bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental risk factors for Lyme disease identified with geographic information systems.
Authors: Glass G E , Schwartz B S , Morgan J M , Johnson D T , Noy P M , Israel E
Published: November 2008

OBJECTIVES. A geographic information system was used to identify and locate residential environmental risk factors for Lyme disease. METHODS. Data were obtained for 53 environmental variables at the residences of Lyme disease case patients in Baltimore County from 1989 through 1990 and compared with data for randomly selected addresses. A risk model was generated combining the geographic information system with logistic regression analysis. The model was validated by comparing the distribution of cases in 1991 with another group of randomly selected addresses. RESULTS. In crude analyses, 11 environmental variables were associated with Lyme disease. In adjusted analyses, residence in forested areas (odds ratio [OR] = 3.7, 95% confidence interval [CI] = 1.2, 11.8), on specific soils (OR = 2.1, 95% CI = 1.0, 4.4), and in two regions of the county (OR = 3.5, 95% CI = 1.6, 7.4) (OR = 2.8, 95% CI = 1.0, 7.7) was associated with elevated risk of getting Lyme disease. Residence in highly developed regions was protective (OR = 0.3, 95% CI = 0.1, 1.0). The risk of Lyme disease in 1991 increased with risk categories defined from the 1989 through 1990 data. CONCLUSIONS. Combining a geographic information system with epidemiologic methods can be used to rapidly identify risk factors of zoonotic disease over large areas.
US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study.
Authors: Sorlie P D , Backlund E , Keller J B
Published: November 2008

OBJECTIVES. A large US sample was used to estimate the effects of race, employment status, income, education, occupation, marital status, and household size on mortality. METHODS. Approximately 530,000 persons 25 years of age or more were identified from selected Current Population Surveys between 1979 and 1985. These individuals were followed for mortality through use of the National Death Index for the years 1979 through 1989. RESULTS. Higher mortality was found in Blacks than in Whites less than 65 years of age; in persons not in the labor force, with lower incomes, with less education, and in service and other lower level occupations; and in persons not married and living alone. With occasional exceptions, in specific sex and age groups, these relationships were reduced but remained strong and statistically significant when each variable was adjusted for all of the other characteristics. The relationships were generally weaker in individuals 65 years of age or more. CONCLUSIONS. Employment status, income, education, occupation, race, and marital status have substantial net associations with mortality. This study identified segments of the population in need of public health attention and demonstrated the importance of including these variables in morbidity and mortality studies.
Alcohol consumption among adolescents and young adults: the Bogalusa Heart Study, 1981 to 1991.
Authors: Johnson C C , Myers L , Webber L S , Hunter S M , Srinivasan S R , Berenson G S
Published: November 2008

This report describes the alcohol consumption of adolescents and young adults who participated in the Bogalusa Heart Study, 1981 to 1991. Data were collected in three cross-sectional surveys of school-age children (11 to 19 years) and three surveys of young adults (18 to 32 years). White males had the highest proportion of drinkers and Black females had the lowest. By the end of the decade, adult White and Black male drinkers were about equal. Most individuals drank once or twice a week, but daily drinkers had the highest weekly alcohol intake. An association between alcohol and high-density lipoprotein cholesterol was found only in the latest survey and probably reflects the aging of the cohort.
A gender-specific measure of binge drinking among college students.
Authors: Wechsler H , Dowdall G W , Davenport A , Rimm E B
Published: November 2008

This study examined the relationship of volume of alcohol consumed to the occurrence of alcohol-related problems among male and female college students to develop a gender-specific measure of heavy episodic or binge drinking by college students for public health research. A self-administered survey was mailed to a national representative sample of students at 140 4-year colleges in 40 states and the District of Columbia. A total of 17,592 college students completed the survey. Women who typically drink four drinks in a row were found to have roughly the same likelihood of experiencing drinking-related problems as men who typically drink five drinks in a row. Use of the same standard for both sexes underestimates binge drinking and the negative health risks for women.
Unintentional carbon monoxide poisoning in Colorado, 1986 through 1991.
Authors: Cook M , Simon P A , Hoffman R E
Published: November 2008

Unintentional carbon monoxide poisonings were identified through death certificates, by hyperbaric chambers, and by laboratories required to report carboxyhemoglobin levels greater than 12%. From 1986 to 1991, 981 cases were reported, including 174 deaths. Deaths most often resulted from fire-related carbon monoxide intoxication (36.2%), followed by motor vehicle exhaust (34.5%), and furnaces (10.3%). Among nonfatal cases, furnaces were the leading source of carbon monoxide exposure (44.3%), followed by motor vehicle exhaust (22.8%). The importance of furnaces and other home heating devices in carbon monoxide intoxication may be underappreciated if only mortality data are examined. Surveillance of carbon monoxide-related morbidity is a useful adjunct to mortality surveillance in guiding prevention efforts.
Estimating mortality in the Hispanic population of Connecticut, 1990 to 1991.
Authors: Polednak A P
Published: November 2008

