Barriers and solutions to addressing tobacco dependence in addiction treatment programs.

Despite the high prevalence of tobacco use among people with substance use disorders, tobacco dependence is often overlooked in addiction treatment programs. Several studies and a meta-analytic review have concluded that patients who receive tobacco dependence treatment during addiction treatment have better overall substance abuse treatment outcomes compared with those who do not. Barriers that contribute to the lack of attention given to this important problem include staff attitudes about and use of tobacco, lack of adequate staff training to address tobacco use, unfounded fears among treatment staff and administration regarding tobacco policies, and limited tobacco dependence treatment resources. Specific clinical-, program-, and system-level changes are recommended to fully address the problem of tobacco use among alcohol and other drug abuse patients

Does Falling Smoking Lead to Rising Obesity?

The strong negative correlation over time between smoking rates and obesity have led some to suggest that reduced smoking is increasing weight gain in the U.S.. This conclusion is supported by the findings of Chou et al. (2004), who conclude that higher cigarette prices lead to increased body weight. We investigate this issue and find no evidence that reduced smoking leads to weight gain. Using the cigarette tax rather than the cigarette price and controlling for non-linear time effects, we find a negative effect of cigarette taxes on body weight, implying that reduced smoking leads to lower body weights. Yet our results, as well as Chou et al., imply implausibly large effects of smoking on body weight. Thus, we cannot confirm that falling smoking leads in a major way to rising obesity rates in the U.S

Caring for Our Kupuna: Building an Aging in Place Movement in Hawaii

Government funding for elder care in the United States is becoming increasingly strained as the number of seniors and the cost of healthcare rise. Medicare paid $560 billion for hospital visits, prescription drugs, and other services in 2010 and expects to pay out just over$1 trillion by 2022. Medicaid, which covers long-term care for individuals with low income and assets, is the source of payment for 70% of nursing home stays across the country and paid $48.2 billion for senior residential care in 2007.As the costs of Medicare and Medicaid soar, practitioners in Hawaii and around the country have experimented with preventive and supportive aging-in-place services that reduce the cost of service while improving the lives of seniors. Rather than rushing an elder to the emergency room after a dangerous fall in the bathroom, providers have begun installing hand and safety rails in the home to prevent falls. Other providers are offering preventive health and nutrition classes that help seniors maintain their health and delay the need for long-term residential care. By focusing on preventive services rather than treating only advanced health needs, aging-in-place service providers are helping seniors maintain independence at home, avoid nursing home admission, reduce hospitalization, and minimize social isolation. Studies show that those who choose to age at home have better health outcomes while incurring significantly lower health costs than those who age in nursing homes. In addition to saving financial resources, aging in place is popular among seniors: a full 90% of American seniors share the desire to remain in their homes as they age.The value of aging in place is particularly relevant in Hawaii, which has the highest life expectancy of any state and the second highest cost of living in the country. By 2030, Hawaii expects to have an older population of 475,000 individuals, representing 29.7% of the population and a 310% increase during the 55-year period from 1980-2035. As the number of seniors aging in Hawaii rapidly increases, the state faces limited capacity in its residential care homes. With only 4,200 beds in nursing homes and 7,000 spaces in residential facilities in 2010, Hawaii's current facilities would be able to serve only 30% of the 38,000 older adults projected to need long-term care in 2035.6Increasing the portion of seniors aging in place could increase the happiness of Hawaii's seniors ("kupuna") and save significant resources for society. However, a continuum of wrap-around services must be available to seniors if they are to age in place effectively. Aging-in-place services must be available to transport elders, support needs in the home (safety, cleaning, cooking, etc.), connect elders with a community, provide respite for caregivers, and monitor and address health/nursing needs. Without this comprehensive support, elders living alone are not empowered to age with dignity and are more likely to become ill or incur injuries

Insuring Quality Long-Term Nursing Care

Includes bibliographical references.The oldest members of the Baby Boom generation born between 1946 and 1964 will turn sixty-five in 2011. As the size of our senior population increases over the next few decades, so will their health care needs. In the early decades of this century, the proportion of elderly citizens in our total population is expected to steadily rise from the present level of approximately 12 percent to an estimated peak of 20 percent in 2030. The needs are great. Researchers, health care professionals, and interested citizens must find ways to care for the growing senior population in ways that meet the elders' needs and insure the quality of the nursing care received

Do Adolescents with Emotional or Behavioral Problems Respond to Cigarette Prices?

