American journal of preventive medicine
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Comparative Study
Correctness of racial coding of American Indians and Alaska Natives on the Washington State death certificate.
Underestimation of death rates for specific races can obscure health problems and impair the ability of public programs to prevent premature death and disability. For accurate race-specific death rates, the racial classification of both the population at risk and the decreased population must be accurately ascertained. However, studies suggest that the American Indian (AI) and Alaska Native (AN) races may be not be accurately recorded on the death certificate. ⋯ The percentage of American Indian ancestry was strongly associated with correct racial classification on the death certificate (P < .001). Birth in Washington State, membership in a large Washington State tribe, and death from an alcohol condition independently added to the likelihood of correct AI or AN racial classification. Persons who died from cancer were significantly less likely to be correctly coded as AI or AN on the death certificate.
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Comparative Study
Board certification among preventive medicine residency graduates: characteristics, advantages, and barriers.
In 1991, a mail survey was conducted of graduates (1979-1989) of general preventive medicine/public health (GPM/PH) residency programs to obtain information about the graduates' demographic characteristics, training, and present professional work. Specifically, we evaluated the survey data for percentage of graduates with board certification, advantages of board certification, and barriers to board certification in preventive medicine (PM). The survey response rate was 74% (797 of 1,070 graduates). ⋯ Reasons for not taking the board examination included the perception of limited benefit of board certification in current employment or professional endeavors, previous board certification in a clinical specialty, lack of a master of public health (MPH) degree, high cost and time commitment for the examination, and uncertainty about examination admission requirements. PM residency graduates with board certification in PM were more likely to be involved in public health and preventive medicine programs, devoted more time to administration and management, and earned more income than those PM residency graduates without PM board certification. Increasing the percentage of residency graduates who pursue PM board certification will require increasing the advantages of certification for practice, encouraging all residents to identify themselves as practicing the specialty of PM, and addressing the unique concerns of physicians who train both in PM and in a purely or primarily clinical specialty.
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We surveyed members of a recent master of public health (MPH) degree program to learn more about how, when, and why physicians and medical students decided to seek formal training in public health. We interviewed physicians and medical students to determine how and why these MPH students became involved in what they considered public health work; how and why they decided to attend public health school; and what their career plans were following completion of the degree program. All 47 medical students and physicians responded to the survey. ⋯ A personal contact directed 62% towards public health school. Those with previous public health work experience were more likely to pursue what they considered public health careers after completion of public health school than those without such previous work experience. The continuing need for qualified practitioners and leaders in public health challenges the medical community to characterize further those factors motivating medical students and physicians to formalize their training in public health.
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Comparative Study
Socioeconomic differences among people with AIDS: results from a Multistate Surveillance Project.
To characterize the socioeconomic status of persons with acquired immunodeficiency syndrome (AIDS), 11 U. S. state and city health departments interviewed 2,898 persons > or = 18 years of age reported with AIDS between June 1, 1990, and January 31, 1993. Among men who have sex with men, white men reported the lowest percentage (9%), and Central/South American (50%) and Mexican men (40%) reported the highest percentages not completing 12 years of school. ⋯ Overall, 77% of the men and 90% of the women were unemployed; we also found racial/ethnic differences by employment but to a lesser degree than differences in education. Among women, but not among men, differences in household income by race and ethnicity were marked; 76% of white and 91% of black female IDUs reported a household income of $10,000. Human immunodeficiency virus (HIV) prevention programs must be targeted toward the educational level of the populations served, and HIV services must adapt to the financial circumstances of their clientele.
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Comparative Study
Health promotion in primary care: The British perspective.
The structure of the British primary health care system allows for the development of a facilitator movement that can organize and encourage health care providers in local communities to coordinate health promotion efforts. We describe the Wycombe Primary Care Prevention Project to show how the facilitator movement can work in a local health district. The project's development and results to date demonstrate that the majority of primary care practices in the health district, departing from exclusive focus on individual care, now include community needs assessment and work on community-based health problems. We identify causative factors and discuss the generalizability of the project to other primary health care settings.