New report documents improvement in Americans' health--Healthy People 2000.
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Could a federal program to promote influenza vaccination among elders be cost-effective?
BACKGROUND: Influenza-related mortality predominately and disproportionately impacts the elderly. Rates of annual influenza vaccination among the elderly are approximately 65%, far below the Healthy People 2010 target of 90%. We estimated the cost-effectiveness of a 10-year federal program to promote influenza vaccine, intended to increase vaccination rates among persons > or = 65 years old. METHODS: Published estimates regarding influenza-associated mortality rates and vaccine efficacy among the US elderly were used to calculate the number needed to vaccinate (NNV) to prevent one all-cause death due to influenza, as well as the mortality reduction expected from increased vaccination rates. The costs per life-year saved were estimated for a hypothetical federal promotional campaign, patterned after a direct-to-consumer (DTC) advertising program (2006-2015). The base case scenario presumed a 25-percentage-point increase in vaccination rates to 90%; in sensitivity analyses, we examined programs that increased rates by 10-20 points. RESULTS: The base case NNV was 1116 (95% CI: 993-1348). Over the 10-year DTC-style influenza vaccine promotion program, 6516 (5576-7435) elderly lives would be saved. The incremental cost-effectiveness (C/E) of the program was dollar 16,300 (dollar 11,347-dollar 25,174) per life-year saved in 2006 and increased to dollar 199,906 (dollar 138,613-dollar 307,423) per life-year saved by 2015. Overall, the C/E for the 10-year program was dollar 37,621 (dollar 32,644-dollar 43,939) per life-year saved. Programs that yielded a 15-percentage-point increase or less in vaccination rates would have C/E values exceeding dollar 50,000 per life-year saved and save fewer than 4000 total lives. CONCLUSIONS: DTC-style promotional campaigns for influenza vaccine among elders may represent a cost-effective strategy for the federal government to pursue as a means of increasing elders' vaccination rates and reducing influenza-related mortality.
Actuarial Analysis↗
State-specific prevalence of selected chronic disease-related characteristics--Behavioral Risk Factor Surveillance System, 2001.
PROBLEM: High-risk behaviors and lack of preventive care are associated with higher rates of morbidity and mortality in the United States. Without continued monitoring of these factors, state health departments would have difficulty tracking and evaluating progress toward Healthy People 2010 and their own state objectives. Monitoring chronic disease-related behaviors is also key to developing targeted education and intervention programs at the national, state, and local levels to improve the health of the public. REPORTING PERIOD COVERED: Data collected in 2001 are compared with data from 1991 and 2000, and progress toward Healthy People 2010 targets is assessed. DESCRIPTION OF SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, telephone survey of persons aged > or =18 years. State health departments collect the data in collaboration with CDC. In 2001, participants in data collection included all 50 states, the District of Columbia, Guam, the U.S. Virgin Islands, and the Commonwealth of Puerto Rico. BRFSS data are used to track the prevalence of chronic disease-related characteristics and monitor progress toward national health objectives related to 1) decreasing high-risk behaviors, 2) increasing awareness of medical conditions, and 3) increasing use of preventive health services. For certain national objectives, BRFSS is the only source of data. RESULTS: BRFSS data indicate changes in certain high-risk behaviors from 1991 to 2001. Among the findings are substantial increases in the prevalence of obesity among adults aged > or =20 years. Among states, prevalence of persons classified as obese in 2001 ranged from 15.5% in Colorado to 27.1% in Mississippi. From 1991 to 2001, the median prevalence for all participating states and territories increased from 12.9% to 21.6%. In 1991, no state had an obesity prevalence of > or =20%; in 2001, 37 states had a prevalence of > or =20%. Percentage increases in prevalence of obesity, from 1991 to 2001, ranged from 24.9% in the District of Columbia to 140.2% in New Mexico. In 2001, substantial variations also existed among states and territories regarding prevalence of other high-risk behaviors and awareness of medical conditions. Ranges included, for no leisure-time physical activity, 16.5% (Utah) to 49.2% (Puerto Rico); cigarette smoking, 9.6% (Virgin Islands) to 31.2% (Guam); binge drinking, 6.8% (Tennessee) to 25.7% (Wisconsin); heavy drinking, 2.5% (Tennessee) to 8.7% (Wisconsin); persons ever told they had diabetes, 4% (Alaska) to 9.8% (Puerto Rico); persons ever told they had high blood pressure, 20% (New Mexico) to 32.5% (West Virginia); and persons ever told they had high blood cholesterol, 24.8% (New Mexico) to 37.7% (West Virginia). Substantial variations also existed among states regarding prevalence of using preventive health services. Ranges included, for persons aged > or =50 years ever screened for colorectal cancer by use of sigmoidoscopy or colonoscopy, 30.5% (Virgin Islands) to 62% (Minnesota); persons aged > or =65 years who received an influenza vaccination in the past year, 36.8% (Puerto Rico) to 79% (Hawaii); persons aged > or =65 years who ever received a pneumococcal vaccination, 24.1% (Puerto Rico) to 70.9% (Oregon). In 2001, 13 states, Guam, and the U.S. Virgin Islands used the women's health