Healthy Regimen

Kevin Lewis

February 02, 2011

Forcing the Navy to Sell Cigarettes on Ships: How the Tobacco Industry and Politicians Torpedoed Navy Tobacco Control

Naphtali Offen, Sarah Arvey, Elizabeth Smith & Ruth Malone
American Journal of Public Health, forthcoming

In 1986, the US Navy announced the goal of becoming smoke-free by 2000. However, efforts to restrict tobacco sales and use aboard the USS Roosevelt prompted tobacco industry lobbyists to persuade their allies in Congress to legislate that all naval ships must sell tobacco. Congress also removed control of ships' stores from the Navy. By 1993, the Navy abandoned its smoke-free goal entirely and promised smokers a place to smoke on all ships. Congressional complicity in promoting the agenda of the tobacco industry thwarted the Navy's efforts to achieve a healthy military workforce. Because of military lobbying constraints, civilian pressure on Congress may be necessary to establish effective tobacco control policies in the armed forces.


The Effect of Job Loss on Overweight and Drinking

Partha Deb et al.
Journal of Health Economics, forthcoming

This paper examines the impact of job loss due to business closings on body mass index (BMI) and alcohol consumption. We suggest that the ambiguous findings in the extant literature may be due in part to unobserved heterogeneity in response and in part due to an overly broad measure of job loss that is partially endogenous (e.g. layoffs). We improve upon this literature by using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data from the Health and Retirement Study. For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. These results suggest the health effects of job loss could be concentrated among "at risk" individuals and could lead to negative outcomes for the individuals, their families, and society at large.


Losing Life and Livelihood: A Systematic Review and Meta-Analysis of Unemployment and All-Cause Mortality

David Roelfs et al.
Social Science & Medicine, forthcoming

Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a random-effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late-career. The risk of death was highest during the first 10 years of follow up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors.


So you want to quit smoking: Have you tried a mobile phone?

Julien Labonne & Robert Chase
Applied Economics Letters, February 2011, Pages 103-106

Using spatially coded data on mobile phone coverage and panel data from 2100 households in 135 communities of the Philippines, we estimate the impact of mobile phone ownership on tobacco consumption. Purchasing a mobile phone leads to a 17.1% decrease in tobacco consumption per adult over the age of 15.


Childhood Adversity Heightens the Impact of Later-Life Caregiving Stress on Telomere Length and Inflammation

Janice Kiecolt-Glaser et al.
Psychosomatic Medicine, January 2011, Pages 16-22

Objective: To address the question of whether childhood abuse and other adversities have lasting, detectable consequences for inflammation and cell aging late in life, and whether the effects are large enough to be discernible beyond that of a major chronic stressor, dementia family caregiving. Previous research on the physical health consequences of childhood abuse and other adversities has been based on data from young or middle-aged adults.

Method: In this community sample of 132 healthy older adults (mean age = 69.70 years; standard deviation = 10.14), including 58 dementia family caregivers and 74 noncaregivers, blood samples were analyzed for interleukin (IL)-6, tumor necrosis factor (TNF)-, and telomere length, a measure of cell aging. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale.

Results: After controlling for age, caregiving status, gender, body mass index, exercise, and sleep, the presence of multiple childhood adversities was related to both heightened IL-6 (0.37 ± 0.03 log10 pg/mL versus 0.44 ± 0.03 log10 pg/mL) and shorter telomeres (6.51 ± 0.17 Kb versus 5.87 ± 0.20 Kb), compared with the absence of adversity; the telomere difference could translate into a 7- to 15-year difference in life span. Abuse was associated with heightened IL-6 and TNF- levels; for TNF-, this relationship was magnified in caregivers compared with controls. Moreover, abuse and caregiving status were associated significantly and independently with higher levels of depressive symptoms.

Conclusions: Adverse childhood events are related to continued vulnerability among older adults, enhancing the impact of chronic stressors. Childhood adversities cast a very long shadow.


