Showing papers in "Public Health Reports in 2010"
TL;DR: This book brings the the surgeon generals vision for a healthy and fit nation book and the system of this book will be much easier.
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439 citations
TL;DR: A systematic review of the literature on TB stigma identified several themes: fear of infection is the most common cause of TB stigma; TB stigma has serious socioeconomic consequences, particularly for women; qualitative approaches to measuring TB stigma are more commonly utilized than quantitative surveys.
Abstract: The social determinants of health refer to the institutional, community, and interpersonal factors that affect health outside of the ease with which an individual can access medical services.1 Stigma, which is shaped and promulgated by institutional and community norms and interpersonal attitudes, is a social determinant of health.2 Stigma is a process that begins when a particular trait or characteristic of an individual or group is identified as being undesirable or disvalued.3 The stigmatized individual often internalizes this sense of disvalue and adopts a set of self-regarding attitudes about the marked characteristic including shame, disgust, and guilt.4 These attitudes produce a set of behaviors that include hiding the stigmatized trait, withdrawing from interpersonal relationships, or increasing risky behavior.5,6 Stigmatization is conceptually distinct from discrimination—another social determinant of health—in that the primary goal of discrimination is exclusion, not necessarily for the target to feel ashamed or guilty.7,8 Stigmatized individuals can, however, suffer discrimination and status loss at the hands of the broader community, whose norms have caused them to be perceived as undesirable.3,9
Stigmatization is a complex process involving institutions, communities, and inter- and intrapersonal attitudes. While it has been recognized as an important social determinant of health and health disparities, the difficulties in identifying, characterizing, measuring, and tracking changes in stigmatization over time have made it challenging to justify devoting resource-intensive interventions to the problem.2,10 One exception is human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) research, where the interactions among stigma, HIV risk behaviors, and HIV-associated outcomes have been fairly well characterized.11,12 Substantially less study has been conducted on the mechanisms through which stigma impacts the health of individuals at risk for or infected with tuberculosis (TB).
In this article, we review the available literature on TB stigma. Our goal was to identify the causes of TB stigma and to assess the impact of stigma on TB diagnosis and treatment. We identified three themes in the existing literature on TB stigma: (1) studies that characterize and measure TB stigma, (2) studies that explore the effect of TB stigma on TB diagnosis and treatment, and (3) studies that describe interventions to reduce TB stigma and the impact of these interventions on TB diagnosis and treatment. We also considered the gaps in existing research on stigma and the TB pandemic, and assessed potential interventions to reduce the health impact of TB stigma.
334 citations
TL;DR: The history of UVGI for air disinfection is reviewed, starting with its biological basis, moving to its application in the real world, and ending with its current status.
Abstract: Public health concerns such as multi- and extensive drug-resistant tuberculosis, bioterrorism, pandemic influenza, and severe acute respiratory syndrome have intensified efforts to prevent transmission of infections that are completely or partially airborne using environmental controls. One such control, ultraviolet germicidal irradiation (UVGI), has received renewed interest after decades of underutilization and neglect. With renewed interest, however, come renewed questions, especially regarding efficacy and safety. There is a long history of investigations concluding that, if used properly, UVGI can be safe and highly effective in disinfecting the air, thereby preventing transmission of a variety of airborne infections. Despite this long history, many infection control professionals are not familiar with the history of UVGI and how it has, and has not, been used safely and effectively. This article reviews that history of UVGI for air disinfection, starting with its biological basis, moving to its application in the real world, and ending with its current status.
287 citations
TL;DR: Influenza A viruses infect large numbers of warm-blooded animals, including wild birds, domestic birds, pigs, horses, and humans, and can switch hosts to form new lineages in novel hosts.
Abstract: Influenza A viruses infect large numbers of warm-blooded animals, including wild birds, domestic birds, pigs, horses, and humans. Influenza viruses can switch hosts to form new lineages in novel hosts. The most significant of these events is the emergence of antigenically novel influenza A viruses in humans, leading to pandemics. Influenza pandemics have been reported for at least 500 years, with inter-pandemic intervals averaging approximately 40 years.
