Search

Despite growing support among public health researchers and practitioners for environmental approaches to obesity prevention, there is a lack of empirical evidence from intervention studies showing a favorable impact of either increased healthy food availability on healthy eating or changes in the built environment on physical activity. It is therefore critical that we carefully evaluate initiatives targeting the community environment to expand the evidence base for environmental interventions. We describe the approaches used to measure the extent and impact of environmental change in 3 community-level obesity-prevention initiatives in California. We focus on measuring changes in the community environment and assessing the impact of those changes on residents most directly exposed to the interventions. (Am J Public Health. 2010;100:2129-2136. doi: 10.2105/AJPH. 2010.300002)

Increasing rates of childhood overweight have been linked to the rising energy density of the diet. We sought to provide temporal profiles of dietary energy density (DED) in a nationally representative sample of U.S. children and adolescents [less than or equal to] 19 y old and to describe associations between DED and predictors of overweight. We used a subset of data from the 1994-1996, 1998 Continuing Survey of Food Intake for Individuals (CSFII) and a multivariate regression model to determine independent associations between DED and socioeconomic and demographic variables after controlling for covariates. In this cross-sectional data set, DED was positively associated with total energy intakes and varied with both age and gender. DED increased from birth, peaked at 7-8 y of age, and then declined. Boys consumed more energy-dense diets than girls. Among children [less than or equal to] 4 y old, higher DED was associated in the regression model with lower household incomes and with enrollment in the food stamp program. Among adolescents 12-19 y old, higher DED was associated with being African-American. In contrast, lower DED among children [less than or equal to] 11 y old was associated with being Asian or Hispanic and with total daily consumption of fluid milk. The quality of the diet for young children, as indexed by high DED, may be adversely affected by limited household economic resources. Although food insecurity and WIC enrollment were not associated with DED in this study sample, milk consumption in children [less than or equal to] 4 y old was associated with lower DED. KEY WORDS: * nutrition * dietary energy density * pediatrics * obesity * overweight

Elderly patients whose bile duct is injured during gallbladder surgery may have a higher death rate, according to a study of 1,570,361 patients who were followed for up to 10 years after the operation. Those whose bile duct was injured during the operation were almost three times more likely to die within the next 10 years. Patients who were oldest and had other diseases were most likely to die.

Surgeons may want to inject a dye into the gallbladder and the bile ducts so they won't injure the bile ducts as they remove the gallbladder, according to a study of 1,570,361 gallbladder operations. The risk of injuring the bile ducts was about 70% higher when this was not done, even after accounting for the surgeon's experience. Injury to the bile ducts is a common cause of medical malpractice claims against surgeons.

Between 1995 and 2001, the California Center for Health Improvement (CCHI) initiated eight large-scale surveys of public opinion and performed policy analyses on issues and alternatives related to population health. A nonpartisan organization, CCHI aimed to advance the understanding of social factors and behavior as determinants of health and promote this understanding as a factor in policy making. Opinions of persons knowledgeable about policy making in California were obtained. Data included ninety brief interviews and twenty-four in-depth interviews with key informants who were capable of judging the impact of CCHI's activity. The entry of CCHI into the Sacramento policy community constitutes a natural experiment on the deliberate use of polls and policy analysis to influence policy. Key informants indicated that both polls and policy analysis affect the actions of policy makers. More than 48 percent believed that opinion polls 'moderately' affected and 42.2 percent believed that opinion polls 'strongly' affected the actions of policy makers. More than 58 percent indicated that policy analysis 'moderately' affected and 33.7 percent believed that policy analysis 'strongly' affected policy decisions. Effects of polling and policy analysis appeared to vary according to several contextual factors, such as the substantive policy issue, point in the legislative cycle, and perceived neutrality of the poll or analysis. Study findings provide evidence that polls and policy analyses affect policy by helping establish visibility and framing issues rather than determining outcomes. Hypotheses under a contingency model of factors in policy decision making are suggested., INTRODUCTION Discussions among political scientists, political sociologists, and specialists in policy analysis express considerable uncertainty regarding the effects of public opinion and policy analysis on public decision making. Nevertheless, advocates [...]

