Showing papers in "American Journal of Public Health in 1999"

Evaluating the public health impact of health promotion interventions: the RE-AIM framework.

Abstract: Progress in public health and community-based interventions has been hampered by the lack of a comprehensive evaluation framework appropriate to such programs. Multilevel interventions that incorporate policy, environmental, and individual components should be evaluated with measurements suited to their settings, goals, and purpose. In this commentary, the authors propose a model (termed the RE-AIM model) for evaluating public health interventions that assesses 5 dimensions: reach, efficacy, adoption, implementation, and maintenance. These dimensions occur at multiple levels (e.g., individual, clinic or organization, community) and interact to determine the public health or population-based impact of a program or policy. The authors discuss issues in evaluating each of these dimensions and combining them to determine overall public health impact. Failure to adequately evaluate programs on all 5 dimensions can lead to a waste of resources, discontinuities between stages of research, and failure to improve ...

Public conceptions of mental illness: labels, causes, dangerousness, and social distance.

Abstract: OBJECTIVES: The authors used nationwide survey data to characterize current public conceptions related to recognition of mental illness and perceived causes, dangerousness, and desired social distance. METHODS: Data were derived from a vignette experiment included in the 1996 General Social Survey. Respondents (n = 1444) were randomly assigned to 1 of 5 vignette conditions. Four vignettes described psychiatric disorders meeting diagnostic criteria, and the fifth depicted a "troubled person" with subclinical problems and worries. RESULTS: Results indicate that the majority of the public identifies schizophrenia (88%) and major depression (69%) as mental illnesses and that most report multicausal explanations combining stressful circumstances with biologic and genetic factors. Results also show, however, that smaller proportions associate alcohol (49%) or drug (44%) abuse with mental illness and that symptoms of mental illness remain strongly connected with public fears about potential violence and with a d...

Social capital and self-rated health: a contextual analysis.

Abstract: OBJECTIVES: Social capital consists of features of social organization--such as trust between citizens, norms of reciprocity, and group membership--that facilitate collective action. This article reports a contextual analysis of social capital and individual self-rated health, with adjustment for individual household income, health behaviors, and other covariates. METHODS: Self-rated health ("Is your overall health excellent, very good, good, fair, or poor?") was assessed among 167,259 individuals residing in 39 US states, sampled by the Behavioral Risk Factor Surveillance System. Social capital indicators, aggregated to the state level, were obtained from the General Social Surveys. RESULTS: Individual-level factors (e.g., low income, low education, smoking) were strongly associated with self-rated poor health. However, even after adjustment for these proximal variables, a contextual effect of low social capital on risk of self-rated poor health was found. For example, the odds ratio for fair or poor hea...

Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis.

Abstract: OBJECTIVES: This study developed prevalence estimates of gambling-related disorders in the United States and Canada, identified differences in prevalence among population segments, and identified changes in prevalence over the past 20 years METHODS: A meta-analytic strategy was employed to synthesize estimates from 119 prevalence studies This method produced more reliable prevalence rates than were available from any single study RESULTS: Prevalence estimates among samples of adolescents were significantly higher than estimates among samples of adults for both clinical (level 3) and subclinical (level 2) measures of disordered gambling within both lifetime and past-year time frames (eg, 39% vs 16% for lifetime estimates of level 3 gambling) Among adults, prevalence estimates of disordered gambling have increased significantly during the past 20 years CONCLUSIONS: Membership in youth, treatment, or prison population segments is significantly associated with experiencing gambling-related disorders

The Latino mortality paradox: a test of the "salmon bias" and healthy migrant hypotheses.

Abstract: OBJECTIVES: Relative to non-Latino Whites, Latinos have a worse socioeconomic profile but a lower mortality rate, a finding that presents an epidemiologic paradox. This study tested the salmon bias hypothesis that Latinos engage in return migration to their country of origin and are thereby rendered "statistically immortal" and the alternative hypothesis that selection of healthier migrants to the United States accounts for the paradox. METHODS: National Longitudinal Mortality Study data were used to examine mortality rates of the following groups for whom the salmon hypothesis is not feasible: Cubans, who face barriers against return migration; Puerto Ricans, whose deaths in Puerto Rico are recorded in US national statistics; and US-born individuals, who are not subject to either salmon or healthy migrant effects. RESULTS: The sample included 301,718 non-Latino Whites and 17,375 Latino Whites 25 years or older. Cubans and Puerto Ricans had lower mortality than non-Latino Whites. Moreover, US-born Latinos...

Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997

Abstract: OBJECTIVES: This study examined whether HIV counseling and testing leads to reductions in sexual risk behavior METHODS: The meta-analysis included 27 published studies that provided sexual behavior outcome data, assessed behavior before and after counseling and testing, and provided details sufficient for the calculation of effect sizes The studies involved 19,597 participants RESULTS: After counseling and testing, HIV-positive participants and HIV-serodiscordant couples reduced unprotected intercourse and increased condom use more than HIV-negative and untested participants HIV-negative participants did not modify their behavior more than untested participants Participants' age, volition for testing, and injection drug use treatment status, as well as the sample seroprevalence and length of the follow-up, explained the variance in results CONCLUSIONS: HIV counseling and testing appears to provide an effective means of secondary prevention for HIV-positive individuals but, as conducted in the review

The effectiveness of a short form of the Household Food Security Scale.

Abstract: OBJECTIVES: On the basis of an 18-item Household Food Security Scale, a short form was developed to assess financially based food insecurity and hunger in surveys of households with and without children. METHODS: To maximize the probability that households would be correctly classified with respect to food insecurity and hunger, 6 items from the full scale were selected on the basis of April 1995 Current Population Survey data. RESULTS: The short form classified 97.7% of households correctly and underestimated the prevalence of overall food insecurity and of hunger by 0.3 percentage points. CONCLUSIONS: The short form of the Household Food Security Scale is a brief but potentially useful tool for national surveys and some state/local applications.

Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly.

Abstract: OBJECTIVES: This study examined the effect of depression on the incidence of physical disability and the role of confounding and explanatory variables in this relationship. METHODS: A cohort of 6247 subjects 65 years and older who were initially free of disability was followed up for 6 years. Baseline depression was assessed by the Center for Epidemiological Studies Depression Scale. Disability in mobility and disability in activities of daily living were measured annually. RESULTS: Compared with the 5751 nondepressed subjects, the 496 depressed subjects had a relative risk (95% confidence interval) of 1.67 (1.44, 1.95) and 1.73 (1.54, 1.94) for incident disability in activities of daily living and mobility, respectively. Adjustment for sociodemographic characteristics and baseline chronic conditions reduced the risks to 1.39 (1.18, 1.63) and 1.45 (1.29, 1.93), respectively. Less physical activity and fewer social contacts among depressed persons further explained part of their increased disability risk. ...

The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems.

Abstract: OBJECTIVES: The authors examined Americans' opinions about financial and treatment competence of people with mental health problems, potential for harm to self or others, and the use of legal means to force treatment. METHODS: The 1996 General Social Survey provided interview data with a nationally representative sample (n = 1444). Respondents were given a vignette based on diagnostic criteria for schizophrenia, major depression, alcohol dependence, or drug dependence, or a "control" case. RESULTS: The specific nature of the problem was the most important factor shaping public reaction. Respondents viewed those with "troubles," alcohol dependence, or depression as able to make treatment decisions. Most reported that persons with alcohol or drug problems or schizophrenia cannot manage money and are likely to be violent toward others. Respondents indicated a willingness to coerce individuals into treatment. Respondent and other case characteristics rarely affected opinions. CONCLUSIONS: Americans report gre...

The role of socioeconomic status gradients in explaining differences in US adolescents' health.

Abstract: OBJECTIVE: This study sought to determine whether socioeconomic status (SES) gradients exist among US adolescents for self-rated health and for 5 diseases that cause serious adolescent and continuing adult morbidity METHODS: Baseline data from 15,483 adolescent and parental surveys from the National Longitudinal Study of Adolescent Health were used SES indicators included parental education and occupation, and household income Dependent variables included self-rated health and the presence of depression, obesity, asthma, suicide attempt in the past year, and prior sexually transmitted disease RESULTS: SES gradients were found for self-rated health, depression, and obesity (P < 01) Suicide attempt was linearly associated with income (P < 01) After adjustment for other SES and sociodemographic factors, education and income remained independent correlates of both depression and obesity; income remained an independent correlate of attempted suicide CONCLUSIONS: Differences in susceptibility to social

Prevalence and correlates of survival sex among runaway and homeless youth.

