Showing papers in "Journal of Public Health Policy in 1992"
815 citations
TL;DR: Because HIV infection and tuberculosis converge in a subpopulation with high rates of substance abuse and homelessness, the problem of ensuring treatment compliance may grow considerably in the future.
Abstract: The resurgence of tuberculosis in New York City has been largely attributed to the acquired immune deficiency syndrome (AIDS) epidemic. However, historical events predating the advent of AIDS, and worsening economic and social conditions, including a rise in homelessness, have contributed significantly to the increase. We prospectively studied 224 consecutive patients with tuberculosis admitted to a large public hospital in New York over the first 9 months of 1988. Initial assessment included medical status, human immunodeficiency virus (HIV) risk factors, and detailed social information, including substance abuse history and housing status. All patients were tracked after discharge to determine compliance and cure rates. Tuberculosis patients were predominantly male (79 %), with high rates of alcohol use (53 %), intravenous drug and/or “crack” cocaine use (64 %), and homelessness or unstable housing (68 %). Half the patients had AIDS or AIDS-related complex (ARC) or were HIV antibody positive. A total of 178 patients were discharged on tuberculosis treatment, but 89% of these were lost to follow-up and failed to complete therapy. Of the 178 discharged patients, 48 (27 %) were readmitted within 12 months with confirmed active tuberculosis. Of these patients, 40 were discharged on treatment and at least 35 were again lost to follow-up. In a multivariate regression model noncompliance was significantly associated with the absence of AIDS or ARC (p<0.001), homelessness (p<0.005), and alcoholism (p<0.05). Because HIV infection and tuberculosis converge in a subpopulation with high rates of substance abuse and homelessness, the problem of ensuring treatment compliance may grow considerably in the future. Positive patient incentives will have to be offered, and mandatory detention may be necessary in some cases.
238 citations
141 citations
136 citations
TL;DR: This essay examines the making of public health data as a social process, both historically and in the present, and critiques the routine omission of social class data from US public healthData bases, the treatment of “race” and “sex” as primarily biological variables, and their conflation with ethnicity and gender.
Abstract: Public health data do not simply exist: the variables included or excluded from any given data set reflect the choices of individuals and institutions with the power to make these decisions. Their judgement typically is guided by prevailing theories of disease causation, which in turn usually resonate with their society's predominant political, economic, and ideological characteristics. This essay examines the making of public health data as a social process, both historically and in the present, and critiques the routine omission of social class data from US public health data bases, the treatment of "race" and "sex" as primarily biological variables, and their conflation with ethnicity and gender. Overcoming these problems will require developing social theories of disease causation and ending the pervasive silence about the health consequences of class, race, and gender inequalities.
108 citations
TL;DR: Beer was more likely to be sold to the underage purchasers at smaller neighborhood stores in urban areas, and sales were least likely in Albany, which experienced recent police enforcement of the alcohol purchase age laws.
Abstract: A study was conducted in which young males, under the legal alcohol purchase age of 21, attempted to purchase beer at grocery stores and other retail outlets. Underage purchases were attempted at a sample of stores in Washington, D.C.; Westchester County, New York: and Albany and Schenectady counties, New York. Beer was sold to the underage purchasers at 97 percent of the Washington, D.C. stores, 80 percent of the Westchester County stores, and 44 percent of the Albany and Schenectady stores, despite the fact that such sales are illegal. Beer was more likely to be sold to the underage purchasers at smaller neighborhood stores in urban areas. Sales were least likely in Albany, which experienced recent police enforcement of the alcohol purchase age laws. Vigorous enforcement of the minimum purchase age laws is needed to reverse the current national trend toward more alcohol-related highway fatalities among youth.
108 citations
TL;DR: The high prevalence of hours-of-service violations among tractor-trailer drivers is a problem in need of urgent attention and potential measures to reduce the prevalence of rules violations include more enforcement directed toward carriers, wider use of electronic recorders, and increasing the number of rest areas.
