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PubMed2003

Adolescent health in the Caribbean: a regional portrait.

OBJECTIVES: This study assessed youth health in the Caribbean Community and Common Market countries and describes the prevalence of health-related factors. METHODS: We used a self-administered classroom questionnaire; questions addressed general health, health care, nutrition, sexual history, drug use, mental health, violence, family characteristics, and relationships with others. RESULTS: Most youths reported good health; however, 1 in 10 reported a limiting disability or significant health problems. Violence was a pervasive concern. Of those who reported history of sexual intercourse, many reported that their first intercourse was forced, and nearly half reported that they were aged 10 years or younger when they first had intercourse. CONCLUSIONS: Although most young people are healthy, problems indicate the importance of monitoring trends and designing effective youth health programs.

Adolescent↗
PubMed2003

Risk factors for Helicobacter pylori infection among a rural population in Japan: relation to living environment and medical history.

BACKGROUND: Helicobacter pylori infection is related to several gastroduodenal diseases, though the route of transmission remains unclear. METHODS: A cross-sectional study that included 695 healthy people (males 308, females 387; median age 60 years) participating in a health checkup program in Yamagata Prefecture was conducted. H. pylori status was determined in all subjects by evaluation of serum anti-H. pylori immunoglobulin G antibody. Antibody against hepatitis A virus was used as a marker of fecal-oral exposure to assess the agreement between H. pylori infection and hepatitis A virus infection. Data on other factors known or suspected to be related to infection status were also collected using a questionnaire. RESULTS: Seroprevalence of H. pylori and hepatitis A virus was 60% and 70%, respectively. Kappa values for subjects aged 20-49 and aged 50 or older were 0.07 and 0.02, respectively, and agreement between the presences of both infections was assessed as slight. In the multivariate logistic regression analysis, H. pylori infection was significantly associated with availability of a sewage system in childhood (presence [reference], absence [odds ratio (OR) = 4.06, 95% confidence interval (CI): 1.36-13.94]) and the number of gastrointestinal endoscopies undergone (none [reference], once [OR = 1.64, 95% CI: 0.83-3.27], 2-3 times [OR = 3.11, 95% CI: 1.65-5.99], or 4 or more times [OR = 3.18, 95% CI: 1.71-6.03]), (p < 0.01 for trend). CONCLUSIONS: Our results suggest that poor hygiene in childhood is related to H. pylori infection. The fecal-oral route does not seem to be an important mode of transmission, but the possibility of transmission by gastrointestinal endoscopic examination exists.

Adult↗
PubMed2005

Trends in cigarette smoking among high school youth in Wisconsin and the United States, 1993-2004.

Trends in current cigarette smoking among high school students in Wisconsin and the United States were examined using data from the Youth Risk Behavior Surveillance System and the Youth Tobacco Survey. Data were analyzed for years 1993 through 2004. Results of the analyses reveal an increasing prevalence in current smoking among high school youth in both Wisconsin and the United states during most of the 1990's, followed by a downward trend. During the period under consideration, peak prevalence is observed for the United States in 1997 (36.4%), with rates decreasing to 22.3% in 2004. In Wisconsin, rates peaked during 1999 (38.1%) and decreased to 20.9% in 2004. Subgroup analyses of Wisconsin data show similar rates of smoking among females (21.9%) and males (19.8%) in 2004. Analysis by grade demonstrate a narrowing of the gap between the oldest and the youngest grades over time, with all 4 grades displaying decreasing rates in current smoking. Overall, the findings are very positive, and suggest that efforts aimed at reducing tobacco use among our youth have been effective at both the state and national level. However, recent cuts in state and federal funding have led to reductions in tobacco control program initiatives. Thus, vigilant monitoring is crucial as we continue to work towards the "Healthy People 2010" goal that states that no more than 16% of high school students will report current cigarette use.

Adolescent↗
PubMed2006

Evaluating the impact of a hypertension program for African Americans.

Although hypertension affects all racial and ethnic groups, its prevalence is highest in the African-American community. The goal of Healthy People 2010 is to reduce hypertension among African Americans from 40% to 16%. Although current levels remain high, culturally sensitive, community-based clinical projects might be helpful in addressing this problem. The goal of this study was to assess whether a community-based clinic's program was effective in improving blood pressure control among a sample of 134 African-American adults. The program design involved health education and physical fitness classes offered over a nine-month period, with blood pressure checks being conducted pre- and postphases to determine whether the program was effective in controlling high blood pressure. Health questionnaires were also administered pre- and posttest to assess whether health behaviors and perceived health status were influenced by the project. Two-thirds (70%) of the sample had high blood pressure at baseline and 43% at program conclusion. This was a statistically significant difference (p=0.003). Overall self-reported health survey results indicated improved health behaviors and health status changes. Findings suggest that culturally sensitive, community-based clinic programs that incorporate both health education and physical fitness might be effective in reducing hypertension among African Americans.

