1. 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

2. 2 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 cost- effective in preventing the onset of conditions. Disparities in behavior counseling can aggravate health disparities. Research regarding disparities in lifestyle and behavior counseling is lacking.

3. 3 Pre-onset vs. post-onset behavior counseling PRE-onset (~HC) Onset of Behavior- related Health Conditions (HC) POST-onset (HC) If P A (HC)>=P B (HC) then It is socially desirable that P A (Counseling|~HC) >= P B (Counseling|~HC) Every one needs to be counseled

4. 4 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

5. 5 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

6. 6 Results by race/ethnicity

7. 7 Smoking cessation counseling: by race/ethnicity *** p<0.001, compared to Whites

8. 8 Diet counseling: by race/ethnicity *** p<0.001, ** p<0.05, compared to Whites

9. 9 Physical activity counseling: by race/ethnicity *** p<0.001, compared to Whites

10. 10 Results by education

11. 11 Smoking cessation counseling: by education

12. 12 Diet counseling: by education *** p<0.001, ** p<0.05, compared to college graduates

13. 13 Physical activity counseling: by education *** p<0.001, ** p<0.05, compared to college graduates

14. 14 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 post- contexts compared to Whites There exists an education gradient in the receipt of diet/PA advice, especially between the lower educated and others.

15. 15 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 patient- physician relationships.