Public Health and Preventive Medicine [15&nbsp;ed.] 0071441980, 9780071441988
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fifteenth edition

Wallace/Maxcy-Rosenau-Last

Public Health & Preventive Medicine Editor Robert B. Wallace, MD, MSc Associate Editor Neal Kohatsu, MD Editor Emeritus John M. Last, MD, DPH

Section Editors Ross Brownson, PhD • Arnold J. Schecter, MD, MPH • F. Douglas Scutchﬁeld, MD Stephanie Zaza, MD, MPH

NEW YORK / CHICAGO / SAN FRANCISCO / LISBON / LONDON MADRID / MEXICO CITY / MILAN / NEW DELHI / SAN JUAN SEOUL / SINGAPORE / SYDNEY / TORONTO

Copyright © 2008 by The McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. 0-07-159318-7 The material in this eBook also appears in the print version of this title: 0-07-144198-0. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. For more information, please contact George Hoare, Special Sales, at [email protected] or (212) 904-4069. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGrawHill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. DOI: 10.1036/0071441980

Preparation of this edition was sponsored by the Association for Prevention Teaching and Research (formerly Association of Teachers of Preventive Medicine (ATPM)), Washington, DC. APTR is the national professional association of academic professionals dedicated to interprofessional health promotion and disease prevention education and research. APTR provides essential linkages to bring together individuals and institutions from all professions to advance health promotion and disease prevention. For more information about APTR, call 202/463-0550, e-mail [email protected], or visit the www.aptrweb.org.

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Contents Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxiii

C.

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxix Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxxi Historical Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxxiii

9 Diseases Controlled Primarily by Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . .101 A.

Section I Public Health Principles and Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Edited by Robert B. Wallace 1 Public Health and Preventive Medicine: Trends and Guideposts . . . . . . . . . . . . . . . . . . . . . . .3 Robert B. Wallace 2 Epidemiology and Public Health . . . . . . . . . . . . . . .5 Robert B. Wallace 3 Ethics and Public Health Policy . . . . . . . . . . . . . . .27 Colin L. Soskolne and John M. Last

HEALTH ADVICE FOR INTERNATIONAL TRAVEL . . .87 Christie M. Reed, Stefanie Steele, and Jay S. Keystone

MEASLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101 Walter A. Orenstein, Mark Papania, Peter Strebel, and Alan R. Hinman

B.

MUMPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105 Francisco Averhoff and Melinda E. Wharton

C.

RUBELLA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108 Susan E. Reef

D.

PERTUSSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111 Margaret Mary Cortese and Kristine M. Bisgard

E.

TETANUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115 Katrina Kretsinger, John S. Moran, and Martha H. Roper

4 Public Health and Population . . . . . . . . . . . . . . . .39 Robert B. Wallace

F.

5 Public Health Informatics . . . . . . . . . . . . . . . . . . . .49 David A. Ross and Alan R. Hinman

G. INFLUENZA

6 Health Disparities and Community-Based Participatory Research: Issues and Illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . .55 N. Andrew Peterson, Joseph Hughey, John B. Lowe, Andria D. Timmer, John E. Schneider, and Jana J. Peterson 7 Genetic Determinants of Disease and Genetics in Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 Fred Lorey Section II Communicable Diseases . . . . . . . . . .75 Edited by Stephanie Zaza

8 Control of Communicable Diseases . . . . . . . . . . . .77 A.

OVERVIEW OF COMMUNICABLE DISEASES . . . . . . .77 Richard P. Wenzel

B.

EMERGING MICROBIAL THREATS TO HEALTH SECURITY . . . . . . . . . . . . . . . . . . . . . . . . . . .79

AND

Stephen M. Ostroff and James M. Hughes

DIPHTHERIA . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Tejpratap S.P. Tiwari

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .120

Mark Katz H.

HAEMOPHILUS INFLUENZAE INFECTIONS . . . . . . .124 Michelle A. Chang, Brendan Flannery, and Nancy Rosenstein

I.

VARICELLA AND HERPES ZOSTER . . . . . . . . . . . .127 Dalya Guris, Mona Marin, and Jane F. Seward

J.

POLIOMYELITIS . . . . . . . . . . . . . . . . . . . . . . . . . .133 Roland W. Sutter and Stephen L. Cochi

K.

PNEUMOCOCCAL INFECTIONS . . . . . . . . . . . . . . .137 Robert B. Wallace

10 Epidemiology and Trends in Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . .155 David Friedel and Suzanne Lavoie 11 The Epidemiology and Prevention of Human Immunodeﬁciency Virus (HIV) Infection and Acquired Immunodeﬁciency Syndrome (AIDS) . . .189 Alan E. Greenberg, D. Peter Drotman, James W. Curran, and Robert S. Janssen vii

Contents

viii

12 Infections Spread by Close Personal Contact . . .201 A.

ACUTE RESPIRATORY INFECTIONS . . . . . . . . . . . .201 Javier Ena

B.

VIRAL HEPATITIS . . . . . . . . . . . . . . . . . . . . . . . .211 Joanna Buffington and Eric Mast

C.

ASEPTIC MENINGITIS . . . . . . . . . . . . . . . . . . . . .228

14 Control of Infections in Institutions: Healthcare-Associated Infections . . . . . . . . . . . . .333 R. Monina Klevens and Denise M. Cardo 15 Viral Diseases Transmitted Primarily by Arthropod Vectors . . . . . . . . . . . . . . . . . . . . . .341 A.

Jeffery L. Meier D.

EPSTEIN-BARR VIRUS AND INFECTIOUS MONONUCLEOSIS . . . . . . . . . . . . . . . . . . . . . . . .230

B.

Jeffrey L. Meier E.

HERPES SIMPLEX VIRUS . . . . . . . . . . . . . . . . . . .232 CYTOMEGALOVIRUS INFECTIONS . . . . . . . . . . . . .235

C.

GROUP A STREPTOCOCCAL DISEASES . . . . . . . . .237

D.

MENINGOCOCCAL DISEASE . . . . . . . . . . . . . . . . .245

E.

F.

J.

K.

G.

H.

TRYPANOSOMIASIS . . . . . . . . . . . . . . . . . . . . . . .392 Louis V. Kirchhoff

ACUTE GASTROINTESTINAL INFECTIONS . . . . . . .263 Victoria Valls

LYME DISEASE . . . . . . . . . . . . . . . . . . . . . . . . . .386 Larissa A. Minicucci

LEPROSY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258 Kenrad E. Nelson

MALARIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .373 S. Patrick Kachur, Alexandre Macedo de Oliveira, and Peter B. Bloland

TUBERCULOSIS . . . . . . . . . . . . . . . . . . . . . . . . . .248 Douglas B. Hornick

PLAGUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .370 J. Erin Staples

Montse Soriano-Gabarró and Nancy Rosenstein I.

Q FEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .368 Herbert A. Thompson and David L. Swerdlow

Susan Assanasen and Gonzalo M.L. Bearman H.

RICKETTSIAL INFECTIONS . . . . . . . . . . . . . . . . . .362 Marta A. Guerra and David L. Swerdlow

Anne Blaschke and James F. Bale, Jr. G.

EPIDEMIOLOGY OF VIRAL HEMORRHAGIC FEVERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .352 James W. LeDuc

Richard J. Whitley F.

VIRAL INFECTIONS . . . . . . . . . . . . . . . . . . . . . . .341 Elizabeth A. Kleiner and Richard P. Wenzel

I.

LEISHMANIASIS . . . . . . . . . . . . . . . . . . . . . . . . . .394 Mary E. Wilson

13 Diseases Spread by Food and Water . . . . . . . . . .301 A.

SHIGELLOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . .303

LYMPHATIC FILARIASIS . . . . . . . . . . . . . . . . . . . .398 Amy D. Klion

TYPHOID FEVER . . . . . . . . . . . . . . . . . . . . . . . . .301 Pavani Kalluri and Eric D. Mintz

B.

J.

16 Diseases Transmitted Primarily from Animals to Humans (Zoonoses) . . . . . . . . . . . . . .419

Anna Bowen and Eric D. Mintz C.

CHOLERA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304

A.

Margaret Kosek and Robert E. Black D.

ESCHERICHIA COLI DIARRHEA . . . . . . . . . . . . . .308

B.

YERSINIOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . .310 M. Patricia Quinlisk

F.

LEGIONELLOSIS . . . . . . . . . . . . . . . . . . . . . . . . .311 Matthew R. Moore and Barry S. Fields

G.

AMEBIASIS AND AMEBIC MENINGOENCHEPHALITIS . . . . . . . . . . . . . . . . . .313 William Stauffer

H.

GIARDIASIS . . . . . . . . . . . . . . . . . . . . . . . . . . . .317 Mary E. Wilson

I.

DRACUNCULIASIS . . . . . . . . . . . . . . . . . . . . . . . .320

C.

HUMAN ENTERIC COCCIDIAL INFECTIONS . . . . . .322 Katharine Bar

TOXOPLASMOSIS . . . . . . . . . . . . . . . . . . . . . . . . .440 Jeffrey L. Jones and Jacob K. Frenkel

Donald R. Hopkins J.

BACTERIA 1. Bacterial Zoonoses—Psittacosis . . . . . . . . . . . . . .423 Lauri A. Hicks and Maria Lucia Tondella 2. Tularemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .424 Paul S. Mead 3. Anthrax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .427 Sean V. Shadomy and Nancy E. Rosenstein 4. Brucellosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .431 Diane K. Gross and Thomas A. Clark 5. Leptospirosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .434 Thomas A. Clark 6. Non-Typhoidal Salmonellosis . . . . . . . . . . . . . . . .437 John Painter, Michael Perch, and Andrew C. Voetsch

Margaret Kosek and Robert E. Black E.

VIRAL ZOONOSES—RABIES . . . . . . . . . . . . . . . .419 Charles E. Rupprecht

D.

TRICHINELLOSIS . . . . . . . . . . . . . . . . . . . . . . . . .443 Michael P. Stevens and Michael Edmond

Contents E.

CLONORCHIASIS AND OPISTHORCHIASIS . . . . . . .445 Kenrad E. Nelson

F.

CESTODE INFECTIONS . . . . . . . . . . . . . . . . . . . . .447 1. Taeniasis and Cysticercosis . . . . . . . . . . . . . . . .447 Kenrad E. Nelson 2. Hydatid Disease (Echinococcosis) . . . . . . . . . . .448 Pedro L. Moro and Peter M. Schantz

17 Opportunistic Fungal Infections . . . . . . . . . . . . .461 Michael A. Pfaller 18 Other Infection-Related Diseases of Public Health Import . . . . . . . . . . . . . . . . . . . . . . . . . . . .469 A.

DERMATOPHYTES . . . . . . . . . . . . . . . . . . . . . . . .469 Marta J. VanBeek

B.

HOOKWORM DISEASE: ANCYLOSTOMIASIS, NECATORIASIS, UNCINARIASIS . . . . . . . . . . . . . .473 Laverne K. Eveland

C.

OTHER INTESTINAL NEMATODES . . . . . . . . . . . . .476 Mark R. Wallace, John W. Sanders, and Shannon D. Putnam

D.

SCHISTOSOMIASIS . . . . . . . . . . . . . . . . . . . . . . . .480 Ettie M. Lipner and Amy D. Klion

E.

