bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Service Access, Use, and Insurance Coverage Among American Indians/Alaska Natives and Whites: What Role Does the Indian Health Service Play?
Authors: Zuckerman Stephen , Haley Jennifer , Roubideaux Yvette , Lillie-Blanton Marsha
Published: December 2008

Objectives. We compared access and utilization of health services among American Indians/Alaska Natives (AIANs) with that among non-Hispanic Whites.

Methods. We used data from the 1997 and 1999 National Survey of America’s Families to estimate odds ratios for several measures of access and utilization and the effects of Indian Health Service (IHS) coverage.

Results. AIANs had less insurance coverage and worse access and utilization than Whites. Over half of low-income uninsured AIANs did not have access to the IHS. However, among the low-income population, AIANs with only IHS access fared better than uninsured AIANs and as well as insured Whites for key measures but received less preventive care.

Conclusions. The IHS partially offsets lack of insurance for some uninsured AIANs, but important needs were potentially unmet.
Prevalence and Correlates of Mental Disorders Among Native American Women in Primary Care
Authors: Duran Bonnie , Sanders Margaret , Skipper Betty , Waitzkin Howard , Malcoe Lorraine Halinka , Paine Susan , Yager Joel
Published: December 2008

Objectives. We examined the lifetime and the past-year prevalence and correlates of common mental disorders among American Indian and Alaska Native women who presented for primary care.

Methods. We screened 489 consecutively presenting female primary care patients aged 18 through 45 years with the General Health Questionnaire, 12-item version. A subsample (n = 234) completed the Composite International Diagnostic Interview. We examined associations between psychiatric disorders and sociodemographic variables, boarding school attendance, and psychopathology in the family of origin.

Results. The study participants had high rates of alcohol use disorders, anxiety disorders, and anxiety/depression comorbidity compared with other samples of non–American Indian/Alaska Native women in primary care settings.

Conclusions. There is a need for culturally appropriate mental health treatments and preventive services.
Unemployment and Mental Health: Understanding the Interactions Among Gender, Family Roles, and Social Class
Authors: Artazcoz Lucía , Benach Joan , Borrell Carme , Cortès Immaculada
Published: December 2008

Objectives. We examined gender differences in the effects of unemployment on mental health and assessed whether such effects are associated with interactions among gender, family roles, and social class.

Methods. Our analysis included 3881 employed and 638 unemployed workers, aged 25 to 64 years, interviewed in the 1994 Catalonian Health Survey.

Results. Unemployment had more of an effect on the mental health of men (age-adjusted odds ratio [OR] = 2.98; 95% confidence interval [CI] = 2.30, 3.87) than on that of women (age-adjusted OR = 1.51; 95% CI = 1.11, 2.06). Gender differences in effects were related to family responsibilities and social class.

Conclusions. Understanding the effects of unemployment on mental health requires consideration of the interactions among gender, family responsibilities, and social class.
The Pitfalls of Bioterrorism Preparedness: the Anthrax and Smallpox Experiences
Authors: Cohen Hillel W. , Gould Robert M. , Sidel Victor W.
Published: December 2008

Bioterrorism preparedness programs have contributed to death, illness, and waste of public health resources without evidence of benefit. Several deaths and many serious illnesses have resulted from the smallpox vaccination program; yet there is no clear evidence that a threat of smallpox exposure ever existed. The anthrax spores released in 2001 have been linked to secret US military laboratories—the resultant illnesses and deaths might not have occurred if those laboratories were not in operation.

The present expansion of bioterrorism preparedness programs will continue to squander health resources, increase the dangers of accidental or purposeful release of dangerous pathogens, and further undermine efforts to enforce international treaties to ban biological and chemical weapons. The public health community should acknowledge the substantial harm that bioterrorism preparedness has already caused and develop mechanisms to increase our public health resources and to allocate them to address the world’s real health needs.
The Importance of Place of Residence: Examining Health in Rural and Nonrural Areas
Authors: Eberhardt Mark S. , Pamuk Elsie R.
Published: December 2008

We examined differences in health measures among rural, suburban, and urban residents and factors that contribute to these differences.

Whereas differences between rural and urban residents were observed for some health measures, a consistent rural-to-urban gradient was not always found. Often, the most rural and the most urban areas were found to be disadvantaged compared with suburban areas.

If health disparities are to be successfully addressed, the relationship between place of residence and health must be understood.
Provision of Health Care in Rural Afghanistan: Needs and Challenges
Authors: Reilley Brigg , Frank Thorsten , Prochnow Thomas , Puertas Gloria , van der Meer Joost
Published: December 2008

Afghanistan’s health system is severely limited in terms of preventive and curative services, referral systems, and human resources. Most of the country’s citizens reside in rural areas, a majority of which are served by “basic health units” (small and simple facilities that provide primary care), and these rural residents face additional challenges regarding timely access to quality health care.

