The findings described in this supplement can help improve collaboration among public health and other stakeholders who influence population health, including employers, health plans, health professionals, and voluntary associations, to increase the use of a set of clinical preventive services that, with improved use, can substantially reduce morbidity and mortality in the U.S. adult population. This supplement highlighted that the use of the clinical preventive services in the U.S. adult population is not optimal and is quite variable, ranging from approximately 10% to 85%, depending on the particular service. Use was particularly low for tobacco cessation, aspirin use to reduce risk of cardiovascular disease, and influenza vaccination; however, ample opportunity exists to improve use of all of these services. Among the specific populations least likely to have used the recommended services, persons with no insurance, no usual source of care, or no recent use of the health-care system (if included in the analysis) were the groups least likely to have used the services. Use among the uninsured was generally 10 to 30 percentage points below the general population averages, suggesting that improvements in insurance coverage are likely to increase use of these clinical preventive services. A randomized, controlled trial of an expansion of Medicaid coverage by Oregon in 2008 supports this hypothesis by demonstrating improved use of clinical services with increased health insurance coverage. A recent survey among the uninsured found a low level of awareness of the provisions of the Patient Protection and Affordable Care Act of 2010 as amended by the Healthcare and Education Reconciliation Act of 2010 (referred to collectively as the Affordable Care Act [ACA]). Therefore, improving opportunities for coverage might be insufficient, and focused efforts by governmental health agencies and other stakeholders are likely to be needed to enroll uninsured persons in health plans. In addition, although use of the preventive services in insured populations was greater than among the uninsured, use among the insured was generally <75%, and often much less. Therefore, having health insurance coverage might not itself be sufficient to optimize use of clinical preventive services, and additional measures to improve use are likely to be necessary.
"In response to these disparities, public policy efforts have been made to increase state Medicaid insurance coverage for evidence-based tobacco cessation treatment (CDC, 2008). As of 2009, 46 states and the District of Columbia offer insurance coverage for tobacco cessation treatment to Medicaid recipients (CDC, 2010), although the degree of coverage for services varies widely and is typically underutilized (Coates et al., 2012). Interventions delivered in health care settings by physicians have the potential to reach a wide range of smokers, considering that more than 70% of smokers see their physician each year (Goldstein et al., 1998; Wadland, Stoffelmayr, & Ives, 2001). "
[Show abstract][Hide abstract] ABSTRACT: Despite decades of tobacco use decline among the general population in the United States, tobacco use among low-income populations continues to be a major public health concern. Smoking rates are higher among individuals with less than a high school education, those with no health insurance, and among individuals living below the federal poverty level. Despite these disparities, smoking cessation treatments for low-income populations have not been extensively tested. In the current study, the efficacy of two adjunctive smoking cessation interventions was evaluated among low-income smokers seen in a primary care setting.
A total of 846 participants were randomly assigned either to motivational enhancement treatment plus brief physician advice and 8 weeks of nicotine replacement therapy (NRT) or to standard care-consisting of brief physician advice and 8 weeks of NRT. Tobacco smoking abstinence was at 1, 2, 6, and 12 months following baseline.
The use of the nicotine patch, telephone counseling, and positive decisional balance were predictive of increased abstinence rates, and elevated stress levels and temptation to smoke in both social/habit and negative affect situations decreased abstinence rates across time. Analyses showed intervention effects on smoking temptations, length of patch use, and number of telephone contacts. Direct intervention effects on abstinence rates were not significant, after adjusting for model predictors and selection bias due to perirandomization attrition.
Integrating therapeutic approaches that promote use of and adherence to medications for quitting smoking, and which target stress management and reducing negative affect may enhance smoking cessation among low-income smokers.
[Show abstract][Hide abstract] ABSTRACT: As interest in systemic lupus erythematosus (SLE) research has increased, it has become apparent that knowledge about SLE epidemiology has lagged behind. The most fundamental aspect of epidemiology of any disease is determining the disease's incidence and prevalence rates. The reported rates for SLE vary greatly. This is due partly to the inherent disparities of the disease; however, great variation also exists in study methodology. Understanding these differences and defining ideal approaches will advance our current understanding of the literature and future efforts. Well-designed epidemiologic studies of SLE also can help further our understanding in several related research areas.
Current Rheumatology Reports 09/2008; 10(4):265-72. DOI:10.1007/s11926-008-0043-4 · 2.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Systemic lupus erythematosus (SLE) patients are at risk for complications that can be mitigated by appropriate preventive care. We examined the receipt of immunizations, cancer screening, and cardiovascular risk preventive services in a predominantly Black cohort of SLE patients from the Southeast U.S. To identify gaps in primary preventive services (PPS) that might be specific to SLE as opposed to local health system factors, we used as reference a population-based sample from the same area.
A cross-sectional design was used to characterize the percentage of PPS received by 751 SLE patients from Atlanta, GA, and 9040 subjects from the same community, of whom 938 had diabetes. Factors associated with the receipt of PPS were examined with multivariable analysis of variance.
Approximately 65% of recommended PPS were provided to the SLE, overall community (OC), and diabetes samples. However, only 22.5%, 45.7%, and 27.6% of SLE, OC, and diabetes subjects, respectively, received all recommended services. Factors associated with a higher percentage of PPS received by SLE patients included older age (63.6% if age ≥65 years, 45.8% if age between 18 and 35 years), having medical insurance (61.1% for insured, 49.7% for uninsured), having a primary care physician (PCP) (59.0% if patient had PCP, 51.8% if patient did not have PCP), and being a non-smoker (61.9% for non-smokers, 49.9% for smokers).
Less than one-quarter of SLE patients from a southeast U.S. community received all the recommended services that were studied. Further research is warranted to unravel the barriers that prevent SLE patients from reaching appropriate standards of preventive care.
Seminars in arthritis and rheumatism 05/2013; 43(2). DOI:10.1016/j.semarthrit.2013.04.003 · 3.93 Impact Factor
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