bluuebunny/crossref_metadata_2025 huggingface dataset:
Health effects associated with sulfuryl fluoride and methyl bromide exposure among structural fumigation workers.
Authors: Calvert G M , Mueller C A , Fajen J M , Chrislip D W , Russo J , Briggle T , Fleming L E , Suruda A J , Steenland K
Published: November 2008

OBJECTIVES: This study assessed the health effects associated with occupational exposure to methyl bromide and sulfuryl fluoride among structural fumigation workers. METHODS: A cross-sectional study of 123 structural fumigation workers and 120 referents in south Florida was conducted. Nerve conduction, vibration, neurobehavioral, visual, olfactory, and renal function testing was included. RESULTS: The median lifetime duration of methyl bromide and sulfuryl fluoride exposure among workers was 1.20 years and 2.85 years, respectively. Sulfuryl fluoride exposure over the year preceding examination was associated with significantly reduced performance on the Pattern Memory Test and on olfactory testing. In addition, fumigation workers had significantly reduced performance on the Santa Ana Dexterity Test of the dominant hand and a nonsignificantly higher prevalence of carpal tunnel syndrome than did the referents. CONCLUSIONS: Occupational sulfuryl fluoride exposures may be associated with subclinical effects on the central nervous system, including effects on olfactory and some cognitive functions. However, no widespread pattern of cognitive deficits was observed. The peripheral nerve effects were likely caused by ergonomic stresses experienced by the fumigation workers.
"Lifeguard lung": endemic granulomatous pneumonitis in an indoor swimming pool.
Authors: Rose C S , Martyny J W , Newman L S , Milton D K , King T E , Beebe J L , McCammon J B , Hoffman R E , Kreiss K
Published: November 2008

OBJECTIVES: Two sequential outbreaks of respiratory disease among lifeguards at an indoor swimming pool with water spray features were investigated. METHODS: Questionnaires were administered to recreation center employees following each outbreak. Respondents reporting 2 or more pool-related symptoms were offered clinical evaluation, including bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. Pool air and water were sampled for fungi, bacteria, amoebae, endotoxin, and respirable particulates. RESULTS: Thirty-three lifeguards had noncaseating granulomas on biopsy and/or bronchoalveolar lavage lymphocytosis. Attack rates for the outbreaks were 27% and 65%. Case patients had higher cumulative hours of work and tended to work more hours per week. Analyses indicated increased levels of endotoxin in pool air and water (relative to control pools) and gram-negative bacterial colonization of water sprays. Use of water spray features generated a 5.2-fold increase in the number of respirable particles and up to an 8-fold increase in air endotoxin levels. CONCLUSIONS: Lifeguards in this indoor swimming pool developed granulomatous lung disease associated with endotoxin-containing respirable bioaerosols from water spray features, which ventilation system improvements did not prevent.
Declining seroprevalence in a very large HIV epidemic: injecting drug users in New York City, 1991 to 1996.
Authors: Des Jarlais D C , Perlis T , Friedman S R , Deren S , Chapman T , Sotheran J L , Tortu S , Beardsley M , Paone D , Torian L V , Beatrice S T , DeBernardo E , Monterroso E , Marmor M
Published: November 2008

OBJECTIVES: This study assessed recent trends in HIV seroprevalence among injecting drug users in New York City. METHODS: We analyzed temporal trends in HIV seroprevalence from 1991 through 1996 in 5 studies of injecting drug users recruited from a detoxification program, a methadone maintenance program, research storefronts in the Lower East Side and Harlem areas, and a citywide network of sexually transmitted disease clinics. A total of 11,334 serum samples were tested. RESULTS: From 1991 through 1996, HIV seroprevalence declined substantially among subjects in all 5 studies: from 53% to 36% in the detoxification program, from 45% to 29% in the methadone program, from 44% to 22% at the Lower East Side storefront, from 48% to 21% at the Harlem storefront, and from 30% to 21% in the sexually transmitted disease clinics (all P < .002 by chi 2 tests for trend). CONCLUSIONS: The reductions in HIV seroprevalence seen among injecting drug users in New York City from 1991 through 1996 indicate a new phase in this large HIV epidemic. Potential explanatory factors include the loss of HIV-seropositive individuals through disability and death and lower rates of risk behavior leading to low HIV incidence.
Quality of life in relation to overweight and body fat distribution.
Authors: Han T S , Tijhuis M A , Lean M E , Seidell J C
Published: November 2008

