bluuebunny/crossref_metadata_2025 huggingface dataset:
The Stanford Nutrition Action Program: a dietary fat intervention for low-literacy adults.
Authors: Howard-Pitney B , Winkleby M A , Albright C L , Bruce B , Fortmann S P
Published: November 2008

OBJECTIVES: This study was undertaken to test the effectiveness of the Stanford Nutrition Action Program, an experimental trial to reduce dietary fat intake among low-literacy, low-income adults. METHODS: Twenty-four paired adult education classes (351 participants, 85% women, mean age = 31 years) were randomly assigned to receive a newly developed dietary fat curriculum (the Stanford Nutrition Action Program) or an existing general nutrition curriculum. Food frequency and nutrition-related data, body mass index, and capillary blood cholesterol were collected at baseline and at two postintervention follow-ups. RESULTS: The Stanford Nutrition Action Program classes showed significantly greater net improvements in nutrition knowledge (+7.7), attitudes (/0.2), and self-efficacy (-0.2) than the general nutrition classes; they also showed significantly greater reductions in the percentage of calories from total (-2.3%) and saturated (-0.9%) fat. There were no significant differences in body mass index or blood cholesterol. All positive intervention effects were maintained for 3 months postintervention. CONCLUSIONS: The Stanford Nutrition Action Program curriculum, tailored to the cultural, economic, and learning needs of low-literacy, low-income adults, was significantly more effective in achieving fat-related nutritional changes than the general nutrition curriculum.
The defeat of Philip Morris' 'California Uniform Tobacco Control Act'.
Authors: Macdonald H , Aguinaga S , Glantz S A
Published: November 2008

OBJECTIVES: This paper describes the strategies used by Philip Morris and other tobacco companies to promote a California initiative (Proposition 188) preempting local control of tobacco and those used by public health groups to defeat the initiative. METHODS: Interviews with key informants were conducted, and the written record was reviewed. RESULTS: Tobacco companies nearly succeeded in passing Proposition 188 by presenting it as a pro-health measure that would prevent children from obtaining cigarettes and provide protection against secondhand smoke. Public health groups defeated it by highlighting tobacco industry backing. A private charitable foundation also played an innovative role by financing a non-partisan public education campaign. CONCLUSIONS: Public health forces must be alert to sophisticated efforts by the tobacco industry to enact preemptive state legislation by making it look like tobacco control legislation. The coalition structure that emerged in the "No on 188" campaign represents an effective model for future tobacco control activities. The new role of charitable foundations defined in the Proposition 188 campaign can be used in other public health issues.
The mental health of informal caregivers in Ontario: an epidemiological survey.
Authors: Cochrane J J , Goering P N , Rogers J M
Published: November 2008

OBJECTIVES: This study describes the mental health status, disability, physical health, and mental health service utilization of informal care-givers under the age of 65 in the province of Ontario. METHODS: The study analyzed data collected in the 1991 province-wide, population-based mental health supplement to the Ontario Health Survey. Diagnoses from the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised, were generated on the basis of a structured diagnostic interview. Caregivers and noncaregivers are compared here on past-year prevalence of psychiatric disorder, physical illness, disability, and utilization of mental health services. The possible confounding effects of age, sex, employment status, and economic disadvantage are explored. RESULTS: Informal caregivers (n = 1219) constituted 15.0% of the sample. Caregivers had higher rates of affective (6.3% vs 4.2%) and anxiety (17.5% vs 10.9%) disorders than noncaregivers and used health services for mental health problems at nearly twice the rate. CONCLUSIONS: Documentation of the prevalence of caregiving and the increased prevalence of psychiatric disorders, disability, and service utilization among caregivers is of critical importance as governments continue to move toward community-based care. To accomplish this goal, the needs of caregivers must be acknowledged and met by the establishment of appropriate and readily accessible support services.
The epidemiology of necrotizing enterocolitis infant mortality in the United States.
Authors: Holman R C , Stoll B J , Clarke M J , Glass R I
Published: November 2008

OBJECTIVES: This study examined trends and risk factors for infant mortality associated with necrotizing enterocolitis in the United States. METHODS: Necrotizing enterocolitis-associated deaths and infant mortality rates from 1979 through 1992 were determined by means of US multiple cause-of-death and linked birth/infant death data. RESULTS: Annual necrotizing enterocolitis infant mortality rates decreased from 1979 through 1986 but increased thereafter and were lower during the 3-year period before (1983 through 1985;11.5 per 100,000 live births) the introduction of surfactants than after (1990 through 1992; 12.3 per 100,000). Low-birthweight singleton infants who were Black male, or born to mothers younger than 17 had increased risk for necrotizing enterocolitis-associated death. CONCLUSIONS: As mortality among low-birth weight infants continues to decline and smaller newborns survive early causes of death, necrotizing enterocolitis-associated infant mortality may increase.
Cryptosporidiosis-associated mortality following a massive waterborne outbreak in Milwaukee, Wisconsin.
Authors: Hoxie N J , Davis J P , Vergeront J M , Nashold R D , Blair K A
Published: November 2008

