A 3-D model of health decline: disease, disability, and depression among Black and White older adults

Much of the research on health decline in older adulthood has specified a single causal direction between two health domains, often measured at the same time point, making it difficult to disentangle the mechanisms of health decline over time. Using three waves of data over seven years from older residents of North Carolina, a 3-D model is used to examine the temporal ordering of general health decline and the pathways of influence across three health domains (disease, disability, and depression). In addition, we test whether the 3-D model of health decline is similar for Black and White older adults. Results indicate that both prevalent and incident disease lead to increases in depression and that prevalent disease leads to greater disability three years later. Depression, in turn, leads to disease, identifying a cycle of health decline that is, for the most part, similar for Black and White older adults. The effect of widowhood is more deleterious to the health of Black older adults than for their White counterparts.     

Heart Ed 101

Cardiovascular disease is the leading cause of death for men and women in the United States. Risk factors and health behaviors combine over time to contribute to the disease process. College communities provide a unique environment for health promotion, risk reduction, and primary intervention. Heart health should be an integral part of college health.     

Immunization documentation practices and vaccine-preventable disease surveillance capacity among institutions of higher education in Indiana

Objective: Complete and accurate documentation of immunization records and surveillance of disease transmission are critical to the public health response to outbreaks of communicable disease in institutions of higher education (IHEs). This study aims to describe immunization documentation practices and disease surveillance capacity among IHEs in Indiana in order to inform public health action. Methods: IHEs in Indiana were identified and included in the study if they offered on-campus housing and had a dedicated student health center. Phone surveys were administered in September 2015 to each institution, inquiring about current immunization documentation policies and practices, disease surveillance capacity, and use of statewide electronic reporting systems. Additionally, IHE websites were searched to identify immunization documentation requirements for matriculating students. Results: Surveys were completed for 33 of 38 eligible IHEs. Twenty-three (70%) IHEs reported that student immunization records are entered into an accessible electronic system or database. Matriculating student immunization requirements were identified for 32 institutions. Of these, 22 (69%) required a physician-signed proof of immunization. No IHEs reported documenting historical immunizations in the statewide electronic immunization system and three IHEs (9%) reported utilizing the state electronic disease surveillance program. Conclusions: Immunization documentation practices vary among IHEs in Indiana and use of statewide immunization and disease reporting systems is minimal. Robust utilization of immunization and disease surveillance systems has been shown to improve public health response to communicable disease outbreaks. Improving mutual understanding of policy and practice between health departments and IHEs could improve the ability to respond to public health challenges.     

Adapting the selective periodic health exam to a college-aged population. Joint American Preventive Services Task Force. Canadian Task Force on Health Care Screening

The periodic health examination is a group of tasks carried out by physicians at regular intervals, but not always yearly. It is designed to determine either the risk of subsequent disease or to identify disease in its early, asymptomatic state. These tasks include immunizations, health promotion topics, and specific clinical screening maneuvers. This paper seeks to increase awareness of the extensive work being done by the Canadian Task Force on Health Care Screening and the Joint American Preventive Services Task Force in setting standards for the periodic health exam. The exam can be reviewed in the office and urgent-care setting or promoted in health education activities. Knowledge of the new standards for the periodic health exam can help in setting priorities for preventive activities in student health services. Implementation in the college-aged group will require cost considerations.     

In sickness but not in health: self-ratings, identity, and mortality

Self-rated health as a predictor of mortality has been studied primarily in large, representative populations, with relatively little progress toward understanding the information processing that individuals use to arrive at these ratings. With subsamples of National Health and Nutrition Examination Survey (NHANES) Epidemiologic Follow-up Study (NHEFS) data for respondents with circulatory system disease (N = 3,709) and respondents with no diagnosable disorders (N = 1,127) at baseline, we test the idea that individuals with experience of chronic disease of the circulatory system will have more predictive self-ratings of health than healthy individuals. Poor or fair self-rated health increased the adjusted hazard of all-cause mortality for respondents with circulatory system disease, but not for respondents who were healthy. Additional analyses confirm that poor or fair self-rated health is particularly predictive for respondents with self-reported history of circulatory system diagnoses and perception of symptoms, but not for respondents without symptoms or diagnoses prior to the NHANES physical exam.     

