bluuebunny/crossref_metadata_2025 huggingface dataset:
Potential health benefits of nutrition label changes.
Authors: Zarkin G A , Dean N , Mauskopf J A , Williams R
Published: November 2008

OBJECTIVES. The Nutrition Labeling and Education Act of 1990 mandates the Food and Drug Administration to promulgate changes in nutrition labeling regulations. This study investigates the potential health benefits associated with expected changes in food consumption resulting from the act. METHODS. This paper provides four estimates of the potential health benefits from the dietary changes expected to occur as a result of the 1990 act. The upper bound estimates begin with the premise that all consumers will adopt the daily reference values of total fat, saturated fat, and cholesterol. The lower bound estimate is based on consumers' responses to a shelf-labeling program sponsored by the Food and Drug Administration in the 1980s. A computer model developed by Dr. Warren Browner and his associates was used to estimate the health benefits from reduced nutrient intakes. RESULTS. Estimates of the number of discounted life-years gained nationwide for the first 20 years after the implementation of the act range from a high of 1.2 million to a low of 40,000. CONCLUSIONS. The results of the study highlight that relatively small changes in nutrient intakes may generate large public health benefits.
Race/ethnicity patterns in the homicide of children in Los Angeles, 1980 through 1989.
Authors: Sorenson S B , Richardson B A , Peterson J G
Published: November 2008

This study investigated age, sex, and race/ethnicity risk patterns for homicide based on 246 children (newborn to 14 years old) who were murdered in the city of Los Angeles 1980 through 1989. Rates of homicide are higher for newborn to 4-year-olds than for 5- to 14-year-olds. Boys and girls have similar rates of homicide at young ages; among 5- to 14-year-olds, however, boys have higher rates. Characteristics of the victim, suspect, and event were fairly consistent across victim race/ethnicity. Rates vary by the victim's race/ethnicity; paralleling patterns among adults, rates of homicide are lowest for non-Hispanic White, higher for Hispanic, and highest for Black children.
Bicycle helmet counseling by pediatricians: a random national survey.
Authors: Ruch-Ross H S , O'Connor K G
Published: November 2008

A random sample of 1201 pediatricians who are members of the American Academy of Pediatrics completed questionnaires regarding bicycle injury prevention counseling. Of the 871 pediatricians in the sample who provide health supervision, 80% reported that they discuss bicycle helmet use with their patients at least once before the patient reaches the age of 12 years. Provision of bicycle helmet counseling did not vary significantly by pediatricians' age, gender, or practice location. The most important predictor of provision of bicycle helmet counseling was professional experience with injured children, including having had a patient who experienced a serious injury or death due to a bicycle accident in the last year.
Occupational and environmental exposures reported to poison centers.
Authors: Litovitz T , Oderda G , White J D , Sheridan M J
Published: November 2008

This analysis of 25,368 occupational and 7,565 environmental exposure cases characterizes the occupational and environmental exposures reported to the American Association of Poison Control Centers Toxic Exposure Surveillance System. Compared with other poisonings, occupational and environmental exposures were predominantly inhalation exposures rather than ingestions, were more often subacute or chronic, and demonstrated greater morbidity, mortality, and increased use of health care resources. As regional poison centers evolve to fill a critical information void in the management and assessment of environmental and occupational exposures, the American Association of Poison Control Centers Toxic Exposure Surveillance System provides an important, untapped passive surveillance mechanism.
Continuing female predominance in depressive illness.
Authors: Leon A C , Klerman G L , Wickramaratne P
Published: November 2008

This paper examines gender differences in temporal trends for major depressive disorder in childhood, adolescence, and young adulthood. The study sample, a high-risk group from the National Institute of Mental Health Collaborative Study on the Psychobiology of Depression, includes 2000 first-degree relatives of probands with affective disorder. The age-specific incidence rates were analyzed to determine the effect of gender, age, period, and cohort on depression by age 35. Women had nearly a twofold increase in risk of major depressive disorder, with rates peaking between adolescence and early adulthood. Vulnerability to depression was highest in the 1960s and 1970s. The rate increase in recent decades has not corresponded to a reduction in the gender differences.
The prevalence of alcohol-related mortality in both sexes: variation between indicators, Stockholm, 1987.
Authors: Romelsjö A , Karlsson G , Henningsohn L , Jakobsson S W
Published: November 2008

