The Need For Real Evidence In Physician Workforce Decision Making: A Reply To Ed Salsberg (3/15/2005)
Health Affairs, Jan-Jun 2005 Supplement Web Exclusiv, Vol. 24, pS-7-S-8, 2p.
Starfield, B., Shi, L., Grover, A. & Macinko, J.
Presents a letter to Edward Salsberg about the need for real evidence in physician workforce decision making. Opinion that one needs more information before making decisions about specialty composition in the health professions; Notion that primary care physicians could maintain expertise in several specialty areas by greatly limiting their practice size; Information that some health systems are trying to increase the supply of at least certain specialists.
Contribution of Primary Care to Health Systems and Health
Milbank Quarterly, Vol. 83 Issue 3, p457-502, 46p.
Starfield, B., Shi, L. & Macinko, J.
Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups.
Reductions In Firearm-Related Mortality And Hospitalizations In Brazil After Gun Control
Health Affairs, Mar/Apr 2007, Vol. 26 Issue 2, p575-584, 10p.
de Souza, M., de Fatima, M., Macinko, J., Alencar, A.P., Malta, D.C. & de Morais Neto, O.L.
This paper provides evidence suggesting that gun control measures have been effective in reducing the toll of violence on population health in Brazil. In 2004, for the first time in more than a decade, firearm-related mortality declined 8 percent from the previous year. Firearm-related hospitalizations also reversed a historical trend that year by decreasing 4.6 percent from 2003 levels. These changes corresponded with anti-gun legislation passed in late 2003 and disarmament campaigns undertaken throughout the country since mid-2004. The estimated impact of these measures, if they prove causal, could be as much as 5,563 firearm-related deaths averted in 2004 alone.
Notes from the Field: Jumpstarting the IRB Approval Process in Multicenter Studies
Health Services Research, Volume 42, Number 4, August 2007 , pp. 1773-1782(10) Blackwell Publishing.
Blustein, J., Regenstein, M., Seigel, B. & Billings, J.
Objective. To identify strategies that facilitate readiness for local Institutional Review Board (IRB) review, in multicenter studies.
Study Setting. Eleven acute care hospitals, as they applied to participate in a foundation-sponsored quality improvement collaborative.
Study Design. Case series.
Data Collection/Extraction. Participant observation, supplemented with review of written and oral communications.
Principal Findings. Applicant hospitals responded positively to efforts to engage them in early planning for the IRB review process. Strategies that were particularly effective were the provisions of application templates, a modular approach to study description, and reliance on conference calls to collectively engage prospective investigators, local IRB members, and the evaluation/national program office teams. Together, these strategies allowed early identification of problems, clarification of intent, and relatively timely completion of the local IRB review process, once hospitals were selected to participate in the learning collaborative.
Conclusions. Engaging potential collaborators in planning for IRB review may help expedite and facilitate review, without compromising the fairness of the grant-making process or the integrity of human subjects protection.
Who Is Accountable for Racial Equity in Health Care?
Journal of the American Medical Association. Vol. 299 No.7, February 20: 814-816.
Racial disparities are a ubiquitous feature of the US medical landscape, with health care delivery substantially segregated by race/ethnicity. Recent evidence from hospitals,1-3 nursing homes,4-5 and physicians' offices6 suggests that those caring for minority patients do not perform as well as those who care for nonminority patients, on average. This evidence is troubling but hardly surprising because the limited resources of those who care for the poor have helped to create and sustain racial disparities. As the United States enters an era of accountability in health care, it is time to consider these familiar circumstances from a new perspective.
Anti-Fett Politik: Ubergevicht und staatliche Interventionspolitik in den USA
in H. Schmidt-Semisch & F. Schorb, eds., Kreuzzug gegen Fette [Political Crusade Against Fat]. Translated from original. Wiesbaden, Germany: VS Verlag / Springer Publishing
Kersh, R. & Monroe, J.
Der Aufruf des Surgeon Generals 2 beginnt dramatisch: „Übergewicht und Adipositas haben epidemische Ausmaße erreicht...." (Satcher zit. nach Mokdad 2001). Wissenschaftler, Regierungssprecher, Medienexperten, Journalisten und Lobbygruppen stimmen zunehmend lauter in diesen alarmistischen Chor ein. Im Gegensatz aber zu vielen anderen Public-Health-Problemen ist Adipositas zu großen Teilen individuellen Verhaltensweisen wie Essen und Trinken geschuldet. In den Vereinigten Staaten mit ihrer starken Kultur des Individualismus wird Privates oft als Tabuzone für staatliche Interventionen betrachtet: „Die Regierung sollte sich aus den persönlichen Entscheidungen, die ich treffe, heraushalten", schreibt der Washingtoner Universitätsprofessor Robert Rüssel, „meine bzw. deine Essgewohnheiten rechtfertigen nicht, dass mir die Regierung in den Kochtopf guckt" (zit. nach St. Louis Dispatch: 21.03.2002).
