Perceptions of E-Cigarettes among Black Youth in California.

Research suggests that Black youth are less likely to use e-cigarettes than their white counterparts, yet little is known as to why. We examined perceptions of e-cigarettes among Black young adults (ages 18-25) to explore the meanings these youth ascribe to e-cigarettes and the role that identity plays in how these devices are viewed. Analysis of in-depth interviews with 36 Black smokers and non-smokers in the San Francisco Bay Area suggests that Black youth perceive e-cigarettes as serving distinct, yet overlapping roles: a utilitarian function, in that they are recognized as legitimate smoking cessation tools, and a social function, insofar as they serve to mark social identity, specifically a social identity from which our participants disassociated. Participants described e-cigarette users in highly racialized and classed terms and generally expressed disinterest in using e-cigarettes, due in part perhaps to the fact that use of these devices would signal alignment with a middle class, hipster identity. This analysis is discussed within a highly charged political and public health debate about the benefits and harms associated with e-cigarette use.

Longitudinal and contemporaneous manganese exposure in apartheid-era South Africa: Implications for the past and future.

Manganese is a potent environmental toxin, with significant effects on human health. Manganese exposure is of particular concern in South Africa where in the last decade, lead in gasoline has been replaced by methylcyclopentadienyl manganese tricarbonyl (MMT). We investigated recent historical levels of manganese exposure in urban Gauteng, South Africa prior to the introduction of MMT in order to generate heretofore non-existent longitudinal public health data on manganese exposure in urban South Africans. Cortical bone manganese concentration was measured by inductively coupled plasma mass spectrometer in 211 deceased adults with skeletal material from a fully identified archived tissue collection at the University of Pretoria, South Africa. All tissues came from individuals who lived and died in urban Gauteng (Transvaal), between 1958 and 1998. Median Mn concentration within the sampled tissues was 0.3µgg-1, which is within reported range for bone manganese concentration in non-occupationally exposed populations and significantly below that reported in individuals environmentally exposed to MMT. No significant differences were seen in bone Mn between men and women or in individuals of different ethnicity, which further suggests environmental, as opposed to occupational exposure. There were no significant temporal or geographic differences in bone Mn. The results suggest that Mn exposure was low and uniformly distributed across the whole population prior to the introduction of MMT as a gasoline additive. In addition, should manganese exposure follow the same patterns as vehicle-emitted lead, a clear pattern of exposure will emerge with individuals in the urban core facing the greatest manganese exposure.

Lead exposure in adult males in urban Transvaal Province, South Africa during the apartheid era.

Human exposure to lead is a substantial public health hazard worldwide and is particularly problematic in the Republic of South Africa given the country's late cessation of leaded petrol. Lead exposure is associated with a number of serious health issues and diseases including developmental and cognitive deficiency, hypertension and heart disease. Understanding the distribution of lifetime lead burden within a given population is critical for reducing exposure rates. Femoral bone from 101 deceased adult males living in urban Transvaal Province (now Gauteng Province), South Africa between 1960 and 1998 were analyzed for lead concentration by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Of the 72 black and 29 white individuals sampled, chronic lead exposure was apparent in nearly all individuals. White males showed significantly higher median bone lead concentration (ME = 10.04 µg·g(-1)), than black males (ME = 3.80 µg·g(-1)) despite higher socioeconomic status. Bone lead concentration covaries significantly, though weakly, with individual age. There was no significant temporal trend in bone lead concentration. These results indicate that long-term low to moderate lead exposure is the historical norm among South African males. Unexpectedly, this research indicates that white males in the sample population were more highly exposed to lead.

Medicaid and CHIP children's healthcare quality measures: what states use and what they want.

OBJECTIVE: The objective of this research was to explore state Medicaid and Children's Health Insurance Program (CHIP) use of children's healthcare quality measures and the need for additional support as the Children's Health Insurance Program Reauthorization Act (CHIPRA) legislation is being implemented. METHODS: This summary analysis draws from a December 2008 survey of state CHIP programs fielded by the National Academy for State Health Policy (NASHP) and a February 2009 survey of Medicaid and CHIP programs conducted by Health Management Associates (HMA). RESULTS: Nearly all (90%) Medicaid and CHIP directors rate children's health care quality as a high priority (7 or above on a 10-point scale). Almost all state Medicaid programs collect performance measures from plans or providers and almost all CHIP programs collect pediatric performance measures from managed care organizations, although significantly fewer collect such data from fee-for-service providers. Most state programs also collect encounter data, perform enrollee surveys, and utilize medical record reviews. Fewer track duration of enrollment in coverage or analyze measures for disparities by race and ethnicity. Almost all state programs feel that their quality improvement efforts have led to positive changes. Less than one third believe current measures are adequate, almost two thirds seek better measures of care coordination, and roughly half agreed better outcome measures are needed. Many state programs supplement existing standard measures with their own state-developed measures. CONCLUSION: The surveys' findings of high levels of state children's health care quality measurement and improvement activity and interest suggest that new federal CHIPRA provisions are coming at an opportune time. To achieve significant state participation in measuring and reporting on children's access to quality care, national programs need to be guided not only by national priorities but by state goals, capacity, and practice.