269 citations
230 citations
TL;DR: This special issue of Public Health Reports (PHR) focuses on innovations and advances in incorporating a social-determinants-of-health (SDH) framework for addressing the interrelated epidemics of human immunodeficiency virus, viral hepatitis, sexually transmitted infections (STIs), and tuberculosis (TB) in the United States and globally.
Abstract: This special issue of Public Health Reports (PHR) focuses on innovations and advances in incorporating a social-determinants-of-health (SDH) framework for addressing the interrelated epidemics of human immunodeficiency virus (HIV), viral hepatitis, sexually transmitted infections (STIs), and tuberculosis (TB) in the United States and globally This focus is particularly timely given the evidence of increasing burden and worsening health disparities for these conditions, the evolution in our understanding of the social and structural influences on disease epidemiology, and the far-reaching implications of the global economic downturn
The global trends and adverse health impact of HIV, viral hepatitis, STIs, and TB remain among the major and urgent public health challenges of our time1 These conditions account for substantial morbidity and mortality, with devastating fiscal and emotional costs to individuals, families, and societies Despite decades of investment and support, the US still experiences a disproportionate burden of these conditions compared with other Western industrialized nations, with substantial health disparities being observed across population subgroups and geographic regions2 The reasons for these inequities are multifaceted and complex It is true that individual-level determinants, including high-risk behaviors such as unsafe sexual and drug-injecting practices, are major drivers of disease transmission and acquisition risk However, it is also clear that the patterns and distribution of these infectious diseases in the population are further influenced by a dynamic interplay among the prevalence of the infectious agent, the effectiveness of preventive and control interventions, and a range of social and structural environmental factors3,4 Many of these conditions arise because of the circumstances in which people grow, live, work, socialize, and form relationships, and because of the systems put in place to deal with illness, all of which are, in turn, shaped by political, social, and economic forces
Understanding the multilevel and overlapping nature of these epidemics, and their social and structural determinants, is key to designing and implementing more effective prevention programs5 Individual risk behaviors influence the probability of contact with other infected or infectious individuals However, these behaviors do not occur in a vacuum With respect to STIs, an individual's sexual risk behavior occurs within the context of a sexual partnership or partnerships, which are, in turn, located within a wider sexual network For other infectious diseases, including TB, the built or physical environment can influence patterns and opportunities for interpersonal contact, social mixing, and probability of onward transmission of the infectious agent6 These more proximal determinants of transmission risk also occur within the context of wider social and structural determinants7,8 Structural factors include those physical, social, cultural, organizational, community, economic, legal, or policy aspects of the environment that impede or facilitate efforts to avoid disease transmission Social factors include the economic and social conditions that influence the health of people and communities as a whole, and include conditions for early childhood development, education, employment, income and job security, food security, health services, and access to services, housing, social exclusion, and stigma
Our understanding of the connections between these determinants, and their relative importance to each other, has evolved over time Earlier models for infectious disease transmission highlighted the primacy of the interactions among the individual, the infectious agent, and the environment, with infectious disease prevention and control programs being focused predominantly on targeting interventions toward the individual—eg, individual-level counseling, testing, screening, and treatment interventions Thus, HIV prevention has been dominated by individual-level behavioral interventions that seek to influence knowledge, attitudes, and behaviors, such as promotion of condom use, education about sexual health, and education of injecting drug users about the dangers of sharing equipment4 While there has been some success with this approach, public health programs have failed to achieve sustained reductions in incidence or achieve elimination of these conditions and their associated inequities There is also a growing appreciation that although some individually oriented interventions have shown results in reducing risk behavior, their success is substantially improved when HIV prevention addresses the broader structural factors that shape or constrain individual behavior, such as poverty and wealth, gender, age, policy, and power9
The growing recognition of the social and structural barriers to prevention and control efforts for HIV, viral hepatitis, STIs, and TB have allowed prevention experts to employ more comprehensive approaches to their interventions Such structural approaches include actions implemented as single policies or programs that aim to change the conditions in which people live, multiple structural actions of this type implemented simultaneously, or community processes that catalyze social and political change (eg, social mobilization to oppose a harmful traditional practice) They also include policy or legal interventions (eg, legal actions to combat or reform a discriminatory practice), interventions to influence the way services are delivered through promoting collaboration and integration,10 contingent funding, and economic and educational interventions11 These approaches can be applied in combination with behavioral or medical interventions targeted at individuals, and aim to address factors affecting individual behavior, rather than targeting the behavior itself
It is within this context that this special issue of PHR has been brought together to reflect upon the influences, opportunities, and impact of SDH on the transmission of HIV, viral hepatitis, STIs, and TB Major strategic priorities for the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) at the Centers for Disease Control and Prevention (CDC)12 are promoting health equity and reducing health disparities through adopting a social-determinants approach to our prevention activities NCHHSTP also intends to place more emphasis on structural and contextual determinants of health, particularly health policy and legislation, economic and social interventions, and cross-sectoral collaboration
206 citations
TL;DR: Findings from this nationally representative cohort demonstrate a socioeconomic gradient in diabetes-related mortality, with both education and income being important determinants of the risk of death.
