bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of prevention in travellers diseases on the basis of latest results in travel medicine
Authors: Felkai Péter
Published: December 2008

Az utazási orvostan prevenciós lehetőségeinek vizsgálatakor megállapítható volt, hogy a „klasszikus” felfogás, amelyet túlnyomórészt még mindig a primer megelőzés, a vakcináció – kemoprofilaxis –, orvosi (legfőképp infektológiai tartalmú) tanácsadás triásza jellemez, nem teszi lehetővé az utazással összefüggő betegségek megelőzésének és kezelésének komplex feladatát. Az utazók ugyan még mindig ki vannak téve az úti cél endémiás fenyegetésének, és bár igaz, hogy a vakcinációval közel tökéletes prevenciót érhetünk el ezen a területen, az utazók többsége nem fertőző betegségben szenved (vagy hal meg), hanem más, az utazás provokálta noxák miatt. Emellett például a magyar utazók túlnyomó többsége európai országokba utazik. A nem egzotikus (trópusi) országokba utazók, az extrém és szabadidősportot űzők, a krónikus betegségben szenvedők ugyancsak tanácsadást – mégpedig profilaktikus szemléletű tanácsadást – igényelnek. A védőoltások mellé be kell hogy vonuljon a prevenció fegyvertárába a védősisak, a sótabletta, az úti patika és a hordozható oxigenizátor is. Beszélnünk kell továbbá azokról az utazókról is, akik külföldön betegednek meg, és szakszerű repatriációjukhoz szükséges a szakorvos, az utazási orvos együttműködése, a beteg háziorvosának anamnesztikus segítsége és a biztosító orvosának szervezőkészsége is. Mindez olyan komplex tudást igényel, amelyet csak akkor tudunk megkövetelni, ha az utazási orvostan tárgyát és módszereit újradefiniáljuk. Meg kellett határozni az utazással összefüggő betegségeket, az utazók kategóriáit, illetve a prevenció elsődleges, másodlagos és harmadlagos szintjeinek tartalmát, valamint a szintekhez tartozó prevenciós módszereket. Megállapítható, hogy az utazási orvostan tudásanyaga fel kell hogy ölelje az infekciók, de az egyéb, utazással összefüggő betegségek megelőzését is, a szabadidősportok orvostanát (vadonorvoslás vagy wilderness medicine), az assistance orvostant (a betegek hazaszállításának tudományát) és az utasbiztosítási orvostan tárgykörét is. Ez a négyes, multidiszciplináris felosztás jól illeszkedik az utazási orvostan komplex szemléletéhez a nemzetközi gyakorlatban, de megfelelőnek bizonyul a magyarországi betegellátó struktúrában is. Lehetővé teszi, hogy az utazókkal kapcsolatba kerülő orvosok (elsősorban az utazási, a házi-, a biztosítási és a foglalkozás-egészségügyi orvosok) hatékonyan tudjanak részt venni az utazók felkészítésében. A prevenció szakmai alapjait ki kell dolgozni, az utazási orvostan interdiszciplináris jellegének megfelelően minden szakterületen. Szintén sürgető feladat az utazási orvostani tanácsadás országos struktúrájának kifejlesztése és az utazási orvostan graduális és posztgraduális oktatásának megszervezése. Az oktatás során – a szakma sajátosságainak megfelelő – új képzési formákat kell igénybe venni. Csak ilyen alapok birtokában várható, hogy a magyar emberek egészségkultúráját utazási vonalon a nemzetközi szintre tudjuk emelni.
Application of ridge regression to quantify marginal effects of collinear soil properties on phytotoxicity of arsenic, cadmium, lead, and zinc
Authors: Anderson Richard H. , Basta Nicholas T.
Published: December 2008

Soil properties that the mitigate hazardous effects of environmental contaminants through soil chemical sequestration should be considered when evaluating ecological risk from terrestrial contamination. The objective of the present research was to identify predominant soil chemical and physical properties that modify the phytotoxicity of As, Cd, Pb, and Zn to the nonhyper-accumulating higher plant perennial ryegrass (Lolium perenne L.). Phytotoxicity parameters were estimated from a dose-response experiment using the aboveground dry matter growth endpoint and were correlated with an assortment of relevant soil property measurements, with the ultimate goal of developing statistical prediction models for soil-specific adjustments to ecological risk assessments. Significant correlations between soil properties and phytotoxicity estimates were observed for all four contaminants; however, intercorrelation was observed among soil properties, necessitating an alternative to the conventional multiple regression commonly used by ecotoxicologists. Ridge regression, a regression-based technique that suppresses the effects of multicollinearity and enables prediction, was used to assess the marginal contributions of all properties found to mitigate phytotoxicity. Ridge regression models are presented along with two common conventional regression methods and are collectively discussed within the context of the mitigating effects of soil properties on metal/metalloid phytotoxicity. Ridge regression appears to be a powerful alternative to conventional multiple regression for ecotoxicological studies when intercorrelation among predictors is experimentally unavoidable, such as with soil properties.
Comparing methods for analyzing overdispersed binary data in aquatic toxicology
Authors: Noble Robert B. , Bailer A. John , Noe Douglas A.
Published: December 2008