Abstract: Fatigue and long driving hours have been implicated as risk factors in truck crashes. Under federal regulations, commercial drivers are permitted to drive no more than 10 hours before having an 8-hour break and cannot work more than 70 hours over an 8-day period. Several studies have suggested that violations of these rules are common. A survey of long haul tractor-trailer drivers was conducted to estimate what proportion of drivers report that they regularly violate the hours-of-service rules and to identify the drivers most likely to commit hours-of-service violations. During December 1990 through April 1991, a total of 1,249 drivers were interviewed at truck safety inspection stations, truck stops, and agricultural inspection stations in Connecticut, Florida, Oklahoma, and Oregon. In each state, interviews were conducted during varying periods of the day over the course of seven days at inspection stations. Overall, 89 percent of eligible drivers asked for interviews participated in the survey. According to self-reports, almost three-fourths of the respondents violate hours-of-service rules. About two-thirds of the drivers reported that they routinely drive or work more than the weekly maximum. A primary impetus for violating rules appears to be economic factors, including tight delivery schedules and low payment rates. Many other driver, job, and vehicle characteristics were significantly associated with being an hours-of-service violator. The high prevalence of hours-of-service violations among tractor-trailer drivers is a problem in need of urgent attention. Potential measures to reduce the prevalence of rules violations include more enforcement directed toward carriers, wider use of electronic recorders, and increasing the number of rest areas.
92 citations
TL;DR: A unified concept of health promotion is proposed which encompasses general as well as specific causative factors in the social environment and the implications for health promotion strategies are discussed.
Abstract: The differing concepts of health promotion are reviewed in their historical context and development, and a unified concept is proposed which encompasses general as well as specific causative factors in the social environment. The implications for health promotion strategies are discussed.
65 citations
50 citations
TL;DR: The rural Cooperative Medical System in China came into existence in the 1950s and along with the development of the collective economy of agriculture and the promotion of this system by the Chinese Government, the coverage rate increased from 1955 through the end of the 1970s, when it was estimated that go percent of the rural population was covered by the CMS.
Abstract: The rural Cooperative Medical System (CMS) in China came into existence in the 1950s. Along with the development of the collective economy of agriculture and the promotion of this system by the Chinese Government, the coverage rate of the CMS in the rural areas increased from 1955 through the end of the 1970s, when it was estimated that go percent of the rural population was covered by the CMS. Since the rural economic reform in the early 1980s destroyed the rural collective economy on which the CMS was based, the coverage rate of the CMS went down to 5 percent. After 1985, the coverage rate of the CMS began to increase gradually because of the development of the collective fund for supporting the CMS and the governments' efforts to strengthen the CMS. The structure of CMS has changed over time. Traditionally, the CMS was organized at the village level. In order to increase the risk-sharing ability of this system, the trend is for it to be organized at the township level in the future.
46 citations
TL;DR: It is suggested that restrictive workplace smoking policies may reduce employees' overall ETS exposure and be associated with a lower proportion of nonsmoking volunteers with detectable salivary cotinine.
Abstract: The health consequences of exposure to environmental tobacco smoke (ETS) are well documented. Although nonsmokers are generally aware of the health risks of ETS exposure, the majority of nonsmokers are regularly exposed. The most common source of exposure is the workplace. Restrictive workplace smoking policies are being used as a primary means of reducing ETS exposure. However, few studies have focused on the relation between workplace policy and ETS exposure. We performed two studies which examined the relationship between smoking policy, self-reported ETS exposure, and salivary cotinine concentrations. Study 1, a pilot study, focused on a workplace-based sample of 106 volunteers; Study 2 examined exposure among 881 nonsmokers in workplace settings. In both studies, more restrictive workplace smoking policies were associated with a lower proportion of nonsmoking volunteers with detectable salivary cotinine. In Study 2, the larger study, the only other variable found to be significantly related to cotinine detection was the presence of smokers in the home. These results suggest that restrictive workplace smoking policies may reduce employees' overall ETS exposure.
TL;DR: It is argued that the development of global advertising has significant implications for the public health of less developed countries and can restrict the public's knowledge about health issues by substituting distorted and manipulative sales messages for vital, accurate health information.
