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.     

Impact of a Problem-Based Learning (PBL) Health Literacy Program on Immigrant Women’s Health Literacy,Health Empowerment,Navigation Efficacy,and Health Care Utilization

We evaluated the effectiveness of a problem-based learning (PBL) health literacy program aimed to improve health literacy, health empowerment, navigation efficacy, and health care utilization among immigrant women in Taiwan.

We employed a quasi-experimental design that included surveys at the baseline, immediately after the intervention, and 6 months after the intervention. The intervention group participated in a 10-session PBL health literacy program and the comparison group did not.

Results showed that 6 months after the intervention, the intervention group had significantly fewer ER visits and hospitalizations than the comparison group. The intervention group reported a greater decrease in delaying/avoiding health care due to communication barriers. Although the intervention group showed improvement in health literacy, health empowerment and navigation self-efficacy, the differences were not statistically significant.

The PBL health literacy program resulted in fewer ER visits and hospitalizations, and better health care access among immigrant women. Cognitive and psychological outcomes examined in the study appeared more difficult to change.

The PBL health literacy program effectively improved health care utilization and reduced barriers to health care access among immigrant women in Taiwan. It would be useful to examine the effectiveness of the program in other populations.     

Mental Health Benefits in Employer-sponsored Health Plans, 1997–2003

Data drawn from the Mercer National Survey of Employer-sponsored Health Plans in 1997 and 2003 indicate that a large majority of employers continue to provide some level of coverage for mental health (MH) services in their primary plans. However, a majority of plans continue to impose different benefit limitations for MH than for other medical treatment. Among plans with limitations on MH coverage, there was a sharp increase in the use of limits on inpatient days and outpatient visits between 1997 and 2003. The proportion of employers providing coverage for some MH services decreased; e.g., among small employers, 88% provided coverage for inpatient MH care in 2003, compared with 94% in 1997. These results suggest that parity legislation has had a noticeable but limited effect, but that, at least in the short-term, it is unlikely that universal parity in employer-based plans will be achieved through a legislative strategy.     

Weight and Mental Health Status in Massachusetts,National Survey of Children’s Health, 2007

This study explores how weight status is related to mental health status among Massachusetts children, aged 10–17 years. We used data from the 2007 National Survey of Children’s Health to examine the association between weight status (body mass index-for-age) and parent-reported mental health status among Massachusetts children (N = 827). Multivariable log binomial regression was performed to calculate the adjusted prevalence ratios (aPR) of three mental health outcomes (behavioral, emotional, and social) as related to weight status, after controlling for covariates including physical activity, sex, race/ethnicity, maternal education, poverty status, special health needs, and neighborhood safety. Almost one-third (32.5 %) of Massachusetts children were either overweight or obese. Sex was a significant effect modifier of the association between weight status and negative emotions. After stratifying by sex and controlling for covariates, the relationship between weight status and negative emotions remained significant among girls (aPR = 1.8, 95 % CI 1.3–2.6). Children who did not exercise at all were significantly more likely to exhibit negative behaviors (aPR = 1.3, 95 % CI 1.0–1.6), negative emotions (boys’ aPR = 3.3, 95 % CI 1.6–6.9; girls’ aPR = 2.6, 95 % CI 1.5–4.5), and fewer social skills (aPR = 1.9, 95 % CI 1.3–2.9) than those who exercised at least 20 min every day of the week. Overweight/obese children, especially girls, were more likely than children of normal weight to have parent-reported negative emotions, suggesting an association between weight status and mental health. Lower levels of physical activity were associated with negative mental health outcomes, supporting the benefits of physical activity for all children.     

Peer Reviewed: Workers’ Health Risk Behaviors by State,Demographic Characteristics,and Health Insurance Status

Introduction

Employers often lack data about their workers'' health risk behaviors. We analyzed state-level prevalence data among workers for 4 common health risk behaviors: obesity, physical inactivity, smoking, and missed influenza vaccination (among workers older than 50 years).

Methods

We analyzed 2007 and 2008 Behavioral Risk Factor Surveillance System data, restricting the sample to employed respondents aged 18 to 64 years. We stratified health risk behavior prevalence by annual household income, educational attainment, health insurance status, and race/ethnicity.

Results

For all 4 health risk behaviors, we found significant differences across states and significant disparities related to social determinants of health — income, education, and race/ethnicity. Among uninsured workers, prevalence of smoking was high and influenza vaccinations were lacking.

Conclusion

In this national survey study, we found that workers'' health risk behaviors vary substantially by state and by workers'' socioeconomic status, insurance status, and race/ethnicity. Employers and workplace health promotion practitioners can use the prevalence tables presented in this article to inform their workplace health promotion programs.     

