bluuebunny/crossref_metadata_2025 huggingface dataset:
Walking, Bicycling, and Urban Landscapes: Evidence From the San Francisco Bay Area
Authors: Cervero Robert , Duncan Michael
Published: December 2008

Some claim that cardependent cities contribute to obesity by discouraging walking and bicycling. In this article, we use household activity data from the San Francisco region to study the links between urban environments and nonmotorized travel.

We used factor analysis to represent the urban design and land-use diversity dimensions of built environments. Combining factor scores with control variables, like steep terrain, that gauge impediments to walking and bicycling, we estimated discrete-choice models. Builtenvironment factors exerted far weaker, although not inconsequential, influences on walking and bicycling than control variables.

Stronger evidence on the importance of urban landscapes in shaping foot and bicycle travel is needed if the urban planning and public health professions are to forge an effective alliance against cardependent sprawl.
The Impact of Community Design and Land-Use Choices on Public Health: A Scientific Research Agenda
Authors: Dannenberg Andrew L. , Jackson Richard J. , Frumkin Howard , Schieber Richard A. , Pratt Michael , Kochtitzky Chris , Tilson Hugh H.
Published: December 2008

The design of a community’s built environment influences the physical and mental health of its residents. Because few studies have investigated this relationship, the Centers for Disease Control and Prevention hosted a workshop in May 2002 to help develop a scientific research agenda on these issues.

Workshop participants’ areas of expertise included physical activity, injury prevention, air pollution, water quality, urban planning, transportation, architecture, epidemiology, land use, mental health, social capital, housing, and social marketing. This report describes the 37 questions in the resulting research agenda.

The next steps are to define priorities and obtain resources. The proposed research will help identify the best practices for designing new communities and revitalizing old ones in ways that promote physical and mental health.
Reestablishing Public Health and Land Use Planning to Protect Public Water Supplies
Authors: Greenberg Michael , Mayer Henry , Miller K. Tyler , Hordon Robert , Knee Daniel
Published: December 2008

Objectives. This study measured the extent to which land use, design, and engineering practices could reduce contamination of major public water supplies.

Methods. Key parcels of land were identified in New Jersey, and the potential uncontrolled loading of contaminants was estimated with the US Environmental Protection Agency’s Long-Term Hydrologic Impact Assessment model for a variety of land use, design, and engineering scenarios.

Results. High-density per-acre development and engineering controls, along with housing and light commercial activity near main railroads, would substantially reduce runoff.

Conclusions. In New Jersey, government and purveyor action is being taken as a result of, and in support of, these findings.
Social Capital and the Built Environment: The Importance of Walkable Neighborhoods
Authors: Leyden Kevin M.
Published: December 2008

Objectives. I sought to examine whether pedestrian-oriented, mixed-use neighborhoods encourage enhanced levels of social and community engagement (i.e., social capital).

Methods. The study investigated the relationship between neighborhood design and individual levels of social capital. Data were obtained from a household survey that measured the social capital of citizens living in neighborhoods that ranged from traditional, mixed-use, pedestrian-oriented designs to modern, car-dependent suburban subdivisions in Galway, Ireland.

Results. The analyses indicate that persons living in walkable, mixed-use neighborhoods have higher levels of social capital compared with those living in car-oriented suburbs. Respondents living in walkable neighborhoods were more likely to know their neighbors, participate politically, trust others, and be socially engaged.

Conclusions. Walkable, mixed-use neighborhood designs can encourage the development of social capital.
Effectiveness of Individually Tailored Calendars in Promoting Childhood Immunization in Urban Public Health Centers
Authors: Kreuter Matthew W. , Caburnay Charlene A. , Chen John J. , Donlin Maureen J.
Published: December 2008

Objectives. We examined the effectiveness of tailored calendars in increasing childhood immunization rates.

Methods. Parents of babies aged birth to 1 year (n = 321) received individually tailored calendars promoting immunization from 2 urban public health centers. For each baby, an age- and sex-matched control was selected from the same center. Immunization status was tracked through age 24 months.

Results. A higher proportion of intervention than of control babies were up to date at the end of a 9-month enrollment period (82% vs 65%, P < .001) and at age 24 months (66% vs 47%, P < .001). The younger the baby’s age at enrollment in the program, the greater was the intervention effect.

Conclusions. Tailored immunization calendars can help increase child immunization rates.
Measuring the Quality of Diabetes Care for Older American Indians and Alaska Natives
Authors: Roubideaux Yvette , Buchwald Dedra , Beals Janette , Middlebrook Denise , Manson Spero , Muneta Ben , Rith-Najarian Steve , Shields Ray , Acton Kelly
Published: December 2008

Objectives. This study evaluated the quality of diabetes care for older American Indians and Alaska Natives.

Methods. We analyzed the Indian Health Service Diabetes Care and Outcomes Audit to determine whether completion of indicators of diabetes care differed as a function of age and whether additional patient and program factors were also associated with completion of the majority of the indicators.

Results. Completion rates varied by age group, with significantly lower rates seen among the youngest and oldest. Patient diabetes education and duration of diabetes were most strongly associated with the completion of the majority of these indicators.

