bluuebunny/crossref_metadata_2025 huggingface dataset:
What Factors Hinder Women of Color From Obtaining Preventive Health Care?
Authors: Cornelius Llewellyn J. , Smith Pamela L. , Simpson Gaynell M.
Published: December 2008

This commentary examines how women of color fare on the use of preventive care. Logistic regression models of women's use of preventive care were computed with data from the 1994 Commonwealth Fund Minority Health Survey. It was found that having a regular doctor was the most consistent predictor of the use of preventive care, irrespective of the women's racial/ethnic background, socioeconomic circumstances, or place of residence.

These findings reinforce the importance of physicians in the delivery of preventive care. Suggestions for improving the use of preventive services by women of color are provided.
Toward a Strategic Approach for Reducing Disparities in Infant Mortality
Authors: Hogue Carol J. Rowland , Vasquez Cynthia
Published: December 2008

The United States' international ranking for infant mortality slipped from 19th in the 1980s to 27th in 1997. This slippage may be related to the segregation of priorities that occurred early in the 1990s, when national concern was diverted from infant mortality to minority health.

To rekindle concern about infant mortality to the level of effective action, public health professionals must refocus the public's attention on assuring that all women are provided adequate education and services to help them avoid unintended pregnancies, that all pregnant women receive services in appropriate facilities, and that the causes of preterm deliveries are discovered. Effective action in these areas would not only improve infant mortality overall; it would also reduce racial and ethnic disparities in infant health.
Who Does the Work of Public Health?
Authors: Avery Byllye
Published: December 2008

Frequently, we take the “public” out of public health and allow the practice to become extremely narrow, limited to experts telling the public what's best for them.
Mobilizing Women for Minority Health and Social Justice in California
Authors: Littlefield Diane , Robison Connie Chan , Engelbrecht Luz , González Belma , Hutcheson Heather
Published: December 2008

Women's Health Leadership is building the leadership capacity of diverse community leaders in California committed to promoting health and social justice in their communities. This program provides opportunities for cross-cultural exchanges of ideas, resources, and expertise.

Graduates continue to receive technical support and to engage in peer learning via an alumnae network. The network is dedicated to advancing social justice issues and to addressing health disparities. It is also a way to mobilize trained grassroots leaders to provide expertise to influence policy decisions, to provide technical support and resources to local communities, and to foster new partnerships across the state.
Safety-Net Institutions Buffer the Impact of Medicaid Managed Care: A Multi-Method Assessment in a Rural State
Authors: Waitzkin Howard , Williams Robert L. , Bock John A. , McCloskey Joanne , Willging Cathleen , Wagner William
Published: December 2008

Objectives. This project used a long-term, multi-method approach to study the impact of Medicaid managed care.

Methods. Survey techniques measured impacts on individuals, and ethnographic methods assessed effects on safety-net providers in New Mexico.

Results. After the first year of Medicaid managed care, uninsured adults reported less access and use (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.34, 0.64) and worse barriers to care (OR = 6.60; 95% CI = 3.95, 11.54) than adults in other insurance categories. Medicaid children experienced greater access and use (OR = 2.11; 95% CI = 1.21, 3.72) and greater communication and satisfaction (OR = 3.64; 95% CI = 1.13, 12.54) than children in other insurance categories; uninsured children encountered greater barriers to care (OR = 6.29; 95% CI = 1.58, 42.21). There were no consistent changes in the major outcome variables over the period of transition to Medicaid managed care. Safety-net institutions experienced marked increases in workload and financial stress, especially in rural areas. Availability of mental health services declined sharply. Providers worked to buffer the impact of Medicaid managed care for patients.

Conclusions. In its first year, Medicaid managed care exerted major effects on safety-net providers but relatively few measurable effects on individuals. This reform did not address the problems of the uninsured.
A Multilevel Analysis of the Relationship Between Institutional and Individual Racial Discrimination and Health Status
Authors: Gee Gilbert C.
Published: December 2008

Objectives. This study examined whether individual (self-perceived) and institutional (segregation and redlining) racial discrimination was associated with poor health status among members of an ethnic group.

Methods. Adult respondents (n = 1503) in the cross-sectional Chinese American Psychiatric Epidemiologic Study were geocoded to the 1990 census and the 1995 Home Mortgage Disclosure Act database. Hierarchical linear modeling assessed the relationship between discrimination and scores on the Medical Outcomes Study Short-Form 36 and revised Symptom Checklist 90 health status measures.

Results. Individual and institutional measures of racial discrimination were associated with health status after control for acculturation, sex, age, social support, income, health insurance, employment status, education, neighborhood poverty, and housing value.

Conclusions. The data support the hypothesis that discrimination at multiple levels influences the health of minority group members.
Increasing Use of Mammography Among Older, Rural African American Women: Results From a Community Trial
Authors: Earp Jo Anne , Eng Eugenia , O'Malley Michael S. , Altpeter Mary , Rauscher Garth , Mayne Linda , Mathews Holly F. , Lynch Kathy S. , Qaqish Bahjat
Published: December 2008

Objectives. A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older.

