Annual Review of Public Health

Published by Annual Reviews
Online ISSN: 1545-2093
Publications
Article
Research studies over the past several decades confirm the health benefits of regular physical activity, a concept with foundations in antiquity. The effects of activity on certain individual health conditions, the precise dose of activity that is required for specific benefits, the role (if any) of intensity of effort, and the elucidation of biological pathways whereby activity contributes to health are topics for further research. Although details remain to be clarified, it is now clear that regular physical activity reduces the risk of morbidity and mortality from several chronic diseases and increases physical fitness, which leads to improved function. Table 3 outlines the relationship of activity to several diseases, a judgment on the strength of the evidence, and a rough determination of the amount of research extant. Results from clinical exercise studies and epidemiological investigations can be integrated into a consistent and coherent theory of healthful physical activity. However, some differences between these two research streams need to be reconciled. Exercise physiologists have generally recommended relatively intensive activity and a formal approach to exercise prescription. The epidemiological studies suggest a linear dose-response relationship, at least up to a point, between physical activity and health and functional effects. These data support public health recommendations directed toward the most sedentary and unfit stratum of the population and emphasize doing at least moderate physical activity. If this group of adults would accumulate 30 minutes of walking per day (or the equivalent energy expenditure in other activities), they would receive clinically significant health benefits. An important point is that it does not matter what type of physical activity is performed: Sports, planned exercise, household or yard work, or occupational tasks are all beneficial. The key factor is total energy expenditure; if that is constant, improvements in fitness and health will be comparable. There are probably 40 million adults in the US whose sedentary habits place them at considerably increased risk of morbidity and mortality from several diseases. These same individuals also are more likely to have functional limitations, especially as they move into the later years of life. The sizable independent relative risk for impaired health in sedentary persons, and the large number at risk, leads to a substantial public health burden. This problem deserves continued and increased attention by physicians and other health professionals, scientists, and the public health establishment.
 
Article
Urbanization, resource exploitation, and lifestyle changes have diminished possibilities for human contact with nature in urbanized societies. Concern about the loss has helped motivate research on the health benefits of contact with nature. Reviewing that research here, we focus on nature as represented by aspects of the physical environment relevant to planning, design, and policy measures that serve broad segments of urbanized societies. We discuss difficulties in defining "nature" and reasons for the current expansion of the research field, and we assess available reviews. We then consider research on pathways between nature and health involving air quality, physical activity, social cohesion, and stress reduction. Finally, we discuss methodological issues and priorities for future research. The extant research does describe an array of benefits of contact with nature, and evidence regarding some benefits is strong; however, some findings indicate caution is needed in applying beliefs about those benefits, and substantial gaps in knowledge remain. Expected final online publication date for the Annual Review of Public Health Volume 35 is March 18, 2014. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
 
Article
Methodologies involving the use of quality-of-life patient outcomes in observational and interventional studies of health are drawn from a large and diverse field of research methods. The multidimensional way in which quality of life is conceptualized will affect the way it is measured and the complexity of the measurement. At the earliest stages of research, one must rely on methods common to the fields of tests and measurement, survey research, psychometrics and sociometrics to measure constructs that are not directly observable. Indices measuring performance can either focus on the scale's ability to perform in noninterventional, cross-sectional studies or interventional, longitudinal studies. Indices of stability, internal consistency, responsiveness with respect to true changes in quality of life, and sensitivity to treatment effects can be used to assess the scale's adequacy as a dependent variable of interest. Respondent variability can occur due to factors such as different reporters (patient, spouse, physician), the manner and form of administration (long form vs short form; self-administration vs interview) and the assessment environment (clinic, home). Finally, since quality-of-life research often involves inferential statistics and hypothesis testing, the statistical and epidemiologic principles of good study design should be followed. In addition, one should account for the reliability, responsiveness, and the sensitivity of the scale when designing the scientific hypotheses, and should specifically address the meaning of quality-of-life effect sizes by interventional-based validation. Design considerations must address the statistical issues of power, the determination of effect sizes through validation by external criteria, longitudinal data, effects of withdrawal and early termination, ceiling and floor effects, and heterogeneity of responsiveness and sensitivity among individuals. The problem of estimating quality-of-life summary parameters for use in pharmacoeconomic models is receiving increasing attention in this era of health-care reform and fiscal restraint. While medical decision theory has used cost-effectiveness models and quality-adjusted life years since the early 1970s, estimation of population parameters to differentiate among different medical interventions is relatively new. The assessment of the patient outcomes associated with medical interventions in terms of the risks, benefits and costs will clearly be a major focus of health-care reform. Development of new methodologies in quality-of-life research should build upon the strong foundation already established in the areas of clinical research, epidemiology, biostatistics, economics and behavioral science.(ABSTRACT TRUNCATED AT 400 WORDS)
 
