bluuebunny/crossref_metadata_2025 huggingface dataset:
Food sources, dietary behavior, and the saturated fat intake of Latino children.
Authors: Basch C E , Shea S , Zybert P
Published: November 2008

BACKGROUND. Recent recommendations for Americans aged 2 and older call for a reduction in the average saturated fat intake to less than 10% of calories. METHODS. Using 24-hour dietary recalls collected from mothers of 4- to 7-year-old urban Latino children, we identified foods and dietary behavior patterns that distinguish children with higher and lower mean daily percentages of calories from saturated fat. RESULTS. Compared with children in the lowest quintile of intake, children in the highest quintile consumed more than twice as much saturated fat per day from high-fat milk products (18.5 g vs 7.8 g), mostly from whole milk. They did not consume different kinds of milk or different amounts of milk per eating occasion, but on average they consumed milk more frequently (2.8 vs 1.6 eating occasions per day). Even children in the lowest quintile, on average, exceeded the 10% of calories from saturated fat currently recommended. If low-fat (1% fat) milk had been substituted without other dietary changes, all but the highest two quintiles would have been within the recommended level. CONCLUSIONS. The substitution of low-fat for whole milk appears to be a key strategy for preschool children for achieving recommended levels of saturated fat intake.
Socioeconomic and behavioral correlates of body mass index in black adults: the Pitt County Study.
Authors: Croft J B , Strogatz D S , James S A , Keenan N L , Ammerman A S , Malarcher A M , Haines P S
Published: November 2008

BACKGROUND. Obesity is more prevalent among Black women than Black men, but there is little information on the correlates of obesity in Blacks. This study describes the relations of sociodemographic factors and health behaviors to body mass index in a southern, Black population. METHODS. In 1988, a community probability sample of 1784 Black adults, aged 25 to 50, was examined in Pitt County, NC. RESULTS. More women than men were at least 20% overweight (57% vs 36%). The relation of socioeconomic status (a composite of education and occupation) to age-adjusted body mass index level was inverse in women but not in men. Body mass index did not differ with either current energy intake or energy expenditure. Smokers and drinkers had lower age-adjusted levels than non-smokers and abstainers. CONCLUSIONS. Since the excess body mass index levels associated with low socioeconomic status in women could not be explained after controlling for adverse health behaviors, further epidemiologic study of risk factors for obesity in Black women is recommended.
Prevention of cigarette smoking through mass media intervention and school programs.
Authors: Flynn B S , Worden J K , Secker-Walker R H , Badger G J , Geller B M , Costanza M C
Published: November 2008

OBJECTIVES. In this study we tested the ability of mass media interventions to enhance the efficacy of school cigarette smoking prevention programs. METHODS. For 4 years, students in one pair of communities received media interventions and school programs that had common educational objectives. Students in a matched pair of communities received only the school programs. The combined cohort of 5458 students was surveyed at baseline in grades 4, 5, and 6 and was followed up annually for 4 years. RESULTS. Significant reductions in reported smoking, along with consistent effects on targeted mediating variables, were observed for the media-and-school group. For cigarettes per week the reduction was 41% (2.6 vs 4.4); for smoking cigarettes yesterday the reduction was 34% (8.6% vs 13.1%); and for smoking in the past week the reduction was 35% (12.8% vs 19.8%). No effects were observed for substance use behaviors not targeted by the interventions. CONCLUSIONS. These results provide evidence that mass media interventions are effective in preventing cigarette smoking when they are carefully targeted at high-risk youths and share educational objectives with school programs.
Functional limitations and disability among elders in the Framingham Study.
Authors: Kelly-Hayes M , Jette A M , Wolf P A , D'Agostino R B , Odell P M
Published: November 2008

BACKGROUND. The measurement of physical disability as an indication of the impact of disease is commonly seen in research. However, these measures often do not clearly differentiate between functional limitations and daily performance of an activity. METHODS. We measured the differences between self-reported disability and observed functional limitations in six activities of daily living tasks among community-dwelling elders. The value of functional limitations vs disability measures in determining risk factors for disablement was ascertained. RESULTS. Systematic differences were found among the 1453 participants. At least 89% of the time when a difference was identified, the subjects ranked disability greater than the functional limitations observed. For those who were cognitively impaired, discrepancies occurred up to 11% of the time. In determining risk factors for disablement, we found that neurological impairments were associated with both functional limitations and disability, while sociocultural factors were associated with disability only. CONCLUSIONS. Our findings suggest that physical functional limitations and disability in the elderly are two distinct concepts and that the measure of choice should be determined by research objectives and the type of population being studied.
Neuroleptic medication and prescription practices with sheltered-care residents: a 12-year perspective.
Authors: Segal S P , Cohen D , Marder S R
Published: November 2008

