Health Information–Seeking Behaviors,Health Indicators,and Health Risks

Objectives. We examined how different types of health information–seeking behaviors (HISBs)—no use, illness information only, wellness information only, and illness and wellness information combined—are associated with health risk factors and health indicators to determine possible motives for health information seeking.Methods. A sample of 559 Seattle–Tacoma area adults completed an Internet-based survey in summer 2006. The survey assessed types of HISB, physical and mental health indicators, health risks, and several covariates. Covariate-adjusted linear and logistic regression models were computed.Results. Almost half (49.4%) of the sample reported HISBs. Most HISBs (40.6%) involved seeking a combination of illness and wellness information, but both illness-only (28.6%) and wellness-only (30.8%) HISBs were also widespread. Wellness-only information seekers reported the most positive health assessments and the lowest occurrence of health risk factors. An opposite pattern emerged for illness-only information seekers.Conclusions. Our findings reveal a unique pattern of linkages between the type of health information sought (wellness, illness, and so on) and health self-assessment among adult Internet users in western Washington State. These associations suggest that distinct health motives may underlie HISB, a phenomenon frequently overlooked in previous research.Internet access is a widely available technology in the United States.^1,2 Among the variety of online activities, searching for and using health information appear to be particularly prevalent, undertaken by between 40% and 70% of US adults.^1,3–7 Hoping to take advantage of the Internet''s potential,⁸ public health practitioners, clinicians, and researchers have contributed to an emerging literature detailing characteristics of individuals engaging in health information–seeking behaviors (HISBs), exploring motives for engaging in HISBs, and documenting the types of health and medical information being sought.^9–11Previous HISB research has primarily examined how patients seek and use health information across diverse health care contexts, yielding the recurrent observation that individuals striving to deal with stressful health challenges—such as a recent illness diagnosis or chronic disease management—were strongly motivated to engage in Internet HISBs.^9,10,12–14 Several population-based studies,^9,15–21 many of which have also conceptualized HISB primarily as “a key coping strategy in health-promotive activities and psychosocial adjustment to illness,”^22(p1006) have yielded corresponding evidence. It should be recognized, however, that a cluster of these studies^17–19,21 were informed by a common evidentiary resource (i.e., 2000–2002 Pew Internet and American Life Project data), potentially exaggerating the apparent consistency of the “disease and illness” motivation for HISB.Although informative, the predominant focus in previous research on a “disease and illness” motive for HISB has left the hypothesis that healthy individuals may pursue information to maximize positive health outcomes essentially unexplored.²³ A small but growing body of findings suggests, however, that many individuals actively seek out wellness information (e.g., information promoting a healthy lifestyle). Specifically, emerging evidence reveals a positive association between a self-reported “health-conscious” or “health-active” orientation and engaging in wellness information–seeking behavior.^20,24–27 Indeed, since 2000, the proportion of American adults reporting that they have looked online for diet, exercise, or fitness information has increased substantially and generally exceeds the proportion seeking online information about disease and illness topics (e.g., cancer, arthritis, diabetes).^28,29Pandey et al. have asked, “Is it a disease or an affliction that motivates the use of the internet, or is it that the well and the healthy use the internet in a proactive manner?”^23(p180) As this question highlights, the nearly exclusive focus in previous research on Internet HISB as a response to health-threatening situations has left questions regarding the potential positive health outcomes motivating HISB unanswered.²² We aimed to fill this knowledge gap and further expand understanding of linkages between HISB and health perceptions and behaviors. Specifically, we compared mental and physical health indicators and health risk factors across 4 discrete categories of Internet HISBs—no use, illness content only, wellness content only, and illness and wellness content combined—among a sample of adults in the Seattle–Tacoma, Washington area to explore motivations of HISB.     

Where Is Women's Health in Maternal and Child Health?

Maternal and Child Health Journal -     

Racial and Ethnic Disparities and Perceptions of Health Care: Does Health Plan Type Matter?

