bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study.
Authors: Wolinsky F D , Fitzgerald J F , Stump T E
Published: November 2008

OBJECTIVES: The purpose of this study was to prospectively assess the independent effect of hip fracture on mortalìty, hospitalization, and functional status. METHODS: Among 7527 members of the Longitudinal Study of Aging who were over age 70 at baseline, 368 persons with hip fracture occurring between 1984 and 1991 were identified. Median length of follow-up was 831 days. RESULTS: Hip fracture was significantly related to mortality (adjusted hazards ratio [AHR] = 1.83; 95% confidence interval [CI] = 1.55, 2.16) when treated as a time-dependent covariate. This effect was concentrated in the first 6 months postfracture (AHR = 38.93, 95% CI = 29.58, 51.23, vs AHR = 1.17; 95% CI = 0.95, 1.44). Hip fracture significantly increased the likelihood of subsequent hospitalization (adjusted odds ratio = 3.31, 95% CI = 2.64, 4.15) and increased the number of subsequent episodes by 9.4%, the number of hospital days by 21.3%, and total charges by 16.3%. Hip fracture also increased the number of functional status dependencies. CONCLUSIONS: The health of older adults deteriorates after hip fracture, and efforts to reduce the incidence of hip fracture could lower subsequent mortality, morbidity, and health services use.
Inappropriate drug prescriptions for elderly residents of board and care facilities.
Authors: Spore D L , Mor V , Larrat P , Hawes C , Hiris J
Published: November 2008

OBJECTIVES: Using 1993 data, this study examines the prevalence of presumptively inappropriate prescriptions among residents, aged 65 and older, of board and care homes. METHODS: Inappropriate drug prescriptions were identified through the use of established criteria developed for application to older nursing home residents and to community-dwelling elderly. This research used a sample of 2054 elderly residents from 410 facilities in 10 states. Weighted analyses were performed with SUDAAN, which accounted for the complex, multistage sampling design. RESULTS: Depending on the criterion applied, between 20% and 25% of residents had at least one inappropriate prescription. Propoxyphene, long-acting benzodiazepines, dipyridamole, and amitriptyline were prescribed most frequently. Residents with inappropriate drug prescriptions had more complex drug regimens prescribed on a routine basis. CONCLUSIONS: The results are a conservative estimate of the extent of inappropriate drug prescribing and utilization in board and care facilities. Increased involvement by pharmacists and physicians in systematic drug utilization review is warranted.
Strategies to improve the reporting of legal blindness in Massachusetts.
Authors: el-Hashimy M M , Aubert R E , Alich K , Warram J H , Harrigan B A , Herman W H
Published: November 2008

OBJECTIVES: Registration practices were evaluated as the initial phase of a validation study of the Register of the Massachusetts Commission for the Blind. METHODS: Massachusetts eye care providers were surveyed to determine factors associated with nonreporting of legal blindness to the commission. RESULTS: Among ophthalmologists, factors associated with nonreporting were small practice size and practicing for 5 years or less in Massachusetts. Among optometrists, factors included small practice size and unawareness of the Massachusetts reporting law. CONCLUSIONS: Information should be disseminated to eye care providers, legally blind patients, and the public to ensure registration and sustain it.
The effect of postmenopausal estrogen therapy on the risk of non-insulin-dependent diabetes mellitus.
Authors: Gabal L L , Goodman-Gruen D , Barrett-Connor E
Published: November 2008

OBJECTIVES: This study examined the effect of postmenopausal estrogen replacement therapy on the incidence of non-insulin-dependent diabetes in women. METHODS: Postmenopausal women aged 50 through 70 years (n=848) without diagnosed diabetes at baseline were followed for 10 to 15 years for incident diabestes. RESULTS: Over the average 11.5 year follow-ip, there were 105 new cases of diabetes. The age-adjusted relative-risk for development of diabetes was nonsignificantly lower for women with continuous estrogen replacement therapy use than for never users. After adjustment for major covariates, a nonsignificant linear trend with increasing duration of estrogen replacement therapy was reversed. CONCLUSIONS: This study suggests that previous results showing a reduced risk of diabetes in women using estrogen may have been due to selection bias regarding who is prescribed estrogen, confounding factors, or differential diagnostic efforts.
The role of diabetes mellitus in the higher prevalence of tuberculosis among Hispanics.
Authors: Pablos-Méndez A , Blustein J , Knirsch C A
Published: November 2008

OBJECTIVES: This research studied the relative contribution of diabetes mellitus to the increased prevalence of tuberculosis in Hispanics. METHODS: A case-control study was conducted involving all 5290 discharges from civilian hospitals in California during 1991 who had a diagnosis of tuberculosis, and 37,366 control subjects who had a primary discharge diagnosis of deep venous thrombosis, pulmonary embolism, or acute appendicitis. Risk of tuberculosis was estimated as the odds ratio (OR) across race/ethnicity, with adjustment for other factors. RESULTS: Diabetes mellitus was found to be an independent risk factor for tuberculosis. The association of diabetes and tuberculosis was higher among Hispanics (adjusted OR [ORadj] = 2.95: 95% confidence interval [CI] = 2.61, 3.33) than among non-Hispanic Whites (ORadj = 1.31: 95% CI = 1.19. 1.45): among non-Hispanic Blacks, diabetes was not found to be associated with tuberculosis (ORadj = 0.93: 95% CI = 0.78, 1.09). Among Hispanics aged 25 to 54, the estimated risk of tuberculosis attributable to diabetes (25.2%) was equivalent to that attributable to HIV infection (25.5%). CONCLUSIONS: Diabetes mellitus remains a significant risk factor for tuberculosis in the United States. The association is especially notable in middle-aged Hispanics.
Mentally disordered women in jail: who receives services?
Authors: Teplin L A , Abram K M , McClelland G M
Published: November 2008