The Community Health Promotion Grants Program, sponsored by the Henry J. Kaiser Family Foundation, represents a major health initiative that established 11 community health promotion projects. Successful implementation was characterized by several critical factors: (1) intervention activities; (2) community activation; (3) success in obtaining external funding; and (4) institutionalization. Analysis of the program was based on data from several sources: program reports, key informant surveys, and a community coalition survey. Results indicate that school-based programs focusing on adolescent health problems were the most successful in reaching the populations they were targeting. The majority of the programs were able to attract external funding, thereby adding to their initial resource base. The programs were less successful in generating health promotion activities and in achieving meaningful institutionalization in their communities.

The way physicians are compensated for their services appears to have no effect on the use and cost of health services in managed care plans. In some plans, physicians are paid a salary and in others, physicians are paid on the basis of the services they provide. Researchers examined data on health services use and cost for 865 physicians in 60 medical groups covering 200,931 patients. There was no relation between the type of physician compensation and cost and use of health care services., Context. -- Growth of at-risk managed care contracts between health plans and medical groups has been well documented, but less is known about the nature of financial incentives within those medical groups or their effects on health care utilization. Objective. -- To test whether utilization and cost of health services per enrollee were influenced independently by the compensation method of the enrollee's primary care physician. Design. -- Survey of medical groups contracting with selected managed care health plans, linked to 1994 plan enrollment and utilization data for adult enrollees. Setting. -- medical groups, major managed care health plans, and their patents/enrollees in the state of Washington. Study Participants. -- Sixty medical groups in Washington, 865 primary care physicians (internal medicine, pediatrics, family practice, or general practice) from those groups and affiliated with 1 or more of 4 managed care health plans, and 200 931 adult plan enrollees. Intervention.--The effect of method of primary care physician's compensation on the utilization and cost of health services was analyzed by weighted least squares and random effects regression. Main Outcome Measures. -- Total visits, hospital days, and per member per year estimated costs. Results. -- Compensation method was not significantly (P [is greater than .30) related to utilization and cost in any multivariate analyses. Patient age (P [is less than .001), female gender (P [is less than] .001), and plan benefit level (P [is less than] .001) were significantly positively related to visits, hospital days, and per member per year costs. The primary care physician's age was significantly negatively related (P [is less than] .001) to all 3 dependent measures. Conclusions. -- Compensation method was not significantly related to use and cost of health services per person. Enrollee, physician, and health plan benefit factors were the prime determinants of utilization and cost of health services.

Objective Evaluations of trials of the effectiveness of dietary intervention programs may be compromised by response set biases, such as those attributable to social desirability. Participants who receive a behavioral intervention may bias their reports of diet to appear in compliance with intervention goals. This study examined whether responses to standard dietary assessment instruments could be affected by a brief dietary intervention. Design We assigned 192 undergraduate students randomly to (a) see a 17-minute videotape on the consequences of eating a high-fat diet or a placebo videotape on workplace management and (b) receive preintervention and postintervention assessments or only postintervention assessment. Dietary assessments included 4 independent measures of fat intake. Results Among women, bias (intervention minus control) was -9.7 g fat (from a short food frequency questionnaire) and -0.6 high-fat foods (from a questionnaire about use of 23 foods in the previous day) (P, Evaluations of most research on interventions to promote healthful diets are based on self-reported dietary behavior. The principle problem with this approach is that some respondents may give biased reports [...]