TOXIC SHOCK SYNDROME (STAPHYLOCOCCAL) . .483

ix

25 Silicosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .591 Stephen Levin and Ruth Lilis 26 Health Signiﬁcance of Metal Exposures . . . . . . .603 Philippe Grandjean 27 Diseases Associated with Exposure to Chemical Substances: Organic Compounds . . . . . . . . . . . .619 Stephen Levin and Ruth Lilis 28 Polychlorinated Biphenyls . . . . . . . . . . . . . . . . . .675 Richard W. Clapp 29 Polychlorinated Dioxins and Polychlorinated Dibenzofurans . . . . . . . . . . . . . . . . . . . . . . . . . . . .679 Yoshito Masuda and Arnold J. Schecter 30 Brominated Flame Retardants . . . . . . . . . . . . . . .685 Daniele F. Staskal and Linda S Birnbaum 31 Multiple Chemical Sensitivities . . . . . . . . . . . . . .687 Mark R. Cullen 32 Pulmonary Responses to Gases and Particles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .691 Kaye H. Kilburn

Arthur L. Reingold F.

REYE’S SYNDROME . . . . . . . . . . . . . . . . . . . . . .492 Robert B. Wallace

Section III Environmental Health . . . . . . . . . . .501

33 Pesticides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .707 Marion Moses 34 Temperature and Health . . . . . . . . . . . . . . . . . . . .725 Edwin M. Kilbourne

Edited by Arnold J. Schecter

19 The Status of Environmental Health . . . . . . . . . .503 Arthur L. Frank 20 Toxicology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .505 A.

PRINCIPLES OF TOXICOLOGY . . . . . . . . . . . . . . . .505 Michael Gochfeld

B.

NEUROBEHAVIORAL TOXICITY . . . . . . . . . . . . . . .523 Nancy Fiedler, Joanna Burger, and Michael Gochfeld

21 Environmental and Ecological Risk Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . .545 Michael Gochfeld and Joanna Burger 22 Biomarkers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .563 Michael D. McClean and Thomas F. Webster 23 Asbestos and Other Fibers . . . . . . . . . . . . . . . . . .567 Kaye H. Kilburn 24 Coal Workers’ Lung Diseases . . . . . . . . . . . . . . . .583 Gregory R. Wagner and Michael D. Attﬁeld

35 Ionizing Radiation . . . . . . . . . . . . . . . . . . . . . . . . .735 Arthur C. Upton 36 Nonionizing Radiation . . . . . . . . . . . . . . . . . . . . .743 Arthur L. Frank and Louis Slesin 37 Effects of the Physical Environment: Noise as a Health Hazard . . . . . . . . . . . . . . . . . . .755 Aage R. Møller 38 Ergonomics and Work-Related Musculoskeletal Disorders . . . . . . . . . . . . . . . . . .763 W. Monroe Keyserling and Thomas J. Armstrong 39 Industrial Hygiene . . . . . . . . . . . . . . . . . . . . . . . . .781 Robert F. Herrick 40 Surveillance and Health Screening in Occupational Health . . . . . . . . . . . . . . . . . . . . .789 Gregory R. Wagner and Lawrence J. Fine 41 Workers with Disabilities . . . . . . . . . . . . . . . . . . .795 Nancy R. Mudrick, Robert J. Weber, and Margaret A. Turk

x

Contents

42 Environmental Justice: From Global to Local . . .803 Howard Frumkin, Enrique Cifuentes, and Mariana I. Gonzalez

58 Risk Communication—An Overlooked Tool for Improving Public Health . . . . . . . . . . . . . . .1029 David P. Ropeik

43 The Health of Hired Farmworkers . . . . . . . . . . .819 Don Villarejo and Marc B. Schenker

59 Health Literacy . . . . . . . . . . . . . . . . . . . . . . . . . .1035 Rima E. Rudd, Jennie E. Anderson Sarah C. Oppenheimer, Lindsay E. Rosenfeld, and Carmen Gomez Mandic

44 Women Workers . . . . . . . . . . . . . . . . . . . . . . . . . .827 Karen Messing 45 Health Hazards of Child Labor . . . . . . . . . . . . . .835 Susan H. Pollack and Philip J. Landrigan 46 Occupational Safety and Health Standards . . . .841 Eula Bingham and Celeste Monforton 47 Ensuring Food Safety . . . . . . . . . . . . . . . . . . . . . .847 Douglas L. Marshall and James S. Dickson 48 Water Quality Management and Water-Borne Disease Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . .863 Patricia L. Meinhardt 49 Hazardous Waste: Assessing, Detecting, and Remediation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .901 William A. Suk 50 Aerospace Medicine . . . . . . . . . . . . . . . . . . . . . . .909 Roy L. DeHart 51 Housing and Health . . . . . . . . . . . . . . . . . . . . . . . .919 John M. Last 52 Human Health in a Changing World . . . . . . . . . .925 John M. Last and Colin L. Soskolne Section IV Behavioral Factors Affecting Health . . . . . . . . . . . . . . . . . . . . . . . . . . .939

Section V Noncommunicable and Chronic Disabling Conditions . . . . . . . . . . . . . . . . . . . . .1041 Edited by Ross Brownson

60 Screening for Early and Asymptomatic Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1043 Robert B. Wallace 61 Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1047 Leslie K. Dennis, Charles F. Lynch, and Elaine M. Smith 62 Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . .1071 Russell V. Luepker 63 Renal and Urinary Tract Disease . . . . . . . . . . . .1089 Rebecca L. Hegeman 64 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1101 Janice C. Zgibor, Janice S. Dorman, and Trevor J. Orchard 65 Respiratory Disease Prevention . . . . . . . . . . . . .1113 David B. Coultas and Jonathan M. Samet 66 Musculoskeletal Disorders . . . . . . . . . . . . . . . . .1125 Jennifer L. Kelsey and MaryFran Sowers

Edited by Neal Kohatsu

67 Neurological Disorders . . . . . . . . . . . . . . . . . . . .1139 James C. Torner and Robert B. Wallace

53 Health Behavior Research and Intervention . . . .941 Kim D. Reynolds, Donna Spruijt-Metz, and Jennifer Unger

68 Disabling Visual Disorders . . . . . . . . . . . . . . . . .1153 Dawn M. Oh and Kean T. Oh

54 Tobacco: Health Effects and Control . . . . . . . . .953 Corinne G. Husten and Stacy L. Thorne

69 Psychiatric Disorders . . . . . . . . . . . . . . . . . . . . .1161 Evelyn J. Bromet

55 Alcohol-Related Health Problems . . . . . . . . . . . .999 Brian L. Cook and Jill Liesveld

70 Childhood Cognitive Disability . . . . . . . . . . . . .1173 Maureen S. Durkin, Nicole Schupf, Zena A. Stein, and Mervyn W. Susser

56 Prevention of Drug Use and Drug Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . .1013 Elizabeth B. Robertson and Wilson M. Compton

71 Prevention of Disability in Older Persons . . . .1185 William H. Barker

57 Community Health Promotion and Disease Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1023 Stephanie Zaza and Peter A. Briss

72 Nutrition in Public Health and Preventive . . . .1195 Medicine Marion Nestle

Contents

73 Postmarketing Medication Safety Surveillance: A Current Public Health Issue . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1205 Mirza I. Rahman and Omar H. Dabbous

E.

xi

PUBLIC HEALTH MANAGEMENT TOOLS EVALUATION . . . . . . . . . . . . . . . . . . . . . . . . . . .1280 Thomas G. Rundall

79 Categorical Public Health Sciences . . . . . . . . . .1285 Section VI Health-Care Planning, Organization, and Evaluation . . . . . . . . . . . . . .1215

A.

Edited by F. Douglas Scutchﬁeld

74 The American Health-Care System: Structure and Function . . . . . . . . . . . . . . . . . . . .1217 Glen P. Mays and F. Douglas Scuthﬁeld 75 Structure and Function of the Public Health System in the United States . . . . . . . . . . . . . . . .1239 F. Douglas Scutchﬁeld and C. William Keck

DISASTER PREPAREDNESS AND RESPONSE . . . . .1285 Theodore J. Cieslak, Scott R. Lillibridge, Trueman W. Sharp, George W. Christopher, and Edward M. Eitzen

B.

MATERNAL AND CHILD HEALTH . . . . . . . . . . . .1294 Lewis H. Margolis and Alan W. Cross

C.

PREVENTIVE MEDICINE SUPPORT OF MILITARY OPERATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . .1297 Robert L. Mott

D.

PUBLIC HEALTH WORKFORCE . . . . . . . . . . . . . .1300 Kristine M. Gebbie

76 International and Global Health . . . . . . . . . . . .1251 Franklin M.M. White and Debra J. Nanan 77 Public Health Law . . . . . . . . . . . . . . . . . . . . . . . .1259 Edward P. Richards, III and Katharine C. Rathbun

E.

FAMILY PLANNING . . . . . . . . . . . . . . . . . . . . . .1303 Herbert B. Peterson, Andreea Creanga, and Amy O. Tsui

Section VII Injury and Violence . . . . . . . . . . . .1317 Edited by Neal Kohatsu

78 Public Health Management Tools . . . . . . . . . . .1267 A.

PLANNING FOR HEALTH IMPROVEMENT: MODELS FOR COMMUNITIES AND INSTITUTIONS . . . . . . .1267 K. Michael Peddecord

B.

PUBLIC HEALTH LEADERSHIP DEVELOPMENT . .1271 Kathleen Wright and Cynthia D. Lamberth

C.

POLICY DEVELOPMENT . . . . . . . . . . . . . . . . . . .1272 Helen H. Schauffler

D.

QUALITY ASSURANCE AND QUALITY IMPROVEMENT . . . . . . . . . . . . . . . . . . . . . . . . .1277 Richard S. Kurz

80 Injury Control: The Public Health Approach . . . . . . . . . . . . . . . . . . . . . . . . .1319 Corinne Peek-Asa and Erin O. Heiden 81 Violence in the Family as a Public Health Concern . . . . . . . . . . . . . . . . . . . . . . .1329 Irene Hanson Frieze, Jeremiah A. Schumm, and Stacey L. Williams Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1335

Contributors Jennie Epstein Anderson, BA Coordinator of Health Literacy Studies Harvard School of Public Health Boston, Massachusetts 59. Health Literacy

Katharine June Bar, MD Fellow in Infectious Diseases University of Alabama at Birmingham Birmingham, Alabama 13J. Human Enteric Coccidial Infections

Thomas J. Armstrong, PhD, MPH Professor Department of Industrial and Operations Engineering Department of Biomedical Engineering Department of Environmental Sciences Ann Arbor, Michigan 38. Ergonomics and Work-Related Musculoskeletal Disorders

William H. Barker, MD, FRCP Edin Professor Emeritus Preventive Medicine and Gerontology University of Rochester Rochester, New York 71. Prevention of Disability in Older Persons

Susan Assanasen, MD Research Fellow in Hospital Epidemiology Virginia Commonwealth University Medical Center Richmond, Virginia Clinical Instructor Division of Infectious Diseases and Tropical Medicine Department of Internal Medicine, Siriraj Hospital Bangkok, Thailand 12G. Group A Streptococcal Diseases Michael Deryck Attﬁeld, BSc, PhD, FSS Surveillance Branch Chief Division of Respiratory Disease Studies Morgantown, West Virginia 24. Coal Worker’s Lung Diseases Francisco Averhoff, MD, MPH Medical Officer Epidemiology and Surveillance Division National Immunization Program Centers for Disease Control and Prevention Atlanta, Georgia 9B. Mumps James F. Bale, Jr., MD Professor and Associate Chair Departments of Pediatrics and Neurology University of Utah School of Medicine Pediatric Residency Office Primary Children’s Medical Center Salt Lake City, Utah 12F. Cytomegalovirus Infections

