bluuebunny/crossref_metadata_2025 huggingface dataset:
Age-Specific Seroprevalence of HIV, Hepatitis B Virus, and Hepatitis C Virus Infection Among Injection Drug Users Admitted to Drug Treatment in 6 US Cities
Authors: Murrill Christopher S. , Weeks Howard , Castrucci Brian C. , Weinstock Hillard S. , Bell Beth P. , Spruill Catherine , Gwinn Marta
Published: December 2008

Objectives. This study measured age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus (HCV) infection among injection drug users (IDUs) admitted to drug treatment programs in 6 US cities.

Methods. Remnant sera collected from persons entering treatment with a history of illicit drug injection were tested for antibodies to HIV, hepatitis C (anti-HCV), and hepatitis B core antigen (anti-HBc).

Results. Prevalence of anti-HBc and anti-HCV increased with age and reached 80% to 100% among older IDUs in all 6 cities. Although overall age-specific HIV prevalence was lower than anti-HCV or anti-HBc, this prevalence was greater in the Northeast than in the Midwest and West.

Conclusions. The need continues for effective primary prevention programs among IDUs specifically targeting young persons who have recently started to inject drugs. (Am J Public Health. 2002;92:385–387)
When the Caregiver Needs Care: The Plight of Vulnerable Caregivers
Authors: Navaie-Waliser Maryam , Feldman Penny H. , Gould David A. , Levine Carol , Kuerbis Alexis N. , Donelan Karen
Published: December 2008

Objectives. This study examined the characteristics, activities, and challenges of high-risk informal caregivers.

Methods. Telephone interviews were conducted with a nationally representative cross-section of 1002 informal caregivers. Vulnerable caregivers with poor health or a serious health condition were compared with nonvulnerable caregivers.

Results. Thirty-six percent of caregivers were vulnerable. Compared with nonvulnerable caregivers, vulnerable caregivers were more likely to have difficulty providing care, to provide higher-intensity care, to report that their physical health had suffered since becoming a caregiver, to be aged 65 years or older, to be married, and to have less than 12 years of education.

Conclusions. Reliance on informal caregivers without considering the caregiver's ability to provide care can create a stressful and potentially unsafe environment for the caregiver and the care recipient.
Spatial Variability in Toxicity Indicators Used to Rank Chemical Risks
Authors: Cutter Susan L. , Scott Michael S. , Hill Arleen A.
Published: December 2008

Objectives. This study used 6 different measures of toxicity to explore spatial and statistical variations in relative risk indicators of Toxic Release Inventory emissions.

Methods. Statistical and spatial correlations between the 6 indices were computed for individual South Carolina facilities.

Results. Although the 6 toxicity indices are not highly correlated in theory, they have more commonality in practice. There was significant spatial variation in the indices by individual facility level.

Conclusions. Environmental justice researchers must be cognizant of differences in toxicity indices because the choice of the toxicity measure can alter (statistically and spatially) the results of equity analyses and lead to erroneous conclusions. (Am J Public Health. 2002;92:420-422)
Effect on Smoking Cessation of Switching Nicotine Replacement Therapy to Over-the-Counter Status
Authors: Thorndike Anne N. , Biener Lois , Rigotti Nancy A.
Published: December 2008

Objectives. This study examined whether the change in nicotine replacement therapy sales from prescription to over the counter (OTC) status affected smoking cessation.

Methods. We used the 1993–1999 Massachusetts Tobacco Surveys to compare data from adult current smokers and recent quitters before and after the OTC switch.

Results. No significant change over time occurred in the proportion of smokers who used nicotine replacement therapy at a quit attempt in the past year (20.1% pre-OTC vs 21.4% post-OTC), made a quit attempt in the past year (48.1% vs 45.2%), or quit smoking in the past year (8.1% vs 11.1%). Fewer non-Whites used nicotine replacement therapy after the switch (20.7% pre-OTC vs 3.2% post-OTC, P = .002), but the proportion of Whites using nicotine replacement therapy did not change significantly (20.6% vs 24.0%).

Conclusions. We observed no increase in Massachusetts smokers' rates of using nicotine replacement therapy, making a quit attempt, or stopping smoking after nicotine replacement therapy became available for OTC sale. There appear to be other barriers to the use of nicotine replacement therapy besides visiting a physician, especially among minority smokers. (Am J Public Health. 2002;92:437–442)
Reconceptualizing Native Women's Health: An “Indigenist” Stress-Coping Model
Authors: Walters Karina L. , Simoni Jane M.
Published: December 2008

This commentary presents an “indigenist” model of Native women's health, a stress-coping paradigm that situates Native women's health within the larger context of their status as a colonized people. The model is grounded in empirical evidence that traumas such as the “soul wound” of historical and contemporary discrimination among Native women influence health and mental health outcomes. The preliminary model also incorporates cultural resilience, including as moderators identity, enculturation, spiritual coping, and traditional healing practices.

Current epidemiological data on Native women's general health and mental health are reconsidered within the framework of this model.
Public Health Needs and Scientific Opportunities in Research on Latinas
Authors: Amaro Hortensia , de la Torre Adela
Published: December 2008

Much of the research on women's health has not deepened our understanding of health issues affecting Latinas. Yet integration of research on Latinas into the women's health agenda is important for at least 2 reasons.

