Select search scope: search across all journals or within the current journal
Restricted accessResearch articleFirst published November, 2003pp. 123-124
Restricted accessResearch articleFirst published November, 2003pp. 125-132We hypothesize that elevated charges among former smokers reflect differential cessation of sicker individuals. We ascertained the relationship between prior health care charges and time to smoking cessation.
Prospective, observational study using panel survey data and administrative health plan records.
A large managed care organization in Minnesota.
A stratified random sample of 8000 health plan members 40 years and older, yielding 611 current smokers at baseline.
Smoking cessation measured via self-report survey. Health care charges, mortality, and disenrollment data derived from automated health plan databases.
Among smoking adults without chronic disease diagnoses at baseline, a first attempt at quitting smoking was positively associated with the presence of any inpatient charges (relative risk [RR], 1.9;
Higher health care charges, particularly from ambulatory (primary care clinic) settings, predicted smoking cessation among both individuals with and without chronic diseases. These charges may be proxies for other factors, such as smoking-related symptoms or physician advice or messaging regarding smoking cessation.
Restricted accessResearch articleFirst published November, 2003pp. 133-142To examine the time frame of changes in medical charges after smoking cessation among (1) those with arthritis, allergies, or back pain and (2) those with none of these chronic conditions.
Cross-sectional study using smoking status determined in 1996 and 4-year average medical charges measured from 1996 to 1999.
Nationwide manufacturing corporation (General Motors Corporation).
A total of 20,332 employees and spouses who completed a health risk appraisal in 1996 were younger than 64 years, were enrolled in indemnity or preferred provider organization health insurance plans during 1996 to 1999, and self-reported no preexisting primary diseases.
Participants were categorized according to 1996 self-reported smoking status into six subgroups: current smokers, former smokers by years since cessation (0–4, 5–9, 10–14, and ≥ 15 years), and never smokers. Average annual medical charges (1996–1999) among those with chronic conditions (arthritis, allergies, or back pain; N = 11,921) or without chronic conditions (N = 8411) were examined independently. Never smokers in each group were compared to respective smoker and former smoker subgroups.
Current smokers and former smokers without chronic conditions who quit fewer than 5 years earlier had higher medical charges compared with never smokers ($2613 and $3356 vs. $2203, respectively). Among those with chronic conditions, current smokers, former smokers who quit 0 to 4 years ago, and former smokers who quit 5 to 9 years ago had higher medical charges than never smokers ($4208, $4027, and $4050 vs. $3108, respectively).
It took approximately 5 years for former smokers without chronic conditions and nearly 10 years for former smokers with chronic conditions to reduce their medical charges to levels close to their respective never smokers. Health promotion practitioners and other decision makers should consider the impact of chronic conditions on the course of medical savings when implementing smoking cessation programs at the worksite.
Restricted accessResearch articleFirst published November, 2003pp. 143-145
Restricted accessResearch articleFirst published November, 2003pp. 146-150Our vision of good health is changing. Extraordinary progress was made over the course of the 20th century—life expectancy at birth increased by nearly 30 years and scientific insights revealed that our health fates are determined by interacting factors within each of the five major health domains. As life expectancies extend far beyond customary notions of old age, attention shifts from survival and toward improving the quality of life. Our beliefs about what makes for a healthy life are reorienting around a vision of new possibilities, in which we take full advantage of what we know about getting each child off to the right start; providing all the opportunity for lifelong vitality borne of healthy lifestyles; designing safe and nurturing physical environments for our communities; assuring that all have access to the kind of medical care they need; protecting the isolated or estranged from the illness or injury that often accompanies their condition; and providing comfort and choices for all at the end of life.