Gonzalo M.L. Bearman, MD, MPH Assistant Professor of Medicine, Epidemiology and Community Medicine Associate Hospital Epidemiologist Virginia Commonwealth University Richmond, Virginia 12G. Group A Streptococcal Diseases Eula Bingham, PhD Professor University of Cincinnati College of Medicine Cincinnati, Ohio 46. Occupational Safety and Health Standards Linda S. Birnbaum, PhD, DABT U.S. Environmental Protection Agency Research Triangle Park, North Carolina 30. Brominated Flame Retardants Kristine M. Bisgard, DVM, MPH Medical Epidemiologist National Immunization Program Centers for Disease Control and Prevention Atlanta, Goeogia 9D. Pertussis Robert Edward Black, MD, MPH Edgar Berman Professor & Chair Department of International Health Bloomberg School of Public Health Johns Hopkins University Baltimore, Maryland 13C. Cholera 13D. Escherichia coli Diarrhea xiii

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Contributors

Anne Blaschke, MD, PhD Instructor, Department of Pediatrics Division of Pediatric Infectious Diseases University of Utah School of Medicine Salt Lake City, Utah 12F. Cytomegalovirus Infections Peter B. Bloland, DVM, MPVM Malaria Branch, Division of Parasitic Diseases Centers for Disease Control and Prevention Atlanta, Georgia 15F. Malaria

Denise M. Cardo, MD Director Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta, Georgia 14. Control of Infections in Institutions: Healthcare-Associated Infections Michelle A. Chang, MD Medical Epidemiologist Centers for Disease Control and Prevention Atlanta, Georgia 9H. Haemophilus Inﬂuenzae Infections

Anna Bowen, MD, MPH Medical Epidemiologist Enteric Diseases Epidemiology Branch Centers for Disease Control and Prevention Atlanta, Georgia 13B. Shigellosis

George W. Christopher, MD Assistant Professor of Medicine Uniformed Services University of the Health Sciences Lackland Air Force Base, Texas 79A. Disaster Preparedness and Response

Peter A. Briss, MD, MPH Director, Community Guide Centers for Disease Control and Prevention Atlanta, Georgia 57. Community Health Promotion and Disease Prevention

Theodore J. Cieslak, MD Chairman, San Antonio Military Pediatric Center Biodefense Consultant Office of the Army Surgeon General Department of Pediatrics, Brooke Army Medical Center Fort Sam Houston, Texas 79A. Disaster Preparedness and Response

Evelyn J. Bromet, PhD Professor of Psychiatry & Preventive Medicine Department of Psychiatry and Behavioral Science State University of New York at Stony Brook Stony Brook, New York 69. Psychiatric Disorders

Enrique Cifuentes, MD, PhD Professor Children’s Hospital, Morelos, (Mexico) Sta Maria Ahuacatitlan. Cuernavaca, Morelos, Mexico 42. Environmental Justice

Ross C. Brownson, PhD Professor of Epidemiology School of Public Health, Saint Louis University St. Louis, Missouri Editor of Section V: Noncommunicable and Chronic Disabling Conditions

Richard W. Clapp, DSc, MPH Professor, Boston University School of Public Health Adjunct Professor, University of Massachusetts Boston, Massachusetts 28. Polychlorinated Biphenyls

Joanna Buffington, MD, MPH Medical Epidemiologist Division of Viral Hepatitis Centers for Disease Control and Prevention Atlanta, Georgia 12B. Viral Hepatitis Joanna Burger, PhD Distinguish Professor Division of Life Sciences Rutgers University Piscataway, New Jersey 20B. Neurobehavioral Toxicity 21. Environmental and Ecological Risk Assessment

Thomas A. Clark, MD, MPH Medical Epidemiologist National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Atlanta, Georgia 16B4. Brucellosis 16B5. Leptospirosis Stephen L. Cochi, MD, MPH Acting Director National Immunization Program Centers for Disease Control and Prevention Atlanta, Georgia 9J. Poliomyelitis

Contributors

Wilson M. Compton, MD, MPE Director, Division of Epidemiology, Services and Prevention Research National Institute on Drug Abuse Bethesda, Maryland 56. Prevention of Drug Use and Drug Use Disorders

Omar H. Dabbous, MD, MPH Associate Director, Health Economics and Clinical Outcomes Research, Medical Affairs Centocor Incorporated Horsham, Pennsylvania 73. Postmarketing Medication Safety Surveillance

Brian L. Cook, DO Professor and Vice Chair of Psychiatry University of Iowa Carver College of Medicine Iowa City, Iowa 55. Alcohol-Related Health Problems

Roy L. DeHart, MD, MPH, MS Professor and Medical Director Corporate Health Services Vanderbilt University Medical Center Nashville, Tennessee 50. Aerospace Medicine

Margaret Mary Cortese, MD Medical Epidemiologist National Immunization Program Centers for Disease Control and Prevention Atlanta, Georgia 9D. Pertussis David B. Coultas, MD Physician-in-Chief, Professor and Chair Department of Medicine University of Texas Health Center at Tyler Tyler, Texas 65. Respiratory Disease Prevention Andreea A. Creanga, MD Postdoctoral Fellow Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland 79E. Family Planning Alan W. Cross, MD Clinical Professor, Maternal and Child Health Department of Social Medicine University of North Carolina at Chapel Hill Chapel Hill, North Carolina 79B. Maternal and Child Health Mark R. Cullen, MD Professor of Medicine and Public Health Yale Occupational and Environmental Medicine Program New Haven, Connecticut 31. Multiple Chemical Sensitivities James W. Curran, MD, MPH Dean and Professor of Epidemiology Rollins School of Public Health of Emory University Atlanta, Georgia 11. The Epidemiology and Prevention of Human Immunodeﬁciency Virus (HIV) Infection and Acquired Immunodeﬁciency Syndrome (AIDS)

Leslie K. Dennis, MS, PhD Associate Professor Department of Epidemiology University of Iowa Iowa City, Iowa 61. Cancer James S. Dickson, PhD Professor Department of Animal Science Iowa State University Ames, Iowa 47. Ensuring Food Safety Janice S. Dorman, MS, PhD Associate Dean for Scientiﬁc & International Affairs University of Pittsburgh, School of Nursing Pittsburgh, Pennsylvania 64. Diabetes D. Peter Drotman, MD, MPH Editor-in-Chief Emerging Infectious Diseases Centers for Disease Control and Prevention Atlanta, Georgia 11. The Epidemiology and Prevention of Human Immunodeﬁciency Virus (HIV) Infection and Acquired Immunodeﬁciency Syndrome (AIDS) Maureen S. Durkin, PhD, DrPH Associate Professor Department of Population Health Sciences University of Wisconsin School of Medicine and Public Health and Waisman Center Madison, Wisconsin 70. Childhood Cognitive Disability Michael B. Edmond, MD, MPH, MPA Professor of Internal Medicine, Epidemiology and Community Health Virginia Commonwealth University School of Medicine Richmond, Virginia 16D. Trichinellosis

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xvi

Contributors

Edward M. Eitzen, Jr., MD, MPH Adjunct Associate Professor of Emergency Medicine and Pediatrics Uniformed Services University of the Health Sciences Bethesda, Maryland 79A. Disaster Preparedness and Response Javier Ena, MD Consultant Internal Medicine Department Hospital Marina Baixa Alicante, Spain 12A. Acute Respiratory Infections Laverne K. Eveland, MS, PhD Professor Biological Sciences California State University Long Beach, California 18B. Hookworm Disease Mariana Irina Gonzalez Fernandez, BA Research Assistant Student, Master in Sciences (Environmental Health) Sta Maria Ahuacatitlan Cuernavaca, Morelos, Mexico 42. Environmental Justice Nancy L. Fiedler, PhD Associate Professor University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School Piscataway, New Jersey 20B. Neurobehavioral Toxicity Barry S. Fields, PhD Respiratory Diseases Branch Centers for Disease Control and Prevention Atlanta, Georgia 13F. Legionellosis Lawrence J. Fine, MD, DrPH National Institutes of Health Bethesda, Maryland 40. Surveillance and Health Screening in Occupational Health Brendan Flannery, PhD Epidemiologist Centers for Disease Control and Prevention Atlanta, Georgia 9H. Haemophilus Inﬂuenzae Infections Arthur L. Frank, MD, PhD Professor and Chair Drexel University School of Public Health Philadelphia, Pennsylvania 19. The Status of Environmental Health 36. Nonionizing Radiation

Jacob K. Frenkel, MD, PhD Adjunct Professor University of New Mexico Santa Fe, New Mexico 16C. Toxoplasmosis David J. Friedel, MD Post-graduate Fellow, Adult and Pediatric Infectious Diseases Virginia Commonwealth University Health System Richmond, Virginia 10. Epidemiology and Trends in Sexually Transmitted Diseases Irene Hanson Frieze, PhD Professor Department of Psychology University of Pittsburgh Pittsburgh, Pennsylvania 81. Violence in the Family as a Public Health Concern Howard Frumkin, MD, MPH, DrPH Director National Center for Environmental Health Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention Atlanta, Georgia 42. Environmental Justice Kristine M. Gebbie, DrPH, RN Elizabeth Standish Gill Professor of Nursing Columbia University School of Nursing New York, New York 79D. Public Health Workforce Michael Gochfeld, MD, PhD Professor of Environmental and Occupational Medicine University of Medicine and Dentistry of New Jersey Robert W. Johnson Medical School Piscataway, New Jersey 20A. Principles of Toxicology 20B. Neurobehavioral Toxicity 21. Environmental and Ecological Risk Assessment Philippe Grandjean, MD, DMSc Professor of Environmental Medicine University of Southern Denmark, Institute of Public Health Odense, Denmark Adjunct Professor of Environmental Health Harvard School of Public Health Boston, Massachusetts 26. Health Signiﬁcance of Metal Exposures Alan E. Greenberg, MD, MPH Professor and Chair Department of Epidemiology and Biostatistics George Washington University School of Public Health and Health Services Washington, District of Columbia 11. The Epidemiology and Prevention of Human Immunodeﬁciency Virus (HIV) Infection and Acquired Immunodeﬁciency Syndrome (AIDS)

Contributors

Diane K. Gross, DVM, PhD Epidemic Intelligence Service Officer Meningitis and Special Pathogens Branch Division of Bacterial and Mycotic Diseases National Center for Infectious Diseases Centers for Disease Control and Prevention Atlanta, Georgia 16B4. Brucellosis Marta A. Guerra, DVM, MPH, PhD Senior Staff Epidemiologist Viral and Rickettsial Zoonoses Branch Division of Viral and Rickettsial Diseases Centers for Disease Control and Prevention Atlanta, Georgia 15C. Rickettsial Infections Dalya Guris, MD, MPH Team Leader, Herpes Viruses Team National Immunization Program Centers for Disease Control and Prevention Atlanta, Georgia 9I. Varicella and Herpes Zoster Rebecca L. Hegeman, MD Associate Professor Clinical Internal Medicine Department of Internal Medicine University of Iowa Health Care Iowa City, Iowa 63. Renal and Urinary Tract Disease Erin O. Heiden, MPH Doctoral Student University of Iowa College of Public Health Iowa City, Iowa 80. Injury Control: The Public Health Approach Robert F. Herrick, MS, ScD Senior Lecturer Harvard School of Public Health Boston, Massachusetts 39. Industrial Hygiene