Historically, death is the most commonly studied effect in aquatic toxicity tests. These tests typically employ a gradient of concentrations and exposure with more than one organism in a series of replicate chambers in each concentration. Whereas a binomial distribution commonly is employed for such effects, variability may exceed that predicted by binomial probability models. This additional variability could result from heterogeneity in the probabilities across the chambers in which the organisms are housed and subsequently exposed to concentrations of toxins. Incorrectly assuming a binomial distribution for the statistical analysis may lead to incorrect statistical inference. We consider the analysis of grouped binary data, here motivated by the study of survival. We use a computer simulation study to examine the impact of overdispersion or outliers on the analysis of binary data. We compare methods that assume binomial or generalizations that accommodate this potential overdispersion. These generalizations include adjusting the standard probit model for clustering/correlation or using alternative estimation methods, generalized estimating equations, or generalized linear mixed models (GLMM). When data were binomial or overdispersed binomial, none of the models exhibited any significant bias when estimating regression coefficients. When the data were truly binomial, the probit model controlled type I errors, as did the Donald and Donner method and the GLMM method. When data were overdispersed, the probit model no longer controlled type I error, and the standard errors were too small. In general, the Donald and Donner and the GLMM methods performed reasonably based on this study, although all procedures suffered some impact in the presence of potential outliers.
Uptake and biotransformation of structurally diverse brominated flame retardants in zebrafish (Danio rerio) after dietary exposure
Authors: Nyholm Jenny Rattfelt , Norman Anna , Norrgren Leif , Haglund Peter , Andersson Patrik L.
Published: December 2008

Zebrafish (Danio rerio) were fed a diet containing a mixture of 11 structurally diverse brominated flame retardants (BFRs) at nominal concentrations of either 1 or 100 nmol/g for up to 42 d, followed by an elimination period of 14 d. Uptake rates and elimination constants for five of the BFRs were calculated from measurements of their concentrations in the male fish during the exposure and elimination phases. Observed uptake efficiencies were highest for 2,4,4′-tribromodiphenyl ether (BDE 28) and 1,2-dibromo-4-(1,2-dibromoethyl)cyclohexane (TBECH) and were lowest for decabromodiphenyl ether (BDE 209). Estimated half-lives for TBECH and 2,4,6-tribromophenol were short (<2 d). Four BFR metabolites were identified in the fish: 2,2′,3,4′,5′,6-Hexabromodiphenyl ether (BDE 149), 2,2′,4,4′,5,6′-hexabromodiphenyl ether (BDE 154), 2,4,6-tribromoanisole, and 1,2,4,5-hex-abromobenzene. These metabolites were still present in the zebrafish after the 14-d elimination period. No relationship between the BFR concentrations in the zebrafish and their log octanol-water partition coefficient (KOW) values was found. Generally, low tendencies to bioaccumulate were observed for perbrominated and hydroxylated compounds. The observed accumulation of BFR metabolites in fish, however, shows that low concentration of a BFR does not provide, in isolation, a sound indication that the BFR poses low risks.
Touched by Homelessness: An Examination of Hospitality for the Down and Out
Authors: Bolland John M. , McCallum Debra Moehle
Published: December 2008

Objectives. This study investigated patterns of “doubled-up” homelessness using an indirect measure based on host households.

Methods. In random household telephone surveys conducted in Alabama between 1990 and 2000 and nationally in 1997, respondents indicated whether any individual had stayed with them during the past year because that person was homeless.

Results. The percentage of Alabama households providing shelter during the past year declined from 16.2% in 1990 to 7.1% in 2000. The national rate for providing shelter in 1997 was 18.0%.

Conclusions. Many households provide shelter to people to prevent them from being literally homeless. As the economy has expanded, these rates have declined in Alabama.
Incomplete Birth Certificates: A Risk Marker for Infant Mortality
Authors: Gould Jeffrey B. , Chavez Gilberto , Marks Amy R. , Liu Hao
Published: December 2008

Objectives. This study assessed the relationship between incomplete birth certificates and infant mortality.

Methods. Birth certificates from California (n = 538 945) were assessed in regard to underreporting of 13 predictors of perinatal outcomes and mortality.

Results. Of the birth certificates studied, 7.25% were incomplete. Underreporting was most common in the case of women at high risk for poor perinatal outcomes and infants dying within the first day. Increasing numbers of unreported items were shown to be associated with corresponding increases in neonatal and postneonatal mortality rates.

Conclusions. Incomplete birth certificates provide an important marker for identifying high-risk women and vulnerable infants. Because data “cleaning” will result in the removal of mothers and infants at highest risk, birth certificate analyses should include incomplete records.
A Public Health Agenda for Traditional, Complementary, and Alternative Medicine
Authors: Bodeker Gerard , Kronenberg Fredi
Published: December 2008

Traditional medicine (a term used here to denote the indigenous health traditions of the world) and complementary and alternative medicine (T/CAM) have, in the past 10 years, claimed an increasing share of the public’s awareness and the agenda of medical researchers. Studies have documented that about half the population of many industrialized countries now use T/CAM, and the proportion is as high as 80% in many developing countries.

