This paper describes some of our personal efforts to launch research projects that address public health issues of interest to geographers in the United States, Canada and Britain. In pressing these agendas we have found through our experiences that there are personal and disciplinary costs associated with activism. We describe the loss of identity with geography; the frustration of trying to persuade bench scientists, corporate representatives, and government officials of the importance of our work; the loss of research time and contact with both our academic colleagues and students.
OBJECTIVES: We examined the extent to which adolescents in Norway have been exposed to tobacco marketing despite an existing ban, and whether exposure is related to their current smoking or expectations they will smoke in the future. METHODS: Questionnaires were administered to nationally representative systematic samples of Norwegian youths aged 13 to 15 years in 1990 (n = 4282) and 1995 (n = 4065). RESULTS: About half in each cohort reported exposure to marketing. Youths reporting exposure were significantly more likely to be current smokers and to expect to be smokers at 20 years of age, after control for important social influence predictors. CONCLUSIONS: Adolescents' current smoking and future smoking expectations are linked to marketing exposure even in limited settings, suggesting the need for comprehensive controls to eliminate the function of marketing in promoting adolescent smoking.
Controversy persists about the most efficient allocation of healthcare funds for cardiovascular disease prevention. Previous economic analyses have generally focused on primary or secondary prevention as discrete categories.
To address the information required by decision-makers to distribute budgets optimally across an entire population at risk in view of recommendations promulgated by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III).
The Continuum of Risk Evaluation (CORE) model is an individual patient simulation of the occurrence of cardiovascular disease allowing for analyses over a broad range of risk. All events are tallied, costs are applied, and survival is modified accordingly. Disaggregated presentation of the results allows decision-makers to evaluate the budgetary implications and cost effectiveness of different strategies according to the risk at which treatment is initiated. This process is illustrated for the United States using information from the 1988-1994 National Health and Nutrition Examination Survey and pravastatin trials.
Secondary prevention with pravastatin costs dollar 2900 per life-year gained for men and dollar 1100 per life-year gained for women. Lowering the treatment threshold to incorporate primary prevention yields cost-effectiveness ratios that remain below dollar 25 000 per undiscounted life-year gained until a 10-year cardiovascular disease risk of 14.4%. Cost savings are possible for very high-risk patients.
The economic impact of an integrated approach to prevention of cardiovascular disease has not been thoroughly explored. CORE permits realistic analysis of policy decisions involving the entire continuum of risk rather than isolated consideration of specific disease stages, and thus provides a unique tool for assessing the full implications of treatment guidelines such as those of the NCEP ATP III.
Department of Social Pharmacy, Institute of Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100, Copenhagen Ø, Denmark. email@example.com
To explore how ethnic minorities at risk of vitamin D deficiency are constructed in Danish policy documents (current as of April 2009), regarding vitamin D supplementation.
Ten policy documents were analysed through content analysis, focusing on definitions and explanations of ethnic minorities being at risk of vitamin D deficiency. This formed the basis for an analysis of constructions of ethnic minorities at risk which was undertaken using the Social Construction of Technology (SCOT) theory as an organising framework.
The analysis showed a high degree of interpretative flexibility regarding how ethnic minorities are constructed as a risk group for vitamin D deficiency. The ten documents analysed revealed eight different constructions of the ethnic minorities groups at risk. A low degree of interpretative flexibility was found regarding the importance of skin colour and skin covering. Major disagreements were found regarding the importance attributed to the Islamic religion, other traditions, immigration, gender and age, and use of an evolutionary explanation for the increased risk.
Ethnic minorities at risk of vitamin D deficiency are constructed very differently in Danish policies current as of April 2009. A more precise definition of ethnic minorities in policies and research may be helpful in seeking to identify which ethnic minorities are and are not at risk of vitamin D deficiency.