bluuebunny/crossref_metadata_2025 huggingface dataset:
Labor Rekindles Reform
Authors: Stern Andrew L.
Published: December 2008

The health care crisis is back. There is intensifying sentiment across the country that universal coverage is our only way out.

The labor movement has used historically such opportunities for change to win health benefits at the bargaining table and strengthen the social safety net. Eighty years of incremental victories and many failed attempts at major health reform have taught labor a crucial lesson: we must build a powerful grassroots movement to drive our effort to achieve universal coverage, or it is doomed to be corrupted by those wedded to the status quo.

Now is the right time for reform.
Tribal Benefits Counseling Program: Expanding Health Care Opportunities for Tribal Members
Authors: Friedsam Donna , Haug Gretchen , Rust Mike , Lake Amy
Published: December 2008

American Indian tribal clinics hired benefits counselors to increase the number of patients with public and private insurance coverage, expand the range of health care options available to tribal members, and increase third-party revenues for tribal clinics. Benefits counselors received intensive training, technical assistance, and evaluation over a 2-year period.

Six tribal clinics participated in the full training program, including follow-up, process evaluation, and outcomes reporting. Participating tribal sites experienced a 78% increase in Medicaid enrollment among pregnant women and children, compared with a 26% enrollment increase statewide during the same period.

Trained benefits counselors on-site at tribal clinics can substantially increase third-party insurance coverage among patients.
Race/Ethnicity, Gender, and Monitoring Socioeconomic Gradients in Health: A Comparison of Area-Based Socioeconomic Measures—The Public Health Disparities Geocoding Project
Authors: Krieger Nancy , Chen Jarvis T. , Waterman Pamela D. , Rehkopf David H. , Subramanian S. V.
Published: December 2008

Use of multilevel frameworks and area-based socioeconomic measures (ABSMs) for public health monitoring can potentially overcome the absence of socioeconomic data in most US public health surveillance systems.

To assess whether ABSMs can meaningfully be used for diverse race/ethnicity–gender groups, we geocoded and linked public health surveillance data from Massachusetts and Rhode Island to 1990 block group, tract, and zip code ABSMs. Outcomes comprised death, birth, cancer incidence, tuberculosis, sexually transmitted infections, childhood lead poisoning, and nonfatal weapons-related injuries.

Among White, Black, and Hispanic women and men, measures of economic deprivation (e.g., percentage below poverty) were most sensitive to expected socioeconomic gradients in health, with the most consistent results and maximal geocoding linkage evident for tract-level analyses.
Stage at Diagnosis and Survival in a Multiethnic Cohort of Prostate Cancer Patients
Authors: Oakley-Girvan Ingrid , Kolonel Laurence N. , Gallagher Richard P. , Wu Anna H. , Felberg Anna , Whittemore Alice S.
Published: December 2008

Objectives. We evaluated the effects of socioeconomic status and comorbidity on stage of disease and survival among 1,509 population-based prostate cancer patients.

Methods. We applied logistic regression and Cox proportional hazards regression to data from Whites, African Americans, and Asian Americans who were diagnosed from 1987 to 1991.

Results. Patients with existing comorbid conditions were less likely than those without these conditions to be diagnosed with advanced cancer. Compared with Whites, African Americans (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.1, 2.2) and foreign-born Asian Americans (OR = 1.6; 95% CI = 1.0, 2.4) were more likely to be diagnosed with advanced cancer. Among men with localized disease, prostate cancer death rates were higher for African Americans than for Whites (death rate ratio = 2.3; 95% CI = 1.2, 4.7).

Conclusions. These findings support the need for further investigation of factors that affect access to and use of health care among African Americans and Asian Americans.
Navigating the Road to Implementation of the Health Insurance Portability and Accountability Act
Authors: Turner Shiloh , Foong Serena
Published: December 2008

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) has a profound impact on safety net providers. To help agencies afford expert consultation and provide the opportunity for collaboration, a regional health foundation has created the first model in the nation to bring together safety net providers to work toward implementation of the HIPAA.
Validity of Assessments of Youth Access to Tobacco: The Familiarity Effect
Authors: Landrine Hope , Klonoff Elizabeth A.
Published: December 2008

Objectives. We examined the standard compliance protocol and its validity as a measure of youth access to tobacco.

Methods. In Study 1, youth smokers reported buying cigarettes in stores where they are regular customers. In Study 2, youths attempted to purchase cigarettes by using the Standard Protocol, in which they appeared at stores once for cigarettes, and by using the Familiarity Protocol, in which they were rendered regular customers by purchasing nontobacco items 4 times and then requested cigarettes during their fifth visit.

Results. Sales to youths aged 17 years in the Familiarity Protocol were significantly higher than sales to the same age group in the Standard Protocols (62.5% vs. 6%, respectively).