Among all deaths to Connecticut residents (1990/91), 1260 were acceptable Spanish-surname matches (using father's surname for females), of which only 793 (62.9%) were identified as Hispanic origin on the death certificate. Certificates also identified 127 non-Spanish-surnamed Hispanics. With death rates for non-Hispanics used as the standard, the standardized mortality ratio for Hispanics based on the 920 (793 plus 127) deaths identified by the Hispanic-origin item was lower (by 33% in males and 36% in females) than that based on all 1387 (1260 plus 127) Hispanics. Spanish-surname matching should improve estimation of mortality rates in some Hispanic populations.
Community health workers: integral members of the health care work force.
Authors: Witmer A , Seifer S D , Finocchio L , Leslie J , O'Neil E H
Published: November 2008

As the US health care system strives to function efficiently, encourage preventive and primary care, improve quality, and overcome nonfinancial barriers to care, the potential exists for community health workers to further these goals. Community health workers can increase access to care and facilitate appropriate use of health resources by providing outreach and cultural linkages between communities and delivery systems; reduce costs by providing health education, screening, detection, and basic emergency care; and improve quality by contributing to patient-provider communication, continuity of care, and consumer protection. Information sharing, program support, program evaluation, and continuing education are needed to expand the use of community health workers and better integrate them into the health care delivery system.
The effects of vitamin A supplementation on the morbidity of children born to HIV-infected women.
Authors: Coutsoudis A , Bobat R A , Coovadia H M , Kuhn L , Tsai W Y , Stein Z A
Published: November 2008

OBJECTIVE. The effects of vitamin A supplementation on morbidity of children born to human immunodeficiency virus (HIV)-infected women were evaluated in a population where vitamin A deficiency is not endemic. METHODS. A randomized, placebo-controlled trial of vitamin A supplementation was carried out in 118 offspring of HIV-infected women in Durban, South Africa. Those assigned to receive a supplement were given 50,000 IU of vitamin A at 1 and 3 months of age; 100,000 IU at 6 and 9 months; and 200,000 IU at 12 and 15 months. Morbidity in the past month was then recalled at each follow-up visit. Analysis was based on 806 child-months. RESULTS. Among all children, the supplemented group had lower overall morbidity than the placebo group (OR = 0.69; 95% confidence interval [CI] = 0.48, 0.99). Among the 85 children of known HIV status (28 infected, 57 uninfected), morbidity associated with diarrhea was significantly reduced in the supplemented infected children (OR = 0.51; 95% CI = 0.27, 0.99), whereas no effect of supplementation on diarrheal morbidity was noted among the uninfected children. CONCLUSION. In a population not generally vitamin A deficient, vitamin A supplementation for children of HIV-infected women appeared to be beneficial, reducing morbidity. The benefit was observed particularly for diarrhea among HIV-infected children.
The association between alcohol and breast cancer: popular press coverage of research.
Authors: Houn F , Bober M A , Huerta E E , Hursting S D , Lemon S , Weed D L
Published: November 2008

OBJECTIVES. This study was undertaken to examine popular press reports of the association between alcohol and breast cancer. METHODS. Articles from scientific journals and stories from newspapers and magazines published from January 1, 1985, to July 1, 1992, were retrieved from six on-line databases. Lay press stories were analyzed to determine which medical articles were publicized and what information was reported. RESULTS. Fifty-eight scientific articles on the relationship of alcohol and breast cancer were found, and 64 newspaper and 23 magazine stories were retrieved. The press cited 11 studies, 19% of those published during the study period. Three studies were featured in 77% of popular press stories. No scientific review articles were reported. Behavioral recommendations were given to the public in 63% of stories. CONCLUSIONS. The vast majority of scientific studies on alcohol and breast cancer were ignored in press reports. We encourage researchers and the popular press to give the public a broader understanding of public health issues.
The relationship between physicians' qualifications and experience and the adequacy of prenatal care and low birthweight.
Authors: Haas J S , Orav E J , Goldman L
Published: November 2008

OBJECTIVES. The purpose of this study was to examine the relationship between physicians' qualifications and experience and rates of completion of the recommended number of prenatal visits and delivery of a low-birthweight infant. METHODS. All deliveries performed by a permanently licensed physician in Massachusetts in 1990 (n = 80,537) were examined. Qualification was measured by board certification. Experience was measured by both volume of deliveries and duration of practice. RESULTS. Women cared for by a non-board-certified physician were less likely to receive the recommended number of prenatal visits (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.54, 0.85) and were more likely to have a low-birthweight infant (OR = 1.20, 95% CI = 1.00, 1.42). Physicians with a smaller volume of deliveries or a shorter duration of practice were more likely to deliver a low-birthweight infant. CONCLUSIONS. The data show an association of board certification with rates of the recommended number of prenatal visits and low birthweight. In addition, volume and duration of practice were significantly associated with low birthweight. Further research should examine whether these associations are related to differences in patient referral or to physicians' judgement and efficiency in provision of prenatal care.
Violence by male partners against women during the childbearing year: a contextual analysis.
Authors: O'Campo P , Gielen A C , Faden R R , Xue X , Kass N , Wang M C
Published: November 2008

