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1.
Med Decis Making ; 41(5): 559-572, 2021 07.
Article in English | MEDLINE | ID: mdl-33655790

ABSTRACT

OBJECTIVE: To decrease referrals to cardiology of patients ages 7 to 21 years with low-probability cardiac pathology who presented to primary care with chest pain by 50% within 24 months. STUDY DESIGN: A multidisciplinary team designed and implemented an initiative consisting of 1) a decision support tool (DST), 2) educational sessions, 3) routine feedback to improve use of referral criteria, and 4) patient family education. Four pediatric practices, comprising 34 pediatricians and 7 nurse practitioners, were included in this study. We tracked progress via statistical process control charts. RESULTS: A total of 421 patients ages 7 to 21 years presented with chest pain to their pediatrician. The utilization of the DST increased from baseline of 16% to 68%. Concurrently, the percentage of low-probability cardiology referrals in pediatric patients ages 7 to 21 years who presented with chest pain decreased from 17% to 5% after our interventions. At a median follow-up time of 0.9 years (interquartile range, 0.3-1.6 years), no patient had a life-threatening cardiac event. CONCLUSION: Our health care improvement initiative to reduce low-probability cardiology referrals for children presenting to primary care practices with chest pain was feasible, effective, and safe.


Subject(s)
Cardiology , Quality Improvement , Adolescent , Adult , Chest Pain/therapy , Child , Humans , Primary Health Care , Referral and Consultation , Young Adult
2.
Am J Public Health ; 92(3): 414-9, 2002 Mar.
Article in English | MEDLINE | ID: mdl-11867322

ABSTRACT

OBJECTIVES: This article describes the tobacco industry's use of bars and nightclubs to encourage smoking among young adults. METHODS: Previously secret tobacco industry marketing documents were analyzed. RESULTS: Tobacco industry bar and nightclub promotions in the 1980s and 1990s included aggressive advertising, tobacco brand--sponsored activities, and distribution of samples. Financial incentives for club owners and staff were used to encourage smoking through peer influence. Increased use of these strategies occurred concurrently with an increase in smoking among persons aged 18 through 24 years. CONCLUSIONS: The tobacco industry's bar and nightclub promotions are not yet politically controversial and are not regulated by the 1998 Master Settlement Agreement between the industry and the states. Tobacco control advocates should include young adults in research and advocacy efforts and should design interventions to counter this industry strategy to solidify smoking patterns and recruit young adult smokers.


Subject(s)
Advertising/methods , Commerce/trends , Motivation , Persuasive Communication , Restaurants/economics , Smoking/psychology , Tobacco Industry/trends , Adolescent , Adult , Advertising/economics , Commerce/economics , Financial Support , Humans , Life Style , Peer Group , Smoking/epidemiology , Tobacco Industry/economics , United States/epidemiology
3.
Am J Public Health ; 92(1): 75-8, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11772765

ABSTRACT

OBJECTIVES: This study examined changes in tobacco promotions in the alternative press in San Francisco and Philadelphia from 1994 to 1999. METHODS: A random sample of alternative newspapers was analyzed, and a content analysis was conducted. RESULTS: Between 1994 and 1999, numbers of tobacco advertisements increased from 8 to 337 in San Francisco and from 8 to 351 in Philadelphia. Product advertisements represented only 45% to 50% of the total; the remaining advertisements were entertainment-focused promotions, mostly bar-club and event promotions. CONCLUSIONS: The tobacco industry has increased its use of bars and clubs as promotional venues and has used the alternative press to reach the young adults who frequent these establishments. This increased targeting of young adults may be associated with an increase in smoking among this group.


Subject(s)
Advertising , Leisure Activities , Newspapers as Topic , Smoking/epidemiology , Tobacco Industry , Tobacco Smoke Pollution/prevention & control , Tobacco Use Disorder/epidemiology , Adolescent , Adult , Age Factors , California , Humans , Pennsylvania , Tobacco Smoke Pollution/legislation & jurisprudence
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