April American Journal of Public Health Articles

The articles below are published online by the American Journal of Public Health under "First Look," and will appear in the April 2006 print issue of the Journal. "First Look" articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. Following the embargo, articles will appear under "First Look" at http://www.ajph.org/first_look.shtml. The American Journal of Public Health is published by the American Public Health Association and is available at http://www.ajph.org.

Obesity ups male drivers' death risk, as does being very thin

Being obese increases male drivers' risk of dying in a car crash, as does being very slim, according to an analysis of data from more than 22,000 drivers ages 16 and older.

Researchers, led by Shankuan Zhu, MD, Ph.D, in the Injury Research Center at the Medical College of Wisconsin, Milwaukee, used the National Automotive Sampling System, Crashworthiness Data System, a data collection system sponsored by the U.S. Department of Transportation. Using data collected from 1997-2001, they found obese men and those with a very low body mass index had the highest death rate from motor vehicle crashes. Obesity did not affect women's risk of death from such crashes.

Men with the highest body mass index were at greatest risk for death from front or left-side collisions. And men with the lowest BMI also had higher death rates than the lowest rates found among overweight but not obese men. The researchers said their findings lend credence to the theory of a "cushioning effect" for overweight men that might protect them from fatal injury in a crash.

The study was funded by the Centers for Disease Control and Prevention. Motor-vehicle crashes are the leading cause of injury-related death in the United States, taking more than 42,000 lives in 2002. [From "Obesity and risk for death due to motor vehicle crashes" . ]

Breastfeeding less likely among U.S.-born moms

Foreign-born women living in the United States are much more likely to breastfeed their babies than U.S.-born women, according to a study of about 4,200 mothers and 3,000 fathers participating in a birth cohort study.

Researchers divided participants by their immigration status and ethnicity and found mothers born in the United States were 85 percent less likely to breastfeed than foreign-born mothers and 66 percent less likely to breastfeed their babies at 6 months of age. And each additional year of U.S. residency decreased breastfeeding rates by 4 percent for the mothers in the study.

"For immigrant women, breastfeeding may not be so much of a choice, but rather the expected method of feeding," the study's authors said. "In contrast, American women may view it differently, and believe that breastfeeding is just one of multiple feeding options." [From: "Couples Immigration Status and Ethnicity as Determinants of Breastfeeding." ]

Increasing SCHIP premiums leads to more cost, less care access

While many states are increasing premiums for subsidized insurance under the State Children's Health Insurance Program, such a move may prove costly in the long run.

Researchers estimated the net cost to a community if SCHIP premiums increased in a border area where the majority of children were Latino. They estimated a $10 SCHIP premium increase in Yuma County, Ariz., would result in a 21-percent rise of uninsured children in the area, resulting in an overall $167,000 increase annually in total health care expenditures. Without insurance for doctor visits, many children would be taken to expensive emergency departments for care.

"While demand-side cost sharing is seen as a way to reduce unnecessary services, it also reduces necessary service utilization by low-income individuals and results in delaying needed care and increasing the severity of potentially avoidable illnesses," the study's authors said. The increase in severity can ultimately translate into large and significant increases in both the quantity and intensity of services."[From: "Reducing SCHIPCoverage: Saving Money or Shifting Costs?" ]

Lack of trust a barrier to care

Distrust of health providers and the government can prove to be serious care obstacles, according to a survey of 600 HIV-positive individuals from the Deep South.

Those who trusted their health care providers were more likely to have had three or more HIV-related outpatient clinic visits in the previous nine months and to have taken their antiretroviral medication. Those patients also reported better physical and mental health than patients who distrusted their health care providers.

Those patients who trusted the government had fewer emergency room visits, and better mental and physical health. More than one-quarter of those patients surveyed said they believed the government created HIV to kill minorities, and more than half believed a lot of AIDS information is being withheld from the public. One in 10 did not trust their provider to give them the best possible care. [From: "Exploring Trust as a Barrier to Health Services Use." ]

Pool drownings disproportionately affect black males.

Black males are at highest risk from drowning in swimming pools, according to a study of almost 700 pool drownings among youth ages 5-24.

Based on recorded swimming pool drownings in the United States from 1995-1998, 75 percent of victims were male, and 47 percent were black, compared to 33 percent white and 12 percent Hispanic. Among black males, the majority of swimming pool drownings were in public pools, while the majority of white victims drowned in residential pools. Hispanic victims were more likely than others to drown in neighborhood pools, such as a pool in an apartment community. Foreign-born males were also at increased risk as compared with males born in the United States, especially in the 5-9-year-old age group.

"Targeted interventions are needed to reduce the incidence of pool drowning across racial and ethnic groups, particularly focusing on supervision in public pools," the study's authors said. [From: "Swimming Pool Drownings in Youth Ages 5-24: Understanding Racial and Ethnic Disparities." ]

The American Journal of Public Health is the monthly journal of the American Public Health Association, the oldest organization of public health professionals in the world. APHA is a leading publisher of public health-related books and periodicals promoting high scientific standards, action programs and policy for good health. More information is available at http://www.apha.org.