Douglas A. Luke

Family Smoking Prevention and Tobacco Control Act Banning Outdoor Tobacco Advertising Near Schools and Playgrounds

BACKGROUND The tobacco industry has challenged new FDA rules restricting outdoor tobacco advertising near schools and playgrounds on First Amendment grounds, arguing that they would lead to a near complete ban on tobacco advertising in dense urban areas. PURPOSE To examine how the 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) rules banning outdoor tobacco advertising near schools and playgrounds would affect tobacco retailers. METHODS GIS spatial analyses of two different states (Missouri, New York), along with more detailed analyses of two urban areas within those states (St. Louis, New York City), were conducted in 2010. The percentage of tobacco retailers falling within 350-, 500-, and 1000-foot buffer zones was then calculated. RESULTS 22% of retailers in Missouri and 51% in New York fall within 1000-foot buffers around schools. In urban settings, more retailers are affected, 29% in St. Louis and 79% in New York City. Sensitivity analyses demonstrate that smaller buffers decrease the proportion of affected retailers. That is, 350-foot buffers affect only 6.7% of retailers in St. Louis and 29% in New York City. CONCLUSIONS The effects of new outdoor tobacco advertising restrictions vary by location and population density. In Missouri and New York, outdoor tobacco advertising would still be permitted in many locations if such advertising was prohibited in a 1000-foot buffer zone around schools and playgrounds. Much smaller buffer zones of 350 feet may result in almost no reduction of outdoor advertising in many parts of the country.

Systems Science Methods in Public Health: Dynamics, Networks, and Agents

Complex systems abound in public health. Complex systems are made up of heterogeneous elements that interact with one another, have emergent properties that are not explained by understanding the individual elements of the system, persist over time, and adapt to changing circumstances. Public health is starting to use results from systems science studies to shape practice and policy, for example in preparing for global pandemics. However, systems science study designs and analytic methods remain underutilized and are not widely featured in public health curricula or training. In this review we present an argument for the utility of systems science methods in public health, introduce three important systems science methods (system dynamics, network analysis, and agent-based modeling), and provide three case studies in which these methods have been used to answer important public health science questions in the areas of infectious disease, tobacco control, and obesity.

Cluster analysis in community research: Epistemology and practice

Cluster analysis refers to a family of methods for identifying cases with distinctive characteristics in heterogeneous samples and combining them into homogeneous groups. This approach provides a great deal of information about the types of cases and the distributions of variables in a sample. This paper considers cluster analysis as a quantitative complement to the traditional linear statistics that often characterize community psychology research. Cluster analysis emphasizes diversity rather than central tendency. This makes it a valuable tool for a wide range of familiar problems in community research. A number of these applications are considered here, including the assessment of change over time, network composition, network density, person-setting relationships, and community diversity. A Users Guide section is included, which outlines the major decisions involved in a basic cluster analyses. Despite difficulties associated with the identification of optimal cluster solutions, carefully planned, theoretically informed application of cluster analysis has much to offer community researchers.

Minimizing participant attrition in panel studies through the use of effective retention and tracking strategies: Review and recommendations☆

Abstract Participant attrition poses a significant threat to the internal and external validity of panel studies, in part because participants who successfully complete all follow-up measurements often differ in significant ways from those respondents lost to attrition. The only certain safeguard against potential biases resulting from attrition is to ensure high interview completion rates during follow-up. Unfortunately, information about reducing preventable attrition is not discussed in most research reports and a comprehensive review paper has not yet been published. The purpose of the present paper is to provide a brief overview of how attrition can threaten the validity of panel studies and to discuss eight promising methods of minimizing attrition through the use of effective retention and tracking strategies. Attempts to reduce attrition are not always met with complete success, therefore, a brief discussion of statistical techniques to assess and correct for potential attrition biases is provided. Finally, methods of calculating attrition rates are suggested along with recommendations for future research.