Methods. A stratified random sample of 801 African American women completed baseline (1993–1994) and follow-up (1996–1997) surveys. The primary outcome was self-reported mammography use in the previous 2 years.

Results. The intervention was associated with an overall 6 percentage point increase (95% confidence interval [CI] = –1, 14) in communitywide mammography use. Low-income women in intervention counties showed an 11 percentage point increase (95% CI = 2, 21) in use above that exhibited by lowincome women in comparison counties. Adjustment for potentially confounding characteristics did not change the results.

Conclusions. A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations.
Hepatitis C Virus Infection in Young, Low-Income Women: The Role of Sexually Transmitted Infection as a Potential Cofactor for HCV Infection
Authors: Page-Shafer Kimberly A. , Cahoon-Young Barbara , Klausner Jeffrey D. , Morrow Scott , Molitor Fred , Ruiz Juan , McFarland Willi
Published: December 2008

Objectives. We evaluated risk for hepatitis C virus (HCV) infection in women residing in low-income neighborhoods of northern California.

Methods. A population-based sample of 1707 women, aged 18 to 29, were surveyed and screened for sexually transmitted infections and HCV.

Results. Women infected with HCV (2.5%) were more likely to have a history of injection and noninjection drug use, to exchange sex for money or drugs, and to have sexually transmitted infections. HCV was independently associated with history of injection drug use, herpes simplex virus type 2 (HSV-2) infection, and heroin and cocaine use.

Conclusions. Injection drug use is the highest risk exposure for HCV, but HSV-2 and noninjection drug use contribute significantly to increased risk. HCV prevention programs in impoverished areas should integrate drug treatment and sexually transmitted infection control.
The Human Right to Adequate Housing: A Tool for Promoting and Protecting Individual and Community Health
Authors: Thiele Bret
Published: December 2008

The human right to adequate housing is enshrined in international law. The right to adequate housing can be traced to the Universal Declaration of Human Rights, which was unanimously adopted by the world community in 1948. Since that time, the right to adequate housing has been reaffirmed on numerous occasions and further defined and elaborated.

A key component of this right is habitability of housing, which should comply with health and safety standards. Therefore, the right to adequate housing provides an additional tool for advocates and others interested in promoting healthful housing and living conditions and thereby protecting individual and community health.
Home Is Where the Harm Is: Inadequate Housing as a Public Health Crisis
Authors: Bashir Samiya A.
Published: December 2008

Overcrowding and poor-quality housing have a direct relationship to poor mental health, developmental delay, heart disease, and even short stature.
Role of Black Churches in Health Promotion Programs: Lessons From the Los Angeles Mammography Promotion in Churches Program
Authors: Markens Susan , Fox Sarah A. , Taub Bonnie , Gilbert Mary Lou
Published: December 2008

Objectives. This article assesses pastor-level factors that affect the successful recruitment and implementation of community-based health promotion programs in Black churches.

Methods. Semistructured interviews with 16 pastors of Black churches were analyzed for content.

Results. We found that although the involvement of Black pastors in an array of secular activities makes them open to participate in health programs, their overcommitment to other issues can negatively influence their ability to participate. Second, although Black pastors appreciate being included in and benefiting from health research, minorities' history of being underserved and exploited can lead to suspiciousness and reluctance to participate.

Conclusions. Our findings suggest that those interested in developing church-based health programs in the Black community must be attuned to how the same factors can both facilitate and hinder a program's development.
Relationship Between Patients' Perceptions of Disadvantage and Discrimination and Listing for Kidney Transplantation
Authors: Klassen Ann C. , Hall Allyson G. , Saksvig Brit , Curbow Barbara , Klassen David K.
Published: December 2008

Objectives. This study explored wait-listing decisions among African American and White men and women eligible for kidney transplants, focusing on lifetime experiences of race and sex discrimination as a possible influence.

Methods. Patient records from 3 Baltimore-area hemodialysis units were reviewed, and semistructured face-to-face interviews were conducted with transplant-eligible patients and with unit staff members.

Results. African American patients reported more racial discrimination, and women reported more sex discrimination. Women and older patients were less likely to be placed on the waiting list, as were patients with previous experiences of racial discrimination. Discrimination measures predicted list access more strongly than patient race.

Conclusions. Lifetime experience of and response to discrimination may contribute to race and sex differences in access to care and should be included in research on health care disparities.
HIV and AIDS Risk Behaviors Among Female Jail Detainees: Implications for Public Health Policy
Authors: McClelland Gary Michael , Teplin Linda A. , Abram Karen M. , Jacobs Naomi
Published: December 2008

Objectives. We examined the sexual and injection drug use HIV and AIDS risk behaviors of female jail detainees.

Methods. The sample (n = 948) was stratified by charge type (felony vs misdemeanor) and race/ethnicity (African American, non-Hispanic White, Hispanic, other).

Results. Non-Hispanic White women, women arrested for less serious charges, women who had prior arrests, women arrested on drug charges, and women with severe mental disorders were at especially high risk for sexual and injection drug transmission of HIV and AIDS.

