American Journal of Public Health Highlights: November 2009

Newswise — The articles below will be published online September 17, 2009, at 4 p.m. (ET) by the American Journal of Public Health under “First Look” at http://www.ajph.org/first_look.shtml, and they are currently scheduled to appear in the November 2009 print issue of the Journal. “First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, www.apha.org, and is available at www.ajph.org.

(1) Lack of health insurance leads to 45,000 excess deaths annually

A new study shows that a lack of health insurance is associated with nearly 45,000 deaths in the United States each year — or one death every 12 minutes.

Researchers conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey and analyzed participants aged 17 to 64 years to determine whether uninsurance at the time of interview predicted death. After adjusting for age, gender, education, employment status, smoking and other factors, the authors found that lack of health insurance causes 44,789 deaths each year.

The number of excess deaths is nearly two-and-a-half times greater than previous estimates by the Institute of Medicine, which were based on older studies.

[From: “Health Insurance and Mortality in U.S. Adults.” ].

(2) Effective prevention extends lives and increases medical cost savings

Prevention measures against chronic diseases such as obesity, hypertension and diabetes will lead to both health benefits as well as medical cost savings in older Americans, a new study indicates.

Researchers tracked a national cohort of persons 51 and 52 years of age and projected their health and medical spending in prevention scenarios for diabetes, hypertension, obesity and smoking. The gain in life span from successful treatment of a person aged 51 years for obesity would be 0.85 years; for hypertension, 2.05 years; and for diabetes, 3.17 years. In addition, a 51- or 52-year-old who quit smoking would gain 3.44 years. The study claims that despite living longer, those successfully treated would still accumulate less health care spending over their lifetime for obesity (savings of $7,168), hypertension (savings of $13,702) and diabetes (savings of $34,483). Smoking cessation, however, would cost an additional $15,959 over an individual’s life.

The researchers suggest, “Our data indicate that primary prevention could improve the health and longevity of future cohorts of elderly persons in the United States at a relatively low cost.”

[From: “The Benefits of Risk Factor Prevention in Americans Aged 51 Years and Older.” ].

(3) Risky behaviors among truckers lead to higher rates of STIs including hepatitis C

Long-distance truck drivers participate in higher risk behaviors, a New Mexico study reports.

Researchers examined sexually transmitted infection, HIV and hepatitis C virus prevalence and risk behaviors among 652 truck drivers between 2004 and 2006. Mobile clinic vans were used to conduct this study at a large trucking terminal in Albuquerque, N.M., and at 10 truck stops throughout the state. Fifty-four drivers — 8.5 percent — tested positive for hepatitis C. Furthermore, alcohol consumption is a strong independent risk factor for the progression of hepatitis C Virus-associated liver disease that potentially can be modified through patient education and behavior change, researchers imply. Results suggest a need for hepatitis C screening and STI risk-reduction interventions in this population.

The study’s authors conclude, “Our results suggest that drivers may benefit from HIV, STI and hepatitis prevention interventions embedded within comprehensive wellness programs that are convenient and easily integrated into the mobile environment of the trucking industry.”

[From: “Risk Assessment and Screening for Sexually Transmitted Infections, HIV, and Hepatitis Virus Among Long-Distance Truck Drivers in New Mexico, 2004-2006.” ]. (4) Pregnancy serves as opportune time for HIV prevention education

Coupling an HIV prevention program with group prenatal care may be an effective method of reducing risks for HIV and sexually transmitted infections. Researchers bundled an HIV prevention program with group prenatal care and examined its effect on STI incidence, repeat pregnancy, sexual risk behavior and psychosocial risk. Among the sample of 1,047, the average age of participants was 20.4 years and 80 percent were African American women. Researchers found that women assigned to the HIV-prevention group intervention were significantly less likely to have repeat pregnancy at six months postpartum than individual-care and attention-matched controls. Furthermore, they demonstrated increased condom use and decreased unprotected sexual intercourse compared with individual-care and attention-matched controls.

“Pregnancy may be an important window of opportunity to foster behavioral change and improve the health of women across multiple domains,” Reported researchers. “Making HIV/STI prevention a part of prenatal care may prove to be a useful tool in the reduction of HIV, STIs and repeat pregnancy.”

[From: “Pregnancy as a Window of Opportunity for HIV Prevention: Effects of an HIV Intervention Delivered Within Prenatal Care.” ].

The American Journal of Public Health is the monthly Journal of the American Public Health Association (APHA), the oldest and most diverse organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at www.apha.org.

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