This study investigates the relative contributions of socioeconomic status (SES), behavioral and clinical risk factors on mortality. The Third National Health and Nutrition Survey Linked Mortality File was used to examine the association of SES (race, insurance, education, income), behavioral (smoking, obesity, physical activity), and clinical (elevated blood pressure, triglyceride level, lipid levels, C-reactive protein (CRP)) risk factors with 6-12-year all-cause mortality. Respondents were stratified by known chronic diseases into one of the following categories: no chronic disease, non-cardiovascular chronic disease, cardiovascular disease, and diabetes. The overall weighted mortality rate was 9.5% with the highest mortality rate among diabetics. Race, insurance coverage, income, smoking status, inadequate physical activity, elevated blood pressure and elevated CRP were independently associated with mortality in the overall population. When stratified by chronic disease, SES factors remained associated with mortality, most strongly in the healthy population. Current smoking and inadequate physical activity were also associated with mortality across disease groups while clinical risk factors were less consistent. SES factors, health behaviors and clinical risk factors were all associated with mortality even when baseline health status and chronic diseases are taken into account. Efforts to reduce mortality will require a multi-faceted approach incorporating healthy behaviors and accessible health care systems in addition to clinical advances.
The Advisory Committee on Immunization Practices (ACIP) recently recommended that all children 6 months to 18 years be vaccinated annually against influenza. Because pediatricians will be critical for implementing this recommendation, we assessed the characteristics of immunization providers associated with the greatest efforts to vaccinate children against influenza. Using a cross-sectional survey of 35 private pediatric clinics in Georgia, we found that adding extra hours for immunization during the influenza vaccination season and having a policy of allowing six or more vaccines to be delivered at one appointment were characteristics associated with a greater intent to vaccinate children in the 2004-2005 influenza vaccination season. Most respondents indicated that for their clinic to implement a universal childhood vaccination policy it would be important to have a formal recommendation from the ACIP and American Academy of Pediatrics, and to be assured that they could receive credits or refunds for unused vaccine.
Recently, it has been recommended that all persons 6 months to 18 years be vaccinated annually against influenza. To assess support for this universal recommendation leading up to its implementation, a cross-sectional survey of healthcare workers at private pediatric clinics (N = 44) and public health departments (N = 75) was conducted. The survey, conducted in the state of Georgia during 2005-2006, asked about (a) support for universal childhood vaccination against influenza, (b) general and influenza-specific immunization practices in 2004-2005, and (c) types of assistance needed to implement a universal childhood recommendation. Our response rate was 70 percent for private clinics and 71 percent for public health departments. The majority of providers supported universal childhood vaccination against influenza; agreement was especially pronounced at public health departments. Public health departments employed more nurses and were more likely to have a policy of vaccinating parents along with their children; private clinics were more likely to use patient reminders or add extra hours during the influenza vaccination season. Respondents from both types of clinics indicated they would need multiple forms of assistance to implement a universal recommendation for childhood vaccination against influenza. Given the strong support for universal vaccination among healthcare workers at public health departments, these facilities may be instrumental for reaching the large number of children recently added to the recommendations. However, these facilities will need multiple forms of assistance.
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