bluuebunny/crossref_metadata_2025 huggingface dataset:
The current state of health care in the former Soviet Union: implications for health care policy and reform.
Authors: Barr D A , Field M G
Published: November 2008

OBJECTIVES. Given the many profound health care problems facing Russia and the other former Soviet republics, there are a number of fundamental policy questions that deserve close attention as part of the reform process. METHODS. Summary data regarding Soviet health care issues were drawn from government agency reports, scholarly books and journals, recent press reports, and the authors' personal research. RESULTS. Smoking, alcohol, accidents, poor sanitation, inadequate nutrition, and extensive environmental pollution contribute to illness and premature mortality in Russia and the other newly independent states. Hospitals and clinics are poorly maintained and equipped; most physicians are poorly trained and inadequately paid; and there is essentially no system of quality management. While efforts at reform, which emphasize shifting to a system of "insurance medicine," have been largely unsuccessful, they have raised several important policy issues that warrant extensive research and discussion. CONCLUSIONS. Without considering the implications and consequences of alternative policy directions, Russia and the other states face the very real possibility of developing health care systems that improve the overall level of care but also incorporate limited access and escalating costs. Russian health care reform leaders can learn from the health care successes in the West and avoid repeating our mistakes.
The nutritional status of the elderly in Russia, 1992 through 1994.
Authors: Popkin B M , Zohoori N , Baturin A
Published: November 2008

OBJECTIVES. The purpose of this study was to ascertain how economic reform has affected nutritional well-being of the elderly in the Russian Federation. METHODS. A sample of more than 2932 Russians 60 years of age and older was selected from a nationally representative survey of Russian households. A 24-hour dietary recall and data on weight, height, and socioeconomic status were collected during 1992 and 1993 and from a separate nationally representative sample of 1955 persons in the same age group in 1994. RESULTS. Russia's elderly did not experience major declines in economic or nutritional well-being during the first 2 years of the reform period. Dietary composition shifted slightly toward reduced fat consumption. A small proportion of individuals showed signs of underweight. Of those who were underweight in 1992, none had lost more than 3 kg of weight by 1993. Among those 70 years of age and older, none who were underweight had lost any appreciable weight, although half lost small amounts. CONCLUSIONS. Many more underweight elderly people increased than reduced their weight. Mean weight increased among all body mass index groups over the year reported here. However, economic conditions in December 1994 raise concerns.
Acculturation and low-birthweight infants among Latino women: a reanalysis of HHANES data with structural equation models.
Authors: Cobas J A , Balcazar H , Benin M B , Keith V M , Chong Y
Published: November 2008

Previous studies have demonstrated that acculturation is associated with negative birth outcomes among mothers in numerous immigrant populations, including Latinas. This study used structural equation models to reanalyze data employed in the 1989 Scribner and Dwyer study on the effect of acculturation (measured through the Cuellar scale) on mothers' low-birthweight status. Data revealed that language components dominate the effects of acculturation on low-birthweight status. Acculturuation appears to affect low-birthweight status indirectly through smoking and dietary intake but not through parity. Acculturation has a persistent direct effect on low-birthweight status, suggesting that other intervening variables are operant.
Iron deficiency in Massachusetts communities: Socioeconomic and demographic risk factors among children.
Authors: Sargent J D , Stukel T A , Dalton M A , Freeman J L , Brown M J
Published: November 2008

OBJECTIVES: This study examined the association between community rates of iron deficiency in children and sociodemographic characteristics of Massachusetts communities. METHODS: Between April 1990 and March 1991, 238 273 Mssachusetts children 6 through 59 months of age were screened; iron deficiency was defined as an erythrocyte protopophyrin concentration of 0.62 micromol/L or higher and a blood lead level of less than 1.2 micromol/L. Sociodemographic data were obtained from the 1990 US Census. RESULTS: Five percent of communities had iron deficiency rates greater than 13.9 per 100 children screened. Iron deficiency rate was positively associated with proportion of Southeast Asians (odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.08, 1.12), proportion of Hispanics (OR = 1.008, 95% CI = 1.002, 1.013), and high school incompletion (OR = 1.028, 95% CI = 1.020, 1.035). Similarly, an examination of three Massachusetts cities indicated that the iron deficiency rate was higher for children with Southeast Asian (relative risk [RR] = 3.6, 95% CI = 3.3, 3.8) and Hispanic (RR = 1.6, 95% CI = 1.5, 1.8) surnames than for all other children. CONCLUSIONS: Wide variation exists in iron deficiency rates for children in Massachusetts communities. Community iron deficiency was associated with low socioeconomic status and high proportions of Southeast Asians and Hispanics.
The transcontinental transmission of tuberculosis: A molecular epidemiological assessment.
Authors: Casper C , Singh S P , Rave S , Daley C L , Schecter G S , Riley L W , Kreiswirth B N , Small P M
Published: November 2008

