We analyzed beer, spirits, and alcopop magazine advertisements to determine adherence to federal and voluntary advertising standards. We assessed the efficacy of these standards in curtailing potentially damaging content and protecting public health.
We obtained data from a content analysis of a census of 1795 unique advertising creatives for beer, spirits, and alcopops placed in nationally available magazines between 2008 and 2010. We coded creatives for manifest content and adherence to federal regulations and industry codes.
Advertisements largely adhered to existing regulations and codes. We assessed only 23 ads as noncompliant with federal regulations and 38 with industry codes. Content consistent with the codes was, however, often culturally positive in terms of aspirational depictions. In addition, creatives included degrading and sexualized images, promoted risky behavior, and made health claims associated with low-calorie content.
Existing codes and regulations are largely followed regarding content but do not adequately protect against content that promotes unhealthy and irresponsible consumption and degrades potentially vulnerable populations in its depictions. Our findings suggest further limitations and enhanced federal oversight may be necessary to protect public health.
We compared participant characteristics and abstinence outcomes of smokers who chose in-person or telephone tobacco dependence treatment.
We provided the same treatment content to 7267 smokers in Arkansas between 2005 and 2008 who self-selected treatment modality; examined demographic, clinical, environmental, and treatment utilization differences between modalities; and modeled outcomes and participants’ choice of modality with logistic regression.
At end of treatment, in-person participants were more likely to be abstinent than telephone participants, and smokers of higher socioeconomic status (SES) were more likely to be abstinent with telephone treatment than lower-SES smokers. Long term, modality had no effect on treatment outcomes. Higher-SES smokers and smokers exposed to more treatment content were more likely to achieve long-term abstinence, regardless of modality. Men and more recalcitrant smokers were more likely to choose in-person treatment; lower-SES, ethnic minority, and more dependent smokers were more likely to choose telephone treatment.
Treatment modality attracts different groups of smokers, but has no effect on long-term abstinence. Multiple treatment modalities are needed to provide treatment to a heterogeneous population of smokers. More research is needed to understand the influences on treatment choice.
We investigated the possibility that men who have sex with men (MSM) and women who have sex with women (WSW) may be at higher risk for early mortality associated with suicide and other sexual orientation–associated health risks.
We used data from the 1988–2002 General Social Surveys, with respondents followed up for mortality status as of December 31, 2008. The surveys included 17 886 persons aged 18 years or older, who reported at least 1 lifetime sexual partner. Of these, 853 reported any same-sex partners; 17 033 reported only different-sex partners. Using gender-stratified analyses, we compared these 2 groups for all-cause mortality and HIV-, suicide-, and breast cancer–related mortality.
The WSW evidenced greater risk for suicide mortality than presumptively heterosexual women, but there was no evidence of similar sexual orientation–associated risk among men. All-cause mortality did not appear to differ by sexual orientation among either women or men. HIV-related deaths were not elevated among MSM or breast cancer deaths among WSW.
The elevated suicide mortality risk observed among WSW partially confirms public health concerns that sexual minorities experience greater burden from suicide-related mortality.
To ascertain HCV testing practices among US prisons and jails, we conducted a survey study in 2012, consisting of medical directors of all US state prisons and 40 of the largest US jails, that demonstrated a minority of US prisons and jails conduct routine HCV testing. Routine voluntary HCV testing in correctional facilities is urgently needed to increase diagnosis, enable risk-reduction counseling and preventive health care, and facilitate evaluation for antiviral treatment.
We explored possible disparities in seasonal influenza treatment in Georgia’s disabled Medicaid population. We sought to determine whether racial/ethnic, geographic, or gender disparities existed in antiviral drugs usage in the treatment of influenza.
Medicaid claims were analyzed from 69 556 clients with disabilities enrolled in a Georgia Medicaid disease management program.
There were 519 patients who met inclusion criteria (i.e., adults aged 18–64 years with an influenza diagnosis on a 2006 or 2007 Medicaid claim). Roughly one third (36.2%) of patients were classified as African American, 44.5% as White, and 19.3% as “other.” Most patients had 2 or more comorbid chronic diseases. Antivirals were used in only 14.5% of patients diagnosed with influenza. Treatment rates were nearly 3 times higher for White patients (19.5%) than for African American patients (6.9%).
Our analysis suggests limited use of antiviral treatment of influenza overall, as well as significant racial disparities in treatment. Additional studies are needed to further explore this finding and its implications for care of racial/ethnic minority populations during seasonal influenza and for effective pandemic influenza planning for racial/ethnic minority populations.
We investigated the association between anticipatory stress, also known as racism-related vigilance, and hypertension prevalence in Black, Hispanic, and White adults.
We used data from the Chicago Community Adult Health Study, a population-representative sample of adults (n=3105) surveyed in 2001 to 2003, to regress hypertension prevalence on the interaction between race/ethnicity and vigilance in logit models.
