bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV seroprevalence in clients of sentinel family planning clinics.
Authors: Stricof R L , Nattell T C , Novick L F
Published: November 2008

In February 1988 the New York State Department of Health initiated a study to determine the prevalence of HIV antibody in women attending selected, publicly subsidized family planning clinics. During a 26-month study period, 27,549 blood specimens were obtained from women having an initial medical examination in 41 clinic sites throughout the state. Of these clients 144 (0.52 percent) were seropositive. The HIV seroprevalence rate increased with age to a high of 1.56 percent for 831 women ages 35 to 39. The seroprevalence rate for non-Hispanic Black or Hispanic clients (0.76 percent) was about six times the rate for non-Hispanic Whites (0.13 percent). No overall increasing or decreasing trend in prevalence of HIV infection was detected during the study period.
HIV seroprevalence in a facility for runaway and homeless adolescents.
Authors: Stricof R L , Kennedy J T , Nattell T C , Weisfuse I B , Novick L F
Published: November 2008

In October 1987, the New York State Department of Health initiated a study to determine the prevalence of antibody to HIV in clients of a facility for runaway and homeless adolescents in New York City. A risk-assessment component was added in May 1988. As of December 1989, a total of 2,667 adolescents had been tested, and 142 (5.3 percent) were found to be HIV-seropositive (males 6.0 percent, females 4.2 percent). The seroprevalence rate increased from 1.3 percent for 15-year-olds to 8.6 percent for 20-year-olds. Hispanics had the highest seroprevalence rate (6.8 percent), followed by non-Hispanic Whites (6.0 percent) and non-Hispanic Blacks (4.6 percent). HIV seropositivity was associated with intravenous drug use, male homosexual/bisexual activity, prostitution, and history of another sexually transmitted disease. The alarmingly high prevalence of HIV infection in this selected population illustrates the immediate need for prevention programs for adolescents.
The AIDS epidemic in New York State.
Authors: Smith P F , Mikl J , Hyde S , Morse D L
Published: November 2008

New York State has reported more AIDS cases (26,576) through November 1989 than any other state, accounting for 23 percent of all reported cases in the nation at the time. New York City has reported 22,231 (84 percent) of the statewide cases. The epidemiology of AIDS in New York State has been easily influenced by the large number of cases among IVDUs. Whereas intravenous drug use accounts for 16 percent of adult/adolescent cases in the rest of the nation, it accounts for 39 percent of the cases in New York State. Intravenous drug use is the leading exposure category among racial minorities, with a disproportionately high rate of cases among Blacks and Hispanics. The epidemic among women and children has also been severe, resulting from intravenous drug use by women, heterosexual transmission from drug users to women, and perinatal transmission to their children.
Geographic and gender variations in total tobacco use.
Authors: Shopland D R , Niemcryk S J , Marconi K M
Published: November 2008

This study is the first to provide complete information on prevalence rates by gender and geographic variation for each type of tobacco product used in the United States. Results indicate that, in nearly half of all states, total tobacco use in men exceeded 40% and, in four states, exceeded 50%. In women, only Nevada, Kentucky, and Michigan reported prevalence exceeding 33%. Results also indicate, however, that concurrent use of multiple tobacco forms is relatively rare. Substantial regional variation in male total tobacco use was evident, with southern males exhibiting the highest prevalence rate (44.6%). As a result, this region represents a target group in special need of comprehensive and effective tobacco use interventions.
Improvement in intergenerational health.
Authors: Fries J F , Williams C A , Morfeld D
Published: November 2008

Differences in health status between subjects, their parents, and their children were analyzed in 2206 subjects who had attended the University of Pennsylvania during the 1939 to 1940 school year. Subjects compared their overall health status at the average age of 70 with that of their same-sex parent at the same age and with that of their same-sex child at the approximate average age of 45, providing reasons for reported differences. Thus, health status in family members of the same sex at the same age in 1988 was compared with that in approximately 1963. Subject health was strikingly improved compared with that of their parents a generation earlier, with 58% reporting their health to be better or much better, and only 9% reporting it to be worse or much worse (P less than .001). The major reasons for the difference were decreased prevalence of chronic conditions and healthier life-styles. The same results were observed in a community-based population of 317 subjects and, even more strikingly, in a group of 422 aging long-distance runners. These observations suggest substantial improvement in senior health status over the past quarter century in selected populations, and they contrast with equivocal changes that have been noted with traditional serial survey techniques.
Surveillance of sentinel occupational mortality in the District of Columbia: 1980 to 1987.
Authors: Cottrell A , Schwartz E , Sokas R , Kofie V , Welch L
Published: November 2008