OBJECTIVES. The purpose of this study was to analyze the prevalence rates of alcohol-related mortality--according to various indicators--in both sexes in Stockholm, Sweden. METHODS. A study of alcohol involvement at death was undertaken for all 668 deceased persons aged 15 through 54 years in 1987 in Stockholm. Death certificates, autopsy information, police records, and information about earlier conviction were analyzed. RESULTS. When different measures of estimation were compared, there were great differences in the prevalence rates of alcohol involvement. According to the death certificates, 9.2% of the males and 11.2% of the females had alcoholism, alcohol intoxication, pancreatitis or liver cirrhosis as underlying cause of death. When all accessible information was used, potential alcohol involvement was found in 57.5% of the male and in 32.2% of the female deaths. There was a marked association between earlier drunken driving and alcohol involvement. After reevaluation of the diagnoses with autopsy findings, the number of cases with cardiac enlargement and suspected cardiomyopathy increased from 10 to 62. CONCLUSION. The results point to the serious underdiagnosis of alcohol involvement in death certificates and the misclassification of important causes of death (i.e., liver cirrhosis and cardiac disease); they also call for increased efforts regarding prevention.
Preventing adolescent drug use: long-term results of a junior high program.
Authors: Ellickson P L , Bell R M , McGuigan K
Published: November 2008

OBJECTIVES. Although several studies have reported short-term gains for drug-use prevention programs targeted at young adolescents, few have assessed the long-term effects of such programs. Such information is essential for judging how long prevention benefits last. This paper reports results over a 6-year period for a multisite randomized trial that achieved reductions in drug use during the junior high school years. METHODS. The 11-lesson curriculum, which was tested in 30 schools in eight highly diverse West Coast communities, focused on helping 7th and 8th grade students develop the motivation and skills to resist drugs. Schools were randomly assigned to treatment and control conditions. About 4000 students were assessed in grade 7 and six times thereafter through grade 12. Program effects were adjusted for pretest covariates and school effects. RESULTS. Once the lessons stopped, the program's effects on drug use stopped. Effects on cognitive risk factors persisted for a longer time (many through grade 10), but were not sufficient to produce corresponding reductions in use. CONCLUSIONS. It is unlikely that early prevention gains can be maintained without additional prevention efforts during high school. Future research is needed to develop and test such efforts.
Congenital hypothyroidism screening and the cutoff for thyrotropin measurement: recommendations from The Netherlands.
Authors: Verkerk P H , Buitendijk S E , Verloove-Vanhorick S P
Published: November 2008

OBJECTIVES: There is little agreement as to the optimal cutoff point for thyrotropin testing in primary thyroxine screening programs for congenital hypothyroidism. Most programs in the United States use a cutoff point of 10% of the lowest thyroxine values, whereas in the Netherlands a cutoff point of 20% is used. Therefore, the results of the Dutch program may provide valuable information about the optimal cutoff point. METHODS. The frequency distribution of screening thyroxine values was studied in all cases of permanent primary congenital hypothyroidism (n = 481) detected in 1,601,603 screened children born during the period from January 1, 1981, to December 31, 1989, in the Netherlands. RESULTS. Programs using a 10% cutoff point would have missed 1.5% of cases. Above the 10% cutoff point, the marginal costs increase quite rapidly because of the escalating numbers of thyrotropin measurements necessary to detect one case of permanent primary congenital hypothyroidism: 20,000 in the range of 11% to 15% and 40,000 in the range of 16% to 20%. CONCLUSIONS. Based on these findings, a cutoff point of at least 10% is recommended.
A meta-analysis of adolescent smoking prevention programs.
Authors: Bruvold W H
Published: November 2008

OBJECTIVES. A large number of studies evaluating adolescent smoking prevention programs have been published. Systematic quantitative reviews of this literature are needed to learn what does and does not work. The present meta-analysis focuses on the efficacy of school-based programs. METHODS. Evaluations of 94 separate interventions were included in the meta-analysis. Studies were screened for methodological rigor and those with weaker methodology were segregated from those with more defensible methodology; major analyses focused on the latter. RESULTS. Behavioral effect sizes were found to be largest for interventions with a social reinforcement orientation, moderate for interventions with either a developmental or a social norms orientation, and small for interventions with the traditional rational orientation. Attitude effect sizes followed the same pattern, but knowledge effect sizes were similar across all four orientation categories. CONCLUSIONS. Because behavioral effect represents the fundamental objective of programs for prevention of adolescent tobacco use, the present results indicate that school-based programs should consider adopting interventions with a social reinforcement, social norms, or developmental orientation.
Two random repeat recall methods to assess alcohol use.
Authors: Midanik L T
Published: November 2008

Two random repeat recall methods were compared with a summary measure to assess alcohol use. Subjects (n = 142) were randomly assigned to one of two groups; they were called either on 14 random days during three 30-day waves and asked about drinking yesterday, or on 2 random days during each wave and asked about drinking in the past week. Follow-up telephone interviews obtained summary measures for each wave. Random repeat methods generally obtained higher estimates. However, the high dropout rate makes questionable the feasibility of using this approach with general population samples.
Active AIDS surveillance: hospital-based case finding in a metropolitan California county.
Authors: Elcock M , Simon T , Gilbert B P , Copello A G , Kelzer P J
Published: November 2008