Pollutants from combustion of biomass and fossil fuels. Adapted from References 142 and 
Article
Energy use is central to human society and provides many health benefits. But each source of energy entails some health risks. This article reviews the health impacts of each major source of energy, focusing on those with major implications for the burden of disease globally. The biggest health impacts accrue to the harvesting and burning of solid fuels, coal and biomass, mainly in the form of occupational health risks and household and general ambient air pollution. Lack of access to clean fuels and electricity in the world's poor households is a particularly serious risk for health. Although energy efficiency brings many benefits, it also entails some health risks, as do renewable energy systems, if not managed carefully. We do not review health impacts of climate change itself, which are due mostly to climate-altering pollutants from energy systems, but do discuss the potential for achieving near-term health cobenefits by reducing certain climate-related emissions. Expected final online publication date for the Annual Review of Public Health Volume 34 is March 17, 2013. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
 
Interventions demonstrated to reduce college drinking problems 
Article
Integrating data from the National Highway Traffic Safety Administration, the Centers for Disease Control and Prevention, national coroner studies, census and college enrollment data for 18-24-year-olds, the National Household Survey on Drug Abuse, and the Harvard College Alcohol Survey, we calculated the alcohol-related unintentional injury deaths and other health problems among college students ages 18-24 in 1998 and 2001. Among college students ages 18-24 from 1998 to 2001, alcohol-related unintentional injury deaths increased from nearly 1600 to more than 1700, an increase of 6% per college population. The proportion of 18-24-year-old college students who reported driving under the influence of alcohol increased from 26.5% to 31.4%, an increase from 2.3 million students to 2.8 million. During both years more than 500,000 students were unintentionally injured because of drinking and more than 600,000 were hit/assaulted by another drinking student. Greater enforcement of the legal drinking age of 21 and zero tolerance laws, increases in alcohol taxes, and wider implementation of screening and counseling programs and comprehensive community interventions can reduce college drinking and associated harm to students and others.
 
Article
Before World War II, epidemiology was a small discipline, practiced by a handful of people working mostly in the United Kingdom and in the United States. Today it is practiced by tens of thousands of people on all continents. Between 1945 and 1965, during what is known as its "classical" phase, epidemiology became recognized as a major academic discipline in medicine and public health. On the basis of a review of the historical evidence, this article examines to which extent classical epidemiology has been a golden age of an action-driven, problem-solving science, in which epidemiologists were less concerned with the sophistication of their methods than with the societal consequences of their work. It also discusses whether the paucity of methods stymied or boosted classical epidemiology's ability to convince political and financial agencies about the needs to intervene in order to improve the health of the people. Expected final online publication date for the Annual Review of Public Health Volume 36 is March 18, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
 
Article
To search for unexplained patterns in cancer incidence, we analyzed data from 1975 to 1994 that represent approximately 10% of the population of the United States. Our analysis focused on long-term time trends in incidence and on deviations from those trends attributable to birth cohorts or to calendar periods. On average, cancer incidence rose 0.8% annually in white women and 1.8% in white men. After removing several cancers related to smoking and increased screening, average annual increases fell to 0.1% in white women but persisted at 1.7% in white men. In particular, yearly increases in non-Hodgkin's lymphoma averaged 2.4% in white women and 4.7% in white men. Among men, incidence changes attributable to cohorts grew progressively larger from one cohort to the next. Cancer incidence patterns among black men and women were similar to those among whites despite smaller population sizes. Unexplained patterns of cancer incidence may signal changes in underlying risk factors and highlight the continuing need for research on cancer etiology and prevention.
 
