bluuebunny/crossref_metadata_2025 huggingface dataset:
Modeling and Reinforcement to Combat HIV: The MARCH Approach to Behavior Change
Authors: Galavotti Christine , Pappas-DeLuca Katina A. , Lansky Amy
Published: November 2008

Theory and research suggest that behavioral interventions to prevent HIV/AIDS may be most effective when they are personalized and affectively compelling, when they provide models of desired behaviors, and when they are linked to social and cultural narratives. Effective strategies must also take into account the opportunities and obstacles present in the local environment. The Modeling and Reinforcement to Combat HIV (MARCH) projects combine key aspects of individual behavior change with efforts to change social norms.

There are 2 main components to the program: entertainment as a vehicle for education (longrunning serialized dramas on radio or television portray role models evolving toward the adoption of positive behaviors) and interpersonal reinforcement at the community level (support from friends, family members, and others can help people initiate behavior changes; support through changes in social norms is necessary for behavioral effects to be sustained over time). Both media and interpersonal intervention activities should be linked to existing resources in the community and, wherever possible, provide increased access to preventive services, supplies, and other supporting elements.
Smoking Among Youths in China
Authors: Hesketh Therese , Ding Qu Jian , Tomkins Andrew
Published: November 2008

Objectives. To inform a prevention strategy, this study determined the prevalence of and attitudes toward smoking among Chinese secondary school students.

Methods. Self-completion questionnaires were administered to 13- to 18-year-olds attending school in Zhejiang Province, eastern China.

Results. Of the 6674 respondents, 15.9% (25.7% of the boys, 5.4% of the girls) were ever smokers. Only 0.3% were regular smokers. Of the ever smokers, 41.9% had smoked before 10 years of age and 7.9% before 5 years of age. Parental smoking was the strongest predictor of smoking.

Conclusions. The very low prevalence of regular smoking found in this age group suggests that prevention programs in school may be beneficial. Parents should be encouraged to adopt more responsible attitudes toward smoking in the home.
Results of the Expanded Program on Immunization in the Macedonian Refugee Camps
Authors: Koop Darryl G. , Jackson Benita M. , Nestel Gilbert
Published: November 2008

Objectives. This report summarizes the results of the Macedonian refugee camps' Expanded Program on Immunization.

Methods. Government agencies and nongovernmental organizations implemented an immunization program consisting of 3 mass vaccination campaigns in each of the 7 camps. Before the second mass campaign, weekly immunization clinics were initiated in each camp. Children younger than 48 months were immunized against 8 antigens according to a schedule established by the Macedonian Ministry of Health.

Results. Immunization coverage rates in the second campaign were 91% in Cegrane and 73% in Brazda. Coverage rates of the weekly clinics averaged 93%.

Conclusions. Initiating an expanded immunization program in the absence of a stable population is problematic.
Partner Violence Among Adolescents in Opposite-Sex Romantic Relationships: Findings From the National Longitudinal Study of Adolescent Health
Authors: Halpern Carolyn Tucker , Oslak Selene G. , Young Mary L. , Martin Sandra L. , Kupper Lawrence L.
Published: November 2008

Objectives. This report examines (1) the prevalence of psychological and minor physical violence victimization in a nationally representative sample of adolescents and (2) associations between sociodemographic factors and victimization.

Methods. Analyses are based on 7500 adolescents who reported exclusively heterosexual romantic relationships in the National Longitudinal Study of Adolescent Health. Items from the Conflict Tactics Scale were used to measure victimization. Associations between victimization patterns and sociodemographic characteristics were assessed with polytomous logistic regression.

Results. One third of adolescents reported some type of victimization, and 12% reported physical violence victimization. Although most sociodemographic characteristics were significantly associated with victimization, patterns varied by sex and type of victimization.

Conclusions. Psychological and minor physical violence victimization is common in opposite-sex romantic relationships during adolescence. The sex-specific associations between sociodemographic characteristics and patterns of partner violence victimization underscore the importance of pursuing longitudinal, theory-driven investigations of the characteristics and developmental histories of both partners in a couple to advance understanding of this public health problem.
A Motivational Interviewing Intervention to Increase Fruit and Vegetable Intake Through Black Churches: Results of the Eat for Life Trial
Authors: Resnicow Ken , Jackson Alice , Wang Terry , De Anindya K. , McCarty Frances , Dudley William N. , Baranowski Tom
Published: November 2008

Objectives. This study reports on Eat for Life, a multicomponent intervention to increase fruit and vegetable consumption among African Americans that was delivered through Black churches.

Methods. Fourteen churches were randomly assigned to 3 treatment conditions: (1) comparison, (2) self-help intervention with 1 telephone cue call, and (3) self-help with 1 cue call and 3 counseling calls. The telephone counseling in group 3 was based on motivational interviewing. The primary outcome, assessed at baseline and 1-year follow-up, was fruit and vegetable intake as assessed by 3 food frequency questionnaires.

