Correlates of mammography among women with low and high socioeconomic resources

BACKGROUND

Although screening mammography rates have increased, even women with higher incomes and more formal education do not all obtain the exam. This study examined why a modest proportion of higher income/higher education women do not get screened and, conversely, why a small percentage of lower income/lower education women do receive screening.

METHODS

Data were from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention. A total of 3,014 women, ages 40-75, were in the sample. Low-resource women had incomes of less than $20,000 and less than a high school diploma. High-resource women had incomes of $30,000 or more and at least some college education.

RESULTS

Correlates of screening status were similar for both resource groups. Recency of Papanicolaou test, recency of clinical breast exam, and regular breast self-examination were associated with higher rates of screening. Four or more persons in a household were associated with lower rates. Among low-resource women, incomes of $10,000-$19,999 were associated with higher likelihood of screening. An income of $50,000 or more was associated with screening among high-resource women.

CONCLUSIONS

The fact that several variables were important for both resource groups suggests that targeted interventions could have benefits across a wide population. Nonetheless, in the high-resource group, 2-year rates never exceeded 80% and repeated screening never exceeded 60%. Rates for low-resource women were over 30% lower. Medical care utilization data did not differ between the two resource groups sufficiently to account for the discrepant rates. Improving screening rates in both resource groups remains a major challenge.

Integrating Self-Rated Health and Social Involvement for the Examination of Mortality among Older Persons

Self-rated health status and social network variables have each been shown to independently predict mortality among older persons. However, the potential effect of these two variables when combined into a single index has not been studied. Therefore, this investigation integrated ratings of global health status and reports of social involvements into a single, combined variable. This variable was then used to predict mortality over three time periods (1984–1986, 1984–1988, 1984–1990). Data were drawn from the Longitudinal Study of Aging, and were based on 6053 self-respondents aged seventy and older at baseline in 1984. Multiple logistic regression analysis, using several health status and demographic controls, showed that the combined variable produced substantial effects on mortality, particularly for the 1984–86 and 1984–88 follow-up time periods. Results suggested that integrating these two constructs may be a helpful step in research on the psychosocial epidemiology of aging.

Determinants of breast cancer screening among inner-city Hispanic women in comparison with other inner-city women

A telephone survey of a random sample of Rhode Island women ages 40 and older residing in minority low-income census tracts--census tracts in the lowest quartile of a variety of socioeconomic indicators in which at least 5 percent of the population was classified as Hispanic or non-Hispanic black--was conducted in 1991, focusing on breast cancer screening. Hispanic women were found to have about half the breast cancer screening rate (20 percent, according to current screening guidelines) of other respondents (37 percent). Determinants of screening were explored to suggest reasons for this difference. The Health Belief Model was used to identify and compare determinants of breast cancer screening (sociodemographics, health care utilization, perceived susceptibility to breast cancer, perceived seriousness of breast cancer, cues to screening such as a provider's recommendation, and the perceived benefits and costs of screening) among Hispanics, non-Hispanic whites, and non-Hispanic blacks. Hispanics were younger, less educated, and had lower family incomes than other women residing in minority low-income census tracts, were less likely to receive medical care, to perceive themselves as susceptible to breast cancer, and to perceive breast cancer as curable. Logistic regression analyses revealed the importance of use of health care, cues for screening, and perceptions of mammography to explain the screening behavior of Hispanics and non-Hispanics alike. Access to medical care is a significant problem in the Rhode Island Hispanic community, related to recent immigration, undocumented immigration, and low income characteristics of its members. Efforts to increase long-term screening for breast cancer in this community should focus on access while paying attention to its unique perceptions of breast cancer.

An investigation of nonresponse to self-assessment of health by older persons. Associations with mortality

This study examined the association between mortality and nonresponse to questions about health status (both refusals and "don't know" responses) using a national sample of persons aged 70 and over. Data were drawn from the 1984-1990 Longitudinal Study of Aging. Three time points of vital status were used as the outcome indicators (1984-1986, 1984-1988, 1984-1990). Five self-assessment questions were examined; three of the five questions had bivariate odds ratios that indicated significant associations between a nonresponse and all three mortality indexes. Results of the study suggest that nonresponses by older persons can convey meaningful information. Research on self-assessments of health in later life should not routinely exclude nonresponses as missing data, even if they are an infrequent response.

Functional transitions among the elderly: patterns, predictors, and related hospital use

OBJECTIVES

This paper describes 6-year rates and correlates of functional change in the elderly, as well as associated hospital use.