Conclusions. The Standard Protocol does not match how youths obtain cigarettes. Access is low for stranger youths within compliance studies, but access is high for familiar youths outside of compliance studies.
Protecting the Public From Mercury Exposure: Success Through Microexchange Events
Authors: Shoemaker Paul A. , Ghaemghami Jalal
Published: December 2008

Mercury is a growing environmental threat that can cause serious health problems and birth defects. Household thermometers are high-risk sources of mercury because most people lack the knowledge to properly dispose of one when it is broken. The Boston Public Health Commission’s Environmental Health Office, with local and national partners, created the Boston Mercury Thermometer Exchange Program to address this hazard.

Large central exchanges are successful, but multiple smaller targeted “microexchanges” can be another effective way to reach the general public and specific vulnerable subpopulations such as the elderly, the homebound disabled, or recent immigrants. By conducting exchanges in community health centers and public housing developments for the elderly and disabled, and by working through home health care providers, the program collected 4477 thermometers.
Racial and Ethnic Disparities in Emergency Department Analgesic Prescription
Authors: Tamayo-Sarver Joshua H. , Hinze Susan W. , Cydulka Rita K. , Baker David W.
Published: December 2008

Objectives. We examined racial and ethnic disparities in analgesic prescription among a national sample of emergency department patients.

Methods. We analyzed Black, Latino, and White patients in the 1997–1999 National Hospital Ambulatory Medical Care Surveys to compare prescription of any analgesics and opioid analgesics by race/ethnicity.

Results. For any analgesic, no association was found between race and prescription; opioids, however, were less likely to be prescribed to Blacks than to Whites with migraines and back pain, though race was not significant for patients with long bone fracture. Differences in opioid use between Latinos and Whites with the same conditions were less and nonsignificant.

Conclusions. Physicians were less likely to prescribe opioids to Blacks; this disparity appears greatest for conditions with fewer objective findings (e.g., migraine).
Secular Trends in Adolescent Never Smoking From 1990 to 1999 in California: An Age–Period–Cohort Analysis
Authors: Chen Xinguang , Li Guohua , Unger Jennifer B. , Liu Xiaowei , Johnson C. Anderson
Published: December 2008

Objectives. We analyzed age, time period, and cohort effects on trends in adolescent cigarette smoking in California from 1990 to 1999.

Methods. Data from subjects aged 12 to 17 years (n = 26 536; 50.4% male) from the California Tobacco Survey and the California Youth Tobacco Survey were analyzed, and never smokers were used as the outcome measure.

Results. The proportion of never smokers increased from 60% for males and 66% for females in 1990 to around 70% for both sexes in 1999. Respondents were more likely to be never smokers if born in 1978 or later (i.e., aged 12 years or younger in 1990, when most tobacco control programs started in California).

Conclusions. The statewide antitobacco programs prevented adolescents from starting to smoke, primarily through a cohort effect.
Winners and Losers: Expansion of Insurance Coverage in Russia in the 1990s
Authors: Balabanova Dina C. , Falkingham Jane , McKee Martin
Published: December 2008

Objectives. This study sought to describe the evolution of the Russian compulsory health insurance system and to identify factors associated with noncoverage.

Methods. Data from successive waves of the Russian Longitudinal Monitoring Survey (1992–2000) were analyzed.

Results. Insurance coverage grew rapidly throughout the 1990s, although 11.8% of the country’s citizens were still uninsured by 2000. Coverage initiation rates were greater at first among citizens who were better off, but this gap closed over the study period. Among individuals of working age, coverage rates diminished with age and were lower for the unemployed, for the self-employed, and for those residing outside Moscow or St. Petersburg.

Conclusions. The growth of insurance coverage in Russia slowed toward the end of the 1990s, and gaps remain. Achievement of universal coverage will require new, targeted policies.
Domestic Elder Abuse and the Law
Authors: Jogerst Gerald J. , Daly Jeanette M. , Brinig Margaret F. , Dawson Jeffrey D. , Schmuch Gretchen A. , Ingram Jerry G.
Published: December 2008

Objectives. The authors evaluated the impact of state adult protective service legislation on rates of investigated and substantiated domestic elder abuse.

Methods. Data were collected on all domestic elder abuse reports, investigations, and substantiations for each US state and the District of Columbia for 1999. State statutes and regulations pertaining to adult protective services were reviewed.

Results. There were 190 005 domestic elder abuse reports from 17 states, a rate of 8.6 per 1000 elders; 242 430 domestic elder abuse investigations from 47 states, a rate of 5.9; and 102 879 substantiations from 35 states, a rate of 2.7. Significantly higher investigation rates were found for states requiring mandatory reporting and tracking of numbers of reports.

Conclusions. Domestic elder abuse documentation among states shows substantial differences related to specific aspects of state laws. (Am J Public Health. 2003;93:2131–2136)
Population Health in Canada: A Brief Critique
Authors: Coburn David , Denny Keith , Mykhalovskiy Eric , McDonough Peggy , Robertson Ann , Love Rhonda
Published: December 2008

An internationally influential model of population health was developed in Canada in the 1990s, shifting the research agenda beyond health care to the social and economic determinants of health. While agreeing that health has important social determinants, the authors believe that this model has serious shortcomings; they critique the model by focusing on its hidden assumptions.

