bluuebunny/crossref_metadata_2025 huggingface dataset:
Public health in managed care: a randomized controlled trial of the effectiveness of postcard reminders.
Authors: Clayton A E , McNutt L A , Homestead H L , Hartman T W , Senecal S
Published: November 2008

OBJECTIVES: This study evaluated the effectiveness of an annual public health intervention in a managed care setting. METHODS: Managed care organization members 65 years and older who received influenza immunization in 1996 were randomized to an intervention group (mailed a postcard reminder to receive an influenza vaccination in 1997) or a control group (no postcard). Vaccination rates for both groups were assessed monthly. RESULTS: Members receiving the intervention were no more likely to be immunized (78.6%) than members of the control group (77.2%, P = .222). Members were vaccinated at the same pace regardless of vaccination history and postcard intervention status. CONCLUSIONS: Postcard reminders were not an effective intervention among seniors who had been vaccinated the previous year.
Ethnicity and birthplace in relation to tumor size and stage in Asian American women with breast cancer.
Authors: Hedeen A N , White E , Taylor V
Published: November 2008

OBJECTIVES: This study examined whether Asian American women with breast cancer have tumor characteristics associated with delayed detection of their disease. METHODS: Breast cancer size and stage were examined in relation to subjects' ethnic group and birthplace, on the basis of Surveillance, Epidemiology, and End Results program data. RESULTS: Asian-born Asian American women with breast cancer had a greater proportion of tumors larger than 1 cm at diagnosis (79%) than did US White women (70%) (P < .001). In contrast, the proportion of tumors larger than 1 cm among Asian American women born in the United States (67%) did not differ significantly from that among US White women. CONCLUSIONS: Lower utilization of breast cancer screening by Asian-born Asian American women is probably responsible for their greater proportion of tumors larger than 1 cm relative to US White women in the study population. Interventional measures should be taken to increase the use of mammographic screening by first-generation Asian American women.
Defending diversity: affirmative action and medical education.
Authors: DeVille K
Published: November 2008

Affirmative action programs of all types are under attack legally and politically. Although medical schools have not been specifically targeted, their affirmative action programs, like others in higher education, are potentially in danger. This article examines the current legal status of affirmative action in medical education and concludes that a refurbished defense of such programs is essential if they are to survive impending judicial and political scrutiny. An analysis of existing case law and available evidence suggests that a carefully reinvigorated diversity argument is the tactic most likely to pass constitutional muster, as well as the justification most likely to blunt growing public and political opposition to admissions policies that take race and ethnicity into consideration.
The global burden of mental disorders.
Authors: Ustün T B
Published: November 2008

Recent data on the burden of mental disorders worldwide demonstrates a major public health problem that affects patients, society, and nations as a whole. Research must be done to find effective ways to deal with the increasing burden of mental disorders. Given the growing evidence that mental disorders are disorders of the brain and that they can be treated effectively with both psychosocial counseling and psychotropic medications, intervention packages could be developed to deal with the increasing burden. Such packages should be tested for real-world effectiveness and their cost-effectiveness should be demonstrated to guide policymakers to choose from among many other non-mental health interventions. The transportability and sustainability of intervention packages should be studied in public health research and a link between efficacy, effectiveness, cost-effectiveness, generalizability, and sustainability should be demonstrated. The World Health Organization's initiative on the World Mental Health 2000 Survey will provide the first basic epidemiologic data. Together with other data, the initiative will provide solid evidence for including mental disorders into essential treatment packages. In this way, parity can be achieved for mental disorders and mental health can be mainstreamed into health and public health practice.
Labor Day and the war on workers.
Authors: Rosner D , Markowitz G
Published: November 2008

We celebrate Labor Day every year with barbecues and picnics, rarely remembering that the holiday was born in the midst of tremendous labor struggles to improve working conditions. In the last century, 16-hour workdays and 6- and 7-day workweeks led to terribly high injury rates in the nation's mines and mills. Thousands upon thousands of workers died, caught in the grinding machinery of our growing industries. Today, despite improvements, thousands of workers still die in what has been described as a form of war on the American workforce. This commentary reminds us of the historical toll in lives and limbs that workers have paid to provide us with our modern prosperity. It also reminds us that the continuing toll is far too high and that workers who died and continue to die in order to produce our wealth deserve to be remembered and honored on this national holiday.
Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly.
Authors: Penninx B W , Leveille S , Ferrucci L , van Eijk J T , Guralnik J M
Published: November 2008