OBJECTIVES. Most adult residents of sheltered-care facilities (board and care, family care, psychosocial rehabilitation, and other supported housing arrangements) for the chronically mentally ill receive neuroleptics. These facilities house over 300,000 mentally ill residents, but neuroleptic prescription practices with this population have not been studied. METHODS. A probability sample (n = 393) of all adult former psychiatric patients in sheltered care in California was surveyed in 1973; 94% of the located survivors (n = 243) were reinterviewed 12 years later. RESULTS. In 1973, 79% received neuroleptics; in 1985, 76%. Polypharmacy decreased, and the elderly remained less medicated than adults. Yet, mean daily neuroleptic doses doubled, more persons received higher doses, and 62% reported adverse effects. Furthermore, high dosing was attributed to psychiatrists rather than other physicians, even when controlling for residents clinical and sociodemographic characteristics. CONCLUSIONS. Neuroleptic drugs became the staple pharmacological treatment for mentally ill sheltered-care residents. While physicians more cautiously medicated the elderly, they had not reduced doses by 1985, even after a decade of treatment. The specialty of the prescriber was an important factor in preference for high-dose treatment.
Young women's antisocial behavior and the later emotional and behavioral health of their children.
Authors: Martin S L , Burchinal M R
Published: November 2008

OBJECTIVES. Antisocial and criminal behavior are increasing among US youth, especially among females. Thus, questions arise concerning whether youthful female deviant behavior eventually will have negative behavioral and emotional consequences for the later children of these women. METHODS. Associations between the severity of early female antisocial behavior (including both drug-related and non-drug related offenses) and the later behavioral and emotional health of the children of these women were examined among 1425 mother-child pairs of the National Longitudinal Survey of Youth. RESULTS. Multiple linear regression procedures indicated a significant positive relationship between the severity of the mothers' early non-drug-related offenses and the later severity of the children's scores on the Antisocial, Hyperactive, Anxious/Depressed, Headstrong, Peer Conflict/Social Withdrawal, Immature Dependency, and Total Problem subscales of the Behavior Problem Index. CONCLUSIONS. This study demonstrated an association between the antisocial behavior of female youth and the later behavioral and emotional problems of the children of these women. Future research needs to determine the mechanisms underlying the intergenerational transmission of these types of problems so that effective preventive and therapeutic public health practices may be designed and implemented.
Identification of nonfatal family and intimate assault incidents in police data.
Authors: Saltzman L E , Mercy J A , Rhodes P H
Published: November 2008

We examined different strategies for identifying nonfatal family and intimate assaults (FIAs) in police data. Police most often classify such incidents in the "assault" category, but they also use other crime categories. We estimated that, during 1984, 3300 FIAs (or 837 per 100,000 population) occurred in Atlanta. Of those, 77% were classified as assaults; 23% were classified in nonassault categories. Research measuring the magnitude of FIAs should take into account incidents classified in nonassault crime categories.
The cost and frequency of hospitalization for fall-related injuries in older adults.
Authors: Alexander B H , Rivara F P , Wolf M E
Published: November 2008

Using a population-based hospital discharge registry with E codes, we examine the 1989 hospitalizations of older adults in Washington State for fall-related injuries. Fall-related trauma accounted for 5.3% of all hospitalizations of older adults, with hospital charges totaling $53,346,191, and resulted in discharge to nursing care more often than other such hospitalizations. An annual hospitalization rate of 13.5 per 1000 persons and an annual cost of $92 per person is reported. The importance of preventing fall-related injuries in older adults is discussed.
Carcinogens in tobacco smoke: benzo[a]pyrene from Canadian cigarettes and cigarette tobacco.
Authors: Kaiserman M J , Rickert W S
Published: November 2008

We evaluated the benzo[a]pyrene (BaP) content in the smoke from 35 brands of Canadian cigarettes and 5 brands of Canadian tobaccos for roll-your-own cigarettes. For the cigarettes, mean values of BaP ranged from 3.36 ng to 28.39 ng per cigarette, roughly in proportion with declared tar values. The relationship between declared tar and yields of BaP, however, does not allow accurate prediction of one from the other. For the tobaccos, mean BaP values ranged from 22.92 ng to 26.27 ng (average, 24.7 ng) per cigarette. The implications of these findings are discussed with respect to overall exposure.
Recall of AIDS public service announcements and their impact on the ranking of AIDS as a national problem.
Authors: Siska M , Jason J , Murdoch P , Yang W S , Donovan R J
Published: November 2008

The efficacy of two public service announcements from Phase V of the "America Responds to AIDS" (ARTA) campaign was assessed at two sites. Participants were randomly assigned to view a local news program, one with an ARTA public service announcement appearing six times and the other with no AIDS public service announcements. During telephone interviews with 907 participants 1 to 3 nights after viewing, 21% at Site A and 59% at Site B could correctly recall the ARTA public service announcements. Absolute mentions of AIDS as an important national issue increased.
The potential impact of epidemiology on the prevention of occupational disease.
Authors: Wegman D H
Published: November 2008