OBJECTIVES: This study quantified the impairment of quality of life attributable to body fatness by using the standardized SF-36 Health Survey. METHODS: Tertiles of waist circumference and body mass index (BMI) in 1885 men and 2156 women aged 20 to 59 years in the Netherlands in 1995 were compared. RESULTS: The odds ratios and 95% confidence intervals of subjects with the largest waist circumferences, compared with those in the lowest tertile, were 1.8 (1.3, 2.4) in men and 2.2 (1.7, 2.9) in women with difficulties in bending, kneeling, or stooping; 2.2 (1.4, 3.7) in men and 1.7 (1.2, 2.6) in women with difficulties in walking 500 m; and 1.3 (1.0, 1.9) in men and 1.5 (1.1, 1.9) in women with difficulties in lifting or carrying groceries. Anthropometric measures were less strongly associated with social functioning, role limitations due to physical or emotional problems, mental health, vitality, pain, or health change in 1 year. The relationship between quality of life measures and BMI were similar to those between quality of life measures and waist circumference. CONCLUSIONS: Large waist circumferences and high BMIs are more likely to be associated with impaired quality of life and disability affecting basic activities of daily living.
Claims incidence of work-related disorders of the upper extremities: Washington state, 1987 through 1995.
Authors: Silverstein B , Welp E , Nelson N , Kalat J
Published: November 2008

OBJECTIVES: This study examined the claim incidence rate, cost, and industry distribution of work-related upper extremity disorders in Washington. METHODS: Washington State Fund workers' compensation claims from 1987 to 1995 were abstracted and categorized into general and specific disorders of gradual or sudden onset. RESULTS: Accepted claims included 100,449 for hand/wrist disorders (incidence rate: 98.2/10,000 full-time equivalents; carpal tunnel syndrome rate: 27.3), 30,468 for elbow disorders (incidence rate: 29.7; epicondylitis rate: 11.7), and 55,315 for shoulder disorders (incidence rate: 54.0; rotator cuff syndrome rate: 19.9). Average direct workers' compensation claims costs (medical treatment and indemnity) were $15,790 (median: $6774) for rotator cuff syndrome, $12,794 for carpal tunnel syndrome (median: $4190), and $6593 for epicondylitis (median: $534). Construction and food processing were among the industries with the highest rate ratios for all disorders (> 4.0). CONCLUSIONS: Upper extremity disorders represent a large and costly problem in Washington State industry. Industries characterized by manual handling and repetitive work have high rate ratios. The contingent workforce appears to be at high risk.
Children's exposure to traffic and pedestrian injuries.
Authors: Macpherson A , Roberts I , Pless I B
Published: November 2008

OBJECTIVES: The purpose of this study was to estimate children's exposure to traffic (number of streets crossed) and to determine the role of exposure in pedestrian injury. METHODS: Questionnaires were distributed to a random sample of 4080 first- and fourth-grade children in 43 Montreal schools. RESULTS: When analyzed by police district, injury and exposure rates were positively correlated (r2 = 0.53). Crossings were similar by sex but increased with age and were inversely related to socioeconomic status. CONCLUSIONS: These results suggest that although children's exposure to traffic could be reduced by transporting them to school, a more reasonable prevention strategy involves environmental changes.
A community-initiated study of blood lead levels of Nicaraguan children living near a battery factory.
Authors: Morales Bonilla C , Mauss E A
Published: November 2008

OBJECTIVES: In response to requests by parents in Managua, Nicaragua, whose neighborhood borders a battery factory, 97 children were tested for blood lead, as were 30 children in a neighborhood without an obvious source of environmental lead. METHODS: Venous blood was examined by atomic absorption spectrophotometry. Educational workshops were conducted. RESULTS: Mean blood lead levels were 17.21 +/- 9.92 micrograms/dL in the index children and 7.40 +/- 5.37 micrograms/dL in the controls (P < .001). CONCLUSIONS: Children living near the battery factory are at increased risk of lead poisoning. The parents were able to petition the government to control the factory emissions and to improve appropriate health services. The factory is now closed.
The effectiveness of a tobacco prevention program with adolescents living in a tobacco-producing region.
Authors: Noland M P , Kryscio R J , Riggs R S , Linville L H , Ford V Y , Tucker T C
Published: November 2008

OBJECTIVES: This study investigated the efficacy of a social-influences tobacco prevention program conducted with adolescents living in a high tobacco production area. METHODS: Students in 10 experimental schools completed the tobacco prevention program and a booster intervention. Control students received health education as usual. RESULTS: After 2 years of treatment, smoking rates in the treatment group (vs the control group) were lower for 30-day, 7-day, and 24-hour smoking. The intervention had more of an impact on those who were involved in raising tobacco than it did on those not involved in raising tobacco. CONCLUSIONS: Although modest, effects were achieved with minimal intervention time in a high-risk group, indicating that social-influences prevention programs may be effective in such groups.
Bringing context back into epidemiology: variables and fallacies in multilevel analysis.
Authors: Diez-Roux A V
Published: November 2008

A large portion of current epidemiologic research is based on methodologic individualism: the notion that the distribution of health and disease in populations can be explained exclusively in terms of the characteristics of individuals. The present paper discusses the need to include group- or macro-level variables in epidemiologic studies, thus incorporating multiple levels of determination in the study of health outcomes. These types of analyses, which have been called contextual or multi-level analyses, challenge epidemiologists to develop theoretical models of disease causation that extend across levels and explain how group-level and individual-level variables interact in shaping health and disease. They also raise a series of methodological issues, including the need to select the appropriate contextual unit and contextual variables, to correctly specify the individual-level model, and, in some cases, to account for residual correlation between individuals within contexts. Despite its complexities, multilevel analysis holds potential for reemphasizing the role of macro-level variables in shaping health and disease in populations.
Mortality patterns among adult Hispanics: findings from the NHIS, 1986 to 1990.
Authors: Liao Y , Cooper R S , Cao G , Durazo-Arvizu R , Kaufman J S , Luke A , McGee D L
Published: November 2008