OBJECTIVES: This study examined the effect of depression on the incidence of physical disability and the role of confounding and explanatory variables in this relationship. METHODS: A cohort of 6247 subjects 65 years and older who were initially free of disability was followed up for 6 years. Baseline depression was assessed by the Center for Epidemiological Studies Depression Scale. Disability in mobility and disability in activities of daily living were measured annually. RESULTS: Compared with the 5751 nondepressed subjects, the 496 depressed subjects had a relative risk (95% confidence interval) of 1.67 (1.44, 1.95) and 1.73 (1.54, 1.94) for incident disability in activities of daily living and mobility, respectively. Adjustment for sociodemographic characteristics and baseline chronic conditions reduced the risks to 1.39 (1.18, 1.63) and 1.45 (1.29, 1.93), respectively. Less physical activity and fewer social contacts among depressed persons further explained part of their increased disability risk. CONCLUSIONS: Depression in older persons may increase the risk for incident disability. This excess risk is partly explained by depressed persons' decreased physical activity and social interaction. The role of other factors (e.g., biological mechanisms) should be examined.
Effects of health care cost-containment programs on patterns of care and readmissions among children and adolescents.
Authors: Wickizer T M , Lessler D , Boyd-Wickizer J
Published: November 2008

OBJECTIVES: This study examined the effects of a utilization management program on patterns of medical care among children and adolescents. METHODS: From 1989 through 1993, the program conducted 8568 reviews of pediatric patients, ranging in age from birth to 18 years. The program used preadmission and concurrent review procedures to review and certify patients' need for care. This study used multivariate analyses to assess changes in the number of days of inpatient care approved by the program and to determine whether limitations imposed on length of stay affected the risk of 60-day readmission. RESULTS: Concurrent review reduced the number of requested days of inpatient care by 3.2 days per patient. Low-birthweight infants and adolescent patients with depression or alcohol or drug dependence accounted for a disproportionate share of the reduction. Patients classified as admitted for medical or mental health care and whose stay was restricted by concurrent review were more likely (P < .05) to be readmitted within 60 days after discharge. CONCLUSIONS: By limiting care through its review procedures, the utilization management program decreased inpatient resource consumption but also increased the risk of readmission for some patients. Continued investigation should be conducted of the effects of cost-containment programs on the quality of care given to children and adolescents, especially in the area of mental health.
Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis.
Authors: Shaffer H J , Hall M N , Vander Bilt J
Published: November 2008

OBJECTIVES: This study developed prevalence estimates of gambling-related disorders in the United States and Canada, identified differences in prevalence among population segments, and identified changes in prevalence over the past 20 years. METHODS: A meta-analytic strategy was employed to synthesize estimates from 119 prevalence studies. This method produced more reliable prevalence rates than were available from any single study. RESULTS: Prevalence estimates among samples of adolescents were significantly higher than estimates among samples of adults for both clinical (level 3) and subclinical (level 2) measures of disordered gambling within both lifetime and past-year time frames (e.g., 3.9% vs 1.6% for lifetime estimates of level 3 gambling). Among adults, prevalence estimates of disordered gambling have increased significantly during the past 20 years. CONCLUSIONS: Membership in youth, treatment, or prison population segments is significantly associated with experiencing gambling-related disorders. Understanding subclinical gamblers provides a meaningful opportunity to lower the public health burden associated with gambling disorders. Further research is necessary to determine whether the prevalence of disordered gambling will continue to increase among the general adult population and how prevalence among adolescents will change as this cohort ages.
The health of grandparents raising grandchildren: results of a national study.
Authors: Minkler M , Fuller-Thomson E
Published: November 2008

OBJECTIVES: This study sought to compare the functional and self-rated health of grandparents raising grandchildren with that of noncaregiving grandparents. METHODS: A secondary analysis of data from the 1992 to 1994 National Survey of Families and Households was conducted. Bivariate and logistic analyses compared 173 custodial and 3304 noncustodial grandparents in terms of functional health limitations, self-rated health, and satisfaction with health. RESULTS: Custodial grandparents were significantly more likely to have limitations in 4 of the 5 activities of daily living (ADLs) examined, with more than half reporting some limitation in 1 of the 5 ADLs. A logistic regression analysis indicated that caregiving grandparents had 50% higher odds of having an ADL limitation. Caregivers were significantly more likely to report lower satisfaction with health, and a statistical trend indicated that the caregivers had lower self-rated health. CONCLUSIONS: Further research is needed to determine whether the differences observed reflect artifacts or actual differences in functional abilities and other health measures. The need for policies that support rather than penalize grandparents raising grandchildren is stressed.
Prevalence and correlates of survival sex among runaway and homeless youth.
Authors: Greene J M , Ennett S T , Ringwalt C L
Published: November 2008

OBJECTIVE: This study examined the prevalence and correlates of survival sex among runaway and homeless youths. METHODS: A nationally representative sample of shelter youths and a multicity sample of street youths were interviewed. RESULTS: Approximately 28% of street youths and 10% of shelter youths reported having participated in survival sex, which was associated with age, days away from home, victimization, criminal behaviors, substance use, suicide attempts, sexually transmitted disease, and pregnancy. CONCLUSIONS: Intensive and ongoing services are needed to provide resources and residential assistance to enable runaway and homeless youths to avoid survival sex, which is associated with many problem behaviors.
Prevalence of self-reported nutrition-related health problems in the Lower Mississippi Delta.
Authors: Smith J , Lensing S , Horton J A , Lovejoy J , Zaghloul S , Forrester I , McGee B B , Bogle M L
Published: November 2008

