bluuebunny/crossref_metadata_2025 huggingface dataset:
Mortality, disability, and falls in older persons: the role of underlying disease and disability.
Authors: Dunn J E , Rudberg M A , Furner S E , Cassel C K
Published: November 2008

BACKGROUND. Falls are prevalent in older persons and can have serious consequences. METHODS. Data from the Longitudinal Study on Aging were analyzed to study the relationship between falls and both mortality and functional status in 4270 respondents age 70 and over. The effects of demographic traits, chronic conditions, and disability present at baseline were controlled for by means of multivariable analyses. RESULTS. Risk of death within 2 years was greater for both single fallers (crude odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.0) and multiple fallers (crude OR, 2.2; 95% CI, 1.7-2.8). This excess risk was dissipated when selected covariates were added to the model. No crude or adjusted association was evident between single falls and functional impairment; however, multiple falls were an independent risk factor (adjusted OR, 1.6; 95% CI, 1.2-2.0). CONCLUSIONS. Multiple falls in older persons increase risk of functional impairment and may indicate underlying conditions that increase risk of death.
Living arrangements and survival among middle-aged and older adults in the NHANES I epidemiologic follow-up study.
Authors: Davis M A , Neuhaus J M , Moritz D J , Segal M R
Published: November 2008

BACKGROUND. There is concern about but little information on how living alone affects the health and survival of older adults. METHODS. We examined the association between living arrangements (living alone, with a spouse, or with someone other than a spouse) and survival among 7651 adults, aged 45 to 74 years in the National Health and Nutrition Examination Survey (NHANES I) (1971-1975) and traced at the NHANES I Follow-up Study (1982-1984), to see whether certain sociodemographic factors (race, education, income, and employment), health behaviors (alcohol, smoking, physical activity, and obesity), or chronic medical conditions were influential in the association. RESULTS. We found a stronger association of living arrangements with survival for men than for women, and for middle-aged men than for older men. For men, those living alone and those living with someone other than a spouse were equally disadvantaged in terms of survival. Income, race, employment, and physical activity influenced the association of living arrangements and survival, but their impact varied by age, gender, and living arrangement. CONCLUSION. Living arrangements had a weak impact on survival among men, but had no effect among women.
Smokeless tobacco, cardiovascular risk factors, and nicotine and cotinine levels in professional baseball players.
Authors: Siegel D , Benowitz N , Ernster V L , Grady D G , Hauck W W
Published: November 2008

BACKGROUND. The use of smokeless tobacco (ST), which has increased in popularity over the past 2 decades, results in considerable systemic exposure to nicotine. Nicotine might contribute to atherosclerosis by an effect on cardiovascular risk factors. METHODS. The effects of ST use on cardiovascular risk factors and cotinine and nicotine levels were studied in 1061 professional baseball players during spring training in 1988 and 1989. RESULTS. Of the study participants 477 (45%) were users. ST use was more common among Whites (55%) than among Blacks (29%) or Hispanics (21%), and users reported heavier consumption of alcohol (p less than .001) and had higher mean serum caffeine levels (p less than .001) than nonusers. ST users did not differ from nonusers in adjusted levels of systolic and diastolic blood pressure, pulse, and total or HDL-cholesterol. Among ST users, participants using snuff had higher mean serum cotinine levels than those who used chewing tobacco (p less than .001). There was no association between serum cotinine levels and adjusted levels of any cardiovascular risk factor studied. However, higher diastolic blood pressures were associated with higher mean serum nicotine levels (p = .02). CONCLUSIONS. Smokeless tobacco use has at most a modest effect on cardiovascular risk factors in young physically fit men.
Pediatric gonococcal infection, Florida, 1984 to 1988.
Authors: Desenclos J C , Garrity D , Wroten J
Published: November 2008

We reviewed Florida pediatric gonococcal (GC) infection surveillance data collected between 1984 and 1988. The incidence rate was 11 per 100,000 per year for the age group 1 month through 9 years. Incidence rates were higher for females, other-than-Whites, and residents of rural counties than for males, Whites, and residents of urban counties. The ratio of pediatric GC cases in children younger than 10 years per 1000 adult male GC cases, a substitute measure for the proportion of males that may have perpetrated child sexual abuse, was 3.3 for Whites and 4.9 for other-than-Whites, and was higher for residents of nonmetropolitan counties (9.7) than for residents of metropolitan counties (4.2). These data highlight the importance of GC infection in children and suggest that routine surveillance of pediatric GC infection may be a useful tool for monitoring the occurrence of child sexual abuse.
Air quality during the winter in Québec day-care centers.
Authors: Daneault S , Beausoleil M , Messing K
Published: November 2008

Over 90% of 91 day care centers in greater Montréal, Québec exceeded 1000 ppm of CO2 during January through April 1989. Four variables were independent positive predictors of CO2 levels: the density of children in the center; presence of electric heating; absence of a ventilation system; and building age. High levels of CO2 are associated with respiratory tract and other symptoms. Clear standards and inspection policies should be established for day care center air quality.
Infant mortality, per capita income, and adult illiteracy: an ecological approach.
Authors: Tresserras R , Canela J , Alvarez J , Sentis J , Salleras L
Published: November 2008