The analysis described in this article, which focuses on data derived from 2 rural health units during a 1-year period, revealed that infectious diseases, mainly acute respiratory infections, were a primary concern and that there is a clear need for increasing access to health services. In addition, our results showed that women are underrepresented as patients and appear to be at higher risk than men of tuberculosis.
Acute Traumatic Injuries in Rural Populations
Authors: Peek-Asa Corinne , Zwerling Craig , Stallones Lorann
Published: December 2008

In the United States, injuries are the leading cause of death among individuals aged 1 to 45 years and the fourth leading cause of death overall. Rural populations exhibit disproportionately high injury mortality rates. Deaths resulting from motor vehicle crashes, traumatic occupational injuries, drowning, residential fires, and suicide all increase with increasing rurality.

We describe differences in rates and patterns of injury among rural and urban populations and discuss factors that contribute to these differences.
Addressing Externalities From Swine Production to Reduce Public Health and Environmental Impacts
Authors: Osterberg David , Wallinga David
Published: December 2008

Animal agriculture in the United States for the most part has industrialized, with negative consequences for air and water quality and antibiotic use. We consider health and environmental impacts of current US swine production and give an overview of current federal, state, and local strategies being used to address them.
Rurality and Nursing Home Quality: Results from a National Sample of Nursing Home Admissions
Authors: Phillips Charles D. , Holan Scott , Sherman Michael , Williams Malgorzata Leyk , Hawes Catherine
Published: December 2008

Objectives. We examined differences in quality of care among nursing homes in locales of varying degrees of rurality.

Methods. We classified locales into 4 classes according to rurality. We analyzed a 10% sample of nursing home admissions in the United States in 2000 (n=198613) to estimate survival models for 9 quality indicators.

Results. For postacute admissions, we observed significant differences in rates of decline for residents in facilities in large towns compared with urban areas, but differences in quality were both negative and positive. Among admissions for long-term or chronic care, rates of decline in 2 of 9 quality areas were lower for residents in isolated areas.

Conclusions. We observed significant differences in a number of quality indicators among different classes of nursing home locations, but differences varied dramatically according to type of admission. These differences did not exhibit the monotonicity that we would have expected had they derived solely from rurality. Also, quality indicators exhibited more similarities than differences across the 4 classes of locales. The results underscore the importance, in some instances, of emphasizing the effects of specific settings rather than some continuum of rurality and of moving beyond the assumption that nursing home residents constitute a homogeneous population.
Retention of Primary Care Physicians in Rural Health Professional Shortage Areas
Authors: Pathman Donald E. , Konrad Thomas R. , Dann Rebekkah , Koch Gary
Published: December 2008

Objectives. We tested the assumption that average job retention duration is shorter for physicians in rural health professional shortage areas (HPSAs) than for physicians in rural non-HPSAs.

Methods. In 1991, we surveyed nationally representative samples of primary care physicians who recently had moved to rural HPSAs and non-HPSAs who were without service obligations. We resurveyed these physicians in 1996 and 1997 to learn of any job changes.

Results. Physicians in rural HPSAs (n=308) demonstrated retention similar to that of the non-HPSA cohort (n=197) (hazard ratio for leaving=1.28; 95% confidence interval=0.97, 1.69; P=.08), even with adjustments for group demographic differences (P=.24).

Conclusions. Average retention duration for generalist physicians in rural HPSAs is identical to or slightly shorter than for those in rural non-HPSAs. Poor recruitment is likely to be the principal dynamic underlying local rural shortages.
Pounds Off With Empowerment (POWER): A Clinical Trial of Weight Management Strategies for Black and White Adults With Diabetes Who Live in Medically Underserved Rural Communities
Authors: Mayer-Davis Elizabeth J. , D'Antonio Angela M. , Smith Sharon M. , Kirkner Gregory , Levin Martin Sarah , Parra-Medina Deborah , Schultz Richard
Published: December 2008

Objectives. We evaluated lifestyle interventions for diabetic persons who live in rural communities.

Methods. We conducted a 12-month randomized clinical trial (n = 152) of “intensive-lifestyle” (modeled after the NIH Diabetes Prevention Program) and “reimbursable-lifestyle” (intensive-lifestyle intervention delivered in the time allotted for Medicare reimbursement for diabetes education related to nutrition and physical activity) interventions with usual care as a control.

Results. Modest weight loss occurred by 6 months among intensive-lifestyle participants and was greater than the weight loss among usual-care participants (2.6 kg vs 0.4 kg, P<.01). At 12 months, a greater proportion of intensive-lifestyle participants had lost 2 kg or more than usual-care participants (49% vs 25%, P<.05). No differences in weight change were observed between reimbursable-lifestyle and usual-care participants. Glycated hemoglobin was reduced among all groups (P<.05) but was not different between groups.

Conclusions. Improvement in both weight and glycemia was attainable by lifestyle interventions designed for persons who had type 2 diabetes and lived in rural communities.
Differences in Health-Related Quality of Life in Rural and Urban Veterans
Authors: Weeks William B. , Kazis Lewis E. , Shen Yujing , Cong Zhongxiao , Ren Xinhua S. , Miller Donald , Lee Austin , Perlin Jonathan B.
Published: December 2008

Objectives. We sought to determine whether disparities in health-related quality of life exist between veterans who live in rural settings and their suburban or urban counterparts.

