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Brown-Johnson C.G.,Center for Tobacco Control Research and Education | England L.J.,Centers for Disease Control and Prevention | Glantz S.A.,Center for Tobacco Control Research and Education | Glantz S.A.,Philip R Lee Institute For Health Policy Studies | And 2 more authors.
Tobacco Control

Objectives Describe tobacco companies’ marketing strategies targeting low socioeconomic status (SES) females in the USA.Methods Analysis of previously secret tobacco industry documents.Results Tobacco companies focused marketing on low SES women starting in the late 1970s, including military wives, low-income inner-city minority women, ‘discountsusceptible’ older female smokers and less-educated young white women. Strategies included distributing discount coupons with food stamps to reach the very poor, discount offers at point-of-sale and via direct mail to keep cigarette prices low, developing new brands for low SES females and promoting luxury images to low SES African-American women. More recently, companies integrated promotional strategies targeting low-income women into marketing plans for established brands.Conclusions Tobacco companies used numerous marketing strategies to reach low SES females in the USA for at least four decades. Strategies to counteract marketing to low SES women could include (1) counteracting price discounts and direct mail coupons that reduce the price of tobacco products, (2) instituting restrictions on point-of-sale advertising and retail display and (3) creating counteradvertising that builds resistance to psychosocial targeting of low SES women. To achieve health equity, tobacco control efforts are needed to counteract the influence of tobacco industry marketing to low-income women. © 2014 BMJ Publishing Group. All rights reserved. Source

Patel A.I.,University of California at San Francisco | Patel A.I.,Philip R Lee Institute For Health Policy Studies | Hampton K.E.,Public Health Law and Policy
American Journal of Public Health

Children and adolescents are not consuming enough water, instead opting for sugar-sweetened beverages (sodas, sports and energy drinks, milks, coffees, and fruit-flavored drinks with added sugars), 100% fruit juice, and other beverages. Drinking sufficient amounts of water can lead to improved weight status, reduced dental caries and improved cognition among children and adolescents. Because children spend most of their day at school and in child care, ensuring that safe, potable drinking water is available in these settings is a fundamental public health measure. We sought to identify challenges that limit access to drinking water; opportunities, including promising practices, to increase drinking water availability and consumption; and future research, policy efforts, and funding needed in this area. Source

Taylor A.L.,Johns Hopkins University | Parento E.W.,Georgetown University | Schmidt L.A.,Philip R Lee Institute For Health Policy Studies
Indiana Law Journal

Obesity is a global epidemic, exacting an enormous human and economic toll. In the absence of a comprehensive global governance strategy, states have increasingly employed a wide array of legal strategies targeting the drivers of obesity. This Article identifies recent global trends in obesity-related legislation and makes the normative case for an updated global governance strategy. National governments have responded to the epidemic both by strengthening traditional interventions and by developing novel legislative strategies. This response consists of nine important trends: (1) strengthened and tailored tax measures; (2) broadened use of counter-advertising and health campaigns; (3) expanded food labeling; (4) increased attention to the built environment; (5) expanded use of bundled school-based strategies; (6) imposed greater restrictions on advertising and marketing to children; (7) strengthened restrictions, standards, and bans on specific foods and food additives; (8) created more targeted screening and brief interventions; and (9) ensured creative use of integrated programs to promote sustainable agriculture, environment, and healthy food. Despite this response, there remains a need to create a centralized, publicly accessible database of interventions. In addition, the scale of the obesity epidemic combined with the global trend toward more comprehensive regulation may for the first time create political space and will for an international obesity strategy. Copyright © 2015 Allyn L. Taylor, Emily Whelan Parento & Laura A. Schmidt. Source

Kelley R.K.,University of California at San Francisco | Van Bebber S.L.,University of California at San Francisco | Phillips K.A.,University of California at San Francisco | Phillips K.A.,Philip R Lee Institute For Health Policy Studies | Venook A.P.,University of California at San Francisco
JNCCN Journal of the National Comprehensive Cancer Network

Predictive and prognostic biomarkers offer a potential means to personalize cancer medicine, although many reach the marketplace before they have been validated, and their adoption is often hindered by variable clinical evidence. Because of this variability in supporting evidence, clinical practice guidelines formulated by panels of subspecialty experts may be particularly important in guiding stakeholders' acceptance and use of new personalized medicine biomarker tests and other nascent technologies. This article provides a structured review of the clinical evidence supporting 4 contemporary biomarker tests in colorectal cancer: K-ras and B-raf mutation analyses, mismatch repair protein testing, and the Oncotype DX Colon Cancer Assay. All 4 tests have been evaluated for guideline inclusion by the NCCN Guidelines Panel for Colon Cancer. This case study shows significant variability in the level of clinical evidence associated with these tests. In the cases of B-raf and mismatch repair protein testing, the available evidence is also inconsistent as it pertains to the specific NCCN Guideline recommendation. Based on this uncertainty in the evidence base, the authors conclude that expert clinical judgment, experience, and consensus may be more heavily weighted than published clinical trial data in the evaluation of new personalized medicine biomarker tests. Potential implications of this conclusion and future directions for research are discussed. © JNCCN-Journal of the National Comprehensive Cancer Network. Source

Moriates C.,University of California at San Francisco | Dohan D.,University of California at San Francisco | Spetz J.,Philip R Lee Institute For Health Policy Studies | Spetz J.,University of California at San Francisco | Sawaya G.F.,University of California at San Francisco
Academic Medicine

Leaders in medical education have increasingly called for the incorporation of cost awareness and health care value into health professions curricula. Emerging efforts have thus far focused on physicians, but foundational competencies need to be defined related to health care value that span all health professions and stages of training. The University of California, San Francisco (UCSF) Center for Healthcare Value launched an initiative in 2012 that engaged a group of educators from all four health professions schools at UCSF: Dentistry, Medicine, Nursing, and Pharmacy. This group created and agreed on a multidisciplinary set of comprehensive competencies related to health care value. The term "competency" was used to describe components within the larger domain of providing highvalue care. The group then classified the competencies as beginner, proficient, or expert level through an iterative process and group consensus. The group articulated 21 competencies. The beginner competencies include basic principles of health policy, health care delivery, health costs, and insurance. Proficient competencies include real-world applications of concepts to clinical situations, primarily related to the care of individual patients. The expert competencies focus primarily on systems-level design, advocacy, mentorship, and policy. These competencies aim to identify a standard that may help inform the development of curricula across health professions training. These competencies could be translated into the learning objectives and evaluation methods of resources to teach health care value, and they should be considered in educational settings for health care professionals at all levels of training and across a variety of specialties. Source

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