Diet quality,risk factors and access to care among low-income uninsured American adults in states expanding Medicaid vs. states not expanding under the affordable care act

BackgroundThe Affordable Care Act (ACA) Medicaid expansion varies in availability across states.PurposeWe compared characteristics of low-income uninsured residents in both Medicaid nonexpanding and expanding states with respect to their dietary quality, health risk factors, and access to care.MethodsData from the 2007–2012 National Health and Nutrition Examination Survey was matched with the Kaiser Family Foundation Medicaid expansion data. Bivariate and multivariate regressions were estimated to assess differences across expanding and non-expanding states.ResultThe non-expansion group had a lower Healthy Eating Index score (41.8 vs. 44.1, p-value = 0.006), a higher Body Mass Index (29.9 vs. 28.9, p-value = 0.032), higher obesity prevalence (41% vs. 33%, p-value = 0.007), and lower asthma prevalence (14.8% vs. 19.7%, p-value = 0.037) compared with the expansion group.ConclusionsDifferences across states in Medicaid coverage under the ACA may lead to widening disparities in health outcomes between expanding and non-expanding states.     

Predictors of condom use behaviour among male street labourers in urban Vietnam using a modified Information-Motivation-Behavioral Skills (IMB) model

HIV risk in vulnerable groups such as itinerant male street labourers is often examined via a focus on individual determinants. This study provides a test of a modified Information-Motivation-Behavioral Skills (IMB) model to predict condom use behaviour among male street workers in urban Vietnam. In a cross-sectional survey using a social mapping technique, 450 male street labourers from 13 districts of Hanoi, Vietnam were recruited and interviewed. Collected data were first examined for completeness; structural equation modelling was then employed to test the model fit. Condoms were used inconsistently by many of these men, and usage varied in relation to a number of factors. A modified IMB model had a better fit than the original IMB model in predicting condom use behaviour. This modified model accounted for 49% of the variance, versus 10% by the original version. In the modified model, the influence of psychosocial factors was moderately high, whilst the influence of HIV prevention information, motivation and perceived behavioural skills was moderately low, explaining in part the limited level of condom use behaviour. This study provides insights into social factors that should be taken into account in public health planning to promote safer sexual behaviour among Asian male street labourers.     

Curbing the tobacco epidemic: Employing behavioral strategies or rearranging the deckchairs on the Titanic?

Henningfield brilliantly dissected the deadly comprehensive tactics of the tobacco industry but Food and Drug Administration and WHO strategies against the tobacco epidemic must be questioned. The Food and Drug Administration has the authority to regulate tobacco production (2009 Tobacco Control Act) but fails to ban menthol and reduce cigarettes nicotine content. As little has changed, the Healthy People 2010 objective of reducing the prevalence of cigarette smoking among adults to 12% by 2010 in the US will be attained by 2030. The monitoring of the WHO Framework Convention on Tobacco Control (WHO FCTC) is passive, even when governments repeatedly violate the Article 5.3 of the Convention, which specifically requires protecting public policy from tobacco industry interference. Since 2004, the year after the adoption of the Convention, the prevalence of daily smoking has leveled off and the 2012 annualized rate of change in prevalence of daily smoking was almost null. This contrasts with a 2% annual decrease in the prevalence of daily smoking from 1980 to 2004. The tobacco endgame needs acts, not bureaucracies. Two counties have been moving forward, Brazil has banned menthol and Australia has implemented plain packaging.