OBJECTIVES: Many jail inmates have severe psychiatric disorders (e.g., schizophrenia, major affective disorders). The courts have mandated that detainees have a constitutional right to treatment. We investigated what proportion of female jail detainees needed mental health services, what proportion received services, and what variables predicted who received services. METHODS: Trained interviewers administered a psychiatric evaluation (the NIMH Diagnostic Interview Schedule) to 1272 randomly selected female jail detainees during jail intake in a large Midwestern city. Project staff then documented whether women subsequently received services, using records and case files. RESULTS: Of the women who needed services, 23.5% received them while they were in jail. Type of disorder, treatment history, and socio-demographic variables all affected the odds of a mentally ill woman's receiving services. CONCLUSIONS: Correctional health care is a growing national public health problem. The magnitude of mental health service needs far exceeds current resources.
A dietary intervention in primary care practice: the Eating Patterns Study.
Authors: Beresford S A , Curry S J , Kristal A R , Lazovich D , Feng Z , Wagner E H
Published: November 2008

OBJECTIVES: This study evaluated the effectiveness of a low-intensity dietary intervention in primary care practice in lowering dietary fat intake and raising dietary fiber intake. METHODS: A randomized controlled trial of 28 physician practices in six primary care clinics enrolled, by telephone, adult patients who had appointments for nonurgent nonacute visits. Of 3490 eligible patients contacted, 2111 completed baseline interview; 86.1% also completed a 12-month follow-up. Physicians gave intervention participants a self-help booklet and a brief motivational message. Changes in fat and fiber from baseline to 12-month follow-up were evaluated. RESULTS: Intervention and control groups both reported a decrease in fat intake and an increase in fiber intake. The differential change and 95% confidence interval (CI) for the percentage of energy obtained from fat was -1.2 (CI = -0.71, -1.7) (P = .0015), for grams fiber/1000 kcal 0.32 (CI = -0.066, 0.71) (P = .086), for fat score -0.044 (CI = -0.016, -0.072) (P = .010), and for fiber score 0.036 (CI = 0.011, 0.061) (P = .014), with greater reductions in fat and greater increase in fiber in the intervention group. CONCLUSIONS: This low-intensity intervention was effective in dietary behavior change.
Factors contributing to the hospitalization of patients with congestive heart failure.
Authors: Chin M H , Goldman L
Published: November 2008

OBJECTIVES: This study identifies acute precipitants of hospitalization and evaluates utilization of angiotension-converting enzyme inhibitors in patients admitted with congestive heart failure. METHODS: Cross-sectional chart-review study was done of 435 patients admitted nonelectively from February 1993 to February 1994 to an urban university hospital with a complaint of shortness of breath or fatigue and evidence of congestive heart failure. RESULTS: The most common identifiable abnormalities associated with clinical deterioration prior to admission were acute anginal chest pain (33%), respiratory infection (16%), uncontrolled hypertension with initial systolic blood pressure > or = 180 mm Hg (15%), atrial arrhythmia with heart rate > or = 120 (8%), and noncompliance with medications (15%) or diet (6%); in 34% of patients, no clear cause could be identified. After exclusion of those who were already on a different vasodilator or who had relative contraindications, 18 (32%) of the patients with ejection fractions < or = 0.35 measured prior to admission were not taking an angiotensin-converting enzyme inhibitor on presentation to the hospital. CONCLUSIONS: Interventions to improve compliance, the control of hypertension, and the appropriate use of angiotensin-converting enzyme inhibitors may prevent many hospitalizations of heart-failure patients.
Adolescent smokers' provision of tobacco to other adolescents.
Authors: Wolfson M , Forster J L , Claxton A J , Murray D M
Published: November 2008

OBJECTIVES: This study examined adolescent smokers provision of tobacco to other adolescents. METHODS: Data from a survey of 8th-, 9th-, and 10th-grade students in Minnesota were analyzed by using mixed-model logistic regression. RESULTS: More than two thirds (68.8%) of adolescent smokers had provided tobacco to another adolescent in the previous 30 days. Mother's smoking, number of friends who smoke, owning tobacco merchandise, number of cigarettes smoked in the past week, source of last cigarette (commercial), and recent attempt to buy cigarettes were associated with providing. CONCLUSIONS: The social availability of tobacco to youth needs further examination.
Cigarette sales to African-American and white minors in low-income areas of Baltimore.
Authors: Voorhees C C , Swank R T , Stillman F A , Harris D X , Watson H W , Becker D M
Published: November 2008