OBJECTIVES: The purpose of this study was to assess the mortality pattern of the adult Hispanic population in the United States. METHODS: This was a cohort study using data from the National Health Interview Survey from 1986 through 1990. Deaths were ascertained by matching the National Death Index through 1991. RESULTS: This representative national sample included 297,640 non-Hispanic Whites, 53,552 Blacks, and 27,239 Hispanics, all aged 18 years or older at baseline. Different matching criteria resulted in modest differential estimates of the number of deaths by ethnic groups; these differences were quantitatively more important for Hispanics. Overall age-standardized mortality was lower among Hispanics. A prominent age by race interaction was apparent. The Hispanic: White mortality ratio was 1.33, 0.92, and 0.76 among men aged 18 through 44, 45 through 64, and 65 and older, respectively. Among women in the same age groups the Hispanic: White mortality ratio was 1.22, 0.75, and 0.70, respectively. CONCLUSIONS: Longitudinal cohorts provide an important source of health status information on Hispanics. These results suggest that overall mortality is lower among Hispanics than among non-Hispanic Whites, especially in the oldest age group. Among younger and middle-aged persons, the mortality of Hispanics is similar to or even higher than that of Whites.
Results of the TeachWell worksite wellness program.
Authors: Resnicow K , Davis M , Smith M , Baranowski T , Lin L S , Baranowski J , Doyle C , Wang D T
Published: November 2008

OBJECTIVE: This study examined whether providing a school-based teacher wellness program enhances the impact of a health curriculum on student outcomes and improves cognitive, behavioral, and physiological outcomes among participating teachers. METHODS: Thirty-two elementary schools were randomly assigned to experimental or comparison conditions. Comparison group schools received the Gimme-5 program, a curriculum designed to increase fourth and fifty graders' consumption of fruits and vegetables. Experimental schools received Gimme-5 and the teacher wellness program, which included 54 workshops over 2 years, along with several schoolwide health activities. Physiological, behavioral, and cognitive outcomes were assessed in teachers and students. RESULTS: There was no evidence that the intervention favorably modified any student or teacher end points; nor did intervention teachers deliver the Gimme-5 program with greater fidelity than comparison teachers. CONCLUSION: Confidence in the null results is bolstered by the randomized design, baseline sample equivalence, appropriate mixed-model analyses, and lack of selective or differential attrition. Insufficient participation in the wellness program appears a likely explanation for the lack of teacher and student effects. Factors specific to the school setting and intervention may have diminished participation and, thus, intervention effects.
Epidemic obesity in the United States: are fast foods and television viewing contributing?
Authors: Jeffery R W , French S A
Published: November 2008

OBJECTIVES: This study examined the association between TV viewing, fast food eating, and body mass index. METHODS: Associations between hours of TV viewing, frequency of eating at fast food restaurants, body mass index, and behaviors were assessed cross sectionally and longitudinally over 1 year in 1059 men and women. RESULTS: Fast food meals and TV viewing hours were positively associated with energy intake and body mass index in women but not in men. TV viewing predicted weight gain in high-income women. CONCLUSIONS: Secular increases in fast food availability and access to televised entertainment may contribute to increasing obesity rates in the United States.
An ecological study of the effectiveness of mammography in reducing breast cancer mortality.
Authors: Cooper G S , Yuan Z , Bowlin S J , Dennis L K , Kelly R , Chen H , Rimm A A
Published: November 2008

OBJECTIVES: The purpose of this study was to determine the relation of screening mammography to breast cancer incidence and case fatality. METHODS: In a sample of White female Medicare beneficiaries hospitalized in 1990-1991, age-adjusted breast cancer incidence and 2-year case fatality rates were estimated and compared with the frequency of mammographic screening from a population-based survey. RESULTS: The average rates for incidence, case fatality, and mammography within 5 years in 29 states were 414/100,000, 18.8%, and 59.2%, respectively. There was a positive state-level correlation between mammography rates and incidence and an inverse correlation between mammography and case fatality. CONCLUSIONS: High screening mammography rates in some states are associated with reduced breast cancer case fatality rates, presumably as a result of diagnosis of earlier stage cancers.
The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners.
Authors: Swinburn B A , Walter L G , Arroll B , Tilyard M W , Russell D G
Published: November 2008

OBJECTIVES: The purpose of this study was to determine whether written advice from general practitioners increases physical activity among sedentary people more than verbal advice alone. METHODS: Sedentary patients (n = 456) received verbal advice on increasing physical activity and were then randomized to an exercise prescription (green prescription) group or a verbal advice group. RESULTS: The number of people engaging in any recreational physical activity at 6 weeks increased substantially, but significantly more so in the green prescription group. Also, more participants in the green prescription group increased their activity over the period. CONCLUSIONS: A written goal-oriented exercise prescription, in addition to verbal advice, is a useful tool for general practitioners in motivating their parents to increase physical activity.
Blood pressure measurement and antihypertensive treatment in a low-income African-American population.
Authors: Hyman D J , Pavlik V N , Vallbona C , Dunn J K , Louis K , Dewey C M , Wieck L
Published: November 2008