Assumptions about how knowledge is produced and an implicit interest group perspective exclude the sociopolitical and class contexts that shape interest group power and citizen health. Overly rationalist assumptions about change understate the role of agency.

The authors review the policy and practice implications of the Canadian population health model and point to alternative ways of viewing the determinants of health.
Implications of the World Trade Center Attack for the Public Health and Health Care Infrastructures
Authors: Klitzman Susan , Freudenberg Nicholas
Published: December 2008

The September 11, 2001, attack on the World Trade Center had profound effects on the well-being of New York City.

The authors describe and assess the strengths and weaknesses of the city’s response to the public health, environmental/ occupational health, and mental health dimensions of the attack in the first 6 months after the event. They also examine the impact on the city’s health care and social service system.

The authors suggest lessons that can inform the development of a post–September 11th agenda for strengthening urban health infrastructures.
The Population Health Approach in Historical Perspective
Authors: Szreter Simon
Published: December 2008

The origin of the population health approach is an historic debate over the relationship between economic growth and human health.

In Britain and France, the Industrial Revolution disrupted population health and stimulated pioneering epidemiological studies, informing the early preventive public health movement. A century-long process of political adjustment between the forces of liberal democracy and propertied interests ensued.

The 20th-century welfare states resulted as complex political mechanisms for converting economic growth into enhanced population health. However, the rise of a “neoliberal” agenda, denigrating the role of government, has once again brought to the fore the importance of prevention and a population health approach to map and publicize the health impacts of this new phase of “global” economic growth.
Adolescent Health in the Caribbean: Risk and Protective Factors
Authors: Blum Robert W. , Halcón Linda , Beuhring Trish , Pate Ernest , Campell-Forrester Sheila , Venema Anneke
Published: December 2008

Objectives. This study sought to identify, among youths, factors associated with characteristics such as poor health status, substance use, and suicide risk and to explore the extent to which the risk and protective factors identified cut across health-compromising behaviors.

Methods. A survey was administered to representative samples of young people from 9 Caribbean countries.

Results. Physical/sexual abuse and having a friend or relative who had attempted suicide were associated with an increased prevalence of health-compromising behaviors. Connectedness with parents and school and attendance at religious services were associated with fewer health risk behaviors.

Conclusions. When the identified risk and protective factors were compared with those seen among young people in the United States, similarities as well as important differences were found.
Chevron v Echazabal: Public Health Issues Raised by the “Threat-to-Self” Defense to Adverse Employment Actions
Authors: Barnes Mark , Cleaveland Kimberlee A. , Florencio Patrik S.
Published: December 2008

In June of 2002, the US Supreme Court upheld a regulation that allows employers, under the Americans with Disabilities Act, to make disability-related employment decisions based on risks to an employee’s own personal health or safety. Previous judicial decisions had allowed employers to make employment decisions based on the threat that a worker’s medical condition posed to others but had not addressed the issue of risk posed to an employee’s health by his or her own disability.

The authors comment on the potential effects of the court’s decision for occupational health practitioners charged with assessing the degree of risk and harm of a particular workplace environment and for public health efforts aimed at curbing workplace injury and sickness.
Chevron v Echazabal: Protection, Opportunity, and Paternalism
Authors: Daniels Norman
Published: December 2008

The Supreme Court, in Chevron v Echazabal, ruled that risks to a disabled worker, if established by an individualized medical assessment, can disqualify the worker from protections offered by the Americans with Disabilities Act (ADA). This decision rejected the antipaternalist position of ADA advocates that workers with disabilities should be able to determine, through their own consent, the risks they will take.

Such strong antipaternalism may not be compatible with the underlying justification for the protection of workers against health hazards. Stringent regulation of workplace hazards involves restricting the scope of consent to risk.

Resolution of this conflict will depend on more careful examination of the degree to which individualized medical assessments avoid stereotyping and bias.
Altria Means Tobacco: Philip Morris’s Identity Crisis
Authors: Smith Elizabeth A. , Malone Ruth E.
Published: December 2008

Philip Morris Companies, the world’s largest and most profitable tobacco seller, has changed its corporate name to The Altria Group. The company has also embarked on a plan to improve its corporate image.

Examination of internal company documents reveals that these changes have been planned for over a decade and that the company expects to reap specific and substantial rewards from them.

Tobacco control advocates should be alert to the threat Philip Morris’s plans pose to industryfocused tobacco control campaigns.

Company documents also suggest what the vulnerabilities of those plans are and how advocates might best exploit them.
Reconsidering Community-Based Health Promotion: Promise, Performance, and Potential
Authors: Merzel Cheryl , D’Afflitti Joanna
Published: December 2008

Contemporary public health emphasizes a community-based approach to health promotion and disease prevention. The evidence from the past 20 years indicates, however, that many community-based programs have had only modest impact, with the notable exception of a number of HIV prevention programs.

