American Journal of Preventive Medicine

Published by Elsevier Masson
Print ISSN: 0749-3797
Participant flow. IPAQ, completion of the International Physical Activity Questionnaire; PM, completion of the pedometer records. 
Characteristics of participants who completed pedometer and IPAQ registrations 
Currently there is a great deal of interest in multistrategy community-based approaches to changing physical activity or health behaviors. The aim of this article is to describe the effectiveness of the physical activity promotion project "10,000 Steps Ghent" after 1 year of intervention. A multistrategy community-based intervention was implemented in 2005 with follow-up measurements in 2006 to promote physical activity to adults. A local media campaign, environmental approaches, the sale and loan of pedometers, and several local physical activity projects were concurrently implemented. In 2005, 872 randomly selected subjects (aged 25 to 75), from the intervention community Ghent and 810 from a comparison community, participated in the baseline measurements. Of these, 660 intervention subjects and 634 comparison subjects completed the follow-up measurements in 2006. Statistical analyses were performed in 2006. After one year there was an increase of 8% in the number of people reaching the "10,000 steps" standard in Ghent, compared with no increase in the comparison community. Average daily steps increased by 896 (95% CI=599-1192) in the intervention community, but there was no increase in the comparison community (mean change -135 [95% CI= -432 to 162]) (F time x community=22.8, p<0.001). Results are supported by self-reported International Physical Activity Questionnaire (IPAQ) data. The "10,000 steps/day" message reached the Ghent population and the project succeeded in increasing pedometer-determined physical activity levels in Ghent, after 1 year of intervention.
Several themes emerged from the articles in this supplement, as well as from the discussion at the workshop. First, the mental health burden of depression in children and adolescents is empirically supported. More research is needed to understand the economic burden resulting from youth depression, and the cost effectiveness of prevention. Second, psychosocial, biological, and environmental risk factors for depression have been identified across childhood and adolescence. A consistent theme in the articles on risk and protective factors was the need for additional research to improve identification of at-risk youth, based on current (e.g., symptoms and disorders) and past (e.g., family history, early onset internalizing disorders) levels of risk and protective factors and processes. Third, preventive interventions with demonstrated efficacy exist, primarily for high-risk populations. Evidence for the effectiveness of these preventive interventions in real-world settings is needed, including cost effectiveness as well as research on the dissemination of evidence-based interventions within community and practice settings. Fourth, basic research presents opportunities for furthering what is known about the etiology of depression and comorbid disorders as well as opportunities for developing novel interventions, and improving the targeting and timing of preventive interventions.
Epidemiology, as the core science underpinning public health, encompasses methods and concepts that are fundamental to understanding health-related information and health policy. Thus, understanding these concepts would enhance the lay public's ability to make informed decisions with respect to health and prevention, and teaching epidemiology at the undergraduate level would be consistent with the goal of creating an educated citizenry. While epidemiology has traditionally been taught largely within graduate schools, there has been experience at the undergraduate level as well. This experience has demonstrated that such courses are popular and effective. While there may be some challenges inherent to teaching Epidemiology 101 at every college and university, this is a worthy and important goal, and most challenges can be successfully overcome with creativity and effort. Perhaps the greatest barrier is instinctive resistance to this idea, since most faculty with epidemiology training received such training in graduate schools. It is up to us to cast off those preconceptions; if one explores the notion of undergraduate epidemiology teaching with an open and unbiased mind, the logic, feasibility, and importance of this effort becomes clear.
One of the most important factors affecting the use of preventive services is health insurance coverage; however, until recently, most public and private health plans have explicitly excluded coverage of most preventive care. As a result, preventive services are used less frequently than recommended guidelines suggest, which contributes to the high incidence of preventable morbidity and mortality in the United States. Recent congressional efforts to enact national health care reform legislation present an important opportunity to analyze coverage for preventive services. This article presents the results of an analysis of the prevention benefits in 23 comprehensive health care reform bills introduced in 1991 during the first session of the 102nd Congress. I classified each bill by type (employer-based, single payer, managed competition, tax credit, and insurance market reform) and through a content analysis identified benefits for immunization, screening, and counseling services (including cost-sharing provisions), as well as funding for community-based health promotion. I interviewed congressional staff members of the sponsors of each bill to discuss their rationale for including or excluding specific prevention benefits and their reliance on existing policy, guidelines, and health services research or on the involvement of interest groups in developing prevention benefits. I conclude that health care reform is likely to address prevention, particularly in covering specific clinical preventive services, such as well-child visits, prenatal care, immunizations, family planning, and cancer screening. The prevention benefits least likely to be included in health care reform are coverage for counseling services and funding for community-based health promotion.
Passive surveillance using ICD codes for hospital discharges has been used to estimate the incidence of abusive head trauma (AHT) utilizing ICD-9-CM, but not ICD-10, codes. There have been no incidence estimates of AHT in Canada where ICD-10 codes have been used since 2002. The Discharge Abstract Database from the Canadian Institute of Health Information (CIHI) for 2002-2007 was used for analyses conducted in 2011. A case was defined by code combinations that indexed injury specificity (narrow or broad) and degree of certainty (presumptive or probable) that the injury was inflicted. Estimated incidences for the populations at risk in those aged <12 months and 12-23 months from 2002-2007 were determined. For those aged <12 months, the mean incidence for "narrow, presumptive" AHT was 13.0 (95% CIs=11.3, 14.9) per 100,000 person-years; for "broad, probable" it was 15.5 (13.6, 17.6) per 100,000 person-years. For those aged 12-23 months, the "narrow, presumptive" incidence was 2.4 (1.7, 3.3) and the "broad, probable" incidence was 2.8 (2.0, 3.8) per 100,000 person-years, respectively. Month and year of age patterns were similar to previous reports. ICD-10 codes can be used to estimate incidence of AHT. Narrower classifications provide estimates consistent with those from other surveillance programs in Canada and internationally.
Decorate the City posters from events at organizations engaged in collective recovery work.
Decorate the City poster from an event not engaged in collective recovery.
The 9/11 terrorist attacks on New York City represented a new strain on already fractured communities with low collective efficacy. Like the majority of citizens in the greater metropolitan area, researchers at the Community Research Group of Columbia University Mailman School of Public Health wanted to "do" something to help in the aftermath of the attacks. The group proposed to promote collective recovery, that is, rebuilding social connections in the city as the foundation for individual and group recovery. After several months of organizing, New York City RECOVERS (NYCR)--a network of organizations formed to promote trauma recovery post 9/11--in conjunction with the New York University's International Trauma Studies Program, persuaded the New York City Department of Health and Mental Health and the FEMA-funded Project Liberty to sponsor a conference on collective recovery, with a focus on the first anniversary of the tragedy. Utilizing participant observation, the research team documented the outreach and dissemination efforts of NYCR, the partners' organizational engagement in collective recovery, and the recovery activities they pursued. This paper describes the work of the conference and the specific efforts for youth violence prevention that followed. In this circumstance, engaging community partners helped shift the research agenda from one driven by funders and researchers to one co-driven by the organizations and populations they aimed to influence.
