Khoa Truong

Weight Gain Trends Across Sociodemographic Groups in the United States

OBJECTIVES To better understand health disparities, we compared US weight gain trends across sociodemographic groups between 1986 and 2002. METHODS We analyzed mean and 80th-percentile body mass index (BMI), calculated from self-reported weight and height, for subpopulations defined by education, relative income, race/ethnicity, and gender. Data were from the Behavioral Risk Factor Surveillance System, a random-digit-dialed telephone survey (total sample=1.88 million adult respondents). RESULTS Each sociodemographic group experienced generally similar weight gains. We found no statistically significant difference in increase in mean BMI by educational attainment, except that individuals with a college degree gained less weight than did others. The lowest-income group gained as much weight on average as the highest-income group, but lowest-income heavier individuals (80th percentile of BMI) gained weight faster than highest-income heavier individuals. We found no differences across racial/ethnic groups except that non-Hispanic Blacks gained more weight than other groups. Women gained more weight than men. CONCLUSIONS We found fewer differences, especially by relative income and education, in weight gain across subpopulations than we had expected. Women and non-Hispanic Blacks gained weight faster than other groups.

Measuring the physical food environment and its relationship with obesity: evidence from California

There is a growing literature that evaluates the links between the food environment and dietary intake and health outcomes.1–3 Findings are highly contingent on constructed measures of the food environment, which vary substantially across studies. Furthermore, different measures assume different underlying relationships between the food environment and individual outcomes.

Cost effectiveness of tobacco control policies in Vietnam

BackgroundTobacco smoking is one of the leading public health problems in the world. It is also possible to prevent and/or reduce the harm from tobacco use through the use of cost-effective tobacco control measures. However, most of this evidence comes from developed countries and little research has been conducted on this issue in developing countries.ObjectiveThe objective of this study was to analyse the cost effectiveness of four population-level tobacco control interventions in Vietnam.MethodsFour tobacco control interventions were evaluated: excise tax increase; graphic warning labels on cigarette packs; mass media campaigns; and smoking bans (in public or in work places). A multi-state life table model was constructed in Microsoft® Excel to examine the cost effectiveness of the tobacco control intervention options. A government perspective was adopted, with costing conducted using a bottom-up approach. Health improvement was considered in terms of disability-adjusted life-years (DALYs) averted. All assumptions were subject to sensitivity and uncertainty analysis.ResultsAll the interventions fell within the definition of being very cost effective according to the threshold level suggested by the WHO (i.e. <GDP per capita). Graphic warning labels on cigarette packs was the most cost-effective option, followed by excise tax increases, mass media campaigns, public smoking bans and work place smoking bans. If the cost offset was included in the analysis, all interventions would provide cost savings to the government health sector.ConclusionsAll four interventions to reduce the harm from tobacco use appear to be highly cost effective and should be considered as priorities in the context of Vietnam. The government may initially consider graphic warning labels and tax increase, followed by other interventions.

Prevalence of Poor Sleep Quality and its Relationship with Body Mass Index among Teenagers: Evidence from Taiwan.

BACKGROUND The linkage between sleep quality and weight status among teenagers has gained more attention in the recent literature and health policy but no consensus has been reached. METHODS Using both a propensity score method and multivariate linear regression for a cross-sectional sample of 2,113 teenagers, we analyzed their body mass index (BMI) in relation to sleep quality while controlling for family characteristics (household income, parent/guardian level of education, disability status, work night shift, and smoking) and individual factors (age, sex, regular exercise, smoking, employment, and feeling secure in the neighborhood). Sleep quality was assessed using 3 scales: difficulty in initiating sleep, difficulty in maintaining sleep, and non-restorative sleep, based on Diagnostic and Statistical Manual of Mental Disorders-IV-defined insomnia. RESULTS Considering all 3 types of poor sleep quality, 20.9% of teenagers in Taiwan experienced some form of sleep problems. After adjusting for the other variables, 2 factors independently and statistically predicted sleep problems: current smoking and working night shifts by the head of the household. Teens experiencing difficulty in initiating sleep had higher BMIs ranging from 0.86 to 1.41 units. CONCLUSIONS Efforts to address childhood obesity need to take into consideration sleep problems that are highly prevalent among teenagers.

Revenue implications to the Vietnamese government of using taxes to curb cigarette smoking.

