Health Behavior Factors Research Articles

Nutritional Status among Filipino Elderly: Prevalence and Correlates

Objective: The dual burden of undernutrition and overnutrition has received attention around the world, especially in the Philippines, where malnutrition is an issue that the country is continuously facing. Malnutrition have been prevalent and alarming concerns among the Filipino elderly through the years. Several studies support the claim that the prevalence of malnutrition is associated with factors, such as socioeconomic status, biochemical, clinical, dietary intake, and food security. This study aimed to determine the factors associated with the nutritional status of the Filipino elderly.
 Materials and Methods: The study utilized the 2013 National Nutrition Survey. Data of the 1,807 sampled Filipino elderly who had no physical defects were considered. The Rao-Scott test and a multiple correspondence analysis were conducted to assess the association of the nutritional status of the Filipino elderly with the socio-demographics, health/clinical conditions, and nutrient intake factors.
 Results: Majority (54.97%) of the Filipino elderly had a normal nutritional status. However, both the prevalence of underweight and overweight are still alarming with a 20.19% and 24.83% rate, respectively. The socio-demographic characteristics found that are associated with the nutritional status of the Filipino elderly include age, sex, occupation, and education. Health conditions and behavioral risk factors such as smoking and drinking alcohol beverages were also found to have significant association with the elderly’s nutritional status. Lastly, a significant association between the nutritional status and the intake of nutrients such as iron, Vitamin A, niacin, and thiamine was observed.
 Conclusion: With both underweight and overweight/obesity still rampant among the Filipino elderly, their lifestyle and food intake should be given much attention. Further studies about the nutritional status of the Filipino elderly should be conducted to have a sufficient basis on how society can help the elderly maintain and improve their nutritional conditions.

Visual cues of the built environment and perceived stress among a cohort of black breast cancer survivors.

We investigated relationships between independently observed, visual cues of residential environments and subsequent participant-reported stress within a population-based cohort of Black breast cancer survivors (n = 476). Greater visual cues of engagement – presence of team sports, yard decorations, outdoor seating – (compared to less engagement) was marginally associated with lower perceived stress in univariate models, but attenuated towards null with adjustment for socio-demographic, behavioral, and health-related covariates. Similarly, physical disorder and perceived stress were not associated in adjusted models. Relationships between observed built environment characteristics and perceived stress might be influenced by socioeconomic and health behavior factors, which longitudinal studies should investigate.

Health literacy and behavioral health factors in adults

ObjectivesThis study was to examine the relationship between health literacy (HL) and health behaviors in the South Bohemia Region in the Czech Republic (CR) and compare them to HL and health behaviors in the Visegrád group countries (Czech Republic, Hungary, Poland, and Slovakia). The paper reports the results from the research in the CR. Study designA quantitative descriptive study. MethodsThe sample was stratified by sex and age and included a representative sample of 303 adults. The data were collected using the combination of a country-specific questionnaire with the HLS-EU-16 standardized questionnaire. ResultsExercise was significantly associated with perceived health and HL; those with a lower level of HL did not exercise during the previous month. Based only on full answers (N = 251), inadequate HL was identified in 17.5% of the respondents (44), marginal HL in 31.5% (77), and adequate HL in 51% (128) of the respondents. Nearly 49% of the participants evaluated their health as ‘good’, 25.7% rated their health as ‘very good’ and ‘satisfactory’ by 25.7%. But 41.6% experienced one or more chronic diseases, 37.6% had some limitations to their health, and 20.5% smoked. For alcohol consumption, 26% drank weekly and 23% drank two to three times a month. Exercise varied from never (29.7%) to daily (7.9%). ConclusionBased on our results, we conclude that health behavior risk factors are still present in the South Bohemia region of the CR regardless of levels of HL reported on the HLS-EU-16.

External Validation of a Population-Based Prediction Model for High Healthcare Resource Use in Adults.

