Self-reported Health Risk Research Articles

Integrating Well-Being Information and the Multidimensional Adaptive Prediction Process to Estimate Individual-Level Future Health Care Expenditure Levels

Decades of research exist focusing on the utility of self-reported health risk and status data in health care cost predictive models. However, in many of these studies a limited number of self-reported measures were considered. Compounding this issue, prior research evaluated models specified with a single covariate vector and distribution. In this study, the authors incorporate well-being data into the Multidimensional Adaptive Prediction Process (MAPP) and then use a simulation analysis to highlight the value of these findings for future cost mitigation. Data were collected on employees and dependents of a nationally based employer over 36 months beginning in January 2010. The first 2 years of data (2010, 2011) were utilized in model development and selection; 51239 and 54085 members were included in 2010 and 2011, respectively. The final results were based on prospective prediction of 2012 cost levels using 2011 data. The well-being-augmented MAPP results showed a 5.7% and 13% improvement in accurate cost capture relative to a reference modeling approach and the first study of MAPP, respectively. The simulation analysis results demonstrated that reduced well-being risk across a population can help mitigate the expected upward cost trend. This research advances health care cost predictive modeling by incorporating well-being information within MAPP and then leveraging the results in a simulation analysis of well-being improvement.

Physical Health Risk Behaviours in Young People with Mental Illness

Comorbid physical health conditions, commonly associated with mental illness, contribute to increased morbidity and reduced life expectancy. The trajectory to poorer health begins with the onset of mental illness. For young people with mental illness, health risk behaviours and poor physical health can progress to adulthood with long-term detrimental impacts. Using a cross-sectional survey design, self-reported health risk behaviours were gathered from 56 young (16–25 years) Australians who had been hospitalised for mental illness and taking psychotropic medication. Smoking, alcohol use, minimal physical activity, and lack of primary health care were evident. While these behaviours are typical of many young people, those with mental illness have substantially increased vulnerability to poor health and reduced life expectancy. Priority needs to be given to targeted health promotion strategies for young people with mental illness to modify their risky long-term health behaviours and improve morbidity and mortality outcomes. Nurses in mental health settings play a vital role in promoting young peoples’ well-being and preventing poorer physical health outcomes. Implementation of a cardiometabolic health nurse role in inpatient settings for young people with mental illness could facilitate prevention and early intervention for health risk behaviours.

Abstract A88: Medicaid expansion and access to care among breast cancer survivors

Abstract Background: Breast cancer survival is improving due to early detection of the disease and advances in treatment. In the United States, there are more than 3 million breast cancer survivors and approximately 240 thousand women diagnosed with the disease every year. To receive effective treatment, breast cancer survivors need to follow a treatment plan prescribed by their physicians. However, access to healthcare services remains a barrier to completing needed treatment. Medicaid expansion under the Affordable Care Act improves access to care among vulnerable populations, but almost half of the states opted out of the expansion. Research Objective: We shed light on the potential effect of Medicaid expansion on access to care among breast cancer survivors by assessing inability to see a doctor due to cost before Medicaid expansion in non-expansion states versus expansion states. Study Design: We use a logistic model (accounting for the weighted sample) and control for demographics, insurance status, and general health. We calculate the odd ratios of inability of survivors of breast cancer to see a doctor in the past year due to cost. Population Studied: We use data from the Behavioral Risk Factor Surveillance (BRFSS) for the years 2009, 2010, and 2012, which are the only years containing data on cancer survivorship. The BRFSS is a nationally representative survey that collects information on self-reported preventive health practices and risk behaviors. The sample used for this study consists of women ages 40 to 64, in all 50 states and Washington D.C., and who were diagnosed with breast cancer (n = 3,223). Results: Preliminary results suggest that breast cancer survivors in non-expansion states had significantly higher odds of being unable to see a doctor due to cost (OR = 1.63, 95% CI =1.10, 2.42). Conclusions: Living in a state that expands Medicaid will be an advantage for low-income breast cancer survivors because it will improve their access to healthcare services. Existing disparities in access to care are likely to widen between survivors of breast cancer in non-expansion states and expansion states as a result of lack of affordable insurance coverage for low-income cancer survivors in non-expansion states. Citation Format: Wafa W. Tarazi. Medicaid expansion and access to care among breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A88.

Health of the corporate worker: health risk assessment among staff of a corporate organization in Ghana.