OBJECTIVES: The purpose of this study was to assess demographic and geographic differences in prevalence of self-reported nutrition-related health problems in Arkansas, Louisiana, and Mississippi. METHODS: The authors analyzed 1991 and 1993 Behavioral Risk Factor Surveillance System data for adults 18 years or older. RESULTS: Less educated African American women and women of other minority groups who were aged 35 to 64 years reported the highest prevalence of health problems. Geographic differences involved prevalence of hypertension, health status, and insurance status. CONCLUSIONS: Specific demographic subgroups and geographic areas with a high risk of health problems are in particular need of targeted interventions.
Impact of the Safe Water System on Water Quality in Cyclone-Affected Communities in Madagascar
Authors: Mong Yves , Kaiser Reinhard , Ibrahim Dasy , Rasoatiana  , Razafimbololona Lalaina , Quick Robert E.
Published: November 2008

Cyclone Hudah struck the northeastern coast of Madagascar in the spring of 2000. Over a 5-month period, 11 700 relief kits consisting of bottles of water disinfectant and foldable jerry cans were distributed to the affected population. Five months after the cyclone, a survey was conducted in 12 villages to determine the impact of these relief kits on water quality.

Seventy-six percent of the surveyed households reported using jerry cans, and 65% reported using the disinfectant. Stored water in households using both products had significantly less microbiological contamination than stored water in other households. To improve the prospects for a sustainable intervention, the response plan for future disasters should incorporate a transition to recovery and development, including formative research into local customs, beliefs, and water handling habits, and funding support to initiate social marketing.
Community Environmental Health Assessment in Peru's Desert Hills and Rainforest
Authors: Baffigo Virginia , Albinagorta Jorge , Nauca Luis , Rojas Percy , Alegre Rossana , Hubbard Brian , Sarisky John
Published: November 2008

Peru's expanding population and rapid urbanization—a result of migration to its largest cities—have stressed the country's public services infrastructure and the provision of public health and environmental health services. In response, the Ministry of Health established the General Directorate of Environmental Health (DIGESA), the branch charged with assuring adequate environmental health services to populations in rural and urban areas. The magnitude of the environmental health problems in peri-urban settlements, however, has exceeded the capacity of DIGESA to respond. The Urban Environmental Health Project is an effort to develop the ability of local communities to address these problems
Trapping the Vector: Community Action to Curb Sleeping Sickness in Southern Sudan
Authors: Joja Lasu Lauya , Okoli Uzo Amaka
Published: November 2008

South Sudan experienced a resurgence of trypanosomiasis (sleeping sickness) in the 1990s. In 1997 in Tambura County, public health officials combined standard mass screening and treatment techniques for infected persons with an additional component—trapping the vectors of the disease. The intent of this integrated approach was to lower the number and concentration of the tsetse flies that spread the disease while reducing the level of infection in the human population to make the likelihood of transmission extremely low.

Because the trapping project depends on village participation (making, setting, and maintaining the traps), village volunteers and their neighbors learned more about the causes and prevention of sleeping sickness and became much more willing to participate in serosurveys and to seek treatment.
Developing Public Health Management Training Capacity in Nicaragua
Authors: McEwan Elena , Conway Mary J. , Bull David L. , Malison Michael D.
Published: November 2008

The Cooperative for Assistance and Relief Everywhere (CARE) and Centers for Disease Control and Prevention (CDC) Health Initiative in Nicaragua is distinctive in its focus on developing a cadre of in-country trainers whose aim is to equip frontline public health managers with widely applicable tools and techniques to assist them in identifying and solving implementation problems. Since 1999, 137 trainees—37% more than originally planned—have demonstrated competence by completing and presenting applied management projects. Nineteen professors from the preventive medicine faculty at the Autonomous University of Nicaragua also have been trained. The country office now has a cadre of seasoned trainers who can meet the ongoing management training needs of CARE staff and their counterparts in the Ministry of Health and in other nongovernmental organizations.
Transportation for Maternal Emergencies in Tanzania: Empowering Communities Through Participatory Problem Solving
Authors: Schmid Thomas , Kanenda Omari , Ahluwalia Indu , Kouletio Michelle
Published: November 2008

Inadequate health care and long delays in obtaining care during obstetric emergencies are major contributors to high maternal death rates in Tanzania. Formative research conducted in the Mwanza region identified several transportation-related reasons for delays in receiving assistance.

In 1996, the Cooperative for Assistance and Relief Everywhere (CARE) and the Centers for Disease Control and Prevention (CDC) began an effort to build community capacity for problem-solving through participatory development of community-based plans for emergency transportation in 50 villages. An April 2001 assessment showed that 19 villages had begun collecting funds for transportation systems; of 13 villages with systems available, 10 had used the system within the last 3 months. Increased support for village health workers and greater participation of women in decision making were also observed.
Social Medicine Then and Now: Lessons From Latin America
Authors: Waitzkin Howard , Iriart Celia , Estrada Alfredo , Lamadrid Silvia
Published: November 2008

The accomplishments of Latin American social medicine remain little known in the English-speaking world. In Latin America, social medicine differs from public health in its definitions of populations and social institutions, its dialectic vision of “health–illness,” and its stance on causal inference.

