November 2006 American Journal of Public Health Highlights: Human Rights and Ethics

Newswise — The articles below will be published online October 3, at 4 p.m. by the American Journal of Public Health under "First Look" at http://www.ajph.org/first_look.shtml, and will appear in the November 2006 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, http://www.apha.org, and is available at http://www.ajph.org. To stay up to date on the latest in public health research, sign up for new Journal content e-mail alerts at http://www.ajph.org/subscriptions/etoc.shtml?ck=nck.

1) FOLIC ACID MAY PROTECT AGAINST BIRTH DEFECTS, BUT INTAKE STILL FALLS SHORT OF GOALSA national mandate to fortify all U.S. enriched grain products with folic acid has led to an overall intake of the nutrient, yet consumption still falls far short of federal targets and varies greatly among different populations.

The Food and Drug Administration mandated folic acid fortification of U.S. enriched grain products in 1998 with the goal of reducing the number of babies born with neural tube defects. Researchers analyzed food, supplement and total folate intake by age, gender and race/ethnicity from two National Health and Nutrition Examination Surveys and found that daily folate consumption increased by 100 micrograms (mcg) since the national fortification requirement. The proportion of women aged 15-44 consuming greater than 400 mcg/day of folate has increased since fortification, but has not yet reached the Food and Drug Administration's 50 percent target, varying by race/ethnicity from 23 percent to 33 percent.

And while adequate folic acid intake helps protect against birth defects as well as protect against heart disease and colon cancer, consuming too much of the nutrient can mask the anemia caused by vitamin B-12 deficiency among the elderly. The study found that since folic acid fortification of U.S. grains, the percent of people ages 65 and older consuming over 1,000 mcg/day (the "tolerable upper intake level" ) has at least doubled among whites and black men but still remains under 5 percent for all groups.

[From: "Population-Level Changes in Folate Intake by Age, Gender and Race/Ethnicity After Folic Acid Fortification." ]

2) WOMEN AND SUBSTANCE ABUSE: DID WELFARE REFORM MAKE A DIFFERENCE?Substance abuse is less common among women on welfare than the condition was 15 years ago, but Temporary Assistance to Needy Families (TANF) remains an important "portal" to identifying women who need help kicking an addiction.

Two recent studies examined substance use disorders among low-income women with children, and found that welfare reform seemed to have translated into fewer substance-abusing women receiving TANF aid. TANF recipients who have drug problems are more likely to get treatment than poor women who do not receive such aid. Some types of treatment are much more effective than others.

A study based on annual data from mothers between the ages of 18-49 within the 1990-2001 National Household Survey of Drug Abuse and the 2002 National Survey of Drug Use and Health found that welfare receipt among low-income substance-using mothers declined from 54 percent in 1996 to 38 percent in 2001. The decline was much smaller (37 percent to 31 percent) among poor mothers who did not use illicit substances. And among 2002 survey respondents deemed "in-need" of treatment, welfare recipients were more than twice as likely as non-recipients to receive such services. Welfare receipt has declined among drug-using women. This has created a new challenge for policy-makers and the social service systems, as welfare remains a prominent portal to identify low-income women with substance use disorders, and to both provide and fund drug treatment interventions.

Another study found intensive case management was much more effective than the usual model of care for women on welfare who had drug problems. In that study, women who received intensive case management, which involved long-term support and monitoring, were twice as likely to be drug-free 15 months following the first treatment than those enrolled in more traditional treatment programs.[From: "Welfare Receipt and Treatment among Substance-Using Mothers: Did Welfare Reform Make a Difference?" Contact: Harold A. Pollack, PhD, University of Chicago, [email protected] and "A Randomized Field Trial Examining the Effectiveness of Intensive Case Management for Substance Dependent Women Receiving Temporary Assistance for Needy Families (TANF)." Contact: Jon Morgenstern, PhD, CASA, New York, N.Y., [email protected].]

3) TOBACCO COMPANIES MAY USE SMOKE AND MIRRORS TO APPEAR TO COMPLY WITH HEALTH DEMANDSWhen it comes to warnings about the dangers of cigarette smoking, tobacco companies can be adept at appearing to be helpful while not truly complying with public demand. Researchers reviewed internal tobacco industry documents and related materials to construct a case history of how Philip Morris responded to a shareholder campaign requiring health warnings on cigarettes sold worldwide. They found that Philip Morris resisted for 11 years, then unilaterally reversed direction, proposing its own labeling initiative. While activists celebrated, the company's president detailed privately how Philip Morris would yield little and benefit disproportionately. By portraying the industry as preying on the poor and uneducated, advocates helped divide the company from financial and political allies. When Philip Morris "gave in" to their demands, it exchanged negative publicity for positive public relations and political credibility.

In the words of the study's authors, "Negotiating with the tobacco industry can enhance its legitimacy and facilitate its ability to market deadly cigarettes without corresponding benefits to public health." [From: "Making Big Tobacco Give In: You Lose, They Win." ]

4) UPWARD MOBILITIY HELPS LOWER RISK OF LOW BIRTHWEIGHT, BUT NOT FOR BLACK WOMENUpward mobility can help white women who start out poor in life reduce their chance of having a low birthweight baby by up to nearly 50 percent, yet it may do very little to help similarly situated black women. A new study involving more than 1,800 births found that among white women who grew up in poor households, the more their family income increased over time, the less likely they were to give birth to a low birthweight baby. But the same did not hold true for black women. This discrepancy could not be attributable to lifestyle factors such as smoking, drinking or lack of prenatal care.

"Upward mobility is likely to be a qualitatively different experience for black women than white women," notes lead study author Cynthia G. Colen, Ph.D. "Even while their financial situations are improving, black women face obstacles that white women do not " primarily because of racial discrimination. For example, residential segregation makes it more difficult for upwardly mobile black families to secure housing in safe, healthy neighborhoods. Such challenges can create additional stress for black women and ultimately affect the health of their infants."

One factor did lower black women's risk of having a low birthweight baby: the presence of a grandmother in the household, which reduced the overall risk of low birthweight by 53 percent.

"These results suggest that for African-Americans the presence of certain key family members has an independent impact on birthweight above and beyond the provision of financial resources," the study authors write.

However, as black women move up the socioeconomic ladder, they may be less likely to rely on their own mothers for support and assistance with childrearing responsibilities. Forty-seven percent of births to chronically poor black women occurred in households with a co-residential grandmother; for upwardly mobile black women that figure was only 18 percent. [From: "Upward Maternal Socioeconomic Mobility and Black-White Disparities in Infant Birthweight." ]

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