bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventing unintended pregnancy: the cost-effectiveness of three methods of emergency contraception.
Authors: Trussell J , Koenig J , Ellertson C , Stewart F
Published: November 2008

OBJECTIVES: This study examined the cost-effectiveness of emergency contraceptive pills, minipills, and the copper-T intrauterine device (IUD) as emergency contraception. METHODS: Cost savings were modeled for both (1) a single contraceptive treatment following unprotected intercourse and (2) emergency contraceptive pills provided in advance. RESULTS: In a managed care (public payer) setting, a single treatment of emergency contraception after unprotected intercourse saves $142 ($54) with emergency contraceptive pills and $119 ($29) with minipills. The copper-T IUD is not cost-effective as an emergency contraceptive alone, but savings quickly accrue as use continues. Advance provision of emergency contraceptive pills to women using barrier contraceptives, spermicides, withdrawal, or periodic abstinence saves from $263 to $498 ($99 to $205) annually. CONCLUSIONS: Emergency contraception is cost-effective whether provided when the emergency arises or in advance to be used as needed. Greater use of emergency contraception could reduce the considerable medical and social costs of unintended pregnancies.
Mortality related to sexually transmitted diseases in US women, 1973 through 1992.
Authors: Ebrahim S H , Peterman T A , Zaidi A A , Kamb M L
Published: November 2008

OBJECTIVES: This study estimated the trends in mortality related to sexually transmitted diseases (STDs) and their sequelae in US women from 1973 through 1992. METHODS: The total number of deaths was obtained from US national mortality data and from AIDS surveillance data, and current literature was reviewed to estimate proportions of diseases attributable to sexual transmission. RESULTS: From 1973 through 1984, total STD-related deaths decreased 24%. However, from 1985 through 1992, STD-related deaths increased by 31%, primarily because of increasing numbers of deaths from sexually transmitted human immunodeficiency virus (HIV) infection. The most important changes during the 20-year period were the emergence of and continued increase in the number of deaths related to hetero-sexually transmitted HIV. CONCLUSIONS: The leading causes of STD-related mortality in women, viral STDs and their sequelae, are generally not recognized as being sexually transmitted. Increases in STD-related mortality are primarily due to sexually transmitted HIV, which will soon surpass cervical cancer as the leading cause.
Routine prenatal screening for congenital heart disease: what can be expected? A decision-analytic approach.
Authors: Buskens E , Steyerberg E W , Hess J , Wladimiroff J W , Grobbee D E
Published: November 2008

OBJECTIVES: This study assessed the potential impact of fetal ultrasound screening on the number of newborns affected by cardiac anomalies. METHODS: A decision model was developed that included the prevalence and history of congenital heart disease, characteristics of ultrasound, risk of abortion, and attitude toward pregnancy termination. Probabilities were obtained with a literature survey; sensitivity analysis showed their influence on expected outcomes. RESULTS: Presently, screening programs may prevent the birth of approximately 1300 severely affected newborns per million second-trimester pregnancies. However, over 2000 terminations of pregnancy would be required, 750 of which would have ended in intrauterine death or spontaneous abortion. Further, 9900 false-positive screening results would occur, requiring referral. Only the sensitivity of routine screening and attitude toward termination of pregnancy appeared to influence the yield substantially. CONCLUSIONS: The impact of routine screening for congenital heart disease appeared relatively small. Further data may be required to fully assess the utility of prenatal screening.
Questionable data and preconceptions: reconsidering the value of mammography for American Indian Women.
Authors: Partin M R , Korn J E , Slater J S
Published: November 2008

Although the benefits of mammography are well established, many remain skeptical of the value of mammography for American Indian women. This skepticism stems in part from a belief that breast cancer is too rare an event among American Indians to warrant widespread screening. The validity of this assumption for Northern Plains Indians is challenged by a discussion of the limitations of available data on breast cancer in American Indian populations (including lack of generalizability, underestimation, and an overreliance on relative rather than absolute measures of cancer incidence) and by findings from the Minnesota Breast and Cervical Cancer Control Program, a federally funded program providing free breast and cervical cancer screening to American Indian and other women in Minnesota. In light of this information, the authors recommend that the low priority of mammography for American Indian women be reconsidered.
Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis.
Authors: O'Campo P , Xue X , Wang M C , Caughy M
Published: November 2008

OBJECTIVES: Past research on low birthweight has focused on individual-level risk factors. We sought to assess the contribution of macrolevel social factors by using census tract-level data on social stratification, community empowerment, and environmental stressors. METHODS: Census tract-level information on social risk was linked to birth certificate records from Baltimore, Md, for the period 1985 through 1989. Individual level factors included maternal education, maternal age, medical assistance health insurance (Medicaid), and trimester of prenatal care initiation. Methods of multilevel modeling using two-stage regression analyses were employed. RESULTS: Macrolevel factors had both direct associations and interactions with low birthweight. All individual risk factors showed interaction with macrolevel variables; that is, individual-level risk factors for low birthweight behaved differently depending upon the characteristics of the neighborhood of residence. For example, women living in high-risk neighborhoods benefited less from prenatal care than did women living in lower-risk neighborhoods. CONCLUSIONS: Multilevel modeling is an important tool that allows simultaneous study of macro- and individual-level risk factors. Multilevel analyses should play a larger role in the formulation of public health policies.
Tobacco and alcohol use behaviors portrayed in music videos: a content analysis.
Authors: DuRant R H , Rome E S , Rich M , Allred E , Emans S J , Woods E R
Published: November 2008