Results. Change in fruit and vegetable intake was significantly greater in the motvational interviewing group than in the comparison and self-help groups. The net difference between the motivational interviewing and comparison groups was 1.38, 1.03, and 1.21 servings of fruits and vegetables per day for the 2-item, 7-item, and 36-item food frequency questionnaires, respectively. The net difference between the motivational interviewing and self-help groups was 1.14, 1.10, and 0.97 servings for the 2-item, 7-item, and 36-item food frequency questionnaires, respectively.

Conclusions. Motivational interviewing appears to be a promising strategy for modifying dietary behavior, and Black churches are an excellent setting to implement and evaluate health promotion programs.
Turning Science Into Junk: The Tobacco Industry and Passive Smoking
Authors: Samet Jonathan M. , Burke Thomas A.
Published: November 2008

In this issue, Glantz and Ong offer a powerful analysis of the tobacco industry's attempt to discredit the scientific evidence on passive smoking, particularly the industry's use of the label “junk science.” Environmental epidemiologic studies in other arenas have also been targets for the “junk science” label.

Lessons for researchers involved in high-stakes issues in the public policy arena include a need for awareness of competing interests, for transparency concerning funding, and for adherence to rigorous quality assurance and peer review practices. The goal of “sound science” seems an admirable one; it should not, however, be used to dismiss available but uncertain evidence in order to delay action.
Junking Science to Promote Tobacco
Authors: Yach Derek , Bialous Stella Aguinaga
Published: November 2008

Despite the tobacco industry's claims that it has changed its practices, the toll of tobacco-related disease and death continues to grow worldwide, and the industry continues to use a vast array of strategies to promote its products and increase profits. This commentary discusses the ways the tobacco industry has created controversy about risk assessment and about the scientific evidence of the health hazards of secondhand smoke.

The authors recommend that policymakers be more vigilant and that they demand transparency about affiliations and linkages between allegedly independent scientists and tobacco companies. They also urge policymakers to be prepared for new and continuing challenges posed by the tobacco industry, because, despite the industry's claims, there is little evidence of fundamental change in its objectives.
Reproductive Health in Eastern Europe: A Collaborative Training Project in Romania
Authors: Lüdicke Frank , Horga Mihai , Campana Aldo
Published: November 2008

Since the fall of the Berlin Wall, fundamental political changes in eastern Europe have affected the Soviet-style health care systems that formerly provided basic care for everyone. Many of these systems have collapsed, and the new systems of social insurance that have replaced them often are inadequate.

Advanced Training in Reproductive Health in Romania aimed to create an authority in family planning and reproductive health in selected Romanian university centers and to improve training and research capabilities. Initially, the project had 2 main goals: to provide advanced training in reproductive health and family planning to Romanian obstetrics–gynecology specialists from the main university centers—which would allow them to train other physicians (obstetricians, gynecologists, and general practitioners) and medical students—and to develop, test, and finalize specific training materials in Romanian to be used by the new trainers.
An Ethics Framework for Public Health
Authors: Kass Nancy E.
Published: November 2008

More than 100 years ago, public health began as an organized discipline, its purpose being to improve the health of populations rather than of individuals. Given its population-based focus, however, public health perennially faces dilemmas concerning the appropriate extent of its reach and whether its activities infringe on individual liberties in ethically troublesome ways. In this article a framework for ethics analysis of public health programs is proposed.

To advance traditional public health goals while maximizing individual liberties and furthering social justice, public health interventions should reduce morbidity or mortality; data must substantiate that a program (or the series of programs of which a program is a part) will reduce morbidity or mortality; burdens of the program must be identified and minimized; the program must be implemented fairly and must, at times, minimize preexisting social injustices; and fair procedures must be used to determine which burdens are acceptable to a community.
The Relationship of Neighborhood Socioeconomic Characteristics to Birthweight Among 5 Ethnic Groups in California
Authors: Pearl Michelle , Braveman Paula , Abrams Barbara
Published: November 2008

Objectives. This study sought to examine relationships between neighborhood socioeconomic characteristics and birthweight, accounting for individual socioeconomic characteristics, among 5 ethnic groups.

Methods. Birth records were linked to census block-group data for 22 304 women delivering infants at 18 California hospitals during 1994–1995. Information on income and additional factors was obtained from a surveyed subset of 8457 women. Neighborhood levels of poverty, unemployment, and education were examined.

Results. After adjustment for mothers' individual socioeconomic characteristics and other risk factors, less-favorable neighborhood socioeconomic characteristics were associated with lower birthweight among Blacks and Asians. No consistent relationship between neighborhood socioeconomic characteristics and birthweight was found among Whites, US-born Latinas, or foreign-born Latinas overall, but birthweight increased with less-favorable neighborhood socioeconomic characteristics among foreign-born Latinas in high-poverty or high-unemployment neighborhoods. These findings were not explained by measured behavioral or cultural factors.

Conclusions. In addition to individual socioeconomic characteristics, living in neighborhoods that are less socioeconomically advantaged may differentially influence birthweight, depending on women's ethnicity and nativity.
Cigarette Taxes and Smoking During Pregnancy
Authors: Ringel Jeanne S. , Evans William N.
Published: November 2008

Objectives. This study sought to estimate how changes in state cigarette excise taxes affect the smoking behavior of pregnant women.

