The impact of child restraint legislation on the incidence of severe paediatric injury in Chile.

BACKGROUND: The objective of this study is to determine the association between Chile's 2005 child restraint legislation (CRL) and the incidence of severe paediatric motor vehicle-related injury. METHODS: We analysed motor vehicle injury data from Chile's Road Safety Commission from 2000 to 2012 to determine the association between Chile's 2005 CRL and severe paediatric injury. Using Poisson time-series models we assessed the effect of the law on two outcome variables: (1) severely injured children per vehicle fleet; and (2) severely injured children per population. RESULTS: Chile's 2005 CRL is significantly associated with a 24% reduction in severely injured children per vehicle, and 19% reduction in severely injured children per population in the 1st year of its enactment. In 2007 this law is also significantly associated with a 17% decrease in severely injured children per vehicle, and with an 11% decrease in severely injured children per population. However, this legislation had a short-term effect since no reductions in severely injured children per vehicle were observed after 2009 and no reductions for severely injured children per population were registered after 2008. CONCLUSIONS: This is the first study to examine the association between CRL and severe paediatric injury in a Latin-American country. This study suggests that Chile's CRL was only effective in the short term. To support this type of reforms in the long term, other measures such as police enforcement, public information campaigns and involvement of public health professionals in educating parents about the benefits of using child restraints should be considered.

The Public Health Framework of Legalized Marijuana in Colorado.

On January 1, 2014, Colorado became the first state in the nation to sell legal recreational marijuana for adult use. As a result, Colorado has had to carefully examine potential population health and safety impacts as well as the role of public health in response to legalization. We have discussed an emerging public health framework for legalized recreational marijuana. We have outlined this framework according to the core public health functions of assessment, policy development, and assurance. In addition, we have discussed challenges to implementing this framework that other states considering legalization may face.

Achieving all-age helmet use compliance for snow sports: strategic use of education, legislation and enforcement.

BACKGROUND: Nova Scotia is the first jurisdiction in the world to mandate ski and snowboard helmet use for all ages at ski hills in the province. This study represents a longitudinal examination of the effects of social marketing, educational campaigns and the introduction of helmet legislation on all-age snow sport helmet use in Nova Scotia. METHODS: A baseline observational study was conducted to establish the threshold of ski and snowboarding helmet use. Based on focus groups and interviews, a social marketing campaign was designed and implemented to address factors influencing helmet use. A prelegislation observational study assessed the effects of social marketing and educational promotion on helmet use. After all-age snow sport helmet legislation was enacted and enforced, a postlegislation observational study was conducted to determine helmet use prevalence. RESULTS: Baseline data revealed that 74% of skiers and snowboarders were using helmets, of which 80% were females and 70% were males. Helmet use was high in children (96%), but decreased with increasing age. Following educational and social marketing campaigns, overall helmet use increased to 90%. After helmet legislation was enacted, 100% compliance was observed at ski hills in Nova Scotia. CONCLUSIONS: Results from this study demonstrate that a multifaceted approach, including education, legislation and enforcement, was effective in achieving full helmet compliance among all ages of skiers and snowboarders.

Supplemental Nutrition Assistance Program: Nutrition Education and Obesity Prevention Grant Program. Final rule.

This rule adopts the interim rule implementing the Supplemental Nutrition Assistance Program (SNAP) nutrition education and obesity prevention grant program with changes as provided in this rule. This rule also amends SNAP regulations to implement section 28 of the Food and Nutrition Act (FNA) of 2008, as added by section 241 of the Healthy, Hunger-Free Kids Act (HHFKA) of 2010, to award grants to States for provision of nutrition education and obesity prevention programs. These programs provide services for eligible individuals that promote healthy food choices consistent with the current Dietary Guidelines for Americans (DGAs). The rule provides State agencies with requirements for implementing section 28, including the grant award process and describes the process for allocating the Federal grant funding for each State's approved SNAP-Ed plan authorized under the FNA to carry out nutrition education and obesity prevention services each fiscal year. This final rule also implements section 4028 of the Agricultural Act of 2014 (Farm Bill of 2014), which authorizes physical activity promotion in addition to promotion of healthy food choices as part of this nutrition education and obesity prevention program.

