bluuebunny/crossref_metadata_2025 huggingface dataset:
Rekindling Reform—How Goes Business?
Authors: Maher Walter B.
Published: December 2008

Employers were a major cause of the failure of President Clinton’s Health Security bill. This did not have to be so.

The substantive and political factors that caused employers to turn against the Clinton Plan could prove instructive in the next reform effort. The unwillingness of employers who do provide benefits to engage seriously in the struggle over health care reform contributes to maintaining the status quo that penalizes them while rewarding employers who fail to provide coverage.

The lessons that can be learned from the Clinton Plan debate, if heeded by both employers and health reform advocates, raise hope that key elements of the business community can play a positive role in the next comprehensive health reform effort.
Racial/Ethnic Variations in Physician Recommendations for Cardiac Revascularization
Authors: Ibrahim Said A. , Whittle Jeff , Bean-Mayberry Bevanne , Kelley Mary E. , Good Chester , Conigliaro Joseph
Published: December 2008

Objectives. We sought to examine whether physician recommendations for cardiac revascularization vary according to patient race.

Methods. We studied patients scheduled for coronary angiography at 2 hospitals, one public and one private, between November 1997 and June 1999. Cardiologists were interviewed regarding their recommendations for cardiac resvacularization.

Results. African American patients were less likely than Whites to be recommended for revascularization at the public hospital (adjusted odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.12, 0.77) but not at the private hospital (adjusted OR = 1.69; 95% CI = 0.69, 4.14).

Conclusions. Physician recommendations for cardiac revascularization vary by patient race. Further studies are needed to examine physician bias as a factor in racial disparities in cardiac care and outcomes.
Health Behaviors and Quality of Care Among Latinos With Diabetes in Managed Care
Authors: Brown Arleen F. , Gerzoff Robert B. , Karter Andrew J. , Gregg Edward , Safford Monika , Waitzfelder Beth , Beckles Gloria L. A. , Brusuelas Rebecca , Mangione Carol M.
Published: December 2008

Objectives. We evaluated whether ethnicity and language are associated with diabetes care for Latinos in managed care.

Methods. Using data from 4685 individuals in the Translating Research Into Action for Diabetes (TRIAD) Study, a multicenter study of diabetes care in managed care, we constructed multivariate regression models to compare health behaviors, processes of care, and intermediate outcomes for Whites and English- and Spanish-speaking Latinos.

Results. Latinos had lower rates of self-monitoring of blood glucose and worse glycemic control than did Whites, higher rates of foot self-care and dilated-eye examinations, and comparable rates of other processes and intermediate outcomes of care.

Conclusions. Although self-management and quality of care are comparable for Latinos and Whites with diabetes, important ethnic disparities persist in the managed care settings studied.
Patient–Physician Relationships and Racial Disparities in the Quality of Health Care
Authors: Saha Somnath , Arbelaez Jose J. , Cooper Lisa A.
Published: December 2008

Objectives. This study explored whether racial differences in patient–physician relationships contribute to disparities in the quality of health care.

Methods. We analyzed data from The Commonwealth Fund’s 2001 Health Care Quality Survey to determine whether racial differences in patients’ satisfaction with health care and use of basic health services were explained by differences in quality of patient–physician interactions, physicians’ cultural sensitivity, or patient–physician racial concordance.

Results. Both satisfaction with and use of health services were lower for Hispanics and Asians than for Blacks and Whites. Racial differences in the quality of patient–physician interactions helped explain the observed disparities in satisfaction, but not in the use of health services.

Conclusions. Barriers in the patient–physician relationship contribute to racial disparities in the experience of health care.
Research Expectations Among African American Church Leaders in the PRAISE! Project: A Randomized Trial Guided by Community-Based Participatory Research
Authors: Ammerman Alice , Corbie-Smith Giselle , St. George Diane Marie M. , Washington Chanetta , Weathers Beneta , Jackson-Christian Bethany
Published: December 2008

Objectives. This study sought to examine the expectations and satisfaction of pastors and lay leaders regarding a research partnership in a randomized trial guided by community-based participatory research (CBPR) methods.

Methods. Telephone and self-administered print surveys were administered to 78 pastors and lay leaders. In-depth interviews were conducted with 4 pastors after study completion.

Results. The combined survey response rate was 65%. Research expectations included honest and frequent communication, sensitivity to the church environment, interaction as partners, and results provided to the churches. Satisfaction with the research partnership was high, but so was concern about the need for all research teams to establish trust with church partners.

Conclusions. Pastors and lay leaders have high expectations regarding university obligations in research partnerships. An intervention study based on CBPR methods was able to meet most of these expectations.
Effects of a Social-Network Method for Group Assignment Strategies on Peer-Led Tobacco Prevention Programs in Schools
Authors: Valente Thomas W. , Hoffman Beth R. , Ritt-Olson Annamara , Lichtman Kara , Johnson C. Anderson
Published: December 2008

Objectives. Our study tested the effectiveness of network methods for identifying opinion leaders and for constructing groups.

