bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in sexual behavior and condom use among teenaged males: 1988 to 1995.
Authors: Sonenstein F L , Ku L , Lindberg L D , Turner C F , Pleck J H
Published: November 2008

OBJECTIVES: This study examines shifts in sexual experience and condom use among US teenaged males. METHODS: Results from the 1988 and 1995 National Surveys of Adolescent Males were compared. RESULTS: The proportion of never-married 15- to 19-year-old males who had had sex with a female declined from 60% to 55% (P = .06). The share of those sexually active using a condom at last intercourse rose from 57% to 67% (P < .01). Overall, the proportion of males who had sex without condoms last year declined from 37% to 27% (P < .001). CONCLUSIONS: Although protective behaviors among teenagers have increased, significant proportions of teenagers--especially Black and Hispanic males--remain unprotected.
State estimates of household exposure to firearms, loaded firearms, and handguns, 1991 through 1995.
Authors: Powell K E , Jacklin B C , Nelson D E , Bland S
Published: November 2008

OBJECTIVES: Variations among states in household exposure to firearms, loaded firearms, and handguns were examined. METHODS: Data from the Behavioral Risk Factor Surveillance System in 22 states were used to estimate the prevalence of adults and children exposed to household firearms. RESULTS: The prevalence of adults living in households with firearms ranged from 12% to 57%; the corresponding ranges were 1% to 23% for loaded firearms and 5% to 36% for handguns. The prevalence of children less than 18 years of age living in households with loaded firearms ranged from 2% to 12%. CONCLUSIONS: Important variations among states exist in the prevalence of adults and children living in households with firearms, loaded firearms, and handguns.
An uncertain future: the health effects of threats to employment security in white-collar men and women.
Authors: Ferrie J E , Shipley M J , Marmot M G , Stansfeld S A , Smith G D
Published: November 2008

OBJECTIVES: This study examined changes in the health status of civil servants whose employment security was threatened. METHODS: Data were derived from a longitudinal cohort of 10,308 men and women, office staff in 20 British civil service departments. Physiological measurements, self-reported morbidity, and health-related behaviors for 530 members of the department under threat were compared with those of 19 other departments, during the period of uncertainty and during stable employment 5 years earlier. RESULTS: From a position of advantage or no difference at baseline, self-reported morbidity and physiological risk factors tended to increase among respondents from the threatened department compared with those from other departments. For both sexes, increases were significant for body mass index (P < .001) and sleeping 9 or more hours (odds ratio [OR] = 1.88; 95% confidence interval [CI] = 1.3, 2.8; P < .01); modest but significant increases were seen in ischemia (OR = 1.45; 95% CI = 1.0, 2.1) and cholesterol concentration (0.08 mmol/L; 95% CI = 0.01, 0.14). Among women only, a significant relative increase in blood pressure (P < .01) was recorded. Over the same period health-related behaviors changed little. CONCLUSIONS: Threats to employment security have adverse consequences for health status that are unexplained by health selection or health-related behaviors.
Differences between completers and early dropouts from 2 HIV intervention trials: a health belief approach to understanding prevention program attrition.
Authors: DiFranceisco W , Kelly J A , Sikkema K J , Somlai A M , Murphy D A , Stevenson L Y
Published: November 2008

OBJECTIVES: The purpose of this study was to identify factors predicting program attrition among participants in human immunodeficiency virus (HIV) risk reduction trials. METHODS: Participants were gay/bisexual men and severely mentally ill adults recruited to take part in HIV risk reduction small-group interventions. Program completers were compared with participants who were assessed at baseline but then failed to attend any sessions. The health belief model provided a framework for selection of possible predictors of program attrition. RESULTS: Younger age was associated with early dropout in both samples. Other predictors among gay/bisexual men included involvement in an exclusive sexual relationship, minority ethnicity, injection drug use, and higher perceived severity of AIDS. Severely mentally ill dropouts were less knowledgeable about safer sex methods and more likely to hold positive outcome expectancies for condom use. CONCLUSIONS: Evaluation of intervention effectiveness among vulnerable population segments is threatened if there is selective attrition. Better methods are needed to attract and maintain participation in HIV prevention programs. Alternatively, wider application of "intention to treat" analysis of intervention outcomes is recommended to minimize selection bias due to program dropout.
Social heterogeneity in smoking among African Americans.
Authors: King G , Bendel R , Delaronde S R
Published: November 2008

OBJECTIVES: This study assessed the effects of sociodemographic variables on the smoking behavior of African Americans. METHODS: Data for 14,397 African-American respondents (18-64 years old) to the National Health Interview Survey in the years 1990 through 1993 were examined in multivariate models. RESULTS: Age was the strongest predictor of smoking, and men were at least 1.75 times as likely as women to be smokers (P < .001). CONCLUSIONS: The Year 2000 goal of an 18% prevalence rate among African-American adults may not be attained without major community interventions focusing on male and middle-aged African Americans.
Taking chances: problem gamblers and mental health disorders--results from the St. Louis Epidemiologic Catchment Area Study.
Authors: Cunningham-Williams R M , Cottler L B , Compton W M , Spitznagel E L
Published: November 2008

