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PubMed1986

Social risk factors for the mortality from motor vehicle accident.

To clarify major social risk factors affecting the mortality from motor vehicle accident (MVA), we analyzed the effects of a wide variety of socioeconomic and demographic indicators (20 variables) on age-specific and age-adjusted mortality rates from MVA in 46 prefectures in Japan. The analysis was conducted twice at a 5-year interval, i.e., in 1970 and 1975, by stepwise regression analysis after classification of the indicators by factor analysis. The major social risk factors identified in the two years were as follows: (1) rural residence for persons, especially males, of major driving age (15-54 years) and young male children (0-4 years); (2) population growth by social mobility for schoolboys aged 5-14 years; and (3) high income (and employment) for schoolgirls, and proportion of old population for middle-aged females. Age-adjusted male rate of mortality from MVA within 46 prefectures was significantly higher in rural than urban areas in both 1970 and 1975.

Accidents, Traffic↗
PubMed2003

Community-based model boosts BP control in high-risk population.

It's one of medicine's thorniest problems: We know how to treat high BP, but less than half of those with the condition are under adequate control. And the hardest-hit populations are low-income, urban communities with high percentages of African American and Hispanic residents. A model developed at Johns Hopkins University is attacking the problem and has produced impressive results through the use of community health workers.

Community Health Services↗
PubMed1995

Accessing an understudied population in behavioral HIV/AIDS research: low income African American women.

Most HIV/AIDS behavior research involving African American women has focused on traditional high risk populations, such as those in drug treatment centers, STD clinics, and hospitals. Few studies have examined the health needs and behaviors of African American women in the general population (i.e., working mothers and homemakers). The Parent Health Project examined beliefs and concepts of illness, including AIDS, of low income African American mothers of young children. We used a variety of methods of community outreach and recruitment strategies to gain access and trust from these African American women, including (1) recruitment of women who had children in a related research project, (2) subject reimbursement, and (3) culturally sensitive community based outreach. Of approximately 200 women contacted, 147 (74%) agreed to participate in a two-hour face-to-face interview about concepts of health and illness. Through our efforts, we were able to gain access to a population generally not studies in HIV/AIDS research. We were also exposed to a number of issues, concerns and behaviors faced by women not classified as high risk, yet who are at risk as a result of their own and/or their sexual partner's(s) risk behaviors.

Acquired Immunodeficiency Syndrome↗
PubMed1999

What we say and what we do: county-level public spending for health care.

The purpose of this study is to examine county-level public spending for health care services in Kansas and to explain variation in spending levels with a model composed of population density, population age and per capita income. Data are abstracted from budget documents for all 105 counties in Kansas for the years 1994, 1995 and 1996. Health care expenditures are defined as county tax revenues spent for ambulance, hospitals, ambulatory care, home health services, nursing homes, and mental health and substance abuse services. Results show that Kansas counties spent between 12.1 percent and 13.6 percent of their budgets to fund local health care services between 1994 and 1996, spending more than $133 million in 1996 alone. In 10 counties, one-quarter to one-third of the budget went for health services. Low population density and relatively high per capita income explained nearly one-third of the variation in how much counties spent and an even greater proportion when analysis was limited to the most rural counties. Findings from this study suggest there may be a significant local commitment in the United States to publicly supported health care services, more support than typically recognized and perhaps more than is estimated in national health care spending data. Future research on the economic effects of the health sector on local communities should take account of local spending for health care, especially at the county level.

Budgets↗
PubMed1991

Birth order effects and time allocation.

"In this paper, a model is developed in which the explanation for birth-order effects does not rely on absence of capital markets, but follows from optimal allocation of parental time and goods among children over the childrearing years. The model yields two key results, which are then tested using 1967-1968 household survey data from urban Colombia.... It is shown that first and last-born children of mothers who do not work have an advantage over middle-borns.... At the same time, as predicted, there are no differences by birth order among children of working mothers. The persistence of birth-order effects even in high-income families indicates that such effects are at least in part due to the time constraint modelled; this is a strong result given the possibility of better substitutes for mother's time than allowed for in the model, and the likelihood that high-income families are able to purchase better substitutes."

Americas↗
PubMed2000

Firearm availability and homicide rates across 26 high-income countries.