Methods. Three conditions—random, teacher, and network—were randomly assigned to 84 6th-grade classrooms within 16 schools. Pre- and postcurriculum data on mediators of tobacco use were collected from 1961 students. Peer leaders in the network condition were identified by student nominations, and those leaders were matched with the students who nominated them.

Results. Students in the network condition relative to the random condition liked the prevention program more and had improved attitudes (β = −0.06; P < .01), improved self-efficacy (β = −0.10; P < .001), and decreased intention to smoke (adjusted odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.38, 0.55).

Conclusions. The network method was the most effective way to structure the program. Future programs may refine this technique and use it in other settings.
The Public Health Impact of Socioeconomic Status on Adolescent Depression and Obesity
Authors: Goodman Elizabeth , Slap Gail B. , Huang Bin
Published: December 2008

Objectives. We examined the public health impact of the socioeconomic status (SES) gradient on adolescents’ physical and mental health.

Methods. Population attributable risk (PAR) for household income and parental education were calculated relative to depression and obesity among a nationally representative sample of 15 112 adolescents.

Results. PARs for income and education were large. Across each gender and race/ethnicity group, the PAR for education tended to exceed that for income. For depression, the adjusted PAR for income was 26%, and the PAR for education was 40%; for obesity, the adjusted PAR for income was 32%, and the PAR for education was 39%.

Conclusions. SES is associated with a large proportion of the disease burden within the total population.
Do Risk Factors for Childhood Infections and Malnutrition Protect Against Asthma? A Study of Brazilian Male Adolescents
Authors: da Costa Lima Rosângela , Victora Cesar G. , Menezes Ana Maria B. , Barros Fernando C.
Published: December 2008

Objectives. We studied the association between early life conditions and asthma in adolescence.

Methods. We conducted a population-based birth cohort study involving 2250 male 18-year-olds residing in Brazil.

Results. Approximately 18% of the adolescents reported having asthma. Several childhood factors were found to be significantly associated with increased asthma risk: being of high socioeconomic status, living in an uncrowded household, and children being breastfed for 9 months or longer.

Conclusions. The present results are consistent with the “hygiene hypothesis,” according to which early exposure to infections provides protection against asthma. The policy implications of our findings are unclear given that risk factors for asthma protect against serious childhood diseases in developing countries.
Increasing Latino Adolescents’ Adherence to Treatment for Latent Tuberculosis Infection: A Controlled Trial
Authors: Hovell Melbourne F. , Sipan Carol L. , Blumberg Elaine J. , Hofstetter C. Richard , Slymen Donald , Friedman Lawrence , Moser Kathleen , Kelley Norma J. , Vera Alicia Y.
Published: December 2008

Objectives. We sought to determine the efficacy of coaching Latino adolescents with latent tuberculosis infection to adhere to isoniazid treatment.

Methods. Participants (n = 286) were randomly assigned to adherence coaching, attention control, or usual care groups. Adherence was measured via interviews and validated with urine assays.

Results. Coaching resulted in significant increases in adherence compared with attention and usual care groups. Bicultural adolescents were more likely to be adherent than those most or least acculturated. Age and risk behavior were negatively related to adherence.

Conclusions. Coaching can increase Latino adolescents’ adherence to treatment for latent tuberculosis infection and should contribute to tuberculosis control for adolescents at high risk of contracting the disease.
Ethical Issues in Youth Surveys: Potentials for Conducting a National Questionnaire Study on Adolescent Schoolchildren’s Sexual Experiences With Adults
Authors: Helweg-Larsen Karin , Bøving-Larsen Helmer
Published: December 2008

Objectives. We evaluated ethical constraints concerning youth surveys on child sexual abuse (CSA).

Methods. We reviewed internationally published studies and Danish regulations concerning school-based surveys conducted without active parental consent.

Results. Ethical constraints concerning participants in youth community studies have been scantily assessed. Danish legislation accords minors the right to be heard on issues concerning themselves. The anticipated societal benefits of children’s participation in community studies justify conducting anonymous surveys among schoolchildren based upon their own informed consent.

Conclusions. No ethical or legal objections were found to conducting an anonymous survey in Denmark on CSA among 9th-grade pupils without parental consent, provided that the survey was accompanied by an offer of counseling.
Evidence in Support of Foster Care During Acute Refugee Crises
Authors: Duerr Ann , Posner Samuel F. , Gilbert Mark
Published: December 2008

Objectives. The United Nations High Commissioner on Refugees (UNHCR) and United Nations Children’s Fund (UNICEF) policy encourages foster care during refugee emergencies. We examined evidence to support this policy using data from the 1994 Rwandan refugee crisis.

Methods. The association of weight gain and acute illness with family status (foster children vs children living with their biological families) was examined using latent growth curve and repeated measures logistic regression analysis.

Results. Weight gain for all children averaged 0.40 kg/month and was associated with child’s age but not with family status, child’s or caregiver’s sex, caregiver’s marital status, possession of blankets or plastic sheeting, severe malnutrition, month of enrollment, or acute illness. Illness was not more common among foster children than among children living with their biological families.

