Showing papers in "Public Health Reports in 2001"
TL;DR: In this paper, the authors review evidence that suggests that segregation is a primary cause of racial differences in socioeconomic status (SES) by determining access to education and employment opportunities, and conclude that effective efforts to eliminate racial disparities in health must seriously confront segregation and its pervasive consequences.
Abstract: Racial residential segregation is a fundamental cause of racial disparities in health. The physical separation of the races by enforced residence in certain areas is an institutional mechanism of racism that was designed to protect whites from social interaction with blacks. Despite the absence of supportive legal statutes, the degree of residential segregation remains extremely high for most African Americans in the United States. The authors review evidence that suggests that segregation is a primary cause of racial differences in socioeconomic status (SES) by determining access to education and employment opportunities. SES in turn remains a fundamental cause of racial differences in health. Segregation also creates conditions inimical to health in the social and physical environment. The authors conclude that effective efforts to eliminate racial disparities in health must seriously confront segregation and its pervasive consequences.
2,027 citations
TL;DR: The compiled interview data and banked DNA of approximately 35 categories of birth defects will facilitate future research as new hypotheses and improved technologies emerge and enable scientists to study the epidemiology of some rare birth defects for the first time.
Abstract: The National Birth Defects Prevention Study was designed to identify infants with major birth defects and evaluate genetic and environmental factors associated with the occurrence of birth defects. The ongoing case-control study covers an annual birth population of 482,000 and includes cases identified from birth defect surveillance registries in eight states. Infants used as controls are randomly selected from birth certificates or birth hospital records. Mothers of case and control infants are interviewed and parents are asked to collect buccal cells from themselves and their infants for DNA testing. Information gathered from the interviews and the DNA specimens will be used to study independent genetic and environmental factors and gene-environment interactions for a broad range of birth defects. As of December 2000, 7,470 cases and 3,821 controls had been ascertained in the eight states. Interviews had been completed with 70% of the eligible case and control mothers, buccal cell collection had begun in all of the study sites, and researchers were developing analysis plans for the compiled data. This study is the largest and broadest collaborative effort ever conducted among the nation's leading birth defect researchers. The unprecedented statistical power that will result from this study will enable scientists to study the epidemiology of some rare birth defects for the first time. The compiled interview data and banked DNA of approximately 35 categories of birth defects will facilitate future research as new hypotheses and improved technologies emerge.
817 citations
TL;DR: The authors describe a venue-based application of time-space sampling (TSS) that addresses the challenges of accessing hard-to-reach populations and uses it in the ongoing Community Intervention Trial for Youth (CITY) project to generate a systematic sample of young men who have sex with men.
Abstract: Constructing scientifically sound samples of hard-to-reach populations, also known as hidden populations, is a challenge for many research projects. Traditional sample survey methods, such as random sampling from telephone or mailing lists, can yield low numbers of eligible respondents while non-probability sampling introduces unknown biases. The authors describe a venue-based application of time-space sampling (TSS) that addresses the challenges of accessing hard-to-reach populations. The method entails identifying days and times when the target population gathers at specific venues, constructing a sampling frame of venue, day-time units (VDTs), randomly selecting and visiting VDTs (the primary sampling units), and systematically intercepting and collecting information from consenting members of the target population. This allows researchers to construct a sample with known properties, make statistical inference to the larger population of venue visitors, and theorize about the introduction of biases that may limit generalization of results to the target population. The authors describe their use of TSS in the ongoing Community Intervention Trial for Youth (CITY) project to generate a systematic sample of young men who have sex with men. The project is an ongoing community level HIV prevention intervention trial funded by the Centers for Disease Control and Prevention. The TSS method is reproducible and can be adapted to hard-to-reach populations in other situations, environments, and cultures.
508 citations
TL;DR: Church-based interventions can significantly benefit the cardiovascular health of African American women, and intervention participants achieved clinically important improvements in cardiovascular disease risk profiles one year after program initiation, which did not occur in the self-help group.