OBJECTIVES. Health departments that use passive surveillance alone cannot be sure of the level of complete and accurate reporting of acquired immunodeficiency syndrome (AIDS) cases. We sought to develop a model of active AIDS case reporting using limited county resources. METHODS. A validation study of AIDS case reporting using discharge diagnosis codes was undertaken to assess underreporting. Hospital-specific protocols for active surveillance were developed. RESULTS. The validation study revealed that 24% of AIDS cases in all hospitals were not reported through passive surveillance in 1990. In the first 3 months of 1991, active surveillance identified nine unreported cases (69% of the total cases reported) in one hospital. These underreporting estimates far exceed the 15% national underreporting rate estimated by the Centers for Disease Control. CONCLUSIONS. A method of hospital-based case finding was developed and serves as the model for implementing an ongoing program of active surveillance needed to ensure complete, accurate, and timely reporting of diagnosed AIDS cases. Application of this model may be helpful in attempts to minimize underreporting.
Reporting efficiency during a measles outbreak in New York City, 1991.
Authors: Davis S F , Strebel P M , Atkinson W L , Markowitz L E , Sutter R W , Scanlon K S , Friedman S , Hadler S C
Published: November 2008

OBJECTIVES. During an epidemic of measles among preschool children in New York City, an investigation was conducted in 12 city hospitals to estimate reporting efficiency of measles to the New York City Department of Health. METHODS. Measles cases were identified by review of hospital emergency room and infection control logs and health department surveillance records. The Chandra Sekar Deming method was used (1) to estimate the total number of measles cases in persons less than 19 years old who presented to the 12 hospitals from January through March 1991 and (2) to estimate reporting efficiency. Information on mechanisms for reporting measles cases was collected from hospital infection control coordinators. RESULTS. The Chandra Sekar Deming method estimated that 1487 persons with measles presented to the 12 hospitals during the study period. The overall reporting efficiency was 45% (range = 19% to 83%). All 12 hospitals had passive surveillance for measles; 2 also had an active component. These 2 hospitals had the first and third highest measles reporting efficiencies. CONCLUSIONS. The reporting efficiency of measles cases by New York City hospitals to the health department was low, indicating that the magnitude of the outbreak was substantially greater than suggested by the number of reported cases.
Physical activity of public housing residents in Birmingham, Alabama.
Authors: Lewis C E , Raczynski J M , Heath G W , Levinson R , Cutter G R
Published: November 2008

OBJECTIVES. Because few data are available concerning physical activity among minority and low-income persons, we characterized physical activity patterns among public housing residents. METHODS. Two separate cross-sectional surveys were conducted 1 year apart of randomly selected residents of eight rental communities administered by the housing authority of Birmingham, Ala. Indigenous interviewers completed 687 interviews in survey 1 and 599 in survey 2. RESULTS. In both surveys, respondents were most frequently young adult African-American women, reflecting the predominance of women in these communities. Participants were generally poorly educated and either unemployed or working in service occupations. Thirty percent of the respondents in both surveys reported no participation in any of 13 physical activities in the previous year; approximately half reported activity levels equivalent to or less than walking 4 hours per week for 8 months of the year. Respondents who were younger and male were significantly more likely to have higher activity levels. CONCLUSIONS. A sedentary life-style is common among this low-income minority group, and, thus, interventions to promote exercise in these communities are needed.
Mortality differences between New York City municipal and voluntary hospitals, for selected conditions.
Authors: Shapiro M F , Park R E , Keesey J , Brook R H
Published: November 2008

To determine if mortality differences between municipal and voluntary hospitals in New York City persist after adjustment for computerized administrative data (age, sex, principal diagnosis, and secondary diagnosis), six conditions in those hospitals from 1984 through 1987 were studied. Unadjusted mortality was significantly higher in municipal hospitals for myocardial infarction, stroke, and head trauma, and lower for congestive heart failure and pneumonia. Adjustment using administrative data eliminated differences for myocardial infarction, congestive heart failure, and pneumonia, but not for stroke and head trauma. We conclude that adjustment using administrative data eliminates some but not all mortality differences between municipal and voluntary hospitals. Medical record review is needed to determine why these differences persist.
The prevalence of tympanostomy tubes in children in the United States, 1988.
Authors: Bright R A , Moore R M , Jeng L L , Sharkness C M , Hamburger S E , Hamilton P M
Published: November 2008

Information from the 1988 National Health Interview Survey Medical Device Implant Supplement was used to obtain the first population estimates of the prevalence of implanted tympanostomy tubes, a common treatment for otitis media. The prevalence rate was estimated to be 13 per 1000 children aged younger than 18 years. Statistically significant differences in prevalence were found for sex (boys, 15/1000; girls, 10/1000), race (Whites, 15/1000; others, 4/1000), and activity level ("limited," 44/1000; others, 11/1000). Thirty percent of the tubes were replacements; infection was the reason for 75% of the original implants. The morbidity and costs associated with tympanostomy tubes are of public health importance.
The prevalence of internal orthopedic fixation devices in children in the United States, 1988.
Authors: Moore R M , Bright R A , Jeng L L , Sharkness C M , Hamburger S E , Hamilton P M
Published: November 2008

