April 2001

Grant Results

SUMMARY

From 1997 to 1998, the American Medical Association (AMA), Chicago, and its subcontractor, the Gallup Organization, designed, implemented and disseminated two national telephone surveys on the public's health habits, one of young adults and the other of adults conducted by Gallup.

The Gallup surveys were designed to fill gaps in information from existing sources of health data (such as the National Health Interview Survey, the National Nursing Home Survey, and the National Youth Risk Behavior) for the national health index.

The AMA also developed an initial design for an index of health indicators However, delays in receiving federal data, internal reorganization, and downsizing prevented the AMA from completing the index. AMA staff realized also that the Healthy People 2010 health index, then in development, would make the AMA's unnecessary.

Key Findings

  • Gallup completed the health surveys, which found that the public appears to be responsive to the need for physical check-ups and various screening tests, but they remain overweight, stressed, and caught up in bad habits. Specifically, the survey found the following:
    • Some 80 percent of Americans report having seen a physician within the previous 12 months, while 64 percent visited a dentist.
    • High cholesterol is a concern for many: within the past two years, 25 percent of individuals aged 12 or older have made dietary changes to lower blood cholesterol.
    • Many people are responding to the need to screen for various health problems, although there is still much room for improvement.
    • Most adults are generally satisfied with the quality of their sex lives. Satisfaction gradually decreases with age, dropping dramatically by age 65.
    • America continues to be a nation in which weight problems abound. Based on the Body Mass Index, half of Americans, aged 12 and older, are overweight, with 15 percent grossly overweight.

Funding
The Robert Wood Johnson Foundation (RWJF) provided a $322,631 grant to support the project between August 1997 and October 1998.

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THE PROBLEM

Health care purchasers, insurers, regulators, and consumer advocacy groups were increasingly interested in identification, measurement, and direct population-based prevention and health improvement activities.

However, at the time this grant was awarded, there was no annual national health report card or index available that reflected the general health status of the American public and of specific population groups. Such an index (or snapshot) could help target preventive health care activities to match health care needs of specific population groups. As envisaged by the AMA, this index would have been one of the first national health report cards that used statistically sound survey techniques and validated measures.

The AMA viewed the national health index as an important source of information for physicians to identify where health care fell short and where the nation should allocate additional resources.

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THE PROJECT

The AMA planned to collaborate with the Gallup Organization (a subcontractor in the project), to design, implement, and publicly release an annual national health care report card (or snapshot) of the American public's health status. The annual index would compile health status information and help to identify high-priority areas for improving preventive health behaviors in three population groups: youth, adults, and older adults (ages 65–99).

The project would focus on large national and continuous data sources in order to ensure that the index could be replicated on an annual basis. The AMA planned to collect information from several sources, including the National Health Interview Survey, the National Center for Health Statistics, the National Health and Nutrition Examination Survey III, the National Ambulatory Medical Care Survey, the National Nursing Home Survey, the National Youth Risk Behavior Survey, the Behavioral Risk Factor Surveillance Survey, and the National Electronic Injury Surveillance System.

This effort was independent of the development of health indices for Healthy People 2010 which also began in 1997 with the Healthy People Consortium — an alliance of more than 350 national membership organizations and 250 state health, mental health, substance abuse and environmental agencies. In the fall of 1997, more than 700 comments were received concerning the framework for Healthy People 2010. In the fall of 1998, people in every state, the District of Columbia, and Puerto Rico contributed more than 11,000 comments in six public hearings and on the Healthy People Web site.

In 1998, Gallup conducted two national telephone surveys, which were designed to fill the gaps in existing data. The first telephone survey focused on the health behaviors of 1,094 young people (ages 12–17). The survey focused on access to regular health examinations, avoiding tobacco use, limiting alcohol consumption, participating in physical fitness programs, and weight control.

The second telephone survey was geared to adults (ages 18 and older). A nationally representative sample of 2,050 adults was surveyed (1,607 adults, ages 25–64, and 443 adults, ages 65–99), permitting sufficient sample size to study subgroups at risk for certain medical conditions (e.g., females over age 40 at risk for diabetes, men over age 40 at risk for prostate cancer), specific age groups, and ethnic groups, as well as geographic areas that are medically underserved.

While the adult survey focused on many of the same issues as the youth survey, the adult survey also explored self-reports of knowledge of disease prevention, access and barriers to clinical prevention services, and plans for keeping healthy.

In addition to culling information from these data sources, the AMA assembled an internal team to conduct a review of the published literature. The purpose was to help select health indicators in each prevention behavior category for each age-based population.

A National Advisory Committee (NAC) was also established to guide and coordinate the effort with other national projects, such as Healthy People 2010 (a federal health promotion and disease prevention initiative designed to improve the health of all Americans). The committee included representatives from government health agencies, universities, foundations, accrediting agencies, the AMA, and others. (See the Appendix.)

AMA completed the initial design of the index of health indicators and fielded it for validation purposes to state health departments, the Centers for Disease Control and Prevention, the American Public Health Association, and other health care organizations. It then developed a health indicators survey to validate its index, which was sent to public health professionals and physicians.

The AMA was unable to complete the index. The AMA project directors cited several reasons. It was difficult to gain access to federal health data sources in a timely fashion.

In particular, the National Health Interview Survey and The National Center for Health Statistics (NCHS) experienced delays in the release of their data. It also took much longer than anticipated to reach consensus among the various constituencies about which health indicators to use.

Other project delays stemmed from a reorganization of the AMA and downsizing of the scientific division where this project was housed. AMA discontinued the project when it learned that RWJF was not awarding it a continuation grant. AMA staff also realized that the Healthy People 2010 health index, then in development, would make the AMA's unnecessary.

