National Disease Prevention Research Articles

Food preferences and caries status of young hispanic children in a women, infants, and children program

Improving parental and caregiver feeding practices that prevent Baby Bottle Tooth Decay (BBTD) is a Healthy People 2000 National Health Promotion and Disease Prevention objective. The purpose of this study was to identify frequently eaten foods from 9 food groups and relate frequency of consumption to dental caries. In a dental screening project face-to-face interviews were completed with a total of 725 guardians/parents of Hispanic children (1–5 years) in a Women, Infants, and Children (WIC) Supplemental Food Program. A portable computer and custom data entry program were used to document responses to field tested questions designed to identify the two most commonly eaten foods in each food group. Respondents then described daily, weekly, or monthly frequency of consumption of any food within each group. Identified commonly eaten foods from each group did not differ between the one to three and three to five year olds. Some foods reported (fruit juices, dry cereals, milk, cheese, eggs) are those provided by the WIC Program. Traditional Hispanic foods (tortillas, beans, stews) were rarely identified. When frequency consumption of any food group was analyzed children ages three to five who consumed vitamin A and C rich fruits and vegetables on a daily basis had significantly fewer caries than those who did not (p<0.05). Caregivers of children in the same age group who reported less frequent consumption from the fats food group had a lower prevalence of BBTD (p<0.01). Food consumed by young Hispanic children reflect their participation in WIC, i.e., juices, dry cereals, milk, cheese, and eggs. Data to support the interaction between food and tooth decay is inadequate. These data suggest the need to investigate the interaction between multiple dietary factors and caries. Supported by the Centers for Disease Control and Prevention.

Antenatal Formula Advertising: Another Potential Threat to Breast-feeding

Breast-feeding is vitally important to the health and well being of infants throughout the world. The Department of Health and Human Services has identified improved breast-feeding rates as part of the national health and disease prevention objectives for the year 2000. These objectives state that 75% of women will initially breast-feed their infants and 50% will still be breast-feeding at 5 to 6 months.1 Breast-feeding is recognized as the optimal way to nourish most newborns by the American Academy of Pediatrics (AAP), the American College of Obstetricians Gynecologists, and the World Health Organization.2-4 Additionally, the Institute of Medicine of the National Academy of Sciences recommends breast-feeding for all infants in the United States under ordinary circumstances and states that exclusive breast-feeding is the preferred method of feeding for normal full-term infants from birth to age 4 to 6 months.5

Health Promotion and Disease Prevention

FIFTEEN YEARS ago, the US Department of Health, Education, and Welfare publishedHealthy People: The Surgeon General's Report on Health Promotion and Disease Prevention1as a primary strategy for improving the health of US citizens and emphasizing health promotion as an essential element of the prevention imperative. In 1991, the publication ofHealthy People 2000: National Health Promotion and Disease Prevention Objectives2set forth priorities and specific objectives for health promotion, health protection, and preventive services and developed goals to enhance quality of life, decrease preventable death and disability, achieve universal access for preventive services, and reduce disparities in health status. Today, with clinicians, researchers, analysts, and policy makers striving to develop health care systems that provide accessible, affordable, and comprehensive health care, the concepts of health promotion and disease prevention have emerged at the forefront of the reform debate and are receiving greater attention than perhaps ever

Nutritional Risk in New England Elders

To better define nutritional risk among older Americans, a cross-sectional study of nutrition and health status was carried out in a probability sample of 1,156 free-living elders, 70 years and older, from 67 communities representing urban and rural areas of the six New England states. All participants completed telephone interviews concerning demographic and health characteristics. A subsample of 1,156 individuals underwent in-home assessments of oral health, anthropometrics, and nutritional risk, including a 24-hour dietary recall. Nutrition-related problems were common and diverse among New England elders. Some 41.5% were overweight (BMI > 27 kg/m2), and mean dietary lipid intakes were considerably above recommended levels (Healthy People 2000 (National Health Promotion and Disease Prevention Objectives). Some 16% were underweight (BMI < 22 kg/m2), mean dietary calcium levels were low, and about 28% of older individuals failed to consume adequate levels (> 75% the Recommended Dietary Allowance for persons 51 years and older) for three or more key nutrients. Persons of advanced age or who smoked were more likely to have high dietary lipid intakes or less than adequate nutrient intake. Higher dietary lipid levels were also more common among men and individuals who lived with others. Low nutrient intake was more prevalent in those with lower educational attainment and dental problems. Nutrition policies and multidisciplinary interventions for older Americans need to emphasize the spectrum of nutritional problems in the elderly, including dietary excesses and potential nutrient deficiencies. The demographic and life-style characteristics that place older individuals at high nutritional risk need to be considered, particularly advanced age, gender, living situation, smoking, dietary behavior, educational attainment, and dental health.