METHODS

The Longitudinal Study on Aging (n = 7527) and matched Medicare claims were used to calculate 6-year functional status transition rates and hospital use rates. A hierarchical measure that incorporated activities of daily living, instrumental activities of daily living, and competing risks of institutionalization and death was used to assess functional status. Multinomial logistic regression was used to predict 1990 status.

RESULTS

The functional status of 12% of men and women 70 to 79 years of age who were initially impaired in instrumental activities of daily living improved, and about half of the initially independent people in that age group remained so. Multivariate analyses revealed that age, baseline functioning, self-rated health, and comorbidity predicted 1990 status. Both baseline functioning and functional change were related to hospitalization.

CONCLUSIONS

This study supports others that have shown some long-term functional improvement, but more commonly decline, in the elderly. Furthermore, it documents the link between functional decline and increased hospital use.

Developing a competency-based preventive medicine curriculum for medical schools

Trends in patient morbidity and mortality, cost-effectiveness, and national recommendations mandate that we practice more preventive medicine. To address this need, we set out to develop a comprehensive curriculum in preventive medicine for medical schools. We constructed a competency-based (i.e., performance-based) curriculum with specific educational objectives defined by outcomes. Subject areas were subdivided by life stages, and learning objectives were created separately for epidemiology, assessment, and intervention. We hope that adoption of such an educational blueprint by medical schools will measurably enhance the attitudes, knowledge, and skills necessary for the incorporation of preventive principles into all aspects of clinical medicine.

Stages of change and decisional balance for 12 problem behaviors

This integrative study investigated the generalization of the transtheoretical model across 12 problem behaviors. The cross-sectional comparisons involved relationships between two key constructs of the model, the stages of change and decisional balance. The behaviors studied were smoking cessation, quitting cocaine, weight control, high-fat diets, adolescent delinquent behaviors, safer sex, condom use, sunscreen use, radon gas exposure, exercise acquisition, mammography screening, and physicians' preventive practices with smokers. Clear commonalities were observed across the 12 areas, including both the internal structure of the measures and the pattern of changes in decisional balance across stages.

Stages of change and decisional balance for 12 problem behaviors

This integrative study investigated the generalization of the transtheoretical model across 12 problem behaviors. The cross-sectional comparisons involved relationships between two key constructs of the model, the stages of change and decisional balance. The behaviors studied were smoking cessation, quitting cocaine, weight control, high-fat diets, adolescent delinquent behaviors, safer sex, condom use, sunscreen use, radon gas exposure, exercise acquisition, mammography screening, and physicians' preventive practices with smokers. Clear commonalities were observed across the 12 areas, including both the internal structure of the measures and the pattern of changes in decisional balance across stages.

Smoking status and mammography in a statewide survey

The association between smoking status and mammography was examined for women aged 40 to 75 (n = 2902), who were recruited through a statewide random digit dial survey. Controlling for income, education, age, marital status, ethnicity, and self-rated health, logistic regression showed that current smokers were less likely to be screened on each of three indicators of mammography status. Less than a high school education, income less than $20,000, martial status, and age also showed associations with screening. Having a recent medical visit was important for screening specifically among the women who smoked (n = 851). Smoking may pose a challenge to achieving national mammography goals.

Women's decision making about mammography: a replication of the relationship between stages of adoption and decisional balance

The motivational and cognitive processes of behavior change in the area of screening mammography were investigated. A total of 676 women, 40 to 79 years old, were recruited for telephone interview through random selection from designated census tracts and were asked questions that assessed mammography stage-of-adoption and decisional balance constructs from the trans-theoretical model of behavior change. Two definitions of stage of adoption were used. Analysis of covariance showed that a history of regular screening and an intention to continue having the exam were associated with a more favorable decisional balance. Results replicated a prior investigation and demonstrated the usefulness of stage of adoption and decisional balance as guides for designing stage-matched interventions to increase rates of mammography.

Women's decision making about mammography: a replication of the relationship between stages of adoption and decisional balance

The motivational and cognitive processes of behavior change in the area of screening mammography were investigated. A total of 676 women, 40 to 79 years old, were recruited for telephone interview through random selection from designated census tracts and were asked questions that assessed mammography stage-of-adoption and decisional balance constructs from the trans-theoretical model of behavior change. Two definitions of stage of adoption were used. Analysis of covariance showed that a history of regular screening and an intention to continue having the exam were associated with a more favorable decisional balance. Results replicated a prior investigation and demonstrated the usefulness of stage of adoption and decisional balance as guides for designing stage-matched interventions to increase rates of mammography.