OBJECTIVES: The purpose of this study was to describe blood pressure measurement and hypertension treatment in an inner-city African-American community. METHODS: A random-digit dialing telephone survey of adults more than 18 years of age was carried out in 12 predominantly African-American zip code areas in Houston, Texas. RESULTS: More than 90% of subjects reported a blood pressure measurement within the past 2 years, and 87% of known hypertensives reported current medication use. CONCLUSIONS: Further improvements in hypertension control among African Americans in this country are likely to depend primarily on changes in diagnosis and management practices of health care providers and on maintaining primary care access for all socioeconomic groups.
The National Occupational Research Agenda: a model of broad stakeholder input into priority setting.
Authors: Rosenstock L , Olenec C , Wagner G R
Published: November 2008

OBJECTIVES: No single organization has the resources necessary to conduct occupational safety and health research to adequately serve the needs of workers in the United States. The National Institute for Occupational Safety and Health (NIOSH) undertook the task of setting research priorities in response to a broadly perceived need to systematically address those topics most pressing and most likely to yield gains to workers and to the nation. METHODS: NIOSH and its public and private partners used a consensus-building process to set priorities for the next decade for occupational safety and health research--the National Occupational Research Agenda. RESULTS: The process resulted in the identification of 21 research priorities grouped into 3 categories: disease and injury, work environment and workforce, and research tools and approaches. CONCLUSIONS: Although the field of occupational safety and health is often contentious and adversarial, these research priorities reflect a remarkable degree of concurrence among a broad range of stakeholders who provided input into a clearly defined and open process.
State funding of comprehensive primary medical care service programs for medically underserved populations.
Authors: Rosenbaum S , Hawkins D R , Rosenbaum E , Blake S
Published: November 2008

OBJECTIVES: This study examined the availability of state funding for comprehensive primary care programs and the need for primary care subsidies for medically underserved communities. METHODS: A brief questionnaire was used to ask health agencies in all 50 states whether their state funded a program that met our definition of comprehensive primary medical care practice programs. An in-depth written survey instrument was then administered to the states with programs. RESULTS: Almost half of all states provide some funds for the development and/or operation of comprehensive primary medical care practices. Expenditures in most states were found to be relatively modest in comparison with both federal funding and the total level of unmet need for primary care. States that subsidize primary care practices tend to follow the model established under the federal health centers program. CONCLUSIONS: The findings suggest the continued viability of the health center model of care, as well as the presence of some state support for such a program. However, in light of limited state resources for the development and operation of comprehensive practices, a continued and significant federal effort is imperative.
Food insufficiency exists in the United States: results from the third National Health and Nutrition Examination Survey (NHANES III).
Authors: Alaimo K , Briefel R R , Frongillo E A , Olson C M
Published: November 2008

OBJECTIVES: The purpose of this study was to estimate the prevalence of food insufficiency in the United States and to examine sociodemographic characteristics related to food insufficiency. METHODS: Data were analyzed from the third National Health and Nutrition Examination Survey, a cross-sectional representative sample of the civilian noninstitutionalized population living in households. Individuals were classified as "food insufficient" if a family respondent reported that the family sometimes or often did not get enough food to eat. RESULTS: From 1988 through 1994, the overall prevalence of food insufficiency was 4.1% and was primarily related to poverty status. In the low-income population, food insufficiency was positively associated with being Mexican American, being under the age of 60, having a family head who had not completed high school, participating in the Food Stamp Program, and not having health insurance. It was not related to family type or employment status of the family head. Over half of food-insufficient individuals lived in employed families. CONCLUSIONS: Food insufficiency is not limited to very low-income persons, specific racial/ethnic groups, family types, or the unemployed. Understanding food insufficiency is critical to formulating nutrition programs and policies.
Promoting the selection of low-fat milk in elementary school cafeterias in an inner-city Latino community: evaluation of an intervention.
Authors: Wechsler H , Basch C E , Zybert P , Shea S
Published: November 2008

OBJECTIVES: This study examined the effects of a school-based intervention designed to promote the consumption of low-fat white milk at lunchtime in 6 elementary schools in an inner-city, primarily Latino neighborhood. METHODS: A multifaceted intervention based on social marketing techniques was delivered at 3 randomly selected schools. The school was the unit of assignment and analysis; 6902 children were involved in the study. Milk selection and consumption were measured by sampling discarded milk and/or tallying milk carton disappearance at baseline, immediately postintervention, and at 3 to 4 months follow-up. RESULTS: Immediately postintervention, the mean proportion of sampled milk cartons that contained low-fat milk increased in the intervention schools, from 25% to 57%, but remained constant at 28% in the control schools. Differences between intervention and control schools remained significant at 3 to 4 months follow-up. The intervention was not associated with a decrease in overall milk consumption. CONCLUSIONS: A school-based intervention can lead to significant increases in student consumption of low-fat milk.
Metropolitan governance, residential segregation, and mortality among African Americans.
Authors: Hart K D , Kunitz S J , Sell R R , Mukamel D B
Published: November 2008

