News From Health Research: Toward a Better Understanding

News about health research findings, especially regarding controversial topics, can seem confusing and conflicting to students and the general public. Many people eventually develop a "turned-off" attitude toward all health news. Yet medical information is one of the key factors involved in health decision-making, because it influences a person's judgment about the potential health impact of a behavior choice. As part of their health education, youngsters need to learn skills to better understand and evaluate reports of research news, so the information available for health decision-making will be more complete and accurate. Such news is already abundant in television, radio, newspaper and magazine reports and will continue to increase as research advances, knowledge expands and health "facts" are revised. This article outlines concepts and skills to help teachers and students understand the changes and controversies in health news. To most effectively use new information generated by medical research, students need to: 1) understand basic concepts about the nature of research and the research process; 2) apply critical thinking approaches to health news; and 3) locate additional health information resources. Generating ways to address these needs is a high priority of the school health education work at the National Heart, Lung and Blood Institute. Comments are invited on this approach.     

Toward Better Estimates of the Cost of Climate Change Mitigation: Guidelines for Studying Potential Health Benefits

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Worldwide, efforts to mitigate climate change through reduction of greenhouse gas emissions are falling short of what is needed to meet ambitious international goals such as the Paris Agreement.1 Research estimating the health effects of mitigation (HEM) indicates that climate change mitigation activities could have substantial health co-benefits that partially or completely offset the economic costs of mitigation. Yet few HEM findings have been incorporated into cost estimates of mitigation activities, making the activities appear unacceptably expensive to policymakers.2 The authors of a recent commentary in Environmental Health Perspectives present guidelines for conducting and reporting HEM studies so that the results are comparable and responsive to stakeholder priorities and that health benefits are thus more often considered in cost estimates.3Open in a separate windowClimate change mitigation activities often produce health co-benefits in addition to simply reducing greenhouse gas emissions. For example, installing wind power facilities to replace coal-fired power plants means fewer hazardous air pollutants in regional and local air. That could result in fewer hospitalizations for respiratory diseases. Image: © iStockphoto/Baxternator.HEM research has often operated in a silo, not effectively engaging stakeholders in the research process. That could be one reason for the low uptake of their recommendations by policy makers, according to lead commentary author Jeremy Hess, a professor in the University of Washington’s Department of Environmental and Occupational Health Sciences. The University of Washington, the World Health Organization, and the Wellcome Trust’s Our Planet, Our Health funding foundation jointly convened a workshop in London to develop consistent guidelines for planning and reporting HEM research. Among these guidelines were recommendations for how to better engage stakeholders in the research process—ultimately leading to increased uptake when developing mitigation policies.“Ultimately, HEM research aims to inform policy decisions,” says Hess. “Without knowing the priorities of policy makers and how they might use the estimates, such research is at risk of being ignored. Dialogues between policy makers and scientists take time, and such processes are often not supported as part of research activities.”Led by Hess and Kristie Ebi—also a professor of Environmental and Occupational Health Sciences at the University of Washington—the team conducted a modified Delphi process to reach preliminary consensus on issues related to engaging stakeholders before scoping projects, modeling approaches to use, choices about model parameters, and communicating results. The outcome was then discussed in depth at the expert workshop.At the end of the process, the authors developed a list of specific recommendations to optimize stakeholder engagement and study design and reporting. They encouraged the creation of trans- and interdisciplinary stakeholder teams to more thoughtfully develop research questions and anticipate unforeseen consequences. They also recommended ways to ensure future HEM studies yield high-quality results, including best practices for describing the study population and health metrics used, reporting counterfactual scenarios, accounting for different levels of policy uptake, and sharing data.“As the paper notes, a wide range of methods have been used to evaluate ancillary health benefits and costs of technologies and policies to reduce carbon emissions,” says Tracey Holloway, a professor of environmental studies at the University of Wisconsin–Madison who was not involved with the paper. “With so many different study design approaches, it can be difficult to compare study results in an ‘apples to apples’ manner. This study lays a roadmap for future work to enhance the rigor, comparability, and relevance to decision makers.”“I would have loved to see a few specific examples—case studies to show the recommendations in practice,” Holloway adds. “Sharing a few concrete examples would clarify some of the points in the paper, especially to readers who may not have thought about the nuts and bolts of studies like this.”Despite the emphasis on engaging stakeholders and developing more standardized approaches, that result is not assured, says Michael Brauer, a professor of occupational and environmental health at the University of British Columbia who also was not an author of the commentary. “The goal of standardization as a means to hopefully increase uptake of these kinds of analyses for policy development and implementation is certainly worthwhile,” Brauer says. “But even if this guidance is followed, it certainly doesn’t guarantee that there will be more use of [HEM] analyses in policy prioritization.”That is nevertheless the ultimate aim of the guidance. “At the end of the day, we hope these guidelines will lead to more widespread, rapid implementation of climate change mitigation, which will be good for health,” says Hess. “It will help reduce the risks of dangerous climate change in the long run and will produce a raft of important health benefits starting almost immediately.”     

