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- Volume 27, 2006
Annual Review of Public Health - Volume 27, 2006
Volume 27, 2006
- Preface
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EFFECTIVE RECRUITMENT AND RETENTION OF MINORITY RESEARCH PARTICIPANTS
Vol. 27 (2006), pp. 1–28More Less▪ AbstractOur ability, as leaders in public health scholarship and practice, to achieve and measure progress in addressing racial/ethnic disparities in health status and health care is severely constrained by low levels of participation of racial/ethnic minority populations in health-related research. Confining our review to those minority groups federally defined as underrepresented (African Americans/blacks, Latinos/Hispanics, and Native Americans/American Indians), we identified 95 studies published between January 1999 and April 2005 describing methods of increasing minority enrollment and retention in research studies, more than three times the average annual output of scholarly work in this area during the prior 15-year period. Ten themes emerged from the 75 studies that were primarily descriptive. The remaining 20 studies, which directly analyzed the efficacy or effectiveness of recruitment/retention strategies, were examined in detail and provided useful insights related to four of the ten factors: sampling approach/identification of targeted participants, community involvement/nature and timing of contact with prospective participants, incentives and logistical issues, and cultural adaptations. We then characterized the current state of this literature, discussing implications for future research needs and directions.
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MEASURING POPULATION HEALTH: A Review of Indicators
Vol. 27 (2006), pp. 29–55More Less▪ AbstractThis article reviews the historical development of population health indicators. We have long known that environmental, socioeconomic, early life conditions, individual actions, and medical care all interact to affect health. Present quantitative reporting on the impact of these factors on population health grew out of Bills of Mortality published in the 1500s. Since then, regular censuses, civil registration of vital statistics, and international classification systems have improved data quality and comparability. Regular national health interview surveys and application of administrative data contributed information on morbidity, health services use, and some social determinants of health. More recently, traditional health databases and datasets on “nonhealth” sector determinants have been linked. Statistical methods for map-making, risk adjustment, multilevel analysis, calculating population-attributable risks, and summary measures of population health have further helped to integrate information. Reports on the health of populations remain largely confined to focused areas. This paper suggests a conceptual framework for using indicators to report on all the domains of population health. Future ethical development of indicators will incorporate principles of justice, transparency, and effectiveness.
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On Time Series Analysis of Public Health and Biomedical Data
Vol. 27 (2006), pp. 57–79More LessThis paper gives an overview of time series ideas and methods used in public health and biomedical research. A time series is a sequence of observations made over time. Examples in public health include daily ozone concentrations, weekly admissions to an emergency department, or annual expenditures on health care in the United States. Time series models are most commonly used in regression analysis to describe the dependence of the response at each time on predictor variables including covariates and possibly previous values in the series. For example, Bell et al. (2) use time series methods to regress daily mortality in U.S. cities on concentrations of particulate air pollution. Time series methods are necessary to make valid inferences from data by accounting for the correlation among repeated responses over time.
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THE PROMISE AND PITFALLS OF SYSTEMATIC REVIEWS
Vol. 27 (2006), pp. 81–102More Less▪ AbstractThe systematic review “movement” that has transformed medical journal reports of clinical trials and reviews of clinical trials has taken hold in public health, with the most recent milestone, the publication of the first edition of The Guide to Community Health Services in 2005. In this paper we define and distinguish current terms, point out important resources for systematic reviews, describe the impact of systematic review on the quality of primary studies and summaries of the evidence, and provide perspectives on the promise of systematic reviews for shaping the agenda for public health research. Several pitfalls are discussed, including a false sense of rigor implied by the terms “systematic review” and “meta-analysis” and substantial variation in the validity of claims that a particular intervention is “evidence based,” and the difficulty of translating conclusions from systematic reviews into public health advocacy and practice.
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ENVIRONMENTAL JUSTICE: Human Health and Environmental Inequalities
Vol. 27 (2006), pp. 103–124More Less▪ AbstractIn this review, we provide an introduction to the topics of environmental justice and environmental inequality. We provide an overview of the dimensions of unequal exposures to environmental pollution (environmental inequality), followed by a discussion of the theoretical literature that seeks to explain the origins of this phenomenon. We also consider the impact of the environmental justice movement in the United States and the role that federal and state governments have developed to address environmental inequalities. We conclude that more research is needed that links environmental inequalities with public health outcomes.