To better understand the reasons for these outcomes, we conducted a systematic literature review of 32 community-based prevention programs. Reasons for poor performance include methodological challenges to study design and evaluation, concurrent secular trends, smaller-than-expected effect sizes, limitations of the interventions, and limitations of theories used.

The effectiveness of HIV programs appears to be related in part to extensive formative research and an emphasis on changing social norms.
Have Health Conditions Associated With Latex Increased Since the Issuance of Universal Precautions?
Authors: McCall Brian P. , Horwitz Irwin B. , Kammeyer-Mueller John D.
Published: December 2008

Objectives. This study explored whether the prevalence of latex-related health conditions has increased among individuals employed in medical occupations relative to those employed in nonmedical occupations since the issuance of universal precautions in 1987.

Methods. Data derived from the 1983 to 1994 versions of the National Health Interview Survey were used to obtain odds ratios comparing prevalence rates of latex-related symptoms over time.

Results. No statistical evidence was found that the universal precautions resulted in increased prevalence rates of latex-related health conditions among medical workers relative to those employed in nonmedical occupations.

Conclusions. Increased use of latex gloves among health care personnel subsequent to the implementation of universal precautions appears to have had no effect on latex allergic reactions experienced by these workers.
Changes of Attitudes and Patronage Behaviors in Response to a Smoke-Free Bar Law
Authors: Tang Hao , Cowling David W. , Lloyd Jon C. , Rogers Todd , Koumjian Kristi L. , Stevens Colleen M. , Bal Dileep G.
Published: December 2008

Objectives. We examined patron responses to a California smoke-free bar law.

Methods. Three telephone surveys measured attitudes and behavior changes after implementation of the law.

Results. Approval of the law rose from 59.8% to 73.2% (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.58, 2.40). Self-reported noncompliance decreased from 24.6% to 14.0% (OR = 0.50; 95% CI = 0.30, 0.85). Likelihood of visiting a bar or of not changing bar patronage after the law was implemented increased from 86% to 91% (OR = 1.76; 95% CI = 1.29, 2.40).

Conclusions. California bar patrons increasingly support and comply with the smoke-free bar law.
Primary Care: Is There Enough Time for Prevention?
Authors: Yarnall Kimberly S. H. , Pollak Kathryn I. , Østbye Truls , Krause Katrina M. , Michener J. Lloyd
Published: December 2008

Objectives. We sought to determine the amount of time required for a primary care physician to provide recommended preventive services to an average patient panel.

Methods. We used published and estimated times per service to determine the physician time required to provide all services recommended by the US Preventive Services Task Force (USPSTF), at the recommended frequency, to a patient panel of 2500 with an age and sex distribution similar to that of the US population.

Results. To fully satisfy the USPSTF recommendations, 1773 hours of a physician’s annual time, or 7.4 hours per working day, is needed for the provision of preventive services.

Conclusions. Time constraints limit the ability of physicians to comply with preventive services recommendations.
The Gender Gap in Heart Disease: Lessons From Eastern Europe
Authors: Weidner Gerdi , Cain Virginia S.
Published: December 2008

Why are men more susceptible to heart disease than women? Traditional risk factors cannot explain the gender gap in coronary heart disease (CHD) or the rapid increase in CHD mortality among middle-aged men in many of the newly independent states of Eastern Europe.

However, Eastern European men score higher on stressrelated psychosocial factors than men living in the West. Comparisons between the sexes also reveal differences in psychosocial and behavioral coronary risk factors favoring women, indicating that women’s coping with stressful events may be more cardioprotective.

Men’s greater susceptibility to heart disease, particularly observable in many Eastern European countries, poses unique threats to public health and points to solutions in the behavioral and social arena.
The Health Status of American Indian and Alaska Native Males
Authors: Rhoades Everett R.
Published: December 2008

Objectives. This study summarizes current health status information relating to American Indian and Alaska Native (AI/AN) males compared with that of AI/ANfemales.

Methods. I analyzed published data from the Indian Health Service for 1994 through 1996 to determine sex differences in morbidity and mortality rates and use of health care facilities.

Results. AI/AN males’ death rates exceed those of AI/AN females for every age up to 75 years and for 6 of the 8 leading causes of death. Accidents, suicide, and homicide are epidemic among AI/AN males. Paradoxically, AI/AN males contribute only 37.9% of outpatient visits, versus 62.1% for females, and only 47% of hospitalizations excluding childbirth.

Conclusions. AI/AN males suffer inordinately from a combination of increased burden of illness and lack of utilization of health care services. Programs targeted to anomie, loss of traditional male roles, and violence and alcoholism are among the most urgently needed.
Receipt of Preventive Care Among Adults: Insurance Status and Usual Source of Care
Authors: DeVoe Jennifer E. , Fryer George E. , Phillips Robert , Green Larry
Published: December 2008

Objectives. This study ascertained the separate and combined effects of having insurance and a usual source of care on receiving preventive services.