module. Ranges included, for women aged > or =18 years who had a Papanicolaou (Pap) smear test in the past 3 years, 79.8% (Virgin Islands) to 89.6% (Wisconsin); women aged > or =40 years who ever had a mammogram, 71.9% (Virgin Islands) to 93% (Rhode Island); and women aged > or =40 years who had a mammogram in the past 2 years, 57.2% (Virgin Islands) to 85.1% (Rhode Island). BRFSS data in 2001 also indicated variations by sex, race or ethnicity, and age group. Greater percentages of men than women reported cigarette smoking, binge drinking, heavy drinking, and were classified as overweight; greater percentages of women reported no leisure-time physical activity. Among racial or ethnic groups, greater percentages of black non-Hispanics than other groups reported being told by a health professional they had high blood pressure and diabetes, and were classified as obese; greater percentages of white non-Hispanics than other groups reported being told they had high cholesterol. Among age groups, greater percentages of persons aged 18-24 years than those in older groups reported smoking cigarettes, binge drinking and heavy drinking; greater percentages of persons in older age groups than younger age groups reported being told they had diabetes, high blood pressure, and high blood cholesterol. Also, comparison of 2001 BRFSS data with 12 targets from Healthy People 2010 indicates that, in 2001, no state had met the targets for obesity, cigarette smoking, binge drinking, receiving a fecal occult blood test within the past 2 years, receiving annual influenza vaccinations, receiving pneumococcal vaccinations, and receiving Pap tests. Certain states had already met targets for no leisure-time activity, receiving a sigmoidoscopy or colonoscopy, having blood cholesterol checked within the past 5 years, and receiving a mammogram within the past 2 years. INTERPRETATION: BRFSS data in this report indicate that despite certain improvements, persons in a high proportion of U.S. states and territories continue to engage in high-risk behaviors and do not report making sufficient use of preventive health practices. Substantial variations (i.e., by state, sex, age group, and race/ethnicity) in prevalence of behaviors, awareness of medical conditions, and use of preventive services indicate a continued need to monitor these factors at state and local levels and assess progress toward reducing morbidity and mortality. PUBLIC HEALTH ACTIONS: BRFSS data can be used to guide public health actions at local, state, and national levels. For certain states, BRFSS is the only reliable source of chronic-disease-related, risk-behavioral data. BRFSS data enable states to design, implement, evaluate, and monitor health-promotion strategies, targeting specific high-risk behaviors among populations experiencing high burdens of disease. BRFSS data continue to be key sources for assessing progress toward both national Healthy People 2010 objectives and state health objectives.
Adult↗
From survivorship to thrivership: native peoples weaving a healthy life from cancer.
BACKGROUND: In this commentary, we describe culturally specific cancer support and education programs that have been successfully adapted for use with both urban and reservation-based California Indian communities. METHODS: The Native American Cancer Survivor Support Circles were initiated in Los Angeles County in 2000 and were tailored for specific use with reservation-based communities in 2002. Support circles include culturally respectful ground rules, prayers, and culturally specific education topics (spirituality, coping with chemotherapy) and psychosocial support as well. RESULTS AND CONCLUSIONS: Evaluation showed that both Native men and women had greater confidence in their abilities to cope with their healing and recovery from cancer following participation.
California↗
How to improve the effectiveness of caries-preventive programs based on fluoride.
During recent years, an increasing number of reports have been published in which the observed caries-preventive effect of fluoride has been lower than could have been expected on the basis of the earlier literature. The current low levels of caries occurrence and the widespread use of fluoridated toothpastes as well as other fluoride products and methods have been suggested as reasons for the reduced relative effect of fluoride from any single source. Theoretically, one can improve the effectiveness of fluoride in caries-preventive programs by using measures that are more effective than the previous ones and still safe and feasible in everyday conditions. Another possibility is to direct fluoride-based prevention to high caries risk susceptible individuals who are most likely to benefit from it. Thirdly, one can enhance the intensity of existing fluoride prevention by increasing the frequency of applications, but this is of course worthwhile only if the recipients are lacking sufficient exposure to fluoride. In theory, people themselves could easily take care of their adequate fluoride supply by using fluoride toothpastes and/or other home use products frequently enough to maintain a sufficient salivary fluoride concentration at all times. Many people are unwilling to adopt healthy lifestyles, however, and therefore caries-preventive programs will remain necessary for the foreseeable future. Fluoride is the backbone of all such programs. Since conditions strongly determine the usefulness of caries prevention including different fluoride regimes, more research is still needed to monitor the effectiveness of caries-preventive programs and their components in variable conditions of today and tomorrow.
