Men's Health Network

We urge the United States Preventive Services Task Force (USPSTF) to call for aformal review of the evidence regarding testicular self-examination (TSE).Twelve years have since passed since the evidence was last formally analyzedwhere normally re-reviews occur in 5-year cycles. If they would decide to moveforward with this action, we ask for the USPSTF to review their methods forestablishing recommendations to optimize their rating system operationalizationprocess. Finally, emerging evidence demonstrates a net positive effect of TSE.This stands in contrast to the assertions of TSE’s supposed harm that isprevalent in the literature as well as the rationale behind the USPSTF’s “D”rating of TSE.

This survey evaluated resources available to men and boys at the state levelincluding state public health departments (SPHDs), other state agencies, andgovernor’s offices. Most of the resources and programs are found in the SPHDsand these administer state-initiated and federally funded health programs toprovide services and protection to a broad range of populations; however, manymen’s health advocates believe that SPHDs have failed to create equivalentservices for men and boys, inadvertently creating a health disparity. Men’sHealth Network conducts a survey of state resources, including those found inSPHDs, every 2 years to identify resources available for men and women,determine the extent of any disparity, and establish a relationship with SPHDofficials. Data were obtained from all 50 states and Washington, D.C. Ananalysis of the 2016 survey data indicates that there are few resourcesallocated and a lack of readily available information on health and preventivecare created specifically for men and boys. The data observed that most healthinformation intended for men and boys was scarce among states or oftentimesincluded on websites that primarily focused on women’s health. A potentialresult of this is a loss of engagement with appropriate health-care providersdue to a lack of information. This study continues to validate the disparitybetween health outcomes for women and men. It continues to highlight the needfor better resource allocation, outreach, and health programs specificallytailored to men and boys in order to improve overall community well-being.

