Subject: Studies in the News 03-33 (May 22, 2003)


CALIFORNIA RESEARCH BUREAU
CALIFORNIA STATE LIBRARY
Studies in the News
Health Care Supplement


Contents This Week

Introductory Material HEALTH
   Physician-assisted suicide in Oregon increases
   Cancer risks to children
   Breast cancer and hormone replacement therapy
   Mammography service reduces cancer
   Breast cancer trends
   50-state comparisons of SCHIP
   Cost of diabetes
   Health care and former foster children
   Marketing of prescription drugs
   Prevention strategies that work
   Medical savings accounts and the uninsured
   Companies see health premiums rising
   Limited English speakers and health insurance
   Food and nutrition programs across the nation
   Universal health insurance
   Exposure to lead in children
   Long term care county data book
   Water privatization and child mortality rates
   Obesity and cancer
   Drug and alcohol treatment
   Cost of caring for the uninsured
   How much medical care do the uninsured use
   Health centers for the uninsured
   Pneumonia vaccine reduces illness in children
   Influenza vaccination reduces hospital stays
   Women, work and family health
PREVIOUSLY IN STUDIES IN THE NEWS
   Studies in the News, May 13, 2003
   Studies in the News, May 5, 2003
   Studies in the News, April 25, 2003
   Studies in the News, April 15, 2003
   Studies in the News, April 8, 2003
Introduction to Studies in the News

Studies in the News is a very current compilation of items significant to the Legislature and Governor's Office. It is created weekly by the State Library's Research Bureau to supplement the public policy debate in California’s Capitol. To help share the latest information with state policymakers, these reading lists are now being made accessible through the State Library’s website. This week's list of current articles in various public policy areas is presented below.

Service to State Employees:

  • When available, the URL for the full text of each item is provided.

  • Items in the State Library collection can be checked out to state officials and staff.

  • Access to all materials listed will be provided by the State Information Reference Center, either by e-mail to cslsirc@library.ca.gov or by calling 654-0261.

The following studies are currently on hand:

HEALTH

ASSISTED SUICIDE

“Five Years of Legal Physician-Assisted Suicide in Oregon.” IN: New England Journal of Medicine, vol. 348, no. 10 (March 6, 2003) pp. 961-964.

[“Thirty-eight people in Oregon killed themselves with help from their doctors in 2002, the highest number in the five full years that the state’s physician-assistance suicide law had been in effect…. That is more than twice the number of patients who took their own lives in 1998, the first full year the law was in effect.” Sacramento Bee (March 6, 2003) A12.]

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CANCER

Final Guidelines For Carcinogen Risk Assessment: External Review Draft. By the Risk Assessment Forum, U.S. Environmental Protection Agency. (The Forum, Washington, DC) March 2003. 125 p.

Full Text at: oaspub.epa.gov/eims/eimscomm.getfile?p_download_id=36765

["The guidelines ... would dramatically alter current agency policy, which assumes cancer risks to a fetus or an infant are no greater than for a similarly exposed adult.... Increased scrutiny would be limited to assessing a group of chemicals.... Among these are some pesticides and a number of chemicals released in combustion or used in the making of plastics." San Diego Union Tribune (March 4, 2003) A8.]

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“Trends in Incidence Rates of Invasive Lobular and Ductal Breast Carcinoma.” By Christopher I. Li and others. IN: JAMA: Journal of the American Medical Association, vol. 289, no. 11 (March 19, 2003) pp. 1421-1424.

[“A type of breast cancer associated with the use of combination hormone replacement therapy appears to be on the rise and may account for some or all of the increased incidence of the disease nationwide, a new study suggests…. In a sample … lobular breast cancer accounted for 16.5 percent of all breast cancer cases in 1999, up from 9.5 percent in 1987.” San Francisco Chronicle (March 19, 2003) A4.]

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"Mammography Service Screening and Mortality in Breast Cancer Patients: 20-year Follow-up Before and After Introduction of Screening." By Laszlo Tabar and others. IN: The Lancet, vol. 361, no. 9367 (April 26, 2003) pp. 1405-1410.

["Women who get regular mammograms could reduce their risk of dying from breast cancer by 28 percent, new research indicates.... Breast cancer deaths in the United States and Europe have fallen by nearly 30 percent since 1990. Experts are not sure how much of this is a result of catching the disease early with mammograms." San Francisco Chronicle (April 25, 2003) A6.]