Most research has focused on clinical and experimental medicine (safety, efficacy, and mechanism of action) and regulatory issues, to the general neglect of public health dimensions. Public health research must consider social, cultural, political, and economic contexts to maximize the contribution of T/CAM to health care systems globally.
Health Status of People Using Complementary and Alternative Medical Practitioner Services in 4 English Counties
Authors: Ong Chi-Keong , Petersen Sophie , Bodeker Gerard C. , Stewart-Brown Sarah
Published: December 2008

Objectives. This study was undertaken to establish the health status of users of complementary and alternative medicine (CAM) services in England.

Methods. A postal questionnaire (response rate: 64%) covering long-standing illness, use of conventional medical and CAM services, and the United Kingdom Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was sent to more than 14 000 adults in 4 counties.

Results. Sixty percent of CAM users reported having a chronic illness or disability; back pain and bowel problems were the conditions most commonly reported. Regardless of whether chronic illness was reported, CAM users reported poorer health than nonusers, particularly in the dimensions of pain and physical disability, and made more visits to general practitioners.

Conclusions. In England, users of CAM services have poorer physical health than nonusers and make more frequent use of conventional medical services.
Roots, Shoots, but Too Little Fruit: Assessing the Contribution of COPC in South Africa
Authors: Tollman Stephen M. , Pick William M.
Published: December 2008

Community-oriented primary care (COPC) originated in South Africa during the 1940s and 1950s, where it served to inform local church-based and nongovernmental organization–based initiatives during the apartheid years. During the 1990s, COPC played an inspirational role in the process of national health policy formulation.

Yet COPC’s contribution to current health practice remains more symbolic than substantive. Despite a policy framework that favors the widespread introduction of COPC, various political, structural, managerial, and human resource obstacles constrain its effective implementation.

Notwithstanding a rapidly changing health care environment and well-established health transition from infections and nutritional disorders to non-communicable diseases and injury, COPC and its variants remain abidingly relevant to South Africa’s—and Africa’s—health care reality. (Am J Public Health. 2002;92:1725–1728)
Community-Oriented Primary Care in Action: A Dallas Story
Authors: Pickens Sue , Boumbulian Paul , Anderson Ron J. , Ross Samuel , Phillips Sharon
Published: December 2008

Dallas County, Texas, is the site of the largest urban application of the community-oriented primary care (COPC) model in the United States. We summarize the development and implementation of Dallas’s Parkland Health & Hospital System COPC program.

The complexities of implementing and managing this comprehensive community-based program are delineated in terms of Dallas County’s political environment and the components of COPC (assessment, prioritization, community collaboration, health care system, evaluation, and financing). Steps to be taken to ensure the future growth and development of the Dallas program are also considered.

The COPC model, as implemented by Parkland, is replicable in other urban areas.
Pursuing Community-Oriented Primary Care in a Russian Closed Nuclear City: The Sarov–Los Alamos Community Health Partnership
Authors: Rhyne Robert L. , Hertzman Philip A.
Published: December 2008

The Russian health care system historically has not relied on medical evidence to guide practice, uses centralized management, and is burdened by overspecialization. In 1999, a community health partnership was established between Sarov, Russia, and Los Alamos, NM, 2 cities linked by their nuclear weapons histories. Health problems addressed include asthma and diabetes, pediatric dental caries, low prevalence of breastfeeding, and adolescent drug abuse and sexually transmitted diseases.

A community-oriented primary care approach was adopted that includes (1) implementing a “train the trainers” strategy to educate health professionals and lay people, (2) adapting established clinical practice guidelines based on local resources, (3) restricting use of expensive or limited resources, and (4) securing commitments from local government for expendable supplies and medications.
Community-Oriented Primary Care: New Relevance in a Changing World
Authors: Mullan Fitzhugh , Epstein Leon
Published: December 2008

Since its inception in rural, pre-apartheid South Africa, community-oriented primary care (COPC) has intrigued and informed public health and primary care leaders worldwide. COPC has influenced such programs as the US community health center movement, the general practice movement in the United Kingdom, and recent reforms in the public health system of South Africa.

We provide a global overview of COPC, tracing its conceptual roots, reviewing its many manifestations, and exploring its future prospects as an organizational paradigm for the democratic organization of community health services. We examine the pitfalls and paradoxes of COPC and suggest its future utility.

COPC has important values and methods to offer disparate but powerful movements in public health worldwide.
The Contextual Effect of the Local Food Environment on Residents’ Diets: The Atherosclerosis Risk in Communities Study
Authors: Morland Kimberly , Wing Steve , Roux Ana Diez
Published: December 2008

Objectives. We studied the association between the local food environment and residents’ report of recommended dietary intake.

Methods. Recommended intakes of foods and nutrients for 10 623 Atherosclerosis Risk in Communities participants were estimated from food frequency questionnaires. Supermarkets, grocery stores, and full-service and fast-food restaurants were geocoded to census tracts.

Results. Black Americans’ fruit and vegetable intake increased by 32% for each additional supermarket in the census tract (relative risk [RR] = 1.32; 95% confidence interval [CI] = 1.08, 1.60). White Americans’ fruit and vegetable intake increased by 11% with the presence of 1 or more supermarket (RR = 1.11; 95% CI = 0.93, 1.32).