Utilizing health ambassadors to improve type 2 diabetes and cardiovascular disease outcomes in Gadsden County,Florida

Minority racial and ethnic groups are at higher risk for developing type 2 diabetes. These groups also experience more severe complications from diabetes and have higher mortality rates as a result of the disease, such as cardiovascular disease, amputation and kidney failure. Underserved rural ethnically disparate populations benefit from health education outreach efforts that are conveyed and translated by specially-trained community health ambassadors. Project H.I.G.H. (Helping Individuals Get Healthy) was developed to target the priority areas of type 2 diabetes and cardiovascular disease. Utilizing trained community health ambassadors, CDC's The Road to Health Toolkit as well as New Beginnings: A Discussion Guide for Living Well with Diabetes was used as a model for a community-based educational program. The overall goal of Project H.I.G.H was to implement and evaluate: (1) a coordinated, behavior-focused, family-centered, community-based educational program and; (2) a client service coordination effort resulting in improved health outcomes (BMI, Glucose Levels, BP) for individuals with type 2 diabetes and cardiovascular disease in Gadsden County, Florida. Overall, Project H.I.G.H. was very successful in its first year at motivating participants to delay or prevent diabetes and/or cardiovascular disease or at the very least to start taking better care of their health.     

Sexuality and health challenges: responding to a public health imperative

Sexuality is associated with a number of public health imperatives to prevent disease or disability or, if prevention is not possible, to treat and reduce the burden of disease as expeditiously as possible. With the advent of modern testing technology and better sampling of populations, the burden of sexually transmissible infections, sexual assault, and sexual disability have become more apparent. Presented here are U.S. data on the public health dimensions of human sexuality and the evidence for the urgent need to address the magnitude of sexually related public health problems.     

Polymorphism-screening: genetic testing for predisposition—guidance for technology assessment

Health policy is increasingly confronted with the demand for financing genetic testing on inherited susceptibility to disease. Tests on polymorphism/SNP associated with multicausal and chronic conditions are already offered in private commercial institutions or in academic hospitals. The increasing pressure on public health services to offer SNP testing leads to first methodological approaches for a generally valid regulatory framework applicable for inclusion or refusal of genetic tests into the public health services. Systematic search in Medline, Embase and the Web for methodological papers or guidelines for the assessment of polymorphism-screening. Since genetic testing has not only clinical and economic effects on health care, but also primarily ethical consequences by profiling our understanding of “health” and “disease”, this paper gives an overview of relevant aspects and background information to consider in the assessment of genetic tests. Although 2–3 million SNPs are identified and the journals are full of reported “significant” associations between disease and mutation, only a few can be replicated unequivocally. The ACCE (Analytic and Clinical Validity, Clinical utility; Ethical, legal and social implications)-framework was developed by the Center of Disease Control for the assessment of genetic testing. This standardised appraisal approach proposes collecting and evaluating: (a) Prevalence, genotype-/phenotype-relation. (b) Clinical presentation: natural history; the different expressions of disease. (c) Performance of the genetic test. (d) Implications for therapy and prevention. (e) Conclusion for clinical applications of risk-profiling of health on their susceptibility to disease and/or for clarification of disease for therapy planning. Since genetic testing is urging its way into the health care system, the actual danger is, that population screening starts before valid evidence from big prospective studies have been carried out and delivered proofs of direct causal associations. Before diffusing into the health care system we are suggesting to take a cautious and standardised approach.     

Adolescent Loneliness and Health in Early Adulthood

The health consequence of loneliness in the early life course is an understudied topic in the sociological literature. Using data from Waves 1–3 of the National Longitudinal Study of Adolescent Health, we examine pre‐disease pathways in the relationship between adolescent loneliness and early adult health. Our results indicate that loneliness during adolescence is associated with diagnosed depression, poorer adult self‐rated health, and metabolic risk factors related to cardiovascular disease. High depressive symptoms and parent support are important pathways through which the health consequences of loneliness are exacerbated or offset. There is also evidence that lonely youth remain at higher risk for experiencing adult depression and poor self‐rated health even in the presence of equivalent levels of parental support relative to non‐lonely adolescents. Furthermore, lonely adolescent females are more vulnerable to reporting poor adult self‐rated health and being overweight or obese in adulthood. In sum, our study demonstrates the importance of adolescent loneliness for elevating the risk of poor health outcomes in adulthood.     

