bluuebunny/crossref_metadata_2025 huggingface dataset:
The validity of self-reported smoking: a review and meta-analysis.
Authors: Patrick D L , Cheadle A , Thompson D C , Diehr P , Koepsell T , Kinne S
Published: November 2008

OBJECTIVES. The purpose of this study was to identify circumstances in which biochemical assessments of smoking produce systematically higher or lower estimates of smoking than self-reports. A secondary aim was to evaluate different statistical approaches to analyzing variation in validity estimates. METHODS. Literature searches and personal inquiries identified 26 published reports containing 51 comparisons between self-reported behavior and biochemical measures. The sensitivity and specificity of self-reports of smoking were calculated for each study as measures of accuracy. RESULTS. Sensitivity ranged from 6% to 100% (mean = 87.5%), and specificity ranged from 33% to 100% (mean = 89.2%). Interviewer-administered questionnaires, observational studies, reports by adults, and biochemical validation with cotinine plasma were associated with higher estimates of sensitivity and specificity. CONCLUSIONS. Self-reports of smoking are accurate in most studies. To improve accuracy, biochemical assessment, preferably with cotinine plasma, should be considered in intervention studies and student populations.
Self-rated health and survival: a 7-year follow-up study of Australian elderly.
Authors: McCallum J , Shadbolt B , Wang D
Published: November 2008

OBJECTIVES. This study tested the hypothesis, from North American findings, that global self-ratings of health predict survival for older Australians. METHODS. A stratified sample of Australians 60 years of age and older surveyed in 1981 was resurveyed in 1988. Cox proportional hazard general linear models were constructed separately for men and women to predict survival over 7 years. RESULTS. Better self-ratings of health had an incremental association with survival for women, but only men with poor ratings had significantly worse survival than others. After major illnesses, comorbidities, disability, depression, and social support were controlled for, poor ratings of health for both men and women were not significantly different from excellent ratings in predicting survival. Only women's good and fair health ratings remained significant predictors. CONCLUSIONS. People rate their health as poor on the objective basis of illness and disability. Australian findings show gender differences relative to North American results; methodological differences and site and gender variability in health profiles are discussed as reasons for the varying results.
Maternal-infant HIV transmission and circumstances of delivery.
Authors: Kuhn L , Stein Z A , Thomas P A , Singh T , Tsai W Y
Published: November 2008

OBJECTIVES. Circumstances of delivery among children with acquired immunodeficiency syndrome (AIDS) were investigated to assess whether they were consistent with predictions that intrapartum factors affect the risk of maternal-infant human immunodeficiency virus (HIV) transmission. METHODS. Pediatric AIDS patients (maternal-infant transmission; n = 632) reported to the New York City Health Department through 1991 were compared with a series of infants born to predominantly uninfected women. For each case patient, five control subjects were selected and matched from birth certificate files. Hypothesized case-control comparisons for mode of delivery and preselected complications were tested. RESULTS. Compared with control subjects, case patients were less likely to have been delivered by cesarean section without complications (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.59, 1.01) and more likely to have been delivered with complications, whether delivery was by cesarean section (OR = 1.54; 95% CI = 0.98, 2.43) or vaginal (OR = 1.66; 95% CI = 1.15, 2.39). CONCLUSIONS. Assuming that HIV-infected and uninfected women have comparable circumstances of delivery, conditional on sociomedical characteristics, these results suggest that intrapartum events may be associated with maternal-infant HIV transmission.
Substance use and HIV-related sexual behaviors among US high school students: are they related?
Authors: Lowry R , Holtzman D , Truman B I , Kann L , Collins J L , Kolbe L J
Published: November 2008

OBJECTIVES. This study was undertaken to examine whether use of alcohol, cigarettes, marijuana, cocaine, and other illicit drugs is related to the likelihood of sexual behaviors that increase risk for human immunodeficiency virus (HIV) infection among youth. METHODS. The 1990 national Youth Risk Behavior Survey was used to collect self-reported information about a broad range of health risk behaviors from a representative sample of 11,631 high school students in the United States. RESULTS. Students who reported no substance use were least likely to report having had sexual intercourse, having had four or more sex partners, and not having used a condom at last sexual intercourse. Adjusted for age, sex, and race/ethnicity, odds ratios for each of these sexual risk behaviors were greatest among students who had used marijuana, cocaine, or other illicit drugs. Students who had used only alcohol or cigarettes had smaller but still significant increases in the likelihood of having had sexual intercourse and of having had four or more sex partners. CONCLUSIONS. HIV prevention programs for youth should recognize that substance use may be an important indicator of risk for HIV infection and acquired immunodeficiency syndrome through its association with unsafe sexual behaviors.
Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors.
Authors: Kelder S H , Perry C L , Klepp K I , Lytle L L
Published: November 2008

