1. Lifestyles in Malta 2007 A Survey Study Judith Rocchiccioloi, PhD., RN Karen Jagiello, RN, MSN James Madison Univesity

2. CISAT/HHS Health and Human Services Health and Human Services Nursing Nursing Physician Assistants Physician Assistants Communication Science Disorders Communication Science Disorders Occupational Therapy Occupational Therapy Health Sciences Health Sciences Pre-Medical Science Pre-Medical Science

3. Lifestyles Survey 2007 Instrumentation: Lifestyles Questionnaire adapted and revised from the CDC Lifestyles Health Promotion Website (www.cdc.us.gov) and further adapted from Lifestyles Survey 2006 Instrumentation: Lifestyles Questionnaire adapted and revised from the CDC Lifestyles Health Promotion Website (www.cdc.us.gov) and further adapted from Lifestyles Survey 2006www.cdc.us.gov Content Validity: Panel of 2 Nurses Content Validity: Panel of 2 Nurses

4. LifeStyles Survey 2007 Content Areas Content Areas Health Care Access (6 items) Health Care Access (6 items) Exercise (4 items) Exercise (4 items) Nutrition (5 items) Nutrition (5 items) Diabetes (6 items) Diabetes (6 items) Tobacco Use (2 items) Tobacco Use (2 items) Alcohol Consumption (4 items) Alcohol Consumption (4 items) Lifestyle Awareness (12 items) Lifestyle Awareness (12 items) Hypertension, Cholesterol Hypertension, Cholesterol

5. Sampling Convenience Sample (n=471) Convenience Sample (n=471) Surveys gathered from May 15 th to June 1 st 2007 Surveys gathered from May 15 th to June 1 st 2007 Age 18y-29y 75.4% Citizenship Maltese 60.7% USA 4% Other 28.7% Gender 46.5% female 42.5% male

6. Methodology Data was gathered by student researchers at locations all over the island to include the Institute for Health, University of Malta, beaches, café’s, restaurants, on buses, at bus stops and tourist areas Data was gathered by student researchers at locations all over the island to include the Institute for Health, University of Malta, beaches, café’s, restaurants, on buses, at bus stops and tourist areas Students approached potential sample, explained the study purpose, guaranteed confidentiality and asked for cooperation. Students approached potential sample, explained the study purpose, guaranteed confidentiality and asked for cooperation.

7. Methodology Informed Consent was explained and participants were told that their decision to participate implied informed consent. Informed Consent was explained and participants were told that their decision to participate implied informed consent. Sample participants were given pencils and the survey and were asked to complete the survey. Student researchers stayed with participants and answered questions and provided clarification. Sample participants were given pencils and the survey and were asked to complete the survey. Student researchers stayed with participants and answered questions and provided clarification.

8. Data Analysis SPSS for the Social Sciences SPSS for the Social Sciences Descriptive statistics, frequencies and correlations Descriptive statistics, frequencies and correlations

9. Findings and Results 2007 Results

10. Health Care Access 56.1% of respondents reported having government health insurance 56.1% of respondents reported having government health insurance 38.6% reported not having government health insurance 38.6% reported not having government health insurance 39.7% reported having private health insurance 39.7% reported having private health insurance 55% reported not having private health insurance 55% reported not having private health insurance

11. Health Care Access 27.6% of survey respondents answered they had only one personal health care provider 27.6% of survey respondents answered they had only one personal health care provider 48.2% of survey respondents replied they had more than one 48.2% of survey respondents replied they had more than one

12. Health Care Access When you are sick or need advice about your health, to which one of the following places do you usually go? When you are sick or need advice about your health, to which one of the following places do you usually go? A doctor’s office 67.5% A doctor’s office 67.5% A public health clinic or community health center 15.7% A public health clinic or community health center 15.7% A hospital outpatient department 2.3% A hospital outpatient department 2.3% A hospital emergency room 4.5% A hospital emergency room 4.5% Some other kind of place 9.6% Some other kind of place 9.6%

13. Health Care Access Was there a time in the past 12 months when you needed medical care, but could not get it? 35.5% indicated at least some problem accessing healthcare during the past year 35.5% indicated at least some problem accessing healthcare during the past year 64.5% reported that they had no problems getting health care at least once during the past year 64.5% reported that they had no problems getting health care at least once during the past year

14. Health Care Access Of the 35.5% (n=167) of survey respondents answering that they had problems accessing health care Of the 35.5% (n=167) of survey respondents answering that they had problems accessing health care 12% cited cost 12% cited cost 35.9% cited too long of a wait in the waiting room 35.9% cited too long of a wait in the waiting room 19% reported the office wasn’t open when person could get there 19% reported the office wasn’t open when person could get there 44.3% reported too long of a wait for an appointment 44.3% reported too long of a wait for an appointment 16.8% cited transportation problems 16.8% cited transportation problems

15. Tobacco Use On average, how many cigarettes do you smoke per day? On average, how many cigarettes do you smoke per day? None 59.4% None 59.4% Less than one pack 25.1% Less than one pack 25.1% One to two packs 3.6% One to two packs 3.6%

16. Tobacco Use During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking? During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking? 1-3 times 16.6% 1-3 times 16.6% 4-5 times 3.6% 4-5 times 3.6% Over six times 3.6% Over six times 3.6% None 35.5% None 35.5%

17. Alcohol Use A drink of alcohol is 1 can or bottle of beer, 1 glass of wine, 1 cocktail, or 1 shot of liquor. The percentage of respondents who reported having at least one drink per day during the previous week was 80% A drink of alcohol is 1 can or bottle of beer, 1 glass of wine, 1 cocktail, or 1 shot of liquor. The percentage of respondents who reported having at least one drink per day during the previous week was 80%