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FINDINGS

  • Gallup completed the health surveys, which found that the public appears to be responsive to the need for physical check-ups and various screening tests, but they remain overweight, stressed, and caught up in bad habits. Specifically, the survey found the following:
    • Some 80 percent of Americans report having seen a physician within the previous 12 months, while 64 percent visited a dentist.
    • High cholesterol is a concern for many: within the past two years, 25 percent of individuals aged 12 or older have made dietary changes to lower blood cholesterol.
    • Many people are responding to the need to screen for various health problems, although there is still much room for improvement. Some 70 percent of individuals have had their cholesterol checked; 90 percent of individuals have had their blood pressure checked in the past year; 25 percent of individuals have been screened at some point for colon cancer; and a majority of women have had a mammogram. Among men 18 and older, 51 percent have had a rectal examination to check the prostate.
    • Most adults are generally satisfied with the quality of their sex lives. Satisfaction gradually decreases with age, dropping dramatically by age 65.
    • America continues to be a nation in which weight problems abound. Based on the Body Mass Index, half of Americans, aged 12 and older, are overweight, with 15 percent grossly overweight. A high rating on this index is associated with a high risk of heart disease, diabetes, some cancers, and other health problems.
    • The large proportion of overweight Americans may be due to lack of exercise. While 82 percent of young people, aged 12 to 24, participate in strenuous exercise (at least 20 minutes that made them sweat or breathe hard), only 60 percent of adults, aged 25 to 64, engaged in strenuous exercise. Only 25 percent of seniors, aged 65 and older, exercises strenuously.
    • While exposure to sun puts a person at greater risk for skin cancer, 40 percent of individuals report that they never use sunscreen when exposed to the sun, with those living in the Southeast and Southwest least likely to heed the warnings.
    • Work-related stress is common. Some 14 percent of women and 11 percent of men report they experienced unwelcome physical and verbal advances at work. Black workers were more than twice as likely as white workers to say that they have been discriminated against at work.
    • Some 25 percent of people surveyed experienced a personal injury or illness in the past year. About the same proportion experienced a serious problem, illness, or death within the family.
    • Some 67 percent of those surveyed say they feel hurried or rushed with not enough time to get things done, with young adults most likely to feel overwhelmed by the pace of life.
    • One possible consequence of stress and lack of support is suicide. Some 10 percent of individuals, 12 years of age or older, reports having seriously considered suicide at some time. Of those who contemplated suicide, one third report attempting suicide.
    • In an age of sexually transmitted diseases, many adults do not use condoms. Among those who had multiple partners in the past year, 44 percent did not practice safe sex the last time they had sexual intercourse. About 40 percent of adults have been tested for HIV/AIDS, and 30 percent have been tested for other sexually transmitted diseases.
    • Within the 30-day period prior to the interview, 26 percent of Americans, 12 years of age or older, have smoked cigarettes, a pipe, or a cigar. This figure rises to 36 percent among persons 18 to 24 years of age.
    • About 40 percent of the population, aged 12 years or older, report drinking beer, wine, or whiskey in the past 30 days. Some 12 percent of teenagers reports drinking.

Communications

Gallup sent out a press release about its surveys to reporters. The Associated Press published an article on the surveys.

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GRANT DETAILS & CONTACT INFORMATION

Project

Annual Index of the Health of the American Population

Grantee

American Medical Association (Chicago,  IL)

  • Amount: $ 322,631
    Dates: August 1997 to October 1998
    ID#:  030502

Contact

Jonathan VanGeest
(312) 464-5437
jonathan_vangeest@ama-assn.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

The AMA National Health Index National Advisory Committee

Herbert Benson, M.D.
Harvard University
Boston, Mass.

Nelba Chavez, Ph.D.
Administrator
Substance Abuse and Mental Health Services Administration
Department of Health and Human Services
Rockville, Md.

Seth Emont, Ph.D.
Senior Program Officer
Robert Wood Johnson Foundation
Princeton, N.J.

Wanda Jones, Ph.D.
Associate Director for Women's Health Centers for
Disease Control and Prevention
Atlanta, Ga.

Jerod Loeb, Ph.D.
Vice President for Research and Evaluation
Joint Commission on Accreditation of Healthcare Organizations
Oakbrook Terrace, Ill.

Robert McAfee, M.D.
Past President
American Medical Association
Chicago, Ill.

J. Michael McGinnis, M.D.
National Research Council
Washington, D.C.

Harry Rosenberg, Ph.D.
Chief, Mortality Statistics Branch
Division of Vital Statistics
National Center for Health Statistics
Hyattsville, M.D.

Richard Sewell, M.P.H.
Executive Director
Chicago Health Policy Research Council
Chicago, Ill.

Clay Simpson, Ph.D.
Deputy Assistant Secretary
Office of Minority Health
Department of Health and Human Services
Washington, D.C.

Reed Tuckson, M.D.
Group Vice President
Professional Standards
American Medical Association
Chicago, Ill.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Newsletters

The AMA-NHI Update. Chicago, Ill.: American Medical Association. One issue in 1996; one issue in 1997.

Survey Instruments

"The Health of the Nation." The Gallup Organization, fielded 1998. Princeton, N.J.

"Validation for The AMA-National Health Index Survey." American Medical Association, fielded to directors of state health departments, state epidemiologists, and directors within the Centers for Disease Control and Prevention.

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Report prepared by: Laura Newman
Reviewed by: Susan G. Parker
Reviewed by: Molly McKaughan
Program Officer: Marilyn Aguirre-Molina
Program Officer: Seth L. Emont

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