Conclusions. Further studies are needed to determine effective interventions, including diabetes education, to improve the quality of diabetes care in the youngest and oldest age groups.
Implementing the Institute of Medicine’s Recommended Curriculum Content in Schools of Public Health: A Baseline Assessment
Authors: Shortell Stephen M. , Weist Elizabeth M. , Sow Mah-Sere Keita , Foster Allison , Tahir Ramika
Published: December 2008

In September 2003, the Association of Schools of Public Health administered an online survey to representatives of all 33 accredited US schools of public health. The survey assessed the extent to which the schools were offering curriculum content in the 8 areas recommended by the Institute of Medicine: communication, community-based participatory research, cultural competence, ethics, genomics, global health, informatics, and law/policy.

Findings indicated that, for the most part, schools of public health are offering content in these areas through many approaches and have incorporated various aspects of a broad-based ecological approach to public health education and training. The findings also suggested the possible need for greater content in genomics, informatics, community-based participatory research, and cultural competence.
Education-Related Gender Differences in Health in Rural China
Authors: Wu Jing , Liu Yuanli , Rao Keqin , Sun Qi , Qian Juncheng , Li Zhu
Published: December 2008

We investigated gender differences in education-related health inequalities in rural China. Household interview data were obtained from 6 provinces in 1993 and 2001. Remarkable health inequalities existed and favored the higher educational groups; among women, the inequalities were greater and health inequalities increased from 1993 to 2001. Education serves as a more powerful mediating factor for health inequalities among women than among men in rural China.
Results From a Lay Health Advisor Intervention to Prevent Lead Poisoning Among Rural Native American Children
Authors: Kegler Michelle Crozier , Malcoe Lorraine Halinka
Published: December 2008

Objectives. We tested the effectiveness of a community-based lay health advisor intervention for primary prevention of lead poisoning among Native American children who lived in a former mining area.

Methods. We conducted cross-sectional population-based blood lead assessments of Native American and White children aged 1 to 6 years and in-person caregiver interviews before (n=331) and after (n=387) a 2-year intervention.

Results. Mean childhood blood lead levels decreased and selected preventive behaviors improved for both Native American and White (comparison) communities. Several short-term outcomes also improved from pre- to postintervention, but only knowledge and hand-washing self-efficacy increased more among Native Americans than among Whites.

Conclusions. Our findings provide limited support for the effectiveness of lay health advisor interventions as a primary lead poisoning prevention strategy for Native American communities.
Impact of a National Rural Youth Health and Safety Initiative: Results from a Randomized Controlled Trial
Authors: Lee Barbara C. , Westaby James D. , Berg Richard L.
Published: December 2008

Objectives. We conducted a comprehensive evaluation of a rural youth health and safety initiative implemented in 4000 National FFA (formerly Future Farmers of America) chapters across the United States.

Methods. Data were collected from high school students and their FFA advisers at 3 time intervals (preintervention, immediate postintervention, and 1 year postintervention) with a 3-group (standard, enhanced, and control), cluster-randomized, controlled trial design.

Results. Matched data from 3081 students and 81 advisers revealed no significant effect of this initiative on agricultural health and safety knowledge, safety attitudes, leadership, self-concept, and self-reported injuries of project participants. Data from 30 public health nurses following the intervention confirmed the program’s failure to develop sustainable community partnerships.

Conclusions. This nationally coordinated initiative was funded with more than $1 million donated by agribusinesses. Program implementation was inconsistent, and desired outcomes were not achieved. Future efforts should better guide effective use of private sector resources aimed at reducing agricultural disease and injury among rural youths.
Underuse of Screening Sigmoidoscopy and Colonoscopy in a Large Cohort of US Adults
Authors: Chao Ann , Connell Cari J. , Cokkinides Vilma , Jacobs Eric J. , Calle Eugenia E. , Thun Michael J.
Published: December 2008

Objectives. We examined the prevalence of endoscopy (sigmoidoscopy or colonoscopy) by indication and by demographic and lifestyle factors.

Methods. We analyzed cross-sectional data collected in 1997 from participants aged 50 years and older in the Cancer Prevention Study (CPS) II Nutrition Cohort.

Results. Fifty-eight percent of men and 51% of women reported ever having undergone endoscopy; only 42% of men and 31% of women reported endoscopy for screening rather than for disease diagnosis or follow-up. Prevalence varied by demographic and lifestyle factors.

Conclusions. Efforts to increase colorectal cancer screening need to target women, all persons aged 50–64 years, and those with colorectal cancer risk factors. Future studies should distinguish endoscopy for screening from procedures for disease diagnosis and follow-up to avoid overestimating screening compliance.
Neighborhood Context and Mortality Among Older Mexican Americans: Is There a Barrio Advantage?
Authors: Eschbach Karl , Ostir Glenn V. , Patel Kushang V. , Markides Kyriakos S. , Goodwin James S.
Published: December 2008

Objectives. We examined whether Mexican Americans living in high-density Mexican American neighborhoods experience increased morbidity and mortality compared with the rates observed among Mexican Americans living in low-density areas.

