Preferred modes of travel among older adults: what factors affect the choice to walk instead of drive?

INTRODUCTION: There are many factors that influence older adults' travel choices. This paper explores the associations between mode of travel choice for a short trip and older adults' personal characteristics. METHODS: This study included 406 drivers over the age of 64 who were enrolled in a large integrated health plan in the United States between 1991 and 2001. Bivariate analyses and generalized linear modeling were used to examine associations between choosing to walk or drive and respondents' self-reported general health, physical and functional abilities, and confidence in walking and driving. RESULTS: Having more confidence in their ability to walk versus drive increased an older adult's likelihood of walking to make a short trip by about 20% (PR=1.22; 95% CI: 1.06-1.40), and walking for exercise increased the likelihood by about 50% (PR=1.53; 95% CI=1.22-1.91). Reporting fair or poor health decreased the likelihood of walking, as did cutting down on the amount of driving due to a physical problem. DISCUSSION: Factors affecting a person's decision to walk for exercise may not be the same as those that influence their decision to walk as a mode of travel. It is important to understand the barriers to walking for exercise and walking for travel to develop strategies to help older adults meet both their exercise and mobility needs. IMPACT ON INDUSTRY: Increasing walking over driving among older adults may require programs that increase confidence in walking and encourage walking for exercise.

Intimate partner violence among men prevalence, chronicity, and health effects.

CONTEXT: The breadth and depth of intimate partner violence (IPV) experienced by men have not been fully documented. OBJECTIVES: To describe the prevalence, chronicity, and severity of IPV, and the health outcomes associated with IPV, in adult men with healthcare insurance. DESIGN: A retrospective telephone cohort study conducted from 2003 to 2005. The setting was an integrated healthcare system in Washington State and Idaho. PARTICIPANTS: English-speaking men aged 18 and older (N=420) enrolled in the healthcare system for 3 or more years. MAIN OUTCOME MEASURES: Physical, psychological, and sexual IPV were assessed using five questions from the Behavioral Risk Factor Surveillance Survey. Health was measured using the Short Form-36, version 2 (SF-36v2) survey, the Center for Epidemiological Studies Depression Scale, and the National Institute of Mental Health Presence of Symptoms Survey. RESULTS: Men experienced IPV at a rate of 4.6% in the past year, 10.4% in the past 5 years, and 28.8% over their lifetimes. While overall rates of physical and nonphysical IPV were similar, men aged 18-55 were twice as likely to be recently abused (14.2%, SE=2.6%) than were men aged 55 and older (5.3%, SE=1.6%). Abuse was typically nonviolent or mildly violent, occurred on multiple occasions, and was initiated by only one intimate partner. Compared to men with no IPV, older men who experienced IPV had more depressive symptoms (prevalence ratios=2.61 and 2.80 for nonphysical and physical abuse) and had lower SF-36v2 mental health subscales (range=-3.21 to -5.86). CONCLUSIONS: Men experience IPV at moderate rates, and poor mental health outcomes are associated with such experiences.

Health care utilization and costs associated with childhood abuse.

BACKGROUND: Physical and sexual childhood abuse is associated with poor health across the lifespan. However, the association between these types of abuse and actual health care use and costs over the long run has not been documented. OBJECTIVE: To examine long-term health care utilization and costs associated with physical, sexual, or both physical and sexual childhood abuse. DESIGN: Retrospective cohort. PARTICIPANTS: Three thousand three hundred thirty-three women (mean age, 47 years) randomly selected from the membership files of a large integrated health care delivery system. MEASUREMENTS: Automated annual health care utilization and costs were assembled over an average of 7.4 years for women with physical only, sexual only, or both physical and sexual childhood abuse (as reported in a telephone survey), and for women without these abuse histories (reference group). RESULTS: Significantly higher annual health care use and costs were observed for women with a child abuse history compared to women without comparable abuse histories. The most pronounced use and costs were observed for women with a history of both physical and sexual child abuse. Women with both abuse types had higher annual mental health (relative risk [RR] = 2.07; 95% confidence interval [95%CI] = 1.67-2.57); emergency department (RR = 1.86; 95%CI = 1.47-2.35); hospital outpatient (RR = 1.35 = 95%CI = 1.10-1.65); pharmacy (incident rate ratio [IRR] = 1.57; 95%CI = 1.33-1.86); primary care (IRR = 1.41; 95%CI = 1.28-1.56); and specialty care use (IRR = 1.32; 95%CI = 1.13-1.54). Total adjusted annual health care costs were 36% higher for women with both abuse types, 22% higher for women with physical abuse only, and 16% higher for women with sexual abuse only. CONCLUSIONS: Child abuse is associated with long-term elevated health care use and costs, particularly for women who suffer both physical and sexual abuse.

Intimate partner violence and health care costs and utilization for children living in the home.

OBJECTIVE: The goal was to determine whether differences in health care costs and utilization exist for children whose mothers experienced intimate partner violence versus those who did not. METHODS: A longitudinal cohort study was performed in an integrated health care delivery organization with 760 children of mothers with no history of intimate partner violence and 631 children of mothers with a history of intimate partner violence since age 18. Health care utilization and costs for children before, during, and after intimate partner violence exposure were compared with utilization and costs for children with nonabused mothers. RESULTS: Health care utilization and health care costs were higher in most categories of care for children of mothers with a history of intimate partner violence, with significantly higher values for mental health services, primary care visits, primary care costs, and laboratory costs. Children of mothers with a history of intimate partner violence that ended before the child was born had significantly greater utilization of mental health, primary care, specialty care, and pharmacy services than did children of mothers who reported no intimate partner violence. Children exposed directly to intimate partner violence (after birth) had greater emergency department and primary care use during the intimate partner violence and were 3 times as likely to use mental health services after the intimate partner violence ended. CONCLUSIONS: Children whose mothers experienced intimate partner violence have higher health care utilization and costs, even if their mothers' abuse stopped before they were born. Screening of women for intimate partner violence should be a routine part of their health care, and interventions for both the women and their children are likely necessary to minimize the effects of intimate partner violence in the family.

Chlamydia screening in at-risk adolescent females: an evaluation of screening practices and modifiable screening correlates.

PURPOSE: To identify modifiable correlates of chlamydia screening that could offer intervention targets to enhance screening. METHODS: We surveyed a representative sample of primary care providers (n = 186) at an integrated healthcare delivery system to document their self-reported adherence to annual screening of sexually-active adolescents and to identify specific, modifiable constructs that were correlated with annual chlamydia screening. To cross-validate providers' self-report, we also used automated data to examine adolescent screening in an anonymous sample of primary care providers (n = 143). RESULTS: Forty-two percent of providers reported annual chlamydia screening of sexually-active adolescents. Univariate correlates of annual screening were: provider type (non-physician) (p = .01), female gender (p = .001), fewer years of clinical experience (p = .001), greater perceived knowledge about chlamydia (p = .001), greater confidence across a range of screening-related activities (p < or = .01), greater comfort recommending screening for sexually transmitted diseases (p = .001), and greater perceived patient comfort discussing sexual issues (p < .01). In multivariate analyses, providers' perceived knowledge, confidence, comfort, and perceived patient comfort continued to be significantly associated with annual chlamydia screening after controlling for other relevant provider characteristics. Self-reported screening practices were consistent with observed screening rates in the anonymous provider sample. CONCLUSIONS: Routine chlamydia screening among asymptomatic, at-risk adolescent females could be enhanced through additional intervention targeting specific provider attitudes and beliefs about chlamydia screening.