Health Policy

Environmental and individual factors affecting menu labeling utilization: a qualitative research study

Environmental and individual factors affecting menu labeling utilization: a qualitative research study
Journal of the Academy of Nutrition and Dietetics. 2013 May;113(5):667-72. doi: 10.1016/j.jand.2012.11.011. Epub 2013 Feb 9.

Jennifer Schindler, Kamila Kiszko, Courtney Abrams, Nadia Islam, Brian Elbel
02/09/2013

Obesity is a prominent public health concern that disproportionally affects low-income and minority populations. Recent policies mandating the posting of calories on menus in fast-food chain restaurants have not proven to uniformly influence food choice. This qualitative research study used focus groups to study individual and environmental factors affecting the use of these menu labels among low-income minority populations. Ten focus groups targeting low-income residents (n=105) were held at various community organizations throughout New York City over a 9-month period in 2011. The focus groups were conducted in Spanish, English, or a combination of both languages. In late 2011 and early 2012, transcripts were coded through the process of thematic analysis using Atlas.ti for naturally emerging themes, influences, and determinants of food choice. Few participants used menu labels, despite awareness. The most frequently cited as barriers to menu label use included: price and time constraints, confusion and lack of understanding about caloric values, as well as the priority of preference, hunger, and habitual ordering habits. Based on the individual and external influences on food choice that often take priority over calorie consideration, a modified approach may be necessary to make menu labels more effective and user-friendly.

Centralization of Radical Prostatectomy in the United States

Centralization of Radical Prostatectomy in the United States
Journal of Urology, Vol. 189, no. 2, pp. 500-506. DOI: 10.1016/j.juro.2012.10.012

Anderson, C.B., D.F. Penson, S. Ni, D.V. Makarov, and D.A. Barocas
02/01/2013

Purpose: Radical prostatectomy is a common treatment for organ confined prostate cancer and its use is increasing. We examined how the increased volume is being distributed and what hospital characteristics are associated with increasing volume.

Materials and Methods: We identified all men age 40 to less than 80 years who underwent radical prostatectomy for prostate cancer from 2000 to 2008 in the NIS (Nationwide Inpatient Sample) (586,429). Ownership of a surgical robot was determined using the 2007 AHA (American Hospital Association) Annual Survey. The association between hospital radical prostatectomy volume and hospital characteristics, including ownership of a robot, was explored using multivariate linear regression.

Results: From 2000 to 2008 there was a 74% increase in the number of radical prostatectomies performed (p = 0.05) along with a 19% decrease in the number of hospitals performing radical prostatectomy (p <0.001), resulting in an increase in annual hospital radical prostatectomy volume (p = 0.009). Several hospital variables were associated with greater radical prostatectomy volume including teaching status, urban location, large bed size and ownership of a robot in 2007. On multivariate analysis the year, teaching status, large bed size, urban location and presence of a robot were associated with higher hospital radical prostatectomy volume.

Conclusions: Use of radical prostatectomy increased significantly between 2000 and 2008, most notably after 2005. The increase in radical prostatectomy resulted in centralization to select hospitals, particularly those in the top radical prostatectomy volume quartile and those investing in robotic technology. Our findings support the hypothesis that hospitals with the greatest volume increases are specialty centers already performing a high volume of radical prostatectomy procedures.

Long-Term Satisfaction and Predictors of Use of Intracorporeal Injections for Post-Prostatectomy Erectile Dysfunction

Long-Term Satisfaction and Predictors of Use of Intracorporeal Injections for Post-Prostatectomy Erectile Dysfunction
Journal of Urology, Vol. 189, no. 1, pp. 238-242. DOI: 10.1016/j.juro.2012.08.089

Prabhu, V., J.P. Alukal, J. Laze, D.V. Makarov, and H. Lepor
01/01/2013

Purpose: Intracorporeal injections have low use rates and high discontinuation rates. We examined factors associated with intracorporeal injection use, long-term satisfaction with intracorporeal injection and reasons for discontinuation in men treated with radical prostatectomy.

Materials and Methods: Between October 2000 and September 2003, 731 men who underwent open radical retropubic prostatectomy were enrolled in a prospective outcomes study. The 8-year followup evaluation included the UCLA-PCI, and a survey capturing intracorporeal injection use, satisfaction and reasons for discontinuation. Logistic regression was used to determine associations between intracorporeal injection use and preoperative variables.

Results: The 8-year self-assessment was completed by 368 (50.4%) men. Of these men 140 (38%) indicated prior or current intracorporeal injection use, with only 34 using intracorporeal injection at 8 years. Overall, 44% of the men were satisfied with intracorporeal injections. Reasons for discontinuation included dislike (47%), pain (33%), return of erection (19%), inefficacy (14%) and no partner (6%). Men trying intracorporeal injections had greater preoperative UCLA-PCI sexual function scores (75.2 vs 65.62, p = 0.00005) as well as greater decreases in this score at 3 months (p = 0.0002) and 2 years (p = 0.003). Higher preoperative sexual function scores were independently associated with the use of intracorporeal injections in a model adjusted for age, marital status, nerve sparing status and body mass index (OR 1.021, 95% CI 1.008–1.035).