Conclusions. These findings suggest the local food environment is associated with residents’ recommended diets.
Ethics and Public Health: Forging a Strong Relationship
Authors: Callahan Daniel , Jennings Bruce
Published: December 2008

The field of bioethics arose in the late 1960s in response to the emerging ethical dilemmas of that era. The field for many years focused in general on the dilemmas generated by high-technology medicine rather than on issues of population health and the ethical problems of public health programs and regulations. The time has come to more fully integrate the ethical problems of public health into the field of public health and, at the same time, into the field of bioethics. Public health raises a number of moral problems that extend beyond the earlier boundaries of bioethics and require their own form of ethical analysis.
Chewing Tobacco: Who Uses and Who Quits? Findings From NHANES III, 1988–1994
Authors: Howard-Pitney Beth , Winkleby Marilyn A.
Published: December 2008

Objectives. This study identified mutually exclusive groups of men at high and low risk for use of chewing tobacco and for quitting.

Methods. Analyses used a national sample of 1340 non-Hispanic Black, 1358 Mexican American, and 1673 non-Hispanic White men, aged 25 to 64, who participated in the National Health and Nutrition Examination Survey III from 1988 to 1994. Signal detection analysis was used to delineate high- and low-risk subgroups; survival analysis was used to estimate hazard curves for comparing age at onset for chewing tobacco use with that for smoking.

Results. Rural, lower-income Black and White men had the highest regular use of chewing tobacco (33.3%), followed by rural, higher-income men regardless of race/ethnicity (14.9%). Southern men who began using chewing tobacco during adulthood had the lowest quit rate (22.5%). In sharp contrast to smoking, chewing tobacco showed a continued onset throughout adulthood.

Conclusions. Because subgroups of men show highly different chewing tobacco use and quit rates and because age at chewing tobacco onset occurs across the life span, prevention and cessation programs should be specific to different risk groups and distinct from smoking programs.
Cadmium Exposure in Pregnancy and Lactation in Relation to Iron Status
Authors: Åkesson Agneta , Berglund Marika , Schütz Andrejs , Bjellerup Per , Bremme Katarina , Vahter Marie
Published: December 2008

Objectives. The purpose of this study was to determine the impact of iron status on cadmium dose among pregnant women.

Methods. Iron status and cadmium concentration in blood, urine, and placenta were determined among women followed for 2 years from early pregnancy.

Results. Blood cadmium and urinary cadmium were correlated with iron status throughout the study period. Urinary cadmium increased longitudinally among women with exhausted iron stores during their pregnancy. The increase in urinary cadmium with age was more pronounced in multiparous than in nulliparous women.

Conclusions. Iron deficiency during pregnancy leads to increased cadmium absorption and body burden. Multiparous women exhibit additional increases with increasing age.
Tobacco, Commercial Speech, and Libertarian Values: The End of the Line for Restrictions on Advertising?
Authors: Bayer Ronald
Published: December 2008

In June of 2001, the Supreme Court overturned a set of antitobacco measures adopted by the state of Massachusetts designed to protect young people from advertising. Once again, the court expressed its hostility toward measures designed to restrict commercial speech in the name of the social good. In so doing, the court underscored the enduring tension between the libertarian and social welfare dimensions of contemporary democracy and placed into relief the divisions within the American liberal tradition.
Analysis of a Population-Based Pneumocystis carinii Pneumonia Index as an Outcome Measure of Access and Quality of Care for the Treatment of HIV Disease
Authors: Arno Peter S. , Gourevitch Marc N. , Drucker Ernest , Fang Jing , Goldberg Clara , Memmott Margaret , Bonuck Karen , Deb Nandini , Schoenbaum Ellie
Published: December 2008

Objectives. A population-based Pneumocystis carinii pneumonia (PCP) Index was developed in New York City to identify geographic areas and subpopulations at increased risk for PCP.

Methods. A zip code–level PCP Index was created from AIDS surveillance and hospital discharge records and defined as (number of PCP-related hospitalizations)/(number of persons living with AIDS).

Results. In 1997, there were 2262 hospitalizations for PCP among 39 740 persons living with AIDS in New York City (PCP Index = .05691). PCP Index values varied widely across neighborhoods with high AIDS prevalence (West Village = .02532 vs Central Harlem = .08696). Some neighborhoods with moderate AIDS prevalence had strikingly high rates (Staten Island = .14035; northern Manhattan = .08756).

Conclusions. The PCP Index highlights communities in particular need of public health interventions to improve HIV-related service delivery. (Am J Public Health. 2002;92:395–398)
Improving the Health of Infants on Medicaid by Collocating Special Supplemental Nutrition Clinics With Managed Care Provider Sites
Authors: Kendal Alan P. , Peterson Alwin , Manning Claudine , Xu Fujie , Neville Loretta J. , Hogue Carol
Published: December 2008

Objectives. This study tested whether collocation of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics at managed care provider sites improved health care for infants enrolled in Medicaid and WIC.

Methods. Weights and immunization rates were studied for the 1997 birth cohort of African American infants enrolled in WIC and Medicaid in Detroit, Mich. Infants using traditional WIC clinics and health services were compared with those enrolled under Medicaid in 2 managed care organizations (MCOs), of whom about half obtained WIC services at MCO provider sites.

Results. Compared with other infants, those who used collocated WIC sites either were closer to their age-appropriate weight or had higher immunization rates when recertified by WIC after their first birthday. Specific benefits (weight gain or immunizations) varied according to the priorities at the collocated sites operated by the 2 MCOs.