OBJECTIVES: This study determined prevalence estimates of problem gambling and relationships to other psychiatric and substance use disorders. METHODS: In 1981, the Diagnostic Interview Schedule was used to collect epidemiological information on problem gambling and other disorders from 3004 adults in St. Louis, Mo. RESULTS: The lifetime prevalence of pathological gambling was 0.9%; 46% of those surveyed gambled recreationally. Problem gamblers (those reporting at least one gambling-related problem) were 9.2% of the sample and were predominately White (69%), male (78.2%), and young than nongamblers. They were at increased risk for several psychiatric diagnoses, especially for antisocial personality disorder, alcoholism, and tobacco dependence. CONCLUSIONS: Clinicians treating alcoholism and tobacco dependence may need to screen for problem gambling. Additional research in the context of increased gambling opportunities is needed.
The impact of short interpregnancy intervals on pregnancy outcomes in a low-income population.
Authors: Klerman L V , Cliver S P , Goldenberg R L
Published: November 2008

OBJECTIVES: The objective of this study was to determine whether the length of the interval between pregnancies was associated with either preterm birth or intrauterine growth retardation in a low-income, largely Black population. METHODS: The study population consisted of 4400 women who had received prenatal care in county clinics and had two consecutive singleton births between 1980 and 1990. RESULTS: Interpregnancy intervals were positively associated with age and negatively associated with the trimester in which care was initiated in the second pregnancy. Whites had shorter intervals than non-Whites. The percentage of preterm births increased as the length of the interpregnancy interval decreased, but only for women who had not had a previous preterm birth. The association between interval and preterm birth was maintained when other factors associated with preterm birth were controlled. There was no significant relationship between intrauterine growth retardation and interpregnancy interval. CONCLUSIONS: Women, particularly those who are poor and young, should be advised of the potential harm to their infants of short interpregnancy intervals.
The effects of community policies to reduce youth access to tobacco.
Authors: Forster J L , Murray D M , Wolfson M , Blaine T M , Wagenaar A C , Hennrikus D J
Published: November 2008

OBJECTIVES: This study tested the hypothesis that adoption and implementation of local policies regarding youth access to tobacco can affect adolescent smoking. METHODS: A randomized community trial was conducted in 14 Minnesota communities. Seven intervention communities participated in a 32-month community-organizing effort to mobilize citizens and activate the community. The goal was to change ordinances, merchant policies and practices, and enforcement practices to reduce youth access to tobacco. Outcome measures were derived from surveys of students before and after the intervention and from tobacco purchase attempts in all retail outlets in the communities. Data analyses used mixed-model regression to account for the clustering within communities and to adjust for covariates. RESULTS: Each intervention community passed a comprehensive youth access ordinance. Intervention communities showed less pronounced increases in adolescent daily smoking relative to control communities. Tobacco purchase success declined somewhat more in intervention than control communities during the study period, but this difference was not statistically significant. CONCLUSIONS: This study provides compelling evidence that policies designed to reduce youth access to tobacco can have a significant effect on adolescent smoking rates.
Serum ascorbic acid and other correlates of gallbladder disease among US adults.
Authors: Simon J A , Hudes E S
Published: November 2008

OBJECTIVES: This study examined the correlates of clinical gallbladder disease among US adults and whether serum ascorbic acid levels are associated with a decreased prevalence of gallbladder disease. METHODS: Cross-sectional analyses of data from the Second National Health and Nutrition Examination Survey were conducted. RESULTS: A total of 384 women (8%) and 107 men (3%) reported a history of gallstone disease, and 347 women (7%) and 81 men (2%) reported a history of cholecystectomy. An inverted U-shaped relation was found between serum ascorbic acid level and clinical gallbladder disease among women but not among men. CONCLUSIONS: Ascorbic acid, which affects the catabolism of cholesterol to bile acids and, in turn, the development of gallbladder disease in experimental animals, may reduce the risk of clinical gallbladder disease in humans.
Trends in food label use associated with new nutrition labeling regulations.
Authors: Kristal A R , Levy L , Patterson R E , Li S S , White E
Published: November 2008

OBJECTIVES: This study compared use of food labels before and after implementation of new Food and Drug Administration regulations in 1994. METHODS: Data were obtained by random-digit-dial surveys of Washington State residents in 1993 (n = 1001) and 1996 (n = 1450). RESULTS: After implementation of the new regulations, usual label use increased significantly, by 8.5 percentage points in women and 11.3 percentage points in men. More respondents looked for information on fat content and fewer failed to use labels because they "take too much time" or "are too hard to understand. CONCLUSIONS: Use of food labels and satisfaction with their content have increased, but 70% of adults still want labels to be easier to understand.
Hip fracture incidence among elderly Hispanics.
Authors: Lauderdale D S , Jacobsen S J , Furner S E , Levy P S , Brody J A , Goldberg J
Published: November 2008