The ecological association of infant mortality rate (IM) with per capita income (PI) and prevalence of adult illiteracy (AI) has been studied using countries as the unit of analysis. A negative association between IM and PI in 1960 and 1982 has been observed (sample correlation coefficient [r] = -.625 and r = -.729, respectively; P less than .05). A correlation between IM and AI has been found for both men and women (r = .827 and r = .855, respectively; P less than .05). The ecological relative risks were 7.43 for men and 5.82 for women (95% confidence intervals: 5.16-10.71 and 4.36-7.75, respectively). The association of IM and PI shows a slight but not significant improvement between 1960 and 1982. AI can be considered a good predictor of IM in countries.
An epidemiological comparison of Mexican-American and white non-Hispanic 8th- and 12th-grade students' substance use.
Authors: Chavez E L , Swaim R C
Published: November 2008

Surveys of drug and alcohol use were conducted with a national probability sample of 8th- and 12th-grade Mexican-American and White non-Hispanic youth. The drug and alcohol epidemiology is representative of US Mexican-American youth residing in communities with populations of 2500 or more, at least 10% of whom are Mexican Americans. Mexican-American 8th graders reported generally higher rates of use than White non-Hispanics based on life-time prevalence and use in last month. They also reported higher frequency of high-risk drug behaviors. The pattern was reversed among 12th-grade students. The impact of differential school dropout rates is discussed as a probable cause for this reversal.
Analyzing the effect of prenatal care on pregnancy outcome: a conditional approach.
Authors: Malloy M H , Kao T C , Lee Y J
Published: November 2008

We used vital statistics data to examine the effect of the time of entry into prenatal care relative to the gestational age of delivery on pregnancy outcome. Early entry into prenatal care was associated with better outcomes only in women who delivered at 37 through 42 weeks of gestation. We are concerned that the evaluation of the effect of prenatal care using vital statistics data may be questionable because of the problems inherent in the data.
The safety of home birth: the farm study.
Authors: Duran A M
Published: November 2008

Pregnancy outcomes of 1707 women, who enrolled for care between 1971 and 1989 with a home birth service run by lay midwives in rural Tennessee, were compared with outcomes from 14,033 physician-attended hospital deliveries derived from the 1980 US National Natality/National Fetal Mortality Survey. Based on rates of perinatal death, of low 5-minute Apgar scores, of a composite index of labor complications, and of use of assisted delivery, the results suggest that, under certain circumstances, home births attended by lay midwives can be accomplished as safely as, and with less intervention than, physician-attended hospital deliveries.
Skilled nursing facility care for persons with AIDS: comparison with other patients.
Authors: Swan J H , Benjamin A E , Brown A
Published: November 2008

We compared average daily hours of care for patients with and without acquired immunodeficiency syndrome (AIDS) in a hospital-based skilled nursing facility. Patients with AIDS averaged over an hour more direct nursing care per patient day (6.5 vs 5.4 hours). These findings support other reports of greater nursing time and higher costs of caring for nursing home patients with AIDS.
HIV infection in intravenous drug users entering drug treatment, United States, 1988 to 1989. The Field Services Branch of the Centers for Disease Control.
Authors: Allen D M , Onorato I M , Green T A
Published: November 2008

BACKGROUND. Intravenous drug use has played a key role in the human immunodeficiency virus (HIV) epidemic. Standardized surveillance of HIV infection among intravenous drug users (IVDUs) is needed to determine HIV prevalence rates, to monitor changes in prevalence over time, and to describe behaviors associated with HIV infection. METHODS. In 1987, the Centers for Disease Control began collaborating with state and local health departments to conduct a national program of HIV seroprevalence surveys in a variety of populations and settings. This program includes unlinked HIV seroprevalence surveys in IVDUs entering sentinel drug treatment programs. RESULTS. From April 1988 through December 1989, annual studies were completed in 59 drug treatment centers in 33 US cities. Center-specific seroprevalence rates ranged from 0% to 48.2%, with a median of 4.6%. HIV seroprevalence rates varied widely by geographic area, with rates highest in the Northeast, intermediate in the Middle Atlantic cities of Baltimore and Washington, DC, and lower in other parts of the country. Median rates were 15.6% among African Americans, 3.2% among Hispanics, and 3.3% among Whites. CONCLUSIONS. Intravenous drug use is likely to remain an important factor in HIV transmission. This study supports the need to develop or expand programs to prevent the further introduction and spread of HIV among IVDUs and to prevent HIV transmission to their sexual partners.
HIV prevalence and risk behavior among injecting drug users who participate in "low-threshold" methadone programs in Amsterdam.
Authors: Hartgers C , van den Hoek A , Krijnen P , Coutinho R A
Published: November 2008