Conclusions. This analysis supports the UNHCR/UNICEF recommendation of fostering for unaccompanied children during an acute refugee crisis.
Breaking the Alliance: Defeating the Tobacco Industry’s Allies and Enacting Youth Access Restrictions in Massachusetts
Authors: Andersen Brent S. , Begay Michael E. , Lawson Cecil B.
Published: December 2008

Objectives. We describe the tobacco industry’s effort in Massachusetts to block the adoption of local regulations designed to reduce youth access to tobacco products. We also explain how state-funded tobacco control advocates overcame industry opposition.

Methods. We examined internal tobacco industry documents and records of local boards of health and conducted interviews with participants in local regulatory debates.

Results. The industry fought proposed regulations by working through a trade group, the New England Convenience Store Association. With industry direction and financing, the association’s members argued against proposed regulations in local public hearings. However, these efforts failed because community-based advocates worked assiduously to cultivate support for the regulations among board of health members and local community organizations.

Conclusions. Passage of youth access regulations by local boards of health in Massachusetts is attributed to ongoing state funding for local tobacco control initiatives, agreement on common policy goals among tobacco control advocates, and a strategy of persuading boards of health to adopt and enforce their own local regulations.
Watering Down the Drinks: The Moderating Effect of College Demographics on Alcohol Use of High-Risk Groups
Authors: Wechsler Henry , Kuo Meichun
Published: December 2008

Objectives. This study examined whether colleges with larger enrollments of students from demographic groups with lower rates of binge drinking exert a moderating effect on students from groups with higher binge drinking rates.

Methods. The study analyzed data from 114 colleges included in the 1993, 1997, 1999, and 2001 College Alcohol Study surveys.

Results. The binge drinking rates of White, male, and underage students were significantly lower in schools that had more minority, female, and older students. Students who do not binge drink in high school are more likely to start binge drinking at colleges with fewer minority and older students.

Conclusions. Student-body composition and demographic diversity should be examined by colleges wishing to reduce their binge drinking problems.
Caregiving to Children and Grandchildren and Risk of Coronary Heart Disease in Women
Authors: Lee Sunmin , Colditz Graham , Berkman Lisa , Kawachi Ichiro
Published: December 2008

Objectives. We examined the relationship between burden of providing care to non-ill children and grandchildren and incidence of coronary heart disease (CHD) among women.

Methods. A prospective cohort study was conducted as part of the Nurses’ Health Study among 54 412 women aged 46 to 71 years who were registered nurses. Women answered questions about their child care responsibilities.

Results. We documented 321 incident cases of CHD during 4 years of follow-up. Multivariate analyses showed that caring for non-ill children 21 hours or more per week and caring for non-ill grandchildren 9 hours or more per week (vs no caregiving) were associated with an increased risk of CHD (relative risks were 1.59 and 1.55, respectively).

Conclusions. High levels of care provision to grandchildren (and possibly children) may increase the risk of CHD among women.
Racial/Ethnic Differences in Rates of Depression Among Preretirement Adults
Authors: Dunlop Dorothy D. , Song Jing , Lyons John S. , Manheim Larry M. , Chang Rowland W.
Published: December 2008

Objectives. We estimated racial/ethnic differences in rates of major depression and investigated possible mediators.

Methods. Depression prevalence rates among African American, Hispanic, and White adults were estimated from a population-based national sample and adjusted for potential confounders.

Results. African Americans (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 0.93, 1.44) and Hispanics (OR = 1.44, 95% CI = 1.02, 2.04) exhibited elevated rates of major depression relative to Whites. After control for confounders, Hispanics and Whites exhibited similar rates, and African Americans exhibited significantly lower rates than Whites.

Conclusions. Major depression and factors associated with depression were more frequent among members of minority groups than among Whites. Elevated depression rates among minority individuals are largely associated with greater health burdens and lack of health insurance, factors amenable to public policy intervention.
Globalization and Health at the United States–Mexico Border
Authors: Homedes Núria , Ugalde Antonio
Published: December 2008

Objectives. We studied the impact of globalization on the making of health policy. Globalization is understood as economic interdependence among nations. The North American Free Trade Agreement is used as a marker to assess the effects of economic interdependence on binational health cooperation along the United States–Mexico border.

Methods. We observed participants and conducted in-depth interviews with policymakers, public health specialists, representatives of professional organizations, and unions.

Results. Globalization has not promoted binational health policy cooperation. Barriers that keep US and Mexican policymakers apart prevail while health problems that do not recognize international borders go unresolved.

Conclusions. If international health problems are to be solved, political, cultural, and social interdependence need to be built with the same impetus by which policymakers promote international trade.
Environmental Tobacco Smoke and Adult-Onset Asthma: A Population-Based Incident Case–Control Study
Authors: Jaakkola Maritta S. , Piipari Ritva , Jaakkola Niina , Jaakkola Jouni J. K.
Published: December 2008

Objectives. The authors assessed the effects of environmental tobacco smoke (ETS) on the development of asthma in adults.

