Annual Review of Public Health - Volume 17, 1996

Improvements in life expectancy in the twentieth century have resulted from major declines in mortality at younger ages, but it is less well recognized that mortality declines at older ages have also played a substantial role in prolonging expectation of life. A person reaching age 65 in 1900 could expect to live an additional 11.9 years. Life expectancy at age 65 rose to 14.4 years by 1960 and then increased by about three years in the next three decades, reaching 17.5 years in 1992 (56, 70). As a greater proportion of the population survives to very old ages, the public health impact of the burden of disease and disability and related utilization of medical care and need for supportive and long-term care has become an important concern. In particular, the ability of the older person to function independently in the community is a critically important public health issue. A growing body of research in the last decade has addressed the measurement of disability, factors related to its onset, consequences of disability, and the potential for preventive interventions. This article summarizes the state of the art in these areas and discusses their public health relevance.

Breast cancer is the most common cancer in women, accounting for 32% of all newly diagnosed cancers. Demographic characteristics associated with an increased risk include increasing age, birth in North America or northern Europe, high socioeconomic status, never having been married, and, for breast cancer diagnosed after 45 years of age, the white race. Early age at menarche, late age at menopause, late age at first full-term pregnancy, and low parity increase risk, while removal of the ovaries at an early age is protective. Obesity increases risk in postmenopausal women. Having a first degree relative with breast cancer confers an increased risk, especially if both a mother and a sister have had breast cancer at an early age. Mutations in the BRCAl and BRCA2 genes are associated with an inherited susceptibility to breast cancer at an early age. Other markers of increased risk include atypical and hyperplastic epithelial cells in nipple aspirate fluid, nodular densities on mammogram, and biopsy-confirmed benign proliferative breast disease. Little can be done at present to reduce breast cancer risk through primary prevention, but secondary prevention by mammographic screening in women of age 50 and older reduces mortality from breast cancer.

Major progress has been made to control cervical cancer in the United States and Europe using screening programs, although it remains a major cause of morbidity and mortality in the developing world. The association between cervical cancer and a sexually transmissible etiologic agent was hypothesized long before identification of human papillomaviruses (HPV) as agents that infected the genital tract. HPVs are among the most common sexually transmitted agents and have been shown to induce several squamous anogenital cancers, including squamous cell cancer of the cervix. After an etiologic role for HPV was identified in cervical cancer and CIN, efforts to understand the molecular biology of HPV were greatly expanded, enhanced by the advent of deoxyribonucleic acid (DNA) probes to identify HPV infection. Recent research has focused on specific types of HPV in relation to other recognized risk factors in the pathogenesis of CIN and invasive cervical cancer.

Chronic open angle glaucoma is an etiologically heterogeneous group of diseases characterized by damage to the optic nerve, resulting in peripheral visual loss that can progress to involve the fovea and central vision. Open angle glaucoma can be divided into primary conditions and conditions which are secondary to another ocular or systemic disease. Causes of secondary glaucoma include uveitis, cataract, trauma, and disorders affecting the development structure of the angle. This review focuses on primary open angle glaucoma (POAG), since it accounts for the vast majority of the disease burden in the US population and its etiology remains unknown.

In the mid-1980s a new, smokable form of cocaine, called crack, was introduced in the United States. Soon thereafter, it became apparent that crack cocaine abuse was a serious and important public health concern. Over the past several years, crack cocaine use has increasingly been associated with a myriad of immediate and long-term adverse effects. Duing this same period, crack cocaine use has progressively moved away from experimentation and recreational use to chronic and compulsive drug use.

In this review, we focus our discussion on studies examining effects on children and young adults. We believe that the current epidemic of youth violence in the United States justifies a focus on this vulnerable segment of society. We consider media effects on individual children’s behaviors, such as imitating aggressive acts. In addition, we examine how the media influence young people’s perceptions of norms regarding interpersonal relationships. Next, we assess mass media effects on societal beliefs, or what children and adolescents think the “real world” is like. We suggest these media influences are cumulative and mutually reinforcing, and discuss the implications of repeated exposure to prominent and prevalent violent media messages. Finally, we catalog multiple intervention possibilities ranging from education to regulation. From a public health perspective, therefore, we evaluate the effects that pervasive media messages depicting violence have on young people and present multiple strategies to promote more healthful outcomes.

Healthy Cities is a community problem-solving process for health promotion that began in Canada and Europe in the mid-1980s. Although Healthy Cities have expanded worldwide, there is limited scientific literature that documents the effects of these efforts. This review describes the dynamic status of Healthy Cities globally and summarizes what is known about these efforts. It is difficult to draw generalizations or clear differences between Healthy Cities and other efforts with similar objectives in the United States. There appears to be less variation among Healthy Cities in Europe, most likely because of the extensive technical support provided by the WHO European Regional Office to the Healthy Cities Project. Case descriptions present the diversity and types of activities of Healthy Cities. It is concluded that community participation and broad involvement from different sectors of the community are promising approaches to addressing urban problems.

Homeless women are a large and diverse group, constituting one fifth of the US homeless adult population. Although most homeless women do not have major mental illness, homeless women exhibit disproportionately high rates of major mental disorders and other mental problems. Rates of mental disorders are highest among whites and women without children, and important variations by subgroups of homeless women reinforce the need for disaggregated analysis. Many homeless women with serious mental illness are not receiving needed care, apparently due in part to the lack of perception of a mental health problem and the lack of services designed to meet the special needs of homeless women.