Volume 13: Issue 4 March 1999

Healthy People

"Healthy People 2010": National Health Objectives for the United States. R.M. Davis. British Medical Journal 317 (November 28, 1998): 1513-17.

National health objectives such as those contained in the public comment draft of Healthy People 2010 represent a potentially effective strategy for improving public health.

The Healthy People 2010 draft document contains 521 objectives, organized into 26 priority areas. This article compares Healthy People 2010 with similar public health programs in Canada, Australia, Great Britain, and Europe. Suggested changes and improvements to Healthy People 2010 include reducing the number of objectives, especially the "developmental" objectives, which account for nearly half of the total. Current health surveillance systems are unable to provide data to measure the developmental objectives. Other suggestions include improving consistency among the objectives and priority areas and clarifying the Federal Government's role in supporting the goals and objectives in Healthy People 2010.

When completed and released in January 2000, Healthy People 2010 will provide the Nation's disease prevention and health promotion agenda for the next decade.

Can Data-Driven Benchmarks Be Used to Set the Goals of Healthy People 2010? J. Allison, et al. American Journal of Public Health 89 (January 1999): 61-65.

A data-driven benchmark method for defining realistic, achievable goals for specific objectives is a suitable alternative to the consensus-based approach used in Healthy People 2010.

The "pared mean" method-a quantitative methodology that determines the best achieved for at least 10 percent of the population-was developed. This method has several advantages: (1) it is data driven rather than opinion-based, (2) captures what is best by targeting performance that is excellent yet realistic, and (3) is easily revised.

Goals derived from national data using the pared mean method were more realistic than those derived using the consensus-driven method. This was illustrated by using data from the 1994 National Health Interview Survey and calculating the pared mean benchmark for mammography screening by Alabama physicians. The data showed that 72 percent of physicians in the study were best-performing. In comparison, the Healthy People 2000 consensus-driven goal for screening mammography was 60 percent. The study showed that a goal of 71 percent is more realistic than one of 60 percent.

Nutrition

The "Age +5" Rule: Comparisons of Dietary Fiber Intake Among 4- to 10-Year-Old Children. J.S. Hampl, et al. Journal of the American Dietetic Association 98 (December 1998): 1418-23.

Children who increase their intake of high-fiber food can reduce their risk of future chronic disease.

Using 24-hour dietary recalls and 1-day food records, this study assessed the amount of nutrients and the food group choices of children who did and did not meet the recommendations of the "age +5" rule. The age +5 rule recommends that the amount of daily fiber that a child consumes should equal their age plus an additional 5 grams of fiber. The study sample data on 603 children between the ages of 4 and 6 years and 782 children between the ages of 7 and 10 years were supplied by the 1989-1991 U.S. Department of Agriculture Continuing Survey of Food Intakes by Individuals.

Only 45 percent of 4- to 6-year-olds and 32 percent of 7- to 10-year-olds met the age +5 rule of daily fiber consumption. Children who met the age +5 rule ate significantly more high- and low-fiber breads and cereals, fruits, vegetables, legumes, nuts, and seeds. The children who chose foods with a low fiber content had consumed more fat and cholesterol to maintain high energy levels. However, the children who met the age +5 rule consumed considerable amounts of dietary fiber, vitamins A and E, folate, magnesium, and iron and therefore did not feel compelled to consume low-fiber, high-fat cholesterol-laden foods. The study found that the majority of children ate foods low in dietary fiber, which could put them at risk for future chronic diseases. By offering fiber-rich foods to children, parents and school food service personnel may increase children's acceptance and consumption of these types of food.

Tobacco

Neighbors for a Smoke Free North Side: Evaluation of a Community Organization Approach to Promoting Smoking Cessation Among African Americans. E.B. Fisher, et al. American Journal of Public Health 88 (November 1998): 1658-63.

A community organization approach emphasizing local authority for program decisions and involvement of informal networks can lower smoking rates among residents of low-income neighborhoods.

This 2-year study evaluated community involvement in the planning and implementation of programs promoting nonsmoking among African American residents of three low-income neighborhoods in St. Louis. These neighborhoods were compared with comparable noninvolved neighborhoods in Kansas City.

Neighbors for a Smoke Free North Side emphasized neighborhood-based governance. Wellness councils in each program neighborhood organized and directed activities. Activities included smoking cessation classes, billboards, door-to-door campaigns, and a "gospelfest."

The program was successful in engaging African American residents in numerous and diverse neighborhood activities to promote nonsmoking. Collectively, these activities had a direct impact on the prevalence of smoking in neighborhoods involved in the program. Smoking declined from 34 percent to 27 percent in those neighborhoods. Noninvolved neighborhoods experienced a significantly smaller decline rate, from 34 percent to 33 percent.

Occupational Safety and Health

Return to Work Following Injury: The Role of Economic, Social, and Job-Related Factors. E.J. MacKenzie, et al. American Journal of Public Health 88 (November 1998): 1630-37.

Interventions at the patient, employer, and policy levels may improve the chances of resuming work in individuals at high risk for delayed return to work (RTW) after injury.

