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ObjectiveWe examined whether stable, county-level, voter preferences were significantly associated with county-level obesity prevalence using data from the 2012 US Presidential election. County voting preference for the 2012 Republican Party presidential candidate was used as a proxy for voter endorsement of personal responsibility approaches to reducing population obesity risk versus approaches featuring government-sponsored, multi-sectoral efforts like those recommended by the Centers for Disease Control Centers for Disease Control (CDC, 2009).MethodCartographic visualization and spatial analysis were used to evaluate the geographic clustering of obesity prevalence rates by county, and county-level support for the Republican Party candidate in the 2012 U.S. presidential election. The spatial analysis informed the spatial econometric approach employed to model the relationship between political preferences and other covariates with obesity prevalence.ResultsAfter controlling for poverty rate, percent African American and Latino populations, educational attainment, and spatial autocorrelation in the error term, we found that higher county-level obesity prevalence rates were associated with higher levels of support for the 2012 Republican Party presidential candidate.ConclusionFuture public health efforts to understand and reduce obesity risk may benefit from increased surveillance of this and similar linkages between political preferences and health risks.

The family background characteristics of 756 male heroin users were examined to determine the effects of selected family risk factors on the timing of onset of emancipation and drug use, on pre-addiction incarcerations and on educational attainment. These risk factors included family size, birth order, socioeconomic status, family drug use, parental history of alcoholism, parental absence, and family history of incarceration. The two measures of age of emancipation were age on leaving school and age on leaving home. Age of onset of regular use was measured for the following drugs: tobacco, alcohol, marijuana and heroin. Incarceration measures included the occurrence of juvenile detention and the time spent in prison prior to first addiction. Educational attainment was a score on a California State achievement test. Larger family size, higher birth order, parental alcoholism and parental absence were found to have a cumulatively negative effect on how young the respondents were when they first left home and when they first used particular drugs regularly, on their level of tested academic achievement, and on their probability of juvenile detention. Implications for social policies designed to prevent drug abuse are discussed.

Does quitting cigarette smoking help or hurt the polydrug user in treatment for drug use? Data were obtained from 407 polydrug users in 15 treatment centers in Los Angeles at baseline and one-year follow-up. Measures: Smoking status, reported drug use, urine test results, SF-36 scores, Hopkins SCL, ASI-alcohol use, -drug use, -psychiatric problems, and ad hoc employment-related problems. Results: Most respondents (95%) reported some lifetime smoking. Over one-year follow-up, 29% reported a change in smoking status. At follow-up, stable former smokers reported fewer psychiatric problems than stable current smokers. Change in smoking status was associated with reduced heroin use, but with increased psychiatric problems and employment-related problems. Stable former smokers consistently reported healthier outcomes than either stable regular smokers or status changers, as reflected in somatization, obsessive/compulsive behavior, depression, and anxiety scores. Conclusions: Long-term but not short-term abstinence from tobacco use in polydrug users undergoing treatment is associated with consistently more favorable health outcomes.

In an age of growing infrastructure needs and increasingly limited resources to meet those needs, governments at all levels must search for ways to close the resources gap, as is the case of wastewater treatment and the requirement to treat stormwater. Recent efforts to address water quality have focused on collaboration as a mechanism to achieve desired outcomes. This article traces the development and implementation of a mandated collaborative effort to address stormwater infiltration into the sanitary sewer system in the Hampton Roads, Virginia, area. We find that, unlike more traditional conceptions of collaboration, the consent order in place served to require the participants to work together to achieve positive outcomes. We conclude with some general thoughts about the use of mandated collaboration as a lens to understand collaborative processes in public works settings.

To better understand the contribution of cigarette smoking, and its changing role in lung cancer, this article provides an introduction to a special issue of Risk Analysis, which considers the relationship between smoking and lung cancer death rates during the period 1975–2000 for U.S. men and women aged 30–84 years. Six models are employed, which are part of a consortium of lung cancer modelers funded by National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET). Starting with birth‐cohort‐specific smoking histories derived from National Health Interview Surveys, three scenarios are modeled: Actual Tobacco Control (observed trends in smoking), Complete Tobacco Control (a counterfactual lower bound on smoking rates that could have been achieved had all smoking ceased after the first Surgeon General's report in 1964), and No Tobacco Control (a counterfactual upper bound on smoking rates if smoking patterns that prevailed before the first studies in the 1950s began to inform the public about the hazards of smoking). Using these three scenarios and the lung cancer models, the number and percentage of lung cancer deaths averted from 1975–2000, among all deaths that could have been averted if tobacco control efforts been immediate and perfect, can be estimated. The variability of the results across multiple models provides a measure of the robustness of the results to model assumptions and structure. The results provide not only a portrait of the achieved impact of tobacco control on lung cancer mortality, but also the bounds of what still needs to be achieved.