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"Breast Cancer Incidence and Mortality Trends in an Affluent Population: Marin County, California, USA, 1990-1999." By C. A. Clarke and others. IN: Breast Cancer Research, vol. 4, no. 6 (2002) pp. R13.

Full Text at: www.nccc.org/ResearchandTraining/studies/pdf/bcr-4-6-clarke_marin.pdf

["Marin's breast cancer rate is among the highest in the nation.... The rate for the Bay Area is 155, and it is 144 for the United States as a whole.... The study looked at a wide variety of factors, including history of breast-feeding, body mass index, cigarette smoking, number of mammograms -- even being raised with organized religion.... The biggest difference between Marin County women with breast cancer and their neighbors without the disease is the amount of alcohol they consume -- with the heaviest drinkers raising their risk almost fourfold." San Francisco Chronicle (May 6, 2003) 1.]

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CHILDREN

Implementation of the State Children's Health Insurance Program: Synthesis of State Evaluations: Background for the Report to Congress. By Margo Rosebach and others. (Mathematica Policy Research, Cambridge, Massachusetts) March 2003. 324 p.

Full Text at: www.mathematica-mpr.com/PDFs/impchildhlth.pdf

["This analysis of state evaluations provides the first comprehensive picture of the early years of the SCHIP program, using a standardized framework developed to facilitate cross-state comparisons. For all 50 states, the report describes program implementation and progress in reaching and enrolling eligible children and reducing the number of low-income uninsured children. The report also summarizes states' evidence of the effect of SCHIP outreach and enrollment simplification on Medicaid enrollment."]

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DIABETES

Economic Costs Of Diabetes in the U.S. In 2002. By Paul Hogan and others, Lewin Group, Inc. Prepared for the American Diabetes Association. (The Association, Alexandria, Virginia) March 7, 2003. 16 p.

Full Text at: www.house.gov/nethercutt/diabetes/docs/ADACostArticle.pdf

["Diabetes cost the U.S. an estimated $132 billion in 2002 in medical expenditures and lost productivity.... The projected increase in the number of people with diabetes suggests that the annual cost in 2002 dollars of diabetes could rise to an estimated $156 billion by 2010 and to $192 billion by 2020."]

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FOSTER CHILDREN

Children Discharged from Foster Care: Strategies to Prevent the Loss of Health Coverage at a Critical Transition. By Pat Redmond. Center on Budget and Policy Priorities. (The Center, Washington, DC) January 2003. 37 p.

Full Text at: www.kff.org/content/2003/4085/4095.pdf

["Each year, approximately 250,000 children are discharged from foster care. The majority of these children are reunited with their families. Several state-level studies have found that many of these children are at risk of becoming uninsured ... [even when they] remain eligible for Medicaid or other publicly-funded health care coverage. Periods without health insurance -- even brief gaps in coverage -- are especially dangerous for children with the serious health conditions common among children in foster care. Children in foster care suffer from poor health and have much higher rates of chronic physical disabilities, birth defects, developmental delays and serious emotional and behavioral problems than children from the same socioeconomic background who are not in out-of-home care."]

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HEALTH CARE

The CMS Quarterly Provider Update. By Centers for Medicare and Medicaid Services. (The Centers, Baltimore, Maryland) April 2003. Various pagings.

Full Text at: cms.hhs.gov/providerupdate/main.asp

["Prescription drug spending in the United States totaled $141 billion in 2001.... Prescription drugs represent the third largest component of national health care expenditure, after hospital services and physician services. In 2001, prescription drugs accounted for 10 cents of every health care dollar spent, compared with 6 cents in 1990. Drug spending is expected to total 14.2% of national health care expenditures by 2010, up from 10% in 2001, with the increase attributed to multiple factors, including increased utilization, an aging population, development of new therapeutic agents for chronic conditions, increased consumer demand, and rising drug prices." Medscape (April 22, 2003) 1.]

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HEALTH CARE POLICY

Prevention Strategies that Work; Steps to a Healthier US: A Program and Policy Perspective. By the U.S. Department of Health and Human Services. (The Department, Washington, DC) 2003. 125 p.

