Taking California’s Pulse on Health Attitudes : New Gallup Poll Reflects an Upbeat Sense of Self, Excitement About Future

California’s Latinos and Asians are far more likely than blacks and Anglos to say they are depressed, but overall the state’s outwardly upbeat sense of self stands up, according to a new poll.

Moreover, the Gallup poll shows Californians--hospitalized less than people in the rest of the country--use specialists far more than elsewhere and are more willing than other Americans to trust their doctors to select the right hospital while a substantial majority insist a terminally ill person should be allowed to end his or her own life.

Strong Sentiment

And though political administrations at both the state and federal levels have worked actively to cut government-paid health care benefits, more than two thirds of Californians believe government--federal, state or county--should fully cover medical care for people who cannot afford it themselves. The sentiment was consistently strong across a variety of statewide age and geographic lines.

The disparity of feelings of depression was widest among Latinos and Anglos--40% of Latinos versus just over 12% of Anglos, for example--and while all four ethnic groups are identified as “excited about the future” by a wide margin, Anglos and Latinos are significantly less so than blacks and Asians.

The poll, scheduled for release today in Irvine, is intended as the first of an annual series of assessments of Californians’ attitudes toward the medical care system and broader concepts of health.

Solid support for the right to die if one is terminally ill--70%--was stronger among men than women (74% versus 67%), strongest of all among people 25 to 34 and lowest among those 18 to 24 and over 75.

Despite extensive publicity about such dramatic medical advances as the artificial heart, only 47% of Californians would have such a device implanted in themselves or a close family member. Just over half of all men said they would have an artificial heart while only 44% of women would do so. Interest in having an artificial heart declined “dramatically” with age, analysts said, achieving its lowest enthusiasm rate--20%--among people over 75.

Significantly lower proportions of Californians than residents of other parts of the U.S. believe a hospital’s policy of not performing abortions is the right decision. Also, only a third have been persuaded by vigorous hospital marketing campaigns that have sought to depict hospitals more broadly as “wellness centers” to be used to preserve health and not just cure disease.

Joint Venture

Results of the survey, which drew on responses of 750 California heads of household interviewed by phone last month in the state’s four major regions, are being released by SRI-Gallup, a consortium formed by the Gallup organization of Princeton, N.J., and Selection Research, Inc., a Lincoln, Neb., consulting firm. The two organizations have formed a hospital marketing joint venture that recently established a West Coast headquarters. George Gallup Jr., head of the New Jersey polling group, said he was surprised by a variety of the California findings, most notably the clear lack of interest in use of the artificial heart among people here and the strong support for the right to die.

“I was very surprised at the finding on the artificial heart,” Gallup said in a telephone interview. “It means that people would choose to die rather than survive (with that device.) “ SRI-Gallup said its California survey included a representative cross section of the state’s population. However, a comparison of demographic data for the survey group and analogous U.S. Census figures indicated that the new poll may have reached a disproportionate number of comparatively affluent Californians and that its racial and ethnic distribution--which included, for instance, just 7% Latino respondents and 5% black--was at variance with California’s reality.

Census data say California is more than 19% Latino and 7.7% black. In the SRI-Gallup sample, 50 Latinos and 39 blacks were questioned. SRI-Gallup said its sampling techniques, however, make the survey results valid for a true cross section of Californians within a margin of 3.6%.

SRI-Gallup analysts say the survey uncovered important racial and ethnic differences in how Californians perceive themselves and their health--in both narrow physical and broader emotional terms.

At first flush, the new poll finds Californians a generally sophisticated lot in terms of how they manage their health care needs. People here use specialists more--56% versus 30%--than residents of the rest of the country and enter hospitals less often. Just 18% of Californians had been hospitalized in the previous 12 months, compared with 24% nationwide.

Let the Doctor Do It

When they do go into hospitals, Californians are more willing than Americans in general to let their doctors select the hospital for them--by a margin of 36% to 23%, the survey found. But SRI-Gallup analyst Robert Nielsen said the surveyors concluded the disparity may mean that Californians, more affluent than Americans in general, collectively view choice of a doctor like picking a lawyer or an accountant--use of a professional service which, if it is paid for, ought to be relied upon.

Duane Dauner, president of the California Assn. of Hospitals and Health Systems, said the survey finding of heavy support for medical help for the indigent underscores what he contended is a continuing discrepancy between decisions to cut such programs as Medi-Cal and Medicare and the wishes of California residents. “We believe the cutbacks (already announced) will have a devastating effect,” Dauner said. “It’s like a mushrooming snowball, rushing down the mountain.”

Dauner said the California idiosyncracies in hospital and physician selection may be explained by several factors--not the least of which is the proportionately larger numbers of Californians who use prepaid health plans like health maintenance organizations. The survey found about 25% of Californians are enrolled in HMOs, compared with only 10% nationally, according to Dauner. HMO use, he said, influences both hospital admission rates and the utilization of non-hospital alternatives.