OBJECTIVES: This study tested the hypothesis that the degree to which local government is metropolitanized is associated with mortality rates for African Americans and with residential segregation, which has itself previously been shown to be positively associated with mortality among African Americans. METHODS: One hundred fourteen US standard metropolitan statistical areas were examined. The primary dependent variable was the age-adjusted, race- and sex-specific all-cause mortality rate, averaged for 1990 and 1991. The 2 primary independent variables were residential segregation, as measured by the index of dissimilarity, and metropolitanization of government, as measured by the central city's elasticity score. RESULTS: Mortality rates for male and female African Americans were lower in metropolitan statistical areas with more metropolitanized local governments and lower levels of residential segregation. Mortality for male and female Whites was not associated in either direction with residential segregation. White male mortality showed no association with level of metropolitanization, but lower White female mortality rates were associated with less metropolitanization. CONCLUSIONS: This study suggests the need for further research into whether policy changes in areas not traditionally thought of as "health policy" areas can improve the health of urban minorities.
Voting with their feet: public hospitals, health reform, and patient choices.
Authors: Ansell D , Schiff G , Dick S , Cwiak C , Wright K
Published: November 2008

OBJECTIVES: This study identified public hospital patients' preferences under managed care and health reform. METHODS: A cross-sectional survey of 348 ambulatory public hospital patients was conducted. RESULTS: Patients reported a high degree of loyalty to the public hospital given several hypothetical reform scenarios. Those patients who stated they would remain at the hospital increased (from 74.2% to 85.5%) when care elsewhere required copayment for medications and physician visits. CONCLUSIONS: Patients at one public hospital reported a high likelihood of remaining in the public system, and this likelihood increased when copayment for services was required elsewhere.
The use of state and general hospitals for inpatient psychiatric care.
Authors: Banks S M , Pandiani J A
Published: November 2008

OBJECTIVES: This paper explores the relationship of state hospital and general hospital psychiatric caseloads in a statewide system of care. METHODS: Probabilistic population estimation was applied to general hospital and state hospital data sets. RESULTS: General hospitals provide inpatient psychiatric services to more people than do state hospitals, and a significant number are served in both sectors. There were notable differences in use patterns related to patient gender and age. CONCLUSIONS: These results demonstrate that probabilistic methodologies can significantly enhance the value of existing databases for epidemiological research.
Hospital volume differences and five-year survival from breast cancer.
Authors: Roohan P J , Bickell N A , Baptiste M S , Therriault G D , Ferrara E P , Siu A L
Published: November 2008

OBJECTIVES: The purpose of this study was to determine the effect of hospital volume on long-term survival for women with breast cancer. METHODS: Survival analysis and proportional-hazard modeling were used to assess 5-year survival and risk of death, adjusting for clinical and sociodemographic variables. RESULTS: At 5 years, patients from very low-volume hospitals had a 60% greater risk of all-cause mortality than patients from high-volume hospitals. CONCLUSIONS: Hospital volume of breast cancer surgical cases has a strong positive effect on 5-year survival. Research is needed to identify whether processes of care, especially postsurgical adjuvant treatments, contribute to survival differences.
Geographic variations in breast cancer mortality: do higher rates imply elevated incidence or poorer survival?
Authors: Goodwin J S , Freeman J L , Freeman D , Nattinger A B
Published: November 2008

OBJECTIVES: Mortality rates from breast cancer are approximately 25% higher for women in the northeastern United States than for women in the South or West. This study examined the hypothesis that the elevation is due to decreased survival rather than increased incidence. METHODS: Data on breast cancer incidence, treatment, and mortality were reviewed. RESULTS: The elevated mortality in the Northeast is apparent only in older women. For women aged 65 years and older, breast cancer mortality is 26% higher in New England than in the South, while incidence is only 3% higher. Breast cancer mortality for older women by state correlates poorly with incidence (r = 0.28). CONCLUSIONS: Those seeking to explain the excess breast cancer mortality in the Northeast should assess survival and should examine differences in cancer control practices that affect survival.
The racial segregation of hospital care revisited: Medicare discharge patterns and their implications.
Authors: Smith D B
Published: November 2008

OBJECTIVES: This paper measures current patterns of hospital segregation among Medicare beneficiaries. METHODS: Data from the fiscal year 1993 Medicare Provider Analysis and Review (MEDPAR) file, the index of dissimilarity, and a linear regression model are used to test the effects of standard metropolitan area characteristics on hospital segregation. RESULTS: The overall hospital segregation index was 0.529, ranging by state from 0.154 to 0.746. Hospital segregation in 126 standard metropolitan areas was positively related to population size, hospital density, and residential segregation and negatively related to income inequities and location in the South. CONCLUSIONS: Racial segregation remains high and may produce both reporting biases and unequal effects of public policy.
Can Medicaid managed care provide continuity of care to new Medicaid enrollees? An analysis of tenure on Medicaid.
Authors: Carrasquillo O , Himmelstein D U , Woolhandler S , Bor D H
Published: November 2008

