external image Pdf.jpgexternal image 20px-Ajphlogo.jpgKenneth McLeroy Thinking of Systems Am J Public Health 0: AJPH.2005.084459v1.
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgScott J. Leischow, and Bobby Milstein, Systems Thinking and Modeling for Public Health Practice, Am J Public Health 0: AJPH.2005.082842v1.
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgPaul Ong, Matthew Graham, and Douglas Houston, Policy and Programmatic Importance of Spatial Alignment of Data Sources, Am J Public Health 0: AJPH.2005.071373v1.
Abstract Geographic information systems have proven instrumental in assessing environmental impacts on individual and community health, but numerous methodological challenges are associated with analyses of highly localized phenomena in which spatially misaligned data are used.
In a case study based on child care facility and traffic data for the Los Angeles metropolitan area, we assessed the extent of facility misclassification with spatially unreconciled data from 3 different governmental agencies in an attempt to identify child care centers in which young children are at risk from high concentrations of toxic vehicle-exhaust pollutants. Relative to geographically corrected data, unreconciled information produced a modest bias in terms of aggregated number of facilities at risk and a substantial number of false positives and negatives.
Key Words: Environment, Geography, Social Science, Statistics/Evaluation/Research, Urban Health
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgGerald Midgley, Systemic Intervention for Public Health, Am J Public Health 0: AJPH.2005.067660v1.
Abstract Many calls have been made for a systems approach to public health. My response is to offer a methodology for systemic intervention that (1) emphasizes the need to explore stakeholder values and boundaries for analysis, (2) challenges marginalization, and (3) draws upon a wide range of methods (from the systems literature and beyond) to create a flexible and responsive systems practice.
I present and discuss several well-tested methods with a view to identifying their potential for supporting systemic intervention for public health.
Key Words: Community Health, Ethics, Health Administration, Health Policy, Public Health Practice, Statistics/Evaluation/Research
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgTheodore M. Hammett, HIV/AIDS and Other Infectious Diseases Among Correctional Inmates: Transmission, Burden, and Appropriate Response, Am J Public Health 0: AJPH.2005.066993v1. Abstract Correctional inmates engage in drug-related and sexual risk behaviors, and the transmission of HIV, hepatitis, and sexually transmitted diseases occurs in correctional facilities. However, there is uncertainty about the extent of transmission, and hyperbolic descriptions of its extent may further stigmatize inmates and elicit punitive responses.
Whether infection was acquired within or outside correctional facilities, the prevalence of HIV and other infectious diseases is much higher among inmates than among those in the general community, and the burden of disease among inmates and releasees is disproportionately heavy. A comprehensive response is needed, including voluntary counseling and testing on request that is linked to high-quality treatment, disease prevention education, substance abuse treatment, and discharge planning and transitional programs for releasees.
Key Words: Health Service Delivery, HIV/AIDS, Human Rights, Hepatitis
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgJohn D. Sterman, Learning from Evidence in a Complex World , Am J Public Health 0: AJPH.2005.066043v1.Abstract Policies to promote public health and welfare often fail or worsen the problems they are intended to solve. Evidence-based learning should prevent such policy resistance, but learning in complex systems is often weak and slow. Complexity hinders our ability to discover the delayed and distal impacts of interventions, generating unintended "side effects." Yet learning often fails even when strong evidence is available: common mental models lead to erroneous but self-confirming inferences, allowing harmful beliefs and behaviors to persist and undermining implementation of beneficial policies.
Here I show how systems thinking and simulation modeling can help expand the boundaries of our mental models, enhance our ability to generate and learn from evidence, and catalyze effective change in public health and beyond.
Key Words: Health Policy, Health Promotion, Health Service Delivery, Statistics/Evaluation/Research

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgLawrence W. Green, Public Health Asks of Systems Science: To Advance Our Evidence-Based Practice, Can You Help Us Get More Practice-Based Evidence?, Am J Public Health 0: AJPH.2005.066035v1. Abstract Public health asks of sys tems science, as it did of sociology 40 years ago, that it help us unravel the complexity of causal forces in our varied populations and the ecologically layered community and societal circumstances of public health practice.
