Evaluation of a community-based health promotion program supporting public policy initiatives for a healthy diet

The ‘Towards a Healthy Diet’ phase of the SheppartonHealthy Heart Project was evaluated. The principal goal of thisphase was to promote public policy initiatives that promotedhealthy diet, supported by changes in community opinion andinterest in healthy diet. Changing individual behaviour wasa secondary goal only. These public policy initiatives weredirected at eating places, schools and the health services.The eating places initiative promoted healthy practices in foodpreparation and presentation as well as customer healthy foodchoice behaviours. These initiatives were accompanied by media-basedhealth education and community events. The evaluation employeda two-community, quasi-experimental study design which assessedprocess, formative and impact (but not outcome) dimensions relevantto the program's objectives. Community opinion as well as dietarybehaviour and cognition about healthy diet were assessed usinga panel mail questionnaire survey of 1137 residents in the twocommunities. Community awareness and response to Towards a HealthyDiet were assessed at its completion in a separate cross-sectionalmail questionnaire survey of 703 residents of Shepparton. Supermarketsales figures supplemented assessment of behaviour. Fifty-oneeating places were assessed using interviews of a panel of proprietors/managersas well as on-site inspections. Initiatives aimed at schoolswere assessed by on-site interviews, those at general practitionersby a panel mail questionnaire survey. Towards a Healthy Dietachieved its goals only in part. A higher proportion of Sheppartonresidents reported recent increases in the number of eatingplaces offering healthy food and local residents eating healthyfood. There was a significantly greater increase in the numberof fruit dishes offered in Shepparton eating places as wellas customer requests for fruit. Changes in individual behavioursonly differed in the two communities for frequency of eatingtake-away food, where there was a significant decrease in Shepparton.Canteen policies were more frequently implemented in Sheppartonschools. This study provides support for community-based approachesto healthy diet-based public policy initiatives supported bysocial marketing in the future. Further rigorously evaluateddemonstration projects are necessary to replicate and extendthese results. This is true for other alternative approachesto community-based programs so far implemented for promotinghealthy diet.     

Health of workers exposed to a cocktail of pesticides

Summary For evaluation of the health effects of occupational exposure to a cocktail of pesticides, the authors examined several groups of workers, exposed in agriculture etc. and industry. Matched controls have been examined with the same standardized procedures. The following conclusions could be drawn:workers, intensively exposed for more than 4 years to a cocktail of pesticides experience diminished wellbeing (more subjective symptoms);there did not exist any statistically significant difference in findings in physical examination (skin disease excluded); however, the intensively exposed workers tend to show a higher prevalence of slight neurotoxic symptoms (mainly hypo- and areflexia);some blood levels (e.g. perc. ₂-globulin, transaminases, alkalinephosphatase) differ significantly from those in controls; there is no consistent pattern of biochemical response; the deviations may be interpreted as indicating increased variability of some parameters and moderate increase or decrease of average levels, generally still within the ranges found in the control group;exposure of the intensively exposed workers as a group must be regarded as too high to allow undisturbed health;exposure of these workers probably exceds at least 50–100 times exposure of the general population; workers eposed 20–50 times this population level do not show increased prevalence of subjective symptoms;the data do not suggest that exposure of the general population will induce adverse effects on health.The study was supported by a grant from the Central Organization for Applied Scientific Research TNO, The Hague, The Netherlands.     

The Communication Infrastructure as a Social Determinant of Health: Implications for Health Policymaking and Practice

Policy Points

• Persistent communication inequalities limit racial/ethnic minority access to life‐saving health information and make them more vulnerable to the effects of misinformation.
•  Establishing data collection systems that detect and track acute gaps in the supply and/or access of racial/ethnic minority groups to credible health information is long overdue.
• Public investments and support for minority‐serving media and community outlets are needed to close persistent gaps in access to credible health information.

     

某电子企业2560名女工职业健康状况调查

目的 了解电子企业女工的职业健康现状。方法 采用整群抽样的方法,抽取某电子企业一线生产女工2560名作为调查对象进行问卷调查,并对企业作业场所主要职业性危害因素进行监测,对接触职业性危害因素的女工进行职业健康检查。结果 电子企业一线生产女工平均年龄(19.4±2.9)岁,月平均工作(26.2±3.1)d,每天平均工作(9.6±1.4)h,83.8％的女工需要经常加班;作业场所除氧化锡尘和噪声超标外,其他有害因素监测结果均在职业接触限值以下;低浓度苯作业女工以白细胞下降为主的阳性结果检出率达18.1％。劳动负荷大（经常加班、搬动重物）和不合理人机工效设计对腰酸背痛等骨骼肌肉系统症状、神经精神症状、职业应激、视疲劳及意外伤害有明显的增强效应,合理安排工间休息有助于缓解上述事件的发生,差异有统计学意义(P＜0.05,P＜0.01)。结论 对于劳动密集型电子企业,一方面要加强对各种职业性危害的预防控制,同时,要加强对劳动过程中劳动负荷的调节和人机工效的合理设计,减少其对劳动者健康的影响。     