Methods. Detailed information about mothers and their pregnancy was used to examine the impact of taxes on the propensity of pregnant women to smoke. The 1989 to 1995 Natality Detail Files were used in conducting analyses to assess the impact of taxes on smoking among different subpopulations.

Results. Higher cigarette excise taxes reduced smoking rates among pregnant women. A tax hike of $0.55 per pack would reduce maternal smoking by about 22%. Overall, a 10% increase in price would reduce smoking rates by 7%. Estimates for subpopulations suggested that nearly all would be very responsive to tax changes, including the subpopulations with the highest smoking rates.

Conclusions. Smoking rates among pregnant women are responsive to tax hikes.
Mental Health Correlates of Perceived Discrimination Among Lesbian, Gay, and Bisexual Adults in the United States
Authors: Mays Vickie M. , Cochran Susan D.
Published: November 2008

Objectives. Recent studies suggest that lesbians and gay men are at higher risk for stress-sensitive psychiatric disorders than are heterosexual persons. We examined the possible role of perceived discrimination in generating that risk.

Methods. The National Survey of Midlife Development in the United States, a nationally representative sample of adults aged 25 to 74 years, surveyed individuals self-identifying as homosexual or bisexual (n = 73) or heterosexual (n = 2844) about their lifetime and day-to-day experiences with discrimination. Also assessed were 1-year prevalence of depressive, anxiety, and substance dependence disorders; current psychologic distress; and self-rated mental health.

Results. Homosexual and bisexual individuals more frequently than heterosexual persons reported both lifetime and day-to-day experiences with discrimination. Approximately 42% attributed this to their sexual orientation, in whole or part. Perceived discrimination was positively associated with both harmful effects on quality of life and indicators of psychiatric morbidity in the total sample. Controlling for differences in discrimination experiences attenuated observed associations between psychiatric morbidity and sexual orientation.

Conclusions. Higher levels of discrimination may underlie recent observations of greater psychiatric morbidity risk among lesbian, gay, and bisexual individuals.
Effects of Cost Sharing on Care Seeking and Health Status: Results From the Medical Outcomes Study
Authors: Wong Mitchell D. , Andersen Ronald , Sherbourne Cathy D. , Hays Ron D. , Shapiro Martin F.
Published: November 2008

Objectives. This study sought to determine the effect of cost sharing on medical care use for acute symptoms and on health status among chronically ill adults.

Methods. Data from the Medical Outcomes Study were used to compare (1) rates of physician care use for minor and serious symptoms and (2) 6- and 12-month follow-up physical and mental health status among individuals at different levels of cost sharing.

Results. In comparison with a no-copay group, the low- and high-copay groups were less likely to have sought care for minor symptoms, but only the high-copay group had a lower rate of seeking care for serious symptoms. Follow-up physical and mental health status scores were similar among the 3 copay groups.

Conclusions. In a chronically ill population, cost sharing reduced the use of care for both minor and serious symptoms. Although no differences in self-reported health status were observed, health plans featuring cost sharing need careful monitoring for potential adverse health effects because of their propensity to reduce use of care that is considered necessary and appropriate.
Can Public Health Researchers and Agencies Reconcile the Push From Funding Bodies and the Pull From Communities?
Authors: Green Lawrence W. , Mercer Shawna L.
Published: November 2008

Responding to growing impatience with the limited application of research findings to health practices and policies, both funding bodies and communities are demanding that research show greater sensitivity to communities' perceptions, needs, and unique circumstances. One way to assure this is to employ participatory research—to engage communities at least in formulating research questions and interpreting and applying research findings and possibly also in selecting methods and analyzing data.

"Community" should be interpreted broadly as all who will be affected by the research results, including lay residents of a local area, practitioners, service agencies, and policymakers. Participatory research should not be required of every project, but when results are to be used for, in, and by communities, those communities should collaborate not only in applying findings but also in determining the ways in which the findings are produced and interpreted.
The Role of Community Advisory Boards: Involving Communities in the Informed Consent Process
Authors: Strauss Ronald P. , Sengupta Sohini , Quinn Sandra Crouse , Goeppinger Jean , Spaulding Cora , Kegeles Susan M. , Millett Greg
Published: November 2008

Ethical research involving human subjects mandates that individual informed consent be obtained from research participants or from surrogates when participants are not able to consent for themselves. The existing requirements for informed consent assume that all study participants have personal autonomy; fully comprehend the purpose, risks, and benefits of the research; and volunteer for projects that disclose all relevant information. Yet contemporary examples of lapses in the individual informed consent process have been reported.

