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Hawton K, Pirkis J. Preventing suicide: a call to action. Lancet Public Health 2024:S2468-2667(24)00159-2. [PMID: 39265609 DOI: 10.1016/s2468-2667(24)00159-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/19/2024] [Accepted: 07/03/2024] [Indexed: 09/14/2024]
Abstract
The public health approach to suicide prevention requires us to move away from thinking about suicide as a purely clinical problem and to pay heed to the array of social determinants (such as financial hardship or domestic violence and abuse) that might lead people to consider suicide as an option. Clinical factors are important, and, indeed, clinical or indicated interventions are entirely appropriate for people who have reached a point of crisis and should be a mainstay of national suicide prevention strategies. However, our Series stresses the need for selective and universal interventions that tackle the pervasive problem of suicide in a more upstream way, preventing people reaching a crisis point. Many social determinants can best be addressed by sectors outside health, so we are calling for a whole-of-government commitment to suicide prevention. We make recommendations for actions in the areas of policy, practice, research, and advocacy. People with lived experience of suicide should have genuine involvement in all of these actions.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Jane Pirkis
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Hetrick SE, Hobbs M, Fortune S, Marek L, Wiki J, Boden JM, Theodore R, Ruhe T, Kokaua JJ, Thabrew H, Milne B, Bowden N. Proximity of alcohol outlets and presentation to hospital by young people after self-harm: A retrospective geospatial study using the integrated data infrastructure. Aust N Z J Psychiatry 2024; 58:152-161. [PMID: 37888830 PMCID: PMC10838485 DOI: 10.1177/00048674231203909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVES There is a well-established association between alcohol use, misuse, intoxication and self-harm, the latter of which is associated with suicide. This study aimed to better understand the association between proximity to alcohol outlets and the likelihood of young people presenting to hospital following self-harm. METHODS This was a nationwide retrospective geospatial study using data from the New Zealand Integrated Data Infrastructure using population-level data for 10-29-year-olds for the 2018 and 2017 calendar years. Presentations to hospital following self-harm were identified using the national minimum data set. Proximity to alcohol outlets was defined in road network distance (in kilometres) and ascertained using Integrated Data Infrastructure geospatial data. Alternative measures of proximity were employed in sensitivity analyses. Complete-case two-level random intercept logistic regression models were used to estimate the relationship between alcohol outlet proximity and hospital presentation for self-harm. Adjusted models included sex, age, ethnicity, area-level deprivation, urbanicity and distance to nearest medical facility. Analyses were also stratified by urbanicity. RESULTS Of the 1,285,368 individuals (mean [standard deviation] age 20.0 [5.9] years), 7944 (0.6%) were admitted to hospital for self-harm. Overall, the odds of presenting to hospital for self-harm significantly decreased as the distance from the nearest alcohol outlet increased, including in adjusted models (adjusted odds ratio 0.980; 95% confidence interval = [0.969-0.992]); the association was robust to changes in the measure of alcohol proximity. The effect direction was consistent across all categorisations of urbanicity, but only statistically significant in large urban areas and rural areas. CONCLUSIONS The findings of this study show a clear association between young people's access to alcohol outlets and presentation to hospital for self-harm and may provide a mandate for government policies and universal interventions to reduce young people's access to alcohol outlets. Further research regarding causative mechanisms is needed.
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Affiliation(s)
- Sarah E Hetrick
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
- Suicide Prevention Office, Auckland, New Zealand
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
| | - Matthew Hobbs
- Te Taiwhenua o te Hauora–GeoHealth Laboratory, University of Canterbury, Christchurch, Canterbury, New Zealand
- Te Kaupeka Oranga, Faculty of Health, University of Canterbury, Christchurch, Canterbury, New Zealand
- The Cluster for Community and Urban Resilience (CURe), University of Canterbury, Christchurch, Canterbury, New Zealand
| | - Sarah Fortune
- Department of Social and Community Health, School of Population Health, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Lukas Marek
- Te Taiwhenua o te Hauora–GeoHealth Laboratory, University of Canterbury, Christchurch, Canterbury, New Zealand
- Te Kaupeka Oranga, Faculty of Health, University of Canterbury, Christchurch, Canterbury, New Zealand
| | - Jesse Wiki
- Epidemioloigy and Biostatistics, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Joseph M Boden
- Christchurch Health and Development Study, University of Otago, Christchurch, Canterbury, New Zealand
| | - Reremoana Theodore
- National Centre for Lifecourse Research, University of Otago, Dunedin, New Zealand
| | - Troy Ruhe
- Va’a O Tautai – Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Jesse J Kokaua
- National Centre for Lifecourse Research, University of Otago, Dunedin, New Zealand
- Va’a O Tautai – Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Hiran Thabrew
- Te Ara Hāro, Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Barry Milne
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), The University of Auckland, Auckland, New Zealand
| | - Nicholas Bowden
- A Better Start: E Tipu e Rea National Science Challenge, Auckland, New Zealand
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
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Racial Health Disparities Research in Cardiothoracic Surgery Under-represented in Major Meetings. J Surg Res 2023; 284:37-41. [PMID: 36535117 DOI: 10.1016/j.jss.2022.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/25/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Black/African Americans and Latinos face significant health disparities and systemic inequities. Heart and lung disease are leading factors affecting morbidity and mortality in these groups. Given this disparity, we sought to determine how often this topic is presented at the most relevant United States annual cardiothoracic surgery meetings. METHODS Specialty-specific annual meeting abstract books were queried between 2015 and 2021. We included the Society of Thoracic Surgeons, American Association for Thoracic Surgery, Western Thoracic Surgical Association, and the Southern Thoracic Surgical Association. Scientific abstract titles and content were searched for the following keywords and phrases: "racial health disparities," "race," "racism," "racial bias," "institutional racism," and "health disparities". If an abstract included a keyword or phrase, it was counted as a racial health disparity abstract. We calculated the proportion of racial health disparity abstracts and abstracts published as manuscripts in the meeting-associated journals. RESULTS A total of 3664 abstracts were presented between 2015 and 2021. Of those, 0.90% (33/3664) abstracts presented contained at least one of the keywords or phrases. Of these abstracts, the percentage that went on to publication represented 0.38% (14/3664) of the total number of abstracts presented. CONCLUSIONS Abstracts on racial health disparities in cardiothoracic surgery represent a very small fraction of total meeting peer-reviewed content. There is a significant gap in research to identify and develop best practice strategies to address these disparities and mitigate structural racism within the care of underserved patients with cardiothoracic diseases.
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Owens-Young JL, Leider JP, Bell CN. Public Health Workforce Perceptions About Organizational Commitment to Diversity, Equity, and Inclusion: Results From PH WINS 2021. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:S98-S106. [PMID: 36223514 PMCID: PMC10573085 DOI: 10.1097/phh.0000000000001633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In response to calls to achieve racial equity, racism has been declared as a public health crisis. Diversity, equity, and inclusion (DEI) is an approach public health organizations are pursuing to address racial inequities in health. However, public health workforce perceptions about organizational commitment to DEI have not yet been assessed. Using a nationally representative survey of public health practitioners, we examine how perceptions about supervisors' and managers' commitment to DEI and their ability to support a diverse workforce relate to perceptions of organizational culture around DEI. METHODS Data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) to examine the relationship between public health employees' perceptions about their organization's commitment to DEI and factors related to those perceptions. PH WINS received 44 732 responses (35% response rate). We calculated descriptive statistics and constructed a logistic regression model to assess these relationships. RESULTS Findings show that most public health employees perceive that their organizations are committed to DEI; however, perceptions about commitment to DEI vary by race, ethnicity, gender identity, and organizational setting. Across all settings, White respondents were more likely to agree with the statement, "My organization prioritizes diversity, equity, and inclusion" (range, 70%-75%), than Black/African American (range, 55%-65%) and Hispanic/Latino respondents (range, 62.5%-72.5%). Perception that supervisors worked well with individuals with diverse backgrounds had an adjusted odds ratio (AOR) of 5.37 ( P < .001); organizational satisfaction had an AOR of 4.45 ( P < .001). Compared with White staff, all other racial and ethnic groups had lower AOR of reporting their organizations prioritized DEI, with Black/African American staff being the lowest (AOR = 0.55), followed by Hispanic/Latino staff (AOR = 0.71) and all other staff (AOR = 0.82). CONCLUSIONS These differences suggest that there are opportunities for organizational DEI commitment to marginalized public health staff to further support DEI and racial equity efforts. Building a diverse public health workforce pipeline will not be sufficient to achieve health equity if staff perceive that their organization does not prioritize DEI.
