Jonathan E. Fielding's research while affiliated with Department of Public Health - Los Angeles County and other places
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Publications (72)
Objectives
We sought the perspectives of lead public health officials working to improve health equity in the USA regarding the drivers of scientific evidence use, the supply of scientific evidence and the gap between their evidentiary needs and the available scientific evidence.
Design
We conducted 25 semistructured qualitative interviews (April...
An increasing number of individuals in the United States opt for elective joint replacements to maintain active lifestyles. Approximately 505 000 hip replacements and 723 000 knee replacements were performed in the United States in 2014, costing more than $20 billion.¹ In a country spending nearly 18% of its gross domestic product on health care wi...
A federal law prohibits the US Government from negotiating pharmaceutical prices. This law comes with an opportunity cost: resources spent on unnecessarily highly priced drugs cannot be spent on other social goals. To calculate the opportunity cost of this spending, this analysis first identified a proxy for unnecessarily high pharmaceutical spendi...
As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high...
High school completion (HSC) is an established predictor of long-term morbidity and mortality. U.S. rates of HSC are substantially lower among students from low-income families and most racial/ethnic minority populations than students from high-income families and the non-Hispanic white population. This systematic review assesses the effectiveness...
This commentary provides reflections of a public health official on the important role public health departments play in advancing the goals of the larger public health enterprise in big cities, counties, and large metropolitan areas.
Social, physical, and economic environments are the greatest determinants of our individual and collective health. Inadequate or substandard environments of all types present barriers to health. Addressing these broader determinants will be the quintessential core in the next era of public health practice. The framework for health improvement is sh...
The success of public health has been its ability to understand contemporary health problems, to communicate the needs successfully, to identify solutions, and to implement them through programs and policies. In the past 50 years, those successes can be attributed largely to control of infectious disease, improved maternal and child health, deliver...
Dr. Fielding will be receiving the Fries Prize for Improving Health for his pioneering work in identifying and implementing effective work-site and public health programs and policies that have resulted in the improvement of the health of millions of Americans. He will speak about these issues.
The passage of the Affordable Care Act builds on and strengthens the foundation for prevention and wellness that Healthy People—the nation's health promotion and disease prevention aspirations for a healthier nation—established. The Affordable Care Act reaffirms the themes of Healthy People by promoting population-based prevention and sets the stag...
Local and state health departments are well-positioned to serve as catalysts for the institutional and community changes needed to increase physical activity across the population. Efforts should focus on evidence-based strategies, including promotion of high-quality physical education in schools, social support networks and structured programs for...
Monitoring the health status of populations is a core function of all public health agencies but is particularly important at the municipal and community levels, where population health data increasingly are used to drive public health decision making and community health improvement efforts. 1– ³ Unfortunately, most local health jurisdictions lack...
The illegal sale of prescription medications by unlicensed vendors is a widespread practice in Los Angeles County. Many members of ethnic and particularly Latino communities turn to unlicensed vendors because of financial and cultural reasons and/or a lack of access to the U.S. health care system. In response, Los Angeles County Department of Healt...
A promising public health approach for reducing adolescent risk behavior is to recognize and support the role of parents in promoting healthful behaviors. Although there are various settings where parents can be reached, this article focuses on one particular setting--the parent's place of employment. The article discusses the development and imple...
The Los Angeles County Department of Health Services revamped its retail food establishment inspection program in 1998 to include, among other novel provisions, the prominent posting of grades. The purpose of the present study is to examine results from the second year of the revamped program to determine the longer-term impact of the program.
An a...
This report presents the results of systematic reviews of effectiveness, applicability, other effects, economic evaluations, and barriers to use of selected population-based interventions intended to reduce tobacco use and exposure to environmental tobacco smoke. The related systematic reviews are linked by a common conceptual approach. These revie...
Comparison of the evidence summaries presented here reveals considerable general
agreement on the effectiveness or ineffectiveness of the interventions reviewed,
with only a few instances in which different reviews reached different conclusions.There is uniform agreement on the effectiveness of the clinical interventions,
although the magnitude of...
In 1998, Los Angeles County's Department of Health Services (DHS) embarked on a planning process to expand ambulatory care services for the county's 2.7 million uninsured and otherwise medically indigent residents. This planning process was novel in two ways. First, it used a quantitative, needs-based approach for resource allocation to ensure an e...
Contents: When the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) is published in 2001, it will represent a significant national effort in encouraging evidence-based public health practice in defined populations (e.g., communities or members of specific managed care plans). The Guide will m...