OBJECTIVES: The purpose of this study was to analyze duration of coverage among new Medicaid enrollees. METHODS: The 1991 Survey of Income and Program Participation was used to examined the duration of coverage for individuals who did not have Medicaid in January 1991 and obtained coverage by May 1993. RESULTS: Of new Medicaid enrollees, 38% (90% confidence interval [CI] = 34%, 42%) remained covered 1 year later; 26% (90% CI = 21%, 31%) remained covered at 28 months. Of those older than 65 years, 54% (90% CI = 31%, 77%) retained Medicaid for 28 months, vs 20% (90% CI = 14%, 26%) of children. Of people who lost Medicaid, 54% (90% CI = 31%, 77%) had no insurance the following month. CONCLUSIONS: Almost two thirds of new Medicaid recipients lose coverage within 12 months. It is unlikely that Medicaid managed care will enhance continuity of care for new recipients.
Trade-offs in prenatal detection of Down syndrome.
Authors: Serra-Prat M , Gallo P , Jovell A J , Aymerich M , Estrada M D
Published: November 2008

OBJECTIVES: This paper presents the results of different screening policies for prenatal detection of Down syndrome that would allow decision makers to make informed choices. METHODS: A decision analysis model was built to compare 8 screening policies with regard to a selected set of outcome measures. Probabilities used in the analysis were obtained from official administrative data reports in Spain and Catalonia and from data published in the medical literature. Sensitivity analyses were carried out to test the robustness of screening policies' results to changes in uptake rates, diagnostic accuracy, and resources consumed. RESULTS: Selected screening policies posed major trades-offs regarding detection rates, false-positive results, fetal loss, and costs of the programs. All outcome measures considered were found quite robust to changes in uptake rates. Sensitivity and specificity rates of screening tests were shown to be the most influential factors in the outcome measures considered. CONCLUSIONS: The disclosed trade-offs emphasize the need to comprehensively inform decision makers about both positive and negative consequences of adopting one screening policy or another.
Risk factors for congenital syphilis in infants of women with syphilis in South Carolina.
Authors: Mobley J A , McKeown R E , Jackson K L , Sy F , Parham J S , Brenner E R
Published: November 2008

OBJECTIVES: This study examined risk factors for congenital syphilis in South Carolina. METHODS: Case infants with presumptive and confirmed congenital syphilis were compared with control infants born to women with reactive serologies during pregnancy, allowing investigation of risk factors for congenital rather than acquired transmission of syphilis. Data were collected from congenital syphilis report forms and birth certificates for 186 case infants and 487 controls born from 1991 to 1993. Odds ratios were calculated for maternal risk factors. RESULTS: Significant statistical trends were found for timing of first prenatal visit and number of visits. Other significant factors included rural residence (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.4, 2.9) and previous pregnancy loss (OR = 0.3, 95% CI = 0.2, 0.6). CONCLUSIONS: Prevention of congenital syphilis may be less effective among pregnant women with syphilis in South Carolina who have fewer prenatal care visits. Health care providers need further education on maternal/child syphilis management and techniques for motivating and educating patients.
Modeling all-cause mortality: projections of the impact of smoking cessation based on the NHEFS. NHANES I Epidemiologic Follow-up Study.
Authors: Russell L B , Carson J L , Taylor W C , Milan E , Dey A , Jagannathan R
Published: November 2008

OBJECTIVES: A model that relates clinical risk factors to subsequent mortality was used to simulate the impact of smoking cessation. METHODS: Survivor functions derived from multivariate hazard regressions fitted to data from the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Followup Study, a longitudinal survey of a representative sample of US adults, were used to project deaths from all causes. RESULTS: Validation tests showed that the hazard regressions agreed with the risk relationships reported by others, that projected deaths for baseline risk factors closely matched observed mortality, and that the projections attributed deaths to the appropriate levels of important risk factors. Projections of the impact of smoking cessation showed that the number of cumulative deaths would be 15% lower after 5 years and 11% lower after 20 years. CONCLUSIONS: The model produced realistic projections of the effects of risk factor modification on subsequent mortality in adults, Comparison of the projections for smoking cessation with estimates of the risk attributable to smoking published by the Centers for Disease Control and Prevention suggests that cessation could capture most of the benefit possible from eliminating smoking.
Reducing pregnancy and induced abortion rates in China: family planning with husband participation.
Authors: Wang C C , Vittinghoff E , Hua L S , Yun W H , Rong Z M
Published: November 2008

