary and secondary interventions that prevented or reduced 2 or more adolescent health risk behaviors (tobacco use, alcohol use, illicit drug use, risky sexual behavior, aggressive acts). We identified 44 randomized controlled trials of universal or selective interventions and were effective for multiple health risk behaviors. Most were school based, conducted in the United States, and effective for multiple forms of substance use. Effects were small, in line with findings for other universal prevention programs. In some studies, effects for more than 1 health risk behavior only emerged at long-term follow-up. Integrated prevention programs are feasible and effective and may be more efficient than discrete prevention strategies. PMID:24625172
Pincus, Harold Alan; Jun, Miraya; Franx, Gerdien; van der Feltz-Cornelis, Christina; Ito, Hiroto; Mossialos, Elias
A range of integration models for providing effective care to individuals with comorbid general medical and behavioral health conditions have been described and tested in varied settings internationally for several subsets of this population. This column examines models in three countries selected to showcase implementation in a variety of health systems: the national health system in England, nationally regulated individual insurance market in the Netherlands, and a mixture of employer-sponsored and government-funded health insurance plans in Japan. The authors describe a set of key practices for and challenges to the successful implementation of these models.
Prosser, W. H.; Brown, T. L.; Woodard, S. E.; Fleming, G. A.; Cooper, E. G.
NASA is focusing considerable efforts on technology development for Integrated Vehicle Health Management systems. The research in this area is targeted toward increasing aerospace vehicle safety and reliability, while reducing vehicle operating and maintenance costs. Onboard, real-time sensing technologies that can provide detailed information on structural integrity are central to such a health management system. This paper describes a number of sensor technologies currently under development for integrated vehicle health management. The capabilities, current limitations, and future research needs of these technologies are addressed.
As reported in last month's HEJ, the new Sustainable Development Strategy for the Health, Public Health and Social Care System for 2014-20 rightly emphasises the importance of the built environment to health and well-being. Chris Hall, the BRE's health sector lead, says this message 'stretches far beyond hospitals and healthcare buildings into the communities and homes that people live in'. Here he highlights some of the key elements relating to the current carbon efficiency of healthcare buildings, considers the impact of 'good' housing on health and preventing illness, and looks forward to a series of joint IHEEM and BRE 'Building Sustainable Development' mini-conference events planned in the run-up to October's Healthcare Estates 2014 event in response to the new Strategy, designed to share ideas and good practice on sustainable estates issues. The first takes place in London later this month (see panel below).
Conger, Cynthia O'Neill; Baldwin, Joan H.; Abegglen, JoAnn; Callister, Lynn C.
Brigham Young University's nursing curriculum was revised to reflect the community-driven nature of primary health care. Curricular threads of inquiry, practice, stewardship, spirituality, and service are the framework for integrating community health nursing practice. (SK)
Seligman, Jamie; Felder, Stephanie S; Robinson, Maryann E
The Substance Abuse and Mental Health Services Administration (SAMHSA) in the Department of Health and Human Services offers extensive disaster behavior health resources to assist disaster survivors in preparing for, responding to, and recovering from natural and manmade disasters. One of SAMHSA's most innovative resources is the SAMHSA Behavioral Health Disaster Response App (SAMHSA Disaster App). The SAMHSA Disaster App prepares behavioral health responders for any type of traumatic event by allowing them to access disaster-related materials and other key resources right on their phone, at the touch of a button. The SAMHSA Disaster App is available on iPhone, Android, and BlackBerry devices.
de Voursney, David; Huang, Larke N
The health home program established under the Affordable Care Act (2010) is derived from the medical home concept originated by the American Academy of Pediatrics in 1968 to provide a care delivery model for children with special health care needs. As applied to behavioral health, health homes or medical homes have become increasingly adult-focused models, with a primary goal of coordinating physical and behavioral health care. For children and youth with serious emotional disorders, health homes must go beyond physical and behavioral health care to connect with other child-focused sectors, such as education, child welfare, and juvenile justice. Each of these systems have a significant role in helping children meet health and developmental goals, and should be included in integrated approaches to care for children and youth. Health homes for young people should incorporate a continuum of care from health promotion to the prevention and treatment of disorders. The challenge for child- and youth-focused health homes is to integrate effective services and supports into the settings where young people naturally exist, drawing on the best evidence from mental health, physical medicine, and other fields. What may be needed is not a health home as currently conceptualized for adults, nor a traditional medical home, but a family- and child-centered coordinated care and support delivery system supported by health homes or other arrangements. This article sets out a health home framework for children and youth with serious mental health conditions and their families, examining infrastructure and service delivery issues.
Aboagye, Emmanuel; Agyemang, Otuo Serebour
This paper examines how organization and financing of maternal health services influence health-seeking behavior in Bosomtwe district, Ghana. It contributes in furthering the discussions on maternal health-seeking behavior and health outcomes from a health system perspective in sub-Saharan Africa. From a health system standpoint, the paper first presents the resources, organization and financing of maternal health service in Ghana, and later uses case study examples to explain how Ghana's health system has shaped maternal health-seeking behavior of women in the district. The paper employs a qualitative case study technique to build a complex and holistic picture, and report detailed views of the women in their natural setting. A purposeful sampling technique is applied to select 16 women in the district for this study. Through face-to-face interviews and group discussions with the selected women, comprehensive and in-depth information on health- seeking behavior and health outcomes are elicited for the analysis. The study highlights that characteristics embedded in decentralization and provision of free maternal health care influence health-seeking behavior. Particularly, the use of antenatal care has increased after the delivery exemption policy in Ghana. Interestingly, the study also reveals certain social structures, which influence women's attitude towards their decisions and choices of health facilities.
Potvin, Louise; Gendron, Sylvie; Bilodeau, Angèle; Chabot, Patrick
The innovative practice that resulted from the Ottawa Charter challenges public health knowledge about programming and evaluation. Specifically, there is a need to formulate program theory that embraces social determinants of health and local actors’ mobilization for social change. Likewise, it is imperative to develop a theory of evaluation that fosters reflexive understanding of public health programs engaged in social change. We believe advances in contemporary social theory that are founded on a critique of modernity and that articulate a coherent theory of practice should be considered when addressing these critical challenges. PMID:15798114
Fletcher, Jason M.; Frisvold, David E.
Large literatures have shown important links between the quantity of completed education and health outcomes on one hand and the quality or selectivity of schooling on a host of adult outcomes, such as wages, on the other hand. However, little research attempts to produce evidence of the link between school quality and health. The paper presents…
Bickel, Warren K; Moody, Lara; Higgins, Stephen T
Health-related behaviors such as tobacco, alcohol and other substance use, poor diet and physical inactivity, and risky sexual practices are important targets for research and intervention. Health-related behaviors are especially pertinent targets in the United States, which lags behind most other developed nations on common markers of population health. In this essay we examine the application of behavioral economics, a scientific discipline that represents the intersection of economics and psychology, to the study and promotion of health-related behavior change. More specifically, we review what we consider to be some core dimensions of this discipline when applied to the study health-related behavior change. Behavioral economics (1) provides novel conceptual systems to inform scientific understanding of health behaviors, (2) translates scientific understanding into practical and effective behavior-change interventions, (3) leverages varied aspects of behavior change beyond increases or decreases in frequency, (4) recognizes and exploits trans-disease processes and interventions, and (5) leverages technology in efforts to maximize efficacy, cost effectiveness, and reach. These dimensions are overviewed and their implications for the future of the field discussed.
Wartenberg, Daniel; Thompson, W Douglas; Fitzgerald, Edward F; Gross, Hillary J; Condon, Suzanne K; Kim, Nancy; Goun, Barbara D; Opiekun, Richard E
Environmental exposures cause substantial morbidity and mortality in the United States. A major goal of Centers for Disease Control and Prevention Environmental Public Health Tracking program is the development of a national network of health and environmental data with analytic tools for rapid evaluation of specific national or regional environmental health concerns. A six-state collaborative project in the northeast United States was established to assess the feasibility of such a system, assessing the possible association between ambient air quality and adverse birth outcomes. For this regional surveillance project, issues were discussed surrounding the design of a mutually acceptable protocol, obtaining human subjects' protection approvals, obtaining and organizing both the exposure and outcome data, analyzing the data both locally and regionally, and planning subsequent interventions to address identified public health concerns.
The World Health Organization's International Programme on Chemical Safety (IPCS), the Organization for Economic Cooperation and Development (OECD), and the U.S. Environmental Protection Agency have developed a collaborative partnership to foster integration; of assessment approa...
Farina, Joseph; Frechette, Michael
Reports the development of an integrated clinical approach to introductory chemistry education at the undergraduate level for students majoring in nursing and the allied health professions at the University of Lowell. (BT)
Lucas, Anthony G; Primus, Kelly; Kovach, Jamison V; Fredendall, Lawrence D
Clinical evidence-based practices are strongly encouraged and commonly utilized in the behavioral health community. However, evidence-based practices that are related to quality improvement processes, such as Design for Six Sigma, are often not used in behavioral health care. This column describes the unique partnership formed between a behavioral health care provider in the greater Pittsburgh area, a nonprofit oversight and monitoring agency for behavioral health services, and academic researchers. The authors detail how the partnership used the multistep process outlined in Design for Six Sigma to completely redesign the provider's intake process. Implementation of the redesigned process increased access to care, decreased bad debt and uncollected funds, and improved cash flow--while consumer satisfaction remained high.
Palinkas, Lawrence A
Along with other manmade and natural disasters, oil spills produce profound and long-term impacts on the behavioral health of their survivors. Although previous and ongoing research has focused on producing evidence of the breadth and depth of these impacts, future efforts must begin to translate this evidence into developing and implementing policies, programs, and practices that effectively contribute to their prevention and mitigation. Drawing upon a conceptual framework of the behavioral health impacts of oil spills developed from data collected in the aftermath of the Exxon Valdez oil spill in 1989, this paper examines potential interventions designed to prevent or mitigate biopsychosocial, interpersonal, and intrapersonal impacts on behavioral health. Future efforts to translate behavioral health research into effective practice will require the formation and maintenance of academic-community partnerships for the purpose of building resilience to these impacts and providing targeted services to those most vulnerable to their long-term consequences.
Palinkas, Lawrence A.
Along with other manmade and natural disasters, oil spills produce profound and long-term impacts on the behavioral health of their survivors. While previous and ongoing research has focused on producing evidence of the breadth and depth of these impacts, future efforts must begin to translate this evidence into developing and implementing policies, programs and practices that effectively contribute to their prevention and mitigation. Drawing upon a conceptual framework of the behavioral health impacts of oil spills developed from data collected in the aftermath of the Exxon Valdez oil spill in 1989, this paper examines potential interventions designed to prevent or mitigate biopsychosocial, interpersonal and intrapersonal impacts on behavioral health. Future efforts to translate behavioral health research into effective practice will require the formation and maintenance of academic-community partnerships for the purpose of building resilience to these impacts and providing targeted services to those most vulnerable to their long-term consequences. PMID:24443145
Matarazzo, Joseph D.
Asserts that psychologists can contribute to a reduction in national health expenditures by focusing on such illness- and accident-causing behaviors as smoking, alcohol use, improper diet, and speeding and the nonuse of seat belts in cars. (GC)
Leveton, Lauren B.
This viewgraph presentation reviews the performance errors associated with sleep loss, fatigue and psychomotor factors during manned space flight. Short and long term behavioral health factors are also addressed
Scott-Sheldon, Lori A J; Carey, Kate B; Carey, Michael P
The college years offer an opportunity for new experiences, personal freedom, and identity development; however, this period is also noted for the emergence of risky health behaviors that place college students at risk for health problems. Affiliation with on-campus organizations such as fraternities or sororities may increase a students' risk given the rituals and socially endorsed behaviors associated with Greek organizations. In this study, we examined alcohol and drug use, smoking, sexual behavior, eating, physical activity, and sleeping in 1,595 college students (n = 265 Greek members, n = 1,330 non-Greek members). Results show Greek members engaged in more risky health behaviors (e.g., alcohol use, cigarette smoking, sexual partners, and sex under the influence of alcohol or drugs) than non-Greek members. Greek and non-Greek members did not differ in condom use, unprotected sex, eating, and physical activity behaviors. Implications for prevention and intervention strategies among Greek members are discussed.
Follette, William C.; Bach, Patricia A.; Follette, Victoria M.
This paper argues that a behavioral analysis of psychological health is useful and appropriate. Such an analysis will allow us to better evaluate intervention outcomes without resorting only to the assessment of pathological behavior, thus providing an alternative to the Diagnostic and Statistical Manual system of conceptualizing behavior. The goals of such an analysis are to distinguish between people and outcomes using each term of the three-term contingency as a dimension to consider. A brief review of other efforts to define psychological health is provided. Laboratory approaches to a behavioral analysis of healthy behavior are presented along with shortcomings in our science that impede our analysis. Finally, we present some of the functional characteristics of psychological health that we value. PMID:22478160
LaMontagne, Anthony D
Investigation of the association between job stressors and health behaviors has a long history that has been marked by mixed findings. Fransson et al. (Am J Epidemiol. 2012;176(12):1078-1089) find robust prospective and cross-sectional associations between job strain and leisure-time physical inactivity in combined data from 14 cohort studies. Further research to better understand the observed heterogeneity in the contributing cohorts and other studies will be crucial for application to intervention design and tailoring. The population health significance of these findings requires consideration of other job strain-health behavior (particularly the parallel analyses conducted for body mass index and smoking in the same data set) and job strain-health outcome associations, as well as these same associations for other job stressors. Job strain can be seen as a "fundamental cause" of work-related disease, in that intervention to reduce exposure to job strain could have beneficial impacts on many outcomes, making a compelling case for intervention. The significantly strengthened evidence linking job stressors to health behaviors provided by Fransson et al. may help to further direct workplace health promotion research, policy, and practice towards an approach that better integrates intervention on working conditions and health behaviors. The benefits to population health could be substantial.
Buschman, Timothy J; Kastner, Sabine
The brain has a limited capacity and therefore needs mechanisms to selectively enhance the information most relevant to one's current behavior. We refer to these mechanisms as "attention." Attention acts by increasing the strength of selected neural representations and preferentially routing them through the brain's large-scale network. This is a critical component of cognition and therefore has been a central topic in cognitive neuroscience. Here we review a diverse literature that has studied attention at the level of behavior, networks, circuits, and neurons. We then integrate these disparate results into a unified theory of attention.
Buschman, Timothy J.; Kastner, Sabine
The brain has a limited capacity and therefore needs mechanisms to selectively enhance the information most relevant to one’s current behavior. We refer to these mechanisms as ‘attention’. Attention acts by increasing the strength of selected neural representations and preferentially routing them through the brain’s large-scale network. This is a critical component of cognition and therefore has been a central topic in cognitive neuroscience. Here we review a diverse literature that has studied attention at the level of behavior, networks, circuits and neurons. We then integrate these disparate results into a unified theory of attention. PMID:26447577
Background Finland has since 1972 had a primary health care system based on health centres run and funded by the local public authorities called ‘municipalities’. On the world map of primary health care systems, the Finnish solution claims to be the most health centre oriented and also the widest, both in terms of the numbers of staff and also of different professions employed. Offering integrated care through multi-professional health centres has been overshadowed by exceptional difficulties in guaranteeing a reasonable access to the population at times when they need primary medical or dental services. Solutions to the problems of access have been found, but they do not seem durable. Description of policy practice During the past 10 years, the health centres have become a ground of active development structural change, for which no end is in sight. Broader issues of municipal and public administration structures are being solved through rearranging primary health services. In these rearrangements, integration with specialist services and with social services together with mergers of health centres and municipalities are occurring at an accelerated pace. This leads into fundamental questions of the benefits of integration, especially if extensive integration leads into the threat of the loss of identity for primary health care. Discussion This article ends with some lessons to be learned from the situation in Finland for other countries. PMID:19590612
David, H P
Surveying experience with incentives, disincentives, and integrated community development approaches in selected Asian countries, this overview defines concepts, notes policy trends, and discusses ethical and legal constraints, psychosocial and socioeconomic aspects, and cultural-environmental influences on reproductive behavior. Major emphasis is on experience reported from China, India, Indonesia, Korea, Philippines, Singapore, and Thailand. Findings to date suggest that, to be successful, programs using incentives, disincentives, and integrated community development approaches will have to be formulated as consistent, clearly defined, and well-communicated policies, responsive to development needs and sensitive to local autonomy and values, with dynamic leadership to obtain and nurture continued policy backing.
Bosse, Jordon D; Nesteby, J Aleah; Randall, Carla E
The health needs of the lesbian, gay, bisexual, and transgender (LGBT) population are traditionally overlooked by the health care community and are rendered invisible by most nursing school curricula. Initial contact with a nurse during a health history and assessment can have an impact on whether the person will feel comfortable disclosing his or her identity, returning for services, or following plans of care. Because the first interaction with a nurse can be critical, the health assessment course is an appropriate place in the curriculum to discuss the needs of the LGBT community. This article includes a discussion of unique health risks to the LGBT population, benefits, and challenges of incorporating these issues into the classroom and recommendations for including the care of this population into a health assessment nursing course. Specific communication techniques are provided that may be helpful during history taking and physical examination with a patient who is LGBT. Guidance regarding physical examination of the transgender patient is also included. These suggestions will be helpful to nurse faculty who teach health assessment, nursing students, educators who design and implement professional development and continuing education for established nurses, preceptors in the clinical setting, and any nurse who is unfamiliar with the needs and concerns specific to the LGBT population.
