Understanding Cancer Screening Intention Among Physically Active Adults Ages 18-49.

Ideal efforts for cancer prevention would include lifestyle modifications along with routine, age-eligible cancer screening. Employing an asset-based approach within vulnerable populations already engaging in at least one healthy behavior (i.e., physical activity) may be an ideal way to further reduce cancer risk across peer groups with low cancer screening rates. Guided by the theory of planned behavior (TPB), the aim of this study was to identify constructs associated with cancer screening intentions among young to middle aged adults for influencing educational and behavioral interventions designed to promote cancer prevention. A cross-sectional, web-based survey was utilized to assess attitudes, subjective norms, perceived behavioral control, and intention to screen for cancer among physically active adults aged 18-49 years. Descriptive and bivariate analyses were conducted to characterize the sample, and hierarchical linear regression analyses were conducted to assess the influence of sociodemographic variables and TPB constructs on cancer screening intentions. Age, female sex, reporting a routine doctor's visit, reported knowledge of physical activity as a lifestyle behavior to reduce cancer risk, and an increased number of motivating factors for engaging in physical activity were significantly associated with higher cancer screening intention (P < 0.001). With the addition of TPB constructs (i.e., subjective norms and perceived behavioral control), the final analytic model accounted for 31% of the variance in intention to screen for cancer. Findings suggest that the TPB could be used to tailor or design asset-based, cancer education interventions to effectively promote age-eligible cancer screenings among physically active adults. Educational content to increase social support for cancer screening and enhance perceived behavioral control to complete screening is essential in this population.

The roles of biomedical maintenance branch, automation management & informatics departments throughout a clinical information systems's life cycle.

The introduction of new technology, such as a Clinical Information System (CIS), requires hospitals to re-evaluate the roles of the Biomedical Maintenance Branch, Automation Management, and Informatics departments. This paper describes the process a 400-bed hospital underwent to resolve role ambiguity among the three activities. The institution's goal was to reach an optimal solution to using the resources offered by each activity through redrawing lines of responsibilities. This experience demonstrated that relationships among departments are dynamic and vary depending on the stage of the CIS life cycle.

Survey of Florida's public agency psychiatrists.

The results are reported of a statewide survey of 309 physicians practicing at least part-time in public mental health agencies in Florida. Sixty-one percent (189) completed and returned the self-administered mail questionnaire. More than two-thirds received their medical degree outside the United States. Nearly one-half practiced primarily in community mental health centers. More than two-fifths reported total annual income between $75,000 and $100,000. Nearly one-fourth noted community service as an important factor in attracting them to their practice location. One-fifth reported a variety of regulations as important obstacles in their practice. Survey results are compared to other statewide and national psychiatric studies.

Utilization and costs of substance abuse services within The HMO Group.

This paper describes the organizational characteristics, benefit coverage, referral pathways, utilization rates, and costs of substance abuse services within 17 HMOs belonging to The HMO Group in 1990. All 17 health plans responded to the questionnaire. Responses to the survey reflected the complexity of HMO substance abuse services. Overall, The HMO Group members provided substance abuse service coverage partly dependent upon state mandates, employer group priorities, and local competitive benefit structures. The HMOs reported that service utilization rates and the productivity of their substance abuse providers were critical information needs currently not fully reported. Overall, the survey responses reflected the need for improvement of clinical information systems and expansion of the aggregate substance abuse database.

Mental health services within the HMO group.

This paper describes the organizational characteristics, benefits, referral, utilization, and costs of mental health services within 17 health maintenance organization (HMOs) comprising The HMO Group in 1990. All 17 health plans responded to the questionnaire, resulting in a 100% response rate. Responses to the survey reflected the complexity of the HMO mental health services field. Overall, The HMO Group members provided mental health service coverage, partly dependent upon state mandates, employer group priorities, and local competitive benefit structures. HMOs reported that service utilization rates and the productivity of their mental health providers were critical information needs. Overall, the responses reflected the need for continued information sharing between The HMO Group members, the modification of management information systems, and continuation of establishing a mental health aggregate data base.

A national study of state-supported psychiatric research institutes.

States have funded psychiatric research through a variety of mechanisms, including psychiatric research institutes. The authors identified and surveyed 33 such institutes to obtain information on their organizational characteristics. Twenty-nine institutes responded; more than half were organizationally located within a university setting, and a similar number were involved in research, education, and direct services. Clinical research was the most prevalent type of research conducted, and annual state revenue appropriations were the major source of funding. Because budgetary problems have threatened their future funding in some states, the authors believe the institutes should increase efforts to demonstrate their relevance to state mental health needs.