This presentation reviews occupational epidemiology as a foundation for workplace disease prevention activities. By examining descriptive, etiologic and intervention occupational epidemiology studies, a range of opportunities are illustrated where epidemiology has played, or could play a principal role in guiding preventive efforts. Descriptive studies presented include ones based on vital records, on epidemic investigations, cross-sectional surveys, and surveillance. Etiologic studies review the largely successful development of knowledge for lung cancer and asbestos exposure for pulmonary effects of isocyanate exposures. However, attention is also directed to the need for etiologic studies of work environment risks for both cardiovascular and musculoskeletal disease. Finally importance is placed on the too infrequent epidemiologic studies of intervention. Historical examples of control of large risks from nickel cancers and silicosis are balanced with more recent examples of successes at reducing smaller risks of cardiovascular disease and oil acne. Throughout, emphasis is placed on the importance of reintegrating the academic discipline of epidemiology into the application of study findings to prevention of workplace risks.
Surveillance data on US coal miners' pneumoconiosis, 1970 to 1986.
Authors: Attfield M D , Althouse R B
Published: November 2008

OBJECTIVES. Statistics on prevalence of pneumoconiosis among working underground coal miners from data collected as part of a large national radiographic surveillance program between 1970 and 1986 are presented. The main intent was to examine the time-related trend in prevalence over this period, which coincides with historically low dust levels mandated by federal act. METHODS. Tenure-specific prevalence rates and summary statistics derived from them for four consecutive time intervals within the 16-year period were calculated and compared. RESULTS. The results indicate a reduction in pneumoconiosis over the life of the program. This trend is similar to that seen in epidemiologic studies undertaken concurrently. CONCLUSIONS. Although low participation in the surveillance program and other problems complicate the findings, it appears that reductions in dust exposure mandated by federal act in 1969 have led to lower prevalence of pneumoconiosis among underground coal miners.
Job strain and prevalence of hypertension in a biracial population of urban bus drivers.
Authors: Albright C L , Winkleby M A , Ragland D R , Fisher J , Syme S L
Published: November 2008

OBJECTIVES. In this study we tested the association between occupational stress--as measured by job demands, decision latitude, and job strain--and hypertension in a population of 1396 Black and White bus drivers. METHODS. Height, weight, blood pressure, and medical history were assessed by physical exam. Drivers completed a questionnaire assessing their work schedules, personal habits, and self-perceptions about job demands and decision latitude. RESULTS. Univariate analyses revealed significant inverse associations; lower levels of job demands and job strain were associated with a higher prevalence of hypertension for Blacks and Whites. After 12 confounding variables were controlled for, the association between these two measures of occupational stress and hypertension became nonsignificant. Decision latitude was also not significantly associated with hypertension. CONCLUSIONS. Our findings are inconsistent with previous studies' findings of a positive association between job strain and chronic diseases. The difference in results may be explained by our incorporation of individuals' perceptions in the measurement of occupational stressors and our use of individuals from a single occupation with comparable job responsibilities and income, thus controlling for potential confounding by social class.
Education, race, and high-density lipoprotein cholesterol among US adults.
Authors: Freedman D S , Strogatz D S , Williamson D F , Aubert R E
Published: November 2008

OBJECTIVES. Although educational achievement is positively related to levels of high-density lipoprotein cholesterol (HDL-C) among White adults, there is an inverse association among Blacks. We assessed whether this interaction could be attributed to differences in the relation of education to correlates of HDL-C. METHODS. Cross-sectional analyses were based on data from 8391 White and 995 Black adults who participated in the Second National Health and Nutrition Examination Survey. RESULTS. Associations between education and HDL-C levels varied from negative (Black men), to nearly nonexistent (White men and Black women), to positive (White women). Mean HDL-C levels were higher among Blacks than among Whites, but differences varied according to educational achievement. Among adults with less than 9 years of education, mean levels were 6 to 10 mg/dL higher among Blacks, but the radical difference was less than 1 mg/dL among adults with at least 16 years of education. About 20% to 40% of these differences could be accounted for by obesity, alcohol consumption, and other characteristics. CONCLUSIONS. Because of the implications for coronary heart disease risk, consideration should be given to behavioral characteristics associated with the interaction between race and educational achievement.
National mortality rates: the impact of inequality?
Authors: Wilkinson R G
Published: November 2008

Although health is closely associated with income differences within each country there is, at best, only a weak link between national mortality rates and average income among the developed countries. On the other hand, there is evidence of a strong relationship between national mortality rates and the scale of income differences within each society. These three elements are coherent if health is affected less by changes in absolute material standards across affluent populations than it is by relative income or the scale of income differences and the resulting sense of disadvantage within each society. Rather than socioeconomic mortality differentials representing a distribution around given national average mortality rates, it is likely that the degree of income inequality indicates the burden of relative deprivation on national mortality rates.
Pregnancy-related mortality in New Jersey, 1975 to 1989.
Authors: Mertz K J , Parker A L , Halpin G J
Published: November 2008