Health care utilization for new members of the Basic Health Plan (BHP) covering the period from 1989 to 1992 was low during the first 6 to 12 months. The utilization of BHP services during the first two years was relatively stable. New members who did not have insurance for more than a year have higher total expenditures compared with those who did not have insurance for less than one year or to those who had never availed of any insurance plan.

and in five relevant California control communities - two suburban, three rural - in 1988, 1990, and 1992. The results showed that the use of both alcohol and marijuana declined […]

Adolescent bonding - attachment to, commitment to, and involvement in conventional social activities - decreases the likelihood of engaging in some risk-taking behaviors. The extent to which bonding opportunities in the school environment affect individual's bonding and risk-taking behaviors is less explored. This study tested a model that includes individual and environmental indicators of bonding to predict cigarette smoking, drinking, drug use, and sexual activity among ninth grade students. Survey data representing students in 20 schools in seven western states are reported. Twelfth grade students' bonding and other demographic variables aggregated by school served as environmental indicators of bonding opportunities to predict ninth grade students' bonding and risk-taking behavior. Path analyses indicate the school environment has a direct influence on ninth grade students' bonding and, in turn, on the likelihood they will engage in risky behavior. Implications of these findings for future research directions and intervention design are discussed (J Sch Health. 1995;65(2):63-68), Among adolescents, behaviors such as substance use and unprotected sexual activity increase their risk for accidents, sexually transmitted diseases, other chronic diseases, and diminished academic performance.[1,2] While socio-environmental and psychological [...]

Objectives. The purpose of this study was to identify circumstances in which biochemical assessments of smoking produce systematically higher or lower estimates of smoking than self-reports. A secondary aim was to evaluate different statistical approaches to analyzing variation in validity estimates. Methods. Literature searches and personal inquiries identified 26 published reports containing 51 comparisons between self-reported behavior and biochemical measures. The sensitivity and specificity of self-reports of smoking were calculated for each study as measures of accuracy. Results. Sensitivity ranged from 6% to 100% (mean = 87.5%), and specificity ranged from 33% to 100% (mean = 89.2%). Interviewer-administered questionnaires, observational studies, reports by adults, and biochemical validation with cotinine-plasma were associated with higher estimates of sensitivity and specificity. Conclusions. Self-reports of smoking are accurate in most studies. To improve accuracy, biochemical assessment, preferably with cotinine-plasma, should be considered in intervention studies and student populations. (Am J Public Health, 1994;84:1086-1093), It appears that self-reports of smoking are accurate in most studies and for most populations. A total of 26 studies of smokers that used participant self-reports and biochemical measures to confirm smoking status were analyzed. The studies included information on 36,830 participants. Almost 38% of the participants completed self-administered questionnaires about smoking habits. The remaining participants were interviewed about their smoking habits. Slightly less than 23% of the participants were students. Interviewer-administered questionnaires, biochemical validation of smoking status with blood plasma cotinine levels, reports by adults and observational studies were associated with higher reporting accuracy. Student participants were more likely to deny smoking even when there was biochemical evidence that they smoked. Biochemical measurements appear to be most appropriate for student populations and interventional studies.

MONITORING THE HEALTH of American Indians Al) is an important national public health goal (1). While systematic nationwide monitoring of a wide range of risk factors has begun only recently […]

Objectives. The purpose of this study was to examine factors predictive of duration of work-related disability. Methods. Multivariate survival analysis techniques were used to conduct a population-based, retrospective cohort study on a random sample of 28 473 workers' compensation claims from Washington State filed for injuries occurring in 1987 to 1989. The principal outcome measure was length of time for which compensation for lost wages was paid, used as a surrogate for duration of temporary total disability. Results. The findings suggest that, even after adjusting severity of injury, older age, female gender, and a diagnosis of carpal tunnel syndrome or back/neck sprain significantly predict longer duration of disability. Other predictors that were stable and significant, but involved lower magnitudes of effect included divorced marital status, firm size of fewer than 50 employees, higher country unemployment rates, and construction and agricultural work. Conclusions. Greater disability prevention efforts targeting these higher risk subgroup could have significant economic and public health effects. The greatest impact may be on claimants who remain disabled at 6 months after an injury that did not require hospitalization. (Am J Public Health 1994;84:190-196), Carpal tunnel syndrome and back or neck sprain injuries are strongly associated with a longer duration of work-related disability in Washington State. A total of 28,473 workers' compensation claims filed with the state between Jan 1, 1987 and Dec 31, 1989 were analyzed. More than half of those who filed claims returned to work within one month of injury. Slightly more than 17% of claimants lost a minimum of six months from work while 12% lost one year and 7.4% lost at least two years. Back sprains accounted for 34% of all injuries. Employees of firms with fewer than 50 workers accounted for 57% of all claims. Hospitalization within 28 days after the date of injury occurred in 6% of the claims. Longer disability duration was associated with patients who were female, older, divorced, with dependents or working for smaller companies.

