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PubMed1990

Home visitors and child health: analysis of selected programs.

The relationships between selected child health outcomes and programmatic interventions using home visitors are analyzed. The following features of seven programs are systematically reported: program characteristics; description of the home visitors; program objectives, sample size, and research design; outcome measures and reported data. A number of issues such as funding and long-term viability, use of professional or paraprofessional visitors, visitor selection and supervision, and evaluation of home visitor programs require clarification and are discussed. It is concluded that home visitor programs can contribute to child health outcomes such as increased birth weight, improved prenatal care, improved maternal-infant interaction, and improved use of community resources. Pediatricians can be supportive of such programs at many levels: becoming aware of the existence and range of services of home visitor programs in their area that serve families with children and referring families to those programs; being available to advise programs that are in the planning stages; providing advocacy at the local, state, and national level for the funding and development of such programs; and taking the initiative to join multidisciplinary efforts to develop new programs.

Alabama↗
PubMedDate not supplied

An oncology unit's initiation of a bereavement support program.

PURPOSE/OBJECTIVES: To describe how a multidisciplinary task force on an oncology unit developed and implemented a program offering educational and emotional support for recently bereaved families. DATA SOURCES: Published books and articles and bereavement support models. DATA SYNTHESIS: Program components included bereavement cards and a biannual survivor support program. One program held during the holidays offered formal presentations on grief and stressors and coping strategies. A second program held in the spring explored ways for survivors to experience personal growth. In addition to this program, a staff education component was developed. CONCLUSIONS: Sending bereavement cards served as a nonthreatening way for staff members to begin establishing closure after a patient's death. Staff participation in planning a support program is crucial, and initial staff resistance can be overcome by educating them and including them in program planning. The support program was highly rated by participants, and their evaluations showed that they felt a bond with the nursing staff who had cared for their loved ones. IMPLICATIONS FOR NURSING PRACTICE: These types of programs bring survivors and staff members together. Interaction in the program can enhance survivors' coping skills, acknowledge the bond between caregivers and survivors, and ease staff members' stress caused by caring for dying patients.

Bereavement↗
PubMed1993

Family physicians' support for school-based HIV prevention education programs.

OBJECTIVE: To identify the extent to which family physicians support school-based education programs regarding the human immunodeficiency virus (HIV). Sexually active adolescents are at risk for infection with HIV. Education programs on HIV that target this vulnerable group effectively prevent infection, yet family physicians are often not directly involved in the design and implementation of such programs. DESIGN: A systematic random sample of 2660 members of the American Academy of Family Physicians was surveyed using a mailed questionnaire to assess clinical experiences with HIV disease, willingness to provide HIV treatment, and support for school-based HIV education programs. The response rate was 63.7%. Poststratification weights were applied to adjust for the slight under-representation of non-board-certified physicians in the study sample. RESULTS: Support for school-based HIV counseling programs was overwhelmingly positive. The mean level of support was 1.28 (with 1 indicating strong approval and 4 strong disapproval). Physicians' attitudes toward programs that include condom availability were marginally less favorable (1.92). Residency trained (P = .009) and female physicians (P = .010) expressed the greatest support for school-based programs. Physicians with fewer professional concerns about providing direct HIV patient care (P = .030) and who believed that communication with their patients about sexuality was an acceptable component of clinical care (P < .001) were most likely to support school-based programs. CONCLUSIONS: Family physicians can play an important role in designing and implementing HIV education programs. The results of these analyses suggest family physicians may be relied on to endorse school-based HIV prevention programs, including programs that make condoms available to adolescents. School and public health authorities should enlist family physicians' assistance when planning and implementing these or related community-based HIV education activities.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Physician office laboratory education and training in primary care residency programs.

OBJECTIVE: To assess the status of office laboratory residency education and training in family practice, internal medicine, obstetrics and gynecology, and pediatric residency programs. DESIGN: A single mailed survey to 1299 residency programs from December 1992 to February 1993. PARTICIPANTS: Primary care residency directors from 507 (39%) of 1299 programs. INTERVENTIONS: A 27-item survey of residency-based office laboratory practices, education, training, and resources. MAIN OUTCOME MEASURES: Differences between specialties in provision and quantity of office laboratory education and training, presence of a residency-based office laboratory, laboratory classification under the Clinical Laboratory Improvement Amendments, and available laboratory tests. RESULTS: Of those responding, office laboratories were present in 89% of family practice, 19% of internal medicine, 29% of obstetrics and gynecology, and 24% of pediatrics residency programs. Laboratory training was available at 60% of family practice, 16% of internal medicine, 15% of obstetrics and gynecology, and 30% of pediatrics programs. The median number of hours of formal skills training was 10 hours for family practice residency programs but less than 2 hours for the other specialties. Only 25% of the programs reported educational assistance from pathologists. Merely 4% of the programs had postassessment examinations and 2% awarded certificates of achievement. A majority of family practice programs performed waivered tests and physician-performed microscopy tests, but moderately complex tests were performed in less than 50% of family practice programs. CONCLUSIONS: Family practice residency programs provide more office laboratory training for residents than other specialties. There is a need for improved residency training in the basics of office laboratory practice.