BACKGROUND: Among developed nations, the United States has the highest rate of civilian gun ownership, and the highest homicide rate. We examine whether the United States is merely an exception, or if a relationship between gun availability and homicide exists across all developed nations. METHODS: Homicide rates for the early 1990s come from 26 of 27 of the highly industrialized or high-income countries with greater than 1 million population as classified by the World Bank. Two common proxies for gun availability are used, the percentage of suicides with a firearm, and the"Cook index," the average of the percentage of suicides with a firearm and the percentage of homicides with a firearm. RESULTS: In simple regressions (no control variables) across 26 high-income nations, there is a strong and statistically significant association between gun availability and homicide rates. CONCLUSION: Across developed countries, where guns are more available, there are more homicides.

Developed Countries↗
PubMed1991

A ten-year perspective of mortality risk among mentally ill patients in sheltered care.

The ten-year risk of mortality was assessed for a sample of 393 former psychiatric patients who were living in sheltered care settings in California in 1973. Compared with the general state population, residents of sheltered care facilities were 2.85 times more likely to die than would be expected if age-specific rates for the state applied to them. Excess mortality was due to heart disease, cerebrovascular diseases, and all other natural and unnatural causes except malignant neoplasms. The mortality rate of the subjects was closer to that of a low-income subsample of the California population, suggesting that the high mortality rates of patients in sheltered care settings may be due to their low-income status.

Adolescent↗
PubMed1995

Profile of drug use in urban and rural India.

Information on pharmacoepidemiology is particularly important in developing countries where a rational drug policy has not been adopted. In the present study, a profile of 1769 doctors' prescriptions and 763 self-orders were monitored at pharmacy outlets in the twin cities of Hyderabad and Secunderabad and 4 rural areas of Andhra Pradesh with the aim of identifying urban and rural differences, if any, in the self-medication rate, prescription costs, types of drugs purchased and factors influencing self-medication. Self-medication, expressed as the percentage of the total population that self-medicates, was found to be high in urban areas (37%) compared with rural areas (17%), and the majority of the over-the-counter sales were for prescription-only drugs. The majority of physicians' prescriptions were incomplete with respect to diagnosis and dosage regimen. The mean cost of the drugs purchased on doctors' prescriptions was 2-fold higher than the cost of drugs sold over the counter. A higher proportion of patients from rural areas (80%) purchased all the prescribed drugs compared with those from urban areas (54%). Financial constraints in urban areas were a major determinant in the partial purchase of prescribed drugs. In addition, the urban elite (i.e. professional people with high incomes, who comprise 18% of the total population) considered that all of the prescribed drugs were not necessary for their present disease. Nutritional products, potent compounds with analgesic, antipyretic and anti-inflammatory effects, and broad spectrum antibiotics constituted a high proportion of prescriptions in both urban and rural areas. The consumption of food supplements was higher in rural areas than in urban areas. Based on WHO criteria, most of the drugs (60%) prescribed in rural areas were nonessential, compared with 47% in urban areas. The results of this study emphasise the need for comprehensive measures, including information, training, legislation and education at all levels of the drug delivery system, to rationalise drug therapy by improving prescribing patterns and influencing self-medication.

Anti-Bacterial Agents↗
PubMed1987

Development and human resources in the Islamic world: a study of selected countries.

"The present paper attempts to provide an analytical profile of development and human resources in [12] selected [Islamic] countries." The countries--Bangladesh, Somalia, Pakistan, Indonesia, Egypt, Turkey, Malaysia, Algeria, Iraq, Saudi Arabia, Kuwait, and United Arab Emirates--vary in income levels from low to high and in population size from 1 million to 159 million. Using data from the World Bank and the Population Council, comparisons are made on the basis of mortality and fertility levels, family size, income, urbanization, labor force size and growth, education, nutrition, and health. Governmental policy changes and future directions are discussed.

Africa↗
PubMed2002

Development of a prototype system for statewide asthma surveillance.

OBJECTIVES: We developed and evaluated a statewide and community-level asthma surveillance system. METHODS: Databases and measures included a community prevalence survey, hospital admissions data, emergency department/outpatient clinic visit records, and a physician survey of diagnosis and treatment practices. We evaluated the system in 5 Maine communities varying in population and income. RESULTS: Asthma hospitalizations were high in the rural/low-socioeconomic-status communities studied, although diagnosed asthma was low. Males were more likely than females to experience asthma symptoms, although they were less likely to have been diagnosed with asthma or to have used hospital-based asthma care. CONCLUSIONS: Databases were useful for estimating asthma burden and identifying service needs as well as high-risk groups. They were less useful in estimating severity or in identifying environmental risks.

Adolescent↗
PubMed1982

A reassessment of world population trends.

