bluuebunny/crossref_metadata_2025 huggingface dataset:
Mandatory parental involvement in minors' abortions: effects of the laws in Minnesota, Missouri, and Indiana.
Authors: Ellertson C
Published: November 2008

OBJECTIVES: This study examined the effects of parental involvement laws on the birth rate, in-state abortion rate, odds of interstate travel, and odds of late abortion for minors. METHODS: Poisson and logistic regression models fitted to vital records compared the periods before and after the laws were enforced. RESULTS: In each state, the in-state abortion rate for minors fell (relative to the rate for older women) when parental involvement laws took effect. Data offered no empirical support for the proposition that the laws drive up birth rates for minors. Although data were incomplete, the laws appeared to increase the odds of a minor's traveling out of state for her abortion. If one judges from the available data, minors who traveled out of state may have accounted for the entire observed decline in the in-state abortion rate, at least in Missouri. The laws appeared to delay minors' abortions past the eighth week, but probably not into the second trimester. CONCLUSIONS: Several empirical arguments used against and in support of parental involvement laws do not appear to be substantiated.
The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: a prospective primary care study.
Authors: Wessely S , Chalder T , Hirsch S , Wallace P , Wright D
Published: November 2008

OBJECTIVES: This study examined the prevalence and public health impact of chronic fatigue and chronic fatigue syndrome in primary care patients in England. METHODS: There were 2376 subjects, aged 18 through 45 years. Of 214 subjects who fulfilled criteria for chronic fatigue, 185 (86%) were interviewed in the case-control study. Measures included chronic fatigue, psychological morbidity, depression, anxiety, somatic symptoms, symptoms of chronic fatigue syndrome, functional impairment, and psychiatric disorder. RESULTS: The point prevalence of chronic fatigue was 11.3%, falling to 4.1% if comorbid psychological disorders were excluded. The point prevalence of chronic fatigue syndrome was 2.6%, falling to 0.5% if comorbid psychological disorders were excluded. Rates did not vary by social class. After adjustment for psychological disorder, being female was modestly associated with chronic fatigue. Functional impairment was profound and was associated with psychological disorder. CONCLUSIONS: Both chronic fatigue and chronic fatigue syndrome are common in primary care patients and represent a considerable public health burden. Selection bias may account for previous suggestions of a link with higher socioeconomic status.
Quantifying the future impact of disease on society: life table-based measures of potential life lost.
Authors: Lee W C
Published: November 2008

OBJECTIVES: Quantifying health status in human populations by means of an index such as "years of potential life lost" has recently received attention. However, such an index, being cross-sectional in nature, only measures the current burden to society resulting from a specific cause of death. METHODS: The author proposes new indices of potential life lost to quantify future impacts on society of particular causes of death. These indices also properly reflect the effects of competing risks. The computation is simple, requiring no more than a standard life-table calculation. Real-world as well as hypothetical data are used to illustrate the method. RESULTS: The new indices convey valuable health status information about a population that is not revealed by traditional indices. CONCLUSIONS: The new indices are promising alternatives as measures of future potential life lost.
Risk for neural tube defect-affected pregnancies among women of Mexican descent and white women in California.
Authors: Shaw G M , Velie E M , Wasserman C R
Published: November 2008

OBJECTIVES: This study investigated a previously reported 50% or more increased risk for neural tube defect-affected pregnancies among Latina women compared with White women. METHODS: Data were derived from a population-based case-control study of fetuses and live-born infants with neural tube defects in a 1989-through-1991 California birth cohort. Interviews were conducted with mothers of 538 (88% of eligible) infants/fetuses with neural tube defects and mothers of 539 (88%) nonmalformed control infants. RESULTS: The risk for a neural tube defect-affected pregnancy was approximately twice as high among women of Mexican descent than among White women (odds ratio = 1.9, 95% confidence interval [CI] = 1.5, 2.8). The odds ratio for Mexico-born Mexican women compared with White women was 2.4 (95% CI = 1.7, 3.2), whereas the risk for US-born women of Mexican and other racial/ethnic descent was not substantially higher than that for Whites. The higher risk among Mexico-born Mexican women was not attributable to differences in numerous studied parental characteristics and exposures. CONCLUSIONS: Given that nearly 20% of all California births are to Mexico-born Mexican women, the increased risks observed are relevant to the population burden of neural tube defects.
Income dynamics and adult mortality in the United States, 1972 through 1989.
Authors: McDonough P , Duncan G J , Williams D , House J
Published: November 2008

OBJECTIVES: The aim of this study was to examine relationships between income and mortality, focusing on the predictive utility of single-year and multiyear measures of income, the shape of the income gradient in mortality, trends in this gradient over time, the impact of income change on mortality, and the joint effects of income and age, race, and sex on mortality risk. METHODS: Data were taken from the Panel Study of Income Dynamics for the years 1968 through 1989. Fourteen 10-year panels were constructed in which predictors were measured over the first 5 years and vital status over the subsequent 5 years. The panels were pooled and logistic regression was used in the analysis. RESULTS: Income level was a strong predictor of mortality, especially for persons under the age of 65 years. Persistent low income was particularly consequential for mortality. Income instability was also important among middle-income individuals. Single-year and multiyear income measures had comparable predictive power. All effects persisted after adjustment for education and initial health status. CONCLUSIONS: The issues of low income and income instability should be addressed in population health policy.
Social capital, income inequality, and mortality.
Authors: Kawachi I , Kennedy B P , Lochner K , Prothrow-Stith D
Published: November 2008