Conclusions. Many women at risk for HIV and AIDS—women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorders—eventually will cycle through jail. Because most jail detainees return to their communities within days, providing HIV and AIDS education in jail must become a public health priority.
Tuberculosis Screening Among Foreign-Born Persons Applying for Permanent US Residence
Authors: Saraiya Mona , Cookson Susan T. , Tribble Paul , Silk Benjamin , Cass Robert , Poonja Shameer , Walting Marva , Howland Noelle , Paz Edwin A. , Cochran Jennifer , Moser Kathleen S. , Oxtoby Margaret J. , Binkin Nancy J.
Published: December 2008

Objectives. This study sought to determine adherence of physicians to tuberculosis (TB) screening guidelines among foreign-born persons living in the United States who were applying for permanent residency.

Methods. Medical forms of applicants from 5 geographic areas were reviewed, along with information from a national physician database on attending physicians. Applicant and corresponding physician characteristics were compared among those who were and were not correctly screened.

Results. Of 5739 applicants eligible for screening via tuberculin skin test, 75% were appropriately screened. Except in San Diego, where 11% of the applicants received no screening, most of the inappropriate screening resulted from the use of chest x-rays as the initial screening tool.

Conclusions. Focused physician education and periodic monitoring of adherence to screening guidelines are warranted.
Association of Medical Insurance and Other Factors With Receipt of Antiretroviral Therapy
Authors: Keruly Jeanne C. , Conviser Richard , Moore Richard D.
Published: December 2008

Objectives. This study was designed to assess sociodemographic and medical insurer factors associated with receipt of highly active antiretroviral therapy (HAART).

Methods. Patients included (n = 959) were enrolled in the Johns Hopkins HIV Clinic after April 1, 1996, received ≥ 90 days of care, and had a CD4 count ≥ 500 cells/mm3 or HIV-1 RNA > 20 000 copies/mL. We assessed the associations of sociodemographic factors and medical insurance with receipt of HAART, stratified by 2 time periods (April 1996 through March 1997 versus April 1997 through March 1999).

Results. HAART was more likely to be used in patients who were > 39 years, White, had CD4 counts < 350 cells/mm3, had fewer missed clinic visits, and did not have intravenous drug use as their risk factor for HIV transmission. In period 1 (April 1996 through March 1997), HAART was more likely to be used in patients who were commercially insured than in other payer groups; differences between payers narrowed in period 2 (April 1997 through March 1999), however, as did differences by race.

Conclusions. Differences in use of HAART on the basis of payer have narrowed since 1996. This encouraging finding may demonstrate the importance of programs that lower economic barriers to medical care.
Smoking Among Chinese Americans: Behavior, Knowledge, and Beliefs
Authors: Yu Elena S. H. , Chen Edwin H. , Kim Katherine K. , Abdulrahim Sawsan
Published: December 2008

Objectives. This report describes and examines factors significantly associated with smoking among Chinese Americans, using multiple logistic regression methods.

Methods. We conducted a population-based survey (n = 644, age = 40–69 years) in Chicago's Chinatown using a Chinese questionnaire based on the National Health Interview Survey (NHIS).

Results. Smoking prevalence was 34% for males and 2% for females. Some 93% of current smokers had smoked regularly for 10 or more years. Low education (odds ratio [OR] = 2.41; 95% confidence interval [CI] = 1.31, 4.46), use of a non-Western physician or clinic for health care (OR = 2.64; 95% CI = 1.46, 4.80), and no knowledge of early cancer warning signs and symptoms (OR = 2.52; 95% CI = 1.35, 4.70) were significantly associated with smoking among men.

Conclusions. The male prevalence of smoking is higher than those reported in California, the NHIS, and the Behavioral Risk Factor Surveillance System (BRFSS); exceeds the rate for African Americans aged 18 years and older; is comparable with the rate for African American males aged 45 to 64 years; and is far above the Healthy People 2010 target goal of less than 12%. Multisite surveys and smoking cessation campaigns in Chinese are needed.
Maternal Smoking During Pregnancy and Severe Antisocial Behavior in Offspring: A Review
Authors: Wakschlag Lauren S. , Pickett Kate E. , Cook Edwin , Benowitz Neal L. , Leventhal Bennett L.
Published: December 2008

Objectives. Recent research suggests that in utero exposure to maternal smoking is a risk factor for conduct disorder and delinquency. We review evidence of causality, a controversial but important public health question.

Methods. We analyzed studies of maternal prenatal smoking and offspring antisocial behavior within a causal framework.

Results. The association is (1) independent of confounders, (2) present across diverse contexts, and (3) consistent with basic science. Methodological limitations of existing studies preclude causal conclusions.