Article
In the 1960s oral contraception was 1st introduced and IUDs were reintroduced; for the 1st time women in developed countries were liberated from the earlier traditional role of repeated child bearing. Although significant improvements have been made since the 1960s in hormonal and intrauterine contraception very few new contraceptive breakthroughs have been achieved. Developments have been hindered by a decrease in contraceptive research by the pharmaceutical industry. Only 1 major US drug company is currently involved in this area of research as compared with several in the past. This decreased American interest is a result of the product liability issue in the US and complex regulatory requirements. As of 1986 156 million couples are protected by sterilization approximately 72% of these being female sterilization. In the Peoples Republic of China some 59 million women are using IUDs; an additional 24 million women throughout the rest of the world also use this method of birth control. 64 million women are using oral contraceptives; perhaps as many as 200-300 million women have used this method of contraception at 1 time or another over the past 28 years. This makes oral contraceptives probably the most widely used systemic medication for a preventive purpose in the history of medicine. At the same time approximately 57% of the some 850-880 million married couples of reproductive age many of them in the developing world are unprotected. Some of the promising new birth control methods that may be available in the future include new hormonal implants antiprogesterone menses inducers and vaccines.
 
Article
Around 1618 Thomas Adams wrote "He is a better physician that keepes diseases off us than he that cures them being on us; prevention is so much better than healing because it saves the labour of being sick". Where do stand some 370 years later? This review examines the current and possible future world cancer burden identifies the sites of cancer for which a better understanding of etiology is urgently needed (for without knowledge of cause rational prevention is difficult) and sets these topics in the context of cancer prevention today and tomorrow. (excerpt)
 
Article
The use of health-related quality of life measures, especially those based on function, are likely to increase during the next decade. This increase, however, is most likely to occur in clinical research and clinical practice. Unless the necessary political will, resources, data, and policy researchers coexist, there will be relatively little advance in the use of health status measures for decision-making and policy. This prediction is based on the observation that policy research tends to rely on available national data, that currently these data provide limited information about health status, and that there appears to be insufficient interest and resources to broaden data collection or to develop methods that incorporate a broad spectrum of health outcomes (e.g. death, impairment, functional status, and perceptions) into a single instrument or measure of health on large populations and communities. This state of affairs is particularly unfortunate as we face a decade in which available health and medical care may become more limited and social inequity in access and health status may become more marked. The effect of social inequities and restrictions to health care on the health of the nation cannot continue to be determined with reference only to the structure and process of the health care system. Health and quality of life outcomes are what count. And, these outcomes cannot be determined without appropriate and inclusive measures of health-related quality of life. Of course, we hope our prediction is wrong and that the motivation and resources will be found to help resolve methodologic issues in the measurement of population health status and quality of life and to provide the necessary data. We hope that government agencies, employers, and private providers will begin to collect health-related quality of life data on the constituents and populations they serve. Even if these data are imperfect or primitive, the effects of improving accessibility and quality of health care can only be assessed adequately in terms of the health-related quality of life of the nation.
 
Article
Public health policy in the 1990s will be determined not only by factors intrinsic to the health field but by external circumstances related to international and domestic political and economic changes. The prospects for positive action vary with the specific areas of public health policy, since in each instance there are somewhat different sets of interacting factors. In all instances, however, the dominant role of conservative political forces in the United States is a major limiting condition. Gains in specific areas of public health will undoubtedly be made in the coming decade, but fundamental changes in public health policy will require far-reaching changes in the nation's ideology and politics.
 