Full Text at: www.HealthierUS.gov/steps/summit/prevportfolio/Prevention_Strategies.pdf

["This volume is a how-to guide - detailing the most effective methods for prevention.... We have focused on reducing the major health burden created by diabetes, heart disease and stroke, and cancer. Steps will also address the related lifestyle choices of poor nutrition, physical inactivity, tobacco use, and risky youth behavior."]

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HEALTH INSURANCE

Proposed Expansion Of Medical Savings Accounts Could Drive Up Insurance Costs And Increase the Number of Uninsured. By Edwin Park and Iris J. Lav. (Center on Budget and Policy Priorities, Washington, DC) April 30, 2003. 12 p.

Full Text at: www.cbpp.org/4-30-03health.pdf

["MSA Expansion Would Provide Attractive Tax Shelter to Healthy, Affluent Individuals: Proponents ... argue that it would increase health insurance coverage and thereby reduce the ranks of the uninsured.... Leading analysts and research institutions have concluded that the effect is likely to be the reverse."]

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Survey Of Small, Medium and Large Businesses: Key Findings. By Public Opinion Strategies. Prepared for The Robert Wood Johnson Foundation and Cover The Uninsured Week (The Foundation, Princeton, New Jersey) March 13, 2003. 3 p.

Full Text at: covertheuninsuredweek.org/media/BusinessSurveyReport.pdf

["The survey canvassed 600 large and small businesses. It found that 92 percent of the respondents said they are likely to increase the amount that their employees pay for health insurance premiums....Companies of all sizes expect health care costs to rise by an additional 18 percent over the next year." Health Care Policy Report (March 17, 2003) p 370.]

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HISPANICS

Hispanic Patient's Double Burden: Lack of Health Insurance and Limited English. By Michelle M. Doty, The Commonwealth Fund (The Fund, New York, New York) February 2003. 38 p.

Full Text at: www.cmwf.org/programs/insurance/doty_hispanicdoubleburden_592.pdf

["Health Care Worse for Spanish Speakers; Findings Compared Hispanics Who Can and Cannot Speak English: Spanish-speaking families have the greatest difficulty understanding prescription and medical instructions, and they report having the fewest choices on where they are treated.... The language barriers identified in the study aggravate the well-established fact that Hispanics overall face more serious health issues than the general U.S. population." Fresno Bee (February 28, 2003) A1.]

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HUNGER

State Of The States: A Profile Of Food And Nutrition Programs Across The Nation. By The Food Research and Action Center (The Center, Washington, DC) February 2003. 81 p.

Full Text at: www.frac.org/pdf/021903SOS.PDF

["This report provides basic data as one tool for helping ... in the effort to get key public nutrition programs to more people in need and to provide more adequate benefits. These data describe the extent of hunger and the use of nutrition programs for the United States as a whole and for each of the 50 states and the District of Columbia."]

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INSURANCE

Approaching Universal Coverage: Minnesota's Health Insurance Programs. By Deborah Chollet and Lori Achman, Mathematica Policy Research. Prepared for The Commonwealth Fund. (The Fund, New York, New York) February 2003. 48 p.

Full Text at: www.cmwf.org/programs/insurance/chollet_universalcoverage_566.pdf

["Minnesota estimates that in 2001, 95 percent of its nonelderly population had health insurance—among the highest coverage rates in the nation. The state’s secret, a new study reveals, is an effective combination of public programs and publicly sponsored private insurance that complements existing private coverage. It concludes that Minnesota’s experience holds lessons for other states: start programs modestly, expand them as they demonstrate their value, and serve populations in need at all levels of income."]

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LEAD POISONING

"Exposure to Lead in Children — How Low Is Low Enough?" By W. J. Rogan and J. H. Ware. IN: New England Journal of Medicine, vol. 348, no.16 (April 17, 2003) pp. 1515-1516.

[“Blood levels now widely believed to be safe in children actually produce a severe impact on intellectual development, researchers report today. Blood levels of lead below current federal and international guidelines of 10 micrograms per deciliter produce a surprisingly large drop in IQ of up to 7.4 points…. Researchers estimate that one in every 50 U.S. children has lead levels above that guideline.” Los Angles Times (April 17, 2003) 1.]

