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Background There are limited data on typhoid fever cost of illness (COI) and economic impact from Africa. Health economic data are essential for measuring the cost-effectiveness of vaccination or other disease control interventions. Here, we describe the protocol and methods for conducting the health economic studies under the Severe Typhoid Fever in Africa (SETA) program. Methods The SETA health economic studies will rely on the platform for SETA typhoid surveillance in 4 African countries—Burkina Faso, Ethiopia, Ghana, and Madagascar. A COI and long-term socioeconomic study (LT-SES) will be its components. The COI will be assessed among blood culture–positive typhoid fever cases, blood culture–negative clinically suspected cases (clinical cases), and typhoid fever cases with pathognomonic gastrointestinal perforations (special cases). Repeated surveys using pretested questionnaires will be used to measure out-of-pocket expenses, quality of life, and the long-term socioeconomic impact. The cost of resources consumed for diagnosis and treatment will be collected at health facilities. Results Results from these studies will be published in peer-reviewed journals and presented at scientific conferences to make the data available to the wider health economics and public health research communities. Conclusions The health economic data will be analyzed to estimate the average cost per case, the quality of life at different stages of illness, financial stress due to illness, and the burden on the family due to caregiving during illness. The data generated are expected to be used in economic analysis and policy making on typhoid control interventions in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Lower rates of smoking cessation are a major reason for the higher prevalence of smoking among socioeconomically disadvantaged adults. Because barriers to quitting are both more numerous and severe, socioeconomically disadvantaged smokers may benefit from more intensive intervention. We sought to determine whether a smoking cessation intervention delivered by public housing residents trained as Tobacco Treatment Advocates (TTAs) could increase utilization of cessation resources and increase abstinence.Methods: We conducted a group-randomized trial among Boston public housing residents who were interested in quitting smoking. Participants at control sites received standard cessation materials and a one-time visit from a TTA who provided basic counseling and information about cessation resources. Participants at intervention sites were eligible for multiple visits by a TTA who employed motivational interviewing, cessation counseling, and navigation to encourage smokers to utilize cessation treatment (Smokers' Quitline and clinic-based programs). Utilization and 7-day and 30-day point prevalence abstinence were assessed at 12 months. Self-reported abstinence was biochemically verified.Results: Intervention participants (n = 121) were more likely than control participants (n = 129) to both utilize treatment programs (adjusted odds ratio [aOR]: 2.15; 95% confidence interval [CI]: 0.93-4.91) and 7-day and 30-day point prevalence abstinence (aOR: 2.60 (1.72-3.94); 2.98 (1.56-5.68), respectively). Mediation analysis indicated that the higher level of utilization did not explain the intervention effect.Conclusions: An intervention delivered by peer health advocates was able to increase utilization of treatment programs and smoking abstinence among public housing residents. Future studies of similar types of interventions should identify the key mechanisms responsible for success.Implications: In order to narrow the large and growing socioeconomic disparity in smoking rates, more effective cessation interventions are needed for low-income smokers. Individual culturally-relevant coaching provided in smokers' residences may help overcome the heightened barriers to cessation experienced by this group of smokers. In this study among smokers residing in public housing, an intervention delivered by peer health advocates trained in motivational interviewing, basic smoking cessation skills, and client navigation significantly increased abstinence at 12 months. Future research should address whether these findings are replicable in other settings both within and outside of public housing. [ABSTRACT FROM AUTHOR]