First, critical public health issues facing Latinas must be better understood if effective interventions designed to eliminate racial and ethnic disparities in health are to be developed and implemented. Second, studies on the health of Latinas represent unique opportunities to advance scientific understandings of underlying processes relevant to the health of other populations. Such research can further our knowledge of the processes underlying cultural adaptation and negotiation of changing sex roles and how these issues affect the health of women.

Critical research and empirical approaches that help us to understand how race, ethnicity, sex, and class shape the health of Latinas will inform broader public health issues.
Spirituality and Health for Women of Color
Authors: Musgrave Catherine F. , Allen Carol Easley , Allen Gregory J.
Published: December 2008

Spirituality among African American and Hispanic women has been associated with a variety of positive health outcomes.

The purposes of this commentary are (1) to define spirituality, comparing it with religiosity, and briefly examine the historical, cultural, and contextual roots of spirituality among women of color; (2) to explore research data that support a relationship between spirituality and health, particularly among women of color; and (3) to present several examples of how spirituality may enhance public health interventions designed to promote health and prevention.
The Face of Women's Health: Helen Rodriguez-Trias
Authors: Wilcox Joyce
Published: December 2008

The American Public Health Association has announced that it will establish an award in the name of Helen Rodriguez-Trias, MD, its first Latina president, who died of lung cancer on December 27, 2002. Rodriguez-Trias, a nationally known advocate for underserved communities, was awarded the Presidential Citizens Medal by President Clinton in January 2001 for her work on behalf of children, women, people with AIDS, and the poor. This article is based on a dialogue with Rodriguez-Trias that began in September 2001 and ended December 12, 2001.
Eliminating Health Disparities Among Minority Women: A Report on Conference Workshop Process and Outcomes
Authors: Kritek Phyllis Beck , Hargraves Martha , Cuellar Ernestine H. , Dallo Florence , Gauthier Donna M. , Holland Christi A. , Ilkiw Connie , Swanson Jane W. , Swanson Reid
Published: December 2008

A national conference convened in May 2001 explored health disparities among minority women. It included 5 one-hour workshops that randomly assigned each participant to 1 of 4 groups. Groups generated recommendations on conference topics and from these identified priority recommendations. Trained facilitators guided groups through brainstorming and weighted voting processes; individual recommendations were submitted in writing. Participants generated 598 recommendations, 71 of them voted as priorities; these were analyzed to capture participants' “messages.” Central themes focused on access issues and cultural incompetence as deterrents to the elimination of health disparities and on education, funding, and community-based, community-driven research as mechanisms for change. Strategies for change included reinventing or expanding the role of minority communities and changing health care itself and “how” it does its work. The essential element in all recommendations was community leadership and control.
Relation Between Racial Discrimination, Social Class, and Health Among Ethnic Minority Groups
Authors: Karlsen Saffron , Nazroo James Y.
Published: December 2008

Objectives. This study explored associations between racism, social class, and health among ethnic minority people in England and Wales.

Methods. We conducted a series of regression analyses on cross-sectional data from the Fourth National Survey of Ethnic Minorities to explore the relation between different indicators of racism and health and household occupational class.

Results. Marked independent associations existed between reported experience of racism and perceptions of Britain as a “racist society,” household social class, age, sex, and various mental and physical health indicators. These associations showed reasonable consistency across the different ethnic groups.

Conclusions. The different ways in which racism may manifest itself (as interpersonal violence, institutional discrimination, or socioeconomic disadvantage) all have independent detrimental effects on health, regardless of the health indicator used.
HIV-Associated Histories, Perceptions, and Practices Among Low-Income African American Women: Does Rural Residence Matter?
Authors: Crosby Richard A. , Yarber William L. , DiClemente Ralph J. , Wingood Gina M. , Meyerson Beth
Published: December 2008

Objectives. This study compared HIV-associated sexual health history, risk perceptions, and sexual risk behaviors of low-income rural and nonrural African American women.

Methods. A cross-sectional statewide survey of African American women (n = 571) attending federally funded Special Supplemental Nutrition Program for Women, Infants, and Children clinics was conducted.

Results. Adjusted analyses indicated that rural women were more likely to report not being counseled about HIV during pregnancy (P = .001), that a sex partner had not been tested for HIV (P = .005), no preferred method of prevention because they did not worry about sexually transmitted diseases (P = .02), not using condoms (P = .009), and a belief that their partner was HIV negative, despite lack of testing (P = .04).

Conclusions. This study provided initial evidence that low-income rural African American women are an important population for HIV prevention programs.
Does a History of Trauma Contribute to HIV Risk for Women of Color? Implications for Prevention and Policy
Authors: Wyatt Gail E. , Myers Hector F. , Williams John K. , Kitchen Christina Ramirez , Loeb Tamra , Carmona Jennifer Vargas , Wyatt Lacey E. , Chin Dorothy , Presley Nicole
Published: December 2008

Objectives. We investigated history of abuse and other HIV-related risk factors in a community sample of 490 HIV-positive and HIV-negative African American, European American, and Latina women.

