bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes, Safety, and Resource Utilization in a Collaborative Care Birth Center Program Compared With Traditional Physician-Based Perinatal Care
Authors: Jackson Debra J. , Lang Janet M. , Swartz William H. , Ganiats Theodore G. , Fullerton Judith , Ecker Jeffrey , Nguyen Uyensa
Published: December 2008

Objective. We compared outcomes, safety, and resource utilization in a collaborative management birth center model of perinatal care versus traditional physician-based care.

Methods. We studied 2957 low-risk, low-income women: 1808 receiving collaborative care and 1149 receiving traditional care.

Results. Major antepartum (adjusted risk difference [RD] = −0.5%; 95% confidence interval [CI] = −2.5, 1.5), intrapartum (adjusted RD = 0.8%; 95% CI = −2.4, 4.0), and neonatal (adjusted RD = −1.8%; 95% CI = −3.8, 0.1) complications were similar, as were neonatal intensive care unit admissions (adjusted RD = −1.3%; 95% CI = −3.8, 1.1). Collaborative care had a greater number of normal spontaneous vaginal deliveries (adjusted RD = 14.9%; 95% CI = 11.5, 18.3) and less use of epidural anesthesia (adjusted RD = −35.7%; 95% CI = −39.5, −31.8).

Conclusions. For low-risk women, both scenarios result in safe outcomes for mothers and babies. However, fewer operative deliveries and medical resources were used in collaborative care.
Community-Provider Partnerships to Reduce Immunization Disparities: Field Report From Northern Manhattan
Authors: Findley Sally E. , Irigoyen Matilde , See Donna , Sanchez Martha , Chen Shaofu , Sternfels Pamela , Caesar Arturo
Published: December 2008

In 1996 we launched a community–provider partnership to raise immunization coverage for children aged younger than 3 years in Northern Manhattan, New York City. The partnership was aimed at fostering provider knowledge and accountability, practice improvements, and community outreach. By 1999 the partnership included 26 practices and 20 community groups. Between 1996 and 1999, immunization coverage rates increased in Northern Manhattan 5 times faster than in New York City and 8 times faster than in the United States (respectively, 3.4% vs 0.4% [t = 6.05, p < 0.001] and vs 0.6% [t = 5.65, p < 0.001]). The coverage rate for Northern Manhattan stayed constant through 2000, although it declined during this period for the United States and New York City. We attribute the success at reducing the gap to the effectiveness of our partnership.
A Case–Control Study of Female-to-Female Nonintimate Violence in an Urban Area
Authors: Hirschinger Nancy B. , Grisso Jeane Ann , Wallace Donald B. , McCollum Kelly Farley , Schwarz Donald F. , Sammel Mary D. , Brensinger Colleen , Anderson Elijah
Published: December 2008

Objectives. The aims of this study were to describe the characteristics surrounding female-to-female nonpartner violence and to identify independent factors associated with risk of female-to-female intentional injuries.

Methods. A case–control investigation was conducted among women who resided in an urban, low-income community and presented for emergency department care for injuries inflicted by female nonpartners.

Results. Women were typically victimized by women they knew (88%), in outdoor locations (60%), and in the presence of others (91%). Those found to be at risk for injury typically were young and socially active, used marijuana, and had experienced other kinds of violence.

Conclusions. The present results showed that women injured by female nonpartners had limited resources, experienced disorder in their lives, and were the victims of violence within multiple relationships. (Am J Public Health. 2003;93:1098–1103)
Injury Hospitalization and Risks for Subsequent Self-Injury and Suicide: A National Study From New Zealand
Authors: Conner Kenneth R. , Langley John , Tomaszewski Kenneth J. , Conwell Yeates
Published: December 2008

Objectives. Risks for suicide and nonfatal self-injury hospitalizations associated with previous injury hospitalizations were investigated in a nationwide retrospective cohort study conducted in New Zealand.

Methods. Linked data from all New Zealand public hospitals were used to identify individuals with injury hospitalizations. Participants were followed for 12 months.

Results. Significantly increased age- and sex-adjusted relative risks for suicide were associated with previous hospitalization for self-injury, injuries of undetermined causes, and assault. Also, elevated risks were associated with these causes of hospitalization in the case of subsequent self-injury hospitalizations.

Conclusions. Results indicate that identifiable subgroups of individuals hospitalized for injuries are at marked risk for serious suicidal behavior and suggest the potential of targeted suicide prevention for these individuals.
Area Deprivation and Widening Inequalities in US Mortality, 1969–1998
Authors: Singh Gopal K.
Published: December 2008

Objectives. This study examined age-, sex-, and race-specific gradients in US mortality by area deprivation between 1969 and 1998.

Methods. A census-based area deprivation index was linked to county mortality data.

Results. Area deprivation gradients in US mortality increased substantially during 1969 through 1998. The gradients were steepest for men and women aged 25 to 44 years and those younger than 25 years, with higher mortality rates observed in more deprived areas. Although area gradients were less pronounced for women in each age group, they rose sharply for women aged 25 to 44 and 45 to 64 years.