OBJECTIVES: This study assessed the effectiveness of a family planning intervention with and without husband's participation in reducing pregnancy and abortion rates in Shanghai, China. METHODS: In this 3-arm randomized trial among 1800 nonsterilized married women, educational interventions targeting both spouses and targeting the wife only were compared with usual family planning care. RESULTS: Among women not using intrauterine devices (IUDs), the intervention with husband's participation had an effect in reducing pregnancy rates (adjusted odds ratio [OR] = 0.36, 95% confidence interval [CI] = 0.12, 1.1) and abortion rates (adjusted OR = 0.29, CI = 0.09, 0.94) compared with control subjects, and a significant effect in reducing pregnancy rates (adjusted OR = 0.29, CI = 0.10, 0.85) and abortion rates (adjusted OR = 0.24, CI = 0.07, 0.77) compared with wife-only subjects. CONCLUSIONS: Family planning interventions involving husbands may reduce pregnancy and abortion rates among non-IUD users.
Reporting sexual risk behavior for HIV: a practical risk index and a method for improving risk indices.
Authors: Susser E , Desvarieux M , Wittkowski K M
Published: November 2008

OBJECTIVES: As a means of enhancing public health efforts to control sexual transmission of human immunodeficiency virus (HIV), methods were developed to report on risk behavior in a manner that is comparable and widely interpretable. METHODS: An elementary sexual behavior risk index (the vaginal episode equivalent index) that is in accord with some of the essential knowledge about sexual transmission of HIV is described, and a multivariate ordinal risk (MOR) method that can be used to improve such risk indices is introduced. RESULTS: An example shows that these approaches are applicable to observational studies of seroconversion. CONCLUSIONS: The MOR represents a powerful new tool to develop valid comparable measures of sexual risk behavior and, thereby, to advance HIV prevention research.
The globalization of public health, I: Threats and opportunities.
Authors: Yach D , Bettcher D
Published: November 2008

The globalization of public health poses new threats to health but also holds important opportunities in the coming century. This commentary identifies the major threats and opportunities presented by the process of globalization and emphasizes the need for transnational public health approaches to take advantage of the positive aspects of global change and to minimize the negative ones. Transnational public health issues are areas of mutual concern for the foreign policies of all countries. These trends indicate a need for cross-national comparisons (e.g., in the areas of health financing and policy development) and for the development of a transnational research agenda in public health.
Keeping competition fair for health insurance: how the Irish beat back risk-rated policies.
Authors: Light D W
Published: November 2008

OBJECTIVES: This paper describes how Ireland created a level playing field for competition in health insurance, the strategies of a major insurer to introduce risk-rated policies that would segment the market, the successful campaign to block these policies, and the policy implications of the European Union requirement of competition in health insurance. METHODS: Policy documents, interviews, and press reports were analyzed. RESULTS: The minister of health forced the commercial insurer to withdraw its policies and replace them with community-rated policies. CONCLUSIONS: Because it is easier and more profitable for insurers to engage in risk selection than to become more efficient, beneficial competition in health insurance markets is extremely difficult to create. Carefully drawn rules and monitoring are required to overcome inherent causes of market failure. The current enthusiasm for saving money through competitive schemes in health insurance seems likely to produce higher costs and greater inequality.
Use of chiropractic services from 1985 through 1991 in the United States and Canada.
Authors: Hurwitz E L , Coulter I D , Adams A H , Genovese B J , Shekelle P G
Published: November 2008

OBJECTIVES: The purpose of this paper is to describe the demographic and clinical characteristics of chiropractic patients and to document chiropractic visit rates in 6 sites in the United States and Canada. METHODS: Random samples of chiropractors from 5 US sites and 1 Canadian site were selected. A record abstraction system was developed to obtain demographic and clinical data from office charts. RESULTS: Of the 185 eligible chiropractors sampled, 131 (71%) participated. Sixty-eight percent of the selected charts showed that care was sought for low back pain, while 32% recorded care for other reasons. Spinal manipulative therapy was recorded in 83% of all charts. There was a greater than 2-fold difference in the median number of visits related to low back pain per episode of care across sites. The chiropractic visit rates in the US sites and Ontario are estimated to be 101.2 and 140.9 visits per 100 person-years, respectively. CONCLUSIONS: The chiropractic use rate in these sites is twice that of estimates made 15 years ago. The great majority of patients receive care for musculoskeletal conditions of the back and neck. The number of visits per episode varies appreciably by site.
Fetal alcohol syndrome in Alaska, 1977 through 1992: an administrative prevalence derived from multiple data sources.
Authors: Egeland G M , Perham-Hester K A , Gessner B D , Ingle D , Berner J E , Middaugh J P
Published: November 2008

OBJECTIVES: The prevalence and characteristics of fetal alcohol syndrome cases and the usefulness of various data sources in surveillance were examined in Alaska to guide prevention and future surveillance efforts. METHODS: Sixteen data sources in Alaska were used to identify children with fetal alcohol syndrome. Medical charts were reviewed to verify cases, and records were reviewed to provide descriptive data. RESULTS: Fetal alcohol syndrome rates varied markedly by birth year and race, with the highest prevalence (4.1 per 1000 live births) found among Alaska Natives born between 1985 and 1988. Screening and referral programs to diagnostic clinics identified 70% of all recorded cases. The intervention program for children 0 to 3 years of age detected 29% of age-appropriate cases, and Medicaid data identified 11% of all cases; birth certificates detected only 9% of the age-appropriate cases. CONCLUSIONS: Our findings indicate a high prevalence of fetal alcohol syndrome in Alaska and illustrate that reliance on any one data source would lead to underestimates of the extent of fetal alcohol syndrome in a population.
Socioeconomic differences in the use of physician services in Nova Scotia.
Authors: Kephart G , Thomas V S , MacLean D R
Published: November 2008

