Archive for the ‘American Journal of Preventive Medicine’ Category

Rising Suicide Among Adults Aged 40–64 Years

March 9, 2015 Comments off

Rising Suicide Among Adults Aged 40–64 Years
Source: American Journal of Preventive Medicine

Suicide rates among middle-aged men and women in the U.S. have been increasing since 1999, with a sharp escalation since 2007.

To examine whether suicides with circumstances related to economic crises increased disproportionately among the middle-aged between 2005 and 2010.

This study used the National Violent Death Reporting System (NVDRS) in 2014 to explore trends and patterns in circumstance and method among adults aged 40–64 years.

Suicide circumstances varied considerably by age, with those related to job, financial, and legal problems most common among individuals aged 40–64 years. Between 2005 and 2010, the proportion of suicides where these circumstances were present increased among this age group, from 32.9% to 37.5% of completed suicides (p65 years (p<0.05).

The growth in the importance of external circumstances and increased use of suffocation jointly pose a challenge for prevention efforts designed for middle-aged adults. Suffocation is a suicide method that is highly lethal, requires relatively little planning, and is readily available. Efforts that target employers and workplaces as important stakeholders in the prevention of suicide and link the unemployed to mental health resources are warranted.

Screening Youth for Suicide Risk in Medical Settings: Time to Ask Questions

September 17, 2014 Comments off

Screening Youth for Suicide Risk in Medical Settings: Time to Ask Questions (PDF)
Source: American Journal of Preventive Medicine

This paper focuses on the National Action Alliance for Suicide Prevention’s Research Prioritization Task Force’s Aspirational Goal 2 (screening for suicide risk) as it pertains specifically to children, adolescents, and young adults. Two assumptions are forwarded: (1) strategies for screening youth for suicide risk need to be tailored developmentally; and (2) we must use instruments that were created and tested specifically for suicide risk detection and developed specifically for youth. Recommendations for shifting the current paradigm include universal suicide screening for youth in medical settings with validated instruments.

Impact of the New U.S. Department of Agriculture School Meal Standards on Food Selection, Consumption, and Waste

March 14, 2014 Comments off

Impact of the New U.S. Department of Agriculture School Meal Standards on Food Selection, Consumption, and Waste (PDF)
Source: American Journal of Preventive Medicine

The U.S Department of Agriculture (USDA) recently made substantial changes to the school meal standards. The media and public outcry have suggested that this has led to substantially more food waste.

School meal selection, consumption, and waste were assessed before and after implementation of the new school meal standards.

Plate waste data were collected in four schools in an urban, low-income school district. Logistic regression and mixed-model ANOVA were used to estimate the differences in selection and consumption of school meals before (fall 2011) and after implementation (fall 2012) of the new standards among 1030 elementary and middle school children. Analyses were conducted in 2013.

After the new standards were implemented, fruit selection increased by 23.0% and entrée and vegetable selection remained unchanged. Additionally, post-implementation entrée consumption increased by 15.6%, vegetable consumption increased by 16.2%, and fruit consumption remained the same. Milk selection and consumption decreased owing to an unrelated milk policy change.

Although food waste levels were substantial both pre- and post-implementation, the new guidelines have positively affected school meal selection and consumption. Despite the increased vegetable portion size requirement, consumption increased and led to significantly more cups of vegetables consumed. Significantly more students selected a fruit, whereas the overall percentage of fruit consumed remained the same, resulting in more students consuming fruits. Contrary to media reports, these results suggest that the new school meal standards have improved students’ overall diet quality. Legislation to weaken the standards is not warranted.

State Costs of Excessive Alcohol Consumption, 2006

August 14, 2013 Comments off

State Costs of Excessive Alcohol Consumption, 2006 (PDF)
Source: American Journal of Preventive Medicine

Excessive alcohol consumption is responsible for an average of 80,000 deaths in the U.S. each year and cost $223.5 billion ($1.90/drink) in 2006. Comparable state estimates of this cost are needed to help inform prevention strategies.

The goal of the study was to estimate the economic cost of excessive drinking by state for 2006.

From December 2011 to November 2012, an expert panel developed methods to allocate component costs from the 2006 national estimate to states for (1) total; (2) government; (3) binge drinking; and (4) underage drinking costs. Differences in average state wages were used to adjust productivity losses.

In 2006, the median state cost of excessive drinking was $2.9 billion (range: $31.9 billion [California] to $419.6 million [North Dakota]); the median cost per drink, $1.91 (range: $2.74 [Utah] to $0.88 [New Hampshire]); and the median per capita cost, $703 (range: $1662 [District of Columbia] to $578 [Utah]). A median of 42% of state costs were paid by government (range: 45.0% [Utah] to 37.0% [Mississippi]). Binge drinking was responsible for a median of 76.6% of state costs (range: 83.1% [Louisiana] to 71.6% [Massachusetts]); underage drinking, a median of 11.2% of state costs (range: 20.0% [Wyoming] to 5.5% [District of Columbia]).

Excessive drinking cost states a median of $2.9 billion in 2006. Most of the costs were due to binge drinking and about $2 of every $5 were paid by government. The Guide to Community Preventive Services has recommended several evidence-based strategies — including increasing alcohol excise taxes, limiting alcohol outlet density, and commercial host liability — that can help reduce excessive alcohol use and the associated economic costs.