Many tuberculosis control activities are based on principles learned from studies of tuberculosis transmission. To date, these have largely been limited to outbreak investigations in confined geographical regions. In this report conventional and computerized DNA fingerprint- based approaches were integrated to demonstrate that the most widely prevalent strain of Mycobacterium tuberculosis from New York City was cultured from only 1 of 755 patients in San Francisco, Calif, who was a traveling salesman. Large-scale molecular epidemiologic studies may provide a better understanding of the dynamics of tuberculosis transmission between geographic regions and suggest rational measures to interrupt such transmission.
Trends and differentials in adolescent and young adult mortality in the United States, 1950 through 1993.
Authors: Singh G K , Yu S M
Published: November 2008

Using data from the National Vital Statistics System and the National Longitudinal Mortality Study, this study examined mortality trends and differentials from 1950 through 1993 among US adolescents and young adults according to sex, race/ethnicity, education, family income, marital status, and cause of dealth. No appreciable reduction in youth mortality has occurred, especially among men. Declines in youth mortality from accidents have been nearly ofset by increases in death rates from homicide, suicide, and firearm injuries. American Indians, Blacks, males, and those with least education and income were at increased risk of both overall and injury-specific youth mortality.
Surgery for colorectal cancer: Race-related differences in rates and survival among Medicare beneficiaries.
Authors: Cooper G S , Yuan Z , Landefeld C S , Rimm A A
Published: November 2008

This study examined surgery for colorectal cancer among Medicare beneficiaries 65 years of age or older with an initial diagnosis in 1987 (n = 81 579). Black patients were less likely than White to undergo surgical resection (68% vs 78%), even after age, comorbidity, and location and extent of tumor were controlled for. Among those who underwent resection, Black patients were more likely to die (a 2-year mortality rate of 40.0% vs 33.5% in White patients); this disparity also remained after confounders had been controlled. The disparities were similar in teaching and nonteaching hospitals and in private and public hospitals. These data may indicate racially based differences among Medicare beneficiaries in access to and quality of care for colorectal cancer.
Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology.
Authors: Susser M , Susser E
Published: November 2008

Part I of this paper traced the evolution of modern epidemiology in terms of three eras, each with its dominant paradigm, culminating in the present era of chronic disease epidemiology with its paradigm, the black box. This paper sees the close of the present era and foresees a new era of eco-epidemiology in which the deployment of a different paradigm will be crucial. Here a paradigm is advocated for the emergent era. Encompassing many levels of organization--molecular and societal as well as individual--this paradigm, termed Chinese boxes, aims to integrate more than a single level in design, analysis, and interpretation. Such a paradigm could sustain and refine a public health-oriented epidemiology. But preventing a decline of creative epidemiology in this new era will require more than a cogent scientific paradigm. Attention will have to be paid to the social processes that foster a cohesive and humane discipline.
Directive counseling on long-acting contraception.
Authors: Moskowitz E , Jennings B
Published: November 2008

National rates of unintended births are a major public health concern. The availability of highly effective long-acting contraceptives has prompted some public officials to promote the coercive use of these methods to reduce such problems as intergenerational poverty and child abuse. Broad-brush public policies that require long-term contraceptive use are unethical. However, persuasion to use these methods can be appropriate. One place for exerting ethically justified influence is in family planning counseling. The dominant nondirective counseling model, which excludes the possibility of vigorous persuasion, is overly rigid. Family planning professionals should develop practice protocols that permit and guide the exercise of directive counseling to use long-acting contraception.
Age-related changes in total and high-density-lipoprotein cholesterol in elderly Dutch men.
Authors: Weijenberg M P , Feskens E J , Kromhout D
Published: November 2008

OBJECTIVES: This study investigated changes in total and high-density-lipoprotein cholesterol (HDL) concentrations with age and time in elderly men. METHODS: A cohort of men born between 1900 and 1920 from the Dutch town of Zutphen was examined in 1977 and 1978 (n = 571), 1985 (n = 885), 1990 (n = 555), and 1993 (n = 345). Linear regression analysis and random-effects models were used to assess cross-sectional and longitudinal age- and time-related changes in cholesterol concentrations. RESULTS: In both cross-sectional and longitudinal analyses, total cholesterol decreased by 0.04 mmol/L a year with age. The longitudinal change was observed in the entire population as well as in men who participated in all four examinations (n = 135) and in a subgroup of men who were free of common chronic diseases, were not on cholesterol-lowering medication or a prescribed diet, and rated themselves as being "healthy" (n = 64). HDL cholesterol did not change significantly with age neither on a cross-sectional nor on a longitudinal basis. CONCLUSIONS: Among elderly men, total cholesterol diminishes with age both on a cross-sectional and on a longitudinal basis; HDL cholesterol does not vary with age in any way.
Prenatal hospitalization and compliance with guidelines for prenatal care.
Authors: Haas J S , Berman S , Goldberg A B , Lee L W , Cook E F
Published: November 2008