OBJECTIVES: This study documented illegal sales of cigarettes to minors in low-income African-American and White urban areas in East Baltimore. METHODS: Six youths, aged 14 through 16 years, were sent to a random sample of 83 corner stores to attempt to purchase cigarettes. The youths provided the investigators with data on merchant, store, and purchase characteristics. RESULTS: The youths successfully purchased cigarettes in 85.5% of the stores; 58% of the stores displayed five or more cigarette advertisements outside their premises. CONCLUSIONS: Cigarette sales to minors and associated advertising remain prevalent in this urban community.
The case of the missing secretary: DHEW's failed efforts to create a Cabinet secretary of health.
Authors: Silver G A
Published: November 2008

In response to professional and political pressures in 1967, an incident occurred at the Department of Health, Education, and Welfare that illustrates the delicacy and complexity of the legislative process. In an effort to bypass interest group influences, the undersecretary of the Department undertook a maneuver that backfired and frustrated an opportunity that might have resulted in the establishment of a Cabinet office of Health. In addition to demonstrating the sensitivity of the legislative process, and the dangers of overconfidence in dealing with the process, the events also offer moral guidance: too stubborn, idealistic convictions of good people, however well intentioned the actions, may serve to defeat the desired ends.
Alcohol, tobacco, and other drug use among rural/small town and urban youth: a secondary analysis of the monitoring the future data set.
Authors: Cronk C E , Sarvela P D
Published: November 2008

OBJECTIVES: This study compared prevalence of substance use among high school seniors in rural and urban areas from 1976 through 1992. METHODS: We used data collected for these years from urban (n = 75,916) and rural (n = 51,182) high school seniors. Thirty-day prevalence for alcohol, cigarettes, marijuana, cocaine, LSD, and inhalant use, binge drinking, smoking a pack or more of cigarettes a day, and daily alcohol and marijuana use were evaluated. RESULTS: Substance use declined from 1976 through 1992. In 1976, urban students had greater prevalence for most substances, but by 1992, rural and urban students were similar, with rural students having higher prevalence for alcohol and cigarette use (particularly excessive use). Trends were similar for both sexes, though rural girls showed a later catch-up to use levels of urban girls. CONCLUSIONS: Rural students are currently at risk approximately equal to that of urban students. Other studies have demonstrated the association of substance use with increased morbidity and mortality. Policy alterations and health education programs should address this pattern in the nation's rural areas.
Race and mammography use in two North Carolina counties.
Authors: O'Malley M S , Earp J A , Harris R P
Published: November 2008

OBJECTIVES: This study investigated racial differences in mammography use and their association with physicians' recommendations and other factors. METHODS: The study used 1988 survey data for 948 women 50 years of age and older from the New Hanover Breast Cancer Screening Program. Racial differences in terms of physician recommendation, personal characteristics, health characteristics, and attitudes toward breast cancer and mammography were examined. Factors at least minimally associated with race and use were included in multivariate logistic regression analyses to examine the effect of race while controlling for other factors. RESULTS: In comparison with White women. Black women were half as likely to report ever having had a mammogram (27% vs 52%) and having a mammogram in the past year (17% vs 36%). Black women also significantly less often reported physician recommendation (25% vs 52%). Although Black and White women differed significantly in other characteristics, multivariate logistic regression analyses indicated that physician recommendation accounted for 60% to 75% of the initial racial differences in mammography use. CONCLUSIONS: Understanding physicians' recommendations for breast cancer screening is a critical first step to increasing mammography use in disadvantaged populations.
Cross-cultural measurements of psychological well-being: the psychometric equivalence of Cantonese, Vietnamese, and Laotian translations of the Affect Balance Scale.
Authors: Devins G M , Beiser M , Dion R , Pelletier L G , Edwards R G
Published: November 2008

OBJECTIVES: This paper evaluates the cultural equivalence of Cantonese, Vietnamese, and Laotian translations of the Affect Balance Scale. METHODS: The scale was completed by 399 Vietnamese, 193 Laotian, 756 Cantonese, and 319 English speakers who were participants in the Clarke Institute-University of Toronto Refugee Resettlement Project (n = 1667). RESULTS: Confirmatory factor analyses indicated a good fit between the hypothesized two-factor model (separate factors for positive and negative affect) across the original English-language version and each of the Asian-language translations. Factorial invariance (numbers and patterns of factor loadings) was evident across all versions of the scale. No evidence of item bias was detected by mixed Language x Item analyses of variance. Acceptable reliability was observed; coefficient alphas ranged from .62 to .72 for positive affect and from .62 to .70 for negative affect items. CONCLUSIONS: These findings substantiate the cultural equivalence of the three translations of the scale for population health research. Important future research directions made possible by the availability of culturally equivalent instruments are discussed.
Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups.
Authors: Pappas G , Hadden W C , Kozak L J , Fisher G F
Published: November 2008