Methods. Baseline interviews were analyzed, and logistic regressions were used to identify predictors of risk for positive HIV serostatus overall and by racial/ethnic group.

Results. Race/ethnicity was not an independent predictor of HIV-related risk, and few racial/ethnic differences in risk factors for HIV were seen. Regardless of race/ethnicity, HIV-positive women had more sexual partners, more sexually transmitted diseases, and more severe histories of abuse than did HIV-negative women. Trauma history was a general risk factor for women, irrespective of race/ethnicity.

Conclusions. Limited material resources, exposure to violence, and high-risk sexual behaviors were the best predictors of HIV risk.
The Anthrax Vaccine Program: An Analysis of the CDC's Recommendations for Vaccine Use
Authors: Nass Meryl
Published: December 2008

The anthrax vaccine was never proved to be safe and effective. It is one cause of Gulf War illnesses, and recent vaccinees report symptoms resembling Gulf War illnesses.

The vaccine's production has been substandard. Without adequate evaluation, the Food and Drug Administration recently approved (retrospectively) significant changes made to the vaccine's composition since 1990. The vaccine's mandatory use for inhalation anthrax is “off-label.”

A skewed review of the vaccine literature by the Centers for Disease Control and Prevention (CDC) led to remunerative collaborative research with the army, involving civilian volunteers. Despite acknowledging possible fetal harm, the CDC offered the vaccine to children and pregnant women.

New trends could weaken prelicensure efficacy and safety review of medical products intended for biodefense and avoid manufacturer liability for their use.
Rethinking McKeown: The Relationship Between Public Health and Social Change
Authors: Szreter Simon
Published: December 2008

Thomas McKeown was a rhetorically powerful critic, from the inside, of the medical profession's mid-20th-century love affair with curative and scientific medicine. He emphasized instead the importance of economic growth, rising living standards, and improved nutrition as the primary sources of most historical improvements in the health of developed nations.

This interpretation failed to emphasize the simultaneous historical importance of an accompanying redistributive social philosophy and practical politics, which has characterized the public health movement from its 19th-century origins. Consequently, the current generation of public health practitioners are having to reconstruct such a politics and practice following its virtual dismantlement during the last 2 decades of the 20th century.
The McKeown Thesis: A Historical Controversy and Its Enduring Influence
Authors: Colgrove James
Published: December 2008

The historical analyses of Thomas McKeown attributed the modern rise in the world population from the 1700s to the present to broad economic and social changes rather than to targeted public health or medical interventions. His work generated considerable controversy in the 1970s and 1980s, and it continues to stimulate support, criticism, and commentary to the present day, in spite of his conclusions' having been largely discredited by subsequent research. The ongoing resonance of his work is due primarily to the importance of the question that underlay it: Are public health ends better served by targeted interventions or by broad-based efforts to redistribute the social, political, and economic resources that determine the health of populations?
Making Better Babies: Public Health and Race Betterment in Indiana, 1920–1935
Authors: Stern Alexandra Minna
Published: December 2008

In 1920, Indiana's Division of Infant and Child Hygiene inaugurated its first Better Babies Contest at the state fair. For the next 12 years, these contests were the centerpiece of a dynamic infant and maternal welfare program that took shape in Indiana during the decade of the federal Sheppard–Towner act. More than just a lively spectacle for fairgoers, these contests brought public health, “race betterment,” and animal breeding together in a unique manner.

This article describes one of the most popular expressions of public health and race betterment in rural America. It also raises questions about the intersections between hereditarian and medical conceptions of human improvement during the early 20th century, especially with respect to child breeding and rearing.
Challenges Faced by Homeless Sexual Minorities: Comparison of Gay, Lesbian, Bisexual, and Transgender Homeless Adolescents With Their Heterosexual Counterparts
Authors: Cochran Bryan N. , Stewart Angela J. , Ginzler Joshua A. , Cauce Ana Mari
Published: December 2008

Objectives. The goal of this study was to identify differences between gay, lesbian, bisexual, and transgender (GLBT) homeless youths and their heterosexual counterparts in terms of physical and mental health difficulties.

Methods. A sample of 84 GLBT adolescents was matched in regard to age and self-reported gender with 84 heterosexual adolescents. The 2 samples were compared on a variety of psychosocial variables.

Results. GLBT adolescents left home more frequently, were victimized more often, used highly addictive substances more frequently, had higher rates of psychopathology, and had more sexual partners than heterosexual adolescents.

Conclusions. Homeless youths who identify themselves as members of sexual minority groups are at increased risk for negative outcomes. Recommendations for treatment programs and implications for public health are discussed.
Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community-Based Study
Authors: Kushel Margot B. , Perry Sharon , Bangsberg David , Clark Richard , Moss Andrew R
Published: December 2008

Objectives. This study examined factors associated with emergency department use among homeless and marginally housed persons.

Methods. Interviews were conducted with 2578 homeless and marginally housed persons, and factors associated with different patterns of emergency department use were assessed in multivariate models.