The School-Age Traction Patient: Toward Better Behavior Patterns

The selective nontreatment of handicapped newborns is an issue that has been of prominent legal debate since the 1982 Department of Health and Human Services 'Baby Doe Regulations It is also an issue of great ethical debate This article analyzes the dilemma using the principle of nonmaleficence In addition the related constructs of ordinary versus extraordinary care, the quahfications of personhood, and the quality of life versus sanctity of life are explained Nonmaleficence is discussed in terms ot the ethical decision-making impact upon the child, the famlly, health care professionals, and society.     

Health Literacy: A Pathway to Better Oral Health

Objectives. We examined whether health literacy was associated with self-rated oral health status and whether the relationship was mediated by patient–dentist communication and dental care patterns.Methods. We tested a path model with data collected from 2 waves of telephone surveys (baseline, 2009–2010; follow-up, 2011) of individuals residing in 36 rural census tracts in northern Florida (final sample size n = 1799).Results. Higher levels of health literacy were associated with better self-rated oral health status (B = 0.091; P < .001). In addition, higher levels of health literacy were associated with better patient–dentist communication, which in turn corresponded with patterns of regular dental care and better self-rated oral health (B = 0.003; P = .01).Conclusions. Our study showed that, beyond the often-reported effects of gender, race, education, financial status, and access to dental care, it is also important to consider the influence of health literacy and quality of patient–dentist communication on oral health status. Improved patient–dentist communication is needed as an initial step in improving the population’s oral health.Oral health status is inexorably linked with general health,1 as evidenced by the association between poor oral health and chronic diseases, such as diabetes,2 cardiovascular disease,3 and respiratory disease.4 Among US adults, the burden of oral disease falls heaviest on vulnerable population groups,5–7 particularly those living in rural areas.8 Although improving oral health is named as one of the top 5 health priorities in Rural Healthy People 2010,9 little progress has been made in establishing public health programs to address this priority area. To achieve the goal of improved oral health, it is essential to study the risk factors associated with the oral health status of individuals residing in rural areas and to understand the relationships among these risk factors.The association between low dental care utilization and poor oral health outcomes has been proposed as a partial explanation for urban–rural disparities in oral health status.10–13 The rate of dental care utilization is lower among US rural than general populations, and dental visits tend to be problem—rather than prevention—oriented.14–17 Low levels of financial security and a lack of dental providers in rural areas are cited as major reasons for the low utilization rates in rural populations.12,18,19 However, evidence that individuals with dental insurance benefits choose to forgo regular preventive dental care suggests the presence of additional determinants in dental care utilization.20Previous research showed that communication between dentists and their patients plays an important role in the use of dental services.21–24 Effective patient–dentist communication increases utilization of dental services by lessening dental anxiety and, as a result, increasing patient perceptions of provider competence.25 Conversely, deficient communication skills, on either side of the patient–provider equation, are likely to increase dental anxiety and overall dissatisfaction with care.Health literacy deficits can interfere with effective patient–dentist communication. Individuals with low health literacy skills often have difficulty describing dental problems to their dentist and understanding dental conditions described by the dentist.26 Rozier et al. surveyed about 2000 dentists in the United States regarding the use of the 5 domains of communication techniques: interpersonal communication, teach-back method, patient-friendly materials and aids, assistance, and patient-friendly practice.27 Findings revealed low routine use by dentists of each communication technique, including those thought to be most effective with patients who demonstrate low health literacy.The association between low health literacy and poor health outcomes is well established.28–30 However, in the context of oral health, the literature offers few studies identifying the relationship between health literacy and oral health outcomes. It has been suggested that those with low health literacy are at highest risk for oral diseases and problems31 and that low health literacy may be associated with barriers to accessing care and with oral health behaviors such as seeking preventive care.32 Furthermore, rural residents have lower health literacy skills than urban residents.33 However, how health literacy is related to oral health status among rural populations remains an unanswered question.Frequently acknowledged risk factors for poor oral health include gender (male), race (Black), educational attainment (low), financial status (low), and access to dental care (none). We controlled for these factors in an examination of the effects of health literacy, patient–dentist communication, and dental care patterns on self-rated oral health status. In addition, we tested mediational pathways between health literacy and self-rated oral health. We hypothesized that greater health literacy would be associated with better patient–dentist communication, and in turn, that better patient–dentist communication would be associated with an increased likelihood of seeking regular dental care, ultimately leading to better self-rated oral health.     

