Agriculture Policy Is Health Policy.

The Farm Bill is meant to supplement and secure farm incomes, ensure a stable food supply, and support the American farm economy. Over time, however, it has evolved into a system that creates substantial health impacts, both directly and indirectly. By generating more profit for food producers and less for family farmers; by effectively subsidizing the production of lower-cost fats, sugars, and oils that intensify the health-destroying obesity epidemic; by amplifying environmentally destructive agricultural practices that impact air, water, and other resources, the Farm Bill influences the health of Americans more than is immediately apparent. In this article, we outline three major public health issues influenced by American farm policy. These are (1) rising obesity; (2) food safety; and (3) environmental health impacts, especially exposure to toxic substances and pesticides

Medication Use Patterns among Urban Youth Participating in School-Based Asthma Education

Although pharmaceutical management is an integral part of asthma control, few community-based analyses have focused on this aspect of disease management. The primary goal of this analysis was to assess whether participation in the school-based Kickin’ Asthma program improved appropriate asthma medication use among middle school students. A secondary goal was to determine whether improvements in medication use were associated with subsequent improvements in asthma-related symptoms among participating students. Students completed an in-class case-identification questionnaire to determine asthma status. Eligible students were invited to enroll in a school-based asthma curriculum delivered over four sessions by an asthma health educator. Students completed a pre-survey and a 3-month follow-up post-survey that compared symptom frequency and medication use. From 2004 to 2007, 579 participating students completed pre- and post-surveys. Program participation resulted in improvements in appropriate use across all three medication use categories: 20.0% of students initiated appropriate reliever use when “feeling symptoms” (p < 0.001), 41.6% of students reporting inappropriate medication use “before exercise” initiated reliever use (p < 0.001), and 26.5% of students reporting inappropriate medication use when “feeling fine” initiated controller use (p < 0.02). More than half (61.6%) of participants reported fewer symptoms at post-survey. Symptom reduction was not positively associated with improvements in medication use in unadjusted and adjusted analysis, controlling for sex, asthma symptom classification, class attendance, season, and length of follow-up. Participation in a school-based asthma education program significantly improved reliever medication use for symptom relief and prior-to-exercise and controller medication use for maintenance. However, given that symptom reduction was not positively associated with improvement in medication use, pharmaceutical education must be just one part of a comprehensive asthma management agenda that addresses the multifactorial nature of asthma-related morbidity

Racial/Ethnic Disparities in Preterm Birth in an Intergenerational Cohort of Mothers and Babies in California: The Role of Neighborhood Disinvestment

BackgroundPreterm birth in the U.S. is higher than other comparable countries. Babies born preterm are at higher risk of life-threatening complications in their first days as well as a range of health and educational problems over the life course. Despite recent declines in preterm birth, significant racial/ethnic disparities persist. A growing body of literature suggests conditions in the places where people live, especially during critical time periods of development, may be playing a fundamental role in shaping the development of maternal health, and disparities in birth outcomes in the subsequent generation. However, this literature is limited by cross-sectional neighborhood and health data and incomplete definition and measurement of complex historical and economic processes that shape neighborhood environments. The overarching goals of this study are 1) to expand current measurement of neighborhood contexts to capture historical and economic processes of structural marginalization that have shaped them, and to assess the relationship between these expanded measures and preterm birth 2) to develop and apply a framework informed by structural marginalization to catalyze a next-generation practice of Maternal and Child Health.MethodThe Life Course Social Context database, which contains geocoded birth records linked between mothers and babies in California, provides a unique opportunity to assess the relationship between neighborhood-level exposures experienced at two different stages of a mother’s life course (early childhood and adulthood) and preterm birth in the next generation. Using these data and other census measures, we construct histories of neighborhood poverty going back to 1970 and examine associations between these neighborhood poverty histories and preterm birth. Next, we assess the relationship between structural neighborhood inequality and preterm birth and preterm birth disparities, using measures of income inequality, racial/ethnic inequality and a combined measure of income and racial/ethnic inequality. Finally, we develop a conceptual model for understanding the broader context in which inequities in birth outcomes arise and provide case examples and lessons for future development of a next-generation MCH practice that will address the root causes of inequities in birth outcomes. SignificanceClearer understanding of complex neighborhood processes and how they shape health through generations is vital for the development of targeted and impactful public health programs. The development and assessment of new measures that approximate structural forces underlying neighborhood conditions shaping health over the life course will help direct the scope and scale of policy and practice efforts aimed at improving health and reducing inequities in birth outcomes. This study aims to contribute to more complete definition, measurement, and intervention for historical and structural forces that shape neighborhood conditions