Conclusions. Collocation of WIC clinics at MCO sites can improve health care of low-income infants. However specific procedures for cooperation between WIC staff and other MCO staff are required to achieve this benefit. (Am J Public Health. 2002;92:399–403)
Smooth Moves: Bar and Nightclub Tobacco Promotions That Target Young Adults
Authors: Sepe Edward , Ling Pamela M. , Glantz Stanton A.
Published: December 2008

Objectives. This article describes the tobacco industry's use of bars and nightclubs to encourage smoking among young adults.

Methods. Previously secret tobacco industry marketing documents were analyzed.

Results. Tobacco industry bar and nightclub promotions in the 1980s and 1990s included aggressive advertising, tobacco brand–sponsored activities, and distribution of samples. Financial incentives for club owners and staff were used to encourage smoking through peer influence. Increased use of these strategies occurred concurrently with an increase in smoking among persons aged 18 through 24 years.

Conclusions. The tobacco industry's bar and nightclub promotions are not yet politically controversial and are not regulated by the 1998 Master Settlement Agreement between the industry and the states. Tobacco control advocates should include young adults in research and advocacy efforts and should design interventions to counter this industry strategy to solidify smoking patterns and recruit young adult smokers.
Timing of Insurance Coverage and Use of Prenatal Care Among Low-Income Women
Authors: Egerter Susan , Braveman Paula , Marchi Kristen
Published: December 2008

Objectives. This study examined the relationship between timing of insurance coverage and prenatal care among low-income women.

Methods. Timeliness of prenatal care initiation and adequacy of number of visits were studied among 5455 low-income participants in a larger cross-sectional statewide survey of postpartum women in California during 1994–1995.

Results. Although only 2% of women remained uninsured throughout pregnancy, one fifth lacked coverage during the first trimester. Rates of untimely care were highest (≥64%) among women who were uninsured throughout their pregnancy or whose coverage began after the first trimester; rates were lowest (about 10%) among women who obtained coverage during the first trimester. Women who first obtained Medi-Cal coverage during pregnancy were at low risk of having too few visits.

Conclusions. Timing of prenatal coverage should be considered in research on the relationship between coverage and care use among low-income women. Earlier studies that relied solely on principal payer information, without data on when coverage began, may have led to inaccurate inferences about lack of coverage as a barrier to prenatal care.
Neighborhood Context and Youth Cardiovascular Health Behaviors
Authors: Lee Rebecca E. , Cubbin Catherine
Published: December 2008

Objectives. This study sought to determine the relationships between race/ethnicity, socioeconomic status (SES), and cardiovascular health behaviors among youths and whether neighborhood characteristics are associated with such behaviors independently of individual characteristics.

Methods. Linear models determined the effects of individual and neighborhood characteristics (SES, social disorganization, racial/ethnic minority concentration, urbanization) on dietary habits, physical activity, and smoking among 8165 youths aged 12 to 21 years.

Results. Low SES was associated with poorer dietary habits, less physical activity, and higher odds of smoking. After adjustment for SES, Black race was associated with poorer dietary habits and lower odds of smoking. Hispanic ethnicity was associated with healthier dietary habits, lower levels of physical activity, and lower odds of smoking than non-Hispanic ethnicity. Low neighborhood SES and high neighborhood social disorganization were independently associated with poorer dietary habits, while high neighborhood Hispanic concentration and urbanicity were associated with healthier dietary habits. Neighborhood characteristics were not associated with physical activity or smoking.

Conclusions. Changes in neighborhood social structures and policies that reduce social inequalities may enhance cardiovascular health behaviors. (Am J Public Health. 2002;92:428–436)
Subgroups of Refusers in a Disability Prevention Trial in Older Adults: Baseline and Follow-Up Analysis
Authors: Minder Christoph E. , Müller Tobias , Gillmann Gerhard , Beck John C. , Stuck Andreas E.
Published: December 2008

Objectives. This study explored differences between refusers and participants in a longitudinal study with extensive baseline and follow-up information.

Methods. Results of a trial comparing 791 participants and 401 community-residing older adults who refused to participate in a study concerning preventive home visits were examined. Information was collected from interviews, insurance records, and government files.

Results. Despite similarities in terms of age, sex, and self-perceived health at baseline, 3-year follow-up data indicated that refusers had a 1.58-fold higher risk of entering a nursing home than participants. There were additional differences between refusers and participants when refusers were categorized in 4 subgroups based on self-reported reason for refusal (too ill, too healthy, no interest, and other reasons).

Conclusions. Future studies should include follow-up data to allow comparisons between refusers and participants and should address the presence of multiple subgroups of refusers. (Am J Public Health. 2002;92:445–450)
Diabetes, Diversity, and Disparity: What Do We Do With the Evidence?
Authors: Black Sandra A.
Published: December 2008

The US Department of Health and Human Services has developed an initiative called “Eliminating Racial and Ethnic Disparities in Health,” which parallels Healthy People 2010, the nation's health goals for the next decade. The initiative focuses on areas of health disparity that are known to affect racially and ethnically diverse groups of the population yet hold the promise of improvement.