Active travel is a possible method to increase physical activity in children, but the precise contribution of walking to school to daily physical activity is unclear. To combine accelerometer and GPS data to quantify moderate-to-vigorous physical activity (MVPA) on the walk to and from school in relation to overall daily levels. Participants were 141 children aged 11-12 years from the PEACH Project (Personal and Environmental Associated with Children's Health) in Bristol, England, measured between 2008 and 2009. Eighty-four children met the inclusion criteria and were included in the final analysis. Accelerometers measured physical activity, GPS receivers recorded location, and mode of travel was self-reported. Data were analyzed between April and October 2011. Combined accelerometer and GPS data were mapped in a GIS. Minutes of MVPA were compared for school journeys taking place between 8:00 AM and 9:00 AM and between 3:00 PM and 5:00 PM and in relation to whole-day levels. Physical activity levels during journeys to and from school were highly similar, and contributed 22.2 minutes (33.7%) of total daily MVPA. In addition, MVPA on the journey did not differ between boys and girls, but because girls have lower levels of daily physical activity than boys, the journey contributed a greater proportion of their daily MVPA (35.6% vs 31.3%). The journey to and from school is a significant contributor to MVPA in children aged 11-12 years. Combining GPS and accelerometer data within a GIS is a useful approach to quantifying specific journeys.
To determine the sunburn experience and factors associated with sunburn among white children aged 6 months to 11 years. Telephone interviews were conducted with parents and primary caretakers of children, selected by random, stratified sampling, in the contiguous United States in the summer of 1998. Information was gathered on demographic characteristics of parents and children, and children's sunburn experience during the past year, protection from sun exposure, and hours per week spent outdoors. The proportion of children experiencing sunburn in the past year was calculated. Multivariate logistic regression analyses were conducted to determine factors associated with sunburn. Information for 1052 white children was available for the analyses. An estimated 42.6% of U.S. white children experienced one or more sunburns within the past year (95% CI 38.2-47.0). Sunburn was less common among children who ever wore hats (adjusted OR 0.59, 95% CI 0.40-0.87) and more common among children who did not always wear sunscreen (OR for using sunscreen sometimes compared with always, 2.25; 95% CI 1.31-3. 86). Sunburn was also more common among children with sun-sensitive skin and older children. A large proportion of U.S. white children experience sunburns. Parents and children may benefit from education about protection from sun exposure.
Few studies have explored the reciprocal relationships between naturally occurring changes in physical activity and depressive symptoms in later life. This study examined the reciprocal associations between changes in physical activity and depressive symptoms in a population-based sample of Taiwanese older adults over an 11-year period. Analyses were based on nationally representative data from the Taiwan's Health and Living Status of the Elderly Survey collected in 1996, 1999, 2003, and 2007. Data from the fixed cohort of 1160 participants aged ≥67 years in 1996 with 11 years of follow-up were studied. Depressive symptoms were assessed using the ten-item Chinese version of the Center for Epidemiologic Studies-Depression Scale. Physical activity was self-reported as the number of sessions per week. Latent growth modeling was used to examine the bidirectional associations between changes in physical activity and depressive symptoms when controlling for sociodemographic variables, lifestyle behaviors, and health status. Data analyses were completed in 2011. With multivariate adjustment, initial levels of physical activity were negatively associated with changes in depressive symptoms (β=-0.34, p<0.05). In contrast, early depressive symptoms were not related to change in physical activity (β=-0.17, p>0.05). Physical activity engagement in later life is associated with a lower risk of subsequent depressive symptoms, but the reverse association is not supported. The finding has underlying implications for future physical activity and mental health promotion in aged populations.
Understanding environmental correlates of physical activity can inform policy changes. Surveys were conducted in 11 countries using the same self-report environmental variables and the International Physical Activity Questionnaire, allowing analyses with pooled data. The participating countries were Belgium, Brazil, Canada, Colombia, China (Hong Kong), Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S., with a combined sample of 11,541 adults living in cities. Samples were reasonably representative, and seasons of data collection were comparable. Participants indicated whether seven environmental attributes were present in their neighborhood. Outcomes were measures of whether health-related guidelines for physical activity were met. Data were collected in 2002-2003 and analyzed in 2007. Logistic regression analyses evaluated associations of physical activity with environmental attributes, adjusted for age, gender, and clustering within country. Five of seven environmental variables were significantly related to meeting physical activity guidelines, ranging from access to low-cost recreation facilities (OR=1.16) to sidewalks on most streets (OR=1.47). A graded association was observed, with the most activity-supportive neighborhoods having 100% higher rates of sufficient physical activity compared to those with no supportive attributes. Results suggest neighborhoods built to support physical activity have a strong potential to contribute to increased physical activity. Designing neighborhoods to support physical activity can now be defined as an international public health issue.
Following the tragic events of 9/11/2001, the Pentagon Post Disaster Health Assessment (PPDHA) survey was created to identify healthcare needs and concerns among Pentagon personnel and to assure that appropriate care and information was provided. The PPDHA was fielded from October 15, 2001, to January 15, 2002. Fundamental in this assessment was the evaluation of the mental health impact as a result of the attack. Although a number of standardized instruments exist for mental health domains, most are lengthy and could not be used as a rapid health assessment. Instead, a short screening instrument consisting of 17 questions was developed that covered important mental health symptom domains, mental health functioning, and possible predictive risk factors. High-risk groups for post-traumatic stress disorder (PTSD), depression, panic attacks, generalized anxiety, and alcohol abuse were assessed, and validation of risk groups was assessed across functional levels. Overall, 1837 (40%) respondents met the screening criteria for any of the symptom domains of interest 1 to 4 months after the attack: PTSD (7.9%), depression (17.7%), panic attacks (23.1%), generalized anxiety (26.9%), or alcohol abuse (2.5%). Mental health risk groups were highly correlated with self-reported reduced daily functioning and use of counseling services. Additionally, risk factors known to be associated with mental health problems after traumatic events were strongly predictive of the high-risk categories identified. Mental health concerns were common among Pentagon employees in the 4 months after the 9/11 attack. Data from this study suggested that the short mental health screening instrument had validity and can serve as a prototype for rapid public health assessment of the mental health impact of future traumatic events.
U.S. adolescents and young adults are using indoor tanning at high rates, even though it has been linked to both melanoma and squamous cell cancer. Because the availability of commercial indoor tanning facilities may influence use, data are needed on the number and density of such facilities. In March 2006, commercial indoor tanning facilities in 116 large U.S. cities were identified, and the number and density (per 100,000 population) were computed for each city. Bivariate and multivariate analyses conducted in 2008 tested the association between tanning-facility density and selected geographic, climatologic, demographic, and legislative variables. Mean facility number and density across cities were 41.8 (SD=30.8) and 11.8 (SD=6.0), respectively. In multivariate analysis, cities with higher percentages of whites and lower ultraviolet (UV)index scores had significantly higher facility densities than those with lower percentages of whites and higher UV index scores. These data indicate that commercial indoor tanning is widely available in the urban U.S., and this availability may help explain the high usage of indoor tanning.
