Health care providers' attitudes and counseling behaviors related to obesity.

Background: Obesity affects over 42% of the U.S. adult population, yet it remains undertreated. Many healthcare providers are biased in their perceptions and attitudes regarding obesity management and lack knowledge about how to treat it. Methods: The authors analyzed the results of the 2021 DocStyles survey to examine primary care providers' treatment and perceptions of obesity. The sample consisted of primary care physicians and nurse practitioners/physician assistants. Questions assessed healthcare providers' attitudes and counseling behaviors related to obesity, including referrals, use of medical therapy, barriers to care, and perceived risk factors for obesity. Results: 1168 primary care providers who treat obesity participated in the survey. About half of the providers reported referring patients for obesity treatment. Almost two-thirds of providers had prescribed anti-obesity medications in the last 12 months. Those who did not prescribe anti-obesity medications reported a lack of familiarity with the medications or concerns about safety. Over three-quarters of providers indicated at least one barrier to treating obesity. Over half of the providers reported that poverty and food insecurity contributed significantly to the high prevalence of obesity in communities of color. Conclusion: Increased familiarity with anti-obesity medications may improve treatment. Reasons for patients' low priority accorded to obesity care remain the focus of future research.

Association between self-reported household practices and body mass index of US children and adolescents, 2005.

INTRODUCTION: Parents can set household practices that influence children's behaviors. The objective of this study was to determine whether children (children and adolescents aged 9-18 y) who live in a household that has healthful practices related to behaviors associated with obesity have a lower body mass index (BMI). METHODS: We analyzed data from the 2005 Styles mail panel survey (N = 1,685 parents and children). We used multiple logistic regression to assess associations between 4 household practices and 3 children's behaviors: watching television, participating in vigorous physical activity, and purchasing sodas and snacks at school. RESULTS: Children watched more television if they had a television in their bedrooms, were less active as a family, and had no junk food restrictions at home. Children in less active families participated in about half as much VPA as children in more active families. Children purchased more sodas and snacks at school if they had a television in their bedrooms and their family consumed more meals at fast-food restaurants. Children whose families were less active were more likely to have a self-reported BMI at or above the 85th percentile. In addition, children who watched more television were more likely to have a self-reported BMI at or above the 85th percentile. CONCLUSION: Household practices were associated with children's behaviors and self-reported BMI. A household profile that includes being active as a family may counteract the increase in childhood obesity.

Validating a health consumer segmentation model: behavioral and attitudinal differences in disease prevention-related practices.

While researchers typically have segmented audiences by demographic or behavioral characteristics, psychobehavioral segmentation schemes may be more useful for developing targeted health information and programs. Previous research described a four segment psychobehavioral segmentation scheme-and a 10-item screening instrument used to identify the segments-based predominantly on people's orientation to their health (active vs. passive) and their degree of independence in health care decision making (independent vs. dependent). This study builds on this prior research by assessing the screening instrument's validity with an independent dataset and exploring whether people with distinct psychobehavioral orientations have different disease prevention attitudes and preferences for receiving information in the primary care setting. Data come from 1,650 respondents to a national mail panel survey. Using the screening instrument, respondents were segmented into four groups-independent actives, doctor-dependent actives, independent passives, and doctor-dependent passives. Consistent with the earlier research, there were clear differences in health-related attitudes and behaviors among the four segments. Members of three segments appear quite receptive to receiving disease prevention information and assistance from professionals in the primary care setting. Our findings provide further indication that the screening instrument and corresponding segmentation strategy may offer a simple, effective tool for targeting and tailoring information and other health programming to the unique characteristics of distinct audience segments.

Opportunities and barriers to disease prevention counseling in the primary care setting: a multisite qualitative study with US health consumers.