Cariostatic Agents↗
Effects of whole body vibration training on postural control in older individuals: a 1 year randomized controlled trial.
This randomized controlled trial investigated the effects of a 12 month whole body vibration training program on postural control in healthy older adults. Two hundred and twenty people were randomly assigned to a whole body vibration group (n=94), a fitness group (n=60) or a control group (n=66). The whole body vibration and fitness groups trained three times a week for 1 year. The vibration group performed exercises on a vibration platform and the fitness group performed cardiovascular, strength, balance and stretching exercises. Balance was measured using dynamic computerized posturography at baseline and after 6 and 12 months. Whole body vibration training was associated with reduced falls frequency on a moving platform when vision was disturbed and improvements in the response to toes down rotations at the ankle induced by the moving platform. The fitness group showed reduced falls frequency on the moving surface when vision was disturbed. Thus, whole body vibration training may improve some aspects of postural control in community dwelling older individuals.
Accidental Falls↗
Three evaluation methods of a community health advocate program.
The title Community Health Advocate (CHA) is one of thirty or more titles used throughout the world for an indigenous outreach worker who is trusted and respected in his or her community and who serves as a bridge between peers and health professionals. In 1992, the Center for Healthy Communities in Dayton, Ohio developed a program to train as Advocates people indigenous to the communities in which they would be working. Since the first CHAs began work in January 1993, the effectiveness of the program has been evaluated from three perspectives: the Community Health Advocates, the managers/directors of the community sites at which the CHAs work, and the clients with whom the CHAs work. Advocates indicated that the training program adequately prepared them for their roles and functions. They also identified systematic frustrations and barriers that made it more difficult for them to perform their job. Community site directors and community leaders indicated that the CHAs were considered a positive force in meeting client needs and facilitating independence, and were very effective in outreach and coordination of resources. A survey of CHA clients revealed an overwhelmingly positive response to the Advocate's work, validating the belief that CHAs can fill an important niche in the health care community. The three evaluation processes described in this paper helped to document the need for and the effectiveness of this program and can serve as a model for similar programs.
Adolescent↗
Superfund research program--accomplishments and future opportunities.
This special issue of the International Journal of Hygiene and Environmental Health provides extensive background on the Superfund programs, findings of specific research studies and future directions. Three federal agencies are leading the effort in this program. They are the National Institute of Environmental Health Sciences, U.S. Environmental Protection Agency and the Agency for Toxic Substances and Disease Registry. As a result of their collaboration, a comprehensive program has been developed that ranges from basic to applied research with the aim of improving public health services and protection. This paper highlights the research within areas of toxicological investigation, exposure assessment, risk evaluation and engaging communities. Each of the agencies has developed strategies and initiatives to enhance the effectiveness of the Superfund research program. The continuation of research will contribute significantly towards achieving the Healthy People 2010 goals that have been set for the United States.
Community-Institutional Relations↗
Voices from an Afghan community.
A major role of the community health nurse is advocating to meet the needs of population groups. This article describes how community health nurses utilized two assessment tools, a windshield survey, a semi-structured interview protocol, and the Healthy People 2000 National Health Objectives to collect pertinent information and recommend program strategies at the primary, secondary and tertiary prevention levels to reduce the prevalence of domestic violence in an Afghan community.
Adult↗
Health promotion for urban middle school students: a survey of learning needs.
Community based education programs and community partnerships are crucial for attaining the objectives of Healthy People 2010. The purpose of this descriptive study was to determine the health promotion needs of urban middle school students from the perspective of the participants in a health promotion partnership project. A convenience sample of 161 urban middle school students participated in the study. A Likert scale of health promotion topics was used for data collection. Findings from the study indicated that urban middle school students have a major interest in finding out more about hair care, safety issues, and prevention of infection. Students expressed a need for more information about issues related to why people use drugs, feelings about self, feelings of sadness and worry, and feelings about death. Important variations were found in the priority of interest in topics among the three grades. The researchers concluded that the psychosocial health promotion needs of urban middle school students should be explored further.
Adolescent↗
Health promotion through employee assistance programs: a role for occupational therapists.