Abstract: Objective: We examined disparities in diabetes-related mortality for socioeconomic status (SES) groups in nationally representative U.S. samples.
Methods: We analyzed National Health Interview Survey respondents linked to their death records and included those eligible for mortality follow-up who were aged 25 years and older at the time of interview and not missing information on covariates (n=527,426). We measured SES by education and family income. There were 5,613 diabetes-related deaths.
Results: Having less than a high school education was associated with a twofold higher mortality from diabetes, after controlling for age, gender, race/ethnicity, marital status, and body mass index, compared with adults with a college degree or higher education level (relative hazard [RH] = 2.05, 95% confidence interval [CI] 1.78, 2.35). Having a family income below poverty level was associated with a twofold higher mortality after adjustments compared with adults with the highest family incomes (RH=2.41, 95% CI 2.05, 2.84). Approximately one-quarter of the excess risk among those in the lowest SES categories was explained by adjusting for potential confounders.
Conclusion: Findings from this nationally representative cohort demonstrate a socioeconomic gradient in diabetes-related mortality, with both education and income being important determinants of the risk of death.
201 citations
TL;DR: Findings from more than 10 studies in Asia, Africa, and Latin America that have contributed to understanding the relationship between gender and men's behaviors, developing useful measurement tools for gender norms, and designing and evaluating the impact of gender-focused program strategies are highlighted.
Abstract: In the field of human immunodeficiency virus (HIV) prevention, there has been increasing interest in the role that gender plays in HIV and violence risk, and in successfully engaging men in the response. This article highlights findings from more than 10 studies in Asia, Africa, and Latin America—conducted from 1997 through 2007 as part of the Horizons program—that have contributed to understanding the relationship between gender and men's behaviors, developing useful measurement tools for gender norms, and designing and evaluating the impact of gender-focused program strategies. Studies showed significant associations between support for inequitable norms and risk, such as more partner violence and less condom use. Programmatic lessons learned ranged from insights into appropriate media messages, to strategies to engage men in critically reflecting upon gender inequality, to the qualities of successful program facilitators. The portfolio of work reveals the potential and importance of directly addressing...
185 citations
TL;DR: Findings from more than 10 studies in Asia, Africa, and Latin America—conducted from 1997 through 2007 as part of the Horizons program—that have contributed to clarifying the relationship between stigma and HIV, determining how best to measure stigma among varied populations, and designing and evaluating the impact of stigma reduction-focused program strategies are highlighted.
Abstract: Since the early years of the human immunodeficiency virus (HIV) epidemic, stigma has been understood to be a major barrier to successful HIV prevention, care, and treatment. This article highlights findings from more than 10 studies in Asia, Africa, and Latin America-conducted from 1997 through 2007 as part of the Horizons program-that have contributed to clarifying the relationship between stigma and HIV, determining how best to measure stigma among varied populations, and designing and evaluating the impact of stigma reduction-focused program strategies. Studies showed significant associations between HIV-related stigma and less use of voluntary counseling and testing, less willingness to disclose test results, and incorrect knowledge about transmission. Programmatic lessons learned included how to assist institutions with recognizing stigma, the importance of confronting both fears of contagion and negative social judgments, and how best to engage people living with HIV in programs. The portfolio of work reveals the potential and importance of directly addressing stigma reduction in HIV programs.
