空气污染治理与公众健康———来自“大气十条”政策的证据

为探究《大气污染防治行动计划》 (以下简称“大气十条”)的健康效应,本文基于中国健康与营养调查(CHNS)数据及省级面板数据,利用基于多项Logit模型的双重差分法(Logit-DID),从微观与宏观两个维度考察“大气十条”政策的健康改善效应及其传导机制,并进一步通过异质性分析探讨环境健康不平等的内在原因 研究发现:“大气十条”实施带来显著的健康效应,该政策不仅能有效控制与空气污染高度相关疾病的发病率和死亡占比,还能够间接降低受空气污染影响较小的疾病病情。其作用机理主要通过控制PM2.5浓度改善公众健康,同时该政策对二氧化硫(SO2)、氮氧化物、烟(粉)尘等其 他污染物浓度的下降起到了协同作用。进一步分析显示环境福利不公平的现象依然存在,“大气十条”政 策显著降低了疾病高发人群的发病率,且对女性、城镇居民和低、高年龄段等疾病高发人群的健康影响更显著。本文为政府构建环境健康公平发展路径,推进“健康中国”战略提供了经验证据和政策借鉴。     

Narrating Sustainability in Canadian Health Care Reform Discourse

In Canada, as in other industrialized welfare states, definitions of health system sustainability reflect different goals and correspondingly diverse ways of understanding exactly what is to be sustained and how. In this article, we report on results from a survey of documents and groups involved in and/or concerned about sustainability of the healthcare system. We identify four broad narratives of sustainability in Canadian healthcare reform discourse, and explore what these different sustainability narratives tell us about the character and contours of these often‐fractious debates. We argue that sustainability itself may not be a paradigm shift, as has been suggested, but a plot device that helps to steer the story in a particular direction, ‘black‐boxing’ certain aspects of context and emphasizing others.     

Vision and state health department public relations practitioners: Prepared to lead?

Visions are important to organizational effectiveness. Although providing vision has been identified as one of the behaviors that best captures organization-wide public relations leadership, little public relations research has focused on vision. Similarly, state health departments have drawn little interest among public relations scholars even though states are a central part of the nation's public health system. This study addressed the perceptions of the top public relations professionals at state health departments concerning vision and their involvement in the visioning process. The practitioners were nearly unanimous in their belief that organizational visions are important. However, results indicate that some top public relations practitioners at state health departments are not prepared to make optimal contributions to the visioning process. In order to take full advantage of opportunities to serve as organization-wide leaders, public relations practitioners should seek out information about visioning in order help chart their organization's future and enhance their careers.     

Trust and the Dilemmas of Suicide Risk Assessment in Non-government Mental Health Services

Reducing suicide rates is a national mental health priority as over 2,200 people die from suicide each year in Australia. Increasingly, nongovernment organisations (NGOs) provide services to people experiencing severe and persistent mental illnesses—a significant cohort at risk of suicide. While clinical services are generally seen as the arbiters of risk, little is known of how suicide risk assessments are undertaken in NGOs. This article reports the findings of a survey-based pilot study of 44 frontline workers in mental health-focused NGOs in Tasmania, Australia, with the aim of sketching a preliminary picture of this under-studied terrain. We identified the assessment practices utilised by workers, and the challenges and dilemmas they experienced in navigating issues of trust in suicide risk assessment in contexts where they often felt vulnerable and under-prepared. We argue that these early findings demonstrate the need for organisations to foster cultures of trust to facilitate both the activities of relationship building between practitioners and clients, and those of monitoring risk.     

Changes in the labour market and health inequalities during the years of the recent economic downturn in Italy

There is widespread concern that episodes of unemployment and unstable working conditions adversely affect health. We add to the debate by focusing on the relationship between work trajectory and the self-reported health of Italian men and women during the present economic downturn. Relying on Italian data in the EU-SILC project (from 2007 to 2010), our sample includes all individuals aged 30 to 60 in 2010, and uses multivariate binomial regression models for preliminary analyses and the Structural Equations modelling (SEM) to observe the cumulative effects of health status according to different job trajectories. Our main findings show similar pictures for men and women. Individuals who are unemployed, ejected or in precarious occupational positions have a higher risk of worsening their health status during these years.     

