scispace - formally typeset
Search or ask a question

Showing papers in "Preventing Chronic Disease in 2004"


Journal Article
TL;DR: Examination of barriers and facilitators to physical activity and exercise among underserved, ethnically diverse older adults suggested strategies for culture-specific programming of community-based physical activity programs.
Abstract: Introduction Increasing physical activity is a goal of Healthy People 2010. Although the health benefits of physical activity are documented, older adults are less physically active than any other age group. The purpose of this study was to examine barriers and facilitators to physical activity and exercise among underserved, ethnically diverse older adults. Methods Seventy-one older adults were recruited through community agencies to participate in seven ethnic-specific focus groups: American Indian/Alaska Native, African American, Filipino, Chinese, Latino, Korean, and Vietnamese. Groups were conducted in the participants' primary language and ranged in size from 7-13 participants. Mean age was 71.6 years (range from 52 to 85 years; SD +/- 7.39). Professional translators transcribed audiotapes into the language of the group and then translated the transcript into English. Transcripts were systematically reviewed using content analysis. Results Suggested features of physical activity programs to enhance participation among ethnically diverse minority older adults included fostering relationships among participants; providing culture-specific exercise; offering programs at residential sites; partnering with and offering classes prior to or after social service programs; educating families about the importance of physical activity for older adults and ways they could help; offering low- or no-cost classes; and involving older adults in program development. Walking was the exercise of choice across all ethnic groups. Health served as both a motivator and a barrier to physical activity. Other factors influencing physical activity were weather, transportation, and personal safety. Conclusion Findings from this study suggest strategies for culture-specific programming of community-based physical activity programs.

366 citations


Journal Article
TL;DR: A review of population-based interventions targeting communities of color or including sufficient samples to permit ethnic-specific analyses is presented in this paper, where the authors identify socio-cultural, political, economic, and physical environmental factors.
Abstract: Introduction The U.S. obesity epidemic is escalating, particularly among communities of color. Obesity control efforts have shifted away from individual-level approaches toward population-based approaches that address socio-cultural, political, economic, and physical environmental factors. Few data exist for ethnic minority groups. This article reviews studies of population-based interventions targeting communities of color or including sufficient samples to permit ethnic-specific analyses.

190 citations


Journal ArticleDOI
TL;DR: The best data available speak more about how to engage and retain people of color in population-based interventions than how to create and sustain weight loss, regular engagement in physical activity, or improved diet.
Abstract: INTRODUCTION: The U.S. obesity epidemic is escalating, particularly among communities of color. Obesity control efforts have shifted away from individual-level approaches toward population-based approaches that address socio-cultural, political, economic, and physical environmental factors. Few data exist for ethnic minority groups. This article reviews studies of population-based interventions targeting communities of color or including sufficient samples to permit ethnic-specific analyses. METHODS: Inclusion criteria were established, an electronic database search conducted, and non-electronically catalogued studies retrieved. Findings were aggregated for earlier (early 1970s to early 1990s) and later (mid-1990s to present) interventions. RESULTS: The search yielded 23 ethnically inclusive intervention studies published between January 1970 and May 2003. Several characteristics of inclusive interventions were consistent with characteristics of community-level interventions among predominantly white European-American samples: use of non-interpersonal channels for information dissemination directed at broad spheres of influence (e.g., mass media), promotion of physical activity, and incorporation of social marketing principles. Ethnically inclusive studies, however, also placed greater emphasis on involving communities and building coalitions from study inception; targeting captive audiences; mobilizing social networks; and tailoring culturally specific messages and messengers. Inclusive studies also focused more on community than individual norms. Later studies used "upstream" approaches more than earlier studies. Fewer than half of the inclusive studies presented outcome evaluation data. Statistically significant effects were few and modest, but several studies demonstrated better outcomes among ethnic minority than white participants sampled. CONCLUSION: The best data available speak more about how to engage and retain people of color in these interventions than about how to create and sustain weight loss, regular engagement in physical activity, or improved diet. Advocacy should be directed at increasing the visibility and budget priority of interventions, particularly at the state and local levels.

