Healthy People 2010--vision objectives for the nation

BACKGROUND

In January 2000, the U.S. Department of Health and Human Services released new national health goals and objectives in a report entitled Healthy People 2010. This national report includes specific objectives for improving the vision of people in the United States during the 2000-2010 decade through prevention, early detection, treatment, and rehabilitation. The vision objectives, along with other health objectives, are designed to help the nation achieve two major outcomes: (1) increase the quality and years of healthy life and (2) eliminate health disparities among different groups. These health objectives will strongly influence many health care programs and the provision of health care through laws, regulations, reimbursements, and clinical guidelines enacted by federal and state agencies.

PURPOSE

The purpose of this article is to inform optometrists about the new Healthy People 2010 vision objectives.

METHODS

A summary of the Healthy People process for developing the objectives--and the specific vision objectives--is provided. These objectives address many important areas, including: regular dilated eye examinations; vision screening for preschool children; uncorrected visual impairment due to refractive errors; blindness and visual impairment in children and adolescents; visual impairment due to diabetic retinopathy, glaucoma, and cataracts; occupational eye injury; the use of personal protective eye wear in recreational activities and hazardous situations around the home; and the use of vision rehabilitation services and adaptive devices by people with visual impairments.

CONCLUSION

These new national health goals and objectives will impact optometrists. Therefore, it is important that optometrists understand these objectives and actively work to help implement them at the national, state, and local levels. By doing this, they can help provide the services needed to reduce visual impairments and improve the vision of people in their communities.

[Workload and health of older employees in service occupations]

Presented are the results of a representative survey of the German work force (N = 34,343) regarding work load and work-related diseases. The study comprises females and males aged 45 years and older, who are occupied in the service sector (N = 8310). The findings show that older workers in this economic sector have to bear considerable physical and mental work loads that are often higher than those for the total labor force. The results presented point to the need to encourage and practice a more comprehensive health promotion for older workers in the service sector.

Adolescent sexual behavior: estimates and trends from four nationally representative surveys

CONTEXT

Accurate information about trends over time in adolescent sexual behavior is essential to understand changes in adolescent pregnancy and sexually transmitted diseases and to monitor the progress of health promotion activities in the United States

METHODS

Estimates from the National Survey of Family Growth (NSFG), the National Survey of Adolescent Males (NSAM), the Youth Risk Behavior Survey (YRBS) and the National Longitudinal Study of Adolescent Health (Add Health) were compared. While methodologies and populations varied by survey, adolescents aged 15-17 who attend high school were a common subpopulation among all four. For each survey, the prevalence of sexual intercourse, contraceptive use and multiple sexual partners was measured in this population.

RESULTS

Trend comparisons fell into four categories. First, some similar significant trends were found across surveys. The proportion of all males and of white males who reported ever having had sexual intercourse decreased significantly, while condom use rose significantly among males in both the NSAM and the YRBS. For such behaviors as ever having had sexual intercourse (among Hispanic males and black females), using the pill and using the condom (among all females) and having four or more lifetime sexual partners (among white males), a significant trend was found in one survey while a similar but nonsignificant trend was found in another. Several trend comparisons were not significant in any survey. Finally, having had intercourse in the past three months (among all males and all females), having had two or more partners in the past three months (for males) and having had four or more lifetime sexual partners (among white females and all males) showed a significant trend in one survey but lacked a parallel nonsignificant trend in another. Prevalence estimates in 1995 differed significantly in at least one comparison of surveys for all behaviors except having four or more lifetime sexual partners (both genders) and having two or more recent sexual partners (females). Gender differences within the YRBS and between the NSFG and the NSAM generally were consistent.

CONCLUSIONS

Trends over time and gender differences were similar across surveys, underscoring their value for tracking adolescent sexual behaviors. Differences in prevalence estimates across surveys probably result from differences in question wording, diverse interview settings and modes of data collection, and varying statistical power. These findings suggest a need to increase our understanding of how methodologies influence survey response in research on adolescents.

