Health status and health practices--Alameda and beyond.

Using the population of St John's, Newfoundland, we did a constructive replication of previous studies testing the association between health practices and health status. A telephone questionnaire was applied to all adults in a probabilistic sample of households (3300 subjects, 85% response rate). Several health practices and preventive behaviours indexes were developed and tested. An additive index of six practices (breakfast, sleeping, drinking, smoking, weight and exercise) using the Alameda County definitions, and an additive score of five practices (excluding breakfast and with revised definitions for smoking, drinking and exercise) were analysed using log-linear models; there was association between the indexes and self-assessed health status when controlling for sex, age and education, with the exception of the six-practice index in males. The association between these two indexes and several variables and constructs of health status showed that the best relationships were with self-assessed health status and with a construct including variables measuring subjective health.

An empirical analysis of the dimensions of health status measures.

The objective of this study is to verify empirically the existence of separate dimensions in the overall concept of health status by analyzing 10 variables included in a questionnaire that was applied to all adults in a simple random sample of households in St John's, Newfoundland. The response rate was 85% for a total of 3300 subjects. These data were analyzed by frequencies and by associations with sex, age and education. Nonparametric correlation, factor and cluster analyses on variables were used to verify if health status had identifiable dimensions. All these methods produced similar results showing five distinct factors. The first factor is composed of variables related to disease (disability/chronic conditions/worry about health); the second, to happiness (happiness/emotional); the third, to subjective appraisal of health (physical condition/comparative level of energy/self-rated health status). Finally, the fourth and fifth factors were single variables; restriction of normal activities and social contacts. An interesting finding was that self-rated health status was distributed with almost equal weight in both the first and third factors. A validation of the 10 variables and the 5 factors was undertaken by studying their association with health care utilization. Two measures of utilization were used; number of physicians' visits in a year and number of hospital days in a 4-year period. Number of chronic conditions, disability and self-rated health status were associated with both measures of utilization; factor 1 was the only summary construct showing association with utilization. This paper demonstrates that self-rated health status is valid as a single measure of overall health status in this sample, being associated with both disease and subjective assessment components.

Newfoundland Panel on Health and Medical Care--adult health survey.

An adult health survey was undertaken on the island portion of the Province of Newfoundland as part of the Newfoundland Panel on Health and Medical Care. This study aims to develop models of medical care utilization over a seven-year period, before and after a major restructuring of the provincial health care system. A health survey on a large sample (11,789 individuals) permits both descriptive and explanatory analysis at the regional level. The results of the survey are presented first in a descriptive format, as they were included in reports for policy makers and managers, using administrative aggregations. To study regional differences, descriptive and multivariate analyses were done on an aggregation by an urban dimension, which divides the island into three areas. As expected, there were major differences across regions, and complex interactions on selected variables. The usefulness of health surveys for planning and evaluation of health reform is discussed.

The association between self-assessed health status and individual health practices.

We report the association between single health practices and self-assessed health status. Data were collected by telephone survey applied to all adults in a sample of households in metropolitan St. John's; questionnaires were completed for 3,300 subjects. Five health practices--smoking, exercise, sleep, weight and drinking--as defined by previous studies were compared with self-assessed health status--good or poor--using logistic regression; linear and quadratic functions were fitted, plots were prepared and the direction and strength of the associations studied using odds and odds ratios. For sleep, smoking, weight and exercise, our results confirm the definitions used in previous studies. Current non-drinkers in our sample do not report good health as frequently as moderate drinkers. Breakfast--which was analyzed by conventional cross-tabulation--showed no association with health status.