Special Issue "Health Behavior and Public Health"

Guest Editor
Prof. Dr. Tetsuji Yamada
Professor of Health Economics, Department of Economics and Center for Children and Childhood Studies, Rutgers University, the State University of New Jersey, 311 North 5th Street, Camden, NJ 08102, USA
Website: http://economics.camden.rutgers.edu/yamada/
E-Mail:
Interests: health economics; economics of health behavior; public health and health promotion; economics of social welfare and public policy; health education

Dear Colleagues,

Behavior change has become a central objective of public health over the last half decade. During the past decade, there has been a remarkable increase in public, private, and professional support in the public health arena in preventing illness and disability by altering individuals’ lifestyle through behavioral changes. Such support comes from behavioral scientists, health educators, health promoters, and health communicators. The influence of prevention within the health services has increased. It is important to underscore the application of behavioral and social science perspectives to research on contemporary health problems.

An increased risk of morbidity and mortality largely depends on individual health behaviors, such as healthcare decisions, smoking, and use of drugs and alcohol. Understanding an influence on health behaviors that are risk factors in disease and illness is essential and associated with behavioral change which would be considered protective and health enhancing. Thus, Disease prevention and early detection contribute to a healthy aging population, curbing a rapid increase in healthcare costs, and improving quality of life. In addition, issues on accessibility of health care and health disparities have become recent important concerns.

Evaluations of health behaviors are key elements to improve public health. Both public and private sectors provide preventive as well as treatment interventions. The increased influence of prevention has coincided with increased multi-lateral levels and the increased need for cost-benefit/effectiveness analyses for allocation of monetary resources.

Health Behavior and Public Health explores research on health education, health communication, health behavioral changes, and public health policies, evaluates them with multilevel aspects, and exchanges knowledge in public health in interdisciplinary and international arenas.

Prof. Dr. Tetsuji Yamada
Guest Editor

Submission

The Int. J. Environ. Res. Public Health (ISSN 1660-4601) was launched in 2004 and is an Open Access journal, with the main Editorial Office located in Basel, Switzerland. It has been accepted for coverage in Science Citation Index Expanded, available as the Web of Science and in Current Contents/Agriculture, Biology, and Environmental Sciences. Coverage will begin with the 2009 issues. This journal is also abstracted and indexed very rapidly by Chemical Abstracts, MedLine/PubMed and EMBASE. The IJERPH maintains a rapid editorial procedure and a rigorous peer-review system. Well written papers have been peer-reviewed and published in less than 4 weeks from manuscript submission. All papers published in IJERPH have DOI numbers.

All papers should be submitted to ijerph@mdpi.org with copy to the guest editor. To be published continuously until the deadline and papers will be listed together at this special issue website.

Please visit the Instructions for Authors page before submitting a paper. Open Access publication fees are 300 CHF per paper. English correction fees (250 CHF) will be added in certain cases (550 CHF per paper for those papers that require extensive additional formatting and/or English corrections.).

• illness preventionhealthy lifestyle
• behavioral change
• aging society
• healthcare costs
• accessibility
• quality of life
• health behaviors
• health interventions
• cost-benefit/effective analyses