Abstract: Objective.The authors tested the impact on cardiovascular risk profiles of African American women ages 40 years and older after one year of participation in one of three church-based nutrition and ...
425 citations
TL;DR: Directions for future research are recommended to address persistent questions regarding the function, structure, and significance of prenatal care in improving US perinatal outcomes.
Abstract: Despite the widespread use of prenatal care, the evidence for its effectiveness remains equivocal and its primary purpose and effects continue to be a subject of debate. To provide some perspective on why the effectiveness and organization of prenatal care continue to be debated, the authors (a) briefly review the history of the development of prenatal care in the US; (b) attempt to conceptually define prenatal care in terms of its utilization, content, and quality; and, (c) highlight some of the research controversies and challenges facing investigators and advocates who seek to establish the value of prenatal care. In addition, the authors recommend directions for future research to address persistent questions regarding the function, structure, and significance of prenatal care in improving US perinatal outcomes.
396 citations
TL;DR: Without fundamental changes in the ways medical and public health practitioners are trained, evaluated, and compensated for prevention-related activities, it is likely that simply reducing disparities in access to care and/or medical treatment will be insufficient.
Abstract: Objectives. Optimistic predictions for the Healthy People 2010 goals of eliminating racial/ethnic disparities in health have been made based on absolute improvements in life expectancy and mortality. This study sought to determine whether there is evidence of relative improvement (a more valid measure of inequality) in life expectancy and mortality, and whether such improvement, if demonstrated, predicts future success in eliminating disparities. Methods. Historical data from the National Center for Health Statistics and the Census Bureau were used to predict future trends in relative mortality and life expectancy, employing an Autoregressive Integrated Moving Average (ARIMA) model. Excess mortality and time lags in mortality and life expectancy for blacks relative to whites were also estimated. Results. Based on data for 1945 to 1999, forecasts for relative black:white ageadjusted, all-cause mortality and white:black life expectancy at birth showed trends toward increasing disparities. From 1979, when the Healthy People initiative began, to 1998, the black:white ratio of age-adjusted, gender specific mortality increased for all but one of nine causes of death that accounted for 83.4% of all US mortality in 1998. From 1980 to 1998, average numbers of excess deaths per day among American blacks relative to whites increased by 20%. American blacks experienced 4.3 to 4.5 million premature deaths relative to whites in 1940–1999. Conclusions. The rationale that underlies the optimistic Healthy People 2010 forecasts, that future success can be built on a foundation of past success, is not supported when relative measures of inequality are used. There has been no sustained decrease in blackwhite inequalities in age-adjusted mortality or life expectancy at birth at the national level since 1945. Without fundamental changes, most probably related to the ways medical and public health practitioners are trained, evaluated, and compensated for prevention- related activities, as well as further research on translating the findings of prevention studies into clinical practice, it is likely that simply reducing disparities in access to care and/or medical treatment will be insufficient. Millions of premature deaths will continue to occur among African Americans.
231 citations
TL;DR: The Safer Choices program was effective in reducing important risk behaviors for HIV, other STDs, and pregnancy and in enhancing most psychosocial determinants of such behavior.
Abstract: Objectives.This study evaluated the long-term effectiveness of Safer Choices, a theory-based, multi-component educational program designed to reduce sexual risk behaviors and increase protective behaviors in preventing HIV, other STDs, and pregnancy among high school students.Methods.The study used a randomized controlled trial involving 20 high schools in California and Texas. A cohort of 3869 ninth-grade students was tracked for 31 months from fall semester 1993 (baseline) to spring semester 1996 (31-month follow-up). Data were collected using self-report surveys administered by trained data collectors. Response rate at 31-month follow-up was 79%.Results.Safer Choices had its greatest effect on measures involving condom use. The program reduced the frequency of intercourse without a condom during the three months prior to the survey, reduced the number of sexual partners with whom students had intercourse without a condom, and increased use of condoms and other protection against pregnancy at last inter...
209 citations
TL;DR: The authors aimed to guide the use of two common socioeconomic indicators, education and income, in studies of racial/ethnic disparities in low birthweight, delayed prenatal care, unintended pregnancy, and breastfeeding intention.