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LONG TERM CARE

Long Term Care: County Data Book: A Vital Planning Resource for California. By the California Association for Adult Day Care Services. (The Association, Sacramento, California) April 2003. 133 p.

Full Text at: www.caads.org/ltcdata/ltc_data.html

["'Huge Gaps' Reported in Elder Care: The study paints the first picture of how long-term care services for older Californians vary greatly from county to county.... The Sacramento region shows a dramatic growth in the number of people 65 and older, especially in Placer County." Sacramento Bee (April 2, 2003) 1.]

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MORTALITY

Water For Life: The Impact of the Privatization of Water Services On Child Mortality. By Sebastian Galiant and others, Center for Research on Economic Development and Policy. Working Paper Series 01-4. Prepared for Stanford University. (The University, Stanford, California) 2003. 46 p.

Full Text at: www.rppi.org/credpr154.pdf

["Before privatization really got under way, in 1995, child mortality rates were falling at much the same pace in municipalities that eventually privatized and those that did not. After 1995, the fall accelerated in privatizing municipalities.... These effects were much stronger in municipalities with high levels of poverty." The Economist (March 22, 2003).]

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OBESITY

“Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults.” E. E. Calle. IN: New England Journal of Medicine, vol. 348, no. 17 (April 24, 2003) pp. 1625-1638.

[“Obesity plays a much bigger role in causing cancer than researchers had previously believed, accounting for 14% of cancers in men and 20% in women, according to a massive new study by the American Cancer Society. An estimated 90,000 Americans die each year of cancer caused primarily by obesity and excess weight, according to the study…. That makes weighing too much second only to smoking -- which causes about 170,000 cancer deaths per year -- as a preventable cause of cancer.” Los Angeles Times (April 24, 2003) 1.]

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SUBSTANCE ABUSE

Drug and Alcohol Treatment Services Among Privately Insured Individuals in Managed Behavioral Health Care: Dissertation. By Bradley D. Stein, Rand Graduate School. RGSD-170. (RAND, Santa Monica, California) December 2002. 70 p.

Full Text at: www.rand.org/publications/RGSD/RGSD170/RGSD170.pdf

["Behavioral health benefit management has been changing dramatically.... The primary goal of this dissertation is to use existing data to contribute to the empirical information available to assist decision-makers in understanding the effect of these rapid changes in the private insurance marketplace on substance abuse treatment services."]

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UNINSURED

Who Pays and How Much? The Cost of Caring For the Uninsured. By Jack Hadley and John Holahan, The Urban Institute. Prepared for the Kaiser Commission on Medicaid and the Uninsured. (The Commission, Menlo Park, California) February 2003. 74 p.

Full Text at: www.kff.org/content/2003/4088/4088.pdf

["We used two independent approaches and several sources of data to estimate how much uncompensated care people without insurance receive and who pays for it.... The convergence of the two approaches suggests that the true amount of uncompensated care in 2001 was probably in the range of $34-36 billion, with a 'best guess' point estimate of $35 billion in uncompensated care received by the uninsured."]

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"How Much Medical Care Do the Uninsured Use, And Who Pays For It?" By Jack Hadley and John Holahan. IN: Health Affairs (February 2003) pp. W3-66-W3-81.

Full Text at: www.healthaffairs.org/WebExclusives/2202Hadley.pdf

["According to the report, uninsured Americans received about $35 billion in uncompensated health care treatment in 2001, with federal, state, and local governments picking up about 85 percent of the tab." Health Care Policy Report, vol. 11, no. 7 (February 17, 2003)]

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Health Centers and the President's Growth Iniatative. By Laura Tobler, National Conference of State Legislatures. Legisbrief. Vol. 11, No. 17. (NCSL, Denver, Colorado) March 2003. 2 p.

["Health centers are a nationwide network of 3,000 plus community and migrant clinics, health centers for the homeless, public housing primary care clinics and public school clinics. For the uninsured -- at last count there were 41.2 million -- health centers, with subsidized or free services, are sometimes their only option for care.... The Bush administration is addressing one of the biggest challenges health centers face: finding the money to improve or add sites that can provide services to a growing patient population."]