We seek a more evidence-based public health practice, but too much of our evidence comes from artificially controlled research that does not fit the realities of practice.
What can we learn from our experience with sociology in the past that might guide us in drawing effectively on systems science?
Key Words: Community Health, Health Policy, Health Professionals, Public Health Practice, Social Science, Socioeconomic Factors

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgWilliam M. Trochim, Derek A. Cabrera, Bobby Milstein, Richard S. Gallagher, and Scott J. Leischow, Practical Challenges of Systems Thinking and Modeling in Public Health, Am J Public Health 0: AJPH.2005.066001v1. Abstract Objectives. Awareness of and support for systems thinking and modeling in the public health field are growing, yet there are many practical challenges to implementation. We sought to identify and describe these challenges from the perspectives of practicing public health professionals.
Methods. A systems-based methodology, concept mapping, was used in a study of 133 participants from 2 systems-based public health initiatives (the Initiative for the Study and Implementation of Systems and the Syndemics Prevention Network). This method identified 100 key challenges to implementation of systems thinking and modeling in public health work.
Results. The project resulted in a map identifying 8 categories of challenges and the dynamic interactions among them.
Conclusions. Implementation by public health professionals of the 8 simple rules we derived from the clusters in the map identified here will help to address challenges and improve the organization of systems that protect the public's health.
Key Words: Health Administration, Health Education, Health Policy, Social Science, Statistics/Evaluation/Research, Tobacco Control
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgNorman Daniels, Toward Ethical Review of Health System Transformations, Am J Public Health 0: AJPH.2005.065706v1.Abstract Efforts to transform health systems constitute social experiments on a population. Like clinical research, they deploy measures that are unproven in the context of the reform, and they often impose significant risks on some people in order to achieve a social goal: the improvement of health delivery.
The rationale for proactively evaluating clinical experimentation on human subjects also applies to these social experiments. We used the "benchmarks of fairness" methodology to illustrate the elements such an evidence-based review should encompass, leaving open the question of who should perform it. The review must include the ethical objectives of reform, namely, an integrated approach to equity, accountability, and efficiency; the fit between measures taken and these objectives; and the governance of the reform.
Key Words: Ethics, Health Care Facilities/Services, Health Financing, Health Policy, Access to Care, Health Service Delivery
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgYaneer Bar-Yam, Improving the Effectiveness of Health Care and Public Health: A Multiscale Complex Systems Analysis,Am J Public Health 0: AJPH.2005.064444v1.
The US health care system is struggling with a mismatch between the large, simple (low-information) financial flow and the complex (high-information) treatment of individual patients. Efforts to implement cost controls and industrial efficiency that are appropriate for repetitive tasks but not high-complexity tasks lead to poor quality of care.
Multiscale complex systems analysis suggests that an important step toward relieving this structural problem is a separation of responsibility for 2 distinct types of tasks: medical care of individual patients and prevention/population health. These distinct tasks require qualitatively different organizational structures. The current use of care providers and organizations for both purposes leads to compromises in organizational process that adversely affect the ability of health care organizations to provide either individual or prevention/population services.
Thus, the overall system can be dramatically improved by establishing 2 separate but linked systems with distinct organizational forms: (a) a high-efficiency system performing large-scale repetitive tasks such as screening tests, inoculations, and generic health care, and (b) a high-complexity system treating complex medical problems of individual patients.
Key Words: Community Health, Health Care Facilities/Services, Health Policy, Quality of Care, Prevention, Public Health Practice
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgGlen P. Mays, Megan C. McHugh, Kyumin Shim, Natalie Perry, Dennis Lenaway, Paul K. Halverson, and Ramal Moonesinghe, Institutional and Economic Determinants of Public Health System Performance, Am J Public Health 0: AJPH.2005.064253v1.