OBJECTIVES: The National Hospital Discharge Survey (NHDS) was used to evaluate potentially avoidable hospital conditions as an indicator of equity and efficiency in the US health care system. METHODS: With the use of 1990 data from the NHDS, the National Health Interview Survey, and the census, national rates of hospitalization were calculated for avoidable conditions by age, race, median income of zip code, and insurance status. RESULTS: An estimated 3.1 million hospitalizations were for potentially avoidable conditions. This was 12% of all hospitalizations in 1990 (excluding psychiatric admissions, women with deliveries, and newborns). Rates of potentially avoidable hospitalizations were higher for persons living in middle- and low-income areas than for persons living in high-income areas, and were higher among Blacks than among Whites. These class and racial differences were also found among the privately insured. Differences among income and racial groups for persons aged 65 and over were not significant. CONCLUSIONS: Inequalities in potentially avoidable hospitalizations suggest inequity and inefficiency in the health care delivery system. Avoidable hospital conditions are a useful national indicator to monitor access to care.
Motor vehicle rollover and static stability: an exposure study.
Authors: Robertson L S , Maloney A
Published: November 2008

OBJECTIVES: This study examined vehicle rollovers in terms of site-specific exposure and speeds of vehicles of varying stability. METHODS: Fifty-one rollover sites in two states were visited at the same time of day and day of week as the rollover. A sample of vehicles moving in the same direction as the rollover were observed, and vehicle-specific data were obtained from identification numbers. RESULTS: Low stability, exacerbated by the addition of passengers, increased the risk of rollover. Speed was not correlated with stability and is not a confounder. CONCLUSIONS: Rollovers could be substantially reduced if motor vehicles were manufactured with a static stability of 1.2 or greater.
A persistent rise in mortality among injection drug users in Rome, 1980 through 1992.
Authors: Davoli M , Perucci C A , Rapiti E , Bargagli A M , D'Ippoliti D , Forastiere F , Abeni D
Published: November 2008

OBJECTIVES: The purpose of the study was to analyze overall and cause-specific mortality among injection drug users in Rome. METHODS: A cohort of 4200 injection drug users was enrolled in drug treatment centers from 1980 through 1988 and followed up until December 1992. RESULTS: The age-adjusted mortality rate from all causes increased from 7.8/1000 person-years in 1985/86 to 27.7/1000 in 1991/92. The rise was mainly attributable to acquired immunodeficiency syndrome (AIDS), but mortality from overdose and other causes increased as well. The cumulative risk of death by the age of 40 was 29.3%. CONCLUSIONS: The impact of AIDS deaths appears to be additional to a persistent increase of mortality for all other causes.
The effect of high altitude and other risk factors on birthweight: independent or interactive effects?
Authors: Jensen G M , Moore L G
Published: November 2008

OBJECTIVES: This study examined whether the decline in birth-weight with increasing altitude is due to an independent effect of altitude or an exacerbation of other risk factors. METHODS: Maternal, paternal, and infant characteristics were obtained from 3836 Colorado birth certificates from 1989 through 1991. Average altitude of residence for each county was determined. RESULTS: None of the characteristics related to birthweight (gestational age, maternal weight gain, parity, smoking, prenatal care visits, hypertension, previous small-for-gestational-age infant, female newborn) interacted with the effect of altitude. Birthweight declined an average of 102 g per 3300 ft (1000 m) elevation when the other characteristics were taken into account, increasing the percentage of low birthweight by 54% from the lowest to the highest elevations in Colorado. CONCLUSIONS: High altitude acts independently from other factors to reduce birthweight and accounts for Colorado's high rate of low birthweight.
The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women.
Authors: Wingood G M , DiClemente R J
Published: November 2008

OBJECTIVES: This study examined the consequences of having a physically abusive primary partner on the condom use and sexual negotiation practices of young African-American women. METHODS: Interviews were conducted with 165 sexually active African-American women aged 18 through 29 in San Francisco, Calif. RESULTS: Women in abusive relationships were less likely than others to use condoms and were more likely to experience verbal abuse, emotional abuse, or threats of physical abuse when they discussed condoms. They were more fearful of asking their partners to use condoms, worried more about acquiring the human immunodeficiency virus (HIV), and felt more isolated than did women not in abusive relationships. CONCLUSIONS: HIV prevention programs for women should address domestic violence prevention strategies.
Prenatal health behaviors and psychosocial risk factors in pregnant women of Mexican origin: the role of acculturation.
Authors: Zambrana R E , Scrimshaw S C , Collins N , Dunkel-Schetter C
Published: November 2008

OBJECTIVES: This study examined the association between acculturation of Mexican-origin women and factors in low birthweight and preterm delivery. METHODS: Interviews were conducted with 911 Mexican-origin respondents in Los Angeles prenatal care clinics. Infant outcome data were retrieved from delivery records. RESULTS: Mexican-American women had generally more undesirable prenatal behaviors and risk factors than Mexican-immigrant women. Although higher acculturation was significantly associated with behavioral risk factors, there were no direct effects of acculturation on infant gestational age or birthweight. CONCLUSIONS: Future research needs to measure multiple factors to assess their effects on culture-specific protective factors.
Employee and public responses to simulated violations of no-smoking regulations in Spain.
Authors: Bonfill X , Serra C , López V
Published: November 2008