OBJECTIVE: To examine whether racial and ethnic differences in the distribution of individuals across types of health plans explain differences in satisfaction and trust with their physicians. DATA SOURCES: Data were derived from the 1998-1999 Community Tracking Household and Followback Studies and consisted of a nationwide sample of adults (18 years and older). DATA COLLECTION: The data were collected by telephone survey. Surveys were administered in English and Spanish. The response rate for the Household Survey was 63 percent, and the match rate for the Followback Survey was 59 percent. STUDY DESIGN: Multivariate analyses used regression methods to detect independent effects of respondent race and ethnicity on satisfaction and trust with physician, while controlling for enrollment in different types of health plans. PRINCIPAL FINDINGS: Racial and ethnic minorities are more likely than whites to have lower levels of trust and satisfaction with their physician. The most prominent differences occurred within the Latino and Native American/Asian American/Pacific Islander/Other ("Other") populations. Plan type does not mitigate the relationship between race/ethnicity and trust and satisfaction for the overall adult population. CONCLUSIONS: Disparate levels of trust and satisfaction exist within ethnic and minority populations, even when controlling for the distribution of individuals across types of health plans. The results demonstrate a need to better understand the health care-related factors that drive disparate trust and satisfaction.     

Tweeting as Health Communication: Health Organizations’ Use of Twitter for Health Promotion and Public Engagement

This study examined how major health organizations use Twitter for disseminating health information, building relationships, and encouraging actions to improve health. The sampled organizations were the American Heart Association, American Cancer Society, and American Diabetes Association. A content analysis was conducted on 1,583 tweets to examine these organizations’ use of Twitter's interactive features and to understand the message functions and topics of their tweets. The numbers of retweets and favorites were also measured as engagement indicators and compared by different message functions. The results revealed that all of the organizations posted original tweets most, but they differed in the degree to which they used the retweet and reply functions. Hashtags and hyperlinks were the most frequently used interactive tools. The majority of the tweets were about organization-related topics, whereas personal health–related tweets represented a relatively small portion of the sample. Followers were most likely to like and retweet personal health action-based messages.     

Health Promotion and Managed Care:: Surveys of California’s Health Plans and Population

Introduction:The purpose was to examine whether health-promotion programs offered by California health plans are a serious attempt to improve health status or a marketing device used in an increasingly competetive marketplace. The research examined differences in the coverage, availability, utilization, and evaluation of health-promotion programs in California health plans.Methods:A mail survey was done of the 35 HMOs (86% response) and 18 health insurance carriers (83% response) licensed to sell comprehensive health insurance in California in 1996 (some plans sell both HMO and PPO/indemnity products). The final sample included 30 commercial HMOs and 20 PPO and indemnity plans. The 1996 California Behavioral Risk Factor Survey (BRFS) of 4,000 adults was used to estimate population participation rates in health-promotion programs.Results:California’s HMOs in 1996 offered more comprehensive preventive benefits and health-promotion programs compared to PPO and indemnity plans. HMOs relied on a more comprehensive set of health-education methods to communicate health information to members and were more likely to open their programs to the public. HMOs are also more likely to have developed relationships with community-based and public health providers. Participation in health-promotion programs is low (2%–3%), regardless of plan type, and most health plans limit evaluations to assessment of member satisfaction and utilization. Only 35%–45% of HMOs, and no PPO/indemnity plans, assess the impact of health-promotion programs on health risks and behaviors, health status, or health care costs.Conclusion:For the majority of California’s PPO and indemnity plans, health promotion is not an integral part of their business. For the majority of HMOs, health-promotion programs are offered primarily as a marketing vehicle. However, a substantial minority of HMOs offer health-promotion programs to achieve other organizational goals of health improvement and cost control.     

