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Abstract: This paper reports the home-facility and level of care changes, discharges, and deaths over a five-year period for 1,653 clients newly admitted in 1978 to a long-term care program in British Columbia, Canada. Five years after admission, of clients initially admitted to care at home (N = 1241), 34,3 per ¢ were still in the program (14.5 per ¢ unchanged; 6.7 per ¢ at home but at a higher level of care, and 11.7 per ¢ in facilities). Of the remainder, 38.9 per ¢ had died and 26.8 per ¢ had been discharged. Findings for those initially admitted to care in facilities (N = 412) are remarkably similar. After five years, 28.4 per ¢ of these clients were still in the program; 39.3 per ¢ had died. Moves from facility to home care were few (2.4 per ¢). Despite their advanced age at admission (X = 74.7, S.D. 14.6), one-third were still in the program five years later, some with status virtually unchanged. INSET: Health Implications of Smokeless Tobacco Use. [ABSTRACT FROM AUTHOR]

This paper examines the uses of some health status indices in measuring equity of access to medical care. Empirical examples are provided using data from national surveys of the U.S. population conducted from 1964 through 1976. A simple indicator, mean number of physician visits, suggests that between 1963 and 1976 the poor improved their position relative to the rest of the population and, indeed, currently enjoy the highest level of access. However, a second measure, the use-disability ratio indicates that the poor may still receive less care relative to their need. A third measure, the symptoms-response ratio suggests how norms of appropriate behavior might be incorporated into an access measure. [ABSTRACT FROM AUTHOR]

Objectives. This paper analyzes the impact of seven chronic conditions (three nonfatal: arthritis, visual impairment, hearing impairment; four fatal: ischemic heart disease, chronic obstructive pulmonary disease, diabetes mellitus, malignant neoplasms) on US adults aged 18 and older. Impact refers to how readily a condition prompts activity limitations, physician visits, and hospital stays. Methods. Data come from three national health surveys and vital statistics. For comparability, a single disease classification scheme was applied, and new rates were estimated. Frequency, impact, and prominence of the target conditions are studied via rates, ratios of rates, and ranks, respectively. Results. In young adulthood, the nonfatal conditions prompt limitations less readily than do the fatal ones, but by older ages, arthritis and visual impairment have a limiting impact equivalent to that of fatal conditions. Despite high prevalence and limitations, nonfatal conditions stand well below fatal conditions for health services use. Conclusions. Although statistics on frequency, impact, and prominence all indicate conditions' "importance," they give only weak clues about specific service needs of affected persons. The persistent finding that nonfatal conditions do not receive health services care commensurate with their prevalence and impact reflects long-standing imbalanced attention on fatal conditions in research and medical care. [ABSTRACT FROM AUTHOR]

We divided 900 general practitioners into two groups: one group received a questionnaire measuring both attitudes and behaviors toward preventive aspects of medical care, while the other received two separate questionnaires--one measuring behaviors, and one measuring attitudes. Response rates of the two groups were similar. Respondents in the first group retrieved their answer to the attitudinal items when responding to behavioral items increasing the correlations between attitudes and behaviors by an average of 147 as compared to the second group; hence the second procedure was preferable. [ABSTRACT FROM AUTHOR]

Objectives. We conducted a mixed-method study in rural southwestern Bangladesh, a country in which an estimated 730000 elective pregnancy terminations occur each year, to explore women's and couples' motivations to terminate pregnancies. Methods. Quantitative data derived from a 1998 cross-sectional survey and a longitudinal demographic surveillance system (1998-2003) were combined with qualitative data gathered through 84 in-depth interviews conducted with 19 couples during 2004-2005. Results. Quantitative results indicated that 11% of couples reported a pregnancy termination in the study period; the rate was highest among couples who reported in 1998 that they wanted no more children (29%). Both wives' and husbands' fertility preferences independently and significantly predicted pregnancy termination. Qualitative findings showed that more than half of the participants had attempted to terminate a pregnancy at least once in their lifetime. Conclusions. Our results highlight the importance of collecting data from both partners and the influence of husbands' fertility preferences on reproductive decisionmaking. The prevalence of reported pregnancy terminations in our population, along with the use of informal methods in termination attempts, highlights the need for continued provision of contraceptives and access to safe and affordable pregnancy termination services in this setting. (Am J Public Health. 2008; 98:1827-1832. doi:10.2105/AJPH.2007.129262) [ABSTRACT FROM AUTHOR]