Curriculum↗
PubMed2002

Pharmaceutical manufacturer assistance programs.

BACKGROUND AND OBJECTIVE: While there have been many public discussions concerning Medicare covering outpatient prescription medications, currently, Medicare does not pay for most outpatient prescriptions. Meanwhile, costs associated with prescription medications as well as the number of underinsured patients are rapidly increasing. Many pharmaceutical companies offer assistance programs for patients who require medications but have inadequate financial resources to obtain them. Because patient access to required prescriptions is critical and clinician involvement is necessary for patient enrollment, the purpose of this article is to facilitate awareness of pharmaceutical companies' assistance programs, the availability of such programs, and their enrollment process. METHODS: English-language articles from MEDLINE (1963-2000) and Internet Web pages describing medication assistance programs were reviewed. Data obtained from pharmaceutical companies' medication assistance programs were also included. In addition to general information concerning medication assistance programs, all studies found in the literature search describing the clinical and financial impact of using these programs and data obtained from contacting several medication assistance programs were selected. To determine if an assistance program was available for a medication listed as one of the top 200 medications prescribed in the United States, we contacted the pharmaceutical company that manufactures each medication. RESULTS: Approximately 53% of the top 200 prescribed medications in 1999 were offered through assistance programs to indigent patients. Physician office personnel can obtain medications for eligible patients by completing the enrollment process. CONCLUSION: Pharmaceutical companies' medication assistance programs can be used to reduce individual patient drug expenditures and improve patient outcomes by increasing medication access to those in need.

Directories as Topic↗
PubMed2002

A comparison of a lecture and computer program to teach fundamentals of the Draw-a-Person test.

BACKGROUND: Although computer-assisted education has been used to augment education in many areas, there are few studies of programs designed to replace lectures in a medical curriculum. OBJECTIVE: To test whether a thoughtfully designed computer program can replace a standard lecture in a pediatrics curriculum while teaching the subject matter equally well. METHODS: A computer program was developed to teach the Draw-a-Person developmental test using the multimedia-authoring tool Director. One of us (A.E.C.) tested and modified the program several times during its creation after submitting it to several objective evaluators. Thirty-nine students taking the clinical pediatrics rotation were chosen by month to interact with the program or attend the lecture. All students then scored 3 drawings and assigned them a developmental age according to the Draw-a-Person test rules. Students assigned to the computer program also completed a questionnaire evaluating the program in several subjective areas. A t test for 2 samples assuming equal variance was used to analyze the test results. RESULTS: Students receiving the lecture (control group) scored the 3 drawings as 5.43 years (age range, 4.5-8 years), 9.08 years (age range, 7-12 years), and 3.5 years (age range, 2-5 years), respectively. Those using the computer program (study group) scored the 3 drawings as 5.91 years (age range, 5-7 years), 7.68 years (age range, 7-8 years), and 4.34 years (age range, 3-5 years), respectively. The correct answers for the ages were 6, 7.75, and 4.25 years, respectively. A t test for 2 samples assuming equal variance showed that students using the computer program performed better on all 3 drawings (P<.05, P<.02, and P<.002, respectively). CONCLUSIONS: Students using the computer program were more accurate than students attending the lecture when scoring drawings and estimating a developmental age from them. These results support the conclusion that a thoughtfully designed computer program can replace a standard lecture in a pediatrics curriculum.

Attitude to Computers↗
PubMed2006

Resident training in neurosurgical oncology: results of the survey of North American training programs by the AANS/CNS Section on Tumors.

