Smoking, growing private hospital care for poor and US flu vaccine policies

Also, a community's ethnic diversity can influence on a woman's decision to smoke during pregnancy, according to another study in this JUH issue, which also includes reports on how private hospitals have surpassed public hospitals in caring for Medicaid patients, as well as on the effect of 2004-2005 influenza vaccine shortage on minority groups.

Influenza Vaccine Shortage Did Not Results in Racial Disparities in Inner City Health Centers

Despite fears that the 50 percent reduction in available flu vaccines in 2004-2005 would leave those with the greatest flu risk unprotected, that did not happen, according to an analysis by researchers from the University of Pittsburgh's School of Medicine and Graduate School of Public Health. In fact, the researchers conclude, the priority vaccination groups established by the Centers for Disease Control and Prevention (CDC) could serve as a model for establishing future priority vaccine groups in anticipation of a possible flu pandemic. The 2004-2005 flu shortage resulted when the U.S. Food and Drug Administration and British authorities suspended the license of one of only two manufacturers that provided the U.S. supply of inactivated influenza vaccine. The CDC stepped in and recommended that adults older than 65 and those with chronic health conditions, among other groups, should receive priority vaccination. In an analysis of vaccination rates among 288 patients 50 years old and older who used four inner city health centers, researchers found that the majority of patients (73 percent) between the ages of 50 and 64 and in good health did not get the vaccine during the shortage, while 64 percent of those age 65 and older were vaccinated. Furthermore, no racial discrimination in vaccination distribution resulted.

Better Health More Than Twice as Likely for Nonsmokers who Live and Work with Smoking Restrictions

Nonsmokers who live under both a total household and total workplace smoking ban are 2.61 times more likely to report better health status than those facing no smoking bans at work or home, according to first-of-its-kind study, which surveyed 1,472 Chinese American adults living in New York City. Even those with just a smoking ban at home fared better and were 1.90 times more likely to report better health status than those under no smoking bans. Before the New York City Clean Indoor Air Act, second-hand smoke exposure among this immigrant Chinese population at home and work was high, note the researchers. More private apartment buildings are enforcing smoking bans and public housing is considering adopting them. "Although these policies raise difficult ethical issues, this study provides additional support for aggressively promoting smoke free homes," said lead author Donna Shelley of the Department of Sociomedical Sciences at Columbia University's Mailman School of Public Health. In the new report, 43 percent of respondents report a total smoking ban at home and the workplace, 20 percent at work only, 22 percent at home only, and 15 percent report no smoking restriction at home or work.

Racial Diversity of Neighborhood Influences Decision to Smoke During Pregnancy for African-American Women

African-American women are 30 to 40 percent more likely to smoke during pregnancy if they live in areas of high segregation or low segregation compared to areas that are moderately segregated, according to researchers at the University of Washington. In highly segregated residential areas, the authors suggest, the higher smoking rates among pregnant black women may reflect less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products or limited access to smoking cessation treatment. In contrast, the higher smoking rates in highly integrated areas may reflect how exposure to harmful behaviors of the majority population can dilute the normally salutatory no-smoking habits of the African Americans. While just 10 percent of African American women smoke during pregnancy, compared to 16 percent of white women, this rate is well above the 1 percent goal for pregnant smokers put forward in the U.S. health agenda, Healthy People 2010. "Effective interventions to promote smoking cessation during pregnancy may require new approaches that consider the social environment," said lead author Janice Bell, PhD, post-doctoral Fellow in the School of Public Health and Community Medicine at the University of Washington. The analysis linked measures of segregation to birth certificates and 2000 U.S. census data in a sample of more than 400,000 African American women in 216 U.S. metro areas.

Private Urban Hospitals Surpass Public Hospitals in Caring for Medicaid Patients

Private, for-profit urban hospitals far surpassed public hospitals in caring for patients on Medicaid, the federal-state insurance program for the poor, between 1996 and 2002, investigators from Drexel University School of Public Health discovered. During those years, hospital closures were highest in the poorest suburban areas.
Medicaid admissions in city for-profit and non-profit hospitals rose 39 percent and 17 percent respectively over these years, while falling by more than 21 percent in public hospitals, researchers found. They also found that as the number of hospitals decline, there are growing disparities between hospitals in rich and poor suburbs, with hospitals in richer areas receiving a highly disproportionate share of basic and high-tech services. Usage and availability of PET scans for residents in the wealthiest suburbs, for example, were generally double that for residents living in the poorest suburbs. -New York Academy of Medicine