OBJECTIVES: This study estimated the magnitude of cryptosporidiosis-associated mortality in the Milwaukee vicinity for 2 years following a massive waterborne outbreak. METHODS: Death certificates were reviewed. RESULTS: During approximately 2 years before the outbreak, cryptosporidiosis was listed as an underlying or contributing cause of death on the death certificates of four Milwaukee-vicinity residents. In the approximately 2 years after the outbreak, this number was 54, of whom 85% had acquired immunodeficiency syndrome (AIDS) listed as the underlying cause of death. In the first 6 months after the outbreak, the number of death certificates indicating AIDS, but not cryptosporidiosis, as a cause of death was 19 (95% confidence interval = 12.26) higher than preoutbreak trends would have predicted. CONCLUSIONS: Waterborne outbreaks of cryptosporidium infection can result in significant mortality, particularly among immunocompromised populations. Any discussion of policies to ensure safe drinking water must consider the potential fatal consequences of waterborne cryptosporidiosis among immunocompromised populations.
Predisposing factors for individuals' Lyme disease prevention practices: Connecticut, Maine, and Montana.
Authors: Herrington J E , Campbell G L , Bailey R E , Cartter M L , Adams M , Frazier E L , Damrow T A , Gensheimer K F
Published: November 2008

OBJECTIVES: This study examined factors that predispose individuals to protect against Lyme disease. METHODS: Knowledge, attitude, and practice questions concerning Lyme disease prevention were included in the Behavioral Risk Factor Surveillance surveys in Connecticut, Maine, and Montana. A total of 4246 persons were interviewed. RESULTS: Perceived risk of acquiring Lyme disease, knowing anyone with Lyme disease, knowledge about Lyme disease, and believing Lyme disease to be a common problem were significantly associated with prevention practices. CONCLUSIONS: Predisposing factors differ substantially between states and appear related to disease incidence. Personal risk, knowing someone with Lyme disease, and cognizance about Lyme disease and acting on this information are consistent with social learning theories.
Posttraumatic stress disorder among female Vietnam veterans: a causal model of etiology.
Authors: Fontana A , Schwartz L S , Rosenheck R
Published: November 2008

OBJECTIVES: The Vietnam and Persian Gulf wars have awakened people to the realization that military service can be traumatizing for women as well as men. This study investigated the etiological roles of both war and sexual trauma in the development of chronic posttraumatic stress disorder among female Vietnam veterans. METHODS: Data from the National Vietnam Veterans Readjustment Study for 396 Vietnam theater women and 250 Vietnam era women were analyzed with structural equation modeling. RESULTS: An etiological model with highly satisfactory fit and parsimony was developed. Exposure to war trauma contributed to the probability of posttraumatic stress disorder in theater women, as did sexual trauma in both theater and era women. Lack of social support at the time of homecoming acted as a powerful mediator of trauma for both groups of women. CONCLUSIONS: Within the constraints and assumptions of causal modeling, there is evidence that both war trauma and sexual trauma are powerful contributors to the development of posttraumatic stress disorder among female Vietnam veterans.
Maternal smoking and medical expenditures for childhood respiratory illness.
Authors: Stoddard J J , Gray B
Published: November 2008

OBJECTIVES: This study sought to assess the association between environmental tobacco smoke exposure from maternal smoking and health care expenditures for respiratory conditions among US children. METHODS: Multivariate analysis of the 1987 National Medical Expenditure Survey was undertaken with a sample that included 2624 children 5 years of age and under. RESULTS: After analysis that controlled for various sociodemographic factors associated with health care usage, respiratory-related health care expenditures among children whose mothers smoke were found to be significantly higher than those expenditures for children of nonsmoking mothers. Truncated regression techniques were used to estimate that maternal smoking was associated with increased health care expenditures averaging (in 1995 dollars) $120 per year for children aged 5 years and under and $175 per year for children aged 2 years and under. Our analysis indicates that passive smoking was associated with $661 million in annual medical expenditures in 1987, representing 19% of all expenditures for childhood respiratory conditions. CONCLUSIONS: Maternal smoking is associated with significantly increased child health expenditures and contributes significantly to the overall cost of medical care.
The impact of payor/provider type on health care use and expenditures among the frail elderly.
Authors: Experton B , Li Z , Branch L G , Ozminkowski R J , Mellon-Lacey D M
Published: November 2008

OBJECTIVES: This study examined whether health care expenditures and usage by the frail elderly differ under three payor/provider types: Medicare fee for service, Medicare health maintenance organization (HMO), and dual Medicare-Medicaid enrollment. METHODS: In-home interviews were conducted among 450 frail elderly patients of a San Diego, Calif, health care system. Cost and use data were collected from providers. RESULTS: Analyses revealed no difference in total expenditures between fee-for-service and HMO enrollees, but Medicare-Medicaid beneficiaries' expenditures were 46.8% higher than those for HMO enrollees and 52.2% higher than those for the fee-for-service group. Fee-for-service participants were less than half as likely as HMO enrollees to have two or more hospital admissions, but hospital usage rates between those two payor/provider groups did not differ. Not were there payor/provider differences in access to home health care, but HMO home health care users received significantly fewer services than the others. CONCLUSIONS: The care provided to these HMO beneficiaries resulted in a combination of restricted home health use and higher multiple hospitalizations. This raises compelling questions for future research. For the dually enrolled, stronger cost containment may be required.
Substance use among runaway and homeless youth in three national samples.
Authors: Greene J M , Ennett S T , Ringwalt C L
Published: November 2008

