ISRN Public Health

Modern Natural Gas Development and Harm to Health: The Need for Proactive Public Health Policies

Madelon L. Finkel, Jake Hays, and Adam Law — Thu, 16 May 2013 15:06:04 +0000

High-volume horizontal hydraulic fracturing of shale formations has the potential to make natural gas a significant, economical energy source, but the potential for harm to human health is often dismissed by proponents of this method. While adverse health outcomes of medical conditions with long latency periods will not be evident for years and will depend on the exposure, duration of exposure, dose, and other factors, we argue that it would be prudent to begin to track and monitor trends in the incidence and prevalence of diseases that already have been shown to be influenced by environmental agents. The dirty downside of modern, unconventional natural gas development, as well as the potential for harm, is discussed.

The European Hot Spot of B[a]P and PM2.5 Exposure—The Ostrava Region, Czech Republic: Health Research Results

Thu, 09 May 2013 15:08:19 +0000

The Ostrava Region in the Czech Republic is a heavily polluted industrial area. Concentrations of PM10, PM2.5, and benzo[a]pyrene (B[a]P) significantly exceed limit values. To investigate the impact of these levels on human health, epidemiological, molecular epidemiology, and in vitro studies were done in 2008–2011. Morbidity of children was followed in 10 pediatric districts. In the most polluted district, children suffered higher incidence of acute respiratory diseases in the first year of life, and higher prevalence of asthma bronchiale. Gene expression was studied in children from Ostrava and from a control rural area. Genes specific to asthma bronchiale differed, suggesting a different molecular phenotype in children in the polluted region compared to children in the control area. A molecular epidemiology study showed adverse effect of the Ostrava exposures, but also an increased expression of XRCC5, which probably protects these exposed subjects against the degree of genetic damage that would otherwise be expected. In vitro studies clearly related concentration of B[a]P from PM2.5 extracts to induced PAH-DNA adducts. These studies clearly demonstrate that under the present local environmental conditions, the health of the population is severely impaired and will likely remain so for a significant period of time.

Life Style Factors Associated with Premenstrual Syndrome among El-Minia University Students, Egypt

Amany Edward Seedhom, Eman Sameh Mohammed, and Eman Mohammed Mahfouz — Thu, 09 May 2013 12:01:43 +0000

Aim. To determine the score and frequency of premenstrual syndrome (PMS) among female college students and to detect the possible risk factors of PMS. A trial of life style modification regarding prevention and control of PMS symptoms was carried out using counseling. Materials and Methods. A cross-sectional study was conducted on 253 El-Minia University unmarried female students. A self-administered questionnaire inquiring about symptoms of PMS in the previous three months and risk factors possibly related to it was used. PMS score was calculated. Multiple regression analysis was performed to determine which of several biopsychosocial and dietary factors influenced PMS. Life style modification counseling was done to prevent and control PMS. Results. The study revealed that 80.2% of the participants experienced various degrees of PMS symptoms which were significantly associated with a family history of PMS, physical inactivity, habitual excess consumption of coffee, BMI, frequent consumption of fast food, and smoking, but these factors explained only 52% of the variability in the logistic regression model. Conclusion. We recommend the introduction of a reproductive health component into school and college health education programs and encourage female adolescents and young adults to adopt a healthy behavior.

Sex, Conception Interval, Gestational Age, Apgar Score, and Anthropometric Surrogates in relation to Birth Weight of Bangladeshi Newborns: A Cross-Sectional Study

Wed, 08 May 2013 16:31:43 +0000

In developing countries, where about 75% of births occur at home or in the community, logistic problems prevent the weighing of every newborn child. Baby born with a weight less than 2,500 g is considered low birth weight, since below this value birth-specific infant mortality begins to rise rapidly. In Bangladesh, the prevalence of low birth weight is unacceptably high. Infant's sex differences, birth to conception interval, gestational age, and Apgar score are associated with infant birth weight. To screen low-birth-weight babies, simple anthropometric parameters can be used in rural areas where 80–90% of deliveries take place. A sample of 343 newborn singletons, 186 male and 157 female babies, were studied in Southwest region of Bangladesh to examine the birth weight status of newborns and to identify the relationship between birth weight and other anthropometric parameters of newborns. The mean birth weight was g, and 28.6% were low-birth-weight (<2,500 g) babies. All key anthropometric parameters of the newborns significantly correlated with infant birth weight . Mid upper arm circumference and chest circumference were identified as the optimal surrogate indicators of LBW babies. In the community where weighing of newborns is difficult, these measurements can be used to identify the LBW babies.

