Funding public health: The public's willingness to pay for domestic violence prevention programming

OBJECTIVES: The author investigated the willingness of the general public to pay for domestic violence prevention programs. METHODS: An experimental design was used in a telephone survey of 522 California adults. One of 11 funding methods and one of 4 dollar amounts were randomly assigned to each respondent. RESULTS: Most respondents (79.4%) reported support for domestic violence prevention programming. They were most willing to pay 5 US dollars or less via "user fees" (e.g., increased fines for batterers) and humanitarian "donations" (e.g., sales of special postage stamps). CONCLUSIONS: Health departments that want to increase their domestic violence prevention programming need to identify widely accepted methods by which funds can be raised. The methods used here can be applied to numerous public health activities and issues.     

Awareness of family health history as a risk factor for disease--United States, 2004

Persons who have close relatives with certain diseases (e.g., heart disease, diabetes, and osteoporosis) are more likely to develop those diseases themselves. Family health history is an important risk factor that reflects inherited genetic susceptibility, shared environment, and common behaviors. Although clinicians are trained to collect family histories, substantial barriers exist to obtaining this information in primary care practice (e.g., lack of time or lack of reimbursement). To promote the use of family history as a screening tool for disease prevention and health promotion, several initiatives have called for new self-administered family history collection tools and educational programs to help clinicians interpret and apply family history information to patient care. To assess attitudes, knowledge, and practices of U.S. residents regarding their family health histories, CDC analyzed data from the 2004 HealthStyles Survey. This report summarizes the results of that analysis, which indicated that although 96.3% of survey respondents believe their family history is important for their own health, few have actively collected health information from their relatives to develop a family history. Targeted public health efforts are needed to 1) help persons collect family history information to share with their health-care providers and 2) educate and assist providers to interpret and apply this information effectively.     

Prevention of HIV Among Adolescents

Adolescents are at risk for HIV primarily through their sexual behavior. A comprehensive prevention strategy includes a national HIV campaign based on social marketing principles; targeted social marketing, intensive skill building, and sexually transmitted disease control programs for youth at high risk; programs targeting institutions (e.g., school health clinics), providers, and parents; and interventions to identify and reduce risk acts among seropositive youth. The U.S. focus for HIV prevention has been single-session educational classes (an ineffective strategy) or intensive multi-session, small-group interventions for youth at high risk (demonstrated to increase condom use by about 30%). There is a need to expand the range, modalities, and dissemination of HIV prevention programs nationally, to recognize (especially by policymakers) limitations of abstinence programs, and to increase early detection of HIV among youth.     

上海市社区居民大肠癌筛查分析

目的了解上海社区市民大肠癌筛查情况。方法对1000名符合筛查条件的居民由社区卫生服务中心使用《上海市社区居民大肠癌筛查危险度评估表》开展大肠癌患病风险评估,并进行大便隐血试验（FOBT）,对问卷结果和FOBT结果进行分析。结果 1000名居民中,女性560人,占总数56%;男性440人,占总数44%;评价高危险度的人占总样本的11.6%,其中男性55人,女性61人;FOBT检查为阳性的总样本的占2.8%;在这些人中患慢性疾病以及有一级亲属遗传史的比例明显高于普通人,男女差异无统计学意义,但患病可能性却与年龄呈现高相关;慢性便秘史、黏液血便史以及直系家庭癌症史与FOBT检验结果差异有统计学意义,OR值分别为4.38（95%CI：1.71-11.21,P〈0.05）,8.86（95%CI：2.37-32.96,P〈0.05）和4.89（95%CI：1.60-14.91,P〈0.05）。结论即使在危险评估中显示阴性的人群,仍有FOBT检查为阳性的可能性,大肠癌筛查工作中不能掉以轻心,同时对于检查为阴性的人群同样需要进行相关的预防和健康教育干预。     

Worksite health promotion programs in the U.S.: factors associated with availability and participation