OBJECTIVES: Standardized estimates of the prevalence of substance use by runaway and homeless youth between the ages of 12 and 21 in various settings were compared with each other and with estimates for youth in the general population. METHODS: Four surveys were used: (1) a nationally representative survey of runaway and homeless youth residing in federally and non-federally funded shelters; (2) a multicity survey of street youth; (3) a nationally representative household survey of youth with and without recent runaway and homeless experiences; and (4) a nationally representative household survey of youth whose previous runaway/homeless status was unknown. RESULTS: For almost every substance, substance use prevalence was highest among street youth. Shelter youth and household youth with recent runaway/homeless experiences reported similar rates. In the household surveys, substance use rates were lowest and were generally comparable. CONCLUSIONS: Many homeless and runaway youth use tobacco, alcohol, and other drugs at rates substantially higher than nonrunaway and nonhomeless youth, indicating a need for comprehensive and intensive substance abuse prevention and treatment services for these youth.
Adverse childhood experiences: are they risk factors for adult homelessness?
Authors: Herman D B , Susser E S , Struening E L , Link B L
Published: November 2008

OBJECTIVES: We tested the hypothesis that adverse childhood experiences are risk factors for adult homelessness. METHODS: We interviewed a nationally representative sample of 92 US household members who had previously been homeless and a comparison group of 395 individuals with no prior homelessness. We assessed childhood adversity with a structured protocol that included a previously validated scale indicating lack of care from parents and single-item measures of physical and sexual abuse. RESULTS: Lack of care from a parent during childhood sharply increased the likelihood of subsequent homelessness (odds ratio [OR] = 13), as did physical abuse (OR = 16). Sexual abuse during childhood was associated with a nonsignificant trend toward homelessness (OR = 1.7). The risk of subsequent homelessness among individuals who experienced both lack of care and either type of abuse was dramatically increased compared with subjects reporting neither of these adversities (OR = 26). CONCLUSIONS: Adverse childhood experiences are powerful risk factors for adult homelessness. Effectively reducing child abuse and neglect may ultimately help prevent critical social problems including homelessness.
Motor-vehicle crash fatalities among American Indians and non-Indians in Arizona, 1979 through 1988.
Authors: Campos-Outcalt D , Prybylski D , Watkins A J , Rothfus G , Dellapenna A
Published: November 2008

OBJECTIVES: This study evaluated the contributions of rural residence, alcohol use, and pedestrian fatalities to the high American Indian motor-vehicle crash mortality rate in Arizona. METHODS: Records from the Fatal Accident Reporting System were used to examine mortality rates between 1979 and 1988. RESULTS: American Indians had increased relative risks in all motor-vehicle crash categories in all residence-gender groups. The percentage of excess mortality associated with alcohol varied from 36.8% to 66.7%, and the percentage associated with pedestrian deaths ranged from 27.2% to 55.4%. CONCLUSIONS: Efforts to reduce excess motor-vehicle crash mortality among American Indians should concentrate on preventing pedestrian and alcohol-related fatalities.
Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study.
Authors: Bitto A , Gray R H , Simpson J L , Queenan J T , Kambic R T , Perez A , Mena P , Barbato M , Li C , Jennings V
Published: November 2008

OBJECTIVES: The purpose of this study was to determine prospectively whether unplanned pregnancies are associated with adverse pregnancy outcomes among users of natural family planning. METHODS: Women who became pregnant while using natural family planning were identified in five centers worldwide: there were 373 unplanned and 367 planned pregnancies in this cohort. The subjects were followed up at 16 and 32 weeks' gestation and after delivery. The risks of spontaneous abortion, low birth-weight, and preterm birth were estimated after adjustment by logistic regression. RESULTS: The women with unplanned pregnancies were more likely to be at the extremes of age, to report more medical problems before and during the index pregnancy, and to seek antenatal care later in gestation than the women with planned pregnancies. However, women with planned pregnancies reported a higher rate of spontaneous abortion in previous pregnancies (28.8%) than did women with unplanned pregnancies (12.9%). There were no significant differences in the rates of spontaneous abortion, low birthweight, or preterm birth between the two groups. CONCLUSIONS: No increased risk of adverse pregnancy outcomes was observed among women who experienced an unplanned pregnancy while using natural family planning.
The early use of alcohol and tobacco: its relation to children's competence and parents' behavior.
Authors: Jackson C , Henriksen L , Dickinson D , Levine D W
Published: November 2008