OBJECTIVES: Music videos from five genres of music were analyzed for portrayals of tobacco and alcohol use and for portrayals of such behaviors in conjunction with sexuality. METHODS: Music videos (n = 518) were recorded during randomly selected days and times from four television networks. Four female and four male observers aged 17 to 24 years were trained to use a standardized content analysis instrument. All videos were observed by rotating two-person, male-female teams who were required to reach agreement on each behavior that was scored. Music genre and network differences in behaviors were analyzed with chi-squared tests. RESULTS: A higher percentage (25.7%) of MTV videos than other network videos portrayed tobacco use. The percentage of videos showing alcohol use was similar on all four networks. In videos that portrayed tobacco and alcohol use, the lead performer was most often the one smoking or drinking and the use of alcohol was associated with a high degree of sexuality on all the videos. CONCLUSIONS: These data indicate that even modest levels of viewing may result in substantial exposure to glamorized depictions of alcohol and tobacco use and alcohol use coupled with sexuality.
Hospital use and health status of women during the 5 years following the birth of a premature, low-birthweight infant.
Authors: Haas J S , McCormick M C
Published: November 2008

OBJECTIVE: This study examined the health status and hospital use of women after the birth of a premature, low-birthweight infant. METHODS: The subjects were women with infants who participated in a multisite, randomized trial of an early intervention program. The outcomes examined were (1) a maternal health rating of poor or fair (i.e., poorer health) 5 years following delivery and (2) hospital use for a non-pregnancy-related condition. RESULTS: By the fifth year after delivery, 29.7% of the women had been hospitalized for a non-pregnancy-related condition. Women who reported poorer health status (adjusted relative risk [RR] = 2.39; 95% confidence interval [CI] = 1.86, 3.07) or who had asthma (RR = 2.24; CI = 1.31, 3.80) were at greatest risk. After 5 years, 16.9% of the women said they were in poorer health. The number of intervening years in poorer health (1 year, RR = 3.17; CI = 2.04, 4.94; > 1 year, RR = 8.42; CI = 2.20, 12.88), more than 1 year of poverty (RR = 3.28; CI = 1.90, 5.66), obesity (RR = 3.30; CI = 1.44, 7.55), and more than 1 year of employment (RR = 0.55; CI = 0.36, 0.86) were all significantly associated with poorer health. CONCLUSIONS: The continued, substantial morbidity and hospital use of women with a premature, low-birthweight infant has not previously been reported. This observation needs to be verified.
The delivery of preventive services in primary care practices according to chronic disease status.
Authors: Fontana S A , Baumann L C , Helberg C , Love R R
Published: November 2008

OBJECTIVES: The current study examined the relationship between chronic disease status and the receipt of cancer preventive services over a 3-year period. METHODS: Adults (n = 4320) cared for by 167 nonacademic physicians in 42 primary care group practices were studied. Medical records were audited for each patient, as were patient responses to two questionnaires assessing health and sociodemographic characteristics. RESULTS: While the odds of having received counseling to obtain regular checkups were increased for men (1.56) and women (1.46) with hypertension, the odds were reduced (range = 0.32 to 0.81) for having received a sigmoidoscopy (women with diabetes or hypertension, men with hypertension or heart disease), fecal occult blood test (men with diabetes or heart disease, women with heart disease), mammogram or counseling about smoking (women with diabetes), clinical breast exam (women with heart disease), and Pap test (women with diabetes or heart disease). CONCLUSIONS: The presence of common chronic health problems in older adults is associated with lower levels of cancer screening services.
Job strain and blood pressure in African Americans: the Pitt County Study.
Authors: Curtis A B , James S A , Raghunathan T E , Alcser K H
Published: November 2008

OBJECTIVES: This report examined whether job strain (or its components, decision latitude and job demands) was associated with elevated blood pressure levels in a community-based sample of 726 African-American adults. METHODS: Blood-pressure, anthropometric, behavioral, demographic, and psychosocial data were collected for the current cross-sectional analyses during home interviews conducted for the second wave (1993) of the Pitt County Study (North Carolina), a prospective cohort study of hypertension among African Americans. RESULTS: Job strain was not associated with blood pressure among men or women in this study. However, men in the 80th percentile of decision latitude had more than a 50% decrease in the prevalence of hypertension compared with men in the 20th percentile (odds ratio = .46, 95% confidence interval = .22, .96). CONCLUSIONS: These results indicate that decision latitude may be important for hypertension risk among African-American men. More research is needed on African Americans to determine why job strain and its two component variables differ in their associations with blood pressure for men and women.
Psychiatric symptoms in adolescence as predictors of obesity in early adulthood: a longitudinal study.
Authors: Pine D S , Cohen P , Brook J , Coplan J D
Published: November 2008