OBJECTIVES. National data are thought to underestimate pregnancy-related mortality in the United States. A multisource surveillance system for pregnancy-associated deaths in New Jersey offers an opportunity to identify the magnitude of and the trends in pregnancy-related mortality at the state level. METHODS. Data from all reported pregnancy-related deaths in the state from 1975 to 1989 were studied, and pregnancy mortality ratios were calculated. RESULTS. The New Jersey pregnancy mortality ratio decreased from the late 1970s to the early 1980s but began to rise in the late 1980s. The pregnancy mortality ratio for non-Whites was 3.6 times that for Whites for the 15-year period. The causes of pregnancy-related deaths changed over the 15-year period, with direct obstetrical causes playing a decreasing role. AIDS has become the major cause of pregnancy-related mortality in New Jersey. Finally, approximately 44% of the pregnancy-related deaths were considered to be preventable by the physician or patient or both. CONCLUSIONS. New efforts must be made to combat the recent rise in pregnancy-related deaths, with special attention to preventing deaths among non-White women.
The quality of life in the year before death.
Authors: Lentzner H R , Pamuk E R , Rhodenhiser E P , Rothenberg R , Powell-Griner E
Published: November 2008

OBJECTIVES. Most Americans wish to live a long healthy life, but fear disease and dependency in their last years. Until recently, little has been known about the prevalence of opposite extremes of health in old age, particularly in the period leading up to death. METHODS. We used results from the 1986 National Mortality Follow-back Survey to estimate proportions of elderly decedents who were "fully functional" or "severely restricted" in the last year of life. Estimates were based on responses from proxies to questions regarding the decedent's functional status, mental awareness, and time spent in institutions. RESULTS. Approximately 14% of all decedents aged 65 years and older were defined as fully functional in the last year of life; 10% were defined as severely restricted. Proportions varied with the decedent's age and sex, the underlying cause of death, and the presence of other preexisting conditions. CONCLUSIONS. Results from this survey and future surveys can be used to learn more about "successful agers"--their medical histories, their life-styles, and whether their relative number is increasing or decreasing overtime.
Car size or car mass: which has greater influence on fatality risk?
Authors: Evans L , Frick M C
Published: November 2008

OBJECTIVES. Proposed increases in corporate average fuel economy standards would probably lead to lighter cars. Well-established relationships between occupant risk and car mass predict consequent additional casualties. However, if size, not mass, is the causative factor in these relationships, then decreasing car mass need not increase risk. This study examines whether mass or size is the causative factor. METHODS. Data from the Fatal Accident Reporting System are used to explore relationships between car mass, car size (as represented by wheelbase), and driver fatality risk in two-car crashes. RESULTS. When cars of identical (or similar) wheelbase but different mass crash into each other, driver fatality risk depends strongly on mass; the relationship is quantitatively similar to that found in studies that ignore wheelbase. On the other hand, when cars of similar mass but different wheelbase crash into each other, the data reveal no dependence of driver fatality risk on wheelbase. CONCLUSIONS. Mass is the dominant causative factor in relationships between driver risk and car size in two-car crashes, with size, as such, playing at most a secondary role. Reducing car mass increases occupant risk.
The development of registries for surveillance of adult lead exposure, 1981 to 1992.
Authors: Baser M E
Published: November 2008

OBJECTIVES. Since 1981, 15 states have established registries for surveillance of adult lead absorption, primarily based on reports of elevated blood lead levels from clinical laboratories. I review the status of the registries and recommend steps for further development. METHODS. Companies reported to the New York registry are compared with those cited by the Occupational Safety and Health Administration (OSHA). I present data on US workers and plants with potential lead exposures and blood tests, as well as review registries' reporting requirements. RESULTS. Registries identify many companies not cited by the Occupational Safety and Health Administration, but underreporting occurs because (1) reporting is usually not required from laboratories outside the state, (2) most registries use a blood lead reporting level of 1.21 mumol/L, which excludes many exposed workers, and (3) many companies with potential exposures do not have routine monitoring programs. CONCLUSIONS. Registries' reporting requirements and procedures should be standardized, including a blood lead reporting level of 0.72 mumol/L. Elevated blood lead levels should be a reportable condition nationwide, and a comprehensive national surveillance system should be established: clinical laboratories should be required to report cases to those states with lead registries or directly to the national adult lead registry.
Lower respiratory illness in infants and low socioeconomic status.
Authors: Margolis P A , Greenberg R A , Keyes L L , LaVange L M , Chapman R S , Denny F W , Bauman K E , Boat B W
Published: November 2008

OBJECTIVES. Infants from families of low socioeconomic status are said to suffer higher rates of lower respiratory illness, but this assertion has not been carefully examined. METHODS. We studied the frequency and determinants of lower respiratory illness in infants of different socioeconomic status (n = 393) by analyzing data from a community-based cohort study of respiratory illness during the first year of life in central North Carolina. RESULTS. The incidence of lower respiratory illness was 1.41 in the low socioeconomic group, 1.26 in the middle group, and 0.67 in the high group. The prevalence of persistent respiratory symptoms was 39% in infants in the low socioeconomic group, 24% in infants in the middle group, and 14% in infants in the high group. The odds of persistent respiratory symptoms in infants of low and middle socioeconomic status were reduced after controlling for environmental risk factors for lower respiratory illness. Enrollment in day care was associated with an increased risk of persistent symptoms among infants of high but not low socioeconomic status. CONCLUSIONS. Infants of low socioeconomic status are at increased risk of persistent respiratory symptoms. This risk can be partly attributed to environmental exposures, most of which could be changed.
Imported leprosy in the United States, 1978 through 1988: an epidemic without secondary transmission.
Authors: Mastro T D , Redd S C , Breiman R F
Published: November 2008

