Knowing the risk: relationships between risk behaviour and health knowledge

Communicating risk is a key public health strategy. The implicit assumptions are that the public interprets risk information in a logical fashion and adopts behavioural changes to reduce risk. We assessed risk behaviour, and knowledge and perception of voluntary and involuntary risks using an anonymous questionnaire completed by 472 students. Risk-taking behaviour was measured as the number of different risk behaviours undertaken in the previous 12 months. Knowledge and perception were measured by the extent to which subjects agreed with statements of risk-related information. These varied in complexity from simple statements linking a behaviour with a health risk to numerical statements describing the strength of such relationships. Risk-taking behaviour was highest amongst younger people, males, people whose parents were in non-manual occupations, and people who believed in God (risk-taking behaviour was not related to voting preference or birth order). Overall, knowledge was not significantly related to risk-taking behaviour (P=0.889). However, risk-taking was positively related to more accurate responses to numerical risk questions (P<0.001) and risk-takers were also more likely to perceive both voluntary and involuntary risks as less risky (P<0.05). At least in this cohort, more information about risk is not related to lower risk behaviour. In fact, those individuals with a better understanding of the precise risk associated with certain behaviours were more likely to be higher risk-takers while those who consistently over-estimated risks were low risk-takers. Overall, knowledge and perception of risk explained relatively little of the variance in behaviour. Although these findings need further examination within the general population, public health measures should not assume that information campaigns will necessarily lead to a reduction in risk behaviour.     

Organisation of ambulatory care by consumers

Abstract This paper deals with how consumers arrange their ambulatory care in a system such as the United States which offers many possible choices. Patters of the different affiliations (sources) that people maintain throughout the year for ambulatory care are formed. The data were obtained in interviews in a sample survey of Rhode Island households conducted in 1974. Although most people in the sample (89.5 per cent) cluster with one to three sources of care, there were over 80 people with four or more affiliations. For those persons with a large number of affiliations, the provider sets become quite varied. Two conceptual typologies are formed, one focusing on type (private physicians versus places) and the other focusing on both the speciality of the physicians involved and the number of different affiliations involved. The United States, at least in theory, maintains a‘free market’health care system. Are there limitations of choice imposed by differential distributions of knowledge, income or age? A wide array of social, demographic, and illness variables were examined to determine their relationship to the patterns. Income has little relationship with the provider set patterns, but persons with a higher education are more likely to report a provider set that includes a primary care specialist (internist or paediatrician), rather than a general practitioner or osteopath. Blacks have different patterns of providers, as do those on Medicaid funding. Thus there is evidence of the continuation of a dual market for health care. The research describes the diversity and complexity of current health care patterns under a loosely structured system of health care such as that found in the United States. While the British health system has traditionally represented a tightly structured system with one path of entry (the general practitioner) into more complex health care services, this may be changing somewhat if current trends in the growth of the private insurance sector in Great Britain continue. Thus the experience of the United States may be of greater policy interest in Britain in the future. There has been a great deal of research in medical sociology and health services research dealing with health behaviour, especially as it relates to ambulatory medical care services. This paper examines how people structure their own health care with the presumably‘free market’system of choice such as operates in the United States. It provides an introductory picture of how people organise services and the variety of sources to which they go to fulfil their medical needs. Berkanovic and Reeder have pointed out that one can study use of medical services through examining the sources from which care Is received or the volume.¹ Much past research has focused on volume of care, emphasising amount of utilisation and number of physicians visits or outpatients visits.^2,3,4,5 The aim of this paper is to analyse sources of care and patterns of ambulatory medical care, not utilisation statistics. An important question is whether there are limitations of choice imposed by differential distribution of social characteristics such as knowledge, income or age. This paper first describes patterns of care-seeking and then relates them to social, demographic and illness variables.     