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Affiliation(s)
- Jessica L. Owens-Young
- Department of Health Studies, American University, Washington, District of Columbia (Dr Owens-Young); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); and Department of Social, Behavioral, and Population Sciences, Tulane University, New Orleans, Louisiana (Dr Bell)
| | - Jonathon P. Leider
- Department of Health Studies, American University, Washington, District of Columbia (Dr Owens-Young); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); and Department of Social, Behavioral, and Population Sciences, Tulane University, New Orleans, Louisiana (Dr Bell)
| | - Caryn N. Bell
- Department of Health Studies, American University, Washington, District of Columbia (Dr Owens-Young); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); and Department of Social, Behavioral, and Population Sciences, Tulane University, New Orleans, Louisiana (Dr Bell)
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Doherty E, Wiggers J, Nathan N, Hall A, Wolfenden L, Tully B, Elliott EJ, Attia J, Dunlop AJ, Symonds I, Tsang TW, Reeves P, McFadyen T, Wynne O, Kingsland M. Iterative delivery of an implementation support package to increase and sustain the routine provision of antenatal care addressing alcohol consumption during pregnancy: study protocol for a stepped-wedge cluster trial. BMJ Open 2022; 12:e063486. [PMID: 35882461 PMCID: PMC9330336 DOI: 10.1136/bmjopen-2022-063486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Antenatal care addressing alcohol consumption during pregnancy is not routinely delivered in maternity services. Although a number of implementation trials have reported significant increases in such care, the majority of women still did not receive all recommended care elements, and improvements dissipated over time. This study aims to assess the effectiveness of an iteratively developed and delivered implementation support package in: (1) increasing the proportion of pregnant women who receive antenatal care addressing alcohol consumption and (2) sustaining the rate of care over time. METHODS AND ANALYSIS A stepped-wedge cluster trial will be conducted as a second phase of a previous trial. All public maternity services within three sectors of a local health district in Australia will receive an implementation support package that was developed based on an assessment of outcomes and learnings following the initial trial. The package will consist of evidence-based strategies to support increases in care provision (remind clinicians; facilitation; conduct educational meetings) and sustainment (develop a formal implementation blueprint; purposely re-examine the implementation; conduct ongoing training). Measurement of outcomes will occur via surveys with women who attend antenatal appointments each week. Primary outcomes will be the proportion of women who report being asked about alcohol consumption at subsequent antenatal appointments; and receiving complete care (advice and referral) relative to alcohol risk at initial and subsequent antenatal appointments. Economic and process evaluation measures will also be reported. ETHICS AND DISSEMINATION Ethical approval was obtained through the Hunter New England (16/11/16/4.07, 16/10/19/5.15) and University of Newcastle Human Research Ethics Committees (H-2017-0032, H-2016-0422) and the Aboriginal Health and Medical Research Council (1236/16). Trial findings will be disseminated to health service decision makers to inform the feasibility of conducting additional cycles to further improve antenatal care addressing alcohol consumption as well as at scientific conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry (ACTRN12622000295741).
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Affiliation(s)
- Emma Doherty
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Clinical Research Design and Statistics, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Adrian John Dunlop
- Drug and Alcohol Clinical Services Research, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - Penny Reeves
- Health Research Economics, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Tameka McFadyen
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Thurru Indigenous Health Unit, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Melanie Kingsland
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
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Mikton C, Beaulieu M, Yon Y, Cadieux Genesse J, St‐Martin K, Byrne M, Phelan A, Storey J, Rogers M, Campbell F, Ali P, Burnes D, Band‐Winterstein T, Penhale B, Lachs M, Pillemer K, Estenson L, Marnfeldt K, Eustace‐Cook J, Sutton A, Lacasse F. PROTOCOL: Global elder abuse: A mega-map of systematic reviews on prevalence, consequences, risk and protective factors and interventions. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1227. [PMID: 36911355 PMCID: PMC9046657 DOI: 10.1002/cl2.1227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: to produce a mega-map which identifies, maps and provides a visual interactive display, based on systematic reviews on all the main aspects of elder abuse in both the community and in institutions, such as residential and long-term care institutions.
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Affiliation(s)
- Christopher Mikton
- Department of Social Determinants of HealthWorld Health OrganizationGenevaSwitzerland
| | - Marie Beaulieu
- École de travail social, Faculté des lettres et sciences humainesUniversité de SherbrookeSherbrookeQuébecCanada
- Research Chair on Mistreatment of Older AdultsSherbrookeQuébecCanada
| | - Yongjie Yon
- World Health Organization Regional Office for EuropeCopenhagenDenmark
| | | | - Kevin St‐Martin
- École de travail social, Faculté des lettres et sciences humainesUniversité de SherbrookeSherbrookeQuébecCanada
| | - Mark Byrne
- School of Nursing and Midwifery, Trinity College DublinDublinIreland
| | - Amanda Phelan
- School of Nursing and Midwifery, Trinity College DublinDublinIreland
| | | | - Michaela Rogers
- Department of Sociological StudiesUniversity of SheffieldSheffieldUK
| | - Fiona Campbell
- School of Health and Related ResearchThe University of SheffieldSheffieldUK
| | - Parveen Ali
- Department of Sociological StudiesUniversity of SheffieldSheffieldUK
| | - David Burnes
- Rotman Research Institute, Factor‐Inwentash Faculty of Social Work Affiliate Scientist, BaycrestUniversity of TorontoOntarioTorontoCanada
| | - Tova Band‐Winterstein
- Department of GerontologyFaculty of Social Welfare and Health SciencesUniversity of HaifaHaifaIsrael
| | | | - Mark Lachs
- Geriatric MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Karl Pillemer
- Cornell Institute for Translational Research on AgingCornell UniversityNew YorkNew YorkUSA
| | - Lilly Estenson
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kelly Marnfeldt
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Anthea Sutton
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
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Levin J. Human Flourishing: A New Concept for Preventive Medicine. Am J Prev Med 2021; 61:761-764. [PMID: 34187711 DOI: 10.1016/j.amepre.2021.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jeff Levin
- Medical Humanities Program, Baylor University, Waco, Texas; Institute for Studies of Religion, Baylor University, Waco, Texas.
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Mark K, Bradley J, Chute C, Sumpter C, Adil M, Crooks G. Using Innovation to Develop Digital Tools for Public Health During the COVID-19 Pandemic. EUROPEAN MEDICAL JOURNAL 2021. [DOI: 10.33590/emj/20-00227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Technology has played a key role in enabling public health to respond to the COVID-19 pandemic at a pace and scale never seen before. The Digital Health and Care Innovation Centre (DHI) assisted with development of two new digital services to enable testing and contact tracing at scale using innovative methods.
Methods: The DHI employed a design innovation approach by bringing all relevant stakeholders together to co-design new technology services to identify the ‘preferred future’. Workshops were used to identify the preferred solutions. The innovative methods for development of digital health tools included adopting an iterative approach, addressing the situational requirements posed by COVID-19, and democratising technology for purposes of pandemic control.