OBJECTIVES: This study estimated hip fracture incidence for elderly Hispanics in the United States. METHODS: A cohort of Spanish-surnamed 1992 Medicare enrollees was followed for 2 years. Hip fractures were identified by inpatient diagnostic code. RESULTS: For Hispanic women, the national age-adjusted hip fracture rate was 7.3 per 1000 person-years; for men, the rate was 3.3. Rates varied markedly, with higher rates for the predominantly Mexican-American southwestern states than for Puerto Ricans. CONCLUSIONS: Nationally, the Hispanic population is at intermediate risk of hip fracture between Blacks and Whites, but geographic variation suggests that Mexican Americans are at higher risk than Puerto Ricans.
The entry of underrepresented minority students into US medical schools: an evaluation of recent trends.
Authors: Carlisle D M , Gardner J E , Liu H
Published: November 2008

OBJECTIVES: Recent challenges to affirmative action suggest the need to reassess the status of the admission of underrepresented minority students to US medical schools. METHODS: The Association of American medical colleges provided US medical school enrollment data and characteristics. Five measures of underrepresented minority enrolled and an overall performance scale were constructed for each school. Multivariate regression identified significant overall performance predictors. Predicted and observed values were compared. RESULTS: Underrepresented minority enrollment increased by 43% after 1986, peaked at 2014 in 1994, did not increase in 1995, and decreased by 5% in 1996. Enrollment was associated with increasing federal research funding and with percentage of underrepresented minorities in the sources population P < .001). The 1996 decline was almost entirely limited to public medical schools. Those in California, Texas, Mississippi, and Louisiana accounted for 18% of 1995 enrollment but 44% of the 1996 decline. CONCLUSIONS: Recent gains in medical school enrollment of underrepresented minorities are being reversed, particularly at public institutions. Implications exist for the health of poor, minority, and underserved communities, which are most likely to be cared for by underrepresented minority physicians.
The development of sex differences in cardiovascular disease mortality: a historical perspective.
Authors: Nikiforov S V , Mamaev V B
Published: November 2008

OBJECTIVES: Little is known about why males have higher cardiovascular disease (CVD) mortality rates than do females. An important factor that has hampered efforts in this regard is the lack of clarity about whether male excess mortality from CVD has existed throughout history. To answer this question, an investigation was conducted of trends in CVD mortality differences between the sexes from the time when data first became available until the present, including the full range of age groups. METHODS: Mortality statistics for CVD in England and Wales from 1861 through 1992 and in the United States from 1900 through 1991 were used. RESULTS: Three stages in the relationship between male and female CVD mortality were found: (1) An early stage of equal male and female mortality, (2) a stage of the appearance of sex differences in mortality, and (3) a stage with consistently present male excess mortality. CONCLUSION: Male excess mortality from CVD has not always been present in the historical record. Further research is needed to elucidate the causes of this excess mortality.
The effect of WIC and Medicaid on infant mortality in the United States.
Authors: Moss N , Carver K
Published: November 2008

OBJECTIVES: This study examine the impact of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Medicaid on risk of infant death in the United States. METHODS: The 1988 National Maternal and Infant Health Survey was used to consider the risk of endogenous and exogenous death among infants of women participating in WIC and Medicaid during pregnancy and the infant's first year. RESULTS: Participation in the WIC program during pregnancy and infancy was associated with a reduced risk of endogenous and exogenous infant deaths (odds ratios [ORs] = 0.68 and 0.62, respectively). The risk of endogenous death among infants whose mothers participated in Medicaid during pregnancy was equal to that of the privately insured (OR = 1.04). Uninsured infants faced higher risks of endogenous death (OR = 1.42). CONCLUSIONS: These results show that it is important to consider the net effect of WIC and Medicaid participation and to differentiate both the timing of program receipt and cause of death. Evidence suggests that WIC and Medicaid programs have beneficial effects for poor women and their infants.
Evaluating cluster alarms: a space-time scan statistic and brain cancer in Los Alamos, New Mexico.
Authors: Kulldorff M , Athas W F , Feurer E J , Miller B A , Key C R
Published: November 2008

OBJECTIVES: This article presents a space-time scan statistic, useful for evaluating space-time cluster alarms, and illustrates the method on a recent brain cancer cluster alarms in Los Alamos, NM. METHODS: The space-time scan statistic accounts for the preselection bias and multiple testing inherent in a cluster alarm. Confounders and time trends can be adjusted for. RESULTS: The observed excess of brain cancer in Los Alamos was not statistically significant. CONCLUSIONS: The space-time scan statistic is useful as a screening tool for evaluating which cluster alarms merit further investigation and which clusters are probably chance occurrences.
Hyaline membrane disease is underreported in a linked birth-infant death certificate database.
Authors: Hamvas A , Kwong P , DeBaun M , Schramm W , Cole F S
Published: November 2008

OBJECTIVE: This study compared the Missouri State Department of Health linked birth-infant death certificate database and medical records with respect to recording hyaline membrane disease in very low-birth-weight infants. METHODS: We reviewed the records for all 976 infants weighing 500 to 1500 g who were born to St. Louis, Mo, residents in 1989, 1991, and 1992. RESULTS: Eighteen percent of the birth certificates and 54% of the medical records documented hyaline membrane disease, resulting in 34% sensitivity and 99% specificity. CONCLUSIONS: The Missouri State Department of Health birth-infant death certificate database underestimates the incidence of hyaline membrane disease, which suggest that national statistics for the disease are also underestimated.
Social class, ethnicity, and mental illness: the importance of being more than earnest.
Authors: Vander Stoep A , Link B
Published: November 2008