Health promotion is predicted to have a major impact on occupational therapy practice. Keeping people well and promoting a healthy life-style will be the focus for the future. Many companies and agencies are taking the lead by instituting employee assistance programs (EAPs). With the de-emphasis on long-term hospital care, many occupational therapists will be seeking employment with community health programs. This paper advocates a role for occupational therapists in health promotion and disease prevention in an EAP. A description of EAPs and the contributions that occupational therapists can make to these programs is offered. Practice and education considerations for occupational therapists' roles in EAPs are provided.
Health Promotion↗
Energizing community health improvement: the promise of microgrants.
BACKGROUND: The Healthy Carolinians community microgrants project provided microgrants to community-based organizations (CBOs) across North Carolina. These grants were made to serve as a catalyst to engage the CBOs in health promotion activities that addressed Healthy People 2010 objectives. The purpose of this initiative was to increase the awareness of Healthy People 2010 objectives, mobilize resources, and create new partners in community health improvement. CONTEXT: In 1993, Healthy Carolinians, a statewide network of public-private partnerships, was established at the county level to address North Carolina's health objectives that aligned with national Healthy People 2010 objectives. This network of Healthy Carolinians partnerships provided the vehicle for distributing the microgrants. METHODS: Funding was distributed to 32 Healthy Carolinians partnerships that, in turn, awarded 199 microgrants (2010 dollars each) to CBOs to address state and national health objectives. Each CBO selected its own objectives based on Healthy People 2010 objectives and designed its own interventions. Surveys of the CBO project managers and final reports were used for evaluation. A survey of the Healthy Carolinians partnership coordinators provided additional insight. CONSEQUENCES: Of the 199 surveys mailed to CBOs, 153 (77%) responded. Nearly half (43.7%) of the microgrants were used to focus on three major health risk factors: 27.1% on physical activity and fitness, 13.1% on nutrition and overweight, and 3.5% on tobacco use. At the end of the project, 96.1% of the respondents reported that they were familiar with the Healthy People 2010 objectives. Final reports showed that an estimated 52,739 hours of CBO staff and volunteer time were contributed to microgrant programs. All Healthy Carolinians partnership coordinators responded to a survey; 100% stated that they had new access to priority populations within their community. INTERPRETATION: The Healthy Carolinians microgrant project demonstrated a cost-effective, alternative approach to funding community-based health promotion and injury control activities. This model was decentralized, so it empowered communities and CBOs to be responsible for community health improvement. Public health professionals with limited funds should consider this alternative approach, which mobilized existing community organizations and effectively addressed national and state health objectives.
Community Health Services↗
Changing medical students' attitudes about older adults and future older patients.
BACKGROUND: An important step in educating future physicians to care for older patients is to diminish the influence of negative stereotypes they often hold about older people. This study presents outcomes of a mentors-on-aging program designed to promote positive attitudes toward older adults and older patients among medical students. METHOD: A pretest, posttest, control group design, with survey data, was used. RESULTS: Analysis of students' preprogram responses compared to postprogram responses indicated that their attitudes did improve. Furthermore, the students' postprogram attitudes toward older adults were more positive than the control group's; however, their attitudes toward older patients did not differ from the control group. CONCLUSIONS: A mentors-on-aging program offering students interaction with healthy, active older adults can help students to acquire positive attitudes toward older people. More targeted experiences with generally healthy older people as patients may be needed to significantly improve students' attitudes toward older patients.
Adult↗
Exercise, immunity and aging.
In general population, many protective immune responses are impaired in old age, leading to an increased risk of infection. However, recent studies in SENIEUR subjects (healthy centenarians who are examples of successful aging) suggest that complex remodeling and reshaping of the immune system occurs with aging. An appropriate regular regimen of endurance exercise might help elderly to lead a quality of life by preserving immune function. However, very little is known regarding the interaction between exercise, aging and the immune system. Given that a number of age-related changes occur in many physiological systems which are known to alter the immune function both at rest and during exercise, it would be of value to learn the extent to which both acute and chronic exercise influence immune function in the elderly. The immune system response to exercise is multifaceted, depending on the nature of exercise. Significant interaction between the neuroendocrine and immune systems, and the role of lifestyle factors in immune function are known to occur. In theory, moderate exercise should help to reverse the adverse effects of aging upon the immune system by increasing the production of endocrine hormones which may contribute to less accumulation of autoreactive immune cells by enhancing the programmed cell death. Active elderly subjects demonstrated a significantly greater proliferative response to phytohemagglutinins (PHA) and to pokeweed mitogen (PWM), and higher rates of interleukin-2 (IL-2), interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) production. A moderate training program can enhance the resting natural killer (NK) cell function of healthy elderly people, potentially increasing resistance to both viral infections and preventing the formation of malignant cells. Recent studies have suggested that endurance training in later life is associated with a lesser age-related decline in certain aspects of circulating T cell function and related cytokine production. It is important that the dose of physical activity needed to optimize immune function be defined more clearly at various points during the aging process both in females and males in order to optimize the immune function and to prevent any rise in adverse effects of exercise on the elderly population.