[The effective growth of the population as a factor of regional social and economic activity and living conditions]

"The author analyses changes in location of the Polish population in the years 1989-1991. From the analysis it appears...that the role of the Warszawa, Lodz, Wroclaw, Krakow and Legnica voivodeships in the process of population concentration is decreasing, and...the role of Western, Northern and South-Eastern regions [is increasing].... It is difficult to say how much [current changes are] due to economic transformations and how much to the crisis in local economies." (SUMMARY IN ENG AND RUS)

Integrating behavior and intention regarding mammography by respondents in the 1990 National Health Interview Survey of Health Promotion and Disease Prevention

Achieving and maintaining high rates of screening mammography are major public health priorities. This report examines data from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention on the utilization of mammography among women ages 40-75. Results show that progress is being made in some areas--57.7 percent of women "ever had" a mammogram; 50.3 percent, in previous 2 years. However, those not having repeated regular screening appear to be a sizable proportion. Only 28.6 percent of women ages 40-75 had been both screened on the recommended age-specific schedule and expressed an intention to continue screening; another 29.2 percent indicated no intention to have a mammogram in the near future. Income, clinical breast examination, and Pap (Papanicolaou's) test, having no regular source of care, region of the country and residential variables, smoking status, not exercising, not knowing how to do breast self-examination, and race were among the variables having the strongest associations with mammography status. Several groups in the population therefore remain at risk of not receiving regular screening. The combination of mammography status to date and future intention to have the examination provides an important perspective on efforts to reach public health screening objectives and appears to provide a strategy for targeting interventions.

Mammography for older women: who uses, who benefits?

In order to juxtapose the health, social, and behavioral factors associated with use of screening mammography with short-term mortality among elderly women, we analyzed the NHIS Cancer Epidemiology Supplemental Survey and the Longitudinal Study of Aging. After controlling for sociodemographic factors, having a usual source of care of and knowledge of screening guidelines, we found that a woman's health status is unrelated to having had a screening mammogram. Analyses of the LSOA, however, revealed that health factors were strongly related to 4-year mortality, particularly among women 75 and over. As it is unlikely that the subpopulation of older women who are at high risk of death within 4 years will benefit from a program of universal screening, outreach program messages and physician education programs should probably be designed to proactively recruit those most likely to benefit.

Mortality and the attribution of health problems to aging among older adults

This study examined the association between mortality and attributing health problems to aging among 1391 respondents from the Longitudinal Study of Aging who indicated difficulty with activities of daily living. Of this number, 72 persons attributed impairment primarily to "old age." Logistic regression controlling for demographics, physical health problems, self-rated health, and social involvements showed an association with mortality (adjusted odds ratio = 1.78, CI = 1.05, 3.00). Attributing health problems to aging may carry a risk of adverse health events.

The association of physical activity with mortality among older adults in the Longitudinal Study of Aging (1984-1988)

Self-reported physical activity/exercise and mortality among adults aged 70 and over were examined using data drawn from the 1984-1988 Longitudinal Study of Aging (LSOA). Analyses were conducted for the LSOA sample as a whole (N = 5901), for women (n = 3679) and men (n = 2222), and for persons with 1 + IADL difficulties (n = 1592). Results for the whole sample indicated that less activity/exercise was associated with a higher risk of mortality for each of four questions (activity compared to peers, have regular exercise routine, get enough exercise, days walking a mile per week). Analyses by gender indicated that all four questions were important for women, while the two questions asking for a judgment about activity were important for men. For persons with 1 + IADL impairments, walking was associated with lower mortality. This investigation supports literature on the importance of maintaining physical activity into older adulthood, and suggests that clinicians should attend to reports of activity level by their patients as one of the broader psychosocial domains of patient care.

Assessing motivational readiness and decision making for exercise

Motivational and cognitive processes of behavior change with respect to the area of exercise adoption were investigated. A total of 778 men and women, recruited from four worksites, answered a 40-item questionnaire consisting of statements based on constructs from the trans-theoretical model of behavior change. Principal-components analysis identified two factors--one a 6-item component representing avoidance of exercise (Cons), the other a 10-item component representing positive perceptions of exercise (Pros). Analysis of variance showed that the Pros, Cons, and a Decisional Balance measure (Pros minus Cons) were significantly associated with stage of exercise adoption. Results are consistent with applications of the model to smoking cessation and other areas of behavior change. Distinctions between exercise adoption and behaviors such as smoking cessation, weight loss, and alcoholism are discussed.