With funds available from revenue generated by a voter-initiated ballot measure to increase the state cigarette excise tax,1 the Oregon Health Division created the Tobacco Prevention and Education Program. Coalitions in all Oregon counties, a countermarketing campaign, a statewide tobacco cessation quitters' helpline, and competitive grants to community groups, tribal associations, and school districts are supported by the program2; 12 percent of the program's $8.5 million annual funding was used to implement the CDC's Guidelines for School Health Programs to Prevent Tobacco Use and Addiction3 in 23 school districts or consortia of districts. Data from annual school-based surveys conducted to monitor adolescent risk behavior indicated that from 1999 to 2000, the 30-day smoking prevalence among eighth grade students declined more in funded schools than in a comparison group of nonfunded schools. The declines were significantly greater among schools with high and medium levels of implementation. These results suggest that comprehensive school-based programs can be an effective component of statewide anti-tobacco efforts. Data on smoking behavior among students were collected by the Oregon Health Division from either the Oregon Public School Drug Use Survey questionnaire or the Youth Risk Behavior Survey questionnaire. In 1999, 49 (53%) of 93 funded schools and 61 (25%) of 246 nonfunded schools used the latter questionnaire. In 2000, 58 funded schools and 47 nonfunded schools used either questionnaire. All analyses were based on data from 38 funded schools and 14 nonfunded schools that participated in both 1999 and 2000. Eighth graders were selected for analysis because the Tobacco Prevention and Education Program's most intensive interventions targeted middle schools, which meant that eighth graders in 2000, who were seventh graders in 1999, had been exposed to the program for two years. Smoking prevalence for 1999 and 2000 was measured in both funded and nonfunded schools, and multivariate logistic regression was used to compare the 2000 difference in prevalence between the two groups of schools. The prevalence in 2000 in schools with high, medium, or low program implementation scores also was compared with 2000 prevalence in nonfunded schools. Among the 52 schools, 1,942 (55%) of 3,519 eighth graders surveyed attended funded schools in 1999. In 2000, 4,089 (74%) of 5,556 eighth graders surveyed attended funded schools. Funded schools were required to conduct an eighth grade student census; nonfunded schools participated on a voluntary basis. The number of participating students varied as a result of differences in sampling protocol between the two surveys. Without knowledge of the school survey results, each funded school district was categorized on cumulative implementation (progress before and during funding) of six areas identified in CDC guidelines3—tobacco-free school policies, family involvement, community involvement, tobacco prevention curriculum instruction, teacher/staff training, and student tobacco use cessation support. Tobacco-free school policies were assessed by summing the number of elements completed out of 19.3 Family involvement and student tobacco use cessation support were assessed by summing the total completed out of five criteria in each of two components.3 Community involvement was measured by whether the district sent a representative to community tobacco coalition meetings; teacher/staff training was assessed by whether the district had provided training during the survey period; and tobacco prevention curriculum instruction was assessed by the implementation of a CDC-identified curriculum. The quartile score for the first three areas (scored one to four) was added to the dichotomous measures of the latter three areas (“yes” was scored zero and “no” was scored one) for a final score that ranged from three (best score) to 15 (worst score). Based on natural cut-off points in the distribution of scores, the schools then were classified as low (nine—15), medium (six—eight), or high (three—five) on the six areas. Of the 38 participating funded schools, 14 were in low-ranked districts, 15 were ranked medium, and nine were ranked high on implementation criteria. Both questionnaires were administered anonymously to all students in the participating eighth grade classrooms. The Youth Risk Behavior Survey question used to determine smoking status was “During the past 30 days, on how many days did you smoke cigarettes?” The question for the other survey was “How frequently have you smoked cigarettes during the past 30 days?” Students who indicated that they had smoked on more than one day were classified as smokers on each survey. In 1999, no statistical differences were observed in student or school characteristics, including eighth grade smoking prevalence, in funded versus nonfunded schools. The 30-day smoking prevalence decreased from 16.6 percent in 1999 to 13.0 percent in 2000 in funded schools and from 17.0 percent in 1999 to 15.7 percent in 2000 in nonfunded schools. Stratified by implementation level in 1999 and 2000, the changes in prevalence among eighth grade students were larger in schools in districts with high (from 14.2% to 8.2%) or medium (from 17.8% to 13.9%) ratings; changes in smoking prevalence in schools in districts with low ratings (from 17.1% to 15.6%) were almost equal to those in nonfunded schools (from 17.0% to 15.7%). Logistic regression was conducted to compare prevalence in funded and nonfunded schools and was adjusted for respondent sex, other substance use (e.g., alcohol, cocaine, marijuana, and inhalants), school size, school geographic location in state, and socioeconomic status of each school. Based on the regression model, students in the funded schools in 2000 were approximately 20% less likely to smoke compared with students in nonfunded schools. School funding status in 1999 was not associated with student smoking prevalence. Based on similar multivariate logistic regression analyses using 2000 results, the odds of an eighth grade student reporting smoking during the past 30 days were lowest among schools in districts with high or medium cumulative implementation. Commentary The findings in this report suggest that a comprehensive school-based tobacco prevention program that includes tobacco-free school policies and community involvement as one component of a statewide tobacco program may contribute to reductions in current smoking among eighth graders.3 The significantly greater declines in smoking prevalence in the schools that rated high and medium on implementation criteria emphasize the importance of monitoring activity in funded school programs and the need for ongoing assistance to facilitate implementation of evidence-based recommendations.3 Limitations The findings in this report are subject to multiple limitations. Two different student surveys, each with slightly different questions, were used to measure prevalence. Question wording and context in the questionnaires may have affected responses.4 Funded districts self-selected to apply for the competitive grants to implement the tobacco prevention program and represented approximately one third of the public school students in Oregon. Among them, only 38 of 93 schools conducted school-based surveys in both 1999 and 2000. The nonfunded schools also represented a self-selected sample, and the 14 nonfunded schools with survey data from both 1999 and 2000 represented only six percent of all nonfunded Oregon schools. The funded and nonfunded schools may have differed in unmeasured characteristics (e.g., the effectiveness of a county coalition's antitobacco activities) that may have influenced 2000 smoking prevalence. In the multivariate analyses, sample clustering by school was represented in the analysis; however, variable sampling rates within each school could not be accounted for because information on these rates was unavailable. Student smoking prevalence was based on self-reports, and in schools with stronger programs, students might have underreported smoking because of stronger antismoking norms. No information was available on the student response rate for the schools in this study; however, the average student response rate for Oregon surveys using the Youth Risk Behavior Survey questionnaire has been 78 percent. Changes in smoking prevalence from 1999 to 2000 were based on comparisons of cross-sectional samples of eighth graders rather than on a longitudinal cohort. Measurements of program implementation were based on coordinator self-reports and, although these reports assessed policies for a range of characteristics, they did not include measures of policy enforcement, and the self-reports could not be validated externally. Finally, the results of this study were based on a comparison of only two years of data, and further surveillance is necessary to confirm trends and the impact of this school-based program. The implementation of a tobacco prevention curriculum alone may be insufficient to prevent cigarette smoking among adolescents.5 CDC recommends a combination of tobacco-free school policies and an evidence-based curriculum linked to communitywide programs involving families, peers, and organizations. School-based activities are most effective when integrated with countermarketing campaigns and community-based activities.6 Several states, including Oregon, have reported declines in youth smoking rates after implementing multicomponent tobacco prevention and control efforts.2,7–9 Consistent with the CDC's Best Practices for Comprehensive Tobacco Control Programs,9 the data in this report suggest that school-based programs can be an effective element of statewide tobacco prevention and education. Partnering Hospitals & Hospices A major aim of the second annual meeting of the Center to Advance Palliative Care was to encourage hospital-hospice collaborations. Speakers at the meeting, held in Chicago in October, described the advantages of a partnership in which hospitals, hospices, and patients and families all stand to benefit. Bringing together hospices, with their palliative care capacity and expertise, and hospitals, where more than 50 percent of US adult deaths occur, may seem obvious. In fact, it's considerably more difficult than it seems, noted Diane E. Meier, MD, Co-Director of the Center and Director of the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine. She pointed to what she called the “culture of cure” that pervades hospitals, conflicting reimbursement and financing strategies, the nursing shortage, and the lack of established leaders in this very new area of medicine as barriers to closer ties. And yet, the potential benefits make the effort worthwhile. “This approach adapts the philosophy of care and interdisciplinary practice developed in the hospice movement and applies it to hospital patients based on need and severity of illness, independent of prognosis,” Dr. Meier told attendees at a session entitled, “Hospital-Hospice Collaborations: The New Imperative.” “Very few hospitals have palliative care expertise, but almost every community has a funded hospice program,” she noted. “Partnering with hospice gives hospitals access to an untapped repository of fiscally stable palliative care expertise, as well as access to an integrated continuity of care for our sickest and most vulnerable patients and their families.” If the benefits are clear, strategies for achieving them are not. Dr. Meier suggested that hospitals begin by meeting with the local hospice CEO to discuss mutual needs in terms of case finding, discharge planning, and staff education. Hospices, for their part, should cultivate links with hospital clinicians. Equally important, they must be able to present hard evidence of the benefits they can offer. This means collecting data on length of stay, cost avoidance, discharge options, and quality of care.