Methods. We conducted a prospective analysis of a cohort of 3050 Mexican Americans aged 65 years or older. We examined prevalence of 6 medical conditions and survival over 7 years of follow-up in relation to percentage of Mexican Americans in the census tract.

Results. With adjustment for covariates, odds for disease prevalence among older Mexican Americans as a function of percentage of Mexican Americans in the census tract were 0.33 (95% confidence interval [CI]=0.16, 0.71) for stroke, 0.28 (95% CI= 0.11, 0.70) for cancer, and 0.31 (95% CI=0.10, 0.98) for hip fracture. The hazard ratio for all-cause mortality over 7 years’ follow-up was 0.64 (95% CI=0.42, 0.96).

Conclusions. Sociocultural advantages conferred on Mexican Americans by living in high-density Mexican American neighborhoods outweigh the disadvantages conferred by the high poverty of those neighborhoods.
The ORIGINS of Primary Health Care and SELECTIVE Primary Health Care
Authors: Cueto Marcos
Published: December 2008

I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations’ political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care.

These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America.
Human Testing of Pesticides: Ethical and Scientific Considerations
Authors: Lockwood Alan H.
Published: December 2008

I reviewed ethical and scientific aspects of 6 human pesticide-dosing studies submitted to the Environmental Protection Agency (EPA) for consideration during the pesticide reregistration process. All had serious ethical or scientific deficiencies—or both—including unacceptable informed consent procedures, unmanaged financial conflicts of interest, inadequate statistical power, inappropriate test methods and endpoints, and distorted results.

Given today’s knowledge of the effects of pesticides, there is no assurance that any such study can be completely free of short-term risks, long-term risks, or both. Therefore, there is no basis for allowing pesticide studies to continue or for using them during the pesticide reregistration process. An EPA committee that is free from political and financial conflicts of interest should review this practice.
A Global Perspective on Vaccine Safety and Public Health: The Global Advisory Committee on Vaccine Safety
Authors: Folb Peter I. , Bernatowska Ewa , Chen Robert , Clemens John , Dodoo Alex N. O. , Ellenberg Susan S. , Farrington C. Patrick , John T. Jacob , Lambert Paul-Henri , MacDonald Noni E. , Miller Elizabeth , Salisbury David , Schmitt Heinz-J. , Siegrist Claire-Anne , Wimalaratne Omala
Published: December 2008

Established in 1999, the Global Advisory Committee on Vaccine Safety advises the World Health Organization (WHO) on vaccine-related safety issues and enables WHO to respond promptly, efficiently, and with scientific rigor to issues of vaccine safety with potential global importance. The committee also assesses the implications of vaccine safety for practice worldwide and for WHO policies. We describe the principles on which the committee was established, its modus operandi, and the scope of the work undertaken, both present and future. We highlight its recent recommendations on major issues, including the purported link between the measles–mumps–rubella vaccine and autism and the safety of the mumps, influenza, yellow fever, BCG, and smallpox vaccines as well as that of thiomersal-containing vaccines.
Self-Care Among Chronically Ill African Americans: Culture, Health Disparities, and Health Insurance Status
Authors: Becker Gay , Gates Rahima Jan , Newsom Edwina
Published: December 2008

Little is known about the self-care practices of chronically ill African Americans or how lack of access to health care affects self-care. Results from a qualitative interview study of 167 African Americans who had one or more chronic illnesses found that self-care practices were culturally based, and the insured reported more extensive programs of self-care. Those who had some form of health insurance much more frequently reported the influence of physicians and health education programs in self-care regimens than did those who were uninsured. It is concluded that the cultural components of self-care have been underemphasized, and further, that the potential to maximize chronic illness management through self-care strategies is not realized for those who lack access to health care.
Variations in Health Communication Needs Among Combat Veterans
Authors: Schneiderman Aaron I. , Lincoln Andrew E. , Curbow Barbara , Kang Han K.
Published: December 2008

In this cross-sectional study of US military combat veterans, we assessed the helpfulness of different media for providing health risk communication messages. We have provided preliminary results from a postal survey of 5000 veterans sampled because of their deployment to Vietnam, the Persian Gulf, or Bosnia–Kosovo. Respondents endorsed the primary care provider as the most helpful source of health information. Access to the Internet and use of this medium for seeking health information differed by race, age, and cohort.
Patient Race/Ethnicity and Quality of Patient–Physician Communication During Medical Visits
Authors: Johnson Rachel L. , Roter Debra , Powe Neil R. , Cooper Lisa A.
Published: December 2008

Objectives. We examined the association between patient race/ethnicity and patient–physician communication during medical visits.

Methods. We used audiotape and questionnaire data collected in 1998 and 2002 to determine whether the quality of medical-visit communication differs among African American versus White patients. We analyzed data from 458 African American and White patients who visited 61 physicians in the Baltimore, Md–Washington, DC–Northern Virginia metropolitan area. Outcome measures that assessed the communication process, patient-centeredness, and emotional tone (affect) of the medical visit were derived from audiotapes coded by independent raters.

Results. Physicians were 23% more verbally dominant and engaged in 33% less patient-centered communication with African American patients than with White patients. Furthermore, both African American patients and their physicians exhibited lower levels of positive affect than White patients and their physicians did.

