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The struggle for public health : seven people who saved the lives of millions and transformed the way we live
\"The fascinating stories of public health innovators who overcame immense obstacles to improve the health of millions.In the nineteenth century, the scourge of deadly infectious diseases permanently receded for the first time in human history. This progress was due in large part to advances in the public health field, including improved sanitation and cleaner water. Progress in health and longevity continued through the twentieth century, again thanks in part to public health advances in safer food, access to nursing care, an understanding of health disparities, reduced tobacco use, and a global network for vaccine distribution.In The Struggle for Public Health, Fred C. Pampel shares the stories of public health innovators who, over a period of 150 years, helped save lives and change the way we live. These engaging stories feature scientific discoveries, strong personalities, and new forms of social behavior. But these changes did not come without struggle: public health advances met vigorous resistance from vested interests in the status quo, attachment to deeply embedded but false beliefs, and the sheer difficulty of creating large-scale changes in public behavior. This well-researched and historically grounded volume chronicles the fascinating lives of seven advocates for public health progress, including a London bureaucrat who devoted his life to cleaning up filthy streets and neighborhoods, an activist nurse who provided first-rate care and health guidance to newly arrived immigrants, and the organizational genius who overcame limited funding, bureaucratic inertia, and political infighting to deliver vaccines across the world. The inspiring stories in The Struggle for Public Health offer insights on past advances and the potential for future solutions that could save lives and improve the quality of life for millions of people.This book features public health innovations developed by W.E.B. DuBois, Harvey Wiley, Lilian Wald, Edwin Chadwick, John Snow, Richard Doll, and D. A. Henderson\"-- Provided by publisher.
Book
Socioeconomic Disparities in Health Behaviors
The inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition have been well demonstrated empirically but encompass diverse underlying causal mechanisms. These mechanisms have special theoretical importance because disparities in health behaviors, unlike disparities in many other components of health, involve something more than the ability to use income to purchase good health. Based on a review of broad literatures in sociology, economics, and public health, we classify explanations of higher smoking, lower exercise, poorer diet, and excess weight among low-SES persons into nine broad groups that specify related but conceptually distinct mechanisms. The lack of clear support for any one explanation suggests that the literature on SES disparities in health and health behaviors can do more to design studies that better test for the importance of the varied mechanisms.
Journal Article
Cohort Changes in the Social Distribution of Tolerant Sexual Attitudes
Though many studies have described societal-wide changes in tolerance for sexual behaviors outside marriage, few have examined how the social distribution of tolerant attitudes has changed. A diffusion-of-innovations approach predicts nonlinear change in the distribution: high SES groups adopt the attitudes first, which produces a positive relationship, but diffusion to other SES groups subsequently weakens the association with SES. I test this argument using the General Social Survey from 1973 to 2014 to compare the SES determinants of attitudes toward premarital sex, extramarital sex, same-gender sex, and teenage sex across 86 cohorts born from around 1900 to 1985. Multilevel age, period, and cohort models support diffusion arguments concerning tolerance of premarital sex by demonstrating that the effects of indicators of SES first strengthen and then weaken across cohorts. Little support emerges for diffusion arguments concerning tolerance of extramarital sex and teenage sex, and preliminary but suggestive support emerges concerning tolerance of same-gender sex.
Journal Article
Trends in the Genetic Influences on Smoking
Using twin pairs from the National Survey of Midlife Development in the United States, we estimate that 35 percent of the variance in regular smoking is due to additive genetic influences. When we disaggregate the sample by birth cohort we witness strong genetic influences on smoking for those born in the 1920s, 1930s, and 1950s, but negligible influences for those born in the 1940s and 1960s. We show that the timing of the first Surgeon General's Report coincides with an increase in the genetic influences on regular smoking, but subsequent legislation prohibiting smoking in public places has significantly reduced these influences. These results are in line with existing gene-environment interaction theory, and we argue that variation in genetic influences across cohorts makes it difficult and potentially misleading to estimate genetic effects on health behaviors from data obtained from a single point in time.
Journal Article
Cross-National Sources of Health Inequality: Education and Tobacco Use in the World Health Survey
The spread of tobacco use from the West to other parts of the world, especially among disadvantaged socioeconomic groups, raises concerns not only about the indisputable harm to global health but also about worsening health inequality. Arguments relating to economic cost and diffusion posit that rising educational disparities in tobacco use—and associated disparities in health and premature mortality—are associated with higher national income and more advanced stages of cigarette diffusion, particularly among younger persons and males. To test these arguments, we use World Health Survey data for 99,661 men and 123,953 women from 50 low-income to upper-middle-income nations. Multilevel logistic regression models show that increases in national income and cigarette diffusion widen educational disparities in smoking among young persons and men but have weaker influences among older persons and women. The results suggest that the social and economic patterns of cigarette adoption across low-and middle-income nations foretell continuing, and perhaps widening, disparities in mortality.
Journal Article
Racial Convergence in Cigarette Use from Adolescence to the Mid-Thirties
Cigarette smoking by whites and African Americans shows puzzling age differences: An African American advantage during the teen years no longer appears in mid-adulthood. This study uses two data sets to examine whether the life-course change is real—and not due to misleading comparisons across different cohorts—and then whether the racial convergence is consistent with resource or stress arguments emphasizing, respectively, cessation among whites or late initiation among African Americans. First, multilevel growth models using data from the National Youth Survey—a prospective, longitudinal study of a randomly selected national sample of teens followed from ages 12 to 18 in 1977 to ages 26 to 34 in 1992—reveal that the racial convergence in smoking prevalence over the life course among this cohort is due primarily to greater white cessation. Second, consecutive cross-sectional samples of the National Health Survey replicate the broad patterns found in the NYS and show that convergence in smoking trajectories by race has strengthened over time. Together, the results most favor a resource explanation of the different life-course patterns of smoking among whites and African Americans.
