Drinking Patterns, Gender and Health II: Predictors of Preventive Service Use

Investigating Awareness Regarding Travel-Related Infectious Disease Prevention in a Metropolitan Area

The rise in international travel has led to an increase in travel-related infectious diseases. It is predicted that by 2030, the number of international travelers will reach 1.8 billion, with over 250 million people affected globally. This issue also has an economic impact, as the eradication of travel-related infectious diseases leads to a loss of USD 12 billion in tourism. To understand the association between demographic variables and knowledge, attitude, and behaviors related to travel-related infectious diseases, a cross-sectional survey-based study was conducted among 1191 individuals in the metropolitan city of Naples, Italy. Multiple linear regression was performed over three models. The results revealed that knowledge about travel-related infectious diseases was positively associated with age, female gender, non-smoking habits, being single, and higher education attainment. The attitude towards travel-related infectious diseases was positively associated with being female, non-smoking habits, being single, higher education attainment, and a higher level of knowledge. A statistically significant association was observed between behaviors and non-smoking habits and between higher levels of knowledge and attitudes. To address this issue, public health programs could be implemented to improve behaviors in the general population. Overall, this study provides valuable information about the determinants of knowledge, attitude, and behaviors related to travel-related infectious diseases in the general population.

Understanding Factors Contributing to Vaccine Hesitancy in a Large Metropolitan Area

Vaccine hesitancy has become a major global concern, leading to a significant decrease in the vaccination rate, with the World Health Organization recognizing it as one of the top ten threats to public health. Moreover, the health cost generated is evaluated to be 27 billion dollars per year in the US alone. To investigate the association between demographic variables and knowledge, attitudes, and behaviours related to vaccination, a survey-based cross-sectional study was conducted with 1163 individuals. Three models were used to perform a multiple linear regression analysis. In Model I, knowledge about vaccinations was found to be associated with smoking habits, education, and marital status. In Model II, attitudes towards vaccinations were significantly associated with sex, smoking habits, education, marital status, and knowledge. In Model III, behaviours related to vaccination were associated with sex, smoking habits, having children, knowledge, and attitudes. One potential solution to improve behaviours related to vaccinations in the general population is to implement specific public health programs, which can be a cost-effective intervention. This study provides valuable insights into the determinants of knowledge, attitudes, and behaviours related to vaccinations in the general population.

Alcohol use among older adults and health care utilization

OBJECTIVE

Examinations of the association between health care utilization and levels of alcohol use are lacking in nationally representative samples of older adults. The present study set out to fill this gap by demonstrating how various aspects of health care utilization are associated with alcohol use among older adults in the United States.

METHOD

Cross-sectional panel data from 11 years of the National Health and Interview Survey were used to examine prevalence and rates of alcohol use among older adults (n = 106,511) and associations with demographic variables and recency of health care use, health care office visits, and use of emergency room/emergency department.

RESULTS

About 70% of older adults (aged 65+; mean age = 74.1, SD = 0.04) had drunk alcohol in their lifetime, and 15.8% were current moderate or heavy drinkers. Results of an adjusted multinomial logistic regression revealed that individuals with any lifetime alcohol use had more recent health care visits and more office visits (but not current heavy users) than lifetime abstainers. Former alcohol users had more ER/ED visits but current moderate users at all levels had fewer ER/ED visits than lifetime abstainers, controlling for sex, race, educational attainment, marital status, and concurrent tobacco use.

CONCLUSION

Older adults who have any history of alcohol use are more likely than abstainers to have had recent health care visits, more office visits, (but not moderate or heavy users), and less likely to have had an emergency department visit.

Seeking, delaying, and avoiding routine health care services: patient perspectives

PURPOSE

To explore/identify patient perspectives regarding seeking, delaying, and avoiding health care services, particularly barriers and facilitators.

DESIGN

Face-to-face interviews with health plan survey respondents.

SETTING

An integrated health plan providing comprehensive care to 480,000 people in Oregon and Washington.

PARTICIPANTS

Willing respondents randomly selected to maximize heterogeneity within the following strata: gender, health care utilization, and self-reported alcohol consumption (indicator of health practices). Participants were 75 men and 75 women (150 total), 21 to 64 years old, with ≥12 months of health plan membership.

METHOD

Participants were recruited by letter (52.5% agreed). Data collection stopped when planned interviews were completed; saturation (the point at which additional interviews were not producing novel information) was achieved for key study questions. Semi-structured interviews were recorded, transcribed, and coded. Reviews of codes related to care seeking and feelings/attitudes about providers produced common themes.

RESULTS

Facilitators of care seeking included welcoming staff, collaborative relationships with providers, and education about the value of preventive care. Barriers included costs, time needed for appointments, and cumbersome processes. Some participants delayed procedures, some avoided care until absolutely necessary, others framed care as routinely necessary.

CONCLUSION

Increasing comfort, improving appointment and visit-related processes, having positive patient-physician relationships, and enhancing communication and clinician-provided education may facilitate appropriate use of preventive services. Further research is needed with larger, representative samples to evaluate findings.

Self-affirmation, intentions and alcohol consumption in students: a randomized exploratory trial

AIMS

This study tests whether enhancing alcohol risk messages with self-affirmation, the process of focusing on cherished aspects of oneself, increases intentions to reduce alcohol consumption and reduces actual alcohol consumption. It was also examined whether these effects differed by risk status as indicated by standard drinks consumed in an average week.