This paper revisits a landmark study of the prevalence of mental illness in the state of Massachusetts conducted by Edward Jarvis in the 19th century. Jarvis drew an improper conclusion about the relationship between social class, ethnicity, and insanity, asserting that the Irish foreign-born had a higher prevalence of insanity in each social stratum. A reanalysis of Jarvis' data shows that in both the pauper and independent social classes in Massachusetts, the prevalence of insanity was significantly lower among foreign-born persons than among native-born persons. On the basis of his misperception, Jarvis constructed elaborate etiological theories. These theories made a strong impact on the mental health service policies of his day. The effects of incomplete examination of data on etiological theories and mental health policy in current times are highlighted in this article.
Human rights is a US problem, too: the case of women and HIV.
Authors: Gollub E L
Published: November 2008

Overall, US AIDS incidence and mortality have shown significant declines since 1996, probably because of new antiviral therapies. For women, however, these benefits have been much less pronounced than for men. At the heart of women's HIV risk is gender-based discrimination, which keeps women, and especially women of color, poor and dependent. Although human rights issues are often linked with AIDS issues abroad, in the US they receive insufficient attention in our response to women's HIV risk. Advocacy from public health professionals is needed to overcome the longstanding paternalistic attitudes of federal agencies toward women and to change the paradigm of women's HIV/AIDS prevention and care. Examples of unjust and punitive social policies that may affect women's HIV risk include the 1996 welfare policy legislation, drug treatment policies for women, and women's access to medical research and technology. The overriding public health response to AIDS consists of behavioral interventions aimed at the individual. But this approach will not successfully address the issues of women with AIDS until efforts are made to eliminate society's unjust and unhealthy laws, policies, and practicles.
Public health and complex emergencies: new issues, new conditions.
Authors: Waldman R , Martone G
Published: November 2008

Public health practice in complex emergencies has become increasingly sophisticated and well informed over the course of the past quarter century. Humanitarian relief organizations have learned many lessons in the areas of food, water and sanitation, shelter, and primary health. However, closer scrutiny from the media and funding agencies, together with changing conditions and an increasingly insecure environment, will require that changes be made. First and foremost, nongovernmental organizations must recognize that an increasing proportion of morbidity and mortality is the consequence of widespread human rights abuses. These organizations should become more familiar with international human rights and humanitarian law, and their personnel should receive clear guidance as to how to recognize and report violations. At the same time, nongovernmental organizations will have to work more closely with military forces that have a very different organizational culture. In addition, as emergencies become more complex, nongovernmental organizations should do more to attract and retain seasoned professionals. Finally, advances in both technical and operational areas will occur only through carefully designed and implemented research.
Sanctions and the struggle for health in South Africa.
Authors: Coovadia H M
Published: November 2008

This commentary describes the role of a major antiapartheid health organization, the National Medical and Dental Association (NAMDA), in reinforcing and maintaining international pressure on the racist South African government. NAMDA was a constituent of the Mass Democratic Movement (MDM), which was at the forefront in the struggle for freedom in South Africa. NAMDA endorsed the programs of the banned African National Congress (ANC), which included a range of sanctions. Debates within NAMDA on enlarging sanctions into an academic boycott are summarized. The development of a policy of selective academic support, which approved academic exchanges in accord with the aims of the MDM, is explained. Indirect evidence shows that international pressures created by specific types of economic sanctions and the forms of academic boycott decided on by NAMDA achieved their objectives. I have highlighted the tension between these strategies, which resulted in the isolation of the apartheid regime, as well as the responsibility to protect the most vulnerable from the burdens that resulted from these policies.
Assessing the effects of welfare reform policies on reproductive and infant health.
Authors: Wise P , Chavkin W , Romero D
Published: November 2008

OBJECTIVES: The welfare reform law of 1996 marked a historical moment in US policy toward the poor by ending the entitlement to cash assistance, by requiring work, and by establishing time limits. This article examines the potential impact on the health of women and children, the primary recipients of welfare benefits. METHODS: The authors outline the reproductive health outcomes most likely to be sensitive to welfare policies, identify indicators that might be used to assess these outcomes, review empirical evidence, and suggest specific methods and data sources. RESULTS: State welfare requirements could improve health outcomes or deter families from Medicaid and food stamps, as well as income support, thus worsening health outcomes. National and state data may prove useful in detecting these effects; however, new data sources may be required for specific health-related questions. CONCLUSIONS: Assessing the effects of welfare policies on reproductive and infant health is possible, although challenging. Reauthorization of the legislation is required in 2002; it is essential that the consequences for health be included in the next round of public debate.
A public health vs a risk-based intervention to improve cardiovascular health in elementary school children: the Cardiovascular Health in Children Study.
Authors: Harrell J S , McMurray R G , Gansky S A , Bangdiwala S I , Bradley C B
Published: November 2008