Biomedical Pollutants in the Urban Environment and Implications for Public Health: A Case Study

Jeffrey N. T. Squire — Tue, 07 May 2013 08:36:02 +0000

This study investigated the management of biomedical pollutants in the Accra Metropolitan Area in Ghana, using a qualitative case study approach involving interviews, focus-group discussions, and observation techniques. A state of precariousness was found to characterize the management of biomedical pollutants in the study area, culminating in the magnification of risks to the environment and public health. There is neither a single sanitary landfill nor a properly functioning incineration system in the entire metropolis, and most of the healthcare facilities surveyed lack access to suitable treatment technologies. As a result, crude burning and indiscriminate dumping of infectious and toxic biomedical residues were found to be widespread. The crude burning of toxic biomedical pollutants was found to provide environmental pathways for carcinogenic substances. These include polynuclear aromatic hydrocarbons (PAHs), polychlorinated dibenzofurans (PCDFs), polychlorinated dibenzo-para-dioxins (PCDDs), polychlorinated biphenyls (PCBs), hydrogen, lead, mercury, cadmium, chlorobenzenes, particulate matter, and chlorophenols. The improper disposal of biomedical pollutants in open dumps and unsanitary landfills also carries a risk of providing environmental entry points for volatile organic compounds (VOCs), inorganic macrocomponents, heavy metals, and xenobiotic organic compounds.

Validation of a Chinese Version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale in Patients with Hypertension in Primary Care

Huanhuan Hu, Gang Li, and Takashi Arao — Thu, 02 May 2013 14:47:08 +0000

The aim of this study was to validate a Chinese version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6C). In 2012, a cross-sectional study was conducted in a community clinic, in Beijing, China. A total of 262 hypertension patients participated in this study. Concurrent validity was validated by Pearson’s correlations between the SES6C and Hospital Anxiety and Depression Scale (HADS). Intraclass correlation coefficients (ICC) were performed to evaluate test-retest reliability of the scale. Related factors of self-efficacy were explored in linear regression models. The results of our study display acceptable psychometric properties: the scale was two-dimensional, reproducible (ICC = 0.78; 95% CI, 0.70–0.84), and the reliability was good (Cronbach’s alpha = 0.88). Significant (; ) correlation was found between the level of self-efficacy and the level of psychological distress. In multivariable analysis, the factors significantly associated with self-efficacy were regular exercise (, ), HADS total score (, ) and health status (, ). The study provides evidence that the SES6C is acceptable, valid and repeatable for hypertension patients.

Alcohol Exposures, Alcohol Marketing, and Their Associations with Problem Drinking and Drunkenness among Youth Living in the Slums of Kampala, Uganda

Monica H. Swahn, Jane B. Palmier, and Rogers Kasirye — Tue, 30 Apr 2013 14:21:45 +0000

This study determined the associations between alcohol use exposures, marketing, education, and problem drinking and drunkenness among youth living in the slums of Kampala. This cross-sectional study of youth was conducted in 2011 to quantify and describe high-risk behavior and exposures in a convenience sample () of urban youth living in the slums, 14–24 years of age, who were participating in a drop-in center for disadvantaged street youth. Logistic regression analyses were computed to determine associations between alcohol use exposures, marketing exposures, alcohol education, and problem drinking and drunkenness while controlling for possible confounders. Among participants, 30.2% reported problem drinking and 32.8% reported drunkenness. In multivariate analyses, obtaining free drinks was associated with problem drinking (AOR: 2.47; 95% CI = 1.23–4.96) and drunkenness (AOR: 2.40; 95% CI = 1.22–4.70) after controlling for potential confounders. Alcohol education measures were not significantly associated with either problem drinking or drunkenness in multivariate analyses. There are important associations between alcohol marketing and drinking among these youth. Moreover, the findings underscore the need for additional research related to the impact of alcohol marketing among vulnerable youth and also the need for policy regulations that restrict alcohol marketing that involve providing free alcohol directly to youth.

Risky Sexual Practices and Associated Factors for HIV/AIDS Infection among Private College Students in Bahir Dar City, Northwest Ethiopia

Zelalem Alamrew, Melkamu Bedimo, and Muluken Azage — Tue, 12 Mar 2013 15:41:52 +0000