OBJECTIVES: Socioeconomic differences in use of physician services in Nova Scotia, Canada were examined. METHODS: The study was based on survey data, containing information on socioeconomic status, linked to physician claims data. Socioeconomic differences in use of physician services were estimated, adjusted for age, sex, and region of residence. RESULTS: Large socioeconomic differences were observed in the use of physician services, with use inversely related to both household income and education. These differences remained after adjustment for age, sex, and region. CONCLUSIONS: Use of physician services is inversely associated with socioeconomic status.
Contraception and induced abortion in Armenia: a critical need for family planning programs in eastern Europe.
Authors: Dolian G , Lüdicke F , Katchatrian N , Campana A , Morabia A
Published: November 2008

OBJECTIVES: The purpose of this study was to determine the number of induced abortions per woman and the reasons for selecting induced abortion among parous Armenian women. METHODS: A consecutive series of 200 women attending an abortion clinic in Yerevan, Armenia, were queried by a physician about their reproductive histories. RESULTS: Women younger than 20 years of age reported a median of 1 and women older than 40 years reported a median of 8 induced abortions in their lifetimes (overall median = 3). Lack of contraceptive information was the major reason cited for not using contraception. CONCLUSIONS: Induced abortion is the major form of birth control among parous Armenian women. Concerted public health campaigns are needed to inform women and their physicians in Armenia and other Eastern European countries about alternative contraceptive methods.
Explaining recent increases in students' marijuana use: impacts of perceived risks and disapproval, 1976 through 1996.
Authors: Bachman J G , Johnson L D , O'Malley P M
Published: November 2008

OBJECTIVES: Marijuana use among high school seniors increased during most of the 1970s, decreased throughout the 1980s, and has been increasing again during the 1990s. Earlier analyses of the classes of 1976 through 1986 attributed the historic trends during that period to specific changes in views about marijuana. This study examined whether recent increases in marijuana use among seniors and among students in earlier grades reflect similar processes. METHODS: Multivariate regression analyses were conducted on data from large annual nationwide surveys of high school seniors from 1976 through 1996 (approximate n = 61,000) and 8th and 10th graders from 1991 through 1996 (n's = 87,911 and 82,475, respectively). RESULTS: Individual lifestyle factors (grades, truancy, religious commitment, evenings out for recreation) correlated substantially with marijuana use but did not explain the historic changes in marijuana use. Rather, decreases in perceived risk of harmfulness and in disapproval can account for the recent increases in all 3 grades and for earlier decreases among seniors. CONCLUSIONS: These findings indicate that perceived risks and disapproval are important determinants of marijuana use. Accordingly, prevention efforts should include realistic information about risks and consequences of marijuana use.
Coronary heart disease risk factors and attributable risks in African-American women and men: NHANES I epidemiologic follow-up study.
Authors: Gillum R F , Mussolino M E , Madans J H
Published: November 2008

OBJECTIVES: This study assessed associations of risk factors with coronary heart disease incidence in African Americans. METHODS: The participants in the NHANES I Epidemiologic Follow-Up Study included in this analysis were 1641 Black and 9660 White persons who were aged 25 to 74 years when examined and who did not have a history of coronary heart disease. Average follow-up for survivors was 19 years. RESULTS: Significant, independent risk factors for coronary heart disease were age, systolic blood pressure, and smoking in Black women and age, systolic blood pressure, serum cholesterol, low education, and low family income in Black men. In this cohort, 19% of incident coronary heart disease in Black women and 34% in Black men might be prevented if systolic blood pressure were below 140 mm Hg. In Black men, attributable risk for low education (46%) was even higher than that for elevated blood pressure. CONCLUSIONS: Elevated systolic blood pressure and smoking were predictive of coronary heart disease incidence in African Americans. Estimates of population attributable risk were highest for elevated systolic blood pressure in women and education less than high school in men. Further studies of serum lipids, education, and coronary heart disease in Black women are needed.
Evaluation of an enforcement program to reduce tobacco sales to minors.
Authors: Cummings K M , Hyland A , Saunders-Martin T , Perla J , Coppola P R , Pechacek T F
Published: November 2008

OBJECTIVES: This study evaluated an active enforcement program to increase retailers' compliance with the law prohibiting tobacco sales to minors. METHODS: Tobacco sales to minors were monitored in 319 outlets in 6 pairs of communities in Erie County, New York. One community in each pair was randomly assigned to an enforcement intervention. RESULTS: Retailers' compliance with the law increased from 35% in 1994 to 73% in 1995. However, the change in compliance rates was roughly the same for stores in the enforcement and nonenforcement communities. CONCLUSIONS: Active compliance checking of retail outlets as a strategy to reduce illegal tobacco sales to minors may only be necessary insofar as it contributes to an increase in retailers' perception that the threat of enforcement is real.