Conclusions. Areal inequalities in mortality widened because of slower mortality declines in more deprived areas. Future research needs to examine population-level social, behavioral, and medical care factors that may account for the increasing gradient.
Food Environment in Secondary Schools: À La Carte, Vending Machines, and Food Policies and Practices
Authors: French Simone A. , Story Mary , Fulkerson Jayne A. , Gerlach Anne Faricy
Published: December 2008

Objectives. This study described the food environment in 20 Minnesota secondary schools.

Methods. Data were collected on school food policies and the availability and nutritional content of foods in school à la carte (ALC) areas and vending machines (VMs).

Results. Approximately 36% and 35% of foods in ALC areas and in VMs, respectively, met the lower-fat criterion (≤ 5.5 fat grams/serving). The chips/crackers category constituted the largest share of ALC foods (11.5%). The median number of VMs per school was 12 (4 soft drink, 2 snack, 5 other). Few school food policies were reported.

Conclusions. The availability of healthful foods and beverages in schools as well as school food policies that foster healthful food choices among students needs greater attention.
The Association of the School Food Environment With Dietary Behaviors of Young Adolescents
Authors: Kubik Martha Y. , Lytle Leslie A. , Hannan Peter J. , Perry Cheryl L. , Story Mary
Published: December 2008

Objectives. We examined the association between young adolescents’ dietary behaviors and school vending machines, à la carte programs, and fried potatoes’ being served at school lunch.

Methods. Using a cross-sectional study design, we measured à la carte availability and the number of school stores, vending machines, and amounts of fried potatoes served to students at school lunch in 16 schools. Grade 7 students (n = 598) completed 24-hour dietary recall interviews.

Results. À la carte availability was inversely associated with fruit and fruit/vegetable consumption and positively associated with total and saturated fat intake. Snack vending machines were negatively correlated with fruit consumption. Fried potatoes’ being served at school lunch was positively associated with vegetable and fruit/vegetable intake.

Conclusions. School-based programs that aim to promote healthy eating among youths should target school-level environmental factors.
The Fox Guarding the Chicken Coop: Monitoring Exposure to Respirable Coal Mine Dust, 1969–2000
Authors: Weeks James L.
Published: December 2008

Following passage of the Coal Mine Health and Safety Act of 1969, underground coal mine operators were required to take air samples in order to monitor compliance with the exposure limit for respirable dust, a task essential for the prevention of pneumoconiosis among coal workers. Miners objected, claiming that having the mine operators perform this task was like “having the fox guard the chicken coop.”

This article is a historical narrative of mining industry corruption and of efforts to reform the program of monitoring exposure to coal mine dust. Several important themes common to the practice of occupational health are illustrated; most prominently, that employers should not be expected to regulate themselves.
Should the Centers for Disease Control and Prevention’s Childhood Lead Poisoning Intervention Level Be Lowered?
Authors: Bernard Susan M.
Published: December 2008

The US Centers for Disease Control and Prevention (CDC) in 1991 chose 10 μg/dL as an initial screening level for lead in children’s blood.

Current data on health risks and intervention options do not support generally lowering that level, but federal lead poisoning prevention efforts can be improved by revising the follow-up testing schedule for infants aged 1 year or less with blood lead levels of 5 μg/dL or higher; universal education about lead exposure risks; universal administration of improved, locally validated risk-screening questionnaires; enhanced compliance with targeted screening recommendations and federal health program requirements; and development by regulatory agencies of primary prevention criteria that do not use the CDC’s intervention level as a target “safe” lead exposure.
Why Don’t We See More Translation of Health Promotion Research to Practice? Rethinking the Efficacy-to-Effectiveness Transition
Authors: Glasgow Russell E. , Lichtenstein Edward , Marcus Alfred C.
Published: December 2008

The gap between research and practice is well documented. We address one of the underlying reasons for this gap: the assumption that effectiveness research naturally and logically follows from successful efficacy research. These 2 research traditions have evolved different methods and values; consequently, there are inherent differences between the characteristics of a successful efficacy intervention versus those of an effectiveness one. Moderating factors that limit robustness across settings, populations, and intervention staff need to be addressed in efficacy studies, as well as in effectiveness trials. Greater attention needs to be paid to documenting intervention reach, adoption, implementation, and maintenance. Recommendations are offered to help close the gap between efficacy and effectiveness research and to guide evaluation and possible adoption of new programs.
Nondaily Smokers: Who Are They?
Authors: Hassmiller Kristen M. , Warner Kenneth E. , Mendez David , Levy David T. , Romano Eduardo
Published: December 2008

Objective. We sought to understand who constitutes the sizable population of nondaily, or some-day (SD), smokers.

Methods. We analyzed descriptive statistics and regression results using the 1998–1999 Current Population Survey Tobacco Use Supplement to determine the prevalence of SD smokers, their sociodemographic characteristics, and the smoking patterns and histories of groups differentiated by the length and stability of their SD smoking.

Results. SD smokers make up 19.2% of all current smokers. Among SD smokers, 44.6% have smoked less than daily for at least 1 year, no more than 14.4% are just starting to smoke, and the rest are likely in transition. Overall, SD smokers smoked a mean of 102 cigarettes per month (compared to 566.4 for daily smokers), on an average of 14.5 days out of the past 30.