OBJECTIVES. A major assumption underlying youth health promotion has been that physiological risk factors track from childhood into adulthood. However, few studies have systematically examined how behaviors change during adolescence. This paper describes longitudinal tracking of adolescent health behaviors in two Minnesota Heart Health Program communities. METHODS. Beginning in sixth grade (1983), seven annual waves of behavioral measurements were taken from both communities (baseline n = 2376). Self-reported data included smoking behavior, physical activity, and food preferences. RESULTS. A progressive increase in the change to weekly smoking status was observed across the smoking status categories. As students began to experiment with smoking, they were more likely to either begin to be or remain regular smokers. Tracking of physical activity and food choice variables was also apparent. In nearly all the follow-up periods, the students identified at baseline as measuring high remained high, and those measuring low remained low. CONCLUSIONS. These results indicate that there is evidence of early consolidation and tracking of physical activity, food preference, and smoking behavior. The early consolidation of health behaviors implies that interventions should begin prior to sixth grade, before behavioral patterns are resistant to change. The smoking results suggest that students are experiencing difficulty quitting smoking; thus, youth smoking cessation interventions are warranted.
Exposure to hair-coloring products and the risk of multiple myeloma.
Authors: Herrinton L J , Weiss N S , Koepsell T D , Daling J R , Taylor J W , Lyon J L , Swanson G M , Greenberg R S
Published: November 2008

An interview study of persons diagnosed with multiple myeloma between 1977 and 1981 and suitable control subjects was conducted to test the hypothesis that exposure to hair dyes increases the risk of multiple myeloma. Among women, there was little evidence that prior regular use of hair dyes (odds ratio [OR] = 1.0; 95% confidence interval [CI] = 0.70, 1.4) or prior employment as a hairdresser (OR = 1.1; 95% CI = 0.43, 2.7) increased risk; however, the former comparison was limited by the lack of detailed information concerning the exposure. Among men, there was a modest association of regular use of hair dyes (OR = 1.5; 95% CI = 0.75, 2.9) with myeloma, but this was based on a small number of exposed persons.
A decision-analytic approach to postexposure rabies prophylaxis.
Authors: Cantor S B , Clover R D , Thompson R F
Published: November 2008

The risks and benefits of postexposure rabies prophylaxis were analyzed from clinical and economic perspectives. A decision-analytic model was constructed by using probability and outcome data from the literature and the state health department. Health outcomes were measured in quality-adjusted life years. In the base case (overweight adult male), treatment is optimal when the probability of animal rabidity is greater than 1 in 2000. Sensitivity analysis showed robustness in the treatment decision; however, the incremental cost-effectiveness ratio ($140,000/quality-adjusted life year) is sensitive to the rabidity probability. Treatment is optimal from the patient's perspective; however, it may not be cost-effective when the probability of rabidity is low.
Using a geographic information system to understand child pedestrian injury.
Authors: Braddock M , Lapidus G , Cromley E , Cromley R , Burke G , Banco L
Published: November 2008

Data from police accident reports involving pedestrians less than 20 years of age in Hartford, Conn, during 1988 through 1990 were abstracted and entered into a geographic information system. Two high-frequency collision areas were identified and compared. There were 374 child pedestrians involved in collisions (a rate of 28 per 10,000). Two high-occurrence areas accounted for 30% of collisions. Collisions in one of these areas were more likely to involve younger children (8.1 vs 10.2 years of age) and to occur in the late afternoon, and occurred closer to the child's residence, than collisions in the other area. The geographic information system is a useful tool in the study of child pedestrian collisions.
Socioeconomic factors and height of preschool children in the Czech Republic.
Authors: Bobák M , Kríz B , Leon D A , Dánová J , Marmot M
Published: November 2008

The effect of socioeconomic factors on growth was investigated among 2275 children 3 to 6 years old attending nurseries in the Czech Republic. Measured heights of children were converted into height-for-age z scores. After adjustment for birthweight, parental height, and other socioeconomic variables, only mother's education was independently and significantly associated with children's height; adjusted differences in z scores between children of secondary- and university-educated mothers and children of mothers with only primary education were 0.12 and 0.31, respectively. This is equivalent to 0.5 and 1.5 cm, respectively, for children 5 years old.
The agrarian myth and policy responses to farm safety.
Authors: Kelsey T W
Published: November 2008

Agriculture's status as one of the nation's most hazardous occupations has been an impetus for a reexamination of the federal role in agricultural safety and for various proposals to make farming safer. During the 1970s congressional debate and farm group testimony that led to agriculture's current exemption from the Occupational Safety and Health Administration's enforcement efforts, regulation foes made use of the "Agrarian Myth." The myth portrays farmers as the bedrock of democracy, suffering so that society may prosper and living a natural life away from the artificiality and evils of cities. Despite the inaccuracy of its images, the myth is a potent symbol in American culture, and its influence could arise again in current policy debates. This paper examines specific issues that may be obscured by the myth but that must be addressed in any agricultural safety policy debate. It then recommends that responses to agricultural safety be carefully considered and that value judgements about what the issues are, who would benefit, and who would bear the costs be explicitly discussed during debate.
The demographic distribution of US drinking patterns in 1990: description and trends from 1984.
Authors: Midanik L T , Clark W B
Published: November 2008

