Preventing Chronic Disease Dialogue

SPECIAL TOPIC

Julie A. Schmittdiel, PhD; Susan D. Brown, PhD; Romain Neugebauer, PhD; Sara R. Adams, MPH; Alyce S. Adams, PhD; Deanne Wiley, BA; Assiamira Ferrara, MD, PhD

Suggested citation for this article: Schmittdiel JA, Brown SD, Neugebauer R, Adams SR, Adams AS, Wiley D, et al. Health-Plan and Employer-Based Wellness Programs to Reduce Diabetes Risk: The Kaiser Permanente Northern California NEXT-D Study. Prev Chronic Dis 2013;10:120146. DOI: http://dx.doi.org/10.5888/pcd10.120146.

PEER REVIEWED

Abstract

Primary prevention of diabetes is increasingly recognized by both health plans and employers as an important strategy to improve the health of insured populations. As a part of the Natural Experiments in Translation for Diabetes (NEXT-D) network, the Kaiser Permanente Northern California (KPNC) Division of Research is assessing the effectiveness of 2 health plan-initiated programs to prevent the onset of diabetes in patients at high risk. The first study evaluates a telephonic health-coaching program that provides counseling on healthful eating, active living, and weight loss to KPNC members. The second evaluation examines a postpartum glucose screening and educational diabetes prevention program for women with gestational diabetes mellitus that KPNC implemented in 2006. Identifying effective approaches to preventing diabetes will be of value to health care systems, policy makers, and public health officials seeking to understand the roles systems and employers can play in preventing chronic illness.

SYSTEMATIC REVIEW

Damian Hoy, PhD; Chalapati Rao, PhD; Nguyen Thi Trang Nhung, MPH; Geoffrey Marks, PhD; Nguyen Phuong Hoa, PhD

Suggested citation for this article: Hoy D, Rao C, Nhung NT, Marks G, Hoa NP. Risk Factors for Chronic Disease in Viet Nam: A Review of the Literature. Prev Chronic Dis 2013;10:120067. DOI: http://dx.doi.org/10.5888/pcd10.120067.

PEER REVIEWED

Abstract

Introduction

Chronic diseases account for most of the disease burden in low- and middle-income countries, particularly those in Asia. We reviewed literature on chronic disease risk factors in Viet Nam to identify patterns and data gaps.

Methods

All population-based studies published from 2000 to 2012 that reported chronic disease risk factors were considered. We used standard chronic disease terminology to search PubMed and assessed titles, abstracts, and articles for eligibility for inclusion. We summarized relevant study information in tables listing available studies, risk factors measured, and the prevalence of these risk factors.

Results

We identified 23 studies conducted before 2010. The most common age range studied was 25 to 64 years. Sample sizes varied, and sample frames were national in 5 studies. A combination of behavioral, physical, and biological risk factors was studied. Being overweight or obese was the most common risk factor studied (n = 14), followed by high blood pressure (n = 11) and tobacco use (n = 10). Tobacco and alcohol use were high among men, and tobacco use may be increasing among Vietnamese women. High blood pressure is common; however, people’s knowledge that they have high blood pressure may be low. A high proportion of diets do not meet international criteria for fruit and vegetable consumption. Prevalence of overweight and obesity is increasing. None of the studies evaluated measured dietary patterns or total caloric intake, and only 1 study measured dietary salt intake.

Conclusion

Risk factors for chronic diseases are common in Viet Nam; however, more recent and context-specific information is required for planning and monitoring interventions to reduce risk factors and chronic disease in this country.

BRIEF

Stacey L. Tannenbaum, PhD, RD, LDN; Diana Kachan, BS; Cristina A. Fernandez, MSEd; Laura A. McClure, MSPH; William G. LeBlanc, PhD; Kristopher L. Arheart, EdD; David J. Lee, PhD

Suggested citation for this article: Tannenbaum SL, Kachan D, Fernandez CA, McClure LA, LeBlanc WG, Arheart KL, et al. State Variations of Chronic Disease Risk Factors in Older Americans. Prev Chronic Dis 2012;9:120143. DOI: http://dx.doi.org/10.5888/pcd9.120143.

PEER REVIEWED

Abstract

The objective of this study was to examine and compare 3 key health behaviors associated with chronic disease (ie, risky drinking, smoking, and sedentary lifestyle). We used data from the National Health Interview Survey from 1997 through 2010 to calculate the prevalence of these behaviors among older Americans and rank each state, and we analyzed overall trends in prevalence for each behavior over the 14 years. Older adults residing in Arkansas and Montana had the worst chronic disease risk profile compared with other states. These findings indicate the need for improved or increased targeted interventions in these states.

SPECIAL TOPIC

Daniel S. Morris, MS, PhD; Steven C. Fiala, MPH; Rebecca Pawlak, MPH

Suggested citation for this article: Morris DS, Fiala SC, Pawlak R. Opportunities for Policy Interventions to Reduce Youth Hookah Smoking in the United States. Prev Chronic Dis 2012;9:120082.
DOI: http://dx.doi.org/10.5888/pcd9.120082.