Results: A National Notification Service (NNS) for automation of delivery and feedback (if results messages were viewed) was developed and adopted by five of the 14 health boards in Scotland, processing over 7 million results since inception.
The Simple Tracing Tools (STT) is an open-platform web-based app that is designed for data entry by contact tracing teams. STT was adopted by all local health protection teams and informed development of the national case management system.
Discussion: The Cynefin framework can be used to understand the design innovation process when facing the challenges of designing digital tools during a pandemic. There are significant opportunities for public health to engage with digital health to transform the pandemic response and derive benefit for tackling future population health challenges.
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Affiliation(s)
- Kate Mark
- Digital Health and Care Innovation Centre, Glasgow, UK
| | | | | | | | | | - George Crooks
- Digital Health and Care Innovation Centre, Glasgow, UK
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Nwanaji-Enwerem JC, Jackson CL, Ottinger MA, Cardenas A, James KA, Malecki KM, Chen JC, Geller AM, Mitchell UA. Adopting a "Compound" Exposome Approach in Environmental Aging Biomarker Research: A Call to Action for Advancing Racial Health Equity. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:45001. [PMID: 33822649 PMCID: PMC8043128 DOI: 10.1289/ehp8392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/24/2021] [Accepted: 03/15/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND In June 2020, the National Academies of Sciences, Engineering, and Medicine hosted a virtual workshop focused on integrating the science of aging and environmental health research. The concurrent COVID-19 pandemic and national attention on racism exposed shortcomings in the environmental research field's conceptualization and methodological use of race, which have subsequently hindered the ability of research to address racial health disparities. By the workshop's conclusion, the authors deduced that the utility of environmental aging biomarkers-aging biomarkers shown to be specifically influenced by environmental exposures-would be greatly diminished if these biomarkers are developed absent of considerations of broader societal factors-like structural racism-that impinge on racial health equity. OBJECTIVES The authors reached a post-workshop consensus recommendation: To advance racial health equity, a "compound" exposome approach should be widely adopted in environmental aging biomarker research. We present this recommendation here. DISCUSSION The authors believe that without explicit considerations of racial health equity, people in most need of the benefits afforded by a better understanding of the relationships between exposures and aging will be the least likely to receive them because biomarkers may not encompass cumulative impacts from their unique social and environmental stressors. Employing an exposome approach that allows for more comprehensive exposure-disease pathway characterization across broad domains, including the social exposome and neighborhood factors, is the first step. Exposome-centered study designs must then be supported with efforts aimed at increasing the recruitment and retention of racially diverse study populations and researchers and further "compounded" with strategies directed at improving the use and interpretation of race throughout the publication and dissemination process. This compound exposome approach maximizes the ability of our science to identify environmental aging biomarkers that explicate racial disparities in health and best positions the environmental research community to contribute to the elimination of racial health disparities. https://doi.org/10.1289/EHP8392.
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Affiliation(s)
- Jamaji C. Nwanaji-Enwerem
- Department of Environmental Health, Harvard T.H. Chan School of Public Health and MD/PhD Program, Harvard Medical School, Boston, Massachusetts, USA
- Division of Environmental Health Sciences, School of Public Health and Center for Computational Biology, University of California, Berkeley, Berkeley, California, USA
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), U.S. Department of Health and Human Services (U.S. HHS), Research Triangle Park, North Carolina, USA
- Intramural Program, National Institute on Minority Health and Health Disparities, NIH, U.S. HHS, Bethesda, Maryland, USA
| | - Mary Ann Ottinger
- Department of Biology and Biochemistry, University of Houston, Houston, Texas USA
| | - Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health and Center for Computational Biology, University of California, Berkeley, Berkeley, California, USA
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristen M.C. Malecki
- Department of Population Health Sciences, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jiu-Chiuan Chen
- Departments of Preventive Medicine and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Andrew M. Geller
- Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Uchechi A. Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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Diaz-Cruz ES, Harland MD, Darensbourg C. Using Biochemistry to Educate Students on the Causal Link between Social Epigenetics and Health Disparities. Innov Pharm 2020; 11. [PMID: 34007637 PMCID: PMC8075150 DOI: 10.24926/iip.v11i3.2418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background While pharmacy education standards require students to recognize social determinants of health (SDOH), there is an opportunity to improve how this is taught in the curriculum. One innovative approach is to educate student pharmacists in a biochemistry course through the integration of topics like epigenetics using SDOH as the framework. Innovation A 50-minute educational activity was used to supplement material on the regulation of gene expression, in which epigenetic changes are driven by SDOH. It provided students with a biochemical basis to explain some health disparities, rather than viewing them exclusively as social obstacles to health. The activity employed a mini-lecture, a short video, as well as both small and large group discussion. A reflective paper was used to assess students' understanding of the topic, and the role of the pharmacist in helping patients prevent diseases caused by epigenetic changes due to social determinants of health. Findings A post-activity survey showed that the activity increased students' perception of knowledge about SDOH, as well as the effect of epigenetic changes on health outcomes. Furthermore, this activity increased students' awareness about the role that SDOH play in epigenetic changes and challenged students to understand the role that society plays in health outcomes. Conclusions The preventable nature of health inequities creates an opportunity to integrate public health into pharmacy education. The integration of epigenetics and SDOH gives the student an opportunity to provide a mechanistic link between social inequities and biochemical processes.
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11
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Pickett S, Burchenal CA, Haber L, Batten K, Phillips E. Understanding and effectively addressing disparities in obesity: A systematic review of the psychological determinants of emotional eating behaviours among Black women. Obes Rev 2020; 21:e13010. [PMID: 32067355 DOI: 10.1111/obr.13010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/21/2019] [Accepted: 01/17/2020] [Indexed: 11/28/2022]
Abstract
Emotional eating may be a particularly important contributor to differences in body weight and weight loss response to behavioural interventions among non-Hispanic Black women. We performed a systematic review on the impact of psychological factors (stress, anxiety, depression, and discrimination) upon emotional eating and weight among non-Hispanic Black women, applying the Preferred Reporting Items for Systematic Reviews and Meta-analysis for relevant studies. The initial search yielded 4593 articles with 15 accepted for review. Based on this review, there is a suggestion that negative emotions, in particular, perceived stress, may be predictive of emotional eating among non-Hispanic Black women. Results from the only two longitudinal studies identified by the review indicate that stress influences emotional eating, and emotional eating predicts weight gain over time. Findings from this review highlight the need for more studies that examine various negative emotions that may lead to emotional eating and weight gain among non-Hispanic Black women. Findings from this review also highlight the need for more rigorous studies to differentiate the effects of emotional eating from that of the physiologic (ie, activation of the hypothalamic-pituitary axis) responses to stress and its impact on high-risk groups.
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Affiliation(s)
- Stephanie Pickett
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Clare A Burchenal
- School of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Leora Haber
- School of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kendra Batten
- School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Erica Phillips
- Division of General Internal Medicine, Weill Cornell Medical College, New York, NY, USA
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Diaz-Cruz ES. If cultural sensitivity is not enough to reduce health disparities, what will pharmacy education do next? CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:538-540. [PMID: 31171258 DOI: 10.1016/j.cptl.2019.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/13/2018] [Accepted: 02/07/2019] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Social determinants greatly impact health, and evidence suggests that health disparities still exist between patient populations. The pharmacist's role in public health continues to evolve; therefore, the deliberate integration of public health into pharmacy education is essential. Pharmacy graduates must be able to recognize social determinants of health in order to help reduce disparities and inequities in access to quality care. PERSPECTIVE Cultural sensitivity training has been one of the most commonly used vehicles to educate students about health disparities. Whereas cultural sensitivity is of critical importance, it could unintentionally perpetuate the idea of culture as the sole construct to predict health outcomes. Consequently, it is important that we approach this societal problem from a public health perspective by addressing not just culture, but all other social determinants of health. IMPLICATIONS As disparities in health outcomes continue to widen for some patient groups, it is imperative for pharmacy programs to explore novel instructional approaches to teach health disparities. A paradigm shift from awareness to action and advocacy must involve educating students on the multifaceted effects of social determinants when designing interventions to help reduce health disparities.