Abstract: OBJECTIVE: This study examined the prevalence and correlates of survival sex among runaway and homeless youths. METHODS: A nationally representative sample of shelter youths and a multicity sample of street youths were interviewed. RESULTS: Approximately 28% of street youths and 10% of shelter youths reported having participated in survival sex, which was associated with age, days away from home, victimization, criminal behaviors, substance use, suicide attempts, sexually transmitted disease, and pregnancy. CONCLUSIONS: Intensive and ongoing services are needed to provide resources and residential assistance to enable runaway and homeless youths to avoid survival sex, which is associated with many problem behaviors.

Back pain prevalence in US industry and estimates of lost workdays.

Abstract: OBJECTIVES: Back pain is the most common reason for filing workers' compensation claims and often causes lost workdays. Data from the 1988 National Health Interview Survey were analyzed to identify high-risk industries and to estimate the prevalence of work-related back pain and number of workdays lost. METHODS: Analyses included 30074 respondents who worked during the 12 months before the interview. A case patient was defined as a respondent who had back pain every day for a week or more during that period. RESULTS: The prevalence of lost-workday back pain was 4.6%, and individuals with work-related cases lost 101.8 million workdays owing to back pain. Male and female case patients lost about the same number of workdays. Industries in high-risk categories were also identified for future research and intervention, including those seldom studied. CONCLUSIONS: This study provides statistically reliable national estimates of the prevalence of back pain among workers and the enormous effect of this condition ...

Prevalence of hepatitis B virus infection in the United States: the National Health and Nutrition Examination Surveys, 1976 through 1994.

Abstract: OBJECTIVE: Data from 2 National Health and Nutrition Examination Surveys (NHANES), NHANES II (1976-1980) and NHANES III (1988-1994), were analyzed to examine trends in the prevalence of hepatitis B infection in the United States. METHODS: Serum specimens were tested for markers of hepatitis B virus infection, and risk factors were determined from questionnaires. RESULTS: The overall age-adjusted prevalence of hepatitis B virus infection was 5.5% (95% confidence interval [CI] = 4.8, 6.2) in NHANES II, as compared with 4.9% (95% CI = 4.3, 5.6) in NHANES III. In both surveys, Black participants had the highest prevalence of infection (NHANES II, 15.8%; NHANES III, 11.9%). No differences in infection were found in the major racial groups between surveys, except for a decrease among those older than 50 years. Black race, increasing number of lifetime sexual partners, and foreign birth had the strongest independent associations with hepatitis B virus infection. CONCLUSIONS: Testing of participants in 2 national...

Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health project.

Abstract: OBJECTIVES: This study assessed the effects of the Black Churches United for Better Health project on increasing fruit and vegetable consumption among rural African American church members in North Carolina. METHODS: Ten counties comprising 50 churches were pair matched and randomly assigned to either intervention or delayed intervention (no program until after the follow-up survey) conditions. A multicomponent intervention was conducted over approximately 20 months. A total of 2519 adults (77.3% response rate) completed both the baseline and 2-year follow-up interviews. RESULTS: The 2 study groups consumed similar amounts of fruits and vegetables at baseline. AT the 2-year follow-up, the intervention group consumed 0.85 (SE = 0.12) servings more than the delayed intervention group (P < .0001). The largest increases were observed among people 66 years or older (1 serving), those with education beyond high school (0.92 servings), those widowed or divorced (0.96 servings), and those attending church frequen...

Exercise--it's never too late: the strong-for-life program.

Abstract: OBJECTIVES: This investigation determined whether an in-home resistance training program achieved health benefits in older adults with disabilities. METHODS: A randomized controlled trial compared the effects of assigning 215 older persons to either a home-based resistance exercise training group or a waiting list control group. Assessments were conducted at baseline and at 3 and 6 months following randomization. The program consisted of videotaped exercise routines performed with elastic bands of varying thickness. RESULTS: High rates of exercise adherence were achieved, with 89% of the recommended exercise sessions performed over 6 months. Relative to controls, subjects who participated in the program achieved statistically significant lower extremity strength improvements of 6% to 12%, a 20% improvement in tandem gait, and a 15% to 18% reduction in physical and overall disability at the 6-month follow-up. No adverse health effects were encountered. CONCLUSIONS: These findings provide important evidence...

Mortality among homeless shelter residents in New York City.