Toward Proof of Concept of a One Health Approach to Disease Prediction and Control

A One Health approach considers the role of changing environments with regard to infectious and chronic disease risks affecting humans and nonhuman animals. Recent disease emergence events have lent support to a One Health approach. In 2010, the Stone Mountain Working Group on One Health Proof of Concept assembled and evaluated the evidence regarding proof of concept of the One Health approach to disease prediction and control. Aspects examined included the feasibility of integrating human, animal, and environmental health and whether such integration could improve disease prediction and control efforts. They found evidence to support each of these concepts but also identified the need for greater incorporation of environmental and ecosystem factors into disease assessments and interventions. The findings of the Working Group argue for larger controlled studies to evaluate the comparative effectiveness of the One Health approach.     

Advancing Health Literacy Measurement: A Pathway to Better Health and Health System Performance

The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy—especially when combined with a focus on prevention and integrative health—is one of the most promising approaches to advancing public health.     

Examining Item Content and Structure in Health Status and Health Outcomes Instruments: Toward the Development of a Grammar for Better Understanding of the Concepts Being Measured

ObjectivesHealth outcomes instruments assess diverse health concepts. Although item-level concepts are considered fundamental elements, the field lacks structures for evaluating and organizing them for decision making. This article proposes a grammar using item stems, response options, and recall periods to systematically identify item-level concepts. The grammar uses “core concept,” “evaluative component,” and “recall period” as intuitive terms for communicating with stakeholders. Better characterization of concepts is necessary for classifying instrument content and linking it to treatment benefit.MethodsItems in 2 generic and 21 disease-specific instruments were evaluated to develop and illustrate the use of the grammar. Concepts were assigned International Classification of Functioning, Disability and Health codes for exploring the value that the grammar and a classification system add to the understanding of content across instruments.ResultsThe 23 instruments include many core concepts; emotional function is the only concept assessed in all instruments. Concepts in disease-specific instruments show obvious patterns; for example, arthritis instruments focus on physical function. The majority of instruments used the same response options across all items, with five-point scales being the most common. Most instruments used one recall period for all items. Shorter recall periods were used for conditions associated with “flares,” such as chronic obstructive pulmonary disease and “skin disease.” Every diagnosis, however, showed variation across instruments in the recall period used.ConclusionsThis analysis indicates the proposed grammar’s potential for discerning the conceptual content within and between health outcomes instruments and illustrates its value for improving communication between stakeholders and for making decisions related to treatment benefit.     