OBJECTIVES: This study evaluated compliance with regulations prohibiting smoking in public places by using a new method of smoking simulation. METHODS: Sites in Sabadell, Spain, were visited by observers who lit a cigarette, simulating the act of smoking, and noted the placement and content of signs indicating smoking restrictions. RESULTS: A warning was given in only 17% of sites. A significant association was observed between the presence of signs banning smoking and the elicitation of a warning from people present. CONCLUSIONS: Simulating the violation of smoking restrictions may be used as an efficient method of assessing enforcement of the prohibition of public smoking.
Trends in fatal occupational injuries and industrial restructuring in North Carolina in the 1980s.
Authors: Richardson D , Loomis D
Published: November 2008

OBJECTIVES: This study examined the relationship between changes in employment in North Carolina in the 1980s and fatal occupational injury rates. METHODS: Unintentional fatal occupational injuries (n = 1989) in North Carolina between 1978 and 1991 were identified via the medical examiner's system. RESULTS: Overall fatal injury rates declined during the 1980s, but rates increased 9.6% per year among manufacturing industries that declined in employment size; rates fell among service sector and manufacturing industries that grew. CONCLUSIONS: Increasing occupational fatal injury rates accompanied the decline in workforce in North Carolina's traditional, labor-intensive manufacturing industries during the 1980s, while service sector and expanding manufacturing industries have experienced declining fatal injury rates.
Assessing children's ultraviolet radiation exposure: the use of parental recall via telephone interviews.
Authors: Mayer J A , Sallis J F , Eckhardt L , Creech L , Johnston M R , Elder J P , Lui K J
Published: November 2008

OBJECTIVES: This study evaluated the validity of a parental report measure of children's solar protection behaviors. METHODS: Fifty-eight children had skin color assessed twice with a colorimeter. Between measurement sessions, parents were interviewed by telephone to assess children's indoor-outdoor status and solar protection across 40 hourly intervals. RESULTS: Parental report of child's indoor-outdoor status was significantly correlated with the colorimeter values, whereas the use of sunscreen and protective clothing was not. CONCLUSIONS: This measure was feasible for assessing ultraviolet exposure in young children. The component that assessed the number of intervals spent outdoors evidenced predictive validity.
Injuries to bicyclists in Wuhan, People's Republic of China.
Authors: Li G , Baker S P
Published: November 2008

OBJECTIVES: This study examined the morbidity and mortality from bicycling injuries in Wuhan, China. METHODS: Police department data for the year 1993 complemented by data from emergency room interviews were analyzed. RESULTS: The death rate from bicycling injuries was estimated as 2.2 per 100000 population, more than seven times the rate for the United States. At least 79% of the fatalities and 17% of the emergency room cases sustained head injuries, the majority (71%) of which resulted from contact of the head with the concrete or asphalt road. None of the patients was wearing a helmet at the time of injury, and helmet use among the general bicyclist population was nonexistent. CONCLUSIONS: Bicycle-related head injury is an important public health issue in China. The effectiveness of safety helmets in developing countries needs to be evaluated.
Ethical dilemmas in current planning for polio eradication.
Authors: Taylor C E , Cutts F , Taylor M E
Published: November 2008

Intensification of polio eradication efforts worldwide raises concerns about costs and benefits for poor countries. A major argument for global funding is the high benefit-cost ratio of eradication; however, financial benefits are greatest for rich countries. By contrast, the greatest costs are borne by poor countries; the Pan American Health Organization has estimated that host countries bore 80% of costs for polio eradication in the Americas. The 1988 World Health Assembly resolution setting up the Polio Eradication Initiative carried the proviso that programs should strengthen health infrastructures. Drastic cuts in donor funding for health make this commitment even more important. Two international evaluations have reported both positive and negative effects of polio and Expanded Programme on Immunization programs on the functioning and sustainability of primary health care. Negative effects were greatest in poor countries with many other diseases of public health importance. If poor countries are expected to divert funds from their own urgent priorities, donors should make solid commitments to long-term support for sustainable health development.
Infant survival, HIV infection, and feeding alternatives in less-developed countries.
Authors: Kuhn L , Stein Z
Published: November 2008

OBJECTIVES: This study examines, in the context of the human immunodeficiency virus (HIV) epidemic, the effects of optimal breast-feeding, complete avoidance of breast-feeding, and early cessation of breast-feeding. METHODS: The three categories of breast-feeding were weighed in terms of HIV transmission and infant mortality. Estimates of the frequency of adverse outcomes were obtained by simulation. RESULTS: Avoidance of all breast-feeding by the whole population always produces the worst outcome. The lowest frequency of adverse outcomes occurs if no HIV-seropositive women breast-feed and all seronegative women breast-feed optimally, given infant mortality rates below 100 per 1000 and relative risks of dying set at 2.5 for non-breast-fed compared with optimally breast-fed infants. For known HIV-seropositive mothers, fewer adverse outcomes result from early cessation than from prolonged breast-feeding if the hazard of HIV transmission through breast-feeding after 3 months is 7% or more, even at high mortality rates, given relative risks of dying set at 1.5 for early cessation compared with optimal duration of breast-feeding. CONCLUSIONS: The risk of HIV transmission through breast-feeding at various ages needs to be more precisely quantified. The grave issues that may accompany a possible decline in breast-feeding in the less developed world demand evaluation.
Maternal employment and breast-feeding: findings from the 1988 National Maternal and Infant Health Survey.
Authors: Visness C M , Kennedy K I
Published: November 2008