A “golden age” occurred during the 1930s, when Salvador Allende, a pathologist and future president of Chile, played a key role. Later influences included the Cuban revolution, the failed peaceful transition to socialism in Chile, the Nicaraguan revolution, liberation theology, and empowerment strategies in education. Most of the leaders of Latin American social medicine have experienced political repression, partly because they have tried to combine theory and political practice—a combination known as “praxis.”

Theoretic debates in social medicine take their bearings from historical materialism and recent trends in European philosophy. Methodologically, differing historical, quantitative, and qualitative approaches aim to avoid perceived problems of positivism and reductionism in traditional public health and clinical methods. Key themes emphasize the effects of broad social policies on health and health care; the social determinants of illness and death; the relationships between work, reproduction, and the environment; and the impact of violence and trauma.
Community Health Worker Performance in the Management of Multiple Childhood Illnesses: Siaya District, Kenya, 1997–2001
Authors: Kelly Jane M. , Osamba Benta , Garg Renu M. , Hamel Mary J. , Lewis Jennifer J. , Rowe Samantha Y. , Rowe Alexander K. , Deming Michael S.
Published: November 2008

Objectives. To characterize community health worker (CHW) performance using an algorithm for managing common childhood illnesses in Siaya District, Kenya, we conducted CHW evaluations in 1998, 1999, and 2001.

Methods. Randomly selected CHWs were observed managing sick outpatient and inpatient children at a hospital, and their management was compared with that of an expert clinician who used the algorithm.

Results. One hundred, 108, and 114 CHWs participated in the evaluations in 1998, 1999, and 2001, respectively. The proportions of children treated “adequately” (with an antibiotic, antimalarial, oral rehydration solution, or referral, depending on the child's disease classifications) were 57.8%, 35.5%, and 38.9%, respectively, for children with a severe classification and 27.7%, 77.3%, and 74.3%, respectively, for children with a moderate (but not severe) classification. CHWs adequately treated 90.5% of malaria cases (the most commonly encountered classification). CHWs often made mistakes assessing symptoms, classifying illnesses, and prescribing correct doses of medications.

Conclusions. Deficiencies were found in the management of sick children by CHWs, although care was not consistently poor. Key reasons for the deficiencies appear to be guideline complexity and inadequate clinical supervision; other possible causes are discussed.
Self-Assessed Health Among Indigenous Australians: How Valid Is a Global Question?
Authors: Sibthorpe Beverly , Anderson Ian , Cunningham Joan
Published: November 2008

Objectives. This study assessed the validity of a global measure of self-assessed health among Indigenous Australians.

Methods. Logistic regression was used to identify factors associated with self-assessed health in a nationally representative sample.

Results. Among 8782 adult respondents, poorer self-assessed health was strongly associated with several factors, including age, number of health conditions, and recent health actions. The association with health conditions was attenuated when the respondent's primary language was not English.

Conclusions. Self-assessed health may be a valid measure among indigenous Australians whose primary language is English. However, although the measure draws on common experiences of health and illness, it may obscure differences in how people incorporate these experiences into social actions.
Predictors of Low Back Pain Onset in a Prospective British Study
Authors: Power Chris , Frank John , Hertzman Clyde , Schierhout Gill , Li Leah
Published: November 2008

Objectives. This study examined predictors of low back pain onset in a British birth cohort.

Methods. Univariate and multivariate analyses focused on individuals who experienced onset of low back pain at 32 to 33 years of age (n= 571) and individuals who were pain free (n = 5210). Participants were members of the 1958 British birth cohort.

Results. Incident pain was elevated among those with psychological distress at 23 years of age (adjusted odds ratio [OR] = 2.52, 95% confidence interval [CI] = 1.65, 3.86) and among persistent moderate or heavy smokers (adjusted OR = 1.63, 95% CI = 1.23, 2.17). Significant univariate associations involving other factors (e.g., social class, childhood emotional status, body mass index, job satisfaction) did not persist in multivariate analyses.

Conclusions. This prospectively studied cohort provides evidence that psychological distress more than doubles later risk of low back pain, with smoking having a modest independent effect. Other prospective studies are needed to confirm these findings before implications for low back pain prevention can be assessed.
Evaluation and Reform of Mexican National Epidemiological Surveillance System
Authors: Tapia-Conyer Roberto , Kuri-Morales Pablo , González-Urbán Luis , Sarti Elsa
Published: November 2008

To generate timely and reliable information for decision making in local health centers, Mexico's National Epidemiological Surveillance System (SINAVE) was evaluated and reformed. The reform was achieved by consensus through national meetings of epidemiologists, using a conceptual model of requirements, leadership, participation, and motivation.