OBJECTIVES: This study examined the relationship between compliance with the US Public Health Service guidelines for prenatal care and the rate of prenatal hospitalization. METHODS: For all women admitted to a Boston referral center during January and February 1993 with a pregnancy of at least 18 weeks gestation (n = 1400), a proportional hazards model was used to examine factors associated with prenatal hospitalization. RESULTS: Prenatal hospitalization occurred during 248 (17.7%) pregnancies. The median length of stay for all prenatal admissions was 4 days; the medial total charge was $5667. Prior medical and obstetrical problems were strongly associated with prenatal hospitalization. After adjustment for age, race, and medical and obstetrical complications, women who received less than 70% of the prenatal care recommended were significantly more likely to be hospitalized (relative risk [RR] = 2.14, 95% confidence interval [CI] 1.50, 3.06). CONCLUSIONS: Prenatal hospitalization is a common, costly complication of pregnancy. Because of its association with compliance with the Public Health Service guidelines for the content of prenatal care, prenatal hospitalization may be a sentinel indicator of inadequate prenatal care amenable to intervention.
Adverse pregnancy outcomes: differences between US- and foreign-born women in major US racial and ethnic groups.
Authors: Singh G K , Yu S M
Published: November 2008

OBJECTIVES: This study examined whether there were significant differentials between US-born and foreign-born women in risks of infant mortality, low birthweight, and preterm birth and whether these differentials, if they existed, varied across major US racial/ethnic groups. METHODS: Multivariate logistic regression was applied to national linked birth/infant death records for 1985 through 1987 to estimate overall and ethnic-specific maternal nativity effects on pregnancy outcomes. RESULTS: Substantial maternal nativity differences in risks of infant mortality and low birthweight were found, with the magnitude of the nativity effect varying significantly across racial/ethnic groups. Overall, foreign-born status was associated with 7% and 20% lower risks of low birthweight and infant mortality, respectively. However, the reduced risk of adverse pregnancy outcome associated with immigrant status tended to be substantially larger for Blacks, Cubans, Mexicans, and Chinese than for other ethnic groups. CONCLUSIONS: Maternal nativity status, along with ethnicity, may serve as an important axis of differentiation in birth outcome studies. Further research needs to be conducted to assess the effects of behavioral, cultural, and psychosocial factors in explaining the nativity differentials observed here.
What proportion of multiple births are due to ovulation induction? A register-based study in Italy.
Authors: Corchia C , Mastroiacovo P , Lanni R , Mannazzu R , Currò V , Fabris C
Published: November 2008

OBJECTIVES: This study evaluated the increase in risk of multiple births associated with ovulation induction and calculated the proportion of multiple births attributable to this treatment. METHODS: Cases were 350 multiple births and controls were 737 single births enrolled from April 1993 to March 1994 in the Mercurio Project, an investigation of reproductive outcomes in Italy. RESULTS: Ovulation induction was used in 45 case births (12.9%) and 24 control births (3.3%); the adjusted odds ratio was 4.1 (95% confidence interval [CI] = 2.4, 6.9). The odds ratio for triplet or higher order births was 72.2 (95% CI = 25.7, 202.8). When unlike-sexed multiple births were considered, the odds ratio increased for twin births, but not for triplet or higher births. The highest odds ratios were found when ovulation induction was used with assisted reproduction. The proportion of multiple births attributable to ovulation induction was 9.7% overall, 5.4% for twin births, and 69.8% for triplet or higher births. CONCLUSIONS: Ovulation induction increases the risk of multiple births and has been responsible for the rise in the rate of triplet or higher order births in Italy in the last decade. Its indiscriminate and improper use should be avoided.
Risk factors for self-reported uterine fibroids: a case-control study.
Authors: Samadi A R , Lee N C , Flanders W D , Boring J R , Parris E B
Published: November 2008

To identify risk factors for uterine fibroids, a case-control design used to analyze data from control subjects enrolled in the Cancer and Steroid Hormone Study. Case patients were 201 women who reported a history of uterine fibroids, and control subjects were 1503 women without fibroids, individually matched by age to case patients. Reporting of fibroids was more frequent among premenopausal women, women who had frequent Papanicolaou (Pap) smears, women who used oral contraceptives and had infrequent Pap smears, and women with higher education. Reporting of fibroids was less frequent among women with a lower body mass index who were current or long-time smokers.
Prematurity as a public health problem: US policy from the 1920s to the 1960s.
Authors: Oppenheimer G M
Published: November 2008

During the 1920s and 1930s, a number of physicians created model premature infant stations in select hospitals, arguing that medicine could successfully treat premature infants, most of whom could be expected to live normal lives. Most hospitals and doctors, however, remained indifferent to the special medical needs of premature infants. Subsequently, public health officials, beginning in Chicago, took up the cause of the medical management of newborn premature infants, defining the problem and finding the resources for a community-wide solution. The latter included multiple, high-quality premature nurseries, infant transport, regionalization, and public financing. The "Chicago model" was adapted by many state and municipal departments of health, particularly after World War II, to create community-based programs, the largest of which was in New York City. As premature infant care became of greater interest to pediatricians and hospitals, in part because of the success achieved by public health officials, the earlier, prominent role of the latter was increasingly diminished and historically forgotten.
Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort.
Authors: Martikainen P , Valkonen T
Published: November 2008