OBJECTIVES: Recent studies have demonstrated that income inequality is related to mortality rates. It was hypothesized, in this study, that income inequality is related to reduction in social cohesion and that disinvestment in social capital is in turn associated with increased mortality. METHODS: In this cross-sectional ecologic study based on data from 39 states, social capital was measured by weighted responses to two items from the General Social Survey: per capita density of membership in voluntary groups in each state and level of social trust, as gauged by the proportion of residents in each state who believed that people could be trusted. Age-standardized total and cause-specific mortality rates in 1990 were obtained for each state. RESULTS: Income inequality was strongly correlated with both per capita group membership (r = -.46) and lack of social trust (r = .76). In turn, both social trust and group membership were associated with total mortality, as well as rates of death from coronary heart disease, malignant neoplasms, and infant mortality. CONCLUSIONS: These data support the notion that income inequality leads to increased mortality via disinvestment in social capital.
Socioeconomic differences in hysterectomy: the Wisconsin Longitudinal Study.
Authors: Marks N F , Shinberg D S
Published: November 2008

OBJECTIVES: This study evaluated the relative gross and net predictive value of multiple socioeconomic status indicators for the likelihood of undergoing hysterectomy. METHODS: Data from a sample of Wisconsin Longitudinal Study women respondents (n = 3326) followed for 35 years were analyzed by means of multivariate logistic regression. RESULTS: Women's own higher occupational status and greater family net worth were significant net predictors of a lower likelihood of hysterectomy. Women's own education was a significant bivariate predictor. Mental ability did not account for the education effect. CONCLUSIONS: Higher education's association with a lower rate of hysterectomy is not due to ability, but to the opportunities that more-educated women have for higher-status employment and its health-related benefits. Measures of women's own occupational status should be included in future health surveys.
Mortality in Chicago attributed to the July 1995 heat wave.
Authors: Whitman S , Good G , Donoghue E R , Benbow N , Shou W , Mou S
Published: November 2008

OBJECTIVES: This study assessed mortality associated with the mid-July 1995 heat wave in Chicago. METHODS: Analyses focused on heat-related deaths, as designated by the medical examiner, and on the number of excess deaths. RESULTS: In July 1995, there were 514 heat-related deaths and 696 excess deaths. People 65 years of age or older were overrepresented and Hispanic people underrepresented. During the most intense heat (July 14 through 20), there were 485 heat-related deaths and 739 excess deaths. CONCLUSIONS: The methods used here provide insight into the great impact of the Chicago heat wave on selected populations, but the lack of methodological standards makes comparisons across geographical areas problematic.
The relationship of cigarette prices and no-smoking bylaws to the prevalence of smoking in Canada.
Authors: Stephens T , Pederson L L , Koval J J , Kim C
Published: November 2008

OBJECTIVES: The aim of this study was to analyze the association of cigarette prices and no-smoking bylaws with the prevalence of smoking. METHODS: Data on individual smoking status were taken from two national household surveys in Canada. Current cigarette price, the 1-year and 10-year increase in price, and the extent of local restrictions on public smoking were added to the model. Logistic regression was used to estimate the odds of being a smoker. RESULTS: The odds ratio for being a smoker was 1.21 where no-smoking by-laws were relatively infrequent and 1.26 when cigarettes were relatively inexpensive, after adjusting for individual age, sex, education, and marital status. CONCLUSIONS: Both cigarette prices and no-smoking bylaws are effective in controlling smoking; either alone will likely have less impact than the two measures together.
Is incarceration during pregnancy associated with infant birthweight?
Authors: Martin S L , Kim H , Kupper L L , Meyer R E , Hays M
Published: November 2008

OBJECTIVES: This study examined whether incarceration during pregnancy is associated with infant birthweight. METHODS: Multivariable analyses compared infant birthweight outcomes among three groups of women: 168 women incarcerated during pregnancy, 630 women incarcerated at a time other than during pregnancy, and 3910 women never incarcerated. RESULTS: After confounders were controlled for, infant birthweights among women incarcerated during pregnancy were not significantly different from women never incarcerated; however, infant birthweights were significantly worse among women incarcerated at a time other than during pregnancy than among never-incarcerated women and women incarcerated during pregnancy. CONCLUSIONS: Certain aspects of the prison environment (shelter, food, etc.) may be health-promoting for high-risk pregnant women.
Injectable contraceptive discontinuation and subsequent unintended pregnancy among low-income women.
Authors: Davidson A R , Kalmuss D , Cushman L F , Romero D , Heartwell S , Rulin M
Published: November 2008