Abstract: This paper argues that the development of global advertising has significant implications for the public health of less developed countries. These implications can be seen in three areas. First, it is clear that advertising and marketing of lethal or health-compromising products like alcohol and tobacco not only can increase the level of death and disease, but can also produce serious indirect effects upon families, communities, and entire societies. Second, advertising promotes a consumption ethic which can have far-reaching effects that go beyond individual behavior, significantly altering social relationships, and influencing public policies and allocation of scarce resources. Third, advertising can restrict the public's knowledge about health issues by substituting distorted and manipulative sales messages for vital, accurate health information. In addition, revenues from advertising are a primary support for many mass media systems and this further limits the presentation of critical information.
TL;DR: There are a number of important areas where epidemiologists can contribute to making disaster management more effective, as well as the need for accurate information as the basis for relief decisions.
Abstract: Better epidemiologic knowledge of the causes of death and types of injuries and illnesses caused by disasters is clearly essential to determine appropriate relief supplies, equipment and personnel needed to respond effectively to such situations. The overall objective of disaster epidemiology is to scientifically measure and describe the health effects of disasters and contributing factors to these effects, with the goals of assessing the needs of disaster-affected populations, efficient matching of resources to needs, further prevention of adverse health effects, evaluation of program effectiveness, and contingency planning. In addition, the epidemiologist has an important role to play in providing informed advice about the probable health effects which may arise in the future, in establishing priorities for action and in emphasizing the need for accurate information as the basis for relief decisions. This presentation outlines a number of important areas where epidemiologists can contribute to making disaster management more effective.
TL;DR: This paper describes the changes occurring, examines the literature for its contributions in providing direction, and presents treatment method and policy issues which need to be part of the overall discourse.
Abstract: Alcohol and drug treatment have separate histories in the United States. The large public treatment systems were established as separate institutions in the early 1970s and have developed separate research traditions and treatment programs. However, as a response to current treatment financing policy and epidemiologic descriptions of combined alcohol and other drug use in the population, the two treatment systems are merging at the state and local levels. This large structural change is taking place without the development and evaluation of treatment methods for combined problems and without discussion of overall health service or policy implications. This paper describes the changes occurring, examines the literature for its contributions in providing direction, and presents treatment method and policy issues which need to be part of the overall discourse.
TL;DR: Introduction Public health and medical issues Legal issues Normative and social issuesNormative andsocial issues Conclusion
Abstract: Introduction Public health and medical issues Legal issues Normative and social issues Conclusion.
TL;DR: The time is right for passage of bold policies to protect young people from tobacco, from the perspective of corporate and regional headquarters of retail chains and franchises that sell tobacco.
Abstract: Minors' access to tobacco has become an important public health issue. Little is known, however, about the knowledge, attitudes, beliefs, and behavior toward access among executives from businesses that sell tobacco. This study examined access from the perspective of corporate and regional headquarters of retail chains and franchises that sell tobacco. A total of 148 U.S. companies with the largest overall retail sales volume that sold tobacco were asked to participate; 91 agreed. The sample included grocery stores, convenience stores, gas station mini-marts, liquor stores, and drug stores. Data revealed at least moderate support for policies limiting youth tobacco access. Although most companies reported having in place policies to prevent minors from purchasing tobacco, these policies did not seem intensive. In addition, executives underestimated the extent of youth access. We conclude that the time is right for passage of bold policies to protect young people from tobacco.
TL;DR: Harry L. Watson masterfully draws together the various strands of recent scholarship into a smooth, compelling synthesis of Jacksonian politics, and even specialists will find Watson's account illuminating.