This reassessment is limited to observations concerning trends in mortality and fertility and concerning longrun prospects for population growth. Recorded changes in mortality are compared with 3 projections made many years ago. Projections of European mortality made in 1941-42 understated by a wide margin the actual increase in expectation of life because of unforeseen technological changes in the prevention and cure of fatal disease. On the other hand, a projection made in 1955 for India, foreseeing a rapid rise in the 1950s and slower progress later on because of the exhaustion of the easier gains, appears to have been accurate and also to depict the prospects in other populations of relatively high mortality and low income. A different projection of life expectancy in Mexico was also quite close to actual changes in Mexican mortality; it was based on a universal curve constructed to represent how life expectancy rises, increasing ever more slowly as it approaches an upper limit. This curve (1 for each sex), constructed for projection of Mexican mortality, is employed as a standard of comparison for mortality changes in many countries. A number have followed the standard for females very closely for more than 3 decades; in developed countries, male life expectancy has generally fallen short of the standard. The almost universal low fertility in developed countries contrasts with the great diversity of levels and trends of fertility in developing countries, some of which retain undiminished high fertility and others of which have recently attained rates of childbearing as low as in the developed areas. Instances of surprisingly little change and surprisingly rapid change in fertility are described. In the future, growth of populations of developed countries will probably be slight; the future rate of increase in the developing areas depends on the unpredictable timing and pace of childbearing reduction in populations where fertility remains high. In the long run, world population growth may resume its typical pattern of moderate growth interrupted by catastrophic setbacks.

Australia↗
PubMed2005

Coronary heart disease risk in men and the epidemic of overweight and obesity.

OBJECTIVE: To evaluate the contributions of socioeconomic, lifestyle, and body weight factors to predicted risk of coronary heart disease (CHD) in the population and thus provide a focus for policies on prevention. DESIGN: Prospective study and cross-sectional population health survey. SUBJECTS: In all, 3090 men in the Framingham study and 2571 men in the 1998 Health Survey for England (HSE) aged 35-74 y with no history of cardiovascular disease participated in the study. MEASUREMENTS: Data on sex, age, systolic blood pressure and antihypertensive medication, total and high-density lipoprotein cholesterol levels, diabetes, and their association with the incidence of myocardial infarction and fatal CHD in the Framingham study population were used to derive functions for predicting individual 10-y risk of CHD. These functions were applied to the same data on participants in the HSE. High risk was defined as 10-y CHD risk > or = 15%. The proportion of high risk in the English population attributable to each of the risk factors examined was assessed. RESULTS: In all, 32% of men in England had predicted 10-y CHD risk > or =15%. Such high risk was significantly associated with body mass index (BMI, kg/m2), waist:hip ratio (WHR), smoking, and levels of physical activity, educational attainment, and income (all P < or = 0.007). In this population, 47% of high CHD risk was attributable to excess body weight--BMI > or = 25 kg/m2 and/or WHR > or = 0.95--and 31% to the sum of the four other significant factors: lack of educational qualifications, low income, smoking, and physical inactivity. CONCLUSION: Overweight and obesity now dominate the standard risk factors of CHD in men and should be the focus of national policies for prevention.

Adult↗
PubMed1990

Screening for cervical cancer in emergency centers and sexually transmitted disease clinics.

Low-income women are at increased risk of developing cervical cancer compared with middle- and upper-income women. How can poor women be reached for screening and early diagnosis of cervical cancer and its precursor stages? One answer to this question is based on the observation that a high percentage of the unscreened population has received some form of medical care within the previous 5 years. Emergency centers and sexually transmitted disease (STD) clinics often provide such care to patients who lack a regular source of health care. Thus, they represent potential resources for cervical cancer screening. However, in a survey of 19 hospitals whose patient populations include a high proportion of low-income patients, only five reported a protocol for cervical cancer screening in their emergency centers. Similarly, all 11 STD clinics included in this survey reported that fewer than 5% of their female patients had a Papanicolaou smear taken even though virtually all of them received a pelvic examination. Based on these findings, it appears that health care administrators and policymakers could intensify their cancer prevention programs by mobilizing these resources for cancer control.

Community Health Centers↗
PubMed1978

Education and integration of midlevel health-care practitioners in obstetrics and gynecology: experience of a training program in Washington state.