Type of Paper: Article
Title: What are the Characteristics of an Effective Anti-Tobacco Advertisement: The Role of Emotional Context and Content
Authors: Constantine I. Vardavas¹, Emmanouil K. Symvoulakis¹, Gregory Connolly², Evridiki Patelarou³ and Christos Lionis¹
Affiliations: ¹ Clinic of Social and Family Medicine, Department of Social Medicine, Faculty of Medicine, University of Crete, Greece; E-Mails: vardavas@edu.med.uoc.gr (C.I.V.), symvouman@yahoo.com (E.K.S.), lionis@galinos.med.uoc.gr (C.L)
² Harvard School of Public Health, Harvard University, MA, US; E-Mail: gconnoll@hsph.harvard.edu (G.C.)
³ University Hospital of Heraklion, Crete, Greece; E-Mail: patelarou@edu.med.uoc.gr (E.P)
Abstract: As the Framework Convention on Tobacco Control calls for public health awareness on tobacco use, mass media campaigns should be ideally designed so as to maximize their effectiveness. In this study, 95 Greek adolescents (mean age 15 ±1.8 years), were projected seven different anti tobacco ads, and asked to rate their content and emotional context on a 1-7 Likert scale. Health related ads were rated the highest, and as identified through a logistic regression analysis, adolescents who perceived an ad to be emotional or have a clear message relevant to them were more likely to rate it as more effective.
Keywords: smoking; prevention; mass media; health education; adolescents; tobacco control; anti-tobacco; counter advertising

Type of Paper: Article
Title: The Influence of Secondhand Smoke Exposure on Birth Outcome in Jordan
Authors: Nesrin Abu Baker ¹, Linda Haddad ² and Christine Savage ³
Affiliations: ¹ School of Nursing, Jordan University of Science & Technology, P.O Box 3030, Irbid 22110, Jordan
² Department of Family and Community Health & Institute for Drug and Alcohol Studies, Faculty of Nursing, Virginia Commonwealth University, Richmond, P.O. Box 980567,Virginia, 23298-0567, USA
³ College of Nursing, Department of Public Health Science, College of Medicine, University of Cincinnati Academic Health Center, P.O. Box 210038Cincinnati, OH 45221-0038, USA; E-Mail: Christine.savage@uc.edu (C.S.)
Abstract: This study investigates how secondhand smoke (SHS) exposure influences neonatal birth weight in Jordan, a country with high smoking prevalence. The findings revealed that as the average number of SHS exposure hours per week increased in the second trimester, the neonatal birth weight decreased while holding all covariates constant. Women who reported a higher average number of SHS exposure hours per week from work in the second trimester, home in the third trimester, and outside in the third trimester were at greater risk for having a low birth weight neonate than women who reported a lower average number of SHS exposure hours.
Keywords: Secondhand Smoke (SHS); environmental tobacco smoke; Jordan; birth outcomes; neonates weight

Type of Paper: Article
Title: Are Adolescents with ADHD Interested in Genetic Testing for Nicotine Addiction Susceptibility?
Authors: Linda J. Herbert ¹, Leslie R. Walker ², McKane E. Sharff ³, Anisha A. Abraham ³ and Kenneth P. Tercyak ³
Affiliations: ¹ University of Maryland Baltimore County / 1000 Hilltop Circle, Baltimore, MD 21250, USA
² Seattle Children’s Hospital / 4800 Sand Point Way NE, Seattle, WA 98105, USA
³ Georgetown University Medical Center / 3300 Whitehaven Street, NW, Washington, DC 20007, USA; E-Mail: tercyakk@georgetown.edu
Abstract: It has been well-established that some adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking. Current research on the genetic basis of this association could ultimately translate into genetic tests capable of identifying smoking-prone adolescents with ADHD. In this study we examined 81 ADHD affected adolescents’ (age 13-21) interest in genetic testing for nicotine addiction susceptibility. Fifty-seven percent of adolescents indicated a fair amount of interest or more in testing. Most adolescents indicated that the personal information revealed from testing would be either useful (29%) or interesting (37%). Implications for genetically-informed smoking prevention and cessation interventions in high risk adolescents with ADHD are discussed.
Keywords: attention-deficit/hyperactivity disorder (ADHD); genetic testing; Nicotine addiction