Adolescents with mental health problems have much higher rates of smoking than those without such problems. Although a large body of evidence suggests that higher cigarette prices reduce smoking prevalence and the quantity smoked, little is known about the interaction between mental health or behavioral problems and tobacco consumption in the general population or among adolescents. Using a national representative sample of adolescents from the National Longitudinal Study of Adolescent Health and employing validated psychiatric measures of emotional distress and behavioral problems, we estimate the price elasticity of cigarette demand for adolescents who have behavioral or emotional problems. The results indicate that these adolescents are at least as responsive to cigarette prices as adolescents with no emotional or behavioral problems.

Lessons From a Health Information Technology Demonstration in New York Nursing Homes

Outlines the New York State Nursing Home Health Information Technology Demonstration Project; variations in organizational aims in adopting HIT, perceived or real effects, and resulting quality improvement efforts; and considerations for replication

Does Falling Smoking Lead to Rising Obesity?

The strong negative correlation over time between smoking rates and obesity have led some to suggest that reduced smoking is increasing weight gain in the U.S.. This conclusion is supported by the findings of Chou et al. (2004), who conclude that higher cigarette prices lead to increased body weight. We investigate this issue and find no evidence that reduced smoking leads to weight gain. Using the cigarette tax rather than the cigarette price and controlling for non-linear time effects, we find a negative effect of cigarette taxes on body weight, implying that reduced smoking leads to lower body weights. Yet our results, as well as Chou et al., imply implausibly large effects of smoking on body weight. Thus, we cannot confirm that falling smoking leads in a major way to rising obesity rates in the U.S.

Private Profits and Public Health: Does Advertising Smoking Cessation Products Encourage Smokers to Quit?

To shed new light on the role private profit incentives play in promoting public health, in this paper we conduct an empirical study of the impact of pharmaceutical industry advertising on smoking cessation decisions. We link survey data on individual smokers with an archive of magazine advertisements. The rich survey data allow us to measure smokers' exposure to smoking cessation advertisements based on their magazine-reading habits. Because we observe the same information about the consumers that the advertisers observe, we can control for the potential endogeneity of advertising due to firms' targeting decisions. We find that when smokers are exposed to more advertising, they are more likely to attempt to quit and are more likely to have successfully quit. While some of the increased quitting behavior involves purchases of smoking cessation products, our results indicate that advertisements for smoking cessation products also increase the probability of quitting without the use of any product. Thus, the public health returns to smoking cessation product advertisements exceed the private returns to the manufacturers. Because advertising of a wide range of consumer products may have important and under-studied spillover effects on various non-market behaviors, our results have broad implications for the economics of advertising.

Investing in Entry-Level Talent

Even in today's competitive economic environment, there is much that companies can do to reduce entry-level turnover costs, increase employee engagement and retention, and create a talent pipeline for the future. Many companies pursue basic strategies to address turnover and promote advancement, such as offering competitive benefits and developing internal career paths. But our research found pioneering companies that are going beyond the basics and addressing turnover in remarkable ways. In examining the practices of these leading companies, we identified four strategies, outlined below, that markedly improve entry-level retention and advancement. This report is designed to share those strategies and practical suggestions for implementation with corporate leaders across the United States who are seeking to engage, retain, and advance their entry-level workforce

US regional and national cause-specific mortality and trends in income inequality: descriptive findings

We examined the concordance of income inequality trends with 30-year US regional trends in cause-specific mortality and 100-year trends in heart disease and infant mortality. The evidence suggests that any effects of income inequality on population health trends cannot be reduced to simple processes that operate across all contexts and in all time periods. If income inequality does indeed drive population health, it implies that income inequality would have to be linked and de-linked across different time periods, with different exposures to generate the observed heterogeneous trends and levels in the causes of mortality shown here.cause-specific mortality, income, income inequality, mortality, population health, trends, USA