Conclusions: Men pursuing intracorporeal injections have better baseline erectile function and experience greater deterioration in erectile function during the early postoperative period. Despite the high efficacy of injections, many men discontinue intracorporeal injections due to dislike or discomfort. Satisfaction rates for intracorporeal injections indicate their long-term role in restoring sexual function in men with post-prostatectomy erectile dysfunction.

A new approach to understanding racial disparities in prostate cancer treatment

A new approach to understanding racial disparities in prostate cancer treatment
Journal of Geriatric Oncology, Vol. 4, no. 1, pp. 1-8. DOI: 10.1016/j.jgo.2012.07.005

Presley, C.J., A.C. Raldow, L.D. Cramer, P.R. Soulos, J.B. Long, J.B. Yu, D.V. Makarov, and C.P. Gross
01/01/2013

Objective: Previous studies addressing racial disparities in treatment for early-stage prostate cancer have focused on the etiology of undertreatment of black men. Our objective was to determine whether racial disparities are attributable to undertreatment, overtreatment, or both.

Methods: Using the SEER-Medicare dataset, we identified men 67–84 years-old diagnosed with localized prostate cancer from 1998 to 2007. We stratified men into clinical benefit groups using tumor aggressiveness and life expectancy. Low-benefit was defined as low-risk tumors and life expectancy < 10 years; high-benefit as moderate-risk tumors and life expectancy ≥ 10 years; all others were intermediate-benefit. Logistic regression modeled the association between race and treatment (radical prostatectomy or radiotherapy) across benefit groups.

Results: Of 68,817 men (9.8% black and 90.2% white), 56.2% of black and 66.3% of white men received treatment (adjusted odds ratio (OR) = 0.65; 95% CI, 0.62–0.69). The percent of low-, intermediate-, and high-benefit men who received treatment was 56.7%, 68.4%, and 79.6%, respectively (P = < 0.001). In the low-benefit group, 51.9% of black vs. 57.2% of white patients received treatment (OR = 0.74; 95% CI, 0.67–0.81) compared to 57.2% vs. 69.6% in the intermediate-benefit group (OR = 0.64; 95% CI, 0.59–0.70). Racial disparity was largest in the high-benefit group (64.2% of black vs. 81.4% of white patients received treatment; OR = 0.57; 95% CI, 0.48–0.68). The interaction between race and clinical benefit was significant (P < 0.001).

Conclusion: Racial disparities were largest among men most likely to benefit from treatment. However, a substantial proportion of both black and white men with a low clinical benefit received treatment, indicating a high level of overtreatment.

Who Experiences Discrimination in Brazil? Evidence From a Large Metropolitan Region

Who Experiences Discrimination in Brazil? Evidence From a Large Metropolitan Region
International Journal for Equity in Health, 2012 Dec 18;11:80. doi: 10.1186/1475-9276-11-80

Macinko, J., P. Mullachery, F.A. Proietti, and M.F. Lima-Costa
12/18/2012

Introduction Perceived discrimination is related to poor health and has been offered as one explanation for the persistence of health inequalities in some societies. In this study, we explore the prevalence and correlates of perceived discrimination in a large, multiracial Brazilian metropolitan area.

Methods The study uses secondary analysis of a regionally representative household survey conducted in 2010 (n=12,213). Bivariate analyses and multiple logistic regression assess the magnitude and statistical significance of covariates associated with reports of any discrimination and with discrimination in specific settings, including when seeking healthcare services, in the work environment, in the family, in social occasions among friends or in public places, or in other situations.

Results Nearly 9% of the sample reported some type of discrimination. In multivariable models, reports of any discrimination were higher among people who identify as black versus white (OR 1.91), higher (OR 1.21) among women than men, higher (OR 1.33) among people in their 30’s and lower (OR 0.63) among older individuals. People with many health problems (OR 4.97) were more likely to report discrimination than those with few health problems. Subjective social status (OR 1.23) and low social trust (OR 1.27) were additional associated factors. Perceived discrimination experienced while seeking healthcare differed from all other types of discrimination, in that it was not associated with skin color, social status or trust, but was associated with sex, poverty, and poor health.

Conclusions There appear to be multiple factors associated with perceived discrimination in this population that may affect health. Policies and programs aimed at reducing discrimination in Brazil will likely need to address this wider set of interrelated risk factors across different populations.

Beyond Black: Diversity among Black Immigrant Students in New York City Public Schools

Beyond Black: Diversity among Black Immigrant Students in New York City Public Schools
Randy Capps and Michael Fix, editors, Young Children of Black Immigrants in America: Changing Flows, Changing Faces. Washington, DC: Migration Policy Institute: 299-331

Doucet, F., Schwartz, A. E., & Debraggio, E.
12/14/2012

The child population in the United States is rapidly changing and diversifying — in large part because of immigration. Today, nearly one in four US children under the age of 18 is the child of an immigrant. While research has focused on the largest of these groups (Latinos and Asians), far less academic attention has been paid to the changing Black child population, with the children of Black immigrants representing an increasing share of the US Black child population.

