AJPH News Release March 29, 2006 4 PM

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AJPH NEWS Release

EMBARGOED UNTIL March 29, 2005, 4 PM (ET)
CONTACT: For copies of articles, call Natalie Raynor, (202) 777-2511

All articles will be online under "First Look" at www.ajph.org following the embargo.

American Journal of Public Health Highlights

· Trauma of Hurricane Katrina evacuees underscores need for better disaster preparedness
· Living in a race-conscious society take health toll on American blacks
· Rise in U.S. C-sections not due to rise in moms' risk factors
· Smokeless tobacco use has dropped dramatically among nation's youth

The articles below are published online by the American Journal of Public Health under "First Look," and will appear in the May 2006 print issue of the Journal, with the exception of the article by Brodie, which will appear in a future print issue. "First Look" articles have undergone peer review, copyediting and approval by authors, but have not yet been printed to paper or posted online by issue. Following the embargo, articles will appear under "First Look" at www.ajph.org/first_look.shtml. The American Journal of Public Health is published by the American Public Health Association and is available at www.ajph.org.

Trauma of Hurricane Katrina evacuees underscores need for better disaster preparedness
Many Hurricane Katrina Evacuees suffered emotional trauma during and after the storm, underscoring the need for better public health preparedness.
In a survey of 680 evacuees living in Houston-area shelters, researchers found most were poor, black and uninsured, a population already struggling when the storm devastated their homes. To make matters worse, many suffered from chronic health problems such as diabetes and heart disease and relied on the New Orleans public hospital system for care. When Katrina destroyed that system, many evacuees had no fallback plan when it came to health care.
The survey of 680 randomly selected evacuees was conducted in mid-September 2005 and was jointly designed by the Washington Post, Kaiser Family Foundation and Harvard University School of Public Health. More than 90 percent of survey evacuees were black, compared to New Orleans' 69-perecnt black population. And 54 percent of evacuees were uninsured, compared to a 26-percent uninsurance rate in Louisiana.
"The results make clear the vulnerable situation facing victims of hurricane Katrina, confirming the trends found in previous disasters," the study's authors said. "The results also shed light on critical policy choices facing public health officials and policymakers
in the Gulf Coast and across the nation. In particular, the survey illuminates the challenge facing disaster planners in effectively evacuating cities' most at-risk residents, and the challenge of providing for the long-term health care needs of a vulnerable population in the face of a future natural or man-made disaster." [From: "Experiences of Hurricane Katrina Evacuees: Findings from a Survey of Evacuees in Houston Area Shelters." Contact: Mollyann Brodie, PhD, Kaiser Family Foundation, mbrodie@kff.org.]

Living in a race-conscious society make take health toll on American blacks
The health of American blacks appears to be worse than that of whites regardless of income, and researchers think living in a race-conscious society may be at least partly to blame.
Using National Health and Nutrition Examination Survey data, researchers examined allostatic load scores for adults ages 18-64 and estimated probability of a high score by age, rage, gender and poverty status. The study's authors also estimated blacks' odds of having a high score relative to whites' odds. They found blacks had higher scores, indicating worse health, at all ages and particularly at 35-64 years. Racial differences were not explained by poverty.
"We found evidence that racial inequalities in health exist across a range of biological systems among adults and are not explained by racial differences in poverty," the study's authors said. "The weathering effects of living in a race-conscious society may be greatest among those [b]lacks most likely to engage in high-effort coping."
[From: "'Weathering' and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States." Contact: Arline T. Geronimus, ScD, University of Michigan School of Public Health, Ann Arbor, arline@umich.edu.]

Rise in U.S. C-sections not due to rise in moms' risk factors
More than one-fourth of all first-time mothers in the United States deliver their babies by cesarean section, and the recent rise in the nation's C-section rate can't be attributed to rising risk factors among mothers.
Using national birth certificate data from 1991 through 2002, researchers analyzed both the overall C-section rate as well as the primary rate for first-time mothers. While the primary C-section rate actually dropped between 1991 and 1996, it shot up in the remaining study years, accounting for about 53 percent of all C-sections. As concerns about the safety of vaginal births after C-section rose, overall C-section rates rose as well. The increasing rate was not attributed to higher risk factors among mothers.
The study's author said growing restrictions on VBACs, coupled with the current rise in primary C-sections, will result in "a large cohort of women in which repeat cesareans will become the norm.
"More research is needed into the causes of these trends since the growth in primary cesareans combined with increasing restrictions on vaginal birth after cesareans will lead to a continuation and likely acceleration of the current growth in the overall cesarean rate in the U.S." [From: "The Rise in Primary Cesarean Births in the U.S., 1991- 2002: Changing Risk Profiles or Changing Practice?" Contact: Eugene R. Declercq, Boston University School of Public Health, declercq@bu.edu.]

Smokeless tobacco use has dropped dramatically among nation's youth.
The anti-tobacco message seems to have hit home among American adolescents when it comes to smokeless tobacco. Smokeless tobacco use between 1986 and 2003 was low among adolescent girls and remained unchanged during the study period. [For 12th grade boys, it rose slightly from 1986 until the early 1990s. From the mid-1990s to 2003, however, smokeless tobacco use among 8th, 10th, and 12th grade boys dropped sharply, researchers found.] Anti-smoking advocates caution that smokeless tobacco should not be considered an alternative to cigarettes and that educational messages need to continue to drive that point home.[From: Trends in Smokeless Tobacco Use among Adults and Adolescents in the United States. Contact: David E. Nelson, MD, MPH, Centers for Disease Control and Prevention, Office on Smoking & Health, Atlanta, den2@cdc.gov.]

The American Journal of Public Health is the monthly journal of the American Public Health Association, the oldest organization of public health professionals in the world. APHA is a leading publisher of public health-related books and periodicals promoting high scientific standards, action programs and policy for good health. More information is available at www.apha.org.

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