176 citations


Journal Article
TL;DR: The challenge of involving the community is especially difficult if one has been trained, as the "expert," to be an arrogant, elitist prima donna.
Abstract: While we in public health know the importance of involving community partners in our programs, we also know how difficult it is to do. The challenge of involving the community is especially difficult if one has been trained, as I have been trained, to be an arrogant, elitist prima donna. I am the \"expert,\" after all, and I help people by sharing my expertise.

174 citations


Journal Article
TL;DR: This paper describes how the social marketing principles of product, price, place, and promotion were applied to formulate the strategies and tactics of the VERB campaign, and it provides examples of the multimedia materials that were created.
Abstract: The VERB campaign is a multiethnic media campaign with a goal to increase and maintain physical activity among tweens, or children aged nine to 13 years. Parents, especially mothers aged 29 to 46, and other sources of influence on tweens (e.g., teachers, youth program leaders) are the secondary audiences of the VERB initiative. VERB applies sophisticated commercial marketing techniques to address the public health problem of sedentary lifestyles of American children, using the social marketing principles of product, price, place, and promotion. In this paper, we describe how these four principles were applied to formulate the strategies and tactics of the VERB campaign, and we provide examples of the multimedia materials (e.g., posters, print advertising, television, radio spots) that were created.

168 citations


Journal Article
TL;DR: Almost half of the population the authors studied will have difficulty interpreting written medical materials, even in Spanish, which means programs and service providers need to be aware that the women most in need of information about screening may be more likely to be unable to read any written materials provided to them, regardless of the language or level of simplicity of the materials.
Abstract: Objective The objective of this study was to examine the association between inadequate functional health literacy in Spanish among low-income Latinas aged 40 and older and cervical cancer screening knowledge and behavior.

142 citations


Journal Article
TL;DR: Hispanic and non-Hispanic white arthritis patients used CAM to supplement conventional treatments, and current CAM use was significantly associated with being female, being under 55 years of age, and having some college education.
Abstract: Introduction Use of complementary and alternative medicine (CAM) for chronic conditions has increased in recent years. There is little information, however, on CAM use among adults with clinic-confirmed diagnoses, including arthritis, who are treated by primary care physicians. Methods To assess the frequency and types of CAM therapy used by Hispanic and non-Hispanic white women and men with osteoarthritis, rheumatoid arthritis, or fibromyalgia, we used stratified random selection to identify 612 participants aged 18-84 years and seen in university-based primary care clinics. Respondents completed an interviewer-administered survey in English or Spanish. Results Nearly half (44.6%) of the study population was of Hispanic ethnicity, 71.4% were women, and 65.0% had annual incomes of less than 25,000 dollars. Most (90.2%) had ever used CAM for arthritis, and 69.2% were using CAM at the time of the interview. Current use was highest for oral supplements (mainly glucosamine and chondroitin) (34.1%), mind-body therapies (29.0%), and herbal topical ointments (25.1%). Fewer participants made current use of vitamins and minerals (16.6%), herbs taken orally (13.6%), a CAM therapist (12.7%), CAM movement therapies (10.6%), special diets (10.1%), or copper jewelry or magnets (9.2%). Those with fibromyalgia currently used an average of 3.9 CAM therapies versus 2.4 for those with rheumatoid arthritis and 2.1 for those with osteoarthritis. Current CAM use was significantly associated with being female, being under 55 years of age, and having some college education. Conclusion Hispanic and non-Hispanic white arthritis patients used CAM to supplement conventional treatments. Health care providers should be aware of the high use of CAM and incorporate questions about its use into routine assessments and treatment planning.