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SPEED, ROAD INJURY, AND PUBLIC HEALTH
Vol. 27 (2006), pp. 125–152More Less▪ AbstractWe review milestones in the history of increases in speed limits and travel speeds (“speed creep”) and risks for road deaths and injury. Reduced speed limits, speed-camera networks, and speed calming substantially reduce these tolls in absolute numbers—a trend that is apparent in the United Kingdom, Australia, France, and other countries, but not in the United States, which has raised speed limits and does not have speed-camera networks. Newtonian relationships between the fourth power of small increases or reductions in speed and large increases or reductions in deaths state the case for speed control. Speed adaptation and the interaction between speed and other determinants of injury risks, including congestion and countermeasures, enter into these relationships. Speed-camera networks and speed calming lead to large, sustainable, and highly cost-effective drops in road deaths and injuries and should target entire populations, not merely high-risk subgroups or situations. Yet, there are major barriers to preventive strategies based on the discovery that speed kills. Modal shifts from speed on roads to speed on rail, lower maximum vehicle speeds, and speed-camera networks are required for progress toward Vision Zero—the goal of no road deaths—through Killing Speed. The human cost of the delay in killing speed in the United States may be as high as 20,000 lives lost per year.
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THE BIG BANG? AN EVENTFUL YEAR IN WORKERS' COMPENSATION
Vol. 27 (2006), pp. 153–166More Less▪ AbstractWorkers' compensation in the past two years has been dominated by events in California, which have been so fundamental as to merit the term big bang. Passage of Senate Bill 899 has led to a comprehensive program of reform in access to medical care, access to rehabilitation services, temporary and permanent disability, evidence-based management, dispute resolution, and system innovation. Two noteworthy developments thus arose: a new requirement for apportionment by cause in causation analysis, and the adoption of evidence-based criteria for impairment assessment, treatment guidelines, and, soon, utilization review. Elsewhere in the United States, changes were modest, but extensive legislative activity in Texas suggests that Texas will be next to make major changes. In Canada, the Workers' Compensation Board of British Columbia has adopted an ambitious strategic initiative, and there is a Canadawide movement to establish presumption for certain diseases in firefighters. Suggestions for future directions include an increased emphasis on prevention, integration of programs, worker participation, enhancing the expertise of health care professionals, evidence-based management, process evaluation, and opportunities for innovation.
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HEALTH DISPARITIES AND HEALTH EQUITY: Concepts and Measurement
Vol. 27 (2006), pp. 167–194More Less▪ AbstractThere is little consensus about the meaning of the terms “health disparities,” “health inequalities,” or “health equity.” The definitions can have important practical consequences, determining the measurements that are monitored by governments and international agencies and the activities that will be supported by resources earmarked to address health disparities/inequalities or health equity. This paper aims to clarify the concepts of health disparities/inequalities (used interchangeably here) and health equity, focusing on the implications of different definitions for measurement and hence for accountability. Health disparities/inequalities do not refer to all differences in health. A health disparity/inequality is a particular type of difference in health (or in the most important influences on health that could potentially be shaped by policies); it is a difference in which disadvantaged social groups—such as the poor, racial/ethnic minorities, women, or other groups who have persistently experienced social disadvantage or discrimination—systematically experience worse health or greater health risks than more advantaged social groups. (“Social advantage” refers to one's relative position in a social hierarchy determined by wealth, power, and/or prestige.) Health disparities/inequalities include differences between the most advantaged group in a given category—e.g., the wealthiest, the most powerful racial/ethnic group—and all others, not only between the best- and worst-off groups. Pursuing health equity means pursuing the elimination of such health disparities/inequalities.
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THE POLITICS OF PUBLIC HEALTH POLICY
Vol. 27 (2006), pp. 195–233More Less▪ AbstractPolitics, for better or worse, plays a critical role in health affairs. The purpose of this article is to articulate a role for political analysis of public health issues, ranging from injury and disease prevention to health care reform. It begins by examining how health problems make it onto the policy agenda. Perceptions regarding the severity of the problem, responsibility for the problem, and affected populations all influence governmental responses. Next, it considers how bounded rationality, fragmented political institutions, resistance from concentrated interests, and fiscal constraints usually lead political leaders to adopt incremental policy changes rather than comprehensive reforms even when faced with serious public health problems. It then identifies conditions under which larger-scale transformation of health policy can occur, focusing on critical junctures in policy development and the role of policy entrepreneurs in seizing opportunities for innovation. Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. Public health professionals who understand the political dimensions of health policy can conduct more realistic research and evaluation, better anticipate opportunities as well as constraints on governmental action, and design more effective policies and programs.
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VACCINE SHORTAGES: History, Impact, and Prospects for the Future*
Vol. 27 (2006), pp. 235–259More Less▪ AbstractVaccine shortages can result from higher-than-expected demand, interruptions in production/supply, or a lack of resources to purchase vaccines. Each of these factors has played a role in vaccine shortages in the United States during the past 20 years. Since 2000, the United States has experienced an unprecedented series of shortages of vaccines recommended for widespread use against 9 diseases, after more than 15 years without vaccine supply problems. In developing countries, the major cause of vaccine shortages is lack of resources to purchase them. Although there are several steps that could reduce the likelihood of future vaccine shortages, many would take several years to implement. Consequently, we will probably continue to see occasional shortages of vaccines in the United States in the next few years.