OBJECTIVES: This study sought to determine the population effects of both classroom-based and risk-based interventions designed to reduce cardiovascular disease risk factors in children. METHODS: Elementary school children (n = 2109; age range: 7-12 years) were randomized by school to a classroom-based intervention for all third and fourth graders, a risk-based intervention only for those with 1 or more cardiovascular disease risk factors, or a control group. The 8-week interventions involved both knowledge--attitude and physical activity components. RESULTS: School-level analyses showed that physical activity in the risk-based group and posttest knowledge in the classroom-based group were significantly higher than in the control group. With regard to trends shown by individual-level analyses, cholesterol dropped more in the classroom-based than in the control group, and skinfold thickness decreased 2.9% in the classroom-based group and 3.2% in the risk-based group (as compared with a 1.1% increase in the control group). CONCLUSIONS: Both classroom-based and risk-based interventions had positive effects on physical activity and knowledge, with trends toward reduced body fat and cholesterol. However, the classroom-based approach was easier to implement and evidenced stronger results than the risk-based intervention.
Retail trade incentives: how tobacco industry practices compare with those of other industries.
Authors: Feighery E C , Ribisl K M , Achabal D D , Tyebjee T
Published: November 2008

OBJECTIVES: This study compared the incentive payments for premium shelf space and discounts on volume purchases paid to retailers by 5 types of companies. METHODS: Merchants were interviewed at 108 randomly selected small retail outlets that sell tobacco in Santa Clara County, California. RESULTS: Significantly more retailers reported receiving slotting/display allowances for tobacco (62.4%) than for any other product type. An average store participating in a retailer incentive program received approximately $3157 annually from all sampled product types, of which approximately $2462 (78%) came from tobacco companies. CONCLUSIONS: Future research should assess the impact of tobacco industry incentive programs on the in-store marketing and sales practices of retailers.
The need of community health centers for international medical graduates.
Authors: Baer L D , Konrad T R , Miller J S
Published: November 2008

OBJECTIVES: This study sought to determine whether community health centers need international medical graduates to fill staff positions. METHODS: The authors surveyed 100 community health center administrators to learn about their perceptions of international medical graduates. RESULTS: Nationally, about one quarter of community health centers depend on international medical graduates to fill physician vacancies; most of these centers foresee unfilled positions in the event of a cutback. CONCLUSIONS: Policies calling for a national reduction in the supply of international medical graduates need to be balanced by an understanding of these individuals' role in reducing local physician shortages.
Progress in coverage with hepatitis B vaccine among US children, 1994-1997.
Authors: Yusuf H R , Coronado V G , Averhoff F A , Maes E F , Rodewald L E , Battaglia M P , Mahoney F J
Published: November 2008

OBJECTIVES: This study was done to assess progress in hepatitis B vaccination of children from 1994 through 1997. METHODS: We used data from the National Immunization Survey (NIS), a random-digit-dialed telephone survey that includes a mail survey to verify vaccination providers' records. The NIS is conducted in 78 geographic areas (50 states and 28 selected urban areas) in the United States. RESULTS: A total of 32,433 household interviews were completed in the 1997 NIS. An estimated 83.7% of children aged 19 to 35 months received 3 or more doses of hepatitis B vaccine. Coverage with 3 doses was greater (86.7%) among children in states that had day care entry requirements for hepatitis B vaccination than among children in states without such requirements (83.0%) and was greater among children from families with incomes at or above the poverty level (85.0%) than among children below the poverty level (80.6%). Hepatitis B vaccination of children increased from 1994 through 1996, from 41% to 84%, but coverage reached a constant level of 84% to 85% in 1996/97. CONCLUSION: Although substantial progress has been made in fully vaccinating children against hepatitis B, greater efforts are needed to ensure that all infants receive 3 doses of hepatitis B vaccine.
Over-the-counter nicotine patch therapy for smoking cessation: results from randomized, double-blind, placebo-controlled, and open label trials.
Authors: Hays J T , Croghan I T , Schroeder D R , Offord K P , Hurt R D , Wolter T D , Nides M A , Davidson M
Published: November 2008

OBJECTIVES: The purpose of this study was to determine the efficacy and safety of the nicotine patch for smoking cessation in an over-the-counter environment. The years of study were 1994 to 1995. METHODS: Parallel 6-week trials were conducted: a placebo-controlled trial of no-cost 22-mg, 24-hour nicotine patch therapy and an open label trial of the same therapy with patches purchased by subjects. Participants (n = 958) were 18 years or older, had smoked at least 15 cigarettes daily for at least 6 months, and were enrolled at 3 study sites. The main outcome measure was self-reported smoking abstinence confirmed by expired carbon monoxide measurements. RESULTS: Smoking cessation rates in the placebo-controlled trial were 16.8% and 9.6% at week 6 and 8.7% and 4.3% at week 24 for the active patch and placebo groups, respectively. Smoking cessation rates in the open label-pay trial were 19.0% and 10.8% at weeks 6 and 24, respectively. A slight increase in adverse cardiovascular events was noted only in the open label-pay group in comparison with the placebo group. CONCLUSIONS: In an over-the-counter environment, the 22-mg, 24-hour nicotine patch is effective and safe for smoking cessation treatment.
The Denver school-based adolescent hepatitis B vaccination program: a cost analysis with risk simulation.
Authors: Deuson R R , Hoekstra E J , Sedjo R , Bakker G , Melinkovich P , Daeke D , Hammer A L , Goldsman D , Judson F N
Published: November 2008