New Zealand's tobacco control programme 1985-1998

OBJECTIVE

To review the impact of New Zealand's tobacco control programme from 1985 to 1998 on smoking prevalence and tobacco consumption, and to estimate the scope for further reduction.

DESIGN

Country case study; interventions, with outcomes ranked internationally across time.

SETTING

New Zealand 1985-98; for 1985-95, 23 OECD countries.

INTERVENTIONS

Between 1985 and 1998, New Zealand eliminated tobacco advertising, halved the affordability of cigarettes, and reduced smoke exposure in work time by 39%.

MAIN OUTCOME MEASURE

Reduction in adult smoking prevalence and in tobacco products consumption per adult.

RESULTS

Changes in prevalence 1985-98: in adults (aged 15+ years), -17% (from 30% to 25%) but short of the 20% target for 2000; in youth (aged 15-24 years), -20% (from 35% to 28%); and in Maori adults (aged 15+ years), -17% (from 56% in 1981 to 46% in 1996). Changes in consumption 1985-98: tobacco products per adult aged 15+ years, -45% (2493 to 1377 cigarette equivalents); cigarettes smoked per smoker, -34% (22. 7 to 15.0 per day). Between 1985 and 1995 New Zealand reduced tobacco products consumption per adult more rapidly than any other OECD country, and reduced youth prevalence more rapidly than most. The acceleration of the decline in cigarette attributable mortality rates in men and in women age 35-69 years averted an additional 1400 deaths between 1985 and 1996. Between 1981 and 1996 smoking prevalence among blue collar workers decreased only marginally, and in 14-15 year olds, rose by one third between 1992 and 1997.

CONCLUSION

In 13 years, New Zealand's tobacco control programme has been successful in almost halving tobacco products consumption, particularly by lowering consumption per smoker. With strong political support for quit campaigns, increased taxation, and the elimination of displays of tobacco products on sale, the consumption could theoretically be halved again in as little as 3-6 years.

The potential variances of tailoring in health behavior interventions

The success of tailored print communications depends upon having a sufficiently diverse inventory of both content messages and delivery formats to respond to important differences among individuals. This article discusses means by which this diversity--the variances of tailoring--may be developed. One of the foundations of tailoring is the definition of a "focal point" for intervention. A focal point is characterized by a simultaneous combination of variables which specify a population group of interest, a target health behavior, and a setting in which the behavior occurs. All persons defined by the focal point may receive some intervention in common (i.e. targeted intervention). Tailored content responds to individuals within the focal point, based upon the antecedents of behavior within that focal point. This article elaborates on the focal point concept and then discusses factors that contribute to variations of tailoring. The psychosocial resources required by health behaviors are also reviewed, because tailoring must prepare the individual to make changes specific to the nature of a particular health behavior. This article does not specify what the variations of tailoring should be; the potential diversity of tailored messages is too great. Instead, the article presents basic elements that will go into the development of tailored interventions.

One size does not fit all: the case for tailoring print materials

Printed health education materials frequently consist of mass-produced brochures, booklets, or pamphlets designed for a general population audience. Although this one-size-fits-all approach might be appropriate under certain circumstances and even produce small changes at relatively modest costs, it cannot address the unique needs, interests, and concerns of different individuals. With the advent and dissemination of new communication technologies, our ability to collect information from individuals and provide feedback tailored to the specific information collected is not only possible, but practical. The purpose of this article is to: (a) distinguish between tailored print communication and other common communication-based approaches to health education and behavior change; (b) present a theoretical and public health rationale for tailoring health information; and (c) describe the steps involved in creating and delivering tailored print communication programs. Studies suggest computer tailoring is a promising strategy for health education and behavior change. Practitioners and researchers should understand the approach and consider the possibilities it presents for enhancing their work in disease prevention.