Methods. We determined health-related quality-of-life scores (physical and mental health component summaries) for 767109 veterans who had used Veterans Health Administration services within the past 3 years. We used rural/urban commuting area codes to categorize veterans into rural, suburban, or urban residence.

Results. Health-related quality-of-life scores were significantly lower for veterans who lived in rural settings than for those who lived in suburban or urban settings. Rural veterans had significantly more physical health comorbidities, but fewer mental health comorbidities, than their suburban and urban counterparts. Rural–urban disparities persisted in all survey subscales, across regional delivery networks, and after we controlled for sociodemographic factors.

Conclusions. When compared with their urban and suburban counterparts, veterans who live in a rural setting have worse health-related quality-of-life scores. Policymakers, within and outside the Veterans Health Administration, should anticipate greater health care demands from rural populations.
Local Area Deprivation and Urban–Rural Differences in Anxiety and Depression Among People Older Than 75 Years in Britain
Authors: Walters Kate , Breeze Elizabeth , Wilkinson Paul , Price Gill M. , Bulpitt Chris J. , Fletcher Astrid
Published: December 2008

Objectives. We sought to determine the association of depression and anxiety with “area deprivation” (neighborhood socioeconomic deprivation) and population density among people older than 75 years in Britain.

Methods. Postal codes were used to link census area information to individual data on depression and anxiety in 13349 people aged 75 years and older taking part in a trial of health screening.

Results. Living in the most socioeconomically deprived areas was associated with depression (OR=1.4), but this relation disappeared after adjusting for individual deprivation characteristics. There was no association with anxiety. Living in the highest density and intermediate low-density areas was associated with depression (OR=1.6 and 1.5) and anxiety (OR=1.5 and 1.3) compared with the lowest density areas.

Conclusions. An association between area deprivation and depression in older people was explained by individual health, demographic, and socioeconomic factors. Higher population density was consistently associated with increased depression and anxiety.
Cost-Related Medication Underuse Among Chronically III Adults: the Treatments People Forgo, How Often, and Who Is at Risk
Authors: Piette John D. , Heisler Michele , Wagner Todd H.
Published: December 2008

Objectives. We sought information about the cost-related underuse of medications—which medications are underused, by whom, and how often.

Methods. Chronically ill adults were asked to identify how often they underused prescription medication for 16 health conditions because of the cost.

Results. Eighteen percent of respondents cut back on medication use owing to cost in the previous year, and 14% used less medication at least monthly. Although rates of underuse varied substantially across treatments, prescription coverage and out-of-pocket costs were determinants of underuse across medication types.

Conclusions. Many chronically ill adults frequently cut back on medications owing to cost. Patients are selective about the treatments they forgo. Out-of-pocket costs and inadequate prescription coverage may lead to adherence problems for many important medication types.
Uncertain Advances
Authors: Bhattacharya Sanjoy
Published: December 2008

In this article, I describe the complex nature of the final phases of the Indian smallpox eradication program. I examine the unfolding of policies at different levels of administration and the roles played by a wide range of national and international actors. A careful examination of unpublished official correspondence, on which this article is largely based, shows that the program’s managers were divided and that this division determined the timing of the achievement of eradication. This material also reveals that Indian health workers and bureaucrats were far more capable of reshaping policies in specific localities, often in response to local infrastructural and political concerns, than has been acknowledged in the historiography.
The Global Alliance for Vaccines and Immunization: Is It a New Model for Effective Public–Private Cooperation in International Public Health?
Authors: Muraskin William
Published: December 2008

The Global Alliance for Vaccines and Immunization (GAVI) has in many ways been remarkably successful in revitalizing the international coalition of institutions and organizations concerned with getting vaccines to the children of the poorest countries. Many have seen this high-profile venture in public–private cooperation as a model for other groups concerned with more effectively helping to solve health problems in the developing world. We examined major flaws in the GAVI and argue that in fact the alliance does not represent a new paradigm for international public health. However, the experience of the GAVI may suggest an alternative, and more effective, way to conceptualize future global initiatives.
Risk of Hospitalization Among Firefighters: The National Health Interview Survey, 1986–1994
Authors: Lee David J. , Fleming Lora E. , Gomez-Marín Orlando , LeBlanc William
Published: December 2008

This study assessed the risk of hospitalization among firefighters. Data were derived from a nationally representative sample of 235 897 employed men from the National Health Interview Survey. Firefighters aged 30 to 39 years were at significantly increased risk for hospitalization relative to other employed men in the same age group (odds ratio = 1.93; 95% confidence interval=1.21, 3.09). Findings from this study and others support the call for longitudinal studies to monitor the health of this high-risk occupational group.
Epidemiology of Hospitalizations Resulting From Dog Bites in California, 1991–1998
Authors: Feldman Katherine A. , Trent Roger , Jay Michele T.
Published: December 2008

