Managed Behavioral Health Research Articles

Work Change in Multiple Sclerosis as Motivated by the Pursuit of Illness-Work-Life Balance: A Qualitative Study.

Individuals with multiple sclerosis have a tendency to make early decisions for work change, even in reversible, episodic, or mild disease stages. To better understand how a multiple sclerosis (MS) diagnosis influences perceptions of work and motivations for work changes, we conducted a hermeneutic phenomenology study to explore the work lives of ten individuals with MS in Malaysia. The interpretive analysis and cumulative narratives depict an overarching change in their concept of ideal work and life aspirations and how participants make preemptive work changes to manage illness-work-life futures in subjectively meaningful ways. Discussions on their integrated pursuit of finding dynamic and subjective illness-work-life balance include reconciling the problem of hard work and stress on disease activity and progress, making positive lifestyle changes as health management behaviour, and the motivational influence of their own life and family roles: the consideration of their spouses, parents, and children. At an action level, work change was seen as moral and necessary for the management of illness futures. Our findings contribute insights on how individual perceptions and holistic life management decisions contribute to on-going and disrupted work trajectories, which can inform practice and policy on early interventions to support continued employment.

The oral health status of the preschool child according to the oral health management behaviors performed by their parents

The oral health status of the preschool child according to the oral health management behaviors performed by their parents

Design Considerations in Development of a Mobile Health Intervention Program: The TEXT ME and TEXTMEDS Experience.

BackgroundMobile health (mHealth) has huge potential to deliver preventative health services. However, there is paucity of literature on theoretical constructs, technical, practical, and regulatory considerations that enable delivery of such services.ObjectivesThe objective of this study was to outline the key considerations in the development of a text message-based mHealth program; thus providing broad recommendations and guidance to future researchers designing similar programs.MethodsWe describe the key considerations in designing the intervention with respect to functionality, technical infrastructure, data management, software components, regulatory requirements, and operationalization. We also illustrate some of the potential issues and decision points utilizing our experience of developing text message (short message service, SMS) management systems to support 2 large randomized controlled trials: TEXT messages to improve MEDication adherence & Secondary prevention (TEXTMEDS) and Tobacco, EXercise and dieT MEssages (TEXT ME).ResultsThe steps identified in the development process were: (1) background research and development of the text message bank based on scientific evidence and disease-specific guidelines, (2) pilot testing with target audience and incorporating feedback, (3) software-hardware customization to enable delivery of complex personalized programs using prespecified algorithms, and (4) legal and regulatory considerations. Additional considerations in developing text message management systems include: balancing the use of customized versus preexisting software systems, the level of automation versus need for human inputs, monitoring, ensuring data security, interface flexibility, and the ability for upscaling.ConclusionsA merging of expertise in clinical and behavioral sciences, health and research data management systems, software engineering, and mobile phone regulatory requirements is essential to develop a platform to deliver and manage support programs to hundreds of participants simultaneously as in TEXT ME and TEXTMEDS trials. This research provides broad principles that may assist other researchers in developing mHealth programs.

Erratum to: An interpretative phenomenological analysis (IPA) of coercion towards community dwelling older adults with dementia: findings from Mysore studies of natal effects on ageing and health (MYNAH).

Limited availability of specialist services places a considerable burden on caregivers of Persons with Dementia (PwD) in Low- and Middle-Income Countries (LMICs). There are limited qualitative data on coercive behavior towards PwD in an LMIC setting. The aim of this study was to find relevant themes of the lived experience of relatives as caregivers for PwD in view of their use of coercive measures in community setting in South India. Primary caregivers (n = 13) of PwDs from the Mysore study of Natal effects on Ageing and Health (MYNAH) in South India were interviewed to explore the nature and impact of coercion towards community dwelling older adults with dementia. The narrative data were coded using an Interpretative Phenomenological Analysis (IPA) approach for thematic analysis and theory formation. Caregivers reported feeling physical and emotional burn-out, a lack of respite care, an absence of shared caregiving arrangements, limited knowledge of dementia, and a complete lack of community support services. They reported restrictions on their lives through not being able take employment, a poor social life, reduced income and job opportunities, and restricted movement that impacted on their physical and emotional well-being. Inappropriate use of sedatives, seclusion and environmental restraint, and restricted dietary intake, access to finances and participation in social events, was commonly reported methods of coercion used by caregivers towards PwD. Reasons given by caregivers for employing these coercive measures included safeguarding of the PwD and for the management of behavioral problems and physical health. There is an urgent need for training health and social care professionals to better understand the use of coercive measures and their impact on persons with dementia in India. It is feasible to conduct qualitative research using IPA in South India.