PURPOSE: To examine how the availability of and participation in worksite health promotion programs varies as a function of individual (e.g., age), organizational (e.g., occupation), and health (e.g., high blood pressure) characteristics. Availability of worksite programs was also compared to that reported in two previous national surveys of private companies. DESIGN: Data analyzed were from the 1994 National Health Interview Survey (NHIS), a national cross-sectional probability sample of the U.S. civilian population. SUBJECTS: Five thousand two hundred nineteen NHIS respondents met the inclusion criteria of (1) being currently employed in a company of at least 50 employees, and (2) completing the NHIS section on worksite health promotion. MEASURES: Employees indicated the availability of, and their participation in, 33 different types of worksite programs. National Health Interview Survey data were also available regarding general health, blood pressure, body mass index, and medical conditions. RESULTS: Smoking cessation programs had the highest mean availability (43%), followed by health education programs (31%) and screening tests (31%). Overall, availability of worksite programs appeared comparable to that reported in a recent national survey. Participation ranged from 32% for health education programs to 5% for smoking cessation programs. Compared to availability, participation depended less on individual and organizational characteristics. Healthy employees were not consistently more likely to participate in worksite health promotion programs than nonhealthy employees. CONCLUSIONS: Although availability of worksite health promotion programs remains high, participation by employees in specific types of programs can vary widely. Attempts to increase participation should look beyond individual, health, and organizational variables, to specific features of the work environment that encourage involvement in health promotion activities.     

Gender-specific health behaviors of German university students predict the interest in campus health promotion

This cross-sectional study aimed to provide an assessment of the needs for health promotion in university freshmen, based on lifestyle variables and the interest in health-promoting activities. A questionnaire survey was performed using a sample of 288 male and 362 female university freshmen from 19 to 33 years of age. Male students were significantly more likely to engage in drug-taking behaviors, referring to alcohol and cannabis use, and had a higher body mass index. No gender difference was noted in the numbers of regular smokers. Preventive behaviors with respect to healthy nutrition and dental hygiene were reported more often in females, whereas the duration of physical activity per week and the use of condoms with a new sexual partner showed no gender difference. There was a strong demand for group health-oriented programs (79.5% of respondents). Substantial proportions of students had a high interest in individual counseling aiming at stress management (24.5%), healthy nutrition (19.3%) and prevention of sexually transmitted diseases (18.2%). Women expressed a greater interest in most programs than men. Multivariate regression analyses showed that a disposition for alcohol abuse was the strongest predictor of interest in health counseling in male students (p < 0.001), while psychosocial stress was the most important predictor in female students (p < 0.001). From the prevalence of health risks and the students' interest in health promotion programs it was concluded that there is a strong need for health promotion in the university setting in Germany. Results suggested that individuals at risk would probably benefit most from an individual counseling program.     

The role of community pharmacists in health education and disease prevention: a survey of their interests and needs in relation to cardiovascular disease

BACKGROUND: Recently there has been increased interest in broadening the role of community pharmacists to include more health education and disease prevention activities such as patient counseling for risk management and interventions to improve compliance. However, to date, there is little information on interest in prevention among community pharmacists or on their current prevention practices. METHOD: Data on current health education and disease prevention practices, as well as interest in expanding their role in prevention, were collected in a cross-sectional mail survey of a random representative sample of community pharmacists currently practicing in the province of Quebec. RESULTS: Among 597 eligible subjects, 455 (76.2%) completed the questionnaire. Few pharmacists practice prevention routinely. Independent correlates of engaging in prevention included working in a smaller pharmacy (odds ratio (OR) 3. 2 (95% confidence interval 2.0-5.3)), owning the pharmacy (OR 1.9 (1. 2-3.0)), moderate/high job satisfaction (OR 2.1 (1.4-4.3)), and history of prevention activities in the pharmacy (OR 2.2 (1.4-3.6)). Over 90% of respondents reported that integrating prevention into their practices was important. Independent correlates of high perceived importance included working as a salaried pharmacist (OR 2. 3 (1.4-3.8)), high job satisfaction (OR 4.1 (1.7-9.7)), and currently practicing prevention (OR 2.0 (1.2-3.2)). The most important perceived barriers to integrating prevention included lack of time and lack of skills/instrumentation for practicing prevention. CONCLUSIONS: There is considerable interest among community pharmacists in expanding their role to include more prevention, but there are many barriers to actualizing this role. Further work should focus on ways to overcome these barriers because pharmacists are particularly well-situated to make an important contribution to prevention.     