OBJECTIVES: This study examined the longitudinal relationship between psychopathology and obesity in young adulthood. METHODS: More than 700 youth in a population-based sample were psychiatrically assessed in 1983 (mean age = 14 years) and 1992 (mean age = 22 years). Self-reported body mass index (BMI) in 1992 was regressed on measures of depression and conduct disorder as well as a set of covariates including indices of physical health, social class, intelligence, and cigarette and alcohol use. Associations were examined with BMI treated as a continuous variable and with a binary index of obesity derived from the BMI distribution in each gender. RESULTS: BMI in young adults was positively related to a number of covariates. With all covariates controlled, BMI was inversely related to adult depressive symptoms in males but not females. BMI was positively related to adolescent symptoms of conduct disorder in both sexes. Similar associations were found between psychiatric symptoms and obesity. CONCLUSIONS: Conduct disorder symptoms in adolescence predicted BMI and obesity in early adulthood. These associations remained after controlling for factors that can affect the association between psychopathology and obesity.
Youth and violence on local television news in California.
Authors: Dorfman L , Woodruff K , Chavez V , Wallack L
Published: November 2008

OBJECTIVES: This study explores how local television news structures the public and policy debate on youth violence. METHODS: A content analysis was performed on 214 hours of local television news from California. Each of the 1791 stories concerning youth, violence, or both was coded and analyzed for whether it included a public health perspective. RESULTS: There were five key findings. First, violence dominated local television news coverage. Second, the specifics of particular crimes dominated coverage of violence. Third, over half of the stories on youth involved violence, while more than two thirds of the violence stories concerned youth. Fourth, episodic coverage of violence was more than five times more frequent than thematic coverage, which included links to broader social factors. Finally, only one story had an explicit public health frame. CONCLUSIONS: Local television news provides extremely limited coverage of contributing etiological factors in stories on violence. If our nation's most popular source of news continues to report on violence primarily through crime stories isolated from their social context, the chance for widespread support for public health solutions to violence will be diminished.
The impact of parental consent on the HIV testing of minors.
Authors: Meehan T M , Hansen H , Klein W C
Published: November 2008

OBJECTIVES: This investigation assessed change in use of human immunodeficiency virus (HIV) testing by minors after removal of the parental consent requirement in Connecticut. METHODS: HIV counseling and testing records for 13- to 17-year-olds who accessed publicly funded testing sites were analyzed. RESULTS: The number of visits increased by 44% from the 12-month period before the statutory change (n = 656) to the 12-month period thereafter (n = 965). The number of HIV tests increased twofold. Visits and tests of high-risk minors tripled. CONCLUSIONS: Minors should have the right to consent to HIV testing.
Blood lead testing by pediatricians: practice, attitudes, and demographics.
Authors: Ferguson S C , Lieu T A
Published: November 2008

OBJECTIVES: This study aimed to evaluate adherence and identify ways to improve concordance between blood lead testing guidelines and practice. METHODS: One hundred fifty-five pediatricians responded to a questionnaire assessing demographic, knowledge, and attitudinal factors relating to lead testing. RESULTS: Only 27% of the respondents adhered to the guidelines, and less than half knew all of the answers to three factual questions about the recommendations. Adherence was higher among physicians who knew the guidelines, were more recently trained, or had high proportions of Medicaid or minority patients. CONCLUSIONS: Physician education and financial incentives hold the most promise for increasing adherence to blood lead testing guidelines.
Elevated blood lead levels in children of construction workers.
Authors: Whelan E A , Piacitelli G M , Gerwel B , Schnorr T M , Mueller C A , Gittleman J , Matte T D
Published: November 2008

OBJECTIVES: This study examined whether children of lead-exposed construction workers had higher blood lead levels than neighborhood control children. METHODS: Twenty-nine construction workers were identified from the New Jersey Adult Blood Lead Epidemiology and Surveillance (ABLES) registry. Eighteen control families were referred by workers. Venous blood samples were collected from 50 children (31 exposed, 19 control subjects) under age 6. RESULTS: Twenty-six percent of workers children had blood lead levels at or over the Centers for Disease Control and Prevention action level of 0.48 mumol/L (10 micrograms/dL), compared with 5% of control children (unadjusted odds ratio = 6.1; 95% confidence interval = 0.9, 147.2). CONCLUSIONS: Children of construction workers may be at risk for excessive lead exposure. Health care providers should assess parental occupation as a possible pathway for lead exposure of young children.
Can dietary interventions change diet and cardiovascular risk factors? A meta-analysis of randomized controlled trials.
Authors: Brunner E , White I , Thorogood M , Bristow A , Curle D , Marmot M
Published: November 2008