Challenges and future directions for tailored communication research

As informatics technology advances, a growing number of research trials on tailored communications provide an accumulation of promising evidence to support their efficacy. These trials also reveal gaps and opportunities for future research. The scope and boundaries of tailoring must be redefined in terms of both new technology and the trade-offs between complexity, demand burden on participants, and the minimal information required for effective and efficient tailoring. Basic and methods research is needed to broaden theory, develop a common language, standardize measures, and isolate the key mediating mechanisms that facilitate tailored communications. Applied research must consider more rigorous research designs for efficacy trials and conduct more effectiveness trials to investigate the mechanisms of technology transfer to enhance large-scale diffusion of tailored communications. The role of contextual variables needs to be examined, as well as their interaction with different population groups, and also the channels, modes, and methods of tailored message delivery. Research is also needed on the feasibility of tailoring across clusters of multiple risk factors to identify the commonalities, differences, and interrelations among diverse behaviors. The potential cost-effectiveness of tailored communications must also be examined. No matter how efficacious, tailored communications delivered to large populations (i.e. mass-customization) will not make a public health impact unless proven to be practical and cost-efficient.

Two pathways to prevention

Health promotion and disease prevention programs are becoming important components of contemporary health care. There are at least 2 pathways to the enhancement of population health status through disease prevention. The first pathway requires the early diagnosis and treatment of disease. The second pathway promotes healthy lifestyles and disregards the requirement that a condition must be diagnosed before intervention is recommended. Data from several evaluations suggest that prevention efforts that rely on diagnosis have produced somewhat limited benefits, whereas primary prevention efforts may have substantial benefits. Current health policy places greater emphasis on secondary prevention. The objectives of improved population health might be better achieved by devoting relatively more resources to primary prevention through the promotion of healthy behaviors.

Telemedicine in the Malaysian Multimedia Super Corridor: towards personalized lifetime health plans

The Malaysian Telemedicine initiative advocates a paradigm shift in healthcare delivery patterns by way of implementing a person-centred and wellness-focused healthcare system. This paper introduces the Malaysian Telemedicine vision, its functionality and associated operational conditions. In particular, we focus on the conceptualisation of one key Telemedicine component i.e. the Lifetime Health Plan (LHP) system--a distributed multimodule application for the periodic monitoring and generation of health-care advisories for all Malaysians. In line with the LHP project, we present an innovative healthcare delivery info-structure--LifePlan--that aims to provide life-long, pro-active, personalised, wellness-oriented healthcare services to assist individuals to manage and interpret their health needs. Functionally, LifePlan based healthcare services are delivered over the WWW, packaged as Personalised Lifetime Health Plans that allow individuals to both monitor their health status and to guide them in healthcare planning.

Restructuring public health in Ontario: implications for heart health promotion

Community-based heart health promotion is viewed as an effective means of reducing cardiovascular disease risk. Although public health agencies have a central role in the implementation and dissemination of heart health programmes, their effectiveness is being challenged by major structural changes to Provincial public health systems across Canada, although the impacts of the changes have received relatively little attention in the research literature. As part of the Canadian Heart Health Initiative--Ontario Project (CHHIOP), this study used a qualitative approach to address the perceived implications of these changes to Ontario's public health system for heart health promotion. Interviews (n = 38) were conducted in eight public health units with staff most familiar with managing and/or delivering heart health activities. The results are mixed; that is, while many see the future of heart health promotion programming in Ontario as being at risk, others see recent changes as a step forward toward their institutionalization, particularly in light of recent funding decisions made by the Ministry of Health's Health Promotion Branch.

Health and productivity management: emerging opportunities for health promotion professionals for the 21st century

The authors recognize the emergence of health and productivity management as an important stage in the evolution of workplace health promotion and describe how health promotion professionals should take the lead in redirecting their employers' efforts to work together.