Abstract: OBJECTIVE: Theoretical and empiric considerations raise concerns about how socioeconomic status/position (abbreviated here as SES) is often measured in health research. The authors aimed to guide the use of two common socioeconomic indicators, education and income, in studies of racial/ethnic disparities in low birthweight, delayed prenatal care, unintended pregnancy, and breastfeeding intention.
METHODS: Data from a statewide postpartum survey in California (N = 10,055) were linked to birth certificates. Overall and by race/ethnicity, the authors examined: (a) correlations among several measures of education and income; (b) associations between each SES measure and health indicator; and (c) racial/ethnic disparities in the health indicators "adjusting" for different SES measures.
RESULTS: Education-income correlations were moderate and varied by race/ethnicity. Racial/ethnic associations with the health indicators varied by SES measure, how SES was specified, and by health indicator.
CONCLUSIONS: Conclusions about the role of race/ethnicity could vary with how SES is measured. Education is not an acceptable proxy for income in studies of ethnically diverse populations of childbearing women. SES measures generally should be outcome- and population-specific, and chosen on explicit conceptual grounds; researchers should test multiple theoretically appropriate measures and consider how conclusions might vary with how SES is measured. Researchers should recognize the difficulty of measuring SES and interpret findings accordingly.
192 citations
180 citations
TL;DR: This commentary blends the findings of various studies, reviews, and guides with general principles and guidelines that have emerged from combined experience and observa tions in academic, foundation, federal, state, and local situations in the United States, Canada, Australia, and other countries.
Abstract: Address correspondence to Dr. Green, Office on Smoking and Health, CDC, 4770 Buford Hwy, MS K-50, Atlanta GA 30341-3717; tel. 770-488-5701; fax 770-488-5767; e-mail . WHAT HAVE SEVERAL DECADES OF HEALTH EDUCATION, PROMOTION, and engagement with community and academic partners taught us about community-based research in public health? We know that some lessons derive from specific studies,1,2 others from reviews of international research literature,3,4 and still others from guides that help practitioners apply their apparent lessons.5 This commentary blends the findings of these various studies, reviews, and guides with general principles and guidelines that have emerged from our combined experience and observa tions in academic, foundation, federal, state, and local situations in the United States, Canada, Australia, and other countries. Our comments center on community-based partnerships, coalitions, and infrastructure building, but we emphasize that horizontal commu nity coalitions and partnerships must be based on strong vertical rela tionships between local entities and their state and national counter parts or headquarter organizations. We assume that university-based researchers are often, but not necessarily or always, part of community based partnership. In order to answer our first question, we pose additional questions: Why is some partnering essential to community-based research? How much partnering is needed to facilitate the research, community planning, and execution of programs? What are the principles and components of good community partnerships, and how do they fit with the principles of participatory research and the particular demands of academic-community partnerships? What are some cautions for partnerships that become large coalitions? Finally, what lessons have the large community trials in chronic disease prevention taught us?
180 citations
TL;DR: A review of naturally occurring food- and waterborne outbreaks exposes this vulnerability and reaffirms that, depending on the site of contamination, a significant number of people could be infected or injured over a wide geographic area.
Abstract: Deliberate food and water contamination remains the easiest way to distribute biological or chemical agents for the purpose of terrorism, despite the national focus on dissemination of these agents as small-particle aerosols or volatile liquids. Moreover, biological terrorism as a result of sabotage of our food supply has already occurred in the United States. A review of naturally occurring food- and waterborne outbreaks exposes this vulnerability and reaffirms that, depending on the site of contamination, a significant number of people could be infected or injured over a wide geographic area. Major knowledge gaps exist with regard to the feasibility of current disinfection and inspection methods to protect our food and water against contamination by a number of biological and chemical agents. However, a global increase in food and water safety initiatives combined with enhanced disease surveillance and response activities are our best hope to prevent and respond quickly to food- and waterborne bioterrorism.
TL;DR: Preliminary evidence suggests that in-home telephone or video-based interventions do improve health-related outcomes for newly injured SCI patients.