Objectives. Although a growing body of evidence demonstrates that availability and quality of essential public health services vary widely across communities, relatively little is known about the factors that give rise to these variations. We examined the association of institutional, financial, and community characteristics of local public health delivery systems and the performance of essential services.
Methods. Performance measures were collected from local public health systems in 7 states and combined with secondary data sources. Multivariate, linear, and nonlinear regression models were used to estimate associations between system characteristics and the performance of essential services.
Results. Performance varied significantly with the size, financial resources, and organizational structure of local public health systems, with some public health services appearing more sensitive to these characteristics than others. Staffing levels and community characteristics also appeared to be related to the performance of selected services.
Conclusions. Reconfiguring the organization and financing of public health systems in some communities--such as through consolidation and enhanced intergovernmental coordination--may hold promise for improving the performance of essential services.
Key Words: Health Administration, Quality of Care, Public Health Practice

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgDavid T. Levy, Joseph E. Bauer, and Hye-ryeon Lee, Simulation Modeling and Tobacco Control: Creating More Robust Public Health Policies, Am J Public Health 0: AJPH.2005.063974v1.
Although previous empirical studies have shown that tobacco control policies are effective at reducing smoking rates, such studies have proven of limited effectiveness in distinguishing how the effect of policies depend on the other policies in place, the length of adjustment period, the way the policy is implemented, and the demographic groups considered.
An alternative and complementary approach to purely statistical equations is simulation models. We describe the SimSmoke simulation model and how we used it to assess tobacco control policy in a specific case study. Simulation models are not only useful for policy prediction and planning but also may help to broaden our understanding of the role of different public health policies within a complex, dynamic social system.
Key Words: Epidemiology, Health Administration, Health Policy, Prevention, Public Health Practice
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgMichael Joffe, and Jennifer Mindell, Complex Causal Process Diagrams for Analyzing the Health Impacts of Policy Interventions, Am J Public Health 0: AJPH.2005.063693v1.
Causal diagrams are rigorous tools for controlling confounding. They also can be used to describe complex causal systems, which is done routinely in communicable disease epidemiology. The use of change diagrams has advantages over static diagrams, because change diagrams are more tractable, relate better to interventions, and have clearer interpretations.
Causal diagrams are a useful basis for modeling. They make assumptions explicit, provide a framework for analysis, generate testable predictions, explore the effects of interventions, and identify data gaps. Causal diagrams can be used to integrate different types of information and to facilitate communication both between public health experts and with experts in other fields. Causal diagrams allow the use of instrumental variables, which can help control confounding and reverse causation.
Key Words: Epidemiology, Health Policy, Prevention, Socioeconomic Factors
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgAndrew P. Jones, Jack B. Homer, Dara L. Murphy, Joyce D. Essien, Bobby Milstein, Don A. Seville, and Michael Engelgau, Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation, Am J Public Health 0: AJPH.2005.063529v1.
Health planners in the Division of Diabetes Translation and others from the National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention used system dynamics simulation modeling to gain a better understanding of diabetes population dynamics and to explore implications for public health strategy. A system dynamics simulation model was developed to explain the growth of diabetes since 1980 and portray possible futures through 2050. This model was used to conduct simulated experiments involving interventions for disease management and primary prevention.
The model simulations suggested characteristic dynamics of the diabetes population, including unintended increases in diabetes or prediabetes prevalence due to diabetes control or prediabetes management, the inability of diabetes control efforts alone to reduce diabetes-related deaths in the long term, and significant delays between primary prevention efforts and downstream improvements in diabetes outcomes. Simulated diabetes interventions often produce impacts that look different in the short term than they do in the long term. For example, intervention strategies that focus entirely on diabetes management may quickly reduce diabetes-related complications and deaths but are less effective in the long term than strategies that balance disease management with primary prevention.
System dynamics modeling can help diabetes planners identify more effective public health strategies and set appropriate goals.
