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One of the most pressing unmet challenges for preventing and controlling epidemic obesity is ensuring that socially disadvantaged populations benefit from relevant public health interventions. Obesity levels are disproportionately high in ethnic minority, low-income, and other socially marginalized US population groups. Current policy, systems, and environmental change interventions target obesity-promoting aspects of physical, economic, social, and information environments but do not necessarily account for inequities in environmental contexts and, therefore, may perpetuate disparities.I propose a framework to guide practitioners and researchers in public health and other fields that contribute to obesity prevention in identifying ways to give greater priority to equity issues when undertaking policy, systems, and environmental change strategies. My core argument is that these approaches to improving options for healthy eating and physical activity should be linked to strategies that account for or directly address social determinants of health.I describe the framework rationale and elements and provide research and practice examples of its use in the US context. The approach may also apply to other health problems and in countries where similar inequities are observed.

To compensate for an unhealthy food environment, foods high in calories, fat, or sugar could be subjected to special taxes, with costs of healthful foods subsidized. This paper reviews state tax laws, identifying 19 states and cities that levy such taxes. These taxes raise about $1 billion annually. The paper proposes using such revenues to fund health promotion programs. (SM)

The Tuskegee study of untreated syphilis in black males caused distrust by blacks of the public health system that has implications for Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) studies. AIDS prevention among blacks may require openness about the Tuskegee study to allay fears of repetition. (SLD)

Demographic impacts of meeting the National Health Objectives for 2000 were studied using life-table methods. Meeting the targets would increase life expectancy at birth by 1.5-2.1 years to 76.6-77.2 years. Modifying the coronary heart disease and unintentional injury targets to be more optimistic would further increase life expectancy. (SLD)

Few U.S. youths particularly from minority groups, pursue careers in science or environmental health. This description of efforts to boost the number of black scientists considers why such initiatives may not work. Economic concerns and the low prestige of many college science programs contribute to minority disinterest in science. (SLD)

Studying the prevalence of Acquired Immune Deficiency Syndrome (AIDS) among American Indians and Alaskan Native populations reveals a low 1990 case rate but a rapid increase in diagnosed cases, at a rate higher than any other racial/ethnic group. Culturally sensitive prevention programs are required. (SLD)

The article presents a call for original manuscripts for a theme issue on "Issues and Innovations in Financing and Reimbursement of Health Promotion and Education Programs."

Biological questions about Acquired Immune Deficiency Syndrome (AIDS) are minor compared with political and ethical problems related to the AIDS epidemic in the United States. Lack of public confidence in the work of public health officials and the controversy surrounding New York City's syringe exchange program are two examples. (SLD)

Outlines public policy goals regarding substance abuse, sexually transmitted diseases, unintended pregnancies, and violence. Concludes that the nation will continue to be high-risk until reforms are implemented that will equalize access to the opportunity structure. (DM)

Evaluative studies of outcomes of traditional school health education programs have shown that they are very effective in increasing knowledge, somewhat effective in improving attitudes, and, with a few notable exceptions, generally ineffective in changing health practices. This paper discusses the previous reviews of the literature of outcomes of school health education programs, and discusses the constraints inherent in school-based activities: an emphasis on cognitive learning, lecture-oriented teaching methods, inadequate pupil assessment procedures, a captive audience, competing subject areas, competing behavioral influences, behavior change attempts directed at ingrained health habits, inadequate coordination with community resources, and lack of consensus regarding educational goals. The paper then examines several recent successful school health education programs emphasizing non-traditional approaches in self-initiated care, pregnancy prevention, smoking prevention, and nutrition. It is concluded that school-based health education programs have three important roles in community health promotion: 1) the provision of a fundamental understanding of health and disease concepts to large segments of the population; 2) the reinforcement of positive health attitudes; and 3) the alteration of concurrent health behaviors for significant health problems. Although school health education may be helpful in enhancing decision-making and social interaction skills, little empirical evidence exists at this time to support this conclusion. (Am J Public Health 1981; 71:1384-1391.) [ABSTRACT FROM AUTHOR]

This paper discusses mechanisms that can assist local government in meeting health responsibilities that have so far not been well met. It is based on the experience of the Denver Department of Health and Hospitals. [ABSTRACT FROM AUTHOR]

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]

