Highlights from the American Journal of Public Health: November 2012 issue

Newswise — The articles below will be published online September 20, 2012, at 4 p.m. (EDT) by the American Journal of Public Health® under “First Look” at http://www.ajph.org/first_look.shmtl, and they are currently scheduled to appear in the November 2012 print issue of the Journal. “First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, www.apha.org, and is available at www.ajph.org.

American Journal of Public Health Highlights:1) Secondhand smoke exposure is attributable to health and economic burden2) Suicide has surpassed motor vehicle deaths as leading cause of injury mortality in U.S. 3) Tobacco use patterns differ across U.S. states and subpopulations4) Income inequalities in health pervade in both the United States and England

1) Secondhand smoke exposure is attributable to health and economic burden

Secondhand smoke exposure contributes to deaths and economic loss, with communities of color disproportionately burdened, reports a new national study published today in the American Journal of Public Health.

Researchers analyzed the number of deaths attributable to secondhand smoke, years of potential life lost and the value of lost productivity for different U.S. racial/ethnic groups in 2006. The sample study included a total of 12,704 adults, consisting of 6,562 non-Hispanic whites, 2,436 non-Hispanic blacks, 3,230 Hispanics and 476 others. Using multiple data sources, they estimated the number of secondhand smoking attributable deaths for adults using cotinine-measured SHS exposure for the first time. They found that black adults had significantly greater exposure rates than did whites in all age groups and for men and women. The highest SHS exposure was for black men aged 45 to 64 years measuring at 63.6 percent, followed by black men aged 20 to 44 years at 62.7 percent. Black women aged 20 to 44 years had a higher exposure rate at 62.3 percent than did any other women. In 2006, more than 42,000 Americans died of secondhand smoking attributable diseases, including more than 41,000 adults and nearly 900 infants.

Researchers also found that black infants dying as a result of exposure to maternal smoking in utero accounted for
a startlingly high 24 to 36 percent of infant SHS-attributable deaths though blacks account for only 13 percent of the population. The value of lost productivity per death was highest among blacks and Hispanics. The researchers reported, “The economic toll resulting from SHS-attributable deaths from just 2 adult and 4 infant conditions is substantial, totaling 42,000 deaths, 600,000 YPLL, and $6.6 billion in lost productivity.”

“With the high rates of smoking prevalence and the resulting high rates of SHS-exposure in the United States and in many parts of the world, interventions need to be designed that target particularly vulnerable groups and that reduce the health and economic burden of smoking on smokers and non-smokers alike,” concluded the study’s authors.

[From: “Deaths from Secondhand Smoke Exposure in the United States: Economic Implications.” Contact: Wendy Max, PhD, Institute for Health & Aging, San Francisco, Calif., [email protected].]

2) Suicide has surpassed motor vehicle deaths as leading cause of injury mortality in U.S.

While public health interventions have reduced motor vehicle traffic mortalities over the past decade in the United States, mortality rates for suicide, poisoning and falls rose substantially, according to a new national study on unintentional and intentional injury mortality published in the American Journal of Public Health.

The five leading external causes of injury deaths comprise three unintentional (motor vehicle traffic crashes, poisoning, and falls) and two intentional (suicide and homicide) or violence-related categories. Researchers characterized patterns and trends in rates of total combined national unintentional and intentional injury mortality and its five leading external causes for the decade 2000 to 2009. They used annual underlying cause-of-death data from the National Center for Health Statistics to describe national patterns and trends in fatal injury for the period 2000 to 2009. The total combined unintentional and intentional injury mortality rate was 10 percent higher in 2009 than in 2000.

According to the study, mortality rates for unintentional poisoning, unintentional falls, and suicide increased by 128 percent, 71 percent, and 15 percent, respectively. The unintentional motor vehicle traffic crash mortality rate declined 25 percent. Suicide ranked first as a cause of injury mortality, followed by motor vehicle traffic crashes, poisoning, falls, and homicide. Females had a lower injury mortality rate than did males. Blacks and Hispanics had lower adjusted motor vehicle traffic crash and suicide mortality rates and higher adjusted homicide rates than did whites. “The injury mortality rate shifted upward over the past decade, with substantial rises in the rates for poisoning, falls, and suicide.” The study’s authors suggest, “Comprehensive and sustained traffic safety measures have apparently substantially diminished the motor vehicle traffic mortality rate, and similar attention and resources are needed to reduce the burden of other injury.”