Conclusions. SD smokers make up a substantial segment of the smoking population. They are not just beginning to smoke nor trying to quit. Many have developed a long-standing pattern of nondaily smoking, smoking relatively few cigarettes on the days when they do smoke. They are not substantially younger than daily smokers, as one might expect.
A Comparison of National Estimates From the National Health Interview Survey and the Behavioral Risk Factor Surveillance System
Authors: Nelson David E. , Powell-Griner Eve , Town Machell , Kovar Mary Grace
Published: December 2008

Objectives. The purpose of this study was to compare national estimates from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS).

Methods. The authors compared data from the 2 surveys on smoking, height, weight, body mass index, diabetes, hypertension, immunization, lack of insurance coverage, cost as a barrier to medical care, and health status.

Results. Overall national estimates were similar for 13 of the 14 measures examined. Small differences according to demographic characteristics were found for height and body mass index, with larger differences for health status.

Conclusions. Although estimates differed within subgroups, the BRFSS provided national estimates comparable to those of the NHIS. BRFSS national data could provide rapidly available information to guide national policy and program decisions.
Local Ordinances That Promote Physical Activity: A Survey of Municipal Policies
Authors: Librett John J. , Yore Michelle M. , Schmid Thomas L.
Published: December 2008

In this Utah-based study, we sought to identify the types of municipal employees responsible for physical activity policies, identify municipal ordinances that may influence physical activity, and determine local governments’ intentions to implement policies.

In 2001, we mailed a survey to all of the state’s municipalities with the goal of measuring 6 physical activity domains: sidewalks, bicycle lanes, shared-use paths, work sites, greenways, and recreational facilities. Data from 74 municipalities revealed that planners made up a small proportion of municipal staff. Relative to cities experiencing slow or medium growth, high growth cities reported more ordinances encouraging physical activity.

Physical activity policies can be monitored across municipalities. Moreover, evidence-based public health practice provides direction for limited staff and funding resources.
Health, Morality, and Housing: The “Tenement Problem” in Chicago
Authors: Garb Margaret
Published: December 2008

In this article, I trace the history of Chicago’s Health Department, exploring when and how housing conditions came to be considered a serious social problem requiring municipal regulation. Although journalists and labor leaders were among the first Chicagoans to link tenement housing to the spread of contagious disease, Health Department officials quickly began regulating the city’s housing stock under their own authority. I argue that in attempting to eliminate the dangers of contagious disease, a long-standing public health threat, health officials drew new attention to the dangers of multifamily dwellings and set a precedent for government regulation of living conditions in tenement dwellings.
Promoting Safe Walking and Biking to School: The Marin County Success Story
Authors: Staunton Catherine E. , Hubsmith Deb , Kallins Wendi
Published: December 2008

Walking and biking to school can be an important part of a healthy lifestyle, yet most US children do not start their day with these activities.

The Safe Routes to School Program in Marin County, California, is working to promote walking and biking to school. Using a multipronged approach, the program identifies and creates safe routes to schools and invites communitywide involvement. By its second year, the program was serving 4665 students in 15 schools.

Participating public schools reported an increase in school trips made by walking (64%), biking (114%), and carpooling (91%) and a decrease in trips by private vehicles carrying only one student (39%).
Community Gardens: Lessons Learned From California Healthy Cities and Communities
Authors: Twiss Joan , Dickinson Joy , Duma Shirley , Kleinman Tanya , Paulsen Heather , Rilveria Liz
Published: December 2008

Community gardens enhance nutrition and physical activity and promote the role of public health in improving quality of life. Opportunities to organize around other issues and build social capital also emerge through community gardens.

California Healthy Cities and Communities (CHCC) promotes an inclusionary and systems approach to improving community health. CHCC has funded community-based nutrition and physical activity programs in several cities. Successful community gardens were developed by many cities incorporating local leadership and resources, volunteers and community partners, and skills-building opportunities for participants.

Through community garden initiatives, cities have enacted policies for interim land and complimentary water use, improved access to produce, elevated public consciousness about public health, created culturally appropriate educational and training materials, and strengthened community building skills.
New Roads and Human Health: A Systematic Review
Authors: Egan Matt , Petticrew Mark , Ogilvie David , Hamilton Val
Published: December 2008

We sought to synthesize evidence of the health effects of construction of new roads by systematically reviewing observational studies of such effects. We included and critically appraised 32 studies.

The review suggested that out-of-town bypasses decrease injuries on main roads through or around towns, although more robust evidence is needed on effects on secondary roads. New major urban roads have statistically insignificant effects on injury incidence. New major roads between towns decrease injuries. Out-of-town bypasses reduce disturbance and community severance in towns but increase them elsewhere. Major urban roads increase disturbance and severance.