Leaving my religion: Understanding the relationship between religious disaffiliation,health, and well-being

Religious disaffiliation—leaving the religious tradition in which one was raised for no religious affiliation in adulthood—has become more common in recent years, though few studies have examined its consequences for the health and well-being of individuals. We use an innovative approach, comparing the health and subjective well-being of religious disaffiliates to those who remain affiliated using pooled General Social Survey samples from 1973 through 2012. We find that religious disaffiliates experience poorer health and lower well-being than those consistently affiliated and those who are consistently unaffiliated. We also demonstrate that the disadvantage for those who leave religious traditions is completely mediated by the frequency of church attendance, as disaffiliates attend church less often. Our results point to the importance of the social processes surrounding religious disaffiliation and emphasize the role of dynamics in the relationship between religious affiliation and health.     

Deriving Behavior Model Parameters from Survey Data: Self‐Protective Behavior Adoption During the 2009–2010 Influenza A(H1N1) Pandemic

In this paper, we demonstrate how public opinion surveys can be designed to collect information pertinent to computational behavior modeling, and we present the results of a public opinion and behavior survey conducted during the 2009–2010 H1N1 influenza pandemic. The results are used to parameterize the Health Belief Model of individual health‐protective decision making. Survey subjects were asked questions about their perceptions of the then‐circulating influenza and attitudes towards two personal protective behaviors: vaccination and avoidance of crowds. We empirically address two important issues in applying the Health Belief Model of behavior to computational infectious disease simulation: (1) the factors dynamically influencing the states of the Health Belief Model variables and (2) the appropriateness of the Health Belief Model in describing self‐protective behavior in the context of pandemic influenza.     

Examining Outpatient Health Care Utilization Among Adults with Severe or Profound Intellectual Disabilities Living in an Urban Setting

Abstract

The present study examined the health status and outpatient health care utilization among 52 adults with severe or profound intellectual disabilities (IDs) living with their families or in group homes in New York City. Bivariate and regression analyses among demographic variables, medical conditions, health care utilization, and type of living situation were conducted. Findings indicate that demographic factors andhealth statuses were similar regardless of living situation, except for ageand the presence of Down Syndrome, that is, younger people and people with Down Syndrome were more likely to live with family than in group homes. The results indicated that regardless of where they lived, individuals had high rates (70%) of overweight/obesity. The mean number of internal medicine, specialty medicine, nursing, and total clinic visits were significantly higher for those living in group homes compared to those living with their families. The findings and their implications are discussed with respect to social work policy and practice.     

Efficacy of Statistical Outlier Analysis for Monitoring Quality of Care

Researchers have proposed that hospitals with excessive statistically unexplained mortality rates are more likely to have quality-of-care problems. The U.S. Health Care Financing Administration currently uses this statistical “outlier” approach to screen for poor quality in hospitals. Little is known, however, about the validity of this technique, since direct measures of quality are difficult to obtain. We use Monte Carlo methods to evaluate the performance of the outlier technique as parameters of the true mortality process are varied. Results indicate that the screening ability of the technique may be very sensitive to how widespread quality-related mortality is among hospitals but insensitive to other factors generally thought to be important.     

The Culture of High-Risk Alcohol Use Among Club and Intramural Athletes

Abstract

Objective: The purpose of this study was to examine the drinking patterns of club and intramural college athletes and compare their alcohol consumption, perceived norms around the excessive use of alcohol, experience of negative consequences, and employment of protective strategies with those of campus varsity athletes. Participants: A total of 442 undergraduate students attending a private, suburban institution in the Northeast participated in the American College Health Association National College Health Assessment-II Web survey in spring 2011. Thirty-five students identified themselves as varsity athletes, 76 identified as club sport athletes, and 196 students identified themselves as intramural athletes. Methods: Survey responses were analyzed using Statistical Package for the Social Sciences. The Pearson's correlation coefficient and test for independence were applied to identify significant relationships between athlete status and identified variables related to alcohol use. Results: Results indicated that there were significant correlations between athlete status and all variables, to varying degrees. Conclusions: These findings have implications for campus health promotion professionals and athletics program coordinators seeking to address high-risk alcohol use among college athletes.