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Donald R. Hopkins, MD, MPH Vice President The Carter Center Atlanta, Georgia 13I. Dracunculiasis Douglas B. Hornick, MD Professor University of Iowa Carver College of Medicine Director of TB Chest Clinic and Clinical Services Division of Pulmonary, Critical Care and Occupational Medicine Iowa City, Iowa 12I. Tuberculosis James M. Hughes, MD Director, Program in Global Infectious Diseases Emory University, School of Medicine Atlanta, Georgia 8B. Emerging Microbial Threats to Health and Security Joseph Hughey, PhD University of Missouri Kansas City, Missouri 6. Health Disparities and Community-Based Participatory Research Corinne G. Husten, MD, MPH Director (Acting) Office on Smoking and Health Centers for Disease Control and Prevention Atlanta, Georgia 54. Tobacco: Health Effects and Control Robert S. Janssen, MD Director, Divisions of HIV/AIDS Prevention Centers for Disease Control and Prevention Atlanta, Georgia 11. The Epidemiology and Prevention of Human Immunodeﬁciency Virus (HIV) Infection and Acquired Immunodeﬁciency Syndrome (AIDS)

Lauri A. Hicks, DO Epidemic Intelligence Service Officer, Respiratory Diseases Centers for Disease Control and Prevention Atlanta, Georgia 16B1. Bacterial Zoonoses-Psittacosis

Jeffrey L. Jones, MD, MPH Chief, Diagnostics and Epidemiology Parasitic Diseases Branch Division of Parasitic Diseases National Center for Infectious Diseases Centers for Disease Control and Prevention Atlanta, Georgia 16C. Toxoplasmosis

Alan R. Hinman, MD, MPH Senior Public Health Scientist Task Force for Child Survival and Development Decatur, Georgia 5. Public Health Informatics 9A. Measles

S. Patrick Kachur, MD, MPH, FACPM Chief, Strategic and Applied Sciences Unit, Malaria Branch Centers for Disease Control and Prevention Atlanta, Georgia 15F. Malaria

xviii

Contributors

Mark Katz, MD Medical Epidemiologist Global Disease Detection Division Centers for Disease Control and Prevention Nairobi, Kenya 9G. Inﬂuenza C. William Keck, MD, MPH Department of Community Health Sciences Northeastern Ohio Universities College of Medicine Rootstown, Ohio 75. Structure and Function of the Public Health System in the U.S. Jennifer L. Kelsey, PhD Professor Department of Medicine Department of Family Medicine and Community Health University of Massachusetts Medical School Worcester, Massachusetts 66. Musculoskeletal Disorders W. Monroe Keyserling, PhD Professor Department of Industrial and Operations Engineering University of Michigan Ann Arbor, Michigan 38. Ergonomics and Work-Related Musculoskeletal Disorders

Elizabeth A. Kleiner, MD, MS Division of Infectious Disease Medical College of Virginia Virginia Commonwealth University 15A. Viral Infections R. Monina Klevens, DDS, MPH Medical Epidemiologist Centers for Disease Control and Prevention Atlanta, Georgia 14. Control of Infections in Institutions Amy D. Klion, MD Staff Clinician Laboratory of Parasitic Diseases National Institute of Allergy and Infectious Disease National Institutes of Health Bethesda, Maryland 16J. Lymphatic Filariasis 18D. Schistosomiasis Neal D. Kohatsu, MD, MPH Chief, Cancer Control Branch California Department of Public Health Sacramento, California Associate Editor Editor of Section IV: Behavioral Factors Affecting Health Editor of Section VII: Injury and Violence

Jay S. Keystone, MD, MSc, FRCPC Professor of Medicine Tropical Disease Unit University of Toronto Toronto, Ontario, Canada 8C. Health Advice for International Travel

Margaret Kosek, MD Assistant Scientist Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland 13C. Cholera 13D. Escherichia coli Diarrhea

Edwin M. Kilbourne, MD Director, Scientist Redirection Program Director, Iraqi Interim Center for Science & Industry Embassy of the United States of America Baghdad, Iraq 34. Temperature and Health

Katrina Kretsinger, MD, MA Medical Epidemiologist Meningitis and Vaccine Preventable Diseases Branch Division of Bacterial Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Atlanta, Georgia 9E. Tetanus

Kaye H. Kilburn, MD Professor Emeritus Ralph Edgington Chair in Medicine University of Southern California Keck School of Medicine Los Angeles, California 23. Asbestos and Other Fibers 32. Pulmonary Responses to Gases and Particles Louis V. Kirchhoff, MD, MPH Professor Departments of Internal Medicine & Epidemiology University of Iowa Iowa City, Iowa 15H. Trypanosomiasis

Richard S. Kurz, PhD Professor and Chair Department of Health Management and Policy St. Louis University, School of Public Health St Louis, Missouri 78D. Quality Assurance and Quality Improvement Cynthia D. Lamberth, MPH Director, Kentucky Public Health Leadership Institute University of Kentucky College of Public Health Lexington, Kentucky 78B. Public Health Leadership Development

Contributors

Philip J. Landrigan, MD, MSc Professor and Chair Department of Community and Preventive Medicine Professor of Pediatrics Mount Sinai School of Medicine New York, New York 45. Health Hazzards of Child Labor John M. Last, MD, DPH, FFPH, FACPM, FRACP, FRCPC, FAFPHM, FACE Emeritus Professor of Epidemiology Department, Epidemiology & Community Medicine University of Ottawa Ottawan, Ontario, Canada 3. Ethics and Public Health Policy 51. Housing and Health 52. Human Health in a Changing World Suzanne R. Lavoie, MD Professor of Pediatrics and Internal Medicine Chair, Division of Pediatric Infectious Diseases Virginia Commonwealth University Health System Richmond, Virginia 10. Epidemiology and Trends in Sexually Transmitted Diseases James W. LeDuc, PhD Director, Division of Viral and Rickettsial Diseases Centers for Disease Control and Prevention Atlanta, Georgia 15B. Epidemiology of Viral Hemorrhagic Fevers Stephen M. Levin, MD Associate Professor Department of Community and Preventive Medicine Mount Sinai School of Medicine New York, New York 25. Silicosis 27. Diseases Associated with Exposure to Chemical Substances Jill L. Liesveld, MD Clinical Associate Professor University of Iowa Carver College of Medicine University of Iowa Hospitals and Clinics Iowa City, Iowa 55. Alcohol-Related Health Problems Scott R. Lillibridge, MD Professor of Epidemiology Director, Center for Public Health Preparedness and Biosecurity University of Texas School of Public Health Houston, Texas 79A. Disaster Preparedness and Response

Ruth Lilis, MD† Professor Emeritus Division of Environmental and Occupational Medicine Department of Community Medicine Mount Sinai School of Medicine New York, New York 25. Silicosis 27. Diseases Associated with Exposure to Chemical Substances Ettie M. Lipner, MPH Epidemiology Fellow, Office of Global Research National Institute of Allergy & Infectious Diseases National Institutes of Health Bethesda, Maryland 18D. Schistosomiasis Fred Lorey, PhD Chief, Program Evaluation Section Genetic Disease Branch California Department of Health Services Richmond, California 7. Genetic Determinants of Disease and Genetics in Public Health John Bruce Lowe, DrPH Professor Department of Community and Behavioral Health College of Public Health University of Iowa Iowa City, Iowa 6. Health Disparities and Community-Based Participatory Research Russell V. Luepker, MD, MS Mayo Professor University of Minnesota Division of Epidemiology Minneapolis, Minnesota 62. Heart Disease Charles F. Lynch, MD, MS, PhD Professor Department of Epidemiology University of Iowa Iowa City, Iowa 61. Cancer Alexandre Macedo de Oliveira, MD, MSc Senior Service Fellow Malaria Branch, Division of Parasitic Diseases Centers for Disease Control and Prevention Atlanta, Georgia 15F. Malaria

†Deceased.

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Contributors

Carmen Gomez Mandic, MPH Doctoral Candidate Harvard School of Public Health Department of Society, Human Development and Health Boston, Massachusetts 59. Health Literacy Lewis H. Margolis, MD, MPH Associate Professor Department of Maternal and Child Health University of North Carolina at Chapel Hill Chapel Hill, North Carolina 79B. Maternal and Child Health Mona Marin, MD Medical Epidemiologist Centers for Disease Control and Prevention Atlanta, Georgia 9I. Varicella and Herpes Zoster

Paul S. Mead, MD, MPH Medical Epidemiologist Bacterial Zoonoses Branch Division of Vector-borne Infectious Diseases Centers for Disease Control and Prevention Fort Collins, Colorado 16B2. Tularemia Jeffrey L. Meier, MD Associate Professor of Medicine University of Iowa Carver College of Medicine Iowa City, Iowa 12C. Aseptic Meningitis 12D. Epstein-Barr Virus and Infectious Mononucleosis

Douglas L. Marshall, PhD Associate Dean College of Natural and Health Sciences University of Northern Colorado Greeley, Colorado 47. Ensuring Food Safety

Patricia L. Meinhardt, MD, MPH, MA Adjunct Associate Professor Department of Environmental & Occupational Health Drexel University School of Public Health Drexel University Philadelphia, Pennsylvania Executive Medical Director Center for Occupational & Environmental Medicine Arnot Ogden Medical Center Elmira, New York 48. Water Quality Management and Waterborne Disease Trends

Eric E. Mast, MD, MPH Chief, Prevention Branch Division of Viral Hepatitis National Center for Infectious Diseases Centers for Disease Control and Prevention Atlanta, Georgia 12B. Viral Hepatitis

Karen Messing, PhD Professor Department of Biological Sciences Université du Québec à Montréal Montréal, Québec Canada 44. Women Workers

Yoshito Masuda, PhD Emeritus Professor Division of Health Chemistry Department of Pharmacy Daiichi College of Pharmaceutical Sciences Fukuoka, Japan 29. Polychlorinated Dioxins and Polychlorinated Dibenzofurans

Larissa Minicucci, DVM, MPH Epidemic Intelligence Service Officer Bacterial Zoonoses Branch Division of Vector-borne Infectious Diseases Centers for Disease Control and Prevention Fort Collins, Colorado 15G. Lyme Disease

Glen P. Mays, MPH, PhD Associate Professor and Vice Chairman Department of Health Policy and Management Fay W. Boozman College of Public Health University of Arkansas for Medical Sciences Little Rock, Arkansas 74. The American Health Care System Michael D. McClean, ScD Assistant Professor Department of Environmental Health Boston University School of Public Health Boston, Massachusetts 22. Biomarkers

Eric Daniel Mintz, MD, MPH Chief, Diarrheal Diseases Epidemiology Section Foodborne and Diarrheal Diseases Branch Centers for Disease Control and Prevention Atlanta, Georgia 13A. Typhoid Fever 13B. Shigellosis Aage R. Møller, PhD Professor University of Texas at Dallas School of Behavioral and Brain Sciences Richardson, Texas 37. Effects of the Physical Environment