Key Words: Diabetes, Chronic Disease, Obesity, Overweight, Underweight, Prevention, Social Science
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgNicholas Freudenberg, Marianne Fahs, Sandro Galea, and Andrew Greenberg, The Impact of New York City's 1975 Fiscal Crisis on the Tuberculosis, HIV, and Homicide Syndemic, Am J Public Health 0: AJPH.2005.063511v1.
In 1975, New York City experienced a fiscal crisis rooted in long-term political and economic changes in the city. Budget and policy decisions designed to alleviate this fiscal crisis contributed to the subsequent epidemics of tuberculosis, human immunodeficiency virus (HIV) infection, and homicide in New York City.
Because these conditions share underlying social determinants, we consider them a syndemic, i.e., all 3 combined to create an excess disease burden on the population. Cuts in services; the dismantling of health, public safety, and social service infrastructures; and the deterioration of living conditions for vulnerable populations contributed to the amplification of these health conditions over 2 decades.
We estimate that the costs incurred in controlling these epidemics exceeded $50 billion (in 2004 dollars); in contrast, the overall budgetary saving during the fiscal crisis was $10 billion. This history has implications for public health professionals who must respond to current perceptions of local fiscal crises.
Key Words: Government, Health Policy, HIV/AIDS, Tuberculosis, Injury/Emergency Care/Violence, Urban Health
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgMichele S. Garfinkel, Daniel Sarewitz, and Alan L. Porter, A Societal Outcomes Map for Health Research and Policy, Am J Public Health 0: AJPH.2005.063495v1.
The linkages between decisions about health research and policy and actual health outcomes may be extraordinarily difficult to specify.
We performed a pilot application of a "road mapping" and technology assessment technique to perinatal health to illustrate how this technique can clarify the relations between available options and improved health outcomes. We used a combination of datamining techniques and qualitative analyses to set up the underlying structure of a societal health outcomes road map.
Societal health outcomes road mapping may be a useful tool for enhancing the ability of the public health community, policymakers, and other stakeholders, such as research administrators, to understand health research and policy options.
Key Words: Health Policy, Qualitative Research
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgDavid W. Baker, Kenzie A. Cameron, Joseph Feinglass, Jason A. Thompson, Patricia Georgas, Shawn Foster, Deborah Pierce, and Romana Hasnain-Wynia, A System for Rapidly and Accurately Collecting Patients' Race and Ethnicity, Am J Public Health 0: AJPH.2005.062620v1.
Objectives. We assessed the feasibility of collecting race/ethnicity data from patients using their own preferred racial/ethnic terms.
Methods. The 424 patients described their race/ethnicity using their own categories, and we compared their descriptions with their responses to the questions (1) "Do you consider yourself Latino or Hispanic?" and (2) "Which category best describes your race?" (7 response options in our computer interview). We also determined patients' preferences between the 2 approaches.
Results. The proportions of patients who described themselves with 1, 2, 3, or 4 terms were 46%, 33%, 14%, and 6%, respectively; 2 said only "American" (1%,) and 1 refused to answer (0.5%). The average completion time was 37 plus/minus 17 seconds. Rates of missing values and categorization as "other" race were lower than with the closed questions. Agreement between racial/ethnic categorization with openended and closed responses was 93% (?=0.88). Latino/Hispanic and multiracial/multiethnic individuals were more likely to prefer using their own categories to describe their race/ethnicity.
Conclusions. Collecting race/ethnicity data using patients' own racial/ethnic categories is feasible with the use of computerized systems to capture verbatim responses and results in lower rates of missing and unusable data than do standard questions.
Key Words: African Americans/Blacks, Asians, Hispanics/Latinos, Race/Ethnicity, Statistics/Evaluation/Research
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgJack B. Homer, and Gary B. Hirsch, System Dynamics Modeling for Public Health: Background and Opportunities, Am J Public Health 0: AJPH.2005.062059v1.
The systems modeling methodology of system dynamics is well suited to address the dynamic complexity that characterizes many public health issues. The system dynamics approach involves the development of computer simulation models that portray processes of accumulation and feedback and that may be tested systematically to find effective policies for overcoming policy resistance.