OBJECTIVES: This study investigated rates of discontinuation of the recently introduced injectable contraceptive depot medroxyprogesterone acetate (DMPA) and postdiscontinuation rates of unprotected intercourse and unintended pregnancy. METHODS: A sample of 402 low-income, urban, minority women were interviewed when they initiated DMPA use and 12 months later. RESULTS: The 12-month life-table discontinuation rate was 58%, with half of the discontinuers stopping after only one injection. Menstrual changes and other side effects were the most frequently cited reasons for discontinuation. Approximately half of the discontinuers at risk for unintended pregnancy either did not make the transition to another contraceptive or used contraception only sporadically. The cumulative unintended pregnancy rate by 9 months postdiscontinuation was 20%. CONCLUSIONS: DMPA initiators were at substantial risk for unintended pregnancy because most quickly discontinued use and did not make the transition to consistent use of another contraceptive.
Controlling tuberculosis in an urban emergency department: a rapid decision instrument for patient isolation.
Authors: Redd J T , Susser E
Published: November 2008

OBJECTIVES: This study examined whether data routinely available in emergency departments could be used to improve isolation decisions for tuberculosis patients. METHODS: In a large emergency department in New York City, we compared the exposure histories of tuberculosis culture-positive and culture-negative patients and used these data to develop a rapid decision instrument to predict culture-positive tuberculosis. The screen used only data that are routinely available to emergency physicians. RESULTS: The method had high sensitivity (.96) and moderate specificity (.54). CONCLUSIONS: The method is easily adaptable for a broad range of settings and illustrates the potential benefits of applying basic epidemiologic methods in a clinical setting.
Predictors of smoking among US college students.
Authors: Emmons K M , Wechsler H , Dowdall G , Abraham M
Published: November 2008

OBJECTIVES: This study explored predictors of smoking among a large, representative national sample of students enrolled in American 4-year colleges. METHODS: A sample of undergraduate students, randomly selected from 140 colleges, was sent a detailed questionnaire that included questions about smoking status. RESULTS: The 30-day smoking prevalence was 22.3%; 25% of the participants were former smokers. Multivariate analyses suggested that, among college students, men are less likely to smoke than women. In addition, high-risk behaviors (e.g., marijuana use) and lifestyle choices (e.g., nonparticipation in athletics) increased the likelihood of being a smoker. CONCLUSIONS: This study's findings have important implications for health education and promotion among college populations.
HIV seroprevalence among street-recruited injection drug and crack cocaine users in 16 US municipalities.
Authors: Kral A H , Bluthenthal R N , Booth R E , Watters J K
Published: November 2008

OBJECTIVES: This study deter- mined human immunodeficiency virus (HIV) seroprevalence and factors associated with HIV infection among street-recruited injection drug users and crack cocaine smokers. METHODS: An analysis was performed on HIV serologies and risk behaviors of 6402 injection drug users and 3383 crack smokers in 16 US municipalities in 1992 and 1993. RESULTS: HIV seroprevalence was 12.7% among injection drug users and 7.5% among crack smokers. Most high-seroprevalence municipalities (>25%) were located along the eastern seaboard of the United States. In high-seroprevalence municipalities, but not in others, HIV seroprevalence was higher for injection drug users than for crack smokers. Among injection drug users, cocaine injection, use of speedballs (cocaine or amphetamines with heroin), and sexual risk behaviors were independently associated with HIV infection. Among crack smokers, sexual risk behaviors were associated with HIV infection. CONCLUSIONS: Injection drug users and crack smokers are at high risk for HIV infection.
Incidence and predictors of smokeless tobacco use among US youth.
Authors: Tomar S L , Giovino G A
Published: November 2008

OBJECTIVES: The purpose of this study was to provide estimates of the cumulative incidence of initiation of smokeless tobacco use in a cohort of young persons and to explore sociodemographic, environmental, behavioral, and personal predictors of experimentation with and regular use of snuff or chewing tobacco. METHODS: The data for this cohort study were derived from the 1989 Teenage Attitudes and Practices Survey and its 1993 follow-up. The study included 7830 young people 11 through 19 years of age at baseline. RESULTS: During the 4 years, 12.7% of participants (20.9% of male participants) first tried smokeless tobacco, and 4.0% (8.0% of male participants) became self-classified regular users. This suggests that, each year, approximately 824000 young people in the United States 11 to 19 years of age experiment with smokeless tobacco and about 304 000 become regular users. Cumulative incidence was highest for male non-Hispanic Whites. Predictors of regular use included age, geographic region, cigarette smoking, participation in organized sports, and perceived friends' approval or indifference. CONCLUSIONS: Public health approaches to preventing use of smokeless tobacco should include development of skills for responding to pressures to use tobacco.
An evaluation of Safe Dates, an adolescent dating violence prevention program.
Authors: Foshee V A , Bauman K E , Arriaga X B , Helms R W , Koch G G , Linder G F
Published: November 2008

OBJECTIVES: This study assessed the effects of the Safe Dates program on the primary and secondary prevention of adolescent dating violence. METHODS: Fourteen schools were randomly allocated to treatment conditions. Eighty percent (n=1886) of the eighth and ninth graders in a rural county completed baseline questionnaires, and 1700 (90%) completed follow-up questionnaires. RESULTS: Treatment and control groups were comparable at baseline. In the full sample at follow-up, less psychological abuse, sexual violence, and violence perpetrated against the current dating partner were reported in treatment than in control schools. In a subsample of adolescents reporting no dating violence at baseline (a primary prevention subsample), there was less initiation of psychological abuse in treatment than in control schools. In a subsample of adolescents reporting dating violence at baseline (a secondary prevention subsample), there was less psychological abuse and sexual violence perpetration reported at follow-up in treatment than in control schools. Most program effects were explained by changes in dating violence norms, gender stereotyping, and awareness of services. CONCLUSIONS: The Safe Dates program shows promise for preventing dating violence among adolescents.
Two alternative job stress models and the risk of coronary heart disease.
Authors: Bosma H , Peter R , Siegrist J , Marmot M
Published: November 2008