Objectives: This paper describes the methods used in the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) for conducting systematic reviews of economic evaluations across community health-promotion and disease-prevention interventions. The lack of standardized methods to improve the comparabi...
Systematic reviews and evidence-based recommendations are increasingly important for decision making in health and medicine. Over the past 20 years, information on the science of synthesizing research results has exploded. However, some approaches to systematic reviews of the effectiveness of clinical preventive services and medical care may be les...
The purpose of this research is to examine the state-of-the-art in community health report card development and use in order to increase their effective integration into community health improvement efforts.
A mailed survey was sent to 115 "report card" communities nationwide. This list was generated through multiple key informants at the national,...
Substantial advances in public health methods, practice, and the health of the public have occurred in the twentieth century. Some of the contributions most notable for their impact on mortality and longevity are vaccine development and widespread use, smallpox eradication, large reductions in communicable disease epidemics, and the rise and declin...
Introduction: The purpose of this research is to examine the state-of-the-art in community health report card development and use in order to increase their effective integration into community health improvement efforts.Methods: A mailed survey was sent to 115 “report card” communities nationwide. This list was generated through multiple key infor...
The purpose of this project is to develop a health risk appraisal for the elderly (HRA-E) and test its application in both medical and nonmedical settings. The HRA-E system consists of a questionnaire and software for computer-generation of personalized reports to participants, 55 years and older, and their physicians. Items in the questionnaire co...
This article identifies new research and policy directions for the field of worksite health in the context of the changing American workplace. These directions are viewed from an ecological perspective on worksite health and are organized around three major themes: (1) the joint influence of physical and social environmental factors on occupational...
THIS ARTICLE examines the role of worksite health promotion in the context of the changing American workplace and the rapidly evolving US health care system. Societal changes are altering the structure, incentives for, and locations of work, as well as the organization and provision of health care services. These changes—including trends toward cor...
To evaluate the incremental effectiveness of a worksite cholesterol control management program when added to an established, comprehensive health promotion program at the worksite, we conducted a randomized, controlled trial including both blue- and white-collar employees at four geographically dispersed worksites. One hundred twenty-seven employee...
To evaluate the association of participation in IBM's "A Plan for Life" program with changes in blood pressure, serum total, high-density lipoprotein, and non-high-density lipoprotein cholesterol, body mass index, and cigarette smoking, we compared changes in these measures over a 1- to 5-year period among program participants and nonparticipants i...
To evaluate the incremental effectiveness of a work-site blood pressure control program, we conducted a randomized, controlled trial at four work sites with established health promotion programs. Workers with blood pressures of 140/90 mm Hg or higher were eligible. Eighty subjects were assigned to receive a referral to a community physician, monthl...
The effect of an employer-sponsored health promotion program on worker absenteeism is examined over a 4-year period in a group of 4972 Duke University hourly employees. Program participants experienced an average of 4.6 fewer absentee hours in the third year of program availability than did nonparticipants, after controlling for baseline absenteeis...
Purpose of the Review
Psychological disorders are one of the 10 leading work-related diseases and injuries in the United States according to the National Institute for Occupational Safety and Health. This article addresses occupational mental health and preventive stress management in the workplace. The individual and organizational costs are brief...
To assess the impact of safety belt laws, we compared self-reported use of safety belts among employed residents of states with primary, secondary, and no laws in a group of 17,830 volunteer health profile participants. Failure to wear safety belts at least 80% of the time was reported by 22% of subjects covered by primary laws, 23% of those covere...
To determine the utilization rates of selected preventive services in an employed population, we analyzed the responses of 18,053 health profile participants. Overall utilization rates for preventive services were high: 86.0% of respondents had their blood pressure checked, 94.0% of all women had a Pap smear and 81.3% had clinical breast examinatio...
To determine the prevalence and correlates in a working population of failure to wear seat belts, drinking and driving, and speeding, we examined the responses of 18,046 health-profile participants. Twenty-four percent of subjects reported failure to wear seat belts at least 80% of the time. Twenty-two percent reported speeding at least 10 miles pe...
To determine the prevalence and correlates in a working population of failure to wear seat belts, drinking and driving, and speeding, we examined the responses of 18 046 health-profile participants. Twenty-four percent of subjects reported failure to wear seat belts at least 80% of the time. Twenty-two percent reported speeding at least 10 miles pe...