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VACCINES

"Decline in Invasive Pneumococcal Disease after the Introduction of Protein–Polysaccharide Conjugate Vaccine." By Cynthia G. Whitney and others. IN: New England Journal of Medicine, vol. 348, no. 18 (May 1, 2003) pp. 1737-1746.

["A new pneumonia vaccine for infants dramatically reduces serious illness in young children and may curb the spread of the bacteria to adults.... Researchers ... believe the vaccine, Prevnar, reduced the rate of blood infections and meningitis in children under 2 by nearly 70 percent." The Sacramento Bee (May 1, 2003) A9.]

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"Influenza Vaccination and Reduction in Hospitalization for Cardiac Disease and Stroke Among the Elderly." By Kristin L. Nichol and others. IN: New England Journal of Medicine, vol. 348, no. 14 (April 3, 2003) 1322-1333 pp.

["Flu shots may do more for the elderly than fend off the flu bug they also protect against heart disease and stroke, new research shows.... The flu vaccine reduces deaths overall and prevents pneumonia in the elderly ... some studies suggested that they help ward off heart disease and strokes." Sacramento Bee (April 3, 2003) A8.]

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WOMEN

Women, Work and Family Health: A Balancing Act. By Roberta Wyn, the UCLA Center for Health Policy Research, and others. Prepared for the Henry J. Kaiser Family Foundation. (The Foundation, Menlo Park, California) April 2003. 4 p.

Full Text at: www.kff.org/content/2003/3336/Balancing_Act_Issue_Brief.pdf

["This brief examines women's role in family health care decision-making and coordination, the effect of that involvement for women who work, and women's caregiving responsibilities. The brief presents information, in both text and graphic formats, on women's role in coordinating care for their children, balancing work and family responsibilities, characteristics and health concerns of female caregivers, and access-to-care barriers. National Center for Education in Maternal and Child Health and Georgetown University's listserv, MCH Alert (May 16, 2003).]

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PREVIOUSLY IN STUDIES IN THE NEWS
[This section links to items in Studies in the News since the last Environmental Supplement.]

HEALTH CARE

"Health." IN: Studies in the News, 03-31 (May 13, 2003).

Full Text at: www.library.ca.gov/SITN/2003/0331.htm

[Includes: "Dietary supplements and metabolife 356;" "Health insurance underwriting cycle;" "Global threat of infectious diseases;" "Data on people without health insurance;" "Regulation of private long-term care insurance;" "Health of migrant farmworkers in California;" "Ephedra and ephedrine risks;" "Current cigarette smoking patterns;" and others.]

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"Health." IN: Studies in the News, 03-29 (May 5, 2003).

Full Text at: www.library.ca.gov/SITN/2003/0329.htm

[Includes: "Blue Shield plan for universal coverage;" "Financing long-term care;" "Medicare beneficiaries' links to drug coverage;" "Master plan for mental health;" "Measures of local responder preparedness;" "Improvement in bioterrorism preparedness;" and others.]

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"Health." IN: Studies in the News, 03-27 (April 25, 2003).

Full Text at: www.library.ca.gov/SITN/2003/0327.htm

[Includes: "Newborn screening for genetic disorders;" "Trends in Medicare health plans;" "Medicare prescription coverage;" "Medicare HMOs provide less;" "Rebuilding public health system;" "Reforms in nursing homes;" "Increases in assisted living facilities;" "Hospital uncompensated care;" and others.]

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"Health." IN: Studies in the News, 03-23 (April 15, 2003).

Full Text at: www.library.ca.gov/SITN/2003/0323.htm

[Includes: "Low-wage workers and health insurance coverage;" "Pathways to substance abuse;" "Children and terrorism;" "Inflation of hospital charges;" "Seeking health information on the Internet;" "Children and health insurance;" "Federal drug plan savings to state;" "Controlling infectious diseases;" "Effects of cigarette tax increase;" and others.]

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Health." IN: Studies in the News, 03-20 (April 8, 2003).

Full Text at: www.library.ca.gov/SITN/2003/0320.htm

[Includes: "Reducing alcohol and drug addiction;" "Strokes and Alzheimer's;" "Immigrant welfare use;" "Court ruling on HMOs;" "Medicare HMO guide;" "Attorney General sues Internet cigarette sellers;" "Perspectives on the chronic care system;" "California teen pregnancy;" and others.]

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