More robust research is needed in this area, particularly regarding effects of new roads on respiratory health, mental health, access to health services, and physical activity.
Healthy Housing: A Structured Review of Published Evaluations of US Interventions to Improve Health by Modifying Housing in the United States, 1990–2001
Authors: Saegert Susan C. , Klitzman Susan , Freudenberg Nicholas , Cooperman-Mroczek Jana , Nassar Salwa
Published: December 2008

We sought to characterize and to evaluate the success of current public health interventions related to housing.

Two reviewers contentanalyzed 72 articles selected from 12 electronic databases of US interventions from 1990 to 2001. Ninety-two percent of the interventions addressed a single condition, most often lead poisoning, injury, or asthma. Fifty-seven percent targeted children, and 13% targeted seniors. The most common intervention strategies employed a one-time treatment to improve the environment; to change behavior, attitudes, or knowledge; or both. Most studies reported statistically significant improvements, but few (14%) were judged extremely successful.

Current interventions are limited by narrow definitions of housing and health, by brief time spans, and by limited geographic and social scales. An ecological paradigm is recommended as a guide to more effective approaches.
Indoor Environments and Health: Moving Into the 21st Century
Authors: Samet Jonathan M. , Spengler John D.
Published: December 2008

The quality of our indoor environments affects well-being and productivity, and risks for diverse diseases are increased by indoor air pollutants, surface contamination with toxins and microbes, and contact among people at home, at work, in transportation, and in many other public and private places.

We offer an overview of nearly a century of research directed at understanding indoor environments and health, consider current research needs, and set out policy matters that need to be addressed if we are to have the healthiest possible built environments. The policy context for built environments extends beyond health considerations to include energy use for air-conditioning, selection of materials for sustainability, and design for safety, security, and productivity.
Promoting Safe Walking and Cycling to Improve Public Health: Lessons From The Netherlands and Germany
Authors: Pucher John , Dijkstra Lewis
Published: December 2008

Objectives. We examined the public health consequences of unsafe and inconvenient walking and bicycling conditions in American cities to suggest improvements based on successful policies in The Netherlands and Germany.

Methods. Secondary data from national travel and crash surveys were used to compute fatality trends from 1975 to 2001 and fatality and injury rates for pedestrians and cyclists in The Netherlands, Germany, and the United States in 2000.

Results. American pedestrians and cyclists were much more likely to be killed or injured than were Dutch and German pedestrians and cyclists, both on a per-trip and on a per-kilometer basis.

Conclusions. A wide range of measures are available to improve the safety of walking and cycling in American cities, both to reduce fatalities and injuries and to encourage walking and cycling.
Housing and Health in Europe: Preliminary Results of a Pan-European Study
Authors: Bonnefoy Xavier R. , Braubach Matthias , Moissonnier Brigitte , Monolbaev Kubanychbek , Röbbel Nathalie
Published: December 2008

Objectives. The World Health Organization’s Regional Office for Europe has undertaken a large study to evaluate housing and health in 7 European cities.

Methods. Survey tools were used to obtain information about housing and living conditions, health perception, and health status from a representative sample of the population in each city.

Results. In Forli, Italy, the first city studied, preliminary findings indicate some important potential links between housing and health.

Conclusions. These findings, when combined with those from the remaining European cities, will likely generate concrete recommendations for the allocation of resources to programs that can improve housing and health.
Moving to Opportunity: an Experimental Study of Neighborhood Effects on Mental Health
Authors: Leventhal Tama , Brooks-Gunn Jeanne
Published: December 2008

Objectives. The health consequences of neighborhood poverty are a public health problem. Data were obtained to examine links between neighborhood residence and mental health outcomes.

Methods. Moving to Opportunity was a randomized, controlled trial in which families from public housing in high-poverty neighborhoods were moved into private housing in near-poor or nonpoor neighborhoods, with a subset remaining in public housing. At the 3-year follow-up of the New York site, 550 families were reinterviewed.

Results. Parents who moved to low-poverty neighborhoods reported significantly less distress than parents who remained in high-poverty neighborhoods. Boys who moved to less poor neighborhoods reported significantly fewer anxious/depressive and dependency problems than did boys who stayed in public housing.

Conclusions. This study provides experimental evidence of neighborhood income effects on mental health.
Comparison of Health Status Indicators in Chicago: Are Black–White Disparities Worsening?
Authors: Margellos Helen , Silva Abigail , Whitman Steven
Published: December 2008

Objectives. This study examined Chicago residents’ progress toward the Healthy People 2000 goal of reducing racial disparities in health and compared the results with a recent analysis of US data.

Methods. Non-Hispanic Black–to–non-Hispanic White rate ratios were computed for 14 health status indicators for 1990 and for 1998.

Results. Nationally and in Chicago, indicators for both Blacks and Whites improved between 1990 and 1998; however, Whites consistently fared better. Nationally, gaps narrowed on 10 indicators; for Chicago, they widened on 10 indicators.

Conclusions. Nationally, there is apparent progress in reducing Black–White disparities; this is not true for Chicago. Whether failure to reduce racial disparities is unique to Chicago or is common to other urban centers remains an open question with important implications.
Racial/Ethnic Differences in Cigarette Smoking Initiation and Progression to Daily Smoking: A Multilevel Analysis
Authors: Kandel Denise B. , Kiros Gebre-Egziabher , Schaffran Christine , Hu Mei-Chen
Published: December 2008

Objectives. We sought to identify individual and contextual predictors of adolescent smoking initiation and progression to daily smoking by race/ethnicity.