OBJECTIVES: Use of tobacco and alcohol during childhood predicts heavy use of these substances and use of illicit drugs during adolescence. This study aims to identify developmental correlates of tobacco and alcohol use among elementary-school children. METHODS: Cross-sectional surveys were used to measure tobacco and alcohol use, multiple indicators of child competence, parenting behaviors, and parental modeling of tobacco and alcohol use in a sample of 1470 third- and fifth-grade children. Both self-report and teacher-rated assessments were obtained, which allowed collateral testing of study hypotheses. RESULTS: Children's tobacco and alcohol use was strongly related to low scores on several measures of child competence, both self-reported and teacher rated. Children's tobacco and alcohol use was also associated with less effective parenting behaviors and with parental use of tobacco and alcohol. CONCLUSIONS: Children's early experience with tobacco and alcohol is associated with weak competence development and exposure to socialization factors that promote risk taking. Interventions to prevent early use of tobacco and alcohol are needed.
Unmet health care needs and mortality among Spanish elderly.
Authors: Alonso J , Orfila F , Ruigómez A , Ferrer M , Antó J M
Published: November 2008

OBJECTIVES: This study estimates the prevalence of unmet health care needs among the elderly of Barcelona, Spain, and analyzes the association between unmet needs and mortality. METHODS: Home interviews were conducted with 1315 elderly in Barcelona. Individuals were classified as having a "health services need" if they reported being in fair, poor, or very poor health; suffering from two or more chronic conditions; or being dependent in at least one basic activity of daily living. Need was considered unmet if no visits to or from a physician in the previous 12 months were reported. Mortality was assessed from census data in August 1991. RESULTS: Between 10% and 25% of the elderly in need reported no use of health services. After a median of 60.3 months, those with unmet health care needs presented a higher risk of mortality, adjusted for several confounding factors: relative risk [RR] = 2.55 (95% confidence interval [CI] = 1.22, 5.32) for unmet activity of daily living dependency; RR = 1.80 (95% CI = 1.20, 2.70) for unmet comorbidity; and odds ratio = 1.10 (95% CI = 0.59, 2.05) for unmet poor self-rated health. CONCLUSION: Noninstitutionalized elderly individuals with unmet health care needs are at increased risk of dying.
Living arrangements, changes in living arrangements, and survival among community dwelling older adults.
Authors: Davis M A , Moritz D J , Neuhaus J M , Barclay J D , Gee L
Published: November 2008

OBJECTIVES: This study examines whether living arrangements and changes in living arrangements are associated with survival among older community-dwelling adults, and whether differences in health status account for observed differences in survival. METHODS: The sample consisted of 5085 persons aged 70 years or older who had participated in the Longitudinal Study of Aging in 1984 and 1986. Proportional hazards models were used to examine associations of survival time through 1990 with living arrangements in 1984 and with changes in living arrangements from 1984 to 1986. RESULTS: Women who lived with someone other than a spouse at baseline or who changed from living with a spouse to living with someone other than a spouse were at greater risk of dying than women in other living arrangements, independent of health status or functioning. Among men, survival time was not generally associated with baseline living arrangements. CONCLUSIONS: Older adults who live alone or who change from living with someone to living alone do not have an increased mortality risk. However, living with or changing to living with someone other than a spouse may be associated with increased mortality risk.
Characteristics of older pedestrians who have difficulty crossing the street.
Authors: Langlois J A , Keyl P M , Guralnik J M , Foley D J , Marottoli R A , Wallace R B
Published: November 2008

OBJECTIVES: This study examined the sociodemographic and health characteristics and problems of older pedestrians. METHODS: Interviews and assessments were conducted with 1249 enrollees aged 72 or older from the New Haven, Conn, community of the Established Populations for Epidemiologic Studies of the Elderly who agreed to participate in a seventh follow-up. RESULTS: Approximately 11% of the New Haven residents reported difficulty crossing the street. Older pedestrians needing help in one or more activities of daily living were more than 10 times as likely as others, and those with the slowest walking speeds were nearly 3 times as likely as others, to report difficulty crossing the street. Fewer than 1% of these pedestrians aged 72 or older had a normal walking speed sufficient to cross the street in the time typically allotted at signalized intersections (1.22 m/sec). CONCLUSIONS: Crossing times at signalized intersectíons in areas with large populations of elders should be extended, and the recommended walking speed for timing signalized crossings should be modified to reflect the range of abilities among older pedestrians.
Decreasing smoking prevalence during pregnancy in Sweden: the effect on small-for-gestational-age births.
Authors: Cnattingius S , Haglund B
Published: November 2008