Social Stigma Toward Suicide: Effects of Group Categorization and Attributions in Korean Health News

The purpose of this study is to examine the influence of health news content on the stigma of suicide. In particular, this study tested whether the onset controllability and group categorization had a causal effect on people’s stigma toward suicide. The results indicated that stigma scores were lower for those who read an article explaining the causes of suicide as uncontrollable than for those who read an article explaining the causes as controllable. Also, lower stigma scores were observed for those who read an article depicting suicidal people as the in-group compared to those who read an article depicting suicidal people as the out-group. Furthermore, stigma scores were the highest for those exposed to an article with the out-group categorization combined with the controllable causes of suicide.     

Better Health With More Friends: The Role of Social Capital in Producing Health

This paper estimates the effect of an individual's number of friends on own health outcomes. The identification strategy exploits the panel structure of the friendship data from the National Longitudinal Study of Adolescent Health to estimate individual fixed effects in the likelihood of friendship formation and then uses the fixed effect estimates as a control function in a model relating health outcomes to number of friends. Empirical results show that having a larger number of friends improves physical and mental health and also lowers the frequency of smoking cigarettes. Specifically, making one more friend increases an individual's general health measure by 6.6% of a standard deviation. This suggests that accumulating social capital through friendship interactions is beneficial to health. Copyright © 2014 John Wiley & Sons, Ltd.     

Bingo halls and smoking: Perspectives of First Nations women

The purpose of this study was to examine bingo halls as a frequent site for exposure to secondhand cigarette smoke for First Nations women in rural communities. Thematic analysis of interviews with key informants, group discussions with young women, and observations in the study communities revealed that smoky bingo halls provided an important refuge from everyday experiences of stress and trauma, as well as increased women's risk for addiction, marginalization, and criticism. The findings illustrate how the bingo economy in isolated, rural First Nation communities influences tobacco use and second-hand smoke exposure, and how efforts to establish smoke-free bingos can be supported.     

Predictors of Quality-of-Care Processes in Geriatric Assessment Units: Toward a Better Organizational Framework

ObjectivesTo identify the structural and patient characteristics associated with better care processes in older vulnerable hospitalized patients.DesignRetrospective study.SettingForty-four Geriatric Assessment Units (GAU).ParticipantsPatients aged 65 and older who were admitted to a GAU for a fall with trauma.MeasurementsThree care processes (comprehensiveness, informational continuity, completion of advance health care directives) assessed through chart audit; 14 patient- and 23 GAU-related characteristics obtained from hospitalization records, national databases, and GAU managers.ResultsA total of 877 hospitalization records were included. Final models were based on multilevel modeling using stepwise variable selection. Strongest predictors of better comprehensiveness were longer hospital length of stay (LOS), higher clinical complexity (eg, higher mortality risk), and having a geriatrician as attending physician. Comprehensiveness score increased sharply up to 3 weeks LOS and then tended to plateau. Better informational continuity was associated with more comprehensive care, higher risk of mortality, acute rather than rehabilitation care, communication with community health care professionals within 48 hours after admission, and a target LOS of 3 weeks or longer. The completion of advance directives was more likely in the presence of advanced age, higher risk of mortality, cognitive impairment, discharge to another care facility, longer LOS, university-affiliated institution, and nonurban location.ConclusionIn GAUs, quality-of-care processes are related to both structural and patient characteristics. Our results pointed toward an organizational framework that may help to streamline the geriatric units and better use resources, notably by narrowing the admission criteria, targeting a proper LOS, improving communication with community organizations, and making systematic completion of advance directives.