165 citations
TL;DR: In this population, there was no detectable additional benefit of hand sanitizer or face masks over targeted education on overall rates of URIs, but mask wearing was associated with reduced secondary transmission and should be encouraged during outbreak situations.
Abstract: Objectives.We compared the impact of three household interventions—education, education with alcohol-based hand sanitizer, and education with hand sanitizer and face masks—on incidence and secondar...
147 citations
TL;DR: Homeless people who seek care in urban EDs come by ambulance, lack medical insurance, and have psychiatric and substance abuse diagnoses more often than non-homeless people, which identifies a pressing need for policy remedies.
Abstract: Objective.Homeless individuals frequently use emergency departments (EDs), but previous studies have investigated local rather than national ED utilization rates. This study sought to characterize ...
TL;DR: The literature on what has increasingly become known as the positive-wealth gradient in HIV infection in SSA, or the counterintuitive finding that the poor do not have higher rates of HIV, is reviewed.
Abstract: Contrary to theories that poverty acts as an underlying driver of human immunodeficiency virus (HIV) infection in sub-Saharan Africa (SSA), an increasing body of evidence at the national and individual levels indicates that wealthier countries, and wealthier individuals within countries, are at heightened risk for HIV This article reviews the literature on what has increasingly become known as the positive-wealth gradient in HIV infection in SSA, or the counterintuitive finding that the poor do not have higher rates of HIV This article also discusses the programmatic and theoretical implications of the positive HIV-wealth gradient for traditional behavioral interventions and the social determinants of health literature, and concludes by proposing that economic and social policies be leveraged as structural interventions to prevent HIV in SSA
TL;DR: Children whose parents delay vaccinations may be at increased risk of not receiving all recommended vaccine doses by 19 months of age and are more vulnerable to vaccine-preventable diseases.
Abstract: Objectives.We evaluated the association between intentional delay of vaccine administration and timely vaccination coverage.Methods.We used data from 2,921 parents of 19- to 35-month-old children that included parents' reports of intentional delay of vaccine administration. Timely vaccination was defined as administration with ≥4 doses of diphtheria, tetanus, and pertussis; ≥3 doses of polio vaccine; ≥1 dose of measles, mumps, and rubella vaccine; ≥3 doses of Haemophilus influenzae type b vaccine; ≥3 doses of hepatitis B vaccine; and ≥1 dose of varicella vaccine by 19 months of age, as reported by vaccination providers.Results.In all, 21.8% of parents reported intentionally delaying vaccinations for their children. Among parents who intentionally delayed, 44.8% did so because of concerns about vaccine safety or efficacy and 36.1% delayed because of an ill child. Children whose parents intentionally delayed were significantly less likely to receive all vaccines by 19 months of age than children whose paren...
TL;DR: Elevated PTSD risk was associated with exposure to the WTC site as well as functional impairment, and remained largely unabated during the first four years of the study.
Abstract: Objectives.We identified trends in the prevalence of elevated posttraumatic stress disorder (PTSD) risk as determined by the Fire Department of the City of New York (FDNY)-modified PTSD Checklist in World Trade Center (WTC)-exposed firefighters. We also examined trends in relation to WTC exposure, social support, change in recreational activities, and functional health.Methods.We analyzed 16,826 questionnaires from 10,074 firefighters in yearly intervals, from September 12, 2001, to September 11, 2005.Results.The prevalence of elevated PTSD risk increased over time, from 9.8% in year 1 to 10.6% in year 4 (p<0.0001). Earliest arrival at the WTC site (odds ratio [OR] = 6.0; 95% confidence interval [CI] 4.4, 8.3), prolonged work at the site (OR=2.0; 95% CI 1.8, 2.3), providing supervision without previous supervisory experience (OR=4.1; 95% CI 2.8, 6.1), and retirement due to a WTC-related disability (OR=1.3; 95% CI 1.1, 1.5) were associated with ever having elevated PTSD risk. Difficulty functioning at home...
TL;DR: The study revealed several implications for new human immunodeficiency virus-prevention interventions that mobilize these networks and social networking technologies.