Many factors interact to influence an injured individual's risk of sustaining a second injury. However, the quantitative assessment of subsequent injury risk has been limited, primarily due to methodologic constraints. The purpose of this study is to present analytical methodology not previously employed in injury epidemiology to identify risk factors for subsequent injury. Data were collected from a retrospective cohort of 1214 U.S. Army Airborne soldiers. Lower extremity and low-back musculoskeletal injuries were identified from outpatient medical records. The Prentice, Williams, and Peterson (PWP) model, stratified by injury event, was used to identify risk factors for initial and subsequent injuries. A Cox proportional hazards model to the time of last injury was used to determine the magnitude of the increased risk associated with having a previous injury history. Risk factors for initial injuries were similar to those seen in other epidemiologic studies of military populations. However, this study found that race/ethnicity, physical fitness, medical provider training, and initial injury types (traumatic versus other) were associated with subsequent injury risk. Additionally, the observed risk of injury was seven times greater among previously injured individuals. In this population, the risk factors for injury differed by event (initial or subsequent injury), and prior injury history was a risk factor for subsequent injury. The associations between demographic characteristics, the nature of the initial injury, and risk of subsequent injury suggest that changes in the evaluation and medical management of injured individuals may decrease the risk of subsequent injury.
Insufficient physical activity among young people aged 5-18 years is a global public health issue, with considerable disparities among countries. A systematic review was conducted to identify studies reporting pedometer daily steps (steps x day(-1)) in order to compile comparative, global cross-sectional data on youth physical activity patterns. Articles were included if they were in English, published by April 2009, and reported steps x day(-1) for boys and girls, separately, and reported steps x day(-1) for age groupings of no more than 4 years (e.g., 5-8 years) or combined no more than three grade levels (e.g., third- to fifth-graders). Studies could have been intervention-based but had to have reported baseline steps x day(-1), which would reflect unadulterated physical activity steps x day(-1) estimates. Inverse variance weighted estimates (steps x day(-1w)) were calculated for each country, and random effects models were estimated. Analyses were conducted in May and June 2009. Forty-three studies, representing young people in 13 countries (N=14,200), were included. The majority of studies were from the U.S. (17/43). Overall, there was considerable variation within and among countries in steps x day(-1w). Boys and girls from European and Western Pacific regions had significantly more steps x day(-1w) than young people from the U.S. and Canada. Significantly lower steps x day(-1w) estimates for girls were observed for studies that combined measured steps x day(-1) for weekdays and weekend days, in comparison to weekdays only. Limited sample sizes and non-population-based data preclude definitive statements regarding projected steps x day(-1) within countries. Nevertheless, these findings provide preliminary information for policymakers and researchers on the extent of the disparities among countries in the physical activity patterns of young people.
2002 and 2005 YMCLS respondent demographics
Parents' attitudes, beliefs, and support for children's physical activity by 2005 VERB awareness
Summary of regression analysis for parents' 2005 support of children's physical activity
The CDC's VERB campaign was designed to increase physical activity among children aged 9-13 years (tweens). As part of the strategy to surround tweens with support to be physically active, VERB developed messages for parents, the secondary target audience, to encourage them to support their tween's physical activity. Multiple regression analyses were conducted to determine whether parent awareness of VERB was a significant predictor of seven factors that related to parental attitudes, beliefs, and supportive behaviors for tweens' physical activity using the Youth Media Campaign Longitudinal Survey (YMCLS). Parents (N=1946) of U.S. children aged 9-13 years. Advertising directed at tweens through paid television, radio, print, Internet, and schools was the primary VERB intervention; tween advertising could have been also seen by parents. Messages directed at parents encouraging their support of tweens' physical activity were delivered in English through mainly print and radio. In-language messages for Latino and Asian audiences were delivered through print, radio, television, and at events. Parents' awareness of VERB; parents' attitudes, beliefs, and support for their tweens' physical activities. Awareness increased each year of the campaign; more than 50% of parents were aware of VERB by the third year of the campaign. Parents reported that their main source of awareness was television, the main channel used to reach tweens. Awareness of VERB was predictive of positive attitudes about physical activity for all children, belief in the importance of physical activity for their own child, and the number of days parents were physically active with their child. Parents' awareness of VERB was associated with positive attitudes, beliefs, and behavior. Parents' awareness probably resulted from a combination of messages directed to parents and tweens. To maximize audience reach, social marketers who are developing health messages should consider the potential value of parents and their children seeing or hearing the same messages, separately or together.
The childhood obesity epidemic is a current public health priority in many countries, and the consumption of fast food has been associated with obesity. This study aims to assess the relationship between fast-food consumption and obesity as well as the relationship between fast-food outlet access and consumption in a cohort of United Kingdom teenagers. A weighted accessibility score of the number of fast-food outlets within a 1-km network buffer of the participant's residence at age 13 years was calculated. Geographically weighted regression was used to assess the relationships between fast-food consumption at age 13 years and weight status at ages 13 and 15 years, and separately between fast-food accessibility and consumption. Data were collected from 2004 to 2008. The consumption of fast food was associated with a higher BMI SD score (β=0.08, 95% CI=0.03, 0.14); higher body fat percentage (β=2.06, 95% CI=1.33, 2.79); and increased odds of being obese (OR=1.23, 95% CI=1.02, 1.49). All these relationships were stationary and did not vary over space in the study area. The relationship between the accessibility of outlets and consumption did vary over space, with some areas (more rural areas) showing that increased accessibility was associated with consumption, whereas in some urban areas increased accessibility was associated with lack of consumption. There is continued need for nutritional education regarding fast food, but public health interventions that place restrictions on the location of fast-food outlets may not uniformly decrease consumption.
Factors correlated with cigarette smoking in young people have yet to be documented in most developing countries. This study assesses the correlates of smoking in Mexican young people. School-based, cross-sectional study in the central Mexican state of Morelos during the 1998-1999 school year of 13,293 public school students aged 11 to 24 years. Multinomial logistic regression models were constructed with smoking as the dependent variable. Regular smoking (one or more cigarettes daily) prevalence was 13.1% (95% confidence interval [CI]=12.2-13.9) in males, and 6.1% (95% CI=5.6-6.6) in females. Frequent alcohol intoxication was strongly associated with regular smoking (females, odds ratio [OR]=68.5, 95% CI=37.6-125.2; males, OR=34.5, 95% CI=22.6-52.7). Regular smoking was associated with illegal drug use and smoking by both parents in females, and with illegal drug use in males (males, OR=4.9, 95% CI=3.7-6.5). Also associated with tobacco smoking were high socioeconomic status, low academic achievement, illegal drug use by peers, marijuana use by parents, and depression in adolescents. This study documents a strong correlation between tobacco smoking and other health risk behaviors, especially alcohol and drug abuse. In young women especially, the risk of tobacco use increased with alcohol abuse and higher socioeconomic status. School-based interventions are needed that focus on preventing smoking and also take into account other unhealthy behaviors.