18. Alcohol Use 27.8% of respondents reporting having 1 to 2 drinks per day on days when they drank 27.8% of respondents reporting having 1 to 2 drinks per day on days when they drank 30.4% of respondents reporting having 3 to 4 drinks per day on days when they drank 30.4% of respondents reporting having 3 to 4 drinks per day on days when they drank 25.9% of respondents reporting having 5 or more drinks per day on days when they drank 25.9% of respondents reporting having 5 or more drinks per day on days when they drank

19. Alcohol Use Considering all types of alcoholic beverages, how many times during the past seven days did you have five or more drinks on one occasion? Considering all types of alcoholic beverages, how many times during the past seven days did you have five or more drinks on one occasion? 40.8% reported 0 times 40.8% reported 0 times 18.5% reported 1 times 18.5% reported 1 times 11.5% reported 2 times 11.5% reported 2 times 4.5% reported 3 times 4.5% reported 3 times

20. Alcohol Use 9.7% of respondents reported driving at least once in the past thirty days after they had had too much to drink. 9.7% of respondents reported driving at least once in the past thirty days after they had had too much to drink. 10% of respondents reported not knowing whether they had driven at least once in the past thirty days after they had had too much to drink 10% of respondents reported not knowing whether they had driven at least once in the past thirty days after they had had too much to drink

21. Exercise 32.5% of respondents stated that they believed exercise was very important. 32.5% of respondents stated that they believed exercise was very important. 40.1% of respondents stated that they believed exercise was important. 40.1% of respondents stated that they believed exercise was important. 26.7 of respondents stated that they believed exercise was unimportant or neutral 26.7 of respondents stated that they believed exercise was unimportant or neutral

22. Exercise 24.6% of respondents have been told by their doctors to exercise more 24.6% of respondents have been told by their doctors to exercise more 39.9% of respondents reported not participating in aerobic exercise 39.9% of respondents reported not participating in aerobic exercise 40.3% of respondents reported participating in aerobic exercise 3 to 4 times per week. 40.3% of respondents reported participating in aerobic exercise 3 to 4 times per week.

23. Body Weight 47.1% of respondents report not being overweight 47.1% of respondents report not being overweight 29.3% of respondents report being less than 5 kg overweight. 29.3% of respondents report being less than 5 kg overweight. 19.4% of respondents report being 6 to 12 kg overweight 19.4% of respondents report being 6 to 12 kg overweight 2.8% of respondents report being more than 13 kg overweight 2.8% of respondents report being more than 13 kg overweight

24. Diabetes Have you ever been told by a doctor that you have diabetes? Have you ever been told by a doctor that you have diabetes? Yes 1.5% Yes 1.5% No 78.2% No 78.2% Don’t know 4.5% Don’t know 4.5%

25. Diabetes 51.4% of respondents reported needing at least some help in understanding diet restrictions. 51.4% of respondents reported needing at least some help in understanding diet restrictions. 48.8% of respondents reported needing at least some help in understanding exercise needs as related to diabetes. 48.8% of respondents reported needing at least some help in understanding exercise needs as related to diabetes. 51.2%of respondents reported needing at least some help in understanding diabetes complications. 51.2%of respondents reported needing at least some help in understanding diabetes complications. 51.6%of respondents reported needing at least some help in understanding insulin. 51.6%of respondents reported needing at least some help in understanding insulin.

26. Diabetes Does your health system offer the supplies you need to monitor and take care of diabetic needs (syringes for insulin, medication, glucometer machine and strips to check blood sugar) Does your health system offer the supplies you need to monitor and take care of diabetic needs (syringes for insulin, medication, glucometer machine and strips to check blood sugar) Yes 58.6% Yes 58.6% No 20.8% No 20.8%

27. Hypertension Awareness Have you ever been told by a doctor nurse or other health care professional that you have high blood pressure? Have you ever been told by a doctor nurse or other health care professional that you have high blood pressure? Yes 4.9% Yes 4.9% No 74.5% No 74.5% Don’t know 3.6% Don’t know 3.6%

28. Hypertension Awareness Are you currently taking medicine for high blood pressure? Are you currently taking medicine for high blood pressure? Yes 1.5% Yes 1.5% No 81.3% No 81.3%

29. Hypertension Awareness Did you know that high blood pressure can cause the following? Did you know that high blood pressure can cause the following? Stroke Yes 69.9% No 13.6% Stroke Yes 69.9% No 13.6% Heart Attack Yes 73.3% No 10% Heart Attack Yes 73.3% No 10% Kidney Failure Yes 49% No 34.4% Kidney Failure Yes 49% No 34.4% Headaches Yes 60.3% No 23.1% Headaches Yes 60.3% No 23.1%

30. Lifestyle Awareness Did you know that poor nutrition can cause high blood pressure? Did you know that poor nutrition can cause high blood pressure? Yes 52.9% No 30.6% Yes 52.9% No 30.6% Did you know that smoking and being overweight can cause high blood pressure Did you know that smoking and being overweight can cause high blood pressure Yes 69.9% No 13.8% Yes 69.9% No 13.8% Did you know that excess alcohol intake can cause high blood pressure and stroke Did you know that excess alcohol intake can cause high blood pressure and stroke Yes 62% No 21.2% Yes 62% No 21.2%

31. Conclusions

32. Study Limitations Self-report survey. Self-report survey. Language and cultural differences Language and cultural differences No pilot test on revised survey No pilot test on revised survey

33. Implications Education Education Clinical practice Clinical practice Future research Future research