OBJECTIVES. Since 1981, per capita consumption of alcohol (based on sales figures) has decreased in the United States. This study describes drinking patterns in the 1990 national alcohol survey by demographic correlates and assesses changes in drinking patterns from the 1984 survey. METHODS. Data were obtained from a national household probability sample within the 48 contiguous states; face-to-face interviews were conducted with 2058 adults. The instrument contained questions pertaining to the respondent's background, attitudes toward alcohol, and use of alcohol. RESULTS. The proportions of current drinkers; current drinkers of wine, beer, and liquor; weekly drinkers; and drinkers who reported having five or more drinks per occasion at least once a week were significantly lower in 1990 than in 1984. These changes remained significant when demographic characteristics were controlled by logistic regression. The findings held for Whites only; there were no significant trends for Blacks or Hispanics. CONCLUSIONS. While there has been a downward turn in alcohol use in the United States, the correlates of alcohol use have not changed. How these shifts affect alcohol-related problems is an important area for future research.
A national study of transitional hospital services in mental health.
Authors: Dorwart R A , Hoover C W
Published: November 2008

OBJECTIVES. Shifts in care for the seriously mentally ill from inpatient to community-based treatment have highlighted the importance of transitional care. Our objectives were to document the kinds and quantity of transitional services provided by psychiatric hospitals nationally and to assess the impact of hospital type (psychiatric vs general), ownership (public vs private), case mix, and revenue source on provision of these services. METHODS. A national sample of nonfederal inpatient mental health facilities (n = 915) was surveyed in 1988, and data were analyzed by using multiple regression. RESULTS. Half (46%) of the facilities surveyed provided patient follow-up of 1 week or less, and almost all (93%) conducted team review of discharge plans, but 74% provided no case management services. Hospital type was the most consistent predictor of transitional care, with psychiatric hospitals providing more of these services than general hospitals. Severity of illness, level of nonfederal funding, urbanicity, and teaching hospital affiliation were positively associated with provision of case management. CONCLUSIONS. Transitional care services for mentally ill patients leaving the hospital were found to be uneven and often inadequate. Reasons for broad variation in services are discussed.
A recent decline in cocaine use among youthful arrestees in Manhattan, 1987 through 1993.
Authors: Golub A , Johnson B D
Published: November 2008

OBJECTIVES. Cocaine use among youths as measured by several annual surveys was most popular from about 1979 to 1986, after which it declined. This study carefully examines the nature of the decline by focusing on microdata for youthful arrestees in Manhattan. METHODS. Multiple statistical analyses examine whether the decline in cocaine use detected by urinalysis is attributable to fewer arrested youths born more recently having become regular users (cohort effect), to regular users decreasing their consumption (period effect), or to changes in arrest or sampling priorities (artifact). RESULTS. All analyses suggest that the dramatic decline in detected cocaine use among arrestees--from 69% in 1987 to 17% in 1993--was a cohort effect. Detected cocaine use, which was highest (78%) among arrestees reaching 18 in 1986 at the height of the crack epidemic in New York City, subsequently declined to a low of 10% among arrestees reaching 18 in 1993. DISCUSSION. These findings suggests that the epidemic in use of cocaine and crack entered a decline in the late 1980s. However, widespread use of these drugs will probably continue to prevail as an aging population with established habits persists in its use.
The US economic and social costs of Alzheimer's disease revisited.
Authors: Ernst R L , Hay J W
Published: November 2008

OBJECTIVEs. An earlier paper estimated the per-case and national incidence costs of Alzheimer's disease for 1983. This paper updates the estimates of costs per case to 1991 and presents new national prevalence estimates of the economic and social costs of the disease. METHODS. All data for the cost estimates were taken from published sources or provided by other researchers. RESULTS. At midrange values of the estimated cost and epidemiological parameters, the discounted (at 4%) direct and total costs of Alzheimer's disease were $47,581 and $173,932 per case, respectively. The estimated 1991 national direct and total prevalence costs were $20.6 billion and $67.3 billion, respectively. Assuming conservatively that the prevalence of the disease remains constant, the estimated discounted present values of the direct and total costs of all current and future generations of Alzheimer's patients are $536 billion and $1.75 trillion, respectively. CONCLUSIONS. The $536 billion and $1.75 trillion figures are minimum estimates of the long-term dollar losses to the US economy in 1991 caused by Alzheimer's disease.
The burden and outcomes associated with dehydration among US elderly, 1991.
Authors: Warren J L , Bacon W E , Harris T , McBean A M , Foley D J , Phillips C
Published: November 2008