Contributors

Celeste Monforton, MPH George Washington University School of Public Health & Health Services Department of Environmental & Occupational Health Washington, District of Columbia 46. Occupational Safety and Health Standards Matthew R. Moore, MD, MPH Medical Epidemiologist Centers for Disease Control and Prevention Atlanta, Georgia 13F. Legionellosis John S. Moran, MD, MPH Captain, United States Public Health Service Acting Chief, Bacterial Vaccine-Preventable Diseases Branch Epidemiology and Surveillance Division National Immunization Program Centers for Disease Control and Prevention Atlanta, Georgia 9E. Tetanus Pedro L. Moro, MD, MPH Immunization Safety Office Centers for Disease Control and Prevention Atlanta, Georgia 16F2. Hydatid Disease (Echinococcosis) Marion Moses, MD Director Pesticide Education Center San Francisco, California 33. Pesticides Robert L. Mott, Jr., LTC, USA, MD, MPH Director, Division of Preventive Medicine Walter Reed Army Institute of Research Silver Spring, Maryland 79C. Preventive Medicine Support of Military Operations Nancy R. Mudrick, PhD Professor School of Social Work Syracuse University Syracuse, New York 41. Workers with Disabilities Debra J. Nanan, MPH Consultant and Program Coordinator Paciﬁc Health & Development Sciences Inc. Victoria, British Columbia Canada 76. International and Global Health

xxi

Kenrad E. Nelson, MD Professor of Epidemiology, Medicine & International Health Johns Hopkins University Baltimore, Maryland 12J. Leprosy 16E. Clonorchiasis and Opisthorchiasis 16F2. Taeniasis and Cysticercosis Marion Nestle, PhD, MPH Paulette Goddard Professor of Nutrition, Food Studies, and Public Health New York University New York, New York 72. Nutrition in Public Health and Preventive Medicine Dawn M. Oh, MS Biostatistics Private Biostatistics Consultant Phoenix, Arizona 68. Disabling Visual Disorders Kean T. Oh, MD Physician-Partner Retinal Consultants of Arizona Phoenix, Arizona 68. Disabling Visual Disorders Sarah C. Oppenheimer, ScM Housing Services Program Manager Cambridge Cares About AIDS Cambridge, Massachusetts 59. Health Literacy Trevor J. Orchard, MD, MMedSci Professor of Epidemiology, Pediatrics and Medicine University of Pittsburgh Diabetes and Lipid Research Pittsburgh, Pennsylvania 64. Diabetes Walter A. Orenstein, MD Professor, Medicine & Pediatrics Emory University Atlanta, Georgia 9A. Measles Stephen M. Ostroff, MD Health & Human Services Rep to the Paciﬁc Islands U.S. Department of Health and Human Services Honolulu, Hawaii 8B. Emerging Microbial Threats to Health and Security

xxii

Contributors

John Adam Painter, DVM, MS Foodborne and Diarrheal Diseases Branch Centers for Disease Control and Prevention Atlanta, Georgia 16B6. Non-Typhoidal Salmonellosis Mark J. Papania, MD, MPH Medical Epidemiologist Immunization Safety Office Centers for Disease Control and Prevention Atlanta, Georgia 9A. Measles K. Michael Peddecord, MS, DrPH Professor Emeritus of Public Health Graduate School of Public Health San Diego State University San Diego, California 78A. Planning for Health Improvement Corinne Peek-Asa, MPH, PhD Professor Injury Prevention Research Center University of Iowa Iowa City, Iowa 80. Injury control Michael Perch, MD Foodborne and Diarrheal Diseases Branch Centers for Disease Control and Prevention Atlanta, Georgia 16B6. Non-Typhoidal Salmonellosis Herbert B. Peterson, MD Professor and Chair Department of Maternal & Child Health Professor Department of Obstetrics and Gynecology University of North Carolina School of Public Health Chapel Hill, North Carolina 79E. Family Planning Jana J. Peterson, MPH Doctoral Candidate and Pﬁzer Fellow Iowa City, Iowa 6. Health Disparities and Community-Based Participatory Research N. Andrew Peterson, PhD Associate Professor School of Social Work Rutgers University New Brunswick, New Jersey 6. Health Disparities and Community-Based Participatory Research

Michael A. Pfaller, MD Professor Emeritus Department of Pathology College of Medicine Department of Epidemiology College of Public Health University of Iowa Iowa City, Iowa 17. Opportunistic Fungal Infections Susan H. Pollack, MD Department of Pediatrics, College of Medicine Injury Prevention and Research Center Department of Preventive Medicine & Environmental Health, College of Public Health University of Kentucky Lexington, Kentucky 45. Health Hazzards of Child Labor Shannon D. Putnam, PhD Adjunct Faculty University of Iowa Head, Bacterial Diseases Program Naval Medical Research Unit No. 2 U.S. Embassy–Jakarta, Indonesia 18C. Other Intestinal Nematodes M. Patricia Quinlisk, MD, MPH Medical Director/State Epidemiologist Iowa Department of Public Health Des Moines, Iowa 13E. Yersiniosis Pavani Kalluri Ram, MD Medical Epidemiologist Centers for Disease Control and Prevention Department of Social and Preventive Medicine State University of New York at Buffalo School of Public Health and Health Professions Buffalo, New York 13A. Typhoid Fever Mirza I. Rahman, MD, MPH, FAAFP, FACPM Senior Director Health Economics and Clinical Outcomes Research Medical Affairs Centocor Incorporated Adjunct Professor Temple University School of Pharmacy Attending Physician Bryn Mawr Family Practice Residency Program Horsham, Pennsylvania 73. Postmarketing Medication Safety Surveillance Katharine C. Rathbun, MD, MPH Preventive Medicine/Family Practice Baton Rouge, Louisiana 77. Public Health Law

Contributors

Christie M. Reed, MD, MPH, FAAP Travelers’ Health Team Lead Centers for Disease Control and Prevention Atlanta, Georgia 8C. Health Advice for International Travel

Lindsay Rosenfeld, MS Doctoral Student Harvard School of Public Health Boston, Massachusetts 59. Health Literacy

Susan E. Reef, MD Medical Epidemiologist Centers for Disease Control and Prevention Atlanta, Georgia 9C. Rubella

Nancy E. Rosenstein, MD Chief, Meningitis and Special Pathogens Branch Centers for Disease Control and Prevention Atlanta, Georgia 9H. Haemophilus Inﬂuenzae Infections 12H. Meningococcal Disease 16B3. Anthrax

Arthur L. Reingold, MD Professor and Head, Division of Epidemiology University of California, Berkeley School of Public Health Berkeley, California 18E. Toxic Shock Syndrome (Staphylococcal) Kim D. Reynolds, PhD Associate Professor Department of Preventive Medicine University of Southern California Alhambra, California 53. Health Behavior Research and Intervention Edward P. Richards, JD, MPH Harvey A. Peltier Professor of Law Director Center for Law, Science, and Public Health Louisiana State University Law Center Baton Rouge, Louisiana 77. Public Health Law Elizabeth B. Robertson, PhD Chief, Prevention Research Branch National Institute on Drug Abuse National Institutes of Health Bethesda, Maryland 56. Prevention of Drug Use and Drug Use Disorders David P. Ropeik, BSJ, MSJ Consultant in Risk Perception and risk Communication Instructor in Harvard Extension School Program on Environmental Management Concord, Massachusetts 58. Risk Communication—An Overlooked Tool for Improving Public Health Martha H. Roper, MD, MPH Medical Epidemiologist Bacterial Vaccine Preventable Diseases Branch Epidemiology and Surveillance Division National Immunization Program Centers for Disease Control and Prevention Weybridge, Vermont 9E. Tetanus

David A. Ross, ScD Director Public Health Informatics Institute The Task Force for Child Survival and Development Decatur, Georgia 5. Public Health Informatics Rima E. Rudd, MSPH, ScD Senior Lecturer on Society, Human Development & Health Harvard School of Public Health Boston, Massachusetts 59. Health Literacy Thomas G. Rundall, PhD Henry J. Kaiser Professor of Organized Health Systems University of California, Berkeley School of Public Health Berkeley, California 78E. Public Health Management Tools Evaluation Charles E. Rupprecht, VMD, MS, PhD Chief, Rabies Program Centers for Disease Control and Prevention Atlanta, Georgia 16A. Rabies Jonathan M. Samet, MD, MS Professor and Chairman Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland 65. Respiratory Disease Prevention John W. Sanders, MD Head, Department of Infectious Disease National Naval Medical Center Bethesda, Maryland 18C. Other Intestinal Nematodes

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Contributors

Peter M. Schantz, VMD, PhD Epidemiologist National Center for Infectious Diseases Centers for Disease Control and Prevention Atlanta, Georgia 16F2. Hydatid Disease (Echinococcosis) Arnold J. Schecter, MD, MPH Professor Division of Environmental & Occupational Health Sciences University of Texas Health Science Center at Houston Dallas, Texas Editor of Section III: Environmental Health Marc B. Schenker, MD, MPH Professor, University of California Davis Public Health Sciences Davis, California 29. Polychlorinated Dioxins and Polychlorinated Dibenzofurans 43. The Health of Hired Farmworkers Helen H. Schauffler PhD, ScM Professor of Health Policy Center for Health and Public Policy Studies School of Public Health University of California, Berkeley Berkeley, California 78C. Policy Development John E. Schneider, PhD Assistant Professor Department of Health Management and Policy University of Iowa, College of Public Health Iowa City, Iowa 6. Health Disparities and Community-Based Participatory Research Jeremiah A. Schumm, PhD Instructor of Psychology in Psychiatry Harvard Medical School at the VA Boston Healthcare System Brockton, Massachusetts 81. Violence in the Family as a Public Health Concern Nicole Schupf, PhD, MPH, DrPh Associate Professor of Clinical Epidemiology Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center G.H. Sergievsky Center New York, New York 70. Childhood Cognitive Disability

F. Douglas Scutchﬁeld, MD Peter B. Bosomworth Professor of Health Services Research & Policy University of Kentucky College of Public Health Lexington, Kentucky Editor of Section VI: Health-Care Planning, Organizations, and Evaluation 74. The American Health-Care System: Structure and Function 75. Structure and Function of the Public Health System in the U.S. Jane F. Seward, MBBS, MPH Chief, Viral Vaccine Preventable Disease Branch National Immunization Program Centers for Disease Control and Prevention Atlanta, Georgia 9I. Varicella and Herpes Zoster Sean V. Shadomy, DVM, MPH Medical Epidemiologist National Center for Zoonotic, Vector-Borne, and Enteric Diseases Division of Foodborne, Bacterial, and Mycotic Diseases Centers for Disease Control and Prevention Atlanta, Georgia 16B3. Anthrax Trueman W. Sharp, MD, MPH Commanding Officer U.S. Naval Medical Research Unit Cairo, Egypt 79A. Disater Preparedness and Response Louis E. Slesin, PhD Editor, Microwave News New York, New York 36. Nonionizing Radiation Elaine M. Smith, MBA, PhD, MPH Professor Department of Epidemiology University of Iowa Iowa City, Iowa 61. Cancer Montse Soriano-Gabarro, MD, MSc Medical Epidemiologist Centers for Disease Control and Prevention Rixensart, Belgium 12H. Meningococcal Disease Colin L. Soskolne, PhD Professor Department of Public Health Sciences School of Public Health University of Alberta Edmonton, Alberta Canada 3. Ethics and Public Health Policy 52. Human Health in a Changing World