INTRODUCTION. After the onset of the HIV epidemic, the hope arose that the "harm reduction" approach of the Amsterdam "low-threshold" methadone programs would have a function in controlling the spread of HIV among injecting drug users (IDUs). METHODS. To find evidence for this assumption, 386 IDUs participating in an HIV study between 1985 and 1989 were studied. Long-term regular participants in low-threshold methadone programs were compared with short-term and/or irregular participants. RESULTS. Controlling for possible confounders, long-term regular participants had a slightly increased but not statistically significant risk of being HIV infected. With regard to current drug use, they injected daily and shared needles as often as did short-term and/or irregular participants. CONCLUSIONS. The results suggest that the Amsterdam low-threshold methadone programs fail to diminish HIV risk behavior. If these programs want to have a positive effect on the spread of HIV, expansion of existing HIV prevention efforts, an increase in the daily methadone dose level, and measures to enforce regular attendance may be required.
The potential role of custody facilities in controlling sexually transmitted diseases.
Authors: Cohen D , Scribner R , Clark J , Cory D
Published: November 2008

BACKGROUND. The National Commission on Correctional Health Care recommends that medical screening, including tests for syphilis and other sexually transmitted diseases, be performed by the 14th day after initial booking procedures. Because the average length of stay in detention is usually less than 14 days, most detainees are not screened or treated for asymptomatic communicable diseases. METHODS. In order to determine the incidence and prevalence of syphilis among those booked through a large county jail, a rapid screening procedure to test newly incarcerated inmates and treat those infected was implemented over a 3-week period. RESULTS. Among 6309 detainees eligible for testing during the 3-week period of the study, 129 (2%) were diagnosed with syphilis. During the preceding month when only those reporting symptoms or high-risk behaviors were screened, 20 cases were diagnosed. The sensitivity and predictive value of self-reported risk factors for syphilis infection were low. Among the first 110 diagnosed cases, 17 (15.5%) were released within 3 days and 86 (78%) were released within 6 days. CONCLUSIONS. If screening and treatment for syphilis are delayed until the 14th day after booking, the majority of infected inmates will be released prior to evaluation and treatment. Rapid screening and treatment for selected sexually transmitted diseases are likely to be an effective public health measure when implemented in custody settings.
Occupational injuries among minors doing farm work in Washington State: 1986 to 1989.
Authors: Heyer N J , Franklin G , Rivara F P , Parker P , Haug J A
Published: November 2008

BACKGROUND. There is growing evidence that many children are injured while engaged in agricultural work. However, little specific information on farm work-related injuries among minors is available, probably because employment or workers' compensation data for children are hard to obtain. METHODS. Workers' compensation data were used to evaluate occupational injuries among children in Washington State from 1986 through 1989. The frequency and severity of injuries among minors doing farm work were compared with the distributions of injuries among minors working in food service and all other occupations by year of injury, age of injury, and month and hour of injury. RESULTS. A total of 16,481 claims filed by children under age 18 were evaluated. Although farm workers accounted for only 7% of all claims, they made up 36% of claims filed by children under age 14, and 17% of claims filed by children aged 14 or 15. Injuries classified as serious accounted for 26% of farm worker claims compared with only 16% of all claims filed by children. CONCLUSIONS. Although injury rates could not be developed owing to the lack of denominator data, this study demonstrates that farm work is dangerous for young children.
Seroprevalence of HIV-type 1 in a northern California health plan population: an unlinked survey.
Authors: Hiatt R A , Capell F J , Ascher M S
Published: November 2008

We conducted an unlinked seroprevalence survey for human immunodeficiency virus-type 1 (HIV-1) of 9821 persons who had a routine personal health appraisal examination in 1989 while members of the Kaiser Permanente Medical Care Program in northern California. An outside laboratory performed enzyme immunoassay (EIA) analyses, and the California Viral and Rickettsial Diseases Laboratory confirmed EIA-reactive samples by immunofluorescent assay and Western blot assay. Only 20 specimens (0.2%) were confirmed as positive, and 18 were from men. These data suggest that, at the time of this survey, HIV-1 infection was not widespread in the northern California population represented by this health plan membership.
Duration of Medicaid AIDS hospitalizations--variation by season, stage, and year.
Authors: Markson L E , Turner B J , Fanning T R
Published: November 2008

Using New York State Medicaid data from 1984 to 1987, we analyzed hospital length-of-stay patterns for acquired immunodeficiency syndrome (AIDS) patients. We found an overall decline in monthly average length of stay, with seasonal fluctuations producing longer stays in the fall and winter months. These findings suggest that hospital utilization for AIDS patients is changing over time and may vary by season.
Decline in human immunodeficiency virus seropositivity and seroconversion in US Navy enlisted personnel: 1986 to 1989. Navy HIV Working Group.
Authors: Garland F C , Gorham E D , Cunnion S O , Miller M R , Balazs L L
Published: November 2008

