Preventing Chronic Disease Dialogue

PEER REVIEWED

Garry Egger, PhD, MPH

Suggested citation for this article: Egger G. In Search of a Germ Theory Equivalent for Chronic Disease. Prev Chronic Dis 2012;9:110301. DOI: http://dx.doi.org/10.5888/pcd9.110301.

Abstract

The fight against infectious disease advanced dramatically with the consolidation of the germ theory in the 19th century. This focus on a predominant cause of infections (ie, microbial pathogens) ultimately led to medical and public health advances (eg, immunization, pasteurization, antibiotics). However, the resulting declines in infections in the 20th century were matched by a rise in chronic, noncommunicable diseases, for which there is no single underlying etiology. The discovery of a form of low-grade systemic and chronic inflammation (“metaflammation”), linked to inducers (broadly termed “anthropogens”) associated with modern man-made environments and lifestyles, suggests an underlying basis for chronic disease that could provide a 21st-century equivalent of the germ theory.

PEER REVIEWED

Xiao-Jun Wen, MD; Dafna Kanny, PhD; William W. Thompson, PhD; Catherine A. Okoro, MS; Machell Town, MS; Lina S. Balluz, ScD, MPH

Suggested citation for this article: Wen XJ, Kanny D, Thompson WW, Okoro CA, Town M, Balluz LS. Binge drinking intensity and health-related quality of life among US adult binge drinkers. Prev Chronic Dis 2012;9:110204. DOI: http://dx.doi.org/10.5888/pcd9.110204.

Abstract

Introduction

Binge drinking (men, ≥5 drinks, women, ≥4 on an occasion) accounts for more than half of the 79,000 annual deaths due to excessive alcohol use in the United States. The frequency of binge drinking is associated with poor health-related quality of life (HRQOL), but the association between binge drinking intensity and HRQOL is unknown. Our objective was to examine this association.

Methods

We used 2008-2010 Behavioral Risk Factor Surveillance System data and multivariate linear regression models to examine the association between binge drinking intensity (largest number of drinks consumed on any occasion) among US adult binge drinkers and 2 HRQOL indicators: number of physically and mentally unhealthy days.

Results

Among binge drinkers, the highest-intensity binge drinkers (women consuming ≥7 drinks and men consuming ≥8 drinks on any occasion) were more likely to report poor HRQOL than binge drinkers who reported lower levels of intensity (women who consumed 4 drinks and men who consumed 5 drinks on any occasion). On average, female binge drinkers reported more physically and mentally unhealthy days (2.8 d and 5.1 d, respectively) than male binge drinkers (2.5 d and 3.6 d, respectively). After adjustment for confounding factors, women who consumed ≥7 drinks on any occasion reported more mentally unhealthy days (6.3 d) than women who consumed 4 drinks (4.6 d). Compared with male binge drinkers across the age groups, female binge drinkers had a significantly higher mean number of mentally unhealthy days.

Conclusion

Our findings underscore the importance of implementing effective population-level strategies to prevent binge drinking and improve HRQOL.

ESSAY

Amanda K. Hall, MHSE, MS; Michael Stellefson, PhD; Jay M. Bernhardt, PhD, MPH

Suggested citation for this article: Hall AK, Stellefson M, Bernhardt JM. Healthy Aging 2.0: the potential of new media and technology. Prev Chronic Dis 2012;9:110241. DOI: http://dx.doi.org/10.5888/pcd9.110241.

Introduction

The emergence of e-patients (consumers who use the Internet and electronic communication tools to research and communicate about medical conditions) has spawned the era of “Healthy Aging 2.0” to support chronic disease management. Approximately 125 million Americans are living with 1 or more chronic diseases, and this number is expected to grow to 157 million by 2020 (1). Approximately 84% of adults who are aged 65 or older have 1 or more chronic conditions (1). Healthy Aging 2.0 proposes that 21st century information and communications technology offers public health practitioners the unique opportunity to empower, engage, and educate these older adults in chronic disease management.

SPECIAL TOPIC

Heather Schacht Reisinger, PhD; Stephen C. Hunt, MD, MPH; A. Lucile Burgo-Black, MD; Madhulika A. Agarwal, MD, MPH

Suggested citation for this article: Reisinger HS, Hunt SC, Burgo-Black AL, Agarwal MA. A population approach to mitigating the long-term health effects of combat deployments. Prev Chronic Dis 2012;9:110116. DOI: http://dx.doi.org/10.5888/pcd9.110116.