System dynamics modeling of chronic disease prevention should seek to incorporate all the basic elements of a modern ecological approach, including disease outcomes, health and risk behaviors, environmental factors, and healthrelated resources and delivery systems. System dynamics shows promise as a means of modeling multiple interacting diseases and risks, the interaction of delivery systems and diseased populations, and matters of national and state policy.
Key Words: Chronic Disease, Epidemiology, Health Policy, Health Service Delivery, Prevention
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgEric J. Suba, Sean K. Murphy, Amber D. Donnelly, Lisa M. Furia, My Linh D. Huynh, and Stephen S. Raab, Systems Analysis of Real-World Obstacles to Successful Cervical Cancer Prevention in Developing Countries, Am J Public Health 0: AJPH.2004.061606v1.
Papanicolaou screening is feasible anywhere that screening for cervical cancer, the leading cause of cancer-related death among women in developing countries, is appropriate. After documenting that the Vietnam War had contributed to the problem of cervical cancer in Vietnam, we participated in a grassroots effort to establish a nationwide cervical cancer prevention program in that country and performed root cause analyses of program deficiencies.
We found that real-world obstacles to successful cervical cancer prevention in developing countries involve people far more than technology and that such obstacles can be appropriately managed through a systems approach focused on programmatic quality rather than through ideological commitments to technology. A focus on quality satisfies public health goals, whereas a focus on technology is compatible with market forces.
Key Words: Cancer, Global Health, Access to Care, Quality of Care, Screening, Women's Health
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgJosé Ricardo de Carvalho Mesquita Ayres, Vera Paiva, Ivan França Jr, Neide Gravato, Regina Lacerda, Marinella Della Negra, Heloisa Helena de Sousa Marques, Eliana Galano, Pilar Lecussan, Aluísio Cotrim Segurado, and Mariliza Henrique Silva, Vulnerability, Human Rights, and Comprehensive Health Care Needs of Young People Living With HIV/AIDS, Am J Public Health 0: AJPH.2004.060905v1.
We sought to identify and understand the health care needs of young people living with HIV/AIDS, particularly in terms of their psychosocial well-being. We conducted a qualitative analysis of HIV-positive young people and their caregivers, focusing on the implications of an HIV diagnosis for health care needs.
Stigma was a recurrent issue that arose in the interviews conducted with the respondents, and it was evident that youths had been denied many rights related to health. We concluded that young people living with HIV need comprehensive care based on a human rights approach. In this regard, we offer some practical recommendations for health programs.
Key Words: Adolescent Health, Quality of Care, HIV/AIDS, Human Rights, Public Health Practice, Qualitative Research

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgPeter Fajans, Ruth Simmons, and Laura Ghiron, Helping Public Sector Health Systems Innovate: The Strategic Approach to StrengtheningReproductive Health Policies and Programs, Am J Public Health 0: AJPH.2004.059907v1.
Public sector health systems that provide services to poor and marginalized populations in developing countries face great challenges. Change associated with health sector reform and structural adjustment often leaves these already strained institutions with fewer resources and insufficient capacity to relieve health burdens.
The Strategic Approach to Strengthening Reproductive Health Policies and Programs is a methodological innovation developed by the World Health Organization and its partners to help countries identify and prioritize their reproductive health service needs, test appropriate interventions, and scale up successful innovations to a subnational or national level. The participatory, interdisciplinary, and country-owned process can set in motion much needed change.
We describe key features of this approach, provide illustrations from country experiences, and use insights from the diffusion of innovation literature to explain the approach's dissemination and sustainability.
Key Words: Contraception, Global Health, Health Policy, Access to Care, Quality of Care, Health Service Delivery
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgStephenie C. Lemon, Jane G. Zapka, Barbara Estabrook, and Evan Benjamin, Challenges to Research in Urban Community Health Centers, Am J Public Health 0: AJPH.2004.057976v1.
Community health centers (CHCs) are important settings for research aimed at reducing health disparities. However, CHCs pose many challenges to research at patient, provider, and system levels.
