An Evidence-Based Approach to Interactive Health Communication: A Challenge to Medicine in the Information Age. T.N. Robinson, et al. Journal of the American Medical Association 280 (October 14, 1998): 1264-69.

A rigorous evaluation frameowrk for itneractive health applications can help improve the quality and efficacy of standalone products.

Access to Health Information and Support: A Public Highway or a Private Road? T.R. Eng, et al. Journal of the American Medical Association 280 (October 21, 1998): 1371-75.

Given the potential benefits of health information technologies, a goal of universal access to health information and support is needed to reduce disparities between "haves" and "have nots."

Effect of an Intensive Educational Program for Minority College Students and Recent Graduates on the Probability of Acceptance to Medical School. J.C. Cantor, et al. Journal of the American Medical Association 280 (September 2, 1998): 772-76.

Summer enrichment programs for minority premedical students can increase the likelihood of their acceptance to medical school.

African Americans, Mexican Americans, Puerto Ricans, and American Indians make up 21 percent of the United States population but only 8.6 percent of United States physicians and approximately 13 percent of students entering medical school. The Association of American Medical Colleges (AAMC) has deemed these groups "underrepresented" in medical fields, which raises concern over equal access to medical careers and medical service to minority and traditionally underserved populations.

The Robert Wood Johnson Foundation Minority Medical Education Program (MMEP) is intended to increase minority students' medical school acceptance rate by providing 6-week summer sessions with instruction in studying, test taking, interviewing, presentation skills, sciences, writing, verbal reasoning and clinical experience. MMEP accepts participants from the AAMC-defined underrepresented minority groups. The United Hospital Fund, AAMC, and Stanford University School of Medicine evaluated the effectiveness of MMEP by comparing the medical school acceptance rate of minority program participants to minority nonparticipants in 1992, 1996, and 1997. Data were provided by sources kept in the AAMC Student and Applicant Information Management System. Numbers of students participating in MMEP for 1992, 1996, and 1997 were 773, 741, and 842, respectively. Numbers of nonparticipating minority students included in the study for 1992, 1996, and 1997 were 3,081, 4,121 and 3,830, respectively.

Medical school acceptance rates were higher for MMEP students than non-MMEP students in all 3 years included in the study. In 1992, 56.6 percent of MMEP students were admitted to medical school compared to 48.8 percent of nonparticipants; in 1996, 45.6 percent of participants were accepted compared to 39.7 percent of nonparticipants; and in 1997, 49.3 percent of participants were admitted compared to 41.6 percent of nonparticipants. Acceptance rates for nonminority students were not provided.

MMEP proved beneficial for students with varied academic backgrounds, although students with higher science GPAs and MCAT scores demonstrated greater effects from MMEP.

A Randomized Walking Trial in Postmenopausal Women: Effects on Physical Activity and Health 10 Years Later. M.A. Pereira, et al. Archives of Internal Medicine 158 (August 10/24, 1998): 1695-1701.

Long-term exercise compliance with a walking intervention may produce health benefits in postmenopausal women.

A 10-year followup was conducted of physical activity and self-reported health status among participants in a randomized clinical trial of a walking intervention. Of the original 229 volunteer postmenopausal women who participated in the original clinical trial, 196 (96 intervention and 100 controls) completed the 10-year followup telephone interview. The interview included questions on self-reported walking for exercise and purposes other than exercise, the Paffenbarger sport and exercise index, functional status, and various chronic diseases and conditions.

The median values for both usual walking for exercise and total walking were significantly higher for walkers compared with controls, with median differences of 706 and 420 kcal/wk, respectively. After excluding women who reported heart disease during the original trial, two women in the walking group and 11 women in the control group reported physician-diagnosed heart disease over the last 10 years. There also were fewer hospitalizations, surgeries, and falls among women in the walking group, although these differences were not statistically significant.

Can Inexpensive Signs Encourage the Use of Stairs? Results from a Community Intervention. R.E. Andersen, et al. Annals of Internal Medicine 129 (September 1, 1998): 363-69.

Basic health- and weight-related signs can increase the use of stairs versus escalators among shoppers in the United States.

The Johns Hopkins School of Medicine and Johns Hopkins Weight Management Center conducted a study to determine the effectiveness of signage in altering shoppers' patterns of stair use. The study was conducted at a shopping mall in suburban Baltimore, where 17,901 adults were observed using the escalators/stairs. A baseline for stair use was established by observing shoppers for one month when signs were not posted promoting stair use. During the second month of observation, a sign referring to the health benefits of using stairs was placed in the area near the escalator and stairs. During the third month, a sign referring to the weight control benefits of stair use was placed in the same location.