The purpose of this study is to understand people's receptivity to seeking out disease prevention counseling from their primary care provider. Since patients' openness to health messages may vary depending on how they seek out their health information, participants were segmented into one of four unique information-seeking groups. This study explores the differences among these groups, what approaches would be most effective in motivating different health consumers to seek out behavioral counseling in the primary care setting and the opportunities during the medical visit most appropriate for this counseling. To this end, a total of 32 focus groups were conducted with American adults. Participants were segmented by information-seeking orientation (independent actives, doctor-dependent actives, independent passives and doctor-dependent passives), age and gender. Findings showed that participants of the four information-seeking groups possessed distinct differences in their desire for and perceived barriers to requesting counseling from their provider. Overall, participants wanted prevention counseling to include tailored information, encouragement and follow-up. Participants among the various segments identified two key windows of opportunity-during a routine checkup and when discussing their family history-where patients and providers can incorporate more in-depth prevention discussions into the medical visit. Findings from this study suggest that targeting health messages according to health consumers' information-seeking orientations may provide an effective tool for practitioners. Additionally, many health consumers are open to behavioral counseling in the primary care setting and would be satisfied if this counseling were integrated into traditional procedures, such as during a routine checkup or when discussing their family medical history.

Parents questioning immunization: evaluation of an intervention.

OBJECTIVES: To compare attitudes of parents who filed or considered filing an exemption to school immunization requirements and/or would not have their child immunized if it were not required by law (cases) to controls. To develop and evaluate a brochure intervention for parents considering an exemption. METHODS: Interviews, focus groups, mailed surveys. RESULTS: Cases had more negative attitudes about vaccines than controls did. Although the brochure did not significantly improve parents' immunization attitudes compared to controls, most parents who received the intervention reported a positive impression. CONCLUSIONS: A science-based educational intervention for parents considering a vaccine exemption may help improve parents' opinions of childhood vaccines.

Psychosocial correlates of fruit and vegetable consumption among African American men.

OBJECTIVE: To determine the best predictors of fruit and vegetable consumption among African American men age 35 years and older. DESIGN: Data (n = 291) from a 2001 nationally representative mail survey commissioned by the American Cancer Society. PARTICIPANTS: 291 African American men age 35 years and older. DEPENDENT VARIABLES: (1) total fruits and vegetables without fried potatoes, (2) total fruit with juice, and (3) total vegetables without fried potatoes. Independent variables included 3 blocks of predictors: (1) demographics, (2) a set of psychosocial scales, and (3) intent to change variables based on a theoretical algorithm. ANALYSIS: Linear regression models; analysis of variance for the intent to change group. Alpha = .05. RESULTS: Regression model for total fruits and vegetables, significant psychosocial predictors: social norms, benefits, tangible rewards, and barriers-other. Total fruit with juice: social norms, benefits, tangible rewards. Total vegetables, no fried potatoes: tangible rewards, barriers-other interests. CONCLUSIONS AND IMPLICATIONS: For African American men, fruit consumption appears to be motivated by perceived benefits and standards set by important people in their lives; vegetable consumption is a function of extrinsic rewards and preferences for high-calorie, fatty foods. The results suggest that communications to increase fruit and vegetable consumption should be crafted to reflect differences in sources of motivation for eating fruits versus eating vegetables.

Assessing the need for a standardized cancer HUman Biobank (caHUB): findings from a national survey with cancer researchers.

BACKGROUND: Before developing a national standardized cancer HUman Biobank (caHUB), the National Cancer Institute sought feedback from the cancer research community. METHODS: NCI conducted an online survey (N = 727) about current biospecimen needs and reactions to creating a national resource cancer researchers and others. RESULTS: Most (56%) participants obtained biospecimens within their own institutions, and 63% wanted more information about their biospecimens. Large proportions reported difficulty obtaining biospecimens of adequate numbers (39%) and quality (47%). Low-quality biospecimens resulted in 60% questioning their findings and 81% limiting the scope of their work. Nine in every 10 (91.3%) respondents reacted positively to the idea of a national biospecimen resource, with 62% reporting that they would obtain biospecimens from it and 53% reporting that they would be willing to contribute biospecimens to it. CONCLUSIONS: Initial reactions to caHUB were positive and seen as a feasible option to addressing respondents' research challenges. National Cancer Institute will need to address several concerns to assure its adoption, including standardization and sustainability.

Compared to whom? Subjective social status, self-rated health, and referent group sensitivity in a diverse US sample.