IntroductionHealth promotion at the workplace and for workers is important to promote workers’ health, improve working environments and work practices. The goal of this analysis was to provide an example of health risk assessment conducted in a large media organization in Ghana for its workers and to identify correlates of health risks identified among different categories of workers.MethodsThis was a cross sectional study of the health risk of staff in a large corporate media organization in Accra, Ghana, conducted in 2012. In all 161 members of staff were screened and records included in the analysis. An abstraction form was used to collect data on age and sex of staff, staff category, self-reported health risk, history of chronic disease and self-rated health status. Measurements included weight, height, Body Mass Index, fasting blood sugar, total cholesterol/ HDL cholesterol and blood pressure. Data were entered into SPSS version 21, and analyzed by simple frequencies, proportions and ratios. Measured health indices were analyzed by mean ± standard deviation. Significant association between categorical outcome measures were determined with chi-square test at the 95 % confidence level.ResultsThe sex characteristics of the workers indicated more males than females, male: female sex ratio of 2.3: 1. Close to half of the workers 66 (41.0 %) self-reported history of chronic disease and 40 (24.8 %) self-rated their overall state of health as poor. In all, 31.7 % of workers self-reported hypertension, while measured blood pressure indicated 60.2 % prevalence of diastolic blood pressure. Prevalence of obesity was 63.8 %; 49.1 % of staff had above normal total cholesterol levels and 12.4 % had blood glucose indicative of diabetes. Senior and management staff had relatively higher prevalence of obesity, high blood pressure, above normal cholesterol and fasting blood sugar levels.ConclusionMore staff were unaware of their individual health risks and the health risks were higher among senior staff and management members. Adoption of regular health educational and health promotion activities as well as health surveillance procedures is essential to improve health of workers and promote positive social climate at the work place.

Health-related Quality Of Life In School Children

Health- related quality of life (HRQoL) is a multidimensional construct, which in children includes measurements of physical and emotional well-being; and social and school functioning. HRQoL in children has been related to self-reported chronic diseases and health risk factors including higher body mass index (BMI) and physical inactivity. However, few studies have explored HRQoL in healthy population-based samples. PURPOSE: To determine the relationship between HRQoL and BMI, moderate to vigorous physical activity (MVPA), sedentary behavior and aerobic fitness. METHODS: We recruited 497 apparently healthy children from seven secondary schools in England (age range: 11 to 12 years old, 64% female, BMI = 20.1 ± 3.9 kg/m2). HRQoL was assessed through the self-reported Kidscreen-27 questionnaire over five dimensions (physical well-being; psychological well-being; autonomy and parent relation; social and peer support; and school environment). Aerobic fitness was measured by the 20m shuttle run test, while MVPA and sedentary behavior were assessed via a waist-mounted accelerometer over 8 days (Evenson cutpoints). Hierarchical multiple regression was used to assess the association between HRQoL and BMI, MVPA, sedentary behavior and aerobic fitness after adjusting for gender and school. RESULTS: The model explained 12% of variance in physical well-being (p < 0.001); 3% of psychological well-being (p= 0.04) and 6% of social and peer support (p=0.006). Aerobic fitness was the strongest and only significant influence variable for these three HRQoL dimensions: physical well-being (beta = 0.39; 95% confidence interval (CI) 0.13 to 0.32; p<0.001); psychological well-being (beta = 0.26; 95% CI 0.05 to 0.25; p = 0.003); and social and peer support (beta = 0.29, 95% CI 0.77 to 0.28, p = 0.001). CONCLUSIONS: Although the association between HRQoL and markers of body weight, fitness and physical activity and inactivity were not strong (3% to 12%), the results suggest that aerobic fitness had the strongest influence on physical and psychological well-being and social and peer support. The results do not provide information on whether aerobic fitness is the cause or consequence of higher HRQoL. Longitudinal studies exploring the long-term effect of aerobic fitness on HRQoL are needed.

Patient-reported areas for quality improvement in general practice: a cross-sectional survey.

GPs are often a patient's first point of contact with the health system. The increasing demands imposed on GPs may have an impact on the quality of care delivered. Patients are well placed to make judgements about aspects of care that need to be improved. To determine whether general practice patients perceive that the care they receive is 'patient-centred' across eight domains of care, and to determine the association between sociodemographic, GP and practice characteristics, detection of preventive health risks, and receipt of patient-centred care. Cross-sectional survey of patients attending Australian general practice clinics. Patients completed a touchscreen survey in the waiting room to rate the care received from their GP across eight domains of patient-centred care. Patients also completed the Patient Health Questionnaire (PHQ-9) and self-reported health risk factors. GPs completed a checklist for each patient asking about the presence of health risk factors. In total 1486 patients and 51 GPs participated. Overall, 83% of patients perceived that the care they received was patient-centred across all eight domains. Patients most frequently perceived the 'access to health care when needed' domain as requiring improvement (8.3%). Not having private health insurance and attending a practice located in a disadvantaged area were significantly associated with perceived need for improvements in care (P<0.05). Patients in general practice report that accessibility is an aspect of care that could be improved. Further investigation of how indicators of lower socioeconomic status interact with the provision of patient-centred care and health outcomes is required.

