Harold A. Pollack

Investing in youth tobacco control: a review of smoking prevention and control strategies

OBJECTIVE To provide a comprehensive review of interventions and policies aimed at reducing youth cigarette smoking in the United States, including strategies that have undergone evaluation and emerging innovations that have not yet been assessed for efficacy. DATA SOURCES Medline literature searches, books, reports, electronic list servers, and interviews with tobacco control advocates. DATA SYNTHESIS Interventions and policy approaches that have been assessed or evaluated were categorised using a typology with seven categories (school based, community interventions, mass media/public education, advertising restrictions, youth access restrictions, tobacco excise taxes, and direct restrictions on smoking). Novel and largely untested interventions were described using nine categories. CONCLUSIONS Youth smoking prevention and control efforts have had mixed results. However, this review suggests a number of prevention strategies that are promising, especially if conducted in a coordinated way to take advantage of potential synergies across interventions. Several types of strategies warrant additional attention and evaluation, including aggressive media campaigns, teen smoking cessation programmes, social environment changes, community interventions, and increasing cigarette prices. A significant proportion of the resources obtained from the recent settlement between 46 US states and the tobacco industry should be devoted to expanding, improving and evaluating “youth centred” tobacco prevention and control activities.

Decrease in the Prevalence of Environmental Tobacco Smoke Exposure in the Home During the 1990s in Families With Children

OBJECTIVES This study explored correlates with and changes in the prevalence of environmental tobacco smoke (ETS) exposure of children in the home. METHODS We used multiple logistic regression to explore ETS exposures as reported in the 1992 and 2000 National Health Interview Survey. RESULTS ETS exposure in homes with children declined from 35.6% to 25.1% (P <.001) between 1992 and 2000, whereas smoking prevalence declined 26.5% to 23.3%. Home ETS exposures were more prevalent among non-Hispanic Whites than among African Americans (adjusted odds ratio [AOR] = 0.702; 95% confidence interval [CI] = 0.614, 0.802), Asian Americans (AOR = 0.534; 95% CI = 0.378, 0.754), and Hispanics (AOR = 0.388; 95% CI = 0.294, 0.389). Exposures declined across all groups, with greater gains in higher education and income groups. CONCLUSIONS Home ETS exposure declined sharply between 1992 and 2000, more than would be predicted by the decline in adult smoking prevalence.

Obesity and the Economy: From Crisis to Opportunity

The onset of a major recession places the economic correlates of obesity into sharp relief. Even in good economic times, obesity imposes great financial burden on society in the form of higher medical costs and lower worker productivity. The economic downturn can be expected to reduce nutrition quality and physical activity, worsening obesity prevalence when society is least able to bear the escalating financial burden. Yet this crisis also offers unprecedented opportunity. The economic stimulus under consideration in Washington could help launch a comprehensive national obesity initiative with immediate public health benefits, while laying the foundations for economic well-being into the 21st century. To the authors of this article, the economic stimulus program in Washington provides a unique opportunity to develop and institute a comprehensive national obesity initiative with immediate and long-term benefits to public health and the economy. They believe that part of the estimated

Housing Instability Among Current and Former Welfare Recipients

700 billion economic stimulus program should be invested in a national initiative to prevent obesity. This article provides an overview of the factors responsible for the obesity epidemic and highlights lifestyle choices among Americans that lead inevitably to obesity and obesity-related diseases, thereby addressing the need for a long-term national initiative to prevent obesity. An increasingly unhealthful lifestyle among the US population in the last 50 years has led to an obesity epidemic as a consequence of national economic, social, and policy decisions. During this time, government subsidies to industrial agriculture have supported low-cost high-calorie commodities-highly processed fat and sugar-based products-that have largely displaced a wide range of more expensive nutritious whole foods, such as fresh fruits and vegetables, once grown at low cost on family farms. One consequence of these policies is the increasing popularity of low cost fast food that contains a high amount of fat and low-quality carbohydrates and has little nutritional value or fiber.