Abstract: OBJECTIVE: To examine the impact of condom-using peers in the social networks of homeless young people differences in behaviors were assessed based on the social location of ties (home-based vs. street-based) and how those ties are maintained (face-to-face vs. via social networking technology). METHODS: "Ego-centric" social network data were collected from 103 currently sexually active homeless young people aged 16-26 years in Los Angeles California. Associations between condom use and the condom-using behaviors of social network influences were assessed using standard logistic regression. RESULTS: About 52% of respondents had a street-based peer who was a condom user. Having such a peer was associated with a 70% reduction in the odds of having unprotected sex at last intercourse. About 22% of respondents had a condom-using home-based peer with whom they communicated only via social networking technology. Having such a peer was associated with a 90% reduction in risky sexual behavior and a 3.5 times increase in safer sex behavior. CONCLUSION: The study revealed several implications for new human immunodeficiency virus-prevention interventions that mobilize these networks and social networking technologies.
TL;DR: Overall, the oral health status of Americans as measured by HP 2010 objectives mostly showed improvement or remained unchanged between 1998–1994 and 1999–2004, however, some changes in Oral health status for some traditionally low-risk groups, such as non-poor children, may be reversing improvements in oral health that have consistently been observed in previous decades.
Abstract: Objective.Poverty is a significant social determinant for oral health, yet Healthy People2010 (HP 2010) does not monitor changes in oral health status by poverty. We assessed recent trends for six ...
TL;DR: Findings indicate the violence- and HIV-related vulnerability of FSWs who report debt and further highlight how male partners may contribute to the debt and economic insecurity of F SWs.
Abstract: OBJECTIVE: We examined the context of economic insecurity and debt among female sex workers (FSWs), how this context varies among FSWs, and its association with experiences of violence and sexual risk factors for human immunodeficiency virus (HIV). METHODS: We recruited FSWs aged > or =18 years (n = 673) through respondent-driven sampling for a survey on HIV risk in this region. Using logistic regression models (adjusted for partner status, education, financial support, and literacy), we assessed the relation between debt and sexual and physical victimization as well as sexual risk. We also conducted qualitative interviews with a sub-sample of the survey participants and examined these for related themes. RESULTS: In adjusted logistic regression models, FSWs who reported debt were more likely to report the following: recent physical violence (adjusted odds ratio AOR = 2.4, 95% confidence interval CI 1.5, 3.9), unprotected sex with occasional clients in the past week (AOR = 2.3, 95% CI 1.2, 4.3), anal sex with clients in the past 30 days (AOR = 2.0, 95% CI 1.1, 3.9), and at least one sexually transmitted infection symptom in the past six months (AOR = 1.6, 95% CI 1.1, 2.4). FSWs with debt were more likely to report current husbands or other male partners, and less likely to report condom use with these partners, further increasing their sexual risk. Qualitative data elaborated on these findings. CONCLUSION: Findings indicate the violence- and HIV-related vulnerability of FSWs who report debt and further highlight how male partners may contribute to the debt and economic insecurity of FSWs. Keywords: Human trafficking Language: en
TL;DR: Focused skills development is needed to address personal barriers, particularly for chronic disease practitioners without graduate-level training, and approaches must be developed to address organizational barriers to EBDM.
Abstract: Objective.Existing knowledge of evidence-based chronic disease prevention is not systematically disseminated or applied. This study investigated state and territorial chronic disease practitioners' self-reported barriers to evidence-based decision making (EBDM).Methods.In a nationwide survey, participants indicated the extent to which they agreed with statements reflecting four personal and five organizational barriers to EBDM. Responses were measured on a Likert scale from 0 to 10, with higher scores indicating a larger barrier to EBDM. We analyzed mean levels of barriers and calculated adjusted odds ratios for barriers that were considered modifiable through interventions.Results.Overall, survey participants (n=447) reported higher scores for organizational barriers than for personal barriers. The largest reported barriers to EBDM were lack of incentives/rewards, inadequate funding, a perception of state legislators not supporting evidence-based interventions and policies, and feeling the need to be an ...
TL;DR: In this article, the authors explored links among economically motivated relationships, transactional sex, and risk behavior for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) among individuals.
Abstract: Objective.We explored links among economically motivated relationships, transactional sex, and risk behavior for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) among ...
TL;DR: Preliminary findings demonstrate that a community-based model of care tailored to this disenfranchised population successfully engages them in seeking health care.