Emerging research has revealed that subjective social status (SSS), or how people perceive their position in the social hierarchy, is significantly associated with multiple health outcomes. Yet few studies have examined how this association is affected by the person or group to whom respondents are comparing themselves. While previous studies have used distal referent groups when assessing SSS, scholars have suggested that individuals may prefer to make comparisons to those who share similar characteristics to themselves. Overall, there has been little empirical analysis assessing the health impact of comparing oneself to one referent group over another. Using a diverse, national US sample (n=3644), this study explores whether the relationship between SSS and self-rated health is sensitive to the referent used for social comparison. Data are from respondents who completed the ConsumerStyles and HealthStyles mail surveys and who have assessed their SSS against four referents: others in American society, others of the same race or ethnicity, neighbors, and parents at the same age. Self-rated health was the dependent variable, while we controlled for household income, education, home ownership, race/ethnicity, and other covariates. In logistic regression models, SSS using each of the four referents was significantly associated with self-rated health, but the model using the referent of others in American society had the strongest association with self-rated health and was the most parsimonious. Findings validate previous studies which typically have used a more distal referent such as others in American society in exploring the SSS-health relationship. However, future work should explore whether this referent is salient to diverse population groups when making social comparisons. Researchers may also want to consider using SSS as an additional status measure since it may capture more subtle differences in the status hierarchy than traditional economic measures.

Identifying subgroups of U.S. adults at risk for prolonged television viewing to inform program development.

BACKGROUND: Although adverse health effects of prolonged TV viewing have been increasingly recognized, little population-wide information is available concerning subgroups at greatest risk for this behavior. PURPOSE: This study sought to identify, in a U.S. population-derived sample, combinations of variables that defined subgroups with higher versus lower levels of usual TV-viewing time. METHODS: A total of 5556 adults from a national consumer panel participated in the mail survey in 2001 (55% women, 71% white, 13% black, and 11% Hispanic). Nonparametric risk classification analyses were conducted in 2008. RESULTS: Subgroups with the highest proportions of people watching >14 hours/week of TV were identified and described using a combination of demographic (i.e., lower household incomes, divorced/separated); health and mental health (i.e., poorer rated overall health, higher BMI, more depression); and behavioral (i.e., eating dinner in front of the TV, smoking, less physical activity) variables. The subgroup with the highest rates of TV viewing routinely ate dinner while watching TV and had lower income and poorer health. Prolonged TV viewing also was associated with perceived aspects of the neighborhood environment (i.e., heavy traffic and crime, lack of neighborhood lighting, and poor scenery). CONCLUSIONS: The results can help inform intervention development in this increasingly important behavioral health area.

Subjective social status, a new measure in health disparities research: do race/ethnicity and choice of referent group matter?

Studies have shown subjective social status (SSS) is associated with multiple health outcomes. This article examines the predictors of SSS, whether these associations vary by race/ethnicity, and whether SSS is sensitive to different referents used for social comparison. Data were from a national US mail survey. Income was strongly associated with SSS only among Whites and Hispanics. While there were no SSS differences by race/ethnicity using a distal referent, Blacks had higher SSS than Whites when using more proximal referents, even after controlling for objective status indicators. Findings indicate SSS measurement may be sensitive to race/ethnicity and the comparison referent.

Practicing what they preach: health behaviors of those who provide health advice to extensive social networks.

As a way of identifying a conduit to disseminate health information, this study aims to explore health behaviors and attitudes of a unique group of extensively socially-networked individuals who regularly are asked for their health advice. Respondents from a population-based consumer opinion panel (n = 2,639) were categorized as "extensively socially-networked" (75+ friends and acquaintances, and almost daily giving friends advice on general issues) vs. "non-networked." The networked respondents were further divided into "health-networked" (regularly asked for health advice) versus "only-socially-networked" groups (asked for general advice, not health). Chi-square analyses, ANOVA tests, and multivariate regressions controlling for sociodemographic variables compared health behaviors and attitudes between groups. Results indicated that health-networked individuals reported more positive health behaviors (e.g., fruit and vegetable consumption) and attitudes than only-socially-networked and non-networked individuals. Future research is warranted to elucidate how providing health advice to a large network contributes to the positive health of health-networked individuals. Exploratory analyses revealed that doctors and health/fitness magazines were main sources of health and nutrition information for health-networked respondents. Through their advice and word-of-mouth, health-networked individuals have the potential to influence the health information of large groups of people and, therefore, may serve as valuable change agents to disseminate health and nutrition information.

Physicians who do and do not recommend children get all vaccinations.