Methods. In the Pirkanmaa district of South Finland, all 21- to 63-year-old adults with new cases of asthma diagnosed during a 2.5-year period (n = 521 case patients, out of 441 000 inhabitants) and a random sample of control subjects from the source population (932 control subjects) participated in a population-based incident case–control study.

Results. Risk of asthma was related to workplace ETS exposure (adjusted odds ratio [OR] = 2.16; 95% confidence interval [CI] = 1.26, 3.72) and home exposure (OR = 4.77; 95% CI = 1.29, 17.7) in the past year. Cumulative ETS exposure over a lifetime at work and at home increased the risk.

Conclusions. This study indicates for the first time that both cumulative lifetime and recent ETS exposures increase the risk of adult-onset asthma.
Racial/Ethnic Differences in Influenza Vaccination Coverage in High-Risk Adults
Authors: Egede Leonard E. , Zheng Deyi
Published: December 2008

Objectives. This study identified racial/ethnic disparities in influenza vaccination in high-risk adults.

Methods. We analyzed data on influenza vaccination in 7655 adults with high-risk conditions, using data from the 1999 National Health Interview Survey (NHIS). We stratified data by age and used multiple logistic regression to adjust for gender, education, income, employment, and health care access.

Results. After control for covariates, White patients with diabetes, chronic heart conditions, and cancer had a higher prevalence of influenza vaccination than did Black patients with the same conditions. Similarly, White patients with 2 or more high-risk conditions were more likely to receive the influenza vaccine than Black patients with the same conditions.

Conclusions. Significant racial/ethnic differences exist in influenza vaccination of high-risk individuals, and missed vaccination opportunities seem to contribute to the less-than-optimal influenza vaccination coverage in the United States.
Substance Use, Dependence, and Service Utilization Among the US Uninsured Nonelderly Population
Authors: Wu Li-Tzy , Kouzis Anthony C. , Schlenger William E.
Published: December 2008

Objectives. We examined the prevalence and correlates of substance use, dependence, and service utilization among uninsured persons aged 12 to 64 years.

Methods. We drew study data from the 1998 National Household Survey on Drug Abuse.

Results. An estimated 80% of uninsured nonelderly persons reported being uninsured for more than 6 months in the prior year. Only 9% of these uninsured persons who were dependent on alcohol or drugs had received any substance abuse service in the past year. Non-Hispanic Whites were an estimated 3 times more likely than Blacks to receive substance abuse services.

Conclusions. Compared with the privately insured, uninsured persons had increased odds of having alcohol/drug dependence and appeared to face substantial barriers to health services for substance use problems.
The Association of Race, Socioeconomic Status, and Health Insurance Status With the Prevalence of Overweight Among Children and Adolescents
Authors: Haas Jennifer S. , Lee Lisa B. , Kaplan Celia P. , Sonneborn Dean , Phillips Kathryn A. , Liang Su-Ying
Published: December 2008

Objectives. We examined the effect of race, socioeconomic status, and health insurance status on the prevalence of overweight among children and adolescents.

Methods. We studied an observational cohort from the 1996 Medical Expenditure Panel Survey Household Component.

Results. In the younger group, both Black and Latino children had a greater likelihood of being overweight compared with White children. Among the adolescent group, Latinos and Asian/Pacific Islanders were more likely to be overweight. Among adolescents, lacking health insurance and having public insurance were both positively associated with the prevalence of overweight. A relationship between insurance status and overweight was not observed for younger children.

Conclusions. There are substantial racial differences in the prevalence of overweight for children and adolescents. Health insurance status is associated with the prevalence of overweight among adolescents. (Am J Public Health. 2003;93:2105–2110)
Environmental Equity and Health: Understanding Complexity and Moving Forward
Authors: Northridge Mary E. , Stover Gabriel N. , Rosenthal Joyce E. , Sherard Donna
Published: December 2008

The authors invoke a population health perspective to assess the distribution of environmental hazards according to race/ethnicity, social class, age, gender, and sexuality and the implications of these hazards for health.

The unequal burden of environmental hazards borne by African American, Native American, Latino, and Asian American/Pacific Islander communities and their relationship to welldocumented racial/ethnic disparities in health have not been critically examined across all population groups, regions of the United States, and ages.

The determinants of existing environmental inequities also require critical research attention. To ensure inclusiveness and fill important gaps, scientific evidence is needed on the health effects of the built environment as well as the natural environment, cities and suburbs as well as rural areas, and indoor as well as outdoor pollutants.
Bias in Mental Health Assessment and Intervention: Theory and Evidence
Authors: Snowden Lonnie R.
Published: December 2008

A recent surgeon general’s report and various studies document racial and ethnic disparities in mental health care, including gaps in access, questionable diagnostic practices, and limited provision of optimum treatments. Bias is a little studied but viable explanation for these disparities.