Abstract: Most California prisoners experience discontinuity of health care upon return to the community. In January 2006, physicians working with community organizations and representatives of the San Francisco Department of Public Health's safety-net health system opened the Transitions Clinic (TC) to provide transitional and primary care as well as case management for prisoners returning to San Francisco. This article provides a complete description of TC, including an illustrative case, and reports information about the recently released individuals who participated in the program. From January 2006 to October 2007, TC saw 185 patients with chronic medical conditions. TC patients are socially and economically disenfranchised; 86% belong to ethnic minority groups and 38% are homeless. Eighty-nine percent of patients did not have a primary care provider prior to their incarceration. Preliminary findings demonstrate that a community-based model of care tailored to this disenfranchised population successfully engages them in seeking health care.
TL;DR: Sex ratios and incarceration rates were associated with the number of opposite-sex partners in some groups and varied greatly by race/ethnicity; however, there were significant associations within each racial/ethnic group.
Abstract: It is widely recognized that black people are disproportionately impacted by the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic in the U.S. Non-Hispanic black (NHB) individuals represented 47% of new diagnoses of HIV or AIDS in 2006.1 Similar disparities exist for chlamydia, gonorrhea, syphilis, and genital herpes.2,3 Among NHB individuals, heterosexual contact is reported to be the leading route of HIV acquisition for women and the second leading route of acquisition for men.1 The number of sexual partners is a principal determinant of the likelihood of acquiring HIV infection and other sexually transmitted infections (STIs).4 National data show that NHB individuals report more recent opposite-sex partners, on average, than do non-Hispanic white (NHW) or Hispanic people.5,6 The rate of acquisition of opposite-sex partners can be influenced by the availability of those partners.
TL;DR: Very few states ensure coverage of recommended treatments for adult and pediatric obesity through Medicaid or private insurance, and most states allow obesity to be used to adjust rates in the small-group and individual markets and to deny coverage in the individual market.
Abstract: Objectives.We determined whether state Medicaid programs cover recommended treatments for adult and pediatric obesity and to what extent states regulate the treatment and coverage of obesity by private insurers.Methods.We conducted a state-by-state document review of Medicaid manuals and private insurance laws and regulations.Results.Eight state Medicaid programs appear to cover all recommended obesity treatment modalities for adults. Only 10 states appear to reimburse for obesity-related treatment in children. In the small-group insurance market, 35 states expressly allow obesity to be used for rate adjustments, while 10 states do so in the individual market. Two states expressly allow obesity to be used in eligibility decisions in the individual market. Five states provide for coverage of one or more treatments for obesity in both small-group and individual markets.Conclusions.Very few states ensure coverage of recommended treatments for adult and pediatric obesity through Medicaid or private insurance....
TL;DR: Adding condoms to other methods should be considered seriously as the first line of defense against unplanned pregnancy and STIs as part of target interventions where dual-method promotion is needed most.
Abstract: OBJECTIVES: U.S. women experience high rates of unplanned pregnancy and sexually transmitted infections (STIs) yet they seldom combine condoms with highly effective contraceptives for optimal protection. Because oral contracep tives (OCs) have been the predominant form of highly effective contraceptio in the U.S. it is unknown whether condom use is similarly low with increasingly promoted user-independent methods. METHODS: We used weighted data from the National Survey of Family Growth to assess condom use odds among women relying on OCs vs. user-independent methods (i.e. injectibles intrauterine devices and implants). We also estimated the expected reduction in unplanned pregnancies and abortions if half or all of the women currently using a single highly effective method also used condoms. RESULTS: Across every demographic subgroup based on age partner status race/ethnicity household income and education condom use prevalence was lower for women relying on user-independent methods vs. OCs. Multivariable models for adult women also revealed a significant reduction within most demographic subgroups in the odds of condom use among women relying on user-independent methods vs. OCs. Population estimates suggested that if half of all women using highly effective methods alone also used condoms approximately 40% of unplanned pregnancies and abortions among these women could be prevented for an annual reduction of 393000 unplanned pregnancies and nearly 76000 abortions. If all highly effective method users also used condoms approximately 80% of unplanned pregnancies and abortions among these women could be prevented for an annual reduction of 786000 unplanned pregnancies and nearly 152000 abortions. CONCLUSIONS: Adding condoms to other methods should be considered seriously as the first line of defense against unplanned pregnancy and STls. This analysis can serve to target interventions where dual-method promotion is needed most.