Methods. We used data from the National Longitudinal Study of Adolescent Health to estimate the effects of individual (adolescent, family, peer) and contextual (school and state) factors on smoking onset among nonsmokers (n = 5374) and progression to daily smoking among smokers (n = 4474) with multilevel regression models.

Results. Individual factors were more important predictors of smoking behaviors than were contextual factors. Predictors of smoking behaviors were mostly common across racial/ethnic groups.

Conclusions. The few identified racial/ethnic differences in predictors of smoking behavior suggest that universal prevention and intervention efforts could reach most adolescents regardless of race/ethnicity. With 2 exceptions, important contextual factors remain to be identified.
Family Planning in the Balance
Authors: Hwang Ann C. , Stewart Felicia H.
Published: December 2008

Family planning has long been acknowledged as an effective public health intervention. In recent years, however, family planning has come under increased scrutiny from conservative politicians and constituents.

National US policies instituted since 2001 are resulting in cutbacks in family planning programs worldwide. In the long run, these conservative initiatives may set back several decades of progress in reproductive health and reproductive rights.

In promoting an ideologically driven approach to sexual and reproductive health, the recent policy developments threaten to subvert ethical standards of medical care and the principle of evidence-based policy.
Using Peer Recruitment and OraSure to Increase HIV Testing
Authors: Vargo Sue , Agronick Gail , O’Donnell Lydia , Stueve Ann
Published: December 2008

We describe a community-based pilot study to boost HIV testing in a minority community through social network recruitment and a noninvasive HIV testing methodology.

Over an 11-month period, the number of test takers at the intervention site increased by 71.7%, and the proportions of test takers with risk factors similar to those of peer recruiters (heterosexual sex and multiple partners) increased by 24.2% and 19.5%, respectively. At a comparison site, testing remained stable, while the proportion of test takers reporting heterosexual sex and multiple partners decreased by 42.5% and 21.8%, respectively.

The use of a social network recruitment strategy in combination with an oral HIV test shows promise in increasing testing and in targeting populations.
Ethnicity/Race, Paranoia, and Hospitalization for Mental Health Problems Among Men
Authors: Whaley Arthur L.
Published: December 2008

Objectives. I tested the hypothesis that Black men with high levels of distrust (i.e., mild paranoia) are at greater risk of hospitalization for mental health problems than their White counterparts.

Methods. Secondary analysis was conducted of data from a subsample of 180 men in an epidemiological study. Mental health hospitalization was the outcome and ethnicity/race, mild paranoia, and their interaction were main predictors in a logistic regression analysis. The ethnicity/race by mild paranoia interaction tested the study hypothesis.

Results. The ethnicity/race by mild paranoia interaction was statistically significant. Contrary to the hypothesis, Black men with mild paranoia were less likely to be hospitalized.

Conclusions. Black men’s lack of trust regarding the mental health system may cause them not to seek services. Factors critical to increasing their trust are acknowledgment of racial biases in the mental health system and sincere efforts to eliminate racial disparities in mental health treatment.
Aiming at “De Feet” and Diabetes: A Rural Model to Increase Annual Foot Examinations
Authors: Beem Susie E. , Machala Margaret , Holman Craig , Wraalstad Randal , Bybee Ann
Published: December 2008

Something is afoot in south central Idaho. After 2 years of work, the percentage of people with diabetes receiving recommended annual foot examinations has increased by 13.8%, exceeding the state average. This turnaround, from being the region with the lowest percentage of foot examinations in the state, was made possible when South Central District Health joined diabetes coalition members to develop a comprehensive program that maximizes limited resources in the rural, 8-county service area.

Key program components include (1) development of a curriculum on CD-ROM called 2 Minute Diabetes Foot Examination, (2) training area physicians and nurses in the curriculum, (3) incorporating the curriculum into the nursing program at the local college, (4) offering free foot-screening clinics to targeted populations, and (5) conducting public education and outreach.
Rural Health Disparities, Population Health, and Rural Culture
Authors: Hartley David
Published: December 2008

In this commentary, I place the maturing field of rural health research and policy in the context of the rural health disparities documented in Health United States, 2001, Urban and Rural Health Chartbook. Because of recent advances in our understanding of the determinants of health, the field must branch out from its traditional focus on access to health care services toward initiatives that are based on models of population health.

In addition to presenting distinct regional differences, the chartbook shows a pattern of risky health behaviors among rural populations that suggest a “rural culture” health determinant. This pattern suggests that there may be environmental and cultural factors unique to towns, regions, or United States Department of Agriculture (USDA) economic types that affect health behavior and health.
Person and Place: The Compounding Effects of Race/Ethnicity and Rurality on Health
Authors: Probst Janice C. , Moore Charity G. , Glover Saundra H. , Samuels Michael E.
Published: December 2008

Rural racial/ethnic minorities constitute a forgotten population. The limited research addressing rural Black, Hispanic, and American Indian/Alaska Native populations suggests that disparities in health and in health care access found among rural racial/ethnic minority populations are generally more severe than those among urban racial/ethnic minorities.

