Liberation Health and the Role of the Public Health Leader

The following short report lays the groundwork for rethinking the practice and implications of public health leadership in the context of liberation health. Liberation health reduces to a universal idea:health is freedom. In short, everyone holds a subjective notion of health and, within certain bounds, has the right to promote and maintain that health. This report briefly describes liberation health, discusses the implications of liberation health for public health leadership, and outlines two needed transformations in moving towards a liberation health model of leadership. The report details areas for future research on this topic among public health leaders and within public health curricul

Clinical Leadership and Asymmetric Information: The Impact of Physician Advice on Smoking Cessation

A knowledge gradient exists between experts in a given field and consumers of that knowledge. When the need arises, not knowing the best path, an average individual typically relies on the advice of an expert. Given the steep knowledge gradient between patient and provider, clinicians play an essential role in the clinical setting, acting as both a health leader and a health facilitator; however, this asymmetric information implies that clinical providers face an acute pressure not only to advise but to advise correctly. This paper explores the importance of physician advice within the context of smoking cessation, addressing two specific research questions: (1) among current smokers, do patients have a higher probability of any quit attempts in the last twelve months if a physician advised them to quit over the same period? and, (2) among current smokers who were advised to quit, do patients have a higher probability of any quit attempts in the past twelve months based, at least in part, on the specific quitting strategy suggested by the physician? The results suggest that physicians play a crucial role in promoting smoking cessation efforts. The findings further highlight a significant association between the advised cessation strategy and any quit attempts, although the direction of this relationship varies by the cessation strategy suggested

The Association Between Self-Rated Mental Health Status and Total Health Care Expenditure: A Cross-Sectional Analysis of a Nationally Representative Sample

Both clinical diagnoses and self-rated measures of mental illness are associated with a variety of outcomes, including physical well-being, health utilization, and expenditure. However, much of current literature primarily utilizes clinically diagnosed data. This cross-sectional study explores the impact of mental illness and health care expenditure using 2 self-rated measures: self-rated measured of perceived mental health status (SRMH) and Kessler Screening Scale for Psychological Distress (K6). Data from the 2011 Medical Expenditure Panel Survey Household Component, a nationally representative sample of noninstitutionalized individuals (n = 18,295), were analyzed using bivariate χ2 tests and a 2-part model (logistics regression and generalized linear model regression for the first and second stages, respectively). Although predictive of any health expenditure, SRMH alone was not highly predictive of the dollar value of that health expenditure conditional on any spending. By comparison, the K6 measure was significantly and positively associated with the probability of any health expenditure as well as the dollar value of that spending. Taken together, both the K6 and SRMH measures suggest a positive relationship between poor mental health and the probability of any health expenditure and total expenditure conditional on any spending, even when adjusting for other confounding factors such as race/ethnicity, sex, age, educational attainment, insurance status, and some regional characteristics. Our results suggest that psychological distress and SRMH may represent potential pathways linking poor mental health to increased health care expenditure. Further research exploring the nuances of these relationships may aid researchers, practitioners, and policy makers in addressing issues of inflated health care expenditure in populations at risk for poor mental health

Substance use, risky sexual behavior, and employment among young people

Using data from the National Longitudinal Study of Adolescent Health, this work examines the impact of individual substance use, peer substance use, and depression on risky sexual behaviors, rape victimization among women, and labor market outcomes. The data are nationally representative of American youth. Although Fagan (1993) hypothesized that substance use not only increases the probability of perpetrating violent crimes but also the probability of becoming a victim of violent crime, the impact of substance use and depression on rape victimization remains largely uninvestigated. Previous research often neglects the concurrent impact of depression and the role of peer substance use in shaping the outcomes of interest. I fill these gaps by controlling for individual and peer substance use as well as depression. I use zero-inflated negative binomial, linear probability, and two-part models to investigate these relationships. Given the endogeneity of depression and substance use, analyses incorporate instrumental variable approaches. The results suggest that neither substance use nor depression have a causal impact on the risky sexual behavior, rape, or labor market outcomes. The analyses do indicate, however, that peer substance use influences the observed health and employment outcomes. As a result, health providers may want to consider a patient's social environment when devising prevention and treatment plans.Doctor of Philosoph