OBJECTIVES: This study examined the association between two alternative job stress models-the effort-reward imbalance model and the job strain model-and the risk of coronary heart disease among male and female British civil servants. METHODS: The logistic regression analyses were based on a prospective cohort study (Whitehall II study) comprising 6895 men and 3413 women aged 35 to 55 years. Baseline measures of both job stress models were related to new reports of coronary heart disease over a mean 5.3 years of follow-up. RESULTS: The imbalance between personal efforts (competitiveness, work-related overcommitment, and hostility) and rewards (poor promotion prospects and a blocked career') was associated with a 2.15-fold higher risk of new coronary heart disease. Job strain and high job demands were not related to coronary heart disease; however, low job control was strongly associated with new disease. The odds ratios for low job control were 2.38 and 1.56 for self-reported and externally assessed job control, respectively. Work characteristics were simultaneously adjusted and controlled for employment grade level, negative affectivity, and coronary risk factors. CONCLUSIONS: This is apparently the first report showing independent effects of components of two alternative job stress models-the effort-reward imbalance model and the job strain model (job control only)-on coronary heart disease.
Smoking cessation, weight gain, and changes in cardiovascular risk factors during menopause: the Healthy Women Study.
Authors: Burnette M M , Meilahn E , Wing R R , Kuller L H
Published: November 2008

OBJECTIVES: The relationship between smoking cessation, subsequent weight gain, and cardiovascular disease risk factors from premenopause to postmenopause was studied. METHODS: Healthy Women Study participants were assessed for changes in coronary heart disease risk factors from a premenopausal baseline assessment to first- and second-year postmenopausal assessments. RESULTS: Although ex-smokers gained substantially more weight than nonsmokers and smokers, they did not experience a greater increase in cardiovascular risk factors. In fact, the results indicated a trend toward ex-smokers' high-density lipoprotein cholesterol levels increasing slightly more than those of nonsmokers and smokers. CONCLUSIONS: Smoking cessation in perimenopausal to postmenopausal women is associated with greater weight gain but appears to be modestly associated with certain positive changes in cardiovascular risk factors.
Ex-smokers and risk of hip fracture.
Authors: Forsén L , Bjartveit K , Bjørndal A , Edna T H , Meyer H E , Schei B
Published: November 2008

OBJECTIVES: The purpose of this study was to examine the reversibility of the effect of smoking on hip fracture incidence rates. METHODS: A 3-year follow-up cohort study was conducted involving 35,767 adults 50 years of age or older. Of these individuals, 421 suffered a hip fracture. RESULTS: Among participants less than 75 years of age, the relative risk (RR) of hip fracture was elevated for ex-smokers, even for those who had quit smoking more than 5 years previously (men: RR = 4.4, 95% confidence interval [CI] = 1.2, 15.3; women: RR = 1.3, 95% CI = 0.6, 3.0), but was not as high as that for current smokers (men: RR = 5.0, 95% CI = 1.5, 16.9; women: RR = 1.9, 95% CI = 1.2, 3.1). CONCLUSIONS: The effect of smoking on risk of hip fracture was not reversed completely 5 years after smoking cessation.
The evolving epidemiology of chlamydial and gonococcal infections in response to control programs in Winnipeg, Canada.
Authors: Blanchard J F , Moses S , Greenaway C , Orr P , Hammond G W , Brunham R C
Published: November 2008

OBJECTIVES: The purpose of this study was to describe and compare the transmission dynamics of chlamydia and gonorrhea in Winnipeg, Manitoba, Canada, and to assess implications for control programs. METHODS: Chlamydia and gonorrhea surveillance case reports (1988 through 1995) and contact-tracing reports (1991 through 1995) were examined. RESULTS: High incidence rates of both chlamydia and gonorrhea clustered in geographic core areas characterized by low socioeconomic status. A decline in the number of reported cases of chlamydia (61%) and gonorrhea (64%) occurred between 1988 and 1995. For chlamydia, the decline was most prominent in non-core area cases, while for gonorrhea it was similar in core and non-core areas. CONCLUSIONS: Chlamydia and gonorrhea appear to be evolving through different epidemic phases, with chlamydia transmission, in response to a newly introduced control program, becoming more core dependent and gonorrhea transmission becoming more sporadic in the face of a sustained control effort. Focused control programs, based on an understanding of the transmission dynamics of chlamydia and gonorrhea, may make their elimination a feasible goal.
Misclassification rates for current smokers misclassified as nonsmokers.
Authors: Wells A J , English P B , Posner S F , Wagenknecht L E , Perez-Stable E J
Published: November 2008

