bluuebunny/crossref_metadata_2025_split huggingface dataset:
If Suicide Is a Public Health Problem, What Are We Doing to Prevent It?
Authors: Knox Kerry L. , Conwell Yeates , Caine Eric D. 
Published: December 2008

Although not a disease, suicide is a tragic endpoint of complex etiology and a leading cause of death worldwide.Just as preventing heart disease once meant that specialists treated myocardial infarctions in emergency care settings, in the past decade, suicide prevention has been viewed as the responsibility of mental health professionals within clinical settings. By contrast, over the past 50 years, population-based risk reduction approaches have been used with varying levels of effectiveness to prevent morbidity and mortality associated with heart disease.We examined whether the current urgency to develop effective interventions for suicide prevention can benefit from an understanding of the evolution of population-based strategies to prevent heart disease.
Health Service Access, Use, and Insurance Coverage Among American Indians/Alaska Natives and Whites: What Role Does the Indian Health Service Play?
Authors: Zuckerman Stephen , Haley Jennifer , Roubideaux Yvette , Lillie-Blanton Marsha 
Published: December 2008

Objectives. We compared access and utilization of health services among American Indians/Alaska Natives (AIANs) with that among non-Hispanic Whites. Methods. We used data from the 1997 and 1999 National Survey of America’s Families to estimate odds ratios for several measures of access and utilization and the effects of Indian Health Service (IHS) coverage. Results. AIANs had less insurance coverage and worse access and utilization than Whites. Over half of low-income uninsured AIANs did not have access to the IHS. However, among the low-income population, AIANs with only IHS access fared better than uninsured AIANs and as well as insured Whites for key measures but received less preventive care. Conclusions. The IHS partially offsets lack of insurance for some uninsured AIANs, but important needs were potentially unmet.
Prevalence and Correlates of Mental Disorders Among Native American Women in Primary Care
Authors: Duran Bonnie , Sanders Margaret , Skipper Betty , Waitzkin Howard , Malcoe Lorraine Halinka , Paine Susan , Yager Joel 
Published: December 2008

Objectives. We examined the lifetime and the past-year prevalence and correlates of common mental disorders among American Indian and Alaska Native women who presented for primary care. Methods. We screened 489 consecutively presenting female primary care patients aged 18 through 45 years with the General Health Questionnaire, 12-item version. A subsample (n = 234) completed the Composite International Diagnostic Interview. We examined associations between psychiatric disorders and sociodemographic variables, boarding school attendance, and psychopathology in the family of origin. Results. The study participants had high rates of alcohol use disorders, anxiety disorders, and anxiety/depression comorbidity compared with other samples of non–American Indian/Alaska Native women in primary care settings. Conclusions. There is a need for culturally appropriate mental health treatments and preventive services.
Unemployment and Mental Health: Understanding the Interactions Among Gender, Family Roles, and Social Class
Authors: Artazcoz Lucía , Benach Joan , Borrell Carme , Cortès Immaculada 
Published: December 2008

Objectives. We examined gender differences in the effects of unemployment on mental health and assessed whether such effects are associated with interactions among gender, family roles, and social class. Methods. Our analysis included 3881 employed and 638 unemployed workers, aged 25 to 64 years, interviewed in the 1994 Catalonian Health Survey. Results. Unemployment had more of an effect on the mental health of men (age-adjusted odds ratio [OR] = 2.98; 95% confidence interval [CI] = 2.30, 3.87) than on that of women (age-adjusted OR = 1.51; 95% CI = 1.11, 2.06). Gender differences in effects were related to family responsibilities and social class. Conclusions. Understanding the effects of unemployment on mental health requires consideration of the interactions among gender, family responsibilities, and social class.
The Pitfalls of Bioterrorism Preparedness: the Anthrax and Smallpox Experiences
Authors: Cohen Hillel W. , Gould Robert M. , Sidel Victor W. 
Published: December 2008