Epidemiological surveillance of sentinel occupationally related deaths commonly relies on computerized analyses of mortality data obtained from vital statistics records. A computer search of death records in the District of Columbia for the period 1980 to 1987 identified 15 cases that noted asbestosis, silicosis, coal worker's pneumoconiosis, or primary cancer of the pleura/mesothelioma as the underlying cause of death. A manual review of the death certificates for the same period identified three times as many cases (n = 48) with any mention of these conditions. Problems with performing surveillance of these events using death certificates include the lack of sufficient information to identify mesotheliomas and the failure to code and computerize all contributing causes of death.
Diversity of tick species biting humans in an emerging area for Lyme disease.
Authors: Smith R P , Lacombe E H , Rand P W , Dearborn R
Published: November 2008

BACKGROUND. Although most tick bites in humans in areas of the northeastern United States in which Lyme disease is highly endemic are due to Ixodes dammini, no study documents the frequency of I. dammini bites in low-prevalence or emerging areas for Lyme disease. Data on the proportion of tick bites in humans that are due to I. dammini in a region may have implications for public health policy and clinical management. METHODS. A statewide survey of the tick species that parasitized humans in Maine was conducted during 1989 and 1990. Tick submissions from throughout the state were elicited through media announcements. All ticks that had been removed from humans were identified, and data were collected that included bite seasonality and geography and demographics of tick bite victims. RESULTS. Of 709 ticks submitted, only 17% were I. dammini. Ixodes cookei, a vector for Powassan encephalitis, accounted for 34% of bites, and Dermacentor variabilis accounted for 45%. Other tick species were occasionally implicated. CONCLUSIONS. The likelihood that a tick bite was due to I. dammini was lower in Maine than in areas in the northeastern United States in which Lyme disease is highly endemic. Other tick vectors, associated with diseases other than Lyme disease, were more frequently implicated. Regional tick bite surveys may prove useful in assessing the risk of Lyme disease following a tick bite.
Cigarette, alcohol, and coffee consumption and spontaneous abortion.
Authors: Armstrong B G , McDonald A D , Sloan M
Published: November 2008

We analyzed data from a survey of occupational factors and pregnancy outcome to examine the effects of cigarette, alcohol, and coffee consumption on pregnancy outcome. Clear and statistically significant associations were found between cigarette and alcohol consumption and spontaneous abortion. There was a weaker but statistically significant association with coffee consumption: If the associations were casual, 11% of the spontaneous abortions could be attributed to smoking, 5% to alcohol, and 2% to coffee.
Cigarette, alcohol, and coffee consumption and congenital defects.
Authors: McDonald A D , Armstrong B G , Sloan M
Published: November 2008

We analyzed data from a survey of occupational and other factors and pregnancy outcome to assess the effects of cigarette, alcohol, and coffee consumption. There was no evidence of an association between any congenital defect and smoking. Results for alcohol and coffee consumption were largely negative, but there was a weak association with musculoskeletal defects in babies born to women who drank one or more alcoholic drinks a day.
Demographic and socioeconomic differences in beliefs about the health effects of smoking.
Authors: Brownson R C , Jackson-Thompson J , Wilkerson J C , Davis J R , Owens N W , Fisher E B
Published: November 2008

To assess sociodemographic differences in beliefs about the health effects of cigarette smoking and passive smoke exposure, we recently surveyed 2092 adults in St. Louis and Kansas City, Mo. The percentages of respondents who knew that smoking causes lung cancer, emphysema, and heart disease were 76.7, 74.1, and 67.2, respectively. After multivariate adjustment, knowledge about smoking's health effects was generally lower among women, older respondents, those of lower education level, and current smokers. Blacks were generally less likely to appreciate the health effects of active smoking, but were more likely to acknowledge the health effects of passive smoking.
Commentary: the public health consequences of restricted induced abortion--lessons from Romania.
Authors: Stephenson P , Wagner M , Badea M , Serbanescu F
Published: November 2008

The question of whether abortion should be legal is currently being decided in many countries. Although much of the discussion has focused on ethical issues, the public health consequences should not be overlooked and should be addressed realistically and responsibly. Nowhere are the public health manifestations of restricted abortion more apparent than in Romania. The pronatalist policies of the Ceaucescu regime resulted in the highest maternal mortality rate in Europe (approximately 150 maternal deaths per 100,000 live births) and in thousands of unwanted children in institutions.
Trends in obstetric operative procedures, 1980 to 1987.
Authors: Zahniser S C , Kendrick J S , Franks A L , Saftlas A F
Published: November 2008

OBJECTIVES. Increasing rates of cesarean deliveries have received widespread attention in recent years, as concern in the United States about unnecessary surgical procedures has increased. However, little information has been published on the national trends of other operative obstetric procedures occurring during deliveries. METHODS. We analyzed data from the National Hospital Discharge Survey to examine trends in the use of forceps, vacuum extraction, and cesarean section from 1980 through 1987. RESULTS. The rate of cesarean sections increased by 48%, while the rate of forceps procedures declined by 43%. Although the risk of cesarean section was significantly increased for older women, the risk of forceps and vacuum extraction procedures did not vary by age. Women with private insurance were significantly more likely to receive a cesarean section (rate ratio [RR] = 1.2), forceps procedure (RR = 1.7), and vacuum extraction procedure (RR = 1.8) than were women without private insurance. CONCLUSIONS. As pressure mounts to decrease the national cesarean section rate from 24% to 15% by the year 2000, attention should also be given to surveillance of other operative delivery procedures.
Changes in mammography use: economic, need, and service factors.
Authors: Zapka J G , Hosmer D , Costanza M E , Harris D R , Stoddard A
Published: November 2008

