Health Behavior and Lifestyle Counseling
Pre and Post the Onset of Health
Conditions
and Potential Racial/Ethnic and SES
Disparities
Yuhua Bao, Ph.D.
Naihua Duan, Ph.D.
Sarah Fox, Ed.D.
University of California, Los Angeles
Academy Health Annual Research Meeting
June 28, 2005
Background
 Health behaviors and lifestyles are well known risk
factors for a number of serious conditions.
 Physician counseling can be highly effective in
changing patient behaviors.
 Recent studies show lifestyle intervention to be costeffective in preventing the onset of conditions.
 Disparities in behavior counseling can aggravate
health disparities.
 Research regarding disparities in lifestyle and
behavior counseling is lacking.
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Pre-onset vs. post-onset
behavior counseling
PRE-onset (~HC)
POST-onset (HC)
Onset of Behaviorrelated Health Conditions
(HC)
Every one needs to
If
PA(HC)>=PB(HC) then
be counseled
It is socially desirable that
PA(Counseling|~HC) >= PB(Counseling|~HC)
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This paper aims to …
 Examine the potential racial/ethnic or SES
disparities in the receipt of physician counseling
of several major types of health behaviors
 Study the disparities in the context of pre- vs.
post- onset of behavior-related health conditions
 Discuss implications of findings for the
underlying mechanisms of the disparities
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Data and methods
 Data: NHIS 2001 Sample Adult File
 Focus on those who had some contact with regular
healthcare providers last 12 mos (n=23,967)
 Types of counseling
 Smoking cessation
(restricted to current smokers; n=4,975)
 Diet
 Physical activity
 Race/ethnicity: white, Black, Hispanic, other
 SES (education): <high sch, high sch, some col,
col graduates
 Logistic model to simultaneously estimate the
disparities and to adjust for co-variates
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Results
by
race/ethnicity
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Smoking cessation counseling:
by race/ethnicity
80
70
60
74
73
69
68
68
68
65
69
68
61
***
57
***
49
50
40
30
20
10
0
Unconditional
White
*** p<0.001, compared to Whites
Pre-onset
Hispanic
Black
Post-onset
Other
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Diet counseling: by race/ethnicity
***
64
70
60
50
40
***
47
***
55
***56
51
35
46
***
*** 41
38
42
33
30
**
27
20
10
0
Unconditional
White
Pre-onset
Hispanic
*** p<0.001, ** p<0.05, compared to Whites
Black
Post-onset
Other
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Physical activity counseling:
by race/ethnicity
70
***
60
***
56
***
54
50
50
44
41
40
49
*** ***
42 42
36
***
60
50
32
30
20
10
0
Unconditional
White
*** p<0.001, compared to Whites
Pre-onset
Hispanic
Black
Post-onset
Other
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Results
by
education
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Smoking cessation counseling:
by education
80
74
67 68 68 68
61
65 65 62
71
74 75
60
40
20
0
Unconditional
Pre-onset
Post-onset
Less than high school
High school
Some college
College or higher
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Diet counseling: by education
60
50
52
42
43
43
54
53
53
44
***
40
***
30
32
**
34
37
30
20
10
0
Unconditional
Less than high school
Pre-onset
High school
Some college
*** p<0.001, ** p<0.05, compared to college graduates
Post-onset
College or higher
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Physical activity counseling:
by education
60
50
***
***
42
***
44
47
48
40
47
*** ***
32 34
**
50
52
53
41
37
30
20
10
0
Unconditional
Less than high school
Pre-onset
High school
Some college
*** p<0.001, ** p<0.05, compared to college graduates
Post-onset
College or higher
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Summary of findings
 Hispanic/white difference in the receipt of
smoking cessation counseling arose solely in
the pre-onset context
 Blacks and Hispanics were more likely to be
advised on diet/PA in both pre- and postcontexts compared to Whites
 There exists an education gradient in the
receipt of diet/PA advice, especially between
the lower educated and others.
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Conclusions and implications
 Some serious disparities in the receipt of
lifestyle and behavior counseling exist.
 Physicians may have relied more on population
profiles (rather than individual “signals”) when
assessing minority patients’ need for
counseling.
 Disparities by education suggest disparities in
physician training, quality of care and patientphysician relationships.
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