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Affiliation(s)
- Edgar S Diaz-Cruz
- Pharmaceutical Sciences, Belmont University College of Pharmacy, 1900 Belmont Boulevard, Nashville, TN 37212-3757, United States.
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Becker A, Suther S, Harris C, Pawlowicz G, Tucker G, Dutton M, Close F, Hilliard A, Gragg R. Community-Based Participatory Research at Jacksonville Florida Superfund Ash Site: Toxicology Training to Improve the Knowledge of the Lay Community. FLORIDA PUBLIC HEALTH REVIEW 2019; 15:61-74. [PMID: 32337512 PMCID: PMC7181972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Until the late 1960's, Jacksonville, Florida incinerated its solid waste with the resultant ash deposited in landfills or used to fill flood-prone areas. These filled areas were later developed into parks, school sites and residential areas. Lead in soil at these sites was the major toxicant of concern and driver of clean-up actions. During the period of assessment of lead-levels in soil, there were no established lines of communication between the City and residents of affected neighborhoods resulting in mistrust in the community. To address communication issues, a community-based, culturally sensitive Community Environmental Toxicology Curriculum (CETC) and a short video were developed for community stakeholders to inform them of risks, health effects, remediation processes and preventive measures. Pre-and post-tests were developed to measure knowledge gained from the toxicology training. Learning gains averaged 47% and 24% for the community leaders and residents respectively. Most participants strongly agreed that the community toxicology curriculum was a useful tool for promoting awareness of environmental risks in their community and addressing the gap in trust between residents and agencies involved in site remediation.
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Affiliation(s)
- Alan Becker
- Florida A&M University, Institute of Public Health, Tallahassee, Florida, 32307
| | - Sandra Suther
- Florida A&M University, Economic, Social and Administrative Pharmacy, Tallahassee, Florida, 32307
| | - Cynthia Harris
- Florida A&M University, Institute of Public Health, Tallahassee, Florida, 32307
| | - Grazyna Pawlowicz
- Florida Department of Health, Duval County Health Department, Jacksonville, Florida, 32211
| | - Gale Tucker
- Public Health Programs, Florida Department of Health, Duval County Health Department, Jacksonville, Florida, 32211
| | - Matthew Dutton
- Florida A&M University, Economic, Social and Administrative Pharmacy Tallahassee, Florida, 32307
| | - Fran Close
- Florida A&M University, Institute of Public Health, Tallahassee, Florida, 32307
| | - Aaron Hilliard
- Florida A&M University, College of Pharmacy, Tallahassee, Florida, 32307
| | - Richard Gragg
- Florida A&M University, College of the Environment, Tallahassee, Florida, 32307
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Kim MS, Cardinal BJ. Differences in university students' motivation between a required and an elective physical activity education policy. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:207-214. [PMID: 29952738 DOI: 10.1080/07448481.2018.1469501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/09/2018] [Accepted: 04/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim of this study was to examine differences in students' physical activity motivation, competence, and weekly exercise metabolic equivalent units (METs) between universities with different physical activity education (PAE) policy arrangements (ie, a required PAE vs. an elective PAE). PARTICIPANTS Participants (N = 953) were purposefully recruited from two universities with different PAE policies 1 week before the start of fall term 2015. METHODS Participants completed questionnaires assessing their physical activity motivation, competence, and weekly exercise METs. RESULTS The results of this study suggest that having a required PAE policy allows for more students with lower self-determined forms of motivation (ie, amotivation) to be reached in comparison to the elective PAE policy. CONCLUSIONS This finding highlights that a primary value of having a required PAE policy is its ability to reach less motivated students.
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Affiliation(s)
- Moo Song Kim
- a Department of Health and Kinesiology, College of Education , Northeastern State University , Tahlequah , Oklahoma , USA
| | - Bradley J Cardinal
- b Kinesiology Program, School of Biological and Population Health Sciences, College of Public Health and Human Sciences , Oregon State University , Corvallis , Oregon , USA
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15
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Abstract
Medical data is one of the most rewarding and yet most complicated data to analyze. How can healthcare providers use modern data analytics tools and technologies to analyze and create value from complex data? Data analytics, with its promise to efficiently discover valuable pattern by analyzing large amount of unstructured, heterogeneous, non-standard and incomplete healthcare data. It does not only forecast but also helps in decision making and is increasingly noticed as breakthrough in ongoing advancement with the goal is to improve the quality of patient care and reduces the healthcare cost. The aim of this study is to provide a comprehensive and structured overview of extensive research on the advancement of data analytics methods for disease prevention. This review first introduces disease prevention and its challenges followed by traditional prevention methodologies. We summarize state-of-the-art data analytics algorithms used for classification of disease, clustering (unusually high incidence of a particular disease), anomalies detection (detection of disease) and association as well as their respective advantages, drawbacks and guidelines for selection of specific model followed by discussion on recent development and successful application of disease prevention methods. The article concludes with open research challenges and recommendations.
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Cangelosi J, Kim D, Ranelli E, Griffin K. A needs assessment study of what health care consumers seek from social media and social networking. Health Mark Q 2019; 35:266-279. [PMID: 30757975 DOI: 10.1080/07359683.2018.1524595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Given that prevention is crucial to long healthy life and restraining escalating health care costs, this study examines social media and networking (SM&N) needs among health consumers regarding preventive health. Results showed the most important SM&N needs included: education about health issues, connecting to a support group, knowing the implications of health condition, opportunities and understanding of preventive health care, and tracking physical activity. Among demographic groups women, younger aged groups, and African Americans considered SM&N needs to be more important. Homemakers indicated greatest need for information about health issues and facilitating interaction with others. Full-time employees placed greater importance on managing their own health.
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Affiliation(s)
- Joe Cangelosi
- a Department of Marketing & Management , University of Central Arkansas , Conway , Arkansas , USA
| | - David Kim
- a Department of Marketing & Management , University of Central Arkansas , Conway , Arkansas , USA
| | - Ed Ranelli
- b Professor Emeritus, College of Business, University of West Florida , Pensacola , Florida , USA
| | - Ken Griffin
- c Department of Management Information Systems , University of Central Arkansas , Conway , Arkansas , USA
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Warren RC. Ethics and Well-Being: Ages 45-64: 70 is the New 50. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2019; 9:38-50. [PMID: 36819764 PMCID: PMC9930476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The age range 45-64 covers a life-stage when ideally, health status is reasonably manageable. However, this life-stage also poses health risks, which may lead to diseases, illnesses, dysfunctions, disabilities and early death. In fact, over the last three years, life expectancy among non-Hispanic white men has decreased. The opportunity to synergize ethics, health and well-being at the individual and group/community level is also highlighted. Various sphere of ethics and how they impact on individual, group/community well-being strategically, infuses ethics into health and health care conversations. Difficult term to operationalize like well-being, health, ethics and healing are deliberated. The phrase "70 is the new 50" reflects an importance opportunity to discuss what it means to be middle age and be healthy. There are health threats created by social and environment injustices and food deserts which are important considerations influencing health. The concept of Optimal Health, as a group strategy to advance health, particularly for people of African descent, details five group domains: optimal physical, emotional, social-economic, intellectual, and spiritual health. Optimal Health translated into individual behavior also has five health promotion principles that are detailed in the article. Synergizing Optimal Health, at the group/community level, with the five Health Promotion Principles, at the individual level, is the ideal journey toward individual and group/community well-being. Persons ages 45-64 are poised to combine the wisdom gained from their lived experiences, with the knowledge acquired from their positive or negative interfaces with the health delivery system, are generously available to achieve Optimal Health. The article concludes by discussing the Ancient African Imhotep, True Father of Medicine, 2980 B.C.E.