Abstract: ObjectivesThe authors present preliminary results on health-related outcomes of a randomized trial of telehealth interventions designed to reduce the incidence of secondary conditions among people
TL;DR: Short-term non-injection drug use, particularly exclusive crack smoking, was associated with adolescent initiation of injection drug use and early prevention efforts targeting this high-risk group of younger drug users are warranted.
Abstract: E P I D E M I O L O G Y A N D D E T E R M I N A N T S C RYSTAL M. F ULLER , P H D A MELIA M. A RRIA , P H D R ICHARD G ARFEIN , P H D s s s D AV I D V L A H O V , P H D D ANIELLE C. O MPAD , MHS S TEFFANIE A. S TRATHDEE , P H D Factors Associated with Adolescent Initiation of Injection Drug Use Dr. Fuller is an Assistant Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. She is also an Investigator with the Center for Urban Epidemiologic Studies, New York Academy of Medicine. At the time of this study, she was Project Director, Collaborative Injection Drug Users Study (CIDUS-2), Baltimore site. Dr. Vlahov is Director, Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York. At the time of this study, Dr. Fuller also was a doctoral candidate, and Dr. Vlahov was a Professor, Infectious Disease Program, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (JHUBSPH), Baltimore; Dr. Vlahov was also principal investigator of CIDUS-2. Dr. Arria is Deputy Director, Center for Substance Abuse Research, University of Maryland, College Park. At the time of this study, Dr. Arria was also an Assistant Scientist with the Department of Mental Hygiene, JHUBSPH. Ms. Ompad and Dr. Strathdee are with the Infectious Disease Program, Department of Epidemiology, JHUBSPH. Ms. Ompad is a doctoral candidate, and Dr. Strathdee is an Associate Professor and serves as the current principal investigator of CIDUS-2. Dr. Garfein is a Project Officer, National Center for HIV, STD, and TB Prevention, Division of HIV/AIDS Prevention, CDC, Atlanta. S Y N O P S I S Objective. The purpose of this study was to evaluate the extent to which demographic, sexual, and non-injection drug use practices predict adoles- cent initiation of injection drug use. Methods. Street recruited injection drug users 15–30 years of age in Balti- more, Maryland, who initiated injection within five years of study enroll- ment, completed a questionnaire that included a year-by-year history regarding the five years prior to initiation of injection. Factors associated with initiation during adolescence (≤21 years of age) versus young adult- hood (>21) were determined using logistic regression. Results. Of 226 participants, most were female (61%) and African American (64%). Median age of participants was 25; median age at initiation of injec- tion was 23. Factors significantly associated with adolescent initiation in multivariate analysis included race other than African American, and prac- tices prior to initiating injection including condom use, lack of cocaine use, exclusive crack smoking just prior to initiation, and smoking marijuana. Ado- lescent initiates also had shorter durations of illicit drug use prior to initiat- ing injection. Conclusion. Short-term non-injection drug use, particularly exclusive crack smoking, was associated with adolescent initiation of injection drug use. Early prevention efforts targeting this high-risk group of younger drug users are warranted in order to delay or prevent onset of injection drug use. Address correspondence to: Dr. Fuller, Mailman School of Public Health, PH18-120, Columbia Univ., 622 W. 168th St., New York NY 10032; tel. 212- 305-6223; fax 212-305-9413; e-mail . PUBLIC HEALTH REPORTS • 2001 SUPPLEMENT 1 • VOLUME 116
TL;DR: The costs of farm injuries are on a par with the costs of hepatitis C, and an underappreciated contributor to the overall national burden of health and medical costs.