The Relationship Between Health Management and Information Behavior Over Time: A Study of the Illness Journeys of People Living With Fibromyalgia.

BackgroundOver the course of a chronic illness, patients face many challenges, including understanding what is happening to them and developing an effective strategy for managing illness. While there is existing literature concerning how people seek health-related information and cope with chronic illnesses, there is a need for additional research on how information affects patients’ understandings of their illness, and how changes in this understanding affect their health management strategies over time.ObjectiveThis study examined how health management, information seeking, and information consumption and use processes are related throughout an illness.MethodsA diversified recruitment strategy involving multiple media channels was used to recruit participants for an interview study. During the interviews, participants were asked to draw an “illness journey” timeline. The data were analyzed using a qualitative approach drawn from Interpretative Phenomenological Analysis and Grounded Theory.ResultsThe study identified four main health management features of illness journeys: onset, progression toward diagnosis, acceptance, and development of an effective management strategy. The study then focused on how information seeking changes over illness journeys, particularly in terms of a transition from active information seeking to monitoring with intermittent focused searching. Last, the paper describes the information consumption and use processes that patients engaged in throughout their journey.ConclusionsThis study makes three important contributions to the field. First, it presents an integrated conceptualization of how health management and information behaviors are related on illness journeys. Second, it adds to our existing knowledge on health literacy and self-management of chronic illness. Third, the study has implications for health interface design.

A Study on High School Students’ Self-Concept Clarity, Stress and Interpersonal Relationships Affect Subjective Oral Health

The present study was conducted in order to provide basic data that increases preventive oral health management behaviors by researching and analyzing the effect of high school students' self-identity, stress and interpersonal relationships on subjective oral health, and, consequently, the results are as follows. First, oral health appeared better when the self-identity of students was higher. Second, the degree of practicing oral health was higher when interpersonal relationships were better. Third, food intake habits related to oral health were better when stress was lowers and smoking behaviors were better. Fourth, subjective oral health was higher when students had good interpersonal relationships and did not smoke. The results of the present study may help the development of data and programs concerned with factors influencing the subjective oral health of high school students, but is considered too limited to be generalized.

A Study on Factors that may affect the Oral Health Status of University Students

The present study investigated and analyzed how dietary habits, snack intake behavior, and stress affect the subjective oral health status of university students. Subject data involved oral health status and oral health awareness inquires via survey inquiries and the SPSS 20.0 statistics program. The results of the study are as follows. Snack intake increases when stress increases, and this affects oral health. Furthermore, nutrition labeling awareness increases when stress is lower and dietary habits are better, which affects oral health status. College is a transitional period between adolescence and adulthood, when adequate intake of nutrition and establishing proper dietary habits are important. University students may establish different dietary habits from adolescence due to the sudden change in environment, so by actively using nutrition labels, they can choose foods that fit their oral health status and needs, and the adequate education for filling in the lacking nutrients is important. The oral health awareness and behavior of university students appear to have difference in accordance with the general characteristics of subjects, and oral health education must consider such differences. Because awareness toward oral knowledge and oral education is low, education corresponding to this must be strengthened. The present study investigates the effect of dietary habits, snack intake behavior, and stress on subjective oral health status in order to provide basic data necessary in building programs for increasing preventive oral health management behaviors.

Developing effective communication materials on the health effects of climate change for vulnerable groups: a mixed methods study.

