Should Health Studies Measure Wealth? : A Systematic Review

BACKGROUND: Health researchers rarely measure accumulated wealth to reflect socioeconomic status/position (SES). In order to determine whether health research should more frequently include measures of wealth, this study assessed the relationship between wealth and health. METHODS: Studies published between 1990 to 2006 were systematically reviewed. Included studies used wealth and at least one other SES measure as independent variables, and a health-related dependent variable. RESULTS: Twenty-nine studies met inclusion criteria. Measures of wealth varied greatly. In most studies, greater wealth was associated with better health, even after adjusting for other SES measures. The findings appeared most consistent when using detailed wealth measures on specific assets and debts, rather than a single question. Adjusting for wealth generally decreased observed racial/ethnic disparities in health. CONCLUSIONS: Health studies should include wealth as an important SES indicator. Failure to measure wealth may result in under-estimating the contribution of SES to health, such as when studying the etiology of racial/ethnic disparities. Validation is needed for simpler approaches to measuring wealth that would be feasible in health studies.     

What Do Binge Drinkers Drink?: Implications for Alcohol Control Policy

BACKGROUND: Although binge drinking (drinking five or more drinks on an occasion) is an important public health problem, little is known about which beverage types are consumed by binge drinkers. This knowledge could guide prevention efforts because beer, wine, and liquor are taxed, marketed, and distributed differently. METHODS: Data from 14,150 adult binge drinkers who responded to the Behavioral Risk Factor Surveillance System binge-drinking module in 2003 and 2004 were analyzed. Information pertained to the amount of alcohol consumed during a binge drinker's most recent binge episode, including beverage-specific consumption. RESULTS: Overall, 74.4% of binge drinkers consumed beer exclusively or predominantly, and those who consumed at least some beer accounted for 80.5% of all binge alcohol consumption. By beverage type, beer accounted for 67.1%, liquor for 21.9%, and wine accounted for 10.9% of binge drinks consumed. Beer also accounted for most of the alcohol consumed by those at highest risk of causing or incurring alcohol-related harm, including people aged 18-20 years (67.0% of drinks were beer); those with three or more binge episodes per month (70.7%); those drinking eight or more drinks per binge episode (69.9%); those binging in public places (64.4%); and those who drove during or within 2 hours of binge drinking (67.1%). CONCLUSIONS: Beer accounted for two thirds of all alcohol consumed by binge drinkers and accounted for most alcohol consumed by those at greatest risk of causing or incurring alcohol-related harm. Lower excise taxes and relatively permissive sales and marketing practices for beer as compared with other beverage types may account for some of these findings. These findings suggest that equalizing alcohol control policies at more stringent levels would be an effective way to prevent excessive drinking.     

Physical Activity Among Adolescents: When Do Parks Matter?

BACKGROUND: The availability of places to engage in physical activity may influence physical activity levels. This study examined whether the relationship between physical activity and access to parks differs depending on adolescents' sociodemographic, housing, and neighborhood characteristics. METHODS: Data were analyzed from 4010 adolescents who responded to the 2003 California Health Interview Survey (CHIS). Analyses were conducted in 2005-2006. Five sets of logistic regressions were conducted to examine the relationship between physical activity and access to a safe park among adolescents living in (1) urban versus rural areas; (2) apartment buildings versus houses, (3) neighborhoods perceived as unsafe versus safe; (4) lower- versus higher-income families; and (5) adolescents who were Latino, African American, Asian, or white. Analyses also examined interactions between park access and these factors. RESULTS: Access to a safe park was positively associated with regular physical activity and negatively associated with inactivity for adolescents in urban areas, but not rural areas. Additionally, adolescents with access to a safe park were less likely to be inactive than those without access among those living in (1) apartment buildings, (2) unsafe neighborhoods, and (3) lower-income families. Park access was not associated with regular physical activity for these groups. The association between park access and physical activity varied by race/ethnicity. CONCLUSIONS: These findings suggest that the relationship between physical activity and access to parks differs depending on adolescents' sociodemographic, housing, and neighborhood characteristics, and that parks may be particularly important for promoting physical activity among urban adolescents.     

Have Americans Increased Their Fruit and Vegetable Intake? : The Trends Between 1988 and 2002

BACKGROUND: Previous research indicates that few Americans meet the United States Department of Agriculture (USDA) guidelines for fruit and vegetable consumption, and that adequate fruit and vegetable consumption may decrease the risk for chronic disease. METHODS: Twenty-four-hour dietary recall data from NHANES III, 1988-1994 (n=14,997) and NHANES 1999-2002 (n=8910) were used to assess adult (equal to or more than 18 years) trends in daily fruit and vegetable consumption (number of servings and types). RESULTS: In 1988-1994, an estimated 27% of adults met the USDA guidelines for fruit (equal to or more than two servings) and 35% met the guidelines for vegetables (equal to or more than three servings). In 1999-2002, 28% and 32% of adults met fruit and vegetable guidelines, respectively. There was a significant decrease in vegetable consumption over time (p=0.026). Only 11% met USDA guidelines for both fruits and vegetables in 1988-1994 and 1999-2002, indicating no change in consumption (p=0.963). In both data sets, non-Hispanic blacks were less likely to meet USDA guidelines compared to non-Hispanic whites (p<0.05). Higher income and greater education were significantly associated with meeting the guidelines in both data sets (p<0.05). CONCLUSIONS: Despite the initiation of a national fruit and vegetable campaign in 1991, the findings indicated that Americans' fruit and vegetable consumption did not increase in 1999-2002, and only a small proportion met the related dietary recommendations. Greater public health efforts and approaches are needed to promote healthy eating in the United States.     