Adult↗
PubMedDate not supplied

Psychosocial benefits of three formats of a standardized behavioral stress management program.

OBJECTIVE: Psychosocial factors are associated with increased morbidity and mortality in healthy and clinical populations. Behavioral interventions are needed to train the large number of people in the community setting who are affected by stressors to use coping skills that will reduce these risk factors. The aim of the current study was to evaluate the efficacy of three forms of delivery of a standardized, behavioral intervention-the Williams LifeSkills program-designed to reduce levels of psychosocial risk factors in nonclinical populations. METHODS: One hundred ninety-six participants screening positive for elevated psychosocial distress were randomized to either a waitlist control group or one of three intervention groups: the LifeSkills Workshop, the LifeSkills Video, or the LifeSkills Video and Workshop combined. Psychosocial risk factors were evaluated at baseline and at 10 days, 2 months, and 6 months after the training/wait period. RESULTS: At 10 days follow up, the workshop + video and video-only groups showed significant improvements over control subjects in trait anxiety and perceived stress. Moreover, the workshop + video group maintained benefit over control subjects throughout 6 months follow up in both of these measures, whereas the video-only group maintained benefit in trait anxiety. CONCLUSIONS: Because the psychosocial well-being of two of the treated groups improved over that of the control group, it appears that the Williams LifeSkills program accelerates and maintains a normal return to low distress after a stressful time. This is the first study to show that a commercially available, facilitator- or self-administered behavioral training product can have significant beneficial effects on psychosocial well-being in a healthy community sample.

Adult↗
PubMed2003

Development of a master's in public health nutrition degree program using distance education.

The Professional Practice Program in Nutrition (PPPN) uses distance education to offer a master's degree in public health (MPH) nutrition designed for practitioners who desire to maintain their employment and develop new skills. Public health nutrition leadership faces challenges in recruiting a large enough workforce to (a) carry out the core functions of assessment, policy, and assurance; (b) update current nutritionists in new skill areas to face the demands of dynamic health care and public health climates; and (c) conduct monitoring and surveillance of Healthy People 2010 objectives. In 1996, the University of North Carolina at Chapel Hill designed and implemented this program after a market analysis to identify advanced educational need in a nine state area. PPPN was initiated as a pilot program and enrolled two cohorts of students from 1996 through 1998. This project identified four key steps: (a) conduct a detailed market analysis; (b) establish an infrastructure to deliver the program; (c) tailor the curriculum using the technology; and (d) identify, accommodate, and develop student capabilities. The findings indicate that distance education strategies are appropriate to carry out a full MPH curriculum in nutrition, but sufficient enrollment is necessary to cover the added curriculum expenditures.

Curriculum↗
PubMed2002

Options for expanding health insurance for people with chronic conditions.

As policy makers explore options such as tax credits and expansion of public programs to cover uninsured Americans, working-age adults with chronic conditions merit special attention. Because their medical needs are likely to be greater than healthy people's, coverage expansion proposals that don't factor in the greater need of people with chronic conditions are likely to fall short of reaching this vulnerable group. Often perceived primarily as a problem of the elderly, chronic conditions are widespread among working-age adults, according to a new study by the Center for Studying Health System Change (HSC). This Issue Brief examines existing coverage sources for insured working-age people with chronic conditions and assesses how various coverage proposals might affect uninsured people with chronic conditions.

Adult↗
PubMed2002

The ageing male: demographics and challenges.

In the year 2000, there were more than 400 million people aged 65 and over in the world--projected to increase to almost 1.5 billion by the year 2050--a close to fourfold increase compared to the 50% increase for the global population as a whole. More than 25% of these 1.5 billion elderly people are projected to be "oldest-old" (aged 80 and over). Global ageing is a triumph and a challenge. As we enter the 21st century, it will put increased economic and social demands in all countries. But if more and more individuals reach older age in good health--and remain healthy for longer--the benefits will be shared by all. Therefore, the promotion of healthy ageing and the prevention of disability in all older people must assume a central role in medical care and research as well as in the formulation of national health and social policies. Effective programs promoting healthy ageing will ensure a more efficient use of health and social services and improve the quality of life in older persons by enabling them to remain independent and productive. With prolonged life expectancy, men and women can expect to live one-third of their lives with some form of hormone deficiency. Life expectancy differences between men and women exist in various regions of the world with a mean of 4.2 years, and is projected to increase to 4.8 years by the year 2050. The ageing male, in particular, has the risk of developing gender-specific urological diseases, such as prostate cancer, benign prostate hyperplasia continence disorders (generally ignored by men) and erectile dysfunction. Hormonal changes in the ageing male are associated with changes in the body mass index, osteoporosis, and sleep and mood disorders. A significant relationship between body fat mass and both cardiovascular and overall mortality in men has been demonstrated. In some populations, at least, men may run a higher risk for cardiovascular complications than women. It is our sincere hope that the next few years will enrich us with facts and clarify the state of our present knowledge, permit us to recognize some of the missing links, give us the tools and methodology to design and plan ways to understand ageing in men, allow us to help to improve the quality of life, prevent the preventable, and postpone and decrease the pain and suffering of the inevitable.

