Basis For Public Health Policy Research Articles

Cross-country and panel data estimates of the price elasticity of demand for cigarettes in Europe

ObjectiveOur goal is to provide estimates of the price elasticity of demand for cigarettes in Europe as a basis for public health policy on tobacco taxation.MethodsWe use secondary data on...

Safety and effectiveness of vaccines against COVID-19 in children aged 5–11 years: a systematic review and meta-analysis

To date, more than 761 million confirmed SARS-CoV-2 infections have been recorded globally, and more than half of all children are estimated to be seropositive. Despite high SARS-CoV-2 infection incidences, the rate of severe COVID-19 in children is low. We aimed to assess the safety and efficacy or effectiveness of COVID-19 vaccines approved in the EU for children aged 5-11 years. In this systematic review and meta-analysis, we included studies of any design identified through searching the COVID-19 L·OVE (living overview of evidence) platform up to Jan 23, 2023. We included studies with participants aged 5-11 years, with any COVID-19 vaccine approved by the European Medicines Agency-ie, mRNA vaccines BNT162b2 (Pfizer-BioNTech), BNT162b2 Bivalent (against original strain and omicron [BA.4 or BA.5]), mRNA-1273 (Moderna), or mRNA-1273.214 (against original strain and omicron BA.1). Efficacy and effectiveness outcomes were SARS-CoV-2 infection (PCR-confirmed or antigen-test confirmed), symptomatic COVID-19, hospital admission due to COVID-19, COVID-19-related mortality, multisystem inflammatory syndrome in children (MIS-C), and long-term effects of COVID-19 (long COVID or post-COVID-19 condition as defined by study investigators or per WHO definition). Safety outcomes of interest were serious adverse events, adverse events of special interest (eg, myocarditis), solicited local and systemic events, and unsolicited adverse events. We assessed risk of bias and rated the certainty of evidence (CoE) using the Grading of Recommendations Assessment, Development and Evaluation approach. This study was prospectively registered with PROSPERO, CRD42022306822. Of 5272 screened records, we included 51 (1·0%) studies (n=17 [33%] in quantitative synthesis). Vaccine effectiveness after two doses against omicron infections was 41·6% (95% CI 28·1-52·6; eight non-randomised studies of interventions [NRSIs]; CoE low), 36·2% (21·5-48·2; six NRSIs; CoE low) against symptomatic COVID-19, 75·3% (68·0-81·0; six NRSIs; CoE moderate) against COVID-19-related hospitalisations, and 78% (48-90, one NRSI; CoE very low) against MIS-C. Vaccine effectiveness against COVID-19-related mortality was not estimable. Crude event rates for deaths in unvaccinated children were less than one case per 100 000 children, and no events were reported for vaccinated children (four NRSIs; CoE low). No study on vaccine effectiveness against long-term effects was identified. Vaccine effectiveness after three doses was 55% (50-60; one NRSI; CoE moderate) against omicron infections, and 61% (55-67; one NRSI; CoE moderate) against symptomatic COVID-19. No study reported vaccine efficacy or effectiveness against hospitalisation following a third dose. Safety data suggested no increased risk of serious adverse events (risk ratio [RR] 0·83 [95% CI 0·21-3·33]; two randomised controlled trials; CoE low), with approximately 0·23-1·2 events per 100 000 administered vaccines reported in real-life observations. Evidence on the risk of myocarditis was uncertain (RR 4·6 [0·1-156·1]; one NRSI; CoE low), with 0·13-1·04 observed events per 100 000 administered vaccines. The risk of solicited local reactions was 2·07 (1·80-2·39; two RCTs; CoE moderate) after one dose and 2·06 (1·70-2·49; two RCTs; CoE moderate) after two doses. The risk of solicited systemic reactions was 1·09 (1·04-1·16; two RCTs; CoE moderate) after one dose and 1·49 (1·34-1·65; two RCTs; CoE moderate) after two doses. The risk of unsolicited adverse events after two doses (RR 1·21 [1·07-1·38]; CoE moderate) was higher among mRNA-vaccinated compared with unvaccinated children. In children aged 5-11 years, mRNA vaccines are moderately effective against infections with the omicron variant, but probably protect well against COVID-19 hospitalisations. Vaccines were reactogenic but probably safe. Findings of this systematic review can serve as a basis for public health policy and individual decision making on COVID-19 vaccination in children aged 5-11 years. German Federal Joint Committee.