This study provides the first estimated prevalence of implanted orthopedic fixation devices (e.g., pins or wires) among children in the United States, based on the Medical Device Implant Supplement to the 1988 National Health Interview Survey. The overall prevalence was 27 per 10,000 children younger than 18 years; prevalence was highest (59/10,000) among those aged 12 to 17 years. The lower extremities were the most frequent body site (43%) and injury was the leading specific reason for implantation (37%). Some (10%) were replacement implants.
Home-delivered meals programs for the elderly: distribution of services in New York State.
Authors: Ellis L , Roe D A
Published: November 2008

This study examined the ability of six countywide home-delivered meals programs in upstate New York to meet the challenge of serving the elderly in geographically isolated and impoverished regions. The six counties were divided geographically into county subdivisions. For each subdivision, program client levels were analyzed in relation to two subdivision-level census statistics: poverty rates and population densities for community-residing individuals aged 65 years and older. Client levels were positively correlated with population densities but not with poverty rates. These findings suggest that service delivery was concentrated in densely populated regions. In contrast, impoverished and sparsely populated regions received minimal services.
Public health initiatives in South Africa in the 1940s and 1950s: lessons for a post-apartheid era.
Authors: Yach D , Tollman S M
Published: November 2008

Inspiration drawn from South African public health initiatives in the 1940s played an important role in the development of the network of community and migrant health centers in the United States. The first such center at Pholela in Natal emphasized the need for a comprehensive (preventive and curative) service that based its practices on empirical data derived from epidemiological and anthropological research. In addition, community consultation preceded the introduction of new service or research initiatives. The Institute of Family and Community Health in Durban pioneered community-based multidisciplinary training and developed Pholela and other sites as centers for service, teaching, and research. Several important lessons for South African health professionals emerge from the Pholela experience. First, public health models of the past need to be reintroduced locally; second, the training of public health professionals needs to be upgraded and reoriented; third, appropriate research programs need to respond to community needs and address service demands; fourth, community involvement strategies need to be implemented early on; and fifth, funding sources for innovation in health service provision should be sought.
Race, ethnicity, and access to ambulatory care among US adolescents.
Authors: Lieu T A , Newacheck P W , McManus M A
Published: November 2008

OBJECTIVES. Improving the health of minority adolescents will require a better understanding of factors that influence their access to and use of health care. This study describes the differences in health care access and use among White, Black and Hispanic adolescents and evaluates how such differences are influenced by insurance. METHODS. We used data on 7465 10- to 17-year-olds included in the child health supplement to the 1988 National Health Interview Survey. RESULTS. Much higher proportions of Blacks (16%) and Hispanics (28%) than of Whites (11%) were uninsured. Despite having worse reported health status, Black and Hispanic adolescents made notably fewer doctor visits in the past year than their White peers, and were more apt to lack usual sources of routine and acute care as well as continuity between sources of care. Having health insurance was associated with greater increase in access and usage measures for minority youth than for White youth. However, racial differences persisted even after adjusting for health insurance, family income, need, and other factors. CONCLUSIONS. Minority adolescents are particularly vulnerable to the problems of health care access that affect all youth. While health insurance is especially important for increasing appropriate health care use among minority youth, nonfinancial methods of enabling more equitable use also deserve further study.
Mortality in a public and a private hospital compared: the severity of antecedent disorders in Medicare patients.
Authors: Burns R , Nichols L O , Graney M J , Applegate W B
Published: November 2008

OBJECTIVES. The objectives of this study were to determine (1) if there were significant differences between patients who died at a public hospital and those who died at a university hospital that functions as a private, community hospital, and (2) if those differences were associated with an increased risk of death. METHODS. Chart review collected variables used by the Health Care Financing Administration in mortality analyses to examine how severity of illness data contribute to accurate predictions of death in a public hospital compared with a university hospital. RESULTS. Compared with patients who died at the university hospital, public hospital patients who died had more comorbid disease, were more severely ill, more likely to be emergently admitted, and more likely to be admitted from an extended-care facility. Inclusion of severity of illness with variables previously used to predict mortality significantly improved the accuracy of mortality prediction models for the public hospital but not for the university hospital. CONCLUSIONS. The results suggest that urban public hospitals provide care to more severely ill patients. Administrative data sets may not be adequate to identify these differences between patient populations.
Nutrition and health risks in the elderly: the nutrition screening initiative.
Authors: Posner B M , Jette A M , Smith K W , Miller D R
Published: November 2008