Health Promotion and Disease Prevention

Fifteen years ago,<i>Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention</i>¹established disease prevention as a primary strategy for improving the health of US citizens and emphasized health promotion as an essential component of the prevention imperative. In 1991, the publication of<i>Healthy People 2000: National Health Promotion and Disease Prevention Objectives</i>²set forth priorities and specific objectives for health promotion, health protection, and preventive services and developed goals to enhance quality of life, decrease preventable death and disability, achieve universal access for preventive services, and reduce disparities in health status. Today, with health care providers, researchers, analysts, and policymakers attempting to design health care systems that provide accessible, affordable, and comprehensive health care, the concepts of health promotion and disease prevention have emerged at the forefront of the reform debate and are receiving greater attention than ever before. Despite health improvements achieved through

Nutrition education sources and priorities of elementary school teachers

Comprehensive health education for kindergarten through grade 12 is a stated goal of the Healthy People 2000 objectives ( 1. US Dept of Health and Human Services Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Jones and Bartlett, Boston, Mass1991 Google Scholar ). In 1989, 32 states required that health education be taught during kindergarten through grades 12 ( 2. Lovato CY Allensworth DD Chan FA School Health in American: An Assessment of State Policies to Protect and Improve the Health of Students. American School Health Association, Kent, Ohio1989 Google Scholar ). Remaining states have health education requirements or recommendations at various grade levels ( 2. Lovato CY Allensworth DD Chan FA School Health in American: An Assessment of State Policies to Protect and Improve the Health of Students. American School Health Association, Kent, Ohio1989 Google Scholar ).

Professional Relevance: Meeting the Contemporary Public Health Agenda

Abstract Recent publications that outline the community health agenda for the 1990s describe processes that are designed to assist local communities in the diagnosis of health problems and development and evaluation of interventions. These documents include: Assessment Protocol for Excellence in Public Health (APEXPH), Planned Approach to Community Health (PATCH), Healthy People 2000: National Health Promotion and Disease Prevention Objectives, and Healthy Communities 2000: Model Standards. A close examination of these sentinel documents indicates that the skills called for in these community processes are the same skills outlined in A Framework for the Development of Competency-Based Curricula for Entry-Level Health Educators. It is thereby important for employers and health education practitioners to realize that those individuals prepared in the competencies of health education are well suited to assume a leadership role in the public health agenda of the future.

The Case for School Health Educators Becoming Certified Health Education Specialists

Abstract General agreement exists that health promotion and health education at the school, community, and worksite settings are necessary if the nation is to realize the goals of Healthy People 2000: The National Health Promotion and Disease Prevention Objectives. If so, those individuals who are responsible for planning, implementing, and evaluating health promotion and disease prevention programs must have the requisite skills and knowledge to be successful. Much dialogue has transpired about the adequacy of preparation programs and the generic competencies needed to be considered a health educator. This article details reasons why public school health educators should consider becoming Certified Health Education Specialists (CHES).

Master's degree nursing education: state of the art.