Effect of ambient temperature variability on sperm quality: A retrospective population-based cohort study

BackgroundsAbnormal sperm quality in men is one of the common causes of infertility. Both ambient temperature and extreme heat exposure have been shown to be associated with sperm quality, but there is no epidemiological evidence for the effect of ambient temperature variability. Our aim was to investigate the association between ambient temperature variability exposure and a decline in sperm quality at different stages of sperm development. MethodsA total of 4912 semen samples collected from the Guangdong Human Sperm Bank between 1 January 2019 and 31 December 2019 were analyzed. We selected three exposure periods: the full-stage (0–90 lag days), early-stage (34–77 lag days) and late-stage (0–37 lag days) of sperm development, and then calculated the standard deviation of daily temperature (TVSD), the maximum day-to-day temperature difference (TVDmax) and the mean day-to-day temperature difference (TVDmean) for the three exposure periods. A linear mixed model was used to explore the exposure response relationship between temperature variability exposure and sperm quality indicators (including sperm concentration, sperm count and sperm motility). ResultsThere was a significant negative association of decreased sperm count with the exposure to temperature variability during 0–90 days prior to sperm collection. (TVDmax: −0.041; −0.063, −0.019; TVDmean: −0.237; −0.386, −0.088; TVSD: −0.103; −0.196, −0.011). We observed a significant association between the decline in sperm concentration, sperm count and per 1 °C increase in TVDmean during early spermatogenesis. No significant association of temperature variability with sperm motility was found. ConclusionsThe results indicate that exposure to temperature variability during the entire period of sperm development is significantly associated with a decline in sperm counts. We found that mean day-to-day temperature differences had a detrimental effect on sperm counts in the early-stage. Our findings provide a scientific basis for public health policy and further mechanistic studies.

Effects of county-level attributes on geographic variation in female breast cancer mortality rates across counties in United States.

e13093 Background: Though studies have examined geographic disparities in breast cancer mortality among United States (U.S.) counties, county-level risk factors were not accounted for. The aim of this study is to efficiently map the spatial association between female breast cancer mortality rates & socioeconomic attributes across U.S. counties for identifying high risk geographical clusters in terms of socioeconomic attributes. Methods: County-specific age standardized breast cancer mortality rates for women ≥20 years in the U.S. were obtained for 3,109 counties in 48 contiguous states from Surveillance Epidemiology and End Results program from 1990-2012. County-level attributes such as percentages of Hispanic white, Non-Hispanic white, Non-Hispanic black, < high school education, below 200% poverty, urban, foreign born, language isolation, women aged ≥ 40 years with mammography within last 2 years, and median household income were gathered from U.S. decennial census. Factor analysis condensed county attributes into three factor covariates namely Hispanic immigrants, health care access among urban high socioeconomic population, and non-Hispanic black unemployment. Spatiotemporal analysis was carried out by structured additive regression model to incorporate spatial functions & Markov chain Monte Carlo simulation techniques. Results: Moran’s index suggested existence of spatial dependence for breast cancer mortality among U.S. counties. As mammography screening, %urban population, % with high socioeconomic status and non-Hispanic black unemployment increased in counties of the Southwest region, Rocky mountain region and those in the western border of Midwest region of U.S, risk of breast cancer mortality increased significantly above the national average. As the Hispanic immigrant culture increased, counties of Midwest region of U.S had significantly higher mortality rates compared to national average. Conclusions: These initial results describe socio-economic, cultural, and healthcare access factors for observed geographic variations in female breast cancer mortality, and in turn, could support a stronger theoretical basis for public health policy.