Abstract: OBJECTIVE: This study was conducted to estimate the costs of job-related injuries in agriculture in the United States for 1992. METHODS: The authors reviewed data from national surveys to assess the incidence of fatal and non-fatal farm injuries. Numerical adjustments were made for weaknesses in the most reliable data sets. For example, the Bureau of Labor Statistics (BLS) Annual Survey estimate of non-fatal injuries is adjusted upward by a factor of 4.7 to reflect the BLS undercount of farm injuries. To assess costs, the authors used the human capital method that allocates costs to direct categories such as medical expenses, as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Cost data were drawn from the Health Care Financing Administration and the National Council on Compensation Insurance. RESULTS: Eight hundred forty-one (841) deaths and 512,539 non-fatal injuries are estimated for 1992. The non-fatal injuries include 281,896 that led to at least one full day of work loss. Agricultural occupational injuries cost an estimated $4.57 billion (range $3.14 billion to $13.99 billion) in 1992. On a per person basis, farming contributes roughly 30% more than the national average to occupational injury costs. Direct costs are estimated to be $1.66 billion and indirect costs, $2.93 billion. CONCLUSIONS: The costs of farm injuries are on a par with the costs of hepatitis C. This high cost is in sharp contrast to the limited public attention and economic resources devoted to prevention and amelioration of farm injuries. Agricultural occupational injuries are an underappreciated contributor to the overall national burden of health and medical costs. Language: en
TL;DR: The authors identify underlying causes for the 12 most problematic variables in three multiethnic surveys and describe them in terms of ethnic differences in reliability, validity, and cognitive processes, and differences with regard to cultural appropriateness and translation problems.
Abstract: Objective.There has been insufficient research on the influence of ethno-cultural and language differences in public health surveys. Using data from three independent studies, the authors examine methods to assess data quality and to identify causes of problematic survey questions.Methods.Qualitative and quantitative methods were used in this exploratory study, including secondary analyses of data from three baseline surveys (conducted in English, Spanish, Cantonese, Mandarin, and Vietnamese). Collection of additional data included interviews with investigators and interviewers; observations of item development; focus groups; think-aloud interviews; a test-retest assessment survey; and a pilot test of alternatively worded questions.Results.The authors identify underlying causes for the 12 most problematic variables in three multiethnic surveys and describe them in terms of ethnic differences in reliability, validity, and cognitive processes (interpretation, memory retrieval, judgment formation, and respon...
TL;DR: Ecologic studies of the relationships among social factors and population health can measure attributes of the social context that may be relevant for population health, providing the basis for imputing macro-level relationships.
Abstract: Objective. This ecologic study examined the association of mortality with selectedsocioeconomic indicators of inequality and segregation among blacks and whitesyounger than age 65 in 267 US metropolitan areas. The primary aim of theanalysis was to operationalize the concept of institutional racism in public health.Methods. Socioeconomic indicators were drawn from Census and vital statis-tics data for 1989–1991 and included median household income; two measuresof income inequality; percentage of the population that was black; and ameasure of residential segregation.Results. Age-adjusted premature mortality was 81% higher in blacks than inwhites, and median household income was 40% lower. Income inequality, asmeasured by the Gini coefficient, was greater within the black population (0.45)than within the white population (0.40; p < 0.001). To confirm that the proxysocioeconomic variables were relevant markers of population health status,regression analysis was performed initially on data for the total population. Thesevariables were all independently and significantly related to premature mortality(p 20.01; R = 0.74). Income inequality for the total population was significantlycorrelated with premature mortality (r = 0.33). Black (r = 0.26) and white (r = 0.20)population-specific correlations between income inequality and prematuremortality, while still significant, were smaller. Residential segregation was signifi-cantly related to premature mortality and income inequality for blacks (r = 0.38 forboth); among whites, however, segregation was modestly correlated with prema-ture mortality (r = 0.19) and uncorrelated with income inequality. Regional analysesdemonstrated that the association of segregation with premature mortality wasmuch more pronounced in the South and in areas with larger black populations.Conclusion. Social factors such as income inequality and segregation stronglyinfluence premature mortality in the US. Ecologic studies of the relationshipsamong social factors and population health can measure attributes of the socialcontext that may be relevant for population health, providing the basis forimputing macro-level relationships.
TL;DR: The research, which resulted in specific legislative action, demonstrated the importance of linkages among academic, practice, and grassroots community groups in working together to diminish one of the social causes of health disparities.
