Greater collaboration across the disciplines: challenges and opportunities.

This paper reports a panel discussion--Opportunities for and Limitations to Greater Collaboration Across the Disciplines--held at the conference. It highlights the need for greater collaboration between demographers and epidemiologists and notes the institutional and disciplinary challenges to and opportunities for promoting greater cooperation.

Advocacy in epidemiology and demography.

This paper is a summary of a panel discussion at the Conference on Epidemiology and Demography held at Georgetown University, in Washington D.C. on February 8-9, 2001. The participants were Al Hermalin, Linda Martin, Mike Stoto, Robert Wallace, Douglas Weed, and Rose Li (who chaired the session). A list of questions similar to the section headings in this paper was prepared in advance of the conference, and each of the participants was asked to address specific issues, although the presentations typically covered a range of topics. This summary also includes comments from the floor.

Saving statistical lives: contributions of statistics to public health.

Prevention is about saving "statistical lives"-lives that society knows about only through the efforts of public health statisticians like Jack Smith. As Mr. Smith's lifework suggests, statistics in public health are critical for calling attention to problems, identifying risk factors, and suggesting solutions, and ultimately for taking credit for our successes. His work illustrates two important lessons about public health statistics today.First, it's important to get the facts straight. Mr. Smith's experience shows that a careful, thoughtful analysis is not only more convincing in the end, but also brings to light important subtleties not seen in the initial analysis. Second, it takes considerable time and attention to get the facts straight. Jack Smith's work illustrates the importance of partnerships with other federal agencies, state statistical organizations, and private-sector entities.

Preventing perinatal transmission of human immunodeficiency virus in the United States. Committee on Perinatal Transmission of HIV.

Prenatal human immunodeficiency virus (HIV) testing and treatment instituted in the 1990s is responsible for a substantial reduction in the number of children diagnosed with AIDS, yet the number of children born with HIV infection remains unacceptably high. To prevent perinatal transmission of HIV, the United States must adopt a goal to test all pregnant women for HIV and to provide optimal treatment for women who test positive and their children. To meet this goal, the United States should adopt a national policy of universal HIV testing with patient notification as a routine component of prenatal care. Adopting this policy will require the establishment of, and resources for, a comprehensive infrastructure. This infrastructure must include education of prenatal care providers, the development and implementation of practice guidelines and the implementation of clinical policies, the development and adoption of performance measures and Medicaid managed care contract language for prenatal HIV testing, efforts to improve coordination of care and access to high-quality HIV treatment, interventions to overcome pregnant women's concerns about HIV testing and treatment, and efforts to increase use of prenatal care, as described above.

Sharing responsibility for the public's health: a new perspective from the Institute of Medicine.

The health of a community is a shared responsibility of many entities. Within this context, specific entities should identify, and be held accountable for, the actions they can take to contribute toward the community's health. Governmental public health agencies, especially at the state and local levels, can take the lead in getting public and private community organizations to advance the health of the community, and should play a leadership role by developing partnerships with managed care organizations and community-based organizations.

Do businesses comply with a no-smoking law? Assessing the self-enforcement approach.

BACKGROUND: Many states and cities have adopted laws restricting smoking in public places. Health departments generally regard the laws as self-enforcing, implying little need for monitoring or enforcement. Whether this achieves good compliance at the workplace, a major site of passive smoke exposure, is not known. METHODS: We assessed workplace compliance with a no-smoking ordinance in Cambridge, Massachusetts, by conducting telephone surveys of two stratified random samples of city businesses, 3 and 24 months after the law took effect. Response rates were 76% at 3 months (n = 312) and 79% at 24 months (n = 317). RESULTS: Employers' awareness and approval of the law were initially high. Approval remained high, but awareness declined over 2 years, from 92 to 73% (P < 0.0001), and employers' knowledge of the law's requirements was incomplete. Eighty percent of companies restricted smoking 3 and 24 months after the law, but only half of businesses fully complied with the law at either time. On multivariate analysis, compliance was significantly better in businesses that were aware of the law, in favor of it, and whose owners were nonsmokers. One fifth of firms with smoking policies cited the law as a reason for policy adoption. CONCLUSION: A self-enforcement approach to implementing a no-smoking law achieved high levels of awareness and intermediate levels of compliance in a city's businesses. Awareness of the law declined over 2 years without reinforcement. The law was popular with employers and was associated with a high level of smoking restrictions in city businesses, but further efforts are needed to maximize compliance with a no-smoking law and reduce workplace smoke exposure.

Retail stores' compliance with a city no-smoking law.

OBJECTIVES: Laws restricting smoking in public places and workplaces can protect the public only if they are obeyed. We sought to assess compliance with a Cambridge, Mass, no-smoking ordinance. METHODS: We prospectively observed 174 retail stores 1 month before and 3, 11, and 24 months after the law took effect. At 24 months, we interviewed one employee per store. RESULTS: Full compliance with the law was low; at 24 months, only 4% of stores displayed the mandated sign and were free of smokers and smoke. Fewer than half the stores posted any no-smoking sign. Sign prevalence increased over 2 years (22% to 41%, P < .001), but the frequency of smoke or smokers (13% and 10%, respectively, at baseline) did not change. According to employees interviewed at 24 months, 38% of stores illegally permitted customers or employees to smoke. These stores had more smoke and fewer signs than did stores prohibiting smoking. Compliance was poor in liquor and convenience stores. Employees who had been told how to handle customers' smoking were more likely to enforce the law. CONCLUSIONS: Compliance with a no-smoking law is not guaranteed. For retail stores, compliance may improve if stores adopt no-smoking policies, post signs, and teach employees to enforce the law.

National health objectives for the year 2000: the demographic impact of health promotion and disease prevention.

BACKGROUND: The national objectives in Healthy People 2000, drafted by health professionals aware of currently available public health interventions, represent a wealth of information about near-term future mortality and morbidity. METHODS: Life table methods were used to calculate the impact of projected changes in mortality and activity limitation rates on life expectancy and expected disability years. RESULTS: Meeting the mortality objectives would increase life expectancy at birth by 1.5 to 2.1 years, raising life expectancy to 76.6 to 77.2 years. In addition, meeting the target for disability from chronic conditions would increase the number of years of life without activity limitations from 66.8 years to 69.3-69.7 years. If the targets for coronary heart disease and unintentional injury were changed to reflect recent trends, a greater improvement in life expectancy at birth would be achieved: from 1.8 to 2.7 years to 76.9 to 77.8 years. CONCLUSION: Meeting the targets would have an important demographic impact. Including changes in the coronary heart disease and injuries targets, life expectancy in the year 2000 would be above the middle of the ranges used in current Census Bureau projections.