In counties where a greater percentage of babies are delivered through cesarean section, physicians extend the procedure to patients who benefit less from the procedure, according to a study published August 8 on the Web site of the journal Health Affairs. The study by Amitabh Chandra and coauthors found great geographic variation in the use of cesareans, mostly unrelated to patients' medical conditions. Rather, the study found that nonmedical factors such as the density of providers and local medical malpractice pressures drove variation in the cesarean rate. The study also determined that counties performing cesareans more often could reduce the rate of this expensive and hazardous intervention by three to five percentage points without increasing maternal or newborn mortality.

In the July/August Health Affairs, Kevin Ryan and coauthors say Arkansas was able to adopt measures to fight childhood obesity in schools by using a two-stage strategy. State anti-obesity legislation contained noncontroversial requirements such as removing vending machines from elementary schools. More contentious matters, such as vending machine restrictions in high schools, were left to a Child Health Advisory Committee, which reported directly to the state's independent Board of Education without further legislative or gubernatorial intervention. Arkansas defused schools' resistance to unfunded anti-obesity mandates by providing implementation assistance, and the state adopted privacy protections for children's body mass index measurements.

Also in the July/August Health Affairs, Jenifer Kincheloe and coauthors find that carefully designed population surveys such as the California Health Interview Survey (CHIS) can produce reasonably accurate measurements of adult Medicaid enrollment. Thus, the authors say, "estimates of the uninsured population derived from these surveys can be trusted. In the CHIS, underreporting of Medicaid coverage is most common among enrollees [in Medi-Cal, the California Medicaid program] with limited beneifits, who might pay out of pocket for many - perhaps most - health services," say Kincheloe and coauthors, but, overall, "CHIS estimates of adult Medi-Cal enrollment match administrative counts."