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Appendix A: Domains Reviewed But Not Selected for the Candidate Set
Pages 273-318

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From page 273...
... What follows provides domain descriptions, including examples of each one's association with health, along with illustrations of useful interventions for individuals or the population and priorities for research. The committee reviewed the evidence for these domains and found that the evidence of the association with health and usefulness was less compelling than that for the candidate domains included in Chapter 3.
From page 274...
... * activation, optimism, self-efficacy Coping, positive affect, life satisfaction *
From page 275...
... * Military service *
From page 276...
... * Availability of nutritious food options *
From page 277...
... . The following domains were considered and are included in the list below in the general context of the domains identified in Table 2-1: Sociodemographic Domains Gender identity Psychological Domains Negative mood and affect: Hostility and anger, hopelessness Cognitive function in late life Positive psychological asset: Coping, positive affect, life satisfaction Behavioral Domains Abuse of other substances Sexual practices Exposure to firearms Risk-taking behaviors: Distractive driving and helmet use Individual-Level Social Relationships and Living Conditions Domains Social support: Emotional, instrumental, and other Work conditions History of incarceration Military service Community and cultural norms: Health decision making Neighborhoods and Communities Contextual Characteristics E  nvironmental exposures: Air pollution, allergens, other hazardous exposures Availability of nutritious food options Transportation, parks, and open spaces Health care and social services Educational and job opportunities GENDER IDENTITY Gender identity is a person's subjective sense of his or her gender, which may or may not be the same as that person's gender at birth.
From page 278...
... . Data are lacking, however, about whether gender identity is a risk factor for other disorders such that diagnosis or treatment would be informed by knowledge of gender identity.
From page 279...
... The committee concluded that including gender identity in every individual's EHR at this time would not result in sufficient improvements in overall clinical care or population health to justify its inclusion. Instead, the committee concluded that more work needs to be done on the assessment tools.
From page 280...
... This domain was ranked as useful for research purposes. Conclusion Anger and hostility predict future heart disease and are associated with risky health behaviors.
From page 281...
... Given the conceptual overlap of hopelessness with other negative emotions and attitudes, including epidemiological data on the associations of optimism/pessimism with depression, and stronger and more complete data on the relationship of other variables such as optimism/pessimism and depression with health outcomes, the committee elected not to include hopelessness as one of its candidate domains.
From page 282...
... Thus, the committee elected not to include cognitive function in late life as one of its candidate domains.
From page 283...
... As summarized by Taylor and Stanton (2007) , use of problem-focused approach coping methods is associated with better health and positive adjustment, provided that the stressor is potentially controllable, while avoidance coping, especially in relation to long-term stressors, may increase distress and poor adjustment.
From page 284...
... Therefore, along with the concern about complexity of measuring coping and questions about usefulness given current data, the committee elected not to include coping as a candidate domain. Positive Affect Positive affect is defined as the extent to which an individual experiences pleasurable feelings, including joy, happiness, and cheerfulness.
From page 285...
... At a later date, there may be additional evidence that monitoring positive affect may be helpful to chart changes in response to treatment. Therefore the committee elected not to include positive affect as a candidate domain.
From page 286...
... For these reasons, the committee elected not to select life satisfaction as a candidate domain. ABUSE OF OTHER SUBSTANCES Substance abuse includes the abuse of illegal drugs as well as the misuse of household substances and legal substances (e.g., prescription drugs, aerosols, and glue)
From page 287...
... Thus, the committee did not select abuse of other substances as a candidate domain. SEXUAL PRACTICES Sexual practices refer to the specific ways that people have sex with themselves or with others.
From page 288...
... Having knowledge of patient sexual practices could enable health care providers to provide their patients with the appropriate screenings for sexually transmitted infections. For example, rectal cultures for gonorrhea can be done in people who engage in anal intercourse but do not need be done in persons who do not engage in that sexual practice.
From page 289...
... In particular, adolescents may have incorrect information about the likelihood of pregnancy or sexually transmitted infections involved with certain sexual practices (e.g., transmission of gonorrhea through oral sex)
From page 290...
... To date, the Task Force has found that the scientific evidence on the following types of firearm interventions is insufficient to recommend that community health interventions be implemented to prevent them: bans on specified firearms or ammunition, restrictions on firearm acquisition, waiting periods for firearm acquisition, firearm registration and licensing of firearm owners, laws on carrying concealed weapons, child access prevention laws, zero tolerance of firearms in schools, and combinations of firearms laws. It was unclear to the committee how useful a clinical intervention about firearm ownership could be.
From page 291...
... Because of the lack of a research base, the impracticality of screening in primary care settings, and the evidence of appropriate interventions, the committee elected not to select exposure to firearms as a candidate domain. RISK-TAKING BEHAVIORS: DISTRACTIVE DRIVING AND HELMET USE Risk-taking is defined as engaging in behaviors having at least one uncertain outcome (Fischoff, 1992)
From page 292...