It is important to isolate bias from other barriers to high-quality mental health care and to understand bias at several levels (practitioner, practice network or program, and community). More research is needed that directly evaluates the contribution of particular forms of bias to disparities in the area of mental health care.
Physiological Responses to Racism and Discrimination: An Assessment of the Evidence
Authors: Harrell Jules P. , Hall Sadiki , Taliaferro James
Published: December 2008

A growing body of research explores the impact of encounters with racism or discrimination on physiological activity. Investigators have collected these data in laboratories and in controlled clinical settings. Several but not all of the studies suggest that higher blood pressure levels are associated with the tendency not to recall or report occurrences identified as racist and discriminatory.

Investigators have reported that physiological arousal is associated with laboratory analogues of ethnic discrimination and mistreatment. Evidence from survey and laboratory studies suggests that personality variables and cultural orientation moderate the impact of racial discrimination. The neural pathways that mediate these physiological reactions are not known.

The evidence supports the notion that direct encounters with discriminatory events contribute to negative health outcomes.
Paved With Good Intentions: Do Public Health and Human Service Providers Contribute to Racial/Ethnic Disparities in Health?
Authors: van Ryn Michelle , Fu Steven S.
Published: December 2008

There is extensive evidence of racial/ethnic disparities in receipt of health care. The potential contribution of provider behavior to such disparities has remained largely unexplored. Do health and human service providers behave in ways that contribute to systematic inequities in care and outcomes? If so, why does this occur?

The authors build on existing evidence to provide an integrated, coherent, and sound approach to research on providers’ contributions to racial/ethnic disparities. They review the evidence regarding provider contributions to disparities in outcomes and describe a causal model representing an integrated set of hypothesized mechanisms through which health care providers’ behaviors may contribute to these disparities.
Smoking and Ill Health: Does Lay Epidemiology Explain the Failure of Smoking Cessation Programs Among Deprived Populations?
Authors: Lawlor Debbie A , Frankel Stephen , Shaw Mary , Ebrahim Shah , Smith George Davey
Published: December 2008

The resistance of disadvantaged groups to anti-smoking advice is remarkable. In relation to the study of differing cultures, there is a long-standing academic tradition assuming that behavior that may otherwise be difficult to understand is indeed rational within particular cultural contexts.

Persistent smoking among the most deprived members of society may represent a rational response to their life chances informed by a lay epidemiology. Health promotion initiatives designed to reduce smoking among members of these groups may continue to fail unless the general health and life chances of such individuals are first improved.
Onset of Natural Menopause in African American Women
Authors: Palmer Julie R. , Rosenberg Lynn , Wise Lauren A. , Horton Nicholas J. , Adams-Campbell Lucile L.
Published: December 2008

Objectives. This study assessed predictors of the onset of natural menopause in African American women.

Methods. We used mailed questionnaires to collect data at baseline in 1995 and during follow-up from Black Women’s Health Study participants. Cox proportional hazards regression was used to assess potential predictors—including experiences of racism—of the onset of natural menopause among 17 070 women aged 35 to 55 years and premenopausal in 1995.

Results. The hazard ratio (HR) was 1.43 for current smokers (95% confidence interval [CI] = 1.24, 1.66) and 1.21 (95% CI = 1.06, 1.38) for ex-smokers and significantly less for obese women and oral contraceptive users. Hazard ratios for most questions about racism were elevated by 10% to 30% but were not statistically significant.

Conclusions.Earlier onset of natural menopause among African American women is strongly associated with smoking and inversely associated with body mass index and oral contraceptive use.
Consuming Research, Producing Policy?
Authors: Evans Robert G. , Stoddart Greg L.
Published: December 2008

The authors’ 1990 article “Producing Health, Consuming Health Care” presented a conceptual framework for synthesizing a rapidly growing body of findings on the nonmedical determinants of health. The article received a very positive response, and here the authors reflect on what lessons might be learned from that response about the style or content of effective interdisciplinary communication.

Much substantive knowledge has been accumulated since 1990, and a number of different frameworks have been developed before and since. The authors situate theirs within this literature and consider how they might have modified it if they “knew then what they know now.” They ask what impact this article, and the much broader stream of research on the determinants of health, has had on public policy?
The Contribution of the World Health Organization to a New Public Health and Health Promotion
Authors: Kickbusch Ilona
Published: December 2008

The author traces the development of the concept of health promotion from 1980s policies of the World Health Organization. Two approaches that signify the modernization of public health are outlined in detail: the European Health for All targets and the settings approach. Both aim to reorient health policy priorities from a risk factor approach to strategies that address the determinants of health and empower people to participate in improving the health of their communities.

These approaches combine classic public health dictums with “new” strategies, some setting explicit goals to integrate public health with general welfare policy. Health for All, health promotion, and population health have contributed to this reorientation in thinking and strategy, but the focus of health policy remains expenditure rather than investment.
African American Women and Smoking: Starting Later
Authors: Moon-Howard Joyce
Published: December 2008

It is commonly accepted that adolescence is the period for initiation into smoking and other tobacco use behaviors. However, evidence is increasing that the set of presumptions about adolescent onset of tobacco use may not be true for all cultural or subpopulation groups.

Secondary analysis of data from the 2000 National Health Interview Survey (NHIS) was used to examine ethnic differences in smoking patterns among African American and White women. Results showed a striking racial/ethnic difference in age of onset; African American women initiate smoking later than White women at each age group.