Aging↗
PubMed2000

Vaccination coverage among children enrolled in Head Start programs or day care facilities or entering school.

PROBLEM/CONDITION: Undervaccinated children enrolled in day care centers and schools are vulnerable to outbreaks of vaccine-preventable diseases. A Healthy People 2000 objective is to increase to > or = 95% vaccination coverage among children attending licensed day care facilities and kindergarten through postsecondary school (objective 20.11). REPORTING PERIOD COVERED: September 1997-June 1998. DESCRIPTION OF SYSTEM: CDC's National Immunization Program administers grants to support 64 vaccination programs. These programs are in all 50 states, eight territories or jurisdictions (American Samoa, Republic of Marshall Islands, Federated States of Micronesia, Guam, Commonwealth of Northern Mariana Islands, Puerto Rico, Republic of Palau, and the U.S. Virgin Islands), five cities (Chicago, Houston, San Antonio, New York City, and Philadelphia), and the District of Columbia. Grant guidelines require annual school vaccination surveys and biennial surveys of Head Start programs and licensed day care facilities. This system constitutes the only source of nationally representative vaccination coverage estimates for these populations. RESULTS: Head Start Programs: Of the 64 reporting areas, 33 (51.6%) submitted coverage levels for children enrolled in Head Start programs. Of these, all 33 programs reported coverage levels for diphtheria and tetanus toxoids and pertussis vaccine (DTP), diphtheria and tetanus toxoids (DT), or tetanus toxoids (Td), poliovirus vaccine, and measles vaccine; and 32 reported coverage levels for mumps and rubella vaccines. Four programs reported coverage levels for the combined measles, mumps, and rubella vaccine (MMR). The mean vaccination coverage levels for the 1997-98 school year among the reporting vaccination programs were 97.8% for poliovirus vaccine (range: 80.0%-100.0%), 97.0% for DTP/DT/Td (range: 87.7%-100.0%), 93.3% for measles vaccine (range: 91.4%-100.0%), and 93.2% for mumps and rubella vaccines (range: 91.4%-100.0%). Licensed Day Care Facilities: Of the 63 reporting areas with licensed day care facilities, 38 (60.3%) submitted coverage levels for enrolled children. Of these, all 38 programs reported coverage levels for poliovirus vaccine and DTP/DT/Td, 37 reported coverage levels for measles vaccine, and 36 reported coverage levels for mumps and rubella vaccines. Four programs reported coverage levels for the combined MMR. The mean vaccination coverage levels among the reporting areas were 95.8% for poliovirus vaccine (range: 85.1%-99.8%), 95.7% for DTP/DT/Td (range: 77.6%-99.9%), 89.1% for measles vaccine (range: 78.0%-99.9%), and 89.1% for mumps and rubella vaccines (range: 78.0%-99.9%). Kindergarten/First Grade: Of the 64 reporting areas, 43 (67.2%) submitted coverage levels for children enrolled in kindergarten and first grade. Of these 43 programs, 42 reported coverage levels for poliovirus vaccine and DTP/DT/Td, and 43 reported coverage levels for measles, mumps, and rubella vaccines. Four of the 43 programs reported coverage levels for the combined MMR. The mean vaccination coverage levels among the reporting areas were 96.7% for poliovirus vaccine (range: 82.8%-99.9%), 96.7% for DTP/DT/Td (range: 82.8%-99.8%), 96.0% for measles vaccine (range: 82.8%-99.9%), and 96.5% for mumps and rubella vaccines (range: 82.8%-99.9%). INTERPRETATION: High levels of vaccination coverage among children entering school most likely result from the successful implementation of state-specific school vaccination laws, which have applied to children entering school in all states and the District of Columbia since at least 1990. All states, territories, and the District of Columbia have additional laws that require vaccination of children in licensed day care facilities. However, because a high proportion of states and territories did not submit vaccination coverage reports to CDC, these estimated means may not reflect levels for all children in the United States.