Background Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy. Methods A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model. Results The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively. Conclusions Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings. PMID:22276600
The Integrated Health Interview Series (IHIS) is a public data repository that harmonizes four decades of the National Health Interview Survey (NHIS). The NHIS is the premier source of information on the health of the U.S. population. Since 1957 the survey has collected information on health behaviors, health conditions, and health care access. The long running time series of the NHIS is a powerful tool for health research. However, efforts to fully utilize its time span are obstructed by difficult documentation, unstable variable and coding definitions, and non-ignorable sample re-designs. To overcome these hurdles the IHIS, a freely available and web-accessible resource, provides harmonized NHIS data from 1969-2010. This paper describes the challenges of working with the NHIS and how the IHIS reduces such burdens. To demonstrate one potential use of the IHIS we examine utilization patterns in the U.S. from 1972-2008. PMID:22463071
Javalgi, R; Joseph, W B
The authors investigate physicians' attitudes, information-seeking behaviors, and behavioral intentions toward home health care programs. Survey results show that physicians favor the concept, but knowledge and awareness levels about available programs vary with the physicians' specialties. Evidence also is reported on specific problems encountered, sources of information used to make home care referrals, and physicians' perceptions of the impact of home care programs on their practice. Finally, policy implications are drawn for marketers of home health care programs.
Governali, Joseph F.; Hodges, Bonni C.; Videto, Donna M.
School health education has been and still is guided by a number of different and often competing philosophical orientations. The field seems to be moving toward a skills-based philosophy, but the adoption of this approach is taking place with little discussion or analysis in the professional health education literature. The purpose of this…
White-Traut, Rosemary; Emerita; Rankin, Kristin M.; Pham, Thao; Li, Zhuoying; Liu, Li
Preterm infants are challenged by immature infant behavioral organization which may negatively influence their ability to oral feed. The purpose of this study was to determine whether the integrated H-HOPE (Hospital to Home: Optimizing the Infant’s Environment) intervention would improve infant behavioral organization by increasing the frequency of orally directed behaviors and the proportion of time spent in an alert behavioral state when offered prior to oral feeding. Mother–infant dyads (n = 198) were randomly assigned to the H-HOPE intervention or the Attention Control groups. Infants were born at 29 to 34 weeks gestation and were clinically stable. Mothers had at least two social environmental risk factors such as minority status or less than high school education. H-HOPE is an integrated intervention that included (1) twice-daily infant directed stimulation using the ATVV intervention (auditory, tactile, visual, and vestibular stimuli) and (2) maternal participatory guidance sessions by a nurse-community advocate team. Orally directed behaviors and behavioral states were assessed weekly prior to feeding during hospitalization when infants were able to feed orally. There were no differences between the groups at baseline (Day 0, prior to the initiation of the integrated H-HOPE intervention). We observed a pattern of increased frequency of orally directed behaviors in the H-HOPE intervention group when compared to the Attention Control group, however, the proportion of time spent in an alert behavioral state remained stable in both groups over the course of the study. On Day 7, the H-HOPE intervention group exhibited a significantly higher mean frequency of orally directed behaviors than the Attention Control group (12.6 vs. 7.1 pre-intervention, 51.8 vs. 33.2 during intervention, 4.3 vs. 3.2 immediately after intervention, and 8.9 vs. 5.3 immediately prior to feeding). On Day 7, the H-HOPE intervention group exhibited a significantly higher proportion of
Krause, Neal; Hill, Peter C; Emmons, Robert; Pargament, Kenneth I; Ironson, Gail
A growing body of research suggests that people who are more deeply involved in religion may be more likely to adopt beneficial health behaviors. However, religion is a complex phenomenon, and as a result, religion may affect health behaviors in a number of ways. The purpose of the current study was to see whether a sacred view of the body (i.e., belief that the body is the temple of God) is associated with better health behavior. It was proposed that the relationship between a sacred body view and health behavior will emerge only among study participants who have a stronger sense of religiously oriented control (i.e., stronger God-mediated control beliefs). Five positive health behaviors were evaluated: more frequent strenuous exercise, more frequent moderate exercise, more frequent consumption of fruits and vegetables, higher quality sleep, and the adoption of healthy lifestyles. Data from a recent nationwide sample reveal that a sacred body view is associated with each health behavior, but only among study participants who have a strong religiously oriented sense of control.
Chng, Chwee Lye
Approaches for teaching about homosexuality as part of the school health curriculum are offered. Suggestions include discussion of popular values and stereotypes, teaching by example, and teaching through role playing. (JMF)
Decker, P J; Sullivan, E; Moore, R
Behavior modeling is one training method found effective in helping health care managers deal with their day-to-day management problems. This article defines and explains the five basic steps of behavior modeling training, suggests the workshop format as its most effective mode of instruction, and presents examples of successful use of the method.
Littleton, Heather L.; Grills-Taquechel, Amie E.; Buck, Katherine S.; Rosman, Lindsey; Dodd, Julia C.
Sexual assault is associated with a number of health risk behaviors in women. It has been hypothesized that these risk behaviors, such as hazardous drinking, may represent women's attempts to cope with psychological distress, such as symptoms of depression and anxiety. However, extant research has failed to evaluate these relationships among…
German, Pearl S.
Reports that the elderly appear most influenced in health attitudes and behaviors by various factors within the setting so those who identify a major source of care tend to be higher utilizers, do less "shopping-around," and exhibit less negative behaviors such as needing care without seeking it. Discussion of the article follows. (Author)
van Leer, Eva; Hapner, Edie R; Connor, Nadine P
Studies of patient adherence to health behavior programs, such as physical exercise, smoking cessation, and diet, have resulted in the formulation and validation of the Transtheoretical Model (TTM) of behavior change. Although widely accepted as a guide for the development of health behavior interventions, this model has not been applied to vocal rehabilitation. Because resolution of vocal difficulties frequently depends on a patient's ability to make changes in vocal and health behaviors, the TTM may be a useful way to conceptualize voice behavior change processes, including the patient's readiness for change. The purpose of this paper is to apply the TTM to the voice therapy process to: (1) provide an organizing framework for understanding of behavior change in voice therapy, (2) explain how treatment adherence problems can arise, and (3) provide broad strategies to improve treatment adherence. Given the significant role of treatment adherence in treatment outcome, considering readiness for behavior change should be taken into account when planning treatment. Principles of health behavior change can aid speech pathologists in such understanding and estimating readiness for voice therapy.
Barrish, I. J.
Families experiencing severe conflict are often unable to effectively implement applied behavioral procedures due to interfering emotional responses (anger, blaming, anxiety and depression) and behavioral responses (yelling, crying and physical fighting), which often reduce effective implementation of applied behavioral procedures. Specific…
Hester, Nanci Robertson; Macrina, David M.
This study was formulated to examine the contraceptive behavior of college women and to elucidate distinctions between contraceptive users and nonusers. A survey instrument, conceptually and theoretically based in the Health Belief Model, was designed to elicit self-reports of contraceptive behavior. Findings and implications for health education…
Jiang, Feng; Lu, Su; Hou, Yubo; Yue, Xiaodong
The primary purpose of this study was to investigate whether the theory of planned behavior (TPB) mediated the relationship between dialectical thinking and health behaviors. A sample of 285 undergraduates was tested with a dialectical thinking styles scale, health promoting lifestyle profiles, and TPB questionnaires. Structural equation modeling was used for data analysis. Results indicated that all the three dimensions of thinking styles (belief in the connection, acceptance of change, and acceptance of contradiction) exerted significant effects on TPB constructs. Specifically, the connection and the change dimensions had positive effects on health behaviors mediated by TPB, whereas the contradiction dimension had a negative effect. Model 2 showed a satisfactory fit, demonstrating the influential pathways between dialectical thinking and health behaviors. Implications in issues of health promotion and future research are discussed.
Zin, Thi Thi; Tin, Pyke; Hama, Hiromitsu; Toriu, Takashi
In this paper, we propose an integrated framework for detecting suspicious behaviors in video surveillance systems which are established in public places such as railway stations, airports, shopping malls and etc. Especially, people loitering in suspicion, unattended objects left behind and exchanging suspicious objects between persons are common security concerns in airports and other transit scenarios. These involve understanding scene/event, analyzing human movements, recognizing controllable objects, and observing the effect of the human movement on those objects. In the proposed framework, multiple background modeling technique, high level motion feature extraction method and embedded Markov chain models are integrated for detecting suspicious behaviors in real time video surveillance systems. Specifically, the proposed framework employs probability based multiple backgrounds modeling technique to detect moving objects. Then the velocity and distance measures are computed as the high level motion features of the interests. By using an integration of the computed features and the first passage time probabilities of the embedded Markov chain, the suspicious behaviors in video surveillance are analyzed for detecting loitering persons, objects left behind and human interactions such as fighting. The proposed framework has been tested by using standard public datasets and our own video surveillance scenarios.
Diez, Keri S.; Pleban, Francis T.; Wood, Ralph J.
This article discusses the benefits as well as the important considerations that should be taken into account in integrating popular films in health education classes. Use of popular films in the classroom, termed "cinema education," is becoming increasingly popular in teaching health education. As a matter of convenience, popular films are easy…
Patterson, Sheila M.; Graf, Helen M.
Reviews the popularity of complementary and alternative medicine (CAM) approaches in health education, suggesting a proposed CAM course for health education professional preparation and offering a course outline which can be used as a self- standing course or integrated into existing courses. It includes a proposed course description and goals,…
Chafouleas, Sandra M.; Polifroni, E. Carol
This commentary reinforces a call to recognize the need for substantive collaboration, communication, and cooperation across education and health sectors. Themes throughout the body of articles contained in the special issue are discussed as strengthening knowledge about the benefits to integration of education and health domains in prevention and…
This paper intends to present the design and the production of a software for the Occupational Health and Safety Integrated Management System with the view to a rapid drawing up of the system documents in the field of occupational health and safety.
Ell, Kathleen; Oh, Hyunsung; Wu, Shinyi
Objective: Safety net care systems are experiencing unprecedented change from the "Affordable Care Act," Patient-Centered Medical Home (PCMH) uptake, health information technology application, and growing of mental health care integration within primary care. This article provides a review of previous and current efforts in which social…
Cox, Gary; Brandt, Vickie
This report is a comprehensive description of Minnesota's children's mental health system. It is designed to provide background and guidance to the Children's Integrated Fund Task Force, to assist local coordinating councils, and to serve policymakers outside of mental health who are increasingly asked to consider problems from an interagency…
Rose, Theda; Joe, Sean; Shields, Joseph; Caldwell, Cleopatra H.
The influence of family, school, and religious social contexts on the mental health of Black adolescents has been understudied. This study used Durkheim's social integration theory to examine these associations in a nationally representative sample of 1,170 Black adolescents, ages 13-17. Mental health was represented by positive and negative…
Guo, Kristina L
This research develops an integrated systems model of entrepreneurship management as a method for achieving health care organizational survival and growth. Specifically, it analyzes current health care environment challenges, identifies roles of managers and discusses organizational theories that are relevant to the health care environment, outlines the role of entrepreneurship in health care, and describes the entrepreneurial manager in the entrepreneurial management process to produce desirable organizational outcomes. The study concludes that as current health care environment continues to show intense competition, entrepreneurial managers are responsible for creating innovations, managing change, investing in resources, and recognizing opportunities in the environment to increase organizational viability.
Barry, Adam E.; Chaney, Beth H.; Piazza-Gardner, Anna K.; Chavarria, Enmanuel A.
Health education and behavior researchers and practitioners often develop, adapt, or adopt surveys/scales to quantify and measure cognitive, behavioral, emotional, and psychosocial characteristics. To ensure the integrity of data collected from these scales, it is vital that psychometric properties (i.e., validity and reliability) be assessed. The…
Plescia, M; Koontz, S; Laurent, S
OBJECTIVES: In this report, the authors present a representative case of the implementation of community assessment and the subsequent application of findings by a large, vertically integrated health care system. METHODS: Geographic information systems technology was used to access and analyze secondary data for a geographically defined community. Primary data included a community survey and asset maps. RESULTS: In this case presentation, information has been collected on demographics, prevalent health problems, access to health care, citizens' perceptions, and community assets. The assessment has been used to plan services for a new health center and to engage community members in health promotion interventions. CONCLUSIONS: Geographically focused assessments help target specific community needs and promote community participation. This project provides a practical application for integrating aspects of medicine and public health. PMID:11344895
Coll-Black, Sarah; Bhushan, Anjana; Fritsch, Kathleen
Evidence increasingly shows that poverty and gender inequalities are important determinants of health and influence the opportunity for timely and appropriate health care. These findings suggest that health professionals need to have a sound understanding of health inequalities and their causes, as well as of how they can be addressed. However, through surveys to health ministries and educational institutions in 2001, the World Health Organization Regional Office for the Western Pacific found that awareness of, and capacity to respond to, poverty and gender concerns in health was weak. In response, the Regional Office initiated a project to develop materials to support the integration of poverty and gender concerns into health professional education curricula. The multimodule publication, Integrating Poverty and Gender into Health Programmes: A Sourcebook for Health Professionals, supports evidence-based and participatory learning. The experience to date suggests that the publication might be meeting a long-felt need for such a response.
Amaral, Gorette; Geierstanger, Sara; Soleimanpour, Samira; Brindis, Claire
Background: The purpose of this study is to compare the mental health risk profile and health utilization behaviors of adolescent school-based health center (SBHC) users and nonusers and discuss the role that SBHCs can play in addressing adolescent health needs. Methods: The sample included 4640 students in grades 9 and 11 who completed the…
Rumbaugh, Daune M.; Washburn, David A.; Hillix, William A.
A triarchic organization of behavior, building on Skinner's description of respondents and operants, is proposed by introducing a third class of behavior called 'emergents.' Emergents are new responses, never specifically reinforced, that require operations more complex than association. Some of these operations occur naturally only in animals above a minimum level of brain complexity, and are developed in an interaction between treatment and organismic variables. (Here complexity is defined in terms of relative levels of hierarchical integration made possible both by the amount of brain, afforded both by brain-body allometric relationships and by encephalization, and, also, the elaboration of dendritic and synaptic connections within the cortex and connections between various parts/regions of the brain.) Examples of emergents are discussed to advance this triarchic view, of behavior. The prime example is language. This triarchic view reflects both the common goals and the cumulative nature of psychological science.
Lopez-Gonzalez, Lorena; Aravena, Veronica C.; Hummer, Robert A.
Previous research shows that the health behavior of immigrants is favorable to that of native-born adults in the United States. We utilize pooled data from the 1998-2001 National Health Interview Surveys and multinomial logistic regression techniques to build on this literature and examine the association between acculturation and immigrant…
Bakke, Sandra I.
A description is provided of a course, "Behavior of Man in Health and Illness," designed to introduce first-year undergraduate nursing students to the theories and concepts related to the health-illness continuum, the stress of illness, and coping theory. The description begins with an overview of course content, followed by information on the…
Kimbro, Rachel Tolbert
Using Fragile Families and Child Wellbeing Data (N = 4,871), this paper examines why relationship status matters for prenatal health behaviors. The paper argues that a mother's potential investments in her child's health are conditioned by socioeconomic and interpersonal resources, including the quality of her relationship with the child's father.…
Chisolm, Deena J.; Manganello, Jennifer A.; Kelleher, Kelly J.; Marshal, Michael P.
Objective Alcohol expectancies are developed, in part, through exposure to health messages, the understanding of which may be influenced by health literacy. This study explores the relationships among health literacy, alcohol expectancies, and alcohol use behaviors in teens. Methods We studied alcohol use behaviors in the past six months in youths aged 14–19 recruited from two adolescent medicine clinics. We assessed covariate-adjusted bivariate relationships between HL, expectancies, and four measures of alcohol use and tested health literacy as a moderator of the relationship between expectancies and use. Results Of the 293 study teens, 45 percent reported use of alcohol in the past six months. Use behaviors were positively associated with higher health literacy and positive expectancies. Our moderation model suggested that health literacy moderates the relationship between expectancies and use, with the expectancy/use relationship being significantly stronger in higher literacy teens. Conclusion Findings suggest that health literacy can influence alcohol expectancies and behaviors. Practice implications: Health literacy should be explicitly considered in the design of alcohol prevention messages. PMID:25085549
Bazargan, Mohsen; Makar, Marian; Bazargan-Hejazi, Shahrzad; Ani, Chizobam; Wolf, Kenneth E.