OBJECTIVE: The AANS/CNS Section on Tumors is involved in the education of practitioners managing patients with tumors involving the nervous system. We report the results of a survey commissioned by this body to investigate how neurosurgical residents are trained in the neurosurgical oncology subspecialty. METHODS: One hundred six North American training centers were anonymously surveyed regarding faculty background; resident rotations, research opportunities, and caseload; and post-graduate neuro-oncology-related activities. Additionally, the AANS membership database was searched to quantify self-identified neuro-oncologists. RESULTS: Forty-four of 106 (41.5%) programs responded to the survey. Over 90% of responding programs have a faculty member specializing in neurosurgical oncology. Neurosurgical oncology fellowships or dedicated neuro-oncology resident rotation were found only in a small number of programs. Most residency programs support resident research, including exposure to brain tumor clinical trials. Twenty-nine (66%) programs reported their residents are exposed to >100 surgical cases of primary brain tumors. Twenty (46%) programs reported their residents are exposed to <50 skull base tumors. Thirty (70%) programs reported their resident would be exposed to <50 spine and peripheral nerve tumor cases. Half of the responding programs indicated that graduates of their programs had taken faculty positions focusing on neurosurgical oncology. Fifty-two members of the tumor section are in leadership positions for their given residency programs. CONCLUSIONS: Neuro-surgical oncology training appears to be strong at the programs that responded to our survey. However, resident training in neurosurgical oncology can be improved and residents with interests in this subspecialty need support to further this field.

Clinical Competence↗
PubMed1987

Screening for secretory otitis media: evaluation of some impedance screening programs for long-lasting secretory otitis media in 7-year-old children.

In an unselected cohort of 387 seven-year-old children 90% had all 9 planned impedance audiometries during their first year at school. The results from these 348 children were analyzed in different impedance screening programs, as 3 consecutive screening series, each comprising two or 3 tests at an interval of 4-8 weeks. The specificity of the ASHA and Nashville programs was too low in finding long-lasting secretory otitis media, namely about 70%, so that there were too many false positive cases. Therefore, a new impedance screening program was designed. It had about the same sensitivity (80%) but a far better specificity (95%) than the ASHA and Nashville programs. The predictive value of a positive test was 15% in the ASHA and Nashville programs, but 3 times better (48%) in the designed Hirtshals program. The Hirtshals program had a referral rate of 9% compared with the 32-36% in the ASHA and Nashville programs. The frequencies of retesting were 31% in the ASHA program, 52% in the Nashville Program and 45% in the Hirtshals program. Before general screening for long-lasting secretory otitis media can be recommended, additional information is needed.

Acoustic Impedance Tests↗
PubMed1990

Testing a 3-D radiation therapy planning program.

This report describes a systematic effort to test all functions of a large 3-D radiation therapy planning program, including graphics and user interaction. Previous studies in quality assurance for radiation therapy programs do not adequately address the problem of programming errors. They compare dose estimates calculated by planning programs to actual doses measured in phantoms, so they cannot distinguish programming errors from measurement errors or physical unsoundness of the beam model. Moreover, they fail to exercise graphics and user interaction functions. This report describes a different methodology: test cases are derived from the program specification, results are calculated by an independent technique, and compared to program output. Derivation of test cases is described in detail. Effectiveness of testing is assessed by reporting the number of errors revealed by testing and comparing to the number of errors discovered during routine use in five successive program versions. The size of the test set is related to the total program size, and the effort devoted to deriving and performing tests is compared to the total program development effort. We conclude that systematic testing can reveal errors that are not found by informal testing, routine program use, or comparison with measurements. However, additional errors remain that are only discovered during use. This study suggests that a typical large planning system may include more than 100 errors when it is released for clinical use. Methods for increasing testing effectiveness are recommended.

Radiotherapy, Computer-Assisted↗
PubMed1996

Changes in HIV risk behavior following alternative residential programs of drug abuse treatment and AIDS education.

We compared the effectiveness in changing human immunodeficiency virus (HIV) risk behavior of two different approaches to acquired immunodeficiency syndrome (AIDS) education given by residential drug abuse treatment programs differing in their planned duration. Two randomized controlled trials compared (a) a 6-month with a 12-month therapeutic community (TC) program, and (b) a 6-month with a 3-month relapse prevention (RP) program. Three composite variables assessing HIV risk (a) drug injection, (b) sexual partners, and (c) condom use-were measured for the 3 months prior to admission and follow-up. The TC program comprised a four-part AIDS information intervention. The RP program comprised a 21- or 42-session small-group program in the principles of RP, 5 skills-building AIDS education sessions, and 6 other health education sessions. Four hundred ninety-five clients were enrolled in the study and completed a follow-up interview within 6 months of exit (79% of those enrolled). Clients in the RP program reduced their drug injection and condom use risk. Female clients in the TC program reduced their condom use risk. There were no differential effects on risk behavior change of either planned duration (randomization assignment) or program type (RP versus TC). Thus, differences in the treatment programs, including AIDS education components, had no apparent effect on HIV risk behavior change. The contribution of residential drug abuse treatment programs to AIDS prevention remains unproved.

