American Public Health Association
800 I Street, NW • Washington, DC 20001-3710
(202) 777-APHA • Fax: (202) 777-2534 •

For Immediate Release
Contact: For copies of articles, call Olivia Chang, (202) 777-2511 or e-mail .

October 2004 AJPH Press Release

All articles are online at after the embargo.

American Journal of Public Health October 2004 Highlights

  • High drug prices force many to skip needed doses
  • White/black gap narrowing among elderly patients’ access to medical tests
  • Guns linked to more murders in cities, more suicides in rural areas
  • Mexican American communities offer health benefits to long-time residents
  • Colon cancer screening tools widely underused
  • Rural veterans face lower quality of life than urban counterparts

The articles highlighted below appear in the October 2004 issue of the American Journal of Public Health, the Journal of the American Public Health Association.

High drug prices force many to skip needed doses

Many chronically ill adults cut back on their medication due to cost concerns, according to a study of more than 4,000 people suffering from such conditions as hypertension, diabetes, asthma, and heart disease. Almost one in five survey respondents said they cut back on recommended medication doses because of the high price of their prescription drugs, and 14 percent used less medication at least once a month. The researchers estimate that more than one million of the roughly 11 million adults with diabetes may be taking less hypoglycemic medication than prescribed because of the cost, and 3 million of

the 14 million American adults with asthma may be cutting back on their asthma

medication because of cost pressures.

[From: “Cost-Related Medication Underuse Among Chronically Ill Adults.” Contact: John D. Piette, Center For Practice Management and Outcomes Research, Ann Arbor, Mich.,]

White/black gap narrowing among elderly patients’ access to medical tests

Elderly black patients still have much lower rates of access to a range of medical tests and procedures than their white counterparts, but the racial gap is narrowing.

According to a study of 5 percent of Medicare beneficiary’s age 65 and older, the racial gap in rates of access to medical tests, such as cardiac angioplasty, cataract removal and hip replacement surgery, is beginning to narrow. Researchers compared rates in 1986 and 1997 for a range of test and procedures and found that for almost every procedure white patients still have higher access rates, but black rates for black patients are improving. For example, in 1986 white elderly patients were almost twice as likely to have an exercise stress test as black patients, but in 1997 whites were 1.37 times as likely to have the test. In 1986 elderly white patients were 3.11 times as likely as blacks to have a coronary angioplasty, according to the study, but in 1997 whites were only twice as likely to undergo the heart procedure.

Rates for some procedures improved much more than others, and across the board, racial disparities still are troubling, researchers said.

[From: “Changes in Racial Differences in Use of Medical Procedures and Diagnostic Tests Among Elderly Persons: 1986-1997.” Contact: T. G. McGuire, PhD, Department of Health Care Policy, Harvard Medical School, Boston,]

Big cities and small towns at similar risk of gun death

People in rural areas are statistically as likely to die from gunfire as people in big cities. The difference is who pulls the trigger, you or someone else.

Researchers looked at almost 600,000 intentional deaths linked to a firearm from 1989 to1999. After statistically controlling various social, demographic, and economic factors, they found that gun death was as big a problem in rural as in urban communities and that the high rate of gun suicide in America's most rural areas closely resembled the high rate of gun homicide in her largest cities. These same trends were not found for suicide and homicide committed by means other than guns.

"Big cities and small towns have become less and less distinguishable through things like better schools, better highways, and the internet,” researchers said. “Now, unfortunately, gun death can be added to this list."

A goal of the federal government's Healthy People 2010 initiative is to reduce firearm-related deaths to 4.1 per 100,000 people, or about one-third the current rate. Researchers said that gun suicides, which actually outnumber gun homicides each year, should be a focus of this initiative, particularly among rural residents. They also added that, although

prevention efforts must be continued in big cities, dispelling the urban myth that gun death does not touch areas outside of big cities should be a high priority.

[From: "Urban-Rural Shifts in Intentional Firearm Death: Different Causes, Same Results." Contact: Charles C. Branas, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia,]

Mexican American communities offer health benefits to long-time residents

Living in a barrio can have significant health benefits for older Mexican Americans, according to a study of 3,050 Mexican Americans age 65 and older.

Researchers found that socio-cultural advantages of living in a neighborhood among other Mexican Americans afforded elderly residents protection against stroke, cancer and hip fracture. When compared with Mexican Americans who lived in neighborhoods where less than one-third of their neighbors were the same ethnicity, those who lived in areas with 90 to100 percent Mexican American residents were about one-third as likely to have a stroke, cancer or hip fracture. Their rates for heart attack and hypertension were also lower.

Researchers say hypotheses for the health benefits include lower drug and alcohol use, a less fast-food-centered diet and rushed Americanized lifestyle and high levels of social support.

[From: “Neighborhood Context and Mortality Among Mexican Americans: Is There a Barrio Advantage?” Contact: Karl Eschbach, University of Texas Medical Branch, Department of Internal Medicine—Geriatrics, Galveston, Texas,]

Colorectal cancer screening tools widely underused

A study of more than 58,000 men and 71,000 women aged 50 and older found two

of the most effective early screening tools for colorectal cancer are widely underused.

Only about half of the people surveyed had ever undergone sigmoidoscopy or colonoscopy, both procedures that allow for the early detection and removal of colorectal cancer and early lesions. Furthermore, only two-thirds of the procedures were used for screening, rather than for disease diagnosis or follow-up.

Colorectal cancer screening is recommended for people aged 50 and older, yet those ages 50to64 were the least likely to have been screened, especially women.

[From: "Underuse of Screening Sigmoidoscopy and Colonoscopy in a Large Cohort of US Adults." Contact: Ann Chao or Michael Thun, Epidemiology and Surveillance Research, American Cancer Society, Atlanta,,]

Rural veterans face lower quality of life than urban counterparts

Veterans who live in rural settings seem to have poorer health than their urban and suburban counterparts, according to study of more than 750,000 veterans who had visited a US Dept of Veterans Affairs health facility within the previous year.

Researchers used a survey that measures eight concepts of health: physical functioning, role limitations owing to physical problems, bodily pain, general health perceptions,

energy/vitality, social functioning, role imitations owing to emotional problems and

mental health. Health-related quality-of-life scores for veterans who lived in rural areas were significantly lower when compared to scores for veterans who lived in cities or suburbs.

The rural veterans lived farther from both private and VA hospitals than their urban and suburban counterparts and tended to be older and suffering from a number of physical health problems. Researchers suggested increasing the number of VA-sponsored health facilities in rural settings and offering coordinated health benefits that would allow veterans better access to privately funded primary care clinics.

[From: “Differences in Health-Related Quality of Life in Rural and Urban Veterans.” Contact: William B. Weeks, MD, MBA, White River Junction, Vt.,]

# # #

The American Journal of Public Health is the monthly journal of the American Public Health Association (APHA), the oldest organization of public health professionals in the world. APHA is a leading publisher of  books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at .


Complimentary online access to the journal is available to credentialed members of the media.  Address inquiries to Olivia Chang at APHA, (202) 777-2511, or via e-mail, A single print issue of the Journal is available for $20 from the Journal’s Subscriptions department at If you are not a member of the press, a member of APHA or a subscriber, online single issue access is $22 and online single article access is $10 at If you would like to order or renew a subscription, visit, or for direct customer service, call 202-777-2516 or email


To stay up to date on the latest in public health research, sign up for new content e-mail alerts at