Jennie Jacobs Kronenfeld

Physical fitness, physical activity, and functional limitation in adults aged 40 and older

PURPOSE A cohort of middle-aged and older men and women were followed for an average of 5.5 yr to examine the association between physical fitness, physical activity, and the prevalence of functional limitation. METHODS The participants received medical assessments between 1980 and 1988 and responded to a mail-back survey regarding functional status in 1990. RESULTS Among 3495 men and 1175 women over 40 yr of age at baseline, 350 (7.5%) reported at least one functional limitation in daily or household activities at follow-up. The prevalence of functional limitation was higher among women than men. Physically fit and physically active participants reported less functional limitation than unfit or sedentary participants. After controlling for age and other risk factors, the prevalence of functional limitation was lower for both moderately fit (odds ratio = 0.4, 95% CI = 0.2-0.6) and high fit men (odds ratio = 0.3, 95% CI = 0.2-0.4), compared with low fit men. Corresponding figures for women were 0.5 (0.3-0.7) and 0.3 (0.2-0.5) for moderately fit and high fit women. The association between physical activity and functional limitation was similar to the data for physical fitness. CONCLUSIONS These data support a protective effect of physical fitness and physical activity on functional limitation among older adults and extend this protective effect to middle-aged men and women.

Chronic illness and health-seeking information on the Internet

ABSRACT By using the theories of help-seeking behavior and health-information seeking, this article demonstrates the relationship between chronic illness, retrieving health information from the Internet and changing health behavior. Research on the impact of health information on the Internet and changing health behavior is fairly new, given the growth of the Internet in recent years. Using US data on Internet use within the US population, multiple regression analysis was performed to explore the relationships between chronic medical conditions and frequency of Internet use, as well as changes in health behavior due to frequency of Internet use. The findings suggest that it is not merely the presence of a particular chronic illness, but rather the total number of chronic conditions that determine Internet use. Also, the more frequently a person uses the Internet as a source of health information, the more likely they are to change their health behavior.

Patterns of non-response to a mail survey

This paper describes a basic investigation of possible non-response bias in a mail survey. We compare characteristics of responders and non-responders to a mail survey of health outcomes among participants of a longitudinal study of physical activity, physical fitness, and health. Results indicate that, at the first clinic visit, the responders were essentially the same as the non-responders on personal health history and laboratory measurements, while reporting significantly more family history of specific chronic diseases (cardiovascular disease, hypertension, stroke). The male responders were younger and reported more positive health behaviors as well as better weight and treadmill times at the first clinic visit. These results suggest that both response groups were equally healthy at entry, and that individuals who had family members with certain chronic conditions and who had positive health behaviors were more likely to respond (participate) in this health-related survey. Differences of this type could affect interpretation of future analyses. This work illustrates the importance of incorporating methods to examine non-response into any epidemiologic study.

STI/HIV Risks for Mexican Migrant Laborers: Exploratory Ethnographies

The influx of Latino laborers into the U.S. and the confluence of migration-driven factors in an environment ripe for risk-taking have the potential to exacerbate already rising STI/HIV rates among migrants and their social networks at both the home and receiving regions. This paper focuses on Mexican migrant laborers who are among the most marginalized and exploited Latinos in the U.S. This study used ethnographic methods to delineate the sociocultural and spatial contexts and social organization of migrant farmwork, and examined how intertwined individual and environmental factors render migrant farmworkers vulnerable to STI/HIV risks. Findings indicate the presence of a number of factors in the study population of Mexican migrant workers (N = 23)—such as poverty, limited education, physical/social/cultural isolation, long work hours, constant mobility, hazardous work conditions, limited access to health care, low rates of condom use, multipartnering, and use of sexworkers—which increase their risks for STI/HIV transmission. To be successful, prevention efforts need to focus not only on condom education and HIV awareness and testing, but also on reducing migrants’ social isolation and understanding their social networks.