Where There's Smoking, There's Fire: The Effects of Smoking Policies on the Incidence of Fires in the United States

Sara Markowitz
NBER Working Paper, December 2010

Fires and burns are among the top ten leading causes of unintentional death in the United States, with thousands of deaths occurring annually. The majority of these deaths and injuries occur in residential fires, and cigarettes have been identified as one of the leading causes of these fire-related deaths. In this paper, I explore the relationship between cigarette smoking and fires caused by cigarettes in the United States. As fewer people smoke, there is less opportunity for fires to start as a result of cigarettes. However, the magnitude of any reduction is in question as it is not obvious that the people who quit smoking are the ones who start fires. I also examine the contribution of tobacco-related public policies in influencing the incidence of cigarette-related fires. I use a state-level panel of reported fires over time to estimate both the structural and reduced form equations for cigarette fires. Results indicate that reductions in smoking and increases in cigarette prices are associated with fewer fires. However, laws regulating indoor smoking are associated with increases in some types of fires. Specifically, workplace restrictions and bans are associated with increases in fires in all locations and in residential units. Restaurant and bar bans are associated with increases in fires in restaurants and all eating/drinking establishments.


Inheritances, health and death

Beomsoo Kim & Christopher Ruhm
Health Economics, forthcoming

We examine how wealth shocks, in the form of inheritances, affect the mortality rates, health status and health behaviors of older adults, using data from eight waves of the Health and Retirement Survey. Our main finding is that bequests do not have substantial effects on health, although improvements in quality-of-life are possible. This absence occurs despite increases in out-of-pocket spending on healthcare and in the utilization of medical services, especially discretionary and non-lifesaving types such as dental care. Nor can we find a convincing indication of changes in lifestyles that offset the benefits of increased medical care. Inheritances are associated with higher alcohol consumption, but with no change in smoking or exercise and a possible decrease in obesity.


The Effect of an Early Education Program on Adult Health: The Carolina Abecedarian Project Randomized Controlled Trial

Peter Muennig et al.
American Journal of Public Health, forthcoming

Objectives: We explored whether a successful randomized controlled trial of early education, the Carolina Abecedarian Project (ABC), which enrolled infants from 1972 to 1977 at the Frank Porter Graham Child Development Institute in Chapel Hill, North Carolina, improved health outcomes and behaviors by 21 years of age.

Methods: ABC randomized 111 infants to receive an intensive early education program or nutritional supplements and parental counseling alone; participants have been followed to the present day. We examined the effect of ABC on health outcomes and behavioral risk factors when participants were aged 21 years, and then explored the mediators of this relationship.

Results: Relative to the control group, the ABC treatment group was previously found to have improved cognition and educational attainment. We found that the intervention also improved heath (P=.05) and health behaviors (P=.03) when participants were aged 21 years. These improvements in behaviors were not mediated by IQ, math and reading scores at 15 years of age, educational attainment, or health insurance.

Conclusions: Effective early education programs may improve health and reduce risky health behaviors in adulthood.


Longer Breastfeeding Is Associated with Increased Lower Body Explosive Strength during Adolescence

Enrique Artero et al.
Journal of Nutrition, November 2010, Pages 1989-1995

Our aim in this study was to examine the association between breastfeeding duration and cardiorespiratory fitness, isometric strength, and explosive strength during adolescence. A total of 2567 adolescents (1426 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study aged 12.5-17.5 y were included. Information about duration of any and exclusive breastfeeding was obtained retrospectively by means of a parental questionnaire. The 20-m shuttle run, handgrip strength, and standing long jump tests were used to assess physical fitness. Significant differences among the categories of breastfeeding duration were tested using ANCOVA after adjusting for a set of potential confounders: gestational and current age, birth weight, sexual maturation, fat mass, fat-free mass, maternal education, parental weight status, country, smoking behavior, and days of vigorous physical activity. Longer breastfeeding (either any or exclusive) was associated with a higher performance in the standing long jump test in both boys and girls (P < 0.001), regardless of fat mass, fat-free mass, and the rest of potential confounders. In adolescents who were breastfed for 3-5 mo or ≥6 mo, the risk of having a standing long jump performance below the 5th percentile was reduced by half compared with those who were never breastfed [odds ratio (OR) = 0.54, 95% CI = 0.30-0.96, P < 0.05; and OR = 0.40, 95% CI = 0.22-0.74, P < 0.01, respectively). These findings suggest a role of breastfeeding in determining lower body explosive strength during adolescence.


The Impact of Education on Health Knowledge

Duha Altindag, Colin Cannonier & Naci Mocan
Economics of Education Review, forthcoming

The theory on the demand for health suggests that schooling causes health because schooling increases the efficiency of health production. Alternatively, the allocative efficiency hypothesis argues that schooling alters the input mix chosen to produce health. This suggests that the more educated have more knowledge about the health production function and they have more health knowledge. This paper uses data from the 1997 and 2002 waves of the NLSY97 to conduct an investigation of the allocative efficiency hypothesis by analyzing whether education improves health knowledge. The survey design allows us to observe the increase in health knowledge of young adults after their level of schooling is increased by differential and plausibly exogenous amounts. Using nine different questions measuring health knowledge, we find weak evidence that an increase in education generates an improvement in health knowledge for those who ultimately attend college. For those with high school as the terminal degree, no relationship is found between education and health knowledge. These results imply that the allocative efficiency hypothesis may not be the primary reason for why schooling impacts health outcomes.