We used population-based hospital discharge data to describe hospitalizations resulting from dog bites in California from 1991 through 1998, when there were 6676 such hospitalizations (average 835 per year; range 732 to 930), and the annual cumulative incidence for all ages was 2.6 per 100 000. Children had more than twice the risk of adults, and Asians had lower rates than Whites. Children aged 0 to 9 years were more likely to suffer wounds to the head and face.
Cigarette Smoking and Exposure to Environmental Tobacco Smoke in China: The International Collaborative Study of Cardiovascular Disease in Asia
Authors: Gu Dongfeng , Wu Xigui , Reynolds Kristi , Duan Xiufang , Xin Xue , Reynolds Robert F. , Whelton Paul K. , He Jiang
Published: December 2008

Objectives. We estimated the prevalence of cigarette smoking and the extent of environmental tobacco smoke exposure (ETS) in the general population in China.

Methods. A cross-sectional survey was conducted on a nationally representative sample of 15540 Chinese adults aged 35–74 years in 2000–2001. Information on cigarette smoking was obtained by trained interviewers using a standard questionnaire.

Results. The prevalence of current cigarette smoking was much higher among men (60.2%) than among women (6.9%). Among nonsmokers, 12.1% of men and 51.3% of women reported exposure to ETS at home, and 26.7% of men and 26.2% of women reported exposure to ETS in their workplaces. On the basis of our findings, 147358000 Chinese men and 15895000 Chinese women aged 35–74 years were current cigarette smokers, 8658000 men and 108402000 women were exposed to ETS at home, and 19072000 men and 55372000 women were exposed to ETS in their workplaces.

Conclusions. The high prevalence of cigarette smoking and environmental tobacco smoke exposure in the Chinese population indicates an urgent need for smoking prevention and cessation efforts.
Immigration and Acculturation in Relation to Health and Health-Related Risk Factors Among Specific Asian Subgroups in a Health Maintenance Organization
Authors: Gomez Scarlett L. , Kelsey Jennifer L. , Glaser Sally L. , Lee Marion M. , Sidney Stephen
Published: December 2008

Objectives. We sought to determine how risk factors for disease vary among Asian subgroups.

Methods. Using data from a case–control study conducted at Northern California Kaiser Medical Centers (from 1996 to 2001), we compared prevalence of selected risk factors among Asian subgroups and evaluated the associations of these risk factors with sociodemographic factors.

Results. Chinese and Japanese patients had a lower body mass index (kg/m2) than did other Asians. In all subgroups, being born in the United States was associated with having a body mass index greater than 25 kg/m2. Compared with other Asians, more Japanese and multiple-race Asians smoked, and more Filipino and multiple-race Asian smokers started smoking at 18 years or younger. Filipinos and multiple-race Asians also were more likely to report diabetes.

Conclusions. These data support the importance of efforts to distinguish among Asian subgroups in public health practice and research.
High-Risk Alcohol Consumption and Late-Life Alcohol Use Problems
Authors: Moos Rudolf H. , Brennan Penny L. , Schutte Kathleen K. , Moos Bernice S.
Published: December 2008

Objectives. We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems.

Methods. A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later.

Results. Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals.

Conclusion. Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.
State Trends in Uninsurance Among Individuals Aged 18 to 64 Years: United States, 1992–2001
Authors: Nelson David E. , Bolen Julie , Wells Henry E. , Smith Suzanne M. , Bland Shayne
Published: December 2008

Objectives. We analyzed state-specific uninsurance trends among US adults aged 18 to 64 years.

Methods. We used logistic regression models to examine Behavioral Risk Factor Surveillance System data for uninsurance from 1992 to 2001 in 47 states.

Results. Overall, uninsurance rates increased in 35 states and remained unchanged in 12 states. Increases were observed among people aged 30 to 49 years (in 34 states) and 50 to 64 years (in 24 states), and increases were also observed among individuals at middle and low income levels (in 39 states and 19 states, respectively), individuals employed for wages (in 33 states), and the self-employed (in 18 states).

Conclusions. Among adults aged 18–64, rates of uninsurance increased in most states from 1992 through 2001. Decreased availability of employer-sponsored health insurance, rising health care costs, and state fiscal crises are likely to worsen the growing uninsurance problem.
Effects on Alcohol Use and Anxiety of the September 11, 2001, Attacks and Chronic Work Stressors: A Longitudinal Cohort Study
Authors: Richman Judith A. , Wislar Joseph S. , Flaherty Joseph A. , Fendrich Michael , Rospenda Kathleen M.
Published: December 2008

Objectives. We hypothesized that chronic stressors associated with an everyday social role (work) would interact with a traumatic macrosocial stressor (the terrorist attacks of September 11, 2001) in predicting mental health status (during the fall of 2001).

Methods. We used mail surveys returned as part of wave 3 of a workplace cohort study, both before and after September 11, 2001, to assess decision latitude, sexual harassment, generalized workplace abuse, psychological distress, and alcohol use. We also used regression analyses to assess the main effect of September 11 and interactions between September 11 and stressors, after control for baseline mental health.

