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PubMed1995

A framework for health promotion and disease prevention programs.

There is a disquieting sense that many theoretically based health behavior change programs have been only minimally effective. Part of the problem may be that most current theories have considerable overlap, primarily focus on intraindividual and other individual-level variables, and tend to neglect the environment and issues related to program implementation. A framework is developed for health promotion and disease prevention programs that makes use of epidemiological and health indicator data and Healthy People 2000 goals to prioritize efforts, provides a schema to formulate programs on the basis of timing (prevention) and level of intervention, and addresses the marketing approach to target and implement programs. The framework integrates current theories to guide marketing and phases of research.

Epidemiology↗
PubMed2004

U.S. health care policy and the rising uninsured: an alternative solution.

The lack of adequate health insurance affects one's ability to access care, which directly affects one's health. In the 21st century, there are 44 million people in the United States without health care insurance. The majority of people without health care insurance are working people under age 65, because most people over age 65 are retired and have health insurance through the federal Medicare program. Maintaining a healthy population makes good business sense because healthy people are more able to work, buy goods, and pay taxes that contribute to a healthy economy and strong government. We must understand, through provider "cost shifting," the American public is already "footing the bill" for the uninsured. However, the actual amount is hidden and passed on to consumers in payments to insurance companies through raised premiums, deductibles, co-payments, exclusions from coverage, and direct out-of-pocket payments to providers (e.g., physicians, hospitals). Ironically, the very working poor who are uninsured and underinsured help fund the health insurance of select federally protected groups through taxation. A huge gap exists in the current United States system of health care wherein there is no cogent benefit, only a vicious cycle as the insured continue to pay more for their care to help compensate provider losses due to the uninsured. This in turn causes a growing rank of uninsured individuals that lack access to adequate health care. The purpose of this article is to assert an alternative to the current U.S. health care insurance system. It takes advantage of structures already in place to promote a "win-win" American health system premised on a workable tiered universal health care system in which there is a benefit to the major populace. As an emanation of a diverse society, the proposed system does not advocate a one-payer universal system that is not amenable to the U.S. health care, social, or political environment.

Cost Allocation↗
PubMed2003

Public health surveillance of diabetes in the United States.

The Centers for Disease Control and Prevention Division of Diabetes Translation supports a national and state surveillance system that analyzes, interprets, and reports on diabetes risk behaviors, risk factors, care practices, morbidity, and mortality. Data sources include surveys, the U.S. Renal Data System, the Indian Health Service, information on hospital inpatients, birth and death certificates, and special studies to use and to better understand the usefulness of data from managed care, Medicare, and Medicaid for monitoring diabetes. These data are used to define the magnitude and burden of diabetes; monitor changes in burden over time; guide public health planning and policy making, and assess progress toward diabetes objectives, such as those in Healthy People 2010. Challenges facing the diabetes surveillance system are limitations in data sources; the capture of undiagnosed diabetes; tracking key risk factors, such as levels of glycemia and lipids; and surveillance of high- or emerging-risk populations such as racial and ethnic groups, children and youth, and those with prediabetes. Limited resources, competing priorities, and issues of data privacy also challenge surveillance. To overcome these factors, the Division of Diabetes Translation strongly emphasizes partnering with other organizations, such as the Medicare and Medicaid programs, managed care, and other chronic disease programs.

Centers for Disease Control and Prevention, U.S.↗
PubMed2004

Surveillance for disparities in maternal health-related behaviors--selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2001.