PEER REVIEWED

Abstract

A major focus of the mission of the US Department of Veterans Affairs (VA) is to respond to the needs of military personnel returning from war. Given the broad spectrum of the potential effects of combat deployment on the health and well being of service members, VA is increasingly oriented toward comprehensive postcombat support, health promotion, disease prevention, and proactive approaches to caring for combat veterans. This article briefly summarizes the health care needs of service members returning from Afghanistan and Iraq, describes VA’s approaches to addressing their needs, and outlines VA’s evolving vision for how to apply principles of population health management to ensure prompt and effective response to the postdeployment needs of veterans returning from future conflicts. At the heart of postcombat care will be population-based approaches oriented to health recovery using interdisciplinary, team-based platforms.

ORIGINAL RESEARCH

Erika R. Cheng, MPA; David A. Kindig, MD, PhD

Suggested citation for this article: Cheng ER, Kindig DA. Disparities in premature mortality between high- and low-income US counties. Prev Chronic Dis 2012;9:110120. DOI:
http://dx.doi.org/10.5888/pcd9.110120.

PEER REVIEWED

Abstract

Introduction

Several well-established determinants of health are associated with premature mortality. Using data from the 2010 County Health Rankings, we describe the association of selected determinants of health with premature mortality among counties with broadly differing levels of income.

Methods

County-level data on 3,139 US counties from the 2010 County Health Rankings were linked to county mortality data from the Centers for Disease Control and Prevention Compressed Mortality database. We divided counties into 3 groups, defined by sample median household income levels: low-income (≤25th percentile, $29,631), mid-income (25th-75th percentile, $29,631-$39,401), and high-income (≥75th percentile, ≥$39,401). We analyzed group differences in geographic, sociodemographic, racial/ethnic, health care, social, and behavioral factors. Stratified multivariable linear regression explored the associations of these health determinants with premature mortality for high- and low-income groups.

Results

The association between income and premature mortality was stronger among low-income counties than high-income counties. We found differences in the pattern of risk factors between high- and low-income groups. Significant geographic, sociodemographic, racial/ethnic, health care, social, and behavioral disparities exist among income groups.

Conclusion

Geographic location and the percentages of adult smokers and adults with a college education were associated with premature mortality rates in US counties. These relationships varied in magnitude and significance across income groups. Our findings suggest that population health policies aimed at reducing mortality disparities require an understanding of the socioeconomic context within which modifiable variables exist.

ORIGINAL RESEARCH

Pamela Samson, MS; Kenneth R. Casey, MD, MPH; James Knepler, MD; Ralph
J. Panos, MD

Suggested citation for this article: Samson P,
Casey KR, Knepler J, Panos RJ. Clinical characteristics, comorbidities, and
response to treatment of veterans with obstructive sleep apnea, Cincinnati
Veterans Affairs Medical Center, 2005-2007. Prev Chronic Dis 2012;9:110117.
DOI:

http://dx.doi.org/10.5888/pcd9.110117.

PEER REVIEWED

Abstract

Introduction

Obstructive sleep apnea (OSA) is a common disorder that is associated with
significant morbidity. Veterans may be at an elevated risk for OSA because of
increased prevalence of factors associated with the development and progression
of OSA. The objective of this study was to determine the clinical
characteristics, comorbidities, polysomnographic findings, and response to
treatment of veterans with OSA.

Methods

We performed a retrospective chart review of 596 patients undergoing
polysomnography at the Cincinnati Veterans Affairs Medical Center from February
2005 through December 2007. We assessed potential correlations of clinical data
with polysomnography findings and response to treatment.

Results

Polysomnography demonstrated OSA in 76% of patients; 30% had mild OSA, 23%
moderate OSA, and 47% severe OSA. Increasing body mass index, neck
circumference, Epworth Sleepiness Scale score, hypertension, congestive heart
failure, and type 2 diabetes correlated with increasing OSA severity. Positive
airway pressure treatment was initiated in 81% of veterans with OSA, but only
59% reported good adherence to this treatment method. Of the patients reporting
good adherence, a greater proportion of those with severe OSA (27%) than with
mild or moderate disease (0%-12%) reported an excellent response to treatment.