Article
One image of health promotion views lean and lonely people grimly pursuing health-directed behavior to reduce their risks of premature death, disease, and even aging. Important behavior as such goal-oriented activity may be for that small minority of individuals, and much as public health can point with pride to its development in recent years, it is but a small piece of the more pervasive and problematic web of health-related behavior of individuals, as well as whole families, groups, communities, and organizations. This more pervasive behavior has to do with patterns and conditions of living, eating, playing , working, and just plain loafing, most of which lie outside the realm of the health sector and are not consciously health directed. Here lies the role of health promotion as a public health strategy for the 1990s. HEALTH PROMOTION'S RECENT DEVELOPMENT Health education in public health and medical care has adhered, as a matter of professional ethics and principles of learning, to approaches that involved people actively in the process of setting their own goals and priorities for behavior related to health (34, 35). This insistence on participation and voluntary change in behavior has achieved notable success with conscious health-directed behavior. Health education can be made to work effectively and humanely where people are clearly oriented to solve a discrete and IThis review is adapted from Chapter I of a forthcoming book, Health Promotion Planning:
 
Article
In this review we assess the extent to which programmatic and intellectual emphasis on CCD problems should remain as an appropriate focus in the decade of the 1990s and beyond. To summarize our conclusions we believe that more attention will need to be paid to the problems of postepidemiologic transition environments; that within the pretransition environment relatively more attention needs to be paid to concerns of adults; and that the passage of large fractions of the population of many countries through the transition will impose additional problems in providing continued attention to the health needs of pretransition population subgroups. Several important programmatic shifts are likely to follow from shifts of emphasis toward adults and toward posttransition needs. The nature (and perhaps primacy) of primary prevention will markedly change. Different personnel skills and mixes of facilities will be required. Far more concern for cost containment cost effectiveness and selectivity will need to be shown. To underpin these programmatic shifts parallel changes and developments in research on health issues in developing countries will be needed. (excerpt)
 
Article
During the latter half of the 1980s the broad dimensions of the HIV/AIDS pandemic were delineated through public health surveillance efforts; a global strategy to respond to its growing magnitude was developed by the World Health Organization (WHO) and countries all over the world were mobilized. This chapter reviews the global epidemiologic patterns of HIV/AIDS during the 1980s and provides projections on the future course of these patterns with emphasis on major issues in the prevention and control of this unprecedented challenge to public health and health care systems throughout the world. (excerpt)
 
Article
tuberculo­ sis, and unacceptably high levels of infant and maternal mortality that prevailed during the latter nineteenth and early twentieth century. These problems were due largely to gross lack of sanitation, including fecal con­ tamination of water and food; crowding; and poor public understanding of basic hygiene. In response, many states and local jurisdictions developed health de­ partments to protect people against these severe threats to health. With strong support from legislative bodies, as well as technical and financial support from the federal government, state and local boards of health guided their activities. The departments established laboratories and epidemiologic ser­ vices for investigating the most pressing problems; adopted regulations, including measures of enforcement, for controlling environmental hazards; initiated public health nursing, maternal and child health and other personal health services; and undertook public health education. The formerly high rates of disease and mortality, which typically occur in developing industrial societies, have been vastly reduced through specific public health activities as well as improvements in the general level of living.
 
Article
Where have we come since the Occupational Safety and Health Act was passed in 1970? Have we made progress in this country toward "safe and healthful working conditions for working men and women?" Many hazardous exposures that were prevalent before the creation of NIOSH, OSHA, and MSHA have been reduced. Exposure to asbestos, coal dust, silica, lead, and cotton dust are common examples. Through OSHA's Hazard Communication Standard and state Right to Know laws as well as an increase in the dissemination of information, the average employer and worker today is better informed of specific hazards on the job, and more attentive to safety measures. However, the high toll of work related disease and injuries continues today.
 