130 citations


Journal Article
TL;DR: Use of the Internet for health information by chronically ill patients is moderate, and a sizable minority of respondents — particularly individuals with diabetes — reported that the Internet helped them to manage their condition themselves.
Abstract: Introduction Chronic conditions are among the leading causes of death and disability in the United States. The Internet is a source of health information and advice for individuals with chronic conditions and shows promise for helping individuals manage their conditions and improve their quality of life. Methods We assessed Internet use for health information by people who had one or more of five common chronic conditions. We conducted a national survey of adults aged 21 and older, then analyzed data from 1980 respondents who had Internet access and who reported that they had hypertension, diabetes, cancer, heart problems, and/or depression. Results Adjusted rates for any Internet use for health information ranged from 33.8% (heart problems only) to 52.0% (diabetes only). A sizable minority of respondents - particularly individuals with diabetes - reported that the Internet helped them to manage their condition themselves, and 7.9% said information on the Internet led them to seek care from a different doctor. Conclusion Use of the Internet for health information by chronically ill patients is moderate. Self-reported effects on choice of treatment or provider are small but noteworthy.

117 citations


Journal Article
TL;DR: The difference between the mean servings in the seniors who received the baskets compared to the controls was 1.31 (95% CI, 0.68-1.95, P <.001) as discussed by the authors.
Abstract: Seniors who received the baskets reported consuming an increase of 1.04 servings of fruits and vegetables. The difference between the mean servings in the seniors who received the baskets compared to the controls was 1.31 (95% CI, 0.68-1.95, P < .001). At baseline, 22% of the basket recipients were consuming 5 or more servings of fruits and vegetables per day, but by the end of the season, 39% reported consuming 5 or more per day. Conclusion

85 citations


Journal Article
TL;DR: In this article, the authors examined barriers and facilitators to physical activity and exercise among underserved, ethnically diverse older adults and found that older adults are less physically active than any other age group.
Abstract: Introduction Increasing physical activity is a goal of Healthy People 2010. Although the health benefits of physical activity are documented, older adults are less physically active than any other age group. The purpose of this study was to examine barriers and facilitators to physical activity and exercise among underserved, ethnically diverse older adults.

68 citations


Journal Article
TL;DR: The VERB campaign uses a logic model as a tool to share information, to facilitate program planning, and to provide direction for evaluation to help hypothesize how behavior change might occur.
Abstract: The VERB campaign uses a logic model as a tool to share information, to facilitate program planning, and to provide direction for evaluation. Behavior change and communication theories are incorporated to help hypothesize how behavior change might occur. Evaluation of the campaign follows the process of the logic model. The elements of the logic model are described and further explanation “pops up” as the reader rolls over the graphic of the logic model.

Journal Article
TL;DR: Results suggest that frequent communication among network partners is related to more highly productive relationships, and highlight the importance of lead agencies and statewide coalitions in implementing a comprehensive state tobacco control program.
Abstract: INTRODUCTION State tobacco control programs are implemented by networks of public and private agencies with a common goal to reduce tobacco use. The degree of a program's comprehensiveness depends on the scope of its activities and the variety of agencies involved in the network. Structural aspects of these networks could help describe the process of implementing a state's tobacco control program, but have not yet been examined. METHODS Social network analysis was used to examine the structure of five state tobacco control networks. Semi-structured interviews with key agencies collected quantitative and qualitative data on frequency of contact among network partners, money flow, relationship productivity, level of network effectiveness, and methods for improvement. RESULTS Most states had hierarchical communication structures in which partner agencies had frequent contact with one or two central agencies. Lead agencies had the highest control over network communication. Networks with denser communication structures had denser productivity structures. Lead agencies had the highest financial influence within the networks, while statewide coalitions were financially influenced by others. Lead agencies had highly productive relationships with others, while agencies with narrow roles had fewer productive relationships. Statewide coalitions that received Robert Wood Johnson Foundation funding had more highly productive relationships than coalitions that did not receive the funding. CONCLUSION Results suggest that frequent communication among network partners is related to more highly productive relationships. Results also highlight the importance of lead agencies and statewide coalitions in implementing a comprehensive state tobacco control program. Network analysis could be useful in developing process indicators for state tobacco control programs.

Journal Article
TL;DR: A community trail may be an important vehicle for promoting physically active lifestyles, however, new exercisers must overcome issues of proximal and safe access from residential areas in addition to other safety concerns to achieve regular physical activity.
Abstract: Introduction We evaluated physical activity patterns and trail use among new and habitually active exercisers using onsite trail interviews.