Availability of tobacco to young people is believed to be an important factor in the onset of tobacco use. We still do not have a complete picture of how tobacco is obtained by youths or how access can be curtailed. This article describes tobacco availability to youths in 14 communities that are part of a randomized trial, known as TPOP (Tobacco Policy Options for Prevention). The data reported here were obtained from student surveys and tobacco-purchase attempts by underage confederates. Students who have smoked at least once were likely to cite social sources for cigarettes. However, more than half of weekly smokers and almost one third of tenth-grade ever smokers reported purchasing cigarettes in the last 30 days. Tobacco-purchase attempts by confederate buyers at all outlets resulted in an overall success rate of 40.8%, lower than previously reported for urban communities. Fifty-five percent of the over-the-counter outlets had no self-service displays of tobacco at baseline. Store factors that predicted purchase success include tobacco location; purchase success was lower when all tobacco was locked or behind a service counter. The percentage of smokers who reported purchasing their own tobacco soon after starting to smoke was highest in towns where purchase success by teenage study confederates was highest. These results suggest that sources of cigarettes shift from social to commercial with age and that sources of cigarettes for rural youths may be different than for urban youths.
Reports on prevalence estimates and risk factors of intimate partner violence (IPV) are limited in that they (1) focus on specific subgroup populations that are not representative of all women or (2) involve long questionnaires that are not useful as surveillance tools. To report prevalence estimates and identify demographic and lifestyle factors associated with IPV in a large population-based sample of U.S. women using surveillance data. Behavioral Risk Factor Surveillance System (BRFSS) data from eight U.S. states were analyzed individually and as a pooled sample (N=18,415). Multivariate logistic regression models were used to examine associations between IPV and the factors of interest. Factors consistently associated with IPV across the majority of states and in the pooled analysis included young age (pooled adjusted odds ratio [aOR], 3.07), single marital status (pooled aOR, 2.89), divorced/separated marital status (pooled aOR, 4.67), and annual household income <$25,000 (pooled aOR, 1.89). In addition, lack of health insurance, receipt of Medicaid, cigarette smoking, presence of children in the home, self-reported fair/poor health, and frequent mental distress were associated with IPV after adjustment for covariates. This study provides population-based estimates of IPV prevalence and factors associated with IPV using surveillance data. By pooling BRFSS data from individual states, the resulting large sample has adequate power to detect significant associations and has increased precision in the estimates of IPV risk. In addition, this study identifies high-risk populations to target for education and intervention programs and demonstrates the need for improved IPV surveillance.
Little is known about the correlates of low-grade inflammation in U.S. children. This study describes the factors associated with increased levels of C-reactive protein (CRP) in U.S. children and tests whether differences in CRP emerge in childhood because of socioeconomic factors. Data were analyzed in 2009 from 6004 children aged 3-16 years from the National Health and Nutrition Examination Survey, 1999-2004, a representative sample of the U.S. non-institutionalized population. Tobit regression models are used to evaluate associations between predictors, including BMI-for-age, skinfold body fat measures, chronic infections, environmental tobacco exposure, low birth weight, and sociodemographics and continuous high-sensitivity CRP in milligrams per liter. CRP levels were higher in U.S. children with lower family income, and these differences were largely accounted for by differences in adiposity and recent illness. Mexican-American children had higher levels of CRP compared to both whites and blacks, but these differences were not explained by measured physical risk factors. Increased adiposity is associated with higher CRP concentrations in U.S children aged 3-16 years, and both socioeconomic and racial/ethnic differences exist in systemic inflammation in U.S. children. Increased childhood obesity and low-grade inflammation may contribute to later life chronic disease risk.
On June 26, 2007, Ronald M. Davis, MD, was inaugurated as the 162nd president of the American Medical Association at an ornate ceremony in the Grand Ballroom of the Hilton Chicago Hotel. He is the first AMA president to be board-certified in preventive medicine. After Dr. Davis completed the Epidemic Intelligence Service program and the preventive medicine residency program at the U.S. Centers for Disease Control and Prevention, he served as director of CDC’s Office on Smoking and Health and then as medical director of the Michigan Department of Public Health. Since 1995, he has served as director of the Center for Health Promotion and Disease Prevention at the Henry Ford Health System in Detroit. By tradition, the presidents of state medical societies and the leaders of a few other medical organizations sit on the dais during the AMA president’s inaugural speech. Reflecting Dr. Davis’s interest in strengthening the partnership between clinical medicine and public health, he invited leaders of seven preventive medicine and public health organizations to join him on the dais during his address: the Aerospace Medical Association, the American Association of Public Health Physicians, the American College of Occupational and Environmental Medicine, the American College of Preventive Medicine, the American Public Health Association, the Association of State and Territorial Health Officials, and the National Association of County and City Health Officials. Dr. Davis’s inaugural address appears below, except for a portion at the beginning in which he gave tribute to many family members, friends, and colleagues for their support through the years. This portion of his speech can be found on the Journal’s website at
Although nearly half of bladder cancer cases are due to smoking, the cause of nearly half is unexplained. This study aims to determine whether an inverse association exists between ultraviolet B (UVB) irradiance and incidence rates of bladder cancer worldwide. This study used an ecologic approach. Age-adjusted incidence rates of bladder cancer from 2002 were obtained for all 174 countries in GLOBOCAN, a database of the International Agency for Research on Cancer. The relationship of latitude and estimated serum 25-hydroxyvitamin D [25(OH)D] with incidence rates was determined. The independent contributions to incidence rates of bladder cancer of UVB, per capita cigarette consumption in 1980, and per capita health expenditure for 2001 were assessed using multiple regression. The analyses were performed in July 2008. Bladder cancer incidence rates were higher in countries at higher latitudes than those nearer to the equator (r=-0.66, 95% CI=-0.74, -0.57, p<0.01). Ultraviolet B irradiance was independently inversely associated with incidence rates of bladder cancer after controlling for per capita cigarette consumption (beta=-0.28, 95% CI=-0.51, -0.05; R(2) for model=0.38, p<0.0001). Further, UVB irradiance was also inversely associated with incidence rates after controlling for per capita health expenditure (beta=-0.23, 95% CI=-0.36, -0.01; R(2) for model=0.49, p<0.0001) in a separate regression model. Further investigation is needed to confirm the associations identified in this study using observational studies of individuals. The focus of this research should include the association of serum 25(OH)D levels with risk of bladder cancer.