OBJECTIVES. The Nutrition Screening Initiative is a national collaborative effort committed to the identification and treatment of nutritional problems in older persons. METHODS. A 14-item checklist of characteristics associated with nutritional status was administered to a random sample of Medicare beneficiaries, aged 70 years and older, in New England. Regression analysis was used to derive item weights that would predict poor nutrient intakes and low perceived health status. Sensitivity and specificity values were reviewed to define low, moderate, and high nutritional risk scores. RESULTS. A revised checklist containing 10 yes/no items was adopted. Scores of 6 or more points defined persons at high nutritional risk. Twenty-four percent of the Medicare population was estimated to be at high nutritional risk according to the checklist. Among those in the high-risk group, 56% perceived their health to be "fair" or "poor" and 38% had dietary intakes below 75% of the recommended dietary allowances for three or more nutrients. CONCLUSIONS. The Nutrition Screening Initiative Checklist is a brief, easily scored instrument that can accurately identify noninstitutionalized older persons at risk for low nutrient intake and health problems.
Health promotion counseling of chronic-disease patients during primary care visits.
Authors: Russell N K , Roter D L
Published: November 2008

OBJECTIVES. This study was designed to provide an empirical description, based on a review of visit audiotapes, of primary care practice with chronic-disease patients. METHODS. We analyzed 439 interactions between adult patients with chronic disease and 49 physicians. We explored the content, frequency, intensity, and dynamics of health promotion discussion during these routine visits. RESULTS. There was evidence of health promotion discussion in more than half (53%) of the audiotapes reviewed. When life-style topics were discussed, the discussion lasted a mean of 4 1/2 minutes, or 20% of the length of the visit. Diet/weight control was the most frequently discussed topic, followed by exercise, stress, smoking, and alcohol. Stress was by far the most time-consuming topic; stress-related discussion took an average of 6 minutes. CONCLUSIONS. Nearly 60% of the discussion that took place were not merely perfunctory but were attempts to counsel or encourage behavior change in the patient. Physicians used a wide range of behavioral counseling strategies, including providing a rationale for the recommended change and specific instructions to facilitate change. Other strategies noted as "effective" in the literature, however, were used infrequently and indicate obvious areas of weakness in physician performance.
Forecasting the number of diabetic patients in The Netherlands in 2005.
Authors: Ruwaard D , Hoogenveen R T , Verkleij H , Kromhout D , Casparie A F , van der Veen E A
Published: November 2008

OBJECTIVES. There is evidence from past decades that the number of diabetic patients has increased independently of changes in demography. A static model that takes into account only demographic changes is therefore unable to forecast the expected number of diabetic patients correctly. METHODS. We developed a dynamic model in which actual incidence, prevalence, and life expectancy data are used and alternative assumptions about future trends in these parameters can be incorporated. RESULTS. This dynamic model forecasts higher numbers of diabetic patients than the less sophisticated static model. According to the dynamic model, a 46% increase in the number of diabetic patients in The Netherlands can be expected, from 244,000 in 1990 to 355,000 in 2005 (about 2.5% annually). The static model forecasts a 22% increase. CONCLUSIONS. Diabetes mellitus will become a more serious public health problem than can be expected from demographic changes only. In planning future health care, monitoring of trends in incidence, prevalence, remission, and mortality or life expectancy is a necessary prerequisite.
Pregnancy-related weight gain and retention: implications of the 1990 Institute of Medicine guidelines.
Authors: Keppel K G , Taffel S M
Published: November 2008

OBJECTIVES. Guidelines from the Institute of Medicine's 1990 report call for weight gains during pregnancy that are higher than those previously recommended. This study examines the potential implications of compliance with these guidelines for postpartum weight retention. METHODS. Weight retention 10 to 18 months following delivery was examined for selected women who had live births in the 1988 National Maternal and Infant Health Survey. Women's actual weight gains during pregnancy were retrospectively classified according to the Institute of Medicine's guidelines. RESULTS. Weight retention following delivery increased as weight gain increased, and Black women retained more weight than White women with comparable weight gain. The median retained weight for White women who gained the amount now being recommended was 1.6 lb whereas that for Black women was 7.2 lb. CONCLUSIONS. If pregnant White women gain weight according to the institute's guidelines, they need not be concerned about retaining a substantial amount of weight postpartum. Our findings suggest, however, that Black women are in need of advice about how to lose weight following delivery.
Variation in cesarean section rates among hospitals in Washington State.
Authors: McKenzie L , Stephenson P A
Published: November 2008

OBJECTIVES. This study examined hospital characteristics and hospital population risk factors and their associations with hospital-specific cesarean section rates in Washington State. METHODS. Data were obtained from 1987 birth certificates. The study population included all hospitals that had 12 or more singleton live births. RESULTS. Hospital-specific cesarean section rates varied from 0% to 43% and were positively associated with proprietary ownership, size of delivery service, and the proportions of women who had complications or high-birthweight infants. The proportion of women who had late prenatal care was inversely associated with cesarean section rates. Although proprietary hospitals had higher cesarean section rates, their patient populations were lower risk than patients of public or teaching hospitals. CONCLUSIONS. Variation in cesarean section rates among hospitals cannot be fully explained by either hospital or patient population characteristics. A combined strategy may be necessary to lower unjustifiably high cesarean section rates.
Smoking and pregnancy outcome: trends among black teenage mothers in Missouri.
Authors: Land G H , Stockbauer J W
Published: November 2008