OBJECTIVES: This study evaluated the effectiveness of dietary advice in primary prevention of chronic disease. METHODS: A meta-analysis was conducted of 17 randomized controlled trials of dietary behavior interventions of at least 3 months' duration. Results were analyzed as changes in reported dietary fat intakes and biomedical measures (serum cholesterol, urinary sodium, systolic and diastolic blood pressure) in the intervention group minus changes in the control group at 3 to 6 months and 9 to 18 months of follow-up. RESULTS: After 3 to 6 months, mean net changes in each of the five outcomes favored intervention. For dietary fat as a percentage of food energy, the change was -2.5% (95% confidence interval [CI] = -3.9%, -1.1%). Mean net changes over 9 to 18 months were as follows: serum cholesterol, -0.22 (95% CI = -0.39, -0.05) mmol/L; urinary sodium, -45.0 (95% CI = -57.1, -32.8) mmol/24 hours; systolic blood pressure, -1.9 (95% CI = -3.0, 0.8) mm Hg; and diastolic blood pressure, -1.2 (95% CI = -2.6, 0.2) mm Hg. CONCLUSIONS: Individual dietary interventions in primary prevention can achieve modest improvements in diet and cardiovascular disease risk status that are maintained for 9 to 18 months.
Rapid screening and treatment for sexually transmitted diseases in arrestees: a feasible control measure.
Authors: Beltrami J F , Cohen D A , Hamrick J T , Farley T A
Published: November 2008

OBJECTIVES: The purpose of this study was to determine the feasibility and usefulness of rapid screening and immediate presumptive treatment for sexually transmitted diseases among arrestees at a county jail. METHODS: The rapid plasma reagin test (for syphilis) and the urine leukocyte esterase test (for urethritis) were used in establishing routine screening and presumptive treatment for sexually transmitted diseases among arrestees. RESULTS: Of 4757 arrestees screened, 82 (1.7%) had untreated syphilis, and, of 4174 male arrestees screened, 541 (13%) had a positive leukocyte esterase test. The syphilis prevalence rate was higher among women than among men (3.1% vs 1.5%), and the rate was higher among Blacks than among Whites (2.3% vs 0.7%). Although leukocyte esterase test positivity was higher among persons reporting a urethral discharge (57% vs 12%), 88% of persons with a positive test result did not report such symptoms. CONCLUSIONS: The program described here has reached persons with sexually transmitted diseases who are unlikely to use traditional health care services and thus are likely to remain untreated. Rapid screening and treatment for sexually transmitted diseases among arrestees is feasible and should be considered in areas with high sexually transmitted disease rates.
Condom availability in New York City public high schools: relationships to condom use and sexual behavior.
Authors: Guttmacher S , Lieberman L , Ward D , Freudenberg N , Radosh A , Des Jarlais D
Published: November 2008

OBJECTIVES: This study examines the impact of the condom availability program in New York City public high schools by comparing rates of sexual activity and condom use for New York students and similar students in Chicago. METHODS: A total of 7119 students from 12 randomly selected New York schools and 5738 students from 10 Chicago schools participated in a cross-sectional survey. RESULTS: New York students, compared with Chicago students, reported equal rates of sexual activity but higher rates of condom use at last intercourse (odds ratio [OR] = 1.36). For higher-risk students (those with three or more sexual partners in the past 6 months), condom use was greater in New York (OR = 1.85) than in Chicago. CONCLUSIONS: Condom availability has a modest but significant effect on condom use and does not increase rates of sexual activity. These findings suggest that school-based condom availability can lower the risk of HIV and other sexually transmitted diseases for urban teenagers in the United States.
The effects of occupation-based social position on mortality in a large American cohort.
Authors: Gregorio D I , Walsh S J , Paturzo D
Published: November 2008

OBJECTIVES: Four occupation-based measures were used to derive estimates of social position's effect on all-cause mortality among men and women in a large national cohort. METHODS: The National Longitudinal Mortality Study provided information on principal occupation and 9-year follow-up for 229,851 persons aged 25 through 64 years. Cox's proportional hazards model was used to estimate the age-adjusted risk of death relative to six ordinal categories of social position. The Slope Index of Inequality described average change in death rates across categories. RESULTS: Risk of death was consistently elevated among persons at lower positions in the social hierarchy. Estimates comparing lowest with highest categories varied within a narrow range (1.47-1.92 for men and 1.23-1.55 for women). However, several discrepancies among analyses were noted. The analysis by US census groups revealed nonlinear associations, whereas those using other scales found incremental increases in risk. Effect modification by sex was observed for analyses by two of the four measures. Race/ ethnicity did not modify the underlying association between variables. CONCLUSIONS: Our analysis complements previous findings and supports, with few qualifications, the interchangeability of occupation-based measures of social position in mortality studies. Explanations for why relative risk estimates were modified by sex are offered.
Social differences in health: life-cycle effects between ages 23 and 33 in the 1958 British birth cohort.
Authors: Power C , Hertzman C , Matthews S , Manor O
Published: November 2008