Assessing elements of women's decisions about mammography

We investigated motivational and cognitive processes of behavior change with respect to mammography screening. One hundred forty-two women (ages 40 and older) recruited from three worksites answered a 41-item questionnaire consisting of statements based on constructs from the transtheoretical model of behavior change. Principal-components analysis identified two factors: a six-item component representing positive perceptions of mammography (Pros) and a six-item component representing avoidance of mammography (Cons). Analysis of variance showed that Pros, Cons, and a derived Decisional Balance measure (Pros minus Cons) were associated with stage of mammography adoption. Results are consistent with applications of the model to smoking cessation. The model is also discussed as it relates to other theories of behavior change and as a general strategy for analyzing perceptual data pertinent to health-related actions and intentions for behavioral change.

Daily illness characteristics and health care decisions of older people

Although investigations of health care decision making typically deal with patterns of health service use, increasing attention has focused on lay- and self-care actions in response to illness symptoms. This study examined the health care actions of a community sample of 142 older adults, who recorded illness symptoms and corresponding health care actions in daily health diaries for a 14-day period. Self-treatment and no-action decisions were found to be the most frequent response to illness symptoms. Professional-care decisions were associated with greater health care need, such as multiple symptoms and increased pain. Lay-care decisions were significantly related to symptoms of shorter duration. Women were also more likely than men to self-treat their illness symptoms. Results suggest that older people deal with a greater number of recurrent chronic symptoms than previously thought and that they make most treatment decisions without consulting their doctors or other health care providers. This investigation underscores the importance of a prospective diary methodology for studying the daily complexities of chronic illness experiences and for validating and conducting useful interventions.

Correlates of expected success at health habit change and its role as a predictor in health behavior research

Perceived ability to change health habits successfully is undoubtedly an important factor underlying personal health behavior. This report examines expected success in changing future habits, using a sample of community-resident adults 18-65 years of age (n = 1,367). One set of analyses used expected success as a dependent variable, whereas another set used it as an independent variable for health behavior and knowledge indices. In the dependent variable analysis, results showed that reported past success at health habit change was the strongest predictor of success expected in the future. Optimism about future success was also associated with variables that already placed individuals at an advantage to change behavior (e.g., not smoking, regular exercise, lower Body Mass Index, support in the family). When used as a predictor variable, expected future success was not associated with five health-related, self-report indices of behavior, knowledge, and perceived risk. Further examination showed, however, that in three instances the association between expected success and the outcome indices seemed to plateau in the most optimistic group. Extreme optimism (that admits no chance of failure) may be a belief characteristic that deserves further investigation, one that will present a challenge to research and practice. Men tended to report greater expected future success than women, although women had more favorable reports on three of the five health-related behavior/knowledge indices.

Information-seeking about health in a community sample of adults: correlates and associations with other health-related practices

Action by individuals to acquire information about their health has been an element incorporated throughout theory, research, and programs related to health promotion. This report describes an attempt to determine if an information-seeking dimension could be empirically identified in a general community-resident sample, and if so, to examine some of its characteristics. A total of 281 adults aged 18-75 were contacted by telephone using random digit dialing and were interviewed about a variety of personal health practices. Factor analysis identified a five-item cluster representing a tendency to seek out information about health. Women were more likely than men to report seeking information. In addition, more frequent information-seeking was associated with favorable responses to several other health-related practices. Formal health service use was the only type of health practice not associated with information-seeking, perhaps because regularity of contact is influenced strongly by health professionals (e.g., reminder cards and having staff call to schedule annual exams). Overall, results of the investigation support the importance of information-seeking as a component of a personal health practice repertoire. Additional attention might be directed toward elaborating its role as a "process" variable in health education programs and social marketing efforts, particularly in areas such as response to recruitment messages, dropout vs. maintenance, and differential gains on outcome measures of program effectiveness.