Type of Paper: Review
Title: Improving Physical Activity and Dietary Behaviours with Single or Multiple Health Behaviour Interventions? A Synthesis of Meta-Analyses and Reviews
Authors: Shane N. Sweet ¹ and Michelle S. Fortier ²
Affiliations: ¹ School of Psychology, University of Ottawa / 125 University Pr., Montpetit Hall, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada; E-Mail: ssweet@uottawa.ca
² School of Human Kinetics, University of Ottawa / 125 University Pr., Montpetit Hall, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada; E-Mail: mfortier@uottawa.ca
Abstract: Since multiple health behaviour interventions have gained popularity, it is important to investigate their effectiveness compared to single health behaviour interventions. This synthesis aims to determine whether single intervention (physical activity or dietary) or multiple interventions (physical activity and dietary) are more effective at increasing these behaviours by synthesizing reviews and meta-analyses. A sub-purpose also explored their impact on weight. Overall, single health behaviour interventions were more effective at increasing the targeted behaviours, while multiple health behaviour interventions resulted in greater weight loss. This review may assist policies aiming at improving physical activity and nutrition and reversing the obesity epidemic.
Keywords: health behaviours; interventions, reviews, meta-analyses, physical activity, dietary behaviours

Type of Paper: Article
Title: External Costs of Risky Heath Behaviors Associated With Leading Actual Causes of Death in the U.S.: A Review of the Evidence and Implications for Future Research
Authors: Armineh Zohrabian1,* and Tomas J Philipson 2
Affiliations: ¹ Division of Adult and Community Health, Centers for Disease Control and Prevention CDC/ 3005 Chamblee-Tucker Rd, MS-K67, Atlanta, GA 30341
² Harris School of Public Policy Studies, University of Chicago/ 1155 E. 60th Street, Suite 112, Chicago, IL 60637; E-Mails: abz8@cdc.gov; t-philipson@uchicago.edu
Abstract: This paper reviews the evidence on external costs of risky behaviors and provides a framework for estimating them. External costs arise when a person does not bear all the costs of their behavior. They provide one of the strongest rationales for government interventions on the grounds of equity, efficiency and fairness. Although the earlier estimates of external costs no longer have policy relevance, they demonstrated that the existence of external costs is an empirical question, and that the assumptions of models can lead to qualitatively different results. We recommend that the estimates of external costs be updated as insurance structures, technologies, environments and knowledge about the effects of these behaviors change.
Keywords: costs; smoking; environmental tobacco smoke; alcohol; excessive drinking; obesity; poor diet; physical activity

Type of Paper: Article
Title: Quality of Life: Relations with Health Status and with Behavior and Lifestyle in a Japanese Community
Authors: Saeko Fujimori ¹, Luyinga Kalay ¹, Keiko Minamoto ¹, Koichi Harada ³, Chang-Nian Wei ¹, Kimiyo Ueda ² and Atsushi Ueda ¹
Affiliations: ¹ Kumamoto University, Graduate School of Medical and Pharmaceutical Sciences, Department of Preventive and Environmental Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan; E-Mails: s_huzi041_r5138@yahoo.co.jp (S.F); anifakalay@gmail.com (L.K.); may20@kumamoto-u.ac.jp (K.M.); cnwei@gpo.kumamoto-u.ac.jp (C.N.W.); a-ueda@gpo.kumamoto-u.ac.jp (A.U.)
² Kumamoto University, School of Health Sciences, Department of Community Health Nursing, 4-24-1Kuhonji, Kumamoto 862-0976, Japan; E-Mail: kiueda@kumamoto-u.ac.jp (K.U.)
³ Kumamoto University, School of Health Sciences, Department of Microbiology and Environmental Chemistry, 4-24-1Kuhonji, Kumamoto 862-0976, Japan; E-Mail:haradako@gpo.kumamoto-u.ac.jp (K.H.)
Abstract: Using a questionnaire developed through focus group interviews, we investigated the relations of health status (HS) or behavior and lifestyle (BLS) with the quality of life (QOL) in Japanese community members stratified by sex and life stage. ANOVA and logistic regression were performed. HS and BLS had a stronger influence on QOL than sex or life stage. Moreover, HS and BLS varied with sex and life stage. This suggests that health promotion programs to enhance QOL should not only emphasize improvement of HS and BLS but also allow for the influence of gender and age.
Keywords: quality of life (QOL); focus group interview (FGI); health status (HS); behavior and lifestyle (BSL); life stage