Predicting high healthcare resource users is important for informing prevention strategies and healthcare decision-making. We aimed to cross-provincially validate the High Resource User Population Risk Tool (HRUPoRT), a predictive model that uses population survey data to estimate 5 year risk of becoming a high healthcare resource user. The model, originally derived and validated in Ontario, Canada, was applied to an external validation cohort. HRUPoRT model predictors included chronic conditions, socio-demographics, and health behavioural risk factors. The cohort consisted of 10,504 adults (≥18 years old) from the Canadian Community Health Survey in Manitoba, Canada (cycles 2007/08 and 2009/10). A person-centred costing algorithm was applied to linked health administrative databases to determine respondents’ healthcare utilization over 5 years. Model fit was assessed using the c-statistic for discrimination and calibration plots. In the external validation cohort, HRUPoRT demonstrated strong discrimination (c statistic = 0.83) and was well calibrated across the range of risk. HRUPoRT performed well in an external validation cohort, demonstrating transportability of the model in other jurisdictions. HRUPoRT’s use of population survey data enables a health equity focus to assist with decision-making on prevention of high healthcare resource use.

Newly diagnosed disease and job loss: a nationwide longitudinal study among middle-aged Japanese

ObjectivesSince previous studies have only used past or current medical history of disease, there is no information on newly diagnosed disease in relation to job loss. Our objective was therefore...

The influence of healthcare provider’s autonomy support, autonomous motivation and competence on self-care behaviors in kidney transplant patients based on self-determination theory

Background: It is important for transplant patients to perform continuous self-care behavior after transplantation. The self-deter mination theory is that explains the persistence factors of health behavior of chronically ill patients. This study was conducted to identify the factors of the self-determination theory of kidney transplant patients and to prepare basic data to improve self-care behavior of them. Methods: The subjects of this study were 79 transplant patients who underwent follow-up care in an outpatient clinic after re ceiving a kidney transplant at one G university hospital in Seoul. Survey research was done using the “Health care climate ques tionnaire,” “autonomous motivation,” “Perceived competence scale” tools, and “self-management” tools. The data collected from April 20, 2020 to August 20, and the collected data were analyzed using SPSS ver. 21.0 for windows. Results: The average age of the subjects was 54.1 years (27-78 years), and male patients were 46 (58.2%). The duration after transplantation was 5.25 years. The factors a significant correlation was confirmed were Healthcare provider’s autonomy sup port and autonomous motivation (r=0.39, P<0.001), healthcare provider’s autonomy and competence (r=0.29, P<0.05), health care) , Healthcare provider’s autonomy and self-care behavior (r=0.34, p<0.01), autonomous motivation and competence (r=0.39, P<0.001), autonomous motivation and self-care behavior (r=0.47, P<0.001), competence and self-care behavior (r=0.44, P<0.001). As a result of multiple regression analysis, the factors that have the greatest influence on self-care behavior were identified in the order of competence (β=0.377, P<0.01), and autonomous motivation (β=0.293, P<0.01). The total explanatory power was 30.1%. Conclusions: As a result of this study, it was consistent with the results of previous studies that autonomous motivation in creased competence and continuation self-care behavior. This could contribute to the development of an intervention program for improving the self-care behavior of patients.

Regional Exposure to Air Pollution and Health Behaviors as a Risk Factor for Suicide Attempt: The Seventh Korean National Health and Nutrition Examination Survey (KNHANES), 2016-2017, Korea Centers for Disease Control and Prevention

Background/Objectives: The purpose of this study is to identify the influencing factors of fine particleconcentration levelby region and health behaviors on suicide attempts.Method/Statistical Analysis: This study used the 7th (2016-2017) primitive data disclosed by the NationalHealth Nutrition Examination Survey. Considering the design features of the sample data, it is analyzed witha complex sampling method by reflecting stratas, clusters, and weight. The data were analyzed using logisticregression analysis of the complex sampleusing the SPSS/WIN 18.0 program.Findings: As a result of logistic regression analysis, the provability of suicide attempt was 12.32 times(95% CI 5.33-28.49, p&lt;.001) higher in depression diagnosis group, 5.55 times (95% CI 1.87-16.46, p=.002)higher in 10 or more drinks in single session group, 2.48 times (95% CI 1.07-5.73, p=.003) higher in highperceived stress group, and 0.1 unit increase in Health-related Quality of life (? = -2.35, p=.030) resulted in0.79 times factor on suicide attempt rate.Improvements/Applications: This study can provide basic data to develop an intervention program that canreduce suicide attempt rate by analyzing environmental and health related factors affecting suicide attempts.