Adult↗
PubMedDate not supplied

Why do residents leave general surgery? The hidden problem in today's programs.

OBJECTIVE: Much has been written and discussed about the reasons for reduced interest in surgery, but few institutions have chosen to examine the loss or attrition of general surgery residents from their own programs. In preparation for an upcoming Residency Review Committee analysis of our program, we took the opportunity to examine the reasons for attrition in our own institution. DESIGN, SETTING, AND PARTICIPANTS: During the years 1990 to 2003, 120 categorical residents were admitted into our general surgery residency program. Residents who matched into preliminary positions or non-5-year categorical positions were not included in this study. During this period of time, 20 residents (9 female and 11 male) left the program for a variety of reasons. The folders of those 20 residents along with all of the correspondence pertaining to each resident were reviewed in detail. RESULTS: Our overall attrition rate during this 13-year period of time was 20 of 120 residents or 17%. This is comparable with the often-quoted figure of approximately 20% attrition in other general surgery programs. The reasons for leaving could be divided into 4 categories: (1) lifestyle, (2) opportunity for early specialization, (3) asked to leave the program because of emotional or performance difficulties, or (4) decided to leave medicine entirely. The largest group was related to lifestyle issues and comprised 13 of the total of 20 residents who left the program. Of this group of 13, 3 went into plastic surgery, 4 went into anesthesiology, 2 went into radiology, and the remaining 4 went into public health, internal medicine, pathology, and emergency medicine. Seven of these 13 individuals were women. Two individuals entered residency with the goal of specializing in plastic surgery. They both left their 5-year categorical general surgery positions after the third year when they were offered the opportunity to enter three-year plastic surgery fellowship positions. The third category was composed of 4 individuals who were asked to leave the program during this 13-year period because of performance or emotional problems, with 3 of these 4 being men. Only 1 person left medicine entirely, and he is now the vice-president of a successful software company. Of the total of 20 residents who left our program, 9 (45%) were female. Given that there were 33 females in our program during the subject period of time, these 9 females represent an attrition rate of 27%. The 11 males who left during this period represent, however, an attrition rate of only 13%. CONCLUSIONS: Although much concern has been expressed over the declining numbers of medical students interested in surgery, loss of residents after matching in general surgery is an equally significant problem. In our program over a 13-year period, 20 out 120 residents, or 17% dropped out or were released. The attrition rate for females (27%) was approximately twice that of males (13%), with 7 out of 9 females (78%) leaving for lifestyle reasons.

Attitude of Health Personnel↗
PubMed2006

Lions Clubs International Foundation Core Four Photoscreening: results from 17 programs and 400,000 preschool children.

INTRODUCTION: Photoscreening programs for preschool vision screening have been promoted by Lions Clubs International Foundation (LCIF) via their 17 Core Four grant project awards since 1999. Results from 15 Core Four grant programs in the United States and one in Taiwan are presented here. METHODS: Photoscreening was modeled after the Tennessee program and instituted statewide in each area. Programs were given latitude with respect to screening instrument and referral criteria, but a partnering academic institution and medical director were expected. Preschool children were screened by volunteers; referred children were examined by community optometrists and ophthalmologists who returned results to each program's coordinating center. Outcome data included number of children screened, referral rate, follow-up rate, and positive predictive value, which was generally determined using AAPOS-defined vision screening criteria. RESULTS: All but one program used the MTI photoscreener (it chose not to participate); photoscreening referral criteria were standard for 13 programs. Through December 2004, more than 400,000 preschool children had been screened. The referral rate for programs using the MTI photoscreener averaged 5.2% (range, 3.7-12.6%). The predictive value of a positive photoscreen was 80%. Overall, 54% of referred children received follow-up examinations. Follow-up rate was the largest variable: 4 programs, screening nearly 250,000 children, had follow-up rates 70% or greater; 10 programs had follow-up data from fewer than 40% of referred children. CONCLUSIONS: Volunteer-led photoscreening programs can be instituted in other locations, including overseas, with high levels of effectiveness. Limitations include the possibility of poor success and variable attention to follow-up.

Amblyopia↗
PubMed2004

Nutrition education is positively associated with substance abuse treatment program outcomes.

