bluuebunny/crossref_metadata_2025_split huggingface dataset:
How does spatial heterogeneity influence resilience to climatic changes? Ecological dynamics in southeast Madagascar
Authors: Virah-Sawmy Malika , Gillson Lindsey , Willis Katherine Jane 
Published: October 2009

Conceptual models suggest a link between spatial heterogeneity, diversity, and resilience, but few empirical studies exist to demonstrate such an ecological relationship. In this study, we investigated the nature of spatial heterogeneity and resilience of two forest fragments from Madagascar's highly endangered littoral forest, and two nearby sites in the surrounding ericoid grassland. This ecosystem has been subjected to a number of large environmental disturbances over the last 6000 years, including a late Holocene sea‐level rise of 1–3 m above the present level, pronounced drought events, and natural and anthropogenic fires. The aims were to determine the driving mechanisms for heterogeneity and to compare the impact of large environmental disturbances among the four sites.Overall, our results indicate that, contrary to previous assumptions of continuous forest cover, the ecosystem was already spatially heterogeneous prior to the arrival of humans. Differences in groundwater, nutrients, and fires maintained a natural mosaic of forest and open vegetation giving rise to high floristic diversity. The four sites differed significantly in their resilience to climatic disturbances, as measured by compositional turnover and by the timing and extent of biotic recovery. The highly diverse littoral forest reverted more quickly to forest than the surrounding vegetation, which was composed of open Uapaca woodland (a no‐analogue community) prior to the formation of the ericoid grassland. Further, species and populations from sites with low nutrients and nitrogen‐fixing species as dominants were able to persist despite climatic perturbations, whereas there was higher turnover in the other sites. Overall, minimal extinction occurred in the ecosystem despite widespread landscape transformations. It is suggested that spatial heterogeneity and diversity in southeastern Madagascar may have enhanced species survival during climatic perturbations.
Racial Differences in the Relationship Between Alcohol Consumption in Early Adulthood and Occupational Attainment at Midlife
Authors: Sloan Frank A. , Malone Patrick S. , Kertesz Stefan G. , Wang Yang , Costanzo Philip R. 
Published: October 2009

Objectives. We assessed the relationship between alcohol consumption in young adulthood (ages 18–30 years) and occupational success 15 years later among Blacks and Whites. Methods. We analyzed data from the Coronary Artery Risk Development in Young Adults Study on employment status and occupational prestige at year 15 from baseline. The primary predictor was weekly alcohol use at baseline, after stratification by race and adjustment for socioeconomic factors. Results. We detected racial differences in the relationship between alcohol use in early adulthood and employment status at midlife. Blacks who were very heavy drinkers at baseline were more than 4 times as likely as Blacks who were occasional drinkers to be unemployed at year 15 (odds ratio [OR] = 4.34; 95% confidence interval [CI] = 2.22, 8.47). We found no statistically significant relationship among Whites. Occupational prestige at midlife was negatively related to very heavy drinking, but after adjustment for marital status, active coping, life stress, and educational attainment, this relationship was statistically significant only among Blacks. Conclusions. Heavy drinking during young adulthood was negatively associated with labor market success at midlife, especially among Blacks.
Health Care Coverage and the Health Care Industry
Authors: Chou Chiu-Fang , Johnson Pamela Jo , Ward Andrew , Blewett Lynn A. 
Published: October 2009

Objectives. We examined rates of uninsurance among workers in the US health care workforce by health care industry subtype and workforce category. Methods. We used 2004 to 2006 National Health Interview Survey data to assess health insurance coverage rates. Multivariate logistic regression analyses were conducted to estimate the odds of uninsurance among health care workers by industry subtype. Results. Overall, 11% of the US health care workforce is uninsured. Ambulatory care workers were 3.1 times as likely as hospital workers (95% confidence interval [CI] = 2.3, 4.3) to be uninsured, and residential care workers were 4.3 times as likely to be uninsured (95% CI = 3.0, 6.1). Health service workers had 50% greater odds of being uninsured relative to workers in health diagnosing and treating occupations (odds ratio [OR] = 1.5; 95% CI = 1.0, 2.4). Conclusions. Because uninsurance leads to delays in seeking care, fewer prevention visits, and poorer health status, the fact that nearly 1 in 8 health care workers lacks insurance coverage is cause for concern.
Forecasting the Future Economic Burden of Current Adolescent Overweight: An Estimate of the Coronary Heart Disease Policy Model
Authors: Lightwood James , Bibbins-Domingo Kirsten , Coxson Pamela , Wang Y. Claire , Williams Lawrence , Goldman Lee 
Published: October 2009