We suggest that disparities must be understood as both collective and contextual phenomena. Rural racial/ethnic minority disparities in part stem from the aggregation of disadvantaged individuals in rural areas. Disparities also emerge from a context of limited educational and economic opportunity. Linking public health planning to the education and economic development sectors will reduce racial/ethnic minority disparities while increasing overall well-being in rural communities.
Providing Health Care to Latino Immigrants: Community-Based Efforts in the Rural Midwest
Authors: Casey Michelle M. , Blewett Lynn A. , Call Kathleen T.
Published: December 2008

We examined case studies of 3 rural Midwestern communities to assess local health care systems’ response to rapidly growing Latino populations. Currently, clinics provide free or low-cost care, and schools, public health, social services, and religious organizations connect Latinos to the health care system. However, many unmet health care needs result from lack of health insurance, limited income, and linguistic and cultural barriers. Targeted safety net funding would help meet Latino health care needs in rural communities with limited resources.
Fatal Occupational Injury Rates in Southern and Non-Southern States, by Race and Hispanic Ethnicity
Authors: Richardson David B. , Loomis Dana , Bena James , Bailer A. John
Published: December 2008

Objectives. We investigated fatal occupational injury rates in the United States by race and Hispanic ethnicity during the period 1990–1996.

Methods. Fatalities were identified by means of the national traumatic occupational fatalities surveillance system. Fatal occupational injury rates were calculated by race/ethnicity and region using US-census–based workforce estimates.

Results. Non-Hispanic Black men in the South had the highest fatal occupational injury rate (8.5 per 100000 worker-years), followed by Hispanic men in the South (7.9 per 100000 worker-years). Fatal injury rates for Hispanic men increased over the study period, exceeding rates for non-Hispanic Black men in the latter years of observation.

Conclusions. These data suggest a change in the demographics of fatal occupational injuries in the United States. Hispanic men in the South appear to be emerging as the group with the nation’s highest unintentional fatal occupational injury rate.
Barriers to Health Care Access Among the Elderly and Who Perceives Them
Authors: Fitzpatrick Annette L. , Powe Neil R. , Cooper Lawton S. , Ives Diane G. , Robbins John A.
Published: December 2008

Objectives. We evaluated self-perceived access to health care in a cohort of Medicare beneficiaries.

Methods. We identified patterns of use and barriers to health care from self-administered questionnaires collected during the 1993–1994 annual examination of the Cardiovascular Health Study.

Results. The questionnaires were completed by 4889 (91.1%) participants, with a mean age of 76.0 years. The most common barriers to seeing a physician were the doctor’s lack of responsiveness to patient concerns, medical bills, transportation, and street safety. Low income, no supplemental insurance, older age, and female gender were independently related to perceptions of barriers. Race was not significant after adjustment for other factors.

Conclusions. Psychological and physical barriers affect access to care among the elderly; these may be influenced by poverty more than by race.
Changes in Racial Differences in Use of Medical Procedures and Diagnostic Tests Among Elderly Persons: 1986–1997
Authors: Escarce José J. , McGuire Thomas G.
Published: December 2008

Objectives. We used 1997 Medicare data to replicate an earlier study that used data from 1986 to examine racial differences in usage of specific medical procedures or tests among elderly persons.

Methods. We used 1997 physician claims data to obtain a random sample of 5% of Medicare beneficiaries aged 65 years and older. We used this sample to study 30 procedures and tests that were analyzed in the 1986 study, as well as several new procedures that became more widely used in the early 1990s.

Results. Racial differences remain in the rates of use of these procedures; in general, Blacks have lower rates of use than do Whites. Between 1986 and 1997, the ratio of White to Black use moved in favor of Blacks for all but 4 of the established procedures studied.

Conclusions. The White–Black gap in health care use under Medicare is narrowing.
Predictors of Beginning and Ending Caregiving During a 3-Year Period in a Biracial Community Population of Older Adults
Authors: McCann Judith J. , Hebert Liesi E. , Bienias Julia L. , Morris Martha Clare , Evans Denis A.
Published: December 2008

Objectives. We sought to identify predictors of beginning and ending caregiving.

Methods. At baseline and 3-year follow-up, we interviewed 4245 community residents (61.4% Black, 38.4% White, 0.20% other) aged 65 years or older. We used logistic regression to test predictors of beginning caregiving among baseline noncaregivers and of continuing caregiving among baseline caregivers.

Results. After control for demographic variables, physically healthier individuals were significantly more likely to become caregivers and to continue caregiving. Mental health had little influence on beginning caregiving, but declining mental heath was associated with continuing caregiving.

