11th
Annual HMO Research Network Conference
Abstracts from the HMO Research Network
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With this issue we include abstracts from the 2005 11th Annual HMO
Research Network Conference, held in Santa Fe, New Mexico that focused
on "Translating Research into Practice."
April
4-6, 2005 Santa Fe, NM
"Translating Research Into Practice--Scaling New Heights"
From
HMO Research Network Member: Centers for Disease Control
Patterns
in weight management behavior among the enrollees of eight insurance
plans
Sotnikov
S, Jones R, Moonesinghe R, Etchason J. Centers for Disease Control,
Atlanta, GA
During
the last decade obesity has become an important driver of medical and
insurance costs. Health plans are positioned to play an important role
in encouraging positive changes in individual weight management behavior.
How large are the variations in the incidence of obesity across health
insurance plans? Which weight management techniques or combinations
of techniques make some individuals more successful in achieving and
maintaining their healthy weight? How does the use of these techniques
differ across health plans? The 2003 ConsumerStyles survey contains
self-reported data on weight and height of 5613 individuals enrolled
in eight insurance plans. Individuals also reported on use of 12 weight
management techniques. A body mass index (BMI) of less than 25 was used
as the threshold for defining healthy weight. The difference between
actual and healthy weight was used as a measure of success in weight
management. A multivariate regression model was used to evaluate how
that measure varies across insurance plans. Separate models were used
to estimate the relationship of the measure to the types of weight management
techniques employed by the individuals enrolled in each plan. The results
indicated that obesity was most severe for individuals who were uninsured
or on Medicaid. No statistically significant differences in the weight
loss required to achieve their healthy weight was found for enrollees
in Medicare, veterans' benefits and private provider plans (HMO and
PPO). Significant differences were revealed in the methods of weight
management employed by individuals enrolled in different health plans.
Individuals with Medicare, PPO, or HMO coverage and those without health
insurance relied on exercise and high protein/low carbohydrate dieting,
while those on Medicaid and Medigap were more likely to use diet pills
to manage their weight. The marginal effects of health and nutrition
knowledge, income, and education on excess weight were greater for persons
with more severe weight problems, suggesting that targeting severely
obese individuals for health and nutrition interventions may bring larger
marginal benefits than a one-size-fits-all approach.
From
HMO Research Network Members: Center for Health Studies, Group Health
Cooperative; Henry Ford Health System; and University of Michigan
Internet-based
smoking-cessation counseling: the project quit experience
McClure
J, Greene S, Johnson K, et al.
background:
Internet-based treatment has many potential advantages, including the
ability to individually tailor risk messages and health advice, and
added convenience for the consumer. Tailored treatments are generally
considered more salient and more effective than generic self-help programs,
but it is not clear what accounts for these effects. That is, what factors
are important to a successful tailored intervention? Project Quit is
an Internet-based, individually tailored, smoking-cessation program.
The purpose of this study is to determine the "active ingredients"
of a tailored smoking-cessation intervention. Information learned from
this study will be relevant to the design of other tailored behavioral
interventions.
methods: This project is being conducted by the University of Michigan,
Group Health Cooperative (GHC), and Henry Ford Health System (HFHS).
Smokers at GHC and HFHS are invited to enroll in the study. All participants
receive access to a tailored online behavioral program and nicotine
replacement patches. We will analyze the effectiveness of 32 different
combinations of relevant tailoring variables on motivation and abstinence
at six-month follow-up.
results: Data collection is underway. Preliminary results suggest
that about 4% of smokers invited to participate enroll. Demographically,
participants appear similar to those in other (ie, non-Internet) cessation
trials.
conclusion: Implementation of an Internet-based smoking cessation
program is feasible in the health care delivery system setting, and
may be a suitable adjunct to telephone-based or in-person smoking cessation
programs.
From
HMO Research Network Member: Kaiser Permanente Colorado
Research
partnerships with prevention: developing practical and generalizable
health behavior interventions
Estabrooks
P.
A large
body of research has demonstrated that innovations are adopted at a
high rate when they can demonstrate a relative advantage over the standard
practice and are compatible with existing organizational values, experiences,
and needs. We conducted three participatory research projects that included
operational decision makers as well as staff who will ultimately deliver
the proposed interventions to collect information on relative advantage
and compatibility of new physical activity, nutrition, and weight management
strategies. Each of these projects provided a case study for a participatory
research model that heightens the potential of health promotion interventions
to be taken to scale. As demonstrated by these case studies, interventions
that were effective and were compatible with the system of care (Project
1 and 2) were adopted and implemented across Kaiser Permanente Colorado.
