To quantify the contributions of household and environmental factors to Helicobacter pylori infection, the authors examined H. pylori infection among several generations of Hispanics in the San Francisco Bay Area.

Between 2000 and 2004, household members were tested for H. pylori and interviewed about demographic factors and household pedigree. An immigrant was defined as someone born in Latin America with at least one Latin America-born parent; a first-generation US-born Hispanic was defined as someone born in the United States with at least one Latin America-born parent; and a second-generation US-born Hispanic was defined as someone born in the United States with at least one US-born parent.

Prevalences of H. pylori in immigrants and first- and second-generation US-born Hispanics were 31.4% (102/325), 9.1% (98/1,076), and 3.1% (2/64), respectively. Compared with second-generation US-born Hispanics, the age-adjusted odds ratios for H. pylori were 9.70 (95% confidence interval (CI): 1.57, 60.00) for immigrants and 4.32 (95% CI: 0.69, 26.96) for first-generation US-born Hispanics (p(trend) < 0.001). These odds ratios decreased to 6.19 (95% CI: 1.13, 33.77) and 3.24 (95% CI: 0.59, 17.82), respectively, after adjustment for parental infection (odds ratio (OR) = 2.94, 95% CI: 1.59, 4.38), low education (OR = 1.76, 95% CI: 1.20, 2.68), and crowding (OR = 1.23, 95% CI: 0.84, 1.79).

Both the household and birth-country environments probably contributed to declining H. pylori prevalence among successive generations of Hispanics.

The performance of medical groups is receiving increased attention. Relatively little conceptual or empirical work exists that examines the various dimensions of medical group performance. Using a national database of 693 medical groups, this article develops a scorecard approach to assessing group performance and presents a theory-driven framework for differentiating between high-performing versus low-performing medical groups. The clinical quality of care, financial performance, and organizational learning capability of medical groups are assessed in relation to environmental forces, resource acquisition and resource deployment factors, and a quality-centered culture. Findings support the utility of the performance scorecard approach and identification of a number of key factors differentiating high-performing from low-performing groups including, in particular, the importance of a quality-centered culture and the requirement of outside reporting from third party organizations. The findings hold a number of important implications for policy and practice, and the framework presented provides a foundation for future research.

Concern about health care expenditures is not a new phenomenon. Seventy-five years ago, President Herbert Hoover appointed a committee to investigate the cost of medical care under the chairmanship of Ray Lyman Wilbur, MD, president of Stanford University. Thirty-eight years ago, John Gardner, Secretary of Health, Education, and Welfare, convened a national conference on medical care costs. Since then, not a year has passed without professional and lay periodicals addressing this subject. Most recently, Annals has published 4 articles by Thomas Bodenheimer on health care costs, the last of which, coauthored by Alicia Fernandez, appears in this issue. These articles provide valuable background material and address several key questions about expenditures from many different perspectives. Possible approaches to cost containment are discussed, with special emphasis on the potential role of physicians and with the caveat that this is "an overview of a complex topic, written by a noneconomist for noneconomists."

This editorial, written by an economist for physicians, emphasizes some critical distinctions and offers a somewhat different set of questions and answers. It differentiates sharply between levels of expenditures and their rates of growth, addresses the question of why either should be of concern for public policy, and discusses strategies for containing expenditures.

This issue of CHP/PCOR's quarterly newsletter covers developments from the spring 2005 quarter. It includes articles about:

• research on HIV/AIDS in Russia -- presented in May at an international conference -- which shows that in order to contain the country's rapidly expanding HIV/AIDS epidemic, Russia must aggressively treat HIV-positive injection drug users;
• a CHP/PCOR-hosted discussion session with Edward Sondik, director of the National Center for Health Statistics;
• an ongoing CHP/PCOR study that examines older adults' preferences about health states in which they would need help with basic tasks like bathing or eating;
• a panel discussion on "International Responses to Infectious Diseases," led by CHP/PCOR at the Stanford Institute for International Studies' first annual conference, featuring the World Health Organization's chief of infectious diseases;
• a widely publicized study by CHP/PCOR researchers which found that obese workers are paid less than non-obese workers in similar jobs, but only when they have employer-sponsored health insurance -- a finding suggesting that the wage gap is due to obese workers' higher medical costs, rather than outright prejudice; and
• an update on the Center on Advancing Decision Making for Aging, including two new seed projects and a lecture given by economics and psychology professor George Loewenstein.

Objective: Relatively little is known about the intergenerational mechanisms that lead to social disparities in child health. We examined whether the association between low socioeconomic status (SES) and child behavior problems is mediated by maternal health conditions and behavior.

Methods: Prospective cohort data (1979-1998) on 2,677 children and their mothers were obtained from the National Longitudinal Survey of Youth. SES, the Child Behavior Problems Index (BPI), and maternal smoking, depressive symptoms, and alcohol use before, during, and after pregnancy were examined.

Results: Lower income and lower maternal education were associated with increased child BPI scores. Adjustment for maternal smoking, depressive symptoms, and alcohol use attenuated the associations between SES and child BPI by 26% to 49%. These maternal health conditions often occurred together, persisted over time, and were associated with the mother's own childhood SES and pre-pregnancy health.

Conclusions: Social disparities in women's health conditions may help shape the

likelihood of behavior problems in the subsequent generation. Improved public

health programs and services for disadvantaged women across the lifecourse may

not only address their own urgent health needs, but reduce social disparities in the health and well-being of their children.