PROBLEM/CONDITION: Disparities in maternal and infant health have been observed among members of different racial and ethnic populations and persons of differing socioeconomic status. For the Healthy People 2010 objectives for maternal and child health to be achieved (US Department of Health and Human Services. Healthy People 2010. 2nd ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington DC: US Department of Health and Human Services, 2000), the nature and extent of disparities in maternal behaviors that affect maternal or infant health should be understood. Identifying these disparities can assist public health authorities in developing policies and programs targeting persons at greatest risk for adverse health outcomes. REPORTING PERIOD COVERED: 2000-2001. DESCRIPTION OF THE SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants. PRAMS employs a mixed mode data-collection methodology; up to three self-administered surveys are mailed to a sample of mothers, and nonresponders are followed up with telephone interviews. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets that can be used to produce statewide estimates of different perinatal health behaviors and experiences among women delivering live infants in 31 states and New York City. This report summarizes data for 2000-2001 from eight states (Alabama, Colorado, Florida, Hawaii, Illinois, Maine, Nebraska, and North Carolina) on four behaviors (smoking during pregnancy, alcohol use during pregnancy, breastfeeding initiation, and use of the infant back sleep position) for which substantial health disparities have been identified previously. RESULTS: Although the prevalence of each behavior varied by state, consistent patterns were observed among the eight states by age, race, ethnicity, education, and income level. Overall, the prevalence of smoking during pregnancy ranged from 9.0% to 17.4%. Younger (aged <25 years) women, white women, American Indian women, non-Hispanic women (except in Hawaii), women with a high school education or less, and women with low incomes consistently reported the highest rates of smoking. Overall, the prevalence of alcohol use during pregnancy ranged from 3.4% to 9.9%. In seven states, women aged >35 years, non-Hispanic women, women with more than a high school education, and women with higher incomes reported the highest prevalence of alcohol use during pregnancy. Overall, the prevalence of breastfeeding initiation ranged from 54.8% to 89.6%. Younger women, black women, women with a high school education or less, and women with low incomes reported the lowest rates of breastfeeding initiation. The size of the black-white disparity in breastfeeding varied among states. Overall, use of the back sleep position for infants ranged from 49.7% to 74.8%. Use of the back sleep position was lowest among younger women, black women, women with lower levels of education, and women with low incomes. Ethnic differences in sleep position varied substantially by state. INTERPRETATION: PRAMS data can be used to identify racial, ethnic, and socioeconomic disparities in critical maternal health-related behaviors. Although similar general patterns by age, education, and income were observed in at least seven states, certain racial and ethnic disparities varied by state. Prevalence of the four behaviors among each population often varied by state, indicating the potential impact of state-specific policies and programs. PUBLIC HEALTH ACTION: States can use PRAMS data to identify populations at greatest risk for maternal behaviors that have negative consequences for maternal and infant health and to develop policies and plan programs that target populations at high risk.sk. Although prevalence data cannot be used to identify causes or interventions to improve health outcomes, they do indicate the magnitude of disparities and identify populations that should be targeted for intervention. This report indicates a need for wider targeting than is often done. The results from this report can aid state and national agencies in creating more effective public health policies and programs. The data described in this report should serve as a baseline that states can use to measure the impact of policies and programs on eliminating these health disparities.

Female↗
PubMed2006

The future of health promotion/disease prevention programs: the incentives and barriers faced by stakeholders.

According to Healthy People 2010, 95% of employers with more than 50 employees reported that they offered at least one health promotion activity by 1999. Employment-based health promotion/disease prevention (hp/dp) programs have significantly increased in frequency and scope since 1985. Yet, 20 years later, the reported results for employee health lag behind the literature documenting the impact of lifestyle-related health risks on morbidity, healthcare utilization, and costs. In this article, we consider the key stakeholders involved-employers, health plans, and employees-and explore their legitimate and feasible roles in employment-based hp/dp programs, including the incentives and barriers they face to program participation. We argue for the integration of hp/dp programs into the traditional health protection mission of occupational health and safety professionals.

Disease Management↗
PubMed1998

Improving the fit: adolescents' needs and future programs for sexual and reproductive health in developing countries.

Demand is growing in developing countries for sexual and reproductive health programs for young people. However, little scientifically based evidence exists about which program approaches are most effective in shaping healthy behaviors. Careful evaluation and research must be increased, but meanwhile, planners need guidance as they expand programming. Research indicates that current programs often do not match the needs and health-seeking behaviors of young people. Behavioral theories and expert opinion agree that adolescents must be taught generic and health-specific skills necessary for adopting healthy behaviors. Constraints on financial and human resources, coupled with the great size of the youth population, highlight the need to find less costly ways to reach young people. These observations generate six programming principles to help planners and communities experiment with a wide variety of programming approaching.

Adolescent↗
PubMed2003

Surveillance for selected maternal behaviors and experiences before, during, and after pregnancy. Pregnancy Risk Assessment Monitoring System (PRAMS), 2000.