The article presents a position paper from the American Public Health Association relative to the availability of nutrition status data to local health agencies in the U.S. The association encourages that there be adequate personnel and funding to make surveillance data collected by the Center for Disease Control available to all the states and territories of the U.S. It also encourages that there be enough funding and manpower to enable the administrators of the Health and Nutrition Examination Survey of the National Center for Health Statistics to formulate a method to make data available and more useful to local communities and develop future surveys to accomplish the purpose.

Abstract: In October 1983, a retrospective survey was initiated to determine if patients reported to the Centers for Disease Control as having recurrent tuberculosis truly had recurrent disease and, if so, why they had developed tuberculosis again. Twenty-three health jurisdictions provided information on 800 patients diagnosed as having recurrent tuberculosis during 1981 and 1982. We found that 199 (25 per ¢) of the cases did not meet the criteria for recurrent disease. Of the remaining 601 recurrent cases, 20 per ¢ had no chemotherapy prescribed for their previous episodes of tuberculosis, 20 per ¢ were prescribed inadequate or inappropriate therapy, and 33 per ¢ were not compliant with their prescribed therapy regimens. Patients who, during their original episode of tuberculosis, received the major portion of their medical care from physicians in private practice were more compliant than those treated by other health care providers. However, those same patients were more likely to have received inappropriate therapy than patients treated by other providers. Better patient and physician education, closer monitoring, and greater use of preventive therapy and directly observed therapy are necessary to resolve these problems. [ABSTRACT FROM AUTHOR]

Abstract: This study compares diagnosis and commencement of treatment for cancer among persons with fully financed fee-for-service coverage, persons with copaid fee-for-service coverage, and persons in an HMO (health maintenance organization). A total of 242 subjects actively employed at the time of their diagnosis were interviewed, typically within six months of beginning cancer treatment. After sex, age, income, education, residence turban vs rural, and disease site and stage had been controlled, those who made copayments were found to have waited an average of 1.25 months longer (95 per ¢ confidence limit (cl) +/- .88) between initial suspicion or illness and obtaining a definitive diagnosis than those with full insurance coverage. Time from diagnosis until the beginning of treatment averaged .83 months longer (95 per ¢ cl +/- .41) for HMO members than those in fee-for-service. These relations were strongest in income categories equal to or exceeding $20,000 per year. (Am J Public Health 1987: 77:464-466.) [ABSTRACT FROM AUTHOR]

We examined the concurrent and longitudinal associations between risk factors and substance use for a sample of high school students. Ten risk factors were defined that assessed numerous important personal and social areas of life. These factors were found to be associated with ever using, frequency of use, and heavy use of cigarettes, alcohol, cannabis, and hard drugs. Few effects were noted for nonprescription medication. No sex differences were evident for number of risk factors. Finally, the number of different risk factors was predictive of increases in use of all types of substances over a one-year period, after controlling for initial level of use. [ABSTRACT FROM AUTHOR]

Abstract: In a nationwide survey we found 72 PKU (phenylketonuria) patients who had terminated diet but later returned to diet. Sixty-one patients resumed diet due to clinical problems. Age at initial diet discontinuation ranged from three to 20 years. The most prevalent problems reported were poor school performance, and mood and/or behavior changes. Following diet reinstitution, only positive changes were noted for 42 patients, no changes for 19 patients, and 11 had one or more negative changes. Improvements and blood phenylalanine levels were not significantly correlated, but only Il patients maintained levels < 10 mg/dl. The number of improvements was significantly correlated with length of time on diet (p < 0.001 ). After a median of 10 months on diet. 22 patients had again discontinued due 10 poor diet control, lack of motivation, poor formula tolerance, lack of apparent benefits and/or changes [or the worse, Median time on diet for the 50 second-time continuers was two years nine months. [ABSTRACT FROM AUTHOR]