Health and Humanitarian Migrants’ Economic Participation

Refugees and immigrants being resettled in Australia on humanitarian grounds are known to have poorer health than other immigrants. Using data from the Longitudinal Surveys of Immigrants to Australia, the paper examines the influence of three measures of health—self-reported health status, the presence of a long-term health condition and mental health status—on the economic participation of humanitarian migrants. Multivariate logistic regression is used to control for other factors known to affect immigrants’ economic participation, such as age, skills and English language proficiency, to see if health has an independent effect. The results show that migrants with poor physical health are less likely than migrants with good health to be in the work force. Mental health status affects the economic participation of male but not female migrants. The findings provide important empirical evidence of the significant role of health in the economic integration of migrants of refugee background.     

Disparities in Adolescent Health and Health Care: Does Socioeconomic Status Matter?

DATA COLLECTION/EXTRACTION METHODS: National household survey. DATA SOURCES/STUDY SETTING: We analyzed data on 12,434 adolescents (10 through 18 years old) included in the 1999 and 2000 editions of the National Health Interview Survey. STUDY DESIGN: We assessed the presence of income gradients using four income groups. Outcome variables included health status, health insurance coverage, access to and satisfaction with care, utilization, and unmet health needs. PRINCIPAL FINDINGS: After adjustment for confounding variables using multivariate analysis, statistically significant disparities were found between poor adolescents and their counterparts in middle- and higher-income families for three of four health status measures, six of eight measures of access to and satisfaction with care, and for six of nine indicators of access to and use of medical care, dental care, and mental health care. CONCLUSION: Our analyses indicate adolescents in low-income families remain at a disadvantage despite expansions of the Medicaid program and the comparatively new State Children's Health Insurance Program (SCHIP). Additional efforts are needed to ensure eligible adolescents are enrolled in these programs. Nonfinancial barriers to care must also be addressed to reduce inequities.     

Patterns of Health Insurance Discontinuity and Children’s Access to Health Care

Objectives This study classified patterns of discontinuous health insurance coverage, including change in coverage type and gaps in coverage, and described their associations with children’s access to health care. Methods Using the 2011–2013 National Health Interview Survey data, we determined children’s insurance coverage over the past year, and whether children had a usual source of care, had to delay getting care, or had unmet health care needs. Using multivariable logistic regression, we compared measures of access to care across insurance coverage patterns, classified as continuous private coverage; continuous public coverage; continuous lack of coverage; change in coverage type (public versus private) without gaps in coverage; and any gap in coverage. A subgroup analysis repeated this comparison for children with a caregiver-reported chronic physical illness. Results The analysis included 34,105 children, of whom 7% had a gap in coverage and 1% had a change in coverage type. On multivariable analysis, gaps in coverage were associated with increased likelihood of unmet health care needs, compared to continuous private (OR 6.9; 95% CI 5.9, 8.0) or continuous public coverage (OR 5.1; 95% CI 4.4, 6.0). Seamless changes in coverage were also associated with greater likelihood of unmet health care needs [OR vs. private: 3.8 (95% CI 2.3, 6.1); OR vs. public: 2.8 (95% CI 1.8, 4.6); all p < 0.001]. Results were similar for other study outcomes, and among children with chronic physical illness. Conclusions for Practice Both gaps in coverage and seamless changes between coverage types were associated with limited health care access for children.

     

Children’s Receipt of Health Care Services and Family Health Insurance Patterns

PURPOSE Insured children in the United States have better access to health care services; less is known about how parental coverage affects children’s access to care. We examined the association between parent-child health insurance coverage patterns and children’s access to health care and preventive counseling services.METHODS We conducted secondary analyses of nationally representative, cross-sectional, pooled 2002–2006 data from children (n = 43,509), aged 2 to 17 years, in households responding to the Medical Expenditure Panel Survey (MEPS). We assessed 9 outcome measures pertaining to children’s unmet health care and preventive counseling needs.RESULTS Cross-sectionally, among US children (aged 2 to 17 years) living with at least 1 parent, 73.6% were insured with insured parents, 8.0% were uninsured with uninsured parents, and the remaining 18.4% had discordant family insurance coverage patterns. In multivariable analyses, insured children with uninsured parents had higher odds of an insurance coverage gap (odds ratio [OR] = 2.45; 95% confidence interval [CI], 2.02–2.97), no usual source of care (OR = 1.31; 95% CI, 1.10–1.56), unmet health care needs (OR = 1.11; 95% CI, 1.01–1.22), and having never received at least 1 preventive counseling service (OR = 1.20; 95% CI, 1.04–1.39) when compared with insured children with insured parents. Insured children with mixed parental insurance coverage had similar vulnerabilities.CONCLUSIONS Uninsured children had the highest rates of unmet needs overall, with fewer differences based on parental insurance status. For insured children, having uninsured parents was associated with higher odds of going without necessary services when compared with having insured parents.     