OBJECTIVES: This paper provides misclassification rates for current cigarette smokers who report themselves as nonsmokers. Such rates are important in determining smoker misclassification bias in the estimation of relative risks in passive smoking studies. METHODS: True smoking status, either occasional or regular, was determined for individual current smokers in 3 existing studies of nonsmokers by inspecting the cotinine levels of body fluids. The new data, combined with an approximately equal amount in the 1992 Environmental Protection Agency (EPA) report on passive smoking and lung cancer, yielded misclassification rates that not only had lower standard errors but also were stratified by sex and US minority majority status. RESULTS: The misclassification rates for the important category of female smokers misclassified as never smokers were, respectively, 0.8%, 6.0%, 2.8%, and 15.3% for majority regular, majority occasional, US minority regular, and US minority occasional smokers. Misclassification rates for males were mostly somewhat higher. CONCLUSIONS: The new information supports EPA's conclusion that smoker misclassification bias is small. Also, investigators are advised to pay attention to minority/majority status of cohorts when correcting for smoker misclassification bias.
Prevalence of adult domestic violence among women seeking routine care in a Native American health care facility.
Authors: Fairchild D G , Fairchild M W , Stoner S
Published: November 2008

OBJECTIVES: The purpose of this study was to determine the prevalence of, and sociodemographic factors associated with, adult domestic violence within a Native American community. METHODS: Adult women in the community were surveyed. RESULTS: Of 371 eligible women, 341 (92%) were surveyed. Among respondents, 179 reported a history of at least 1 episode of domestic violence. Fifty-six (16.4%) reported violence within the previous 12 months. Age under 40 years and living in a household receiving governmental financial assistance were independently associated with 1-year prevalence of adult domestic violence. CONCLUSIONS: Adult domestic violence is prevalent within this Native American community. Additional research is required to characterize further the relationship between domestic violence and socioeconomic status.
Does passive smoking in early pregnancy increase the risk of small-for-gestational-age infants?
Authors: Dejin-Karlsson E , Hanson B S , Ostergren P O , Sjöberg N O , Marsal K
Published: November 2008

OBJECTIVES: This study tested the hypothesis that women who deliver small-for-gestational-age infants are more often exposed to passive smoking at home or at work. METHODS: Among a 1-year cohort of nulliparous women in the city of Malmö, Sweden 872 (87.7%) women completed a questionnaire during their first prenatal visit. The study was carried out among women whose pregnancies resulted in a singleton live birth (n = 826), 6.7% of infants were classified as small for their gestational age. RESULTS: Passive smoking in early pregnancy was shown to double a woman's risk of delivering a small-for-gestational-age infant, independent of potential confounding factors such as age, height, weight, nationality, educational level, and the mother's own active smoking (odds ratio [OR] = 2.7). A stratified analysis indicated interactional effects of maternal smoking and passive smoking on relative small-for-gestational-age risk. CONCLUSIONS: Based on an attributable risk estimate, a considerable reduction in the incidence of small-for-gestational-age births could be reached if pregnant women were not exposed to passive smoking.
Maternal leisure-time exercise and timely delivery.
Authors: Hatch M , Levin B , Shu X O , Susser M
Published: November 2008

OBJECTIVES: This study investigated whether, in a general obstetric population, exercise in pregnancy affects the timeliness of delivery. The hypothesis was that maternal exercise would not raise the risk of preterm birth. METHODS: A community cohort of 557 prenatal patients was followed up until the time of delivery. Data were collected on exercise in each trimester: none, low-moderate (< 1000 kcal [4184 kJ]/wk in energy expenditure), or heavy (> or = 1000 kcal/wk). Timely delivery was adopted as an outcome criterion. Thus, in the analysis, a term birth was treated as optimal and survival techniques were used to estimate risks for both preterm and postdates delivery. RESULTS: No association was found between low-moderate exercise and gestational length. Heavier exercise appeared to reduce, rather than raise, the risk of preterm birth. The adjusted relative risk among conditioned heavy exercisers was 0.11 (95% confidence interval = 0.02, 0.81). After term, conditioned heavy exercisers delivered faster than nonexercisers. CONCLUSIONS: The most important finding was the lack of evidence that vigorous maternal exercise is a risk factor for preterm delivery. A promising finding was that conditioned heavy exercisers have timely deliveries.
A rivalry of foulness: official and unofficial investigations of the London cholera epidemic of 1854.
Authors: Paneth N , Vinten-Johansen P , Brody H , Rip M
Published: November 2008

Contemporaneous with John Snow's famous study of the 1854 London cholera epidemic were 2 other investigations: a local study of the Broad Street outbreak and an investigation of the entire epidemic, undertaken by England's General Board of Health. More than a quarter-century prior to Koch's description of Vibrio comma, a Board of Health investigator saw microscopic "vibriones" in the rice-water stools of cholera patients that, in his later life, he concluded had been cholera bacilli. Although this finding was potential evidence for Snow's view that cholera was due to a contagious and probably live agent transmitted in the water supply, the Board of Health rejected Snow's conclusions. The Board of Health amassed a huge amount of information which it interpreted as supportive of its conclusion that the epidemic was attributable not so much to water as to air. Snow, by contrast, systematically tested his hypothesis that cholera was water-borne by exploring evidence that at first glance ran contrary to his expectations. Snow's success provides support for using a hypothetico-deductive approach in epidemiology, based on tightly focused hypotheses strongly grounded in pathophysiology.
Substance abuse and the course of welfare dependency.
Authors: Schmidt L , Weisner C , Wiley J
Published: November 2008