OBJECTIVES: This analysis uses nationally representative data from the 1988 National Maternal and Infant Health Survey to explore the factors, including employment, associated with breast-feeding initiation and duration. METHODS: Multiple logistic regression was used to model the determinants of breast-feeding initiation among 9087 US women. Multiple linear regression was used to model the duration of breast-feeding among women who breast-fed. RESULTS: Fifty-three percent of mothers initiated breast-feeding in 1988, and the decision to breast-feed was not associated with maternal employment. However, among breast-feeders, returning to work within a year of delivery was associated with a shorter duration of breast-feeding when other factors were controlled. Among employed mothers, the duration of maternity leave was positively associated with the duration of breast-feeding. CONCLUSIONS: The low rates of breast-feeding initiation in the United States are not attributable to maternal participation in the labor force. However, returning to work is associated with earlier weaning among women who breast-feed.
The campaign to raise the tobacco tax in Massachusetts.
Authors: Heiser P F , Begay M E
Published: November 2008

OBJECTIVES: Question 1 raised the Massachusetts state tobacco tax to fund tobacco education programs. This paper examines the process of qualifying and passing Question 1. METHODS: Information was gathered from internal memoranda, meeting minutes, newspaper articles, internal documents, letters, newsletters, news and press releases, and personal interviews. Data about campaign contributions were obtained from the Massachusetts Office of Campaign and Political Finance. RESULTS: Three factors help explain why Question 1 passed: (1) the policy environment was favorable because of the social unacceptability of smoking; (2) the activists assembled a large coalition of supporters; and (3) the activists countered industry claims that the new tax would hurt small business and lower-income smokers and would be wasted by the legislature. The ballot initiative passed despite the industry's $7 million campaign to defeat it. CONCLUSIONS: The apparent influence of the tobacco industry on the legislature was the driving force behind the decision of public health activists to qualify Question 1. Moving policy-making out of the legislature into the public arena widened the scope of conflict and enabled public health activists to win.
The effectiveness of a school-based curriculum for reducing violence among urban sixth-grade students.
Authors: Farrell A D , Meyer A L
Published: November 2008

OBJECTIVES: In this study, we examine the impact of a school-based curriculum designed to reduce violence among urban sixth-grade students. METHODS: This study used a staggered implementation design in which sixth-graders in six middle schools were taught an 18-session violence-prevention curriculum during either the fall or spring semester. Outcome measures were completed at the beginning, middle, and end of the school year. RESULTS: For boys, participation in the program during the fall resulted in significant posintervention differences in the self-reported frequency of violence and several other problem behaviors. Most of these differences were maintained at the end of the school year. Girls, in contrast, did not appear to benefit from the program. CONCLUSION: These results support the use of a school-based curriculum for reducing violence among sixth-grade boys. They also underscore the importance of early intervention and the necessity of examining gender effects in evaluating such programs.
Profiles of violent youth: substance use and other concurrent problems.
Authors: Ellickson P , Saner H , McGuigan K A
Published: November 2008

OBJECTIVES: This study examined the prevalence of various violent behaviors among high school-age adolescents, the co-occurrence of teenage violence with other public health problems, and gender differences in violence. METHODS: Longitudinal data for more than 4500 high school seniors and dropouts from California and Oregon were used to develop weighted estimates of the prevalence of violent behavior and its co-occurrence with other emotional and behavioral problems. RESULTS: More than half the sample had engaged in violence during the last year, and one in four had committed predatory violence. Boys were more likely than girls to engage in most types of violence, but both were equally prone to violence within the family. Violent youth were more likely than their peers to have poor mental health, use drugs, drop out of school, and be delinquent. Violent boys were more likely than violent girls to commit nonviolent felonies and sell drugs, but less likely to have poor mental health or become a parent. Prevalence estimates for violence co-occurring with three or more other problems ranged from 4% to 21%. CONCLUSIONS: Teenage violence typically coexists with additional emotional and behavioral problems. Programs must consider the broader public health context in which violence occurs.
Milk, dietary calcium, and bone fractures in women: a 12-year prospective study.
Authors: Feskanich D , Willett W C , Stampfer M J , Colditz G A
Published: November 2008

OBJECTIVES: This study examined whether higher intakes of milk and other calcium-rich foods during adult years can reduce the risk of osteoporotic fractures. METHODS: This was a 12-year prospective study among 77761 women, aged 34 through 59 years in 1980, who had never used calcium supplements. Dietary intake was assessed with a food-frequency questionnaire in 1980, 1984, and 1986. Fractures of the proximal femur (n = 133) and distal radius (n = 1046) from low or moderate trauma were self-reported on biennial questionnaires. RESULTS: We found no evidence that higher intakes of milk or calcium from food sources reduce fracture incidence. Women who drank two or more glasses of milk per day had relative risks of 1.45 for hip fracture (95% confidence interval [CI] = 0.87, 2.43) and 1.05 for forearm fracture (95% CI = 0.88, 1.25) when compared with women consuming one glass or less per week. Likewise, higher intakes of total dietary calcium or calcium from dairy foods were not associated with decreased risk of hip or forearm fracture. CONCLUSIONS: These data do not support the hypothesis that higher consumption of milk or other food sources of calcium by adult women protects against hip or forearm fractures.
National health care reform and the 103rd Congress: the activities and influence of public health advocates.
Authors: Schauffler H , Wilkerson J
Published: November 2008