A qualitative review of sports concussion education: prime time for evidence-based knowledge translation.

BACKGROUND: Educating athletes, coaches, parents and healthcare providers about concussion management is a public health priority. There is an abundance of information on sports concussions supported by position statements from governing sport and medical organisations. Yet surveys of athletes, parents, coaches and healthcare providers continue to identify multiple barriers to the successful management of sports concussion. To date, efforts to provide education using empirically sound methodologies are lacking. PURPOSE: To provide a comprehensive review of scientific research on concussion education efforts and make recommendations for enhancing these efforts. STUDY DESIGN: Qualitative literature review of sports concussion education. METHODS: Databases including PubMed, Sport Discus and MEDLINE were searched using standardised terms, alone and in combination, including 'concussion', 'sport', 'knowledge', 'education' and 'outcome'. RESULTS: Studies measuring the success of education interventions suggest that simply presenting available information may help to increase knowledge about concussions, but it does not produce long-term changes in behaviour among athletes. Currently, no empirical reviews have evaluated the success of commercially available sports concussion applications. The most successful education efforts have taken steps to ensure materials are user-friendly, interactive, utilise more than one modality to present information and are embedded in mandated training programmes or support legislation. Psychosocial theory-driven methods used to understand and improve 'buy in' from intended audiences have shown promise in changing behaviour. CONCLUSIONS: More deliberate and methodologically sound steps must be taken to optimise education and knowledge translation efforts in sports concussion.

[Toulouse, an "urban figure of public health". Dealing with public local struggles against health social differences]. / Toulouse, une "figure urbaine de la santé publique". À propos de l'action publique municipale de lutte contre les inégalités sociales de santé.

When drawing up the portrait of "urban figures of public health", in 1998, Didier Fassin considered Toulouse to be one of the worthy "local experiments". Fifteen years after his precursory work, the recently developed local public policy against health social differences gives an opportunity to question ourselves about the effectiveness of such a quality then associated to the city. A cognitive analysis of the elaboration of the Toulousian health public policy meaning enables to notice that the process of health legitimization on a local scale takes the following forms. On the one hand, renaming health as a legitimate object of public policies sets it up as a common wealth. On the other hand, local public policy puts the emphasis on health education and tries to increase the standing of social appraisal coming from associative experiments and abilities of the inhabitants themselves. Finally, it calls for citizens' mobilization and solidarity in order to promote a "health democracy" able to struggle efficiently against health social differences.

Public school parents' perspectives of the Mississippi Healthy Students Act of 2007: findings from 2009-2011.

Annual evaluations of the Mississippi Healthy Students Act of 2007 (MHSA) were conducted from 2009-2011 among four stakeholder groups: (1) parents of public school students; (2) adolescents; (3) school officials (e.g., superintendents); (4) state-level policymakers (e.g., legislators). We examine results from the first state-wide study among a randomized sample of parents (N>3,600 per year) on childhood obesity as it related to MHSA. Parents were surveyed to determine: (1) knowledge/attitudes towards MHSA; (2) knowledge/attitudes/behaviors (KAB) that influence children's health; and (3) perceived overweight/obesity of self and child versus BMI-determined overweight/obesity. Across all three years, parents were very supportive of MHSA across a number of variables, while parents greatly underestimated obesity among self and child when compared to their BMI data. Results highlight complexities of parents' KAB that potentially influence children's health, including the MHSA. Policy implications are discussed.

The impact of graphic cigarette warning labels and smoke-free law on health awareness and thoughts of quitting in Taiwan.

The present study evaluated the impact of Taiwan's graphic cigarette warning labels and smoke-free law on awareness of the health hazards of smoking and thoughts of quitting smoking. National representative samples of 1074 and 1094 people, respectively, were conducted successfully by telephone in July 2008 (pre-law) and March 2009 (post-law). Results reveal that the prevalence of thinking about the health hazards of smoking among smokers increased from 50.6% pre-law to 79.6% post-law, while the prevalence among non-smokers increased from 68.8 to 94.1% during the same period. The prevalence rates of smokers who reported thinking of quitting rose from 30.2% pre-law to 51.7% post-law. Multivariate analyses results indicated that the implementation of graphic warning labels and the smoke-free law significantly increased the odds of awareness about the health hazards of smoking [odds ratio (OR) = 6.39, 95% confidence interval (CI) = 4.84-8.44] and thoughts of quitting smoking (OR = 2.39, 95% CI = 1.48-3.87). In conclusion, the implementation of a smoke-free law in combination with graphic cigarette warning labels has been effective in increasing thoughts about the health hazards of smoking and quitting smoking.