OBJECTIVES. This study examines excess mortality among Finnish persons after the death of a spouse, by sex, the subject's cause of death, duration of bereavement, and age. METHODS. The subjects were 1580000 married Finnish persons aged 35 through 84 years who were followed up from 1986 through 1991. RESULTS. Excess mortality among the bereaved was high from accidental, violent, and alcohol-related causes (50% to 150%), moderate for chronic ischemic heart disease and lung cancer (20% to 35%), and small for other causes (5% to 15%). Excess mortality was greater at short ( < 6 months) rather than long durations of bereavement and among younger rather than older bereaved persons for most causes of death; it was also greater among men that women. CONCLUSIONS. The results are consistent with the hypothesis that excess mortality after the death of a spouse is partly caused by stress. The loss of social support or the inability to cope with stress may explain why men suffer from bereavement more than do women.
HIV infection and AIDS in China, 1985 through 1994.
Authors: Yu E S , Xie Q , Zhang K , Lu P , Chan L L
Published: November 2008

OBJECTIVES. This paper analyzes data on the distribution of and risk factors for the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection in China. METHODS. Ten years of data on persons tested for HIV infection and AIDS and the proportion who tested positive were analyzed against the background of China's population count. The Chinese- and English-language literature on HIV and AIDS from 1985 through 1995 was also reviewed. RESULTS. Overall, more males than females had HIV infection. Intravenous drug use was the primary source of transmission, followed by heterosexual contacts. Only a small number of the persons tested were homosexual, but their proportion of HIV seropositivity ranked third to that of drug users; that of general hospital patients ranked fourth. CONCLUSIONS. HIV infection and AIDS in China began as a highly regionalized and largely rural problem in Yunnan Province. However, HIV infection and AIDS have become an emerging urban problem. HIV seropositivity is low among several groups thought to have an elevated risk.
State tobacco lobbyists and organizations in the United States: crossed lines.
Authors: Goldstein A O , Bearman N S
Published: November 2008

OBJECTIVES. This research took a quantitative look at state-level tobacco lobbying in the United States. METHODS. Publicly available lobbying data were collected from all states during 1994. Data were compiled on tobacco industry lobbyists, their tobacco employers, health lobbyists, and factors associated with such lobbying. RESULTS. In 1994, 450 tobacco industry lobbyists lobbied at a state level. Most lobbying was on behalf of four organizations: Philip Morris (34%), the Tobacco Institute (21%), RJ Reynolds (17%), and the Smokeless Tobacco Council (15%). Approximately one half of all tobacco lobbyists also lobbied for a health-related organization (e.g., state medical association, hospital, physician association). CONCLUSIONS. All US states have tobacco lobbyists. Many health organizations knowingly or unknowingly employ lobbyists who also lobby for the tobacco industry.
A new route of transmission for Escherichia coli: infection from dry fermented salami.
Authors: Tilden J , Young W , McNamara A M , Custer C , Boesel B , Lambert-Fair M A , Majkowski J , Vugia D , Werner S B , Hollingsworth J , Morris J G
Published: November 2008

OBJECTIVES. This study evaluated the production of dry fermented salami associated with an outbreak of Escherichia coli O157.H7 infection in Washington State and California. METHODS. Facility inspections, review of plant monitoring data, food handler interviews, and microbiological testing of salami products were conducted. RESULTS. Production methods complied with federal requirements and industry-developed good manufacturing practices. No evidence suggested that postprocessing contamination occurred. Calculations suggested that the infectious dose was smaller than 50 E. coli O157:H7 bacteria. CONCLUSIONS. Dry fermented salami can serve as a vehicle of transmission for O157:H7 strains. Our investigation and prior laboratory studies suggest that E. coli O157:H7 can survive currently accepted processing methods.
Seventh graders' self-reported exposure to cigarette marketing and its relationship to their smoking behavior.
Authors: Schooler C , Feighery E , Flora J A
Published: November 2008

OBJECTIVES: This study examined among youth the extent of their perceived exposure to cigarette marketing and the relationship of their perceptions to their smoking behavior. METHODS: Surveys measuring exposure to cigarette advertisements and promotions were completed by 571 seventh graders in San Jose, Calif. RESULTS: Eighty-eight percent of these 13-year-olds reported exposure to cigarette marketing: the majority often saw ads in magazines, on billboards, and at stores and events, and one quarter owned cigarette promotional items. After social influences to smoke were controlled for, exposure to cigarette marketing was related to self-reported smoking behavior. Likelihood of experimenting with smoking was 2.2 times greater among those who owned promotional items and 2.8 times greater among those who had received mail from a tobacco company. Seeing cigarette advertisements in magazines increased this likelihood by 21%, and seeing tobacco marketing in stores increased it by 38%. CONCLUSIONS: Youth are daily and widely exposed to tobacco industry marketing efforts; this exposure is related to smoking behavior. More effective regulation is needed.
Toward a more realistic appraisal of the lung cancer risk from radon: the effects of residential mobility.
Authors: Warner K E , Mendez D , Courant P N
Published: November 2008