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Affiliation(s)
- Rueben C Warren
- Professor and Director, National Center for Bioethics in Research and Health Care, Tuskegee University, (334) 724-4554,
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Hardeman RR, Murphy KA, Karbeah J, Kozhimannil KB. Naming Institutionalized Racism in the Public Health Literature: A Systematic Literature Review. Public Health Rep 2018; 133:240-249. [PMID: 29614234 PMCID: PMC5958385 DOI: 10.1177/0033354918760574] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Although a range of factors shapes health and well-being, institutionalized racism (societal allocation of privilege based on race) plays an important role in generating inequities by race. The goal of this analysis was to review the contemporary peer-reviewed public health literature from 2002-2015 to determine whether the concept of institutionalized racism was named (ie, explicitly mentioned) and whether it was a core concept in the article. METHODS We used a systematic literature review methodology to find articles from the top 50 highest-impact journals in each of 6 categories (249 journals in total) that most closely represented the public health field, were published during 2002-2015, were US focused, were indexed in PubMed/MEDLINE and/or Ovid/MEDLINE, and mentioned terms relating to institutionalized racism in their titles or abstracts. We analyzed the content of these articles for the use of related terms and concepts. RESULTS We found only 25 articles that named institutionalized racism in the title or abstract among all articles published in the public health literature during 2002-2015 in the 50 highest-impact journals and 6 categories representing the public health field in the United States. Institutionalized racism was a core concept in 16 of the 25 articles. CONCLUSIONS Although institutionalized racism is recognized as a fundamental cause of health inequities, it was not often explicitly named in the titles or abstracts of articles published in the public health literature during 2002-2015. Our results highlight the need to explicitly name institutionalized racism in articles in the public health literature and to make it a central concept in inequities research. More public health research on institutionalized racism could help efforts to overcome its substantial, longstanding effects on health and well-being.
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Affiliation(s)
- Rachel R. Hardeman
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Katy A. Murphy
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - J’Mag Karbeah
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Katy Backes Kozhimannil
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Kones R, Rumana U. Cultural primer for cardiometabolic health: health disparities, structural factors, community, pathways to improvement, and clinical applications. Postgrad Med 2018; 130:200-221. [PMID: 29291669 DOI: 10.1080/00325481.2018.1421395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The quest to optimize cardiometabolic health has created great interest in nonmedical health variables in the population, community-based research and coordination, and addressing social, ethnic, and cultural barriers. All of these may be of equal or even greater importance than classical health care delivery in achieving individual well-being. One dominant issue is health disparity - causes, methods of reduction, and community versus other levels of solutions. This communication summarizes some major views regarding social structures, followed by amplification and synthesis of central ideas in the literature. The role of community involvement, tools, and partnerships is also presented in this Primer. Recent views of how these approaches could be incorporated into cardiometabolic initiatives and strategies follow, with implications for research. Two examples comparing selected aspects of community leverage and interventions in relation to individual approaches to health care equity are examined in depth: overall performance in reducing cardiovascular risk and mortality, and the recent National Diabetes Prevention Program, both touching upon healthy diets and adherence. Finally, the potential that precision medicine offers, and possible effects on disparities are also discussed.
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Affiliation(s)
- Richard Kones
- a The Cardiometabolic Research Institute , Houston , TX , USA
| | - Umme Rumana
- a The Cardiometabolic Research Institute , Houston , TX , USA.,b University of Texas Health Science Center , Houston , TX , USA
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20
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Levin J. An Antipoverty Agenda for Public Health: Background and Recommendations. Public Health Rep 2017; 132:431-435. [PMID: 28538109 DOI: 10.1177/0033354917708990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Jeff Levin
- 1 Institute for Studies of Religion, Baylor University, Waco, TX, USA
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21
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Capawana MR. Intimate attractions and sexual misconduct in the therapeutic relationship: Implications for socially just practice. COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2016.1194176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Michael R. Capawana
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Lynch School of Education, Chestnut Hill, MA, USA
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Jayawardene WP, Lohrmann DK, Dickinson S, Torabi MR. Population-Level Measures to Predict Obesity Burden in Public Schools: Looking Upstream for Midstream Actions. Am J Health Promot 2016; 32:708-717. [PMID: 27708069 DOI: 10.1177/0890117116670305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To estimate school-level obesity burden, as reflected in prevalence of obesity, based on the characteristics of students' socioeconomic and geographic environments. DESIGN Secondary analysis of cross-sectional data. SETTING Public schools (N = 504) from 43 of 67 counties in Pennsylvania. PARTICIPANTS Kindergarten through grade 12 students (N = 255 949). MEASURES School-level obesity prevalence for the year 2014 was calculated from state-mandated student body mass index (BMI) measurements. Eighteen aggregate variables, characterizing schools and counties, were retrieved from federal data sources. ANALYSIS Three classification variables-excess weight (BMI ≥ 85th percentile), obesity (BMI ≥ 95th percentile), and severe obesity (BMI > 35% or 120% of 95th percentile)-each with 3 groups of schools (low-, average-, and high-prevalence) were created for discriminant function analysis, based on state mean and standard deviation of school distribution. Analysis tested each classification model to reveal school- and county-level dimensions on which school groups differed from each other. RESULTS Discriminant functions for obesity, which contained school enrollment, percentage of students receiving free/reduced-price lunch, percentage of black/Hispanic students, school location (suburban/other), percentage of county adults with postsecondary education, and percentage of county adults with obesity, yielded 67.86% correct classification (highest accuracy), compared to 34.23% schools classified by chance alone. CONCLUSION In the absence of mandated student BMI screenings, the model developed in this study can be used to identify schools most likely to have high obesity burden and, thereafter, determine dissemination of enhanced resources for the implementation of proven prevention policies and programs.
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Affiliation(s)
- Wasantha P Jayawardene
- 1 Applied Health Science, School of Public Health Bloomington, Indiana University, Bloomington, IN, USA
| | - David K Lohrmann
- 1 Applied Health Science, School of Public Health Bloomington, Indiana University, Bloomington, IN, USA
| | - Stephanie Dickinson
- 2 Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University, Bloomington, IN, USA
| | - Mohammad R Torabi
- 1 Applied Health Science, School of Public Health Bloomington, Indiana University, Bloomington, IN, USA
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Moore KL, Mercado J, Hill J, Katz SC. Disparities in Health Insurance Coverage and Health Status Among Farmworkers, Sonoma County, California, 2013-2014. Prev Chronic Dis 2016; 13:E45. [PMID: 27032988 PMCID: PMC4825749 DOI: 10.5888/pcd13.150519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The Sonoma County Farmworker Health Survey (FHS) was conducted to describe the health and well-being of adult farmworkers in Sonoma County, California, and to identify preventable health disparities for this population. METHODS From September 2013 through January 2014, venue-based and convenience sampling were used to survey 293 farmworkers aged 18 years or older. The questions included self-rated general health, diabetes and hypertension, and body mass index. To identify disparities between surveyed farmworkers and Sonoma County residents overall, age-adjusted prevalence estimates were developed by using indirect standardization to the adult (≥18 years) Sonoma County sample from the California Health Interview Survey for 2011-2012. RESULTS Surveyed farmworkers were mostly male (91%) and Latino or Hispanic (95%), and 54% had an educational attainment of 8th grade or less. Most (81%) farmworkers reported their families earned less than $30,000 in 2012. After adjusting for age, 30% of farmworkers had US-based health insurance as compared with the 86% of Sonoma County adults in 2011-2012 (P < .001), and 15% of farmworkers reported ever being diagnosed with diabetes after adjusting for age as compared with 5% of Sonoma County adults (P = .002). After adjusting for age, 44% of farmworkers reported poor or fair health in general as compared with 13% of Sonoma County adults (P < .001). CONCLUSION We identified significant health disparities between Sonoma County farmworkers and Sonoma County adults overall. Additional research and new health policies are necessary to eliminate these health disparities and to facilitate farmworker access to the health care system.
