Background:  Colour vision deficiency (CVD) has a high prevalence and is often a handicap in everyday life. Those who have CVD will be better able to adapt and make more informed career choices, if they know about their deficiency. The fact that from 20 to 30 per cent of adults with abnormal colour vision do not know they have CVD suggests that colour vision is not tested as often as it should be. This may be because of practitioner uncertainty about which tests to use, how to interpret them and the advice that should be given to patients on the basis of the results. The purpose of this paper is to recommend tests for primary care assessment of colour vision and provide guidance on the advice that can be given to patients with CVD. Methods:  The literature on colour vision tests and the relationship between the results of the tests and performance at practical colour tasks was reviewed. Results:  The colour vision tests that are most suitable for primary care clinical practice are the Ishihara test, the Richmond HRR 4th edition 2002 test, the Medmont C‐100 test and the Farnsworth D15 test. These tests are quick to administer, give clear results and are easy to interpret. Tables are provided summarising how these tests should be interpreted, the advice that can be given to CVD patients on basis of the test results, and the occupations in which CVD is a handicap. Conclusion:  Optometrists should test the colour vision of all new patients with the Ishihara and Richmond HRR (2002) tests. Those shown to have CVD should be assessed with the Medmont C‐100 test and the Farnsworth D15 test and given appropriate advice based on the test results.

Context: Commercial marketing is a critical but understudied element of the sociocultural environment influencing Americans' food and beverage preferences and purchases. This marketing also likely influences the utilization of goods and services related to physical activity and sedentary behavior. A growing literature documents the targeting of racial/ethnic and income groups in commercial advertisements in magazines, on billboards, and on television that may contribute to sociodemographic disparities in obesity and chronic disease risk and protective behaviors. This article examines whether African Americans, Latinos, and people living in low-income neighborhoods are disproportionately exposed to advertisements for high-calorie, low nutrient-dense foods and beverages and for sedentary entertainment and transportation and are relatively underexposed to advertising for nutritious foods and beverages and goods and services promoting physical activities. Methods:Outdoor advertising density and content were compared in zip code areas selected to offer contrasts by area income and ethnicity in four cities: Los Angeles, Austin, New York City, and Philadelphia.

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Aim:The Hardy-Rand-Rittler (HRR) pseudoisochromatic test for colour vision is highly regarded but has long been out of print. Richmond Products produced a new edition in 2002 that has been re-engineered to rectify shortcomings of the original test. This study is a validation trial of the new test using a larger sample and different criteria of evaluation from those of the previously reported validation study. Methods: The Richmond HRR test was given to 100 consecutively presenting patients with abnormal colour vision and 50 patients with normal colour vision. Colour vision was diagnosed using the Ishihara test, the Farnsworth D15 test, the Medmont C-100 test and the Type 1 Nagel anomaloscope. Results: The Richmond HRR test has a sensitivity of 1.00 and a specificity of 0.975 when the criterion for failing is two or more errors with the screening plates. Sensitivity and specificity become 0.98 and 1.0, respectively, when the fail criterion is three or more errors. Those with red-green colour vision deficiency were correctly classified as protan or deutan on 86 per cent of occasions, with 11 per cent unclassified and three per cent incorrectly classified. All those graded as having a 'mild' defect by the Richmond HRR test passed the Farnsworth D15 test and had an anomaloscope range of 30 or less. Not all dichromats were classified as 'strong', which was one of the goals of the re-engineering and those graded as 'medium' and 'strong' included dichromats and those who have a mild colour vision deficiency based on the results of the Farnsworth D15 test and the anomaloscope range. Conclusions:The test is as good as the Ishihara test for detection of the red-green colour vision deficiencies but unlike the Ishihara, also has plates for the detection of the tritan defects. Its classification of protans and deutans is useful but the Medmont C-100 test is better. Those graded as 'mild' by the Richmond HRR test can be regarded as having a mild colour vision defect but a 'medium' or 'strong' grading needs to be interpreted in conjunction with other tests such as the Farnsworth D15 and the anomaloscope. The Richmond HRR test could be the test of choice for clinicians who wish to use a single test for colour vision.

Health impact assessment (HIA)-a combination of methods to examine formally the potential health effects of a proposed policy, program, or project-has received considerable interest over the past decade internationally as a practical mechanism for collaborating with other sectors to address the environmental determinants of health and to achieve more effectively the goals of population health promotion. Demand for HIA in the United States seems to be growing. This review outlines the common principles and methodologies of HIA and compares different approaches to HIA. Lessons learned from the related field of environmental impact assessment and from experience with HIA in other countries are examined. Possible avenues for advancing both the field and the broader goals of population health promotion are outlined. HIA AS A NEW TOOL FOR AN OLD WAY OF DOING PUBLIC HEALTHFrom the time of Hippocrates public health practitioners have looked to the environment to identify the causes of ill health and for potential opportunities to advance well being. The seminal "Report on a General Plan for the Promotion of Public and Personal Health" to the Massachusetts legislature, authored by Lemuel Shattuck (69) in the mid nineteenth century, and the writings of Rudolf Virchow (72, p. 72) in that same century suggest a continuing recognition of the centrality of social and physical environmental effects on health. Snow's apocryphal removal of well pump handles to stem an outbreak of cholera, Gorgas' efforts to control yellow fever and malaria during the building of the Panama Canal, the dramatic improvements in motor vehicle safety in the United States as a result of improved vehicle standards and roadway infrastructure, and reductions in tobacco use over the past several decades demonstrate the potential of an environmental approach for improving public health. Although a more individualistic approach, emphasizing biomedical and behavioral paradigms, has frequently dominated the field since the mid-twentieth century (72), concern about the environmental determinants of disease remains a vital principal of public health (45). Over the past quarter century the World Health Organization has set forth a number of major declarations and initiatives calling for a return to an environmental approach to improving population health, including the Alma Ata Declaration (82), the Ottawa Charter on Health Promotion (82a), the Jakarta Declaration on Health Promotion (83), the Bangkok Charter for Health Promotion (86), and the Healthy Cities movement (5). Similar declarations have been made at the national level, including most significantly the Lalonde Report (39) in Canada and the Acheson Report (2) in the United Kingdom. Because the ability to modify many of the environmental determinants of disease lies outside the traditional province of public health agencies, intersectoral cooperation in creating healthy public policy (46) has been a common theme throughout these declarations and initiatives. Questions remain, however, about how...

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All people with abnormal colour vision, except for a few mildly affected deuteranomals, report that they experience problems with colour in everyday life and at work. Contemporary society presents them with increasing problems because colour is now so widely used in printed materials and in computer displays. Equal opportunity law gives them protection against unfair discrimination in employment, so a decision to exclude a person from employment on the grounds of abnormal colour vision must now be well supported by good evidence and sound argument. This paper reviews the investigations that have contributed to understanding the nature and consequences of the problems they have. All those with abnormal colour vision are at a disadvantage with comparative colour tasks that involve precise matching of colours or discrimination of fine colour differences either because of their loss of colour discrimination or anomalous perception of metamers. The majority have problems when colour is used to code information, in man-made colour codes and in naturally occurring colour codes that signal ripeness of fruit, freshness of meat or illness. They can be denied the benefit of colour to mark out objects and organise complex visual displays. They may be unreliable when a colour name is used as an identifier. They are slower and less successful in search when colour is an attribute of the target object or is used to organise the visual display. Because those with the more severe forms of abnormal colour vision perceive a very limited gamut of colours, they are at a disadvantage in the pursuit and appreciation of those forms of art that use colour.