Conclusions. Maintenance of physical health and function is essential to the ability of older adults to begin and to continue caregiving. Studies that compare the health of current caregivers with that of noncaregivers may substantially underestimate the impact of caregiving on health.
PLUMBISM REINVENTED
Authors: Fassin Didier , Naudé Anne-Jeanne
Published: December 2008

Although the history of childhood lead poisoning started a century ago in the United States, the first French cases were identified in 1985. Instead of merely adopting knowledge accumulated for decades, the public health professionals and activists involved had to reestablish, against incredulity from medical authorities and resistance from policymakers, all the evidence: that children were the main group concerned; that cases were not isolated but part of an epidemic; that wall paint in old, dilapidated apartments was the source of contamination; and that poor housing conditions, and not cultural practices, were responsible for the high incidence in African families.

This “reinvention” illustrates more general sociological phenomena: discontinuities in medical history, strength of culturalist prejudices toward immigrants, resistance to socioeconomic interpretations of disease, and struggles between different perspectives in public health. The history shows that public health is the product of intellectual and political struggles to impose visions of the world.
The Making and Breaking of Yugoslavia and Its Impact on Health
Authors: Kunitz Stephen J.
Published: December 2008

The creation of nation-states in Europe has generally been assumed to be intrinsic to modernization and to be irreversible. The disintegration of Czechoslovakia, the Soviet Union, and Yugoslavia demonstrates that the process is not irreversible. I argue that in the case of Yugoslavia, (1) disintegration was caused by the interaction between domestic policies with regard to nationalities and integration into the global economy and (2) the impact of the disintegration of the federation on health care and public health systems has been profound. Improving and converging measures of mortality before the collapse gave way to increasing disparities afterward.

The lesson is that processes of individual and social modernization do not result in improvements in health and well-being that are necessarily irreversible or shared equally.
Occupational Health Research in Developing Countries: A Partner for Social Justice
Authors: Nuwayhid Iman A.
Published: December 2008

Occupational health remains neglected in developing countries because of competing social, economic, and political challenges. Occupational health research in developing countries should recognize the social and political context of work relations, especially the fact that the majority of developing countries lack the political mechanisms to translate scientific findings into effective policies.

Researchers in the developing world can achieve tangible progress in promoting occupational health only if they end their professional isolation and examine occupational health in the broader context of social justice and national development in alliance with researchers from other disciplines. An occupational health research paradigm in developing countries should focus less on the workplace and more on the worker in his or her social context.
Environmental Justice, Cumulative Environmental Risk, and Health Among Low- and Middle-Income Children in Upstate New York
Authors: Evans Gary W. , Marcynyszyn Lyscha A.
Published: December 2008

Objectives. We documented inequitable, cumulative environmental risk exposure and health between predominantly White low-income and middle-income children residing in rural areas in upstate New York.

Methods. Cross-sectional data for 216 third- through fifth-grade children included overnight urinary neuroendocrine levels, noise levels, residential crowding (people/room), and housing quality.

Results. After control for income, maternal education, family structure, age, and gender, cumulative environmental risk exposure (0–3) (risk >1 SD above the mean for each singular risk factor [0, 1]) was substantially greater for low-income children. Cumulative environmental risk was positively correlated with elevated overnight epinephrine, norepinephrine, and cortisol in the low-income sample but not in the middle-income sample.

Conclusions. Cumulative environmental risk exposure among low-income families may contribute to bad health, beginning in early childhood.
High-Intensity Targeted Screening for Elevated Blood Lead Levels Among Children in 2 Inner-City Chicago Communities
Authors: Dignam Timothy A. , Evens Anne , Eduardo Eduard , Ramirez Shokufeh M. , Caldwell Kathleen L. , Kilpatrick Nikki , Noonan Gary P. , Flanders W. Dana , Meyer Pamela A. , McGeehin Michael A.
Published: December 2008

Objectives. We assessed the prevalence of elevated blood lead levels (≥ 10 micrograms of lead per deciliter of blood), risk factors, and previous blood lead testing among children in 2 high-risk Chicago, Ill, communities.

Methods. Through high-intensity targeted screening, blood lead levels were tested and risks were assessed among a representative sample of children aged 1 to 5 years who were at risk for lead exposure.

Results. Of the 539 children who were tested, 27% had elevated blood lead levels, and 61% had never been tested previously. Elevated blood lead levels were associated with chipped exterior house paint.

Conclusions. Most of the children who lived in these communities—where the prevalence for elevated blood lead levels among children was 12 times higher than the national prevalence—were not tested for lead poisoning. Our findings highlight the need for targeted community outreach that includes testing blood lead levels in accordance with the American Academy of Pediatrics’ recommendations.
Racial and Ethnic Differences in the Seroprevalence of 6 Infectious Diseases in the United States: Data From NHANES III, 1988–1994
Authors: McQuillan Geraldine M. , Kruszon-Moran Deanna , Kottiri Benny J. , Curtin Lester R. , Lucas Jacqueline W. , Kington Raynard S.
Published: December 2008

Objectives. We examined racial/ethnic differences in the seroprevalence of selected infectious agents in analyses stratified according to risk categories to identify patterns and to determine whether demographic, socioeconomic, and behavioral characteristics explain these differences.