Background There is a lack of nationwide epidemiologic survey data on the prevalence estimate of erectile dysfunction (ED) in Chinese men living on the mainland China. Aim To attain the representative prevalence estimate of ED in the Chinese male population and to analyze potential risk factors associated with ED by demographics, socioeconomic status, and medical comorbidities. Methods The study was community based. The five-item Internation Index of Erectile Function questionnaire and in-person interview were used to obtain data. The survey subjects were 5,210 non-institutionalized Chinese men at least 40 years old residing in 30 provinces and autonomies of China. Multiple logistic regression analysis was used to disclose risk factors associated with ED. Outcomes The prevalence estimate of ED was 40.56% in Chinese men at least 40 years old. Results The prevalence of ED increased with increasing age. A significant high prevalence of ED was observed in men who smoked heavily, were estranged from a partner, had diabetes, and lower urinary tract symptoms from benign prostatic hyperplasia. Smoking more than 30 cigarettes daily and obesity (body mass index ≥ 30 kg/m 2 ) significantly increased the risk for ED by multivariable-adjusted odds ratios. Stable or erratic sexual partners, personal incomes, alcohol consumption, and cardiovascular and/or cerebrovascular diseases were not risk factors associated with ED prevalence. Other sexual problems commonly seen in this group of men included difficulty achieving erectile rigidness, ejaculation, and climax during intercourse. Clinical Translation Knowledge on the prevalence of ED and its associated risk factors will help physicians in the clinical management and prevention of ED with the use of counseling for lifestyle adjustment and drug therapy. Strengths and Limitations Data on the influence of psychological conditions on ED were not collected. ED was not categorized as minor, moderate, or severe for analysis during processing of data. Conclusion The national representative prevalence of ED was determined for the first time in the Chinese male population. Zhang X, Yang B, Li N, Li H. Prevalence and Risk Factors for Erectile Dysfunction in Chinese Adult Males. J Sex Med 2017;14:1201–1208. [ABSTRACT FROM AUTHOR]

Background: For decades, US taxpayers have been lamenting the high cost of health care. Since the mid-1980s, Americans have had double-digit spending on health care. Despite this investment, Americans are less healthy than their European and Scandinavian counterparts across an array of health measures. Aim: We sought to explore how inadequate attention to the social, behavioral and environmental determinants of health may contribute to the American health care paradox of high health care spending and poor health outcomes. Design: Mixed methods. Methods: We report previous findings related from a 10-year analysis of national-level health and social service spending and health outcome data from the Organization of Economic and Cooperation and Development (OECD). We also put forth case studies representing different socioeconomic strata to illustrate the relationship between health care and social service spending and health. Results: Although the US spending more of its GDP on health care than any other country, it is not a high spender when one sums spending on both health care and social services. The U.S. however has the lowest ratio of our social service spending to health care spending in the OECD, and countries with lower ratios on average have worse health outcomes. Cases from diverse socioeconomic strata demonstrate how limited attention to the social determinants of health can result in extremely high health care costs and poor health outcomes. Conclusions: Greater investment in addressing the social, behavioral and environmental determinants of health may foster better health without accelerating health care costs in America. [ABSTRACT FROM AUTHOR]

Efforts to reduce the public health burden of tobacco use have not equally benefited all members of society, leading to disparities in tobacco use as a function of ethnicity/race, socioeconomic position, physical/behavioral comorbidity, and other factors. Although multilevel transdisciplinary models are needed to comprehensively understand sources of tobacco-related health disparities (TRHD), the incorporation of psychopharmacology into TRHD research is rare. Similarly, psychopharmacology researchers have often overlooked the societal context in which tobacco is consumed. In an effort to facilitate transdisciplinary research agendas for studying TRHD and the psychopharmacology of tobacco use, this article introduces a novel paradigm, called "sociopharmacology." Sociopharmacology is a platform for investigating how contextual factors amplify psychopharmacological determinants of smoking to disproportionately enhance vulnerability to smoking in populations subject to TRHD. The overall goal of sociopharmacology is to identify proximal person-level psychopharmacological mechanisms that channel distal societal-level influences on TRHD. In this article I describe: (1) sociopharmacology's overarching methodology and theoretical framework; (2) example models that apply sociopharmacology to understand mechanisms underlying TRHD; (3) how sociopharmacological approaches may enhance the public health impact of basic research on the psychopharmacology of tobacco use; and (4) how understanding sociopharmacological mechanisms of TRHD might ultimately translate into interventions that reduce TRHD. [ABSTRACT FROM AUTHOR]