This study examines the state of the art in master's nursing education in the United States in light of projected national trends in the health care delivery system. The specific questions addressed are: What are the general characteristics of master's programs, including admission requirements and prerequisites, program requirements, major and minor areas of clinical concentration, functional role preparation, and career mobility options? What is the curricular organization, particularly with respect to required core courses? Is there a difference between master's programs in schools with a doctoral program in nursing and those with master's programs only? Is there a difference between master's programs with public support and master's programs with private support? Data were collected from 175 accredited master's programs in 1990. Study results and the projected trends derived from Nursing's Agenda for Health Care Reform, Healthy People 2000: National Health Promotion and Disease Prevention Objectives, and Healthy America: Practitioners for 2005 provide the foundation for recommendations. Recommendations are organized around communication and curricular issues that master's nursing education needs to address as the profession approaches the 21st century.

Health promotion and disease prevention: a survey of rural family physicians.

Family and general practice physicians deliver comprehensive health care over time and are well suited to promote health and prevent disease. Prior studies of preventive medicine routines have tended to address a limited number of the recommended practices. The purpose of this study was to: (1) estimate the level of primary care physician compliance with the wide range of physician recommendations in Healthy People 2000: National Health Promotion and Disease Prevention Objectives for the Year 2000 and (2) identify practice characteristics associated with performance of preventive health care. Full-time family and general practice physicians, located in rural Mississippi towns of 5,000 to 10,000, were selected for the study. Of 94 eligible physicians, 81 were surveyed (73 surveys completed on site and 8 surveys returned by mail). The physicians treated a mean of 35 patients per day, with a disproportionate number of elderly patients. Limited physician time was ranked by physicians as the greatest obstacle to preventive medicine. Physicians were found to practice more preventive medicine in the adult and elderly patients than in the children and adolescents. Cancer, cardiovascular, and infectious disease risks were well addressed, with little attention directed toward occupational and environmental (e.g., lead, firearm, automobile) risks. Two practice characteristics were consistently associated with higher preventive medicine scores: an assigned preventive medicine staff member and preventive medicine flow charts. This information, obtained in a medically underserved area, may be used to assist physicians in meeting the Healthy People 2000 objectives. More research is needed to identify effective approaches for health risks that were not well addressed in physician offices.

Healthy People 2000

To examine the rationale for preventive nutrition intervention and the potential efficacy of nutrition-related risk factor modification on heart disease incidence, the cardiovascular disease risk and dietary profiles of Framingham (Mass) men and women, 30 to 79 years old (n = 1798 and 1845, respectively), were compared with the Healthy People 2000: National Health Promotion and Disease Prevention Objectives for the Nation and used to project the 10-year incidence of coronary heart disease with and without lowering serum cholesterol levels.Data for this report are derived from the 1984 to 1988 cycle III examinations of the Framingham offspring-spouse cohort. Estimates of the reduction in coronary heart disease risk associated with modifications in serum cholesterol levels and other cardiovascular disease risk factors are projected using Framingham models.About 40% met guidelines for desirable total cholesterol levels (< 5.17 mmol/L [< 200 mg/dL]); 20% were hypertensive; one quarter smoked; and 10% of women and 20% of men were obese. Twenty-four-hour dietary data, adjusted for estimates of usual intake, indicated that about 50% to 80% met dietary cholesterol (< 300 mg) and 55% to 94% met sodium (< 3 g/d) objectives. In contrast, mean total fat intakes were high (38% of total energy), and only 6% to 9% of subjects met total fat, 9% to 14% met saturated fat, and fewer than 3% met dietary fiber guidelines. Ten-year cumulative incidence for coronary heart disease was projected to be up to 25% lower with reduction in serum cholesterol level.Risk factor lowering, emphasizing preventive nutrition measures, is an important element of health care reform, particularly strategies to reduce cardiovascular disease rates and to promote population health.

Healthy People 2000. The rationale and potential efficacy of preventive nutrition in heart disease: the Framingham Offspring-Spouse Study