PROBLEM/CONDITION: Various maternal behaviors and experiences are associated with adverse health outcomes for both the mother and the infant. These behaviors and experiences can occur before pregnancy (e.g., insufficient intake of folic acid), during pregnancy (e.g., complications requiring hospitalization, such as high blood pressure), and after pregnancy (e.g., inadequate follow-up of infants who were discharged early). Information regarding maternal behaviors and experiences is needed to monitor trends, to enhance the understanding of the relations between behaviors and health outcomes, to plan and evaluate programs, to direct policy decisions, and to monitor progress toward Healthy People 2010 objectives (US Department of Health and Human Services. Healthy People 2010. 2nd. ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington DC: US Department of Health and Human Services, 2000). REPORTING PERIOD COVERED: This report covers data for 2000. DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected self-reported maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver a live-born infant in 31 states and New York City. PRAMS employs a mixed-mode data collection methodology; as many as three self-administered surveys are mailed to a sample of mothers, and nonresponders are followed up with a telephone interview. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets. PRAMS data can be used to produce statewide estimates of various perinatal health behaviors and experiences among women delivering a live infant. Four indicators for the year 2000 (multivitamin use, pregnancy-related complications, infant checkup, and postpartum contraceptive use) from 19 states are examined in this report. RESULTS: In 2000, the prevalence of multivitamin use > or =4 times per week in the month before pregnancy ranged from 25.0% to 40.7% across the 19 states. Prevalence of pregnancy-related complications requiring hospitalization ranged from 8.8% to 16.3%. Prevalence of infant checkups within 1 week of early (< or =48 hours) hospital discharge ranged from 51.5% to 88.6%. Prevalence of postpartum contraceptive use ranged from 77.9% to 89.9%. INTERPRETATION: PRAMS data indicate that 19 states are well below the Healthy People 2010 objective for folic acid consumption, as measured by multivitamin use. Data for infant checkups indicate that guidelines for care are not being followed for as many as half of those discharged early. However, data for additional years are needed to assess trends in these four indicators. PUBLIC HEALTH ACTION: State maternal and child health programs can use these population-based data to monitor progress toward Healthy People 2010 objectives, evaluate adherence to guidelines for care, and assess changes in prevalence of other health behaviors. The data can be shared with policy makers to direct policy decisions that might affect the health of mothers and infants. By providing data on maternal behaviors and experiences that are associated with adverse outcomes, PRAMS supports the activities of two CDC initiatives-to promote safe motherhood and to reduce infant mortality and low birthweight.

Contraception Behavior↗
PubMed2006

Opinions of South Carolina dental students toward tobacco use interventions.

OBJECTIVES: Tobacco use accounts for 75 percent of oral cancer deaths in the United States. One objective of Healthy People 2010 is to increase the percentage of dentists who provide smoking cessation counseling. However, studies of dentists have shown that the majority feel inadequately prepared to do so. The objective of this study was to determine the opinions of dental students at the Medical University of South Carolina (MUSC) regarding the provision of tobacco use interventions for patients. METHODS: In 2002, 163 students were administered a written questionnaire which included questions about tobacco use interventions (response rate=80 percent). Opinion items were analyzed using factor analysis, Fisher's Exact Test, and ANOVA (a < or = 0.025). RESULTS: While 89 percent of students agreed that dentists should be trained to provide tobacco cessation education, only 39 percent thought that they themselves were adequately trained. Students' opinions toward the role and training of dentists in providing tobacco use interventions differed by academic year. Only 14.1 percent of dental students were quite or very confident in their ability to help patients to stop smoking. CONCLUSIONS: This study indicates that although MUSC dental students support tobacco cessation training for dentists, the majority responded that they are not adequately trained and are not comfortable providing tobacco cessation education to patients. A comprehensive tobacco prevention and cessation program is indicated for the objective of Healthy People 2010 to be met.

Attitude of Health Personnel↗
PubMedDate not supplied

Clinical Prevention and Population Health Curriculum Framework: the nursing perspective.

The Clinical Prevention and Population Health Curriculum Framework (Curriculum Framework) was developed by the Healthy People Curriculum Task Force comprised of representatives from allopathic and osteopathic medicine, dentistry, nursing and nurse practitioners, pharmacy and physicians assistants. This multidiscipline Task Force was covened to address the Healthy People 2010 objective of increasing the health promotion/prevention content in health professional education. A focus on clinical prevention and population health activities is central to the goal of improving the health status of the nation and offers the greatest potential to reduce many leading causes of death and improve quality of life across diverse populations. The Curriculum Framework provides a set of 4 components (evidence base for practice, clinical preventive services, health systems/health policy and community aspects of practice) and 19 domains for organizing and implementing the curriculum. The title "Clinical Prevention and Population Health" includes both individual and population focused health promotion and prevention efforts. The role of nursing in developing the Curriculum Framework, and the tailoring and implementation of the Curriculum Framework for undergraduate and graduate programs in nursing is discussed.

Clinical Competence↗
PubMed2006

Primary care health issues among men who have sex with men.