Background: Hypertension is one of the most important public health issues worldwide.Aim: We assessed the prevalence rates of self-reported hypertension in Hong Kong between 2001 and 2008 and evaluated factors associated with its prevalence.Design: Serial cross-sectional surveys.Methods: Territory-wide Household surveys in the Hong Kong population in the years 2001, 2002, 2005 and 2008 were included. Population-adjusted prevalence of self-reported hypertension were compared across calendar years. The independent association of these variables with hypertension was evaluated by multivariate regression analysis with self-reported hypertension as a binary outcome.Results: There were 121 895 subjects interviewed, among which 103 367 were adults aged ≥15 years. The age- and gender-adjusted prevalence of self-reported hypertension in 2001, 2002, 2005 and 2008 among male adults was 4.73, 6.68, 7.96 and 9.82%, respectively, and among female adults, the prevalence was 6.13, 8.28, 10.00 and 11.58%, respectively. Advanced age (adjusted odds ratios [AOR]: 47.1, 95% CI 33.6–66.0 for the age group 40–65 years; AOR 256.2, 95% CI 182.4–360.0 for the age group 66–100 years; referent 0–39 years), female gender (AOR 0.81, 95% CI 0.74–0.88 for male) and a low median household income (AOR 1.56, 95% CI 1.31–1.85 for income ≤ US$1289; referent ≥ US$6444) were significantly associated with hypertension (all P < 0.001).Conclusions: This is the first study to show differences between socioeconomic groups in this Chinese population with higher rates among women and the less affluent. Similarly, it is the first to show gender differences with higher rates among women. [ABSTRACT FROM AUTHOR]

The main aim of the Gezondheid en Levens Omstandigheden Bevolking Eindhoven en omstreken (GLOBE) study (the letters of whose name represent the first letters of the Dutch acronym for Health and Living Conditions of the Population of Eindhoven and surroundings) is to quantitatively assess mechanisms and factors explaining socio-economic inequalities in health in the Netherlands. Baseline data for the study were collected by postal survey in 1991 among 18 973 respondents ranging in age from 15–75 years from the city of Eindhoven and its surrounding municipalities. Subsamples (total N = 5667) were interviewed and/or surveyed in 1991, 1997, 2004 (also including a new sample), and most recently in 2011. Information was asked on indicators of socio-economic position, a range of potential explanatory factors (material, behavioural, psychosocial, and environmental) and health outcomes. From 2004 onwards, special emphasis was given to the identification of physical, social, and cultural environmental factors in the explanation of socio-economic inequalities in health behaviours. Information from the baseline postal survey onwards can and has been linked to several registries of causes of death, hospital admissions, and cancer. Researchers are cordially invited to contact the project leader (f.vanlenthe@erasmusmc.nl) to propose research based on the data. [ABSTRACT FROM PUBLISHER]

The Caerphilly Health and Social Needs study was established to inform and support collaborative multiagency working on reducing inequalities in health and to investigate neighbourhood influences on mental health. Initially, we collated a robust small-area multiagency dataset of contextual health determinants and outcomes from routine sources and sharing of data between the National Health Service and Caerphilly county borough council. These data were widely used in local joint planning to improve health and reduce health inequalities. Secondly, we carried out a baseline population questionnaire survey, collecting data from 10 892 (60.6%) respondents aged 18–74 years on a wide range of socio-economic, lifestyle, health and housing factors and perceptions of the local neighbourhood, including access to services, social cohesion and neighbourhood quality. We carried out wave 2 of the survey after 7 years with responses from 4558 (50.2%) participants to the same range of questions. We developed the study into an electronic cohort, linking all 17 979 sampled participants aged 18–74 years to mortality and hospital admission records with 10-year follow-up and full recording of migration both within and out of the borough. Readers with an interest in collaborative use of the data should contact Professor David Fone, Principal Investigator. [ABSTRACT FROM PUBLISHER]