Conclusions. Existing evidence provides consistent support for, but not proof of, an etiologic role for prenatal smoking in the onset of antisocial behavior. The possibility of identifying a preventable prenatal risk factor for a serious mental disorder makes further research on this topic important for public health.
Critical Policy Challenges in the Third Decade of the HIV/AIDS Epidemic
Authors: Kates Jennifer , Sorian Richard , Crowley Jeffrey S. , Summers Todd A.
Published: December 2008

Numerous policy challenges continue to face the United States in the third decade of the HIV/AIDS pandemic, in both the health and foreign policy arenas. They include long-standing questions about care, treatment, prevention, and research, as well as new ones introduced by the changing nature of the epidemic itself and the need to balance demands for limited resources.

These challenges concern the United States not only in its role as a world leader in combating a global epidemic, but in its decisions and focus at home, where the epidemic continues to take a toll.
Alternatives to a National System of Population-Based State Cancer Registries
Authors: Thomas David B.
Published: December 2008

To support cancer control efforts, the National Program of Cancer Registries was established to enhance or develop cancer registries in every state. But there is an alternative.

State cancer control programs could be adequately planned and evaluated without a cancer registry, and federal support of cancer registration could be selectively provided to registries that provide data needed to monitor cancer incidence and survival for the nation or that serve as a resource for population-based etiologic and cancer control research. The funds saved could be redirected to support the continued collection of high-quality cancer incidence and survival data for the nation as such efforts become more costly and complex in the future, and to expand support of population-based cancer research efforts. (Am J Public Health. 2002;92:1064–1066)
Nontherapeutic Research with Children: Grimes v Kennedy Krieger Institute
Authors: Glantz Leonard H.
Published: December 2008

Research with young children raises difficult issues of law and ethics. A recent Maryland case, Grimes v Kennedy Krieger Institute, Inc, appears to impose restrictive rules on research with children when the subjects are put at risk but cannot derive direct benefit from their involvement in the research project. This case exemplifies the tension that exists between the goal of science to increase knowledge and the protection of the rights and welfare of nonconsenting research subjects. While some language in the opinion may be difficult to understand or apply, for the most part the case reflects the problems other courts and ethicists have had in delineating the role of children in “nontherapeutic” research. (Am J Public Health. 2002;92:1070–1073)
Burning Love: Big Tobacco Takes Aim at LGBT Youths
Authors: Washington Harriet A.
Published: December 2008

Secret tobacco industry documents lay bare the industry's targeting, seduction, and recruitment of minority groups and children. They also unmask Big Tobacco's disdain for its targets.
Increasing the Use of Child Restraints in Motor Vehicles in a Hispanic Neighborhood
Authors: Istre Gregory R. , McCoy Mary A. , Womack Katie N. , Fanning Linda , Dekat Laurette , Stowe Martha
Published: December 2008

The use of restraints in motor vehicles is less common in minority and low-income populations than in the general population. A preliminary survey of Hispanic preschool-aged children in west Dallas, Tex, conducted in 1997 showed much lower child restraint use (19% of those surveyed) than among preschool children of all races in the rest of the city (62%).

Because there are few reports of successful programs to increase child restraint use among Hispanics, we undertook to implement and evaluate such a program. The program was conducted by bilingual staff and was tailored for this community. It was successful in increasing both child restraint use and driver seat belt use.
Effects of Hospital Staffing and Organizational Climate on Needlestick Injuries to Nurses
Authors: Clarke Sean P. , Sloane Douglas M. , Aiken Linda H.
Published: December 2008

Objectives. This study determined the effects of nurse staffing and nursing organization on the likelihood of needlestick injuries in hospital nurses.

Methods. We analyzed retrospective data from 732 and prospective data from 960 nurses on needlestick exposures and near misses over different 1-month periods in 1990 and 1991. Staffing levels and survey data about working climate and risk factors for needlestick injuries were collected on 40 units in 20 hospitals.

Results. Nurses from units with low staffing and poor organizational climates were generally twice as likely as nurses on well-staffed and better-organized units to report risk factors, needlestick injuries, and near misses.

Conclusions. Staffing and organizational climate influence hospital nurses' likelihood of sustaining needlestick injuries. Remedying problems with understaffing, inadequate administrative support, and poor morale could reduce needlestick injuries.
Mammography Screening and Differences in Stage of Disease by Race/Ethnicity
Authors: Jacobellis Jillian , Cutter Gary
Published: December 2008

Objectives. We examined the effect of routine screening on breast cancer staging by race/ethnicity.

Methods. We used a 1990 to 1998 mammography database (N = 5182) of metropolitan Denver, Colo, women to examine each racial/ethnic cohort's incident cancer cases (n = 1902) and tumor stage distribution given similar patterns of routine screening use.

Results. Regardless of race/ethnicity, women participating in routine screenings had earlier-stage disease by 5 to 13 percentage points. After control for possible confounding factors, White women were more likely to have early-stage disease compared with Black and Hispanic women.

Conclusions. Lack of screening coverage in certain racial/ethnic populations has often been cited as a reason for tumor stage differences at detection. In this study, correcting for screening did not completely reduce stage differentials among Black and Hispanic women. (Am J Public Health. 2002;92:1144–1150)
Optimal Indicators of Socioeconomic Status for Health Research
Authors: Duncan Greg J. , Daly Mary C. , McDonough Peggy , Williams David R.
Published: December 2008

Objectives. In this study we examined the relationship between indicators of socioeconomic status (SES) and mortality for a representative sample of individuals.