OBJECTIVES. Many contextual analyses that bridge the micro-level-macro-level gap in identifying risk factors for adverse outcomes have not used methods appropriate for multilevel data. The purpose of this paper is to illustrate the application of appropriate multi-level analytic methods and discuss their implications for public health. METHODS. A previously published individual-level model of physical violence perpetrated by male partners during the childbearing year was reanalyzed to include variables describing the neighborhoods where the women resided. Logistic regression with estimation methods of the generalized estimating equation was used for the contextual analysis. To assess the advantages of the generalized estimating equation over conventional logistic regression, both were used for the two-level model. RESULTS. The regression coefficients from the contextual model differed from the betas obtained in the individual-level model. Not only were neighborhood-level variables related to the risk of partner-perpetrated violence, but the presence of these macro-level variables in the models modified the relationships of the individual-level variables to the risk of violence. CONCLUSIONS. Two-level models that include individual- and community-level factors may be beneficial for purposes of explanation in public health research.
Spermicide acceptability among patients at a sexually transmitted disease clinic in Zambia.
Authors: Hira S K , Spruyt A B , Feldblum P J , Sunkutu M R , Glover L H , Steiner M J
Published: November 2008

OBJECTIVE. This study assessed the acceptability of three nonoxynol-9 spermicides among persons attending a sexually transmitted disease clinic in Lusaka, Zambia. METHODS. Spermicidal foam, suppositories, and foaming tablets were evaluated. Women (n = 114) and men (n = 150) attending an sexually transmitted disease clinic were enrolled. After each participant used two products, each for 2 weeks, consistency of use and acceptability were evaluated. RESULTS. At admission, most women (74%) and men (58%) were not using any family planning method. Moreover, most women (85%) and men (98%) had at least one sexually transmitted disease or genital infection. During the study, the proportion of coital episodes protected by spermicide use was high, yet loss to follow-up and discontinuation were also substantial. Discontinuation was frequently unrelated to acceptability. Women and men rated all three products positively along several acceptability parameters. Foam was the least desirable delivery system due to excess messiness. CONCLUSIONS. The results of this study suggest that it is feasible to distribute spermicides to women and men at increased risk for sexually transmitted disease and that the products will be used. Further research should be done among different populations and include other spermicidal delivery mechanisms.
Form of day care and respiratory infections among Finnish children.
Authors: Louhiala P J , Jaakkola N , Ruotsalainen R , Jaakkola J J
Published: November 2008

The relationship between respiratory infectious diseases and form of day care was assessed in a retrospective cohort study of 2568 randomly selected children aged 1 through 7 years in Espoo, Finland. Day-care center children had an increased risk for the common cold, acute otitis media, and pneumonia. The risk concentrated in 1-year-old children, for whom the adjusted relative risks (incidence density ratios) for the common cold, otitis media, and pneumonia were 1.69 (95% confidence interval [CI] = 1.43, 2.01), 1.99 (95% CI = 1.57, 2.52), and 9.69 (95% CI = 2.31, 40.55), respectively. Among 1-year-old children, the proportion of infections attributable to care at day-care centers were 41% (95% CI = 30, 50) for colds, 50% (95% CI = 36, 60) for otitis media, and 85% (95% CI = 57, 98) for pneumonia. The results provide evidence that care in day-care centers is a determinant of acute respiratory infections in children under 2, whereas family day care does not essentially increase risk.
The classification of AIDS cases: concordance between two AIDS surveillance systems in Italy.
Authors: Serraino D , Franceschi S , Dal Maso L , Lepri A C , Tirelli U , Rezza G
Published: November 2008

This study assessed the concordance between the transmission classification of 725 acquired immunodeficiency syndrome (AIDS) cases by the Italian AIDS Registry (the national surveillance system) and the classification of the same cases by the Italian Cooperative Group on AIDS-Related Tumors. A high degree of concordance emerged for intravenous drug users in both sexes (kappa = 0.88; 95% confidence interval [CI] = 0.84, 0.92), for homosexual men (kappa = 0.83; 95% CI = 0.79, 0.87), and for persons infected through contaminated blood or blood derivatives (kappa = 1.00). The concordance was lower among heterosexual men (kappa = 0.51; 95% CI = 0.37, 0.65) and especially among men whose risk group was not determined (kappa = 0.28; 95% CI = 0.12, 0.44). The discrepancies observed among heterosexual men indicate a need for continuing and accurate monitoring of AIDS reporting by transmission category.
The estimated frequency of cosmetic breast augmentation among US women, 1963 through 1988.
Authors: Terry M B , Skovron M L , Garbers S , Sonnenschein E , Toniolo P
Published: November 2008

Estimates ranging from 1 to 2 million have been used to describe the number of women in the United States who have had cosmetic breast implants. Original data from a historical cohort study of women with breast augmentation were combined with simulation techniques to compute new estimates grounded on a more objective set of information and assumptions than previous attempts. It was estimated that the number of women who had cosmetic augmentation mammoplasty between 1963 and 1988 was 894,206 (range = 437,602 to 2,035,783). The number of women ever treated with cosmetic augmentation mammoplasty may be substantially smaller than previously reported.
Mortality rates among 15- to 44-year-old women in Boston: looking beyond reproductive status.
Authors: Katz M E , Holmes M D , Power K L , Wise P H
Published: November 2008