The Mbita Health and Demographic Surveillance System (Mbita HDSS), located on the shores of Lake Victoria in Kenya, was established in 2006. The main objective of the HDSS is to provide a platform for population-based research on relationships between diseases and socio-economic and environmental factors, and for the evaluation of disease control interventions. The Mbita HDSS had a population of approximately 54 014 inhabitants from 11 576 households in June 2013. Regular data are collected using personal digital assistants (PDAs) every 3 months, which includes births, pregnancies, migration events and deaths. Coordinates are taken using geographical positioning system (GPS) units to map all dwelling units during data collection. Cause of death is inferred from verbal autopsy questionnaires. In addition, other health-related data such as vaccination status, socio-economic status, water sources, acute illness and bed net distribution are collected. The HDSS has also provided a platform for conducting various other research activities such as entomology studies, research on neglected tropical diseases, and environmental health projects which have benefited the organization as well as the HDSS community residents. Data collected are shared with the community members, health officials, local administration and other relevant organizations. Opportunities for collaboration and data sharing with the wider research community are available and those interested should contact shimadam@nagasaki-u.ac.jp or mhmdkarama@yahoo.com. [ABSTRACT FROM PUBLISHER]

Background. Late diagnosis of cancer may partly be explained by the fact that some patients do not seek health care promptly when experiencing an alarm symptom. Socioeconomic and demographic differences exist concerning knowledge and awareness of cancer alarm symptoms in the general population and socioeconomic differences are found in cancer incidence and survival. We therefore hypothesise that socioeconomic and demographic differences in health care-seeking behaviour are present among people with alarm symptoms. Objectives. To analyse associations between health care seeking and socioeconomic and demographic factors among people reporting cancer alarm symptoms. Methods. A questionnaire survey comprising 20000 people aged >20 from the Danish population. The questionnaire concerned alarm symptoms of common cancers and subsequent health care seeking. Data on socioeconomic factors were obtained from Statistics Denmark. Main outcomes: health care seeking and patient interval. Results. A total of 26.1% of all subjects reported that they did not seek health care when having experienced an alarm symptom. Women—subjects aged >40, subjects living with a partner and subjects having a cancer diagnosis—were more likely to seek health care, whereas medium educational level was negatively associated with health care seeking. Further, women were more likely to seek health care within 1 month, whereas subjects out of the workforce were less likely to do so. Conclusions. Approximately three out of four subjects sought health care when having experienced an alarm symptom but 50% waited for at least 1 month. Some demographic factors were found to be associated with health care-seeking behaviour and the patient interval, whereas no consistent associations were found with regard to socioeconomics. [ABSTRACT FROM PUBLISHER]

The 1991 Canadian Census Cohort is the largest population-based cohort in Canada (N = 2 734 835). Prior to the creation of this Cohort, no national population-based Canadian cohort was available to examine mortality by socioeconomic indicators. The 1991 Canadian Census Cohort was created via the linkage of a sub-sample of respondents from the mandatory 1991 Canadian Census long-form to historical tax summary files, Canadian Mortality Database, Canadian Cancer Database, 1991 Health and Activity Limitation Survey and a sub-sample of the Longitudinal Worker File. Overall ascertainment of mortality and cancer is anticipated to be nearly complete and the Cohort is broadly representative of most groups in the Canadian population. The Cohort has been used to examine mortality outcomes by different indicators of socioeconomic status, occupational categories, ethnic groups, educational attainment, and for exposure to ambient air pollution. Results have shown that the estimated remaining years of life at age 25 differed substantially by income adequacy quintile, educational attainment, housing type and Aboriginal ancestry. [ABSTRACT FROM AUTHOR]