Health practice correlates in three adult age groups: results from two community surveys

Independently done surveys of a target population can make an important contribution to knowledge about the determinants of personal health behavior by highlighting variables that consistently emerge as significant predictors. This investigation examined the correlates of four health practice and knowledge indices related to cardiovascular disease (CVD) in two baseline community surveys of the Pawtucket Heart Health Program (N = 2,413; N = 2,808). An additional dimension was the use of three adult age groups (18-29, 30-49, 50-64) in conducting the analyses. Results of both surveys showed that sex was the strongest correlate of the four indices--knowledge of CVD, encouraging health practice changes in others, dietary intake, and exercise. The four indices related to CVD were also associated with years of education, primary language, and whether or not a recent cholesterol measurement had been obtained, although these relationships were not as consistent as the results for sex. Overall, about half of each survey's significant associations were also found in the other survey (survey 1, 30 of 62; survey 2, 30 of 56). Consistency of significant results between surveys was best for the group ages 30-49. In either survey, it was rare for an association between a predictor and behavioral index to appear in each of the three age groups. This study supports the importance of the subjects' sex in research on personal health practices, suggests the potential for independence even among health-related indices pertinent to a single type of illness, and emphasizes the usefulness of utilizing independent samples to identify important correlates of health behavior.

[Spatial and socio-demographic characteristics of commuters in Olsztyn Voivodship]

The authors discuss changes in commuting patterns and characteristics of commuters in Olsztyn Voivodship, Poland. It is found that "commuters to towns are considerably younger than [those] commuting in the opposite direction [and] a decisive majority of commuters are employed as manual workers (85%). Education level of female commuters in both directions was relatively higher than that of males, [with a] higher per cent of females [working] as white-collar workers." (SUMMARY IN ENG AND RUS)

A comparison of perceived and objective CVD risk in a general population

This report examines correspondence between perceived and objective (American Heart Association's RISKO) risk of heart attack and stroke in a randomly selected sample from two surveys (n = 4,171) conducted in each of two New England cities, in 1981-82 and 1983-84, respectively. Results confirmed prior reports that people tend to underestimate their CVD (cardiovascular disease) risk and showed that estimates of those at lowest risk were most accurate.

Preventive health practices among older men and women

The preventive health practices of older men and women were examined from interviews with a community sample of 172 adults aged 64-96. Differences between men and women were found with only 10 of the 37 individual health practices. A mixed pattern was found in the relationship of personal and demographic characteristics, life outlook, self-health perceptions, and social network with health practices. The results suggest caution in interpreting how age and gender interact to influence the preventive health practices and health behaviors of older adults.

Age cohorts and personal health behavior in adulthood

Secular trends in morbidity, mortality, and risk factor prevalence highlight the importance of adopting a life-span approach to the study of health-related behaviors. To help address this question, the predictors of nine personal health practices were examined within four adult age cohorts (ages 20-64), using data from Wave 1 of the National Survey of Personal Health Practices and Consequences (N= 3,025). Analyses showed that education and gender were the most consistently important predictors of the nine practices within each cohort. Across all four cohorts, however, no predictor was statistically significant for a majority of the practices. Functional health status, income, subjective health, perceived locus of control, a regular source of health care, and group participations were of relative importance in specific cohorts. Tracking of health practices and their predictors should continue as current cohorts progress through adulthood and into older age. However, it is still an open question whether predictors of health behavior are robust longitudinally in cohorts moving through adulthood.

Daily symptoms and behavioral responses. Results of a health diary with older adults

Research on the health care behavior of older adults in response to symptoms will benefit from having data collection methods that can monitor health actions as they occur on a daily basis. In the present study, symptom experiences over a 2-week period and the actions taken in response to them were studied with a self-kept daily diary. Participants were 142 community-resident older persons, aged 62-94. Diary information about number of daily symptoms and the accompanying pain/discomfort was correlated with health perceptions and psychosocial indices obtained in an interview prior to the diary period. Women tended to take a more active response to symptoms than men, particularly in the area of personal care actions. Preventive health behaviors were not strongly related to symptom-related actions. Satisfaction with one's income was the only predictor of seeking professional assistance. Overall, the diary method is feasible to use with older adults, although certain groups may require special consideration (e.g., the visually impaired, persons with multiple symptoms per day, or those with a limitation on writing ability).

Predictors of health practices within age-sex groups: National Survey of Personal Health Practices and Consequences, 1979

Health promotion-disease prevention programs share with health behavior research the common objective of identifying population subgroups toward whom services can be targeted. For this report, six age-sex groups were examined to determine similarities and differences in the predictors of eight health practice indices. Data were from the 1979 National Survey of Personal Health Practices and Consequences. Results showed very little similarity of predictors across the three age cohorts (20-34, 35-49, 50-64), between men and women, and among the six age-sex groups. No predictor achieved significance consistently for several health practices in any of the six groups, although years of education made the best showing. The lack of overlap among predictors helps to explain why health promotion messages and recruitment strategies may not appeal to as diverse an audience as initially intended. Possible explanations for the absence of similar predictors include differences in the nature of the various practices themselves, absence of data on intentions behind a person's behavior, and the "over-determined" character of an individual person's behavior.