The US Navy administered 1,795,578 enzyme-linked immunosorbent assay (ELISA) tests to 848,632 active-duty Navy enlisted personnel during 1986 to 1989. This study identified 2438 human immunodeficiency virus (HIV)-seropositive active-duty enlisted Navy personnel, including 778 seroconverters. Three types of quarterly rates of HIV seropositivity and seroconversion were determined. All three rates declined. This decline could not be explained by changes in the population tested according to age, race, sex, occupation, or geographic location of home port.
Predictors of condom accessibility among Hispanics in San Francisco.
Authors: Marin B V , Marin G
Published: November 2008

Ready access to condoms can be an important means of slowing the spread of sexually transmitted diseases and human immunodeficiency virus. We identified the factors associated with keeping or carrying condoms in a random-digit dialing survey of 522 Hispanic adults aged 18 to 65 years in San Francisco. Overall, more Hispanic men reported having condoms than Hispanic women (55.2% vs 23.8%). Hispanic men also reported much higher levels of risky sexual behavior than Hispanic women. Condom promotion efforts with Hispanics will require different approaches for each gender.
Folic acid and neural tube defect: can't we come to closure?
Authors: Willett W C
Published: November 2008

In a series of nonrandomized and randomized intervention trials and case-control and cohort studies, women using multivitamins or folic acid supplements during the first 6 weeks of pregnancy experienced a three- to fourfold reduction in neural tube defects among their offspring. Viewed collectively, these data provide strong evidence that an important subset of US women do not receive sufficient folic acid to minimize their risk of a defective pregnancy. Further, the amounts of folic acid contained in multivitamins (usually 200-400 micrograms per day) appear adequate to greatly reduce, and probably eliminate, the excess risk.
The influence of social and political violence on the risk of pregnancy complications.
Authors: Zapata B C , Rebolledo A , Atalah E , Newman B , King M C
Published: November 2008

BACKGROUND. Events in Chile provided an opportunity to evaluate health effects associated with exposure to high levels of social and political violence. METHODS. Neighborhoods in Santiago, Chile, were mapped for occurrences of sociopolitical violence during 1985-86, such as bomb threats, military presence, undercover surveillance, and political demonstrations. Six health centers providing prenatal care were then chosen at random: three from "high-violence" and three from "low-violence" neighborhoods. The 161 healthy, pregnant women due to deliver between August 1 and September 7, 1986, who attended these health centers were interviewed twice about their living conditions. Pregnancy complications and labor/delivery information were subsequently obtained from clinic and hospital records. RESULTS. Women living in the high-violence neighborhoods were significantly more likely to experience pregnancy complications than women living in lower violence neighborhoods (OR = 5.0; 95% CI = 1.9-12.6; p less than 0.01). Residence in a high-violence neighborhood was the strongest risk factor observed; results persisted after controlling for several sets of potential confounders. CONCLUSION. Living in areas of high social and political violence increased the risk of pregnancy complications among otherwise healthy women.
A new definition of maternal depletion syndrome.
Authors: Winkvist A , Rasmussen K M , Habicht J P
Published: November 2008

BACKGROUND. Although the term "maternal depletion syndrome" has been commonly used to explain poor maternal and infant health, whether such a syndrome actually exists remains unclear. This uncertainty may be due to the lack of a clear definition of the syndrome and the absence of theoretical frameworks that account for the many factors related to reproductive nutrition. METHODS. We propose a new definition of maternal depletion syndrome within a framework that accounts for potential confounding factors. RESULTS. Our conceptual framework distinguishes between childbearing pattern and inadequate diet as causes of poor maternal health; hence, our definition of maternal depletion syndrome has both biological and practical meaning. The new definition is based on overall change in maternal nutritional status over one reproductive cycle in relation to possible depletion and repletion phases and in relation to initial nutritional status. CONCLUSIONS. The empirical application of this approach should permit the testing of the existence of maternal depletion syndrome in the developing world, and the distinction between populations where family planning will alleviate maternal depletion and those in which an improved diet is also necessary.
Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology.
Authors: Krieger N
Published: November 2008

BACKGROUND. Most US medical records lack socioeconomic data, hindering studies of social gradients in health and ascertainment of whether study samples are representative of the general population. This study assessed the validity of a census-based approach in addressing these problems. METHODS. Socioeconomic data from 1980 census tracts and block groups were matched to the 1985 membership records of a large prepaid health plan (n = 1.9 million), with the link provided by each individual's residential address. Among a subset of 14,420 Black and White members, comparisons were made of the association of individual, census tract, and census block-group socioeconomic measures with hypertension, height, smoking, and reproductive history. RESULTS. Census-level and individual-level socioeconomic measures were similarly associated with the selected health outcomes. Census data permitted assessing response bias due to missing individual-level socioeconomic data and also contextual effects involving the interaction of individual- and neighborhood-level socioeconomic traits. On the basis of block-group characteristics, health plan members generally were representative of the total population; persons in impoverished neighborhoods, however, were underrepresented. CONCLUSIONS. This census-based methodology offers a valid and useful approach to overcoming the absence of socioeconomic data in most US medical records.
Moderate physical activity and bone density among perimenopausal women.
Authors: Zhang J , Feldblum P J , Fortney J A
Published: November 2008