Type of Paper: Review
Title: Facilitating Patients’ Dietary Change: Importance of Dietitian–General Practitioner Collaboration via Dietitians’ Consultation Letters: A Review
Author: Robyn Cant; E-Mail: Robyn.Cant@med.monash.edu.au
Abstract: AIM: To review the literature on correspondence practices of dietitians and recipient GPs regarding the care of patients who have received a nutrition intervention from a dietitian. METHODS: A search was conducted of publications between 1995- November 2009 Keywords were used to search electronic databases such as Medline, ProQuest and Google Scholar. Twenty papers were selected by two authors for inclusion. FINDINGS: Although general practitioners (GPs) are key to co-ordination of patients’healthcare including nutrition care, they may not be provided with adequate patient information via dietitians’ consultation letters. Doctors report a lack of access to patient letters and dietitians report providing them for about two in every threepatients. Information about nutrition care of hospital patients often remains withinhospital records. There is a skill in drafting reports which are useful for GPs. Theyprefer standardized letter formats and content selected as of value to doctors.Dietitians should include a nutrition diagnosis; agreed goals; a plan for on going dietetic visits and instructions for GPs’ supportive actions. Planned implementation of shared encrypted electronic records in Australia will facilitate information transfer and is crucial to dietitians’ correspondence practices in the future. CONCLUSION: Dietitians need to be partnered with GPs through use of electronicclinical packages to facilitate effective correspondence using structured templates to realize collaborative care of patients. Further investigations of dietitian–general practitioner correspondence are warranted, to determine best practice.

Type of Paper: Article
Title: Promotion of Physical Activity Using Point-of-Decision Prompts in Berlin Underground Stations
Authors: Falk Müller-Riemenschneider, Marc Nocon, Thomas Reinhold and Stefan N. Willich
Affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre Berlin, Germany; E-Mail: Falk.Mueller-Riemenschneider@charite.de
Abstract: To evaluate point-of-decision prompts in the promotion of stair use in Germany, motivational posters were fastened at three underground stations in Berlin. The proportion of passengers using stairs or stairways was counted before, during fixation, and two weeks after removal of posters. In total, 5603 passengers were counted. Stair use increased significantly in women but not in men. The present pilot study thereby shows that the use of point-of-decision prompts is also feasible in Germany and it provides some evidence of effectiveness. Methodologically rigorous studies are warranted to confirm these findings.
Keywords: prevention; health promotion; physical activity

Type of Paper: Article
Title: The Geography of Diabetes in London, Canada: The Need for Local Level Policy for Prevention and Management
Authors: Jordan W. Tompkins ^1,2, Isaac N. Luginaah ², Gillian L. Booth ^3,4,5 and Stewart B. Harris ¹
Affiliations: ¹ Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, N6G 4X8, Canada; E-Mail: sharris1@uwo.ca (S.B.H.); jordan.tompkins@uwo.ca (J.W.T.)
² Department of Geography, The University of Western Ontario, London, ON, N6A 5C2, Canada; E-Mail: iluginaa@uwo.ca (I.L.)
³ Institute of Clinical Evaluative Sciences, Toronto, ON, M4N 3M5, Canada; E-Mail: boothg@smh.toronto.on.ca (G.B.)
⁴ Department of Medicine and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
⁵ Department of Medicine and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, M5B 1W8, Canada
Abstract: Recent reports aimed at improving diabetes care in socially disadvantaged populations suggest that interventions must be tailored to meet the unique needs of the local community – specifically, the community’s geography. We examined the spatial distribution of diabetes in the context of socioeconomic determinants of health in London, Canada to characterize neighbourhoods in an effort to target these neighbourhoods for local level community-based program planning and intervention. Multivariate spatial-statistical techniques and geographic information systems were used to examine diabetes rates and socioeconomic variables aggregated at the census tract level. Creation of a deprivation index facilitated investigation across multiple determinants of health. Findings from our research identified ‘at risk’ neighbourhoods in London with socioeconomic disadvantage and high diabetes. Future endeavours must continue to identify local level trends in order to support policy development, resource planning and care for improved health outcomes and improved equity in access to care across geographic regions.
Keywords: Diabetes Mellitus; London; Ontario; public health; geography; socioeconomic determinants of health, health behaviours; health interventions