BackgroundIndividuals with chronic health conditions or low socioeconomic status (SES) are more vulnerable to the health impacts of climate change. Health communication can provide information on the management of these impacts. This study tested, among vulnerable audiences, whether viewing targeted materials increases knowledge about the health impacts of climate change and strength of climate change beliefs, and whether each are associated with stronger intentions to practice recommended behaviors.MethodsLow-SES respondents with chronic conditions were recruited for an online survey in six cities. Respondents were shown targeted materials illustrating the relationship between climate change and chronic conditions. Changes in knowledge and climate change beliefs (pre- and post-test) and behavioral intentions (post-test only) were tested using McNemar tests of marginal frequencies of two binary outcomes or paired t-tests, and multivariable linear regression. Qualitative interviews were conducted among target audiences to triangulate survey findings and make recommendations on the design of messages.ResultsRespondents (N = 122) reflected the target population regarding income, educational level and prevalence of household health conditions. (1) Knowledge. Significant increases in knowledge were found regarding: groups that are most vulnerable to heat (children [p < 0.001], individuals with heart disease [p < 0.001], or lung disease [p = 0.019]); and environmental conditions that increase allergy-producing pollen (increased heat [p = 0.003], increased carbon dioxide [p < 0.001]). (2) Strength of certainty that climate change is happening increased significantly between pre- and post-test (p < 0.001), as did belief that climate change affected respondents’ health (p < 0.001). (3) Behavioral intention. At post-test, higher knowledge of heat vulnerabilities and environmental conditions that trigger pollen allergies were associated with greater behavioral intention scores (p = 0.001 and p = 0.002, respectively). In-depth interviews (N = 15) revealed that vulnerable audiences are interested in immediate-term advice on health management and protective behaviors related to their chronic conditions, but took less notice of messages about collective action to slow or stop climate change. Respondents identified both appealing and less favorable design elements in the materials.ConclusionsIndividuals who are vulnerable to the health effects of climate change benefit from communication materials that explain, using graphics and concise language, how climate change affects health conditions and how to engage in protective adaptation behaviors.

Disclosure of Depression in Primary Care: A Qualitative Study of Women’s Perceptions

BackgroundHealth care providers are better able to diagnose depression and initiate treatment when patients disclose symptoms. However, many women are reluctant to disclose depressive symptoms. Little is known about the experience of disclosing depression symptoms in primary care among racially and ethnically diverse women across the life course. We qualitatively explore experiences of disclosure of depressive symptoms to primary care providers among self-identified African American, Hispanic and non-Hispanic White women. MethodsTwenty-four women with depression were recruited for open-ended interviews. We recorded, transcribed, and coded interviews using inductive content analysis. FindingsTwo distinct domains emerged: participant factors that hinder and facilitate disclosure and provider cues that encourage and dissuade discussing depression. Participants described perceptions about primary care not being the appropriate place, fear of not having a choice in treatment decisions, and the emotional cost of retelling as impediments to disclosure; perceiving an increased likelihood of getting help was described as a facilitator. Women identified provider behaviors of asking about depression and showing concern as facilitators, and provider time constraints as a barrier to disclosure. ConclusionsWomen perceive that primary care is not the appropriate place to disclose depression symptoms. Increased public education about behavioral health management in primary care, as well as more robust integration of the two, is needed. Efforts to improve depression disclosure in primary care must also encompass systematic use of depression screening tools and implementation of targeted interventions to cultivate provider empathy.

Validation of the Self-Efficacy for Managing Chronic Disease Scale: A Scleroderma Patient-Centered Intervention Network Cohort Study.

Self-management programs for patients with chronic illnesses, including rheumatic diseases, seek to enhance self-efficacy for performing health management behaviors. No measure of self-efficacy has been validated for patients with systemic sclerosis (SSc; scleroderma). The objective of this study was to assess the validity and internal consistency reliability of the Self-Efficacy for Managing Chronic Disease (SEMCD) scale in SSc. English-speaking SSc patients enrolled in the Scleroderma Patient-centered Intervention Network Cohort who completed the SEMCD scale at their baseline assessment between March 2014 and June 2015 were included. Patients were enrolled from 21 sites in Canada, the US, and the UK. Confirmatory factor analysis (CFA) was used to evaluate the factor structure of the SEMCD scale. Cronbach's alpha was calculated to assess internal consistency reliability. Hypotheses on the direction and magnitude of Pearson's correlations with psychological and physical outcome measures were formulated and tested to examine convergent validity. A total of 553 patients were included. CFA supported the single-factor structure of the SEMCD scale (Tucker Lewis Index = 0.99, comparative fit index = 0.99, root mean square error of approximation = 0.10). Internal consistency was high (α = 0.93), and correlations with measures of psychological and physical functioning were moderate to large (|r| = 0.48-0.67, P < 0.001), confirming study hypotheses. Scores from the SEMCD scale are valid for measuring self-efficacy in patients with SSc, and results support using the scale as an outcome measure to evaluate the effectiveness of self-management programs in SSc.