OBJECTIVES. Dehydration has been underappreciated as a cause of hospitalization and increased hospital-associated mortality in older people. This study used national data to analyze the burden and outcomes following hospitalizations with dehydration in the elderly. METHODS. Data from 1991 Medicare files were used to calculate rates of hospitalization with dehydration, to examine demographic characteristics and concomitant diagnoses associated with dehydration, and to analyze the contribution of dehydration to mortality. RESULTS. In 1991, 6.7% (731,695) of Medicare hospitalizations had dehydration listed as one of the five reported diagnoses, a rate of 236.2/10,000 elderly Medicare beneficiaries. In 1991, Medicare reimbursed over $446 million for hospitalizations with dehydration as the principal diagnosis. Older people, men, and Blacks had elevated risks for hospitalization with dehydration. Acute infections, such as pneumonia and urinary tract infections, were frequent concomitant diagnoses. About 50% of elderly Medicare beneficiaries hospitalized with dehydration died within a year of admission. CONCLUSIONS. Hospitalization of elderly people with dehydration is a serious and costly medical problem. Attention should be focused on understanding predisposing factors and devising strategies for prevention.
Treatment and survival among elderly Americans with hip fractures: a population-based study.
Authors: Lu-Yao G L , Baron J A , Barrett J A , Fisher E S
Published: November 2008

OBJECTIVES. This study was undertaken to examine the patterns of treatment and survival among elderly Americans with hip fracture. METHODS. A 5% national sample of Medicare claims was used to identify patients who sustained hip fractures between 1986 and 1989. In comparing treatment patterns across regions, direct standardization was used to derive age- and race-adjusted percentages. Logistic regression and Cox regression were used to examine short- and long-term survival. RESULTS. In the United States, 64% of femoral neck fractures were treated with arthroplasty; 90% of pertrochanteric fractures were treated with internal fixation. Higher short- and long-term mortality was associated with being male, being older, residing in a nursing home prior to fracture, having a higher comorbidity score, and having a pertrochanteric fracture. Blacks and Whites had similar 90-day postfracture mortality, but Blacks had a higher mortality later on. For femoral neck fracture, internal fixation has a modestly lower short-term mortality associated with it than arthroplasty has. CONCLUSION. Variation in the treatment of hip fracture was modest, The increased delayed mortality after hip fracture among Blacks requires further study.
The prevalence and demographic predictors of illicit and licit drug use among lesbians and gay men.
Authors: Skinner W F
Published: November 2008

Studies on illicit and licit drug use among homosexuals of both sexes have focused primarily on gay men, used limited drug measures, and been conducted in cities known for large homosexual populations. This paper examines (1) the prevalence of 12 illicit and licit drugs by sex and age group and (2) the demographic predictors of past-year frequency of marijuana, alcohol, and cigarette use. Organizational mailing lists were used to collect self-report data on 455 homosexuals living in a southern state. Differences were found between gay men and lesbians in the use of specific substances and in the demographic predictors of drug use.
Subsequent hip fracture among older adults.
Authors: Wolinsky F D , Fitzgerald J F
Published: November 2008

Subsequent hip fracture among the 368 Longitudinal Study on Aging respondents who fractured their hips from 1984 through 1991 was prospectively examined. Case-by-case review of the billing records indicated that 27 subsequent hip fractures occurred, for a rate of 1 every 33.8 person-years. Multivariable proportional hazard regression revealed that increased risks of subsequent hip fracture were associated with poor perceived health status and dizziness.
Lifetime milk consumption and bone mineral density in older women.
Authors: Soroko S , Holbrook T L , Edelstein S , Barrett-Connor E
Published: November 2008

This study examined the relationship between lifetime milk consumption both axial and appendicular bone mineral density in 581 postmenopausal White women. Positive significant, graded associations between milk consumption in adulthood and bone mineral density at the spine, total hip, trochanter, intertrochanter, and midradius, but not the ultradistal wrist or femoral neck, were observed. Adolescent milk consumption showed similar, statistically significant associations (spine and midradius). Associations were independent of age, body mass index, years postmenopausal, thiazide, estrogen and alcohol use, smoking, and exercise. Regular milk consumption in youth and adulthood is associated with better bone mineral density at cortical and trabecular sites in elderly women.
Attitudes toward body size and dieting: differences between elderly black and white women.
Authors: Stevens J , Kumanyika S K , Keil J E
Published: November 2008

Eating restraint and body size perceptions of 404 White and African-American women 66 to 105 years of age (mean age = 73 years) were assessed by questionnaire. Compared with overweight White women, overweight Black women were 0.6 times as likely to feel guilty after overeating, 0.4 times as likely to diet, 2.5 times as likely to be satisfied with their weight, and 2.7 times as likely to consider themselves attractive. Among those who were not overweight, Black women were half as likely as White women to consider themselves overweight. Compared with Black women, White women perceived themselves to be larger and reported a lower ideal body weight.
The 1966 enactment of Medicare: its effect on discharges from Los Angeles County-operated hospitals.
Authors: Glassman P A , Bell R M , Tranquada R E
Published: November 2008