Abstract: By Harry L. Watson. Liberty & Power: The Politics ofJacksonian America. (New York: Hill and Wang, 1990. pp. xii, 275. $22.95.) Liberty and Power marks the maturation of a new generation in Jacksonian scholarship. In the 1960s and 1970s historians reacting against Arthur Schlesinger, Jr.'s Age ofjackson argued that ethnic and religious differences, rather than economic inequities, gave rise to Jacksonian party battles. For some years this \"ethnocultural\" thesis has held sway. But in the last decade Harry L. Watson and other young scholars have returned to the questions which concerned Schlesinger, while bringing to them more refined tools of analysis and a great deal of new information. Liberty and Power is the first full statement of their case. It is also the first comprehensive treatment of Jacksonian politics to appear in twenty years and, as such, it will find a ready audience. And deservedly so. Watson masterfully draws together the various strands of recent scholarship into a smooth, compelling synthesis. Though many of the events covered in Liberty and Power are familiar, even specialists will find Watson's account illuminating. Besides incorporating new material (especially on state and local affairs), Watson's narrative displays a fine impartiality, an ability to describe both Whigs and Democrats dispassionately but sensitively. If this balanced approach leaves little room for rhetorical thrusts of wit and sarcasm, it imparts greater authority to Watson's judgments. Compared to predecessors like Schlesinger and Edward Pessen, Watson is less the partisan and critic, more the judicious though sympathetic analyst. Watson sets his narrative within the interweaving themes of economic change (the \"Market Revolution\") and political ideology (\"republicanism\"). According to Watson, early nineteenth-century breakthroughs in transportation and communications contributed to a sudden and dramatic transformation of American work habits, business relations, class structures, and modes of thinking. The impact of this \"Market Revolution\" was invigorating but also unsettling. Signs of growing instability and inequality prompted Americans-especially those whose livelihoods were jeopardized by \"progress\"-to wonder about the future of the republic. Their hopes and fears sparked a revitalization of partisan politics, as groups of citizens joined to do battle over government policies through which they hoped to control the direction and pace of economic change. The question of how society, through government, should respond to the Market Revolution thus brought politics to \"a critical turning point\" (p. 251) that gave birth to the Second American Party System. \"Republicanism\" was the ideological legacy of the American Revolution. Amern-
TL;DR: In this paper, the authors present an overview of the systems and regulations concerning medical technology and diffusion of six technologies factors influencing the effectiveness of mechanisms to control medical technology a view from outside heart transplantation in the Netherlands - a case study heart transplant operation in the UK - the decision-making context of an economic evaluation the introduction of the first lithotripter in France the process of diffusion of the lithottripter in the Federal Republic of Germany making decisions about medical technology - the need for information financial incentives to change behaviour towards health technology summary and conclusions.
Abstract: Exchange rates for EEC currencies. Part 1 Proceedings of the workshop: an overview of the systems and regulations concerning medical technology and diffusion of six technologies factors influencing the effectiveness of mechanisms to control medical technology a view from outside heart transplantation in the Netherlands - a case study heart transplantation in the UK - the decision-making context of an economic evaluation the introduction of the first lithotripter in France the process of diffusion of the lithotripter in the Federal Republic of Germany making decisions about medical technology - the need for information financial incentives to change behaviour towards health technology summary and conclusions. Part 2 Regulations concerning expensive health technology - country reports: medical technology in Belgium, Denmark, Ireland, France, the Federal Republic of Germany, Greece, Italy, Luxembourg, the Netherlands and the United Kingdom. Appendices: 1 - EEC workshop on regulatory mechanisms concerning expensive health technology, London 22-25 April 1986 - programme. 2 - EEC workshop on regulatory mechanisms - participants.
TL;DR: The epidemiologic basis for emphasis on healthy lifestyles as an important aspect of prevention is presented and the need to shift priorities from planning for medical care to epidemiologically oriented health planning is discussed in terms of the relative impact of preventive versus treatment services in improving the health of the population.
Abstract: The epidemiologic basis for emphasis on healthy lifestyles as an important aspect of prevention is presented. Experience in changing lifestyles in the United States is reviewed in terms of health education, regulation, taxation, and resources. The need to shift priorities from planning for medical care to epidemiologically oriented health planning is discussed in terms of the relative impact of preventive versus treatment services in improving the health of the population.
TL;DR: Between 1976 and 1983 a brutal military dictatorship governed Argentina and the method of forced disappearances of approximately 30,000 political dissidents was instituted, in this process, about 300 babies and children of the disappeared victims were also abducted by the military and given to childless families linked to the security forces.
Abstract: Between 1976 and 1983 a brutal military dictatorship governed Argentina. The most basic human rights were severely violated and the method of forced disappearances of approximately 30,000 political dissidents was instituted. In this process, about 300 babies and children of the disappeared victims were also abducted by the military and given to childless families linked to the security forces. Women whose children and grandchildren had disappeared organized themselves as Grandmothers of Plaza de Mayo to search for their missing loved ones. This search was aided by human geneticists from different parts of the world who provided the scientific basis to establish the genetic identification through "grandpaternity testing," and by mental health professionals who provided the psychological theory supporting restitution of appropriated children to their legitimate families. Thus far, close to 50 children have been located, identified and restituted.