OBJECTIVES. The purpose of this study is to analyze the smoking changes that have occurred among pregnant Black teenagers in Missouri. The study also examines changes in Black teenage pregnancy outcomes in relation to smoking behavior changes. METHODS. This analysis used computerized data files from the 1978 to 1990 Missouri birth certificates to acquire information on smoking during pregnancy for 41,544 Black teenagers and 105,170 White teenagers. All Missouri births with smoking history were included in the study. RESULTS. During the study period, the rate for Blacks who smoked during pregnancy decreased from 37% in 1978 to less than 22% in 1990. A large part of this reduction is attributable to Black teenagers, whose smoking-during-pregnancy rate declined from 35.8% to 7.2%. Additionally, the Black teenage-specific low-birthweight rate decreased by 13.6% over the study period, possibly influenced by the decrease in smoking. CONCLUSIONS. The results indicate that a major norm has changed in smoking status among pregnant Black teenagers. Understanding the reasons behind this change could assist smoking cessation and other health promotion efforts.
HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack.
Authors: Booth R E , Watters J K , Chitwood D D
Published: November 2008

OBJECTIVES. This study was designed to assess and compare sex risk behaviors for human immunodeficiency virus (HIV) transmission of three drug user groups: injectors who do not smoke crack, crack smokers who do not inject, and injectors who also smoke crack. METHODS. Sexual risk behaviors for HIV were assessed among 246 drug users from Denver, Miami, and San Francisco. Respondents were classified into the three drug groups based on self-report and verified through urinalysis and physical inspection. RESULTS. An increased risk for HIV through sexual transmission was associated with crack cocaine use, particularly among those who also injected. Crack smoking injectors were more likely to report sex with an injector, exchanging sex for drugs and/or money, drug use before or during sex, and unprotected sexual intercourse. They also injected more than injectors only, smoked crack as often as smokers only, and reported higher overall frequencies of drug use. CONCLUSIONS. These findings, together with the higher rates of gonorrhea and syphilis reported by smokers and injectors/smokers, are indicators of the risk crack poses for the heterosexual transmission of HIV.
Frequent cocaine users and their use of treatment.
Authors: Gfroerer J C , Brodsky M D
Published: November 2008

OBJECTIVES. Despite decreases in the number of cocaine users since 1985, the consequences of cocaine use continue to rise. This paper provides descriptive data on frequent cocaine users that will help to explain these diverging trends and enable treatment planners to better predict the types of cocaine users who are likely to seek treatment. METHODS. Data from the National Household Survey on Drug Abuse were used to study the characteristics of frequent cocaine users since 1985. The 1991 data were used to compare frequent users with infrequent users and nonusers. RESULTS. Since 1985, frequent cocaine users have become older. In 1991, they were likely to be unemployed (32.4%), unmarried (82.3%), and without health insurance (39.4%). Most were cigarette smokers (86.8%) and marijuana users (88.4%), and 32.0% reported getting drunk weekly. Criminal behavior was more likely among frequent cocaine users than among frequent cocaine users than among infrequent users and nonusers. Almost a third (30.0%) reported drug abuse treatment experience in the past year. CONCLUSIONS. Despite the recent decreases in overall prevalence of cocaine use, the need for treatment of cocaine abusers will continue. Treatment must address multiple problems that occur in conjunction with cocaine abuse.
Lead content in 70 brands of dietary calcium supplements.
Authors: Bourgoin B P , Evans D R , Cornett J R , Lingard S M , Quattrone A J
Published: November 2008

OBJECTIVES. Elevated lead levels in calcium supplements may pose a health risk, particularly to children with milk intolerance who rely on these products to meet their calcium requirement. Earlier reports chiefly focused on the lead content in supplements derived from bonemeal and dolomite. This study undertook to determine the lead levels in the major forms of calcium supplements currently available. METHODS. The lead content was measured in 70 brands of calcium supplements grouped in the following five categories: dolomite, bonemeal, refined and natural source calcium carbonate, and calcium chelates. RESULTS. The lead levels measured in the supplements ranged from 0.03 microgram/g to 8.83 micrograms/g. Daily lead ingestion rates revealed that about 25% of the products exceeded the US Food and Drug Administration's "provisional" total tolerable daily intake of lead for children aged 6 years and under. Less than 20% of the supplements had "normalized" lead levels comparable to or lower than that reported for cow's milk. CONCLUSIONS. Children are the most sensitive to the low-level effects of lead. If calcium supplements are to provide an alternate source of calcium to some of these individuals, they should also deliver concomitant lead dosages no greater than those obtained from milk products themselves.
Black leaders' perceptions of the year 2000 public health goals for black Americans.
Authors: Schneider D , Greenberg M R , Choi D
Published: November 2008