The authors propose the use of community advisory boards, which can facilitate research by providing advice about the informed consent process and the design and implementation of research protocols. These activities could help reduce the number of individual informed consent lapses, benefiting study participants and the scientific integrity of the research in question.
Urban History, Urban Health
Authors: Knowlton Kim
Published: November 2008

Over the course of the 20th century, the United States became an urban nation: 80% of Americans now live in metropolitan areas. Supplying basic sanitary services—drinking water, sewers, and garbage removal—to these cities is a gargantuan task, yet most people have little understanding of urban infrastructure systems and their enormous regional ecologic impacts.

Municipalization of sanitary services, especially since 1880, distanced people from their wastes and gave city dwellers a simplistic experience of one-way material flow through cities, without knowledge of the environmental costs. Most sanitary infrastructures were built primarily for durability and lack the elasticity to meet changing needs. The challenge now is to adapt sanitary systems for flexibility and simultaneously move from unchecked material consumption toward resource-based thinking.
Meeting the Data Needs of a Local Health Department: The Los Angeles County Health Survey
Authors: Simon Paul A. , Wold Cheryl M. , Cousineau Michael R. , Fielding Jonathan E.
Published: November 2008

Monitoring the health status of populations is a core function of all public health agencies but is particularly important at the municipal and community levels, where population health data increasingly are used to drive public health decision making and community health improvement efforts. 1– 3 Unfortunately, most local health jurisdictions lack important data for developing population health profiles, such as data on chronic disease prevalence, quality-of-life measures, functional status, and self-perceptions of health status. In addition, data on important determinants of health, including health behaviors and access to health care services, are rarely available locally.

These data frequently are collected in national and state surveys (e.g., the National Health Interview Survey and the Behavioral Risk Factor Surveillance System) and provide critical information to assess progress toward achieving state and national health objectives. 4 The surveys rarely serve local data needs, however, because of insufficient sample size and lack of flexibility to address local health issues. To address gaps in local health data, in 1997 the Los Angeles County Department of Health Services inaugurated the Los Angeles County Health Survey.
Understanding and Responding to Youth Substance Use: The Contribution of a Health and Human Rights Framework
Authors: Gruskin Sofia , Plafker Karen , Smith-Estelle Allison
Published: November 2008

This article examines the utility of a health and human rights framework for conceptualizing and responding to the causes and consequences of substance use among young people. It provides operational definitions of “youth” and “substances,” a review of current international and national efforts to address substance use among youths, and an introduction to human rights and the intersection between health and human rights. A methodology for modeling vulnerability in relation to harmful substance use is introduced and contemporary international and national responses are discussed.

When governments uphold their obligations to respect, protect, and fulfill human rights, vulnerability to harmful substance use and its consequences can be reduced.
Grassroots Participation, Peer Education, and HIV Prevention by Sex Workers in South Africa
Authors: Campbell Catherine , Mzaidume Zodwa
Published: November 2008

Objectives. This microqualitative case study of a community-based peer education program led by sex workers at a South African mine examined the role of grassroots participation in sexual health promotion.

Methods. The study involved in-depth interviews with 30 members of the target community. The interviews were analyzed in terms of social capital, empowerment, and identity.

Results. The study yielded a detailed analysis of the way in which community dynamics have shaped the peer education program's development in a deprived, violent community where existing norms and networks are inconsistent with ideal criteria for participatory health promotion.

Conclusions. Much remains to be learned about the complexities of translating theoretically and politically vital notions of “community participation” into practice among hard-to-reach groups. The fabric of local community life is shaped by nonlocal structural conditions of poverty and sexual inequality in ways that challenge those seeking to theorize the role of social capital in community development in general and in sexual health promotion in particular.
The Visibility of Illicit Drugs: Implications for Community-Based Drug Control Strategies
Authors: Saxe Leonard , Kadushin Charles , Beveridge Andrew , Livert David , Tighe Elizabeth , Rindskopf David , Ford Julie , Brodsky Archie
Published: November 2008

Objectives. This study examined differences between the visibility of drugs and drug use in more than 2100 neighborhoods, challenging an assumption about drug use in poor, minority, and urban communities.

Methods. A telephone survey assessed substance use and attitudes across 41 communities in an evaluation of a national community-based demand reduction program. Three waves of data were collected from more than 42 000 respondents.

Results. Measures of neighborhood disadvantage, population density, and proportion of minority residents explained more than 57% of the variance between census tracts in visibility of drug sales but less than 10% of tract-to-tract variance in drug use. Visible drug sales were 6.3 times more likely to be reported in the most disadvantaged neighborhoods than in the least disadvantaged, while illicit drug use was only 1.3 times more likely.

Conclusions. The most disadvantaged neighborhoods have the most visible drug problems, but drug use is nearly equally distributed across all communities. Thus, efforts to address drug-related problems in poorer areas need to take into account the broader drug market served by these neighborhoods.
Using Signs, Artwork, and Music to Promote Stair Use in a Public Building
Authors: Boutelle Kerri N. , Jeffery Robert W. , Murray David M. , Schmitz M. Kathryn H.
Published: November 2008

Objectives. This study assessed the impact on stair use of improving the attractiveness of a stairwell.