The new SINAVE is run by committees that use data from 16 468 local health centers that generate homogeneous information from all health institutions. Indicators, flowcharts, and standardized instruments were created. The reforms modernized SINAVE and strengthened epidemiologists' leadership, consolidated local decision making, and assessed control actions needed to improve the health of the Mexican population.
“Do It Now!” Yakima, Wash, and the Campaign Against Rural Typhoid
Authors: Casner Nicholas
Published: November 2008

In 1911, Yakima, in western Washington, suffered a typhoid epidemic that turned the nation's attention to a crisis in public health. The response exemplified the ideals of the “new public health” as a more proactive, scientific, federal commitment to the problems of rural America.

A US Public Health Service investigation led by Dr Leslie Lumsden found a typhoid mortality rate of nearly 5 times the national average. The cause was bad sanitation. Typhoid rates dropped dramatically as the community adopted pragmatic solutions. Lumsden helped organize a “Do It Now” sanitation campaign and one of the country's first city–county health units. Yakima provided a model for other rural areas and small towns across the country.

This episode in one of the country's most productive fruit-growing regions raised serious questions regarding the geographic dynamics of disease. For Lumsden and other like-minded health officials, the countryside represented a dangerous reservoir of disease, a particular threat to the nation's agriculturally dependent urban populations. Yakima showed that the country needed a more comprehensive public health system that addressed urban and rural problems.
Growth Status and Related Medical Conditions Among Refugee Children in Massachusetts, 1995–1998
Authors: Geltman Paul L. , Radin Marjorie , Zhang Zi , Cochran Jennifer , Meyers Alan F.
Published: November 2008

Objectives. This study analyzed growth and identified related medical conditions among refugee children in Massachusetts.

Methods. Between July 1995 and June 1998, 1825 refugee children were screened. Variables included positive tuberculin (purified protein derivative; PPD) test; dental abnormalities; pathogenic parasites; weight-for-age, height-for-age, and weight-for-height z scores; and body mass index greater than the 84th percentile.

Results. Of all the children, 21% had parasites, 62% had caries, and 25% had a positive PPD reaction. Twelve percent overall and 28% younger than 2 years had anemia. Eight percent had height-for-age z scores less than –2, and 6% had weight-for-age z scores greater than +2. Of those aged 1 to 9 years, 7% had weight-for-height z scores greater than +2. Weight-for-height z scores less than –2 were concentrated among Africans and East Asians (both 8%). Height-for-age z scores less than –2 were seen among African (13%), Near Eastern (19%), and East Asian (30%) children. Weight-for-height z scores greater than +2 and body mass index greater than the 84th percentile were concentrated among children from the former Yugoslavia (8% and 15%) and the former Soviet Union (8% and 14%).

Conclusions. Recently arrived refugee children have significant growth abnormalities. European refugees were overweight; those from developing countries had growth retardation.
Health Care for Latino Children: Impact of Child and Parental Birthplace on Insurance Status and Access to Health Services
Authors: Granados Gilberto , Puvvula Jyoti , Berman Nancy , Dowling Patrick T.
Published: November 2008

Objectives. This study sought to assess the impact of child and parental birthplace on insurance status and access to health care among Latino children in the United States.

Methods. A cross-sectional, in-person survey of 376 random households with children aged 1 to 12 years was conducted in a predominantly Latino community. Children's insurance status and access to routine health care were compared among 3 child–parent groups: US born–US born (UU), US born–immigrant (UI), and immigrant–immigrant (II).

Results. Uninsured rates for the 3 groups of children were 10% (UU), 23% (UI), and 64% (II). Rates for lack of access to routine health care were 5% (UU), 12% (UI), and 32% (II).

Conclusion. Latino children of immigrant parents are more likely to lack insurance and access to routine health care than are Latino children of US-born parents.
The Contribution of Maternal Age to Racial Disparities in Birthweight: A Multilevel Perspective
Authors: Rauh Virginia A. , Andrews Howard F. , Garfinkel Robin S.
Published: November 2008

Objectives. This study assessed the contribution of age and other risk factors to racial disparities in rates of moderately low birthweight (MLBW; 1500–2499 g) and very low birthweight (VLBW; <1500 g).

Methods. Logistic regression models were developed to determine the effects on MLBW and VLBW of maternal age, race, and poverty, adjusting for birth order, smoking, substance abuse, marital status, and educational level. The sample consisted of 158 174 singleton births to US-born African American and White women in New York City between 1987 and 1993.

Results. The effects of maternal age on MLBW varied by race and poverty, with the most extreme effects among poor African American women. The effects of maternal age on VLBW also varied by race, but these effects were not moderated by poverty. Community poverty had a significant effect on MLBW among African American women, but no effect on VLBW. The adverse effect of older maternal age on MLBW and VLBW did not vary with community poverty.

Conclusions. Older maternal age is associated with reduced birthweight among infants born to African American women, and the age effect is exacerbated by individual poverty.
Relying on Surveys to Understand Abortion Behavior: Some Cautionary Evidence
Authors: Jagannathan Radha
Published: November 2008

Objectives. The reliability of abortion self-reports has raised questions about the general usefulness of surveys in research about abortion behavior; however, the extent of underreporting remains a subject of some debate. This study sought to examine abortion reporting in a sample of welfare mothers and to determine factors in underreporting.

