Preventive medicine
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Preventive medicine · Jan 2020
Comparative StudyThree large scale surveys highlight the complexity of cervical cancer under-screening among women 45-65years of age in the United States.
Large scale United States (US) surveys guide efforts to maximize the health of its population. Cervical cancer screening is an effective preventive measure with a consistent question format among surveys. The aim of this study is to describe the predictors of cervical cancer screening in older women as reported by three national surveys. ⋯ All three surveys show that cervical cancer screening rates in women 45-65years are insufficient to reduce cervical cancer incidence. Insurance is the major positive predictor of screening, followed by younger age and more education. Race/ethnicity are variable predictors depending on the survey.
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Preventive medicine · Jan 2020
Universal or targeted cardiovascular screening? Modelling study using a sector-specific distributional cost effectiveness analysis.
Distributional cost effectiveness analysis is a new method that can help to redesign prevention programmes by explicitly modelling the distribution of health opportunity costs as well as the distribution of health benefits. Previously we modelled cardiovascular disease (CVD) screening audit data from Liverpool, UK to see if the city could redesign its cardiovascular screening programme to enhance its cost effectiveness and equity. Building on this previous analysis, we explicitly examined the distribution of health opportunity costs and we looked at new redesign options co-designed with stakeholders. ⋯ The main outcomes were net health benefit and change in the slope index of inequality (SII) in QALYs per 100,000 person years. 'Universal plus targeted' dominated 'increased' and 'current' and also reduced health inequality by -0.65 QALYs per 100,000 person years. Results are highly sensitive to assumptions about opportunity costs and, in particular, whether funding comes from health care or local government budgets. By analysing who loses as well as who gains from expenditure decisions, distributional cost effectiveness analysis can help decision makers to redesign prevention programmes in ways that improve health and reduce health inequality.
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Preventive medicine · Jan 2020
Reading for pleasure in childhood and adolescent healthy behaviours: Longitudinal associations using the Millennium Cohort Study.
Leading a heathy lifestyle in adolescence is vital to individual health in later life. Drawing upon various existing theories, this study hypothesised that engagement in reading for pleasure may enhance healthy behaviours amongst young people. ⋯ However, spending more time reading was associated with less time spent engaging in moderate to vigorous physical activity. Our findings suggest the importance of further studies exploring the potential health benefits of reading amongst young people.
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Preventive medicine · Jan 2020
Comparative StudyClustering of unhealthy behaviors in a nationally representative sample of U.S. children and adolescents.
Poor diet, low physical activity, sedentary behavior and smoking are modifiable risk factors for chronic diseases that often develop early in life. An improved understanding of how unhealthy behaviors co-occur within individual children across childhood and adolescence could inform the development of more effective prevention approaches. Using data from the 2011-2016 National Health and Nutrition Examination Survey, we calculated weighted prevalence of five unhealthy behaviors - excessive screen time, poor diet quality, low physical activity, fast food consumption, and smoking (adolescents only) - alone and in combination among U. ⋯ Associations with household characteristics varied by age group. These results provide a population-level understanding of the extent to which unhealthy behaviors co-occur in U. S. children and adolescents.
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Preventive medicine · Jan 2020
Does the social context of early alcohol use affect alcohol-related harms in adulthood? Findings from a national birth cohort.
Internationally, laws on the provision of alcohol commonly exempt that provided by parents and/or consumed in private premises. Whether these exemptions mitigate alcohol-related harms, as has been posited, is unclear. We used data from 10,968 individuals (5216 women) from the 1970 British Birth Cohort Study. ⋯ Neither consuming alcohol with parents nor the acquisition of alcohol from home was associated with later high consumption or alcohol problems. There was a suggestion, however, that drinking with other teenagers was related to an increased risk of both outcomes (consumption: 1.32 (1.16, 1.51); alcohol problems: 1.27 (1.01, 1.58), as was acquisition from an off-license (consumption: 1.23 (0.99, 1.51); alcohol problems: 1.49 (1.17, 1.90). This study strengthens the evidence that alcohol consumption with parents, or acquisition from home, does not protect against later alcohol-related harms.