Restricted accessResearch articleFirst published November, 2003pp. 151-156The end of the 20th century saw a sea of change in the view of individuals in relation to their health and health care. The term “consumer” began to be used to describe myriad new roles and responsibilities for lay people who receive health services and who are often the target of health promotion and disease prevention interventions. This article (1) describes how the term “consumer” is used by various stakeholders in the health care sector; (2) specifies the assumptions that underlie the notion that a “new” kind of health care consumer can (and should) have a significant effect on their own health and on the health care system; (3) challenges the evidence base of these assumptions, noting that many are either unsupported or clearly contradicted by what we know; (4) articulates a set of principles to inform an alternative, more productive, and feasible role for individuals with respect to their health and health care; and (5) identifies the implications of those principles for health promotion and health care professionals in the 21st century.
Restricted accessResearch articleFirst published November, 2003pp. 157-161All health professionals must become actively engaged in preparing for the genomics revolution. Healthy lifestyles will continue to be of utmost importance, and we must maintain a balance between health promotion activities and genomic-based tests and therapies. We must understand the specific changes likely to occur as advances in genomics are developed and applied to medicine, as well as their ethical, social, and legal implications. We must develop new, Web-based systems and new educational models to most appropriately incorporate these changes into routine practice. Finally, we must offer timely, useful advice and guidance to the public as well as to policymakers in order to maintain realistic expectations and to ensure adequate and balanced funding for health promotion initiatives and research.
Restricted accessResearch articleFirst published November, 2003pp. 162-167
Restricted accessResearch articleFirst published November, 2003pp. 168-176Although there is general agreement about the complex interplay among individual-, family-, organizational-, and community-level factors as they influence health outcomes, there is still a gap between health promotion research and practice. The authors suggest that a disjuncture exists between the multiple theories and models of health promotion and the practitioner's need for a more unified set of guidelines for comprehensive planning of programs. Therefore, we put forward in this paper an idea toward closing the gap between research and practice, a case for developing an overarching framework—with several health promotion models that could integrate existing theories—and applying it to comprehensive health promotion strategy.
We outline a theoretical foundation for future health promotion research and practice that integrates four models: the social ecology; the Life Course Health Development; the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation–Policy, Regulatory and Organizational Constructs in Educational and Environmental Development; and the community partnering models. The first three models are well developed and complementary. There is little consensus on the latter model, community partnering. However, we suggest that such a model is a vital part of an overall framework, and we present an approach to reconciling theoretical tensions among researchers and practitioners involved in community health promotion.
Systems theory has been relatively ignored both by the health promotion field and, more generally, by the health services. We make a case for greater use of systems theory in the development of an overall framework, both to improve integration and to incorporate key concepts from the diverse systems literatures of other disciplines.
(1) Researchers and practitioners understand the complex interplay among individual-, family-, organizational-, and community-level factors as they influence population health; (2) health promotion researchers and practitioners collaborate effectively with others in the community to create integrated strategies that work as a system to address a wide array of health-related factors; (3) The Healthy People Objectives for the Nation includes balanced indicators to reflect health promotion realities and research-measures effects on all levels; (4) the gap between community health promotion “best practices” guidelines and the way things work in the everyday world of health promotion practice has been substantially closed.
We suggest critical next steps toward closing the gap between health promotion research and practice: investing in networks that promote, support, and sustain ongoing dialogue and sharing of experience; finding common ground in an approach to community partnering; and gaining consensus on the proposed integrating framework.
Restricted accessResearch articleFirst published November, 2003pp. 177-181A thriving democracy requires engaged citizens. Although voting is one aspect of participating in the democratic process, it is not sufficient if one wishes to be truly involved in shaping and influencing policy. Congress, the body of elected officials representing the citizenry, works not just for the people but also with the people. Working with Congress requires participation—as experts, as advocates, and as citizens who have an interest in their community. This article is aimed at those who wish to actively work with the Congress. Thus, instead of giving a comprehensive description of Congress, it focuses on those aspects that are essential to effective advocacy. Part 1 presents basic information about the structure of Congress and the nature of the legislative process. Part 2 presents some observations about the basic structure and process that have implications for advocates. Part 3 translates these observations into concrete strategies for effective advocacy.