The scope and types of nutrition services provided in substance abuse treatment programs has not been well defined nor has there been an attempt to determine if associations exist between the provision of nutrition services and substance abuse treatment outcomes. The objectives of this study were to assess the provision (use and extent) of nutrition education in substance abuse treatment programs in facilities that provide a single or two or more substance abuse treatment programs, and to determine the possible association between nutrition intervention and substance abuse treatment program outcome measures (defined as changes in Addiction Severity Index [ASI] composite scores). A descriptive, single, cross-sectional survey of registered dietitians with clinical nutrition program management responsibility (n=152) was used to define the use and extent of nutrition services in substance abuse treatment programs. Positive associations between nutrition services provided, particularly nutrition education services and substance abuse treatment program outcome measures, were detected. When group nutrition/substance abuse education was offered, ASI psychological and medical domain scores improved by 68% and 56%, respectively (P<.05). Individual nutrition/substance abuse education was a predictor of ASI family/social domain change scores improving by 99% (P<.05). In those programs where group nutrition/substance abuse education was offered, moderate to strong correlations with various nutrition education services were observed, specifically in individual nutrition/substance abuse education (r=0.51; P<.05), group normal/nutrition education (r=0.64; P<.01), and individual normal/nutrition education (r=0.46; P<.05). Substance abuse treatment programs offering group nutrition/substance abuse education offered significantly (P<.05) more nutrition services overall. Findings support the position that nutrition education is an essential component of substance abuse treatment programs and can enhance substance abuse treatment outcomes. Dietitians should promote and encourage the inclusion of nutrition education into substance abuse treatment programs.

Cross-Sectional Studies↗
PubMed1996

The impact of the Women, Infants and Children Food Supplement Program on birth outcome.

OBJECTIVE: Our purpose was to compare the birth outcomes of pregnant women in the Women, Infants and Children Food Supplement Program with women not in the program. STUDY DESIGN: The vital records of 4713 women, 2895 enrolled in the Women, Infants and Children Food Supplement Program and 1812 not enrolled in the program, whose infants were delivered at Wishard Memorial Hospital over 18 months were reviewed with respect to age, education, race, substance habits, trimester of entry into prenatal care, maternal weight gain, and status in the program. The primary outcome variables evaluated were low birth weight, as defined by the delivery of an infant < 2500 gm, and infant mortality. The primary predictor was program participation versus nonparticipation. Analysis was by t test, chi2, and logistic regression models. RESULTS: Black women, women with no prenatal care, and women who smoke were more likely to deliver a low-birth-weight infant. The incidence of low birth weight was 13.1% for nonparticipants versus 10.2% for program participants (p < 0.05). Univariate analysis confirmed program participants to be at significantly less risk for a low-birth-weight delivery (odds ratio = 0.75, p < 0.05). This relation, however, was not significant in the multivariate model (odds ratio = 0.88), indicating that the effect of participating in the program is being confounded by race, entry into prenatal care, and smoking. The overall infant mortality rate was 12.4 per 1000 for participants and 16 per 1000 for nonparticipants (p = not significant). CONCLUSION: Nutritional and nonnutritional benefits to participation in the Women, Infants and Children Food Supplement Program were confirmed. Women enrolled in the program were less likely to deliver a low-birth-weight infant. Multiple variables likely contribute to the poorer outcome for nonparticipants.

Birth Weight↗
PubMed1997

Analysis of the effectiveness of an endoscopy education program in improving residents' laparoscopic skills.

OBJECTIVE: To evaluate the effectiveness of a gynecologic endoscopy education program in enhancing residents' proficiency in laparoscopic surgery. METHODS: The program was designed to provide residents with the knowledge and skills necessary for laparoscopic surgery, before entering the operating room, in a cost-effective manner that honored the principles of adult education. The 7-week program included didactic sessions to provide conceptual learning but focused on practical skills enhancement through practice in both pelvic trainer and animal laboratory settings. The program design included dominant, nondominant, and two-handed skills as well as models for laparoscopic dissection, hemostasis, and suturing. The evaluation of the program is based on timing of laparoscopic skills as well as resident and faculty evaluation of laparoscopic proficiency at the beginning and end of the program. RESULTS: Prior to the program, 48% of residents and 75% of faculty were satisfied with laparoscopic training. All residents improved operating times in pelvic trainer skills after the program, with first-year residents improving by 68%, third-year residents by 58%, and fourth-year residents by 72%. The residents self-assessment of competence in 14 laparoscopic skills revealed an increase in all skills following the program. The faculty assessment showed an upward trend in skills competence. At the conclusion of the program, 100% of residents and 92% of faculty were satisfied with the laparoscopic training. CONCLUSION: A structured program emphasizing skills enhancement is an effective approach to improve residents' performance in laparoscopic surgery.