OBJECTIVES: This study examined the activities and influence of public health interest groups and coalitions on the national health care reform debates in the 103rd Congress. METHODS: Congressional staff and representatives of public health interest groups, coalitions, and government health agencies were interviewed. Content analysis of eight leading national health care reform bills was performed. RESULTS: The public health community coalesced around public health in health care reform; nearly all the major interest groups and government health agencies joined two or more public health or prevention coalitions, and half joined three or more. The most effective influence on health care reform legislation was early, sustained personal contact with Congress members and their staffs, accompanied by succinct written materials summarizing key points. Media campaigns and grassroots mobilization were less effective. Seven of the eight leading health care reform bills included one or more of the priorities supported by public health advocates. CONCLUSIONS: The public health community played an important role in increasing awareness and support for public health programs in the health care reform bills of the 103rd Congress.
The distance to community medical care and the likelihood of hospitalization: is closer always better?
Authors: Goodman D C , Fisher E , Stukel T A , Chang C
Published: November 2008

OBJECTIVES: This study examined the influence that distance from residence to the nearest hospital had on the likelihood of hospitalization and mortality. METHODS: Hospitalizations were studied for Maine. New Hampshire, and Vermont during 1989 (adults) and for 1985 through 1989 (children) and for mortality (1989) in Medicare enrollees. RESULTS: After other known predictors of hospitalization (age, sex, bed supply, median household income, rural residence, academic medical center, and presence of nursing home patients) were controlled for, the adjusted rate ratio of medical hospitalization for residents living more than 30 minutes away was 0.85 (95% confidence interval [CI] = 0.82, 0.88) for adults and 0.78 (95% CI = 0.74, 0.81) for children, compared with those living in a zip code with a hospital. Similar effects were seen for the four most common diagnosis-related groups for both adults and children. The likelihood of hospitalization for conditions usually requiring hospitalization and for mortality in the elderly did not differ by distance. CONCLUSIONS: Distance to the hospital exerts an important influence on hospitalization rates that is unlikely to be explained by illness rates.
Survival rates for four forms of cancer in the United States and Ontario.
Authors: Keller D M , Peterson E A , Silberman G
Published: November 2008

OBJECTIVES: In this study, cancer survival rates for patients diagnosed in Ontario and selected areas within the United States were compared. METHODS: Relative survival rates were computed for patients aged 15 through 84 years diagnosed with any of four forms of cancer (breast, colon, lung, and Hodgkin's disease). The cohorts represented those diagnosed over the years 1978 through 1986 in the Canadian province of Ontario and in nine regions covered by the US National Cancer Institute's Surveillance Epidemiology and End Results program. Patients were followed through the end of 1990. RESULTS: The cumulative relative survival rates were similar for American and Canadian patients. The largest difference was observed for breast cancer, where patients in the United States enjoyed a survival advantage throughout the follow-up period. CONCLUSIONS: Patients in the United States and Ontario with the diseases studied, except for breast cancer, experience very similar survival. The greater use of mammographic screening in the United States could account for that country's higher breast cancer survival rate by promoting earlier and therefore more efficacious treatment, by introducing bias, or by a combination of both treatment and bias factors.
The costs and effects of cervical and breast cancer screening in a public hospital emergency room. The Cancer Control Center of Harlem.
Authors: Mandelblatt J , Freeman H , Winczewski D , Cagney K , Williams S , Trowers R , Tang J , Gold K , Lin T H , Kerner J
Published: November 2008

OBJECTIVES: This study assessed the cost-effectiveness of cervix and breast cancer screening in a public hospital emergency room. METHODS: Age-eligible women with nonurgent conditions and without recent screening were offered screening by a nurse. A decision analysis compared the costs and outcomes of emergency room screening and standard hospital screening efforts. RESULTS: The undiscounted cost-effectiveness results for establishing new programs were $4050 (cervical cancer), $403,203 (breast cancer), and $4375 (joint cervix and breast cancer) per year of life saved. If screening is added to an existing program, results are more favorable ($429, $21,324, and $479 per year of life saved for cervix, breast, and joint screening, respectively). Results were most sensitive to volume and probability of receiving treatment after an abnormal screen. CONCLUSIONS: Emergency room screening was cost-effective for cervical cancer; breast cancer screening was relatively expensive given the low number of women reached. More intensive recruitment and follow-up strategies are needed to maximize the cost-effectiveness of such programs.
An association between the heat-humidity index and preterm labor and delivery: a preliminary analysis.
Authors: Lajinian S , Hudson S , Applewhite L , Feldman J , Minkoff H L
Published: November 2008