Abstract: OBJECTIVES: This study examined the rates and predictors of mortality among sheltered homeless men and women in New York City. METHODS: Identifying data on a representative sample of shelter residents surveyed in 1987 were matched against national mortality records for 1987 through 1994. Standardized mortality ratios were computed to compare death rates among homeless people with those of the general US and New York City populations. Logistic regression analysis was used to examine predictors of mortality within the homeless sample. RESULTS: Age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City. Among homeless men, prior use of injectable drugs, incarceration, and chronic homelessness increased the likelihood of death. CONCLUSIONS: For homeless shelter users, chronic homelessness itself compounds the high risk of death associated with disease/disability and intravenous drug use. Interventions mus...

Socioeconomic inequalities in mortality among women and among men: an international study.

Abstract: OBJECTIVES: This study compared differences in total and cause-specific mortality by educational level among women with those among men in 7 countries: the United States, Finland, Norway, Italy, the Czech Republic, Hungary, and Estonia METHODS: National data were obtained for the period ca 1980 to ca 1990 Age-adjusted rate ratios comparing a broad lower-educational group with a broad upper-educational group were calculated with Poisson regression analysis RESULTS: Total mortality rate ratios among women ranged from 109 in the Czech Republic to 131 in the United States and Estonia Higher mortality rates among lower-educated women were found for most causes of death, but not for neoplasms Relative inequalities in total mortality tended to be smaller among women than among men In the United States and Western Europe, but not in Central and Eastern Europe, this sex difference was largely due to differences between women and men in cause-of-death pattern For specific causes of death, inequalities are usually larger among men CONCLUSIONS: Further study of the interaction between socioeconomic factors, sex, and mortality may provide important clues to the explanation of inequalities in health

Tobacco smoking and depressed mood in late childhood and early adolescence.

Abstract: OBJECTIVES: This study builds on previous observations about a suspected causal association linking tobacco smoking with depression. With prospective data, the study sheds new light on the temporal sequencing of tobacco smoking and depressed mood in late childhood and early adolescence. METHODS: The epidemiologic sample that was studied consisted of 1731 youths (aged 8-9 to 13-14 years) attending public schools in a mid-Atlantic metropolitan area, who were assessed at least twice from 1989 to 1994. A survival analysis was used to examine the temporal relationship from antecedent tobacco smoking to subsequent onset of depressed mood, as well as from antecedent depressed mood to subsequent initiation of tobacco use. RESULTS: Tobacco smoking signaled a modestly increased risk for the subsequent onset of depressed mood, but antecedent depressed mood was not associated with a later risk of starting to smoke tobacco cigarettes. CONCLUSIONS: This evidence is consistent with a possible causal link from tobacco sm...

Sexual harassment and generalized workplace abuse among university employees: prevalence and mental health correlates.

Abstract: OBJECTIVES: This study hypothesized that interpersonal workplace stressors involving sexual harassment and generalized workplace abuse are highly prevalent and significantly linked with mental health outcomes including symptomatic distress, the use and abuse of alcohol, and other drug use. METHODS: Employees in 4 university occupational groups (faculty, student, clerical, and service workers; n = 2492) were surveyed by means of a mailed self-report instrument. Cross-tabular and ordinary least squares and logistic regression analyses examined the prevalence of harassment and abuse and their association with mental health status. RESULTS: The data show high rates of harassment and abuse. Among faculty, females were subjected to higher rates; among clerical and service workers, males were subjected to higher rates. Male and female clerical and service workers experienced higher levels of particularly severe mistreatment. Generalized abuse was more prevalent than harassment for all groups. Both harassment and...

The global burden of mental disorders.

Abstract: Recent data on the burden of mental disorders worldwide demonstrates a major public health problem that affects patients, society, and nations as a whole. Research must be done to find effective ways to deal with the increasing burden of mental disorders. Given the growing evidence that mental disorders are disorders of the brain and that they can be treated effectively with both psychosocial counseling and psychotropic medications, intervention packages could be developed to deal with the increasing burden. Such packages should be tested for real-world effectiveness and their cost-effectiveness should be demonstrated to guide policymakers to choose from among many other non-mental health interventions. The transportability and sustainability of intervention packages should be studied in public health research and a link between efficacy, effectiveness, cost-effectiveness, generalizability, and sustainability should be demonstrated. The World Health Organization's initiative on the World Mental Health 2000 Survey will provide the first basic epidemiologic data. Together with other data, the initiative will provide solid evidence for including mental disorders into essential treatment packages. In this way, parity can be achieved for mental disorders and mental health can be mainstreamed into health and public health practice.

Sexual mixing patterns in the spread of gonococcal and chlamydial infections.