The costs and benefits of breast cancer screening can be placed in the framework usually used for sensitivity and specificity. All those screened incur the costs associated with the test. In addition, only the segment of the true positives who, in the absence of screening, would die of their disease but with screening will survive to die of another cause truly benefit; all other true positives acquire lead time without benefit. In the Canadian National Breast Screening Study, simpler treatment of screen-detected cancer was not achieved. The true negatives benefited from reassurance, but the majority were not at risk of breast cancer anyway. The false negatives were disadvantaged from false reassurance, but in practice the percentage is low, and the consequences are not dire. There are major costs associated with the false positive state, including anxiety, unnecessary biopsies, and residual scarring; major endeavors are justified to reduce them and improve the specificity of screening. In practice, with no benefit demonstrated for women 40-49 years of age, the costs are too great to justify continuation of screening this age group merely in the hope that benefits will eventually be demonstrated. For women older than 50, the degree of benefit may have been overestimated, especially in an era when improvements in therapy affect screen-detected and nonscreen-detected cases alike. We may have overestimated the benefit-cost ratio of screening this age group also; thus, careful monitoring of the outcome of ongoing programs over the next few years is essential.
Systolic and fourth-phase and fifth-phase diastolic blood pressure (SBP, DBP4, DBP5) have appeared to differ in their patterns of age-related change, and SBP and DBP5 differ in their respective associations with anthropometric variables. Project HeartBeat! investigated trajectories of change in SBP, DBP4, and SBP5 with age and their relationships with indices of adiposity, controlling for energy intake, physical activity, and sexual maturation. Project HeartBeat! was a mixed longitudinal study in 678 black and white girls and boys aged 8, 11, or 14 years at first examination, followed at 4-month intervals for up to 4 years (1991-1995). A statistical model was estimated for the trajectory of change in each blood pressure measure from ages 8 to 18 years. For SBP, DBP4, and DBP5, the trajectories were sigmoid, parabolic, and linear in form, respectively. SBP and DBP4 differed significantly by gender; DBP4 and DBP5 were significantly related to race. Adjusted for age, gender, and race, all relationships of adiposity-related variables (percent body fat, abdominal circumference, skinfold thickness, and BMI and its fat and fat-free components) with SBP were positive and significant. Corresponding relationships for DBP4 were notably weaker but significant, and for DBP5, weak or not significant. After adjusting for diet, physical inactivity, and maturation, no DBP5 relationship with adiposity indices remained significant. SBP, DBP4, and DBP5 are distinct in patterns of change with age, relationships to gender and race, and patterns of association with multiple anthropometric indices related to adiposity.
The study's objective was to examine the effects of "real-world," community-based implementation of universal preventive interventions selected from a menu, including effects specific to higher- and lower-risk subsamples. School districts were selected based on size and location, and then randomly assigned to a control condition or to an experimental condition in a cohort sequential design. The study included 28 public school districts in Iowa and Pennsylvania that were located in rural towns and small cities, ranging in size from 6975 to 44,510. Sixth and seventh graders in these school districts participated in the study. Community teams were mobilized; each team implemented one of three evidence-based, family-focused interventions (5 to 12 sessions) and one of three evidence-based school interventions (11 to 15 sessions), for 6th and 7th graders, respectively. Observations showed that interventions were implemented with fidelity. Outcomes included student reports of past month, past year, and lifetime use of alcohol, cigarettes, marijuana, methamphetamines, ecstasy, and inhalants, as well as indices of gateway and illicit substance initiation, at pretest and at a follow-up assessment 18 months later. Intent-to-treat analyses demonstrated significant effects on substance initiation (marijuana, inhalants, methamphetamines, ecstasy, gateway index, illicit-use index), as well as past-year use of marijuana and inhalants, with positive trends for all substances measured. For three outcomes, intervention effects were stronger for higher-risk students than lower-risk students. Community-based implementation of brief universal interventions designed for general populations has potential for public health impact by reducing substance use among adolescents.
A study was undertaken to analyze the independent relationship between race (black/white) and cigarette smoking among 18- to 24-year-olds in the United States, 1983-1993. An 11-year analysis of cross-sectional national surveys was used in the study. Odds ratio for current smoking among black-surveyed subjects (vs. whites) was determined. The multiple logistic regression-derived odds ratio (OR) for current smoking for blacks aged 18 to 24 years, vs. whites, decreased from 0.69 (95% CI 0.53, 0.89) in 1983 to 0.26 (95% CI 0.17, 0.42) in 1993. The combined-years model predicted a decrease in OR for blacks from 0.82 in 1983 to 0.30 in 1993, adjusted for sex, age, education, poverty status, and geographic region. From 1983 to 1993, blacks aged 18 to 24 years became decreasingly at risk to be smokers, compared to whites, even after adjustment for confounding factors. Young blacks have been more resistant than young whites to begin smoking in recent years. Understanding reasons behind this widening black/white difference could lead to better prevention strategies.
Assessment of vaccination coverage is an important component of the U.S. vaccination program and is primarily measured by the National Immunization Survey (NIS). The 1999 NIS is a nationally representative sample of children aged 19 to 35 months, verified by provider records, that is conducted to obtain estimates of vaccination coverage rates. Coverage estimates are calculated for the nation, states, and selected urban areas for recommended vaccines and selected vaccine series. Coverage estimates are presented by a variety of demographic and healthcare-related factors: overall, by poverty status, race/ethnicity, selected milestone ages, participation in WIC, level of urbanicity, provider participation in VFC, and by provider facility type. In 1999, national coverage estimates were high for most vaccines and among most demographic groups. State and urban-area level estimates varied.
Childhood vaccinations have a major impact on the reduction and elimination of many causes of morbidity and mortality among children. Monitoring of annual vaccination coverage levels over time is necessary to characterize undervaccination. Here, coverage estimates for 1996 (1997 for varicella) were compared with those of 1999. Immunization coverage among children aged 19 to 35 months in 1996 (1997 for varicella) and 1999 for a variety of vaccines and vaccine series were compared using Wald chi-square tests and data from the National Immunization Survey. Record high immunization coverage among children aged 19 to 35 months in the United States has increased by a statistically significant amount between 1996 and 1999 for diphtheria, tetanus, and pertussis; measles, mumps, and rubella; Haemophilus influenzae type b; hepatitis B; and standard series made up of these individual vaccines. Coverage with the vaccine for varicella dramatically increased between 1997 and 1999. However, between 1996 and 1999, coverage with three or more doses of polio vaccine decreased by a small but statistically significant amount. Despite the drop for polio vaccine, coverage remains high. Continued monitoring is required to determine if the drop in polio coverage is a cause for concern.