Objectives. To date, evaluations of community-based prevention programs have focused on assessing outcomes, not the process of organizing communities for health promotion. An approach was developed to analyze community organization efforts aimed at advancing community health objectives. These organizational processes are referred to as community activation. Methods. Information was gathered from 762 informants through a key informant survey conducted in 28 western communities. The data collected included informant ratings of community activation and information about interorganizational activities analyzed through network analytic techniques. Results. Activation levels, as measured by informant ratings, varied across communities. Program coordination, measured by network analysis, occurred, on average, approximately 30% of the time. Higher income communities tended to be more activated than lower income communities. Conclusions. There is a widely recognized need for improved information about health-related community organization activities. It appears possible to gather such information through key informant surveys and to develop measures of community organization status that can be used in the evaluation of community health promotion programs. (Am J Public Health. 1993;83:561-567), Evaluating the organization and implementation of community health programs may assist other communities and advance public health goals. Most community-based prevention programs are evaluated on outcomes, not on the techniques used to lay the foundation and activate the community. Information on levels of community activation was assessed from interviews with 762 key informants in 28 communities. The informants were health experts and representatives of organization and agencies involved in health promotion and were asked to rate aspects of activation such as community leadership, funding, political support and public awareness. They were also asked about relationships between the informant's organization and other organizations in the community to assess the degree to which organizations work together or provide overlapping services. Activation levels varied significantly from community to community, with the higher income communities having higher levels of activation.

We provide an overview of the Kaiser Permanente Community Health Initiative--created in 2003 to promote obesity-prevention policy and environmental change in communities served by Kaiser Permanente--and describe the design for evaluating the initiative. The Initiative focuses on 3 ethnically diverse northern California communities that range in size from 37000 to 52000 residents. The evaluation assesses impact by measuring intermediate outcomes and conducting pre-and posttracking of population-level measures of physical activity, nutrition, and overweight. (Am J Public Health. 2010;100:2111-2113. doi:10.2105/ AJPH.2010.300001)

County data on the percentage of people without health insurance are seldom available, although state program planning requires such information. As part of an evaluation of Washington's Basic Health Plan (BHP), we conducted a telephone survey in nine Washington counties to estimate the percentage of people under the age of 65 who were uninsured. We used regression analysis to estimate the percentage uninsured in a county as a function of the percentage unemployed. Two validation approaches yielded very good results, suggesting that the equation could be used to estimate the percentage uninsured in unsurveyed counties. The variation ranged from 15% to 23% uninsured in the 9 surveyed counties, and was estimated to range from 9% to 35% among the state's 39 counties. With proper caution, estimates based on this equation can probably be used in other states if better data are unavailable.

Programs have been devised in communities to help modify adverse dietary behavior associated with coronary heart disease and cancer. In an effort to change poor eating habits, grocery stores are being used to disseminate information regarding healthy food choices. In a pilot test, grocery store displays were designed to indicate whether a product was 'healthy' (eg, low-fat, whole wheat) and printed material was strategically placed near the displays. To evaluate the effectiveness of grocery store displays, four product areas were studied: produce, meat, milk and poultry. The percentages of display space given to poultry and fish, reduced-fat milk and whole wheat products in independent stores, local and national/regional food chains were established. National and region food chains offered more health-promotion items than the independent stores, particularly in the meat and produce display areas. Milk displays offered the least amount of health promotion items. Although actual food consumption of each healthy food would be the most accurate assessment, the reliability of display indices was high for poultry and fish, (0.78), reduced-fat milk (0.75) and whole-wheat bread (0.73). For the health promotion items, the reliability was low for milk (0.63) and meat (0.46). The results did not change significantly when retested one week to two months later. The validity of this testing approach is currently being assessed. (Consumer Summary produced by Reliance Medical Information, Inc.)