Contributors

MaryFran Sowers, PhD Professor Department of Epidemiology School of Public Health University of Michigan Ann Arbor, Michigan 66. Musculoskeletal Disorders Donna Spruijt-Metz, MFA, PhD Assistant Professor University of Southern California Institute for Health Promotion and Disease Prevention Alhambra, California 53. Health Behavior Research and Intervention J. Erin Staples, MD, PhD Epidemic Intelligence Service Officer Bacterial Zoonoses Branch DVBID, NCID Center for Disease Control and Prevention Fort Collins, Colorado Pediatric Infectious Diseases Children’s Health Center Duke University Medical Center Durham, North Carolina 15E. Plague Daniele F. Staskal, PhD University of North Carolina Curriculum in Toxicology ChemRisk Austin, Texas 30. Brominated Flame Retardants William Stauffer MD, MSPH, DTM&H Assistant Professor University of Minnesota, Department of Medicine, Department of Pediatrics, Infectious Diseases School of Public Health, Epidemiology and Community Health Minneapolis, Minnesota 13G. Amebiasis and Amebic Meningoenchephalitis Stefanie Steele, RN, MPH Health Educator Centers for Disease Control and Prevention Atlanta, Georgia 8C. Health Advice for International Travel Zena Stein, MA, MB, BCh Professor of Epidemiology and Psychiatry Emerita Columbia University and New York State Psychiatric Institute G.H. Sergievsky Center New York, New York 70. Childhood Cognitive Disability

Michael P. Stevens, MD Resident in Internal Medicine Virginia Commonwealth University School of Medicine West Hospital Richmond, Virginia 16D. Trichinellosis Peter M. Strebel, MBChB, MPH Medical Officer Department of Immunization, Vaccines and Biologicals Expanded Programme on Immunization World Health Organization Geneva, Switzerland 9A. Measles William A. Suk, PhD, MPH Director, Center for Risk & Integrated Sciences Director, Superfund Basic Research Program National Institute of Environmental Health Sciences Research Triangle Park, North Carolina 49. Hazardous Waste Mervyn W. Susser, MB, BCh, FRCP Sergievsky Professor of Epidemiology Emeritus Columbia University G.H. Sergievsky Center New York, New York 70. Childhood Cognitive Disability Roland W. Sutter, MD, MPH&TM Coordinator, Research and Product Development Polio Eradication Initiative World Health Organization Geneva, Switzerland 9J. Poliomyelitis David L. Swerdlow, MD Team Leader, Epidemiology Team Viral and Rickettsial Zoonoses Branch Centers for Disease Control and Prevention Atlanta, Georgia 15C. Rickettsial Infections 15D. Q Fever Herbert A. Thompson, PhD, MA, BA Branch Chief Viral and Rickettsial Zoonoses Branch Centers for Disease Control and Prevention Atlanta, Georgia 15D. Q Fever Stacy L. Thorne, MPH, CHES Public Health Analyst Office on Smoking and Health Centers for Disease Control and Prevention Atlanta, Georgia 54. Tobacco: Health Effects and Control

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Contributors

Andria D. Timmer, MA, MPH candidate University of Iowa Iowa City, Iowa 6. Health Disparities and Community-Based Participatory Research

Marta J. VanBeek, MD, MPH Assistant Professor of Dermatology University of Iowa Carver College of Medicine Iowa City, Iowa 18A. Dermatophytes

Tejpratap S.P. Tiwari, MD Medical Epidemiologist National Immunization Program Centers for Disease Control and Prevention Atlanta, Georgia 9F. Diphtheria

Don Villarejo, PhD, MS, BS Davis, California 43. The Health of Hired Farmworkers

Maria Lucia C. Tondella, PhD Research Microbiologist Centers for Disease Control and Prevention Atlanta, Georgia 16B1. Bacterial Zoonoses-Psittacosis James C. Torner, MS, PhD Professor and Head Department of Epidemiology University of Iowa College of Public Health Iowa City, Iowa 67. Neurological Disorders Amy O. Tsui, MA, PhD Professor, Department of Population, Family and Reproductive Health Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland 79E. Family Planning Margaret A. Turk, MD Professor, Physical Medicine & Rehabilitation SUNY Upstate Medical University Syracuse, New York 41. Workers with Disabilities Jennifer B. Unger, PhD Associate Professor University of SC Keck School of Medicine Alhambra, California 53. Health Behavior Research and Intervention Arthur C. Upton, MD Clinical Professor of Environmental & Community Medicine IRM-CRESP Robert Wood Johnson Medical School Piscataway, New Jersey 35. Ionizing Radiation Victoria Valls, MD Associate Professor Department of Public Health Universidad “Miguel Hernandez” Elche, Spain 12K. Acute Gastrointestinal Infections

Andrew C. Voetsch, PhD Epidemiologist Centers for Disease Control and Prevention Atlanta, Georgia 16B6. Non-Typhoidal Samonellosis Gregory R. Wagner, MD Senior Advisor National Institute for Occupational Safety and Health Adjunct Professor, Department of Environmental Health Harvard School of Public Health Boston, Massachusetts 24. Coal Workers’ Lung Diseases 40. Surveillance and Health Screening in Occupational Health Mark R. Wallace, MD Head, ID Fellowship Program Orlando Regional Healthcare Orlando, Florida 18C. Other Intestinal Nematodes Robert B. Wallace, MD, MSc Professor of Epidemiology and Internal Medicine University of Iowa College of Public Health Iowa City, Iowa Editor of Section I: Public Health Principles and Methods 1. Public Health and Preventive Medicine 2. Epidemiology and Public Health 4. Public Health and Population 9K. Pneumococcal Infections 18F. Reye’s Syndrome 60. Screening for Early and Asymptomic Conditions 67. Neurological Disorders Robert J. Weber, MD Professor and Chairman Department of Physical Medicine & Rehabilitation SUNY Upstate Medical University Syracuse, New York 41. Workers with Disabilities Thomas F. Webster, DSc Associate Professor Department of Environmental Health (T2E) Boston University School of Public Health Boston, Massachusetts 22. Biomarkers

Contributors

Richard P. Wenzel, MD, MSc Professor and Chairman Department of Internal Medicine Virginia Commonwealth University School of Medicine Richmond, Virginia 8A. Overview of Communicable Diseases 15A. Viral Infections Melinda E. Wharton, MD, MPH Acting Deputy Director Centers for Disease Control and Prevention National Immunization Program Office of the Director Atlanta, Georgia 9B. Mumps Franklin White, MD, CM, MSc, FRCPC, FFPH Consultant & President Paciﬁc Health & Development Sciences Inc. Victoria, British Columbia, Canada Adjunct Professor, Community Health & Epidemiology Dalhousie University Halifax, Nova Scotia, Canada 76. International and Global Health Richard J. Whitley, MD Professor of Pediatrics Microbiology, Medicine, and Neurosurgery University of Alabama at Birmingham Birmingham, Alabama 12E. Herpes Simplex Virus Stacey L. Williams, PhD Assistant Professor Department of Psychology East Tennessee State University Johnson City, Tennessee 81. Violence in the Family as a Public Health Concern

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Mary E. Wilson, MD Professor Departments of Internal Medicine, Microbiology and Epidemiology University of Iowa and Veteran’s Administration Medical Center Iowa City, Iowa 13H. Gardiasis 15I. Leishmaniasis Kathleen S. Wright, EdD, MPH Associate Professor School of Public Health Saint Louis University St. Louis, Misouri 78B. Public Health Leadership Development Stephanie Zaza, MD, MPH Captain, US Public Health Service Strategy and Innovation Officer, Coordinating Office for Terrorism Preparedness and Emergency Response Centers for Disease Control and Prevention Atlanta, Georgia Editor of Section II: Communicable Diseases 57. Community Health Promotion and disease Prevention Janice C. Zgibor, RPh, PhD Assistant Professor University of Pittsburgh, Graduate School of Public Health Department of Epidemiology Pittsburgh, Pennsylvania 64. Diabetes

Preface Public Health & Preventive Medicine is in its ninth decade of existence since being ﬁrst published in 1913, and it therefore contains much of the lore of public health and preventive medicine over the twentieth century. With each edition, selecting the appropriate information to include has become increasingly difficult for several reasons. Nearly all the same public health and prevention themes and issues continue to be with us, and new knowledge, research, and practice information for public health and preventive medicine grow at a rapid rate. New diseases are being discovered and our knowledge of existing ones is constantly being reﬁned and expanded. New microorganisms of public health import continue to be discovered and new conditions of public health importance have emerged. Behavioral science has helped us better understand how to promote healthful, hygienic behaviors and better educate our citizens and patients. Science and engineering have created occupational and other environmental exposures never before experienced. The increased survivorship of the populations of industrialized nations has heightened the importance of degenerative diseases, complex medical care programs, and the opportunities for prevention of disease. The population growth of our ﬁnite and frail planet may be causing present and future public health dilemmas that are not, yet, completely understood. There has been increasing attention to

the social and “unnatural” causes of human suffering and the recognition of human conﬂict as a public health problem. The increased convergence of public health practice and the delivery of clinical health services has created and elevated several topics that must be given some prominence. Every attempt has been made to update the information and acquire new knowledge in this ﬁfteenth edition of Public Health & Preventive Medicine. Although several new topics have been introduced in this edition, inevitably certain issues could not be fully considered. In particular, to keep this textbook at a reasonable size, there is somewhat less emphasis on the issues of developing countries and some topics worthy of extended length have been shortened. Some of the chapters have been adapted from those in the fourteenth edition, usually in situations where the previous author was unable to participate again. Full credit for the preserved portions of previous editions is not possible, but can be found by perusing those editions. Although the majority of the more than 200 contributors to this textbook are from North America, most of the themes presented here have universal application and the lore comes from scientists and practitioners worldwide. Robert B. Wallace, MD, MSc Iowa City, Iowa

xxix Copyright © 2008 by The McGraw-Hill Companies, Inc. Click here for terms of use.

Acknowledgments Many persons gave generously of their time in the preparation of the fifteenth edition of Public Health & Preventive Medicine. The scientific contributors were most responsive to comments and editorial suggestions, and many had colleagues, too numerous to mention, who skillfully gave of their time in facilitating manuscript preparation and in communicating with the section editors and the editorial office. Particular appreciation is noted for Julie Bobitt, Linsey Abbott, and

Nicole Schmidt who provided high-quality logistical and editing support for assembling the many contributions to this volume. Michael Brown and Maya Barahona of the McGraw-Hill Publishing Company also gave invaluable support, advice, and assistance in the assembly of this book. Finally, John M. Last, editor emeritus and the immediate past editor of the volume, has continued to provide skilled and welcome support for its content.