Methods. Observations of stair usage were made in a university building during baseline, 2 interventions, and follow-up. The first intervention involved signs; the second intervention added artwork and music in the stairwell.

Results. More participants used the stairs during the music and artwork intervention than at baseline or when signs alone were used.

Conclusions. Improving the aesthetic qualities of a stairwell can increase rates of stair usage in a public building. Designs for buildings should take accessibility and aesthetic issues into consideration.
Bringing the Mountain to Mohammed: A Mobile Dental Team Serves a Community-Based Program for People With HIV/AIDS
Authors: Zabos Georgina P. , Trinh Chau
Published: November 2008

In spite of the direct referral system and family-centered model of primary oral health care linking medical and dental care providers, most HIV-positive patients at the Columbia Presbyterian Medical Center received only emergency and episodic dental care between 1993 and 1998. To improve access to dental care for HIV/AIDS patients, a mobile program, called WE CARE, was developed and colocated in community-based organizations serving HIV-infected people. WE CARE provided preventive, early intervention, and comprehensive oral health services to minorities, low-income women and children, homeless youths, gays and lesbians, transgender individuals, and victims of past abuse. More efforts to colocate dental services with HIV/AIDS care at community-based organizations are urgently needed, however.
Association of Normal Weather Periods and El Niño Events With Hospitalization for Viral Pneumonia in Females: California, 1983–1998
Authors: Ebi Kristie L. , Exuzides K. Alex , Lau Edmund , Kelsh Michael , Barnston Anthony
Published: November 2008

Objectives. This study examined associations between weather and hospitalizations of females for viral pneumonia during normal weather periods and El Niño events in the California counties of Sacramento and Yolo, San Francisco and San Mateo, and Los Angeles and Orange.

Methods. Associations between weather and hospitalizations (lagged 7 days) for January 1983 through June 1998 were evaluated with Poisson regression models. Generalized estimating equations were used to adjust for autocorrelation and overdispersion. Data were summed over 4 days.

Results. Associations varied by region. Hospitalizations in San Francisco and Los Angeles increased significantly (30%–50%) with a 5°F decrease in minimum temperature. Hospitalizations in Sacramento increased significantly (25%–40%) with a 5°F decrease in maximum temperature difference. The associations were independent of season. El Niño events were associated with hospitalizations only in Sacramento, with significant decreases for girls and increases for women.

Conclusions. The results suggest that viral pneumonia could continue to be a major public health issue, with a significant association between weather and hospitalizations, even as the global mean temperature continues to rise. An understanding of population sensitivity under different weather conditions could lead to an improved understanding of virus transmission.
Changing to the 2000 Standard Million: Are Declining Racial/Ethnic and Socioeconomic Inequalities in Health Real Progress or Statistical Illusion?
Authors: Krieger Nancy , Williams David R.
Published: November 2008

Objectives. This study determined the effects of changing from the 1940 to the 2000 standard million on monitoring socioeconomic and racial/ethnic inequalities in health.

Methods. Using the 1940, 1970, and 2000 standard million, we calculated and compared age-adjusted rates for selected health outcomes stratified by socioeconomic level.

Results. Changing from the 1940 to the 2000 standard million markedly reduced the age-adjusted relative risks for self-reported fair or poor health status of poor Americans compared with high-income Americans.

Conclusions. Public health researchers and practitioners should give serious consideration to the implications of the change to the 2000 standard million for monitoring social inequalities in health.
A Conceptual Framework to Measure Performance of the Public Health System
Authors: Handler Arden , Issel Michele , Turnock Bernard
Published: November 2008

Objectives. This article describes a unifying conceptual framework for the public health system as a way to facilitate the measurement of public health system performance.

Methods. A conceptual framework for the public health system was developed on the basis of the work of Donabedian and a conceptual model previously developed by Bernard Turnock and Arden Handler.

Results. The conceptual framework consists of 5 components that can be considered in relationship to each other: macro context, mission, structural capacity, processes, and outcomes. Although the availability of measures for each of these components varies, the framework can be used to examine the performance of public health systems as well as that of agencies and programs.

Conclusions. A conceptual framework that explicates the relationships among the various components of the public health system is an essential step toward providing a science base for the study of public health system performance.
Accessibility of Primary Care Services in Safety Net Clinics in New York City
Authors: Weiss Eve , Haslanger Kathryn , Cantor Joel C.
Published: November 2008

Objectives. This study analyzed data from a survey of New York City ambulatory care facilities to determine primary care accessibility for low-income patients, as evidenced by the availability of enabling services, after-hours coverage, and policies for serving the uninsured.

Methods. Ambulatory care facilities were surveyed in 1997, and analysis was performed on a set of measures related to access to care. Only sites that provided comprehensive primary care services were included in the analysis. For comparison, sites were classified by sponsorship (public, nonprofit voluntary hospital, federally qualified health center, non-hospital-sponsored community health center).

Results. Publicly sponsored sites and federally qualified health center sites showed the strongest performance across nearly all the measures of accessibility that were examined.