Journal Article
TL;DR: This inexpensive program, delivered entirely by e-mail, to reduce dietary fat and increase fruit and vegetable intake is feasible and appears to be effective.
Abstract: Author(s): Block, Gladys; Block, Torin; Wakimoto, Patricia; Block, Clifford H | Abstract: IntroductionDietary fat and low fruit and vegetable intake are linked to many chronic diseases, and U.S. population intake does not meet recommendations. Interventions are needed that incorporate effective behavior-change principles and that can be delivered inexpensively to large segments of the population.MethodsEmployees at a corporate worksite were invited to participate in a program, delivered entirely by e-mail, to reduce dietary fat and increase fruit and vegetable intake. Behavior-change principles underlying the intervention included tailoring to the participant's dietary lifestyle, baseline assessment and feedback about dietary intake, family participation, and goal setting. Assessment, tailoring, and delivery was fully automated. The program was delivered weekly to participants' e-mail inboxes for 12 weeks. Each e-mail included information on nutrition or on the relationship between diet and health, dietary tips tailored to the individual, and small goals to try for the next week. In this nonrandomized pilot study, we assessed technical feasibility, acceptability to employees, improvement in Stage of Change, increase in fruit and vegetable consumption, and decrease in fat intake.ResultsApproximately one third (n = 84) of employees who were offered the 12-week program signed up for it, and satisfaction was high. There was significant improvement in Stage of Change: 74% of those not already at the top had forward movement (P l .001). In addition, results suggest significant increase in fruit and vegetable consumption (0.73 times/day, P l .001) and significant decrease in intake of fat sources (-0.39 times/day, P l .001).ConclusionThis inexpensive program is feasible and appears to be effective. A randomized controlled trial is needed.

Journal Article
TL;DR: In this paper, the authors examined the self-reported breast and cervical cancer screening practices of women in the United States by using data from the 1999 Behavioral Risk Factor Surveillance System (RBFS).
Abstract: Background Several preventive practices that reduce chronic disease risk have been associated with breast and cervical cancer screening, including maintenance of normal weight and avoidance of cigarette smoking. A history of certain chronic illnesses such as diabetes and cardiovascular disease has also been related to cancer screening. Nevertheless, studies that have attempted to identify women who are less likely to have had a recent breast or cervical cancer screening test have infrequently examined the associations of breast and cervical cancer screening with multiple health factors that influence chronic disease risk. Methods To clarify relationships between cancer screening and health behaviors and other factors that influence chronic disease risk, we examined the self-reported breast and cervical cancer screening practices of women in the United States by using data from the 1999 Behavioral Risk Factor Surveillance System. The women were described according to their recent use of mammography and the Papanicolaou test, physician visits within the past year, health insurance coverage, and preventive practices that reduce chronic disease risk. Results Overall, 74.5% (95% CI, 73.9%-75.1%) of the women in this sample aged 40 years or older (n = 56,528) had received a mammogram within the past 2 years. The percentage of women who had been screened for breast cancer, however, varied widely by factors associated with reducing the risk of chronic disease (e.g., cholesterol check in the past 2 years, blood pressure check in the past 2 years, normal weight, avoidance of cigarette smoking) and having access to health care (e.g., health insurance coverage, recent physician visit). Similarly, 84.4% (95% CI, 83.9%-84.9%) of all women aged 18 years or older who had not undergone a hysterectomy (n = 69,113) had received a Papanicolaou test in the past 3 years, and factors associated with reduced chronic disease risk and health care access were related to having had a recent Papanicolaou test. Conclusion The results of this study suggest that underscreened women who are at risk for breast and cervical cancer are likely to benefit from programs that identify and address coexisting prevention needs. The identification of coexisting prevention needs might assist in developing interventions that address multiple risks for chronic disease among women and might subsequently help improve the efficiency and effectiveness of prevention programs.