OBJECTIVES: A consideration of the effects of residential mobility produces much more realistic estimates of typical individuals' radon exposures and mortality risks than those of the Environmental Protection Agency (EPA). METHODS: A model linking residential mobility, the distribution of radon in US homes, and lung cancer risk is used to simulate lifetime radon exposure, with and without mitigation of high-radon homes, for typical mobile individuals. Radon-related lung cancer mortality risks are then estimated for smokers and never-smokers. RESULTS: Most individuals residing in high-radon homes have equivalent lifelong radon exposures well below those they are currently experiencing. Consequently, actual lung cancer risks are generally well below those implied in the EPA's radon risk charts. For most people who mitigate high-radon homes, risk reduction is modest. CONCLUSIONS: Radon may indeed be responsible for as large a population risk of lung cancer as the EPA estimates. However, caution must be used in interpreting the EPA's risk assessment for individuals; in many cases, mitigation will have little effect on residents' health risks.
Marine waters contaminated with domestic sewage: nonenteric illnesses associated with bather exposure in the United Kingdom.
Authors: Fleisher J M , Kay D , Salmon R L , Jones F , Wyer M D , Godfree A F
Published: November 2008

OBJECTIVES: This study identified possible dose-response relationships among bathers exposed to marine waters contaminated with domestic sewage and subsequent risk of nonenteric illness. METHODS: Four intervention follow-up studies were conducted within the United Kingdom. Healthy volunteers (n = 1273) were randomized into bather and nonbather groups. Intensive water-quality monitoring was used to assign five bacteriological indices of water quality to individual bathers. Illnesses studied were acute febrile respiratory illness, and eye, ear, and skin ailments. RESULTS: Fecal streptococci exposure was predictive of acute febrile respiratory illness, while fecal coliform exposure was predictive of ear ailments. Estimated thresholds of effect occurred at bather exposures above 60 fecal streptococci and 100 fecal coliform per 100 ml of water, respectively. Although no relationship was found between eye ailments and indicator organism exposure, compared with nonbathers, bathers were at higher risk for eye ailments. CONCLUSIONS: Nonenteric illness can be transmitted via recreational contact with marine waters contaminated with sewage. These results argue against the use of a single indicator to establish water quality standards.
Trends in smokeless tobacco use among men in four states, 1988 through 1993.
Authors: Nelson D E , Tomar S L , Mowery P , Siegel P Z
Published: November 2008

OBJECTIVES: Trends in smokeless tobacco use were examined for men in Indiana, Iowa, Montana, and West Virginia from 1988 through 1993. METHODS: State survey data from the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. RESULTS: Demographic characteristics associated with smokeless tobacco use included age less than 35 years, a high school education or less, and rural residence. Overall, there was little change in smokeless tobacco use among men in these states (range = -0.4-0.4 percentage points annually); only West Virginia had a significant decline. CONCLUSIONS: Reasons for the overall lack of decline may include increased advertising and promotional expenditures or substitution of smokeless tobacco for cigarettes. Increased prevention and cessation efforts are needed.
Daily exposure to environmental tobacco smoke: smokers vs nonsmokers in California.
Authors: Robinson J P , Switzer P , Ott W
Published: November 2008

OBJECTIVES: This study examined the differences in environmental tobacco smoke exposure between smokers and non-smokers. METHODS: A probability sample of 1579 California adults completed a 1-day time diary of a full day's activities in which they reported whether any smoker was present during each activity. RESULTS: Some 61% of respondents reported at least some environmental tobacco smoke exposure in these diary accounts (for an average of up to 5 hours per day), and potential exposure rose monotonically with number of cigarettes actively smoked. Heaviest smokers reported about four times as much such exposure as nonsmokers. CONCLUSIONS: Because smokers lead life-styles that expose them to far higher levels of environmental tobacco smoke exposure, that factor needs to be controlled in studies estimating the effects of active smoking.
Risk factors for occupational injuries among older workers: an analysis of the health and retirement study.
Authors: Zwerling C , Sprince N L , Wallace R B , Davis C S , Whitten P S , Heeringa S G
Published: November 2008

OBJECTIVES: This study examined risk factors for occupational injury among older workers. METHODS: We analyzed data on 6854 employed nonfarmers from the Health and Retirement Study (HRS), a population-based sample of Americans 51 through 61 years old. RESULTS: Occupational injuries were associated with the following: the occupations of mechanics and repairers (odds ratio [OR] = 2.27), service personnel (OR = 1.68), and laborers (OR = 2.18); jobs requiring heavy lifting (OR = 2.75); workers' impaired hearing (OR = 1.60) and impaired vision (OR = 1.53); and jobs requiring good vision (OR = 1.43). Self-employment was associated with fewer injuries (OR = 0.47). CONCLUSIONS: These results emphasize the importance of a good match between job demands and worker capabilities.
Reproductive history, socioeconomic status, and self-reported health status of women aged 50 years or older.
Authors: Kington R , Lillard L , Rogowski J
Published: November 2008