Methods. Descriptive and multivariate analyses of 1996 Medical Expenditure Panel Survey data were conducted.

Results. Receipt of preventive services was strongly associated with insurance and a usual source of care. Significant differences were found between insured adults with a usual source of care, who were most likely to have received services, compared with uninsured adults without regular care, who were least likely to have received services. Those with either a usual source of care or insurance had intermediate levels of preventive services.

Conclusions. Having a usual source of care and health insurance are both important to achieving national prevention goals.
Markers of Access to and Quality of Primary Care for Aboriginal People in Ontario, Canada
Authors: Shah Baiju R. , Gunraj Nadia , Hux Janet E.
Published: December 2008

Objectives. We evaluated primary care accessibility and quality for Ontario’s aboriginal population.

Methods. We compared a defined aboriginal cohort with nonaboriginal populations with analogous geographic isolation and low socioeconomic status. We determined rates of hospitalization for the following indicators of adequacy of primary care: ambulatory care–sensitive (ACS) conditions and utilization of referral care–sensitive (RCS) procedures from administrative databases.

Results. ACS hospitalization rates, relative to the general population, were 2.54, 1.50, and 1.14 for the aboriginal population, the geographic control populations, and the socioeconomic control populations, respectively. The relative RCS procedure utilization rates were 0.64, 0.91, and 1.00, respectively.

Conclusions. The increased ACS hospitalization rate and reduced RCS procedure utilization rate suggest that northern Ontario’s aboriginal residents have insufficient or ineffective primary care.
Sex Without Disclosure of Positive HIV Serostatus in a US Probability Sample of Persons Receiving Medical Care for HIV Infection
Authors: Ciccarone Daniel H. , Kanouse David E. , Collins Rebecca L. , Miu Angela , Chen James L. , Morton Sally C. , Stall Ron
Published: December 2008

Objectives. We estimated the proportion of HIV-positive adults who have any sexual contact without disclosure and the proportion of their sexual partnerships that involve unprotected sex without disclosure.

Methods. We drew participants from the HIV Cost and Services Utilization Study (n = 1421). Interviews assessed disclosure and sexual activities with up to 5 recent partners.

Results. Overall, 42% of the gay or bisexual men, 19% of the heterosexual men, and 17% of all the women reported any sex without disclosure, predominately within nonexclusive partnerships (P < .001). Across all groups, 13% of serodiscordant partnerships involved unprotected anal or vaginal sex without disclosure, with no significant difference between groups.

Conclusions. Risky sex without disclosure of serostatus is not uncommon among people with HIV.
Malaria Films: Motion Pictures as a Public Health Tool
Authors: Fedunkiw Marianne
Published: December 2008

I offer a historical examination of a group of malaria motion pictures, a subset of a larger genre of public health films. The majority of these more than 100 films were produced or coproduced by American and British agencies or production companies since 1940. The material is divided into 5 chronological periods, which include World War II, the postcolonial or DDT era (1946–1961), and the past 2 decades.

The films themselves, I argue, represent a unique record of preventive measures, clinical techniques, and sociocultural biases, all within the context of a history of one of the greatest continuing challenges in public health. The malaria films, as a group, represent a large body of work that has not yet been brought together or analyzed as historical sources.
Violence Against Women in Mexico: A Study of Abuse Before and During Pregnancy
Authors: Castro Roberto , Peek-Asa Corinne , Ruiz Agustin
Published: December 2008

Objective. We identified the prevalence and types of violence experienced by pregnant women, the ways victimization changed during pregnancy from the year prior to pregnancy, and factors associated with violence during pregnancy.

Methods. We interviewed 914 pregnant women treated in health clinics in Mexico about violence during and prior to pregnancy, violence during childhood and against their own children, and other socioeconomic indicators.

Results. Approximately one quarter of the women experienced violence during pregnancy. The severity of emotional violence increased during pregnancy, whereas physical and sexual violence decreased. The strongest predictors of abuse were violence prior to pregnancy, low socioeconomic status, parental violence witnessed by women in childhood, and violence in the abusive partner’s childhood. The probability of violence during pregnancy for women experiencing all of these factors was 61%.

Conclusions. Violence is common among pregnant women, but pregnancy does not appear to be an initiating factor. Intergenerational violence is highly predictive of violence during pregnancy.
Childhood Residential Stability and Health at Midlife
Authors: Bures Regina M.
Published: December 2008

Objectives. This study examined the association between 2 dimensions of adults’ self-rated health and residential stability in childhood.

Methods. Using data from the nationally representative survey Midlife in the United States, I assessed the impact of neighborhood and family stability on positive perceptions of global health and mental health in midlife.

Results. Neighborhood stability in childhood is associated with a significant increase in the likelihood that an individual will rate his or her global health highly in midlife. Both neighborhood and family stability are positively associated with good mental health in midlife.

