Suicide and increased availability of handguns in the United States

During the 25 years between 1959 and 1984, the suicide rate in the United States increased from 10.5/100,000 to 12.4/100,000. The increase was confined to those suicides using a firearm, which had reached 58.5% of the total by the end of the period. At the same time, there was a marked increase in the household ownership of handguns (but not of shotguns and rifles). The present study investigates whether the increase in suicide might be due to the increase in the ownership of handguns. Regression analyses showed a strong relationship between handgun ownership and the rate of gun suicides, but not between handgun ownership and the overall rate of suicide. These results support the hypothesis that the rise in handguns has led to an increase in gun suicides, but, they do not permit a choice between two further competing hypotheses: (i) that more people are now committing suicide because there are more handguns available or, (ii) that people who would otherwise have killed themselves in some different way are now using guns. Because of the potential implications for prevention, further study of these issues is needed.     

Prevention of smoking-related deaths in the United States

BACKGROUND: Tobacco is the leading cause of death in the United States. The majority of people who smoke begin before age 18. OBJECTIVE: Determine the number of smoking-attributable deaths and years of potential life lost (YPLL) in adults that might be saved through interventions to reduce smoking prevalence among children and adolescents. METHODS: Calculation of the smoking-attributable mortality and years of potential life lost by age 85 among the cohort of people aged 18 in 2000. RESULTS: By age 85, there would be 127,670 smoking-attributable deaths among women and 284,502 deaths among men, for a total 412,172 smoking-attributable deaths in the United States among the cohort of 3,964,704 people aged 18 years alive in 2000. Through large-scale multimedia campaigns and a $1 increase in the price per pack of cigarettes, smoking prevalence could be reduced by 26% and would result in an annual savings of 108,466 lives and 1.6 million YPLL. CONCLUSIONS: Interventions to decrease smoking prevalence among children and adolescents can have large effects on adult mortality.     

Suicide attempts in the United States: the role of physical illness

The study aimed to determine the relationship between physical illness, mental disorder, and the likelihood of suicide attempt among adults aged 15-54 in the United States. Data were drawn from the National Comorbidity Survey (N=8,098), a national probability sample of adults in the United States. Multivariate logistic regression analyses were used to determine the relationship between self-reported physical illness and the likelihood of suicide attempt. Lung disease (OR=1.8 (1.1, 2.7)), ulcer (OR=2.1 (1.3, 3.4)), and AIDS (OR=44.1 (10.5, 185.6)) were each associated with a significantly increased likelihood of suicide attempt, independent of the effects of mental disorders. Consistent with previous studies, the number of physical illnesses was linearly related to an increased odds of suicide attempt (OR=1.3 (1.2, 1.5)). Possible mechanisms for these associations are discussed. These findings call for the inclusion of a range of physical health problems, especially chronic illnesses, in future research on suicide attempts in the population.     

Suicide mortality in the United States: differentials by industrial and occupational groups

BACKGROUND: The objective of this study was to investigate variations in the risk of suicide by industrial and occupational groups. METHODS: Cox proportional hazards regression models were fitted to the data from the National Longitudinal Mortality Study (1979-1989). In estimating the effects of industry and occupation, controls were made for the potentially confounding effects of age, sex, marital status, education, income, and region of residence. RESULTS: It was found that persons employed in mining experienced the highest risk of suicide (RR=4.29, CI=1.59, 12.13) compared to workers in finance, insurance, and real estate. Elevated risks were also observed among business and repair services (RR=4.20, CI=1.72, 10.25), professional and related services (RR=2.92, CI=1.25,6.82), and wholesale and retail trade (RR=2.71, CI=1.17,6.25). When comparisons were made by occupational status, it was found that laborers experienced the highest risk of suicide (RR=2.12, CI=1.09,4. 12) when compared to farmers, farm managers, and farm workers. CONCLUSIONS: There are differentials in the risk of suicide among industrial groups, and the industry with the highest risk is mining. The disparities in suicide remained even after the effects of socioeconomic and other variables were controlled. Further research needs to determine if the high suicide risk observed in some industrial groups may be linked to possible depressive symptomatology in the workplace.     

Culturally Competent HIV Prevention Strategies for Women of Color in the United States

Many studies suggest that aspects of culture be included in human immunodeficiency virus (HIV) education efforts in the United States. Few, however, clearly identify specific strategies that respond to the unique cultural issues of women of color. This article reviews the literature for culturally competent HIV prevention efforts for women of color—Latina, African American, Asian Pacific Islander, and Native American—and synthesizes components that need to be addressed in programs and interventions. Findings suggest that for programs to be culturally competent, both race/ethnicity and gender, along with population-specific, culturally based attitudes, beliefs, and behaviors, must be considered in interpersonal and organizational strategies.     