OBJECTIVES: New provisions in welfare reform target recipients with addictions, even though there is limited research on how substance abuse affects people's experiences on welfare. This prospective study examined substance abuse as a determinant of subsequent welfare dependency. METHODS: Representative samples of clients on Aid to Families with Dependent Children (AFDC) and general assistance in a California county were interviewed while applying for services in 1989 and were reinterviewed in 1995. RESULTS: Among AFDC recipients, substance abuse was not a significant determinant of long welfare stays, repeat welfare use, or the total time a person remained on welfare during the 6-year period. However, substance abuse was a strong predictor of repeat welfare use among general assistance recipients. CONCLUSIONS: Alcohol and drug problems have played dramatically different roles in welfare dependency within the AFDC and general assistance populations. Under welfare reform, local general assistance programs will be the final safety net for recipients removed from federal entitlement programs. These programs will probably be confronted with clients with more complex disabilities related to addiction, as well as with greater family needs for cash assistance.
The effect of expanding Medicaid prenatal services on birth outcomes.
Authors: Baldwin L M , Larson E H , Connell F A , Nordlund D , Cain K C , Cawthon M L , Byrns P , Rosenblatt R A
Published: November 2008

OBJECTIVES: Over 80% of US states have implemented expansions in prenatal services for Medicaid-enrolled women, including case management, nutritional and psychosocial counseling, health education, and home visiting. This study evaluates the effect of Washington State's expansion of such services on prenatal care use and low-birthweight rates. METHODS: The change in prenatal care use and low-birthweight rates among Washington's Medicaid-enrolled pregnant women before and after initiation of expanded prenatal services was compared with the change in these outcomes in Colorado, a control state. RESULTS: The percentage of expected prenatal visits completed increased significantly, from 84% to 87%, in both states. Washington's low-birthweight rate decreased (7.1% to 6.4%, P = .12), while Colorado's rate increased slightly (10.4% to 10.6%, P = .74). Washington's improvement was largely due to decreases in low-birthweight rates for medically high-risk women (18.0% to 13.7%, P = .01, for adults; 22.5% to 11.5%, P = .03, for teenagers), especially those with preexisting medical conditions. CONCLUSIONS: A statewide Medicaid-sponsored support service and case management program was associated with a decrease in the low-birthweight rate of medically high-risk women.
Return to work following injury: the role of economic, social, and job-related factors.
Authors: MacKenzie E J , Morris J A , Jurkovich G J , Yasui Y , Cushing B M , Burgess A R , DeLateur B J , McAndrew M P , Swiontkowski M F
Published: November 2008

OBJECTIVES: This study examined factors influencing return to work (RTW) following severe fracture to a lower extremity. METHODS: This prospective cohort study followed 312 individuals treated for a lower extremity fracture at 3 level-1 trauma centers. Kaplan-Meier estimates of the proportion of RTW were computed, and a Cox proportional hazards model was used to examine the contribution of multiple risk factors on RTW. RESULTS: Cumulative proportions of RTW at 3, 6, 9, and 12 months post-injury were 0.26, 0.49, 0.60, and 0.72. After accounting for the extent of impairment, characteristics of the patient that correlated with higher rates of RTW included younger age, higher education, higher income, the presence of strong social support, and employment in a white-collar job that was not physically demanding. Receipt of disability compensation had a strong negative effect on RTW. CONCLUSIONS: Despite relatively high rates of recovery, one quarter of persons with lower extremity fractures did not return to work by the end of 1 year. The analysis points to subgroups of individuals who are at high risk of delayed RTW, with implications for interventions at the patient, employer, and policy levels.
A method for estimating solid organ donor potential by organ procurement region.
Authors: Christiansen C L , Gortmaker S L , Williams J M , Beasley C L , Brigham L E , Capossela C , Matthiesen M E , Gunderson S
Published: November 2008

OBJECTIVES: This study sought to develop a methodology for estimating potential solid organ donors and measuring donation performance in a geographic region based on readily available data on the hospitals in that region. METHODS: Medical records were reviewed in a stratified random sample of 89 hospitals from 3 regions to attain a baseline of donor potential. Data on a range of hospital characteristics were collected and tested as predictors of donor potential through the use of hierarchical Poisson regression modeling. RESULTS: Five hospital characteristics predicted donor potential: hospital deaths, hospital Medicare case-mix index, total hospital staffed beds, medical school affiliation, and trauma center certification. Regional estimates were attained by aggregating individual hospital estimates. Confidence intervals for these regional estimates indicated that actual donations represented from 28% to 44% of the potential in the regions studied. CONCLUSIONS: This methodology accurately estimates organ donor potential within 3 geographic regions and lays the foundation for evaluating organ donation effectiveness nationwide. Additional research is needed to test the validity of the model in other geographic regions and to further explore organ donor potential in hospitals with fewer than 50 beds.
Predictors of homelessness among families in New York City: from shelter request to housing stability.
Authors: Shinn M , Weitzman B C , Stojanovic D , Knickman J R , Jiménez L , Duchon L , James S , Krantz D H
Published: November 2008