The religious community as a partner in health care

In-depth structured interviews were conducted with spokespeople for 176 inner-city churches regarding perceptions of existing community problems, number of currently offered church-based social and health programs, and potential interest in church sponsorship of new maternal and child health programs. The sample of respondents represented 78% of the 227 churches located in a low-income, primarily black urban area with 150,000 residents. The typical church participating in the survey was Baptist with a congregation of 100 to 500 people, most of whom were not community residents. The leading community problems identified by the clergy were, in descending order: lack of jobs, teenage pregnancy, gang crime, school drop-outs, and hunger. The perception of community problems matched the church services offered as measured by the number of food and clothing pantries. Few churches had ongoing programs for neighborhood youths. Although many of these same churches expressed interest in expanding services for mothers, adolescents and children, few perceived themselves as having the necessary staff, funds, or technical expertise to conduct such programs.Lynn M. Olson, Ph.D. is Assistant Professor, Center for Urban Affairs and Policy Research. Northwestern University, 2040 Sheridan Road, Evanston, Illinois 60208.Janet Reis, Ph.D. is Assistant Professor, School of Nursing. State University of New York at Buffalo, Buffalo, New York.Larry Murphy, Ph.D. is Associate Professor, Institute for Black Religious Research. Garrett-Evangelican Seminary, Evanston, Illinois.Jennifer H. Gehm, B.A. is Research Analyst, Center for Health Economics Research, Boston, Massachusetts.This work is supported in part by grants to the Center for Health Services and Policy Research, Northwestern University; The Ford Foundation; The Chicago Community Trust; and The Field Foundation of Illinois. An earlier version of this paper was presented at the Annual Meeting of the American Public Health Association, Las Vegas, Nevada, September 1986.     

Opportunities for Skin Cancer Prevention Education among Individuals Attending a Community Skin Cancer Screening in a High-Risk Catchment Area

Despite the highly preventable nature of skin cancer, it remains the most commonly diagnosed form of cancer in the United States. Recommendations for a complete skin cancer prevention regimen include engaging in photoprotection (e.g., sunscreen use), avoiding skin cancer risk behaviors (e.g., tanning), and receiving total body skin exams from a health care provider. The current study examined reported engagement in these behaviors among participants attending a community skin cancer screening (N?=?319) in a high-risk catchment area to assess the need for increased health education on skin cancer prevention. Participants’ responses indicate a history of suboptimal avoidance of skin cancer risk behaviors. Over half of participants (52%) reported four or more blistering sunburns before age 20, and 46% reported indoor tanning at least one during their lifetime. There is a need among this population for education regarding a complete skin cancer prevention regimen, which could improve adherence to photoprotection and avoidance of skin cancer risk behaviors, thereby reducing morbidity and mortality due to skin cancer.     

Power Outage Preparedness and Concern among Vulnerable New York City Residents

Power outages can impact health, and certain populations may be more at risk. Personal preparedness may reduce impacts, but information on power outage preparedness and risk perception among vulnerable populations is limited. We examined power outage preparedness and concern among New York City residents, including vulnerable populations defined as older adults (≥?65 years), and respondents with household members who require assistance with daily activities or depend on electric medical devices. A random sample telephone survey was conducted during November–December 2016. Preparedness was defined as having a three-day supply of drinking water, non-perishable food, and a working flashlight. Among all respondents (n?=?887), 58% were prepared and 46% expressed concern about health. Respondents with electric-dependent household members (9% of all respondents) tended to have higher preparedness (70 vs. 56% of respondents without electric-dependent household members). Among this group, only 40% reported being registered with a utility company to receive early notification of outages. While the subgroup sample was small, respondents with registered electric-dependent household members had lower preparedness than those with non-registered users (59 vs. 76%). Respondents with household members who needed assistance had comparable levels of preparedness to respondents without someone who needed assistance (59 vs. 57%). Older adults had greater preparedness than younger adults (65 vs. 56%). Health concerns were greater among all vulnerable groups than the general population. Levels of preparedness varied among vulnerable respondents, and awareness of power outage notification programs was low. Our findings highlight the need to increase awareness and preparedness among at-risk people.     