Implementation of a Walking School Bus: Lessons Learned*

Background: Obesity is rapidly becoming the most common chronic medical condition affecting children. To address this crisis, an Albuquerque, New Mexico, elementary school partnered with University of New Mexico researchers and conducted a Walking School Bus (WSB). The purpose of this article is to examine the feasibility of implementing a WSB. Methods: This pilot study featured 2 WSBs conducted for 10 weeks with kindergarten through fifth‐grade students from a predominantly Hispanic elementary school. Qualitative and quantitative data, including coordinator field notes, attendance records, surveys of student and parent satisfaction, and a focus group, were used to evaluate feasibility. Results: Student and adult participants expressed a high degree of enthusiasm regarding their involvement in the WSB. Participants uniformly indicated that the WSB provided a supportive and safe environment to promote social interaction and physical activity. Conducting a WSB in an urban, underserved school district is feasible but requires attention to ensure participants’ involvement and safety. In particular, it is recommended to begin the planning process early to enhance investment from key stakeholders. Conclusion: Effective, low‐cost interventions are increasingly desired as solutions to the problem of obesity. The WSB has emerged as a promising strategy to address obesity and encourage partnerships across different social levels. Further research is necessary to assess the logistical challenges associated with conducting a large‐scale WSB trial and whether such efforts lead to reductions in obesity risk factors.     

Making poverty a practice issue

Trends in poverty and changes in service provision are combining to make the promotion of health in poverty a particular challenge to health and welfare practitioners. The evidence suggests that practitioner groups have failed to respond adequately to this challenge. Factors concerned with professional perceptions of poverty, the nature of qualifying and post-qualifying education and the difficulties associated with taking research into practice all appear, in some way, to contribute to practitioners’ failure to incorporate a poverty perspective in their work. A team training approach appears to offer one way forward in the practice-setting. Using a team training approach, the‘Health Promotion in Poverty Project’ has sought to enable the lessons learnt from the broad base of poverty theory and research to be used by practitioners to build responsive and integrated support strategies for low-income families with dependent children.     

Public health strategies in Sheffield and England: a comparison of conceptual foundations

This paper compares the conceptual foundations of two recentUK public health strategy documents: Our City Our Health, adiscussion document associated with the Healthy Sheffield initiative,and the British Government's The Health of the Nation as appliedto England. The aspects of the conceptual foundations consideredare, firstly, the definitions of health employed, and secondly,the conceptualization of the determinants of health. The questionposed is: how do these compare with current knowledge aboutthe nature of health and the social processes and factors whichshape health for better or worse? Key findings in recent Britishresearch on concepts of health and the determination of healthare reviewed as the basis for comparison.     

Functional health literacy and health-promoting behaviour in a national sample of British adults

OBJECTIVES: To measure the prevalence of limited functional health literacy in the UK, and examine associations with health behaviours and self-rated health. DESIGN: Psychometric testing using a British version of the Test of Functional Health Literacy in Adults (TOFHLA) in a population sample of adults. SETTING: UK-wide interview survey (excluding Northern Ireland and the Scottish Isles). PARTICIPANTS: 759 adults (439 women, 320 men) aged 18-90 years (mean age _ 47.6 years) selected using random location sampling. MAIN OUTCOME MEASURES: Functional health literacy, self-rated health, fruit and vegetable consumption, physical exercise and smoking. RESULTS: We found that 11.4% of participants had either marginal or inadequate health literacy. Multivariable logistic regression analysis indicated that the risk of having limitations in health literacy increased with age (adjusted odds ratio 1.04; 95% confidence interval 1.02 to 1.06), being male (odds ratio _ 2.04; 95% confidence interval 1.16 to 3.55), low educational attainment (odds ratio _ 7.46; 95% confidence interval 3.35 to 16.58) and low income (odds ratio _ 5.94; 95% confidence interval 1.87 to 18.89). In a second multivariable logistic regression analysis, every point higher on the health literacy scale increased the likelihood of eating at least five portions of fruit and vegetables a day (odds ratio _ 1.02; 95% confidence interval 1.003 to 1.03), being a non-smoker (odds ratio _ 1.02; 95% confidence interval 1.0003 to 1.03) and having good self-rated health (odds ratio _ 1.02; 95% confidence interval 1.01 to 1.04), independently of age, education, gender, ethnicity and income. CONCLUSIONS: The results encourage efforts to monitor health literacy in the British population and examine associations with engagement with preventative health behaviours.     

