The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee

PURPOSE: To assess the relationship between modifiable health risks and total health care expenditures for a large employee group. DESIGN: Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period. SETTING: The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers. SUBJECTS: Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. MEASURES: Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures. RESULTS: Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures. CONCLUSIONS: Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.     

Lifestyle health behaviours of 11- to 16-year-old youth with physical disabilities

Health promotion strategies for youth with physical disabilitiesare needed to reduce their high risk of acquiring secondarydisabilities in adulthood. Many secondary disabilities are associatedwith lifestyle habits and are potentially preventable. To determinetheir health promotion needs, the Health Behaviours in School-agedChildren, a WHO Cross-national Study questionnaire, was administeredto 101 youth with physical disabilities. Their responses werecompared with youth in a Canadian national sample. In comparisonwith the national sample, youth with physical disabilities reportedthat they were equally healthy, but experienced higher frequencyof symptoms of poor health such as headaches, stomachaches andbackaches. With respect to lifestyle health behaviours theywere less likely to smoke, drink alcohol and use marijuana thantheir counterparts in the national sample. Youth with physicaldisabilities reported less healthy diets, less exercise andmore sedentary leisure activities. These findings support theneed for health promotion strategies tailored to the particularpattern of risks for youth with physical disabilities.     

Attempts to undermine tobacco control: tobacco industry "youth smoking prevention" programs to undermine meaningful tobacco control in Latin America

We sought to understand how the tobacco industry uses "youth smoking prevention" programs in Latin America. We analyzed tobacco industry documents, so-called "social reports," media reports, and material provided by Latin American public health advocates. Since the early 1990s, multinational tobacco companies have promoted "youth smoking prevention" programs as part of their "Corporate Social Responsibility" campaigns. The companies also partnered with third-party allies in Latin America, most notably nonprofit educational organizations and education and health ministries. Even though there is no evidence that these programs reduce smoking among youths, they have met the industry's goal of portraying the companies as concerned corporate citizens and undermining effective tobacco control interventions that are required by the World Health Organization Framework Convention on Tobacco Control.     

Public health nurses in Quebec: an essential contribution that remains to be known

Public health nurses in Quebec are essential although little is known about their role. Generally trained at the undergraduate level, with additional qualifications in community health, they essentially work in CLSCs in maternal and child health programs, youth clinics or occupational health. In regional public health departments, they also work in the field of infectious disease prevention or other programs. Like their colleagues, they are confronted to the profession's challenges, the most notable being current and future shortage of nurses. However, they can now count on a new. As nurses further develop their practice and orient it even more towards primary prevention and health promotion, they will significantly contribute to the National Public Health Program and to the improvement of population health and wellbeing.     

Tobacco cessation in adolescent females in Appalachian communities

Adolescents who live in tobacco-growing areas use tobacco at earlier ages and more frequently than other youth. These adolescents, like all tobacco users, have many health risks. To be successful, cessation efforts targeting these youth must reflect the cultural, social, and economic import of tobacco in their communities. Six focus groups with girls aged 12 to 14 who lived in tobacco-growing communities in Appalachian Ohio, Tennessee, and Virginia and 20 interviews with key informants were conducted. Barriers identified by informants included community norms around tobacco use, family use of tobacco, school practices and policies, peer influences, youth attitudes, and logistical difficulties with cessation program efforts. Key findings indicated: (1) the social community in tobacco-growing communities is a significant influence in tobacco use; (2) family is important among young people in tobacco-growing communities and influences cessation positively and negatively; (3) parental smoking was an influence to smoke (4) some parents condone and even facilitate tobacco use by their children, but others actively discourage use; and (5) concern for the health of younger brothers and sisters elicits a strongly protective reaction from youth in discussions of health risks related to secondhand smoke. Youth in tobacco-growing regions have many similarities to others, but they also have unique cultural characteristics pertinent in the development and delivery of tobacco cessation programs.     

Public health week: marketing the concept of public health.