Studies indicate that women abused by their intimate partners are at increased risk for a number of health problems and have increased rates of health care utilization. However, these findings are based mainly on studies using clinic or health plan populations. In this study, we examined the association between intimate partner abuse (IPA) and health concerns and health care utilization in a population-based sample of adult women. We analyzed data on 2043 women aged 18 to 59 who participated in the 1998 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey that included questions on IPA. IPA was defined as experiencing physical violence by, fear of, or control by an intimate partner. Consequences of IPA and self-rated health status and health care utilization of women experiencing IPA were examined. A total of 6.3% of Massachusetts women aged 18 to 59 reported IPA during the past year. Women experiencing IPA were more likely than other women to report depression, anxiety, sleep problems, suicidal ideation, disabilities, smoking, unwanted pregnancy, HIV testing, and condom use. Women experiencing IPA were less likely to have health insurance, but received routine health care at similar rates as other women. These results indicate that women in the general population experiencing IPA are at increased risk for several serious emotional and physical health concerns. Most of these women are in routine contact with health care providers. These findings also suggest that the BRFSS may provide a valuable mechanism for tracking state-based IPA prevalence rates over time.
Background: Trends in state-level prevalence of pre-pregnancy diabetes mellitus (PDM; i.e., type 1 or type 2 diabetes diagnosed before pregnancy) among delivery hospitalizations are needed to inform healthcare delivery planning and prevention programs. Purpose: To examine PDM trends overall, by age group, race/ethnicity, primary payer, and with comorbidities such as pre-eclampsia and pre-pregnancy hypertension, and to report changes in prevalence over 11 years. Methods: In 2014, State Inpatient Databases from the Agency for Healthcare Research and Quality were analyzed to identify deliveries with PDM and comorbidities using diagnosis-related group codes and ICD-9-CM codes. General linear regression with a log-link and binomial distribution was used to assess the annual change. Results: Between 2000 and 2010, PDM deliveries increased significantly in all age groups, all race/ethnicity groups, and in all states examined (p<0.01). The age-standardized prevalence of PDM increased from 0.65 per 100 deliveries in 2000 to 0.89 per 100 deliveries in 2010, with a relative change of 37% (p<0.01). Although PDM rates were highest in the South, some of the largest relative increases occurred in five Western states (≥69%). Non-Hispanic blacks had the highest PDM rates and the highest absolute increase (0.26 per 100 deliveries). From 2000 to 2010, the proportion of PDM deliveries with pre-pregnancy hypertension increased significantly (p<0.01) from 7.4% to 14.1%. Conclusions: PDM deliveries are increasing overall and particularly among those with PDM who have hypertension. Effective diabetes prevention and control strategies for women of childbearing age may help protect their health and that of their newborns.
A relative lack of medical services is common in rural areas, and it has been suggested that the number of births in the mother's county of residence reflects both the availability of obstetric services as well as attitudes toward local and nonlocal medical care. In order to better understand these relationships, we analyzed the evolution of medical and geographical patterns of births to women of a rural Kentucky county in the context of both a changing philosophy and a changing availability of medical care. Specifically, using archival data, we assessed the locus (i.e., home versus hospital) and location (i.e., county) of births to Robertson County women from 1911 to 1980. Without a hospital for the entire period and with the number of physicians declining, the percentage of in-county home births increased steadily, reaching virtually 100 percent by 1950. During this same period, the number of physicians practicing there decreased from 22 to 2. Subsequent delivery patterns reflect the acceptance by the physicians and women of the "principle" of hospital delivery formally enounced in 1945. By 1965, home births had been eliminated, and Robertson County women were, of necessity, traveling the 25-30 miles to the several hospitals in contiguous counties. In the past 15 years, a substantial proportion (almost 20 percent) have elected to travel to hospitals even farther (55-60 miles) from Robertson County. Generally, the Robertson County experience reflects the "lag" observed in the rural-urban, home versus hospital birth experience. Nevertheless, since 1966, all recorded births to Robertson County women have occurred in hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)
The analysis of motor vehicle traffic accident mortality through the use of cross-sectional and secular death rates indicates that motor vehicle traffic accident death rates increased over all age and sex groups from 1921 to 1970. Each generation, defined as a birth cohort, experienced successively higher motor vehicle traffic accident mortality rates until the 1970s. The most striking increase occurred among youths 15-24 years of age. Motor vehicle traffic accidents were responsible for 518,488 hospital days in Canadian hospitals in 1981-82. Approximately 47% of the days involved youths below the age of 25. Among youths in the 15-24 age group, about 30% of the hospital separations attributable to motor vehicle traffic accidents involved head injuries. Between 1970 and 1984, motor vehicle traffic accident mortality rates declined in all age groups. The possible reasons for the decline and the current pattern of motor vehicle traffic accident mortality are discussed in terms of the implications for hospital utilization and the prevalence of disability.
Background: The affordability of alcoholic beverages, determined by the relationship of prices to incomes, may be an important factor in relation to heavy drinking, but little is known about how affordability has changed over time. Purpose: To calculate real prices and affordability measures for alcoholic beverages in the U.S. over the period from 1950 to 2011. Methods: Affordability is calculated as the percentage of mean disposable income required to purchase 1 drink per day of the cheapest spirits, as well as popular brands of spirits, beer, and wine. Alternative income and price measures also are considered. Analyses were conducted in 2012. Results: One drink per day of the cheapest brand of spirits required 0.29% of U.S. mean per capita disposable income in 2011 as compared to 1.02% in 1980, 2.24% in 1970, 3.61% in 1960, and 4.46% in 1950. One drink per day of a popular beer required 0.96% of income in 2010 compared to 4.87% in 1950, whereas a low-priced wine in 2011 required 0.36% of income compared to 1.05% in 1978. Reduced real federal and state tax rates were an important source of the declines in real prices. Conclusions: Alcoholic beverages sold for off-premises consumption are more affordable today than at any time in the past 60 years; dramatic increases in affordability occurred particularly in the 1960s and 1970s. Declines in real prices are a major component of this change. Increases in alcoholic beverage tax rates and/or implementing minimum prices, together with indexing these to inflation could be used to mitigate further declines in real prices.
Teenage childbearing in the United States has declined significantly in the 1990s. Still the U.S. teen birth rate is higher than in other developed countries; in 1997 it was 52.3 births per 1000 women aged 15 to 19. A steep rise in teen birth rates in the late 1980s generated a great deal of public concern and a variety of initiatives targeted to reducing teen births. Data from the National Center for Health Statistics' National Vital Statistics System are used to review and describe trends and variations in births and birth rates for teenagers for the period 1960-1997. Teen birth rates were much higher in the early 1960s than at present; in fact, rates for 18- to 19-year-olds were double what they are currently. In the 1990s, birth rates for teenagers dropped for younger and older teenagers, with greater declines recorded for younger teens. While rates have fallen in all population groups, the greatest declines have been experienced by black teenagers, whose rates have dropped 24% on average. %Trends in teen births and birth rates since 1960 have been affected by a variety of factors. These include wide swings in the number of female teenagers, substantial declines in marriage among older teens, falling birth rates for married teens concurrent with rapidly rising birth rates for unmarried teens, and sharp increases in sexual activity among teens that have abated only recently, according to the National Center for Health Statistics' National Survey of Family Growth. This review article also tracks changes in contraceptive practice and abortion rates.