Journal Article
TL;DR: In an effort to expand the range of effective public health interventions, the Centers for Disease Control and Prevention will work with its partners to explore the development of systematic legal frameworks as a tool for preventing chronic diseases and addressing the growing epidemic of obesity, heart disease, stroke, and other chronic diseases.
Abstract: Law, which is a fundamental element of effective public health policy and practice, played a crucial role in many of public health's greatest achievements of the 20th century. Still, conceptual legal frameworks for the systematic application of law to chronic disease prevention and control have not been fully recognized and used to address public health needs. Development and implementation of legal frameworks could broaden the range of effective public health strategies and provide valuable tools for the public health workforce, especially for state and local health department program managers and state and national policy makers. In an effort to expand the range of effective public health interventions, the Centers for Disease Control and Prevention will work with its partners to explore the development of systematic legal frameworks as a tool for preventing chronic diseases and addressing the growing epidemic of obesity, heart disease, stroke, and other chronic diseases and their risk factors.

Journal Article
TL;DR: The Little by Little CD-ROM may be useful in public health and clinical situations to increase fruit and vegetable intake in low-income women.
Abstract: Introduction Research indicates that low fruit and vegetable intake is a risk factor for many chronic diseases. Despite large-scale education campaigns, the great majority of Americans do not consume recommended levels. We tested the ability of a single brief interactive experience of the Little by Little CD-ROM to increase fruit and vegetable intake in low-income women.

Journal Article
TL;DR: The most recent survey of tobacco control practices and policies in health plans was conducted by America's Health Insurance Plans' technical assistance office as part of the Addressing Tobacco in Managed Care (ATMC) program as discussed by the authors.
Abstract: Introduction In the United States, tobacco use is the leading preventable cause of death and disease. The health and cost consequences of tobacco dependence have made treatment and prevention of tobacco use a key priority among multiple stakeholders, including health plans, insurers, providers, employers, and policymakers. In 2002, the third survey of tobacco control practices and policies in health plans was conducted by America's Health Insurance Plans' technical assistance office as part of the Addressing Tobacco in Managed Care (ATMC) program. Methods The ATMC survey was conducted in the spring of 2002 via mail, e-mail, and fax. A 19-item survey instrument was developed and pilot-tested. Of the 19 items, 12 were the same as in previous years, four were modified to collect more detailed data on areas of key interest, and three were added to gain information about strategies to promote smoking cessation. The sample for the survey was drawn from the 687 plans listed in the national directory of member and nonmember health plans in America's Health Insurance Plans. Results Of the 246 plans in the sample, 152 plans (62%) representing more than 43.5 million health maintenance organization members completed the survey. Results show that health plans are using evidence-based programs and clinical guidelines to address tobacco use. Compared to ATMC survey data collected in 1997 and 2000, the 2002 ATMC survey results indicate that more health plans are providing full coverage for first-line pharmacotherapies and telephone counseling for smoking cessation. Plans have also shown improvement in their ability to identify at least some members who smoke. Similarly, a greater percentage of plans are employing strategies to address smoking cessation during the postpartum period to prevent smoking relapse and during pediatric visits to reduce or eliminate children's exposure to environmental tobacco smoke. Conclusion The results of the 2002 ATMC survey reflect both tremendous accomplishments and important opportunities for health plans to collaborate in tobacco control efforts. With appropriate support, analytical tools, and resources, it is likely that health plans, clinicians, providers, and consumers will continue to evolve in their efforts to reduce the negative consequences of tobacco use.

Journal Article
TL;DR: The Cancer Prevention and Control Research Network's research work groups include projects to increase screening for breast, cervical, and colorectal cancers; to promote informed decision making for prostate cancer screening; and to validate educational materials developed for low-literacy populations.
Abstract: The Cancer Prevention and Control Research Network is a national network recently established to focus on developing new interventions and disseminating and translating proven interventions into practice to reduce cancer burden and disparities, especially among minority and medically underserved populations. Jointly funded by the Centers for Disease Control and Prevention and the National Cancer Institute, the Cancer Prevention and Control Research Network consists of sites administered through Prevention Research Centers funded by the Centers for Disease Control and Prevention. The five sites are located in Kentucky, Massachusetts, South Carolina, Texas, Washington State, and West Virginia. The Cancer Prevention and Control Research Network's intervention areas include primary prevention of cancer through healthy eating, physical activity, sun avoidance, tobacco control, and early detection of cancer through screening. The Cancer Prevention and Control Research Network uses the methods of community-based participatory research and seeks to build on the cancer-relevant sys- tematic reviews of the Guide to Community Preventive Services. Initial foci for the Cancer Prevention and Control Research Network's research work groups include projects to increase screening for breast, cervical, and colorectal cancers; to promote informed decision making for prostate cancer screening; and to validate educational materials developed for low-literacy populations.