OBJECTIVES: The purpose of this study was to determine whether social differences in health persist or widen during early adulthood. METHODS: A longitudinal follow-up of the 1958 British birth cohort was investigated, using social class at birth and six health measures at ages 23 and 33. A slope of inequality was estimated to represent social differences in health. RESULTS: Social gradients in health were evident by age 23: the prevalence of poor health increased with decreasing social position. This was observed for several but not all health indicators. Social gradients persisted to age 33. The slope of inequality was greatest for malaise (odds ratio [OR] = 3.37 for men, 3.21 for women) and obesity (OR = 4.80 for men and 2.84 for women), both at age 23, and for self-rated health in women at age 23 (OR = 2.94) and age 33 (OR = 3.22). Inequality increased significantly between ages 23 and 33 for limiting illness in men, and lessened, although not significantly, for malaise, overweight, and obesity; social gradients remained constant for self-rated health, respiratory symptoms, and asthma or wheezing. CONCLUSIONS: Social gradients in health evident in this sample by age 23 persisted to age 33. Inequalities did not appear to widen consistently, but variable findings for several health measures suggest that inequalities reproduce through different pathways.
Social class and premature mortality among men: a method for state-based surveillance.
Authors: Barnett E , Armstrong D L , Casper M L
Published: November 2008

OBJECTIVES: This study examined trends in mortality by social class for Black and White men aged 35 through 54 years in North Carolina, for 1984 through 1993, using an inexpensive, newly developed state-based surveillance method. METHODS: Data from death certificates and census files permitted examination of four social classes, defined on the basis of occupation. RESULTS: Premature mortality was inversely associated with social class for both Blacks and Whites. Blacks were at least twice as likely to die as Whites within each social class. CONCLUSIONS: Adoption of state-specific surveillance of social class and premature mortality would provide data crucial for developing and evaluating public health programs to reduce social inequalities in health.
Could salicylates in food have contributed to the decline in cardiovascular disease mortality? A new hypothesis.
Authors: Ingster L M , Feinleib M
Published: November 2008

OBJECTIVES: The prophylactic effect of aspirin (at 80 mg/day) for the prevention of cardiovascular disease mortality has long been recognized. This study examined whether other salicylates are present in comparable quantities in the US food supply. METHODS: To estimate the order of magnitude for salicylates in the food supply, annual production data for selected synthetic salicylates were analyzed. RESULTS: Production figures for 1960 indicate exposure to salicylates of 250 mg/day per person, or 95 mg/day per person excluding aspirin. Trend data indicate a rise in the production of salicylates over time, reaching 341 mg/day per person, or 126 mg/day per person excluding aspirin, in 1970. CONCLUSIONS: The US ingestion of salicylates with aspirinlike properties may have increased to the point that many susceptible individuals have received a beneficial effect that has contributed to the decline in cardiovascular disease mortality.
Histories of substance use and risk behavior: precursors to HIV seroconversion in homosexual men.
Authors: Chesney M A , Barrett D C , Stall R
Published: November 2008

OBJECTIVES: This study compared history of substance use and episodic use in terms of HIV seroconversion. METHODS: A sample of 337 baseline HIV-negative gay men was followed for 6 years. Bivariate and survival analyses were used to compare 39 converters with nonconverters on substance use behaviors. RESULTS: Seroconverters were consistently more likely to report use of marijuana, nitrite inhalants, amphetamines, and cocaine than nonconverters. Consistent use of nitrite inhalants and amphetamines increases the relative risk of seroconversion, while episodic use does not. Both patterns of cocaine use increase seroconversion risk. CONCLUSIONS: There are three potential mechanisms for an increased risk of conversion due to consistent substance use.
National survey of the states: policies and practices regarding drug-using pregnant women.
Authors: Chavkin W , Breitbart V , Elman D , Wise P H
Published: November 2008

OBJECTIVES: This study assessed the impact of national policy shifts on state policies and practices regarding substance-using mothers. METHODS: A 1995 telephone survey of substance abuse and child protective services directors in all 50 states and the District of Columbia was compared with a similar 1992 survey. RESULTS: There have been significant increases in state interventions for drug-using pregnant women (e.g., criminal prosecution, toxicology testing of women and neonates). Federal resources for treatment and oversight are being replaced by state control of reduced funds for treatment. CONCLUSIONS: The earlier policy of expanding treatment for addicted women is being replaced by reduction of services and increased state intervention.
Initiation of use of alcohol, cigarettes, marijuana, cocaine, and other substances in US birth cohorts since 1919.
Authors: Johnson R A , Gerstein D R
Published: November 2008