OBJECTIVES: This study examined whether recent changes in smoking prevalence among pregnant women have affected risks of small-for-gestational-age births. METHODS: With data for all live single births in Sweden from 1983 through 1992 (n = 1048139), odds ratios [ORs] and attributable risks of small-for-gestational-age births were calculated for 1983 through 1985, 1986 through 1989, and 1990 through 1992. RESULTS: Daily smoking decreased from 29.4% in 1983 to 21.8% in 1992. For the three time periods, the odds ratios of small-for-gestational-age births by maternal smoking were almost identical: 1-9 cigarettes/day OR = 2.1 or 2.2; for > or = 10 cigarettes/day, OR = 2.8. The attributable risk of smoking for small-for-gestational-age births declined from 26.2% in 1983 through 1985 to 20.9% in 1990 through 1992. CONCLUSIONS: The findings point to a true decrease in tobacco exposure during pregnancy and a reduction in the attributable risk for small-for-gestational-age births.
Very-low-birthweight infants and income incongruity among African American and white parents in Chicago.
Authors: Collins J W , Herman A A , David R J
Published: November 2008

OBJECTIVES: Illinois vital records for 1982/1983 and US census income data for 1980 were analyzed to ascertain the relationship of income incongruity, race, and very low birthweight. METHODS: Positive income incongruity was considered present when study infants resided in wealthier neighborhoods than non-Latino Whites at the same level of parental education attainment and marital status. RESULTS: The odds ratios of very low birthweight for African Americans (n = 44,266) and Whites (n = 27,139) who experienced positive income incongruity were 0.7 (95% confidence interval [CI] = 0.5, 0.9) and 0.6 (95% CI = 0.5, 0.9), respectively. CONCLUSIONS: Positive income incongruity is associated with lower race-specific rates of very low birthweight.
South Africa's early experiment in social medicine: its pioneers and politics.
Authors: Marks S
Published: November 2008

The election of a democratic, nonracial government in South Africa has moved the health needs of the majority of the population to center stage. In the search for precedents, health policymakers have turned to South Africa's pioneering of health centers and social medicine in the 1940s. This paper looks at the intellectual context in which these ideas were first developed; the particular political circumstances and relationships between doctors and the state in the late 1930s, which facilitated the establishment of health centers; the role that the health centers were intended to play in South Africa's wider postwar health plans; and the reasons for the centers' failure. Contrary to conventional wisdom, it argues that the failure of the health centers and the wider health plans predated the advent of the National Party to power in 1948, and resulted mainly from the marginalization of the centers as a low-cost option for the poor, which was itself a consequence of underfunding and the vested interests of local health authorities and private practitioners.
Increased condom use without other major changes in sexual behavior among the general population in Switzerland.
Authors: Dubois-Arber F , Jeannin A , Konings E , Paccaud F
Published: November 2008

OBJECTIVES: This study is part of a continuous evaluation of the Swiss AIDS prevention strategy from 1987 through 1994. METHODS: Annual telephone surveys of samples representative of the general population aged 17 through 45 years have been conducted since 1987 to monitor behavioral change. RESULTS: No major changes in level of sexual activity (lifetime number of partners, frequency of sexual encounters in the past week) or potential exposure to risk of HIV transmission (acquisition of a new steady partner during the year or of casual partners in the last 6 months) were observed. Systematic condom use with a new steady partner increased between 1988 and 1994, from 40% to 64% among 17- to 30-year-olds and from 57% to 72% among those aged 31 to 45. Systematic condom use with casual partners increased from 8% to 56% between 1987 and 1994 among 17- to 30-year-olds and from 22% to 42% between 1989 and 1994 among those aged 31 to 45. Condom use was higher among those with multiple partners. CONCLUSIONS: A general-population approach to AIDS prevention was able to achieve large-scale improvements in condom-based protection against HIV infection without inducing other major changes in sexual behavior.
Neighborhood social environments and the distribution of low birthweight in Chicago.
Authors: Roberts E M
Published: November 2008

OBJECTIVES: This study examined the socioeconomic precursors of disparities in maternal health by measuring the associations of nine neighborhood-level indicators of social phenomena with low infant birthweight. METHODS: Vital records and census data for the Chicago metropolitan area in 1990 were merged (n = 112,327); a logistic regression model predicting low birthweight was estimated by backward elimination. RESULTS: With individual-level variables held constant, six neighborhood-level indicators predicted low birthweight, together contributing to a variation in rate of 5.5%. Community economic hardship and housing costs were positively associated with low birthweight, while community socioeconomic status, crowded housing, and high percentages of young and African-American residents were negatively associated with low birthweight. CONCLUSIONS: Maternal health inequalities should be explored in the context of historical segregation, social stratification, the dynamics of social support, and resource sharing among communities. Several community characteristics associated with poverty are negatively associated with low birthweight. The traditional focus on individual risk factors for low birthweight limits our understanding.
Seven-year trends in body weight and associations with lifestyle and behavioral characteristics in black and white young adults: the CARDIA study.
Authors: Lewis C E , Smith D E , Wallace D D , Williams O D , Bild D E , Jacobs D R
Published: November 2008