Bioterrorism preparedness programs have contributed to death, illness, and waste of public health resources without evidence of benefit. Several deaths and many serious illnesses have resulted from the smallpox vaccination program; yet there is no clear evidence that a threat of smallpox exposure ever existed. The anthrax spores released in 2001 have been linked to secret US military laboratories—the resultant illnesses and deaths might not have occurred if those laboratories were not in operation. The present expansion of bioterrorism preparedness programs will continue to squander health resources, increase the dangers of accidental or purposeful release of dangerous pathogens, and further undermine efforts to enforce international treaties to ban biological and chemical weapons. The public health community should acknowledge the substantial harm that bioterrorism preparedness has already caused and develop mechanisms to increase our public health resources and to allocate them to address the world’s real health needs.
The Importance of Place of Residence: Examining Health in Rural and Nonrural Areas
Authors: Eberhardt Mark S. , Pamuk Elsie R. 
Published: December 2008

We examined differences in health measures among rural, suburban, and urban residents and factors that contribute to these differences. Whereas differences between rural and urban residents were observed for some health measures, a consistent rural-to-urban gradient was not always found. Often, the most rural and the most urban areas were found to be disadvantaged compared with suburban areas. If health disparities are to be successfully addressed, the relationship between place of residence and health must be understood.
Provision of Health Care in Rural Afghanistan: Needs and Challenges
Authors: Reilley Brigg , Frank Thorsten , Prochnow Thomas , Puertas Gloria , van der Meer Joost 
Published: December 2008

Afghanistan’s health system is severely limited in terms of preventive and curative services, referral systems, and human resources. Most of the country’s citizens reside in rural areas, a majority of which are served by “basic health units” (small and simple facilities that provide primary care), and these rural residents face additional challenges regarding timely access to quality health care. The analysis described in this article, which focuses on data derived from 2 rural health units during a 1-year period, revealed that infectious diseases, mainly acute respiratory infections, were a primary concern and that there is a clear need for increasing access to health services. In addition, our results showed that women are underrepresented as patients and appear to be at higher risk than men of tuberculosis.
Acute Traumatic Injuries in Rural Populations
Authors: Peek-Asa Corinne , Zwerling Craig , Stallones Lorann 
Published: December 2008

In the United States, injuries are the leading cause of death among individuals aged 1 to 45 years and the fourth leading cause of death overall. Rural populations exhibit disproportionately high injury mortality rates. Deaths resulting from motor vehicle crashes, traumatic occupational injuries, drowning, residential fires, and suicide all increase with increasing rurality. We describe differences in rates and patterns of injury among rural and urban populations and discuss factors that contribute to these differences.
Rurality and Nursing Home Quality: Results from a National Sample of Nursing Home Admissions
Authors: Phillips Charles D. , Holan Scott , Sherman Michael , Williams Malgorzata Leyk , Hawes Catherine 
Published: December 2008

Objectives. We examined differences in quality of care among nursing homes in locales of varying degrees of rurality. Methods. We classified locales into 4 classes according to rurality. We analyzed a 10% sample of nursing home admissions in the United States in 2000 (n=198613) to estimate survival models for 9 quality indicators. Results. For postacute admissions, we observed significant differences in rates of decline for residents in facilities in large towns compared with urban areas, but differences in quality were both negative and positive. Among admissions for long-term or chronic care, rates of decline in 2 of 9 quality areas were lower for residents in isolated areas. Conclusions. We observed significant differences in a number of quality indicators among different classes of nursing home locations, but differences varied dramatically according to type of admission. These differences did not exhibit the monotonicity that we would have expected had they derived solely from rurality. Also, quality indicators exhibited more similarities than differences across the 4 classes of locales. The results underscore the importance, in some instances, of emphasizing the effects of specific settings rather than some continuum of rurality and of moving beyond the assumption that nursing home residents constitute a homogeneous population.
Retention of Primary Care Physicians in Rural Health Professional Shortage Areas
Authors: Pathman Donald E. , Konrad Thomas R. , Dann Rebekkah , Koch Gary 
Published: December 2008