In this chapter we review the epidemiology of lung cancer incidence and mortality among never smokers/nonsmokers and describe the never smoker lung cancer risk models used by the Cancer Intervention and Surveillance Network (CISNET) modelers. Our review focuses on those influences likely to have measurable population impact on never smoker risk, such as secondhand smoke, even though the individual‐level impact may be small. Occupational exposures may also contribute importantly to the population attributable risk of lung cancer. We examine the following risk factors in this chapter: age, environmental tobacco smoke, cooking fumes, ionizing radiation including radon gas, inherited genetic susceptibility, selected occupational exposures, preexisting lung disease, and oncogenic viruses. We also compare the prevalence of never smokers between the three CISNET smoking scenarios and present the corresponding lung cancer mortality estimates among never smokers as predicted by a typical CISNET model.

Purpose. Describe and evaluate a media campaign to encourage 1% or nonfat milk consumption. Design. Uncontrolled pre/post test. Setting. One largely rural (Santa Paula) and one urban (East Los Angeles) California community. Subjects. Community residents and milk vendors in primarily low-income Latino/Hispanic communities. Intervention. The "1% or Less" milk campaign, which promotes substitution of 2% fat or whole milk with 1% or less fat milk was adapted and implemented. Measures. Comparison of post-campaign milk sales with pre-campaign sales. Analysis. Chi-square tests of independence used to compare precampaign and postcampaign sales. Results. There were decreases in the proportion of whole milk sold and increases in the proportion of reduced-fat, low-fat, and nonfat milk sold in the weeks following each campaign (Santa Paula: p = .0165; East Los Angeles: p < .0001). However, follow-up data from East Los Angeles suggest that these changes were not sustained. The proportions of the different units of milk sold also changed in the weeks following each campaign (p < .0001). Sales of whole milk gallon units decreased from 36.3% to 28.4% in Santa Paula, and from 43.5% to 10.2% in East Los Angeles. Conclusion. Highly focused campaigns to promote substitution of high-fat milk with low-fat or nonfat milk can show dramatic initial changes in sales patterns. However, whether such campaigns can have a sustained impact in largely Latino/Hispanic communities is not evident.

Afin de mieux comprendre la réticence chez beaucoup de travailleurs et de syndicats à appuyer les politiques antitabac et les programmes d'éducation sur les lieux de travail, les auteurs ont fait enquête auprès des membres d'un syndicat national de travailleurs dans des industries à haut risque. L'article présente les résultats de deux enquêtes. Quatre répondants sur dix se sont déclarés fumeurs, mais neuf sur dix fumeurs ont déclaré qu'ils aimeraient arrêter de fumer. Quoique les non-fumeurs ont montré une tendance plus forte à appuyer des restrictions antitabac sur les lieux de travail, trois sur quatre fumeurs ont aussi appuyé des restrictions. Le pourcentage des répondants qui appuyait la préoccupation de l'entreprise et du syndicat pour l'usage du tabac en dehors du milieu du travail et le pourcentage qui s'y opposait était à peu près égal. En général, les répondants qui croyaient que l'employeur et le syndicat travaillaient pour améliorer la santé et la sécurité au travail ont montré une tendance plus forte à appuyer des politiques antitabac. Les auteurs discutent des implications de ces résultats pour leurs hypothèses et pour les programmes d'éducation antitabac sur les lieux de travail.

BackgroundRacial/ethnic minority groups have higher risks for disease resulting from obesity.Community contextThe University of California, Los Angeles, and the Los Angeles County Department of Public Health partnered with community organizations to disseminate culturally targeted physical activity and nutrition-based interventions in worksites.MethodsWe conducted community dialogues with people from 59 government and nonprofit health and social service agencies to develop wellness strategies for implementation in worksites. Strategies included structured group exercise breaks and serving healthy refreshments at organizational functions. During the first 2 years, we subcontracted with 6 community-based organizations (primary partners) who disseminated these wellness strategies to 29 organizations within their own professional networks (secondary worksites) through peer modeling and social support. We analyzed data from the first 2 years of the project to evaluate our dissemination approach.OutcomePrimary partners had difficulty recruiting organizations in their professional network as secondary partners to adopt wellness strategies. Within their own organizations, primary partners reported significant increases in implementation in 2 of the 6 core organizational strategies for promoting physical activity and healthy eating. Twelve secondary worksites that completed organizational assessments on 2 occasions reported significant increases in implementation in 4 of the 6 core organizational strategies.InterpretationDissemination of organizational wellness strategies by trained community organizations through their existing networks (train-the-trainer) was only marginally successful. Therefore, we discontinued this dissemination approach and focused on recruiting leaders of organizational networks.