Conclusions. These results demonstrate that both childhood family stability and adult social context are associated with health outcomes later in life. (Am J Public Health. 2003;93:1144–1148)
Income Inequality, Household Income, and Health Status in Canada: A Prospective Cohort Study
Authors: McLeod Christopher B. , Lavis John N. , Mustard Cameron A. , Stoddart Greg L.
Published: December 2008

Objectives. This study sought to determine whether income inequality, household income, and their interaction are associated with health status.

Methods. Income inequality and area income measures were linked to data on household income and individual characteristics from the 1994 Canadian National Population Health Survey and to data on self-reported health status from the 1994, 1996, and 1998 survey waves.

Results. Income inequality was not associated with health status. Low household income was consistently associated with poor health. The combination of low household income and residence in a metropolitan area with less income inequality was associated with poorer health status than was residence in an area with more income inequality.

Conclusions. Household income, but not income inequality, appears to explain some of the differences in health status among Canadians.
Income Inequality, Illiteracy Rate, and Life Expectancy in Brazil
Authors: Messias Erick
Published: December 2008

Objectives. The link between income disparities and health has been studied mostly in developed nations. This study assesses the relationship between income disparities and life expectancy in Brazil and measures the impact of illiteracy rates on the association.

Methods. The units of analysis (n = 27) are all the Brazilian states and the federal capital. Simple and multiple linear regressions were performed to measure the association between income disparity, measured by the Gini coefficient, gross domestic product (GDP) per capita, and illiteracy rate. Data came from publicly available sources at the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics.

Results. Income disparities and illiteracy rates were negatively associated with life expectancy in Brazil. GDP per capita was positively associated with life expectancy. The inclusion of illiteracy rates in the regression model removed the effect of income disparities.

Conclusions. Illiteracy rate is strongly associated with life expectancy in Brazil. This finding is in accord with reports from the United States and has implications for health policy and planning for both developed and developing countries.
A Medicaid Population’s Use of Physicians’ Offices for Dental Problems
Authors: Cohen Leonard A. , Manski Richard J. , Magder Laurence S. , Mullins C. Daniel
Published: December 2008

Objectives. This study evaluated how the elimination of Medicaid reimbursement to dentists for the treatment of adult dental problems affected patients’ visits to physicians.

Methods. Data tapes describing physicians’ claims for adult Medicaid patients were obtained from the Maryland Medicaid Management Information System. The database contains information on all claims made to Maryland Medicaid, including date, provider, International Classification of Diseases, Ninth Revision, Clinical Modification Manual code, and payments.

Results. A total of 5334 individuals made physician’s office claims related to dental problems sometime during the 4-year study period. The rate of dental-related claims by physicians decreased by 8% after the policy change.

Conclusions. Visits to physicians’ offices decreased even though an increase might have been expected because of the elimination of access to dentists in private practice. Patients might have assumed that if visits to dentists would no longer be paid for, neither would visits to physicians’ offices.
Portrayals of Overweight and Obese Individuals on Commercial Television
Authors: Greenberg Bradley S. , Eastin Matthew , Hofschire Linda , Lachlan Ken , Brownell Kelly D.
Published: December 2008

Objectives. This study examined the distribution and individual characteristics of body types on prime-time television.

Methods. Five episodes of each of the 10 top-rated prime-time fictional programs on 6 broadcast networks during the 1999–2000 season were quantitatively analyzed.

Results. Of 1018 major television characters, 14% of females and 24% of males were overweight or obese, less than half their percentages in the general population. Overweight and obese females were less likely to be considered attractive, to interact with romantic partners, or to display physical affection. Overweight and obese males were less likely to interact with romantic partners and friends or to talk about dating and were more likely to be shown eating.

Conclusions. Overweight and obese television characters are associated with specific negative characteristics.
The Intersection of Urban Planning, Art, and Public Health: The Sunnyside Piazza
Authors: Semenza Jan C.
Published: December 2008

Deteriorating physical features of urban environments can negatively influence public health. Dilapidated environments and urban blight tend to promote alienation and can be associated with social disorder, vandalism, crime, drug abuse, traffic violations, and littering, which in turn affects health and well-being.

In the late 1990s, the Sunnyside neighborhood in Portland, Ore, was plagued by many of these problems. In an attempt to invigorate neighborhood stewardship, the community organized and created a public gathering place; together, they painted a gigantic sunflower in the middle of an intersection and installed several interactive art features.

As a result of these collective actions of “place-making,” social capital has increased, thus revitalizing the community, and expanded social networks among residents have stimulated a sense of well-being.
Creating Healthy Communities, Healthy Homes, Healthy People: Initiating a Research Agenda on the Built Environment and Public Health
Authors: Srinivasan Shobha , O’Fallon Liam R. , Dearry Allen
Published: December 2008

Mounting evidence suggests physical and mental health problems relate to the built environment, including human-modified places such as homes, schools, workplaces, parks, industrial areas, farms, roads and highways. The public health relevance of the built environment requires examination.