The effect of Medicare on two public hospitals in Los Angeles County was analyzed by examining the percentage of patients 65 years of age and older among all discharges from 1958 through 1971. At Harbor General Hospital, discharges of elderly patients had dropped from 21.7% to 7.9% by late 1966; at Los Angeles County General Hospital, discharges decreased from 15.3% to 10.7% between 1966 and 1967. Monitoring public hospitals' demographic changes after enacting a national health plan may provide information on patients' and providers' acceptance of insurance and on resources needed by public hospitals to care for those left without coverage.
Patients' rights to care under Clinton's Health Security Act: the structure of reform.
Authors: Mariner W K
Published: November 2008

Like most reform proposals, President Clinton's proposed Health Security Act offers universal access to care but does not significantly alter the nature of patients' legal rights to services. The act would create a system of delegated federal regulation in which the states would act like federal administrative agencies to carry out reform. To achieve uniform, universal coverage, the act would establish a form of mandatory health insurance, with federal law controlling the minimum services to which everyone would be entitled. Because there is no constitutionally protected right to health care and no independent constitutional standard for judging what insurance benefits are appropriate, the federal government would retain considerable freedom to decide what services would and would not be covered. If specific benefits are necessary for patients, they will have to be stated in the legislation that produces reform.
Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program.
Authors: Luepker R V , Murray D M , Jacobs D R , Mittelmark M B , Bracht N , Carlaw R , Crow R , Elmer P , Finnegan J , Folsom A R
Published: November 2008

OBJECTIVES. The Minnesota Heart Health Program is a 13-year research and demonstration project to reduce morbidity and mortality from coronary heart disease in whole communities. METHODS. Three pairs of communities were matched on size and type; each pair had one education site and one comparison site. After baseline surveys, a 5- to 6-year program of mass media, community organization, and direct education for risk reduction was begun in the education communities, whereas surveys continued in all sites. RESULTS. Many intervention components proved effective in targeted groups. However, against a background of strong secular trends of increasing health promotion and declining risk factors, the overall program effects were modest in size and duration and generally within chance levels. CONCLUSIONS. These findings suggest that even such an intense program may not be able to generate enough additional exposure to risk reduction messages and activities in a large enough fraction of the population to accelerate the remarkably favorable secular trends in health promotion activities and in most coronary heart disease risk factors present in the study communities.
Maternal smoking during pregnancy and smoking by adolescent daughters.
Authors: Kandel D B , Wu P , Davies M
Published: November 2008

OBJECTIVES. Since cigarette smoking in adolescence represents a crucial entry point in the progression to illicit drugs, risk factors for adolescent smoking have public health implications. The influence of mothers on children's smoking appears to be greater than that of fathers. To explain the selective influence of mothers, we examined the consequences of maternal smoking during pregnancy in two longitudinal samples. METHODS. Analyses were conducted on follow-up interview data from two dyadic samples of mothers and firstborn adolescents for whom data on maternal smoking during and after pregnancy were available (192 mother-child pairs originating from New York State and 797 dyads from a national sample). RESULTS. In both samples, maternal smoking during pregnancy, when postnatal smoking was controlled, selectively increased the probability that female children would smoke and would persist in smoking (adjusted odds ratios of about 4). CONCLUSIONS. The findings suggest that nicotine or other substances released by maternal smoking can affect the fetus, perhaps through the nicotinic input to the dopaminergic motivational system, so as to predispose the brain in a critical period of its development to the subsequent addictive influence of nicotine consumed more than a decade later in life.
An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index.
Authors: Kotelchuck M
Published: November 2008

OBJECTIVES. The assessment of the adequacy of prenatal care utilization is heavily shaped by the way in which utilization is measured. Although it is widely used, the current major index of utilization, the Kessner/Institute of Medicine Index, has not been subjected to systematic examination. This paper provides such an examination. METHODS. Data from the 1980 National Natality Survey are used to disaggregate the components of the Kessner Index for detailed analysis. An alternative two-part index, the Adequacy of Prenatal Care Utilization Index, is proposed that combines independent assessments of the timing of prenatal care initiation and the frequency of visits received after initiation. RESULTS. The Kessner Index is seriously flawed. It is heavily weighted toward timing of prenatal care initiation does not distinguish timing of initiation from poor subsequent utilization, inaccurately measures utilization for full- or post-term pregnancies, and lacks sufficient documentation for consistent computer programming. CONCLUSIONS. The Adequacy of Prenatal Care Utilization Index offers a more accurate and comprehensive set of measures of prenatal care utilization than the Kessner Index.
Prenatal alcohol exposure, birthweight, and measures of child size from birth to age 14 years.
Authors: Sampson P D , Bookstein F L , Barr H M , Streissguth A P
Published: November 2008