To better understand a unique segment of the child population, chapters in this interdisciplinary volume examine the health, well-being, school readiness, and academic achievement of children in Black immigrant families (most with parents from Africa and the Caribbean).

The volume explores the migration and settlement experiences of Black immigrants to the United States, focusing on contextual factors such as family circumstances, parenting behaviors, social supports, and school climate that influence outcomes during early childhood and the elementary and middle-school years.  Many of its findings hold important policy implications for education, health care, child care, early childhood development, immigrant integration, and refugee assistance.

Changes in ten years of social inequalities in health among elderly Brazilians (1998-2008)

Changes in ten years of social inequalities in health among elderly Brazilians (1998-2008)
Revista de Saude Publica, Vol. 46, supp. 1. 10.1590/S0034-89102012005000059

Lima-Costa, M.F.; L.A. Facchini; D.L. Matos, and J. Macinko
12/11/2012

OBJECTIVE: To assess the changes in income-related inequalities in health conditions and in the use of health services among elderly Brazilians.

METHODS: Representative samples of the Brazilian population aged 60 years and more were analyzed between 1998 and 2008 (n = 27,872 and 41,198, respectively), derived from the Pesquisa Nacional por Amostra de Domicílios (National Household Sample Survey). The following variables were considered in this study: per capita monthly household income, self-rated health, physical functioning, medical consultations and hospitalizations in the previous 12 months and exclusive use of the Sistema Único de Saúde (Unified Health System). Data analysis was based on estimates of prevalence and prevalence ratios obtained with robust Poisson regression.

RESULTS: In 1998 and 2008, the prevalence of poor self-rated health, mobility limitations and inability to perform activities of daily living (ADLs), adjusted for age and sex, showed strong gradients associated with per capita household income quintiles, with the lowest values being found among those in the lowest income quintile. The prevalence ratios adjusted for age and sex between the lowest quintile (poorest individuals) and highest quintile (richest individuals) of income remained stable for poor self-rated health (PR = 3.12 [95%CI 2.79;3.51] in 1998 and 2.98 [95%CI 2.69;3.29] in 2008), mobility limitations (PR = 1.54 [95%CI 1.44;1.65 and 1.69 [95%CI 1.60;1.78], respectively) and inability to perform ADLs (PR = 1.79 [95%CI 1.52;2.11] and 2.02 [95%CI 1.78;2.29], respectively). There was a reduction in income-related disparities when three or more medical consultations had been made and with the exclusive use of the Unified Health System. Inequalities were not observed for hospitalizations. 

CONCLUSIONS: Despite reductions in income-related inequalities among indicators of use of health services, the magnitude of disparities in health conditions has not decreased. Longitudinal studies are necessary to better understand the persistence of such inequalities among elderly Brazilians.

Improving State Health Policy Assessment: An Agenda for Measurement and Analysis

Improving State Health Policy Assessment: An Agenda for Measurement and Analysis
American Journal of Public Health: September 2012, Vol. 102, No. 9, pp. 1697-1705. doi: 10.2105/AJPH.2012.300716

Macinko, J., and D. Silver
09/01/2012

We examine the scope of inquiry into the measurement and assessment of the state public health policy environment. We argue that there are gains to be made by looking systematically at policies both within and across health domains. We draw from the public health and public policy literature to develop the concepts of interdomain and intradomain policy comprehensiveness and illustrate how these concepts can be used to enhance surveillance of the current public health policy environment, improve understanding of the adoption of new policies, and enhance evaluations of the impact of such policies on health outcomes.

Infant Antibiotic Exposures and Early-Life Body Mass

Infant Antibiotic Exposures and Early-Life Body Mass
International Journal of Obesity , (21 August 2012) | doi:10.1038/ijo.2012.132

Trasande, Leonardo, Jan Blustein, Mengling Liu, Elise Corwin, Laura M Cox, Martin J Blaser
08/21/2012

Objectives:

To examine the associations of antibiotic exposures during the first 2 years of life and the development of body mass over the first 7 years of life.

Design:

Longitudinal birth cohort study.

Subjects:
A total of 11 532 children born at greater than or equal to2500 g in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based study of children born in Avon, UK in 1991–1992.

Measurements:

Exposures to antibiotics during three different early-life time windows (

Results:

Antibiotic exposure during the earliest time window (

Conclusions:

Exposure to antibiotics during the first 6 months of life is associated with consistent increases in body mass from 10 to 38 months. Exposures later in infancy (6–14 months, 15–23 months) are not consistently associated with increased body mass. Although effects of early exposures are modest at the individual level, they could have substantial consequences for population health. Given the prevalence of antibiotic exposures in infants, and in light of the growing concerns about childhood obesity, further studies are needed to isolate effects and define life-course implications for body mass and cardiovascular risks.

Pages

Subscribe to Health Policy