TL;DR: Collectively, rare tumors account for a sizable portion of adult cancers, and disproportionately affect some demographic groups, potentially leading to a greater understanding of these cancers and eventually to improved treatment, control, and prevention.
Abstract: Objective.Rare cancers have been traditionally understudied, reducing the progress of research and hindering decisions for patients, physicians, and policy makers. We evaluated the descriptive epid...
TL;DR: The overconsumption of discretionary calories was much greater than the undercons consumption of fruit and vegetables, suggesting that unless the excessive consumption of salty snacks, cookies, candy, and sugar-sweetened beverages is curtailed, other interventions focusing on increasing physical activity and fruit and vegetable consumption will have a limited impact on obesity control.
Abstract: Objectives.There are many contributors to obesity, including excess consumption of “discretionary calories” (foods high in sugar and fat and low in essential nutrients), lack of fruit/vegetable consumption, and insufficient physical activity. This study contrasted physical activity, fruit/vegetable consumption, and discretionary calorie consumption from selected foods relative to the 2005 dietary guidelines.Methods.We conducted a cross-sectional survey in 228 urban census tracts in Los Angeles County (LAC) and Southern Louisiana (SL) and estimated calories in the past 24 hours from fruit, vegetables, cookies, candy, salty snacks, sweetened soda, and alcohol among 2,767 participants.Results.The population-weighted mean daily intake of calories from candy, cookies, salty snacks, soda, and alcohol was 438 in LAC and 617 in SL. Alcohol comprised a small portion of the calories consumed. Reported discretionary calorie consumption from a small set of items exceeded guidelines by more than 60% in LAC and 120% in...
TL;DR: A more broad-based and systematic approach is needed to adequately address the health inequities that have been abundantly documented in the U.S. and which I have seen on a daily basis across the country.
Abstract: Reducing health disparities, primarily those based on race/ethnicity and gender, has long been a public health priority in the United States, but the first official goal to eliminate health disparities came with Healthy People 2010.1 Recent developments led by the World Health Organization (WHO), however, have accelerated the thinking about the causes of health inequities—i.e., disparities that are systematic, avoidable, and unjust2—and how best to address their reduction.3,4 The WHO Commission on Social Determinants of Health concluded in 2008 that the social conditions in which people are born, live, and work are the single most important determinant of one's health status.3 Certainly, individual choices are important, but factors in the social environment are what determine access to health services and influence lifestyle choices in the first place.
In addition to the WHO's work, state and local health departments, national government agencies (such as the Centers for Disease Control and Prevention and other divisions of the Department of Health and Human Services in the U.S.), and other national organizations have recognized the need to address health inequities in a systematic way by addressing more than individual behavioral factors.5–12 This global movement recognizes that to reduce health inequities, it will be necessary to incorporate a social determinants of health approach with existing approaches. Social determinants are defined as follows: “… the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.”13
Broadening our collective approaches to reducing health inequities by addressing the social and structural conditions needed for good health for all is urgently needed now. These social and structural conditions include education; housing; employment; living wages; access to health care; access to healthy foods and green spaces; justice; occupational safety; hopefulness; and freedom from racism, classism, sexism, and other forms of exclusion, marginalization, and discrimination based on social status. The inequitable distribution of these social conditions across groups contributes to persistent health inequities. While a social-determinants approach is important for people of all ages, it is critically valuable for children, whose positive early development can improve their health throughout the life span.14
As a former U.S. Surgeon General, I am committed to eliminating health disparities in the United States and providing care to vulnerable populations such as the indigent, foreign-born, and homeless. I urge a more broad-based and systematic approach to adequately address the health inequities that have been abundantly documented in the U.S. and which I have seen on a daily basis across the country. I call on people from all disciplines and sectors to come together and work toward achieving the Healthy People 2020 objectives, especially as they relate to social determinants of health.
We need a new way of thinking, one where, as public health professionals, we lead by taking an interdisciplinary approach and collaborating across a wide range of disciplines, developing our own workforce to effectively address social determinants of health, and insisting health and non-health policies incorporate a social-determinants approach.