Methods. In New Jersey, which covers abortions requested by welfare recipients under its Medicaid program, the responses of a randomly drawn sample of 1236 welfare mothers about abortion events were compared with the Medicaid claims records of these women.

Results. Only 29% of actual abortions were self-reported by the women in the sample. This finding varied dramatically by race, with substantially higher rates of underreporting by Blacks than by Whites or Hispanics.

Conclusions. Although race is the most consistent predictor of underreporting behavior, attitudinal factors and survey technology also help in explaining abortion reporting behavior.
Area-Level Characteristics and Smoking in Women
Authors: Tseng Marilyn , Yeatts Karin , Millikan Robert , Newman Beth
Published: November 2008

Objectives. This study examined whether area-level characteristics are associated with individual smoking behavior among women.

Methods. Analyses included 648 women enrolled as control patients in the Carolina Breast Cancer Study (1993–1996). Smoking and covariate information was obtained from interviews. Area-level characteristics included census block-group education level, poverty, unemployment, car–home ownership, crowding, and, for 431 women, city-level crime rates.

Results. In multivariate logistic regression models, no area characteristics were clearly associated with a history of smoking. Among those who had ever smoked, continued smoking was associated with living in low-education areas (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.0, 2.9), highunemployment areas (OR = 1.7, 95% CI = 1.0, 2.8), and high-crime areas (OR = 1.6, 95% CI = 0.8, 3.2).

Conclusions. The present findings are consistent with a growing literature suggesting that area-level social and economic disadvantage influences individual smoking behavior.
Welfare Reform and the Perinatal Health and Health Care Use of Latino Women in California, New York City, and Texas
Authors: Joyce Ted , Bauer Tamar , Minkoff Howard , Kaestner Robert
Published: November 2008

Objectives. This study analyzed changes in the financing of prenatal care and delivery, the use of prenatal care, and birth outcomes among foreign-born vs US-born Latino women following enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in August 1996.

Methods. We used a pre–post design with a comparison group. The sample consisted of resident Latinas in California, New York City, and Texas who delivered a live infant in 1995 or 1998.

Results. The proportion of births to Latinas that initiated prenatal care in the first 4 months of pregnancy increased for all foreign-born Latinas in California, New York City, and Texas between 1995 and 1998 (P < .05). Except for non-Dominicans in New York City, there was no increase in the proportion of low- or very-low-birthweight births among foreign-born vs US-born Latinas in the 3 localities between 1995 and 1996.

Conclusions. There is little evidence from vital statistics in California, New York City, and Texas that PRWORA had any substantive impact on the perinatal health and health care utilization of foreign-born relative to US-born Latinas.
Prenatal Care Use Among Selected Asian American Groups
Authors: Yu Stella M. , Alexander Greg R. , Schwalberg Renee , Kogan Michael D.
Published: November 2008

Objectives. This study examined the predictors of 3 patterns of prenatal care use (no care, late initiation of care, and inadequate use after early initiation) for 4 Asian American ethnic groups in the United States.

Methods. Single live births to US resident mothers of Chinese, Japanese, Korean, and Vietnamese ancestry (n = 273 604) were selected from the 1992–1996 US natality files. Logistic regression was used to analyze the effects of maternal characteristics on the 3 use measures.

Results. Korean Americans and Vietnamese Americans had the lowest levels of prenatal care use. Young or single motherhood, high parity for age, and low educational attainment were the main risk factors for low use.

Conclusions. Considerable variability exists in prenatal care use among Asian American ethnic groups.
HIV-Related Behaviors and Perceptions Among Adults in 25 States: 1997 Behavioral Risk Factor Surveillance System
Authors: Holtzman Deborah , Bland Shayne D. , Lansky Amy , Mack Karin A.
Published: November 2008

Objectives. To assess the level of HIV-related risk behavior among the general US adult population, we analyzed data from the first sexual behavior questions available for states to use with the Behavioral Risk Factor Surveillance System.

Methods. The Behavioral Risk Factor Surveillance System is a state-specific, population-based, random telephone survey. In 1997, 25 states collected sexual behavior data. Annual prevalence estimates for selected behaviors were calculated and examined by sociodemographic characteristics. The correlation between actual and perceived HIV risk also was determined.

Results. Most (77.1%) of the respondents reported just 1 sexual partner in the past year; 26.0% reported using a condom at last intercourse. Males, persons who were younger, and Blacks were more likely to report 2 or more partners but also more likely to report using a condom at last intercourse. Only 4.1% of the respondents reported a risk factor for HIV infection; 7.7% reported that they were at medium or high risk for HIV. Actual and perceived HIV risk were positively associated.