OBJECTIVES: This study sought to compare the cost-effectiveness of a school-based hepatitis B vaccine delivery program with that of a vaccine delivery program associated with a network health maintenance organization (HMO). METHODS: The vaccination program enrolled 3359 sixth-grade students from 18 middle schools in Denver, Colo. Immunization status and direct and indirect program costs were compiled. The sensitivity of the outcomes was assessed by simulation methods. RESULTS: The per-dose cost-effectiveness ratio for the school-based delivery system was $31. This cost-effectiveness ratio remained stable when the model was simulated with costs that were underestimated or overestimated by 20%. In the network HMO, the direct cost per dose was $68 and the societal cost was $118 when the child's father worked full-time and the mother worked part-time. There is less than a 5% chance that the network HMO-based vaccination program could be more cost-effective than the school-based program. CONCLUSIONS: The cost per dose of the school-based program was significantly less than that of the network HMO-based program, because in the school program government-purchased vaccine was available at a lower cost and parents did not incur work-loss costs.
Children on the move and vaccination coverage in a low-income, urban Latino population.
Authors: Findley S E , Irigoyen M , Schulman A
Published: November 2008

OBJECTIVES: The purpose of this study was to determine the impact of childhood moves and foreign birth on vaccination coverage among Latino children in New York City. METHODS: Vaccination coverage was assessed in a survey of 314 children younger than 5 years at 2 immunization clinics. RESULTS: Forty-seven percent of the study children had moved abroad. After adjustment for health insurance, regular source of care, and country of birth, child moves had no independent effect on vaccination coverage. Foreign-born children had diphtheria-pertussis-tetanus, oral polio vaccine, and measles-mumps-rubella vaccination coverage rates similar to those of US-born children, but they were underimmunized in regard to Haemophilus influenzae type b and hepatitis B. CONCLUSIONS: Foreign birth, but not childhood moves, is a barrier to vaccinations among low-income, urban Latino children.
Correlates of urinary symptom scores in men.
Authors: Klein B E , Klein R , Lee K E , Bruskewitz R C
Published: November 2008

OBJECTIVES: This study determined the prevalence of urinary symptoms and their relationship to characteristics of a cohort of men in Beaver Dam, Wis, from 1993 to 1995. METHODS: A standardized questionnaire concerning urinary symptoms (the American Urological Association Urinary Symptom Questionnaire) was administered. RESULTS: All outcomes were associated with age and history of enlarged prostate. Urinary frequency (57%) and nocturia (65%) were the most common individual symptoms. Diuretic usage, diabetes, history of cardiovascular disease, and smoking were related to specific symptoms. CONCLUSIONS: While urinary symptoms are associated with age and history of enlarged prostate, symptoms may also be attributable to other diseases and exposures.
What is the leading cause of infant mortality? A note on the interpretation of official statistics.
Authors: Sowards K A
Published: November 2008

OBJECTIVES: According to vital statistics reports, congenital malformation is the leading cause of infant death in the United States and accounts for a much greater proportion of infant mortality than does premature birth. The purpose of this study was to examine the potential underestimation of prematurity-related mortality in current vital statistics reports. METHODS: National mortality data from 1985, 1991, and 1996 were analyzed. RESULTS: The official statistics significantly understate the role of prematurity-related mortality. An alternative etiology-based classification designates prematurity as the underlying cause in approximately one third of all infant deaths. CONCLUSIONS: Although no single scheme is suitable for every objective, analysts and policymakers should recognize the degree to which technical classification practices can influence the apparent importance of various causes of death.
Socioeconomic inequalities in mortality among women and among men: an international study.
Authors: Mackenbach J P , Kunst A E , Groenhof F , Borgan J K , Costa G , Faggiano F , Józan P , Leinsalu M , Martikainen P , Rychtarikova J , Valkonen T
Published: November 2008

OBJECTIVES: This study compared differences in total and cause-specific mortality by educational level among women with those among men in 7 countries: the United States, Finland, Norway, Italy, the Czech Republic, Hungary, and Estonia. METHODS: National data were obtained for the period ca. 1980 to ca. 1990. Age-adjusted rate ratios comparing a broad lower-educational group with a broad upper-educational group were calculated with Poisson regression analysis. RESULTS: Total mortality rate ratios among women ranged from 1.09 in the Czech Republic to 1.31 in the United States and Estonia. Higher mortality rates among lower-educated women were found for most causes of death, but not for neoplasms. Relative inequalities in total mortality tended to be smaller among women than among men. In the United States and Western Europe, but not in Central and Eastern Europe, this sex difference was largely due to differences between women and men in cause-of-death pattern. For specific causes of death, inequalities are usually larger among men. CONCLUSIONS: Further study of the interaction between socioeconomic factors, sex, and mortality may provide important clues to the explanation of inequalities in health.
Sexual and drug-use risk factors for HIV and STDs: a comparison of women with and without bisexual experiences.
Authors: Gonzales V , Washienko K M , Krone M R , Chapman L I , Arredondo E M , Huckeba H J , Downer A
Published: November 2008