This study examined the prevalence and demographic characteristics of chronic heavy drinkers, binge drinkers, those who report a problem with alcohol, and those at high risk for alcohol-related problems.
The sample comprised a worksite population of 18,053 employees. The study was based on responses to questions contained in a confidential health p...
Adolescent pregnancy, often unplanned and unwanted, has a negative impact on the physical, emotional, educational, and economic condition of the pregnant teenager. Forty percent of the one million adolescents who became pregnant in 1986 chose abortion, and, of the remainder, 61% were unmarried. Teenage mothers in greater numbers and at younger ages...
As part of the National Worksite Health Promotion Survey, a representative sample of worksites across the United States with 50 or more employees was asked about the presence and types of activities they sponsor to promote smoking control. Smoking control activities were reported at 35.6% (CI 32.6-38.6) of all worksites. Among worksites with any sm...
Worksite health promotion programs have become increasingly prevalent in the United States, and one or more health promotion
programs are found in two-thirds of all private worksites with 50 or more employees. Reasons for recent growth in program
frequency include increased concern for worker health, rapidly escalating employer payments for health...
Approximately 1 million teenage girls in the United States become pregnant each year. In 1986, more than 40% obtained abortions and over 470,000 gave birth, with 38% of those births to women 17 years and younger.1 In 1986, 61% of the adolescents who completed their pregnancies were unmarried at the time of the infant’s birth, compared to 15% in 196...
Colorectal cancer has long been the target of efforts aimed at early detection. It is the second most common cancer in the United States, with 140,000 new cases and 60,000 deaths estimated to have occurred in 1987.1 Uncommon in individuals under 50, its incidence increases sharply thereafter.2 Investigations into the causes of colorectal cancer hav...
Data from the National Survey of Worksite Health Promotion Activities include information about health risk assessment (HRA) activities available at private sector worksites in the United States. HRA activities were found at 29.5% of all worksites. Of those worksites, 24% provided HRA questionnaires and 77.4% provided periodic health/physical exami...
GENERAL BACKGROUND
Colorectal cancer has long been the target of efforts aimed at early detection. It is the second most common cancer in the United States, with 140 000 new cases and 60 000 deaths estimated to have occurred in 1987.1 It is uncommon in persons younger than 50 years but its incidence increases sharply thereafter.2 Investigations in...
ALTHOUGH each year since 1964 the Surgeon General has identified smoking as the single most important cause of preventable mortality, of late attention has been focused increasingly on the health effects of involuntary, or passive, smoking. When this topic was first raised in the 1972 Report of the Surgeon General,1 only a handful of studies addres...
This study examined the effectiveness of a tobacco and alcohol prevention program that was delivered to sixth and seventh grade students by minimally trained classroom teachers. The program focused on (a) teaching students to identify and resist peer influences, (b) information about short- and long-term consequences of tobacco and alcohol use, (c)...
This paper deals with the economic and social factors that influence the provision of preventive services in the United States. While preventive services may be provided efficiently and effectively by a variety of health care professionals, physicians are the primary target of this review. Reference is also made to the role of other health professi...
Every year, highway crashes cause tens of thousands of deaths and millions of nonfatal injuries, many of which can be prevented. Following a mandate from the US Preventive Services Task Force, in this article we describe the magnitude of the automobile injury problem, identify injury risk factors that might be reduced by clinically based preventive...
This study reexamines the use of the bogus pipeline as a means of enhancing self-reports of cigarette smoking among adolescent subjects who have been measured previously. Ninth graders who had been measured four times previously and eighth graders who had been measured twice previously were either put under the bogus pipeline condition through the...
Selective attrition can detract from the internal and external validity of longitudinal research. Four tests of selective attrition applicable to longitudinal prevention research were conducted on data bases from two recent studies. These tests assessed (1) differences between dropouts and stayers in terms of pretest indices of primary outcome vari...
Drawing upon the epidemiological, clinical, and behavioral studies suggesting the importance and feasibility of multidisciplinary efforts to reduce levels of risk variables for cardiovascular and other chronic diseases, a short-term live-in intervention program was developed. The program includes efforts to reduce smoking, weight, blood lipids, blo...
The smoking cessation component of a residential program which attempts to concurrently intervene on several risk factors related to chronic disease is described. Seventy-two per cent of the 43 smokers in the first 13 cohorts were abstinent at discharge. Fifty-five per cent were abstinent at two months. Six-month data for the first nine cohorts sho...