Blacks reported the highest vigilance levels. For Blacks, each unit increase in vigilance (range=0–12) was associated with a 4% increase in the odds of hypertension (odds ratio [OR]=1.04; 95% confidence interval [CI]=1.00, 1.09). Hispanics showed a similar but nonsignificant association (OR=1.05; 95% CI=0.99, 1.12), and Whites showed no association (OR=0.95; 95% CI=0.87, 1.03).
Vigilance may represent an important and unique source of chronic stress that contributes to the well-documented higher prevalence of hypertension among Blacks than Whites; it is a possible contributor to hypertension among Hispanics but not Whites.
We assessed the protocols and systems processes for colorectal cancer (CRC) screening at federally qualified health centers (FQHC) in four midwestern states.
We identified 49 FQHCs in 4 states. In January, 2013, we mailed their medical directors a 49-item questionnaire about policies on CRC screening, use of electronic medical records, types of CRC screening recommended, clinic tracking systems, referrals for colonoscopy, and barriers to providing CRC.
Forty-four (90%) questionnaires were returned. Thirty-three of the respondents (75%) estimated the proportion of their patients up-to-date with CRC screening, with a mean of 35%. One major barrier to screening was inability to provide colonoscopy for patients with a positive fecal occult blood test (59%). The correlation of system strategies and estimated percent of patients up-to-date with CRC screening was 0.43 (p = 0.01).
CRC system strategies were associated with higher CRC screening rates. Implementing system strategies for CRC screening takes time and effort and is important to maintain to help prevent or cure many cases of CRC, the second leading cause of cancer in the United States.
The educational gradient of U.S. adult mortality has increased at the national level since the mid-1980s. This study investigates trends in the gradient within U.S. regions.
We used data from the 1986–2006 National Health Interview Survey Linked Mortality File on non-Hispanic white and black adults aged 45–84 years (N=498,517). We examined trends in the gradient within four U.S. regions by race-gender subgroup using age-standardized death rates.
Trends in the gradient exhibited a few subtle regional differences. Among women, the gradient was often narrowest in the Northeast. The region’s distinction grew over time mainly because low-educated women in the Northeast did not experience a significant increase in mortality like their counterparts in other regions (particularly for white women). Among white men, the gradient narrowed to a small degree in the West.
The subtle regional differences indicate that geographic context can accentuate or suppress trends in the gradient. Studies of smaller areas may provide insights into the specific contextual characteristics (e.g., state tax policies) that have shaped the trends, and thus help explain and reverse the widening mortality disparities among U.S. adults.
Translational research applies basic science discoveries in clinical and community settings. Implementation research is often limited by tremendous variability among settings; therefore, generalization of findings may be limited. Adoption of a novel procedure in a community practice is usually a local decision guided by setting-specific knowledge. The conventional statistical framework that aims to produce generalizable knowledge is inappropriate for local quality improvement investigations. We propose an analytic framework based on cost-effectiveness of the implementation study design, taking into account prior knowledge from local experts. When prior knowledge does not indicate a clear preference between the new and standard procedures, local investigation should guide the choice. The proposed approach requires substantially smaller sample sizes than the conventional approach. Sample size formulae and general guidance are provided.
This study compares a statewide telephone health survey and EHR data from a large Wisconsin health system to estimate asthma prevalence in Wisconsin.
Frequency tables and logistic regression models were developed for children and adults using Wisconsin Behavioral Risk Factor Surveillance Survey (BRFSS) and University of Wisconsin primary care clinic data. Adjusted odds ratios (OR) from each model were compared.
Between 2007 and 2009, the EHR database contained 376,000 patients (30,000 with asthma) compared to 23,000 (1,850 with asthma) responding to the BRFSS telephone survey. Adjusted ORs for asthma were similar in magnitude and direction for the majority of covariates, including gender, age, and race between survey and EHR models. The EHR data had greater statistical power to detect associations than survey data, especially in pediatric and ethnic populations, due to larger sample sizes.
EHRs can be used to estimate asthma prevalence in Wisconsin adults and children. EHR data may improve public health chronic disease surveillance using high quality data at the local level to better identify areas of disparity, risk factors, and guide education and healthcare interventions.
Federally supported health centers provide primary care services for over 20 million medically underserved patients across the U.S. Health centers are well-positioned to identify patients who smoke and ensure receipt of needed cessation counseling or treatment.
Determine the prevalence of current cigarette smoking, desire to quit, and receipt of tobacco-related counseling among a national sample of adult health center patients; identify sociodemographic and health-related factors associated with these measures.
Data came from the 2009 Health Center Patient Survey and the 2009 National Health Interview Survey. The analytic sample included 3,949 adult health center patients and 27,731 U.S. adults.
