American journal of preventive medicine
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Although the relationship between diet and disease is well established, sustainable dietary changes that would affect risk for disease have been difficult to achieve. Whereas individual factors are traditional explanations for the inability of some people to change dietary habits, little research has investigated how the physical availability of healthy foods affects individuals' diets. This study examines the distribution of food stores and food service places by neighborhood wealth and racial segregation. ⋯ Without access to supermarkets, which offer a wide variety of foods at lower prices, poor and minority communities may not have equal access to the variety of healthy food choices available to nonminority and wealthy communities.
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Little data exist on the reliability of self-reported regular mammography use measures. We used data from two successive interviews of 892 women aged 50 to 74 years without a history of abnormal mammograms to investigate how consistently women report their lifetime number of mammograms. ⋯ Self-reported lifetime number of mammograms is a reasonably consistent measure for younger women or women with less mammography experience, but it is less reliable for women with long mammography histories. In these women, it may be useful to distinguish those who obtain regular screening from those who do not. Assessing reliability as well as validity for other measures of regular mammography use will allow additional measures to be identified.
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Most studies of immunization behaviors measure adherence to standard immunization practices, relying on surveys without linking reported behaviors to objectively measured immunization rates. This study attempts to close that gap. ⋯ Pediatricians have higher coverage rates than family/general practitioners. Although pediatricians see more children, the number of immunization-delayed children at 12 months is approximately the same for both provider groups. Therefore, efforts to improve coverage should continue to be directed toward both groups.
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Implementation of screening guidelines for domestic violence has been challenging. The multifaceted "systems model" may provide an effective means to improve domestic violence screening, identification, and intervention in the healthcare setting. ⋯ A systems model approach improved domestic violence services in a managed care health setting within 1 year and affected clinicians' behavior as well as health plan members' experience. This successful implementation makes it possible to address critical research questions about the impact of a healthcare intervention for victims of domestic violence in a managed healthcare setting.
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We examined levels of diabetes preventive care services and glycemic and lipid control among African Americans with diabetes in two North Carolina communities. ⋯ Levels of diabetes preventive care services were comparable to U.S. estimates, but glycemic and lipid control and levels of self-management behaviors were poor. These findings indicate a need to understand barriers to achieving and implementing good glycemic and lipid control among African Americans with diabetes.