Objectives. We tested the assumption that average job retention duration is shorter for physicians in rural health professional shortage areas (HPSAs) than for physicians in rural non-HPSAs. Methods. In 1991, we surveyed nationally representative samples of primary care physicians who recently had moved to rural HPSAs and non-HPSAs who were without service obligations. We resurveyed these physicians in 1996 and 1997 to learn of any job changes. Results. Physicians in rural HPSAs (n=308) demonstrated retention similar to that of the non-HPSA cohort (n=197) (hazard ratio for leaving=1.28; 95% confidence interval=0.97, 1.69; P=.08), even with adjustments for group demographic differences (P=.24). Conclusions. Average retention duration for generalist physicians in rural HPSAs is identical to or slightly shorter than for those in rural non-HPSAs. Poor recruitment is likely to be the principal dynamic underlying local rural shortages.
Pounds Off With Empowerment (POWER): A Clinical Trial of Weight Management Strategies for Black and White Adults With Diabetes Who Live in Medically Underserved Rural Communities
Authors: Mayer-Davis Elizabeth J. , D'Antonio Angela M. , Smith Sharon M. , Kirkner Gregory , Levin Martin Sarah , Parra-Medina Deborah , Schultz Richard 
Published: December 2008

Objectives. We evaluated lifestyle interventions for diabetic persons who live in rural communities. Methods. We conducted a 12-month randomized clinical trial (n = 152) of “intensive-lifestyle” (modeled after the NIH Diabetes Prevention Program) and “reimbursable-lifestyle” (intensive-lifestyle intervention delivered in the time allotted for Medicare reimbursement for diabetes education related to nutrition and physical activity) interventions with usual care as a control. Results. Modest weight loss occurred by 6 months among intensive-lifestyle participants and was greater than the weight loss among usual-care participants (2.6 kg vs 0.4 kg, P<.01). At 12 months, a greater proportion of intensive-lifestyle participants had lost 2 kg or more than usual-care participants (49% vs 25%, P<.05). No differences in weight change were observed between reimbursable-lifestyle and usual-care participants. Glycated hemoglobin was reduced among all groups (P<.05) but was not different between groups. Conclusions. Improvement in both weight and glycemia was attainable by lifestyle interventions designed for persons who had type 2 diabetes and lived in rural communities.
Differences in Health-Related Quality of Life in Rural and Urban Veterans
Authors: Weeks William B. , Kazis Lewis E. , Shen Yujing , Cong Zhongxiao , Ren Xinhua S. , Miller Donald , Lee Austin , Perlin Jonathan B. 
Published: December 2008

Objectives. We sought to determine whether disparities in health-related quality of life exist between veterans who live in rural settings and their suburban or urban counterparts. Methods. We determined health-related quality-of-life scores (physical and mental health component summaries) for 767109 veterans who had used Veterans Health Administration services within the past 3 years. We used rural/urban commuting area codes to categorize veterans into rural, suburban, or urban residence. Results. Health-related quality-of-life scores were significantly lower for veterans who lived in rural settings than for those who lived in suburban or urban settings. Rural veterans had significantly more physical health comorbidities, but fewer mental health comorbidities, than their suburban and urban counterparts. Rural–urban disparities persisted in all survey subscales, across regional delivery networks, and after we controlled for sociodemographic factors. Conclusions. When compared with their urban and suburban counterparts, veterans who live in a rural setting have worse health-related quality-of-life scores. Policymakers, within and outside the Veterans Health Administration, should anticipate greater health care demands from rural populations.
Local Area Deprivation and Urban–Rural Differences in Anxiety and Depression Among People Older Than 75 Years in Britain
Authors: Walters Kate , Breeze Elizabeth , Wilkinson Paul , Price Gill M. , Bulpitt Chris J. , Fletcher Astrid 
Published: December 2008