PEER REVIEWED

Abstract

Preventing youth smoking initiation is a priority for tobacco control programs, because most adult tobacco smokers become addicted during adolescence. Interventions that restrict the affordability, accessibility, and marketing of cigarettes have been effective in reducing youth cigarette smoking. However, increasing numbers of youth are smoking tobacco using hookahs. Predictors of smoking tobacco with hookahs are the same as those for smoking cigarettes. Established interventions that curb youth cigarette smoking should therefore be effective in reducing hookah use. Potential policy interventions include equalizing tobacco tax rates for all tobacco types, requiring warning labels on hookah tobacco and accurate labeling of product contents, extending the cigarette flavoring ban to hookah tobacco, enacting smoke-free air laws and removing exemptions for hookah lounges, and expanding shipping restrictions on tobacco products.

EDITORIAL

Tim McAfee, MD, MPH; Michael Tynan

Suggested citation for this article: McAfee T, Tynan M. Smoking in Movies: A New Centers for Disease Control and Prevention Core Surveillance Indicator. Prev Chronic Dis 2012;9:120261.
DOI: http://dx.doi.org/10.5888/pcd9.120261.

Youth who are heavily exposed to onscreen smoking are approximately 2 to 3 times as likely to begin smoking as youth who are lightly exposed (1), and the Surgeon General concluded that there is a causal relationship between depictions of smoking in the movies and smoking initiation among young people (2). Among the 3 major motion picture companies with policies aimed at reducing tobacco-use incidents in their movies, the number of onscreen incidents per youth-rated movie (rated G, PG, or PG-13 by the Motion Picture Association of America) decreased 95.8% from 2005 through 2010 (3). These results appeared to indicate that movie companies were making progress at reducing smoking depictions in youth-oriented movies and that a company-by-company approach of adopting voluntary policies could be effective in nearly eliminating youth exposure to tobacco imagery in movies. However, new data from 2011 published by Glantz and colleagues (4) in Preventing Chronic Disease raise serious concerns about this individual company approach.

ORIGINAL RESEARCH

DeAnnah R. Byrd, MS

Suggested citation for this article: Byrd DR. Race/Ethnicity and Self-Reported Levels of Discrimination and Psychological Distress, California, 2005. Prev Chronic Dis 2012;9:120042. DOI: http://dx.doi.org/10.5888/pcd9.120042.

PEER REVIEWED

Abstract

Introduction

Little is known about the relationship between discrimination and distress among multiple racial groups because previous studies have focused primarily on either blacks or Asian Americans. The objective of this study was to assess the association between self-reported experiences of racial discrimination and symptoms of psychological distress among 5 racial/ethnic groups in California.

Methods

I used data from the 2005 California Health Interview Survey describing an adult sample of 27,511 non-Hispanic whites, 8,020 Hispanics, 1,813 non-Hispanic blacks, 3,875 non-Hispanic Asians, and 1,660 people of other races/ethnicities. The Kessler 6-item Psychological Distress Scale determined symptoms of psychological distress. I used a single-item, self-reported measure to ascertain experiences of racial discrimination.

Results

Reports of racial discrimination differed significantly among racial groups. Self-reported discrimination was independently associated with psychological distress after adjusting for race/ethnicity, age, sex, education level, employment status, general health status, nativity and citizenship status, English use and proficiency, ability to understand the doctor at last visit, and geographic location. The relationship between discrimination and psychological distress was modified by the interaction between discrimination and race/ethnicity; the effect of discrimination on distress was weaker for minority groups (ie, blacks and people of other races/ethnicities) than for whites.

Conclusion

Self-reported discrimination may be a key predictor of high levels of psychological distress among racial/ethnic groups in California, and race appears to modify this association. Public health practitioners should consider the adverse effects of racial discrimination on minority health.

ESSAY

Jeffrey R. Harris, MD, MPH, MBA; Robert B. Wallace, MD, MSc

Suggested citation for this article: Harris JR, Wallace RB. The Institute of Medicine’s New Report on Living Well With Chronic Illness. Prev Chronic Dis 2012;9:120126. DOI: http://dx.doi.org/10.5888/pcd9.120126.

In the United States, chronic illnesses such as heart disease, cancer, diabetes, stroke, and chronic lung disease account for 70% of deaths and 75% of health care costs (1,2) and have received attention in the professional and lay literature. Although efforts in managing chronic illness typically originate in the health care system, governmental and community-based public health organizations play an important role in helping people with chronic illness maintain optimal health. To help advance the chronic illness programs and policies of public health organizations, the Institute of Medicine (IOM), with the sponsorship of the Arthritis Foundation and the Centers for Disease Control and Prevention (CDC), has produced a new report, “Living Well With Chronic Illness: A Call for Public Health Action” (3). In this essay, we highlight findings from the report related to the consequences of chronic illness, the need for enhanced surveillance, the state of interventions and policies to decrease the effects of chronic illness, and the need for coordinated action in both health care and community-based settings. We close with a discussion of the report’s implications for public health organizations.