Abstract P2-07-14: Geographic variation in the female breast cancer mortality rates across counties in United States

Abstract Background: Few studies have examined geographic disparities in breast cancer mortality at smaller geographical areas in the United States (U.S,) taking into account geographical details and spatial auto-correlations. Though these have identified counties with high breast cancer mortality risk, county-level socioeconomic attributes which are proven to be risk factors for breast cancer mortality were not examined and accounted for. The aim of this study is to efficiently map the spatial variation in the female breast cancer mortality rates across the counties of U.S., and to identify the high risk geographical clusters while adjusting for the county attributes, such as ethnic distribution of the population, educational attainment, poverty, unemployment and health care access. Methodology: County-specific age standardized rates for breast cancer mortality for women aged ≥ 20 years in the U.S. were obtained for 3,109 counties from Surveillance Epidemiology and End Results (SEER) program from 1990-2012. We gathered county attributes from American Community Survey, such as the percentages of Hispanic white, Non-Hispanic white, Non-Hispanic black, < high school education, below 200% poverty, urban, foreign born, language isolation, women aged ≥ 40 years with mammography within last 2 years, and median household income. Then, we applied factor analysis to condense county attributes into three factors as covariates namely Hispanic immigrants, health care access among urban high income population, and non-Hispanic black unemployment. Spatiotemporal analysis was carried out by the structured additive regression model to incorporate spatial functions and Bayesian inference using Markov Chain Monte Carlo simulation techniques. Deviance Information Criteria was used for model comparisons and selections. Results: Moran's index for the age standardized breast cancer mortality rate was 0.12 (p-value :< 0.001) suggesting the existence of spatial dependence for the breast cancer mortality among the counties of U.S. Estimated effects [Mean (95%CI)] of spatial estimates for the factors were 0.03(0.02-0.05) for Hispanic immigrant culture, 0.06(0.04-0.09) for health care access among urban & high income groups and 0.41(0.31-0.51) for the non-Hispanic black unemployment. Counties in the Southwest region, Rocky mountain region and those in the western border of Midwest region of U.S with more Hispanic immigrants, have significantly lower mortality rates, a finding that can attributed to the lower incidence of breast cancer among Hispanics. As the mammography screening among urban and high income areas of the counties in the Mid-west region increase, the risk of breast cancer mortality increase significantly above the national average. And as the non-Hispanic black unemployment rates increase, the counties of Mid-West and those of South-West were at higher risk of mortality compared to national average. The percentage of counties with significant positive spatial function were 3.8% for the health care access factor and 6.3% for non-Hispanic black unemployment factor. Conclusion: These initial results might explain social, cultural, and other reasons for the observed geographic variations, and in turn, could support a stronger theoretical basis for public health policy. Citation Format: Sagiraju HKR, Chien L-C, Valerio MA, Jatoi I, Gimeno D. Geographic variation in the female breast cancer mortality rates across counties in United States [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-07-14.

Monitoring socio-economic differences in healthy life expectancy in the Netherlands

Background In the Netherlands, like in other countries, health differs between those with a low and a high socio-economic position. This is shown by several figures on socio-economic differences in health. Insight in the meaning of these figures and their trends is a basis for public health policy (e.g. the Dutch National Prevention Program aims to increase healthy life …

Trends and Characteristics of HIV Infection among Suspected Tuberculosis Cases in Public Health Centers in Korea: 2001–2013

ObjectivesThe Republic of Korea reports approximately 35,000 new tuberculosis (TB) patients each year, and the number of HIV-infected individuals is steadily increasing. Public health centers (PHCs) conduct TB diagnosis and treatment for risk groups in communities. This study aimed to identify possible trends and characteristics of HIV infection among suspected TB cases in PHCs. MethodsStudy subjects were suspected TB cases in PHCs who agreed to be tested for HIV from 2001 to 2013. Trends in HIV seroprevalence were assessed through a series of annual cross-sectional analyses. We analyzed suspected TB cases, and HIV-infected individuals among suspected TB cases, by gender, age, nationality, and region. ResultsThe number of suspected tuberculosis cases who took an HIV test in PHCs was approximately 6,000 each year from 2001 to 2013. Among the suspected TB cases who took an HIV test, the number of those aged 20–39 is gradually decreasing, while the number of those aged 50–69 is increasing. During this period, 32 HIV-infected individuals were identified; the majority were men (94%), aged 30–49 (68%), Korean (94%), and residents in a metropolitan area (53%). HIV seroprevalence decreased from 8.2 per 10,000 persons in 2001 to 1.9 per 10,000 persons in 2013. ConclusionThis study has identified trends and characteristics of HIV infection among suspected tuberculosis cases in PHCs. This national data provides a basis for public health policy for HIV and tuberculosis infections.