We surveyed 1196 Black health and political leaders on their perceptions about the US Department of Health and Human Services' Healthy People 2000 public health goals. Respondents identified reducing the incidence of acquired immunodeficiency syndrome, improving maternal and infant health, and controlling sexually transmitted diseases as the three most important public health goals for Black Americans that are amenable to intervention. The leaders assigned nearly all responsibility for prevention efforts to the federal government and the individual. With the American health care system now in flux, Black leaders need to organize to see that these priority issues are addressed.
Error in smoking measures: effects of intervention on relations of cotinine and carbon monoxide to self-reported smoking. The Lung Health Study Research Group.
Authors: Murray R P , Connett J E , Lauger G G , Voelker H T
Published: November 2008

OBJECTIVES. Sources of measurement error in assessing smoking status are examined. METHODS. The Lung Health Study, a randomized trial in 10 clinical centers, includes 3923 participants in a smoking cessation program and 1964 usual care participants. Smoking at first annual follow-up was assessed by salivary cotinine, expired air carbon monoxide, and self-report. Each of these measures is known to contain some error. Sensitivity and specificity were calculated by comparing a biochemical measure with self-report to produce an undifferentiated estimate of error. Classification error rates due to imprecision of the biochemical measures and to the error in self-report were estimated separately. RESULTS. For cotinine compared with self-report, the sensitivity was 99.0% and the specificity 91.5%. For carbon monoxide compared with self-report, the sensitivity was 93.7% and the specificity 87.2%. The classification error attributed to self-report, estimated by comparing the results from intervention and control groups, was associated with the responses of 3% and 5% of participants, indicating a small but significant bias toward a socially desirable response. CONCLUSIONS. In absolute terms in these data, both types of error were small.
Cigarette smoking and bone mineral density in older men and women.
Authors: Hollenbach K A , Barrett-Connor E , Edelstein S L , Holbrook T
Published: November 2008

OBJECTIVES. The association between cigarette smoking and bone mineral density was examined prospectively in a population-based study of older Caucasian men and women. METHODS. Smoking patterns were determined at a 1972-1974 baseline evaluation and, again, 16 years later when 544 men and 822 women had bone mineral density measurements taken. RESULTS. Men and women who were cigarette smokers at baseline demonstrated significantly reduced bone mineral density of the hip compared with nonsmokers. Baseline smoking was not associated with significantly lower bone density at non-hip sites. Women demonstrated a significant dose-response relationship between baseline smoking status at all hip sites measured. Both sexes exhibited significant dose-response relationships between hip bone mineral density and change in smoking status between baseline and follow-up, demonstrating that smoking cessation in later life was beneficial in halting bone density loss associated with smoking. CONCLUSIONS. Smoking was positively and significantly associated with decreased hip bone mineral density in old age. Bone loss associated with smoking would be expected to predict an increased risk of hip fracture in those who do not succumb earlier to another complication of tobacco use.
Smoking, alcohol consumption, and susceptibility to the common cold.
Authors: Cohen S , Tyrrell D A , Russell M A , Jarvis M J , Smith A P
Published: November 2008

OBJECTIVES. This study was conducted to test the supposition that both smoking and consuming alcohol suppress host resistance to viral infections. METHODS. The relations between smoking, alcohol consumption, and the incidence of documented clinical colds were prospectively studied among 391 subjects intentionally exposed to one of five respiratory viruses and 26 subjects given saline. Clinical colds were defined as clinical symptoms verified by the isolation of virus or by an increase in virus-specific antibody titer. Analyses included control variables for demographics; body weight; virus; and environmental, immunological and psychological factors. RESULTS. Smokers were at greater risk for developing colds than nonsmokers because smokers were more likely both to develop infections and to develop illness following infection. Greater numbers of alcoholic drinks (up to three or four per day) were associated with decreased risk for developing colds because drinking was associated with decreased illness following infection. However, the benefits of drinking occurred only among nonsmokers. CONCLUSIONS. Susceptibility to colds was increased by smoking. Although alcohol consumption did not influence risk of clinical illness for smokers, moderate alcohol consumption was associated with decreased risk for nonsmokers.
Health insurance and subjective health status: data from the 1987 National Medical Expenditure survey.
Authors: Franks P , Clancy C M , Gold M R , Nutting P A
Published: November 2008

OBJECTIVES. The relationship between health insurance and subjective health status was investigated. It was hypothesized that persons without health insurance would have lower levels of subjective health status than those with health insurance and that this relationship would hold for both poor and nonpoor persons. METHODS. Data from the 1987 National Medical Expenditure Survey were analyzed to examine the relationship between health insurance and self-reported health status. The analysis controlled for sociodemographic and attitudinal variables and medical conditions. RESULTS. Persons without health insurance had significantly lower levels of subjective health status than did persons with insurance. This adverse effect persisted after adjustments were made for the effects of age, sex, race, income, attitude toward the value of medical care and health insurance, and medical conditions. The detrimental effect of lacking health insurance on subjective health status was present for persons at all income levels and was greater than the effect on subjective health status found for 2 of the 11 reported medical conditions. CONCLUSIONS. Lacking health insurance is associated with clinically significant lower levels of subjective health status in both poor and non-poor persons.
The dependence potential of short half-life benzodiazepines: a meta-analysis.
Authors: Hallfors D D , Saxe L
Published: November 2008