This study explores the impact on government taxation revenue from increasing excise on cigarettes in Vietnam. A dynamic population model is used to estimate future patterns (both prevalence and consumption) of tobacco use in Vietnam, with and without changes to tobacco excise for the period 2006-2016. Three increases in the base case excise tax rate of 55% are modelled: 65%, 75% and 90%. Various price elasticities are used to examine variations in cigarette consumption while cross price elasticities are used to explore shifts from cigarette to other forms of tobacco. Revenue implications for the period 2006-2016 are reported as discounted net present values (NPV) in 2006 values. The model predicts that smoking rates in 2016, for both males and females, are marginally lower than base case estimates for all taxation excise options with higher price elasticities generating greater reductions in prevalence. In all cases, compared to base case estimates, the results indicate a fall in number of smokers, a reduction in amount of tobacco consumed and an increase in overall taxation revenue. The additional gain in government revenue, expressed in NPV terms, ranges from a low of VND 69,579 billion (or USD

Impacts of a government social franchise model on perceptions of service quality and client satisfaction at commune health stations in Vietnam

4.35 billion) to a high of VND 108,492 billion (or USD

Changes in utilization and peri-operative outcomes of bariatric surgery in large U.S. hospital database, 2011-2014

6.79 billion). Increases in tobacco excise provide an opportunity for the Vietnamese government to increase revenue at the same time as reducing tobacco consumption. Further research into the wider social and economic consequences of increasing tobacco excise in Vietnam is warranted.

Assessing medical student cultural competence: what really matters

This study evaluates behavioural outcomes associated with a new approach – the government social franchise (GSF) model – developed to improve reproductive health and family planning (RHFP) service quality and capacity in Vietnams commune health stations. A quasi-experimental design with a matched control group assessed GSF model effects on client perceptions of serviced quality and satisfaction. Survey data from 1181 users and potential users were collected at baseline, six months and 12 months after implementation of the franchise network. Regression analyses controlled for baseline differences between intervention and control groups. Commune health station franchise membership was significantly associated with improvement of community perceptions of service quality and client satisfaction as well as their likeliness to return and recommend low-cost, community-based RHFP services to others. This study provides preliminary evidence regarding the ability of the GSF model to increase client satisfaction with RHFP services in primary public healthcare clinics.

Seasonality in the adverse outcomes in weight loss surgeries

Background With the epidemic of morbid obesity, bariatric surgery has been accepted as one of the most effective treatments of obesity. Objective To investigate recent changes in the utilization of bariatric surgery, patients and hospital characteristics, and in-hospital complications in a nationwide hospital database in the United States. Setting This is a secondary data analysis of the Premier Perspective database. Methods ICD-9 codes were used to identify bariatric surgeries performed between 2011 and 2014. Descriptive statistics were computed and regression was used. Results A total of 74,774 bariatric procedures were identified from 436 hospitals between 2011 and 2014. During this time period, the proportion of gastric bypass (from 44.8% to 31.3%; P for trend < 0.0001) and gastric banding (from 22.8% to 5.2%; P for trend < 0.0001) decreased, while the proportion of sleeve gastrectomy (from 13.7% to 56.9%; P for trend < 0.0001) increased substantially. The proportion of bariatric surgery performed for outpatients decreased from 17.15% in 2011 to 8.11% in 2014 (P for trend < 0.0001). The majority of patients undergoing surgery were female (78.5%), white (65.6%), younger than 65 years (93.8%), and insured with managed care (53.6%). In-hospital mortality rate and length of hospital stay remained stable. The majority of surgeries were performed in high-volume (71.8%) and urban (91.6%) hospitals. Conclusions Results based on our study sample indicated that the popularity of various bariatric surgery procedures changed significantly from 2011 to 2014. While the rates of in-hospital complications were stable, disparities in the use of bariatric surgery regarding gender, race, and insurance still exist.

Liquor store density and acute pancreatitis hospitalization

Objectives The study aimed to explore medical students’ attitudes and beliefs toward Latino patients, specifically: to assess students’ levels of knowledge, cultural competence, and comfort with Latinos; to determine students’ exposure to and previous experience with Latinos; and to evaluate whether factors such as study abroad, living abroad, previous clinical experience with Latinos, and language proficiency predict Latino knowledge, cultural competence, and comfort with Latinos. Methods This study utilized a cross-sectional survey design. Participants were third and fourth year medical students at three medical schools in the Southeastern United States. Three composite measures: Latino knowledge, Cultural competence, and Comfort with Latino patients, were predicted in a multivariate regression model including individual sociodemographic characteristics and past clinical or social experience with Latinos. Results A total of 170 medical students completed the survey (43% response rate). Spanish language proficiency was a statistically significant predictor (t(131)=2.72, p<0.05) of Latino knowledge. Social interaction with Latinos in the past year (t(126)=3.09, p<0.01), ever having lived in a Spanish-speaking country (t(126)=2.86, p<0.01), and Spanish language proficiency (t(126)=3.28, p<0.01) independently predicted cultural competence. Previous clinical experience with Latinos was not significantly associated with the three composite dependent variables, and comfort with Latino patients was not significantly predicted by any of the six Latino-related explanatory variables. Conclusions Factors prior to medical school matriculation and during medical education may contribute to increased cultural competence and comfort with multicultural patients. Cultural patient-partner programs may be an effective way to increase cultural competence within the confines of medical school curricula.