Community attitudes to the sexual behaviour of young people in an urban area with high rates of sexual ill-health

CONTEXT: Adults in any community are a potentially important source of sexual health information for young people. Open discussion of sexual health issues is associated with low rates of sexual ill-health. Adults who disapprove of teenage sexual behaviour are poor sources of advice. The study of adult attitudes to the sexual behaviour of young people is relevant to work on improving access to sexual health services. SETTING: Adults' attitudes to the sexual behaviour of young people in an urban area with high indices of sexual ill-health were documented. DESIGN: Data were collected via questionnaires administered in popular shopping areas by local people after training. RESULTS: A total of 283 interviews were completed. Eighty-eight percent of respondents thought that the likely age of first sex among young people was under the age of consent but only 8% thought that the acceptable age of first intercourse was under 16 years. Knowledge of local services was suboptimal. Twenty percent of respondents did not know where young people could get contraception or advice on sexual health issues. Less than half (42%) suggested a general practitioner with a similar proportion suggesting a family planning clinic (FPC) or Brook clinic. When asked what services FPCs provide, only 40% mentioned contraception and 32% did not know. Despite their lack of knowledge, the majority (84%) of respondents would tell a young person where they could obtain contraception or sexual health advice. Seventy-six percent thought parents and 56% thought schools are the key sources of sexual health information for young people.CONCLUSIONS: Adults resident in this area have negative attitudes to the sexual behaviour of local young people and suboptimal knowledge of local contraceptive services. They do, however, identify themselves as potentially important sources of sexual health advice and may therefore benefit from more information and an opportunity to discuss their attitudes.     

A survey of nutrition knowledge, practice, attitudes and behaviour of general practitioner trainees in Ireland

Background: Medical research has acknowledged the relationship between nutrition and the development of chronic diseases, as well as the interaction between disease and nutritional status. However, nutrition education in the medical curriculum has been far from adequate. The present study was undertaken to examine the current status of nutrition awareness amongst general practitioner trainees throughout Ireland. Methods: A self-administered questionnaire (Q1) was used to assess the nutrition knowledge, attitudes, practice and behaviour of one hundred final year general practitioner trainees. A second questionnaire (Q2) was sent to the relevant medical faculties to ascertain the level of nutrition taught within the medical curricula. Results: The overall response rate to Q1 was 52% (34 females, 18 males). Respondents showed little awareness that nutrition had been included in their medical training. Q2 verified that nutrition mostly featured in the biochemistry component of the medical curricula. The results indicate the need to improve basic nutritional knowledge and its application in clinical practice. The disparity between the perceived importance of nutrition and personal lifestyle behaviours concurred with other studies. Conclusion: The general practitioner trainees were ill equipped to appreciate and value the extent of dietetic intervention for nutrition-related problems in clinical practice.     

Help-seeking at the time of stroke: stroke survivors' perspectives on their decisions

Stroke is a major cause of death and disability in many countries. Early access to the most appropriate medical treatment can improve health outcomes. Despite this, only 30-60% of people who experience a stroke seek medical help within the recommended 3-hour timeframe. This study used open-ended interviews to explore patients' views on factors that influenced their decision to seek help at the time of stroke. Twenty participants were recruited from five centres: three hospitals, a community-based stroke support service and a primary healthcare service focused on providing health care for Maori. A qualitative methodology drawing on Grounded Theory informed data collection and analysis. Four main themes influenced the decision to seek help: making sense of symptoms, maintaining a sense of normality, presence and influence of another person and perception of medical services. Participants appeared to go through a process of recognition, interpretation and negotiation during their decision-making. Each of the four themes seemed to influence this process, either assisting or delaying help-seeking behaviour. The more time spent going through this process (or repeating each step), the longer the delay appeared to be. Our key findings which add to current help-seeking literature, include: (1) people tended to prioritise everyday commitments and responsibilities over their own health; (2) at times the presence and influence of another person contributed to delays in seeking help; and (3) people had different personal thresholds for when they perceived themselves to be 'sick enough' to seek medical help.     