The third intervention, although effective, did not satisfactorily fit
into the current model of care and was therefore not adopted. The cases
highlighted the need to ensure that health promotion interventions demonstrate
both a relative advantage and that they are compatible to the existing
model of care.
From
HMO Research Network Member: Centers for Disease Control
Knowledge
of health risks, attitude about health, and prevalence of obesity and
smoking
Jones
K, Moonesinghe R, Sotnikov S, Etchason J.
background:
The CDC's chronic disease model is based on the premise that population
health is a function of heredity, social circumstances, environment,
medical care, and behavior. Approximately 40% of early deaths in the
United States are attributed to behavioral patterns. Behavior is influenced
by attitude and knowledge.
methods: Data are from the 2003 ConsumerStyles and HealthStyles
(CSHS) database, generated from consumer surveys of a stratified, random
sample of US adults, aged 18+, over-sampled for minorities and households
with children. CSHS surveys include questions regarding health beliefs,
attitudes, social norms, and behaviors. We used logistic regression
to analyze factors associated with obesity and smoking.
results: The odds of being obese are significantly higher (p <
0.05) for females, blacks, people with lower educational attainment,
those who exercise less than recommended, and those who perceive their
weight as healthier than CDC guidelines suggest. After controlling for
these and other factors, the odds that respondents who do not agree
that living life in the best possible health is important (NEGATIVES)
are obese increases 43% over that of respondents who agree that living
life in the best possible health is important (POSITIVES). Significantly
higher (p < 0.05) odds of smoking are associated with lower educational
attainment. Controlling for these and other factors, the odds that NEGATIVES
smoke increases 79% over that of POSITIVES. Among smokers, 46% did not
agree that their smoking was a threat to their health [the percentage
is higher for HMOs than PPOs (p = 0.046) and for HMOs than fee-for-service
plans (p = 0.074)]. Among obese respondents, 40% did not agree that
their weight was a threat to their health, with no significant difference
between health plan types. Among POSITIVES, 17% smoked, while a significantly
higher 29% of NEGATIVES were smokers (p < 0.01). A significantly
higher percentage (p < 0.01) of NEGATIVES were obese (35%) than POSITIVES
(27%).
conclusions: These survey data reveal that misconceptions about
the health effects of obesity and smoking are common and that attitudes
about health affect behavior. Health plans that screen for risky health
behaviors would likely benefit from screening for health attitudes and
misconceptions as well.
From
HMO Research Network Members: Henry Ford Health Systems, Group Health
Cooperative, HealthPartners Research Foundation, Kaiser Permanente Georgia,
and Kaiser Permanente Colorado
Racial/ethnic
differences in factors influencing vegetable consumption in the MENU
Web-based intervention pilot program
Claud
SL, Alexander G, Divine G, et al.
background:
On average, African Americans eat fewer fruits and vegetables than all
other ethnic/racial groups. We explored racial differences in participants
of the pilot study for MENU, a Web-based intervention program designed
to support increasing the dietary intake of vegetables.
methods: Potential participants were mailed an invitation letter
inviting them to the study's Web site. Eligible participants completed
an initial survey relevant to the targeted behavior change. The survey
evaluated perceived general health status, change in vegetable intake
as adults, and motivation, barriers, and confidence related to increasing
vegetable intake. For these analyses, respondents were subgrouped as
African American (AA) or White/Other. Responses to the survey were evaluated
for racial/ethnic differences by gender.
results: A total of 530 people enrolled in this study, including
28% AA women, 35% White women, 15% AA men, and 22% White men. Women
and men perceived health status equally, and both White women and men
rated their health as better than AA women and men. AA and White women
were similar in confidence that they could eat more servings of vegetables
(68% vs 62% very confident). More AA men were very confident (63%) compared
to White men (46%). For all groups, the most frequently named barrier
for eating more vegetables was fear of spoilage, and the most frequently
named motivation for eating more vegetables was to feel healthier (84%-90%)
followed closely by weight management (70%-87%). A higher proportion
of AA women and men reported eating fewer vegetables now than when young.
About 40% of women compared to 66% of men who are now eating more vegetables
reported some or a lot of family encouragement to eat more. Nearly twice
as many AA men compared to White men said they would be motivated to
eat more vegetables if recommended by their physician.
conclusions: Exploring differences among racial/ethnic groups is
a way to better understand factors that influence dietary change. By
identifying these factors, we may be able to specifically tailor intervention
materials and improve efforts in changing eating behaviors.