Our objective was to review historical trends in U.S. fatal firearm-related injuries for the years 1962-1993. Using mortality data from the National Center for Health Statistics and population estimates projected from census data, we calculated national age-adjusted mortality rates and examined trends over the 32-year period. Data were also examined by type of firearm-related death (unintentional, suicide, homicide, legal intervention, and undetermined intention), race, gender, and age group. During the 32-year period, the total number of firearm-related deaths increased by 137%, from 16,720 in 1962 to 39,595 in 1993. Suicide and homicide were responsible for most firearm fatalities. Rates for both firearm suicides and firearm homicides increased over time, while rates for unintentional, legal intervention, and undetermined intention decreased. The highest rates and widest variation in total firearm-related mortality occurred among African-American men (35.2/100,000 to 84.5/100,000). Persons 15-19, 20-24, and > or = 75 years of age experienced the largest changes in rates during recent years; total firearm mortality was higher for the younger age groups (15-19, 20-24) during 1990 through 1993 than any other time during the 32-year period. These surveillance data help characterize trends over time and the magnitude of firearm-related mortality and identify groups at risk. However, further efforts to improve our understanding of firearm-related deaths and injuries, such as expansion of current surveillance to include information about morbidity associated with firearms and additional epidemiologic research to identify modifiable individual and societal risk factors, are necessary.
Although historically a training program in applied epidemiology for physicians, veterinarians, and dentists, CDC's Epidemic Intelligence Service (EIS) has been attracting an increasing number of other doctoral-level scientists with prior experience and training in advanced analytic methods. Using data from alumni records, we studied the participation of these nonmedical scientists in the EIS program and their subsequent employment. 160 nonmedical doctoral level scientists enrolled in EIS from 1964 through 1997; 135 had completed EIS as of July 1997. Of 160 enrolled, 94 (59%) had an advanced degree in epidemiology; other degrees included demography, anthropology, behavioral sciences, statistics, and other health areas; 66% were women. Most (112; 70%) were assigned to work in noninfectious disease areas. After completion of EIS, 113 (84%) of 135 officers continued to work in public health activities: 75 (56%) remained employed at CDC; 17 (13%) in academic institutions; 14 (10%) in local or state health departments; 3 (2%) in international health agencies; 2 (1%) in other federal health agencies; and 2 (1%) in public health foundations. Compared with trainees recruited during 1964-1989, greater proportions of those recruited during 1990-1995 remained employed at CDC (44/74 [59%] versus 31/61 [51%]) or at state or local health departments (10 [14%] versus 4 [7%]). Those training during EIS at a state or local health department (15/20, 75%) or in occupational health (17/24, 71%) were more likely than those in other assignments to work outside CDC following EIS. There is increasing participation and collaboration of persons trained in nonmedical sciences with those trained in traditional medical areas in the EIS training program and in careers in public health at all levels: local, state, and federal.
The prospective effects of smoking status and body mass on change in leisure-time physical activity from 1965 to 1974 were examined in a cohort of 4,622 persons 20-94 years of age from the Alameda County Study. With adjustment for age and baseline physical activity, current smokers showed a greater nine-year decline in leisure-time physical activity than those who had never smoked. The coefficient for current smokers from a multivariate linear regression model was of a similar magnitude among women and men (coefficient = -0.27, 95% confidence interval [CI] = -0.50 to -0.05 for women; coefficient = -0.26, 95% CI = -0.54 to 0.02 for men). Larger declines in physical activity were seen with increasing number of current pack-years exposure among both women and men. Compared with women of average body mass index, women of heaviest body mass index had larger declines (coefficient = -0.70, 95% CI = -1.04 to -0.36) while women of the lightest body mass index had larger increases (or smaller declines) in physical activity (coefficient = 0.33, 95% CI = 0.00 to 0.66). Although body mass index did not initially appear to be associated with a change in physical activity among men, age-specific analyses indicated that the effect of body mass index on physical activity varied with age such that younger (20-39 years of age), thinner men increased their activity, while older (60 years of age and over), thinner men decreased their physical activity more than men of the same age with average body mass index.
Many studies have examined rapidly changing trends in U.S. dietary intake, but not as they correspond to other health inequalities among black and white Americans. The purpose of this study was to explore 30-year trends in diet quality and to examine whether income or education is the key socioeconomic factor linked with these shifts. The 1965 Nationwide Food Consumption Survey and the 1994-1996 Continuing Survey of Food Intake by Individuals were used and included, respectively, 6476 and 9241 respondents who were aged > or =18 years. The Revised Diet Quality Index (DQI-R), an instrument that provides a summary assessment of a diet's overall healthfulness, was also used. Between 1965 and 1996, improvements were found in both the overall DQI-R and its components across all education levels, with the exception of calcium intake. Conversely, improvements linked with income effects were inconsistent and less clear. In 1965, the effect of college attendance resulted in a 1.8 point higher DQI-R, higher calcium intake, and increased servings of fruits and vegetables. In 1994-1996, there were consistently improved diets for the overall DQI-R and its components, particularly among college attendees. Diet quality has improved across both race and socioeconomic status groupings between 1965 and 1994-1996; however, education provides a much clearer differentiation. Education efforts must be emphasized to eliminate disadvantages in diet quality.
Characterizing the smoking patterns for different birth cohorts is essential for evaluating the impact of tobacco control interventions and predicting smoking-related mortality, but the process of estimating birth cohort smoking histories has received limited attention. Smoking history summaries were estimated beginning with the 1890 birth cohort in order to provide fundamental parameters that can be used in studies of cigarette smoking intervention strategies. U.S. National Health Interview Surveys conducted from 1965 to 2009 were used to obtain cross-sectional information on current smoking behavior. Surveys that provided additional detail on history for smokers including age at initiation and cessation and smoking intensity were used to construct smoking histories for participants up to the date of survey. After incorporating survival differences by smoking status, age-period-cohort models with constrained natural splines were used to estimate the prevalence of current, former, and never smokers in cohorts beginning in 1890. This approach was then used to obtain yearly estimates of initiation, cessation, and smoking intensity for the age-specific distribution for each birth cohort. These rates were projected forward through 2050 based on recent trends. This summary of smoking history shows clear trends by gender, cohort, and age over time. If current patterns persist, a slow decline in smoking prevalence is projected from 2010 through 2040. A novel method of generating smoking histories has been applied to develop smoking histories that can be used in micro-simulation models, and has been incorporated in the National Cancer Institute's Smoking History Generator. These aggregate estimates developed by age, gender, and cohort will provide a complete source of smoking data over time.