Practitioner and lay perspectives of the service provision of nutrition information leaflets in primary care

Background: In primary care, leaflets are often used to communicate health information. Increasingly, primary healthcare practitioners need to provide dietary advice. There is limited research exploring how nutrition information leaflets are used in primary care. The present study explored practitioner and lay experiences with respect to providing and receiving nutrition information in primary care, focusing in particular on the use of leaflets for nutrition information. Methods: A qualitative design was used incorporating focus groups with 57 practitioners based at seven general practitioner practices and a purposive sample of 30 lay participants attending six Consumer Health Organisations within one primary care trust. Focus groups were taped and transcribed verbatim and data were analysed thematically, assisted by computer software n6 ® (QSR International Pty Ltd, Melbourne, Australia). Results: Practitioners discussed barriers to giving nutritional advice, access to leaflets, lay receptiveness to advice and their perceptions about the value of leaflets to lay people. Food was not considered in terms of its nutritional components by lay participants and the need for nutritional information was not perceived to be relevant until they had received a medical diagnosis. Lay participants discussed the importance of receiving nutritional advice relating to their medical diagnosis and the altered status of written information that was delivered personally. Practitioner and lay groups suggested improvements to ensure that nutritional advice be supported by relevant and appropriate written information. Conclusions: This research has underlined the continuing importance of nutrition information leaflets and concludes that there is particular value in involving lay participants in the development of nutrition information leaflets.     

Socioeconomic status overrides age and gender in determining health-seeking behaviour in rural Bangladesh

OBJECTIVE: To study the health-seeking behaviour of elderly members (aged > 60 years) of households in rural Bangladesh, to ascertain how their behaviour differs from that of younger people (aged 20-59 years) living in the same household and to explore the determinants of health-seeking behaviour. METHODS: Structured interviews were conducted to elicit information on the health-seeking behaviour of household members aged > 20 years. Respondents were asked about major illnesses occurring within 15 days prior to the interview. The sample consisted of 966 households that had at least one resident who was aged > 60 (32% of 3031 households). FINDINGS: We found no major differences in health-seeking behaviour between elderly people and younger adults. On average about 35% (405/1169) of those who reported having been ill during the previous 15 days in both age groups chose self-care/self-treatment; for both age groups the most commonly consulted type of provider was a paraprofessional such as a village doctor, a medical assistant or a community health worker. A household''s poverty status emerged as a major determinant of health-seeking behaviour. The odds ratio (OR) that individuals from poor households would seek treatment from unqualified allopathic practitioners was 0.6 (95% confidence interval (CI) = 0.40-0.78); the odds ratio that individuals from poor households would seek treatment from qualified allopathic practitioners was 0.7 (95% CI = 0.60-0.95). For self-care or self-treatment it was 1.8 (95% CI = 1.43-2.36). Patients'' level of education affected whether they avoided self-care/self-treatment and drugstore salespeople (who are usually unlicensed and untrained but who diagnose illnesses and sell medicine) and instead chose a formal allopathic practitioner (OR = 1.5; 95% CI = 1.15-1.96). When a household''s poverty status was controlled for, there were no differences in age or gender in terms of health-care expenditure. CONCLUSION: We found that socioeconomic indicators were the single most pervasive determinant of health-seeking behaviour among the study population, overriding age and sex, and in case of health-care expenditure, types of illness as well.     

Use of online health information to manage children’s health care: a prospective study investigating parental decisions

Background

The use of the internet to access information is rapidly increasing; however, the quality of health information provided on various online sites is questionable. We aimed to examine the underlying factors that guide parents’ decisions to use online information to manage their child’s health care, a behaviour which has not yet been explored systematically.

Methods

Parents (N?=?391) completed a questionnaire assessing the standard theory of planned behaviour (TPB) measures of attitude, subjective norm, perceived behavioural control (PBC), and intention as well as the underlying TPB belief-based items (i.e., behavioural, normative, and control beliefs) in addition to a measure of perceived risk and demographic variables. Two months later, consenting parents completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their use of online information to manage their child’s health care during the previous 2 months.