Conclusions. Patient–physician communication during medical visits differs among African American versus White patients. Interventions that increase physicians’ patient-centeredness and awareness of affective cues with African Americans patients and that activate African American patients to participate in their health care are important strategies for addressing racial/ethnic disparities in health care.
Unemployment and Early Cause-Specific Mortality: A Study Based on the Swedish Twin Registry
Authors: Voss Margaretha , Nylén Lotta , Floderus Birgitta , Diderichsen Finn , Terry Paul D.
Published: December 2008

Objectives. We investigated the association between unemployment and early cause-specific mortality to determine whether the relationship was modified by other risk indicators.

Methods. Female and male twins (n=20632) were followed with regard to mortality from 1973 through 1996. Questionnaire data from 1973 were used to obtain information on experience of unemployment and on social, behavioral, health, and personality characteristics.

Results. Unemployment was associated with an increased risk of suicide and death from undetermined causes. Low education, personality characteristics, use of sleeping pills or tranquilizers, and serious or long-lasting illness tended to strengthen the association between unemployment and early mortality.

Conclusions. An increased risk of death from external causes implies a need for support for those experiencing unemployment, particularly susceptible individuals.
Poor Smokers, Poor Quitters, and Cigarette Tax Regressivity
Authors: Remler Dahlia K.
Published: December 2008

The traditional view that excise taxes are regressive has been challenged. I document the history of the term regressive tax, show that traditional definitions have always found cigarette taxes to be regressive, and illustrate the implications of the greater price responsiveness observed among the poor. I explain the different definitions of tax burden: accounting, welfare-based willingness to pay, and welfare-based time inconsistent. Progressivity (equity across income groups) is sensitive to the way in which tax burden is assessed. Analysis of horizontal equity (fairness within a given income group) shows that cigarette taxes heavily burden poor smokers who do not quit, no matter how tax burden is assessed.
Sustained Increased Consumption of Cigarettes, Alcohol, and Marijuana Among Manhattan Residents After September 11, 2001
Authors: Vlahov David , Galea Sandro , Ahern Jennifer , Resnick Heidi , Kilpatrick Dean
Published: December 2008

We compared reports of increased substance use in Manhattan 1 and 6 months after the September 11, 2001, terrorist attacks. Data from 2 random-digit-dial surveys conducted 1 and 6 months after September 11 showed that 30.8% and 27.3% of respondents, respectively, reported increased use of cigarettes, alcohol, or marijuana. These sustained increases in substance use following the September 11 terrorist attacks suggest potential long-term health consequences as a result of disasters.
Effect of Local Restaurant Smoking Regulations on Environmental Tobacco Smoke Exposure Among Youths
Authors: Siegel Michael , Albers Alison B. , Cheng Debbie M. , Biener Lois , Rigotti Nancy A.
Published: December 2008

Objectives. We examined the effect of local restaurant smoking regulations on restaurant environmental tobacco smoke exposure among youths.

Methods. We interviewed 3863 Massachusetts youths aged 12–17 years and ascertained how often they saw smokers in restaurants in their town. We assessed the effect of local restaurant smoking regulation strength on nonexposure to environmental tobacco smoke (seeing smokers never or only rarely).

Results. Compared with youths from towns with weak regulations, youths from towns with medium-strength regulations had 1.4 times the odds (odds ratio = 1.36; 95% confidence interval = 1.12, 1.65) and youths from towns with strong regulations had twice the odds (odds ratio = 2.03; 95% confidence interval = 1.64, 2.52) of reporting nonexposure.

Conclusions. Strong local restaurant smoking regulations are associated with reduced environmental tobacco smoke exposure among youths
Young Adults: Vulnerable New Targets of Tobacco Marketing
Authors: Biener Lois , Albers Alison B.
Published: December 2008

Objectives. We examined young adult smoking patterns and receptivity to cigarette advertising to assess vulnerability to tobacco marketing strategies.

Methods. We obtained data from a telephone survey of 12 072 Massachusetts adults.

Results. Smokers aged 18 to 30 years were more likely than older adults to smoke only occasionally and to consume fewer than 10 cigarettes per day. They also were more receptive to cigarette marketing and were more likely to be frequent patrons of bars and clubs.

Conclusions. Many young adult smokers are in the initiation phase of smoking and are likely to undergo a transition to either nonsmoking or heavier smoking. If unimpeded by regulation, tobacco promotion in bars and clubs is likely to lead to increased adult smoking prevalence.
Is It Time to Reassess the Categorization of Disease Burdens in Low-Income Countries?
Authors: Setel Philip W. , Saker Lance , Unwin Nigel C. , Hemed Yusuf , Whiting David R. , Kitange Henry
Published: December 2008