The Interaction of Personal and Parental Education on Health

Catherine Ross & John Mirowsky
Social Science & Medicine, forthcoming

The association between education and good health is well established, but whether the strength of the association depends on other social statuses is not. We test a theory of resource substitution which predicts a larger correlation between education and health (measured for physical impairment) for people who grew up in families with poorly educated parents than for those whose parents' were well educated. This is supported in the Aging, Status, and Sense of control (ASOC) survey, a representative national U.S. sample with data collected in 1995, 1998, and 2001. Some of the reason that parental education matters more to people who are poorly educated themselves is due to an unhealthy lifestyle, specifically to smoking and being overweight. Finally, as the poorly educated age, the negative health effects of their parents' low educational attainment get worse.


The health cost of living in a city: The case of France at the end of the 19th century

Lionel Kesztenbaum & Jean-Laurent Rosenthal
Explorations in Economic History, forthcoming

Despite a long standing debate over urban living conditions during industrialization, the impact of rural-urban migrations on health and mortality remains an open question. We observe both mortality and geographical mobility in a large longitudinal dataset of French males and show that rural-urban migrants benefited from clear advantages over those who already lived in the city. However, this benefit fades in a few years. Further we find no evidence of a spike in mortality among rural migrants as they encountered the more severe disease environment of cities, instead it seems their initially superior physical human capital was depleted over time.


Traffic Air Pollution and Oxidized LDL

Lotte Jacobs et al.
PLoS ONE, January 2011, e16200

Background: Epidemiologic studies indirectly suggest that air pollution accelerates atherosclerosis. We hypothesized that individual exposure to particulate matter (PM) derived from fossil fuel would correlate with plasma concentrations of oxidized low-density lipoprotein (LDL), taken as a marker of atherosclerosis. We tested this hypothesis in patients with diabetes, who are at high risk for atherosclerosis.

Methodology/Principal Findings: In a cross-sectional study of non-smoking adult outpatients with diabetes we assessed individual chronic exposure to PM by measuring the area occupied by carbon in airway macrophages, collected by sputum induction and by determining the distance from the patient's residence to a major road, through geocoding. These exposure indices were regressed against plasma concentrations of oxidized LDL, von Willebrand factor and plasminogen activator inhibitor 1 (PAI-1). We could assess the carbon load of airway macrophages in 79 subjects (58 percent). Each doubling in the distance of residence from major roads was associated with a 0.027 µm2 decrease (95% confidence interval (CI): -0.048 to -0.0051) in the carbon load of airway macrophages. Independently from other covariates, we found that each increase of 0.25 µm2 [interquartile range (IQR)] in carbon load was associated with an increase of 7.3 U/L (95% CI: 1.3 to 13.3) in plasma oxidized LDL. Each doubling in distance of residence from major roads was associated with a decrease of -2.9 U/L (95% CI: -5.2 to -0.72) in oxidized LDL. Neither the carbon load of macrophages nor the distance from residence to major roads, were associated with plasma von Willebrand factor or PAI-1.

Conclusions: The observed positive association, in a susceptible group of the general population, between plasma oxidized LDL levels and either the carbon load of airway macrophages or the proximity of the subject's residence to busy roads suggests a proatherogenic effect of traffic air pollution.


Are recessions good for everyone's health? The association between mortality and the business cycle by race/ethnicity in the US

Matias Fontenla, Fidel Gonzalez & Troy Quast
Applied Economics Letters, February 2011, Pages 207-212

This article studies the effect of the business cycle on the mortality rates of the major racial/ethnic groups in the USA. We use county-level data from 1999 to 2005 and employ a panel econometric approach that includes county- and year-fixed effects. We found that the mortality rates for whites and latinos are procyclical, i.e, that economic expansions (contractions) are associated with increases (decreases) in mortality. Moreover, the magnitude of this relationship is larger for latinos than for whites. However, we generally do not find a statistically significant relationship for blacks. Finally, the procyclical relationship for whites and latinos increases in magnitude as the county becomes less racially/ethnically diverse. Taken together, these findings suggest that the procyclical association identified in previous studies of the overall US population may vary by race and ethnicity.


Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes?

Zachary Cahn & Michael Siegel
Journal of Public Health Policy, February 2011, Pages 16-31

The issue of harm reduction has long been controversial in the public health practice of tobacco control. Health advocates have been reluctant to endorse a harm reduction approach out of fear that tobacco companies cannot be trusted to produce and market products that will reduce the risks associated with tobacco use. Recently, companies independent of the tobacco industry introduced electronic cigarettes, devices that deliver vaporized nicotine without combusting tobacco. We review the existing evidence on the safety and efficacy of electronic cigarettes. We then revisit the tobacco harm reduction debate, with a focus on these novel products. We conclude that electronic cigarettes show tremendous promise in the fight against tobacco-related morbidity and mortality. By dramatically expanding the potential for harm reduction strategies to achieve substantial health gains, they may fundamentally alter the tobacco harm reduction debate.


Time Does Not Heal All Wounds: Mortality Following the Death of a Parent

Mikael Rostila & Jan Saarela
Journal of Marriage and Family, February 2011, Pages 236-249

People linked through social ties are known to have interdependent health. Our aim was to investigate such collateral health effects in the context of offspring mortality after a parent's death in children aged 10-59 years. The data (N = 3,753,368) were from a linked-registers database that contains the total Swedish population. In minor children, we found elevations in mortality risks associated with a parent's death. Adult offspring experienced a reduced mortality risk recently after a parent's death, which over time approached, and in some instances even exceeded, that of the general population. Mother's death tended to have a stronger influence than father's death, unnatural parental deaths had a stronger effect than natural ones, and male offspring were more vulnerable than female offspring.


Education and Health in Late-life among High School Graduates: Cognitive versus Psychological Aspects of Human Capital

Pamela Herd
Journal of Health and Social Behavior, December 2010, Pages 478-496

Just as postsecondary schooling serves as a dividing line between the advantaged and disadvantaged on outcomes like income and marital status, it also serves as a dividing line between the healthy and unhealthy. Why are the better educated healthier? Human capital theory posits that education makes one healthier via cognitive (skill improvements) and noncognitive psychological resources (traits such as conscientiousness and a sense of mastery). I employ the Wisconsin Longitudinal Study (1957-2005) to test the relative strength of measures of cognitive human capital versus noncognitive psychological human capital in explaining the relationship between education and health outcomes among high school graduates. I find little evidence that noncognitive psychological human capital is a significant mediator, but find a relatively significant role for cognitive human capital, as measured by high school academic performance. It is not just higher educational attainment; academic performance is strongly linked to health in later life.


Changes in Compulsory Schooling and the Causal Effect of Education on Health: Evidence from Germany

Daniel Kemptner, Hendrik Jürges & Steffen Reinhold
Journal of Health Economics, forthcoming

In this paper we investigate the causal effect of years of schooling on health and health-related behavior in West Germany. We apply an instrumental variables approach using as natural experiments several changes in compulsory schooling laws between 1949 and 1969. These law changes generate exogenous variation in years of schooling both across states and over time. We find evidence for a strong and significant causal effect of years of schooling on long-term illness for men but not for women. Moreover, we provide somewhat weaker evidence of a causal effect of education on the likelihood of having weight problems for both sexes. On the other hand, we find little evidence for a causal effect of education on smoking behavior. Overall, our estimates suggest significant non-monetary returns to education with respect to health outcomes and not necessarily with respect to health-related behavior.


Quality of Life as Medicine: Interventions that Induce Salutogenesis. A Review of the Literature

Søren Ventegodt, Hatim Omar & Joav Merrick
Social Indicators Research, February 2011, Pages 415-433

