HMO Members Research Articles

Daily cigarette consumption in early adulthood: age of smoking initiation and duration of smoking

This study considers the extent to which daily consumption of cigarettes in young adults varies by age at first cigarette and duration of smoking. Data come from a random sample of 21- to 30-year-old members of a large HMO in the Detroit area. Daily cigarette consumption by current smokers varied by duration of daily smoking: the longer the duration, the higher the number of cigarettes smoked. Duration from first cigarette to daily smoking bore no relationship to cigarette consumption. When duration of daily smoking was statistically controlled, the association between cigarette consumption and age at first cigarette was not statistically significant. The findings suggest that public health efforts to delay daily smoking among adolescents might reduce cigarette consumption in early adulthood.

Early smoking initiation and nicotine dependence in a cohort of young adults

We examined the extent to which nicotine dependence and daily smoking might vary by age at first cigarette. The potential confounding effects of sex, race and history of childhood behaviour problems were examined as well. A sample of 1200 was randomly selected from the subset of 21–30-year-old members of a large HMO in the Detroit SMSA; 1007 (84%) agreed to participate. Personal interviews were conducted in respondents' homes, using the NIMH-DIS to elicit information on DSM-III-R diagnoses, including nicotine dependence. Controlling for sex and race, persons who smoked their first cigarette at 14 to 16 years of age were 1.6 times more likely to become dependent than those who initiated smoking at an older age ( P = 0.03). The association was unchanged when history of childhood behaviour problems was also controlled. Smoking initiation before age 14 was not associated with increased probability of dependence. Persons who initiated smoking before age 14 had a longer lag time to daily smoking and a lower likelihood of progressing to daily smoking, compared to persons who initiated smoking later on. The findings suggest that, among persons who have ever smoked, there might be two distinct groups in whom the chances of developing dependence are considerably reduced. The first comprises persons who delayed first use until age 17. The second comprises persons who smoked their first cigarette before age 14, a group in whom the progression to daily smoking might be markedly slower than in persons who initiated smoking when they were older.

The quality of social roles as predictors of morbidity and mortality

This study uses a longitudinal design to examine the health effects of the quality of social roles among a cohort of women and men. The specific roles of interest are the spouse role, the parent role, and the worker role. The cumulative and interactive effects of role characteristics and role satisfactions and stresses are also examined. The study population was randomly selected from among members of a large HMO and were part of a household interview conducted in 1970-71. Medical records for the 2 years prior to the interview and for 15 years after the interview for the cohort members are linked with the survey data. The findings show that for women, particular qualities of the marital and work roles are predictive of subsequent morbidity and mortality. For married women, equality in decision making and companionship in marriage are protective against death. None of the marriage characteristics are predictive of health outcomes among men. Work support is protective against death, malignancy, and stroke among employed women, and work stress increases the risk of ischemic heart disease among employed men. None of the parental role characteristics were significant predictors of health outcomes for men or women. No interaction were found.

Social networks as predictors of ischemic heart disease, cancer, stroke and hypertension: Incidence, survival and mortality

Three social network measures were obtained from a randomly sampled cohort of 2603 HMO members in 1970–1971. Mortality and first incidence of ischemic heart disease, cancer, stroke, and hypertension were assessed over the next 15 years. Outcome data were adjusted for age, sex, smoking, SES, and baseline health status. Persons with histories of a given morbidity at or prior to baseline were excluded from the analyses of that morbidity. Social network measures, particularly network scope (a measure of the number of different domains in which a person has social contacts), were powerful predictors of 15-year mortality hazard, but weak predictors of incident disease. Only network scope predicted IHD incidence, and none of the other morbidities was predicted by the social network measures. However, social network measures were strong predictors of both cause-specific and all-cause mortality among persons who had incident cases of IHD, cancer, and stroke. These data suggest that social networks may be more effective in supporting recovery after illness has occurred than in preventing the incidence of new disease.

Women's employment, social support, and mortality.