Objective: This study examines personal health behaviors and wellness, health-related lifestyles, and prevention screening practices among licensed physicians. Methods: An anonymous questionnaire was mailed to a random sample of 1,875 physicians practicing in California. Data from 763 returned questionnaires (41%) were analyzed. Results: Our data…
Undergraduate students increase their understanding of human geography and become aware of their community's health ecology by examining the degree and geographical pattern of dog-associated health hazards in Athens, Georgia, and by studying the behavioral patterns and attitudes of Athens's residents that might be causally related to these health…
Heiby, Elaine M.
It has become recognized that major health problems are caused, precipitated, exacerbated, or maintained by lifestyle factors such as exercise, diet, and consumption of psychoactive substances. The introduction of complex behavior change into the medical prescription for health promotion and disease prevention has resulted in a large body of…
Sullivan, Claire F.
This semester-long activity requires students to reflect on their own strengths and weaknesses in attempting to take on a personally meaningful health behavior change challenge. This assignment affords them the opportunity to take a deeper look at theory and health concepts learned throughout the semester and to see how it has informed their own…
Zimmer, Michelle; Desch, Larry
Sensory-based therapies are increasingly used by occupational therapists and sometimes by other types of therapists in treatment of children with developmental and behavioral disorders. Sensory-based therapies involve activities that are believed to organize the sensory system by providing vestibular, proprioceptive, auditory, and tactile inputs. Brushes, swings, balls, and other specially designed therapeutic or recreational equipment are used to provide these inputs. However, it is unclear whether children who present with sensory-based problems have an actual "disorder" of the sensory pathways of the brain or whether these deficits are characteristics associated with other developmental and behavioral disorders. Because there is no universally accepted framework for diagnosis, sensory processing disorder generally should not be diagnosed. Other developmental and behavioral disorders must always be considered, and a thorough evaluation should be completed. Difficulty tolerating or processing sensory information is a characteristic that may be seen in many developmental behavioral disorders, including autism spectrum disorders, attention-deficit/hyperactivity disorder, developmental coordination disorders, and childhood anxiety disorders. Occupational therapy with the use of sensory-based therapies may be acceptable as one of the components of a comprehensive treatment plan. However, parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive. Important roles for pediatricians and other clinicians may include discussing these limitations with parents, talking with families about a trial period of sensory integration therapy, and teaching families how to evaluate the effectiveness of a therapy.
Kim, Yong-Chan; Lim, Ji Young; Park, Keeho
This study aimed to examine whether social capital (bonding and bridging social capital) attenuate the effect of low functional health literacy on health information resources, efficacy, and behaviors. In-person interviews were conducted with 1,000 residents in Seoul, Korea, in 2011. The authors found that respondents' functional health literacy had positive effects on the scope of health information sources and health information self-efficacy but not health information-seeking intention. Respondents' social capital had positive effects on the scope of health information sources, health information efficacy, and health information-seeking intention. The authors found (a) a significant moderation effect of bridging social capital on the relation between health literacy and health information self-efficacy and (b) a moderation effect of bonding social capital on the relation between health literacy and health information-seeking intention.
Abood, Doris A.; Conway, Terry L.
Study examined relationships between self-esteem, health values, specific health behaviors, and general practice of wellness behaviors in Navy personnel. Lifestyle surveys indicated health values predicted specific health behaviors and general practice of wellness behaviors. After controlling for health values, self-esteem predicted general…
Li, Jinhui; Theng, Yin-Leng; Foo, Schubert
The Internet has become an important and preferred source of health information. Although the literature has highlighted several key predictors that influence an individual's online health information seeking behavior, insufficient attention has been paid to the changes in the predictors' roles and effects over time. This study explores and compares the effects that specific predictors had on online health information seeking behavior over a period of 10 years by integrating and analyzing two Pew datasets collected in 2002 and 2012. Hierarchical regression analyses indicate that socio-demographic factors and overall health condition are significant predictors that had an increasing impact on online health information seeking behavior. However, the impact of Internet usage decreased significantly from 2002 to 2012. A comparison across time contributes to a vertical understanding of the changes in online health information seeking behavior and its predictors and helps health professionals and researchers tailor their informational interventions to meet the up-to-date needs and preferences of users.
Ribisl, Kurt M.; Leeman, Jennifer; Glasser, Allison M.
The relatively high cost of delivering many public health interventions limits their potential for broad public impact by reducing their likelihood of adoption and maintenance over time. Practitioners identify cost as the primary factor for which interventions they select to implement, but researchers rarely disseminate cost information or consider its importance when developing new interventions. A new approach is proposed, whereby intervention developers assess what individuals and agencies adopting their interventions are willing to pay and then design interventions that are responsive to this price range. The ultimate goal is to develop effective and affordable interventions, called lean interventions, which are widely adopted and have greater public health impact. PMID:24842743
Farhat, Tilda; Iannotti, Ronald J.; Simons-Morton, Bruce
Background The prevalence and severity of obesity have increased among children and adolescents. While the medical and psychosocial consequences of youth obesity have been well-documented, less information exists on the association of overweight/obesity with health risk behaviors, which are considered to be a primary threat to adolescent health. Objectives This study examined the association of overweight and obesity with health-risk behaviors among U.S. youth. Methods Self-reported height and weight, substance use, violence and bullying were assessed in a nationally representative sample of students aged 11 to 17 years (N=7825) who participated in the 2005/6 Health Behaviors in School-Aged Children survey. Data were analyzed in 2009. Results Significant gender and age differences in the relationship of overweight/obesity with risk behaviors were observed. Overweight and obesity were significantly associated with substance use among girls only: frequent smoking and drinking were associated with overweight and obesity among younger girls, whereas they were associated with obesity among older girls. Frequent smoking and cannabis use were associated with overweight among younger girls only. Relationships between violent behavior and overweight/obesity were mainly observed among boys: Younger obese boys were more likely to be victims of bullying, whereas older obese boys were more likely to carry weapons, compared to boys of normal weight. Conclusions Overweight and obese youth are at risk of developing health compromising behaviors which may compound medical and social problems associated with excess weight. PMID:20171527
Hanoch, Yaniv; Finkelstein, Eric Andrew
Introduces the special issue of Health Psychology, entitled Health Psychology Meets Behavioral Economics. Psychologists have long been interested in understanding the processes that underlie health behaviors and, based on health behavior models that they have developed, have devised a spectrum of effective prevention and treatment programs. More recently, behavioral economists have also provided evidence of effective behavior change strategies through nonprice mechanisms in a variety of contexts, including smoking cessation, weight loss, and illicit drug use. Yet, although all are addressing similar issues, surprisingly little cross-fertilization has taken place between traditional economists, behavioral economists, and psychologists. This special issue is rooted in the assumption that collaboration between economists and psychologists can promote the development of new methodologies and encourage exploration of novel solutions to enduring health problems. The hope is that readers will be intrigued and inspired by the methodologies used in the different articles and will explore whether they might be applicable to the problems they are addressing. Collaborative efforts, although challenging and at times risky, are a promising way to produce more innovative studies, results, and interventions.
Cooklin, A; Joss, N; Husser, E; Oldenburg, B
Objective . The study objective was to conduct a systematic review of the effectiveness of integrated workplace interventions that combine health promotion with occupational health and safety. Data Source . Electronic databases (n = 8), including PsychInfo and MEDLINE, were systematically searched. Study Inclusion and Exclusion Criteria . Studies included were those that reported on workplace interventions that met the consensus definition of an "integrated approach," published in English, in the scientific literature since 1990. Data Extraction . Data extracted were occupation, worksite, country, sample size, intervention targets, follow-up period, and results reported. Quality was assessed according to American College of Occupational and Environmental Medicine Practice Guidelines. Data Synthesis . Heterogeneity precluded formal meta-analyses. Results were classified according to the outcome(s) assessed into five categories (health promotion, injury prevention, occupational health and safety management, psychosocial, and return-on-investment). Narrative synthesis of outcomes was performed. Results . A total of 31 eligible studies were identified; 23 (74%) were (quasi-)experimental trials. Effective interventions were most of those aimed at improving employee physical or mental health. Less consistent results were reported from integrated interventions targeting occupational health and safety management, injury prevention, or organizational cost savings. Conclusion . Integrated approaches have been posed as comprehensive solutions to complex issues. Empirical evidence, while still emerging, provides some support for this. Continuing investment in, and evaluation of, integrated approaches are worthwhile.
Centers for Disease Control and Prevention, 2011
The national Youth Risk Behavior Survey (YRBS) monitors priority health risk behaviors that contribute to the leading causes of death, disability, and social problems among youth and adults in the United States. The national YRBS is conducted every two years during the spring semester and provides data representative of 9th through 12th grade…
Hoge, Michael A; Morris, John A; Stuart, Gail W; Huey, Leighton Y; Bergeson, Sue; Flaherty, Michael T; Morgan, Oscar; Peterson, Janice; Daniels, Allen S; Paris, Manuel; Madenwald, Kappy
Across all sectors of the behavioral health field there has been growing concern about a workforce crisis. Difficulties encompass the recruitment and retention of staff and the delivery of accessible and effective training in both initial, preservice training and continuing education settings. Concern about the crisis led to a multiphased, cross-sector collaboration known as the Annapolis Coalition on the Behavioral Health Workforce. With support from the Substance Abuse and Mental Health Services Administration, this public-private partnership crafted An Action Plan for Behavioral Health Workforce Development. Created with input from a dozen expert panels, the action plan outlines seven core strategic goals that are relevant to all sectors of the behavioral health field: expand the role of consumers and their families in the workforce, expand the role of communities in promoting behavioral health and wellness, use systematic recruitment and retention strategies, improve training and education, foster leadership development, enhance infrastructure to support workforce development, and implement a national research and evaluation agenda. Detailed implementation tables identify the action steps for diverse groups and organizations to take in order to achieve these goals. The action plan serves as a call to action and is being used to guide workforce initiatives across the nation.
Venkatesh, Meera; Kapadia, Ravi; Walker, Mark; Wilkins, Kim
A framework of software components has been implemented to facilitate the development of ISHM systems according to a methodology based on Reliability Centered Maintenance (RCM). This framework is collectively referred to as the Toolkit and was developed using General Atomics' Health MAP (TM) technology. The toolkit is intended to provide assistance to software developers of mission-critical system health monitoring applications in the specification, implementation, configuration, and deployment of such applications. In addition to software tools designed to facilitate these objectives, the toolkit also provides direction to software developers in accordance with an ISHM specification and development methodology. The development tools are based on an RCM approach for the development of ISHM systems. This approach focuses on defining, detecting, and predicting the likelihood of system functional failures and their undesirable consequences.
Hou, Su-I; Charlery, Su-Anne Robyn; Roberson, Kiersten
Purpose: This review examines Internet interventions aiming to change health behaviors in the general population. Methods: Internet health interventions in the USA published between January 2005 and December 2013 were identified through Medline and CINAHL. Keywords used were (Internet or e-health or social media or web) paired with (intervention or program*). A total of 38 articles met all criteria and were reviewed. Results: Studies were analyzed by targeted health behavior interventions: tobacco (5), alcohol (4), weight loss (7), physical activity (PA) (7), nutrition (2), PA and nutrition combined (5), HIV or sexual health (4), and chronic diseases (4). Interventions ranged from one session to 24 weeks (average 6–12 weeks). Common strategies used, including web-based information, tailored feedback, weekly e-mails, goal setting, and self-assessment. Social cognitive theory and the transtheoretical models were the most commonly used frameworks. Recruitment strategies were typically media based varied by settings and populations. Except for the tobacco interventions, the majority studies yielded significant outcomes. Conclusion: This review provides updates and synthesized knowledge on the design and consistent effectiveness of Internet interventions across health behaviors. Results have implications for public health and healthcare professionals, as they play a key role in developing and delivering health promotion interventions as well as in assisting the communities and clients serviced obtaining evidence-based health information. PMID:25750795
Berman, E M; Shimshony, A
The control of foodborne diseases from an animal source has become an important part of public health policy. Since the agents that cause these diseases originate in animals, Veterinary Services, as well as Public Health Services, must be involved in their control. Control programmes should be established either through cooperation between the two Services or by the consolidation of all those involved into a single food control agency. Surveillance is an important part of these control programmes. The following questions must be addressed when planning an effective surveillance programme. What is the relative incidence, morbidity, mortality and economic cost of the foodborne disease in humans? Is the animal population the exclusive or a significant source of the human foodborne infection? What kind of surveillance is needed to identify the disease-causing agent in the animal population? Are we interested in identifying all cases of a disease in order to eradicate it or is our aim to reduce its incidence in the animal population? Do we have the ability to control the disease in the animal population? What disease detection tests are available? What are the sensitivity, specificity and cost of these diagnostic tests? Finally, does the country, region or agency involved have the legal, financial and educational resources to carry out this surveillance and follow it up with appropriate action? After these questions have been resolved,the veterinary and public health sectors must jointly decide if surveillance and control are feasible. If so, they can then begin to develop an appropriate programme.
Alcaraz, Kassandra I; Sly, Jamilia; Ashing, Kimlin; Fleisher, Linda; Gil-Rivas, Virginia; Ford, Sabrina; Yi, Jean C; Lu, Qian; Meade, Cathy D; Menon, Usha; Gwede, Clement K
Health disparities persist despite ongoing efforts. Given the United States' rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the ConNECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT's five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice.
Patterson, Chris; Arthur, Heather M.
Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM) in many countries without the health care infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative health care teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary health care agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a) professional and research development, b) health human resource planning, c) regulation and legislation and d) practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in health care; a culturally sensitive health care system and a broader spectrum of services for achieving public health goals. PMID:21614155
Kinchin, Irina; Tsey, Komla; Heyeres, Marion; Cadet-James, Yvonne
Quality mental health care is based on the integration of care across organisations and disciplines. The aims of this study were, first, to assess the extent, characteristics and reported outcomes of publications concerned with youth mental health service integration in Australia and internationally; and second, to investigate the study design quality of evaluative interventions and determine whether the studies report on the cost-effectiveness of the integration in order to inform the reform of youth mental health services by Queensland Health. A systematic search of the peer-reviewed literature and a narrative synthesis were undertaken of English language publications from 21 electronic databases. Inclusion criteria were: published 1998-2014 (inclusive); peer-reviewed research; focused on mental health services integration; reported data for youth aged 12-25 years. The methodological quality of evaluative interventions was assessed using the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project (EPHPP). Twenty-five studies met the inclusion criteria: one (4%) was classified as a measurement research, 13 (52%) as descriptive, and 11 (44%) as interventions including five (45%) evaluative interventions. Four out of the five evaluative interventions reported positive effects of youth mental health service integration. Particular problems included ambiguity of definitions, absence of economic or cost analyses and insufficient consumer involvement. The methodological quality of the interventions was variable with, on average, a moderate level of selection bias and study design. Despite a slight increase in the number of studies in the last couple of years, there are important gaps in the evidence base for youth mental health service integration processes. The relatively small number of evaluative studies and lack of economic evaluations point to the need for additional research in this important area.
Saeed, Bashiru I. I.; Abdul-Aziz, A. R.; Nguah, Samuel Blay; Zhao, Xicang
The article here investigated the impact of Preventive Health Behaviors and Risk Factors as measures of Health Status of Ghanaians. We carry out a cross-sectional analysis of 5573 adults who participated and had indicated that they needed to state their health description in the three years prior to the phase 2007 World Health Organization, a study on Global Ageing and Adult health (SAGE) conducted in Ghana. The ordinal logistic regression model was employed for analysis using R. The results suggest that, there is incontrovertible evidence showing a strong relationship between preventive health behaviors and health status of Ghanaians. Again, the lifestyle of Ghanaians clearly manifests in their positive correlation with the good and moderate health state due to the high percentage (38.96% and 39.04%) respectively. The outcome points to a potential link with the Ghanaian social and health policies. PMID:23985114
De Luca, Susan M; Franklin, Cynthia; Yueqi, Yan; Johnson, Shannon; Brownson, Chris
The impact of suicidal ideation on college students' academic performance has yet to be examined, yet mental health is often linked with academic performance. Underclassmen and upperclassmen were compared on behavioral health outcomes related to academic success (N = 26,457). Ideation (b = -0.05, p < .05), increased mental health (b = -0.03, p < .01) or substance use severity (b = -0.02, p < .01) was associated with lower GPAs. Underclassmen's behavioral health severity was related to lower GPA. Students reported higher GPAs when participating in extracurricular activities during the past year. Ideation, beyond mental health, is an important when assessing academic performance. Increasing students' connections benefits students experiencing behavioral concerns but also aids in suicide prevention initiatives and improves academic outcomes. Creating integrated health care systems on campus where physical, mental health and academic support services is crucial to offer solutions for students with severe or co-morbid mental health histories.