TL;DR: Examination of the health policy and politics curricula of the 24 accredited schools of public health in the U.S. finds that most public health students are not exposed to these areas during their graduate coursework, including linkages with prevention activities.
Abstract: Because most public health endeavors in the United States are funded by the public sector, public health practitioners need to be adept at working within the political system. However, the 1988 Institute of Medicine report, The Future of Public Health, found that many public health professionals are ignorant or disdainful of political processes and will not participate in activities that they perceive to be political. Our study examined the health policy and politics curricula of the 24 accredited schools of public health in the U.S., finding that most public health students are not exposed to these areas during their graduate coursework. Moreover, those students who do take health policy and politics courses study these areas within the context of health care delivery; the politics of public health and prevention are ignored by most schools of public health. Recommendations for improving public health curricula in health policy and politics are presented, including linkages with prevention activities.
TL;DR: This paper presents the first comparable comprehensive cost estimates for crashes and crime and applies them to crash and crime incidence data for Michigan to generate dollar losses for the state.
Abstract: Traffic crashes and crime both impose significant economic and social burdens through injury and loss of life, as well as property damage and loss. Efforts to reduce crashes and crime often result in competing demands on limited public resources. Comparable and up-to-date cost data on crashes and crime contribute to informed decisions about allocation of these resources in important ways. As a first step, cost data provide information about the magnitude of the problems of crashes and crime by allowing us to estimate associated dollar losses to society. More importantly, cost data on crashes and crime are essential to evaluating costs and benefits of various policy alternatives that compete for resources. This paper presents the first comparable comprehensive cost estimates for crashes and crime and applies them to crash and crime incidence data for Michigan to generate dollar losses for the state. An example illustrates how cost estimates can be used to evaluate costs and benefits of crash-reduction and crime-reduction policies in making resource allocation decisions. Traffic crash and selected index crime incidence data from the calendar year 1988 were obtained from the Michigan State Police. Costs for crashes and index crimes were generated and applied to incidence data to estimate dollar losses from crashes and index crimes for the state of Michigan. In 1988, index crimes in Michigan resulted in $0.8 billion in monetary costs and $2.4 billion in total monetary and nonmonetary quality-of-life costs (using the willingness-to-pay approach). Traffic crashes in Michigan resulted in $2.3 billion in monetary costs and $7.1 billion in total monetary and nonmonetary quality-of-life costs, nearly three times the costs of index crimes. Based on dollar losses to the state, the magnitude of the problem of traffic crashes clearly exceeded that of index crimes in Michigan in 1988. From a policy perspective, summing the total dollar losses from crashes or crime is of less importance than understanding the costs and benefits of various policy alternatives. This paper therefore concludes with an example of how our cost estimates can be used to compare the costs and benefits of competing policies.
TL;DR: The development of mistrust of the government from the nuclear power industry and the citizens near Three Mile Island regarding the 1979 disaster at the plant is documented.
Abstract: Goldsteen and Schorr document the development of mistrust of the government from the nuclear power industry and the citizens near Three Mile Island regarding the 1979 disaster at the plant. (Environmental Studies)
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TL;DR: This paper tries to set the current changes in the British National Health Service in historical perspective, aiming to bring about an “internal market,” regulated by contract between “purchasers” and “providers.”
Abstract: This paper tries to set the current changes in the British National Health Service in historical perspective. The NHS was born in 1948 amid controversy, both political and professional; but in the 50s and 60s a consensus was reached which won it the support of patients and doctors. But in the 70s and 80s it has undergone the stress of successive reorganizations, in the attempt to meet the economic strains imposed by an ageing population and expensive medical advances. The present changes aim to bring about an “internal market,” regulated by contract between “purchasers” and “providers.” Reasons are given for the view that this artificial arrangement will impair the coherence of the NHS, will add administrative expense and complexity, and will impair the important role of general practitioners as “gate-keepers.“