Abstract: Community activists in Chicago believed their neighborhoods were being targeted by alcohol and tobacco outdoor advertisers, despite the Outdoor Advertising Association of America's voluntary code of principles, which claims to restrict the placement of ads for age-restricted products and prevent billboard saturation of urban neighborhoods. A research and action plan resulted from a 10-year collaborative partnership among Loyola University Chicago, the American Lung Association of Metropolitan Chicago (ALAMC), and community activists from a predominately African American church, St. Sabina Parish. In 1997 Loyola University and ALAMC researchers conducted a cross-sectional prevalence survey of alcohol and tobacco outdoor advertising. Computer mapping was used to locate all 4,247 licensed billboards in Chicago that were within 500- and 1,000-foot radiuses of schools, parks, and playlots. A 50% sample of billboards was visually surveyed and coded for advertising content. The percentage of alcohol and tobacco billboards within the 500- and 1,000-foot zones ranged from 0% to 54%. African American and Hispanic neighborhoods were disproportionately targeted for outdoor advertising of alcohol and tobacco. Data were used to convince the Chicago City Council to pass one of the nation's toughest anti-alcohol and tobacco billboard ordinances, based on zoning rather than advertising content. The ordinance was challenged in court by advertisers. Recent Supreme Court rulings made enactment of local billboard ordinances problematic. Nevertheless, the research, which resulted in specific legislative action, demonstrated the importance of linkages among academic, practice, and grassroots community groups in working together to diminish one of the social causes of health disparities.
TL;DR: The findings suggest that birth certificate data may be useful for exploratory or corroborative studies estimating the association between birth defects and some risk factors recorded on birth certificates.
Abstract: Objectives.The authors sought to assess the validity of birth certificate data for estimating the association between maternal smoking and birth defects. The US standard birth certificate includes ...
TL;DR: Significant disagreement in agreement between menstrual and clinical estimates of gestational age occurs most often close to term, with significant disagreement in preterm and postterm births.
Abstract: Objective. This study compares gestational age data obtained by clinical estimate with data calculated from the date of the last menstrual period (LMP) as recorded on birth certificates. Methods. The authors analyzed 476,034 computerized birth records from three overlap years, that is, those that contained both menstrual and clinical estimates of gestational age, concentrating on cases within the biologically plausible range of 20-44 weeks. Results. The overall exact concordance between the two measurements was 46%. For +1 week it was 78%, and for +2 weeks it was 87%. Incidence of prematurity was 16% with menstrual gestational age, while it was 12% with clinical estimate. About 47% of the LMP-based preterm births were classified as term by clinical estimate. Eighty-three percent of clinical estimate-based preterms were also preterms by LMP-based gestation. Birthweight frequency distribution curves for LMP-based gestational age are bimodal, indicating probable miscoding of term births. An apparent over-representation of births coded as exactly 40 weeks by clinical estimate suggests rounding off near term for this method. Conclusion. Agreement between menstrual and clinical estimates of gestational age occurs most often close to term, with significant disagreement in preterm and postterm births. Use of different methods of determining gestation in different years or geographic populations will result in artifactual differences in important indicators such as prematurity rate.
TL;DR: Health education and incentives are helpful adjuncts to the completion of treatment for latent tuberculosis infection in adolescents by demonstrating significantly greater improvements in self-efficacy and mastery.
Abstract: Objectives. Activation of latent tuberculosis infection into tuberculosis disease(TB), the primary killer among infectious diseases worldwide, can be preventedwith six months of anti-TB medication. A large percentage of adolescents startedon medication, however, fail to complete their treatment. The authors developedand tested the effects of innovative educational strategies on infected adoles-cents at two health centers serving ethnically diverse populations.Methods. The authors used a randomized experimental four-group design toassess the independent and combined effects of peer counseling and aparticipant-parent contingency contract intervention.Results. A total of 794 adolescents were recruited into the study, for a 79%participation rate. The overall rate of treatment completion was 79.8%. Self-efficacy for medication-taking behavior at post-test correlated strongly withcompletion of care (R = 0.367, p = 0.002). Participants randomized to the peercounseling groups demonstrated significantly greater improvements in self-efficacy and mastery than the usual care control group. Based on the studyresults, continuing education seminars and workshops were implemented forTB control staff at the two health clinics and for all TB Control Division staff atthe Los Angeles County Health Department. Educational materials and atraining manual for enhancing completion of treatment of latent TB infectionthrough tailored educational approaches were developed and disseminated tothe clinics.Conclusions. Health education and incentives are helpful adjuncts to thecompletion of treatment for latent tuberculosis infection in adolescents.