OBJECTIVES. The purpose of the study was to examine the effect of prenatal alcohol exposure on offspring's weight, height, and head circumference from birth through 14 years of age. METHODS. This longitudinal prospective study examined a cohort of approximately 500 offspring (oversampled for heavier drinkers and stratified for smoking from a population of 1529 women in prenatal care at the 5th gestational month) at birth; 8 and 18 months; and 4, 7, and 14 years of age. Covariates were examined by means of multiple regression. Birth size measures were also examined as predictors of 7-year neurodevelopmental outcomes. RESULTS. Effects of alcohol were observed on weight, length, and head circumference at birth; these effects were not altered by adjustment for covariates including smoking. However, the birthweight effect is clearly transient: although alcohol effects remained observable at 8 months, they were not measurable thereafter through age 14 years. CONCLUSIONS. In this population-based sample, neither birthweight nor any later size measure was as useful an indicator of the enduring effects of prenatal alcohol exposure as were certain neurodevelopmental outcomes.
The relationship of prenatal care and pregnancy complications to birthweight in Winnipeg, Canada.
Authors: Mustard C A , Roos N P
Published: November 2008

OBJECTIVES. Prenatal care is commonly understood to have a beneficial impact on birthweight. This study describes socioeconomic differences in utilization of prenatal medical care and birthweight in a population with universal health insurance. METHODS. Measures of prenatal care utilization, incidence of pregnancy complications, and birthweight were obtained from physician reimbursement claims and hospital separation abstracts for 12,646 pregnant women. Maternal socioeconomic status was derived from small-area census data. RESULTS. Infants born to women in the poorest income quintile had lower birthweights than infants born to wealthier women. Much of the difference was associated with a higher prevalence of complications, smoking, unmarried status, and inadequate prenatal care among low-income women. The difference in birthweight between adequate and less than adequate care groups was small, and the benefit associated with prenatal care was no greater among women with pregnancy complications. CONCLUSIONS. The lower utilization of prenatal care by poorer women accounted for a small proportion of the difference in birthweight. Socioeconomic differences in birthweight are primarily attributable to factors not directly influenced by early prenatal medical care.
State family planning and abortion expenditures: their effect on public health.
Authors: Meier K J , McFarlane D R
Published: November 2008

OBJECTIVES. This study examines whether state family planning expenditures and abortion funding for Medicaid-eligible women might reduce the number of low-birthweight babies, babies with late or no prenatal care, and premature births, as well as the rates of infant and neonatal mortality. METHODS. Using a pooled time-series analysis from 1982 to 1988 with the 50 states as units of analysis, this study assessed the impact of family planning expenditures and abortion funding on several public health outcomes while controlling for other important variables and statistical problems inherent in pooled time-series studies. RESULTS. States that funded abortions had a significantly higher rate of abortions and significantly lower rates of teen pregnancy, low-birthweight babies, premature births, and births with late or no prenatal care. States that had higher expenditures for family planning had significantly fewer abortions, low-birthweight babies, births with late or no prenatal care, infant deaths, and neonatal deaths. CONCLUSIONS. Funding abortions for Medicaid-eligible women and increasing the level of expenditures for family planning are associated with major differences in infant and maternal health in the United States.
Targeting cancer control: the state cancer control map and data program.
Authors: Pommerenke F A , Miller R W , Srivastava S , Ackermann S P
Published: November 2008

The State Cancer Control Map and Data Program (National Technical Information Service, Springfield, Va) allows state and county mortality maps and data tables to be tailored according to the user's choice of cancer site, age, gender, race, county, and time period between 1953 and 1987. Counties and subpopulations within these maps and data tables that are identified as having exceptionally high rates of specific cancers can then be targeted for early detection or primary prevention. These maps and data tables provide a means for focusing state, local, and individual efforts to reduce cancer mortality in appropriate populations in areas with high mortality rates.
Elevated blood lead levels among construction workers in the Massachusetts Occupational Lead Registry.
Authors: Rabin R , Brooks D R , Davis L K
Published: November 2008

Although the construction industry until recently was exempt from the Occupational Health and Safety Administration General Industry Lead Standard, including its medical monitoring provisions, periodic blood lead tests have been required for residential "deleaders" and structural painters in Massachusetts. Sixty-three percent of the 381 registrants in the Massachusetts Occupational Lead Registry with blood lead levels of 1.93 mumol/L or higher are construction workers. This proportion is much higher than that reported by registries of several states selected for comparison. These data highlight the need for better protection from lead exposure and the effectiveness of mandatory medical surveillance in identifying elevated blood lead levels among construction workers.
Selected antepartum medical complications and very-low-birthweight infants among black and white women.
Authors: DeBaun M , Rowley D , Province M , Stockbauer J W , Cole F S
Published: November 2008

This study estimated the risk of very-low-birthweight delivery among Black and White women with selected treatable antepartum medical conditions. A logistic regression model was applied to a retrospective, population-based data set identified by computerized, linked birth certificate and maternal hospital discharge records. For Black mothers, the adjusted odds ratio for very-low-birthweight delivery was statistically significant for essential hypertension and urinary tract infection. For White mothers, the adjusted odds ratio was statistically significant for essential hypertension, urinary tract infection, pregnancy-induced hypertension, and diabetes mellitus. Public policy designed to reduce the risk of very-low-birthweight delivery must include strategies for attenuating the impact of treatable antepartum medical conditions.
The perinatal and infant health status of Native Hawaiians.
Authors: Kieffer E C , Mor J M , Alexander G R
Published: November 2008