Methods. The sample included 3734 individuals aged 45 and older interviewed in 1984 in the Panel Study of Income Dynamics. In the current study, mortality was tracked between 1984 and 1994 and is related to SES indicators of education, occupation, income, and wealth.

Results. Wealth and recent family income were the indicators that were most strongly associated with subsequent mortality. These associations persisted after we controlled for the other SES indicators and were stronger for women than for men and for nonelderly than for elderly individuals.

Conclusions. We found that the economic indicators of SES were usually as strongly associated with mortality as, if not more strongly associated with mortality than, the more conventional indicators of completed schooling and occupation. (Am J Public Health. 2002;92:1151–1157)
Checking the Pulse: Midwestern Reporters' Opinions on Their Ability to Report Health Care News
Authors: Voss Melinda
Published: December 2008

Objectives. Newspapers play a key role in disseminating information and shaping perceptions about health, research, and policies. Inadequate or misleading reporting constitutes a public health threat that can jeopardize individual health and lead to harmful health policies.

Methods. Surveys were mailed to 165 reporters at 122 newspapers in 5 Midwest states. The association of training, newspaper size, and experience with reporter's self-perceived reporting ability was assessed.

Results. The response rate was 69.6% (115/165). Between 66% and 85% of the reporters assessed 4 tasks vital to sound health reporting as “sometimes difficult” to “nearly always difficult.” No significant differences in perceived ability were found by training or newspaper size. Respondents with less experience reported higher perceived ability.

Conclusions. These findings show that reporters may have difficulty understanding complex health issues and interpreting statistics because they are inadequately trained.
Increasing Rural–Urban Gradients in US Suicide Mortality, 1970–1997
Authors: Singh Gopal K. , Siahpush Mohammad
Published: December 2008

Objectives. This study examined rural–urban gradients in US suicide mortality and the extent to which such gradients varied across time, sex, and age.

Methods. Using a 10-category rural–urban continuum measure and 1970–1997 county mortality data, we estimated rural–urban differentials in suicide mortality over time by multiple regression and Poisson regression models.

Results. Significant rural–urban gradients in age-adjusted male suicide mortality were found in each time period, indicating rising suicide rates with increasing levels of rurality. The gradient increased consistently, suggesting widening rural–urban differentials in male suicides over time. When controlled for geographic variation in divorce rate and ethnic composition, rural men, in each age cohort, had about twice the suicide rate of their most urban counterparts. Observed rural–urban differentials for women diminished over time. In 1995 to 1997, the adjusted suicide rates for young and working-age women were 85% and 22% higher, respectively, in rural than in the most urban areas.

Conclusions. The slope of the relationship between rural–urban continuum and suicide mortality varied substantially by time, sex, and age. Widening rural–urban disparities in suicide may reflect differential changes over time in key social integration indicators. (Am J Public Health. 2002;92:1161–1167)
Distribution of African Americans in Residential Care/Assisted Living and Nursing Homes: More Evidence of Racial Disparity?
Authors: Howard Daniel L. , Sloane Philip D. , Zimmerman Sheryl , Eckert J. Kevin , Walsh Joan F. , Buie Verita C. , Taylor Persephone J. , Koch Gary G.
Published: December 2008

Objectives. In this study, we examined racial separation in long-term care.

Methods. We used a survey of a stratified sample of 181 residential care/assisted living (RC/AL) facilities and 39 nursing homes in 4 states.

Results. Most African Americans resided in nursing homes and smaller RC/AL facilities and tended to be concentrated in a few predominantly African American facilities, whereas the vast majority of Whites resided in predominantly White facilities. Facilities housing African Americans tended to be located in rural, nonpoor, African American communities, to admit individuals with mental retardation and difficulty in ambulating, and to have lower ratings of cleanliness/maintenance and lighting.

Conclusions. These racial disparities may result from economic factors, exclusionary practices, or resident choice. Whether separation relates to inequities in care is undetermined. (Am J Public Health. 2002;92:1272–1277)
Functional Health Literacy and the Risk of Hospital Admission Among Medicare Managed Care Enrollees
Authors: Baker David W. , Gazmararian Julie A. , Williams Mark V. , Scott Tracy , Parker Ruth M. , Green Diane , Ren Junling , Peel Jennifer
Published: December 2008

Objectives. This study analyzed whether inadequate functional health literacy is an independent risk factor for hospital admission.

Methods. We studied a prospective cohort of 3260 Medicare managed care enrollees.

Results. Of the participants, 29.5% were hospitalized. The crude relative risk (RR) of hospitalization was higher for individuals with inadequate literacy (n = 800; RR = 1.43; 95% confidence interval [CI] = 1.24, 1.65) and marginal literacy (n = 366; RR = 1.33; 95% CI = 1.09, 1.61) than for those with adequate literacy (n = 2094). In multivariate analysis, the adjusted relative risk of hospital admission was 1.29 (95% CI = 1.07, 1.55) for individuals with inadequate literacy and 1.21 (95% CI = 0.97, 1.50) for those with marginal literacy.