Objectives. We predicted the future economic burden attributable to high rates of current adolescent overweight. Methods. We constructed models to simulate the costs of excess obesity and associated diabetes and coronary heart disease (CHD) among adults aged 35–64 years in the US population in 2020 to 2050. Results. Current adolescent overweight is projected to result in 161 million life-years complicated by obesity, diabetes, or CHD and 1.5 million life-years lost. The cumulative excess attributable total costs are estimated at $254 billion: $208 billion because of lost productivity from earlier death or morbidity and $46 billion from direct medical costs. Currently available therapies for hypertension, hyperlipidemia, and diabetes, used according to guidelines, if applied in the future, would result in modest reductions in excess mortality (decreased to 1.1 million life-years lost) but increase total excess costs by another $7 billion (increased to $261 billion total). Conclusions. Current adolescent overweight will likely lead to large future economic and health burdens, especially lost productivity from premature death and disability. Application of currently available medical treatments will not greatly reduce these future burdens of increased adult obesity.
Effects of Sustained Abstinence Among Treated Substance-Abusing Homeless Persons on Housing and Employment
Authors: Milby Jesse B. , Schumacher Joseph E. , Wallace Dennis , Vuchinich Rudy , Mennemeyer Stephen T. , Kertesz Stefan G. 
Published: October 2009

Objectives. We examined whether cocaine-dependent homeless persons had stable housing and were employed 6, 12, and 18 months after they entered a randomized controlled trial comparing 2 treatments. Methods. One group (n = 103) received abstinence-contingent housing, vocational training, and work; another group (n = 103) received the same intervention plus cognitive behavioral day treatment. We examined baseline and early treatment variables for association with long-term housing and employment. Results. Although the enhanced-treatment group achieved better abstinence rates, the groups did not differ in long-term housing and employment stability. However, consecutive weeks of abstinence during treatment (and to a lesser extent, older age and male gender) predicted long-term housing and employment stability after adjustment for baseline differences in employment, housing, and treatment. Conclusions. Our data showed a relationship of abstinence with housing stability. Contrasting these results with the increasingly popular Housing First interventions reveals important gaps in our knowledge to be addressed in future research.
State-Level Policies and Psychiatric Morbidity In Lesbian, Gay, and Bisexual Populations
Authors: Hatzenbuehler Mark L. , Keyes Katherine M. , Hasin Deborah S. 
Published: October 2009

Objectives. We investigated the modifying effect of state-level policies on the association between lesbian, gay, or bisexual status and the prevalence of psychiatric disorders. Methods. Data were from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative study of noninstitutionalized US adults (N = 34 653). States were coded for policies extending protections against hate crimes and employment discrimination based on sexual orientation. Results. Compared with living in states with policies extending protections, living in states without these policies predicted a significantly stronger association between lesbian, gay, or bisexual status and psychiatric disorders in the past 12 months, including generalized anxiety disorder (F = 3.87; df = 2; P = .02), post-traumatic stress disorder (F = 3.42; df = 2; P = .04), and dysthymia (F = 5.20; df = 2; P = .02). Living in states with policies that did not extend protections also predicted a stronger relation between lesbian, gay, or bisexual status and psychiatric comorbidity (F = 2.47; df = 2; P = .04). Conclusions. State-level protective policies modify the effect of lesbian, gay, or bisexual status on psychiatric disorders. Policies that reduce discrimination against gays and lesbians are urgently needed to protect the health and well-being of this population.
Characteristics of Health Information Gatherers, Disseminators, and Blockers Within Families at Risk of Hereditary Cancer: Implications for Family Health Communication Interventions
Authors: Koehly Laura M. , Peters June A. , Kenen Regina , Hoskins Lindsey M. , Ersig Anne L. , Kuhn Natalia R. , Loud Jennifer T. , Greene Mark H. 
Published: October 2009

Objectives. Given the importance of the dissemination of accurate family history to assess disease risk, we characterized the gatherers, disseminators, and blockers of health information within families at high genetic risk of cancer. Methods. A total of 5466 personal network members of 183 female participants of the Breast Imaging Study from 124 families with known mutations in the BRCA1/2 genes (associated with high risk of breast, ovarian, and other types of cancer) were identified by using the Colored Eco-Genetic Relationship Map (CEGRM). Hierarchical nonlinear models were fitted to characterize information gatherers, disseminators, and blockers. Results. Gatherers of information were more often female (P < .001), parents (P < .001), and emotional support providers (P < .001). Disseminators were more likely female first- and second- degree relatives (both P < .001), family members in the older or same generation as the participant (P < .001), those with a cancer history (P < .001), and providers of emotional (P < .001) or tangible support (P < .001). Blockers tended to be spouses or partners (P < .001) and male, first-degree relatives (P < .001). Conclusions. Our results provide insight into which family members may, within a family-based intervention, effectively gather family risk information, disseminate information, and encourage discussions regarding shared family risk.
Increasing Youths' Exposure to a Tobacco Prevention Media Campaign in Rural and Low-Population-Density Communities
Authors: Duke Jennifer C. , Vallone Donna M. , Allen Jane A. , Cullen Jennifer , Mowery Paul D. , Xiao Haijun , Dorrler Nicole , Asche Eric T. , Healton Cheryl 
Published: October 2009