Background. Adolescents and young adults engage in risky sexual behaviours that may expose them to risk of contracting sexual transmitted diseases. The aim of this study was to assess risky sexual practices and associated factors for HIV/AIDS infection. Methods. A cross-sectional study was conducted in March 2012 among 790 college students. Self-administered questionnaire was used to collect the data. The data were analyzed using univariate, bivariate, and multivariate analyses with SPSS version 16 software package. Results. About 40.6% of sexually active respondents had risky sexual behaviours. Multiple sexual partners and unprotected sex were reported by 45.3% and 38.4% of sexually active respondents. Having multiple sexual partners was associated with alcohol use (AOR = 3.20; 95% CI: 2.02–5.08) and having a close friend who started sex (AOR = 5.99; 95% CI: 3.66–9.81). Unprotected sex was associated with marital status (AOR = 2.68; 95% CI: 1.55–4.64), alcohol intake (AOR = 2.19; 95% CI: 1.36–3.54), and frequency of visiting night clubs (AOR = 0.25; 95% CI: 0.12–0.52) for those who visit occasionally and (AOR = 0.45; 95% CI: (0.21–0.97) for those who visited at least once a week. Conclusion. Large proportions of students engaged in risky sexual behaviours and various risk factors were associated with risky sexual behaviours. Therefore, interventions targeting on alcohol intake, peer pressure, and attending night clubs are recommended.

Impact of Comorbidities on Racial/Ethnic Disparities in Hypertension in the United States

Tue, 15 Jan 2013 11:38:16 +0000

Background. Racial/ethnic disparities in hypertension (HTN) prevalence continue to persist in United States. We aimed in this study to examine the racial/ethnic disparities in hypertension prevalence and to determine whether or not health disparities may be explained by racial/ethnic disparities in co-morbidities. Materials and Methods. A cross-sectional design was used to examine the prevalence of hypertension among African Americans (AAs), Caucasians, and Hispanics in the National Health Interview Survey, 2003. The overall sample comprised 30, 852 adults. Results. There was a statistically significant racial/ethnic variability in hypertension prevalence, with AA/Blacks with the highest prevalence, (3), . Hypertension was associated with co-morbidities, age, education, physical inactivity, marital status, income, sex, alcohol, and cigarette consumption, but not insurance. Relative to Caucasians, AAA/Blacks were 43% more likely while Hispanics were 40% less likely to report being diagnosed with high blood pressure, prevalence odds ratio (POR) = 1.43, 99% CI, 1.25–1.64, , and POR = 0.60, 99% CI, 0.55–0.66, respectively. After adjustment for the relevant covariates including co-morbidities, racial/ethnic disparities in hypertension persisted; thus compared to Caucasians, African Americans were 61% more likely to be told by their health care providers that they were hypertensive, adjusted prevalence odds ratio (APOR) = 1.61, 99% CI, 1.39–1.86, . In contrast, Hispanics were 27% less likely to be diagnosed with hypertension compared to Caucasians, APOR = 0.73, 99% CI, 0.68–0.79, . Conclusions. There was racial/ethnic variability in hypertension prevalence in this large sample of non-institutionalized US residents, with the highest prevalence of hypertension observed among African Americans. These disparities were not removed after controlling for relevant covariates including co-morbidities.

The Effectiveness of Educational Support to Orphans and Vulnerable Children in Tanzania and Uganda

Thu, 10 Jan 2013 15:13:51 +0000

Little evidence is available to assist policy makers and donors in deciding what kinds of programs in developing countries are more likely to be effective in supporting the entry and continuation of OVC in secondary schools. This is particularly important for females whose education has direct bearing on child mortality in the next generation. This study gathered four kinds of educational outcome measures in two East African countries ravaged by the AIDS/HIV pandemic. The goal was to determine whether direct scholarship aid to individual students versus various forms of block grants would be more effective in promoting lower rates of absenteeism, lower dropout rates, higher national examination scores, and higher pass rates for OVC of both genders. Insufficient evidence was available for recipients of scholarships, but OVC with block grant support performed as well or better than their non-OVC counterparts, and significantly better than OVC without support. Contrary to popular belief, girls had lower rates of absenteeism. There were no gender differences in dropout. However, boys consistently outperformed girls on academic tests. Insufficient data systems continue to impede more detailed analysis.

Expectations Confounded: Patients Are Satisfied with THR and TKR Delivery in Australian Public Hospitals—A Multisite Case Study

Julie Lynette Walters, Shylie Mackintosh, and Lorraine Sheppard — Tue, 04 Dec 2012 15:26:31 +0000

Background. The popular media infer that satisfaction with waiting lists for total hip or knee replacement surgery is poor; however, there is little supporting evidence for this. The purpose of this study was to describe patients satisfaction with the service they received for joint replacement surgery in a public hospital. Methods. A cross-sectional design was used to survey 450 patients. Data was analysed descriptively and chi-squared analyses (significance level of ) were used to examine associations between variables. Results. The response rate was 71%. Nearly three-quarters () of the sample were “very happy” with the service and 92.0% () indicated that they would have their surgery again. Satisfaction was significantly associated with waiting time to the first appointment (chi-square; ), whether the patients enquired about their waiting time (chisquare; ), and the number of preoperative appointments (chisquare; ). Most participants reported a maximum acceptable waiting period for initial appointment of less than 6 months but nearly half waited longer. Conclusions. The perception that patients are unhappy with elective surgery services in Australia may be unfounded despite many waiting longer than they consider appropriate.