Conclusions. Most US adults do not engage in HIV-related risk behavior; those that do are more likely to report protective behavior.
Promoting Stair Use in a US–Mexico Border Community
Authors: Coleman Karen J. , Gonzalez Eugenia C.
Published: November 2008

Objectives. This study sought to determine whether a culturally relevant health message would promote stair use in a predominantly Hispanic community.

Methods. Observations of stair, elevator, and escalator use were collected over a 6-month period at 4 sites throughout the city of El Paso, Tex. The efficacy of individual and family health promotion signs was tested.

Results. Stair use increased in response to both individual and family promotion health messages, and use varied widely by intervention site.

Conclusions. These results underscore the importance of considering the physical characteristics of the environments targeted for health promotion campaigns.
Limitations on the Use of a Single Screening Question to Measure Sedentary Behavior
Authors: Macera Caroline A. , Ham Sandra A. , Jones Deborah A. , Kimsey C. Dexter , Ainsworth Barbara E. , Neff Linda J.
Published: November 2008

Objectives. This study explored the limitations of identifying sedentary individuals via an existing screening question in a state-based surveillance system.

Methods. A national sample (n = 7529) of adults, selected by random-digit dialing between November 1999 and May 2000, responded about participation in leisure-time physical activity.

Results. Of those who initially reported no leisure-time physical activity (25%), 85% were engaging in at least some activity, and 20% were engaging in enough moderate- or vigorous-intensity activity to meet health-related recommendations.

Conclusions. Public health programs that use only 1 screening question to identify sedentary behavior may not be able to target physical activity messages effectively, especially if physical activity is defined to include a broad range of activities beyond sports.
A Population-Based Assessment of Human Rights Abuses Committed Against Ethnic Albanian Refugees From Kosovo
Authors: Iacopino Vincent , Frank Martina W. , Bauer Heidi M. , Keller Allen S. , Fink Sheri L. , Ford Doug , Pallin Daniel J. , Waldman Ronald
Published: November 2008

Objectives. This study assessed patterns of displacement and human rights abuses among Kosovar refugees in Macedonia and Albania.

Methods. Between April 19 and May 3, 1999, 1180 ethnic Albanian refugees living in 31 refugee camps and collective centers in Macedonia and Albania were interviewed.

Results. The majority (68%) of participants reported that their families were directly expelled from their homes by Serb forces. Overall, 50% of participants saw Serb police or soldiers burning the houses of others, 16% saw Serb police or soldiers burn their own home, and 14% witnessed Serb police or soldiers killing someone. Large percentages of participants saw destroyed mosques, schools, or medical facilities. Thirty-one percent of respondents reported human rights abuses committed against their household members, including beatings, killings, torture, forced separation and disappearances, gunshot wounds, and sexual assault.

Conclusions. The present findings confirm that Serb forces engaged in a systematic and brutal campaign to forcibly expel the ethnic Albanian population of Kosovo. In the course of these mass deportations, Serb forces committed widespread abuses of human rights against ethnic Albanians.
Retrospective Validation of a Surveillance System for Unexplained Illness and Death: New Haven County, Connecticut
Authors: Kluger Michael D. , Sofair Andre N. , Heye Constance J. , Meek James I. , Sodhi Rajesh K. , Hadler James L.
Published: November 2008

Objectives. This study investigated retrospective validation of a prospective surveillance system for unexplained illness and death due to possibly infectious causes.

Methods. A computerized search of hospital discharge data identified patients with potential unexplained illness and death due to possibly infectious causes. Medical records for such patients were reviewed for satisfaction of study criteria. Cases identified retrospectively were combined with prospectively identified cases to form a reference population against which sensitivity could be measured.

Results. Retrospective validation was 41% sensitive, whereas prospective surveillance was 73% sensitive. The annual incidence of unexplained illness and death due to possibly infectious causes during 1995 and 1996 in the study county was conservatively estimated to range from 2.7 to 6.2 per 100 000 residents aged 1 to 49 years.

Conclusions. Active prospective surveillance for unexplained illness and death due to possibly infectious causes is more sensitive than retrospective surveillance conducted through a published list of indicator codes. However, retrospective surveillance can be a feasible and much less labor-intensive alternative to active prospective surveillance when the latter is not possible or desired.
An Outbreak of Syphilis in Alabama Prisons: Correctional Health Policy and Communicable Disease Control
Authors: Wolfe Mitchell I. , Xu Fujie , Patel Priti , O'Cain Michael , Schillinger Julia A. , St. Louis Michael E. , Finelli Lyn
Published: November 2008

Objectives. After syphilis outbreaks were reported at 3 Alabama State men's prisons in early 1999, we conducted an investigation to evaluate risk factors for syphilis infection and describe patterns of syphilis transmission.

Methods. We reviewed medical, patient interview, and prison transfer records and documented sexual networks. Presumptive source cases were identified. Odds of exposure to unscreened jail populations and transfer from other prisons were calculated for case patients at 1 prison.

Results. Thirty-nine case patients with early syphilis were identified from 3 prisons. Recent jail exposure (odds ratio [OR] = 8.0, 95% confidence interval [CI] = 0.3, 158.7, P = .14) and prison transfer (OR = 32.0, 95% CI = 1.6, 1668.1, P < .01) were associated with being a source case patient.