Results. Findings showed that 40.4% of respondents had 1 or more emergency department encounters in the previous year; 7.9% exhibited high rates of use (more than 3 visits) and accounted for 54.5% of all visits. Factors associated with high use rates included less stable housing, victimization, arrests, physical and mental illness, and substance abuse. Predisposing and need factors appeared to drive emergency department use.

Conclusions. Efforts to reduce emergency department use among the homeless should be targeted toward addressing underlying risk factors among those exhibiting high rates of use.
Unraveling the Ecology of Risks for Early Childhood Asthma Among Ethnically Diverse Families in the Southwest
Authors: Klinnert Mary D. , Price Marcella R. , Liu Andrew H. , Robinson JoAnn L.
Published: December 2008

Objectives. We describe the prevalence of asthma risk factors within racial/ethnic and language groups of infants participating in an intervention study for reducing chronic asthma.

Methods. Low-income children aged 9 to 24 months with 3 or more episodes of wheezing illness were enrolled. Baseline information included family and medical histories, allergic status, environmental exposures, emotional environment, and caregiver psychosocial resources.

Results. Racial/ethnic and language groups—European Americans, African Americans, high-acculturated Hispanics, and low-acculturated Hispanics—showed different patterns of risk factors for childhood asthma, with low-acculturated Hispanics showing the most distinctive pattern.

Conclusions. Patterns of covariation of biological and psychosocial risk factors for childhood asthma were associated with racial/ethnic and language status among urban, low-income children.
Effects of Participation in the WIC Program on Birthweight: Evidence From the National Longitudinal Survey of Youth
Authors: Kowaleski-Jones Lori , Duncan Greg J.
Published: December 2008

Objectives. This study sought to estimate the impact on birthweight of maternal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Methods. WIC estimates were based on sibling models incorporating data on children born between 1990 and 1996 to women taking part in the National Longitudinal Survey of Youth.

Results. Fixed-effects estimates indicated that prenatal WIC participation was associated with a 0.075 unit difference (95% confidence interval [CI] = –0.007, 0.157) in siblings' logged birthweight. At the 88-oz (2464-g) low-birthweight cutoff, this difference translated into an estimated impact of 6.6 oz (184.8 g).

Conclusion. Earlier WIC impact estimates may have been biased by unmeasured characteristics affecting both program participation and birth outcomes. Our approach controlled for such biases and revealed a significant positive association between WIC participation and birthweight.
Body Mass Index and Disability in Adulthood: A 20-Year Panel Study
Authors: Ferraro Kenneth F. , Su Ya-ping , Gretebeck Randall J. , Black David R. , Badylak Stephen F.
Published: December 2008

Objectives. This study examined whether body mass index (BMI) or change in BMI raises the risk of disability in adulthood.

Methods. The relation between BMI and upper- and lower-body disability was examined among adult subjects from a national longitudinal survey (n = 6833). Tobit regression models were used to examine the effect of BMI on disability 10 and 20 years later.

Results. Obesity (BMI ≥ 30) at baseline or becoming obese during the study was associated with higher levels of upper- and, especially, lower-body disability. In persons who began the study with a BMI of 30 or more and became normal weight, disability was not reduced. Underweight persons (BMI < 18.5) also manifested higher disability in most instances.

Conclusions. Disability risk was higher for obese persons, but overweight was not consistently associated with higher disability.
Effect of Birth Cohort on Risk of Hip Fracture: Age-Specific Incidence Rates in the Framingham Study
Authors: Samelson Elizabeth J. , Zhang Yuqing , Kiel Douglas P. , Hannan Marian T. , Felson David T.
Published: December 2008

Objectives. This study examined the effect of birth cohort on incidence rates of hip fracture among women and men in the Framingham Study.

Methods. Age-specific incidence rates of first hip fracture were presented according to tertile of year of birth for 5209 participants of the Framingham Study, a population-based cohort followed since 1948. Sex-specific incidence rate ratios were calculated by Cox regression to assess the relation between birth cohort and hip fracture incidence.

Results. An increasing trend in hip fracture incidence rates was observed with year of birth for women (trend, P = .05) and men (trend, P = .03). Relative to those born from 1887 to 1900 (incidence rate ratio [IRR] = 1.0), age-specific incidence rates were greatest in the most recent birth cohort, born from 1911 to 1921 (IRR = 1.4 for women, IRR = 2.0 for men), and intermediate in those born from 1901 to 1910 (IRR = 1.2 for women, IRR = 1.5 for men).

Conclusions. Results suggest risk of hip fracture is increasing for successive birth cohorts. Projections that fail to account for the increase in rates associated with birth cohort underestimate the future public health impact of hip fracture in the United States.
Estimates of Global and Regional Smoking Prevalence in 1995, by Age and Sex
Authors: Jha Prabhat , Ranson M. Kent , Nguyen Son N. , Yach Derek
Published: December 2008

Objectives. We calculated regional and sex- and age-specific smoking prevalence estimates worldwide in 1995.

Methods. Sex-specific smoking prevalence data from studies in 139 countries and age distribution data from 7 studies were analyzed.

