IJERPH: Health Behavior and Public Health

IJERPH, Vol. 9, Pages 223-243: The Relevance of Personal Characteristics in Allocating Health Care Resources—Controversial Preferences of Laypersons with Different Educational Backgrounds

Jeannette Winkelhage — Mon, 16 Jan 2012 00:00:00 CET

In all industrial countries publicly funded health care systems are confronted with budget constraints. Therefore, priority setting in resource allocation seems inevitable. This paper examines whether personal characteristics could be taken into consideration when allocating health services in Germany, and whether attitudes towards prioritizing health care vary among individuals with different levels of education. Using a conjoint analysis approach, hypothetical patients described in terms of ‘lifestyle’, ‘age’, ‘severity of illness’, ‘type of illness’, ‘improvement in health’, and ‘treatment costs’ were constructed, and the importance weights for these personal characteristics were elicited from 120 members of the general public. Participants were selected according to a sampling guide including educational background, age, chronic illness and gender. Results are reported for groups with different levels of education (low, middle, high) only. The findings show that the patients’ age is the most important criterion for the allocation of health care resources, followed by ‘severity of illness’ and ‘improvement in health’. Preferences vary among participants with different educational backgrounds, which refer to different attitudes towards distributive justice and might represent different socialization experiences.

IJERPH, Vol. 9, Pages 100-109: Implications of Edentulism on Quality of Life among Elderly

Suely Maria Rodrigues — Wed, 04 Jan 2012 00:00:00 CET

This study aimed was to test the association between quality of life and edentulism among elderly individuals in a city in southeastern Brazil. This cross-sectional study was carried out with 163 individuals aged 60 years or older, functionally independent and non-institutionalized. Data were collected with a questionnaire and oral examination. The edentulism was the dependent variable. The independent variables were sex, age, household income and quality of life (WHOQOL-Old) and their scores. To assess the association between the dependent variable and independent variables was used bivariate analysis (p < 0.10). Poisson regression model was performed, adjusting for age and sex. The average age of participants was 69 years (± 6.1), 68.7% were female and 52.8% were diagnosed as completely edentulous (90% CI: 0.33–1.24). When the independent variables were associated to the prevalence of edentulism, statistically significant associations were found for age (p = 0.03) and social participation dimension of the WHOQOL-Old (p = 0.08). In the Poisson regression, social participation remained statistically associated to edentulism {RP = 2.12 [90% CI (1.10–4.00)]}. The social participation proved to have a significant association to edentulism, thereby attesting to the negative effect of this condition on social aspects.

IJERPH, Vol. 9, Pages 44-54: Self-Reported Dental Fear among Dental Students and Their Patients

Junia Serra-Negra — Thu, 29 Dec 2011 00:00:00 CET

The aim of the present study was to compare self-reported dental fear among dental students and patients at a School of Dentistry in Belo Horizonte, Brazil. Eighty students ranging in age from 20 to 29 years and 80 patients ranging in age from 18 to 65 years participated in the study. A self-administered pre-tested questionnaire consisting of 13 items was used for data acquisition. The city of Belo Horizonte Social Vulnerability Index (SVI) was employed for socioeconomic classification. The chi-square test and binary and multinomial logistic regression were employed in the statistical analysis, with the significance level set at 0.05. The majority of dental students (76.5%) sought the dentist for the first time for a routine exam, while patients (77.3%) mostly sought a dentist for the treatment of dental pain. Dental fear was more prevalent among the patients (72.5%) than the students (27.5%). A total of 47.1% of the students and 52.9% of the patients reported having had negative dental experiences in childhood. The logistic model revealed an association between dental fear and a pain-related experience (OR: 1.8; 95%CI: 1.3–2.6). Patients were more prone to dental fear (OR: 2.2; 95%CI: 1.0–5.0). Although at different percentages, both students and patients experienced dental fear. Current patient with previous experience of dental pain had more dental fear.

