Developing principles for health impact assessment.
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BACKGROUND: Policies and practice in many sectors affect health. Health impact assessment (HIA) is a way to predict these health impacts, in order to recommend improvements in policies to improve health. There has been debate about appropriate methods for this work. The Scottish Executive funded the Scottish Needs Assessment Programme to conduct two pilot HIAs and from these to develop guidance on HIA. METHODS: Case study 1 compared three possible future scenarios for developing transport in Edinburgh, based on funding levels. It used a literature review, analysis of local data and the knowledge and opinions of key informants. Impacts borne by different population groups.were compared using grids. Case study 2 assessed the health impacts of housing investment in a disadvantaged part of Edinburgh, using published literature, focus groups with community groups and interviews with professionals. RESULTS: Disadvantaged communities bore more detrimental effects from the low transport investment scenario, in the areas of: accidents; pollution; access to amenities, jobs and social contacts; physical activity; and impacts on community networks. The housing investment had greatest impact on residents' mental health, by reducing overcrowding, noise pollution, stigma and fear of crime. CONCLUSION: Although there is no single 'blueprint' for HIA that will be appropriate for all circumstances, key principles to inform future HIA were defined. HIA should be systematic; involve decision-makers and affected communities; take into account local factors; use evidence and methods appropriate to the impacts identified and the importance and scope of the policy; and make practical recommendations. (+info)
Independent predictors of breastfeeding intention in a disadvantaged population of pregnant women.
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BACKGROUND: Breastfeeding rates in Scotland are very low, particularly in the more disadvantaged areas. Despite a number of interventions to promote breastfeeding very few women actually intend to breastfeed their baby. The aim of this study was to identify personal and social factors independently associated with intention to breastfeed. METHODS: Nine hundred and ninety seven women from two socio-economically disadvantaged housing estates located on the outskirts of Glasgow participated in a study that aimed to increase the prevalence of breastfeeding. Self-administered questionnaires completed by each participant collected information in early pregnancy, prior to exposure to the study intervention, on feeding intention, previous feeding experience and socio-demographic data. RESULTS: Five factors were independently predictive of breastfeeding intention. These were previous breastfeeding experience, living with a partner, smoking, parity and maternal age. After adjusting for these five factors, neither deprivation nor receipt of milk tokens provided useful additional predictive information. CONCLUSION: In this population of socially disadvantaged pregnant women we identified five variables that were independently predictive of breastfeeding intention. These variables could be useful in identifying women at greatest risk of choosing not to breastfeed. Appropriate promotional efforts could then be designed to give due consideration to individual circumstances. (+info)
Giardiasis in children living in post-earthquake camps from Armenia (Colombia).
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BACKGROUND: An earthquake in the coffee growing region of Colombia on January 25, 1999 destroyed 70% of the houses in Armenia city. Transitory housing camps still remained until two years after the disaster. Parasitological studies found that, in this population, giardiasis was the most frequent parasitic infection. This study was carried out in order to determine the epidemiological risk factors associated with this high prevalence. METHODS: Fecal samples were obtained from 217 children aged between 3 and 13 years. Stool samples were studied by direct wet examination and stained with ferric hematoxilin for microscopical examination. Epidemiological data were collected by questionnaire and analyzed by using the Epi-info software (CDC, Atlanta 2001). RESULTS: Giardia cysts were observed in 60.4% of the samples presented and trophozoites in 4.6%. The following epidemiological and laboratory factors were significantly associated with Giardia infection: 1. Use of communal toilet (vs. individual toilet) OR: 3.9, CI95%: 1.2-16; 2. water provision by municipal ducts (vs. water provision by individual tanks) OR: 3.5, CI95% 1.1-14, and 3. presence of mucus in stool OR: 2.3, IC95%: 0.9-6.7. CONCLUSIONS: A high prevalence of giardiasis was found in children living in temporary houses after the 1999 earthquake in Armenia (Colombia). Giardiasis is an emerging disease in post-disaster situations and adequate prevention measures should be implemented during these circumstances. (+info)
America's affordable housing crisis: a contract unfulfilled.