A study of health and social care waste management behaviour

Understanding waste management behaviour requires a range of data collection approaches. Observational studies collecting qualitative data are as useful as quantitative studies for understanding behaviour. Previous studies have examined quantities of waste being disposed of, who disposed of the waste, and the material composition of the waste, however, attention to the motivations and reasoning behind the disposal of the waste has been limited. The study was conducted at one healthcare site and three social care sites in the South West of England from 1 May to 31 July 2012. Data were collected by overt observation using photographs, diagrammatic sketches, field notes and digitally recorded informal discussions with employees responsible for disposing of waste. Three primary themes were evident in the data; communication; influence of the environment on the employee; how employees think about waste management. Ensuring that the environment facilitates appropriate waste management behaviour can help improve waste segregation and recycling rates. Clear and visible communication of waste management information will help remind employees how best to dispose of waste. Understanding how employees think about waste management can inform the development of interventions to improve overall waste management practice.

Practical Opportunities for Healthy Diet and Physical Activity: Relationship to Intentions, Behaviors, and Body Mass Index.

Current strategies for improving diet and activity patterns focus on encouraging patients to make better choices, but they meet with limited success. Because the choices people make depend on the choices they have, we examined how practical opportunities for diet and physical activity shape behavioral intentions and achieved behaviors. Participants included 746 adults who visited 8 large primary care practices in the Residency Research Network of Texas in 2012. We used structural equation models to confirm factor structures for a previously validated measure of practical opportunities, and then modeled achieved diet (Starting the Conversation - Diet questionnaire), physical activity (International Physical Activity Questionnaire), and BMI as a function of opportunities (classified as either resources or conversion factors that influence use of resources), behavioral intentions, and demographic covariates. In path models, resources (P <.001) and conversion factors (P = .005) predicted behavioral intentions for activity. Conversion factors (P <.001), but not resources, predicted diet intentions. Both activity resources (P = .01) and conversion factors (P <.001) were positively associated with weekly activity minutes. Diet conversion factors (P <.001), but not diet resources (P = .08), were positively associated with diet quality. The same patterns were observed for body mass index (BMI). Socioeconomic gradients in resources and conversion factors were evident. Individuals' feasible opportunities for healthy diet and activity have clinically meaningful associations with intentions, achieved behaviors, and BMI. Assessing opportunities as part of health behavior management could lead to more effective, efficient, and compassionate interventions.

어머니의 구강건강정보이해력이 유아 자녀의 구강건강상태와 행동에 미치는 영향

The purpose of this study was to examine how oral health literacy of mothers affect the oral health status of their preschool children. The subjects were 233 mothers and their preschool children who are between 5 and 6 years old. They were selected according to the convenience sampling method. The individual self-administered questionnaire was used for the mother's survey while the children were interviewed using structured questionnaire to examine their oral health status and behavior. According to study results, the number of decayed primary teeth and the number of decayed and filled primary teeth had a statistically significant negative correlation with the oral health literacy of the mother, the children's oral health knowledge, attitude and behavior (COHKAB), and the mother's oral health management behavior. Hierarchical multiple regression analysis was performed after including general characteristics variables, the COHKAB and the mother's oral health management behavior. Meanwhile, mother's oral health literacy had a statistically influence on children's oral health status. The higher the mother's oral health literacy level, the lower the number of decayed and filled primary teeth were. The findings suggest that efforts to improve the oral health status of preschool children should consider mother's oral health literacy as an important factor. Therefore, the effective intervention and education programs are necessary to enhance mother's oral health literacy.

Partnership is alive and underpinning healthcare delivery

556 British Journal of Healthcare Management 2015 Vol 21 No 12 © 2 01 5 M A H ea lth ca re L td effective and enhanced performance and create a knowledge and understanding of employee aspirations with attention to the employee’s voice. The employee voice can be expressed in a number of ways and through a variety of two way channels, both cascading down and feeding back up through the most direct routes. Attitude surveys provide another commonly used channel, which is inherently flexible, but not interactive. Broad forms of employee voice include direct involvement in the way work is organised and indirect influence on decisions affecting the broader organisation through works councils or joint consultation committees (Bacon and Samuel, 2009). The employer’s organisational culture and management style impact directly on productivity and performance, and research has shown that employee relations similarly impact on performance. Herein lies the challenge, as key elements of good practice include job design, skills development, and a climate of regular, consistent consultation and involvement; and it is these areas which are highly contested. Theoretically, these areas are associated with good management practice that provides a positive psychological contract based on trust and fairness tied into an organisational culture that delivers positive outcomes linked to performance. In reality, a ‘blame culture’ is still prevalent in many areas of the NHS. When this partnership works, the effect at an employee level is commitment, job satisfaction, and a willingness to produce, but when it fails (for whatever reason) a perverse psychological contract develops, which is inevitably destructive. From an employee’s perspective, either version of this contract is subjective. Assessments of wellbeing at work are affected by a variety of factors including the nature of the work task, social integration in the workplace, participation in decision-making and job security, which link into the total experience of work. Although the contract is individual in nature, there will be work group-, departmentaland organisational-wide aspects, which imply that while structures and relationships adjust, the historical legacy may take time to change (McIntosh and Voyer, 2012). Within the NHS the promotion of partnership between employer, employee and trade unions has emerged as an inclusive mechanism, whereby union relevance is supportive of long-term interests of the Bryan McIntosh, senior lecturer in health management and organisational behaviour at the University of Bradford, explores the role of partnerships in the health service Partnership is alive and underpinning healthcare delivery