Preliminary research demonstrates the health benefits of sustainable communities. However, the impact of mediating and moderating factors within the built environment on health must be explored further. Given the complexity of the built environment, understanding its influence on human health requires a community-based, multilevel, interdisciplinary research approach.

The authors offer recommendations, based upon a recent conference sponsored by the National Institute of Environmental Health Sciences (NIEHS), for research and policy approaches, and suggest interagency research alliances for greater public health impact.
Healthy Places: Exploring the Evidence
Authors: Frumkin Howard
Published: December 2008

“Sense of place” is a widely discussed concept in fields as diverse as geography, environmental psychology, and art, but it has little traction in the field of public health. The health impact of place includes physical, psychological, social, spiritual, and aesthetic outcomes.

In this article, the author introduces sense of place as a public health construct. While many recommendations for “good places” are available, few are based on empirical evidence, and thus they are incompatible with current public health practice. Evidence-based recommendations for healthy place making could have important public health implications.

Four aspects of the built environment, at different spatial scales—nature contact, buildings, public spaces, and urban form—are identified as offering promising opportunities for public health research, and potential research agendas for each are discussed.
A Review of Evidence-Based Traffic Engineering Measures Designed to Reduce Pedestrian–Motor Vehicle Crashes
Authors: Retting Richard A. , Ferguson Susan A. , McCartt Anne T.
Published: December 2008

We provide a brief critical review and assessment of engineering modifications to the built environment that can reduce the risk of pedestrian injuries.

In our review, we used the Transportation Research Information Services database to conduct a search for studies on engineering countermeasures documented in the scientific literature. We classified countermeasures into 3 categories—speed control, separation of pedestrians from vehicles, and measures that increase the visibility and conspicuity of pedestrians. We determined the measures and settings with the greatest potential for crash prevention.

Our review, which emphasized inclusion of studies with adequate methodological designs, showed that modification of the built environment can substantially reduce the risk of pedestrian–vehicle crashes.
Health, Supportive Environments, and the Reasonable Person Model
Authors: Kaplan Stephen , Kaplan Rachel
Published: December 2008

The Reasonable Person Model is a conceptual framework that links environmental factors with human behavior. People are more reasonable, cooperative, helpful, and satisfied when the environment supports their basic informational needs. The same environmental supports are important factors in enhancing human health.

We use this framework to identify the informational requirements common to various health-promoting factors that are realizable through welldesigned physical environments. Environmental attractors, support of way-finding, and facilitation of social interaction all contribute to the health-relevant themes of community, crime, and mode of transportation. In addition, the nearby natural environment, although often neglected, can serve as a remarkably effective resource.
Mortality Risk Associated With Leaving Home: Recognizing the Relevance of the Built Environment
Authors: Lucy William H.
Published: December 2008

Objectives. I analyzed traffic fatalities and homicides related to leaving home for routine activities, and considered connections between these fatalities and the built environment.

Methods. I analyzed city, county, state, and federal data for traffic fatalities and homicides by strangers for 15 metropolitan areas, and classified deaths as occurring in the central city, in inner suburbs, or in outer suburbs (exurbs).

Results. Traffic fatality rates were highest in exurban areas. Combined traffic fatality and homicide-by-stranger rates were higher in some or all outer counties than in central cities or inner suburbs in all of the metropolitan areas studied.

Conclusions. Traffic fatalities are largely unrecognized as a danger to be factored into residential location decisions. Land use controls that deter sprawl along narrow exurban roads can reduce the mortality risks associated with leaving home.
Relative Influences of Individual, Social Environmental, and Physical Environmental Correlates of Walking
Authors: Giles-Corti Billie , Donovan Robert J.
Published: December 2008

Objectives. This study sought to examine individual, social environmental, and physical environmental correlates of walking.

Methods. A cross-sectional survey was conducted among healthy workers and homemakers residing in metropolitan Perth, Western Australia.

Results. Most respondents walked for transport or recreation, but only 17.2% did a sufficient amount of walking to accrue health benefits. After adjustment, the relative influences of individual, social environmental, and physical environmental factors were found to be almost equally important.

Conclusions. Although walking is popular, few people do enough walking to benefit their health. Those who walk as well as engage in other physical activities appear more likely to achieve recommended levels of activity. Promoting walking may require a comprehensive strategy.
Are Rates of Psychiatric Disorders in the Homeless Population Changing?
Authors: North Carol S. , Eyrich Karin M. , Pollio David E. , Spitznagel Edward L.
Published: December 2008

Objectives. We examined the prevalence of psychiatric illness among 3 homeless populations in St. Louis, Mo, in approximately 1980, 1990, and 2000. The 3 studies were conducted with the same systemic research methodology.

Methods. We compared selected demographics and lifetime substance abuse and dependence and other mental illness among the 3 populations.

Results. Among the homeless populations we studied, the prevalence of mood and substance use disorders dramatically increased, and the number of minorities within these populations has increased.