Healthy People 2020 and Education for Health: What Are the Objectives?

The Education for Health framework is designed as an educational roadmap for Healthy People 2020. It aims to connect the educational phases and suggests overall educational strategies needed to educate health professionals and the public to achieve a healthier America. The framework seeks to develop a seamless approach to prevention and population health education from Pre-K through graduate school. The framework is built on national movements in health literacy, undergraduate public health education and evidence-based thinking. It envisions a coordinated set of learning objectives divided into Pre-K through Grade 12, 2-year and 4-year colleges, and graduate education in the health professions as well as for health education for the community-at-large. The Healthy People Curriculum Task Force, a consortium of eight health professions education associations, has developed the framework and connected the framework with new and revised educational objectives of Healthy People 2020. The Task Force envisions a decade-long process to define and implement specific learning outcomes that can be integrated across the educational continuum. Interprofessional prevention education, in which health professionals learn and practice together, is seen by the Task Force as a key method for implementation. Understanding the roles played by a range of clinical health professions is also essential to communication and understanding. Healthy People 2020 and its new and revised educational objectives provide a vehicle for promoting the discussion and experimentation that will be needed to achieve an integrated and seamless approach to education for health for the American public as well as for health professionals.     

Does health insurance improve health?: Evidence from a randomized community-based insurance rollout in rural Burkina Faso

From 2004 to 2006, a community-based health insurance (CBI) scheme was rolled out in Nouna District, Burkina Faso, with the objective of improving access to health services and population health. We explore the random timing of the insurance rollout generated by the stepped wedge cluster-randomized design to evaluate the welfare and health impact of the insurance program. Our results suggest that the insurance had limited effects on average out-of-pocket expenditures in the target areas, but substantially reduced the likelihood of catastrophic health expenditure. The introduction of the insurance scheme did not have any effect on health outcomes for children and young adults, but appears to have increased mortality among individuals aged 65 and older. The negative health effects of the program appear to be primarily driven by the adverse provider incentives generated by the scheme and the resulting decline in the quality of care received by patients.     

Risk management by labelling 26 fragrances?: Evaluation of Article 10 (1) of the seventh Amendment (Guideline 2003/15/EC) of the Cosmetic Directive

Background

Some fragrance compounds are severe contact allergens. According to the so-called “26 allergens rule” (Article 1 (10) of Directive 2003/15/EC) (EC, 2003), 26 supposedly allergenic fragrances must be listed on the containers of cosmetics products if they are present above certain mass percentages in the product. This declaration is meant to inform the consumer of potential risks of skin sensitizers in the products.

Objective

The objective of this paper is to validate whether “the 26 allergens rule” meets the expectations to improve consumer protection.

Methods

The method used for this validation was on one hand a reflection on the elements of the approach used in “the 26 allergens rule” and on the other hand a product analysis of 742 products by 4 large producers of cosmetic products on the German market.

Results

It was found that more than 50% of these cosmetic and washing and cleansing products contain at least one of the 26 substances above the thresholds for labelling and that there are 14% of all products which contain strong allergens. Many consumers apparently still buy these products. The indirect effect that producers reduce the amounts of these fragrances to avoid declaration seems to be small.

Discussion and recommendations

Several arguments were assembled which show that other instruments are needed to ensure consumer protection or protection of the environment. This paper recommends different approaches. The use of a list of single substances in such a directive is not in line with scientific standards. It is recommended to base decision making on comprehensive risk assessments or at least on valid and strong criteria. More parameters need to be involved, not only contact allergy. As illustrated in this article, the roles taken over by authorities and manufacturers in risk management of the “26 allergens” are relatively small compared with the responsibility carried by consumers. However, consumers are only able to take over their part properly if they are sufficiently trained and have the necessary infrastructure, capability and time to inform themselves. Regulations are not effective if they load the major responsibility for risk management on consumers, instead of on authorities and manufacturers. A successful risk management would include bans and restrictions of especially hazardous substances issued by governments, as well as efficient surveys to control the implementation of regulations by the responsible authorities. It would also include that producers meet the legal standards and take over voluntary action to make products safer. The evaluation of “the 26 allergens rule” is an example which can be transferred to other regulations and which could help to improve future regulatory approaches, with a focus on the roles authorities, manufacturers and consumers play in a promising risk management.