Article
For many decades there has been adequate information for the elimination of acute dietary deficiency diseases. Scurvy, beri-beri, and pellagra, once serious scourges, are now seen only rarely. The severe forms of protein-energy malnutrition, kwashiorkor and marasmus, have also decreased greatly. Nonetheless, mild to moderate forms of protein-energy deficiency, exacerbated by infection, continue to impair growth and development in a majority of the low-income pre-school age populations of most developing countries. Deficiencies of iron, iodine, and vitamin A are still widespread in developing countries. Fortunately, the success of the WHO/UNICEF "Child Survival and Development Revolution" in persuading most developing countries to introduce expanded programs of immunization, growth monitoring, and appropriate feeding of young children, control of diarrheal disease, and specific campaigns against avitaminosis A, iodine deficiency disorders, and the functional consequences of iron deficiency, will accelerate the decline of acute deficiency diseases in the developing world. Diets are changing among the more affluent in these countries, however, and it is time for them to stress dietary goals for the health of rich and poor alike. For the first time there is enough information regarding dietary risk factors for chronic disease to provide an opportunity in the 1990s to accelerate the dietary changes that have already brought significant health benefits to some populations in North America and Europe. The changes, which include a lower dietary intake of fat, particularly saturated fat, less salt, and more green and yellow vegetable and whole grain cereals, can be expected to influence favorably morbidity from cardiovascular diseases and some kinds of cancer. For maximum benefit, these measures need to be combined with the avoidance of obesity, reasonable physical activity, abstention from, or moderate use of, alcohol, and avoidance of tobacco in any form. Since there is already considerable momentum toward these changes in North America and some European countries, the 1990s are likely to see substantial further progress in the reduction of chronic diseases known to be influenced by diet.
 
Article
General health status and a broader concept of quality of life are discussed and methods of widely used surveys are reviewed. A consensus regarding the inclusion of measures of physical, mental, social, and role functioning and general health perceptions is noted for comprehensive assessments of health. A schematic of relationships among condition-specific and generic measures is presented along with results expected for objective and subjective measures of physical and mental dimensions of health. Suggestions are offered for the labeling of disease-specific and generic measures and ways to avoid confounding of content. Applications of health surveys in general population monitoring, health policy evaluation, clinical trials of alternative treatments, monitoring and improving of health care outcomes, and in everyday clinical practice are exemplified and discussed. A unified measurement strategy is proposed and arguments in favor of standardizing the content of health surveys across applications are offered.
 
Article
Economic evaluation of pharmaceutical products, or pharmacoeconomics, is a rapidly growing area of research. Pharmacoeconomic evaluation is important in helping clinicians and managers make choices about new pharmaceutical products and in helping patients obtain access to new medications. Over the last few years, the scientific rigor of this field has increased greatly. At the same time, new types of analysis, based on prospective data collection, have been developed. This article reviews the basic concept of pharmacoeconomics, the types of data available for economic evaluation, and the "state of the art" in pharmacoeconomics as reported in the medical literature.
 
Number of articies using spatial methods, total by year and total for first part of decade and second part of decade (2000–2011).  
Percent of total articles using spatial methods by substantive topic and publication during the first (2000–2005) and second parts of decade (2006–2010) " Resources " category includes health care, food and physical activity environments, facility location analyses etc.; " Other environmental " includes toxic waste, pesticides, electromagnetic fields, etc.  
Article
Understanding the impact of place on health is a key element of epidemiologic investigation, and numerous tools are being employed for analysis of spatial health-related data. This review documents the huge growth in spatial epidemiology, summarizes the tools that have been employed, and provides in-depth discussion of several methods. Relevant research articles for 2000-2010 from seven epidemiology journals were included if the study utilized a spatial analysis method in primary analysis (n = 207). Results summarized frequency of spatial methods and substantive focus; graphs explored trends over time. The most common spatial methods were distance calculations, spatial aggregation, clustering, spatial smoothing and interpolation, and spatial regression. Proximity measures were predominant and were applied primarily to air quality and climate science and resource access studies. The review concludes by noting emerging areas that are likely to be important to future spatial analysis in public health.
 