Child↗
PubMedDate not supplied

Development of a breastfeeding support program at Naval Hospital Sigonella, Italy.

The Naval Hospital (NH) Sigonella, which contains a level one nursery, cares for prenatal patients in an isolated military community. Many of the traditional support systems available to breastfeeding mothers in the United States, such as Le Leche League, are unavailable in this setting. Some prenatal patients in this setting who have had the desire to breastfeed have failed to do so because they were not offered a structured educational support system that encouraged and monitored their breastfeeding efforts. This prompted the pediatric nurse, functioning as breastfeeding counselor nurse at NH Sigonella, to develop a breastfeeding support program. The goal of the program is to educate new mothers about breastfeeding and to encourage them to initiate and continue breastfeeding for at least 5 to 6 months. These goals are in line with the Healthy People 2000 (1990) objectives, which are to increase to at least 75% the proportion of mothers who breastfeed their babies in the early postpartum period and to at least 50% the proportion of those who continue breastfeeding until their babies are 5 to 6 months old. At delivery, the breastfeeding counselor meets individually with each new mother who expresses the desire to breastfeed. During this visit, she observes and evaluates each mother's breastfeeding technique. Discharge follow-up via telephone is conducted weekly for 4 weeks and at 3 and 6 months postpartum. Data collection after 6 months revealed that 86.7% of all new mothers initiated breastfeeding and 51.4% of those mothers continued breastfeeding for 5 to 6 months. The Breastfeeding Counseling Support Program will enhance NH Sigonella's efforts in continuing to meeting the objectives of Healthy People 2000 and the Breast Feeding Hospital Initiative while providing the benefits of breastfeeding to mother and infant.

Adult↗
PubMed1996

Work-site wellness: a model hospital-operated program.

Work-site wellness programs are hardly new to most US healthcare markets. Emerging out of the 1980s fitness craze, traditional wellness programs usually consisted of classes that encouraged healthy lifestyle practices among company employees. Since the prevalent fee-for-service environment didn't provide an inherent incentive for keeping people well, hospital-operated work-site wellness programs rarely advanced past this basic level of service. Corporations, payers, and hospitals see the economic value of managing health, therefore, these types of programs are becoming a part of hospital delivery systems and a growing revenue center. This article presents a hospital-operated, work-site wellness model that was developed for the WorkingWell Network, the corporate wellness program offered by The Methodist Hospitals, Inc. (Gary and Merrillville, IN).

Case Management↗
PubMed1997

Guidelines for school and community programs to promote lifelong physical activity among young people. Centers for Disease Control and Prevention.

Regular physical activity is linked to enhanced health and to reduced risk for all-cause mortality and the development of many chronic diseases in adults. However, many U.S. adults are either sedentary or less physically active than recommended. Children and adolescents are more physically active than adults, but participation in physical activity declines in adolescence. School and community programs have the potential to help children and adolescents establish lifelong, healthy physical activity patterns. This report summarizes recommendations for encouraging physical activity among young people so that they will continue to engage in physical activity in adulthood and obtain the benefits of physical activity throughout life. These guidelines were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies and organizations. They are based on an in-depth review of research, theory, and current practice in physical education, exercise science, health education, and public health. The guidelines include recommendations about 10 aspects of school and community programs to promote lifelong physical activity among young people; policies that promote enjoyable, lifelong physical activity; physical and social environments that encourage and enable physical activity; physical education curricula and instruction; health education curricula and instruction; extracurricular physical activity programs that meet the needs and interests of students involvement of parents and guardians in physical activity instruction and programs for young people, personnel training; health services for children and adolescents; developmentally appropriate community sports and recreation programs that are attractive to young people; and regular evaluation of physical activity instruction, programs, and facilities.

Adolescent↗
PubMed2004

The National Survey of Children's Health: a new data resource.