Estimating the potential reduction in future sickness absence from optimizing group-level psychosocial work characteristics: a prospective, multicenter cohort study in German industrial settings

BackgroundAbsence from work due to sickness impairs organizational productivity and performance. Even in organizations with perfect work conditions, some inevitable baseline sickness absence exists amongst working populations. The excess sickness absence observed above this baseline rate has become the focus of traditional health promotion efforts, addressing preventable physical illness, health behavior and mental health at the personal level. However, a health and safety approach following the TOP-rule would consider work-group psychosocial work characteristics as a potential risk factor amenable to organizational measures. To date, there is a scarcity of studies relating psychosocial work characteristics to possible reduction of excess sickness-absence rates.MethodsWe aimed to estimate the potentially avoidable excess fraction of absence attributable to work-group psychosocial characteristics. We considered work-group averaged perception of psychosocial work characteristics as a proxy to the methodologically elusive objective assessment of organizational characteristics. Participants were recruited from multiple sites of a German automotive manufacturer with individuals nested within work groups. We predicted 12-month follow-up work-group sickness absence rates using data from a baseline comprehensive health examination assessing work characteristics, health behavior, and biomedical risk factors. We considered the quartile of work-groups yielding favorable psychosocial work characteristics as a realistic existing benchmark. Using the population attributable fraction method we estimated the potentially amenable sickness absence from improving work-group psychosocial characteristics.ResultsData from 3992 eligible participants from 29 work groups were analyzed (39% participation rate, average age 41.4 years (SD = 10.3 years), 89.9% males and 49% manual workers.). Work-group absence rates at follow up varied from 2.1 to 8.9% (mean 5.1%, 11.7 missed days). A prediction model of seven psychosocial work characteristics at the work group level explained 70% of the variance of future absence rates. The estimated reduction from improving psychosocial work characteristics to the benchmark level amounted to 32% of all sickness absence, compared to a 31% reduction from eliminating health behavioral and medical risk factors to the benchmark target.ConclusionsPsychosocial characteristics at the work-group level account for a relevant proportion of all sickness absence. Health promotion interventions should therefore address psychosocial characteristics at the work group level.

Early childhood caries and oral health-related quality of life of Brazilian children: Does parents' resilience act as moderator?

Early childhood caries (ECC) is the most common chronic disease in childhood. Measures to reduce the prevalence of ECC cannot be taken without recognizing that oral health is influenced by biopsychosocial factors on individual and community levels. To evaluate the impact of ECC on OHRQoL and moderation effect of parents' resilience. Population-based, cross-sectional study with 497 children (4-6years old) at preschools in Ribeirão das Neves, MG, Brazil. Parents self-completed the Brazilian version of the early childhood oral health impact scale (B-ECOHIS), the Resilience Scale and questionnaires about socioeconomic and oral health behaviour factors. Calibrated dentists conducted examinations for ECC (ICDASepi) and pulp consequences (pufa). Data analysis used multivariate Poisson regression for complex sample (P<.05). Model#1, adjusted for parents' resilience and socioeconomic factors, revealed that preschoolers with pulp involvement had 2.36 (95% CI: 1.60-3.49) and fistula/abscess had 3.57 (95% CI: 2.23-5.72) more prevalence of negative impact on OHRQoL than preschoolers with ECC without pulp consequences. In Model#2, resilience was removed from the analysis and the strength of associations almost did not change (OHRQoL vs pulp involvement RP=2.33;95% CI: 1.58-3.43; OHRQoL vs fistula/abscess RP=3.65;95% CI: 2.22-5.99). Early childhood caries with pulp consequences had negative impact on OHRQoL of preschoolers and families, and it is not moderated by parents' resilience.

노년기 건강행동의 결정요인 : 앤더슨 행동 모델의 적용

본 연구의 목적은 앤더슨 행동 모델을 기반으로 노년기의 건강행동에 어떠한 요인이 영향을 미치는지를 분석하기 위함이다. 국민노후보장패널 6차 부가조사 자료를 활용하여 65세 이상의 노인 4,229명의 건강행동관련 응답에 대한 위계적 로지스틱 회귀분석이 사용되었다. 연구 결과 첫째, 배우자가 있고, 사회적지지가 높으며, 기타질환이 없는 노인일수록 아침식사 실천이 높았다. 둘째, 남성이며, 종교가 있고, 사회적지지와 가족관계 만족도가 높을수록, 주관적 건강상태가 높고, 질환이 존재하지 않는 경우 적정수면 실천이 높게 나타났다. 셋째, 연령이 낮고, 종교가 있으며, 학력, 사회적지지, 주관적 건강상태가 높을수록, 4대 중증질환, 기타질환이 없을수록 규칙적 운동을 하는 것으로 나타났다. 넷째, 연령이 낮고, 배우자와 종교가 있으며, 학력, 월평균 소득, 사회적지지, 주관적 건강상태가 높을수록, 가족 외 관계만족도가 낮을수록, 질환이 존재할수록 정기 건강검진을 실천하는 것으로 나타났다. 이는 건강행동의 영향요인별로 접근을 달리하여야 함을 의미하며, 노년기의 건강수명 유지를 위해 지역사회의 보건복지교육 프로그램과 관련 정책마련의 필요성을 제안한다.