Overall, stair use increased from 4.8 percent to 6.9 percent during the posting of the health-related sign and from 4.8 percent to 7.2 percent during the posting of the weight-related sign. Younger people (estimated under age 40) increased their stair use from 4.6 percent to 6.0 percent with the health-related sign and to 6.1 percent with the weight-related sign. Older populations (estimated age 40 and above) increased stair use from 5.1 percent to 8.1 percent with the health-related sign and to 8.7 percent with the weight-related sign. Stair use among whites increased from 5.1 percent to 7.5 percent with the health-related sign and to 7.8 percent with the weight-related sign. Among African-Americans, stair use decreased from 4.1 percent to 3.4 percent with the health-related sign, but increased to 5.0 percent with the weight-related sign.

Outcomes of a High School Program to Increase Fruit and Vegetable Consumption: Gimme 5-A Fresh Nutrition Concept for Students. T.A. Nicklas, et al. Journal of School Health 68 (August 1998): 248-53.

Dietary habits of high school students can be influenced by positive media messages relative to that age group, increased exposure to a variety of tasty products, and minimal classroom activity.

Interest in improving eating habits of teens was sparked by research revealing that the consumption of five servings of fresh fruit or vegetables each day can reduce the risk of cancer by as much as 15 percent. "Gimme 5," the first intervention to use mass media and marketing to influence teenagers' eating habits, was implemented in a study that assigned 12 schools to intervention or control conditions. Seven other schools served as pilot-testing sites. The sample population was 56 percent female and 84 percent white, 4 percent African American, 9 percent Hispanic, and 3 percent other. Measurements of 2,213 students' eating habits were taken by means of written surveys assessing their knowledge about fruit and vegetable nutrition, their consumption of fruits and vegetables, and their confidence in eating more fruits and vegetables in the future. After the surveys, the "Gimme 5" intervention was implemented, including a media-marketing campaign within the school, a series of five 55-minute workshops, supplementary subject activities, modification of school lunches, and parental involvement in the campaign.

Through the first 3 years of the intervention, surveys recorded a 14 percent increase in the servings of fruits and vegetables consumed by the students participating in "Gimme 5," while the control group displayed no such increase. However, 3 years after the intervention began, a followup survey showed an increase in the fruit and vegetable consumption of the control group while the intervention group stayed constant. This leveling of the two groups may have been the result of a community-based health initiative. While the control group and the intervention group displayed no significant differences in fruit and vegetable consumption at followup, the 14 percent increase of the intervention group during the "Gimme 5" intervention indicates that the program can help change teenagers' eating habits.

Patients report positive nutrition counseling outcomes. M.R. Schiller, et al. Journal of the American Dietetic Association 98 (September 1998): 977-82.

Because patient nutrition counseling has positive outcomes, key counseling points should be introduced or reinforced in inpatient settings, in conjunction with multiple-session protocols during the pre- and/or posthospitalization continuum of care.

A descriptive study used the results of a telephone interview performed 2 to 8 weeks after counseling. Subjects were 400 adult patients referred for nutrition counseling at two academic health centers. Of these, 274 patients received nutrition counseling during hospitalization and 126 as outpatients.

Most patients (83 percent) gave a partial or full description of their diet modifications and 79 percent had a moderate or good understanding of their diet. Most patients reported that the dietitian's advice was suited to their special needs (88 percent) and that they knew what to eat (83 percent). A majority (62 percent) had made dietary changes, but 17 percent said they had had trouble changing their diets as suggested. After talking with a dietitian, 57 percent felt better emotionally, 37 percent felt better physically, 64 percent felt in control of their condition, and 43 percent noticed improved health indicators.

Use and Cost Effectiveness of Smoking Cessation Services Under Four Insurance Plans in a Health Maintenance Organization. The New England Journal of Medicine 339 (September 1998): 673-79.

A fully covered smoking cessation program that includes nicotine replacement therapy and behavioral modification will achieve greater smoking cessation rates than partially covered services, and fully covered services are extremely cost-effective compared to the potential medical costs of smoking-related health problems.

Conducted at Group Health Cooperative of Puget Sound (GHC), this study compared the smoking cessation rates and cost-effectiveness of a standard smoking cessation service (50 percent copayment required for behavioral program, but no copayment for nicotine replacement therapy) to three alternative services: reduced coverage (50 percent copayment required for both behavioral program and nicotine replacement therapy), flipped coverage (50 percent copayment required for nicotine replacement therapy, but no copayment for behavioral program), and full coverage (no copayment required).