Methods. We analyzed data from the third National Health and Nutrition Examination Survey, comparing differences among groups in regard to the prevalence of infection with hepatitis A, B, and C viruses, Toxoplasma gondii, Helicobacter pylori, and herpes simplex virus type 2.

Results. Racial/ethnic differences were greater among those in the low-risk category. In the case of most infectious agents, odds associated with race/ethnicity were almost 2 times greater in that category than in the high-risk category.

Conclusions. Stratification and adjustment for socioeconomic factors reduced or eliminated racial/ethnic differences in the prevalence of infection in the high-risk but not the low-risk group, wherein race/ethnicity remained significant and might have been a surrogate for unmeasured risk factors.
Effects of Restaurant and Bar Smoking Regulations on Exposure to Environmental Tobacco Smoke Among Massachusetts Adults
Authors: Albers Alison B. , Siegel Michael , Cheng Debbie M. , Rigotti Nancy A. , Biener Lois
Published: December 2008

Objectives. We examined the association of local restaurant and bar regulations with self-reported exposure to environmental tobacco smoke among adults.

Methods. Data were derived from a telephone survey involving a random sample of Massachusetts households.

Results. Compared with adults from towns with no restaurant smoking restrictions, those from towns with strong regulations had more than twice the odds of reporting nonexposure to environmental tobacco smoke (odds ratio [OR]=2.74; 95% confidence interval [CI]=1.97, 3.80), and those from towns with some restrictions had 1.62 times the odds of reporting nonexposure (OR=1.62; 95% CI=1.29, 2.02). Bar smoking bans had even greater effects on exposure.

Conclusions. Strong local clean indoor air regulations were associated with lower levels of reported exposure to environmental tobacco smoke in restaurants and bars.
Disparities in Smoking Cessation Between African Americans and Whites: 1990–2000
Authors: King Gary , Polednak Anthony , Bendel Robert B. , Vilsaint My C. , Nahata Sunny B.
Published: December 2008

Objectives. We examined disparities in smoking cessation rates between African Americans and Whites from 1990 through 2000.

Methods. We performed an analysis of smoking cessation with data from the National Health Interview Surveys of 30660 African Americans and 209828 Whites, 18 to 64 years old, with adjustment for covariates in multiple logistic regression models.

Results. Whites were significantly more likely than African Americans to be former smokers, and this disparity in the quit ratio persisted from 1990 through 2000. After adjustment for covariates, disparities were substantially reduced especially among women. Among former smokers, African Americans were significantly more likely than Whites to have quit successfully within the past 10 years.

Conclusions. Statistical adjustment for covariates reduces African American–White disparities in quit ratios, and recent cessation patterns suggest possible future reductions in disparities.
Correlates of Sex Trading Among Drug-Using Men Who Have Sex With Men
Authors: Newman Peter A. , Rhodes Fen , Weiss Robert E.
Published: December 2008

Objectives. We examined correlates of trading sex for money, drugs, and shelter, or food among drug-using men who have sex with men (MSM).

Methods. Audio computer-assisted self-interviewing questionnaires were completed by 387 MSM. The association of predictors with sex trading was assessed with χ2 tests and multiple logistic regression.

Results. Sex-trading prevalence was 62.5% (95% confidence interval=57.7%, 67.4%). Sex trading was associated with crack use, injection drug use, childhood maltreatment, nongay self-identification, and homelessness (adjusted odds ratios=3.72, 2.28, 2.62, 2.21, and 1.88, respectively).

Conclusions. Multiple risk factors are associated with sex trading among MSM. Interventions may need to address crack and injection drug use, homelessness, and childhood maltreatment and target non–gay-identified MSM who engage in sex trading.
Effects of Macroeconomic Trends on Social Security Spending Due to Sickness and Disability
Authors: Khan Jahangir , Gerdtham Ulf-G. , Jansson Bjarne
Published: December 2008

Objectives. We analyzed the relationship between macroeconomic conditions, measured as unemployment rate and social security spending, from 4 social security schemes and total spending due to sickness and disability.

Methods. We obtained aggregated panel data from 13 Organization for Economic Cooperation and Development member countries for 1980–1996. We used regression analysis and fixed effect models to examine spending on sickness benefits, disability pensions, occupational-injury benefits, survivor’s pensions, and total spending.

Results. A decline in unemployment increased sickness benefits spending and reduced disability pension spending. These effects reversed direction after 4 years of unemployment. Inclusion of mortality rate as an additional variable in the analysis did not affect the findings.

Conclusions. Macroeconomic conditions influence some reimbursements from social security schemes but not total spending.
The Health Impact of Resolving Racial Disparities: An Analysis of US Mortality Data
Authors: Woolf Steven H. , Johnson Robert E. , Fryer George E. , Rust George , Satcher David
Published: December 2008

The US health system spends far more on the “technology” of care (e.g., drugs, devices) than on achieving equity in its delivery. For 1991 to 2000, we contrasted the number of lives saved by medical advances with the number of deaths attributable to excess mortality among African Americans. Medical advances averted 176 633 deaths, but equalizing the mortality rates of Whites and African Americans would have averted 886202 deaths. Achieving equity may do more for health than perfecting the technology of care.