OBJECTIVES. Leprosy remains a major health problem in many regions of the world. In the United States, although leprosy continues to be reported, approximately 90% of cases are imported (i.e., occur among immigrants and refugees). An increase in imported cases began in 1978. This study was conducted to analyze this trend and to characterize the contributing cases. METHODS. Centers for Disease Control leprosy surveillance data from 1971 through 1988 were analyzed. RESULTS. The number of imported cases reported annually was relatively constant from 1971 through 1977 (mean = 119 per year), increased to 307 in 1985, and then decreased to 102 in 1988. Of the 957 excess cases reported from 1978 through 1988, 73.4% were among persons from Southeast Asia, including 51.3% from Vietnam, Cambodia, and Laos (Indochina). There was no coincident increase in indigenous cases of leprosy; the mean annual number of such cases was 17.7 (range = 10 to 29). Leprosy remains endemic in Texas, Hawaii, Louisiana, and possibly California. CONCLUSIONS. An epidemic of imported leprosy began in the United States in 1978, peaked in 1985, and ended by 1988. This increase was primarily due to cases among refugees from Indochina and was limited by a decrease in the influx of Indochinese refugees in the mid-1980s. There is no evidence that these cases resulted in transmission in the United States.
Socioeconomic status and childhood mortality in North Carolina.
Authors: Nelson M D
Published: November 2008

Children in families eligible to receive Aid to Families with Dependent Children (AFDC) were found to have substantially higher mortality rates than non-AFDC children. The disparity seems to be greater for Whites than for non-Whites. These results suggest the presence of social class differentials in access to and use of health care and related services and facilities, in exposure to environmental risks, and in knowledge of injury control measures.
Cigarette smoking and occupational status: 1977 to 1990.
Authors: Covey L S , Zang E A , Wynder E L
Published: November 2008

OBJECTIVES. In this study we examined the relationship between occupational status and smoking habits in men and women during the period from 1977 to 1990. METHODS. Cigarette smoking and occupational history were obtained from 8045 men and women who served as controls for a hospital-based study of tobacco-related diseases. RESULTS. There was an association between increasing occupational status and tobacco exposure in men, but not in women. The quit rate increased over time in all sex-occupational groups except for male laborers, whose quit rate remained constant. Nicotine-dependent smokers are likely to find it difficult to quit. Male nicotine-dependent smokers were consistently found in greater numbers among blue collar workers throughout the study period. Initially, female nicotine-dependent smokers were more often found among blue collar workers, but in recent years became more frequent among white collar workers. CONCLUSION. These trends provide clues to the future epidemiological distribution of lung cancer and other tobacco-related diseases. An understanding of gender differences in the occupational profile of cigarette smokers can provide guidelines for effective antismoking interventions.
Predictors of smoking relapse after noncardiac surgery. Study of Perioperative Ischemia (SPI) Research Group.
Authors: Simon J A , Browner W S , Mangano D T
Published: November 2008

OBJECTIVES. We studied 235 smokers who were admitted for major noncardiac surgery and who survived hospitalization to determine the frequency and predictors of smoking relapse 1 year after hospitalization. METHODS. We analyzed data collected prospectively from the Study of Perioperative Ischemia. We determined smoking status by self-report. RESULTS. At 12 months posthospitalization, 142 (76%) of the 186 surviving patients had resumed smoking. Significant independent predictors of relapse at 12 months were a history of alcohol abuse and a history of heavy cigarette smoking (P less than 0.01 and P less than 0.05, respectively). CONCLUSIONS. Since smokers commonly undergo surgery, the perioperative period provides a valuable window of opportunity for smoking cessation interventions designed to decrease the high rate of smoking relapse after surgery.
Smoking cessation in women concerned about weight.
Authors: Pirie P L , McBride C M , Hellerstedt W , Jeffery R W , Hatsukami D , Allen S , Lando H
Published: November 2008

BACKGROUND. Weight gain after smoking cessation is often cited by women smokers as a primary reason for not attempting to quit smoking or for relapsing after a cessation attempt. METHODS. A randomized trial of 417 women smokers was conducted to test the addition of two weight control strategies to a smoking cessation program. Participants received the standard smoking cessation program, the program plus nicotine gum, the program plus behavioral weight control, or the program plus both nicotine gum and behavioral weight control. Weight and smoking status were measured at the end of treatment and at 6 and 12 months posttreatment. RESULTS. Smoking cessation rates were highest in the group receiving the smoking cessation program plus nicotine gum. Weight gain did not vary by treatment condition, so its effect on relapse could not be examined by group. There was no significant relationship between weight gained and relapse in individuals. CONCLUSIONS. The added behavioral weight control program was attractive to the participants and did not reduce smoking cessation rates. However, it did not produce the expected effect on weight, thereby restricting our ability to examine the effect of weight control on smoking cessation and relapse.
Restricted activity days among older adults.
Authors: Kosorok M R , Omenn G S , Diehr P , Koepsell T D , Patrick D L
Published: November 2008