The classification of disease burdens is an important topic that receives little attention or debate. One common classification scheme, the broad cause grouping, is based on etiology and health transition theory and is mainly concerned with distinguishing communicable from noncommunicable diseases. This may be of limited utility to policymakers and planners. We propose a broad care needs framework to complement the broad cause grouping. This alternative scheme may be of equal or greater value to planners. We apply these schemes to disability-adjusted life year estimates for 2000 and to mortality data from Tanzania. The results suggest that a broad care needs approach could shift the priorities of health planners and policymakers and deserves further evaluation.
Does Walking 15 Minutes per Day Keep the Obesity Epidemic Away? Simulation of the Efficacy of a Populationwide Campaign
Authors: Morabia Alfredo , Costanza Michael C.
Published: December 2008

Small physical activity increases may prevent weight gain in most populations. Geneva residents completed validated quantitative physical activity frequency questionnaires from 1997 to 2001. Fifteen minutes per day of moderate or brisk walking, or 30 minutes per day of slow walking, could increase physical activity at the population level; however, if the specific goal is to approach expending 420 kJ/d (100 kcal/d) through walking, the duration should be closer to 60 minutes for slow walking and 30 minutes for moderate or brisk walking.
Confronting the Challenges in Reconnecting Urban Planning and Public Health
Authors: Corburn Jason
Published: December 2008

Although public health and urban planning emerged with the common goal of preventing urban outbreaks of infectious disease, there is little overlap between the fields today. The separation of the fields has contributed to uncoordinated efforts to address the health of urban populations and a general failure to recognize the links between, for example, the built environment and health disparities facing low-income populations and people of color.

I review the historic connections and lack thereof between urban planning and public health, highlight some challenges facing efforts to recouple the fields, and suggest that insights from ecosocial theory and environmental justice offer a preliminary framework for reconnecting the fields around a social justice agenda.
Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis
Authors: Tsemberis Sam , Gulcur Leyla , Nakae Maria
Published: December 2008

Objectives. We examined the longitudinal effects of a Housing First program for homeless, mentally ill individuals’ on those individuals’ consumer choice, housing stability, substance use, treatment utilization, and psychiatric symptoms.

Methods. Two hundred twenty-five participants were randomly assigned to receive housing contingent on treatment and sobriety (control) or to receive immediate housing without treatment prerequisites (experimental). Interviews were conducted every 6 months for 24 months.

Results. The experimental group obtained housing earlier, remained stably housed, and reported higher perceived choice. Utilization of substance abuse treatment was significantly higher for the control group, but no differences were found in substance use or psychiatric symptoms.

Conclusions. Participants in the Housing First program were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms.
Professional and Hospital DISCRIMINATION and the US Court of Appeals Fourth Circuit 1956–1967
Authors: Reynolds P. Preston
Published: December 2008

A series of court cases litigated by the National Association for the Advancement of Colored People Legal Defense and Education Fund between 1956 and 1967 laid the foundation for elimination of overt discrimination in hospitals and professional associations.

The landmark case, Simkins v Moses H. Cone Memorial Hospital (1963), challenged the use of public funds to expand segregated hospital care. The second case, Cypress v Newport News Hospital Association (1967), reaffirmed the federal government’s application of Medicare certification guidelines to force hospitals to open up patient admissions, education programs, and staff privileges to all citizens and physicians.

Pursuit of a legal strategy against racist policies was an essential element in a national campaign to eliminate discrimination in health care delivery in the United States.
Prevalence of Multiple Chemical Sensitivities: A Population-Based Study in the Southeastern United States
Authors: Caress Stanley M. , Steinemann Anne C.
Published: December 2008

We examined the prevalence of multiple chemical sensitivities (MCS), a hypersensitivity to common chemical substances. We used a randomly selected sample of 1582 respondents from the Atlanta, Ga, standard metropolitan statistical area. We found that 12.6% of our sample reported the hypersensitivity and that, while the hypersensitivity is more common in women, it is experienced by both men and women of a variety of ages and educational levels. Our prevalence for MCS is similar to that (15.9%) found by the California Department of Health Services in California and suggests that the national prevalence may be similar.
Dental Care Use and Self-Reported Dental Problems in Relation to Pregnancy
Authors: Lydon-Rochelle Mona T. , Krakowiak Paula , Hujoel Philippe P. , Peters Riley M.
Published: December 2008

Objectives. We examined the relationships between risk factors amenable to intervention and the likelihood of dental care use during pregnancy.

Methods. We used data from the Washington State Department of Health’s Pregnancy Risk Assessment Monitoring System.

Results. Of the women surveyed, 58% reported no dental care during their pregnancy. Among women with no dental problems, those not receiving dental care were at markedly increased risk of having received no counseling on oral health care, being overweight, and using tobacco. Among women who received dental care, those with dental problems were more likely to have lower incomes and Medicaid coverage than those without dental problems.

Conclusions. There is a need for enhanced education and training of maternity care providers concerning oral health in pregnancy.
Use of Preventive Services by Men Enrolled in Medicare+Choice Plans
Authors: Morales Leo S. , Rogowski Jeannette , Freedman Vicki A. , Wickstrom Steven L. , Adams John L. , Escarce José J.
Published: December 2008

Objectives. We examined the effect of demographic and socioeconomic factors on use of preventive services (prostate-specific antigen testing, colorectal cancer screening, and influenza vaccination) among elderly men enrolled in 2 Medicare+Choice health plans.