OBJECTIVES: This study was done to compare risk factors for HIV/STDs in women who reported having had sex with both men and women and women who reported having had sex with men only. METHODS: Female participants in a multisite, randomized HIV/STD prevention study in the Seattle area reported both having had sex with a man in the 3 months before and having at least 1 risk factor for HIV/STDs during the year before the study. Of these women, 38% who reported ever having had sex with a woman were compared with those who reported having had sex with men only. RESULTS: Women who had had sex with both men and women were more likely than women who had had sex with men only to report drug use in the 3 months before the study, a greater lifetime number of male partners, a sex partner who had had sex with a prostitute, an earlier age at sexual debut, and forced sexual contact (P < .01 for all comparisons). Women who had had sex with both men and women had a mean of 3.2 of these 5 risk factors, vs 2.1 among women who had had sex with men only (P < .001). CONCLUSION: Women who had had sex with both men and women were more likely than women who had had sex with men only to engage in multiple risk behaviors. Health workers should be aware of bisexual experience among women, since this may be a marker for multiple risk behaviors for HIV/STDs.
Effectiveness of a comprehensive multisector campaign to increase seat belt use in the greater Athens area, Greece. Hellenic Road Traffic Police Department.
Authors: Petridou E , Trichopoulos D , Stappa M , Tsoufis Y , Skalkidou A
Published: November 2008

OBJECTIVES: This study assessed the effectiveness of a comprehensive campaign to increase seat belt use in Athens. METHODS: In 1996 a survey focusing on seat belt use was undertaken among occupants of 1400 passenger cars. From October 1997 to June 1998 the campaign was implemented; during the campaign, seat belt law enforcement was not intensified. In 1998 another inspection survey of 2250 cars was undertaken. RESULTS: The program brought only a 6% increase in compliance, but there was an estimated gain of about 50 averted deaths and 1500 averted injuries. CONCLUSIONS: An intensive campaign to increase seat belt use, conducted in the absence of increased law enforcement, resulted in moderate gains.
The effect of health education on the rate of ophthalmic examinations among African Americans with diabetes mellitus.
Authors: Basch C E , Walker E A , Howard C J , Shamoon H , Zybert P
Published: November 2008

OBJECTIVES: This study evaluated a multicomponent educational intervention to increase ophthalmic examination rates among African Americans with diabetes. METHODS: A randomized trial was conducted with 280 African Americans with diabetes, enrolled from outpatient departments of 5 medical centers in the New York City metropolitan area, who had not had a dilated retinal examination within 14 months of randomization (65.7% female, mean age = 54.7 years [SD = 12.8 years]). RESULTS: After site differences were controlled, the odds ratio for receiving a retinal examination associated with the intervention was 4.3 (95% confidence interval = 2.4, 7.8). The examination rate pooled across sites was 54.7% in the intervention group and 27.3% in the control group. CONCLUSIONS: The intervention was associated with a rate of ophthalmic examination double the rate achieved with routine medical care.
Roe v Wade and American fertility.
Authors: Levine P B , Staiger D , Kane T J , Zimmerman D J
Published: November 2008

OBJECTIVES: This article examines the effect of abortion legalization on fertility rates in the United States. METHODS: Fertility rates were compared over time between states that varied in the timing of abortion legalization. RESULTS: States legalizing abortion experienced a 4% decline in fertility relative to states where the legal status of abortion was unchanged. The relative reductions in births to teens, women more than 35 years of age, non-White women, and unmarried women were considerably larger. If women did not travel between states to obtain an abortion, the estimated impact of abortion legalization on birth rates would be about 11%. CONCLUSIONS: A complete recriminalization of abortion nationwide could result in 440,000 additional births per year. A reversal of the Roe v Wade decision leaving abortion legal in some states would substantially limit this impact because of the extent of travel between states.
Community measures of low-fat milk consumption: comparing store shelves with households.
Authors: Fisher B D , Strogatz D S
Published: November 2008

OBJECTIVES: This study examined the relationship between the proportion of milk in food stores that is low-fat and consumption of low-fat milk in the community. METHODS: Data were gathered from 503 stores across 53 New York State zip codes. In 19 zip codes, a telephone survey measured household low-fat milk use. Census data were obtained to examine sociodemographic predictors of the percentage of low-fat milk in stores. RESULTS: The proportion of low-fat milk in stores was directly related to low-fat milk consumption in households and to the median income and urban level of the zip code. CONCLUSIONS: These results support using food store shelf-space observations to estimate low-fat milk consumption.
Predictors of injury among adult recreational in-line skaters: a multicity study.
Authors: Seldes R M , Grisso J A , Pavell J R , Berlin J A , Tan V , Bowman B , Kinman J L , Fitzgerald R H
Published: November 2008