HIV Prevention for Black Men Who Have Sex With Men in the United States

The HIV/AIDS epidemic has exacted a devastating toll upon Black men who have sex with men (MSM) in the United States, and there is a tremendous need to escalate HIV-prevention efforts for this population.The social context in which Black MSM experience the impact of racism and heterosexism strongly affects their risk for HIV infection; thus, HIV-prevention research focused on Black MSM should focus on contextual and structural factors. There is a pronounced lack of community-level HIV-intervention research for Black MSM, but effective preliminary strategies involve adapting existing effective models and tailoring them to the needs of Black MSM.Future research should develop new, innovative approaches, especially structural interventions, that are specifically targeted toward HIV prevention among Black MSM.FOR MORE THAN 20 YEARS, the HIV/AIDS epidemic has been a tremendous burden on Black men who have sex with men (MSM) in the United States. Black MSM account for an increasingly large proportion of AIDS cases and have the highest rates of AIDS mortality among MSM.^1–4 HIV prevalence and incidence rates are disproportionately high among Black MSM compared to other racial/ethnic groups of MSM, including both younger (aged 15–22 years) and older (aged 23–49 years) Black MSM.^5–10 Moreover, rates of unrecognized HIV infection and sexually transmitted infections are higher among Black MSM than among other MSM.^11–13 Black MSM in the United States now experience rates of HIV infection that rival those among the general population in the developing world.^9,11The extremely high risk of HIV infection for Black MSM portends further devastation unless prevention efforts among this population become much more successful. There is a need for community-level risk-reduction interventions with proven efficacy among this population. However, few such interventions have been developed or adapted for Black MSM. In addition, there are salient contextual factors in the lives of Black MSM—especially racism and sexual prejudice—that can diminish their access to resources needed to protect them from HIV transmission, thus presenting formidable barriers to prevention. These barriers have not been well described in the literature because HIV prevention research has typically not focused on minority men within the general MSM population. When non-White MSM were considered, the pervasive influence of social context was not well delineated.To remedy this previous omission, we offer a detailed review of the social contextual factors that influence HIV risks in the lives of Black MSM. Then we describe the paucity of community-level HIV-prevention interventions specifically designed and implemented for Black MSM in the United States. We conclude with suggestions for a social–contextual approach for future intervention research among this population.MSM are not a homogenous population; the category includes all homosexually active and bisexually active men, regardless of their sexual identity.¹⁴ In this article, we use the term MSM as inclusive of all men who have sex with men, regardless of their sexual orientation, except for those studies that explicitly state that their participants'' sexual identity is homosexual, gay, or bisexual.     

美国疾病预防控制中心“健康社区项目”简介

2009年《中共中央国务院关于深化医药卫生体制改革的意见》明确指出"加强健康促进与教育。医疗卫生机构及机关、学校、社区、企业等要大力开展健康教育"。因此,提高我国社区健康教育工作水平、促进社区健康教育工作非常重要和紧迫。美国疾病预防控制中心组织开展的"健康社     

Long-term care in the United States: an overview

Although long-term care receives far less U.S. policy attention than health care does, long-term care matters to many Americans of all ages and affects spending by public programs. Problems in the current long-term care system abound, ranging from unmet needs and catastrophic burdens among the impaired population to controversies between state and federal governments about who bears responsibility for meeting them. As the population ages, the pressure to improve the system will grow, raising key policy issues that include the balance between institutional and noninstitutional care, assurance of high-quality care, the integration of acute and long-term care, and financing mechanisms to provide affordable protection.     

Preliminary evidence for an emerging nonmetropolitan mortality penalty in the United States

We discovered an emerging non-metropolitan mortality penalty by contrasting 37 years of age-adjusted mortality rates for metropolitan versus nonmetropolitan US counties. During the 1980s, annual metropolitan-nonmetropolitan differences averaged 6.2 excess deaths per 100,000 nonmetropolitan population, or approximately 3600 excess deaths; however, by 2000 to 2004, the difference had increased more than 10 times to average 71.7 excess deaths, or approximately 35,000 excess deaths. We recommend that research be undertaken to evaluate and utilize our preliminary findings of an emerging US nonmetropolitan mortality penalty.     

Contraceptive failure in the United States: an update

This report provides an update of the authors' previous estimates of first-year probabilities of contraceptive failure for all methods of contraception. Estimates are provided of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct use at every act of intercourse). The difference between these two probabilities provides a measure of how forgiving of imperfect use each method is. These revisions are prompted by recent studies that provide the first estimates of failure during perfect use for periodic abstinence and the cervical cap, by more complete evaluations of implants, and by the appearance of the Copper T 380A and disappearance of other IUDs from the US market. Also provided is a more complete explanation of how the previous estimate of the probability of becoming pregnant while relying solely on chance should be interpreted, and this estimate is revised slightly downward.     

The need for an urban HIV/AIDS policy in the United States

Urban centers in America are the hardest hit areas by the HIV/AIDS epidemic. The incidence of HIV/AIDS is higher in these areas because of high levels of poverty, sexually transmitted diseases, injection drug use, and the limited participation of urban residents in the design and delivery of health services. This article argues that a new urban HIV/AIDS policy is needed to focus on the vigorous implementation of risk reduction activities, linking HIV reduction with poverty alleviation programs, and the implementation of neighborhood health services.