The first step to addressing such health inequities is to understand the scope and nature of the diseases that contribute to such disparities. This commentary reviews the epidemiology and consequences of type 2 diabetes, particularly as it is manifested in socially and culturally diverse groups, and offers recommendations for actions to address the disparities resulting from diabetes.
Considerations for Community-Based Research With African American Women
Authors: Jackson Fleda Mask
Published: December 2008

Although community-based research is intended to be culturally sensitive, more advanced consideration of the impact of race, gender, and class is needed for health disparity research involving women of color. Research processes must permit the simultaneous disclosures of the racial, gender, and class identities among women of color that are assumed and imposed.

The authoritative knowledge that women of color have about their lives and their health should form the basis for collaboration between researchers and study participants. The dissemination of research findings to study participants, and dialogue on those findings, is imperative for the development of sustainable interventions.
Racial/Ethnic Variations in Women's Health: The Social Embeddedness of Health
Authors: Williams David R.
Published: December 2008

This article provides an overview of the magnitude of and trends in racial/ethnic disparities in health for women in the United States. It emphasizes the importance of attending to diversity in the health profiles and populations of minority women. Socioeconomic status is a central determinant of racial/ethnic disparities in health, but several other factors, including medical care, geographic location, migration and acculturation, racism, and exposure to stress and resources also play a role. There is a need for renewed attention to monitoring, understanding, and actively seeking to eliminate racial/ethnic disparities in health.
Papanicolaou Test Use Among Reproductive-Age Women at High Risk for Cervical Cancer: Analyses of the 1995 National Survey of Family Growth
Authors: Hewitt Maria , Devesa Susan , Breen Nancy
Published: December 2008

Objectives. This study assessed the relationship between risk factors for cervical cancer and Papanicolaou (Pap) test use within the past year among reproductive-age women.

Methods. The 1995 National Survey of Family Growth, a demographic and reproductive health survey of 10 847 women aged 15 to 44, was analyzed with multiple logistic regression.

Results. Of the women, 62% reported having had a Pap test within the past year. Use was significantly higher among women with risk factors and among African American women. Use was significantly lower among uninsured, poor, and foreign-born women and among women with lower educational attainment and of “other” race/ethnicity.

Conclusions. Strategies to improve Pap test use include (1) educational campaigns that inform women of cervical cancer risk factors and encourage screening and (2) increased support for programs that expand access to Pap tests.
America's Affordable Housing Crisis: A Contract Unfulfilled
Authors: Freeman Lance
Published: December 2008

For many poor Americans, having a decent home and suitable living environment remains a dream. This lack of adequate housing is not only a burden for many of the poor, but it is harmful to the larger society as well, because of the adverse effects of inadequate housing on public health.

Not only is the failure to provide adequate housing shortsighted from a policy perspective, but it is also a failure to live up to societal obligations. There is a societal obligation to meet the housing needs of everyone, including the most disadvantaged. Housing assistance must become a federally-funded entitlement.
Lead Awareness: North Philly Style
Authors: Rothman Nancy L. , Lourie Rita J. , Gaughan John
Published: December 2008

Lead poisoning in children has been associated with reduced intelligence, shortened memory, slowed reaction times, poor hand–eye coordination, and antisocial behavior. The cost to society includes not only medical treatment and special education but also higher high-school drop-out rates, which are associated with crime and low earning potential.
Clean Indoor Air: Advances in California, 1990–1999
Authors: Gilpin Elizabeth A. , Farkas Arthur J. , Emery Sherry L. , Ake Christopher F. , Pierce John P.
Published: December 2008

Objectives. This study assessed progress in achieving clean indoor air in California.

Methods. Data were from large, cross-sectional population-based surveys (1990–1999).

Results. Indoor workers reporting smoke-free workplaces increased from 35.0% (95% confidence interval [CI] = 33.7, 36.3) in 1990 to 93.4% (95% CI = 92.6, 94.2) in 1999. Exposure of nonsmoking indoor workers to secondhand tobacco smoke decreased from 29.0% (95% CI = 27.2, 30.8) to 15.6% (95% CI = 14.1, 17.1). Adults with smoke-free homes increased from 37.6 % (95% CI = 35.1, 40.1) in 1992 to 73.7% (95% CI = 73.2, 74.2) in 1999; nearly half of smokers in 1999 had smoke-free homes. In 1999, 82.2% (95% CI = 81.5, 82.9) of children and adolescents (0–17 years) had smoke-free homes, up from 38.0% (95% CI = 35.1, 40.9) in 1992.

Conclusions. California's advances highlight an important opportunity for tobacco control.
Science, Politics, and Ideology in the Campaign Against Environmental Tobacco Smoke
Authors: Bayer Ronald , Colgrove James
Published: December 2008

The issue of environmental tobacco smoke (ETS) and the harms it causes to nonsmoking bystanders has occupied a central place in the rhetoric and strategy of antismoking forces in the United States over the past 3 decades. Beginning in the 1970s, anti-tobacco activists drew on suggestive and incomplete evidence to push for far-reaching prohibitions on smoking in a variety of public settings. Public health professionals and other antismoking activists, although concerned about the potential illness and death that ETS might cause in nonsmokers, also used restrictions on public smoking as a way to erode the social acceptability of cigarettes and thereby reduce smoking prevalence. This strategy was necessitated by the context of American political culture, especially the hostility toward public health interventions that are overtly paternalistic.
Evaluating the Tobacco Settlement Damage Awards: Too Much or Not Enough?
Authors: Coller Maribeth , Harrison Glenn W. , McInnes Melayne Morgan
Published: December 2008

Objectives. This study compared the present economic value of the 1998 tobacco settlement with the present economic value of the damages attributable to tobacco.