Abstract: Personal and telephone interview surveys were conducted simultaneously during 1981 in the same area (four counties on the area of Tampa Bay, Florida and utilizing the same interview schedule. Following completion of the surveys, validity checks were made with the medical providers reported by a subsample of respondents to each mode. The telephone survey yielded a lower response rate but cost less than half the personal interview. There was some evidence of nonresponse bias in the telephone survey, and some relatively minor differences in responses were found between the two modes, but there was no conclusive evidence that the response differences resulted from mode effects. Telephone respondents appeared to be somewhat more accurate in their reporting of visits to medical provides, although accuracy comparisons must be interpreted with caution in view of the disparate success experienced for the two modes in securing permission forms for the release of medical record information. [ABSTRACT FROM AUTHOR]

In 1977 the National Center for Health Services Research, US Department of Health and Human Services, undertook a survey of 40,000 individuals in the United States, soliciting information on expenditures and sources of payment for health services including prescribed medicines. Differences in the use of prescribed medicines by age, sex, ethnic/racial background, family income, and perceived health status were found across and within therapeutic categories. More than one-fifth of expenditures were for cardiovascular-renal agents. Sources of payment were similar in all but a few therapeutic categories. [ABSTRACT FROM AUTHOR]

Abstract: The placement of subsidized primary care programs in rural communities has been an important aspect of national health policy over the last decade. Using survey and secondary data from programs in over 700 counties in the United States, it was found that while about one-fourth of all counties with some rural populations have been affected by these programs, certain environmental factors are associated with more or less likelihood of placement. High levels of need and Low levels of health care resources are positively associated with the presence of a program. Stales with health policy climates supportive of reimbursement and broader staffing of primary care programs also contained programs in a higher proportion of their rural counties. The effects of decreased federal funding, increased state responsibility, and the precarious market conditions for primary care programs are discussed with emphasis on the mechanisms for developing favorable climates for these programs. (Am J Public Health 1983: 73:406-413.) [ABSTRACT FROM AUTHOR]

Seventy-one individuals were mislabeled on the basis of a prevalence survey (N - 1.031) conducted in low-income community. They were told by a physician that they were hypertensive but were later judged normotensive on the basis of three blood pressure measures. None of these persons was taking antihypertensive medication or under medical care. Compared to the total normotensive sample, the mislabeled group reported more depressive symptoms (P = .005). lower present health (p = .001), and a worsening of their health over the past five year (p = .035). Compared to a control group matched on gender, age, ethnicity, education, and marital status, the mislabeled group reported even more depressive symptoms (p = .005), and lower present health (p = .034). They did not, however, have a worsening of health over the past five years (p = .074). These findings could not be explained by greater utilization of medical care or comorbidity. It is suggested that these findings are a result of people being falsely labeled as hypertensive. (Am J Public Health 1981: 71:1228-1232.) [ABSTRACT FROM AUTHOR]

Abstract: The method of data collection in household health surveys can be a major determinant of cost and data quality. A survey strategy can comprise mail. telephone, or home interview methods, individually or in combination to follow up non-respondents. The purpose of this study in Montreal was to compare cost and data quality of various strategies. Strategies which began with mail or telephone contact, followed by the two other methods, provided response rates as high as a home interview strategy (all between 80 and 90 percent), for one-half the cost of home interviews when used as the sole method. The telephone response rate was higher than the mail response rate. Comparing different follow-up approaches to strategies beginning with mail or telephone, it proved less costly, and equally effective, to use home interviewing as a last resort for persistent non-respondents. Validity of response (comparing individual responses with records of a government health insurance data bank) and willingness to answer sensitive questions were greatest in mail strategy. [ABSTRACT FROM AUTHOR]

A set propositions is offered to provide a frame of reference for proposed strategies to improve healthful behavior by placing personal choice-making in the context of societal option-setting. The health status of populations at a given point in time is seen as a result of customary personal choice-making. These choices in turn are limited by both the perceived and actual options available to individuals, depending on their personal and their community's resources, from which to make choices, Most people, most of the time will make the easiest choices, i.e., will do the things, develop the patterns or life-styles, which seem to cost them less and/or from which they will gain more of what they value in tangible and/or intangible terms. The range of options available to them, and the ease with which they may choose certain ones over others, is typically set by organizations, public and private, formal and informal. The more powerful the organization, i.e., the more effective it is in carrying out its policies, the more it affects the populations, whether or not these effects are immediately perceived by individuals in their day-by-day choicemaking. Implications for health education strategies are noted. [ABSTRACT FROM AUTHOR]