The Public Health Programs and Services (PHP&S) Branch of the Los Angeles County Department of Health Services began a strategic planning effort in January 1986 to meet new disease trends, curb rising health care costs, consolidate limited resources, and handle shifting demographics. A strategic plan was designed to assess the opportunities and challenges facing the agency over a 5-year horizon. Priority areas were recognized, and seven strategic directives were formulated to guide PHP&S in expanding public health services to a changing community. Health promotion was acknowledged as a critical target of the strategic planning process. Among the most significant results of the health promotion directive was the establishment of an annual Public Health Week in Los Angeles County. Beginning in 1988, 1 week per year was selected to enhance the community's awareness of public health programs and the leadership role PHP&S plays in providing these programs to nearly 9 million residents of Los Angeles County. Events in Public Health Week include a professional lecture series and the honoring of an outstanding public health activist and a media personality who has fostered health promotion. Other free community activities such as mobile clinics, screenings, and health fairs are held throughout the county. With intensive media coverage of Public Health Week, PHP&S has been aggressive in promoting its own services and accomplishments while also educating the community on vital wellness issues. The strategic methodology employed by PHP&S, with its emphasis on long-range proactive planning, is receiving national recognition and could be adopted by similar agencies wishing to enhance their image and develop unique health promotion projects in their communities.     

Youth exposure to alcohol advertising on radio--United States, June-August 2004

In the United States, more underage youth drink alcohol than smoke tobacco or use illicit drugs. Excessive alcohol consumption leads to many adverse health and social consequences and results in approximately 4,500 deaths among underage youth each year. Recent studies have emphasized the contribution of alcohol marketing to underage drinking and have demonstrated that a substantial proportion of alcohol advertising appears in media for which the audience composition is youth-oriented (i.e., composed disproportionately of persons aged 12-20 years). To determine the proportion of radio advertisements that occurred on radio programs with audiences composed disproportionately of underage youth and the proportion of total youth exposure to alcohol advertising that occurs as a result of such advertising, researchers at the Center on Alcohol Marketing and Youth (Health Policy Institute, Georgetown University, District of Columbia) evaluated the placement of individual radio advertisements for the most advertised U.S. alcohol brands and the composition of audiences in the largest 104 markets in the United States. This report summarizes the results of that study, which indicate that alcohol advertising is common on radio programs which have disproportionately large youth audiences and that this advertising accounts for a substantial proportion of all alcohol radio advertising heard by underage youth. These results further indicate that 1) the current voluntary standards limiting alcohol marketing to youth should be enforced and ultimately strengthened, and 2) ongoing monitoring of youth exposure to alcohol advertising should continue.     

Position of the American Dietetic Association: the role of dietetics professionals in health promotion and disease prevention

In the United States, the leading determinants of morbidity and mortality are rooted in behavioral choices related to eating habits, exercise, tobacco, alcohol consumption, and stress reduction. Scientific data consistently provide evidence that diet plays an important role in health promotion and disease prevention. Healthy eating habits--coupled with other healthful lifestyle behaviors--have the potential to reduce the risk of chronic disease. Health care typically assumes a curative or treatment role in the United States. However, dietetics professionals are shaping an alternate view of health, which includes developing healthy public policies, creating safe and supportive environments, building communities and coalitions, and reorienting health services to include health promotion as a primary approach to delivering health care. Individual-level approaches, such as counseling and group education, have been employed most often in modifying health behaviors. However, population-level approaches that affect availability of or access to healthy foods, opportunities for physical activity, and other healthy lifestyle determinants also are important. Dietetics professionals have pivotal roles in both individual- and population-level approaches.     

Durability of tobacco control activities in 11 north American communities: life after the Community Intervention Trial for Smoking Cessation (COMMIT)

Durability of tobacco control activities in the 11 intervention sites of the Community Intervention Trial for Heavy Smokers (COMMIT) was examined. Although continuation of COMMIT activities was not a major goal, all communities made plans to continue some tobacco control activity. Information was gathered at focus groups of former COMMIT volunteers and staff who were assembled in each community and asked to describe tobacco control activities in their communities during the past 12-16 months-the period after the termination of COMMIT funding. It was found that a tobacco coalition, board or other structure was still operating in nine of the 11 communities and 10 had some level of paid staff dedicated to smoking control. There was also substantial activity in three of the four channels that COMMIT used as an intervention framework: worksites, public education and cessation resources. Many communities were currently engaged in considerable smoking control activity aimed at youth, an area that was intentionally de-emphasized by COMMIT. Implications for the durability of health promotion programs by communities are discussed.     