OBJECTIVES: This study examined risk factors for injury, injury prevalence, safety gear use, and skating habits of adult recreational in-line skaters. METHODS: Randomly selected in-line skaters in 6 major US cities were interviewed. RESULTS: Only 6% of skaters consistently wore all 4 recommended types of safety gear. Skaters with greater skating experience were more likely to perform tricks, wear less safety gear, and sustain an injury. CONCLUSION: More experienced adult recreational in-line skaters are at increased risk for injury. Safety gear use in alarmingly low in adult recreational in-line skaters, especially experienced skaters. Safe skating education programs should consider targeting this newly recognized at-risk skating population.
Lead and hypertension in a sample of middle-aged women.
Authors: Korrick S A , Hunter D J , Rotnitzky A , Hu H , Speizer F E
Published: November 2008

OBJECTIVES: The role of lead exposure as a risk factor for hypertension is less well defined among women than among men. This case-control study assessed the relation of blood and bone lead concentrations to hypertension in women. METHODS: Cases and controls were a subsample of women from the Nurses' Health Study. Hypertension was defined as a physician diagnosis of hypertension between 1988 and 1994 or measured systolic blood pressure > or = 140 mm Hg or diastolic blood pressure > or = 90 mm Hg. RESULTS: Mean (SD) blood lead concentration was 0.15 (0.11) mumol/L; mean tibia and patella lead concentrations by K-x-ray fluorescence were 13.3 (9.0) and 17.3 (11.1) micrograms/g, respectively. After adjustment for potentially confounding factors, an increase from the 10th to the 90th percentile of patella lead values (25 micrograms/g) was associated with approximately 2-fold (95% confidence interval = 1.1, 3.2) increased risk of hypertension. There was no association between hypertension and either blood or tibia lead concentrations. CONCLUSIONS: These findings support a potentially important role for low-level lead exposure as a risk factor for hypertension among non-occupationally exposed women.
Radon and lung cancer: a cost-effectiveness analysis.
Authors: Ford E S , Kelly A E , Teutsch S M , Thacker S B , Garbe P L
Published: November 2008

OBJECTIVES: This study examined the cost-effectiveness of general and targeted strategies for residential radon testing and mitigation in the United States. METHODS: A decision-tree model was used to perform a cost-effectiveness analysis of preventing radon-associated deaths from lung cancer. RESULTS: For a radon threshold of 4 pCi/L, the estimated costs to prevent 1 lung cancer death are about $3 million (154 lung cancer deaths prevented), or $480,000 per life-year saved, based on universal radon screening and mitigation, and about $2 million (104 lung cancer deaths prevented), or $330,000 per life-year saved, if testing and mitigation are confined to geographic areas at high risk for radon exposure. For mitigation undertaken after a single screening test and after a second confirmatory test, the estimated costs are about $920,000 and $520,000, respectively, to prevent a lung cancer death with universal screening and $130,000 and $80,000 per life-year for high risk screening. The numbers of preventable lung cancer deaths are 811 and 527 for universal and targeted approaches, respectively. CONCLUSIONS: These data suggest possible alternatives to current recommendations.
A deviation bar chart for detecting dengue outbreaks in Puerto Rico.
Authors: Rigau-Pérez J G , Millard P S , Walker D R , Deseda C C , Casta-Vélez A
Published: November 2008

OBJECTIVES: A Centers for Disease Control and Prevention deviation bar chart (Statistical Software for Public Health Surveillance) and laboratory-based surveillance data were evaluated for their utility in detecting dengue outbreaks in Puerto Rico. METHODS: A significant increase in dengue incidence was defined as an excess of suspected cases of more than 2 SDs beyond the mean for all 4-week periods from April through June (the period of lowest seasonal incidence), 1989 through 1993. An outbreak was defined as a cumulative annual rate of reported dengue greater than 3 per 1000 population. RESULTS: Retrospective application of the system to 1994 data showed agreement with previous analyses. In 1995 and 1996, 36.4% and 27.3%, respectively, of municipalities with a significant increase in reports for 2 or more consecutive weeks before the first week of September had an outbreak, compared with 9.0% (in 1995, P = .042) and 6.0% (in 1996, P = .054) of towns without a significant increase. The system showed sensitivity near 40%, specificity near 89%, and accuracy in classifying municipalities near 84%. CONCLUSIONS: This method provides a statistically based, visually striking, specific, and timely signal for dengue control efforts.
The new old epidemic of coronary heart disease.
Authors: Bonneux L , Barendregt J J , van der Maas P J
Published: November 2008

OBJECTIVES: This study quantified the consequences for prevalence of increased survival of coronary heart disease (CHD) in the Netherlands from 1980 to 1993. METHODS: A multistage life table fitted observed mortality and registration rates from the nationwide hospital register. The outcome was prevalence by age, sex, period, and disease state. RESULTS: The prevalence of CHD from 1980 to 1993 was 4.4% (men, aged 25 to 84 years) and 1.4% (women, aged 25 to 84 years). Between 1980-1983 and 1990-1993, the incidence changed little, but age-adjusted prevalence increased by 19% (men) and 59% (women). CONCLUSIONS: Sharply decreasing mortality but near-constant attack rates of CHD caused distinct increases in prevalence, particularly among the elderly.