Assessing the Stages of Change Among African American Women in a Weight Management Program.

The objective of this study was to assess the relationship between stage of change (SOC) and behavioral outcomes among African American women entering obesity treatment in two settings. Fifty-five overweight/obese (body mass index = 26.50-48.13), but otherwise healthy African American women, 23 to 56 years old, attended a 13-week weight loss-treatment program that took place at churches (n = 36) or a university (n = 19). Participants were weighed, completed SOC measures, and had a physical fitness test at pre- and posttreatment. Pretreatment measures of SOC placed 47% of the participants as actors, 31% as contemplators, and 22% as maintainers. Of the 45 women who reported posttreatment SOC, 7% regressed, 44% did not change, and 31% progressed in SOC. Pretreatment SOC predicted posttreatment weight loss in the church setting but not in the university setting. At churches, contemplators lost more weight than actors and maintainers. The church may be a more conducive setting for weight change behaviors for African American women who are categorized as contemplators in the SOC model.

The impact of nurse case management home visitation on birth outcomes in African-American women.

UNLABELLED: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, Department of the Navy, Department of Defense or the U. S. government. Dr. Wells is a military service member (employee of the U.S. government). This work was prepared as a part of her official duties. Title 17, USC Section 101 defines a U.S. government work as a work prepared by a military service member or employee of the U.S. government as part of the person's official duties. Despite substantial reductions in U.S. infant mortality rates, racial disparities persist, with black Americans experiencing 2.4 times the rate of their white counterparts. Low birthweight and preterm delivery contribute to this disparity. METHODS: To examine the association between antepartum nurse case management home visitation and the occurrence of low birthweight and preterm deliveries in African-American women in Montgomery County, MD, a retrospective cohort study was conducted using existing data from 109 mothers who were enrolled in the Black Babies Start More Infants Living Equally Healthy (SMILE) program. Logistic regression analysis was used. RESULTS: Women who received antepartum home visits were 0.37 (CI 0.15-0.94) times less likely to experience preterm delivery than women who did not receive antepartum home visits. The effect of antepartum home visits on preterm delivery was independent of level of prenatal care, negative life events and number of prior live births. There was no significant association between antepartum home visits and low birthweight. CONCLUSION: Antepartum home visits appeared to be protective against preterm delivery and could contribute to reducing racial disparities in infant mortality. Further study is needed to understand and replicate specific program components that may contribute to improved birth outcomes in African-American women.

Insurance coverage and health care consumers' use of emergency departments: has managed care made a difference?

How successful has managed care been in controlling costs and consumers' inappropriate use of health care services? This study compares national data from 1992 and 1996 to determine the effect of managed care on appropriateness of ED utilization. ED utilization was described in two ways as defined in Gooding, Smith, and Peyrot (1996): (1) urgency of visit (urgent vs. non-urgent), and (2) appropriateness of visit taking into account the care provided upon visits (including treatment and diagnostic procedures) and disposition of visit (admit, transfer, and discharge against medical advice). Potentially appropriate visits were the non-urgent cases at which treatment procedures and/or non-routine diagnostic procedures were performed. All urgent visits were defined as appropriate. Study results reveal that consumers' ED misuse changed in complex ways over the period examined. Contrary to our assumptions based on earlier research, the pattern of change was not the same for the two different measures of misuse. Non-urgent use decreased, as hypothesized, but there was an increase in non-urgent use which we have defined as inappropriate (i.e., no treatment and no non-routine diagnostic tests). ED misuse did not decrease more for insured than uninsured consumers, nor more for managed care than fee-for-service consumers. These findings bring into question the efficacy of efforts to address rising health care costs through controlling consumer utilization of services via managed care, efforts mirrored by many fee-for-service indemnity plans. Future research is needed to determine why this consumer misuse of the ED appears to continue and how the recent increase in the marketing of ED services may exacerbate this problem.