Conclusions. As safety net clinics confront the financial strain of implementing mandatory Medicaid managed care while also dealing with declining Medicaid caseloads and increasing numbers of uninsured, their ability to sustain the policies and services that support primary care accessibility may be threatened.
The Effect of Primary Care Physician Supply and Income Inequality on Mortality Among Blacks and Whites in US Metropolitan Areas
Authors: Shi Leiyu , Starfield Barbara
Published: November 2008

Objectives. This study assessed whether income inequality and primary care physician supply have a different effect on mortality among Blacks compared with Whites.

Methods. We conducted a multivariate ecologic analysis of 1990 data from 273 US metropolitan areas.

Results. Both income inequality and primary care physician supply were significantly associated with White mortality (P < .01). After the inclusion of the socioeconomic status covariates, the effect of income inequality on Black mortality remained significant (P < .01), but the effect of primary care physician supply was no longer significant (P > .10), particularly in areas with high income inequality.

Conclusions. Improvement in population health requires addressing socioeconomic determinants of health, including income inequality and primary care availability and access.
Heart Rate as a Predictor of Mortality: The MATISS Project
Authors: Seccareccia Fulvia , Pannozzo Fabio , Dima Francesco , Minoprio Anna , Menditto Antonio , Lo Noce Cinzia , Giampaoli Simona
Published: November 2008

Objectives. This study sought to verify the independent role of heart rate in the prediction of all-cause, cardiovascular, and noncardiovascular mortality in a low-risk male population.

Methods. In an Italian population-based observational study, heart rate was measured in 2533 men, aged 40 to 69 years, between 1984 and 1993. Data on cardiovascular risk factors were collected according to standardized procedures. Vital status was updated to December 1997.

Results. Of 2533 men followed up (representing 24 457 person-years), 393 men died. Age-adjusted death rates for 5 heart rate levels showed increasing trends. The adjusted hazard rate ratios for each heart rate increment were 1.52 (95% confidence interval [CI] = 1.29, 1.78) for all-cause mortality, 1.63 (95% CI = 1.26, 2.10) for cardiovascular mortality, and 1.47 (95% CI = 1.19, 1.80) for noncardiovascular mortality. Relative risks between extreme levels were more than 2-fold for all endpoints considered.

Conclusions. Heart rate is an independent predictor of cardiovascular, noncardiovascular, and total mortality in this Italian middle-aged male population.
Prevalence of Genital Chlamydial Infection in Young Women Entering a National Job Training Program, 1990–1997
Authors: Mertz Kristen J. , Ransom Raymond L. , St. Louis Michael E. , Groseclose Samuel L. , Hadgu Alula , Levine William C. , Hayman Charles
Published: November 2008

Objectives. This analysis describes trends in the prevalence of genital chlamydial infection in economically disadvantaged young women entering a national job training program.

Methods. We examined chlamydia test data for May 1990 through June 1997 for women aged 16 to 24 years who enrolled in the program. The significance of trends was evaluated with the χ2 test for trend.

Results. Prevalence of chlamydial infection declined 32.9%, from 14.9% in 1990 to 10.0% in 1997 (P < .001). Prevalence decreased significantly in all age groups, racial/ethnic groups, and geographic regions.

Conclusions. The decrease in prevalence of chlamydial infection suggests that prevention activities have reached disadvantaged women across the United States; however, prevalence of chlamydial infection remains high, and enhanced prevention efforts in disadvantaged communities are urgently needed.
The Precautionary Principle Also Applies to Public Health Actions
Authors: Goldstein Bernard D.
Published: November 2008

The precautionary principle asserts that the burden of proof for potentially harmful actions by industry or government rests on the assurance of safety and that when there are threats of serious damage, scientific uncertainty must be resolved in favor of prevention. Yet we in public health are sometimes guilty of not adhering to this principle.

Examples of actions with unintended negative consequences include the addition of methyl tert-butyl ether to gasoline in the United States to decrease air pollution, the drilling of tube wells in Bangladesh to avoid surface water microbial contamination, and villagewide parenteral antischistosomiasis therapy in Egypt. Each of these actions had unintended negative consequences. Lessons include the importance of multidisciplinary approaches to public health and the value of risk–benefit analysis, of public health surveillance, and of a functioning tort system—all of which contribute to effective precautionary approaches.
Strengthening the Legal Foundation for Public Health Practice: A Framework for Action
Authors: Moulton Anthony D. , Matthews Gene W.
Published: November 2008

Growing concern that public health laws may be inadequate to the challenges that confront public health practitioners has led to adoption of a Healthy People 2010 objective for improved laws and policies. It has also led to concerted efforts to strengthen the legal foundation for public health practice. In this editorial, the authors present a framework for collaborative research, analysis, and development to strengthen public health laws, skill in applying laws, and law-related information resources.
Retaining Hard-to-Reach Women in HIV Prevention and Vaccine Trials: Project ACHIEVE
Authors: Brown-Peterside Pamela , Rivera Evelyn , Lucy Debbie , Slaughter Izzie , Ren Leigh , Chiasson Mary Ann , Koblin Beryl A.
Published: November 2008