School-Based Health Centers: Cost�CBenefit Analysis and Impact on Health Care Disparities

Objectives. We evaluated the impact of school-based health centers—which provide essential health care for students by aiming to eliminate many access barriers—on health care access disparities and conducted a cost–benefit analysis.Methods. We employed a longitudinal quasi-experimental repeated-measures design. Primary data sources included the Ohio Medicaid claims, enrollment file with race/ethnicity, and survey reports from parents. We used hierarchical linear modeling to control unbalanced data because of student attrition. We assessed quarterly total Medicaid reimbursement costs for 5056 students in the SBHC and non-SBHC groups from 1997 to 2003. We calculated net social benefit to compare the cost of the SBHC programs with the value that SBHCs might save or create.Results. With SBHCs, the gap of lower health care cost for African Americans was closed. The net social benefits of the SBHC program in 4 school districts were estimated as $1 352 087 over 3 years. We estimated that the SBHCs could have saved Medicaid about $35 per student per year.Conclusions. SBHCs are cost beneficial to both the Medicaid system and society, and may close health care disparity gaps.Racial or ethnic health care disparities are a social phenomenon that reveals differences in utilization and quality of health care because of accessibility, operation of health care systems, cultural or socioeconomic status, and discrimination at the individual and patient–provider level.^1–5 Recent literature has documented ethnic and racial disparities in the health care system across a wide range of diseases. According to the Centers for Disease Control and Prevention,⁶ African Americans had higher prevalence rates across many chronic diseases, including perinatal diseases, diabetes mellitus, hypertension, and obesity. Health care disparities can lead to decreased quality of life, loss of economic opportunities, and perceptions of injustice.⁷ Twenty-two percent of African American children and adolescents were classified as overweight or obese and 68% were fully vaccinated, compared with White children and adolescents, who were less likely to be overweight or obese (12%) and more likely to be fully vaccinated (78%).^6,8For some illnesses, health care disparities are manifested through the underuse of treatments and procedures.^9–11 School-aged children and adolescents have high prevalence rates of some chronic diseases, including asthma (estimated at 7%) and attention deficit/hyperactivity disorder (estimated at between 3% and 6%).^7,12,13 However, African American children and adolescents with asthma had more hospitalizations, disability, and a higher mortality rate compared with that of White children and adolescents with asthma.^14,15 Moreover, African American children and adolescents were also less likely to access mental health services.^16–19School-based health centers (SBHCs) are thought to be 1 solution to reduce these health status and health care disparities across groups. SBHCs provide essential primary care (e.g., mental health treatment, dental care, well-child checkups) for students. SBHCs, by their location in schools, are designed to overcome many health care access barriers, including transportation, lack of providers, lack of insurance coverage, and inconvenient appointment times because of parents working. By 2008, more than 1980 SBHCs nationwide had been established with partial support from the federal government, foundations, Medicaid, health insurance companies, and other programs such as “Healthy Schools Healthy Communities.”^20–22 In many SBHCs, the majority of enrolled students are uninsured or low income, ranging from 50% to 90% of the patient load.Numerous studies have documented that SBHCs can effectively reduce health care access barriers and emergency room visits in children and adolescents.^23–31 These in-school services can also alleviate barriers such as nonadherence and inadequate access to mental health services for youths.^23,32–34 With the SBHC, students received more mental health care services,²³ less hospitalization,^24,26 fewer urgent or emergency visits,^25–28 and fewer transportation and pharmacy costs.²⁶Although SBHCs have demonstrated their value to school-aged children and adolescents, their impact on addressing health care disparities has not been evaluated. Moreover, it is unclear whether the SBHC is cost-beneficial. With these considerations in mind, we sought to measure the impact of SBHCs on addressing health care disparities among students in schools with SBHCs compared with students in comparable schools without SBHCs. The central hypotheses were that increased accessibility to primary care services with SBHCs would reduce the gaps of health care disparities over time by increasing needed primary care. Second, by providing timely and essential primary care, the SBHC program would have a positive net social benefit to the population.     

