Behavioral Health Risk Factors and Motivation to Change among Cardiovascular General Hospital Patients Aged 50 to 79 Years.

Little is known about the (co-)occurrence of smoking, alcohol at-risk drinking, physical inactivity and overweight, and the motivation to change these behavioral health risk factors (HRFs) in older general hospital patients with cardiovascular disease. Between October and December 2016, all consecutively admitted patients aged 50 to 79 years were proactively recruited on 3 cardiology wards and asked to participate in a survey on HRFs and behavior change motivation. Of the eligible patients, 80.4% participated in the survey (n = 328). The mean age was 66.5 years (standard deviation 9.0), and 65.5% were male. At least 1 HRF was present in 91.8% (n = 280), at least 2 HRFs in 54.4% (n = 166), and 3 or 4 HRFs in 12.1% (n = 37) of participants. The proportion of older adults who contemplated or were changing or planning to change their behavior to meet health behavior recommendations ranged between 66.0% (smoking) and 93.2% (alcohol consumption). The results indicate a notable co-occurrence of behavioral HRFs in older patients with cardiovascular disease. The majority of older adults were at least considering changing the respective behavior. To prevent and treat diseases efficiently, hospitalization may be a suitable moment for systematic multiple HRF screening and intervention.

In-person alcohol counseling versus computer-generated feedback: Results from a randomized controlled trial.

OBJECTIVE: To investigate the comparative 2-year efficacy of brief alcohol interventions delivered in-person versus through computer-generated feedback letters among general hospital inpatients with at-risk alcohol use. METHODS: In 2011-2012, all general hospital inpatients aged 18-64 years on 13 wards at 4 medical departments in 1 general hospital were systematically screened for at-risk alcohol use. Nine-hundred sixty-one inpatients who screened positive for at-risk alcohol use and negative for more severe alcohol problems were randomized by timeframe to in-person counseling (PE), computer-generated feedback letters (CO) and assessment only (AO). Both interventions included 3 contacts: on the ward and 1 and 3 months later and were based on the transtheoretical model (TTM). After 6, 12, 18, and 24 months computer-assisted telephone interviews assessed self-report outcomes: gram alcohol per week (primary), at-risk alcohol use and highest blood alcohol concentration (both secondary). Latent growth models were used. RESULTS: After 24 months, CO resulted in a greater reduction of self-reported gram alcohol per week than AO (p = .027); PE did not differ significantly from AO (p = .503) and CO (p = .088); and group differences concerning secondary outcomes were not statistically significant (ps > 0.07). After 6 months, the odds of at-risk alcohol use were reduced by half in PE versus AO (odds ratio = 0.50, 95% confidence interval: 0.25-0.98). CONCLUSIONS: No significant group differences between in-person counseling and computer-generated feedback letters were found. TTM-based computer-generated feedback letters reduced self-reported gram alcohol over 2 years and can be considered a long-term effective alternative in medical settings when addressing at-risk alcohol use. (PsycINFO Database Record

In-person and computer-based alcohol interventions at general hospitals: reach and retention.

BACKGROUND: High reach of target populations is relevant for public health impact of interventions. Concerning intervention programs requiring multiple contacts, little is known about how many persons may be kept in the intervention program over multiple time points. The aim of this study was to investigate (i) the reach of general hospital inpatients with at-risk alcohol use through screening and brief intervention and (ii) whether their continued intervention participation after hospital discharge differs by in-person vs. computer-based intervention (CO) delivery. METHODS: As part of a randomized controlled trial, general hospital inpatients aged 18-64 years were screened for at-risk alcohol use on 13 wards. Participants were allocated to in-person intervention (PE), CO and assessment only. Both interventions were provided on site, and 1 and 3 months after baseline. RESULTS: Ninety-two percent of all eligible inpatients ( N: = 6251) completed the screening. Eighty-one percent ( N: = 961) of the screening-positives participated in the trial and received their allocated intervention. At months 1 and 3, interventions were delivered to 83 and 79% of the CO participants and to 74 and 64% of the PE participants. The delivery of CO and PE required an average of 5.2 and 7.7 contact attempts per delivered intervention, respectively. CONCLUSION: General hospital inpatients with at-risk alcohol use were well reached through proactive interventions. COs may result in higher retention rates over 1 and 3 months and may require less contact attempts than PEs. Public health efforts that aim to achieve high intervention retention should consider proactive COs.

Health risk factors and self-rated health among job-seekers.

BACKGROUND: To determine a) proportions of behavior related health risk factors among job-seekers and b) to what extend these are related to self-rated health. METHODS: Over 12 months, job-seekers were recruited at three job-agencies in northeastern Germany. Among all individuals eligible for study inclusion, 7,906 (79.8%) provided information on smoking, risky drinking, overweight/obesity (body mass index), fruit and vegetable intake, physical inactivity, illicit drug use, and self-rated health. Proportions and 95% confidence intervals stratified by gender, age and duration of unemployment were calculated. Multivariate logistic regression analyses predicting self-rated health were conducted. RESULTS: The proportions of each health-risk factor were high, and 52.4% of the sample (53.4% male, 33.5 years mean age) had 3 or more health risk factors. Mostly, the proportions were particularly high among men and long-term unemployed individuals; e.g. 84.8% of the 18-24 year old long-term unemployed men were current smokers. Proportions of substance use related health risk factors were highest among the 18-24 year olds (e.g. risky drinking 28.7%), and proportions of health risk factors related to nutrition and physical inactivity were highest among the 40-64 year olds (e.g. overweight/obesity 65.4%). Depending on gender, all health risk factors and having 3 or more health risk factors were associated with lower self-rated health; odd ratios ranged between 1.2 for smoking (95% CI: 1.0-1.3) and 1.7 for overweight and physical inactivity (95% CI: 1.5-1.9). CONCLUSIONS: Prevention efforts to reduce health risk factors and to increase health among job-seekers are needed, and job agencies appear a feasible setting for their implementation.