The objectives of this study were to determine (1) the proportion of physicians who do and do not recommend that children receive all available vaccines and (2) physician characteristics, attitudes, and behaviors associated with not recommending children receive all vaccines. A self-administered, cross-sectional electronic survey of physicians was conducted in 2005. Analyses were restricted to pediatricians (n = 250) and family practitioners (n = 484) who indicated they see at least five pediatric patients per week. A total of 1,935 surveys were distributed, and 1,251 (65%) physicians responded. Eleven percent of the physicians included in the analysis did not recommend to parents that children receive all available vaccines. Compared with physicians who recommended all vaccines for children, physicians who did not were more likely to be family practitioners versus pediatricians (OR = 2.9, CI = 1.4-5.8), agree or be neutral versus disagree that they have some concerns about childhood immunization safety (OR = 3.1, CI = 1.8-5.2), and have or= 8 physicians in their practice (OR = 2.0, CI = 1.1-3.7). We conclude that physician characteristics and concerns about childhood immunizations are associated with not recommending all childhood vaccines. Further investigation of physicians' concerns about vaccine safety is needed to improve health communications directed toward health care providers.

Correlates of weight-bearing physical activity among adolescent girls: results from a national survey of girls and their parents.

BACKGROUND: Despite the potential benefits of reducing the risk of osteoporosis in later life, research on adolescent girls' weight-bearing physical activity (WBPA) is limited. This study explores correlates for WBPA in this population. METHODS: A nationally representative telephone survey sponsored by the National Bone Health Campaign was conducted with 1000 girls age 9 to 12 years and a parent. Girls' physical activities were coded as weight bearing or not and correlated with cognitive, social, and environmental variables. RESULTS: Regression analysis revealed that WBPA was significantly associated with self-reported parents' education, parental self-efficacy, girls' normative beliefs about time spent in physical activity, being physically active with a parent, having physically active friends, and perceived availability of after-school physical activities. CONCLUSIONS: Interventions encouraging parents to participate in WBPA with their daughters and increasing parents' positive attitudes and self-efficacy in getting their daughters to be physically active should be tested.

Smokers' attitudes and behaviors related to consumer demand for cessation counseling in the medical care setting.

This study describes a new segmentation strategy exploring smokers' interest levels in counseling in the medical care setting in order to understand how public health communications can be designed to increase consumer demand for cessation services within this population. A subsample of 431 smokers from a large, nationally representative mail survey was analyzed and categorized into three cessation-demand groups: Low demand (LD), medium demand (MD), and high demand (HD). HD smokers were most likely to be heavy smokers, to make quitting a high priority, and to have self-efficacy in quitting. MD and LD smokers were less likely than HD smokers to have been told to quit smoking by a health care provider in the past or to believe that counseling is effective. The first step in the regression analysis revealed that age, cigarettes smoked per month, whether smokers were currently trying to quit, and whether they were ever told to quit smoking by their health care provider accounted for 21% of the variance in smokers' interest in smoking cessation counseling, F(4, 234) = 16.49, p<.001. When additional variables on attitudes toward smoking and quitting and perceived effectiveness of receiving counseling in the medical care setting were added to the model, an additional 11% of the variance in smokers' interest in cessation counseling was explained, F(12, 234) = 10.07, p<.001. Results suggest that by categorizing smokers by interest level in cessation counseling, we emerge with three distinct portraits of smokers who might be activated in different ways to increase consumer demand for cessation counseling.

Understanding consumers' health information preferences: development and validation of a brief screening instrument.

The impact of health communication is generally enhanced when it is targeted or tailored to the needs of a specific population or individual. In a segmentation analysis of the U.S adult population - using data from 2,636 respondents to a mail panel survey - we identified four segments of the adult population that vary significantly with regard to health information preferences based on their degree of engagement in health enhancement, and their degree of independence in health decision making. We also created a brief (10 item), easy-to-administer screening instrument that indicates into which segment people fall. The purpose of this article is to describe the segments, and the screening instrument, and to present initial tests of its validity. We believe this instrument offers a practical tool for differentiating motivationally coherent subgroups of the adult population with regard to their health information preferences, and therefore may have practical value in improving health communication and health services provision efforts. Additional research is needed to further validate the tool and test its utility in guiding the creation of targeted health messages and programs.