Methods. Data were derived from administrative files and a survey of 1915 male enrollees. We used multivariate logistic regression to assess the effects of enrollee characteristics on preventive service use.

Results. Age, marital status, educational attainment, and household wealth were associated with receipt of one or more preventive services. However, the effects of these variables were substantially attenuated relative to earlier studies of Medicare.

Conclusions. Some Medicare HMOs have been successful in attenuating racial and socioeconomic disparities in the use of preventive services by older men.
Vitamin C Deficiency and Depletion in the United States: The Third National Health and Nutrition Examination Survey, 1988 to 1994
Authors: Hampl Jeffrey S , Taylor Christopher A. , Johnston Carol S.
Published: December 2008

Objectives. We sought to determine prevalence rates of vitamin C deficiency and depletion in the United States.

Methods. We used data from the Third National Health and Nutrition Examination Survey to assess intake of dietary, supplemental, and serum vitamin C.

Results. Mean intakes and serum levels of vitamin C were normal; however, vitamin C deficiency and depletion were common (occurring among 5%–17% and 13%–23% of respondents, respectively). Smokers, those who did not use supplements, and non-Hispanic Black males had elevated risks of vitamin C deficiency, while Mexican Americans had lower risks.

Conclusions. Health professionals should recommend consumption of vegetables and fruits rich in vitamin C and should recommend supplementation for individuals at risk of vitamin C deficiency.
Measuring the Prevalence of Overweight in Texas Schoolchildren
Authors: Hoelscher Deanna M. , Day R. Sue , Lee Eun Sul , Frankowski Ralph F. , Kelder Steven H. , Ward Jerri L. , Scheurer Michael E.
Published: December 2008

Objectives. We describe results from year 1 of a surveillance system to monitor body mass index in children at the state level.

Methods. A sample of 6630 children attending Texas public schools, weighted to represent 4th, 8th, and 11th grades within race/ethnic subpopulations, was assessed. Body mass index was calculated from measured height and weight; demographic information was obtained from a questionnaire.

Results. Prevalence of overweight was 22.4%, 19.2%, and 15.5% for 4th-, 8th-, and 11th-grade students, respectively. Overweight prevalence was highest among Hispanic boys (29.5%–32.6%), fourth-grade Hispanic girls (26.7%), and fourth- and eighth-grade African American girls (30.8% and 23.1%, respectively). Eleventh-grade White/other girls had the lowest prevalence of overweight (5.5%).

Conclusions. These data confirm the increasing prevalence of overweight among US children, especially among Hispanic and African American students compared to White/other students and fourth-grade students relative to 8th- and 11th-grade students.
Availability and Perceived Effectiveness of Public Health Activities in the Nation’s Most Populous Communities
Authors: Mays Glen P. , Halverson Paul K. , Baker Edward L. , Stevens Rachel , Vann Julie J.
Published: December 2008

Objectives. We examined the availability and perceived effectiveness of 20 basic public health activities in the communities where most Americans reside.

Methods. A self-administered questionnaire was mailed to the 497 directors of US local health departments serving at least 100 000 residents.

Results. On average, two thirds of the 20 public health activities were performed in the local jurisdictions surveyed, and the perceived effectiveness rating averaged 35% of the maximum possible. In multivariate models, availability of public health activities varied significantly according to population size, socioeconomic measures, local health department spending, and presence of local boards of health.

Conclusions. Local public health capacity varies widely across the nation’s most populous communities, highlighting the need for targeted improvement efforts.
All-Cause and Cause-Specific Mortality by Socioeconomic Status Among Employed Persons in 27 US States, 1984–1997
Authors: Steenland Kyle , Hu Sherry , Walker James
Published: December 2008

Objectives. We investigated mortality differences according to socioeconomic status (SES) for employed persons in 27 states during 1984–1997.

Methods. SES was determined for persons aged 35–64 years according to the “usual occupation” listed on their death certificates. We used US Census denominator data.

Results. For all-cause mortality, rate ratios from lowest to highest SES quartile for men and women were 2.02, 1.69, 1.25, and 1.00 and 1.29, 1.01, 1.07, and 1.00, respectively. Percentage of all deaths attributable to being in the lowest 3 SES quartiles was 27%. Inverse SES gradients were strong for most major causes of death except breast cancer and colorectal cancer. Heart disease mortality for highest and lowest SES quartiles dropped 45% and 25%, respectively, between 1984 and 1997.

Conclusions. Mortality differences by SES were sustained through the 1990s and are increasing for men.
What Patients Expect From Complementary Therapy: A Qualitative Study
Authors: Richardson Janet
Published: December 2008

Objectives. Complementary and alternative therapies have become popular with patients in Western countries. Studies have suggested motivations for patients’ choosing a wide range of complementary therapies. Data on the expectations of patients who use complementary therapy are limited. We assessed the expectations of patients who use complementary therapy.

Methods. Patients attending a British National Health Service (NHS) outpatient department that provided acupuncture, osteopathy, and homoeopathy were asked to complete a qualitative survey.

Results. Patients expected symptom relief, information, a holistic approach, improved quality of life, self-help advice, and wide availability of such therapies on the NHS.