Mortality rates were examined for Boston women, aged 15 to 44, from 1980 to 1989. There were 1234 deaths, with a rate of 787.8/100,000 for the decade. Leading causes were cancer, accidents, heart disease, homicide, suicide, and chronic liver disease. After age adjustment, African-American women in this age group were 2.3 times more likely to die than White women. Deaths at least partly attributable to smoking and alcohol amounted to 29.8% and 31.9%, respectively. Mortality was found to be related more directly to the general well-being of young women than to their reproductive status, and many deaths were preventable. African-American/White disparities were most likely linked to social factors. These findings suggest that health needs of reproductive-age women transcend reproductive health and require comprehensive interventions.
Adolescent parity and infant mortality, Minnesota, 1980 through 1988.
Authors: Hellerstedt W L , Pirie P L , Alexander G R
Published: November 2008

The association of parity and infant mortality was studied using linked birth-death files for 46,985 infants born to 11- to 19-year-old Minnesota residents between 1980 and 1988. Compared with infants of primiparas, infants of multiparas were at twice the risk for infant and postneonatal death but at no increased risk for neonatal death. They were also at two to three times the risk for deaths due to accidents, infections, and sudden infant death syndrome. The higher sociodemographic disadvantage and poorer prenatal care of multiparas did not explain the excess infant mortality risk that was concentrated in causes of death that are potentially preventable through primary care and parent education.
Using ICD-9 codes to identify indications for primary and repeat cesarean sections: agreement with clinical records.
Authors: Henry O A , Gregory K D , Hobel C J , Platt L D
Published: November 2008

Aggregate databases are increasingly being used to evaluate appropriateness of care, and, for cesarean sections, Anderson and Lomas' International Classification of Diseases, 9th Revision (ICD-9), coding hierarchy is a widely used tool. The aim of this study was to assess the validity of the hierarchy and expand its applicability to repeat cesareans. Hospital records of 1885 singleton cesareans were reviewed. Clinical indications and ICD-9 hierarchical codes were concordant for 83% of primary and 86% of repeat cesareans; modification allowed elective repeat cesareans to be distinguished from indicated procedures. The Anderson and Lomas ICD-9 hierarchy is a valid tool for assessing indications for cesarean. The current modification improves its clinical utility and expands its application to repeat procedures.
Policy as intervention: environmental and policy approaches to the prevention of cardiovascular disease.
Authors: Schmid T L , Pratt M , Howze E
Published: November 2008

This paper describes the evolution of efforts to prevent cardiovascular disease, from individual health education approaches to broader community education efforts and, finally, to comprehensive and integrated programs addressing environmental, policy, and individual behavior change. Policies are divided into two areas: legislation/regulation and organizational policy. Environmental strategies are measures that alter or control the physical or social environment. Dimensions along which these strategies might be implemented are provided. Policy and environmental approaches can be justified on economic, strategic, and theoretical grounds. Experiences from other fields and other countries provide a framework for conceptualizing cardiovascular disease prevention approaches.
Reducing cigarette consumption in California: tobacco taxes vs an anti-smoking media campaign.
Authors: Hu T W , Sung H Y , Keeler T E
Published: November 2008

OBJECTIVES: The purpose of this study was to examine the relative effects of taxation vs an anti-smoking media campaign on cigarette consumption in California. METHODS: Quarterly cigarette sales data reported by the California State Board of Equalization between 1980 and 1992 were used to estimate a time-series model, adjusted for seasonal variations and time trends. RESULTS: The estimated results show that sales of cigarettes were reduced by 819 million packs from the third quarter of 1990 through the fourth quarter of 1992 owing to an additional 25-cent state tax increase, while the anti-smoking media campaign reduced the cigarette sales by 232 million packs during the same period. CONCLUSIONS: Both taxation and anti-smoking media campaigns are effective means of reducing cigarette consumption. The strength of those effects, however, is influenced by the magnitude of the taxes and the amount of media campaign expenditures.
Sociodemographic and psychosocial factors in childhood as predictors of adult mortality.
Authors: Schwartz J E , Friedman H S , Tucker J S , Tomlinson-Keasey C , Wingard D L , Criqui M H
Published: November 2008

OBJECTIVES: Childhood sociodemographic, psychosocial, and environmental factors are often assumed to affect adult health and longevity. These relationships were prospectively tested by using the 7-decade Terman Life Cycle Study of Children With High Ability (n = 1285). METHODS: Parental socioeconomic status, childhood health, objective childhood stressors (e.g., death or divorce of parents), and childhood personality were considered as potential predictors in hazard regression analyses of longevity through 1991. RESULTS: Parental divorce during childhood predicted decreased longevity, with sex controlled. Other potential social predictors failed to show significant associations with longevity. Three dimensions of childhood personality--conscientiousness, lack of cheerfulness, and permanency of mood (males only)--predicted increased longevity. The effects of parental divorce and childhood personality were largely independent and did not account for any of the gender difference in mortality. CONCLUSIONS: A small number of childhood factors significantly predicted mortality across the life span in this sample. Further research should focus on how these psychosocial factors influence longevity.
Improving the E coding of hospitalizations for injury: do hospital records contain adequate documentation?
Authors: Langlois J A , Buechner J S , O'Connor E A , Nacar E Q , Smith G S
Published: November 2008