The impetus for the development of the Gynecorps Training Program was the identification of medically underserved populations of women in Washington State and their need for preventive health care, the maldistribution of physicians, and the success of a pilot program for training midlevel personnel conducted in 1972 by the Department of Obstetrics and Gynecology, University of Washington School of Medicine. The program trains community-based and -sponsored Registered Nurses and Physician's Assistants as women's health-care specialists, with the goal of delivering preventive care in obstetrics and gynecology to populations of high-risk, low-income, and/or underserved women. A summary of the training program, its curriculum, and the integration of its graduates into community health teams is presented and discussed.

Certification↗
PubMed1992

Models for effective prevention.

The social influence models do provide some optimism for primary prevention efforts. Prevention programs appear most effective when 1) the target behavior of the intervention has received increasing societal disapproval (such as cigarette smoking), 2) multiple years of behavioral health education are planned, and 3) community-wide involvement or mass media complement a school-based peer-led program (45,46). Short-term programs and those involving alcohol use have had less favorable outcomes. Future research in primary prevention should address concerns of high-risk groups and high-risk countries, such as lower income populations in the United States or countries that have large adolescent homeless populations. The utilization of adolescent leaders for program dissemination might be particularly critical in these settings. A second major and global concern should focus upon alcohol use and alcohol-related problems. In many communities adolescent alcohol use is normative and even adult supported. Thus, young people are getting quite inconsistent messages on alcohol from their schools, from TV, from peers, and from parents. This inconsistency may translate into many tragic and avoidable deaths for young people. Clearly, in the area of alcohol-related problems, community-wide involvement may be necessary. A third direction for prevention research should involve issues of norms, access, and enforcement including policy interventions, such as involve the availability of cigarette vending machines or the ease of under-age buying or levels of taxation. These methods affect adolescents more acutely since their financial resources, for the most part, are more limited. These policy level methods also signify to adolescents what adults consider appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Tobacco advertising in communities: associations with race and class.

BACKGROUND: Individuals of lower socioeconomic position smoke at higher rates than those of higher socioeconomic position. Because of this disparity, the National Cancer Institute has called for studies of targeted tobacco marketing to clarify mechanisms contributing to higher tobacco use among low-income Americans and other high-risk populations. METHODS: We observed tobacco industry marketing in six Boston area communities (two of high socioeconomic position and four of low position; total of 41 observations) and in selected print publications that circulated in those communities during a 22-month period in 2000-2002. RESULTS: On average, there were fewer tobacco advertisements in the higher socioeconomic communities, compared to the lower socioeconomic communities (P < 0.001). In the low socioeconomic communities, there were more than three times as many brand advertisements as youth access signs (P = 0.0012). Although brand advertisements outnumbered smoke-free signs, on average, there was no difference in the ratio of brand advertisements to smoke-free signs in low and high socioeconomic communities (P = 0.06). CONCLUSIONS: The tobacco industry is actively present in community settings, particularly in communities with a low socioeconomic profile (SEP). Tobacco control researchers and advocates need to continue to monitor the tobacco industry's behavior at the community level and develop strategies to counter this behavior.

Advertising↗
PubMed1976

Geographic patterns of large bowel cancer in the United States.

Age-adjusted rates of mortality from colon and rectal cancer during 1950-69 were correlated by sex and race (white and nonwhite) with demographic data for the 3,056 counties of the contiguous United States. Mortality was consistently elevated in counties with large populations, higher income and education levels, and high percentages of residents of Irish, German, or Czechoslovak descent. The urban, socioeconomic, and, ethnic factors were each linked to large bowel cancer, but they only partly explained the predominance of this tumor in the Northern United States. A survey was made of the limited data available on dietary habits by region and on alcohol sales by county, but the concomitant variation with bowel cancer mortality rates was not impressive.

Adult↗
PubMed2004

Barriers to colorectal cancer screening: an educational diagnosis.

BACKGROUND: Colorectal cancer (CRC) is a largely preventable disease through early detection and treatment, yet screening rates remain low and mortality rates remain high, particularly among low-income, minority populations. This study was conducted to identify barriers to CRC screening. METHODS: Repeated telephone contacts were conducted with 226 individuals from 52 to 80 years of age, who had not recently received CRC screening. The contacts were intended to educate and encourage participants to obtain CRC screening. Within this context, CRC screening barriers were identified and categorized using an educational diagnosis as specified in the Precede-Proceed Framework. RESULTS: Findings showed that the most frequently observed barrier was lack of familiarity with CRC screening guidelines and tests. Availability and accessibility to screening tests was a barrier that was difficult to overcome for many participants. The majority of participants faced two or more barriers. CONCLUSIONS: This study suggests a need for public health education about CRC screening guidelines and tests and greater accessibility to CRC screening.

Aged↗