There has been an increased focus on non-communicable diseases (NCDs) in India, especially on cardiovascular diseases and associated risk factors. In this essay, we scrutinize the prevailing narrative that cardiovascular risk factors (CVRF) and cardiovascular disease (CVD) are no longer confined to the economically advantaged groups but are an increasing burden among the poor in India. We conducted a comprehensive review of studies reporting the association between socioeconomic status (SES) and CVRF, CVD, and CVD-related mortality in India. With the exception of smoking and low fruit and vegetable intake, the studies clearly suggest that CVRF/CVD is more prevalent among high SES groups in India than among the low SES groups. Although CVD-related mortality rates appear to be higher among the lower SES groups, the proportion of deaths from CVD-related causes was found to be greatest among higher SES groups. The studies on SES and CVRF/CVD also reveal a substantial discrepancy between the data presented and the authors’ interpretations and conclusions, along with an unsubstantiated claim that a reversal in the positive SES-CVRF/CVD association has occurred or is occurring in India. We conclude our essay by emphasizing the need to prioritize public health policies that are focused on the health concerns of the majority of the Indian population. Resource allocation in the context of efforts to make health care in India free and universal should reflect the proportional burden of disease on different population groups if it is not to entrench inequity. [ABSTRACT FROM AUTHOR]

Fifty-four and fifty samples of home-prepared feeding bottles for infants from a public health unit (low socioeconomic group, LSG) and from a private pediatric clinic (high socioeconomic group, HSG), respectively, were chemically analyzed, and their energy, macronutrient and iron contents were compared with the standard composition recommended for follow-up formulas. Cow’s milk and sucrose and cereals added to the bottles were largely used in the study. Energy, protein and carbohydrate contents were higher than the recommended level in 75.9, 27.7 and 81.5% of LSG samples and 62.0, 48.0 and 34.0% of HSG samples, respectively. Fat content was lower than the recommended level in 83.3% of LSG and 58.0% of HSG samples. Excessive values of energy, carbohydrates and protein, low fat content and macronutrient imbalance were found regardless of the socioeconomic class, thus indicating the need to improve the domestic feeding bottles’ preparation practices and discourage the use of cow’s milk and the addition of other ingredients. [ABSTRACT FROM AUTHOR]

Much has been written about the measurement of socio-economic position (SEP) in high-income countries (HIC). Less has been written for an epidemiology, health systems and public health audience about the measurement of SEP in low- and middle-income countries (LMIC). The social stratification processes in many LMIC—and therefore the appropriate measurement tools—differ considerably from those in HIC. Many measures of SEP have been utilized in epidemiological studies; the aspects of SEP captured by these measures and the pathways through which they may affect health are likely to be slightly different but overlapping. No single measure of SEP will be ideal for all studies and contexts; the strengths and limitations of a given indicator are likely to vary according to the specific research question. Understanding the general properties of different indicators, however, is essential for all those involved in the design or interpretation of epidemiological studies. In this article, we describe the measures of SEP used in LMIC. We concentrate on measures of individual or household-level SEP rather than area-based or ecological measures such as gross domestic product. We describe each indicator in terms of its theoretical basis, interpretation, measurement, strengths and limitations. We also provide brief comparisons between LMIC and HIC for each measure. [ABSTRACT FROM AUTHOR]