Lobbyists: Ten Myths About Power and Influence
Health Politics & Policy, Jan 2008, 4th ed.
The fourth edition of Health Politics and Policy examines the political arena in which United States health care policies are made, and provides a framework for understanding how the process works. This book conveys the excitement of health care politics and covers the issues facing the American health care system. Factors that shape health policy are discussed in detail, including values, private players, and government, as well as the resulting dynamic of these forces. A comparison of the U.S. system to others offers a foundation for understanding our system within an international context.
Political Parties and Interest Groups: The New Symbiosis
in Richard Skinner, ed., Webs of Power. Oxford University Press.
Panel Discussion: Incarcerated Adolescents and AIDS
Journal of Prison and Jail Health, Vol. 8, No. 2, 1989.
Future Challenges: Creativity in the Business of Improving the World for the Children
in Sheahan, Paula M. (ed.)., Health Care of Incarcerated Youth: Report from the 1991 Tri-Regional Workshops, Washington, D.C.: National Center for Education in Maternal and Child Health, pp. 141-153
The Case of the Unhealthy Hospital
case comment, Harvard Business Review, September-October 1991, pp.18-20
Engaging the Next Generation in Family Philanthropy
Case Study No. 1, Andreas and Charles Bronfman Philanthropies
Kaplan, S.A. & Schall, E.
Every family has its own unique dynamics and conversations. Philanthropy adds a new dimension to these conversations which are often taking place both within and between generations. This is why 21/64 partnered with New York University's Robert F. Wagner Graduate School of Public Service to create a case study about multigenerational issues in family foundations. By exploring the issues of a hypothetical family in this case study, and utilizing questions in the accompanying Facilitator's Guide, families and professional advisors can begin to develop a healthy family process and productive philanthropic enterprise.
School-Based Health Education: What Works?
American Journal of Preventive Medicine, Vol. 10, No. 3, pp. 30-32.
Long-Term Associations of Homelessness with Children's Well-Being
American Behavioral Scientist, Feb 2008, Vol. 51 Issue 6, p789-809, 21p
Shinn, M., Schteingart, J.S., Williams, N.P., Carlin-Mathis, J., Bialo-Karagis, N.,Becker-Klein, R. & Weitzman, B.C.
To analyze long-term consequences of homelessness, the authors compared 388 formerly homeless children 55 months after shelter entry with 382 housed peers, birth to 17, using mother- and child-reported health, mental health, community involvement, cognitive performance, and educational records. Both groups scored below cognitive and achievement norms. Small group differences favored housed 4- to 6-year-olds on cognition and 4- to 10-year-olds on mental health only. Child care and recent stressful events, which were high, were as or more important than prior homelessness. Only children living with mothers were included, potentially biasing results. Policy implications are discussed.
A New Approach to the Comparative Analysis of Health Systems: Invasive Treatment for Heart Disease in the US, France, and Their Two World Cities
Health Economics, Policy and Law, Volume 2, Issue 01, January 2007, pp 73-92
Gusmano, M.K., Rodwin, V.G., Weisz, D. & Das, D.
Cross-national comparisons that assess dimensions of health system performance indicate that the US provides higher rates of revascularization procedures than France and other developed nations, but we believe these findings are misleading. In this paper, we compare the use of these procedures in the US, France and their two world cities, Manhattan and Paris. In doing so, we address a number of limitations associated with existing cross-national comparisons of heart disease treatment. After adjusting for the prevalence of disease in these nations and cities, we found that residents of France aged 45ï¿½64 years receive more revascularization procedures than residents of the US and that Parisians receive more revascularizations than residents of Manhattan. Older residents 65 years and over (65 ) in the US receive more of these procedures than their French counterparts, but the differences are not nearly as great as previous studies suggest. Moreover, our data on Manhattan and Paris where the population and level of health resources are more comparable, indicate that older Parisians obtain more revascularization procedures than older Manhattanites. Finally, we found that the use of revascularization procedures is significantly lower in Manhattan among persons without private health insurance and among racial and ethnic minorities.
Attitudinal and contextual factors associated with discussion of sexual issues during adolescent health visits
Journal of Adolescent Health 2004:35(2)108-115.
Merzel, C.R., Van Devanter, N., Middlestadt, S.E., Bleakley, A., Ledsky, R. & Messeri, P.A.