Abstract: OBJECTIVES: This study sought to define, among sexually transmitted disease (STD) clinic attendees, (1) patterns of sex partner selection, (2) relative risks for gonococcal or chlamydial infection associated with each mixing pattern, and (3) selected links and potential and actual bridge populations. METHODS: Mixing matrices were computed based on characteristics of the study participants and their partners. Risk of infection was determined in study participants with various types of partners, and odds ratios were used to estimate relative risk of infection for discordant vs concordant partnerships. RESULTS: Partnerships discordant in terms of race/ethnicity, age, education, and number of partners were associated with significant risk for gonorrhea and chlamydial infection. In low-prevalence subpopulations, within-subpopulation mixing was associated with chlamydial infection, and direct links with high-prevalence subpopulations were associated with gonorrhea. CONCLUSIONS: Mixing patterns influence the ris...

Explaining educational differences in mortality: the role of behavioral and material factors.

Abstract: OBJECTIVES: This study examined the role of behavioral and material factors in explaining educational differences in all-cause mortality, taking into account the overlap between both types of factors. METHODS: Prospective data were used on 15,451 participants in a Dutch longitudinal study. Relative hazards of all-cause mortality by educational level were calculated before and after adjustment for behavioral factors (alcohol intake, smoking, body mass index, physical activity, dietary habits) and material factors (financial problems, neighborhood conditions, housing conditions, crowding, employment status, a proxy of income). RESULTS: Mortality was higher in lower educational groups. Four behavioral factors (alcohol, smoking, body mass index, physical activity) and 3 material factors (financial problems, employment status, income proxy) explained part of the educational differences in mortality. With the overlap between both types of factors accounted for, material factors were more important than behavior...

Cardiovascular risk factors in Mexican American adults: a transcultural analysis of NHANES III, 1988-1994.

Abstract: OBJECTIVES: This study examined the extent to which cardiovascular disease risk factors differ among subgroups of Mexican Americans living in the United States. METHODS: Using data from a national sample (1988-1994) of 1387 Mexican American women and 1404 Mexican American men, aged 25 to 64 years, we examined an estimate of coronary heart disease mortality risk and 5 primary cardiovascular disease risk factors: systolic blood pressure, body mass index, cigarette smoking, non-high-density lipoprotein cholesterol, and type 2 diabetes mellitus. Differences in risk were evaluated by country of birth and primary language spoken. RESULTS: Estimated 10-year coronary heart disease mortality risk per 1000 persons, adjusted for age and education, was highest for US-born Spanish-speaking men and women (27.5 and 11.4, respectively), intermediate for US-born English-speaking men and women (22.5 and 7.0), and lowest for Mexican-born men and women (20.0 and 6.6). A similar pattern of higher risk among US-born Spanish-sp...

The direct health care costs of obesity in the United States.

Abstract: OBJECTIVES: Recent estimates suggest that obesity accounts for 5.7% of US total direct health care costs, but these estimates have not accounted for the increased death rate among obese people. This article examines whether the estimated direct health care costs attributable to obesity are offset by the increased mortality rate among obese individuals. METHODS: Data on death rates, relative risks of death with obesity, and health care costs at different ages were used to estimate direct health care costs of obesity from 20 to 85 years of age with and without accounting for increased death rates associated with obesity. Sensitivity analyses used different values of relative risk of death, given obesity, and allowed the relative costs due to obesity per unit of time to vary with age. RESULTS: Direct health care costs from 20 to 85 years of age were estimated to be approximately 25% lower when differential mortality was taken into account. Sensitivity analyses suggested that direct health care costs of obesi...

Breast-feeding and infant illness: a dose-response relationship?

Abstract: OBJECTIVES: The purpose of this study was to determine whether breast-feeding has a dose-related protective effect against illness and whether it confers special health benefits to poor infants. METHODS: The association between breast-feeding dose and illnesses in the first 6 months of life was analyzed with generalized estimating equations regression for 7092 infants from the National Maternal and Infant Health Survey. Breast-feeding dose (ratio of breast-feedings to other feedings) was categorized as full, most, equal, less, or no breast-feeding. RESULTS: Compared with no breast-feeding, full breast-feeding infants had lower odds ratios of diarrhea, cough or wheeze, and vomiting and lower mean ratios of illness months and sick baby medical visits. Most breast-feeding infants had lower odds ratios of diarrhea and cough or wheeze, and equal breast-feeding infants had lower odds ratios of cough or wheeze. Full, most, and equal breast-feeding infants without siblings had lower odds ratios of ear infections ...