Ten Suggested Health Literacy Attributes of a Health Care Organization

The health care system in the United States is becoming increasingly complex, placing greater demands on consumers to be more proactive and informed about their care. However, 88% of the population is unable to successfully navigate the health care system due to low levels of health literacy. Health care organizations can play a role in improving health literacy. The “Ten Attributes of the Health Literate Health Care Organizations” produced by members of the Institute of Medicine’s Roundtable on Health Literacy provides guidance.     

某高校本科生健商与亚健康的相关性研究

目的 探讨在校大学生健商与其亚健康状态之间的相关性,为探索基于校园平台的亚健康干预方法提供科学依据。方法 采用目的抽样法对1 000名在校大学生进行健商、亚健康问卷调查。结果 895名在校大学生亚健康率为64.69%,疾病、亚健康、健康3组大学生健商得分分别为(7.14±1.29)分、(7.35±0.88)分、(8.00±1.76)分,差异有统计学意义(F＝22.332,P＜0.01),健康组健商水平显著高于亚健康组和疾病组(P＜0.05),亚健康组和疾病组健商得分差异无统计学意义(P＞0.05);不同类型亚健康大学生健商得分差异无统计学意义(F=2.412,P＞0.05);在校大学生健商水平与亚健康状态呈正相关(P＜0.05)。结论 在校大学生健商与其亚健康状态之间密切相关,健商水平越高,发生亚健康的概率越小,健康程度越高。     

Policy Commercializing Nonprofits in Health: The History of a Paradox From the 19th Century to the ACA

Policy Points:

• Health policy in the United States has, for more than a century, simultaneously and paradoxically incentivized the growth as well as the commercialization of nonprofit organizations in the health sector.
• This policy paradox persists during the implementation of the Affordable Care Act of 2010.

Context

For more than a century, policy in the United States has incentivized both expansion in the number and size of tax-exempt nonprofit organizations in the health sector and their commercialization. The implementation of the Affordable Care Act of 2010 (ACA) began yet another chapter in the history of this policy paradox.

Methods

This article explores the origin and persistence of the paradox using what many scholars call “interpretive social science.” This methodology prioritizes history and contingency over formal theory and methods in order to present coherent and plausible narratives of events and explanations for them. These narratives are grounded in documents generated by participants in particular events, as well as conversations with them, observing them in action, and analysis of pertinent secondary sources. The methodology achieves validity and reliability by gathering information from multiple sources and making disciplined judgments about its coherence and correspondence with reality.

Findings

A paradox with deep historical roots persists as a result of consensus about its value for both population health and the revenue of individuals and organizations in the health sector. Participants in this consensus include leaders of governance who have disagreed about many other issues. The paradox persists because of assumptions about the burden of disease and how to address it, as well as about the effects of biomedical science that is translated into professional education, practice, and the organization of services for the prevention, diagnosis, treatment, and management of illness.

Conclusions

The policy paradox that has incentivized the growth and commercialization of nonprofits in the health sector since the late 19th century remains influential in health policy, especially for the allocation of resources. However, aspects of the implementation of the ACA may constrain some of the effects of the paradox.     

Regional variation in the survival and health of older Australian women: a prospective cohort study

Objective: Older people may act as sensitive indicators of the effectiveness of health systems. Our objective is to distinguish between the effects of socio-economic and behavioural factors and use of health services on urban-rural differences in mortality and health of elderly women.
Methods: Baseline and longitudinal analysis of data from a prospective cohort study. Participants were a community-based random sample of women (n=12778) aged 70-75 years when recruited in 1996 to the Australian Longitudinal Study on Women's Health. Measures used were: urban or rural residence in Australian States and Territories, socio-demographic characteristics, health related behaviour, survival up to 1 October 2006, physical and mental health scores and use of medical services.
Results: Mortality was higher in rural than in urban women (hazard ratio, HR 1.14; 95% CI, 1.03,-1.26) but there were no differences between States and Territories. There were no consistent baseline or longitudinal differences between women for physical or mental health, with or without adjustment for socio-demographic and behavioural factors. Rural women had fewer visits to general practitioners (odds ratio, OR=0.54; 95% CI, 0.48-0.61) and medical specialists (OR=0.60; 95% CI, 0.55-0.65).
Conclusions: Differences in use of health services are a more plausible explanation for higher mortality in rural than urban areas than differences in other factors.
Implications: Older people may be the 'grey canaries' of the health system and may thus provide an 'early warning system' to policy makers and governments.     