Prevention interventions need to continue beyond adolescence well into the adult years, especially for African American women. Late onset for these women represents an often missed window of opportunity for prevention.
Why Do WIC Participants Fail to Pick Up Their Checks? An Urban Study in the Wake of Welfare Reform
Authors: Rosenberg Terry J. , Alperen Julie K. , Chiasson Mary Ann
Published: December 2008

Objectives. This study explored whether work or immigration concerns affect women’s participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Methods. The sample included women who had withdrawn from the WIC program and current WIC clients from 1 center in New York City. Logistic regression analyses were used to predict noncollection of checks; demographic characteristics, program participation, and problems with the WIC program were independent variables.

Results. Strong predictors of noncollection of checks were job conflicts, transportation or illness problems, and WIC receipt by the woman herself (rather than by her children).

Conclusions. Employment conflicts were related to failure to pick up WIC checks; immigration concerns were not. As a means of enhancing WIC participation, flexibility is recommended in terms of center hours, locations, and staffing and program check distribution policies.
Workers’ Liberty, Workers’ Welfare: The Supreme Court Speaks on the Rights of Disabled Employees
Authors: Bayer Ronald
Published: December 2008

On June 10, 2002, a unanimous US Supreme Court rejected the claim by Mario Echazabal that he had been denied his rights under the Americans with Disabilities Act when Chevron USA had refused to employ him because he had hepatitis C. Chevron believed that Echazabal’s exposure to hepatotoxic chemicals in its refinery would pose a grave risk to his health.

This case poses critical questions about the ethics of public health: When, if ever, is paternalism justified? Must choice always trump other values? What ought to be the balance between welfare and liberty?

Strikingly, the groups that came to Echazabal’s defense adopted an antipaternalistic posture fundamentally at odds with the ethical foundations of occupational health and safety policy.
Tobacco Industry Efforts to Defeat the Occupational Safety and Health Administration Indoor Air Quality Rule
Authors: Bryan-Jones Katherine , Bero Lisa A.
Published: December 2008

Objectives. We describe tobacco industry strategies to defeat the Occupational Safety and Health Administration (OSHA) Indoor Air Quality rule and the implementation of those strategies.

Methods. We analyzed tobacco industry documents, public commentary on, and media coverage of the OSHA rule.

Results. The tobacco industry had 5 strategies: (1) maintain scientific debate about the basis of the rule, (2) delay deliberation on the rule, (3) redefine the scope of the rule, (4) recruit and assist labor and business organizations in opposing the rule, and (5) increase media coverage of the tobacco industry position. The tobacco industry successfully implemented all 5 strategies.

Conclusions. Our findings suggest that regulatory authorities must take into account the source, motivation, and validity of arguments used in the regulatory process in order to make accurately informed decisions.
Occupational Health of Southeast Asian Immigrants in a US City: A Comparison of Data Sources
Authors: Azaroff Lenore S. , Levenstein Charles , Wegman David H.
Published: December 2008

Objectives. This study sought to characterize occupational injury and illness cases identified through 3 different sources of data on a population of immigrant workers.

Methods. Participants were Cambodian and Lao workers living in Lowell, Mass. A household survey allowed comparisons between characteristics of work-related cases documented in workers’ compensation wage replacement records and hospital records and characteristics of self-reported cases.

Results. The household survey captured types of cases missing from existing data, particularly illnesses self-reported to be associated with chemical exposures. Injuries and illnesses affecting the study population appeared to be significantly underrepresented in workers’ compensation wage replacement data.

Conclusions. Community-based methods can supplement available occupational health data sources.
Acute Pesticide-Related Illnesses Among Working Youths, 1988–1999
Authors: Calvert Geoffrey M. , Mehler Louise N. , Rosales Rachel , Baum Lynden , Thomsen Catherine , Male Dorilee , Shafey Omar , Das Rupali , Lackovic Michelle , Arvizu Ernest
Published: December 2008

Objectives. The goal of this study was to describe acute occupational pesticide-related illnesses among youths and to provide prevention recommendations.

Methods. Survey data from 8 states and from poison control center data were analyzed. Illness incidence rates and incidence rate ratios were calculated.

Results. A total of 531 youths were identified with acute occupational pesticide-related illnesses. Insecticides were responsible for most of these illnesses (68%), most of which were of minor severity (79%). The average annual incidence rate among youths aged 15 to 17 years was 20.4 per billion hours worked, and the incidence rate ratio among youths vs adults was 1.71 (95% confidence interval = 1.53, 1.91).

Conclusions. The present findings suggest the need for greater efforts to prevent acute occupational pesticide-related illnesses among adolescents.
Magnitude of Maternal Morbidity During Labor and Delivery: United States, 1993–1997
Authors: Danel Isabella , Berg Cynthia , Johnson Christopher H. , Atrash Hani
Published: December 2008

Objectives. This study sought to determine the prevalence of maternal morbidity during labor and delivery in the United States.