Results. The main effect of September 11 on elevated alcohol use was significant for women but not for men. For women, work stressors significantly interacted with experiencing the events of September 11 to affect alcohol use and anxiety outcomes.

Conclusions. Women experiencing chronic work stressors were most vulnerable to elevated psychological distress and alcohol use after September 11, 2001.
Accounting for Apparent “Reverse” Racial Disparities in Department of Veterans Affairs (VA)–Based Medical Care: Influence of Out-of-VA Care
Authors: Gurmankin Andrea D. , Polsky Daniel , Volpp Kevin G.
Published: December 2008

Conclusions regarding racial differences in care following a newly elevated prostate-specific antigen (PSA) test at the Department of Veterans Affairs (VA) may differ depending on whether follow-up care outside the VA is considered. Consecutive Philadelphia, Pa, VA patients with newly elevated PSA tests (n = 183) were interviewed 1 year after baseline. Among exclusive VA users, Blacks had higher rates of urology referrals and prostate biopsies compared with Whites. However, these racial differences were attenuated when care obtained outside the VA also was considered.
Racial Differences in Cardiac Catheterization as a Function of Patients’ Beliefs
Authors: Kressin Nancy R. , Chang Bei-Hung , Whittle Jeff , Peterson Eric D. , Clark Jack A. , Rosen Amy K. , Orner Michelle , Collins Tracie C. , Alley Linda G. , Petersen Laura A.
Published: December 2008

Objectives. We examined racial differences in cardiac catheterization rates and reviewed whether patients’ beliefs or other variables were associated with observed disparities.

Methods. We did a prospective observational cohort study of 1045 White and African American patients at 5 Veterans Affairs (VA) medical centers whose nuclear imaging studies indicated reversible cardiac ischemia.

Results. There were few demographic differences between White and African American patients in our sample. African Americans were less likely than Whites to undergo cardiac catheterization. African Americans were more likely than Whites to indicate a strong reliance on religion and to report racial and social class discrimination and were less likely to indicate a generalized trust in people but did not differ from White patients on numerous other attitudes about health and health care. Neither sociodemographic or clinical characteristics nor patients’ beliefs explained the observed disparities, but physicians’ assessments of the procedure’s importance and patients’ likelihood of coronary disease seemed to account for differences not otherwise explained.

Conclusions. Patients’ preferences are not the likely source of racial disparities in the use of cardiac catheterization among veterans using VA care, but physicians’ assessments warrant further attention.
Endometrial Cancer: Socioeconomic Status and Racial/Ethnic Differences in Stage at Diagnosis, Treatment, and Survival
Authors: Madison Terri , Schottenfeld David , James Sherman A. , Schwartz Ann G. , Gruber Stephen B.
Published: December 2008

Objective. We evaluated the association between socioeconomic status and racial/ ethnic differences in endometrial cancer stage at diagnosis, treatment, and survival.

Methods. We conducted a population-based study among 3656 women.

Results. Multivariate analyses showed that either race/ethnicity or income, but not both, was associated with advanced-stage disease. Age, stage at diagnosis, and income were independent predictors of hysterectomy. African American ethnicity, increased age, aggressive histology, poor tumor grade, and advanced-stage disease were associated with increased risk for death; higher income and hysterectomy were associated with decreased risk for death.

Conclusions. Lower income was associated with advanced-stage disease, lower likelihood of receiving a hysterectomy, and lower rates of survival. Earlier diagnosis and removal of barriers to optimal treatment among lower-socioeconomic status women will diminish racial/ethnic differences in endometrial cancer survival.
Experiences of Racism Among African American Parents and the Mental Health of Their Preschool-Aged Children
Authors: Caughy Margaret O'Brien , O'Campo Patricia J. , Muntaner Carles
Published: December 2008

Objectives. We examined the relationship between parents’ experiences of racism and children’s well-being and the influence of the residential neighborhood characteristics on this relationship.

Methods. African American families were recruited from Baltimore neighborhoods. Parental measures included racism experiences and coping. Neighborhood measures included demographic characteristics, social cohesion, and social climate. Children’s mental health was assessed with the Child Behavior Checklist. Analysis was performed with multilevel modeling.

Results. Parents who denied experiences of racism also reported higher rates of behavior problems among their preschool-aged children. For families living in neighborhoods characterized by fear of victimization, parents who actively coped with racism experiences by confronting the person involved or taking some sort of action in response to racism reported lower rates of anxiety and depression for their preschool-aged children.

Conclusions. Experiences of and responses to racism among African American parents have important effects on the well-being of their young children.
Self-Reported Experiences of Racial Discrimination and Black–White Differences in Preterm and Low-Birthweight Deliveries: The CARDIA Study
Authors: Mustillo Sarah , Krieger Nancy , Gunderson Erica P. , Sidney Stephen , McCreath Heather , Kiefe Catarina I.
Published: December 2008

Objectives. We examined the effects of self-reported experiences of racial discrimination on Black–White differences in preterm (less than 37 weeks gestation) and low-birthweight (less than 2500 g) deliveries.

Methods. Using logistic regression models, we analyzed data on 352 births among women enrolled in the Coronary Artery Risk Development in Young Adults Study.