To examine the rationale for preventive nutrition intervention and the potential efficacy of nutrition-related risk factor modification on heart disease incidence, the cardiovascular disease risk and dietary profiles of Framingham (Mass) men and women, 30 to 79 years old (n = 1798 and 1845, respectively), were compared with the Healthy People 2000: National Health Promotion and Disease Prevention Objectives for the Nation and used to project the 10-year incidence of coronary heart disease with and without lowering serum cholesterol levels. Data for this report are derived from the 1984 to 1988 cycle III examinations of the Framingham offspring-spouse cohort. Estimates of the reduction in coronary heart disease risk associated with modifications in serum cholesterol levels and other cardiovascular disease risk factors are projected using Framingham models. About 40% met guidelines for desirable total cholesterol levels (< 5.17 mmol/L [< 200 mg/dL]); 20% were hypertensive; one quarter smoked; and 10% of women and 20% of men were obese. Twenty-four-hour dietary data, adjusted for estimates of usual intake, indicated that about 50% to 80% met dietary cholesterol (< 300 mg) and 55% to 94% met sodium (< 3 g/d) objectives. In contrast, mean total fat intakes were high (38% of total energy), and only 6% to 9% of subjects met total fat, 9% to 14% met saturated fat, and fewer than 3% met dietary fiber guidelines. Ten-year cumulative incidence for coronary heart disease was projected to be up to 25% lower with reduction in serum cholesterol level. Risk factor lowering, emphasizing preventive nutrition measures, is an important element of health care reform, particularly strategies to reduce cardiovascular disease rates and to promote population health.

Preconception care: An opportunity to maximize health in pregnancy

In 1990, the United States Public Health Service published Healthy People 2000: National Health Promotion and Disease Prevention Objectives. One of the objectives included in the family planning priority area and repeated in the maternal and infant health priority area is the following: “Increase to at least 60 percent the proportion of primary care providers who provide age-appropriate preconception care and counseling.” Drawing on the guidelines proposed by the Public Health Service Expert Panel on the Content of Prenatal Care, this article describes the components of preconception care: 1) appropriate and ongoing risk assessment, 2) health promotion, and 3) medical and psychological interventions and follow-up. The organization of this article is based on a preconception class outline developed by the authors; recommendations included in the article are consistent with those of the Expert Panel. After discussing opportunities for providing preconception care, this article addresses: 1) helping women evaluate their psychological readiness; 2) evaluating physical readiness; 3) the examination and concerns of the father; 4) evaluating the need for genetic counseling; 5) creating a positive environment for conception; 6) discontinuing family planning methods and timing conception; and 7) choosing a provider and birth place.

Use of Smokeless Tobacco Among Adults— United States, 1991

Consumption of moist snuff and other smokeless tobacco products in the United States almost tripled from 1972 through 1991 (1). Long-term use of smokeless tobacco is associated with nicotine addiction and increased risk of oral cancer (2)--the incidence of which could increase if young persons who currently use smokeless tobacco continue to use these products frequently (1). To monitor trends in the prevalence of use of smokeless tobacco products, CDC's 1991 National Health Interview Survey-Health Promotion and Disease Prevention supplement (NHIS-HPDP) collected information on snuff and chewing tobacco use and smoking from a representative sample of the U.S. civilian, noninstitutionalized population aged > or = 18 years. This report summarizes findings from this survey.

Prevention and adolescent health. Commentary on progress of the past 2 years.

Two years ago I wrote an article for AJDC that briefly reviewed two new initiatives that could have a major impact on adolescent health. These were the identification of national health objectives in Healthy People 2000: The National Health Promotion and Disease Prevention Objectives 1 and the release of the recommendations of the US Preventive Services Task Force in the Guide to Clinical Preventive Services . 2 These two efforts were viewed as important because they focused attention on prevention and on the special health issues of adolescents. Since the publication of the special issue of the AJDC , it has become clear that these two documents have contributed substantially to intensified efforts to improve the health and well-being of adolescents. After decades of identifying the critical health issues facing youth, solid national programs are taking shape that have the potential to fundamentally change how health care is provided to adolescents. The