Results

We found support for the TPB constructs of attitude, subjective norm, and PBC as well as the additional construct of perceived risk in predicting parents’ intentions to use online information to manage their child’s health care, with further support found for intentions, but not PBC, in predicting parents’ behaviour. The results of the TPB belief-based analyses also revealed important information about the critical beliefs that guide parents’ decisions to engage in this child health management behaviour.

Conclusions

This theory-based investigation to understand parents’ motivations and online information-seeking behaviour is key to developing recommendations and policies to guide more appropriate help-seeking actions among parents.

     

Where do college students get health information? Believability and use of health information sources

This study aims to identify predictors of use of health information sources among U.S. college students. For this purpose, the Spring 2006 American College Health Association-National College Health Assessment (ACHA-NCHA) database of 94,806 students at 117 colleges and universities was used. Univariate and multivariable analyses of survey data were conducted. The four most believable sources of health information as indicated by survey respondents were health center medical staff, health educators, faculty or coursework, and parents. Health center medical staff, health educators, and faculty or coursework were underutilized in relation to their perceived believability, whereas parents were both used and believed at high frequencies. In general, older students, females, full time students, and Black and Hispanic students were more likely to use information from one of the four health sources. However, there was considerable subgroup variability, especially in the use of parents as a health information source. The authors conclude that information on use and believability of health information sources can help colleges to design more effective health information campaigns.     

Variations in trust in Dr Google when experiencing potential breast cancer symptoms: exploring motivations to seek health information online

How people trust the internet and seek health information online when experiencing and interpreting potential cancer symptoms is not well understood. We interviewed 27 women who had recently experienced at least one potential breast cancer symptom, and explored their symptom experience, help-seeking strategies, and whether they consulted the internet in relation to their symptoms. We conducted a thematic analysis and constructed a typology of attitudes towards, and experiences of, consulting the internet about the symptoms: i) confident; ii) neutral; iii) hesitant; and iv) avoidant. ‘Hesitant’ and ‘avoidant’ participants rarely mentioned cancer explicitly, doubted being able to interpret the information found online, and expressed concerns over finding ‘scaremongering’ information or making incorrect self-diagnosis. The ‘avoiders’ and the ‘hesitant’ participants perceived online information-seeking as being inherently risky, partly because online health content is likely to be inaccurate or exaggerated, and partly because the process of lay interpretation is likely to be flawed by lack of medical expertise. The findings suggest that not all women experiencing potential breast cancer symptoms seek health information online spontaneously or trust the internet as a legitimate source of health information. The women who did engage in online information seeking, particularly those with lower education, felt unsure about how to appraise online health sources to interpret their symptoms.     

Why do older people not get immunised against influenza? A community survey

Many older people who would benefit from influenza vaccine do not get immunised. We carried out a postal questionnaire survey of people aged 65 years and over living in the community to explore views about influenza vaccine and identify ways of improving uptake. Completed questionnaires were returned by 1468/2553 (57.5%). Vaccine coverage for 1998-1999 season was 50.5% (95% confidence interval (CI) 47.9-53.1%). Important predictor variables for non-uptake included absence of medical risk factors, perceived good health, lack of advice from a doctor or nurse, and negative views on vaccine efficacy and safety. Most people had to request vaccination, only one in five got a reminder from their general practitioner. There is scope for improving influenza vaccine coverage in older people by placing more emphasis in patient information materials on vaccine efficacy and safety and by greater use of reminders.     