Conclusions. The prevalence of psychiatric illness, including substance abuse and dependence, is not static in the homeless population. Service systems need to be aware of potential prevalence changes and the impact of these changes on service needs.
Risk and Protective Factors for Adult and Child Hunger Among Low-Income Housed and Homeless Female-Headed Families
Authors: Wehler Cheryl , Weinreb Linda F. , Huntington Nicholas , Scott Richard , Hosmer David , Fletcher Kenneth , Goldberg Robert , Gundersen Craig
Published: December 2008

Objectives. We sought to identify factors associated with adult or child hunger.

Methods. Low-income housed and homeless mothers were interviewed about socioeconomic, psychosocial, health, and food sufficiency information. Multinomial logistic regression produced models predicting adult or child hunger.

Results. Predictors of adult hunger included mothers’ childhood sexual molestation and current parenting difficulties, or “hassles.” Risk factors for child hunger included mothers’ childhood sexual molestation, housing subsidies, brief local residence, having more or older children, and substandard housing.

Conclusions. This study found that the odds of hunger, although affected by resource constraints in low-income female-headed families, were also worsened by mothers’ poor physical and mental health. Eliminating hunger thus may require broader interventions than food programs.
Social Science and Health Research: Growth at the National Institutes of Health
Authors: Bachrach Christine A. , Abeles Ronald P.
Published: December 2008

Programs within the National Institutes of Health (NIH) have recently taken steps to enhance social science contributions to health research.

A June 2000 conference convened by the NIH Office of Behavioral and Social Sciences Research highlighted the role of the social sciences in health research and developed an agenda for advancing such research. The conference and agenda underscored the importance of research on basic social scientific concepts and constructs, basic social science research on the etiology of health and illness, and the application of basic social science constructs in health services, treatment, and prevention research.

Recent activities at NIH suggest a growing commitment to social science research and its integration into interdisciplinary multilevel studies of health.
Relationship Between Continuity of Care and Diabetes Control: Evidence From the Third National Health and Nutrition Examination Survey
Authors: Mainous Arch G. , Koopman Richelle J. , Gill James M. , Baker Richard , Pearson William S.
Published: December 2008

Objectives. We examined the relationship between continuity of care and diabetes control.

Methods. We analyzed data on 1400 adults with diabetes who took part in the Third National Health and Nutrition Examination Survey. We examined the relationship of continuity of care with glycemic, blood pressure, and lipid control.

Results. Continuity of care was associated with both acceptable and optimal levels of glycemic control. Continuity was not associated with blood pressure or lipid control. There was no difference between having a usual site but no usual provider and having a usual provider in any of the investigated outcomes.

Conclusions. Continuity of care is associated with better glycemic control among people with diabetes. Our results do not support a benefit of having a usual provider above having a usual site of care.
Suicide and Friendships Among American Adolescents
Authors: Bearman Peter S. , Moody James
Published: December 2008

Objectives. We investigated the relationship between friendships and suicidality among male and female adolescents.

Methods. We analyzed friendship data on 13 465 adolescents from the National Longitudinal Survey of Adolescent Health to explore the relationship between friendship and suicidal ideation and suicide attempts. We controlled for known factors associated with suicidality.

Results. Having had a friend who committed suicide increased the likelihood of suicidal ideation and attempts for both boys and girls. Socially isolated females were more likely to have suicidal thoughts, as were females whose friends were not friends with each other. Among adolescents thinking about suicide, suicide attempts appear largely stochastic, with few consistent risk factors between boys and girls.

Conclusions. The friendship environment affects suicidality for both boys and girls. Female adolescents’ suicidal thoughts are significantly increased by social isolation and friendship patterns in which friends were not friends with each other.
Substance Use Among Adults 35 Years of Age: Prevalence, Adulthood Predictors, and Impact of Adolescent Substance Use
Authors: Merline Alicia C. , O’Malley Patrick M. , Schulenberg John E. , Bachman Jerald G. , Johnston Lloyd D.
Published: December 2008

Objectives. We examined the prevalence of substance use among American adults aged 35 years, and we considered adulthood predictors and the impact of adolescent substance use.

Methods. National panel data were drawn from the Monitoring the Future study. Logistic regressions were conducted to assess the impact of demographics, life experiences, and adolescent substance use on smoking, heavy drinking, prescription drug misuse, marijuana use, and cocaine use at 35 years of age.

Results. Factors related to increased likelihood of substance use include high school use, unemployment, and noncustodial parenthood. Lower use was associated with being female, a college graduate, a professional, married, or a custodial parent.

Conclusions. Among those aged 35 years, substance use was still rather prevalent and was a function of adulthood roles, experiences, and previous use.
Rural Public Health Service Delivery: Promising New Directions
Authors: Berkowitz Bobbie
Published: December 2008

I describe variations in the structure and in the practice of rural public health and how rural communities meet the challenges of current public health practice, including primary methods of service delivery and partnership development.

I present examples of promising models for the creation of rural public health capacity—the ability of local health departments to carry out core public health responsibilities.