We summarized lessons learned from a multimethod, formative study to develop intervention strategies for improving colorectal cancer screening in CHCs, and make recommendations for future research. The call for research in "real world" settings such as CHCs must be matched with greater understanding of the challenges, as well as the resources to meet those challenges.
Key Words: Quality of Care, Health Service Delivery, African Americans/Blacks, Hispanics/Latinos, Urban Health
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgAmber A. Guth, Andrea O'Neill, H. Leon Pachter, and Thomas Diflo, Public Health Lessons Learned from New York City Subway Injuries, Am J Public Health 0: AJPH.2004.057315v1.
Subway injuries are devastating, with young victims and a high mortality and amputation rate. This report identifies the urban population at greatest risk for subway injuries, looks at the influence of a local economy on injury rates, and proposes the use of changes in social conditions as a “trigger” for increased vigilance and protective measures at times of higher risk.
Key Words: Community Health, Injury/Emergency Care/Violence, Prevention, Urban Health

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgDon C. Des Jarlais, Sandro Galea, Melissa Tracy, Susan Tross, and David Vlahov, Stigmatization of Newly Emerging Infectious Diseases: AIDS and SARS, Am J Public Health 0: AJPH.2004.054742v1.
Objectives. We assessed relationships between sociodemographic characteristics and mental health status and knowledge of, being worried about, and stigmatization of 2 emerging infectious diseases, AIDS and SARS.
Methods. We conducted a random-digit-dialed survey of 928 residents of the New York City metropolitan area as part of a study of the effects of the September 11, 2001, terrorist attacks. Questions added for this study concerned respondents' knowledge of, worry about, and support of stigmatizing actions to control AIDS and SARS.
Results. In general, respondents with greater personal resources (income, education, social support) and better mental health status had more knowledge, were less worried, and were less likely to stigmatize. This pattern held for both AIDS and SARS.
Conclusions. Personal resources and mental health factors are likely to influence the public's ability to learn about, rationally appraise the threat of, and minimize stigmatization of emerging infectious diseases such as AIDS and SARS.
Key Words: Epidemiology, HIV/AIDS, Prevention, Drugs

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgMichelle Chino, and Lemyra DeBruyn, Building True Capacity: Indigenous Models for Indigenous Communities, Am J Public Health 0: AJPH.2004.053801v1.
Within the past 2 decades, community capacity building and community empowerment have emerged as key strategies for reducing health disparities and promoting public health. As with other strategies and best practices, these concepts have been brought to indigenous (American Indian and Alaska Native) communities primarily by mainstream researchers and practitioners.
Mainstream models and their resultant programs, however, often have limited application in meeting the needs and realities of indigenous populations. Tribes are increasingly taking control of their local health care services. It is time for indigenous people not only to develop tribal programs but also to define and integrate the underlying theoretical and cultural frameworks for public health application.
Key Words: Health Policy, Public Health Practice, Native Americans

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgSherman A. James, Angela Fowler-Brown, Trivellore E. Raghunathan, and John Van Hoewyk, Life-course Socioeconomic Position and Obesity in African American Women: The Pitt County Study, Am J Public Health 0: AJPH.2004.053447v1.
Objectives. We studied obesity in African American women in relationship to their socioeconomic position (SEP) in childhood and adulthood.
Methods. On the basis of parents' occupation, we classified 679 women in the Pitt County (North Carolina) Study into low and high childhood SEP. Women's education, occupation, employment status, and home ownership were used to classify them into low and high adulthood SEP. Four life-course SEP categories resulted: low childhood/low adulthood, low childhood/high adulthood, high childhood/low adulthood, and high childhood/high adulthood.
Results. The odds of obesity were twice as high among women from low versus high childhood SEP backgrounds, and 25% higher among women of low versus high adulthood SEP. Compared to that in women of high SEP in both childhood and adulthood, the odds of obesity doubled for low/low SEP women, were 55% higher for low/high SEP women, and were comparable for high/low SEP women.