Objectives. We examined the effectiveness of a program to increase exposure to national “truth” tobacco countermarketing messages among youths in rural and low-population-density communities. Methods. A longitudinal survey of 2618 youths aged 12 to 17 years was conducted over 5 months in 8 media markets receiving supplemental advertising and 8 comparison markets receiving less than the national average of “truth” messages. Results. Confirmed awareness of “truth” increased from 40% to 71% among youths in treatment markets while remaining stable in comparison markets. Over 35% of all youths who were unaware of the campaign at baseline became aware of it as a direct result of the increased advertising. Youths living in rural and low-population-density communities were receptive to the campaign's messages. Conclusions. Through purchase of airtime in local broadcast media, the reach of a national tobacco countermarketing campaign was expanded among youths living in rural and low-population-density areas. This strategy of augmenting delivery of nationally broadcast antitobacco ads can serve as a model for leveraging limited tobacco control resources to increase the impact of evidence-based tobacco prevention campaigns.
Reframing the Dissemination Challenge: A Marketing and Distribution Perspective
Authors: Kreuter Matthew W. , Bernhardt Jay M. 
Published: October 2009

A fundamental obstacle to successful dissemination and implementation of evidence-based public health programs is the near-total absence of systems and infrastructure for marketing and distribution. We describe the functions of a marketing and distribution system, and we explain how it would help move effective public health programs from research to practice. Then we critically evaluate the 4 dominant strategies now used to promote dissemination and implementation, and we explain how each would be enhanced by marketing and distribution systems. Finally, we make 6 recommendations for building the needed system infrastructure and discuss the responsibility within the public health community for implementation of these recommendations. Without serious investment in such infrastructure, application of proven solutions in public health practice will continue to occur slowly and rarely.
Audience Segmentation as a Social-Marketing Tool in Health Promotion: Use of the Risk Perception Attitude Framework in HIV Prevention in Malawi
Authors: Rimal Rajiv N. , Brown Jane , Mkandawire Glory , Folda Lisa , Böse Kirsten , Creel Alisha H. 
Published: October 2009

Objectives. We sought to determine whether individuals' risk perceptions and efficacy beliefs could be used to meaningfully segment audiences to assist interventions that seek to change HIV-related behaviors. Methods. A household-level survey of individuals (N = 968) was conducted in 4 districts in Malawi. On the basis of responses about perceptions of risk and beliefs about personal efficacy, we used cluster analysis to create 4 groups within the risk perception attitude framework: responsive (high risk, strong efficacy), avoidance (high risk, weak efficacy), proactive (low risk, strong efficacy), and indifference (low risk, weak efficacy). We ran analysis of covariance models (controlling for known predictors) to determine how membership in the risk perception attitude framework groups would affect knowledge about HIV, HIV-testing uptake, and condom use. Results. A significant association was found between membership in 1 or more of the 4 risk perception attitude framework groups and the 3 study variables of interest: knowledge about HIV (F8, 956 = 20.77; P < .001), HIV testing uptake (F8, 952 = 10.91; P < .001), and condom use (F8, 885 = 29.59; P < .001). Conclusions. The risk perception attitude framework can serve as a theoretically sound audience segmentation technique that can be used to determine whether messages should augment perceptions of risk, beliefs about personal efficacy, or both.
From Health as a Rational Choice to Health as an Affordable Choice
Authors: Maziak Wasim , Ward Kenneth D. 
Published: October 2009

Sedentary, consumption-based lifestyles are placing entire populations at serious health risks; obesity is a prime example.The individual approach to obesity, which targets those at risk, has largely failed because it ignores wider influences on behavior. Although the population–ecological approach is gaining support, it cannot disentangle clear targets for policy change. Consequently, health promotion has been relegated to the mass marketing of healthy behaviors, which is based on a rational notion that informed people tend to behave in their best interest.Creating environments that support behavior change and providing individuals incentives can be more effective to reduce lifestyle-related risks. A paradigm shift from trying to sell health to the public to creating the conditions whereby healthy choices become accessible and affordable is required.
Participatory Design of Mass Health Communication in Three Languages for Seniors and People With Disabilities on Medicaid
Authors: Neuhauser Linda , Rothschild Beccah , Graham Carrie , Ivey Susan L. , Konishi Susana 
Published: October 2009