James S. Marks, MD, MPH; Risa Lavizzo-Mourey, MD, MBA

Suggested citation for this article: Marks JS, Lavizzo-Mourey R. Philadelphia Freedom. Prev Chronic Dis 2012;9:120182. DOI: http://dx.doi.org/10.5888/pcd9.120182.

The song “Philadelphia Freedom” became popular in 1976, the bicentennial of our nation’s birth. That was also about the time that the obesity rate in our young people began to rise (1). And it has done so inexorably since then — until now.

That’s what makes the report from Philadelphia so exciting. It’s the latest in a small but growing series of studies that point to the first signs of declining rates of obesity among children in places like New York City and California (2,3). In New York City, declines were seen citywide, but the largest changes were among white and Asian students, who already had the lowest rates (2). In California, the state had a significant overall decline, but progress was uneven. Although counties like Los Angeles, which had been at the forefront of making healthy changes, succeeded in reducing childhood obesity rates, more than half of the state’s counties showed continued increases (3).

Thomas E. Kottke, MD, MSPH; Courtney Jordan Baechler, MD, MCE; Emily D.
Parker, PhD

Suggested citation for this article: Kottke TE, Baechler CJ, Parker ED. Accuracy of Heart Disease Prevalence Estimated from Claims Data Compared With an Electronic Health Record. Prev Chronic Dis 2012;9:120009.
DOI: http://dx.doi.org/10.5888/pcd9.120009.

PEER REVIEWED

Abstract

Introduction

We developed a decision support tool that can guide the development of heart disease prevention programs to focus on the interventions that have the most potential to benefit populations. To use it, however, users need to know the prevalence of heart disease in the population that they wish to help. We sought to determine the accuracy with which the prevalence of heart disease can be estimated from health care claims data.

Methods

We compared estimates of disease prevalence based on insurance claims to estimates derived from manual health records in a stratified random sample of 480 patients aged 30 years or older who were enrolled at any time from August 1, 2007, through July 31, 2008 (N = 474,089) in HealthPartners insurance and had a HealthPartners Medical Group electronic record. We compared randomly selected development and validation samples to a subsample that was also enrolled on August 1, 2005 (n = 272,348). We also compared the records of patients who had a gap in enrollment of more than 31 days with those who did not, and compared patients who had no visits, only 1 visit, or 2 or more visits more than 31 days apart for heart disease.

Results

Agreement between claims data and manual review was best in both the development and the validation samples (Cohen’s κ, 0.92, 95% confidence interval [CI], 0.87–0.97; and Cohen’s κ, 0.94, 95% CI, 0.89–0.98, respectively) when patients with only 1 visit were considered to have heart disease.

Conclusion

In this population, prevalence of heart disease can be estimated from claims data with acceptable accuracy.

Miriam Lutski, MSc; Varda Shalev, MD; Avi Porath, MD; Gabriel Chodick, PhD

Suggested citation for this article: Lutski M, Shalev V, Porath A, Chodick G. Continuation With Statin Therapy and the Risk of Primary Cancer: A Population-Based Study. Prev Chronic Dis 2012;9:120005. DOI: http://dx.doi.org/10.5888/pcd9.120005.

PEER REVIEWED

Abstract

Introduction

Studies have suggested that statins may inhibit tumor cell growth and possibly prevent carcinogenesis. The objective of this study was to investigate the association between persistent statin use and the risk of primary cancer in adults.

Methods

This retrospective study was conducted by using the computerized data sets of a large health maintenance organization (HMO) in Israel. The study population was 202,648 enrollees aged 21 or older who purchased at least 1 pack of statin medication from 1998 to 2006. The follow-up period was from the date of first statin dispensation (index date) to the date of first cancer diagnosis, death, leaving the HMO, or September 1, 2007, whichever occurred first. Persistence was measured by calculating the mean proportion of follow-up days covered (PDC) with statins by dividing the quantity of statin dispensed by the total follow-up time.

Results

During the study period, 8,662 incident cancers were reported. In a multivariable model, the highest cancer risk was calculated among nonpersistent statin users. A strong negative association between persistence with statin therapy and cancer risk was calculated for hematopoietic malignancies, where patients covered with statins in 86% or more of the follow-up time had a 31% (95% confidence interval, 0.55-0.88) lower risk than patients in the lowest persistence level (≤12%).

Conclusion

Our study demonstrated that persistent use of statins is associated with a lower overall cancer risk and particularly the risk of incident hematopoietic malignancies. In light of widespread statin consumption and increases in cancer incidence, the association between statins and cancer incidence may be relevant for cancer prevention.