Methods. The 1987 National Medical Expenditure Survey was used to estimate the smoking attributable fraction (SAF) of medical expenditures. SAFs were then applied to Medicaid and other expenditures.

Results. Settlement payments covered only 40% of Medicaid treatment costs already incurred and only 30% of past and projected future Medicaid costs. Excess medical expenditures for all other payment sources were roughly comparable to those incurred by Medicaid.

Conclusions. Although the settlement may reduce future smoking prevalence rates by limiting the ability of tobacco companies to promote smoking and by raising cigarette prices, euphoria over the huge settlement funds should be balanced by a sober comparison with the even larger damage amounts.
Twenty Years of Public Health Research: Inclusion of Lesbian, Gay, Bisexual, and Transgender Populations
Authors: Boehmer Ulrike
Published: December 2008

Objectives. This study determined to what extent lesbian, gay, bisexual, and transgender (LGBT) populations have been studied over the past 20 years of public health research.

Methods. From MEDLINE English-language articles on human subjects published between 1980 and 1999, I identified articles that included LGBT individuals. The abstracts were analyzed with a coding procedure that categorized the content by topic, sexual orientation, and race/ethnicity.

Results. LGBT issues were addressed by 3777 articles, or 0.1% of all Medline articles; 61% of the articles were disease-specific, and 85% omitted reference to race/ethnicity. Research unrelated to sexually transmitted diseases addressed lesbians and gay men with similar frequency, whereas bisexual persons were less frequently considered, and the least amount of research focused on transgender individuals.

Conclusions. Findings supported that LGBT issues have been neglected by public health research and that research unrelated to sexually transmitted diseases is lacking.
Prediction of Depressive Distress in a Community Sample of Women: The Role of Sexual Orientation
Authors: Matthews Alicia K. , Hughes Tonda L. , Johnson Timothy , Razzano Lisa A. , Cassidy Roberta
Published: December 2008

Objectives. This study compared factors known or hypothesized to influence depressive symptomatology in a community sample of lesbians and heterosexual women.

Methods. Data were collected in a multisite survey of lesbians' physical and mental health.

Results. Findings confirmed earlier reports suggesting that traumatic life events such as physical and sexual abuse, and individual traits and coping styles are risk factors for depressive distress. However, findings of higher rates of suicidal behavior and of several risk factors for depressive distress among lesbians suggest that risk for depression may differ among lesbians and heterosexual women.

Conclusions. Sexual orientation may represent an important but poorly understood risk factor for depressive distress as well as suicidal ideation and behavior.
Risk Behaviors, Medical Care, and Chlamydial Infection Among Young Men in the United States
Authors: Ku Leighton , St. Louis Michael , Farshy Carol , Aral Sevgi , Turner Charles F. , Lindberg Laura D. , Sonenstein Freya
Published: December 2008

Objectives. This study assessed factors related to chlamydial infection among young men in the United States.

Methods. Data were from interviews of nationally representative samples of 470 men aged 18 to 19 years (teenagers) and 995 men aged 22 to 26 years (young adults) and from urine specimens tested by means of polymerase chain reaction.

Results. Although a majority of the men reported occasional unprotected intercourse, only a minority perceived themselves to be at risk for contracting a sexually transmitted disease (STD). Chlamydial infection was detected in 3.1% of the teenagers and 4.5% of the young adults. A minority of those infected had symptoms or had been tested for STDs; very few had been diagnosed with STDs.

Conclusions. Chlamydial infection is common but usually asymptomatic and undiagnosed. Primary and secondary prevention efforts should be increased, particularly among young adult men. (Am J Public Health. 2002;92:1140–1143)
Assessment of a New Approach to Family Planning Services in Rural Pakistan
Authors: Sultan Mehboob , Cleland John G. , Ali Mohamed M.
Published: December 2008

Objectives. In 1993, the government of Pakistan started a new approach to the delivery of contraceptive services by training literate married women to provide doorstep advice and supplies in their own and neighboring communities. This report assesses whether this community-based approach is starting to have an impact on contraceptive use in rural areas.

Methods. A clustered nationally representative survey was used to collect data on contraceptive use and access to services in each cluster. Two-level logistic regression was applied to assess the effects of service access, after potential confounders were taken into account.

Results. Married women living within 5 km of 2 community-based workers were significantly more likely to be using a modern, reversible method of contraception than those with no access (odds ratio = 1.74; 95% confidence interval = 1.11, 2.71).

Conclusions. After decades of failure, the managers of the family planning program have designed a way of presenting modern contraceptives that is appropriate to the conditions of rural Pakistan. The new community-based approach should be steadily expanded. (Am J Public Health. 2002;92:1168–1172)
The Social Constructions of Sexuality: Marital Infidelity and Sexually Transmitted Disease–HIV Risk in a Mexican Migrant Community
Authors: Hirsch Jennifer S. , Higgins Jennifer , Bentley Margaret E. , Nathanson Constance A.
Published: December 2008

Objectives. This article explores the social context of the migration-related HIV epidemic in western Mexico.