There is limited research on rural-urban disparities in U.S. life expectancy. This study examined trends in rural-urban disparities in life expectancy at birth in the U.S. between 1969 and 2009. The 1969-2009 U.S. county-level mortality data linked to a rural-urban continuum measure were analyzed. Life expectancies were calculated by age, gender, and race for 3-year time periods between 1969 and 2004 and for 2005-2009 using standard life-table methodology. Differences in life expectancy were decomposed by age and cause of death. Life expectancy was inversely related to levels of rurality. In 2005-2009, those in large metropolitan areas had a life expectancy of 79.1 years, compared with 76.9 years in small urban towns and 76.7 years in rural areas. When stratified by gender, race, and income, life expectancy ranged from 67.7 years among poor black men in nonmetropolitan areas to 89.6 among poor Asian/Pacific Islander women in metropolitan areas. Rural-urban disparities widened over time. In 1969-1971, life expectancy was 0.4 years longer in metropolitan than in nonmetropolitan areas (70.9 vs 70.5 years). By 2005-2009, the life expectancy difference had increased to 2.0 years (78.8 vs 76.8 years). The rural poor and rural blacks currently experience survival probabilities that urban rich and urban whites enjoyed 4 decades earlier. Causes of death contributing most to the increasing rural-urban disparity and lower life expectancy in rural areas include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, and diabetes. Between 1969 and 2009, residents in metropolitan areas experienced larger gains in life expectancy than those in nonmetropolitan areas, contributing to the widening gap.
Hip fractures are a major cause of morbidity and mortality in the United States. Twenty to 40% of persons who fracture their hips die within 6 months of the injury, and many survivors need long-term care. To assess the public health impact of hip fractures in the United States, we analyzed sample-based data from the National Hospital Discharge Survey, National Center for Health Statistics, for the United States for the period 1970-83. For these years, an estimated annual average of 197,000 persons 45 years of age or older was hospitalized for hip fractures. The age-, race-, and sex-adjusted hospitalization rates for hip fractures rose from 28.9 per 10,000 persons in 1970 to 30.9 per 10,000 in 1983 (P less than .01). Hospitalization rates rose exponentially by successive 10-year age groups, with persons 85 years of age or older having the highest rate (251.4 per 10,000). For each age group, women had hospitalization rates twice those of men, and whites had hospitalization rates twice those of other races. Never-married and divorced persons had higher hospitalization rates than currently married persons. The percentage of mortality before discharge from hospital fell from 11% in 1970 to 6% in 1983, with most of the decrease occurring among persons 75 years of age or older. The age-adjusted mean length of hospital stay declined 24%, from 23.9 days in 1970 to 18.2 days in 1983.(ABSTRACT TRUNCATED AT 250 WORDS)
The purpose of this study was to examine how major nightly television networks reported on the health benefits of physical activity. A retrospective content analysis of physical activity coverage on four major nightly television networks from 1970 to 2001 was performed. The Vanderbilt Television News Archives were searched for keywords "physical activity," "physical fitness," and "exercise." During the 31-year time period, 111 non-overlapping reports aired on all networks combined. The link between physical activity and health was reported in 53 (47.7%) articles, with general health (n =16, 14.4%) and heart disease (n =12, 12.6%) cited most frequently. Just three broadcasts related to the Surgeon's General Report on Physical Activity and Health were aired following its publication in 1996. Although the protective health benefits of physical activity are well established, physical activity received a modest amount of television coverage from 1970 through 2001.
Massachusetts birth and death certificate tapes for the years 1970-1980 were linked and analyzed to determine causes of death in the neonatal and postneonatal periods and to identify any related sociodemographic factors. Our analysis suggests that, although the neonatal mortality rate declined by about 43 percent, the postneonatal mortality rate remained relatively unchanged. Perinatal problems remained the principal cause of death during the neonatal period, throughout the decade. In the postneonatal period, congenital malformations became a leading cause of death toward the end of the decade because of a reduction in mortality from infectious diseases and perinatal problems. Infants born to mothers under 18 and over 34 years of age had the highest death rates from congenital birth defects. Higher mortality rates caused by congenital malformations were found in the more industrialized areas of Massachusetts. Further declines in infant mortality rates in Massachusetts will depend on preventive measures to reduce the incidence of congenital malformations.
Breast cancer is the second-leading cause of cancer-related deaths among women aged <50 years. Studies on the effects of breast cancer mortality among young women are limited. To assess trends in breast cancer mortality rates among women aged 20-49 years, estimate years of potential life lost (YPLL), and the value of productivity losses due to premature mortality. Age-adjusted rates and rate ratios (RRs) were calculated using 1970-2008 U.S. mortality data. Breast cancer mortality rates over time were assessed using Joinpoint regression modeling. YPLL was calculated using number of cancer deaths and the remaining life expectancy at the age of death. Value of productivity losses was estimated using the number of deaths and the present value of future lifetime earnings. From 1970 to 2008, the age-adjusted breast cancer mortality rate among young women was 12.02/100,000. Rates were higher in the Northeast (RR=1.03, 95% CI, 1.02-1.04). The annual decline in breast cancer mortality rates among blacks was smaller (-0.68%) compared with whites (-2.02%). The total number of deaths associated with breast cancer was 225,866, which accounted for an estimated 7.98 million YPLL. The estimated total productivity loss in 2008 was $5.49 billion and individual lifetime lost earnings were $1.10 million. Considering the effect of breast cancer on women of working age and the disproportionate impact on black women, more age-appropriate interventions with multiple strategies are needed to help reduce these substantial health and economic burdens, improve survival, and in turn reduce productivity costs associated with premature death.
Disparities in the health status of blacks and whites have persisted despite considerable gains in improved health of the U.S. population. Tracking changes in black-white differentials in dietary attributes over time may help in understanding the contribution of diet to these disparities. Data were used from four National Health and Nutrition Examination Surveys conducted between 1971 and 2002 for trends in self-reported intakes of energy, macronutrients, micronutrients, fruits and vegetables, and the energy density of foods among U.S. non-Hispanic black (n=7099) and white (n=23,314) men and women aged 25 to 74 years. Logistic and linear regression methods were used to adjust for multiple covariates and survey design. Energy intake, amount of food, and carbohydrate energy increased, whereas percentage of energy from protein, fat, and saturated fat decreased over time in all race and gender groups (p<0.001). In whites and in black women, energy density increased (p<0.001) in parallel to increases in obesity prevalence. In all surveys, black men and women reported lower intakes of vegetables, potassium, and calcium (p<0.001) than their white counterparts. In men, the race differential in calcium intake increased across surveys (p=0.004). Dietary intake trends in blacks and whites from 1971 to 2002 were similar, which suggests that previously identified dietary risk factors that differentially affect black Americans have not improved in a relative sense.
Top-cited authors
Dale Nordenberg
Valerie Edwards
  • Centers for Disease Control and Prevention
Neville Owen
  • Baker Heart and Diabetes Institute
Steven Teutsch
Steven Woolf
  • Virginia Commonwealth University