Characteristics of participants in community health promotion programs: four-year results

Four years of participant tracking data (N = 24,995) for community-based programs targeting cardiovascular disease risk factors are presented. Over two-thirds of contacts were female; age segment representation in these programs was comparable to the city's demography. However, the data show that programs of varying formats which target specific risk factors attract different types of participants. Implications for marketing strategy are discussed.

Correlates of preventive health behavior in late life

A sample of 172 community-resident older adults (aged 64-96) were interviewed to investigate correlates of their preventively oriented, health-related practices. Four health practice groupings were used: Information-Seeking, Regular Health Routines, Medical and Self-Examination, and Risk Avoidance. Results indicated modest associations among individual behaviors and among the four health practice groups. Gender (i.e., women) and a supportive family environment were among the consistent predictors of good health practices, although each of the four behavior groups tended to have its own set of major predictors.

Congruence of health and treatment perceptions among older patients and providers of primary care

High utilization of primary health care services by older adults, and factors which promote discrepancies between personal and professional health judgments, create a need for effective communication between providers and patients. The present study was designed to extend existing reports on the congruence of health ratings among older adult patients and their primary care physicians and nurses. Congruence ranged from 29 to 69 percent across fourteen health and treatment questions (N = 108 patient/provider pairs). Patients appeared to be more favorable on most questions, and questions with a present orientation exhibited greater congruence than those with a future orientation. Few variables predicted congruence. Providers' ratings were associated with congruence more strongly than were patients' ratings. Further research should examine the uniformity of content and structure in patient/provider communication both across providers, and with their individual patients.

Persistence of personal health practices over a 1-year period

A large amount of research has been devoted to identifying the psychosocial and demographic correlates of personal preventive health practices. An additional factor to consider, however, is the stability of personal health practices over time. At least over short periods, the prediction of current behavior may be substantially improved by having information about an individual's previous performance of the practice being studied. To address this question, data from Wave 1 (1979) and Wave 2 (1980) of the National Survey of Personal Health Practices were examined. Using nine health practices as indices, performance reported at Wave 1 was used to predict performance of that same practice as reported at Wave 2, 1 year later. A two-step analysis strategy was followed to estimate how much more variance could be explained when the behavioral reports were added to a list of psychosocial and demographic predictors. Results showed that over the 1-year interval, the Wave 1 behavioral reports were by far the strongest predictors of their corresponding measures obtained at Wave 2. The explained variance was increased substantially for most of the nine health practices, suggesting a strong tendency for persistence of the practices. Psychosocial and demographic variables tended to account for much smaller amounts of variance and often dropped out of the prediction equation when the Wave 1 behavior report was entered in the second step of analysis. Health practices other than the corresponding Wave 1 index did not improve prediction of the Wave 2 index greatly. The tendency for previous behavior to persist may overshadow the influence of other factors and account for the modest amounts of explained variance that are usually found for psychosocial and demographic indices in cross-sectional surveys. Although stability does not imply rigidity or impossibility of change, the strength of prediction found in these data attest to the "force of habit" that community interventions can encounter.

Personal health practices, health status, and expected control over future health

Data from Wave 1 of the National Survey of Personal Health Practices and Consequences were used to examine the association between perceived control over future health and 13 health behavior indices. Analyses were conducted within three strata of health status, defined by a cross-tabulation of subjective and functional health ratings. Greater control expected over future health was associated with 11 of the 13 practices in the stratum of persons in best health, but with only 2 practices in the lowest and 3 practices in the middle health strata. Age, gender, education, and a regular source of health care were also important predictors. Overall, persons in the lowest health stratum had the fewest number and least consistent set of predictors of preventive practices. Although the rationales proposed for following preventive practices often rely upon individuals' favorable outlooks on their futures, the present data suggest that background health status may mediate the relationship. Health status can be viewed as a personal resource, which provides an opportunity for predispositions such as perceived control over future health to be consistently expressed in behavior. Attempts to develop theoretical frameworks and intervention programs that are applicable to several behaviors appear to face a difficult challenge, since few of the predictors were consistently related to more than a small number of the 13 practices. Health promotion programs may need to include health status as an additional characteristic around which to structure both the content of recruitment messages, and expectations for persons who will be relatively more easy or difficult to reach.