American Journal of Public Health: September 2012 Highlights

Newswise — The articles below will be published online July 19, 2012, at 4 p.m. (EDT) by the American Journal of Public Health® under “First Look” at http://www.ajph.org/first_look.shmtl, and they are currently scheduled to appear in the September 2012 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.American Journal of Public Health Highlights:

(1) E-cigarettes becoming increasingly popular despite unknown consequences(2) Specialized primary care offers better, cheaper treatment for former prisoners(3) STD rates drop in communities with integrated local health departments

(1) E-cigarettes becoming increasingly popular despite unknown consequencesConsumption and awareness of “e-cigarettes,” electronic nicotine inhalers that contain nicotine derived from tobacco, are high in the United States despite limited knowledge of their side effects, according to a new study from the American Journal of Public Health. While the products are marketed as safe alternatives to smoking, more research is necessary to determine their health impact on both the individual and population levels.

Researchers conducted separate online and phone surveys in 2010 to determine American consciousness of electronic nicotine delivery systems (ENDS), usage rates and public perceptions of their harmfulness. Surveys compiled data from never, former and current smokers, with large samples of African Americans and Hispanics. Each asked respondents for their experience with e-cigarettes, and to quantify their risk compared to regular cigarettes on a five-point scale. The online sample showed that more than 40 percent of Americans ages 18 and older had heard of e-cigarettes, including 57.1 percent of current smokers. Additionally, a majority of smokers — 70.6 percent of online respondents and 84.7 percent of phone respondents — believed that e-cigarettes were less harmful than regular cigarettes. Researchers found some evidence that the electronic products were specifically popular among smokers who were considering quitting within six months, possibly as cessation treatments. Because e-cigarettes have not been regulated by the Food and Drug Administration and were only recently introduced to American consumers, neither their value as a cessation aid nor their claims as a reduced harm/modified risk product can be determined.

“Awareness of ENDS is widespread and experimentation and use by millions of smokers, especially young adults, is of concern,” the study’s authors concluded. The authors call for FDA regulation of these products and for further research to determine the prevalence of consistent ENDS use, the role of ENDS as a starter product and the impact of dual use on both harm reduction and on whether e-cigarettes are facilitating or undermining smokers’ cessation efforts.

[From: “e-Cigarette Awareness, Use, and Harm Perceptions in US Adults.” Contact: Jennifer L. Pearson, PhD, Legacy, Wash., D.C., [email protected]].

(2) Specialized primary care offers better treatment for former prisonersPrimary care programs with specialized treatment for released prisoners are more effective than common practices, reports a recent study from the American Journal of Public Health. Researchers placed 200 inmates in one of two primary care systems within two weeks of their release from prison. One program offered ongoing treatment at a transitions clinic — which included primary care from an experienced provider and a previously incarcerated community health worker — while the other provided expedited primary care at randomly assigned clinics. All participants were English speaking, had no previous primary care provider, and either had one chronic illness or were aged 50 years or older. In the 12-month follow-up period of the two-year study, participants who received ongoing care in transitions clinics visited emergency departments 51 percent fewer times than ones in the alternative program. Authors add that 700,000 individuals are imprisoned in the U.S. at any time, the highest rate in the world. “Modest amounts of funding from either federal or state governments to local safety-net health care systems to hire and supervise a [community health worker] could expand health care access and enhance primary care for formerly incarcerated individuals,” the study’s authors concluded. [From: “Engaging Individuals Recently Released From Prison Into Primary Care: A Randomized Trial.” Contact: Emily A. Wang, Yale University School of Medicine, New Haven, Conn., [email protected]].

(3) STD rates drop in communities with integrated local health departmentsThe occurrence of sexually transmitted diseases within a population may be lowest in communities where core public health activities are shared by many partners, according to a new study from the American Journal of Public Health. Conversely, public health systems where the local health department shoulders much of the effort and offers comprehensive services may lead to higher STD rates.

Researchers linked county-wide STD incidence rates — specifically chlamydia and gonorrhea — to the organization and governance of local public health systems and health departments. The 307 counties included in the study were separated into six categories of local health systems determined by size, financial allotments and amount of services offered. Data showed that local boards of health deemed independent and comprehensive by researchers — meaning departments individually offered a wide range of health services — produced higher STD rates (540.6 annual cases per 100,000 people). When local health boards shared public health activities with many working partners, the number of annual cases dropped by over 75,000. An additional finding showed that counties with higher concentrations of black residents were more likely to have independent and comprehensive local public health services, and higher STD incidence.

“Interventions for the modifiable local public health system correlates of STD incidence, including the involvement of public health system partners in core activities, might improve the reach and effectiveness of surveillance and control activities and reduce racial disparities in the burden of STDs,” the authors of the study concluded. “To improve public health system effectiveness, clarifying how to build and maintain effective community health partnerships should be a high priority for researchers and public health practitioners.”

[From: “Local Public Health Systems and the Incidence of Sexually Transmitted Diseases.” Contact: Hector P. Rodriguez, UCLA School of Public Health, Los Angeles, Calif., [email protected]].

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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