Results. Among Black women, 50% of those with preterm deliveries and 61% of those with low-birthweight infants reported having experienced racial discrimination in at least 3 situations; among White women, the corresponding percentages were 5% and 0%. The unadjusted odds ratio for preterm delivery among Black versus White women was 2.54 (95% confidence interval [CI]=1.33, 4.85), but this value decreased to 1.88 (95% CI=0.85, 4.12) after adjustment for experiences of racial discrimination and to 1.11 (95% CI=0.51, 2.41) after additional adjustment for alcohol and tobacco use, depression, education, and income. The corresponding odds ratios for low birthweight were 4.24 (95% CI=1.31, 13.67), 2.11 (95% CI=0.75, 5.93), and 2.43 (95% CI=0.79, 7.42).

Conclusions. Self-reported experiences of racial discrimination were associated with preterm and low-birthweight deliveries, and such experiences may contribute to Black–White disparities in perinatal outcomes.
Socioeconomic Position and Hormone Replacement Therapy Use: Explaining the Discrepancy in Evidence From Observational and Randomized Controlled Trials
Authors: Lawlor Debbie A , Davey Smith George , Ebrahim Shah
Published: December 2008

Objectives. We assessed the association between life-course socioeconomic status or position (SEP) and hormone replacement therapy (HRT).

Methods. We conducted a cross-sectional analysis of 4286 women aged 60 to 79 years.

Results. Women experiencing adverse socioeconomic circumstances across the life course were less likely to have used HRT. The associations of childhood socioeconomic measures with HRT use were independent of adult SEP, behavioral risk factors, and physiological risk factors for heart disease.

Conclusions. SEP from across the life course is associated with HRT use. Because the association between early life SEP and HRT is not fully explained by adult risk factors, residual confounding (which is not captured by adjustment for adult variables only) may explain some of the disparity between observational studies and randomized controlled trials in this area.
Prevalence of Smoking in 8 Countries of the Former Soviet Union: Results From the Living Conditions, Lifestyles and Health Study
Authors: Gilmore Anna , Pomerleau Joceline , McKee Martin , Rose Richard , Haerpfer Christian W. , Rotman David , Tumanov Sergej
Published: December 2008

Objectives. We sought to provide comparative data on smoking habits in countries of the former Soviet Union.

Methods. We conducted cross-sectional surveys in 8 former Soviet countries with representative national samples of the population 18 years or older.

Results. Smoking rates varied among men, from 43.3% to 65.3% among the countries examined. Results showed that smoking among women remains uncommon in Armenia, Georgia, Kyrgyzstan, and Moldova (rates of 2.4%–6.3%). In Belarus, Ukraine, Kazakhstan, and Russia, rates were higher (9.3%–15.5%). Men start smoking at significantly younger ages than women, smoke more cigarettes per day, and are more likely to be nicotine dependent.

Conclusions. Smoking rates among men in these countries have been high for some time and remain among the highest in the world. Smoking rates among women have increased from previous years and appear to reflect transnational tobacco company activity.
Appalachian Teen Smokers: Not On Tobacco 15 Months Later
Authors: Horn Kimberly A. , Dino Geri A. , Kalsekar Iftekhar D. , Fernandes Ancilla W.
Published: December 2008

High school smokers from 2 central Appalachian states received the American Lung Association’s 10-session Not On Tobacco (N-O-T) program or a 15-minute brief self-help intervention. Our study compared the efficacy of N-O-T with that of the brief intervention by examining group differences in the 15-month-postbaseline (12-month-postprogram) smoking quit rates.

N-O-T youths had higher overall quit rates. Review of end-of-program (3-month-postbaseline) and 3-month-postprogram (6-month-postbaseline) follow-up data showed state-level differences and positive cessation trends over time, regardless of treatment intensity. Quit rates were lower than rates found in other N-O-T studies of nonrural youths, suggesting that Appalachian youths are a recalcitrant smoking sample. Findings suggest that N-O-T is one option for long-term smoking cessation among rural teens.
Eliminating Tobacco-Related Health Disparities: Directions for Future Research
Authors: Fagan Pebbles , King Gary , Lawrence Deirdre , Petrucci Sallie Anne , Robinson Robert G. , Banks David , Marable Sharon , Grana Rachel
Published: December 2008

Certain groups in the United States remain at high risk and suffer disproportionately from tobacco-related illness and death despite progress made in reducing tobacco use. To address gaps in research on tobacco-related disparities and develop a comprehensive agenda aimed at reducing such disparities, representatives from funding agencies, community-based organizations, and academic institutions convened at the National Conference on Tobacco and Health Disparities in 2002. Conference participants reviewed the current research, identified existing gaps, and prioritized scientific recommendations. Panel discussions were organized to address research areas affecting underserved and understudied populations. We report major research recommendations made by the conference participants in several scientific domains. These recommendations will ultimately help guide the field in reducing and eliminating tobacco-related disparities in the United States.
Adult Cigarette Smoking Prevalence: Declining as Expected (Not as Desired)
Authors: Mendez David , Warner Kenneth E.
Published: December 2008