He said the “style” of medicine practiced in California is different from the rest of the country with greater availability of such options as outpatient surgical centers and other facilities that replace traditional hospital services. “We’re not saying that’s bad,” Dauner said.

In terms of such emotions as stress, depression and happiness, SRI-Gallup analysts found Californians to be people caught between such concerns as having jobs they found fulfilling and finding stress in their lives. In fact, the poll found a clear relationship between the amount of stress respondents reported and the degree to which they said they found their jobs fulfilling or exciting, with the emotions paralleling one another.

The Stress Picture

Overall, 23% of the respondents said they experience a great deal of stress and 5% said they often find themselves depressed. Another 47% said they are excited about their personal futures and 45% said their occupations are exciting and fulfilling. Sixty-five percent said they are “generally” happy.

Not surprisingly, occupational fulfillment increased with both education and income, with college graduates earning more than $50,000 a year reporting the highest levels of satisfaction. Depression, on the other hand, the California responses indicated, afflicts the less educated and less wealthy, with nearly 30% of heads of households with incomes of less than $20,000 reporting significant depression symptoms as opposed to 7% of those earning more than $50,000.

Catholics reported greater depression than Protestants--just over 22% versus 13%. Jews made up only 4% of the sample--a proportion consistent with Census data--and were not asked specifically about depression symptoms. About 12% of whites reported depression symptoms, with the proportion rising to about 26% among blacks, 38% among people of Asian descent and 40% among Latinos.

SRI-Gallup analysts said the high incidence of depression among Latinos could possibly be explained by the pervasiveness of poverty among California Latinos. But among persons of Asian descent, the incidence of depression appeared to cut across economic lines. “Depression among these respondents is, therefore,” the poll results noted, “not easily explained by obvious demographics.”

Asked if they were “excited about the future,” a surprising 100% of respondents 18 to 24 said they were, with the proportion dropping off to 89% in the 25 to 34 age bracket and less than 30% over 75. Overall, though, only 47% of Californians said they felt such excitement. But such amorphous happiness was influenced by race, too, with blacks and Asians expressing greater agreement with the notion that the future excited them than Anglos and Latinos.

Among other observations were these:

- Californians overwhelmingly believe--71%--the federal government should finance research to find a cure for acquired immune deficiency syndrome (AIDS), with Catholics feeling significantly more strongly about the issue (79% versus 64%) than Protestants. The young have stronger feelings about the question than people over 75. A third of the respondents said they would be “less likely” to use a specific hospital themselves if they knew it specialized in treating AIDS. Gallup said the fact that fully a third of Californians would prefer to avoid a hospital specializing in AIDS was “very important.”

- A total 76% of Californians said they don’t smoke, with the incidence of smoking greatest in the central part of the state--an area taking in the San Joaquin Valley, San Luis Obispo County, Bakersfield, Fresno and Merced. In that central California area, smokers made up nearly 28% of the population, compared to less than 19% in the San Diego-Imperial County area. A total of 40% of Californians said they were ex-smokers and 45% of people who said they smoke now have tried to quit. The observations were roughly similar to results for California published recently by the federal government’s Centers for Disease Control, which show California to have a lower proportion of smokers (26.3% versus 28.5%) than the rest of the country and more evidence of trying to quit (47.2% compared to 42.3%).

- Smokers are more likely to say they get depressed and experience stress in their lives. People who drink admit to depression less often than those who don’t, but say they encounter more stress than teetotalers. Smokers perceive themselves as less financially secure than nonsmokers and are less likely to find their jobs rewarding.

- Sixty-two percent of Californians drink, with consumption greatest among those heading households earning $50,000 a year or more. Californians consume an average of 6.09 drinks a week, with the central part of the state reporting both the lowest proportion of drinkers overall but the highest ratio of drinks per week among people who do indulge. Only 48% of heads of households earning less than $20,000 said they drank, compared to 74% of those earning $50,000 or more.

- While 59% of Californians claim to exercise regularly, 84% say they do so on their own, with just 15% saying they take part in formal exercise activities. More men than women (63% versus 55%) said they exercise regularly. State Department of Health Services survey data contend that 53.5% of Californians admit to leading a sedentary life style.

- A total of 59% of Californians claim to pay a “great deal” of attention to nutrition, with only 6% admitting to paying “very little” attention to the issue. Women were more attuned to nutritional issues than men by a margin of 66% to 51%.

- A total of 37% of Californians say they have dieted within the last two years, with more women (45%) doing so than men (28%). Of those who did diet, 66% claimed they met their weight-loss objectives. Women are more frequent dieters than men--45% to 28%--but, by a margin of 62% to 73%, say they were less successful in weight loss programs.