Background Commissioned by the International Epidemiological Association, this article is part of a series on burden of disease, health indicators and the challenges faced by epidemiologists in bringing their discoveries to provide equitable benefit to the populations in their regions and globally. This report covers the health status and epidemiological capacity in the North American region (USA and Canada).Methods We assessed data from country-specific sources to identify health priorities and areas of greatest need for modifiable risk factors. We examined inequalities in health as a function of social deprivation. We also reviewed information on epidemiological capacity building and scientific contributions by epidemiologists in the region.Findings The USA and Canada enjoy technologically advanced healthcare systems that, in principle, prioritize preventive services. Both countries experience a life expectancy at birth that is higher than the global mean. Health indicator measures are consistently worse in the USA than in Canada for many outcomes, although typically by only marginal amounts. Socio-economic and racial/ethnic disparities in indicators exist for many diseases and risk factors in the USA. To a lesser extent, these social inequalities also exist in Canada, particularly among the Aboriginal populations. Epidemiology is a well-established discipline in the region, with many degree-granting schools, societies and job opportunities in the public and private sectors. North American epidemiologists have made important contributions in disease control and prevention and provide nearly a third of the global scientific output via published papers.Conclusions Critical challenges for North American epidemiologists include social determinants of disease distribution and the underlying inequalities in access to and benefit from preventive services and healthcare, particularly in the USA. The gains in life expectancy also underscore the need for research on health promotion and prevention of disease and disability in older adults. The diversity in epidemiological subspecialties poses new challenges in training and accreditation and has occurred in parallel with a decrease in research funding. [ABSTRACT FROM AUTHOR]

Physical activity tends to decline from childhood into adulthood. Maintaining high levels of physical activity throughout life is therefore an important public health objective. Relatively little is known about changes in physical activity behavior over the life course, the domains of physical activity in which they occur, the characteristics of those whose physical activity declines, and the factors associated with such changes. In the future, incorporating more accurate measures of physical activity in large population studies would help to establish more accurate estimates of associations in this area. Determinants of behavior change, including the effects of socioeconomic position and social mobility on physical activity and fitness, are likely to change constantly throughout life, but it is largely unknown which determinants are most important at each life stage, let alone whether and at what times those determinants change. Better evidence on determinants of behavior change throughout the life course would contribute greatly to understanding when and how to intervene to help create and sustain lifelong healthy behavior patterns in those who have the most to gain from adopting them. [ABSTRACT FROM PUBLISHER]

Background: Advertising in magazines contributes to nutritional knowledge and social norms and may play a role in food choice and adiposity. In contrast to food advertising on television, that in magazines has received little research attention. We describe the type and nutritional content of foods advertised in popular UK weekly magazines and explore variations in these according to the socio-economic and gender profile of readers. Method: Four consecutive issues of 30 popular UK weekly magazines were obtained. Food advertisements were categorized into one of eight food groups. Manufacturer's data on the nutritional content of advertised foods was used to determine the nutritional content of advertised foods. Socio-economic and gender profile of magazines was determined from national readership statistics. Results: Four hundred forty three advertisements for food products were identified. The most common categories of foods advertised were meals, combination foods, soups and sauces (26%) and foods containing fat/sugar (23%). Advertised foods had a lower percentage of energy from carbohydrate (43%), lower fibre density (2 g/MJ), but higher percentage of energy from sugars (24%) and higher sodium density (0.5 g/MJ) than a diet recommended to avoid diet-related disease. There were variations in the type of foods advertised according to the socio-economic profile of readers and in the nutritional content of advertised foods according to the socio-economic and gender profile of readers. Conclusions: Food advertising reflects, and may reinforce, socio-economic and gender variations in food choice and adiposity. Producers of more healthy food may need help from policy makers and health promoters to effectively market their products. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic differences in old-age mortality have not been studied in Germany. This study fills in the gap, evaluating mortality and life expectancy differentials among retired. German men aged 65+ in 2003. Methods: Mortality rates are calculated from the administrative database on all public pensions and deaths of pensioners in 2003. Relative mortality rates and life expectancies are estimated for population subgroups according to the quintiles of lifetime earnings, type of medical insurance, broad occupational group, and residence in eastern or western Germany. Results: Among pension income quintiles, mortality varies by 60% and life expectancy at age 65 ranges from 14.9 to 18.5 years. Quintile-specific mortality and life-expectancy values are only slightly more favorable in western compared to eastern Germany. The mortality of manual workers is by 35% greater than that of salaried employees, while the mortality of those with mandatory public health insurance is 44% greater than the mortality of those with private or voluntary public health insurance. When all four characteristics are taken into account, relative mortality in the group with the highest mortality is three times higher than at the opposite end of the distribution, and corresponding life expectancies are 12.5 and 20 years. Half of all male deaths at ages 65+ are attributable to this variation. The mortality differentials remain significant at ages 80+. Conclusions: Socioeconomic mortality differentials persist into old age. They are similar in both regions and their magnitude is much greater than the diminishing mortality gap between the two parts of the country. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine if people living in communities with higher socio-economic deprivation are at an increased risk of cognitive and functional impairment even after controlling for the effects of individual socio-economic status. Methods: We analysed cross-sectional data from the Medical Research Council Cognitive Function and Ageing Study which consists of a community-based sample of Cambridgeshire, Gwynedd, Newcastle, Nottingham and Oxford. The study included 13004 men and women aged 65 years and over who were randomly selected from Family Health Services Authority computerized records after being stratified to ensure equal numbers of those aged 75 years and over and those under 75 years. The outcome measures were cognitive impairment (Mini-Mental State Exam 0-21) and functional impairment (Instrumental Activities of Daily Living and/or Activities of Daily Living disability). Results: Individuals living in more deprived areas, as measured by the Townsend deprivation score, were found to have a higher prevalence of cognitive impairment [odds ratio (OR) (most deprived versus least deprived quintile)=2.3; 95% confidence interval (CI)1.8-3.0; P<0.001] and functional impairment [OR (most deprived versus least)= 1.6; 95% CI 1.4-1.9; P<0.001] after controlling for age, sex, centre effects, education and social class. Conclusions: There is a significantly higher prevalence of cognitive impairment and functional impairment in elderly individuals living in socio-economically deprived areas regardless of their own socio-economic status. This evidence is of relevance for informing public health policy and those allocating resources for the long-term care of the elderly. [ABSTRACT FROM AUTHOR]

