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Objectives. A population-based Pneumocystis carinii pneumonia (PCP)Index was developed in New York City to identify geographic areas and subpopulations at increased risk for PCP. Methods. A zip code-level PCP Index was created from AIDS surveillance and hospital discharge records and defined as (number of PCP-related hospitalizations)/(number of persons living with AIDS), Results, In 1997, there were 2262 hospitalizations for PCP among 39 740 persons living with AIDS in New York City (PCP Index = .05691). PCP Index values varied widely across neighborhoods with high AIDS prevalence (West Village = .02532 vs Central Harlem = .08696). Some neighborhoods with moderate AIDS prevalence had strikingly high rates (Staten Island = .14035; northern Manhattan = ,08756). Conclusions. The PCP Index highlights communities in particular need of public health interventions to improve HIV-related service delivery, (Am J Public Health, 2002;92:395-398)

Public health concerns raised by smoking have increased public support for FDA regulation of tobacco advertising despite concerns about commercial speech protections. The discovery that tobacco companies knew nicotine was addictive, the targeting of young consumers and the dangers of second-hand smoke have changed the perception of smoking as a voluntarily accepted health risk. FDA regulation of tobacco advertising is reasonable especially when compared to the health hazards involved. Increased law enforcement and health education have been unsuccessful in reducing youth smoking because of limited resources., Perspectives on tobacco control in American society have shifted markedly. As the view that smoking as a voluntarily assumed health risk has declined, the social and political environment has become more conducive to industry regulation. This transformation can be traced to the mounting evidence of the health risks of secondary smoke; the addictive quality of nicotine; the vulnerability and exploitation of young people; and industry knowledge of the harmful effects of tobacco. Regulation of tobacco advertising and promotions by the Food and Drug Administration (FDA) raises serious concerns about constitutional protection for commercial speech. However, the minimal informational value of tobacco advertising suggests that it should be afforded a low level of constitutional protection. The FDA regulations impose reasonable "time, place, and manner" restrictions, leave open alternative channels of communication, restrict messages that are harmful to the public health, do not restrict political speech, prevent misleading messages, and help deter the unlawful sale of tobacco products to minors. The regulations meet the traditional criteria for regulating commercial speech, in that the government's asserted interest is strong, the agency's regulations directly advance that interest, and the regulations are no more extensive than necessary. Thus, the judiciary should defend the FDA's historical social and legislative mission to protect the public health. JAMA. 1997;277:410-418

Those who propose laws and regulations controlling the sale of tobacco products should be aware of the tobacco industry's typical response. The industry has consistently claimed that government regulation of tobacco violates the citizen's personal rights. It does this despite the fact that one of the roles of government is to protect its citizens from harm. The tobacco industry has stepped up its lobbying and political activities since the FDA proposed classifying nicotine as a drug and regulating cigarettes as a drug delivery device. The industry sought to delay the regulatory process by flooding the agency with 640,000 responses during the public comment period, most of which were form letters provided by the industry to individual smokers. It donated $1.5 million to Republican Congresspersons between Jan-June, 1995. It reduced media coverage of tobacco issues by filing a $10 billion libel suit against ABC. And it argues that the FDA has no authority to regulate cigarette advertising, which it claims would violate the First Amendment to the Constitution.

Ambulatory care and early intervention increasingly have been the focus of treatment for acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection, leading to a growing involvement of primary […]