IJERPH, Vol. 8, Pages 4300-4311: Physician Consultations According to Different BMI Levels of the Greek General Population

Evelina Pappa — Mon, 14 Nov 2011 00:00:00 CET

Obesity constitutes a global epidemic which is rapidly becoming a major public health problem in many parts of the world, threatening peoples’ health and quality of life. The aim of our study was to estimate the prevalence and impact of overweight and obesity on physician consultations and frequency of use and furthermore, to investigate whether physician consultations in each of the groups defined by BMI level correspond to the need for care implied by health risk level, using logistic regression models. The survey was carried out in Greece in 2006 and involved complete data from 645 individuals consulted by physicians. Overweight and obese users constituted 41.7% and 19% of the sample respectively. The findings showed firstly that the odds of obese individuals visiting a physician (OR 2.15) or making more than three visits (OR 2.12) was doubled compared to the odds of individuals with normal weight. Secondly, we conclude that physician consultations in overweight and obese subgroups as well as the frequency of visits were predicted by factors such as co-morbidities, low HRQL, low educational level which are associated directly or indirectly with obesity, and thus with a greater health need, assuming vertical equity in the utilization of such services.

IJERPH, Vol. 8, Pages 4207-4219: Knowledge, Attitudes, and Behavior in Avoiding Secondhand Smoke Exposure Among Non-Smoking Employed Women with Higher Education in Jordan

Huda Gharaibeh — Wed, 09 Nov 2011 00:00:00 CET

Secondhand smoke (SHS) exposure is a serious public health threat worldwide; in the developing world there are less serious efforts towards controlling women’s and children’s exposure to SHS. Knowledge, attitudes and avoidance practices among Jordanian women have never been thoroughly studied. The purpose of this study was to assess the knowledge, attitudes, and avoidance behavior towards SHS exposure among employed Jordanian women with higher education. Methods: A survey was conducted among employed Jordanian women at two universities. A total of 209 women were included in the analysis. Two questionnaires regarding SHS exposure were used to measure knowledge, attitudes and avoidance practices. Results: Most respondents were regularly exposed to SHS in various locations during daily life, even though they were very knowledgeable about the dangers of SHS exposure for women and children. However, the subject’s attitudes and avoidance behavior did not reflect the level of knowledge about SHS risks. The results suggests there is a large discrepancy between SHS exposure, knowledge, attitudes and avoidance behavior among highly educated Jordanian women that is likely influenced by culture and traditional gender roles. Public health initiatives are needed in Jordan to address public policy, institutional practices and to empowerment of women to reduce SHS exposure.

IJERPH, Vol. 8, Pages 4197-4206: Influenza Vaccination Among Adults 65 Years or Older: A 2009–2010 Community Health Survey in the Honam Region of Korea

So Yeon Ryu — Tue, 08 Nov 2011 00:00:00 CET

The present study examined the rates and related factors for influenza vaccination among the elderly Korean population during the 2008/09 influenza seasons. We obtained data for 6,391 adults aged 65 years or older from Community Health Surveys conducted in 2009 and 2010 in 13 communities in the Honam region of Korea. A multiple logistic regression analysis was used to identify the factors associated with self-reported influenza vaccinations. In this elderly population, 81.7% reported to having received an influenza vaccination in the past year. The main contributing factors were older age, lower economic status, lower educational level, married, non-smoking, regular alcohol consumption, regular walking exercise, receiving a health check-up during the past two years, not stressed, and having comorbid conditions. The influenza vaccination coverage rate among elderly Koreans was relatively high, but improvements in vaccination rates are required.

