American journal of preventive medicine
-
Comparative Study
Socioeconomic differences among people with AIDS: results from a Multistate Surveillance Project.
To characterize the socioeconomic status of persons with acquired immunodeficiency syndrome (AIDS), 11 U. S. state and city health departments interviewed 2,898 persons > or = 18 years of age reported with AIDS between June 1, 1990, and January 31, 1993. Among men who have sex with men, white men reported the lowest percentage (9%), and Central/South American (50%) and Mexican men (40%) reported the highest percentages not completing 12 years of school. ⋯ Overall, 77% of the men and 90% of the women were unemployed; we also found racial/ethnic differences by employment but to a lesser degree than differences in education. Among women, but not among men, differences in household income by race and ethnicity were marked; 76% of white and 91% of black female IDUs reported a household income of $10,000. Human immunodeficiency virus (HIV) prevention programs must be targeted toward the educational level of the populations served, and HIV services must adapt to the financial circumstances of their clientele.
-
Comparative Study
Health promotion in primary care: The British perspective.
The structure of the British primary health care system allows for the development of a facilitator movement that can organize and encourage health care providers in local communities to coordinate health promotion efforts. We describe the Wycombe Primary Care Prevention Project to show how the facilitator movement can work in a local health district. The project's development and results to date demonstrate that the majority of primary care practices in the health district, departing from exclusive focus on individual care, now include community needs assessment and work on community-based health problems. We identify causative factors and discuss the generalizability of the project to other primary health care settings.
-
Comparative Study
Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale).
We derived and tested a short form of the Center for Epidemiologic Studies Depression Scale (CES-D) for reliability and validity among a sample of well older adults in a large Health Maintenance Organization. The 10-item screening questionnaire, the CESD-10, showed good predictive accuracy when compared to the full-length 20-item version of the CES-D (kappa = .97, P < .001). Cutoff scores for depressive symptoms were > or = 16 for the full-length questionnaire and > or = 10 for the 10-item version. ⋯ The CESD-10 showed an expected positive correlation with poorer health status scores (r = .37) and a strong negative correlation with positive affect (r = -.63). Retest correlations for the CESD-10 were comparable to those in other studies (r = .71). We administered the CESD-10 again after 12 months, and scores were stable with strong correlation of r = .59.
-
Comparative Study
When children have children: the teen pregnancy predicament.
Despite developments in contraceptive technology and changes in societal norms, adolescent pregnancy remains a key issue for politicians, social scientists, health care providers, and educators. The adolescent's access to contraception and abortion services continues to spark legal debate. The implications of research call for the development of innovative programs to address larger issues, such as poverty and limited access to health care, in the management and prevention of adolescent pregnancies. Clinical interventions, such as school-linked clinics to provide contraception and prenatal care programs to reduce perinatal morbidity, have varied in their approaches and their subsequent success.
-
Comparative Study
Smoking prevalence during pregnancy for women who are and women who are not Medicaid-funded.
Maternal smoking has been related to a number of adverse pregnancy outcomes. Although maternal smoking prevalence has decreased over time, certain populations have retained a high smoking prevalence and remain at high risk for adverse pregnancy outcomes. This study used the Washington State First Steps Program Database to estimate the difference in maternal smoking prevalence between mothers whose prenatal or delivery care was Medicaid-funded and mothers whose care was not Medicaid-funded. ⋯ Adequacy of prenatal care also influences smoking prevalence. For white and black mothers, the maternal smoking prevalence was lower for those receiving adequate prenatal care than for mothers of the same race who received inadequate prenatal care. The increased maternal smoking prevalence in older single mothers and the higher maternal smoking prevalence in women with Medicaid-funded deliveries suggest that infants born to these mothers may be particularly susceptible to smoking-related health effects.