Beneficial effects of weekend catch-up sleep on metabolic syndrome in chronic short sleepers

ObjectivesShort sleep duration has been known to be related to metabolic syndrome (MetS) . The aim of this study was to investigate the beneficial effects of weekend catch-up sleep (WCUS) on MetS in the Korean middle-aged population. MethodsFor this cross-sectional study, 1,812 participants aged 35-60 years were selected from the 2016-2018 Korean National Health and Nutrition Examination Survey (mean age 46.94 years, 49% male). Short sleep duration was defined as <6hrs on weekdays, and participants were divided into two groups: WCUS group and no weekend catch-up sleep group.Multiple logistic regression was performed to determine the association between WCUS and MetS prevalence. The covariates included age, sex, education, income, occupation, smoking, alcohol consumption, and physical activity. ResultsWCUS was significantly associated with lower MetS prevalence in the unadjusted model and in the model adjusted for socioeconomic and health behavior factors. ConclusionThese results support the beneficial effects of WCUS on lowering the risk of MetS among middle-aged chronic short sleepers.

Use of E-Cigarettes and Self-Reported Lung Disease Among US Adults.

Initially marketed for smoking cessation, electronic cigarettes (e-cigarettes) are commonly regarded as safer than combustible cigarettes because they usually contain less nicotine and do not use combustion. However, few studies have examined the health effects of e-cigarettes. The objective of this study was to examine whether e-cigarette use had a differential effect on the prevalence of lung disease among current, former, and never tobacco users. We analyzed data from respondents aged ≥18 (n = 45 908) who responded to questions about e-cigarette use and lung disease in the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey. We calculated crude odd ratios (ORs) and ORs adjusted by 15 sociodemographic and health behavior factors: age, sex, race/ethnicity, annual household income, health insurance, personal physician, health status, body mass index, education, marital status, exercise, alcohol use, tobacco smoking, tobacco chewing, and metropolitan status. We found a significant association between e-cigarette use and lung disease, which was significantly modified by tobacco use. Among never tobacco users, the adjusted odds of reporting lung disease were 4.36 (95% CI, 1.76-10.77) times higher among everyday e-cigarette users than among never e-cigarette users. Among current tobacco users, the adjusted odds of reporting lung disease were 1.47 (95% CI, 1.13-1.92) times higher among everyday e-cigarette users than among never e-cigarette users. People who have never smoked combustible cigarettes should refrain from starting e-cigarettes, because e-cigarettes carry a significant risk of lung disease independent of tobacco smoking. Additional prospective research into the harmful effects of e-cigarettes would help to further elucidate this link.

Risk Factors Associated With Child Protective Services Involvement Among Parents With a Serious Mental Illness

People with serious mental illnesses are as likely to be parents as people in the general population but are much more likely to have contact with child protective services (CPS) and experience an out-of-home placement of their children. This study sought to identify risk factors for CPS involvement among parents with serious mental illnesses. Parents with a serious mental illness were identified through a national, representative survey. Data from a follow-up interview were used to compare characteristics of parents who had a CPS contact (N=36) with those who did not (N=38). The interview assessed demographic and health characteristics, social support, traumatic life events, and other general risk factors for CPS involvement. Compared with parents without CPS contact, parents with a CPS contact were more likely to be nonwhite and to be less educated. They were also more likely to have less attachment-related social support, more parenting-related needs in numerous areas, and more substance use-related issues and to have experienced adverse childhood and traumatic events. One-quarter of the parents with CPS contact reported not having a mental disorder diagnosis at the time of the first contact, and those in the CPS group were less likely to have taken medications at the time of the first contact than were parents who did not have a CPS contact. Results suggest a need for policies, programs, and practices that attend to common risk factors associated with CPS involvement that are present in the general population rather than concentrating efforts on addressing behavioral health factors specific to parents with serious mental illness.