OBJECTIVES. The dependence potential of benzodiazepine medications is now widely recognized, but uncertainty exists as to whether use of short half-life vs long half-life drugs results in greater dependence. The present study reports a meta-analysis of the extant research to evaluate the dependence potential of different types of benzodiazepines. METHOD. Seven studies were found that specifically compared long half-life and short half-life benzodiazepines and allowed statistical comparison by their homogeneous dependent variables. Drugs in these studies were used as daytime sedatives. RESULTS. Substantial evidence was found for differential effects of short vs long half-life drugs at withdrawal. In all studies, dropouts were higher among short half-life subjects. In the random-assignment short-term use studies, Hamilton Anxiety Scale scores showed higher incidence of rebound among subjects who used the short half-life drugs. CONCLUSIONS. The present meta-analysis confirms clinical impressions of the greater dependence potential of short vs long half-life benzodiazepines. Doctors, patients, and policymakers need to be informed so as to avoid harm to the public health through unintended drug dependence.
Child care arrangements and repeated ear infections in young children.
Authors: Hardy A M , Fowler M G
Published: November 2008

OBJECTIVES. The purpose of this study was to assess the association between child care arrangements and repeated ear infections in young children. METHODS. Data on 5818 children younger than 6 years of age were taken from the 1988 National Health Interview Survey of Child Health. RESULTS. Seventeen percent of the children had had repeated ear infections in the year preceding the interview. Multiple logistic regression analysis showed that factors significantly associated with repeated ear infections were age (1 to 2 years), race (White), sex (male), and medical history (repeated tonsillitis, enlarged adenoids, or asthma). When these factors were controlled for, children in a current child care arrangement still had a 50% higher chance of repeated ear infections than did children not in care. Children in day care centers were at higher risk than children cared for in homes. Care in settings with more than six children elevated the risk, but hours per week of care did not. CONCLUSIONS. Decreasing the risk of repeated ear infections in young children in out-of-home child care settings may require smaller group sizes. Given the increasing use of child care, research should continue to identify specific aspects of child care that contribute to this problem.
Environmental tobacco smoke concentrations in no-smoking and smoking sections of restaurants.
Authors: Lambert W E , Samet J M , Spengler J D
Published: November 2008

To characterize the effectiveness of a local ordinance that restricts smoking in restaurants to one third of the seating area, this study made simultaneous measurements of two markers of environmental tobacco smoke, respirable suspended particles and nicotine, in the smoking and no-smoking sections of seven restaurants. The mean concentrations of respirable suspended particles and nicotine were 40% and 65% lower, respectively, in the no-smoking than in the smoking sections, indicating substantial but not complete protection against exposure.
An evaluation of the workplace smoking bylaw in the city of Toronto.
Authors: Pederson L L , Bull S B , Ashley M J , Garcia J M , Lefcoe N M
Published: November 2008

Random-digit dialing surveys were conducted before (n = 1543) and 8 to 9 months after (n = 1430) implementation of the city of Toronto workplace smoking bylaw. Compared with workers in the rest of metropolitan Toronto and persons not working outside the home, city workers evidenced more positive changes in regard to knowledge of the bylaw, its requirements, and enforcement provisions. City workers reported more changes in workplace restrictions and satisfaction with such restrictions. Patterns of smoking at work changed.
The use of mammography vans by low-income women: the accuracy of self-reports.
Authors: Etzi S , Lane D S , Grimson R
Published: November 2008

The objective of this study was to determine the accuracy of self-reports of mammography use by low-income income women. Mammography van records were used to verify self-reports of mammography use in the past year by women aged 50 through 75 years who had visited five community health centers (n = 237). Van records verified mammography use for 99% of these women (82% within the previous year and 98% within the past 2 years). Forty percent of those with van records who reported both the month and year of the mammogram were accurate. Inaccurately reported dates were more frequently after (74%) rather than before (26%) the actual date. These findings indicate that self-reports of mammography use by low-income women are generally reliable.
Who participates in cardiovascular disease risk factor screenings? Experience with a religious organization-based program.
Authors: Wells B L , Brown C C , Horm J W , Carleton R A , Lasater T M
Published: November 2008

Adult members who declined participation in cardiovascular disease risk factor screenings offered at religious organizations were randomly selected and asked to participate in screenings at their homes. Relationships between screening participation and sociodemographic, behavioral, and physiological measures were examined. Age, knowledge of cardiovascular disease risk factors, body mass index, current smoking status, previous report of elevated blood pressure, current diastolic blood pressure measurement, frequency of worship service attendance, and residential distance from the religious organization screening site were important predictors of screening response. Those with conspicuous risk factors appeared less likely to initially respond to religious organization site screening invitations.