General Comments

As the year 2000 approaches, we as a nation face unique challenges in facilitating the development of systems of services for children and their families which support and nurture our next generation in healthy, productive lives. Title V of the Social Security Act has a proud history of leadership in response to needs of children and families and has worked to improve the health of underserved women, infants, children, and youth, including children with special health care needs. In 1989, amendments were enacted to the Title V Maternal and Child Health Grant (MCH block grant). These amendments redefine the mission of the state Children With Special Health Care Needs programs (CSHCN programs). The MCH block grant mandates the state CSHCN programs to assume a leadership role in developing community-based systems of services for children with special health care needs and their families. The mandate in the MCH block grant to the CSHCN programs to assume a leadership role with respect to systems development reflects the national goal of building systems of services for children with special health care needs and their families that are family-centered, community-based, and coordinated. This goal was first enunciated in 1987 by the US Surgeon General's office and the federal Bureau of Maternal and Child Health. In accordance with this national goal, the recently issued Year 2000 National Health Promotion and Disease Prevention Objectives includes objective 17.20, which specifically calls for the building of family-centered, community-based, coordinated systems of services for this population. The national initiative to develop systems of services for children with special health care needs and their families can and should be seen as part of a larger national movement to develop community-based systems of services.

US health care reform and the economy of prevention.

The current dialogue on reform of the US health care system is conspicuous for the absence of an epidemiologically driven framework that focuses on the prevention of disease. Review of epidemiologic and demographic trends in the American population illustrates that if reform fails to advance the point of intervention to earlier in the course of disease, a restructured health care system is unlikely to provide comprehensive services with universal access. Sustainable reform warrants a preventive orientation and greater balance between primary, secondary, and tertiary levels of intervention. This report considers trends that may render economically driven reform rapidly obsolete, as well as cultural obstacles to the development of a prevention ethos in US health care and culture. The economy of prevention is described in the context of leading causes of US morbidity and mortality. Elements of a national disease prevention strategy are considered that include changes in mechanisms of physician/provider reimbursement, the orientation of private-sector biotechnology/health care research, tertiary medical centers and academia, and improved abilities to reduce the concentration of preventable morbidity and mortality in high-risk communities and to use epidemiology in formulating health policy.

Position of the American dietetic association: Promotion and support of breast-feeding

Breast-feeding promotion is currently among the Healthy People 2000 National Health Promotion and Disease Prevention Objectives. Dietitians have a vital role and responsibility to promote breast-feeding among all women to achieve these objectives.

The NIMH community violence project: II. Children's distress symptoms associated with violence exposure.

The rising tide of violence in American cities has placed the causes and consequences of violence squarely on the public health agenda. The U.S. Government's Year 2000 National Health Promotion and Disease Prevention Objectives includes a full chapter devoted to violence issues and delineates a number of goals and programs aimed at reducing the number of deaths and injuries associated with violence (Public Health Service 1990). Notably absent from these objectives, however, is attention to the possible adverse psychological consequences of exposure to acute or chronic violence. Nonetheless, in light of numerous media reports of children's exposure to community violence and recent reports documenting high levels of exposure even among very young children (Richters and Martinez 1993), it is reasonable to question whether the risks of exposure extend beyond death and physical injury to psychological well-being.

Connotative meanings assigned to contraceptive options.

Healthy People 2000: National Health Promotion and Disease Prevention Objectives states that the reduction of unintended pregnancies is one of the primary health objectives for college-aged people. In addition, the reduction in rates of sexually transmitted diseases, with special emphasis on reducing the incidence of HIV infection, is an important objective for this population. One way of addressing these objectives is through promoting use of effective contraception methods. Attitudes toward a particular contraceptive option may play an important role in acceptance of, and predisposition toward, using a given method. The authors used semantic differential scaling to study the connotative meanings college students assigned to 13 contraceptive methods. They asked 751 students (mean age = 19.6 years) to rate each method of contraception, using 7-point scales composed of 15 bipolar adjective pairs. Scale internal consistency was estimated using Cronbach's alpha, and ranges were from .68 for douching to .92 for oral contraceptives. Respondents' rank-ordered approval ratings of the 13 options were as follows: oral contraceptives; abstinence; the condom; the diaphragm; the contraceptive sponge; female sterilization; rhythm; male sterilization; douching, the IUD, and vaginal suppositories (tied); spermicidal foam; and withdrawal. These results indicated general approval for methods that are effective in preventing conception. Semantic interpretation of selected contraceptive options differed by gender and race, but not by age. Implications for contraception education and future research issues are discussed.