The widespread adoption of electronic health records (EHRs) is a public policy strategy to improve healthcare quality and reduce accelerating health care costs. Much research has focused on medical providers' perceptions of EHRs, but little is known about those of behavioral health providers. This research was informed by the theory of reasoned…
Calvert, Wilma J.; Isaac,, E. Paulette; Johnson, Sharon
This study examined the health-related quality of life and health-promoting behaviors in a convenience sample of low-income black men. Almost three-fourths reported their overall health as good or better. However, the mean number of recent (that is, past 30 days) mentally unhealthy days was 13.12, and more than half reported frequent (greater than…
Jones, Emily; Ku, Leighton; Smith, Shelagh; Lardiere, Michael
This study describes on-site behavioral health treatment capacity in health centers in 2007 and examines whether capacity was associated with health center characteristics, county-level behavioral health workforce, and same-day billing restrictions. Cross-sectional data from the 2007 Area Resource File and Uniform Data System were linked with data on Medicaid same-day billing restrictions. Mental health treatment capacity was common; almost four in five health centers provided on-site mental health services. Additional services such as crisis counseling (20 %), treatment from a psychiatrist (29 %), and substance abuse treatment were offered by fewer health centers (51 % provide on-site services and only 20 % employ substance abuse specialists). In multivariate analysis, larger health centers, health centers located in counties with a larger behavioral health workforce per capita, and those located in the West and Northeast were more likely to have behavioral health capacity. Same-day billing restrictions were associated with lower odds of substance use treatment capacity and providing 24 hr crisis counseling services.
White, Sabina; Park, Yong S.; Israel, Tania; Cordero, Elizabeth D.
Objective: The authors investigated the longitudinal impact of peer health education on the health behaviors of undergraduate students pertaining to alcohol and drug use, eating and nutrition, and sexual health. Participants: From fall 2003 to spring 2006, the authors annually administered a Web-based survey to a cohort of 2,000 randomly selected…
This article discusses factors that affect the well-being and health of female children in India: sex ratio, literacy, food intake, morbidity, mortality, early marriage, maternal mortality, nutrition, prenatal care and delivery, family planning responsibilities, and access to health services. India has recognized within its Constitution and other government documents and programs equality for women, but practices lag behind principles. A National Action Plan was formulated for the period 1991-2000 for the girl child. Women themselves must change their attitudes about themselves and their female children. Several pilot programs have demonstrated the potential to empower girls to be outspoken, vocal, and enthusiastic. Girls in India are disadvantaged even before their birth. Patriarchal norms reinforce the view of girls as a bad investment. Women are blamed for not bearing a son, despite the evidence that males carry the deciding gender-specific chromosome. Tamil Nadu districts are known for their female infanticide. The declining sex ratio is attributed to the higher death rate among females younger than 35 years. Females until recently had a lower life expectancy than males. Sex ratios vary between states. The only state with a positive female sex ratio is Kerala. Males outnumber females by almost 10% in most of the northern and eastern states. Illiteracy among women is high in about 100 districts. Female school enrollment is 50% less than male enrollment. Females suffer from higher rates of malnutrition, morbidity, and death. Girls' adolescent growth spurt is delayed until 18 years. Maternal mortality accounts for the largest proportion of deaths among women of reproductive age. The most common reason for abortion is "too many children." Lower socioeconomic status is associated with lower nutrition. Women do not have control over their fertility. Women are limited in their access to reproductive health care.
... HUMAN SERVICES Advisory Group on Prevention, Health Promotion, and Integrative and Public Health; Notice... for the Advisory Group on Prevention, Health Promotion, and Integrative and Public ] Health (the... Prevention, Health Promotion and Public Health (the ``Council''). The Advisory Group shall provide...
investigator(s) adhered to current guidelines promulgated by the National Institutes of Health. In the conduct of research utilizing recombinant DNA, the...investigator(s) adhered to the NIH Guidelines for Research Involving Recombinant DNA Molecules. In the conduct of research involving hazardous... Drug and Alcohol Abuse. Portions of this paper appeared in an earlier form in F.H. Gabbay, R.J. Ursano, A.E. Norwood, C.S. Fullerton, and C.C. Duncan
Schnell, Bettina; Weir, Peter T; Roth, Eatai; Fairhall, Adrienne L; Dickinson, Michael H
Sensory feedback is a ubiquitous feature of guidance systems in both animals and engineered vehicles. For example, a common strategy for moving along a straight path is to turn such that the measured rate of rotation is zero. This task can be accomplished by using a feedback signal that is proportional to the instantaneous value of the measured sensory signal. In such a system, the addition of an integral term depending on past values of the sensory input is needed to eliminate steady-state error [proportional-integral (PI) control]. However, the means by which nervous systems implement such a computation are poorly understood. Here, we show that the optomotor responses of flying Drosophila follow a time course consistent with temporal integration of horizontal motion input. To investigate the cellular basis of this effect, we performed whole-cell patch-clamp recordings from the set of identified visual interneurons [horizontal system (HS) cells] thought to control this reflex during tethered flight. At high stimulus speeds, HS cells exhibit steady-state responses during flight that are absent during quiescence, a state-dependent difference in physiology that is explained by changes in their presynaptic inputs. However, even during flight, the membrane potential of the large-field interneurons exhibits no evidence for integration that could explain the behavioral responses. However, using a genetically encoded indicator, we found that calcium accumulates in the terminals of the interneurons along a time course consistent with the behavior and propose that this accumulation provides a mechanism for temporal integration of sensory feedback consistent with PI control.
Norton, Julie L; Raciti, Maria M
Primary caregivers of very young children are subject to excessive and often disparate information regarding the instilling of healthful eating behaviors. Our study focuses on the integration of the operant resources of primary caregivers (i.e., their knowledge and modeling skills) and that of their very young children (i.e., their self-regulation of energy intake and food preferences) to co-create healthful eating behaviors as a measure to curb overweight and obesity in adulthood. Our two-stage qualitative study makes original contributions demonstrating that primary caregivers' efforts to co-create healthful eating behaviors with their very young children are adversely affected by information overload.
Ervin, David A.; Williams, Ashley; Merrick, Joav
Introduction: There are multiple ways to address the mental and behavioral health needs of people with intellectual and developmental disabilities (IDD). Method: In this paper, we do not argue for a particular approach or set of approaches, but instead review the benefits of integrating mental and behavioral health supports with primary healthcare based primarily on our experience in and understanding of healthcare systems in the United States. It is estimated that between 35 and 40% of people with IDD also live with psychiatric disorders. NADD, an association for persons with developmental disabilities and mental health needs in the US holds that coexisting IDD and a psychiatric disorder interferes with a person’s education and job readiness, and disrupts family and peer relationships. Historically, the presence of such disorders among people with IDD was not well understood or was discounted altogether. Conclusion: Over the past 15 years, however, greater attention is being paid to these comorbidities and their treatment, including the need to integrate mental and behavioral health treatments into primary care. Healthcare must account for multiple domains of quality of life, going beyond yearly physicals, and acute care visits, for example, to assess individuals’ healthcare goals and support them in achieving those goals. While integrated healthcare delivery systems can be difficult to find and access for people with IDD, such approaches are more responsive to the comprehensive needs and desires of people with IDD. PMID:25072047
Satyanarayana, Veena A.; Lukose, Ammu; Srinivasan, K.
Maternal mental health research is a public health priority due to its impact on both maternal and child health. Despite the growing number of empirical studies in this area, particularly from developing countries, there is a paucity of synthetic review articles. Therefore, attempting to synthesize the existing literature in this area seems relevant to appraise the readers of the field's progress and to infer directions for future research. The present review aims to provide an overview of the literature on maternal mental health and its association with birth outcomes and child behavior. Specifically, the literature on mental health during pregnancy and in the postpartum period and its influence on birth outcomes and child behavior have been reviewed. Further, a conceptual and methodological evaluation of the existing literature has been provided to identify gaps in the literature and to suggest directions for future research. PMID:22303046
Crosnoe, Robert; McNeely, Clea
Peer relations are central to adolescent life and, therefore, are crucial to understanding adolescents' engagement in various behaviors. In recent years, public health research has increasingly devoted attention to the implications of peer relations for the kinds of adolescent behaviors that have a direct impact on health. This article advocates for a continuation of this trend. With this aim, we highlight key themes in the rich literature on the general developmental significance of adolescent-peer relations, provide an overview of how these themes have been incorporated into public health research and practice, and suggest future avenues for peer-focused public health research that can inform adolescent health promotion in the United States.
Knowlden, Adam P; Sharma, Manoj; Nahar, Vinayak K
The purpose of this article was to use the multitheory model of health behavior change in predicting adequate sleep behavior in college students. A valid and reliable survey was administered in a cross-sectional design (n = 151). For initiation of adequate sleep behavior, the construct of behavioral confidence (P < .001) was found to be significant and accounted for 24.4% of the variance. For sustenance of adequate sleep behavior, changes in social environment (P < .02), emotional transformation (P < .001), and practice for change (P < .001) were significant and accounted for 34.2% of the variance.
Rise, J; Wold, B; Aarö, L E
As part of the comprehensive study "Health Behavior in Schoolchildren. A WHO Cross National Survey", this paper set out to identify determinants of four dental health behavioral dimensions in Finnish, Norwegian, and Swedish schoolchildren aged 11, 13, and 15. The data were collected by means of self-administered questionnaires, and the results are considered to be representative of each country. The total sample size approximated 3000 pupils in each country. The four dependent variables, fluoride, interdental cleaning, sugar, and brushing behavior, were all based upon sum-scores of several questions, and were subsequently regressed upon five predictors: school achievement, sex, time spent with friends, educational plans, and family meal pattern. This model provided a far better fit to the data on sugar and brushing behavior than to fluoride and interdental cleaning behavior. However, brushing seems to be different from sugar behavior, being influenced by different factors. While brushing is closely linked to the prevailing sex-role pattern, sugar behavior is stronger related to peer group norms. Thus, the symbolic function of sweet consumption of the youth culture should have implications for the design of intervention strategies. For example, the provision of alternative behaviors will only be successful if the behaviors serve the same function as sugar consumption.
Background Recent studies show several health-related behaviors to cluster in adolescents. This has important implications for public health. Interrelated behaviors have been shown to be most effectively targeted by multimodal interventions addressing wider-ranging improvements in lifestyle instead of via separate interventions targeting individual behaviors. However, few previous studies have taken into account a broad, multi-disciplinary range of health-related behaviors and connected these behavioral patterns to health-related outcomes. This paper presents an analysis of the clustering of a broad range of health-related behaviors with relevant demographic factors and several health-related outcomes in adolescents. Methods Self-report questionnaire data were collected from a sample of 2,690 Dutch high school adolescents. Behavioral patterns were deducted via Principal Components Analysis. Subsequently a Two-Step Cluster Analysis was used to identify groups of adolescents with similar behavioral patterns and health-related outcomes. Results Four distinct behavioral patterns describe the analyzed individual behaviors: 1- risk-prone behavior, 2- bully behavior, 3- problematic screen time use, and 4- sedentary behavior. Subsequent cluster analysis identified four clusters of adolescents. Multi-problem behavior was associated with problematic physical and psychosocial health outcomes, as opposed to those exerting relatively few unhealthy behaviors. These associations were relatively independent of demographics such as ethnicity, gender and socio-economic status. Conclusions The results show that health-related behaviors tend to cluster, indicating that specific behavioral patterns underlie individual health behaviors. In addition, specific patterns of health-related behaviors were associated with specific health outcomes and demographic factors. In general, unhealthy behavior on account of multiple health-related behaviors was associated with both poor psychosocial
Oh, Kyeung Mi; Kreps, Gary L; Jun, Jungmi; Chong, Elizabeth; Ramsey, Lolita
Many Korean Americans suffer from high levels of cancer incidence and have low cancer screening rates. A significant number of Korean Americans lack adequate information about cancer screening tests. However, little is known about their health behaviors. This article examines exposure to mass media and health information-seeking behaviors for Korean Americans, and their associations with demographic characteristics influencing variations in exposure to the different health information and trust in health information sources. The authors gathered data for this study using a cross-sectional, community-based survey conducted in the Washington, DC, metropolitan area during 2006 and 2007. It was administered to 254 Korean Americans who were 40 years of age or older. This study is part of the first health-related program of research to study exposure to mass media, health and cancer information sources, and seeking preferences and experiences of Korean Americans. Results indicated that Korean ethnic media sources and Internet are important sources used regularly. Age, years of education completed, and English proficiency levels for Korean Americans significantly predicted the likelihood of their Internet use. Low-income Korean Americans with less education were more likely to seek health information in Korean ethnic magazines and newspapers, whereas Korean Americans with higher education and English proficiency were more likely to seek information online. The most trusted source of health information among respondents was from a doctor or other health care professional. Future research should be conducted to determine whether physicians are actually used as a primary source for health information.
Summary Background Persons with an optimistic attitude do not give up despite obstacles and failures. Optimistic athletes compete more out of hope for success than out of fear of defeat. The purpose of my research was to determine if optimism also promotes good health behavior in athletes. Material/Methods In order to measure the role of optimism in shaping the health behavior of athletes, I examined a group of women (N=147) and men (N=385) who were currently in training for athletic competition. The control group consisted of women (N=262) and men (N=435) who were not and had never been competitive athletes. The “O-P” Attitude Questionnaire was used to measure optimism, while health behavior was measured with the Juczynski Health Behavior Inventory, which measures proper nutrition habits, preventive behavior, positive attitude, and healthy practices. Results The level of pessimism in these athletes was average. The female athletes were less pessimistic than the female controls. A similar, highly significant difference occurred between the male athletes and non-athletes. Gender did not differentiate the level of optimism in either group. Among the women, optimism correlated with healthy practices, such as daily sleep and recreation habits, or physical activity. The greater the pessimism increased, positive attitudes declined in the female controls, the female athletes, and the male controls. Conclusions The athletes displayed greater optimism than the controls. Among the women, optimism correlated with good health practices. PMID:22207118
Hill, Jeffrey V; Brown, Mark C; Diebold, Carroll J; Borders, Michael A; Staudenmeier, James; Detwiler, Howard F; Francis, Dave B
The changing role of the military presents a unique challenge for military behavioral health organizations in dealing with the geographic isolation of personnel. Telemedical solutions should help to meet this challenge. In the behavioral health arena, there are many uses for videoconferencing and other communications technology in maintaining continuity when patients or clinicians travel or deploy; assisting isolated behavioral health-care providers and general practitioners; evaluating and treating isolated military personnel; and addressing family issues. Family interventions by videoconference and other communications technology may be particularly useful in treating military personnel and in promoting morale of the fighting force. Although much remains to be researched and proven empirically, anecdotal experience supports the utility of using communications technology to enhance behavioral health interventions. This article describes the clinical videoconference experience within the Department of Psychiatry at Tripler Army Medical Center (TAMC), during a Multinational force deployment to the Sinai, and during training at the Joint Readiness Training Center, Fort Polk, Louisiana. A brief discussion of potential legal issues involving videoconferencing in behavioral health is also included.
Thompson, Michael; Checkley, Joseph
Consumer-driven health care is a misnomer. Notwithstanding the enormous role the individual consumer has to play in reshaping the U.S. health care delivery system, this article will focus on the employer as the key driver of change and innovation in the consumerism revolution. American Standard provides a case study of how one major employer has evaluated health care in the context of its business and aggressively integrated consumerism and health into the core of its business. Other companies will appropriately execute consumerism strategies in a fashion consistent with their own needs, culture, resources and populations. However, the principles supporting those strategies will be very much consistent.
Darden, Michael; Gilleskie, Donna
An important avenue for smoking deterrence may be through familial ties if adult smokers respond to parental health shocks. In this paper, we merge the Original Cohort and the Offspring Cohort of the Framingham Heart Study to study how adult offspring smoking behavior and subjective health assessments vary with elder parent smoking behavior and health outcomes. These data allow us to model the smoking behavior of adult offspring over a 30-year period contemporaneously with parental behaviors and outcomes. We find strong 'like father, like son' and 'like mother, like daughter' correlations in smoking behavior. We find that adult offspring significantly curtail their own smoking following an own health shock; however, we find limited evidence that offspring smoking behavior is sensitive to parent health, with the notable exception that women significantly reduce both their smoking participation and intensity following a smoking-related cardiovascular event of a parent. We also model the subjective health assessment of adult offspring as a function of parent health, and we find that women report significantly worse health following the smoking-related death of a parent. Copyright © 2015 John Wiley & Sons, Ltd.
Oliff, Monique; Mayaud, Philippe; Brugha, Ruairí; Semakafu, Ave Maria
Universal access to comprehensive reproductive health services, integrated into a well-functioning health system, remains an unfulfilled objective in many countries. In 2000-2001, in Tanzania, in-depth interviews were conducted with central level stakeholders and focus group discussions held with health management staff in three regional and nine district health offices, to assess progress in the integration of reproductive health services. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support and lack of linkages with the Health Sector Reform Secretariat. Among reproductive health programmes, sexually transmitted infection (STI) control alone retained its vertical planning, management and implementation structures. District-level respondents expressed frustration in their efforts to coordinate STI service delivery with other, more integrated programmes. They reported contradictory directives and poor communication channels with higher levels of the Ministry of Health; lack of technical skills at district level to undertake supervision of integrated services; low morale due to low salaries; and lack of district autonomy in decision-making. Integration requires a coherent policy environment. The uncoordinated and conflicting agendas of donors, on whom Tanzania is too heavily reliant, is a major obstacle.