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Affiliation(s)
- Kristin L Moore
- Health Policy, Planning, and Evaluation Division, County of Sonoma Department of Health Services, 490 Mendocino Ave, Ste 101, Santa Rosa, CA 95401.
| | - Jenny Mercado
- Health Policy, Planning, and Evaluation Division, County of Sonoma Department of Health Services, Santa Rosa, California
| | - Jana Hill
- Health Policy, Planning, and Evaluation Division, County of Sonoma Department of Health Services, Santa Rosa, California
| | - Sarah C Katz
- Health Policy, Planning, and Evaluation Division, County of Sonoma Department of Health Services, Santa Rosa, California
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Dumitrescu AL. Editorial: Periodontal Disease - A Public Health Problem. Front Public Health 2016; 3:278. [PMID: 26779473 PMCID: PMC4705816 DOI: 10.3389/fpubh.2015.00278] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/09/2015] [Indexed: 01/22/2023] Open
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Gilbert KL, Ray R, Siddiqi A, Shetty S, Baker EA, Elder K, Griffith DM. Visible and Invisible Trends in Black Men's Health: Pitfalls and Promises for Addressing Racial, Ethnic, and Gender Inequities in Health. Annu Rev Public Health 2016; 37:295-311. [PMID: 26989830 PMCID: PMC6531286 DOI: 10.1146/annurev-publhealth-032315-021556] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past two decades, there has been growing interest in improving black men's health and the health disparities affecting them. Yet, the health of black men consistently ranks lowest across nearly all groups in the United States. Evidence on the health and social causes of morbidity and mortality among black men has been narrowly concentrated on public health problems (e.g., violence, prostate cancer, and HIV/AIDS) and determinants of health (e.g., education and male gender socialization). This limited focus omits age-specific leading causes of death and other social determinants of health, such as discrimination, segregation, access to health care, employment, and income. This review discusses the leading causes of death for black men and the associated risk factors, as well as identifies gaps in the literature and presents a racialized and gendered framework to guide efforts to address the persistent inequities in health affecting black men.
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Affiliation(s)
- Keon L Gilbert
- Department of Behavioral Sciences and Health Education and
| | - Rashawn Ray
- Department of Sociology, University of Maryland at College Park, College Park, Maryland 20742
| | - Arjumand Siddiqi
- Division of Epidemiology and
- Division of Social and Behavioral Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina 27599
| | - Shivan Shetty
- Department of Behavioral Sciences and Health Education and
| | | | - Keith Elder
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri 63104;
| | - Derek M Griffith
- Center for Medicine, Health, and Society and
- Institute for Research on Men's Health, Vanderbilt University, Nashville, Tennessee 37240
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Metzger J, Mastrocinque JM, Navratil P, Cerulli C. Improving Systematic Response in the Face of Homicide: Family and Friends of Homicide Victims Service Needs. VIOLENCE AND VICTIMS 2015; 30:522-532. [PMID: 26118270 DOI: 10.1891/0886-6708.vv-d-13-00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Homicide is a pressing issue in America. This study used qualitative data obtained from focus groups of family and friends of homicide victims (FFHV) to assess and better meet the needs of victims post homicide. The study results posit myriad changes to the systematic response to homicide. The article concludes with recommendations for training and resources, with specific attention to legal, law enforcement, medical, and behavioral health providers.
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Abstract
Guided by Leventhal's common sense model of illness representations, this study examined the relationship between hypertension beliefs and self-care behaviors necessary for blood pressure (BP) control in a sample of 111 community-dwelling African Americans with hypertension. Participants completed the revised Illness Perception Questionnaire, BP Self-Care Scale, and a demographic data sheet, and had BP measured. Analyses revealed that beliefs about the causes of hypertension differed by gender and educational level. Stress-related causal attributions accounted for 34.7% of the variance in hypertension beliefs. Participants who believed stress or external factors caused hypertension were less likely to engage in healthy self-care behaviors (e.g., keeping doctor visits, eating low-salt, low-fat diets). Results suggest that patients who are nonadherent with hypertension self-care recommendations may hold hypertension beliefs that are not consistent with the medically endorsed views of this disease. To more effectively treat and control BP, providers should assess patients' hypertension beliefs.
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Abstract
Health systems are complex organizations. They are often the largest single employer in a country, with expenditures of public and private money of 4–17 percent of gross domestic product. Overall and individual facility management requires mission statements, objectives, targets, budgets, activities planning, human interaction, services delivery, and quality assurance. Health organization involves a vast complex of stakeholders and participants, suppliers and purchasers, regulators and direct providers, and individual patients, and their decision-making. These include pyramidal and network organizations and ethical decision-making based on public interest, resource allocations, priority selection, and assurance of certain codes of law and ethical conduct. This chapter discusses how complex organizations work, with potential for application in health, and the motivations of workers and of the population being served. Organization theory helps in devising methods to integrate relevant factors to become more effective in defining and achieving goals and missions.
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Abstract
The dietary behaviors of underserved populations contribute to diet-related health disparities. Behavior change is affected by many factors that may be grouped in four main categories; individual, interpersonal, institutional, and community and public factors.6However, underserved populations experience additional stressors that create greater barriers to achieving dietary behavior change. Researchers and health professionals are encouraged to work with and within underserved communities to provide appropriate and acceptable programming. This article highlights other stressors that make behavior change more challenging for underserved populations. Additionally, guidance to developing and implementing successful interventions to improve dietary behavior change in underserved populations is included.
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Affiliation(s)
- Onikia Brown
- Nutrition, Dietetics & Hospitality Management, Auburn University, Auburn, Alabama
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Abstract
African Americans, compared with white Americans, underutilize mental health services for major depressive disorder. Church-based programs are effective in reducing racial disparities in health; however, the literature on church-based programs for depression is limited. The purpose of this study was to explore ministers' perceptions about depression and the feasibility of utilizing the church to implement evidence-based assessments and psychotherapy for depression. From August 2011 to March 2012, data were collected from three focus groups conducted with adult ministers (n = 21) from a black mega-church in New York City. Using consensual qualitative research to analyze data, eight main domains emerged: definition of depression, identification of depression, causal factors, perceived responsibilities, limitations, assessment, group interpersonal psychotherapy, and stigma. A major finding was that ministers described depression within a context of vast suffering due to socioeconomic inequalities (e.g., financial strain and unstable housing) in many African American communities. Implementing evidence-based assessments and psychotherapy in a church was deemed feasible if principles of community-based participatory research were utilized and safeguards to protect participants' confidentiality were employed. In conclusion, ministers were enthusiastic about the possibility of implementing church-based programs for depression care and emphasized partnering with academic researchers throughout the implementation process. More research is needed to identify effective, multidisciplinary interventions that address social inequalities which contribute to racial disparities in depression treatment.
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Barrera M, Castro FG, Strycker LA, Toobert DJ. Cultural adaptations of behavioral health interventions: a progress report. J Consult Clin Psychol 2013; 81:196-205. [PMID: 22289132 PMCID: PMC3965302 DOI: 10.1037/a0027085] [Citation(s) in RCA: 385] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research. METHOD Influential literature from the past decade was examined to identify points of consensus. RESULTS There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions. CONCLUSIONS Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy.