Results. Globally, 29% of persons aged 15 years or older were regular smokers in 1995. Four fifths of the world's 1.1 billion smokers lived in low- or middle-income countries. East Asian countries accounted for a disproportionately high percentage (38%) of the world's smokers. Males accounted for four fifths of all smokers, and prevalence among males and females was highest among those aged 30 to 49 years (34%).

Conclusions. Future decades will see dramatic increases in tobacco-attributable deaths in low- and middle-income regions. Although much of this excess mortality can be prevented if smokers stop smoking, quitting remains rare in low- and middle-income countries. (Am J Public Health. 2002;92:1002–1006)
Prevalence and Predictors of Tobacco Use Among Asian Americans in the Delaware Valley Region
Authors: Ma Grace X. , Shive Steve , Tan Yin , Toubbeh Jamil
Published: December 2008

Objectives. This study examined tobacco use rates and potential predictors of use among Asian Americans residing in the Delaware Valley region.

Methods. A cross-sectional survey design was used. The sample consisted of 1174 Chinese, Koreans, Vietnamese, and Cambodians.

Results. Findings indicated that the mean age at initiation of tobacco use was 18.3 years. Among the respondents, 40.2% had a history of tobacco use, and 29.6% were current users. Men were more likely than women to smoke. There were significant differences between never smokers, current smokers, and ex-smokers in sex, ethnicity, educational attainment, and marital and employment status.

Conclusions. The findings suggest that tobacco use is still a serious public health problem among Asian Americans, especially men.
Getting to the Truth: Evaluating National Tobacco Countermarketing Campaigns
Authors: Farrelly Matthew C. , Healton Cheryl G. , Davis Kevin C. , Messeri Peter , Hersey James C. , Haviland M. Lyndon
Published: December 2008

Objectives. This study examines how the American Legacy Foundation's “truth” campaign and Philip Morris's “Think. Don't Smoke” campaign have influenced youths' attitudes, beliefs, and intentions toward tobacco.

Methods. We analyzed 2 telephone surveys of 12- to 17-year-olds with multivariate logistic regressions: a baseline survey conducted before the launch of “truth” and a second survey 10 months into the “truth” campaign.

Results. Exposure to “truth” countermarketing advertisements was consistently associated with an increase in anti-tobacco attitudes and beliefs, whereas exposure to Philip Morris advertisements generally was not. In addition, those exposed to Philip Morris advertisements were more likely to be open to the idea of smoking.

Conclusions. Whereas exposure to the “truth” campaign positively changed youths' attitudes toward tobacco, the Philip Morris campaign had a counterproductive influence. (Am J Public Health. 2002;92:901–907)
Tobacco Industry Surveillance of Public Health Groups: The Case of STAT and INFACT
Authors: Malone Ruth E.
Published: December 2008

Objectives. The goal of this study was to describe how the tobacco industry collects information about public health groups.

Methods. Publicly available internal tobacco industry documents were reviewed and analyzed using a chronological case study approach.

Results. The industry engaged in aggressive intelligence gathering, used intermediaries to obtain materials under false pretenses, sent public relations spies to the organizations' meetings, and covertly taped strategy sessions. Other industry strategies included publicly minimizing the effects of boycotts, painting health advocates as “extreme,” identifying and exploiting disagreements, and planning to “redirect the funding” of tobacco control organizations to other purposes.

Conclusions. Public health advocates often make light of tobacco industry observers, but industry surveillance may be real, intense, and covert and may obstruct public health initiatives.
Independent Evaluation of the California Tobacco Control Program: Relationships Between Program Exposure and Outcomes, 1996–1998
Authors: Rohrbach Louise Ann , Howard-Pitney Beth , Unger Jennifer B. , Dent Clyde W. , Howard Kim Ammann , Cruz Tess Boley , Ribisl Kurt M. , Norman Gregory J. , Fishbein Howard , Johnson C. Anderson
Published: December 2008

Objectives. This study sought to determine the effects of the California Tobacco Control Program on tobacco-related attitudes and behaviors.

Methods. In 1996 and 1998, a telephone survey was conducted among adults in randomly selected households in 18 California counties. Tenth-grade youths in 84 randomly selected high schools completed a written survey. In analyses conducted at the county level, differences in outcomes were regressed on an index of program exposure.

Results. Among adults, program exposure was associated with decreased smoking prevalence rates, increased no-smoking policies in homes, and decreased violations of workplace no-smoking policies. Among youths, there was no effect of program exposure on outcomes.

Conclusions. These results suggest that the California Tobacco Control Program may have reduced adult smoking prevalence rates and exposure to environmental tobacco smoke. (Am J Public Health. 2002;92:975–983)
Benefits of Smoking Cessation for Longevity
Authors: Taylor Donald H. , Hasselblad Vic , Henley S. Jane , Thun Michael J. , Sloan Frank A.
Published: December 2008

Objectives. This study determined the life extension obtained from stopping smoking at various ages.

Methods. We estimated the relation between smoking and mortality among 877 243 respondents to the Cancer Prevention Study II. These estimates were applied to the 1990 US census population to examine the longevity benefits of smoking cessation.