[Nature-like swimming ponds and bathing: public health issues for congruous guidelines]. / Biopiscine e balneazione: considerazioni igienico sanitarie per lo sviluppo di adeguate linee guida.

Nature-like swimming ponds represent an emerging approach to recreational waters. The substitution of traditional disinfection with biodepuration enhances environmental sustainability, but implies relevant public health issues. No European regulations are available while several countries delivered local guidelines. Appropriate microbiological analysis, user education, and correct water management based on HACCP approach, represent key points for the development of future guidelines.

[The activity of the State Sanitary Inspectorate after implementation of the act of January, 23 2009 "Amending certain acts regarding reorganization and redistribution of competences of the public administration at the provincial level"]. / Dzialalnosc Panstwowej Inspekcji Sanitarnej po wdrozeniu przepisów Ustawy z dnia 23 stycznia 2009 r. "O zmianie niektórych ustaw w zwiazku ze zmianami w organizacji i podziale zadan administracji publicznej w województwie".

The restructuring of the State Sanitary Inspectorate was determined by the need to adjust the existing system to the new structure- and task-oriented standards introduced by the administrative reforms at the provincial level. This brought about a lot of changes in the way State County Sanitary Inspectors operate. For first few months after the enforcement of the Act of January 23.2009 amending certain acts regarding reorganization and redistribution of competences of the public administration at the provincial level (Journal of Laws, No. 92, item. 753, 2009) brought about a lot of ambiguities and expectations. Such unresolved issues are typical for the initial or transition period after implementation of a new law. The approach to the operation of the State Sanitary Inspectorate at the county level depicted in the article lays the emphasis on the challenges in the legal and task-oriented domain that arose after coming into force of the aforementioned amendment. By way of conclusion, the authors of the article briefly summaries the practical outcomes of the transformations undergone by the State Sanitary Inspectorate at the county level.

Decolonizing Global Health Education: Rethinking Institutional Partnerships and Approaches.

Global health often entails partnerships between institutions in low- and middle-income countries (LMICs) that were previously colonized and high-income countries (HICs) that were colonizers. Little attention has been paid to the legacy of former colonial relationships and the influence they have on global health initiatives. There have been recent calls for the decolonization of global health education and the reexamination of assumptions and practices under pinning global health partnerships. Medicine's role in colonialism cannot be ignored and requires critical review. There is a growing awareness of how knowledge generated in HICs defines practices and informs thinking to the detriment of knowledge systems in LMICs. Additionally, research partnerships often benefit the better-resourced partner. In this article, the authors offer a brief analysis of the intersections between colonialism, medicine, and global health education and explore the lingering impact of colonialist legacies on current global health programs and partnerships. They describe how "decolonized" perspectives have not gained sufficient traction and how inequitable power dynamics and neocolonialist assumptions continue to dominate. They discuss 5 approaches, and highlight resources, that challenge colonial paradigms in the global health arena. Furthermore, they argue for the inclusion of more transfor mative learning approaches to promote change in attitudes and practice. They call for critical reflection and concomitant action to shift colonial paradigms toward more equitable partnerships in global education.

Increased smoker recognition of a national quitline number following introduction of improved pack warnings: ITC Project New Zealand.