Clinical Competence↗
PubMedDate not supplied

Feeling the stress: perceptions of burnout among general surgery program directors.

PURPOSE: To document the types and levels of stress experienced by general surgery program directors as they fulfill their education and administrative responsibilities. METHODS: This study consisted of a 3-part survey that incorporated 2 established instruments to help determine the presence of burnout in program directors. A personal projects analysis was used to help identify the tasks most relevant to the role of program director as well as to evaluate their perceptions of these tasks. The Maslach Burnout Inventory (MBI) was used to measure the degree of burnout among program directors. Demographic data were gathered to develop a picture of the background of the program directors and how they spent their time. RESULTS: A total of 71.8% of program directors responded. Of all tasks, teaching received the highest ratings for importance, enjoyment, and control, as well as the lowest ratings for stress. Emotional exhaustion was the most notable aspect of burnout in program directors on the MBI. Program directors scoring high in burnout were younger, had been in their current position fewer years, and had fewer years overall as a program director. CONCLUSIONS: Burnout is more related to age and experience of program director than to features of the program itself.

Journal Article↗
PubMed2000

Evidence-based medicine training in internal medicine residency programs a national survey.

To characterize evidence-based medicine (EBM) curricula in internal medicine residency programs, a written survey was mailed to 417 program directors of U.S. internal medicine residency programs. For programs offering a freestanding (dedicated curricular time) EBM curriculum, the survey inquired about its objectives, format, curricular time, attendance, faculty development, resources, and evaluation. All directors responded to questions regarding integrating EBM teaching into established educational venues. Of 417 program directors, 269 (65%) responded. Of these 269 programs, 99 (37%) offered a freestanding EBM curriculum. Among these, the most common objectives were performing critical appraisal (78%), searching for evidence (53%), posing a focused question (44%), and applying the evidence in decision making (35%). Although 97% of the programs provided MEDLINE, only 33% provided Best Evidence or the Cochrane Library. Evaluation was performed in 37% of the freestanding curricula. Considering all respondents, most programs reported efforts to integrate EBM teaching into established venues, including attending rounds (84%), resident report (82%), continuity clinic (76%), bedside rounds (68%), and emergency department (35%). However, only 51% to 64% of the programs provided on-site electronic information and 31% to 45% provided site-specific faculty development. One third of the training programs reported offering freestanding EBM curricula, which commonly targeted important EBM skills, utilized the residents' experiences, and employed an interactive format. Less than one half of the curricula, however, included curriculum evaluation, and many failed to provide important medical information sources. Most programs reported efforts to integrate EBM teaching, but many of these attempts lacked important structural elements.

Curriculum↗
PubMed2002

State expenditures for tobacco-control programs and the tobacco settlement.

BACKGROUND: Despite controversy surrounding the use of funds arising from settlement agreements with the tobacco industry, little is known about the role of these funds in expenditures for state tobacco-control programs. METHODS: We evaluated state expenditures for tobacco-control programs in fiscal year 2001 in the context of the amount of tobacco-settlement funds received and allocated to tobacco-control programs and in the context of other state-level economic and health data. RESULTS: In 2001 the average state received $28.35 per capita from the tobacco settlement but allocated approximately 6 percent of these funds to tobacco-control programs. The average state dedicated $3.49 per capita (range, $0.10 to $15.47) to tobacco-control programs. The proportion of settlement funds allocated to tobacco-control programs varied from 0 to 100 percent and was strongly related to levels of tobacco-control funding (P<0.001). States with higher smoking rates tended to invest less per capita in tobacco-control programs (P=0.007), as did tobacco-producing states (the mean per capita expenditure was $1.20, as compared with $3.81 in non-tobacco-producing states; P<0.008). In a multivariate analysis, the proportion of the settlement revenue allocated to tobacco-control programs was the primary determinant of the level of total funding; the state tobacco-related health burden was unrelated to program funding. CONCLUSIONS: State health needs appear to have little effect on the funding of state tobacco-control programs. Because only a very small proportion of the tobacco settlement is being used for tobacco-control programs, the settlement represents an unrealized opportunity to reduce morbidity and mortality from smoking.

Health Expenditures↗