This study uses a longitudinal design to examine the extent to which social support at work is protective against death and the degree to which it explains mortality differences between employed women and those not in paid employment. Women's total role responsibilities and community involvement, as an alternative source of social support and social integration, are also considered in the analysis. The outcome examined is mortality risk over a 15 year period. The 1140 women included in this study were randomly selected from among members of a large HMO and were part of a household interview conducted in 1970-71. Medical and vital records for 15 years post interview period are linked with the survey data. The results of this analysis suggest that social support at work is protective against mortality among employed women and contributes to mortality risk differences between employed and nonemployed women. While the relative hazard of death for nonemployed women who have some community involvement is greater than for employed women, the difference is not statistically significant. Community involvement may provide an alternative, albeit weaker, avenue for gaining some of the same advantages available in paid employment. Future research directions are discussed.

Comparing Sources of Drug Data about the Elderly

This project assessed the extent of agreement between drug-taking data obtained from an in-home assessment and that obtained from an automated outpatient pharmacy system and from a mail questionnaire. The underlying assumption is that an in-home assessment provides the most complete information (criterion standard) about the prescription medications being taken. The drug data from the mail questionnaire and automated outpatient pharmacies were compared with that from the in-home assessment by use of t tests and measures of sensitivity, specificity, and positive predictive value. Kaiser Permanente, Northwest Region, a prepaid group practice HMO. All elderly HMO members enrolled in the Social HMO demonstration project who had a comprehensive assessment within 30 days of returning a mail questionnaire between March 1986 and March 1988 (n = 83 frail elderly). The number of medications currently being taken and the number of different therapeutic classes of drugs being taken per elderly HMO member. The in-home assessment and the automated prescription system closely agreed on the number of different medications and the different therapeutic classes of prescription drugs being taken. The in-home assessment and mail questionnaire were in less agreement. Agreement was less for non-prescription drugs. An automated prescription system is an adequate source of information about the prescription drugs currently being taken by frail elderly HMO enrollees with a prepaid prescription drug benefit.

Psychological and Behavioral Implications of Abnormal Mammograms

To evaluate women's psychological responses to abnormal mammograms and the effect on mammography adherence. To identify psychological responses and other factors that predict mammography adherence in women with normal or abnormal mammograms. Survey study with prospective analysis of factors associated with mammography adherence. Health Maintenance Organization of Pennsylvania and New Jersey (HMO PA/NJ). Study patients, members of HMO PA/NJ who were 50 years of age or older, and who had had mammography done 3 months earlier, included women with normal mammograms (n = 121), women with low-suspicion mammograms (n = 119), and women with high-suspicion mammograms (n = 68), but not women with breast cancer. Psychological responses 3 months after mammography and adherence to subsequent annual mammography were assessed. Women with high-suspicion mammograms had substantial mammography-related anxiety (47%) and worries about breast cancer (41%). Such worries affected the moods (26%) and daily functioning (17%) of these women, despite diagnostic evaluation excluding malignancy. For each variable, a consistent trend (P greater than 0.05) was seen with degree of mammogram abnormality. Sixty-eight percent of women with normal results, 78% of women with low-suspicion results, and 74% of women with high-suspicion results obtained their subsequent annual mammograms (P greater than 0.05). The number of previous mammograms (odds ratio, 3.2; 95% CI, 1.6 to 6.2) and the effect of the previous results on concerns about breast cancer (odds ratio, 0.5; CI, 0.2 to 1.0) were independent predictors of adherence in logistic regression analyses (P less than 0.05). A substantial proportion of women with suspicious mammograms have psychological difficulties, even after learning that they do not have cancer. Such sequelae do not appear to interfere with subsequent adherence.

Effect of domestic and occupational roles on morbidity and mortality

This study examines the effect of labor force participation, occupational status and domestic roles on morbidity and mortality among women and men over a 15-year period. The main research questions address the long-term effects of multiple roles. Does the combination of domestic and work roles result in adverse health effects, or provide some health advantage? The study population was randomly selected from among members of a large HMO and were part of a household interview conducted in 1970-71. Medical records for the two years prior to the interview and for 15 years after the interview for the cohort members are linked with the survey data. The findings show that for women there is some longevity advantage in paid employment. Overall, the combination of employment and domestic roles apparently poses no health threat to women, and may provide some advantage. Multiple roles are unrelated to mortality and morbidity outcomes among men.