Objectives. We sought to determine the association of depression and anxiety with “area deprivation” (neighborhood socioeconomic deprivation) and population density among people older than 75 years in Britain. Methods. Postal codes were used to link census area information to individual data on depression and anxiety in 13349 people aged 75 years and older taking part in a trial of health screening. Results. Living in the most socioeconomically deprived areas was associated with depression (OR=1.4), but this relation disappeared after adjusting for individual deprivation characteristics. There was no association with anxiety. Living in the highest density and intermediate low-density areas was associated with depression (OR=1.6 and 1.5) and anxiety (OR=1.5 and 1.3) compared with the lowest density areas. Conclusions. An association between area deprivation and depression in older people was explained by individual health, demographic, and socioeconomic factors. Higher population density was consistently associated with increased depression and anxiety.
Cost-Related Medication Underuse Among Chronically III Adults: the Treatments People Forgo, How Often, and Who Is at Risk
Authors: Piette John D. , Heisler Michele , Wagner Todd H. 
Published: December 2008

Objectives. We sought information about the cost-related underuse of medications—which medications are underused, by whom, and how often. Methods. Chronically ill adults were asked to identify how often they underused prescription medication for 16 health conditions because of the cost. Results. Eighteen percent of respondents cut back on medication use owing to cost in the previous year, and 14% used less medication at least monthly. Although rates of underuse varied substantially across treatments, prescription coverage and out-of-pocket costs were determinants of underuse across medication types. Conclusions. Many chronically ill adults frequently cut back on medications owing to cost. Patients are selective about the treatments they forgo. Out-of-pocket costs and inadequate prescription coverage may lead to adherence problems for many important medication types.
Cigarette Smoking and Exposure to Environmental Tobacco Smoke in China: The International Collaborative Study of Cardiovascular Disease in Asia
Authors: Gu Dongfeng , Wu Xigui , Reynolds Kristi , Duan Xiufang , Xin Xue , Reynolds Robert F. , Whelton Paul K. , He Jiang 
Published: December 2008

Objectives. We estimated the prevalence of cigarette smoking and the extent of environmental tobacco smoke exposure (ETS) in the general population in China. Methods. A cross-sectional survey was conducted on a nationally representative sample of 15540 Chinese adults aged 35–74 years in 2000–2001. Information on cigarette smoking was obtained by trained interviewers using a standard questionnaire. Results. The prevalence of current cigarette smoking was much higher among men (60.2%) than among women (6.9%). Among nonsmokers, 12.1% of men and 51.3% of women reported exposure to ETS at home, and 26.7% of men and 26.2% of women reported exposure to ETS in their workplaces. On the basis of our findings, 147358000 Chinese men and 15895000 Chinese women aged 35–74 years were current cigarette smokers, 8658000 men and 108402000 women were exposed to ETS at home, and 19072000 men and 55372000 women were exposed to ETS in their workplaces. Conclusions. The high prevalence of cigarette smoking and environmental tobacco smoke exposure in the Chinese population indicates an urgent need for smoking prevention and cessation efforts.
Immigration and Acculturation in Relation to Health and Health-Related Risk Factors Among Specific Asian Subgroups in a Health Maintenance Organization
Authors: Gomez Scarlett L. , Kelsey Jennifer L. , Glaser Sally L. , Lee Marion M. , Sidney Stephen 
Published: December 2008

Objectives. We sought to determine how risk factors for disease vary among Asian subgroups. Methods. Using data from a case–control study conducted at Northern California Kaiser Medical Centers (from 1996 to 2001), we compared prevalence of selected risk factors among Asian subgroups and evaluated the associations of these risk factors with sociodemographic factors. Results. Chinese and Japanese patients had a lower body mass index (kg/m2) than did other Asians. In all subgroups, being born in the United States was associated with having a body mass index greater than 25 kg/m2. Compared with other Asians, more Japanese and multiple-race Asians smoked, and more Filipino and multiple-race Asian smokers started smoking at 18 years or younger. Filipinos and multiple-race Asians also were more likely to report diabetes. Conclusions. These data support the importance of efforts to distinguish among Asian subgroups in public health practice and research.
High-Risk Alcohol Consumption and Late-Life Alcohol Use Problems
Authors: Moos Rudolf H. , Brennan Penny L. , Schutte Kathleen K. , Moos Bernice S. 
Published: December 2008