The use of unorthodox therapies and marginal practitioners

This study examines the extent of utilization of unorthodox therapies and marginal practitioners among patients with one broad category of chronic disease, rheumatic disorders. Almost all respondents (94%) had tried some unorthodox remedy or practitioner, and several had used 13 different unorthodox remedies or practitioners. There was no relationship between age, sex, race, geographic location and magnitude of usage of treatments. There was no statistically significant relationship between education and income and amount of usage, although there was some variation by income group in which unorthodox remedies were employed. Thus, this study provides evidence that some elements of folk medicine practice continue to exist among most segments of the American population and this issue deserves further research. An important role for medical sociologists is to examine disease and disease treatment from the perspectives of the lay culture, as well as that of the medical community.

Access to cancer screening services for women

A major effort in preventive care for women has emphasized the obtaining of Pap smears and mammograms. This paper uses survey data from one state to examine issues of access to Pap smears and mammograms. Poor women receiving health care through a managed-care Medicaid program received these services at the same rate as women with other types of health insurance, while the uninsured were less likely to have had either type of service.

Assessing the effects of race and ethnicity on use of complementary and alternative therapies in the USA

Objective To investigate the use of alternative therapies among different racial/ethnic groups in the USA. Specifically, we examined whether alternative medicine use differs for working aged whites, Asian Americans, African Americans, and Hispanics. Design Using the 1996 Medical Expenditure Panel Survey, racial differences in utilization were investigated at two levels: (1) the bivariate level with no controls for other factors and (2) at the multivariate level with controls for age, sex, region, marital status, education, income, health status, satisfaction with conventional healthcare, and access measures. Results Americans in this sample population used alternative and complementary therapies at a fairly low rate (6.5%). This 6.5%, however, was not consistent across all groups. African Americans and Hispanics were less likely than whites to utilize alternative therapies, whereas Asian Americans did not differ significantly from whites. Conclusions The use of alternative and complementary therapies varied across racial/ethnic groups. Evidence showed that individuals who were dissatisfied with the availability of conventional healthcare, who were in poor health, but very satisfied with their conventional provider were more likely to use complementary and alternative medicine (CAM) therapies. The addition of these variables to a logistic regression model did not change the findings for differential use by ethnicity, the relative ranking of groups, or the overall strength of the relationship.

The costs of spinal cord injury

An ongoing study of medical care and associated costs relative to spinal cord injury is being conducted at the University of Alabama in Birmingham, one of 11 federally funded Model Regional Spinal Cord Injury Centres. It was hypothesised such costs would be lower among patients admitted into an organised continuum of care (system) soon after injury than among patients whose entry into the organised system of care was delayed (non-system).A comprehensive economic data set has been acquired on 142 of 233 (61 per cent) patients admitted since implementation of the project.Analysis of these data reveals: (1) system patients require, on average, expenditures of almost

Intent to Participate in Worksite Health Promotion Activities: A Model of Risk Factors and Psychosocial Variables

5,000 less than their non-system counterparts; (2) there is little difference in medical or associated costs and length of hospitalisation between tetraplegics and paraplegics; (3) spinal cord injuries secondary to motor vehicle accidents have higher associated costs and longer lengths of stay than do those injuries resulting from other causes including acts of violence.

Determinants of Participation in Worksite Health Promotion Activities

A model of risk factors and psychosocial variables that should enhance the prediction of participation in worksite health promotion programs was evaluated by a sample survey (10% random sample) of approximately 13,000 State employees in South Carolina. The response rate for the survey was 66.3%, n = 854. A split sample strategy was employed to develop and then validate the psychosocial model. Degree of satisfaction with ones current status and intent to change it were assessed in six health areas: weight, nutrition, exercise, cigarette smoking, alcohol consumption, and the handling of stress and tension. In each area, a known risk factor was used to predict degree of satisfaction and intent to change. Variables from the psychosocial model were added in a step-wise regression procedure. The key variables in the psychosocial model were Personal Efficacy (specific to each of five areas), Job Stress, Trait Anxiety, and Health Knowledge. Risk factors contribute significantly to the prediction of dissatisfaction and intent to change in all areas except cigarette smoking and nutrition. The model of psychosocial factors contributed significantly to the prediction of dissatisfaction and intent to change in all areas. Personal Efficacy was significantly related both to dissatisfaction and intent to change, whereas the Job Stress and Anxiety variables were more effective in predicting dissatisfaction than intent to change. Health Knowledge had little direct or interactive effects on dissatisfaction or intent to participate. The implications of these findings for health promotion programs were examined.