Shibata, Ai; Ishii, Kaori; Oka, Koichiro
Background In the rapidly developing use of the Internet in society, eHealth literacy—having the skills to utilize health information on the Internet—has become an important prerequisite for promoting healthy behavior. However, little is known about whether eHealth literacy is associated with health behavior in a representative sample of adult Internet users. Objective The aim of this study was to examine the association between eHealth literacy and general health behavior (cigarette smoking, physical exercise, alcohol consumption, sleeping hours, eating breakfast, eating between meals, and balanced nutrition) among adult Internet users in Japan. Methods The participants were recruited among registrants of a Japanese Internet research service company and asked to answer a cross-sectional Internet-based survey in 2012. The potential respondents (N=10,178) were randomly and blindly invited via email from the registrants in accordance with the set sample size and other attributes. eHealth literacy was assessed using the Japanese version of the eHealth Literacy Scale. The self-reported health behaviors investigated included never smoking cigarettes, physical exercise, alcohol consumption, sleeping hours, eating breakfast, not eating between meals, and balanced nutrition. We obtained details of sociodemographic attributes (sex, age, marital status, educational attainment, and household income level) and frequency of conducting Internet searches. To determine the association of each health behavior with eHealth literacy, we performed a logistic regression analysis; we adjusted for sociodemographic attributes and frequency of Internet searching as well as for other health behaviors that were statistically significant with respect to eHealth literacy in univariate analyses. Results We analyzed the data of 2115 adults (response rate: 24.04%, 2142/10,178; male: 49.74%, 1052/2115; age: mean 39.7, SD 10.9 years) who responded to the survey. Logistic regression analysis
Peltzer, Karl; Pengpid, Supa; Yung, Tony K C; Aounallah-Skhiri, Hajer; Rehman, Rehana
This study determines the differences in health risk behavior, knowledge, and health benefit beliefs between health science and non-health science university students in 17 low and middle income countries. Anonymous questionnaire data were collected in a cross-sectional survey of 13,042 undergraduate university students (4,981 health science and 8,061 non-health science students) from 17 universities in 17 countries across Asia, Africa, and the Americas. Results indicate that overall, health science students had the same mean number of health risk behaviors as non-health science university students. Regarding addictive risk behavior, fewer health science students used tobacco, were binge drinkers, or gambled once a week or more. Health science students also had a greater awareness of health behavior risks (5.5) than non-health science students (4.6). Linear regression analysis found a strong association with poor or weak health benefit beliefs and the health risk behavior index. There was no association between risk awareness and health risk behavior among health science students and an inverse association among non-health science students.
Vo, Holly; Cheng, Diana; Cheng, Tina L; Mistry, Kamila B
Objective To describe associated perinatal behaviors among women using fertility treatment. Methods Data were obtained for 12,197 Maryland women who delivered live neonates from 2004 to 2011 and completed the Pregnancy Risk Assessment Monitoring System survey postpartum. We conducted weighted descriptive and multivariable analyses. Results Among 1368 women using fertility treatments, 28.4 % did not take folic acid daily 1 month before pregnancy, 58.1 % consumed alcohol, 16.0 % were binge drinking, and 7.5 % smoked 3 months before pregnancy, and 12.9 % consumed alcohol and 3.7 % smoked during pregnancy. Additionally, among those who consumed alcohol and smoked before pregnancy, 36.0 % and 25.7 %, respectively, reported not receiving prenatal counseling about alcohol use and smoking. Lack of counseling for these women was higher than for women with unintended pregnancies who consumed alcohol (36.0 % vs. 26.3 %, P < .001) or smoked (25.7 % vs. 15.0 %, P < .001). Women using fertility treatments were less likely to have inadequate folic acid intake [adjusted odds ratio (aOR) 0.14, 95 % confidence interval (CI) 0.10-0.18), consume alcohol (aOR 0.52, 95 % CI 0.40-0.69), and smoke (aOR 0.35, 95 % CI 0.21-0.59) before pregnancy, and no statistically significant differences were found during pregnancy for alcohol consumption (aOR 0.89, 95 % CI 0.59-1.33) or smoking (aOR 0.64, 95 % CI 0.28-1.45) compared to women with unintended pregnancies. Conclusion A significant proportion of women using fertility treatments were not practicing recommended perinatal behaviors or receiving prenatal counseling on preventable risk factors. Ongoing counseling before and during pregnancy may be especially effective for optimizing healthy behaviors among these motivated women undergoing often stressful treatments for fertility.
Bhatia, Rajiv; Wernham, Aaron
Objectives The National Environmental Policy Act and related state laws require many public agencies to analyze and disclose potentially significant environmental effects of agency actions, including effects on human health. In this paper we review the purpose and procedures of environmental impact assessment (EIA), existing regulatory requirements for health effects analysis, and potential barriers to and opportunities for improving integration of human health concerns within the EIA process. Data sources We use statutes, regulations, guidelines, court opinions, and empirical research on EIA along with recent case examples of integrated health impact assessment (HIA)/EIA at both the state and federal level. Data synthesis We extract lessons and recommendations for integrated HIA/EIA practice from both existing practices as well as case studies. Conclusions The case studies demonstrate the adequacy, scope, and power of existing statutory requirements for health analysis within EIA. The following support the success of integrated HIA/EIA: a proponent recognizing EIA as an available regulatory strategy for public health; the openness of the agency conducting the EIA; involvement of public health institutions; and complementary objectives among community stakeholders and health practitioners. We recommend greater collaboration among institutions responsible for EIA, public health institutions, and affected stakeholders along with guidance, resources, and training for integrated HIA/EIA practice. PMID:18709140
Clinical trials of investigational drugs and devices are often conducted within healthcare facilities concurrently with clinical care. With implementation of electronic health records, new communication methods are required to notify nonresearch clinicians of research participation. This article reviews clinical research source documentation, the electronic health record and the medical record, areas in which the research record and electronic health record overlap, and implications for the research nurse coordinator in documentation of the care of the patient/subject. Incorporation of clinical research documentation in the electronic health record will lead to a more complete patient/subject medical record in compliance with both research and medical records regulations. A literature search provided little information about the inclusion of clinical research documentation within the electronic health record. Although regulations and guidelines define both source documentation and the medical record, integration of research documentation in the electronic health record is not clearly defined. At minimum, the signed informed consent(s), investigational drug or device usage, and research team contact information should be documented within the electronic health record. Institutional policies should define a standardized process for this integration in the absence federal guidance. Nurses coordinating clinical trials are in an ideal position to define this integration.
Arcury, T A; Quandt, S A; Bell, R A
Beliefs about what constitutes health promoting behaviors vary by culture and class, and knowing how an older adult interprets a specific health behavior can improve health education and medical compliance. Ethnomedical approaches have investigated how people define disease and the therapies used to return to a state of health. However, little research has addressed how individuals define health, or the behaviors they use to maintain health. We analyze the behaviors elders state are needed to stay healthy, and their meanings for these behaviors. Narratives collected through in-depth interviews with 145 male and female rural North Carolina residents aged 70 and older, including African Americans, Native Americans and European Americans are analyzed using systematic text analysis. The participants' narratives include seven salient health maintenance domains: (1) Eating Right, (2) Drinking Water, (3) "Taking" Exercise, (4) Staying Busy, (5) Being with People, (6) Trusting in God and Participating in Church, and (7) Taking Care of Yourself. Several of these domains are multi-dimensional in the meanings the elders ascribe to them. There is also overlap in the content of some of the domains; they are not discrete in the minds of the elders and a specific health behavior can reflect more than one domain. Four themes cross-cut the domains: "balance and moderation", "the holistic view of health", "social integration", and "personal responsibility". Elders in these rural communities hold a definition of health that overlaps with, but is not synonymous with a biomedical model. These elders' concept of health seamlessly integrates physical, mental, spiritual, and social aspects of health, reflecting how health is embedded in the everyday experience of these elders. Staying healthy is maintaining the ability to function in a community. These results indicate that providers cannot assume that older patients will share their interpretation of general health promotion advice.
This article first illustrates the EU and national regulatory frameworks related to policies and integrated actions for health and environmental protection, with particular reference to evaluation of the impact of the environment on health, then provides definitions of "evaluation of health impact" and of "environmental epidemiology" and provides synthetic proposals on procedures and operational levels (national, regional and local). Finally, the responsibilities of regional and local government bodies in supporting ARPA, Departments of Prevention of local health departments and physicians.
Background Health behaviors are a key determinant of health and well-being that are influenced by the nature of the social environment. This study examined associations between social relationships and health-related behaviors among a nationally representative sample of older people. Methods We analyzed data from three waves (1999–2004) of the US National Health and Nutrition Examination Survey (NHANES). Participants were 4,014 older Americans aged 60 and over. Log-binomial regression models estimated prevalence ratios (PR) for the associations between social relationships and each of the following health behaviors: alcohol use, smoking, physical activity and dental attendance. Results Health-compromising behaviors (smoking, heavy drinking and less frequent dental visits) were related to marital status, while physical activity, a health-promoting behavior, was associated with the size of friendship networks. Smoking was more common among divorced/separated (PR = 2.1; 95% CI: 1.6, 2.7) and widowed (PR = 1.7; 95% CI: 1.3, 2.3) respondents than among those married or cohabiting, after adjusting for socio-demographic background. Heavy drinking was 2.6 times more common among divorced/separated and 1.7 times more common among widowed men compared to married/cohabiting men, while there was no such association among women. For women, heavy drinking was associated with being single (PR = 1.7; 95% CI: 1.0, 2.9). Being widowed was related to a lower prevalence of having visited a dentist compared to being married or living with a partner (PR = 0.92; 95% CI 0.86, 0.99). Those with a larger circle of friends were more likely to be physically active (PR = 1.17; 95% CI:1.06, 1.28 for 5–8 versus less than 5 friends). Conclusions Social relationships of older Americans were independently associated with different health-related behaviors, even after adjusting for demographic and socioeconomic determinants. Availability of emotional support did not however
Jackson, Suzanne F; Birn, Anne-Emanuelle; Fawcett, Stephen B; Poland, Blake; Schultz, Jerry A
Health promotion and social determinants of health approaches, when integrated, can better contribute to understanding and addressing health inequities. Yet, they have typically been pursued as two solitudes. This paper presents the key elements, principles, actions, and potential synergies of these complementary frameworks for addressing health equity. The value-added of integrating these two approaches is illustrated by three examples drawn from the authors' experiences in the Americas: at the community level, through a community-based coalition for reducing chronic disease disparities among minorities in an urban center in the United States; at the national level, through healthy-settings interventions in Canada; and at the Regional level, through health cooperation based on social justice values in Latin America. Challenges to integrating health promotion and social determinants of health approaches in the Americas are also discussed.
Yang, Nancy Y; Wroth, Shelley; Parham, Catherine; Strait, Melva; Simmons, Leigh Ann
Health coaching is an emerging behavioral intervention to improve outcomes in chronic disease management and prevention; however, no studies have investigated its utility in postpartum women who have gained excess weight during pregnancy. A 32-year-old primigravida woman who was overweight at conception and gained 23 lbs more than Institute of Medicine recommendations for her pre-pregnancy body mass index participated in a 6-month personalized health planning with integrative health coaching (PHPIHC) intervention. The intervention included a baseline health risk assessment review with a healthcare provider and eight biweekly, 30-minute telephonic health coaching sessions. The participant demonstrated improvement in physical activity, energy expenditure, knowledge, and confidence to engage in healthpromoting behaviors. Although the participant did not reach the target weight by completion of the health coaching sessions, follow up 8 months later indicated she achieved the target goal (within 5% of prepregnancy weight). This case report suggests that PHP-IHC can support postpartum women in returning to pre-pregnancy weight after gaining excess gestational weight. Future research and clinical trials are needed to determine the best timing, length, and medium (online, in-person, telephonic) of PHP-IHC for postpartum women.
Wenger, Lynn; Lorvick, Jennifer; Shiboski, Caroline; Kral, Alex H.
Few existing studies have examined health and oral health needs and treatment-seeking behavior among the homeless and injection drug users (IDUs). This paper describes the prevalence and correlates of health and oral health care needs and treatment-seeking behaviors in homeless IDUs recruited in San Francisco, California, from 2003 to 2005 (N = 340). We examined sociodemographic characteristics, drug use patterns, HIV status via oral fluid testing, physical health using the Short Form 12 Physical Component Score, self-reported needs for physical and oral health care, and the self-reported frequency of seeking medical and oral health care. The sample had a lower health status as compared to the general population and reported a frequent need for physical and oral health care. In bivariate analysis, being in methadone treatment was associated with care-seeking behavior. In addition, being enrolled in Medi-Cal, California’s state Medicaid program, was associated with greater odds of seeking physical and oral health care. Methamphetamine use was not associated with higher odds of needing oral health care as compared to people who reported using other illicit drugs. Homeless IDUs in San Francisco have a large burden of unmet health and oral health needs. Recent cuts in Medi-Cal’s adult dental coverage may result in a greater burden of oral health care which will need to be provided by emergency departments and neighborhood dental clinics. PMID:20945108
Yu, Catherine H; Guarna, Giuliana; Tsao, Pamela; Jesuthasan, Jude R; Lau, Adrian NC; Siddiqi, Ferhan S; Gilmour, Julie Anne; Ladha, Danyal; Halapy, Henry; Advani, Andrew
Purpose For emerging adults with chronic medical diseases, the transition from pediatric to adult health care is often a time of great upheaval, commonly associated with unhealthy self-management choices, loss to follow-up, and adverse outcomes. We conducted a systematic review to examine the use of incentive strategies to promote positive health-related behaviors in young adults with chronic medical diseases. Methods The Medline, CINAHL, Embase, PsycInfo, and Cochrane databases were searched through June 2014. Studies of any design where an incentive was used to achieve a target behavior or outcome in a pediatric or emerging adult population (age <30 years) with chronic medical conditions including addictions, were included. Results A total of 26 studies comprising 10,880 patients met our inclusion criteria after screening 10,305 abstracts and 301 full-text articles. Of these studies, 20 examined the effects of behavioral incentives on cigarette smoking or substance abuse, including alcohol; four studies explored behavioral incentives in the setting of HIV or sexual health; and two articles studied individuals with other chronic medical conditions. Seventeen articles reported a statistically significant benefit of the behavioral incentive on one or more outcomes, although only half reported follow-up after the incentive period was terminated. Conclusion While the majority of studies reported positive outcomes, these studies focused on promoting the cessation of adverse behaviors rather than promoting positive behaviors. In addition, conclusions were limited by the high risk of bias present in the majority of studies, as well as lack of follow-up after the incentive period. Whether behavioral incentives facilitate the adoption of positive health choices in this population remains to be determined. PMID:27069356
Dohan, Daniel; Garrett, Sarah B; Rendle, Katharine A; Halley, Meghan; Abramson, Corey
When making health care decisions, patients and consumers use data but also gather stories from family and friends. When advising patients, clinicians consult the medical evidence but also use professional judgment. These stories and judgments, as well as other forms of narrative, shape decision making but remain poorly understood. Furthermore, qualitative research methods to examine narrative are rarely included in health science research. We illustrate how narratives shape decision making and explain why it is difficult but necessary to integrate qualitative research on narrative into the health sciences. We draw on social-scientific insights on rigorous qualitative research and our ongoing studies of decision making by patients with cancer, and we describe new tools and approaches that link qualitative research findings with the predominantly quantitative health science scholarship. Finally, we highlight the benefits of more fully integrating qualitative research and narrative analysis into the medical evidence base and into evidence-based medical practice.
Davitt, Joan K; Gellis, Zvi D
Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.
Wyshak, G; Lawrence, R S
This report compares the health-promoting behaviors of lawyers and judges and contrasts these behaviors with published data from nationwide surveys of the general population. Data were obtained from a self-administered questionnaire distributed to a random sample of Massachusetts lawyers and a group of judges attending an annual meeting of midwestern state municipal judges. Compared to the United States general population, lawyers and judges have more favorable health-promoting practices with respect to smoking, exercise, and use of seatbelts but are similar in terms of drinking habits and drinking problems, diet and weight consciousness, and the prevalence of tension, stress or pressure from their work.