The earthquakes that hit Mexico City in September 1985 caused considerable damage both to the population and to important medical facilities. The disaster took place while the country was undertaking a profound reform of its health care system. This reform had introduced a new principle for allocating and distributing the benefits of health care, namely, the principle of citizenship. Operationally, the reform includes an effort to decentralize the decision-making authority, to modernize the administration, to achieve greater coordination within the health sector and among sectors, and to extend coverage to the entire population through an ambitious primary care program. This paper examines the health context in which the reform was taking place when the September earthquakes hit. After presenting the damages caused by the quakes, the paper analyzes the characteristics of the immediate response by the health system. Since many facilities within the system were severely damaged, a series of options for reconstruction are posited. The main lesson to be learned from the Mexican case is that cuts in health care programs are not the inevitable response to economic or natural crises. On the contrary, it is precisely when the majority of the population is undergoing difficulties that a universal and equitable health system becomes most necessary. [ABSTRACT FROM AUTHOR]

This paper documents oral health and public health expenditures for fiscal years 1984, 1986, 1988, and 1989, as reported by state health agencies. During this period, reported national expenditures for public and oral health increased 68% and 46%, respectively; between successive fiscal years, fewer states (73%, 67%, 57%) reported increased oral health expenditures, while increasingly more states reported no categorical oral health expenditures. Block grant expenditures for oral health increased overall but decreased as a percentage of total oral health expenditures; 16 stages reported no block grant expenditures for oral health in fiscal year 1989, perhaps reflecting either substantial state support, or marginal to nonexistent oral health programs in these states. [ABSTRACT FROM AUTHOR]

The article presents abstracts of books related to medicine. They include "Arthritis and Society: The Impact of Musculoskeletal Diseases," edited by Nortin M. Hadler and Dennis B. Gilliup, "Measurement and Evaluation in Health Education and Health Promotion," edited by Lawrence W. Green and Francis Marcus Lewis, and "Collected Essays on Public Health and Epidemiology," by Rudolf Virchow.

The article comments on the paper published in this periodical titled "Theory and Action for Health Promotion: Illustrations from the North Karelia Project," by Alfred McAlister. The said project materialized as a reaction to a community demand that the high rates of cardiovascular disease in Eastern Finland be remedied. The North Karelia Project was not an experiment in testing the effectivity of a discrete intervention strategy but a representation of an operational program demonstration and analysis. The project must be regarded as a potential case study instead of a critical analysis of the effects of health promotion.

This paper offers an historical review, an assessment of the present status, and some indication of the immediate future of federal programs in the field of occupational health. [ABSTRACT FROM AUTHOR]

The author comments on a study by S. H. Woolf, published in the issue about life expectancy in the U.S. She discusses some caveats on the comparisons presented by Woolf in discussing methodology and data, three of the four causes that Woolf notes are causing midlife mortality to rise in the U.S., and results that do not make a lack of higher education causal in the higher mortality rates for those without a four-year college degree.

The article comments on the paper published in this periodical titled "Theory and Action for Health Promotion: Illustrations from the North Karelia Project," by Alfred McAlister. The said project provides theoretical and conceptual analyses of the six primary classes of objectives that have guided the undertaking, namely preventive services, persuasion, information, community organization, environmental change, and training. The paper suggests that several intervention strategies can be combined for health improvement.

This paper traces the development of the US federal government's program to provide personal and public health services to American Indians and Alaska Natives since the 1940s. Minimal services had been provided since the mid 19th century through the Bureau of Indian Affairs of the Department of the Interior. As a result of attempts by western congressmen to weaken and destroy the bureau during the 1940s, responsibility for health services was placed with the US Public Health Service. The transfer thus created the only US national health program for civilians. providing virtually the full range of personal and public health services to a defined population at relatively low cost. Policy changes since the 1970s have led to an emphasis on self-determination that did not exist during the 1950s and 1960s. Programs administered by tribal governments tend to be more expensive than those provided by the Indian Health Service, but appropriations have not risen to meet the rising costs, nor are the appropriated funds distributed equitably among Indian Health Service regions. The result is likely to be an unequal deterioration in accessibility and quality of care. [ABSTRACT FROM AUTHOR]