Conclusions. Inadequate literacy was an independent risk factor for hospital admission among elderly managed care enrollees. (Am J Public Health. 2002;92:1278–1283)
Driving Life Expectancy of Persons Aged 70 Years and Older in the United States
Authors: Foley Daniel J. , Heimovitz Harley K. , Guralnik Jack M. , Brock Dwight B.
Published: December 2008

Objectives. We estimated total life expectancy and driving life expectancy of US drivers aged 70 years and older.

Methods. Life table methods were applied to 4699 elderly persons who were driving in 1993 and reassessed in a 1995 survey.

Results. Drivers aged 70 to 74 years had a driving life expectancy of approximately 11 years. A higher risk of mortality among men as a cause of driving cessation offset a higher risk of driving cessation not related to mortality among women that resulted in similar driving life expectancies.

Conclusions. Nationwide, many elderly drivers quit driving each year and must seek alternative sources of transportation. Because of differences in life expectancy, women require more years of support for transportation, on average, than men after age 70.
Sex Differences in the Association of Socioeconomic Status With Obesity
Authors: Wardle Jane , Waller Jo , Jarvis Martin J.
Published: December 2008

Objectives. This study investigated socioeconomic predictors of obesity in men and women.

Methods. Data from the 1996 Health Survey for England were used to compare odds ratios for obesity by education, occupation, and 2 economic markers after control for age, marital status, and ethnicity.

Results. Obesity risk was greater among men and women with fewer years of education and poorer economic circumstances and among women, but not men, of lower occupational status.

Conclusions. Higher educational attainment and higher socioeconomic status were associated with a lower risk of obesity in both men and women, whereas higher occupational status was associated with a lower risk only for women. The implications of these findings for understanding causes and prevention of obesity are discussed.
HIV-Positive Women Report More Lifetime Partner Violence: Findings From a Voluntary Counseling and Testing Clinic in Dar es Salaam, Tanzania
Authors: Maman Suzanne , Mbwambo Jessie K. , Hogan Nora M. , Kilonzo Gad P. , Campbell Jacquelyn C. , Weiss Ellen , Sweat Michael D.
Published: December 2008

Objectives. Experiences of partner violence were compared between HIV-positive and HIV-negative women.

Methods. Of 340 women enrolled, 245 (72%) were followed and interviewed 3 months after HIV testing to estimate the prevalence and identify the correlates of violence.

Results. The odds of reporting at least 1 violent event was significantly higher among HIV-positive women than among HIV-negative women (physical violence odds ratio [OR] = 2.63; 95% confidence interval [CI] = 1.23, 5.63; sexual violence OR = 2.39; 95% CI = 1.21, 4.73). Odds of reporting partner violence was 10 times higher among younger (< 30 years) HIV-positive women than among younger HIV-negative women (OR = 9.99; 95% CI = 2.67, 37.37).

Conclusions. Violence is a risk factor for HIV infection that must be addressed through multilevel prevention approaches.
Assessing the Impact of Antidrug Advertising on Adolescent Drug Consumption: Results From a Behavioral Economic Model
Authors: Block Lauren G. , Morwitz Vicki G. , Putsis William P. , Sen Subrata K.
Published: December 2008

Objectives. This study examined whether adolescents’ recall of antidrug advertising is associated with a decreased probability of using illicit drugs and, given drug use, a reduced volume of use.

Methods. A behavioral economic model of influences on drug consumption was developed with survey data from a nationally representative sample of adolescents to determine the incremental impact of antidrug advertising.

Results. The findings provided evidence that recall of antidrug advertising was associated with a lower probability of marijuana and cocaine/crack use. Recall of such advertising was not associated with the decision of how much marijuana or cocaine/crack to use. Results suggest that individuals predisposed to try marijuana are also predisposed to try cocaine/crack.

Conclusions. The present results provide support for the effectiveness of antidrug advertising programs. (Am J Public Health. 2002;92:1346–1351)
Employment Barriers Among Welfare Recipients and Applicants With Chronically Ill Children
Authors: Smith Lauren A. , Romero Diana , Wood Pamela R. , Wampler Nina S. , Chavkin Wendy , Wise Paul H.
Published: December 2008

Objectives. This study evaluated the association of chronic child illness with parental employment among individuals who have had contact with the welfare system.

Methods. Parents of children with chronic illnesses were interviewed.

Results. Current and former welfare recipients and welfare applicants were more likely than those with no contact with the welfare system to report that their children’s illnesses adversely affected their employment. Logistic regression analyses showed that current and former receipt of welfare, pending welfare application, and high rates of child health care use were predictors of unemployment.