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WHAT WORKS, AND WHAT REMAINS TO BE DONE, IN HIV PREVENTION IN THE UNITED STATES
Vol. 27 (2006), pp. 261–275More Less▪ AbstractSince the beginning of the HIV epidemic in the United States, HIV prevention programs have prevented hundreds of thousands of HIV infections, and the investment in these programs has actually been cost-saving to society in terms of medical costs averted. A substantial body of evidence exists (including randomized controlled trials and careful meta-analyses) which demonstrates that various HIV prevention services are effective; an increasingly large body of data also demonstrates the cost-effectiveness of these interventions. However, the efforts to utilize these interventions in a comprehensive HIV prevention program are hampered by insufficient funding, imperfect targeting strategies, and a problematic policy environment that creates barriers to the use of some of these life-saving interventions. Progress toward reducing new HIV infections will likely be as much a function of improvements in funding and policies as it will in the development of new tools for HIV prevention.
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A PUBLIC HEALTH SUCCESS: Understanding Policy Changes Related to Teen Sexual Activity and Pregnancy
Vol. 27 (2006), pp. 277–295More Less▪ AbstractTeenage pregnancy prevention has long been on the American public health agenda. Over the past decade, a number of concurrent federal, state, and local policies have responded to the myriad and diverse needs of adolescents, from supporting adolescents who have not initiated sexual intercourse to strategies aimed at avoiding a repeat pregnancy among teenage parents. Key policies, including comprehensive family life education, access to contraceptive care, and youth development, have resulted in delays in sexual debut, improved contraceptive use, and have achieved reductions in pregnancies, abortions, and births. Although improvements are documented across all ethnic and racial subgroups, substantial health disparities continue to exist. Synergistic policy approaches represent a substantial change from the past when narrow, single-issue strategies were adopted and were limited in their effectiveness. Renewed efforts to implement narrow policy approaches (e.g., abstinence-until-marriage or restrictions to contraceptive access) need to be considered in light of existing research findings.
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AN ECOLOGICAL APPROACH TO CREATING ACTIVE LIVING COMMUNITIES
Vol. 27 (2006), pp. 297–322More Less▪ AbstractThe thesis of this article is that multilevel interventions based on ecological models and targeting individuals, social environments, physical environments, and policies must be implemented to achieve population change in physical activity. A model is proposed that identifies potential environmental and policy influences on four domains of active living: recreation, transport, occupation, and household. Multilevel research and interventions require multiple disciplines to combine concepts and methods to create new transdisciplinary approaches. The contributions being made by a broad range of disciplines are summarized. Research to date supports a conclusion that there are multiple levels of influence on physical activity, and the active living domains are associated with different environmental variables. Continued research is needed to provide detailed findings that can inform improved designs of communities, transportation systems, and recreation facilities. Collaborations with policy researchers may improve the likelihood of translating research findings into changes in environments, policies, and practices.
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PROCESS EVALUATION FOR COMMUNITY PARTICIPATION
Vol. 27 (2006), pp. 323–340More Less▪ AbstractThis review provides a synthesis of published public health and social science literature to determine how process evaluation has been used to examine community participation and its intermediary role in health and social change outcomes. Community participation is defined, and its relationship to other community-development principles and evaluation and research methods is described. Then, case studies and research initiatives help answer questions such as who participates and why? What are the benefits and challenges of community participation? What qualitative and quantitative methods are used in process evaluations to measure community participation? What measures are used to help define the influence of community participation in community-based interventions? A better understanding of these issues is needed to ensure that community participation is valued and used effectively to plan and implement health-promotion initiatives and evaluate their processes and outcomes.
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SHAPING THE CONTEXT OF HEALTH: A Review of Environmental and Policy Approaches in the Prevention of Chronic Diseases
Vol. 27 (2006), pp. 341–370More Less▪ AbstractGiven the growing attention on how environmental and policy interventions can affect chronic disease burden, our objectives are to describe (a) effective and promising interventions to address tobacco use, physical activity, and healthy eating and (b) lessons learned from the literature and practice experience in applying environmental and policy approaches. A total of 17 interventions were reviewed, organized across 3 domains affecting the physical environment/access, economic environment, and communication environment. Many of these interventions are effective. Several lessons are important to consider, such as the need to start with environmental and policy approaches, intervene comprehensively and across multiple levels, make use of economic evaluations, make better use of existing analytic tools, understand the politics and local context, address health disparities, and conduct sound policy research.