Effectiveness of Taxicab Security Equipment in Reducing Driver Homicide Rates

July 12, 2013 Comments off

Effectiveness of Taxicab Security Equipment in Reducing Driver Homicide Rates (PDF)
Source: American Journal of Preventive Medicine

Taxicab drivers historically have had one of the highest work-related homicide rates of any occupation. In 2010 the taxicab driver homicide rate was 7.4 per 100,000 drivers, compared to the overall rate of 0.37 per 100,000 workers.

Evaluate the effectiveness of taxicab security cameras and partitions on citywide taxicab driver homicide rates.

Taxicab driver homicide rates were compared in 26 major cities in the U.S. licensing taxicabs with security cameras (n¼8); bullet-resistant partitions (n¼7); and cities where taxicabs were not equipped with either security cameras or partitions (n¼11). News clippings of taxicab driver homicides and the number of licensed taxicabs by city were used to construct taxicab driver homicide rates spanning 15 years (1996–2010). Generalized estimating equations were constructed to model the Poisson-distributed homicide rates on city-specific safety equipment installation status, controlling for city homicide rate and the concurrent decline of homicide rates over time. Data were analyzed in 2012.

Cities with cameras experienced a threefold reduction in taxicab driver homicides compared with control cities (RR¼0.27; 95% CI¼0.12, 0.61; p¼0.002). There was no difference in homicide rates for cities with partitions compared with control cities (RR¼1.15; 95% CI¼0.80, 1.64; p¼0.575).

Municipal ordinances and company policies mandating security cameras appear to be highly effective in reducing taxicab driver deaths due to workplace violence. (Am J Prev Med 2013;45(1):1–8) Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine)

See: Reducing Taxicab Homicides (CDC)

Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures

July 11, 2012 Comments off

Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures (PDF)

Source: American Journal of Preventive Medicine


The 2010 Affordable Care Act relies on Federally Qualifıed Health Centers (FQHCs) and FQHC look-alikes (look-alikes) to provide care for newly insured patients, but ties increased funding to demonstrated quality and effıciency.


To compare FQHC and look-alike physician performance with private practice primary care physicians (PCPs) on ambulatory care quality measures.


The study was a cross-sectional analysis of visits in the 2006 –2008 National Ambulatory Medical Care Survey. Performance of FQHCs and look-alikes on 18 quality measures was compared with private practice PCPs. Data analysis was completed in 2011.


Compared to private practice PCPs, FQHCs and look-alikes performed better on six measures (p 0.05); worse on diet counseling in at-risk adolescents (26% vs 36%, p 0.05); and no differently on 11 measures. Higher performance occurred in ACE inhibitors use for congestive heart failure (51% vs 37%, p 0.004); aspirin use in coronary artery disease (CAD) (57% vs 44%, p 0.004); -blocker use for CAD (59% vs 47%, p 0.01); no use of benzodiazepines in depression (91% vs 84%, p 0.008); blood pressure screening (90% vs 86%, p 0.001); and screening electrocardiogram (EKG) avoidance in low-risk patients (99% vs 93%, p 0.001). Adjusting for patient characteristics yielded similar results, except that private practice PCPs no longer performed better on any measures.


FQHCs and look-alikes demonstrated equal or better performance than private practice PCPs on select quality measures despite serving patients who have more chronic disease and socioeconomic complexity. These fındings can provide policymakers with some reassurance as to the quality of chronic disease and preventive care at Federally Qualifıed Health Centers and look-alikes, as they plan to use these health centers to serve 20 million newly insured individuals.

See: When Public Beats Private: Community Clinics That Keep Costs Down and Do a Better Job, Too (The Atlantic)

Obesogenic Neighborhood Environments, Child and Parent Obesity: The Neighborhood Impact on Kids Study

April 18, 2012 Comments off
Source:  American Journal of Preventive Medicine
Background: Identifying neighborhood environment attributes related to childhood obesity can inform environmental changes for obesity prevention. Purpose: To evaluate child and parent weight status across neighborhoods in King County (Seattle metropolitan area) and San Diego County differing in GIS-defıned physical activity environment (PAE) and nutrition environment (NE) characteristics.
Methods: Neighborhoods were selected to represent high (favorable) versus low (unfavorable) on the two measures, forming four neighborhood types (low on both measures, low PAE/high NE, high PAE/low NE, and high on both measures). Weight and height of children aged 6–11 years and one parent (n 730) from selected neighborhoods were assessed in 2007–2009. Differences in child and parent overweight and obesity by neighborhood type were examined, adjusting for neighborhood-, family-, and individual-level demographics.
Results: Children from neighborhoods high on both environment measures were less likely to be obese (7.7% vs 15.9%, OR 0.44, p 0.02) and marginally less likely to be overweight (23.7% vs 31.7%, OR 0.67, p 0.08) than children from neighborhoods low on both measures. In models adjusted for parent weight status and demographic factors, neighborhood environment type remained related to child obesity (high vs low on both measures, OR 0.41, p 0.03). Parents in neighborhoods high on both measures (versus low on both) were marginally less likely to be obese (20.1% vs 27.7%, OR 0.66, p 0.08), although parent overweight did not differ by neighborhood environment. The lower odds of parent obesity in neighborhoods with environments supportive of physical activity and healthy eating remained in models adjusted for demographics (high vs low on the environment measures, OR 0.57, p 0.053).
Conclusions: Findings support the proposed GIS-based defınitions of obesogenic neighborhoods for children and parents that consider both physical activity and nutrition environment features.

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