Obesity Prevention and National Food Security: A Food Systems Approach

Lila Finney Rutten, Amy Lazarus Yaroch, Heather Patrick, and Mary Story — Thu, 29 Nov 2012 15:49:24 +0000

Interventions that cultivate sustainable food systems to promote health, prevent obesity, and improve food security have the potential for many large-scale and long-lasting benefits including improvements in social, environmental, health, and economic outcomes. We briefly summarize findings from previous research examining associations between obesity and food insecurity and discuss the need for greater synergy between food insecurity initiatives and national obesity prevention public health goals in the United States. The common ground between these two nutrition-related public health issues is explored, and the transformation needed in research and advocacy communities around the shared goal of improving population health through individual, environmental, and policy level changes to promote healthy sustainable food systems is discussed. We propose an ecological framework to simultaneously consider food insecurity and obesity that identifies levers for change to promote sustainable food systems to improve food security and prevent obesity.

Individual, Social, Economic, and Environmental Model: A Paradigm Shift for Obesity Prevention

Anura Amarasinghe and Gerard D'Souza — Mon, 26 Nov 2012 16:05:28 +0000

Obesity has joined the list of “wicked problems” with associated implications for public health, food security, and the entire food supply chain. This paper examines the possible causes, consequences, and policy implications, especially important in an environment of shrinking budgets. The causes of obesity are multifaceted and involve complex interactions; hence any successful prevention and mitigation strategy should identify the key factors and interactions thereof. We propose a dynamic and integrated individual, social, economic and environmental model (ISEEM) to accomplish this. Within this framework, the optimal mix of economic incentives, better education, and land use planning emerge as key factors in obesity prevention and mitigation and the promotion of healthier, more sustainable communities. The use of the ISEEM framework, involving a combination of strategies targeted to specific circumstances of individual communities and localities, could address this wicked problem in an environment characterized by increasing conflicts among budgets, heuristics, and politics.

A Social Ecological Approach to Exploring Barriers to Accessing Sexual and Reproductive Health Services among Couples Living with HIV in Southern Malawi

Mon, 26 Nov 2012 14:37:36 +0000

With wide access to antiretroviral therapy, people living with HIV are living longer. The reduction in the mother-to-child transmission of HIV has encouraged some people living with HIV to have children and remarry. However, some continue to have limited access to sexual and reproductive health services. The study explores barriers encountered by couples living with HIV in accessing sexual and reproductive health services using the social ecological model. Data were collected using in-depth interviews with twenty couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa communities in Malawi from July to December 2010. Data were analyzed using framework analysis method. The study findings identify barriers across the five levels of the social ecological model indicating that the use of sexual and reproductive health services is influenced by diverse factors. We suggest three main areas for primary intervention: services must be located closer to their communities and integrated with existing antiretroviral services. In addition, information gatekeepers, both formal and informal, should be empowered with knowledge about sexual and reproductive health, including HIV and AIDS. Finally, there is a need to coordinate the flow of reproductive health, HIV, and AIDS information between Malawi Ministry of Health and formal and informal organizations.

Diagnoses of Patients with Severe Subjective Health Complaints in Scandinavia: A Cross Sectional Study

Wed, 14 Nov 2012 10:15:37 +0000

Background. A diagnosis is the basis of medical action, the key to various social privileges and national sick leave statistics. The objectives of this study were to investigate which diagnoses general practitioners in Scandinavia give patients with severe subjective health complaints, and what kind of treatments they suggested. Methods. One hundred and twenty-six self-selected general practitioners in Scandinavia diagnosed nine patients, presented as video vignettes, in a cross-sectional study. The main outcome measures were primary, secondary, and tertiary diagnoses. Results. The nine patients got between 13 and 31 different primary diagnoses and a large variety of secondary and tertiary diagnoses. Fifty-eight percent of the general practitioners chose different primary and secondary diagnoses, indicating that they judged the patients to have multimorbid complaints. The most commonly recommended treatment was referral to a psychologist, a mix of psychological and physical treatments, or treatment by the general practitioner. Conclusion. Scandinavian general practitioners give a large variety of symptom diagnoses, mainly psychological and general and unspecified, to patients with severe subjective health complaints. Referral to a psychologist or a mix of psychological or physical treatments was most commonly suggested to treat the patients.