Framing pandemic management: New governance, science or culture?

Management of a pandemic engages multiple sites where previously settled or uncontroversial understandings may be transformed by global and domestic forces. This article examines the iconography of social distancing implicated in the discourses of ‘quarantine’ and ‘risk control’ in public health, and the tension between scientific and popular media readings of the contours of acceptable public health models for managing particular pandemics. The role of culture in shaping and reshaping borders at an operational level is explored as a basis for explaining the apparent paradoxes in the way historic and contemporary pandemics are actually managed, and the different ways particular pandemics are framed. The article argues that a rational-scientific approach to pandemic management is insufficient and that a more nuanced socio-political blend of science, culture and public perceptions offers a more substantial basis for public health policy.

FRAMING PANDEMIC MANAGEMENT: NEW GOVERNANCE, SCIENCE OR CULTURE?

Management of a pandemic engages multiple sites where previously settled or uncontroversial understandings may be transformed by global and domestic forces. This article examines the iconography of social distancing implicated in the discourses of ‘quarantine’ and ‘risk control’ in public health, and the tension between scientific and popular media readings of the contours of acceptable public health models for managing particular pandemics. The role of culture in shaping and reshaping borders at an operational level is explored as a basis for explaining the apparent paradoxes in the way historic and contemporary pandemics are actually managed, and the different ways particular pandemics are framed. The article argues that a rational-scientific approach to pandemic management is insufficient and that a more nuanced socio-political blend of science, culture and public perceptions offers a more substantial basis for public health policy.

Demographic and Geographic Variations in Breast Cancer Mortality among U.S. Hispanics

This paper examines demographic and geographic differences in breast cancer mortality (1999 to 2009) between U.S. Hispanic and non-Hispanic women from different racial groups. Data were publically available from the U.S. Centers for Disease Control and Prevention (CDC). Four racial groups are included: American Indian/Alaska Natives, Asian/Pacific Islanders, Blacks/African Americans, and Whites. Age-adjusted rates were obtained for women ages 35-64 and 65 years and older. Hispanic mortality was generally lower than non-Hispanic mortality regardless of age, race, Census Region, State, or county. The lone exception was Hispanic Asian/Pacific Islanders residing in Hawaii. Despite generally lower rates, there was considerable variation in Hispanic breast cancer mortality within the country. Poverty, percentage of renters, and educational attainment were important explanatory factors. Analytic epidemiologic studies might explain social, cultural, and other reasons for the observed geographic variations. Such studies, in turn, could support a stronger theoretical basis for public health policy.

Civil Society Organisations and Public Health Research - Evidence from Eight European Union New Member States

Civil society organisations (CSO) are not-for-profit, non-governmental organisations operating in the public interest. They are the "third sector" that is strongly developed in Western European countries, ensuring the link between citizens and government and working as a counterbalance to the business sector. Their role in support of public health research deserves attention. Within a broader European study (STEPS--Strengthening Engagement in Public Health Research), public health organisations in eight European Union new member states (Cyprus, Estonia, Latvia, Lithuania, Malta, Romania, Slovakia, Slovenia) identified national CSOs with interests in health. A questionnaire was developed jointly, translated into national languages and sent by e-mail to 474 organisations, with 128 completed responses (27%). Most CSOs would like to be more involved in setting or advising on public-health research policy, and greater collaboration between CSOs, professional organisations and governmental institutions. Respondents did not see CSOs directly doing research, but recommended mobilizing researchers and organsations, supporting research themes, and lobbying to use public health evidence in policy and decision-making. They could receive more education for, and discussion of, public health research, and offer support in applying for research funding. Civil society organisations can contribute importantly,in setting public health research agendas. Research commissioning should give greater recognition of this role, improve links between CSOs, researchers and governmental institutions, and develop a stronger shared basis for public health policy and practice.