Journal Article
TL;DR: In this paper, the authors evaluated physical activity patterns and trail use among new and habitually active exercisers using onsite trail interviews and found that new exercisers were more dependent on the trails as a primary outlet for physical activity than were habitually-active exercisers.
Abstract: INTRODUCTION We evaluated physical activity patterns and trail use among new and habitually active exercisers using onsite trail interviews. METHODS Using a cross-sectional study design, 414 adults who accessed two new trails that bisect a rural community of 26,809 residents were interviewed during the first summer of the trails' official operation (2001). The trails comprise 12 miles of level and paved surface and run parallel to adjacent water sheds, businesses, and neighborhoods. Recent trail activity patterns were obtained, including the following: frequency of use, mode of activity, duration, distance traveled on trail, access points, time of day used, use of exercise companions, and distance traveled to get to trail. Perceived enablers and barriers related to trail use were also obtained. Data were compared between newly adopted exercisers (new exercisers) and individuals active prior to development of the trails (habitually active exercisers). RESULTS Twenty-three percent of the trail users were new exercisers. New exercisers were more dependent on the trails as a primary outlet for physical activity than were habitually active exercisers (P < .001). New exercisers traveled shorter distances to access the trails and rated convenience as a primary reason for using them. Both safety and terrain issues emerged as enablers for trail use, and unsafe conditions emerged as a concern among new exercisers. CONCLUSION A community trail may be an important vehicle for promoting physically active lifestyles. However, new exercisers must overcome issues of proximal and safe access from residential areas in addition to other safety concerns to achieve regular physical activity.

Journal Article
TL;DR: Information is shared about data-related issues that were encountered when using GIS to validate responses to a questionnaire about environmental supports for physical activity.
Abstract: The use of a geographic information system (GIS) to study environmental supports for physical activity raises several issues, including acquisition and development, quality, and analysis. We recommend to public health professionals interested in using GIS that they investigate available data, plan for data development where none exists, ensure the availability of trained personnel and sufficient time, and consider issues such as data quality, analyses, and confidentiality. This article shares information about data-related issues that we encountered when using GIS to validate responses to a questionnaire about environmental supports for physical activity.

Journal Article
TL;DR: American Indian women presented a fatalistic view of diabetes, regarding the disease as an inevitable event that destroys health and ultimately results in death.
Abstract: INTRODUCTION The prevalence of diabetes is disproportionately higher among minority populations, especially American Indians Prevention or delay of diabetes in this population would improve quality of life and reduce health care costs Identifying cultural definitions of health and diabetes is critically important to developing effective diabetes prevention programs METHODS In-home qualitative interviews were conducted with 79 American Indian women from 3 tribal clinics in northeast Oklahoma to identify a cultural definition of health and diabetes Grounded theory was used to analyze verbatim transcripts RESULTS The women interviewed defined health in terms of physical functionality and absence of disease, with family members and friends serving as treatment promoters Conversely, the women considered their overall health to be a personal issue addressed individually without burdening others The women presented a fatalistic view of diabetes, regarding the disease as an inevitable event that destroys health and ultimately results in death CONCLUSION Further understanding of the perceptions of health in at-risk populations will aid in developing diabetes prevention programs