Project ACHIEVE, which conducts HIV prevention research studies, maintains a women's site in the South Bronx in New York City. Owing to a focused retention effort at the South Bronx site, high retention rates were achieved in a vaccine preparedness study for women at high risk of HIV infection. Comparable retention rates have been achieved in HIV vaccine trials with similar cohorts of women at this site. These results suggest that concerns about retaining hard-to-reach populations should not cause these populations to be excluded from HIV vaccine and prevention trials.
Minority Women and Advocacy for Women's Health
Authors: Kumanyika Shiriki K. , Morssink Christiaan B. , Nestle Marion
Published: November 2008

US minority health issues involve racial/ethnic disparities that affect both women and men. However, women's health advocacy in the United States does not consistently address problems specific to minority women.

The underlying evolution and political strength of the women's health and minority health movements differ profoundly. Women of color comprise only one quarter of women's health movement constituents and are, on average, socioeconomically disadvantaged. Potential alliances may be inhibited by vestiges of historical racial and social divisions that detract from feelings of commonality and mutual support.

Nevertheless, insufficient attention to minority women's issues undermines the legitimacy of the women's health movement and may prevent important advances that can be achieved only when diversity is fully considered.
The Short-Term Impact of National Smoke-Free Workplace Legislation on Passive Smoking and Tobacco Use
Authors: Heloma Antero , Jaakkola Maritta S. , Kähkönen Erkki , Reijula Kari
Published: November 2008

Objectives. This study sought to evaluate the short-term impact of national smoke-free workplace legislation on employee exposure to environmental tobacco smoke at work and on employee smoking habits.

Methods. We performed 2 cross-sectional studies in 9 medium-sized and large Finnish workplaces, before and after implementation of national smoke-free workplace legislation. We assessed tobacco smoke exposure via questionnaire and indoor air nicotine measurements.

Results. Exposure to environmental tobacco smoke declined considerably after the legislation was implemented. Tobacco consumption among smokers diminished. Nicotine concentrations fell significantly.

Conclusions. Legislation was more efficient than voluntary workplace-specific smoking restrictions in reducing passive smoking and cigarette consumption. (Am J Public Health. 2001;91:1416–1418)
Cigarette Smoking Behavior Among US Latino Men and Women From Different Countries of Origin
Authors: Pérez-Stable Eliseo J. , Ramirez Amelie , Villareal Roberto , Talavera Gregory A. , Trapido Edward , Suarez Lucina , Marti José , McAlister Alfred
Published: November 2008

Objectives. This study sought to compare smoking behavior among Latino men and women from different countries of origin.

Methods. A telephone-administered survey was conducted in 8 cities with Latino men and women of different national origin living in census tracts with at least 70% Latino individuals.

Results. A total of 8882 participants completed the survey; 53% were women. The average age of respondents was 44 years; 63% were foreign-born, and 59% preferred Spanish for the interview. Current smoking was more prevalent among men (25.0%, 95% confidence interval [CI] = 23.7, 26.3) than among women (12.1%, 95% CI = 11.1, 13.0). Smoking rates were not significantly different by national origin among men, but Puerto Rican women had higher rates of smoking than other women. Central American men and women had the lowest smoking rates. Foreign-born respondents were less likely to be smokers (odds ratio [OR] = 0.77, 95% CI = 0.66, 0.90) than US-born respondents, and respondents with 12 years or less of education had an increased odds of smoking (OR = 1.17, 95% CI = 1.01, 1.35). High acculturation was associated with more smoking in women (OR = 1.12, 95% CI = 1.00–1.25) and less smoking in men (OR = 0.86, 95% CI = 0.78–0.95). Puerto Rican and Cuban respondents were more likely to be current smokers and to smoke more than 20 cigarettes per day.

Conclusions. Older, US-born, and more-educated respondents were less likely to be current smokers. Respondents of Puerto Rican and Cuban origin were more likely to smoke. Acculturation has divergent effects on smoking behavior by sex.
Changes in Access to Mental Health Care Among the Poor and Nonpoor: Results From the Health Care Reform in Puerto Rico
Authors: Alegría Margarita , McGuire Thomas , Vera Mildred , Canino Glorisa , Matías Leida , Calderón José
Published: November 2008

Objectives. Health care reforms associated with managed care may adversely affect the health care safety net for disadvantaged populations. This study compared changes in health care use among poor and nonpoor individuals enrolled in managed care.

Methods. Data from 3 waves of a random community sample were collected on approximately 3000 adults. Changes in use of mental health services were assessed in a pretest–posttest, quasi-experimental design.

Results. Managed care increased use of specialty services among the nonpoor while maintaining the same level of use for the poor in the public sector.

Conclusions. Reallocation of mental health services may be a result of expanding Medicaid eligibility.
Cost-Effectiveness of Earlier Initiation of Antiretroviral Therapy for Uninsured HIV-Infected Adults
Authors: Schackman Bruce R. , Goldie Sue J. , Weinstein Milton C. , Losina Elena , Zhang Hong , Freedberg Kenneth A.
Published: November 2008

Objectives. This study was designed to examine the societal cost-effectiveness and the impact on government payers of earlier initiation of antiretroviral therapy for uninsured HIV-infected adults.