Objectives. We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems. Methods. A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later. Results. Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals. Conclusion. Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.
State Trends in Uninsurance Among Individuals Aged 18 to 64 Years: United States, 1992–2001
Authors: Nelson David E. , Bolen Julie , Wells Henry E. , Smith Suzanne M. , Bland Shayne 
Published: December 2008

Objectives. We analyzed state-specific uninsurance trends among US adults aged 18 to 64 years. Methods. We used logistic regression models to examine Behavioral Risk Factor Surveillance System data for uninsurance from 1992 to 2001 in 47 states. Results. Overall, uninsurance rates increased in 35 states and remained unchanged in 12 states. Increases were observed among people aged 30 to 49 years (in 34 states) and 50 to 64 years (in 24 states), and increases were also observed among individuals at middle and low income levels (in 39 states and 19 states, respectively), individuals employed for wages (in 33 states), and the self-employed (in 18 states). Conclusions. Among adults aged 18–64, rates of uninsurance increased in most states from 1992 through 2001. Decreased availability of employer-sponsored health insurance, rising health care costs, and state fiscal crises are likely to worsen the growing uninsurance problem.
Effects on Alcohol Use and Anxiety of the September 11, 2001, Attacks and Chronic Work Stressors: A Longitudinal Cohort Study
Authors: Richman Judith A. , Wislar Joseph S. , Flaherty Joseph A. , Fendrich Michael , Rospenda Kathleen M. 
Published: December 2008

Objectives. We hypothesized that chronic stressors associated with an everyday social role (work) would interact with a traumatic macrosocial stressor (the terrorist attacks of September 11, 2001) in predicting mental health status (during the fall of 2001). Methods. We used mail surveys returned as part of wave 3 of a workplace cohort study, both before and after September 11, 2001, to assess decision latitude, sexual harassment, generalized workplace abuse, psychological distress, and alcohol use. We also used regression analyses to assess the main effect of September 11 and interactions between September 11 and stressors, after control for baseline mental health. Results. The main effect of September 11 on elevated alcohol use was significant for women but not for men. For women, work stressors significantly interacted with experiencing the events of September 11 to affect alcohol use and anxiety outcomes. Conclusions. Women experiencing chronic work stressors were most vulnerable to elevated psychological distress and alcohol use after September 11, 2001.
Racial Differences in Cardiac Catheterization as a Function of Patients’ Beliefs
Authors: Kressin Nancy R. , Chang Bei-Hung , Whittle Jeff , Peterson Eric D. , Clark Jack A. , Rosen Amy K. , Orner Michelle , Collins Tracie C. , Alley Linda G. , Petersen Laura A. 
Published: December 2008

Objectives. We examined racial differences in cardiac catheterization rates and reviewed whether patients’ beliefs or other variables were associated with observed disparities. Methods. We did a prospective observational cohort study of 1045 White and African American patients at 5 Veterans Affairs (VA) medical centers whose nuclear imaging studies indicated reversible cardiac ischemia. Results. There were few demographic differences between White and African American patients in our sample. African Americans were less likely than Whites to undergo cardiac catheterization. African Americans were more likely than Whites to indicate a strong reliance on religion and to report racial and social class discrimination and were less likely to indicate a generalized trust in people but did not differ from White patients on numerous other attitudes about health and health care. Neither sociodemographic or clinical characteristics nor patients’ beliefs explained the observed disparities, but physicians’ assessments of the procedure’s importance and patients’ likelihood of coronary disease seemed to account for differences not otherwise explained. Conclusions. Patients’ preferences are not the likely source of racial disparities in the use of cardiac catheterization among veterans using VA care, but physicians’ assessments warrant further attention.