Perceived Health Status and Health Insurance Status: Protective Factors Against Health-Related Debt?

Current health care debate has largely focused on the need for health insurance coverage rather than quality coverage. Yet the economic downturn has resulted in an increasing number of individuals who are uninsured or underinsured, and consequently face financial hardships. Multivariate analyses were used with 95 adults to examine relationships between health insurance, health status, and health debt. Controlling for demographics, and human and financial capital, findings suggest that health debt is not related to health insurance or health status. However, individuals with post-secondary education and non-homeowners appear to be more at risk for accumulating health debt.     

Primary Care and Public Health Services Integration in Brazil’s Unified Health System

Objectives. We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice.Methods. We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience.Results. Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidence-based practice engagement and service integration were moderately correlated.Conclusions. Age and race of providers, transdisciplinary collaboration, and familiarity with the community are significant variables that should inform design and implementation of provider training. Promising practices that facilitate service integration in Brazil may be used in other countries.The integration of primary care and public health is a key strategy, recommended nationally and internationally, for assisting underserved populations; it encourages community-focused initiatives and transdisciplinary approaches to practice. Integration allows health providers (e.g., physicians, nurses, health workers) to use individual- and community-level interventions to influence, respectively, individual behavior and community health.1–3 Brazil’s Sistema Único de Saúde (Unified Health System) was created as a result of Brazil’s 1988 federal constitution and the 1990 Lei Orgânica da Saúde (Organic Health Law). This law aimed to establish a large, decentralized health system offering free, universal care from medical consultations to organ transplants, health campaigns, and sanitation.4 This system struggles with access, quality, and service coordination (e.g., scheduling, monitoring) mainly because it is incorporated under a single legal structure that contradicts decentralization and affects the integration of services that different sectors of the Sistema Único de Saúde, such as hospitals, provide.5To integrate primary care and public health, the Sistema Único de Saúde employs the Estratégia Saúde da Família (ESF; Family Health Strategy), a transdisciplinary approach used by health providers. ESF reflects “the new public health” paradigm, positing that integration best addresses health and environmental issues affecting communities.6–8 The World Health Organization recommends that diverse providers pursue community-level outcomes and medical cost reductions through service integration.9 Established in 1994 as the Programa de Saúde da Família, today the ESF consolidates a model of assistance operationalized by professional teams, including nurses, physicians, and community health workers (CHWs), that serve about 4000 individuals per team.10,11In Brazil, service integration is accomplished by transdisciplinary collaboration—providers delivering primary care alongside public health interventions (e.g., disease prevention campaigns).11–14 Providers strive to engage in evidence-based practice (EBP), which is characterized by providers assessing the impact of environmental issues (e.g., water supply) on health and by incorporating patient input and research findings into diagnosis and treatment. EBP is encouraged by training local providers in integration methods.15,16 ESF has improved adult patients’ awareness of their diagnoses and prognoses and their adherence to children’s immunization schedules and has decreased infant mortality, hospitalizations, and medication costs.10,11,17–19     