OBJECTIVES: This paper describes the relationship between self-reported general health status and several facets of reproductive history. METHODS: We analyzed survey data on a national probability sample of 1341 women aged 50 and older from the Panel Study of Income Dynamics. We used multivariate regression techniques to control for differences in health indices that assessed health status and functioning. RESULTS: Women with a history of six or more completed pregnancies were found to be disadvantaged in educational attainment, financial resources, and health status compared with women with no or fewer pregnancies. When current sociodemographic factors were controlled, six or more pregnancies were associated with worse general health and worse physical role functioning. When sociodemographic factors and number of births were controlled, among women with at least one delivery, women who had experienced an infant's death reported worse health as measured by all three indices. Women with a first delivery before the age of 18 were more likely to report a functional limitation. CONCLUSIONS: Women with high parity status, a history of an infant's death, and an early first pregnancy may be at greater risk of poor health in later life.
The effect of school dropout rates on estimates of adolescent substance use among three racial/ethnic groups.
Authors: Swaim R C , Beauvais F , Chavez E L , Oetting E R
Published: November 2008

OBJECTIVES: This study examined, across three racial/ethnic groups, how the inclusion of data on drug use of dropouts can alter estimates of adolescent drug use rates. METHODS: Self-report rates of lifetime prevalence and use in the previous 30 days were obtained from Mexican American, White non-Hispanic, and Native American student (n = 738) and dropouts (n = 774). Rates for the age cohort (students and dropouts) were estimated with a weighted correction formula. RESULTS: Rates of use reported by dropouts were 1.2 to 6.4 times higher than those reported by students. Corrected rates resulted in changes in relative rates of use by different ethnic groups. CONCLUSIONS: When only in-school data are available, errors in estimating drug use among groups with high rates of school dropout can be substantial. Correction of student-based data to include drug use of dropouts leads to important changes in estimated levels of drug use and alters estimates of the relative rates of use for racial/ethnic minority groups with high dropout rates.
Substance use in the US college-age population: differences according to educational status and living arrangement.
Authors: Gfroerer J C , Greenblatt J C , Wright D A
Published: November 2008

OBJECTIVES: Substance use in the college-age population is an important public health and educational concern. This study compared rates of use among college students and nonstudents, including high school dropouts, from a single data source representative of the nation. METHODS: Rates of use were estimated from the combined National Household Surveys on Drug Abuse from 1991 to 1993. Logistic regression models were used to test the effects of educational status and living arrangement. RESULTS: Educational status and living arrangement were found to be significant predictors of substance use. Rates of illicit drug and cigarette use were highest among high school dropouts, while current and heavy alcohol use were highest among college students who did not live with their parents. CONCLUSIONS: Substantial variation in substance use patterns within the college-age population suggests that overall rates of use for young adults should not be used to characterize specific subgroups of young adults. These data from a single source will thus help planners more clearly distinguish the service needs of the diverse subgroups within this population.
Mortality and cancer incidence among sawmill workers exposed to chlorophenate wood preservatives.
Authors: Hertzman C , Teschke K , Ostry A , Hershler R , Dimich-Ward H , Kelly S , Spinelli J J , Gallagher R P , McBride M , Marion S A
Published: November 2008

OBJECTIVES: This study examined the association between exposure to chlorophenates and the risk of soft tissue sarcoma; non-Hodgkin's lymphoma; Hodgkin's disease; and cancers of the lung, nose, and nasopharynx. METHODS: A retrospective cohort study was conducted of 26487 workers employed for at least 1 year between 1950 and 1985 in 11 chlorophenate-using and 3 non-using sawmills in British Columbia, Canada. Exposures by job were ascertained with interviews of senior employees. RESULTS: Probabilistic record linkage to the Canadian Mortality Data Base and the British Columbia Cancer Registry found 4710 deaths between 1950 and 1990, and 1547 incident cases of cancer between 1969 and 1989. None of the cancers of interest had elevated mortality related to chlorophenate exposure. Non-Hodgkin's lymphoma incidence (n = 65) increased with increasing chlorophenate exposure hours, yielding the following standardized incidence ratios: less than 120 hours 0.68; 120 to 1999 hours, 0.59; 2000 to 3999 hours, 1.04; 4000 to 9999 hours, 1.02; and 10000 or more hours, 1.30. CONCLUSIONS: These results are consistent with the borderline positive associations seen in other recently reported studies of chlorophenate-exposed workforces.
Primary care case management and birth outcomes in the Iowa Medicaid program.
Authors: Schulman E D , Sheriff D J , Momany E T
Published: November 2008

OBJECTIVES: This study compares prenatal care utilization and birth outcomes between Iowa Medicaid recipients receiving care in a primary care case management (PCCM) system and those receiving care in a fee-for-service (FFS) system. METHODS: Birth certificates linked with Medicaid hospitalization claims were analyzed for seven PCCM and seven FFS counties. RESULTS: From 1989 through 1992, there was (1) a 20% increase in the number of women who received adequate prenatal care in the FFS counties, vs a 5% increase in the PCCM counties; (2) a 17% increase in the number of women who initiated care within the first trimester in the FFS counties, vs a 6% increase in the PCCM counties; and (3) a 442% increase in the number of women who received enhanced prenatal services in the FFS counties, vs a 278% increase in the PCCM counties. There were no significant differences between groups in mean gestational age or birthweight; however, there was an increase of very-low-birthweight babies in both groups. CONCLUSIONS: PCCM, as implemented by the Iowa Medicaid program, has not appreciably improved prenatal care utilization or birth outcomes.
Are the best coronary artery bypass surgeons identified by physician surveys?
Authors: Hartz A J , Pulido J S , Kuhn E M
Published: November 2008