Educational differences in age-related patterns of disease: reconsidering the cumulative disadvantage and age-as-leveler hypotheses

Some studies suggest that the relationship between education and health strengthens with age (cumulative disadvantage hypothesis), while other studies find that it weakens (age-as-leveler hypothesis). This research addresses this inconsistency by differentiating individual-level changes in health from those occurring at the aggregate level due to selective mortality. Using retrospective and prospective data from a nationally representative sample of US. adults, I examine educational differences in age-specific rates of disease prevalence, incidence, and survival. At the aggregate level, I find that educational differences in disease prevalence are largest at mid-life and then decline. At the individual level, however, disease incidence and mortality increase with age at a greater rate for less-educated persons compared to the well educated. These findings suggest that the cumulative disadvantage hypothesis explains how education affects the health of individuals with increasing age, whereas the leveling hypothesis describes the aggregated by-product of these educational disparities in health decline.     

The risks associated with alcohol use and alcoholism

Alcohol consumption, particularly heavier drinking, is an important risk factor for many health problems and, thus, is a major contributor to the global burden of disease. In fact, alcohol is a necessary underlying cause for more than 30 conditions and a contributing factor to many more. The most common disease categories that are entirely or partly caused by alcohol consumption include infectious diseases, cancer, diabetes, neuropsychiatric diseases (including alcohol use disorders), cardiovascular disease, liver and pancreas disease, and unintentional and intentional injury. Knowledge of these disease risks has helped in the development of low-risk drinking guidelines. In addition to these disease risks that affect the drinker, alcohol consumption also can affect the health of others and cause social harm both to the drinker and to others, adding to the overall cost associated with alcohol consumption. These findings underscore the need to develop effective prevention efforts to reduce the pain and suffering, and the associated costs, resulting from excessive alcohol use.     

Understanding the Russian Health Crisis: a Sociological Perspective

This essay applies a sociological perspective to the health crisis in Russia by delving increasingly deeper into the layers of causes. The major characteristic of this crisis is the decline in life expectancy among men and the relative stagnation of longevity among women. The primary cause is increased cardiovascular disease and alcohol-related poisoning and accidents. However, in order to determine the ultimate cause, it is necessary to examine secondary level factors to explain what is responsible for the rise in heart disease and alcohol-based afflictions. Several secondary factors were considered, including infectious disease, poor medical care, environmental pollution, policy, and stress, but the strongest evidence supported negative health lifestyles. The next step is find what is causing a lifestyle harmful to male health in particular and while stress is likely important – the best tertiary level cause is the deeply embedded working-class style of heavy drinking that is normative in Russia.     

Health Care for Older Women:

The issue of health care for older women as it relates to their financial resources and health care reimbursement is the focus of this paper. Federal regulations that affect older women and also the role of the medical establishment are examined. Suggestions are given for policy changes on the federal and local levels and for a redirection of the women's health movement. It is suggested that women tend to be seen as burdens to the health care system and face both age and sex discrimination from many health care providers. This is the disease that needs to be cured.     

Incarceration as exposure: the prison, infectious disease, and other stress-related illnesses

This article examines the relationship between incarceration and health functioning. Using data from the National Longitudinal Survey of Youth, the relationship between incarceration and more than 20 different measures of health are tested. Using multiple analytic procedures, a distinctive pattern of association emerges. Individuals with a history of incarceration appear consistently more likely to be afflicted with infectious disease and other illnesses associated with stress. In contrast, no consistent relationships were observed between incarceration status and ailments unrelated to stress or infectious disease. The results suggest that exposure to infectious disease and stress are important to understanding the lasting impact of incarceration on health.     

Evaluating the complex interactions between malaria and cholera prevalence,neglected tropical disease comorbidities,and community perception of health risks of climate change

The burgeoning literature on the climate change–human health nexus has focused almost exclusively on the health impacts of climate change with little attention to how ill-health and disease influence public perception of the health risks of climate change. Based on a cross-sectional survey of 1,253 individuals, linear regression was used to examine the independent effects of malaria and cholera prevalence, and neglected tropical disease comorbidities on perceived health risks of climate change. Individuals who reported more comorbidities had higher scores on perceived health risks of climate change compared with those who did not report any comorbidities. Unexpectedly, at the multivariate level, there were no statistically significant relationships between age of respondents, gender, and educational attainment on the one hand, and perceived health risks of climate change on the other hand. Individuals who were diagnosed with cholera in the past 12 months had higher scores on perceived health risks of climate change but there was no relationship between diagnosis with malaria in the past 12 months and perceived health risks. Individuals who had attained secondary education had lower scores on perceived health risks of climate change compared with those without any formal education. Given that this relationship did not exist at the bivariate level, it indicates that biosocial and sociocultural factors suppressed the relationship between secondary education attainment and perceived health risks of climate change. The findings underscore the complex relationship between perceived health risks of climate change and infectious disease, comorbidities, compositional, and contextual factors at the multivariate level.     