Aged↗
An integrated exploration into the social and environmental determinants of health: the Saskatchewan Population Health and Evaluation Research Unit (SPHERU).
The Saskatchewan Population Health and Evaluation Research Unit (SPHERU) is a new interdisciplinary research institute established by the Universities of Saskatchewan and Regina. SPHERU developed four of its research programs using a hierarchic model of health determining conditions and contexts. In descending order these programs include: Economic and Environmental Globalization, Governance and Health Community/Environment as a Health Determinant Multiple Roles, Gender and Health Determinants of Healthy Childhood Development A fifth program researching the determinants of health of indigenous peoples spans all four levels. Two research projects, one on power, control and health, and another on community capacity building approaches to human service programs, assist SPHERU in developing the theoretical linkages between its programs. This article describes SPHERU's research model and the Unit's approach to research and summarizes each of its current research programs and projects.
Canada↗
Tobacco use among adults--United States, 2005.
Four of the Healthy People 2010 objectives regarding tobacco use are to reduce the prevalence of cigarette smoking to 12.0%, cigar smoking to 1.2%, use of smokeless tobacco to 0.4%, and to increase cessation attempts among adult smokers to 75.0%. To assess progress toward achieving these four objectives, CDC analyzed self-reported data from the 2005 National Health Interview Survey (NHIS). This report summarizes the results of these analyses, which indicated lagging progress on all four objectives. In 2005, approximately 20.9% of U.S. adults were current cigarette smokers, the same percentage as in 2004, suggesting that the 8-year decline in smoking prevalence among adults in the United States might be stalling. In addition, the findings indicated that, in 2005, an estimated 2.2% of U.S. adults were current cigar smokers, 2.3% used smokeless tobacco, and 42.5% of current cigarette smokers had stopped smoking for at least 1 day in the preceding 12 months because they were trying to quit. To meet the Healthy People objectives for 2010, full implementation of effective, comprehensive tobacco-control programs that address both initiation and cessation of tobacco use is needed in all states and U.S. territories.
Adult↗
Educating the older cancer patient: obstacles and opportunities.
Cancer is a serious health problem among the elderly, with over 50% of all cancers occurring in the 11% of the population over age 65. Little research, however, has focused on the educational needs of elderly cancer patients and little is known about the emotional and psychological impact of cancer in this population. This paper describes two surveys which provide baseline data on the knowledge, attitudes, and beliefs of older people about cancer. These findings have implications for programs directed both at the healthy elderly and at older cancer patients.
Age Factors↗
Prevalence of hypercholesterolemia among siblings of persons with premature coronary heart disease. Application of the Second Adult Treatment Panel guidelines.
BACKGROUND: Increased blood cholesterol, specifically high low-density lipoprotein cholesterol, increases risk for coronary heart disease (CHD). Persons with a positive family history of premature CHD also are at markedly increased risk. OBJECTIVE: To examine the prevalence of hypercholesterolemia based on the second report of the National Cholesterol Educational Program Adult Treatment Panel (ATP II) guidelines in the asymptomatic healthy siblings of people with premature CHD. METHODS: A total of 668 asymptomatic healthy siblings (354 men and 314 women) underwent screening for risk factors for CHD. Siblings were categorized into treatment categories for primary prevention defined by ATP II. The percentage who were candidates for intervention were compared with the published national estimates for those without CHD from the third National Health and Nutrition Examination Survey (NHANES III). RESULTS: Based on ATP II guidelines, 65% of the asymptomatic adult siblings required fasting lipoprotein analysis compared with 33% of adults without CHD in the national reference population. Of the siblings who met the criteria for fasting lipoprotein analysis, most (56%) were candidates for dietary therapy, more than twice the proportion of adults from NHANES III. The percentage of the siblings who qualified for drug intervention and dietary therapy was 3 times greater than the national sample, 33% vs 11%, respectively. Assuming a 10% hypothetical reduction in low-density lipoprotein cholesterol levels as the result of dietary modification, the proportion of the sibling sample who were possible candidates for drug therapy was 20%, still 4 times that predicted for the national sample. CONCLUSIONS: These results underscore the need for aggressive detection and treatment of hypercholesterolemia in this easily identifiable high-risk population of siblings of people with premature CHD.
Adult↗