Findings showed that 31% of adult health center patients were current smokers, compared with 21% of U.S. adults in general. Among currently smoking health center patients, 83% reported a desire to quit and 68% reported receiving tobacco counseling. In multivariable models, patients had higher odds of wanting to quit if they showed signs of severe mental illness (OR=3.26, 95% CI: 1.19–8.97) and lower odds if they had health insurance (OR=0.43, 95% CI: 0.22–0.86). Patients had higher odds of receiving counseling if they had two or more chronic conditions (OR=2.05, 95% CI: 1.11–3.78) and lower odds if they were Hispanic (OR=0.57-0.34-0.96).
The prevalence of cigarette smoking is substantially higher among health center patients than the U.S. in general. However, most smokers seen in health centers desire to quit smoking. Continued efforts are warranted to reduce tobacco use in this vulnerable segment of the population.
We examined the effectiveness of state cigarette price and smoke-free homes on smoking behaviors of low-income and high-income populations in the United States.
We used the 2006–2007 Tobacco Use Supplement to the Current Population Survey. The primary outcomes were average daily cigarette consumption and successful quitting. We used multivariable regression to examine the association of cigarette price and smoke-free home policies on these outcomes.
High state cigarette price (pack price ≥ $4.50) was associated with lower consumption across all income levels. Although low-income individuals were least likely to adopt smoke-free homes, those who adopted them had consumption levels and successful quit rates that were similar to those among higher-income individuals. In multivariable analysis, both policies were independently associated with lower consumption, but only smoke-free homes were associated with sustained cessation at 90 days.
High cigarette prices and especially smoke-free homes have the potential to reduce smoking behaviors among low-income individuals. Interventions are needed to increase adoption of smoke-free homes among low-income populations to increase cessation rates and prevent relapse.
We examined racial/ethnic differences in prenatal antiretroviral (ARV) treatment among 3259 HIV-infected pregnant Medicaid enrollees.
We analyzed 2005–2007 Medicaid claims data from 14 southern states, comparing rates of not receiving ARVs and suboptimal versus optimal ARV therapy.
More than one third (37.3%) had zero claims for ARV drugs. Three quarters (73.4%) of 346 Hispanic women received no prenatal ARVs. After we adjusted for covariates, Hispanic women had 3.89 (95% confidence interval = 2.58, 5.87) times the risk of not receiving ARVs compared with Whites. Hispanic women often had only 1 or 2 months of Medicaid eligibility, perhaps associated with barriers for immigrants. Less than 3 months of eligibility was strongly associated with nontreatment (adjusted odds ratio = 29.0; 95% confidence interval = 13.4, 62.7).
Optimal HIV treatment rates in pregnancy are a public health priority, especially for preventing transmission to infants. Medicaid has the surveillance and drug coverage to ensure that all HIV-infected pregnant women are offered treatment. States that offer emergency Medicaid coverage for only delivery services to pregnant immigrants are missing an opportunity to screen, diagnose, and treat pregnant women with HIV, and to prevent HIV in children.
Permanent supportive housing (PSH) is an intervention to address long-term homelessness. Evidence has resulted in a shift in US policy toward using PSH rather than shelters and transitional housing.
Despite recognizing that individuals transitioning from homelessness to PSH experience a high burden of disease and health disparities, public health research has not considered whether and how PSH improves physical health outcomes.
Based on diverse areas of research, we argue that in addition to improved access to quality health care, social determinants of health (including housing itself, neighborhood characteristics, and built environment) affect health outcomes. We identify implications for practice and research, and conclude that federal and local efforts to end long-term homelessness can interact with concurrent efforts to build healthy communities
We examined the empirical link between money mismanagement and subsequent homelessness among veterans.
We used a random sample of Afghanistan/Iraq era veterans from the National Post-Deployment Adjustment Survey in 2009–2011.
Veterans were randomly selected from a roster of all U.S. military service members in Operation Iraqi Freedom or Operation Enduring Freedom who were separated from active duty or in the Reserves/National Guard. Veterans (n = 1090) from 50 states and all military branches completed 2 waves of data collection 1 year apart (79% retention rate). Thirty percent reported money mismanagement (e.g., bouncing or forging a check, going over one’s credit limit, falling victim to a money scam in the past year). Multivariate analysis revealed money mismanagement (odds ratio [OR] = 4.09, 95% CI = 1.87, 8.94) was associated with homelessness in the next year, as were arrest history (OR = 2.65, 95% CI = 1.33, 5.29), mental health diagnosis (OR = 2.59, 95% CI = 1.26, 5.33), and income (OR = 0.30, 95% CI = 0.13, 0.71).
Money mismanagement, reported by a substantial number of veterans, was related to a higher rate of subsequent homelessness. The findings have implications for policymakers and clinicians, suggesting that financial education programs offered by the US Departments of Defense and Veterans Affairs may be targeted to effectively address veteran homelessness.