Methods. Analyses focused on National Hospital Discharge Survey data available for women giving birth between 1993 and 1997.

Results. The prevalence of specific types of maternal morbidity was low, but the burden of overall morbidity was high. Forty-three percent of women experienced some type of morbidity during their delivery hospitalization. Thirty-one percent (1.2 million women) had at least 1 obstetric complication or at least 1 preexisting medical condition.

Conclusions. Maternal morbidity during delivery is frequent and often preventable. Reducing maternal morbidity is a national health objective, and its monitoring is key to improving maternal health.
Health Policy and the Coloring of an American Male Crisis: A Perspective on Community-Based Health Services
Authors: Smith Amos L.
Published: December 2008

Health services at the community level are organized and financed in such a way that men need access but encounter barriers to care such as poor service design, lack of insurance, and the absence of health literacy.

Community health delivery systems may not be appropriate, effective, fit, or able to meet the needs they are charged to fill. Community-based health services, including health departments, are underfunded, understaffed, and unable to carry out their mission in a way that protects the health of the community.

The current design for funding and delivering health care services excludes poor men, particularly men of color. Improving the health of men requires modifications in the way health care is financed, delivered, and managed.
Informed Consent for Cancer Screening With Prostate-Specific Antigen: How Well Are Men Getting the Message?
Authors: Chan Evelyn C. Y. , Vernon Sally W. , O’Donnell Frederick T. , Ahn Chul , Greisinger Anthony , Aga Donnie W.
Published: December 2008

Objectives. This study examined knowledge about prostate-specific antigen (PSA) screening among African Americans and Whites. Because PSA screening for prostate cancer is controversial, professional organizations recommend informed consent for screening.

Methods. Men (n = 304) attending outpatient clinics were surveyed for their knowledge about and experience with screening.

Results. Most men did not know the key facts about screening with PSA. African Americans appeared less knowledgeable than Whites, but these differences were mediated by differences in educational level and experience with prostate cancer screening.

Conclusions. Public health efforts to improve informed consent for prostate cancer screening should focus on highlighting the key facts and developing different approaches for men at different levels of formal education and prior experience with screening.
Racial/Ethnic Disparities in the Use of Mental Health Services in Poverty Areas
Authors: Chow Julian Chun-Chung , Jaffee Kim , Snowden Lonnie
Published: December 2008

Objectives. This study examined racial/ethnic disparities in mental health service access and use at different poverty levels.

Methods. We compared demographic and clinical characteristics and service use patterns of Whites, Blacks, Hispanics, and Asians living in low-poverty and high-poverty areas. Logistic regression models were used to assess service use patterns of minority racial/ethnic groups compared with Whites in different poverty areas.

Results. Residence in a poverty neighborhood moderates the relationship between race/ethnicity and mental health service access and use. Disparities in using emergency and inpatient services and having coercive referrals were more evident in low-poverty than in high-poverty areas.

Conclusions. Neighborhood poverty is a key to understanding racial/ethnic disparities in the use of mental health services.
Migration and HIV Risk Behaviors: Puerto Rican Drug Injectors in New York City and Puerto Rico
Authors: Deren Sherry , Kang Sung-Yeon , Colón Hector M. , Andia Jonny F. , Robles Rafaela R. , Oliver-Velez Denise , Finlinson Ann
Published: December 2008

Objectives. We compared injection-related HIV risk behaviors of Puerto Rican current injection drug users (IDUs) living in New York City and in Puerto Rico who also had injected in the other location with those who had not.

Methods. We recruited Puerto Rican IDUs in New York City (n = 561) and in Puerto Rico (n = 312). Of the former, 39% were “newcomers,” having previously injected in Puerto Rico; of the latter, 14% were “returnees,” having previously injected in New York. We compared risk behaviors within each sample between those with and without experience injecting in the other location.

Results. Newcomers reported higher levels of risk behaviors than other New York IDUs. Newcomer status (adjusted odds ratio [OR] = 1.62) and homelessness (adjusted OR = 2.52) were significant predictors of “shooting gallery” use; newcomer status also predicted paraphernalia sharing (adjusted OR = 1.67). Returnee status was not related to these variables.

Conclusions. Intervention services are needed that target mobile populations who are coming from an environment of high-risk behavior to one of low-risk behavior.
Rethinking the Socioeconomics and Geography of Tuberculosis Among Foreign-Born Residents of New Jersey, 1994–1999
Authors: Davidow Amy L. , Mangura Bonita T. , Napolitano Eileen C. , Reichman Lee B.
Published: December 2008

Objectives. This study investigated the socioeconomic profile of foreign-born tuberculosis patients in New Jersey.

Methods. Foreign- and US-born tuberculosis patients in 1994–1999 were compared using various measures of socioeconomic status.

Results. Out of 4295 tuberculosis patients, 2005 (47%) were foreign-born. Foreign-born patients resided in more affluent, more educated, and less crowded areas than did US-born patients (P < .005). They were also more likely to have been employed during the 2 years before diagnosis (62% vs 41%, P < .001). Private physicians treated the majority of South Asian–born patients.