IJERPH, Vol. 8, Pages 3333-3350: Street Connectivity is Negatively Associated with Physical Activity in Canadian Youth

Graham Mecredy — Tue, 16 Aug 2011 00:00:00 CEST

Street connectivity, defined as how well streets connect to one and other and the density of intersections, is positively associated with active transportation in adults. Our objective was to study the relation between street connectivity and physical activity in youth. Study participants consisted of 8,535 students in grades 6–10 from 180 schools across Canada who completed the 2006 Health Behaviour in School-aged Children (HBSC) survey. Street connectivity was measured in a 5 km circular buffer around these schools using established geographic information system measures. Physical activity performed outside of school hours was assessed by questionnaire, and multi-level regression analyses were used to estimate associations with street connectivity after controlling for several covariates. Compared to students living in the highest street connectivity quartile, those in the second (relative risk = 1.22, 95% confidence interval = 1.10–1.35), third (1.25, 1.13–1.37), and fourth (1.21, 1.09–1.34) quartiles were more likely to be physically active outside of school. In conclusion, youth in neighbourhoods with the most highly connected streets reported less physical activity outside of school than youth from neighbourhoods with less connected streets. Relationships between street connectivity and physical activity reported in this national study are in the opposite direction to those previously observed for active transportation in adult populations.

IJERPH, Vol. 8, Pages 3192-3201: Prevalence of Symptoms of Severe Asthma and Allergies in Irish School Children: An ISAAC Protocol Study, 1995–2007

Zubair Kabir — Tue, 02 Aug 2011 00:00:00 CEST

Childhood asthma is a recurring health burden and symptoms of severe asthma in children are also emerging as a health and economic issue. This study examined changing patterns in symptoms of severe asthma and allergies (ever eczema and hay fever), using the Irish International Study of Asthma and Allergies in Childhood (ISAAC) protocol. ISAAC is a cross-sectional self-administered questionnaire survey of randomly selected representative post-primary schools. Children aged 13–14 years were studied: 2,670 (in 1995), 2,273 (in 1998), 2,892 (in 2002–2003), and 2,805 (in 2007). Generalized linear modelling using Poisson distribution was employed to compute adjusted prevalence ratios (PR). A 39% significant increase in symptoms of severe asthma was estimated in 2007 relative to the baseline year 1995 (adjusted PR: 1.39 [95% CI: 1.14–1.69]) increasing from 12% in 1995 to 15.3% in 2007. Opposite trends were observed for allergies, showing a decline in 2007, with an initial rise. The potential explanations for such a complex disease pattern whose aetiological hypothesis is still evolving are speculative. Changing environmental factors may be a factor, for instance, an improvement in both outdoor and indoor air quality further reinforcing the hygiene hypothesis but obesity as a disease modifier must also be considered.

IJERPH, Vol. 7, Pages 3235-3254: Aging Risk and Health Care Expenditure in Korea

Byongho Tchoe — Fri, 20 Aug 2010 00:00:00 CEST

This paper analyzes the impact of population aging on health care expenditures in Korea. Examination of the age-expenditure profile reveals that health care resources are allocated more for the older cohort of population over time, suggesting significant growth of health care expenditures due to population aging. We contend, however, that population aging is considered as a parameter rather than an independent variable to explain rising health care expenditures. This paper shows that population aging is not found to be a significant determinant of health care expenditures according to the econometric analysis using OECD health data and time-series data for Korea. Using the components decomposition method, which measures the contribution of each component of health care expenditure, we estimate that population aging contributes only less than 10 percent.

IJERPH, Vol. 7, Pages 3141-3149: The Global Challenge of Antimicrobial Resistance: Insights from Economic Analysis

Karen Eggleston — Mon, 09 Aug 2010 00:00:00 CEST

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 also discuss integrating antimicrobial stewardship into global health governance.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 also discuss integrating antimicrobial stewardship into global health governance.

IJERPH, Vol. 7, Pages 3063-3070: Promotion of Physical Activity Using Point-of-Decision Prompts in Berlin Underground Stations

Falk Müller-Riemenschneider — Wed, 04 Aug 2010 00:00:00 CEST

To evaluate point-of-decision prompts in the promotion of stair use in Germany, motivational posters were placed at three underground stations in Berlin. The proportion of passengers using stairs or stairways was counted before, during installation, and two weeks after removal of posters. In total, 5,467 passersby 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.