Conclusions. Welfare recipients and applicants with chronically ill children face substantial barriers to employment, including high child health care use rates and missed work. The welfare reform reauthorization scheduled to occur later in 2002 should address the implications of chronic child illness for parental employment.
Welfare to Work? Impact of Maternal Health on Employment
Authors: Romero Diana , Chavkin Wendy , Wise Paul H. , Smith Lauren A. , Wood Pamela R.
Published: December 2008

Objectives. This study investigated whether health problems among poor mothers of chronically ill children affect their ability to obtain and maintain employment.

Methods. Mothers of children with chronic illnesses were surveyed at clinical and welfare agency sites in San Antonio, Tex.

Results. There were distinct health differences according to mothers’ TANF and employment status. Mothers without TANF experience reported better physical and mental health and less domestic violence and substance use than did those who had TANF experience. Those not currently working had higher rates of physical and mental health problems.

Conclusions. Poor maternal health is associated with need for cash assistance and health insurance. Policymakers must recognize that social policies promoting employment will fail if they do not address the health needs of poor women and children.
Perinatal and Infant Health Among Rural and Urban American Indians/Alaska Natives
Authors: Baldwin Laura-Mae , Grossman David C. , Casey Susan , Hollow Walter , Sugarman Jonathan R. , Freeman William L. , Hart L. Gary
Published: December 2008

Objectives. We sought to provide a national profile of rural and urban American Indian/Alaska Native (AI/AN) maternal and infant health.

Methods. In this cross-sectional study of all 1989–1991 singleton AI/AN births to US residents, we compared receipt of an inadequate pattern of prenatal care, low birthweight (< 2500 g), infant mortality, and cause of death for US rural and urban AI/AN and non-AI/AN populations.

Results. Receipt of an inadequate pattern of prenatal care was significantly higher for rural than for urban mothers of AI/AN infants (18.1% vs 14.4%, P ≤ .001); rates for both groups were over twice that for Whites (6.8%). AI/AN postneonatal death rates (rural = 6.7 per 1000; urban = 5.4 per 1000) were more than twice that of Whites (2.6 per 1000).

Conclusions. Preventable disparities between AI/ANs and Whites in maternal and infant health status persist.
The Influence of Chronic Respiratory Conditions on Health Status and Work Disability
Authors: Eisner Mark D. , Yelin Edward H. , Trupin Laura , Blanc Paul D.
Published: December 2008

Objectives. This study examined the impact of asthma and chronic obstructive pulmonary disease (COPD) on health status and work disability.

Methods. We used data from a population-based sample of 3805 California adults.

Results. Compared with adults with no chronic health conditions, adults with COPD or asthma had a greater risk of self-reported diminished general health (odds ratio [OR] = 10.95; 95% confidence interval [CI] = 6.31, 19.0 and OR = 3.92; 95% CI = 2.31, 6.65, respectively). Respondents with COPD or asthma also had worse mental health status, as indicated by a greater risk of depressive symptoms (OR = 10.05; 95% CI = 5.29, 19.08 and OR = 2.59; 95% CI = 1.33, 5.04). COPD was associated with reduced current employment (OR = 0.41; 95% CI = 0.24, 0.71).

Conclusions. Asthma and COPD are associated with poor health status and greater work disability.
The Social–Environmental Context of Violent Behavior in Persons Treated for Severe Mental Illness
Authors: Swanson Jeffrey W. , Swartz Marvin S. , Essock Susan M. , Osher Fred C. , Wagner H. Ryan , Goodman Lisa A. , Rosenberg Stanley D. , Meador Keith G.
Published: December 2008

Objectives. This study examined the prevalence and correlates of violent behavior by individuals with severe mental illness.

Methods. Participants (N = 802) were adults with psychotic or major mood disorders receiving inpatient or outpatient services in public mental health systems in 4 states.

Results. The 1-year prevalence of serious assaultive behavior was 13%. Three variables—past violent victimization, violence in the surrounding environment, and substance abuse—showed a cumulative association with risk of violent behavior.

Conclusions. Violence among individuals with severe mental illness is related to multiple variables with compounded effects over the life span. Interventions to reduce the risk of violence need to be targeted to specific subgroups with different clusters of problems related to violent behavior.
National Health Insurance or Incremental Reform: Aim High, or at Our Feet?
Authors: Himmelstein David U. , Woolhandler Steffie
Published: December 2008

Single-payer national health insurance could cover the uninsured and upgrade coverage for most Americans without increasing costs; savings on insurance overhead and other bureaucracy would fully offset the costs of improved care. In contrast, proposed incremental reforms are projected to cover a fraction of the uninsured, at great cost.

Moreover, even these projections are suspect; reforms of the past quarter century have not stemmed the erosion of coverage. Despite incrementalists’ claims of pragmatism, they have proven unable to shepherd meaningful reform through the political system.

While national health insurance is often dismissed as ultra left by the policy community, it is dead center in public opinion. Polls have consistently shown that at least 40%, and perhaps 60%, of Americans favor such reform.
Affordable Health Insurance for All Is Possible by Means of a Pragmatic Approach
Authors: Tooker John
Published: December 2008

America can attain affordable health insurance coverage for all by using a pragmatic approach. Such an effort must accommodate the realities of the American health care system and resist the temptation to propose radical restructuring.