Public health program capacity for sustainability: a new framework

BackgroundPublic health programs can only deliver benefits if they are able to sustain activities over time. There is a broad literature on program sustainability in public health, but it is fragmented and there is a lack of consensus on core constructs. The purpose of this paper is to present a new conceptual framework for program sustainability in public health.MethodsThis developmental study uses a comprehensive literature review, input from an expert panel, and the results of concept-mapping to identify the core domains of a conceptual framework for public health program capacity for sustainability. The concept-mapping process included three types of participants (scientists, funders, and practitioners) from several public health areas (e.g., tobacco control, heart disease and stroke, physical activity and nutrition, and injury prevention).ResultsThe literature review identified 85 relevant studies focusing on program sustainability in public health. Most of the papers described empirical studies of prevention-oriented programs aimed at the community level. The concept-mapping process identified nine core domains that affect a program’s capacity for sustainability: Political Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Public Health Impacts, and Strategic Planning. Concept-mapping participants further identified 93 items across these domains that have strong face validity—89% of the individual items composing the framework had specific support in the sustainability literature.ConclusionsThe sustainability framework presented here suggests that a number of selected factors may be related to a program’s ability to sustain its activities and benefits over time. These factors have been discussed in the literature, but this framework synthesizes and combines the factors and suggests how they may be interrelated with one another. The framework presents domains for public health decision makers to consider when developing and implementing prevention and intervention programs. The sustainability framework will be useful for public health decision makers, program managers, program evaluators, and dissemination and implementation researchers.

Smoke signs: patterns of tobacco billboard advertising in a metropolitan region

OBJECTIVE To use geographic information systems data and analyses to describe locations and characteristics of tobacco billboards in a large metropolitan area, and to assess the extent to which tobacco companies are locating billboards in close proximity to minority neighbourhoods and schools. DESIGN Observational study of billboards in a large metropolitan region. SETTING City and county of St Louis, Missouri. PARTICIPANTS All stationary billboards in the city and county of St Louis were eligible to be observed, with the exception of bus stop and street side retail advertising signs (for example, cigarette advertising at gas stations). A total of 1239 non-blank billboards were observed. All data were collected in early 1998. MAIN OUTCOME MEASURES Tobacco and non-tobacco billboard geographic distribution; billboard type and product brand frequencies; and billboard neighbourhood characteristics. RESULTS Almost 20% of the billboards contained tobacco advertising. Four of the top five and nine of the top 22 brands displayed on billboards were tobacco products. Billboards were located in all areas of St Louis except for the communities with the highest average incomes. Tobacco billboards were more likely to be found in low income areas and areas with a higher percentage of African Americans. Images of African American figures on tobacco billboards were concentrated in the most heavily African American populated regions of the city. Approximately 74% of all billboards in the city of St Louis were within 2000 feet (700 metres) of public school property. CONCLUSIONS Tobacco products were the single most heavily advertised type of product on billboards in St Louis. The geographic distribution of tobacco billboards, as well as the types of images found on these billboards, is consistent with the hypothesis that tobacco companies are targeting poor and minority communities with their advertising. Methods employing geographic information systems are a powerful technique for examining outdoor tobacco advertising.

Explanations of ethnic and gender differences in youth smoking: A multi-site, qualitative investigation

Two of the most powerful predictors of adolescent smoking are ethnicity and gender, but little research has focused on understanding how these factors play a role in adolescent smoking. This paper reports results from a qualitative, multi-site investigation of explanations for ethnic and gender differences in cigarette smoking with five ethnic groups: whites, African-Americans, Hispanics, Native Americans, and Asian-American/Pacific Islanders. Across 11 states, we conducted 178 focus groups with a total of 1175 adolescents. The groups explored such major research themes as reasons for smoking and not smoking; images of smoking and smokers; messages youth receive about smoking and not smoking; and the social context of smoking. We synthesized data from the focus groups through multiple cross-site collaborations and discussions, with an emphasis on identifying consistent themes across a majority of groups and sites. Striking differences emerged across ethnic and gender sub-groups in reasons for not smoking. African-American females in particular viewed not smoking as a positive identity marker. Asian-American/Pacific Islander females similarly reported strong mandates not to smoke. Youths perceptions of family messages about smoking also varied by ethnicity and gender, with African-American, Hispanic, and Asian-American/Pacific Islander youth consistently reporting strong, clear anti-smoking messages from family. These findings, notable in their consistency across geographic regions, may shed light on the discrepant prevalence of smoking across ethnic and gender groups.