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STRESS, FATIGUE, HEALTH, AND RISK OF ROAD TRAFFIC ACCIDENTS AMONG PROFESSIONAL DRIVERS: The Contribution of Physical Inactivity
Vol. 27 (2006), pp. 371–391More Less▪ AbstractStrategies to achieve ambitious targets for reducing road accidents (34) have largely focused on engineering and technological advancements, the modification of occupational demands, and, to a lesser extent, human factors. These factors include stress and psychological states; sleep, fatigue, and alertness; and health status. Physical activity appears to influence all these human factors but has not previously been systematically considered as a direct or indirect risk factor for driver accidents. This chapter provides an overview, within an evidence-based framework, of the impact each of these human factors has on driver performance and risk of at-work road traffic accidents and then examines how physical (in)activity may moderate and mediate these relationships. Finally, we consider practical implications for work site interventions. The review aims to offer an evidence base for the deployment of resources to promote physical activity, manage stress, facilitate sleep, reduce fatigue, and enhance alertness to improve physical and psychological health among professional drivers.
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The Role of Media Violence in Violent Behavior
Vol. 27 (2006), pp. 393–415More Less▪ AbstractMedia violence poses a threat to public health inasmuch as it leads to an increase in real-world violence and aggression. Research shows that fictional television and film violence contribute to both a short-term and a long-term increase in aggression and violence in young viewers. Television news violence also contributes to increased violence, principally in the form of imitative suicides and acts of aggression. Video games are clearly capable of producing an increase in aggression and violence in the short term, although no long-term longitudinal studies capable of demonstrating long-term effects have been conducted. The relationship between media violence and real-world violence and aggression is moderated by the nature of the media content and characteristics of and social influences on the individual exposed to that content. Still, the average overall size of the effect is large enough to place it in the category of known threats to public health.
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AID TO PEOPLE WITH DISABILITIES: Medicaid's Growing Role
Vol. 27 (2006), pp. 417–442More Less▪ AbstractMedicaid is the nation's largest health care program providing assistance with health and long-term care services for millions of low-income Americans, including people with chronic illness and severe disabilities. This article traces the evolution of Medicaid's now-substantial role for people with disabilities; assesses Medicaid's contributions over the last four decades to improving health insurance coverage, access to care, and the delivery of care; and examines the program's future challenges as a source of assistance to children and adults with disabilities. Medicaid has shown that it is an important source of health insurance coverage for this population, people for whom private coverage is often unavailable or unaffordable, substantially expanding coverage and helping to reduce the disparities in access to care between the low-income population and the privately insured.
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FOR-PROFIT CONVERSION OF BLUE CROSS PLANS: Public Benefit or Public Harm?
Vol. 27 (2006), pp. 443–463More Less▪ AbstractConversions of Blue Cross plans to for-profit status have the potential to remake the corporate landscape of health care finance. Absent regulatory intervention, current trends could easily result in more than half of Blue Cross subscribers being in for-profit plans, a phenomenon far more significant than the conversion of nonprofit hospitals. Therefore, regulators' deliberations over conversion proposals are beginning to focus on the health policy impacts. This chapter surveys the full range of health policy implications by analyzing all existing studies of Blue Cross conversions and reporting on the authors' own case studies of conversion impacts. These studies conclude that conversions have not caused major negative impacts on the availability or accessibility of health care in the states in which conversions have occurred so far. However, a great deal of uncertainty exists about the actual effects of previous conversions, and each state is unique; therefore, even if the historical record were clear, it is difficult to predict with great certainty what the actual effects will be in another state undergoing a Blue conversion.
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Previous Volumes
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Volume 45 (2024)
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Volume 44 (2023)
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Volume 43 (2022)
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Volume 42 (2021)
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Volume 41 (2020)
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Volume 40 (2019)
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Volume 39 (2018)
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Volume 38 (2017)
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Volume 37 (2016)
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Volume 36 (2015)
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Volume 35 (2014)
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Volume 34 (2013)
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Volume 33 (2012)
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Volume 32 (2011)
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Volume 31 (2010)
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Volume 30 (2009)
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Volume 29 (2008)
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Volume 28 (2007)
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Volume 27 (2006)
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Volume 26 (2005)
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Volume 25 (2004)
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Volume 24 (2003)
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Volume 23 (2002)
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Volume 22 (2001)
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Volume 21 (2000)
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Volume 20 (1999)
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Volume 19 (1998)
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Volume 18 (1997)
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Volume 17 (1996)
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Volume 16 (1995)
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Volume 15 (1994)
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Volume 14 (1993)
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Volume 13 (1992)
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Volume 12 (1991)
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Volume 11 (1990)
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Volume 10 (1989)
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Volume 9 (1988)
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Volume 8 (1987)
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Volume 7 (1986)
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Volume 6 (1985)
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Volume 5 (1984)
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Volume 4 (1983)
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Volume 3 (1982)
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Volume 2 (1981)
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Volume 1 (1980)
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Volume 0 (1932)