Objectives. We used participatory design methods to develop and test guidebooks about health care choices intended for 600 000 English-, Spanish-, and Chinese-speaking seniors and people with disabilities receiving Medicaid in California. Methods. Design and testing processes were conducted with consumers and professionals; they included 24 advisory group interviews, 36 usability tests, 18 focus groups (105 participants), 51 key informant interviews, guidebook readability and suitability testing, linguistic adaptation, and iterative revisions of 4 prototypes. Results. Participatory design processes identified preferences of intended audiences for guidebook content, linguistic adaptation, and format; guidebook readability was scored at the sixth- to eighth-grade level and suitability at 95%. These findings informed the design of a separate efficacy study that showed high guidebook usage and satisfaction, and better gains in knowledge, confidence, and intended behaviors among intervention participants than among control participants. Conclusions. Participatory design can be used effectively in mass communication to inform vulnerable audiences of health care choices. The techniques described can be adapted for a broad range of health communication interventions.
Impact of an Organizational Intervention Designed to Improve Snack and Beverage Quality in YMCA After-School Programs
Authors: Mozaffarian Rebecca S. , Wiecha Jean L. , Roth Barbara A. , Nelson Toben F. , Lee Rebekka M. , Gortmaker Steven L. 
Published: October 2009

Objectives. We evaluated the quality of snacks and beverages served at YMCA after-school programs before and after the programs' participation in a YMCA Learning Collaborative. Methods. We collected data on the types and brands of snacks and beverages (including fresh fruits and vegetables, whole grains, foods with trans fats, water, and sugar-sweetened beverages) served daily during 3 different time periods spanning 14 months in total, and the components of the healthy eating standards. We compared snack and beverage quality before and after the intervention. Results. Weekly servings of fresh fruits and vegetables (1.3 vs 3.9; P = .02) and weekly servings of fruits and vegetables as a whole (1.9 vs 5.2; P = .009) increased from baseline to postintervention; weekly servings of desserts (1.3 vs 0.5; P = .049), foods with added sugars (3.9 vs 2.4; P = .03), and foods containing trans fats (2.6 vs 0.7; P = .01) decreased. After the intervention, all YMCAs offered water daily, and none served sugar-sweetened beverages. The percentage of calories from fruits and vegetables significantly increased after the intervention, whereas the percentage of calories from foods containing trans fats and added sugars decreased. Conclusions. A learning collaborative can disseminate healthy eating standards among participating organizations and facilitate improvements in the quality of after-school snacks and beverages.
Communicating Treatment Risk Reduction to People With Low Numeracy Skills: A Cross-Cultural Comparison
Authors: Garcia-Retamero Rocio , Galesic Mirta 
Published: October 2009

Objectives. We sought to address denominator neglect (i.e. the focus on the number of treated and nontreated patients who died, without sufficiently considering the overall numbers of patients) in estimates of treatment risk reduction, and analyzed whether icon arrays aid comprehension. Methods. We performed a survey of probabilistic, national samples in the United States and Germany in July and August of 2008. Participants received scenarios involving equally effective treatments but differing in the overall number of treated and nontreated patients. In some conditions, the number who received a treatment equaled the number who did not; in others the number was smaller or larger. Some participants received icon arrays. Results. Participants—particularly those with low numeracy skills—showed denominator neglect in treatment risk reduction perceptions. Icon arrays were an effective method for eliminating denominator neglect. We found cross-cultural differences that are important in light of the countries' different medical systems. Conclusions. Problems understanding numerical information often reside not in the mind but in the problem's representation. These findings suggest suitable ways to communicate quantitative medical data.
Effects of Different Types of Antismoking Ads on Reducing Disparities in Smoking Cessation Among Socioeconomic Subgroups
Authors: Durkin Sarah J. , Biener Lois , Wakefield Melanie A. 
Published: October 2009

Objectives. We assessed which types of mass media messages might reduce disparities in smoking prevalence among disadvantaged population subgroups.Methods. We followed 1491 adult smokers over 24 months and related quitting status at follow-up to exposure to antismoking ads in the 2 years prior to the baseline assessment.Results. On average, smokers were exposed to more than 200 antismoking ads during the 2-year period, as estimated by televised gross ratings points (GRPs). The odds of having quit at follow-up increased by 11% with each 10 additional potential ad exposures (per 1000 points, odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.00, 1.23; P < .05). Greater exposure to ads that contained highly emotional elements or personal stories drove this effect (OR = 1.14; 95% CI 1.02, 1.29; P < .05), which was greater among respondents with low and mid-socioeconomic status than among high–socioeconomic status groups.Conclusions. Emotionally evocative ads and ads that contain personalized stories about the effects of smoking and quitting hold promise for efforts to promote smoking cessation and reduce socioeconomic disparities in smoking.