Health risk change as a predictor of productivity change.

To assess how health risk change influences concurrent and subsequent change in absenteeism and presenteeism. A retrospective, longitudinal study design analyzed repeated health assessment survey data using maximum likelihood structural equation modeling. A statistically significant relationship was detected between self-reported health risks at one point in time and lower productivity (absenteeism and presenteeism) at the same point in time as well as a longitudinal effect of increasing risks at one point in time associated with decreased productivity at subsequent measurement periods. Health is a predictor of productivity, and the benefits of improved health on improved productivity are cumulative over time.

Risky decision making in a laboratory driving task is associated with health risk behaviors during late adolescence but not adulthood

Adolescence is characterized by increasing incidence of health risk behaviors, including experimentation with drugs and alcohol. To fill the gap in our understanding of the associations between risky decision-making and health risk behaviors, we investigated associations between laboratory-based risky decision-making using the Stoplight task and self-reported health risk behaviors. Given that there has been no examination of potential age differences in the associations between risky decision-making and health risk behaviors, we also examined whether the association of risky decision-making with health risk behaviors is consistent across adolescence and adulthood using two-group structural equation modeling (SEM). The results indicated significant differences across the two age groups: adolescents (17–20 year olds) who took more risks on the Stoplight task reported greater frequency and earlier onset of substance use, whereas stoplight performance was not associated with substance use frequency or onset among adults (31–61 year olds). Our findings suggest that a laboratory-based measure of risky decision-making is significantly related to health risk behaviors among adolescents but not among adults.

An evaluation of the Well at Dell health management program: health risk change and financial return on investment.

To investigate the effectiveness of the Well at Dell comprehensive health management program in delivering health care and productivity cost savings relative to program investment (i.e., return on investment). A quasi-experimental design was used to quantify the financial impact of the program and nonexperimental pre-post design to evaluate change in health risks. Ongoing worksite health management program implemented across multiple U.S. locations. Subjects were 24,651 employees with continuous medical enrollment in 2010-2011 who were eligible for 2011 health management programming. Incentive-driven, outcomes-based multicomponent corporate health management program including health risk appraisal (HRA)/wellness, lifestyle management, and disease management coaching programs. Medical, pharmacy, and short-term disability pre/post expenditure trends adjusted for demographics, health status, and baseline costs. Self-reported health risks from repeat HRA completers. Analysis: Propensity score-weighted and multivariate regression-adjusted comparison of baseline to post trends in health care expenditures and productivity costs for program participants and nonparticipants (i.e., difference in difference) relative to programmatic investment. The Well at Dell program achieved an overall return on investment of 2.48 in 2011. Most of the savings were realized from the HRA/wellness component of the program. Cost savings were supported with high participation and significant health risk improvement. An incentive-driven, well-managed comprehensive corporate health management program can continue to achieve significant health improvement while promoting health care and productivity cost savings in an employee population.

Obesity and other risk factors: The National Survey of U.S. Long‐Haul Truck Driver Health and Injury

Drivers of heavy and tractor-trailer trucks accounted for 56% of all production and nonsupervisory employees in the truck transportation industry in 2011. There are limited data for illness and injury in long-haul truck drivers, which prompted a targeted national survey. Interviewers collected data during 2010 from 1,670 long-haul truck drivers at 32 truck stops across the 48 contiguous United States that were used to compute prevalence estimates for self-reported health conditions and risk factors. Obesity (69% vs. 31%, P < 0.01) and current smoking (51% vs. 19%, P < 0.01) were twice as prevalent in long-haul truck drivers as in the 2010 U.S. adult working population. Sixty-one percent reported having two or more of the risk factors: hypertension, obesity, smoking, high cholesterol, no physical activity, 6 or fewer hours of sleep per 24-hr period. Survey findings suggest a need for targeted interventions and continued surveillance for long-haul truck drivers.