Restructuring public health in Ontario: implications for heart health promotion

Community-based heart health promotion is viewed as an effective means of reducing cardiovascular disease risk. Although public health agencies have a central role in the implementation and dissemination of heart health programmes, their effectiveness is being challenged by major structural changes to Provincial public health systems across Canada, although the impacts of the changes have received relatively little attention in the research literature. As part of the Canadian Heart Health Initiative--Ontario Project (CHHIOP), this study used a qualitative approach to address the perceived implications of these changes to Ontario's public health system for heart health promotion. Interviews (n = 38) were conducted in eight public health units with staff most familiar with managing and/or delivering heart health activities. The results are mixed; that is, while many see the future of heart health promotion programming in Ontario as being at risk, others see recent changes as a step forward toward their institutionalization, particularly in light of recent funding decisions made by the Ministry of Health's Health Promotion Branch.

Auditing health promotion

This review of worksite health promotion (or wellness) programmes in the United States begins with a brief description of the essential elements of effective worksite health promotion programmes citing leading authorities. The evidence supporting the value of worksite health promotion is summarized. The importance of relying on major theories related to health education and health promotion is advocated. Current health promotion trends emerging in the United States are also discussed.

Trends in hospital readmission for asthma: has the Australian National Asthma Campaign had an effect?

OBJECTIVES

To describe patterns of hospital readmission for asthma in South Australia from 1989 to 1996, in relation to implementation of the National Asthma Campaign.

DESIGN AND SETTING

A comparison of hospital admissions in South Australia of patients aged between one year and 49 years for three conditions: asthma (or respiratory failure with asthma as an underlying condition) and two control conditions--diabetes and epilepsy. Individuals were identified by Medicare number and date of birth.

OUTCOME MEASURES

Hospital readmission within 28 days and within one year.

RESULTS

Overall, by 1996, there was a statistically significant decline in the risk of readmission for asthma within 28 days of 18% and within one year of 17% compared with 1989 readmission rates. There were no reductions in the risk of readmission for diabetes or epilepsy, suggesting that the decline in risk of readmission for asthma was greater than the underlying effects of general changes in hospital casemix.

CONCLUSIONS

The decline in risk of readmission may reflect changes in asthma severity or improved management practices. However, hospital readmission rates still remain high, and to further reduce readmissions for asthma there is a need to identify factors related to presentation for asthma at accident and emergency departments.

Assessing perceived health promotion needs and interests of low-income older women

This study focuses on an assessment of perceived health promotion needs and interests among predominantly older low-income women (76%) in the state of Pennsylvania. A questionnaire was completed by a convenience sample of 140 individuals attending four senior centers and two nutrition sites. In addition, 14 focus groups with an average of 8 members per group were conducted for a total of 105 people from two of the four senior centers. The health topics of greatest interest to women were exercise (57.6%), making friends (50.9%), nutrition (37.5%), losing weight (33.6%), and home safety (34.6%). Compared with women, men were significantly more interested in exercise and its effect on mood (41.3% versus 24.0%) and love and sex after 60 (44.8% versus 18.2%) and significantly less interested in nutrition (17.2% versus 37.5%). The fitness activities of greatest interest to women were walking (63.1%), back exercises (37.5%), toning to music (22.1%), and self-defense (18.2%), none of which was significantly different from the men in the sample. Results suggest that many of the key health needs perceived by low-income older women could be addressed by a combination of fitness activities and health education, especially if they are also designed to facilitate social interactions. The barriers to participation in such programs most often cited were transportation, scheduling, and cost factors. Fortunately, many communities already have the resources to offer low-cost interventions in the areas of need, such as walking groups, self-defense, and home safety. Communities interested in serving low-income older women should more closely examine the barriers and the unmet needs of this group when designing intervention programs.

Future scope and expectations: why, when, and how LECs should continue

There is a strong case to continue to use LEC approaches, as they are a comprehensive and cost effective means of delivering the key elements of leprosy control. LECs should be conducted when there is evidence of large numbers of hidden cases. Probably a minimum of two LECs is required but where large number of new cases continue to be detected they could be run on an annual basis. The methodology of LECs needs to be improved through experience, evaluation and from LECs conducted elsewhere; feedback from the community is also important. There is room to improve all aspects of LECs: planning, training, education, diagnosis and treatment completion.