Menopause, multisite pain and work ability among municipal workers

Abstract Background A rising number of women will go through menopause while working. We aimed to examine the association of menopausal status with multisite pain and pain interfering with work ability. Methods We analysed cross sectional data collected in the Helsinki Health Study. Female full-time municipal employees aged 45, 50, 55 or 60 years and of at least normal weight were studied. Premenopausal group included 2420 and postmenopausal group 1364 participants. First, we examined the associations between menopausal status and multisite pain. Second, among those with pain (n = 1481), the association between menopausal status and change in work ability due to pain was studied. Age, health behaviour (including the use of hormone replacement therapy) and work-related factors were controlled for. Results Postmenopause was associated with multisite pain (OR 1,44; 95 % CI 1,11 − 1,87) as compared with premenopause. Postmenopause was also associated with a large change in self¬-perceived work ability caused by pain (OR 1,53; 95 % CI 1,01 − 2,32). Conclusions The results underline the importance of menopause to the experience of multisite pain and its contribution to the change in self¬-perceived work ability. Key messages This study adds evidence to the underresearched topic of menopause and work. Support for women in menopause and further attention in work issues of women in midlife are necessary.

Population-Level Incidence and Use-Related Factors of Comfort and Orthopedic Accessories Among Older Vehicle Occupants in NSW, Australia.

The proportion of people aged 65 years and older regularly traveling in motor vehicles continues to grow worldwide. In a previous convenience sample, we observed many older people using comfort accessories when traveling in vehicles, and these may contribute to the known increased risk of injury in crashes among older people. In this study, we aimed to estimate population-level use of these devices and examine associations between demographic, health, and travel behavior factors and their use. The point estimate of self-reported use of comfort accessories was 25.7% (95% confidence interval [CI] = [19.6%, 31.9%]). Cushions on the vehicle seat were the most common type used (14.3%, 95% CI = [9.7%, 19.0%]), and increasing age, female gender, and frequent vehicle travel were significantly associated with their use. Less frequently used were seat belt padding (10.5%, 95% CI = [6.3%, 14.6%]) and back/neck supports (6.5%, 95% CI = [2.7%, 10.2%]). Back/neck and multiple area pain were significantly associated with the use of the latter.

Ranking sociodemographic, health behavior, prevention, and environmental factors in predicting neighborhood cardiovascular health: A Bayesian machine learning approach

Cardiovascular disease is the leading cause of death in the United States. While abundant research has been conducted to identify risk factors for cardiovascular disease at the individual level, less is known about factors that may influence population cardiovascular health outcomes at the neighborhood level. The purpose of this study is to use Bayesian Additive Regression Trees, a state-of-the-art machine learning approach, to rank sociodemographic, health behavior, prevention, and environmental factors in predicting neighborhood cardiovascular health. We created a new neighborhood health dataset by combining three datasets at the census tract level, including the 500 Cities Data from the Centers for Disease Control and Prevention, the 2011–2015 American Community Survey 5-Year Estimates from the Census Bureau, and the 2015–2016 Environmental Justice Screening database from the Environmental Protection Agency in the United States. Results showed that neighborhood behavioral factors such as the proportions of people who are obese, do not have leisure-time physical activity, and have binge drinking emerged as top five predictors for most of the neighborhood cardiovascular health outcomes. Findings from this study would allow public health researchers and policymakers to prioritize community-based interventions and efficiently use limited resources to improve neighborhood cardiovascular health.

Sleep Duration and Health Care Expenditures in the United States.

To estimate the average incremental health care expenditures associated with habitual long and short duration of sleep as compared with healthy/average sleep duration. Medical Expenditure Panel Survey data (2012; N=6476) linked to the 2010-2011 National Health Interview Survey. Annual differences in health care expenditures are estimated for habitual long and short duration sleepers as compared with average duration sleepers using 2-part logit generalized linear regression models. Habitual short duration sleepers reported an additional $1400 in total unadjusted health care expenditures compared to people with average sleep duration (P<0.01). After adjusting for demographics, socioeconomic factors, and health behavior factors, this difference remained significant with an additional $1278 in total health care expenditures over average duration sleepers (P<0.05). Long duration sleepers reported even higher, $2994 additional health care expenditures over average duration sleepers. This difference in health care expenditures remained significantly high ($1500, P<0.01) in the adjusted model. Expenditure differences are more pronounced for inpatient hospitalization, office expenses, prescription expenses, and home health care expenditures. Habitual short and long sleep duration is associated with higher health care expenditures, which is consistent with the association between unhealthy sleep duration and poorer health outcomes.