OBJECTIVES: Incomplete external cause of injury (E) coding limits the usefulness of hospital discharge data sets for injury surveillance and research. Hospital medical records were examined to determine whether they contained adequate cause of injury documentation to allow for more complete E coding of injury discharges. METHODS: Medical records for a sample of discharges involving a principal diagnosis of injury from the Uniform Hospital Discharge Data Set for Rhode Island were selected. We assigned E codes to these discharges and compared our E codes with those of the discharge data set. RESULTS: Documentation of cause of injury in the medical records was sufficient to allow assignment of a specific E code to 70% of the injuries for which no E codes or vague E codes were submitted on the Uniform Hospital Discharge Data Set. It was estimated that specific cause of injury documentation is available in the medical records of 80% of all injury discharges in Rhode Island; for approximately 90%, an E code describing at least the broad cause of injury could be assigned. CONCLUSIONS: Rates of E coding can be substantially increased by making better use of existing documentation in medical records.
The effect of passenger load on unstable vehicles in fatal, untripped rollover crashes.
Authors: Whitfield R A , Jones I S
Published: November 2008

Consumers may be unaware of the risk of rollover crashes posed by passenger loads in vehicles with poor roll stability. This analysis demonstrates that certain sports utility vehicles and small pickup trucks have designs that are so unstable that the weight of the passengers in the vehicle affects its propensity to roll over. This effect occurs even though the weight of the loaded vehicle is less than the manufacturer's gross vehicle weight rating. The risk of a fatal, "untripped" rollover crash in vehicles with low roll stability is increased as each passenger is added to the vehicle load.
Pediatric mortality and hospital use in Canada and the United States, 1971 through 1987.
Authors: Hodge M J , Dougherty G E , Pless I B
Published: November 2008

Since 1971 pediatric mortality rates have decreased markedly but differently in Canada and the United States. These trends were examined in light of changes in hospital use and health care financing. Annual mortality and hospital use rates for children aged 14 years and younger were calculated. Between 1971 and 1987, all-cause mortality in Canada fell from 165 to 74 per 100,000; the American rate fell from 172 to 96 per 100,000. American hospitalization rates remained essentially constant until 1983 and then fell by 27.5%, while Canadian hospitalization rates declined throughout. In 1987 Canadian children had higher hospitalization rates, while American children had higher mortality rates. These differences may be associated with differences in health financing; the adoption of US prospective payment systems was temporally coincident with sharp declines in hospitalization rates for American children.
Racial discrimination and blood pressure: the CARDIA Study of young black and white adults.
Authors: Krieger N , Sidney S
Published: November 2008

OBJECTIVES: This study examined associations between blood pressure and self reported experiences of racial discrimination and responses to unfair treatment. METHODS: Survey data were collected in year 7 (1992/93) of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective multisite community-based investigation. Participants included 831 Black men, 1143 Black women, 1006 White men, and 1106 White women 25 to 37 years old. RESULTS: Systolic blood pressure among working-class Black adults reporting that they typically accepted unfair treatment and had experienced racial discrimination in none of seven situations was about 7 mm Hg higher than among those reporting that they challenged unfair treatment and experienced racial discrimination in one or two of the situations. Among professional Black adults, systolic blood pressure was 9 to 10 mm Hg lower among those reporting that they typically challenged unfair treatment and had not experienced racial discrimination. Black-White differences in blood pressure were substantially reduced by taking into account reported experiences of racial discrimination and responses to unfair treatment. CONCLUSIONS: Research on racial/ ethnic distributions of blood pressure should take into account how discrimination may harm health.
Do beliefs, knowledge, and perceived norms about diet and cancer predict dietary change?
Authors: Patterson R E , Kristal A R , White E
Published: November 2008

OBJECTIVES: We hypothesized that belief in an association between diet and cancer, knowledge of dietary recommendations and food composition, and perceived norms would predict healthful dietary changes. METHODS: Data are from a population-based sample of Washington State residents (n = 607). Psychosocial constructs measured at baseline (1989/90) were used to predict changes in dietary practices, fat intake, fiber intake, and weight over 3 years. RESULTS: Adults who strongly believed in a diet-cancer connection decreased the percentage of energy consumed from fat by 1.20 percentage points and increased fiber intake by 0.69 g, compared with decreases of 0.21 percentage points and 0.57 g among those with no belief (P < .05). Adults with knowledge of the National Cancer Institute fat and fiber goals decreased their percentage of energy from fat by 1.70 points compared with an increase of 0.27 points among those with little knowledge (P < .05). Food composition knowledge and perceived pressure to eat a healthful diet were not significant predictors of changes in fat intake, fiber intake, or weight. CONCLUSIONS: Interventions that increase the public's beliefs in diet and health associations and communicate diet recommendations can encourage healthful dietary change.
The effects of poverty, race, and family structure on US children's health: data from the NHIS, 1978 through 1980 and 1989 through 1991.
Authors: Montgomery L E , Kiely J L , Pappas G
Published: November 2008