Results. Life expectancy among smokers who quit at age 35 exceeded that of continuing smokers by 6.9 to 8.5 years for men and 6.1 to 7.7 years for women. Smokers who quit at younger ages realized greater life extensions. However, even those who quit much later in life gained some benefits: among smokers who quit at age 65 years, men gained 1.4 to 2.0 years of life, and women gained 2.7 to 3.7 years.

Conclusions. Stopping smoking as early as possible is important, but cessation at any age provides meaningful life extensions. (Am J Public Health. 2002;92:990–996)
Time, Place, and Consciousness: Three Dimensions of Meaning for US Institutional Review Boards
Authors: Putney Sarah B. , Gruskin Sofia
Published: December 2008

In the past few years, US federal agencies governing research with human subjects and institutional review boards have taken a higher-profile path than ever before, both at home and internationally. This trend carries profound significance for US-based institutions and has implications also for the rest of the world.

What does this critical moment of heightened federal scrutiny mean for the workings of US institutional review boards? We examined board activity across 3 dimensions: time, place, and consciousness. We conclude that although institutions in all areas of biomedical and social science research are adapting their practices, the field of public health is especially well positioned to adapt to, and succeed in, new efforts to ensure protection of human research subjects. (Am J Public Health. 2002;92:1067–1070)
Risk and Responsibility: Ethics, Grimes v Kennedy Krieger, and Public Health Research Involving Children
Authors: Mastroianni Anna C. , Kahn Jeffrey P.
Published: December 2008

The legal case of Grimes v. Kennedy Krieger Institute, Inc, has raised concerns in the public health research community regarding the acceptable level of risk in research involving children, parental authority for informed consent, and exploitation of research subjects for the benefit of public health. We provide an overview of the case and discuss the impact of the court's decision and its possible effect on future research protection policies and practices. (Am J Public Health. 2002;92:1073–1076)
The Impact of Genomics on Global Health
Authors: Pang Tikki
Published: December 2008

Ensuring that advances in genomics are applied to the health improvement of people living in developing countries is an important contemporary challenge. In the near term, such advances are likely to alleviate infectious diseases, with longer-term benefits envisaged for chronic disorders.

To ensure that benefits are shared by developing countries, attention must be paid to complex ethical, legal, social, and economic issues, as well as to public education and engagement. Creative and equitable international mechanisms and goodwill are needed to turn high hopes into reality and allow the use of genomics to reduce health inequities between rich and poor nations. (Am J Public Health. 2002;92:1077–1079)
Ethical Oversight of Public Health Research: Can Rules and IRBs Make a Difference in Developing Countries?
Authors: London Leslie ,   (Comm Health)
Published: December 2008

Controversies in the conduct of international research continue to pose challenges for the system of ethical review, particularly for developing countries. Although the concept of vulnerability is key to addressing these challenges, ethical review has typically ignored the agency of vulnerable participants and groups in determining what kind of review process is needed. Concurrent with developments shaping the new public health that seek to operationalize empowerment of communities by placing them as initiators and organizers of their own health, ethical review of public health research must find ways to recognize the agency of vulnerable individuals, groups, and communities in the review process if it is to address effectively the ethical dilemmas currently evident in collaborative international research. (Am J Public Health. 2002;92:1079–1084)
Use of Topical Sunscreens and the Risk of Malignant Melanoma: A Meta-Analysis of 9067 Patients From 11 Case–Control Studies
Authors: Huncharek Michael , Kupelnick Bruce
Published: December 2008

Objectives. This study examined the methodology of epidemiological studies that suggest use of topical sunscreen preparations is associated with increased risk of malignant melanoma.

Methods. We pooled data from observational studies using a general variance–based meta-analytic method that employed confidence intervals (previously described). The outcome of interest was a summary relative risk (RR) reflecting the risk of melanoma associated with sunscreen use versus nonuse. Sensitivity analyses were performed when necessary to explain any observed statistical heterogeneity.

Results. Combining studies that used nonheterogeneous data yielded a summary RR of 1.01, indicating no association between sunscreen use and development of malignant melanoma.

Conclusions. The available epidemiological data do not support the existence of a relationship between topical sunscreen use and an increased risk of cutaneous malignant melanoma. (Am J Public Health. 2002;92:1173–1177)
The Perceived Impact of Privatization on Local Health Departments
Authors: Keane Christopher , Marx John , Ricci Edmund , Barron Gerald
Published: December 2008

Objectives. This article presents nationally representative data on the effects of privatization on local health departments (LHDs).

Methods. A stratified representative national sample of 380 LHDs was drawn from a national list of 2488 departments. Telephone interviews were conducted with 347 LHD directors.

Results. One half of the directors of LHDs with privatized services reported that privatization helped the performance of core functions. Privatization often resulted in increased time needed for management and administration. More than a third of LHD directors reported concern about loss of control over the performance of privatized functions and services.