Conclusions. Substantial numbers of employed foreign-born tuberculosis patients now reside in affluent New Jersey locations. Changes in tuberculosis control programs may be required when the socioeconomic status and place of residence of foreign-born populations diverge from traditional assumptions linking poverty with tuberculosis.
Field-Delivered Therapy Increases Treatment for Chlamydia and Gonorrhea
Authors: Steiner Katherine C. , Davila Veronica , Kent Charlotte K. , Chaw Janice K. , Fischer Lyn , Klausner Jeffrey D.
Published: December 2008

In 1998, treatment completion was low among chlamydia and gonorrhea cases reported to the San Francisco Department of Public Health and assigned for treatment follow-up.

To improve treatment completion among growing numbers of chlamydia and gonorrhea cases, the department implemented field-delivered therapy (FDT), a single-dose, directly observed therapy protocol for uncomplicated chlamydial and gonococcal infections. After the protocol was implemented in March 1999, the proportion of cases completing treatment increased significantly, from 61.8% in 1998 to 81.0% in 2000. The greatest increases in treatment completion were observed for females and individuals younger than 20 years old.

FDT is an effective, feasible, and convenient way to reach and treat individuals who are unlikely to return for chlamydia and gonorrhea treatment.
Characterizing a “New” Disease: Epizootic and Epidemic Anthrax, 1769–1780
Authors: Morens David M.
Published: December 2008

In 1876, Robert Koch established anthrax as the first disease linked to a microbial agent. But Koch’s efforts had followed more than 150 years of scientific progress in characterizing anthrax as a specific human and veterinary disease.

Focusing on France and the period between 1769 and 1780, this brief review examines noteworthy early events in the characterization of anthrax. It suggests that some “new” diseases like anthrax might be “discovered” not only by luck, brilliance, or new technologies, but by clinical/epidemiological “puzzle-fitting,” which can assemble a cohesive picture of a seemingly specific disease entity.

If such processes have operated over 2 or more centuries, studying them may yield clues about desirable interactions between epidemiology/public health and experimental science in the characterization of new diseases.
Condom Availability Programs in Massachusetts High Schools: Relationships With Condom Use and Sexual Behavior
Authors: Blake Susan M. , Ledsky Rebecca , Goodenow Carol , Sawyer Richard , Lohrmann David , Windsor Richard
Published: December 2008

Objectives. This study assessed relationships between condom availability programs accompanied by community discussion and involvement and adolescent sexual practices.

Methods. Sexual practice and condom use differences were assessed in a representative sample of 4166 adolescents enrolled in high schools with and without condom availability programs.

Results. Adolescents in schools where condoms were available were more likely to receive condom use instruction and less likely to report lifetime or recent sexual intercourse. Sexually active adolescents in those schools were twice as likely to use condoms, but less likely to use other contraceptive methods, during their most recent sexual encounter.

Conclusions. The strategy of making condoms available, an indication of socioenvironmental support for condom use, may improve HIV prevention practices.
Rapid Assessment of the HIV/AIDS Crisis in Racial and Ethnic Minority Communities: An Approach for Timely Community Interventions
Authors: Needle Richard H. , Trotter Robert T. , Singer Merrill , Bates Christopher , Page J. Bryan , Metzger David , Marcelin Louis H.
Published: December 2008

Objectives. The US Department of Health and Human Services, in collaboration with the Congressional Black Caucus, created a new initiative to address the disproportionate ongoing HIV/AIDS crisis in racial/ethnic minority populations.

Methods. This initiative included deploying technical assistance teams through the Office of HIV/AIDS Policy. The teams introduced rapid assessment and response methodologies and trained minority communities in their use.

Results. The first 3 eligible cities (Detroit, Miami, and Philadelphia) focused assessments in small geographic areas, using multiple methodologies to obtain data.

Conclusions. Data from the first 3 eligible cities provided critical information about changing the dynamics of the HIV/AIDS epidemic at the local level, including program and policy changes and infrastructure redeployment targeted at the most serious social and environmental conditions.
Use of Alternative Therapists Among People in Care for HIV in the United States
Authors: London Andrew S. , Foote-Ardah Carrie E. , Fleishman John A. , Shapiro Martin F.
Published: December 2008

Objectives. This study examined the influence of sociodemographic, clinical, and attitudinal variables on the use of alternative therapists by people in care for HIV.

Methods. Bivariate and multivariate analyses of baseline data from the nationally representative HIV Cost and Services Utilization Study were conducted.

Results. Overall, 15.4% had used an alternative therapist, and among users, 53.9% had fewer than 5 visits in the past 6 months. Use was higher for people who were gay/lesbian, had incomes above $40 000, lived in the Northeast and West, were depressed, and wanted more information about and more decisionmaking involvement in their care. Among users, number of visits was associated with age, education, sexual orientation, insurance status, and CD4 count.

Conclusions. Among people receiving medical care for HIV, use of complementary care provided by alternative therapists is associated with several sociodemographic, clinical, and attitudinal variables. Evaluation of the coordination of provider-based alternative and standard medical care is needed.