Conclusion

The prevalence of metabolic and cardiovascular comorbidities increased with
increasing OSA severity. Only 59% of treated patients reported good adherence to
treatment with positive airway pressure, and response to treatment correlated
with OSA severity.

ORIGINAL RESEARCH

Jamison Fargo, PhD, MS; Stephen Metraux, PhD; Thomas Byrne, MSW; Ellen Munley; Ann Elizabeth Montgomery, PhD; Harlan Jones; George Sheldon, PhD; Vincent Kane, MSW; Dennis Culhane, PhD

Suggested citation for this article: Fargo J,
Metraux S, Byrne T, Munley E, Montgomery AE, Jones H, et al. Prevalence and
risk of homelessness among US veterans. Prev Chronic Dis 2012;9:110112. DOI:
http://dx.doi.org/10.5888/pcd9.110112.

PEER REVIEWED

Abstract

Introduction

Understanding the prevalence of and risk for homelessness among veterans is
prerequisite to preventing and ending homelessness among this population.
Homeless veterans are at higher risk for chronic disease; understanding the
dynamics of homelessness among veterans can contribute to our understanding of
their health needs.

Methods

We obtained data on demographic characteristics and veteran status for 130,554
homeless people from 7 jurisdictions that provide homelessness services, and for
the population living in poverty and the general population from the American
Community Survey for those same jurisdictions. We calculated prevalence of
veterans in the homeless, poverty, and general populations, and risk ratios (RR)
for veteran status in these populations. Risk for homelessness, as a function of
demographic characteristics and veteran status, was estimated by using multivariate
regression models.

Results

Veterans were overrepresented in the homeless population, compared with both the
general and poverty populations, among both men (RR, 1.3 and 2.1, respectively)
and women (RR, 2.1 and 3.0, respectively). Veteran status and black race
significantly increased the risk for homelessness for both men and women. Men in
the 45- to 54-year-old age group and women in the 18- to 29-year-old age group
were at higher risk compared with other ages.

Conclusion

Our findings confirm previous research associating veteran status with higher
risk for homelessness and imply that there will be specific health needs among
the aging homeless population. This study is a basis for understanding variation
in rates of, and risks for, homelessness in general population groups, and
inclusion of health data from US Department of Veterans Affairs records can
extend these results to identifying links between homelessness and health risks.

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ORIGINAL RESEARCH

Brent A. Langellier, MA

Suggested citation for this article: Langellier BA. The food environment and student weight status, Los Angeles County, 2008-2009. Prev Chronic Dis 2012;9:110191. DOI:
http://dx.doi.org/10.5888/pcd9.110191.

PEER REVIEWED

Abstract

Introduction

One factor believed to affect overweight status is the food environment, or the distribution of outlets that serve healthful or unhealthful foods in residential areas, workplaces, and schools. Few studies have investigated the association between the food environment and the prevalence of overweight among children and adolescents. The objective of this study was to investigate the association between the distribution of corner stores and fast food restaurants around Los Angeles County public
schools and the prevalence of overweight among students.

Methods

Hierarchical linear models were used to assess the association between the presence of corner stores or fast food restaurants within a half-mile of Los Angeles County schools (N = 1,694) and overweight prevalence among students in grades 5, 7, and 9.

Results

The presence of corner stores and fast food restaurants varied significantly by schools’ racial/ethnic composition, Title 1 eligibility, and rural/suburban vs urban location. After adjustment for other factors, overweight prevalence was 1.6 percentage points
higher at majority-Latino schools that had at least 1 corner store within a half-mile than at majority-Latino schools that did not have a corner store within a half-mile. The association between corner stores and overweight
prevalence varied significantly between majority-Latino schools and schools that were majority-white or that had no racial/ethnic majority. The presence of fast food restaurants within a half-mile of schools was not associated with overweight prevalence among students.

Conclusion

This study underscores the importance of interventions that seek to improve the healthfulness of corner store inventories and of student purchases.