Conclusions. Privatization is part of a broader shift toward “managing” rather than directly providing public health services, yet privatization often reduces LHDs' control over the performance of services. (Am J Public Health. 2002;92:1178–1180)
West Nile Virus in New York City
Authors: Lopez Wilfredo
Published: December 2008

In 1999, a cluster of encephalitis cases was detected in New York City. The city applied larvicide to standing water and aerially sprayed pesticides to control adult mosquitoes. The causative agent was West Nile virus, a type of encephalitis that had never before been transmitted in the western hemisphere. This experience offers many lessons for the practitioners of public health and of public health law. A public health infrastructure that does not lose sight of the old threats must be maintained. The public health and environmental governmental establishments must work together. Law is closely intertwined with policy and programmatic initiatives and can facilitate a better public health outcome.
Impact of Generosity Level of Outpatient Prescription Drug Coverage on Prescription Drug Events and Expenditure Among Older Persons
Authors: Artz Margaret B. , Hadsall Ronald S. , Schondelmeyer Stephen W.
Published: December 2008

Objectives. This study examined the impact of drug coverage generosity on older persons’ prescription events (fills) and expenditures.

Methods. A cross-sectional study was conducted of 6237 older persons from the 1995 Medicare Current Beneficiary Survey. Dependent variables were per capita prescription events and expenditures. Independent variables were insurance type and drug coverage generosity. Control variables included sociodemographic and health status factors.

Results. Regardless of insurance type, per capita prescription events increased as drug coverage generosity improved and then decreased at the most generous level. Per capita prescription expenditures increased as generosity improved; with generous prescription coverage, prescription expenditures were approximately 3 times those with Medicare only.

Conclusions. Even when factors that affect drug use and insurance selection are controlled, prescription coverage generosity influences prescription use. (Am J Public Health. 2002;92:1257–1263)
Stability and Change in Health Insurance Among Older Mexican Americans: Longitudinal Evidence From the Hispanic Established Populations for Epidemiologic Study of the Elderly
Authors: Angel Ronald J. , Angel Jacqueline L. , Markides Kyriakos S.
Published: December 2008

Objectives. This study examined the association between health insurance coverage, medical care use, limitations in activities of daily living, and mortality among older Mexican-origin individuals.

Methods. We analyzed longitudinal data from the Hispanic Established Populations for Epidemiologic Study of the Elderly (H-EPESE).

Results. The uninsured tend to be younger, female, poor, and foreign born. They report fewer health care visits, are less likely to have a usual source of care, and more often receive care in Mexico. Conversely, those with private health insurance are economically better off and use more health care services. Over time, the data reveal substantial changes in type of insurance coverage.

Conclusions. The data reveal serious vulnerabilities among older Mexican Americans that result from a lack of private Medigap supplemental coverage. (Am J Public Health. 2002;92:1264–1271)
Socioeconomic Position, Health, and Possible Explanations: A Tale of Two Cohorts
Authors: Fuhrer R. , Shipley M. J. , Chastang J. F. , Schmaus A. , Niedhammer I. , Stansfeld S. A. , Goldberg M. , Marmot M. G.
Published: December 2008

Objectives. We examined whether the social gradient for measures of morbidity is comparable in English and French public employees and investigated risk factors that may explain this gradient.

Methods. This longitudinal study of 2 occupational cohorts—5825 London civil servants and 6818 French office-based employees—used 2 health outcomes: long spells of sickness absence during a 4-year follow-up and self-reported health.

Results. Strong social gradients in health were observed in both cohorts. Health behaviors showed different relations with socioeconomic position in the 2 samples. Psychosocial work characteristics showed strong gradients in both cohorts. Cohort-specific significant risk factors explained between 12% and 56% of the gradient in sickness absence and self-reported health.

Conclusions. Our cross-cultural comparison suggests that some common susceptibility may underlie the social gradient in health and disease, which explains why inequalities occur in cultures with different patterns of morbidity and mortality.
Life-Course Socioeconomic and Behavioral Influences on Cardiovascular Disease Mortality: The Collaborative Study
Authors: Smith George Davey , Hart Carole
Published: December 2008

Objectives. This study sought to demonstrate life-course influences on cardiovascular disease (CVD).

Methods. Data were derived from a prospective observational study in which the main outcome measure was death resulting from CVD.

Results. Combining 4 socioeconomic and behavioral risk indicators into a measure of life-course exposure produced 5 groups whose relative risks of CVD mortality ranged from 1.00 (the group with the most favorable life-course exposures) to 4.55 (the group with the least favorable life-course exposures). If the entire study population had had the CVD mortality risk of the subsample with the most favorable risk factor profile, approximately two thirds of cardiovascular deaths would not have occurred.

Conclusions. CVD risk is influenced in a cumulative fashion by socioeconomic and behavioral factors acting throughout the life course.
Active Surveillance of Maternal Mortality in New York City
Authors: Pallin Daniel J. , Sundaram Vandana , Laraque Fabienne , Berenson Louise , Schomberg David R.
Published: December 2008

Objectives. This study examined the usefulness of computer-assisted active surveillance in identifying maternal deaths in New York City.

Methods. Computerized searches of hospital discharge and autopsy record databases were conducted for maternal deaths occurring in 1997.

Results. Active surveillance revealed 14 new maternal deaths not previously reported, an 88% increase. Nine of these deaths were found through the hospital discharge database search, 1 was found through the autopsy record search, and 4 were found in both searches. Overall maternal mortality ratios associated with active surveillance and routine surveillance were 24.3 and 13.0 deaths per 100 000 live births, respectively.