In the face of contradictory evidence: Report of the Dietary Guidelines for Americans Committee

Concerns that were raised with the first dietary recommendations 30 y ago have yet to be adequately addressed. The initial Dietary Goals for Americans (1977) proposed increases in carbohydrate intake and decreases in fat, saturated fat, cholesterol, and salt consumption that are carried further in the 2010 Dietary Guidelines Advisory Committee (DGAC) Report. Important aspects of these recommendations remain unproven, yet a dietary shift in this direction has already taken place even as overweight/obesity and diabetes have increased. Although appealing to an evidence-based methodology, the DGAC Report demonstrates several critical weaknesses, including use of an incomplete body of relevant science; inaccurately representing, interpreting, or summarizing the literature; and drawing conclusions and/or making recommendations that do not reflect the limitations or controversies in the science. An objective assessment of evidence in the DGAC Report does not suggest a conclusive proscription against low-carbohydrate diets. The DGAC Report does not provide sufficient evidence to conclude that increases in whole grain and fiber and decreases in dietary saturated fat, salt, and animal protein will lead to positive health outcomes. Lack of supporting evidence limits the value of the proposed recommendations as guidance for consumers or as the basis for public health policy. It is time to reexamine how US dietary guidelines are created and ask whether the current process is still appropriate for our needs.

National Nutrition and Public Health Policies: Issues Related to Bioavailability of Nutrients When Developing Dietary Reference Intakes

Dietary reference intakes (DRI), like its predecessor, the recommended dietary allowances (RDA) and the Recommended Nutrient Intakes (RNIs), are reference values, based on the best scientific evidence available. They serve as reference amounts of specific nutrients and food components for use in assessing the adequacy of and in planning for nutritious diets. They have been used for over 50 y as the basis for national nutrition monitoring and intervention programs in the United States, Canada, and other countries and as the basis for dietary guidance developed for both individuals and for targeted groups of people. Thus, although not developed for specific policy applications, they have represented the best scientific perspectives regarding what should be the basis for nutrition and public health policy related to foods and supplements. In determining DRIs, as was the case with the RDA, significant attention must be paid to the form of the nutrient or food component that is evaluated. Research conducted to determine how much of a nutrient is needed must evaluate the chemical form provided, the matrix in which it is given and the effect of other food components on absorption and/or utilization. Because the DRI recommendations will be used in population-wide policy development, assumptions must be made explicitly about what is expected for all of these factors in a typical diet. At the same time, where data exist relative to nontypical but potentially very significant effects on bioavailability, these must also be delineated to be of use in a variety of settings. Finally, one of the most important aspects of determining bioavailability in developing reference intakes is that as new information emerges, new complexities enter into the process. As more chemical complexes of nutrients and food components become available in the marketplace, new bioavailability factors may need to be established. Examples of such changes exist in the DRI reports already published for vitamin B-12 and folate and in previous RDA for iron and protein. It is often the different assumptions related to bioavailability that alter the reference intakes used as the basis for public health policy in different countries, rather than the basic science from which the recommendation is derived.

Disease burden in sub-Saharan Africa: what should we conclude in the absence of data?

In a large data-synthesis project, the Global Burden of Disease (GBD) Study has provided summaries of fatal and nonfatal diseases worldwide. However, the GBD investigators' estimates for sub-Saharan Africa do not help to define the burden of disease for the region and provide no real contrast with developed countries. It is even doubtful that the study results could serve as the basis for public health policy. Throughout sub-Saharan Africa, except in South Africa, births and deaths are not necessarily recorded and a formal system of medical care is unavailable to most of the population. Even population denominators cannot be specified and basic health indices such as death rates or causes of death are not known. The statistics which appear in national ministries and international agencies are merely guesstimates formed from models, extrapolations, and common sense, constrained largely by the need to avoid deviating too far from previous estimates. In the absence of vital records, local community studies are often used to obtain information about population dynamics, but it is more difficult to assess the status of adult health. The GBD study is being heralded as the reference standard. However, if the GBD data are wrong, the consequences will likely by most damaging to the populations which were underrepresented in the fact-gathering process. The GBD projections from sub-Saharan Africa should not be used until data are available which correspond with modelled estimates.