We all have a role to play. The federal government should raise the profile of social determinants and communicate to the public what is meant by this somewhat unfamiliar approach. Public health and the work we do can be framed around health equity. Communities and local governments and organizations will have to be educated about the growing movement. Clear, concise language and concrete examples of how people can affect change will be needed. We should have “health in all policies” because nearly all social determinants are outside the direct control of the health sector. Although the goal of many social and economic policies may not be to affect health outcomes, the fact is they will.14 From funding opportunity announcements to accountability mechanisms, all facets of public health should include addressing social determinants.
Our partnerships will have to be stronger if we are to have an impact. We must reach out to nontraditional partners in the private sector, industry, and other parts of government in the transportation, education, and justice sectors, for example. Analyses of equity effectiveness should be conducted alongside those of cost-effectiveness to ensure that the impact of various policies on health outcomes is given equal consideration.14,15 Finally, we must expand resources to address these underlying determinants. Public resources could be better leveraged and collaborations with the private sector and foundations should also be sought.
In short, we must be proactive, collaborative, inclusive, and deliberate as we advance the use of a social-determinants approach to reducing health inequities among and between populations.
TL;DR: The allostatic score increased the risk of all-cause mortality, and this increased risk was observed for adults younger than 65 years of age regardless of their race/ethnicity Thus, allostatics score may be a contributor to premature death in the U.S.
Abstract: The allostatic score increased the risk of all-cause mortality. Moreover, this increased risk was observed for adults younger than 65 years of age regardless of their race/ethnicity. Thus, allostatic score may be a contributor to premature death in the U.S.
TL;DR: This historical analysis revisits the public health lessons learned during the 1918–1919 pandemic and reflects on their relevance for the present.
Abstract: The Spanish influenza arrived in the United States at a time when new forms of mass transportation, mass media, mass consumption, and mass warfare had vastly expanded the public places in which communicable diseases could spread. Faced with a deadly "crowd" disease, public health authorities tried to implement social-distancing measures at an unprecedented level of intensity. Recent historical work suggests that the early and sustained imposition of gathering bans, school closures, and other social-distancing measures significantly reduced mortality rates during the 1918-1919 epidemics. This finding makes it all the more important to understand the sources of resistance to such measures, especially since social-distancing measures remain a vital tool in managing the current H1N1 influenza pandemic. To that end, this historical analysis revisits the public health lessons learned during the 1918-1919 pandemic and reflects on their relevance for the present.
TL;DR: State-level disability-associated health-care expenditures (DAHE) for the U.S. adult population vary greatly by state and are borne largely by the public sector, and particularly by Medicaid.
Abstract: Objectives.We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population.Methods.We used a two-part model to estimate DAHE for the noninstitutionalize...
TL;DR: Consultants suggested that sufficient evidence exists to propose that heterosexually active males be informed about the significant but partial efficacy of MC in reducing risk for HIV acquisition and be provided with affordable access to voluntary, high-quality surgical and risk-reduction counseling services.
Abstract: In April 2007, the Centers for Disease Control and Prevention (CDC) held a two-day consultation with a broad spectrum of stakeholders to obtain input on the potential role of male circumcision (MC) in preventing transmission of human immunodeficiency virus (HIV) in the U.S. Working groups summarized data and discussed issues about the use of MC for prevention of HIV and other sexually transmitted infections among men who have sex with women, men who have sex with men (MSM), and newborn males. Consultants suggested that (1) sufficient evidence exists to propose that heterosexually active males be informed about the significant but partial efficacy of MC in reducing risk for HIV acquisition and be provided with affordable access to voluntary, high-quality surgical and risk-reduction counseling services; (2) information about the potential health benefits and risks of MC should be presented to parents considering infant circumcision, and financial barriers to accessing MC should be removed; and (3) insufficient data exist about the impact (if any) of MC on HIV acquisition by MSM, and additional research is warranted. If MC is recommended as a public health method, information will be required on its acceptability and uptake. Especially critical will be efforts to understand how to develop effective, culturally appropriate public health messages to mitigate increases in sexual risk behavior among men, both those already circumcised and those who may elect MC to reduce their risk of acquiring HIV.