Self-reported health risk behaviors among adolescents in Luang Namtha province of Lao PDR: Prevalence and determinants

The purpose of this study was to assess self-reported prevalence of alcohol, tobacco, and drug use, and sexual risk behaviors, as well as to identify sources of sex education and individual, family, and peer factors that might influence adolescents’ health risk behaviors (HRB). In a community-based, cross-sectional study, 1360 adolescents aged 14–19 years were interviewed from June to September 2008 in Luang Namtha province. Multistage systematic random sampling was used to select participants. Logistic regression was used to identify the determinants of single HRB. Alcohol and tobacco use, and sexual risk behaviors were common. Just under half (42.5%) used alcohol, 9.6% smoked during the past 30 days, and 1.4% had used amphetamine during their lifetime, and 19.6% had ever had sex. Of those, 58.8% were currently sexually active, 40.1% reported having two or more sexual partners, and 34.5% had used a condom during last sexual intercourse. The mean age at sexual debut was 15.3 years for boys and 15.1 years for girls. Khamu ethnicity, not attending school, and peers’ drinking, smoking, and using drugs were significant determinants of current alcohol use, whereas being male, not attending school, Khamu ethnicity, and peers’ smoking and using drugs predicted current smoking. Being male, younger age, Akha ethnicity, having low level of education, peers’ smoking, being sexually active, and being pregnant or having made someone pregnant were significantly associated with ever having sex, whereas being male, Akha and Khamu ethnicities, peers’ smoking, drinking alcohol, and being sexually active were correlated with sexual risk behaviors. Individual and socio-demographic background factors as well as peer influence are determinants of risk behaviors. Thus, efforts should be made to keep adolescents in school, particularly until secondary school, and increase school connectedness.

Self-reported chronic diseases and occupational health risks among bank employees of southern Karnataka city, India

Self-reported chronic diseases and occupational health risks among bank employees of southern Karnataka city, India

Reliability of self-reported health risk factors and chronic conditions questions collected using the telephone in South Australia, Australia

BackgroundAccurate monitoring of health conditions and behaviours, and health service usage in the population, using an effective and economical method is important for planning and evaluation. This study examines the reliability of questions asked in a telephone survey by conducting a test/retest analysis of a range of questions covering demographic variables, health risk factors and self-reported chronic conditions among people aged 16 years and over.MethodsA Computer Assisted Telephone Interviewing (CATI) survey on health issues of South Australians was re-administered to a random sub-sample of 154 respondents between 13-35 days (mean 17) after the original survey. Reliability between questions was assessed using Cohen’s kappa and intraclass correlation coefficients.ResultsDemographic questions (age, gender, number of adults and children in the household, country of birth) showed extremely high reliability (0.97 to 1.00). Health service use (ICC = 0.90 95% CI 0.86-0.93) and overall health status (Kappa = 0.60 95% CI 0.46-0.75) displayed moderate agreement. Questions relating to self-reported risk factors such as smoking (Kappa = 0.81 95% CI 0.72-0.89) and alcohol drinking (ICC 0.75 = 95% CI 0.63-0.83) behaviour showed good to excellent agreement, while questions relating to self-reported risk factors such as time spent walking for physical activity (ICC 0.47 = 95% CI 0.27-0.61), fruit (Kappaw = 0.60 95% CI 0.45-0.76) and vegetable consumption (Kappaw = 0.50 95% CI 0.32-0.69) showed only moderate agreement. Self-reported chronic conditions displayed substantial to almost perfect agreement (0.72 to 1.00) with the exception of moderate agreement for heart disease (Kappa = 0.82 95% CI 0.57-0.99).ConclusionThese results show the questions assessed to be reliable in South Australia for estimating health conditions and monitoring health related behaviours using a CATI survey.

Early adolescent health risk behaviors, conflict resolution strategies, and school climate

Drawing upon an ethnically and socio-economically diverse sample of 323 7th grade students from twelve urban schools within one school district, this mixed method study examined early adolescents' self-reported health risk behaviors as related to their conflict resolution strategies and their school's conflict resolution climate. Survey data suggested that early adolescents who reported using more cooperative and fewer aggressive conflict resolution strategies also reported to engage in fewer personal health risk behaviors. Reported engagement in fewer behavioral risks also was associated with attending schools with more supportive “conflict resolution climates.” Serial small group interviews in selected schools indicated that conflict resolution climate quality was associated with how well teachers were perceived to respond to students' conflicts and how they managed teacher–student conflicts. In addition, many students in less supportive climates exhibited cynical attitudes regarding the viability of the conflict resolution strategies promoted by schools and prevention programs.