Hawaii vital record data for 1979 through 1990 were analyzed to examine potentially differing relationships between maternal and infant risks and outcomes in native Hawaiian and White infants. Despite high rates of inadequate prenatal care and teenage and unmarried childbearing, the Hawaiian low-birth-weight rate was below the US average. Hawaiian infants experienced an elevated risk of mortality, particularly among those of normal birthweight during the postneonatal period. Public health initiatives to reduce infant mortality must go beyond preventing teenage pregnancy and low birthweight to address Hawaiian infants' unique pattern of risk factors and the social and economic environment in which such risks abound.
Pregnancy risk factors and birth outcomes in Washington State: a comparison of Ethiopian-born and US-born women.
Authors: Wasse H , Holt V L , Daling J R
Published: November 2008

This study compared birth outcomes of three cohorts of women with singleton live births in Washington State between 1980 and 1991: all Black Ethiopian-born women (n = 264) and samples of US-born Black (n = 526) and White (n = 546) women. Ethiopians were older, more likely to be married, and less likely to smoke than were US-born women, and they were less likely to have anemia than US-born Blacks. The adjusted low-birthweight risk among Ethiopians was similar to that of US-born Blacks (relative risk [RR] = 0.9) and Whites (RR = 1.1). Ethiopians were more likely to have high-birthweight infants than were US-born Blacks (RR = 4.0). Cultural and behavioral etiologies may explain these favorable birth outcomes.
The relationship between structural and health services variables and state-level infant mortality in the United States.
Authors: Bird S T , Bauman K E
Published: November 2008

OBJECTIVES. This study compared the relative strength of the associations of a set of structural (social, economic, and political) variables and a set of health services variables with state-level infant, neonatal, and postneonatal mortality. It also examined whether health services mediate the relationships between structural variables and state-level infant, neonatal, and postneonatal mortality. METHODS. With the state as the unit of analysis, data for all 50 states were analyzed by means of multiple regression. RESULTS. Structural variables accounted for substantially more variance in infant, neonatal, and postneonatal mortality than health services variables, and health services variables were more strongly related to infant mortality than to neonatal or postneonatal mortality. When health services variables were controlled, the strengths of the associations between the structural variables and infant, neonatal, and postneonatal mortality were reduced but remained statistically significant. CONCLUSIONS. A substantial portion of the variance in state-level infant mortality is accounted for by states' structural characteristics, which are partially mediated by health services.
The natural history of drug use from adolescence to the mid-thirties in a general population sample.
Authors: Chen K , Kandel D B
Published: November 2008

OBJECTIVES. This study sought to describe patterns of initiation, persistence, and cessation in drug use in individuals from their late 20s to their mid-30s, within a broad perspective that spans 19 years from adolescence to adulthood. METHODS. A fourth wave of personal interviews was conducted at ages 34-35 with a cohort of men and women (n = 1160) representative of adolescents formerly enrolled in New York State public secondary high schools. A school survey was administered at ages 15-16, and personal interviews with participants and school absentees were conducted at ages 24-25 and 28-29. Retrospective continuous histories of 12 drug classes were obtained at each follow-up. RESULTS. There was no initiation into alcohol and cigarettes and hardly any initiation into illicit drugs after age 29, the age at which most use ceased. The largest proportion of new users was observed for prescribed psychoactives. Periods of highest use since adolescence based on relative and absolute criteria were delineated. Among daily users, the proportions of heavy users declined for alcohol and marijuana but not for cigarettes. CONCLUSIONS. Cigarettes are the most persistent of any drug used. Drug-focused interventions must target adolescents and young adults.
Estimating the costs of substance abuse to the Medicaid hospital care program.
Authors: Fox K , Merrill J C , Chang H H , Califano J A
Published: November 2008

OBJECTIVES. The purpose of this study was to develop a model, using the epidemiologic tool of attributable risk, for estimating the cost of substance abuse to Medicaid. METHODS. Based on prior substance-use and morbidity research, population attributable risks for substance abuse-related diseases were calculated. (These risks measure the proportion of total disease cases attributable to smoking, drinking, and drug use.) The risks for each disease were applied to Medicaid hospital discharges and days on the 1991 National Hospital Discharge Survey that had these diseases as primary diagnoses. The cost of these substance abuse-related days were added to Medicaid hospital costs for direct treatment of substance abuse. RESULTS. More than 60 medical conditions involving 1100 diagnoses were identified, at least in part, as attributable to substance abuse. Factoring these substance abuse-related conditions into hospital costs, 1 out of 5 Medicaid hospital days, or 4 million days, were spent on substance abuse-related care in 1991. In 1994, this would account for almost $8 billion in Medicaid expenditures. CONCLUSIONS. The use of tobacco, alcohol, and drugs contributes significantly to hospital costs. To address rising costs, substance abuse treatment and prevention should be an integral part of any health care reform effort.
Compliance with the 1992 California motorcycle helmet use law.
Authors: Kraus J F , Peek C , Williams A
Published: November 2008

