Behavioral Contributors to Health Trajectory

While biology drives the propensity for a potential health trajectory, and the social and physical environments shape the available pathways for health development, individual behavior is often the proximate determinant of health status.

1. Unhealthy behaviors were endemic among women with less than a high school degree and significantly more prevalent when compared with women with high school degrees/some college, and those women were in turn almost always in poorer health and had fewer healthy behaviors than women with a college degree.
2. Two-thirds of women without a high school degree smoked, and they were significantly more likely to be current smokers than women with a high school degree/some college. Latinas (the group most likely to be without a high school diploma) and city residents were significantly more likely to be current smokers than whites and suburban residents.
3. According to the 2006 Monroe County Adult Health Survey, 18% of women 18-44 were at risk of an alcohol use disorder. Younger women (18-29) and non-Healthy Start area residents were significantly more likely than older women and residents of Healthy Start zip codes to be at risk; the majority of African American and Latinas said they never drank.
4. Sixteen percent of Monroe County women 18-44 reported no leisure time physical activities in the past month. Half of women without a high school diploma reported none, significantly higher than the 21% among women with a high school degree/some college. Latinas and African American women were significantly more likely than white women to report no leisure time physical activity.
5. Among Monroe County women 18-44, 22% were obese and an additional 23% were overweight. African American women, women without a high school degree, and residents of the Healthy Start zip codes had the highest rates of overweight/obesity. However, Latinas and women with high school/some college were significantly more likely than white women and women with a college degree to be obese.
6. Across every measure of nutrition, women with college degrees were significantly more likely than women without a high school diploma to report that they had a healthy diet. On the majority of measures, white/non-Latino women were significantly more likely to report good nutrition than African American women; they were significantly more likely than Latinas to report good nutrition in half the categories considered.
7. Sixteen percent of Monroe County women 18-44 reported that they had at some time been a victim of intimate partner violence. Women with less than a college degree and residents of Healthy Start zip codes were significantly more likely to report having been a victim.
8. Ten percent of Monroe County females 18-44 (19% of younger women) had sexual intercourse with two or more people in the past year. There were no significant differences by race/ethnicity, education, or residence.
9. Our community’s pattern of discontinuous health insurance coverage by subgroup is similar to the pattern of lack of coverage. Latinas and women without a high school degree were most likely to have been discontinuously covered. Younger women (18-29) were significantly more likely than older women (30-44) to have been discontinuously covered. Of Monroe Plan for Medical Care enrollees (the dominant provider for Medicaid managed care in our community), less than two thirds (61%) were enrolled for the entire year.
10. According to the 2006 Monroe County Adult Health Survey, 9% of Monroe County women 18-44 reported they did not have a personal health care provider. As with discontinuity of insurance coverage, younger women (18-29) were significantly more likely than older women to be without a provider. Almost one quarter of women with less than a high school education reported that they lacked a personal doctor or health care provider.
11. According to Monroe Plan data, female enrollees 15-44 who live in the Healthy Start area utilize primary care-related services differently. African American females (73%) were less likely than White (82%) females – and slightly less likely than Latinas (77%) to have seen a primary care provider in a 12-month period.
12. From 2005 to 2007, African American and Latina birth mothers living in the Healthy Start area were more likely than their White counterparts to receive inadequate prenatal care. African American birth mothers, however, were the most likely to receive inadequate prenatal care in both study areas. The likelihood that birth mothers received adequate prenatal care from 2005 to 2007 increased with their level of educational attainment.
13. Women 15 to 44 years old living in the Healthy Start neighborhood are 3.3 times as likely as suburban women to have a non-emergent or primary care treatable/preventable ED visit. Almost half of the primary care-related visits in the Healthy Start area are for non-emergent medical issues for which medical care was not required within 12 hours.
14. Ambulatory care-sensitive hospital admission rates for women in the Healthy Start area are four times the rates for suburban women and have increased almost 30 percent over the last eight years. Within the Healthy Start area, African American women are almost twice as likely as White women to be hospitalized for an ambulatory care sensitive condition.