Nasally delivered interferon-λ protects mice against infection by SARS-CoV-2 variants including Omicron

Although vaccines and monoclonal antibody countermeasures have reduced the morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, variants with constellations of mutations in the spike gene jeopardize their efficacy. Accordingly, antiviral interventions that are resistant to further virus evolution are needed. The host-derived cytokine interferon lambda (IFN-λ) has been proposed as a possible treatment based on studies in human coronavirus 2019 (COVID-19) patients. Here, we show that IFN-λ protects against SARS-CoV-2 B.1.351 (Beta) and B.1.1.529 (Omicron) variants in three strains of conventional and human ACE2 transgenic mice. Prophylaxis or therapy with nasally delivered IFN-λ2 limits infection of historical or variant SARS-CoV-2 strains in the upper and lower respiratory tracts without causing excessive inflammation. In the lung, IFN-λ is produced preferentially in epithelial cells and acts on radio-resistant cells to protect against SARS-CoV-2 infection. Thus, inhaled IFN-λ may have promise as a treatment for evolving SARS-CoV-2 variants that develop resistance to antibody-based countermeasures

The Association of Menthol Cigarette Use With Quit Attempts, Successful Cessation, and Intention to Quit Across Racial/Ethnic Groups in the United States

IntroductionFew studies have examined the relationship between menthol use and smoking cessation across various racial/ethnic groups; the findings were mixed. This study explored the association of menthol cigarette use with quit attempts, smoking cessation, and intention-to-quit among US adults and by race/ethnicity.MethodsUsing the 2006/2007 and 2010/2011 Tobacco Use Supplements to the Current Population Survey data, this study analyzed 54 448 recent active smokers, defined as current smokers or former smokers who quit less than 12 months ago. Three behaviors were examined: any quit attempts in the past 12 months, successful cessation for ≥3 months, and intention-to-quit smoking in the next 6 months. For each cessation behavior, multiple logistic regression models were estimated separately for the full-sample and stratified racial/ethnic subsamples.ResultsWhile 72.3% of African American recent active smokers typically smoked menthol cigarettes, this proportion was 21.7%, 21.5%, and 28.0% for whites, Asians, and Hispanics, respectively. African American menthol smokers had higher odds of quit attempts compared to non-African American, non-menthol smokers (full-sample analysis), as well as African American non-menthol smokers (subsample analysis). Menthol use was not significantly associated with quit attempts in other racial/ethnic subsamples. There was no significant difference in either successful cessation or intention-to-quit between menthol and non-menthol smokers.ConclusionsAfrican American menthol smokers were more likely to attempt to quit smoking than non-menthol smokers but these quit attempts did not translate into successful cessation. This study revealed no association of menthol use with quit attempts, successful cessation, and intention-to-quit among other racial/ethnic groups.ImplicationsThe findings suggested that African American menthol smokers were more motivated to quit smoking; yet, the results also indicated no significant differences in successful cessation between African American menthol and non-menthol smokers. Interventions targeting menthol smokers within the African American community may help bridge this gap. While more local sales restrictions are beginning to occur (eg, Tobacco 21 efforts), additional policies restricting price discounting as well as the regulation of access to and the time, place, and/or manner of menthol tobacco advertising could also improve cessation rates. Further evaluation is needed to determine the viability of these policies

Input-dependent modulation of MEG gamma oscillations reflects gain control in the visual cortex