[From: “Leading Causes of Unintentional and Intentional Injury Mortality: United States, 2000-2009.” Contact: Ian R. H. Rockett, PhD, MPH, School of Public Health, West Virginia University, [email protected]]. 3) Tobacco use patterns differ across U.S. states and subpopulationsApproximately one in four U.S. adults was a current tobacco user in 2009-2010, finds a national study by the U.S. Centers for Disease Control and Prevention featured in the November issue of the American Journal of Public Health.

The comprehensive study assessed the prevalence and sociodemographic correlates of tobacco use among U.S. adults. Authors used data from the 2009-2010 National Adult Tobacco Survey, a national landline and cell phone survey of adults aged 18 years and older to estimate current use of any tobacco. They stratified the data by gender, age, race/ethnicity, education, income and sexual orientation. They found that national prevalence of current use was 25.2 percent for any tobacco. Tobacco use was greatest among respondents who were male, younger, of non-Hispanic “other” ethnicity, less educated, less wealthy, and lesbian, gay, bisexual or transgender. Among states usage, Utah had the lowest prevalence of tobacco use, whereas Kentucky had the highest prevalence.

The study’s authors concluded, “These findings underscore the need for fuller implementation of proven strategies to reduce tobacco use in the United States, particularly among subpopulations with the greatest prevalence. Evidence-based prevention strategies, such as tobacco price increases, media campaigns, and smoke-free policies, in concert with full access to
clinical cessation interventions, have been shown to decrease tobacco use and reduce the health burden and economic impact of tobacco-related diseases in the United States.”

[From: “Current Tobacco Use Among Adults in the United States: Findings from the National Adult Tobacco Survey.” Contact: Office on Smoking and Health Press Line, Centers for Disease Control and Prevention, 770-488-5493].

(4) Income inequalities in health pervade in both the United States and England

Although the English enjoy better overall health than Americans, both countries still grapple with large health inequalities, finds a new study published today in the American Journal of Public Health. Using data from the National Health and Nutrition Examination Survey for the United States with a sample size of 36,360 and the Health Survey for England with a sample size of 55,783, the study’s author calculated prevalence rates and risk ratios by income level for the following health risk factors or conditions including: obesity, hypertension, diabetes, low high-density lipoprotein cholesterol, high cholesterol ratio, heart attack or angina, stroke and asthma.

Despite different health care systems and overall population health within each country, health inequality was pervasive in both the United States and England. Americans and the English were affected by the income gradient in health at all ages, from childhood through to later adulthood. Factors such as race/ethnicity, smoking, frequent alcohol consumption, BMI, and health insurance could not explain the magnitude of the income gradient in either country.

The study’s author stated, “This comparison of the income gradient in health suggests that the policy discussion on reducing health disparities requires attention to broader social conditions, not simply health insurance and health care. Understanding disparities in an international context, especially by extending this comparison with other countries, will help shed light on the pervasiveness of health inequalities by income.”

[From: “Income Inequality in Health at All Ages: A Comparison of the United States and England.” Contact: Melissa L. Martinson, University of Washington, Seattle, [email protected]].

The American Journal of Public Health is the monthly journal of the American Public Health Association® (APHA), the oldest and most diverse organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at www.apha.org. Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Daniel Greenberg at APHA, 202-777-3913, or via email, [email protected]. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions department at www.ajph.org/subscriptions. If you are not a member of the press, a member of APHA or a subscriber, online single issue access is $22 and online single article access is $20 at www.ajph.org/. If you would like to order or renew a subscription, visit www.ajph.org/subscriptions, or for direct customer service, call 202-777-2516, or e-mail [email protected]. To stay up-to-date on the latest in public health research, sign up for new content e-mail alerts at www.ajph.org/subscriptions/etoc.shtml?ck=nck.

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