Aims: To identify how current public health policies of 12 developed countries assess alcohol-related problems, the goals and targets that are set and the strategic directives proposed. Methods: Policy documents on alcohol and on general public heath were obtained through repeated searches of government websites. Documents were reviewed by two independent observers. Results: All the countries studied state that alcohol causes substantial harm to individual health and family well-being, increases crime and social disruption, and results in economic loss through lost productivity. All are concerned about consumption of alcohol by young adults and by heavy and problem drinkers. Few aim to reduce total consumption. Only five of the countries set specific targets for changes in drinking behaviour. Countries vary in their commitment to intervene, particularly on taxation, drink-driving, the drinking environment and for high-risk groups. Australia and New Zealand stand out as having coordinated intervention programmes in most areas. Conclusions: Policies differ markedly in their organization, the goals and targets that are set. the strategic approaches proposed and areas identified for intervention. Most countries could improve their policies by following the recommendations in the World Heath Organization's European Alcohol Action Plan. [ABSTRACT FROM AUTHOR]

Background. The objective of this study was to identify the socioeconomic and health characteristics of communities with the largest proportional increases in incidence rates of acquired immunodeficiency syndrome (AIDS). Methods. Reported AIDS cases (1981–1990 and 1995-1999) were used for a comparison between 20 US counties with the largest proportional increases in incidence rates of AIDS and 20 US counties with the smallest increases. Data were obtained from Community Health Status Indicators Reports of the Health Resources and Services Administration (HRSA) and from the US Census Bureau. Results. Counties with the largest increases in the incidence of AIDS had lower levels of income, education, and literacy; higher incidence rates of syphilis, age-adjusted mortality (all causes), and infant mortality; more low-birth- weight infants; and higher levels on all 9 specific mortality measures in the HRSA reports. Conclusions. The incidence of AIDS increased the most in areas where many other health problems occurred. Research is needed to identify and address the root causes of ill health. [ABSTRACT FROM AUTHOR]