Perceptions of neighborhood environment for physical activity: Is it “who you are” or “where you live?”

Lack of physical activity among American adults is a serious public health concern. Many factors influence activity levels, and most research has focused on either individual factors, such as race and income, or on characteristics of the physical environement, such as the availability of parks. Our study used a cross-sectional multilevel design to examine the influences of individual-and neighborhood-level characteristics on participant’s perceptions of their neighborhood as an appropriate venue for physical activity. Study participants were 1,073 African American and white adults living in the St. Louis, Missouri, metropolitan area. Individual-level information was gathered from self-administered questionnaires; neighborhood-level data for these same individuals were obtained from the 2000 US Census. We found that both individual and neighborhood characteristics were significant predictors of how individuals perceived physical activity opportunities in their neighborhood, and that African Americans perceived their neighborhoods as less safe and less pleasant for physical activity than did whites, regardless of the racial composition of the neighborhood. We suggest that any evaluation of opportunities for physical activity within a neighborhood should includd consideration of resident’s perceptions of the safety and pleasantness of using them, and that the role of perceived and actual neighborhood conditions in explaining disparities in physical activity between African American and other populations should be examined further.

Preventing Childhood Obesity Through State Policy Predictors of Bill Enactment

BACKGROUND To address the epidemic of childhood obesity, health professionals are examining policies that address obesogenic environments; however, there has been little systematic examination of state legislative efforts in childhood obesity prevention. Using a policy research framework, this study sought to identify factors that predict successful enactment of childhood obesity prevention in all 50 states. METHODS A legislative scan of bills introduced during 2003-2005 in all 50 states identified 717 bills related to childhood obesity prevention. Multilevel logistic regression modeling was performed in 2006 to identify bill-level (procedure, composition, and content) and state-level (sociodemographic, political, economic, and industrial) factors associated with bill enactment. RESULTS Seventeen percent of bills were enacted. Bill-level factors associated with increased likelihood of enactment included having more than one sponsor; bipartisan sponsorship; introduction in the state senate; budget proposals; and content areas related to safe routes to school, walking/biking trails, model school policies, statewide initiatives, and task forces and studies. State-level political factors, including 2-year legislative session and Democratic control of both chambers, increased enactment. An indicator of state socioeconomic status was inversely associated with bill enactment; economic and industrial variables were not significantly related to bill enactment. CONCLUSIONS In general, bill-level factors were more influential in their effect on policy enactment than state-level factors. This study provides policymakers, practitioners, and advocacy groups with strategies to develop more politically feasible childhood obesity prevention policies, including the identification of several modifiable bill characteristics that might improve bill enactment.

An odd measure of risk: use and misuse of the odds ratio

OBJECTIVE To determine how often the odds ratio, as used in clinical research of obstetrics and gynecology, differs substantially from the risk ratio estimate and to assess whether the difference in these measures leads to misinterpretation of research results. METHODS Articles from 1998 through 1999 in Obstetrics & Gynecology and the American Journal of Obstetrics and Gynecology were searched for the term “odds ratio.” The key odds ratio in each article was identified, and, when possible, an estimated risk ratio was calculated. The odds ratios and the estimated risk ratios were compared quantitatively and graphically. RESULTS Of 151 studies using odds ratios, 107 were suitable to estimate a risk ratio. The difference between the odds ratio and the estimated risk ratio was greater than 20% in 47 (44%) of these articles. An odds ratio appears to magnify an effect compared with a risk ratio. In 39 (26%) articles the odds ratio was interpreted as a risk ratio without explicit justification. CONCLUSION The odds ratio is frequently used, and often misinterpreted, in the current literature of obstetrics and gynecology.