INTRODUCTION: We examined how recognition of a national quitline number changed after new health warnings were required on tobacco packaging in New Zealand (NZ). METHODS: The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) is a cohort study that surveyed smokers in two waves (N = 1,376 and N = 923). Wave 1 respondents were exposed to text-based warnings with a quitline number but no wording to indicate that it was the "Quitline" number. Wave 2 respondents were exposed to pictorial health warnings (PHWs) that included the word "Quitline" beside the number as well as a cessation message featuring the Quitline number and repeating the word "Quitline." RESULTS: The introduction of the new PHWs was associated with a 24 absolute percentage point between-wave increase in Quitline number recognition (from 37% to 61%, p < .001). Recognition increased from a minority of respondents to a majority for all age groups, genders, deprivation levels (using small area and individual measures), financial stress (two measures), and ethnic groups (e.g., the level for Maori in Wave 2: 62%, Pacific peoples: 61%, and European/other: 62%). There was also an equalizing effect on previous differences in Quitline recognition by gender, ethnic group, and for both deprivation measures. DISCUSSION: This study provides some evidence for the value of clearly identifying quitline numbers on tobacco packaging as part of PHWs. While this finding is consistent with previously published studies, the finding that this intervention appeared to benefit all sociodemographic groups is novel.

[Reflections and perspectives on evidence-based health promotion in the French environment]. / Réflexions et perspectives concernant l'evidence-based health promotion dans le contexte français.

In France, current structuring of preventive and health promotion policies has created a context favoring evidence-based actions. Yet, in health promotion and health education, interventions are very much setting dependent, potentially compromising this type of approach to health promotion. Thus, in an attempt to inform participants in health promotion in the French setting of ongoing international debates on the topic, we present the main limitations developed in literature, highlighting recent work responding to the challenge. Our analysis is focused on three points: the issue of the level of intervention and indicators to assess efficacy and effectiveness of health promotion interventions; the issue of research methodologies, their capacity to demonstrate efficacy and effectiveness of health promotion interventions and the transferability of their outcomes; the issue of the external validity of studies, and in particular the information necessary for understanding complex mechanisms of intervention. On the basis of this analysis, and with the aim of improving evidence-based health promotion practices, we propose practical perspectives in the French environment for policymakers, local practitioners and researchers. To conclude, we link this issue with the concept of knowledge transfer, which is developed in other countries.

HIPAA for cancer educators: are you correctly using PHI?

Privacy and confidentiality policies and practices, including Health Insurance Portability and Accountability Act (HIPAA) policies, may vary from institution to institution because they are developed to be institution-specific. HIPAA privacy and security regulations represent the minimum standards, and the expectation is that institutions will develop policies and practices that are reasonable and appropriate for their institution. These privacy and information security safeguards impact the use of sensitive and protected data often used by cancer educators. Therefore, it is important for cancer educators to be familiar with the policies, rules, and guidelines their institution has developed to comply with HIPAA. However, despite institutional differences, certain principles related to the confidentiality, protection, and uses of a patient's health information remain consistent. HIPAA provides two sets of regulations that directly impact the work of many cancer educators: privacy and information security. The HIPAA Privacy Rule includes some security requirements, and HIPAA Security Regulations were designed to ensure privacy of the patient's protected health information (PHI). This paper focuses primarily on the privacy factors.

[The role of regional and local authorities in shaping health-conducive environmental determinants in the light of the Polish legislation]. / Rola samorzadu terytorialnego, gminnego i powiatowego w ksztaltowaniu warunków srodowiska naturalnego sprzyjajacego zdrowiu w swietle ustawodawstwa RP.

BACKGROUND: This study is a continuation of earlier research concerning the role of public health administration (governmental and self-governmental) in health protection and health promotion. The aim of the study was to specify the function of local self-governments (at county, community and district levels) in shaping health-conducive environmental determinants. MATERIAL AND METHODS: Polish legal acts concerning biological, chemical and physical hazards, binding up to November 30, 2009 were the subject of the study. All these acts were analyzed and the provisions referring to the control of the above mentioned hazards and obligations imposed on local self-governments to promote health-conducive environmental factors were identified. RESULTS AND CONCLUSIONS: Of the 41 environment protection legal acts, 24 were selected as the most important from the point of the aim of the analysis. It was found that these acts underline the significance of environmental health determinants and explicitly formulate the role and duties of local authorities in the area of environmental health promotion, as well as in controlling and monitoring harmful biological, chemical and physical factors. The participation of local societies in these activities is also emphasized.