Methods. A state-transition simulation model of HIV disease was used. Data were derived from the Multicenter AIDS Cohort Study, published randomized trials, and medical care cost estimates for all government payers and for Massachusetts, New York, and Florida.

Results. Quality-adjusted life expectancy increased from 7.64 years with therapy initiated at 200 CD4 cells/μL to 8.21 years with therapy initiated at 500 CD4 cells/μL. Initiating therapy at 500 CD4/μL was a more efficient use of resources than initiating therapy at 200 CD4/μL and had an incremental cost-effectiveness ratio of $17 300 per quality-adjusted life-year gained, compared with no therapy. Costs to state payers in the first 5 years ranged from $5500 to $24 900 because of differences among the states in the availability of federal funds for AIDS drug assistance programs.

Conclusions. Antiretroviral therapy initiated at 500 CD4 cells/μL is cost-effective from a societal perspective compared with therapy initiated later. States should consider Medicaid waivers to expand access to early therapy.
Differential HIV Risk in Bathhouses and Public Cruising Areas
Authors: Binson Diane , Woods William J. , Pollack Lance , Paul Jay , Stall Ron , Catania Joseph A.
Published: November 2008

Objectives. This report investigates differences in risk behaviors among men who have sex with men (MSM) who went to gay bathhouses, public cruising areas, or both.

Methods. We used a probability sample of MSM residing in 4 US cities (n = 2881).

Results. Men who used party drugs and had unprotected anal intercourse with nonprimary partners were more likely to go to sex venues than men who did not. Among attendees, MSM who went to public cruising areas only were least likely, and those who went to both public cruising areas and bathhouses were most likely to report risky sex in public settings.

Conclusions. Distinguishing between sex venues previously treated as a single construct revealed a significant association between pattern of venue use and sexual risk. Targeting HIV prevention in the bathhouses would reach the segment of men at greatest risk for HIV transmission.
Neighborhood Poverty and the Resurgence of Tuberculosis in New York City, 1984–1992
Authors: Barr R. Graham , Diez-Roux Ana V. , Knirsch Charles A. , Pablos-Méndez Ariel
Published: November 2008

Objectives. The resurgence of tuberculosis (TB) in New York City has been attributed to AIDS and immigration; however, the role of poverty in the epidemic is unclear. We assessed the relation between neighborhood poverty and TB at the height of the epidemic and longitudinally from 1984 through 1992.

Methods. Census block groups were used as proxies for neighborhoods. For each neighborhood, we calculated TB and AIDS incidence in 1984 and 1992 with data from the Bureaus of Tuberculosis Control and AIDS Surveillance and obtained poverty rates from the census.

Results. For 1992, 3343 TB cases were mapped to 5482 neighborhoods, yielding a mean incidence of 46.5 per 100 000. Neighborhood poverty was associated with TB (relative risk = 1.33; 95% confidence interval = 1.30, 1.36 per 10% increase in poverty). This association persisted after adjustment for AIDS, proportion foreign-born, and race/ethnicity. Neighborhoods with declining income from 1980 to 1990 had larger increases in TB incidence than did neighborhoods with increasing income.

Conclusions. Leading up to and at the height of the TB epidemic in New York City, neighborhood poverty was strongly associated with TB incidence. Public health interventions should target impoverished areas.
Registry-Driven, Community-Based Immunization Outreach: A Randomized Controlled Trial
Authors: Wilcox Sarah A. , Koepke Christopher P. , Levenson Robert , Thalheimer Judith C.
Published: November 2008

Objectives. This study evaluated the effectiveness of registry-driven, community-based outreach directed toward children with immunization delays.

Methods. A sample of 1856 children aged 6 to 10 months was randomly assigned to receive either outreach or no intervention.

Results. Children in the outreach group were more likely to receive an immunization during the observation period than children in the control group (61% vs 43%). Outreach was most effective for children with multiple risks, as measured by their immunization record; it was not effective for children whose mothers had received inadequate prenatal care.

Conclusions. Registry-driven outreach can effectively identify high-risk children and bring them to care.
EFFECTS OF CONCEALABLE STIGMA FOR LEARNING DISABILITIES
Authors: Zhao Jun-yan , Zhang Baoshan , Yu Guoliang
Published: November 2008

In this study, cognitive effects relating to concealable stigma of adolescents with learning disabilities (Learning Disabilities, LD) were examined under the condition in which learning-related information was concealed. A total of 158 adolescents (78 LD adolescents, 80 NLD adolescents)
participated in the present study. Results showed that: (1) the LD group in the concealed condition exhibited a higher level of suppressing learning-relevant thoughts than did those in the disclosed condition; (2) LD children in both conditions showed increasing accessibility of learning-relevant
thoughts than did the NLD (Non-Learning Disabilities) group during the interview.