By means of a two-way audiovisual microwave circuit, physicians at the Massachusetts General Hospital provided medical care to 1000 patients 2.7 miles away at the Logan International Airport Medical Station. This study reports on this service which demonstrates that telediagnosis can increase the availability of quality medical care. [ABSTRACT FROM AUTHOR]

The article presents a survey which identifies the smoking behavior of American Public Health Association (APHA) members in the U.S. The association conducted the survey in order to determine how they could best contribute to the goal of decreasing cigarette smoking within the country. It has shown additional evidence that health professionals' own smoking behavior is related to their attitudes and actions in urging a change in the smoking behavior of those to whom they give care. In addition, the said survey presented the percentage of APHA members who ever tried to persuade someone to stop smoking.

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. Unfortunately, most local health jurisdictions lack important data for developing population health profiles, such as data on chronic disease prevalence, quality-of-life measures, functional status, and self-perceptions of health status. In addition, data on important determinants of health, including health behaviors and access to health care services, are rarely available locally. These data frequently are collected in national and state surveys (e,g,, the National Health Interview Survey and the Behavioral Risk Factor Surveillance System) and provide critical information to assess progress toward achieving state and national health objectives. The surveys rarely serve local data needs, however, because of insufficient sample size and lack of flexibility to address local health issues. To address gaps in local health data, in 1997 the Los Angeles County Department of Health Services inaugurated the Los Angeles County Health Survey. [ABSTRACT FROM AUTHOR]

Objectives. This study examined the frequency of requests that state health departments investigate cancer clusters, the nature of those requests, and the resources available for the investigations. Methods. A mail survey was sent to state health departments requesting data for 1997. Results. Approximately 1100 cluster investigation requests were made in 1997. Most requests were made by citizens, and no pattern emerged for types of cancer or hazards suspected. States rate this work as average in importance and feel satisfied with the successfulness of their communication efforts. Conclusions. Few cluster inquiries require further investigation. Nonetheless, this interaction represents resources well spent in terms of public service and education. (Am J Public Health. 2000; 90:1300-1302) [ABSTRACT FROM AUTHOR]

We surveyed 1196 Black health and political leaders on their perceptions about the US Department of Health and Human Services' Healthy People 2000 public health goals. Respondents identified reducing the incidence of acquired immunodeficiency syndrome, improving maternal and infant health, and controlling sexually transmitted diseases as the three most important public health goals for Black Americans that are amenable to intervention. The leaders assigned nearly all responsibility for prevention efforts to the federal government and the individual. With the American health care system now in flux, Black leaders need to organize to see that these priority issues are addressed. [ABSTRACT FROM AUTHOR]

Abstract: Attitudes of' patients toward the necessity of physician consent in epidemiologic studies were assessed. Questionnaires were mailed to women with breast, endometrial and ovarian cancers who had previously participated in a personal interview study (N-692). Of respondents (N - 514), only 2 per ¢ would have preferred their physician to have withheld approval, and half considered physician permission necessary. Thirty-five per ¢ reported that their doctor talked to them about the study prior to the interview. Implications of including physician consent in study protocols are discussed. [ABSTRACT FROM AUTHOR]

We studied all admissions to the 11 acute care hospitals of the New York City Health and Hospitals Corporation (April 1983-September 1984) matching emergency room (ER) admitted diagnostic related group (DRG) subgroups in each hospital with at least five non-ER admitted patients (N = 222,961). Mean cost per ER patient ($8,385) was greater than non-ER mean cost per patient ($4,386) for Medicare and non-Medicare. Our data suggest that public hospitals with a high proportion of ER admissions may be at a financial disadvantage under DRG reimbursement. [ABSTRACT FROM AUTHOR]

Of the 47 states that participated in a 1983 survey of State Health Departments, 30 were found to have public health standards in place or started. Most states' standards emphasize the range of services to be provided, but substantial variations were found in how standards are formulated, adopted, and used by state and local agencies. (Am J Public Health 1985; 75:649-650) [ABSTRACT FROM AUTHOR]