Although the average cost of providing lifetime medical care for a patient with AIDS ranges from $40,000 to $75,000, there is little information regarding the source of funds used for paying this expense. The present study addresses the issue of who pays the bills for this group of human immunodeficiency virus (HIV)-infected patients. Hospital discharge summaries maintained in databases by the states of California (1983 to 1987) and New York (1983 to 1988) were used to extract information regarding the employment status and payer for hospitalized AIDS patients in New York City, Los Angeles, and San Francisco. These three cities comprise approximately one-third of all AIDS cases within the United States. Over the course of the period studied, there was a conspicuous trend in movement from private insurance to Medicare, referred to as 'Medicaidization'. The incidence of AIDS has increased at a more rapid rate among blacks and hispanics, who tend to be poorer than whites. Because Medicaid eligibility is dependent on financial consideration, whites, blacks and hispanics were studied separately. While blacks and hispanics were found to have a higher probability of utilizing Medicaid, all three groups of patients with AIDS were found to show a 'Medicaidization' over time. In Los Angeles, the possibility that an individual hospitalized with AIDS is likely to be a Medicaid beneficiary is approximately three times that of a patient with another diagnosis. This results, in part, because most persons with AIDS must qualify as disabled before receiving Medicaid. In California persons with AIDS qualify as disabled persons without the usual case-by-case review required for individuals with other diagnoses. In addition, the fact that Medicaid reimbursements are considerably lower than those paid by private insurers leads some physicians to refuse services to particular groups of patients. This leads to a concomitant migration from private physicians to institutional care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Background Proximity to parks and physical activity sites has been linked to an increase in active behaviors, and positive impacts on health outcomes such as lower rates of cardiovascular disease, diabetes, and obesity. Since populations with a low socio-economic status as well as racial and ethnic minorities tend to experience worse health outcomes in the USA, access to parks and physical activity sites may be an environmental justice issue. Geographic Information systems were used to conduct quantitative and qualitative analyses of park accessibility in New York City, which included kernel density estimation, ordinary least squares (global) regression, geographically weighted (local) regression, and longitudinal case studies, consisting of field work and archival research. Accessibility was measured by both density of park acreage and density of physical activity sites. Independent variables included percent non-Hispanic black, percent Hispanic, percent below poverty, percent of adults without high school diploma, percent with limited English-speaking ability, and population density. Results The ordinary least squares linear regression found weak relationships in both the park acreage density and the physical activity site density models (Ra2 = .11 and .23, respectively; AIC = 7162 and 3529, respectively). Geographically weighted regression, however, suggested spatial non-stationarity in both models, indicating disparities in accessibility that vary over space with respect to magnitude and directionality of the relationships (AIC = 2014 and -1241, respectively). The qualitative analysis supported the findings of the local regression, confirming that although there is a geographically inequitable distribution of park space and physical activity sites, it is not globally predicted by race, ethnicity, or socio-economic status. Conclusion The combination of quantitative and qualitative analyses demonstrated the complexity of the issues around racial and ethnic disparities in park access. They revealed trends that may not have been otherwise detectable, such as the spatially inconsistent relationship between physical activity site density and socio-demographics. In order to establish a more stable global model, a number of additional factors, variables, and methods might be used to quantify park accessibility, such as network analysis of proximity, perception of accessibility and usability, and additional park quality characteristics. Accurate measurement of park accessibility can therefore be important in showing the links between opportunities for active behavior and beneficial health outcomes.

The authors call for early intervention in HIV (human immunodeficiency virus) disease and explore the impact of their proposals for expanded services on the US health care system. Ninety percent of the individuals currently infected with the HIV virus are omitted from the count of AIDS (acquired immunodeficiency syndrome) cases. The existing medical care system could not serve even a segment of this population of approximately one million asymptomatic (without symptoms) HIV carriers. To meet the needs of this group for counseling, medications, laboratory tests and general health care approximately five billion dollars would be required annually. Provision of such extensive resources could only be achieved with major commitments from all levels of government and the private sector. A coordinated, efficient network of ambulatory centers would be required. The medical foundation for initiating early intervention is growing. Biologic indicators that track the progression of HIV disease have been identified. Antiviral medications are showing promise of halting immune system deterioration. Scientists are learning how to prevent and control the most common opportunistic infection, Pneumocystis carinii pneumonia. The authors' rationale for launching early intervention strategies is three-fold. First, the history of HIV disease to date suggests that without early intervention, most infected individuals will develop end-stage AIDS. Second, there is evidence that certain medications can stop the virus from reproducing and could thereby reduce the rate of new HIV infections. Third, infections often linked to HIV, such as tuberculosis and pneumonia, may be more effectively treated if anti-HIV drugs are used in combination with conventional treatments. In summary, planning for expansion of health services to provide early intervention should begin immediately. The AIDS policies of the past nine years were created in crisis and must be replaced with efficient, rational strategies. Early intervention would provide society with a chance to influence the progression of this deadly epidemic., ABSTRACT: Early medical intervention in human immunodeficiency virus disease has far-reaching implications for the health care system of the United States. Several factors are enabling the medical community to begin intervention prior to a patient's diagnosis of acquired immunodeficiency syndrome. These factors include an understanding of the biologic markers of disease progression; advances in antiviral therapeutics; and an improved ability to control the most common presenting opportunistic infection, Pneumocystis carinii pneumonia. Providing adequate ambulatory care for large numbers of asymptomatic human immunodeficiency virus-infected individuals and coordinating inner-city health care facilities will become critical. Important questions regarding service provision need to be adequately addressed. The cost of yearly treatment, estimated to be $5 billion per year, will require a major financial commitment at all levels of government and the private sector. Effective early intervention in human immunodeficiency virus disease may alter the course of one of the most devastating epidemics in modern history. Planning for its implementation should begin immediately.

This study examined cost-related prescription drug misuse among older persons, i.e., using leftover drugs, not filling a prescription, and taking less than the prescribed dosage. Data were gathered from a community sample of senior center clients and medical outpatients (n = 82), and callers to a Medicare rights hotline (n = 252). One out of five older persons stretches resources by not taking drugs as recommended. Neither prescription drug coverage nor type of health plan was significantly related to misuse. A 20% rate of cost-related prescription drug misuse is high and cause for concern. [ABSTRACT FROM PUBLISHER]