Tobacco Risk Information and Comparative Risk Assessment of E-Cigarettes Vs. Cigarettes: Application of the Reinforcing Spirals Model

We examine how individuals seek information about e-cigarette risk and selectively expose themselves to media sources that may provide information consistent with their existing beliefs and behaviors related to e-cigarettes in application of the Reinforcing Spirals Model (Slater, 2007). Additionally, the associations among e-cigarette risk information-seeking, tobacco risk information exposure via media, and comparative risk assessment of e-cigarettes versus conventional cigarettes were identified. The results were compared among current users, former users, and those who had never used e-cigarettes (“never users”). A nationally representative data from the 2017 Health Information National Trends Surveys - FDA was employed. Our analyses suggest the presence of comparative risk perception among current users as assessing the health harm and addiction risk of e-cigarettes significantly lower than cigarettes. Current users did not avoid information about the health effects of e-cigarettes; they were more likely to look for such information than former and never users. Current users’ e-cigarette risk information-seeking was negatively associated with the difference between perceived addiction risk of e-cigarettes and that of cigarettes. Current users’ tobacco risk information exposure via social media was related with a lower level of the perceived risk of e-cigarettes, while such exposure via news media was related with a higher level of perceived risk of e-cigarettes. Our findings suggest the need for regulating and counteracting the prevalent e-cigarette information that discounts the relative risks of e-cigarettes as well as the potential of news media as influential sources helping current users scrutinize the risks.     

Factors associated with health care utilization by the elderly in a public health care system

OBJECTIVE: The objective was to determine the factors associated with the use of health care services by the elderly residing in the community. METHODS: A cross-sectional study on 787 elderly people over 64 years of age from Albacete City (Castilla-La Mancha, Spain). The study was carried out by personal home interviews during a 9-month period. The dependent variables were: health care utilization, and characteristics. The independent variables were: self-reported health status, self-reported morbidity, medication use, functional status, mental health, lifestyle habits, social support, and sociodemographic status. RESULTS: The health care services were used by 74.5% in the last 3 months of which 59.4% were general practitioner visits, 18.4% were to nursing staff, and 16.5% were specialist visits. Laboratory tests were performed in 39.2% and radiological examinations in 24.9%. Emergency visits accounted for 2.4%, and hospitalization, 2.9%. Users of health care services among the elderly population were objectively more ill, although there was a group of healthy individuals who also visited the physician and a large group of elderly with considerable health problems who never saw their physician. In the multivariate analysis, general practitioner utilization was independently associated with a perceived unmet need for care (OR = 3.15), a negative self-reported health status (OR = 2.51), and a lower educational level (OR = 2.41). CONCLUSIONS: Subjective factors as perceived need for care, a negative self-reported health status and lower educational level are important factors that influence in the utilization of health care services.     

Explaining variation in health information seeking behaviour – Insights from a multilingual survey

ObjectiveHow best to provide an increasingly diverse population with health information has become a major concern for health policy makers in Europe and beyond. Our study aims to investigate factors explaining variation in people’s health information seeking behaviour. Our findings can be used to identify target groups for policy interventions that aim to provide health information efficiently.MethodsCross-sectional, paper-based, multilingual survey of a random sample of enrolees of two statutory health insurers in Hamburg, Germany. Data were collected from September to December 2017. Multivariable logistic regression was used to examine sociodemographic and health-related individual characteristics and their associations with participants’ choice of ten sources of health information.FindingsParticipants’ choice of information sources differed significantly across the following sociodemographic and health-related characteristics: age, gender, immigration status, education, employment status, marital status and general state of health. Immigrants and individuals with low educational attainment were most likely to use emergency departments as sources of health information.ConclusionPolicy interventions aiming to manage the use of health information sources should focus on immigrants and individuals with low educational attainment. Providing multilingual, low-threshold counselling and information services could be an efficient way to reduce short-term costs of health information seeking behaviour to health insurers or other payers of care while improving patient empowerment.     