OBJECTIVES: This study examined predictors of entry into shelter and subsequent housing stability for a cohort of families receiving public assistance in New York City. METHODS: Interviews were conducted with 266 families as they requested shelter and with a comparison sample of 298 families selected at random from the welfare caseload. Respondents were reinterviewed 5 years later. Families with prior history of shelter use were excluded from the follow-up study. RESULTS: Demographic characteristics and housing conditions were the most important risk factors for shelter entry; enduring poverty and disruptive social experiences also contributed. Five years later, four fifths of sheltered families had their own apartment. Receipt of subsidized housing was the primary predictor of housing stability among formerly homeless families (odds ratio [OR] = 20.6, 95% confidence interval [CI] = 9.9, 42.9). CONCLUSIONS: Housing subsidies are critical to ending homelessness among families.
Neighbors for a smoke free north side: evaluation of a community organization approach to promoting smoking cessation among African Americans.
Authors: Fisher E B , Auslander W F , Munro J F , Arfken C L , Brownson R C , Owens N W
Published: November 2008

OBJECTIVES: This study evaluated a community organization approach that emphasized involvement of audiences in program planning and implementation in promoting nonsmoking among African American residents of low-income neighborhoods. METHODS: The quasi-experimental design involved a 24-month intervention in 3 low-income, predominantly African American neighborhoods in St. Louis. Intervention neighborhoods were compared with comparable, untreated neighborhoods in Kansas City. RESULTS: The program was successful in engaging audience members in its governance and in instigating numerous and diverse neighborhood activities to promote nonsmoking. The prevalence of smoking declined from 34% to 27% in program neighborhoods but only from 34% to 33% in comparison neighborhoods. This difference was apparent within all demographically defined subsamples, indicating that observed changes were consistent and not attributable to confounding by demographic characteristics. CONCLUSIONS: A community organization approach emphasizing local authority for program decisions and involvement of informal networks may have an appreciable impact on smoking among residents of low-income, African American neighborhoods.
Use of multiple surveys to estimate mortality among never, current, and former smokers: changes over a 20-year interval.
Authors: Rosenbaum W L , Sterling T D , Weinkam J J
Published: November 2008

OBJECTIVES: This study sought to demonstrate how data from publicly available large-scale cross-sectional health surveys can be combined to analyze changes in mortality risks among never, current, and former smokers. METHODS: Data from the 1966/68 and 1986 National Mortality Followback Surveys and the 1970 and 1987 National Health Interview Surveys were used to estimate the distribution of never, current, and former smokers among the US population at risk and decedents. Standardized mortality ratios and quotients of standardized mortality ratios were used to estimate mortality risks. RESULTS: Generally, during the period from 1966 through 1986, mortality rates in the United States for most causes of death declined among all smoking groups. However, mortality rates from respiratory diseases increased for current and former smokers. CONCLUSIONS: The reported changes in never and current smoker mortality risks are similar in magnitude and direction to those reported in a previous study based on longitudinal data. The use of combined data from the National Mortality Followback Survey and the National Health Interview Survey offers several advantages as an epidemiological tool.
Socioeconomic status, neighborhood social conditions, and neural tube defects.
Authors: Wasserman C R , Shaw G M , Selvin S , Gould J B , Syme S L
Published: November 2008

OBJECTIVES: This study evaluated the contributions of lower socioeconomic status (SES) and neighborhood socioeconomic characteristics to neural tube defect etiology. The influence of additional factors, including periconceptional multivitamin use and race/ethnicity, was also explored. METHODS: Data derived from a case-control study of California pregnancies from 1989 to 1991. Mothers of 538 (87.8% of eligible) case infants/fetuses with neural tube defects and mothers of 539 (88.2%) nonmalformed infants were interviewed about their SES. Reported addresses were linked to 1990 US census information to characterize neighborhoods. RESULTS: Twofold elevated risks were observed for several SES indicators. Risks were somewhat confounded by vitamin use, race/ethnicity, age, body mass index, and fever but remained elevated after adjustment. A risk gradient was seen with increasing number of lower SES indicators. Women with 1 to 3 and 4 to 6 lower SES indicators had adjusted odds ratios of 1.6 (1.1-2.2) and 3.2 (1.9-5.4), respectively, compared with women with no lower SES indicators. CONCLUSIONS: Both lower SES and residence in a SES-lower neighborhood increased the risk of an neural tube defect-affected pregnancy, with risks increasing across a gradient of SES indicators.
Social factors, treatment, and survival in early-stage non-small cell lung cancer.
Authors: Greenwald H P , Polissar N L , Borgatta E F , McCorkle R , Goodman G
Published: November 2008