This prospective cohort study followed 312 individuals treated for a lower extremity fracture at three level-1 trauma centers in Seattle, Washington; Baltimore, Maryland; and Nashville, Tennessee. Nearly three-quarters of injuries resulted from motor vehicle crashes. Patient interviews were administered before hospital discharge and at 3, 6, and 12 months after the injury.

Estimates of the cumulative proportion of patients who had returned to work at 3, 6, 9, and 12 months postinjury were 0.26, 0.49, 0.60, and 0.72, respectively. Of those returning, 60 percent returned with some limitations. Only one individual retired because of the injury.

High levels of education, family incomes above 125 percent of the Federal poverty level, high levels of social support (particularly in terms of available practical assistance), absence of alcoholism, job stability, job flexibility, white-collar employment, and employment in jobs with low physical demands and good benefits all correlate with higher rates of RTW. Job satisfaction, affective personality traits, and motivation to work did not correlate strongly with RTW rates. The receipt of worker's compensation and a patient's involvement in pursuing legal redress, however, were associated with lower RTW rates.

Oral Health

Dental and Cardiac Risk Factors for Infective Endocarditis: A Population-Based, Case-Control Study. B.L. Strom, et al. Annals of Internal Medicine 129 (November 15, 1998): 761-69.

Because few cases of infective endocarditis would be preventable with antibiotic prophylaxis, current policies on the use of antibiotic prophylaxis in dental treatments need to be reconsidered.

This population-based, case-controlled study compared persons with community-acquired infective endocarditis, not associated with intravenous drug use, to community residents matched by age, sex, and area of residence. Demographic characteristics, host risk factors, and dental treatment were obtained from structured telephone interviews, dental records, and medical records of potential case-patients and community residents.

The study found that dental procedures were not significantly associated with infective endocarditis. During the preceding 3 months, dental treatment was no more frequent among case-patients than controls (odds ratio, 0.8). Of 273 case-patients, 104 (38 percent) knew of previous cardiac lesions, compared with 17 controls (6 percent) (odds ratio, 16.7). Case-patients more often had a history of mitral valve prolapse (odds ratio, 19.4), congenital heart disease (odds ratio, 6.7), cardiac valvular surgery (odds ratio, 74.6), rheumatic fever (odds ratio, 13.4), and heart murmur (odds ratio, 4.2). Among case-patients with known cardiac lesions, the target of prophylaxis, dental therapy was less common than among controls.

Dental treatment does not seem to be a risk factor for infective endocarditis, even in patients with valvular abnormalities, but such abnormalities are strong risk factors.

HIV

Home Sample Collection Tests for HIV Infection. B.M. Branson. Journal of the American Medical Association 280 (November 18, 1998): 1699-1701.

HIV prevention strategies, such as HSC tests and immediate access to test results, could greatly affect the AIDS epidemic.

Home sample collection (HSC) kits allow people to test themselves for HIV infection without face-to-face contact with medical or public health personnel. The anonymity of HSC tests may encourage HIV testing among people at risk of infection who do not know their HIV status and thereby aid in preventing the spread of HIV.

This retrospective study of nearly 175,000 HSC tests shows that consumers can administer the tests correctly. The study also found that nearly half of those individuals who tested positive for HIV had never been tested before, compared with 29 percent for publicly funded clinics. This finding suggests that people at risk of HIV infection prefer to use HSC testing procedures, which include a toll-free telephone number to obtain test results, counseling, and referrals.

Respiratory Diseases

Respiratory Tract Viral Infections in Inner-City Asthmatic Adults. R.L. Atmar, et al. Archives of Internal Medicine 158 (December 7-21, 1998): 2453-59.

The high frequency of respiratory tract viral infections (RTVIs) identified in association with asthmatic exacerbations in adults from the inner city suggests that strategies for preventing RTVIs should be targeted to this population.

RTVIs are frequently associated with asthma in children. To determine rates of RTVIs in adults with asthma, two studies were performed, one a longitudinal cohort study and the other an emergency department (ED) study. In both, respiratory secretions and paired serum samples were collected from subjects with acute wheezing episodes and evaluated using virus culture, serologic testing, and reverse transcription-polymerase chain reaction (RT-PCR).

Picornaviruses (rhinoviruses), coronaviruses, and influenza viruses were the most commonly identified causes of RTVIs. In the longitudinal cohort study, 41 percent of all illnesses and 44 percent of asthma exacerbations were associated with an RTVI. In the ED study, 55 percent were associated with an RTVI.

The Relationship Between Asthma and Obesity in Urban Minority Children and Adolescents. J. Gennuso, et al. Archives of Pediatric Adolescent Medicine 152 (December 1998): 1197-1200.

Asthma is a risk factor for obesity in children and adolescents.

This study examined a total of 171 children aged 4 to 16 years, with 86 as the control group. Of the sample, 78 percent were Hispanic, 17 percent were African American, 2 percent were white, and 3 percent were from other minorities. Significantly more children with asthma (30.6 percent) who were very obese (3 95th body mass percentile) compared with controls (11.6 percent).

Children with asthma were also significantly more overweight than children in the control group. There was a marked difference in obesity between the asthmatic group and the control group for both sexes and across the 4.5 to 10.9 years and 11 to 16 years age groups. The severity of asthma symptoms was not found to be related to obesity.

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