American Journal of Public Health
Volume 105, Issue 1 (January 2015)
http://ajph.aphapublications.org/toc/ajph/current

Coupled Ethical–Epistemic Analysis of Public Health Research and Practice: Categorizing Variables to Improve Population Health and Equity
S. Vittal Katikireddi, MRCP, MFPH, PhD, and Sean A Valles, PhD
S. Vittal Katikireddi is with the Medical Research Council and the Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Sean A. Valles is with Lyman Briggs College and the Department of Philosophy, Michigan State University, East Lansing.
Abstract
The categorization of variables can stigmatize populations, which is ethically problematic and threatens the central purpose of public health: to improve population health and reduce health inequities. How social variables (e.g., behavioral risks for HIV) are categorized can reinforce stigma and cause unintended harms to the populations practitioners and researchers strive to serve.
Although debates about the validity or ethical consequences of epidemiological variables are familiar for specific variables (e.g., ethnicity), these issues apply more widely.
We argue that these tensions and debates regarding epidemiological variables should be analyzed simultaneously as ethical and epistemic challenges. We describe a framework derived from the philosophy of science that may be usefully applied to public health, and we illustrate its application.

EDITORIAL The Moral Challenge of Ebola
Mark A. Rothstein
American Journal of Public Health: January 2015, Vol. 105, No. 1: 6–8.
Citation | Full Text | PDF (651 KB) | PDF Plus (653 KB)

Assessing the Expected Impact of Global Health Treaties: Evidence From 90 Quantitative Evaluations
Steven J. Hoffman, BHSc, MA, JD, and John-Arne Røttingen, MD, PhD, MSc, MPA
Steven J. Hoffman is with the Faculty of Law, University of Ottawa, Canada, and the Department of Global Health and Population, Harvard School of Public Health, Boston, MA. John-Arne Røttingen is with the Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway, and the Institute of Health and Society, University of Oslo, Norway.
Abstract
We assessed what impact can be expected from global health treaties on the basis of 90 quantitative evaluations of existing treaties on trade, finance, human rights, conflict, and the environment.
It appears treaties consistently succeed in shaping economic matters and consistently fail in achieving social progress. There are at least 3 differences between these domains that point to design characteristics that new global health treaties can incorporate to achieve positive impact: (1) incentives for those with power to act on them; (2) institutions designed to bring edicts into effect; and (3) interests advocating their negotiation, adoption, ratification, and domestic implementation.
Experimental and quasiexperimental evaluations of treaties would provide more information about what can be expected from this type of global intervention.

Cognitive Dissonance in the Early Thirties: The League of Nations Health Organization Confronts the Worldwide Economic Depression
Theodore M. Brown, Elizabeth Fee
American Journal of Public Health: January 2015, Vol. 105, No. 1: 65–65.
Citation | Full Text | PDF (163 KB) | PDF Plus (165 KB)

Human Papillomavirus Vaccination Among Young Adult Gay and Bisexual Men in the United States
Paul L. Reiter, PhD, Annie-Laurie McRee, DrPH, Mira L. Katz, PhD, and Electra D. Paskett, PhD
Paul L. Reiter and Electra D. Paskett are with the Division of Cancer Prevention and Control, College of Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus. Annie-Laurie McRee and Mira L. Katz are with the Division of Health Behavior and Health Promotion, College of Public Health and the Comprehensive Cancer Center, Ohio State University.
Abstract
Objectives. We examined human papillomavirus (HPV) vaccination among gay and bisexual men, a population with high rates of HPV infection and HPV-related disease.
Methods. A national sample of gay and bisexual men aged 18 to 26 years (n = 428) completed online surveys in fall 2013. We identified correlates of HPV vaccination using multivariate logistic regression.
Results. Overall, 13% of participants had received any doses of the HPV vaccine. About 83% who had received a health care provider recommendation for vaccination were vaccinated, compared with only 5% without a recommendation (P < .001). Vaccination was lower among participants who perceived greater barriers to getting vaccinated (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.27, 0.78). Vaccination was higher among participants with higher levels of worry about getting HPV-related disease (OR = 1.54; 95% CI =  1.05, 2.27) or perceived positive social norms of HPV vaccination (OR = 1.57; 95% CI =  1.02, 2.43).
Conclusions. HPV vaccine coverage is low among gay and bisexual men in the United States. Future efforts should focus on increasing provider recommendation for vaccination and should target other modifiable factors.