Arthur, Paul B.; DeCleene, Kate
The behavioral health competence of Army Reserve Occupational Therapists (OT) was examined by electronic survey to determine current levels of competence and highlight pre-deployment training needs. Results indicated that while Army Reserve OTs report high levels of behavioral health competence, many questions regarding diagnosis, assessment, evaluation, treatment planning, intervention, and progress arose throughout deployment. OT’s often relied on skills from Level II fieldwork education and entry-level didactic education for competency. Perceived competencies may be compromised by curriculum changes in entry-level education, available fieldwork settings, and a lack of adequate training currently available prior to deployment. PMID:25368437
Van Ouytsel, Joris; Torres, Elizabeth; Choi, Hye Jeong; Ponnet, Koen; Walrave, Michel; Temple, Jeff R
Dating violence is an important public health concern and is considered to be a form of school violence. While digital technologies have enabled perpetrators of dating violence to target their victims online (cyber dating abuse), little is known about how this form of perpetration relates to specific adolescent risk behaviors. This brief research report focuses on the associations between substance use, sexual behaviors, deviant behaviors, self-reported health, and cyber dating abuse perpetration. Participants included 705 ethnically diverse adolescents ( n = 408; 57.9% female) in Southeast Texas. Having had sexual intercourse or using alcohol or drugs before having sex was significantly linked with cyber dating abuse perpetration, as was poor physical health, and substance use. Consistent with limited research, we found a link between cyber dating abuse and engagement in bullying behaviors. The discussion section includes suggestions for school nurse practice and further research.
Wichman, Harvey A
The current enthusiasm over the prospect of space tourism and the belief among many that such civilian spaceflight is imminent are characterized herein. There are many concerns about screening and certifying passengers for future spaceflight. Efforts by several organizations to propose such screening are cited. The problem with some of these proposals, which treat all types of spaceflight the same, is that they are so restrictive that too few people would be eligible for space travel to have a viable tourism industry. However, not all types of spaceflight are the same, so the distinctions between them need to be clarified. Of the five types of spaceflight described, one is proposed as the most likely to be the first significant phase of space tourism: long-term microgravity flight in low Earth orbit. But because of human problems with long-term exposure to microgravity, this phase requires rather conservative screening and extensive training. However, prior to discussing the passenger issues related to this early phase of space tourism, the reasons why Earth-like gravity, as well as microgravity, must be made available to spacefarers before space tourism can take place on a grand scale need to be explained. Finally, major passenger medical and behavioral issues of the first phase of orbital space tourism-long-term microgravity flight-are discussed.
McLeod, Jane D; Uemura, Ryotaro; Rohrman, Shawna
Prior research on the association of mental health and behavior problems with academic achievement is limited because it does not consider multiple problems simultaneously, take co-occurring problems into account, and control for academic aptitude. We addressed these limitations using data from the National Longitudinal Study of Adolescent Health (N = 6,315). We estimated the associations of depression, attention problems, delinquency, and substance use with two indicators of academic achievement (high school GPA and highest degree received) with controls for academic aptitude. Attention problems, delinquency, and substance use were significantly associated with diminished achievement, but depression was not. Combinations of problems involving substance use were especially consequential. Our results demonstrate that the social consequences of mental health problems are not the inevitable result of diminished functional ability but, rather, reflect negative social responses. These results also encourage a broader perspective on mental health by demonstrating that behavior problems heighten the negative consequences of more traditional forms of distress.
Narayanan, Gitanjali; Prabhakaran, Dorairaj
Mental health refers to a diverse field where individuals can cope with daily stress, realize their potential and maintain a state of well-being. In recent years, there has been increasing recognition of the influence of mental health on general health, and in particular on cardiovascular diseases and their risk factors. Epidemiological research has focused on several psychosocial components including social determinants, comorbid psychiatric disorders, psychological stress, coping styles, social support, burden on the family, well-being, life satisfaction, personality and cognitive factors in connection with cardiovascular diseases. There is epidemiological research in India that integrates mental health with common cardiovascular diseases such as coronary health disease and stroke. Data from mental health research is sufficiently compelling to highlight the role of chronic stress, socioeconomic status and psychiatric disorders such as depression, substance use, social networks and support in relation to vulnerability to cardiovascular diseases. There are psychosocial consequences of cardiovascular diseases including deficits in the domains of life skills, coping skills and neurocognition, in addition to caregiver burden. The implications of bio-psychosocial models of assessments and interventions that target complex individual and contextual variables simultaneously on cardiovascular treatment outcomes have highlighted the importance of studying mental health in Indian settings. Integration of mental health into mainstream research is the need of the hour. A multidimensional approach to accomplish this is required including at the level of research conceptualization, discussions with key stakeholders, at the policy level, at the institutional level, and at the clinical and community level.
Cho, Myoung Ok
The present biocultural study aimed to describe the health care use patterns of women with lymphedema. Data came from interviews and participant observations with eight key informants between February 2000 and February 2002. Analyzing the process of seeking health care, this paper explored how Korean women with lymphedema make use of all the available resources in the three sectors of the health care system: professional, folk and popular health. In these three sectors of the health care system, informants showed different patterns of behavior. In the professional health care sector, they behave based on scientific Western medicine and holistic herbal medical frameworks. Informants want scientific technological treatment from a Westernized doctor and perfect humanistic and holistic treatment from a herbal doctor. In the folk sector, informants' behavior is ruled by a pragmatic and supernatural framework. Informants seek religious healers who have strong spirituality and non-religious healers who have experience and skills. Informants complied with these healer's remedies based on efficacy and empirical healing evidence. In the popular sector of the health care system, informants behave based on their concept of illness and rules of daily life. They believe lymphedema comes from poor blood circulation and they want to be regarded as members of society, not as patients with lymphedema. Therefore, informants practised popular remedies that they believed were good for promoting blood circulation and keeping their social network active. This description about health care seeking behaviors being embedded in Korean socio-medical culture can serve to understand patients with other chronic health problems. With these results, we can put a bridge over the river of cultural conflict between health professionals and patients.
Barnes, Donelle M; Harrison, Cara; Heneghan, Richard
Refugees resettling in the U.S. are generally low-income and underserved by health promotion interventions. To begin to address refugee health promotion issues, this study describes health behaviors of newly arrived (less than 90 days) adult refugees in the U.S. The methods used were retrospective description of clients from one refugee health screening program. The sample consisted of adult refugees (n=591), men and women, from Cuba, Bosnia, Vietnam, Kosovo, Iran, Iraq, and other countries. Rates of overweight were highest among Bosnians and lowest among Vietnamese. Cubans reported the most physical activity and Kosovars the least. Rates of smoking were highest among Bosnians and lowest among Cubans. Older refugees were more overweight and reported less physical activity and more smoking than younger adults. In some cases, different refugee groups have similar health promotion needs, while in others needs differ. This baseline descriptive data supports calls for further health promotion research and interventions in refugee populations.
Korda, Holly; Itani, Zena
Rapid and innovative advances in participative Internet communications, referred to as "social media," offer opportunities for modifying health behavior. Social media let users choose to be either anonymous or identified. People of all demographics are adopting these technologies whether on their computers or through mobile devices, and they are increasingly using these social media for health-related issues. Although social media have considerable potential as tools for health promotion and education, these media, like traditional health promotion media, require careful application and may not always achieve their desired outcomes. This article summarizes current evidence and understanding of using social media for health promotion. More important, it discusses the need for evaluating the effectiveness of various forms of social media and incorporating outcomes research and theory in the design of health promotion programs for social media.
Higgins, Stephen T.
This Special Issue of Preventive Medicine (PM) is the 2nd that we have organized on behavior change, health, and health disparities. This is a topic of fundamental importance to improving population health in the U.S. and other industrialized countries that are trying to more effectively manage chronic health conditions. There is broad scientific consensus that personal behavior patterns such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. As such behavior change needs to be a key component of improving population health. There is also broad agreement that while these problems extend across socioeconomic strata, they are overrepresented among more economically disadvantaged populations and contribute directly to the growing problem of health disparities. Hence, behavior change represents an essential step in curtailing that unsettling problem as well. In this 2nd Special Issue, we devote considerable space to the current U.S. prescription opioid addiction epidemic, a crisis that was not addressed in the prior Special Issue. We also continue to devote attention to the two largest contributors to preventable disease and premature death, cigarette smoking and physical inactivity/obesity as well as risks of co-occurrence of these unhealthy behavior patterns. Across each of these topics we included contributions from highly accomplished policymakers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges to effectively managing these important chronic health problems. PMID:26257372
Mas, Francisco Soto; Mein, Erika; Fuentes, Brenda; Thatcher, Barry; Balcázar, Héctor
Adult Hispanic immigrants are at a greater risk of experiencing the negative outcomes related to low health literacy, as they confront cultural and language barriers to the complex and predominately monolingual English-based U.S. health system. One approach that has the potential for simultaneously addressing the health, literacy, and language needs of Hispanics is the combination of health literacy and English as a second language (ESL) instruction. The purpose of the project was to evaluate the feasibility of using ESL instruction as a medium for improving health literacy among Hispanic immigrants. Objectives included the development, implementation, and evaluation of an interdisciplinary health literacy/ESL curriculum that integrates theories of health literacy and health behavior research and practice, sociocultural theories of literacy and communication, and adult learning principles. This article describes the curriculum development process and provides preliminary qualitative data on learners’ experiences with the curriculum. Results indicate that the curriculum was attractive to participants and that they were highly satisfied with both the format and content. The curriculum described here represents one example of an audience-centered approach designed to meet the specific health and literacy needs of the Hispanic population on the U.S.–Mexico border. The combination of ESL and health literacy contributed to a perceived positive learning experience among participants. Interdisciplinary approaches to health literacy are recommended. PMID:22982707
Soto Mas, Francisco; Mein, Erika; Fuentes, Brenda; Thatcher, Barry; Balcázar, Héctor
Adult Hispanic immigrants are at a greater risk of experiencing the negative outcomes related to low health literacy, as they confront cultural and language barriers to the complex and predominately monolingual English-based U.S. health system. One approach that has the potential for simultaneously addressing the health, literacy, and language needs of Hispanics is the combination of health literacy and English as a second language (ESL) instruction. The purpose of the project was to evaluate the feasibility of using ESL instruction as a medium for improving health literacy among Hispanic immigrants. Objectives included the development, implementation, and evaluation of an interdisciplinary health literacy/ESL curriculum that integrates theories of health literacy and health behavior research and practice, sociocultural theories of literacy and communication, and adult learning principles. This article describes the curriculum development process and provides preliminary qualitative data on learners' experiences with the curriculum. Results indicate that the curriculum was attractive to participants and that they were highly satisfied with both the format and content. The curriculum described here represents one example of an audience-centered approach designed to meet the specific health and literacy needs of the Hispanic population on the U.S.-Mexico border. The combination of ESL and health literacy contributed to a perceived positive learning experience among participants. Interdisciplinary approaches to health literacy are recommended.
Raitakari, Suvi; Haahtela, Riikka; Juhila, Kirsi
Integration - and its synonym inclusion - is emphasised in the western welfare states and in the European Union in particular. Integration is also a central topic in the social sciences and in current mental health and homelessness research and practice. As mental healthcare has shifted from psychiatric hospitals to the community, it has inevitably become involved with housing and integration issues. This article explores how community integration is understood and tackled in mental health floating support services (FSSs) and, more precisely, in service user-practitioner home visit interaction. The aim, through shedding light on how the idea of integration is present and discussed in front-line mental health practices, is to offer a 'template' on how we might, in a systematic and reflective way, develop community integration research and practice. The analysis is based on ethnomethodological and micro-sociological interaction research. The research settings are two FSSs located in a large Finnish city. The data contain 24 audio-recorded and transcribed home visits conducted in 2011 and 2012 with 16 different service users. The study shows how the participants in service user-practitioner interaction give meaning to community integration and make decisions about how it should (or should not) be enhanced in each individual case. This activity is called community integration work in action. Community integration work in action is based on various dimensions of integration: getting out of the house, participating in group activities and getting along with those involved in one's life and working life. Additionally, the analysis demonstrates how community integration work is accomplished by discursive devices (resistance, positioning, excuses and justifications, delicacy and advice-giving). The article concludes that community integration is about interaction: it is not only service users' individual challenge but also a social challenge, our challenge.
Takahashi, Paul Y; Ryu, Euijung; Olson, Janet E; Winkler, Erin M; Hathcock, Matthew A; Gupta, Ruchi; Sloan, Jeff A; Pathak, Jyotishman; Bielinski, Suzette J; Cerhan, James R
Background Hospital risk stratification models using electronic health records (EHRs) often use age and comorbid health burden. Our primary aim was to determine if quality of life or health behaviors captured in an EHR-linked biobank can predict future risk of hospitalization. Methods Participants in the Mayo Clinic Biobank completed self-administered questionnaires at enrollment that included quality of life and health behaviors. Participants enrolled as of December 31, 2010 were followed for one year to ascertain hospitalization. Data on comorbidities and hospitalization were derived from the Mayo Clinic EHR. Hazard ratios (HR) and 95% confidence interval (CI) were used, adjusted for age and sex. We used gradient boosting machines models to integrate multiple factors. Different models were compared using C-statistic. Results Of the 8,927 eligible Mayo Clinic Biobank participants, 834 (9.3%) were hospitalized. Self-perceived health status and alcohol use had the strongest associations with risk of hospitalization. Compared to participants with excellent self-perceived health, those reporting poor/fair health had higher risk of hospitalization (HR =3.66, 95% CI 2.74–4.88). Alcohol use was inversely associated with hospitalization (HR =0.57 95% CI 0.45–0.72). The gradient boosting machines model estimated self-perceived health as the most influential factor (relative influence =16%). The predictive ability of the model based on comorbidities was slightly higher than the one based on the self-perceived health (C-statistic =0.67 vs 0.65). Conclusion This study demonstrates that self-perceived health may be an important piece of information to add to the EHR. It may be another method to determine hospitalization risk. PMID:26316799
Thelusma, Naomi; Ralston, Penny
Women from diverse ethnic/racial backgrounds have higher chronic disease mortality rates when compared to White non-Hispanic women. Community-based programs, such as beauty salons, have been used to reach diverse ethnic/racial women, yet little is known about diverse ethnic/racial women cosmetologists’ involvement in health promotion and their health behaviors, which is the purpose of this review. The growing beauty salon health promotion literature indicates that their roles in these studies have been varied, not only as health promoters but also as recruiters, facilitators, and in general major catalysts for investigator-initiated studies. However, the review also identified a major void in the literature in that there were few studies on health behaviors of diverse ethnic/racial women cosmetologists, especially African American women cosmetologists. Recommendations include increasing the capacity of diverse ethnic/racial women cosmetologists as community health leaders and investigating their health status, knowledge, attitudes, and practices. PMID:27199580
Woldemicael, Gebremariam; Tenkorang, Eric Y
This paper examines the net effect of women's autonomy on their health seeking behavior in Ethiopia. We hypothesize that women with higher autonomy are more likely to seek health care during pregnancy and delivery than those with lower autonomy. The paper also examines whether the autonomy-health utilization relationship is influenced by individual (education, work status, religion) and, household (wealth and rural-urban residence) level factors, all of which are important for both autonomy and health-care utilization. Results indicate that women's autonomy remains significant even after adjusting for other individual and household variables. Besides autonomy, our results highlight other individual and household level influences on the health seeking behaviors of women in Ethiopia. Results also demonstrate the need to look beyond individual level factors when examining the health seeking behaviors of women in Ethiopia. The statistical significance of some individual-level measures, such as education means it cannot be used as proxy for women's autonomy. This calls for policy makers not only to empower women, but also provide them with better formal education.
... HUMAN SERVICES Meeting of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health AGENCY: Office of the Surgeon General of the United States Public Health Service, Office of the... Advisory Group on Prevention, Health Promotion, and Integrative and Public Health (the ``Advisory...
... HUMAN SERVICES Meeting of the Advisory Group on Prevention, Health Promotion, and Integrative and Public... Secretary for Health, Office of the Surgeon General of the United States Public Health Service. ACTION... ] Advisory Group on Prevention, Health Promotion, and Integrative and Public Health (the ``Advisory...
... HUMAN SERVICES Meeting of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health AGENCY: Office of the Surgeon General of the United States Public Health Service, Office of the... Advisory Group on Prevention, Health Promotion, and Integrative and Public Health (the ``Advisory...
... HUMAN SERVICES Meeting of the Advisory Group on Prevention, Health Promotion, and Integrative and Public... Advisory Group on Prevention, Health Promotion, and Integrative and Public Health (the ``Advisory Group... Prevention, Health Promotion and Public Health Council (the ``Council''). The Advisory Group shall...
... HUMAN SERVICES Meeting of the Advisory Group on Prevention, Health Promotion, and Integrative and Public... Advisory Group on Prevention, Health Promotion, and Integrative and Public Health (the ``Advisory Group... provide recommendations and advice to the National Prevention, Health Promotion and Public Health...
... HUMAN SERVICES Meeting of the Advisory Group on Prevention, Health Promotion, and Integrative and Public... the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health (the ``Advisory... Prevention, Health Promotion and Public Health Council (the ``Council''). The Advisory Group shall...