IJERPH, Vol. 7, Pages 3022-3037: Micro Data Analysis of Medical and Long-Term Care Utilization Among the Elderly in Japan

Hideki Hashimoto — Fri, 30 Jul 2010 00:00:00 CEST

Japan is currently experiencing the most rapid population aging among all OECD countries. Increasing expenditures on medical care in Japan have been attributed to the aging of the population. Authors in the recent debate on end-of-life care and long-term care (LTC) cost in the United States and Europe have attributed time to death and non-medical care cost for the aged as a source of rising expenditures. In this study, we analyzed a large sample of local public insurance claim data to investigate medical and LTC expenditures in Japan. We examined the impact of aging, time to death, survivorship, and use of LTC on medical care expenditure for people aged 65 and above. On the basis of these findings, we conclude that age is a contributing factor to the rising expenditures on LTC, and that the contribution of aging to rising medical care expenditures should be distinguished according to survivorship.

IJERPH, Vol. 7, Pages 2789-2799: Successful Smoking Cessation and Duration of Abstinence—An Analysis of Socioeconomic Determinants

Marti — Wed, 30 Jun 2010 00:00:00 CEST

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 have 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.

IJERPH, Vol. 7, Pages 2460-2472: External Costs of Risky Health Behaviors Associated with Leading Actual Causes of Death in the U.S.: A Review of the Evidence and Implications for Future Research

Zohrabian — Thu, 03 Jun 2010 00:00:00 CEST

This paper reviews the evidence on external costs of risky behaviors in the U.S. and provides a framework for estimating them. External costs arise when a person does not bear all the costs of his or her behavior. They provide one of the strongest rationales for government interventions. Although the earlier estimates of external costs no longer have policy relevance, they demonstrated that the existence of external costs was an empirical question. We recommend that the estimates of external costs be updated as insurance structures, environments, and knowledge about these behaviors change. The general aspects of external costs may apply to countries other than the U.S. after taking into account differences in institutional, policy and epidemiological characteristics.

IJERPH, Vol. 7, Pages 2407-2422: The Geography of Diabetes in London, Canada: The Need for Local Level Policy for Prevention and Management

Tompkins — Wed, 19 May 2010 00:00:00 CEST

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 have examined the spatial distribution of diabetes in the context of socioeconomic determinants of health in London (Ontario, 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.

IJERPH, Vol. 7, Pages 2161-2176: Adolescent Propensity to Engage in Health Risky Behaviors: The Role of Individual Resilience

Ali — Tue, 04 May 2010 00:00:00 CEST

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.

IJERPH, Vol. 7, Pages 1760-1772: Maternal Diet, Behaviour and Offspring Skeletal Health

Goodfellow — Fri, 16 Apr 2010 00:00:00 CEST

Osteoporotic fracture has a major impact upon health, both in terms of acute and long term disability and economic cost. Peak bone mass, achieved in early adulthood, is a major determinant of osteoporosis risk in later life. Poor early growth predicts reduced bone mass, and so risk of fracture in later life. Maternal lifestyle, body build and 25(OH) vitamin D status predict offspring bone mass. Recent work has suggested epigenetic mechanisms as key to these observations. This review will explore the role of the early environment in determining later osteoporotic fracture risk.

IJERPH, Vol. 7, Pages 1720-1743: Improving Physical Activity and Dietary Behaviours with Single or Multiple Health Behaviour Interventions? A Synthesis of Meta-Analyses and Reviews

Sweet — Fri, 16 Apr 2010 00:00:00 CEST

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, reviews/meta-analyses showed that 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.

IJERPH, Vol. 7, Pages 1694-1707: Are Adolescents with ADHD Interested in Genetic Testing for Nicotine Addiction Susceptibility?

Herbert — Wed, 14 Apr 2010 00:00:00 CEST

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.

IJERPH, Vol. 7, Pages 1330-1341: Barriers to Health Care among the Elderly in Japan

Murata — Fri, 26 Mar 2010 00:00:00 CET

Japan is undergoing a set of health care reforms aimed at cutting rising health care costs and increasing the efficiency of health care delivery. This empirical study used a large-scale community survey on 15,302 elderly people 65 years and older (56.0% women) conducted in seven 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 for the elderly with lower income, while higher income counterparts reported being busy or having a condition not serious enough to seek care.