Conclusions. Socioeconomic deprivation in childhood was a strong predictor of adulthood obesity in this community sample of African American women. Findings are consistent with both critical period and cumulative burden models of life-course socioeconomic deprivation and long-term risk for obesity in African American women.
Key Words: Epidemiology, Obesity, Overweight, Underweight, African Americans/Blacks, Race/Ethnicity, Socioeconomic Factors, Women's Health
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgManish N. Shah, The Formation of the Emergency Medical Services System, Am J Public Health 0: AJPH.2004.048793v1.
The evolution of the emergency medical services system in the United States accelerated rapidly between 1960 and 1973 as a result of a number of medical, historical, and social forces. Current emergency medical services researchers, policy advocates, and administrators must acknowledge these forces and their limitations and work to modify the system into one that provides uniformly high-quality acute care to all patients, improves the overall public health through injury control and disease prevention programs, participates as a full partner in disease surveillance, and is prepared to address new community needs of all types.
Key Words: Health Care Facilities/Services, Health Policy, Health Service Delivery, History, Injury/Emergency Care/Violence
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgDennis Lenaway, Paul Halverson, Sergey Sotnikov, Hugh Tilson, Liza Corso, and Wayne Millington, Public Health Systems Research: Setting a National Agenda, Am J Public Health 0: AJPH.2004.046037v1.
The Institute of Medicine has recommended that policy decisions about improvement of national public health systems be guided by sound scientific evidence. However, to date there is no national research agenda to help guide public health systems.
The Centers for Disease Control and Prevention was called upon to lead a collaborative consensus-based process to define key research questions and establish a framework to create opportunities to better coordinate, leverage, and identify public health resources, which are increasingly scarce. The public health systems research agenda that emerged from this process has 14 overarching priority research themes. This national agenda should stimulate and guide research to meet the urgent need to improve the nation's public health systems.
Key Words: Health Administration, Health Care Facilities/Services, Health Policy, Public Health Practice, Statistics/Evaluation/Research

external image Pdf.jpgexternal image 20px-Ajphlogo.jpgDaniel Grossman, Charlotte Ellertson, Katrina Abuabara, Kelly Blanchard, and Francisco T. Rivas, Do Product Labeling and Practice Guidelines Deter Contraceptive Use?, Am J Public Health 0: AJPH.2004.040774v1. Abstract
Many contraceptives are encumbered with potentially unnecessary restrictions on their use. Indeed, fear of side effects, fostered by alarmist, legalistic labeling, is a leading reason that women do not use contraceptives.
In the United States, hormonal methods currently require a prescription, although research suggests that women can adequately screen themselves for contraindications, manage side effects, and determine an appropriate initiation date, leaving little need for routine direct physician involvement. Sizing, spermicidal use, and length-of-wear limits burden users of cervical barriers and may be unnecessary. Despite recent changes in the labeling of intrauterine devices, clinicians commonly restrict use of this method and in some countries may limit the types of providers authorized to insert them.
Although in some cases additional research is necessary, existing data indicate that evidence-based demedicalization of contraceptive provision could reduce costs and improve access.
Key Words: Contraception, Health Policy, Access to Care, Women's Health
external image Pdf.jpgexternal image 20px-Ajphlogo.jpgPaige Muellerleile, and Brian Mullen, Sufficiency and Stability of Evidence for Public Health Interventions using Cumulative Meta-Analysis, Am J Public Health 0: AJPH.2003.036343v1.
We propose cumulative meta-analysis as the procedure of completing a new meta-analysis at each successive wave in a research database. Two facets of cumulative knowledge are considered: the first, sufficiency, refers to whether the meta-analytic database adequately demonstrates that a public health intervention works. The second, stability, refers to the shifts over time in the accruing evidence about whether a public health intervention works.
We used a hypothetical data set to develop the indicators of sufficiency and stability,and then applied them to existing, published datasets. Our discussion centers on the implications of the use of this procedure in evaluating public health interventions.