OBJECTIVES: This study estimated the amount of weight change in a biracial cohort of young adults and the separate components attributable to time-related and aging-related changes, as well as identified possible determinants of weight change. METHODS: In this population-based prospective study of 18- to 30-year-old African-American and White men and women, body weight and prevalence of overweight were measured from 1985/86 to 1992/93. RESULTS: Average weight increased over the 7 years, increases ranging from 5.2 kg (SE = 0.2, n = 811) in White women to 8.5 kg (SE = 0.3, n = 882) in African-American women. Significant time-related increases in weight, ranging from 2.0 kg (SE = 1.0) in White women to 4.8 kg (SE = 1.0, n = 711) in African-American men, accounted for 40% to 60% of the average total weight gain. Aging-related increases were also significant, ranging from 2.6 kg (SE = 0.8, n = 944) in White men to 5.0 kg (SE = 1.1) in African-American women. The prevalence of overweight increased progressively in each group. Decreased physical fitness was most strongly associated with weight gain in both sexes. CONCLUSIONS: The observed dramatic time-related weight gains, most likely due to secular (period-related) trends, are a serious public health concern.
The effectiveness of a hospital-based program to promote exclusive breast-feeding among low-income women in Brazil.
Authors: Lutter C K , Perez-Escamilla R , Segall A , Sanghvi T , Teruya K , Wickham C
Published: November 2008

OBJECTIVES: This study examined the effectiveness of a hospital program to promote exclusive breast-feeding in Santos, Brazil. METHODS: In a prospective design, women who delivered at a hospital with an active breast-feeding promotion program (n = 236) were compared with women who delivered at a nearby control hospital (n = 206). RESULTS: The two groups had similar demographic characteristics and previous breast-feeding histories. Exposure to breast-feeding activities, assessed by maternal recall prior to discharge, was universally high at the program hospital and universally low at the control hospital. Multivariate survival analysis showed that exclusive breast-feeding lasted 53 days longer among women who delivered at the program hospital. CONCLUSIONS: Hospital-based breast-feeding promotion programs may be effective in extending the duration of exclusive breast-feeding.
Exercise and depression in midlife: a prospective study.
Authors: Cooper-Patrick L , Ford D E , Mead L A , Chang P P , Klag M J
Published: November 2008

OBJECTIVES: This study examined the relationship of self-reported physical activity with subsequent depression and psychiatric distress. METHODS: Physical activity was assessed in medical school and midlife in 973 physicians as part of a prospective observational study. Outcome measures were the incidence of self-reported clinical depression and psychiatric distress on the General Health Questionnaire. RESULTS: The risk of depression was similar for nonexercisers and exercisers. No relationship was observed between physical activity level and subsequent psychiatric distress. CONCLUSIONS: This study found no evidence that exercise reduces risk for depression or psychiatric distress.
Composite cardiovascular risk outcomes of a work-site intervention trial.
Authors: Gomel M K , Oldenburg B , Simpson J M , Chilvers M , Owen N
Published: November 2008

OBJECTIVES: Two composite outcome measures were used to assess the efficacy of work-site risk factor interventions: the Framingham multiple logistic function and a standardized composite equation that was an unweighted combination of risk factors. METHODS: Twenty-eight work sites in Sydney, Australia, were randomly assigned to health risk assessment, risk factor education, behavioral counseling, or behavioral counseling plus incentives. RESULTS: Over 12 months, scores on the multiple logistic function increased for the behavioral counseling plus incentives condition relative to the other conditions. Standardized scores decreased for behavioral counseling relative to the incentive condition and the average of all other conditions. CONCLUSIONS: Behavioral counseling produces larger changes in the life-style behaviors contributing to coronary heart disease risk than other commonly used interventions.
Stable behaviors associated with adults' 10-year change in body mass index and likelihood of gain at the waist.
Authors: Kahn H S , Tatham L M , Rodriguez C , Calle E E , Thun M J , Heath C W
Published: November 2008

OBJECTIVES: The purpose of this study was to identify behaviors associated with change in body mass index or with weight gain at the waist. METHODS: A cohort of 79236 White, non-Hispanic, healthy adults was questioned in 1982 and 1992 about diet and 10 physical activities. Estimates were made of the mean effects of stable behaviors on 10-year change in body mass index and on odds ratios for gain at the waist. RESULTS: Ten-year changes in body mass index was associated positively with meat consumption and smoking cessation and inversely with vegetable consumption, vitamin E supplementation, continued smoking, and some vigorous activities (e.g., jogging/running). Women's body mass index decreased with walking 4 or more hours per week and with regular alcohol intake, but these behaviors had a smaller effect on men's body mass index. weight gain was inversely associated with high vegetable consumption, walking 4 or more hours per week, and jogging/running 1 to 3 hours per week but not with less demanding physical activities. CONCLUSIONS: Simple derivation of behaviors associated with weight loss or reduced abdominal obesity may enhance programs designed to prevent obesity and chronic diseases.
Do smokers understand the mortality effects of smoking? Evidence from the Health and Retirement Survey.
Authors: Schoenbaum M
Published: November 2008