Journal Article
TL;DR: In this article, the authors surveyed 197 small manufacturing worksites prior to an effort to recruit their workforces into a randomized clinical trial designed to test the effectiveness of a cancer prevention intervention among multiethnic, low-wage manufacturing workers.
Abstract: INTRODUCTION Worksites, including those that employ multiethnic, low-wage workforces, represent a strategic venue for reaching populations at risk for developing cancer. METHODS We surveyed 197 small manufacturing worksites prior to an effort to recruit their workforces into a randomized clinical trial designed to test the effectiveness of a cancer prevention intervention among multiethnic, low-wage manufacturing workers. This paper assesses the external validity of the trial based on three factors: the percentage of potential trial sites excluded from consideration, the percentage of eligible worksites that adopted the trial, and worksite characteristics associated with adoption. RESULTS We found no statistically significant differences between worksites that adopted the trial and worksites that declined the trial with regard to employee demographics, anticipated changes in workforce size, and perceived importance and history of offering health promotion and occupational health and safety activities. CONCLUSION Small manufacturing worksites present a viable venue for reaching multiethnic, low-wage populations with cancer prevention programs, although program adoption rates may be low in this sector. Worksites that adopted the trial are likely to represent worksites deemed eligible for the trial.

Journal Article
TL;DR: Home-delivered baskets of fresh fruits and vegetables brought participants joy, stimulated interest in healthy foods, and improved quality of life, and the program newsletter supported consumption of fresh produce.
Abstract: Introduction The Seattle Senior Farmers' Market Nutrition Pilot Program delivered fresh fruits and vegetables to homebound seniors in King County, Washington, from June through October 2001. A primary objective of the program was to increase participants' intake of fruits and vegetables. A qualitative study was conducted to examine the impact of the program on participating homebound seniors.

Journal Article
TL;DR: In this article, the disparity in asthma hospitalization by gender, age, and race/ethnicity is attributed to a combination of disease severity and inadequate health care, and it is found that hospitalization data that fail to differentiate between numbers of admissions and numbers of individuals limit the ability to derive accurate conclusions about disparities and risks.
Abstract: Introduction Disparities in asthma hospitalization by gender, age, and race/ethnicity are thought to be driven by a combination of 2 factors: disease severity and inadequate health care. Hospitalization data that fail to differentiate between numbers of admissions and numbers of individuals limit the ability to derive accurate conclusions about disparities and risks.

Journal Article
TL;DR: Decomposition of ratios of total hospitalizations to population illuminates components of risk and suggests specific causes of disparity in asthma hospitalization by gender, age, and race/ ethnicity.
Abstract: INTRODUCTION Disparities in asthma hospitalization by gender, age, and race/ethnicity are thought to be driven by a combination of 2 factors: disease severity and inadequate health care. Hospitalization data that fail to differentiate between numbers of admissions and numbers of individuals limit the ability to derive accurate conclusions about disparities and risks. METHODS Hospitalization records for pediatric asthma patients (aged one to 14 years) were extracted from New Jersey Hospital Discharge Files (for the years 1994 through 2000) and then linked by patient identifiers using a probabilistic matching algorithm. The analysis file contained 30,400 hospital admissions for 21,016 children. Hospitalization statistics were decomposed into persons hospitalized and number of hospitalizations. Analysis of readmission within 180 days of discharge used additional records from 2001 to avoid bias due to truncated observation. RESULTS Overall, 22.9% of children in our analysis had repeat asthma admissions within the same age interval, accounting for 30.9% of all hospitalizations. Also among all children, 11.7% had at least one readmission within 180 days of a prior discharge. The risk of hospitalization was higher for boys, decreased by age for both genders, was lowest for white children and highest for black children. Readmission rates were higher for black and Hispanic girls than boys in older age groups, but were otherwise relatively uniform by gender and age. CONCLUSION Decomposition of ratios of total hospitalizations to population illuminates components of risk and suggests specific causes of disparity.