OBJECTIVES. The number of restricted activity days experienced by an individual in the course of a year is an important measure of functional well-being, particularly for older adults. We sought to determine multivariate associations between restricted activity days and various health conditions. METHODS. We used data from the 1984 Supplement on Aging of the National Health Interview Survey to estimate the relationship between restricted activity days and age, gender, and the presence or absence of selected chronic conditions and falls for all noninstitutionalized people aged 65 years and over. Chronic conditions and falls accounted for most of the variance in the model. RESULTS. Of an annual average of 31 restricted activity days, 6 days were associated with falls; 4 days with heart disease; 4 days with arthritis and rheumatism; 2 days each with high blood pressure, cerebrovascular disease, and visual impairment; and 1 day each with atherosclerosis, diabetes, major malignancies, and osteoporosis. CONCLUSIONS. These results can be used in estimating the potential impact of health promotion programs on the health status of noninstitutionalized older adults.
HIV risk among Latino adolescents in two New England cities.
Authors: Smith K W , McGraw S A , Crawford S L , Costa L A , McKinlay J B
Published: November 2008

OBJECTIVES. Latino adolescents in two urban New England areas were surveyed to assess risk of human immunodeficiency virus (HIV) transmission. METHODS. Probability of HIV infection during the previous 6 months was estimated from self-reported sexual contacts, condom usage rates, and number of partners. Teens were also asked to show condoms in their possession to the interviewer to validate self-reports of condom use. RESULTS. Overall, 8% of the 586 respondents were classified as high risk for HIV infection (estimated infection probability greater than .0001), 34% were at moderate risk, and the remaining 58% were classified as not at risk (no sexual activity or needle sharing). Teens who said they had purchased condoms or claimed to have used them recently were more likely than others to have condoms in their possession at the time of the interview. CONCLUSIONS. These estimates suggest that a small percentage of Latino adolescents may be at substantial risk for HIV infection over periods as short as 6 months, that self-reports of recent condom use are strongly related to condom possession, and that questionnaire items regarding condom use at last intercourse are poor surrogates for HIV risk.
The sexual behavior of US adults: results from a national survey.
Authors: Leigh B C , Temple M T , Trocki K F
Published: November 2008

OBJECTIVES. One consequence of the acquired immunodeficiency syndrome (AIDS) epidemic has been to highlight the need for population-based estimates of the number of individuals engaging in sexual behaviors that place them at risk for human immunodeficiency virus (HIV) infection. This paper describes the prevalence of various sexual behaviors in a nationally representative sample of adults in the United States. METHODS. Data were collected as part of a household probability survey of adults (n = 2058) in the United States. Data collected on sexual behavior included sexual orientation, frequency of intercourse, condom use, and number of sexual partners. RESULTS. Nearly all respondents were sexually experienced. Of those who were currently sexually active, 13% (1% of married respondents) had had sex with more than one partner in the previous year. Of those reporting having intercourse with more than one partner in the previous year, 7% used condoms consistently and 23% used condoms consistently with their casual partners. CONCLUSIONS. A significant proportion of individuals were found to have intercourse with multiple partners without using condoms. A minority of these respondents acknowledged that their behavior may place them at risk for HIV transmission.
Estimated condom failure and frequency of condom use among gay men.
Authors: Thompson J L , Yager T J , Martin J L
Published: November 2008

OBJECTIVES. Condoms are designed to bar transmission of the human immunodeficiency virus (HIV), but they sometimes fail. This paper explores the effect of experience with condoms on condom failure among gay men. METHODS. Risk of condom failure (breakage or slippage) on a single occasion is estimated for four sexual acts reported over 12 months by a sample of gay New York City men (n = 741). The estimation procedure assumes that each episode in which a condom is used is an independent event. Evidence is offered to support this assumption. RESULTS. Risk of condom failure in a single episode was fairly high, particularly in anal intercourse, for men who had engaged in each act only a few times in the previous year. It declined rapidly with experience (e.g., to below 1% for receptive anal intercourse after about 10 episodes in the previous year). Condoms failed less often in oral than anal sex, but estimated risk of failure also decreased with experience. CONCLUSIONS. Gay men should be especially cautious the first few times they use a condom; after moderate experience, however, they may expect a low risk of condom failure.
The taking of free condoms in a drug abuse treatment clinic: the effects of location and posters.
Authors: Amass L , Bickel W K , Higgins S T , Budney A J , Foerg F E
Published: November 2008