OBJECTIVES: This study assessed the validity of surveys for identifying the best coronary artery bypass surgeons. METHODS: Data on physicians who performed coronary artery bypass surgery were available from New York, Pennsylvania, and Wisconsin. Data on physicians' reputation were obtained from one national and five city surveys. The measure of surgical performance was the mortality ratio (MR), that is, the ratio of the observed to the predicted patient mortality rate. RESULTS: Mortality ratios were very similar for the 10,722 patients treated by the 31 surgeons defined as "best" doctors in the surveys (MR = 98) and for the 74,854 patients treated by 243 other surgeons who had more than a minimal number of cases (MR = .96). The mortality ratio was 1.34 for the patients treated by surgeons with the lowest volumes and .87 for the surgeons who performed more than 400 coronary artery bypass surgeries in 3 years. CONCLUSIONS: These results suggest that the quality of a coronary artery bypass surgeon may be more closely associated with patient volume than with the surgeon's reputation among peers.
Consequences of foot binding among older women in Beijing, China.
Authors: Cummings S R , Ling X , Stone K
Published: November 2008

OBJECTIVES: This study examined the prevalence and consequences of foot binding in older Chinese women. METHODS: Women older than 70 years in Beijing, China, were assessed for bound feet, falls, functional status, and bone density. RESULTS: Thirty-eight percent of women aged 80 years and older and 18% of women aged 70 through 79 years had bound-foot deformities. Women with bound feet were more likely to fall, less able to squat, and less able to stand up from a chair without assistance than women with normal feet. They also had 14.3% less functional reach (a test of balance) and 5.1% lower hip bone density. CONCLUSIONS: Foot binding has caused substantial disability that is still evident in many elderly Chinese women.
The effect of ordinances requiring smoke-free restaurants and bars on revenues: a follow-up.
Authors: Glantz S A , Smith L R
Published: November 2008

OBJECTIVES: The purpose of this study was to extend an earlier evaluation of the economic effects of ordinances requiring smoke-free restaurants and bars. METHODS: Sales tax data for 15 cities with smoke-free restaurant ordinances, 5 cities and 2 counties with smoke-free bar ordinances, and matched comparison locations were analyzed by multiple regression, including time and a dummy variable for the ordinance. RESULTS: Ordinances had no significant effect on the fraction of total retail sales that went to eating and drinking places or on the ratio between sales in communities with ordinances and sales in comparison communities. Ordinances requiring smoke-free bars had no significant effect on the fraction of revenues going to eating and drinking places that serve all types of liquor. CONCLUSIONS: Smoke-free ordinances do not adversely affect either restaurant or bar sales.
Residential lead-based-paint hazard remediation and soil lead abatement: their impact among children with mildly elevated blood lead levels.
Authors: Aschengrau A , Beiser A , Bellinger D , Copenhafer D , Weitzman M
Published: November 2008

OBJECTIVES: This prospective study describes the impact of residential lead-based-paint hazard remediations on children with mildly elevated blood lead levels. METHODS: Changes in blood lead levels were observed following paint hazard remediation alone and in combination with soil abatement. RESULTS: After adjustment for the confounding variables paint hazard remediation alone was associated with a blood lead increase of 6.5 micrograms/dL (P = 0.5), and paint hazard remediation combined with soil abatement was associated with an increase of 0.9 microgram/dL (P = 36). CONCLUSIONS: Lead-based-paint hazard remediation as performed in this study, is not an effective secondary prevention strategy among children with mildly elevated blood lead levels.
Unintended pregnancy and breast-feeding behavior.
Authors: Dye T D , Wojtowycz M A , Aubry R H , Quade J , Kilburn H
Published: November 2008

OBJECTIVES: This study assessed the effect of unintended pregnancy on breast-feeding behavior. METHODS: All women delivering a live birth between January 1, 1995, and July 31, 1996 (n = 33,735), in the 15-county central New York region were asked whether they had intended to become pregnant and their breast-feeding plans. RESULTS: Women with mistimed pregnancies, and pregnancies that were not wanted were significantly less likely to breast-feed than were women whose pregnancies were planned. After adjustment for confounding variables and contraindications for breast-feeding, the odds ratios of not breast-feeding remained significant. CONCLUSIONS: Promoting breast-feeding among women with unintended pregnancies is important to improve health status.
Engendering the dread disease: women, men, and cancer.
Authors: Reagan L J
Published: November 2008

This paper, based on an analysis of cancer articles published in popular periodical literature since the early part of the century, argues that gender has played a key role in medical and popular understandings of cancer. Cancer education, the author finds, has taught women and men different things. Public health materials created with the intention of improving health through education actually send a multiplicity of messages, not all of them helpful. This essay suggests that public health messages targeted by sex are problematic, although perhaps necessary. The paper also contributes to scholarship concerned with the question of how people develop their ideas about risk of disease.
The image and advocacy of public health in American caricature and cartoons from 1860 to 1900.
Authors: Hansen B
Published: November 2008