The purpose was to examine attitudinal and contextual factors associated with the occurrence of sexual health assessments during adolescent primary care visits. A total of 313 primarily African-American youth aged 11-21 years from 16 community-based organizations in suburban Maryland and in New York City completed questionnaires focusing on sexually transmitted diseases (STD) and health care. The analysis examined the relationship of sexual activity, attitudes, and presence of the parent at the health care visit with discussion of three sexual health topics and testing for STD at the most recent health care visit. Data were analyzed using Chi-square tests and logistic regression. Overall, 74% of respondents reported that they had talked about at least one sexual health topic at their last health care visit but only 32% had discussed all three topics of sexual behavior, birth control, and STD. Females were more likely than males to discuss birth control although there were no gender differences in the overall likelihood of talking about a sexual health topic. Few adolescents initiated discussion of sexual issues. Positive attitudes toward discussing sexual issues with a provider and absence of a parent at the visit were independently associated with higher odds of discussing at least one sexuality topic and STD testing. Although relatively large numbers of adolescents in the sample received sexual health assessments, the proportion was below recommended guidelines. The opportunity to speak privately with a clinician and having positive attitudes about discussing sex with a doctor appear to be important influences on the receipt of sexual health assessments. Improving the quality of adolescent preventive care will require creating a health care environment that facilitates discussion of sexual health issues
The WINGS Project: Modeling intervention effectiveness for high-risk women
Evaluation & the Health Professions, Vol. 23, No. 2, 123-148
Greenberg, J., Hennessy, M., Celentano, D., Gonzales, V. & Van Devanter, N.
This study evaluates the effectiveness of two strategiesï¿½communication and condom skills trainingï¿½for increasing condom-protected sex in a sample of 510 high-risk women ages 17 to 61. Baseline and 3- and 6-month postintervention interview data were gathered in three cities participating in a randomized trial of a six-session, group skill-building intervention. This analysis was conducted for the entire sample and for six subgroups categorized by age, single or multiple partners, and history of childhood sexual abuse. The dependent variable was the odds ratio of protected sex acts at each follow-up. Structural equation modeling was used to estimate effects for two intervention pathways. The pathway through condom skills increased the odds of protected sex for the intervention group (2 difference = 35, df = 2, p < .05) as well as for all subgroups. The pathways through communication were significant for the intervention group (2 difference = 23, df =3, p < .05) but fully effective only for participants under 30 and participants who reported childhood sexual abuse. The effectiveness of both pathways diminished at 6 months. WINGS demonstrates that condom skills training can increase protected sex for a heterogeneous group of women. Further research needs to examine how such skill training translates into use of condoms by male partners. To increase the duration of intervention effects, booster sessions may need to be incorporated.
Factors influencing participation in weekly support groups among women completing an HIV/STD Intervention program
Women and Health 2000; 30(1): 15-35
Van Devanter, N., Parikh, N., Cohall, R., Faber, N., Litwak, E., Messeri, P., Gonzales, V., Kruger, S. & Greenberg, J.
Over the past three decades, the influence and importance of social support has been well documented and the findings have suggested a beneficial effect on stress-related situations, mental and physical health, and social functioning. More recently, small group/skills training behavioral interventions have demonstrated success in changing behaviors which affect the transmission of sexually transmitted diseases, including HIV among populations at risk for these diseases. Studies of support groups to date have been conducted exclusively in research settings where women are offered financial incentives for participation. Little is known about the willingness of women to participate in ongoing support groups after successfully completing a skills training intervention. The present study examines the factors that may influence participation among women in a weekly support group after completing a structured, six session HIV/STD intervention. Both quantitative and qualitative data are collected from 265 women in the intervention arm of a multi-site randomized controlled behavioral intervention trial. Results reveal that less than a quarter (22%) of women participated in at least one support group. Participation varied significantly by site, ranging from 34% to 15% (p = .008). Participation was also strongly linked to recent use of domestic violence services. Qualitative data indicated that although monetary incentives play some role in the woman's decision to participate, other factors are also important. These include program outreach, support group size, salience of the group content, consistency of group leadership from the intervention to the support group, and use of peer leaders along with professional facilitators. Implications for design of post-intervention support groups programs are discussed.
Prevention of Sexually Transmitted Diseases: The Need for Social and Behavioral Science Expertise in Public Health Departments (Editorial)
American Journal of Public Health; 1999 89(6) 815-818
Van Devanter, N.
This article reflects on a need for social and behavioral science expertise in public health departments in the U.S. for the prevention of sexually transmitted diseases (STD). In the developed world, the U.S. has the highest rates of STD, higher than for some developing countries. As a result of sexual behaviors, which are shaped by social and environmental factors in communities, individuals are at risk for STD. A landmark report by the Institute of Medicine in 1997 concluded that the outbreak of STD is influenced by the lack of awareness among the general public, lack of skills and training among health professionals and the absence of an effective national system for the prevention of STD.
Transfer of behavioral intervention technology to an STD Clinic setting
Journal of Public Health Management and Practice 1999; 5(5): 40-51.
Van Devanter, N., Cicatelli, B., Weisfuse, I., Halpern, O., Levinson, M., Deli, K. & Dunn, A.