Rural hospital health promotion: Programs,methods, resource limitations

Most hospitals provide health promotion programs for community residents. There is little information concerning the specific types of services offered by rural hospitals. A questionnaire was sent to every acute care hospital in Iowa (N=124), including 99 rural hospitals and 25 urban hospitals. Surveys were returned from 95 rural hospitals (96%) and 20 urban hospitals (80%). Results indicated that 98.9% of rural hospitals offered health promotion services to community residents. These services provided on average 7.5 programs on a regular basis, while using only 1.2 full-time equivalent (FTE) employees. Urban hospitals provided 9.5 regular programs with 2.4 FTE. The most common types of rural promotion programs were blood pressure screening, cholesterol screening, safety and protection programs, diet/nutrition programs, prenatal/maternal health, and breast cancer screening. Over 40% of rural respondents stated that other less common programs, including substance abuse prevention and mental health promotion, were needed but could not be offered because of resource limitations; these types of services were offered more commonly in urban hospitals. Rural hospital health promotion programs are attempting to meet a wide variety of programming needs with limited resources, and attention may be well directed towards finding how best to provide various programs with limited resources to maximize their impact on community health.Michael S. Hendryx is an Associate in the Graduate Program in Hospital and Health Administration and Center for Health Services Research, University of Iowa, Iowa City, Iowa.Supported by a grant from the Department of Iowa Ladies' Auxiliary, Veterans of Foreign Wars, through the University of Iowa Cancer Center. The author acknowledges the assistance of Richard DeGowin, M.D., for helpful comments during the course of this study.     

Peer Reviewed: Nonadherence to Breast and Cervical Cancer Screening: What Are the Linkages to Chronic Disease Risk?

Background

Several preventive practices that reduce chronic disease risk have been associated with breast and cervical cancer screening, including maintenance of normal weight and avoidance of cigarette smoking. A history of certain chronic illnesses such as diabetes and cardiovascular disease has also been related to cancer screening. Nevertheless, studies that have attempted to identify women who are less likely to have had a recent breast or cervical cancer screening test have infrequently examined the associations of breast and cervical cancer screening with multiple health factors that influence chronic disease risk.

Methods

To clarify relationships between cancer screening and health behaviors and other factors that influence chronic disease risk, we examined the self-reported breast and cervical cancer screening practices of women in the United States by using data from the 1999 Behavioral Risk Factor Surveillance System. The women were described according to their recent use of mammography and the Papanicolaou test, physician visits within the past year, health insurance coverage, and preventive practices that reduce chronic disease risk.

Results

Overall, 74.5% (95% CI, 73.9%-75.1%) of the women in this sample aged 40 years or older (n = 56,528) had received a mammogram within the past 2 years. The percentage of women who had been screened for breast cancer, however, varied widely by factors associated with reducing the risk of chronic disease (e.g., cholesterol check in the past 2 years, blood pressure check in the past 2 years, normal weight, avoidance of cigarette smoking) and having access to health care (e.g., health insurance coverage, recent physician visit). Similarly, 84.4% (95% CI, 83.9%-84.9%) of all women aged 18 years or older who had not undergone a hysterectomy (n = 69,113) had received a Papanicolaou test in the past 3 years, and factors associated with reduced chronic disease risk and health care access were related to having had a recent Papanicolaou test.

Conclusion

The results of this study suggest that underscreened women who are at risk for breast and cervical cancer are likely to benefit from programs that identify and address coexisting prevention needs. The identification of coexisting prevention needs might assist in developing interventions that address multiple risks for chronic disease among women and might subsequently help improve the efficiency and effectiveness of prevention programs.     