Objectives. A major assumption underlying youth health promotion has been that physiological risk factors track from childhood into adult-hood. However, few studies have systematically examined how behaviors change during adolescence. This paper describes longitudinal tracking of adolescent health behaviors in two Minnesota Heart Health Program communities. Methods. Beginning in sixth grade (1983), seven annual waves of behavioral measurements were taken from both communities (baseline n = 2376). Self-reported data included smoking behavior, physical activity, and food preferences. Results. A progressive increase in the change to weekly smoking status was observed across the smoking status categories. As students began to experiment with smoking, they were more likely to either begin to be or remain regular smokers. Tracking of physical activity and food choice variables was also apparent. In nearly all the follow-up periods, the students identified at baseline as measuring high remained high, and those measuring low remained low. Conclusions. These results indicate that there is evidence of early consolidation and tracking of physical activity, food preference, and smoking behavior. The early consolidation of health behaviors implies that interventions should begin prior to sixth grade, before behavioral patterns are resistant to change. The smoking results suggest that students are experiencing difficulty quitting smoking; thus, youth smoking cessation interventions are warranted. [ABSTRACT FROM AUTHOR]

The President's Committee on Health Education was created by Richard M. Nixon in September 1971 and submitted its final report in September 1973. The committee resulted from the convergence of (1) a perceived national domestic policy need in response to escalating medical costs, (2) Nixon's personal and political ambitions, and (3) the dynamic political context of the late 1960s and early 1970s. Its work led to both private and public initiatives designed to influence the public's health through education; its findings and recommendations also laid the foundation for the National Consumer Health Information and Health Promotion Act of 1976 and thus contributed significantly to the development of subsequent national policy in health promotion and disease prevention. This paper places the work and contributions of the committee into historical perspective by analyzing the committee's origins and methods and the underlying politics that shaped its work and final report. The impact of the President's Committee is traced from the emergence of health education in the early 1970s as a potentially cost-effective alternative to medical care to the pivotal role health education now plays in health promotion and disease prevention efforts. [ABSTRACT FROM AUTHOR]

The National Cancer Institute (NCI) estimates on the basis of current knowledge alone that, at a minimum, 30,000 lives could be saved in the year 2000 if Americans would modify their dietary habits. A recent innovative way of responding to this challenge was the Kellogg Company/NCI All-Bran advertising campaign. This paper will describe the campaign, and its impact on consumers, cereal industry sales, food industry advertising practices, health regulatory policy, and the organizational credibility of both NCI and Kellogg. For the past three years, Kellogg has included NCI's cancer prevention messages in their advertisements for All-Bran cereal and on their bran cereal boxes. This collaborative effort has stimulated considerable controversy over whether the health claims made on the cereal label are in violation of federal food labeling regulations. Meanwhile, research has demonstrated the positive impact of the campaign on consumer's knowledge and behavior regarding fiber as well as on Kellogg's profits. Other manufacturers are anxious to jump on the "branwagon"; however, many unanswered questions remain about this new approach to health advertising. [ABSTRACT FROM AUTHOR]

Abstract: One of the 1990 Health Objectives established by the U.S. Department of Health and Human Services is for 60 per ¢ of adults 18-65 years of age to be participating regularly in vigorous physical exercise. Unfortunately, no valid and practical measurement system is available that will allow assessment of leisure lime physical activity participation of large populations. Consequently, not only is it difficult to assess progress toward the 1990 goal, an accurate baseline from which to measure potential progress does not exist. This paper presents a time diary technique for measuring aggregate population physical activity participation and utilizes actual time diaries collected from adults by the Institute for Social Research in 1981 to arrive at a possible baseline. The results indicated that time diaries are a viable method for assessing aggregate physical activity behavior of large populations. American Adults were quite sedentary in 1981. Over a period of one week, 31% undertook no leisure time physical activity. Only 14 per ¢ expended more than 1600 kcals/week in leisure time physical activity, and 10 per ¢ met the DHHS physical activity requirements. (Am J Public Health 1987:77:455-460.) [ABSTRACT FROM AUTHOR]

The article discusses the criteria for the development of health promotion and education programs in the U.S. Several organizations and agencies express their interest in sponsoring health promotion or disease prevention programs for their members, clients, employees, or beneficiaries. This paper addresses five criteria that suggest several issues and questions during decision-making process. The first criterion involves the program's respond to one or more risk factors, that are defined, measurable and prevalent among the members of the selected target group. The second criterion is the consideration of the special characteristics, needs and preferences of the target group.