The periodic health examination in college students revisited.

The periodic health examination is a group of tasks carried out by physicians and nurses at regular intervals, but not always yearly, to determine either the risk of subsequent disease or to identify disease in its early, asymptomatic state. The Guide to Clinical Preventive Services, published in 1989 by the United States Preventive Services Task Force, sets common American standards for these procedures. The guide lists those preventive activities recommended for persons aged 19-39 years. Every patient encounter in our student health services should be considered an opportunity for preventive activities. This article offers a simple check list for office use.     

College men's health in practice: a multidisciplinary approach

After a needs assessment indicated that male students underutilized campus health services, the San Francisco State University Student Health Service developed a coordinated complement of outpatient health services for men. The authors review their experience in developing, implementing, operating, and evaluating this ongoing clinical service. The needs assessment and subsequent program evaluation data suggest that male students on a large, culturally diverse, urban campus would respond favorably to targeted, multidisciplinary health initiatives that incorporate the principles of health promotion and disease prevention.     

Marital status, social support, and health transitions in chronic disease patients

Married persons tend to be healthier, both physically and mentally, than unmarried persons. We tested the hypothesis that being married results in better physical and mental health outcomes for chronic disease patients (N = 1,817) by increasing social support. We modeled health outcomes one year later, controlling for initial health status. Cross-validation studies of two random halves of the sample supported an indirect effect of marital status on mental health through social support, but did not support a relationship, direct or indirect, of either marital status or social support with physical health outcomes. In addition, specific types of functional support were not differentially predictive of mental health status.     

Conducting a Hispanic Health Needs Assessment in rural Kansas: Building the foundation for community action

Healthy People 2020 states ethnic health disparities are a priority for the US. Although considerable national statistics document ethnic-related health disparities, information specific to rural areas is scarce and does not provide direction for implementing chronic disease prevention programming. Therefore, the purpose of our project was to use the Hispanic Health Needs Assessment (HHNA), a tool designed by the National Alliance for Hispanic Health (NAHH), in culturally diverse, rural Southwest Kansas. Our focus areas included: access to healthcare, heart disease, diabetes, overweight, nutrition, and physical activity.MethodsThe assessment followed six steps: (1) developing the assessment team, (2) data gathering using community member surveys, existing statistics and community leader interviews, (3) assembling the findings, (4) formulating recommendations for action at individual, institutional, community and policy levels, (5) sharing findings and program planning, and (6) sharing findings with NAHH. We identified several challenges collecting health related data in rural communities, but overall, the HHNA was a comprehensive and useful tool for guiding a community level health assessment.ConclusionThis process has provided our community partners with locally relevant statistics regarding the current status of health, health behaviors, and perceived community needs to inform resource allocation, program planning and applications for new funding initiatives.     

Conducting a Hispanic Health Needs Assessment in rural Kansas: building the foundation for community action

Healthy People 2020 states ethnic health disparities are a priority for the US. Although considerable national statistics document ethnic-related health disparities, information specific to rural areas is scarce and does not provide direction for implementing chronic disease prevention programming. Therefore, the purpose of our project was to use the Hispanic Health Needs Assessment (HHNA), a tool designed by the National Alliance for Hispanic Health (NAHH), in culturally diverse, rural Southwest Kansas. Our focus areas included: access to healthcare, heart disease, diabetes, overweight, nutrition, and physical activity. METHODS: The assessment followed six steps: (1) developing the assessment team, (2) data gathering using community member surveys, existing statistics and community leader interviews, (3) assembling the findings, (4) formulating recommendations for action at individual, institutional, community and policy levels, (5) sharing findings and program planning, and (6) sharing findings with NAHH. We identified several challenges collecting health related data in rural communities, but overall, the HHNA was a comprehensive and useful tool for guiding a community level health assessment. CONCLUSION: This process has provided our community partners with locally relevant statistics regarding the current status of health, health behaviors, and perceived community needs to inform resource allocation, program planning and applications for new funding initiatives.