沂水县社区居民慢性病相关行为危险因素调查

摘要:目的　了解我县农村居民慢性病相关危险因素在不同人群中的分布和流行状况,为制定社区慢性病预防控制策略和措施提供科学依据。方法　按照多阶段分层整群抽样的方法,随机抽取5个乡镇（或街道）20个村（居委会）15岁及以上常住居民2001人,采用集中调查与入户调查相结合的方式调查慢性病相关行为主要危险因素,并随机抽取1个村45户居民进行膳食调查。结果　在2001份有效问卷中男性1002人,女性999人,平均年龄42.8岁,调查对象以初中文化（占43.68%）和小学（占27.64%）为主,职业构成以农民（占77.11%）为主。调查显示:总吸烟率22.29%,总饮酒率为24.99%,体育锻炼14.8%,超重27.44%,肥胖25.54%,人均日调味品食盐摄入量为10.82g,人均日食用植物油43.35 g。结论　针对居民慢性病相关危险因素,应积极采取综合干预措施,有效降低慢性病发病率。     

Risk factor and behavioral correlates of willingness to participate in cancer prevention trials

Because of the growing interest in prospective trials of dietary and chemopreventive interventions for cancer, we studied the characteristics of persons likely to participate in such investigations. The study population consisted of a random sample of 576 persons who had previously attended the Prevention‐Detection Center at Roswell Park Memorial Institute to receive a cancer screening examination and a risk assessment. Data were collected using a mailed questionnaire. Of the respondents, 77% indicated some degree of interest in participating in a cancer prevention study involving dietary changes, 27% indicated a definite interest and 50% indicated a possible interest. A similar pattern of response was obtained with respect to participation in a cancer prevention study that involves subjects taking medication, such as vitamin supplements. The findings suggest that those who are the most interested in participating in cancer prevention research are more likely to (on average) a) be younger, b) better educated, c) have higher annual family incomes, d) be regular vitamin users, e) have greater awareness of the possible link between dietary practices and cancer risk, f) be more concerned about getting cancer, and g) be more likely to believe that changes in dietary practices can decrease the cancer risk. These findings may have important implications for the planning and conduct of prospective trials of cancer prophylaxis.     

Participation of regional inhabitants in cancer screening

As part of the strategic planning for increasing participation by community residents in cancer screening, a survey about life style and attitudes toward cancer screening was carried out in Samukawa town, Kanagawa Prefecture. Subjects were males 40 years old or over, and females 30 years old or over selected by random sampling from residents. Number of subjects was 1,916 (822 males, 1,094 females). Self administered anonymous questionnaires were sent and returned by mail. The response rate was 73%. The results were as follows: (1) The reported participation rates for cancer screening under "the Health and Medical Services Law for the Aged" did not reflect the actual participation rate of residents. (2) The major reason for not participation in screening was lack of interest in cancer prevention. (3) Socio-economic status of regular participants in screening was different from persons who did not participate. (4) Persons who did not participate in screening were more passive with regard to obtaining knowledge of cancer than regular participants. (5) Results of this study show that cancer prevention education at various levels such as by clinical offices, TV and radio programs, and newspapers may be effective. In order to increase participation in screening programs, health education that considers the life style characteristics of persons who do not participate in the screening programs is vitally important.     

Selected allied health professionals' self-confidence in health promotion counseling skills and interest in continuing education programs

Mail surveys of samples of dental hygienists (n = 90, 36% response), registered dietitians (n = 262, 52% response), and physician assistants (n = 289, 89% response) in Texas and certified nurse midwives (n = 143, 57% response) in the US provided data regarding their confidence that they possess skills and knowledge to counsel patients about selected areas of health promotion (self-efficacy). Also, the surveys gathered information regarding respondents' beliefs that patients will follow through on their recommendations (adherence expectation), and their interest in continuing education programs. Overall, respondents displayed highest self-efficacy with regard to counseling patients about blood pressure and smoking. Confidence was lowest in illicit drug abuse and mental health areas. Certified nurse midwives and physician assistants indicated confidence in many more areas than the other two groups. Respondents consistently expressed less certainty about patient adherence than about their own skills and knowledge. They generally indicated a high degree of interest in continuing education across the several health promotion topics. Modest relationships were observed between self-efficacy and interest in continuing education programs for physician assistants and registered dietitians, indicating that those with greater self-efficacy had a greater interest in building their skills. A similar pattern was observed among physician assistant respondents with respect to adherence expectations.     