We compared observed smoking prevalence data for 1995–2002 with predictions derived from a previously published population dynamics model to determine whether the recent trend in smoking prevalence is consistent with the downward pattern we predicted. The observed data fit our projections closely (R 2 = .89). Consistent with the logic underlying the model, we conclude that adult smoking prevalence will continue to fall for the foreseeable future, although at a rate approximately half that of the decline experienced during the 1970s and 1980s.
Confirming “truth”: More Evidence of a Successful Tobacco Countermarketing Campaign in Florida
Authors: Niederdeppe Jeff , Farrelly Matthew C. , Haviland M. Lyndon
Published: December 2008

This study provides additional evidence that Florida’s “truth” tobacco countermarketing campaign was successful in reducing smoking among Florida teens. Smoking rates were substantially lower among Florida teens between fall 2001 and spring 2002, whereas previous studies found that smoking rates were comparable before the launch of “truth.” Florida teens had higher levels of “truth” campaign awareness and were more likely to agree with campaign-targeted beliefs; 2 of these beliefs were the only items associated with current smoking.
American Indian Internet Cigarette Sales: Another Avenue for Selling Tobacco Products
Authors: Hodge Felicia S. , Geishirt Cantrell Betty A. , Struthers Roxanne , Casken John
Published: December 2008

A study conducted by the University of Minnesota found that cigarettes can be purchased on American Indian–owned Internet sites for about one fifth of the price at grocery stores, making this a more convenient, lower-priced, and appealing method of purchasing cigarettes. Researchers and educators are challenged to address this new marketing ploy and to discover ways to curb rising smoking rates in American Indian communities.
Working Class Matters: Socioeconomic Disadvantage, Race/Ethnicity, Gender, and Smoking in NHIS 2000
Authors: Barbeau Elizabeth M. , Krieger Nancy , Soobader Mah-Jabeen
Published: December 2008

Objectives. We sought to describe the burden of smoking on the US population, using diverse socioeconomic measures.

Methods. We analyzed data from the 2000 National Health Interview Survey.

Results. Overall, the prevalence of current smoking was greatest among persons in—and independently associated with—working class jobs, low educational level, and low income. Attempts to quit showed no socioeconomic gradient, while success in quitting was greatest among those with the most socioeconomic resources. These patterns held in most but not all race/ethnicity–gender groups. Finer resolution of smoking patterns was obtained using a relational UK occupational measure, compared to the skill-based measure commonly used in US studies.

Conclusions. Reducing social disparities in smoking requires attention to the complexities of class along with race/ethnicity and gender.
Acculturation and Tobacco Use Among Chinese Americans
Authors: Shelley Donna , Fahs Marianne , Scheinmann Roberta , Swain Susan , Qu Jiaojie , Burton Dee
Published: December 2008

Objectives: We examined the relationship between acculturation and tobacco use behaviors among Chinese Americans.

Methods: Using a Chinese-language instrument based on validated questions from several national surveys, we conducted in-person, household-based interviews with 712 representative adults aged 18–74 years.

Results: Observed smoking prevalence was 29% for men and 4% for women. Predictors of smoking cessation included being 35 years and older and having a high level of tobacco-related knowledge. Acculturation was positively associated with a history of never smoking, as was being younger than 35 years and having a high level of tobacco-related knowledge.

Conclusions: Acculturation was positively associated with never smoking among men but not with smoking cessation. However, knowledge of tobacco-related health risks was associated with both. Results indicate a need for language-specific educational interventions.
Decrease in the Prevalence of Environmental Tobacco Smoke Exposure in the Home During the 1990s in Families With Children
Authors: Soliman Soheil , Pollack Harold A. , Warner Kenneth E.
Published: December 2008

Objectives. This study explored correlates with and changes in the prevalence of environmental tobacco smoke (ETS) exposure of children in the home.

Methods. We used multiple logistic regression to explore ETS exposures as reported in the 1992 and 2000 National Health Interview Survey.

Results. ETS exposure in homes with children declined from 35.6% to 25.1% (P < .001) between 1992 and 2000, whereas smoking prevalence declined 26.5% to 23.3%. Home ETS exposures were more prevalent among non-Hispanic Whites than among African Americans (adjusted odds ratio [AOR] = 0.702; 95% confidence interval [CI] = 0.614, 0.802), Asian Americans (AOR = 0.534; 95% CI = 0.378, 0.754), and Hispanics (AOR = 0.388; 95% CI = 0.294, 0.389). Exposures declined across all groups, with greater gains in higher education and income groups.

Conclusions. Home ETS exposure declined sharply between 1992 and 2000, more than would be predicted by the decline in adult smoking prevalence.
Progression to Established Smoking Among US Youths
Authors: Mowery Paul D. , Farrelly Matthew C. , Haviland M. Lyndon , Gable Julia M. , Wells Henry E.
Published: December 2008

Objectives. Our study presents national estimates of the proportion of youths in each of 7 stages of smoking and investigates the associations between risk/protective factors and progression to established smoking.