OBJECTIVES: This study examined recent trends in initiation of psychoactive drug use. METHODS: Data from the 1991 through 1993 National Household Surveys on Drug Abuse were used to compare the percentages of US cohorts born from 1919 through 1975 who began using drugs before the ages of 15, 21, and 35. RESULTS: Initiation of cigarette smoking by males peaked in the 1941-1945 cohort, then declined steadily. For females, early smoking initiation rose through the 1951-1955 cohort and then stabilized. Initiation of alcohol use was less common than smoking for pre1950 cohorts but increased steadily, approaching cigarette use for cohorts born in the early 1970s. Only 2% of teenagers born in 1930-1940 tried marijuana; half the teenagers born in 1956-1965 did so. The percentage initiating marijuana use declined in the 1980s, more so among young adults than among teenagers. The use of cocaine and other illicit drugs echoed the rise of marijuana use but peaked later and showed less evidence of subsequent decline. Sex differences declined over time for every drug. CONCLUSIONS: Cohorts born since World War II have had much higher rates of illicit drug use initiation, but trends have varied by drug type, possibly reflecting changes in relative prices.
Retention, HIV risk, and illicit drug use during treatment: methadone dose and visit frequency.
Authors: Rhoades H M , Creson D , Elk R , Schmitz J , Grabowski J
Published: November 2008

OBJECTIVES: This study examined two major methadone treatment factors, visit frequency and methadone dose, posited to be important in reducing intravenous drug use and human immunodeficiency virus (HIV) transmission. METHODS: One hundred fifty opiate-dependent subjects randomly assigned to four groups received 50 or 80 mg of methadone and attended a clinic 2 or 5 days per week. RESULTS: Survival analysis indicated higher dropout rates for groups having five vs two visits per week (Chi2[1]=7.76). Higher proportions of opiate-positive results on urine screens were associated with lower methadone doses (F[1,91]=4.74). CONCLUSIONS: Receiving take-home doses early in treatment enhanced treatment retention. The 50-mg dose combined with five visits per week produced the worst outcome. Fewer visits enhanced retention at 50 mg, but opiate use rates were higher at this dose than they were for either 80-mg group. The HIV infection rate at entry was 9%. No subjects seroconverted during the study. Risk behaviors for acquired immunodeficiency syndrome declined over time regardless of group/dose assignment. These results have important implications for modification of regulatory and clinic policy changes.
Fifteen-year follow-up of smoking prevention effects in the North Karelia youth project.
Authors: Vartiainen E , Paavola M , McAlister A , Puska P
Published: November 2008

OBJECTIVES: This study evaluated the long-term effects of a school- and community-based smoking prevention program in Finland. METHODS: Four intervention schools from North Karelia and two control schools from another province were chosen for the evaluation. Students who received the intervention were taught to resist social pressures to smoke. The program began in 1978 with seventh-grade students and ran through 1980, with a 15-year follow-up. In North Karelia, a community-based smoking cessation program for adults was also carried out. RESULTS: Mean lifetime cigarette consumption was 22% lower among program subjects than among control subjects. Smoking and prevalence were lower up to the age of 21. CONCLUSIONS: Long-term smoking prevention effects can be achieved if a school-based program using a social influence model is combined with community and mass media interventions.
Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies.
Authors: Rempel D , Evanoff B , Amadio P C , de Krom M , Franklin G , Franzblau A , Gray R , Gerr F , Hagberg M , Hales T , Katz J N , Pransky G
Published: November 2008

Criteria for the classification of carpal tunnel syndrome for use in epidemiologic studies were developed by means of a consensus process. Twelve medical researchers with experience in conducting epidemiologic studies of carpal tunnel syndrome participated in the process. The group reached agreement on several conceptual issues. First, there is no perfect gold standard for carpal tunnel syndrome. The combination of electrodiagnostic study findings and symptom characteristics will provide the most accurate information for classification of carpal tunnel syndrome. Second, use of only electrodiagnostic study findings is not recommended. Finally, in the absence of electrodiagnostic studies, specific combinations of symptom characteristics and physical examination findings may be useful in some settings but are likely to result in greater misclassification of disease status.
Understanding trends in functional limitations among older Americans.
Authors: Freedman V A , Martin L G
Published: November 2008

OBJECTIVES: This report documents trends in functional limitations among older Americans from 1984 to 1993 and investigates reasons for such trends. METHODS: We applied logistic regression to data for noninstitutionalized Americans aged 50 years and older from the Survey of Income and Program Participation. We focused on 4 functional limitation measures unlikely to be affected by changes in role expectations and living environments: reported difficulty seeing words in a newspaper, lifting and carrying 10 pounds, climbing a flight of stairs, and walking a quarter of a mile. RESULTS: We found large declines in the crude prevalence of functional limitations, especially for those 80 years and older. Generally, changes in population composition explained only a small portion of the downward trends. Once changes in population composition and mobility-related device use were considered for difficulty walking, significant improvements in functioning remained for the 65- to 79-year-old group. CONCLUSIONS: Changes in population composition, device use, survey design, role expectations, and living environments do not appear to account completely for improvements in functioning. We infer that changes in under-lying physiological capability--whether real or perceived--likely underlie such trends.
Religion and mortality among the community-dwelling elderly.
Authors: Oman D , Reed D
Published: November 2008