Vacant Properties and Violence in Neighborhoods

Charles C. Branas, David Rubin, and Wensheng Guo — Wed, 14 Nov 2012 09:34:59 +0000

Objectives. Violence remains a significant public health issue in the United States. To determine if urban vacant properties were associated with an increased risk of assaultive violence and if this association was modified by important neighborhood institutions (e.g., schools, parks/playgrounds, police stations, and alcohol outlets). Methods. Longitudinal ecologic study of all 1816 block groups in Philadelphia. Aggravated assault and vacant property data were compiled yearly from 2002 to 2006 and linked to block groups. A mixed effects negative binomial regression model examined the association of vacant properties and assaults between and within block groups. Results. Among all block groups, 84% experienced at least one vacant property, 89% at least one aggravated assault, and 64% at least one gun assault. Between block groups, the risk of aggravated assault increased 18% for every category shift of vacant properties (IRR 1.18, 95% CI: 1.12, 1.25, ). Parks/playgrounds and alcohol outlets potentially modified the association between vacant properties and aggravated assaults but only at low levels of vacancy. Conclusions. Increasing levels of vacancy were associated with increased risk of assaultive violence in urban block groups.

Local Labor Market Fluctuations and Physical Activity among Adults in the United States, 1990–2009

Ruopeng An and Junyi Liu — Wed, 24 Oct 2012 09:08:58 +0000

Being physically active is a key health promotion strategy. The late-2000s economic downturn, labeled the “Great Recession,” could have profound impact on individuals' health behaviors including engagement in physical activity. We investigated the relationship between local labor market fluctuations and physical activity among adults 18 years and older in the United States by linking individual-level data in the Behavioral Risk Factor Surveillance System 1990–2009 waves to unemployment rate data by residential county and survey month/year. The association between labor market fluctuations and physical activity was examined in multivariate regressions with county and month/year fixed effects. Deteriorating labor market conditions were found to predict decreases in physical activity—a one percentage point increase in monthly county unemployment rate was on average associated with a reduction in monthly moderate-intensity physical activity of 0.18 hours. There was some preliminary evidence on the heterogeneous responses of physical activity to local labor market fluctuations across age and income groups and races/ethnicities. Findings of this study suggest special attentions to be paid to the potential detrimental impact of major recessions on physical activity. This correlational study has design and measurement limitations. Future research with longitudinal or experimental study design is warranted.

Living with a Chemically Sensitive Wife: A “We” Situation

K. Hutton Carlsen, A. M. Topp, and S. Skovbjerg — Mon, 22 Oct 2012 10:32:37 +0000

Objectives. Multiple chemical sensitivity (MCS) is a medically unexplained and socially disabling disorder characterized by negative health effects attributed to exposure to common airborne chemicals. How spouses of chemically sensitive women experience and cope with their partners illness has not been described previously. Methods. This study presents data from three semistructured focus group interviews with a selective sample of 13 men whose spouses had MCS. Data was analyzed using systematic text condensation with a special focus on coping. Results. The informants expressed a great concern for their wives and described their role in the relationship as that of a “watchdog”, always alert and ready to protect. A considerable amount of time and effort was thus given to avoid symptom-eliciting chemicals to prevent illness. Informing guests of restrictions and observing neighbours’ daily routines were common occurrences. Masks, installation of additional air filters in cars and houses, and other protective measures had necessitated several participants taking on extra work to alleviate the economic burden. The wives' illness had thus become a “we” situation. Discussion. In conclusion, MCS was perceived as a “we” situation and may thus impose considerable strain on the relationship and the family as a whole.

Acute, Repeated Exposure to Mobile Phone Noise and Audiometric Status of Young Adult Users in a University Community

Sun, 14 Oct 2012 15:50:46 +0000

Background. Exposure to noise from mobile devices is suspected to affect hearing. Data are limited, particularly in less developed countries. We assessed noise levels from mobile phones and user audiometric status at University of Ibadan, Nigeria, in an initial cross-sectional study. Methods. Fifty-eight staff and 45 young adult students owning mobile phones were selected. A pretested questionnaire assessed demographics, phone attributes, and predominant ear used for making and receiving calls. Noise was measured in A-weighted decibels. Pure tone audiometry was conducted at varying frequencies. Statistics computed included Chi-square and t-tests. Results. Certain phone brands used by students were commonly reported. More utilized right ears to make or receive calls. Mean reported mobile phone use duration by students was years, lower than among staff, years (). There were differences in use of head phones (22.2%, 12.1%) and speakers (51.1%, 15.5%) by students and staff, respectively (). Mean measured noise levels of phones when ringing, per user settings, were high dBA (students) and dBA (staff). Audiometry suggested 22.2% students and 28.0% staff had some evidence of hearing impairment. Conclusions. Mobile phones noise levels were high, but exposures though frequent were of short duration. Larger, longitudinal studies are needed on phone use and hearing impairment.