We examined the association between physical activity and bone mineral density (BMD) among 352 perimenopausal women. A personal activity computer was used to estimate the daily energy expenditure on physical activity. BMD was measured by photon absorptiometry at the lumbar spine, midradius, and distal radius. Multiple linear regression, controlling for other factors, indicated that physical activity was positively and significantly associated with BMD at all sites. Moderate physical activity has beneficial effects on BMD among perimenopausal women.
Medical expenditures for disability and disabling comorbidity.
Authors: Rice D P , LaPlante M P
Published: November 2008

Disability and disabling comorbidity place a disproportionately large burden on the health care system. National Medical Care Utilization and Expenditure Survey data show that medical care expenditures for noninstitutionalized persons amounted to $154 billion ($691 per capita) in 1980. The medical expenditure per capita for people reporting two or more disabling chronic conditions ($2456) was 5 times the amount incurred by those with no limiting conditions ($486) and more than 1.5 times the amount incurred by those with one limiting condition.
Commentary: caring for the indigent mentally ill--new strategies and old problems.
Authors: Ferran E
Published: November 2008

Christianson and his colleagues examine how Medicaid beneficiaries receive mental health services in HMOs by analyzing two important aspects of service delivery: the use of community-based treatment programs by Medicaid beneficiaries enrolled in health maintenance organizations (HMOs) and the reimbursement levels paid to these programs by HMOs. The hypotheses studied are complex issues that concern mental-health advocates and providers. Traditional community-based mental health services have always struggled to maintain their presence in the health care field, having to contend with changing funding priorities and more serious and multiple problems presented by their patients. For prepaid plans to work effectively for the indigent mentally ill, the complex issues have to be made clear and acknowledged as meaningful variables.
Eligibility for publicly financed home care.
Authors: Jackson M E , Burwell B , Clark R F , Harahan M
Published: November 2008

OBJECTIVES. Proposals for publicly financed home care for the elderly now tend to include cognitive impairment criteria as well as activities of daily living (ADL) criteria. The numbers of elderly deemed eligible for services will depend on the definitions of ADL and cognitive impairment used. METHODS. Data from the 1984 National Long-Term Care Survey were used to generate a series of estimates of the community-dwelling elderly with ADL disabilities and cognitive impairment. RESULTS. When only ADL criteria are used, estimates of disability range from 472,000 to over 3 million (1.6% to 12.5% of the community-dwelling elderly). These estimates increase to approximately 1 million to 4.2 million (3.5% to 14.0% of the community-dwelling elderly) when cognitive impairment criteria are added. CONCLUSIONS. The use of more stringent or more liberal eligibility criteria will have dramatic effects on the number of elders who qualify for services. The nature of the eligibility criteria employed in any expansion of federally financed home care benefits will be a major factor in determining the costs of such a program.
Postmarketing surveillance study of permethrin creme rinse.
Authors: Andrews E B , Joseph M C , Magenheim M J , Tilson H H , Doi P A , Schultz M W
Published: November 2008

BACKGROUND. An observational, epidemiological study was undertaken to evaluate the safety of permethrin 1% creme rinse (Nix) for treatment of head lice infestations. METHODS. Thirty-seven local public health departments enrolled a total of 38,160 patients for 47,578 treatments with permethrin or other pediculicides from September 1, 1986, through January 31, 1988. Follow-up safety information was collected between 7 and 14 days following treatment via return visit or telephone contact. RESULTS. One hundred three adverse events were reported among 41,955 evaluable treatments. The rates of reported adverse events were 2.2 per 1000 treatments among permethrin treatments, 3.4 per 1000 treatments among lindane treatments, and 1.5 per 1000 treatments among other over-the-counter treatments. No serious, unexpected adverse events were detected in the 18,950 patients treated with permethrin. CONCLUSIONS. This study confirmed the safety profile of permethrin in conditions of general use, as seen in clinical trials. Postmarketing safety monitoring in public health departments of drugs used to treat public health conditions was shown to be feasible.
Do time trends in food supply levels of macronutrients reflect survey estimates of macronutrient intake?
Authors: Crane N T , Lewis C J , Yetley E A
Published: November 2008

BACKGROUND. Two types of data may be used to estimate trends in food and nutrient intake by the US population: per capita food supply estimates and survey estimates of individual intake. Because these data vary markedly in measurement goals and methods, we examined whether trends in food supply and survey intake estimates for fat, carbohydrate, and protein are reflective of one another. METHODS. The data selected for comparison included all available survey estimates of mean intake by the US population (i.e., periodic estimates from 1965 to 1988) and all available per capita food supply estimates from a comparable time period (i.e., annual estimates from 1965 to 1985). RESULTS. The two types of data generally did not reflect the same trends. Furthermore, expressing macronutrient levels as percentage of calories rather than in grams affected the trend relationships. CONCLUSIONS. Our findings indicate that caution is needed in the selection and application of available data to estimate trends in macronutrient intake by the US population and in the interpretation of these data with regard to public health research, policies, and programs.
First-year impact of the 1989 California cigarette tax increase on cigarette consumption.
Authors: Flewelling R L , Kenney E , Elder J P , Pierce J , Johnson M , Bal D G
Published: November 2008