OBJECTIVES: This study analyzed the prospective association between attending religious services and all-cause mortality to determine whether the association is explainable by 6 confounding factors: demographics, health status, physical functioning, health habits, social functioning and support, and psychological state. METHODS: The association between self-reported religious attendance and subsequent mortality over 5 years for 1931 older residents of Marin County, California, was examined by proportional hazards regression. Interaction terms of religion with social support were used to explore whether other forms of social support could substitute for religion and diminish its protective effect. RESULTS: Persons who attended religious services had lower mortality than those who did not (age- and sex-adjusted relative hazard [RH] = 0.64; 95% confidence interval [CI] = 0.52, 0.78). Multivariate adjustment reduced this relationship only slightly (RH = 0.76; 95% CI = 0.62, 0.94), primarily by including physical functioning and social support. Contrary to hypothesis, religious attendance tended to be slightly more protective for those with high social support. CONCLUSIONS: Lower mortality rates for those who attend religious services are only partly explained by the 6 possible confounders listed above. Psychodynamic and other explanations need further investigation.
Targeting early antecedents to prevent tobacco smoking: findings from an epidemiologically based randomized field trial.
Authors: Kellam S G , Anthony J C
Published: November 2008

OBJECTIVES: This study examined whether interventions aimed at aggressive/disruptive classroom behavior and poor academic achievement would reduce the incidence of initiation of smoking. METHODS: An epidemiologically based, universal randomized preventive trial involved 2311 children in 2 classroom-based preventive interventions or controls. Each intervention was directed at 1 of the aforementioned 2 antecedents over first and second grades in 19 urban schools. RESULTS: Smoking initiation was reduced in both cohorts for boys assigned to the behavioral intervention. CONCLUSIONS: Targeting early risk antecedents such as aggressive behavior appears to be an important smoking prevention strategy.
Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness.
Authors: Rosenheck R , Morrissey J , Lam J , Calloway M , Johnsen M , Goldman H , Randolph F , Blasinsky M , Fontana A , Calsyn R , Teague G
Published: November 2008

OBJECTIVES: This study evaluated the hypothesis that greater integration and coordination between agencies within service systems is associated with greater accessibility of services and improved client housing outcomes. METHODS: As part of the Access to Community Care and Effective Services and Supports program, data were obtained on baseline client characteristics, service use, and 3-month and 12-month outcomes from 1832 clients seen at 18 sites during the first year of program operation. Data on interorganizational relationships were obtained from structured interviews with key informants from relevant organizations in each community (n = 32-82 at each site). RESULTS: Complete follow-up data were obtained from 1340 clients (73%). After control for baseline characteristics, service system integration was associated with superior housing outcomes at 12 months, and this relationship was mediated through greater access to housing agencies. CONCLUSIONS: Service system integration is related to improved access to housing services and better housing outcomes among homeless people with mental illness.
Costs and cost-effectiveness of a universal, school-based hepatitis B vaccination program.
Authors: Krahn M , Guasparini R , Sherman M , Detsky A S
Published: November 2008

OBJECTIVES: This study evaluated the costs and cost-effectiveness of a school-based grade 6 universal vaccination program against hepatitis B. METHODS: We performed a descriptive cost study and cost-effectiveness analysis of British Columbia's vaccination program for 1994 and 1995. Since 1992, public health nurses have administered hepatitis B vaccine to grade 6 students in schools. We measured costs of vaccine, vaccine administration, and net program costs and used a validated Markov model to calculate the cost-effectiveness of the program. RESULTS: Vaccinating each student cost $44, $24 of which was the cost of vaccine administration. The net cost was $9 per person; considering productivity costs, net savings were $75 per person. Marginal cost per life year gained was $2100. Universal adolescent vaccination is also economically attractive in the United States but less attractive in regions with incidence rates below 3 cases per 100,000 per year. CONCLUSIONS: Hepatitis B vaccine can be delivered in North American schools at a reasonable cost. Adolescent vaccination is economically attractive in North American regions of high and average incidence rates. Our analysis supports vaccination in adolescents who remain at risk for hepatitis B virus infection.
Occupational injuries among older workers with disabilities: a prospective cohort study of the Health and Retirement Survey, 1992 to 1994.
Authors: Zwerling C , Sprince N L , Davis C S , Whitten P S , Wallace R R , Heeringa S G
Published: November 2008

OBJECTIVES: We tested the hypothesis that among older workers, disabilities in general, and hearing and visual impairments in particular, are risk factors for occupational injuries. METHODS: Using the first 2 interviews of the Health and Retirement Study, a nationally representative survey of Americans aged 51 to 61 years, we conducted a prospective cohort study of 5600 employed nonfarmers. RESULTS: Testing a logistic regression model developed in a previous cross-sectional study, we found that the following occupations and risk factors were associated with occupational injury as estimated by odds ratios: service personnel, odds ratio = 1.71 (95% confidence interval = 1.13, 2.57); mechanics and repairers, 3.47 (1.98, 6.10); operators and assemblers, 2.33 (1.51, 3.61); laborers, 3.16 (1.67, 5.98); jobs requiring heavy lifting, 2.05 (1.55, 2.70); self-employment, 0.50 (0.34, 0.73); and self-reported disability, 1.58 (1.14, 2.19). Replacing the general disability variable with specific hearing and visual impairment variables, we found that poor hearing (1.35 [0.95, 1.93]) and poor sight (1.45 [0.94, 2.22]) both had elevated odds ratios. CONCLUSIONS: Poor sight and poor hearing, as well as work disabilities in general, are associated with occupational injuries among older workers.
Physician financial incentives and feedback: failure to increase cancer screening in Medicaid managed care.
Authors: Hillman A L , Ripley K , Goldfarb N , Nuamah I , Weiner J , Lusk E
Published: November 2008