OBJECTIVES: This study assessed the importance of socioeconomic status, race, and likelihood of receiving surgery in explaining mortality among patients with stage-I non-small cell lung cancer. METHODS: Analyses focused on Black and White individuals 75 years of age and younger (n = 5189) diagnosed between 1980 and 1982 with stage-I non-small cell lung cancer in Detroit, San Francisco, and Seattle. The main outcome measure was months of survival after diagnosis. RESULTS: Patients in the highest income decile were 45% more likely to receive surgical treatment and 102% more likely to attain 5-year survival than those in the lowest decile. Whites were 20% more likely to undergo surgery than Blacks and 31% more likely to survive 5 years. Multivariate procedures controlling for age and sex confirmed these observations. CONCLUSIONS: Socioeconomic status and race appear to independently influence likelihood of survival. Failure to receive surgery explains much excess mortality.
Rates of intimate partner violence in the United States.
Authors: Schafer J , Caetano R , Clark C L
Published: November 2008

OBJECTIVES: Estimates of intimate partner violence in the United States based on representative samples have relied on data from one person per household or limited numbers of indicators from both partners. The purpose of this study was to estimate nationwide rates of intimate partner violence with data from both couple members by using a standardized survey instrument, the Conflict Tactics Scale. METHODS: A multistage probability sampling design was used to conduct separate face-to-face interviews in respondents' homes with both members of 1635 representative couples living in the 48 contiguous states. RESULTS: Both partners' reports were used to estimate the following lower- and upper-bound rates: 5.21% and 13.61% for male-to-female partner violence, 6.22% and 18.21% for female-to-male partner violence, and 7.84% to 21.48% for any partner-to-partner violence. CONCLUSIONS: High rates of intimate partner violence in the United States corroborate previous claims that the amount of intimate partner violence is substantial.
Hair-color products and risk for non-Hodgkin's lymphoma: a population-based study in the San Francisco bay area.
Authors: Holly E A , Lele C , Bracci P M
Published: November 2008

OBJECTIVES: As part of a large, epidemiologic study of non-Hodgkin's lymphoma, this study investigated a possible association between use of hair-color products and non-Hodgkin's lymphoma. METHODS: A population-based case-control study was conducted in the San Francisco Bay area. Of 4108 participants, 2544 were questioned about use of hair-color products. Control subjects were identified by use of random-digit dialing. RESULTS: Ever use of hair-color products was reported by 56% of case and 56% of control women and 10% of case and 9% of control men. Risks were not elevated for women for use of any hair-color products. Men who ever used semipermanent hair color had slightly elevated risks for non-Hodgkin's lymphoma, with trends associated with greater lifetime frequency of use and frequency of use per year, although individual confidence intervals overlapped unity. These elevated risks were diminished with exclusive use of semipermanent products, and confidence intervals overlapped unity. CONCLUSIONS: Integration of our results with those from experimental animal studies and other epidemiologic studies provides little convincing evidence linking non-Hodgkin's lymphoma with normal use of hair-color products in humans.
Determinants of nitrogen dioxide concentrations in indoor ice skating rinks.
Authors: Levy J I , Lee K , Yanagisawa Y , Hutchinson P , Spengler J D
Published: November 2008

OBJECTIVES: The combination of poor ventilation and fuel-powered ice resurfacers has resulted in elevated nitrogen dioxide (NO2) concentrations in many indoor ice skating rinks. This study examined the factors influencing concentrations and the effects of various engineering controls in ice rinks with different resurfacer fuels. METHODS: Indoor NO2 concentrations were measured in 19 enclosed ice skating rinks over 3 winters by means of passive samplers, with 1-week average measurements during the first winter pilot study and single-day working-hour measurements in the final 2 winters. Personal exposures to drivers also were assessed during the last winter. RESULTS: Rinks in which propane-fueled resurfacers were used had a daily mean indoor NO2 concentration of 206 ppb, compared with 132 ppb for gasoline-fueled and 37 ppb for electric-powered resurfacers. Engineering controls, such as increased ventilation and resurfacer tuning, reduced NO2 concentrations by 65% on average, but outcomes varied widely, and concentrations increased in subsequent months. CONCLUSIONS: Electric ice resurfacers, increased ventilation, or emission control systems are recommended to protect the health of workers and patrons, with surveillance programs proposed to track implementation and maintain an observer effect.
Immunization status and sociodemographic characteristics: the mediating role of beliefs, attitudes, and perceived control.
Authors: Prislin R , Dyer J A , Blakely C H , Johnson C D
Published: November 2008

OBJECTIVES: This study examined how immunization-related beliefs, attitudes, and perceived control mediate up-to-date immunization among various sociodemographic groups. METHODS: Statewide estimates of immunization rates among children up to the age of 2 years were obtained via a multistage cluster sample. In-person interviews were conducted with 4832 parents. Information about immunization was obtained from official records or from health care providers. RESULTS: Differences in immunization among sociodemographic groups were mediated by beliefs about objective barriers to immunization, protection, medical contraindication, safety concerns, distrust, and natural immunity. Protection beliefs contributed to positive attitudes toward immunization; beliefs in natural immunity and safety concerns contributed to negative attitudes. Beliefs about objective barriers, distrust, safety concerns, and medical contraindications influenced perceived control over immunization. Positive attitudes and a strong sense of control contributed to higher immunization rates. CONCLUSION: These findings provide a basis for efficient educational campaigns by specifying which beliefs should be bolstered (because they facilitate proper immunization) and which should be targeted for change (because they hinder proper immunization) in various sociodemographic groups.