发展健康经济：中国的战略选择

当前,中国经济发展的许多矛盾凸显,面临经济的转型升级。健康经济作为一种新的经济发展模式,倡导以维护和促进健康为导向进行资源配置,从而实现经济发展的健康化,并以健康产业的发展满足人民需求、拉动经济增长。中国应采取健康经济的发展模式,制定有利于健康经济发展的战略和政策,积极推进经济转型升级。     

Baseline Results of the First Healthy Schools Evaluation Among a Community of Young,Irish, Urban Disadvantaged Children and a Comparison of Outcomes With International Norms

BACKGROUND: In 2008, the Irish Government initiated a pilot Healthy Schools Programme based on the World Health Organization Health Promoting Schools Model among children attending schools officially designated as urban and disadvantaged. We present here the first results on physical and emotional health and the relationship between childhood depression and demographic and socioeconomic factors. METHODS: The Healthy Schools Programme evaluation was a 3‐year longitudinal outcome study among urban disadvantaged children aged 4 to 12 years. Physical and psychological health outcomes were measured using validated, international instruments at baseline. Outcomes at baseline were compared with international norms and where differences were found, results were statistically modeled to determine factors predicting poor outcomes. RESULTS: A total of 552 children responded at baseline, representing over 50% of all eligible children available to participate from 7 schools. Findings at baseline revealed that in general, children did not differ significantly from international norms. However, detailed analysis of the childhood depression scores revealed that in order of importance, psychological well‐being, the school environment, social support, and peer relations and age were statistically significant predictors of increased childhood depression in children under 12 years of age. CONCLUSION: Future health and well‐being studies in schools among urban disadvantaged children need to broaden their scope to include measures of depression in children under 12 years of age and be cognisant of the impact of the school environment on the mental and emotional health of the very young.     

山西省某高校本科生健商状况及影响因素分析

目的 了解山西省在校本科生的健康商数现状。方法 采用健康商数问卷对1 000名在校本科学生进行问卷调查。结果 在校本科生整体健康商数得分为(7.39±1.15)分,不同性别大学生在生活方式、精神状态维度差异有统计学意义(P＜0.01),不同家庭所在地大学生在精神状态、生活技能维度差异有统计学意义(P＜0.05),中学是否住校、不同锻炼频率、不同体检状况、父母亲健康状况、不同年级的大学生健康商数各维度差异均有统计学意义(P＜0.05);健商各维度之间呈显著正相关(P＜0.01);锻炼频率、体检状况、母亲健康状况是影响大学生整体健商水平的主要影响因素。结论 ⑴山西省在校大学生健康商数总分虽较为理想,但健康知识维度得分偏低,提示将健商理念融入健康教育,普及健康教育课程是高校教育者的重要任务。⑵高校教育者应因人制宜进行健康教育,通过提高其健商某一方面的水平,促进整体健商水平提高。⑶高校教育者应积极倡导大学生进行规律的体育锻炼、定期体检、将健商教育纳入家庭教育体系,促进其健商水平提高。     

Cost-Effectiveness of a School-Based Emotional Health Screening Program

Background:  School-based screening for health conditions can help extend the reach of health services to underserved populations. Screening for mental health conditions is growing in acceptability, but evidence of cost-effectiveness is lacking. This study assessed costs and effectiveness associated with the Developmental Pathways Screening Program, in which students undergo universal classroom emotional health screening and those who have positive screens are provided with on-site clinical evaluation and referral.
Methods:  Costs are enumerated for screening and clinical evaluation in terms of labor and overhead and summarized as cost per enrolled student, per positive screen, and per referral. Cost-effectiveness is summarized as cost per student successfully linked to services. School demographics are used to generate a predictive formula for estimating the proportion of students likely to screen positive in a particular school, which can be used to estimate program cost.
Results:  Screening costs ranged from $8.88 to $13.64 per enrolled student, depending on the prevalence of positive screens in a school. Of students referred for services, 72% were linked to supportive services within 6 weeks. Cost-effectiveness was estimated to be $416.90 per successful linkage when 5% screened positive and $106.09 when 20% screened positive. A formula to estimate the proportion of students screening positive proved accurate to within 5%.
Conclusion:  Information concerning costs and effectiveness of school-based emotional health screening programs can guide school districts in making decisions concerning resource allocation.