Health promotion capacity mapping: the Korean situation

Ten years ago the Republic of Korea enacted the National Health Promotion Act, setting the stage for health promotion action in the country. A National Health Promotion Fund was established, financed through tobacco taxes, which is now one of the largest in the world. However, despite abundant financial resources, the infrastructure needed to plan, implement, coordinate and evaluate health promotion efforts is still underdeveloped. Currently, health promotion capacity mapping efforts are emerging in Korea. Two international capacity mapping tools have been used to assess the Korean situation, namely HP-Source and the Health Promotion Capacity Profile, which was developed prior to the sixth Global Conference of Health Promotion, held in August 2005 in Bangkok, Thailand. The article summarizes and discusses the results of the capacity mapping exercise, highlights its challenges and suggest ways to improve the accuracy of health promotion capacity mapping.     

Toward a public mental health promotion and intervention system for youth

Substantial limitations exist at all levels of mental health care for youth in most communities in the United States. Particular gaps exist in the areas of prevention, mental health promotion, and early intervention programs. The national movement toward enhancing mental health programs for youth in schools offers an important opportunity to fill gaps in the prevention-services continuum toward the development of a Public Mental Health Promotion and Intervention System for Youth. A strategy--the Child and Adolescent Program Planning Schema (CAPPS)--is presented to analyze gaps in a community's system of mental health programs for youth, and to facilitate planning toward development of a full continuum of programs from broad, population-based prevention, and mental health promotion strategies to treatment of youth with more established problems.     

Towards an epidemiology of health: a basis for planning community health programs.

Raising the quality of life of a community is the ultimate goal of most health promotion programs. Yet such programs are commonly restricted to reducing known risks to health. It is suggested that this linkage of health promotion to disease prevention is self-defeating, and that health promotion needs community recognition and a suitable methodology of its own. To this end the traditional epidemiology of disease is extended to a potential epidemiology of health. A five-part analysis of health issues is then suggested as a basis for planning and evaluating community health programs.     

Health care, not sick care

Senator Tom Harkin announces his introduction of the HeLP (Healthy Lifestyles and Prevention) Act. This comprehensive legislation provides incentives to stimulate health promotion in workplace, school, and community settings, with specific programs for disabled people, food marketing, Medicare reimbursement for preventive services, and research on obesity, and creation of a National Health Promotion Trust Fund to pay for programs by penalties on tobacco companies that fail to cut smoking rates among children, ending federal subsidies for tobacco advertising, and closing other tax loopholes.     

Health promotion approaches to occupant protection: an epidemiologic framework

The size of the problem, the potential for prevention, and the Nation's prevention priorities all support public health action to prevent injuries. A balanced approach to this problem should include both environmental and health promotion strategies. Centers for Disease Control (CDC) is encouraging development of health promotion capability at the community level; the approach bases planning and implementation of programs on epidemiologic analysis to define the problem. Behavioral risk factor surveillance data will help states and communities establish baselines and determine priorities. Baseline data from the state-based surveillance system illustrate risk levels of motor vehicle occupants, e.g., 58% of adults report "seldom" or "never" using seat belts, and one of every seven males ages 18-34 report driving after having too much to drink. A health promotion plan developed by the Oakland County, Michigan, Health Department illustrates the use of these kinds of data as an epidemiologic framework; this plan identifies child passenger safety as a priority for action and establishes measurable objectives to reduce risk through health promotion programs. Health promotion includes not only interventions that support individual behavior change but also community change. By acquiring epidemiologic data and conveying it both to individuals and community decision makers, the public health community supports increased community efforts to protect occupants of motor vehicles.     