The association of health behavioral risk factors with quality of life in northern Sweden-A cross-sectional survey.

BackgroundIt is well known that behavioral risk factors such as obesity, smoking, physical activity, diet, and excessive alcohol are linked to general health in northern Sweden. This study aimed to explore the joint relationship between these risk factors and the quality of life (QoL).MethodsData were collected from Sweden's national public health survey between February and May 2014 in the four northern counties in Sweden. QoL was assessed using the EuroQol (EQ‐5D). Multivariable regression analysis was used to examine the relationship between five risk factors: BMI, physical activity, smoking status, fruit and vegetable intake, and alcohol consumption and QoL.ResultsData from 17 138 complete questionnaires showed that individuals who were not obese, did at least 30 minutes of physical activity daily, consumed at least 3 portions of vegetable or fruits, were not smoking daily, and who did not report being drunk at least once every week were found to have better QoL (P < .005). The mean EQ‐5D score ranged from 0.85 to 0.79. Approximately, two thirds of the studied population reported being physically active for at least 30 minutes every day and two fifths of them had a normal BMI. Only around 7% of the sample reported that they were eating the recommended daily level of fruits and vegetables.ConclusionsThe results of the study suggest that QoL has a significant relationship with lifestyle behaviors. This finding would emphasize the role of interventions to improve population health.

Sex-dependent associations of low birth weight and suicidal ideation in adulthood: a community-based cohort study

Low birth weight (LBW; < 2,500 g) has been identified as a risk factor for adverse mental health outcomes over the life span. However, little is known about the association of LBW and suicidal ideation in middle and late adulthood. We investigated N = 8,278 participants of a representative community cohort: 3,849 men (46.5%) and 4,429 women (53.5%) (35–74 years of age). We assessed standardized measures of mental distress, sociodemographics, health behavior, and somatic factors (based on an extensive medical assessment). Controlling for these confounders, we examined the relationship of birth weight and suicidal ideation in logistic regression models. As men and women differ with regard to their susceptibility to suicidal ideation and behavior, we tested sex-dependent effects. LBW was reported by 458 participants (5.5%). In men, LBW was associated with a higher likelihood of reporting suicidal ideation (OR 2.92, 95% CI 1.58–5.12). In women, there was no such relationship. The findings underscore the interrelatedness of the physical and psychological domain, the role of early adversity in suicidal ideation, and they identify a vulnerable group whose numbers are expected to grow. They also indicate other risk factors for suicidal ideation in the community (mental distress, lack of social support, and health risk behavior).

Predicting Adherence With the Glaucoma Treatment Compliance Assessment Tool.

The purpose of this study was to determine the health behavior factors related to glaucoma adherence in patients with self-reported poor adherence. A research coordinator used the Chang Adherence Measure and the Morisky Medication Adherence Scale to identify subjects with poor self-reported glaucoma medication adherence and enrolled them in a 3-month study to electronically monitor medication adherence. At enrollment, the coordinator administered the GTCAT. We calculated the percentage of prescribed doses taken over a 3-month period using an electronic dose monitor (AdhereTech). We used Rasch analysis, and univariate and multivariable regression to determine the GTCAT statements that predicted electronically monitored adherence. The mean adherence was 73.8% (SD=21.04%, range: 13% to 100%). Rasch analysis showed that the GTCAT had a good overall fit and no differential bias (Anderson likelihood ratio test >0.05). Multiple GTCAT statements were associated with adherence, which represented increased knowledge, increased cues-to-action, decreased barriers, less depression, and increased self-efficacy (P<0.09 for each). The full GTCAT or a subset of statements had a high association with adherence (R range: 0.44 to 0.51, P<0.005 for all). The GTCAT identified >50% of patients who wanted more education about glaucoma; >68% who did not use reminders; and >40% who reported having difficulty using the eye drops. The GTCAT identified multiple factors associated with adherence. Clinicians and researchers could use this tool to identify specific barriers to adherence and develop potential interventions to improve adherence.