CONTEXT: Federal and state maternal and child health programs are responsible for promoting and improving the health and well-being of children. To support achievement of this goal, the federal Maternal and Child Health Bureau (MCHB) in partnership with the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention has developed a new survey that will provide uniform national and state data on the health and well-being of children, as well as the characteristics of their families and neighborhoods. PURPOSE: The National Survey of Children's Health was designed to produce reliable and representative state- and national-level estimates for Healthy People 2010 national prevention objectives, for each state's Title V needs assessment, and for Title V program planning and evaluation. In addition, it will provide a new data resource for researchers, advocacy groups, and other interested parties. It is anticipated that this survey will be repeated periodically, making trend analysis possible. METHODS: This survey was conducted using the State and Local Area Integrated Telephone Survey (SLAITS) mechanism, which shares the random-digit-dial sampling frame of the National Immunization Survey (sponsored by the National Immunization Program and NCHS). Using the SLAITS platform, interviews on approximately 2000 children were conducted in each state and the District of Columbia. The parent or guardian most knowledgeable about the child completed a battery of questions on health and development, health insurance coverage, access to care, utilization of health care services, presence of a medical home, family functioning, parental health, and neighborhood characteristics. Data collection began in January 2003 and continued through April 2004. Summary reports and electronic data files will be available to the public by early 2005. CONCLUSION: This is the second state and national survey jointly completed by MCHB and NCHS. It is designed to complement the 2001 National Survey of Children with Special Health Care Needs by providing data on the health of the general child population.

Centers for Disease Control and Prevention, U.S.↗
PubMed1989

Skills for adolescence: experience with the International Lions-Quest program.

This article describes the development of the Lions-Quest Skills for Adolescence program. The primary purpose of this program is to respond to the needs of young people by helping them become more self aware, more skilled, more able to make positive and healthy choices, and better able to make informed, aware, and considered decisions about their own behavior. Skills for Adolescence is one school/community/parent-based curricular program that attempts to address health, life skills, and prevention issues in ways that have clearly struck a common chord in numerous countries. The program's emphasis on effective communication, on self-efficacy and social skills, and on strengthening the family appear to have a strong appear in many different contexts and cultures. Careful attention to local needs during adaptation while employing collaborative strategies is an essential ingredient to crossing cultural and national boundaries.

Adolescent↗
PubMed1997

Guidelines for school and community programs to promote lifelong physical activity among young people. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and prevention.

Regular physical activity is linked to enhanced health and to reduced risk for all-cause mortality and the development of many chronic diseases in adults. However, many U.S. adults are either sedentary of less physically active than recommended. Children and adolescents are more physically active than adults, but participation in physical activity declines in adolescence. School and community programs have the potential to help children and adolescents establish lifelong, healthy physical activity patterns. This report summarizes recommendations for encouraging physical activity among young people so that they will continue to engage in physical activity in adulthood and obtain the benefits of physical activity throughout life. These guidelines were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies and organizations. They are based on an in-depth review of research, theory, and current practice in physical education, exercise science, health education, and public health. The guidelines include recommendations about 10 aspects of school and community programs to promote lifelong physical activity among young people policies that promote enjoyable physical activity and social environments that encourage and enable physical activity; physical education curricula and instruction; health education curricula and instruction; extracurricular physical activity programs that meet the needs and interests of students; involvement of parents and guardians on physical activity instruction and programs for young people; personnel training; health services for children and adolescents; developmentally appropriate community sports and recreation programs that are attractive to young people; and regular evaluation of physical activity instruction, programs, and facilities.

Adolescent↗
PubMed2006

Health behaviors among American Indian/Alaska Native women, 1998-2000 BRFSS.

BACKGROUND AND OBJECTIVE: Minority populations, including American Indians and Alaska Natives (AI/AN), in the United States generally experience a disproportionate share of adverse health outcomes compared with whites. The prevalence of risk behaviors associated with these adverse health outcomes among AI/AN women is not well documented, especially for those who live outside areas serviced by Indian Health Service. We sought to describe the prevalence of selected health risk behaviors among AI/AN women, document the disparities between AI/AN women and all U.S. women, and demonstrate the efforts needed for AI/AN women to reach Healthy People 2010 goals. METHODS: Age-adjusted prevalence estimates for selected sociodemographic characteristics, current smoking, obesity, lack of leisure time physical activity, and binge drinking were calculated using Behavioral Risk Factor Surveillance System (BRFSS) data from 1998 to 2000, combined. Comparisons were made between prevalence estimates for AI/AN women and all women who participated in the BRFSS and Healthy People 2010 goals. RESULTS: The prevalences of current smoking (27.8%) and obesity (26.8%) were significantly higher among AI/AN women than among all U.S. women. AI/AN women did not meet Healthy People 2010 goals for current smoking, obesity, leisure time physical activity, or binge drinking. CONCLUSIONS: These data highlight both disparities in health risk behaviors between AI/AN women and all U.S. women and improvements needed for AI/AN women to meet Healthy People 2010 goals. This project demonstrates the overwhelming need for culturally appropriate and accessible prevention programs to address health risk behaviors associated with the leading causes of death among urbanized AI/AN women.

Alcohol Drinking↗