OBJECTIVES. The purpose of this study was to document changes in mammography use between 1987 and 1990 and assess the relationship of use to selected economic, need, and health system factors. METHODS. Independent random-digit-dialed telephone surveys of women between 52 and 75 years of age were conducted. RESULTS. Between 1987 and 1990, the proportion of women who had had a mammogram in the past year increased from 31% to 51%. Though income was significantly related to overall patterns of use, it was not associated with recent mammogram use in 1990. Women with a family history of breast cancer reported greater use at both times, as did women who reported having a regular physician (particularly a gynecologist or internist). When all other variables were controlled for, women were over nine times more likely to have had multiple and recent mammograms in 1990 than in 1987. CONCLUSIONS. Mammography use dramatically increased between 1987 and 1990. There were strong relationships between the type of regular physician and mammography screening and between economic and personal history and repeated and recent mammography use.
Legal blindness among 10-year-old children in Metropolitan Atlanta: prevalence, 1985 to 1987.
Authors: Drews C D , Yeargin-Allsopp M , Murphy C C , Decoufle P
Published: November 2008

The prevalence of legal blindness in 10-year-olds in metropolitan Atlanta was 6.8 per 10,000 during 1985 to 1987. The prevalence was 8.8 per 10,000 in Black boys, 8.6 per 10,000 in White boys, 6.7 per 10,000 in White girls, and 1.8 per 10,000 in Black girls. Retinopathy of prematurity was the most common known cause (1.0 per 10,000). Of the 61 cases, 40 had other disabilities, including 14 with mental retardation, cerebral palsy, and epilepsy. The low prevalence among Black girls and the frequent occurrence of blindness with other disabilities are noteworthy.
Measuring the use of mammography: two methods compared.
Authors: Degnan D , Harris R , Ranney J , Quade D , Earp J A , Gonzalez J
Published: November 2008

Population studies often estimate mammography use using women's self-reports. In one North Carolina county, we compared self-report surveys with a second method--counting mammograms per population--for 1987 and 1989. Estimates from self-reports (35% in 1987, 55% in 1989) were considerably higher than those from mammogram counts (20% in 1987, 36% in 1989). We then confirmed 66% of self-reports in the past year. Self-reported use is more accurate regarding whether a woman has had a mammogram than when she had it, but self-reports accurately measure change over time.
The interchange of disease and health between the Old and New Worlds.
Authors: Berlinguer G
Published: November 2008

A review of the five centuries since Columbus discovered America helps us understand the mutual contributions of the Old and the New Worlds to the history of diseases and their treatment. It also shows the consequences of this "mutual discovery" as they are currently emerging in the fields of health, culture, and the environment. To evaluate the multiple aspects of the interchange between the Old and New Worlds, this paper discusses the following: the causes of the rapid decline of the original American populations; the diffusion of communicable diseases between the two civilizations; the health consequences of nutritional changes on both sides of the Atlantic; drug addictions, as they developed through the centuries and as they exist today; the ways diseases were and are evaluated, prevented, diagnosed, and treated; and the mutual impact of different models of health services. Arguing that a major global change following the discovery of America was the transition from isolation of the two worlds to communication, and, more recently, to global interdependence, the paper also discusses some problems of bioethical relevance and the possible impact of new epidemics. Finally, it suggests that a critical analysis of the past may help stimulate future cooperation and solidarity.
Commentary: the quest for women's prophylactic methods--hopes vs science.
Authors: Cates W , Stewart F H , Trussell J
Published: November 2008

The companion article by Rosenberg and Gollub in this issue summarizes data from 10 observational studies and concludes that female-controlled contraceptive methods, under typical conditions, are comparable to condoms in preventing sexually transmitted diseases and should be merchandized as such. While we agree that chemical and mechanical contraceptives provide protection against some sexually transmitted diseases, we think the authors have overstated the scientific case for these methods, especially in comparison with the condom. We think the current data remain inconclusive regarding the absolute protection of spermicides against the human immunodeficiency virus and their level of protection--relative to that of the condom--against other sexually transmitted diseases. Three reasons account for our differences: the limitations in the comparative data; the reported adverse effects of spermicides on vaginal conditions, including genital ulcers; and the relative value of condoms, even under typical conditions, in preventing sexually transmitted diseases. For these reasons, we would currently counsel both women and men who practice high-risk sexual behaviors to use condoms as their first line of defense. If this is unacceptable, the female barriers become a fallback position to protect against bacterial sexually transmitted diseases.
High-risk sexual behavior and condom use among gay and bisexual African-American men.
Authors: Peterson J L , Coates T J , Catania J A , Middleton L , Hilliard B , Hearst N
Published: November 2008