We employed a time series design to evaluate the impact of the 1989 California cigarette tax increase on cigarette consumption in California. Adult per capita consumption data from 1980 to 1990 were analyzed for California and the United States. Trend data indicated a sharp drop in California cigarette consumption coincident with the tax increase. Time-series regression analyses support this observation, and suggest that a 5% to 7% decline in consumption is attributable to the tax increase.
Work-site nutrition intervention and employees' dietary habits: the Treatwell program.
Authors: Sorensen G , Morris D M , Hunt M K , Hebert J R , Harris D R , Stoddard A , Ockene J K
Published: November 2008

In a randomized, controlled study of the Treatwell work-site nutrition intervention program, which focused on promoting eating patterns low in fat and high in fiber, 16 work sites from Massachusetts and Rhode Island were recruited to participate and randomly assigned to either an intervention or a control condition. The intervention included direct education and environmental programming tailored to each work site; control work sites received no intervention. A cohort of workers randomly sampled from each site was surveyed both prior to and following the intervention. Dietary patterns were assessed using a semiquantitative food frequency questionnaire. Adjusting for work site, the decrease in mean dietary fat intake was 1.1% of total calories more in intervention sites than in control sites (P less than .005). Mean changes in dietary fiber intake between intervention and control sites did not differ. This study provides evidence that a work-site nutrition intervention program can effectively influence the dietary habits of workers.
Health status of older male prisoners: a comprehensive survey.
Authors: Colsher P L , Wallace R B , Loeffelholz P L , Sales M
Published: November 2008

Although prison populations remain predominantly young, the number of older inmates in state and federal correctional facilities has been increasing. This report describes the results of a health survey of 119 male inmates 50 years of age and older residing in Iowa state correctional facilities. Subject's disease history included hypertension (40%), myocardial infarction (19%), and emphysema (18%). Most participants (97%) had missing teeth, 42% had gross physical functional impairments, and 70% smoked cigarettes. These findings have implications for health care provision and release planning.
Physician and infection control practitioner HIV/AIDS reporting characteristics.
Authors: Jones J L , Meyer P , Garrison C , Kettinger L , Hermann P
Published: November 2008

We surveyed a random sample of South Carolina physicians and infection control practitioners about the reporting of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) cases. Of physicians surveyed, 79% indicated that HIV infection as well as AIDS should be reported by name. The following characteristics were associated with those physicians who do not report AIDS cases: not feeling responsible for reporting, not reporting a case perceived to have been reported in another state, believing that information required for reporting is not on the chart, and residing in an urban setting. Targeted education can address these underreporting factors.
Commentary: environmental disease--a preventable epidemic.
Authors: Landrigan P J
Published: November 2008

Toxic environmental diseases are highly preventable causes of morbidity and mortality. Toxic diseases in the work environment cause an estimated 50,000 to 70,000 deaths and 350,000 new cases of illness each year in the United States; the asbestos pandemic will ultimately claim at least 300,000 lives; pediatric lead poisoning is epidemic, and an estimated 3 to 4 million US preschool children have blood lead levels above 10 micrograms/dl and could suffer long-term neuropsychological impairment. Prevention of environmental diseases can be achieved through legislation and regulation that control common-source exposures to chemical toxins. Modification of personal behaviors, such as tobacco and alcohol consumption, complements but does not replace control of toxic environmental exposures.
Chlorination, chlorination by-products, and cancer: a meta-analysis.
Authors: Morris R D , Audet A M , Angelillo I F , Chalmers T C , Mosteller F
Published: November 2008

OBJECTIVES. Individual epidemiological investigations into the association between chlorination by-products in drinking water and cancer have been suggestive but inconclusive. Enough studies exist to provide the basis for a meaningful meta-analysis. METHODS. An extensive literature search was performed to identify pertinent case-control studies and cohort studies. Consumption of chlorinated water, surface water, or water with high levels of chloroform was used as a surrogate for exposure to chlorination by-products. Relative risk estimates were abstracted from the individual studies and pooled. RESULTS. A simple meta-analysis of all cancer sites yielded a relative risk estimate for exposure to chlorination by-products of 1.15 (95% CI: 1.09, 1.20). Pooled relative risk estimates for organ-specific neoplasms were 1.21 (95% CI: 1.09, 1.34) for bladder cancer and 1.38 (95% CI: 1.01, 1.87) for rectal cancer. When studies that adjusted for potential confounders were pooled separately, estimates of relative risks did not change substantially. CONCLUSIONS. The results of this meta-analysis suggest a positive association between consumption of chlorination by-products in drinking water and bladder and rectal cancer in humans.
Epidemiological data on US coal miners' pneumoconiosis, 1960 to 1988.
Authors: Attfield M D , Castellan R M
Published: November 2008