This paper reports findings concerning the impact on quality of life of a case management focused program of small board and care facilities serving aging, mental health, and mental retardation adult target populations--the Pennsylvania Domiciliary Care Program. Program participants from the counties m which the Domiciliary Care Program was initiated were matched with persons residing in similar counties without the program who were comparable on a large array of characteristics prior lo program initiation. Conducted separately by target group. 10-month follow-up assessments provided the basis for determining impact, In general, the effects were positive, particularly with respect to meeting program quality of life goals (providing needed services, improving living conditions, increasing community integration, and reducing institutional days); the effects were more positive for the aging and mental health than for the mentally retarded target populations. [ABSTRACT FROM AUTHOR]

The design of a comprehensive evaluation of subsidized rural primary care programs on a large national scale is described. Its major purpose is to derive data whose analysis will answer major policy questions about the factors influencing the outcome of the major types of such programs in different communities. This first paper also delineates a typology which was developed of five principal organizational forms of these programs. This classification appears to provide suitable operational definitions of forms of rural practice as a basis for evaluating the differential impact of alternative types of primary care programs. [ABSTRACT FROM AUTHOR]

Injuries claim the lives of more children each year than the next six leading pediatric disorders combined, and produce injuries that require medical attention for one in three children. In the preschool age group, 91 per cent of these accidents and over one-half the resultant fatalities occur in the home. This paper reports the results of a controlled clinical trial conducted to evaluate the implementation of a health education program intended to reduce the risk of childhood household injuries. The study population was randomly assigned into two demographically comparable groups. Only the experimental group mothers received an educational intervention consisting of a tutorial, home safety-proofing assignments, and followup. The homes of the two groups were later assessed for hazards during an unannounced visit by an interviewer who did not know to which group each home belonged. A home safety score mean for the two groups was almost identical. The program stimulated heightened interest and stated intent to improve, but did not result in actual reduction of household hazards. Active health education, as used and evaluated in this study, appears to have limited effectiveness when applied to home safety. Approaches such as "passive" measures may offer greater potential for household injury reduction. [ABSTRACT FROM AUTHOR]

A statistical decision model is applied to the benefit evaluation of screening projects to derive an expression which provides upper and lower limits for average benefits in terms of prevalance rates of screen positives and negatives, and the average cost of screening and referral. Possible applications of such a technique are discussed and a numerical example is given. [ABSTRACT FROM AUTHOR]

This paper examines the potential of a Cooperative Extension Service to create a new context for the provision of health education services and offers a plan for the use of this potential in the health education of the public. [ABSTRACT FROM AUTHOR]

As in the preceding paper, the activities of a consortium in Newark, New Jersey, to develop appropriate programs to meet the needs for health personnel in an urban situation are discussed. [ABSTRACT FROM AUTHOR]

This paper attempts to present a schema for understanding and reacting to efforts at drug education. The basic question presented deals with the role of the community in developing a drug education program. [ABSTRACT FROM AUTHOR]

This paper endeavors to overcome one difficulty in health planning, namely, the transformation of general goals and ideas into operational objectives for programs. A method is developed to be used for generating such program objectives. [ABSTRACT FROM AUTHOR]

This paper offers cross tabulations between parameters on family planning and other health practices. The findings indicate that people who act positively with respect to health practices are similarly motivated in family planning. This point lends support to the policy of integrating family planning services with health services. [ABSTRACT FROM AUTHOR]

This paper presents a detailed longitudinal study of the costs—human, physical, and financial—of a family planning program. Both results obtained and methods used are presented in detail. It should provide a better idea of the cost of such programs and also help in planning similar projects. [ABSTRACT FROM AUTHOR]

This paper describes the use of simulation modeling technique to support the management of family planning programs, using data in an organized way for problem diagnosis, forecasting and the examination of alternative strategies. [ABSTRACT FROM AUTHOR]

This paper describes and discusses the evolution and operation of a patient advisory committee to a family planning program. The concerns and activities which have occupied the Committee are presented. Successes and frustrations of professionals and consumers are elucidated and changes in progress are noted. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to explore how a Markov model may be significant for understanding a disease process, for analyzing trends, for comparing disease distributions before and after the application of health programs, and for developing large health system models. [ABSTRACT FROM AUTHOR]

This paper offers an overview of the development of services for the aged in Great Britain and suggests parallels with the United States. [ABSTRACT FROM AUTHOR]

The need for sex education led the author to develop an approach which she discusses in this paper. The approach is related to actual programs and techniques used in them. Some common questions asked by students are presented. [ABSTRACT FROM AUTHOR]