Determinants of health care satisfaction: a national study of HMO and fee-for-service consumers.

This study examines the extent to which different health care attributes determine health care satisfaction. It employed two national cross-sectional samples, one of HMO members and the other of NON-HMO health care users. The comparative analysis revealed that the pattern of results for both samples were similar. The two most important attributes for both samples were health care costs and availability of specialists. Results suggest different marketing and related management strategies.

Consistently High Users of Medical Care Among the Elderly

This study identified consistently high and low users of medical care services in a group of older HMO members continuously enrolled for six years. Consistently high users made up 26% of the sample, but accounted for more than 50% of total outpatient contacts and hospital admissions. Average ambulatory care costs were more than four times greater for the high users compared with the low users. Consistently high users were older than consistently low users, but did not differ significantly in other sociodemographic characteristics. Compared with the low users, the high users reported more total medical conditions and were more likely to indicate they had arthritis, high blood pressure, heart conditions, and other chronic problems. They perceived themselves to be in poorer health and reported higher levels of psychologic distress. The low users tended to be less satisfied, but the two user groups were not significantly different regarding use of services outside the HMO.

Do HMO Members Get More Cancer Checkups?

One justification for Congressional support of Health Maintenance Organizations has been the supposition that they promote preventive medicine. This study found HMO members no more likely overall to receive appropriate cancer checkups than individuals with traditional (reimbursement) insurance coverage, although in the under-40 age category, HMO members were more likely to receive the checkups. The study identified reminders, rather than type of health plan coverage, as the key predictor of obtaining checkups.

Older Adults' Use of Health Maintenance Organizations

The effects of Health Maintenance Organization membership on the use of physicians and hospitals. by older adults was examined using data from the 1975 National Health Interview Survey. Comparison of the HMO and non-H MO groups revealed that the HMO members differed on several demographic variables. While the HMO members tended to have more frequent physicians' visits than the nonmembers, the two groups did not differ in their number of hospitalized days or hospital episodes. In both populations, use of physician's services was most strongly influenced by poor health, although the effects were stronger in the HMO than the non-HMO group, indicating the physicians' services were more accessible by older adults in HMOs than in fee-for-service systems. Hospital utilization was affected equally strongly by poor health in both groups.

More Effective Living: a partnership approach to health education programming.

In September, 1974, the Kaiser-Permanente Medical Center in Santa Clara, California, and the West Valley Community College District entered into cooperative planning for delivery of consumer health education. Two months later, the first five classes commenced with a total enrollment of 53 persons, all of whom were HMO members. Seven years later, this joining HMO-community college health education program entitled More Effective Living (MEL) contains over 50 different class titles, is offered cooperatively by two Kaiser-Permanente facilities and three locally-based community colleges, is scheduled in three academic semester time periods spanning 12 months and, is expected to serve an estimated 760 HMO members and community residents in the Spring 1981 semester. Although this paper addresses the HMO-community college partnership primarily from an administrative perspective, some background information is given to explain the basic concepts of the program design. For health educators, particularly those working in medical care, partnership with a community organization can be an effective way to deliver health education to a target population at minimal cost.

Assessing the Evidence on HMO Performance

HMOs contract to provide physician and hospital services to enrolled populations in return for fixed periodic payments. Total costs for HMO members are shown to be lower than for those enrolled in conventional insurance plans. But the explanation for this and related differences cannot be attributed solely to matters of efficiency, quality, or even consumer self-selection or physician satisfaction. Although public policy assumes that HMOs will encourage beneficial competitive responses by traditional health care providers, too little is known to predict the nature and extent of such probabilities.

Relationships among HMO hospital utilization, physician visits, and years operational.

Statistical tests are performed on the membership of HMOs for which data are available (N = 124) to determine if (1) hospital utilization by HMO members is correlated with physician visits, (2) hospital utilization is correlated with the number of years a HMO is operational, and (3) physician visits is correlated with the number of years a HMO is operational. Statistical tests indicate that there is no correlation among the three pairs of variables.