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For many poor Americans, having a decent home and suitable living environment remains a dream. This lack of adequate housing is not only a burden for many of the poor, but it is harmful to the larger society as well, because of the adverse effects of inadequate housing on public health. Not only is the failure to provide adequate housing shortsighted from a policy perspective, but it is also a failure to live up to societal obligations. There is a societal obligation to meet the housing needs of everyone, including the most disadvantaged. Housing assistance must become a federally-funded entitlement. (+info)
Nontherapeutic research with children: Grimes v Kennedy Krieger Institute.
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Research with young children raises difficult issues of law and ethics. A recent Maryland case, Grimes v Kennedy Krieger Institute, Inc, appears to impose restrictive rules on research with children when the subjects are put at risk but cannot derive direct benefit from their involvement in the research project. This case exemplifies the tension that exists between the goal of science to increase knowledge and the protection of the rights and welfare of nonconsenting research subjects. While some language in the opinion may be difficult to understand or apply, for the most part the case reflects the problems other courts and ethicists have had in delineating the role of children in "nontherapeutic" research. (+info)
Risk and responsibility: ethics, Grimes v Kennedy Krieger, and public health research involving children.
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The legal case of Grimes v. Kennedy Krieger Institute, Inc, has raised concerns in the public health research community regarding the acceptable level of risk in research involving children, parental authority for informed consent, and exploitation of research subjects for the benefit of public health. We provide an overview of the case and discuss the impact of the court's decision and its possible effect on future research protection policies and practices. (+info)
Trend in the prevalence of overweight and obesity among urban African American hospital employees and public housing residents.
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INTRODUCTION: To help understand the impact of socioeconomic status, we examined the current prevalence and age-specific trend in overweight and obesity among two socioeconomically diverse groups of African Americans in the Washington, DC, area. MATERIALS AND METHODS: Data on height and weight were collected between March 1995 and December 1996 as a part of nutrition survey to develop a food frequency questionnaire. Gender-stratified multiple logistic regression analyses were used to examine factors related to the current prevalence of overweight and obesity. RESULTS: Three hundred nine African American public housing residents and 293 African American hospital employees participated in this survey. Overall, hospital workers and public housing residents differed significantly in the distribution of BMI (p = 0.003). Among men, the prevalence of overweight and obesity were 34.9% and 29.4% for hospital workers and 27.0% and 18.2% for public housing residents, respectively. For females these rates were 31.3% and 46.3% for hospital employees and 26.1% and 42.9% for public housing residents, respectively. CONCLUSION: Overweight and obesity were highly prevalent among all age and socioeconomic groups. Future research should focus on a more in-depth study of the relationship between socioeconomic status and the correlates of obesity among African-Americans, particularly women. (+info)
Building for the future: influence of housing on intelligence quotients of children in an urban slum.
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INTRODUCTION: Interventions on behalf of the marginalized in society can assume many formats. In an urban slum the Government of Delhi built one-room houses for some of the residents in what is termed a 'plot area'. Not all residents could be accommodated in the project and the remainder continued to live next door in shanty houses of the slum. Nineteen years later, young children who had migrated with their parents, have grown up and have children of their own. We looked at the development of the children living in the two types of accommodation. METHODS: A total of 373 children were studied. All children (n = 200) between the ages of 3.5 and 5.5 years in a cluster of five residential blocks in the plot area were studied. As a control, children in two large clusters of shanty houses (n = 173) were also studied. For development assessment the Central Institute of Education (CIE) Test was performed. This is an Indian adaptation of the Standford-Binet Test. Multiple regression analysis was utilized to determine the factors that influenced IQ most. RESULTS: The mean IQ of the children in the plot area was 92.5 (s.d. 13.38) and in the shanty houses 89.5 (s.d. 12.9) (p = 0.05). Analysis showed that the most significant factors affecting IQ were malnutrition in the first 6 months of life and attendance of the child at pre-school. For nutrition in the first 6 months, there was no difference between the groups. For attendance at pre-school, 110 of 200 in the plot area and 47 of 173 in the shanty houses were attending pre-school (p < 0.01). CONCLUSION: We find that children living in the permanent houses had a significantly better IQ than those in shanty houses. A review of the literature did not reveal a comparable study. (+info)