Restricted accessResearch articleFirst published November, 2003pp. 182-185Providing medical care for the treatment and prevention of injuries and health problems for competitive or recreational athletes is the most widely recognized role of sports medicine. However, the field is much broader and includes clinical practice and research in many areas related to physical activity in the prevention and treatment of chronic disease. Sports medicine and exercise science involve not only physicians and other licensed health care practitioners but also physiologists, social scientists, epidemiologists, kinesiologists, and other public health and medical professionals. There is overwhelming scientific evidence that a physically active lifestyle is important for optimal health. A key role of sports medicine is to focus the attention of a wide variety of health professionals, educators, and policy makers on developing and implementing strategies to help more individuals enjoy the many health-promoting benefits of regular physical activity.
Restricted accessResearch articleFirst published November, 2003pp. 186-191Increased integration and collaboration of health promotion and nutrition education professionals to effectively engage consumers, debunk nutrition and health information, and mitigate the effect of chronic diseases is the vision presented for success in the future. Current and optimal roles of educators are discussed in relation to societal trends and their inherent opportunities and barriers. Recommendations for strengthening the role of health promotion in settings where nutrition educators work are provided and include the need for strong academic preparation, field-based training, and continual professional development. The overall goal of these recommendations is to enable nutrition educators and health promotion professionals to advance their professions and develop effective strategies that support the achievement of improved health for all.
Restricted accessResearch articleFirst published November, 2003pp. 192-194Never before has health promotion been more important than it is today. Nurses in education, practice, and research settings can participate in the advancement of health promotion not only to the mainstream but to the forefront of nursing practice. Historically, nurse educators have taught patients how to manage illness; in the future, the focus must be on teaching people how to remain healthy. Nurses must have an evidence-based understanding of the significant effect that can be made through health promotion interventions and communicate this understanding to the public at large. As more people grow in their awareness of activities that lead to good health and become knowledgeable about their own health status and the health of their families, the overall health of the population will improve.
Restricted accessResearch articleFirst published November, 2003pp. 195-199The estimated 800,000 U.S. deaths in 1990 related to behavioral decisions challenge physicians to better assist behavioral change through expanded health promotion activities. Based on the format guidelines of this special issue, this brief paper first examines the current and optimal roles of health promotion within Preventive Medicine, including five physician roles for improving modifiable public health-risk behavior burdens: (1) preventive services clinician, (2) health promotion researcher, (3) educator-communicator, (4) systems manager, and (5) health promotion advocate. After presenting a new vision statement, this paper proceeds to discuss the opportunities and barriers, including system, clinician-office, and patient factors, to attaining this new vision of empowering health promotion within Preventive Medicine. Finally, all physicians are invited to engage in a threefold strategic plan for change through at least one of five action items: (1) health promotion advocacy, (2) health promotion research, (3) public communication, (4) protocol dissemination and implementation, and (5) Preventive Medicine training.
Restricted accessResearch articleFirst published November, 2003pp. 200-204Our rapidly aging population is expected to place heavy demands on all segments of society, particularly the health care resources needed to attend to health concerns associated with aging. Is this a looming crisis, as some predict, or a challenge to use resources more wisely and to help older adults and their caregivers share in the responsibility for health promotion and chronic disease self-management activities? Community-based organizations serving older adults are uniquely positioned to augment health care providers' health promotion counseling activities and to bridge the gap between the research and practice of health promotion in older adults. They already play a crucial role by providing appropriate health promotion education, screening and referral, service planning, and reinforcement to facilitate self-care activities and behavior changes that promote healthy aging. By increasing teamwork across the network of services for the aging, the health sector, public and private organizations, and academe, there is a great opportunity to enhance the health and well-being of all older Americans.
If I'd known I was gonna live this long, I'd have taken better care of myself. —Eubie Blake at age 100
Restricted accessCorrectionFirst published November, 2003pp. 214-214Poster Session Abstracts.
The following Research Abstract was inadvertently omitted from the Poster Session Abstracts.
Restricted accessResearch articleFirst published November, 2003pp. ii-iii
Restricted accessEditorialFirst published November, 2003pp. iv-v