Type of Paper: Article
Title: Adolescent Propensity to Engage in Health Risky Behaviors: The Role of Individual Resilience
Authors: Mir M. Ali ¹, Debra S. Dwyer ², Elizabeth A. Vanner ³, Alexander Lopez ³
Affiliations: ¹ Department of Economics, University of Toledo, Toledo, OH, USA; E-Mail: mir.ali3@utoledo.edu
² School of Health Technology & Management and Department of Economics, Stony Brook University, Stony Brook, NY, USA; E-Mail: debra.dwyer@stonybrook.edu
³ School of Health Technology & Management, Stony Brook University, Stony Brook, NY, USA; E-Mails: elizabeth.vanner@stonybrook.edu (E.A.V.); alexander.lopez@sunysb.edu (A.L.)
Abstract: In this paper we create indices of resilience to identify adolescents at risk of smoking, drinking alcohol, and using illegal drugs. Using data from the National Longitudinal Study of Adolescent Health, three manifestations of resilience were identified: overall-resilience, self/family-resilience, and self-resilience. Our analysis reveals that the overall-resilient were less likely to engage in risky behaviors. The self/family resilient were more likely to engage in risky behaviors, but consumed less. The self-resilient had reduced risk for smoking and drinking alcohol but elevated risk for using illegal drugs and being in an addictive stage of smoking and drinking, if participating.
Keywords: resilience; health risky behavior; factor analysis; adolescent health

Type of Paper: Article
Title: Micro Data Analysis of Medical and Long-Term Care Utilization among the Elderly in Japan
Authors: Hideki Hashimoto ¹, Hiromasa Horiguchi ² and Shinya Matsuda ³
Affiliations: ¹ Department of Health Economics and Epidemiology Research, University of Tokyo School of Public Health, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan; E-Mail: hidehashimoto-circ@umin.ac.jp
² Department of Health Management and Policy, University of Tokyo Graduate School of Medicine / 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan; E-Mail: hiromasa-tky@umin.ac.jp
3 Department of Public Health, University of Occupational and Environmental Health /1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu City, Fukuoka 807-8555, Japan; E-Mail: smatsuda@med.uoeh-u.ac.jp
Abstract: Japan experiences the most rapid population ageing among OECD countries, and ageing has been accused of increasing medical and long-term care expenditure. Recent debate in the U.S. and European countries on end-of-life care and long-term care cost, however, differently attributes population ageing to the source of expenditure rise. In this study, we analyzed a large claim data of Japanese public local insurance for medical and long-term care, and described how ageing, time to death, survivorship, and use of long-term care affected the medical care expenditure among those aged 65 and over in this country.
Keywords: end-of-life medical cost; long-term care; ageing; survivorship; Japan