The importance of mentoring for practitioners

Dr Bryan McIntosh, senior lecturer in health management and organisational behaviour at the University of Bradford, reflects on the crucial role of mentors

일부 치기공과 학생의 구강보건행태에 관한 연구

Purpose: This study studied and investigated the oral health behavior of students in the Department of Dental Technology at D College at D City. Methods: A self-administrated survey was conducted by students currently enrolled at the Department of Dental Laboratory Technology at D College (June 4, 2015 ~ June 12, 2015), and 320 copies that were available for statistical processing were statistically analyzed by using the SPSS 19.0 Program. Results: Among the survey respondents, 91.6% had experience of dental treatment. The highest response regarding the frequency of tooth brushing appeared to be 'twice' with 44.7%. The responses regarding the time of tooth brushing appeared to be highest for 'before sleeping' with 65.3%, which was followed by 'after breakfast' with 60.6%. To the question asking which areas are brushed during tooth brushing, the response of 'teeth, gum, and tongue' appeared to be highest with 44.4%. Among the respondents, 64.7% experienced scaling, however, the experience rate for scaling appeared to increase in proportion with the increase of class year (p< .001). Regarding the subjective feel for the importance of oral health and necessity of tooth brushing, the scores appeared to be both 4.56. However, the score appeared to be 3.27 regarding one's subjective perception of one's own oral health condition. Regarding one's subjective oral health knowledge level depending on gender, female students showed a meaningfully lower rate (3.12 points) compared to male students (3.29 points) (p< .05), and depending on class, the knowledge level appeared to be meaningfully higher along with the increase in class year (p< .001). The experience of receiving oral health education appeared to be 78.4%, and 88.8% of the respondents responded that there is need for oral health education, however, the intent to participate in an oral health education program appeared to be 56.6%. Conclusion: As a result of the study, it could be concluded that oral health management behaviors and awareness of the students at the Department of Dental Technology at D University to prevent oral diseases were rather poor.

Homeless Caseload is Associated with Behavioral Health and Case Management Staffing in Health Centers.

Community health centers provide co-located medical, behavioral, and case management services to meet the unique and complex needs of the underserved, including homeless individuals. Multivariate analysis of staffing patterns in health centers serving high homeless caseloads highlights above-average behavioral and case management staffing, regardless of Health Care for the Homeless funding status. Rural health centers and those in the South had lower behavioral health and enabling services staffing. Implications include the need to monitor disparities, link health centers with available technical assistance, and emphasize integrating co-located behavioral health, enabling, and medical services through grant oversight mechanisms.

Work-related stress factors and health management among Korean workers with diabetes

Purpose– The purpose of this paper is to test a model in which emotional and work-related conflicts associated with diabetes contribute to health management efficacy and behaviour.Design/methodology/approach– The authors investigated 193 Korean employees with diabetes in a two-phased longitudinal study (101 participants were retained at Time 2).Findings– After controlling for severity of diabetes (HbA1C), structural equation modelling revealed that higher work-health conflict (a proxy for demand) and higher inauthenticity at work (a proxy for control) were associated with more diabetes-related distress at Time 1. Results also revealed support for longitudinal mediation, such that more diabetes-related distress at Time 1 predicted lower health management efficacy one year later (at Time 2), which was associated with less health management behaviour at Time 2.Research limitations/implications– Results support the importance of applying the biopsychosocial perspective to diabetes management through the use of subjective measures of demand and control.Practical implications– Suggestions are provided for occupational programmes for workers with disease, including on-site education, health-management training, and flexible job redesign such as telecommuting.Originality/value– Research in workers with diabetes for stress relief and disease management.