The Effects of Two Maternal Vitamin A Supplementation Regimens on Serum Retinol in Postpartum Mothers: A Randomised Controlled Trial in Brazil

Thu, 13 Sep 2012 11:45:55 +0000

Objective. To test whether the serum retinol level in mothers supplemented with 400,000 IU of vitamin A is higher than in those supplemented with 200,000 IU and to estimate duration of the protective effect of vitamin A supplementation in the serum retinol level. Methods. Double-blind, randomised controlled trial performed in two hospitals in the state of Pernambuco in northeast Brazil. Three hundred twelve mothers were recruited immediately postpartum. All women received a capsule containing 200,000 IU of vitamin A, and 10 days after delivery, they were randomly assigned to one of two treatment groups. One group received a second capsule containing vitamin A and the other group received a placebo. Each group was invited back after 2, 4, and 6 months for serum retinol analyses. Results. No difference was found between the two groups in serum maternal retinol concentration at 2 months (2.13 versus 2.03 μmol/L), 4 months (2.20 versus 2.24 μmol/L) or 6 months (2.29 versus 2.31 μmol/L). Because there was no further effect and because this population has a level of vitamin A deficiency considered mild, our results do not support a proposal to increase the dosing schedule for vitamin A in postpartum women as recommended by the IVACG.

Entrepreneurial Environment and the Prevalence of Diabetes in U.S. Counities

Troy C. Blanchard, Jing Li, Carson Mencken, and Charles M. Tolbert — Sun, 09 Sep 2012 14:22:56 +0000

Objective. To examine whether the presence of an entrepreneurial culture in a community is associated with county-level diabetes prevalence in the U.S. after accounting for high level of spatial clustering of prevalence rates observed in prior research. Methods. We perform a county-level spatial regression analysis of CDC diabetes prevalence rates. We measure entrepreneurial culture as the number of businesses with 0 to 4 employees per 1,000 residents. Results. The level of entrepreneurial culture in a community is associated with lower rates of diabetes. Our findings show that the key measure of entrepreneurial culture has expected effects on county diabetes rates. However, we show that failure to control for spatial error dependence in previous research leads to an overestimation of the effects of entrepreneurial culture on diabetes prevalence. Conclusion. Policies aimed at curbing diabetes prevalence should utilize the business community as a key agent of social change. Researchers should also utilize spatial regression techniques when analyzing county-level diabetes prevalence rates, because of high level of spatial clustering of rates.

Mental Health Needs of Young People with Problematic Drug and Alcohol Use in Manchester

Ruth Marshall, Louise Theodosiou, Prashant Bhat, Anita Ghosh, and Jade Ark — Sun, 02 Sep 2012 13:26:48 +0000

Background. Studies have indicated possible links between substance use disorder and other psychiatric disorders and suggested a high prevalence of unmet mental health needs amongst those with substance use disorders compared to the general population. Method. The study investigated the mental health needs of adolescents attending a substance misuse service. Mental health needs were assessed using the Strengths and Difficulties Questionnaire, the Conners screen for Attention Deficit Hyperactivity Disorder and a brief measure ascertaining demographics, drug use, and the service required by young people. Results. Young people were found to have higher than normal rates of mental health problems; this was not reflected in referral rates from the service. Conclusion. The findings are relevant to both commissioners and service providers. There is a need for integration between mental health services and those working with young substance users to provide a model of care that caters for dual diagnosis. Furthermore, offering mental health training to teams working with drug-using young people is recommended.

Evaluation of a Fresh Fruit Distribution Program in an Ethnically Diverse San Francisco High School

Jason M. Nagata, Melvin B. Heyman, and Janet M. Wojcicki — Mon, 27 Aug 2012 09:36:00 +0000

Objectives. We evaluated the effects of a Department of Education Fresh Fruit and Vegetable Program (FFVP) on food consumption habits in an inner-city, San Francisco high school. Methods. One intervention high school received a California state grant from the Department of Education to distribute fruit biweekly from fall 2008 to spring 2010 and coordinate associated nutrition education. Students completed 1793 surveys at the intervention school and 778 surveys at a comparison school that assessed fruit, vegetable, fast food and soda consumption habits. Pearson's chi-squared tests were used to compare consumption of foods. Results. At the end of the intervention period, the percentage of students consuming soft drinks once or more per day was significantly lower in the intervention versus comparison school (3.1% versus 8.9%, 𝑃=0.01). Consumption of candy once or more per week was also lower in the intervention versus the comparison school in fall 2009 (55.7% versus 64.0%, 𝑃=0.01). No significant changes in fruit and vegetable consumption were observed in the intervention or comparison schools. Conclusions. Fruit distribution programs in high schools may decrease high school students' consumption of soft drinks and candy.