OBJECTIVES: This study examined whether smokers recognize that smoking is likely to shorten their lives and, if so, whether they understand the magnitude of this effect. METHODS: People's expectations about their chances of reaching age 75 were compared with epidemiological predictions from life tables for never, former, current light, and current heavy smokers. Data on expectations of reaching age 75 came from the Health and Retirement Survey, a national probability sample of adults aged 50 through 62 years. Predictions came from smoking-specific life tables constituted from the 1986 National Mortality Followback Survey and the 1985 and 1987 National Health Interview Surveys. RESULTS: Among men and women, the survival expectations of never, former, and current light smokers were close to actual predictions. However, among current heavy smokers, expectations of reaching age 75 were nearly twice as high as actuarial predictions. CONCLUSIONS: These findings suggest that at least heavy smokers significantly underestimate their risk of premature mortality.
The relationship between the race/ethnicity of generalist physicians and their care for underserved populations.
Authors: Xu G , Fields S K , Laine C , Veloski J J , Barzansky B , Martini C J
Published: November 2008

OBJECTIVES: The purpose of this study was to examine empirically the relationship between physicians' race or ethnicity and their care for medically underserved populations. METHODS: Generalist physicians who received the MD degree in 1983 or 1984 (n = 1581) were surveyed. The personal and background characteristics of four racial/ethnic groups of physicians were compared with the characteristics of their patients. RESULTS: When the potentially confounding variables of gender, childhood family income, childhood residence, and National Health Services Corps financial aid obligations were controlled, generalist physicians from underrepresented minorities were more likely than their nonminority counterparts to care for medically underserved populations. CONCLUSIONS: Physicians from underrepresented minorities are more likely than others to care for medically underserved populations.
Psychiatric disorders among American Indian and white youth in Appalachia: the Great Smoky Mountains Study.
Authors: Costello E J , Farmer E M , Angold A , Burns B J , Erkanli A
Published: November 2008

OBJECTIVES: This study examined prevalence of psychiatric disorders, social and family risk factors for disorders, and met and unmet needs for mental health care among Appalachian youth. METHODS: All 9-, 11-, and 13-year-old American Indian children in an 11-county area of the southern Appalachians were recruited, together with a representative sample of the surrounding population of White children. RESULTS: Three-month prevalences of psychiatric disorders were similar (American Indian, 16.7%; White, 19.2%). Substance use was more common in American Indian children (9.0% vs 3.8% in White children), as was comorbidity of substance use and psychiatric disorder (2.5% vs 0.9%). American Indian poverty, family adversity (e.g., parental unemployment, welfare dependency), and family deviance (parental violence, substance abuse, and crime) rates were higher, but the rate of family mental illness, excluding substance abuse, was lower. Child psychiatric disorder and mental health service use were associated with family mental illness in both ethnic groups but were associated with poverty and family deviance only in White children. Despite lower financial barriers, American Indian children used fewer mental health services. CONCLUSIONS: This study suggests that poverty and crime play different roles in different communities in the etiology of child psychiatric disorder.
Relative risk in the news media: a quantification of misrepresentation.
Authors: Frost K , Frank E , Maibach E
Published: November 2008

OBJECTIVES: This study quantifies the representativeness with which the print news media depict mortality. METHODS: The proportion of mortality-related copy in samples of national print media was compared with the proportion of actual deaths attributable to the leading causes of US mortality over a 1-year period. RESULTS: For every tested cause of death, a significant disproportion was found between amount of text devoted to the cause and the actual number of attributable deaths. Underrepresented causes included tobacco use (23% of expected copy) and heart disease (33%); overrepresented causes included illicit use of drugs (1740%), motor vehicles (1280%), and toxic agents (1070%). CONCLUSIONS: The news media significantly misrepresent the prevalence of leading causes of death and their risk factors. This misrepresentation may contribute to the public's distorted perceptions of health threats.
The impact of public assistance factors on the immunization levels of children younger than 2 years.
Authors: Suarez L , Simpson D M , Smith D R
Published: November 2008

OBJECTIVES: This study examined how children's immunization status varied with enrollment in the Women, Infants, and Children (WIC); Aid to Families with Dependent Children (AFDC); food stamp; and Medicaid programs. METHODS: A statewide survey was used to determine the percentage of children less than 2 years of age who were up to date for diphtheria, tetanus, and pertussis; polio; and measles, mumps, and rubella vaccines. RESULTS: WIC and uninsured children were more likely and AFDC and Medicaid children less likely to be up to date than others. CONCLUSIONS: The higher immunization status of WIC and uninsured children suggests that integrating immunization practices with government programs may be effective.
Injection drug use among homeless adults with severe mental illness.
Authors: Susser E , Betne P , Valencia E , Goldfinger S M , Lehman A F
Published: November 2008

OBJECTIVES: This study examined injection drug use among homeless men and women with severe mental illness in two sites. METHODS: The data were drawn from related clinical trials conducted in Baltimore (101 men, 49 women) and Boston (85 men, 33 women). RESULTS: The percentages of homeless men with a history of injection drug use were 26% in Baltimore and 16% in Boston; the corresponding rates among homeless women were 8% and 6%. CONCLUSIONS: Taken together, these and previous results suggest high lifetime prevalences of injection drug use-and associated risks of HIV transmission-in this elusive population.
Reduced probability of HIV infection among crack cocaine--using injection drug users.
Authors: Iguchi M Y , Bux D A
Published: November 2008