The congressional strategy for universal health care described here was developed by the American College of Physicians–American Society of Internal Medicine. It builds on the strengths of the current pluralistic system by combining the benefits of public health plans such as Medicaid and the State Children’s Health Insurance Program with a more competitive and affordable private insurance market.

The health care system has reached a crisis point. Allowing the status quo to continue courts certain disaster.
Rekindling Reform: Principles and Goals
Authors:   The Rekindling Reform Steering Committee
Published: December 2008

Members of the Rekindling Reform Steering Committee collaborated over a period of several months in early 2002 to develop a set of principles and goals to help guide and define the group’s efforts for comprehensive health care reform in the United States.

The next step is to circulate this document to the sponsoring organizations for their approval. This document is, then, a work in progress, subject to revision as the process of discussion and review continues.

These principles provide a sense of the lessons members of the Rekindling Reform Steering Committee have learned from their study of other countries’ universal health care systems, and how those lessons have informed their thinking about the nature of the health care reform needed in United States.
A Joint Urban Planning and Public Health Framework: Contributions to Health Impact Assessment
Authors: Northridge Mary E. , Sclar Elliott
Published: December 2008

A joint urban planning and public health perspective is articulated here for use, in health impact assessment. Absent a blueprint for a coherent and supportive structure on which to test our thinking, we are bound to fall flat.

Such a perspective is made necessary by the sheer number of people living in cities throughout the world, the need for explicit attention to land use and transportation systems as determinants of population health, and the dearth of useful indicators of the built environment for monitoring progress.

If explicit attention is not paid to the overarching goals of equality and democracy, they have little if any chance of being realized in projects, programs, and policies that shape the built environment and therefore the public’s health.
Is Social Capital the Key to Inequalities in Health?
Authors: Pearce Neil , Davey Smith George
Published: December 2008

There has been vigorous debate between the “social capital” and “neomaterialist” interpretations of the epidemiological evidence regarding socioeconomic determinants of health. We argue that levels of income inequality, social capital, and health in a community may all be consequences of more macrolevel social and economic processes that influence health across the life course.

We discuss the many reasons for the prominence of social capital theory, and the potential drawbacks to making social capital a major focus of social policy. Intervening in communities to increase their levels of social capital may be ineffective, create resentment, and overload community resources, and to take such an approach may be to “blame the victim” at the community level while ignoring the health effects of macrolevel social and economic policies.
Intermittent Lack of Health Insurance Coverage and Use of Preventive Services
Authors: Sudano Joseph J. , Baker David W.
Published: December 2008

Objectives. This study examined the association between intermittent lack of health insurance coverage and use of preventive health services.

Methods. Analyses focused on longitudinal data on insurance status and preventive service use among a national sample of US adults who participated in the Health and Retirement Study.

Results. Findings showed that, among individuals who obtain insurance coverage after histories of intermittent coverage, relatively long periods may be necessary to reestablish clinically appropriate care patterns. Increasing periods of noncoverage led to successively lower rates of use of most preventive services.

Conclusions. Intermittent lack of insurance coverage—even across a relatively long period—results in less use of preventive services. Studies that examine only current insurance status may underestimate the population at risk from being uninsured.
Universal Health Care: Lessons From the British Experience
Authors: Light Donald W.
Published: December 2008

Britain’s National Health Service (NHS) was established in the wake of World War II amid a broad consensus that health care should be made available to all. Yet the British only barely succeeded in overcoming professional opposition to form the NHS out of the prewar mixture of limited national insurance, various voluntary insurance schemes, charity care, and public health services.

Success stemmed from extraordinary leadership, a parliamentary system of government that gives the winning party great control, and a willingness to make major concessions to key stakeholders. As one of the basic models emulated worldwide, the NHS—in both its original form and its current restructuring—offers a number of relevant lessons for health reform in the United States.
The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States
Authors: Rodwin Victor G.
Published: December 2008

The French health system combines universal coverage with a public–private mix of hospital and ambulatory care and a higher volume of service provision than in the United States. Although the system is far from perfect, its indicators of health status and consumer satisfaction are high; its expenditures, as a share of gross domestic product, are far lower than in the United States; and patients have an extraordinary degree of choice among providers.

Lessons for the United States include the importance of government’s role in providing a statutory framework for universal health insurance; recognition that piecemeal reform can broaden a partial program (like Medicare) to cover, eventually, the entire population; and understanding that universal coverage can be achieved without excluding private insurers from the supplementary insurance market.
Policy Without Politics: The Limits of Social Engineering
Authors: Navarro Vicente
Published: December 2008

The extent of coverage provided by a country’s health services is directly related to the level of development of that country’s democratic process (and its power relations).

The United States is the only developed country whose government does not guarantee access to health care for its citizens. It is also the developed country with the least representative and most insufficient democratic institutions, owing to the constitutional framework of the political system, the privatization of the electoral process, and the enormous power of corporate interests in both the media and the political process.

As international experience shows, without a strong labor-based movement willing to be radical in its protests, a universal health care program will never be accepted by the US establishment.