西宁市居民的肿瘤防治健康素养现况调查

目的 了解西宁市居民肿瘤防治健康素养现况,为当地制定肿瘤防控策略及措施提供科学依据。方法 2021年6至8月,通过整群方便抽样在西宁市5个社区对1 036名居民进行肿瘤防治健康素养问卷调查,采用χ²、Fisher精确检验比较不同特征的居民肿瘤防治健康素养水平差异。结果 西宁市居民肿瘤防治健康素养水平为63.3%。各维度分析显示,肿瘤预防意识相关问题的正确回答率范围为43.0%～94.0%,其中,饮食及锻炼因素等问题的正确回答率最高,超88%,女性针对雌激素会增加患乳腺癌风险的预防意识最低,仅43.0%; 早发现意识中,34%的居民自评有患癌风险,有风险人群考虑肿瘤筛查者占83.8%,近五年参加体检者占79.3%,但体检项目包含肿瘤筛查的比例为46.2%; 早诊断意识中,90.7%的居民发现异常结果后会选择进一步检查; 早治疗意识中,88.4%的居民若被确诊为癌前病变或癌症时会选择积极治疗; 居民对肿瘤防治知识的需求度为79.0%。不同年龄、性别、文化程度、职业及自评患癌风险者的健康素养水平有差异。结论 西宁市居民肿瘤防治健康素养达到一定水平,但仍有较大提升空间。居民肿瘤预防意识、早发现意识有待提升,早诊早治意识水平较高,对肿瘤防治知识、筛查的需求度大,需加大肿瘤防治知识普及及相关防控措施落实的力度。     

Personal exposure meets risk assessment: a comparison of measured and modeled exposures and risks in an urban community

Human exposure research has consistently shown that, for most volatile organic compounds (VOCs), personal exposures are vastly different from outdoor air concentrations. Therefore, risk estimates based on ambient measurements may over- or underestimate risk, leading to ineffective or inefficient management strategies. In the present study we examine the extent of exposure misclassification and its impact on risk for exposure estimated by the U.S. Environmental Protection Agency (U.S. EPA) Assessment System for Population Exposure Nationwide (ASPEN) model relative to monitoring results from a community-based exposure assessment conducted in Baltimore, Maryland (USA). This study is the first direct comparison of the ASPEN model (as used by the U.S. EPA for the Cumulative Exposure Project and subsequently the National-Scale Air Toxics Assessment) and human exposure data to estimate health risks. A random sampling strategy was used to recruit 33 nonsmoking adult community residents. Passive air sampling badges were used to assess 3-day time-weighted-average personal exposure as well as outdoor and indoor residential concentrations of VOCs for each study participant. In general, personal exposures were greater than indoor VOC concentrations, which were greater than outdoor VOC concentrations. Public health risks due to actual personal exposures were estimated. In comparing measured personal exposures and indoor and outdoor VOC concentrations with ASPEN model estimates for ambient concentrations, our data suggest that ASPEN was reasonably accurate as a surrogate for personal exposures (measured exposures of community residents) for VOCs emitted primarily from mobile sources or VOCs that occur as global "background" source pollutant with no indoor source contributions. Otherwise, the ASPEN model estimates were generally lower than measured personal exposures and the estimated health risks. ASPEN's lower exposures resulted in proportional underestimation of cumulative cancer risk when pollutant exposures were combined to estimate cumulative risk. Median cumulative lifetime cancer risk based on personal exposures was 3-fold greater than estimates based on ASPEN-modeled concentrations. These findings demonstrate the significance of indoor exposure sources and the importance of indoor and/or personal monitoring for accurate assessment of risk. Environmental health policies may not be sufficient in reducing exposures and risks if they are based solely on modeled ambient VOC concentrations. Results from our study underscore the need for a coordinated multimedia approach to exposure assessment for setting public health policy.