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Historical Note Milton J. Rosenau was a Harvard man, as was his principal collaborator, George C. Whipple. His successor, Kenneth Maxcy, moved to Johns Hopkins University. When Maxcy was in turn succeeded as editor by Philip E. Sartwell and the size of the writing team began to grow, the center of gravity of “MaxcyRosenau” was decisively located in Baltimore: twenty of the thirty-nine contributors to the tenth edition were on the Johns Hopkins staff, and all but two or three contributors were associated with schools of public health. In 1976, the Publisher invited the Association of Teachers of Preventive Medicine (ATPM) to assume responsibility for the eleventh and subsequent editions. After a search, John M. Last, from the University of Ottawa, was selected as editor. Under his leadership,

“Maxcy-Rosenau-Last” evolved in several ways, becoming more comprehensive and international and with an increased number of contributors. Under the auspices of the ATPM, the thirteenth edition was coedited by Last and Robert B. Wallace, from the University of Iowa. Wallace became the editor for the fourteenth edition. The current ﬁfteenth edition has been edited by Wallace with the capable assistance of Neal Kohatsu, now at the California Department of Public Heath. More than 200 authors from diverse disciplines and geographic situations have contributed to this edition. John Last continues to be an active contributor to this volume and to public health in general. Robert B. Wallace, MD, MSc Iowa City, Iowa

xxxiii Copyright © 2008 by The McGraw-Hill Companies, Inc. Click here for terms of use.

fifteenth edition

Wallace/Maxcy-Rosenau-Last

Public Health & Preventive Medicine

I Public Health Principles and Methods

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Public Health and Preventive Medicine: Trends and Guideposts

1

Robert B. Wallace

There are varied deﬁnitions of public health. Recent volumes from the U.S. Institute of Medicine have addressed the deﬁnitions and functions of public health1,2 in a careful and thoughtful way, and described several pathways to healthier communities. The ﬁeld of preventive medicine, the interface between public health and medical practice, is also critical to the health of populations, but is in a faster transition as the roles traditionally performed by physicians in population medicine are reconsidered and the structure of public health evolves. In the meantime, the health needs of the public are as acute as ever and demand all of the energy, skill, and science that public health and preventive medicine can muster. Fortunately, there have been rapid and important advancements in public health and preventive medicine. Some have come as a result of inexorable achievements in productive science, and others were prodded by special public health emergencies and problems, or organizational changes in the delivery of preventive and curative health services. Many advancements in both practice and knowledge have been evolutionary, but in a few instances, there have been fundamental enhancements to our knowledge of the universe and their applications to the public health sciences. While there may be disagreements about what these achievements have been, and indeed some may not yet be fully recognized, the past several years have witnessed several striking and rapidly advancing trends. The following are some of the important trends that have shaped public health and preventive medicine, particularly within industrialized countries. • Increased incorporation of business and administrative practices into prevention and public health service delivery. While general administrative principles and practices have long been a part of public health education and program delivery, the administrative and business emphasis that has swept through most sectors of Western society has also had a clear impact on public health practice. The further application of “industrial standards,” quality improvement techniques, outcome measures, and complex accounting practices have changed the vocabulary and skills requisite for modern public health practice.3,4 With this has come more emphasis on outcome measures. The emphases on both practice guidelines and evidence-based practice have yielded a further orientation toward both traditional and new outcome measures as indicators of community health. More sophisticated measures are in development, and more comprehensive attempts at program performance monitoring are occurring. As more sophisticated, detailed, and measurable outcomes are developed, this monitoring may not only evaluate speciﬁc public health or community programs, but may also work toward

assessing the entire public health, health education, and clinical service structure within a community. • Changes in the deﬁnition of the group or population, the fundamental unit of public health. In general, “the population” that is both the target of preventive and public health programs and interventions has been historically deﬁned as referring to geographic boundaries, due to their encompassing nature and concordance with governmental jurisdictions. That is, of course, still the case, but there has also been a trend toward increasing delivery of comprehensive clinical services to large groups of individuals deﬁned administratively rather than geographically, often referred to as “managed care.” With the health and programmatic information available on these groups and the increasing ability to apply and evaluate public health and preventive services to them, the fundamental public health target group is no longer solely deﬁned in the spatial sense. This has led to the need and opportunity for new partnerships among various private and public health organizations and agencies in order to deliver more effective and efficient public health services.5 In certain respects, this phenomenon has further blurred the boundaries between community-based programs and clinical, preventive, and curative services, thus increasing the need to update and redeﬁne the tasks necessary for complete public health and prevention service delivery. However, the emergence of these new groups that are programmatically important and for whom health information is available has probably served to heighten public health program accountability to a higher proportion of the general population than ever before. • Enhanced conceptualization and measurement of personal health status. This has taken several forms and, while not totally new, has been increasingly incorporated into health status assessment. Perhaps the most important is the increased use of the so-called “quality-of-life” (QOL) measures.6 While the scope and measures of QOL techniques are not consensual, the supplementation of traditional measures of morbidity and mortality with measures and indices of symptoms and syndromes, less well-deﬁned clinical conditions and entities, physical function and disability, affective states and the behavioral manifestations of mental diseases, social functions within and outside the family, and economic well-being and risk status irrespective of health status have added importantly to the understanding of health and optimization of health status. This has changed the meaning and benchmarks for “healthy communities.” 3

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4

Public Health Principles and Methods

In keeping with the theme of enhanced administration in public and preventive services, health status measures for groups and individuals increasingly have become intertwined with the “health” status of preventive and curative programs and service delivery units. That is, the health of members (consumers) of various administered health-care units (providers) can be partially assessed or inferred by process measures of the programs themselves, such as rates of vaccine delivery or early disease detection programs. • Increased codiﬁcation and interpretation of scientiﬁc ﬁndings relevant to prevention and public health. One of the early important and continuing exercises in deﬁning the scientiﬁc and evidentiary basis for clinical preventive practice was performed by what is now the Canadian Task Force on Preventive Health Care7, followed by the continuing reports of the U.S. Preventive Services Task Force8, and many others. Making explicit the scientiﬁc basis for preventive practices and interventions and using this evidence to structure practice guidelines has had many important effects, including (a) placing greater priority on effective interventions, (b) educating health practitioners on the strengths and limitations of various interventions, (c) providing one basis for program evaluation of these effective interventions, and (d) identifying the research gaps in these preventive and public health interventions. Parallel tracks of creating guidelines for curative medicine, often called “evidence-based medicine”9 have made similar and important contributions. More recently, a similar effort has been developed under the banner of “evidence-based public health.”9 • Establishment of goals for communities to attain improvement in health status. This exercise has been a part of strategic program planning for a long time, but in the past decade it has been elevated to explicit goal setting for communities and larger jurisdictions. While national goals for health status improvement10 may be useful at the local level, most public health officials and community organizations would rather have goal setting performed at the local level. This allows engagement of local professionals and other citizens and takes greater account of local priorities, needs, and perceptions of the most compelling health problems to which limited resources should be allocated. • Application of more advanced community health information systems.

This takes many forms, but accurate, comprehensive, and timely community health data are an essential requisite of goal setting and program performance monitoring. Clinical and public health information are both essential and interrelated, raising special issues of ethics and privacy, as well as access. However, the information revolution should allow better program management and assessment, and with appropriate controls should serve the prevention and public health communities in ways not previously possible.11 In summary, the current era has been a time of clear change for both preventive medicine and public health. This book attempts to capture and review these changes for the practitioner and student of these strategically important disciplines. 䉴 REFERENCES

1. Institute of Medicine. Informing the Future. Critical Issues in Health, 2nd ed. Washington, DC: National Academy Press; 2003. 2. Institute of Medicine, Board on Health Promotion and Disease Prevention. The Future of the Public’s Health in the 21st Century. Washington, DC: National Academy Press; 2002. 3. Baker EL, Potter MA, Jones DL, et al. The public health infrastructure and our nation’s health. Annu Rev Public Health. 2005;26:303–18. 4. Novick LF, Mays GP. Health Administration: Principles for Population-Based Management. Sudbury, MA: Jones and Bartlett Publishers; 2006. 5. American Public Health Association. Healthy Communities 2000: Model Standards. 3rd ed. Washington, DC: American Public Health Association; 2006. 6. Ward MM. Outcome measurement: Health-related quality of life. Curr Opin Rheumatol. 2004;16:96–101. 7. References and publications can be found at: http://www.ctfphc.org. 8. Publications and clinical recommendations can be found at: http://www. ahrq.gov/clinic/uspstﬁx.htm. 9. The “Community Guide to Preventive Services” is supported by the U.S. Centers for Disease Control and Prevention, and available at: http://www.thecommunityguide.org. 10. The Healthy People 2010 Project is available at: http://www.healthypeople.gov. This is a series of state and local as well as U.S. national activities for strategic planning and prioritizing of community-based intervention programs. 11. Virnig BA, McBean M. Administrative data for public health surveillance and planning. Annu Rev Public Health. 2001;22:213–30.

Epidemiology and Public Health

2

Robert B. Wallace

Epidemiology is the basic science and most fundamental practice of public health and preventive medicine. We can study health and disease by observing their effects on individuals, by laboratory investigation of experimental animals, and by measuring their distribution in the population. Each of these ways of investigating health and disease is used by the epidemiologist. Epidemiology is therefore the scientiﬁc foundation for the practice of public health. The word “epidemiology” comes from epidemic, which translated literally from the Greek means “upon the people.” Historically, the earliest concern of the epidemiologist was to investigate, control, and prevent epidemics. This chapter deals with the scientiﬁc principles that are the foundation of epidemiology. We then address the sources and characteristics of information used to assess the health of populations. Next, we discuss the ways this information can be analyzed. Finally, we show how to use epidemiology in controlling and preventing health problems. 䉴 HISTORY

Epidemiology has roots in the Bible and in the writings of Hippocrates, as does much of Western medicine. The Aphorisms of Hippocrates (fourth to ﬁfth century BC) contain many generalizations based on prolonged and careful observation of large numbers of cases. The introductory paragraph of Airs, Waters, Places offers timeless advice on good environmental epidemiology: Whoever would study medicine aright must learn of the following subjects. First he must consider the effect of each season of the year and the differences between them. Secondly he must study the warm and the cold winds, both those that are common to every country and those peculiar to a particular locality. Lastly, the effect of water on the health must not be forgotten. When, therefore, a physician comes to a district previously unknown to him, he should consider both its situation and its aspect to the winds. Similarly, the nature of the water supply must be considered …. Then think of the soil, whether it be bare and waterless or thickly covered with vegetation and wellwatered, whether in a hollow and stiﬂing, or exposed and cold. Lastly consider the life of the inhabitants themselves, are they heavy drinkers and eaters and consequently unable to stand fatigue or, being fond of work and exercise, eat wisely but drink sparely?1

Epidemics of infection seriously concerned physicians in ancient times, although often they could do little more than observe

Note: This is a revision of a chapter from the 14th edition, originally written by Carl W. Tyler, Jr., and John M. Last; revised by the editor.

