American journal of public health
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Historical Article
Meanings & motives. Experts debating tobacco addiction.
Over the last 50 years, tobacco has been excluded from and then included in the category of addictive substances. We investigated influences on these opposing definitions and their application in expert witness testimony in litigation in the 1990s and 2000s. A scientist with ties to the tobacco industry influenced the selection of a definition of addiction that led to the classification of tobacco as a "habituation" in the 1964 Surgeon General's Advisory Committee report. ⋯ Expert witnesses for tobacco companies used the 1964 report's definition until Philip Morris Tobacco Company publicly changed its position in 1997 to agree that nicotine was addictive. Expert witnesses for plaintiffs suing the tobacco industry used the 1988 report's definition, arguing that new definitions were superior because of scientific advance. Both sides viewed addiction as an objective entity that could be defined more or less accurately.
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Because the rate of consumption of away-from-home meals has increased dramatically, the distinction between requiring nutrition information for packaged but not restaurant products is no longer reasonable. Public health necessitates that nutrition labels must be included with restaurant menus as a strategy to educate consumers and address the escalation of obesity. ⋯ We discuss the public health rationale and set forth the government's legal authority for the enactment of menu-labeling laws. We further aim to educate the public health community of the potential legal challenges to such laws, and we set forth methods for governments to survive these challenges by drafting laws according to current legal standards.
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We examined trends in delivery of mental health and substance abuse services at the nation's community health centers. ⋯ Community health centers are playing an increasingly central role in providing mental health/substance abuse treatment services in the United States. It is critical both to ensure that these centers have adequate resources for providing mental health/substance abuse care and that they develop effective linkages with mental health/substance abuse clinicians in the communities they serve.
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The standard terminal age category in disease reporting in the United States has been 85 years and older since the 1940s, but the dramatically increasing share of the US population reaching this age has rendered the single category inadequate for surveillance, research, and analysis. Important age-specific variations in mortality among the oldest old are masked by the continued use of this category. Greater specificity in age-specific data for the oldest old would aid in disease surveillance and etiologic research and broaden awareness and understanding of human longevity.
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Comparative Study
Effects of enrollment in medicaid versus the state children's health insurance program on kindergarten children's untreated dental caries.
We compared levels of untreated dental caries in children enrolled in public insurance programs with those in nonenrolled children to determine the impact of public dental insurance and the type of plan (Medicaid vs State Children's Health Insurance Program [SCHIP]) on untreated dental caries in children. ⋯ Untreated tooth decay continues to be a significant problem for children with public insurance coverage. Children who participated in a separate SCHIP program had fewer untreated dental caries than did children enrolled in Medicaid.