IJERPH, Vol. 7, Pages 853-869: Workplace Vaccination and Other Factors Impacting Influenza Vaccination Decision among Employees in Israel

Shosh Shahrabani — Mon, 08 Mar 2010 00:00:00 CET

The study examined the factors affecting the decision to be vaccinated against influenza among employees in Israel. The research, conducted in 2007/2008, included 616 employees aged 18−65 at various workplaces in Israel, among them companies that offered their employees influenza vaccination. The research questionnaire included socio-demographic characteristics, and the Health Belief Model principles. The results show that the significant factors affecting vaccination compliance include a vaccination program at workplaces, vaccinations in the past, higher levels of vaccine's perceived benefits, and lower levels of barriers to getting the vaccine. We conclude that vaccine compliance is larger at companies with workplace vaccination programs providing easier accessibility to vaccination.

IJERPH, Vol. 7, Pages 616-634: The Influence of Secondhand Smoke Exposure on Birth Outcomes in Jordan

Nesrin N. Abu-Baker — Mon, 22 Feb 2010 00:00:00 CET

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.

IJERPH, Vol. 7, Pages 443-459: Do Health Beliefs and Behaviors Differ According to Severity of Obesity? A Qualitative Study of Australian Adults

Sophie Lewis — Wed, 03 Feb 2010 00:00:00 CET

Public responses to obesity have focused on providing standardized messages and supports to all obese individuals, but there is limited understanding of the impact of these messages on obese adults. This descriptive qualitative study using in-depth interviews and a thematic method of analysis, compares the health beliefs and behaviors of 141 Australian adults with mild to moderate (BMI 30−39.9) and severe (BMI ≥ 40) obesity. Mildly obese individuals felt little need to change their health behaviors or to lose weight for health reasons. Most believed they could “lose weight” if they needed to, distanced themselves from the word obesity, and stigmatized those “fatter” than themselves. Severely obese individuals felt an urgent need to change their health behaviors, but felt powerless to do so. They blamed themselves for their weight, used stereotypical language to describe their health behaviors, and described being “at war” with their bodies. Further research, particularly about the role of stigma and stereotyping, is needed to fully understand the impact of obesity messaging on the health beliefs, behaviors, and wellbeing of obese and severely obese adults.

IJERPH, Vol. 7, Pages 413-426: Nutritionist’s Variation in Counseling Style and the Effect on Weight Change of Patients Attending a Community Based Lifestyle Modification Program

Kris Y. W. Lok — Tue, 02 Feb 2010 00:00:00 CET

Information concerning the nature of nutritionist-patient relationships is very limited. This qualitative and quantitative study examined nutritionist’s skills, attributes, and beliefs towards nutrition counseling during a lifestyle modification intervention program, and whether this affected the patient’s weight outcome. 24 nutrition consultations were observed during the program and the nutritionists were interviewed for their perception on practice (n = 4). A statistically significant difference was observed between the nutritionists in regard to patient’s weight change after adjustment for age and baseline weight (p < 0.001). Key nutritionist skills identified that influenced weight outcome were meticulous investigation of the underlying obesity cause, identification of the subject’s stage of change, and psychological support.

IJERPH, Vol. 7, Pages 78-88: What Defines an Effective Anti-Tobacco TV Advertisement? A Pilot Study among Greek Adolescents

Constantine I. Vardavas — Fri, 08 Jan 2010 00:00:00 CET

As the Framework Convention on Tobacco Control (FCTC) calls for public health awareness on tobacco use, mass media campaigns should be appropriately designed so as to maximize their effectiveness. In this methodological pilot study, 95 Greek adolescents (mean age 15 ± 1.8 years), were shown seven different anti tobacco ads, and asked to rate the ad theme, message and emotional context on a 1−7 Likert scale. Health related ads were rated the highest, and as identified through the logistic regression analysis, adolescents who perceived an ad to be emotional or to have a clear message that was relevant to them, were more likely to rate the ad as more effective. The strong agreement between the above findings and the existing literature indicates the applicability of this pilot study’s methodological approach.