This paper reviews the medical (salutogenic) effect of interventions that aim to improve quality of life. Review of studies where the global quality of life in chronically ill patients was improved independently of subjective and objective factors (like physical and mental health, yearly income, education, social network, self-esteem, sexual ability and problems or work). The methods used were subtypes of integrative medicine (non-drug CAM) like mind body medicine, body psychotherapy, clinical holistic medicine, consciousness-based medicine and sexology. In about 20 papers on QOL as medicine, in cancer, coronary heart disease, chronic pain, mental illness, sexual dysfunction, low self-esteem, low working ability and poor QOL, the most successful intervention strategy seems to be to create a maternal, infantile bonding induced by a combination of conversation therapy and bodywork. The papers examined the treatments of over 2,000 chronically ill or dysfunctional patients and more than 20 different types of health problems. Global QOL measured by SEQOL, QOL5, QOL1, self-rated physical health, self-rated mental health, self-rated sexual functioning, anorgasmia, genital pain, self-rated working ability, self-rated relation to self, well-being, life-satisfaction, happiness, fulfillment of needs, experience of temporal and spatial domains, expression of life's potentials, and objective functioning. We found "QOL as medicine" able in the treatment of physical disorders and illnesses including chronic pain (Number Needed to Treat (NNT) = 1-3, Number Needed to Harm (NNH) > 500), in mental illness (NNT = 1-3, NNH > 500), in sexual dysfunctions (NNT = 1-2, NNH > 1,000), self-rated low working ability (NNT = 2, NNH > 500), and self-rated low QOL (NNT = 2, NNH > 2,000). We found that QOL improving interventions helped or cured 30-90% of the patients, typically within one year, independent of the type of health problem. "QOL as medicine" seems to be able in improving chronic mental, somatic and sexual health issues without side effects.


Antibiotic Exposure by 6 Months and Asthma and Allergy at 6 Years: Findings in a Cohort of 1,401 US Children

Kari Risnes, Kathleen Belanger, William Murk & Michael Bracken
American Journal of Epidemiology, February 2011, Pages 310-318

Many studies have reported that antibiotic use may be associated with increased risk of childhood asthma. Respiratory tract infections in small children may be difficult to distinguish from early symptoms of asthma, and studies may have been confounded by "protopathic" bias, where antibiotics are used to treat early symptoms of asthma. These analyses of a cohort including 1,401 US children assess the association between antibiotic use within the first 6 months of life and asthma and allergy at 6 years of age between 2003 and 2007. Antibiotic exposure was associated with increased risk of asthma (adjusted odds ratio = 1.52, 95% confidence interval (CI): 1.07, 2.16). The odds ratio if asthma was first diagnosed after 3 years of age was 1.66 (95% CI: 0.99, 2.79) and, in children with no history of lower respiratory infection in the first year of life, the odds ratio was 1.66 (95% CI: 1.12, 3.46). The adverse effect of antibiotics was particularly strong in children with no family history of asthma (odds ratio = 1.89, 95% CI: 1.00, 3.58) (Pinteraction = 0.03). The odds ratio for a positive allergy blood or skin test was 1.59 (95% CI: 1.10, 2.28). The results show that early antibiotic use was associated with asthma and allergy at 6 years of age, and that protopathic bias was unlikely to account for the main findings.


High Frequency Hearing Sensitivity in Adolescent Females of a Lower Socioeconomic Status Over a Period of 24 Years (1985-2008)

Abbey Berg & Yula Serpanos
Journal of Adolescent Health, February 2011, Pages 203-208

Purpose: To examine annually over a period of 24 years, the high frequency hearing sensitivity in different groups of urban female adolescents with a low socioeconomic status (SES) and residential foster care.

Methods: Hearing screening (15 decibel [dB] hearing level ranging from 1,000 to 8,000 Hertz [Hz]) and threshold (>15 dB hearing level) records were obtained from 8,710 female adolescents (mean age, 15.8 years [range, 12-20 years]), predominantly Hispanic and African American from households with a low SES. Data related to the use of personal listening devices (PLDs), daily hours of usage, occurrence of tinnitus, and hearing thresholds between 1,000 and 8,000 Hz over an 8-year period (2001-2008) were obtained from the adolescents.

Results: High frequency hearing loss (HFHL) doubled over the 24-year period from 10.1% in 1985 to 19.2% in 2008. In comparison with the general adolescent population, this group of female adolescents presented with a higher percentage of bilateral mild or greater degrees of HFHL at two or more frequencies including 3,000, 4,000, and 6,000 Hz. Use of PLDs increased four-fold, from 18.3% (n = 68) in 2001 to 76.4% (n = 227) in 2008. Of the total number reporting tinnitus (n = 286), 99.7% (n = 285) also reported regular PLD use. A significant relationship was found between PLD use and reported tinnitus and HFHL irrespective of time of use of PLD.

Conclusions: Increased incidence of HFHL, reported tinnitus, PLD use, and hours of daily use in at-risk female adolescents of a low SES was found. A frequency interval of 3,000-6,000 Hz should be included in hearing screening protocols to identify potentially disabling hearing loss. Hearing conservation strategies need to be developed and/or modified that target and reach at-risk children and adolescents.