OBJECTIVES. Statistics on prevalence of pneumoconiosis among working underground coal miners based on epidemiologic data collected between 1960 and 1988 are presented. The main intent was to examine the time-related trend in prevalence, particularly after 1969, when substantially lower dust levels were mandated by federal act. METHODS. Data from studies undertaken between 1960 and 1968 were collected and compared. Information for the period 1969 to 1988 was extracted from a large ongoing national epidemiologic study. Tenure-specific prevalence rates and summary statistics derived from the latter data for four consecutive time intervals within the 19-year period were calculated and compared. RESULTS. The results indicate a reduction in pneumoconiosis over time. The trend is similar to that seen in a large radiologic surveillance program of underground miners operated concurrently. CONCLUSIONS. Although such factors as x-ray reader variation, changes in x-ray standards, and worker self-selection for examination may have influenced the findings to some extent, adjusted summary rates reveal a reduction in prevalence concurrent with reductions in coal mine dust levels mandated by federal act in 1969.
British data on coal miners' pneumoconiosis and relevance to US conditions.
Authors: Attfield M D
Published: November 2008

OBJECTIVES. The current primary federal dust standard for US underground coal miners of 2 mg/m3 respirable dust is based on British epidemiological information on exposure-response derived in 1969. Since then, much new information has become available. This paper reviews and compares the available information as it relates to the US mining situation. METHODS. Recent exposure-response information on pneumoconiosis and dust exposure derived by British researchers was employed to estimate working-life risks of pneumoconiosis for miners exposed to 2 mg/m3. RESULTS. It is estimated that close to 9% of underground coal miners who work for 40 years in a 2 mg/m3 environment would develop pneumoconiosis (category 1 or greater). Progressive massive fibrosis would develop in 0.7%. CONCLUSIONS. There are unresolved questions relating to the validity of extrapolating findings on British mines and miners to the US and also in predicting disease levels at the low end of the dust exposure spectrum. Given the data available, current information suggests miners who are employed for a working life-time at the current federal dust limit of 2 mg/m3 are still at risk of developing pneumoconiosis.
HMO membership, treatment, and mortality risk among prostatic cancer patients.
Authors: Greenwald H P , Henke C J
Published: November 2008

OBJECTIVES. Treatment and mortality risk were compared between prostate cancer patients receiving care in fee-for-service settings and those receiving care in a health maintenance organization (HMO). METHODS. Two samples were obtained from a population-based tumor registry. Patients in the first sample (n = 201) were interviewed shortly after diagnosis to obtain data on income, education, overall health status, and expenditures for health status, and expenditures for health care. These data were combined with information from the tumor registry on cancer stage, age, treatment, place of residence, and source of care. Only tumor registry data were obtained for most patients in the second sample (n = 962). For both samples, survival time was monitored for up to 80 months. RESULTS. Multivariate analysis of data from the interviewed sample indicated that HMO patients were less likely to receive surgery but more likely to receive radiation therapy than were those in fee-for-service settings. Mortality risk was lower for the HMO patients than for those in fee-for-service plans. Findings based on the second sample were nearly identical. CONCLUSIONS. This study suggests that HMOs may offer important advantages to lower-income patients at risk for specific life-threatening diseases.
Does equal socioeconomic status in black and white men mean equal risk of mortality?
Authors: Keil J E , Sutherland S E , Knapp R G , Tyroler H A
Published: November 2008

Although concerns have been expressed that mortality from coronary disease and all other causes is greater among Blacks than Whites, we hypothesized that, when socioeconomic status is adequately considered, mortality inequalities between Blacks and Whites are insignificant. The study population was a random sampling of Black and White men who were 35 years of age or older when recruited into the Charleston Heart Study in 1960. Education level and occupational status at baseline were used to compare mortality over the ensuing 28 years between Black and White men, who were classified as low or high socioeconomic status. In no instance were Black-White differences in all-cause or coronary disease mortality rates significantly different when socioeconomic status was controlled. We conclude that socioeconomic status is an important predictor of mortality and that, when socioeconomic status is considered, differences in Black-White mortality rates may be small.
Mortality and the attribution of health problems to aging among older adults.
Authors: Rakowski W , Hickey T
Published: November 2008

This study examined the association between mortality and attributing health problems to aging among 1391 respondents from the Longitudinal Study of Aging who indicated difficulty with activities of daily living. Of this number, 72 persons attributed impairment primarily to "old age." Logistic regression controlling for demographics, physical health problems, self-rated health, and social involvements showed an association with mortality (adjusted odds ratio = 1.78, CI = 1.05, 3.00). Attributing health problems to aging may carry a risk of adverse health events.
The accuracy of the National Death Index when personal identifiers other than Social Security number are used.
Authors: Williams B C , Demitrack L B , Fries B E
Published: November 2008