Three estimates of the prevalence of Alzheimer's disease, by stage, United States, 2000-2050*
Article
Recent developments in basic research suggest that therapeutic breakthroughs may occur in Alzheimer's disease treatment over the coming decades. To model the potential magnitude and nature of the effect of these advances, historical data from congestive heart failure and Parkinson's disease were used. Projections indicate that therapies which delay disease onset will markedly reduce overall disease prevalence, whereas therapies to treat existing disease will alter the proportion of cases that are mild as opposed to moderate/severe. The public health impact of such changes would likely involve both the amount and type of health services needed. Particularly likely to arise are new forms of outpatient services, such as disease-specific clinics and centers. None of our models predicts less than a threefold rise in the total number of persons with Alzheimer's disease between 2000 and 2050. Therefore, Alzheimer's care is likely to remain a major public health problem during the coming decades.
 
Article
Report focus is on the general problem of designing and developing information systems equal to the task of promoting and monitoring "Health for All by the Year 2000." Attempting to bridge the gap between theory and practice, this 2-part report proposes some priorities and guidelines for organizing and focusing the efforts of the many agencies, groups, and individuals working on health statistics worldwide; and concentrates on the situation in less developed countries where health information networks in support of the decision making process continue to be very weak and their content and organization need reappraisal. An illustrative set of health indicators for national health planning in a developing country is used to take stock of available concepts of measurement, to test their relevance and feasibility, and to consider the steps necessary to translate these concepts into operational health information systems. There are numerous advantages in concentrating on what are commonly termed "health indicators" and using them as a point of departure for collecting data and building information networks. Indicators define the content of data systems, a step that should logically precede decisions regarding data series, methods, staffing, and organizations. If properly designed to reflect the primary objectives of national or community health policy, a set of indicators serves as the minimum specifications of the information support system and describes its overall task. Health indicators are also an excellent way to promote statistical comparability within and among health care systems. Health indicators in the model presented are defined as statistics selected from the larger pool because they have the power to summarize, to represent a larger body of statistics, or to serve as indirect or proxy measures for information that is lacking. It would be both self-defeating and contrary to World Health Organization (WHO) goals to adopt a narrow perspective on health indicators and information systems. Those working on health indicators need to be in close touch with developments in the social indicators field. The following are among the major points made in the review and evaluation of some of the concepts and methods available to developing countries in designing health information systems for the year 2000: utility of proposed indicators, primarily for planning, monitoring, and evaluation at the national level, but also to some extent at the community level; state of readiness; validity, reliability, specificity, sensitivity, and economy or efficiency of proposed measures; feasibility, i.e., have practical and affordable methods of data acquisition been demonstrated; basic subcategories and disaggregations; compatibility with socioeconomic concerns and indicators; comparability with concepts of measurement used in more developed countries; and principal areas in need of further research and development.
 
Article
Healthy People 2010 is a comprehensive framework for improving the health of Americans, built on the foundation of several decades of predecessor initiatives. Its two overarching goals, to "[i]ncrease the quality and years of healthy life" and "[e]liminate health disparities," subsume 28 focus areas and comprise 955 objectives and subobjectives. This review evaluates progress toward meeting the Healthy People 2010 program's challenging agenda in the context of leading health indicator (LHI) measures, developed by the Department of Health and Human Services (DHHS), augmented by additional objectives for a total of 31 measures. Our evaluation of progress includes analysis of changes in objective values, including progress toward Healthy People 2010 targets, where appropriate, and analysis of changes in disparities. The Healthy People 2010 LHI measures suggest that although some progress has been made, there is much work to be done toward the Healthy People 2010 targets and both overarching goals.
 
