An international comparison of web-based reporting about health care quality: content analysis.

BACKGROUND: On more and more websites, consumers are provided with public reports about health care. This move toward provision of more comparative information has resulted in different information types being published that often contain contradictory information. OBJECTIVE: The objective was to assess the current state of the art in the presentation of online comparative health care information and to compare how the integration of different information types is dealt with on websites. The content analysis was performed in order to provide website managers and Internet researchers with a resource of knowledge about presentation formats being applied internationally. METHODS: A Web search was used to identify websites that contained comparative health care information. The websites were systematically examined to assess how three different types of information (provider characteristics and services, performance indicators, and health care user experience) were presented to consumers. Furthermore, a short survey was disseminated to the reviewed websites to assess how the presentation formats were selected. RESULTS: We reviewed 42 websites from the following countries: Australia, Canada, Denmark, Germany, Ireland, the Netherlands, Norway, the United Kingdom, the United States, and Sweden. We found the most common ways to integrate different information types were the two extreme options: no integration at all (on 36% of the websites) and high levels of integration in single tables on 41% of the websites). Nearly 70% of the websites offered drill down paths to more detailed information. Diverse presentation approaches were used to display comparative health care information on the Internet. Numbers were used on the majority of websites (88%) to display comparative information. CONCLUSIONS: Currently, approaches to the presentation of comparative health care information do not seem to be systematically selected. It seems important, however, that website managers become aware of the complexities inherent in comparative information when they release information on the Web. Important complexities to pay attention to are the use of numbers, the display of contradictory information, and the extent of variation among attributes and attribute levels. As for the integration of different information types, it remains unclear which presentation approaches are preferable. Our study provides a good starting point for Internet research to further address the question of how different types of information can be more effectively presented to consumers.

Survey non-response in the Netherlands: effects on prevalence estimates and associations.

PURPOSE: Differences in respondent characteristics may lead to bias in prevalence estimates and bias in associations. Both forms of non-response bias are investigated in a study on psychosocial factors and cancer risk, which is a sub-study of a large-scale monitoring survey in the Netherlands. METHODS: Respondents of a cross-sectional monitoring project (MORGEN; N = 22,769) were also asked to participate in a prospective study on psychosocial factors and cancer risk (HLEQ; N = 12,097). To investigate diverse aspects of non-response in the HLEQ on prevalence estimates and associations are studied, based on information gathered in the MORGEN-project. RESULTS: A response percentage of 45% was obtained in the MORGEN-project. Response rates were found to be lower among men and younger people. The HLEQ showed a response percentage of 56%, and respondents reported higher socioeconomic status, better subjective health and healthier lifestyle behaviors than non-respondents. However, associations between smoking status and either socioeconomic status or subjective health based on respondents only were not statistically different from those based on the entire MORGEN-population. CONCLUSION: Non-response leads to bias in prevalence estimates of current smoking, current alcohol intake, and low physical activity or poor subjective health. However, non-response did not cause bias in the examined associations.

Determinants of smoking status: cross-sectional data on smoking initiation and cessation.

BACKGROUND: Cigarette smoking is known to increase the risk of chronic disease. Improved understanding of factors that contribute to smoking initiation and cessation may help to underpin strategies that lead to smoking behavior change. METHODS: Cross-sectional data obtained from 11,967 men and women, aged 20-65 years, were used to study associations with smoking initiation and smoking cessation within the general population. Information on smoking habits, socio-demographic factors and psychosocial factors were collected through self-administered questionnaires. Multiple logistic regression analyses were undertaken by gender. RESULTS: Adverse childhood experiences and personality characteristics (including extraversion, neuroticism and hostility) were found to be related to smoking initiation. Age, marital status and tobacco-related factors were consistently associated with smoking cessation. Older people, married persons and those who smoked more cigarettes per day had a higher likelihood of quitting, both for men and women. CONCLUSIONS: Smoking initiation was found to be associated with adverse childhood events and with measures of personality whereas smoking cessation was associated predominantly with socio-demographic and tobacco use-related factors.

Clustering of lifestyle risk factors in a general adult population.

BACKGROUND: The objective of the study was to evaluate the degree of clustering of common lifestyle risk factors in a general adult population and to define subgroups with elevated clustering. METHODS: Data on lifestyle risk factors (smoking, low vegetable and fruit consumption, excessive alcohol intake, and low physical activity), sociodemographics, and health perception were collected by questionnaire from 16,789 men and women aged 20 to 59. RESULTS: About 20% of the subjects had at least three lifestyle risk factors. Prevalence of risk factors was higher among unemployed, low-educated subjects and those who had experienced health deterioration. All lifestyle risk factors showed significant clustering, except for low physical activity and excessive alcohol consumption. The strongest association was observed for alcohol and smoking (prevalence odds ratio (POR): 2.38; 95% confidence interval: 2.18-2.61). Clustering of smoking and alcohol consumption was strongest among the young subjects (POR: 3.78) and, although moderately, clustering of lifestyle risk factors was elevated in subjects who had experienced a deterioration in health. CONCLUSIONS: These findings suggest that common lifestyle risk factors cluster among adult subjects. The tendency for risk factors to aggregate has important implications for health promotion. Information on high-risk groups will help in planning future preventive strategies.

Are stress related factors associated with alcohol intake?

Moderate alcohol consumption is related to reduced risks of coronary heart disease and all-cause mortality. Our goal is to advance our understanding of the associations between stress-related factors and alcohol consumption, using cutoff points for alcohol intake that reflect health benefits rather than health risks. Cross-sectional data were used from 4,131 respondents (age 20-65 years) participating in a cohort study in the Netherlands on psychosocial factors and cancer risk. Analyses were performed among drinkers only, for men and women separately. Heavy alcohol intake (>/= 3 glasses per day for men, >/= 2 glasses per day for women) was associated with only a few stress-related factors in multivariate analyses. No significant associations between the total amount of stressors and alcohol intake were found. We conclude that stress-related factors are only marginally associated with a heavy alcohol intake compared with fair drinking, using the safe limits of drinking as cutoff point.