PURPOSE: The purpose of the article is to examine "appropriate" health care for men who have sex with men (MSM), which is not to suggest "special" health care. As a group, MSM are at increased risk for sexually transmitted infections, anal cancer, and mental health disorders. Focus areas in this article will address health issues that the primary care nurse practitioner (NP) may encounter in clinical practice: anal carcinoma, sexually transmitted diseases (STDs), high-risk sexual practices, depression, and substance abuse were topics chosen for inclusion in this article. These topics were among those highlighted in the Healthy People 2010 Companion Document for LGBT Health, which served to examine the healthcare disparities and lack of access to needed services related to sexual orientation. DATA SOURCE: Extensive literature review of research articles, journals, clinical practice guidelines, books, and public health department Internet Web sites. CONCLUSIONS: There are unique health disparities that exist for MSM related to social, emotional, and mental health factors, in addition to physical issues such as STDs. There is an increasing need for primary care providers to be aware of these disparities, as well as the factors that influence these disparities, in order to provide multidimensional care and health counseling that is unique to NP practice. IMPLICATIONS FOR PRACTICE: Both the primary care NP and the patient should be aware of the unique healthcare issues among MSM that should be incorporated into the patient's routine health maintenance program. As primary care providers, it is within the standards of practice for NPs to provide culturally competent care, along with health promotion and disease prevention for MSM.

Algorithms↗
PubMed2003

Correlates of clinical preventive practices among internal medicine residents.

BACKGROUND: Healthy People: 2010 calls for improvement in the delivery of clinical preventive services. Physicians value preventive services, yet their rates of prevention consistently fall below recommendations. This study examines the relationship between personal characteristics of internal medicine residents and their clinical prevention practices in an outpatient setting. METHODS: Participants were 56 of 80 physicians (70%) in an internal medicine residency program in New Jersey. Personal characteristics (i.e., demographics, specialty orientation, attitudes toward prevention, and personal health behaviors) of the residents were collected via a self-administered survey. A 12-month retrospective chart review of 184 new doctor-patient encounters was performed to determine rates of clinical preventive services. RESULTS: Clinical preventive services were performed at varying rates, and differential practices specific to the patient's gender and/or age were detected for several services. Multiple regression revealed four significant predictors of overall prevention practice: clinic site, international medical graduates, generalist orientation, and self perceived health status (R(2) = 0.32). Predictors of health promotion counseling were clinic site, international medical graduates, and generalist orientation (R(2) = 0.30). CONCLUSIONS: While personal characteristics such as self-rated health and generalist orientation were associated with preventive practices, factors related to the office environment were also associated with increased delivery of clinical preventive services. Prevention-oriented office systems, such as "Put Prevention Into Practice," should be worthwhile considerations to increase delivery of preventive services.

Adult↗
PubMedDate not supplied

A comprehensive Laboratory Services Survey of State Public Health Laboratories.

In November 2004, the Association of Public Health Laboratories (APHL) conducted a Comprehensive Laboratory Services Survey of State Public Health Laboratories (SPHLs) in order to establish the baseline data necessary for Healthy People 2010 Objective 23-13. This objective aims to measure the increase in the proportion of health agencies that provide or assure access to comprehensive laboratory services to support essential public health services. This assessment addressed only SPHLs and served as a baseline to periodically evaluate the level of improvement in the provision of laboratory services over the decade ending 2010. The 2004 survey used selected questions that were identified as key indicators of provision of comprehensive laboratory services. The survey was developed in consultation with the Centers for Disease Control and Prevention National Center for Health Statistics, based on newly developed data sources. Forty-seven states and one territory responded to the survey. The survey was based on the 11 core functions of SPHLs as previously defined by APHL. The range of performance among individual laboratories for the 11 core functions (subobjectives) reflects the challenging issues that have confronted SPHLs in the first half of this decade. APHL is now working on a coordinated effort with other stakeholders to create seamless state and national systems for the provision of laboratory services in support of public health programs. These services are necessary to help face the threats raised by the specter of terrorism, emerging infections, and natural disasters.

Centers for Disease Control and Prevention, U.S.↗
PubMed1998

Testing the influence of the health belief model and a television program on nutrition behavior.

This study proposed to identify relevant factors of the health belief model (HBM) that provide motivation for people to engage in healthy dietary behavior. The impact of a TV program was also assessed using a longitudinal study with 300 participants and measuring the influence of path coefficients in the HBM that predicted salience, motivation, and healthy eating practices. Findings suggested that nutrition behavior was influenced by susceptibility and efficacy mediated through health motivation and salience. Program viewing boosted salience regardless of age, education, or household size by significantly increasing viewers' confidence in their nutrition knowledge base.

Journal Article↗
PubMed2007

Favorable effects of non-instrumental resistance training on fat distribution and metabolic profiles in healthy elderly people.