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Affiliation(s)
- Manuel Barrera
- Department of Psychology, Arizona State University (Tempe, Arizona) and Oregon Research Institute (Eugene, Oregon)
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Willis KF, Rayner JA. Integrative medical doctors—Public health practitioner or lifestyle coach? Eur J Integr Med 2013. [DOI: 10.1016/j.eujim.2012.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McCarty F, DePadilla L, Elifson K, Sterk C. Excessive drinking among African American men: individual and contextual correlates. J Ethn Subst Abuse 2012; 11:113-29. [PMID: 22679893 DOI: 10.1080/15332640.2012.675227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In this article, the authors explored associations of multiple domains with regular drinking and getting drunk among adult African American men. Questionnaire-based, computer-assisted interviews were conducted with 484 men in Atlanta, Georgia. Data analysis involved multivariate logistic regression analyses. Findings show that being older increased the odds of both drinking behaviors. Sensation seeking increased the odds of regular drinking, and having experienced childhood sexual and physical abuse increased the odds of getting drunk. Having health insurance reduced the odds of both outcomes. Insurance coverage and the heterogeneity among adult African American men must be considered in risk reduction efforts.
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Abstract
Somali women living in the US are at increased risk for chronic health conditions due to changes in lifestyle following immigration. Numerous barriers to physical activity have been reported in this population. Behavioral theory may inform the design of successful health interventions. We explored in focus groups the behavioral determinants of physical activity (theory of planned behavior, self-efficacy) among Somali women (N = 30). We found that most (two-thirds) subjects were sedentary, although women who had lived in the US for 10 years or longer were more likely to be active. Somali women recognize the health threat of physical inactivity, including high rates of obesity. Moral norms appear to be the major barrier to physical activity, due to prohibitions against exercising in public or in Western-style clothing. Taking moral norms into consideration should allow for the design of culturally-appropriate exercise programs that can address a major health threat in this vulnerable population.
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Bright CM. Commentary: what role should physician organizations play in addressing social justice issues? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:684-686. [PMID: 22643373 DOI: 10.1097/acm.0b013e318253b29b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A study by Peek and colleagues in this issue reveals that although racial and ethnic health disparities are recognized as a major national challenge, few physician organizations with both the influence and ability to change practice standards and address disparities appear to be effectively directing their resources to mitigate health disparities. In this commentary, the author examines the history of U.S. health disparities through the lens of social justice. He argues that today, physician organizations have the opportunity to change the paradigm of medicine from being a reactive industry to becoming a proactive industry through collaborations such as the Commission to End Health Disparities, which brings together more than 60 organizations, and the National Medical Association's "We Stand With You" program to improve health and combat disparities. Physician organizations can also address health disparities through advocacy for fair reimbursement policies, funding for pipeline programs to increase the diversity of the workforce, diversity in clinical trials, and other issues. Health disparities present to us in organized medicine a challenge that is cleverly disguised as an immovable object but that is truly a great opportunity for innovation, improvement, and growth. Physician organizations have a unique opportunity to provide avenues of innovation and accomplishment.
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Affiliation(s)
- Cedric M Bright
- University of North Carolina at Chapel Hill School of Medicine, Department of Internal Medicine, 506 Berryhill Hall, Chapel Hill, NC 27599, USA.
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Translating public health knowledge into practice: development of a lay health advisor perinatal tobacco cessation program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 16:E9-E19. [PMID: 20357602 DOI: 10.1097/phh.0b013e3181af6387] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The value of lay health advisor (LHA) interventions as an effective approach toward ameliorating racial, ethnic and/socioeconomic health disparities has been noted by researchers and policy makers. Translating scientific knowledge to bring state-of-the-art health promotion/disease prevention innovation to underserved populations is critical for addressing these health disparities. This article examines the experiences of a community-academic partnership in designing, developing, and implementing an evidence-based, LHA-driven perinatal tobacco cessation program for low-income, predominately African American and Hispanic women. A multimethod process evaluation was conducted to analyze three essential domains of program implementation: (1) fit of the tobacco cessation program into the broader project context, (2) feasibility of program implementation, and (3) fidelity to program implementation protocols. Findings indicate that project partners have largely succeeded in integrating an evidence-based tobacco cessation program into a community-based maternal and infant health project. The successful implementation of this intervention appears to be attributable to the following two predominant factors: (1) the utilization of a scientifically validated tobacco cessation intervention model and (2) the emphasis on continuous LHA training and capacity development.
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Dovidio JF, Fiske ST. Under the radar: how unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities. Am J Public Health 2012; 102:945-52. [PMID: 22420809 PMCID: PMC3483919 DOI: 10.2105/ajph.2011.300601] [Citation(s) in RCA: 202] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2011] [Indexed: 12/16/2022]
Abstract
Several aspects of social psychological science shed light on how unexamined racial/ethnic biases contribute to health care disparities. Biases are complex but systematic, differing by racial/ethnic group and not limited to love-hate polarities. Group images on the universal social cognitive dimensions of competence and warmth determine the content of each group's overall stereotype, distinct emotional prejudices (pity, envy, disgust, pride), and discriminatory tendencies. These biases are often unconscious and occur despite the best intentions. Such ambivalent and automatic biases can influence medical decisions and interactions, systematically producing discrimination in health care and ultimately disparities in health. Understanding how these processes may contribute to bias in health care can help guide interventions to address racial and ethnic disparities in health.
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Affiliation(s)
- John F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA.
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Baum FE, Sanders DM. Ottawa 25 years on: a more radical agenda for health equity is still required. Health Promot Int 2012; 26 Suppl 2:ii253-7. [PMID: 22080080 DOI: 10.1093/heapro/dar078] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article revisits our 1995 assessment of the international health promotion agenda. Then we concluded that a more radical agenda for change was required in which responses were both technically sound and infused with an appreciation of the imperative for a change in politics and power. We conclude that this message is even more relevant in 2011 in an era when the continuing rise of transnational corporations (TNCs) poses a major threat to achieving improved and more equitable health. We support and illustrate this claim through the example of food and agriculture TNCs where the combination of producer subsidies, global trade liberalization and strengthened property rights has given increasing power to the corporate food industry and undermined national food security in many countries. We argue that a Health in All Policies approach should be used to monitor and enforce TNC accountability for health. Part of this process should include the use of a form of health impact assessment and health equity impact assessment on their activities. Civil society groups such as the People's Health Movement have a central role to play in monitoring the impacts of TNCs.
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Affiliation(s)
- Frances Elaine Baum
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, Adelaide, 5001 SA, Australia.
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Setting the Stage for a Business Case for Leadership Diversity in Healthcare: History, Research, and Leverage. J Healthc Manag 2012. [DOI: 10.1097/00115514-201201000-00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moving from evidence-based medicine to evidence-based health. J Gen Intern Med 2011; 26:658-60. [PMID: 21203858 PMCID: PMC3101967 DOI: 10.1007/s11606-010-1606-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 11/29/2010] [Accepted: 12/02/2010] [Indexed: 01/13/2023]
Abstract
While evidence-based medicine (EBM) has advanced medical practice, the health care system has been inconsistent in translating EBM into improvements in health. Disparities in health and health care play out through patients' limited ability to incorporate the advances of EBM into their daily lives. Assisting patients to self-manage their chronic conditions and paying attention to unhealthy community factors could be added to EBM to create a broader paradigm of evidence-based health. A perspective of evidence-based health may encourage physicians to consider their role in upstream efforts to combat socially patterned chronic disease.
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Golding L, Rubin D. Training for public information officers in communication to reduce health disparities: a needs assessment. Health Promot Pract 2011; 12:406-13. [PMID: 20539021 DOI: 10.1177/1524839909344185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Government public information officers and risk communicators bear the burden for reaching all Americans with public health and emergency messages. To assess needs specifically regarding communication to reduce health disparities, an Internet survey is made available to members of the National Public Health Information Coalition. Respondents are asked to rate their own needs at their level of organizational responsibility as well as the needs of staff whom they may be supervising on 25 communication and cultural competencies. Multicultural understanding, culturally appropriate message development, and ways to better collaborate with diverse populations are identified as communication competencies in which more training is especially needed.