the victims and record mortality. Their limited knowledge rarely permitted effective intervention. Until the Renaissance, physicians based their approach more on impressions than real numbers. John Graunt is often regarded as the founder of vital statistics. He ﬁrst published his numerical methods for examining health problems in Natural and Political Observations on the Bills of Mortality in 1662. He was the ﬁrst to attempt this approach. Epidemiology was ﬁrst applied to the control of communicable diseases and public health through quarantine and isolation, even though ideas about disease transmission and microbiology and epidemiology were rudimentary. Johann Peter Frank, a physician who became “director-general of public health” (in modern terminology) to the Hapsburg Empire, systematized and codiﬁed many rules for personal and communal behavior in the eighteenth century. His work contributed to public health and is published in System einer vollstandigen medicinischen Polizey (1779). Careful clinical observation, precise counts of well-deﬁned cases, and demonstration of relationships between cases and the populations in which they occur all combine in the method upon which epidemiology depends. This method was ﬁrst developed in the nineteenth century. Modern epidemiologists hold John Snow2 in high esteem. He painstakingly collected the facts about sources of drinking water that he related to mortality rates from cholera in London. This proved a classic demonstration of the mode of transmission about 30 years before Koch isolated and identiﬁed the cholera Vibrio. Snow’s great contemporary, William Farr,3 deﬁned and clariﬁed many basic ideas of vital statistics and epidemiology. Among his most important contributions were the following: (a) the scope of epidemiology, (b) the concept of person-years, (c) the relationship between mortality rate and probability of dying, (d) standardized mortality ratios, (e) dose-response relationships, (f) herd immunity, (g) the relationship between incidence and prevalence, and (h) the concepts of retrospective and prospective study. He also developed the ﬁrst effective classiﬁcation of disease, the direct ancestor of the nosology that we still use today. Vital Statistics (1885), an edited volume of excerpts from Farr’s annual reports to the registrar-general, is perhaps the best textbook of epidemiology ever written, graced by beautiful writing and well-chosen tables to illustrate the text. Methods of epidemiological investigation have evolved since the mid-nineteenth century. The case-control study reentered medicine from the social sciences in the third decade of the twentieth century. The cohort study came into use after World War II, as a means of identifying risks associated with heart disease, lung cancer, and other emerging public health problems. Epidemiological “experiments” as now conducted in randomized trials are essentially modern innovations. Statistical methods and electronic computation have greatly improved epidemiological analysis. Present indications suggest expanding potential and an exciting future for epidemiology. Populationbased medicine makes community assessment and diagnosis important for determining the need for health services. An increasingly broad 5

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6

Public Health Principles and Methods

interface between clinical medicine and epidemiology is called clinical epidemiology. Molecular epidemiology promises to let epidemiologists link genetic and many other biological markers to health conditions, thereby creating new potential approaches to intervention. Case-control studies are adding rapidly to our understanding of causeeffect relationships in many chronic and disabling disorders. Epidemiological methods can also help in evaluating health services. What does this brief history of epidemiology teach? First, the community and environment inﬂuence the health of humans, as do our own inherited characteristics. Second, knowing how a disease is transmitted permits us to control and prevent it, even though we may not know the causal agent. Third, even the simplest information about vital events, illnesses, and populations can detect and analyze epidemiological problems. Finally, epidemiology can help ﬁnd, investigate, analyze, control, and prevent a wide range of health problems.

䉴 DEFINITION

Epidemiology is both the basic science of public health and its most fundamental practice. Therefore, we need to examine both aspects of its meaning.

Characteristics of individuals or populations, identiﬁed by the term “lifestyle,” may include such factors as use of tobacco, alcohol, and automobiles. Past and present environment—including the period of intrauterine life—may inﬂuence exposure and susceptibility to disease.

Practice The practice of a science is best deﬁned by what the scientist does. Langmuir points out that, “the basic operation of the epidemiologist is to count cases and measure the population in which they arise.”5 The practice of epidemiology, therefore, is the scientiﬁc process that detects, investigates, and analyzes health problems, followed by applying this information to the control and prevention of these problems. This practice requires health problems to be the subject of public health surveillance, epidemiological investigation, and analysis. The ﬁndings of this analysis linked to health policy can lead to the control and prevention programs intended to resolve health problems. Evaluation of control and prevention is also the responsibility of the practicing epidemiologist as is the clear and persuasive communication of the scientiﬁc ﬁndings to the public, policy makers, and program staff.

Uses of Epidemiology Science Epidemiology was originally deﬁned as the scientiﬁc study of epidemics. An epidemic is the occurrence in excess of normal of an illness, health event, or health-related behavior that occurs in a speciﬁc place or among a group. Reports of cholera by John Snow and childbed fever by Holmes are among the classic examples. In recent years, excessive use of tobacco, called by some “the brown plague,” and the acquired immunodeﬁciency syndrome (AIDS) are examples of modern epidemics. Because the word “epidemic” may lead to chaotic, unreasoned responses to health problems, journalists use the term more often than epidemiologists. Other words, such as outbreak and cluster, are employed by practicing public health professionals to avoid unreasoned public response. In current use, however, the deﬁnition of epidemiology is broader and recognizes the application of this basic science of public health to the control and prevention of health problems. The following deﬁnition, recently agreed upon by an international panel, is widely accepted: Epidemiology is the study of the distribution and determinants of health-related states and events in speciﬁed populations and the application of this study to the control of health problems.4

Some terms in this deﬁnition require discussion. Distribution relates to time, place, and person. The relevant population characteristics include location, age, sex, and race; occupation and other social characteristics; living places; susceptibility; and exposure to speciﬁc agents. In addition, the distribution of the exposed cases needs to examine time as a factor. Relationships in time reveal information about trends, cyclic or secular patterns, clusters, and intervals from exposure to inciting factors to the onset of disease. Determinants include both causes and factors that inﬂuence the risk of disease. Many diseases have a single necessary cause. When the agent of disease causes a single, speciﬁc condition, as occurs with the tubercle bacillus or the lead in lead-based paint, we know the necessary cause. In addition, there are usually many other determinants. They fall into two broad groups: (a) host factors that determine the susceptibility of the individual and (b) environmental factors that determine the host’s exposure to the speciﬁc agent. Host factors include age, sex, race, genetic or constitutional makeup, physiologic state, nutritional condition, and previous immunological experience. Environmental factors include all conditions of living. Among these factors are family size and composition; crowding; hygienic conditions; occupation; and geographic, climatic, and seasonal circumstances.

The most important use for epidemiology is to improve our understanding of health and disease—a goal shared by all the disciplines and branches of the biomedical sciences. Morris6 deﬁned seven uses of epidemiology: historical study, community assessment, working of health services, individual risks and chances, completing the clinical picture, identiﬁcation of syndromes, and the search for causes (Table 2-1). Each deserves brief comment.

Historical Study The classic question “Is health improving?” can be answered only by comparing experience (rates) over time; this is one essential routine activity in all health services. Sometimes when the data are closely examined, unexpected trends appear. For example, asthma deaths increased unexpectedly in children and young adults in Britain and other countries in the 1950s, and continued to increase into the mid1960s, before the cause—self-use of isoprenaline nebulizers—was discovered. Removing the offending product from the market halted the unfortunate trend.

Community Assessment What are the health problems? This question can be answered in many ways. For example, what proportion of school children have become regular cigarette smokers by various stages of their progress through school? Or what proportion of people always or never use seat belts when driving or riding in cars? Answers to such questions TABLE 2-1. USES OF EPIDEMIOLOGY Historical study: is community health getting better or worse? Community assessment: what actual and potential health problems are there? Working of health services Efficacy Effectiveness Efficiency Individual risk and chances Actuarial risks Health hazard appraisal Completing the clinical picture: different presentations of a disease Identiﬁcation of syndromes: “lumping and splitting” Search for causes: case-control and cohort studies Evaluation of presenting symptoms and signs Clinical decision analysis

2 have prognostic and also diagnostic value. Community assessment makes it possible to predict the impact of future health problems by known effects of many risk factors.

The Search for Causes This is the most obvious use for epidemiology. Most hypothesistesting studies (discussed later) have the primary aim of identifying causal factors, or at least of risk factors for disease. This chapter cites many examples of such studies.

Working of Health Services Are all needed services available, accessible, and used appropriately? Are children receiving necessary immunizations? Can pregnant women begin prenatal care before the end of the ﬁrst trimester of pregnancy? Do known contacts of persons with sexually transmitted diseases receive follow-up and treatment? Information on these and many other questions is often gathered routinely or by special survey. Health service administrators should not only always think of these simple routine questions, but should be alert to less obvious potential gaps in coverage. For example, the census will state the numbers of elderly persons who live alone. Is all or only a small portion of these known to the public health nurses and others who provide home surveillance and care?

Individual Chances What is the risk that a person will die before the next birthday? Actuaries who evaluate the risks for persons seeking life insurance have calculated answers based on probabilities derived from experience. This has become a prominent activity of epidemiologists who work on risk assessment and has led to many new insights, for example, about occupational and environmental risks and the hazards associated with immunizations.7

Identiﬁcation of Syndromes Epidemiologists are called “lumpers and splitters” because epidemiological investigations sometimes make it possible to group together several differing manifestations of a condition or to separate seemingly identical diseases into more than one category. The latter are more common than the former; examples include the differentiation of hepatitis A from hepatitis B and the distinction between several varieties of childhood leukemia. Examples of “lumping” include the identiﬁcation of many manifestations of tuberculosis. At one time, each group of symptoms and signs had a different name, such as phthisis, consumption, or pleurisy. Addiction to tobacco is the underlying cause of a variety of outcomes. Among them are respiratory cancers, chronic obstructive pulmonary disease, and a portion of the risk of coronary heart disease. All these conditions could result from “tobaccoism.”

Completing the Clinical Picture One of Morris’ original illustrations of this use for epidemiology was the demonstration that myocardial infarction occurs commonly in women as well as in men. An important difference is that this condition occurs in women at older ages and presents more often as “ruptured ventricle”; this causes sudden death. Last used the technique of “completing the clinical picture” to construct a model8 of what might occur in the average general practice population. In the course of a year, facts known and seen by the physician may be ampliﬁed by epidemiological study even though they might be unidentiﬁed, undiagnosed, or in a single practitioner’s experience and only the submerged part of the iceberg of disease.

Other Uses Clinical epidemiologists have deﬁned other uses for epidemiology that do not ﬁt any of Morris’s original seven uses. One important use is the evaluation of presenting symptoms and signs of disease. Analyzing the data in hospital charts and relating symptoms and complaints to ﬁnal diagnoses makes it possible for an epidemiologist to

Epidemiology and Public Health

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study clinical outcomes, including assessing the adverse effects of therapy. A related use is clinical decision analysis.9 This technique is a rigorous quantitative method used to decide the best method of managing patients with particular diseases. This procedure involves the use of decision trees. Decision trees are algorithms in which the probability of an outcome for each different decision is predicted based on clinical experience.

Epidemiological Method Epidemiologists use a wide range of scientiﬁc information, including clinical ﬁndings, laboratory data, and ﬁeld observations. In the end, it is the reasoning of the epidemiologist that ties these facts together. This reasoning is the logic behind disease control and prevention measures. Epidemiological reasoning is fundamental and straightforward. First, we deﬁne events or clinical cases using careful, speciﬁc, and objective observations. Next, we count these events or cases and orient them to time, place, and person. Then we determine the population at risk and calculate rates of occurrences for the events or clinical cases. This requires the use of nothing more complicated than long division. We put the events or cases in the numerator according to their relevant characteristics. The next step involves using a denominator of the portion of the population at risk and characterizing this group in the same way as those in the numerator are characterized. At this point, we calculate rates of occurrence in the group of cases. These rates are then compared with the rates of occurrence in other population groups. Finally, using this information, we draw inferences about the events that deﬁne the health problem and the agent or agents that cause it. These rates also provide information about the host and the environmental factors that inﬂuence the risk of occurrence and the transmission of the health problem. Using this information and collaborating with other health professionals, we propose control measures and then continue the observations required to assess the control program. In identifying a health problem or case, many kinds of clinical examination may be employed. The patient’s history may reveal information about exposure to risk, incubation period, susceptibility, occupation, residence, course 