Conclusions. Physicians’ understanding of patients’ expectations of complementary therapies will help patients make appropriate and realistic treatment choices.
Getting the Science Right and Doing the Right Science in Vaccine Safety
Authors: Bernier Roger , Midthun Karen
Published: December 2008

Because of the potential for conflicts of interest, Salmon et al. propose in this issue the creation of an independent vaccine safety board to assume responsibility for assessing the safety of licensed vaccines.

We believe that the current system at the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) facilitates needed interactions between those involved in risk assessment and risk management, provides substantial safeguards against conflicts of interest, and results in sound decisions.

The CDC, given its role in promoting immunization, may be perceived to have a greater potential conflict and plans to review its vaccine safety activities. Both agencies recognize the importance of transparency in considering vaccine safety and welcome the opportunity to work with the public and the medical community to improve the quality of scientific information and decisionmaking.
The Standard of Care Debate: Can Research in Developing Countries Be Both Ethical and Responsive to Those Countries’ Health Needs?
Authors: Wendler David , Emanuel Ezekiel J. , Lie Reidar K.
Published: December 2008

To avoid exploitaiton of host communities, many commentators argue that subjects must receive the best methods available worldwide. Others worry that this requirement may block important research intended to improve health care, especially in developing countries.

To resolve this dilemma, we propose a framework for the conditions under which it is acceptable to provide subjects with less than the best methods. Specifically, institutional review boards should assume a default of requiring the “worldwide best” methods, meaning the best methods available anywhere in the world, in all cases.

However, institutional review boards should be willing to grant exceptions to this default for research studies that satisfy the following 4 conditions: (1) scientific necessity, (2) relevance for the host community, (3) sufficient host community benefit, and (4) subject and host community nonmaleficence.
A Middle School Immunization Law Rapidly and Substantially Increases Immunization Coverage Among Adolescents
Authors: Averhoff Francisco , Linton Leslie , Peddecord K. Michael , Edwards Christine , Wang Wendy , Fishbein Daniel
Published: December 2008

Objectives. This study assessed the effectiveness of a middle school vaccination requirement for raising second-dose measles, mumps, and rubella vaccine and hepatitis B vaccine coverage among adolescents.

Methods. Random-digit-dialed telephone surveys were conducted before (1998) and after (1999) the implementation of a vaccination requirement for entry into the seventh grade in San Diego, Calif.

Results. Vaccination coverage was higher among children subject to the vaccination requirement (seventh-grade students; 60%) than among fifth- and sixth-grade students 1 year before the requirement (13%, P < .001), and 8th- through 12th-grade students not subject to the requirement (27%, P < .0001).

Conclusions. Middle school–entry vaccination requirements can rapidly and substantially raise vaccination coverage among students subject to the law.
Hepatitis A Incidence and Hepatitis A Vaccination Among American Indians and Alaska Natives, 1990–2001
Authors: Bialek Stephanie R. , Thoroughman Douglas A. , Hu Diana , Simard Edgar P. , Chattin Jody , Cheek Jim , Bell Beth P.
Published: December 2008

Objectives. We assessed the effect on trends in hepatitis A incidence of the 1996 recommendation for routine hepatitis A vaccination of American Indian/Alaska Native (AIAN) children.

Methods. We examined trends in hepatitis A incidence among AIAN peoples during 1990–2001 and vaccination coverage levels among children on the largest American Indian reservation.

Results. Hepatitis A rates among AIANs declined 20-fold during 1997–2001. Declines in hepatitis A incidence occurred among AIANs in reservation and metropolitan areas. Among 1956 children living on the Navajo Nation whose medical records were reviewed, 1508 (77.1%) had received at least one dose of hepatitis A vaccine, and 1020 (52.1%) had completed the vaccine series.

Conclusions. Hepatitis A rates among AIAN peoples have declined dramatically coincident with implementation of routine hepatitis A vaccination of AIAN children.
Depressive Symptoms and AIDS-Related Mortality Among a Multisite Cohort of HIV-Positive Women
Authors: Cook Judith A. , Grey Dennis , Burke Jane , Cohen Mardge H. , Gurtman Alejandra C. , Richardson Jean L. , Wilson Tracey E. , Young Mary A. , Hessol Nancy A.
Published: December 2008

Objectives. We examined associations between depressive symptoms and AIDS-related mortality after controlling for antiretroviral therapy use, mental health treatment, medication adherence, substance abuse, clinical indicators, and demographic factors.

Methods. One thousand seven hundred sixteen HIV-seropositive women completed semiannual visits from 1994 through 2001 to clinics at 6 sites. Multivariate Cox and logistic regression analyses estimated time to AIDS-related death and depressive symptom severity.

Results. After we controlled for all other factors, AIDS-related deaths were more likely among women with chronic depressive symptoms, and symptoms were more severe among women in the terminal phase of their illness. Mental health service use was associated with reduced mortality.