METHODS

Participants (n = 121) were randomly allocated to a self-affirmation or matched control condition before viewing emotive graphic alcohol warning posters in a questionnaire-based study.

RESULTS

There were significant increases in intentions to reduce alcohol consumption in self-affirmed participants, and these effects were stronger in participants with higher behavioural risk. Intentions in turn significantly predicted a reduction in self-reported alcohol consumption.

CONCLUSIONS

These findings support the use of self-affirmation to enhance alcohol awareness campaigns, particularly in individuals with high behavioural risk.

Smoking and use of primary care services: findings from a population-based cohort study linked with administrative claims data

Background

Available evidence suggests that smokers have a lower propensity than others to use primary care services. But previous studies have incorporated only limited adjustment for confounding and mediating factors such as income, access to services and health status. We used data from a large prospective cohort study (the 45 and Up Study), linked to administrative claims data, to quantify the relationship between smoking status and use of primary care services, including specific preventive services, in a contemporary Australian population.

Methods

Baseline questionnaire data from the 45 and Up Study were linked to administrative claims (Medicare) data for the 12-month period following study entry. The main outcome measures were Medicare benefit claimed for unreferred services, out-of-pocket costs (OOPC) paid, and claims for specific preventive services (immunisations, health assessments, chronic disease management services, PSA tests and Pap smears). Rate ratios with 95% confidence intervals were estimated using a hierarchical series of models, adjusted for predisposing, access- and health-related factors. Separate hurdle (two part) regression models were constructed for Medicare benefit and OOPC. Poisson models with robust error variance were used to model use of each specific preventive service.

Results

Participants included 254,382 people aged 45 years and over of whom 7.3% were current smokers. After adjustment for predisposing, access- and health-related factors, current smokers were very slightly less likely to have claimed Medicare benefit than never smokers. Among those who claimed benefit, current smokers claimed similar total benefit, but recent quitters claimed significantly greater benefit, compared to never-smokers. Current smokers were around 10% less likely than never smokers to have paid any OOPC. Current smokers were 15-20% less likely than never smokers to use immunisations, Pap smears and prostate specific antigen tests.

Conclusions

Current smokers were less likely than others to use primary care services that incurred out of pocket costs, and specific preventive services. This was independent of a wide range of predisposing, access- and health-related factors, suggesting that smokers have a lower propensity to seek health care. Smokers may be missing out on preventive services from which they would differentially benefit.

Associations between binge and heavy drinking and health behaviors in a nationally representative sample

BACKGROUND

Binge and heavy drinking are noted in the literature for their relatively high prevalence and adverse health-related effects.

DESIGN AND PARTICIPANTS

We used data from the 2006 Behavioral Risk Factor Surveillance Survey (BRFSS) to determine the associations between binge and heavy drinking and a wide range of health-related variables, including positive and negative health behaviors, preventive care practices, and quality of life indices in a nationally representative sample of 344,793 adults.

RESULTS

Rates of binge and heavy drinking in the current sample were 15% and 5%, respectively. Binge and heavy drinking were more common among men, younger adults, and individuals with higher incomes and at least some college education. After controlling for relevant demographic variables, binge and heavy drinking were associated with a number of adverse health-related and preventive care behaviors (e.g., smoking, failing to receive a mammogram), as well as less life satisfaction and a greater number of poor mental health days than those who did not engage in these drinking behaviors. Interestingly, binge and heavy drinking were also associated with some positive health-related variables (e.g., recent physical activity, positive perceptions of one's own health).

CONCLUSIONS

The current study findings provide additional information regarding the relations between health-related attitudes and behaviors and binge and heavy drinking in the U.S. population. Implications of study findings are discussed.

Drinking Patterns, Gender and Health III: Avoiding vs. Seeking Healthcare

BACKGROUND

Inability to predict most health services use and costs using demographics and health status suggests that other factors affect use, including attitudes and practices that influence health and willingness to seek care. Alcohol consumption has generated interest because heavy, chronic consumption causes adverse health consequences, acute consumption increases injury, and moderate drinking is linked to better health while hazardous drinking and alcohol-related problems are stigmatized and may affect willingness to seek care.

METHODS

A stratified random sample of health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). We linked survey data to 24 months of health-plan records to examine relationships between alcohol use, gender, health-related attitudes, practices, health, and service use. In-depth interviews with a stratified 150-respondent subsample explored individuals' reasons for seeking or avoiding care.

RESULTS

Quantitative results suggest health-related practices and attitudes predict subsequent service use. Consistent predictors of care were having quit drinking, current at-risk consumption, cigarette smoking, higher BMI, disliking visiting doctors, and strong religious/spiritual beliefs. Qualitative analyses suggest embarrassment and shame are strong motivators for avoiding care.

CONCLUSIONS

Although models included numerous health, functional status, attitudinal and behavioral predictors, variance explained was similar to previous reports, suggesting more complex relationships than expected. Qualitative analyses suggest several potential predictive factors not typically measured in service-use studies: embarrassment and shame, fear, faith that the body will heal, expectations about likelihood of becoming seriously ill, disliking the care process, the need to understand health problems, and the effects of self-assessments of health-related functional limitations.