Disparities in Whites’ Versus Blacks’ Self-Rated Health: Social Status, Health-Care Services, and Health Behaviors

Using 2009 National Health Interview Survey data, we examined how social-status factors, variables describing health services, and health-related behaviors explained self-rated health among Black adults and among White adults. We wanted to evaluate whether self-rated health’s relationships with these three sets of variables were conditional on race. Our results overall indicated that social-status, health-care-services, and health-behaviors variables are important to the explanation of both groups’ self-rated health. But in this study, when all social-status, health-care-services, and health-behaviors variables were controlled, Black respondents’ self-reported health did not differ, on average, from White respondents’. Such a finding firmly suggests that the three sets of variables partially explain disparities in the groups’ self-reported health. In the end, our results showed racial health disparities to be partially explained by racial differences in distribution of health resources and health behaviors.     

Economic Crisis,Restrictive Policies,and the Population’s Health and Health Care: The Greek Case

The global economic crisis has affected the Greek economy with unprecedented severity, making Greece an important test of the relationship between socioeconomic determinants and a population’s well-being.Suicide and homicide mortality rates among men increased by 22.7% and 27.6%, respectively, between 2007 and 2009, and mental disorders, substance abuse, and infectious disease morbidity showed deteriorating trends during 2010 and 2011. Utilization of public inpatient and primary care services rose by 6.2% and 21.9%, respectively, between 2010 and 2011, while the Ministry of Health’s total expenditures fell by 23.7% between 2009 and 2011.In a time of economic turmoil, rising health care needs and increasing demand for public services collide with austerity and privatization policies, exposing Greece’s population health to further risks.THE CURRENT GLOBAL ECOnomic crisis, manifested in 2007 with the collapse of the subprime mortgage market and the bankruptcy of several financial institutions in the United States, affected the Greek economy—viewed by some as the Eurozone’s weakened economic link—with unprecedented severity.Many commentators in the past and present have debated whether the ongoing international economic turmoil, the worst since the Great Depression, threatens the health of the population both in the United States and throughout the developed and less-developed world.1–5 The World Health Organization has added one more concern to this dialogue: whether spending restrictions in times of economic downturn (especially in countries that have required emergency assistance from the International Monetary Fund [IMF]) could impose further risks on the population’s health.6,7We present empirical evidence from Greece’s experience that clarifies the impact of restrictive policies during economic crisis and illustrates the implications for public health in other countries.     

Occupational Health—Public Health Service

Thirteen cases of sudden pupil dilatation were observed among civilians in Rotterdam in the course of two days. Except for one person, all victims had been in the neighborhood of a quay where a ship had been unloading Duboisia myoporoides leaves from Australia. Two workmen, who had also suffered from unilateral mydriasis, gave the clue to the ship from which the dust originated. The material was apparently too coarsely divided and too heavy to cause more cases of mydriasis.     

An Ill Wind? Climate Change,Migration, and Health

Background: Climate change is projected to cause substantial increases in population movement in coming decades. Previous research has considered the likely causal influences and magnitude of such movements and the risks to national and international security. There has been little research on the consequences of climate-related migration and the health of people who move.Objectives: In this review, we explore the role that health impacts of climate change may play in population movements and then examine the health implications of three types of movements likely to be induced by climate change: forcible displacement by climate impacts, resettlement schemes, and migration as an adaptive response.Methods: This risk assessment draws on research into the health of refugees, migrants, and people in resettlement schemes as analogs of the likely health consequences of climate-related migration. Some account is taken of the possible modulation of those health risks by climate change.Discussion: Climate-change–related migration is likely to result in adverse health outcomes, both for displaced and for host populations, particularly in situations of forced migration. However, where migration and other mobility are used as adaptive strategies, health risks are likely to be minimized, and in some cases there will be health gains.Conclusions: Purposeful and timely policy interventions can facilitate the mobility of people, enhance well-being, and maximize social and economic development in both places of origin and places of destination. Nevertheless, the anticipated occurrence of substantial relocation of groups and communities will underscore the fundamental seriousness of human-induced climate change.     

Physical Activity,Medical Home,and Health Behavior Counseling Among Adolescents with Special Health Care Needs: NSCH 2016–2017

Maternal and Child Health Journal - Aim 1 was to establish updated prevalence estimates for meeting national physical activity (PA) guidelines among adolescents with and without special healthcare...     

Individual Income,Area Deprivation,and Health: Do Income‐Related Health Inequalities Vary by Small Area Deprivation?

This paper aims to explore potential associations between health inequalities related to socioeconomic deprivation at the individual and the small area level. We use German cross‐sectional survey data for the years 2002 and 2006, and measure small area deprivation via the German Index of Multiple Deprivation. We test the differences between concentration indices of income‐related and small area deprivation related inequalities in obesity, hypertension, and diabetes. Our results suggest that small area deprivation and individual income both yield inequalities in health favoring the better‐off, where individual income‐related inequalities are significantly more pronounced than those related to small area deprivation. We then apply a semiparametric extension of Wagstaff's corrected concentration index to explore how individual‐level health inequalities vary with the degree of regional deprivation. We find that the concentration of obesity, hypertension, and diabetes among lower income groups also exists at the small area level. The degree of deprivation‐specific income‐related inequalities in the three health outcomes exhibits only little variations across different levels of multiple deprivation for both sexes. Copyright © 2014 John Wiley & Sons, Ltd.