Project SUCCESS: Results from a Randomized Controlled Trial

Thu, 09 Aug 2012 13:59:42 +0000

The present investigation tested whether an enhanced smoking cessation program produced higher cessation rates for participants than for controls. Participants in the enhanced intervention condition received in-person motivational counseling with health feedback, a tailored internet-based program, and nicotine patch. Participants in the control group received a smoking cessation self-help manual and nicotine patch. This randomized controlled trial was conducted at a 4-year university with a student body of 32,000. Five hundred-nine students who smoked ≥1 cigarette daily were individually randomized into the enhanced intervention and control groups. Over a 3-month period, participants in the enhanced intervention condition attended two personal sessions with smoking cessation counselors. Participants in both conditions were reassessed for smoking status 12 months post-baseline. Multivariate logistic regression techniques were used to analyze the data using the intent to treat approach. Results indicated that the odds of smoking cessation were 2 times larger for the enhanced intervention group than controls (odds ratio = 2.3, 95%, confidence interval = 1.3, 3.9, P<.01). This study begins to fill research gaps regarding college students and smoking cessation. Suggestions for future advancements in smoking cessation interventions for college students are provided.

Age Variance in the Survival of United States Pediatric Leukemia Patients (1973–2006)

L. Holmes Jr, F. Opara, M. Des-Vignes-Kendrick, and J. Hossain — Tue, 07 Aug 2012 10:20:01 +0000

Background. Age at diagnosis remains an important prognostic factor in pediatric leukemia. However, it is not fully understood which prognostic factors are related to its effect on survival. This study aimed to assess the effect of age at diagnosis on pediatric leukemia survival in the United States (US). Methods. We utilized the Surveillance Epidemiology and End Results (SEER) data of the diagnosed pediatric leukemia patients (𝑛=15215) from 1973–2006. Life table, Kaplan-Meier, log rank test, and Cox proportional hazard methods were used to examine the data. Results. The overall 5-year survival was 67.9%. Infants and children of 18 and 19 years had the highest risk of dying, with a rapid declining risk of death at age of 1 year that continued until age of 3 years and thereafter a steady trend of increased risk of death. The increased risk of dying was associated with boys, T-cell type and more than one primary tumor, 𝑃 < 0.0001. There was significant variability in survival by the age group at diagnosis. Compared to age group <1 year, children of ages 1–4 years, 5–9 years, 10–14 years, and 15–19 years were 76% (adjusted hazard ratio (AHR) = 0.24, 99% CI = 0.21–0.28), 69% (AHR = 0.31, 99% CI = 0.26–0.36), 46% (AHR = 0.54, 99% CI = 0.46–0.62), and 18% (AHR = 0.82, 99% CI = 0.70–0.95) less likely to die, respectively. Conclusion. The age at tumor diagnosis was a single most potent prognostic factor of childhood leukemia survival, with infants and children of age group 15–19 years experiencing the poorest survival. This significant variability persisted after adjustment for the effect of other covariates. Therefore, there is a need to identify other prognostic factors that are associated with age in order to provide a meaningful explanation of the impact of age on pediatric leukemia survival in the US.

Gender Disparity in Structured Physical Activity and Overall Activity Level in Adolescence: Evaluation of Youth Risk Behavior Surveillance Data

Sun, 29 Jul 2012 08:55:48 +0000

Background. Adolescent girls are less likely to meet physical activity recommendations than boys. This study examined the relative contribution of structured physical activity opportunities including physical education (PE) class and sports teams to overall activity levels for girls and boys. Methods. Data from 591 9th–12th grade students who completed the 2009 Philadelphia Youth Risk Behavior Survey were examined. Logistic regression was used to estimate the relationship between PE and sports teams and physical activity levels. Models were stratified by gender to estimate gender differences. Results. Girls were less likely to be active than boys: 27.9% of girls were sedentary as compared to 10.6% of boys. PE class was not related to activity levels among boys, while highly active girls were seven times more likely to participate in daily PE than were sedentary girls. Playing on one or more sports teams was associated with low-moderate and high activity in girls; among boys, sports team participation was only associated with high activity. Conclusions. The structured physical activity opportunities of PE and sports teams may contribute more to overall activity levels in girls than boys. A more rigorous assessment of this hypothesis is warranted to inform efforts to promote activity levels in girls.