OBJECTIVES: This study investigated the independent and relative effects of family structure, race, and poverty on the health of US children and youth under 20 years of age at two time periods, 1978 through 1980 and 1989 through 1991. METHODS: Data were from the National Health Interview Surveys. Multivariate logit regression methods were used to analyze the effects of family structure, poverty, and race on children's health. RESULTS: Children in families headed by single mothers, Black children, and those living below 150% of the poverty index were much more likely to be in poor or fair health than children in two-parent families, White children, or those in more affluent families. Poverty had the strongest effect on child health in both time periods. CONCLUSIONS: The association between children's health and living below 150% of the poverty index is not explained by race or family structure. The disparity in child health by family income has serious consequences for both the child and society.
Race, asthma, and persistent wheeze in Philadelphia schoolchildren.
Authors: Cunningham J , Dockery D W , Speizer F E
Published: November 2008

OBJECTIVES: Many studies show asthma to be more common in Black than in White children. This study assessed how much of this difference remains after adjustment for other potentially race-associated predictors of asthma. METHODS: We assessed the predictors of active diagnosed asthma and persistent wheeze in 1416 Black and White Philadelphia children aged 9 to 11 years, as reported by parents. RESULTS: Black race remained a significant predictor of active diagnosed asthma (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.3, 4.1) but not of persistent wheeze (OR = 1.0; 95% CI = 0.6, 1.8). The excess risk of asthma in Black children was not appreciably altered by adjustment for other demographic and environmental factors. CONCLUSIONS: Black race is an important risk factor for active diagnosed asthma in these urban children, a relationship not explained by social factors. This finding and the lack of an association of race with persistent wheeze after adjustment for social factors suggest that race may be more important to the acquisition of an asthma diagnosis than to the prevalence of the symptoms.
Factors associated with emergency department visits by children with asthma: implications for health education.
Authors: Wasilewski Y , Clark N M , Evans D , Levison M J , Levin B , Mellins R B
Published: November 2008

OBJECTIVES: This study investigated the relationship between psychosocial and behavioral factors and the frequency of emergency department visits for childhood asthma. METHODS: Data obtained from a survey of parents of 445 children who were being treated for asthma in the emergency room of a large urban hospital were examined. RESULTS: Factors associated with high emergency department use included the child's being of younger age, a greater number of days with symptoms of asthma, a higher number of asthma medicines prescribed, a prior hospitalization for asthma, a lower level of parental confidence in the efficacy of medicines, and a failure to use a criterion for deciding to seek emergency care. CONCLUSIONS: Younger children with asthma and children with previous hospitalization for asthma are at high risk for using emergency care. Families who use the emergency department frequently need to be further educated in the inflammatory nature of the disease, in the efficacy of proper use of medicine, in the need for ongoing care, and in criteria to distinguish those symptoms that can be handled at home from those requiring emergency care.
Lead-contaminated house dust and urban children's blood lead levels.
Authors: Lanphear B P , Weitzman M , Winter N L , Eberly S , Yakir B , Tanner M , Emond M , Matte T D
Published: November 2008

OBJECTIVES: This study assessed the relationship between lead-contaminated house dust and urban children's blood lead levels. METHODS: A random-sample survey was used to identify and enroll 205 children, 12 to 31 months of age, who had resided in the same house since at least 6 months of age. Children's blood and household dust, water, soil, and paint were analyzed for lead, and interviews were conducted to ascertain risk factors for elevated blood lead (> or = 10 micrograms/dL). RESULTS: Children's mean blood lead level was 7.7 micrograms/dL. In addition to dust lead loading (micrograms of lead per square foot), independent predictors of children's blood lead were Black race, soil lead levels, ingestion of soil or dirt, lead content and condition of painted surfaces, and water lead levels. For dust lead standards of 5 micrograms/sq ft, 20 micrograms/sq ft, and 40 micrograms/sq ft on noncarpeted floors, the estimated percentages of children having blood lead levels at or above 10 micrograms/dL were 4%, 15%, and 20%, respectively, after adjusting for other significant covariates. CONCLUSIONS: Lead-contaminated house dust is a significant contributor to lead intake among urban children who have low-level elevations in blood lead. A substantial proportion of children may have blood lead levels of at least 10 micrograms/dL at dust lead levels considerably lower than current standards.
Predictors of mortality in children with severe mental retardation: the effect of placement.
Authors: Strauss D , Eyman R K , Grossman H J
Published: November 2008

OBJECTIVES: This study was undertaken to assess the predictors of mortality in severely disabled children with mental retardation, and to compare risk-adjusted mortality rates for those living in institutions with rates for those living in the community. METHODS: Statistical analysis was performed on a set of 24,469 person-years, derived from a population of all children with severe mental retardation and a fragile medical condition who are registered with the California Department of Developmental Services. Variables included age, several measures of mobility, the presence or absence of tube feeding, the level of retardation, and certain adaptive skills. RESULTS: Reduced mobility and the use of tube feeding were associated with a large increase in mortality risk. Own home residence and community care facilities have an estimated 25% higher risk-adjusted odds on mortality than institutions and health facilities. CONCLUSIONS: The differential mortality in the placements points to a possible effect of quality of care. One consequence of the current trend toward deinstitutionalization may be an increased mortality rate in children with severe developmental disability.
The recovery of Guatemalan children with mild to moderate wasting: factors enhancing the impact of supplementary feeding.
Authors: Rivera J A , Habicht J P
Published: November 2008