OBJECTIVES. Little is known about the human immunodeficiency virus (HIV) high-risk sexual practices of gay and bisexual African-American men. These data are needed so that better interventions can be developed and implemented in this population. METHODS. The frequency and correlates of unprotected anal intercourse were examined among 250 gay and bisexual African-American men in the San Francisco Bay Area. The cohort was recruited in 1990 from bars, bathhouses, and erotic bookstores, and through African-American gay organizations, street outreach, advertisements in gay mainstream and African-American newspapers, health clinics, and personal referral from other participants. RESULTS. More than 50% of the men in our sample reported having unprotected anal intercourse in the past 6 months, a considerably higher percentage than that among gay White men in San Francisco through 1988 and 1989. Men who practiced unprotected anal intercourse were more likely to be poor, to have been paid for sex, or to have used injection drugs; to have a higher perceived risk of HIV infection; and to report less social support for concerns about risky sexual behavior. Condom norms, condom efficacy, and negative expectations about using condoms predicted these men's failure to use them. CONCLUSION. In the second decade of the acquired immunodeficiency syndrome epidemic, risk reduction programs are still needed for gay and bisexual African-American men.
Responses to anonymous questionnaires concerning sexual behavior: a method to examine potential biases.
Authors: Biggar R J , Melbye M
Published: November 2008

OBJECTIVES. Low response rates to voluntary surveys raise questions about how representative the responses are. We compared the behavior and attitudes of responders, willing and reluctant, and nonresponders to anonymous questionnaires about behaviors that might expose participants to the human immunodeficiency virus (HIV). METHODS. Questionnaires were sent to 1080 Danish adults 18 through 59 years including explicit questions about sexual acts and illegal drug use. Identical questionnaires were sent to 3600 other Danes, similarly chosen; packets sent to these persons included cards to be returned separately informing us that they had responded. Questionnaires were sent twice more to nonresponders, who, if they then responded, were considered reluctant responders. One hundred nonresponders were telephoned and asked why they had refused to respond. RESULTS. Enclosing return cards did not affect initial response rate, but prompting boosted replies from 52% to 73%. However, behaviors were generally similar among initial and reluctant responders. One third of nonresponders agreed to respond if we wished (total potential response: 82%). In general, the reasons for nonresponse did not suggest that the life-styles of nonresponders placed them at risk for HIV infection. CONCLUSIONS. This method provides a simple, inexpensive approach to improving response rates and learning about the biases of reluctant responders and nonresponders.
Pneumococcal bacteremia in Monroe County, New York.
Authors: Bennett N M , Buffington J , LaForce F M
Published: November 2008

OBJECTIVES. Knowledge of the epidemiology of pneumococcal disease is critical for public health planning, evaluation of preventive strategies, and development of immunization recommendations. METHODS. We studied the incidence and case-fatality rates of pneumococcal bacteremia as a proxy for pneumococcal disease in Monroe County, New York, from 1985 through 1989 by reviewing the laboratory and clinical care records of all cases occurring among residents. RESULTS. There were 671 cases identified, for an overall yearly rate of 18.8 per 100,000. The rates were highest in the very young, in the very old, and in non-White populations. Age-specific rates were consistently higher in Blacks than in Whites. Predisposing medical conditions were present in 61% of cases. Case-fatality rates were 15% overall, 27% in those with predisposing medical conditions, and approximately 30% in Blacks older than 55 years and Whites older than 65 years. CONCLUSIONS. This study documents the incidence of and mortality from pneumococcal bacteremia. It supports previous observations that Black populations have an increased risk of invasive pneumococcal infection and suggests that immunization should be considered for Blacks older than 55 years.
Implications of the revised surveillance definition: AIDS among New York City drug users.
Authors: Des Jarlais D C , Wenston J , Friedman S R , Sotheran J L , Maslansky R , Marmor M , Yancovitz S , Beatrice S
Published: November 2008

The Centers for Disease Control (CDC) has proposed revising the AIDS surveillance definition to include any HIV-seropositive person with a CD4 cell count of less than 200 cells per microliter. Based on a study of persons receiving treatment for HIV infection, this new definition would lead to an estimated 50% increase in the number of persons recognized as living with AIDS. Among 440 HIV-seropositive research subjects recruited from drug treatment programs and through street outreach in New York City, 59 met this definition, yet only 25% of those had been reported to the New York City AIDS registry. The new definition, if combined with HIV and T-cell testing at drug treatment and street outreach programs, could thus yield very large increases in the number of injecting drug users meeting the new surveillance definition of AIDS.
Decontamination of an HIV-contaminated CPR manikin.
Authors: Corless I B , Lisker A , Buckheit R W
Published: November 2008

