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The U.S. healthcare system is by far the most expensive per capita in the world and does not deliver the best outcomes. The literature shows that the U.S. population is distressed about what it is paying for and is especially distressed about people and companies that it perceives as sacrificing the public good for personal profit. Nevertheless, studies show high levels of trust in nurses, pharmacists, personal physicians, fire and security officers, engineers, and other practitioners who provide services at the local scale. Artificial intelligence (AI) poses an opportunity to reduce healthcare costs, yet it concerns the public because its misuse may violate personal boundaries, spread inaccurate data, and lead to other undesirable outcomes. The literature illustrates the benefits of cooperative relationships between community groups, local governments, and experts using new AI tools in support of local public health and well-being programs. One important example is preventing and reducing the consequences of acute hazard events. Overall, this review makes a case that focusing on the community scale represents an opportunity to improve health and well-being outcomes by establishing trusted and sustainable relationships. [ABSTRACT FROM AUTHOR]

Objectives. As part of an asthma screening study, we evaluated the relationship of health care insurance coverage to the diagnosis and treatment of elementary school children for asthma and related respiratory problems from 1998 through 2001. Methods. A bilingual questionnaire assessing health care coverage, asthma diagnosis, respiratory symptoms, and use of medications was distributed to parents of 6235 public and private school children in grades 2 through 5 in Passaic, NJ. Results. Responses for 4380 children (70%) revealed disparities in health care coverage and asthma diagnosis among racial and ethnic groups. Mexican and Dominican children had significant increases in health care coverage over the 4 years. Conclusions. The percentage of children with health insurance grew from 67% in 1998 to 81% in 2001, and the increase was related to NJ KidCare. Diagnosis of asthma and treatment were related to health care coverage.

Objectives. This study compared dietary risk factors among Southern-born and other Blacks in Central Harlem. Methods. A survey of residents of Central Harlem was use to compute a 'healthy diet' score for 621 subjects. Results. Southern-born respondents had the highest-risk diets. Although their numbers were small, Caribbean-born respondents, particularly those younger than 45 years, had the lowest-risk diets. Conclusions. The variation in diets in Central Harlem was considerable, with Southern-born Blacks at highest dietary risk for chronic diseases. These results remain to be tested elsewhere, as does the contribution of other chronic disease risk factors. (Am J Public Health. 1998;88: 1199-1202)

Varsity athletes at a Big East University were questioned regarding their attitudes to a mandatory drug education and testing program, and to check if there were variations in drug-related attitudes and behaviors dependent on sex or on team affiliation. Results showed that tennis players were the most likely to treat drug use by college athletes as socially acceptable. Half of the respondents believed that drug testing was not necessary, and did not discourage drug use. Seventeen percent saw the program as an invasion of privacy.

It has been suggested that relaxed rules in dormitories encourage college students to engage in risky behaviors because they are free from the moral supervision of parents. Those who live off campus comprise another segment of students generally free from parental supervision. The authors surveyed 250 dormitory and 250 commuting students at Rutgers University and examined student patterns of risk-taking behavior. The survey contained questions on race, gender, academic standing, and multiple questions about risky behaviors. Four of those behaviors are discussed here in detail: smoking, alcohol abuse, drug abuse, and sexual behavior.

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., Black-American political leaders and leaders in the area of health rated three of 21 of the US Department of Health and Human Services 'Healthy People 2000' goals as the most important. Almost 1,200 black health and political leaders were queried on their perceptions of the plan. These three goals for black Americans are reducing the incidence of AIDS, improving the health of infants and mothers and controlling the spread of sexually transmitted diseases. Those ranked next were preventing, treating and controlling heart disease and strokes, cancer and diabetes. The respondents hold individuals and the federal government responsible for achieving these goals. The federal, state and local legislators, mayors, public health officials, hospital administrators and other leaders ranked the 21 items both on importance and feasibility for change.

Mortality from pulmonary embolism (PE) has declined in the United States over the past two decades, yet significant racia l disparities persist with the age-adjusted rates for blacks about twice those for whites. Incidence studies to date have not been successful in defining reasons for this disparity, primarily because they have not enrolled sufficient numbers of blacks to allow for racial comparisons. This study overcomes that limitation by using New Jersey hospital discharge data as a surrogate measure for PE incidence. It examines whether differences in access to care, in-hospital case fatality, discharge planning or other factors might help explain the observed patterns. Our results revealed an elevation in the incidence of PE among blacks compared with whites, similar to the contrasts in mortality. In-hospital case fatality did not differ notably between blacks and whites, indicating that treatment in-hospital is an unlikely contributing factor. We found differences in hospital discharge planning and insurance status, suggesting that these factors may play a role. Our results point to the need for longitudinal studies on the natural history of the disease to better identify and hopefully modify the risk factors responsible for the persistent disparity in mortality from PE.