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Affiliation(s)
- Lenette Golding
- Center for Health and Risk Communication, 107 Paul D. Coverdell Center, University of Georgia, 501 DW Brooks Drive, Athens, GA 30602-7394, USA
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Wallerstein NB, Yen IH, Syme SL. Integration of social epidemiology and community-engaged interventions to improve health equity. Am J Public Health 2011; 101:822-30. [PMID: 21421960 PMCID: PMC3076386 DOI: 10.2105/ajph.2008.140988] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2010] [Indexed: 11/04/2022]
Abstract
The past quarter century has seen an explosion of concern about widening health inequities in the United States and worldwide. These inequities are central to the research mission in 2 arenas of public health: social epidemiology and community-engaged interventions. Yet only modest success has been achieved in eliminating health inequities. We advocate dialogue and reciprocal learning between researchers with these 2 perspectives to enhance emerging transdisciplinary language, support new approaches to identifying research questions, and apply integrated theories and methods. We recommend ways to promote transdisciplinary training, practice, and research through creative academic opportunities as well as new funding and structural mechanisms.
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Affiliation(s)
- Nina B Wallerstein
- Master of Public Health Program, Department of Family and Community Medicine, University of New Mexico, Albuquerque, 87131, USA.
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Abstract
Adequate provision of vitamin D has been found, in ecological, cross-sectional, and observational studies, to be associated with reduction in the risk of many types of cancer, cardiovascular diseases (CVDs), autoimmune diseases, diabetes mellitus types 1 and 2, neurological disorders, several bacterial and viral infections, and adverse pregnancy outcomes in addition to the classical bone disorders of rickets and osteomalacia. Furthermore, investigators have found adequate repletion and increased intakes of vitamin D to be associated with reduced all-cause mortality rates. These findings have been supported by the limited number of properly conducted randomized controlled trials (RCTs) that used more than 400 IU/day of vitamin D. This review presents an overview of the role of vitamin D for the promotion of health for the more important vitamin D-related diseases and conditions. Serum 25-hydroxyvitamin D concentrations of 30—60 ng/ml, corresponding to oral intake or skin production of 1,000—4,000 IU/day of vitamin D, appear necessary in adults for avoidance of hypovitaminosis D-related ill health. People of all ages are encouraged to obtain more vitamin D from judicious exposure to sunshine (for ultraviolet B [UVB] irradiation) or from regular vitamin D supplements because dietary sources do not provide sufficient vitamin D to prevent any health risks other than those of rickets and osteomalacia.
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Affiliation(s)
- William B. Grant
- Sunlight, Nutrition, and Health Research Center (SUNARC), San Francisco, CA, USA,
| | - Barbara J. Boucher
- Centre for Diabetes, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, Blizard Institute of Cell and Molecular Science, London, UK
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McNall MA, Lichty LF, Mavis B. The impact of school-based health centers on the health outcomes of middle school and high school students. Am J Public Health 2010; 100:1604-10. [PMID: 20634451 DOI: 10.2105/ajph.2009.183590] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We studied the direct and indirect effects of school-based health centers (SBHCs) on the health and health behaviors of middle and high school students. METHODS We used a prospective cohort design to measure health outcomes annually over 2 consecutive years by student self-report. Cohorts of middle school and high school students were recruited from matched schools with and without SBHCs. Data were obtained from 744 students in both year 1 and year 2 of the study. We used 2-level hierarchical linear models to estimate the effects of the presence of SBHCs at the school level and of SBHC use at the student level. RESULTS At year 2, users of SBHCs experienced greater satisfaction with their health, more physical activity, and greater consumption of healthy food than did nonusers of SBHCs. CONCLUSIONS Students who used SBHCs were more satisfied with their health and engaged in a greater number of health-promoting behaviors than did students who did not use SBHCs. These findings indicate that SBHCs are achieving their goal of promoting children's health.
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Affiliation(s)
- Miles A McNall
- Community Education and Research Collaborative, University Outreach and Engagement, Michigan State University, Kellogg Center-Garden Level, East Lansing, MI 48824-1022, USA.
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Affiliation(s)
- Howell Wechsler
- Division of Adolescent and School Health, National Center
for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease
Control and Prevention
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Abstract
In this article, I make the case for using an integrative approach to health, broadly defined as social, emotional, mental, and physical well-being; for studying health among the young as an important marker for future health and well-being across the life course; and for understanding health disparities among the young as both causes and consequences of social stratification. An integrative approach bridges biomedical sciences with social and behavioral sciences by understanding the linkages between social, behavioral, psychological, and biological factors in health. It is furthermore vital that integration occur in all steps of the research process: in theory, design, data collection, and analysis. I use the National Longitudinal Study of Adolescent Health, or Add Health, as an example of an integrative approach to health and of the importance of adolescence and the transition to adulthood years for setting health trajectories into adulthood. Evidence is also presented on the linkages between health trajectories during adolescence and the transition to adulthood and social stratification in adulthood.
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Affiliation(s)
- Kathleen Mullan Harris
- Carolina Population Center, CB# 8120, University Square, 123 W. Franklin Street, Chapel Hill, NC 27516, USA.
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Villanueva LP, Darrow WW, Uribe C, Sánchez-Braña E, Obiaja K, Gladwin H. Ethnic differences in HIV risk perceptions and behaviors among Black 18-39 year-old residents of Broward County, Florida. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2010; 22:160-171. [PMID: 20387986 DOI: 10.1521/aeap.2010.22.2.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The study assessed ethnic differences in the perceived risks of HIV infection, sexual experiences, and HIV-antibody testing histories among Black populations in Broward County, Florida. Data were analyzed for 2,731 well-characterized survey respondents 18-39 years old who indicated they were African Americans, Caribbean Islanders, English-speaking, or Creole-speaking Haitians. Creole-speaking Haitians were least likely to consider themselves at risk of HIV infection, report using condoms in the last 12 months, and indicate that they had ever been tested for HIV. English-speaking Haitians were more likely than African Americans to report never engaging in sexual intercourse and were less likely to have ever been tested for HIV. English-speaking Caribbean Islanders reported preventive behaviors similar to those of African Americans, but had lower perceptions of HIV risk and were less likely to have ever been tested. Health promotion programs designed to improve HIV prevention practices must appreciate social and cultural differences among Black populations.
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Castro FG, Marsiglia FF, Kulis S, Kellison JG. Lifetime segmented assimilation trajectories and health outcomes in Latino and other community residents. Am J Public Health 2010; 100:669-76. [PMID: 20167890 DOI: 10.2105/ajph.2009.167999] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Under an ecodevelopmental framework, we examined lifetime segmented assimilation trajectories (diverging assimilation pathways influenced by prior life conditions) and related them to quality-of-life indicators in a diverse sample of 258 men in the Phoenix, AZ, metropolitan area. METHODS We used a growth mixture model analysis of lifetime changes in socioeconomic status, and used acculturation to identify distinct lifetime segmented assimilation trajectory groups, which we compared on life satisfaction, exercise, and dietary behaviors. We hypothesized that lifetime assimilation change toward mainstream American culture (upward assimilation) would be associated with favorable health outcomes, and downward assimilation change with unfavorable health outcomes. RESULTS A growth mixture model latent class analysis identified 4 distinct assimilation trajectory groups. In partial support of the study hypotheses, the extreme upward assimilation trajectory group (the most successful of the assimilation pathways) exhibited the highest life satisfaction and the lowest frequency of unhealthy food consumption. CONCLUSIONS Upward segmented assimilation is associated in adulthood with certain positive health outcomes. This may be the first study to model upward and downward lifetime segmented assimilation trajectories, and to associate these with life satisfaction, exercise, and dietary behaviors.
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