OBJECTIVES: A randomized controlled trial evaluated the impact of feedback and financial incentives on physician compliance with cancer screening guidelines for women 50 years of age and older in a Medicaid health maintenance organization (HMO). METHODS: Half of 52 primary care sites received the intervention, which included written feedback and a financial bonus. Mammography, breast exam, colorectal screening, and Pap testing compliance rates were evaluated. RESULTS: From 1993 to 1995, screening rates doubled overall (from 24% to 50%), with no significant differences between intervention and control group sites. CONCLUSIONS: Financial incentives and feedback did not improve physician compliance with cancer screening guidelines in a Medicaid HMO.
Poverty area residence and changes in physical activity level: evidence from the Alameda County Study.
Authors: Yen I H , Kaplan G A
Published: November 2008

OBJECTIVES: Evidence from the Alameda County Study indicated that residential area has an independent effect on mortality risk. The current research examined the effect of poverty area residence on change in physical activity (n = 1737). METHODS: Data were from a longitudinal population-based cohort. Multiple linear regression analyses were used. RESULTS: Age- and sex-adjusted change scores between 1965 and 1974 for physical activity were 0.67 units lower for people living in poverty areas (P = .0001). Independent of individual income, education, smoking status, body mass index, and alcohol consumption, poverty area residence remained associated with physical activity change. CONCLUSION: These results further support the hypothesis that place affects health behaviors.
The use of mammography by survivors of breast cancer.
Authors: Andersen M R , Urban N
Published: November 2008

OBJECTIVES: Survivors of breast cancer are at high risk for development of a second breast cancer and are thus a group for whom annual mammography screening is recommended. However, survivors' use of mammography rarely has been examined. METHODS: We surveyed a representative population sample of survivors who lived in rural communities about their mammography use after cancer. RESULTS: Of these women, 30% had not received a mammogram in the preceding year. Predictors of mammography use included physician recommendation and whether the original cancer had been detected by mammography. CONCLUSIONS: Physicians should recommend mammography to survivors of breast cancer to ensure regular use.
The gender gap in reporting household gun ownership.
Authors: Ludwig J , Cook P J , Smith T W
Published: November 2008

OBJECTIVES: This study examined errors in estimating household gun ownership that result from interviewing only 1 adult per household. METHODS: Data from 2 recent telephone surveys and a series of in-person surveys were used to compare reports of household gun ownership by husbands and wives. RESULTS: In the telephone surveys, the rate of household gun ownership reported by husbands exceeded wives' reports by an average of 12 percentage points; husbands' reports also implied 43.3 million more guns. The median "gender gap" in recent in-person surveys is 7 percentage points. CONCLUSIONS: Future research should focus on respondents' reports about personally owned guns.
Nighttime observations of safety belt use: an evaluation of California's primary law.
Authors: Lange J E , Voas R B
Published: November 2008

OBJECTIVES: An analysis was conducted to determine what effect California's change to a primary safety belt law had on safety belt use among nighttime weekend drivers. METHODS: Observations of 18,469 drivers in 2 California communities were made during voluntary roadside surveys conducted every other Friday and Saturday night from 9 PM to 2 AM for 4 years. RESULTS: Rates of safety belt use rose from 73.0% to 95.6% (P < .0005). For drivers with blood alcohol concentrations of 0.10 or higher, rates rose from 53.4% to 92.1% (P < .0005). CONCLUSIONS: Because substantial improvement in safety belt use was seen even in a group of high-risk drivers, the injury reduction benefits of this law may be high.
Economic organization of medicine and the Committee on the Costs of Medical Care.
Authors: Perkins B B
Published: November 2008

Recent strategies in managed care and managed competition illustrate how health care reforms may reproduce the patterns of economic organization of their times. Such a reform approach is not a new development in the United States. The work of the 1927-1932 Committee on the Costs of Medical Care exemplifies an earlier effort that applied forms of economic organization to medical care. The committee tried to restructure medicine along lines consistent with its economic environment while attributing its models variously to science, profession, and business. Like current approaches, the committee's reports defined costs as the major problem and business models of organization as the major solution. The reports recommended expanded financial management and group medicine, which would include growth in self-supporting middle-class services such as fee clinics and middle-rate hospital units. Identifying these elements as corporate practice of medicine, the American Medical Association-based minority dissented from the final report in favor of conserving individual entrepreneurial practice. This continuum in forms of economic organization has limited structural reform strategies in medicine for the remainder of the century.