구강건강관리행위에 따른 치면세균막지수와의 관련성

구강건강관리행위의 실태를 파악하고, 치면세균막 검사법에 따른 치면세균막지수의 차이와 이 둘의 상관성을 조사하기 위해 2013년 10월부터 2014년 10월까지 경기도와 충청남도에 소재한 3개 대학의 치위생과 학생을 대상으로 자기기입식 설문지 작성과 치면세균막지수를 각각 측정하여 진행하여 다음과 같은 결론을 얻었다. 1년 이내에 구강검진을 받았다고 응답한 대상자는 62.8%, 예방치과처치를 한 번이라도 받아봤다고 응답한 대상자는 84.1%로 조사되었다. 불소가 포함된 세치제를 사용하고 있다고 응답한 대상자는 80.5%였으며, 칫솔질은 하루에 3회 한다고 응답한 대상자가 68.9%로 가장 높게 나타났다. 칫솔질 방법은 회전법이, 칫솔질 시간은 3분이 각각 90.9%, 50.0%로 조사되었다. 치면세균막 검사법 중 O'leary index로 조사한 결과 평균 27.88로 조사되었으며, PHP index는 평균 1.30, PHP-M index는 평균 12.12로 조사되었다. 구강건강관리행위에 따른 치면세균막지수는 칫솔질 시간이 통계적으로 유의한 차이를 보이는 것으로 조사되었다. 칫솔질 시간이 2분 이하일 경우 O'leary index 31.37, PHP index 1.61, PHP-M index 14.61로 조사되었으며, 4분 이상일 경우 O'leary index 23.32, PHP index 1.07, PHP-M index 9.59로 조사되어 칫솔질 시간이 늘어날수록 치면세균막지수는 낮아지는 것으로 나타났다(p<0.05). 치면세균막지수에 가장 영향을 미치는 요인은 "구강건강을 위한 칫솔질 여부" (B=-9.747, t=-3.752, p<0.001)로 나타났으며, 이는 통계적으로 유의한 차이를 보였다. 설명력은 O'leary index 13.3%, PHP index (B=-0.375, t=-3.016, p=0.003)와 PHP-M index (B=-4.541, t=-3.708, p<0.001)는 각각 12.3%, 17.5%로 조사되었다. 이상의 결과를 정리해보면, 치면세균막지수에 영향을 미치는 구강건강관리행위는 칫솔질 시간과 구강건강을 위한 칫솔질 여부로 조사되었다. A self-administered survey was conducted on the dental hygiene students at three different colleges located in Gyeonggi Province and South Chungcheong Province respectively from October, 2013, to the same month of 2014 to grasp their oral health management behavior, differences in plaque index according to plaque index systems and the correlation of the two. And their plaque index was measured. The findings of the study were as follows: 62.8% of the respondents replied they got a dental checkup over the past year, and 84.1% answered they received preventive dental treatment once at least or more. 80.5% replied they used a fluorine-containing dentifrice. 90.9% answered they used the rolling method to brush their teeth, and 50.0% replied it took three minutes to brush their teeth. They got a mean of 27.88 when O'leary index was used among plaque index systems. Their PHP index and PHP-M index were respectively a mean of 1.30 and a mean of 12.12. Their plaque index became lower when they spent more time brushing their teeth, and the toothbrushing time made a statistically significant difference to that (p<0.05). The factor that exerted the largest influence on plaque index was whether to brush teeth for the sake of oral health (B=-9.747, t=-3.752, p<0.001) or not. That made a statistically significant difference to it. The above-mentioned findings illustrated that more patients visited dental clinics than before to receive preventive dental treatment or to get dental checkups, and that toothbrushing time and whether to brush teeth for the sake of oral health or not were identified as the oral health management behaviors to affect plaque index.

Economic pressure and health and weight management behaviors in African American couples: A family stress perspective.

This study extends the family stress model by examining the influence of economic pressure on health and weight management behaviors mediated by depressive symptoms and spousal support among 506 African American married couples. The actor-partner interdependence model accounted for the interdependent nature of relationships. Findings support the family stress model; yet pathways differed slightly for husbands and wives. Economic pressure directly influenced depressive symptoms and spousal support. Spousal support was a buffer against poor health and weight management behaviors for husbands, while depressive symptoms exacerbated poor health and weight management behaviors for wives. These mechanisms have implications for practitioners who promote African American couples' well-being.