Conclusions. Treatment for depression is a critically important component of comprehensive care for HIV-seropositive women, especially those with end-stage disease.
Latinas and HIV/AIDS Risk Factors: Implications for Harm Reduction Strategies
Authors: Zambrana Ruth E. , Cornelius Llewllyn J. , Boykin Stephanie Sims , Lopez Debbie Salas
Published: December 2008

Objectives. We examined risk factors for HIV infection among Puerto Rican and Mexican American women aged 15 through 44 years.

Methods. We used data from the 1995 National Survey of Family Growth. Analyses focused on the relation between sex role attitudes, sex education, anxiety, and consistent condom use.

Results. Nearly 60% of Puerto Rican and Mexican American women received no sex education from parents. Twenty-one percent of Puerto Rican and 38.3% of Mexican American women reported no sex education in schools. Women with some sex education in school, less than 13 years of education, or higher sex role attitude scores were more likely than other women to have partners who consistently used condoms.

Conclusions. Harm reduction interventions must be designed to reach multiple Latino audiences by age, gender, and subgroup
HIV Risk Behaviors Among Male-to-Female Transgender Persons of Color in San Francisco
Authors: Nemoto Tooru , Operario Don , Keatley JoAnne , Han Lei , Soma Toho
Published: December 2008

Objectives. The authors examined HIV risk behaviors among African American, Asian/Pacific Islander (API), and Latina male-to-female (MTF) transgender persons in order to improve HIV prevention programs.

Methods. Individual survey interviews with MTF transgender persons of color (n = 332; 112 African Americans, 110 Latinas, and 110 APIs) were conducted.

Results. Prevalence and correlates of receptive anal sex and unprotected receptive anal sex (URAS) varied by type of partner (primary, casual, or commercial sex partners). URAS with primary partners was associated with drug use before sex; URAS with casual partners was associated with HIV-positive status and drug use before sex; and URAS with commercial sex partners was associated with African American ethnicity and low income.

Conclusions. Findings on current risk behaviors among MTF transgender persons provided meaningful implications for HIV prevention interventions.
Adolescent Smoking and Exposure to Tobacco Marketing Under a Tobacco Advertising Ban: Findings From 2 Norwegian National Samples
Authors: Braverman Marc T. , Aarø Leif Edvard
Published: December 2008

Objectives. We examined the extent to which adolescents in Norway have been exposed to tobacco marketing despite an existing ban, and whether exposure is related to their current smoking or expectations they will smoke in the future.

Methods. Questionnaires were administered to nationally representative systematic samples of Norwegian youths aged 13 to 15 years in 1990 (n = 4282) and 1995 (n = 4065).

Results. About half in each cohort reported exposure to marketing. Youths reporting exposure were significantly more likely to be current smokers and to expect to be smokers at 20 years of age, after control for important social influence predictors.

Conclusions. Adolescents’ current smoking and future smoking expectations are linked to marketing exposure even in limited settings, suggesting the need for comprehensive controls to eliminate the function of marketing in promoting adolescent smoking.
Do Favorite Movie Stars Influence Adolescent Smoking Initiation?
Authors: Distefan Janet M. , Pierce John P. , Gilpin Elizabeth A.
Published: December 2008

Objectives. We sought to determine whether adolescents whose favorite movie stars smoke on-screen are at increased risk of tobacco use.

Methods. During interviews, adolescent never smokers taking part in the California Tobacco Survey nominated their favorite stars. We reviewed popular films released during 1994 through 1996 to determine whether stars smoked on-screen in at least 2 films.

Results. One third of never smokers nominated a star who smoked on-screen, which independently predicted later smoking risk (odds ratio [OR] = 1.36; 95% confidence interval [CI] = 1.02, 1.82). The effect was strong among girls (OR = 1.86; 95% CI = 1.26, 2.73). Among boys, there was no independent effect after control for receptivity to tobacco industry promotions.

Conclusions. Public health efforts to reduce adolescent smoking must confront smoking in films as a tobacco marketing strategy.
The Decline in Maternal Mortality in Sweden
Authors: Högberg Ulf
Published: December 2008

The maternal mortality rate in Sweden in the early 20th century was one third that in the United States. This rate was recognized by American visitors as an achievement of Swedish maternity care, in which highly competent midwives attend home deliveries. The 19th century decline in maternal mortality was largely caused by improvements in obstetric care, but was also helped along by the national health strategy of giving midwives and doctors complementary roles in maternity care, as well as equal involvement in setting public health policy.

The 20th century decline in maternal mortality, seen in all Western countries, was made possible by the emergence of modern medicine. However, the contribution of the mobilization of human resources should not be underestimated, nor should key developments in public health policy.
Do Men Know That They Have Had a Prostate-Specific Antigen Test? Accuracy of Self-Reports of Testing at 2 Sites
Authors: Chan Evelyn C. Y. , Vernon Sally W. , Ahn Chul , Greisinger Anthony
Published: December 2008

This study determined the accuracy of self-reports of prostatespecific antigen (PSA) testing. Men (N = 402) attending 2 outpatient clinics were asked: “Did you have a PSA test today?” and their medical records were checked. Concordance, sensitivity, and false-negative values were 65%, 67%, and 33%, respectively, at 1 clinic site and 88%, 64%, and 36% at the other. The accuracy of self-reports of PSA testing should be interpreted with caution.