The Safe Motherhood Initiative: why has it stalled?

Abstract: Complications of pregnancy and childbirth are still the leading cause of death and disability among women of reproductive age in developing countries. After decades of neglect, the founding of the Safe Motherhood Initiative in 1987 promised action on this problem. A dozen years later, there is no evidence that maternal mortality has declined and there are still few sizeable programs. A major reason for this disappointing record is that the initiative lacks a clear, concise, feasible strategy. This article reviews the available options and proposes a strategy based on improving the availability and quality of medical treatment of obstetric complications. Once district hospitals and health centers provide such needed care, community mobilization to improve prove utilization may be beneficial. Substantial reductions in maternal deaths would be possible in a relatively short period of time if this strategy were embraced.

The impact of smoke-free workplaces on declining cigarette consumption in Australia and the United States.

Abstract: OBJECTIVES: This study estimates the contribution of smoke-free workplaces to the recent national declines in cigarette consumption in Australia and the United States METHODS: Nineteen studies of the impact of smoke-free workplaces on workday cigarette consumption were reviewed The number and cost of cigarettes forgone were calculated and extrapolated to a scenario in which all indoor work areas were smoke-free RESULTS: Of the 19 studies, 18 reported declines in daily smoking rates, and 17 reported declines in smoking prevalence Smoke-free workplaces are currently responsible for an annual reduction of some 602 million cigarettes, or 18% of all cigarettes that might otherwise be consumed, in Australia, and an annual reduction of 97 billion cigarettes (2%) in the United States Approximately 223% of the 27 billion decrease in cigarette consumption in Australia between 1988 and 1995 can be attributed to smoke-free workplaces, as can 127% of the 765 billion decrease in the United States between 198

The impact of ethnicity, family income, and parental education on children's health and use of health services

Abstract: OBJECTIVES: This study characterized ethnic disparities for children in demographics, health status, and use of services; explored whether ethnic subgroups (Puerto Rican, Cuban, and Mexican) have additional distinctive differences; and determined whether disparities are explained by differences in family income and parental education. METHODS: Bivariate and multivariate analyses of data on 99,268 children from the 1989-91 National Health Interview Surveys were conducted. RESULTS: Native American, Black, and Hispanic children are poorest (35%, 41% below poverty level vs 10% of Whites), least healthy (66%-74% in excellent or very good health vs 85% of Whites), and have the least well educated parents. Compared with Whites, non-White children average fewer doctor visits and are more likely to have excessive intervals between visits. Hispanic subgroup differences in demographics, health, and use of services equal or surpass differences among major ethnic groups. In multivariate analyses, almost all ethnic gro...

Neighborhood environment and self-reported health status: a multilevel analysis.

Abstract: OBJECTIVES: This study examined whether neighborhood socioeconomic environment helps to explain the proportion of community members with self-reported poor health status. METHODS: A random sample of 9240 persons aged 25 to 74 years were interviewed during 1988 and 1989. The socioeconomic environment of each respondent's neighborhood was measured with the Care Need Index (CNI) and the Townsend score. The data were analyzed with a multilevel model adjusted for the independent variables. The second-level variables were the 2 neighborhood scores. RESULTS: There was a clear gradient for poor health and education within every CNI interval so that with an increasing CNI (indicating more deprivation), the prevalence of poor health increased in all 3 education groups (P = .001). In the full model, decreasing educational level, obesity, length and frequency of smoking, physical inactivity, and increasing CNI were associated with poor health. Persons living in the most deprived neighborhoods had a prevalence ratio o...

The health of grandparents raising grandchildren: results of a national study.

Abstract: OBJECTIVES: This study sought to compare the functional and self-rated health of grandparents raising grandchildren with that of noncaregiving grandparents. METHODS: A secondary analysis of data from the 1992 to 1994 National Survey of Families and Households was conducted. Bivariate and logistic analyses compared 173 custodial and 3304 noncustodial grandparents in terms of functional health limitations, self-rated health, and satisfaction with health. RESULTS: Custodial grandparents were significantly more likely to have limitations in 4 of the 5 activities of daily living (ADLs) examined, with more than half reporting some limitation in 1 of the 5 ADLs. A logistic regression analysis indicated that caregiving grandparents had 50% higher odds of having an ADL limitation. Caregivers were significantly more likely to report lower satisfaction with health, and a statistical trend indicated that the caregivers had lower self-rated health. CONCLUSIONS: Further research is needed to determine whether the diffe...