There has been a concern that the number of persons engaging in cardiopulmonary resuscitation (CPR) training could decline because of questions about human immunodeficiency virus (HIV-1) transmission. We investigated the theoretical possibility that a CPR manikin might serve as a fomite for HIV-1 transmission. Decontamination protocols were tested by using elevated levels of virus and decreasing decontamination times. Even under these compromising conditions, however, decontamination was effective.
The Supreme Court, abortion, and the jurisprudence of class.
Authors: Mariner W K
Published: November 2008

The US Supreme Court's decision in Planned Parenthood of Southeastern Pennsylvania v Casey both protects a woman's liberty to choose to terminate her pregnancy and permits the state to make it more difficult for her to exercise her choice. In their opinion on the case, Justices O'Connor, Kennedy, and Souter eloquently defend constitutional protection of the right to make intimate decisions like continuing or ending a pregnancy. At the same time, they permit the state to try to persuade pregnant women not to have abortions and to make abortion harder to obtain and more costly, as long as the state's methods do not create an "undue burden" on the decision. Any restriction on abortion is a burden; whether it is "undue" (and therefore unconstitutional) depends on one's circumstances. The Court appears to view the difference between an undue burden and mere inconvenience from the perspective of privilege. The restrictions that were upheld may not significantly affect middle-class access to abortion, but they could prove insurmountable for many less privileged women.
The US decline in stroke mortality: what does ecological analysis tell us?
Authors: Jacobs D R , McGovern P G , Blackburn H
Published: November 2008

We review a study in this issue that concludes, from analyses of ecological associations, that the use of medication to lower high blood pressure has caused at most a small decline in US stroke mortality rates. Our analysis suggests that other possible sources of the decline may be population-wide falls in levels of blood pressure, cigarette smoking, and coronary heart disease mortality, as well as improved treatment of cardiac and respiratory sequelae of stroke. Although the ecological method is powerful for answering questions about medical interventions' population-wide effects on disease, it must be used with care. Of particular concern are variables with meanings that differ between the ecological and the individual levels, the number of ecological units available for analysis, the sample size within the ecological units, and the range of independent variables used in ecological regression.
US National Health Data on Asian Americans and Pacific Islanders: a research agenda for the 1990s.
Authors: Yu E S , Liu W T
Published: November 2008

OBJECTIVES. In spite of over 30 years of periodic nationwide surveys, we have thus far only the most rudimentary estimates of the determinants of the health of Asian Americans and Pacific Islanders. This paper explores ways to improve the capability of the National Center for Health Statistics (NCHS) to collect national health data on these populations. METHODS. The NCHS "race" coding practices are reviewed, their limitations stated, ways to improve the numerator and denominator data discussed, and a research agenda presented. RESULTS. Resources can be intensified to produce better denominator data, and to improve the collection of detailed ethnicity information for the numerators, in at least the three states (California, New York, and Hawaii) where the majority of Asian/Pacific Islanders lived in 1990. Subsequently, these efforts should be extended to the 10 states where 79% of these individuals reside or to the top 15 metropolitan areas where they are concentrated. CONCLUSIONS. If the recommendations are implemented, several coordinated multisite, multiwave epidemiologic surveys can be conducted using standardized interview instruments and data collection procedures that will capitalize on the geographic distribution of Asian/Pacific Islanders.
Potential lead exposures from lead crystal decanters.
Authors: Appel B R , Kahlon J K , Ferguson J , Quattrone A J , Book S A
Published: November 2008

We measured the concentrations of lead leached into 4% acetic acid, white port, and a synthetic alcoholic beverage that were stored in lead crystal decanters for 1-, 2-, and 10-day periods at room temperature. In decanters from 14 different manufacturers, measured lead concentrations ranged from 100 to 1800 micrograms/L. The pH of the leaching medium is probably the dominant factor determining the extent of lead leached, with greater leaching occurring at lower pH values. The consumption of alcoholic beverages stored in lead crystal decanters is judged to pose a hazard.
Hair dye use and multiple myeloma in white men.
Authors: Brown L M , Everett G D , Burmeister L F , Blair A
Published: November 2008

In recent reports, multiple myeloma has been linked to use of hair coloring products containing mutagenic and carcinogenic chemicals. A population-based case-control study in Iowa of 173 White men with multiple myeloma and 650 controls obtained information on hair dye use. Risk of multiple myeloma was significantly elevated (OR = 1.9) among hair dye users and was greatest among those using hair dyes at least once a month for a year or more (OR = 4.3). These data, along with results from other studies, suggest that use of hair dyes contributes to the development of multiple myeloma.
Attitudes about infertility interventions among fertile and infertile couples.
Authors: Halman L J , Abbey A , Andrews F M
Published: November 2008