This study examined the effect of a 12-week non-instrumental resistance training program using body weight as a load (RT-BW) on body composition, fat distribution and metabolic profiles in elderly males and females. Healthy, non-diabetic, elderly volunteers (22 males and 30 females) aged 65-82 years were non-randomly divided into RT-BW (12 males and 20 females) and control (10 males and 10 females) groups. The RT-BW subjects were trained three times per week for 12 weeks according to a specified protocol involving a combination of upper and lower body weight and rubber tubing exercises. We evaluated body composition and fat distribution using anthropometry, dual energy X-ray absorptiometry and ultrasonography, and measured serum lipid levels and HbA(1c) at baseline and after 12 weeks of training. Changes over 12 weeks were significantly greater in the RT-BW group compared with the control group, with a decrease in waist circumference, pre-peritoneal (visceral) fat thickness and thigh fat thickness, and an increase in thigh muscle thickness. On the other hand, the changes in body weight, fat mass and fat free mass were no different between the groups. Further, there were significantly greater changes of metabolic profiles in the RT-BW group with an increase in HDL cholesterol and a decrease in triglyceride and HbA(1c). There was a significant between-group difference in diastolic blood pressure. Relatively short-term, non-instrumental resistance training using body weight as a load was effective in improving fat distribution and metabolic profiles in healthy elderly people without weight loss.

Aged↗
PubMedDate not supplied

Healthy cities: overview of a WHO international program.

Health is the outcome of all the factors and activities impinging upon the lives of individuals and communities. The last decade has seen an emerging understanding within development circles that living conditions are greatly affected by local action, by the work of local government, and by community groups and organizations. In addressing health and environmental issues and making interventions, an integrated approach, based on 'settings', exemplified in the Healthy Cities approach, has proved most effective. A Healthy City project can involve people and organizations in the programs and activities that are needed for better health, and enables a city or neighborhood to mobilize the human and financial resources required to address many health and quality of life issues. The WHO program involves implementating city projects and networks in all regions of the world and serves as a vehicle for many health programs, including major disease control initiatives. Healthy City projects allow Ministries of Health to develop stronger partnerships with local government organizations (such as the Union of Local Authorities and its members, "Local Agenda 21" initiatives, and others). One focus for the program is the development of 'multi-'multi-city action plans' for major global priority issues, including AIDS, sanitation, women's health, and violence, to ensure that major public health programs are strengthened by wider community participation. It is recognized that city networking--at national, regional, and international levels--now must be better exploited by individual cities and municipalities to solve local health problems.

Environmental Health↗
PubMed2005

The Healthy People 2010 smoking prevalence and tobacco control objectives: results from the SimSmoke tobacco control policy simulation model (United States).

OBJECTIVES: Healthy People 2010 (HP2010) set a goal of reducing the adult smoking prevalence to 12% by 2010. Smoking prevalence rates do not appear to be declining at or near the rate targeted in the HP2010 goals. The purpose of this paper is to examine the attainability of HP2010 smoking prevalence objectives through the stricter tobacco control policies suggested in HP2010. METHODS: A tested dynamic simulation model of smoking trends, known as SimSmoke, is applied. Smoking prevalence evolves over time through initiation and cessation, behaviors which are in turned influenced by tobacco control policies. We consider the effect of changes in taxes/prices, clean air laws, media campaigns, cessation programs and youth access policies on projected smoking prevalence over the period 2003-2020, focusing on the levels in 2010. RESULTS: The SimSmoke model projects that the aging of older cohorts and the impact of policies in years prior to 2004 will yield a reduction in smoking rates to 18.4% by 2010, which is substantially above the 2010 target of 12%. When policies similar to the HP2010 tobacco control policy objectives are implemented, SimSmoke projects that smoking rates could be reduced to 16.1%. Further reductions might be realized by increasing the tax rate by $1.00. CONCLUSIONS: The SimSmoke model suggests that the HP2010 smoking prevalence objective is unlikely to be attained. Although we are unlikely to reach the goals by meeting the HP2010 policy objectives, they could get us much closer to the goal. Emphasis should be placed on meeting the tax, clean air, media/comprehensive campaigns, and cessation treatment objectives.

Computer Simulation↗
PubMed2002

[Non-typical measurements during a isokinetic training session after ACL-reconstruction].

Rehabilitative resistance work programs after ACL-injuries are derived from programs known from competitive sports training. The development of different parameters (max. Power output, total work per set) was examined in 12 patients after ACL-reconstruction during a training session on an isokinetic training machine with a velocity of 120 degrees /sec and 60 degrees /sec. The results let suppose that neuromuscular structures of patients with ACL-reconstruction react different to those of healthy people in the control group. Therefore the rehabilitation programs have to be adjusted to the recruitment pattern of motor units after ACL-injury. In this case there has to be a progression of intensity during the isokinetic training session.

Adult↗