TL;DR: The enhanced intervention was generally effective in the HIV+ study and in the at-risk study, however, intervention effects were minimal and short-lived.
Abstract: Objective.The authors used data from a larger study to evaluate the long-term effects of a peer advocate intervention on condom and contraceptive use among HIV-infected women and women at high risk...
TL;DR: The major goal of the East Side Village Health Worker Partnership is to address the social determinants of health on Detroit's east side, using a lay health advisor intervention approach.
Abstract: This article describes the work of the East Side Village Health Worker Partnership as a case study of an initiative that seeks to reduce the disproportionate health risks experienced by residents of Detroit's east side. The Partnership is a community-based participatory research and intervention collaboration among academia, public health practitioners, and the east side Detroit community. The Partnership is guided by a steering committee that is actively involved in all aspects of the research, intervention, and dissemination process, made up of representatives of five community-based organizations, residents of Detroit's east side, the local health department, a managed care provider, and an academic institution. The major goal of the East Side Village Health Worker Partnership is to address the social determinants of health on Detroit's east side, using a lay health advisor intervention approach. Data collected from 1996 to 2001 are used here to describe improvements in research methods, practice activities, and community relationships that emerged through this academic-practice-community linkage.
TL;DR: Perceptions of deans and directors of medical education at 128 allopathic schools of medicine in the US about the importance of physical activity and exercise topics and their perceptions about the competence of graduating medical students to perform six fundamental skills related to exercise prescription are examined.
Abstract: Objectives.This study examined perceptions of deans and directors of medical education at 128 allopathic schools of medicine in the US about the importance of physical activity and exercise topics,...
TL;DR: The high prevalence of health risk behaviors among the inmates suggests a number of areas for intervention, and these findings may also be used to guide topics addressed during intake interviews of new inmates, and to help identify inmates that require additional medical or social services.
Abstract: b SYNOPSIS Objectives. This study was performed to assess the prevalence of behavioral risk factors and correlates of poor self-reported health among incarcerated women in a county jail in Oregon. Methods. The authors collected self-reported data from recently incarcerated women at a county jail, focusing on prevalence of high-risk health behaviors, history of health care use, history of physical and sexual abuse, and health care coverage. The authors assessed factors associated with poor self-reported health using logistic regression techniques. Results. More than half of the participants reported a history of intravenous drug use, 67% reported a history of sexual abuse, 79% reported a history of physical abuse, and 43% stated that they had a history of trading sex for money or drugs. Two factors were associated with poor self-reported health: history of physical assault (odds ratio (OR) = 2.7; 95% confidence interval (CI) 1.4, 5.2) and use of heroin during the month prior to arrest (OR = 2.9; 95% CI 1.3, 6.6). Conclusions. The high prevalence of health risk behaviors among the inmates suggests a number of areas for intervention. These findings may also be used to guide topics addressed during intake interviews of new inmates, and to help identify inmates that require additional medical or social services.
TL;DR: As screening protocols are contemplated for entire populations—for newborns and others—it will remain essential that the public participate in an open process of reviewing the justification for and logistics of screening.
Abstract: The development of a new technology, called tandem mass spectrometry (tandem MS), has challenged governments worldwide to consider expanding universal newborn screening for rare metabolic disorders. In 1997 the Massachusetts Department of Public Health developed a public process to meet this challenge. After addressing significant medical, legal, ethical, and logistical issues raised by tandem MS, Massachusetts incorporated one new disorder into the mandatory newborn screen and developed an optional pilot program for 20 additional disorders. The Massachusetts experience has wide relevance for other nations and states. As screening protocols are contemplated for entire populations-for newborns and others- it will remain essential that the public participate in an open process of reviewing the justification for and logistics of screening.