Training of health education aides is an important area and this paper adds to the knowledge on the preparation and employment of paraprofessionals. Review of the literature and description of a program in Chicago are presented clearly and concisely. [ABSTRACT FROM AUTHOR]

Objectives: Although several studies have reported short-term gains for drug-use prevention programs targeted at young adolescents, few have assessed the long-term effects of such programs. Such information is essential for judging how long prevention benefits last. This paper reports results over a 6-year period for a multisite randomized trial that achieved reductions in drug use during the junior high school years., Methods: The 11-lesson curriculum, which was tested in 30 schools in eight highly diverse West Coast communities, focused on helping 7th and 8th grade students develop the motivation and skills to resist drugs. Schools were randomly assigned to treatment and control conditions. About 4000 students were assessed in grade 7 and six times thereafter through grade 12. Program effects were adjusted for pretest covariates and school effects., Results: Once the lessons stopped, the program's effects on drug use stopped. Effects on cognitive risk factors persisted for a longer time (many through grade 10), but were not sufficient to produce corresponding reductions in use., Conclusions: It is unlikely that early prevention gains can be maintained without additional prevention efforts during high school. Future research is needed to develop and test such efforts.

Objectives: The Class of 1989 Study is part of the Minnesota Heart Health Program (MHHP), a populationwide research and demonstration project designed to reduce cardiovascular disease in three educated communities from 1980 to 1993. This paper describes an intensive, school-based behavioral intervention on cigarette smoking, comparing long-term outcomes in one of the intervention communities with those in a matched reference community., Methods: Beginning in sixth grade (1983), seven annual waves of cohort and cross-sectional behavioral measurements were taken from one MHHP intervention community and its matched pair. All students in each community were eligible to participate (baseline n = 2401). Self-reported data collected at each period described prevalence and intensity of cigarette smoking., Results: There were no differences at baseline for either weekly smoking prevalence or intensity of smoking. Throughout the follow-up period, however, smoking rates as determined by these measures were significantly lower in the intervention community: 14.6% of students were weekly smokers at the end of high school compared with 24.1% in the reference community., Conclusions: These results suggest that multiple intervention components such as behavioral education in schools, booster programs to sustain training, and complementary communitywide strategies may all be needed for lasting reductions in adolescent tobacco use.

Vaccination remains key to reducing the risk of COVID-19–related severe illness and death. Because of historic medical exclusion and barriers to access, Black communities have had lower rates of COVID-19 vaccination than White communities. We describe the efforts of an academic medical institution to implement community-based COVID-19 vaccine clinics in medically underserved neighborhoods in Philadelphia, Pennsylvania. Over a 13-month period (April 2021–April 2022), the initiative delivered 9038 vaccine doses to community members, a majority of whom (57%) identified as Black. (Am J Public Health. 2022;112(12):1721–1725. https://doi.org/10.2105/AJPH.2022.307030) [ABSTRACT FROM AUTHOR]

The article offers a perspective on the attainability or desirability of the aspirational goal of healthiest nation that requires a culture change in all aspects of society. It identifies implications of striving to become the healthiest nation including promotion of the concepts of otherness and inequity and self-defeat by creation of a false sense of achievement and complacency. Emphasis is given on the need to know the limitations of health and to strive for continuous health maintenance.

The article presents the second part of the paper on tuberculosis (TB) program and the channel for patient/consumer advocacy on Alumni-Patient Council that was organized to help TB patients in the U.S. It explores the role and goal of patients/consumers group in the delivery of health services, the onset of different mode of treatment for tuberculosis, and the representation of the voice of patients/consumers group over the method of treatment for tuberculosis. The role of patients/consumer group in health services is deemed necessary in improving the effectiveness of the country's health care delivery system.

Evaluation of health programs is a basic need if their impact is to be determined and to make sound decisions for future action. The papers presented in this group on evaluation deal with the problem from different viewpoints: from that of the executive branch, from the legislative angle, in terms of a specific program and on the local level. [ABSTRACT FROM AUTHOR]

The article discusses patient engagement and empowerment within the National Institute on Minority Health and Disparities Research Framework in relation to the study, published in the issue, which examined insurance-based discrimination in Minnesota. Topics covered include how to enhance patient-physician interactions, the importance of patient activation, confidence and empowerment and the systematic approach to improve patient-centered care.