BACKGROUND. There has been marked progress in the development of infertility interventions. This paper reports attitudes about 11 interventions for infertility. METHODS. Face-to-face interviews were conducted with each member of 185 infertile and 90 presumed fertile couples in southeastern Michigan. RESULTS. Seven of these interventions were generally viewed favorably and four were generally viewed negatively, regardless of the couple's fertility status. Infertile couples viewed all interventions, except for adoption, more favorably than did fertile couples. Multidimensional scaling was used to cluster the interventions according to similarity in endorsement. These clusters form a continuum from interventions that allow only one member of the couple to be a biological parent to the most noninvasive techniques. All clusters remain roughly equidistant from adoption, in which neither member of the couple is a biological parent. CONCLUSIONS. Interventions that produce a child who is biologically related to only one member of the couple were viewed most negatively. Members of couples who were receiving fertility treatment made finer discriminations among infertility interventions than did individuals who had not received treatment.
Breast cancer screening practices among users of county-funded health centers vs women in the entire community.
Authors: Lane D S , Polednak A P , Burg M A
Published: November 2008

BACKGROUND. Breast cancer screening rates tend to be lower among women with lower income and/or education. METHODS. Telephone surveys of random samples of women aged 50 to 75 who had visited five health centers (n = 795) and women in the same age group residing in the entire community (n = 404) were conducted in 1988. RESULTS. Despite the significantly lower socioeconomic level, a higher proportion of minority women, and a poorer knowledge of mammography, screening rates in the health center group were not lower than in the community sample. About half or more of the health center respondents had ever had a mammogram regardless of income, education, age, and ethnic group. Of the community respondents, 49% had ever had a mammogram, but the proportion varied significantly by income and education. Within the subgroup of women having annual incomes below $15,000, mammography use was actually higher among health center women; that is, 50% of health center vs 35% of community women reported ever having a mammogram and 31% vs 14%, respectively, reported having a mammogram in the past year. CONCLUSION. The findings demonstrate the importance of publicly funded health centers in achieving screening rates among the socioeconomically disadvantaged that are comparable to (or even higher than) those in the general population.
Vaginal douching among women of reproductive age in the United States: 1988.
Authors: Aral S O , Mosher W D , Cates W
Published: November 2008

BACKGROUND. Vaginal douching has been associated with pelvic inflammatory disease (PID) in several epidemiologic studies. METHODS. To determine the extent to which douching is practiced and to describe the population subgroups in which it is most prevalent, we analyzed data from the 1988 National Survey of Family Growth, which is based on a nationally representative sample of 8450 United States women between the ages of 15 and 44 years. RESULTS. Thirty-seven percent of the sample reported douching; 18% douched at least once a week. The variable most strongly and consistently associated with douching was race: two thirds of Black women, but only one third of White women, reported douching. The practice was least frequent among 15- to 19-year-olds (31%) and most frequent among 20- to 24-year-olds (41%). Douching was more common among women who lived in poverty (50%) than among those who did not (28%). Seventy percent of Black women living in poverty reported douching. Women with less than a high school education were almost four times more likely to report douching as those with 16 or more years of schooling (56% vs 16%). Women with only 1 partner and those with 10 or more partners were less likely to douche than others. Sixteen percent of women who reported douching, compared with 10% of those who did not, also reported a history of PID. CONCLUSIONS. Douching may be a modifiable risk factor for PID, it should be a high priority for future etiologic research.
Distribution of HIV type 1 infection in childbearing women in California.
Authors: Capell F J , Vugia D J , Mordaunt V L , Marelich W D , Ascher M S , Trachtenberg A I , Cunningham G C , Arnon S S , Kizer K W
Published: November 2008

The incidence of acquired immunodeficiency syndrome (AIDS) is increasing among California heterosexuals and children. To assess human immunodeficiency virus (HIV)-1 infection in childbearing women, we conducted a blinded serosurvey of newborns. Dried blood specimens taken from 99% of California births during the third quarter of 1988 (n = 135,808) and linked only to maternal demographic categories were tested for HIV-1 antibody by enzyme immunoassay and confirmed by Western blot. Period prevalence of HIV-1 infection was 7.4 per 10,000 childbearing women. Prevalence was highest for Black women and was also elevated for Hispanic and San Francisco Bay Area women. Findings suggest that California Hispanic women will make up an increasing proportion of new AIDS cases.
Factors associated with artificial feeding in Shanghai.
Authors: Chen Y
Published: November 2008

Factors associated with artificial feeding were analyzed for 3285 infants in Shanghai. Boys, those from more highly educated families, and those born by assisted delivery or by cesarean section were more likely to be artificially fed than were girls, those from less educated families, and those born by spontaneous delivery. Infants whose birth weight was around 3750 g had the lowest probability of artificial feeding; higher and lower birth weights were positively associated with artificial feeding.
Inaccuracies in certification of nonmelanoma skin cancer deaths.
Authors: Weinstock M A , Bogaars H A , Ashley M , Litle V , Bilodeau E , Kimmel S
Published: November 2008