Methods. Data collection involved life histories and participant observation with migrant women in Atlanta and their sisters or sisters-in-law in Mexico.

Results. Both younger and older women acknowledged that migrant men’s sexual behavior may expose them to HIV and other sexually transmitted diseases.Younger Mexican women in both communities expressed a marital ideal characterized by mutual intimacy, communication, joint decisionmaking, and sexual pleasure, but not by willingness to use condoms as an HIV prevention strategy.

Conclusions. Migrant Mexican women’s commitment to an illusion of fidelity will hinder HIV prevention initiatives targeted toward them. Furthermore, the changing meanings of marital sex may make it harder to convince young couples to use condoms as an HIV prevention strategy. If the chain of heterosexual marital HIV transmission is to be interrupted in this community, prevention programs must target men. (Am J Public Health. 2002;92:1227–1237)
Women’s Health After Pregnancy and Child Outcomes at Age 3 Years: A Prospective Cohort Study
Authors: Kahn Robert S. , Zuckerman Barry , Bauchner Howard , Homer Charles J. , Wise Paul H.
Published: December 2008

Objectives. This study examined the persistence and comorbidity of women’s physical and mental health conditions after pregnancy and the association of these conditions with child outcomes.

Methods. A national cohort of women who recently gave birth were surveyed in 1988 and again in 1991. We examined longitudinal data on maternal poor physical health, depressive symptoms, and smoking, and maternal report of child outcomes (at age ∼3 years).

Results. Women’s poor physical health and smoking had strong, graded associations with children’s physical health and behavior problems, whereas women’s depressive symptoms were associated with children’s delayed language and behavior problems.

Conclusions. Substantial persistence and comorbidity of women’s health conditions exist after pregnancy with adverse effects on early child outcomes. Child health professionals should support services and policies that promote women’s health outside the context of pregnancy.
Changes in Use of Health Insurance and Food Assistance Programs in Medically Underserved Communities in the Era of Welfare Reform: An Urban Study
Authors: Pati Susmita , Romero Diana , Chavkin Wendy
Published: December 2008

Objectives. The purpose of this study was to assess changes in health insurance and food assistance enrollment following passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

Methods. Extant data sources were used to calculate changes in Temporary Assistance for Needy Families (TANF), Medicaid, and Food Stamp program enrollment in medically underserved Manhattan communities after 1996.

Results. Dramatic declines in TANF enrollment were accompanied by declines in Food Stamp program enrollment and a deceleration in Medicaid enrollment among several communities.

Conclusions. As the Personal Responsibility and Work Opportunity Reconciliation Act comes up for reauthorization later in 2002, policymakers should revise legislation so that needy families do not lose health insurance or food assistance support.
Universal Coverage and Public Health: New State Studies
Authors: Shaffer Ellen R.
Published: December 2008

Recent evaluations of the California Health Service Plan (CHSP) confirmed that financing health care through a single government payer can provide universal coverage—while saving significantly on health care spending—to a degree unparalleled by alternative approaches. Public ownership of the delivery system can further provide authority and accountability for critical reforms that improve the population’s health and quality of care, including coordination of the delivery system.

The federal government’s State Planning Grant Program provides states with funding to develop plans to cover their uninsured populations. California created a Health Care Options Project that requested proposals that could expand coverage and contracted with a financial modeler and a qualitative analyst to evaluate the resulting plans. The CHSP was one of 9 plans evaluated through this process.
Health Care Reform in South Korea: Success or Failure?
Authors: Lee Jong-Chan
Published: December 2008

South Korea is one of the world’s most rapidly industrializing countries. Along with industrialization has come universal health insurance. Within the span of 12 years, South Korea went from private voluntary health insurance to government-mandated universal coverage.

Since 1997, with the intervention of the International Monetary Fund, Korean national health insurance (NHI) has experienced deficits and disruption. However, there are lessons to be drawn for the United States from the Korean NHI experience.
Comparing Health Systems in Four Countries: Lessons for the United States
Authors: Brown Lawrence D.
Published: December 2008

The Rekindling Reform initiative examined the health systems of 4 countries: Canada, France, Germany, and Great Britain (United Kingdom). From the 4 country reports published in this issue of the American Journal of Public Health, 10 crosscutting themes emerge: (1) coverage, (2) funding, (3) costs, (4) providers, (5) integration, (6) markets, (7) analysis, (8) supply, (9) satisfaction, and (10) leadership. Lessons for the United States are presented under each point.
Lessons for (and From) America
Authors: Klein Rudolf
Published: December 2008

Drawing lessons from international experience for health care reform in the United States requires striking a difficult balance between historical determinism and free will, between cynical pessimism and naïve optimism. The key to this puzzle may lie in a paradox: the United States is the most successful exporter of public health policy ideas and instruments yet has failed to build an effective health care system.

General ideas (like notions about the role of competition) and microinstruments (like diagnosis-related groups) travel better than do health care systems. Ideas can be adapted to local circumstances, and instruments may easily fit into preexisting systems.

Importing systems from countries with different histories and institutions would require a tectonic shift in the American political landscape.