... The risk-taking behavior domain was rated moderately useful for population health management and research. However, the domain was rated minimally useful for individual patient management given the limited interventions available to the clinical team.
From page 293...
... Evidence of Association with Health Many small-scale studies and some larger population studies have found that social support is positively associated with health indicators. The association may reflect a direct/additive relationship and/or a buffering/interactive effect in which support mitigates or moderates the adverse effects of other risk factors for health, especially acute or chronic stress (Bowen et al., 2013; Cohen and Wills, 1985; Cohen et al., 2007; Dour et al., 2013; Sarason et al., 1990a,b)
From page 294...
... For example, exposure to physical risks and hazards, stress and poor mental health, and salary level or workplace benefits affect a person's ability to obtain nutritious foods, achieve adequate physical activity, locate healthy housing, and have access to medical care. Psychosocial aspects of work that influence health include work schedules, commuting conditions, how work is organized, social support at work, and discrimination in the workplace.
From page 295...
... At this time, the committee elected not to include work conditions as a candidate domain. HISTORY OF INCARCERATION A history of incarceration refers to prior contact with the correctional system, including prisons and jails.
From page 296...
... Therefore the committee did not select history of incarceration as a candidate domain.
From page 297...
... . Other health consequences of military service include traumatic brain injury and posttraumatic stress disorder (PTSD)
From page 298...
... For example, the recommended screening for depression and stress would likely identify mental health issues that may have their roots in earlier military service and can be addressed without that knowledge. Therefore the committee did not select history of military service as a candidate domain.
From page 299...
... . A CIS includes contextual information such as the geospatial distribution of grocery stores selling healthy food options, transportation resources, open spaces and parks, health care facilities, social services, and job and educational opportunities.
From page 300...
... -- depending on the questions of interest. The addition of environmental factors and community resources to the EHR to enable a more comprehensive understanding of the social and environmental determinants of health and the resources available to patients for implementation of health care treatments does not require any new information to be recorded in the EHR.
From page 301...
... . Chronic exposure to air pollutants is a risk factor for the development of respiratory and cardiovascular disease.
From page 302...
... Their research indicated that measures of neighborhood context, such as physical and social decay and social trust, may be underlying factors associated with asthma. Research links asthma to social adversity brought on by environmental factors and disparities in population health (Rauh et al., 2008)
From page 303...
... Availability of Nutritious Food Options Within the context of communities, the availability of nutritious food options refers to the geospatial distribution of grocery stores, food vendors generally located in small stores, and restaurants. It can refer to overall food availability or, more specifically, to access to specific types of food, such as fruits and vegetables, sweetened beverages, calorie-dense foods, and
From page 304...
... Although no uniform consensus on the meaning of available nutritious food options exists, most would agree that it includes proximity of food options, price, and travel time -- the amount of time required to travel to purchase food. Evidence on Association with Health The hypothesized link between food options in the community and health is that the greater availability of nutritious food will increase the intake of healthful foods, such as fruits, vegetables, and whole grains, while lower availability of sweetened beverages will reduce the risk of obesity.
From page 305...
... The Philadelphia Department of Health, for example, has compiled a rich database on the locations of nutritious food options throughout the city of Philadelphia and has developed programs to reduce the amount of salt in Chinese restaurants and increase the amount of fruit and vegetables sold in corner stores (The Food Trust, 2012; Get Healthy Philly, 2013)
From page 306...
... . Less clear is how specific changes in the built environment lead to predictable decrements in physical activity, although specific environmental variables such as access to recreation facilities, living in neighborhoods where others exercise, and the presence of enjoyable scenery have been positively associated with physical activity in several studies (Trost et al., 2010)
From page 307...
... . One vision of how the PCMH could leverage community resources is through the creation of a merged EHR-community resources database that enables the creation of a personalized set of recommendations of local community resources for each patient that is based on his or her health needs and that can be provided to the patient during a medical encounter.
From page 308...
... domains show that there are associations with health; further research to understand the validity and usefulness of these domains is currently being conducted. In some instances these domains are interrelated with candidate domains (e.g., availability of nutritious food options is interrelated with financial resource strain and dietary food patterns)
From page 309...
... For these reasons, the committee elected not to select environmental pollution and neighborhood resources (availability of nutritious food options; transportation, parks, and open spaces; health care and social services; and educational and job opportunities) as candidate domains.
From page 310...
... 2013. The stress-buffering effects of functional social support on ambulatory blood pressure.
From page 311...
... 2006. Inequality in the built environment underlies key health disparities in physical activity and obesity.
From page 312...
... 2013a. Collecting sexual orientation and gender identity data in electronic health re cords: Workshop summary.
From page 313...
... 2005. The benefits of frequent positive affect: Does happiness lead to success?
From page 314...
... 2005. Does positive affect influence health?
From page 315...
... 1984. Research on social support, loneliness, and social isolation: Towards an integration.
From page 316...
... 2000. Occupational risk factors for shoulder pain: A systematic review.
From page 317...
... 2003. Firearms in US homes as a risk factor for unintentional gunshot fatality.


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