Medication Adherence, Comorbidities, and Health Risk Impacts on Workforce Absence and Job Performance

To understand impacts of medication adherence, comorbidities, and health risks on workforce absence and job performance. Retrospective observational study using employees' medical/pharmacy claims and self-reported health risk appraisals. Statin medication adherence in individuals with Coronary Artery Disease was significant predictor (P < 0.05) of decreasing absenteeism. Insulin, oral hypoglycemic, or metformin medication adherence in type 2 diabetics was significant (P < 0.05) predictor of decreasing job performance. Number of comorbidities was found as significant (P < 0.5) predictor of absenteeism in five of nine subsamples. Significant links (P < 0.05) between high health risks and lower job performance were found across all nine subsamples. Results suggest integrated health and productivity management strategies should include an emphasis on primary and secondary prevention to reduce health risks in addition to tertiary prevention efforts of disease management and medication management.

Psychomotor slowness is associated with self-reported sleep duration among the general population

Short and long self-reported sleep durations have been found to be associated with several seemingly disparate health risks and impaired functional abilities, including cognitive functioning. The role of long sleep is especially poorly understood in this context. Psychomotor slowness, shown to have analogous associations with cognitive performance and health risks as self-reported long sleep duration, has not been studied together with sleep duration in epidemiological settings. We hypothesized that self-reported habitual sleep duration, especially long sleep, is associated with slow psychomotor reaction time, and that this association is independent of vigilance-related factors. The hypothesis was tested in a sample of 5352 individuals, representing the general adult population. We found a U-shaped association between self-reported sleep duration and psychomotor speed, which prevailed even after controlling for several pertinent confounders. This novel finding can be interpreted to mean that self-reported sleep duration, at least in the case of long sleep, is an indicator of bodily/brain integrity and, taken together with the results of cognitive epidemiology, may provide some new insights into the mechanisms underlying the associations between habitual self-reported sleep duration, health risks and impaired functional abilities.

C-B1-03: The Association of Optimal Lifestyle Adherence with Emotional Health Indicators Among Active Employees

Background and Aims: Adherence to an optimal lifestyle defined as adequate physical activity (=150 minutes per week), no use of tobacco, moderate alcohol use (=1 drink/d for women or =2 drinks/d for men), and eating five servings of fruits and vegetables per day has been associated with as much as 14 years of increased longevity and improved functional health status. Unfortunately, adherence to these four behaviors is relatively low in the United States. Furthermore, it is unclear the extent to which adherence to these health behaviors among working adults is associated with emotional health indicators such as self-reported stress, depression, depression risk, overall emotional health, and self-perceived general health. Improved understanding of this impact may hold significant potential for population health improvement strategies implemented via the worksite. The purpose of this investigation was to define the association of varying levels of self-reported optimal lifestyle with self-reported emotional health risks. Methods: All data were self-reported and collected as part of a health assessment process implemented through employer-sponsored programs during the year 2007. The number of subjects (N total=28,897) reporting from zero to 4 behaviors were 77; 1,294; 8,162; 15,085; and, 4,279 respectively. Emotional health variables included self-reported stress concerns, depression, depression risk based on personal history of depression, emotional health concerns, and self-perceived general health status. Results: The ratio of the percentage of the population with a positive response if no optimal lifestyles are practiced/the percentage of the population with a positive response if 4 optimal lifestyles are practiced is 3.8 for stress concerns, 1.9 for depression, 14.2 for high risk for depression, 5.3 for emotional health concerns and 5.6 for self-perceived poor general health status. Conclusions: Adherence to an optimal lifestyle is associated with lower rates of self-reported stress, depression, and poor perceived health status. The relationship is most likely bi-directional. If it is, enhanced focus and attention to population-based strategies that improve adherence to these four behaviors may positively affect a variety of emotional health outcomes, and addressing issues of emotional health may help individuals adhere to healthy lifestyles.

Social desirability and self-reported health risk behaviors in web-based research: three longitudinal studies

BackgroundThese studies sought to investigate the relation between social desirability and self-reported health risk behaviors (e.g., alcohol use, drug use, smoking) in web-based research.MethodsThree longitudinal studies (Study 1: N = 5612, 51% women; Study 2: N = 619, 60%; Study 3: N = 846, 59%) among randomly selected members of two online panels (Dutch; German) using several social desirability measures (Marlowe-Crowne Scale; Balanced Inventory of Desirable Responding; The Social Desirability Scale-17) were conducted.ResultsSocial desirability was not associated with self-reported current behavior or behavior frequency. Socio-demographics (age; sex; education) did not moderate the effect of social desirability on self-reported measures regarding health risk behaviors.ConclusionsThe studies at hand provided no convincing evidence to throw doubt on the usefulness of the Internet as a medium to collect self-reports on health risk behaviors.