Substance Use among Welfare Recipients: Trends and Policy Responses

OBJECTIVES We examined correlates of eviction and homelessness among current and former welfare recipients from 1997 to 2003 in an urban Michigan community. METHODS Longitudinal cohort data were drawn from the Womens Employment Study, a representative panel study of mothers who were receiving cash welfare in February 1997. We used logistic regression analysis to identify risk factors for both eviction and homelessness over the survey period. RESULTS Twenty percent (95% confidence interval [CI]=16%, 23%) of respondents were evicted and 12% (95% CI=10%, 15%) experienced homelessness at least once between fall 1997 and fall 2003. Multivariate analyses indicated 2 consistent risk factors: having less than a high school education and having used illicit drugs other than marijuana. Mental and physical health problems were significantly associated with homelessness but not evictions. A multivariate screening algorithm achieved 75% sensitivity and 67% specificity in identifying individuals at risk for homelessness. A corresponding algorithm for eviction achieved 75% sensitivity and 50% specificity. CONCLUSIONS The high prevalence of housing instability among our respondents suggests the need to better target housing assistance and other social services to current and former welfare recipients with identifiable personal problems.

Addressing the Fentanyl Threat to Public Health

Substance use by welfare recipients is frequently mentioned as a barrier to well‐being and social performance. This article uses nationally representative cross‐sectional data and Michigan‐specific panel data to summarize trends in substance use among AFDC/TANF recipients. It also examines the prevalence of substance dependence within the welfare population. Although almost 20 percent of welfare recipients report recent use of some illicit drug during the year, few satisfy criteria for drug or alcohol dependence as indicated by the short‐form Composite International Diagnostic Interview. The article concludes by considering policy responses to substance use disorders following welfare reform.

Cost-effectiveness of Harm Reduction in Preventing Hepatitis C among Injection Drug Users

Governments can address widespread fentanyl-related deaths by pursuing a harm-reduction approach involving increased transparency for users and public health and public safety organizations, harm-reduction policing, expanded naloxone use, and targeted treatment.

Dosage patterns in methadone treatment: results from a national survey, 1988-2005.

Objectives. Hepatitis C (HCV) has emerged as a major epidemic among injection drug users (IDUs), with observed prevalence exceeding 70% in many American and European cities. This article explores the potential of syringe exchange programs (SEPs) to reduce HCV incidence and prevalence. Design. A random-mixing epidemiological model is used to examine the potential impact of harm reduction interventions. Methods. Steady-state analysis is used to scrutinize the impact of SEP on HCV incidence and prevalence and to examine the accuracy of short-term incidence analysis in predicting long-run program effects. Results. SEP is predicted to have little impact on HCV incidence and prevalence within realistic populations of IDUs. Conclusions. Short-term incidence analysis substantially overstates SEP effectiveness and cost-effectiveness in preventing HCV. More comprehensive harm reduction models, coupled with referral of active IDUs to treatment, must complement syringe exchange to successfully contain highly infectious blood-borne diseases.

Dental Examinations as an Untapped Opportunity to Provide HIV Testing for High-Risk Individuals

OBJECTIVE To examine the extent to which U.S. methadone maintenance facilities meet established standards for minimum dosages, 1988-2005. DATA SOURCE Data were collected from a nationally representative sample of outpatient treatment facilities in 1988 (n=172), 1990 (n=140), 1995 (n=116), 2000 (n=150), and 2005 (n=146). STUDY DESIGN Random-effects multiple regression analysis was used to examine unit characteristics associated with below recommended doses. DATA COLLECTION Data regarding the proportion of patients who received maintenance dosages of <40, 60, and 80 mg/day were collected from unit directors and clinical supervisors. PRINCIPAL FINDINGS Forty-four percent of patients receive doses of at least 80 mg/day--the threshold identified as recommended practice in recent work. Thirty-four percent of patients receive doses below 60 mg/day, while 17 percent receive doses below 40 mg/day. Units that serve a high proportion of African American or Latino clients were more likely to report low-dose care. Units managed by individuals who strongly favor abstinence models (e.g., Narcotics Anonymous) were more likely to provide low-dose care. CONCLUSIONS One-third of methadone facilities provide doses below recommended levels. Managerial attitudes about abstinence and their relationship to low doses underscore the contested role of methadone in treatment of opiate disorders.

Allocating HIV prevention resources

We used data from the 2005 National Health Interview Survey to examine the potential role of dental care in reaching untested individuals at self-reported risk for HIV. An estimated 3.6 million Americans report that they are at significant HIV risk yet have never been HIV tested. Three quarters of these people have seen a dentist within the past 2 years. Dental care offers opportunities to serve at-risk individuals who are otherwise unlikely to be tested or to receive preventive care services.