A research and training needs assessment of Florida's mental health system.

The authors conducted an assessment of mental health training, consultation, and research needs in Florida. The purpose was to document the current training, consultation, and information needs within the mental health care delivery system. The data collection included a six-page, self-administered mail questionnaire and a structured telephone interview of selected key informants throughout the state. The questions on the survey instrument asked for background information on the respondents as well as their training and research priorities for mental health services. Accountability procedures, financing issues, and clinical diagnostic and assessment techniques were among the most frequently rated priorities for training and research. Results are discussed with emphasis on the statewide dissemination of study findings, a national standardization of the needs assessment process, and the importance of systematic decision-making for administrators in the mental health service delivery system.

National trends in coverage and utilization of mental health, alcohol, and substance abuse services within managed health care systems.

This study reports the results of a 1986 national survey of mental health, alcohol, and substance abuse services within health maintenance organizations in the United States. Ninety-seven percent of responding health maintenance organizations (HMOs) offered mental health service coverage and two-thirds of responding HMOs offered alcohol and substance abuse service coverage. Annual mean mental health hospitalization was 36.90 days per 1,000 members and annual mean ambulatory mental health utilization was 0.29 physician encounters per member.

Changing patterns in mental health service coverage within health maintenance organizations.

This 1982 national survey of all operational health maintenance organizations (HMOs) provides information on the current status of mental health services, benefits, costs, and utilization within HMOs, updating and augmenting a 1978 study. Approximately 94 per cent of the responding HMOs offered mental health service coverage; over one-half (54 per cent) offered alcohol and drug abuse service coverage. The present coverage benefits and utilization of mental health services within HMOs continue to reflect greater variability vis-a-vis other health services within HMOs. Over one-half (57 per cent) of the HMOs provided for 30 days of inpatient mental health coverage (per member per year). Three out of four (77 per cent) of the health plans provided for 20 ambulatory visits (per member per year). The mean mental health hospital utilization rate was 32 days (per 1,000 members per year). The mean mental health ambulatory utilization rate was 0.33 encounters (per member per year). Further studies should investigate the combined influence of organization characteristics, mental health service organization characteristics, and service benefits on the costs and utilization of HMO mental health services.

A national survey of prepaid mental health services.

The degree to which mental health services and coverage have been integrated into prepaid health plans (PHPs) on a national level is unknown. Using two self-administered mail questionnaires, the authors obtained descriptive data on the organization and delivery of mental health services within 205 PHPs throughout the United States and Guam. After discussing the growth of PHPs in the United States and the development of prepaid mental health services, the authors analyze the survey data using the PHP as the unit of analysis. Although 94 percent of the PHPs in the survey offered mental health benefits as part of their basic health plan, the authors found that the varied organizational characteristics of both the PHPs and their mental health components may have affected the specific mental health services provided as well as their costs, utilization, and referral patterns. The authors believe that further analysis of the various PHP organizational models is necessary to understand the utilization and costs of prepaid mental health services.

Driving phobia in the city of Houston: a pilot study.

To study the fear of driving phenomenon the authors contacted 48 subjects who, in response to a newspaper article, had expressed an intense fear of driving in the city of Houston and compared them with an age- and sex-matched control group. The information elicited from the subjects suggested the existence of a driving phobia. No significant differences emerged between the phobic subjects and the controls on relevant driving history and background. Although the phobic subjects reported significantly higher levels of anxiety while driving in normal and difficult situations, most of them reported anxiety of phobic intensity only about difficult driving situations, such as driving on freeways and in congested traffic.

A survey of mental health service coverage within health maintenance organizations.

This 1978 national survey of all operating Health Maintenance Organizations (HMOs) provided information on the current status of mental health services utilization and service coverage within HMOs. It achieved a 68 per cent response rate. Approximately 90 per cent (108) of the HMOs offered mental health services through basic or supplemental coverage plans; HMO organization characteristics reflected relative heterogeneity; the mean monthly costs for basic health plan coverage (physical and mental health services) were $33.85 (for individuals) and $95.15 (for families); HMOs reported lower physical and mental health hospital utilization and higher ambulatory utilization when compared to more traditional forms of health insurance coverage. The present coverage and uitlization of mental health services within HMOs reflect greater variability of benefits and utilization within HMOs. There is need for further studies of mental health utilization in relation to organizational structure and delivery pattern relationships within HMOs.