Understanding Health Information Seeking: A Test of the Risk Perception Attitude Framework

The authors used the Risk Perception Attitude framework, which is grounded in the Extended Parallel Process Model, to predict people's intentions to seek health information. In an online survey, 689 participants recruited from a crowdsource website were queried about their anticipated health information seeking, perceived risk, and efficacy in response to four scenarios pertaining to hypertension, hypercholesterolemia, alcohol dependence, and diabetes. Each participant was categorized for each scenario as responsive (higher risk, higher efficacy), avoidant (higher risk, lower efficacy), proactive (lower risk, higher efficacy), or indifferent (lower risk, lower efficacy). As predicted, responsive individuals were more likely to seek information than avoidant individuals, but only in three of the four scenarios. Also as expected, there was no difference between proactive and indifferent individuals’ likelihood of seeking health information for any scenario. Risk and efficacy, while significant predictors of anticipated health information seeking, left much of the variance unexplained. An analysis of the reasons for information seeking and nonseeking among nonconforming cases suggests that a wider range of influences on health information seeking should be investigated, including curiosity, prior knowledge, social expectations, and situational norms.     

Believing in Expertise: How Authors’ Credentials and Language Use Influence the Credibility of Online Health Information

Today, many people use the Internet to seek health advice. This study examines how an author’s expertise is established and how this affects the credibility of his or her online health information. In a 2 (authors’ credentials: medical vs. nonmedical) × 2 (authors’ language use: technical vs. every day) within-subjects design, 127 study participants, or “seekers,” judged authors’ expertise, benevolence, and integrity as well as the credibility of their medical statements. In addition, we assessed seekers’ awareness of their own knowledge and behavior. Results revealed that users consciously rewarded authors’ credentials and subconsciously punished technical language. Seekers were keenly aware of authors’ credentials and perceived authors with medical credentials to have a higher level of expertise and their information to be more credible. Technical language use negatively affected authors’ integrity and the credibility of their health information, despite seekers being unaware of it. Practical implications for health communication and implications for future research are outlined.     

XRAYS (eXamining Relevance of Articles to Young Survivors) Program Survey of Information Needs and Media Use by Young Breast Cancer Survivors and Young Women at High-Risk for Breast Cancer

Women age 45 years or younger with breast cancer, or who are at high-risk for breast cancer due to previously having the disease or to genetic risk, have distinct health risks and needs from their older counterparts. Young women frequently seek health information through the Internet and mainstream media, but often find it does not address their particular concerns, that it is difficult to evaluate or interpret, or even misleading. To help women better understand media coverage about new research, Facing Our Risk of Cancer Empowered (FORCE) developed the CDC-funded XRAYS (eXamining Relevance of Articles to Young Survivors) program. To assure that the XRAYS program is responsive to the community’s needs, FORCE launched a web-based survey to assess where young women seek information about breast cancer, and to learn their unmet information needs. A total of 1,178 eligible women responded to the survey. In general, the breast cancer survivors and high-risk women between ages 18–45 years who responded to this survey, are using multiple media sources to seek information about breast cancer risk, prevention, screening, and treatment. They place trust in several media sources and use them to inform their medical decisions. Only about one-third of respondents to this survey report discussing media sources with their health care providers. Current survey results indicate that, by providing credible information on the quality of evidence and reporting in media reports on cancer, XRAYS is addressing a key need for health information. Results suggest that it will be useful for XRAYS to offer reviews of articles on a broad range of topics that can inform decisions at each stage of risk assessment and treatment.     

Chronic disease, functional health status, and demographics: a multi-dimensional approach to risk adjustment.