Gamma-band oscillations arise from the interplay between neural excitation (E) and inhibition (I) and may provide a non-invasive window into the state of cortical circuitry. A bell-shaped modulation of gamma response power by increasing the intensity of sensory input was observed in animals and is thought to reflect neural gain control. Here we sought to find a similar input-output relationship in humans with MEG via modulating the intensity of a visual stimulation by changing the velocity/temporal-frequency of visual motion. In the first experiment, adult participants observed static and moving gratings. The frequency of the MEG gamma response monotonically increased with motion velocity whereas power followed a bell-shape. In the second experiment, on a large group of children and adults, we found that despite drastic developmental changes in frequency and power of gamma oscillations, the relative suppression at high motion velocities was scaled to the same range of values across the life-span. In light of animal and modeling studies, the modulation of gamma power and frequency at high stimulation intensities characterizes the capacity of inhibitory neurons to counterbalance increasing excitation in visual networks. Gamma suppression may thus provide a non-invasive measure of inhibitory-based gain control in the healthy and diseased brain

Clinical Leadership and Asymmetric Information: The Impact of Physician Advice on Smoking Cessation

A knowledge gradient exists between experts in a given field and consumers of that knowledge. When the need arises, not knowing the best path, an average individual typically relies on the ad-vice of an expert. Given the steep knowledge gradient between patient and provider, clinicians play an essential role in the clinical setting, acting as both a health leader and a health facilitator; however, this asymmetric information implies that clinical providers face an acute pressure not only to advise but to advise correctly. This paper explores the importance of physician advice within the context of smoking cessation, addressing two specific research questions: (1) among current smokers, do patients have a higher probability of any quit attempts in the last twelve months if a physician advised them to quit over the same period? and, (2) among current smokers who were advised to quit, do patients have a higher probability of any quit attempts in the past twelve months based, at least in part, on the specific quitting strategy suggested by the physician? The results suggest that physicians play a crucial role in promoting smoking cessation efforts. The findings further highlight a significant association between the advised cessation strategy and any quit attempts, although the direction of this relationship varies by the cessation strategy suggest

Differential price-responsiveness of smoking behaviors among non-Hispanic African Americans and non-Hispanic whites in the United States

Background and aims: Non-Hispanic African Americans (African Americans) smoke fewer cigarettes per day (CPD) and are more likely to be non-daily smokers than non-Hispanic whites (whites). Little is known about how changes in cigarette prices might contribute to these differences. This study aimed to measure the price-responsiveness of smoking participation, non-daily smoking among current smokers and smoking intensity among daily or non-daily smokers for African Americans and compare the price-responsiveness estimates with those for whites.Design: Analysis of data from the 2009-14 National Adult Tobacco Surveys and cigarette price data from the Tax Burden on Tobacco report.Setting: United States.Participants: A total of 19 232 African American and 197 939 white adults aged 18+.Measurements: We used a three-part econometric model of cigarette demand to estimate the price-responsiveness of smoking participation, daily versus non-daily smoking and smoking intensity. The model controlled for secular variation, state-level anti-smoking sentiment and smoke-free air laws and socio-demographics.Findings: In 2009-14, 20.2% of African Americans and 17.7% of whites identified as current smokers; 70.2% of African American smokers and 81.4% of white smokers smoked daily. The price elasticity of smoking participation was significant for whites at -0.16 [95% confidence interval (CI) = -0.23, -0.09], indicating that a 10% increase in prices would reduce smoking participation by 1.6%, but not statistically significant for African Americans, and this racial/ethnic differential price responsiveness was not statistically significant. The price elasticity of smoking intensity was statistically significant for African American daily smokers at -0.29 (95% CI = -0.42, -0.16), but not statistically significant for white daily smokers, and this racial/ethnic differential price-responsiveness was statistically significant. The price elasticity of daily versus non-daily smoking among current smokers, and the price elasticity of smoking intensity among non-daily smokers were not statistically significant for either racial/ethnic group.Conclusion: In the United States, cigarette price increases may have stronger effects on decreasing daily smokers' consumption among African Americans than among non-Hispanic whites