Conclusions. Active surveillance of maternal mortality is useful in identifying new maternal deaths. Existing databases can be used relatively easily to augment routine surveillance of maternal mortality.
The Impact of the Increasing Number of Multiple Births on the Rates of Preterm Birth and Low Birthweight: An International Study
Authors: Blondel Béatrice , Kogan Michael D. , Alexander Greg R. , Dattani Nirupa , Kramer Michael S. , Macfarlane Alison , Wen Shi Wu
Published: December 2008

Objectives. We studied the effects of twins and triplets on perinatal health indicators in the overall population in the 1980s and 1990s in Canada, England and Wales, France, and the United States.

Methods. Data were derived mostly from live birth registration. We used rates, relative risks, and population attributable risks for twins and triplets separately.

Results. In each country, the increase in multiple births, and the increase in preterm delivery among multiple births, contributed almost equally to the rise in or stabilization of the overall rates of preterm delivery. Twins contributed a much larger proportion of the preterm deliveries and low-birthweight newborns than did triplets.

Conclusions. Twins have a major population-based impact on the trends of perinatal health indicators. (Am J Public Health. 2002;92:1323–1330)
Autopsy Study of Motorcyclist Fatalities: The Effect of the 1992 Maryland Motorcycle Helmet Use Law
Authors: Auman Kimberly M. , Kufera Joseph A. , Ballesteros Michael F. , Smialek John E. , Dischinger Patricia C.
Published: December 2008

Objectives. This study sought to determine the impact of Maryland’s all-rider motorcycle helmet law (enacted on October 1, 1992) on preventing deaths and traumatic brain injuries among motorcyclists.

Methods. Statewide motorcyclist fatalities occurring during seasonally comparable 33-month periods immediately preceding and following enactment of the law were compared.

Results. The motorcyclist fatality rate dropped from 10.3 per 10 000 registered motorcycles prelaw to 4.5 postlaw despite almost identical numbers of registered motorcycles. Motorcyclists wearing helmets had a lower risk of traumatic brain injury than those not wearing helmets (odds ratio = 0.31, 95% confidence interval = 0.14, 0.68).

Conclusions. Maryland’s controversial motorcycle helmet law appears to be an effective public health policy and may be responsible for saving many lives.
Improving the Health of Future Generations: The Canadian Institutes of Health Research Institute of Aboriginal Peoples’ Health
Authors: Reading Jeff , Nowgesic Earl
Published: December 2008

In the past and in the present, research studies and media reports have focused on pathology and dysfunction in aboriginal communities and have often failed to present a true and complete picture of the aboriginal experience. The Canadian Institutes of Health Research Institute of Aboriginal Peoples’ Health is a national strategic research initiative led by both the aboriginal and research communities. This initiative aims to improve aboriginal health information, develop research capacity, better translate research into practice, and inform public health policy with the goal of improving the health of indigenous peoples.
Perspectives on American Indian Health
Authors: Roubideaux Yvette
Published: December 2008

American Indians and Alaska Natives continue to experience significant disparities in health status compared with the US general population and now are facing the new challenges of rising rates of chronic diseases. The Indian health system continues to try to meet the federal trust responsibility to provide health care for American Indians and Alaska Natives despite significant shortfalls in funding, resources, and staff. New approaches to these Indian health challenges, including a greater focus on public health, community-based interventions, and tribal management of health programs, provide hope that the health of Indian communities will improve in the near future.
The Melting Ice Cellar
Authors: Cochran Patricia Longley , Geller Alyson L.
Published: December 2008

Environmental problems have often been observed by Alaska Native communities decades before they have been confirmed by scientific research.
The History of Uranium Mining and the Navajo People
Authors: Brugge Doug , Goble Rob
Published: December 2008

From World War II until 1971, the government was the sole purchaser of uranium ore in the United States. Uranium mining occurred mostly in the southwestern United States and drew many Native Americans and others into work in the mines and mills. Despite a long and well-developed understanding, based on the European experience earlier in the century, that uranium mining led to high rates of lung cancer, few protections were provided for US miners before 1962 and their adoption after that time was slow and incomplete. The resulting high rates of illness among miners led in 1990 to passage of the Radiation Exposure Compensation Act.
Occupational Injury and Illness Surveillance: Conceptual Filters Explain Underreporting
Authors: Azaroff Lenore S. , Levenstein Charles , Wegman David H.
Published: December 2008

Occupational health surveillance data are key to effective intervention. However, the US Bureau of Labor Statistics survey significantly underestimates the incidence of work-related injuries and illnesses. Researchers supplement these statistics with data from other systems not designed for surveillance.

The authors apply the filter model of Webb et al. to underreporting by the Bureau of Labor Statistics, workers’ compensation wage-replacement documents, physician reporting systems, and medical records of treatment charged to workers’ compensation. Mechanisms are described for the loss of cases at successive steps of documentation. Empirical findings indicate that workers repeatedly risk adverse consequences for attempting to complete these steps, while systems for ensuring their completion are weak or absent.