How the Most Trusted Venues for Health-Related Information Influence Physician Referrals to Smoking Cessation Services

Judy Kruger, Angela Trosclair, Crystal Bruce, and Diane Beistle — Wed, 11 Jul 2012 09:10:56 +0000

Public health programs seek to educate physicians by using a variety of venues. Therefore, it is important to understand which health information sources physicians are using and how these sources affect referrals. We explored how venues for health-related information affect physicians' referral practices to smoking cessation services. The 2008 DocStyles survey asked physicians to rank a list of their most trusted sources of health-related information. The analysis was restricted to 1,617 physicians who responded to all variables of interest. In this sample, the most trusted sources of health-related information cited by physicians were medical journals (95.9%), government health agencies (82.2%), other physicians (76.4%), professional medical societies (75.2%), and medical Web sites or podcasts (65.9%). Medical providers were more likely to refer tobacco users to cessation services if they used professional medical societies as a source to obtain patient health-related information, compared with medical providers not using this source (multivariate odds ratio = 1.31; 95% confidence interval = 1.03–1.66). Physicians use many health information sources. Therefore, to reach physicians effectively, a broad dissemination of guidelines and best practices in tobacco control is needed and should include information for medical societies.

Impact of the Built Environment on Mental and Sexual Health: Policy Implications and Recommendations

David Satcher, Martha Okafor, and LeConté J. Dill — Thu, 14 Jun 2012 09:31:27 +0000

Research related to the intersection of the built environment and health has particularly flourished in the last decade. The authors highlight the theoretical and policy insights that have been made while also noting paucity in this literature as specifically related to mental and sexual health. Overall, the authors discuss policy implications of aspects of the built environment on both mental and sexual health behaviors and outcomes and suggest avenues for future research, program implementation, and policymaking for advancing health equity in these areas.

Racial/Ethnic Variability in Diabetes Mellitus among United States Residents Is Unexplained by Lifestyle, Sociodemographics and Prognostic Factors

Laurens Holmes Jr., Jobayer Hossain, Doriel Ward, and Franklin Opara — Sun, 03 Jun 2012 11:44:43 +0000

Background. The mortality and prevalence of diabetes mellitus (DM) vary across racial/ethnic groups with African Americans/blacks being disproportionately affected. However, it is unclear to what extent such disparities persist after the adjustment for covariates related to race/ethnicity and/or DM in the population. We aimed to assess racial/ethnic disparities in DM and to determine which covariates account for the observed racial/ethnic variabilities. Materials and Methods. We utilized a large cross-sectional survey of the US noninstitutionalized residents (𝑛=30,852) to investigate the racial/ethnic disparities in diabetes mellitus, and the degree in which the disparities are explained by the relevant covariates. Pearson’s chi-square was used to examine study variables by race/ethnicity, while logistic regression was used to assess the effect of race/ethnicity and other covariates on DM prevalence. Results. There were statistically significant ethnic/racial differences with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, 𝑃<0.05, but not insurance coverage, 𝑃>0.05. Race/ethnicity was a single independent predictor of DM, with African Americans (non-Hispanic blacks) more likely to be diagnosed for DM compared with non-Hispanic whites, prevalence odds ratio (POR) 1.45, 95% confidence interval (CI) 1.30–1.62, while Hispanics were less likely to be diagnosed, POR = 0.98, 95% CI 0.87–1.09. Similarly, after controlling for potential confounders, the racial/ethnic variability in DM between AA/blacks and non-Hispanic whites persisted, adjusted POR = 1.30, 95% CI 1.15–1.47. Conclusions. Racial/ethnic variability exists in DM prevalence and is unexplained by racial/ethnic variance in education, income, marital status, smoking, alcohol, physical activities, age, and sex.

Factors Contributing to Job Engagement in Ugandan Nurses and Midwives

Pauline Bakibinga, Hege Forbech Vinje, and Maurice Mittelmark — Tue, 29 May 2012 10:59:45 +0000

Despite the difficult working conditions many nurses in Sub-Saharan Africa experience resulting in their migration or leaving the profession, there are nurses who thrive and stay engaged. Understanding what factors play a role in enhancing nurses' job engagement might help health care and training institutions develop interventions to enable nurses learn methods to help retain their job engagement. Research in Norway has produced a theory about how job engagement can be protected, called the Self-tuning Model of Self-Care, which was used to explore the phenomenon of job engagement in Ugandan nurses. In-depth interviews were conducted in 2010, with a purposive sample of 15 nurses and midwives. Qualitative content analysis of the data was conducted. Findings from Uganda show that the Self-Tuning Model can be used both as a framework for analysis and as a model of how nurses can promote their experience of job engagement. Nurses should be encouraged to practice habitual introspection and reflection about the satisfactions they derive from work, to enable them retain a high level of job engagement despite the adversities of nursing practice.