To evaluate helmet use in California before and after the introduction of an unrestricted helmet use law on January 1, 1992, observations of motorcycles and their riders were made at 60 locations in seven California counties, twice before and four times after the law was introduced. Helmet use increased from about 50% in 1991 to more than 99% throughout 1992. Compliance was achieved despite variations in helmet use by motorcycle design and road type. Seven percent of riders used nonstandard helmets after the law. With adequate enforcement, unrestricted helmet use laws can achieve almost 100% compliance and reduce the number of people riding motorcycles.
Health policy approaches to measuring and valuing human life: conceptual and ethical issues.
Authors: Morrow R H , Bryant J H
Published: November 2008

To achieve more cost-effective and equitable use of health resources, improved methods for defining disease burdens and for guiding resource allocations are needed by health care decision makers. Three approaches are discussed that use indicators that combine losses due to disability with losses due to premature mortality as a measure of disease burden. These indicators can also serve as outcome measures for health status in economic analyses. However, their use as tools for measuring and valuing human life raises important questions concerning the measurement of mortality and the multidimensions of morbidity; valuing of life, particularly regarding weighting productivity, dependency, age, and time-preference factors; and conflicts between equity and efficiency that arise in allocation decisions. Further refinement of these tools is needed to (1) incorporate national and local values into weighting; (2) elaborate methods for disaggregating calculations to assess local disease patterns and intervention packages; and (3) develop guidelines for estimating marginal effects and costs of interventions. Of utmost importance are methods that ensure equity while achieving reasonable efficiency.
Health services access and use among older adults in North Carolina: urban vs rural residents.
Authors: Blazer D G , Landerman L R , Fillenbaum G , Horner R
Published: November 2008

OBJECTIVES. This study compared health service use and satisfaction with health care among older adults living in urban vs rural counties in North Carolina. METHODS. A stratified random sample of 4162 residents of one urban and four rural counties of North Carolina was surveyed to determine urban/rural variation in inpatient and outpatient health service use, continuity of care and satisfaction with care, and barriers (transportation, cost) to care. RESULTS. Inpatient and outpatient service use did not vary by residence in controlled analyses. Continuity of care was more frequent in rural counties. Transportation was not perceived as a barrier to health care more frequently in rural than in urban counties, but cost was a greater barrier to care among rural elderly people. CONCLUSIONS. In this sample, older persons living in rural counties within reasonable driving distance of urban counties with major medical centers used health services as frequently and were as satisfied with their health care as persons in urban counties. Cost of care, however, was a significant and persistent barrier among rural elderly people, despite Medicare coverage.
State health care expenditures under competition and regulation, 1980 through 1991.
Authors: Melnick G A , Zwanziger J
Published: November 2008

OBJECTIVES. This paper examines health expenditure growth under two alternative policy approaches: competition-based managed care and state government rate regulation. METHODS. Data are presented on cumulative growth in real per capita health expenditures between 1980 and 1991 so as to compare California, a state with a pro-competitive policy, with the US average and with four states with established regulation programs. RESULTS. Real per capita expenditures for hospital services in the United States grew 54% between 1980 and 1991, while in California the growth was half the national rate, or 27%. Real per capita expenditures for physician services and drug expenditures in the United States grew by 82% and 65%, respectively, while in California these expenditures increased only 58% and 41%, respectively. California's growth rate was below that of all four regulatory states for all measures of health care cost inflation. CONCLUSIONS. On the basis of these findings, a properly structured competitive approach could play a significant role in controlling health expenditures in the United States.
The challenge of defining and counting generalist physicians: an analysis of Physician Masterfile data.
Authors: Grumbach K , Becker S H , Osborn E H , Bindman A B
Published: November 2008

OBJECTIVES. The study reviewed methods for measuring the specialty distribution of the US physician workforce. It was hypothesized that current databases and measurement conventions overestimate the number of generalist physicians. METHODS. A descriptive analysis of the American Medical Association (AMA) Physician Masterfile for California was done with different assumptions about the definition of generalists based on primary and secondary specialty information. RESULTS. A rigorous definition of generalist physician that excludes physicians with secondary practices in specialist fields resulted in an estimate of generalist physicians 25% lower than the number estimated by conventional workforce evaluation methods. Physicians who reported practicing in both generalist and specialist fields were more likely to be older, to be international medical school graduates, and to be in solo or duo practice compared with physicians who listed only generalist or specialist fields. CONCLUSIONS. The actual number of generalist physicians in the United States may be less than previously believed. Although the exact magnitude of the "hidden system" of specialists providing primary care is difficult to measure, at least a portion appear to already be counted as generalist physicians by current conventions.