The articles below will be published online Oct. 31, 2006, at 4 p.m. (ET) by the American Journal of Public Health under "First Look" at http://www.ajph.org/first_look.shtml. "First Look" articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. These articles are scheduled to appear in the December 2006 print issue of the Journal. The American Journal of Public Health is published by the American Public Health Association, and is available at http://www.ajph.org.
1) POOR PEOPLE IN WELL-TO-DO NEIGHBORHOODS AT INCREASED RISK OF DEATHPoor people living in well-to-do neighborhoods have higher death rates than poor people in lower-income neighborhoods, despite the better health care and other health-related resources generally associated with well-to-do neighborhoods.
A population-based, 17-year mortality follow-up study of 4,476 women and 3,721 men who were age 25-74 at the start of the study found that death rates among low-income women were highest in the higher-income neighborhoods, lower in moderate-income neighborhoods, and lowest in low-income neighborhoods. Rates among men showed a similar pattern. The findings were not explained by differences in age or health risk factors. Income deprivation or low status compared with one's well-to-do neighbors may account for the findings.
"The disparities in mortality by neighborhood of residence among [low-income] women and men demonstrate that they do not benefit from the higher quality of resources and knowledge generally associated with [higher-income] neighborhoods," the study's authors wrote. [From: "Excess Mortality Among Low SES Adults in High SES Neighborhoods." ]
2) TOBACCO COMPANIES' ANTI-SMOKING ADS MAY ACTUALLY ENCOURAGE YOUTH SMOKINGThe smoking prevention ads broadcast by tobacco companies may not be reducing youth smoking, and ads aimed at parents may actually be encouraging youth in their middle and later teenage years to smoke.
A study merged commercial television ratings data from 75 U.S. media markets on average youth exposure to tobacco companies' youth-targeted and parent-targeted smoking prevention advertising with nationally representative school-based survey data taken from more than 100,000 youth from 1999- 2002. After adjusting for other factors that could influence youth smoking, researchers found few links between exposure to industry-sponsored, youth-targeted advertising and youth smoking attitudes and behavior. Yet among tenth and twelfth graders, each additional viewing of a tobacco industry parent-targeted commercial in the previous four months was associated with lower perceived harm of smoking, stronger approval of smoking, stronger intentions to smoke in the future and greater likelihood of having smoked in the past 30 days. The study's authors described the parent-targeted ads as possibly having "harmful effects on youth" by actually encouraging them to smoke. [From: "Impact of Televised Tobacco Industry Smoking Prevention Advertising on Youth Smoking-Related Beliefs, Intentions and Behavior." ]
3) PHYSICIANS OFTEN SKIP GIVING SMOKING CESSATION ADVICE, ESPECIALLY TO HISPANIC PATIENTS Some 16 million smokers could not recall receiving advice from their physician about kicking the habit in the previous year, and Hispanic smokers are least likely to hear smoking cessation advice from their doctor.
Those were the results of a study based on an analysis of data from the 2000 National Health Interview Survey involving about 5,650 smokers. Compared with Hispanics, whites, blacks and people of other non-Hispanic ethnicities were significantly more likely to report receiving advice from their physician about quitting smoking. English proficiency did not have an impact on the likelihood of receiving that advice.
The study's authors called each doctor visit with a smoker that goes by without some discussion of quitting a "missed opportunity." When combined with racial/ethnic disparities such as those found in this study, both "suggest that considerably greater effort is needed to diminish the toll stemming from smoking and smoking-related diseases." [From: "Racial/Ethnic Disparities in Report of Physician-Provided Smoking Cessation Advice: Analysis of the 2000 National Health Interview Survey." ]
4) AMERICAN INDIAN/ALASKAN NATIVE INFANTS STILL FACE HIGHER DEATH RATES American Indian/Alaska Native infants were almost twice as likely to die as white infants in 1998-2000, with much of the disparity due to sudden infant death syndrome, accidents, pneumonia and influenza.
A study that analyzed infant mortality rates in the United States in 1989-1991 and 1998-2000 found infant mortality rates dropped both among American Indian/Alaska Native infants and white infants during that time period. But in 1998-2000, American Indian/Alaska Native infants were 1.7 times more likely than white infants to die before their first birthday. Researchers found that the difference was mostly due to elevated rates of death among infants 28-364 days old. In other words, American Indian/Alaska Native infants were more likely to die from causes after the first month of life, and many of those causes are preventable with access to primary care.
"Reducing racial and ethnic disparities in infant mortality rates is a national goal," the study's authors wrote. "Preventable causes of infant mortality identified in this analysis should be targeted to reduce excess deaths among AI/AN communities." [From: "Infant mortality trends and differential between American Indians and Alaska Natives and White infants in the United States, 1989-1991 and 1998-2000." ]
5) WOMEN WITH HIGH-POWERED CAREERS LESS LIKELY TO CARRY DOWN SYNDROME BABY TO TERM Technological advances that have allowed women to know early in a pregnancy whether the baby they are carrying has Down syndrome have resulted in a shift when it comes to decisions about continuing such pregnancies, yet such advances don't seem available to all women.
A study based on data for 1,428 cases of Down syndrome in France found that 70 percent of those cases had a prenatal diagnosis. Women with higher-level professions had the highest likelihood of prenatal diagnosis of Down syndrome. The study also found that native French women were much more likely to have a prenatal diagnosis of Down syndrome than African immigrants.
Of the prenatal Down syndrome diagnoses, just 5.5 percent of the women chose to continue the pregnancy after the diagnosis. Women from lower professional categories and those of African origin tended to have higher probabilities of continuing their pregnancy after prenatal diagnosis of Down syndrome.
In the study, women without a profession had more than a two-fold increase in the odds of a Down syndrome live birth as compared with women in the highest professional category. "These disparities in prenatal diagnosis and live birth prevalence of Down syndrome persist in the context of an active national prenatal testing policy with egalitarian intentions and specific regulations and programs aimed at increasing reimbursed access to prenatal testing for Down syndrome," the study's authors wrote.
In a previous study, the authors found greater socioeconomic differences in the United States than France for prenatal testing use.[From: "Advances in Medical Technology and Creation of Disparities: The Case of Down Syndrome." ]
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