Impact of body mass index on the effectiveness of a disease management-health promotion intervention on disability status.

PURPOSE: To examine the impact of body mass index (BMI) on the effectiveness of a disease management-health promotion intervention among community-dwelling Medicare beneficiaries with disabilities. DESIGN: Secondary data analyses of a randomized controlled trial. SETTINGS: Nineteen counties in upstate New York and on the West Virginia-Ohio border. SUBJECTS: Four hundred fifty-two Medicare beneficiaries who participated in the Medicare Primary and Consumer-Directed Care Demonstration between August 1998 and June 2002 and completed the 22-month follow-up. INTERVENTION: Multicomponent disease management-health promotion intervention involving patient education, individualized health promotion coaching, medication management, and physician care management. MEASURES: Body mass index and dependence in Activities of Daily Living (ADLs). ANALYSIS: Multivariate linear regression. RESULTS: The intervention resulted in significantly less worsening in ADLs dependence among normal-weight participants (coefficient, -.42; p = .04). However, the intervention did not have a significant effect for underweight participants (F test p = .33 vs. underweight participants in the control group) or overweight or obese participants (F test p = .78 vs. overweight or obese participants in the control group). CONCLUSIONS: A positive effect of the intervention on disability was found among normal-weight participants but not among underweight or overweight or obese participants. Future health promotion interventions should take into consideration the influence of BMI categories on treatment effects.

Employment, Social Support, and HIV Sexual-Risk Behavior in Puerto Rican Women.

This study examined psychosocial factors associated with HIV-risk behavior among Latina women at self-disclosed heterosexual risk for HIV infection. Data were collected via structured interviews for 187 Puerto Rican women, aged 18-35, who attended a health clinic in the Bronx, New York. Over 64% of all participants reported unprotected vaginal sex with primary sexual partners. Higher levels of unprotected vaginal sex were associated with living with the partner, residing with children, current employment, heightened negative mood, and greater social support from the partner. The relationship between increased negative mood and increased unprotected vaginal sex use was mediated by employment, after controlling for educational level, living with the partner, and residing with children. The findings suggest that interventions designed to facilitate HIV-protective behaviors may need to consider that employment may supercede relationship factors among populations of urban women identified at increased heterosexual risk for HIV infection.