Severe Physical Violence and Black Women’s Health and Well-Being

Objectives. We evaluated the association between intimate partner violence and the mental and physical health status of US Caribbean Black and African American women.Methods. We used 2001 to 2003 cross-sectional data from the National Survey of American Life—the most detailed study to date of physical and mental health disorders of Americans of African descent. We assessed participants’ health conditions by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Washington, DC; American Psychological Association) Composite International Diagnostic Interview.Results. We found differences in health conditions between abused African American and Caribbean Black women. There were increased risks for lifetime dysthymia, alcohol dependence, drug abuse, and poor perceived health for African American victims of partner abuse, and binge eating disorder was associated with partner violence among Caribbean Black women.Conclusions. Severe intimate partner violence was associated with negative mental and physical health outcomes for US Black women, with different patterns between African American and Caribbean Blacks. Understanding intimate partner violence experiences of US Black women requires recognition of key intragroup differences, including nativity and immigrant status, and their differential relationships to women’s health.Intimate partner violence (IPV) is a serious public health problem that has devastating consequences for the health and well-being of women.1 Nearly 28% of women in the United States have experienced IPV.2 The risk is heightened for Black women, with an estimated 4 in 10 experiencing physical abuse by a partner in their lifetimes.2 The long- and short-term effects of partner violence may be greater for women within this population, who not only experience violence at much higher rates than do other ethnic groups (e.g., White, Hispanic)1,3–9 but also are exposed to external factors and social conditions that increase their chances for poorer outcomes.4,9–14Previous studies have indicated that associated mental conditions of IPV include depression, posttraumatic stress disorder, anxiety, suicide, and tendencies for substance use (both legal and illegal).15–27 Along with these possible mental disorders, IPV victims are prone to physical health problems, such as increased risk for back, limb, gastrointestinal, stomach, and gynecological problems.22,28–31Despite the various health problems that are associated with IPV toward women in general, research devoted to understanding the influences on US Black women is limited.19,32–34 The few studies conducted have primarily used unstructured clinical assessment and are determined by clinical and community-based samples.33,35 Studies using national samples and structured clinical tools are rare, limiting valid assessments and definitive statements on the resulting effects of IPV on women within this population.In addition to these shortcomings, previous research has typically aggregated Blacks into a single category, which may obscure key intragroup differences.5,11,36 This is especially problematic because groups may have culturally distinct behaviors, practices, and experiences that may exacerbate certain health conditions or, conversely, serve as protective factors. Evidence suggests that health conditions may vary according to race and ethnicity.10,13,28,37–39 These differences, in particular, have become more apparent between African Americans and Caribbean Blacks.40 To date, however, we have less knowledge about the differences in health outcomes that may exist among abused women within these populations. Importantly, the impact of IPV on the health and well-being of US Caribbean women, one of the largest and fastest growing ethnic groups in the United States,41 has not been explored in depth.We addressed 2 underlying questions: (1) What are the associations between IPV, mental health disorders, and the physical health of African American and US Caribbean Black women? and (2) Are there differences in health outcomes between abused African American and US Caribbean Black women?     

Women's Health in Maternal and Child Health: Time for a New Tradition?

Objectives. The status quo in maternal and child health (MCH) focuses on obstetric health. An emerging alternative is to broaden the notion to reproductive health. An inclusive perspective encompasses women's health issues in MCH. The purpose of this paper is to further the debate on the relationship of women's health to MCH. Specific aims are (1) to describe activities promoting women's health in MCH and (2) to examine consequences of alternative perspectives for MCH research, services, and training. Method. To achieve the first objective, I discuss developments in a state health agency and pertinent documents from the MCH Section of the American Public Health Association. To address the second aim, I follow the Bush Policy Analysis Model of weighing the three paradigms against the following evaluative criteria: equity, efficiency, satisfaction, stigma, indirect effects, feasibility, sensitivity to class and race, and social responsibility. Results. The obstetric approach meets most criteria in a positive fashion; reproductive health satisfies criteria more positively and less equivocally. A women's health perspective bears the most potential for improving reproductive outcomes at this time, since no area of women's general health has been definitively shown to be irrelevant to reproduction (or vice versa). Conclusions: This analysis suggests that women's health should be incorporated more fully into the MCH field, as well as other areas of public health and medicine. Once research deficits have been addressed and the scope of reproductive health delineated more clearly, the alignment of women's health with MCH may be reevaluated.