Drug abuse treatment programs can help reduce high-risk sexual behavior in drug users by promoting condom use. This study examined the influence of distribution location and poster prompts on the taking of free condoms in a drug abuse treatment clinic. Over 6 months, condoms were available alternately, with and without poster prompts, in the clinic's private restroom or public waiting area. Overall, 381% more condoms were taken from the restroom. The presence of poster prompts did not affect condom taking. These results suggest that distribution location is a critical factor in promoting condom taking in public clinic.
Commentary: in search of innovative approaches to international health.
Authors: Kark S L , Kark E , Abramson J H
Published: November 2008

The community health program of the Aga Khan University in Pakistan is reviewed from the perspective of historic and present-day developments in primary health care based in and focused on the community. The approach commonly referred to as community-oriented primary health care involves the complementary functions of clinical practice and epidemiology in partnership with the community. Encouragement and support by governments and other organizations for teaching and research in this field would ensure more adequate preparation of future practitioners and health scientists for community-oriented primary health care and would lead to improved health. Continuity of support for community health programs is important.
Low birthweight and infant mortality in Puerto Rico.
Authors: Becerra J E , Atrash H K , Pérez N , Saliceti J A
Published: November 2008

OBJECTIVES. The purpose of this study was to quantify the relative contributions of maternal age, education, marital status, hospital of birth, and use of prenatal care to the high incidence of low birthweight and infant mortality in Puerto Rico. METHODS. An analysis was conducted of 257,537 live births that occurred from 1986 through 1989 among Puerto Rico residents and the 3373 corresponding infant deaths. Binomial multiple regression models were used to calculate the adjusted population attributable risks for each variable. RESULTS. Our estimates indicate that approximately 6 of every 10 infant deaths on the island are potentially preventable if low birthweight were eradicated, regardless of other associated factors. Eliminating risks associated with sociodemographic and socioeconomic factors (including hospital of birth) would potentially decrease the incidence of low birth-weight in Puerto Rico by one third. Specifically, the elimination of risks associated with the socioeconomic disadvantage of women delivering in public hospitals alone would potentially decrease Puerto Rico's low birthweight incidence by 28%, regardless of other factors considered in our study. CONCLUSIONS. Efforts to prevent low birthweight and infant mortality in Puerto Rico should focus on reducing the gap between the private and public sectors.
The epidemiology of child abuse: findings from the Second National Incidence and Prevalence Study of Child Abuse and Neglect.
Authors: Cappelleri J C , Eckenrode J , Powers J L
Published: November 2008

The epidemiology of child abuse was investigated with data from the Second National Incidence and Prevalence Study of Child Abuse and Neglect. A statistical comparison of incidence rates suggested that age, family income, and ethnicity were risk factors for both sexual abuse and physical abuse, but county metrostatus was not. Gender was a risk factor for sexual abuse but not for physical abuse. A logistic regression analysis showed that ethnicity, county metrostatus, and a gender-by-income interaction distinguished sexual abuse from physical abuse.
Activity, inactivity, and obesity: racial, ethnic, and age differences among schoolgirls.
Authors: Wolf A M , Gortmaker S L , Cheung L , Gray H M , Herzog D B , Colditz G A
Published: November 2008

Physical activity, inactivity, and obesity were assessed by questionnaire among a multiethnic sample of 552 girls in grades 5 through 12. Hispanics and Asians reported lower activity levels than other racial groups. Only 36% of the entire sample and less than one fifth of either Asians or Hispanics met the year 2000 goal for strenuous physical activity. Physical activity was inversely associated with age and age-adjusted body mass index. Obesity was unrelated to inactivity.
The choice of weapons in firearm suicides in Iowa.
Authors: Zwerling C , Lynch C F , Burmeister L F , Goertz U
Published: November 2008

This study reports the types of firearms used in firearm suicides in Iowa and tests the hypothesis that the use of handguns, rifles, and shotguns in such suicides reflects the availability of these weapons. The percentage of firearm suicides involving handguns increased from 36.6% in 1980 through 1984 to 43.3% during 1990 and 1991. In both time periods, the use of handguns was more likely than would be expected from their household prevalence. Our data suggest that handguns are disproportionately represented among firearm suicides and that this overrepresentation has increased during the last decade.
The effects of resistance strategies on rape.
Authors: Zoucha-Jensen J M , Coyne A
Published: November 2008

This investigation sought to clarify which resistance strategies were associated with rape avoidance and at what cost. Data were gathered from initial and supplemental police reports about 150 sexual assault victims, ages 16 and older, who were assaulted between June 1, 1988, and May 31, 1989, in Omaha, Neb. Although this analysis could not determine causality, it did indicate that forceful verbal resistance, physical resistance, and fleeing were all associated with rape avoidance, whereas nonforceful verbal resistance and no resistance were associated with being raped. Further, women who used forceful resistance were no more likely to be injured than women who did not resist.
Hepatitis B control in China: knowledge and practices among village doctors.
Authors: Clayton S , Yang H , Guan J , Lin Z , Wang R
Published: November 2008