OBJECTIVES: The purpose of this study was to identify factors that enhance the recovery due to supplementary feeding in wasted children. METHODS: Recovery rates were obtained in mild to moderately wasted 6- to 48-month-old rural Guatemalan children living in four villages. Children in two villages received a high protein-energy supplement (supplemented children), while children in the other villages received a low protein-energy supplement (nonsupplemented children). The difference in recovery rates between the groups was the attributable benefit. The net supplementation amounted to 11% of the recommended energy intake and its associated nutrients. RESULTS: Attributable supplement benefits were achieved in younger children (6 to 24 months old) and increased with decreasing weight for length, longer duration of supplementation, and duration of diarrhea, but not with chronicity of wasting. CONCLUSIONS: Supplementation's effectiveness can be improved in similar populations by programs targeted according to these findings.
Preventing HIV/AIDS among high-risk urban women: the cost-effectiveness of a behavioral group intervention.
Authors: Holtgrave D R , Kelly J A
Published: November 2008

OBJECTIVES: A human immunodeficiency virus (HIV) intervention trial for women at high risk for acquired immunodeficiency syndrome and attending an urban clinic was reported previously. The behavioral group intervention was shown to increase condom use behaviors significantly. This study retrospectively assessed the intervention's cost-effectiveness. METHODS: Standard methods of cost and cost-utility analysis were used. RESULTS: The intervention cost was just over $2000 for each quality-adjusted life-year saved; this is favorable compared with other life-saving programs. However, the results are sensitive to changes in some model assumptions. CONCLUSIONS: Under most scenarios, the HIV prevention intervention was cost-effective.
Spina bifida and cleft lip among newborns of Norwegian women with epilepsy: changes related to the use of anticonvulsants.
Authors: King P B , Lie R T , Irgens L M
Published: November 2008

OBJECTIVES: This study examined the connection between the use of anticonvulsants for epilepsy during or before pregnancy and the risk of spina bifida and cleft lip in newborns. METHODS: Among mothers registered from 1967 to 1992 by the Medical Birth Registry of Norway, 7588 who had epilepsy were identified and their newborns' prevalence of spina bifida and cleft lip examined. RESULTS: The odds ratio of spina bifida in children of mothers with epilepsy compared with other children increased from 1.5 in 1967 through 1980 (95% confidence interval [CI] = 0.3, 4.5) to 4.4 in 1981 through 1992 (95% CI = 2.0, 8.5). The odds ratio of cleft lip, however, decreased from 3.0 before 1981 (95% CI = 1.6, 5.1) to 1.1 after 1981 (95% CI = 0.4, 2.3). CONCLUSIONS: This shift toward more serious birth defects is consistent with the different teratogenic effects of newer and older anticonvulsants.
Lower respiratory tract infections among Norwegian infants with siblings in day care.
Authors: Nafstad P , Hagen J A , Botten G , Jaakkola J J
Published: November 2008

OBJECTIVES: The purpose of this study was to assess the role of siblings in day care as a determinant of infants' risk of lower respiratory tract infections. METHODS: A total of 3238 children (86%) out of 3754 Oslo, Norway, newborns recruited in 1992/93 were followed for 1 year. RESULTS: In logistic regression analysis, the risk of infection was increased in (1) infants with one or more siblings compared with infants without siblings (adjusted odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.84, 2.85) and (2) infants with one or more siblings in day care compared with infants with siblings not in day care (adjusted OR = 1.7; 95% CI = 1.21, 2.26). CONCLUSIONS: The results suggest that siblings in day care outside the home increase infants' risk of lower respiratory tract infections.
Socioeconomic factors in Helicobacter pylori infection among Danish adults.
Authors: Rosenstock S J , Andersen L P , Rosenstock C V , Bonnevie O , Jørgensen T
Published: November 2008

OBJECTIVES: This study examined the relationship between housing conditions, educational level, occupational factors, and serologically diagnosed acute and chronic Helicobacter pylori infection. METHODS: Immunoglobulin G and immunoglobulin M serum antibodies against H. pylori were measured in 3589 Danish adults who participated in a population study. RESULTS: Low socioeconomic status (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.7, 3.0), short duration of schooling (OR = 2.0, 95% CI = 1.3, 2.5), lack of training/education (OR = 1.4, 95% CI = 1.2, 1.7]), unskilled work (OR = 1.7, 95% CI = 1.2, 2.5), and high work-related energy expenditure (OR = 1.4, 95% CI = 1.1, 1.9) increased the likelihood of chronic H. pylori infection. Infection was frequent in people who had lived abroad. Increased levels solely of immunoglobulin M antibodies were found more often in people who were divorced (OR = 2.3, 95% CI = 1.2, 4.4) or unmarried (OR = 2.0, 95% CI = 1.1, 3.8) or who worked long hours (OR = 2.0, 95% CI = 1.1, 4.0). CONCLUSIONS: Educational and occupational factors relate to the likelihood of chronic H. pylori infection in adults. The rate of acute infection is high in single individuals.
Measles vaccination levels of children enrolled in WIC during the 1991 measles epidemic in New York City.
Authors: LeBaron C W , Birkhead G S , Parsons P , Grabau J C , Barr-Gale L , Fuhrman J , Brooks S , Maes E , Friedman S , Hadler S C
Published: November 2008