Type of Paper: Article
Title: Barriers to Health Care among the Elderly in Japan
Authors: Chiyoe Murata ¹, Tetsuji Yamada ², Chia-Ching Chen ³, Toshiyuki Ojima ¹, Hiroshi Hirai ⁴ and Katsunori Kondo ⁴
Affiliations: ¹ Hamamatsu University School of Medicine, Department of Community Health and Preventive Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, 431-3192, Japan; E-Mail: cmurata@hama-med.ac.jp
² Rutgers University, Department of Economics and Center for Children and Childhood Studies, Camden, NJ 08102, USA
³ New York Medical College, School of Health Sciences & Practice, Department of Epidemiology & Community Health, Valhalla, NY 10595, USA
⁴ Nihon Fukushi University, Center for Well-being and Society / 5-22-35 Chiyoda Nakaku Nagoya, Aichi, 460-0012, Japan
Abstract: Japan is undergoing a set of health care reforms aiming to cut rising health care costs and increase the efficiency of health care delivery. This empirical study used a large-scale community survey on 15,302 elderly people aged 65 years and older (56.0% women) conducted in 7 municipalities in 2006 to reveal clear-cut evidence of barriers to necessary care. The reasons for not getting health care is attributed to health care cost in the lower income elderly, while higher income counterparts reported being busy or condition not serious enough.
Keywords: cost burden; socioeconomic status (SES); barriers to health care

Type of Paper: Article
Title: Aging Risk and Health Care Cost in Korea
Author: Byongho Tchoe
Affiliation: Senior Researcher, Korea Institute for Health and Social Affairs, Eunpyong-gu, Bulkwang-dong, Seoul 122-705, Korea; E-Mail: choice1313@hanmail.net
Abstract: To analyze the impact of ageing on medical costs for Korea, we examine three different approaches. The first is a projection based on age profile of medical costs. Examination of Korean age profile reveals a steep U-shaped curve, suggesting huge increases due to ageing. We argue, however, that ageing and age profile are not exogenous. We show that, in the second approach based on panel regression of OECD countries, ageing is not found to be a significant factor, and in the third approach, a factor decomposition of increases in the medical costs, aging has contributed only less than 10 percent.
Keywords: age profile of Korean medical costs; factor decomposition of increases in medical costs; effect of aging on medical costs

Type of Paper: Article
Title: The Global Challenge of Antimicrobial Resistance: Insights from Economic Analysis
Authors: Karen Eggleston ¹, Ruifang Zhang ² and Richard J. Zeckhauser ³
Affiliations: ¹ Stanford University Shorenstein Asia-Pacific Research Center, Stanford, CA, USA; E-Mail: karene@stanford.edu
² Goldman Sachs International, Global Investment Research, London, UK; E-Mail: ruifang.zhang@gs.com
³ Harvard University Kennedy School of Government, Cambridge, MA, USA; E-Mail: richard_zeckhauser@harvard.edu
Abstract: The prevalence of antimicrobial resistance (AR) limits the therapeutic options for treatment of infections, and increases the social benefit from disease prevention. Like an environmental resource, antimicrobials require stewardship. The effectiveness of an antimicrobial agent is a global public good. We argue for greater use of economic analysis as an input to policy discussion about AR, including for understanding the incentives underlying health behaviors that spawn AR, and to supplement other methods of tracing the evolution of AR internationally. We conclude with a short discussion of integrating antimicrobial stewardship into global health governance.
Keywords: antimicrobial resistance; economic analysis; drug resistance; behavioral economics

Type of Paper: Article
Title: Successful Smoking Cessation and Duration of Abstinence—An Analysis of Socioeconomic Determinants
Author: Joachim Marti
Affiliation: Institute for research in economics, Economics department, University of Neuchâtel, CH-2000 Neuchâtel, Switzerland; E-Mail: joachim.marti@unine.ch
Abstract: Smoking does not affect every socioeconomic subgroup of the population equally, resulting in major inequalities in terms of smoking-related morbidity and mortality. While previous studies mainly focused on inequalities in smoking prevalence, we analysed the socioeconomic dimensions that might be associated with two other smoking-related outcomes: the odds of successfully quitting and the duration of abstinence. Using nationally representative Swiss data, we found evidence of a socioeconomic gradient in successful cessation and abstinence duration with respect to education level and income for both men and women.
Keywords: socioeconomic status; inequalities; smoking cessation; abstinence, duration analysis