Journal Article
The Varied Influence of SES on Environmental Concern
Objective. Cross-national studies have found positive relationships of socioeconomic status (SES) with environmental concern at the individual level but have not systematically examined how the relationships may differ across nations. Such comparisons have relevance to identifying the generality of theories of postmaterialism, affluence, and global environmentalism. Methods. This study specifies how the individual-level influence of SES varies across national contexts and tests predictions using four waves of the World Values Survey on up to 96 nations. Results. The results show that SES is associated only weakly with environmental concern in lower income nations with poor environmental conditions but is associated strongly and positively in higher income nations with better environmental conditions. Conclusion. SES has a contingent relationship with environmental concern such that the global environmentalism theory receives support for lower income nations, while the postmaterialism and affluence theories receive support for higher income nations.
Journal Article
Cohort Change, Diffusion, and Support for Environmental Spending in the United States
The long-standing and sometimes heated debates over the direction and size of the effect of socioeconomic status (SES) on environmental concern contrast post-materialist and affluence arguments, suggesting a positive relationship in high-income nations, with counter arguments for a negative or near zero relationship. A diffusion-of-innovations approach adapts parts of both arguments by predicting that high SES groups first adopt pro-environmental views, which produces a positive relationship. Like other innovations, however, environmentalism diffuses over time to other SES groups, which subsequently weakens the association. We test this argument using the General Social Survey from 1973 to 2008 to compare support for environmental spending across 83 cohorts born from around 1900 to 1982. In developing attitudes before, during, and after the emergence of environmentalism, varying cohorts provide the contrast needed to identify long-term changes in environmental concern. Multilevel age, period, and cohort models support diffusion arguments by demonstrating the effects, across cohorts, of three common indicators of SES - education, income and occupational prestige - first strengthen and then weaken. This finding suggests that diffusion of environmental concern first produces positive relationships consistent with postmaterialism arguments and later produces null or negative relationships consistent with global environmentalism arguments.
Journal Article
Racial and Ethnic Representation in Preventive Intervention Research: a Methodological Study
Individuals who are Asian or Asian American, Black or African American, Native American or American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and Hispanic or Latino (i.e., presently considered racial ethnic minoritized groups in the USA) lacked equal access to resources for mitigating risk during COVID-19, which highlighted public health disparities and exacerbated inequities rooted in structural racism that have contributed to many injustices, such as failing public school systems and unsafe neighborhoods. Minoritized groups are also vulnerable to climate change wherein the most severe harms disproportionately fall upon underserved communities. While systemic changes are needed to address these pervasive syndemic conditions, immediate efforts involve examining strategies to promote equitable health and well-being-which served as the impetus for this study. We conducted a descriptive analysis on the prevalence of culturally tailored interventions and reporting of sample characteristics among 885 programs with evaluations published from 2010 to 2021 and recorded in the Blueprints for Healthy Youth Development registry. Inferential analyses also examined (1) reporting time trends and (2) the relationship between study quality (i.e., strong methods, beneficial effects) and culturally tailored programs and racial ethnic enrollment. Two percent of programs were developed for Black or African American youth, and 4% targeted Hispanic or Latino populations. For the 77% of studies that reported race, most enrollees were White (35%) followed by Black or African American (28%), and 31% collapsed across race or categorized race with ethnicity. In the 64% of studies that reported ethnicity, 32% of enrollees were Hispanic or Latino. Reporting has not improved, and there was no relationship between high-quality studies and programs developed for racial ethnic youth, or samples with high proportions of racial ethnic enrollees. Research gaps on racial ethnic groups call for clear reporting and better representation to reduce disparities and improve the utility of interventions.
Journal Article
Common Methodological Problems in Randomized Controlled Trials of Preventive Interventions
Randomized controlled trials (RCTs) are often considered the gold standard in evaluating whether intervention results are in line with causal claims of beneficial effects. However, given that poor design and incorrect analysis may lead to biased outcomes, simply employing an RCT is not enough to say an intervention “works.” This paper applies a subset of the Society for Prevention Research (SPR) Standards of Evidence for Efficacy, Effectiveness, and Scale-up Research, with a focus on internal validity (making causal inferences) to determine the degree to which RCTs of preventive interventions are well-designed and analyzed, and whether authors provide a clear description of the methods used to report their study findings. We conducted a descriptive analysis of 851 RCTs published from 2010 to 2020 and reviewed by the Blueprints for Healthy Youth Development web-based registry of scientifically proven and scalable interventions. We used Blueprints’ evaluation criteria that correspond to a subset of SPR’s standards of evidence. Only 22% of the sample satisfied important criteria for minimizing biases that threaten internal validity. Overall, we identified an average of 1–2 methodological weaknesses per RCT. The most frequent sources of bias were problems related to baseline non-equivalence (i.e., differences between conditions at randomization) or differential attrition (i.e., differences between completers versus attritors or differences between study conditions that may compromise the randomization). Additionally, over half the sample (51%) had missing or incomplete tests to rule out these potential sources of bias. Most preventive intervention RCTs need improvement in rigor to permit causal inference claims that an intervention is effective. Researchers also must improve reporting of methods and results to fully assess methodological quality. These advancements will increase the usefulness of preventive interventions by ensuring the credibility and usability of RCT findings.
Journal Article