OBJECTIVE. The goal of this study was to develop unbiased risk-assessment models to be used for paying health plans on the basis of enrollee health status and use propensity. We explored the risk structure of adult employed HMO members using self-reported morbidities, functional status, perceived health status, and demographic characteristics. DATA SOURCES/STUDY SETTING. Data were collected on a random sample of members of a large, federally qualified, prepaid group practice, hospital-based HMO located in the Pacific Northwest. STUDY DESIGN. Multivariate linear nonparametric techniques were used to estimate risk weights on demographic, morbidity, and health status factors at the individual level. The dependent variable was annual real total health plan expense for covered services for the year following the survey. Repeated random split-sample validation techniques minimized outlier influences and avoided inappropriate distributional assumptions required by parametric techniques. DATA COLLECTION/EXTRACTION METHODS. A mail questionnaire containing an abbreviated medical history and the RAND-36 Health Survey was administered to a 5 percent sample of adult subscribers and their spouses in 1990 and 1991, with an overall 44 percent response rate. Utilization data were extracted from HMO automated information systems. Annual expenses were computed by weighting all utilization elements by standard unit costs for the HMO. PRINCIPAL FINDINGS. Prevalence of such major chronic diseases as heart disease, diabetes, depression, and asthma improve prediction of future medical expense; functional health status and morbidities are each better than simple demographic factors alone; functional and perceived health status as well as demographic characteristics and diagnoses together yield the best prediction performance and reduce opportunities for selection bias. We also found evidence of important interaction effects between functional/perceived health status scales and disease classes. CONCLUSIONS. Self-reported morbidities and functional health status are useful risk measures for adults. Risk-assessment research should focus on combining clinical information with social survey techniques to capitalize on the strengths of both approaches. Disease-specific functional health status scales should be developed and tested to capture the most information for prediction.     

Dietary behaviour of pregnant versus non-pregnant women

This study investigates dietary behaviour and the perceived role of food for health of pregnant versus non-pregnant women. Data were collected between 15 January 2003 and 15 March 2003 in Belgium. One hundred and forty-eight pregnant and 130 non-pregnant women aged between 20 and 40 years completed a self-administered questionnaire about their dietary behaviour and nutritional attitudes. Both sub-samples match with respect to individual factors such as relevant socio-demographics and general food perceptions. Pregnant women report higher consumption of fruits, which results in a better score for fibre intake. They also report higher consumption of beef and dairy products, as well as a higher fat intake. No difference in fish consumption between pregnant and non-pregnant women is observed. In line with recommendations, pregnant women report reduced consumption of food products with heightened safety-related risks, lower use of alcohol and tobacco, and safer food handling practices. Reduced intake of raw vegetables for food safety reasons is not compensated by higher intake of cooked vegetables. Pregnant women also report a lower frequency of moderate physical activity. Most differences in food choice by pregnant versus non-pregnant women pertain to the avoidance of specific, potentially harmful food groups. A substantial share of pregnant women does not follow upon recommendations with respect to alcohol use and exposure to tobacco. Personal medical sources for pregnant women and personal social sources for non-pregnant women are reported as the most attended sources of diet-related information. The perceived role of food for health is not different between pregnant and non-pregnant women, and there were no significant interaction effects between pregnancy and presence of children, which indicates that the observed differences in dietary behaviour can be attributed to the state of being pregnant.     

Access to health care among Australian adolescents young people's perspectives and their sociodemographic distribution.

PURPOSE: To identify the health concerns for which adolescent residents in New South Wales, Australia, do not receive health care, and the associated factors, including their sociodemographic distribution. METHODS: Purposive sampling was used to recruit school students who were stratified by gender and age (12-14, 14-16 and 16-17 years), from schools stratified by socioeconomic status and urban/rural location. Out-of-school young people were recruited through youth health services. Qualitative methods were used to collect and analyze data. RESULTS: Eighty-one focus groups were conducted. Most young people defined health solely in terms of their physical well-being, but still identified a broad range of situations, conditions, or behaviors which they believed might affect their health. One-third of females and two-thirds of males said they would not seek help for their health concerns, and when they did, were most likely to seek help from family, friends, or others they trusted. When professional help was sought, young people again preferred someone they knew and trusted. The three groups of barriers to accessing health care were: concerns about confidentiality, knowledge of services and discomfort in disclosing health concerns, and accessibility and characteristics of services. Factors related to use of health care services were associated with age, gender, and location, but rarely with socioeconomic status. CONCLUSIONS: The majority of these young people in New South Wales (particularly males) do not seek health care despite identifying a broad range of issues that affect their health.