Journal Article
David L. Katz1
TL;DR: To do this well, academic researchers and people like you — who know and care about a community — have the potential to become a new kind of whole greater than the sum of its parts.
Abstract: As someone who cares about your community, you may see no particular reason to care about community-based research. Why not simply address what you know is important? Where does research come in? Gertrude Stein is quoted as saying, "A difference to be a difference must make a difference." Often, the very best intentions and noblest of actions fail to make a difference. Or, perhaps worse, actions do make a difference, but the difference is not measured and is overlooked. Investigators are good at measuring things, and every public health researcher receives formal training in robust evaluation methods. But researchers outside a community often lack the insights, the relationships, and the trust needed to make meaningful and lasting changes within the community. Here, then, is our shared dilemma — and our shared challenge. Community leaders may be able to make differences they don't know how to measure. And academic researchers may know how to measure differences they don't know how to make! Each of us without the other is like the proverbial sound of one hand clapping. Community-based participatory research, or CBPR, is a dedicated effort to measure the differences our actions make. To do this well, academic researchers and people like you — who know and care about a community — have the potential to become a new kind of whole greater than the sum of its parts. For that relationship to be successful, CBPR must include well-planned partnerships between community advocates and researchers. So, how can community advocates identify researchers who are genuinely interested in working with the community to make real differences? Look for these clues:

Journal Article
TL;DR: Patients who had high initial clinical indicators including blood pressure and hemoglobin A1c and those who smoked currently or smoked in the past were more likely to drop out of the diabetes program.
Abstract: INTRODUCTION The objective of this study was to determine the demographic, treatment, clinical, and behavioral factors associated with dropping out of a nurse-based, low-income, multiethnic San Diego diabetes program. METHODS Data were collected during a 17-month period in 2000 and 2002 on patients with type 2 diabetes from Project Dulce, a disease management program in San Diego County designed to care for an underserved diabetic population. The study sample included 69 cases and 504 controls representing a racial/ethnic mix of 53% Hispanic, 7% black, 16% Asian, 22% white, and 2% other. Logistic regression was used to determine factors associated with patient dropout. RESULTS Patients who had high initial clinical indicators including blood pressure and hemoglobin A1c and those who smoked currently or smoked in the past were more likely to drop out of the diabetes program. CONCLUSION This study provides markers of patient dropout in a low-income, multiethnic, type 2 diabetic population. Reasons for dropout in this program can be investigated to prevent further cohort loss.

Journal Article
TL;DR: In this paper, the authors defined Internet and Web access issues for health researchers and grouped them into two categories: connectivity and human interface, and conceptualized access as a multicomponent issue that can either reduce or enhance public health utility of electronic communications.
Abstract: Much is written about Internet access, Web access, Web site accessibility, and access to online health information. The term access has, however, a variety of meanings to authors in different contexts when applied to the Internet, the Web, and interactive health communication. We have summarized those varied uses and definitions and consolidated them into a framework that defines Internet and Web access issues for health researchers. We group issues into two categories: connectivity and human interface. Our focus is to conceptualize access as a multicomponent issue that can either reduce or enhance the public health utility of electronic communications.

Journal Article
TL;DR: The mission of the Utah Cancer Action Network is to reduce cancer incidence and mortality in Utah and in its first year of operation, the network planned and implemented a cancer awareness campaign that was organized along two tracks: marketing research, consisting of two telephone surveys, and two advertising/awareness campaigns, one for colon cancer and one for skin cancer.
Abstract: The mission of the Utah Cancer Action Network is to reduce cancer incidence and mortality in Utah. Established in 2003, the network selected skin and colon cancers as the first priorities in its comprehensive plan. In its first year of operation, the network planned and implemented a cancer awareness campaign that was organized along two tracks: 1) marketing research, consisting of two telephone surveys, and 2) two advertising/awareness campaigns, one for colon cancer and one for skin cancer. The first telephone survey was conducted in January 2003 to obtain a baseline measurement of the Utah population's knowledge, attitudes, and behaviors. The advertising campaigns were launched in April 2003, and the second telephone survey was conducted in May. In January 2003, 18% of survey respondents reported seeing or hearing skin cancer prevention or sun protection announcements; in May, this percentage increased to 76%. In January, 36% indicated they had seen, read, or heard colorectal cancer early detection announcements; in May, this percentage increased to 79%.