Obesity-related costs and the economic impact of laparoscopic adjustable gastric banding procedures: benefits in the Texas Employees Retirement System

Objective: To assess the return on investment (ROI) and economic impact of providing insurance coverage for the laparoscopic adjustable gastric banding (LAGB) procedure in classes II and III obese members of the Texas Employees Retirement System (ERS) and their dependents from payer, employer, and societal perspectives.Methods: Classes II and III obese employee members and their adult dependents were identified in a Texas ERS database using self-reported health risk assessment (HRA) data. Direct health costs and related absenteeism and mortality losses were estimated using data from previous research. A dynamic input–output model was then used to calculate overall economic effects by incorporating direct, indirect, and induced impacts. Direct health costs were inflation-adjusted to 2008 US dollars using the Consumer Price Index for Medical Care and other spending categories were similarly adjusted using relevant consumer and industrial indices. The future cost savings and other monetary benefits were discounted to present value using a real rate of 4.00%.Results: From the payer perspective (ERS), the payback period for direct health costs associated with the LAGB procedure was 23–24 months and the annual return (over 5 years) was 28.8%. From the employer perspective (State of Texas), the costs associated with the LAGB procedure were recouped within 17–19 months (in terms of direct, indirect, and induced gains as they translated into State revenue) and the annual return (over 5 years) was 45.5%. From a societal perspective, the impact on total business activity for Texas (over 5 years) included gains of $195.3 million in total expenditures, $93.8 million in gross product, and 1354 person-years of employment.Limitations: The analysis was limited by the following: reliance on other studies for methodology and use of a control sample; restriction of cost savings to 2.5 years which required out-of-sample forecasting; conservative assumptions related to the cost of the procedure; exclusion of presenteeism; and no sensitivity analyses performed.Conclusion: This analysis indicates that providing benefits for the LAGB procedure to eligible members of the Texas ERS and their dependents is worthy of support from payer, employer, and societal perspectives.

Health Risks, Chronic Diseases, and Access to Care Among US Pacific Islanders

Because Pacific Islanders and Asian Americans have often been aggregated in federal health surveys, we assessed whether they differ substantially in important health measures. Retrospective analyses of the 2005-2007 Behavioral Risk Factor Surveillance System (BRFSS) surveys. A total of 2,609 Pacific Islanders, 17,892 Asians, and 894,289 whites over age 18. We compared self-reported health risk factors (smoking, BMI > or = 25 kg/m(2), alcohol intake, physical activity, fruit/vegetable intake), chronic diseases (diabetes, hypertension, coronary heart disease, asthma, hypercholesterolemia, arthritis, fair or poor health status), and access to care (insurance status, cost barriers, and regular physician) for Pacific Islanders relative to Asian Americans and whites. Logistic regression was used to adjust for sociodemographic factors. Pacific Islanders were more likely than Asian Americans to report an elevated body-mass index (adjusted odds ratio 2.26; 95% confidence interval 1.80, 2.84), current smoking (2.15; 1.57, 2.93), and high alcohol intake (3.14; 1.60, 6.18), but also more likely to report adequate physical activity (1.62; 1.23, 2.14). Pacific Islanders reported higher adjusted rates of hypertension (1.50; 1.06, 2.13), diabetes (1.82; 1.25, 2.63), asthma (2.32; 1.65, 3.25), and arthritis (1.68; 1.20, 2.35). Pacific Islanders also more frequently reported having fair or poor health (1.46; 1.05, 2.04). Most differences in self-reported health status and chronic disease outcomes were mediated by higher rates of overweight and obesity, but not higher rates of smoking, among Pacific Islanders. Differences in smoking, hypertension, and diabetes were more pronounced among Pacific Islander women than men. Relative to whites, Pacific Islanders were more likely to report a diagnosis of diabetes (1.56; 1.13, 2.14) and less likely to report arthritis (0.61; 0.46, 0.82). All other outcomes measures were statistically similar for whites and Pacific Islanders. Health surveys and policies should distinguish between Pacific Islanders and Asian Americans given the significantly higher rates of health risks and chronic diseases among Pacific Islanders.