Conclusions. Probable sources of syphilis introduction into and transmission within prisons included mixing of prisoners with unscreened jail populations, transfer of infected inmates between prisons, and multiple concurrent sexual partnerships. Reducing sexual transmission of disease in correctional settings is a public health priority and will require innovative prevention strategies.
Acculturation and Leisure-Time Physical Inactivity in Mexican American Adults: Results From NHANES III, 1988–1994
Authors: Crespo Carlos J. , Smit Ellen , Carter-Pokras Olivia , Andersen Ross
Published: November 2008

Objectives. This study examined the relationship between acculturation and leisure-time physical inactivity among Mexican American adults.

Methods. Using data from the Third National Health and Nutrition Examination Survey, we estimated the prevalence of physical inactivity according to place of birth and language used at home.

Results. Spanish-speaking Mexican Americans had a higher prevalence of physical inactivity during leisure time than those who spoke mostly English, independent of place of birth.

Conclusions. Acculturation seems to be positively associated with participation in leisure-time physical activity.
Adolescent Sexual Orientation and Suicide Risk: Evidence From a National Study
Authors: Russell Stephen T. , Joyner Kara
Published: November 2008

Objectives. Sexual orientation has been a debated risk factor for adolescent suicidality over the past 20 years. This study examined the link between sexual orientation and suicidality, using data that are nationally representative and that include other critical youth suicide risk factors.

Methods. Data from the National Longitudinal Study of Adolescent Health were examined. Survey logistic regression was used to control for sample design effects.

Results. There is a strong link between adolescent sexual orientation and suicidal thoughts and behaviors. The strong effect of sexual orientation on suicidal thoughts is mediated by critical youth suicide risk factors, including depression, hopelessness, alcohol abuse, recent suicide attempts by a peer or a family member, and experiences of victimization.

Conclusions. The findings provide strong evidence that sexual minority youths are more likely than their peers to think about and attempt suicide.
Beyond Assumptions of Negligible Risk: Sexually Transmitted Diseases and Women Who Have Sex With Women
Authors: Bauer Greta R. , Welles Seth L.
Published: November 2008

Objectives. This study evaluated the association of female–female sexual behavior with sexually transmitted diseases (STDs).

Methods. Female participants (n = 286) were recruited from the Twin Cities Gay/Lesbian/Bisexual/Transgender Pride Festival. Logistic regression was used to examine the association between female–female sexual behavior and STDs.

Results. Women in all partner history groups, including 13% of women with only female partners, reported a history of STD. Increased sexual exposures with women predicted an increase in the likelihood of STDs after known risk factors had been controlled. Neither number of female partners nor number of exposures was associated with obtaining regular STD testing.

Conclusions. The risk of STDs through female–female sexual exposure is not negligible. Nevertheless, patterns of STD testing do not reflect this risk.
An Intervention for Parents With AIDS and Their Adolescent Children
Authors: Rotheram-Borus Mary Jane , Lee Martha B. , Gwadz Marya , Draimin Barbara
Published: November 2008

Objectives. This study evaluated an intervention designed to improve behavioral and mental health outcomes among adolescents and their parents with AIDS.

Methods. Parents with AIDS (n = 307) and their adolescent children (n = 412) were randomly assigned to an intensive intervention or a standard care control condition. Ninety-five percent of subjects were reassessed at least once annually over 2 years.

Results. Adolescents in the intensive intervention condition reported significantly lower levels of emotional distress, of multiple problem behaviors, of conduct problems, and of family-related stressors and higher levels of self-esteem than adolescents in the standard care condition. Parents with AIDS in the intervention condition also reported significantly lower levels of emotional distress and multiple problem behaviors. Coping style, levels of disclosure regarding serostatus, and formation of legal custody plans were similar across intervention conditions.

Conclusions. Interventions can reduce the long-term impact of parents' HIV status on themselves and their children.
Challenges Associated With Increased Survival Among Parents Living With HIV
Authors: Lee Martha , Rotheram-Borus Mary Jane
Published: November 2008

Objectives. This study examined sociodemographic and psychosocial factors that predict survival among parents living with HIV.

Methods. Parents with HIV (n = 307) were recruited from 1993 to 1995 in New York City and repeatedly assessed. Survival was monitored among the sample (81% mothers; 45% Latino, 34% African American).

Results. Over a median period of 28 months (range = 0–53 months), 44% (n = 135) of the parents died. Having an AIDS diagnosis and being African American were associated with earlier death. Sex, age, and financial status were not related to survival. Parents who survived had initially higher levels of anxiety that decreased over time; in contrast, parents who died reported initially lower, but constant, levels of anxiety over time. After HIV diagnostic status was controlled for, it was found that parents who reported having more children, using a coping style of seeking social support, and being sexually active at baseline survived longer.

Conclusions. The counterintuitive findings raise hypotheses regarding the role of change and responsibilities in the survival of parents with HIV.