Michelle O’Hegarty, PhD, Linda L. Pederson, PhD, Gayane Yenokyan, MD, MPH, David Nelson, MD, MPH, Pascale Wortley, MD, MPH

Suggested citation for this article: O’Hegarty M, Pederson LL, Yenokyan G, Nelson D, Wortley P. Young adults’ perceptions of cigarette warning labels in the United States and Canada. Prev Chronic Dis [serial online] 2007
Apr [date cited]. Available from:
http://www.cdc.gov/pcd/issues/2007/
apr/06_0024.htm.  

PEER REVIEWED  

Abstract

Introduction 

For the past 20 years, there have been no changes to the text-only cigarette warning labels in the United States. During this same time period, other countries placed large graphic warning labels on cigarette packages. The purpose of this study was to investigate the reactions of
U.S. young adult smokers and nonsmokers aged 18 to 24 years to Canadian cigarette label
text and graphic warnings. The study focused on determining their perceptions and
the potential impact of Canadian labels on smoking, and study participants were asked for suggestions for modifications of U.S. cigarette warning labels so they would be effective for smoking deterrence and cessation.  

Methods 

During January and February 2002, 11 focus groups consisting of 54 smokers and 41 nonsmokers were conducted in the Detroit metropolitan area. Current smokers were defined as those who had smoked a cigarette within the past 30 days. Participants were asked about their knowledge and perceptions of current U.S. cigarette warning labels and their impressions of Canadian cigarette warning
labels.  

Analysis 

A content analysis and a word index were
applied to the transcripts of all focus groups to identify and clarify
themes and domains that appeared in group discussions and to compare results
across different groups.  

Results 

Focus group participants reported that Canadian cigarette warning labels were
more visible and informative than U.S. cigarette warning labels. Messages
perceived to be relevant to smokers were considered effective. Education level
did not appear related to how participants responded to warning labels. There
were some differences for warning labels that had sex-specific messages.  

Discussion 

Warning labels are one component of comprehensive tobacco control and smoking cessation efforts. Stronger warnings on cigarette packages need to be part of a larger U.S. public health educational effort. 

Christina D. Williams, PhD, MPH; Brian M. Whitley, MD; Cathrine Hoyo, PhD, MPH; Delores J. Grant, PhD; Gary G. Schwartz, PhD; Joseph C. Presti, Jr, MD; Jared D. Iraggi; Kathryn A. Newman; Leah Gerber; Loretta A. Taylor; Madeline G. McKeever; Stephen J. Freedland, MD

Suggested citation for this article: Williams CD, Whitley BM, Hoyo C, Grant DJ, Schwartz GG, Presti JC Jr, et al. Dietary calcium and risk for prostate cancer: a case-control study among US veterans. Prev Chronic Dis 2012;9:110125. DOI: http://dx.doi.org/10.5888/pcd9.110125.

PEER REVIEWED

Abstract

Introduction

The objective of this study was to examine the association between calcium
intake and prostate cancer risk. We hypothesized that calcium intake would be
positively associated with lower risk for prostate cancer.

Methods

We used data from a case-control study conducted among veterans between 2007 and
2010 at the Durham Veterans Affairs Medical Center. The study consisted of 108
biopsy-positive prostate cancer cases, 161 biopsy-negative controls, and 237
healthy controls. We also determined whether these associations differed for
blacks and whites or for low-grade (Gleason score <7) and high-grade prostate
cancer (Gleason score ≥7). We administered the Harvard food frequency
questionnaire to assess diet and estimate calcium intake. We used logistic
regression models to obtain odds ratios (ORs) and 95% confidence intervals (CIs).

Results

Intake of calcium from food was inversely related to risk for prostate cancer
among all races in a comparison of cases and biopsy-negative controls (P =
.05) and cases and healthy controls (P = .02). Total calcium was
associated with lower prostate cancer risk among black men but not among white
men in analyses of healthy controls. The highest tertile of calcium from food
was associated with lower risk for high-grade prostate cancer in a comparison of
high-grade cases and biopsy-negative controls (OR, 0.37; 95% CI, 0.15-0.90) and
high-grade cases and healthy controls (OR, 0.38; 95% CI, 0.17-0.86).

Conclusion

Calcium from food is associated with lower risk for prostate cancer,
particularly among black men, and lower risk for high-grade prostate cancer
among all men.