Contents: When the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) is published in 2001, it will represent a significant national effort in encouraging evidence-based public health practice in defined populations (e.g., communities or members of specific managed care plans). The Guide will m...
Citations
... 5 Data derived from quantitative and economic models estimating the relative impact and cost of public health or multisector interventions on different subpopulations may help leaders optimize the use of resources. 6 Multiple qualitative analyses of policy advisors and lead public health officials suggest a high level of interest in using information derived from quantitative and economic models to make policy and program decisions. [7][8][9] However, there is also evidence that substantial barriers to the acquisition and use of this type of information among public health departments exist. ...
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... 5 6 9 Moreover, randomised control trials as well as observational evidence have suggested that first-line interventions have the potential to delay the need for knee replacement, a surgery expected to become economically unsustainable in the upcoming decades. [10][11][12][13][14] Mapping the management of knee OA preceding knee replacement can thus provide valuable information to identify gaps and guide implementation strategies. Current evidence describing the pathway to knee replacement is limited by small studies with crosssectional designs, studies focusing on a single therapy such as analgesics, or relying on self-reported data. ...
... The result has been a creeping accrual of serious harms: people having to choose between health care and food; life-altering government programs cut or pared to the bone. Some of those programs, such as public education, 4 have a stronger association with health outcomes than many medical interventions. ...
... The consequences are even more profound, given the uncomfortable reality that the nation spent approximately 19.7% of its gross domestic product on health care in 2020-and more than double the average of 11 other wealthy Organisation for Economic Co-operation and Development (OECD) countries in 2015-thereby crowding out socially needed investments in education, childcare, and other social determinants of health. 12,13,14,15 It is time for the medical profession to double down on its long-standing and admirable commitment to patient autonomy by including informed financial consent as a critical component of its foundational definition of informed consent. In other words, a physician's ethical obligation to a patient should include adequately informing the patient of any financial consequences of nonurgent medical care before that care is provided. ...
... "obesity is the best bet" [P2]). While aligning PA policy with other objectives recognises the benefit of cross-sectoral approaches to public health [64], and participants seemed to realise their interdependent endeavours, it is unclear to what extent they understood their interactions with wider elements in the system, in a manner consistent with the specific implications of interaction that complexity theory proffers. ...
... Moreover, there are some obstacles such as shortage knowledge, sigma, culture difference, poverty affect minority people mental health (Umpierre et al., 2015). And the mental health can be improved by strengthening individual capacity and reducing the stressor (Campell Quick J, 1992). The knowledge and understanding about the nature of mental health is the main key to changing health policies and practices (Herrman H. 2001). ...
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... En la actualidad, ha existido un particular interés en comprender lo que sucede en la educación secundaria (ej. De Witte & Rogge, 2013;Hahn et al., 2015;Mughal, 2020), mientras que en la educación primaria la literatura trata, principalmente, de experiencias locales. ...
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... Networks have been shown to improve LHD performance12131415 and can make the policy process more efficient and innovative [16]. The BCHC has purposefully created a network of the largest health departments in the United States with a key objective of leading the development, adoption, and implementation of public health policy nationwide171819. Their stated purpose makes the group an appropriate point of inquiry around policy-related network issues. ...
... Pour chaque traitement, la force de l'évidence a été déterminée selon les critères de Briss et al. (2000), qui suggèrent un niveau de force pour un ensemble d'études en fonction de leur qualité méthodologique et de la pertinence de leur conception. La force des preuves d'un traitement est jugée forte s'il existe au moins deux études dont l'exécution et la conception conviennent; suffisante s'il n'existe qu'une seule étude dont l'exécution et la conception conviennent; avis d'expert si la qualité de l'exécution et de la conception varie; ou insuffisante s'il n'y a pas assez d'études et si les conceptions ou les exécutions sont insuffisantes. ...
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... With rapidly rising healthcare costs from chronic conditions (Elmslie, 2012;Mirolla, 2004;Public Health Agency of Canada, 2011;Tsasis & Bains, 2008), and such conditions serving as key risk factors for severe infection in pandemics like COVID-19 (Földi et al., 2020;Soeroto et al., 2020;Yang et al., 2021), increasing active living, healthy eating, and social connections are more critical than ever. Individual behaviour change interventions are limited, requiring environmental support (Cole et al., 2019;The Community Guide, 2022;Truman et al., 2000). In 2017, the Chief Public Health Officer of Canada issued a Call to Action for concerted efforts to improve BE to support healthy living (Public Health Agency of Canada, 2017). ...
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