This study analyzed the accuracy of the National Death Index when personal identifiers were used that included or excluded Social Security number. Computerized records of the Department of Veterans Affairs were used for comparison. Different combinations of identifiers other than Social Security number correctly identified from 83 to 92 percent of dead and 92 to 99 percent of living persons. These results should prove useful in ascertaining the mortality status of patient populations without information on Social Security numbers.
Seroprevalence of HIV-1 and hepatitis B and C in prostitutes in Albuquerque, New Mexico.
Authors: Tabet S R , Palmer D L , Wiese W H , Voorhees R E , Pathak D R
Published: November 2008

A survey of persons soliciting sex in an area known to be frequented by prostitutes in Albuquerque, NM, included 43 females and 66 males. Seroprevalence rates found in this population-based study were as follows: human immunodeficiency virus type 1 (HIV-1), 3%; hepatitis B, 39%; hepatitis C, 45%. Increased age, intravenous drug use, and condom use were independent risk factors for hepatitis B. Female gender and intravenous drug use were independent risk factors for hepatitis C. Neither sharing injection equipment nor engaging in receptive anal intercourse was independently associated with hepatitis B or C.
Decreased access to medical care for girls in Punjab, India: the roles of age, religion, and distance.
Authors: Booth B E , Verma M
Published: November 2008

Risk factors that increase the likelihood of discrimination against girls in India have not been well studied. In this study of hospitalized children in Punjab, India, girls were less likely to be in the newborn or infant age groups, to be of the Sikh religion, or to come from far away than were boys. These differences suggest that these factors are significant risk factors for denied access to medical care for girls living in Punjab, India.
Communitywide smoking prevention: long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study.
Authors: Perry C L , Kelder S H , Murray D M , Klepp K I
Published: November 2008

OBJECTIVES. The Class of 1989 Study is part of the Minnesota Heart Health Program (MHHP), a populationwide research and demonstration project designed to reduce cardiovascular disease in three educated communities from 1980 to 1993. This paper describes an intensive, school-based behavioral intervention on cigarette smoking, comparing long-term outcomes in one of the intervention communities with those in a matched reference community. METHODS. Beginning in sixth grade (1983), seven annual waves of cohort and cross-sectional behavioral measurements were taken from one MHHP intervention community and its matched pair. All students in each community were eligible to participate (baseline n = 2401). Self-reported data collected at each period described prevalence and intensity of cigarette smoking. RESULTS. There were no differences at baseline for either weekly smoking prevalence or intensity of smoking. Throughout the follow-up period, however, smoking rates as determined by these measures were significantly lower in the intervention community: 14.6% of students were weekly smokers at the end of high school compared with 24.1% in the reference community. CONCLUSIONS. These results suggest that multiple intervention components such as behavioral education in schools, booster programs to sustain training, and complementary communitywide strategies may all be needed for lasting reductions in adolescent tobacco use.
Locking devices on cigarette vending machines: evaluation of a city ordinance.
Authors: Forster J L , Hourigan M E , Kelder S
Published: November 2008

OBJECTIVES. Policymakers, researchers, and citizens are beginning to recognize the need to limit minors' access to tobacco by restricting the sale of cigarettes through vending machines. One policy alternative that has been proposed by the tobacco industry is a requirement that vending machines be fitted with electronic locking devices. This study evaluates such a policy as enacted in St. Paul, Minn. METHODS. A random sample of vending machine locations was selected for cigarette purchase attempts conducted before implementation and at 3 and 12 months postimplementation. RESULTS. The rate of noncompliance by merchants was 34% after 3 months and 30% after 1 year. The effect of the law was to reduce the ability of a minor to purchase cigarettes from locations originally selling cigarettes through vending machines from 86% at baseline to 36% at 3 months. The purchase rate at these locations rose to 48% at 1 year. CONCLUSIONS. Our results suggest that cigarette vending machine locking devices may not be as effective as vending machine bans and require additional enforcement to ensure compliance with the law.
Adolescents' multisubstance use patterns: the role of heavy alcohol and cigarette use.
Authors: Bailey S L
Published: November 2008

OBJECTIVES. Knowledge about the roles that heavy alcohol and cigarette use play in patterns of concurrent substance use among adolescents is lacking despite studies showing that adolescent substance users are typically multisubstance users and that alcohol and cigarettes are commonly used heavily by those who use illicit substances. METHODS. The roles of increasing use and heavy first-time use of alcohol and cigarettes in multisubstance use patterns were examined in a cohort of 4192 secondary students who were surveyed three times over a 4-year period. RESULTS. When subsequent use patterns were compared for students who increased their levels of alcohol or cigarette use and those who initiated use for the first time but at heavy frequencies, analyses indicated that the former group was more likely to initiate the subsequent use of other substances and to maintain and increase use already initiated. CONCLUSIONS. These results suggest that adolescents are likely to have been involved in a history of licit substance use characterized by increasing levels of use before progressing to and maintaining the use of other substances. Increasing frequencies of alcohol and cigarette use, therefore, may be markers for more serious patterns of substance use.