Profiles of the adolescent smoker: models of tobacco use among 9th grade high school students: Acadiana Coalition of Teens against Tobacco (ACTT)

BACKGROUND: Tobacco use, underreported among Louisiana youth, was examined among 9th grade students in south central Louisiana; profiles of tobacco use were developed to inform adolescent tobacco control programs. METHODS: Cross-sectional Health Habits Survey was administered to 4,808 students who were about 15 years old, predominantly white, with gender almost evenly distributed. Saliva samples were collected from 1,966 students. Analysis of a subsample resulted in good concordance between self-reported daily tobacco use and cotinine. RESULTS: About 58% of students ever smoked a cigarette, 25% had a cigarette within the previous 30 days, 17% smoked within the past 7 days and almost 8% reported smokeless tobacco use. Smokeless tobacco use was greater for males than females. Caucasians, native Americans, and Latinos were more likely to smoke than African-Americans. Social relationships associated with adolescent smoking included having a friend, parent and/or sibling who smoked, having a friend who consumed alcohol, and being around people who used alcohol for "kicks." The attitudes of nonsmokers were consistently in the positive direction relative to disapproval of tobacco and alcohol use. The profiles differed demographically between black and white students. CONCLUSIONS: These data provide the needed information for guiding health promotion and tobacco control efforts, specifically regarding black/white differences.     

From evidence to action: health promotion and alcohol

Preventing alcohol‐related harm presents a range of challenges including those related to political will, competing interests with disproportionate resources, and embedded drinking cultures. On the other hand there are opportunities for health promotion, including clear evidence on both the extent of the problem and evidence‐based responses and growing community support for action. Australian researchers continue to contribute substantially to the international evidence base on alcohol, generating evidence for translation into effective programs and producing policy‐relevant research on which action and advocacy can be based. Successes in other public health areas also provide useful models for public health approaches to alcohol. Those engaged in health promotion have often been required to do a lot with a little, including communicating health messages on a range of themes, countering industry activities that are contrary to good public health and involvement in policy development. Coalition approaches to alcohol related harm, including links with groups outside health, have recently gained momentum and show much potential. Alcohol issues are now firmly on the agenda of the public and decision‐makers, and the alcohol industry has expressed clear concern at current levels of activity. This paper will consider briefly the nature of the challenge; evidencebased approaches; achievements and developments thus far; challenges and obstacles; and the role of health promotion and the health promotion workforce.     

北京市239厂健康促进项目中期评估报告

目的 对北京市239厂2001-2003年期间健康促进干预的效果进行评估。方法 调查239厂职工吸烟、饮酒、不参加体育锻炼的情况，对不健康行为进行干预。结果 职工吸烟率、饮酒率、不参加体育锻炼率等下降，职工健康知识知晓率提高，项目覆盖了65％的人群，79％的职工对健康教育表示满意。结论 239厂健康教育工作得到了加强，多部门合作的机制已形成。工厂还要加大多部门配合，提高群众参与健康促进的力度。     

Health policies (population interventions) in health services. 2008 SESPAS Report

Health interventions addressed to the population as a whole from health care services are scarce and only exceptionally involve coordination among public health services (vaccinations and, in some autonomous communities, secondary breast cancer prevention). Health education programs addressed to schools are one of the most frequent interventions but their outcomes are not systematically evaluated. However, primary health care services carry out many clinical preventive activities. While the aims of these activities are laudable, the interventions themselves have substantial limitations, because they are an important source of dependency, a powerful incentive to consume drugs, and are also inefficient and inequitable ways of spending health resources. These limitations justify the testing of combined approaches between public health services and citizens' collectives to improve and protect community health. Developing community health programs based on cooperation between primary health care services and public health services requires strategies that produce appreciable results in the short term to both health sectors, as well as to the population, so that these programs stimulate the process and encourage further development. The settings in which collaboration is most promising are population health surveillance and monitoring in basic health areas, control of communicable diseases and epidemic outbreaks, health promotion and health protection programs through simultaneous clinical and community-based interventions, and improved management of all health services in local communities through joint evaluation. The resources needed to carry out these activities should be drawn from a reduction of clinical preventive activities that reduce workload and from an increase in the number and quality of the public health workforce.