Operario, Don; Kuo, Caroline C.; Sosa-Rubí, Sandra G.; Gálarraga, Omar
Objective This paper reviews psychology and behavioral economic approaches to HIV prevention, and examines the integration and application of these approaches in conditional economic incentive (CEI) programs for reducing HIV risk behavior. Methods We discuss the history of HIV prevention approaches, highlighting the important insights and limitations of psychological theories. We provide an overview of the theoretical tenets of behavioral economics that are relevant to HIV prevention, and utilize CEIs as an illustrative example of how traditional psychological theories end behavioral economics can be combined into new approaches for HIV prevention. Results Behavioral economic interventions can complement psychological frameworks for reducing HIV risk by introducing unique theoretical understandings about the conditions under which risky decisions are amenable to intervention. Findings from illustrative CEI programs show mixed but generally promising effects of economic interventions on HIV and STI prevalence, HIV testing, HIV medication adherence, and drug use. Conclusion CEI programs can complement psychological interventions for HIV prevention and behavioral risk reduction. To maximize program effectiveness, CEI programs must be designed according to contextual and population-specific factors that may determine intervention applicability and success. PMID:24001243
Knecht, S; Kenning, P
In the past, medicine was dominated by acute diseases. Since treatments were unknown to patients they followed their medical doctors´ directives-at least for the duration of the disease. Behavior was thus largely motivated by avoiding expected costs associated with alternative behaviors (I-must). The health challenges prevailing today are chronic conditions resulting from the way we chose to live. Traditional directive communication has not been successful in eliciting and maintaining appropriate lifestyle changes. An approach successful in other fields is to motivate behavior by increasing expected rewards (I-want). Drawing on neuroeconomic and marketing research, we outline strategies including simplification, repeated exposure, default framing, social comparisons, and consumer friendliness to foster sustained changes in preference. We further show how these measures could be integrated into the health care system.
... HUMAN SERVICES Establishment of the Advisory Group on Prevention, Health Promotion, and Integrative and... March 23, 2010. The Advisory Group on Prevention, Health Promotion, and Integrative and Public Health... Prevention, Health Promotion, and Integrative and Public Health, as directed by Executive Order 13544....
Holden, Kisha; McGregor, Brian; Thandi, Poonam; Fresh, Edith; Sheats, Kameron; Belton, Allyson; Mattox, Gail; Satcher, David
Despite decades of research, recognition and treatment of mental illness and its co-morbidities still remain a significant public health problem in the United States. Ethnic minorities are identified as a population that is vulnerable to mental health disparities and face unique challenges pertaining to mental health care. Psychiatric illness is associated with great physical, emotional, functional, and societal burden. The primary health care setting may be a promising venue for screening, assessment, and treatment of mental illnesses for ethnic minority populations. We propose a comprehensive, innovative, culturally centered integrated care model to address the complexities within the health care system, from the individual level, that includes provider and patient factors, to the system level, which include practice culture and system functionality issues. Our multi-disciplinary investigative team acknowledges the importance of providing culturally tailored integrative healthcare to holistically concentrate on physical, mental, emotional, and behavioral problems among ethnic minorities in a primary care setting. It is our intention that the proposed model will be useful for health practitioners, contribute to the reduction of mental health disparities, and promote better mental health and well-being for ethnic minority individuals, families, and communities. PMID:25383991
Rapport, D.J.; Gaudet, C.; Karr, J.R.; Baron, J. S.; Bohlen, C.; Jackson, W.; Jones, B.; Naiman, R.J.; Norton, B.; Pollock, M. M.
Evaluating landscape change requires the integration of the social and natural sciences. The social sciences contribute to articulating societal values that govern landscape change, while the natural sciences contribute to understanding the biophysical processes that are influenced by human activity and result in ecological change. Building upon Aldo Leopold's criteria for landscape health, the roles of societal values and biophysical processes in shaping the landscape are explored. A framework is developed for indicators of landscape health and integrity. Indicators of integrity are useful in measuring biological condition relative to the condition in landscapes largely unaffected by human activity, while indicators of health are useful in evaluating changes in highly modified landscapes. Integrating societal goals and biophysical processes requires identification of ecological services to be sustained within a given landscape. It also requires the proper choice of temporal and spatial scales. Societal values are based upon inter-generational concerns at regional scales (e.g. soil and ground water quality). Assessing the health and integrity of the environment at the landscape scale over a period of decades best integrates societal values with underlying biophysical processes. These principles are illustrated in two contrasting case studies: (1) the South Platte River study demonstrates the role of complex biophysical processes acting at a distance; and (2) the Kissimmee River study illustrates the critical importance of social, cultural and economic concerns in the design of remedial action plans. In both studies, however, interactions between the social and the biophysical governed the landscape outcomes. The legacy of evolution and the legacy of culture requires integration for the purpose of effectively coping with environmental change.
Bhuyan, Soumitra S; Lu, Ning; Chandak, Aastha; Kim, Hyunmin; Wyant, David; Bhatt, Jay; Kedia, Satish; Chang, Cyril F
Roddy, McKenzie K; Nowlan, Kathryn M; Doss, Brian D; Christensen, Andrew
Integrative Behavioral Couple Therapy (IBCT), developed by Drs. Andrew Christensen and Neil Jacobson, builds off the tradition of behavioral couple therapy by including acceptance strategies as key components of treatment. Results from a large randomized clinical trial of IBCT indicate that it yields large and significant gains in relationship satisfaction. Furthermore, these benefits have been shown to persist for at least 5 years after treatment for the average couple. Not only does IBCT positively impact relationship constructs such as satisfaction and communication, but the benefits of therapy extend to individual, co-parenting, and child functioning. Moreover, IBCT has been shown to operate through the putative mechanisms of improvements in emotional acceptance, behavior change, and communication. IBCT was chosen for nationwide training and dissemination through the Veteran Affairs Medical Centers. Furthermore, the principles of IBCT have been translated into a web-based intervention for distressed couples, OurRelationship.com. IBCT is continuing to evolve and grow as research and technologies allow for continued evaluation and dissemination of this well-supported theoretical model.
Baicker, Katherine; Congdon, William J; Mullainathan, Sendhil
Context Millions of uninsured Americans ostensibly have insurance available to them—many at very low cost—but do not take it up. Traditional economic analysis is based on the premise that these are rational decisions, but it is hard to reconcile observed enrollment patterns with this view. The policy prescriptions that the traditional model generates may thus fail to achieve their goals. Behavioral economics, which integrates insights from psychology into economic analysis, identifies important deviations from the traditional assumptions of rationality and can thus improve our understanding of what drives health insurance take-up and improved policy design. Methods Rather than a systematic review of the coverage literature, this article is a primer for considering issues in health insurance coverage from a behavioral economics perspective, supplementing the standard model. We present relevant evidence on decision making and insurance take-up and use it to develop a behavioral approach to both the policy problem posed by the lack of health insurance coverage and possible policy solutions to that problem. Findings We found that evidence from behavioral economics can shed light on both the sources of low take-up and the efficacy of different policy levers intended to expand coverage. We then applied these insights to policy design questions for public and private insurance coverage and to the implementation of the recently enacted health reform, focusing on the use of behavioral insights to maximize the value of spending on coverage. Conclusions We concluded that the success of health insurance coverage reform depends crucially on understanding the behavioral barriers to take-up. The take-up process is likely governed by psychology as much as economics, and public resources can likely be used much more effectively with behaviorally informed policy design. PMID:22428694
Ali, Dena A.
Aim: The aims of this study were to assess attitudes and behavior of oral health maintenance among students in four faculties (Medicine, Dentistry, Pharmacy, and Allied Health) and to compare oral health attitudes and behavior of all students at Kuwait University Health Sciences Center (KUHSC) based on their academic level. Materials and Methods: Students enrolled in the Faculties of Dentistry, Medicine, Pharmacy, and Allied Health at KUHSC were evaluated regarding their oral health attitudes and behavior by an e-mail invitation with a link to the Hiroshima University Dental Behavior Inventory survey that was sent to all 1802 students with Kuwait University Health Sciences Center e-mail addresses. The data were analyzed for frequency distributions, and differences among the groups were assessed using the Mann–Whitney U test, Chi-square test, and Kruskal–Wallis test. P values less than 0.05 were considered to be statistically significant (P < 0.05). Results: The results of this study indicated that dental students achieved better oral health attitudes and behavior than that of their nondental professional fellow students (P < 0.05). Students in advanced academic levels and female students demonstrated better oral health attitudes and behavior. Conclusion: Dental students and students who were in advanced levels of their training along with female students demonstrated better oral health practices and perceptions than students in lower academic levels and male students, respectively. Additional studies for investigating the effectiveness and identifying areas requiring modification within the dental curriculum at KUHSC may be warranted. PMID:27891310
Nair, Uma S; Jordan, Jeremy S; Funk, Daniel; Gavin, Kristin; Tibbetts, Erica; Collins, Bradley N
Female inmate populations in the United States tend to be overweight, physically inactive, experience high stress, and have a history of nicotine and other drug dependence. Thus, they bear an elevated risk of cardiovascular (CV) disease than the general population. However, few evidence-based health interventions exist for this population. This study will test proof of concept, feasibility, and potential efficacy of a multiple health behavior change intervention that integrates CV-health promotion education delivered during a physical activity (PA) program (indoor cycling) tailored to this population. This study uses a quasi-experimental 2-group design with two measurement time-points: baseline and 8-week end of treatment. N=120 incarcerated women (18-59years of age) who are medically cleared for participation in PA will be enrolled. Indoor cycling instructors will be trained to deliver five health education topics over an 8-week period during twice-weekly cycling classes. Topics match the American Heart Association recommendations for CV health: (a) nutrition, (b) PA promotion, (c) weight management, (d) stress management, and (e) smoking cessation and relapse prevention. Modes of intervention include instructor advice, written materials and audio/video clips reviewed during class. CV-related and mental health measures will be assessed at both time-points. Results will guide a full scale efficacy study. Future research in this area has potential to impact the health of female inmates, a high-risk population. Moreover, this multiple health behavior change intervention model represents a community approach to health promotion that could generalize to other underserved populations who may benefit most from similar intervention efforts.
David, Daniel; Szentagotai, Aurora
There seems to be a lack of a coherent and integrative theory and theoretically informed manuals in cognitive behavioral therapies that could negatively impact both the program of CBT as a platform for psychotherapy integration, as well as its efficacy and effectiveness. Although CBT is the golden psychological treatment for various disorders, overall, about 30-40% of the patients are still non-responsive to these interventions and various schools debate their status as promoters of the best theoretical view. The objective of the present paper is to use cognitive psychology/science as a tool to clarify several theoretical confusions in CBT, with impact on a coherent science and practice of CBT. As a general conclusion, we believe that CBT has reached preeminence in the clinical field betting on cold cognitions. Despite obvious advantages and accomplishments, this approach seems to loose its heuristic value. We believe that the next phase of CBT development lies in the construct of hot cognitions (which would increase its effectiveness) and in cognitive psychology (which would contribute to a coherent science of CBT beyond various schools). These developments could offer CBT the chance to be a platform for the integration of psychotherapy.
O'Neal, Catherine Walker; Lucier-Greer, Mallory; Mancini, Jay A; Ferraro, Anthony J; Ross, D Bruce
In addition to facing stressors that are typical of life course development (e.g., marital struggles, balancing work/family demands), military families face additional stress attributed to their military context (e.g., deployments, relocations). Using a systems framework and stress process perspective, this study examined military couples' relational health, as a gauge for how couples collectively cope and address challenges as a united front and how their relational health influences crucial health behaviors (sleeping and eating) through the promotion or erosion of psychological resources (N = 236 couples). This study evaluated a latent variable structural equation dyadic model whereby each partner's perspective of their family's relational health was hypothesized to influence their own eating and sleeping behaviors (actor effects), as well as the eating and sleeping behaviors of their spouse (partner effects). The role of psychological resources (high self-efficacy, few depressive symptoms, and minimal anxiety) as a mechanism linking family functioning to health behaviors was also examined. Overall, the findings supported the hypothesized model, particularly for actor (intraindividual) effects. Discussion is provided pertinent to service providers and researchers, including the importance of improving, or maintaining, family relational health, as a means for encouraging positive health behaviors among active duty military members and their spouses.
Booth, Mark; Hill, Graham; Moore, Michael J; Dalla, Danielle; Moore, Michael G; Messenger, Anne
On 1 July 2015, the Australian Government established 31 new Primary Health Networks (PHNs), following a review by its former Chief Medical Officer, John Horvath, of 61 Medicare Locals created under the previous Labor administration. The Horvath review recommended, among other things, that new, larger primary health organisations be established to reduce fragmentation of care by integrating and coordinating health services, supporting the role of general practice, and leveraging and administering health program funding. The two main objectives of the new PHNs, as stated on the Department of Health's website, are "increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time". Below are three viewpoints, commissioned for this primary health care themed issue of Public Health Research & Practice, from the Australian Government Department of Health, the Public Health Association of Australia and a Sydney-based PHN. We asked the authors to focus particularly on how the newly established networks might help to integrate public health within the primary health care landscape. Our authors have pointed out the huge overlap between public health and primary care and looked at evidence showing the great benefits for health systems of collaboration between the two. Challenges ahead include a possible government focus on delivery of 'frontline' medical services, which may come at the expense of population health, and the complexity of dealing with all primary health care stakeholders, including health professionals, Local Health Districts, nongovernment organisations, research institutions and local communities.
Burris, Scott; Mays, Glen P; Douglas Scutchfield, F; Ibrahim, Jennifer K
Context For three decades, experts have been stressing the importance of law to the effective operation of public health systems. Most recently, in a 2011 report, the Institute of Medicine recommended a review of state and local public health laws to ensure appropriate authority for public health agencies; adequate access to legal counsel for public health agencies; evaluations of the health effects and costs associated with legislation, regulations, and policies; and enhancement of research methods to assess the strength of evidence regarding the health effects of public policies. These recommendations, and the continued interest in law as a determinant of health system performance, speak to the need for integrating the emerging fields of Public Health Law Research (PHLR) and Public Health Systems and Services Research (PHSSR). Methods Expert commentary. Findings This article sets out a unified framework for the two fields and a shared research agenda built around three broad inquiries: (1) the structural role of law in shaping the organization, powers, prerogatives, duties, and limitations of public health agencies and thereby their functioning and ultimately their impact on public health (“infrastructure”); (2) the mechanisms through which public health system characteristics influence the implementation of interventional public health laws (“implementation”); and (3) the individual and system characteristics that influence the ability of public health systems and their community partners to develop and secure enactment of legal initiatives to advance public health (“innovation”). Research to date has laid a foundation of evidence, but progress requires better and more accessible data, a new generation of researchers comfortable in both law and health research, and more rigorous methods. Conclusions The routine integration of law as a salient factor in broader PHSSR studies of public health system functioning and health outcomes will enhance the
Tucker, Cary; Sloan, Sarah K.; Vance, Mary; Brownson, Chris
This case study describes 1 international student's treatment experience with an integrated health program on a college campus. This program uses a multidisciplinary, mind-body approach, which incorporates individual counseling, primary care, psychiatric consultation, a mindfulness-based cognitive therapy class, and a meditation group.
It is clear from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report published last month that hospitals are failing to integrate physical and mental healthcare. As a result, patients with mental health issues are receiving poor care and nurses are too often failing to refer such patients to the appropriate specialist support.
Werth, James L., Jr.; Borges, Nicole J.; McNally, Christopher J.; Maguire, Colleen P.; Britton, Paula J.
This article introduces the Major Contribution on integrating health and vocational psychology, using persons with HIV who have work-related concerns as an example. The authors describe the demographics associated with HIV disease and new treatments that have allowed people with HIV to remain healthy and continue working, or consider returning to…
Blobel, Bernd G M E; Pharow, Peter; Norgall, Thomas
For improving quality and efficiency of health delivery under the well-known burdens, the health service paradigm has to change from organization-centered over process-controlled to personal health. The growing complexity of highly distributed and fully integrated healthcare settings can only be managed through an advanced architectural approach, which has to include all dimensions of personal health. Here, ICT, medicine, biomedical engineering, bioinformatics and genomics, legal and administrative aspects, terminology and ontology have to be mentioned. The Generic Component Model allows for different domains' concept representation and aggregation. Framework, requirements, methodology and process design possibilities for such a future-proof and meanwhile practically demonstrated approach are discussed in detail. The deployment of the Generic Component Model and the concept representation to biomedical engineering aspects of eHealth are touched upon as essential issues.
Ramirez-Valles, Jesus; Kuhns, Lisa M.; Campbell, Richard T.; Diaz, Rafael M.
