American Journal of Health Promotion

To determine the meanings that rural adults have for 11 different unconventional arthritis remedies.

Interviews were conducted with 219 adults from a nonmetropolitan North Carolina county. Open-ended responses to questions surrounding the use of 11 unconventional arthritis therapies were tape recorded and transcribed verbatim. A variable-based approach was used to analyze and interpret these qualitative data.

Several themes were present for the different unconventional therapies. The most extensive set of themes was present for religion, which included faith, transformation, communion, self-help, and spiritual healing. The mechanical aspect of rubbing used in the application of several therapies (ointments as well as turpentine) was also an important theme. Skepticism about the effectiveness of the unconventional therapies was another pervasive theme.

The respondents had a consistent set of meanings about the unconventional therapies that transcended gender and ethnic groups. Understanding the meanings or belief systems of rural adults is essential to the development of culturally appropriate health education and intervention.

To examine the relationship between stage of exercise adoption and the practice of other health behaviors.

Demographic, socioeconomic, and health behavior data were collected using a cross-sectional mail survey. Data were collected as part of a larger employee benefits research study.

Montana State University-Bozeman, Bozeman, Montana.

University employees (n = 1269) comprised of 46% men with a mean age of 44 years.

Demographic and socioeconomic data included age, sex, marital status, level of income and education, dependent status, and job classification. Stage of exercise adoption classifications were based on self-reported responses to four exercise statements. The health behaviors included in this study were cigarette and smokeless tobacco use, seat belt use, alcohol use, and use of stress management practices. Logistic regression analysis was used to determine if stage of exercise predicted the presence of each of the health behaviors while controlling for demographic, socioeconomic, and other health behavior variables.

The survey response rate was 68%. Respondents in action exercise stage (p = .0367) were less likely to smoke cigarettes than respondents in precontemplation stage of exercise. Respondents in contemplation (p = .0419), preparation (p = .0060), action (p = .0432), and maintenance (p = .0006) were more likely to use seat belts than respondents in precontemplation. Respondents in maintenance (p = .0059) were more likely to use regular stress reduction techniques than respondents in precontemplation.

Although longitudinal research is needed to determine any causal relationships, this research suggests that encouraging individuals to become more involved in exercise could indirectly influence other health behaviors. Hence, exercise could be a possible “gateway” behavior toward healthier lifestyle practices.

Citibank, N.A., initiated a comprehensive health, demand, and disease management program in 1994, using program services offered by Healthtrac, Inc., of Menlo Park, California. Program components included an initial screening of employees, computerized triage of subjects into higher and lower risk intervention programs, extensive follow-up with the higher risk subjects, and general health education and awareness building. The objective of this study was to estimate the financial impact of this program on medical expenditures.

A quasiexperimental design was applied comparing medical expenditures before vs. after the intervention for program participants and nonparticipants. The 22,838 subjects (11,194 program participants and 11,644 nonparticipants) were followed for an average of 38 months before and after administration of a Healthtrac health risk appraisal (HRA) instrument that triggered the start of the program. To adjust for selection bias to the extent possible with these data, multiple regression models were used to estimate the savings in medical expenditures associated with program participation. The resulting dollar savings were compared to program costs to estimate the economic return on the company's investment in the program.

The return on investment (ROI) was estimated to be between $4.56 and $4.73 saved per dollar spent on the program, depending on the discount rate applied. These results are similar to published evaluations of Healthtrac programs implemented with other populations.

Despite limitations inherent in any retrospective observational study, the strong, positive ROI shown here suggests that a well-designed health management program (HMP), which focuses interventions on high risk populations, can result in monetary savings to an organization.