Nonmelanoma skin cancer is the most common cancer site in the United States, yet mortality from this cause is poorly understood. We sought medical records of the 16 reported deaths during 1979 through 1987 from this cause (International Classification of Diseases, 9th version [ICD-9], code 173) among Rhode Island residents to evaluate the accuracy of the reported cause of death. Of the 110 cases for which the cause of death could be classified as correct or incorrect, 59 (54%) were misclassified, 49 (83%) of which were mucous-membrane, squamous-cell carcinomas of the head and neck. For most of these, the written death certificate diagnosis was squamous-cell carcinoma of the head and neck, which was coded 173.4. Other problematic diagnoses were cancer of the head and neck and malignant fibrous histiocytoma. In response to a mailed survey, most health departments replied that squamous-cell carcinoma of the head and neck was coded under rubric 173 and malignant fibrous histiocytoma was coded under rubric 171, but there was no unanimity. The misclassification of other causes of death to ICD-9 rubric 173 is substantial. The vast majority were coded to rubric 173.4 and were due to a small number of diagnoses that are recognizable on examination of the death certificate.
Mum's the word: the Supreme Court and family planning.
Authors: Mariner W K
Published: November 2008

On May 23, 1991, the US Supreme Court upheld federal regulations that prohibit federally funded family planning programs from counseling about or referring for abortion. As a result, government benefits may now entail substantial costs. The regulations changed the nature of government-assisted family planning from comprehensive care and counseling to limited services and government-prescribed information. The reasoning in Rust v Sullivan allows government to limit freedom of speech in federally funded programs. The decision may have been influenced by antiabortion sentiment, but it does not affect the legality of abortion. Instead, it sets a precedent for government control of whether and how health care can be discussed wherever government pays some of the bills.
Nutrition: the need to define "optimal" intake as a basis for public policy decisions.
Authors: Wynder E L , Weisburger J H , Ng S K
Published: November 2008

Much of the current chronic disease incidence, notably coronary artery disease and certain types of cancer, relates to nutritionally induced metabolic overload. The evidence for this conclusion is based on extensive analytical, descriptive, and metabolic epidemiological investigations as well as critical experimental studies in animals. Dietary assessments within homogenous populations, because of inherent measurement errors and similarities in eating habits, make only limited contributions to this issue. This communication makes recommendations as to an "optimal" diet, especially for fats and fibers, as a goal for effective disease prevention that is within our reach with the appropriate support of an informed public and a cooperative food industry. To facilitate effective public health action, the "optimal" diet is called the 25/25 diet, that is, 25% of calories as fat and 25 g per day of fiber.
Snuffing tobacco out of sport.
Authors: Connolly G N , Orleans C T , Blum A
Published: November 2008

Use of oral snuff has risen sharply among baseball players following a tobacco industry marketing campaign that linked smokeless tobacco with athletic performance and virility. Millions of adolescents have copied these professional role models and, today, are at risk of developing oral cancer and other mouth disorders. New policies and programs are needed to break the powerful grip that the tobacco industry has on professional sport. Health agencies, including the National Cancer Institute and the National Institute for Dental Research, have teamed up with major league baseball to help players quit and reduce public use of oral tobacco. If these efforts are successful, our national pastime will once again become America's classroom for teaching health and fitness, not nicotine addiction.
Prevalence of obesity among children of military dependents at two major medical centers.
Authors: Tiwary C M , Holguin A H
Published: November 2008

BACKGROUND. Prevalence of childhood obesity is unknown among military dependents. We ascertained the prevalence among all children aged 1 year or older attending the pediatric and adolescent clinics at the Walter Reed Army Medical Center (WRAMC) during 1978 and the Brooke Army Medical Center (BAMC) during 1986 and 1990. METHODS. Obesity was defined according to the child's relative weight computed from growth charts of the National Center for Health Statistics. RESULTS. The study sample included 1715 children (1078 at BAMC, 637 at WRAMC). Among them, 14.8% were overweight, 10.8% were obese, and 7.7% (3.0% males, 4.7% females) were grossly obese. The prevalence of grossly obese children was 5.5% at WRAMC and 9.0% at BAMC; 11.5% among children of retirees and 7.3% among children of active duty personnel (P less than .008); 5.5% among children of officers and 12.2% among children of sergeants (P less than .0005). The prevalence of very obese children was 10.1% for those older than 12 years of age and 3.3% for those aged 6 years or younger (P less than .0001). CONCLUSIONS. Retiree status of the sponsor was more important than sponsor's rank or child's age in determining the prevalence of childhood obesity. Prevalence of obesity approximately doubled over the 8 to 12 years of the study.
Estimation of the break-even point for smoking cessation programs in pregnancy.
Authors: Shipp M , Croughan-Minihane M S , Petitti D B , Washington A E
Published: November 2008

BACKGROUND. Successful programs to help pregnant women quit smoking have been developed and evaluated, but formal smoking cessation programs are not a part of care at most prenatal sites. The cost of such programs may be an issue. Considering the costs of adverse maternal and infant outcomes resulting from smoking, we estimated there would be an amount of money a prenatal program could invest in smoking cessation and still "break even" economically. METHODS. A model was developed and published data, along with 1989 hospital charge data, were used to arrive at a break-even point for smoking cessation programs in pregnancy. RESULTS. Using overall United States data, we arrived at a break-even cost of $32 per pregnant woman. When these data were varied to fit specific US populations, the break-even costs varied from $10 to $237, with the incidence of preterm low birth weight having the most impact on the cost. CONCLUSIONS. It may be advisable to invest greater amounts of money in a prenatal smoking cessation program for some populations. However, for every population there is an amount that can be invested while still breaking even.
Readmission after surgery in Washington State rural hospitals.
Authors: Welch H G , Larson E H , Hart L G , Rosenblatt R A
Published: November 2008