TL;DR: After controlling for age, gender, race, and education, there was no evidence that adults with asthma were less likely to ever smoke, and asthma do not appear to selectively avoid cigarette smoking.
Abstract: Objective.Because they experience respiratory symptoms, adults with asthma might be expected to avoid cigarette smoking. However, previous studies have not adequately addressed whether adults with asthma have a lower prevalence of smoking than the general population. The authors sought to determine whether adult asthmatics are less likely to smoke cigarettes than members of the general population.Methods.The authors used data from a random sample of 2,902 California adults ages 18 years or older, with oversampling of African Americans, Asian/Pacific Islanders, adults with disabilities, and adults aged 45 to 70 years. Sampling weights were used in all analyses. In this cross-sectional study, 217 participants (7.5%) reported a physician diagnosis of asthma.Results.The prevalence of “ever smoking” was similar among adults with asthma (48.3%) and those without asthma (43.0%) (risk difference 5.3%; 95% CI −1.6%, 12.2%). There was also no difference in the prevalence of “current smoking” among adults with asthm...
TL;DR: The first-ever systematic enumeration of homeless population size using data previously collected from administrative records of homeless services providers in nine US jurisdictions over a one year period provides the basis for establishing an ongoing measure of the parameters of the homeless population and for tracking related trends on the use of homelessness services over time.
Abstract: iSYNOPSIS Objectives. This study reports findings from the first-ever systematic enumeration of homeless population size using data previously collected from administrative records of homeless services providers in nine US jurisdictions over a one year period. As such, it provides the basis for establishing an ongoing measure of the parameters of the homeless population and for tracking related trends on the use of homeless services over time. Methods. Each participating jurisdiction collected data through its homeless services management information systems for persons and families who use emergency shelter and transitional housing. The jurisdictions organized the data by a standardized reporting format. These data form the basis for reporting homeless population size, both in raw numbers and as adjusted for each jurisdiction’s overall population size, as well as the rate of turnover and average annual length of stay in emergency shelters and transitional housing. Results. Individual jurisdictions had annual rates of sheltered homelessness ranging from 0.1% to 2.1% of their overall population, and 1.3% to 10.2% of their poverty population. Annual population size was 2.5 to 10.2 times greater than the point-prevalent population size. Results are broken down for adults and families. Conclusions. The prevalence of homelessness varies greatly among the jurisdictions included in this study, and possible factors for this diversity are discussed. Future reports of this nature will furnish similar series of homeless enumerations across a growing number of jurisdictions, thereby providing a basis for exploring the effects of different contextual factors on local prevalence rates of homelessness.
TL;DR: Only checking for ticks during outdoor activity and the use of repellents prior to outdoor activities outside the yard were unequivocally associated with a reduced risk of Lyme disease.
Abstract: Objective.To identify factors associated with increased or decreased risk of infection for Lyme disease in Chester County, Pennyslvania.Methods.The authors designed an unmatched case-control study ...
TL;DR: At issue are ways in which population patterns of health, disease, and well-being, from conception to death, reflect societal conditions, including social inequality, across the lifecourse.
Abstract: Concern for social inequalities in health in the United States is increasingly becoming part of the mainstream public health and health research agenda. Responding to organized efforts within and outside the health sector, the
Department of Health and Human Services (DHHS) is supporting programs dedicated to eliminating social disparities in health, and within DHHS, the National Institutes of Health (NIH) are supporting research into health disparities.
The NIH Office of Research on Women’s Health (founded in 1990) and the new National Center on Minority Health and Health Disparities (including socioeconomic disparities) are, for example, focusing attention on multiple health outcomes in relation to specified social determinants, rather than parsing out ailments solely by body parts. At issue are ways in which population patterns of health, disease, and well-being, from conception to death, reflect societal conditions, including social inequality, across the lifecourse.