OBJECTIVES: This study examined in greater detail the authors' previously reported finding that crack use among injection drug users is associated with lower levels of infection with the human immunodeficiency virus (HIV). METHODS: Self-reported data and blood tests for HIV antibodies from 4840 out-of-treatment injection drug users were used to examine relationships among crack use, HIV risk behavior, and HIV infection. RESULTS: Crack use was significantly associated with higher levels of many sexual risk and needle use behaviors and was consistently associated, independently of all behavioral variables examined, with lower rates of HIV infection. CONCLUSIONS: Crack use among injection drug users appears to be associated with lower risk for HIV infection independently of other behavioral variables.
The relationship of patient reading ability to self-reported health and use of health services.
Authors: Baker D W , Parker R M , Williams M V , Clark W S , Nurss J
Published: November 2008

OBJECTIVES: This study examined the relationship of functional health literacy to self-reported health and use of health services. METHODS: Patients presenting to two large, urban public hospitals in Atlanta, Ga, and Torrance, Calif, were administered a health literacy test about their overall health and use of health care services during the 3 months preceding their visit. RESULTS: Patients with inadequate functional health literacy were more likely than patients with adequate literacy to report their health as poor. Number of years of school completed was less strongly associated with self-reported health. Literacy was not related to regular source of care or physician visits, but patients in Atlanta with inadequate literacy were more likely than patients with adequate literacy to report a hospitalization in the previous year. CONCLUSIONS: Low literacy is strongly associated with self-reported poor health and is more closely associated with self-reported health than number of years of school completed.
Weapon carrying among black adolescents: a social network perspective.
Authors: Myers G P , McGrady G A , Marrow C , Mueller C W
Published: November 2008

OBJECTIVES: This report describes the salience of social networks to the phenomena of adolescent weapon carrying. METHODS: A random-walk network sampling design was used to survey 113 adolescents about topics, including weapon carrying. RESULTS: In a probability sample of 12- to 15-year-olds, 20.9% reported ever carrying a weapon. Carriers were eight times as likely as noncarriers to report weapon carrying by an older associate, and 19 times as likely to report weapon carrying by a peer. A significant dose-response effect was present. CONCLUSIONS: This evidence supports the interpretation that modeling of weapon carrying by personal network members is important for its initiation and maintenance in adolescence.
Increasing car seat use for toddlers from inner-city families.
Authors: Louis B , Lewis M
Published: November 2008

OBJECTIVES: The purpose of this project was to increase toddler car seat use in low-income minority families. METHODS: Families from Newark, NJ, were divided into two study groups. Both groups were given car seats; one group also received education regarding car restraint use. Observations were made of car seat use before car seat distribution, immediately after distribution, 4 to 5 months later, and 1 year later. RESULTS: Car seat use increased markedly immediately after distribution and remained high 1 year later, regardless of education. CONCLUSIONS: These results indicate that distributing car seats results in long-term use among a currently low-use population.
Medical necessity and defined coverage benefits in the Oregon Health Plan.
Authors: Glassman P A , Jacobson P D , Asch S
Published: November 2008

The policy debate in Oregon has primarily focused on the Prioritized List of Services. However, little information is available on how defined coverage benefits and managed care affect the role of medical necessity in determining care for Medicaid patients. This issue is important because medical necessity determinations are currently used by many states to limit extraneous health care costs but require resource-intensive oversight, are open to wide variance, and frequently prompt litigation challenging interpretations of what is necessary and what is not. The qualitative study described here addressed whether medical necessity remains a salient and useful concept in the Oregon Health Plan. Our results indicate that defined coverage benefits, as described by the funded portion of the Prioritized List of Services, supplant medical necessity determinations for coverage, while managed care incentives limit the need for medical necessity determinations at the provider level. Clinical choices are, for the most part, guided by providers' judgment within the financial constraints of capitation and by targeted use management techniques. The combination of capitated care and Oregon's defined coverage benefits package has marginalized the use of medical necessity, albeit with consequences for state oversight of Medicaid services.
Flawed gun policy research could endanger public safety.
Authors: Webster D W , Vernick J S , Ludwig J , Lester K J
Published: November 2008

A highly publicized recent study by Lott and Mustard concludes that laws easing restrictions on licenses for carrying concealed firearms in public substantially reduce violent crime. Several serious flaws in the study render the authors' conclusions insupportable. These flaws include misclassification of gun-carrying laws, endogeneity of predictor variables, omission of confounding variables, and failure to control for the cyclical nature of crime trends. Most of these problems should bias results toward overestimating the crime-reducing effects of laws making it easier to carry concealed firearms in public. Lott and Mustard's statistical models produce findings inconsistent with criminological theories and well-established facts about crime, and subsequent reanalysis of their data challenges their conclusions. Public health professionals should understand the methodological issues raised in this commentary, particularly when flawed research could influence the introduction of policies with potentially deleterious consequences.