BACKGROUND. Because of concern about the quality of care in rural hospitals, we examined readmission following four surgical procedures commonly performed in Washington State rural hospitals: appendectomy, cesarean section, cholecystectomy, and transurethral prostatectomy. METHODS. In a retrospective cohort study, we identified all patients discharged after receiving one of the foregoing procedures using the statewide hospital discharge database. Readmissions to any hospital in the state within 7 or 30 days of discharge were also identified. RESULTS. During the 2-year period examined, there were no significant differences in readmission rates for surgeries performed in rural and urban hospitals, although the readmission rates for all four procedures were nominally lower in rural hospitals. Logistic regression analyses that controlled for factors that influence readmission did not change these results. CONCLUSIONS. Investigating readmission rates following common surgeries, we found no evidence of low-quality surgical care in Washington State rural hospitals. Early readmission is an imperfect marker for poor surgical outcome, however, and other proxies for quality remain to be examined.
Morbidity among pediatric motor vehicle crash victims: the effectiveness of seat belts.
Authors: Osberg J S , Di Scala C
Published: November 2008

It is well established that seat belts reduce mortality and morbidity among children. Data are presented for 413 children injured severely enough in motor vehicle crashes to require hospitalization. Of the unrestrained children, 4.5% died, compared with 2.4% of the belted children. Unrestrained children had a higher proportion of injuries in four of five anatomical regions, were more severely injured, stayed longer in the hospital, and were 15% more likely than belted children to be discharged with impairments.
Risk factors associated with the classification of unspecified and/or unexplained causes of death in an occupational cohort.
Authors: Cragle D L , Fetcher A
Published: November 2008

In a matched case-control study of an occupational cohort in East Tennessee, data from the death certificates of 608 cases and controls were abstracted and analyzed in order to investigate possible risk factors associated with the certification on the death certificate of an ill-defined cause of death. There was a very strong association between the ill-defined classification and the certifier, especially if the certifier was a medical examiner (OR = 10.4, 95% CI: 6.0, 18.0).
Factors associated with AIDS risk behaviors among high school students in an AIDS epicenter.
Authors: Walter H J , Vaughan R D , Gladis M M , Ragin D F , Kasen S , Cohall A T
Published: November 2008

BACKGROUND. A greater understanding of the determinants of risky behaviors is an essential precursor to the development of successful AIDS prevention programs for adolescents. METHODS. A survey measuring AIDS-related behaviors, beliefs, and knowledge was administered to a sample of 531 10th-grade students residing in an AIDS epicenter. RESULTS. Of the 56.8% of students reporting past-year involvement in sexual intercourse, 67.3% reported unprotected intercourse with low-risk partners, 1.3% reported unprotected intercourse with high-risk partners, and 6.6% reported a past-year history of a sexually transmitted disease. Students whose friends had intercourse and never or inconsistently used condoms, who personally sanctioned intercourse involvement, who believed that the majority of their peers had intercourse, and who perceived low preventive action self-efficacy, were 5.1, 3.0, 2.1, 3.7, and 2.8 times more likely, respectively, to score in the riskier categories of an AIDS behavior index. CONCLUSIONS. These findings suggest that addressing socioenvironmental influences on risky and preventive behaviors may prove to be the most effective AIDS prevention strategy among adolescents.
AIDS education for drug abusers: evaluation of short-term effectiveness.
Authors: McCusker J , Stoddard A M , Zapka J G , Morrison C S , Zorn M , Lewis B F
Published: November 2008

BACKGROUND. Interventions are needed to assist drug abusers in reducing risky drug and sexual behavior. METHODS. A randomized controlled trial compared three small-group AIDS educational interventions among 567 clients of a 21-day inpatient drug detoxification program: a two-session informational intervention, given either during the first (early) or second (late) week of treatment; and a six-session enhanced intervention. Changes in knowledge, attitudes, and psychomotor skills were assessed before and after each intervention, and behavioral outcomes were assessed at follow-up 10 to 18 weeks after admission. RESULTS. Immediately after the interventions, enhanced group members reported significantly greater self-efficacy to talk themselves out of AIDS-risky behavior; other knowledge and attitude scales did not differ by intervention. At follow-up, significant reductions in risky drug use were reported by all groups. Enhanced group members reported significantly greater reduction in injection frequency than did late informational subjects. CONCLUSIONS. No beneficial effect was detected of delaying AIDS education for clients entering detoxification. At this early stage of follow-up, there is only weak evidence that an enhanced intervention improved outcomes.