IJERPH, Vol. 7, Pages 1-8: Quality Health Care in the European Union Thanks to Competition Law

Diego Fornaciari — Thu, 24 Dec 2009 00:00:00 CET

There are many biases concerning the application of competition law in health care. Quality concerns can however be integrated into competition law analysis. The aim of this paper is to identify the links between the application of competition law in the European Union and the right to quality health care and to point out the problems that arise when integrating quality concerns in competition law analysis. Guidelines must be issued and competition authorities must work together with institutions that have expertise in the field of health care quality measurement in order to integrate these dimensions in competition practice.

IJERPH, Vol. 6, Pages 3143-3155: Effect of Medicaid Coverage of Tobacco-Dependence Treatments on Smoking Cessation

Feng Liu — Wed, 09 Dec 2009 00:00:00 CET

Smoking cessation aids (nicotine replacement products and anti-depressant medication) have been proven to double quitting rates compared to placebo in several randomized controlled trials. But the high initial cost of cessation aids might create a financial barrier to cessation for low-income smokers. In the U.S., Medicaid provides health insurance coverage to low-income people, and in some states covers smoking cessation products. This paper uses nationally representative data of the U.S. to examine how the Medicaid coverage of cessation aids affect smoking behavior. The results indicate the Medicaid coverage of cessation products is positively associated with successful quitting among women aged 18–44.

IJERPH, Vol. 6, Pages 2833-2842: Application of the WHO Keys of Safer Food to Improve Food Handling Practices of Food Vendors in a Poor Resource Community in Ghana

Eric S. Donkor — Fri, 13 Nov 2009 00:00:00 CET

Data was collected from food vendors in a poor resource community in Ghana, which showed that the vendors constituted an important source of oro-faecal transmission. Following this, the WHO five keys of safer food were utilized in an evidence based training programme for the vendors to improve their food handling practices. Impact assessment of the food safety training showed that 67.6% of the vendors had acquired some knowledge from the workshop and were putting it into practice. Lack of food safety equipment was a major hinderance to behavioral change among the vendors as far food handling practices are concerned.

IJERPH, Vol. 6, Pages 2712-2724: Factors Affecting Use of Preventive Tests for Cardiovascular Risk among Greeks

Evelina Pappa — Fri, 23 Oct 2009 00:00:00 CEST

Data from a Greek national representative sample was used to investigate socio-demographic, self-perceived health, and health risk factors that determine the use of cardiovascular preventive tests (blood pressure, cholesterol and blood glucose). Chi-square and logistic regression analyses were used (p < 0.05). Older age, marriage, regular family doctor and chronic diseases increased the likelihood of receiving preventive tests, whereas low education and alcohol consumption reduced the likelihood of having these tests. The effect of obesity varied. Interventions which improve the knowledge of the poorly educated and empower the preventive role of the physicians may redress the inequalities and improve the effectiveness of preventive services utilization.

IJERPH, Vol. 6, Pages 2608-2622: Clients’ Experiences of a Community Based Lifestyle Modification Program: A Qualitative Study

Ruth S.M. Chan — Fri, 02 Oct 2009 00:00:00 CEST

There is little information about how clients attending lifestyle modification programs view the outcomes. This qualitative study examined the clients’ experience of a community based lifestyle modification program in Hong Kong. Semi-structured interviews were conducted with 25 clients attending the program. Clients perceived the program had positive impacts on their health and nutrition knowledge. They experienced frustration, negative emotion, lack of motivation, and pressure from others during the program. Working environment and lack of healthy food choices in restaurants were the major perceived environmental barriers for lifestyle modification. Clients valued nutritionists’ capability of providing professional information and psychological support in the program. Our results suggest that nutritionist’s capability of providing quality consultations and patient-centered care are important for empowering clients achieve lifestyle modification.