Methods. We analyzed data from the 1999 and 2000 National Youth Tobacco Surveys.

Results. In 1999 and 2000, 48.6% of US adolescents had at least experimented with tobacco, and 7.8% were established smokers. Important correlates of progression to established smoking included parental advice not to smoke, antismoking lessons in school, susceptibility to tobacco industry advertising and promotion, peer smoking, and exposure to smoking at home.

Conclusions. Interventions to stop adolescent progression to established smoking should target susceptible never smokers and early experimenters as well as those in later stages of smoking.
Sample Size Estimation in Research With Dependent Measures and Dichotomous Outcomes
Authors: Delucchi Kevin L.
Published: December 2008

I reviewed sample estimation methods for research designs involving nonindependent data and a dichotomous response variable to examine the importance of proper sample size estimation and the need to align methods of sample size estimation with planned methods of statistical analysis. Examples and references to published literature are provided in this article.

When the method of sample size estimation is not in concert with the method of planned analysis, poor estimates may result. The effects of multiple measures over time also need to be considered.

Proper sample size estimation is often overlooked. Alignment of the sample size estimation method with the planned analysis method, especially in studies involving nonindependent data, will produce appropriate estimates.
Achieving National Health Objectives: The Impact on Life Expectancy and on Healthy Life Expectancy
Authors: Pamuk Elsie R. , Wagener Diane K. , Molla Michael T.
Published: December 2008

Our study quantifies the impact of achieving specific Healthy People 2010 targets and of eliminating racial/ethnic health disparities on summary measures of health. We used life table methods to calculate gains in life expectancy and healthy life expectancy that would result from achievement of Healthy People 2010 objectives or of current mortality rates in the Asian/Pacific Islander (API) population.

Attainment of Healthy People 2010 mortality targets would increase life expectancy by 2.8 years, and reduction of populationwide mortality rates to current API rates would add 4.1 years. Healthy life expectancy would increase by 5.8 years if Healthy People 2010 mortality and assumed morbidity targets were attained and by 8.1 years if API mortality and activity limitation rates were attained.

Achievement of specific Healthy People 2010 targets would produce significant increases in longevity and health, and elimination of racial/ethnic health disparities could result in even larger gains.
On the Classification of Population Health Measurements
Authors: McDowell Ian , Spasoff Robert A. , Kristjansson Betsy
Published: December 2008

Summary measures of population health, such as health-adjusted life expectancy, are increasingly being used to monitor the health status of regions and to evaluate public health interventions. Such measures are based on aggregated indicators of individual health and summarize health in a population. They describe population health status but have limitations in analytic studies of population health.

We propose a broader framework for population health measurement. This classifies indicators according to their application (descriptive, prognostic, or explanatory), according to the conception of population (as an aggregate or a dynamic entity), and according to the underlying model of health. This approach extends the measurement repertoire to include indicators of the health of a population.
Associations of Perceived Social and Physical Environmental Supports With Physical Activity and Walking Behavior
Authors: Addy Cheryl L. , Wilson Dawn K. , Kirtland Karen A. , Ainsworth Barbara E. , Sharpe Patricia , Kimsey Dexter
Published: December 2008

We evaluated perceived social and environmental supports for physical activity and walking using multivariable modeling. Perceptions were obtained on a sample of households in a southeastern county. Respondents were classified according to physical activity levels and walking behaviors. Respondents who had good street lighting; trusted their neighbors; and used private recreational facilities, parks, playgrounds, and sports fields were more likely to be regularly active. Perceiving neighbors as being active, having access to sidewalks, and using malls were associated with regular walking.
Prevalence of Secondary Conditions Among People With Disabilities
Authors: Kinne Susan , Patrick Donald L. , Doyle Debra Lochner
Published: December 2008

We analyzed data from 2075 respondents to the disability supplement of the 2001 Washington State Behavior Risk Factor Surveillance Survey to describe population prevalence of secondary conditions among adults with disabilities. Eighty-seven percent of respondents with disabilities and 49% without disabilities reported at least 1 secondary condition. Adjusted odds ratios for disability for 14 of 16 conditions were positive and significant. The association of disability with substantial disparities in common conditions shows a need for increased access to general and targeted prevention interventions to improve health.
An Outcome Evaluation of the SOS Suicide Prevention Program
Authors: Aseltine Robert H. , DeMartino Robert
Published: December 2008

Objectives. We examined the effectiveness of the Signs of Suicide (SOS) prevention program in reducing suicidal behavior.

Methods. Twenty-one hundred students in 5 high schools in Columbus, Ga, and Hartford, Conn, were randomly assigned to intervention and control groups. Self-administered questionnaires were completed by students in both groups approximately 3 months after program implementation.

Results. Significantly lower rates of suicide attempts and greater knowledge and more adaptive attitudes about depression and suicide were observed among students in the intervention group. The modest changes in knowledge and attitudes partially explained the beneficial effects of the program.

Conclusions. SOS is the first school-based suicide prevention program to demonstrate significant reductions in self-reported suicide attempts.