In a sample of 90,005 adult enrollees, 26,983 persons were enrolled in the standard service; 34,455 persons were enrolled in the reduced service; 10,068 persons were enrolled in the flipped service; and 18,499 persons were enrolled in the full service. Initial telephone surveys determined the demographic characteristics (53 percent female, average age of 42 years, and 80 percent white), tobacco use, alcohol use, exercise habits, and other health-related behaviors of the sample. Additional telephone surveys were performed on the benefit users 6 months after the initial use of the benefits; data pertaining to demographics, previous and current status regarding tobacco use, and satisfaction with smoking cessation services were obtained.

Compared to standard coverage, 20 percent fewer smokers with reduced coverage used the services and 1.8 percent more smokers with flipped coverage used the services. The number of smokers with full coverage who used the services increased 300 percent. Smoking cessation rates were recorded as 28 percent to 38 percent, with the highest rates occurring in the standard group and the lowest in the full-coverage group. It was determined, however, that 1.5 times as many smokers would quit per year under the full-coverage services than under any of the other three. This increase can be achieved at a cost $328 per benefit user, which is much lower than the average annual cost of medical treatment for hypertension ($5,921) or heart disease ($6,941).

Using Picture Identification for Research with Preschool Children. D.C. Wiley and C.M. Hendricks. Journal of School Health 68 (August 1998): 227-30.

Picture identification can be effectively used to determine a preschool child's level of health knowledge, skill, or behavior.

Picture identification tools enable children to identify pictures associated with healthy behaviors. The tools have been used to evaluate various health curricula, including Hale and Hardy's Helpful Health Hints, the Preschool Health Education Project (PHEP) curriculum, and the Lub Dub Club. The tools demonstrated some reliability; for example, the retest reliability for the Health and Safety Behavior Preferences picture identification tool used for the PHEP evaluation ranged from r = 0.71 to 0.62. Picture identification was used to assess the Heart Treasure Chest Curriculum; the reliability coefficients were .72 (stability) and .63 (internal consistency).

Recommendations for obtaining the most accurate test measurements include helping the child focus on the subject in question and being aware of the child's limited attention span. In addition, the pictures must be of easily recognizable, age-appropriate objects. Evaluation of the effectiveness of various picture identification tools is essential to refine the measurement process. Assessing the health knowledge of preschool children can facilitate the development of health education programs appropriate for this age group.

Intrauterine Growth Restriction: Identification and Management. D. Peleg, et al. American Family Physician (August 1998): 453-64.

Identification of intrauterine growth restriction (IUGR) is crucial because proper evaluation and management can result in a favorable outcome.

IUGR is the second leading cause of perinatal morbidity and mortality, preceded only by prematurity. A fetus whose estimated weight falls below the 10th percentile and whose abdominal circumference falls below the 2.5th percentile for its gestational age is generally said to demonstrate IUGR. Infants whose birthweight is below 2,500 g also are considered to have IUGR. Among the general population, approximately 5 percent of pregnancies demonstrate IUGR.

Ultrasound biometry is now the accepted method of measuring fetal growth. Ultrasound should be used early in pregnancy (ideally at 8-13 weeks) to determine gestational age, when the ultrasound provides the most reliable data. The size of the uterus should be asseessed at each prenatal visit, using technqiues such as seiral measuremetns of the uterine fundus. A tape measure should be used to emasure the distance from the top of the pubic symphsysis to the dome of the uterine fundus. A fundal height that lags by more than 3 cm or is increasing in disparity witht gestational age may signal IUGR. Once diagnosed, the progression and severity of IUGR should be monitored using ultrasound.

Women with growth-restricted infants should be monitored carefully in subsequent pregnancies. The likelihood that these women will deliver another IUGR-affected infant is two to four times that of the general population.

The Prevalence of Homelessness Among Adolescents in the United States. American Journal of Public Health 88 (September 1998): 1325-29.

Homeless youths constitute a high-risk population that requires the immediate attention of policymakers.

A sample of 6,496 youths aged 12 to 17 who had responded to the 1992 Youth Risk Behavior Survey were interviewed in the form of audio cassette-recorded questions to which written responses were recorded on forms. Minority families were oversampled. The questions that contributed to the study's final statistics asked whether the youths had, in the last 12 months, spent the night in a youth or adult shelter, in a public place, in an abandoned building, outside, in a subway or other public place underground, with someone they did not know because they needed a place to stay, or in a vehicle. Altogether, 7.6 percent of the youths reported that they had been homeless, with boys significantly more likely to be homeless than girls. Other demographic differences pertaining to race, poverty status, family situation, and region were minimal.

Because certain segments of the homeless youth population; such as those currently homeless or staying in hotels, group quarters, or juvenile detention facilities, have been excluded from the sampling of this study, the problem of homelessness among youth could be much worse than was reported.