Article
The chapter begins with a reminder that forecasting changes in the health care sector a quarter to a third of a century in the future is likely to be a losing effort, based on past experience. It next considers changing organization and financing and questions that managed care and market competition will be the key forces introducing change. The author looks forward to the passage of universal health insurance coverage for essential care by early in the new century, with patients having to pay for more choice and more quality. The analysis next focuses on the physician supply and points to three challenges: how to moderate the numbers being trained; whether to reconsider the conventional wisdom of training more generalists; and how to support more resources for the National Health Service Corps to improve coverage in underserved areas. The author predicts the restructuring of acute care hospitals, with a marked reduction of in-patient beds, and that leading-edge research-oriented academic health centers should be able to remain out in front. There are also potential gains in health status from prevention and molecular medicine in a nation where chronic disease will dominate.
 
Article
Health among the older population as measured by most dimensions has improved during the last two decades. Mortality has continued to decline, and disability and functioning loss are less common now than in the past. However, the prevalence of most diseases has increased in the older population as people survive longer with disease, and the reduction in incidence does not counter the effect of increased survival. On the other hand, having a disease appears to be less disabling than in the past.
 
Article
Community-based research in public health focuses on social, structural, and physical environmental inequities through active involvement of community members, organizational representatives, and researchers in all aspects of the research process. Partners contribute their expertise to enhance understanding of a given phenomenon and to integrate the knowledge gained with action to benefit the community involved. This review provides a synthesis of key principles of community-based research, examines its place within the context of different scientific paradigms, discusses rationales for its use, and explores major challenges and facilitating factors and their implications for conducting effective community-based research aimed at improving the public's health.
 
Article
Abortion is an issue of great public concern and debate. The majority of US citizens support a woman's right to choose, but it has not always been that way. Abortion was made legal in 1973 but women have been abortions for hundreds of years before that. The history of abortion is therefore a history of women breaking the law and subjecting themselves to great physical and social risk. Abortion law in the US has been changed mostly by the Supreme Court. After Roe v Wade (1973) there were many other cases brought before the Court involving federal and state funding of abortion, father's rights, parental consent for minors, and many other finer points of law and policy regarding abortion. Abortion is commonly practiced in many developing countries including the ones where it is illegal. The data collected from these countries gives researchers here a great deal of information on the clinical and sociological aspects of abortion. Medical technology has broadened the scope of abortion by introducing medication to induce abortion such as RU486. Abortion is no longer an exclusively surgical procedure. Since it can performed now with a pill it will be almost impossible to regulate it as strictly as before.
 
Article
Abortion is an extremely safe and common medical procedure. In the United States, over one million women had an abortion in the year 2000. Advances in early abortion techniques have helped to increase the proportion of early procedures, the safest type. Abortion rates have been declining since the early nineties among adults and adolescents, but rates among poor, minority women remain high. State restrictions to abortion have a larger impact on poor women and young women. Restrictions and regulations have also resulted in the concentration of abortion services in specialized clinics. These clinics are subject to harassment. The expansion of abortion services to more types of providers could increase access, as well as integrate abortion into women's health care.
 
Article
Tobacco use exerts a huge toll on persons with mental illnesses and substance abuse disorders, accounting for 200,000 of the annual 443,000 annual tobacco-related deaths in the United States. Persons with chronic mental illness die 25 years earlier than the general population does, and smoking is the major contributor to that premature mortality. This population consumes 44% of all cigarettes, reflecting very high prevalence rates plus heavy smoking by users. The pattern reflects a combination of biological, psychosocial, cultural, and tobacco industry-related factors. Although provider and patient perspectives are changing, smoking has been a historically accepted part of behavioral health settings. Additional harm results from the economic burden imposed by purchasing cigarettes and enduring the stigma attached to smoking. Tailored treatment for this population involves standard cessation treatments including counseling, medications, and telephone quitlines. Further progress depends on clinician and patient education, expanded access to treatment, and the resolution of existing knowledge gaps.
 
Top-cited authors
Howard Frumkin
  • University of Washington School of Public Health
Ronald C. Kessler
  • Harvard Medical School
Evelyn Bromet
  • Stony Brook University
William Ascher
  • Claremont McKenna College
Karla A Henderson
  • North Carolina State University