OBJECTIVES: The goal of this study was to determine whether a relationship exists between heat-humidity indexes and rates of preterm labor and preterm delivery. METHODS: Preterm labor and delivery rates were compared during the 2 summer and 2 winter weeks with the highest and lowest heat-humidity indexes for each season. RESULTS: The rate of preterm labor increased consistently from 1.23% to 3.00% as the heat-humidity index rose. When preterm births were examined, the trend was similar but not statistically significant. CONCLUSIONS: Given the public health import of preterm labor and the frequency with which pregnant women may be exposed to extremes of heat, studies designed to confirm or refuse our preliminary observations are warranted.
Socioeconomic status and breast cancer mortality, 1989 through 1993: an analysis of education data from death certificates.
Authors: Heck K E , Wagener D K , Schatzkin A , Devesa S S , Breen N
Published: November 2008

OBJECTIVES: This study examined whether more highly educated women were at greater risk of dying of breast cancer during 1989 through 1993. METHODS: Breast cancer mortality rates were calculated through death certificates and Current Population Survey data. RESULTS: Breast cancer mortality rates were highest among women with 12 and with 16 or more years of education. Non-Hispanic Black women had the highest mortality rates and Asian women the lowest. Positive relationships between mortality and education were found for Hispanic women as well as non-Hispanic Black and Asian women. CONCLUSIONS: The previously seen positive relationship between breast cancer mortality and education was found among US women of color but not non-Hispanic White women.
The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, Play and Active Recreation for Kids.
Authors: Sallis J F , McKenzie T L , Alcaraz J E , Kolody B , Faucette N , Hovell M F
Published: November 2008

OBJECTIVES: This study evaluated a health-related physical education program for fourth- and fifth-grade students designed to increase physical activity during physical education classes and outside of school. METHODS: Seven schools were assigned to three conditions in a quasi-experimental design. Health-related physical education was taught by physical education specialists or trained classroom teachers. Students from these classes were compared with those in control classes. Analyses were conducted on 955 students with complete data. RESULTS: Students spent more minutes per week being physically active in specialist-led (40 min) and teacher-led (33 min) physical education classes than in control classes (18 min; P < .001). After 2 years, girls in the specialist-led condition were superior to girls in the control condition on abdominal strength and endurance (P < .001) and cardiorespiratory endurance (P < .001). There were no effects on physical activity outside of school. CONCLUSIONS: A health-related physical education curriculum can provide students with substantially more physical activity during physical education classes. Improved physical education classes can potentially benefit 97% of elementary school students.
Universal radiographic screening for tuberculosis among inmates upon admission to jail.
Authors: Layton M C , Henning K J , Alexander T A , Gooding A L , Reid C , Heyman B M , Leung J , Gilmore D M , Frieden T R
Published: November 2008

OBJECTIVES: This study evaluated the efficacy of radiographic screening for tuberculosis in correctional facilities. METHODS: Inmates at an admission facility in New York, NY, were screened for tuberculosis by registry cross-match, symptom interviews, tuberculin testing, and chest radiography. RESULTS: Thirty-two cases of tuberculosis were detected among 4172 inmate admissions (767 cases per 100,000). Twenty-five inmates (78%) were previously diagnosed but incompletely treated; all were identified by registry cross-match. Seven inmates (22%) were newly diagnosed, of whom four (57%) were asymptomatic, had negative skin tests, and were detected only by their abnormal radiographs. CONCLUSIONS: Screening strategies that limit radiographic testing to inmates with either positive skin tests or symptoms may result in missed opportunities for diagnosing active tuberculosis.
Cigarette smoking attitudes and first use among third- through sixth-grade students: the Bogalusa Heart Study.
Authors: Greenlund K J , Johnson C C , Webber L S , Berenson G S
Published: November 2008

OBJECTIVES: This study examined cigarette smoking attitudes, peer and parental influence, and first use among children in southeastern Louisiana. METHODS: Data from 933 children in grades 3 through 6 in the Bogalusa Heart Study (1993 through 1994) were analyzed. RESULTS: Fifteen percent of the children had tried smoking. Of these, 40% first smoked with a family member, and 46% obtained their first cigarette from a family member or from home. Correlates of ever having smoked were race, sex, having a best friend or family member who smoked, and attitudes that smoking is disgusting and that nonsmokers get better grades. CONCLUSIONS: Prevention programs should begin early and focus on family and peer influences as well as attitudes.
The effect of vitamin A supplementation on the growth of preschool children in the Sudan.
Authors: Fawzi W W , Herrera M G , Willett W C , Nestel P , el Amin A , Mohamed K A
Published: November 2008

OBJECTIVES: This study assessed the effect of vitamin A supplementation at 6-month intervals on child growth. METHODS: Sudanese children (n = 28,740) 6 to 72 months of age were weighed and measured at baseline and at each of three follow-up visits. RESULTS: Periodic vitamin A supplementation had no effect on the rate of weight or height gain in the total population or on the incidence of wasting, stunting, or wasting and stunting among children who were normally nourished at baseline. CONCLUSIONS: Reducing poverty and improving access to adequate diets should remain the goals of programs designed to improve the nutritional status of malnourished populations.