To date, comprehensive community health projects have not been evaluated in terms of their effect at the individual level, because outcomes are usually not defined at this level. In a community health project in the Netherlands, evaluation outcome mapping, a technique derived from intervention mapping, was used to identify distal as well as proximal programme objectives from which outcome measures could be derived. The intervention took place in a deprived area, where community members themselves defined stress, lack of area safety and parenting problems as the health-related problems they wanted to see addressed in the project. Local organizations wrote and implemented an action plan. The effects among residents were studied in a quasi-experimental design. Although no significant effects on improved perceived health or health-related problems were found at the level of the residents, the problems identified and their assumed causes showed significant coherence. This study is believed to be of relevance to evidence-based health promotion theory and practice as it demonstrates that it is possible to conduct an individual effect evaluation in a comprehensive community approach without jeopardizing the process of the intervention. [ABSTRACT FROM AUTHOR]

The WHO European Healthy Cities project developed city health profiles (CHPs) to provide the evidence base for health planning. A CHP is a public health report that brings together key pieces of information on health and its determinants in the city and interprets and analyses the information. This CHP would then form the basis of a city health development plan that would set out strategies and programmes of intervention to improve the health of a city's population. A content review of the CHPs produced by the cities in the WHO European Healthy Cities Network in 1995 and repeated 10 years later, attempted to undertake a systematic and comprehensive content review of the CHPs. The results show that in both reviews, demographic information was covered comprehensively. The inadequate coverage of areas of health status and socio-economic conditions in the 1995 review was covered comprehensively in 2005. Coverage of lifestyles, infrastructures and public health policies and services had improved since the 1995 review. The findings indicate that profiles presenting information on health and its determinants provide an evidence-base to inform health planning for the city. However, problems were still encountered in undertaking appropriate analysis to identify inequalities within the city and make recommendations that could be translated into targets. Just as the cities have adapted and evolved throughout the WHO Healthy Cities project, so have CHPs. The range of health profiles produced by cities demonstrate how they have evolved from basic tools that started by collecting routinely available information on death and disease to sophisticated mechanisms that gather an array of relevant information from a wide variety of sources through a range of methods. Most cities have understood the concept of a CHP as an evidence-based tool to inform health policy and planning and to strengthen the public health agenda. [ABSTRACT FROM PUBLISHER]

The authors investigated what risk factors contribute to an excess risk of poor adult health among children who experience socioeconomic disadvantage. Data came from 1,037 children born in Dunedin, New Zealand, in 1972–1973, who were followed from birth to age 32 years (2004–2005). Childhood socioeconomic status (SES) was measured at multiple points between birth and age 15 years. Risk factors evaluated included a familial liability to poor health, childhood/adolescent health characteristics, low childhood intelligence quotient (IQ), exposure to childhood maltreatment, and adult SES. Adult health outcomes evaluated at age 32 years were major depressive disorder, anxiety disorders, tobacco dependence, alcohol or drug dependence, and clustering of cardiovascular disease risk factors. Results showed that low childhood SES was associated with an increased risk of substance dependence and poor physical health in adulthood (for tobacco dependence, sex-adjusted relative risk (RR) = 2.27, 95% confidence interval (CI): 1.41, 3.65; for alcohol or drug dependence, RR = 2.11, 95% CI: 1.16, 3.84; for cardiovascular risk factor status, RR = 2.55, 95% CI: 1.46, 4.46). Together, the risk factors studied here accounted for 55–67% of poor health outcomes among adults exposed to low SES as children. No single risk factor emerged as the prime explanation, suggesting that the processes mediating the link between childhood low SES and adult poor health are multifactorial. [ABSTRACT FROM AUTHOR]

The author comments on health inequalities in Europe. Among the major explanations for health inequalities include the Black Report artefacts and selection to socio-economic groups. Based on research, material living conditions, income and housing are among the factors that affect health inequalities. These inequalities are considered unjust and remain a potential obstacle for a positive overall development of health among the population.