The purpose of this study is to contribute to the conceptual understanding and practical application of social integration theory to health behaviors. We test whether community involvement in AIDS and GLBT organizations moderates the relationship of racial and homosexual stigmata to sexual risk behavior among gay and bisexual men and transgender persons of Latin American origin or descent. We use structural equation modeling to analyze data from a sample of 643 individuals recruited via respondent-driven sampling. Among those not involved in community organizations, homosexual and racial stigmata are related to sexual activity under the influence of alcohol and drugs, which is linked to sexual risk behavior. Among the involved group, the stigmata are not linked to sexual activity under the influence of alcohol and drugs, or to sexual risk behavior. The moderating role of community involvement seems to be more salient in those currently involved than those ever involved. PMID:20420293
Ramirez-Valles, Jesus; Kuhns, Lisa M; Campbell, Richard T; Diaz, Rafael M
The purpose of this study is to contribute to the conceptual understanding and practical application of social integration theory to health behaviors. We test whether community involvement in AIDS and GLBT organizations moderates the relationship of racial and homosexual stigmata to sexual risk behavior among gay and bisexual men and transgender persons of Latin American origin or descent. We use structural equation modeling to analyze data from a sample of 643 individuals recruited via respondent-driven sampling. Among those not involved in community organizations, homosexual and racial stigmata are related to sexual activity under the influence of alcohol and drugs, which is linked to sexual risk behavior. Among the involved group, the stigmata are not linked to sexual activity under the influence of alcohol and drugs, or to sexual risk behavior. The moderating role of community involvement seems to be more salient in those currently involved than those ever involved.
de Groot, Esther; Jaarsma, Debbie; Endedijk, Maaike; Mainhard, Tim; Lam, Ineke; Simons, Robert-Jan; van Beukelen, Peter
Introduction: Better understanding of critically reflective work behavior (CRWB), an approach for work-related informal learning, is important in order to gain more profound insight in the continuing development of health care professionals. Methods: A survey, developed to measure CRWB and its predictors, was distributed to veterinary…
Clement, Madeleine; Jankowski, Louis W.; Bouchard, Louise; Perreault, Michel; Lepage, Yves
A 3-year study compared 52 undergraduate nursing students with 93 education majors and with the general population. No significant differences among students on 9 health behaviors appeared. Compared with the general population, nursing students had inadequate time for sleep, exercise, and eating breakfast. (Contains 77 references.) (SK)
Brouskeli, Vasiliki; Loumakou, Maria
In this study we investigated materialism among future educators and its relationship with stress and a number of health behaviors. Participants were 228 students (Mean = 20.64 years of age, S.D = 2.571) of the Department of Education Sciences in Early Childhood of the University of Thrace, Greece. The instrument consisted of a short form of the…
Roberts, Kimberly C.; Danoff-Burg, Sharon
Objective: The investigators examined relations between mindfulness and health behaviors in college students, as well as the role of stress in mediating these effects. Participants: Participants were 553 undergraduates (385 females; mean age = 18.8 years, SD = 2.1) recruited from a university in the northeastern United States. Methods:…
Copeland-Linder, Nikeea; Lambert, Sharon F.; Chen, Yi-Fu; Ialongo, Nicholas S.
This study examined the longitudinal association between contextual stress and health risk behaviors and the role of protective factors in a community epidemiologically-defined sample of urban African American adolescents (N = 500; 46.4% female). Structural equation modeling was used to create a latent variable measuring contextual stress…
Johnson, Ping H.
This study examined the priority health behaviors among Chinese youth by administering a questionnaire to 1,917 undergraduates enrolled in three universities in China. The response rate was 89.7%. This survey found that 75.2% of the participants tried cigarettes at least once during their lifetime, over half had their first cigarette and alcoholic…
Kristjansson, Alfgeir Logi; Sigfusdottir, Inga Dora; Allegrante, John P.; Helgason, Asgeir R.
Objectives: To examine the association between health behavior indicators, school contentment, and academic achievement. Methods: Structural equation modeling with 5810 adolescents. Results: Our model explained 36% of the variance in academic achievement and 24% in school contentment. BMI and sedentary lifestyle were negatively related to school…
Waldron, Jennifer J.; Krane, Vikki
The power and performance model of sport stresses a sport ethic of doing "whatever it takes" to win (Coakley, 2004). Uncritical acceptance of this model may lead to various health-compromising behaviors. Employing achievement goal theory, we examine why female athletes may adopt the power and performance approach. An ego motivational climate and a…
Bleck, Jennifer; DeBate, Rita
Introduction: Based on internal and external assets, the positive youth development approach aims to increase the capacity among adolescents to overcome challenges as they transition to adulthood. Developmental assets have been found to be positively associated with academic achievement, a variety of health promoting behaviors, and improved…
Porter, Kandice; Johnson, Ping Hu; Petrillo, Jane
This study examined the priority health behaviors of South African youth by administering a questionnaire to 635 undergraduate students enrolled in a large metropolitan university in South Africa. Results indicate that 65.5% of the participants tried cigarettes at least once during their lifetime, over 15.2% had their first cigarette and 31.2% had…
Sarvela, Paul D.; Monge, Eduardo A.
A study of patterns of health behavior among rural and small-town children surveyed 1,950 K-6 students from seven southern Illinois elementary schools. Findings indicate that less than half of the students ate the recommended amounts of fruits, vegetables, and grain each day. Males and females smoked at about the same rates, but sixth-grade boys…
Massachusetts Department of Elementary and Secondary Education, 2008
This paper presents the results of two coordinated surveys of Massachusetts adolescents, the 2007 Massachusetts Youth Risk Behavior Survey (ESE) and the Massachusetts Youth Health Survey (DPH). These two surveys were supported by funding from the Centers for Disease Control and Prevention (CDC) and administered in a random selection of 124 public…
Sabia, Joseph J.
This study examines whether offering sex education to young teenagers affects several measures of adolescent sexual behavior and health: virginity status, contraceptive use, frequency of intercourse, likelihood of pregnancy, and probability of contracting a sexually transmitted disease. Using data from the National Longitudinal Study of Adolescent…
White, Marilyn Domas
Using a thorough analytical framework, this study characterizes the questioning behavior on a consumer health-related electronic list. Analysis examines the dedication of the list to questioning; pattern of question asking within a message; type of question; length of answer anticipated; subject of question; combination of type of question and…
Many investigators are considering developing video games for health (video-G4Hs) but have questions about how to get started. This report provides guidance for investigators considering a G4H as a behavioral intervention procedure from a team of experienced G4H developers. Thirteen commonly asked q...
Owen, Neville; Healy, Geneviève N; Matthews, Charles E; Dunstan, David W
Even when adults meet physical activity guidelines, sitting for prolonged periods can compromise metabolic health. Television (TV) time and objective measurement studies show deleterious associations, and breaking up sedentary time is beneficial. Sitting time, TV time, and time sitting in automobiles increase premature mortality risk. Further evidence from prospective studies, intervention trials, and population-based behavioral studies is required.
Wiley, David C.; And Others
Using telephone surveys, researchers examined the health behaviors of 1,408 Texas college students. Results indicated that most had consumed alcohol at least once, and nearly one-third were regular smokers. Most were sexually active but did not use condoms. Over half had never received HIV/AIDS education in college. (SM)
Gonzalez-Ramirez, Leivy Patricia; De la Roca-Chiapas, Jose Maria; Colunga-Rodriguez, Cecilia; Preciado-Serrano, Maria de Lourdes; Daneri-Navarro, Adrian; Pedroza-Cabrera, Francisco Javier; Martinez-Arriaga, Reyna Jazmin
Background The transtheoretical model (TTM) has been widely used to promote healthy behaviors in different groups. However, a questionnaire has not yet been developed to evaluate the health behaviors that medical practitioners often consider in individuals with cancer or at a high risk of developing cancer. Purpose The aim of this study was to construct and validate the Health Behavior and Stages of Change Questionnaire (HBSCQ), which is based on the TTM and health recommendations related to risk and factors that protect against cancer. Methods Content validity was conducted in two phases (qualitative and quantitative). Item difficulty index, item discrimination index, and discrimination coefficient were obtained based on the classical test theory. Finally, Cronbach’s alpha was used. Results Measure of concordance showed scores considered adequate and excellent. The item discrimination index obtained a rating of “excellent” and suggested the preservation of all items. The discrimination coefficient scores are >0.74. The global internal consistency of the HBSCQ was 0.384. HBSCQ specification between groups of internal consistency for the sample of men was 0.712 and that for the sample of women was 0.378. Conclusion/implications for practice The HBSCQ represents a proposal for a fast, simple, and innovative screening test, which aims to identify persons who may benefit from interventions to promote health behaviors delimited to the stage of change. PMID:28356769
Mabary-Olsen, Elizabeth A.; Litchfield, Ruth E.; Foster, Randal; Lanningham-Foster, Lorraine; Campbell, Christina
Summer 4-H camps present an untapped opportunity for advancement of mission mandates. The project reported here immersed campers in healthy living experiential learning. The goal was to improve self-efficacy and health behaviors related to nutrition and physical activity. Data was collected from enrolled campers through multiple survey tools. A…
Duncan, Greg J.; Ziol-Guest, Kathleen M.; Kalil, Ariel
This article assesses the consequences of poverty between a child's prenatal year and 5th birthday for several adult achievement, health, and behavior outcomes, measured as late as age 37. Using data from the Panel Study of Income Dynamics (1,589) and controlling for economic conditions in middle childhood and adolescence, as well as demographic…
Mustafa, Osama M.
The high prevalence of burnout among healthcare professionals warrants a thorough examination aimed at improving the current understanding of its predictors and preventive measures. Cecil et al. have underscored the alarming prevalence of burnout among medical students and assessed its association with demographic, lifestyle, and behavioral factors. Of interest, health behaviors were found to be predictive of burnout. The study suggests certain behaviors (such as high physical activity) to be protective, and thus, calls for their establishment early in college life to prevent the development of this professionally-disabling mental state. Although the adoption of advisable health behaviors may independently reduce the risk of burnout, recognition of the existence and influence of closely related factors allows for an enhanced understanding and a greater precision for any conclusions to be made. Personality, through deductive and inductive reasoning, is likely to exert significant influence on both the student's behavior and his/her susceptibility to burnout. Thus, with personality representing – in and of itself – a principal model for prediction of burnout risk, controlling for personality traits when addressing health behaviors’ influence per se on burnout is essential. PMID:26365101
Testa, Marcia A.; Spackman, Thomas J.
The transfer of information within the academic health center is complicated by the complex nature of the institution's multi-dimensional role. The diverse functions of patient care, administration, education and research result in a complex web of information exchange which requires an integrated approach to system management. System integration involves a thorough assessment of “end user” needs in terms of hardware and software as well as specification of the communications network architecture. The network will consist of a series of end user nodes which capture, process, archive and display information. This paper will consider some requirements of these nodes, also called intelligent workstations, relating to their management and integration into a total health care network.
Stucki, Gerold; Bickenbach, Jerome; Melvin, John
A complete understanding of the experience of health requires information relevant not merely to the health indicators of mortality and morbidity but also to functioning-that is, information about what it means to live in a health state, "the lived experience of health." Not only is functioning information relevant to healthcare and the overall objectives of person-centered healthcare but to the successful operation of all components of health systems.In light of population aging and major epidemiological trends, the health strategy of rehabilitation, whose aim has always been to optimize functioning and minimize disability, will become a key health strategy. The increasing prominence of the rehabilitative strategy within the health system drives the argument for the integration of functioning information as an essential component in national health information systems.Rehabilitation professionals and researchers have long recognized in WHO's International Classification of Functioning, Disability and Health the best prospect for an internationally recognized, sufficiently complete and powerful information reference for the documentation of functioning information. This paper opens the discussion of the promise of integrating the ICF as an essential component in national health systems to secure access to functioning information for rehabilitation, across health systems and countries.
Park, Grace; Miller, Diane; Tien, George; Sheppard, Irene; Bernard, Michael
Background A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions. Description of integrated practice An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues. Early results The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased). Conclusion Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients. PMID:24648834
Kim, Sang Hoon; Yang, Kyung Hoon; Park, Sunyoung
The authors found the behavioral factors that influence the organization members' compliance with the information security policy in organizations on the basis of neutralization theory, Theory of planned behavior, and protection motivation theory. Depending on the theory of planned behavior, members' attitudes towards compliance, as well as normative belief and self-efficacy, were believed to determine the intention to comply with the information security policy. Neutralization theory, a prominent theory in criminology, could be expected to provide the explanation for information system security policy violations. Based on the protection motivation theory, it was inferred that the expected efficacy could have an impact on intentions of compliance. By the above logical reasoning, the integrative behavioral model and eight hypotheses could be derived. Data were collected by conducting a survey; 194 out of 207 questionnaires were available. The test of the causal model was conducted by PLS. The reliability, validity, and model fit were found to be statistically significant. The results of the hypotheses tests showed that seven of the eight hypotheses were acceptable. The theoretical implications of this study are as follows: (1) the study is expected to play a role of the baseline for future research about organization members' compliance with the information security policy, (2) the study attempted an interdisciplinary approach by combining psychology and information system security research, and (3) the study suggested concrete operational definitions of influencing factors for information security policy compliance through a comprehensive theoretical review. Also, the study has some practical implications. First, it can provide the guideline to support the successful execution of the strategic establishment for the implement of information system security policies in organizations. Second, it proves that the need of education and training programs suppressing
Kim, Sang Hoon; Yang, Kyung Hoon; Park, Sunyoung
The authors found the behavioral factors that influence the organization members' compliance with the information security policy in organizations on the basis of neutralization theory, Theory of planned behavior, and protection motivation theory. Depending on the theory of planned behavior, members' attitudes towards compliance, as well as normative belief and self-efficacy, were believed to determine the intention to comply with the information security policy. Neutralization theory, a prominent theory in criminology, could be expected to provide the explanation for information system security policy violations. Based on the protection motivation theory, it was inferred that the expected efficacy could have an impact on intentions of compliance. By the above logical reasoning, the integrative behavioral model and eight hypotheses could be derived. Data were collected by conducting a survey; 194 out of 207 questionnaires were available. The test of the causal model was conducted by PLS. The reliability, validity, and model fit were found to be statistically significant. The results of the hypotheses tests showed that seven of the eight hypotheses were acceptable. The theoretical implications of this study are as follows: (1) the study is expected to play a role of the baseline for future research about organization members' compliance with the information security policy, (2) the study attempted an interdisciplinary approach by combining psychology and information system security research, and (3) the study suggested concrete operational definitions of influencing factors for information security policy compliance through a comprehensive theoretical review. Also, the study has some practical implications. First, it can provide the guideline to support the successful execution of the strategic establishment for the implement of information system security policies in organizations. Second, it proves that the need of education and training programs suppressing
Lee, Young Ji; Boden-Albala, Bernadette; Quarles, Leigh; Wilcox, Adam; Bakken, Suzanne
The objective of this study was to examine factors predicting use of the Internet to seek health information among Hispanics in the Washington Heights and Inwood areas of New York City. Data were collected by community health workers through the Washington Heights/Inwood Informatics Infrastructure for Community-Centered Comparative Effectiveness Research (WICER) community survey and a random sample of 100 surveys was selected for analysis. Binary logistic regression (N=100) was used to examine predictors of online health information-seeking behaviors (HISBs) of respondent and household members (dependent variables). Younger age, better health status, and higher education level significantly predicted respondents' HISBs. Respondents' health status and education level also significantly predicted household members' HISBs.
Kahn, Robert S.; Wilson, Kathryn; Wise, Paul H.
OBJECTIVE: Relatively little is known about the intergenerational mechanisms that lead to social disparities in child health. We examined whether the association between low socioeconomic status (SES) and child behavior problems is mediated by maternal health conditions and behavior. METHODS: Prospective cohort data (1979-1998) on 2,677 children and their mothers were obtained from the National Longitudinal Survey of Youth. SES, the Child Behavior Problems Index (BPI), and maternal smoking, depressive symptoms, and alcohol use before, during, and after pregnancy were examined. RESULTS: Lower income and lower maternal education were associated with increased child BPI scores. Adjustment for maternal smoking, depressive symptoms, and alcohol use attenuated the associations between SES and child BPI by 26% to 49%. These maternal health conditions often occurred together, persisted over time, and were associated with the mother's own childhood SES and pre-pregnancy health. CONCLUSIONS: Social disparities in women's health conditions may help shape the likelihood of behavior problems in the subsequent generation. Improved public health programs and services for disadvantaged women across the lifecourse may not only address their own urgent health needs, but reduce social disparities in the health and well-being of their children. PMID:16025720
Parent, Mike C.; Alquist, Jessica L.
Although some popular press and nonscholarly sources have claimed that weight is largely unchangeable, the relationship between this belief and objective measures of health remains unclear. We tested the hypothesis that people who believe weight is unchangeable will have poorer objective and subjective health, and fewer exercise behaviors and…
Higgins, Stephen T.
This Special Issue of Preventive Medicine (PM) is the 3rd that we have organized on behavior change, health, and health disparities. This is a topic of critical importance to improving U.S. population health. There is broad scientific consensus that personal behaviors such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. Hence, effectively promoting health-related behavior change needs to be a key component of health care research and policy. There is also broad recognition that while these problems extend throughout the population, they disproportionately impact economically disadvantaged populations and other vulnerable populations and represent a major contributor to health disparities. Thus, behavior change represents an essential step in curtailing health disparities, which receives special attention in this 3rd Special Issue. We also devote considerable space to the longstanding challenges of reducing cigarette smoking and use of other tobacco and nicotine delivery products in vulnerable populations, obesity, and for the first time food insecurity. Across each of these topics we include contributions from highly accomplished policymakers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges. PMID:27693562