OBJECTIVES. To guide development of a hepatitis B control program in China, we investigated village doctors' sterilization practices, injection use, vaccination levels, and knowledge and counseling skills. METHODS. The head doctor from each village health station in a rural county (n = 260) completed a self-administered questionnaire. RESULTS. Of the respondents, 94.2% reported adequate sterilization of needles; however, inadequate sterilization of syringes and acupuncture needles was common. Injections were found to be frequent and profitable. Of head doctors, 16.2% reported that most infants in their villages are vaccinated against hepatitis B. There was very high knowledge of modes of hepatitis B transmission, but it was not used to formulate advice for a hypothetical carrier. Knowledge of the consequences, prevalence, and use of condoms to prevent sexual transmission was lower. CONCLUSIONS. The sterilization of acupuncture needles, reuse of syringes, and frequent injections are practices that may transmit the hepatitis B virus. Research into issues of vaccine acceptance is needed to expand immunization. A review of treatment practices and better training in counseling for village doctors is suggested.
Custody of cocaine-exposed newborns: determinants of discharge decisions.
Authors: Neuspiel D R , Zingman T M , Templeton V H , DiStabile P , Drucker E
Published: November 2008

OBJECTIVES. Maternal cocaine use is a leading grounds for newborn foster placement. This study was initiated to investigate the factors that predict custody status of infants born to substance-abusing women. METHODS. A retrospective cohort design was used to study the correlates of discharge custody decisions for 99 consecutive infants testing positive for cocaine in a public hospital. RESULTS. The population was 49% Black, 40% Hispanic, and 11% other or unknown. Custody at discharge was to mothers (38%), other family members (25%), or agency foster care (36%). Placement outside the family was greater when mothers had prior child welfare records, in Blacks vs others, with no prenatal care, and when mothers were younger at their first delivery or older at the index birth. Denial of custody to the mother was higher with prior child welfare involvement, in Blacks, and when the mother did not live in her own home. Both models also controlled for parity, child sex, and birthweight. CONCLUSIONS. Earlier involvement with child welfare authorities, race, and other factors predict continued separation of mothers and children at newborn discharge, suggesting the need to reexamine current policies and practices.
Cause of death in patients with end-stage renal disease: death certificates vs registry reports.
Authors: Perneger T V , Klag M J , Whelton P K
Published: November 2008

OBJECTIVES. The purpose of this study was to assess agreement on cause of death reporting in end-stage renal disease patients by comparing death certificates and reports to an end-stage renal disease registry. METHODS. Death certificates and registry reporting forms were retrieved for a random sample of 335 treated end-stage renal disease patients who died between 1980 and 1986 in Maryland. On the registry form, patient death was ascribed to 1 of 22 precoded causes by the patient's nephrologist of record. Corresponding death certificates were coded, according to rules of the International Classification of Diseases, 9th edition, by a trained observer unaware of the registry report. Agreement was measured by the kappa statistic. RESULTS. Overall cause of death agreement was poor (31%), and varied by the following categories: renal disease (40% on death certificates vs 0% on registry reports), cardiovascular disease (26% vs 47%), infectious disease (16% vs 22%), cancer (7% vs 5%), and withdrawal from therapy (0% vs 3%). Agreement was higher for transplant recipients than for dialyzed patients. CONCLUSIONS. Death certificates and registry reports yield different descriptions of mortality in end-stage renal disease patients. These sources of information should not be used interchangeably. Improvements to International Classification of Diseases coding of renal diseases and the determination of the reliability and validity of the US Renal Data System reporting process are necessary steps in the development of renal disease epidemiology.
Antibodies to Borrelia burgdorferi and tick salivary gland proteins in New Jersey outdoor workers.
Authors: Schwartz B S , Goldstein M D , Childs J E
Published: November 2008

In 1990, a second cross-sectional study of outdoor workers (n = 758) at high risk for Lyme disease was conducted. A questionnaire was administered, and antibodies to Borrelia burgdorferi and tick salivary gland proteins (antitick saliva antibody, a biologic marker of tick exposure) were assayed by enzyme-linked immunosorbent assay. The statewide Lyme disease seroprevalence increased from 8.1% in 1988 to 18.7% in 1990. Antitick saliva antibody seropositivity varied by county and was associated with measures of self-reported tick exposure. The data suggested that the prevalence of B. burgdorferi infection increased in New Jersey outdoor workers from 1988 to 1990.
The school-based immunization survey: an inexpensive tool for measuring vaccine coverage.
Authors: Rodewald L E , Roghmann K J , Szilagyi P G , Winter N L , Campbell J R , Humiston S G
Published: November 2008

A school-based immunization survey was conducted among the 36 Rochester, NY, elementary schools (n = 5584 children) to determine (1) the vaccination rates at 2 years of age by type of primary care provider and (2) the accuracy of school immunization records (by comparing them with medical charts for children attending hospital-based clinics). These rates varied by provider type from 58% to 86% and were all below the national goal of 90%. In comparison with medical chart review, the school data had error rates of 15%; however, these errors occurred in both directions and were thus unbiased. School-based surveys include children who lack connections to the primary care system. With minimal effort these surveys can help identify populations in need of intervention.