OBJECTIVES: This study assessed measles vaccination rates and risk factors for lack of vaccination among preschool children enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC) during the 1991 measles epidemic in New York City. METHODS: Children aged 12 to 59 months presenting for WIC certification between April 1 and September 30, 1991, at six volunteer WIC sites in New York City were surveyed. RESULTS: Of the 6181 children enrolled in the study, measles immunization status was ascertained for 6074 (98%). Overall measles coverage was 86% (95% confidence interval [CI] = +/- 1%) and at least 90% by 21 months of age (95% CI = +/- 1%). Young age of the child, use of a private provider, and Medicaid as a source of health care payment were risk factors for lack of vaccination (P < .001). CONCLUSIONS: During the peak of a measles epidemic, measles immunization rates were more than 80% by 24 months of age in a sample of WIC children. The ease of ascertaining immunization status and the size of the total WIC population underscore the importance of WIC immunization initiatives.
A nurse-managed smoking cessation program for hospitalized smokers.
Authors: Taylor C B , Miller N H , Herman S , Smith P M , Sobel D , Fisher L , DeBusk R F
Published: November 2008

OBJECTIVES: This study evaluated a nurse-managed smoking cessation program for smokers hospitalized for a variety of conditions. METHODS: Hospitalized patients who smoked prior to hospitalization and who were motivated to quit (n = 660) were randomized to intervention or usual-care groups and followed for the next year. The intervention included a meeting with the nurse-case manager; the use of a videotape, workbook, relaxation audiotape, and nicotine replacement therapy; and nurse-initiated phone contacts after discharge. RESULTS: The 12-month confirmed cessation rates were 21% and 31% for, respectively, the usual-care and intervention groups (odds ratio = 1.7; 95% confidence interval = 1.1, 2.3). CONCLUSIONS: A nurse-managed smoking cessation intervention can significantly increase cessation rates for hospitalized patients.
Burmese political dissidents in Thailand: trauma and survival among young adults in exile.
Authors: Allden K , Poole C , Chantavanich S , Ohmar K , Aung N N , Mollica R F
Published: November 2008

OBJECTIVES: This study assessed the self-reported mental health, physical health, and social functioning of young adult political exiles and relates their psychiatric symptoms to their trauma and survival strategies. METHODS: A 1992/93 survey of Burmese who fled to Bangkok, Thailand, after participating in a 1988 uprising against Burma's government elicited information on employment, education, disability, trauma, survival strategies, and depressive and posttraumatic stress symptoms. RESULTS: The 104 participants reported a mean of 30 trauma events, including interrogation (89%), imprisonment (78%), threats of deportation (70%), and torture (38%). Many reported poor health and lack of social supports, but few reported substantial social disability. The prevalence of elevated symptom scores was 38% for depressive symptoms and 23% for criterion symptoms of posttraumatic stress disorder. Symptoms of avoidance and of increased arousal were the most strongly related to cumulative trauma. Two survival strategies, camaraderie and a Buddhist concept of self-confidence (weria), were associated with somewhat reduced levels of both classes of symptoms. CONCLUSIONS: Burmese political exiles in Thailand are young adults adversely affected by severe trauma. Their psychosocial well-being may deteriorate further without legal protections to reduce the continuing stress and violence.
The sexual practices of adolescent virgins: genital sexual activities of high school students who have never had vaginal intercourse.
Authors: Schuster M A , Bell R M , Kanouse D E
Published: November 2008

OBJECTIVES: The purpose of this study was to determine whether high school-aged virgins engage in sexual practices that can transmit sexually transmitted diseases, including the human immunodeficiency virus (HIV). METHODS: Data were collected from an anonymous self-administered survey of 2026 urban students in 9th through 12th grades. RESULTS: Forty-seven percent of adolescents were virgins (42% of male adolescents and 53% of female adolescents). Of those who were virgins, 29% and 31% reported that, during the prior year, they had engaged in heterosexual masturbation of a partner and masturbation by a partner, respectively. The corresponding rates for heterosexual fellatio with ejaculation, cunnilingus, and anal intercourse were 9%, 10%, and 1%. Homosexual sexual activities were rare. Condom use for fellatio was also rare. Level of risk of virgins' sexual activities was associated with illicit substance use and other non-sexual risk behaviors, even after demographic variables had been controlled. CONCLUSIONS: Few high school-aged virgins engaged in anal intercourse, but many engaged in other genital sexual activities. Some of these activities can transmit disease, and all can indicate a need for counseling about sexual decision making, risk, and prevention.