Lifting Boats Without Closing Gaps: Child Health Outcomes in Distressed US Cities From 1992-2002

Diana Silver et al.
American Journal of Public Health, February 2011, Pages 278-284

Objectives: We compared cause-specific mortality and birth rates for children and youths aged younger than 18 years in 100 US cities from 1992 through 2002.

Methods: We used 5 census indicators to categorize the 100 most populous US cities in 1990 as economically distressed or nondistressed. We used Poisson regression to calculate rate ratios for cause-specific mortality and birth rates, comparing distressed cities to nondistressed cities overall and by race/ethnicity from 1992 through 2002. We also calculated rates of change in these variables within each city over this period.

Results: Despite improvements in health for the study population in all cities, disparities between city groups held steady or widened over the study period. Gaps in outcomes between Whites and Blacks persisted across all cities. Living in a distressed city compounded the disparities in poor outcomes for Black children and youths.

Conclusions: A strong national economy during the study period may have facilitated improvements in health outcomes for children and youths in US cities, but these benefits did not close gaps between distressed and nondistressed cities.


Promoting Health (Implicitly)? A Longitudinal Content Analysis of Implicit Health Information in Cigarette Advertising, 1954-2003

Hye-Jin Paek, Leonard Reid, Hojoon Choi & Hyun Ju Jeong
Journal of Health Communication, October 2010, Pages 769-787

Tobacco studies indicate that health-related information in cigarette advertising leads consumers to underestimate the detrimental health effects of smoking and contributes to their smoking-related perceptions, beliefs, and attitudes. This study examined the frequencies and kinds of implicit health information in cigarette advertising across five distinct smoking eras covering the years 1954-2003. Analysis of 1,135 cigarette advertisements collected through multistage probability sampling of three popular consumer magazines found that the level of implicit health information (i.e., "light" cigarette, cigarette pack color, verbal and visual health cues, cigarette portrayals, and human model-cigarette interaction) in post-Master Settlement Agreement [MSA] era ads is similar to the level in ads from early smoking eras. Specifically, "light" cigarettes were frequently promoted, and presence of light colors in cigarette packs seemed dominant after the probroadcast ban era. Impressionistic verbal health cues (e.g., soft, mild, and refreshing) appeared more frequently in post-MSA era ads than in pre-MSA era ads. Most notably, a majority of the cigarette ads portrayed models smoking, lighting, or offering a cigarette to others. The potential impact of implicit health information is discussed in the contexts of social cognition and Social Cognitive Theory. Policy implications regarding our findings are also detailed.


Race, Ethnicity, Language, Social Class, and Health Communication Inequalities: A Nationally-Representative Cross-Sectional Study

Kasisomayajula Viswanath & Leland Ackerson
PLoS ONE, January 2011, e14550

Background: While mass media communications can be an important source of health information, there are substantial social disparities in health knowledge that may be related to media use. The purpose of this study is to investigate how the use of cancer-related health communications is patterned by race, ethnicity, language, and social class.

Methodology/Principal Findings: In a nationally-representative cross-sectional telephone survey, 5,187 U.S. adults provided information about demographic characteristics, cancer information seeking, and attention to and trust in health information from television, radio, newspaper, magazines, and the Internet. Cancer information seeking was lowest among Spanish-speaking Hispanics (odds ratio: 0.42; 95% confidence interval: 0.28-0.63) compared to non-Hispanic whites. Spanish-speaking Hispanics were more likely than non-Hispanic whites to pay attention to (odds ratio: 3.10; 95% confidence interval: 2.07-4.66) and trust (odds ratio: 2.61; 95% confidence interval: 1.53-4.47) health messages from the radio. Non-Hispanic blacks were more likely than non-Hispanic whites to pay attention to (odds ratio: 2.39; 95% confidence interval: 1.88-3.04) and trust (odds ratio: 2.16; 95% confidence interval: 1.61-2.90) health messages on television. Those who were college graduates tended to pay more attention to health information from newspapers (odds ratio: 1.98; 95% confidence interval: 1.42-2.75), magazines (odds ratio: 1.86; 95% confidence interval: 1.32-2.60), and the Internet (odds ratio: 4.74; 95% confidence interval: 2.70-8.31) and had less trust in cancer-related health information from television (odds ratio: 0.44; 95% confidence interval: 0.32-0.62) and radio (odds ratio: 0.54; 95% confidence interval: 0.34-0.86) compared to those who were not high school graduates.

Conclusions/Significance: Health media use is patterned by race, ethnicity, language and social class. Providing greater access to and enhancing the quality of health media by taking into account factors associated with social determinants may contribute to addressing social disparities in health.


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