The decades just before and after the founding of the American Public Health Association in 1872 saw an efflorescence of political cartooning and caricature in national-circulation weeklies. Part of the political and social critique that cartoonists and their editors provided the public focused on needs or opportunities for preventing illness and accidents. This paper presents a small selection of editorial cartoons that agitated in support of public health activities over 4 decades. The goals are to illustrate several concerns that rose to national prominence in that era, to examine the kinds of imagery that newspapers and magazine editors offered their readers, and to observe how frequently the public was encouraged to see politicians and commercial interests as responsible for preventable health problems. This discussion focuses exclusively on propagandistic images, leaving aside the reportorial depictions of events in the news and the neutral illustrations of methods and machines in scientific and technical publications.
Discovering environmental cancer: Wilhelm Hueper, post-World War II epidemiology, and the vanishing clinician's eye.
Authors: Sellers C
Published: November 2008

Today, our understanding of and approach to the exogenous causes of cancer are dominated by epidemiological practices that came into widespread use after World War II. This paper examines the forces, considerations, and controversies that shaped postwar risk factor epidemiology in the United States. It is argued that, for all of the new capabilities it brought, this risk factor epidemiology has left us with less of a clinical eye for unrecognized cancer hazards, especially from limited and localized exposures in the work-place. The focus here is on Wilhelm Hueper, author of the first textbook on occupational cancer (1942). Hueper became the foremost spokesman for earlier identification practices centering on occupational exposures. The new epidemiological methods and associated institutions that arose in the 1940s and 1950s bore an unsettled relation to earlier claims and methods that some, Hueper among them, interpreted as a challenge. Hueper's critique of the new epidemiology identified some of its limitations and potentially debilitating consequences that remain with us today.
Public health on the railroad: William Freeman Snow and the California Sanitation Exhibit.
Authors: Keller T M
Published: November 2008

This paper describes the California Sanitation Exhibit, a railroad car outfitted for instruction in public health that toured California in 1909 and 1910. The sanitation exhibit used display models, photographs, and lectures to educate the public about tuberculosis and other infectious diseases, waste contamination, and the dangers of bad milk. The success of the exhibit, which reached 5% of the state's population, resulted in the appointment of its creator, William Freeman Snow, as secretary of the California State Board of Health.
The impact of influenza epidemics on mortality: introducing a severity index.
Authors: Simonsen L , Clarke M J , Williamson G D , Stroup D F , Arden N H , Schonberger L B
Published: November 2008

OBJECTIVES: The purpose of this study was to assess the impact of recent influenza epidemics on mortality in the United States and to develop an index for comparing the severity of individual epidemics. METHODS: A cyclical regression model was applied to weekly national vital statistics from 1972 through 1992 to estimate excesses in pneumonia and influenza mortality and all-cause mortality for each influenza season. Each season was categorized on the basis of increments of 2000 pneumonia and influenza excess deaths, and each of these severity categories was correlated with a range of all-cause excess mortality. RESULTS: Each of the 20 influenza seasons studied was associated with an average of 5600 pneumonia and influenza excess deaths (range, 0-11,800) and 21,300 all-cause excess deaths (range, 0-47,200). Most influenza A(H3N2) seasons fell into severity categories 4 to 6 (23,000-45,000 all-cause excess deaths), whereas most A(H1N1) and B seasons were ranked in categories 1 to 3 (0-23,000 such deaths). CONCLUSIONS: From 1972 through 1992, influenza epidemics accounted for a total of 426,000 deaths in the United States, many times more than those associated with recent pandemics. The influenza epidemic severity index was useful for categorizing severity and provided improved seasonal estimates of the total number of influenza-related deaths.
The cost-effectiveness of alternative methods of nutrition education for hypercholesterolemic children.
Authors: Brannon S D , Tershakovec A M , Shannon B M
Published: November 2008

OBJECTIVES: This study compared the cost-effectiveness, from the family's perspective, of a parent-child auto-tutorial nutrition education program with that of counseling by a dietitian after identification of hypercholesterolemic children in pediatric offices. METHODS: Personnel, parent time, equipment, and laboratory costs associated with the interventions were analyzed. Reductions in dietary fat as a percentage of total calories were analyzed by means of 24-hour dietary recalls and in plasma low-density lipoprotein cholesterol at 3 and 12 months postintervention. RESULTS: Average costs totaled $208.08 for the parent-child auto-tutorial program and $213.28 for counseling. While the parent-child program was somewhat less cost-effective in terms of dietary change, it was more cost-effective in terms of lipid reduction at 3 months, although this advantage disappeared by 12 months. CONCLUSIONS: Modest reductions in fat in the diet and in plasma lipid levels were achieved at costs that also appear modest in comparison with treatment of elevated cholesterol in adulthood. Follow-up interventions may be needed to sustain effects, while longitudinal studies are needed to assess the long-term cost benefit.